NESTHESIA A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R EFERENCES
J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS
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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright Ó2003 by ICON Group International, Inc. Copyright Ó2003 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1
Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Anesthesia: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-83731-7 1. Anesthesia-Popular works. I. Title.
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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.
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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on anesthesia. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.
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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications.
Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.
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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health
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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON ANESTHESIA ............................................................................................. 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Anesthesia ................................................................................... 12 E-Journals: PubMed Central ....................................................................................................... 66 The National Library of Medicine: PubMed ................................................................................ 68 CHAPTER 2. NUTRITION AND ANESTHESIA.................................................................................. 101 Overview.................................................................................................................................... 101 Finding Nutrition Studies on Anesthesia.................................................................................. 101 Federal Resources on Nutrition ................................................................................................. 103 Additional Web Resources ......................................................................................................... 104 CHAPTER 3. ALTERNATIVE MEDICINE AND ANESTHESIA ........................................................... 105 Overview.................................................................................................................................... 105 National Center for Complementary and Alternative Medicine................................................ 105 Additional Web Resources ......................................................................................................... 109 General References ..................................................................................................................... 112 CHAPTER 4. DISSERTATIONS ON ANESTHESIA ............................................................................. 113 Overview.................................................................................................................................... 113 Dissertations on Anesthesia....................................................................................................... 113 Keeping Current ........................................................................................................................ 115 CHAPTER 5. CLINICAL TRIALS AND ANESTHESIA ........................................................................ 117 Overview.................................................................................................................................... 117 Recent Trials on Anesthesia....................................................................................................... 117 Keeping Current on Clinical Trials ........................................................................................... 118 CHAPTER 6. PATENTS ON ANESTHESIA ........................................................................................ 121 Overview.................................................................................................................................... 121 Patents on Anesthesia ................................................................................................................ 121 Patent Applications on Anesthesia ............................................................................................ 150 Keeping Current ........................................................................................................................ 187 CHAPTER 7. BOOKS ON ANESTHESIA ............................................................................................ 189 Overview.................................................................................................................................... 189 Book Summaries: Federal Agencies............................................................................................ 189 Book Summaries: Online Booksellers......................................................................................... 200 The National Library of Medicine Book Index ........................................................................... 206 Chapters on Anesthesia.............................................................................................................. 207 CHAPTER 8. MULTIMEDIA ON ANESTHESIA ................................................................................. 211 Overview.................................................................................................................................... 211 Video Recordings ....................................................................................................................... 211 Audio Recordings....................................................................................................................... 212 Bibliography: Multimedia on Anesthesia................................................................................... 213 CHAPTER 9. PERIODICALS AND NEWS ON ANESTHESIA .............................................................. 215 Overview.................................................................................................................................... 215 News Services and Press Releases.............................................................................................. 215 Newsletters on Anesthesia ......................................................................................................... 218 Newsletter Articles .................................................................................................................... 218 Academic Periodicals covering Anesthesia ................................................................................ 220 CHAPTER 10. RESEARCHING MEDICATIONS................................................................................. 221 Overview.................................................................................................................................... 221 U.S. Pharmacopeia..................................................................................................................... 221 Commercial Databases ............................................................................................................... 223
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APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 227 Overview.................................................................................................................................... 227 NIH Guidelines.......................................................................................................................... 227 NIH Databases........................................................................................................................... 229 Other Commercial Databases..................................................................................................... 232 APPENDIX B. PATIENT RESOURCES ............................................................................................... 233 Overview.................................................................................................................................... 233 Patient Guideline Sources.......................................................................................................... 233 Finding Associations.................................................................................................................. 240 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 243 Overview.................................................................................................................................... 243 Preparation................................................................................................................................. 243 Finding a Local Medical Library................................................................................................ 243 Medical Libraries in the U.S. and Canada ................................................................................. 243 ONLINE GLOSSARIES ................................................................................................................ 249 Online Dictionary Directories ................................................................................................... 249 ANESTHESIA DICTIONARY..................................................................................................... 251 INDEX .............................................................................................................................................. 353
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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with anesthesia is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about anesthesia, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to anesthesia, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on anesthesia. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to anesthesia, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on anesthesia. The Editors
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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.
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CHAPTER 1. STUDIES ON ANESTHESIA Overview In this chapter, we will show you how to locate peer-reviewed references and studies on anesthesia.
The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and anesthesia, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “anesthesia” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: ·
General Anesthesia Protocol for the Dental Patient: Emphasis for Older Adults Source: SCD. Special Care in Dentistry. 20(3): 81-108. May-June 2000. Contact: Available from Special Care Dentistry. 211 East Chicago Avenue, Chicago, IL 60611. (312) 440-2660. Fax (312) 440-2824. Summary: As the population ages, with increased retention of the natural dentition, there will be a greater responsibility for dental professionals to maintain the oral health of medically, behaviorally, cognitively, and physically impaired adults. This lengthy article describes the use of general anesthesia in a hospital environment for this population. Oral sedatives and nitrous oxide analgesia are frequently and successfully used for dental treatments in these patients. However, many compromised older adults cannot safely tolerate dental treatment with these sedative techniques in an outpatient
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setting. Coordinated with medical and anesthesia specialists, general anesthesia is a viable, safe, and effective treatment tool for providing comprehensive dental and oral surgical treatment for the older patient. The authors consider the numerous risks and benefits involved in the comprehensive treatment of dental and periodontal diseases at one visit under general anesthesia. Not every older adult is eligible for treatment under general anesthesia, usually due to underlying medical conditions. Patients must satisfy acceptance criteria for general anesthesia; undergo thorough evaluations and accurate documentation of necessary medical, dental, nutritional, social, and behavioral factors; and be treated by an interactive, multidisciplinary health care team. Detailed, lengthy appendices offer recordkeeping forms and patient care strategies. 34 references. ·
Dental Health Behavior of Children with BBTD Treated Using General Anesthesia or Sedation, and of Their Parents in a Recall Examination Source: Journal of Dentistry for Children. 67(1): 50-54. January-February 2000. Contact: Available from American Society of Dentistry for Children. John Hancock Center, 875 North Michigan Avenue, Suite 4040, Chicago, IL 60611-1901. (312) 943-1244. Summary: Baby bottle tooth decay (BBTD) or 'nursing caries' are terms used to describe a form of rampant caries (cavities or decay) of the primary dentition originating from prolonged use of bottle feeding. Treatment of BBTD generally requires sedation or general anesthesia because the very young are unable to cope with the procedures. This article reports on a study undertaken to compare the dental status and dental health behavior of children with BBTD treated using general anesthesia or sedation, and the dental health behavior of their parents, in a recall examination. Prior studies demonstrated that children who have been sedated or under general anesthesia exhibit changes in postoperative behavior not seen by children receiving routine dental treatment. The study followed 65 children who were treated between 1995 and 1997 using general anesthesia (n = 34) or sedation (n = 31). The authors hypothesized that because general anesthesia is a more radical and dramatic mode of treatment, parents of those children would change their families' dental health behaviors to avoid future dental disease and the subsequent treatment. The authors discuss the variables and results that they found, concluding that some preventive behaviors regarding children's dental health were indeed more frequently adopted among the families of children treated using general anesthesia. In light of the knowledge that children who had dental treatment using general anesthesia or sedation may be more vulnerable to future caries attacks, the authors recommend the teaching preventive behaviors to parents of these groups be reinforced. 3 tables. 22 references.
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Implications of Parental Compliance on Decision Making in Care Provided Using General Anesthesia in a Low-Income Population Source: Journal of Dentistry for Children. 67(3): 197-199. May-June 2000. Contact: Available from American Society of Dentistry for Children. John Hancock Center, 875 Michigan Avenue, Suite 4040, Chicago, IL 60611-1901. (312) 943-1244. Summary: Children of low income families have been shown to be at high risk for the development of dental caries and to receive less dental care than children of higher socioeconomic families. This article reports on a study undertaken to determine the parental compliance in bringing the child back to the dentist following complete oral rehabilitation using general anesthesia in a low income population. The retrospective study was completed examining the dental records of 244 healthy, low income children (covered by Medicaid) who were treated in the operating room for dental rehabilitation
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in 1994 and 1995 (age range 18 months to twelve years, with the majority between two and five years old). All of the parents and children were given oral hygiene instructions and informed of the importance of routine follow up dental care. They were also given oral and written instructions in their native language regarding return visits at the time of surgery. During the time in which the study was made, 43 percent of the children did not return to the dental clinic for any procedure. Thirty-six percent returned for the initial postoperative visit, but had not returned for recall (usually 3 to 6 months postop). Three percent did not return for the postoperative, but did have a subsequent recall. Twelve percent followed the instruction and returned for both the postoperative and recall. Twenty percent of the patients treated before the eruption of the primary second molars required subsequent dental rehabilitation using general anesthesia. The authors conclude that, because of the high failure rate of amalgam and composite restorations seen in other studies, along with low compliance of parents in bringing their children back for follow up care, a definitive treatment plan of stainless steel crowns, pulp therapy, and or extraction is indicated in children of low income families treated using general anesthesia. In addition, space maintenance such as bands and loops, lower lingual holding arches and distal shoes may be contraindicated until compliance can be established. Full coverage (dental sealants) of primary molars should be considered even without evidence of extensive lesions. Extra emphasis should be given to education of the families in the importance of dental health and of returning for follow up care. 2 tables. 16 references. ·
Retrospective Review of Service to Provide Comprehensive Dental Care Under General Anesthesia Source: SCD. Special Care in Dentistry. 15(3): 97-101. May-June 1995. Summary: Day stay general anesthesia is indicated for a number of dental reasons, not least for those patients who are unable to accept routine dental care (such as very young children or people with severe anxiety or disabilities). Since 1979, the Dental Hospital of the University of Newcastle upon Tyne, United Kingdom, has provided a weekly day stay service for the dental care of such patients. This service was reviewed in 1983 and again in 1993; this article reports on the latter study in which the provision of care for 265 patients was reviewed and compared to the 96 patients reviewed in the earlier studies. The types of treatments being offered to children under general anesthesia have changed between the two review periods: more fissure sealants have been provided, more restorations were placed in primary teeth, fewer restorations were carried out for permanent teeth, and more extractions have been undertaken. The authors underscore the need for a very aggressive approach to preventive dental care for patients treated by this modality. 7 tables. 15 references. (AA-M).
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Four Common Mandibular Nerve Anomalies That Lead to Local Anesthesia Failures Source: JADA. Journal of American Dental Association. 127(6): 1081-1086. July 1996. Summary: Local anesthesia is essential in treating many dental and oral disorders. However, many types of anatomical anomalies are seen in the nervous system of the mandible that interfere with achieving local anesthesia. This article describes four such anomalies and offers ways to overcome them when trying to properly anesthetize affected patients. The authors begin with a review of normal anatomy of the jaw, with particularly emphasis on the nervous system. The four anomalies discussed are accessory mylohyoid nerve, bifid mandibular nerve, retromolar foramen, and contralateral innervation of anterior teeth. The authors stress the importance of clinician
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ability to assess whether operator error or anatomical anomaly is to blame for inadequate pain management. 2 figures. 25 references. (AA-M). ·
Review of Paresthesia in Association with Administration of Local Anesthesia Source: Dentistry Today. 22(2): 64-69. February 2003. Contact: Available from Dentistry Today, Inc. 26 Park Street, Montclair, NJ 07042. (973) 783-3935. Summary: Local anesthetics allow dentistry to be practiced without patient discomfort. Serious complications associated with the use of these drugs are rare. The occurrence of paresthesia following the use of anesthesia in dentistry, however, represents and important side effects. Paresthesia is persistent anesthesia (well beyond the expected duration) or altered sensation (tingling or itching). This continuing education article examines the occurrences of paresthesia to the lingual (tongue) and inferior alveolar nerve resulting from the injection of local anesthetic agents. Besides the range of altered sensations considered as paresthesia, there can be oral dysfunction (tongue biting, drooling, loss of taste, speech impediment) and pain. 5 tables. 18 references.
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Effectiveness of Local Anesthesia in Pediatric Dental Practice Source: JADA. Journal of the American Dental Association. 131(12): 1699-1705. December 2000. Contact: Available from American Dental Association. ADA Publishing Co, Inc., 211 East Chicago Avenue, Chicago, IL 60611. (312) 440-2867. Website: www.ada.org. Summary: Pain control in dental treatment for children is important. This article reports on a study undertaken to describe the characteristics of local anesthetic use by pediatric dentists and to examine factors related to its effectiveness in children. The authors observed 361 patients in 17 pediatric dental practices in Washington State while each child received restorative or surgical dental treatment. The authors recorded data concerning local anesthetic use and effectiveness. The children's mean age was 87 months, and 181 (50.1 percent) of the patients were female. A pediatric dentist observed rated each child's anxiety before the initial injection of local anesthetic and the effectiveness of pain control during restorative treatment. The observing dentist asked the treating dentist about the effectiveness of pain control after completion of treatment. Forty-two of 361 children (11.6 percent) were observed to experience ineffective pain control. Fourteen of 17 dentists (82.4 percent) were observed to have at least one patient in whom pain control was ineffective. Lidocaine was used by 15 of 17 dentists and in 312 of 361 cases (86.4 percent). The average amount of agent was one cartridge (36 milligrams of lidocaine). Children who were anxious, who had symptoms before treatment, and who underwent more invasive operative and endodontic procedures were more likely to experience ineffective pain control. The authors conclude that the data suggest painful treatment is relatively frequent even in specialized pediatric practice. Variability in general practice is likely to be greater. The authors hypothesize that the incidence of ineffective pain control may be less if clinicians use methods to reduce anxiety and perioperative infection and symptoms. 2 tables. 47 references.
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Special Considerations Concerning General Anesthesia for Dental Treatment of Handicapped Patients Source: Anesthesia Progress. 42(3-4): 93-94. 1995.
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Summary: Patients with disabilities should have access to regular dental care in order to maintain good oral health. This article outlines special considerations concerning general anesthesia for the dental treatment of patients with disabilities. The author stresses that the choice of anesthesia to be administered depends on multiple factors: the health of the patients; his or her ability to cooperate; the preference of the patient, parent, or guardian; the anticipated dental procedure to be done; the familiarity of the operating dentist with the conditions presented by various forms of anesthesia; the skill of the operating dentist; and the experience and training of the anesthesiologist. In addition to the anesthetic equipment, supplies, and medications required, the author describes the use of appropriate monitoring equipment. The author notes that drugs and techniques that provide a rapid emergence from anesthesia will permit handicapped patients to return to their own particular state of normalcy and will facilitate ambulation and early discharge. Special considerations may include difficulty in determining the chief complaint, history of present illness, past medical and surgical history, oral examination, and physical examination. For the operating dentist who has no formal training in sedation or general anesthesia, the properly trained and equipped officebased dentist anesthesiologist is an attractive option to the hospital or ambulatory centers in safely providing conscious sedation, deep sedation, or general anesthesia utilizing a variety of anesthetic drugs and techniques specifically designed for selected dental patients with disabilities. (AA-M). ·
Dental Anesthesia and Pediatric Dentistry Source: Anesthesia Progress. 42(3-4): 95-99. 1995. Summary: Pediatric patients between the ages of 18 months and 6 years are some of the most difficult patients to manage in dentistry. This article outlines considerations of dental anesthesia and pediatric dentistry. The author explores the reasons why pediatric patients can have such a difficult time at the dentist and outlines the goals of pediatric anesthesia. Other topics discussed are pediatric anatomy and physiology; dissociative sedation with ketamine, including the pharmacology and general clinical effects, the respiratory, cardiovascular, and neuromuscular effects, emergence phenomenon, and technique of administration; and the use of propofol, including the technique of administration. The author stresses that, although advances in monitoring technology and better training have dramatically enhanced the safety of pediatric sedation, it should only be attempted by properly trained individuals, with appropriate monitoring, and with resuscitative equipment readily available. 20 references.
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Alzheimer's Disease and Cumulative Exposure to Anesthesia: A Case-Control Study Source: Journal of the American Geriatrics Society. 42(2): 198-201. February 1994. Summary: Researchers conducted a retrospective, population-based, case-control study to evaluate prior exposure to general anesthesia as a potential risk factor for Alzheimer's disease (AD). Two hundred fifty-two subjects were incident cases of AD from 1975 to 1984 who lived for 40 years or more in Olmsted County of Minnesota. One age- and gender-matched control for each case was selected from all Mayo Clinic registrations during the year of onset in the incident case. Two hundred eight AD cases and 199 controls had at least 1 exposure to general anesthesia before the year of onset of dementia in the matched AD patient. There was no significant difference in mean cumulative exposure (in minutes) to general anesthesia (188.4 minutes for patients versus 170.5 minutes for controls). Neither exposure to six or more episodes of general anesthesia nor cumulative anesthesia were associated with a significantly increased risk of AD. 4 tables, 13 references.
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What You Should Know About Anesthesia Source: Renalife. 10(2): 13-14, 27. 1995. Contact: Available from American Association of Kidney Patients (AAKP). 100 South Ashley Drive, Suite 280, Tampa, FL 33602. (800) 749-AAKP or (813) 223-7099. Summary: The author covers different anesthetic options, how they relate to the kidney patient, and how the kidney patient can help the doctors and nurses deliver a safe, least painful surgical experience. The author stresses that, regardless of the particular case, kidney disease presents some unique challenges for the operating room team, particularly the anesthesiologist. Topics include the three different techniques of anesthesia, i.e., local, regional, and general; the use of an endotracheal tube; electrolytes and fluids; dialysis access; medications; and bleeding problems.
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New Technologies in Anesthesia: Update for Nurse Anesthetists: Lasers Source: Journal of the American Association of Nurse Anesthetists. 58(4): 313-319. August 1990. Summary: The common use of the laser in many specialty areas, including treatment of gastrointestinal lesions, has challenged the anesthetist to possess more than a cursory knowledge of laser function and safety. This article, part of a continuing education series for nurse anesthetists, discusses principles of laser technology, safety for patients and personnel, and precautions in anesthetic management. The unique property of laser light and its effect on tissues presents unique safety consideration for patients and personnel. While the majority of procedures pose few problems beyond protection of the eyes of operation room personnel and patients, laser surgery, especially of the upper airway with the CO2 laser, requires careful anesthetic planning. The protection of flammable materials, selection of the least flammable gas mixture, and determination of the most appropriate anesthetic technique all work in concert to provide a beneficial outcome. A self-administered quiz follows the article. 4 references. 3 tables. 4 figures.
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General Anesthesia: An Alternative to Sedation for Pediatric Endoscopic Procedures Source: Gastroenterology Nursing. 13(3): 166-168. Winter 1991. Summary: The main objective of pediatric endoscopy is to examine completely the upper or lower gastrointestinal tract with the least trauma and risk to the child. This article proposes that general anesthesia be used as an alternative to sedation for pediatric endoscopic procedures. The author presents a detailed description of this method as it has been used successfully at a midwest children's hospital for a number of years. The advantages and disadvantages of using general anesthesia are discussed. 4 references. (AA-M).
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General Anesthesia for the Provision of Dental Treatment to Adults with Developmental Disability Source: Anesthesia Progress. 45(1): 12-17. Winter 1998. Contact: Available from American Dental Society of Anesthesiology. 810 East 10th Street, P.O. Box 1897, Lawrence, KS 66044-8897. Summary: The management of the behavior of mentally challenged adults when providing required dental care is often a problem, whether in the dental office or in a hospital setting. The authors of this article describe their institution's designated program to provide dental care to this group of patients. They note that, because of the
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high incidence of poor cooperation, which may include aggressive antagonistic behavior, many of these patients are scheduled for dental care under general anesthesia with an incomplete preoperative medical assessment. The authors report on their study undertaken to determine the impact and limitations that an incomplete medical assessment may present in the delivery of dental care under general anesthesia to adults with developmental disabilities. The medical records of 139 patients treated in the program between 1992 and 1994 were reviewed to determine the patient profiles, anesthesia management, and complications. The charts of these patients, who underwent dental and radiographic examination, scaling and prophylaxis, and restoration and extraction of teeth under general anesthesia, were reviewed. There were 149 procedures performed on these patients, some more than once. The mean age was 29.5 years. Males predominated females by a ratio of 2 to 1. All had multiple diagnoses, medical problems, and medications. Twenty-three patients had Down syndrome, four had schizophrenia disorders, 42 had seizure disorders, 11 had hypothyroidism, seven had heart disease, and 14 had central nervous system and neuromuscular disorders. One hundred had intravenous, 25 had mask inhalation, and 24 had intramuscular ketamine induction. Ten patients experienced intraoperative complications, including nonfatal ventricular arrhythmia, slight fall in blood pressure and hypertension (greater than 20 percent of preoperative value), and four individuals developed laryngospasm. In the Post Anesthetic Care Unit, five patients experienced minor airway problems resulting in a desaturation of oxygen to a level below 85 percent. The authors conclude that adults with developmental disabilities can be safely managed under general anesthesia for dental treatment in a hospital setting with minimal morbidity and without extensive preoperative investigations. 2 tables. 24 references. (AA-M). ·
Anesthesia for the Elderly and Special Needs Patient Source: Dental Clinics of North America. 43(2): 301-319. April 1999. Contact: Available from W.B. Saunders. Periodicals Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452. Website: www.wbsaunders.com. Summary: The special needs dental patient can be defined as any patient who is unable to receive dental care in a traditional dental setting. This article focuses on the use of anesthesia for the elderly patient and for developmentally disabled children and adults. Although many individuals in these groups can receive dental care with the use of local anesthetic, the authors focus on those who require sedation or general anesthesia. Areas where the management of these patients significantly differs from routine anesthesia care are emphasized. Topics include delivery of care to special needs patients, the demographics of the aging population, scheduling the anesthetic, the preanesthetic evaluation, location of the surgery, preparation for anesthesia, premedication (oral sedatives or other), airway management, and postanesthetic recovery. The authors then briefly discuss the indications for patients with specific diseases or conditions, including Alzheimer disease, cardiovascular and pulmonary disease, thromboembolic disease, tracheotomy, ventilator dependency, attention deficit hyperactivity disorder (ADHD), mental retardation, trisomy 21 (Down syndrome), autism, cerebral palsy, seizure disorder, organ transplantation, and disorders affecting the airway. 2 tables. 53 references.
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Operation Under General Anesthesia as a Risk Factor for Age-Related Cognitive Decline: Results from a Large Cross-Sectional Population Study Source: JAGS. Journal of the American Geriatrics Society. 46: 1258-1265. 1998.
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Summary: This article describes a study that evaluated an operation under general anesthesia as a possible risk factor for age-related cognitive decline. Researchers used a retrospective, population-based, cross-sectional design to study 1,257 healthy subjects aged 24 to 86 years old. Of these, 1,257 healthy subjects, 946 had a history of undergoing at least one operation under general anesthesia. Measurements included the history of an operation under general anesthesia, number of operations, duration of anesthesia, cognitive performance, subjective health, and subjective memory. Data showed that a history of an operation under general anesthesia, the number of operations, and the total duration of anesthesia significantly contributed to the number of subjective healthrelated complaints but did not predict cognitive performance or memory complaints. No interactions with age were found. The authors concluded that no support exists for a history of an operation under general anesthesia being a determinant or risk factor for accelerated, age-related cognitive decline. 1 figure, 4 tables, 29 references (AA-M). ·
Use of Intraosseous Anesthesia in a Patient with Myositis Ossificans Progressiva Source: SCD. Special Care in Dentistry. 16(1): 29-32. January-February 1996. Summary: This article presents the case of a pediatric patient with myositis ossificans progressiva, for whom it became increasingly difficult to provide local anesthesia. Intraosseous anesthesia was successful in allowing pain-free dental treatment, including restorative dentistry and extractions. The authors conclude that this approach should be considered in other patients who have limited mouth-opening ability due to injury or disease. The authors also present a brief review of the literature. 5 figures. 14 references. (AA-M).
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Tolerability of High Energy Transurethral Microwave Thermotherapy with Topical Urethral Anesthesia: Results of a Prospective, Randomized, Single Blinded Clinical Trial Source: Journal of Urology. 160(3): 772-776. September 1998. Summary: This article reports on a study undertaken to determine the tolerability of high energy transurethral microwave thermotherapy with topical urethral anesthesia alone without supplementary systemic sedoanalgesia. A total of 45 patients with symptomatic benign prostatic hyperplasia were randomized to high energy transurethral microwave thermotherapy (TUMT) using either topical urethral anesthesia alone or topical anesthesia with adjunctive intravenous sedoanalgesia. Pain was evaluated sequentially by means of a 0 to 10 visual analog scale score. Posttreatment followup included determinations of International Prostate Symptom Score, peak flow rate, post-void residual urine, and quality of life score at 6 and 12 weeks. Upon commencement of microwave treatment, the mean visual analog scale score was 1.3 in the sedoanalgesia group and 1.4 in the topical anesthesia group. During therapy, visual analog scale score increased to a peak at 30 minutes of 2.0 and 2.2 in the sedoanalgesia and topical anesthesia groups, respectively. Thereafter, visual analog scale score continuously declined. There was no statistically significant difference between the groups in the treatment profile of visual analog scale scores. Significant posttreatment improvements were demonstrated in the International Prostate Symptom Score, peak flow rate, and post-void residual urine and quality of life scores, but there were no significant differences between the groups in the magnitude of improvement in these outcome measures. The authors conclude that high energy TUMT is well tolerated by patients under topical anesthesia alone and, therefore, can be administered in the outpatient setting without potent medications that necessitate intensive patient
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monitoring, pose risks for side effects, and add to treatment costs. 5 figures. 30 references. (AA-M). ·
Guidelines for the Elective Use of Conscious Sedation, Deep Sedation and General Anesthesia in Pediatric Dental Patients Source: Pediatric Dentistry. 20(6): 47-53. November 1998. Contact: Available from American Academy of Pediatric Dentistry. Publications Department, 211 East Chicago Avenue, Suite 700, Chicago, IL 60611-2616. Summary: This Guideline, published by the American Academy of Pediatric Dentistry (revised in 1998), summarizes guidelines for the elective use of conscious sedation, deep sedation, and general anesthesia in pediatric dental patients. This is a revision from the 1996 guidelines which did not address the issue of general anesthesia for pediatric dental patients. The Guideline first discusses the educational preparation and other requirements for safe general anesthesia care; provides a brief definition of terms; and outlines the goals of sedation and general anesthesia. The Guideline then lists the indications for sedation and general anesthesia, local anesthesia considerations during sedation, candidates, the presence of a responsible adult, facilities and equipment, back up emergency services, documentation (informed consent, instructions to parents, dietary precautions, preoperative health evaluation, hospitalized patients, the child's physician, rationale for sedation or general anesthesia, baseline vital signs, preprocedural prescriptions, vital signs, and drugs), recovery, conscious sedation, operating facility and equipment, monitoring procedures, deep sedation, intravenous access, and general anesthesia. The Guideline also offers four appendices that review the definitions and characteristics for levels of sedation and anesthesia, the recommended discharge criteria, the American Society of Anesthesiologists (ASA) classification system, and appropriate emergency equipment.
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Risk Factors for Dementia: Impact of Anesthesia on the Cognitive Functioning of the Elderly Source: International Psychogeriatrics. 9(3): 309-326. September 1997. Summary: This journal article explores the association of exposure to general anesthesia to postoperative cognitive impairment and the subsequent onset of senile dementia in older people. The authors conducted a systematic literature search of five bibliographic databases to identify relevant clinical reports and studies published through June 1997. The databases included PASCAL, Medline, Excerpta Medica, Psychological Abstracts, and Science Citation Index. Results indicate that significant cognitive impairment is common in older people 1 to 3 days after surgery, but reports of longer-term impairment are inconsistent due to the heterogeneity of the procedures used and the populations studied. The incidence and degree of impairment vary widely and are related to type of surgery, with the highest rates reported for cardiac surgery, independent of the type of anesthesia used. This suggests that factors other than anesthesia may explain a large portion of the observed variance in postoperative cognitive impairment. The authors conclude that anesthesia may be associated with longer term cognitive disorder and an earlier onset of dementia symptoms, but only in a small number of cases, suggesting an interaction with other etiological factors. 1 table, 82 references. (AA-M).
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Federally Funded Research on Anesthesia The U.S. Government supports a variety of research studies relating to anesthesia. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to anesthesia. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore anesthesia. The following is typical of the type of information found when searching the CRISP database for anesthesia: ·
Project Title: A NOVEL WAVEFORM FOR ELECTRICAL NERVE CONDUCTION BLOCK Principal Investigator & Institution: Kilgore, Kevin L.; Orthopaedics; Case Western Reserve University 10900 Euclid Ave Cleveland, Oh 44106 Timing: Fiscal Year 2001; Project Start 15-JUN-2001; Project End 31-MAY-2004 Summary: (Verbatim from application) The goal of this research is to develop a reversible method for chronically blocking the conduction of action potentials in human peripheral nerves. Unwanted or uncoordinated generation of nerve impulses is a major factor in many disabling conditions, such as peripheral pain, spinal cord injury, stroke, cerebral palsy and multiple sclerosis. For example, unregulated nerve impulses produce spasticity in stroke, cause spasms in spinal cord injury, and generate neuroma pain in amputation. If these impulses can be intercepted along the peripheral nerves over which they travel, then the disabling condition can be reduced or eliminated. Although there are a few existing methods for surgically or pharmacologically blocking nerve impulses, none of these methods are broadly applicable or successful, are non-specific with sometimes serious side-effects, and, in many cases, are destructive to the nerve. Therefore, there is a widespread clinical need for a safe, reliable and reversible nerve block. The use of electrical stimulation, delivered through electrodes surrounding the nerve, has previously been shown to block nerve impulses in a reversible and predictable manner in acute situations. However, the present methods of electrical nerve block are likely to be damaging to the nerve during chronic usage. A novel stimulus waveform has now been developed that is likely to be safe for chronic human applications, while still producing an effective and reversible nerve conduction block. In this project, the effectiveness of this waveform to block action potential propagation in whole nerves in acute in-vivo experiments will be measured. Specifically, it will be demonstrated that this new waveform is capable of a complete block of both motor and sensory activity, including A-delta and C-fiber activity, and that this new waveform can also be used to selectively block activity in large diameter axons. The effect of nerve diameter and nerve fiber size on block effectiveness will also be evaluated. At the
2 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).
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completion of this project, it will have demonstrated that an electrical nerve block can be achieved, and that it is effective in blocking conduction in both motor and sensory nerve fibers. In the future, chronic in vivo studies will be performed to test the long-term safety of this technique prior to human use. The initial intended human application will be to alleviate pain in individuals with neuromas secondary to limb amputation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: ABUSED TRANSCRIPTION
INHALANTS
AND
DROSPHILA
K+
CHANNEL
Principal Investigator & Institution: Atkinson, Nigel S.; Associate Professor; Zoology; University of Texas Austin 101 E. 27Th/Po Box 7726 Austin, Tx 78712 Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 31-JUL-2004 Summary: (provided by applicant): We are using Drosophila melanogaster as a model system to understand the acute side-effects of exposure to organic solvent inhaLants. These inhalants, which are abused by a startling large number of adolescents, are commonly found components of many household cleaning solutions and fuels. In general, solvent inhalants owe much of their ability to intoxicate on their anesthetic-like qualities. Abuse of these compounds can have severe side effects. We have observed that Drosophila knocked out by low level exposure to benzyl alcohol vapor recover in approximately 6 hours. This occurs even though one can demonstrate that the solvent in the exposure chamber can still knock out naive flies. Furthermore, the acutely-resistant animals show cross-resistance to the abused solvent toluene. Concomitant with recovery we have observed that mANA from the slowpoke Ca2+-activated K+ channel gene increases in abundance. Because of our many mutant animals and animals carrying various transgenes we will be able to determme the biological meaning of these observations. SpecificalLy, we will determine if cross-resistance and slowpoke mRNA induction is a response common to different abused solvents. During solvent exposure the animals first become hyperexcitable and then 'unconscious'. We would like to know, to which phase, the acute resistance and channel mRNA induction is a response. Using a temperature sensitive mutation in a sodium channel gene which reversibly blocks neural signaling we can answer this question. We will 'turn off' neural signaling during each phase of solvent exposure and determine if the solvent-induced changes occur. Furthermore, using slowpoke mutants we will determine if the change in slowpoke expression is involved in the recovery from solvent-anesthesia. Using our large bank of slowpoke transgenes, which have small lesions in their transcriptional control regions, we will determine if the mRNA abundance change is the result of changed transcriptional regulation and if it results in increases in the channel protein. Finally, we will determine if other ion channel genes shows the same response. We have already shown that a sodium channel gene does not. Future directions include a mutagenic screen to isolate mutations that interfere with the acquisition of acute resistance. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: AGE ANESTHETICS
RELATED
CARDIAC
SENSITIVITY
TO
VOLATILE
Principal Investigator & Institution: Prakash, Y S.; Mayo Clinic Rochester 200 1St St Sw Rochester, Mn 55905 Timing: Fiscal Year 2001; Project Start 01-AUG-1998; Project End 31-JUL-2002 Summary: Cardiac depression is more pronounced in the neonatal heart than in the adult organ. The studies described in this project are designed to achieve the overall
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goal of identifying the mechanism underlying age-related (neonate versus adult) differences in the cardiac depressant effects of volatile anesthetics. This proposal addresses two of the three possible factors altering cardiac function: intracellular calcium and the sensitivity of the contractile apparatus to intracellular calcium. Using an adult versus neonatal rat model, the mechanisms underlying the effect of volatile anesthetics on 1) intracellular calcium regulation related specifically to influx through the L-type channel sand calcium release from the sarcoplasmic reticulum, and 2) Casensitivity of force generation will be addressed, with the underlying hypothesis that both factors contribute to cardiodepression secondary to volatile anesthetics. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: ANESTHETIC ACTIONS AT GABA AND GLUTAMATE SYNAPSES Principal Investigator & Institution: Maciver, M Bruce.; Anesthesia; Stanford University Stanford, Ca 94305 Timing: Fiscal Year 2001; Project Start 01-MAY-1997; Project End 31-MAY-2005 Summary: Loss of recall (memory) is an essential component of general anesthesia, yet the mechanisms underlying this important effect remain unknown. Failure to block recall during anesthesia continues to be a health care problem-over 40,000 incidents of recall are reported annually in the United States. Experiments outlined in the proposed research will investigate anesthetic effects on Long Term Potentiation (LTP) of synaptic transmission, as a cellular basis for anesthetic-induced loss of recall. Mechanisms of action leading to a block of LTP will be investigated using electrophysiological recordings and specific pharmacological probes to isolate the synaptic and molecular targets for three widely used agents: isoflurane, propofol and midazolam. Experiments will be conducted using rat hippocampal brain slices and the well characterized Schaffer-collateral fiber to CA 1 pyramidal neuron synaptic circuit-the best studied synapse for LTP in the brain. The hippocampus is essential for learning and memory in humans and animals and LTP is the leading candidate for a cellular basis of learning in hippocampal cortex. Three Specific Aims will be undertaken in the proposed research: 1) To determine the effective concentration range for anesthetic-induced block of LTP. 2) To determine the involvement of GABA and glutamate-mediated synapses in anesthetic-induced block of LTP. 3) To determine whether postsynaptic actions at or downstream from NMDA receptors contribute to the anesthetic-induced block of LTP. It has not been possible to undertake experiments of this nature before now, because studies of anesthetic concentrations required to block recall, in vivo, have only recently appeared in the literature. Results from our research will provide a quantitative analysis of anesthetic concentrations needed to block LTP, and will determine the mechanisms of action which lead to this block. An understanding of the mechanisms of anestheticinduced block of LTP could lead to the development of highly targeted agents for producing loss of recall during anesthesia-this could minimize undesirable side effects produced by anesthetics in current use. Preliminary results from our laboratory indicate that isoflurane blocks LTP at concentrations which are indistinguishable from those that block recall in humans, and considerably lower than those needed to block synaptic transmission. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: ANESTHETIC MECHANISMS IN VASCULAR SMOOTH MUSCLE Principal Investigator & Institution: Boyle, Walter A.; Associate Professor; Anesthesiology; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130
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Timing: Fiscal Year 2001; Project Start 01-JAN-1998; Project End 31-MAR-2002 Summary: (Adapted from the applicant's abstract) The goal of the proposed study is to determine the molecular mechanisms responsible for smooth muscle relaxation induced by halogenated volatile anesthetic agents. Contraction, intracellular calcium concentration, and contractile protein activation will be studied in small resistance arteries. Preliminary experiments have led to the hypothesis that anesthetics relax muscle by inhibiting myosin light chain phosphorylation independent of changes in intracellular calcium concentration. Experiments are proposed to validate the importance of this effect by determining the concentration dependence of anesthetic effects on calcium-activated contractions and myosin light chain phosphorylation in potassium-depolarized intact vascular smooth muscle. Differences between intact and membrane permeabilized smooth muscle suggest the hypothesis that the membrane permeabilized muscle lacks an important modulator essential for anesthetic-induced smooth muscle relaxation. To determine the nature of the missing modulator, experiments are proposed to characterize the systems which modulate contraction in both intact and permeabilized muscle. Finally, attempts will be made to reconstitute the relaxing effect of anesthetics in skinned muscle in order to identify the essential components of the modulator. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: ANESTHETIC REACTIONS IN SURGERY Principal Investigator & Institution: Louis, Charles F.; Head, Department of Biochemistry; Biochem/Mole Biol/Biophysics; University of Minnesota Twin Cities 200 Oak Street Se Minneapolis, Mn 554552070 Timing: Fiscal Year 2001; Project Start 01-APR-1984; Project End 31-MAR-2004 Summary: Malignant hyperthermia (MH) is a potentially fatal pharmacogenetic disorder in which exposure to volatile anesthetics or depolarizing muscle relaxants during surgery triggers uncontrolled Ca2+ release through sarcoplasmic reticulum (SR) ryanodine receptor (RYR) channels in skeletal muscle. The long term goal of this research is to define the molecular mechanisms that control RYR channels in situ, and to determine how anesthetics disrupt these mechanisms in the MH-susceptible (MHS) patient. Towards this goal, the proposed studies focus on identifying how agents that trigger or suppress the MH response affect the molecular interactions and structural events that underlie the gating of both MHS and normal RYR channels in situ. These studies will utilize the pig RYR1 Arg615Cys model of MH to address three specific aims. Aim I will determine the role of calmodulin (CaM) as a physiologic effector of MHS and normal RYR1 channels. [125I]CaM binding properties of the different channel isoforms (RYR1, RYR2, and RYR3) will be characterized, and compared with CaM's functional effects on the isolated channels as determined using [3H]ryanodine binding, Ca2+ flux, and single channel measurements. Effects of the Arg615Cys mutation on RYR1 [125I]CaM binding will also be characterized to determine the basis of the increased CaM-dependent activation of MHS channels. Related experiments will define CaM's in situ role controlling SR Ca2+ release in permeabilized fiber preparations, where the architecture of excitation-contraction (E-C) coupling remains intact. Aim II will define the mechanism of action of dantrolene, the specific treatment of MH. Experiments using recombinant, heterologously expressed RYRs will test the hypothesis that dantrolene inhibition of SR Ca release reflects a direct action of this agent at the RYR1. Characterization of dantrolene's functional effects on RYR1 in isolated preparations will be complemented with investigations of dantrolene's effects on SR CA2+ release in muscle fiber preparations. Aim III will identify the structural events that underlie gating
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of MHS and normal RYR1 channels. Fluorescently-labeled FKBP12 and CaM bound to specific regions on the RYR1 will reveal specific actions of the MHS mutation, dantrolene, and anesthetics on rotational and structural transitions of the RYR1 protein. MH remains a significant cuase of anesthetic-induced death and is an important model for a variety of disorders characterized by a loss of intracellular Ca2+ homeostasis. Identification of the molecular and biophysical mechanisms that underlie the triggering and suppression of the MH response will aid in the development of improved strategies for the prevention and treatment of this life-threatening response to anesthetics. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: ANESTHETICS--CELLULAR AND MOLECULAR ACTIONS Principal Investigator & Institution: Steinbach, Joseph H.; Professor; Anesthesiology; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130 Timing: Fiscal Year 2001; Project Start 01-AUG-1992; Project End 31-JUL-2002 Summary: The mechanisms by which general anesthetics have their clinically desired effects are not understood. The work proposed in the Program seeks to define the molecular target(s) for these drugs, and to clarify the way in which action at these targets results in anesthesia. The underlying idea is that anesthetics act at defined sites on proteins and , in particular, the proteins involved in formation transfer between neurons. A major emphasis of the Program is to understand the properties of steroid anesthetics, as a result of progress in the preceding Program is to understand the properties of steroid anesthetics, as a result of progress in the preceding Program period. One objective of the Program is to define the actions of steroid anesthetics on several classes of membrane channel, including GABA- A receptors, glutamatergic receptors, neuronal nicotinic receptors and voltage-gate calcium channels. The second objective of the Program is to define the structural basis for steroid interaction with on specific target, the GABA-A receptor. These studies will involve complementary studies of steroid analogue structure and molecular manipulation of recombinant receptor subunits. Photo-activated site specific probes for steroid binding sites will also be developed. The third objective of the Program is to delineate the mechanisms by which steroid anesthetics have their effects on their targets. The final objective is to correlate pharmacological results with production of anesthesia or other states defined only at the whole animal level. Although the overall focus is on anesthetic steroids, the program will include examination of additional anesthetics for comparison to the steroids. Each project, then, addresses on or another aspect of the action of anesthetic drugs at the cellular and molecular level. The Program as a whole will integrate these complementary studies, and relate them to behavioral states. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: BRAIN AND SPINAL CORD CONTRIBUTIONS TO ANESTHETIC ACTION Principal Investigator & Institution: Antognini, Joseph F.; Anesthesiology & Pain Medicine; University of California Davis Sponsored Programs, 118 Everson Hall Davis, Ca 95616 Timing: Fiscal Year 2002; Project Start 01-AUG-1998; Project End 31-MAR-2006 Summary: (provided by applicant) Our research efforts have been directed towards elucidation of anatomic sites of anesthetic action. Our earlier studies indicated that anesthetics such as isoflurane depress the movement response that occurs following noxious stimulation via an action in the spinal cord. In the past grant cycle we
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determined that isoflurane and propofol action in the spinal cord depressed the ascending transmission of nociceptive impulses to the brain. This resulted in ablation of the noxious-evoked activation of the electroencephalogram (EEG) and single-units in the thalamus and midbrain reticular formation (MRF). Because the MRF and thalamus are critical to consciousness and memory, it is likely that disruption of nociceptive input to these sites decreases the likelihood of consciousness and memory formation during anesthesia. In this proposal we aim to 1) determine whether isoflurane and propofol action at the spinal level affects the "arousal" state of the brain, as measured by MRF, pedunculopontine tegmental (PPT) and medial thalamic stimulation-induced effects on the EEG; 2) determine the neurotransmitter systems that modulate the ascending transmission of nociceptive impulses to the brain, and how isoflurane and propofol affect these systems. We hypothesize that 1) isoflurane and propofol will increase the threshold stimulation current in the MRF, PPT and medial thalamus required to cause EEG activation; 2) glutamatergic agonists, glycinergic antagonists and GABAergic antagonists applied to the spinal cord will enhance, while glutamatergic antagonists and GABAergic agonists will depress, the ascending transmission of nociceptive impulses to the brain, and thereby cause EEG activation; 3) isoflurane and propofol will indirectly depress evoked glutamate, aspartate and acetylcholine, but enhance GABA concentrations in the cerebral cortex and medial thalamus via an action in the spinal cord. The results of these projects will further our understanding of the in vivo sites where isoflurane and propofol exert their effects. This information will aid the development of newer and safer anesthetics, as well as lead to clinically useful means of modulating the neurotransmitter systems that are themselves modulated by anesthetics. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: CHOLINERGIC PHENOTYPE IN MURINE MODELS OF SLEEP Principal Investigator & Institution: Lydic, Ralph B.; Bert La Du Professor of Anesthesia; Anesthesiology; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2003; Project Start 30-SEP-1999; Project End 31-AUG-2007 Summary: (provided by applicant): This research program was initiated in 1999 in response to RFA HL99001. The goal of the RFA was to stimulate improved molecular, cellular, and systems approaches to investigate sleep in mice. Every human gene has a mouse homologue. This remarkable homology means that the mouse genome may provide unique insights into human disease. Advances in sequencing the mouse genome now require complimentary data regarding normal and abnormal phenotypes. In accord with consensus statements published by The Jackson Laboratory, this application focuses on the C57BL/6J (B6) mouse strain. The long-term objectives are to advance scientific knowledge by providing data not presently available concerning molecules that regulate ACh release and alter electroencephalographic (EEG) excitability, sleep, and breathing. Aim 1 will test the hypothesis that microinjecting neostigmine into the pontine reticular formation of B6 mouse causes a REM sleep-like state and changes in breathing that are concentration-dependent, site-specific within the pons, and blocked by atropine. Aim 2 will use in vivo microdialysis and high performance liquid chromatography (HPLC) to test the hypothesis that dialysis delivery of an adenosine A1 receptor agonist into the prefrontal cortex of B6 mouse will decrease cortical ACh release and EEG power, and delay wake-up time from anesthesia. Aim 3 will use combined microdialysis and microinjection to test the hypothesis that ACh release in the pontine reticular formation of B6 mouse is altered by nitric oxide donors and by inhibitors of nitric oxide synthase. Aim 4 will use a quantitative Western assay to
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test the hypothesis that brain expression of M2 muscarinic receptor protein varies significantly as a function of mouse strain and brain region. These aims will take this research program in new directions by developing a pharmacological model of rapid eye movement sleep in mouse (Aim 1), quantifying the effects of endogenous neuromodulators on ACh release (Aims 2 and 3), and initiating strain comparisons of muscarinic receptor protein expression (Aim 4). The unifying conceptual scheme of this proposal is that higher level phenotypes such as sleep and breathing (Aim 1) emerge from the expression of lower level phenotypes such as ACh (Aims 2 and 3) and muscarinic cholinergic receptors (Aim 4). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: CHRONIC MONITORING OF ISCHEMIC MODELS OF SUDDEN DEATH Principal Investigator & Institution: Smith, William M.; Professor of Biomedical Engineering And; University of Alabama at Birmingham Uab Station Birmingham, Al 35294 Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 31-JUL-2006 Summary: Most sudden cardiac death (SCD) is associated with coronary artery disease, but little is known about the exact sequence of events that leads up to it and the mechanisms responsible for it. There is a complex interplay between old myocardial infarcts, acute ischemia, the status of the autonomic system, mechanical viability, and electrophysiology that leads to SCD and influences whether tachycardia or bardycardia is the final rhythm. In this project, it is proposed to combine a unique set of technological and physiological resources to study the events surrounding sudden death. An animal model of infarct/ischemia leading to spontaneous SCD has been developing and will be studied in two complementary ways. One set of animals will be instrumented with a custom-developed telemetry system to acquire electrophysiologic and functional data during the conscious, ambulatory state, eliminating the confounding effects of thoracotomy and anesthesia and anesthesia on the incidence and nature of sudden death. Another set of animals will be studied with high resolution, three dimensional mapping to elucidate the mechanisms of the spontaneous arrhythmias that lead to SCD. It is hypothesized that the balance between the vagal and sympathetic arms of the autonomic system and that changes in repolarization properties of the myocardium are predictors of which animals die suddenly and spontaneously and spontaneously as well as the mode of death. It is also hypothesized that spontaneous tachycardia/fibrillation is initially reentrant and that the old infarct is involved in the arrhythmia maintenance. Further, it is hypothesized that bradycardia is associated with pump failure rather than a vagal reflex leading to hypotension. It is proposed to use the data from this research to develop, implement and validate measures that predict imminent SCD on the time scale of seconds to minutes. Because of the continuous nature of data acquisition over several days when no sustained arrhythmias are observed, it will be possible to determine the specificity as well as the sensitivity of derived predictors. Innovations in telemetry capability, cardiac mapping, and new animal models of spontaneous sudden cardiac death will provide information about the context and mechanisms of sudden death that has not been available before. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: CNS AUTONOMIC REGULATION BY ELECTROACUPUNCTURE Principal Investigator & Institution: Longhurst, John C.; Professor; Medicine; University of California Irvine Campus Dr Irvine, Ca 92697
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Timing: Fiscal Year 2001; Project Start 20-SEP-2000; Project End 31-JUL-2003 Summary: (Adapted from Applicant's Abstract): Acupuncture is an effective therapeutic modality in Eastern cultures, but has not achieved widespread recognition as a useful therapeutic option in Western medicine. In addition to its use in pain and anesthesia, electro-acupuncture (EA) has been used in hypertension, hypotension, angina and cardiac arrhythmias. Recently, the Pl's laboratory has begun to explore the physiological basis of EA. An initial study demonstrated that low frequency EA ameliorates myocardial ischemia by reducing myocardial oxygen demand in a feline model of reversible ischemia. In this model, stimulation of gallbladder chemosensitive afferent nerve endings reflexly increased arterial blood pressure, and augmented myocardial oxygen demand, which outstripped coronary blood supply following partial coronary ligation. Concurrent stimulation of the median nerves underlying the Neiguan acupoints reduced myocardial ischemia, measured as a reduction in regional wall thickening. A second study employing EA suggests a role of the endogenous opiate system in the rostral ventral lateral medulla (rVLM). Preliminary data from the Pl's laboratory indicate that the rVLM and periaqueductal gray (PAG) mediate the interaction between visceral (gallbladder) and somatic (EA) afferent nerve stimulation, and suggest a role for mu- and delta-opioid receptors. Also, the Pl has demonstrated in preliminary studies the ability to identify cells in the rVLM that receive convergent input from the greater splanchnic nerve (supplying the gallbladder) and the median nerve. Five hypotheses are now proposed: 1 ) The order of potency for the blood pressure-lowering effect of EA will be mu-equal to or greater than delta-greater than kappa-opioid receptors; 2) Non-NMDA excitatory amino acid receptors are responsible for stimulation of its neuronal subpopulation; 3) EA of Neiguan produces post-synaptic inhibition of an excitatory input to these neurons; 4) The ventrolateral PAG participates in EA modulation of reflex autonomic responses through an opioid mechanism and by influencing sympathoexcitatory rVLM neurons; and 5) Deep but not superficial somatic nerves underlying specific acupoints provide convergent input into rVLM and PAG neurons, and, through an opioid mechanism, modulate neuronal activity. Studies will be conducted in anesthetized cats whose rVLM and PAG are approached stereotaxically for extracellular recording and to deliver pharmacologic antagonists and agonists. Collaboration with both US and Chinese authorities on central neural electrophysiological and acupuncture research will significantly contribute to the ability to accomplish this investigation. By demonstrating the central neural mechanisms underlying this clinically beneficial modification of a cardiovascular reflex response by EA, scientists and clinicians will have a better understanding that will likely aid in acceptance and use of this alternative therapy. The Pl indicates that this project has important clinical implications. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: CNS TARGETS OF PROPOFOL'S HYPNOTIC AND MEMORY EFFECTS Principal Investigator & Institution: Veselis, Robert A.; Sloan-Kettering Institute for Cancer Res New York, Ny 10021 Timing: Fiscal Year 2001; Project Start 01-FEB-2001; Project End 31-JAN-2004 Summary: Many sedative/hypnotic drugs used in anesthesia are given specifically to ablate memory formation during unpleasant medical experiences. The production of this reversible memory impairment, with the avoidance of excessive sedation, is of key concern to both patients and clinicians on a daily basis. These drugs may impair memory solely by their sedative effects on arousal and attention systems in the brain, or
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additionally by specifically affecting memory processes. We have shown that one such drug, propofol, has memory effects independent of sedation during behavioral testing. We wish to delineate the physiologic basis for this finding. Recent functional neuroimaging studies have identified differing neuroanatomical regions mediating arousal, attention and memory processes in humans who have not had any drug. Thus, the separate memory and sedative effects of propofol could be mediated in different neuroanatomical regions. The main hypothesis tested in this research proposal is that there are differing neuroanatomical regions mediating drug-induced sedation and amnesia, and that these can be identified by specific changes in electrophysiology and more precisely by changes in regional cerebral blood flow (rCBF). If a physiologic basis for the separation of drug- induced memory from sedation effects can be shown, then it is possible that these can be manipulated separately, and that sensitive and specific measures of these functional effects can be developed. Even in the absence of explicit recall, poorly understood unconscious memory processes are still present during anesthesia. These are of clear concern to both patients receiving anesthesia and clinicians administering anesthetic drugs. The methods developed and used in this proposal will be applicable to the study of anesthetic effects, and possibly the study of memory enhancing drugs, on memory processes. Propofol and thiopental, models of anesthetic drugs with differing sedative and memory effects, will be studied over a wide dose range. Current measures of sedation are inadequate monitors over both sedative and anesthetic concentrations of drug. The first specific aim will determine the best electrophysiologic measure of sedation over all concentrations of the drugs studied, and locate generators of this measure in the brain with a low resolution technique. The sedation independent effect of propofol on memory will be delineated using this electrophysiologic parameter. The second specific aim will locate the neuroanatomical regions mediating the sedative/hypnotic and memory effects of propofol using a high resolution rCBF technique by separately manipulating memory versus sedative processes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: COGNITIVE EFFECTS OF ANESTHETICS AND DOPAMINE TRANSPORT Principal Investigator & Institution: Votaw, John R.; Professor & Pet Ctr Physicist; Radiology; Emory University 1784 North Decatur Road Atlanta, Ga 30322 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-JUL-2004 Description (provided by applicant): This grant is being submitted in response to the program announcement, PA-96-026, "Molecular Pharmacology of Anesthetic Action." The announcement states (in part).".it has been difficult to assign a direct correlation between molecular events that are influenced by anesthetics and the physiological effects that subsequently occur." In the preliminary data section, we present evidence of molecular interaction between volatile anesthetics and the dopamine transporter (DAT). Our model is: Initially, there is normal trafficking between expressed and cytoplasmic (DAT). At induction of anesthesia, some anesthetic binds directly to the DAT and some activates protein kinase C (PKC) causing some internalization of DAT. The extracellular concentration of DA increases because fewer expressed DAT result in less reuptake of DA. Continued release of DA is inhibited by a feedback mechanism signaled from extracellular DA. During prolonged anesthesia, the extracellular DA is metabolized, which decreases its concentration while increasing the concentration of its metabolites. After cessation of anesthesia, the anesthetic first clears from the body allowing the expressed DAT to function and PKC to return to the inactive state. Then, DA
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concentration begins to recover. After the system has nearly recovered, the DAT and extracellular DA concentrations return to normal but additional DA must be synthesized to replenish that lost to metabolism. Cognitive ability normalizes after all subsystems return to baseline values. We propose to test this model with a series of in vitro, rat, non-human primate and human studies and to determine the physiological significance of these changes as they relate to cognitive performance in humans through 3 specific aims: Specific Aim 1: Analyze the DAT-anesthetic interaction at the cellular and sub-cellular level. We hypothesize that DAT-anesthetic interaction will be significant at clinically relevant concentrations for certain anesthetics and, we expect to see reduced [18F]FECNT binding and [3H]dopamine uptake following anesthetic administration due to trasnporter internalization. Specific Aim 2: Characterize the DATanesthetic interaction in intact living tissue. We expect to confirm DAT internalization and observe an initial increase in extracellular DA followed by decreased DA and increased metabolites indicating decreased functioning of the DAT. Results of these experiments in comparison with aim 1 will determine if interaction with other neural systems is important. They will also provide a direct calibration for interpreting the PET results in aim 3. Specific Aim 3: Measure the duration of decreased [18F]FECNT binding potential following anesthesia in humans and correlate with cognitive functioning. Using the results from aims 1 and 2, this PET experiment will give information about DAT expression in humans following anesthesia. We expect the time course to normalization of the binding potential and cognitive performance to correlate well. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: CORE -- ANIMAL HEALTH SERVICE Principal Investigator & Institution: Homberger, Felix; Sloan-Kettering Institute for Cancer Res New York, Ny 10021 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-AUG-2008 Summary: ABSTRACT NOT PROVIDED Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: CORE CLINICAL CENTER FOR NHLBI TM/H RESEARCH NETWORK Principal Investigator & Institution: Ness, Paul M.; Pathology; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-AUG-2007 Summary: (provided by applicant): This proposal is to participate in a Transfusion Medicine/Hemostasis Clinical Research Network. The proposal is submitted by the Transfusion Medicine Division of the Johns Hopkins Medical Institutions (JHMI) with specific collaborations from the Hematology divisions of the Departments of Medicine and Pediatrics (responsible for the management of sickle cell anemia and hemostatic disorders), the Department of Anesthesia and Critical Care Medicine, the Hematopoietic and Therapeutic Support service (HATS) (a joint program of the Departments of Pathology and Oncology), and the Advanced Transfusion Practices (ATP) Center at JHMI. The JHMI core clinical center will coordinate the activities of individuals with expertise in transfusion medicine/hemostasis, taking advantage of preexisting links between the JHMI departments and programs, and utilizing a large and diverse patient base whose therapy is highly dependent upon transfusion and hemostatic therapies. The Hopkins team will participate with other institutions and the coordinating center of the network, proposing study protocols and amending protocols
22 Anesthesia
suggested by collaborating institutions. The proposal describes two clinical protocols that could be selected by the clinical research network. One study will focus upon the transfusion needs of patients with sickle cell anemia in the perioperative setting using hemoglobin based oxygen carriers as one therapeutic option compared to transfusions. A second protocol will study a widely used but incompletely evaluated alternative to transfusion, acute normovolemic hemodilution (ANH), whose efficacy and adverse event profile is unclear. If the ANH procedure is efficacious, and important element is its provision of fresh autologous blood elements to reduce bleeding in perioperative patients, an important hemostasis endpoint. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: CORE--ANIMAL Principal Investigator & Institution: Mucke, Lennart; Associate Professor; J. David Gladstone Institutes 365 Vermont St San Francisco, Ca 94103 Timing: Fiscal Year 2003; Project Start 01-APR-2003; Project End 31-MAR-2008 Summary: Genetically modified mouse models have been very useful in research on neurodegenerative disorders, and the proposed program will take maximal advantage of this valuable resource. The main goal of the Animal Core is to help the project leaders of this program address their research questions conclusively with the minimal number of animals 1and experiments possible. To achieve this goal, we propose five specific aims. Aim 1: Maintain all animals in a I manner that ensures the reliable selection of experimental and control groups for timely distribution to the different projects. Rodents will be housed in specific-pathogen-free animal care facilities on the San Francisco General Hospital campus of the University of California, San Francisco, and on the La Jolla campus of the University of California at San Diego (UCSD). Receipts of mice and rats, matings, pregnancies, births, weanings, coat colors, ear markings, genotyping results, pedigrees, weights, health problems, deaths, and transfers or shipments of mice will all be recorded in a database that will be accessible to all project leaders and their coworkers via the computer networks of the Gladstone Institutes and the University of California. Aim 2: Breed the different lines of genetically modified mice and determine the genotype of the resulting offspring by PCR. Breedings will include timed matings for the generation of primary neural cell and tissue cultures, and crosses between distinct lines to generate mice with two or more genetic modifications. The core personnel have ample experience in genotyping genetically modified mice and maintaining complex animal databases. Aim 3: Receive mice from the Gladstone microinjection facility and blastocyst core and identify new transgenic founders and knockin mice by PCR and southern blot analysis. Gladstone and UCSD maintain stateof-the-art facilities for the microinjection of transgenes into one-cell mouse embryos and for gene targeting to inactivate or selectively modify endogenous mouse genes. Aim 4: Periodically analyze all lines of mice to confirm that levels and patterns of (trans)gene expression have remained stable. Cerebral levels of transgene expression will be tested by quantitative fluorogenic RT-PCR. The distribution of transgene expression will be characterized in collaboration with the Neuropathology/Imaging Core. We will also collaborate closely with the Neuropathology/Imaging Core and veterinary staff to optimize our protocols for the anesthesia and perfusion of animals and for the removal, dissection, and proper storage of neural tissues. Aim 5: Ship mice to Dr. Masliah at UCSD and to investigators at other institutions and advise them on the genotyping and husbandry of the mice. We have distributed our animal models to many institutions and will continue to make our models available to the scientific community. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: CORE--ANIMAL FACILITY Principal Investigator & Institution: Dysko, Robert; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2001; Project Start 30-SEP-1988; Project End 31-MAY-2006 Summary: The Animal Core provides a wide range of services related toe care and use of animals in cancer research. These services will include: Animal husbandry including housing of immunodeficient and transgenic animals; Training in animal research techniques including anesthesia and surgical procedures; Tumor induction and measurement; Animal biocontainment procedures for carcinogens and pathogens; Procurement of special animal strains and animal models; Training in rodent breeding colony management; Animal necropsy services including veterinary pathology consultation; Animal clinical pathology and diagnostic services; Barrier animal facilities and animal health surveillance to assurance SPF rodent status. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: CORE--ANIMAL RESOURCE Principal Investigator & Institution: Ksander, Bruce R.; Associate Scientist; Schepens Eye Research Institute Boston, Ma 02114 Timing: Fiscal Year 2002; Project Start 01-AUG-2002; Project End 31-JUL-2003 Summary: Abstract: Funds are requested by 30 vision scientists to support 4 research modules that facilitate and enhance interaction among the vision scientists in the various disciplines represented at the Schepens Eye Research Institute. The modules will extend endeavors of individual research programs by providing collaborative opportunities for projects in which investigators do not have expertise, funding, or technical capabilities. The modules are: Morphology, Animal Resource, Laboratory Computer Applications and Flow Cytometry. The Morphology Module will provide light and electron microscopy, confocal microscopy and image analysis capabilities and tissue preparation for histochemistry and in situ hybridization, thereby increasing of morphologic techniques to biochemists, pharmacologists, cell and molecular biologists, and immunologists who need correlative morphologic data for their research. The module houses and maintains shared equipment for morphologic work and is available to all members of the Core. The Animal Resource Module will provide expertise and assistance in animal surgical techniques and postoperative care, administration of anesthesia, drugs, and medications. In addition, it will also provide for daily animal husbandry that is required to maintain our high standards for animal housing, sanitation, and veterinary care. The Laboratory Computer Applications Module will provide support to individual and collaborative efforts by assisting in interfacing of microcomputers with lab equipment and by developing software for gathering, processing, and analyzing experimental data by microcomputer systems. The module will also provide assistance to projects involving image processing and analysis from several types of equipment sources. The module interacts actively with the Morphology and Flow Cytometry Modules supporting computer- based technology. The Flow Cytometry Module is a centralized service providing principle investigators and collaborators access to equipment and technical support for flow cytometry and cell sorting. Available to the investigators are the Coulter Epics XL flow cytometer and the Coulter ELITE EPICS ESP fluorescent cell sorting. Available to the investigators are the Coulter Epics XL flow cytometer and the Coulter ELITE EPICS ESP fluorescent cell sorter. The modules are staffed by personnel with specialized training in the respective fields and equipment. Each module is under the immediate supervision of an
24 Anesthesia
established, experienced investigator(s). The module heads constitute the Core Grant Committee, which is responsible to the Director of Research. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: CORE--IN VIVO PDT--ANIMAL, DOSIMETRY AND STATISTICS Principal Investigator & Institution: Hamblin, Michael R.; Massachusetts General Hospital 55 Fruit St Boston, Ma 02114 Timing: Fiscal Year 2001; Project Start 09-AUG-2001; Project End 31-JUL-2006 Summary: APPLICANT'S (Provided by Applicant) The In vivo PDT: Animals, Dosimetry, and Statistics Core will provide equipment, services and training necessary for a wide range of PDT experiments on living animals. The Core aims to catalyze the fusion of biological and physics expertise and together with appropriate dosimetry and statistical input allow animal experiments to be carried out as efficiently and economically as possible. The Core has three broad Specific Aims: (1) Experimental animals. (a) The core will provide equipment and support for the ordering, identification by implanted radio-frequency tags, tracking and record keeping of animals. (b) Provide equipment, anesthetics and assistance in the treatment and postoperative monitoring of animals, this will include digital electronic calipers for measurements of tumor dimensions. Conduct pilot studies to determine times after injection for intravascular and extravascular localizations of BPD, test for phototoxicology during PDT with the photosensitizers BPD and ALA-induced PPIX, and test implanted light-dose measurement fibers, correlate fiber-measured fluorescence with extracted photosensitizer content, and test oxygen measuring apparatus in small rodent tumor models. (d) Provide education and training for investigators, concerning MGH SRAC and federal forms and regulations on animal experiments, provide manuals dealing with anesthesia, surgical techniques and proper animal husbandry of small rodents during experiments and ensure that the Program remains in compliance with Institutional and USDA guidelines. A full-time technician will be available for the performance of these duties. (2) Light delivery and dosimetry. The core will provide evaluation, acquisition, implementation of technology, and training in its use in the areas of (a) Light delivery including KTP-pumped dye laser and diode lasers, LED devices, fiber optics and wavelength and power measurement devices. (b) In vivo light dosimetry based on a system using implanted fiber optics that provide on-line measurements of the dose-rate and total accumulated light dose at each monitor point. In vivo photosensitizer quantitation based on a system using either surface or implanted fiber optics that can measure fluorescence from tissue quantitatively, and independent of the tissue's intrinsic optical properties, (d) Measurements of bulk tissue oxygen pressure and blood flow using a fiber optic based system with a fluorescent tipped probe together with a Doppler blood flow probe. A full-time technician will be available for the performance of these duties. (3)Statistics (a) Provide statistical advice in planning experimental protocols in order to achieve the desired aims in a manner that is costeffective, humane, and scientifically sound. (b) Provide advice and assistance in data collection and data management. (c) Provide advice and assistance in statistical analysis of data and interpretation of results. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: CORE--MURINE ASTHMA Principal Investigator & Institution: Grunig, Gabriele G.; Assistant Professor of Pathology; Columbia University Health Sciences New York, Ny 10032
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Timing: Fiscal Year 2001; Project Start 27-AUG-2001; Project End 31-JUL-2006 Description (provided by applicant): The Core will be set up to provide the scientific and technical expertise and the equipment and space to perform mouse asthma models for the investigators of the program project. The Core is set up so that service can be provided at different levels. Investigators can choose to have the complete experiment including analysis done by the Core. Alternately, investigators may seek advice and training so that they can perform the experiments partially or fully themselves. The Core facilities are located in the Institute for Health Sciences of the St. Luke's-Roosevelt Hospital and are part of the J.P. Mara Center for Diseases of the Lungs (director, Dr. G.M. Turino). The facilities are within 20 minutes reach from the Columbia University Health Sciences campus using the subway or taxis. Mice will be transported by private car or by a commercial carrier. The Core facilities include lung function equipment (including plethysmograph), computer and software to examine lung function in anaesthetized, ventilated mice. The facilities also include an apparatus for Isofluorane anesthesia used for the intranasal challenges. Instruments and equipment for surgery and for collection and analysis of bronchioalveolar ravage, blood and organs are available and set up as to optimize the work-flow. A large variety of models have been set up or further developed by myself and the most appropriate model for each question will be selected. Ovalbumin and an organism-free extract of Aspergillus fumigatus will be used to induce antigen-dependent airway disease. For each study, priming and challenge protocols will be selected to achieve the appropriate intensities of the immune and inflammatory responses in the control, wild type mice T cell transfer studies will be performed to either determine the effects in the lungs of specific T cell lines. The T cell lines will be made in vitro from spleens of T cell-receptor transgenic mice. Another T cell transfer model will be used to determine the requirements for T cell priming. T cells will be isolated from the spleens of naive, wild type mice. Dendritic cell transfer studies will be used to determine the immune response induced by antigen-pulsed dendritic cells in the lungs. Intranasal challenges with recombinant cytokines will be used to determine the effects of specific cytokines in the lungs. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: ANESTHETICS
DEVELOPMENT
OF
SENSORY/PAIN-SELECTIVE
LOCAL
Principal Investigator & Institution: Gerner, Peter; Brigham and Women's Hospital 75 Francis Street Boston, Ma 02115 Timing: Fiscal Year 2002; Project Start 15-SEP-2002; Project End 31-AUG-2007 Summary: (provided by applicant) The candidate is an Instructor in Anesthesiology at Brigham and Women's Hospital, Boston, MA. He will use the next 5 years to acquire basic molecular biology and electrophysiology skills to achieve his long-term goal of developing clinically useful pharmacological agents for the safe and specific treatment of pain. Local anesthetics (LAs) are used routinely for surgical anesthesia and for management of acute and chronic pain from all causes. In addition to blocking voltagegated Na+ channels in sensory nerves fibers, LAs also block Na+ channels in motor and sympathetic fibers, as well as in brain and heart. Therefore, complete pain relief often cannot be accomplished, or serious adverse effects occur, e.g., cardiac arrest, seizures, low blood pressure, and motor blockade causing immobility. The specific aims of this proposal are (1) To identify novel drugs with LA properties in vivo and in vitro. (2) To examine these drugs for pain-selective properties. (3) To define their affinities to both the activated and inactivated states of different Na+ channel isoforms and (4) Using site directed mutagenesis, map the LA receptor in sensory neuron-specific Na+ channels to
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aid in future drug design. Whole-cell voltage-clamp recordings of newly developed quaternary ammonium (QA) derivatives of lidocaine (tonicaine) and amitriptyline (e.g., N-methyl amitriptyline) defined a high level of additional block (use-dependent block) when neuronal cells were stimulated at a high frequency. These QA drugs will be used to study the hypothesis that they selectively treat conditions caused by high-frequency discharge, e.g., acute postoperative and neuropathic pain. To further improve design of new drugs, the candidate will use drugs with good clinical properties (best efficacy and the fewest side effects in treating postoperative and neuropathic pain in animal surgical models) to define their binding sites in sensory neuron-specific Na+ channels transiently expressed in mammalian cells. It is hypothesized that this binding site is in areas responsible for use-dependent blockade, as there is no difference of the intrinsic affinity among different Na+ channel isoforms. With the use of site-directed mutagenesis, detailed structural information about the LA binding site in sensory-specific Na+ channels will be obtained by studying the effects of specific amino acid mutations on LA action and will help to direct and further refine drug design efforts. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: DIMENSIONS AND POLARITY OF ANESTHETIC BINDING SITES Principal Investigator & Institution: Trudell, James R.; Anesthesia; Stanford University Stanford, Ca 94305 Timing: Fiscal Year 2002; Project Start 15-JAN-2002; Project End 31-DEC-2004 Summary: (provided by applicant): Our long-term goal is to improve the design and administration of volatile anesthetics by learning the molecular mechanisms of anesthesia. Our short-term goal is to understand how volatile anesthetic potency is altered by site-directed mutations in the transmembrane domains of ligand-gated ion channels. Our hypothesis is that cavities within transmembrane domains provide a common motif for volatile anesthetic binding sites within the superfamily of GABA, glycine, nicotinic acetyicholine, and 5-NT receptors. We suggest that specific amino acid residues define the dimensions and polarity of these binding sites and thereby determine the relative efficacy of volatile anesthetics. This hypothesis will be tested in two Specific Aims: Aim 1. We will test the hypothesis that variations in the dimensions of cavities within transmembrane subunits determine the relative potency of anesthetics within the superfamily of GABA, glycine, and nicotinic acetyicholine receptors. Mutation of two critical amino acid residues in transmembrane segments of the glycine alpha 1 receptor (S267 and A288) modulates the potentiation of agonists by volatile anesthetics. The volume of these residues is the best predictor of anesthetic potency. We will build molecular models of the transmembrane domains of these subunits and predict additional residues that may define the dimensions of these putative cavities. Aim 2. We will test the hypothesis that variations in the polarity of cavities within transmembrane subunits determine the relative potency of volatile anesthetics. Although the volume of amino acid side-chains has a dominant effect, the distinct in vivo and in vitro pharmacology of pairs of anesthetic isomers demonstrate that the polarity and shape of binding sites is important. We will use molecular modeling to rationalize existing data and predict new site-directed mutations for study by our collaborators in an iterative series of experiments. In summary, our initial computational models with two transmembrane alpha helices have been of value in rationalizing and predicting the effect of site-directed mutations. Building a more complete 3-dimensional model of an anesthetic binding site will allow us to define those molecular properties that confer distinct pharmacologies on volatile anesthetics. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: DIRECT NEUROTOXICITY OF LOCAL ANESTHETICS Principal Investigator & Institution: Johnson, Michael E.; Mayo Clinic Rochester 200 1St St Sw Rochester, Mn 55905 Timing: Fiscal Year 2001; Project Start 01-APR-2000; Project End 31-MAR-2003 Summary: The objective of this proposal is to determine the mechanism of direct neurotoxicity of spinal (intrathecal) lidocaine. Other local anesthetics have a risk of persistent lumbosacral neurotoxicity of approximately 1 in 10,000. Lidocaine at doses producing surgical anesthesia has an increased risk of approximately 1 in 200 via continuous spinal anesthesia, and approximately 1 in 1300 via single injection spinal anesthesia. Transient neurologic symptoms (TNS) of buttock and leg pain occur in 16-40 percent of patients receiving spinal lidocaine in multiple large studies. Lidocaine is also neurotoxic in an animal model that produces lower extremity anesthesia with 5 percent lidocaine, and in cell culture and in vitro nerve studies. To address the mechanism of this neurotoxicity, most studies will be conducted at the level of the single cell, using digitized video fluorescence microscopy, phase microscopy, and flow cytometry, with appropriate, specific, fluorescent probes. Immunoblotting and fluorogenic assays of fractionated cell lysates will also be utilized. The ND7 cell line, derived from rat dorsal root ganglion, will be used as a model system for neuronal injury. Two hypotheses will be tested as specific aims: (1) Lidocaine interferes with multiple mechanisms for maintaining normal cytoplasmic calcium (Ca2+cyt), causing an increase to toxic levels. Preliminary data show a marked effect of lidocaine to elevate Ca2+cyt (5-7 fold with 5 percent lidocaine; greater than 15 percent cell death within 60 min). The effect of lidocaine on possible mechanisms of Ca2+cyt elevation will be tested, including influx from extracellular buffer, release from endoplasmic reticulum, and release from mitochondria. The causal relationship of lidocaine-induced Ca2+cyt elevation to neurite injury, plasma membrane blebbing, and neuronal death by necrosis and apoptosis will be determined. (2) Lidocaine activates multiple mechanisms of mitochondrial injury. Preliminary data show a marked effect of lidocaine to decrease mitochondrial membrane potential deltapsi in whole cells. Potential mechanisms of decreased deltapsi by lidocaine will be tested: protonophoric mitochondrial uncoupling, inhibition of mitochondrial respiration, and induction of the mitochondrial permeability transition. The effect of lidocaine will also be tested on mitochondrially based mechanisms of cell death: release of mitochondrial cytochrome c, and caspase activation. The Ca2+cyt dependence of each mechanism of mitochondrial injury will be determined by experiments with and without Ca2+cyt clamped at a normal level. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: DISTRIBUTION INNERVATION
AND
ULTRASTRUCTURE
OF
DENTAL
Principal Investigator & Institution: Byers, Margaret R.; Research Professor; Anesthesiology; University of Washington Seattle, Wa 98195 Timing: Fiscal Year 2001; Project Start 01-MAY-1979; Project End 31-JAN-2004 Summary: Dental innervation is still not fully understood concerning its variety of nerve fibers, their interactions with pulp and dentin in normal teeth, and the mechanisms that cause hypersensitive dentin, postoperative pain, and difficult anesthesia for inflamed teeth. There is important plasticity in expression of sodium channels in injured cutaneous sensory neurons, driven by neurotrophic factors, but it is not known whether similar events underlie persistent neuroplasticity and pain after tooth injury. Teeth are an excellent model tissue for studying neuroinflammatory interactions in the periphery
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and their effects on trigeminal nerves, the ganglion and the central nervous. Tooth injury also affects non-dental neurons in the ganglion, in the brain stem and sometimes in contralateral trigeminal neurons by mechanisms that in part depend on paracrine signalling by nerve growth factor. The Aims of this work are: (1) to determine the effects of specific types of tooth injury on sodium channel expression in dental neurons, neighboring uninjured trigeminal neurons and central neurons in relation to pain behavior, pulpal pathology and anti-inflammatory treatment, (2) to determine whether trigeminal sodium channel expression, pulpal reactions and behavior are affected in mutant mice that have altered neurotrophin mechanisms, and (3) to define the complexities of cells in the pulp, especially the odontoblast layer, in relation to expression of neurotrophins and calcium channels, in order to better understand the pulpal-nerve interactions in normal and injured teeth. We will use dental injury models in rats and mutant mice for analysis by behavioral testing, immunocytochemistry and in situ hybridization. There will be specific labeling of injured dental neurons by retrograde transport of fluorogold for comparison with uninjured labeled neurons. Our newly developed behavioral assays allow the characterization of pain periods in relation to pulpal and neural cytochemistry during anti-inflammatory treatment or in mutant mice. Our goal is to understand neuroinflammatory interactions in inflamed teeth in order to develop better treatments for dental pain. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: EEG DATA MONITORING SYSTEM USED IN CONJUNCTION WITH FMRI Principal Investigator & Institution: Johnson, William A.; Techen, Inc. 115 Cedar St Milford, Ma 01757 Timing: Fiscal Year 2003; Project Start 01-JAN-2003; Project End 31-OCT-2003 Summary: (provided by applicant): In the United States, approximately 600,000 patients have epilepsy uncontrolled by medication [29]. Approximately 3,000 of these patients every year in the USA are treated surgically to relieve from medically refractory seizures [48]. The main goals of the proposed project is to develop and demonstrate the feasibility of data acquisition of clean EEG brain signals in conjunction with MRI, using fields up to a maximum of seven (7) Tesla. The simultaneous measurement of fMRI and EEG will enable neuroscientists to study various physiological brain states such as (a) EEG a-waves, (b) sleep, and (c) anesthesia and pharmacologically induced changes of brain activity, leading to more useful diagnostic procedures. Electroencephalography (EEG) and functional MRI (fMRI) provide complementary information about the timing and location of brain processes. Understanding brain processing requires both types of data. We aim to (1) develop DSP hardware and software (firmware) for noise cancellation to use in the existing prototype for simultaneous EEG and MRI acquisition system based on an adaptive filtering technique; (2) test and improve the system with the use of a special phantom with a piezo-electric transducer to mimic Ballistocardiogram noise; (3) test the real-time version of the adaptive filter on the data acquired. While the main goal of this project is to develop hardware and signalprocessing code for the EEG system for research studies in conjunction and simultaneously with fMRI, the system will also have value for the basic science community interested in functional brain imaging, and could have important implications for the monitoring of neuronal activity in other clinical populations (e.g., epilepsy, migraine, coma/neurology ICU, stroke). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: EFFECTS OF STRETCH ON IC AND NORMAL UROTHELIA Principal Investigator & Institution: Chai, Toby C.; Associate Professor; Surgery; University of Maryland Balt Prof School Baltimore, Md 21201 Timing: Fiscal Year 2001; Project Start 15-JUN-2001; Project End 31-MAY-2006 Summary: (Adapted from the Applicant's Abstract): Interstitial cystitis (IC) patients typically present with extreme urinary frequency, urgency and pelvic pain. It has a 10:1 female:male predominance. Since the pathophysiologic picture of IC is unclear, cure remains elusive and treatment options are largely ineffectual. Even the diagnosis of IC is controversial. An objective diagnostic criterion is the cystoscopic appearance of glomerulations after bladder hydrodistention (stretch) under anesthesia. Recent data disputed the diagnostic specificity of this procedure because hydrodistention of control bladders resulted in glomerulations. Based on the investigators' preliminary data which showed that IC urothelia responded to stretch significantly differently than controls in cystoscopic appearance, levels of urinary heparin binding epidermal growth factor-like growth factor (HB-EGF), antiproliferative activity (APF), and adenosine triphosphate (ATP), they propose to test these hypotheses: 1. Bladder glomerulations, which appear after hydrodistention, are specific for NIH-IC symptoms criteria (NISC). 2. Male patients with chronic non-bacterial prostatitis (prostatitis class III or chronic pelvic pain syndrome, CPPS) and NISC have post-hydrodistention glomerulations whereas males with CPPS and no NISC do not. This observation would further strengthen the association of glomerulations with NISC. 3. Some NISC patients improve symptomatically after hydrodistention and degree of improvement correlates with changes in urinary markers (APF, HB-EGF and ATP). 4. In vitro stretch of IC urothelial cells results in increased ATP, HBEGF and decreased APF activity compared to stretch of control cells. 5. There is increased expression of P2X1 and P2X3 ATP receptors in IC compared to control bladder urothelium and suburothelium. This project is unique because it links clinical and laboratory data to test the central hypothesis that IC urothelia respond differently to stretch. Only human samples will be used to provide optimal clinical relevance. Findings from this study will clarify the current diagnostic dilemma regarding specificity of glomerulations for diagnosing IC and determine the therapeutic efficacy of hydrodistention. Furthermore, this study will explore the exciting new discovery that ATP released by stretched IC cells is significantly higher compared to controls. ATP may mediate nociception in the bladder. Urothelial stretch thus appears to be an important consideration in diagnosis, treatment and pathophysiology of IC. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: BLOCKADE
ELDER
SURGERY-FUNCTIONAL
RECOVERY
AFTER
BETA
Principal Investigator & Institution: Silverstein, Jeffrey H.; Associate Professor; Anesthesiology; Mount Sinai School of Medicine of Nyu of New York University New York, Ny 10029 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-AUG-2007 Summary: (provided by applicant): The ultimate objective of this work is to understand the major determinants of postoperative outcomes and to develop therapeutic modalities and practice parameters that maximize the rate, magnitude and quality of postoperative functional recovery in elderly surgical patients. The immediate objective is to evaluate the impact of anesthetic-coupled intra-operative beta-blockade on long term functional recovery in elders undergoing elective major abdominal surgery. The proposed research is a five-year randomized partial open-label trial of approximately
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1100 patients 65 years of age or older having elective major abdominal surgery. Eligible patients will be divided into two groups: those currently receiving chronic betablockade or possessing risk factors for myocardial ischemia will be assigned to receive beta-blockers before and after surgery, those without risk factors will not. Within each group, eligible patients will be randomized to receive either a control anesthetic or anesthetic-coupled intra-operative beta-blockade. Patients will be evaluated preoperatively and postoperatively using a broad battery of functional and performance measures. Postoperative evaluations will take place over three stages: Stage 1 - end of surgery to discharge from the Post-Anesthesia Care Unit; Stage 2 - end of PACU stay through postoperative day three; and Stage 3 - postoperatively at one, three, and six weeks and three and six months. The impact of the intra-operative intervention will be assessed by pursuing the following specific aims: 1) comparison of the time course and extent of long-term (stage 3) functional recovery in elderly surgical patients receiving either a control or an anesthetic-coupled beta-blockade regimen; 2) comparison of the course of early (stage 1 and 2) recovery with particular reference to postoperative pain and analgesic medications in elderly surgical patients receiving either a control or an anesthetic-coupled beta-blockade regimen, and; 3) evaluation of the correlation between cardiac troponin release and cardiovascular outcome for six months following operation in elderly surgical patients receiving either a control or an anesthetic-coupled betablockade regimen. Primary outcomes measures will include: 1) Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) (Stage 3 recovery); 2) time to discharge from the Post Anesthesia Care Unit; 3) analgesic requirements self-reported pain by visual analogue scale; 4) incidence of delirium (confusion Assessment Method) (Stage 2 recovery); and 5) troponin I levels (Stage 1 and 2 recovery). The proposed trial leverages recent new data on the natural history of postoperative functional recovery in elders after abdominal surgery with pilot data suggesting that beta-blockade have beneficial effects on functional recovery to support the conduct of a randomized trial of an anesthetic intervention designed to improve short and long-term functional recovery in elders. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: ESTROGEN EFFECTS ON CARDIOVASCULAR RESPONSE TO EXERCISE Principal Investigator & Institution: Kaufman, Marc P.; Professor of Internal Medicine & Human p; Internal Medicine; University of California Davis Sponsored Programs, 118 Everson Hall Davis, Ca 95616 Timing: Fiscal Year 2001; Project Start 01-FEB-2001; Project End 31-JAN-2006 Summary: (Applicant's abstract): Static and moderate dynamic exercise are known to increase heart rate, myocardial contractility, arterial blood pressure, breathing and muscle sympathetic nerve discharge. These effects, which are believed to increase the delivery of oxygen to metabolically active tissues (i.e., the exercising muscles), appear to be less in women than in men. This difference is often attributed to the effect of estrogen on neuronal function. Consequently, the aim of the experiments proposed in this application is to identify the effect of estrogen on "central command" and the muscle reflex, the two neural mechanisms responsible for evoking the autonomic responses to exercise. The proposed studies will be done in decerebrate unanesthetized female and male cats, which have been either ovariectomized or castrated, respectively two to four weeks prior to the experiment. In this preparation, the two neural mechanisms, central command and the muscle reflex, can be investigated separately without the influence of anesthesia. The effect of estrogen (i.e., 17-beta-estradiol) on the central command to
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exercise will be studied while the cats are paralyzed with vecuronium, and will be evoked by both electrical and chemical stimulation of the hypothalamic and mesencephalic locomotor regions. Motoneuron discharge to agonist and antagonist hindlimb muscles will be recorded. The criterion for elicitation of central command will be "fictive locomotion." Likewise, the effect of estrogen on the muscle reflex will be studied, but the cats will not be paralyzed. The muscle reflex will be evoked both while the hindlimb muscles are freely perfused and while they are ischemic. Dose response relationships for the effect of estrogen on both the cardiovascular and respiratory responses to central command and the muscle reflex will be determined. Moreover, studies will be extended to estrogen pretreatment with timed release pellets implanted into castrated male cats and ovariectomized females. In addition, the effect of microinjections of 17beta-estradiol into the hypothalamic and mesencephalic locomotor regions will be determined because preliminary data suggest that central command, but not the muscle reflex, is responsible for the estrogen-induced attenuation of the cardiovascular and ventilatory responses to exercise. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: GABAERGIC CIRCUITS IN AUDITORY CORTEX Principal Investigator & Institution: Banks, Matthew I.; Physiology; University of Wisconsin Madison 750 University Ave Madison, Wi 53706 Timing: Fiscal Year 2003; Project Start 15-MAR-2003; Project End 31-JAN-2008 Summary: (provided by applicant): Our long-term objective is to understand the role of cortical GABAA receptor-mediated inhibition in the perception of sensory stimuli, and how modulation of GABAA receptors by general anesthetics and changes in cortical inhibition in various neuropathologies alters sensory perception. In this proposal, we seek to understand how GABAergic cells control the timing of action potentials in auditory cortex (ACx). Firing patterns distributed across populations of pyramidal cells in ACx are postulated to represent certain features of acoustic stimuli. Spikes in these population codes are either time-locked to transitions in the stimulus, or comprise temporal patterns generated internally. Evidence suggests that networks of cortical interneurons are involved in establishing both types of patterns. Thalamocortical (TC) afferents activate multiple populations of 'feedforward' GABAergic interneurons in ACx. Lemniscal TC fibers target cells in layers III and IV (LIII/IV), while extralemniscal TC afferents target cells in layer I (LI). Activation of the latter afferents triggers gamma frequency oscillations in ACx. We propose that feedforward interneurons in ACx regulate spike timing in pyramidal cells and that this capability is enhanced by network interactions among inhibitory cells. We will test the hypothesis that LI interneurons control internally generated firing patterns, while LIII/IV interneurons coordinate firing patterns that are time-locked to the stimulus. Disruption of cortical timing signals has also been postulated to underlie sensory and cognitive impairment during general anesthesia, and modulation of cortical rhythms in ACx is being pursued as a solution to the important medical application of monitoring depth of anesthesia in patients. GABAergic interneurons are central players in normal, pathological and exogenously modulated cortical processing. Thus, understanding how these cells are activated and organized and the functional implications of this structure is critical to understanding cortical information processing. Although evidence abounds that these cells play a pivotal role in setting the response properties of principal cells, we seek to fill the gap in our knowledge of their organization and how they interact with principal cells. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: GENERAL ANESTHETICS AND NACCHOR AGONIST AFFINITY Principal Investigator & Institution: Raines, Douglas E.; Massachusetts General Hospital 55 Fruit St Boston, Ma 02114 Timing: Fiscal Year 2001; Project Start 01-APR-2001; Project End 31-MAR-2005 Summary: (Verbatim from the applicant's abstract) The broad. Iong-term objective of this project is to define the molecular mechanisms by which general anesthetics act on protein targets in the CNS and periphery. This will guide the development of new anesthetic compounds possessing fewer side effects. The overall aim is to disentangle the effects of general anesthetics on agonist binding, channel gating kinetics, and agonist-induced desensitization in the best-characterized model ligand-gated ion channel (LGIC), the Torpedo nicotinic acetyicholine receptor (nAcChoR), and to identify the physicochemical features of anesthetics that govern their action on each kinetic step. The overall hypothesis is that general anesthetics act on the nAcChoR in a structurally specific manner because anesthetic binding affinity is strongly influenced by attractive electrostatic and repulsive steric interactions between anesthetics and their protein binding sites. The specific aims are: Aim 1: (1) to test the hypothesis that electrostatic (dipolar, quadrupolar, and/or hydrogen bonding) interactions between general anesthetics and the nAcChoR enhance binding to functionally important sites on this receptor and (2) to identify the kinetic step(s) leading to nAcChoR channel opening that are altered by general anesthetics to determine whether an anesthetic's molecular volume or chemical class governs its action. Aim 2: (1) to test the hypothesis that small general anesthetics increase nAcChoR's rate constant for desensitization by binding to a protein binding site that sterically limits the binding of large anesthetics and (2) to test the hypothesis that general anesthetics stabilize the open channel state and increase the rate constant for desensitization by binding to the same small receptor binding site. The proposed studies will lead to a better understanding of the fundamental interactions between anesthetics and their targets in the CNS and periphery. The nAcChoR was chosen as the experimental model because its function is far better defined than that of any other LGIC, allowing one to interpret anesthetic actions within the framework of a well-established and robust kinetic model. The method used to define anesthetic actions on the nAcChoR is a new rapid sequential mixing stopped-flow fluorescence assay developed and validated by the PI that can assess anesthetic actions on agonist binding, channel gating, and desensitization kinetics without the potentially confounding effects of anesthetic-induced channel blockade. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: GENES THAT REGULATE ETHANOL RESPONSES IN DROSOPHILA Principal Investigator & Institution: Heberlein, Ulrike A.; Associate Professor; Anatomy; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 94122 Timing: Fiscal Year 2001; Project Start 01-FEB-1999; Project End 31-DEC-2003 Summary: A growing body of evidence is emerging from studies in animal and cellular model systems that indicates that the effects of ethanol on a variety of cellular functions are mediated by changes in specific proteins. In these systems, however, it is difficult to establish whether these proteins directly or indirectly mediate ethanol-induced changes in nervous system function. It is therefore important to establish a simple model system for alcoholism that is easily accessible to genetic and molecular analyses. We have recently initiated studies using the fruit fly Drosophila as a potential model system for.alcoholism. Preliminary studies have shown that flies display many of the behaviors observed in humans after both acute and chronic exposure to ethanol. Flies display signs
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of hyperactivity and incoordination, followed by sedation and anesthesia. In addition, flies develop tolerance after single or multiple exposures to ethanol. We propose to generate and isolate Drosophila mutants that have altered responses to ethanol. For this purpose an "inebriometer" has been constructed, which allows the separation of flies with different sensitivity to ethanol. A genetic screen for mutants with increased or decreased sensitivity to an acute ethanol exposure will be carried out. In addition, mutant flies that fail to become tolerant or become excessively tolerant to ethanol will be isolated. Several secondary behavioral assays will be carried out to determine whether the phenotype is ethanol-specific and whether the focus of the mutation is in the central nervous system. Mutations will be mapped to specific chromosomal locations. Some of the genes affected will be isolated and sequenced. These genes will serve as tools to study molecular and biochemical mechanisms underlying ethanol-induced responses, and may in the future serve as genetic markers for alcoholism or targets for potential therapeutic intervention. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: GENETICS, DYSFUNCTION
INFLAMMATION
&
POST-OP
COGNITIVE
Principal Investigator & Institution: Newman, Mark J.; Vice President; Anesthesiology; Duke University Durham, Nc 27706 Timing: Fiscal Year 2001; Project Start 30-SEP-1999; Project End 31-JUL-2004 Summary: Our investigative team has recently discovered a genetic association between late-onset Alzheimer's disease and the apolipoprotein E (APOE, gene; apoE, protein) epsilon-4 gene. This finding has triggered many recent studies showing an important role of apoE in the determination of neurologic injury and recovery following a variety of acute ischemic insults including intracerebral hemorrhage, closed head injury, acute stroke and dementia pugilistica (chronic traumatic brain injury). An important aspect of our work is the finding of an association between APOE4 and neurocognitive decline after cardiac surgery. Although mounting evidence suggests apoE plays a role in acute and chronic neurological disease, the mechanism underlying these observations and the influence of aging is not completely understood. We hypothesize that a genetic predisposition exists for the easily documented neurologic and neurocognitive dysfunction observed after anesthesia and surgery. ApoE may play a role in modulating the inflammatory response to ischemia and perioperative stress. We have recently determined that ApoE, in vivo, modulates the release of nitric oxide and TNFalpha in glial cells. This may compound the autonomic dysregulation that we recently reported in the elderly. The combination of these two factors may modulate an exaggerated inflammatory response increasing the susceptibility to perioperative injury. Our pilot data associating APOE4 with cognitive impairment after cardiac surgery support this hypothesis. Therefore, we propose to determine the association between post-operative neurocognitive dysfunction, neurocognitive recovery, and APOE4 genotype in patients undergoing thoracic and vascular surgery. The unifying hypothesis is that a genetic susceptibility to neurologic dysfunction after surgery results either from a predisposition to immunologic dysregulation, the failure of normal genetically encoded reparative processes, or a combination of these mechanisms resulting in a greater incidence and severity of neurocognitive dysfunction and reduction in quality of life and independence in the aging population after surgery. Thus, our extensive preliminary work as well as our expanded collaborative interdisciplinary research group including cardiac anesthesiologists, cardiac surgeons, neuroscientists, geneticists and neurologists is uniquely able to investigate the genetic predisposition to
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neurocognitive dysfunction after surgery. Such an association is an important first step in elucidating the mechanism underlying genetic susceptibility to ischemic insults, and designing interventional strategies to improve outcome. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: HIGH STRUCTURES
RESOLUTION
FUNCTIONAL
MRI
OF
COLUMNAR
Principal Investigator & Institution: Menon, Ravi S.; Canada Research Chair in Functional Neur; John P. Robarts Research Institute P.O. Box 5015 London, on N6a 5K8 Timing: Fiscal Year 2003; Project Start 27-SEP-2003; Project End 31-JUL-2008 Summary: Revised Abstract: Functional magnetic resonance imaging (fMRI) has become the major tool for examining human brain function in sensory and cognitive neuroscience. Despite this enormous acceptance across many disciplines, fundamental aspects of the fMRI response remain poorly understood in large part because of difficulties in linking studies in animal models under the confounding effects of anesthesia with those done in awake humans. The studies proposed here are aimed at understanding the links between neural activity in the brain, the blood flow, blood volume and blood and tissue oxygenation changes that follow, and the fMRI signal. These experiments will be performed in an awake animal model. Awake animal models have the greatest relevance to human neuroscience, with the major advantage that they still allow minimally invasive multi-modality measurements of electrophysiology, oximetry and flow. Our previous NIH funded high-resolution fMRI data in humans has motivated us to develop a better understanding of the spatio-temporal characteristics of the fMRI signal. The techniques we will use to accomplish this are fMRI (BOLD and AST based), electrophysiology, fluorescence quenching, laser Doppler and near-infrared spectroscopy at high spatial and temporal resolution in a well-characterized animal model. Well-known modular functional organization of the primary visual cortex (V1) offers us a variety of opportunities to explore the source of the fMRI signal. Our fundamental hypothesis is that hemodynamic responses to neural activity are modulated at a sub-millimeter scale in this model brain system. A consequence of this hypothesis is that we would predict that fMRI signals should reflect functional specialization of neurons at the cortical columnar and lamellar level. In order to test our fundamental hypothesis, we propose 6 experiments with the following 3 Specific Aims. Specific Aim 1 will be to optimize fMRI parameters to obtain the highest spatial selectivity and sensitivity of BOLD and arterial spin tagging (AST) in-vivo. Specific Aim 2 will be to determine the spatial extent and temporal dependence of the fundamental underlying physiological quantities that the BOLD and AST signal depends on. Specific Aim 3 will be to use the responses of the quantities measured in Specific Aim 1 and 2 to generate a multi-parametric model that explains the BOLD effect in terms of its underlying physiological parameters. To quantify BOLD and AST resolution of functional domains in the horizontal direction in the cortex, we will examine the physiologic and fMRI responses in ocular dominance columns (ODCs). To quantify the BOLD resolution in the vertical direction (depth) in cortex, we will measure these responses as a function of cortical layer. Electrical activity will be measured using both local field potentials and unit activity using tungsten electrodes. The redox state of the mitochondrial enzyme cytochrome oxidase (Cyt-aa3) in the cells will be measured using a novel near-infrared (NIR) spectrometer of our own design. The partial pressure of oxygen in the tissue (pO2) will be measured using a commercial fluorescence-lifetime fiber optic technique (Oxylite, Oxford Optronix). The concentrations of oxyhemoglobin [HbO] and deoxyhemoglobin [Hbr] will also be measured using NIR spectroscopy
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(NIRS). Blood flow will be measured using a commercial fiber optic laser Doppler flow system (Oxyflow, Oxford Optronix). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: HOMEOSTATIC CONTROL OF AMNIOTIC FLUID VOLUME Principal Investigator & Institution: Davis, Lowell E.; Professor; Physiology and Pharmacology; Oregon Health & Science University Portland, or 972393098 Timing: Fiscal Year 2003; Project Start 01-JUN-2000; Project End 31-MAY-2005 Summary: (Adapted from the Investigator's Abstract) Experiments will be performed on fetal sheep of known gestational ages. Indwelling fetal catheters, flow sensors and amniotic and allantoic fluid catheters will be placed during sterile surgeries under general anesthesia. Hypotheses to be tested include: (l) Urine production, although variable, detracts from, rather than contributes to the control of amniotic fluid volume. (2) Neither lung fluid production, nor drinking of amniotic fluid are necessary for an adequate homeostatic response to abnormal production of amniotic fluid. (3) Fetal swallowing may contribute to amniotic fluid volume regulation even if not necessary in sheep. (4) Reabsorption of amniotic fluid is largely insensitive to electrolyte load. (5) Neither the crystalloid osmotic gradient nor the oncotic gradient between amniotic fluid and fetal plasma are involved in volume regulation. (6) The quantity that is being regulated is amniotic fluid volume, rather than intrauterine volume. (7) The absorptive mechanism permits passage of large quantities of macromolecules, such as plasma albumin, even in the absence of drinking. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: HOST RESPONSE TO POST-OPERATIVE PNEUMONIA Principal Investigator & Institution: Knight, Paul R.; Professor and Vice Chairman; Anesthesiology; State University of New York at Buffalo Suite 211 Ub Commons Amherst, Ny 14228 Timing: Fiscal Year 2001; Project Start 01-JUL-2001; Project End 31-MAY-2006 Summary: (Verbatim from the Applicant's Abstract): Anesthesia/surgery predisposes the patient to develop nosocomial pneumonia by mechanisms that are not completely defined. The presence of a viral respiratory tract infection (RTI) during anesthesia/surgery further complicates the host antibacterial response. Evidence from our laboratory has demonstrated anesthesia/surgery induces changes in cytokine response (e.g., TNFalpha, MIP-2, IFNgamma), leukocyte recruitment, and lung injury to influenza RTI. These responses are also critical to innate host defenses against bacterial pathogens. Our focus is to examine cellular mechanisms during a viral RTI that predispose the host to a post-surgical bacterial pneumonia. We hypothesize that anesthesia/surgery will change host responses differently during distinct periods in the course of a viral RTI by altering expression of pro- and antiinflammatory cytokines, thereby decreasing antibacterial defenses. Aim #1 will assess the effects of anesthesia/surgery during influenza on bacterial clearance, inflammatory cell influx, and cytokine expression an Escherichia coli challenge. We predict that laparotomy during influenza will promote the relative expression of MCP-1 and IL-10 over TNFalpha, MIP-2, and IFNgamma. Aim #2: will assess ex vivo the combined effect of laparotomy and influenza on a) LPS stimulated aMphi cytokine expression and phagocytic activity, and b) the ability of in vitro antiMCP-1, antiIL-10, or IFNgamma administration to improve M dysfunction. We postulate that laparotomy during influenza will alter aMphi regulatory functions and decrease effector functions as a
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result of selective enhancement of expression anti-compared to proinflammatory cytokines. Finally, in Aim #3, we will examine the contribution of endogenous cytokines in the suppression of antibacterial defenses following laparotomy during influenza by selective cytokine manipulations. Bacterial clearance, inflammatory cell influx, and cytokine levels will be assessed. We anticipate that neutralization of IL-10 or MCP-1, administration of IFNgamma, or increased TNFalphaexpression will improve antibacterial host defenses following laparotomy during physical signs of influenza. These studies will examine mechanisms that lead to alterations in bacterial clearance post-surgically following a viral RTI, assess the pathogenesis of post-surgical pneumonia in general, and suggest immune adjuvant strategies to prevent this complication. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: IMPORTANCE OF PERIPHERAL SITES OF ANALGESIC ACTION Principal Investigator & Institution: Collins, J G.; Professor; Anesthesiology; Yale University 47 College Street, Suite 203 New Haven, Ct 065208047 Timing: Fiscal Year 2001; Project Start 01-FEB-1999; Project End 31-JAN-2003 Summary: (adapted from applicant's abstract): The goal of this work is to conduct a systematic study of the ability of centrally acting analgesic agents to produce analgesia by actions on the peripheral nervous system. The study is designed to provide answers to three questions: (1) What peripheral receptor systems among those that modulate pain centrally are capable of producing peripheral analgesia? (2) Is the peripheral analgesia produced by the systems identified as efficacious in the periphery greater or less than the analgesia produced by those same systems within the spinal cord? (3) Are there additive or synergistic peripheral interactions between those systems and between them and low doses of local anesthetics? Studies will be carried out in a behavioral model developed by the investigator which permits testing in both a normal and a hyperalgesic state. A thermal injury to one hind foot is created in a rat under general anesthesia and withdrawal latency to a thermal stimulus tested two hours later. If hyperalgesia, considered as a difference >1.5 sec in withdrawal latency between injured and uninjured paws, is present, the animal is used for analgesia testing twenty-four hours later. Hyperalgesia is again documented at this time. Drug injection into one paw is carried out under halothane anesthesia, which is then discontinued, and latencies to withdrawal measured every 15 minutes after the animal awakens. Latencies of treated and untreated paws are compared to detect systemic versus local analgesic effects. Agents to be tested include agonists at cholinergic, opiate and adenosine A1 receptors, and antagonists at excitatory amino acid, NK1 and adenosine A2 receptors. Attempts will be made to obtain and test new compounds that do not cross the blood-brain barrier. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: IMPROVING SAFETY OF PEDIATRIC SEDATION Principal Investigator & Institution: Lightdale, Jenifer R.; Children's Hospital (Boston) Boston, Ma 021155737 Timing: Fiscal Year 2003; Project Start 01-JUN-2003; Project End 31-MAY-2007 Summary: (provided by the applicant): Children undergoing non-surgical procedures are routinely sedated with either intravenous (IV) sedation or general anesthesia (GA) to ensure their safety, comfort, and cooperation. There are no prediction rules to guide the chief clinical decision as to which children should receive IV sedation and which
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should be referred to GA. Both types of sedation involve life-threatening risks to patient safety from unanticipated pharmacological effects or medical errors. Intolerance of IV sedation represents an additional important safety issue, as many children become highly agitated, risking unnecessary harm. The primary goal of this Mentored Career Development Award is to provide a mechanism for the candidate, a trained pediatric gastroenterologist, to develop skills in patient safety research while studying complex issues of sedation choice and patient safety, using gastrointestinal (GI) endoscopy as a high-volume procedural model. With strong mentorship in patient safety and clinical investigation and in collaboration with a multidisciplinary team that includes experts in research design, prediction rules, gastroenterology, anesthesiology and pediatric psychology, the candidate will: 1) use robust, precise methods to prospectively assess intolerance, other adverse events and medical errors during sedation for GI endoscopy; 2) utilize regression modeling to develop prediction rules to improve the safety of sedation for children undergoing this procedure; and 3) tailor existing taxonomies to classify medical errors associated with IV sedation for GI endoscopy. Primary and secondary outcomes data, including measures of intolerance, other adverse events, and errors related to sedation, will be collected in a large prospective, observational pediatric cohort study. The short term goals of this proposal are to allow the candidate to gain: 1) formal education in the quantitative and qualitative tools necessary for conducting health services research; 2) substantial training in the study of patient safety and improvement strategies for pediatric healthcare; and 3) valuable mentorship required to ensure her progress towards becoming an independent clinical scientist. The long-term goals of this research are to develop prediction rules for determining safe sedation regimens for children undergoing GI procedures that may lead to generalizable improvement strategies for pediatric sedation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: IN UTERO MURINE EMBRYO CV PHENOTYPE SCREENING Principal Investigator & Institution: Keller, Bradley B.; Chief, Division of Pediatric Cardiology; Pediatrics; University of Kentucky 109 Kinkead Hall Lexington, Ky 40506 Timing: Fiscal Year 2001; Project Start 30-SEP-2000; Project End 31-JUL-2004 Summary: (Adapted from the applicant's abstract) All major structural cardiovascular (CV) malformations occur in utero and the genetic "risk" for developing serious CV disease is present at the time of birth. Trained fetal sonographers can now detect major structural defects in the human fetus after 16 weeks gestation in utero. These CV defects then present clinically at varying ages dependent on the degree of functional impairment. The investigators propose to develop, validate, and apply accurate and efficient screening technology to define murine embryo CV phenotype in utero. They also propose to provide an annual workshop for investigators and students to learn basic CV developmental morphology, integrated physiology, and murine embryo screening techniques for use in their laboratories. Most of the technology and applications to define embryonic CV performance in chick and mouse embryos has been developed in their labs. These invasive in vivo and in vitro protocols have provided detailed information on normal CV performance (blood pressure, blood flow, chamber dimensions, vascular impedance), the functional reserve of the normal embryo, and the relationship between altered structure and functional adaptation (Keller 1997, review). Most of these techniques cannot be applied as "screening" technologies, however, they provide the critical foundation for determining "normal" CV structure and function in utero. In addition to their focus on embryonic CV performance, they are now defining the normal hemodynamics and impact of anesthesia and experimental protocols on the
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pregnant mouse due to the direct effect of altered maternal hemodynamic and metabolic state on embryonic CV function. A wide range of altered CV phenotypes have already been produced using targeted genetic and mutagenesis techniques. The most severely affected embryos die in utero from failed vasculogenesis starting at embryo day (ED) 8.5 or failed CV function starting at ED 9.0. Some of these altered CV phenotypes have been detected in utero, however, the accuracy of these studies has varied and there has been no uniform approach to maternal sedation, technical measurement of embryo CV function, or interpretation of hemodynamic results (Dyson 1995, Gui 1966, Huang 1998). It is important to note that heterozygous embryos can also have altered CV phenotype, thus it is critical to detect these embryos during primary screening. They propose to develop standardized methods for embryonic CV phenotype screening in utero and to then train investigators to perform these screens at individual labs or regional centers. (End of Abstract.) Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: INSTRUMENTATION FOR PEPTIDE SYNTHESIS FACILITY Principal Investigator & Institution: Ivanetich, Kathryn; Pharmaceutical Chemistry; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 94122 Timing: Fiscal Year 2003; Project Start 01-APR-2003; Project End 31-MAR-2004 Summary: (provided by applicant): The Health Sciences campus of the University of California at San Francisco is one of the foremost centers of biomedical research in the world. Its Schools of Medicine, Pharmacy, Dentistry and Nursing employ several hundred outstanding investigators who have an exceptional record in achieving NIH awards. The UCSF campus is served by a state-of-the-art biotechnology core facility, the Biomolecular Resource Center (BRC). The BRC has served the UCSF campus since 1985, and fulfills investigators' needs in DNA and peptide sequencing, synthesis, analysis and purification. It is housed in 1,900 sq. ft. of laboratory/office space. Approximately 225 principal investigators have used the facility in the last year. Approximately 190 PIs have had 31,150 DNA templates sequenced, 105 PIs had ca. 3,100 oligonucleotides synthesized, over 30 PIs have had 155 peptides synthesized, and approximately 20 PIs had approximately 50 proteins sequenced. The facility is overseen by a Board of Overseers. Dr. Kathryn Ivanetich is the Director and oversees the day-to-day scientific, financial and administrative aspects of the BRC. Funding is requested for an Applied Biosystems 433A peptide synthesizer, Rainin Symphony Multiplex multiple peptide synthesizer, a Shimadzu analytical and preparative HPLC systems. The instruments are requested to replace outdated and obsolete instrumentation, and to provide increased automation to provide peptide synthesis, analysis and purification quickly, inexpensively and reliably to UCSF investigators. This request is supported by eleven UCSF Principal Investigators with considerable, ongoing PHS/NIH grant support. These PIs represent 8 UCSF departments, including Biochemistry and Biophysics, Medicine, Anatomy, Microbiology and Immunology, Physiology, Anesthesia, and Laboratory Medicine, plus the Cardiovascular Research Institute. The requested instrumentation would be a truly shared resource. No single investigator, group of investigators or department would dominate its use. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: MAPPING THE ALCOHOL SITE OF A NEURONAL POTASSIUM CHANNEL Principal Investigator & Institution: Covarrubias, Manuel L.; Assistant Professor; Pathology, Anat/Cell Biology; Thomas Jefferson University Office of Research Administration Philadelphia, Pa 191075587 Timing: Fiscal Year 2002; Project Start 01-JAN-1997; Project End 31-MAR-2005 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: MECHANISMS OF POST-ANESTHETIC CNS DYSFUNCTION IN AGING Principal Investigator & Institution: Crosby, Gregory J.; Brigham and Women's Hospital 75 Francis Street Boston, Ma 02115 Timing: Fiscal Year 2003; Project Start 01-APR-2003; Project End 31-MAR-2007 Summary: (provided by applicant): "Healthy" aging is associated with widespread changes in the CNS that include alterations in neurotransmitter systems, synaptic plasticity, and hippocampal neurogenesis. These changes make the aged brain more "fragile" and may account for development of age-related cognitive dysfunction. Elderly patients frequently require surgery and anesthesia but may suffer prolonged cognitive impairment as a result. However, the mechanisms involved are unknown and the role of anesthetic agents is unclear. Using a well-established behavioral model, we have demonstrated that an uncomplicated general anesthetic with isoflurane-nitrous oxide produces long-lasting impairment in memory for an established spatial task in aged rats and isoflurane alone disrupts the ability of young and old rats to learn a new task. Moreover, these changes are associated with reduced phosphorylation of a nuclear protein involved in memory, a decrease in a dendritic marker of synaptic plasticity, and an increase in neurogenesis in young adult rats but no change or a decrease in aged rats. This suggests that general anesthesia could be a factor in human postoperative cognitive dysfunction and that anesthetic-induced changes in memory processing may explain the impairment. The objectives of this proposal are to characterize the mechanisms of anesthesia-related cognitive impairment and to define the neurobiological basis of it. We will use selective anesthetic and non-anesthetic agents to manipulate GABA and glutaminergic tone, in conjunction with behavioral testing and neurochemistry, to systematically investigate the relationship between prolonged postanesthetic changes in spatial memory and alterations in cholinergic neurotransmission, synaptic plasticity, and neurogenesis. From this analysis, we expect to be able to draw inferences about whether post-anesthetic impairment is a function of the receptor characteristics of the agents, an imbalance between excitatory and inhibitory neurotransmission, or the state of anesthesia. We will investigate mechanisms of prolonged post-anesthetic learning impairment by examining relationships between anesthetic pharmacology, age, and mediators or makers of learning and memory. As such, these experiments will clarify how general anesthesia produces persistent cognitive impairment in aging, enhance understanding of anesthetic effects on memory, and potentially lead to methods to mitigate the cognitive morbidity associated with anesthesia and surgery. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: MICROENVIRONMENT OF THE RETINA Principal Investigator & Institution: Linsenmeier, Robert A.; Professor; Biomedical Engineering; Northwestern University 633 Clark St Evanston, Il 60208 Timing: Fiscal Year 2002; Project Start 01-JUL-1983; Project End 31-JUL-2007 Summary: (provided by applicant): The long-term objectives of this work are to understand aspects of the retinal microenvironment related to oxygen and pH, and how these relate to energy metabolism and function of the mammalian retina in vivo. While this work will be done in animals, it is particularly relevant to blinding diseases that affect the relationships between the circulation and retinal neurons in humans. During the next project period, our main interests are in diabetic retinopathy, retinal detachment, and retinal arterial occlusive disease. However, the results will also provide fundamental information that may be relevant to other types of retinal dysfunction. The proposed work will be done primarily on intact anesthetized cats, since their retina provides a good model for much of the human retina. The techniques are primarily to use oxygen and pH sensitive microelectrodes to map out retinal oxygen levels, pH and electrical activity (the electroretinogram) with high spatial and temporal resolution, as we have done previously under other experimental conditions. Following the measurements, mathematical modeling of diffusion will be used to extract metabolic parameters that are not apparent from the measurements alone, and to perform simulations of situations that may not be amenable to experimentation. Some measurements of retinal histology will also be made. The project has 5 specific aims. 1) We will study intraretinal oxygenation following photocoagulation, because the mechanism by which photocoagulation blocks neovascularization is still unclear. 2) We will use information about oxygenation after photocoagulation from specific aim 1 to create an appropriate two-dimensional diffusion model of this situation, with the hope of providing a better rationale for the density and size of lesions designed to treat retinopathy. 3) We will study retinal oxygenation in the detached retina in order to understand the basis for the protective effect of hyperoxia in retinal detachment, which has been shown recently in cats. 4) We will study pH after retinal arterial occlusion, to understand the potential role of acidosis in damaging the retina. 5) We will investigate the influence of anesthesia on the metabolic measurements we make, and will study metabolic differences between the cat and primate retinas. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: MICROVASCULAR HEMOGLOBINS
EFFECTS
OF
SURFACE
DECORATED
Principal Investigator & Institution: Intaglietta, Marcos; Chairman of Board of Trustees; Yeshiva University 500 W 185Th St New York, Ny 10033 Timing: Fiscal Year 2002; Project Start 05-AUG-2002; Project End 31-JUL-2007 Summary: (provided by applicant): We propose to determine the mechanisms that cause vasoconstriction when cell free hemoglobins are introduced into the circulation as the O2 carrier of an O2-carrying plasma expander (OCPE) by studying the vascular effects produced by polyethylene glycol (PEG) surface decorated hemoglobins (HbS) developed in this program. We will study the presser response to top loads of various formulations and quantify the reactions of the microcirculation in the hamster skinfold model, which can be studied without anesthesia, in the awake condition for periods of up to 2 weeks. The principal microvascular parameters to be evaluated in vivo are functional capillary density and intravascular oxygen tension distribution. Tests will analyze different hypothesis on the genesis of vasoactivity due to molecular hemoglobin
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in the circulation, namely: 1) NO scavenging by hemoglobin; 2) lowered viscosity in hemodilution, leading to lowered shear stress and production of endothelial relaxing factors; 3) Increased facilitated diffusion and O2 autoregulation by oxyhemoglobin; and, 4) Extent of hemoglobin surface shielding by PEG molecules. Efficacy of the OCPEs will be determined in conditions of isovolemic hemodilution and hemorrhagic shock. An effective OCPE must also insure sufficiently elevated blood viscosity, which is necessary for the maintenance of adequate microvascular function, and condition that can be obtained with PEG-Hbs. In hemodilution these molecules increase plasma viscosity, causing redistribution of hydraulic pressure in the circulation, decreasing systemic viscosity dependent pressure losses and increasing peripheral resistance. Additionally the O2 dissociation curve for these modified hemoglobins should be left shifted, so O2 release occurs only in anoxic regions and not from arterioles and where tissue oxygenation is adequate. Our goal is to obtain an understanding of vasoactivity in support of OCPE development that prioritizes maintenance of microvascular function in terms of capillary perfusion, which is as critical for tissue survival as adequate oxygenation, by using methods for the analysis at the cellular microscopic level, where blood performs its vital functions. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: MOLECULAR ACTIONS OF VOLATILE ANESTHETICS ON GPROTEINS Principal Investigator & Institution: Rebecchi, Mario J.; Associate Professor; Anesthesiology; State University New York Stony Brook Stony Brook, Ny 11794 Timing: Fiscal Year 2001; Project Start 01-FEB-2000; Project End 31-JAN-2004 Summary: (adapted from applicant's abstract): Volatile anesthetics perturb the coupling of metabotropic receptors to specific heterotrimeric guanine nucleotide-binding proteins (G-proteins), but the relevance to anesthesia and its molecular basis are not understood. Heterotrimeric G-proteins, consisting of alpha, beta, and gamma subunits, are GTPdriven molecular switches that couple metabotropic receptors to downstream effectors, including ion channels. In the inactive state, the G-protein is a heterotrimer with GDP tightly bound to the Galpha subunit. Binding of agonist to the receptor triggers exchange of GTP for bound GDP, hydrolyzing the former in the presence of Mg2+. The GTP-charged alpha subunit dissociates from betagamma and may be free to diffuse some distance on the membrane surface. Either the alpha subunit bound to GTP or the free betagamma heterodimer or both regulate effector enzymes such adenyl cyclase (AC) and phospholipase C, or modulate ion channels, thereby amplifying the initial receptor stimulus. Thus, alpha subunits function as on/off switches based on the occupant of the nucleotide binding site, GTP or GDP, such that alterations in nucleotide exchange, like those induced by volatile anesthetics, modulate signal output. To test for correlation between clinical potency and inhibition of GDP/GTP exchange, various anesthetic compounds, as well as non-immobilizing drugs, will be tested on Galpha subunits. Similar experiments will be performed on living cells in which the pathways are reconstructed by expression of the signaling components: receptors, G-protein subunits and effectors. The hypothesis that volatile agents disrupt receptor/effector coupling by locking the Galpha subunit into a complex with Gbetagamma will be tested on artificial membranes by measuring the lateral interactions of these proteins using fluorescence resonance energy transfer. To understand the molecular basis of the anesthetic effect, intrinsic fluorescence and isothermal titration microcalorimetry will be used to measure the binding of these drugs to soluble Galpha subunits. Finally, regions essential to the actions of anesthetics will be established by swapping homologous
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portions of sensitive and insensitive alpha subunits. These studies will generate predictions for future experiments to be conducted on animals exposed to anesthetic agents. Completion of the proposed study will also form the basis for future crystallographic work on the nature of interactions between anesthetics and these potential protein targets. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: MULTICENTER NETWORK OF MATERNAL-FETAL MEDICINE UNITS Principal Investigator & Institution: Ramin, Susan M.; Associate Professor with Tenure; Ob, Gyn and Reproductive Scis; University of Texas Hlth Sci Ctr Houston Box 20036 Houston, Tx 77225 Timing: Fiscal Year 2001; Project Start 01-APR-2001; Project End 31-MAR-2006 Summary: The Division of Maternal-Fetal Medicine at the University of Texas- Houston Medical School has a major commitment to evidence-based medicine and the performance of randomized clinical trials. Members of this division have experience in performing such trials in the areas of corticosteroids for fetal maturation, preterm premature rupture of the membranes, effects of anesthesia/analgesia in labor and method of delivery, and obstetrical infections. There is an established clinical research unit in place, including a research coordinator, data management systems, personnel, facilities and equipment. There is more than an adequate population base to perform randomized clinical trials and this obstetric population base is diverse in socioeconomic, racial and ethnic character. There is a very large obstetric network, which provides a large number of high-risk pregnancies to further support the performance of randomized clinical trials. The Division of Maternal-Fetal Medicine has both the capability and University support to provide protected research time, as well as the capability, desire and commitment to work with other centers in collaborative research regarding pregnancy outcome. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: MULTICHANNEL DEEP BRAIN STIMULATION SYSTEM Principal Investigator & Institution: Larsen, Hugh G.; Advanced Bionics Corporation 12740 San Fernando Rd Sylmar, Ca 91342 Timing: Fiscal Year 2002; Project Start 15-AUG-2002; Project End 31-JUL-2007 Summary: (provided by applicant): This proposal is submitted in response to RFA-NS02-004 (Technology development for safe and effective deep brain stimulation). We have addressed Research Objective #3, "The development of stimulators that are rechargeable and/or that have a wider range of stimulation rates, stimulation currents, pulse widths, pulse waveforms, and that permit recording from electrodes as well as stimulation." 1) We will develop a stimulator for deep brain stimulation that is rechargeable and that has a wider range of stimulation rates, stimulation currents, and pulse widths than any other available system. This development will include the external recharger and the tools required to program the stimulator. 2) We will develop a stimulator for deep brain stimulation with the above capabilities that can be mounted in the skull, thereby obviating the need to tunnel a lead through the neck. This allows implantation of the DBS system without the need and the attendant risks of general anesthesia, and this reduces the risk of lead fracture or breakage by avoiding passage of the lead through the highly mobile neck area. 3) We will develop a stimulator for deep brain stimulation that includes sensing of the electrical activity of neurons. This system may use the
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stimulation electrodes for sensing or may incorporate separate recording electrodes integrated with the stimulation electrode array. The system may also be configured with a connector for a separate recording lead that may be place in a part of the brain that is relatively far removed from the area of stimulation. 4) We plan to make the above stimulators available to members of the NIH Deep Brain Stimulation (DBS) consortium as well as other DBS researchers for research and testing. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: MULTIPLE MOUSE MR IMAGING (MMMRI) Principal Investigator & Institution: Henkelman, R Mark.; Hospital for Sick Chldrn (Toronto) 555 University Ave Toronto, Timing: Fiscal Year 2003; Project Start 20-SEP-2003; Project End 31-JUL-2008 Summary: (provided by applicant): Understanding the role of human genes in normal development and in disease will be accomplished primarily in the mouse which has a remarkable 99% gene overlap with the human. Finding and identifying human diseases is crucially dependent on medical imaging. Finding and monitoring comparable diseases in mice will be just as crucially dependent on mouse imaging. It is, therefore, important to adapt the range of human imaging modalities to the scale of the mouse where possible. This application proposes to adapt magnetic resonance imaging (MRI) to the mouse and to solve the through put bottleneck by imaging multiple mice (MMMRI) in parallel in the same magnet. This will increase throughput 19 fold. Implementation of MMMRI requires solving issues of RF coil interference, simultaneous data acquisition, large data reconstruction, handling, anesthesia and monitoring of multiple mice, and motion correction methods. After the MMMRI has been developed and tested, its use will be demonstrated in primary screening of NU mutagenized mice, characterizing normal ranges of anatomical variations in inbred strains of mice, detailed mapping of the structures of excised organs (brain and heart), and following the time course of cancer progression in mouse models of brain tumors. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: NATURAL HISTORY AND TREATMENT OUTCOME IN BRAIN AVM Principal Investigator & Institution: Mohr, Jay P.; Sciarra Professor; Neurology; Columbia University Health Sciences New York, Ny 10032 Timing: Fiscal Year 2001; Project Start 15-SEP-2001; Project End 31-JUL-2006 Summary: Brain arteriovenous malformations (AVMs) have been the subject of a 15year study at our institution. Our first efforts were to identify factors predictive of postoperative perfusion- breakthrough hemorrhage, then of cerebral 'steal', and more recently of risk factors predicting first and recurrent hemorrhage, single-center treatment study including quantitation of 'eloquence', and most recently a populationbased prospective collection of AVM incidence hemorrhage and estimates of outcome and efforts to developed a world-wide study of this complex low- frequency illness. The current proposal is, in part, a continuation of work funded by prior RO1s, mainly NS34747 relocated as of 1-Jan-2000 to Univ Calif San Francisco by the our long-term collaborator PI, WL Young, now a newly-chaired Professor of Research Anesthesia there, but also a change in focus and extension into new areas which we believe justifies our application for new funding. Dr Young's plans for an AVM project in San Francisco should lead to the development of another project which we hope can eventually lead to a bi-coastal effort. Three proposals are made. Specific aim 1 is a population-based
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acquisition of the incidence of AVM hemorrhage, its morbidity, and mortality drawn from the roughly 9,000,000 population in the `New York Islands' (Manhattan, Staten Island, and Long Island - including Queens, Brooklyn, and Nassau and Suffolk Counties), a study begun within the last year. The feasibility has been tested, the goals expanded, and data collection is well under way. The results are expected to provide useful assessments for AVM hemorrhage to permit better decisions for treatment versus conservative follow-up, and allow estimates of comparative costs of each of the current management plans. Specific aim 2 is to bring to fruition our worldwide web site for AVMs. The initial steps taken with colleagues from 19 countries to date has revealed the need for consensus on the interpretation of AVM imaging, planned for its first meeting in Feb-2000. Following consensus, centers whose population-based capabilities (i.e., Singapore, a population of 4,000,000 served by three hospitals some of whose staff members trained with us) will provide a means to test the risk factors for hemorrhage created from our referral-based Columbia center and identify possible other factors not represented in our data base. The findings will also test our current center-based data for the morphologic imaging characteristics of AVM in predicting hemorrhage. The two preceding aims should permit estimates for the formulation of a clinical trial, but we cannot promise the organization of a trial until more complete data available. Specific aim 3 is our proposal for a single-center treatment study, including more intensive studies of 'eloquence', a term in current use to decide suitability for treatment, but one based on largely-outmoded concepts of anatomical-clinical correlations. The methods employed are on-the-table assessments of cerebral function derived from Behavior Science principles and undertaken with local anesthesia challenges using agents with differential effects on brain white and gray matter. The results are improving the prediction for short- and long-term outcome for embolization and surgery. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: NEURAL CORRELATES OF MEMORY FMR IN HUMAN CORTEX. Principal Investigator & Institution: Ojemann, George A.; Professor; Neurological Surgery; University of Washington Seattle, Wa 98195 Timing: Fiscal Year 2003; Project Start 20-SEP-2003; Project End 31-JUL-2007 Summary: (provided by applicant): The overall aim of this proposal is to establish the relationships between changes in BOLD signals obtained with functional magnetic resonance imaging (fMR) and changes in activity of neurons during the same cognitive measures, at the same sites, in the same subjects in human association cortex. The proposal utilizes a unique clinical opportunity, patients undergoing surgery for epilepsy with a technique where they are awake under local anesthesia for a portion of the operation. In that context we have previously recorded neuronal activity, both action potentials (AP) and overlying electroencephalogram (ECoG) from lateral temporal association cortex during recent verbal memory, finding that a substantial proportion of neurons changed the frequency of AP activity with that task. Both the fMR literature and our preliminary fMR data show fMR changes in lateral temporal cortex with recent memory measures. Having developed a recent verbal memory measure suitable for both fMR and intraoperative recording, we propose investigating the spatial and temporal relation between AP, local field potential (LFP), ECoG and fMR. Hypotheses to be tested include a closer relation between fMR and LFP than AP activity, based on findings reported from nonhuman studies, and specificity of fMR changes to sites with sustained patterns of AP activity during memory. These studies provide a unique window into how neural activity is reflected in changes in BOLD fMR during higher-level cognitive measures.
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Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: NEUROMUSCULAR BLOCKER-INDUCED ASTHMA DURING ANESTHESIA Principal Investigator & Institution: Emala, Charles W.; Anesthesiology; Columbia University Health Sciences New York, Ny 10032 Timing: Fiscal Year 2003; Project Start 01-APR-2003; Project End 31-MAR-2007 Summary: (provided by applicant): Rapacuronium, a new rapidly acting nondepolarizing neuromuscular blocking drug, was released for use in 1999. It was developed specifically to facilitate tracheal intubation during the induction of general anesthesia, but has been associated with life threatening bronchospasm. At least five patients have died and the drug was recently withdrawn from clinical use. The mechanism underlying this airway constriction is not currently known. Possible mechanisms include histamine release, cholinesterase inhibition, M3 muscarinic receptor agonism and M2 muscarinic receptor antagonism. It is extremely important that we understand the mechanism by which this drug induces airway constriction to prevent this from ever occurring again with newly introduced neuromuscular blocking agents. A safe and effective ultra-short acting nondepolarizing neuromuscular blocker is urgently needed for routine clinical use, and until one is found the search will continue. We hypothesize that neuromuscular blocking agents that have selective M2 antagonistic properties potentiate parasympathetic release of acetylcholine mediating bronchoconstriction. During intubation of the trachea, parasympathetic nerves release acetylcholine that act on M3 muscarinic receptors on airway smooth muscle to promote bronchoconstriction. Preliminary data generated from this proposal strongly suggest that the mechanism by which rapacuronium induced fatal bronchospasm is by selective inhibition of M2 muscarinic receptors. We will use in vivo and in vitro approaches to define the mechanism of neuromuscular blocking agent-induced potentiation of bronchoconstriction. Neuromuscular affinities for M2 and M3 muscarinic receptors will be defined by radioligand binding and functional assays (adenylyl cyclase and inositol phosphate assays). Neuromuscular blocking agents effects on acetyl cholinesterase activity will also be measured. The ability of neuromuscular blocking agents to enhance acetylcholine release from parasympathetic nerves will be measured using guinea pig trachea in organ baths. The ability of neuromuscular blocking agents to potentiate vagal nerve mediated bronchoconstriction or to increase airway pressure via histamine release will be measured in vivo using a well-characterized guinea pig model. This mechanism needs to be clearly characterized so that it can serve as a gold standard screen for new agents developed for clinical practice. It is imperative that the mechanism of neuromuscular blocking agents potential to induce bronchospasm be understood so that the millions of patients who undergo general anesthesia on a yearly basis are not subjected to unnecessary life threatening bronchospasm. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: THALAMUS
NEUROTRANSMITTER
ACTIONS
IN
NEOCORTEX
AND
Principal Investigator & Institution: Mccormick, David A.; Neurobiology; Yale University 47 College Street, Suite 203 New Haven, Ct 065208047 Timing: Fiscal Year 2001; Project Start 01-APR-1988; Project End 31-MAR-2005 Summary: adapted from applicant's abstract): Neuronal activity in the cerebral cortex underlies sensory processing, learning and memory, sleep, and the generation of
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epileptic seizures. These tasks are diverse, yet depend upon the operation of the same local and global neuronal networks in the neocortex. Investigations of the neurophysiological basis for these different properties of cortical function have recently begun to merge together into a unified understanding of the operation of local and longrange cortical networks. Our advance in knowledge of cortical function, however, is limited in part by the ability to directly address the cellular mechanisms of operation of these circuits. In vitro studies have traditionally been limited to the analysis of the properties of single cells and synapses. Circuit activity in the neocortex has been restricted to activity generated in response to artificial electrical stimulation of afferent pathways or the administration of convulsants or epileptic conditions. We have recently discovered an in vitro neocortical slice preparation that spontaneously generates normal network activity. Traditionally, the extracellular solution in slice medium contains abnormally high levels of Ca2+ and Mg2+ in order to foster stability of intracellular recordings. By changing extracellular levels of these ions to match that occurring in vivo, we have obtained slices of neocortex that generate periods of persistent activity of 0.75-1.5 seconds in duration and that recur once every 2-5 seconds. This pattern of activity is nearly identical to that occurring in vivo during periods of slow wave sleep and anesthesia, and underlies the generation of the so-called "slow oscillation." We have recorded this pattern of activity in layers Il-VI of neocortical slices from both occipital and prefrontal cortical areas and found that it associated with a synchronous depolarization of all cortical neurons (pyramidal and non-pyramidal) that is mediated by recurrent network excitation and inhibition. Alteration in the balance of excitation and inhibition result in the generation of epileptiform activity resembling interictal spikes and electrographic seizures. In this application, we propose to examine the precise cellular and network mechanisms by which local cortical networks generate this pattern of recurring persistent activity and how this activity may be modulated by the administration of neuromodulatory transmitters. Specifically, we will address both the mechanisms of generation of the depolarized and hyperpolarized states of activity in cortical neurons, as well as the mechanisms by which the activity propagates throughout the network. We hypothesize that this activity is generated as a natural consequence of recurrent excitation and inhibition and divergent and convergent connections in local cortical networks, interacting with intrinsic membrane properties, particularly those underlying adaptation. By understanding the mechanisms by which local cortical networks generate rhythmic periods of sustained activity, we expect to gain in sight into the mechanisms of EEG generation during sleep, the generation of persistent activity during short term memory formation, the operation of local cortical circuits in sensory processing, and the generation of some forms of epileptic seizures. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: NMR STUDIES OF MECHANISMS OF GENERAL ANESTHESIA Principal Investigator & Institution: Xu, Yan; Associate Professor; Anestheslgy/Critical Care Med; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2001; Project Start 01-JAN-1995; Project End 31-DEC-2003 Summary: The molecular mechanisms of action of general anesthetics remain an enigma. A superfamily of ligand-gated ion channels has been implicated as the primary target sites for general anesthetics. It has become increasingly clear from our own and other studies that amphiphilicity in regions near the membrane interface is a unifying property of anesthetic binding site(s). Thus, general anesthetics, but not nonimmobilizers (nonanesthetics), have been shown to target amphiphilic interfacial
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residues of transmembrane channel peptides, and point mutations in the transmembrane domains II and III (TM2 and TM3) of glycine and gamma- aminobutyric acidA (GABAA) receptors can completely abolish or even reverse the sensitivity of these receptors to alcohol and general anesthetics. Complete and detailed elucidation of the structure-function relationship will dramatically advance our understanding of general anesthetic action beyond what was even imaginable in the recent past. This competitive renewal will quantify specific interactions of strategically selected pairs of general anesthetics and nonimmobilizers with the TM2 and TM3 domains of the alpha1 subunit of human glycine receptors (GlyR). State-of-the-art protein expression and purification techniques will be coupled with high-resolution and solid-state nuclear magnetic resonance (NMR) spectroscopy, circular dichroism (CD), and molecular dynamic simulations to accomplish three specific aims: (1) To express the wild-type and mutated TM2 and TM3 segments of GlyR alpha1 subunit for structural study by NMR. (2) To determine, at or near atomic resolution, the structures of the functional TM2 and TM3 segments of the human GlyR alpha1 subunit and the associated anesthetic-insensitive mutants. (3) To investigate the structural motifs contained in TM2 and TM3 for general anesthetic binding, and to quantify the effects of general anesthetic binding on channel dynamics within the determined structural frame, thereby elucidating the structural requirement that controls the channel sensitivity to general anesthetics. The long-term goal is to relate the structural events to functional changes caused by general anesthetics, paving the way for future in vivo and other studies to finally identify the sites of action of general anesthetics in the central nervous system. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: NO SIGNALING IN MECHANISMS OF ANALGESIA AND ANESTHESIA Principal Investigator & Institution: Johns, Roger A.; Professor; Anesthesiology/Crit Care Med; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2001; Project Start 01-MAY-1993; Project End 31-MAY-2004 Summary: The long-term goal of this research program is to understand the regulation of the NO signaling pathway and its role in the mechanisms of anesthesia and analgesia. PSD-95/SAP9O is one of a family of proteins recently shown to physically link other proteins (e.g. NMDA receptor and neuronal NO synthase) together into macromolecular structures via PDZ domain interactions at the synapse. This proposal is focused on the interaction of PSD-95/SAP90 with the excitatory neurotransmitter-NO signaling pathway in spinal analgesic and anesthetic mechanisms. We have made the novel discovery that the PSD-95/SAP9O protein interacts with both NMDA receptors and neuronal NOS in the spinal cord, and that suppression of the expression of PSD95/SAP90 protein both significantly attenuated spinal hyperalgesia triggered by NMDA receptor activation and reduced the requirement for inhalational anesthetics. The current proposal seeks to further define the role of PSD-95/SAP90 in spinal analgesia and anesthesia, to understand the molecular mechanisms of spinal analgesia resulting from suppressing PSD-95/SAP90 expression, and to further determine the molecular mechanisms of interaction of inhalational anesthetics with the excitatory neurotransmitter-NO signaling pathway. This proposal will determine whether suppression of the expression of PSD-95/SAP90 affects the development of hyperalgesia in formalin and neuropathic models of pain, and the responses of spinal dorsal horn neurons to noxious stimulation. Ultra structural localization of PSD- 95/SAP90 and its synaptic relationship with glutamate, neuronal NOS and GABA in the spinal cord will be determined in order to define synaptic mechanisms of PSD-95/SAP90's action. The
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effect of suppressing PSD- 95/SAP90's expression on the NO-cGMP signaling pathway via NMDA receptor activation in the spinal cord will be investigated to define whether the NO signaling pathway is one of the downstream pathways by which PSD-95/SAP90 couples NMDA receptor activity to spinal cord pad mechanisms. To further define the role of PSD-95/SAP90 in the anesthetic state, studies will be performed to observe dosedependent changes in requirement for inhalational anesthetics and in locomotor activity in rats with a deficiency of PSD-95/SAP90 expression. The molecular effect of inhalational anesthetics on the PDZ domain interaction between PSD- 95/SAP90 and NMDA receptors of neuronal NOS will be investigated to elucidate the mechanism of anesthetic inhibition of the NO signaling pathway. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: OPTICAL IMAGING OF TACTILE INFORMATION IN SI CORTEX Principal Investigator & Institution: Roe, Anna W.; Associate Professor; Psychology; Vanderbilt University 3319 West End Ave. Nashville, Tn 372036917 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-JUL-2008 Summary: (provided by applicant): This proposal aims to study the stability of cortical representation by examining cortical maps under different states of anesthesia and alertness (pentothal and isofluane anesthesia, and awake state). Previous studies have hypothesized that different parts of single thalamocortical arbors have different degrees of dominance in Area 3b and that the effects of these secondary arbor inputs may be masked under some conditions and revealed under others. Using optical imaging and electrophysiological methods, we will probe this hypothesis by examining three aspects of finger pad representation in Area 3b and Area 1 of the squirrel monkey: topography, vibrotactile information (pressure SA, flutter RA, and vibration PC), and spatial integration (two digit). We will examine whether digit representation can, in contrast to the standard somatotopic maps, take on non-topographic organizations that are characterized by hotspots and secondary activation zones. We will examine whether SA, RA, and PC inputs can map in both overlapping and segregated manners in the superficial layers. To examine spatial integration in Area 3b and 1, we will examine whether mapping with simultaneous two-finger stimulation paradigm will result in an apparent shift in topography, and whether such a shift is more pronounced in Area 1 and more pronounced in the awake state. These examinations of alternative and shifting topographies are likely to modify the definition of topographic organization in SI and what shifting topographies are likely to modify the definition of topographic organization in SI and what topographic organization is used for in the awake animal. Furthermore, these studies may reveal that the establishment of topography is areaspecific and is based on a stimulus-driven or behavior-driven integration of features rather than a simple representation of the sensory epithelium. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: PALLIATIVE CARE FELLOWSHIP Principal Investigator & Institution: Abrahm, Janet L.; Dana-Farber Cancer Institute 44 Binney St Boston, Ma 02115 Timing: Fiscal Year 2003; Project Start 25-AUG-2003; Project End 31-MAR-2008 Summary: (provided by applicant): As the IOM reports in 1997 and 2001 document, there is a paucity of trained experts, educators, and researchers in palliative and end-oflife care. Physicians therefore lack expertise in palliative medicine, do not acquire the needed communication and self-reflection skills, and do not know how to work as
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members of an interdisciplinary team. They are unable to ameliorate the suffering of patients during active antineoplastic therapy; relieve the psychological, spiritual, and physical distress of patients who stop responding to chemotherapy agents; assist patients and their families in defining and achieving their last goals; or provide bereavement support for the survivors. This proposal describes a continuation and expansion of the previously funded year-long fellowship program in palliative and endof-life care. Using the resources of Harvard Medical School, the Dana-Farber Cancer Institute, the Brigham and Women's Hospital, the Children's Hospital of Boston, a longterm care facility, and a community hospice, we now hope to train physicians who wish to become role models, educators, and researchers in adult or pediatric palliative medicine and end-of-life care. Training will include an adult and a pediatric tract, each with closely mentored didactic and clinical training. Required didactic training includes an introductory palliative care lecture series, palliative care grand rounds, and monthly palliative care seminars and journal club. Fellows will also be trained as palliative care educators. Fellows will receive the bulk of their clinical training as members of interdisciplinary palliative care and psychosocial oncology consult teams, and as members of a hospice team. Fellows will follow patients across treatment settings (inpatient, outpatient, home, and hospice). Other adult training sites include Anesthesia Pain Clinic, a geriatric long-term care facility, advanced cardiac/pulmonary disease or ALS clinics, the ethics committee, and chaplaincy service. For qualified fellows, a research elective is available. The fellow's progress will be formally assessed with tools designed to measure attitudes and knowledge; the fellowship director will closely monitor fellow skill development by personal observation and by discussion with other preceptors. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: PATHOPHYSIOLOGIC RESPOSE TO FETAL CARDIAC SURGERY Principal Investigator & Institution: Hanley, Frank L.; Surgery; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 94122 Timing: Fiscal Year 2001; Project Start 01-FEB-1992; Project End 31-MAR-2002 Summary: The goal of this ongoing project is to continue the development of fetal cardiac surgery. Certain congenital defects are uncorrectable after birth and there is a clear advantage for intrauterine corrective surgery. This approach requires an understanding of the physiological effects of surgical intervention and extracorporeal circulation on the fetus. Our work in this area to date has allowed us to gain a substantial but incomplete understanding of these issues. The three major pathophysiological responses which limit fetal survival following intervention and extracorporeal circulation (which we identified in the original grant proposal) include: 1. The loss of fetal cardiovascular homeostasis in the pre-bypass phase of fetal intervention. 2. The "step function" rise in fetal vascular resistance at the institution of fetal bypass which is associated with acute decompensation. 3. The gradual rise in placental vascular resistance during and after fetal bypass which results in depressed placental blood flow. The specific focus of this project remains as stated in the original proposal, to identify the mediators and detailed pathophysiologic mechanisms of these three responses with an eye towards clinical application of this information to advance the development of human fetal cardiac surgery. Each of the three responses will be systematically evaluated. Experiments examining the pre-bypass problem will focus on the role of the fetal stress response. Further understanding of this response is presently limited by our fetal animal model (sheep). We propose to study the efficacy of narcotic anesthesia in blunting the stress response in an instrumented primate model.
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Experiments addressing the 'step function' rise in fetal vascular resistances will examine the inhibition of this response using specifically designed bypass circuitry. Our methodology will include ultrasonic flow transducers to continuously measure instantaneous changes in organ flow in addition to our more specific microsphere techniques, which do not have this capability. In recognition of the multiple factors effecting the placental vasculature, experiments addressing the gradual rise in post bypass placental resistance will examine the role of placental vascular dysfunction in addition to the role of eicosanoids. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: PHARMACOLOGY OF ANESTHETICS IN HEMORRHAGIC SHOCK Principal Investigator & Institution: Johnson, Ken B.; Anesthesiology; University of Utah 200 S University St Salt Lake City, Ut 84112 Timing: Fiscal Year 2001; Project Start 01-AUG-2000; Project End 31-JUL-2003 Summary: Anesthesiologists have long recognized the need to reduce the dose of intravenous anesthetic for patients who suffer significant blood loss before or during surgery. The scientific foundation upon which to base rational dosing regimens, however, does not exist. In the setting of hemorrhagic shock, intravenous agents can produce adverse hemodynamic consequences and prolonged duration of anesthetic effect. The absence of a scientific foundation to guide the rational selection and administration of intravenous anesthetics during shock represents a huge gap in the anesthesia clinical pharmacology literature. The goal of this grant is to investigate the influence of hemorrhagic shock and fluid resuscitation on the pharmacokinetic and pharmacodynamic properties of a short and long acting opioid, neuromuscular blocker, and sedative-hypnotic. The specific aims of this proposal are to characterize the influence of hemorrhagic shock and crystalloid resuscitation after hemorrhagic shock on the pharmacokinetic and pharmacodynamic profile of intravenously administered opioids, muscle relaxants, and sedative hypnotics. With this data, combined pharmacokinetic/pharmacodynamic models for each agent studied under normotensive, shocked, and resuscitated conditions will serve as a tool to explore how dosing can be adjusted to optimize the desired effect while minimizing the adverse consequences of over or under dosing. The principal investigator has had preliminary research experience in the areas of pharmacokinetic and pharmacodynamic analysis and the pathophysiology of hemorrhagic shock. The principal investigator has selected a mentor with (i) extensive research training in clinical pharmacology and (ii) a willingness to dedicate time and resources to ensure appropriate clinical research training. This grant will enable the principal investigator to expand his expertise in high resolution pharmacokinetic/ pharmacodynamic analysis and apply it to the study of how hemorrhagic shock influences the clinical pharmacology of intravenous anesthetics. Career development associated with this grant will include presenting results at national meetings, submission of results to peer reviewed journals for publication, and participation in courses and workshops related to the proposed study. The proposed studies will be carried out in the Department of Anesthesiology at the University of Utah which include an AAALAC accredited animal laboratory and animal housing facility. The principal investigator's long term career goals include: (i) develop collaborations with other investigators outside the University of Utah to enhance the work performed under this grant and future work and (ii) develop expertise and experimental methods needed to establish a laboratory capable of attracting future funding in areas pertinent to anesthesia and trauma care. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: PHYSIOLOGICAL STUDIES OF NEUROSTEROID ANALOGUES Principal Investigator & Institution: Zorumski, Charles F.; Samuel B. Guze Professor and Chair; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130 Timing: Fiscal Year 2002; Project Start 01-AUG-2002; Project End 31-JUL-2007 Summary: Neuroactive steroids are effective modulators of gamma-aminobutyric acidA receptors (GABAaRs), augmenting the actions of GABA at low concentrations and directly activating chloride channels at higher concentrations. Other steroids, particularly those with charged substituents at the 3-position, are negative modulators of GABAARs and other potentiators or inhibitors of N-methyl-D-aspartate receptors (NMDARs). Present evidence indicates that GABAAR potentiation and NMDAR inhibition represent two key mechanisms in clinical anesthesia. Over the past funding period, we identified a novel steroid that both potentiates GABAARs and inhibits NMDARs. This agent represent a potential new of anesthetics that combines two of the major features of presently used anesthetics in a single agent. In this present proposal, we will extend our studies of neuroactive steroids by addressing three specific aims: 1. To gain new information about structural requirements for steroid effects on GABAARs in cultured rat hippocampal neurons and Xenopus oocytes expressing defined GABAARs. These studies will include efforts to develop specific antagonists for steroid sites on GABAARs. 2. To understand mechanisms involved in neurosteroid-mediated modulation of hippocampal GABAergic synaptic transmission. Using a combination of synaptic recordings and studies using rapid agonist applications on isolated membrane. Using a combination of synaptic recordings and studies using rapid agonist applications on isolated membrane patches, these studies will examine mechanisms involved in steroid modulation. 3. To examine mechanisms involved in modulation of NMDARs by neuroactive steroids in hippocampal neurons and Xenopus oocytes. These studies include a combination of structure-activity and mechanistic studies based upon our initial observations with the novel steroid that enhances GABAARs and inhibits NMDARs. These studies have the potential to provide new information about neurosteroid effects in the CNS and a better understanding of mechanisms involved in steroid-mediated anesthesia. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: PLACE DETOXIFICATION
OF
LOW-DOSE
NALTREXONE
IN
OPIATE
Principal Investigator & Institution: Mannelli, Paolo; Psychiatry and Human Behavior; Thomas Jefferson University Office of Research Administration Philadelphia, Pa 191075587 Timing: Fiscal Year 2003; Project Start 20-SEP-2003; Project End 31-JUL-2006 Summary: (provided by applicant): This study is being submitted for review under the R21 (exploratory grant) mechanism, Its purpose is to explore whether the addition of very low doses of naltrexone to a methadone tapering schedule for opiate detoxification is safe, decreases withdrawal intensity and enhances patient treatment compliance. Although many different techniques for opiate detoxification have been employed, there is a continuing search for more effective approaches to reduce the duration and discomfort of withdrawal. Recent attempts have included the use of opiate antagonists to induce "ultra rapid" detoxification. However, the resulting need for heavy sedation or anesthesia to control withdrawal intensity and the increased possibility of medical complications has discouraged and limited the use of this approach. By contrast, there is experimental evidence that very low doses of naltrexone administered in the presence of
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opiates has analgesic and dependency reducing properties, suggesting that the use of very low dose naltrexone in the clinical management of opiate detoxification might be a useful strategy. To test this hypothesis, 360 volunteer opiate dependent subjects, admitted to the inpatient detoxification program of a community hospital and placed on a 4-day detoxification schedule, will be randomly assigned to receive one of three different low-dose naltrexone schedules or placebo in addition to their routine methadone tapering treatment. The four groups will be compared with respect to behavioral, biological and subjective withdrawal signs and symptoms, detoxification completion rates, acceptance of referral to outpatient treatment, and one and seven day post-detoxification follow-up evaluations. If the administration of low-dose naltrexone (antagonist) at the same time as methadone (agonist) is found to be more effective than placebo in reducing withdrawal discomfort, the findings will have clear treatment implications and raise important questions about the mechanisms of opiate agonist and antagonist interactions at the receptor. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: POSTOPERATIVE COGNITIVE DYSFUNCTION IN THE ELDERLY Principal Investigator & Institution: Monk, Terri G.; Anesthesiology; University of Florida Gainesville, Fl 32611 Timing: Fiscal Year 2002; Project Start 01-FEB-2002; Project End 31-DEC-2004 Summary: (Provided by applicant): As a faculty member in the Department of Anesthesiology at the University of Florida, I have previous experience as a principal investigator for industry-funded clinical trials, but no formal training in research design and data analysis. The primary intent of this K01 proposal is to enter a three-year career development program that will allow me to redirect my research efforts towards evaluating the influence of anesthesia and surgery on cognitive aging. During the first year of the proposal, I will complete a Master's Degree in Medical Science in Clinical Investigation with electives in cognitive aging and the neurosciences. The final two years of the career development award will be devoted to intensive training in neurocognitive testing and clinical research. The proposed research plan is designed to characterize the incidence, risk factors, and neurpsychological profile of postoperative cognitive dysfunction (POCD). Our preliminary data indicate that POCD is common in elderly patients undergoing orthopedic joint replacement surgery. During the early stages of the training program, I will work with my mentors to design a prospective study to determine if intraoperative embolic events during total knee arthroplasty (TKA) correlate with the occurrence of POCD. We will also determine if changes in medullary instrumentation techniques influence the incidence of embolic events and postoperative cognitive outcome. This study will use magnetic resonance imaging (MRI), transesophageal echocardiography, and transcranial doppler monitoring to identify the mechanisms and sites of cerebral injury during TKA. At the completion of my career development training, I will be uniquely trained in three major approaches to the investigation of cognitive changes in older adults: clinical assessment, neuroscience and neuroimaging, and psychometric/neuropsychological approaches to the assessment of everyday cognitive functioning. I plan to use this expertise to become the director of a Division of Clinical Research. This research division will participate in multidisciplinary research investigating aging issues in the perioperative period. Initial research will evaluate the etiology of POCD and interventions to decrease or prevent this complication. Given the breadth of my proposed training program, I will be able to interact with and serve as a mentor for anesthesiologists and also the broader corpus of scientists, both clinical and basic, interested in aging and neuroscience.
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Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: PREDICTORS OF POSTOPERATIVE ATELECTASIS PNEUMONIA Principal Investigator & Institution: Brooks-Brunn, Jo A.; Assoc Scientist, Sch of Nursing; Medicine; Indiana Univ-Purdue Univ at Indianapolis 620 Union Drive, Room 618 Indianapolis, in 462025167 Timing: Fiscal Year 2001; Project Start 15-JAN-1997; Project End 31-DEC-2001 Summary: (Adapted from investigator's abstract) Postoperative pulmonary complications (PPCs) are frequent and associated with increased morbidity, mortality, hospital length of stay and resource utilization. Atelectasis and pneumonia account for >80% of reported PPCs. The objective of this study is to develop predictive models for stratifying the risk of clinically significant atelectasis and/or pneumonia using readily accessible or existing clinical data in an adult abdominal and cardiothoracic surgical population. The long term goal is to develop predictive model(s) for use in the clinical setting to guide preoperative and postoperative pulmonary care. The primary aim of this study is to develop, compare and validate models to predict the risk of clinically significant atelectasis and/or pneumonia following abdominal or cardiothoracic procedures by assessing combinations of risk factors available at differing time periods during the surgical episode of care. Secondary aims are to compare the incidence of clinically significant atelectasis and/or pneumonia following abdominal and cardiothoracic procedures and postoperative length of stay between patients who develop these complications and those who do not. Four institutions will be utilized for data collection and the target population is adults who are undergoing elective abdominal or cardiothoracic procedures with general anesthesia. The target sample size is 1500 subjects over a three year period. Multi-criteria definitions will be used to measure the outcomes of clinically significant atelectasis and pneumonia as not to overestimate the incidence. The risk factors of interest are: increased age, impaired preoperative level of cognitive function, history of chronic lung disease, preexisting comorbid diseases, low or high body mass index (BMI), increased preoperative length of stay, smoking history, absence of preoperative respiratory education, high anesthesia physical risk status (ASA), increased duration of anesthesia, type and location of surgical procedure, incision direction and length, duration of intubation/mechanical ventilation in the postanesthesia period, pain management, postoperative mobility, administration of H2 blockers/antacids and presence of a nasogastric tube. Data will be collected on each subject prior to surgery and on a daily basis until hospital discharge. Logistic regression analysis will be used to examine the risk factors for univariate effects on clinically significant atelectasis and pneumonia and to develop and compare the multivariate models. Models will be evaluated for utility and goodness-of-fit. A splitsample technique will be used for model validation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: PRENATAL SET POINT FOR ADULT BLOOD PRESSURE Principal Investigator & Institution: Faber, Job J.; Professor; Oregon Health & Science University Portland, or 972393098 Timing: Fiscal Year 2002; Project Start 01-JUN-2002; Project End 31-MAY-2007 Summary: Late gestation fetal sheep will be treated to create systemic and pulmonary arterial hypertensions. One group will have high circulating angiotensin-II levels. There will be two normotensive control groups, one with normal and one with low angiotensin-II. The animals will be studied as fetuses, as newborns and as young adults.
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Circulatory measurements will include arterial pressures, right and left atrial pressures and cardiac outputs. We will also make plasma renin activity/renal ar6terial pressure response curves and measurements of glomerular filtration rates. Analytical measurements will include plasma renin activities, circulating angiotensin-II levels, catecholamines, plasma protein and blood hemoglobin concentrations, blood gases, osmolalities and electrolytes. Coronary pressure-flow relations will be determined under anesthesia with and without chemical dilation by means of adenosine infusions to determine coronary reserve. The animals will be killed for structural studies of heart and kidney. It is anticipated that prenatal hypertensions will produce lasting circulatory abnormalities later in life. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: PRESURGERY HYPNOSIS--BENEFITS ANALYSIS IN BREAST CANCER Principal Investigator & Institution: Montgomery, Guy; Ruttenberg Cancer Center; Mount Sinai School of Medicine of Nyu of New York University New York, Ny 10029 Timing: Fiscal Year 2001; Project Start 17-AUG-2001; Project End 31-JUL-2004 Summary: Over 90% of the 184,000 women diagnosed with breast cancer in 2000 will undergo surgery as part of their curative treatment. Despite improvements in pharmacological management, surgical procedures under general anesthesia continue to be associated with clinically significant side effects, chief among which are pain and nausea. These clinical problems are particularly severe following surgical treatment for breast cancer and can require additional pharmacologic intervention, prolong recovery room stay, delay discharge, and lead to unanticipated readmission. Clinical research with other surgical populations has indicated that hypnosis can reduce intraoperative complications, reduce postoperative symptoms and enhance recovery (e.g., reduce pain, nausea, hospital stays), however, the treatment efficacy of hypnotic techniques with breast cancer surgical patients has yet to be established. A separate line of previous clinical research with surgery populations has indicated that preoperative psychological factors (emotional distress and cognitive expectations) are predictive of patients' postoperative experiences of side effects, but again research on breast cancer surgical patients is scant. The proposed research will bridge the two previous lines of research by combining a randomized clinical trial, (in which the effects of a preoperative hypnosis intervention to control side effects are compared to attention control), with a prospective quasi-naturalistic study, (in which the relations between preoperative psychological factors and patients' reactions to surgery are examined). In addition to establishing the applicability to breast cancer patients of findings in the general psychological, hypnosis and surgical literatures, the goal of proposed study is to make novel theoretical contribution by examining the potential role of psychological factors as the "active ingredients" in the beneficial effects of hypnosis. The proposed study will also make a novel practical contribution by examining cost-effectiveness of the hypnosis intervention, an approach which may have compelling implications for clinical practice as well as future behavioral research. The Specific Aims of the study are: 1) To investigate the impact of a presurgical hypnosis intervention on women scheduled for surgical treatment for breast cancer; 2) To investigate the contribution of preoperative emotional distress, and cognitive expectations to post- surgery side effects and recovery; 3) To determine whether the beneficial effects of the hypnosis intervention are accounted for (mediated) by differences in presurgery cognitive expectations and emotional distress; and 4) To investigate the cost-effectiveness of the presurgical hypnosis invention. o achieve these aims, 140 breast cancer patients scheduled for
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mastectomy will be randomly assigned to a hypnosis intervention group or an attention control group. The impact of the hypnosis intervention on postoperative nausea, pain, recovery from surgery, and cost- effectiveness will be analyzed within an experimental study design. The influence of presurgery distress and expectations of side effects will be analyzed within quasi-naturalistic study designs. The possible mediational role of these factors in hypnosis effects will be examined will classic statistical approaches. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: PROTECTIVE EFFECTS OF ADENOSINE RECEPTOR MODULATION Principal Investigator & Institution: Lee, H T.; Anesthesiology; Columbia University Health Sciences New York, Ny 10032 Timing: Fiscal Year 2001; Project Start 01-MAR-2001; Project End 31-JAN-2006 Summary: (verbatim from the applicant's abstract) Renal dysfunction secondary to ischemic-reperfusion injury is a serious clinical problem in both aortic and renal transplant anesthesia and surgery. Murry, in 1986, first described the protective effect of "ischemic preconditioning" in cardiac muscle by showing that multiple brief ischemic periods before prolonged ischemia lessened myocardial dysfunction and infarction size after the reperfusion period. The mechanisms of cardiac ischemic preconditioning are known to involve pre-ischemic A' adenosine receptor activation, protein kinase C (PKC), and pertussis toxin-sensitive G-proteins (G'). We have recently demonstrated that ischemic preconditioning also occurs in the kidney and protects rat renal function against ischemic-reperfusion injury via a signaling pathway involving Gj and PKC. Moreover, adenosine treatment protects against renal ischemicreperfusion injury. Systemic adenosine pretreatment protects rat renal function via a pathway involving A adenosine receptors, Gj and PKC. Pre-ischemic A3 adenosine receptor antagonism and agonism also protect and worsen renal function, respectively. In addition, systemic adenosine given after the ischemic insult also protects renal function against reperfusion injury via A2a adenosine receptor activation. Our major aim is to further elucidate the cellular signal transduction mechanisms of renal protection from the receptor to the transcription factor level with pre- and post-ischemic adenosine treatments employing physiological, cellular and molecular techniques. Based on our in vivo data, we hypothesize that A, adenosine receptor activation and A3 adenosine receptor antagonism lead to protection against the ischemic phase of renal injury, and that A2a adenosine receptor activation attenuates the reperfusion phase of renal ischemic reperfusion injury via distinct cellular signal transduction pathways. Our research will aid in a better understanding of the cellular mechanisms of renal ischemic reperfusion injury. This, in turn, will contribute to improved therapeutic regimens for the protection of renal function in patients. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: SELECTIVE ANESTHETIC ACTIONS ON NMDA RECEPTORS Principal Investigator & Institution: Criswell, Hugh E.; Research Associate Professor; Anesthesiology; University of North Carolina Chapel Hill Office of Sponsored Research Chapel Hill, Nc 27599 Timing: Fiscal Year 2001; Project Start 01-AUG-1999; Project End 31-JUL-2003 Summary: Volatile anesthetics produce a balanced anesthesia by acting on a number of neural systems. While early studies attributed this array of actions to a nonspecific fluidization of phospholipid membranes, more recent work has pointed to specific actions of anesthetics on ion channels. Selective blockade of NMDA- sensitive glutamate
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receptors by volatile anesthetics has been linked to their amnesic, analgesic, hypnotic and neuroprotective action. Recent work by our laboratory and others has shown that both volatile anesthetics and n-alcohols have differing effects on NMDA-receptor function depending on the brain area studied. Further, we have preliminary data showing that the effects of volatile anesthetics on the NMDA receptor are influenced by the presence of the exon-5 splice in the NMDAR-1 subunit the receptor. The proposed studies will examine the effect of various volatile anesthetics on the electrophysiological properties of native NMDA receptors in rat brain and correlate those effects with the subunit composition of the receptors using single-cell RT-PCR. Specific Aim I will use whole-cell patch recording of NMDA- induced currents from acutely dissociated neurons and neurons maintained in primary culture to examine the effect of isoflurane on NMDA receptor function. Following recording of the NMDA- mediated currents, cytoplasm will be extracted from individual cells to analyze the mRNAs for NMDA receptor subunits present in each cell. This specific aim will extend our preliminary data linking the presence of the exon-5 splice to increased anesthetic potency and extend this work to other NMDAR-1 and NMDAR-2 isoforms. This aim will test the hypothesis that the effect of isoflurane on NMDA receptor function depends upon the subunit composition of that receptor. Specific Aim II will compare the effects of ethyl ether, isoflurane, enflurane, halothane and chloral hydrate on whole- cell currents elicited by NMDA and correlate those responses with the presence or absence of specific NMDA receptor subunit mRNAs. This specific aim will test the hypothesis that volatile anesthetics share a common dependence on subunit composition. Specific Aim III will examine the effect of volatile anesthetics on NMDA receptors expressed in HEK-293 cells transfected with combinations of NMDA receptor subunits found to influence anesthetic potency in native receptors. This Aim will verify experimentally, the correlational data from Specific Aims I and II. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: SITES AND MECHANISMS OF INHALED ANESTHETIC ACTIONS Principal Investigator & Institution: Eger, Edmond I.; Anesthesia and Perioperative Care; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 94122 Timing: Fiscal Year 2001; Project Start 01-AUG-1994; Project End 31-JUL-2004 Summary: OVERALL This program project proposal continues to be focused on determination of the sites and mechanisms of action of volatile anesthetics. The current applications proposes four research projects and three cores. Three of the projects continue studies begun by investigators in the previous funding period, and one investigator is new to the program project. The projects are interrelated by the application of a common test panel of compounds of standard anesthetic potency which includes non-immobilizer and translational compounds that were used in the previous funding period. A new feature is the introduction of mutagenesis of putative anesthetic active sites on membrane receptors and studies utilizing transgenic mouse technology. The program will continue to have biannual meetings involving the participant investigators and a number of consultants and advisory board members. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: SITES OF ANESTHETIC ACTION IN INHIBITORY RECEPTORS Principal Investigator & Institution: Greenblatt, Eric P.; Anesthesia; University of Pennsylvania 3451 Walnut Street Philadelphia, Pa 19104 Timing: Fiscal Year 2001; Project Start 01-FEB-1998; Project End 31-JAN-2003
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Summary: Volatile anesthetics (Vas) are invaluable aids in surgical anesthesia, yet serious side effects complicate their use. An understanding of the fundamental mechanisms underlying VA action will contribute to the development of more specifically targeted, and thereby safer agents. The clinically essential site of VA action is the central nervous system (CNS). The molecular mechanism of action of VAs in the CNS remains controversial. The effects of such agents in the CNS may be explained in part by their ability to potentiate neuronal inhibition mediated by the neurotransmitters gamma-aminobutyric acid (GABA) and glycine at GABAa and glycine receptors, respectively. Ligand-gated chloride channel receptors exhibit differential sensitivities to the VAs; whereas GABAa and glycine receptors are positively modulated, GABAc receptors are negatively modulated. Such differences suggest that there may be a structural basis for interactions with VAs. Halothane and other halogenated alkane VAs appear to have a different site of action in these receptors, when compared to VA ethers, such as isoflurane and enflurane, or alcohol. This is consistent with data supporting multiple sites of VA action. The goal of this research is to elucidate the molecular site(s) of action of halothane and related VAs in GABAa and glycine receptors using the tools of molecular biology and electrophysiology. The hypotheses are that (a) there are specific sites at which halothane and related VAs interact with these receptors, and (b) these interactions are subunit dependent. The specific aims are: 1) to generate, and study the pharmacology of, chimeric receptors by interchanging portions of GABAa, glycine and GABAc subunits, to identify specific domains of the protein involved in sensitivity to these VAs. Two electrode voltage clamp (TEVC) will be used to record currents from Xenopus oocytes expressing chimeras. 2) to generate, and study the pharmacology of, point-mutated GABAa,glycine and GABAC subunits, to demonstrate that sensitivity to such VAs requires interaction with specific amino acid residues of these proteins. Mutants will be expressed in oocytes and studies by TEVC. 3) to replicate point mutants of interest in other GABAa and glycine subunits, and to study the pharmacology of various subunit combinations, defining the role of subunit dependence in the effects of halothane and related VAs at these sites. These studies will provide insights into the molecular interaction of this group of Vas with specific neuronal components, which may facilitate the design of improved general anesthetics. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: SPATIAL AND TEMPORAL CHARACTERISTICS OF CENTRAL PAIN SE Principal Investigator & Institution: Mauderli, Andre P.; Prosthodontics; University of Florida Gainesville, Fl 32611 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 31-MAY-2007 Summary: (provided by the applicant): Prolonged pain appears to have the potential to modulate its own intensity through positive and negative feedback (central sensitization by pain, pain inhibition by pain). If the feedback is positive, the result is a vicious pain cycle and a progressive increase in pain sensitivity. Increased pain sensitivity means that a given stimulus is perceived as more painful (hyperalgesia), or - in more extreme cases - that a previously non-painful stimulus becomes painful (allodynia). The vicious cycle may lead to sensitization beyond the topographical boundaries of the original pain, and thus it may render remote body regions more pain-prone. The result may be a snowball effect of progressive expansion of the painful area. There is evidence suggesting that the vicious cycle may be a pathophysiological factor in certain chronic pain diseases, including fibromyalgia syndrome (FMS), myofascial pain syndrome (MPS), and irritable bowel syndrome (IBS). This research is guided by 4 questions: 1) Does the intensity and
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duration of a persistent pain have an effect on how pain sensitivity changes over time? 2) Does the sensitizing effect of pain signals reach beyond the topographical location of the original pain focus? 3) Is it possible to interrupt the vicious pain cycle and allow the sensitized state to return to normal by temporarily silencing the local pain focus that presumably started the cycle? 4) Does the maintenance of the sensitized state depend on central NMDA receptor function, molecular constituents known to play a role in temporal integration of pain stimuli and other memory systems? The subjects in this study will be asked to rate pain intensities by setting the slider on an electronic visual analog scale. Novel methodology will be used for probing the temporal and spatial response properties of central pain modulation with experimental pain with prolonged series of thermal pulses. The effect of silencing clinical pain foci with transdermally delivered local anesthetics on thermallyinduced sensitization will be studied. The importance of NMDA receptor systems in the maintenance of a sensitized state will be assessed by measuring pain sensitization properties before and after pharmacologically blocking them. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: SPATIAL- TEMPORAL ASPECTS OF DROSOPHILA MEMORY FORMATION Principal Investigator & Institution: Yin, Jerry C.; Associate Professor; Cold Spring Harbor Laboratory 1 Bungtown Road Cold Spring Harbor, Ny 11724 Timing: Fiscal Year 2003; Project Start 08-APR-2003; Project End 31-MAR-2008 Summary: (provided by applicant): Since the dawn of language, one of the most intriguing questions has been the physical location of human memories in the brain. Neurologists have inferred anatomical function from studies of injury and disease to different areas of the brain. Experimental psychologists have used brain lesion as a tool to dissect function in experimental animals. We propose to use genetic tools to address this question in the common fruit fly, Drosophila melanogaster. This genetically tractable, genome-mined and experimentally pliable model organism exhibits complex neuronal functions such as learning and memory formation, circadian biology, sleep, and stereotyped behavioral responses to addictive drugs. Because of the rich history of genetics in this animal, the total access to the genome structure and information-coding capacity, and the variety of molecular tools that can be applied, it is likely that we will achieve a complete, multilevel understanding of complex neuronal function in this organism. There are two types of consolidated memory that exists for an olfactoryavoidance behavior in Drosophila, anesthesia-resistant memory (ARM) and long-term memory (LTM). We have disrupted and enhanced both of these processes through the reverse genetic manipulation of single genes. In parallel, we have developed new technology that allows both spatial (anatomical) and temporal control over the induction of transgenes. In this proposal, we will utilize this technology to conditionally express genes that inhibit each of these types of memory. Because we can control the brain regions where the disrupting genes are expressed, it will be possible to anatomically dissect these memories. This information will provide a first-glimpse of what a memory looks like in the three-dimensional space of the brain. In mammals, there are some very intriguing temporal properties of memory formation, suggesting that memory "consolidation" is not necessarily a process with a fixed starting and ending point in time. Since we can also control when the interfering genes are induced, we will analyze temporal questions about memory formation. These experiments should help us understand the complexity of memory formation and its relationship with ongoing neuronal processes. Finally, we will test the feasibility of using the
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spatialtemporal system to ablate adult brain neurons, complementary approach to many of the same issues.
providing
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Project Title: ENCODING
STATISTICAL
MODELING
OF
NEURAL
Principal Investigator & Institution: Brown, Emery N.; Massachusetts General Hospital 55 Fruit St Boston, Ma 02114
INFORMATION
Associate
Professor;
Timing: Fiscal Year 2001; Project Start 05-MAY-2000; Project End 31-MAR-2005 Summary: (Adapted from the Investigator's Abstract) This is an application for a KO2 Independent Scientist Award. The candidate is an anesthesiologist/statistician whose research to date has focused on the development of statistical models for the quantitative study of how neural systems represent and transmit information the central focus of his career research. The study of how neural systems encode information is one of the most challenging and fascinating problems in science. The point process character of neural spike trains means that standard signal processing techniques developed to analyze continuous signals will have limited application in the analysis of neural systems. The study of neural signal processing requires the development of new quantitative techniques to accurately characterize the properties of neural systems. These methods should be developed in close collaboration with experimentalists to ensure that the models remain completely faithful to the neurophysiology. For this reason, the candidate will collaborate with Professor Matt Wilson in the Department of Brain and Cognitive Science at MIT. The research will use Professor Wilson's paradigm of simultaneous multiunit recordings of pyramidal (place) cells in the hippocampus of freely behaving rodents to model, how these neurons encode spatial information as the animals perform specific behavioral tasks. The statistical methods to be developed will be based on spatio-temporal point process models of hippocampal place cell spiking activity and nonlinear recursive filtering algorithms based on Bayesian statistical theory. The experimental work in this project will be carried out in Professor Wilson's laboratory at MIT and is an integral part of his research on characterizing the role of the hippocampus in short- and long-term memory formation. The methodology research will be conducted in parallel at the candidate's laboratory in the Department of Anesthesia at Massachusetts General Hospital. The candidate will use the additional funded research time provided by KO2 award to enhance his knowledge of hippocampus physiology and anatomy and to develop a sound theoretical framework based on theory of point processes from which to derive signal processing methods appropriate for neural systems. The candidate's long-term objectives are to continue his work on neural information processing and the study of the hippocampus in memory formation. The research to be undertaken in this project will also provide a set of statistical tools with which neuroscientists will be able to study information representation and transmission in neural systems using multiunit activity data recorded along with relevant biological signals. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: SUBTLE DISTURBANCES OF COBALAMIN STATUS Principal Investigator & Institution: Carmel, Ralph; Director of Research; New York Methodist Hospital 506 60Th St New York, Ny 11215 Timing: Fiscal Year 2003; Project Start 01-SEP-1983; Project End 31-MAY-2008
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Summary: (provided by applicant): Low cobalamin (vitamin B12) levels are frequent, especially in the elderly, several million of whom are affected. Most often the low levels reflect "subclinical cobalamin deficiency", an asymptomatic state marked only by metabolic evidence of cobalamin insufficiency. It is unclear if these persons need intervention because progression to clinical deficiency may be uncommon, and many people with low levels have no deficiency at all. The proposal aims to study whether nitrous oxide (N2O), used in most general anesthesia in the US, worsens cobalamin status in elderly people who have unrecognized subclinical cobalamin deficiency. The reason for concern is that N2O inactivates cobalamin and therefore can cause neurological dysfunction in some patients with underlying clinically expressed cobalamin deficiency. The elderly are known to have an increased risk of postoperative cognitive complications. The study will recruit patients >60 years old who are scheduled for elective surgery in which N2O use for more than 1 hour is planned. Patients will be randomized in a blinded fashion to receive a standard anesthetic regimen of several agents, in which N2O is either included or replaced by air; the two regimens are equally safe and effective. They will undergo cognitive function and depression scale testing, blood testing of cobalamin-related metabolism, and clinical evaluation before surgery and at 48 hours, 14 days and 28 days after surgery. Those with cognitive changes will be treated with cobalamin and reevaluated after 3 months. Statistical analysis will compare the subgroups' metabolic, neuropsychological, demographic, genetic and clinical data. The primary question is what effect routine N2O anesthesia has on metabolic and clinical status related to subclinical cobalamin deficiency. It will also resolve whether or not the combination of N2O and the deficiency can explain the increased rate of postoperative cognitive problems in the elderly, and thus if preoperative or postoperative attention to cobalamin is needed in the elderly. A secondary goal is to extensively study cobalamin-related and homocysteine-related metabolism in these patients and their conditions, particularly as changes evolve after N2O use and later improvement. The clinical study provides a unique opportunity to establish these metabolic details and to compare their interactions with common genetic mutations in the patients that affect enzymes relevant to cobalamin deficiency, N2O effects, and their contribution to the clinical outcomes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: SYNAPTIC INHIBITION BY VOLATILE ANSETHETICS Principal Investigator & Institution: Wu, Ling-Gang; Anesthesiology; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130 Timing: Fiscal Year 2002; Project Start 01-APR-2002; Project End 31-MAR-2006 Summary: Volatile anesthetics achieve their anesthetic effects partly by depressing excitatory glutamatergic synaptic transmission. Evidence suggests that depression of glutamatergic synaptic transmission is caused by inhibition of transmitter release. However, the cellular and molecular mechanisms underlying inhibition of transmitter release remain unclear. Based on our preliminary results, I hypothesize that volatile anesthetics depress glutamatergic synaptic transmission by reducing the presynaptic Ca2+ influx by two mechanisms: 1) inhibition of presynaptic Na+ channels, which decreases the action potential amplitude and thus the action potential-evoked Ca2+ influx, and 2) inhibition of presynaptic Ca2+ channels. We will test this hypothesis at a glutamatergic synapse in the medial nucleus of the trapezoid body in rat brainstem slices. This synapse offers a significant advantage over other synapses, because it has a large nerve terminal that allows for direct recordings of presynaptic action potentials, Na+, K+ and Ca2+ currents and fluorescence recordings of Ca2+ influx. These
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presynaptic recordings can be performed simultaneously with recordings of the postsynaptic excitatory current (EPSC) at the same synapse, which allows us to quantitatively evaluate the involvement of each presynaptic ion channel type in controlling action potential-evoked transmitter release. With these techniques, we will study the action of three commonly used volatile anesthetics, isoflurane, halothane and sevoflurane at clinically relevant concentrations. We will characterize the effects of these anesthetics on presynaptic Na+, K+ and Ca2+ channels and the contribution of each of these effects to depression of the EPSC. In addition, we will investigate whether these anesthetics also inhibit the EPSC by a mechanism independent of modulation of ion channels, i.e., direct inhibition of the release machinery. By revealing mechanisms underlying volatile anesthetic-induced depression of glutamate release, the proposed work will significantly contribute to our understanding of the cellular and molecular mechanisms of general anesthesia, and may ultimately help to design better general anesthetics. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: SYNAPTIC MECHANISMS OF GENERAL ANESTHETIC ACTION Principal Investigator & Institution: Hemmings, Hugh C.; Professor of Anesthesiology and Pharmaco; Anesthesiology; Weill Medical College of Cornell Univ New York, Ny 10021 Timing: Fiscal Year 2001; Project Start 01-AUG-1998; Project End 31-JUL-2002 Summary: The broad, long-term objective of this proposal is to understand at a molecular level the mechanisms of action of general anesthetics on synaptic transmission in the central nervous system. Identification of the mechanisms involved in the therapeutic and toxic effects of existing anesthetic agents will facilitate the development of more specific agents with fewer adverse effects. The hypothesis to be evaluated is that general anesthetics affect transmitter release by agent- and transmitterspecific presynaptic mechanisms. The Specific Aims are to 1) Determine the effects of general anesthetics on synaptosomal neurotransmitter release; 2) Determine the mechanisms of general anesthetic effects on neurotransmitter release; and 3) Investigate the effects of general anesthetics on neuronal Na+ channels (which mediate anesthetic inhibition of glutamate release). The experimental design is to identify the effects of general anesthetics on neurotransmitter release in a subcellular preparation (synaptosomes) that is free of cellular interactions and amenable to pharmacological analysis, and then to characterize the mechanism(s) of the anesthetic effects by analyzing associated changes in presynaptic ion channel function, intracellular ion concentrations, membrane potential, presynaptic receptor function and second messenger systems. The methods to be used include neurochemical analysis of anesthetic effects on spontaneous and evoked glutamate, gamma-aminobutyric acid, norepinephrine, dopamine and cholecystokinin-8 release from rat brain synaptosomes; spectrofluorimetric assays of synaptosomal Na+, Ca2+, and C1-concentrations, membrane potential and pH; pharmacologic analysis of the roles of specific ion channels and protein kinases in the effects of anesthetics on transmitter release; and patch-clamp recording of presynaptic Na+ currents in vesicles made by fusing synaptosomes. Determination of the presynaptic effects of general anesthetics on transmitter release, and the mechanisms of these effects, is essential in linking the molecular and cellular actions of anesthetics on neuronal function and thus in understanding the mechanisms of action of this clinically important, but poorly understood, class of drugs. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: SYNAPTIC TRANSMISSION IN FEAR CONDITIONING CIRCUITS Principal Investigator & Institution: Ledoux, Joseph E.; Professor; Center for Neural Science; New York University 15 Washington Place New York, Ny 10003 Timing: Fiscal Year 2001; Project Start 01-APR-1991; Project End 31-MAR-2006 Summary: (Adapted from applicant's abstract): Considerable evidence points to the amygdala, and specifically its lateral nucleus (LA), as a key site of the plasticity underlying fear conditioning, a behavioral procedure useful for studying how fear, including psychopathological fear, is learned and remembered. In this proposal past findings are built upon in an attempt to gain a deeper understanding of the nature of plasticity that occurs at synapses linking neurons in the auditory system (thalamus and cortex) with postsynaptic neurons in LA, and the relation of this plasticity to conditioned fear behavior. To do this, four broad projects, all involving rats, are proposed. The first examines synaptic plasticity in LA in vitro, as this level is useful for pursuing cellular/molecular mechanisms that might underlie plasticity. Mechanisms uncovered in vitro are then examined for relevance to living brains by performing similar in vivo studies of LA plasticity using intracellular recordings in anesthetized animals. The findings from anesthesia are then evaluated for their relevance to awake animals by performing behavioral and physiological studies in behaving rats. The final project attempts to take a step forward from the mechanisms of plasticity at the input synapses in LA and begins to look at the contribution of local circuits within the amygdala. Much of the work at all levels is aimed at determining the relative contribution the L-type voltage gated calcium channels and the NMDA class of glutamate receptors to synaptic plasticity in fear conditioning circuits, and to fear conditioning itself. Together, these studies should reveal new information about the cellular basis of fear learning, and may, in the long run, lead to better understanding of the genesis and maintenance, and hopefully the treatment, of pathological fear. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: TARGETED MUTATIONS TO STUDY ANESTHETIC MECHANISMS Principal Investigator & Institution: Chandra, Dev; Anesthesiology; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2001; Project Start 15-AUG-2001; Project End 31-JUL-2006 Summary: (provided by applicant) The goal of this five-year career development proposal is to provide the Principal Investigator, Dev Chandra, with the opportunity to develop into an independent researcher and competent Clinician in the field of dental anesthesiology. The PI will engage in training that will culminate in a Ph.D. degree from the Center for Neuroscience at the University of Pittsburgh. His research training will be conducted in the laboratory of Gregg Homanics, Ph.D., at the University of Pittsburgh in the Departments of Anesthesiology and Pharmacology. Clinical training in dental anesthesiology will be undertaken at the University of Pittsburgh School of Dental Medicine. While the discovery of anesthesia has revolutionized delivery of dental and medical treatment, it remains unknown how anesthetics induce their clinical effects in a reversible manner. Understanding these mechanisms will ultimately lead to the development of safer and more effective anesthetic treatment modalities. Gene knockout mice have revolutionized the investigation of the role of individual proteins in the action of anesthetics within the context of the whole animal. This approach has been further refined using conditional gene knockout technology which allows the inactivation of a gene only in certain cells or during specific developmental periods. The gamma-aminobutyric acid type A receptor (GABAA-R) has been extensively implicated
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as a key component of the mechanism of action of anesthetics. This study proposes to investigate the contribution of different subunits of the GABAA-R. Mouse models with globally or regionally altered expression patterns of the gamma2 or alpha4 subunits will be created and analyzed using a battery of molecular, cellular and behavioral assays. These studies will elucidate the role of the gamma2 or alpha4 subunits in clinically relevant behaviors induced by centrally acting anesthetics. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: THE MOLECULAR BASIS OF LOCAL ANESTHESIA Principal Investigator & Institution: Balser, Jeffrey R.; Professor; Anesthesiology; Vanderbilt University 3319 West End Ave. Nashville, Tn 372036917 Timing: Fiscal Year 2001; Project Start 01-AUG-1997; Project End 31-JUL-2005 Summary: (Verbatim from the applicant's abstract) Sodium (Na) channels, the principle target of local anesthetic agents, change their conformational state in response to membrane potential. Depolarization increases the intensity of the drug-receptor interaction nearly 100-fold. While this phenomenon imderlies the broad therapeutic efficacy of local anesthetics, these voltage-dependent interactions also provoke lifethreatening side effects (arrhythmias, seizures). Clarifying this dynamic modulation of the drug-receptor interaction will complement new data identifying local anesthetic binding domains, and will improve the design of these compounds. A number of distinct Na channel loci that mediate intrinsic conformational changes (fast and slow inactivation) also modulate local anesthetic action, consistent with the original proposal (the Modulated Receptor Hypothesis) that local anesthetic binding affinity is governed by conformational state. A corollary prediction is that local anesthetics, when bound, should induce the Na channel to occupy higher-affinity conformational state(s). Recent work reveals that intrinsic Na channel conformational changes involve sizeable molecular motions that modify the architecture of the pore. We propose that local anesthetics function as allosteric effectors to induce intrinsic conformational changes in the pore, analogous to ligand effects on allosteric enzymes. Our studies will examine the gating conformational properties of heterologously-expressed Na channels containing engineered cysteine residues using patch-clamp methods. Using methanethiosulfonate reagents, we will examine how slow inactivation changes the sulfhydryl accessibility of amino acid residues in the outer pore region in response to local anesthetic binding. In addition, we will examine the linkage between the earliest phase of depolarizationinduced block and motion of the charged S4 segments, with a view to linking motion of these segments to conformational changes in the outer pore. Finally, we will utilize a disulfide trapping approach to constrain the interdomain distance changes induced by local anesthetic block, and will interpret these using a new molecular model of the Na channel pore. Our studies will illuminate the dynamic structure of the Na channel pore, and will facilitate the design of more targeted and less toxic local anesthetic agents. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: THE ROLE OF THE AMYGDALA IN ANESTHETIC-INDUCED AMNESIA Principal Investigator & Institution: Alkire, Michael T.; Assistant Anesthesiology; University of California Irvine Campus Dr Irvine, Ca 92697
Professor;
Timing: Fiscal Year 2003; Project Start 01-JAN-2003; Project End 31-DEC-2006 Summary: (provided by applicant): General anesthetic agents have two fundamental properties, an ability to cause immobility in response to pain and an ability to cause
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amnesia. Understanding anesthesia requires understanding both phenomenon. We recently demonstrated, using inhibitory avoidance learning in rats, that the basolateral amygdala (BL) is critically nvolved with mediating the amnesic effects of propofol general anesthesia. Propofol does not produce amnesia if the BL is lesioned. Further pilot work found that intra-amygdala microinfusions of the GABA antagonist bicuculline also attenuated the amnesic effects of propofol, suggesting that GABAergic mechanisms may underlie this response. This proposal will help fill the gap in knowledge that exists regarding the role of the amygdala as a mediator of anestheticinduced amnesia. We specifically aim to: 1) determine whether the amygdala mediates the amnesia of volatile anesthetic agents studied under steady-state learning conditions at equivalent MAC% doses, 2) further elucidate the cellular mechanisms of propofol's amnesic effects, and 3) begin to determine how neuroanatomic pathways to and from the amygdala mediate these effects. We will use the rat inhibitory avoidance model to assess, in vivo, the effects of various anesthetics and amygdala manipulations on memory processing. Initial experiments, following appropriate dose-response studies, will determine whether excitotoxic-induced bilateral lesions of the BL will block the amnesia of the volitile anesthetic agents halothane (thought to act preferentially on the amygdala) and isoflurane (a commonly used inhalational agent). Subsequent experiments will use intra-amygdala microinfusion techniques with the specific GABA blocker picrotoxin to assess the contribution played by the GABAergic system in mediating propofol-induced amnesia. Lesions of a main amygdala pathway, the stria terminalis, will also be studied. Collectively, the proposed experiments should provide the most complete understanding to date of specific brain systems mediating anestheticinduced amnesia and will provide a solid foundation for further work on the mechanisms of drug induced amnesia. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: TRANSPLANTATION OF HUMAN BONE MARROW STROMAL CELLS Principal Investigator & Institution: Fischer, Itzhak; Professor and Chair; Neurobiology and Anatomy; Mcp Hahnemann University Broad & Vine Sts Philadelphia, Pa 19102 Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 31-JUL-2005 Summary: (provided by applicant): This proposal is focused on application of recent advances in stem cell biology to a potential therapy for spinal cord injury. The proposed experiments will utilize mesenchymal stem cells derived from human bone marrow (marrow stromal cells, hMSCs), examine their phenotype following transplantation into spinal cord and test their ability to promote regeneration and recovery of function. Human MSCs are easy to obtain from a patient under local anesthesia, provide a renewal population and can be used for autologous grafting. Our preliminary data show that hMSCs grafted into spinal cord lesions survive, integrate well and appear to be permissive for axonal growth, and thus are excellent candidates for use in spinal core repair strategies. The full potential of hMSCs to differentiate is not well understood, but there is growing evidence that adult cells from bone marrow have remarkable plasticity and can assume diverse phenotypes dependent on the environment that they encounter. We reasoned that by transplanting hMSCs cells into spinal cord we can combine a systematic and direct examination of their fate in vivo with a detailed analysis of their therapeutic effects in neuronal rescue, axon regeneration and functional recovery in a well characterized model of spinal cord injury. Previous studies and our preliminary data suggest that hMSCs produce a variety of cytokines and neurotrophic factors that support survival and regeneration. The proposed experiments will examine the
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behavior of untreated and treated hMSCs in normal spinal cord (AIM 1) and in a wellcharacterized injury model of a unilateral C4 lesioned spinal cord (AIM 2). These cells will be analyzed with respect to their survival, migration and phenotype as well as their ability to rescue axotomized neurons (in the Red Nucleus), promote axon regeneration (of corticospinal and rubrospinal tracts) and restore function (using cylinder, rope and grid walking, reaching and patch removal tests). The therapeutic potential of different batches of hMSCs will then be correlated to their expression profile of secretory factors. In Aim 3 we will study the ability of grafted hMSCs to deliver therapeutic genes (BDNF and NT3) to the injured spinal cord and the effects of the genetic modification on the phenotypic properties of these cells and the potential for repair and restoration of function. Taken together, these experiments will provide a through preclinical analysis of the properties and therapeutic potential of hMSCs in the injured CNS. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: VOLATILE TRANSPORTERS
ANESTHETIC
MODULATION
OF GLUTAMATE
Principal Investigator & Institution: Zuo, Zhiyi; Anesthesiology; University of Virginia Charlottesville Box 400195 Charlottesville, Va 22904 Timing: Fiscal Year 2003; Project Start 01-FEB-2003; Project End 31-JAN-2008 Summary: (provided by applicant) Glutamate transporters (EAATs) play an important role in the regulation of extracellular levels of glutamate, a major excitatory neurotransmitter in the central nervous system. Current data suggest that increased extracellular glutamate concentration is involved in the pathophysiology of ischemic brain injury and several major human neurodegenerative disorders, such as Alzheimer's and Huntington's diseases, as well as amyotrophic lateral sclerosis. Thus, normal functioning of EAATs is important for maintaining efficient neurotransmission and preventing neuronal injury. Our long-term research goals are to understand the regulation of EAATs and their role in the mechanisms of anesthesia and neuroprotection. Volatile anesthetics increase the activity of EAATs. Ischemia causes reversed transport of glutamate via EAATs. This proposal aims to 1) determine the effects and mechanisms of volatile anesthetics on the trafficking and activity of EAATs, especially the role of protein kinase C (PKC) in mediating these anesthetic effects; 2) study the anesthetic effects on reversed transport of glutamate via EAATs. Cultured cells will be exposed to volatile anesthetics and cellular distribution of EAATs will be studied by immunocytochemistry with confocal microscopy and Western blotting of the subcellular fractions. The importance of potential PKC-dependent phosphorylation sites in mediating the anesthetic effects on the type 3 glutamate transporter will be determined by site-directed mutagensis. The PKC-isozyme dependence of the anesthetic regulation of this transporter also will be investigated by using isozyme specific inhibitors, down-regulation of isozymes and re-introduction of implicated isozymes. Ischemia-/hypoxia-induced reversed transport of glutamate in different rat brain regions (hippocampus, cerebral cortex and cerebellum) and cultured cell types (glia and neurons) will be evaluated in the presence or absence of volatile anesthetics. These studies will provide a molecular basis for the anesthetic and PKC regulation of glutamate transport and may suggest new targets for anesthesia or neuroprotection. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: VOLATILE ANESTHETICS AND CARDIAC FUNCTION Principal Investigator & Institution: Housmans, Philippe R.; Professor; Mayo Clinic Rochester 200 1St St Sw Rochester, Mn 55905
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Timing: Fiscal Year 2001; Project Start 01-DEC-1986; Project End 31-DEC-2003 Summary: (Adapted from the applicant's abstract) The overall goal of this research proposal is to investigate the cellular mechanisms of myocardial contractile depression by drugs used in clinical anesthesia. There is evidence that anesthetics depress myocardial contractility by directly decreasing the availability of calcium ions in the cytoplasm and (for some anesthetics) by altering myofibrillar calcium sensitivity (i.e., the amount of force developed at a given intracellular calcium). The specific goal is to elucidate mechanisms responsible for these direct effects which occur at clinically useful anesthetic concentrations. In experimental models of different physiological complexity, the applicant will test the following hypotheses: 1) Anesthetics delay the onset of myofibrillar activation by decreasing the rate of calcium release from the SR. 2) Peak unload velocity of shortening in cardiac muscle is dependent on intracellular calcium only in the initial 50 ms of contraction. The ability of anesthetic to slow the rate of rise of intracellular calcium results in a delayed and lower peak velocity of unloaded shortening. 3) Anesthetics do not influence the rate of relaxation, suggesting minimal effects on calcium uptake by the SR. 4) Anesthetics decrease myofibrillar calcium sensitivity in all contractile conditions. 5) Anesthetics do not alter the relation between bound calcium and force in skinned cardiac fibers, suggesting that changes in calcium sensitivity are due mostly to alterations in calcium affinity of troponin C. It is hoped that these results will allow one to quantify the effects of anesthetics on each step in cardiac excitation/contraction coupling addressed and to identify the underlying mechanisms. Moreover, these results might provide a rational basis of knowledge on which to formulate pharmacological action to reverse or prevent myocardial depression in surgical patients. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “anesthesia” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for anesthesia in the PubMed Central database: ·
A hypothesis about the endogenous analogue of general anesthesia. by Lerner RA.; 1997 Dec 9; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=33784
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Anesthesia Abstracts. by Dittrick H.; 1944 Apr; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=194365
3 4
Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.
With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print.
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Anesthesia the sleeper in 2001 residency match. by Buske L.; 2001 Jul 10; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=81263
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Clinical Anesthesia. A Manual of Clinical Anesthesiology. by Jones HW.; 1943 Apr; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=194195
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Deletion of phosphodiesterase 4D in mice shortens [alpha]2-adrenoceptor --mediated anesthesia, a behavioral correlate of emesis. by Robichaud A, Stamatiou PB, Jin SL, Lachance N, MacDonald D, Laliberte F, Liu S, Huang Z, Conti M, Chan CC.; 2002 Oct 1; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=151147
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Effect of mivacurium 200 and 250 [mu]g/kg in infants during isoflurane anesthesia: a randomized controlled trial [ISRCTN07742712]. by Nava-Ocampo AA, Aguirre-Garay FT, Velazquez-Armenta EY, Moyao-Garcia D.; 2001; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=60007
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Effects of anesthesia on functional activation of cerebral blood flow and metabolism. by Nakao Y, Itoh Y, Kuang TY, Cook M, Jehle J, Sokoloff L.; 2001 Jun 19; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=34713
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Figure-ground activity in primary visual cortex is suppressed by anesthesia. by Lamme VA, Zipser K, Spekreijse H.; 1998 Mar 17; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=19730
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History of Anesthesia, With Emphasis on the Nurse Specialist. by Keys TE.; 1954 Jul; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=199756
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Influence of Intravenous Anesthesia on Mucosal and Systemic Antibody Responses to Nasal Vaccines. by Janakova L, Bakke H, Haugen IL, Berstad AK, Hoiby EA, Aaberge IS, Haneberg B.; 2002 Oct; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=128324
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Intravenous Anesthesia. by Dittrick H.; 1944 Oct; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=194413
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Relative value to surgical patients and anesthesia providers of selected anesthesia related outcomes. by Rashiq S, Bray P.; 2003; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=152656
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Stimulated changes in localized cerebral energy consumption under anesthesia. by Shulman RG, Rothman DL, Hyder F.; 1999 Mar 16; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=15927
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The History of Surgical Anesthesia. by Viets HR.; 1945 Oct; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=194546
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Victory Over Pain, A History of Anesthesia. by Robb S.; 1947 Oct; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=194689
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The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with anesthesia, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “anesthesia” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for anesthesia (hyperlinks lead to article summaries): ·
A comparative evaluation of transcutaneous and end-tidal measurements of CO2 in thoracic anesthesia. Author(s): Oshibuchi M, Cho S, Hara T, Tomiyasu S, Makita T, Sumikawa K. Source: Anesthesia and Analgesia. 2003 September; 97(3): 776-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12933401&dopt=Abstract
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A comparison of psoas compartment block and spinal and general anesthesia for outpatient knee arthroscopy. Author(s): Jankowski CJ, Hebl JR, Stuart MJ, Rock MG, Pagnano MW, Beighley CM, Schroeder DR, Horlocker TT. Source: Anesthesia and Analgesia. 2003 October; 97(4): 1003-9, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14500148&dopt=Abstract
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A prospective cohort study of emergence agitation in the pediatric postanesthesia care unit. Author(s): Voepel-Lewis T, Malviya S, Tait AR. Source: Anesthesia and Analgesia. 2003 June; 96(6): 1625-30, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12760985&dopt=Abstract
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A prospective, randomized, double-blind comparison of buffered versus plain tetracaine in reducing the pain of topical ophthalmic anesthesia. Author(s): Weaver CS, Rusyniak DE, Brizendine EJ, Abel S, Somerville GG, Howard JD, Root T. Source: Annals of Emergency Medicine. 2003 June; 41(6): 827-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12764338&dopt=Abstract
6 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.
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A review of paresthesia in association with administration of local anesthesia. Author(s): Dower JS Jr. Source: Dent Today. 2003 February; 22(2): 64-9. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12680261&dopt=Abstract
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A systematic review of the safety and effectiveness of fast-track cardiac anesthesia. Author(s): Myles PS, Daly DJ, Djaiani G, Lee A, Cheng DC. Source: Anesthesiology. 2003 October; 99(4): 982-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14508335&dopt=Abstract
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A teaching tool in spinal anesthesia. Author(s): Allen J, Meincke K, Ramirez M, Watts R, Marienau MS. Source: Aana Journal. 2003 February; 71(1): 29-36. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12776647&dopt=Abstract
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Ability of the bispectral index, autoregressive modelling with exogenous inputderived auditory evoked potentials, and predicted propofol concentrations to measure patient responsiveness during anesthesia with propofol and remifentanil. Author(s): Struys MM, Vereecke H, Moerman A, Jensen EW, Verhaeghen D, De Neve N, Dumortier FJ, Mortier EP. Source: Anesthesiology. 2003 October; 99(4): 802-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14508310&dopt=Abstract
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About local anesthesia infiltration. Author(s): Abenavoli FM, Corelli R. Source: Annals of Plastic Surgery. 2003 June; 50(6): 666-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12783030&dopt=Abstract
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Accessing the living laboratory: trigger films as an aid to developing, enabling, and assessing anesthesia clinical instructors. Author(s): Hartland W, Biddle C, Fallacaro M. Source: Aana Journal. 2003 August; 71(4): 287-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=13677224&dopt=Abstract
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Accidental subdural catheterization due to complication of epidural anesthesia--a case report. Author(s): Huang HW, Ho WM, Shih ER, Lee SC, Shen CH. Source: Acta Anaesthesiol Sin. 2003 March; 41(1): 37-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12747346&dopt=Abstract
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Adverse events with outpatient anesthesia in Massachusetts. Author(s): D'eramo EM, Bookless SJ, Howard JB. Source: Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons. 2003 July; 61(7): 793-800; Discussion 800. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12856252&dopt=Abstract
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Alteration of surgical management following intraoperative transesophageal echocardiography in a patient with mobile left atrial thrombi embolized during anesthesia. Author(s): Ha JW, Chung N, Hong YW, Kwak YR, Chang BC, Cho SY. Source: Echocardiography (Mount Kisco, N.Y.). 2003 April; 20(3): 291-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12848669&dopt=Abstract
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Alternating-pulse iontophoresis for targeted cutaneous anesthesia. Author(s): Meyer PF, Oddsson LI. Source: Journal of Neuroscience Methods. 2003 May 30; 125(1-2): 209-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12763247&dopt=Abstract
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Alternatives for topical anesthesia. Author(s): McArdle BF. Source: Dent Today. 2003 February; 22(2): 106-8, 110-1. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12680269&dopt=Abstract
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An evaluation of the Laryngeal Tube during general anesthesia using mechanical ventilation. Author(s): Gaitini LA, Vaida SJ, Somri M, Kaplan V, Yanovski B, Markovits R, Hagberg CA. Source: Anesthesia and Analgesia. 2003 June; 96(6): 1750-5, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12761007&dopt=Abstract
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An evaluation of topical and local anesthesia in phacoemulsification. Author(s): Rizvi Z, Rehman T, Malik S, Qureshi A, Paul L, Qureshi K, Memon S, Rafi S, Ali A. Source: J Pak Med Assoc. 2003 April; 53(4): 167-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12776905&dopt=Abstract
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An overview of outpatient sedation and general anesthesia for dental care in California. Author(s): Silegy T, Kingston RS. Source: J Calif Dent Assoc. 2003 May; 31(5): 405-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12839233&dopt=Abstract
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Anaphylactic and anaphylactoid reactions occurring during anesthesia in France in 1999-2000. Author(s): Mertes PM, Laxenaire MC, Alla F; Groupe d'Etudes des Reactions Anaphylactoides Peranesthesiques. Source: Anesthesiology. 2003 September; 99(3): 536-45. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12960536&dopt=Abstract
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Anesthesia for breech presentation and multiple gestation. Author(s): Pratt SD. Source: Clinical Obstetrics and Gynecology. 2003 September; 46(3): 711-29. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12972752&dopt=Abstract
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Anesthesia for cosmetic facial surgery. Author(s): Friedberg BL. Source: International Anesthesiology Clinics. 2003 Summer; 41(3): 13-28. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12872023&dopt=Abstract
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Anesthesia for endovascular repair of abdominal and thoracic aortic aneurysms: a review article. Author(s): Lippmann M, Lingam K, Rubin S, Julka I, White R. Source: The Journal of Cardiovascular Surgery. 2003 June; 44(3): 443-51. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12832999&dopt=Abstract
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Anesthesia for groin hernia surgery. Author(s): Amado WJ. Source: The Surgical Clinics of North America. 2003 October; 83(5): 1065-77. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14533904&dopt=Abstract
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Anesthesia for in vitro fertilization. Author(s): Sequeira PM. Source: International Anesthesiology Clinics. 2003 Spring; 41(2): 95-105. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12711917&dopt=Abstract
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Anesthesia for magnetic resonance imaging. Author(s): Gooden CK, Dilos B. Source: International Anesthesiology Clinics. 2003 Spring; 41(2): 29-37. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12711911&dopt=Abstract
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Anesthesia for off-pump coronary artery bypass grafting. Author(s): Michelsen LG, Horswell J. Source: Semin Thorac Cardiovasc Surg. 2003 January; 15(1): 71-82. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12813692&dopt=Abstract
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Anesthesia for pediatric patients with Prader-Willi syndrome: report of two cases. Author(s): Tseng CH, Chen C, Wong CH, Wong SY, Wong KM. Source: Chang Gung Med J. 2003 June; 26(6): 453-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12956294&dopt=Abstract
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Anesthesia in the cardiac catheterization lab. Author(s): Joe RR, Chen LQ. Source: Anesthesiology Clinics of North America. 2003 September; 21(3): 639-51. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14562570&dopt=Abstract
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Anesthesia management for spine surgery using spinal navigation in combination with computed tomography. Author(s): Fritz HG, Kuehn D, Haberland N, Kalff R. Source: Anesthesia and Analgesia. 2003 September; 97(3): 863-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12933417&dopt=Abstract
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Anesthesia of a patient with cured myasthenia gravis. Author(s): Basaranoglu G, Erden V, Delatioglu H. Source: Anesthesia and Analgesia. 2003 June; 96(6): 1842-3; Author Reply 1843. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12761029&dopt=Abstract
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Anesthesia options in cataract surgery. Author(s): Hoverkamp K. Source: Insight (American Society of Ophthalmic Registered Nurses). 2003 JanuaryMarch; 28(1): 8-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12703250&dopt=Abstract
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Anesthesia outside the operating room: general overview and monitoring standards. Author(s): Kotob F, Twersky RS. Source: International Anesthesiology Clinics. 2003 Spring; 41(2): 1-15. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12711909&dopt=Abstract
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Anesthesia related complications of laparoscopic cholecystectomy. Author(s): Qureshi FA. Source: J Coll Physicians Surg Pak. 2003 July; 13(7): 369-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12887833&dopt=Abstract
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Anesthesia-assisted opiate detoxification. Author(s): Gevirtz C. Source: International Anesthesiology Clinics. 2003 Spring; 41(2): 79-93. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12711916&dopt=Abstract
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Anesthesia--past, present and future. Author(s): Wong KC. Source: J Chin Med Assoc. 2003 March; 66(3): 135-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12779032&dopt=Abstract
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Anesthesia-related maternal mortality. Author(s): Hawkins JL. Source: Clinical Obstetrics and Gynecology. 2003 September; 46(3): 679-87. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12972749&dopt=Abstract
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Anesthesiologists and the education of dentists (and others) in anesthesia. Author(s): Schartel SA. Source: International Anesthesiology Clinics. 2003 Summer; 41(3): 103-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12872028&dopt=Abstract
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Anticoagulation and neuraxial regional anesthesia: perspectives. Author(s): Bergqvist D, Wu CL, Neal JM. Source: Regional Anesthesia and Pain Medicine. 2003 May-June; 28(3): 163-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12772132&dopt=Abstract
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Antiphospholipid antibody and anesthesia. Author(s): Kone A. Source: Acta Anaesthesiol Belg. 2003; 54(2): 169-71. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12872437&dopt=Abstract
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Aortic valve replacement in the conscious patient under regional anesthesia without endotracheal intubation. Author(s): Schachner T, Bonatti J, Balogh D, Margreiter J, Mair P, Laufer G, Putz G. Source: The Journal of Thoracic and Cardiovascular Surgery. 2003 June; 125(6): 1526-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12830075&dopt=Abstract
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Apples and oranges: the fruits of labor in anesthesia care. Author(s): Lagasse RS. Source: Anesthesiology. 2003 August; 99(2): 248-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12883394&dopt=Abstract
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Are you prepared for a shortage of anesthesia providers? Author(s): Rowland RG, Wofford DA. Source: Healthcare Financial Management : Journal of the Healthcare Financial Management Association. 2003 March; 57(3): 66-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12747055&dopt=Abstract
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ARX-derived auditory evoked potential index and bispectral index during the induction of anesthesia with propofol and remifentanil. Author(s): Schmidt GN, Bischoff P, Standl T, Issleib M, Voigt M, Schulte Am Esch J. Source: Anesthesia and Analgesia. 2003 July; 97(1): 139-44, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12818956&dopt=Abstract
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Assessing the pain reaction of children receiving periodontal ligament anesthesia using a computerized device (Wand). Author(s): Ran D, Peretz B. Source: J Clin Pediatr Dent. 2003 Spring; 27(3): 247-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12739685&dopt=Abstract
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Avoiding complications in local anesthesia induction: anatomical considerations. Author(s): Blanton PL, Jeske AH; ADA Council on Scientific Affairs; ADA Division of Science. Source: The Journal of the American Dental Association. 2003 July; 134(7): 888-93. Review. Summary for Patients In: http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12892447&dopt=Abstract
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Backache, headache, and neurologic deficit after regional anesthesia. Author(s): Munnur U, Suresh MS. Source: Anesthesiology Clinics of North America. 2003 March; 21(1): 71-86. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12698833&dopt=Abstract
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Belgian guidelines and recommendations for safe practice in obstetric anesthesia. Author(s): Belgian Association for Regional Anesthesia. Source: Acta Anaesthesiol Belg. 2003; 54(2): 119-25. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12872428&dopt=Abstract
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Bilateral intravenous regional anesthesia: a new method to test additives to local anesthetic solutions. Author(s): Hartmannsgruber MW, Plessmann S, Atanassoff PG. Source: Anesthesiology. 2003 June; 98(6): 1427-30; Discussion 6A. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12766653&dopt=Abstract
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Can anesthesia improve the outcome in high risk obstertric patients? Author(s): Lyons G. Source: Middle East J Anesthesiol. 2003 February; 17(1): 71-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12754772&dopt=Abstract
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Can we explain the high incidence of cardiac arrest during spinal anesthesia for hip surgery? Author(s): Pollard JB. Source: Anesthesiology. 2003 September; 99(3): 754-5; Author Reply 755. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12960565&dopt=Abstract
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Cerebral blood flow velocity alterations, under two different carbon dioxide management strategies, during sevoflurane anesthesia in gynecological laparoscopic surgery. Author(s): Papadimitriou LS, Livanios SH, Moka EG, Demesticha TD, Papadimitriou JD. Source: Neurological Research. 2003 June; 25(4): 361-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12870262&dopt=Abstract
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Changes in the provision of anesthesia for the parturient undergoing cesarean section. Author(s): Gaiser RR. Source: Clinical Obstetrics and Gynecology. 2003 September; 46(3): 646-56. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12972746&dopt=Abstract
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Chromatographic determination of free lidocaine and its active metabolites in plasma from patients under epidural anesthesia. Author(s): Kakiuchi Y, Fukuda T, Miyabe M, Homma M, Toyooka H, Kohda Y. Source: Int J Clin Pharmacol Ther. 2002 November; 40(11): 493-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12698986&dopt=Abstract
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Clinical manifestations of latex anaphylaxis during anesthesia differ from those not anesthesia/surgery-related. Author(s): Brock-Utne JG. Source: Anesthesia and Analgesia. 2003 October; 97(4): 1204; Author Reply 1204-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14500193&dopt=Abstract
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Clonidine combined with small-dose bupivacaine during spinal anesthesia for inguinal herniorrhaphy: a randomized double-blinded study. Author(s): Dobrydnjov I, Axelsson K, Thorn SE, Matthiesen P, Klockhoff H, Holmstrom B, Gupta A. Source: Anesthesia and Analgesia. 2003 May; 96(5): 1496-503, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12707157&dopt=Abstract
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Closed-circuit anesthesia prolongs the neuromuscular blockade of rocuronium. Author(s): Yeh CC, Kong SS, Chang FL, Huang GS, Ho ST, Wu CT, Wong CS. Source: Acta Anaesthesiol Sin. 2003 June; 41(2): 55-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12934417&dopt=Abstract
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Coagulopathy and obstetric anesthesia. Author(s): Benhamou D. Source: Acta Anaesthesiol Belg. 2003; 54(2): 151-5. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12872432&dopt=Abstract
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Colpocleisis and tension-free vaginal tape sling for severe uterine and vaginal prolapse and stress urinary incontinence under local anesthesia. Author(s): Moore RD, Miklos JR. Source: The Journal of the American Association of Gynecologic Laparoscopists. 2003 May; 10(2): 276-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12732784&dopt=Abstract
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Combined spinal/epidural anesthesia. Author(s): Hodgson E. Source: Middle East J Anesthesiol. 2003 February; 17(1): 103-12. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12754775&dopt=Abstract
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Combined topical anesthesia and sedation for open-globe injuries in selected patients. Author(s): Boscia F, La Tegola MG, Columbo G, Alessio G, Sborgia C. Source: Ophthalmology. 2003 August; 110(8): 1555-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12917172&dopt=Abstract
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Comments on anesthesia for cataract surgery. Author(s): Leo SW, Au Eong KG. Source: Journal of Cataract and Refractive Surgery. 2003 April; 29(4): 633-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12686218&dopt=Abstract
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Comparison of the effects of neuroleptanesthesia and enflurane or sevoflurane anesthesia on neuromuscular blockade by rocuronium. Author(s): Gungor I, Bozkirli F, Celebi H, Gunaydin B. Source: Journal of Anesthesia. 2003; 17(2): 129-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12903925&dopt=Abstract
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Complications of regional anesthesia in obstetrics. Author(s): Wlody D. Source: Clinical Obstetrics and Gynecology. 2003 September; 46(3): 667-78. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12972748&dopt=Abstract
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Computerize anesthesia record keeping in thoracic surgery--suitability of electronic anesthesia records in evaluating predictors for hypoxemia during one-lung ventilation. Author(s): Sticher J, Junger A, Hartmann B, Benson M, Jost A, Golinski M, Scholz S, Hempelmann G. Source: Journal of Clinical Monitoring and Computing. 2002 August; 17(6): 335-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12885177&dopt=Abstract
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Confirmation of direct epidural catheter placement using nerve stimulation in pediatric anesthesia. Author(s): Goobie SM, Montgomery CJ, Basu R, McFadzean J, O'Connor GJ, Poskitt K, Tsui BC. Source: Anesthesia and Analgesia. 2003 October; 97(4): 984-8, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14500145&dopt=Abstract
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Confounding factors in infant pain assessment during recovery from anesthesia. Author(s): Neu M, Fuller BF. Source: Journal for Specialists in Pediatric Nursing : Jspn. 2003 April-June; 8(2): 45-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12875172&dopt=Abstract
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Conscious analgesia/sedation with remifentanil and propofol versus total intravenous anesthesia with fentanyl, midazolam, and propofol for outpatient colonoscopy. Author(s): Rudner R, Jalowiecki P, Kawecki P, Gonciarz M, Mularczyk A, Petelenz M. Source: Gastrointestinal Endoscopy. 2003 May; 57(6): 657-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12709693&dopt=Abstract
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Controversial issues in ambulatory anesthesia. Author(s): Chikungwa M, Smith I. Source: Anesthesiology Clinics of North America. 2003 June; 21(2): 313-27, Ix. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12812398&dopt=Abstract
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Coronary artery spasm during initiation of epidural anesthesia. Author(s): Easley RB, Rosen RE, Lindeman KS. Source: Anesthesiology. 2003 October; 99(4): 1015-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14508337&dopt=Abstract
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Current issues in pediatric ambulatory anesthesia. Author(s): Fishkin S, Litman RS. Source: Anesthesiology Clinics of North America. 2003 June; 21(2): 305-11, Ix. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12812397&dopt=Abstract
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Delayed hypoxemia after bone cement insertion during total hip replacement under spinal anesthesia--a case report. Author(s): Hong CL, Liu HP, Wu CY, Ho AC, Shyr MH, Wong CH, Chun HS. Source: Acta Anaesthesiol Sin. 2003 March; 41(1): 47-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12747348&dopt=Abstract
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Description of the oxygen concentration delivered using different combinations of oxygen reservoir volumes and supplemental oxygen flow rates with the Ohmeda Universal Portable Anesthesia Complete draw-over vaporizer system. Author(s): Fritz LA, Kay JK, Garrett N. Source: Military Medicine. 2003 April; 168(4): 304-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12733675&dopt=Abstract
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Diabetic patients have an impaired cerebral vasodilatory response to hypercapnia under propofol anesthesia. Author(s): Kadoi Y, Hinohara H, Kunimoto F, Saito S, Ide M, Hiraoka H, Kawahara F, Goto F. Source: Stroke; a Journal of Cerebral Circulation. 2003 October; 34(10): 2399-403. Epub 2003 September 04. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12958324&dopt=Abstract
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Differing incidences of relevant hypotension with combined spinal-epidural anesthesia and spinal anesthesia. Author(s): Klasen J, Junger A, Hartmann B, Benson M, Jost A, Banzhaf A, Kwapisz M, Hempelmann G. Source: Anesthesia and Analgesia. 2003 May; 96(5): 1491-5, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12707156&dopt=Abstract
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Direction and side used to determine the extent of sensory block after subarachnoid anesthesia do not influence the level of the block. Author(s): Fassoulaki A, Zotou M, Pourgiezi T, Siafaka I, Hogan Q. Source: Acta Anaesthesiol Belg. 2003; 54(1): 33-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12703344&dopt=Abstract
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Educating patients about anesthesia: a systematic review of randomized controlled trials of media-based interventions. Author(s): Lee A, Chui PT, Gin T. Source: Anesthesia and Analgesia. 2003 May; 96(5): 1424-31, Table of Contents. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12707146&dopt=Abstract
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Effect of anesthesia on voiding function after tension-free vaginal tape procedure. Author(s): Murphy M, Heit MH, Fouts L, Graham CA, Blackwell L, Culligan PJ. Source: Obstetrics and Gynecology. 2003 April; 101(4): 666-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12681868&dopt=Abstract
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Effect of increasing depth of propofol anesthesia on upper airway configuration in children. Author(s): Evans RG, Crawford MW, Noseworthy MD, Yoo SJ. Source: Anesthesiology. 2003 September; 99(3): 596-602. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12960543&dopt=Abstract
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Effects of anesthesia on linguistic skills. Author(s): Bryan Y, Glick D. Source: Anesthesia and Analgesia. 2003 May; 96(5): 1534. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12707175&dopt=Abstract
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Effects of TMJ anesthesia and jaw gape on jaw-stretch reflexes in humans. Author(s): Lobbezoo F, Wang K, Aartman IH, Svensson P. Source: Clinical Neurophysiology : Official Journal of the International Federation of Clinical Neurophysiology. 2003 September; 114(9): 1656-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12948794&dopt=Abstract
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Efficacy of 1% ropivacaine at sacral segments in lumbar epidural anesthesia. Author(s): Arakawa M, Aoyama Y, Ohe Y. Source: Regional Anesthesia and Pain Medicine. 2003 May-June; 28(3): 208-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12772138&dopt=Abstract
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Efficacy of anterior and middle superior alveolar (AMSA) anesthesia using a new injection system: the Wand. Author(s): Fukayama H, Yoshikawa F, Kohase H, Umino M, Suzuki N. Source: Quintessence Int. 2003 July-August; 34(7): 537-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12946073&dopt=Abstract
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Electroencephalographic burst suppression versus loss of reflexes anesthesia with propofol or thiopental: differences of variance in the catecholamine and cardiovascular response to tracheal intubation. Author(s): Mustola ST, Baer GA, Toivonen JK, Salomaki A, Scheinin M, Huhtala H, Laippala P, Jantti V. Source: Anesthesia and Analgesia. 2003 October; 97(4): 1040-5, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14500154&dopt=Abstract
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Electromyographic assessment of blink and corneal reflexes during midazolam administration: useful methods for assessing depth of anesthesia? Author(s): Mourisse J, Gerrits W, Lerou J, van Egmond J, Zwarts MJ, Booij L. Source: Acta Anaesthesiologica Scandinavica. 2003 May; 47(5): 593-600. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12699519&dopt=Abstract
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Elevated inspiratory CO2 concentrations caused by the design of an anesthesia machine. Author(s): Sperl K, Johr M. Source: Acta Anaesthesiologica Scandinavica. 2003 April; 47(4): 496. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12694161&dopt=Abstract
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Ephedrine, but not phenylephrine, increases bispectral index values during combined general and epidural anesthesia. Author(s): Ishiyama T, Oguchi T, Iijima T, Matsukawa T, Kashimoto S, Kumazawa T. Source: Anesthesia and Analgesia. 2003 September; 97(3): 780-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12933402&dopt=Abstract
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Epidural abscess after epidural anesthesia and continuous epidural analgesia in a patient with gastric lymphoma. Author(s): Hernandez JM, Coyle FP, Wright CD, Ballantyne JC. Source: Journal of Clinical Anesthesia. 2003 February; 15(1): 48-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12693415&dopt=Abstract
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Epidural anesthesia does not increase the incidences of urinary retention and hesitancy in micturition after ambulatory hemorrhoidectomy. Author(s): Kau YC, Lee YH, Li JY, Chen C, Wong SY, Wong TK. Source: Acta Anaesthesiol Sin. 2003 June; 41(2): 61-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12934418&dopt=Abstract
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Ethical issue: The patient undergoes surgery that she knows will not benefit her, hoping that she will die in the process while under anesthesia. Author(s): Basta LL. Source: The American Journal of Geriatric Cardiology. 2003 May-June; 12(3): 207-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12732818&dopt=Abstract
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Ethics: an essential dimension of clinical obstetric anesthesia. Author(s): Chervenak FA, McCullough LB, Birnbach DJ. Source: Anesthesia and Analgesia. 2003 May; 96(5): 1480-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12707153&dopt=Abstract
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Excision of thrombosed external hemorrhoid under local anesthesia: a retrospective evaluation of 340 patients. Author(s): Jongen J, Bach S, Stubinger SH, Bock JU. Source: Diseases of the Colon and Rectum. 2003 September; 46(9): 1226-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12972967&dopt=Abstract
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Expansion of nurse anesthesia educational programs: where are the barriers? Author(s): Fiedler MA. Source: Aana Journal. 2003 February; 71(1): 9; Author Reply 9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12776643&dopt=Abstract
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Factors related to patient satisfaction regarding spinal anesthesia. Author(s): Charuluxananan S, Sriprajittichai P, Sirichotvithyakorn P, Rodanant O, Kyokong O. Source: J Med Assoc Thai. 2003 June; 86 Suppl 2: S338-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12930008&dopt=Abstract
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Forearm rescue cuff improves tourniquet tolerance during intravenous regional anesthesia. Author(s): Perlas A, Peng PW, Plaza MB, Middleton WJ, Chan VW, Sanandaji K. Source: Regional Anesthesia and Pain Medicine. 2003 March-April; 28(2): 98-102. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12677618&dopt=Abstract
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Free lidocaine concentrations during continuous epidural anesthesia in geriatric patients. Author(s): Fukuda T, Kakiuchi Y, Miyabe M, Kihara S, Kohda Y, Toyooka H. Source: Regional Anesthesia and Pain Medicine. 2003 May-June; 28(3): 215-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12772139&dopt=Abstract
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Full-face laser resurfacing using a supplemented topical anesthesia protocol. Author(s): Kilmer SL, Chotzen V, Zelickson BD, McClaren M, Silva S, Calkin J, No D. Source: Archives of Dermatology. 2003 October; 139(10): 1279-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14568831&dopt=Abstract
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Galactosialidosis: a unique disease with significant clinical implications during perioperative anesthesia management. Author(s): Friedhoff RJ, Rose SH, Brown MJ, Long TR, Wass CT. Source: Anesthesia and Analgesia. 2003 July; 97(1): 53-5, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12818943&dopt=Abstract
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General anesthesia or sedation in the intensive care unit: are we aware of the difference when we use propofol? Author(s): Bloomfield EL, Murray MJ. Source: Critical Care Medicine. 2003 May; 31(5): 1603. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12771655&dopt=Abstract
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Genioglossus advancement and hyoid myotomy under local anesthesia. Author(s): Neruntarat C. Source: Otolaryngology and Head and Neck Surgery. 2003 July; 129(1): 85-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12869922&dopt=Abstract
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Guidelines on anticoagulants and the use of locoregional anesthesia. Author(s): Vandermeulen E. Source: Minerva Anestesiol. 2003 May; 69(5): 407-11. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12768175&dopt=Abstract
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Hemodynamic differences in sevoflurane versus propofol anesthesia. Author(s): Husedzinovic I, Tonkovic D, Barisin S, Bradic N, Gasparovic S. Source: Coll Antropol. 2003 June; 27(1): 205-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12974148&dopt=Abstract
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History of the development and evolution of local anesthesia since the coca leaf. Author(s): Calatayud J, Gonzalez A. Source: Anesthesiology. 2003 June; 98(6): 1503-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12766665&dopt=Abstract
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Ho: Yag laser-assisted lumbar disc decompression: a minimally invasive procedure under local anesthesia. Author(s): Agarwal S, Bhagwat AS. Source: Neurology India. 2003 March; 51(1): 35-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12865512&dopt=Abstract
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How have perioperative anesthesia procedures changed? More monitoring is better? A question of common sense. Author(s): Montanini S, Puliatti F. Source: Minerva Anestesiol. 2003 January-February; 69(1-2): 1-2, 3-4. English, Italian. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12677159&dopt=Abstract
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Hyoid myotomy with suspension under local anesthesia for obstructive sleep apnea syndrome. Author(s): Neruntarat C. Source: Eur Arch Otorhinolaryngol. 2003 May;260(5):286-90. Epub 2002 December 05. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12750922&dopt=Abstract
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Immediate extubation after aortic valve surgery using high thoracic epidural anesthesia: a pilot study. Author(s): Hemmerling TM, Choiniere JL, Fortier JD, Prieto I, Basile F. Source: Anesthesia and Analgesia. 2003 August; 97(2): 601. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12873961&dopt=Abstract
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Inhalational anesthetic technique in microlaryngeal surgery: a comparison between sevoflurane-remifentanil and sevoflurane-alfentanil anesthesia. Author(s): Pandazi AK, Louizos AA, Davilis DJ, Stivaktakis JM, Georgiou LG. Source: The Annals of Otology, Rhinology, and Laryngology. 2003 April; 112(4): 373-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12731635&dopt=Abstract
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Inhalational techniques in ambulatory anesthesia. Author(s): Joshi GP. Source: Anesthesiology Clinics of North America. 2003 June; 21(2): 263-72. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12812394&dopt=Abstract
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Interleukin balance and early recovery from anesthesia in elderly surgical patients exposed to beta-adrenergic antagonism. Author(s): Shyong EQ, Lucchinetti E, Tagliente TM, Hossain S, Silverstein JH, Zaugg M. Source: Journal of Clinical Anesthesia. 2003 May; 15(3): 170-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12770651&dopt=Abstract
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Interscalene brachial plexus anesthesia and analgesia for open shoulder surgery: what about pharmacokinetics? Author(s): Nadig M, Blumenthal S, Ekatodramis G, Borgeat A. Source: Anesthesia and Analgesia. 2003 August; 97(2): 605-6; Author Reply 606. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12873967&dopt=Abstract
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Intervertebral epidural anesthesia in 2,050 infants and children using the drip and tube method. Author(s): Osaka Y, Yamashita M. Source: Regional Anesthesia and Pain Medicine. 2003 March-April; 28(2): 103-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12677619&dopt=Abstract
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Intraocular pressure changes during laparoscopy in patients anesthetized with propofol total intravenous anesthesia versus isoflurane inhaled anesthesia. Author(s): Mowafi HA, Al-Ghamdi A, Rushood A. Source: Anesthesia and Analgesia. 2003 August; 97(2): 471-4, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12873937&dopt=Abstract
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Intraoperative changes in arterial oxygenation during volume-controlled mechanical ventilation in modestly obese patients undergoing laparotomies with general anesthesia. Author(s): Yoshino J, Akata T, Takahashi S. Source: Acta Anaesthesiologica Scandinavica. 2003 July; 47(6): 742-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12803594&dopt=Abstract
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Intraoperative epidural anesthesia and postoperative analgesia with levobupivacaine for major orthopedic surgery: a double-blind, randomized comparison of racemic bupivacaine and ropivacaine. Author(s): Casati A, Santorsola R, Aldegheri G, Ravasi F, Fanelli G, Berti M, Fraschini G, Torri G. Source: Journal of Clinical Anesthesia. 2003 March; 15(2): 126-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12719052&dopt=Abstract
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Intraoperative resource utilization in anesthesia for liver transplantation in the United States: a survey. Author(s): Schumann R. Source: Anesthesia and Analgesia. 2003 July; 97(1): 21-8, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12818937&dopt=Abstract
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Intraosseous anesthesia: implications, instrumentation and techniques. Author(s): Kleber CH. Source: The Journal of the American Dental Association. 2003 April; 134(4): 487-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12733784&dopt=Abstract
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Intrapocket anesthesia for scaling and root planing in pain-sensitive patients. Author(s): Magnusson L, Geurs NC, Harris PA, Hefti AF, Mariotti AJ, Mauriello SM, Soler L, Offenbacher S. Source: J Periodontol. 2003 May; 74(5): 597-602. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12828139&dopt=Abstract
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Intravenous anesthesia provides optimal surgical conditions during microscopic and endoscopic sinus surgery. Author(s): Eberhart LH, Folz BJ, Wulf H, Geldner G. Source: The Laryngoscope. 2003 August; 113(8): 1369-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12897561&dopt=Abstract
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Intravenous lidocaine as adjuvant to sevoflurane anesthesia for endotracheal intubation in children. Author(s): Aouad MT, Sayyid SS, Zalaket MI, Baraka AS. Source: Anesthesia and Analgesia. 2003 May; 96(5): 1325-7, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12707127&dopt=Abstract
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Intravenous procedural sedation: an alternative to general anesthesia in the treatment of early childhood caries. Author(s): Milnes AR. Source: Journal (Canadian Dental Association). 2003 May; 69(5): 298-302. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12734023&dopt=Abstract
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Intravenous sedation vs general anesthesia for pediatric otolaryngology procedures. Author(s): Shiley SG, Lalwani K, Milczuk HA. Source: Archives of Otolaryngology--Head & Neck Surgery. 2003 June; 129(6): 637-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12810468&dopt=Abstract
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Intravenous techniques in ambulatory anesthesia. Author(s): Tesniere A, Servin F. Source: Anesthesiology Clinics of North America. 2003 June; 21(2): 273-88. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12812395&dopt=Abstract
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Is regional anesthesia simply an exercise in applied sonoanatomy?: aiming at higher frequencies of ultrasonographic imaging. Author(s): Greher M, Kapral S. Source: Anesthesiology. 2003 August; 99(2): 250-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12883395&dopt=Abstract
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Labyrinth anesthesia--a forgotten but practical treatment option in Meniere's disease. Author(s): Adunka O, Moustaklis E, Weber A, May A, von Ilberg C, Gstoettner W, Kierner AC. Source: Orl; Journal for Oto-Rhino-Laryngology and Its Related Specialties. 2003 MarchApril; 65(2): 84-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12824729&dopt=Abstract
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Laryngeal mask anesthesia in children: a case report. Author(s): Ross B, Vater Y, Dembo G, Hunter C, Martay K. Source: Aana Journal. 2003 August; 71(4): 285-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=13677223&dopt=Abstract
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Lidocaine iontophoresis for local anesthesia before shave biopsy. Author(s): Zempsky WT, Parkinson TM. Source: Dermatologic Surgery : Official Publication for American Society for Dermatologic Surgery [et Al.]. 2003 June; 29(6): 627-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12786707&dopt=Abstract
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Lidocaine priming reduces tourniquet pain during intravenous regional anesthesia: A preliminary study. Author(s): Estebe JP, Gentili ME, Langlois G, Mouilleron P, Bernard F, Ecoffey C. Source: Regional Anesthesia and Pain Medicine. 2003 March-April; 28(2): 120-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12677622&dopt=Abstract
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Linear and nonlinear analysis of heart rate variability during propofol anesthesia for short-duration procedures in children. Author(s): Toweill DL, Kovarik WD, Carr R, Kaplan D, Lai S, Bratton S, Goldstein B. Source: Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. 2003 July; 4(3): 308-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12831412&dopt=Abstract
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Local anesthesia and midazolam versus spinal anesthesia in ambulatory pilonidal surgery. Author(s): Sungurtekin H, Sungurtekin U, Erdem E. Source: Journal of Clinical Anesthesia. 2003 May; 15(3): 201-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12770656&dopt=Abstract
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Local anesthesia for surgical drain removal: a prospective, randomized, double-blind, patient-controlled study. Author(s): Rayatt S, Rimmer J, Khanna A. Source: Plastic and Reconstructive Surgery. 2003 October; 112(5): 1493-4; Author Reply 1494. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14504549&dopt=Abstract
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Local or general anesthesia for open hernia repair: a randomized trial. Author(s): O'Dwyer PJ, Serpell MG, Millar K, Paterson C, Young D, Hair A, Courtney CA, Horgan P, Kumar S, Walker A, Ford I. Source: Annals of Surgery. 2003 April; 237(4): 574-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12677155&dopt=Abstract
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Local versus general anesthesia for carotid endarterectomy: report of 329 cases. Author(s): Gurer O, Yapici F, Enc Y, Cinar B, Ketenci B, Ozler A. Source: Vascular and Endovascular Surgery. 2003 May-June; 37(3): 171-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12799725&dopt=Abstract
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Mechanisms of anesthesia: towards integrating network, cellular, and molecular level modeling. Author(s): Arhem P, Klement G, Nilsson J. Source: Neuropsychopharmacology : Official Publication of the American College of Neuropsychopharmacology. 2003 July; 28 Suppl 1: S40-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12827143&dopt=Abstract
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Midazolam, spinal anesthesia, and myoclonic jerks. Author(s): Galeone M, Montreuil B, Stewart J, Schricker T. Source: Anesthesia and Analgesia. 2003 September; 97(3): 921-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12933436&dopt=Abstract
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Modern draw-over anesthetic vaporizers used to deliver anesthesia in austere and battlefield conditions. Author(s): Reynolds PC, Furukawa KT. Source: Military Medicine. 2003 May; 168(5): Ii-Iii. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12775161&dopt=Abstract
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Mortality risks associated with pediatric dental care using general anesthesia in a hospital setting. Author(s): Lee JY, Roberts MW. Source: J Clin Pediatr Dent. 2003 Summer; 27(4): 381-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12924740&dopt=Abstract
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Mutism as a complication of total intravenous anesthesia by propofol. Author(s): Srinivasa V, Gerner P, Eappen S. Source: Anesthesia and Analgesia. 2003 July; 97(1): 292. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12818988&dopt=Abstract
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Narcotrend monitoring allows faster emergence and a reduction of drug consumption in propofol-remifentanil anesthesia. Author(s): Kreuer S, Biedler A, Larsen R, Altmann S, Wilhelm W. Source: Anesthesiology. 2003 July; 99(1): 34-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12826839&dopt=Abstract
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Necrosis of the eyelids and sclera after retrobulbar anesthesia. Author(s): Sharma A, Gupta A, Bandyopadhyay S, Vinekar AS, Ram J, Dogra MR, Gupta A. Source: Journal of Cataract and Refractive Surgery. 2003 April; 29(4): 842-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12686260&dopt=Abstract
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Needle and trocar injuries in diagnostic laparoscopy under local anesthesia: what is the true incidence of these complications? Author(s): Orlando R, Palatini P, Lirussi F. Source: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A. 2003 June; 13(3): 181-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12855100&dopt=Abstract
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Nurse anesthesia. The time has come. Author(s): Schreiber R, MacDonald M. Source: Can Nurse. 2003 June; 99(6): 20-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12858670&dopt=Abstract
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Nurse-administered propofol sedation without anesthesia specialists in 9152 endoscopic cases in an ambulatory surgery center. Author(s): Walker JA, McIntyre RD, Schleinitz PF, Jacobson KN, Haulk AA, Adesman P, Tolleson S, Parent R, Donnelly R, Rex DK. Source: The American Journal of Gastroenterology. 2003 August; 98(8): 1744-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12907328&dopt=Abstract
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Office-based ambulatory anesthesia: outcomes of clinical practice of oral and maxillofacial surgeons. Author(s): Perrott DH, Yuen JP, Andresen RV, Dodson TB. Source: Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons. 2003 September; 61(9): 983-95; Discussion 995-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12966471&dopt=Abstract
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Office-based anesthesia: an overview. Author(s): Koch ME, Dayan S, Barinholtz D. Source: Anesthesiology Clinics of North America. 2003 June; 21(2): 417-43. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12812404&dopt=Abstract
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One-minute schirmer test with anesthesia. Author(s): Bawazeer AM, Hodge WG. Source: Cornea. 2003 May; 22(4): 285-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12792467&dopt=Abstract
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One-stop surgery in pediatric surgery. Aspects of anesthesia. Preliminary report. Author(s): Astuto M, Disma N, Sentina P, Sanges G. Source: Minerva Anestesiol. 2003 March; 69(3): 137-42, 142-44. English, Italian. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12792582&dopt=Abstract
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Paravertebral block: an alternative to general anesthesia in breast cancer surgery. Author(s): Najarian MM, Johnson JM, Landercasper J, Havlik P, Lambert PJ, McCarthy D. Source: The American Surgeon. 2003 March; 69(3): 213-8; Discussion 218. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12678477&dopt=Abstract
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Patient comfort during clear corneal phacoemulsification with sub-Tenon's local anesthesia. Author(s): Mathew MR, Williams A, Esakowitz L, Webb LA, Murray SB, Bennett HG. Source: Journal of Cataract and Refractive Surgery. 2003 June; 29(6): 1132-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12842680&dopt=Abstract
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Patient outcomes following ambulatory anesthesia. Author(s): Deutsch N, Wu CL. Source: Anesthesiology Clinics of North America. 2003 June; 21(2): 403-15. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12812403&dopt=Abstract
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Patient safety in anesthesia practice: partnerships that make the impossible routine. Author(s): Assael LA. Source: Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons. 2003 September; 61(9): 981-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12966470&dopt=Abstract
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Patients with severe preeclampsia experience less hypotension during spinal anesthesia for elective cesarean delivery than healthy parturients: a prospective cohort comparison. Author(s): Aya AG, Mangin R, Vialles N, Ferrer JM, Robert C, Ripart J, de La Coussaye JE. Source: Anesthesia and Analgesia. 2003 September; 97(3): 867-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12933418&dopt=Abstract
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Pediatric anesthesia--a review of current progress. Author(s): Hatch D. Source: Middle East J Anesthesiol. 2003 February; 17(1): 59-69. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12754771&dopt=Abstract
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Performance and accountability in anesthesia. Author(s): Hatch D. Source: Middle East J Anesthesiol. 2003 February; 17(1): 9-17. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12754768&dopt=Abstract
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Phacoemulsification with transpupillary silicone oil removal and lens implantation through a corneal incision using topical anesthesia. Author(s): Boscia F, Recchimurzo N, Cardascia N, Sborgia L, Ferrari TM, Sborgia C. Source: Journal of Cataract and Refractive Surgery. 2003 June; 29(6): 1113-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12842677&dopt=Abstract
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Pharmacologic platelet anesthesia by glycoprotein IIb/IIIa complex antagonist and argatroban during in vitro extracorporeal circulation. Author(s): Kanemitsu S, Nishikawa M, Onoda K, Shimono T, Shimpo H, Yazaki A, Tanaka K, Shiku H, Yada I. Source: The Journal of Thoracic and Cardiovascular Surgery. 2003 August; 126(2): 42835. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12928640&dopt=Abstract
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Preoperative combined with intraoperative skin-surface warming avoids hypothermia caused by general anesthesia and surgery. Author(s): Vanni SM, Braz JR, Modolo NS, Amorim RB, Rodrigues GR Jr. Source: Journal of Clinical Anesthesia. 2003 March; 15(2): 119-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12719051&dopt=Abstract
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Preoperative risk factors of intraoperative hypothermia in major surgery under general anesthesia. Author(s): Moons KG, van Klei W, Kalkman CJ. Source: Anesthesia and Analgesia. 2003 June; 96(6): 1843-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12761031&dopt=Abstract
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Propofol and sufentanil titration with the bispectral index to provide anesthesia for coronary artery surgery. Author(s): Forestier F, Hirschi M, Rouget P, Rigal JC, Videcoq M, Girardet P, Durand M, Maitrasse B, Girard C, Lehot JJ, Du Gres B, Sellin M, Depoix JP, Janvier G, Longrois D. Source: Anesthesiology. 2003 August; 99(2): 334-46. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12883406&dopt=Abstract
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Propofol ketamine anesthesia for cosmetic surgery in the office suite. Author(s): Friedberg BL. Source: International Anesthesiology Clinics. 2003 Spring; 41(2): 39-50. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12711912&dopt=Abstract
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Propofol or sevoflurane anesthesia without muscle relaxants allow the early extubation of myasthenic patients. Author(s): Della Rocca G, Coccia C, Diana L, Pompei L, Costa MG, Tomaselli E, Di Marco P, Vilardi V, Pietropaoli P. Source: Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 2003 JuneJuly; 50(6): 547-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12826544&dopt=Abstract
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Prospective, randomized trial comparing general with spinal anesthesia for cesarean delivery in preeclamptic patients with a nonreassuring fetal heart trace. Author(s): Dyer RA, Els I, Farbas J, Torr GJ, Schoeman LK, James MF. Source: Anesthesiology. 2003 September; 99(3): 561-9; Discussion 5A-6A. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12960539&dopt=Abstract
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Rapid anesthesia: three sure-fire paths to rapid, profound, predictable anesthesia. Author(s): Perkins S. Source: Dent Today. 2002 February; 21(2): 112-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14508999&dopt=Abstract
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Re: Editorial--Where is the line between deep sedation and general anesthesia? Author(s): Wengrower D, Goldin E, Gozal D. Source: The American Journal of Gastroenterology. 2003 July; 98(7): 1667. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12873611&dopt=Abstract
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Reduction of potential respiratory pathogens by oral hygienic treatment in patients undergoing endotracheal anesthesia. Author(s): Okuda M, Kaneko Y, Ichinohe T, Ishihara K, Okuda K. Source: Journal of Anesthesia. 2003; 17(2): 84-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12903918&dopt=Abstract
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Regarding “Hemodynamic benefits of regional anesthesia for carotid endarterectomy”. Author(s): Mehta M, Veith FJ. Source: Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter. 2003 May; 37(5): 1134. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12756368&dopt=Abstract
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Regional anesthesia and analgesia for labor and delivery. Author(s): Zwissler B. Source: The New England Journal of Medicine. 2003 May 1; 348(18): 1818-20; Author Reply 1818-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12728920&dopt=Abstract
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Regional anesthesia and analgesia for labor and delivery. Author(s): Van de Velde M, Teunkens A, Vandermeersch E. Source: The New England Journal of Medicine. 2003 May 1; 348(18): 1818-20; Author Reply 1818-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12728919&dopt=Abstract
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Regional anesthesia and analgesia for labor and delivery. Author(s): Jakobi P, Solt I, Zimmer EZ. Source: The New England Journal of Medicine. 2003 May 1; 348(18): 1818-20; Author Reply 1818-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12724495&dopt=Abstract
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Regional anesthesia for outpatient surgery. Author(s): Mulroy MF, McDonald SB. Source: Anesthesiology Clinics of North America. 2003 June; 21(2): 289-303. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12812396&dopt=Abstract
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Regional anesthesia in the anticoagulated patient: defining the risks (the second ASRA Consensus Conference on Neuraxial Anesthesia and Anticoagulation). Author(s): Horlocker TT, Wedel DJ, Benzon H, Brown DL, Enneking FK, Heit JA, Mulroy MF, Rosenquist RW, Rowlingson J, Tryba M, Yuan CS. Source: Regional Anesthesia and Pain Medicine. 2003 May-June; 28(3): 172-97. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12772135&dopt=Abstract
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Reproducible hepatic dysfunction following separate anesthesia with sevoflurane and desflurane. Author(s): Chung PC, Chiou SC, Lien JM, Li AH, Wong CH. Source: Chang Gung Med J. 2003 May; 26(5): 357-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12934853&dopt=Abstract
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Reversal of visceral and cutaneous hyperalgesia by local rectal anesthesia in irritable bowel syndrome (IBS) patients. Author(s): Verne GN, Robinson ME, Vase L, Price DD. Source: Pain. 2003 September; 105(1-2): 223-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14499439&dopt=Abstract
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Sacral osteomyelitis after single-shot epidural anesthesia via the caudal approach in a child. Author(s): Wittum S, Hofer CK, Rolli U, Suhner M, Gubler J, Zollinger A. Source: Anesthesiology. 2003 August; 99(2): 503-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12883426&dopt=Abstract
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Safety of low-flow sevoflurane anesthesia in patients with chronically impaired renal function is not proven. Author(s): Saidman LJ, Eger EI. Source: Anesthesiology. 2003 September; 99(3): 752; Author Reply 752-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12960564&dopt=Abstract
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Severe bradycardia during spinal and epidural anesthesia recorded by an anesthesia information management system. Author(s): Lesser JB, Sanborn KV, Valskys R, Kuroda M. Source: Anesthesiology. 2003 October; 99(4): 859-66. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14508318&dopt=Abstract
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Sevoflurane requirements to suppress responses to transcutaneous electrical stimulation during epidural anesthesia with 0.5% and 1% lidocaine. Author(s): Shono A, Saito Y, Sakura S, Doi K, Yokokawa N. Source: Anesthesia and Analgesia. 2003 October; 97(4): 1168-72, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14500176&dopt=Abstract
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Should a mucoadhesive patch (DentiPatch) be used for gingival anesthesia in children? Author(s): Stecker SS, Swift JQ, Hodges JS, Erickson PR. Source: Anesthesia Progress. 2002 Winter; 49(1): 3-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12779107&dopt=Abstract
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Sino-atrial block during anesthesia in a patient with breast cancer being treated with the anticancer drug epirubicin. Author(s): Okamoto T, Ogata J, Minami K. Source: Anesthesia and Analgesia. 2003 July; 97(1): 19-20, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12818936&dopt=Abstract
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Sodium pentobarbital anesthesia transiently enhances the severity of infection following intragastric, but not intravenous, inoculation of Listeria monocytogenes in mice. Author(s): Czuprynski CJ, Faith NG, Steinberg H, Neudeck B. Source: Microbial Pathogenesis. 2003 August; 35(2): 81-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12901847&dopt=Abstract
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Some open questions in pediatric regional anesthesia. Author(s): Dalens B. Source: Minerva Anestesiol. 2003 May; 69(5): 451-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12768183&dopt=Abstract
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Spinal and epidural versus general anesthesia for elective cesarean section at term: effect on the acid-base status of the mother and newborn. Author(s): Petropoulos G, Siristatidis C, Salamalekis E, Creatsas G. Source: J Matern Fetal Neonatal Med. 2003 April;13(4):260-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12854928&dopt=Abstract
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Spinal anesthesia for cesarean delivery in a woman with a surgically corrected type I Arnold Chiari malformation. Author(s): Landau R, Giraud R, Delrue V, Kern C. Source: Anesthesia and Analgesia. 2003 July; 97(1): 253-5, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12818976&dopt=Abstract
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Spinal anesthesia for magnetic resonance imaging examination. Author(s): Gozal D, Gozal Y. Source: Anesthesiology. 2003 September; 99(3): 764. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12960576&dopt=Abstract
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Spinal anesthesia in the parturient with severe preeclampsia: time for reconsideration. Author(s): Santos AC, Birnbach DJ. Source: Anesthesia and Analgesia. 2003 September; 97(3): 621-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12933372&dopt=Abstract
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Stiff person syndrome and anesthesia: case report. Author(s): Bouw J, Leendertse K, Tijssen MA, Dzoljic M. Source: Anesthesia and Analgesia. 2003 August; 97(2): 486-7, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12873941&dopt=Abstract
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Surgical and anesthesia standards in physicians' offices. Alternative Privileges Rule, N.J.A.C. 13:35-4A.12. Author(s): Maressa VA. Source: N J Med. 2003 May; 100(5): 33-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12776631&dopt=Abstract
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Surgical mortality and type of anesthesia provider. Author(s): Gabel RA. Source: Aana Journal. 2003 August; 71(4): 257; Author Reply 257. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=13677219&dopt=Abstract
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Surgical mortality and type of anesthesia provider. Author(s): Pine M, Holt KD, Lou YB. Source: Aana Journal. 2003 April; 71(2): 109-16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12776638&dopt=Abstract
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Suspected methemoglobinemia following awake intubation: one possible effect of benzocaine topical anesthesia--a case report. Author(s): Rinehart RS, Norman D. Source: Aana Journal. 2003 April; 71(2): 117-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12776639&dopt=Abstract
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Temporal patient state characterization using Iterative Order and Noise (ION) estimation: applications to anesthesia patient monitoring. Author(s): Alterovitz G, Staelin DH, Philip JH. Source: Journal of Clinical Monitoring and Computing. 2002 August; 17(6): 351-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12885179&dopt=Abstract
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Terlipressin versus norepinephrine to correct refractory arterial hypotension after general anesthesia in patients chronically treated with renin-angiotensin system inhibitors. Author(s): Boccara G, Ouattara A, Godet G, Dufresne E, Bertrand M, Riou B, Coriat P. Source: Anesthesiology. 2003 June; 98(6): 1338-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12766641&dopt=Abstract
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The art and science of office-based anesthesia in dentistry: a 150-year history. Author(s): Finder RL. Source: International Anesthesiology Clinics. 2003 Summer; 41(3): 1-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12872022&dopt=Abstract
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The danger of using a nurse who is not a CRNA to administer anesthesia. Author(s): Blumenreich GA. Source: Aana Journal. 2003 June; 71(3): 177-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12847939&dopt=Abstract
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The development of ambulatory anesthesia and future challenges. Author(s): Pregler JL, Kapur PA. Source: Anesthesiology Clinics of North America. 2003 June; 21(2): 207-28. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12812391&dopt=Abstract
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The effect of mixing lidocaine with propofol on the dose of propofol required for induction of anesthesia. Author(s): Tan LH, Hwang NC. Source: Anesthesia and Analgesia. 2003 August; 97(2): 461-4, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12873935&dopt=Abstract
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The effect of nitrous oxide on cerebrovascular reactivity to carbon dioxide in children during propofol anesthesia. Author(s): Karsli C, Wilson-Smith E, Luginbuehl I, Bissonnette B. Source: Anesthesia and Analgesia. 2003 September; 97(3): 694-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12933387&dopt=Abstract
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The effect of small dose fentanyl on the emergence characteristics of pediatric patients after sevoflurane anesthesia without surgery. Author(s): Cravero JP, Beach M, Thyr B, Whalen K. Source: Anesthesia and Analgesia. 2003 August; 97(2): 364-7, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12873918&dopt=Abstract
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The effects of epidural and general anesthesia on tissue oxygenation. Author(s): Treschan TA, Taguchi A, Ali SZ, Sharma N, Kabon B, Sessler DI, Kurz A. Source: Anesthesia and Analgesia. 2003 June; 96(6): 1553-7, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12760974&dopt=Abstract
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The influence of the duration of anesthesia on neuromuscular potency. Author(s): Kopman AF. Source: Anesthesiology. 2003 May; 98(5): 1300; Author Reply 1300-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12717164&dopt=Abstract
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The inhibition of central nicotinic nAch receptors is the possible cause of prolonged cognitive impairment after anesthesia. Author(s): Fodale V, Santamaria LB. Source: Anesthesia and Analgesia. 2003 October; 97(4): 1207; Author Reply 1207. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14500198&dopt=Abstract
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The interaction between fentanyl and propofol during emergence from anesthesia: monitoring with the EEG-Bispectral index. Author(s): Mi W, Sakai T, Kudo T, Kudo M, Matsuki A. Source: Journal of Clinical Anesthesia. 2003 March; 15(2): 103-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12719048&dopt=Abstract
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The key to profound local anesthesia: neuroanatomy. Author(s): Blanton PL, Jeske AH; ADA Council on Scientific Affairs; ADA Division of Science. Source: The Journal of the American Dental Association. 2003 June; 134(6): 753-60. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12839412&dopt=Abstract
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The place of ropivacaine in anesthesia. Author(s): Stienstra R. Source: Acta Anaesthesiol Belg. 2003; 54(2): 141-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12872430&dopt=Abstract
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The quality of epidural anesthesia is crucial in the assessment of perioperative outcome. Author(s): Gogarten W, Buerkle H, Van Aken H. Source: Anesthesia and Analgesia. 2003 July; 97(1): 298; Author Reply 298-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12818995&dopt=Abstract
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The retrojugular route: the ideal exposure for carotid endarterectomy performed under locoregional anesthesia. Author(s): Neri E, Giubbolini M, Setacci F, Baldi I, Setacci C. Source: European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery. 2003 September; 26(3): 250-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14509886&dopt=Abstract
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The use of general anesthesia for the tension-free vaginal tape procedure and concomitant surgery. Author(s): Lo TS, Lin CT, Huang HJ, Chang CL, Liang CC, Soong YK. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2003 April; 82(4): 367-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12716322&dopt=Abstract
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Thoracic epidural anesthesia: more than just anesthesia/analgesia. Author(s): Sielenkamper AW, Van Aken H. Source: Anesthesiology. 2003 September; 99(3): 523-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12960534&dopt=Abstract
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Thrombocytopenia, low molecular weight heparin, and obstetric anesthesia. Author(s): Abramovitz S, Beilin Y. Source: Anesthesiology Clinics of North America. 2003 March; 21(1): 99-109. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12698835&dopt=Abstract
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Topical nasal anesthesia for transnasal fiberoptic laryngoscopy: a prospective, double-blind, cross-over study. Author(s): Johnson PE, Belafsky PC, Postma GN. Source: Otolaryngology and Head and Neck Surgery. 2003 April; 128(4): 452-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12707645&dopt=Abstract
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Transcranial Doppler ultrasound study of the effects of nitrous oxide on cerebral autoregulation during neurosurgical anesthesia: a randomized controlled trial. Author(s): Iacopino DG, Conti A, Battaglia C, Siliotti C, Lucanto T, Santamaria LB, Tomasello F. Source: Journal of Neurosurgery. 2003 July; 99(1): 58-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12854745&dopt=Abstract
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Treatment of perianal fistulizing Crohn's disease with infliximab alone or as an adjunct to exam under anesthesia with seton placement. Author(s): Regueiro M, Mardini H. Source: Inflammatory Bowel Diseases. 2003 March; 9(2): 98-103. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12769443&dopt=Abstract
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Two randomized, double-blind, placebo-controlled studies evaluating the S-Caine Peel for induction of local anesthesia before long-pulsed Nd:YAG laser therapy for leg veins. Author(s): Chen JZ, Alexiades-Armenakas MR, Bernstein LJ, Jacobson LG, Friedman PM, Geronemus RG. Source: Dermatologic Surgery : Official Publication for American Society for Dermatologic Surgery [et Al.]. 2003 October; 29(10): 1012-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12974697&dopt=Abstract
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Upper respiratory tract infections and pediatric anesthesia. Author(s): Serafini G, Cavalloro F, Mori A, Rossi C, Tagliaferri C. Source: Minerva Anestesiol. 2003 May; 69(5): 457-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12768184&dopt=Abstract
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Use of an anesthesia cerebral monitor bispectral index to assess burst-suppression in pentobarbital coma. Author(s): Jaggi P, Schwabe MJ, Gill K, Horowitz IN. Source: Pediatric Neurology. 2003 March; 28(3): 219-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12770677&dopt=Abstract
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Use of anesthesia-assisted detoxification in the opioid-dependent pain patient. Author(s): Gourlay D. Source: Anesthesiology. 2003 October; 99(4): 1030; Author Reply 1030. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14508344&dopt=Abstract
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Vulnerable time periods for attrition during nurse anesthesia education. Author(s): Waugaman WR, Aron GL. Source: Aana Journal. 2003 February; 71(1): 11-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12776644&dopt=Abstract
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Why patients choose regional anesthesia for orthopedic and trauma surgery. Author(s): Pelinka LE, Pelinka H, Leixnering M, Mauritz W. Source: Archives of Orthopaedic and Trauma Surgery. 2003 May; 123(4): 164-7. Epub 2003 March 20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12734714&dopt=Abstract
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CHAPTER 2. NUTRITION AND ANESTHESIA Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and anesthesia.
Finding Nutrition Studies on Anesthesia The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail:
[email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “anesthesia” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.
7 Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.
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The following information is typical of that found when using the “Full IBIDS Database” to search for “anesthesia” (or a synonym): ·
A comparison of antagonist-precipitated withdrawal under anesthesia to standard inpatient withdrawal as a precursor to maintenance naltrexone treatment in heroin users: outcomes at 6 and 12 months. Author(s): Clinical Policy and Research, Drug and Alcohol Services Council of South Australia, 161 Greenhill Road, Parkside, SA 5063, Australia. Source: McGregor, C Ali, R White, J M Thomas, P Gowing, L Drug-Alcohol-Depend. 2002 September 1; 68(1): 5-14 0376-8716
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A comparison of thiopental, propofol, and diazepam-ketamine anesthesia for evaluation of laryngeal function in dogs premedicated with butorphanolglycopyrrolate. Author(s): Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia 65211, USA. Source: Gross, M E Dodam, J R Pope, E R Jones, B D J-Am-Anim-Hosp-Assoc. 2002 NovDecember; 38(6): 503-6 0587-2871
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Adverse drug reactions to local anesthesia. Author(s): Department of Physiology and Pharmacology, School of Dental Medicine, University of Pittsburgh, 3501 Terrace Street, Pittsburgh, PA 15261, USA. Source: Finder, R L Moore, P A Dent-Clin-North-Am. 2002 October; 46(4): 747-57, x 0011-8532
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Anesthesia of boma-captured Lichtenstein's hartebeest (Sigmoceros lichtensteinii) with a combination of thiafentanil, medetomidine, and ketamine. Author(s): White Oak Conservation Center, 3823 Owens Road, Yulee, Florida 32097, USA.
[email protected] Source: Citino, S B Bush, M Grobler, D Lance, W J-Wildl-Dis. 2002 April; 38(2): 457-62 0090-3558
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Early effects of tribromoethanol, ketamine/xylazine, pentobarbitol, and isoflurane anesthesia on hepatic and lymphoid tissue in ICR mice. Source: Thompson, J.S. Brown, S.A. Khurdayan, V. Zeynalzadedan, A. Sullivan, P.G. Scheff, S.W. Comp-med. Memphis, TN : American Association for Laboratory Animal Science, 2000-. February 2002. volume 52 (1) page 63-67. 1532-0820
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Efficacy of inhaled anticholinergics and anesthesia in treatment of a patient in status asthmaticus. Author(s): Department of Pediatrics, Gunma University School of Medicine, Maebashi, Japan.
[email protected] Source: Arakawa, Hirokazu Takizawa, Takumi Tokuyama, Kenichi Mochizuki, Hiroyuki Morikawa, Akihiro J-Asthma. 2002 February; 39(1): 77-80 0277-0903
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Efficacy of simulated epinephrine-containing epidural test dose after intravenous atropine during isoflurane anesthesia in children. Author(s): Department of Anesthesia, Children's Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA 02115, USA.
[email protected] Source: Sethna, N F Sullivan, L Retik, A McGowan, F X Di Canzio J Zurakowski, D RegAnesth-Pain-Med. 2000 Nov-December; 25(6): 566-72 1098-7339
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Healing pathways through energy work in the perianesthesia care setting. Author(s): Post-Anesthesia Care Unit, Naval Medical Center, Portsmouth, VA 23708, USA. Source: King C, E CRNA. 2000 November; 11(4): 180-5 1048-2687
Nutrition
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Herbal medicines and possible anesthesia interactions. Author(s): University of Pittsburgh School of Nursing, Nurse Anesthesia Program, Pittsburgh, Pa., USA. Source: Lyons, Timothy R AANA-J. 2002 February; 70(1): 47-51 0094-6354
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Methemoglobinemia: an unusual complication of topical anesthesia. Author(s): St. Joseph Health Center-Endoscopy Suite, St. Charles, MO 63301, USA. Source: Maher, P Gastroenterol-Nurs. 1998 Jul-August; 21(4): 173-5 1042-895X
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Pain control following elective gastrointestinal surgery: is epidural anesthesia warranted? Author(s): Department of Surgery, Hartford Hospital, USA. Source: Welch, J P Cohen, J L Vignati, P V Allen, L W Morrow, J S Carter, J J Conn-Med. 1998 August; 62(8): 461-4 0010-6178
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Preoperative diclofenac is a useful adjunct to spinal anesthesia for day-case varicose vein repair. Author(s): Department of Anesthesia and Intensive Care Medicine, Helsinki University Hospital, Helsinki, Finland.
[email protected] Source: Rautoma, P Santanen, U Luurila, H Perhoniemi, V Erkola, O Can-J-Anaesth. 2001 Jul-August; 48(7): 661-4 0832-610X
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Prophylactic caffeine to prevent postoperative apnea following general anesthesia in preterm infants (Cochrane Review). Author(s): NSW Centre for Perinatal Health Services Research, Queen Elizabeth II Institute for Mothers and Infants, Building DO2, University of Sydney, Sydney, NSW, AUSTRALIA, 2006.
[email protected] Source: Henderson Smart, D J Steer, P Cochrane-Database-Syst-Revolume 2001; 4: CD000048 1469-493X
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Taste disturbance in two patients after dental anesthesia by inferior alveolar nerve block. Author(s): Department of Otorhinolaryngology, Nihon University School of Medicine, Tokyo, Japan. Source: Hotta, M Endo, S Tomita, H Acta-Otolaryngol-Suppl. 2002; (546): 94-8 0365-5237
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Topical anesthesia for penetrating trabeculectomy. Author(s): Department of Ophthalmology and Eye Hospital, Faculty of Clinical Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
[email protected] Source: Sauder, G Jonas, J B Graefes-Arch-Clin-Exp-Ophthalmol. 2002 September; 240(9): 739-42 0721-832X
Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: ·
healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0
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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov
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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov
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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/
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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/
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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/
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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/
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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/
Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats
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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html
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Google: http://directory.google.com/Top/Health/Nutrition/
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Healthnotes: http://www.healthnotes.com/
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Open Directory Project: http://dmoz.org/Health/Nutrition/
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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/
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WebMDÒHealth: http://my.webmd.com/nutrition
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html
The following is a specific Web list relating to anesthesia; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: ·
Minerals Fluoxetine Source: Healthnotes, Inc.; www.healthnotes.com
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Food and Diet Low Back Pain Source: Healthnotes, Inc.; www.healthnotes.com
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CHAPTER 3. ALTERNATIVE MEDICINE AND ANESTHESIA Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to anesthesia. At the conclusion of this chapter, we will provide additional sources.
National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to anesthesia and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “anesthesia” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to anesthesia: ·
Acupuncture. A useful complement of anesthesia? Author(s): Akca O, Sessler DI. Source: Minerva Anestesiol. 2002 April; 68(4): 147-51. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12024072&dopt=Abstract
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An evaluation of the experimental and investigational status and clinical validity of manipulation of patients under anesthesia: a contemporary opinion. Author(s): Gordon RC. Source: Journal of Manipulative and Physiological Therapeutics. 2001 NovemberDecember; 24(9): 603-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11753335&dopt=Abstract
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Assessing pain responses during general anesthesia. Author(s): Stomberg MW, Sjostrom B, Haljamae H.
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Source: Aana Journal. 2001 June; 69(3): 218-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11759565&dopt=Abstract ·
Assessment of the effects of a taped cognitive behavior message on postoperative complications (therapeutic suggestions under anesthesia). Author(s): Cowan GS Jr, Buffington CK, Cowan GS 3rd, Hathaway D. Source: Obesity Surgery : the Official Journal of the American Society for Bariatric Surgery and of the Obesity Surgery Society of Australia and New Zealand. 2001 October; 11(5): 589-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11594100&dopt=Abstract
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Case series: IV regional anesthesia with ketorolac and lidocaine: is it effective for the management of complex regional pain syndrome 1 in children and adolescents? Author(s): Suresh S, Wheeler M, Patel A. Source: Anesthesia and Analgesia. 2003 March; 96(3): 694-5, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12598246&dopt=Abstract
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Chronic low back pain: a study of the effects of manipulation under anesthesia. Author(s): Palmieri NF, Smoyak S. Source: Journal of Manipulative and Physiological Therapeutics. 2002 October; 25(8): E8E17. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12381983&dopt=Abstract
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Clinical applications of acupuncture in anesthesia practice. Author(s): Reilly MP. Source: Crna. 2000 November; 11(4): 173-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11866024&dopt=Abstract
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Clinical hypnosis and anesthesia: an historical review and its clinical implications in today's practice. Author(s): Schulz-Stubner S. Source: Bull Anesth Hist. 2000 January; 18(1): 1, 4-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11858258&dopt=Abstract
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Clinical hypnosis instead of drug-based sedation for procedures under regional anesthesia. Author(s): Schulz-Stubner S. Source: Regional Anesthesia and Pain Medicine. 2002 November-December; 27(6): 622-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12430119&dopt=Abstract
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Comparison of time to anesthesia for block, infiltration, and intraosseous local anesthetic injections: a clinical study. Author(s): Quarnstrom F.
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Source: Dent Today. 2001 February; 20(2): 114-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12524856&dopt=Abstract ·
Dialysis delivery of an adenosine A1 receptor agonist to the pontine reticular formation decreases acetylcholine release and increases anesthesia recovery time. Author(s): Tanase D, Baghdoyan HA, Lydic R. Source: Anesthesiology. 2003 April; 98(4): 912-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12657853&dopt=Abstract
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Different benefit of bispectal index (BIS) in desflurane and propofol anesthesia. Author(s): Luginbuhl M, Wuthrich S, Petersen-Felix S, Zbinden AM, Schnider TW. Source: Acta Anaesthesiologica Scandinavica. 2003 February; 47(2): 165-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12631045&dopt=Abstract
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Flumazenil reduces the hypnotic dose of propofol in male patients under spinal anesthesia. Author(s): Adachi YU, Watanabe K, Higuchi H, Satoh T. Source: Journal of Anesthesia. 2002; 16(1): 9-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14566489&dopt=Abstract
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Healing pathways through energy work in the perianesthesia care setting. Author(s): King CE. Source: Crna. 2000 November; 11(4): 180-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11866025&dopt=Abstract
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Herbal medicines and possible anesthesia interactions. Author(s): Lyons TR. Source: Aana Journal. 2002 February; 70(1): 47-51. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11887544&dopt=Abstract
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Implicit memory for words played during isoflurane- or propofol-based anesthesia: the lexical decision task. Author(s): Munte S, Schmidt M, Meyer M, Nager W, Lullwitz E, Munte TF, Piepenbrock S. Source: Anesthesiology. 2002 March; 96(3): 588-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11873032&dopt=Abstract
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Levobupivacaine 0.125% and lidocaine 0.5% for intravenous regional anesthesia in volunteers. Author(s): Atanassoff PG, Aouad R, Hartmannsgruber MW, Halaszynski T.
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Source: Anesthesiology. 2002 August; 97(2): 325-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12151920&dopt=Abstract ·
Local anesthesia: advances in agents and techniques. Author(s): Hawkins JM, Moore PA. Source: Dent Clin North Am. 2002 October; 46(4): 719-32, Ix. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12436827&dopt=Abstract
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Methods for assessing adequacy of anesthesia. Author(s): van Gils M, Korhonen I, Yli-Hankala A. Source: Crit Rev Biomed Eng. 2002; 30(1-3): 99-130. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12650288&dopt=Abstract
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Music decreases sedative requirements during spinal anesthesia. Author(s): Lepage C, Drolet P, Girard M, Grenier Y, DeGagne R. Source: Anesthesia and Analgesia. 2001 October; 93(4): 912-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11574356&dopt=Abstract
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Neural mechanism of propofol anesthesia in severe depression: a positron emission tomographic study. Author(s): Ogawa K, Uema T, Motohashi N, Nishikawa M, Takano H, Hiroki M, Imabayashi E, Ohnishi T, Inoue T, Takayama Y, Takeda M, Matsuda H, Andoh T, Yamada Y. Source: Anesthesiology. 2003 May; 98(5): 1101-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12717131&dopt=Abstract
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Patient State Index: titration of delivery and recovery from propofol, alfentanil, and nitrous oxide anesthesia. Author(s): Drover DR, Lemmens HJ, Pierce ET, Plourde G, Loyd G, Ornstein E, Prichep LS, Chabot RJ, Gugino L. Source: Anesthesiology. 2002 July; 97(1): 82-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12131107&dopt=Abstract
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Propofol-sufentanil anesthesia for thyroid surgery: optimal concentrations for hemodynamic and electroencephalogram stability, and recovery features. Author(s): Hentgen E, Houfani M, Billard V, Capron F, Ropars JM, Travagli JP. Source: Anesthesia and Analgesia. 2002 September; 95(3): 597-605, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12198044&dopt=Abstract
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Self-hypnosis: alternative anesthesia for childbirth. Author(s): Ketterhagen D, VandeVusse L, Berner MA.
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Source: Mcn. the American Journal of Maternal Child Nursing. 2002 NovemberDecember; 27(6): 335-40; Quiz 341. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12439135&dopt=Abstract ·
Small doses of remifentanil and alfetanil in continuous total intravenous anesthesia in major abdominal surgery. A double blind comparison. Author(s): Iannuzzi E, Iannuzzi M, Cirillo V, Viola G, Parisi R, Chiefari M. Source: Minerva Anestesiol. 2003 March; 69(3): 127-33, 133-6. English, Italian. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12792581&dopt=Abstract
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The auditory steady-state response is not a suitable monitor of anesthesia. Author(s): Pockett S, Tan SM. Source: Anesthesia and Analgesia. 2002 November; 95(5): 1318-23, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12401619&dopt=Abstract
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The influence of the click stimulus of the Alaris AEP monitor on the depth of anesthesia. Author(s): Kreuer S, Wilhelm W, Bruhn J. Source: Anesthesia and Analgesia. 2003 August; 97(2): 604. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12873966&dopt=Abstract
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The recovery of cognitive function after general anesthesia in elderly patients: a comparison of desflurane and sevoflurane. Author(s): Chen X, Zhao M, White PF, Li S, Tang J, Wender RH, Sloninsky A, Naruse R, Kariger R, Webb T, Norel E. Source: Anesthesia and Analgesia. 2001 December; 93(6): 1489-94, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11726429&dopt=Abstract
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The use of pre-, intra-, and posthypnotic suggestion in anesthesia and surgery. Author(s): Hernandez A Jr, Tatarunis AM. Source: Crna. 2000 November; 11(4): 167-72. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11866023&dopt=Abstract
Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: ·
Alternative Medicine Foundation, Inc.: http://www.herbmed.org/
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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats
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Chinese Medicine: http://www.newcenturynutrition.com/
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drkoop.comÒ: http://www.drkoop.com/InteractiveMedicine/IndexC.html
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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm
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Google: http://directory.google.com/Top/Health/Alternative/
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Healthnotes: http://www.healthnotes.com/
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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine
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Open Directory Project: http://dmoz.org/Health/Alternative/
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HealthGate: http://www.tnp.com/
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WebMDÒHealth: http://my.webmd.com/drugs_and_herbs
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html
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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/
The following is a specific Web list relating to anesthesia; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: ·
General Overview Appendicitis Source: Integrative Medicine Communications; www.drkoop.com Cervical Dysplasia Source: Integrative Medicine Communications; www.drkoop.com Depression (mild to Moderate) Source: Prima Communications, Inc.www.personalhealthzone.com Ear Infection Source: Integrative Medicine Communications; www.drkoop.com Insomnia Source: Prima Communications, Inc.www.personalhealthzone.com Low Back Pain Source: Integrative Medicine Communications; www.drkoop.com Nausea Source: Prima Communications, Inc.www.personalhealthzone.com Otitis Media Source: Integrative Medicine Communications; www.drkoop.com Pain Source: Healthnotes, Inc.; www.healthnotes.com Peripheral Vascular Disease Source: Healthnotes, Inc.; www.healthnotes.com
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Post Traumatic Stress Disorder Source: Integrative Medicine Communications; www.drkoop.com Ptsd Source: Integrative Medicine Communications; www.drkoop.com ·
Alternative Therapy Acupuncture Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,663,00.html Acupuncture Anesthesia Alternative names: acupuncture analgesia acupuncture assisted anesthesia anesthetic acupuncture Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/a.html Music Therapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,719,00.html
·
Herbs and Supplements Citalopram Source: Healthnotes, Inc.; www.healthnotes.com Ephedra Alternative names: Ephedra sinensis, Ma huang Source: Integrative Medicine Communications; www.drkoop.com Ephedra Sinensis Source: Integrative Medicine Communications; www.drkoop.com Fentanyl Source: Healthnotes, Inc.; www.healthnotes.com Fluvoxamine Source: Healthnotes, Inc.; www.healthnotes.com Ginger Alternative names: Zingiber officinale Source: Healthnotes, Inc.; www.healthnotes.com Ginger Source: Prima Communications, Inc.www.personalhealthzone.com
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Ginger Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,787,00.html Ginkgo Alternative names: Ginkgo biloba Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Glycyrrhiza1 Alternative names: Licorice; Glycyrrhiza glabra L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Ma Huang Source: Integrative Medicine Communications; www.drkoop.com Nitrous Oxide Source: Healthnotes, Inc.; www.healthnotes.com Nitrous Oxide Source: Prima Communications, Inc.www.personalhealthzone.com St. John's Wort Source: Prima Communications, Inc.www.personalhealthzone.com Valerian Source: Prima Communications, Inc.www.personalhealthzone.com
General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.
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CHAPTER 4. DISSERTATIONS ON ANESTHESIA Overview In this chapter, we will give you a bibliography on recent dissertations relating to anesthesia. We will also provide you with information on how to use the Internet to stay current on dissertations. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical dissertations that use the generic term “anesthesia” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on anesthesia, we have not necessarily excluded nonmedical dissertations in this bibliography.
Dissertations on Anesthesia ProQuest Digital Dissertations, the largest archive of academic dissertations available, is located at the following Web address: http://wwwlib.umi.com/dissertations. From this archive, we have compiled the following list covering dissertations devoted to anesthesia. You will see that the information provided includes the dissertation’s title, its author, and the institution with which the author is associated. The following covers recent dissertations found when using this search procedure: ·
A Calculus of Suffering: Pain, Anesthesia, and Utilitarian Professionalism in Nineteenth Century American Medicine by Pernick, Martin Steven, Phd from Columbia University, 1979, 560 pages http://wwwlib.umi.com/dissertations/fullcit/8125367
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An Automated Pre-use Checkout System for an Anesthesia Breathing Circuit by Kuck, Kai; , Phd from The University of Utah, 2003, 485 pages http://wwwlib.umi.com/dissertations/fullcit/3091771
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Anesthesia Delivery in Office-Based Surgery: Quality-of-care and Patient Satisfaction Outcomes by Golinski, Mary Ann; Phd from Wayne State University, 2002, 152 pages http://wwwlib.umi.com/dissertations/fullcit/3047554
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Brief Notes to a History of Anesthesia. by Naccarato, Charles Frederick, Phd from Ohio University, 1976, 61 pages http://wwwlib.umi.com/dissertations/fullcit/7703488
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Determining Proficiencies in Spinal Anesthesia Using the Delphi Technique (anesthesia Programs, Nurse Anesthesia Program) by Ellis, Wayne Enoch, Phd from Texas A&m University, 1990, 236 pages http://wwwlib.umi.com/dissertations/fullcit/9027209
·
Development of a Single Blended Anesthesia Provider: an Exploratory Study by Callahan, Linda Lerline, Phd from The Florida State University, 1994, 205 pages http://wwwlib.umi.com/dissertations/fullcit/9514708
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Effects of Glossopharyngeal Anesthesia on Taste Responses Recorded in the Rat Nucleus of the Solitary Tract by Reich, Christian Gabriel; Phd from State University of New York at Binghamton, 2002, 93 pages http://wwwlib.umi.com/dissertations/fullcit/3059845
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Estimation of the Level of Anesthesia during Surgery by Automatic EEG Pattern Recognition by Mcewen, James Allen; Phd from The University of British Columbia (canada), 1975 http://wwwlib.umi.com/dissertations/fullcit/NK25926
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General Anesthesia, Ascorbic Acid, and Consciousness by Talley, Henry Clinton, V; Phd from The University of Tennessee Center for the Health Sciences, 2003, 127 pages http://wwwlib.umi.com/dissertations/fullcit/3085403
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Hyperspinal: Structural Knowledge Acquisition and Level of Detail in Cognitive Maps Within an Instructional Hypertext on Spinal Anesthesia by Fletcher, Joanne Leslie, Edd from University of Pittsburgh, 1994, 123 pages http://wwwlib.umi.com/dissertations/fullcit/9521405
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Maternal Hypotension and Epidural Anesthesia for Cesarean Section by Fiedler, Michael A.; Phd from The University of Tennessee Center for the Health Sciences, 2002, 115 pages http://wwwlib.umi.com/dissertations/fullcit/3049714
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Nurse Anesthesia Education: Influences on Program Choice (anesthesia Education) by Martin-sheridan, Denise Marie, Edd from State University of New York at Albany, 1992, 117 pages http://wwwlib.umi.com/dissertations/fullcit/9223591
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On the Mechanism of General Anesthesia Effected by Beta-endorphin by Lewis, Johnnye Lynn; Phd from The University of Manitoba (canada), 1989 http://wwwlib.umi.com/dissertations/fullcit/NL54844
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Pain, Suffering and Anesthesia in the Romantic Period by Papper, Emanuel Martin, Phd from University of Miami, 1990, 217 pages http://wwwlib.umi.com/dissertations/fullcit/9104438
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Perceptions and Practices of Nurse Anesthesia Faculty in Clinical Instructional Roles (laboratory) by Foster, Scot Douglas, Phd from University of Kansas, 1984, 207 pages http://wwwlib.umi.com/dissertations/fullcit/8424328
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Post Dural Puncture Headache Following Continuous Spinal Anesthesia in the Morbidly Obese Parturient by Coker, Lanny Leon; Dnsc from The University of Tennessee Center for the Health Sciences, 2002, 31 pages http://wwwlib.umi.com/dissertations/fullcit/3067788
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The Cholinergic Septohippocampal Projection and Hippocampal Activity in Waking Behavior, Sleep and Anesthesia by Stewart, Dwight James; Phd from The University of Western Ontario (canada), 1986 http://wwwlib.umi.com/dissertations/fullcit/NL36095
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The Evaluation of the Dental Anesthesia Elective Program at the University of Pittsburgh School of Dental Medicine by Pasqual, Roberta T., Phd from University of Pittsburgh, 1986, 191 pages http://wwwlib.umi.com/dissertations/fullcit/8620284
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The Impact of Supportive and Non-supportive Surgeon Communication on the Outcome of a Simulated Anesthesia Crisis by Kearney, Leigh Priebe; Phd from University of Denver, 1999, 169 pages http://wwwlib.umi.com/dissertations/fullcit/9939594
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The Use of Simulated Clinical Experiences to Improve Competency in the Novice Anesthesia Provider by Sorenson, Jonathan Lee; Dnsc from The University of Tennessee Center for the Health Sciences, 2002, 73 pages http://wwwlib.umi.com/dissertations/fullcit/3067799
Keeping Current Ask the medical librarian at your library if it has full and unlimited access to the ProQuest Digital Dissertations database. From the library, you should be able to do more complete searches via http://wwwlib.umi.com/dissertations.
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CHAPTER 5. CLINICAL TRIALS AND ANESTHESIA Overview In this chapter, we will show you how to keep informed of the latest clinical trials concerning anesthesia.
Recent Trials on Anesthesia The following is a list of recent trials dedicated to anesthesia.8 Further information on a trial is available at the Web site indicated. ·
Hand Exercise and Upper Arm Anesthesia to Improvements Hand Function in Chronic Stroke Patients Condition(s): Cerebrovascular Accident Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Neurological Disorders and Stroke (NINDS) Purpose - Excerpt: This study will examine the effectiveness of an experimental treatment to improve hand function in patients who have had a stroke affecting one side of the body. One of the main problems of stroke patients is difficulty using the affected hand. Most treatments focus on acute (early) intervention, although special exercises may help some chronic patients. Previous studies have indicated that combining hand exercises with anesthesia (blocking motor and sensory function) of the upper arm may improve hand movement in stroke patients, even in the chronic state. This study will examine whether the exercise plus anesthesia treatment is more beneficial for these patients over the long-term than exercise alone. Patients 18 years or older who are at least 12 months post stroke, which has affected only one side of the body, may be eligible for this study. Candidates will have a medical history and physical and neurological examinations. Participants will be randomly divided into two groups: one will practice hand exercises without upper arm anesthesia and the other will exercise with anesthesia. All patients will perform two consecutive sessions of 30-minute pinch practice-forceful pinching of the thumb and index finger. Patients in the anesthesia group will have the anesthetic injected in the lower neck. Enough anesthetic will be
8
These are listed at www.ClinicalTrials.gov.
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administered to block motor and sensory function in the shoulder and upper arm, while maintaining as much function as possible in the forearm and hand. All patients will also have transcranial magnetic stimulation (TMS) testing. For this procedure, a very brief electrical current is passed through an insulated wire coil placed on the head, producing a magnetic pulse. The pulse travels through the scalp and skull and causes small electrical currents in the outer part of the brain. During the study, the patient will be asked to make movements, do simple tasks, or tense muscles, while the electrical activity of the muscles is recorded. Patients will have four sessions at 3-week intervals and three follow-up sessions at 3 weeks, 9 weeks and 24 weeks after the testing. Followup evaluations will include pinch power testing, TMS, sensory function test and hand function measurement. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00006414
Keeping Current on Clinical Trials The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to the Web site at http://www.clinicaltrials.gov/ and search by “anesthesia” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: ·
For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/
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For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html
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For cancer trials, visit the National Cancer Institute: http://cancertrials.nci.nih.gov/
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For eye-related trials, visit and search the Web page of the National Eye Institute: http://www.nei.nih.gov/neitrials/index.htm
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For heart, lung and blood trials, visit the Web page of the National Heart, Lung and Blood Institute: http://www.nhlbi.nih.gov/studies/index.htm
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For trials on aging, visit and search the Web site of the National Institute on Aging: http://www.grc.nia.nih.gov/studies/index.htm
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For rare diseases, visit and search the Web site sponsored by the Office of Rare Diseases: http://ord.aspensys.com/asp/resources/rsch_trials.asp
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For alcoholism, visit the National Institute on Alcohol Abuse and Alcoholism: http://www.niaaa.nih.gov/intramural/Web_dicbr_hp/particip.htm
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For trials on infectious, immune, and allergic diseases, visit the site of the National Institute of Allergy and Infectious Diseases: http://www.niaid.nih.gov/clintrials/
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For trials on arthritis, musculoskeletal and skin diseases, visit newly revised site of the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health: http://www.niams.nih.gov/hi/studies/index.htm
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For hearing-related trials, visit the National Institute on Deafness and Other Communication Disorders: http://www.nidcd.nih.gov/health/clinical/index.htm
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For trials on diseases of the digestive system and kidneys, and diabetes, visit the National Institute of Diabetes and Digestive and Kidney Diseases: http://www.niddk.nih.gov/patient/patient.htm
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For drug abuse trials, visit and search the Web site sponsored by the National Institute on Drug Abuse: http://www.nida.nih.gov/CTN/Index.htm
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For trials on mental disorders, visit and search the Web site of the National Institute of Mental Health: http://www.nimh.nih.gov/studies/index.cfm
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For trials on neurological disorders and stroke, visit and search the Web site sponsored by the National Institute of Neurological Disorders and Stroke of the NIH: http://www.ninds.nih.gov/funding/funding_opportunities.htm#Clinical_Trials
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CHAPTER 6. PATENTS ON ANESTHESIA Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.9 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “anesthesia” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on anesthesia, we have not necessarily excluded nonmedical patents in this bibliography.
Patents on Anesthesia By performing a patent search focusing on anesthesia, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an 9Adapted from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.
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example of the type of information that you can expect to obtain from a patent search on anesthesia: ·
Apparatus and method as preparation for performing a myringotomy in a child's ear without the need for anaesthesia Inventor(s): Abraham; Martin David (Hod Hasharon, IL), Kadis; Giries (Jaffa, IL), Schechter; Yossi (Holon, IL), Slatkine; Michael (Herzliya, IL) Assignee(s): Laser Industries Ltd. (Tel Aviv, IL) Patent Number: 6,475,138 Date filed: April 24, 1998 Abstract: A focusable imaging laser otoscope for performing laser surgery without the need for anesthesia, The apparatus includes a housing, an end member movably disposed within the housing, an imaging device attached to the housing for producing an image of a target area, an illuminating system attached to the housing for illuminating the target area, a speculum having a longitudinal axis and detachably attached to the end member, an optical system attached to the housing and having a main optical axis coaxial with the longitudinal axis of the speculum, for directing a surgical and/or an aiming laser beam from a laser source through the housing and the speculum to strike the target area and for directing image forming light rays to project an image of the target area onto the imaging device such that when the image of the target area is focused, the surgical laser beam and/or aiming laser beam are also focused on the target area, and a focusing assembly attached to the housing and to the end member for adjustably moving the end member and the speculum relative to the housing to focus the image of the target area. The otoscope may also be constructed without a focusing assembly, in which case the speculum may be detachably attached to the housing and the focusing is achieved by selecting an appropriate speculum from an available plurality of specula. The otoscope may also include a sensor system for indicating penetration of the target area. The sensor system may also automatically shut off the surgical laser after penetration of the target area. Excerpt(s): The present invention relates generally to laser devices and biomedical applications thereof. More specifically, the invention relates to setting-up a laser-based system in preparation for performing a myringotomy in an ear without the need for anaesthesia. Myringotomy is a widely-performed procedure used in the treatment of "Otitis Media"-acute inflammation of the middle ear. Typically, it involves a surgical procedure whereby the surgeon performs a tiny incision of the eardrum in order to enable the drainage of fluids that accumulate in the eardrum. The incision in the eardrum must remain open and thus an open drainage ring is placed in the incision to prevent rapid healing and occlusion of the incision. This surgery is done under general anaesthesia. Over the last few years surgeons performed myringotomy surgery using a pulsed CO.sub.2 laser. The advantage of the pulsed CO.sub.2 laser is its generation of thermal heat resulting in delayed healing of the incision of the eardrum. The incision remains open for approximately 3-6 weeks without the aid of an open drainage ring. Both the incision diameter and laser pulse time duration affect the incision healing time. Typically, the incision diameter is approximately 1 mm and the laser pulse time duration is 0.1 second at a 3-5 Watt power. This surgical technique is generally performed under anaesthesia, because the surgery uses a "defocused" beam that does not account for a child's unexpected movement. Web site: http://www.delphion.com/details?pn=US06475138__
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Apparatus for implementing hyperthermia Inventor(s): Clupper; Marc (Hampstead, NC), Fausset; Michael (Lafayette, IN), Keeling; Glenn (McMurray, PA), Rainier; Brad (Noblesville, IN) Assignee(s): Viacirq, Inc. (Pittsburgh, PA) Patent Number: 6,579,496 Date filed: May 25, 1999 Abstract: An apparatus and system for extracorporeal treatment utilizes a hemodialysis machine capable of heating dialysis fluid to 48.degree. C., an optional parallel plate hemodialyzer together with a sorbent-based detoxifier, a tubular heat exchanger and a high flow pump--in addition to various probes and catheters--to effect extracorporeal treatment without adverse physiological effect and without the specific need for general anesthesia. The system inheres in the combined high flow of the pump-up to 2400 ml per minute--and the high temperature--52.degree. C.--achievable in the heat exchanger, which together provide unprecedented speed and efficiency in the administration of hyperthemia treatments. The system is also a potentiating system in the administration of heat sensitive pharmaceutically active agents and is praticularly useful in the isolated anatomic areas of a patient. Excerpt(s): The present invention relates to a specialized method for hyperthermia, including extracorporeal blood heating and sorbent-based detoxification, as an antiviral and antineoplasm protocol. Hyperthemia as a treatment of tumors has been carefully studied and applied since the 1960's. Prior to that time there were multiple reports of tumor regression coincident with febrile episodes. Subsequent analysis revealed that temperatures greater than 41.degree. C. are ordinarily needed to induce tumor necrosis (tumor death). Although there are multiple methods of inducing hyperthermia by either direct skin contact or radiant heating, many physicians now favor an extracorporeal heat exchange (blood) circuit to raise patient temperatures. Patients may be maintained at 41.5.degree. C. to 42.degree. C. (rectal temperature) for three to four hours without severe cardiovascular compromise, although others report elevation of serum transaminases and bilirubin in patients kept at these temperatures for greater than 10 to 40 minutes. Instances of neurologic damage have been reported in association with serum hypophosphatemia, although no significant problems occurred once phosphate levels were maintained. Deaths have also been reported in two patients receiving hiyperthermia at 41.5.degree. C. to 42.degree. C. for 1-1/2 to 2 hours, presumably from massive liver tumor necrosis. DcMoss, J. L. et al., "Hyperthermia in the Treatment of Cancer," The Journal of Extra-Corporeal Technology, Volume 17, No. 1, pp. 37-43, 1985, explains that tumors are vulnerable to heal and that the goal of hyperthermic treatment therapy is to achieve cytotoxic temperatures in the tumor for a sufficient length of time without damaging the surrounding normal tissue. The rate at which blood flows through any given area of tissue. determines the amount of heat that may be carried away and therefore is a major determinant of the temperature rise in that tissue. In normal tissue, heat causes vasodilation. In a tumor, the microvasculature is made up of an overabundance of capillary beds which are unable to dilate. Blood flow through the area is thus more sluggish and commensurately unable to dissipate heat applied to the area. The inability to respond to heat by dilation, as normal vasculature would, also subjects the tumor to hypoxia, anaerobic metabolism and local acidosis, and these conditions in turn make the tumor tissue more vulnerable to thermal injury. Web site: http://www.delphion.com/details?pn=US06579496__
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Application of energy and substances in the treatment of uro-genital disorders Inventor(s): Edwards; Stuart D. (Portola Valley, CA) Assignee(s): Novasys Medical, Inc. (Newark, CA) Patent Number: 6,463,331 Date filed: March 30, 2000 Abstract: This invention provides a method and system for the curative treatment of female uro-genital disorders. One aspect of the invention is that it allows the gynecologist to coagulate the entire endometrium and upper layers of the myometrium in one short procedure that can be performed in a physician's office or other outpatient setting, using local or regional anesthesia. A second aspect of the invention is that it can be used to tighten the urethral sphincter and bladder outlet. Excerpt(s): The assignee is Genesis Medical Technologies, a California corporation having an office in Sunnyvale, Calif. This invention relates to treating menorrhagia, female urinary incontinence and other related uro-genital conditions. Female uro-genital tract disorders include menorrhagia (excessive uterine bleeding) and urinary incontinence. Although both menorrhagia and urinary incontinence cause much embarrassment, they frequently remain untreated. Web site: http://www.delphion.com/details?pn=US06463331__
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Breathing gas mixture containing perfluorocarbons Inventor(s): Albrecht; Detlev Michael (Dresden, DE) Assignee(s): Drager Medical AG & Co. KGaA (DE) Patent Number: 6,432,384 Date filed: July 24, 2001 Abstract: A breathing gas mixture is provided for the treatment of lung diseases, containing an amount of perfluorocarbon and oxygen containing 5 vol. % to 40 vol. % of perfluorocarbon relative to the amount of perfluorocarbon and oxygen. The amount of perfluorocarbon and oxygen in the breathing gas mixture ranges from about 20 vol. % to a maximum of 100 vol. % of the breathing gas mixture, and the remaining amount of up to about 80 vol. % contains one or more of the gases nitrogen, nitrogen monoxide and/or one or more anesthesia gases or noble gases, especially xenon. Perfluorohexane is an especially preferred perfluorocarbon. Excerpt(s): The present invention pertains to a breathing gas mixture and to a device for metering a breathing gas mixture. Various breathing gas mixtures, which may be used for various applications in medicine, have been described in the literature. For example, U.S. Pat. Ser. No. 5,228,434 discloses a breathing gas mixture containing xenon, oxygen and helium, which is said to be used in anesthesia. Liquid perfluorocarbons were hitherto introduced into the lungs of a human patient or mammal for the treatment of lung diseases associated with severe gas exchange disturbances, especially ARDS (Adult Respiratory Distress Syndrome) and pneumonia, and the patient or the mammal was respirated by means of a conventional respirator during that time. Web site: http://www.delphion.com/details?pn=US06432384__
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Circumferential compression device for intracavernosal anesthesia and method for using same Inventor(s): Zappala; Stephen M. (98 Rattlesnake Rd., Andover, MA 01810) Assignee(s): none reported Patent Number: 6,648,872 Date filed: September 6, 2000 Abstract: A preferred embodiment of the device of the invention, which is adapted to be applied circumferentially about a phallus, having a perimeter, and to facilitate intracavernosal anesthesia, generally comprises: a strip having a length at least slightly greater than the perimeter of the phallus, and a first end and a second end; and a hook and loop closure for releasably fixing at least a portion of the strip proximate the first end to a second portion of the strip Excerpt(s): This invention relates to devices used for administering anesthesia for penile surgery and more specifically to a circumferential compression device that facilitates intracavernosal anesthesia. For various types of ambulatory penile surgery, including circumcision, penile biopsy, partial penectomy and cystoscopy, a penile regional anesthetic nerve block is administered. To administer the anesthetic nerve block, a conventional tourniquet is applied to the phallus before injecting the anesthetic into the corpus cavernosum. Although the regional anesthetic is preferred for ambulatory urologic surgery over spinal or inhalation anesthesia, various surgical complications are associated with conventional tourniquet techniques including, neuropraxia, vascular thrombosis, and compression injury to the corpus cavernosum. Such complications arise, in part, because it is difficult to achieve a uniform amount of compression with a conventional tourniquet. It is therefore a primary object of this invention to provide an adjunct device for intracavernosal anesthesia that achieves a more uniformly applied amount of compression than conventional tourniquets. Web site: http://www.delphion.com/details?pn=US06648872__
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Disposable anesthesia delivery system with shortened outer sleeve and inner hollow drill Inventor(s): Feldman; Michael (Toms River, NJ), Meller; Moshe (Haifa, IL) Assignee(s): Tulsa Dental Products Inc. (Tulsa, OK) Patent Number: 6,547,561 Date filed: March 5, 2001 Abstract: An intraosseous delivery apparatus having a drilling member and a sleeve member. The drilling member includes a drill housing, a connecting portion for establishing a connection to a conventional dental drilling apparatus, and a drill extending from the drill housing. The sleeve member includes a sleeve housing, and a hollow sleeve extending from the sleeve housing. The sleeve housing is adapted to be removably engaged with the drill housing such that the drill is inserted into the hollow sleeve. The drill has a length such that when the drill is inserted into the hollow sleeve, a portion of the drill extends beyond the hollow sleeve. As a result, when the drill is used to drill a hole in bone, the drill is inserted deeper into the hole than the hollow sleeve. The hollow sleeve is adapted to be left inserted in the bone when the drill is removed therefrom. The "in place" hollow sleeve is also adapted to receive a syringe needle
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through which anesthesia may be directly introduced into the bone via an exposed bottom portion of the drilled hole as well as via exposed side-wall portions of the drilled hole. The drill is preferably smooth, and may also be hollow so that debris generated during drilling enters the interior of the drill. In this case, when the hollow drill is removed from the hollow sleeve, the debris within the hollow drill may also be removed. Still further, the drill may be made of a titanium alloy whose flexibility, wearability and cutting ability is greater than that of conventional hardened stainless steel. Excerpt(s): The present invention relates to an improved disposable delivery system for intraosseously delivering anesthesia to the jawbone or other parts of the living body. In particular, the present invention relates to an improvement of the disposable intraosseous anesthesia delivery apparatus and method disclosed in earlier U.S. application Ser. No. 09/165,010 and earlier PCT application U.S. Ser. No. 99/07728, the entire contents of both of which are incorporated herein by reference. The present invention is described in detail below with respect to application of dental anesthesia, but the invention is applicable to delivery of anesthesia or other fluids to other parts of a living body, either human or animal. In particular, the present invention is applicable to other surgical procedures such as, for example, orthopedic surgical procedures and/or medical procedures relating to fingers or the nose. Thus, although the invention is described in detail with respect to delivery of dental anesthesia, the invention is not intended to be limited to use only in connection with dental procedures. In general, anesthesia is delivered by injection of a topical anesthetic followed by a deeper injection of anesthetic for desensitizing nerve endings within the region of interest (infiltration) or for blocking off remote sensory nerves which are coupled to the region of interest (nerve blocking). Web site: http://www.delphion.com/details?pn=US06547561__ ·
Electrode assembly and method for signaling a monitor Inventor(s): Bennett; Henry L. (49 Center St., No. 2, Chatham, NJ 07928), Cram; Jeffrey R. (10961 Sutter Way, Nevada City, CA 95959), Simon; Bruce Jay (56 Pollard Rd., Mountain Lakes, NJ 07046) Assignee(s): none reported Patent Number: 6,625,481 Date filed: March 20, 2001 Abstract: An electrode assembly adapted to be attached to the skin over selected facial muscle groups picks up signals to be analyzed by an anesthesia adequacy monitor that measures the level of awareness of a living animal, typically a human being. The electrode assembly also includes a stimulator that stimulates a facial nerve to determine the level of paralysis, or neuro muscular block, of the facial muscles. Also disclosed is a method of manufacturing the electrode assembly by printing a pattern of electrically conductive material through a silk-screen or an ink type process onto a flexible layer, and then coating the result with a non-conducting adhesive except at points corresponding to sensing points for the desired muscle groups. Finally, a method for using such sensing and stimulating devices is shown in determining and maintaining an appropriate level of patient awareness, muscle paralysis, and analgesia under anesthesia.
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Excerpt(s): The following invention relates to devices which are used in the field of assessment of consciousness of a person, electromyography, and specifically for measuring the clinical condition of a patient under anesthesia by noting the muscular activity related to facial micro-expressions. This invention is also concerned with a method for determining the adequacy of anesthesia, and the level of paralysis therefrom, during surgery and otherwise through stimulating and measuring the muscular activity of the face. This method and this device allows for quick application of stimulating and multiple sensing means for the different muscles in the face. U.S. Pat. No. 5,195,531 describing an anesthesia adequacy monitor and method, was issued to Henry L. Bennett on Mar. 23, 1993. The disclosure of U.S. Pat. No. 5,195,531 (the "First Bennett Patent") is specifically incorporated herein by reference. In the past, when the face was stimulated and monitored for facial expressions to indicate the depth of anesthesia, individual electrodes were often applied one at a time. The time required to apply individual electrodes was significant, especially when a full surgical operating crew was standing by or there were patients waiting for their turn in the surgery operating theater. Web site: http://www.delphion.com/details?pn=US06625481__ ·
Heat-moisture exchanger and nebulization device Inventor(s): Ryder; Steven L. (2460 Hartford Ave., Fullerton, CA 92835) Assignee(s): none reported Patent Number: 6,550,476 Date filed: May 21, 1998 Abstract: A heat-moisture exchanger (HME) and nebulization device for connection to a mechanical ventilator or anesthesia apparatus, to provide humidification or an aerosolized medication without disconnection of the HME from the ventilator circuit, a respiratory device comprising a first housing having an output fitting to provide a connection to an artificial airway of a patient, and a rotatable second housing connected to the first housing, having an input fitting to provide a connection to a ventilator circuit, the input fitting, and the output fitting are in communication with a primary gas flow, the first housing is partitioned into at least two chambers, a chamber to provide an enclosure for an absorbent material, and a chamber to provide a passageway for conveyance of an aerosol, the second housing to provide an enclosure for a nebulizer having a reservoir for a liquid medication, an instillation port to inject the liquid medication, interior to the chamber or passageway, a reciprocating member to open and close valves or having valves in linkage with the second housing, and controlled by the rotational direction of the second housing, the second housing in the horizontal orientation to position the valves to control the flow path of the primary gas flow through the chamber having the absorbent material, and control the exhaled gas flow from the patient to pass through the chamber to conserve heat and moisture, then through the ventilator circuit, rotation of the second housing to the vertical orientation to operate the nebulizer, to position the valves for the primary gas flow to entrain an aerosolized medication, and control the flow path of the primary gas flow through the passageway to bypass the absorbent material, and control the exhaled gas flow from the patient through the passageway, then through the ventilator circuit. Excerpt(s): This invention utilized in the medical field, generally relates to an apparatus for the humidification of inspired gases and the administration of aerosolized medication in connection with mechanical ventilators, or anesthesia devices.
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Hygroscopic condensers humidifiers (HCH), heat and moisture exchangers (HME), or an artificial nose are well known in the art. These devices are routinely used for the humidification of inspired gases during mechanical ventilation. These devices essentially work by conserving heat and moisture from the exhaled humidified gas during the exhalation phase from a patient, then recycling the heat and moisture to the subsequent inspiratory phase to humidify the dry gas from the ventilator. Recent studies have indicated, patients requiring mechanical ventilation with adequate hydration, without secretion problems, and no history of severe lung disease, can tolerate these devices for extended periods of time. Also the studies reveal, there are no increased risk of nosocomial infections with the use of these passive humidification devices, compared to heated humidification. Web site: http://www.delphion.com/details?pn=US06550476__ ·
Inhibition of platelet activation, aggregation and/or adhesion by hypothermia Inventor(s): Dae; Michael W. (Belmont, CA), Keller; Wade A. (San Jose, CA), Machold; Timothy R. (Moss Beach, CA) Assignee(s): Radiant Medical, Inc. (Redwood City, CA) Patent Number: 6,544,282 Date filed: February 21, 2001 Abstract: A method for treating acute coronary syndromes (i.e., unstable angina or nonQ-wave MI) or transient ischemic attacks in a human or animal patient by placing a heat exchange apparatus in the patient's vasculature and using that heat exchange apparatus to cool the patient to a temperature (e.g. 30-36.degree. C.) at which platelet inhibition (i.e., inhibition of platelet activation and/or aggregation and/or adhesion) occurs. Antishivering drugs or anesthesia may be administered to patients whose body temperature is cooled below that patient's shivering threshold (typically approximately 35.5 C.). If it is determined that platelet inhibition is no longer desirable, such as when the patient is about to undergo a surgical or interventional procedure wherein bleeding could be problematic, the hypothermia-induced platelet inhibition may be rapidly reversed by using the intravascular heat exchange apparatus to re-warm the patient's body to normothermia or near normothermia. Excerpt(s): This invention relates generally to methods for medical treatment and more particularly to the intravascular application of hypothermia to treat acute coronary syndromes or other disorders that are treatable by inhibiting platelet activation and/or platelet aggregation and/or platelet adhesion. As used in this patent application the terms "anti-platelet" and "platelet inhibiting" shall mean any inhibition of platelet activation and/or platelet aggregation and/or platelet adhesion. Platelet activation, aggregation and/or adhesion are believed to play significant rolls in the pathogenesis of many vaso-occlusive disorders such as unstable angina, acute myocardial infarction, reocclusion of vessels following balloon angioplasty, transient ischemic attacks and strokes. Generally speaking, when a blood vessel becomes damaged, chemical agonists bind with certain binding sites on circulating platelets, causing the platelets to become activated. The types of blood vessel wall damage that can trigger platelet activation include perforation or injury to the vessel wall, progression of atherosclerotic plaque, the performance of some interventional procedure (e.g., angioplasty, atherectomy or stenting) which stretches the vessel wall or causes intimal tearing, or other causes. When activated, platelets interact with fibrinogen, fibronectin and other clotting factors causing them to adhere to the affected blood vessel wall and to aggregate with one
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another and with other blood cells (e.g., leukocytes). This activation, adherence and aggregation of platelets leads to the formation of a thrombus or blood clot. Web site: http://www.delphion.com/details?pn=US06544282__ ·
Local anesthetic compounds and uses Inventor(s): Axt; Sabine M. (Sunnyvale, CA), Church; Timothy J. (San Mateo, CA), Hruzewicz; Witold (New York, NY), Jacobsen; John R. (San Francisco, CA), Jenkins; Thomas E. (La Honda, CA), Ji; Yu-Hua (Redwood City, CA), Judice; J. Kevin (El Granada, CA), Wu; Huiwei (Foster City, CA) Assignee(s): Theravance, Inc. (South San Francisco, CA) Patent Number: 6,462,034 Date filed: October 1, 1999 Abstract: Novel compounds, pharmaceutical compositions and methods are disclosed for producing local anesthesia of long-duration. The compounds of this invention are multibinding compounds that comprise from 2 to 10 ligands covalently attached to a linker or linkers, each ligand being capable of binding to a ligand binding site in a voltage-gated Na.sup.+ channel to modulate the biological processes/functions thereof. Excerpt(s): This invention relates to novel multibinding local anesthetic compounds that bind to voltage-gated Na.sup.+ ion channels and thereby modulate their activity. The compounds of this invention comprise at least two ligands covalently connected by a linker or linkers, wherein at least one of the ligands in its monovalent (i.e. unlinked) state binds to and is capable of modulating the activity of a voltage-gated Na.sup.+ ion channel. The ligands are linked together such that the multibinding compounds thus formed demonstrate a biologic and/or therapeutic effect on processes mediated by voltage-gated Na.sup.+ ion channels that is greater than that of the same number of unlinked ligands made available for binding to the channels. In one preferred embodiment, the compounds of the present invention are capable of producing local anesthesia of longer duration than are the corresponding unlinked monovalent ligands. The invention also relates to methods of using such compounds and to methods of preparing them. These multibinding local anesthetic compounds are particularly useful in treating conditions and diseases that require pain control. Accordingly, this invention also relates to pharmaceutical compositions comprising a pharmaceutically acceptable excipient and an effective amount of a compound of this invention. Action potentials are generated in nerve and muscle cells by ion currents that pass selectively across membranes through transmembrane ion channels. Local anesthetics exert their effects by specifically binding to Na.sup.+ channels, thereby inhibiting Na.sup.+ currents and causing the blockade of Na.sup.+ channel-dependent impulse conduction. The necessary practical advantage of local anesthetics is that their action is reversible at clinically relevant concentrations and their use is followed by complete recovery of nerve and muscle function with no evidence of damage to nerve fibers or cells. Web site: http://www.delphion.com/details?pn=US06462034__
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Maintaining kidney function during surgery or trauma Inventor(s): Kapusta; Daniel R. (Slidell, LA) Assignee(s): Board of Supervisors of Louisiana State University and Agricultural and (Baton Rouge, LA) Patent Number: 6,468,971 Date filed: September 2, 1998 Abstract: Kappa-opioid agonists prevent the impairment of renal function otherwise caused by the combination of gaseous anesthesia and surgery or severe trauma. Not only do these agents preserve renal function and maintain urine output, they also maintain plasma electrolyte concentration and osmolality by reducing renal loss of sodium and potassium when compared to other diuretic agents. The preservation of urine flow as well as the ability to retain body sodium, potassium, calcium, and osmolality during surgery or severe trauma under gaseous anesthesia are novel and unique properties associated only with kappa opioid agonists. To date, no other clinically-used diuretic agent has been shown to provide constant urine flow, or to retain electrolytes during anesthesia and surgery. The kappa opioid agonists may be used in surgical patients with normal cardiovascular function, but are particularly useful in patients with compromised cardiovascular and/or renal function. Continuous intravenous infusion of the kappa agonist preferably begins about 30 to 90 minutes before induction of anesthesia, and continues throughout anesthesia and surgery. The result is a constant and adequate output of urine while maintaining homeostasis of blood volume, electrolyte concentration, and osmolality throughout surgery and anesthesia. The dose of the kappa opioid agonist needed to induce diuresis during anesthesia is significantly higher than the dose needed to induce diuresis in a conscious patient. Excerpt(s): This invention pertains to diuretics, particularly to diuretics that are used during surgery or severe trauma under general anesthesia. This is the United States national stage of International Application PCT/US97/03439, filed Mar. 5, 1997; which claims the priority of the filing date of the United States patent application Ser. No. 08/615,531, filed Mar. 11, 1996, now converted to provisional application Ser. No. 60/040,272. During surgery or severe trauma, gaseous (volatile) general anesthetics such as isoflurane, enflurane, desflurane, nitrous oxide, halothane, ethylene, cyclopropane, sevoflurane and methoxyflurane cause an undesirable side effect on the kidneys: the use of gaseous general anesthetics during the stress of surgery or severe trauma causes acute renal failure and the nearly complete shutdown of urine production. There are profound and sustained reductions in urine output (antidiuresis), urinary sodium excretion (antinatriuresis), and urinary potassium excretion (antikaluresis). When renal function is thus impaired, the kidneys do not produce normal amounts of urine. Water then accumulates in the vascular and interstitial compartments of the body, leading to fluid overload and electrolyte imbalance. In a healthy surgical patient with normal cardiovascular function, the fluid retention and electrolyte imbalance do not necessarily present complications. But potentially life-threatening complications can develop if the same amount of fluid is retained, or if the same electrolyte imbalance occurs in a surgical patient with a preexisting cardiovascular or renal condition, such as hypertension, angina, hepatic cirrhosis, congestive heart failure, renal failure, myocardial infarction, or arrhythmia. Potentially life-threatening conditions that can develop during or after surgery under general anesthesia include pulmonary edema, seizures, angina, myocardial infarction, cardiac arrhythmia, heart failure, renal failure,
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renal tubular necrosis, sepsis, gastrointestinal hemorrhage, and central nervous system edema or dysfunction. Web site: http://www.delphion.com/details?pn=US06468971__ ·
Method and apparatus for positioning an instrument relative to a patients body during a medical procedure Inventor(s): Prokoski; Francine J. (5410 Colchester Meadow La., Fairfax, VA 22030) Assignee(s): none reported Patent Number: 6,529,617 Date filed: November 6, 2000 Abstract: A method and apparatus for annotation of medical imagery to facilitate patient identification, diagnosis, and treatment is characterized by an imaging device for producing a first signal representative of sensed characteristics of the individual and a minutiae generator which receives the first signal and produces a second signal representative of minutiae of the individual, the minutiae corresponding to specific branch points of blood vessels of the individual. A minutiae data generator analyzes the characteristics of minutiae and produces a third signal representative of the characteristics which is stored in a minutiae database for each of the plurality of known individuals and their medical conditions. The minutiae and minutiae data may be used to annotate medical imagery to facilitate subsequent image comparison by providing standardized registration points and time-varying characteristics. A minutiae matcher pairs corresponding second signals and third signals from a current patient with those from a database record, and the paired signals are used to align the images and compare them. The minutiae analysis techniques of the invention can be used to identify medical patients, assist in the diagnosis of medical conditions, and detect and monitor the use of alcohol and drugs, including anesthesia. Excerpt(s): This invention relates generally to the field of image recognition and processing and specifically to methods and systems for identifying, diagnosing, and treating people based on thermal minutiae within a person's body, primarily the face. Improved methods for automated access control and surveillance are vital to ensure the continued security of nuclear weapon storage facilities, as well as other sensitive or valuable items. Potential threats range from terrorist bombings, insider thefts, and industrial espionage to sabotage by environmental activists. There is concern for increased vigilance in the protection of critical strategic assets. Current technology being used for access control is not sufficient reliable, secure, fast rugged or cost effective for routine unattended operations at high-security locations. The challenge is to develop systems to secure facilities and personnel from internal and external threats in a cost effective and timely manner. Replacing human guards with automated systems can provide a significant cost savings. Web site: http://www.delphion.com/details?pn=US06529617__
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Method and apparatus for quantifying the hypnotic component of the depth of anesthesia by monitoring changes in optical scattering properties of brain tissue Inventor(s): Merilainen; Pekka (Helsinki, FI) Assignee(s): Instrumentarium Corp. (Helsinki, FI) Patent Number: 6,526,297 Date filed: September 29, 2000 Abstract: A method/apparatus for non-invasively measuring a neurological activity state in the brain of a subject to ascertain, for example, the state of the hypnotic component of the subject's anesthesia. The method/apparatus comprises means for, or the step of, passing light through a portion of the brain of the subject, the light having a characteristic that subjects it to scattering during passage by tissues of the brain, the light scattering capabilities of the brain tissues varying responsive to their neurological activity. The light exiting the brain tissue portion is measured to determine the amount of scattering it has undergone as a measurement of the state of the hypnotic component of the subject's anesthesia. Light having a wavelength in a range of 650-1000 nm, preferably around 800 nm may be used. Excerpt(s): The reliable monitoring of the depth of anesthesia has remained as one of the main challenges during the past ten years or so while measurement of most of the other key physiological parameters for comprehensive patient monitoring has practically reached a level of maturity. One of the reasons is that the concept of depth of anesthesia, when applying the modern concept of balanced anesthesia, is not a onedimensional parameter, but has no less than five components. A balanced high quality anesthesia consists of adequate hypnosis, analgesia, muscle relaxation, suppression of the autonomous nervous system and blockade of the neuromuscular junction. Hypnosis means loss of consciousness down to a level able to guarantee amnesia, i.e. that no memories about the operation appear afterwards. Analgesia means that no pain is felt during the surgery. Sufficient muscle relaxation is required to ensure optimal operating conditions for the surgeon manipulating the tissue. The autonomous nervous system, if not suppressed, causes the patient to respond to surgical activity by shock reaction which affects heavily on the hemodynamics and endocrine system. To keep the patient completely motionless, the neuromuscular junction transmitting the orders from the brain to the muscles needs to be blocked, which means complete paralysis of the body. One practical consequence of the paralysis is that the patient also needs to be connected to a mechanical ventilator because the breathing muscles also become inoperative. To achieve the state of balanced and adequate anesthesia, several different types of drugs are needed. For hypnosis one needs a drug affecting directly on the brain. Such a drug can be either inhalational anesthetics administered as a vapor into the lungs or intravenous agents infused into the blood circulation. Many of the hypnotically acting drugs also have an useful effect on pain, autonomous nervous system response, and muscle relaxation. However, special, dedicated drugs affect best on pain and neuromuscular blockade. What makes this complex picture even more difficult is that the practices of anesthesia vary from country to country and also among individual anesthesiologists. There are also schools of scientists that emphasize the weight of the components of the anesthesia in differing ways. The importance of reliable monitoring of the depth of anesthesia has both safety and economy related aspects which are partly coupled one to another. Too light anesthesia and especially waking up in the middle of an operation may become an extremely traumatic experience both for the patient and the anesthesiologist. Unnecessarily deep anesthesia means increased costs in use of drugs most of which are rather expensive. Too deep anesthesia usually also affects the
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quality of the postoperative period and may increase time required for active recovery care. Web site: http://www.delphion.com/details?pn=US06526297__ ·
Method of local anesthesia and analgesia Inventor(s): Ku; Baoshan (Beijing, CN), Qi; Shiquan (Beijing, CN) Assignee(s): Wex Medical Instrumentation Co., Ltd. (North Point, HK) Patent Number: 6,599,906 Date filed: November 1, 2000 Abstract: The present invention provides a method of producing local analgesia and anesthesia in a mammal experiencing pain in a nerve tissue region. The method includes topically administrating to the region, in a suitable pharmaceutical vehicle, an effective dose of a sodium channel blocking compound. Excerpt(s): The present invention relates to a method of producing local anesthesia and analgesia in a nerve tissue region of a mammal by topical administration of sodium channel blocking compounds, including tetrodotoxin and/or saxitoxin. Pain is associated with actual or potential injury or tissue damage due to inflammation, ischemia, mechanical or other irritation. Local anesthetics are used to treat pain by blocking neuronal transmission and affect sensation as well as pain. Analgesics are used to relieve pain and they additionally may interfere with the activity of chemical mediators causing inflammation. Damage or stimulation to a sensory nerve region such as the dental pulp is usually associated with severe pain and can result from chemical or physical cause, for example, a decayed tooth, periodontitis, and surgical procedures on a tooth. Web site: http://www.delphion.com/details?pn=US06599906__
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Nitrosated and nitrosylated.alpha.-adrenergic receptor antagonist, compositions and methods of use Inventor(s): de Tejada; Inigo Saenez (Madrid, ES), Garvey; David S. (Dover, MA), Gaston; Ricky D. (Malden, MA), Schroeder; Joseph D. (Dedham, MA), Shelekhin; Tatiana E. (Acton, MA), Wang; Tiansheng (Concord, MA) Assignee(s): NitroMed, Inc. (Bedford, MA) Patent Number: 6,469,065 Date filed: September 1, 1999 Abstract: The present invention describes novel nitrosated and/or nitrosylated.alpha.adrenergic receptor antagonists, and novel compositions containing at least one nitrosated and/or nitrosylated.alpha.-adrenergic receptor antagonist, and, optionally, one or more compounds that donate, transfer or release nitric oxide, elevate endogenous levels of endothelium-derived relaxing factor, stimulate endogenous synthesis of nitric oxide or are a substrate for nitric oxide synthase, and/or one or more vasoactive agents. The present invention also provides novel compositions containing at least one.alpha.adrenergic receptor antagonist, and one or more compounds that donate, transfer or release nitric oxide, elevate endogenous levels of endothelium-derived relaxing factor, stimulate endogenous synthesis of nitric oxide or is a substrate for nitric oxide synthase
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and/or one or more vasoactive agents. The present invention also provides methods for treating or preventing sexual dysfunctions in males and females, for enhancing sexual responses in males and females, and for treating or preventing benign prostatic hyperplasia, hypertension, congestive heart failure, variant (Printzmetal) angina, glaucoma, neurodegenerative disorders, vasospastic diseases, cognitive disorders, urge incontinence, or overactive bladder, and for reversing the state of anesthesia. Excerpt(s): The present invention describes novel nitrosated and/or nitrosylated.alpha.adrenergic receptor antagonists, and novel compositions comprising at least one nitrosated and/or nitrosylated.alpha.-adrenergic receptor antagonist, and, optionally, at least one compound that donates, transfers or releases nitric oxide, elevates endogenous levels of endothelium-derived relaxing factor, stimulates endogenous synthesis of nitric oxide or is a substrate for nitric oxide synthase, and/or at least one vasoactive agent. The present invention also provides novel compositions comprising at least one.alpha.adrenergic receptor antagonist, and at least one compound that donates, transfers or releases nitric oxide, elevates endogenous levels of endothelium-derived relaxing factor, stimulates endogenous synthesis of nitric oxide or is a substrate for nitric oxide synthase, and/or at least one vasoactive agent. The present invention also provides methods for treating or preventing sexual dysfunctions in males and females, for enhancing sexual responses in males and females, and for treating or preventing benign prostatic hyperplasia, hypertension, congestive heart failure, variant (Printzmetal) angina, glaucoma, neurodegenerative disorders, vasospastic diseases, cognitive disorders, urge incontinence, and overactive bladder, and methods for reversing the state of anesthesia. Adequate sexual function is a complex interaction of hormonal events and psychosocial relationships. There are four stages to sexual response as described in the International Journal of Gynecology & Obstetrics, 51(3):265-277 (1995). The first stage of sexual response is desire. The second stage of sexual response is arousal. Both physical and emotional stimulation may lead to breast and genital vasodilation and clitoral engorgement (vasocongestion). In the female, dilation and engorgement of the blood vessels in the labia and tissue surrounding the vagina produce the "orgasmic platform," an area at the distal third of the vagina where blood becomes sequestered. Localized perivaginal swelling and vaginal lubrication make up the changes in this stage of sexual response. Subsequently, ballooning of the proximal portion of the vagina and elevation of the uterus occurs. In the male, vasodilation of the cavernosal arteries and closure of the venous channels that drain the penis produce an erection. The third stage of sexual response is orgasm, while the fourth stage is resolution. Interruption or absence of any of the stages of the sexual response cycle can result in sexual dysfunction. One study found that 35% of males and 42% of females reported some form of sexual dysfunction. Read et al, J. Public Health Med., 19(4):387391 (1997). While there are obvious differences in the sexual response between males and females, one common aspect of the sexual response is the erectile response. The erectile response in both males and females is the result of engorgement of the erectile tissues of the genitalia with blood which is caused by the relaxation of smooth muscles in the arteries serving the genitalia. Web site: http://www.delphion.com/details?pn=US06469065__
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Oral adhesive sheet and oral adhesive preparation Inventor(s): Inoue; Yuichi (Osaka, JP), Saito; Junichi (Osaka, JP) Assignee(s): Nitto Denko Corporation (Osaka, JP) Patent Number: 6,455,030 Date filed: July 20, 2001 Abstract: An oral adhesive preparation has a substrate and a pressure-sensitive adhesive layer provided on at least one surface of the substrate, in which the pressure-sensitive adhesive layer contains a medicine, and is substantially insoluble in water or absorbs substantially no water. Further, an oral adhesive sheet comprising a separator releasetreated on one or both surfaces thereof and a plurality of sections for application to oral mucous membrane mounted on at least one surface of the separator in a specified 2 to 5 by 2 to 5 arrangement with a specified proportion of a minimum inner diameter, Dp, of an incircle passing a center of gravity, W, of a section to a shortest distance, Di, of an adjacent section is 1.5 to 6. The substrate is preferably cloth such as non-woven fabric. Sections containing a local anesthetic can be used in surface anesthesia in dentistry. Excerpt(s): The present invention relates to an adhesive preparation that is applied in the mouth and used upon administration of a medicine in the mouth. Further, the present invention relates to an oral adhesive sheet and more particularly to an oral adhesive sheet including a separator and a plurality of sections mounted on the separator, having a pressure-sensitive adhesive layer containing a medicine for adhering to the oral mucous membrane such as gingival mucous membrane so as to apply the medicine through the mucous membrane to improve handling property of the adhesive sheet. Heretofore, various methods have been known for the administration of medicines in the mouth. For example, there have been known methods using solution, ointment, jelly, spray, troche, buccal tablet, sublingual tablet, etc., respectively. Recently, as a preparation that has good adhesiveness even in an oral cavity mucous membrane wetted with moisture such as saliva, there has been proposed an oral adhesive preparation having a pressure-sensitive adhesive layer containing a medicine, a base (major component) of the pressure-sensitive adhesive layer comprising a water soluble or water swellable polymer. For example, a mucous membrane-adhering preparation having a substrate and a mucous membrane adhering pressure-sensitive adhesive layer on the substrate, containing an alginic acid ester and a medicine (JP-A-61-30516), an external film preparation containing hydroxypropyl cellulose as a major component and a pharmaceutical preparation (JP-A-62-63513), local anesthetic adhesive preparation for application to gingiva, having a pressure-sensitive adhesive layer comprising a watersoluble polymer such as polyvinylpyrrolidone and a water-insoluble or water-swellable polymeric substance such as polyvinyl acetate and a physiologically active component (JP-A-1-272521), an oral application substrate of a two-layer structure produced by casting and drying a liquid containing a polyacrylic acid salt, a carboxyvinyl polymer and polyvinyl alcohol (JP-A-5-310561), etc. Web site: http://www.delphion.com/details?pn=US06455030__
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Out-patient joint lavage kit and protocol Inventor(s): Vad; Vijay B. (1365 York Ave. #5F, New York, NY 10021) Assignee(s): none reported Patent Number: 6,527,760 Date filed: September 25, 2000 Abstract: Out-patient knee lavage is performed by use of a kit comprising:A. Means for preparing the knee joint for lavage;B. An optional surgical drape;C. A first needle and a first syringe containing a first local anesthesia;D. A second needle and second syringe containing a second local anesthesia; andE. A third syringe adapted to fitting the second needle, the third syringe containing a lavage fluid.The knee lavage is performed by:1. Cleansing the knee joint and, preferably, covering it with a surgical drape;2. Applying the first local anesthesia superficially to the joint to create a wheat;3. Injecting through the wheal the second local anesthesia into the knee joint; and4. Performing the lavage on the knee joint without removing the second needle from the knee joint. Excerpt(s): This invention relates to lavage. In one aspect, the invention relates to a kit for performing a joint, e.g., knee, lavage in an out-patient setting while in another aspect, the invention relates to a protocol for performing a joint lavage in an out-patient setting. In yet another aspect, the invention relates to a protocol for the treatment of osteoarthritis of the knee by using knee lavage in combination with sodium hyaluronate or hylan. Osteoarthritis of the knee is an ailment common to a large segment of the elderly population of the United States. Pain and diminished function are common traits of the ailment, and various protocols exist for the treatment of this ailment. Total knee arthroplasty has proven successful for patients with end-stage osteoarthritis of the knee but due to its expense and relatively high failure rate for those patients with active lifestyles, it has not been as available and/or successful for patients with non-end-stage osteoarthritis of the knee. For this latter group of patients, protocols employing hylan or sodium hyaluronate have demonstrated considerable success. Hyaluronic acid is a natural constituent of synovial fluid and cartilage. The function of the hyaluronic acid is to maintain structural and functional characteristics of extracellular matrix and fluids. Presently two products are composed of various fractions of hyaluronate are approved by the United States Food and Drug Administration for relief of pain associated with osteoarthritis of the knee for patients who have failed to respond adequately to conservative nonpharmacologic therapy and simple analgesics. These products are sodium hyaluronate sold under the trademark HYALGAN.TM. and hylan-G-F-20 sold under the trademark SYNVISC.TM. Both of these products are classified as prosthetic devices. Various protocols exist for use of these products, and a typical protocol for sodium hyaluronate is a series of injections over five weeks. For hylan-G-F-20, a typical protocol is a series of injections over three weeks. Web site: http://www.delphion.com/details?pn=US06527760__
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Pediatric prepatory and induction anesthesia device Inventor(s): Buisson; Michael Irwin (206 Willow Oaks Dr., Clinton, MS 39056) Assignee(s): none reported Patent Number: 6,463,928 Date filed: April 6, 1999
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Abstract: The Pediatric Prepatory and Induction Anesthesia Device ("PPIAD") is designed to aid anesthetists in effectively administering anesthetic gas to young patients. The PPIAD has a toy-like appearance, which calms the fears of children. The PPIAD also incorporates toy-like devices such as whistles and balloons. When the PPIAD is given to children prior to treatment, the child can play with it as a toy. During this play time, the PPIAD actually teaches the child proper breathing for the administration of anesthetic gas because the whistle and balloon are only activated by deep breathing. Thus, when the child is administered anesthetic gas with the PPIAD, the application of anesthetic gas is much more effective. In addition, as the anesthetic gas is applied with the PPIAD, the child is encouraged to breathe deeply to activate the toylike devices, enhancing the application of anesthetic gas to the child. Thus, the PPIAD helps doctors provide effective care for child patients as it clams the fears of child patients during these medical procedures. Excerpt(s): One particular problem faced by anesthetists daily is difficulty in the administration of anesthetic gas to children. Children often resist the use of conventional masks used to supply anesthetic gas to adults. They struggle to prevent doctors from covering their face with the mask, and they tense-up when the masks are in place, breathing in short, shallow breaths instead of deeply breathing the gas. This reduces the effectiveness of the anesthetic gas and makes the entire medical procedure more difficult. The instant invention, referred to as a Pediatric Preparatory and Induction Anesthesia Device ("PPIAD"), was developed to reduce these problems inherent in using gas to induce anesthesia in children during medical procedures. It presents the mask as a non-threatening toy, incorporating familiar play-things in order to put the child at ease. This helps the doctors to be able to apply the mask with much less struggle. By presenting itself as a toy, the PPIAD can also assist in the preparation of young children for the application of anesthetic gas in the operating room. The device can be given to the children while they are waiting for the medical procedure (without the anesthesia circuit being attached), allowing them to play with the"toy." This prepatory process allows the children to become familiar with the device, so that when it is used in the operating room (now attached to the anesthesia circuit), the children are not frightened. This prepatory work with the device in the waiting room also allows the children to learn how to use the device properly, since the desired type of breathing is required for the device's toy-like features to operate. Thus, the PPIAD simultaneously teaches the child how to use the device properly (aiding in the application of the anesthetic gas) while calming the child's fears regarding both the anesthesia and the medical procedure by eliminating some of the uncertainty and unfamiliarity before the child even enters the operating room. Web site: http://www.delphion.com/details?pn=US06463928__ ·
Portable anesthesia rebreathing system Inventor(s): Smith; Charles A. (811 Starlite Dr., Louisville, KY 40207) Assignee(s): none reported Patent Number: 6,536,430 Date filed: October 10, 2000 Abstract: A portable anesthesia administering system which includes a compact, lightweight unit that does not require a source of electrical power to provide regulated pressurized anesthesia gas to a patient. The operating elements include a disposable carbon dioxide absorber, a charcoal scavenger absorber, an oxygen pressure sensor and
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alarm for detecting a drop in the oxygen pressure below a pre-selected level. The unit utilizes an anesthesia vaporizer and regulator, an airway pressure limiting valve and airway inlet and outlet control valves to provide a gaseous anesthesia agent in preselected amounts. Attached to the disposable carbon dioxide absorber is a manifold block which provides for a plurality of anesthesia regulating and control elements to facilitate the administration of the anesthesia. Connected to the manifold block is an external breathing bag for assisting in the breathing of the patient. Excerpt(s): This invention relates generally to a portable system for administering anesthetics to a patient at a location remote from the traditional hospital operating room. There has been a long felt need for a simple, reliable, effective portable anesthesia machine which could be easily operated at a site where health care or emergency services need be provided where the procedure is not complex but may necessarily require administration at a remote location. Typically, for example, dentists have found it necessary to have access to anesthetic services for such procedures as the extraction of wisdom teeth. Similarly, the need has arisen for anesthesia to be administered to victims of earthquakes, floods, hurricanes and the like under emergency conditions and in locations remote from an established health care facility. Also, the military recognizes the benefits of having a truly portable anesthesia rebreathing system. Also, there exists an economic incentive to develop such a system simply because more procedures may be performed in a doctor's office or on an out patient basis, thus reducing costly hospital charges. Heretofore, however, anesthesia machines have required a source of electrical power as well as anesthesia gas and oxygen or air. Thus, the portability of such units has been significantly limited in the past. Also, the traditional anesthesia units have suffered from the prospect of cross-contaminating patients by virtue of the fact that the CO2 removal system has been made up of a large canister of soda lime used sequentially for patient after patient. Thus, in those environments where there is an epidemic, the use of anesthesia may contribute to the spread of infection. Cross contamination in the present system is eliminated because the unit uses a single, easily disposable, canister containing CO.sub.2 absorbent. Moreover, the simplicity of the present invention allows for the easy cleaning and sterilization or disposal of any part that is contacted by the patient expired gas. The disposable CO.sub.2 absorbent canister is the subject of U.S. Pat. No. 5,558,088 of Charles A. Smith, the inventor of the instant invention. The present invention is directed to an improved anesthesia system which typically functions as a closed system and overcomes many of the shortcomings of the prior art systems. The present invention is a portable anesthesia administering system comprising tubes or conduits to and from a patient, operatively connected to a unit, which provides regulated, pressurized, anesthesia gas. The unit includes a frame having an upper and lower face and supporting structure therebetween defining a container space, said upper face containing a plurality of orifices each accepting an operating element of said unit therein with said elements projecting into the container space. One of said orifices receives a disposable carbon dioxide absorber supported by said upper face and is operably attached in flow communication with said conduits. Web site: http://www.delphion.com/details?pn=US06536430__
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Process for changing the concentration in an anesthesia apparatus Inventor(s): Hoffmann; Karsten (Griebel/Kasseedorf, DE) Assignee(s): Drager Medizintechnik GmbH (DE) Patent Number: 6,553,990 Date filed: May 29, 2001 Abstract: A process, system and apparatus for changing the concentration in an anesthesia apparatus with a fresh gas metering unit (14) and a pressure sensor (17) in the breathing circuit, with a volume displacement device (1) in the inspiration branch and a PEEP/P.sub.MAX valve (7) in the expiration branch. The fresh gas metering unit (14), the pressure sensor (17), the volume displacement unit (1) and the PEEP/P.sub.MAX valve (7) are connected to an evaluating and control unit (15). To bring about a rapid change in the concentration of the anesthetic or fresh gas supplied in the breathing circuit without additional design effort on the anesthesia apparatus the volume displacement device (1) is rinsed, either under the control of the fresh gas supply or under the control of the speed at which the volume displacement device (1) is returned. The rinsing takes place simultaneously with the regular respiration operation of the anesthesia apparatus, which may take place in a volume-controlled or pressurecontrolled manner. Excerpt(s): The present invention pertains to a process for changing the concentration in an anesthesia apparatus with a breathing circuit with an inspiration branch and an expiration branch, with a fresh gas metering unit and a pressure sensor in the breathing circuit, with a volume displacement means in the inspiration branch and a PEEP/P.sub.MAX valve in the expiration branch, wherein the fresh gas metering unit, the pressure sensor, the volume displacement means and the PEEP/P.sub.MAX valve are connected to an evaluating and control unit. Anesthesia apparatus which have a volume displacement means as the breathing gas delivery unit for the tidal volume to be applied in the patient have the problem that especially at low respiratory minute volumes, i.e., at low volume displacements per minute, called RMV for short, a change in the anesthetic or fresh gas concentration reaches the patient only very slowly. The cause of this is that the anesthetic or fresh gas fed in newly is not distributed immediately uniformly in the entire breathing circuit of the anesthesia apparatus but gas segments with the new concentration, consisting of anesthetic, fresh gas and a certain percentage of expired gas, move to the patient gradually through the inspiration branch of the breathing circuit with the inspiration stroke. The gas segments with the new concentration are moving toward the patient at a speed proportional to the respiratory minute volume. If very small tidal volumes are to be applied, which occurs, e.g., in the case of neonatal respiration, and also in the case of long tubes, it may take several minutes before the change in concentration in the breathing circuit can be detected at the mouthpiece leading to the patient. This process cannot be expedited by increasing the fresh gas supply, which will hereinafter also increase fresh gas containing an anesthetic, because anesthesia apparatus with volume displacement means usually operate uncoupled from the fresh gas. If the fresh gas supply is increased, the portion of the fresh gas supply exceeding the respiratory minute volume is discharged unused via the anesthetic gas discharge without a rapid change in concentration taking place at the mouthpiece leading to the patient. Web site: http://www.delphion.com/details?pn=US06553990__
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Propofol-based anesthetic and method of making same Inventor(s): Carpenter; John R. (Savannah, MO) Assignee(s): Phoenix Scientific, Inc. (St. Joseph, MO) Patent Number: 6,534,547 Date filed: September 12, 2000 Abstract: An anesthetic is provided that includes a mixture of propofol, a tonicity agent, a substantially phospholipid-free emulsifying agent, a preservative such as benzyl alcohol, and water. This anesthetic is made by combining these components and then filtering the mixture of these components through a sterilizing filter. This anesthetic may be parenterally administered to both induce and maintain anesthesia in animals. Excerpt(s): The present invention relates to an anesthetic and a method for making the anesthetic. More specifically, the present invention relates to an anesthetic containing propofol as its active component for use in veterinary applications. Anesthetics are useful in surgical procedures to artificially produce unconsciousness or to reduce sensitivity to pain. Anesthetics are typically viewed as primarily applicable to humans. However, anesthetics also may be administered to all types of animals to reduce pain when setting broken bones, performing internal surgery, or otherwise handling the animal. One common method of veterinary anesthetization is to premedicate the animal with an alpha-2 agonist such as xylazine or detomidine, and then induce anesthesia with ketamine. The ketamine anesthetic may be followed by the administration of a gas anesthetic to maintain anesthesia for the remainder of the procedure. Another common method of veterinary anesthetization is administering a thiobarbiturate mixed with glycerol guaicolate. An anesthesia gas may then be administered to maintain anesthesia for a prolonged surgical procedure. Web site: http://www.delphion.com/details?pn=US06534547__
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Screening the activity of drugs for central nervous system (CNS) Inventor(s): Kumar; Sushil (Lucknow, IN), Sharma; Abhay (Lucknow, IN) Assignee(s): Council of Scientific & Industrial Research (New Delhi, IN) Patent Number: 6,541,193 Date filed: February 22, 2001 Abstract: The invention relates to a method for screening of neuroactive drugs using the fruit fly Drosophila melanogaster, which comprises the steps of, generating a double mutant line of K.sup.+ channel genes in Drosophila melanogaster; culturing the Sh.sup.5 eag.sup.1 mutant flies on Dorsophila medium under standard conditions; and anesthetizing flies with diethyl ether and observing the time taken by flies to recover from anesthesia. Excerpt(s): This invention relates to the development of a novel test model and assay for screening the activity of drugs for central nervous system (CNS). More particularly, the invention identifies the use of the fruit fly as a model to test the neuroactivity of test drugs/samples. Drugs that stimulate or depress CNS play an important role in human therapeutics. They act as anesthetics, analgesics, sedatives, psychostimulants, analeptics, antidepressants, anticonvulsants etc. and are used in the treatment of conditions such as narcolepsy, depression, hyperactivity disorders, epilepsy and drug addiction in human (Wood-Smith and Stewart, 1964, in Drugs in anesthetic practice, Butterworth; Beckman,
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1958, in Drugs, their nature, action and use, W. B. Saunder, Green and Levy, 1976, Drug misuse, human abuse, Dekker). Undesirable side effects and ineffectiveness of currently available CNS stimulants/depressants in many situations call for development of novel drugs. Animal models currently used in neuroactive drug screening mostly include higher animals such as nonhuman primates and rodents. Although their indispensability in advanced stages of drug development can not be denied, using these models in primary rug screening is time, cost and labor intensive. Many components of neuronal signaling are conserved between the fruit fly Drosophila melanogaster and human (Rubin e al, 2000, Science 287:2204-2215; Littleton and Ganetzky, 2000, Neuron 26:35-43). Moreover, many CNS stimulant/depressant drugs used in human therapy also exhibit their neuroactivity in fly (Shaw et al, 2000, Science 287:1834-1837; Hendricks et al, 2000, Neuron 25:129-138; Andretic et al, 1999, Science 285:1066-1068; Li et al, 2000, Curr. Biol. 10:211-214; Baintaon et al, 2000, Curr. Biol. 10:187-194; McClung and Hirsh, 1999, Curr. Biol. 9:853-860). Considering these, the applicants thought of evaluating of potential of Drosophila to serve as a simple, rapid and inexpensive model for screening of CNS active agents. Web site: http://www.delphion.com/details?pn=US06541193__ ·
Single breath induction anesthesia apparatus Inventor(s): Colas; Marie-Jose (1327 Bradley, Sherbrooke, CA J1J 1M1) Assignee(s): none reported Patent Number: 6,634,355 Date filed: June 21, 1999 Abstract: A single breath induction anesthesia apparatus for anesthetizing a patient, comprises a gas delivery system for delivering at least one gas to the patient, an oxygen supply system for providing oxygen, and an oxygen/anesthesia gas supply system for mixing oxygen and at least one anesthesia gas at a preset optimum ratio sufficient to cause anesthesia of the patient with a single breath, thereby providing an oxygen/anesthesia gas mixture. The apparatus of the invention further includes a valve for providing selective gas flow communication between the oxygen supply system and the gas delivery system or between the oxygen/anesthesia gas supply system and the gas delivery system. The valve is operable for first establishing gas flow communication between the oxygen supply system and the gas delivery system to deliver oxygen to the patient and permit pre-oxygenation thereof, while simultaneously inhibiting gas flow communication between the oxygen/anesthesia gas supply system and the gas delivery system to allow the oxygen/anesthesia gas mixture to reach the preset optimum ratio, and thereafter establishing gas flow communication between the oxygen/anesthesia gas supply system and the gas delivery system to deliver the oxygen/anesthesia gas mixture at the preset optimum ratio to the patient and permit single breath induction anesthesia thereof, while inhibiting gas flow communication between the oxygen supply system and the gas delivery system. Excerpt(s): The present invention relates to improvements in the field of anesthesia. More particularly, the invention is concerned with a single breath induction anesthesia apparatus. When it is necessary to anesthetise a patient, it is highly desirable to preoxygenate the patient prior to inducing anesthesia in order to saturate the patient's blood with oxygen so as to increase the safety of a subsequent ventilation and endotracheal intubation. Pre-oxygenation of the patient is carried out by using a parallel oxygen supply and breathing system connected by means of a conduit to the anesthesia
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face mask affixed to the patient. Due to the complexity of such a technique, preoxygenation is often skipped. In the case where pre-oxygenation is effected, while the patient is being pre-oxygenated, the doctor usually closes with his fingers the distal end of the conduit connected to an anesthesia machine and adapted to deliver an oxygen/anesthesia gas mixture to the patient, during operation of the anesthesia machine, so as to permit the anesthesia gas in the mixture to reach a preset concentration sufficient to induce anesthesia of the patient with a single breath. Since it is impossible to close with one's fingers the anesthesia gas conduit in a gas-tight manner, leaks of anesthesia gas often occur, which pollute the operating room. When the desired concentration of anesthesia gas has been reached, the oxygen conduit is disconnected from the anesthesia face mask and the anesthesia gas conduit connected thereto. During this disconnection and connection of conduits, important leaks of anesthesia gas occur, which not only further pollute the operating room but lower the concentration of anesthesia gas in the oxygen/anesthesia gas mixture delivered to the patient so that single breath induction anesthesia of the patient is considerably slowed down. Web site: http://www.delphion.com/details?pn=US06634355__ ·
Smart modular anesthesia respiratory system Inventor(s): Garland; Ross G. (Madison, WI), Hendrickson; Carl H. (Madison, WI), Mashak; James N. (Sun Prairie, WI), Michell; Brian C. (Madison, WI), Pernetti; Denise L. (Cottage Grove, WI), Sullivan; Terrance P. (Madison, WI) Assignee(s): Datex-Ohmeda, Inc. (Madison, WI) Patent Number: 6,571,792 Date filed: March 13, 1998 Abstract: An anesthesia system wherein the respiratory system is fitted with interchangeable patient circuit modules that allows a generic fitting in the machine to have affixed, hereto, a module that has ports suitable for connection to various patient breathing circuits. As such, the anesthesia machine can have the patient circuit modules easily changed and thus be adaptable for use with patient breathing circuits such as the circle system, the open/nonrebreathing circuit and the Bain or Mapleson D circuits. A detector system is provided that identifies that particular patient module installed in the anesthesia machine to alert the main CPU and to thus provide the correct flow sensing schemes and flows to the patient breathing circuit then being used. Excerpt(s): The present invention relates to anesthesia machines, and more particularly, to an anesthesia respiratory system that provides a modular form of connector to the patient breathing circuit used to administer an anesthetic to a patient undergoing surgery. In general, anesthesia systems are utilized in operating rooms and comprise various equipment necessary to anesthetize the patient, support or control respiration, and maintain the patient in that state until the operation is completed and it is possible to terminate the introduction of the anesthetic agent. Such systems comprise various pressure regulators, flow control devices, gas mixing devices and vaporizers to vaporize a volatile liquid anesthetic into life support gases and to introduce these anesthetic laden gases (fresh gas) to the patient via the respiratory system. The respiratory system provides manual and automatic means to control or support the patients breathing of the fresh gas mixture. The patient is connected to the system by means of a face mask or other device and which interfaces with the respiratory system via a patient breathing circuit that may typically have an inspiratory limb tube through which the gases are
Patents 143
introduced into the patient and an expiratory limb tube that conveys the exhaled gases from the patient. Web site: http://www.delphion.com/details?pn=US06571792__ ·
Smoking cessation treatments using naltrexone and related compounds Inventor(s): Krishnan-Sarin; Suchitra (Durham, CT), Meandzija; Boris (Hamden, CT), O'Malley; Stephanie (New Haven, CT) Assignee(s): Yale University (New Haven, CT) Patent Number: 6,541,478 Date filed: September 16, 1999 Abstract: Nicotine dependency is treated by administration of an opioid antagonist. In some embodiments, rapid or ultra rapid detoxification techniques include using a combination of an effective amount of an opioid antagonist such as nalmefene, naloxone or naltrexone or a mixture of any one of these, and either clonidine or related compounds either while awake, or while under sedation or anesthesia, followed by continued administration of an effective amount of an opioid antagonist with or without agents that enhance nicotine dependency treatment. Persons are also treated for nicotine dependency with more gradual detoxification methods using administration of a combination of an effective amount of an opioid antagonist such as nalmefene, naloxone, naltrexone, or a mixture of any of these, and an effective amount of agents used to treat nicotine withdrawal including nicotine, such as that delivered by a nicotine patch, nicotine chewing gum, nicotine inhaler or other methods for delivering nicotine, antidepressants and antianxiety agents, and/or clonidine and related compounds. Administration of an effective amount of an opioid antagonist to prevent relapse, attenuate craving, and reduce weight gain during and after treatment for nicotine dependency is continued in some embodiments. Excerpt(s): This invention relates to the use of opioid antagonists such as naltrexone, naloxone or nalmephene alone or with either nicotine replacement therapy or with other withdrawal attenuating agents, to increase smoking abstinence rates, to decrease craving for cigarettes, reduce relapse to heavy smoking during detoxification or once smoking abstinence has been achieved, and to reduce weight gain associated with smoking cessation. Tobacco dependence continues to be a major health hazard for millions of Americans, and because smoking may pose a health risk for non-smokers as well, smoking cessation treatments are of great public interest. Dependence is an adaptive biological state induced by chronic drug exposure which manifests itself in various behavioral and physiological responses when drug exposure ceases. Withdrawal from nicotine following chronic use of tobacco products results in the emergence of an abstinence syndrome which reaches its peak intensity within the first day. Cessation of smoking has been shown to result in a number of signs and symptoms of withdrawal such as increases in irritability, anxiety, restlessness, impatience, somatic complaints, cigarette craving, hunger, insomnia, tremulousness and heart rate as well as difficulty concentrating, all of which are collectively called the tobacco withdrawal syndrome. Web site: http://www.delphion.com/details?pn=US06541478__
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Substituted quinazolines and analogs and use thereof Inventor(s): Cai; Sui X. (San Diego, CA), Fick; David B. (Newport Beach, CA), Field; George (Danville, CA), Lan; Nancy C. (S. Pasadena, CA), Upasani; Ravi (San Jose, CA), Wang; Yan (San Diego, CA) Assignee(s): Euro-Celtique S.A. (Luxembourg, LU) Patent Number: 6,465,472 Date filed: September 1, 2000 Abstract: The invention relates to novel quinazolines and heterocycles which are antagonists or positive modulators of AMPA receptors, and the use thereof for treating, preventing or ameliorating neuronal loss associated with stroke, global and focal ischemia, CNS trauma, hypoglycemia and surgery, as well as treating or ameliorating neurodegenerative diseases including Alzheimer's disease, amyotrophic lateral sclerosis, Huntington's disease, Parkinson's disease and Down's syndrome, treating, preventing or ameliorating the adverse consequences of the overstimulation of the excitatory amino acids, treating, preventing or ameliorating anxiety, psychosis, convulsions, chronic pain, glaucoma, retinitis, urinary incontinence, muscular spasm and inducing anesthesia, as well as for treating or ameliorating the adverse consequences of excitatory amino acid deficiency such as schizophrenia, myoclonus. Alzheimer's disease and malnutrition and neural maldevelopment, and as cognition and learning enhancers. Excerpt(s): This invention is in the field of medicinal chemistry. In particular, the invention is related to novel substituted quinazolines and analogs thereof. These compounds are antagonists of.alpha.-amino-3-hydroxy-5-methylisoxazole-4-propionic acid (AMPA) ionotropic receptors. Certain of these compounds are positive modulators of AMPA receptors. The invention also is directed to the use of novel substituted quinazolines and analogs thereof for the treatment of neuronal damage following global and focal ischemia, and for the treatment or prevention of neurodegenerative conditions as anticonlvulsants, as cognitive enhancers, and for the treatment of schizophrenia, Parkinson's disease and myoclonus. The compounds of the invention are also useful for treatment or prevention of pain, including acute and chronic pain. The invention also is directed to a process for the preparation of the substituted quinazolines and analogs thereof. Excitatory amino acid receptors are classified into two general types. Receptors that are directly coupled to the opening of cation channels in the cell membrane of the neurons are termed "ionotropic." This type of receptor has been subdivided into at least three subtypes, which are defined by the depolarizing actions of the selective agonist Nmethyl-D-aspartate (NMDA),.alpha.-amino-3-hydroxy-5-methylisoxazole-4-propionic acid (AMPA), and kainic acid (KA). The second general type is the G-protein or second messenger-linked "metabotropic" excitatory amino acid receptor. This second type, when activated by the agonists quisqualate, ibotenate, or trans-1-aminocyclopentane1,3-dicarboxylic acid, leads to enhanced phosphoinositide hydrolysis in the postsynaptic cell. Both types of receptors appear not only to mediate normal synaptic connections during development, but also change in the efficiency of synaptic transmission throughout life. (Schoepp, Bockaert, and Sladeczek, Trends Pharm. Sci. 11:508 (1990); McDonald and Johnson, Brain Res. Rev. 15:41 (1990)). The excessive or inappropriate stimulation of excitatory amino acid receptors leads to neuronal cell damage or loss by a mechanism known as excitotoxicity. The medical consequences of such neuronal degeneration makes the abatement of these degenerative neurological processes an important therapeutic goal. (See U.S. Pat. No. 5,284,957). Antagonists of the AMPA receptor are considered useful in treating, preventing and ameliorating a number of neurologic disorders which are due to overstimulation by the excitatory amino acids.
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These include acute neurologic disorders such as domoic acid poisoning; cerebral ischemia, global ischemia associated with cardiac arrest; stroke; spinal cord trauma; hypoxia; anoxia; poisoning be carbon monoxide, manganese or cyanide; hypoglycemia; mechanical trauma to the nervous system; epileptic seizures; and chronic neurologic disorders such as Huntington's disease, neuronal injury associated with HIV and AIDS, AIDS dementia, neuropathic pain syndrome, olivopontocerebral atrophy, Parkinson's disease, amyotrophic lateral sclerosis, mitochondrial abnormalities, Alzheimer's disease, hepatic encephalopathy, Tourette's syndrome, drug addiction and urinary incontinence (see Lipton and Rosenberg, N. Engl. J. Med. 330: 613-622 (1994)) and treatment or amelioration of a number of chronic neurologic disorders such as schizophrenia. AMPA receptor antagonists are also useful in treating, preventing and ameliorating acute and chronic pain, pain associated with post-therapeutic neurolgia, insterstital cystitis, osteoarthritis, spinal cord injury, cancer and diabetic neuropathy. Web site: http://www.delphion.com/details?pn=US06465472__ ·
Supraglottic airway structure specifically used for anesthesia Inventor(s): Lin; Bin-Chern (Taichung, TW) Assignee(s): Future Top Medical Environment Technic, Co., Ltd. (Taipei, TW) Patent Number: 6,546,931 Date filed: December 13, 2000 Abstract: Supraglottic airway (laryngeal mask) structure specifically used for anesthesia, including a silicone mask and a main tube seat with diverging tube opening. The main tube seat is fitted through the silicone mask. The upper and lower faces of the silicone mask are formed with perforations. A rubber annular tube having different diameters is implanted in the silicone mask at the equator thereof. A soft sleeve is fitted on the silicone mask. The inner diameter of the soft sleeve corresponds to the profile of the main tube seat. The soft sleeve has an irregular profile corresponding to the configuration of inner side of the fauces. The soft sleeve is pushed forward to make an upper tube opening of the main tube seat protrude out of the soft sleeve. An anesthetic gas intake tube having an engaging flange is fitted through the diverging section of the main tube seat and engaged therewith. A fine string is used to tie up the soft sleeve, main tube seat and the intake tube so as to prevent the soft sleeve from detaching from the main tube seat. The laryngeal mask is able to completely air-tightly seal the throat of a patient without leakage and over-compressing the mucous membrane of the throat. Excerpt(s): The present invention is related to a supraglottic airway (laryngeal mask) structure specifically used in anesthesia of a patient who is awake or unconscious. The laryngeal mask has a soft structure with slip-proof and leak-proof effect. In addition, the laryngeal mask is able to completely air-tightly seal the throat of a patient without overcompressing the mucous membrane of the throat. U.S. Pat. No. 5,355,879 discloses a laryngeal mask construction. One end of an intake tube is fitted with a mask. The bottom of the mask is formed with an opening. An inflating ring is disposed along the periphery of the mask. The inflating ring is connected with an extending inflating tube. The entire mask is placed in the throat (pharynx) of a patient with the tip of the mask leant against the gullet (esophagus) of the patient. The opening of the mask is positioned at the windpipe (larynx) of the patient. Through the inflating tube, the inflating ring is inflated and expanded to eliminate the void between the throat of the patient and the mask. Therefore, the anesthetic gas incoming from the intake tube is prevented from escaping through the void. The above laryngeal mask enables the anesthetic gas to
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completely enter human body. However, when 20.about.30 c.c. air is pumped into the inflating ring the pumping pressure is up to 60.about.120 cm water column. Such great pressure is exerted onto the mucous membrane of the throat. As a result, it often takes place that mucous membrane of the throat decays after a period of time. Web site: http://www.delphion.com/details?pn=US06546931__ ·
Surgical device for performing face-lifting surgery using radiofrequency energy Inventor(s): Da Silva; Luiz B. (Danville, CA), Weber; Michael Robert (Palm Harbor, FL), Weber; Paul J. (Fort Lauderdale, FL) Assignee(s): Pearl Technology Holdings, LLC. (Tampa, FL) Patent Number: 6,440,121 Date filed: December 30, 1999 Abstract: The human face is efficiently and precisely dissected while radioifrequency energy is applied to controllably release target tissue bonds and alter surrounding tissues in such a fashion that these facial tissues contract and tighten in response to the energy application while automatically excluding vital nerves and vessels. Tightening will be most dramatic in younger patients between 45 and 55 years of age such that the surgeon may not have to cut-out or stretch skin for a desirable effect in most of this population. The device is inserted through only 3 relatively small 1 cm incisions allowing energy to be applied to the upper subcutaneous, lower dermal and platysmal face-lift layers. The procedures take less than 15 minutes following anesthesia and the effects will last for at least several years. The special arrangement of protrusions and recessions on the tip of the instrument allows the surgeon to efficiently force the device through face-lift planes with instantaneous knowledge of the location and progress simply by the "feel" of the apparatus. Vibrational energy and optional ultrasonic means will yield speed enhancement and tip debris and char reduction. The device and method permit efficient tissue separation and alteration of the lower face-neck-unit tissues, midface-unit tissues and scalp-forehead-temple-unit tissues. Excerpt(s): This invention relates to a surgical device for performing face-lifting surgery using electromagnetic radiation, and more particularly to a device with a specialized tip design that delivers radiofrequency energy and optional ultrasonic energy application. More particularly, the invention provides a surgical device that can improve the accuracy and speed of face-lift operations. Use of the present invention may controllably cause thermally related healing contraction of the target tissues thus allowing face lifting in younger patients without the removal or cutting-out of skin. Cutting (in surgery) will be defined as relatively cleanly breaking through similar or dissimilar tissues with minimal adjacent tissue trauma and thus little tissue stretching, tearing or ripping. Lysis (in surgery) will be defined as breaking through similar or dissimilar tissues with or without adjacent tissue trauma and may involve stretching, tearing or ripping. Depending upon the tissues lysed, the degree of stretching or tearing of lysed tissue edges may be inconsequential or may even result in a desirable benefit such as post surgical contraction. Web site: http://www.delphion.com/details?pn=US06440121__
Patents 147
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Therapeutic uses of polymers and oligomers comprising gamma-hydroxybutyrate Inventor(s): Martin; David P. (Arlington, MA), Williams; Simon F. (Sherborn, MA) Assignee(s): Metabolix, Inc. (Cambridge, MA), Tepha, Inc. (Cambridge, MA) Patent Number: 6,623,730 Date filed: September 14, 2000 Abstract: Oligomers and polymer compositions are provided which comprise GHB and produce GHB after administration in vivo. Devices for the storage and delivery of these polymers and oligomers are also provided. These oligomers and polymer compositions are useful in a variety of applications. The compositions can be used therapeutically, for example, in the treatment of patients with narcolepsy, chronic schizophrenia, catatonic schizophrenia, atypical psychoses, chronic brain syndrome, neurosis, alcoholism, drug addiction and withdrawal, Parkinson's disease and other neuropharmacological illnesses, hypertension, ischemia, circulatory collapse, radiation exposure, cancer, and myocardial infarction. Other uses for the compositions include anesthesia induction, sedation, growth hormone production, heightened sexual desire, anorectic effects, euphoria, smooth muscle relaxation, muscle mass production, and sleep, including rapid eye movement sleep. In a still further embodiment, the oligomers and polymers may be used to produce absence seizures. Excerpt(s): The present invention is generally in the field of therapeutic formulations for delivering gamma-hydroxybutyrate. Gamma-hydroxybutyrate ("GHB") is a naturally occurring substance that is widely distributed in the mammalian body, being present, for example, in the brain, kidney, heart, liver, lung and muscle (Nelson, et al., J. Neurochem., 37:1345-48 (1981)). When administered exogenously, GHB readily crosses the blood-brain barrier and penetrates the brain, producing a number of neuropharmacological effects. For over 35 years, GHB has been used as an intravenous agent for the induction of anesthesia and for long-term sedation, without serious sideeffects on circulation or respiration (Entholzner, et al., Anesthetist, 44:345-50 (1995)), and without an accompanying seizure-inducing activity in humans (Tunnicliff, Clinical Toxicology, 35:581-90 (1997)). Patients with chronic schizophrenia characterized by autism, inactivity, and apathy; catatonic schizophrenia; chronic schizophrenia with hallucination and delusion; atypical psychoses; and chronic brain syndrome due to trauma, as well as neurotic patients (Tanaka, et al., Folia Psychiatrica et Neurologica, 20:9-17 (1966)), have all been treated using GHB. It also has recently been suggested that GHB may be a suitable agent for total intravenous anesthesia in patients with coronary artery disease (Kleinschmidt, et al., Euro. J. Anesthesiology, 14:590-99 (1997)), as well as for sedation during spinal anesthesia (Kleinschmidt, et al., Euro. J. Anaesthesiology, 16:23-30 (1999)). In addition to these uses, GHB also is used to treat narcolepsy, a chronic sleep disorder that usually begins in adolescence or early adulthood and lasts hroughout life. Narcolepsy is characterized by sudden sleep attacks lasting usually from a few to thirty minutes, paralysis upon lying down or waking, visual or auditory hallucinations at the onset of sleep, and temporary loss of muscle tone while awake (cataplexy) or asleep. Treatment with GHB substantially reduces these signs and symptoms of narcolepsy in humans (Scharf, Sleep, 21:507-14 (1998)). Web site: http://www.delphion.com/details?pn=US06623730__
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Transurethral volume reduction of the prostate (TUVOR) Inventor(s): Hossainy; Syed (Fremont, CA), Levy; Baruch (Ramat-Gan, IL), Slepian; Marvin J. (Tucson, AZ), Sohn; Zeev (Ginot Shomron, IL), Yachia; Daniel (Herzlia-on-Sea, IL) Assignee(s): Harmonia Medical Technologies, Inc. (Rosh Ha'Ayin, IL) Patent Number: 6,491,672 Date filed: February 7, 2001 Abstract: A process has been developed to reduce or relieve prostatic obstruction. The steps involved in the TUVOR Process include: 1. Transurethral Incision; 2. De-bulking and Intra-Prostatic Volume Reduction; 3. Intra-prostatic void exclusion and space filling with adhesive and/or therapeutic polymeric materials, alone or in combination with bioactive agents and/or mechanical means for closure; 4. Endourethral compression and prostatic mass remolding; 5. Endourethral Polymer Liner Layer. This liner formed from structurally supportive, yet eventually biodegradable, polymers further bolsters and supports the urethra and peri-urethral tissue during healing, eliminating the need for post-procedure catheter drainage. This step may be optional in specific clinical circumstances. The process is designed to allow outpatient treatment under local anesthesia for BPH. Excerpt(s): This invention relates to apparatus and a method for the removal and treatment of prostate tissue to treat conditions associated with diseases or disorders resulting in obstruction of the uro-genital systems. As men age, their prostate glands typically enlarge due to growth of intraprostatic paraurethral glands tissue (prostate adenoma) obstructing the flow of urine through the urethra. This condition is known as benign prostatic hypertrophy ("BPH"), and results in a partial or total inability to urinate. The incidence of symptomatic BPH for men in their fifties is approximately 50%, rising to 90% by age 85. About 25% of men in the United States will be treated for BPH by age 80. Traditional surgical therapy for BPH has involved open enucleation or transurethral resection of the prostate. Surgical treatment of BPH is generally reserved for patients with severe symptoms or for those who have developed urinary retention, renal damage caused by BPH, or those with significant potential complications if treatment were withheld. These painful procedures usually result in long-term recovery although the patient may be subjected to traumatic side-effects. Web site: http://www.delphion.com/details?pn=US06491672__
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Tricyclic antidepressants and their analogues as long-acting local anesthetics and analgesics Inventor(s): Gerner; Peter (Weston, MA), Wang; Ging Kuo (Westwood, MA) Assignee(s): The Brigham and Women's Hospital Inc. (Boston, MA) Patent Number: 6,545,057 Date filed: September 26, 2001 Abstract: Methods and compositions of tricyclic antidepressants for inducing local longlasting anesthesia and analgesia are provided. The methods and compositions are useful for alleviating acute and chronic pain, particularly useful for treating a localized pain.
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Excerpt(s): This invention relates to the use of the tricyclic antidepressants to produce local long-acting relief of different varieties of pain. To provide a better understanding of the invention it is necessary to distinguish between the two terms analgesia and anesthesia. Analgesia is defined as a condition in which nociceptive stimuli are sensed but are not interpreted as pain. Anesthesia is a state characterized by total loss of sensation, the result of pharmacologic depression of nerve function. Thus, analgesia does not produce anesthesia whereas anesthesia produces analgesia. In general, pain is associated with a known tissue pathology (e.g., cancer pain, arthritic pain), inflammation, or injury to a body tissue (e.g., surgery). Neuropathic pain is thought to be a consequence of damage to peripheral nerves or to regions of the central nervous system. Neuropathic pain can present as an acute pain but frequently occurs as a form of chronic pain. Web site: http://www.delphion.com/details?pn=US06545057__ ·
Use of adenosine compounds to alleviate or normalize pathologically hyperexcited sensory nerve function in a human patient Inventor(s): Fukunaga; Atsuo F. (5411 Littlebow Rd., Rancho Palos Verdes, CA 90275) Assignee(s): none reported Patent Number: 6,642,209 Date filed: May 4, 1998 Abstract: A method of inducing anesthesia, sedation, analgesia, hypothermia, and reduced stress by administering an effective amount of an adenosine compound to a mammal. It also provides a method for preserving donor organs in vivo by contacting them with an adenosine compound, as well as a method for preparing organ recipients for transplant. Excerpt(s): This invention relates to a method of using adenosine compounds to induce anesthesia, sedation, analgesia, hypothermia, and to ameliorate stress. A patient is protected from the pain and stress of surgery and similar procedures by anesthesia which allows the maintenance of physiological homeostasis. Adenosine has a variety of extracellular effects. It is known to have potent vasodilating, blood pressure lowering (hypotensive) and shock-inducing effects, but has never been demonstrated to have anesthetic activity when used clinically. Furthermore, the conventional wisdom is that neither adenosine nor adenosine triphosphate (hereinafter ATP), an adenine nuclectide, circulating in the blood, will cross the blood brain barrier. Therefore, despite analgesic and sedative effects suggested by previous studies in laboratory experiments, neither adenosine nor ATP had ever been thought to be suitable as anesthetics. A major problem with prior studies is that they were performed under such poorly controlled conditions that the vital signs: circulatory, such as blood pressure, heart rate and respiratory functions were not measured. Because data on the behavior of these parameters are essential in determining therapeutic efficacy, these studies failed to teach whether such potential analgesic and sedative effects were caused by the profound effects of these compounds on cardiovascular function, namely: hypotension, coma, bradycardia, or shock. Failure to determine the vital signs, and to isolate the analgesic properties from the coma or shock, which may be produced by potent hypotensive effects of adenosine, render these reports fatally flawed as teaching analgesia or sedation caused by adenosine. Consequently, previous studies do not evaluate usage for treatment purposes of these agents. Based on previous reports, such effects (analgesia, sedation) could not possibly have been translated to clinical applicability.
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Web site: http://www.delphion.com/details?pn=US06642209__ ·
Use of melatonin for induction of general anesthesia Inventor(s): Attala; Mohamed Naguib (Coralville, IA) Assignee(s): University of Iowa Research Foundation (Iowa City, IA) Patent Number: 6,552,064 Date filed: August 10, 2001 Abstract: Melatonin (N-acetyl-5-methoxytryptamine), analogues, are used to induce anesthesia.
or
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biologically
active
Excerpt(s): In the medical field there is a continuing need for new compounds having demonstrated use for inducing anesthesia. It is not only important to induce beneficial anesthesia, but it must be done in a manner that limits toxicity to patients, and as well, minimizes what is known as "anesthesia hangover". The pineal hormone melatonin (Nacetyl-5-methoxytryptamine) has several putative functions, including regulation of circadian rhythms, regulation of the reproductive axis and antioxidant activity. Autoradiographic studies and receptor assays have demonstrated the presence of melatonin receptors in various regions of the central nervous system and in other tissues in humans. Exogenous administration of melatonin has been found by several investigators to facilitate sleep onset and improve quality of sleep. Available data suggest that the sleep-inducing properties of melatonin may differ from those of benzodiazepines. Benzodiazepines decrease duration of REM sleep after single administration of a high dose or long-term administration of low dose. Benzodiazepines also reduce slow-wave sleep, thus negatively influencing sleep quality. In contrast, a single low dose of melatonin produced no suppression of REM sleep. Furthermore, unlike benzodiazepines, melatonin does not induce "hangover" effects. Web site: http://www.delphion.com/details?pn=US06552064__
Patent Applications on Anesthesia As of December 2000, U.S. patent applications are open to public viewing.10 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to anesthesia: ·
Adjustable shelf/tray and anesthesia screen Inventor(s): Haltiner, Richard; (Tualatin, OR), Jensen, Barbara Jean; (Tualatin, OR) Correspondence: Barbara J. Jensen; 17555 SW 65th Avenue; Lake Oswego; OR; 97035; US Patent Application Number: 20030101512 Date filed: November 7, 2002 Abstract: An adjustable instrument shelf or tray and anesthesia screen for use in surgical operating rooms.An auxiliary tray that can be attached to existing operating room beds to provide a level place to lay instrumentation without danger of harming a
10
This has been a common practice outside the United States prior to December 2000.
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draped patient and while at the same time, allowing patient access and monitoring for the anesthesia staff.The vertical position of the tray can be adjusted to accommodate various body types. Normal draping and draping techniques can be used. Excerpt(s): This application claims the benefit of the filing of Provisional Application Serial No. 60/331,281, entitled "adjustable shelf/tray and anesthesia screen", filed on Nov. 13, 2001 and the specification thereof is incorporated herein by reference. Not applicable. The present invention relates to surgical operating room beds, and specifically to an elevated instrument shelf/tray and anesthesia screen to promote safe placement of surgical instrumentation or tools directly above a draped patient while optimizing the view of the patient for anesthesia monitoring and access. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Anesthesia conduction catheter Inventor(s): Brushey, Stephen; (Pittsburgh, PA) Correspondence: THORP REED & ARMSTRONG, LLP; ONE OXFORD CENTRE; 301 GRANT STREET, 14TH FLOOR; PITTSBURGH; PA; 15219-1425; US Patent Application Number: 20030073976 Date filed: November 25, 2002 Abstract: The present invention provides a catheter which combines the benefits of improved drug dispersion, increased accuracy of placement and kink and collapse resistance. The catheter comprises a flexible cylindrical tube having a proximal portion open at one end and a distal portion, the portions in fluid communication, the distal portion comprising a closed, rounded tip and a diffusion area having at least one opening therein which permits fluid flow, the proximal portion including a proximal tip, and at least one reinforcement member attached at the distal tip and at the proximal tip of the flexible cylindrical tube, with the remainder of the at least one reinforcement member movable within the flexible cylindrical tube. The catheters of the present invention can find use in a variety of local, regional and peripheral pain management applications. Excerpt(s): This application claims the benefit of U.S. Provisional Application No. 60/191,726 filed Mar. 24, 2000. This invention relates in general to catheters, and more specifically, to anesthesia conduction catheters, such as epidural catheters and catheters used for local or regional anesthesia and peripheral pain management. Local or regional anesthesia consists of injecting an agent about the nerves thereby producing a loss of sensation in a region or regions of the body. An example of local or regional anesthesia is an epidural block given to women to ease the pain of childbirth. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Anesthesia drug monitor Inventor(s): Agutter, James; (Salt Lake City, UT), Albert, Robert; (Salt Lake City, UT), Drews, Frank; (Salt Lake City, UT), Strayer, David; (Salt Lake City, UT), Syroid, Noah; (Salt Lake City, UT), Westenskow, Dwayne; (Salt Lake City, UT) Correspondence: TRASK BRITT; P.O. BOX 2550; SALT LAKE CITY; UT; 84110; US Patent Application Number: 20030156143 Date filed: October 11, 2002 Abstract: A method, system and apparatus for the monitoring, diagnosis and evaluation of the state of a dynamic drug display system is disclosed. This invention provides for the rapid cognitive grasp of the overall state of drug combination effects with respect to a dynamic system. The system provides for displayed objects, which change in real-time to show the changes of the functions of the system. In particular, this invention is directed to the processing and display of drug data for the use of doctors in the process of monitoring or administering drugs to patients. Excerpt(s): This patent application is a continuation-in-part patent application of copending U.S. patent application Ser. No. 09/457,068, which was filed on Dec. 7, 1999 and of copending Provisional Patent Application Serial No. 60/328,878, filed on Oct. 12, 2001. Priority is hereby claimed to all common material disclosed in these pending patent cases. This invention relates to the visualization, perception, representation and computation of data relating to the attributes or conditions constituting the health state of a dynamic system. More specifically, this invention relates to the display and computation of anesthesia drug data, in which variables constituting attributes and conditions of a dynamic anesthesia system can be interrelated and visually correlated in time as three-dimensional objects. A variety of methods and systems for the visualization of data have been proposed. Traditionally, these methods and systems fail to present in a real-time multi-dimensional format that is directed to facilitating a user"s analysis of multiple variables and the relationships between such multiple variables. Moreover, such prior methods and systems tend not to be specifically directed to the monitoring of anesthesia or which is capable of estimating, predicting and displaying drug dosages, infusions, effect site concentration, and drug effects during anesthesia. Prior methods typically do not process and display data in real-time, rather they use databases or spatial organizations of historical data. Generally, they also simply plot existing information in two or three dimensions, but without using three-dimensional geometric objects to show the interrelations between data. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Anesthetic container with metering elements Inventor(s): Koch, Jochim; (Ratzeburg, DE), Kullik, Gotz; (Lubeck, DE) Correspondence: McGLEW AND TUTTLE, P.C; SCARBOROUGH STATION; SCARBOROUGH; NY; 10510-0827; US Patent Application Number: 20030005930 Date filed: February 7, 2002 Abstract: A reusable anesthetic container (1) has an anesthetic reserve space (2), which is provided with at least one movable wall element (3). The wall element (3) can be caused to follow the liquid anesthetic volume. In one embodiment, the movable wall element
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(3) is designed as a piston, which is caused to follow the anesthetic volume via a toothed piston rod (9). An elastomer ring is preferably provided on the storage container as a detent pawl for the piston rod (9). The anesthetic container (1) has a first metering element (5), which is actuated inductively by means of a complementary second metering element (6) cooperating with another metering element on the anesthesia apparatus (7) for metering the anesthetic. Excerpt(s): The present invention pertains to an anesthetic container with an anesthetic reserve space. Anesthetic containers in the form of glass bottles with universal screw cap and a coding collar for special filling devices are filled with an anesthetic, in general, at the anesthetic producer. These prior-art anesthetic containers in the form of glass bottles are transported to the hospital, e.g., in a Styropor package for protection against breakage. The anesthetics are filled there hitherto into the correct anesthetic metering unit and calibrated for one anesthetic only either by means of a special, coded filling tube or filling adapter or by pouring into an open filling funnel. A filling adapter for filling an anesthetic metering unit with anesthetic is shown in DE 37 20 326 C2. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
ANESTHETIC INJECTION APPARATUS Inventor(s): SPINELLO, RONALD P.; (RED LIOON, PA) Correspondence: DANIEL P BURKE ESQ; GALGANO & BURKE; U S FEDERAL COURTHOUSE BUILDING; 300 RABRO DRIVE-SUITE 135; HAUPPAUGE; NY; 11788 Patent Application Number: 20030100888 Date filed: September 10, 1999 Abstract: Apparatus and methods for the power and computer assisted injection of local anesthesia into a patient in which anesthesia pressure is automatically monitored as an input to the computer, in which the patient is able at any time to order the automatic reduction of anesthetic pressure, in which a single pole switch is the only control input to the computer required of the doctor administering the injection, and/or in which the flow rate of anesthesia from the needle continuously increases with time over a substantial portion of the injection. Excerpt(s): This application is a continuation-in-part of pending U.S. patent application Ser. No. 09/122,915 filed Jul. 27, 1998. The invention relates to the injection of local anesthetic into a body part, particularly the mouth, by means of hollow hypodermic needles. Local anesthetics injected into the body by hand-held syringes to enable otherwise painful medical procedures to be performed without pain have been used for over 100 years. The lesser but nevertheless real pain caused by the syringes persisted until 1986 when the applicant invented an apparatus and method to eliminate it. Such are disclosed in the applicant's U.S. Pat. Nos. 4,747,824 and 5,180,371, which are incorporated herein by reference for their showing of the prior art as it exists today. The invention of those patents is now sold under the trademark Wand by Milestone Scientific Corp. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Antidepressants and their analogues as long-acting local anesthetics and analgesics Inventor(s): Gerner, Peter; (Weston, MA), Verrecchia, Donald K.; (Winchester, MA), Wang, Ging Kuo; (Westwood, MA) Correspondence: Edward R. Gates, Esq.; Chantal Morgan D'Apuzzo, Ph.D.; Wolf, Greenfield & Sacks, P.C.; 600 Atlantic Avenue; Boston; MA; 02210; US Patent Application Number: 20030096805 Date filed: April 4, 2002 Abstract: Methods and compositions of antidepressants and analogs thereof for inducing local long-lasting anesthesia and analgesia are provided. The methods and compositions are useful for alleviating acute and chronic pain, particularly useful for treating a localized pain. Excerpt(s): This application claims priority to and is a continuation in part of co-pending U.S. application Ser. No. 09/965,138 filed on Sep. 26, 2001, which claims priority to U.S. application Serial No. 60/235,432 filed on Sep. 26, 2000. This invention relates to the use of antidepressants and analogs thereof to produce local long-acting relief of different varieties of pain. To provide a better understanding of the invention it is necessary to distinguish between the two terms analgesia and anesthesia. Analgesia is defined as a condition in which nociceptive stimuli are sensed but are not interpreted as pain. Anesthesia is a state characterized by total loss of sensation, the result of pharmacologic depression of nerve function. Thus, analgesia does not produce anesthesia whereas anesthesia produces analgesia. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Assay for nitrous oxide neurologic syndrome Inventor(s): Hogan, Kirk J.; (Madison, WI), Selzer, Rebecca M.R.; (Verona, WI) Correspondence: QUARLES & BRADY LLP; 411 E. WISCONSIN AVENUE, SUITE 2040; MILWAUKEE; WI; 53202-4497; US Patent Application Number: 20030198985 Date filed: February 24, 2003 Abstract: A method for detection of susceptibility to nitrous oxide neurologic syndrome in a subject is disclosed. In one embodiment, the method comprises: (a) providing a sample from a subject, wherein said subject is a candidate for nitrous oxide anesthesia; and (b) detecting the presence or absence of folate, cobalamin, methionine and homocysteine pathway genetic polymorphisms in said sample, wherein the presence of a polymorphism indicates that the subject is susceptible to nitrous oxide neurologic syndrome. Excerpt(s): The present invention claims priority to U.S. Serial No. 60/358,781, incorporated by reference herein. 5,10-methylene tetrahydrofolate reductase (MTHFR) regulates the synthesis of 5-methyl tetrahydrofolate, the primary circulatory form of folate which acts as the methyl donor to methionine. Homocysteine is a sulphur amino acid formed by demethylation of the essential amino acid methionine. A methyltransferase enzyme known as methionine synthase (MTR) is responsible for converting homocysteine back to methionine, the body's sole methyl donor. Among many other reactions, methyl moieties are crucial for the synthesis of neurotransmitters, assembly of the myelin sheath, and DNA synthesis in proliferating tissues such as bone
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marrow and the developing brain. Genetic defects that cause deficiencies in either MTR or MTHFR are associated with high serum homocysteine levels and homocystinurea. Nitrous oxide irreversibly oxidizes the cobalt atom of vitamin B.sub.12, and thus inhibits the activity of the cobalamin-dependent enzyme MTR. Over twenty-four rare mutations in MTHFR have been described as associated with pronounced enzymatic deficiency and homocystinuria. In addition, two common single nucleotide polymorphisms have been identified that affect folate and homocysteine metabolism, both of which are implicated in the pathogenesis of cardiovascular disease, neural tube defects and developmental delay. One polymorphism is a missense mutation consisting of a C.fwdarw.T transition at position 677, which produces an alanine to valine amino acid substitution within the catalytic domain of MTHFR. The resulting enzyme has reduced catalytic activity. The second mutation is found at position 1298, an A.fwdarw.C transition which results in a glutamate to alanine substitution located in the presumed regulatory domain of MTHFR. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Branched chain amino acid-dependent aminotransferase inhibitors and their use in the treatment of neurodegenerative diseases Inventor(s): Hu, Lain-Yen; (Ann Arbor, MI), Kesten, Suzanne Ross; (Ann Arbor, MI), Lei, Huangshu; (Ann Arbor, MI), Ryder, Todd Robert; (Rochester, NY), Wustrow, David Juergen; (Ann Arbor, MI) Correspondence: David R. Kurlandsky; Warner-Lambert Company; 2800 Plymouth Road; Ann Arbor; MI; 48105; US Patent Application Number: 20030149110 Date filed: November 26, 2002 Abstract: The invention relates to BCAT inhibitors and the use thereof for treating or preventing neuronal loss associated with stroke, ischemia, CNS trauma, hypoglycemia and surgery, as well as treating neurodegenerative diseases including Alzheimer's disease, amyotrophic lateral sclerosis, Huntington's disease and Down's syndrome, treating or preventing the adverse consequences of the overstimulation of the excitatory amino acids, treating anxiety, psychosis, convulsions, aminoglycoside antibioticsinduced hearing loss, migraine headache, chronic pain, neuropathic pain, Parkinson's disease, diabetic retinopathy, glaucoma, CMV retinitis, urinary incontinence, opioid tolerance or withdrawal, and inducing anesthesia, as well as for enhancing cognition. Excerpt(s): This application claims benefit of U.S. Provisional Application No. 60/333,636 filed Nov. 27, 2001. This invention is related to branched chain amino aciddependent amino transferase (BCAT) inhibitors. The invention is also directed to the use of BCAT inhibitors as neuro-protective agents for treating conditions such as stroke, cerebral ischemia, central nervous system trauma, hypoglycemia, anxiety, convulsions, aminoglycoside antibiotics-induced hearing loss, migraine headaches, chronic pain, neuropathic pain, glaucoma, CMV retinitis, diabetic retinopathy, psychosis, urinary incontinence, opioid tolerance or withdrawal, or neuro-degenerative disorders such as lathyrism, Alzheimer's disease, Parkinsonism, amyotrophic lateral sclerosis (ALS), and Huntington's Disease. Excessive excitation by neurotransmitters can cause the degeneration and death of neurons. It is believed that this degeneration is in part mediated by the excitotoxic actions of the excitatory amino acids (EAA) glutamate and aspartate at the N-methyl-D-aspartate (NMDA) receptor. This excitotoxic action is considered responsible for the loss of neurons in cerebrovascular disorders such as
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cerebral ischemia or cerebral infarction resulting from a range of conditions, such as thromboembolic or hemorrhagic stroke, cerebral vasospasms, hypoglycemia, cardiac arrest, status epilepticus, perinatal asphyxia, anoxia such as from drowning, pulmonary surgery and cerebral trauma, as well as lathyrism, Alzheimer's disease, Parkinson's disease, and Huntington's disease. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Breathing circuits having unconventional respiratory conduits and systems and methods for optimizing utilization of fresh gases Inventor(s): Fukunaga, Alex S.; (Palos Verdes Peninsula, CA), Fukunaga, Atsuo F.; (Palos Verdes Peninsula, CA), Fukunaga, Blanca M.; (Palos Verdes Peninsula, CA) Correspondence: BRINKS HOFER GILSON & LIONE; P.O. Box 10395; Chicago; IL; 60610; US Patent Application Number: 20030075176 Date filed: September 24, 2002 Abstract: A breathing circuit comprising first and second conduits is disclosed, wherein at least one of the conduits is a non-conventional conduit. A multilumen unilimb breathing circuit is also disclosed having first and second conduits, wherein when the proximal ends of said first and second conduits are each connected to an inlet and outlet fitting, respectively, movement of the distal end of the first conduit causes a corresponding movement of the distal end of the second conduit. In an embodiment, at least one of said conduits is coiled. In another embodiment, a coiled conduit is contained within an outer flexible conduit that is axially extendable and compressible, forming a unilimb multilumen respiratory circuit. The outer flexible conduit may be pleated to provide for axial extension and contraction. The multilumen respiratory circuit can provide a variable rebreathing volume. In an embodiment, at least one tube in a multilumen respiratory conduit is radially collapsible and radially expandable to a maximum radius for carrying respiratory gases to and from a patient. Also disclosed are methods and systems of optimizing utilization of fresh gases during artificial or assisted ventilation, including administering anesthesia. Excerpt(s): This application claims priority of U.S. provisional patent application serial No. 60/340,206, filed Dec. 12, 2001 and U.S. provisional patent application serial No. 60/324,554, filed Sep. 24, 2001. This invention relates to devices for use in resuscitating and/or providing anesthesia and/or assisted and artificial ventilation to patients, and more particularly relates to breathing circuits with interacting mutually adjustable length fluid carrying members, to a multilumen breathing circuit utilizing unconventional (or new era) conduits, and to systems and methods for optimizing utilization of fresh gases (e.g. anesthetic agents and oxygen) during provision of anesthesia and/or assisted and artificial ventilation. Assisted and/or artificial ventilation systems are an essential component of modern medicine. Generally, such systems provide inspiratory fresh gases to a patient from a source of same, such as from an anesthesia or a ventilator machine, and conduct expired gases away from the patient. Inspiratory gases are conducted through a different conduit from the expired gases and thus at least two conduits are required. Commonly used circuits have two limbs (e.g., two independent tubes). The ends of the tubes in a breathing circuit are generally held in spaced relationship by a connector located at the patient, or distal, end of the circuit. The connector can place the distal (i.e., patient) ends of the tubes in a fixed parallel relationship, or the connector can be a Y-piece with the two tubes converging at an
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angle. Conventional respiratory tubes are corrugated and flexible to permit movement while minimizing collapse and kinking of the tubes. Recently, the use of axially expandable and contractible pleated ("accordion-like") tubing has become popular. Commonly used accordion-like or pleated tubing is known as ULTRA-FLEX.RTM. (available from King Systems Corporation, Noblesville, Ind., U.S.A.), FLEXITUBE.RTM. or ISOFLEX.TM., in which the length can be adjusted by axially expanding or contracting one or more pleats between a closed and open position. Whether the pleats are in the open or closed position, the tube wall remains corrugated to minimize the risk of kinking or collapse upon convolution or bending of the tubing. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Breathing systems with post-inspiratory valve fresh gas flow input, components for implementing same, and methods of use Inventor(s): Fukunaga, Alex S.; (Palos Verdes Peninsula, CA), Fukunaga, Atsuo F.; (Palos Verdes Peninsula, CA), Fukunaga, Blanca M.; (Palos Verdes Peninsula, CA) Correspondence: Daniel B. Schein; BRINKS HOFER GILSON & LIONE; P.O. Box 10395; Chicago; IL; 60610; US Patent Application Number: 20030183232 Date filed: March 14, 2003 Abstract: A system for providing anesthesia or assisted ventilation that has a postinspiratory valve fresh gas flow input is disclosed. In a preferred embodiment, a fresh gas flow diverter valve is provided to permit an operator to provide fresh gas flow proximally or distally of the inspiratory valve. Also disclosed is an adaptor and other breathing circuit components for forming a system of the present invention. A method of providing anesthesia or assisted ventilation using low flow fresh gas is disclosed. Excerpt(s): This application is a continuation-in-part of U.S. non-provisional patent application Ser. No. 10/254,700, filed Sep. 24, 2002, which claims priority of U.S. provisional patent application serial No. 60/340,206, filed Dec. 12, 2001 and U.S. provisional patent application serial No. 60/324,554, filed Sep. 24, 2001, all of which are specifically incorporated by reference as if reproduced in full below. This invention relates to devices for use in providing anesthesia and/or assisted and artificial ventilation to patients, and more particularly relates to ventilation systems that optimize utilization of fresh gases (e.g., anesthetic agents and oxygen) during provision of anesthesia and/or assisted and artificial ventilation, components for forming same, and methods of use. These inventions lead to substantial fresh gas savings. Commonly used circuits for use in assisted ventilation systems have two limbs (e.g., two independent tubes). The ends of the tubes in a breathing circuit are generally held in spaced relationship by a connector located at the patient or distal end of the circuit. The connector can place the distal (i.e., patient) ends of the tubes in a fixed parallel relationship, or the connector can be a Y-piece with the two tubes converging at an angle. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Combined anesthesia and biopsy guide Inventor(s): Jordan, George Lee III; (Madison Heights, MI) Correspondence: B. Delano Jordan; 1524 Ingram Terrace; Silver Spring; MD; 20906; US Patent Application Number: 20030036709 Date filed: August 14, 2001 Abstract: A biopsy guide enables biopsies to be performed more quickly and with less patient discomfort. The biopsy guide includes a body portion having surfaces defining an ultrasound aperture for receiving an ultrasound transducer. A biopsy fitting is moveably coupled to the body portion, where the biopsy fitting has surfaces defining a biopsy aperture for receiving a biopsy device. The body portion has a syringe guide for aligning an anesthetic syringe with a trajectory of the biopsy device. Excerpt(s): The present invention generally relates to ultrasound guided biopsies. More particularly, the invention relates to a biopsy guide and method for conducting a biopsy that enables the alignment of an anesthetic syringe with a trajectory of a biopsy device. Biopsies involve the removal of a small piece of living tissue from an organ or other part of the body for microscopic examination and have become an integral part of modern medicine. For example, the procedure can be useful in establishing diagnoses, estimating prognoses, and following the course of a disease. In fact, biopsies are commonly used to treat the liver, lymph node, pancreas, and any other mass in the abdomen, pelvis, or chest. While the above-described biopsy guide 60 has been used for a number of years, certain difficulties remain. For example, in order to reduce patient discomfort and speed up the biopsy procedure, deep local anesthesia is often required. The conventional biopsy guide 60, however, fails to provide an adequate mechanism for anesthetizing the biopsy tract. Thus, the practitioner often must hold the biopsy guide/ultrasound assembly in one hand and administer the anesthesia with a syringe being held freely in the other hand. Furthermore, the practitioner must estimate the subsequent trajectory of the biopsy device when administering the anesthesia. Thus, in addition to the relatively cumbersome aspect of this approach, it is particularly difficult to anesthetize the biopsy tract with the desired level of accuracy. The result can therefore be discomfort to the patient due to insufficient anesthetization of the correct region. It is therefore desirable to provide a system and method for conducting a biopsy that enables the practitioner to confidently and routinely anesthetize the tract of the biopsy device. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Compositions and delivery systems for administration of a local anesthetic agent Inventor(s): Birudaraj, Raj; (Belmont, CA), Cleary, Colin J.; (San Mateo, CA), Cleary, Gary W.; (Los Altos Hills, CA), Mudumba, Sri; (Union City, CA), Parandoosh, Shohreh; (Menlo Park, CA), Park, Pathamar; (Moss Beach, CA) Correspondence: REED & ASSOCIATES; 800 MENLO AVENUE; SUITE 210; MENLO PARK; CA; 94025; US Patent Application Number: 20030027833 Date filed: May 7, 2002 Abstract: A pharmaceutical composition is provided for topical administration of a local anesthetic agent. The composition comprises (a) a therapeutically effective amount of a
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local anesthetic agent and (b) a pharmaceutically acceptable, nonliposomal carrier comprised of a monohydric alcohol, a penetration enhancer, and polymer, which may be a hydrophilic polymer, a hydrophobic polymer or a combination thereof. The composition can be in the form of a gel, or it may form a film following application to a patient's body surface and evaporation of the monohydric alcohol. The composition provides rapid onset of local anesthesia as well as penetration of the active agent into the skin. Methods and drug delivery systems for administration of local anesthetic agents are also provided. Excerpt(s): This application claims priority under 35 U.S.C.sctn.119(e)(1) to U.S. Provisional Application Serial No. 60/289,403, filed May 7, 2001, the disclosure of which is incorporated by reference. The invention relates generally to pharmaceutical compositions and drug delivery systems, and more particularly relates to pharmaceutical compositions and drug delivery systems for administration of an anesthetic agent, particularly a local anesthetic agent. In addition, the invention relates to methods for administering local anesthetic agents to patients using the aforementioned pharmaceutical compositions and drug delivery systems. Anesthetic agents are widely used in the management of pain. Pharmacologically, most anesthetic agents reversibly block the conduction of pulses along nerve axons and other excitable membranes. Clinically, local administration of an anesthetic agent results in selective anesthesia, i.e., anesthesia limited to the area near the location of administration, and only for a limited quantity of time, e.g., on the order of four hours or less. Thus, local anesthetic agents derive their clinical usefulness and popularity by selectively, and reversibly, blocking noxious nerve impulses. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
DOUBLE ENDOBRONCHIAL ANESTHESIA AND SURGERY
CATHETER
FOR
ONE
LUNG
ISOLATION
Inventor(s): Amar, David; (Hillcrest, NY) Correspondence: KLAUBER & JACKSON; 411 HACKENSACK AVENUE; HACKENSACK; NJ; 07601 Patent Application Number: 20020185135 Date filed: June 11, 2001 Abstract: A double endobronchial catheter that is suited for one lung isolation anesthesia and surgery that has an outer sheath that is adapted to be introduced into the patient such that the distal end of the sheath is positioned within the patient and the proximal end remains exterior of the patient. A pair of catheters are slidingly retained in separate lumens within the outer sheath lumen. Each of the catheters has an inflatable balloon at the distal end thereof with the proximal ends extending outwardly from the proximal end of the outer sheath. A stylet is removably positioned within each of the catheters so that each catheter can be manipulated independently of the other catheter within the confines of the outer sheath so that the distal ends of the catheters can be positioned at a site within the bronchi of the patient and, upon inflation of the balloons, one of the patient's lungs can be isolated and ventilation and anesthesia administered to the other lung. Excerpt(s): The present invention relates to catheters, and more particularly, to a double endobronchial catheter that is used to isolate one lung of a patient during anesthesia and surgery. There are many operations that are carried out or performed today on a
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patient that require one lung of that patient to be isolated, that is, one of the patient's lungs must be kept relatively immobilized during the operation so that the surgery can be performed. Typical of such operations include thoracoscopic lung surgery, minor or major lung resection, thoracic aorta repair or reconstruction, esophageal surgery and anterior thoracic spine surgery. The need to isolate such lungs in order to operate stem from the very nature of a surgical operation performed under general anesthesia. In such operations, an anesthesia apparatus actually breathes for the patient by means of an anesthesia ventilator that acts in conjunction with an anesthesia machine. The anesthesia ventilator provides a timed, intermittent flow of gas to the patient to force that gas into the patient to expand the lungs, while the gas is expelled from the lungs as the lungs deflate. The anesthesia machine adds the anesthetic, in the form of a vapor, to the gas so that the anesthetic laden gas is provided to the patient to carry out the induction and maintenance of anesthesia in the patient during the operation. Thus under normal operation, both lungs are continually expanded and contracted during the inhalation and exhalation of the anesthetic laden gases in accordance with the normal cycling of the anesthesia ventilator. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Drugs for spinal anesthesia Inventor(s): Brennan, Timothy J.; (Iowa City, IA) Correspondence: MCKEE, VOORHEES & SEASE, P.L.C.; 801 GRAND AVENUE; SUITE 3200; DES MOINES; IA; 50309-2721; US Patent Application Number: 20030130308 Date filed: December 26, 2001 Abstract: Spinal anesthetics for intrathecal administration to produce spinal anesthesia are provided with use of 6-[2-(1(2)H-tetrazole-5-yl)ethyl]deca- hydroisoquinolone-3carboxylic acid or a pharmaceutically active analogue or its pharmaceutically active analogs. Excerpt(s): This invention relates to spinal anesthetics. Spinal anesthesia has obvious advantages. However, spinal anesthesia, using local anesthetics, is associated with acute side effects including hypotension and urinary retention, persistent sequelae like transient neurologic symptoms (TNS) and on occasion permanent deficits like cauda equina syndrome. Current research in spinal anesthesia has focused on the incidence of TNS and the dose and particular local anesthetic used, the effect of additives like epinephrine, and associated factors like patient position. There has been no recent progress in advancing new drugs for spinal anesthesia. This invention moves forward in the direction of new drugs for spinal anesthesia. Preferred compounds for use in this invention are a class of receptor antagonists/drugs, i.e. the ampa-kainate receptor antagonists. AMPA is a-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid (AMPA) and kainate is a second subclass of these receptors. Another name for these receptors is nonNMDA ionotropic excitatory amino acid receptor antagonists. NMDA=N-methyl-Daspartate. In particular, the most preferred compounds are 6-[2-(1(2)H-tetrazole-5yl)ethyl]decahydroisoquinolone-3-ca- rboxylic acid or its pharmaceutically acceptable analogues such as for example, salt forms. These specific compounds are known but have previously been reported by this inventor as having no effect on pain after incision by local infiltration of the drug active in the incision. This is further evidence of the surprising nature of their operativeness and effectiveness as spinal anesthetics. The compounds of the present invention may be administered with conventional local
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anesthetic carriers such as dextrose solution (8.25% dextrose in water, 5% dextrose in water, or 10% dextrose in water) and saline solution (0.9% saline). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Electrode array system for measuring electrophysiological signals Inventor(s): Chamoun, Nassib G.; (W. Roxbury, MA), Cordero, Rafael M.; (Tewksbury, MA), Devlin, Philip H.; (Brookline, MA), Fendrock, Charles; (Sudbury, MA), McDaniel, Terrie L.; (San Antonio, TX), Shambroom, John R.; (Arlington, MA) Correspondence: HALE AND DORR, LLP; 60 STATE STREET; BOSTON; MA; 02109 Patent Application Number: 20020183605 Date filed: May 28, 2002 Abstract: An array of electrodes is constructed to allow the user to easily adjust to the correct size of the patient's head. The array is self-adhesive, pre-gelled and disposable. The array fits easily over the temple and forehead areas where EEG signals can be acquired by specially designed monitors for purposes of monitoring a number of bodily phenomena, including but not limited to, depth of anesthesia, and/or ischemia, and burst suppression. The array is connected to the monitor via a tab connector that is integral to the disposable device. The tab connector is insertible into a reusable connector that is part of a monitoring system. Excerpt(s): This invention relates to physiological electrical signal monitors and more particularly to a self-prepping multiple electrode array to connect to such monitors. Surgical procedures are becoming more non-invasive, and as a result the use of noninvasive electrophysiological monitoring to evaluate global changes of a patient's condition during surgical procedures has increased significantly. For example, EEG monitors are now being used for monitoring cerebral function during intra-operative procedures. Of particular interest are the assessment of the effects, of anesthetics, the evaluation of asymmetric activity between the left and right hemispheres of the brain in order to detect cerebral ischemia, and the detection of burst suppression. One of the greatest impediments to making intra-operative EEG monitoring more widely practiced in the medical community is the traditional use of multiple electrodes in the standard International (10-20) Electrode Placement on the head, primarily in the scalp. Applying them takes considerable time and expertise, requires multiple, separate and time consuming skin preparation steps, and leaves the patient's scalp and hair in disarray. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Epidermic injection device Inventor(s): Shu, Hang Chung; (Taipei, TW) Correspondence: RABIN & CHAMPAGNE, P.C.; Suite 500; 1101 14th Street, N.W.; Washington; DC; 20005; US Patent Application Number: 20030060780 Date filed: September 24, 2001 Abstract: An epidermic injection device includes a flexible and elastic storing chamber. The storing chamber includes a flat contact surface for contacting with a user's skin. A plurality of thin needles are distributed over the contact surface with their sharp tips
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outward and perpendicularly projected from the contact surface. Each needle has an internal passage communicating with a hollow space in the storing chamber. Liquid medicine is first injected into the hollow space to generate an internal pressure in the storing chamber. When the device is attached at the flat contact surface to the user's skin or mucous membrane, the needles pierce through the skin and the internal pressure urges the liquid medicine to automatically slowly flow through the needles into the skin. The device largely reduces sharp pains that would be otherwise caused by a conventional syringe during injection, and is particularly suitable for use in epidermic local anesthesia. Excerpt(s): The present invention relates to an epidermic injection device, and more particularly to an automatic injection device that does not use any long cannula to pierce through a user's skin and therefore largely reduces pains possibly caused in the injection. In a conventional injection of an amount of liquid medicine into a patient's body, a sharp cannula on a syringe is pierced through the patient's skin, and a plunger is pushed to urge the liquid medicine in a barrel of the syringe through the cannula into the skin. When the cannula pierces through the skin, it would normally cause a sharp pain to frighten most patients. For example, a dental surgery in the oral cavity usually requires a local anesthesia at the gum. When a pointed cannula is pierced through the gum to inject an amount of anesthetic, the patient would feel a sharp pain. In the case the patient is a child, such injection of anesthetic is particular difficult to complete. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Formulations and methods for providing prolonged local anesthesia Inventor(s): Burch, Ronald M.; (Wilton, CT), Chasin, Mark; (Manalapan, NJ), Goldenheim, Paul; (Wilton, CT), Sackler, Richard; (Greenwich, CT), Tigner, Joseph; (New Milford, CT) Correspondence: DAVIDSON, DAVIDSON & KAPPEL, LLC; 485 SEVENTH AVENUE, 14TH FLOOR; NEW YORK; NY; 10018; US Patent Application Number: 20030185873 Date filed: September 9, 2002 Abstract: A formulation and methods for inducing sustained regional local anesthesia in a patient comprising a substrate comprising a local anesthetic and an effective amount of a biocompatible, biodegradable, controlled release material prolonging the release of the local anesthetic from the substrate to obtain a reversible local anesthesia when implanted or injected in a patient, and a pharmaceutically acceptable, i.e., non-toxic, non-glucocorticoid augmenting agent effective to prolong the duration of the local anesthesia for a time period longer than that obtainable from the substrate without the augmenting agent. Excerpt(s): The present invention is related to biodegradable controlled release formulations for the administration of locally active drugs, in particular, local anesthetics and compositions and methods for augmenting the potency and duration of the same. While compounds utilized as general anesthetics reduce pain by producing a loss of consciousness, local anesthetics act by producing a loss of sensation in the localized area of administration in the body. The mechanism by which local anesthetics induce their effect, while not having been determined definitively, is generally thought to be based upon the ability to interfere with the initiation and transmission of the nerve impulse. The duration of action of a local anesthetics is proportional to the time during
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which it is in actual contact with the nervous tissues. Consequently, procedures or formulations that maintain localization of the drug at the nerve greatly prolong anesthesia. All local anesthetics are toxic, i.e., potentially toxic, and therefore it is of great importance that the choice of drug, concentration, rate and site of administration, as well as other factors, be considered in their use. On the other hand, a local anesthetic must remain at the site long enough to allow sufficient time for the localized pain to subside. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Intraoperative neurophysiological monitoring system Inventor(s): Prass, Richard L.; (Virginia Beach, VA) Correspondence: Epstein, Edell, Shapiro, Finnan & Lytle, LLC; 1901 Research Blvd, Suite 400; Rockville; MD; 20850; US Patent Application Number: 20030088185 Date filed: November 6, 2001 Abstract: An intraoperative neurophysiological monitoring system includes an adaptive threshold detection circuit adapted for use in monitoring with a plurality of electrodes placed in muscles which are enervated by a selected nerve and muscles not enervated by the nerve. Nerve monitoring controller algorithms permit the rapid and reliable discrimination between non-repetitive electromyographic (EMG) events repetitive EMG events, thus allowing the surgeon to evaluate whether nerve fatigue is rendering the monitoring results less reliable and whether anesthesia is wearing off. The intraoperative monitoring system is designed as a "surgeon's monitor," and does not require a neurophysiologist or technician to be in attendance during surgery. The advanced features of the intraoperative monitoring system will greatly assist neurophysiological research toward the general advancement of the field intraoperative EMG monitoring through post-surgical analysis. The intraoperative monitoring system is preferably modular, in order to allow for differential system pricing and upgrading as well as to allow for advances in computer technology; modularity can also aid in execution of the design. Excerpt(s): The present invention relates to surgical apparatus and more particularly to a neurophysiological monitoring system including a nerve integrity monitoring instrument for use in conjunction with one or more electrical stimulus probes as an intraoperative aid in defining the course of neural structures. The invention is particularly applicable for use in monitoring facial electromyographic (EMG) activity during surgeries in which a facial motor nerve is at risk due to unintentional manipulation, although it will be appreciated that the invention has broader applications and can be used in other neural monitoring procedures. Despite advances in diagnosis, microsurgical techniques, and neurotological techniques enabling more positive anatomical identification of facial nerves, loss of facial nerve function following head and neck surgery such as acoustic neuroma resection is a significant risk. Nerves are very delicate and even the best and most experienced surgeons, using the most sophisticated equipment known, encounter a considerable hazard that a nerve will be bruised, stretched or severed during an operation. Studies have shown that preservation of the facial nerve during acoustic neuroma resection may be enhanced by the use of intraoperative electrical stimulation to assist in locating nerves. Very broadly stated, the locating procedure, also known as nerve integrity monitoring, involves inserting sensing or recording electrodes directly within cranial muscles enervated or controlled by the
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nerve of interest. A suitable monitoring electrode is disclosed in U.S. Pat. No. 5,161,533 (to Richard L. Prass et al.), the entire disclosure of which is incorporated herein by reference. One method of nerve localization involves the application of electrical stimulation near the area where the subject nerve is believed to be located. If the stimulation probe contacts or is reasonably near the nerve, the stimulation signal applied to the nerve is transmitted through the nerve to excite the related muscle. Excitement of the muscle causes an electrical impulse to be generated within the muscle; the impulse is transferred to the recording electrodes, thereby providing an indication to the surgeon as to the location of the nerve. Stimulation is accomplished using hand held monopolar or bipolar probes such as the Electrical Stimulus Probe disclosed in U.S. Pat. No. 4,892,105 (to Richard L. Prass), the entire disclosure of which is incorporated herein by reference. The probe of Pat. No. 4,892,105 has become known as the Prass Flush-Tip Monopolar Probe and is insulated up to the distal tip to minimize current shunting through undesired paths. An improved structure for a bipolar probe is disclosed in the provisional patent application entitled Bipolar Electrical Stimulus Probe (filed Aug. 12, 1998, application number 60/096,243), the entire disclosure of which is also incorporated herein by reference. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Intubating ventilatory face mask Inventor(s): Johnson, Larry D.; (Red Wing, MN), Kumar, Matthew M.; (Oronoco, MN) Correspondence: Craig F. Taylor; Fredrikson & Byron , P.A.; 900 Second Avenue South; 1100 International Centre; Minneapolis; MN; 55402; US Patent Application Number: 20030047189 Date filed: October 25, 2001 Abstract: Apparatus and methods for providing simultaneous positive pressure ventilation to a patient together with introduction of medical device shafts into the trachea, esophagus, and/or nasal cavity of a patient. A face mask according to present invention can be used to provide positive pressure ventilation and delivery of general anesthesia gas while maintaining an airtight seal about the face, simultaneous with the introduction of a medical device shaft, for example, a fiber optic laryngoscope, into the trachea of a patient. The mask can include a standard breathing circuit port and a second instrument port having a controllably variable or adjustable inside diameter for providing a tight seal about the inserted medical device shaft. One mask has an inflatable and deflatable cuff disposed within the inside tubular walls of the instrument port. The mask may be used in a difficult airway situation, to provide positive pressure ventilation and general anesthesia gas to a critically injured patient, allowing an anesthesiologist to identify the trachea with a fiber optic laryngoscope, and advance an endotracheal breathing tube over the fiber optic laryngoscope, while maintaining an airtight seal between the controllably variable inside diameter instrument port and the inserted medical device shafts. The instrument port may later be opened or dilated to allow the mask to be passed over the proximal end of the endotracheal tube, requiring only brief interruption in positive pressure ventilation. Excerpt(s): This application claims priority to U.S. Provisional Application No. 60/317,258, filed Sep. 5, 2001,titled INTUBATING VENTILATORY FACE MASK, herein incorporated by reference. The present invention is related generally to medical devices. More specifically, the present invention relates to face masks which can find one use in delivery of anesthesia and respiratory gases. The present invention includes a standard
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breathing circuit port and a variable inside diameter port which can be used to form an airtight seal about fiberoptic laryngoscopes and endotracheal tubes. The use of endotracheal tubes or breathing tubes is the preferred and standard method for administering general anesthesia for major surgical procedures. The endotracheal tube typically has a distal end carrying an inflatable balloon disposed about the circumference. The balloon can be inflated to form an air tight seal within the trachea once the endotracheal tube distal end is in place. The proximal end of the endotracheal tube typically has a standard connector, having nominally 3/8.sup.th inch inside diameter and 5/8.sup.th inch outside diameter. The endotracheal tube may be put into position by an anesthesiologist, the distal balloon inflated, and the oxygen and anesthesia gases delivered to the patient. The endotracheal tube is typically put into position after the patient has been put under, to avoid patient gagging on the inserted endotracheal tube. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Living specimen induction chamber Inventor(s): Nelson, Michael Bo; (San Francisco, CA) Correspondence: BEYER WEAVER & THOMAS LLP; P.O. BOX 778; BERKELEY; CA; 94704-0778; US Patent Application Number: 20030209244 Date filed: February 19, 2003 Abstract: The invention described herein provides an induction chamber used to sedate one or more living specimens. The induction chamber comprises at least one gas inlet through which anesthesia gas and oxygen are supplied. To minimize escape of anesthetizing gas is into the ambient room or surroundings, the induction chamber includes a gas outlet or port that draws anesthesia gas. A negative or vacuum pressure is applied to the gas outlet. The negative pressure draws gases from within the induction chamber, and may draw gases from the ambient surroundings around the induction chamber when a door allowing a lab technician access to the induction chamber interior opens. The induction chamber also comprises a device that obstructs gas flow through the gas outlet based on the position of the door. In one chamber design, when the door closes, the gas outlet is blocked. Thus, opening the door to the induction chamber causes anesthesia gas is to be drawn through the outlet while closing the door allows anesthesia gas to collect in the chamber and sedate any specimens located therein. The induction chamber is particularly useful for sedating a living specimen prior to insertion in an imaging box or chamber. Excerpt(s): This application claims priority under 35 U.S.C.sctn.119(e) from co-pending U.S. Provisional Patent Application No. 60/385,397 filed on May 31, 2002, which is herein incorporated by reference for all purposes; this application is also a continuationin-part of U.S. patent application entitled "Multiple Output Anesthesia System" by Richard George Dalgetty et al., filed on Feb. 20, 2002 (U.S. application Ser. No. 10/081,040), which is herein incorporated by reference herein for all purposes. The present invention relates generally to anesthesia delivery systems and imaging systems. In particular, the present invention relates to induction chambers used to anesthetize mammalian specimens in imaging and research applications. One new and specialized type of imaging involves the capture of low intensity light--often on the order of only tens to hundreds of photons--from a light-emitting sample. The low intensity light source may be emitted from any of a variety of light-emitting sources within a living
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specimen, e.g., luciferase expressing cells within a mouse. The source of the light indicates portions of the sample, such as traced molecules in a particular portion of a mammalian specimen, where an activity of interest may be taking place. Some specialized in-vivo imaging applications include analysis of one or more representations of emissions from internal portions of a specimen superimposed on a photographic representation of the specimen. The photographic representation provides the user with a pictorial reference of the specimen. The luminescence representation indicates portions of the specimen where an activity of interest may be taking place. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Local anesthetic methods and kits Inventor(s): Katz, Howard I; (La Jolla, CA), Weber, Eckard; (San Diego, CA) Correspondence: STERNE, KESSLER, GOLDSTEIN & FOX PLLC; 1100 NEW YORK AVENUE, N.W., SUITE 600; WASHINGTON; DC; 20005-3934; US Patent Application Number: 20020183356 Date filed: May 28, 2002 Abstract: Methods of reversing local anesthesia are disclosed. The methods comprise administering a local anesthetic and alpha adrenergic receptor agonist to induce local anesthesia followed by reversing anesthesia with a low dose of an alpha adrenergic receptor antagonist. Also disclosed are kits comprising a local anesthetic, an alpha adrenergic receptor agonist and a low dose of an alpha adrenergic receptor antagonist. Excerpt(s): The invention is in the field of medicinal chemistry. The invention relates in particular to a method of reversing local anesthesia induced by a local anesthetic and an alpha-adrenergic agonist, comprising administering an effective low dose of an alphaadrenergic antagonist. Local anesthesia is widely used by dentists to provide pain relief to patients during dental procedures. To provide pain relief, a drug formulation containing a local anesthetic compound such as lidocaine is injected into the gum tissue surrounding the tooth or teeth on which the dental procedure is to be performed. There are short-acting and long-lasting local anesthetic drug formulations. Short-acting local anesthetic drug formulations contain lidocaine or a related local anesthetic drug dissolved in saline or other suitable injection vehicle. Typically, local anesthesia with short-acting local anesthetics lasts approximately 20-30 minutes, which is not long enough for many dental procedures. To obtain long-lasting local anesthesia, dentists often use lidocaine or other local anesthetic formulations which, in addition to the local anesthetic drug itself, contain low concentrations of epinephrine or another adrenergic receptor agonist such as levonordefrin. More than 90% of the local anesthesia procedures performed by dentists involve local anesthetic formulations containing alpha-adrenergic receptor agonists. The vasoconstrictor is necessary because local anesthetics without vasoconstrictor are too short-acting for most dental procedures. The added epinephrine stimulates alpha-adrenergic receptors on the blood vessels in the injected tissue. This has the effect of constricting the blood vessels in the tissue. The blood vessel constriction causes the local anesthetic to stay in the tissue much longer, resulting in a large increase in the duration of the anesthetic effect (from 20 minutes for the short-acting formulation to 3-6 hours for the long-lasting formulation). A major problem with the use of epinephrine-containing local anesthetics is soft-tissue anesthesia (lip, cheek, tongue) which usually lasts many hours longer than anesthesia and analgesia of the tooth pulp. Tooth pulp anesthesia and analgesia are the desired effects of local anesthesia from a dental procedural perspective while soft-tissue
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anesthesia is usually an undesirable side effect. Soft tissue anesthesia results in a number of problems and inconveniences, such as a prolonged and uncomfortable feeling of numbness in and around the mouth, inability to smile, difficulty eating, drinking and swallowing, loss of productivity by missing work hours or meetings etc. Lingering soft-tissue anesthesia can be the cause of injuries due to biting of the tongue or lips. Lingering soft-tissue anesthesia can also result in loss of productivity due to missed work hours or meetings etc. Furthermore, lingering soft-tissue anesthesia is an inconvenience and it is perceived as an annoyance by many patients. Lingering softtissue anesthesia can lead to injury especially in children who often bite into the anesthetized tissue out of curiosity. It would therefore be desirable to have a drug that could be used at will by dentists to rapidly reverse local anesthesia after it is no longer needed. U.S. Pat. No. 4,659,714 discloses a method of prolonging local anesthesia by coadministering a vasoconstrictor, in particular, a vasoconstrictor that acts upon the alpha-adrenergic receptor sites of the blood vessel walls. The '714 patent also discloses the subsequent administration of an alpha-adrenergic receptor antagonist to cause reduction of the prolonged anesthesia effect. Included within the group of alphaadrenergic receptor antagonists described in this patent are phentolamine mesylate. However, the examples make reference to the administration of "phentolamine." It is much more likely that what was administered was phentolamine mesylate since phentolamine mesylate is FDA approved and readily soluble in water. In contrast, phentolamine is not FDA approved and is relatively insoluble in water. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Mechanically registered videoscopic myringotomy/tympanostomy tube placement system Inventor(s): Jones, Christopher; (Sunnyvale, CA), Kaplan, Aaron V.; (Los Altos, CA), Tartaglia, Joseph; (Morgan Hill, CA), Vaughan, Robert; (Stockton, CA) Correspondence: TOWNSEND AND TOWNSEND AND CREW, LLP; TWO EMBARCADERO CENTER; EIGHTH FLOOR; SAN FRANCISCO; CA; 94111-3834; US Patent Application Number: 20020161379 Date filed: April 26, 2001 Abstract: Devices, systems, methods, and kits for treating the tissue structures of the ear make use of a guide structure that can mechanically register a treatment probe with a target region of a target tissue, the guide structure being fittingly received in an auditory canal and often comprising a conformable body such as a compressible foam, or the like. The guide structure may include an articulating mechanism for selectively orienting the treatment probe toward the target region of, for example, a tympanic membrane. The guide structure may also support a videoscopic image capture device, illumination transmitting optical fibers, an aiming beam transmitter, and the like. Such structures facilitate myringotomy, tympanostomy tube placement, and the like, under local anesthesia in a doctor's office. Excerpt(s): The present invention is generally related to medical devices and apparatus. In particular, the invention provides systems, methods, devices, and kits for treating a patient's ear. In one embodiment, the invention provides a system and method for myringotomy with or without tympanostomy tube placement. Otitis media is among the most common diagnosis made by pediatricians. A majority of children may have at least one episode of otitis media ("earache") prior to their third birthday. Otitis media is often caused by an inability of the eustachian tube to drain fluid from the middle ear.
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Otitis media is often treated with antibiotics. A significant number of children exhibit recurrent episodes of otitis media and/or otitis media with effusion. Treatment of these more severe cases often involves the placement of a tympanostomy tube through the tympanic membrane so as to provide adequate drainage of the middle ear and reduce the likelihood of future infections. Tympanostomy tubes provide fluid communication between the middle and outer ear, and typically fall out spontaneously within about a year of placement. Tympanostomy tube placement is among the most common surgical procedures performed in the pediatric population. It has been estimated that more than a million tympanostomy tubes may be placed each year, with typical patients being between about 18 months and 3 years of age at the time of the procedure. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Medical simulator Inventor(s): Mueller, John M.; (Lexington, KY), Nicholls, Robert J.; (Berkeley Springs, WV), Stahlnecker, Michael A.; (Rockville, MD) Correspondence: MEDICAL TECHNOLOGY SYSTEMS, INC; 3356 FORT MEADE ROAD; SUITE 300; LAUREL; MD; 20724; US Patent Application Number: 20030068606 Date filed: October 9, 2001 Abstract: An apparatus and associated method for simulating anatomic and physiological responses to medical procedures involving administering regional anesthetic/analgesic agent in real time using a mannequin. Such simulation allows trainees to perform regional anesthesia techniques that closely mimic real world medical procedures before performing procedures on live patients. Excerpt(s): This invention relates to medical simulators. The invention is particularly concerned with the provision of a medical simulator designed to teach and to refine the psychomotor skills associated with the medical procedures of administering regional and local anesthetic and analgesic agents. The particular form of medical simulator hereinafter described is designed specifically for the use by medical personnel learning or refining the skills of regional anesthesia. Further it is particularly designed for those procedures where observing the reaction of the nervous system to electrical stimulation allows for accurate placement of anesthesia or analgesic agents. The invention also relates to simulation systems designed to simulate any procedure that requires any device that is conductive to puncture the skin or enter the body through a natural or unnatural orifice, e.g., brachytherapy. The invention is further not limited to simulation of human anatomy, i.e., veterinary procedures can be supported. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Method and apparatus for determining the cerebral state of a patient with fast response Inventor(s): Viertio-Oja, Hanna Elina; (Espoo, FI) Correspondence: DANIEL D. FETTERLEY; ANDRUS, SCEALES, STARKE & SAWALL, LLP; Suite 1100; 100 East Wisconsin Avenue; Milwaukee; WI; 53202-4178; US Patent Application Number: 20030055355 Date filed: April 15, 2002 Abstract: A method and apparatus for ascertaining the depth of anesthesia of the patient. In one embodiment, the entropy of the patient's EEG signal data is determined as an indication of the depth of anesthesia. A frequency domain power spectrum quantity is obtained from the patient's EMG signal data. The latter quantity can be updated more frequently than the EEG entropy due to its higher frequency. The EEG entropy indication and the EMG power spectrum indication can be combined into a composite indicator that provides an immediate indication of changes in the state of the patient. In a further embodiment, the frequency range over which the entropy of the biopotential signal from the patient is determined is selected to encompass both EEG signal data and EMG signal data and the entropy so determined used as an indication of the patients state. In addition, entropy of the EEG range alone can be used together with the entropy of the broadened range to indicate separately contributions from EEG and EMG. In a more generalized version of the further embodiment, a set of frequency components obtained from selected frequency ranges is utilized in determining entropy. The patient signal data from which the frequency components are extracted are obtained from time windows of differing lengths so that the resulting entropy indication will have optimally fast response times. Excerpt(s): The present application is a continuation-in-part application of U.S. patent application Ser. No. 09/688,891, filed Oct. 16, 2000 and now ______. The present invention relates to a method and apparatus for determining the cerebral state of a patient. One application of the method and apparatus is determining the extent of a hypnotic state of the patient resulting, for example, from the administration of an anesthetic agent. That extent is often termed the "depth of anesthesia." In the method and apparatus of the present invention, changes in the cerebral state can be accurately and quickly determined. In a simplistic definition, anesthesia is an artificially induced state of partial or total loss of sensation or pain, i.e. analgesia. For most medical procedures the loss of sensation is accompanied by a loss of consciousness on the part of a patient so that the patient is amnestic and is not aware of the procedure. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Method and apparatus for monitoring intravenous (IV) drug concentration using exhaled breath Inventor(s): Bjoraker, David G.; (Gainesville, FL), Melker, Richard J.; (Gainesville, FL) Correspondence: SALIWANCHIK LLOYD & SALIWANCHIK; A PROFESSIONAL ASSOCIATION; 2421 N.W. 41ST STREET; SUITE A-1; GAINESVILLE; FL; 326066669 Patent Application Number: 20030139681 Date filed: January 22, 2002
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Abstract: A method and system is provided for detecting the depth of anesthesia wherein at least one anesthetic agent is absorbed in a patient's bloodstream during the administration of anesthesia, which includes sampling a patient's expired breath; analyzing the breath for concentration of at least one substance indicative of the anesthetic agent using sensor technology such as free (unmetabolized) anesthetic agent or its metabolites; determining the effect of the agent based on that concentration; and determining depth of anesthesia based thereon. The method also detects endogenous compounds such as ketones and ammonia in exhaled breath as well as other pathologic organisms. Excerpt(s): The present invention relates to non-invasive monitoring substance/compound concentrations in blood, and, more particularly, to a method and apparatus for the detection of such levels utilizing a breath detection system. Anesthesia is extremely safe. Anesthesiologists use sophisticated technology to monitor the vital signs of and to provide respiratory and cardiovascular support for patients undergoing surgical procedures. Historically, most anesthetics were performed using inhaled agents. The depth of anesthesia induced by an inhalational anesthetic depends primarily on the partial pressure (or gas tension) of the anesthetic in the brain, and the rate of induction and recovery from anesthesia depends on the rate of change of partial pressure in the brain. The depth of anesthesia reflects the degree of blockade of sensory, reflex, mental, and motor functions, which can be achieved by using either inhalational or intravenous (IV) anesthetics, or combination of both agents. With inhalation agents, the concentration of drug delivered can be precisely metered and the variation between patients in the depth of anesthesia resulting from known concentrations of inhaled agents is relatively narrow, permitting the anesthesiologist to confidently assume a particular level of anesthesia based on the concentration of anesthetic gas delivered. Occasionally, this is not the case, and patients have recall of events that occurred during the surgical procedure. Recall is usually not a significant issue, however, in instances where a muscle relaxant is also given, rendering the patient paralyzed, an inadequate depth of anesthesia may result in the patient perceiving pain and being unable to alert the anesthesiologist. Also, the patient may remember conversation or other unpleasant events during his surgery. This rare, but dramatic event can be psychologically devastating to a patient. Because of these events, and the desire to more closely titrate the depth of anesthesia, a number of devices have been developed that purport to monitor a patient's depth of anesthesia by processing electrical signals produced by the brain. Studies have shown these technologies tend to be imprecise, and anesthetic agent specific. A more specific method of determining depth of anesthesia, or alternatively the blood concentration of anesthetic agents is desirable. Recently other methods of providing anesthesia, including IV anesthesia, have been popularized, and offer advantages over inhalation anesthetics. Among the newer anesthetic techniques is total IV anesthesia (TIVA) which uses IV agents in place of the conventional vaporized inhalants. Unlike inhaled anesthetics, IV anesthetics produced a wider range of anesthesia for a specific drug dosage (less predictable), owing at least in part to interactions with other drugs, competition for binding sites in the blood and other body tissues, and genetic variation in the enzymes responsible for drug metabolism. At present, a major impediment to the wider use of IV anesthetics, rather than inhaled anesthetics, has been the inability to precisely determine the quantity of drug required to provide a sufficient "depth of anesthesia" without accumulating an excessive amount. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Method and apparatus for treating breathing gases Inventor(s): Anhorn, Erik M.; (Jackson, NJ), Dubois, Charles E.; (Wall Township, NJ), Leighty, David A.; (Beachwood, NJ), Smith, T. Paul; (Oakhurst, NJ) Correspondence: ROBERT M. SKOLNIK; 353 Monmouth Road; PO Box 22; West Long Branch; NJ; 07764-0022; US Patent Application Number: 20030070680 Date filed: October 16, 2001 Abstract: A method of making thin-walled permeable tubing using air blown extrusion, and of using the tubing in a device which enables a substantial humidification or drying of patient breathing gases in the breathing lines for patient monitoring or anesthesia results in cost savings and increased efficiency. Excerpt(s): The present invention relates to methods and apparatus for drying or humidifying breathing gases supplied to a patient during administration of gas anesthesia, or during administration of artificial respiration or of supplemental oxygen when a patient has difficulty breathing. Commonly assigned patents 3,735,558, 4,705,542, and 4,808,201 disclose and claim devices having tubes constructed of permeable materials selected so the humidity and temperature of gases flowing through the tubes equalizes to those of gases surrounding the outside of the tubes. The tubes are formed of extrudable plastic materials that selectively permit water to diff-use through the tube walls, but inhibit the ability of other gases from so diff-using. Water diffuses through the tube walls from the side of higher concentration to that of lower concentration. A difference in total pressure between the inside and the outside of the tubes is not required, only a difference in water concentration. In practice, when highly humid gas passes through the tubes, water vapor in the gas diffuses through the tube walls out into the surrounding dry air or gas. Circulation of a surrounding dry air or gas permits continuous operation of the process. Thus, condensation in the tubing and downstream of the tubing are prevented from occurring, and the problems occasioned by such condensation are eliminated. Because of extreme selectivity in the process, only water is removed, not other gases of interest. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Method and device for neurocryo analgesia and anesthesia Inventor(s): Carroll, Ronald J.; (Portland, ME) Correspondence: PATRICK R. SCANLON; PIERCE ATWOOD; ONE MONUMENT SQUARE; PORTLAND; ME; 04101; US Patent Application Number: 20020161360 Date filed: February 5, 2002 Abstract: A catheter system and method for selectively cooling or freezing target neuronal tissue to induce lesions along the neuroaxis and produce cryoanalgesia by impairing nerve conduction of the targeted neuronal tissue. The system includes a catheter that has cryogenic capability for variable cooling or freezing of neuronal tissue. The catheter also includes temperature sensing and electrodiagnostic capabilities. A pressurized fluid source is included for inflating a portion of the catheter body. The system includes electrodiagnostic equipment for stimulating and monitoring sensory evoked potentials in the patient. The method involves placement of the catheter tip in
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the subarachnoid space of the spinal canal and location of the tip on the neuronal target using imaging and electrodiagnostic techniques. Excerpt(s): This application claims the benefit of U. S. Provisional Application Ser. No. 60/286,636, filed Apr. 26, 2001. This invention relates generally to cryoanalgesia and more particularly to devices and procedures for applying cryoanalgesia to the neuroaxis. Management of acute and chronic pain has been a concern for as long as medicine has been practiced. Many methods of inducing analgesia and anesthesia have been developed. The use of chemical substances is perhaps the most common approach to pain relief. This approach requires suitable substances that are effective, safe to humans, and do not cause complications or abnormal reactions. Despite the great advances that have been made in the field of anesthesiology, and in the field of pain relief in general, there are still some drawbacks to chemical-based approaches. For instance, the anesthetics generally available today must be administered in carefully graduated doses to assure the patient's well being, require extended periods of fasting prior to treatment, and are often accompanied by undesirable after effects such as nausea. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Method for identification and partial-pressure determination of two gases in an unknown anesthesia gas mixture Inventor(s): Al-Soufi, Wajih; (Lugo, ES), Haeusler, Andrea; (Lobeck, DE) Correspondence: NIXON & VANDERHYE P.C.; 8th Floor; 1100 North Glebe Road; Arlington; VA; 22201-4714; US Patent Application Number: 20030038238 Date filed: August 20, 2002 Abstract: The invention relates to a method for identification and partial-pressure determination of two gases in an unknown anesthesia gas mixture comprising n possible gases by measuring the infrared optical radiation, transmitted through the gas mixture, that passes through m filters having different transmission wavelength ranges, in which n is a number greater than 2 and m is a number less than n. A disadvantage of the method known until now is that for the identification and partial-pressure determination, at least as many filters as there are possible gases in the unknown gas mixture are always required. The method of the invention evaluates the exit intensities, measured after passage through the filters, of the infrared optical radiation transmitted through the unknown gas mixture in such a way that with three filters, for instance, two gases in an unknown gas mixture comprising five possible gases can be identified, and their partial pressures can be determined. By dividing the partial pressures by the total pressure, it is optionally also possible to determine the concentration of the gases. First, calibration curves for the five individual gases and the three filters are created, which describe the dependency of the exit intensities of the infrared optical radiation on the partial pressures of the gases, and then the mixture pair having the two gases is ascertained along with their associated partial pressures, whose associated exit intensities best correspond to the exit intensities measured for the unknown gas mixture. Excerpt(s): This application is based on and claims priority of German patent application No. 10140998.2-52 filed on Aug. 21, 2001, the disclosure of which is incorporated herein by reference in its entirety. The invention relates to a method for identification and
Patents 173
partial-pressure determination of two gases in an unknown gas mixture comprising n possible gases, by measurement of the infrared optical radiation emitted by a radiation source and transmitted through a cuvette holding the unknown gas mixture, which radiation passes through m filters with different transmission wavelength ranges; n is a number greater than 2, and m is a number less than n. The gas absorbs infrared optical radiation in a very specific wavelength range, and the transmission of the unabsorbed infrared optical radiation in this wavelength range is characteristic for the gas and its partial pressure. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Method of inducing opioid analgesia and anesthesia without respiratory suppression Inventor(s): Lalley, Peter M.; (Madison, WI) Correspondence: DEWITT ROSS & STEVENS S.C.; 8000 EXCELSIOR DR; SUITE 401; MADISON; WI; 53717-1914; US Patent Application Number: 20030092701 Date filed: November 9, 2001 Abstract: The invention is directed to a pharmaceutical composition and a corresponding method for inducing analgesia or anesthesia in a mammalian subject, while simultaneously inhibiting respiratory depression in the subject. The composition contains in combination, an opiate or opioid analgesic or anesthetic and a D.sub.1dopamine receptor agonist in an amount sufficient to inhibit respiratory depression caused by the opiate or opioid. Excerpt(s): The invention is directed to method of inducing opioid analgesia and anesthesia in mammals, including humans, without suppressing respiration. Opiates have long been known to disrupt respiratory rhythm and to depress breathing and respiratory sensitivity to CO.sub.2 (Jaffe and Martin, 1990). The pons and medulla are known to be the primary sites where opiate drugs produce these respiratory effects (Id.). Endogenous opioids as well as.mu.- and.delta.-subtypes of opioid receptors are present in essentially all respiratory regions of the pons and medulla (Yeadon and Kitchen, 1989). In vivo and in vitro investigations have shown that exogenous opioids depress inspiratory and expiratory neuronal activity postsynaptically (Denavit-Saubie', Champagnat and Zieglgansberger, 1978), as well as presynaptically (Johnson, Smith and Feldman, 1996). The underlying cellular mechanisms responsible for the opiate effects on respiration have not, however, been elucidated. Opiates are widely used medicinal agents. However, because they depress breathing, their use is contraindicated in many instances, especially in patients with compromised cardiovasculare and pulmonary function. Thus, there has been a long-felt need to harness the analgesic power of the opiates, without depressing the respiratory function of the patient. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Multi-functional nasogastric tubular device for use with patients undergoing general anesthesia Inventor(s): Dua, Rup K.; (Pittsburgh, PA), Georgiades, Alexander H.; (Pittsburgh, PA), Peters, George J.; (Pittsburgh, PA), Swartz, Michael R.; (Pittsburgh, PA) Correspondence: Michael R. Swartz, Esq.; 205 Royal Oak Avenue; Pittsburgh; PA; 15235; US Patent Application Number: 20030060764 Date filed: August 28, 2002 Abstract: A multi-functional nasogastric tubular device for insertion into a patient includes an elongated flexible body having a pair of spaced apart opposite proximal and distal ends, a plurality of spaced apart lumens formed in the body so as to extend sideby-side with respect to one another between the proximal and distal ends of the body and being open at least at the proximal end of the body, and a temperature sensor disposed on the body, such as in one of the lumens of the body, and running from the proximal end of the body to the distal end thereof such that the temperature sensor is adapted to monitor internal core temperature of a patient and also to serve as a radiopaque element for marking the position of the elongated body in the patient. Excerpt(s): This utility patent application claims the benefit of provisional application No. 60/316,432 filed Aug. 30, 2001. The present invention generally relates to medical devices used in providing medical care to a patient undergoing general anesthesia or ICU (Intensive Care Unit) and, more particularly, is concerned with a multi-functional nasogastric tubular device for removing gastric contents from a patient's stomach, monitoring core body temperature of the patient, and providing a radiopaque marker of the position of the tubular device in the patient. When a patient undergoes general anesthesia in conjunction with medical procedures, such as laparoscopic and open abdominal surgery, to treat various medical problems, for example surgical peptic ulcers or intestinal obstruction, the standard of care in monitoring that patient involves the placement of a nasogastric (NG) tube for the removal of gastric contents in order to prevent aspiration and the placement of a temperature sensor (TS) tube which carries a thermistor in order to monitor the core body temperature of the patient. Heretofore, each of these tubes, being made of flexible plastic material, has been inserted by a physician, or his appointee, separately through one of the two nostrils of the patient and then extended similarly through the oropharynx and esophagus to the stomach of the patient. The NG tube, generally from 36 to 48 inches in length, may extend into the stomach or further into the gastrointestinal tract. The TS tube, being typically shorter in length than the NG tube, typically terminates above the stomach. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Multiple output anesthesia system Inventor(s): Bates, Brian R.; (Lafayette, CA), Dalgetty, Richard G.; (Oakland, CA), Nelson, Michael B.; (San Francisco, CA) Correspondence: BEYER WEAVER & THOMAS LLP; P.O. BOX 778; BERKELEY; CA; 94704-0778; US Patent Application Number: 20030154976 Date filed: February 20, 2002
Patents 175
Abstract: The present invention provides improved anesthesia delivery systems that consistently and reliably deliver anesthesia gas to multiple gas outlets. The systems are particularly useful for anesthetizing multiple mammals and living specimens to be imaged by a low-light level imaging system. The anesthesia delivery systems are suitable for use with conventional oxygen sources, and convert the high pressures associated with a conventional oxygen source to lower pressures suitable for use with small mammals and suitable for combination with an anesthesia gas at low flow rates. The systems include an anesthesia gas source that combines anesthesia gas with the oxygen. The combination of anesthesia gas and oxygen is supplied to one or more multiple outlets. Excerpt(s): The present invention relates generally to anesthesia delivery systems. In particular, the present invention relates to anesthesia systems for use with living specimen imaging applications. One new and specialized type of imaging involves the capture of low intensity light--often on the order of only tens to hundreds of photons-from a light-emitting sample. The low intensity light source may be emitted from any of a variety of light-emitting sources within a living specimen, e.g., luciferase expressing cells within a mammalian specimen. The source of the light indicates portions of the sample, such as traced molecules in a particular portion of a laboratory mouse, where an activity of interest may be taking place. Some specialized in-vivo imaging applications may include analysis of one or more representations of emissions from internal portions of a specimen superimposed on a photographic representation of the specimen. The photographic representation provides the user with a pictorial reference of the specimen. The luminescence representation indicates portions of the specimen where an activity of interest may be taking place. Obtaining the luminescence representation may involve image capture over an extended period of time, e.g., minutes. The living specimen is typically anesthetized during this time to prevent movement that may compromise image capture. Current imaging systems employ anesthesia delivery systems that do not consistently and reliably anesthetize specimens or deliver anesthesia gases. These conventional systems are miniaturized relatives of anesthesia systems used in hospitals and the like. Systems of this nature are designed for a single recipient. However, many imaging systems as described above may require gas delivery to multiple small mammals. So far, scaling to multiple recipients, and via lower flow rates associated with the smaller recipients has been largely unsuccessful. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
MuO-conopeptides and their use as local anesthetics Inventor(s): Garrett, James E.; (Salt Lake City, UT), Jones, Robert M.; (Salt Lake City, UT), Layer, Richard T.; (Sandy, UT), McCabe, R. Tyler; (Salt Lake City, UT), McIntosh, J. Michael; (Salt Lake City, UT), Olivera, Baldomero M.; (Salt Lake City, UT), Wagstaff, John D.; (Salt Lake City, UT) Correspondence: ROTHWELL, FIGG, ERNST & MANBECK, P.C.; 555 13TH STREET, N.W.; SUITE 701, EAST TOWER; WASHINGTON; DC; 20004; US Patent Application Number: 20020198145 Date filed: July 20, 2001 Abstract: The present invention is directed to the new.mu.O-conopeptides, their coding sequences and their propeptides and to the use of.mu.O-conopeptides as a local anesthetic for treating pain. The.mu.O-conopeptides have long lasting anesthetic activity and are particularly useful for spinal anesthesia, either administered acutely for post-
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operative pain or via an intrathecal pump for severe chronic pain situations or for treatment of pain in epithelial tissue. Excerpt(s): The present application is a continuation-in-part of Ser. No. 09/590,386 filed on Jun. 9, 2000 and claims benefit thereto. The present application also claims benefit under 35 USC.sctn.119(e) to U.S. provisional patent applications Ser. No. 60/138,507 filed on Jun. 10, 1999 and Ser. No. 60/219,451 filed on Jul. 20, 2000. Each of these applications is incorporated herein by reference. The present invention is directed to the use of.mu.O-conopeptides as a local anesthetic for treating pain. The.mu.Oconopeptides have long-lasting anesthetic activity and are particularly useful for spinal anesthesia, administered either acutely for post-operative pain or via an intrathecal pump for severe chronic pain situations. The present invention is further directed to new.mu.O-conopeptides, their coding sequences and their propeptides. The publications and other materials used herein to illuminate the background of the invention, and in particular, cases to provide additional details respecting the practice, are incorporated herein by reference, and for convenience, are referenced by author and date in the following text and respectively grouped in the appended Bibliography. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Non-sedating barbiturate compounds as neuroprotective agents Inventor(s): Levitt, Barrie; (Mamaroneck, NY), Moros, Daniel A; (Larchmont, NY), Yacobi, Avraham; (Englewood, NJ) Correspondence: VENABLE, BAETJER, HOWARD AND CIVILETTI, LLP; P.O. BOX 34385; WASHINGTON; DC; 20043-9998; US Patent Application Number: 20030153589 Date filed: January 27, 2003 Abstract: Methods of providing neuroprotection are disclosed comprising administering a non-sedative barbiturate compound in an amount sufficient to achieve neuroprotection in a mammalian subject. Preferred compounds are in the family of diphenylbarbituric acid and analogs. Preferred doses for a neuroprotective effect exceed the dosage of a corresponding sedative barbiturate without sedative side-effects such as anesthesia and death Excerpt(s): The invention relates to the use of non-sedating barbiturate compounds given in a manner and dosage effective to produce blood levels and brain levels of these drugs and/or their active metabolites sufficient to provide a neuroprotectant effect. In particular, the methods and formulations of the invention permit treatment of cerebral ischemia, head trauma and other acute neurologic injuries, and prevention of resulting neuronal damage. Ischemia (stroke) is the third leading cause of death in the United States. When blood supply to the brain is reduced below a critical threshold, a cascade of biochemical events leads to irreversible damage to neurons and brain infarction. Research on treatment and prevention of ischemia is extensive but unfortunately it remains at a basic stage and no adequate therapies are yet in practice (10). Barbiturates in high concentrations have been shown to be neuroprotective in cerebral ischemia in rodents and primates, to reduce the extent of ischemia brain infarction, and to prevent or lessen brain damage (1-4). One theory as to how barbiturates prevent neuronal injury in ischemia is that they inhibit the ischemia-induced uncontrolled release of neurotransmitters, which can attain high, neurotoxic concentrations that cause neuronal death (5).
Patents 177
Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Novel benzimidazole derivatives and pharmaceutical compositions comprising these compounds Inventor(s): Teuber, Lene; (Vaerlose, DK), Watjen, Frank; (Farum, DK) Correspondence: BIRCH STEWART KOLASCH & BIRCH; PO BOX 747; FALLS CHURCH; VA; 22040-0747; US Patent Application Number: 20030055055 Date filed: December 12, 2001 Abstract: The present invention relates to novel benzimidazole derivatives, pharmaceutical composition containing these compounds, and methods of treatment therewith. The compounds of the invention are useful in the treatment of central nervous system diseases and disorders, which are responsive to modulation of the GABA receptor complex, and in particular for inducing and maintaining anesthesia, sedation and muscle relaxation, as well as for combating febrile convulsions in children. The compounds of the invention may also be used by veterinarians. Excerpt(s): The present invention relates to novel benzimidazole derivatives, pharmaceutical compositions containing these compounds, and methods of treatment therewith. The compounds of the invention are useful in the treatment of central nervous system diseases and disorders, which are responsive to modulation of the GABA.sub.A receptor complex, and in particular for inducing and maintaining anaesthesia, sedation and muscle relaxation, as well as for combating febrile convulsions in children. The compounds of the invention may also be used by veterinarians. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Pharmaceuticals compositions Inventor(s): Jones, Christopher Buchan; (Prestbury, GB), Platt, John Henry; (Congleton, GB) Correspondence: PILLSBURY WINTHROP, LLP; P.O. BOX 10500; MCLEAN; VA; 22102; US Patent Application Number: 20020173547 Date filed: October 26, 2001 Abstract: Pharmaceutical compositions containing 2,6-diisopropylphenol (propofol) are described for use as anesthetics.A method for their preparation is described, as their use in producing anesthesia including induction and maintenance of general anesthesia and sedation. Excerpt(s): The present invention relates to 2,6-diisopropylphenol, known as propofol, and in particular to new pharmaceutical compositions containing propofol. Propofol is an injectable anaesthetic which has hypnotic properties and can be used to induce and maintain general anaesthesia and for sedation for example in Intensive Care Units. Propofol is a highly successful anaesthetic and is marketed under the trademark `Diprivan` for use in treating humans and under the trademark `Rapinovet` for veterinary use. Injectable anaesthetics, such as propofol, are administered directly into the blood stream. This gives rise to a rapid onset of anaesthesia influenced almost
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entirely by the rate at which the anaesthetic agent crosses the blood-brain barrier. It is therefore necessary for the anaesthetic agent to have sufficient lipid solubility to be able to cross this barrier and depress the relevant mechanisms of the brain. However highly lipid soluble molecules are generally poorly soluble in water and thus are difficult to formulate for intravenous injection. In some cases it may be possible to obtain a water soluble salt of the anaesthetic agent which releases a lipid soluble free base in vivo. This is not possible in many cases and, despite considerable research, it did not prove to be feasible with propofol. Thus it was necessary to conduct very substantial research and development into the formulation of propofol in order to obtain pharmaceutical compositions for administration to warm-blooded animals including humans. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
PROKINETIC AGENTS FOR TREATING GASTRIC HYPOMOTILITY AND RELATED DISORDERS Inventor(s): ANDREWS, PAUL L. R.; (LONDON, GB), WATSON, JOHN W.; (LEDYARD, CT), WOODS, ANTHONY J.; (LONDON, GB) Correspondence: PFIZER INC; 150 EAST 42ND STREET; 5TH FLOOR - STOP 49; NEW YORK; NY; 10017-5612; US Patent Application Number: 20030176421 Date filed: December 30, 1999 Abstract: Stasis is treated or prevented in all or any part or parts of the stomach of a patient, especially a human patient, in need of such treatment, where said stasis results from hypomotility in the stomach, particularly gastric hypomotility with delayed emptying of the liquid and/or solid contents of the stomach. Gastric or gastrointestinal disorders are also treated which are characterized by one or more symptoms selected from pain, nausea, vomiting, heartburn, postprandial discomfort, indigestion and gastroesophageal reflux. Such treatment or prevention is achieved by administering to the patient a therapeutically effective amount of an inhibitor of phosphodiesterase-4 (PDE4), including isozyme subtypes thereof, sufficient to treat or prevent such hypomotility or gastric or gastrointestinal disorder in said patient. The PDE4 inhibitor comprises a compound of Formula (IA) or (IB): 1where in a preferred embodiment, R is cyclopentyl or cyclohexyl; R.sup.1 is (C.sub.1-C.sub.2) alkyl; one of R.sup.2.sub.a and R.sup.2.sub.b is hydrogen and the other is a substituent of partial Formula (1.0.0) above, where the dashed line represents a single bond, m is 0, R.sup.113 and R.sup.114 are in a cis relationship to each other, R.sup.113 is cyano, R.sup.115 is hydrogen, and R.sup.114 is carboxy, --CH.sub.2OH, or --CH.sub.2C(.dbd.O)NH.sub.2.Pharmaceutical compositions are also described which are useful for carrying out the above-mentioned methods of treatment and prevention, and which are also useful in the treatment of a gastric or gastrointestinal disorder in a patient which comprises with respect to said patient, (i) a sign or concomitant of diabetic neuropathy, anorexia nervosa, achlorhydria, gastrointestinal surgery, post-surgical recovery in the period of emergence from general anesthesia; or the administration of morphine and morphine-like opioids; (ii) a secondary aspect of a primary disease or disorder in said patient which is organic, wherein said disease or disorder involves particularly a gastroenteric or gastroesophageal organ or tissue, or an organ or tissue of the central nervous system of said patient; or (iii) an adverse side effect of a different therapeutic agent administered to said patient in the course of treating another unrelated disease or disorder in said patient.
Patents 179
Excerpt(s): The method of treatment of the present invention involves a therapeutic agent having a prokinetic effect on, i.e., that promotes activity with regard to gastric motility. This type of drug is useful in treating gastric hypomotility with delayed gastric emptying of liquid and/or solid contents of the antrum (stomach), which is a component of a number of gastric or gastrointestinal disorders. The symptoms of such gastric or gastrointestinal disorders can be quite serious and include pain, nausea, vomiting, heartburn, postprandial discomfort, indigestion, and gastroesophageal reflux. In particular, the present invention relates to therapeutic agents which by various mechanisms are able to elevate cAMP in populations of neurons in the myenteric plexus, leading to release of excitatory transmitters, e.g., acetylcholine, and subsequent stimulation with resulting contraction of the smooth muscle of the antrum. The therapeutic compounds useful as active ingredients in the pharmaceutical compositions and methods of treatment of the present invention are closely related, in terms of their chemical structure and biological activity, to inhibitors of the phosphodiesterase-IV (PDE4) isoenzyme. However, to date the art has incorrectly taught that PDE4 inhibitors antagonize gastrointestinal contractile responses, suggesting their use as antikinetic agents for treating hypermotility disorders; rather than as prokinetic agents for treating gastric hypomotility, as surprisingly discovered in accordance with the present invention. The gastrointestinal system must preserve a proper balance between absorption and secretion of water and electrolytes in order to keep nutrients, wastes, electrolytes and water in a life-sustaining flux. Equally important to successful performance of this ongoing process is the maintenance along the gastrointestinal tract of the appropriate anterograde motility. Gastrointestinal motility is also known to be a key component of vomiting. This aspect of its role is important in light of the fact that some antiemetic agents have enhanced gastric emptying as a significant aspect of their actions. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Salts of bicyclic, N-acylated imidazo-3-amines and imidazo-5-amines Inventor(s): Gerlach, Matthias; (Brachttal, DE), Sundermann, Corinna; (Aachen, DE) Correspondence: CROWELL & MORING LLP; INTELLECTUAL PROPERTY GROUP; P.O. BOX 14300; WASHINGTON; DC; 20044-4300; US Patent Application Number: 20030119842 Date filed: October 18, 2002 Abstract: Salts of a bicyclic, N-acylated imidazo-3-amine or an imidazo-5-amine of the formula: 1addition products thereof with acids, and methods for preparing the salts and addition products. Also disclosed are pharmaceutical compositions comprising the same and methods using the pharmaceutical compositions for the treatment or prophylaxis of pain, drug or alcohol abuse, diarrhoea, gastritis, ulcers, urinary incontinence, depression, narcolepsy, overweight, asthma, glaucoma, tinnitus, itching, hyperkinetic syndrome, epilepsy, or schizophrenia, for inducing anesthesia, and for anxiolysis. Excerpt(s): The present application is a continuation of international patent application no. PCT/EP01/03772, filed Apr. 3, 2001, designating the United States of America, and published in German as WO 01/81344, the entire disclosure of which is incorporated herein by reference. Priority is claimed based on Federal Republic of Germany patent application no. 100 19 714.0, filed Apr. 20, 2000. The present invention relates to salts of bicyclic, N-acylated imidazo-3-amines and imidazo-5-amines, to a process for producing them, to their use for producing pharmaceutical compositions and to pharmaceutical
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compositions containing these compounds. Individual compounds from the category of non-acylated bicyclic imidazo-3-amines and imidazo-5-amines which form the basis of the compounds according to the present invention are known to have interesting pharmacological properties. Thus, certain imidazo[1,2-a]pyridines are described as blood pressure-reducing active ingredients (GB-B-1,135,893), as anthelmintics and antimycotics (J. Med. Chem. 1972, 15, 982-985) and as anti-secretory active ingredients for the treatment of inflammatory diseases (EP-A-0 068 378). EP-A-0 266 890 and J. Med. Chem. 1987, 30, 2031-2046 also describe an effect of individual imidazopyridines against inflammatory diseases, in particular of the stomach. Further pharmacological effects described for individual representatives of the category of non-acylated imidazo-3amines and imidazo-5-amines are antibacterial properties (Chem. Pharm. Bull. 1992, 40, 1170), antiviral properties (J. Med. Chem. 1998, 41 5108-5112) and the effect as benzodiazepine-receptor antagonist (J. Heterocyclic Chem. 1998, 35, 1205-1217). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Short-acting sedative hypnotic agents for anesthesia and sedation Inventor(s): Axt, Sabine; (Sunnyvale, CA), Bolton, Jennifer; (San Francisco, CA), Jenkins, Thomas E.; (La Honda, CA) Correspondence: THERAVANCE, INC.; 901 GATEWAY BOULEVARD; SOUTH SAN FRANCISCO; CA; 94080; US Patent Application Number: 20030153554 Date filed: January 24, 2003 Abstract: The invention provides compounds compositions and methods useful for inducing or maintaining general anesthesia or sedation in mammals. Excerpt(s): This application claims the benefit of U.S. Provisional Application Nos. 60/351,385, filed Jan. 25, 2002, and 60/372,919, filed May 9, 2002, the disclosures of which are incorporated herein by reference. This invention is directed to novel substituted phenylacetic acid ester compounds which are useful as short-acting sedative hypnotic agents for anesthesia and sedation. This invention is also directed to pharmaceutical compositions comprising such compounds; methods for using such compounds for inducing or maintaining anesthesia or sedation; and intermediates for preparing such compounds. Propofol, 2,6-diisopropylphenol, (Diprivan.RTM. Injectable Emulsion, AstraZeneca) is an injectable anesthetic that has hypnotic properties. It can be used to induce and maintain general anesthesia and for sedation. Although propofol is a widely-used anesthetic, its usefulness is somewhat limited due to its long and unpredictable post infusion duration of action. This unpredictable duration of action leads to irregular and often long patient recovery times that are undesirable. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
Patents 181
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Substituted phenol compounds useful for anesthesia and sedation Inventor(s): Bolton, Jennifer; (San Francisco, CA), Jenkins, Thomas E.; (La Honda, CA), Ji, Yu-Hua; (Redwood City, CA), Wu, Huiwei; (Foster City, CA) Correspondence: THERAVANCE, INC.; 901 GATEWAY BOULEVARD; SOUTH SAN FRANCISCO; CA; 94080; US Patent Application Number: 20030119790 Date filed: September 26, 2002 Abstract: The invention provides substituted phenol compounds and pharmaceutical compositions containing substituted phenol compounds which are useful for inducing or maintaining anesthesia or sedation in a mammal. This invention also provides methods for inducing or maintaining anesthesia or sedation in a mammal using substituted phenol compounds. Excerpt(s): This application claims the benefit of U.S. Provisional Application No. 60/325,044, filed on Sep. 26, 2001; the entire disclosure of which is incorporated herein by reference in its entirety. This invention is directed to substituted phenol compounds; pharmaceutical compositions containing substituted phenol compounds; and methods of using such compounds and compositions to induce or maintain general anesthesia or sedation in a mammal. This invention is also directed to processes and intermediates useful for preparing substituted phenol compounds. Propofol (i.e., 2,6diisopropylphenol) is an injectable anesthetic used to induce and maintain general anesthesia and sedation. Because of its beneficial properties and ease of administration, propofol is widely-used for both human and veterinary applications. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Substituted quinazolines and analogs and the use thereof Inventor(s): Cai, Sui X.; (San Diego, CA), Lan, Nancy C.; (Altadena, CA), Upasani, Ravi; (Sunnyvale, CA) Correspondence: STERNE, KESSLER, GOLDSTEIN & FOX PLLC; 1100 NEW YORK AVENUE, N.W., SUITE 600; WASHINGTON; DC; 20005-3934; US Patent Application Number: 20030033089 Date filed: August 16, 2002 Abstract: The invention relates to novel quinazolines and heterocycles which are antagonists or positive modulators of AMPA receptors, and the use thereof for treating, preventing or ameliorating neuronal loss associated with stroke, global and focal ischemia, CNS trauma, hypoglycemia and surgery, as well as treating or ameliorating neurodegenerative diseases including Alzheimer's disease, amyotrophic lateral sclerosis, Huntington's disease, Parkinson's disease and Down's syndrome, treating, preventing or ameliorating the adverse consequences of the overstimulation of the excitatory amino acids, treating, preventing or ameliorating anxiety, psychosis, convulsions, chronic pain, glaucoma, retinitis, urinary incontinence, muscular spasm and inducing anesthesia, as well as for treating or ameliorating the adverse consequences of excitatory amino acid deficiency such as schizophrenia, myoclonus, Alzheimer's disease and malnutrition and neural maldevelopment, and as cognition and learning enhancers. Excerpt(s): This invention is in the field of medicinal chemistry. In particular, the invention is related to novel substituted quinazolines and analogs thereof. These
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compounds are antagonists of x-amino-3-hydroxy-5-methylisoxazole-4-propionic acid (AMPA) ionotropic receptors. Certain of these compounds are positive modulators of AMPA receptors. The invention also is directed to the use of novel substituted quinazolines and analogs thereof for the treatment of neuronal damage following global and focal ischemia, and for the treatment or prevention of neurodegenerative conditions, as anticonvulsants, as cognitive enhancers, and for the treatment of schizophrenia, Parkinson's disease and myoclonus. The compounds of the invention are also useful for treatment or prevention of pain, including acute and chronic pain. The invention also is directed to a process for the preparation of the substituted quinazolines and analogs thereof. Excitatory amino acid receptors are classified into two general types. Receptors that are directly coupled to the opening of cation channels in the cell membrane of the neurons are termed "ionotropic." This type of receptor has been subdivided into at least three subtypes, which are defined by the depolarizing actions of the selective agonist N-methyl-D-aspartate (NMDA),.alpha.-amino-3-hydroxy-5methylisoxazole-4-- propionic acid (AMPA), and kainic acid (KA). The second general type is the G-protein or second messenger-linked "metabotropic" excitatory amino acid receptor. This second type, when activated by the agonists quisqualate, ibotenate, or trans-1-aminocyclopentane-1,3-dicarboxylic acid, leads to enhanced phosphoinositide hydrolysis in the postsynaptic cell. Both types of receptors appear not only to mediate normal synaptic connections during development, but also change in the efficiency of synaptic transmission throughout life. (Schoepp, Bockaert, and Sladeczek, Trends Pharm. Sci. 11:508 (1990); McDonald and Johnson, Brain Res. Rev. 15:41 (1990)). The excessive or inappropriate stimulation of excitatory amino acid receptors leads to neuronal cell damage or loss by a mechanism known as excitotoxicity. The medical consequences of such neuronal degeneration makes the abatement of these degenerative neurological processes an important therapeutic goal. (See U.S. Pat. No. 5,284,957). Antagonists of the AMPA receptor are considered useful in treating, preventing and ameliorating a number of neurologic disorders which are due to overstimulation by the excitatory amino acids. These include acute neurologic disorders such as domoic acid poisoning; cerebral ischemia, global ischemia associated with cardiac arrest; stroke; spinal cord trauma; hypoxia; anoxia; poisoning by carbon monoxide, manganese or cyanide; hypoglycemia; mechanical trauma to the nervous system; epileptic seizures; and chronic neurologic disorders such as Huntington's disease, neuronal injury associated with HIV and AIDS, AIDS dementia, neuropathic pain syndrome, olivopontocerebral atrophy, Parkinson's disease, amyotrophic lateral sclerosis, mitochondrial abnormalities, Alzheimer's disease, hepatic encephalopathy, Tourette's syndrome, drug addiction and urinary incontinence (see Lipton and Rosenberg, N. Engl. J. Med. 330: 613-622 (1994)) and treatment or amelioration of a number of chronic neurologic disorders such as schizophrenia. AMPA receptor antagonists are also useful in treating, preventing and ameliorating acute and chronic pain, pain associated with post-therapeutic neurolgia, insterstital cystitis, osteoarthritis, spinal cord injury, cancer and diabetic neuropathy. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Subtype-selective NMDA receptor ligands and the use thereof Inventor(s): Araldi, Gian Luca; (Washington, DC), Bigge, Christopher F.; (Ann Arbor, MI), Cai, Sui Xiong; (Foothill, CA), Guzikowski, Anthony P.; (Eugene, OR), Keana, John F.W.; (Eugene, OR), Lamunyon, Donald; (Junction City, OR), Lan, Nancy C.; (South Pasadena, CA), Zhou, Zhang-Lin; (Irvine, CA) Correspondence: FITZPATRICK CELLA HARPER & SCINTO; 30 ROCKEFELLER PLAZA; NEW YORK; NY; 10112; US Patent Application Number: 20030144319 Date filed: November 14, 2002 Abstract: The invention relates to subtype-selective NMDA receptor ligands and the use thereof for treating or preventing neuronal loss associated with stroke, ischemia, CNS trauma, hypoglycemia and surgery, as well as treating neurodegenerative diseases including Alzheimer's disease, amyotrophic lateral sclerosis, Huntington's disease and Down's syndrome, treating or preventing the adverse consequences of the overstimulation of the excitatory amino acids, treating anxiety, psychosis, convulsions, aminoglycoside antibiotics-induced hearing loss, migraine headache, chronic pain, Parkinson's disease, glaucoma, CMV retinitis, urinary incontinence, opioid tolerance or withdrawal, and inducing anesthesia, as well as for enhancing cognition. Excerpt(s): This invention is related to 2-substituted piperidine analogs. The analogs are selectively active as antagonists of N-methyl-D-aspartate (NMDA) receptor subtypes. The invention is also directed to the use of 2-substituted piperidine analogs as neuroprotective agents for treating conditions such as stroke, cerebral ischemia, central nervous system trauma, hypoglycemia, anxiety, convulsions, aminoglycoside antibiotics-induced hearing loss, migraine headaches, chronic pain, glaucoma, CMV retinitis, psychosis, urinary incontinence, opioid tolerance or withdrawal, or neurodegenerative disorders such as lathyrism, Alzheimer's Disease, Parkinsonism and Huntington's Disease. Excessive excitation by neurotransmitters can cause the degeneration and death of neurons. It is believed that this degeneration is in part mediated by the excitotoxic actions of the excitatory amino acids (EAA) glutamate and aspartate at the N-methyl-D-Aspartate (NMDA) receptor. This excitotoxic action is considered responsible for the loss of neurons in cerebrovascular disorders such as cerebral ischemia or cerebral infarction resulting from a range of conditions, such as thromboembolic or hemorrhagic stroke, cerebral vasospasms, hypoglycemia, cardiac arrest, status epilepticus, perinatal asphyxia, anoxia such as from drowning, pulmonary surgery and cerebral trauma, as well as lathyrism, Alzheimer's Disease, Parkinson's Disease and Huntington's Disease. Excitatory amino acid receptor antagonists that block NMDA receptors are recognized for usefulness in the treatment of disorders. NMDA receptors are intimately involved in the phenomenon of excitotoxicity, which may be a critical determinant of outcome of several neurological disorders. Disorders known to be responsive to blockade of the NMDA receptor include acute cerebral ischemia (stroke or cerebral trauma, for example), muscular spasm, convulsive disorders, neuropathic pain and anxiety, and may be a significant causal factor in chronic neurodegenerative disorders such as Parkinson's disease [T. Klockgether, L. Turski, Ann. Neurol. 34, 585593 (1993)], human immunodeficiency virus (HIV) related neuronal injury, amyotrophic lateral sclerosis (ALS), Alzheimer's disease [P. T. Francis, N. R. Sims, A. W. Procter, D. M. Bowen, J. Neurochem. 60 (5), 1589-1604 (1993)] and Huntington's disease. [See S. Lipton, TINS 16 (12), 527-532 (1993); S. A. Lipton, P. A. Rosenberg, New Eng. J. Med. 330 (9), 613-622 (1994); and C. F. Bigge, Biochem. Pharmacol. 45, 1547-1561 (1993) and references cited therein.]. NMDA receptor antagonists may also be used to prevent
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tolerance to opiate analgesia or to help control withdrawal symptoms from addictive drugs (Eur. Pat. Appl. 488,959A). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Surgical instrument and method for treating female urinary incontinence Inventor(s): Angelini, Laura; (Rome, IT), Hoepffner, Hans-Jochen; (Barmstedt, DE), Kammerer, Gene W.; (East Brunswick, NJ), Landgrebe, Susanne; (Sulfeld, DE), Lehe, Jorn; (Den Haag, NL), Luscombe, Brian; (Branchburg, NJ), Ulmsten, Ulf; (Bandervd, SE) Correspondence: SELITTO, BEHR & KIM; A PROFESSIONAL CORPORATION; PATENT & TRADEMARK ATTORNEYS; 203 MAIN STREET; METUCHEN; NJ; 08840; US Patent Application Number: 20030149440 Date filed: October 31, 2002 Abstract: Described is a surgical instrument and method for treating female urinary stress incontinence. The instrument includes a first curved needle-like element defining in part a curved shaft having a distal end and a proximal, a tape, or mesh, for implanting into the lower abdomen of a female to provide support to the urethra; a second curved needle element having a proximal end and a distal end, and a coupler for simultaneous attachment to the distal end of the first needle and the distal end of the second needle. In an alternate embodiment, the second curved needle is an anesthesia needle and the method includes anesthetizing the needle pathway through a patient's body to facilitate the passage of the first needle and mesh therethrough. Excerpt(s): The present invention is a continuation in part of co-pending U.S. patent application Ser. No. 09/873,571, filed Jun. 4, 2001, which is a continuation-in-part of U.S. patent application Ser. No. 09/521,801, filed on Mar. 9, 2000, which issued as U.S. Pat. No. 6,273,852 on Aug. 14, 2002 and which claims the benefit of earlier-filed U.S. provisional patent application Ser. No. 60/138,231, filed on Jun. 9, 1999, all of which are hereby incorporated by reference in their entirety herein. The present invention relates generally to a surgical instrument and a method for treating female urinary incontinence and in particular to a needle and mesh configuration for creating a sling beneath the urethra. Women account for more than 11 million of incontinence cases. Moreover, a majority of women with incontinence suffer from stress urinary incontinence (SUI). Women with SUI involuntarily lose urine during normal daily activities and movements, such as laughing, coughing, sneezing and regular exercise. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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System and method for displaying drug information Inventor(s): Evans, Robert F.; (Mobile, AL) Correspondence: LERNER, DAVID, LITTENBERG,; KRUMHOLZ & MENTLIK; 600 SOUTH AVENUE WEST; WESTFIELD; NJ; 07090; US Patent Application Number: 20030065537 Date filed: September 3, 2002 Abstract: A drug administration data management and display system includes a storage device for storing drug data including a database of drugs by drug classification
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and/or color designators. A pharmacy workstation is provided for entering drug data for storage by the storage device. An anesthesia workstation is provided for accessing the drug data in the storage device in response to a drug monitoring system for displaying on a display an icon identifying the drug being administered, the icon including one or more of syringe graphics, drug graphics, drug name, drug concentration, drug administration amount and/or coded background color. The drug monitoring system provides for drug identification and monitoring of drug administration in real time. Excerpt(s): The present application claims the benefit of provisional application No. 60/316,568, filed Aug. 31, 2001, which is incorporated herein by reference. The present invention relates in general to drug delivery systems, and more particularly, to a system and method for use during drug delivery to a patient which improves the quality of the information transmitted to the physician or other health care professional. Manual dispensing of drugs from pharmacy to anesthesia is a common practice in hospitals and other surgical facilities. Anesthesia providing departments generally fill syringes with drugs, administer the drugs directly to the patient and document afterwards using handwritten entries. Human imperfection makes drug diversion, medication errors, errors of admission, medication contamination and inadvertent needle sticks a constant companion to drug administration. Additionally, the process is exacerbated by emergency situations and production pressures which demand hurried setup and administration of drugs, with concurrently less time to pay attention to timely and accurate record keeping. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Technical field Inventor(s): Teuber, Lene; (Vaerloese, DK), Watjen, Frank; (Herlev, DK) Correspondence: BIRCH STEWART KOLASCH & BIRCH; PO BOX 747; FALLS CHURCH; VA; 22040-0747; US Patent Application Number: 20030166638 Date filed: November 20, 2002 Abstract: Chemical compounds of the formula 1as well as pharmaceutical compositions containing them and methods for their use in the treatment of disorders and diseases responsive to modulation of the GABA.sub.A receptor complex of the central nervous system, such disorders and diseases including anxiety, sleep disorders, anesthesia, memory disorders, and epilepsy and other convulsive disorders. Excerpt(s): The present invention relates to novel benzimidazole compounds, pharmaceutical compositions containing these compounds, methods of treating therewith, and to method of preparing such benzimidazole compounds. The novel compounds of the invention are useful in the treatment of central nervous system diseases and disorders, which are responsive to modulation of the GABA.sub.A receptor complex, such as for example anxiety, sleep disorders, anaestesia, memory disorders, and epilepsia or other convulsive disorders. GABA.sub.A receptors for.gamma.aminobutyric acid (GABA) are the most abundant inhibitory receptors in the mammalian brain. The GABA.sub.A receptors are structurally constituted as macromolecular heteropentameric assemblies (combinations of.alpha.,.beta., and.gamma./.delta. protein subunits). Several subtypes of such GABA.sub.A receptors have been described by techniques of modern molecular biology. Each GABA.sub.A
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receptor complex comprises a chloride ion channel that controls chloride flux across the neuronal membrane, and multiple recognition sites for small modulatory molecules such as benzodiazepines, barbiturates, picrotoxin, and certain steroids. When GABA interacts with its receptor, the ion channel is opened, chloride influx is enhanced, the membrane is hyperpolarized and the cell becomes less responsive to excitatory stimuli. This GABA induced ion current can be regulated by diverse agents, including agents that interact with the benzodiazepine receptor or recognition site. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Valve arrangement for controlling the flow rate of a gas Inventor(s): Blumenthal, Tilmann von; (Lubeck, DE), Lorenzen, Ralf; (Lubeck, DE), Ludwig, Bernhard; (Lubeck, DE) Correspondence: McGLEW AND TUTTLE, P.C.; SCARBOROUGH STATION; SCARBOROUGH; NY; 10510-0827; US Patent Application Number: 20020179147 Date filed: March 18, 2002 Abstract: A valve arrangement is provided with a very short minimum valve adjustment time. This is especially suitable for use in respirators or anesthesia apparatuses for metering gases for respirated patients. It has a valve (3, 4) with a seat (3) and with a valve closing part (4) for adjusting the gas flow rate, an inflow line (1) and a discharge line (2) as well as a drive system (5) for controlling the position of the valve closing part (4) relative to the seat (3). A gas flow rate measuring transducer (8) and a control unit (9) are provided for controlling the drive system (5) by means of a control signal. A velocity measuring transducer (7) for measuring the velocity of the valve closing means (4) relative to the seat (3) is present to provide an output signal used to calculate the control signal (40) for the drive system (5). Excerpt(s): A prior-art valve arrangement is disclosed, e.g., in U.S. Pat. No. 5,265,594 with arrangements used especially in respirators. The arrangement generates different time-dependent respiration patterns for the patient These are characterized by the gas flow as well as the respiration pressure at the patient, by means of the gas metering. The apparatuses are connected to a central gas supply for this purpose. The metering valve has the task of supplying the patient with a defined gas flow or to admit a defined overpressure to the patient. The needed mass flow rate or gas volume flow rate is set for this, in general, by changing the cross-sectional area of the gas line carrying the flow. The cross-sectional area of the gas line through which the gas flows is specially designed as a cylinder jacket surface, which is obtained from the circular valve cross section and the linear valve opening path located at right angles thereto. To set the cross-sectional area of the gas line through which the gas flows, an electrically actuated linear drive system is preferably used, whose force adjusts the valve opening path. The movement of the closing means of these prior-art electromechanical valve arrangements is damped very weakly due to the principle involved and it therefore tends to vibrate, especially when the valve arrangement is operated within a simple control circuit for the valve opening path, the gas flow or the patient pressure. Another prior-art arrangement is also shown in the Handbuch fur das Intensivbeatmungsgert Hamillon Veolar [Manual for the Hamilton Veolar Intensive Care Respirator], 1988 edition A valve arrangement that meters a volume flow rate from a reservoir with variable pressure is described there The arrangement is based in the control circuit for the gas flow rate on a displacement sensor, which measures the valve opening path. An attempt is made at increasing the
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stability of this control circuit by differentiating the signal of the valve opening path and superimposing it to the actuating signal of the drive system. The signal disturbances are amplified and the signal is, moreover, delayed in time due to the differentiation with this type of signal generation, so that the use of a signal obtained in this manner for damping has only limited effectiveness. One essential drawback of this prior-art valve arrangement is therefore that an acceptable build-up characteristic is given only up to a minimum valve adjustment time of a few millisec. The object of the present invention is to provide an improved prior-art valve arrangement which makes it possible to markedly shorten the minimum valve adjustment time, to about half, at an equal buildup characteristic According to the invention, a valve arrangement for controlling the flow rate of a gas is provided with a valve with flow passage opening valve part, such as a crater or valve seat with a valve closing means for adjusting the gas flow rate. The arrangement includes an inflow line, a discharge line, a drive system for controlling the position of the valve closing means relative to the crater, a gas flow rate measuring transducer, and a velocity measuring transducer for measuring the velocity of the valve closing means relative to the crater providing an output signal. A control unit is provided for controlling the drive system by a control signal with the velocity measuring transducer output signal used to calculate the control signal for the drive system. If the desired mass flow rate or gas volume flow rate, i.e., the gas flow rate, is to be set quickly and accurately, the movement of the closing means of the valve arrangement must be additionally damped from the outside, because a high degree of damping improves the possibility of adjusting the valve with little overshooting and rapidly. The damping is preferably accomplished according to the present invention by negatively sending the velocity of the closing means to the drive system To achieve the necessary maximum effectiveness of damping, a velocity signal that is highly dynamic and especially has little disturbance and delay is used. The present invention correspondingly uses a means that obtains the velocity signal directly by measurement and ensures that this happens with only minimal time delays and disturbances. The valve adjustment time is markedly reduced as a result by about 50% while the design of the valve arrangement otherwise remains unchanged. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
Keeping Current In order to stay informed about patents and patent applications dealing with anesthesia, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “anesthesia” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on anesthesia. You can also use this procedure to view pending patent applications concerning anesthesia. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.
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CHAPTER 7. BOOKS ON ANESTHESIA Overview This chapter provides bibliographic book references relating to anesthesia. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on anesthesia include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.
Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “anesthesia” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on anesthesia: ·
Laparoscopy in Children Source: Heidelberg, Germany: Springer-Verlag. 2003. 147 p. Contact: Available from Springer-Verlag. Tiergartenstr. 17, D-69121 Heidelberg, Germany. (49)6221-487-0. Website: www.springer.de. E-mail:
[email protected]. PRICE: $69.95 plus shipping and handling. ISBN: 3540429751. Summary: Most surgeons are familiar with the techniques of laparoscopic surgery, however, in children there are variations in size and technical approach. This book describes the differences and characteristic aspects of laparoscopy in small children. The book is an atlas of numerous drawings, accompanied by textual descriptions. Technical guidelines are given on how to perform laparoscopy safely, even in small children. Topics include patient selection, anesthesia, insufflation, trocar insertion, instruments, ligating, needle insertion, suturing, adhesiolysis, appendectomy, cholecystectomy (gallbladder removal), cryptorchidism, fundoplication, inguinal hernia, intussusception,
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liver biopsy, Meckel's diverticulum, ovary, pyloromyotomy, sigmoid resection, splenectomy, varicocele, thoracoscopy, and postoperative care. The aim of the book is to provide surgeons with the knowledge to extend their expertise in adult laparoscopy to children. A subject index concludes the textbook. ·
Dialysis Access: Current Practice Source: London, England: Imperial College Press. 2001. 400 p. Contact: Available from World Scientific Publishing Co., Inc. 1060 Main Street, River Edge, NJ 07661. (800) 227-7562 or (201) 487-9655. Fax (888) 977-2665 or (201) 487-9656. Email:
[email protected]. Website: www.wspc.com. PRICE: $75.00 plus shipping and handling. ISBN: 1860941699. Summary: The incidence of treated end stage renal disease (ESRD) continues to rise, particularly in the western world. Although renal (kidney) transplantation is the treatment of choice for ESRD, the decline in the number of cadaveric organs, coupled with the rising demand for transplantation, means that an increasing number of patients will have to depend on dialysis. Vascular (blood system) and peritoneal (abdominal cavity) access remains the primary issue of concern for dialysis. This book offers a description of the state of the art in providing and preserving a durable and reliable access for dialysis. The contributing authors are drawn from a wide background, with expertise in various aspects of dialysis access, including its history, the technique of placement, anesthesia, radiology, nursing care, and training of vascular access surgeons. Sixteen chapters cover the history of dialysis access; modality selection and patient outcome; continuing quality improvement; the access clinic; recirculation and dialysis access; the value of ultrasonic imaging in defining the anatomy for vascular access; anesthetic management; arteriovenous fistulas; use of autogenous (from the patient) vein or synthetic grafts; complications of vascular access; revision access surgery; central venous catheters; access for pediatric patients (children); radiology of access; peritoneal dialysis access; and the nursing care for patients with dialysis access. Each chapter concludes with a lengthy list of references, and a subject index concludes the volume. The book is intended for use by transplant surgeons, general surgeons with an interest in vascular access, vascular surgeons, nephrologists, trainees, and nurses.
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Oral-Facial Emergencies: Diagnosis and Management Source: Portland, OR: JBK Publishing, Inc. 1994. 412 p. Contact: Available from Special Care Dentistry. 211 East Chicago Avenue, Chicago, IL 60611. (312) 440-2660. Fax (312) 440-2824. PRICE: $27.00 (member) or $30.00 (nonmember), plus shipping and handling; institutional prices and bulk orders available. ISBN: 0945892055. Summary: This book addresses a variety of orofacial injuries that are likely to be encountered in an acute care setting. Eleven chapters cover odontogenic and periodontal sources of oral pain, orofacial infections, dental disease and systemic infections, oral bleeding, acute mucogingival inflammatory conditions, lacerations, dentoalveolar trauma, facial fractures, temporomandibular disorders, extraoral sources of facial pain, and psychological and behavioral evaluations in the acute care setting. Each chapter defines the many types of problems that comprise the topic and then specifically discusses the management and treatment of each. The information presented is intended to be concise, with emphasis on tables and illustrations to promote the book's use as a quick clinical reference for acute care providers. Four appendices cover intraoral and extraoral injection techniques to achieve local anesthesia, a summary of intraoral and
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extraoral dental injections, pharmacological sedation for pediatric patients, and tetanus immunization schedule and prophylaxis recommendations. The handbook concludes with a subject index. ·
Guide to Laparoscopic Surgery Source: Malden, MA: Blackwell Science, Inc. 1998. 169 p. Contact: Available from Blackwell Science, Inc. 350 Main Street, Commerce Place, Malden, MA 02148. (800) 215-1000 or (617) 388-8250. Fax (617) 388-8270. E-mail:
[email protected]. Website: www.blackwell-science.com. PRICE: $54.95. ISBN: 086542649X. Summary: This book reviews the important aspects of laparoscopy that every surgeon needs to know. The authors address the needs of trainees in all surgical disciplines, as well as the concerns of qualified surgeons, urologists, and gynecologists. The emphasis is on procedures and practical approaches; four sections are included. In the introduction, the authors review the advantages and disadvantages of laparoscopy, risk factors, combined laparoscopy and open surgery, physiological changes during laparoscopy, anesthesia during the procedures, and postoperative management. The second section on equipment, instruments, basic techniques, problems and solutions includes: imaging and viewing, sterilization and maintenance of optics and the camera, creation of the pneumoperitoneum access, gasless laparoscopy, Veress needle procedures, primary cannula insertion, open cannulation (Hasson's technique), secondary cannula, extraperitoneal laparoscopy, instruments for dissection, diathermy and electrocautery, hemostasis, laser, ultrasound, high velocity water jet, ligation and suturing, and specimen extraction. The section on setting up in the operating theater covers hand instruments, equipment, patient position and preparation, and setting up for the procedure. The final section on laparoscopic procedures themselves, covers diagnostic laparoscopy, laparoscopic ultrasonography, adhesiolysis, cholecystectomy (gallbladder removal), management of common bile duct stones, appendectomy, laparoscopic Nissen's fundoplication, gastroenterostomy, truncal vagotomy, laparoscopy for perforated duodenal ulcer, splenectomy, laparoscopy for undescended testicles, varicocele, laparoscopic simple nephrectomy (kidney removal), and inguinal hernia repair. The book is illustrated with numerous line drawings of the equipment and procedures being discussed. A subject index concludes the book.
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Oral Symptoms and Signs Source: in Scully, C. Handbook of Oral Disease: Diagnosis and Management. New York, NY: Thieme New York. 2001. p.1-38. Contact: Available from Thieme New York. 333 Seventh Avenue, New York, NY 10001. (212) 760-0888, ext 110. PRICE: $35.00 plus shipping and handling. ISBN: 1841840874. Summary: This chapter on oral symptoms and signs is from a handbook of oral disease that is intended to be used by all members of the dental team who need a ready office reference. The handbook covers the more common and important soft tissue orofacial disorders and gives clinically relevant aspects of the etiology, diagnosis, treatment, and prevention. This chapter covers normal facial sensation, anesthesia (complete loss of facial sensation), hypoaesthesia (partial loss of facial sensation), dry mouth (xerostomia), halitosis (bad breath), hyperpigmentation (discoloration of the oral mucosa), loss of elasticity of oral tissues, lumps and swellings, orofacial pain, paralysis, purpura (bleeding into the skin and mucosa), red and bluish lesions, salivary gland swelling, sialorrhea (excessive saliva or drooling), staining (tooth discoloration), taste
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disturbances, ulcers and erosions, and white lesions. For each condition, the authors note etiology (cause), diagnosis, symptoms, epidemiology, risk factors, treatment, and prevention (where possible). Much of the information is provided in table format for ease of reference. Full color photographs illustrate the more common conditions. 31 figures. 14 tables. 7 references. ·
Inguinal Hernia: Advances or Controversies? Source: New York, NY: Radcliffe Medical Press. 1994. 524 p. Contact: Available from Radcliffe Medical Press. Scoville, Patterson Inc., 141 Fifth Avenue, Suite 8N, New York, NY 10010. PRICE: $99.50 (as of 1995). ISBN: 1857750462. Summary: This comprehensive medical text explains the various types of hernia repairs (classical, contemporary, and laparoscopic) and analyzes in detail the newer laparoscopic approaches. Complications, recurrences, technical, and cost considerations are covered in the text, which includes divergent professional viewpoints. Eighty-six chapters, authored by specialists in the field, cover history, embryology and anatomy; the biology of hernia formation; diagnosis, classification, and anesthesia; biomaterials in hernia repairs; the economics of hernia repair; complications and controversies in open hernia repair; techniques of laparoscopic hernia repairs; and complications, recurrences, and technical considerations in laparoscopic hernia repair. The last 36 chapters present selected studies on hernia repair. Each chapter includes numerous black and white photographs, figures, and references. A subject index concludes the volume.
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Comprehensive Management of Head and Neck Tumors. 2nd ed Source: Philadelphia, PA: W.B. Saunders Company. 1999. 2 v., 2045 p. Contact: Available from W.B. Saunders Company. Book Order Fulfillment Department, 6277 Sea Harbor Drive, Orlando, FL 32821-9854. (800) 545-2522. Fax (800) 874-6418. Website: www.wbsaunders.com. PRICE: $295.00. ISBN: 0721655823. Summary: This comprehensive, two volume textbook covers the study and treatment of patients with head and neck tumors. Each of the 84 chapters addresses individual and collective issues that arise in managing patients with difficult treatment problems and provides insight into the many valid management approaches available. Chapters are organized into thirteen sections: general considerations, including pain control, nursing care, anesthesia, radiation therapy, chemotherapy, morbidity and mortality, and prevention; tumors of the ear; tumors of the nasal cavity and paranasal sinuses; tumors of the oral cavity, including the lip and tongue; tumors of the pharynx; tumors of the larynx; tumors of the salivary glands; tumors of the skin; tumors of the neck; dental and jaw tumors, including odontogenic cysts; tumors of the thyroid and parathyroid glands; tumors of the trachea; and special topics, including tumors of the head and neck in children, and the diagnosis and treatment of lymphomas. Many chapters are illustrated with black and white photographs; all include extensive references. A subject index concludes the two volume set.
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Complete Guide to Dental Health: How to Avoid Being Overcharged and Overtreated Source: Yonkers, NY: Consumer Reports Books. 1991. 315 p. Contact: Available from Consumer Reports Books. 101 Truman Avenue, Yonkers, NY 10703. (914) 378-2000. PRICE: $22.95 plus shipping and handling. ISBN: 0890434360.
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Summary: This cost-conscious guide provides information that consumers can use to assess their dental needs and those of their children. The author, a practicing dentist for over 20 years, discusses guidelines and costs for common dental procedures. Topics covered include proper home care and prevention of dental problems; gold, silver amalgam, and porcelain fillings; frequency of X rays; diagnosing gum disease; local and general anesthesia; special precautions for children; and bleaching and veneering. The author outlines the costs, benefits, and risks of alternative treatments, suggesting ways to save time and money on such procedures as orthodontics, extractions, and bridges. Each chapter includes questions for readers to ask their own dentists. Charts provide information on a range of fees for common procedures and explain how unnecessary add-ons increase the bill. An appendix provides Consumer Reports recommendations on toothbrushes, dental flosses, and other products. A glossary and subject index conclude the volume. (AA-M). ·
Therapy for Diabetes Mellitus and Related Disorders. 3rd ed Source: Alexandria, VA: American Diabetes Association. 1998. 487 p. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. Website: www.diabetes.org. PRICE: $39.95 plus shipping and handling. ISBN: 0945448945. Summary: This handbook focuses on the treatment of problems that are of importance in the management of people with diabetes mellitus. The book attempts to help health professionals apply major advances in health care to their patients. Topics include the diagnosis and classification of diabetes mellitus, genetic counseling for type 1 diabetes, gestational diabetes mellitus, the management of pregnant women who have diabetes, antepartum and intrapartum obstetric care, neonatal problems and their management, type 1 diabetes and diabetic ketoacidosis in children, psychosocial adjustment in children who have type 1 diabetes, psychosocial aspects in adults, diabetic ketoacidosis and hyperosmolar hyperglycemic nonketotic syndrome in adults, and lactic acidosis. Other topics include the role of diabetes education in patient management; self monitoring of blood glucose; the rationale for management of hyperglycemia; medical nutrition therapy; pharmacological treatment of obesity; exercise; oral hypoglycemic agents such as sulfonylureas, repaglinide, metformin, alpha glucosidase inhibitors, and thiazolidinediones; insulin treatment; insulin pump therapy; combination therapy for hyperglycemia; and diabetes complications. In addition, the book discusses surgery and anesthesia in people with diabetes, geriatric patient care, hypoglycemia in patients who have type 1 diabetes, insulin allergy and insulin resistance, drugs and hormones that increase blood glucose levels, diabetic dyslipidemia, antihypertensive therapy, cutaneous disorders associated with diabetes mellitus, infections, visual loss, ocular complications, drug induced renal dysfunction, diabetic nephropathy, chronic kidney disease, painful or insensitive lower extremity, mononeuropathy and amyoradiculopathy, gastrointestinal disturbances, and bladder dysfunction. Final topics include erectile dysfunction, female sexual disorders, postural hypotension, sudomotor dysfunction and dark vision, cardiac denervation syndrome, noninvasive cardiac testing, angina and congestive heart failure, myocardial infarction, peripheral vascular disease, and foot ulcers and infections. The book includes an index. Numerous figures. Numerous tables. Numerous references.
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Hip Replacement: A Self-Care Handbook Source: South Deerfield, MA: Channing L. Bete Co., Inc. 1999. 32 p.
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Contact: Available from Channing L. Bete Co., Inc. 200 State Road, South Deerfield, MA 01373-0200. (800) 628-7733. Fax (800) 499-6464. E-mail:
[email protected]. PRICE: Contact company for pricing information; available in bulk. Order Number 96647A-12-98. Summary: This illustrated handbook provides people who are preparing for or recovering from hip replacement with information on this type of surgery. The hip, a ball and socket joint that joins the thigh bone to the pelvic bone, may need to be replaced as a result of osteoarthritis, rheumatoid arthritis, or fractures. Hip replacement surgery removes the damaged joint and replaces it with an artificial joint called a prosthesis, which can be cemented or uncemented. Preparation for hip replacement surgery may involve getting a physical examination, having medical tests, following an exercise plan, losing weight, donating one's own blood, having a dental checkup, telling one's physician about skin problems, and following special instructions. Prior to surgery, safety improvements should be made to stairways, hallways, and pathways and in the bedroom, living room, kitchen, and bathroom. Also, the patient will meet with a specialist to discuss types of anesthesia. Further, arrangements for help following surgery should be made before it is done. Following surgery, the patient will spend some time in a recovery area and a few days in the hospital. During the hospital stay, the patient will do deep breathing and coughing exercises, receive pain medications, start eating, change positions often, do special exercises, and begin standing and walking. Rehabilitation is a team effort and usually begins the day after surgery. The handbook presents exercises that need to be performed after surgery; lists precautions that need to be followed for 6 to 12 weeks; offers tips on walking, sitting, getting up from a chair, using stairs, getting in and out of a car, bathing, using the toilet, dressing, and sleeping; and provides guidelines for avoiding infections. ·
Glenn's Urologic Surgery. 5th ed Source: Philadelphia, PA: Lippincott Williams and Wilkins. 1998. 1149 p. Contact: Available from Lippincott Williams and Wilkins. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-3030 or (301) 714-2300. Fax (301) 824-7390. Website: lww.com. PRICE: $199.00 plus shipping and handling. ISBN: 0397587376. Summary: This massive textbook on urologic surgery offers 137 chapters on every aspect of anesthesia, antibiosis, medical techniques, diagnostics, and the fundamental considerations and technical aspects of urologic surgery. The chapters are organized into 14 sections: adrenal, kidney, ureter and pelvis, bladder, prostate, urethra, vas deferens and seminal vesicle, testes, penis and scrotum, urinary diversion, pediatric urology, endoscopy, laparoscopy, and frontiers (future developments). Some specific topics covered are Cushing's disease, primary aldosteronism, nephrectomy (removal of the kidney), renovascular disease, renal trauma, kidney transplantation, ureteral reconstruction, cystectomy (bladder removal), bladder augmentation, fistula, interstitial cystitis, prostatectomy (removal of the prostate), prostatic ultrasound and needle biopsy, bladder neck suspension techniques, pelvic floor relaxation, cystocele, female urethral diverticula, vaginal hysterectomy, urethral stricture, vasectomy, simple orchiectomy (removal of the testes), scrotal trauma and reconstruction, Peyronie's disease, priapism, penile prosthesis, penile trauma, urinary diversion techniques, bladder replacement, congenital anomalies, patient selection, circumcision, cystoscopy, kidney stone treatment, urinary stone treatment, stents, and thermotherapy. Each chapter includes diagrams, tables, and a list of references. A detailed subject index concludes the textbook.
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Laparoscopy in Urology Source: Oxford, England: Blackwell Science, Inc. 1994. 162 p. Contact: Available from Blackwell Science, Inc. 350 Main Street, Commerce Place, Malden, MA 02148. (800) 215-1000 or (617) 388-8250. Fax (617) 388-8270. E-mail:
[email protected]. PRICE: $99.95. ISBN: 0632036648. Summary: This medical textbook provides readers with an update of the use of laparoscopy in urology. Twenty chapters cover topics including the history of laparoscopy, instrumentation, general laparoscopic techniques, anesthesia for laparoscopy, complications of laparoscopy, the metabolic response to operative laparoscopy, laparoscopy for the nonpalpable testicle, and the laparoscopic approach to the following procedures: varicocelectomy, herniorrhaphy, appendicectomy, pelvic lymphadenectomy, para-aortic lymphadenectomy, retroperitoneal surgery, transperitoneal nephrectomy, colposuspension, bladder-dome transection, ileal conduit diversion, partial cystectomy, and lymphocele drainage. The book is illustrated throughout with medical drawings and full color photographs of laparoscopic procedures. A subject index concludes the text.
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Evaluating and Managing Interstitial Cystitis Source: Englewood Cliffs, NJ: University Research Associates Rx, Inc. 1997. 47 p. Contact: Available from University Research Associates Rx, Inc. 560 Sylvan Avenue, Englewood Cliffs, NJ 07632. (201) 816-0110. PRICE: Contact distributor directly for current prices for professionals. Summary: This monograph reviews current concepts of the pathogenesis of interstitial cystitis (IC) as well as new methods to successfully diagnose and manage this disease. IC is characterized by severe urinary frequency, urgency, and lower abdominal or perineal pain in the absence of any bacterial infection or other definable pathology. IC also has mild and moderate states. IC typically has a gradual onset with an insidious progression. The author notes that it may be that IC encompasses a number of different etiologies, all involving a bladder insult that ultimately results in urinary frequency and urgency. An important purpose for using this broader definition of IC is that many patients with milder forms could readily benefit from therapy if the diagnosis is considered. One of the main diagnostic problems with IC is a lack of pathologic findings that are readily identified and quantified. Diagnostic procedures discussed include the National Institute of Diabetes and Digestive and Kidney Diseases criteria for IC, the use of a voiding log, the physical examination, urodynamics, the potassium test, cystoscopic inspection and hydrodistension, and biopsy. Treatment options covered include antidepressant therapy, hydrodistension of the bladder under anesthesia, dimethyl sulfoxide (DMSO) instillation, antihistamines, steroids, intravesical silver nitrate, sodium oxychlorosene, heparinoid therapy, pentosan polysulfate (Elmiron), and surgery. The author stresses that, when discussing therapy with the patient, it is important to emphasize that if symptoms have been present for more than a year, no particular therapy is likely to be curative. While the patient may have a significant remission of symptoms, in all probability relapse will occur. The author concludes that perhaps 75 to 85 percent of patients with moderate to severe IC can experience significant, indefinite remissions with conservative therapy and avoid the need for extirpative surgery. The monograph concludes with the package insert information for Elmiron. 3 figures. 6 tables. 105 references. (AA-M).
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Clinician's Manual of Oral and Maxillofacial Surgery Source: Chicago, IL: Quintessence Publishing Co, Inc. 2001. 476 p. Contact: Available from Quintessence Publishing Co, Inc. 551 Kimberly Drive, Carol Stream, IL 60188-9981. (800) 621-0387 or (630) 682-3223. Fax (630) 682-3288. E-mail:
[email protected]. Website: www.quintpub.com. PRICE: $58.00 plus shipping and handling. ISBN: 0867153962. Summary: This spiral-bound handbook offers quick reference information to the oral and maxillofacial surgeon. The outline and chart-based format is designed to offer quick access to information that may be needed in situations that do not allow time for a leisurely perusal of textbooks and journals. The handbook includes 24 chapters: history and physical examination; hospital protocol; laboratory tests; diagnostic imaging; ECG (electrocardiograph) interpretation; fluids and electrolytes; surgical nutrition; blood and blood products; commonly used medications; managing medical emergencies; management of the medically compromised patient; postoperative problems; basic patient management problems; sutures and suturing techniques; outpatient sedation, general anesthesia, and management of anesthetic emergencies; complications of dentoalveolar surgery; treatment planning for implant surgery; the differential diagnosis of cysts and tumors; infections; trauma; the diagnosis and treatment of salivary gland disease; temporomandibular joint disorders (TMD); recognition and management of dentofacial and craniofacial abnormalities; and the evaluation of facial esthetics. Appendices include: cardiac conditions considered for prophylaxis; antibiotic prophylactic regimens for certain dental procedures; summary recommendations for antibiotic prophylaxis; dental procedures considered for antibiotic prophylaxis in susceptible patients; FDA (Food and Drug Administration) pregnancy categories; and DEA (Drug Enforcement Agency) schedule of controlled substances. A subject index concludes the handbook.
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Atlas of Minor Oral Surgery Source: Philadelphia, PA: W.B. Saunders Company. 2001. 320 p. Contact: Available from Harcourt Health Sciences. 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 325-4177. Fax (800) 874-6418. Website: www.harcourthealth.com. PRICE: $75.00 plus shipping and handling. ISBN: 0721679773. Summary: This text provides background information and guidelines for the oral surgical procedures that are an integral component of modern dentistry. The text covers surgical procedures commonly performed in an outpatient office setting with the use of local anesthesia. The text is divided into nine sections: basic principles, exodontia (the extraction of teeth), advanced procedures, infections, pathology, prosthetic surgery, implants, trauma, and salivary gland disease. Specific topics include medical evaluation of the patient, local anesthesia, oral and parenteral sedation, perioperative hemorrhage, impacted third molar teeth, endodontic (root canal) surgery, treatment of sinus infections, antibiotics, cysts, biopsy techniques, bone grafting for implants, the sinus lift procedure, evaluation and treatment planning for implants, evaluating dentoalveolar injuries, repair of lacerations, and management of commonly seen salivary gland diseases. The text is copiously illustrated with black and white line drawings. The text includes one appendix that offers four tables useful laboratory information and common drug interactions information; a subject index concludes the text.
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Vascular Access: Principles and Practice. 4th ed Source: St. Louis, MO: Mosby, Inc. 2002. 289 p. Contact: Available from Elsevier, Health Sciences Division, 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 325-4177. Website: www.us.elsevierhealth.com. PRICE: $99.00. ISBN: 0323011888. Summary: This text reviews the principles and practice of vascular access, including that used for hemodialysis and for critical care, chemotherapy, and nutrition. The text features 25 chapters that cover: the development of vascular access (VA) surgery, planning and patient assessment, anesthesia, surgical anatomy for VA procedures, physiology for the arteriovenous fistula, biologic properties of VA devices, biologic response to prosthetic dialysis grafts, epidemiology of chronic renal (kidney) failure (CRF) and guidelines for the initiation of hemodialysis, autologous arteriovenous fistulas, basilic vein transposition, vascular interposition (bridge fistulas) for hemodialysis, central venous cannulation for hemodialysis access, vascular access in the neonatal and pediatric patient, revision and outcome of VA procedures for hemodialysis, radiologic intervention and instrumentation for the salvage of hemodialysis access grafts, axillosubclavian vein thrombosis (clotting), thrombosis, venous hypertension, arterial steal, and neuropathy (nerve disease or damage), complications of VA procedures, care and use of VA devices, cardiovascular consequences of rapid hemodialysis, peritoneal dialysis, socioeconomic implications of VA surgery, placement of indwelling VA systems, VA for trauma and emergency surgery, and complications of percutaneous VA procedures and their management. Each chapter includes black and white illustrations and a list of references; a subject index concludes the volume.
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Fundamentals of Pediatric Dentistry. 3rd ed Source: Carol Stream, IL: Quintessence Publishing Company, Inc. 1995. 400 p. Contact: Available from Quintessence Publishing Company, Inc. 551 North Kimberly Drive, Carol Stream, IL 60188-1881. (800) 621-0387 or (630) 682-3223. Fax (630) 682-3288. E-mail:
[email protected]. Website: www.quintpub.com. PRICE: $58.00 plus shipping and handling. ISBN: 0867152621. Summary: This text was written to present step by step guidelines for all phases of pediatric dentistry, with the goal of assisting students and practicing dentists in the provision of excellent oral health care for children and adolescent patients. The text features 24 chapters in four sections. The first section, diagnosis, covers behavioral and physical assessment, occlusal assessment, radiographic assessment, soft tissue assessment, and hard tissue assessment. The second section addresses prevention issues, including oral hygiene education, fluoride therapy, and sealants and preventive resin restorations. The third section on child management includes behavior management, conscious sedation, hospital dentistry, local anesthesia, and nitrous oxide oxygen inhalation. The final section outlines clinical procedures, including the morphology of the primary teeth, restorative procedures for primary molars, stainless steel crown procedures for primary molars, restorative procedures for primary incisors, pulp treatment, trauma to anterior teeth, extraction techniques, space maintenance, prosthodontics, guidance of the developing occlusion, and treatment planning. Each chapter includes a list of objectives, extensive references, and review questions. The text concludes with the answers to the review questions and a subject index. The text is illustrated with black and white photographs and illustrations.
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Diabetes and the Adolescent Source: Australia: Miranova Publishers. 384 p. 1998. Contact: Available from Miranova Publishers. P.O. Box 1041, Camberwell, Victoria 3124, Australia. Fax 61398828414. E-mail:
[email protected]. PRICE: $94.95 plus shipping and handling. ISBN: 0958714215. Summary: This textbook focuses on the complicated issue of diabetes and the adolescent. The text includes twenty chapters in five sections: the health behaviors of youth with diabetes, the impact of diabetes on adolescence, early vascular complications of diabetes, strategies for diabetes care in adolescence, and diabetes camping. Topics including a family systems perspective on coping, psychosocial challenges and issues, factors affecting adherence, neuropsychological function, eating disorders, sexual function and pregnancy, patient education, peer support, and the transition to adult health care. The final sixty pages of the book consists of a series of twelve appendices, each providing overviews of practical approaches to the management of specific problems in the adolescent with diabetes: insulin therapy, diabetic ketoacidosis, investigation of recurrent ketoacidosis or persistent poor control, prevention of ketosis during illness, management of surgery and anesthesia, dietary management, diabetes complications screening, the effect of alcohol, drugs, and smoking on diabetes, school and youth with diabetes, obtaining a driving license, safety standards at camps for adolescents, and useful Internet web sites on diabetes. Each chapter concludes with a list of references and a subject index concludes the volume.
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Surgical Laparoscopy Source: St. Louis, MO: Quality Medical Publishing, Inc. 1991. 359 p. Contact: Available from Quality Medical Publishing, Inc. 2086 Craigshire Drive, St. Louis, MO 63146. (314) 878-7808. PRICE: $110, shipping and handling free with prepaid orders. ISBN: 094221921X. Summary: This textbook is a guide to the burgeoning field of surgical laparoscopy. It is intended to introduce surgeons to the principles of laparoscopic surgery and to familiarize those already performing laparoscopic cholecystectomy with the newer procedures and instruments that have been developed. Seventeen chapters cover topics including the history of laparoscopy, laparoscopic equipment and instrumentation, practical anesthesia, open laparoscopy, and clinical applications, including those for preoperative diagnosis and staging for gastrointestinal cancers, for gallstone disease, cholecystectomy, cholangiography and management of choledocholithiasis, appendectomy, pelvic lymphadenectomy, truncal and selective vagotomy, inguinal hernia repair, and intestinal surgery. Two final chapters cover the complications of laparoscopic general surgery and training and credentialing for laparoscopic surgery. One appendix provides a partial listing of manufacturers of surgical laparoscopy equipment. A detailed subject index concludes the volume.
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Dentistry for the Child and Adolescent. 7th ed Source: St. Louis, MO: Mosby, Inc. 2000. 848 p. Contact: Available from Harcourt Health Sciences. 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 325-4177. Fax (800) 874-6418. Website: www.harcourthealth.com. PRICE: $72.00 plus shipping and handling. ISBN: 0815190174.
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Summary: This textbook on dentistry for the child and adolescent is designed to help undergraduate dental students and postdoctoral pediatric dentistry students provide comprehensive oral health care for infants, children, teenagers, and individuals with various disabilities. The text also offers the experienced dentist reference information on new developments and techniques. The text includes 30 chapters, each written by experts in the field. Topics cover examination of the mouth; identification of child abuse and neglect; the psychological management of children's behaviors; development and morphology of the primary teeth; radiographic (x-ray) techniques; clinical genetics for the dental practitioner; acquired and developmental disturbances of the teeth and associated oral structures; tumors of the oral soft tissues and cysts and tumors of the bone; local, systemic, and congenital factors that influence eruption of the teeth; dental caries in the child and adolescent; mechanical and chemotherapeutic home oral hygiene; nutritional considerations for the pediatric dental patient; local anesthesia for the child and adolescent; pharmacologic management of patient behavior; hospital dental services for children and the use of general anesthesia; dental materials; pit and fissure sealants; restorative dentistry; treatment of deep caries, vital pulp exposure, and pulpless teeth; gingivitis and periodontal disease; management of trauma to the teeth and supporting tissues; prosthodontic treatment of the adolescent patient; dental problems of children with disabilities; management of medically compromised patients, including those with blood diseases, cancer, liver disease, and AIDS; growth of the face and dental arches; cephalometrics and facial esthetics as the key to complete treatment planning; managing the developing occlusion; the multidisciplinary team approach to cleft lip and palate management; practice management; and community oral health. Each chapter includes black and white photographs and extensive references; a subject index concludes the text. ·
Pediatric Urology Practice Source: Philadelphia, PA: Lippincott Williams and Wilkins. 1999. 736 p. Contact: Available from Lippincott Williams and Wilkins. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-3030 or (301) 714-2300. Fax (301) 824-7390. Website: lww.com. PRICE: $150.00 plus shipping and handling. ISBN: 0397513682. Summary: This textbook on pediatric urology practice defines pediatric urology, provides an understanding of the physiology of the maturing urinary tract, considers the psychological impact that reconstruction has on the child and his or her family, and encourages a compassion for and a willingness to undertake and manage the many nonsurgical urologic conditions that are common to pediatric urologic practice (e.g., dysfunctional voiding and urinary infection). The text begins with a thorough chapter on the pediatric physical examination. The remaining 39 chapters cover pediatric anesthesia, the surgical physiology of the neonate, the workup of hematuria and tubular disorders, the management of renal failure in children, prenatal diagnosis and therapy, imaging the urinary tract in children, the molecular basis of pediatric urologic disease, clinical genetics, ureteropelvic junction obstruction, megaureter, posterior urethral valves and other obstructions of the urethra, the effect of obstruction on the detrusor, nonvirilizing adrenal disease, disorders of renal position and parenchymal development, ureteral ectopy, ureteroceles, anatomic abnormalities of the bladder, bladder and cloacal exstrophy, pediatric neurogenic bladder, the surgical and nonsurgical management of the neurogenic bladder, physiology of micturition (urination) and dysfunctional voiding, urinary infection in children, vesicoureteral reflex, hypospadias, cryptorchidism (undescended testicle), adolescent varicocele, anomalies of the penis and scrotum, intersex states, menstrual problems in the
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adolescent, urolithiasis (urinary stones) in children, pediatric oncology, hydrocele and hernia, imperforate anus and caudal regression syndrome, urogenital sinus and cloaca, the role of urinary diversion in childhood, and indications for laparoscopic procedures in pediatric urology. Each chapter is written by specialists in the field and includes references, black and white photographs, tables, and figures. A subject index concludes the textbook. ·
Oxford Textbook of Clinical Hepatology: Volume II Source: New York, NY: Oxford University Press. 1991. 825 p. Contact: Available from Oxford University Press. 200 Madison Avenue, New York, NY 10016. PRICE: $275 for 2-volume set. ISBN: 0192621564 (Volume 2); 0192619683 (2volume set). Summary: This textbook provides a comprehensive account of clinical hepatology. Volume II presents 65 chapters in 18 sections: immune disorders of the liver; alcoholic liver disease; non-alcoholic fatty liver; drug-induced liver; toxic liver injury; fulminant and subfulminant liver failure; inherited metabolic disorders; vascular abnormalities of hepatic and portal veins and hepatic arteries; tumors of the liver and bile duct; biliary tract diseases; the liver in diseases of other systems; the effect of liver disease on other systems; pediatric liver; liver in the elderly; hepatitis and HIV infection in homosexual men and injecting drug users; liver disease and pregnancy; the management of liver disease; and surgery, anesthesia, and the liver. The subject index for both volumes in appended. 6 appendices.
Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in PrintÒ). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “anesthesia” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “anesthesia” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “anesthesia” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): ·
A Glossary of Anesthesia and Related Terminology by Sanford L. Klein (1993); ISBN: 0387978313; http://www.amazon.com/exec/obidos/ASIN/0387978313/icongroupinterna
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A Practical Anesthesia Information Guide by Raymond Jerome (1995); ISBN: 0929240219; http://www.amazon.com/exec/obidos/ASIN/0929240219/icongroupinterna
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A Practice of Anesthesia for Infants and Children by Charles J. Cote (Editor), et al (2001); ISBN: 0721672868; http://www.amazon.com/exec/obidos/ASIN/0721672868/icongroupinterna
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Advances in Anesthesia by Carol Lake (1995); ISBN: 0815182775; http://www.amazon.com/exec/obidos/ASIN/0815182775/icongroupinterna
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Advances in Anesthesia 1994 by Carol L., M.D. Lake, Paul G., M.D. Barash (1994); ISBN: 0815182767; http://www.amazon.com/exec/obidos/ASIN/0815182767/icongroupinterna
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Advances in Anesthesia, 1993 by Robert K. Stoeltin (Editor) (1993); ISBN: 0815182759; http://www.amazon.com/exec/obidos/ASIN/0815182759/icongroupinterna
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Advances in Pharmacology: Anesthesia and Cardiovascular Disease (Advances in Pharmacology, 31) by Zeljko J. Bosnjak, et al (1994); ISBN: 0120329328; http://www.amazon.com/exec/obidos/ASIN/0120329328/icongroupinterna
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Anesthesia & Perioperative Complications by Jonathan Benumof (Editor), et al (1999); ISBN: 0815126190; http://www.amazon.com/exec/obidos/ASIN/0815126190/icongroupinterna
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Anesthesia and Perioperative Care of the Combat Casualty (S/N 008-023-00117-1) by Russ Zajtchuk (Editor), Christopher M., Md. Grande (Editor) (2000); ISBN: 0160591376; http://www.amazon.com/exec/obidos/ASIN/0160591376/icongroupinterna
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Anesthesia and the Lung (Developments in Critical Care Medicine and Anesthesiology) by R.J. Sperry (Editor), Theodore H. Stanley (1989); ISBN: 0792300750; http://www.amazon.com/exec/obidos/ASIN/0792300750/icongroupinterna
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Anesthesia and Transplantation by Michael D. Sharpe (Editor), Adrian Gelb (Editor) (1999); ISBN: 0750696648; http://www.amazon.com/exec/obidos/ASIN/0750696648/icongroupinterna
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Anesthesia and Transplantation Surgery: Contemporary Anesthesia Practice by Brunell R., Jr Brown, Jack G. Copeland (Editor) (1987); ISBN: 0803612796; http://www.amazon.com/exec/obidos/ASIN/0803612796/icongroupinterna
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Anesthesia and Uncommon Diseases (1990); ISBN: 0721653022; http://www.amazon.com/exec/obidos/ASIN/0721653022/icongroupinterna
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Anesthesia Equipment: Principles & Applications by Jan Ehrenwerth, et al (2004); ISBN: 0815125380; http://www.amazon.com/exec/obidos/ASIN/0815125380/icongroupinterna
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Anesthesia for Aortic Surgery by Joseph I. Simpson (Editor) (1997); ISBN: 0750695781; http://www.amazon.com/exec/obidos/ASIN/0750695781/icongroupinterna
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Anesthesia for Obstetrics (1993); ISBN: 0683077503; http://www.amazon.com/exec/obidos/ASIN/0683077503/icongroupinterna
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Anesthesia in Emergency Medicine by Glenn Vanstrum (1989); ISBN: 0316897302; http://www.amazon.com/exec/obidos/ASIN/0316897302/icongroupinterna
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Anesthesia Pearls by James Duke (Editor) (2003); ISBN: 1560534958; http://www.amazon.com/exec/obidos/ASIN/1560534958/icongroupinterna
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Anesthesia Secrets by James Duke (Editor), A Hanley & Belfus Publication (2000); ISBN: 1560533544; http://www.amazon.com/exec/obidos/ASIN/1560533544/icongroupinterna
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Anesthesia: Biologic Foundations by T. L. Yaksh (Editor), et al (1998); ISBN: 0397587422; http://www.amazon.com/exec/obidos/ASIN/0397587422/icongroupinterna
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Anesthesiadrugs (Sota Omoigui's Anesthesia Drugs Handbook) (CD-ROM for PDA) by Skyscape (2001); ISBN: 1931302634; http://www.amazon.com/exec/obidos/ASIN/1931302634/icongroupinterna
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Atlas of Anesthesia 8 Volume Set by Miller (1998); ISBN: 0443079072; http://www.amazon.com/exec/obidos/ASIN/0443079072/icongroupinterna
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Basics of Anesthesia (1994); ISBN: 0443085714; http://www.amazon.com/exec/obidos/ASIN/0443085714/icongroupinterna
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Cardiovascular Anesthesia and Postoperative Care by Sait Tarhan (Editor) (1989); ISBN: 0815187041; http://www.amazon.com/exec/obidos/ASIN/0815187041/icongroupinterna
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Cardiovascular Anesthesia and Postoperative Care (1989); ISBN: 0815187025; http://www.amazon.com/exec/obidos/ASIN/0815187025/icongroupinterna
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Centennial of Surgical Anesthesia by John F. Fulton, Madeline E. Stanton (1999); ISBN: 1578981220; http://www.amazon.com/exec/obidos/ASIN/1578981220/icongroupinterna
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Certification Review for Perianesthesia Nursing by Kathy Carlson (Editor), et al (1996); ISBN: 0721644929; http://www.amazon.com/exec/obidos/ASIN/0721644929/icongroupinterna
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Clinical Anesthesia by MD Paul G. Barash (Editor), et al (2001); ISBN: 0781722683; http://www.amazon.com/exec/obidos/ASIN/0781722683/icongroupinterna
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Clinical Anesthesia by J. S. Gravenstein, et al (1996); ISBN: 0443045526; http://www.amazon.com/exec/obidos/ASIN/0443045526/icongroupinterna
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Clinical Anesthesia in Neurosurgery by Elizabeth A.M. Frost (Editor) (1991); ISBN: 0409901717; http://www.amazon.com/exec/obidos/ASIN/0409901717/icongroupinterna
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Clinical Anesthesia in Neurosurgery (1990); ISBN: 0409951021; http://www.amazon.com/exec/obidos/ASIN/0409951021/icongroupinterna
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Complications of Regional Anesthesia by Brendan T. Finucane (Editor), Allan Ross (Editor) (1999); ISBN: 0443075360; http://www.amazon.com/exec/obidos/ASIN/0443075360/icongroupinterna
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Core Curriculum for Post Anesthesia Nursing Practice by Kim Litwack (Editor), Aspan (1995); ISBN: 0721650511; http://www.amazon.com/exec/obidos/ASIN/0721650511/icongroupinterna
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Drugs and Anesthesia (1989); ISBN: 0683092510; http://www.amazon.com/exec/obidos/ASIN/0683092510/icongroupinterna
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Essential Anatomy for Anesthesia by Sue M. Black (1997); ISBN: 0443050546; http://www.amazon.com/exec/obidos/ASIN/0443050546/icongroupinterna
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Foundations of Anesthesia: Basic and Clinical Sciences by Hugh Hemmings M.D. Ph.D., Philip M. Hopkins (2000); ISBN: 0723427879; http://www.amazon.com/exec/obidos/ASIN/0723427879/icongroupinterna
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Going Under: Preparing Yourself for Anesthesia: Your Guide to Pain Control and Healing Techniques - Before, During and After Surgery by Monica Winefryck Furlong, Elliot T. Essman (Contributor) (1993); ISBN: 0963645161; http://www.amazon.com/exec/obidos/ASIN/0963645161/icongroupinterna
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Handbook of Clinical Anesthesia by Brian J. Pollard (2004); ISBN: 0443072590; http://www.amazon.com/exec/obidos/ASIN/0443072590/icongroupinterna
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Handbook of Clinical Anesthesia by John C. Goldstone (1996); ISBN: 044304984X; http://www.amazon.com/exec/obidos/ASIN/044304984X/icongroupinterna
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Handbook of Local Anesthesia by Stanley F. Malamed (1997); ISBN: 0815164238; http://www.amazon.com/exec/obidos/ASIN/0815164238/icongroupinterna
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Handbook of Obstetric Anesthesia by Craig M. Palmer, Michael J. Paech (2002); ISBN: 1859962327; http://www.amazon.com/exec/obidos/ASIN/1859962327/icongroupinterna
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Hazards and Complications of Anesthesia by T. H. Taylor (Editor), Edward Major (Editor) (1993); ISBN: 0443042594; http://www.amazon.com/exec/obidos/ASIN/0443042594/icongroupinterna
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I Awaken to Glory: Essays Celebrating the Sesquicentennial of the Discovery of Anesthesia by Horace Wells December 11, 1844-December 11,1994 by Richard J. Wolfe, et al (1994); ISBN: 088135161X; http://www.amazon.com/exec/obidos/ASIN/088135161X/icongroupinterna
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Introduction to Anesthesia (1991); ISBN: 0721623182; http://www.amazon.com/exec/obidos/ASIN/0721623182/icongroupinterna
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Key Topics in Anesthesia by Timothy M. Craft, et al (1995); ISBN: 0815119089; http://www.amazon.com/exec/obidos/ASIN/0815119089/icongroupinterna
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Laboratory Animal Anesthesia: A Practical Introduction for Research Workers and Technicians by P.A. Flecknell (Editor) (1996); ISBN: 0122603613; http://www.amazon.com/exec/obidos/ASIN/0122603613/icongroupinterna
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Large Animal Anesthesia: Principles and Techniques by T. W. Riebold, et al (1995); ISBN: 0813807743; http://www.amazon.com/exec/obidos/ASIN/0813807743/icongroupinterna
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Laryngeal Mask Anesthesia: Principles and Practice by Joe R. Brimacombe (2003); ISBN: 0702027006; http://www.amazon.com/exec/obidos/ASIN/0702027006/icongroupinterna
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Lippincott's Interactive Cardiac Anesthesia Library by Scott T. Reeves (2003); ISBN: 0781751055; http://www.amazon.com/exec/obidos/ASIN/0781751055/icongroupinterna
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Local Anesthesia in Dentistry by M. Lipp, et al (1993); ISBN: 086715263X; http://www.amazon.com/exec/obidos/ASIN/086715263X/icongroupinterna
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Local Anesthesia in Dentistry/Book and Video by Markus D.W. Lipp, et al (1995); ISBN: 0867152737; http://www.amazon.com/exec/obidos/ASIN/0867152737/icongroupinterna
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Manipulation Under Anesthesia by Robert C. Gordon (2004); ISBN: 0849317002; http://www.amazon.com/exec/obidos/ASIN/0849317002/icongroupinterna
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Manual of Anesthesia by John C. Snow (1995); ISBN: 0316802220; http://www.amazon.com/exec/obidos/ASIN/0316802220/icongroupinterna
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Manual of Drugs in Anesthesia and Critical Care by David W. Herbert (1992); ISBN: 0721645836; http://www.amazon.com/exec/obidos/ASIN/0721645836/icongroupinterna
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Manual of Post Anesthesia Care by Wayne K. Jacobsen (Editor) (1997); ISBN: 0721643728; http://www.amazon.com/exec/obidos/ASIN/0721643728/icongroupinterna
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Mathematics and Statistics in Anesthesia (Oxford Medical Publications) by Steve Cruickshank, Steven Cruickshank (1998); ISBN: 0192623125; http://www.amazon.com/exec/obidos/ASIN/0192623125/icongroupinterna
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McQ Selftest Companion to Lee's Synopsis of Anesthesia by G. B. Rushman, N. H. Davies (1995); ISBN: 075062325X; http://www.amazon.com/exec/obidos/ASIN/075062325X/icongroupinterna
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Monitoring in Anesthesia and Critical Care Medicine (1990); ISBN: 0443082774; http://www.amazon.com/exec/obidos/ASIN/0443082774/icongroupinterna
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Muscle Relaxants in Anesthesia by Nigel J. N. Harper (Editor), et al (1995); ISBN: 0340551550; http://www.amazon.com/exec/obidos/ASIN/0340551550/icongroupinterna
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Near Misses in Neuroanesthesia by Garfield B. Russell (Editor), et al (2001); ISBN: 0750670657; http://www.amazon.com/exec/obidos/ASIN/0750670657/icongroupinterna
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Neuroanesthesia (1991); ISBN: 0316604704; http://www.amazon.com/exec/obidos/ASIN/0316604704/icongroupinterna
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New Drugs in Anesthesia (International Anesthesiology Clinics, Vol 33, No 1, Winter 1995) by Thomas W. Feeley, David Royston (Editor) (1995); ISBN: 0316276847; http://www.amazon.com/exec/obidos/ASIN/0316276847/icongroupinterna
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Now They Lay Me Down to Sleep: What You Don't Know About Anesthesia and Surgery May Harm You by F. W. Ernst, et al (1996); ISBN: 0965145409; http://www.amazon.com/exec/obidos/ASIN/0965145409/icongroupinterna
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Obstetric Anesthesia by David H. Chestnut (Editor) (2004); ISBN: 0323023576; http://www.amazon.com/exec/obidos/ASIN/0323023576/icongroupinterna
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Obstetric Anesthesia and Uncommon Disorders by David R. Gambling (Editor), et al (1998); ISBN: 0721661572; http://www.amazon.com/exec/obidos/ASIN/0721661572/icongroupinterna
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Obstetric Anesthesia: The Complicated Patient by Francis M. Iii James, et al (1988); ISBN: 0803649142; http://www.amazon.com/exec/obidos/ASIN/0803649142/icongroupinterna
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Ocular Anesthesia by Scott Greenbaum (Editor), Richard Lampert (Editor) (1997); ISBN: 0721659551; http://www.amazon.com/exec/obidos/ASIN/0721659551/icongroupinterna
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On Call in Anesthesia and Surgery by Ronald A. Malt, Gilles Chemtob (Contributor) (1995); ISBN: 0721638848; http://www.amazon.com/exec/obidos/ASIN/0721638848/icongroupinterna
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Ophthalmic Anesthesia: A Practical Handbook by G. Barry, Smith, et al (1996); ISBN: 0340567570; http://www.amazon.com/exec/obidos/ASIN/0340567570/icongroupinterna
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Oral and Maxillofacial Surgery, Volume 1: Anesthesia/Dentoalveolar Surgery/Office Management by Raymond J. Fonseca (2000); ISBN: 0721696325; http://www.amazon.com/exec/obidos/ASIN/0721696325/icongroupinterna
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Ostheimer's Manual of Obstetric Anesthesia by David J. Birnbach (Editor), Gerard J. Ostheimer (Editor) (2000); ISBN: 0443065543; http://www.amazon.com/exec/obidos/ASIN/0443065543/icongroupinterna
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Pain Management and Regional Anesthesia for the Trauma Patient by Andrew D. Rosenberg, et al (1999); ISBN: 0702022853; http://www.amazon.com/exec/obidos/ASIN/0702022853/icongroupinterna
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Pain Relief in Anesthesia in Obstetrics by Zunder Van, Andre Van Zundert (1996); ISBN: 0443044740; http://www.amazon.com/exec/obidos/ASIN/0443044740/icongroupinterna
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Pediatric Anesthesia: A Pocket Companion by Edmond C. Bloch (1994); ISBN: 0750696028; http://www.amazon.com/exec/obidos/ASIN/0750696028/icongroupinterna
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Pediatric Anesthesia: A Quick Pocket Reference (A Quick Pocket Reference) by Edmond C. Bloch, et al (1999); ISBN: 0750671424; http://www.amazon.com/exec/obidos/ASIN/0750671424/icongroupinterna
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Pediatric Cardiac Anesthesia (1993); ISBN: 0838577830; http://www.amazon.com/exec/obidos/ASIN/0838577830/icongroupinterna
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Perioperative Care: Anesthesia, Medicine, and Surgery by David J. Stone (Editor), et al (1998); ISBN: 0815146396; http://www.amazon.com/exec/obidos/ASIN/0815146396/icongroupinterna
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Positioning in Anesthesia and Surgery (1987); ISBN: 0721661335; http://www.amazon.com/exec/obidos/ASIN/0721661335/icongroupinterna
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Pre- And Postanesthesia Nursing Knowledge Base and Clinical Competencies by Maria T. Zickuhr, et al (1995); ISBN: 0721656455; http://www.amazon.com/exec/obidos/ASIN/0721656455/icongroupinterna
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Preoperative Preparation and Intraoperative Monitoring (Atlas of Anesthesia, Vol 3) by J. Lance, Md. Lichtor (Editor), Ronald D. Miller (1997); ISBN: 0443079021; http://www.amazon.com/exec/obidos/ASIN/0443079021/icongroupinterna
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Principles and Practice of Nurse Anesthesia by Wynne R. Waugaman, et al (1999); ISBN: 013098020X; http://www.amazon.com/exec/obidos/ASIN/013098020X/icongroupinterna
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Principles and Practice of Nurse Anesthesia (1992); ISBN: 083857940X; http://www.amazon.com/exec/obidos/ASIN/083857940X/icongroupinterna
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Principles and Practice of Regional Anesthesia by J. A. W. Wildsmith, et al (2003); ISBN: 0443062269; http://www.amazon.com/exec/obidos/ASIN/0443062269/icongroupinterna
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Principles of Anesthesiology: General and Regional Anesthesia by Vincent J. Collins (1992); ISBN: 0812113225; http://www.amazon.com/exec/obidos/ASIN/0812113225/icongroupinterna
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Problems in Anesthesia: Cardiothoracic Surgery by Joseph E., MD Arrowsmith (Editor), John Simpson (Editor) (2003); ISBN: 1841841382; http://www.amazon.com/exec/obidos/ASIN/1841841382/icongroupinterna
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Radiographic Imaging for Regional Anesthesia and Pain Management by P. Prithvi Raj (Editor), et al (2002); ISBN: 0443065969; http://www.amazon.com/exec/obidos/ASIN/0443065969/icongroupinterna
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Review of Clinical Anesthesia, Third Edition by Neil Roy Connelly (Editor), et al (2001); ISBN: 078172919X; http://www.amazon.com/exec/obidos/ASIN/078172919X/icongroupinterna
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Standards of Care in Anesthesia by T. H. Taylor, D.R. Goldhill (1992); ISBN: 0750600632; http://www.amazon.com/exec/obidos/ASIN/0750600632/icongroupinterna
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Textbook of Regional Anesthesia by P. Prithvi Raj (Editor) (2002); ISBN: 0443065691; http://www.amazon.com/exec/obidos/ASIN/0443065691/icongroupinterna
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The Anesthesia Fact Book: Everything You Need to Know Before Surgery by Frank Sweeny, Frank, M.D. Sweeny (2003); ISBN: 073820823X; http://www.amazon.com/exec/obidos/ASIN/073820823X/icongroupinterna
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The Patient's Guide to Anesthesia: Making the Right Choices by A. J. Hill (1999); ISBN: 1575664054; http://www.amazon.com/exec/obidos/ASIN/1575664054/icongroupinterna
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The Year Book of Anesthesia, 1989 by Ronald D. Miller, Robert R. Kirby (1989); ISBN: 0815159358; http://www.amazon.com/exec/obidos/ASIN/0815159358/icongroupinterna
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The Year Book of Anesthesia, 1991 by Ronald D. Miller (1991); ISBN: 0815159269; http://www.amazon.com/exec/obidos/ASIN/0815159269/icongroupinterna
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The Yearbook of Anesthesia and Pain Management 1993 (1993 Year Book) by Ronald D., M.D. Miller (Editor) (1993); ISBN: 0815159854; http://www.amazon.com/exec/obidos/ASIN/0815159854/icongroupinterna
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Thoracic Anesthesia by Joel A. Kaplan, Peter D. Slinger (2003); ISBN: 0443066191; http://www.amazon.com/exec/obidos/ASIN/0443066191/icongroupinterna
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Thoracic Anesthesia (1991); ISBN: 0443081662; http://www.amazon.com/exec/obidos/ASIN/0443081662/icongroupinterna
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Tumescent Technique: Tumescent Anesthesia & Microcannular Liposuction by Jeffrey A., Md. Klein (2000); ISBN: 0815152051; http://www.amazon.com/exec/obidos/ASIN/0815152051/icongroupinterna
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Vascular Anesthesia by Joel A., Md Kaplan, Carol L., MD Lake (2004); ISBN: 0443066205; http://www.amazon.com/exec/obidos/ASIN/0443066205/icongroupinterna
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Veterinary Anesthesia and Analgesia by Diane McKelvey, K. Wayne Hollingshead (2003); ISBN: 0323019889; http://www.amazon.com/exec/obidos/ASIN/0323019889/icongroupinterna
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Yearbook of Anesthesia and Pain Management, 1992 (Year Book Series) by Ronald D. Miller (1992); ISBN: 0815159382; http://www.amazon.com/exec/obidos/ASIN/0815159382/icongroupinterna
The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “anesthesia” (or synonyms) into the search box, and select “books only.”
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From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:11 ·
Anesthetic techniques for obstetrical anesthesia and analgesia. Author: Moore, Daniel C.,; Year: 2003; Springfield, Ill., Thomas [c1964]
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Geriatric anesthesia, ed. by Paul H. Lorhan. the assisted respiration unit; chairmen: William W. Mushin and Geert J. van Weerden. Author: Lorhan, Paul H. (Paul Herman),; Year: 2003; Boston, Little, Brown, 1964
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Observations on one thousand consecutive cases of anesthesia in the service of Dr. A. J. Ochsner, Augustana Hospital Author: Herb, I. C.; Year: 2003; St. Louis: Mallinckrodt Chemical Works, [1899?]
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Pediatric anesthesia handbook Author: Yemen, Terrance.; Year: 1997; New York: McGraw-Hill, Medical Pub. Division, c2002; ISBN: 0071586873 http://www.amazon.com/exec/obidos/ASIN/0071586873/icongroupinterna
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Spinal anesthesia and the law of professional liability, by Jack F. Marino and Thomas A. Pyrdek. Author: Marino, Jack F.; Year: 1964; [Chicago, 1965]
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Wylie and Churchill-Davidson's A practice of anesthesia. Author: Healy, T. E. J. (Thomas Edward John); Year: 2002; London: Arnold; New York: Distributed in the U.S.A. by Oxford University Press, 2003; ISBN: 0340731303 http://www.amazon.com/exec/obidos/ASIN/0340731303/icongroupinterna
Chapters on Anesthesia In order to find chapters that specifically relate to anesthesia, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and anesthesia using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “anesthesia” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on anesthesia: ·
Anesthesia and Surgery in the Patient with Renal Failure Source: in Suki, W.N.; Massry, S.G., eds. Therapy of Renal Diseases and Related Disorders, 2nd ed. Hingham, MA: Kluwer Academic Publishers. 1991. p. 669-674. Contact: Available from Kluwer Academic Publishers. P.O. Box 358, Accord Station, Hingham, MA 02018. (617) 871-6600. PRICE: $315. ISBN: 0792306767. Summary: Most patients with chronic renal failure (CRF) will receive an anesthetic, either for vascular access before hemodialysis or at the time of renal transplantation. This chapter, from a medical text on the therapy of renal disease and related disorders,
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In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is currently adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a "Books" button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.
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discusses anesthesia and surgery in the patient with renal failure. The author reviews the major obstacles to safe anesthesia, describes the modification in the activity of anesthetic drugs induced by renal failure, and recommends safe approaches to anesthesia in the functionally anephric patient. 2 tables. 68 references. ·
Anesthesia for the Developmentally Disabled Patient Source: in Dionne, R.A.; Phero, J.C.; Becker, D.E. Management of Pain and Anxiety in the Dental Office. Philadelphia, PA: W.B. Saunders Company. 2002. p. 315-323. Contact: Available from W.B. Saunders Company. Book Orders Fulfillment Department, Harcourt Health Sciences, 11830 Westline Industrial Drive, Saint Louis, MO 63146-9988. (800) 545-2522. Website: www.wbsaunders.com. PRICE: $122.00 plus shipping and handling. ISBN: 072167287. Summary: Pain has always been a barrier to dentistry, serving as the inspiration for pioneering efforts by dentists to control pain. This chapter on anesthesia for the developmentally disabled patient is from a text that addresses the management of acute and chronic pain and dental patient apprehension based on accepted pharmacologic (drug) therapies and special applications for dental outpatients. The authors provide an introduction to the anesthetic management of the patient with mental or physical impairments undergoing dental treatment. The intent is to identify the physiologic and anatomic features associated with the developmentally disabled patient that are significant and that require a modification in the patient's anesthetic management. Anesthetic techniques and pharmacologic agents addressed in other chapters also are discussed here in the context of the developmentally disabled patient. The authors begin with considerations of primary assessment, including respiratory, cardiovascular and neurologic assessment strategies. The authors then discuss specific diseases, including Down syndrome, cerebral palsy, cystic fibrosis, multiple sclerosis, muscular dystrophy, spinal cord injuries, and spina bifida. The remainder of the chapter focuses on anesthetic techniques and anesthetic agents, including ketamine and nitrous oxide. 2 tables. 12 references.
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Local Anesthesia and Oral Surgery in Children Source: in Pinkham, J.R., et al., eds. Pediatric Dentistry: Infancy Through Adolescence. 3rd ed. Philadelphia, PA: W.B. Saunders Company. 1999. p. 411-426. Contact: Available from W.B. Saunders Company. Book Orders Fulfillment Department, Harcourt Health Sciences, 11830 Westline Industrial Drive, Saint Louis, MO 63146-9988. (800) 545-2522. Website: www.wbsaunders.com. PRICE: $69.00 plus shipping and handling. ISBN: 0721682383. Summary: The successful management of patients, especially children, in terms of allaying their anxiety and discomfort during restorative and surgical procedures is helped by the use of local anesthesia. This chapter on local anesthesia and oral surgery in children is from a textbook on pediatric dentistry. The authors stress that good operator technique in obtaining local anesthesia in pediatric patients is essential and requires mastery in four areas: child growth and development (physical and mental), behavior management, physiologic pain modulation, and pharmacology of local anesthetics. Topics covered include topical anesthesia, general considerations for local anesthesia, operator technique, maxillary primary and permanent molar anesthesia, maxillary primary and permanent incisor and canine anesthesia, palatal tissue anesthesia, mandibular tooth anesthesia, and complications of local anesthesia. The second part of the chapter focuses on oral surgery in children, covering preoperative
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evaluation, tooth extractions, soft tissue surgical procedures, dentoalveolar surgery, facial injuries, and odontogenic infections. 20 figures. 2 tables. 13 references. ·
Local Anesthesia for the Child and Adolescent Source: in McDonald, R.E. and Avery, D.A., eds. Dentistry for the Child and Adolescent. 7th ed. St. Louis, MO: Mosby, Inc. 2000. p. 283-296. Contact: Available from Harcourt Health Sciences. 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 325-4177. Fax (800) 874-6418. Website: www.harcourthealth.com. PRICE: $72.00 plus shipping and handling. ISBN: 0815190174. Summary: This chapter on local anesthesia is from a textbook on dentistry for the child and adolescent that is designed to help undergraduate dental students and postdoctoral pediatric dentistry students provide comprehensive oral health care for infants, children, teenagers, and individuals with various disabilities. The authors of this chapter note that one of the most important aspects of child behavior guidance is the control of pain. Dental procedures can be carried out more effectively if the child is comfortable and free of pain. The authors discuss topical anesthetics; jet injection; local anesthesia by conventional injection; anesthetizing mandibular teeth and soft tissue; anesthetizing maxillary primary and permanent incisors and canines; anesthetizing primary molars and premolars; anesthetizing maxillary permanent molars; anesthetizing the palatal tissues; supplemental injection techniques; complications after a local anesthetic, including anesthetic toxicity and trauma to soft tissue; and electronic dental anesthesia. 16 figures. 28 references.
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CHAPTER 8. MULTIMEDIA ON ANESTHESIA Overview In this chapter, we show you how to keep current on multimedia sources of information on anesthesia. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.
Video Recordings An excellent source of multimedia information on anesthesia is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “anesthesia” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” Type “anesthesia” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on anesthesia: ·
AAO-HNS Presents: Surgery of the Middle Ear Source: Alexandria, VA: American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS). 1996. (videocassette). Contact: Available from American Academy of Otolaryngology-Head and Neck Surgery, Inc. (AAO-HNS). One Prince Street, Alexandria, VA 22314. (703) 836-4444. Fax (703) 683-5100. Website: www.entnet.org. PRICE: $175.00 for members; $250.00 for nonmembers; plus shipping and handling. Item Number OT-17. Summary: This patient education videotape explains how the middle ear can become infected and when surgery is necessary. The goals and risks of four major types of surgery (myringoplasty, tympanoplasty, cholesteatoma removal, and mastoidectomy) are discussed. The program also covers preparing for surgery, anesthesia, and discharge from the hospital, as well as the symptoms patients may have during recovery. Home recovery guidelines are given regarding strenuous activity, bandages, keeping the ear dry, and sneezing. The videotape is closed captioned. (AA-M).
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Surgery for Urinary Incontinence in Women Source: Timonium, MD: Milner-Fenwick, Inc. 1995. Contact: Available from Milner-Fenwick, Inc. 2125 Greenspring Drive, Timonium, MD 21093. (800) 432-8433. Fax (410) 252-6316. PRICE: $175 (as of 1995). Order Number OB135. Summary: This patient education videotape is for female patients with stress incontinence who are being recommended for surgery. The program describes the various operations that may be performed and their associated length of recovery in hospital or at home. Techniques include the open abdominal, laparoscopic, and vaginal approaches to bladder surgery. The program also provides general information on the risks involved with bladder surgery, including infection, bleeding, reaction to anesthesia, injury to the bladder or urethra, and difficulty urinating. The videotape depicts a patient discussing these options with her physician. This video is also available with closed captioning. (AA-M).
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Eyes, Ears, Nose, and Throat: Your Passageway to Your Senses Source: Calhoun, KY: NIMCO. 199x. (videocassette). Contact: Available NIMCO. P.O. Box 9, 102 Highway 81 North, Calhoun, KY 423270009. (800) 962-6662 or (502) 273-5050; Fax (502) 273-5844; E-mail:
[email protected]; http://www.nimcoinc.com. PRICE: $89.95 plus shipping and handling. Item Number NIM-SM-EENT-V. Summary: This program, one in a consumer health series, covers the senses of hearing, smell, and taste, and the organs that serve each sense. The program first discusses the anatomy of the ear (outer, middle, and inner); for each part discussed, an anatomical model or illustration is employed for clarity. The narrator describes the role of the ear, nose, and throat specialist (otolaryngologist), their typical patients and symptoms, and the indications for referral from a family care or general practitioner to a specialist. The program next discusses ventilation tubes (myringotomy) including its outpatient nature, the procedure itself, the types of tubes used, recovery time (from the use of general anesthesia), short-term versus long-term tubes, and the use of tubes in adults. Additional topics covered include otitis externa (swimmer's ear) and its prevention, infected tonsils and adenoids, indications for removal of tonsils and adenoids, the role of the inner ear in balance and hearing, how the hearing process works, conductive hearing loss and the types of surgery used to correct it, vertigo and its assessment, and sinus problems, including the surgical treatment for sinus obstructions. The program includes interviews with patients in each category of illness, as well as interviews with otolaryngologists and surgeons who treat these patients. The program includes medical terminology, most of which is defined as part of the narration.
Audio Recordings The Combined Health Information Database contains abstracts on audio productions. To search CHID, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find audio productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Sound Recordings.” Type “anesthesia” (or synonyms) into the “For these words:” box. The following is a typical result when searching for sound recordings on anesthesia:
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AIDS and Other Transmissible Diseases: Protecting Yourself in the Operating Room Contact: California Medical Association, Audio Digest Foundation, 1577 E Chevy Chase Dr, Glendale, CA, 91206, (213) 245-8505. Summary: This sound recording, along with accompanying pre-test and post-test questions, is part of an ongoing series of educational activities. The first speaker, Elizabeth A. Donegan, Assistant Professor of Clinical Laboratory Medicine, University of California, San Francisco, School of Medicine, discusses the major infections transmitted by blood transfusions which include cytomegalovirus (CMV), Human immunodeficiency virus (HIV) infection, and HTLV-1. Nancy B. Bjerke, Major, United States Air Force, in North Carolina, and course supervisor/instructor of Sheppard Air Force Base in Texas, talks about the mechanisms for health care worker protection. Her presentation deals with the most frequent occupational injuries to health-care workers, disease transmission, safety precautions and hepatitis B immunization for health-care workers. The third speaker, Arnold J. Berry, Associate Professor of Anesthesiology, Emory University School of Medicine in Atlanta, looks at disease transmission in the operating room. His presentation deals with the implementation of universal precautions, risks to anesthesiologists other than Acquired immunodeficiency syndrome (AIDS) and Hepatitis B, specific recommendations for anesthesia equipment, handwashing, and infections from intravenous lines. The final speaker, C. Daniel Sooy, Assistant Professor of Otolaryngology, University of California in San Francisco, School of Medicine; and Director of Otolaryngology Clinic, San Francisco General Hospital, discusses policies for protecting the anesthesiologist. This presentation includes universal precautions, preoperative testing for HIV, and exposed health care workers.
Bibliography: Multimedia on Anesthesia The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in anesthesia (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on anesthesia: ·
[Pediatric anesthesia] [motion picture] Source: Dept. of Anaesthesia, Hospital for Sick Children, Toronto; Year: 1979; Format: Pediatric anesthesia; Canada: The Hospital, [197?]
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[Refrigeration anesthesia] [motion picture] Source: [production company unknown]; producers, Frederick M. Allen, Lyman Weeks Crossman; Year: 1944; Format: Refrigeration anesthesia; [S.l.: s.n., 1944]
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[Regional anesthesia for operations on the neck] [motion picture] Source: [produced by Ralph M. Tovell]; Year: 1938; Format: Regional anesthesia for operations on the neck; [S.l.: s.n., 1938]
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[Role of carbon dioxide in convulsions during anesthesia] [motion picture] Source: from the Departments of Anesthesia, Radiology, and Photography, Medical School, University of Wisconsin; Year: 1942; Format: Role of carbon dioxide in convulsions during anesthesia; [S.l.: s.n., 1942]
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[Signs of inhalation anesthesia] [motion picture] Source: [produced by Henry S. Ruth, J. Harvey Sigaloos, Arthur E. Guedel]; Year: 1938; Format: Signs of inhalation anesthesia; [S.l.: s.n., 1938]
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Anesthesia for the uncommon surgical challenge [motion picture] Source: produced by Rainbow Productions, Inc.; Ohio Medical Anesthetics; Year: 1983; Format: Motion picture; United States: Airco, c1983
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Anesthesia with Vinethene (vinyl ether for anesthesia, U.S.R., Merck) in short operative procedures [motion picture] Source: produced by Audio Productions, Inc., Medical Division; [presented by] Merck & Co., Inc.; produced under the supervision of E.A. Rovens; Year: 1953; Format: Motion picture; United States: Merck & Co., c1953
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Intravenous anesthesia [motion picture] Source: [presented by] the United States Army; Year: 1946; Format: Motion picture; United States: War Office, 1946
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Modern methods of anesthesia [motion picture] Source: prepared by the Medical Department of the Winthrop Chemical Company, Inc., with the cooperation of the Gallinger Municipal Hospital; produced by General Business Films, Inc; Year: 1934; Format: Motion picture; United States: General Business Films, [1934]
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Paediatric anesthesia [motion picture] Source: by courtesy E.R. Squibb & Sons; Childrens' Memorial Hospital, Montreal, Canada; Year: 9999; Format: Motion picture; [United States?]: E.R. Squibb, [1944]-
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Paediatric anesthesia [motion picture] Source: E.R. Squibb & Sons; Year: 1944; Format: Motion picture; [United States?]: E.R. Squibb and Sons, [1944]
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Settling in frogs initiated by deep anesthesia [motion picture] Source: Fann Harding and Melvin H. Knisely; Year: 1958; Format: Motion picture; United States: Anatomy Dept., Medical College of South Carolina, 1958
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CHAPTER 9. PERIODICALS AND NEWS ON ANESTHESIA Overview In this chapter, we suggest a number of news sources and present various periodicals that cover anesthesia.
News Services and Press Releases One of the simplest ways of tracking press releases on anesthesia is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing.
PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “anesthesia” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance.
Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to anesthesia. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “anesthesia” (or synonyms). The following was recently listed in this archive for anesthesia: ·
Nitrous oxide anesthesia implicated in death of child with MTHFR deficiency Source: Reuters Medical News Date: July 02, 2003
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Med students often fail to obtain consent before pelvic exams under anesthesia Source: Reuters Medical News Date: March 13, 2003
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Sentinel lymph node biopsy under local anesthesia advantageous for early stage breast cancer Source: Reuters Medical News Date: November 28, 2002
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Anesthesia complications rare during tympanostomy tube placement in children Source: Reuters Medical News Date: October 07, 2002
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Local anesthesia seen as an option for thyroid surgery Source: Reuters Medical News Date: November 09, 2001
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Long-term stress disorder can develop when general anesthesia fails Source: Reuters Medical News Date: September 10, 2001
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New Medicare anesthesia rule maintains physician supervision requirement Source: Reuters Medical News Date: July 09, 2001
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FDA clears enhancements for Aspect Medical Systems' anesthesia monitors Source: Reuters Industry Breifing Date: June 25, 2001
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Organon says it has not ruled out re-launch of withdrawn anesthesia drug Source: Reuters Industry Breifing Date: March 30, 2001
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Organon withdraws anesthesia drug on bronchospasm concerns Source: Reuters Industry Breifing Date: March 29, 2001
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Women differ from men in recovery after general anesthesia Source: Reuters Medical News Date: March 22, 2001
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Physiometrix obtains European approval for anesthesia monitoring system Source: Reuters Industry Breifing Date: March 09, 2001
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FDA approves propofol for pediatric anesthesia Source: Reuters Medical News Date: February 26, 2001
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FDA approves AstraZeneca's Diprivan for pediatric anesthesia Source: Reuters Industry Breifing Date: February 26, 2001
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Epidural anesthesia during labor does not increase long-term backache risk Source: Reuters Medical News Date: February 06, 2001
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HCFA rule would end physician supervision requirement for anesthesia Source: Reuters Industry Breifing Date: January 17, 2001
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FDA clears ESC Medical Systems' dental laser for anesthesia-free drilling Source: Reuters Industry Breifing Date: December 14, 2000
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General anesthesia safe for epileptic children on ketogenic diet Source: Reuters Medical News Date: December 05, 2000
The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine.
Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name.
Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “anesthesia” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests.
Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “anesthesia” (or synonyms). If you know the name of a company that is relevant to anesthesia, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/.
BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “anesthesia” (or synonyms).
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Newsletters on Anesthesia Find newsletters on anesthesia using the Combined Health Information Database (CHID). You will need to use the “Detailed Search” option. To access CHID, go to the following hyperlink: http://chid.nih.gov/detail/detail.html. Limit your search to “Newsletter” and “anesthesia.” Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter.” Type “anesthesia” (or synonyms) into the “For these words:” box. The following list was generated using the options described above: ·
Pain Management Vital in Pediatric Urology Source: Urology Times. 22(4): 13-14. April 1994. Contact: Available from Advanstar Communications, Inc. Corporate and Editorial Offices, 7500 Old Oak Boulevard, Cleveland, OH 44130. (216) 243-8100. Summary: This article, from a professional newsletter, presents an interview with Dr. David Cohen on the contributions pediatric urologists can make to minimize their patients' discomfort. Dr. Cohen stresses that, when planning surgical procedures on infants or young children, urologists need to regard the reality of their patients' postoperative pain seriously and work as a team with anesthesiologists to manage the pain safely and effectively. Other topics include evaluating children's pain, communicating with children, the use of local anesthesia and caudal blocks, the use of a combination of techniques rather that a single technique for pain control, the role of preoperative education in reducing anxiety and postoperative discomfort, the role of parents in helping children with self-administration of pain medications, distraction and psychological techniques, and the importance of individualizing pain management for each patient's needs.
Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “anesthesia” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months. The following is a typical result when searching for newsletter articles on anesthesia: ·
Artificial Knuckles: Relieve Pain, Restore Function Source: Mayo Clinic Newsletter. May 6, 2003. 4 p. Contact: Available from Mayo Foundation for Medical Education and Research. Website: www.mayoclinic.com. Summary: This newsletter article discusses artificial knuckle implants for patients who have joint problems due to rheumatoid arthritis, trauma, or osteoarthritis. Joint replacement surgery is recommended for patients whose pain cannot be controlled by medication. This surgery generally takes 3 to 4 hours and can be performed using general, local, or regional anesthesia. Up to four knuckles can be replaced in a single
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operation. Each implant consists of a plastic and metal piece; the metal half of the implant is inserted into the metacarpal bone, and the plastic piece is attached to the phalanx. Both parts are then connected and reinforced with the ligaments and tendons in the hands. The hand is placed in a splint for 2 to 3 weeks after the surgery to let the soft tissues in the hand heal. Physical therapy will be needed after the surgery. ·
Current Surgical Treatment for Arthritis of the Hand Source: Arthritis Observer. 48(1):1,4; Spring 1996. Contact: Rocky Mountain Chapter of the Arthritis Foundation. Summary: This newsletter article for individuals with arthritis focuses on current surgical treatment for arthritis of the hand. The team concept of care for managing arthritis is discussed. Types of surgical techniques are described, including soft tissue arthroplasty , silicone implants in the joints, artificial joint replacement, and joint fusion. Types of anesthesia used in these surgical procedures are identified. The post-surgical relationship between the patient and the hand therapist is also considered.
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Total Hip Replacement: Relieve Pain, Improve Mobility Source: Mayo Clinic Newsletter. April 18, 2003. 7 p. Contact: Available from Mayo Foundation for Medical Education and Research. Website: www.mayoclinic.com. Summary: This newsletter article provides information to patients considering hip replacement surgery. Hip replacements are performed for many reasons including injury, rheumatoid arthritis, avascular necrosis, and osteoarthritis. Weight, bone density, age, and overall health need to be considered before having surgery. Doctors usually recommend that patients be older than 60 years of age, as the replaced joint lasts an average of 15 to 20 years. Patients should discuss the surgical procedure, risks, postsurgery medications, and possible complications of the surgery with their doctor. Patients should also plan for their return home. The surgery itself takes 2 to 3 hours and is performed under general or regional anesthesia. The femoral head of the thighbone is replaced with a metal ball and is attached to a metal stem fitting into the thighbone. Possible complications include dislocation, infection, and blood clots. Some patients may have long-term complications including loosening, breaking the prosthesis, and an inflammatory reaction. It takes approximately 6 to 8 weeks to recover from this surgery and during that time the patient's activities will be limited. After a follow-up with the surgeon to ensure that the hip is healing properly, most patients are able to resume their usual activities.
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Joint Replacement: Help for When Pain Changes Your Lifestyle Source: Mayo Clinic Health Letter. 19(2-Supplement): 1-8. February 2001. Contact: Available from Mayo Clinic Health Letter, 200 First Street SW, Rochester, MN 55905. (800) 333-9037 or (303) 604-1465. Email:
[email protected]. Summary: This newsletter article provides people who have arthritis with information on joint replacement. This type of surgery is used to help people regain physical function and eliminate joint pain. Arthritis may damage cartilage and cause joints to become stiff and painful to use. In addition to arthritis, other conditions that damage joints include inflammatory type arthritis conditions, posttraumatic arthritis, osteonecrosis, and certain medical conditions. Different joints present different
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challenges to surgeons because they have different stresses or loads applied to them. Although the hip and knee are the most commonly replaced joints, implants can also replace joints in the shoulder, elbow, finger, and other locations. The most common reason for joint replacement is pain that limits function. Age and activity level are factors that the patient and doctor should consider. Hip and knee replacement surgeries are usually performed under general anesthesia or special anesthesia that takes away feeling only in the lower part of the body. Hip replacement surgery usually takes 2 to 3 hours, and other types of joint replacement surgeries may take more or less time, depending on the problems that need to be corrected. The length of the hospital stay will depend on the type of joint operation performed, patient age and health status, and any complications. In addition to the usual risks of major surgery and anesthesia, potential complications include infection; blood clots; prosthetic loosening, dislocation, or breakage; excessive wear; and nerve injury. People who undergo joint replacement need to have regular, ongoing followup care. The article also includes sidebars that provide information on types of joints, the history of joint replacement surgery, finger implants, forms of arthritis, types of implant devices, infection prevention, air travel following joint replacement, and sources of additional information. 4 figures.
Academic Periodicals covering Anesthesia Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to anesthesia. In addition to these sources, you can search for articles covering anesthesia that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”
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CHAPTER 10. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.
U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for anesthesia. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a nonprofit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DIÒ Advice for the PatientÒ can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with anesthesia. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The
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following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to anesthesia: Anesthetics, General ·
Systemic - U.S. Brands: Amidate; Brevital; Diprivan; Ethrane; Fluothane; Forane; Ketalar; Penthrane; Pentothal http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203043.html
Anticholinergics/Antispasmodics ·
Systemic - U.S. Brands: Anaspaz; A-Spas S/L; Banthine; Bentyl; Cantil; Cystospaz; Cystospaz-M; Donnamar; ED-SPAZ; Gastrosed; Homapin; Levbid; Levsin; Levsin/SL; Levsinex Timecaps; Pro-Banthine; Quarzan; Robinul; Robinul Forte; Symax SL; Transderm-Scop http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202049.html
Dantrolene ·
Systemic - U.S. Brands: Dantrium http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202181.html
Desflurane ·
Inhalation-Systemic - U.S. Brands: Suprane http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202685.html
Dolasetron ·
Systemic - U.S. Brands: Anzemet http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203375.html
Droperidol ·
Systemic - U.S. Brands: Inapsine http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203411.html
Lidocaine and Prilocaine ·
Topical - U.S. Brands: EMLA http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203679.html
Narcotic Analgesics for Pain Relief ·
Systemic - U.S. Brands: Astramorph PF; Buprenex; Cotanal-65; Darvon; DarvonN; Demerol; Dilaudid; Dilaudid-5; Dilaudid-HP; Dolophine; Duramorph; Hydrostat IR; Kadian; Levo-Dromoran; M S Contin; Methadose; MS/L; MS/L Concentrate; MS/S; MSIR; Nubain; Numorphan; OMS Concentrate; http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202390.html
Narcotic Analgesics for Surgery and Obstetrics ·
Systemic - U.S. Brands: Alfenta; Astramorph; Astramorph PF; Buprenex; Demerol; Duramorph; Nubain; Stadol; Sublimaze; Sufenta; Ultiva http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202391.html
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Ondansetron ·
Systemic - U.S. Brands: Zofran http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202424.html
Sevoflurane ·
Inhalation-Systemic - U.S. Brands: Ultane http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202793.html
Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.
Mosby’s Drug ConsultÔ Mosby’s Drug ConsultÔ database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/.
PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html.
Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee. If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.
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APPENDICES
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APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.
NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute12: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
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National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/
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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html
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National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25
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National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm
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National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm
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National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375
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National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/
12
These publications are typically written by one or more of the various NIH Institutes.
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·
National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm
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National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/
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National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm
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National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm
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National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/
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National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/
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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm
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National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html
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National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm
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National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm
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National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm
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National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html
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National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm
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Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp
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National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/
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National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp
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Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html
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Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm
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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.13 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:14 ·
Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html
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HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html
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NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html
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Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/
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Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html
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Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html
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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/
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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html
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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html
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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html
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MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html
13 Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 14 See http://www.nlm.nih.gov/databases/databases.html.
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Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html
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Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html The Combined Health Information Database
A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to one of the following: Brochure/Pamphlet, Fact Sheet, or Information Package, and “anesthesia” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For the publication date, select “All Years.” Select your preferred language and the format option “Fact Sheet.” Type “anesthesia” (or synonyms) into the “For these words:” box. The following is a sample result: ·
State of the states: Overview of 1999 state legislation on access to oral health Source: Washington, DC: Center for Policy Alternatives. 1999. 11 pp. Contact: Available from Center for Policy Alternatives, 1875 Connecticut Avenue, N.W., Suite 710, Washington, DC 20009. Telephone: (202) 387- 6030 / fax: (202) 986-2539 / email:
[email protected]. Available at no charge. Summary: This report provides an overview of 1999 state legislation addressing access to oral health. It highlights examples of what states are doing to improve access to oral health services and how they are addressing oral health problems, particularly for underserved communities. Topics discussed include (1) access to dental care, (2) provider incentives, (3) patient rights and quality of care, (4) practice and scope of work, and (5) anesthesia coverage.
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Oral health legislation in the states: 2001 Source: Washington, DC: Children's Dental Health Project and [New York, NY]: MCHB National Oral Health Policy Center. 2001. 19 pp. Contact: Available from National Maternal and Child Oral Health Resource Center, Georgetown University, Box 571272, Washington, DC 20057-1272. Telephone: (202) 7849771 / fax: (202) 784-9777 / e-mail:
[email protected] / Web site: http://www.mchoralhealth.org. Available from the Web site at no charge. Summary: This report summarizes, in annotated table format, introduced and enacted oral health legislation in the states during 2001 as reported to the Children's Dental Health Project and the Maternal and Child Health Bureau (MCHB) National Oral Health Policy Center. Topics include access to dental care, provider incentives, patients' rights and quality of care, practice and scope of work, and anesthesia coverage. Additional topics include insurance regulation, research/study, reporting and identifying abuse, appointment of state dental directors, and routine examination/certificate of health. [Funded by the Maternal and Child Health Bureau].
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The NLM Gateway15 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.16 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “anesthesia” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total
Items Found 163055 5183 845 76 11 169170
HSTAT17 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.18 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.19 Simply search by “anesthesia” (or synonyms) at the following Web site: http://text.nlm.nih.gov.
Coffee Break: Tutorials for Biologists20 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI 15
Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.
16
The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 17 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 18 19
The HSTAT URL is http://hstat.nlm.nih.gov/.
Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations. 20 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.
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staff.21 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.22 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.
Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: ·
CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.
·
Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.
21 The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 22 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.
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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on anesthesia can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.
Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to anesthesia. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly.
The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below.
Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to anesthesia. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “anesthesia”:
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·
Guides on anesthesia Anesthesia http://www.nlm.nih.gov/medlineplus/anesthesia.html
·
Other guides General Anesthesia http://www.nlm.nih.gov/medlineplus/tutorials/generalanesthesialoader.html Knee Injuries and Disorders http://www.nlm.nih.gov/medlineplus/kneeinjuriesanddisorders.html Labor and Delivery http://www.nlm.nih.gov/medlineplus/laboranddelivery.html Plastic & Cosmetic Surgery http://www.nlm.nih.gov/medlineplus/plasticcosmeticsurgery.html Vasculitis http://www.nlm.nih.gov/medlineplus/vasculitis.html
Within the health topic page dedicated to anesthesia, the following was listed: ·
General/Overview Anesthesia: Options and Considerations Source: Mayo Clinic http://www.mayoclinic.com/invoke.cfm?id=SC00026 General Anesthesia http://www.nlm.nih.gov/medlineplus/tutorials/generalanesthesialoader.html
·
Specific Conditions/Aspects After Anesthesia: Your Active Role Assists Your Recovery Source: American Association of Nurse Anesthetists http://www.aana.com/patients/after.asp Anesthesia for Ambulatory Surgery http://www.asahq.org/patientEducation/ambulatoryAnes.pdf Anesthesia for Hip and Knee Surgery Source: American Academy of Orthopaedic Surgeons http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=321&topcategory=Hip Anesthesia for the Dental Visit Source: American Dental Association http://www.ada.org/prof/resources/pubs/jada/patient/patient_06.pdf Before Anesthesia: Your Active Role Makes a Difference Source: American Association of Nurse Anesthetists http://www.aana.com/patients/before.asp Conscious Sedation: What Patients Should Expect Source: American Association of Nurse Anesthetists http://www.aana.com/patients/conscious.asp
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Epidural Anesthesia http://www.nlm.nih.gov/medlineplus/tutorials/epiduralanesthesialoader.html Office-Based Anesthesia and Surgery Source: American Society of Anesthesiologists http://www.asahq.org/patientEducation/officebased.htm Planning Your Childbirth http://www.asahq.org/patientEducation/childbirth.pdf Sedation Analgesia http://www.asahq.org/patientEducation/SedationBrochure.pdf What Is Malignant Hyperthermia? Source: Malignant Hyperthermia Association of the United States http://www.mhaus.org/index.cfm/fuseaction/OnlineBrochures.Display/Brochure PK/8AABF3FB-13B0-430F-BE20FB32516B02D6.cfm What You Should Know about Herbal and Dietary Supplement Use and Anesthesia Source: American Society of Anesthesiologists http://www.asahq.org/patientEducation/herbPatient.pdf ·
Children What Is a Pediatric Anesthesiologist? http://www.aap.org/sections/sap/he3003.pdf When Your Child Needs Anesthesia Source: American Society of Anesthesiologists http://www.asahq.org/patientEducation/childanes.htm Your Child's Anesthesia Source: Nemours Foundation http://kidshealth.org/parent/system/surgery/anesth.html
·
Organizations American Association of Nurse Anesthetists http://www.aana.com/ American Society of Anesthesiologists http://www.asahq.org/
You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search.
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The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on anesthesia. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: ·
Dental Anesthesia: Providing a More Comfortable Dental Visit Source: Chicago, IL: American Dental Association. 1999. [6 p.]. Contact: Available from American Dental Association (ADA). 211 East Chicago Avenue, Chicago, Illinois 60611-2678. (800) 947-4746 or (312) 440-2593. Website: www.ada.org. PRICE: Contact publisher for pricing; bulk orders available. Item Number W181. Summary: A number of medications are available to help create more relaxed, comfortable dental visits. Some drugs control pain, some help the patient to relax, and others put the patient into a deep sleep during dental treatment. This brochure reviews the use of dental anesthesia. The author notes that the type of dental procedure, the patient's overall health, history of allergies, and anxiety level are all considered when determining which approach is best for the individual patient. The brochure covers local anesthesia, anxiety and pain relief, general anesthesia, analgesia (painkillers) for after a procedure, the dentist's education and training in this area, and the role that the patient can play.
·
Ask Your Pediatric Dentist About General Anesthesia Source: Chicago, IL: American Academy of Pediatric Dentistry. 199x. [2 p.]. Contact: Available from American Academy of Pediatric Dentistry. 211 East Chicago Avenue, Suite 700, Chicago, IL 60611-2616. (312) 337-2169; Fax (312) 337-6329; http://aapd.org. PRICE: Single copy free; bulk rates available. Summary: This brochure, one in a series from the American Academy of Pediatric Dentistry, answers questions parents commonly have about the use of general anesthesia for children's dental care. Written in a question-and-answer format, the brochure defines general anesthesia and discusses who should be anesthetized, the safety of general anesthesia, and special instructions that may be necessary before an appointment at which general anesthesia will be used. The brochure emphasizes that pediatric dentists are trained to discuss the benefits and risks involved in general anesthesia and to explain why this anesthesia is being recommended for the child's treatment. The brochure concludes with a brief description of the American Academy of Pediatric Dentistry.
·
Anesthesia Source: Rosemont, IL: American Association of Oral and Maxillofacial Surgeons. 1999. [4 p.]. Contact: Available from American Association of Oral and Maxillofacial Surgeons. 9700 West Bryn Mawr Avenue, Rosemont, IL 60018-5701. (847) 678-6200. Fax (847) 678-6286. Website: www.aaoms.org. PRICE: $25.00 per 100 brochures, plus shipping and handling.
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Summary: This brochure, one in a series of patient education brochures from the American Association of Oral and Maxillofacial Surgeons, reviews the use of anesthesia in oral surgery procedures. The brochure emphasizes that fear and anxiety about oral surgery can be reduced by adequate patient education, including the assurance that pain control methods are now available for during and after surgical procedures. In addition, the more the patient knows about what to expect, the less there is to be anxious about. That is why, before the procedure, the surgeon will review the type of anesthetic to be used, as well as how the patient is likely to feel during the operation. During surgery, one or more of the following can be used in controlling pain and anxiety: local anesthesia, nitrous oxide-oxygen, intravenous sedation, and general anesthesia. After surgery, the oral and maxillofacial surgeon can prescribe a number of medications to make the patient as comfortable as possible. The brochure includes the contact information for the Association (www.aaoms.org). Simple graphics illustrate the brochure. ·
Anesthesia and the Vestibular Patient Source: Portland, OR: Vestibular Disorders Association (VEDA). 199x. [2 p.]. Contact: Available from Vestibular Disorders Association (VEDA). P.O. Box 4467, Portland, OR 97208-4467. (503) 229-7705. Fax (503) 229-8064. E-mail:
[email protected]. Website: www.vestibular.org. PRICE: $0.50 plus shipping and handling. Order number S-5. Summary: This fact sheet provides a summary of a July 1991 talk given by Dr. Richard Kloor, an anesthesiologist, to a vestibular support group. Dr. Kloor addresses concerns about the use of nitrous oxide and provides the reader with alternatives. The presence of nitrous oxide in one's system can cause swelling, especially in an enclosed air space such as the middle ear and possibly the inner ear. In addition, the after effects of nitrous oxide use can cause inner ear problems. These effects include nausea, vomiting, and coughing, which can also cause too much pressure on the delicate system of the inner ear. Some alternatives to general anesthetics are regional blocks and locals. The publication concludes that no perfect anesthetics exist; the final choice of an anesthetic represents a 'best effort' to minimize adverse effects for each individual. The author provides suggestions for patients to follow in an effort to prevent vestibular complications of anesthesia.
·
Anesthesia for the Dental Visit Source: JADA. Journal of the American Dental Association. 132(5): 703. May 2001. Contact: Available from American Dental Association. ADA Publishing Co, Inc., 211 East Chicago Avenue, Chicago, IL 60611. (312) 440-2867. Website: www.ada.org. Summary: This single page patient handout reviews the use of anesthesia for the dental visit. The fact sheet covers both local and general anesthesia. Local anesthesia numbs the teeth and gums to prevent discomfort during dental treatment. Local anesthesia can be topical or injectable. In addition, antianxiety agents or sedatives can help patients relax during dental procedures. Two forms of conscious sedation are nitrous oxide and intravenous sedation. General anesthesia, unlike conscious sedation, causes a loss of consciousness and produces deep sleep. General anesthesia may be used for patients with uncontrollable anxiety or patients who are unable to control their movements (such as young children or some people with disabilities). All states now require dentists who provide general anesthesia to have a special permit from the state based on advanced training. Other trained dental personnel are usually on hand during any procedures
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requiring general anesthesia. The fact sheet concludes with a brief section outlining the patient's role, notably in discussing treatment options with the dental care provider. The fact sheet emphasizes the importance of telling the dental care provider about any medications that the patient may be currently taking, including any alternative therapies such as herbs.
The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search this site located at http://www.guideline.gov/ by using the keyword “anesthesia” (or synonyms). The following was recently posted: ·
Evidence-based clinical practice guideline. Nursing care of the woman receiving regional analgesia/anesthesia in labor Source: Association of Women's Health, Obstetric, and Neonatal Nurses - Professional Association; 2001 January; 36 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2928&nbr=2154&a mp;string=anesthesia
·
Guidelines for the pediatric perioperative anesthesia environment Source: American Academy of Pediatrics - Medical Specialty Society; 1999 February; 7 pages http://www.guideline.gov/summary/summary.aspx?doc_id=1774&nbr=1000&a mp;string=anesthesia
·
Practice guidelines for obstetrical anesthesia Source: American Society of Anesthesiologists - Medical Specialty Society; 1999; 11 pages http://www.guideline.gov/summary/summary.aspx?doc_id=1853&nbr=1079&a mp;string=anesthesia
·
Timing of elective surgery on the genitalia of male children with particular reference to the risks, benefits, and psychological effects of surgery and anesthesia Source: American Academy of Pediatrics - Medical Specialty Society; 1996 April (reaffirmed 2000); 8 pages http://www.guideline.gov/summary/summary.aspx?doc_id=1776&nbr=1002&a mp;string=anesthesia
Healthfinder™ Healthfinder™ is sponsored by the U.S. Department of Health and Human Services and offers links to hundreds of other sites that contain healthcare information. This Web site is
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located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: ·
Anesthesia and You Summary: Important consumer information about anesthesia and the responsibilities of the anesthesiologist during a surgical procedure. Source: American Society of Anesthesiologists http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=2154
·
Anesthesia: Public Education Summary: Important patient education information about the role of anesthesia in your medical treatment and the responsibilities of the anesthesiologist during a surgical procedure. Source: American Society of Anesthesiologists http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=2529
·
Cocaine Facts and Figures Summary: Pure cocaine was first used in the 1880s as a local anesthetic in eye, nose, and throat surgeries because of its ability to provide anesthesia as well as to constrict blood vessels and limit bleeding. Source: Office of National Drug Control Policy, The White House http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=7197
·
Preventing Malignant Hyperthermia - An Anesthesia Protocol Summary: A clinical guide to the diagnosis and treatment of malignant hyperthermia for anesthesia care providers and other health care professionals. Source: Malignant Hyperthermia Association of the United States http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=4528 The NIH Search Utility
The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to anesthesia. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html.
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Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats
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Family Village: http://www.familyvillage.wisc.edu/specific.htm
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Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/
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Med Help International: http://www.medhelp.org/HealthTopics/A.html
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Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/
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Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/
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WebMDÒHealth: http://my.webmd.com/health_topics
Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to anesthesia. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with anesthesia.
The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about anesthesia. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797.
Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “anesthesia” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received
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your search results, click on the name of the organization for its description and contact information.
The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “anesthesia”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “anesthesia” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “anesthesia” (or a synonym) into the search box, and click “Submit Query.”
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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.
Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.23
Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.
Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of
23
Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.
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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)24: ·
Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/
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Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)
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Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm
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California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html
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California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html
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California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html
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California: Gateway Health Library (Sutter Gould Medical Foundation)
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California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/
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California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp
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California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html
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California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/
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California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/
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California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/
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California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html
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California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/
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Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/
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Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/
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Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/
24
Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.
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·
Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml
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Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm
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Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html
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Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm
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Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp
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Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/
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Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm
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Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html
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Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/
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Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm
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Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/
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Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/
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Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/
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Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm
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Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html
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Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm
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Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/
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Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/
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Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10
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Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/
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·
Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html
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Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp
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Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp
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Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/
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Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html
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Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm
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Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp
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Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/
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Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html
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Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/
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Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm
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Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/
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Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html
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Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm
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Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330
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Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)
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National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html
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National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/
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National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/
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·
Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm
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New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/
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New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm
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New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm
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New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/
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New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html
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New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/
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New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html
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New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/
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Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm
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Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp
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Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/
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Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/
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Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml
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Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html
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Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html
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Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml
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Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp
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Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm
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Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/
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South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp
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Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/
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Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/
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Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72
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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: ·
ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html
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MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp
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Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/
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Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html
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On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/
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Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp
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Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm
Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a).
Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: ·
Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical
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MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html
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Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/
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Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine
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ANESTHESIA DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. 3-dimensional: 3-D. A graphic display of depth, width, and height. Three-dimensional radiation therapy uses computers to create a 3-dimensional picture of the tumor. This allows doctors to give the highest possible dose of radiation to the tumor, while sparing the normal tissue as much as possible. [NIH] Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abdominal Pain: Sensation of discomfort, distress, or agony in the abdominal region. [NIH] Ablate: In surgery, is to remove. [NIH] Ablation: The removal of an organ by surgery. [NIH] Abscess: Accumulation of purulent material in tissues, organs, or circumscribed spaces, usually associated with signs of infection. [NIH] Acceptor: A substance which, while normally not oxidized by oxygen or reduced by hydrogen, can be oxidized or reduced in presence of a substance which is itself undergoing oxidation or reduction. [NIH] Accommodation: Adjustment, especially that of the eye for various distances. [EU] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Achlorhydria: A lack of hydrochloric acid in gastric juice despite stimulation of gastric secretion. [NIH] Acidosis: A pathologic condition resulting from accumulation of acid or depletion of the alkaline reserve (bicarbonate content) in the blood and body tissues, and characterized by an increase in hydrogen ion concentration. [EU] Acoustic: Having to do with sound or hearing. [NIH] Acrylonitrile: A highly poisonous compound used widely in the manufacture of plastics, adhesives and synthetic rubber. [NIH] Actin: Essential component of the cell skeleton. [NIH] Action Potentials: The electric response of a nerve or muscle to its stimulation. [NIH] Activities of Daily Living: The performance of the basic activities of self care, such as dressing, ambulation, eating, etc., in rehabilitation. [NIH] Acupuncture Analgesia: Analgesia produced by the insertion of acupuncture needles at certain points in the body. These activate the small myelinated nerve fibers in the muscle which transmit impulses to the spinal cord and then activate three centers - the spinal cord, midbrain and pituitary hypothalamus - to produce analgesia. [NIH] Acute renal: A condition in which the kidneys suddenly stop working. In most cases,
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kidneys can recover from almost complete loss of function. [NIH] Adaptability: Ability to develop some form of tolerance to conditions extremely different from those under which a living organism evolved. [NIH] Adaptation: 1. The adjustment of an organism to its environment, or the process by which it enhances such fitness. 2. The normal ability of the eye to adjust itself to variations in the intensity of light; the adjustment to such variations. 3. The decline in the frequency of firing of a neuron, particularly of a receptor, under conditions of constant stimulation. 4. In dentistry, (a) the proper fitting of a denture, (b) the degree of proximity and interlocking of restorative material to a tooth preparation, (c) the exact adjustment of bands to teeth. 5. In microbiology, the adjustment of bacterial physiology to a new environment. [EU] Adenine: A purine base and a fundamental unit of adenine nucleotides. [NIH] Adenoma: A benign epithelial tumor with a glandular organization. [NIH] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adenosine Triphosphate: Adenosine 5'-(tetrahydrogen triphosphate). An adenine nucleotide containing three phosphate groups esterified to the sugar moiety. In addition to its crucial roles in metabolism adenosine triphosphate is a neurotransmitter. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH] Adrenal Medulla: The inner part of the adrenal gland; it synthesizes, stores and releases catecholamines. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Adverse Effect: An unwanted side effect of treatment. [NIH] Aerobic: In biochemistry, reactions that need oxygen to happen or happen when oxygen is present. [NIH] Aerosol: A solution of a drug which can be atomized into a fine mist for inhalation therapy. [EU]
Afferent: Concerned with the transmission of neural impulse toward the central part of the nervous system. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of
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antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Agar: A complex sulfated polymer of galactose units, extracted from Gelidium cartilagineum, Gracilaria confervoides, and related red algae. It is used as a gel in the preparation of solid culture media for microorganisms, as a bulk laxative, in making emulsions, and as a supporting medium for immunodiffusion and immunoelectrophoresis. [NIH]
Aggravation: An increasing in seriousness or severity; an act or circumstance that intensifies, or makes worse. [EU] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Airway: A device for securing unobstructed passage of air into and out of the lungs during general anesthesia. [NIH] Alanine: A non-essential amino acid that occurs in high levels in its free state in plasma. It is produced from pyruvate by transamination. It is involved in sugar and acid metabolism, increases immunity, and provides energy for muscle tissue, brain, and the central nervous system. [NIH] Albumin: 1. Any protein that is soluble in water and moderately concentrated salt solutions and is coagulable by heat. 2. Serum albumin; the major plasma protein (approximately 60 per cent of the total), which is responsible for much of the plasma colloidal osmotic pressure and serves as a transport protein carrying large organic anions, such as fatty acids, bilirubin, and many drugs, and also carrying certain hormones, such as cortisol and thyroxine, when their specific binding globulins are saturated. Albumin is synthesized in the liver. Low serum levels occur in protein malnutrition, active inflammation and serious hepatic and renal disease. [EU] Alertness: A state of readiness to detect and respond to certain specified small changes occurring at random intervals in the environment. [NIH] Alfentanil: A short-acting opioid anesthetic and analgesic derivative of fentanyl. It produces an early peak analgesic effect and fast recovery of consciousness. Alfentanil is effective as an anesthetic during surgery, for supplementation of analgesia during surgical procedures, and as an analgesic for critically ill patients. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alkaline: Having the reactions of an alkali. [EU] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Allergen: An antigenic substance capable of producing immediate-type hypersensitivity (allergy). [EU] Allylamine: Possesses an unusual and selective cytotoxicity for vascular smooth muscle cells in dogs and rats. Useful for experiments dealing with arterial injury, myocardial fibrosis or cardiac decompensation. [NIH] Alpha Particles: Positively charged particles composed of two protons and two neutrons, i.e., helium nuclei, emitted during disintegration of very heavy isotopes; a beam of alpha particles or an alpha ray has very strong ionizing power, but weak penetrability. [NIH] Alpha-1: A protein with the property of inactivating proteolytic enzymes such as leucocyte
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collagenase and elastase. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Alum: A type of immune adjuvant (a substance used to help boost the immune response to a vaccine). Also called aluminum sulfate. [NIH] Alveoli: Tiny air sacs at the end of the bronchioles in the lungs. [NIH] Ameliorating: A changeable condition which prevents the consequence of a failure or accident from becoming as bad as it otherwise would. [NIH] Ameloblastoma: An epithelial tumor of the jaw originating from the epithelial rests of Malassez or from other epithelial remnants of the developing period of the enamel. [NIH] Amenorrhea: Absence of menstruation. [NIH] Amine: An organic compound containing nitrogen; any member of a group of chemical compounds formed from ammonia by replacement of one or more of the hydrogen atoms by organic (hydrocarbon) radicals. The amines are distinguished as primary, secondary, and tertiary, according to whether one, two, or three hydrogen atoms are replaced. The amines include allylamine, amylamine, ethylamine, methylamine, phenylamine, propylamine, and many other compounds. [EU] Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Amino Acid Substitution: The naturally occurring or experimentally induced replacement of one or more amino acids in a protein with another. If a functionally equivalent amino acid is substituted, the protein may retain wild-type activity. Substitution may also diminish or eliminate protein function. Experimentally induced substitution is often used to study enzyme activities and binding site properties. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Aminopropionitrile: 3-Aminopropanenitrile. Reagent used as an intermediate in the manufacture of beta-alanine and pantothenic acid. [NIH] Amitriptyline: Tricyclic antidepressant with anticholinergic and sedative properties. It appears to prevent the re-uptake of norepinephrine and serotonin at nerve terminals, thus potentiating the action of these neurotransmitters. Amitriptyline also appears to antaganize cholinergic and alpha-1 adrenergic responses to bioactive amines. [NIH] Ammonia: A colorless alkaline gas. It is formed in the body during decomposition of organic materials during a large number of metabolically important reactions. [NIH] Amnesia: Lack or loss of memory; inability to remember past experiences. [EU] Amnestic: Nominal aphasia; a difficulty in finding the right name for an object. [NIH] Amnion: The extraembryonic membrane which contains the embryo and amniotic fluid. [NIH]
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Amniotic Fluid: Amniotic cavity fluid which is produced by the amnion and fetal lungs and kidneys. [NIH] Amphetamines: Analogs or derivatives of amphetamine. Many are sympathomimetics and central nervous system stimulators causing excitation, vasopression, bronchodilation, and to varying degrees, anorexia, analepsis, nasal decongestion, and some smooth muscle relaxation. [NIH] Ampulla: A sac-like enlargement of a canal or duct. [NIH] Amputation: Surgery to remove part or all of a limb or appendage. [NIH] Amygdala: Almond-shaped group of basal nuclei anterior to the inferior horn of the lateral ventricle of the brain, within the temporal lobe. The amygdala is part of the limbic system. [NIH]
Anaerobic: 1. Lacking molecular oxygen. 2. Growing, living, or occurring in the absence of molecular oxygen; pertaining to an anaerobe. [EU] Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Anaesthetic: 1. Pertaining to, characterized by, or producing anaesthesia. 2. A drug or agent that is used to abolish the sensation of pain. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Analogous: Resembling or similar in some respects, as in function or appearance, but not in origin or development;. [EU] Anaphylatoxins: The family of peptides C3a, C4a, C5a, and C5a des-arginine produced in the serum during complement activation. They produce smooth muscle contraction, mast cell histamine release, affect platelet aggregation, and act as mediators of the local inflammatory process. The order of anaphylatoxin activity from strongest to weakest is C5a, C3a, C4a, and C5a des-arginine. The latter is the so-called "classical" anaphylatoxin but shows no spasmogenic activity though it contains some chemotactic ability. [NIH] Anaphylaxis: An acute hypersensitivity reaction due to exposure to a previously encountered antigen. The reaction may include rapidly progressing urticaria, respiratory distress, vascular collapse, systemic shock, and death. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Anesthesia, Local: A blocking of nerve conduction to a specific area by an injection of an anesthetic agent. [NIH] Anesthesiology: A specialty concerned with the study of anesthetics and anesthesia. [NIH] Anesthetics: Agents that are capable of inducing a total or partial loss of sensation, especially tactile sensation and pain. They may act to induce general anesthesia, in which an unconscious state is achieved, or may act locally to induce numbness or lack of sensation at a targeted site. [NIH]
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Aneurysm: A sac formed by the dilatation of the wall of an artery, a vein, or the heart. [NIH] Angina: Chest pain that originates in the heart. [NIH] Angioplasty: Endovascular reconstruction of an artery, which may include the removal of atheromatous plaque and/or the endothelial lining as well as simple dilatation. These are procedures performed by catheterization. When reconstruction of an artery is performed surgically, it is called endarterectomy. [NIH] Angiotensinogen: An alpha-globulin of which a fragment of 14 amino acids is converted by renin to angiotensin I, the inactive precursor of angiotensin II. It is a member of the serpin superfamily. [NIH] Animal Husbandry: The science of breeding, feeding, and care of domestic animals; includes housing and nutrition. [NIH] Animal model: An animal with a disease either the same as or like a disease in humans. Animal models are used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Anions: Negatively charged atoms, radicals or groups of atoms which travel to the anode or positive pole during electrolysis. [NIH] Ankle: That part of the lower limb directly above the foot. [NIH] Anomalies: Birth defects; abnormalities. [NIH] Anorexia: Lack or loss of appetite for food. Appetite is psychologic, dependent on memory and associations. Anorexia can be brought about by unattractive food, surroundings, or company. [NIH] Anorexia Nervosa: The chief symptoms are inability to eat, weight loss, and amenorrhea. [NIH]
Anoxia: Clinical manifestation of respiratory distress consisting of a relatively complete absence of oxygen. [NIH] Antagonism: Interference with, or inhibition of, the growth of a living organism by another living organism, due either to creation of unfavorable conditions (e. g. exhaustion of food supplies) or to production of a specific antibiotic substance (e. g. penicillin). [NIH] Anterior Cerebral Artery: Artery formed by the bifurcation of the internal carotid artery. Branches of the anterior cerebral artery supply the caudate nucleus, internal capsule, putamen, septal nuclei, gyrus cinguli, and surfaces of the frontal lobe and parietal lobe. [NIH] Anterograde: Moving or extending forward; called also antegrade. [EU] Anthelmintics: Agents destructive to parasitic worms. They are used therapeutically in the treatment of helminthiasis in man and animal. [NIH] Anthracycline: A member of a family of anticancer drugs that are also antibiotics. [NIH] Anti-Anxiety Agents: Agents that alleviate anxiety, tension, and neurotic symptoms, promote sedation, and have a calming effect without affecting clarity of consciousness or neurologic conditions. Some are also effective as anticonvulsants, muscle relaxants, or anesthesia adjuvants. Adrenergic beta-antagonists are commonly used in the symptomatic treatment of anxiety but are not included here. [NIH] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiosis: A property of microorganisms which enables one microorganism to kill, injure, or inhibit the growth of a different microorganism. [NIH]
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Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]
Antibiotic Prophylaxis: Use of antibiotics before, during, or after a diagnostic, therapeutic, or surgical procedure to prevent infectious complications. [NIH] Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticholinergic: An agent that blocks the parasympathetic nerves. Called also parasympatholytic. [EU] Anticonvulsants: Drugs used to prevent seizures or reduce their severity. [NIH] Antidepressant: A drug used to treat depression. [NIH] Antidote: A remedy for counteracting a poison. [EU] Antiemetic: An agent that prevents or alleviates nausea and vomiting. Also antinauseant. [EU]
Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antigen-Antibody Complex: The complex formed by the binding of antigen and antibody molecules. The deposition of large antigen-antibody complexes leading to tissue damage causes immune complex diseases. [NIH] Antigen-presenting cell: APC. A cell that shows antigen on its surface to other cells of the immune system. This is an important part of an immune response. [NIH] Antihypertensive: An agent that reduces high blood pressure. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Anti-Inflammatory Agents: Substances that reduce or suppress inflammation. [NIH] Antineoplastic: Inhibiting or preventing the development of neoplasms, checking the maturation and proliferation of malignant cells. [EU] Antioxidant: A substance that prevents damage caused by free radicals. Free radicals are highly reactive chemicals that often contain oxygen. They are produced when molecules are split to give products that have unpaired electrons. This process is called oxidation. [NIH] Antiproliferative: Counteracting a process of proliferation. [EU] Antipyretic: An agent that relieves or reduces fever. Called also antifebrile, antithermic and febrifuge. [EU] Antispasmodic: An agent that relieves spasm. [EU] Antiviral: Destroying viruses or suppressing their replication. [EU] Anus: The opening of the rectum to the outside of the body. [NIH]
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Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Anxiolytic: An anxiolytic or antianxiety agent. [EU] Aorta: The main trunk of the systemic arteries. [NIH] Aortic Aneurysm: Aneurysm of the aorta. [NIH] Aortic Valve: The valve between the left ventricle and the ascending aorta which prevents backflow into the left ventricle. [NIH] Apathy: Lack of feeling or emotion; indifference. [EU] Aperture: A natural hole of perforation, especially one in a bone. [NIH] Aphakia: Absence of crystalline lens totally or partially from field of vision, from any cause except after cataract extraction. Aphakia is mainly congenital or as result of lens dislocation and subluxation. [NIH] Aphasia: A cognitive disorder marked by an impaired ability to comprehend or express language in its written or spoken form. This condition is caused by diseases which affect the language areas of the dominant hemisphere. Clinical features are used to classify the various subtypes of this condition. General categories include receptive, expressive, and mixed forms of aphasia. [NIH] Apnea: A transient absence of spontaneous respiration. [NIH] Aponeurosis: Tendinous expansion consisting of a fibrous or membranous sheath which serves as a fascia to enclose or bind a group of muscles. [NIH] Apoptosis: One of the two mechanisms by which cell death occurs (the other being the pathological process of necrosis). Apoptosis is the mechanism responsible for the physiological deletion of cells and appears to be intrinsically programmed. It is characterized by distinctive morphologic changes in the nucleus and cytoplasm, chromatin cleavage at regularly spaced sites, and the endonucleolytic cleavage of genomic DNA (DNA fragmentation) at internucleosomal sites. This mode of cell death serves as a balance to mitosis in regulating the size of animal tissues and in mediating pathologic processes associated with tumor growth. [NIH] Appendectomy: An operation to remove the appendix. [NIH] Applicability: A list of the commodities to which the candidate method can be applied as presented or with minor modifications. [NIH] Aqueous: Having to do with water. [NIH] Arachidonic Acid: An unsaturated, essential fatty acid. It is found in animal and human fat as well as in the liver, brain, and glandular organs, and is a constituent of animal phosphatides. It is formed by the synthesis from dietary linoleic acid and is a precursor in the biosynthesis of prostaglandins, thromboxanes, and leukotrienes. [NIH] Arginine: An essential amino acid that is physiologically active in the L-form. [NIH] Arrhythmia: Any variation from the normal rhythm or rate of the heart beat. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arteriolar: Pertaining to or resembling arterioles. [EU] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Arteriovenous: Both arterial and venous; pertaining to or affecting an artery and a vein. [EU] Arteriovenous Fistula: An abnormal communication between an artery and a vein. [NIH]
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Arthroplasty: Surgical reconstruction of a joint to relieve pain or restore motion. [NIH] Arthroscopy: Endoscopic examination, therapy and surgery of the joint. [NIH] Articular: Of or pertaining to a joint. [EU] Aspartate: A synthetic amino acid. [NIH] Asphyxia: A pathological condition caused by lack of oxygen, manifested in impending or actual cessation of life. [NIH] Aspiration: The act of inhaling. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Asymptomatic: Having no signs or symptoms of disease. [NIH] Atelectasis: Incomplete expansion of the lung. [NIH] Atherectomy: Endovascular procedure in which atheromatous plaque is excised by a cutting or rotating catheter. It differs from balloon and laser angioplasty procedures which enlarge vessels by dilation but frequently do not remove much plaque. If the plaque is removed by surgical excision under general anesthesia rather than by an endovascular procedure through a catheter, it is called endarterectomy. [NIH] Atrial: Pertaining to an atrium. [EU] Atrium: A chamber; used in anatomical nomenclature to designate a chamber affording entrance to another structure or organ. Usually used alone to designate an atrium of the heart. [EU] Atrophy: Decrease in the size of a cell, tissue, organ, or multiple organs, associated with a variety of pathological conditions such as abnormal cellular changes, ischemia, malnutrition, or hormonal changes. [NIH] Atropine: A toxic alkaloid, originally from Atropa belladonna, but found in other plants, mainly Solanaceae. [NIH] Attenuated: Strain with weakened or reduced virulence. [NIH] Attenuation: Reduction of transmitted sound energy or its electrical equivalent. [NIH] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Auditory: Pertaining to the sense of hearing. [EU] Auditory Cortex: Area of the temporal lobe concerned with hearing. [NIH] Autoimmune disease: A condition in which the body recognizes its own tissues as foreign and directs an immune response against them. [NIH] Autologous: Taken from an individual's own tissues, cells, or DNA. [NIH] Autonomic: Self-controlling; functionally independent. [EU] Autonomic Nervous System: The enteric, parasympathetic, and sympathetic nervous systems taken together. Generally speaking, the autonomic nervous system regulates the internal environment during both peaceful activity and physical or emotional stress. Autonomic activity is controlled and integrated by the central nervous system, especially the hypothalamus and the solitary nucleus, which receive information relayed from visceral afferents; these and related central and sensory structures are sometimes (but not here) considered to be part of the autonomic nervous system itself. [NIH] Avoidance Learning: A response to a cue that is instrumental in avoiding a noxious experience. [NIH]
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Axilla: The underarm or armpit. [NIH] Axonal: Condition associated with metabolic derangement of the entire neuron and is manifest by degeneration of the distal portion of the nerve fiber. [NIH] Axons: Nerve fibers that are capable of rapidly conducting impulses away from the neuron cell body. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacterial Physiology: Physiological processes and activities of bacteria. [NIH] Bactericidal: Substance lethal to bacteria; substance capable of killing bacteria. [NIH] Bacteriophage: A virus whose host is a bacterial cell; A virus that exclusively infects bacteria. It generally has a protein coat surrounding the genome (DNA or RNA). One of the coliphages most extensively studied is the lambda phage, which is also one of the most important. [NIH] Barbiturate: A drug with sedative and hypnotic effects. Barbiturates have been used as sedatives and anesthetics, and they have been used to treat the convulsions associated with epilepsy. [NIH] Basal Ganglia: Large subcortical nuclear masses derived from the telencephalon and located in the basal regions of the cerebral hemispheres. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Basement Membrane: Ubiquitous supportive tissue adjacent to epithelium and around smooth and striated muscle cells. This tissue contains intrinsic macromolecular components such as collagen, laminin, and sulfated proteoglycans. As seen by light microscopy one of its subdivisions is the basal (basement) lamina. [NIH] Basophil: A type of white blood cell. Basophils are granulocytes. [NIH] Baths: The immersion or washing of the body or any of its parts in water or other medium for cleansing or medical treatment. It includes bathing for personal hygiene as well as for medical purposes with the addition of therapeutic agents, such as alkalines, antiseptics, oil, etc. [NIH] Belladonna: A species of very poisonous Solanaceous plants yielding atropine (hyoscyamine), scopolamine, and other belladonna alkaloids, used to block the muscarinic autonomic nervous system. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]
Benign prostatic hyperplasia: A benign (noncancerous) condition in which an overgrowth of prostate tissue pushes against the urethra and the bladder, blocking the flow of urine. Also called benign prostatic hypertrophy or BPH. [NIH] Benzene: Toxic, volatile, flammable liquid hydrocarbon biproduct of coal distillation. It is used as an industrial solvent in paints, varnishes, lacquer thinners, gasoline, etc. Benzene causes central nervous system damage acutely and bone marrow damage chronically and is carcinogenic. It was formerly used as parasiticide. [NIH] Benzocaine: A surface anesthetic that acts by preventing transmission of impulses along nerve fibers and at nerve endings. [NIH]
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Benzodiazepines: A two-ring heterocyclic compound consisting of a benzene ring fused to a diazepine ring. Permitted is any degree of hydrogenation, any substituents and any Hisomer. [NIH] Benzyl Alcohol: A colorless liquid with a sharp burning taste and slight odor. It is used as a local anesthetic and to reduce pain associated with lidocaine injection. Also, it is used in the manufacture of other benzyl compounds, as a pharmaceutic aid, and in perfumery and flavoring. [NIH] Bereavement: Refers to the whole process of grieving and mourning and is associated with a deep sense of loss and sadness. [NIH] Bewilderment: Impairment or loss of will power. [NIH] Bicuculline: Isoquinoline alkaloid from Dicentra cucullaria and other plants that is a competitive antagonist at GABA-A receptors and thus causes convulsions. [NIH] Bifida: A defect in development of the vertebral column in which there is a central deficiency of the vertebral lamina. [NIH] Bilateral: Affecting both the right and left side of body. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bile Acids: Acids made by the liver that work with bile to break down fats. [NIH] Bile Acids and Salts: Steroid acids and salts. The primary bile acids are derived from cholesterol in the liver and usually conjugated with glycine or taurine. The secondary bile acids are further modified by bacteria in the intestine. They play an important role in the digestion and absorption of fat. They have also been used pharmacologically, especially in the treatment of gallstones. [NIH] Bile Ducts: Tubes that carry bile from the liver to the gallbladder for storage and to the small intestine for use in digestion. [NIH] Biliary: Having to do with the liver, bile ducts, and/or gallbladder. [NIH] Biliary Tract: The gallbladder and its ducts. [NIH] Bilirubin: A bile pigment that is a degradation product of heme. [NIH] Binding Sites: The reactive parts of a macromolecule that directly participate in its specific combination with another molecule. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biological Transport: The movement of materials (including biochemical substances and drugs) across cell membranes and epithelial layers, usually by passive diffusion. [NIH] Bioluminescence: The emission of light by living organisms such as the firefly, certain mollusks, beetles, fish, bacteria, fungi and protozoa. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH]
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Bladder: The organ that stores urine. [NIH] Blastocyst: The mammalian embryo in the post-morula stage in which a fluid-filled cavity, enclosed primarily by trophoblast, contains an inner cell mass which becomes the embryonic disc. [NIH] Bloating: Fullness or swelling in the abdomen that often occurs after meals. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood Flow Velocity: A value equal to the total volume flow divided by the cross-sectional area of the vascular bed. [NIH] Blood Glucose: Glucose in blood. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood transfusion: The administration of blood or blood products into a blood vessel. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Blood Viscosity: The internal resistance of the blood to shear forces. The in vitro measure of whole blood viscosity is of limited clinical utility because it bears little relationship to the actual viscosity within the circulation, but an increase in the viscosity of circulating blood can contribute to morbidity in patients suffering from disorders such as sickle cell anemia and polycythemia. [NIH] Blood Volume: Volume of circulating blood. It is the sum of the plasma volume and erythrocyte volume. [NIH] Blood-Brain Barrier: Specialized non-fenestrated tightly-joined endothelial cells (tight junctions) that form a transport barrier for certain substances between the cerebral capillaries and the brain tissue. [NIH] Blot: To transfer DNA, RNA, or proteins to an immobilizing matrix such as nitrocellulose. [NIH]
Body Fluids: Liquid components of living organisms. [NIH] Body Mass Index: One of the anthropometric measures of body mass; it has the highest correlation with skinfold thickness or body density. [NIH] Body Regions: Anatomical areas of the body. [NIH] Bone Density: The amount of mineral per square centimeter of bone. This is the definition used in clinical practice. Actual bone density would be expressed in grams per milliliter. It is most frequently measured by photon absorptiometry or x-ray computed tomography. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bottle Feeding: Use of nursing bottles for feeding. Applies to humans and animals. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH]
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Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Brachial: All the nerves from the arm are ripped from the spinal cord. [NIH] Brachial Plexus: The large network of nerve fibers which distributes the innervation of the upper extremity. The brachial plexus extends from the neck into the axilla. In humans, the nerves of the plexus usually originate from the lower cervical and the first thoracic spinal cord segments (C5-C8 and T1), but variations are not uncommon. [NIH] Brachytherapy: A collective term for interstitial, intracavity, and surface radiotherapy. It uses small sealed or partly-sealed sources that may be placed on or near the body surface or within a natural body cavity or implanted directly into the tissues. [NIH] Bradycardia: Excessive slowness in the action of the heart, usually with a heart rate below 60 beats per minute. [NIH] Bradykinin: A nonapeptide messenger that is enzymatically produced from kallidin in the blood where it is a potent but short-lived agent of arteriolar dilation and increased capillary permeability. Bradykinin is also released from mast cells during asthma attacks, from gut walls as a gastrointestinal vasodilator, from damaged tissues as a pain signal, and may be a neurotransmitter. [NIH] Brain Infarction: The formation of an area of necrosis in the brain, including the cerebral hemispheres (cerebral infarction), thalami, basal ganglia, brain stem (brain stem infarctions), or cerebellum secondary to an insufficiency of arterial or venous blood flow. [NIH] Brain Ischemia: Localized reduction of blood flow to brain tissue due to arterial obtruction or systemic hypoperfusion. This frequently occurs in conjuction with brain hypoxia. Prolonged ischemia is associated with brain infarction. [NIH] Brain Stem: The part of the brain that connects the cerebral hemispheres with the spinal cord. It consists of the mesencephalon, pons, and medulla oblongata. [NIH] Brain Stem Infarctions: Infarctions that occur in the brain stem which is comprised of the midbrain, pons, and medulla. There are several named syndromes characterized by their distinctive clinical manifestations and specific sites of ischemic injury. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]
Breakdown: A physical, metal, or nervous collapse. [NIH] Breeding: The science or art of changing the constitution of a population of plants or animals through sexual reproduction. [NIH] Bronchi: The larger air passages of the lungs arising from the terminal bifurcation of the trachea. [NIH] Bronchial: Pertaining to one or more bronchi. [EU] Bronchiseptica: A small, gram-negative, motile bacillus. A normal inhabitant of the respiratory tract in man, dogs, and pigs, but is also associated with canine infectious tracheobronchitis and atrophic rhinitis in pigs. [NIH] Bronchoconstriction: Diminution of the caliber of a bronchus physiologically or as a result of pharmacological intervention. [NIH] Bronchospasm: Spasmodic contraction of the smooth muscle of the bronchi, as occurs in asthma. [EU] Bronchus: A large air passage that leads from the trachea (windpipe) to the lung. [NIH] Buccal: Pertaining to or directed toward the cheek. In dental anatomy, used to refer to the buccal surface of a tooth. [EU]
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Bupivacaine: A widely used local anesthetic agent. [NIH] Butorphanol: A synthetic morphinan analgesic with narcotic antagonist action. It is used in the management of severe pain. [NIH] Bypass: A surgical procedure in which the doctor creates a new pathway for the flow of body fluids. [NIH] Caffeine: A methylxanthine naturally occurring in some beverages and also used as a pharmacological agent. Caffeine's most notable pharmacological effect is as a central nervous system stimulant, increasing alertness and producing agitation. It also relaxes smooth muscle, stimulates cardiac muscle, stimulates diuresis, and appears to be useful in the treatment of some types of headache. Several cellular actions of caffeine have been observed, but it is not entirely clear how each contributes to its pharmacological profile. Among the most important are inhibition of cyclic nucleotide phosphodiesterases, antagonism of adenosine receptors, and modulation of intracellular calcium handling. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Calcium Channels: Voltage-dependent cell membrane glycoproteins selectively permeable to calcium ions. They are categorized as L-, T-, N-, P-, Q-, and R-types based on the activation and inactivation kinetics, ion specificity, and sensitivity to drugs and toxins. The L- and T-types are present throughout the cardiovascular and central nervous systems and the N-, P-, Q-, & R-types are located in neuronal tissue. [NIH] Calmodulin: A heat-stable, low-molecular-weight activator protein found mainly in the brain and heart. The binding of calcium ions to this protein allows this protein to bind to cyclic nucleotide phosphodiesterases and to adenyl cyclase with subsequent activation. Thereby this protein modulates cyclic AMP and cyclic GMP levels. [NIH] Camping: Living outdoors as a recreational activity. [NIH] Cannula: A tube for insertion into a duct or cavity; during insertion its lumen is usually occupied by a trocar. [EU] Capillary: Any one of the minute vessels that connect the arterioles and venules, forming a network in nearly all parts of the body. Their walls act as semipermeable membranes for the interchange of various substances, including fluids, between the blood and tissue fluid; called also vas capillare. [EU] Capital Financing: Institutional funding for facilities and for equipment which becomes a part of the assets of the institution. [NIH] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Carboxy: Cannabinoid. [NIH] Carcinogenic: Producing carcinoma. [EU]
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Carcinogens: Substances that increase the risk of neoplasms in humans or animals. Both genotoxic chemicals, which affect DNA directly, and nongenotoxic chemicals, which induce neoplasms by other mechanism, are included. [NIH] Cardiac: Having to do with the heart. [NIH] Cardiac arrest: A sudden stop of heart function. [NIH] Cardiac catheterization: A procedure in which a thin, hollow tube is inserted into a blood vessel. The tube is then advanced through the vessel into the heart, enabling a physician to study the heart and its pumping activity. [NIH] Cardiac Output: The volume of blood passing through the heart per unit of time. It is usually expressed as liters (volume) per minute so as not to be confused with stroke volume (volume per beat). [NIH] Cardiopulmonary: Having to do with the heart and lungs. [NIH] Cardiopulmonary Bypass: Diversion of the flow of blood from the entrance of the right atrium directly to the aorta (or femoral artery) via an oxygenator thus bypassing both the heart and lungs. [NIH] Cardiorespiratory: Relating to the heart and lungs and their function. [EU] Cardiotonic: 1. Having a tonic effect on the heart. 2. An agent that has a tonic effect on the heart. [EU] Cardiotoxicity: Toxicity that affects the heart. [NIH] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cardiovascular disease: Any abnormal condition characterized by dysfunction of the heart and blood vessels. CVD includes atherosclerosis (especially coronary heart disease, which can lead to heart attacks), cerebrovascular disease (e.g., stroke), and hypertension (high blood pressure). [NIH] Carotene: The general name for a group of pigments found in green, yellow, and leafy vegetables, and yellow fruits. The pigments are fat-soluble, unsaturated aliphatic hydrocarbons functioning as provitamins and are converted to vitamin A through enzymatic processes in the intestinal wall. [NIH] Carrier Proteins: Transport proteins that carry specific substances in the blood or across cell membranes. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Case series: A group or series of case reports involving patients who were given similar treatment. Reports of case series usually contain detailed information about the individual patients. This includes demographic information (for example, age, gender, ethnic origin) and information on diagnosis, treatment, response to treatment, and follow-up after treatment. [NIH] Caspase: Enzyme released by the cell at a crucial stage in apoptosis in order to shred all cellular proteins. [NIH] Catalytic Domain: The region of an enzyme that interacts with its substrate to cause the enzymatic reaction. [NIH] Cataract: An opacity, partial or complete, of one or both eyes, on or in the lens or capsule, especially an opacity impairing vision or causing blindness. The many kinds of cataract are classified by their morphology (size, shape, location) or etiology (cause and time of occurrence). [EU]
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Catecholamine: A group of chemical substances manufactured by the adrenal medulla and secreted during physiological stress. [NIH] Catheterization: Use or insertion of a tubular device into a duct, blood vessel, hollow organ, or body cavity for injecting or withdrawing fluids for diagnostic or therapeutic purposes. It differs from intubation in that the tube here is used to restore or maintain patency in obstructions. [NIH] Catheters: A small, flexible tube that may be inserted into various parts of the body to inject or remove liquids. [NIH] Cations: Postively charged atoms, radicals or groups of atoms which travel to the cathode or negative pole during electrolysis. [NIH] Cauda Equina: The lower part of the spinal cord consisting of the lumbar, sacral, and coccygeal nerve roots. [NIH] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [EU] Causal: Pertaining to a cause; directed against a cause. [EU] Cause of Death: Factors which produce cessation of all vital bodily functions. They can be analyzed from an epidemiologic viewpoint. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Death: The termination of the cell's ability to carry out vital functions such as metabolism, growth, reproduction, responsiveness, and adaptability. [NIH] Cell Differentiation: Progressive restriction of the developmental potential and increasing specialization of function which takes place during the development of the embryo and leads to the formation of specialized cells, tissues, and organs. [NIH] Cell membrane: Cell membrane = plasma membrane. The structure enveloping a cell, enclosing the cytoplasm, and forming a selective permeability barrier; it consists of lipids, proteins, and some carbohydrates, the lipids thought to form a bilayer in which integral proteins are embedded to varying degrees. [EU] Cell proliferation: An increase in the number of cells as a result of cell growth and cell division. [NIH] Cell Respiration: The metabolic process of all living cells (animal and plant) in which oxygen is used to provide a source of energy for the cell. [NIH] Cell Size: The physical dimensions of a cell. It refers mainly to changes in dimensions correlated with physiological or pathological changes in cells. [NIH] Cellobiose: A disaccharide consisting of two glucose units in beta (1-4) glycosidic linkage. Obtained from the partial hydrolysis of cellulose. [NIH] Cellulose: A polysaccharide with glucose units linked as in cellobiose. It is the chief constituent of plant fibers, cotton being the purest natural form of the substance. As a raw material, it forms the basis for many derivatives used in chromatography, ion exchange materials, explosives manufacturing, and pharmaceutical preparations. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Central Nervous System Diseases: Diseases of any component of the brain (including the cerebral hemispheres, diencephalon, brain stem, and cerebellum) or the spinal cord. [NIH] Central Nervous System Infections: Pathogenic infections of the brain, spinal cord, and meninges. DNA virus infections; RNA virus infections; bacterial infections; mycoplasma
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infections; Spirochaetales infections; fungal infections; protozoan infections; helminthiasis; and prion diseases may involve the central nervous system as a primary or secondary process. [NIH] Centrifugation: A method of separating organelles or large molecules that relies upon differential sedimentation through a preformed density gradient under the influence of a gravitational field generated in a centrifuge. [NIH] Cerebellum: Part of the metencephalon that lies in the posterior cranial fossa behind the brain stem. It is concerned with the coordination of movement. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebral Aqueduct: Narrow channel in the mesencephalon that connects the third and fourth ventricles. [NIH] Cerebral hemispheres: The two halves of the cerebrum, the part of the brain that controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. The right hemisphere controls muscle movement on the left side of the body, and the left hemisphere controls muscle movement on the right side of the body. [NIH] Cerebral Infarction: The formation of an area of necrosis in the cerebrum caused by an insufficiency of arterial or venous blood flow. Infarcts of the cerebrum are generally classified by hemisphere (i.e., left vs. right), lobe (e.g., frontal lobe infarction), arterial distribution (e.g., infarction, anterior cerebral artery), and etiology (e.g., embolic infarction). [NIH]
Cerebral Palsy: Refers to a motor disability caused by a brain dysfunction. [NIH] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] Cerebrovascular Disorders: A broad category of disorders characterized by impairment of blood flow in the arteries and veins which supply the brain. These include cerebral infarction; brain ischemia; hypoxia, brain; intracranial embolism and thrombosis; intracranial arteriovenous malformations; and vasculitis, central nervous system. In common usage, the term cerebrovascular disorders is not limited to conditions that affect the cerebrum, but refers to vascular disorders of the entire brain including the diencephalon; brain stem; and cerebellum. [NIH] Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH] Cesarean Section: Extraction of the fetus by means of abdominal hysterotomy. [NIH] Character: In current usage, approximately equivalent to personality. The sum of the relatively fixed personality traits and habitual modes of response of an individual. [NIH] Checkup: A general physical examination. [NIH] Chemotactic Factors: Chemical substances that attract or repel cells or organisms. The concept denotes especially those factors released as a result of tissue injury, invasion, or immunologic activity, that attract leukocytes, macrophages, or other cells to the site of infection or insult. [NIH] Chemotherapy: Treatment with anticancer drugs. [NIH] Chest wall: The ribs and muscles, bones, and joints that make up the area of the body between the neck and the abdomen. [NIH]
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Child Behavior: Any observable response or action of a child from 24 months through 12 years of age. For neonates or children younger than 24 months, infant behavior is available. [NIH]
Chimeras: Organism that contains a mixture of genetically different cells. [NIH] Chloral Hydrate: A hypnotic and sedative used in the treatment of insomnia. The safety margin is too narrow for chloral hydrate to be used as a general anesthetic in humans, but it is commonly used for that purpose in animal experiments. It is no longer considered useful as an anti-anxiety medication. [NIH] Chloride Channels: Cell membrane glycoproteins selective for chloride ions. [NIH] Cholangiography: Radiographic examination of the bile ducts. [NIH] Cholecystectomy: Surgical removal of the gallbladder. [NIH] Cholecystokinin: A 33-amino acid peptide secreted by the upper intestinal mucosa and also found in the central nervous system. It causes gallbladder contraction, release of pancreatic exocrine (or digestive) enzymes, and affects other gastrointestinal functions. Cholecystokinin may be the mediator of satiety. [NIH] Choledocholithiasis: Gallstones in the bile ducts. [NIH] Cholesteatoma: A non-neoplastic keratinizing mass with stratified squamous epithelium, frequently occurring in the meninges, central nervous system, bones of the skull, and most commonly in the middle ear and mastoid region. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Cholinergic: Resembling acetylcholine in pharmacological action; stimulated by or releasing acetylcholine or a related compound. [EU] Chorioretinitis: Inflammation of the choroid in which the sensory retina becomes edematous and opaque. The inflammatory cells and exudate may burst through the sensory retina to cloud the vitreous body. [NIH] Choroid: The thin, highly vascular membrane covering most of the posterior of the eye between the retina and sclera. [NIH] Chromaffin System: The cells of the body which stain with chromium salts. They occur along the sympathetic nerves, in the adrenal gland, and in various other organs. [NIH] Chromatin: The material of chromosomes. It is a complex of DNA, histones, and nonhistone proteins (chromosomal proteins, non-histone) found within the nucleus of a cell. [NIH] Chromosomal: Pertaining to chromosomes. [EU] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic renal: Slow and progressive loss of kidney function over several years, often resulting in end-stage renal disease. People with end-stage renal disease need dialysis or transplantation to replace the work of the kidneys. [NIH] Circadian: Repeated more or less daily, i. e. on a 23- to 25-hour cycle. [NIH] Circadian Rhythm: The regular recurrence, in cycles of about 24 hours, of biological processes or activities, such as sensitivity to drugs and stimuli, hormone secretion, sleeping, feeding, etc. This rhythm seems to be set by a 'biological clock' which seems to be set by recurring daylight and darkness. [NIH] Circulatory system: The system that contains the heart and the blood vessels and moves
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blood throughout the body. This system helps tissues get enough oxygen and nutrients, and it helps them get rid of waste products. The lymph system, which connects with the blood system, is often considered part of the circulatory system. [NIH] Circumcision: Excision of the prepuce or part of it. [NIH] CIS: Cancer Information Service. The CIS is the National Cancer Institute's link to the public, interpreting and explaining research findings in a clear and understandable manner, and providing personalized responses to specific questions about cancer. Access the CIS by calling 1-800-4-CANCER, or by using the Web site at http://cis.nci.nih.gov. [NIH] Clamp: A u-shaped steel rod used with a pin or wire for skeletal traction in the treatment of certain fractures. [NIH] Clear cell carcinoma: A rare type of tumor of the female genital tract in which the inside of the cells looks clear when viewed under a microscope. [NIH] Clinical Medicine: The study and practice of medicine by direct examination of the patient. [NIH]
Clinical Protocols: Precise and detailed plans for the study of a medical or biomedical problem and/or plans for a regimen of therapy. [NIH] Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Clitoral: Pertaining to the clitoris. [EU] Cloaca: The common chamber into which the intestinal, urinary, and genital tracts discharge in birds, reptiles, amphibians and many fishes; also a phylogenetically related embryonic structure in mammals. [NIH] Clonic: Pertaining to or of the nature of clonus. [EU] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Coagulation: 1. The process of clot formation. 2. In colloid chemistry, the solidification of a sol into a gelatinous mass; an alteration of a disperse phase or of a dissolved solid which causes the separation of the system into a liquid phase and an insoluble mass called the clot or curd. Coagulation is usually irreversible. 3. In surgery, the disruption of tissue by physical means to form an amorphous residuum, as in electrocoagulation and photocoagulation. [EU] Cobalt: A trace element that is a component of vitamin B12. It has the atomic symbol Co, atomic number 27, and atomic weight 58.93. It is used in nuclear weapons, alloys, and pigments. Deficiency in animals leads to anemia; its excess in humans can lead to erythrocytosis. [NIH] Coca: Any of several South American shrubs of the Erythroxylon genus (and family) that yield cocaine; the leaves are chewed with alum for CNS stimulation. [NIH] Cocaine: An alkaloid ester extracted from the leaves of plants including coca. It is a local anesthetic and vasoconstrictor and is clinically used for that purpose, particularly in the eye, ear, nose, and throat. It also has powerful central nervous system effects similar to the amphetamines and is a drug of abuse. Cocaine, like amphetamines, acts by multiple mechanisms on brain catecholaminergic neurons; the mechanism of its reinforcing effects is
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thought to involve inhibition of dopamine uptake. [NIH] Cochlea: The part of the internal ear that is concerned with hearing. It forms the anterior part of the labyrinth, is conical, and is placed almost horizontally anterior to the vestibule. [NIH]
Cochlear: Of or pertaining to the cochlea. [EU] Cochlear Diseases: Diseases of the cochlea, the part of the inner ear that is concerned with hearing. [NIH] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Cognition: Intellectual or mental process whereby an organism becomes aware of or obtains knowledge. [NIH] Colitis: Inflammation of the colon. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Collapse: 1. A state of extreme prostration and depression, with failure of circulation. 2. Abnormal falling in of the walls of any part of organ. [EU] Colloidal: Of the nature of a colloid. [EU] Colonoscopy: Endoscopic examination, therapy or surgery of the luminal surface of the colon. [NIH] Combination Therapy: Association of 3 drugs to treat AIDS (AZT + DDC or DDI + protease inhibitor). [NIH] Common Bile Duct: The largest biliary duct. It is formed by the junction of the cystic duct and the hepatic duct. [NIH] Communicable disease: A disease that can be transmitted by contact between persons. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the
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alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complete remission: The disappearance of all signs of cancer. Also called a complete response. [NIH] Compress: A plug used to occludate an orifice in the control of bleeding, or to mop up secretions; an absorbent pad. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Computed tomography: CT scan. A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized tomography and computerized axial tomography (CAT) scan. [NIH] Computerized axial tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called CAT scan, computed tomography (CT scan), or computerized tomography. [NIH] Computerized tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized axial tomography (CAT) scan and computed tomography (CT scan). [NIH] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Concomitant: Accompanying; accessory; joined with another. [EU] Conduction: The transfer of sound waves, heat, nervous impulses, or electricity. [EU] Cones: One type of specialized light-sensitive cells (photoreceptors) in the retina that provide sharp central vision and color vision. [NIH] Confounding: Extraneous variables resulting in outcome effects that obscure or exaggerate the "true" effect of an intervention. [NIH] Confusion: A mental state characterized by bewilderment, emotional disturbance, lack of clear thinking, and perceptual disorientation. [NIH] Congestive heart failure: Weakness of the heart muscle that leads to a buildup of fluid in body tissues. [NIH]
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Conjugated: Acting or operating as if joined; simultaneous. [EU] Conjunctiva: The mucous membrane that lines the inner surface of the eyelids and the anterior part of the sclera. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Conscious Sedation: An alternative to general anesthesia in patients for whom general anesthesia is refused or considered inadvisable. It involves the administering of an antianxiety drug (minor tranquilizer) and an analgesic or local anesthetic. This renders the patient free of anxiety and pain while allowing the patient to remain in verbal contact with the physician or dentist. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Consolidation: The healing process of a bone fracture. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Constitutional: 1. Affecting the whole constitution of the body; not local. 2. Pertaining to the constitution. [EU] Constrict: Tighten; narrow. [NIH] Constriction: The act of constricting. [NIH] Constriction, Pathologic: The condition of an anatomical structure's being constricted beyond normal dimensions. [NIH] Consultation: A deliberation between two or more physicians concerning the diagnosis and the proper method of treatment in a case. [NIH] Consumption: Pulmonary tuberculosis. [NIH] Contamination: The soiling or pollution by inferior material, as by the introduction of organisms into a wound, or sewage into a stream. [EU] Contractility: Capacity for becoming short in response to a suitable stimulus. [EU] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Contralateral: Having to do with the opposite side of the body. [NIH] Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works. [NIH] Controlled study: An experiment or clinical trial that includes a comparison (control) group. [NIH]
Convulsants: Substances that act in the brain stem or spinal cord to produce tonic or clonic convulsions, often by removing normal inhibitory tone. They were formerly used to stimulate respiration or as antidotes to barbiturate overdose. They are now most commonly used as experimental tools. [NIH] Convulsions: A general term referring to sudden and often violent motor activity of cerebral or brainstem origin. Convulsions may also occur in the absence of an electrical cerebral discharge (e.g., in response to hypotension). [NIH] Convulsive: Relating or referring to spasm; affected with spasm; characterized by a spasm or spasms. [NIH]
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Coordination: Muscular or motor regulation or the harmonious cooperation of muscles or groups of muscles, in a complex action or series of actions. [NIH] Cornea: The transparent part of the eye that covers the iris and the pupil and allows light to enter the inside. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Arteriosclerosis: Thickening and loss of elasticity of the coronary arteries. [NIH] Coronary Artery Bypass: Surgical therapy of ischemic coronary artery disease achieved by grafting a section of saphenous vein, internal mammary artery, or other substitute between the aorta and the obstructed coronary artery distal to the obstructive lesion. [NIH] Coronary heart disease: A type of heart disease caused by narrowing of the coronary arteries that feed the heart, which needs a constant supply of oxygen and nutrients carried by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by fat and cholesterol deposits and cannot supply enough blood to the heart, CHD results. [NIH] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Corpus: The body of the uterus. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Cortical: Pertaining to or of the nature of a cortex or bark. [EU] Corticosteroids: Hormones that have antitumor activity in lymphomas and lymphoid leukemias; in addition, corticosteroids (steroids) may be used for hormone replacement and for the management of some of the complications of cancer and its treatment. [NIH] Cortisol: A steroid hormone secreted by the adrenal cortex as part of the body's response to stress. [NIH] Cost Savings: Reductions in all or any portion of the costs of providing goods or services. Savings may be incurred by the provider or the consumer. [NIH] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Craniocerebral Trauma: Traumatic injuries involving the cranium and intracranial structures (i.e., brain; cranial nerves; meninges; and other structures). Injuries may be classified by whether or not the skull is penetrated (i.e., penetrating vs. nonpenetrating) or whether there is an associated hemorrhage. [NIH] Craniofacial Abnormalities: Congenital structural deformities, malformations, or other abnormalities of the cranium and facial bones. [NIH] Credentialing: The recognition of professional or technical competence through registration, certification, licensure, admission to association membership, the award of a diploma or degree, etc. [NIH] Cricoid Cartilage: The small thick cartilage that forms the lower and posterior parts of the laryngeal wall. [NIH] Criterion: A standard by which something may be judged. [EU] Critical Care: Health care provided to a critically ill patient during a medical emergency or crisis. [NIH]
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Crowns: A prosthetic restoration that reproduces the entire surface anatomy of the visible natural crown of a tooth. It may be partial (covering three or more surfaces of a tooth) or complete (covering all surfaces). It is made of gold or other metal, porcelain, or resin. [NIH] Cryptorchidism: A condition in which one or both testicles fail to move from the abdomen, where they develop before birth, into the scrotum. Cryptorchidism may increase the risk for development of testicular cancer. Also called undescended testicles. [NIH] Curare: Plant extracts from several species, including Strychnos toxifera, S. castelnaei, S. crevauxii, and Chondodendron tomentosum, that produce paralysis of skeletal muscle and are used adjunctively with general anesthesia. These extracts are toxic and must be used with the administration of artificial respiration. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Curettage: Removal of tissue with a curette, a spoon-shaped instrument with a sharp edge. [NIH]
Cutaneous: Having to do with the skin. [NIH] Cyanide: An extremely toxic class of compounds that can be lethal on inhaling of ingesting in minute quantities. [NIH] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cyst: A sac or capsule filled with fluid. [NIH] Cystectomy: Used for excision of the urinary bladder. [NIH] Cysteine: A thiol-containing non-essential amino acid that is oxidized to form cystine. [NIH] Cystic Duct: The tube that carries bile from the gallbladder into the common bile duct and the small intestine. [NIH] Cystine: A covalently linked dimeric nonessential amino acid formed by the oxidation of cysteine. Two molecules of cysteine are joined together by a disulfide bridge to form cystine. [NIH]
Cystitis: Inflammation of the urinary bladder. [EU] Cystocele: Fallen bladder. When the bladder falls or sags from its normal position down to the pelvic floor, it can cause either urinary leakage or urinary retention. [NIH] Cystoscopy: Endoscopic examination, therapy or surgery of the urinary bladder. [NIH] Cytochrome: Any electron transfer hemoprotein having a mode of action in which the transfer of a single electron is effected by a reversible valence change of the central iron atom of the heme prosthetic group between the +2 and +3 oxidation states; classified as cytochromes a in which the heme contains a formyl side chain, cytochromes b, which contain protoheme or a closely similar heme that is not covalently bound to the protein, cytochromes c in which protoheme or other heme is covalently bound to the protein, and cytochromes d in which the iron-tetrapyrrole has fewer conjugated double bonds than the hemes have. Well-known cytochromes have been numbered consecutively within groups and are designated by subscripts (beginning with no subscript), e.g. cytochromes c, c1, C2, . New cytochromes are named according to the wavelength in nanometres of the absorption maximum of the a-band of the iron (II) form in pyridine, e.g., c-555. [EU] Cytokine: Small but highly potent protein that modulates the activity of many cell types, including T and B cells. [NIH] Cytomegalovirus: A genus of the family Herpesviridae, subfamily Betaherpesvirinae, infecting the salivary glands, liver, spleen, lungs, eyes, and other organs, in which they produce characteristically enlarged cells with intranuclear inclusions. Infection with
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Cytomegalovirus is also seen as an opportunistic infection in AIDS. [NIH] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Cytotoxic: Cell-killing. [NIH] Dantrolene: Skeletal muscle relaxant that acts by interfering with excitation-contraction coupling in the muscle fiber. It is used in spasticity and other neuromuscular abnormalities. Although the mechanism of action is probably not central, dantrolene is usually grouped with the central muscle relaxants. [NIH] Data Collection: Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data. [NIH] Databases, Bibliographic: Extensive collections, reputedly complete, of references and citations to books, articles, publications, etc., generally on a single subject or specialized subject area. Databases can operate through automated files, libraries, or computer disks. The concept should be differentiated from factual databases which is used for collections of data and facts apart from bibliographic references to them. [NIH] Decarboxylation: The removal of a carboxyl group, usually in the form of carbon dioxide, from a chemical compound. [NIH] Decompensation: Failure of compensation; cardiac decompensation is marked by dyspnea, venous engorgement, and edema. [EU] Decompression: Decompression external to the body, most often the slow lessening of external pressure on the whole body (especially in caisson workers, deep sea divers, and persons who ascend to great heights) to prevent decompression sickness. It includes also sudden accidental decompression, but not surgical (local) decompression or decompression applied through body openings. [NIH] Decompression Sickness: A condition occurring as a result of exposure to a rapid fall in ambient pressure. Gases, nitrogen in particular, come out of solution and form bubbles in body fluid and blood. These gas bubbles accumulate in joint spaces and the peripheral circulation impairing tissue oxygenation causing disorientation, severe pain, and potentially death. [NIH] Decongestant: An agent that reduces congestion or swelling. [EU] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Deletion: A genetic rearrangement through loss of segments of DNA (chromosomes), bringing sequences, which are normally separated, into close proximity. [NIH] Delirium: (DSM III-R) an acute, reversible organic mental disorder characterized by reduced ability to maintain attention to external stimuli and disorganized thinking as manifested by rambling, irrelevant, or incoherent speech; there are also a reduced level of consciousness, sensory misperceptions, disturbance of the sleep-wakefulness cycle and level of psychomotor activity, disorientation to time, place, or person, and memory impairment. Delirium may be caused by a large number of conditions resulting in derangement of cerebral metabolism, including systemic infection, poisoning, drug intoxication or withdrawal, seizures or head trauma, and metabolic disturbances such as hypoxia, hypoglycaemia, fluid, electrolyte, or acid-base imbalances, or hepatic or renal failure. Called also acute confusional state and acute brain syndrome. [EU] Delusion: A false belief, not susceptible to argument or reason, and determined,
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pathologically, by some form of mental disorder. [NIH] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH] Demethylation: Process that releases substantial amounts of carbon dioxide in the liver. [NIH]
Demyelinating Diseases: Diseases characterized by loss or dysfunction of myelin in the central or peripheral nervous system. [NIH] Dendrites: Extensions of the nerve cell body. They are short and branched and receive stimuli from other neurons. [NIH] Dendritic: 1. Branched like a tree. 2. Pertaining to or possessing dendrites. [EU] Dendritic cell: A special type of antigen-presenting cell (APC) that activates T lymphocytes. [NIH]
Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Dental Care: The total of dental diagnostic, preventive, and restorative services provided to meet the needs of a patient (from Illustrated Dictionary of Dentistry, 1982). [NIH] Dental Caries: Localized destruction of the tooth surface initiated by decalcification of the enamel followed by enzymatic lysis of organic structures and leading to cavity formation. If left unchecked, the cavity may penetrate the enamel and dentin and reach the pulp. The three most prominent theories used to explain the etiology of the disase are that acids produced by bacteria lead to decalcification; that micro-organisms destroy the enamel protein; or that keratolytic micro-organisms produce chelates that lead to decalcification. [NIH]
Dental Materials: Materials used in the production of dental bases, restorations, impressions, prostheses, etc. [NIH] Dentate Gyrus: Gray matter situated above the gyrus hippocampi. It is composed of three layers. The molecular layer is continuous with the hippocampus in the hippocampal fissure. The granular layer consists of closely arranged spherical or oval neurons, called granule cells, whose axons pass through the polymorphic layer ending on the dendrites of pyramidal cells in the hippocampus. [NIH] Dentigerous Cyst: Most common follicular odontogenic cyst. Occurs in relation to a partially erupted or unerupted tooth with at least the crown of the tooth to which the cyst is attached protruding into the cystic cavity. May give rise to an ameloblastoma and, in rare instances, undergo malignant transformation. [NIH] Dentists: Individuals licensed to practice dentistry. [NIH] Dentition: The teeth in the dental arch; ordinarily used to designate the natural teeth in position in their alveoli. [EU] Depolarization: The process or act of neutralizing polarity. In neurophysiology, the reversal of the resting potential in excitable cell membranes when stimulated, i.e., the tendency of the cell membrane potential to become positive with respect to the potential outside the cell. [EU] Dermal: Pertaining to or coming from the skin. [NIH] DES: Diethylstilbestrol. A synthetic hormone that was prescribed from the early 1940s until 1971 to help women with complications of pregnancy. DES has been linked to an increased risk of clear cell carcinoma of the vagina in daughters of women who used DES. DES may also increase the risk of breast cancer in women who used DES. [NIH]
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Desensitization: The prevention or reduction of immediate hypersensitivity reactions by administration of graded doses of allergen; called also hyposensitization and immunotherapy. [EU] Detoxification: Treatment designed to free an addict from his drug habit. [EU] Deuterium: Deuterium. The stable isotope of hydrogen. It has one neutron and one proton in the nucleus. [NIH] Dexmedetomidine: A selective inhibitor of receptors, adrenergic alpha-2 that has analgesic and sedative properties. Medetomidine is the other racemic form. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diabetes, Gestational: Either symptomatic diabetes or impaired glucose tolerance induced by pregnancy but resolved at the end of pregnancy. It does not include previously diagnosed diabetics who become pregnant (pregnancy in diabetics). [NIH] Diabetic Ketoacidosis: Complication of diabetes resulting from severe insulin deficiency coupled with an absolute or relative increase in glucagon concentration. The metabolic acidosis is caused by the breakdown of adipose stores and resulting increased levels of free fatty acids. Glucagon accelerates the oxidation of the free fatty acids producing excess ketone bodies (ketosis). [NIH] Diabetic Retinopathy: Retinopathy associated with diabetes mellitus, which may be of the background type, progressively characterized by microaneurysms, interretinal punctuate macular edema, or of the proliferative type, characterized by neovascularization of the retina and optic disk, which may project into the vitreous, proliferation of fibrous tissue, vitreous hemorrhage, and retinal detachment. [NIH] Diagnostic Errors: Incorrect diagnoses after clinical examination or technical diagnostic procedures. [NIH] Diagnostic Imaging: Any visual display of structural or functional patterns of organs or tissues for diagnostic evaluation. It includes measuring physiologic and metabolic responses to physical and chemical stimuli, as well as ultramicroscopy. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diagnostic Services: Organized services for the purpose of providing diagnosis to promote and maintain health. [NIH] Dialyzer: A part of the hemodialysis machine. (See hemodialysis under dialysis.) The dialyzer has two sections separated by a membrane. One section holds dialysate. The other holds the patient's blood. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diarrhoea: Abnormal frequency and liquidity of faecal discharges. [EU] Diastolic: Of or pertaining to the diastole. [EU] Diathermy: The induction of local hyperthermia by either short radio waves or highfrequency sound waves. [NIH] Diclofenac: A non-steroidal anti-inflammatory agent (NSAID) with antipyretic and analgesic actions. It is primarily available as the sodium salt, diclofenac sodium. [NIH] Diclofenac Sodium: The sodium form of diclofenac. It is used for its analgesic and antiinflammatory properties. [NIH] Dicyclomine: A muscarinic antagonist used as an antispasmodic and in urinary incontinence. It has little effect on glandular secretion or the cardiovascular system. It does have some local anesthetic properties and is used in gastrointestinal, biliary, and urinary
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tract spasms. [NIH] Diencephalon: The paired caudal parts of the prosencephalon from which the thalamus, hypothalamus, epithalamus, and subthalamus are derived. [NIH] Diffusion: The tendency of a gas or solute to pass from a point of higher pressure or concentration to a point of lower pressure or concentration and to distribute itself throughout the available space; a major mechanism of biological transport. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Dihydrotestosterone: Anabolic agent. [NIH] Dilatation: The act of dilating. [NIH] Dilatation, Pathologic: The condition of an anatomical structure's being dilated beyond normal dimensions. [NIH] Dilate: Relax; expand. [NIH] Dilation: A process by which the pupil is temporarily enlarged with special eye drops (mydriatic); allows the eye care specialist to better view the inside of the eye. [NIH] Dimethyl: A volatile metabolite of the amino acid methionine. [NIH] Diploid: Having two sets of chromosomes. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Disabled Children: Children with mental or physical disabilities that interfere with usual activities of daily living and that may require accommodation or intervention. [NIH] Discrimination: The act of qualitative and/or quantitative differentiation between two or more stimuli. [NIH] Disease Transmission: The transmission of infectious disease or pathogens. When transmission is within the same species, the mode can be horizontal (disease transmission, horizontal) or vertical (disease transmission, vertical). [NIH] Disease Transmission, Horizontal: The transmission of infectious disease or pathogens from one individual to another in the same generation. [NIH] Disease Transmission, Vertical: The transmission of infectious disease or pathogens from one generation to another. It includes transmission in utero or intrapartum by exposure to blood and secretions, and postpartum exposure via breastfeeding. [NIH] Disinfectant: An agent that disinfects; applied particularly to agents used on inanimate objects. [EU] Dislocation: The displacement of any part, more especially of a bone. Called also luxation. [EU]
Disorientation: The loss of proper bearings, or a state of mental confusion as to time, place, or identity. [EU] Dissection: Cutting up of an organism for study. [NIH] Dissociation: 1. The act of separating or state of being separated. 2. The separation of a molecule into two or more fragments (atoms, molecules, ions, or free radicals) produced by the absorption of light or thermal energy or by solvation. 3. In psychology, a defense mechanism in which a group of mental processes are segregated from the rest of a person's
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mental activity in order to avoid emotional distress, as in the dissociative disorders (q.v.), or in which an idea or object is segregated from its emotional significance; in the first sense it is roughly equivalent to splitting, in the second, to isolation. 4. A defect of mental integration in which one or more groups of mental processes become separated off from normal consciousness and, thus separated, function as a unitary whole. [EU] Dissociative Disorders: Sudden temporary alterations in the normally integrative functions of consciousness. [NIH] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Diuresis: Increased excretion of urine. [EU] Diuretic: A drug that increases the production of urine. [NIH] Diverticula: Plural form of diverticulum. [NIH] Diverticulum: A pathological condition manifested as a pouch or sac opening from a tubular or sacular organ. [NIH] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Dominance: In genetics, the full phenotypic expression of a gene in both heterozygotes and homozygotes. [EU] Dopamine: An endogenous catecholamine and prominent neurotransmitter in several systems of the brain. In the synthesis of catecholamines from tyrosine, it is the immediate precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. A family of dopaminergic receptor subtypes mediate its action. Dopamine is used pharmacologically for its direct (beta adrenergic agonist) and indirect (adrenergic releasing) sympathomimetic effects including its actions as an inotropic agent and as a renal vasodilator. [NIH] Dorsal: 1. Pertaining to the back or to any dorsum. 2. Denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Dorsum: A plate of bone which forms the posterior boundary of the sella turcica. [NIH] Dose-dependent: Refers to the effects of treatment with a drug. If the effects change when the dose of the drug is changed, the effects are said to be dose dependent. [NIH] Dose-rate: The strength of a treatment given over a period of time. [NIH] Dosimetry: All the methods either of measuring directly, or of measuring indirectly and computing, absorbed dose, absorbed dose rate, exposure, exposure rate, dose equivalent, and the science associated with these methods. [NIH] Double-blinded: A clinical trial in which neither the medical staff nor the person knows which of several possible therapies the person is receiving. [NIH] Doxorubicin: Antineoplastic antibiotic obtained from Streptomyces peucetics. It is a hydroxy derivative of daunorubicin and is used in treatment of both leukemia and solid tumors. [NIH] Drip: The continuous slow introduction of a fluid containing nutrients or drugs. [NIH] Drive: A state of internal activity of an organism that is a necessary condition before a given stimulus will elicit a class of responses; e.g., a certain level of hunger (drive) must be present before food will elicit an eating response. [NIH] Drug Delivery Systems: Systems of administering drugs through controlled delivery so that an optimum amount reaches the target site. Drug delivery systems encompass the carrier,
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route, and target. [NIH] Drug Design: The molecular designing of drugs for specific purposes (such as DNAbinding, enzyme inhibition, anti-cancer efficacy, etc.) based on knowledge of molecular properties such as activity of functional groups, molecular geometry, and electronic structure, and also on information cataloged on analogous molecules. Drug design is generally computer-assisted molecular modeling and does not include pharmacokinetics, dosage analysis, or drug administration analysis. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Drug Monitoring: The process of observing, recording, or detecting the effects of a chemical substance administered to an individual therapeutically or diagnostically. [NIH] Drug Tolerance: Progressive diminution of the susceptibility of a human or animal to the effects of a drug, resulting from its continued administration. It should be differentiated from drug resistance wherein an organism, disease, or tissue fails to respond to the intended effectiveness of a chemical or drug. It should also be differentiated from maximum tolerated dose and no-observed-adverse-effect level. [NIH] Duct: A tube through which body fluids pass. [NIH] Duodenal Ulcer: An ulcer in the lining of the first part of the small intestine (duodenum). [NIH]
Duodenum: The first part of the small intestine. [NIH] Dyslipidemia: Disorders in the lipoprotein metabolism; classified as hypercholesterolemia, hypertriglyceridemia, combined hyperlipidemia, and low levels of high-density lipoprotein (HDL) cholesterol. All of the dyslipidemias can be primary or secondary. Both elevated levels of low-density lipoprotein (LDL) cholesterol and low levels of HDL cholesterol predispose to premature atherosclerosis. [NIH] Dyspepsia: Impaired digestion, especially after eating. [NIH] Dyspnea: Difficult or labored breathing. [NIH] Dystrophy: Any disorder arising from defective or faulty nutrition, especially the muscular dystrophies. [EU] Earache: Pain in the ear. [NIH] Eardrum: A thin, tense membrane forming the greater part of the outer wall of the tympanic cavity and separating it from the external auditory meatus; it constitutes the boundary between the external and middle ear. [NIH] Eating Disorders: A group of disorders characterized by physiological and psychological disturbances in appetite or food intake. [NIH] Echocardiography: Ultrasonic recording of the size, motion, and composition of the heart and surrounding tissues. The standard approach is transthoracic. [NIH] Eclampsia: Onset of convulsions or coma in a previously diagnosed pre-eclamptic patient. [NIH]
Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Effector cell: A cell that performs a specific function in response to a stimulus; usually used to describe cells in the immune system. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service
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produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Eicosanoids: A class of oxygenated, endogenous, unsaturated fatty acids derived from arachidonic acid. They include prostaglandins, leukotrienes, thromboxanes, and hydroxyeicosatetraenoic acid compounds (HETE). They are hormone-like substances that act near the site of synthesis without altering functions throughout the body. [NIH] Elasticity: Resistance and recovery from distortion of shape. [NIH] Elective: Subject to the choice or decision of the patient or physician; applied to procedures that are advantageous to the patient but not urgent. [EU] Electrocardiograph: Apparatus which, by means of currents produced by contractions of the cardiac muscle, records heart movements as electro-cardiograms. [NIH] Electrode: Component of the pacing system which is at the distal end of the lead. It is the interface with living cardiac tissue across which the stimulus is transmitted. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electromyography: Recording of the changes in electric potential of muscle by means of surface or needle electrodes. [NIH] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the latter being a high-energy biproduct of nuclear decay. [NIH] Electrophysiological: Pertaining to electrophysiology, that is a branch of physiology that is concerned with the electric phenomena associated with living bodies and involved in their functional activity. [EU] Electroretinogram: The electrical effect recorded from the surface of the eyeball and originated by a pulse of light. [NIH] Electroshock: Induction of a stress reaction in experimental subjects by means of an electrical shock; applies to either convulsive or non-convulsive states. [NIH] Emboli: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] Embolization: The blocking of an artery by a clot or foreign material. Embolization can be done as treatment to block the flow of blood to a tumor. [NIH] Embolus: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Embryo Transfer: Removal of a mammalian embryo from one environment and replacement in the same or a new environment. The embryo is usually in the pre-nidation phase, i.e., a blastocyst. The process includes embryo or blastocyst transplantation or transfer after in vitro fertilization and transfer of the inner cell mass of the blastocyst. It is not used for transfer of differentiated embryonic tissue, e.g., germ layer cells. [NIH] Embryology: The study of the development of an organism during the embryonic and fetal stages of life. [NIH]
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Emesis: Vomiting; an act of vomiting. Also used as a word termination, as in haematemesis. [EU]
Emollient: Softening or soothing; called also malactic. [EU] Enamel: A very hard whitish substance which covers the dentine of the anatomical crown of a tooth. [NIH] Encephalitis: Inflammation of the brain due to infection, autoimmune processes, toxins, and other conditions. Viral infections (see encephalitis, viral) are a relatively frequent cause of this condition. [NIH] Encephalocele: Cerebral tissue herniation through a congenital or acquired defect in the skull. The majority of congenital encephaloceles occur in the occipital or frontal regions. Clinical features include a protuberant mass that may be pulsatile. The quantity and location of protruding neural tissue determines the type and degree of neurologic deficit. Visual defects, psychomotor developmental delay, and persistent motor deficits frequently occur. [NIH]
Endarterectomy: Surgical excision, performed under general anesthesia, of the atheromatous tunica intima of an artery. When reconstruction of an artery is performed as an endovascular procedure through a catheter, it is called atherectomy. [NIH] Endocrine Glands: Ductless glands that secrete substances which are released directly into the circulation and which influence metabolism and other body functions. [NIH] Endocrine System: The system of glands that release their secretions (hormones) directly into the circulatory system. In addition to the endocrine glands, included are the chromaffin system and the neurosecretory systems. [NIH] Endometrium: The layer of tissue that lines the uterus. [NIH] Endorphin: Opioid peptides derived from beta-lipotropin. Endorphin is the most potent naturally occurring analgesic agent. It is present in pituitary, brain, and peripheral tissues. [NIH]
Endoscope: A thin, lighted tube used to look at tissues inside the body. [NIH] Endoscopic: A technique where a lateral-view endoscope is passed orally to the duodenum for visualization of the ampulla of Vater. [NIH] Endoscopy: Endoscopic examination, therapy or surgery performed on interior parts of the body. [NIH] Endothelial cell: The main type of cell found in the inside lining of blood vessels, lymph vessels, and the heart. [NIH] Endothelium: A layer of epithelium that lines the heart, blood vessels (endothelium, vascular), lymph vessels (endothelium, lymphatic), and the serous cavities of the body. [NIH] Endothelium, Lymphatic: Unbroken cellular lining (intima) of the lymph vessels (e.g., the high endothelial lymphatic venules). It is more permeable than vascular endothelium, lacking selective absorption and functioning mainly to remove plasma proteins that have filtered through the capillaries into the tissue spaces. [NIH] Endothelium, Vascular: Single pavement layer of cells which line the luminal surface of the entire vascular system and regulate the transport of macromolecules and blood components from interstitium to lumen; this function has been most intensively studied in the blood capillaries. [NIH] Endothelium-derived: Small molecule that diffuses to the adjacent muscle layer and relaxes it. [NIH] Endotoxins: Toxins closely associated with the living cytoplasm or cell wall of certain
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microorganisms, which do not readily diffuse into the culture medium, but are released upon lysis of the cells. [NIH] Endotracheal intubation: Insertion of an airtube into the windpipe. [NIH] End-stage renal: Total chronic kidney failure. When the kidneys fail, the body retains fluid and harmful wastes build up. A person with ESRD needs treatment to replace the work of the failed kidneys. [NIH] Enflurane: An extremely stable inhalation anesthetic that allows rapid adjustments of anesthesia depth with little change in pulse or respiratory rate. [NIH] Enhancer: Transcriptional element in the virus genome. [NIH] Entorhinal Cortex: Cortex where the signals are combined with those from other sensory systems. [NIH] Enucleation: Removal of the nucleus from an eucaryiotic cell. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]
Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Enzyme Inhibitors: Compounds or agents that combine with an enzyme in such a manner as to prevent the normal substrate-enzyme combination and the catalytic reaction. [NIH] Eosinophils: Granular leukocytes with a nucleus that usually has two lobes connected by a slender thread of chromatin, and cytoplasm containing coarse, round granules that are uniform in size and stainable by eosin. [NIH] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other healthrelated event occurring in such outbreaks. [EU] Epidermal: Pertaining to or resembling epidermis. Called also epidermic or epidermoid. [EU] Epidermal Growth Factor: A 6 kD polypeptide growth factor initially discovered in mouse submaxillary glands. Human epidermal growth factor was originally isolated from urine based on its ability to inhibit gastric secretion and called urogastrone. epidermal growth factor exerts a wide variety of biological effects including the promotion of proliferation and differentiation of mesenchymal and epithelial cells. [NIH] Epidermis: Nonvascular layer of the skin. It is made up, from within outward, of five layers: 1) basal layer (stratum basale epidermidis); 2) spinous layer (stratum spinosum epidermidis); 3) granular layer (stratum granulosum epidermidis); 4) clear layer (stratum lucidum epidermidis); and 5) horny layer (stratum corneum epidermidis). [NIH] Epidural: The space between the wall of the spinal canal and the covering of the spinal cord. An epidural injection is given into this space. [NIH] Epidural block: An injection of an anesthetic drug into the space between the wall of the spinal canal and the covering of the spinal cord. [NIH] Epigastric: Having to do with the upper middle area of the abdomen. [NIH] Epilepsia: An illusional seizure consisting of a rather sudden alteration of the patient's perceptions, indicative of a lesion in the temporal lobes. [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi
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and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Epirubicin: An anthracycline antibiotic which is the 4'-epi-isomer of doxorubicin. The compound exerts its antitumor effects by interference with the synthesis and function of DNA. Clinical studies indicate activity in breast cancer, non-Hodgkin's lymphomas, ovarian cancer, soft-tissue sarcomas, pancreatic cancer, gastric cancer, small-cell lung cancer and acute leukemia. It is equal in activity to doxorubicin but exhibits less acute toxicities and less cardiotoxicity. [NIH] Episode of Care: An interval of care by a health care facility or provider for a specific medical problem or condition. It may be continuous or it may consist of a series of intervals marked by one or more brief separations from care, and can also identify the sequence of care (e.g., emergency, inpatient, outpatient), thus serving as one measure of health care provided. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelial Cells: Cells that line the inner and outer surfaces of the body. [NIH] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] Erectile: The inability to get or maintain an erection for satisfactory sexual intercourse. Also called impotence. [NIH] Erection: The condition of being made rigid and elevated; as erectile tissue when filled with blood. [EU] Erythrocyte Volume: Volume of circulating erythrocytes. It is usually measured by radioisotope dilution technique. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Esophageal: Having to do with the esophagus, the muscular tube through which food passes from the throat to the stomach. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]
Estradiol: The most potent mammalian estrogenic hormone. It is produced in the ovary, placenta, testis, and possibly the adrenal cortex. [NIH] Estrogen: One of the two female sex hormones. [NIH] Ethanol: A clear, colorless liquid rapidly absorbed from the gastrointestinal tract and distributed throughout the body. It has bactericidal activity and is used often as a topical disinfectant. It is widely used as a solvent and preservative in pharmaceutical preparations as well as serving as the primary ingredient in alcoholic beverages. [NIH] Ether: One of a class of organic compounds in which any two organic radicals are attached directly to a single oxygen atom. [NIH] Ethmoid: An unpaired cranial bone which helps form the medial walls of the orbits and contains the themoidal air cells which drain into the nose. [NIH] Eukaryotic Cells: Cells of the higher organisms, containing a true nucleus bounded by a nuclear membrane. [NIH] Euphoria: An exaggerated feeling of physical and emotional well-being not consonant with apparent stimuli or events; usually of psychologic origin, but also seen in organic brain disease and toxic states. [NIH] Eustachian tube: The middle ear cavity is in communication with the back of the nose
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through the Eustachian tube, which is normally closed, but opens on swallowing, in order to maintain equal air pressure. [NIH] Evacuation: An emptying, as of the bowels. [EU] Evoke: The electric response recorded from the cerebral cortex after stimulation of a peripheral sense organ. [NIH] Evoked Potentials: The electric response evoked in the central nervous system by stimulation of sensory receptors or some point on the sensory pathway leading from the receptor to the cortex. The evoked stimulus can be auditory, somatosensory, or visual, although other modalities have been reported. Event-related potentials is sometimes used synonymously with evoked potentials but is often associated with the execution of a motor, cognitive, or psychophysiological task, as well as with the response to a stimulus. [NIH] Excipient: Any more or less inert substance added to a prescription in order to confer a suitable consistency or form to the drug; a vehicle. [EU] Excitability: Property of a cardiac cell whereby, when the cell is depolarized to a critical level (called threshold), the membrane becomes permeable and a regenerative inward current causes an action potential. [NIH] Excitation: An act of irritation or stimulation or of responding to a stimulus; the addition of energy, as the excitation of a molecule by absorption of photons. [EU] Excitatory: When cortical neurons are excited, their output increases and each new input they receive while they are still excited raises their output markedly. [NIH] Excitatory Amino Acid Agonists: Drugs that bind to and activate excitatory amino acid receptors. [NIH] Excitatory Amino Acids: Endogenous amino acids released by neurons as excitatory neurotransmitters. Glutamic acid is the most common excitatory neurotransmitter in the brain. Aspartic acid has been regarded as an excitatory transmitter for many years, but the extent of its role as a transmitter is unclear. [NIH] Excitotoxicity: Excessive exposure to glutamate or related compounds can kill brain neurons, presumably by overstimulating them. [NIH] Excrete: To get rid of waste from the body. [NIH] Exhaustion: The feeling of weariness of mind and body. [NIH] Exocrine: Secreting outwardly, via a duct. [EU] Exocytosis: Cellular release of material within membrane-limited vesicles by fusion of the vesicles with the cell membrane. [NIH] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Exon: The part of the DNA that encodes the information for the actual amino acid sequence of the protein. In many eucaryotic genes, the coding sequences consist of a series of exons alternating with intron sequences. [NIH] Expander: Any of several colloidal substances of high molecular weight. used as a blood or plasma substitute in transfusion for increasing the volume of the circulating blood. called also extender. [NIH] Expiration: The act of breathing out, or expelling air from the lungs. [EU] Expiratory: The volume of air which leaves the breathing organs in each expiration. [NIH] Extender: Any of several colloidal substances of high molecular weight, used as a blood or plasma substitute in transfusion for increasing the volume of the circulating blood. [NIH] External-beam radiation: Radiation therapy that uses a machine to aim high-energy rays at
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the cancer. Also called external radiation. [NIH] Extracellular: Outside a cell or cells. [EU] Extracellular Matrix: A meshwork-like substance found within the extracellular space and in association with the basement membrane of the cell surface. It promotes cellular proliferation and provides a supporting structure to which cells or cell lysates in culture dishes adhere. [NIH] Extracellular Space: Interstitial space between cells, occupied by fluid as well as amorphous and fibrous substances. [NIH] Extracorporeal: Situated or occurring outside the body. [EU] Extracorporeal Circulation: Diversion of blood flow through a circuit located outside the body but continuous with the bodily circulation. [NIH] Extraction: The process or act of pulling or drawing out. [EU] Extrapyramidal: Outside of the pyramidal tracts. [EU] Extravascular: Situated or occurring outside a vessel or the vessels. [EU] Extremity: A limb; an arm or leg (membrum); sometimes applied specifically to a hand or foot. [EU] Facial: Of or pertaining to the face. [EU] Facial Injuries: General or unspecified injuries to the soft tissue or bony portions of the face. [NIH]
Facial Nerve: The 7th cranial nerve. The facial nerve has two parts, the larger motor root which may be called the facial nerve proper, and the smaller intermediate or sensory root. Together they provide efferent innervation to the muscles of facial expression and to the lacrimal and salivary glands, and convey afferent information for taste from the anterior two-thirds of the tongue and for touch from the external ear. [NIH] Facial Pain: Pain in the facial region including orofacial pain and craniofacial pain. Associated conditions include local inflammatory and neoplastic disorders and neuralgic syndromes involving the trigeminal, facial, and glossopharyngeal nerves. Conditions which feature recurrent or persistent facial pain as the primary manifestation of disease are referred to as facial pain syndromes. [NIH] Faecal: Pertaining to or of the nature of feces. [EU] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]
Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH] Fatty Liver: The buildup of fat in liver cells. The most common cause is alcoholism. Other causes include obesity, diabetes, and pregnancy. Also called steatosis. [NIH] Febrile: Pertaining to or characterized by fever. [EU] Femoral: Pertaining to the femur, or to the thigh. [EU] Femur: The longest and largest bone of the skeleton, it is situated between the hip and the knee. [NIH] Fentanyl: A narcotic opioid drug that is used in the treatment of pain. [NIH]
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Fertilization in Vitro: Fertilization of an egg outside the body when the egg is normally fertilized in the body. [NIH] Fetal Development: Morphologic and physiologic growth and development of the mammalian embryo or fetus. [NIH] Fetal Heart: The heart of the fetus of any viviparous animal. It refers to the heart in the postembryonic period and is differentiated from the embryonic heart (heart/embryology) only on the basis of time. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibrillation: A small, local, involuntary contraction of muscle, invisible under the skin, resulting from spontaneous activation of single muscle cells or muscle fibres. [EU] Fibrin: A protein derived from fibrinogen in the presence of thrombin, which forms part of the blood clot. [NIH] Fibrinogen: Plasma glycoprotein clotted by thrombin, composed of a dimer of three nonidentical pairs of polypeptide chains (alpha, beta, gamma) held together by disulfide bonds. Fibrinogen clotting is a sol-gel change involving complex molecular arrangements: whereas fibrinogen is cleaved by thrombin to form polypeptides A and B, the proteolytic action of other enzymes yields different fibrinogen degradation products. [NIH] Fibronectin: An adhesive glycoprotein. One form circulates in plasma, acting as an opsonin; another is a cell-surface protein which mediates cellular adhesive interactions. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Fine-needle aspiration: The removal of tissue or fluid with a needle for examination under a microscope. Also called needle biopsy. [NIH] Fissure: Any cleft or groove, normal or otherwise; especially a deep fold in the cerebral cortex which involves the entire thickness of the brain wall. [EU] Fistula: Abnormal communication most commonly seen between two internal organs, or between an internal organ and the surface of the body. [NIH] Fixation: 1. The act or operation of holding, suturing, or fastening in a fixed position. 2. The condition of being held in a fixed position. 3. In psychiatry, a term with two related but distinct meanings : (1) arrest of development at a particular stage, which like regression (return to an earlier stage), if temporary is a normal reaction to setbacks and difficulties but if protracted or frequent is a cause of developmental failures and emotional problems, and (2) a close and suffocating attachment to another person, especially a childhood figure, such as one's mother or father. Both meanings are derived from psychoanalytic theory and refer to 'fixation' of libidinal energy either in a specific erogenous zone, hence fixation at the oral, anal, or phallic stage, or in a specific object, hence mother or father fixation. 4. The use of a fixative (q.v.) to preserve histological or cytological specimens. 5. In chemistry, the process whereby a substance is removed from the gaseous or solution phase and localized, as in carbon dioxide fixation or nitrogen fixation. 6. In ophthalmology, direction of the gaze so that the visual image of the object falls on the fovea centralis. 7. In film processing, the chemical removal of all undeveloped salts of the film emulsion, leaving only the developed silver to form a permanent image. [EU] Flatus: Gas passed through the rectum. [NIH] Flow Cytometry: Technique using an instrument system for making, processing, and displaying one or more measurements on individual cells obtained from a cell suspension. Cells are usually stained with one or more fluorescent dyes specific to cell components of interest, e.g., DNA, and fluorescence of each cell is measured as it rapidly transverses the
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excitation beam (laser or mercury arc lamp). Fluorescence provides a quantitative measure of various biochemical and biophysical properties of the cell, as well as a basis for cell sorting. Other measurable optical parameters include light absorption and light scattering, the latter being applicable to the measurement of cell size, shape, density, granularity, and stain uptake. [NIH] Fluorescence: The property of emitting radiation while being irradiated. The radiation emitted is usually of longer wavelength than that incident or absorbed, e.g., a substance can be irradiated with invisible radiation and emit visible light. X-ray fluorescence is used in diagnosis. [NIH] Fluorescent Dyes: Dyes that emit light when exposed to light. The wave length of the emitted light is usually longer than that of the incident light. Fluorochromes are substances that cause fluorescence in other substances, i.e., dyes used to mark or label other compounds with fluorescent tags. They are used as markers in biochemistry and immunology. [NIH] Flutter: A rapid vibration or pulsation. [EU] Folate: A B-complex vitamin that is being studied as a cancer prevention agent. Also called folic acid. [NIH] Fold: A plication or doubling of various parts of the body. [NIH] Folic Acid: N-(4-(((2-Amino-1,4-dihydro-4-oxo-6-pteridinyl)methyl)amino)benzoyl)-Lglutamic acid. A member of the vitamin B family that stimulates the hematopoietic system. It is present in the liver and kidney and is found in mushrooms, spinach, yeast, green leaves, and grasses. Folic acid is used in the treatment and prevention of folate deficiencies and megaloblastic anemia. [NIH] Foot Ulcer: Lesion on the surface of the skin of the foot, usually accompanied by inflammation. The lesion may become infected or necrotic and is frequently associated with diabetes or leprosy. [NIH] Foramen: A natural hole of perforation, especially one in a bone. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Fossa: A cavity, depression, or pit. [NIH] Fractionation: Dividing the total dose of radiation therapy into several smaller, equal doses delivered over a period of several days. [NIH] Friction: Surface resistance to the relative motion of one body against the rubbing, sliding, rolling, or flowing of another with which it is in contact. [NIH] Frontal Lobe: The anterior part of the cerebral hemisphere. [NIH] Frostbite: Damage to tissues as the result of low environmental temperatures. [NIH] Functional magnetic resonance imaging: A noninvasive tool used to observe functioning in the brain or other organs by detecting changes in chemical composition, blood flow, or both. [NIH]
Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gamma Rays: Very powerful and penetrating, high-energy electromagnetic radiation of shorter wavelength than that of x-rays. They are emitted by a decaying nucleus, usually between 0.01 and 10 MeV. They are also called nuclear x-rays. [NIH] Gamma-hydroxybutyrate: Anxiolytic. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH]
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Ganglion: 1. A knot, or knotlike mass. 2. A general term for a group of nerve cell bodies located outside the central nervous system; occasionally applied to certain nuclear groups within the brain or spinal cord, e.g. basal ganglia. 3. A benign cystic tumour occurring on a aponeurosis or tendon, as in the wrist or dorsum of the foot; it consists of a thin fibrous capsule enclosing a clear mucinous fluid. [EU] Gap Junctions: Connections between cells which allow passage of small molecules and electric current. Gap junctions were first described anatomically as regions of close apposition between cells with a narrow (1-2 nm) gap between cell membranes. The variety in the properties of gap junctions is reflected in the number of connexins, the family of proteins which form the junctions. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gas exchange: Primary function of the lungs; transfer of oxygen from inhaled air into the blood and of carbon dioxide from the blood into the lungs. [NIH] Gastric: Having to do with the stomach. [NIH] Gastric Emptying: The evacuation of food from the stomach into the duodenum. [NIH] Gastric Juices: Liquids produced in the stomach to help break down food and kill bacteria. [NIH]
Gastric Mucosa: Surface epithelium in the stomach that invaginates into the lamina propria, forming gastric pits. Tubular glands, characteristic of each region of the stomach (cardiac, gastric, and pyloric), empty into the gastric pits. The gastric mucosa is made up of several different kinds of cells. [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]
Gastritis: Inflammation of the stomach. [EU] Gastroenterology: A subspecialty of internal medicine concerned with the study of the physiology and diseases of the digestive system and related structures (esophagus, liver, gallbladder, and pancreas). [NIH] Gastroenterostomy: Surgical construction of a channel between the stomach and intestines. [NIH]
Gastroesophageal Reflux: Reflux of gastric juice and/or duodenal contents (bile acids, pancreatic juice) into the distal esophagus, commonly due to incompetence of the lower esophageal sphincter. Gastric regurgitation is an extension of this process with entry of fluid into the pharynx or mouth. [NIH] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal Hemorrhage: Bleeding in the gastrointestinal tract. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gelatin: A product formed from skin, white connective tissue, or bone collagen. It is used as a protein food adjuvant, plasma substitute, hemostatic, suspending agent in pharmaceutical preparations, and in the manufacturing of capsules and suppositories. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]
Gene Expression: The phenotypic manifestation of a gene or genes by the processes of gene action. [NIH] Gene Targeting: The integration of exogenous DNA into the genome of an organism at sites
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where its expression can be suitably controlled. This integration occurs as a result of homologous recombination. [NIH] General practitioner: A medical practitioner who does not specialize in a particular branch of medicine or limit his practice to a specific class of diseases. [NIH] Generator: Any system incorporating a fixed parent radionuclide from which is produced a daughter radionuclide which is to be removed by elution or by any other method and used in a radiopharmaceutical. [NIH] Genetic Counseling: Advising families of the risks involved pertaining to birth defects, in order that they may make an informed decision on current or future pregnancies. [NIH] Genetic Markers: A phenotypically recognizable genetic trait which can be used to identify a genetic locus, a linkage group, or a recombination event. [NIH] Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Genital: Pertaining to the genitalia. [EU] Genitourinary: Pertaining to the genital and urinary organs; urogenital; urinosexual. [EU] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Geriatric: Pertaining to the treatment of the aged. [EU] Germ Cells: The reproductive cells in multicellular organisms. [NIH] Gestation: The period of development of the young in viviparous animals, from the time of fertilization of the ovum until birth. [EU] Gestational: Psychosis attributable to or occurring during pregnancy. [NIH] Gestational Age: Age of the conceptus. In humans, this may be assessed by medical history, physical examination, early immunologic pregnancy tests, radiography, ultrasonography, and amniotic fluid analysis. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glomerular: Pertaining to or of the nature of a glomerulus, especially a renal glomerulus. [EU]
Glomerular Filtration Rate: The volume of water filtered out of plasma through glomerular capillary walls into Bowman's capsules per unit of time. It is considered to be equivalent to inulin clearance. [NIH] Glomerulus: A tiny set of looping blood vessels in the nephron where blood is filtered in the kidney. [NIH] Glossopharyngeal Nerve: The 9th cranial nerve. The glossopharyngeal nerve is a mixed motor and sensory nerve; it conveys somatic and autonomic efferents as well as general, special, and visceral afferents. Among the connections are motor fibers to the stylopharyngeus muscle, parasympathetic fibers to the parotid glands, general and taste afferents from the posterior third of the tongue, the nasopharynx, and the palate, and afferents from baroreceptors and chemoreceptors of the carotid sinus. [NIH] Glottis: The vocal apparatus of the larynx, consisting of the true vocal cords (plica vocalis) and the opening between them (rima glottidis). [NIH] Glucocorticoid: A compound that belongs to the family of compounds called corticosteroids (steroids). Glucocorticoids affect metabolism and have anti-inflammatory and immunosuppressive effects. They may be naturally produced (hormones) or synthetic
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(drugs). [NIH] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucose Intolerance: A pathological state in which the fasting plasma glucose level is less than 140 mg per deciliter and the 30-, 60-, or 90-minute plasma glucose concentration following a glucose tolerance test exceeds 200 mg per deciliter. This condition is seen frequently in diabetes mellitus but also occurs with other diseases. [NIH] Glucose tolerance: The power of the normal liver to absorb and store large quantities of glucose and the effectiveness of intestinal absorption of glucose. The glucose tolerance test is a metabolic test of carbohydrate tolerance that measures active insulin, a hepatic function based on the ability of the liver to absorb glucose. The test consists of ingesting 100 grams of glucose into a fasting stomach; blood sugar should return to normal in 2 to 21 hours after ingestion. [NIH] Glucuronic Acid: Derivatives of uronic acid found throughout the plant and animal kingdoms. They detoxify drugs and toxins by conjugating with them to form glucuronides in the liver which are more water-soluble metabolites that can be easily eliminated from the body. [NIH] Glutamate: Excitatory neurotransmitter of the brain. [NIH] Glutamic Acid: A non-essential amino acid naturally occurring in the L-form. Glutamic acid (glutamate) is the most common excitatory neurotransmitter in the central nervous system. [NIH]
Glycerol: A trihydroxy sugar alcohol that is an intermediate in carbohydrate and lipid metabolism. It is used as a solvent, emollient, pharmaceutical agent, and sweetening agent. [NIH]
Glycine: A non-essential amino acid. It is found primarily in gelatin and silk fibroin and used therapeutically as a nutrient. It is also a fast inhibitory neurotransmitter. [NIH] Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Glycopyrrolate: A muscarinic antagonist used as an antispasmodic, in some disorders of the gastrointestinal tract, and to reduce salivation with some anesthetics. [NIH] Gonadal: Pertaining to a gonad. [EU] Goniotomy: A surgical procedure for congenital glaucoma in which a sweeping incision is made in the neshwork at the filtration angle by means of a knife-needle inserted through the opposite limbus and carried across the anterior chamber parallel to the iris. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Grafting: The operation of transfer of tissue from one site to another. [NIH] Granulocytes: Leukocytes with abundant granules in the cytoplasm. They are divided into three groups: neutrophils, eosinophils, and basophils. [NIH] Gravis: Eruption of watery blisters on the skin among those handling animals and animal products. [NIH] Groin: The external junctural region between the lower part of the abdomen and the thigh. [NIH]
Growth: The progressive development of a living being or part of an organism from its
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earliest stage to maturity. [NIH] Guanylate Cyclase: An enzyme that catalyzes the conversion of GTP to 3',5'-cyclic GMP and pyrophosphate. It also acts on ITP and dGTP. (From Enzyme Nomenclature, 1992) EC 4.6.1.2. [NIH] Habitual: Of the nature of a habit; according to habit; established by or repeated by force of habit, customary. [EU] Haematemesis: The vomiting of blood. [EU] Halitosis: An offensive, foul breath odor resulting from a variety of causes such as poor oral hygiene, dental or oral infections, or the ingestion of certain foods. [NIH] Hallucination: A sense perception without a source in the external world; a perception of an external stimulus object in the absence of such an object. [EU] Handwashing: The act of cleansing the hands with water or other liquid, with or without the inclusion of soap or other detergent, for the purpose of removing soil or microorganisms. [NIH] Haptens: Small antigenic determinants capable of eliciting an immune response only when coupled to a carrier. Haptens bind to antibodies but by themselves cannot elicit an antibody response. [NIH] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] Headache Disorders: Common conditions characterized by persistent or recurrent headaches. Headache syndrome classification systems may be based on etiology (e.g., vascular headache, post-traumatic headaches, etc.), temporal pattern (e.g., cluster headache, paroxysmal hemicrania, etc.), and precipitating factors (e.g., cough headache). [NIH] Health Behavior: Behaviors expressed by individuals to protect, maintain or promote their health status. For example, proper diet, and appropriate exercise are activities perceived to influence health status. Life style is closely associated with health behavior and factors influencing life style are socioeconomic, educational, and cultural. [NIH] Health Services: Services for the diagnosis and treatment of disease and the maintenance of health. [NIH] Health Status: The level of health of the individual, group, or population as subjectively assessed by the individual or by more objective measures. [NIH] Heart attack: A seizure of weak or abnormal functioning of the heart. [NIH] Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, breathlessness, and excess fluid accumulation in body tissues. [NIH] Heartbeat: One complete contraction of the heart. [NIH] Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Helminthiasis: Infestation with parasitic worms of the helminth class. [NIH] Hematoma: An extravasation of blood localized in an organ, space, or tissue. [NIH] Hematuria: Presence of blood in the urine. [NIH] Heme: The color-furnishing portion of hemoglobin. It is found free in tissues and as the prosthetic group in many hemeproteins. [NIH]
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Hemodialysis: The use of a machine to clean wastes from the blood after the kidneys have failed. The blood travels through tubes to a dialyzer, which removes wastes and extra fluid. The cleaned blood then flows through another set of tubes back into the body. [NIH] Hemodialyzer: Apparatus for hemodialysis performing the functions of human kidneys in place of the damaged organs; highly specialized medical equipment used for treating kidney failure by passing the body's toxic substances through an external artificial kidney. [NIH] Hemodilution: Reduction of blood viscosity usually by the addition of cell free solutions. Used clinically l) in states of impaired microcirculation, 2) for replacement of intraoperative blood loss without homologous blood transfusion, and 3) in cardiopulmonary bypass and hypothermia. [NIH] Hemodynamics: The movements of the blood and the forces involved in systemic or regional blood circulation. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemoglobin C: A commonly occurring abnormal hemoglobin in which lysine replaces a glutamic acid residue at the sixth position of the beta chains. It results in reduced plasticity of erythrocytes. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemorrhagic stroke: A disorder involving bleeding within ischemic brain tissue. Hemorrhagic stroke occurs when blood vessels that are damaged or dead from lack of blood supply (infarcted), located within an area of infarcted brain tissue, rupture and transform an "ischemic" stroke into a hemorrhagic stroke. Ischemia is inadequate tissue oxygenation caused by reduced blood flow; infarction is tissue death resulting from ischemia. Bleeding irritates the brain tissues, causing swelling (cerebral edema). Blood collects into a mass (hematoma). Both swelling and hematoma will compress and displace brain tissue. [NIH] Hemorrhoid: An enlarged or swollen blood vessel, usually located near the anus or the rectum. [NIH] Hemorrhoidectomy: An operation to remove hemorrhoids. [NIH] Hemostasis: The process which spontaneously arrests the flow of blood from vessels carrying blood under pressure. It is accomplished by contraction of the vessels, adhesion and aggregation of formed blood elements, and the process of blood or plasma coagulation. [NIH]
Heparin: Heparinic acid. A highly acidic mucopolysaccharide formed of equal parts of sulfated D-glucosamine and D-glucuronic acid with sulfaminic bridges. The molecular weight ranges from six to twenty thousand. Heparin occurs in and is obtained from liver, lung, mast cells, etc., of vertebrates. Its function is unknown, but it is used to prevent blood clotting in vivo and vitro, in the form of many different salts. [NIH] Hepatic: Refers to the liver. [NIH] Hepatic Encephalopathy: A condition that may cause loss of consciousness and coma. It is usually the result of advanced liver disease. Also called hepatic coma. [NIH]
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Hepatitis: Inflammation of the liver and liver disease involving degenerative or necrotic alterations of hepatocytes. [NIH] Hepatitis A: Hepatitis caused by hepatovirus. It can be transmitted through fecal contamination of food or water. [NIH] Hepatocytes: The main structural component of the liver. They are specialized epithelial cells that are organized into interconnected plates called lobules. [NIH] Hepatology: The field of medicine concerned with the functions and disorders of the liver. [NIH]
Hepatovirus: A genus of Picornaviridae causing infectious hepatitis naturally in humans and experimentally in other primates. It is transmitted through fecal contamination of food or water. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Hernia: Protrusion of a loop or knuckle of an organ or tissue through an abnormal opening. [NIH]
Herniorrhaphy: An operation to repair a hernia. [NIH] Heterodimer: Zippered pair of nonidentical proteins. [NIH] Heterogeneity: The property of one or more samples or populations which implies that they are not identical in respect of some or all of their parameters, e. g. heterogeneity of variance. [NIH]
Heterozygotes: Having unlike alleles at one or more corresponding loci on homologous chromosomes. [NIH] Hippocampus: A curved elevation of gray matter extending the entire length of the floor of the temporal horn of the lateral ventricle (Dorland, 28th ed). The hippocampus, subiculum, and dentate gyrus constitute the hippocampal formation. Sometimes authors include the entorhinal cortex in the hippocampal formation. [NIH] Histamine: 1H-Imidazole-4-ethanamine. A depressor amine derived by enzymatic decarboxylation of histidine. It is a powerful stimulant of gastric secretion, a constrictor of bronchial smooth muscle, a vasodilator, and also a centrally acting neurotransmitter. [NIH] Histamine Release: The secretion of histamine from mast cell and basophil granules by exocytosis. This can be initiated by a number of factors, all of which involve binding of IgE, cross-linked by antigen, to the mast cell or basophil's Fc receptors. Once released, histamine binds to a number of different target cell receptors and exerts a wide variety of effects. [NIH] Histidine: An essential amino acid important in a number of metabolic processes. It is required for the production of histamine. [NIH] Histology: The study of tissues and cells under a microscope. [NIH] Homeostasis: The processes whereby the internal environment of an organism tends to remain balanced and stable. [NIH] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Homozygotes: An individual having a homozygous gene pair. [NIH] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH]
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Hospice: Institution dedicated to caring for the terminally ill. [NIH] Hospital Charges: The prices a hospital sets for its services. Hospital costs (the direct and indirect expenses incurred by the hospital in providing the services) are one factor in the determination of hospital charges. Other factors may include, for example, profits, competition, and the necessity of recouping the costs of uncompensated care. [NIH] Host: Any animal that receives a transplanted graft. [NIH] Hydration: Combining with water. [NIH] Hydrochloric Acid: A strong corrosive acid that is commonly used as a laboratory reagent. It is formed by dissolving hydrogen chloride in water. Gastric acid is the hydrochloric acid component of gastric juice. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrogen Bonding: A low-energy attractive force between hydrogen and another element. It plays a major role in determining the properties of water, proteins, and other compounds. [NIH]
Hydrolysis: The process of cleaving a chemical compound by the addition of a molecule of water. [NIH] Hydrophilic: Readily absorbing moisture; hygroscopic; having strongly polar groups that readily interact with water. [EU] Hydrophobic: Not readily absorbing water, or being adversely affected by water, as a hydrophobic colloid. [EU] Hygienic: Pertaining to hygiene, or conducive to health. [EU] Hyperalgesia: Excessive sensitiveness or sensibility to pain. [EU] Hypercapnia: A clinical manifestation of abnormal increase in the amount of carbon dioxide in arterial blood. [NIH] Hypercholesterolemia: Abnormally high levels of cholesterol in the blood. [NIH] Hyperglycemia: Abnormally high blood sugar. [NIH] Hyperlipidemia: An excess of lipids in the blood. [NIH] Hyperoxia: An abnormal increase in the amount of oxygen in the tissues and organs. [NIH] Hyperpigmentation: Excessive pigmentation of the skin, usually as a result of increased melanization of the epidermis rather than as a result of an increased number of melanocytes. Etiology is varied and the condition may arise from exposure to light, chemicals or other substances, or from a primary metabolic imbalance. [NIH] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hyperthermia: A type of treatment in which body tissue is exposed to high temperatures to damage and kill cancer cells or to make cancer cells more sensitive to the effects of radiation and certain anticancer drugs. [NIH] Hypertriglyceridemia: Condition of elevated triglyceride concentration in the blood; an inherited form occurs in familial hyperlipoproteinemia IIb and hyperlipoproteinemia type
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IV. It has been linked to higher risk of heart disease and arteriosclerosis. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH] Hypnotic: A drug that acts to induce sleep. [EU] Hypodermic: Applied or administered beneath the skin. [EU] Hypoglycaemia: An abnormally diminished concentration of glucose in the blood, which may lead to tremulousness, cold sweat, piloerection, hypothermia, and headache, accompanied by irritability, confusion, hallucinations, bizarre behaviour, and ultimately, convulsions and coma. [EU] Hypoglycemia: Abnormally low blood sugar [NIH] Hypoglycemic: An orally active drug that produces a fall in blood glucose concentration. [NIH]
Hypoglycemic Agents: Agents which lower the blood glucose level. [NIH] Hypospadias: A developmental anomaly in the male in which the urethra opens on the underside of the penis or on the perineum. [NIH] Hypotension: Abnormally low blood pressure. [NIH] Hypotensive: Characterized by or causing diminished tension or pressure, as abnormally low blood pressure. [EU] Hypothalamic: Of or involving the hypothalamus. [EU] Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH] Hypothermia: Lower than normal body temperature, especially in warm-blooded animals; in man usually accidental or unintentional. [NIH] Hypothyroidism: Deficiency of thyroid activity. In adults, it is most common in women and is characterized by decrease in basal metabolic rate, tiredness and lethargy, sensitivity to cold, and menstrual disturbances. If untreated, it progresses to full-blown myxoedema. In infants, severe hypothyroidism leads to cretinism. In juveniles, the manifestations are intermediate, with less severe mental and developmental retardation and only mild symptoms of the adult form. When due to pituitary deficiency of thyrotropin secretion it is called secondary hypothyroidism. [EU] Hypoxemia: Deficient oxygenation of the blood; hypoxia. [EU] Hypoxia: Reduction of oxygen supply to tissue below physiological levels despite adequate perfusion of the tissue by blood. [EU] Hysterectomy: Excision of the uterus. [NIH] Hysterotomy: An incision in the uterus, performed through either the abdomen or the vagina. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Ileal: Related to the ileum, the lowest end of the small intestine. [NIH] Ileum: The lower end of the small intestine. [NIH] Illusion: A false interpretation of a genuine percept. [NIH] Immersion: The placing of a body or a part thereof into a liquid. [NIH] Immune adjuvant: A drug that stimulates the immune system to respond to disease. [NIH]
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Immune response: The activity of the immune system against foreign substances (antigens). [NIH]
Immune Sera: Serum that contains antibodies. It is obtained from an animal that has been immunized either by antigen injection or infection with microorganisms containing the antigen. [NIH] Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunity: Nonsusceptibility to the invasive or pathogenic microorganisms or to the toxic effect of antigenic substances. [NIH]
effects
of
foreign
Immunization: Deliberate stimulation of the host's immune response. Active immunization involves administration of antigens or immunologic adjuvants. Passive immunization involves administration of immune sera or lymphocytes or their extracts (e.g., transfer factor, immune RNA) or transplantation of immunocompetent cell producing tissue (thymus or bone marrow). [NIH] Immunization Schedule: Schedule giving optimum times usually for primary and/or secondary immunization. [NIH] Immunodeficiency: The decreased ability of the body to fight infection and disease. [NIH] Immunodeficiency syndrome: The inability of the body to produce an immune response. [NIH]
Immunoglobulins: Glycoproteins present in the blood (antibodies) and in other tissue. They are classified by structure and activity into five classes (IgA, IgD, IgE, IgG, IgM). [NIH] Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Immunology: The study of the body's immune system. [NIH] Immunosuppressive: Describes the ability to lower immune system responses. [NIH] Immunotherapy: Manipulation of the host's immune system in treatment of disease. It includes both active and passive immunization as well as immunosuppressive therapy to prevent graft rejection. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Imperforate Anus: A birth defect in which the anal canal fails to develop. The condition is treated with an operation. [NIH] Implant radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called [NIH] Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU] Impotence: The inability to perform sexual intercourse. [NIH] In situ: In the natural or normal place; confined to the site of origin without invasion of neighbouring tissues. [EU] In Situ Hybridization: A technique that localizes specific nucleic acid sequences within intact chromosomes, eukaryotic cells, or bacterial cells through the use of specific nucleic acid-labeled probes. [NIH] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH]
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Incision: A cut made in the body during surgery. [NIH] Incisor: Anything adapted for cutting; any one of the four front teeth in each jaw. [NIH] Incompetence: Physical or mental inadequacy or insufficiency. [EU] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Incubation: The development of an infectious disease from the entrance of the pathogen to the appearance of clinical symptoms. [EU] Incubation period: The period of time likely to elapse between exposure to the agent of the disease and the onset of clinical symptoms. [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Indigestion: Poor digestion. Symptoms include heartburn, nausea, bloating, and gas. Also called dyspepsia. [NIH] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infant Behavior: Any observable response or action of a neonate or infant up through the age of 23 months. [NIH] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]
Infertility: The diminished or absent ability to conceive or produce an offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Influenza: An acute viral infection involving the respiratory tract. It is marked by inflammation of the nasal mucosa, the pharynx, and conjunctiva, and by headache and severe, often generalized, myalgia. [NIH] Informed Consent: Voluntary authorization, given to the physician by the patient, with full comprehension of the risks involved, for diagnostic or investigative procedures and medical and surgical treatment. [NIH] Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] Ingestion: Taking into the body by mouth [NIH] Inguinal: Pertaining to the inguen, or groin. [EU]
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Inguinal Hernia: A small part of the large or small intestine or bladder that pushes into the groin. May cause pain and feelings of pressure or burning in the groin. Often requires surgery. [NIH] Inhalation: The drawing of air or other substances into the lungs. [EU] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH] Inlay: In dentistry, a filling first made to correspond with the form of a dental cavity and then cemented into the cavity. [NIH] Inner ear: The labyrinth, comprising the vestibule, cochlea, and semicircular canals. [NIH] Innervation: 1. The distribution or supply of nerves to a part. 2. The supply of nervous energy or of nerve stimulus sent to a part. [EU] Inorganic: Pertaining to substances not of organic origin. [EU] Inositol: An isomer of glucose that has traditionally been considered to be a B vitamin although it has an uncertain status as a vitamin and a deficiency syndrome has not been identified in man. (From Martindale, The Extra Pharmacopoeia, 30th ed, p1379) Inositol phospholipids are important in signal transduction. [NIH] Inotropic: Affecting the force or energy of muscular contractions. [EU] Insight: The capacity to understand one's own motives, to be aware of one's own psychodynamics, to appreciate the meaning of symbolic behavior. [NIH] Insomnia: Difficulty in going to sleep or getting enough sleep. [NIH] Instillation: . [EU] Insufflation: The act of blowing a powder, vapor, or gas into any body cavity for experimental, diagnostic, or therapeutic purposes. [NIH] Insulator: Material covering the metal conductor of the lead. It is usually polyurethane or silicone. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Intensive Care: Advanced and highly specialized care provided to medical or surgical patients whose conditions are life-threatening and require comprehensive care and constant monitoring. It is usually administered in specially equipped units of a health care facility. [NIH]
Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Internal Medicine: A medical specialty concerned with the diagnosis and treatment of diseases of the internal organ systems of adults. [NIH] Internal radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called brachytherapy, implant radiation, or interstitial radiation therapy. [NIH] Interneurons: Most generally any neurons which are not motor or sensory. Interneurons may also refer to neurons whose axons remain within a particular brain region as contrasted with projection neurons which have axons projecting to other brain regions. [NIH]
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Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intervertebral: Situated between two contiguous vertebrae. [EU] Intervertebral Disk Displacement: An intervertebral disk in which the nucleus pulposus has protruded through surrounding fibrocartilage. This occurs most frequently in the lower lumbar region. [NIH] Intestinal: Having to do with the intestines. [NIH] Intestinal Obstruction: Any impairment, arrest, or reversal of the normal flow of intestinal contents toward the anus. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intoxication: Poisoning, the state of being poisoned. [EU] Intracellular: Inside a cell. [NIH] Intracranial Embolism: The sudden obstruction of a blood vessel by an embolus. [NIH] Intracranial Embolism and Thrombosis: Embolism or thrombosis involving blood vessels which supply intracranial structures. Emboli may originate from extracranial or intracranial sources. Thrombosis may occur in arterial or venous structures. [NIH] Intracranial Hypertension: Increased pressure within the cranial vault. This may result from several conditions, including hydrocephalus; brain edema; intracranial masses; severe systemic hypertension; pseudotumor cerebri; and other disorders. [NIH] Intramuscular: IM. Within or into muscle. [NIH] Intraoperative Complications: Complications that affect patients during surgery. They may or may not be associated with the disease for which the surgery is done, or within the same surgical procedure. [NIH] Intrathecal: Describes the fluid-filled space between the thin layers of tissue that cover the brain and spinal cord. Drugs can be injected into the fluid or a sample of the fluid can be removed for testing. [NIH] Intravascular: Within a vessel or vessels. [EU] Intravenous: IV. Into a vein. [NIH] Intravenous Anesthetics: The systemic administration of an anesthetic drug via an injection into the vein. [NIH] Intravesical: Within the bladder. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Intubation: Introduction of a tube into a hollow organ to restore or maintain patency if obstructed. It is differentiated from catheterization in that the insertion of a catheter is usually performed for the introducing or withdrawing of fluids from the body. [NIH] Intussusception: A rare disorder. A part of the intestines folds into another part of the intestines, causing blockage. Most common in infants. Can be treated with an operation. [NIH]
Inulin: A starch found in the tubers and roots of many plants. Since it is hydrolyzable to fructose, it is classified as a fructosan. It has been used in physiologic investigation for determination of the rate of glomerular function. [NIH] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]
Invertebrates: Animals that have no spinal column. [NIH]
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Involuntary: Reaction occurring without intention or volition. [NIH] Ion Channels: Gated, ion-selective glycoproteins that traverse membranes. The stimulus for channel gating can be a membrane potential, drug, transmitter, cytoplasmic messenger, or a mechanical deformation. Ion channels which are integral parts of ionotropic neurotransmitter receptors are not included. [NIH] Ion Exchange: Reversible chemical reaction between a solid, often an ION exchange resin, and a fluid whereby ions may be exchanged from one substance to another. This technique is used in water purification, in research, and in industry. [NIH] Ionization: 1. Any process by which a neutral atom gains or loses electrons, thus acquiring a net charge, as the dissociation of a substance in solution into ions or ion production by the passage of radioactive particles. 2. Iontophoresis. [EU] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Iontophoresis: Therapeutic introduction of ions of soluble salts into tissues by means of electric current. In medical literature it is commonly used to indicate the process of increasing the penetration of drugs into surface tissues by the application of electric current. It has nothing to do with ion exchange, air ionization nor phonophoresis, none of which requires current. [NIH] Irritable Bowel Syndrome: A disorder that comes and goes. Nerves that control the muscles in the GI tract are too active. The GI tract becomes sensitive to food, stool, gas, and stress. Causes abdominal pain, bloating, and constipation or diarrhea. Also called spastic colon or mucous colitis. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Isoenzyme: Different forms of an enzyme, usually occurring in different tissues. The isoenzymes of a particular enzyme catalyze the same reaction but they differ in some of their properties. [NIH] Isoflurane: A stable, non-explosive inhalation anesthetic, relatively free from significant side effects. [NIH] Isozymes: The multiple forms of a single enzyme. [NIH] Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Kainate: Glutamate receptor. [NIH] Kainic Acid: (2S-(2 alpha,3 beta,4 beta))-2-Carboxy-4-(1-methylethenyl)-3-pyrrolidineacetic acid. Ascaricide obtained from the red alga Digenea simplex. It is a potent excitatory amino acid agonist at some types of excitatory amino acid receptors and has been used to discriminate among receptor types. Like many excitatory amino acid agonists it can cause neurotoxicity and has been used experimentally for that purpose. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Keratolytic: An agent that promotes keratolysis. [EU] Ketamine: A cyclohexanone derivative used for induction of anesthesia. Its mechanism of action is not well understood, but ketamine can block NMDA receptors (receptors, NMethyl-D-Aspartate) and may interact with sigma receptors. [NIH] Keto: It consists of 8 carbon atoms and within the endotoxins, it connects poysaccharide and
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lipid A. [NIH] Ketone Bodies: Chemicals that the body makes when there is not enough insulin in the blood and it must break down fat for its energy. Ketone bodies can poison and even kill body cells. When the body does not have the help of insulin, the ketones build up in the blood and then "spill" over into the urine so that the body can get rid of them. The body can also rid itself of one type of ketone, called acetone, through the lungs. This gives the breath a fruity odor. Ketones that build up in the body for a long time lead to serious illness and coma. [NIH] Ketorolac: A drug that belongs to a family of drugs called nonsteroidal anti-inflammatory agents. It is being studied in cancer prevention. [NIH] Ketosis: A condition of having ketone bodies build up in body tissues and fluids. The signs of ketosis are nausea, vomiting, and stomach pain. Ketosis can lead to ketoacidosis. [NIH] Kidney Disease: Any one of several chronic conditions that are caused by damage to the cells of the kidney. People who have had diabetes for a long time may have kidney damage. Also called nephropathy. [NIH] Kidney Failure: The inability of a kidney to excrete metabolites at normal plasma levels under conditions of normal loading, or the inability to retain electrolytes under conditions of normal intake. In the acute form (kidney failure, acute), it is marked by uremia and usually by oliguria or anuria, with hyperkalemia and pulmonary edema. The chronic form (kidney failure, chronic) is irreversible and requires hemodialysis. [NIH] Kidney Pelvis: The flattened, funnel-shaped expansion connecting the ureter to the kidney calices. [NIH] Kidney stone: A stone that develops from crystals that form in urine and build up on the inner surfaces of the kidney, in the renal pelvis, or in the ureters. [NIH] Kidney Transplantation: The transference of a kidney from one human or animal to another. [NIH] Kinetic: Pertaining to or producing motion. [EU] Kink: Deviation from the normal long axis, as in a fractured bone healed out of line. [NIH] Labile: 1. Gliding; moving from point to point over the surface; unstable; fluctuating. 2. Chemically unstable. [EU] Labyrinth: The internal ear; the essential part of the organ of hearing. It consists of an osseous and a membranous portion. [NIH] Laceration: 1. The act of tearing. 2. A torn, ragged, mangled wound. [EU] Lacrimal: Pertaining to the tears. [EU] Laparoscopy: Examination, therapy or surgery of the abdomen's interior by means of a laparoscope. [NIH] Laparotomy: A surgical incision made in the wall of the abdomen. [NIH] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Laryngeal: Having to do with the larynx. [NIH] Laryngoscope: A thin, lighted tube used to examine the larynx (voice box). [NIH] Laryngoscopy: Examination, therapy, or surgery of the interior of the larynx performed with a specially designed endoscope. [NIH]
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Larynx: An irregularly shaped, musculocartilaginous tubular structure, lined with mucous membrane, located at the top of the trachea and below the root of the tongue and the hyoid bone. It is the essential sphincter guarding the entrance into the trachea and functioning secondarily as the organ of voice. [NIH] Laser Surgery: The use of a laser either to vaporize surface lesions or to make bloodless cuts in tissue. It does not include the coagulation of tissue by laser. [NIH] Laser therapy: The use of an intensely powerful beam of light to kill cancer cells. [NIH] Latency: The period of apparent inactivity between the time when a stimulus is presented and the moment a response occurs. [NIH] Latent: Phoria which occurs at one distance or another and which usually has no troublesome effect. [NIH] Lathyrism: A paralytic condition of the legs caused by ingestion of lathyrogens, especially beta-aminopropionitrile, found in the seeds of plants of the genus Lathyrus. [NIH] Lavage: A cleaning of the stomach and colon. Uses a special drink and enemas. [NIH] Least-Squares Analysis: A principle of estimation in which the estimates of a set of parameters in a statistical model are those quantities minimizing the sum of squared differences between the observed values of a dependent variable and the values predicted by the model. [NIH] Length of Stay: The period of confinement of a patient to a hospital or other health facility. [NIH]
Lens: The transparent, double convex (outward curve on both sides) structure suspended between the aqueous and vitreous; helps to focus light on the retina. [NIH] Leprosy: A chronic granulomatous infection caused by Mycobacterium leprae. The granulomatous lesions are manifested in the skin, the mucous membranes, and the peripheral nerves. Two polar or principal types are lepromatous and tuberculoid. [NIH] Lesion: An area of abnormal tissue change. [NIH] Lethal: Deadly, fatal. [EU] Lethargy: Abnormal drowsiness or stupor; a condition of indifference. [EU] Leukemia: Cancer of blood-forming tissue. [NIH] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Leukotrienes: A family of biologically active compounds derived from arachidonic acid by oxidative metabolism through the 5-lipoxygenase pathway. They participate in host defense reactions and pathophysiological conditions such as immediate hypersensitivity and inflammation. They have potent actions on many essential organs and systems, including the cardiovascular, pulmonary, and central nervous system as well as the gastrointestinal tract and the immune system. [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]
Lidocaine: A local anesthetic and cardiac depressant used as an antiarrhythmia agent. Its actions are more intense and its effects more prolonged than those of procaine but its duration of action is shorter than that of bupivacaine or prilocaine. [NIH] Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Ligands: A RNA simulation method developed by the MIT. [NIH]
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Ligation: Application of a ligature to tie a vessel or strangulate a part. [NIH] Likelihood Functions: Functions constructed from a statistical model and a set of observed data which give the probability of that data for various values of the unknown model parameters. Those parameter values that maximize the probability are the maximum likelihood estimates of the parameters. [NIH] Limbic: Pertaining to a limbus, or margin; forming a border around. [EU] Limbic System: A set of forebrain structures common to all mammals that is defined functionally and anatomically. It is implicated in the higher integration of visceral, olfactory, and somatic information as well as homeostatic responses including fundamental survival behaviors (feeding, mating, emotion). For most authors, it includes the amygdala, epithalamus, gyrus cinguli, hippocampal formation (see hippocampus), hypothalamus, parahippocampal gyrus, septal nuclei, anterior nuclear group of thalamus, and portions of the basal ganglia. (Parent, Carpenter's Human Neuroanatomy, 9th ed, p744; NeuroNames, http://rprcsgi.rprc.washington.edu/neuronames/index.html (September 2, 1998)). [NIH] Linear Models: Statistical models in which the value of a parameter for a given value of a factor is assumed to be equal to a + bx, where a and b are constants. The models predict a linear regression. [NIH] Linkage: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Lip: Either of the two fleshy, full-blooded margins of the mouth. [NIH] Lipid: Fat. [NIH] Lipoprotein: Any of the lipid-protein complexes in which lipids are transported in the blood; lipoprotein particles consist of a spherical hydrophobic core of triglycerides or cholesterol esters surrounded by an amphipathic monolayer of phospholipids, cholesterol, and apolipoproteins; the four principal classes are high-density, low-density, and very-lowdensity lipoproteins and chylomicrons. [EU] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Liver Transplantation: The transference of a part of or an entire liver from one human or animal to another. [NIH] Lobe: A portion of an organ such as the liver, lung, breast, or brain. [NIH] Localization: The process of determining or marking the location or site of a lesion or disease. May also refer to the process of keeping a lesion or disease in a specific location or site. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Locomotion: Movement or the ability to move from one place or another. It can refer to humans, vertebrate or invertebrate animals, and microorganisms. [NIH] Locomotor: Of or pertaining to locomotion; pertaining to or affecting the locomotive apparatus of the body. [EU] Locoregional: The characteristic of a disease-producing organism to transfer itself, but typically to the same region of the body (a leg, the lungs, .) [EU] Logistic Models: Statistical models which describe the relationship between a qualitative dependent variable (that is, one which can take only certain discrete values, such as the presence or absence of a disease) and an independent variable. A common application is in epidemiology for estimating an individual's risk (probability of a disease) as a function of a
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given risk factor. [NIH] Long-Term Care: Care over an extended period, usually for a chronic condition or disability, requiring periodic, intermittent, or continuous care. [NIH] Loop: A wire usually of platinum bent at one end into a small loop (usually 4 mm inside diameter) and used in transferring microorganisms. [NIH] Lordosis: The anterior concavity in the curvature of the lumbar and cervical spine as viewed from the side. The term usually refers to abnormally increased curvature (hollow back, saddle back, swayback). It does not include lordosis as normal mating posture in certain animals ( = posture + sex behavior, animal). [NIH] Low Back Pain: Acute or chronic pain in the lumbar or sacral regions, which may be associated with musculo-ligamentous sprains and strains; intervertebral disk displacement; and other conditions. [NIH] Low-density lipoprotein: Lipoprotein that contains most of the cholesterol in the blood. LDL carries cholesterol to the tissues of the body, including the arteries. A high level of LDL increases the risk of heart disease. LDL typically contains 60 to 70 percent of the total serum cholesterol and both are directly correlated with CHD risk. [NIH] Lower Esophageal Sphincter: The muscle between the esophagus and stomach. When a person swallows, this muscle relaxes to let food pass from the esophagus to the stomach. It stays closed at other times to keep stomach contents from flowing back into the esophagus. [NIH]
Lubricants: Oily or slippery substances. [NIH] Lubrication: The application of a substance to diminish friction between two surfaces. It may refer to oils, greases, and similar substances for the lubrication of medical equipment but it can be used for the application of substances to tissue to reduce friction, such as lotions for skin and vaginal lubricants. [NIH] Luciferase: Any one of several enzymes that catalyze the bioluminescent reaction in certain marine crustaceans, fish, bacteria, and insects. The enzyme is a flavoprotein; it oxidizes luciferins to an electronically excited compound that emits energy in the form of light. The color of light emitted varies with the organism. The firefly enzyme is a valuable reagent for measurement of ATP concentration. (Dorland, 27th ed) EC 1.13.12.-. [NIH] Lumbar: Pertaining to the loins, the part of the back between the thorax and the pelvis. [EU] Lumen: The cavity or channel within a tube or tubular organ. [EU] Luminescence: The property of giving off light without emitting a corresponding degree of heat. It includes the luminescence of inorganic matter or the bioluminescence of human matter, invertebrates and other living organisms. For the luminescence of bacteria, bacterial luminescence is available. [NIH] Luxation: The displacement of the particular surface of a bone from its normal joint, without fracture. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]
Lymphadenectomy: A surgical procedure in which the lymph nodes are removed and examined to see whether they contain cancer. Also called lymph node dissection. [NIH] Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph
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nodes, that produce and store cells that fight infection and disease. [NIH] Lymphatic system: The tissues and organs that produce, store, and carry white blood cells that fight infection and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes and a network of thin tubes that carry lymph and white blood cells. These tubes branch, like blood vessels, into all the tissues of the body. [NIH] Lymphocele: Cystic mass containing lymph from diseased lymphatic channels or following surgical trauma or other injury. [NIH] Lymphocyte: A white blood cell. Lymphocytes have a number of roles in the immune system, including the production of antibodies and other substances that fight infection and diseases. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Lymphoma: A general term for various neoplastic diseases of the lymphoid tissue. [NIH] Lysine: An essential amino acid. It is often added to animal feed. [NIH] Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. [NIH] Malformation: A morphologic developmental process. [EU]
defect
resulting
from
an
intrinsically
abnormal
Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malignant Hyperthermia: Rapid and excessive rise of temperature accompanied by muscular rigidity following general anesthesia. [NIH] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]
Mammary: Pertaining to the mamma, or breast. [EU] Mandible: The largest and strongest bone of the face constituting the lower jaw. It supports the lower teeth. [NIH] Mandibular Nerve: A branch of the trigeminal (5th cranial) nerve. The mandibular nerve carries motor fibers to the muscles of mastication and sensory fibers to the teeth and gingivae, the face in the region of the mandible, and parts of the dura. [NIH] Manic: Affected with mania. [EU] Manic-depressive psychosis: One of a group of psychotic reactions, fundamentally marked by severe mood swings and a tendency to remission and recurrence. [NIH] Manifest: Being the part or aspect of a phenomenon that is directly observable : concretely expressed in behaviour. [EU] Mastectomy: Surgery to remove the breast (or as much of the breast tissue as possible). [NIH] Mastication: The act and process of chewing and grinding food in the mouth. [NIH] Maternal Mortality: Maternal deaths resulting from complications of pregnancy and childbirth in a given population. [NIH] Maxillary: Pertaining to the maxilla : the irregularly shaped bone that with its fellow forms the upper jaw. [EU] Maxillary Nerve: The intermediate sensory division of the trigeminal (5th cranial) nerve. The maxillary nerve carries general afferents from the intermediate region of the face
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including the lower eyelid, nose and upper lip, the maxillary teeth, and parts of the dura. [NIH]
Meatus: A canal running from the internal auditory foramen through the petrous portion of the temporal bone. It gives passage to the facial and auditory nerves together with the auditory branch of the basilar artery and the internal auditory veins. [NIH] Mechanical ventilation: Use of a machine called a ventilator or respirator to improve the exchange of air between the lungs and the atmosphere. [NIH] Medetomidine: An agonist of receptors, adrenergic alpha-2 that is used in veterinary medicine for its analgesic and sedative properties. It is the racemate of dexmedetomidine. [NIH]
Medial: Lying near the midsaggital plane of the body; opposed to lateral. [NIH] Median Nerve: A major nerve of the upper extremity. In humans, the fibers of the median nerve originate in the lower cervical and upper thoracic spinal cord (usually C6 to T1), travel via the brachial plexus, and supply sensory and motor innervation to parts of the forearm and hand. [NIH] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Medical Errors: Errors or mistakes committed by health professionals which result in harm to the patient. They include errors in diagnosis (diagnostic errors), errors in the administration of drugs and other medications (medication errors), errors in the performance of surgical procedures, in the use of other types of therapy, in the use of equipment, and in the interpretation of laboratory findings. Medical errors are differentiated from malpractice in that the former are regarded as honest mistakes or accidents while the latter is the result of negligence, reprehensible ignorance, or criminal intent. [NIH] Medical Records: Recording of pertinent information concerning patient's illness or illnesses. [NIH] Medical Staff: Professional medical personnel who provide care to patients in an organized facility, institution or agency. [NIH] Medication Errors: Errors in prescribing, dispensing, or administering medication with the result that the patient fails to receive the correct drug or the indicated proper drug dosage. [NIH]
MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Medullary: Pertaining to the marrow or to any medulla; resembling marrow. [EU] Meiosis: A special method of cell division, occurring in maturation of the germ cells, by means of which each daughter nucleus receives half the number of chromosomes characteristic of the somatic cells of the species. [NIH] Melanocytes: Epidermal dendritic pigment cells which control long-term morphological color changes by alteration in their number or in the amount of pigment they produce and store in the pigment containing organelles called melanosomes. Melanophores are larger cells which do not exist in mammals. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Membrane Glycoproteins: Glycoproteins found on the membrane or surface of cells. [NIH]
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Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Memory Disorders: Disturbances in registering an impression, in the retention of an acquired impression, or in the recall of an impression. Memory impairments are associated with dementia; craniocerebraltrauma; encephalitis; alcoholism (see also alcohol amnestic disorder); schizophrenia; and other conditions. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Menorrhagia: Excessive menstrual flow. [NIH] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Processes: Conceptual functions or thinking in all its forms. [NIH] Mental Retardation: Refers to sub-average general intellectual functioning which originated during the developmental period and is associated with impairment in adaptive behavior. [NIH]
Mentors: Senior professionals who provide guidance, direction and support to those persons desirous of improvement in academic positions, administrative positions or other career development situations. [NIH] Mercury: A silver metallic element that exists as a liquid at room temperature. It has the atomic symbol Hg (from hydrargyrum, liquid silver), atomic number 80, and atomic weight 200.59. Mercury is used in many industrial applications and its salts have been employed therapeutically as purgatives, antisyphilitics, disinfectants, and astringents. It can be absorbed through the skin and mucous membranes which leads to mercury poisoning. Because of its toxicity, the clinical use of mercury and mercurials is diminishing. [NIH] Mesencephalic: Ipsilateral oculomotor paralysis and contralateral tremor, spasm. or choreic movements of the face and limbs. [NIH] Mesenchymal: Refers to cells that develop into connective tissue, blood vessels, and lymphatic tissue. [NIH] Mesenteric: Pertaining to the mesentery : a membranous fold attaching various organs to the body wall. [EU] Metabolic disorder: A condition in which normal metabolic processes are disrupted, usually because of a missing enzyme. [NIH] Metabolite: Any substance produced by metabolism or by a metabolic process. [EU] Metabotropic: A glutamate receptor which triggers an increase in production of 2 intracellular messengers: diacylglycerol and inositol 1, 4, 5-triphosphate. [NIH] Methionine: A sulfur containing essential amino acid that is important in many body functions. It is a chelating agent for heavy metals. [NIH] Methyltransferase: A drug-metabolizing enzyme. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH]
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Microcirculation: The vascular network lying between the arterioles and venules; includes capillaries, metarterioles and arteriovenous anastomoses. Also, the flow of blood through this network. [NIH] Microcomputers: Small computers using LSI (large-scale integration) microprocessor chips as the CPU (central processing unit) and semiconductor memories for compact, inexpensive storage of program instructions and data. They are smaller and less expensive than minicomputers and are usually built into a dedicated system where they are optimized for a particular application. "Microprocessor" may refer to just the CPU or the entire microcomputer. [NIH] Microdialysis: A technique for measuring extracellular concentrations of substances in tissues, usually in vivo, by means of a small probe equipped with a semipermeable membrane. Substances may also be introduced into the extracellular space through the membrane. [NIH] Microorganism: An organism that can be seen only through a microscope. Microorganisms include bacteria, protozoa, algae, and fungi. Although viruses are not considered living organisms, they are sometimes classified as microorganisms. [NIH] Micro-organism: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microscopy: The application of microscope magnification to the study of materials that cannot be properly seen by the unaided eye. [NIH] Microscopy, Confocal: A light microscopic technique in which only a small spot is illuminated and observed at a time. An image is constructed through point-by-point scanning of the field in this manner. Light sources may be conventional or laser, and fluorescence or transmitted observations are possible. [NIH] Micturition: The passage of urine; urination. [EU] Midazolam: A short-acting compound, water-soluble at pH less than 4 and lipid-soluble at physiological pH. It is a hypnotic-sedative drug with anxiolytic and amnestic properties. It is used for sedation in dentistry, cardiac surgery, endoscopic procedures, as preanesthetic medication, and as an adjunct to local anesthesia. Because of its short duration and cardiorespiratory stability, it is particularly useful in poor-risk, elderly, and cardiac patients. [NIH]
Migration: The systematic movement of genes between populations of the same species, geographic race, or variety. [NIH] Milliliter: A measure of volume for a liquid. A milliliter is approximately 950-times smaller than a quart and 30-times smaller than a fluid ounce. A milliliter of liquid and a cubic centimeter (cc) of liquid are the same. [NIH] Millimeter: A measure of length. A millimeter is approximately 26-times smaller than an inch. [NIH] Minicomputers: Small computers that lack the speed, memory capacity, and instructional capability of the full-size computer but usually retain its programmable flexibility. They are larger, faster, and more flexible, powerful, and expensive than microcomputers. [NIH] Mitochondria: Parts of a cell where aerobic production (also known as cell respiration) takes place. [NIH] Mitochondrial Swelling: Increase in volume of mitochondria due to an influx of fluid; it occurs in hypotonic solutions due to osmotic pressure and in isotonic solutions as a result of altered permeability of the membranes of respiring mitochondria. [NIH] Mitosis: A method of indirect cell division by means of which the two daughter nuclei
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normally receive identical complements of the number of chromosomes of the somatic cells of the species. [NIH] Mobility: Capability of movement, of being moved, or of flowing freely. [EU] Modeling: A treatment procedure whereby the therapist presents the target behavior which the learner is to imitate and make part of his repertoire. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Modulator: A specific inductor that brings out characteristics peculiar to a definite region. [EU]
Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecular Structure: The location of the atoms, groups or ions relative to one another in a molecule, as well as the number, type and location of covalent bonds. [NIH] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monoclonal: An antibody produced by culturing a single type of cell. It therefore consists of a single species of immunoglobulin molecules. [NIH] Monocytes: Large, phagocytic mononuclear leukocytes produced in the vertebrate bone marrow and released into the blood; contain a large, oval or somewhat indented nucleus surrounded by voluminous cytoplasm and numerous organelles. [NIH] Morphine: The principal alkaloid in opium and the prototype opiate analgesic and narcotic. Morphine has widespread effects in the central nervous system and on smooth muscle. [NIH] Morphological: Relating to the configuration or the structure of live organs. [NIH] Morphology: The science of the form and structure of organisms (plants, animals, and other forms of life). [NIH] Morula: The early embryo at the developmental stage in which the blastomeres, resulting from repeated mitotic divisions of the fertilized ovum, form a compact mass. [NIH] Motility: The ability to move spontaneously. [EU] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH] Motor Activity: The physical activity of an organism as a behavioral phenomenon. [NIH] Motor nerve: An efferent nerve conveying an impulse that excites muscular contraction. [NIH]
Mucinous: Containing or resembling mucin, the main compound in mucus. [NIH] Mucins: A secretion containing mucopolysaccharides and protein that is the chief constituent of mucus. [NIH] Mucosa: A mucous membrane, or tunica mucosa. [EU] Multiple sclerosis: A disorder of the central nervous system marked by weakness, numbness, a loss of muscle coordination, and problems with vision, speech, and bladder control. Multiple sclerosis is thought to be an autoimmune disease in which the body's immune system destroys myelin. Myelin is a substance that contains both protein and fat
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(lipid) and serves as a nerve insulator and helps in the transmission of nerve signals. [NIH] Muscle Contraction: A process leading to shortening and/or development of tension in muscle tissue. Muscle contraction occurs by a sliding filament mechanism whereby actin filaments slide inward among the myosin filaments. [NIH] Muscle Fibers: Large single cells, either cylindrical or prismatic in shape, that form the basic unit of muscle tissue. They consist of a soft contractile substance enclosed in a tubular sheath. [NIH] Muscle relaxant: An agent that specifically aids in reducing muscle tension, as those acting at the polysynaptic neurons of motor nerves (e.g. meprobamate) or at the myoneural junction (curare and related compounds). [EU] Muscle Relaxation: That phase of a muscle twitch during which a muscle returns to a resting position. [NIH] Muscle tension: A force in a material tending to produce extension; the state of being stretched. [NIH] Muscular Dystrophies: A general term for a group of inherited disorders which are characterized by progressive degeneration of skeletal muscles. [NIH] Mutagenesis: Process of generating genetic mutations. It may occur spontaneously or be induced by mutagens. [NIH] Mutagenic: Inducing genetic mutation. [EU] Mutagens: Chemical agents that increase the rate of genetic mutation by interfering with the function of nucleic acids. A clastogen is a specific mutagen that causes breaks in chromosomes. [NIH] Myalgia: Pain in a muscle or muscles. [EU] Myasthenia: Muscular debility; any constitutional anomaly of muscle. [EU] Mydriatic: 1. Dilating the pupil. 2. Any drug that dilates the pupil. [EU] Myelin: The fatty substance that covers and protects nerves. [NIH] Myelin Sheath: The lipid-rich sheath investing many axons in both the central and peripheral nervous systems. The myelin sheath is an electrical insulator and allows faster and more energetically efficient conduction of impulses. The sheath is formed by the cell membranes of glial cells (Schwann cells in the peripheral and oligodendroglia in the central nervous system). Deterioration of the sheath in demyelinating diseases is a serious clinical problem. [NIH] Myenteric: On stimulation of an intestinal segment, the segment above contracts and that below relaxes. [NIH] Myocardial infarction: Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Myocardial Ischemia: A disorder of cardiac function caused by insufficient blood flow to the muscle tissue of the heart. The decreased blood flow may be due to narrowing of the coronary arteries (coronary arteriosclerosis), to obstruction by a thrombus (coronary thrombosis), or less commonly, to diffuse narrowing of arterioles and other small vessels within the heart. Severe interruption of the blood supply to the myocardial tissue may result in necrosis of cardiac muscle (myocardial infarction). [NIH] Myocardial Reperfusion: Generally, restoration of blood supply to heart tissue which is ischemic due to decrease in normal blood supply. The decrease may result from any source including atherosclerotic obstruction, narrowing of the artery, or surgical clamping.
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Reperfusion can be induced to treat ischemia. Methods include chemical dissolution of an occluding thrombus, administration of vasodilator drugs, angioplasty, catheterization, and artery bypass graft surgery. However, it is thought that reperfusion can itself further damage the ischemic tissue, causing myocardial reperfusion injury. [NIH] Myocardial Reperfusion Injury: Functional, metabolic, or structural changes in ischemic heart muscle thought to result from reperfusion to the ischemic areas. Changes can be fatal to muscle cells and may include edema with explosive cell swelling and disintegration, sarcolemma disruption, fragmentation of mitochondria, contraction band necrosis, enzyme washout, and calcium overload. Other damage may include hemorrhage and ventricular arrhythmias. One possible mechanism of damage is thought to be oxygen free radicals. Treatment currently includes the introduction of scavengers of oxygen free radicals, and injury is thought to be prevented by warm blood cardioplegic infusion prior to reperfusion. [NIH]
Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Myoclonus: Involuntary shock-like contractions, irregular in rhythm and amplitude, followed by relaxation, of a muscle or a group of muscles. This condition may be a feature of some central nervous systems diseases (e.g., epilepsy, myoclonic). Nocturnal myoclonus may represent a normal physiologic event or occur as the principal feature of the nocturnal myoclonus syndrome. (From Adams et al., Principles of Neurology, 6th ed, pp102-3). [NIH] Myometrium: The smooth muscle coat of the uterus, which forms the main mass of the organ. [NIH] Myopia: That error of refraction in which rays of light entering the eye parallel to the optic axis are brought to a focus in front of the retina, as a result of the eyeball being too long from front to back (axial m.) or of an increased strength in refractive power of the media of the eye (index m.). Called also nearsightedness, because the near point is less distant than it is in emmetropia with an equal amplitude of accommodation. [EU] Myosin: Chief protein in muscle and the main constituent of the thick filaments of muscle fibers. In conjunction with actin, it is responsible for the contraction and relaxation of muscles. [NIH] Myositis: Inflammation of a voluntary muscle. [EU] Myositis Ossificans: A disease characterized by bony deposits or the ossification of muscle tissue. [NIH] Naive: Used to describe an individual who has never taken a certain drug or class of drugs (e. g., AZT-naive, antiretroviral-naive), or to refer to an undifferentiated immune system cell. [NIH] Naloxone: A specific opiate antagonist that has no agonist activity. It is a competitive antagonist at mu, delta, and kappa opioid receptors. [NIH] Naltrexone: Derivative of noroxymorphone that is the N-cyclopropylmethyl congener of naloxone. It is a narcotic antagonist that is effective orally, longer lasting and more potent than naloxone, and has been proposed for the treatment of heroin addiction. The FDA has approved naltrexone for the treatment of alcohol dependence. [NIH] Narcolepsy: A condition of unknown cause characterized by a periodic uncontrollable tendency to fall asleep. [NIH] Narcosis: A general and nonspecific reversible depression of neuronal excitability, produced by a number of physical and chemical aspects, usually resulting in stupor. [NIH] Narcotic: 1. Pertaining to or producing narcosis. 2. An agent that produces insensibility or
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stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Nasal Cavity: The proximal portion of the respiratory passages on either side of the nasal septum, lined with ciliated mucosa, extending from the nares to the pharynx. [NIH] Nasal Mucosa: The mucous membrane lining the nasal cavity. [NIH] Nasal Septum: The partition separating the two nasal cavities in the midplane, composed of cartilaginous, membranous and bony parts. [NIH] Nasogastric: The process of passing a small, flexible plastic tube through the nose or mouth into the stomach or small intestine. [NIH] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] Nebulizer: A device used to turn liquid into a fine spray. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Needle biopsy: The removal of tissue or fluid with a needle for examination under a microscope. Also called fine-needle aspiration. [NIH] Neocortex: The largest portion of the cerebral cortex. It is composed of neurons arranged in six layers. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Neoplasms: New abnormal growth of tissue. Malignant neoplasms show a greater degree of anaplasia and have the properties of invasion and metastasis, compared to benign neoplasms. [NIH] Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU] Neostigmine: A cholinesterase inhibitor used in the treatment of myasthenia gravis and to reverse the effects of muscle relaxants such as gallamine and tubocurarine. Neostigmine, unlike physostigmine, does not cross the blood-brain barrier. [NIH] Nephrectomy: Surgery to remove a kidney. Radical nephrectomy removes the kidney, the adrenal gland, nearby lymph nodes, and other surrounding tissue. Simple nephrectomy removes only the kidney. Partial nephrectomy removes the tumor but not the entire kidney. [NIH]
Nephropathy: Disease of the kidneys. [EU] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nerve Endings: Specialized terminations of peripheral neurons. Nerve endings include neuroeffector junction(s) by which neurons activate target organs and sensory receptors which transduce information from the various sensory modalities and send it centrally in
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the nervous system. Presynaptic nerve endings are presynaptic terminals. [NIH] Nerve Fibers: Slender processes of neurons, especially the prolonged axons that conduct nerve impulses. [NIH] Nerve Growth Factor: Nerve growth factor is the first of a series of neurotrophic factors that were found to influence the growth and differentiation of sympathetic and sensory neurons. It is comprised of alpha, beta, and gamma subunits. The beta subunit is responsible for its growth stimulating activity. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Networks: Pertaining to a nerve or to the nerves, a meshlike structure of interlocking fibers or strands. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neural tube defects: These defects include problems stemming from fetal development of the spinal cord, spine, brain, and skull, and include birth defects such as spina bifida, anencephaly, and encephalocele. Neural tube defects occur early in pregnancy at about 4 to 6 weeks, usually before a woman knows she is pregnant. Many babies with neural tube defects have difficulty walking and with bladder and bowel control. [NIH] Neuroanatomy: Study of the anatomy of the nervous system as a specialty or discipline. [NIH]
Neurodegenerative Diseases: Hereditary and sporadic conditions which are characterized by progressive nervous system dysfunction. These disorders are often associated with atrophy of the affected central or peripheral nervous system structures. [NIH] Neuroeffector Junction: The synapse between a neuron (presynaptic) and an effector cell other than another neuron (postsynaptic). Neuroeffector junctions include synapses onto muscles and onto secretory cells. [NIH] Neurogenic: Loss of bladder control caused by damage to the nerves controlling the bladder. [NIH] Neurologic: Having to do with nerves or the nervous system. [NIH] Neurology: A medical specialty concerned with the study of the structures, functions, and diseases of the nervous system. [NIH] Neuroma: A tumor that arises in nerve cells. [NIH] Neuromuscular: Pertaining to muscles and nerves. [EU] Neuromuscular Blockade: The intentional interruption of transmission at the neuromuscular junction by external agents, usually neuromuscular blocking agents. It is distinguished from nerve block in which nerve conduction is interrupted rather than neuromuscular transmission. Neuromuscular blockade is commonly used to produce muscle relaxation as an adjunct to anesthesia during surgery and other medical procedures. It is also often used as an experimental manipulation in basic research. It is not strictly speaking anesthesia but is grouped here with anesthetic techniques. The failure of neuromuscular transmission as a result of pathological processes is not included here. [NIH] Neuromuscular Blocking Agents: Drugs that interrupt transmission of nerve impulses at the skeletal neuromuscular junction. They can be of two types, competitive, stabilizing blockers (neuromuscular nondepolarizing agents) or noncompetitive, depolarizing agents (neuromuscular depolarizing agents). Both prevent acetylcholine from triggering the muscle contraction and they are used as anesthesia adjuvants, as relaxants during electroshock, in convulsive states, etc. [NIH]
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Neuromuscular Depolarizing Agents: Drugs that interrupt transmission at the skeletal neuromuscular junction by causing sustained depolarization of the motor end plate. These agents are primarily used as adjuvants in surgical anesthesia to cause skeletal muscle relaxation. [NIH] Neuromuscular Junction: The synapse between a neuron and a muscle. [NIH] Neuromuscular Nondepolarizing Agents: Drugs that interrupt transmission at the skeletal neuromuscular junction without causing depolarization of the motor end plate. They prevent acetylcholine from triggering muscle contraction and are used as muscle relaxants during electroshock treatments, in convulsive states, and as anesthesia adjuvants. [NIH] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropathy: A problem in any part of the nervous system except the brain and spinal cord. Neuropathies can be caused by infection, toxic substances, or disease. [NIH] Neurophysiology: The scientific discipline concerned with the physiology of the nervous system. [NIH] Neuroprotective Agents: Drugs intended to prevent damage to the brain or spinal cord from ischemia, stroke, convulsions, or trauma. Some must be administered before the event, but others may be effective for some time after. They act by a variety of mechanisms, but often directly or indirectly minimize the damage produced by endogenous excitatory amino acids. [NIH] Neuroretinitis: Inflammation of the optic nerve head and adjacent retina. [NIH] Neurosciences: The scientific disciplines concerned with the embryology, anatomy, physiology, biochemistry, pharmacology, etc., of the nervous sytem. [NIH] Neurosecretory Systems: A system of neurons that has the specialized function to produce and secrete hormones, and that constitutes, in whole or in part, an endocrine organ or system. [NIH] Neurosis: Functional derangement due to disorders of the nervous system which does not affect the psychic personality of the patient. [NIH] Neurotic: 1. Pertaining to or characterized by neurosis. 2. A person affected with a neurosis. [EU]
Neurotoxic: Poisonous or destructive to nerve tissue. [EU] Neurotoxicity: The tendency of some treatments to cause damage to the nervous system. [NIH]
Neurotransmitters: Endogenous signaling molecules that alter the behavior of neurons or effector cells. Neurotransmitter is used here in its most general sense, including not only messengers that act directly to regulate ion channels, but also those that act through second messenger systems, and those that act at a distance from their site of release. Included are neuromodulators, neuroregulators, neuromediators, and neurohumors, whether or not acting at synapses. [NIH] Neurotrophins: A nerve growth factor. [NIH] Neutralization: An act or process of neutralizing. [EU] Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light hydrogen; the mass is equal to that of the proton and electron combined and they are unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal,
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and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier nuclei during their decay. [NIH] Neutrophils: Granular leukocytes having a nucleus with three to five lobes connected by slender threads of chromatin, and cytoplasm containing fine inconspicuous granules and stainable by neutral dyes. [NIH] Nicotine: Nicotine is highly toxic alkaloid. It is the prototypical agonist at nicotinic cholinergic receptors where it dramatically stimulates neurons and ultimately blocks synaptic transmission. Nicotine is also important medically because of its presence in tobacco smoke. [NIH] Nitric Oxide: A free radical gas produced endogenously by a variety of mammalian cells. It is synthesized from arginine by a complex reaction, catalyzed by nitric oxide synthase. Nitric oxide is endothelium-derived relaxing factor. It is released by the vascular endothelium and mediates the relaxation induced by some vasodilators such as acetylcholine and bradykinin. It also inhibits platelet aggregation, induces disaggregation of aggregated platelets, and inhibits platelet adhesion to the vascular endothelium. Nitric oxide activates cytosolic guanylate cyclase and thus elevates intracellular levels of cyclic GMP. [NIH]
Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Nitrous Oxide: Nitrogen oxide (N2O). A colorless, odorless gas that is used as an anesthetic and analgesic. High concentrations cause a narcotic effect and may replace oxygen, causing death by asphyxia. It is also used as a food aerosol in the preparation of whipping cream. [NIH]
Noble Gases: Gases which are members of the zero group of the periodic system. These gases generally do not react chemically. [NIH] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Normotensive: 1. Characterized by normal tone, tension, or pressure, as by normal blood pressure. 2. A person with normal blood pressure. [EU] Nosocomial: Pertaining to or originating in the hospital, said of an infection not present or incubating prior to admittance to the hospital, but generally occurring 72 hours after admittance; the term is usually used to refer to patient disease, but hospital personnel may also acquire nosocomial infection. [EU] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the next. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH]
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Nurse Anesthetists: Professional nurses who have completed postgraduate training in the administration of anesthetics and who function under the responsibility of the operating surgeon. [NIH] Nursing Care: Care given to patients by nursing service personnel. [NIH] Obstetrics: A medical-surgical specialty concerned with management and care of women during pregnancy, parturition, and the puerperium. [NIH] Occipital Lobe: Posterior part of the cerebral hemisphere. [NIH] Ocular: 1. Of, pertaining to, or affecting the eye. 2. Eyepiece. [EU] Oculomotor: Cranial nerve III. It originate from the lower ventral surface of the midbrain and is classified as a motor nerve. [NIH] Odontogenic Cysts: Cysts found in the jaws and arising from epithelium involved in tooth formation. They include follicular cysts (e.g., primordial cyst, dentigerous cyst, multilocular cyst), lateral periodontal cysts, and radicular cysts. They may become keratinized (odontogenic keratocysts). Follicular cysts may give rise to ameloblastomas and, in rare cases, undergo malignant transformation. [NIH] Oligodendroglia: A class of neuroglial (macroglial) cells in the central nervous system. Oligodendroglia may be called interfascicular, perivascular, or perineuronal satellite cells according to their location. The most important recognized function of these cells is the formation of the insulating myelin sheaths of axons in the central nervous system. [NIH] Oncology: The study of cancer. [NIH] On-line: A sexually-reproducing population derived from a common parentage. [NIH] Oocytes: Female germ cells in stages between the prophase of the first maturation division and the completion of the second maturation division. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH] Operating Rooms: Facilities equipped for performing surgery. [NIH] Ophthalmic: Pertaining to the eye. [EU] Opium: The air-dried exudate from the unripe seed capsule of the opium poppy, Papaver somniferum, or its variant, P. album. It contains a number of alkaloids, but only a few morphine, codeine, and papaverine - have clinical significance. Opium has been used as an analgesic, antitussive, antidiarrheal, and antispasmodic. [NIH] Opsin: A protein formed, together with retinene, by the chemical breakdown of metarhodopsin. [NIH] Optic Disk: The portion of the optic nerve seen in the fundus with the ophthalmoscope. It is formed by the meeting of all the retinal ganglion cell axons as they enter the optic nerve. [NIH]
Optic Nerve: The 2nd cranial nerve. The optic nerve conveys visual information from the retina to the brain. The nerve carries the axons of the retinal ganglion cells which sort at the optic chiasm and continue via the optic tracts to the brain. The largest projection is to the lateral geniculate nuclei; other important targets include the superior colliculi and the suprachiasmatic nuclei. Though known as the second cranial nerve, it is considered part of the central nervous system. [NIH] Oral Health: The optimal state of the mouth and normal functioning of the organs of the mouth without evidence of disease. [NIH] Oral Hygiene: The practice of personal hygiene of the mouth. It includes the maintenance of oral cleanliness, tissue tone, and general preservation of oral health. [NIH]
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Oral Surgical Procedures: Procedures used to treat disease, injuries, and defects of the oral and maxillofacial region. [NIH] Orchiectomy: The surgical removal of one or both testicles. [NIH] Organ Culture: The growth in aseptic culture of plant organs such as roots or shoots, beginning with organ primordia or segments and maintaining the characteristics of the organ. [NIH] Organ Transplantation: Transference of an organ between individuals of the same species or between individuals of different species. [NIH] Organelles: Specific particles of membrane-bound organized living substances present in eukaryotic cells, such as the mitochondria; the golgi apparatus; endoplasmic reticulum; lysomomes; plastids; and vacuoles. [NIH] Orgasm: The crisis of sexual excitement in either humans or animals. [NIH] Orofacial: Of or relating to the mouth and face. [EU] Oropharynx: Oral part of the pharynx. [NIH] Orthodontics: A dental specialty concerned with the prevention and correction of dental and oral anomalies (malocclusion). [NIH] Osmolality: The concentration of osmotically active particles in solution expressed in terms of osmoles of solute per kilogram of solvent. The osmolality is directly proportional to the colligative properties of solutions; osmotic pressure, boiling point elevation, freezing point depression, and vapour pressure lowering. [EU] Osmoles: The standard unit of osmotic pressure. [NIH] Osmosis: Tendency of fluids (e.g., water) to move from the less concentrated to the more concentrated side of a semipermeable membrane. [NIH] Osmotic: Pertaining to or of the nature of osmosis (= the passage of pure solvent from a solution of lesser to one of greater solute concentration when the two solutions are separated by a membrane which selectively prevents the passage of solute molecules, but is permeable to the solvent). [EU] Ossification: The formation of bone or of a bony substance; the conversion of fibrous tissue or of cartilage into bone or a bony substance. [EU] Osteoarthritis: A progressive, degenerative joint disease, the most common form of arthritis, especially in older persons. The disease is thought to result not from the aging process but from biochemical changes and biomechanical stresses affecting articular cartilage. In the foreign literature it is often called osteoarthrosis deformans. [NIH] Osteomyelitis: Inflammation of bone caused by a pyogenic organism. It may remain localized or may spread through the bone to involve the marrow, cortex, cancellous tissue, and periosteum. [EU] Osteonecrosis: Death of a bone or part of a bone, either atraumatic or posttraumatic. [NIH] Otitis: Inflammation of the ear, which may be marked by pain, fever, abnormalities of hearing, hearing loss, tinnitus, and vertigo. [EU] Otitis Media: Inflammation of the middle ear. [NIH] Otitis Media with Effusion: Inflammation of the middle ear with a clear pale yellowcolored transudate. [NIH] Otolaryngologist: A doctor who specializes in treating diseases of the ear, nose, and throat. Also called an ENT doctor. [NIH] Otolaryngology: A surgical specialty concerned with the study and treatment of disorders
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of the ear, nose, and throat. [NIH] Outer ear: The pinna and external meatus of the ear. [NIH] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Ovaries: The pair of female reproductive glands in which the ova, or eggs, are formed. The ovaries are located in the pelvis, one on each side of the uterus. [NIH] Ovary: Either of the paired glands in the female that produce the female germ cells and secrete some of the female sex hormones. [NIH] Overactive bladder: A condition in which the patient experiences two or all three of the following conditions: [NIH] Overdose: An accidental or deliberate dose of a medication or street drug that is in excess of what is normally used. [NIH] Overweight: An excess of body weight but not necessarily body fat; a body mass index of 25 to 29.9 kg/m2. [NIH] Ovum: A female germ cell extruded from the ovary at ovulation. [NIH] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]
Oximetry: The determination of oxygen-hemoglobin saturation of blood either by withdrawing a sample and passing it through a classical photoelectric oximeter or by electrodes attached to some translucent part of the body like finger, earlobe, or skin fold. It includes non-invasive oxygen monitoring by pulse oximetry. [NIH] Oxygen Consumption: The oxygen consumption is determined by calculating the difference between the amount of oxygen inhaled and exhaled. [NIH] Oxygenation: The process of supplying, treating, or mixing with oxygen. No:1245 oxygenation the process of supplying, treating, or mixing with oxygen. [EU] Palate: The structure that forms the roof of the mouth. It consists of the anterior hard palate and the posterior soft palate. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Pancreatic: Having to do with the pancreas. [NIH] Pancreatic cancer: Cancer of the pancreas, a salivary gland of the abdomen. [NIH] Pancreatic Juice: The fluid containing digestive enzymes secreted by the pancreas in response to food in the duodenum. [NIH] Paralysis: Loss of ability to move all or part of the body. [NIH] Paranasal Sinuses: Air-filled extensions of the respiratory part of the nasal cavity into the frontal, ethmoid, sphenoid, and maxillary cranial bones. They vary in size and form in different individuals and are lined by the ciliated mucous membranes of the nasal cavity. [NIH]
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Parasitic: Having to do with or being a parasite. A parasite is an animal or a plant that lives on or in an organism of another species and gets at least some of its nutrients from it. [NIH] Parathyroid: 1. Situated beside the thyroid gland. 2. One of the parathyroid glands. 3. A sterile preparation of the water-soluble principle(s) of the parathyroid glands, ad-ministered parenterally as an antihypocalcaemic, especially in the treatment of acute hypoparathyroidism with tetany. [EU] Parathyroid Glands: Two small paired endocrine glands in the region of the thyroid gland. They secrete parathyroid hormone and are concerned with the metabolism of calcium and phosphorus. [NIH] Parathyroid hormone: A substance made by the parathyroid gland that helps the body store and use calcium. Also called parathormone, parathyrin, or PTH. [NIH] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Paresthesia: Subjective cutaneous sensations (e.g., cold, warmth, tingling, pressure, etc.) that are experienced spontaneously in the absence of stimulation. [NIH] Paroxysmal: Recurring in paroxysms (= spasms or seizures). [EU] Partial remission: The shrinking, but not complete disappearance, of a tumor in response to therapy. Also called partial response. [NIH] Particle: A tiny mass of material. [EU] Parturition: The act or process of given birth to a child. [EU] Patch: A piece of material used to cover or protect a wound, an injured part, etc.: a patch over the eye. [NIH] Pathogen: Any disease-producing microorganism. [EU] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]
Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathologic Processes: The abnormal mechanisms and forms involved in the dysfunctions of tissues and organs. [NIH] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]
Patient Satisfaction: The degree to which the individual regards the health care service or product or the manner in which it is delivered by the provider as useful, effective, or beneficial. [NIH] Patient Selection: Criteria and standards used for the determination of the appropriateness of the inclusion of patients with specific conditions in proposed treatment plans and the criteria used for the inclusion of subjects in various clinical trials and other research protocols. [NIH] Peak flow: The maximum amount of air breathed out; the power needed to produce this amount. [EU] Pediatric Dentistry: The practice of dentistry concerned with the dental problems of children, proper maintenance, and treatment. The dental care may include the services provided by dental specialists. [NIH]
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Pediatric Gastroenterologist: A doctor who treats children with digestive diseases. [NIH] Peer Review: An organized procedure carried out by a select committee of professionals in evaluating the performance of other professionals in meeting the standards of their specialty. Review by peers is used by editors in the evaluation of articles and other papers submitted for publication. Peer review is used also in the evaluation of grant applications. It is applied also in evaluating the quality of health care provided to patients. [NIH] Pelvic: Pertaining to the pelvis. [EU] Penicillin: An antibiotic drug used to treat infection. [NIH] Penile Prosthesis: Rigid, semi-rigid, or inflatable cylindric hydraulic devices, with either combined or separate reservoir and pumping systems, implanted for the surgical treatment of organic impotence. [NIH] Penis: The external reproductive organ of males. It is composed of a mass of erectile tissue enclosed in three cylindrical fibrous compartments. Two of the three compartments, the corpus cavernosa, are placed side-by-side along the upper part of the organ. The third compartment below, the corpus spongiosum, houses the urethra. [NIH] Pentosan polysulfate: A drug used to relieve pain or discomfort associated with chronic inflammation of the bladder. It is also being evaluated for its protective effects on the gastrointestinal tract in people undergoing radiation therapy. [NIH] Pepsin: An enzyme made in the stomach that breaks down proteins. [NIH] Pepsin A: Formed from pig pepsinogen by cleavage of one peptide bond. The enzyme is a single polypeptide chain and is inhibited by methyl 2-diaazoacetamidohexanoate. It cleaves peptides preferentially at the carbonyl linkages of phenylalanine or leucine and acts as the principal digestive enzyme of gastric juice. [NIH] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Peptic Ulcer: Ulcer that occurs in those portions of the alimentary tract which come into contact with gastric juice containing pepsin and acid. It occurs when the amount of acid and pepsin is sufficient to overcome the gastric mucosal barrier. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Perception: The ability quickly and accurately to recognize similarities and differences among presented objects, whether these be pairs of words, pairs of number series, or multiple sets of these or other symbols such as geometric figures. [NIH] Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] Perforation: 1. The act of boring or piercing through a part. 2. A hole made through a part or substance. [EU] Perfusion: Bathing an organ or tissue with a fluid. In regional perfusion, a specific area of the body (usually an arm or a leg) receives high doses of anticancer drugs through a blood vessel. Such a procedure is performed to treat cancer that has not spread. [NIH] Perianal: Located around the anus. [EU] Periaqueductal Gray: Central gray matter surrounding the cerebral aqueduct in the mesencephalon. Physiologically it is probably involved in rage reactions, the lordosis reflex, feeding responses, bladder tonus, and pain. [NIH] Perinatal: Pertaining to or occurring in the period shortly before and after birth; variously defined as beginning with completion of the twentieth to twenty-eighth week of gestation and ending 7 to 28 days after birth. [EU]
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Perineal: Pertaining to the perineum. [EU] Perineum: The area between the anus and the sex organs. [NIH] Periodontal Cyst: An epithelium-lined sac containing fluid; usually found at the apex of a pulp-involved tooth. The lateral type occurs less frequently along the side of the root. [NIH] Periodontal disease: Disease involving the supporting structures of the teeth (as the gums and periodontal membranes). [NIH] Periodontal Ligament: Fibrous connective tissue surrounding the root of a tooth that separates it from and attaches it to the alveolar bone. [NIH] Periodontitis: Inflammation of the periodontal membrane; also called periodontitis simplex. [NIH]
Perioperative: Around the time of surgery; usually lasts from the time of going into the hospital or doctor's office for surgery until the time the patient goes home. [NIH] Peripheral Nerves: The nerves outside of the brain and spinal cord, including the autonomic, cranial, and spinal nerves. Peripheral nerves contain non-neuronal cells and connective tissue as well as axons. The connective tissue layers include, from the outside to the inside, the epineurium, the perineurium, and the endoneurium. [NIH] Peripheral Nervous System: The nervous system outside of the brain and spinal cord. The peripheral nervous system has autonomic and somatic divisions. The autonomic nervous system includes the enteric, parasympathetic, and sympathetic subdivisions. The somatic nervous system includes the cranial and spinal nerves and their ganglia and the peripheral sensory receptors. [NIH] Peripheral Vascular Disease: Disease in the large blood vessels of the arms, legs, and feet. People who have had diabetes for a long time may get this because major blood vessels in their arms, legs, and feet are blocked and these limbs do not receive enough blood. The signs of PVD are aching pains in the arms, legs, and feet (especially when walking) and foot sores that heal slowly. Although people with diabetes cannot always avoid PVD, doctors say they have a better chance of avoiding it if they take good care of their feet, do not smoke, and keep both their blood pressure and diabetes under good control. [NIH] Peritoneal: Having to do with the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH] Peritoneal Cavity: The space enclosed by the peritoneum. It is divided into two portions, the greater sac and the lesser sac or omental bursa, which lies behind the stomach. The two sacs are connected by the foramen of Winslow, or epiploic foramen. [NIH] Peritoneal Dialysis: Dialysis fluid being introduced into and removed from the peritoneal cavity as either a continuous or an intermittent procedure. [NIH] Peritoneum: Endothelial lining of the abdominal cavity, the parietal peritoneum covering the inside of the abdominal wall and the visceral peritoneum covering the bowel, the mesentery, and certain of the organs. The portion that covers the bowel becomes the serosal layer of the bowel wall. [NIH] Pertussis: An acute, highly contagious infection of the respiratory tract, most frequently affecting young children, usually caused by Bordetella pertussis; a similar illness has been associated with infection by B. parapertussis and B. bronchiseptica. It is characterized by a catarrhal stage, beginning after an incubation period of about two weeks, with slight fever, sneezing, running at the nose, and a dry cough. In a week or two the paroxysmal stage begins, with the characteristic paroxysmal cough, consisting of a deep inspiration, followed by a series of quick, short coughs, continuing until the air is expelled from the lungs; the close of the paroxysm is marked by a long-drawn, shrill, whooping inspiration, due to
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spasmodic closure of the glottis. This stage lasts three to four weeks, after which the convalescent stage begins, in which paroxysms grow less frequent and less violent, and finally cease. Called also whooping cough. [EU] PH: The symbol relating the hydrogen ion (H+) concentration or activity of a solution to that of a given standard solution. Numerically the pH is approximately equal to the negative logarithm of H+ concentration expressed in molarity. pH 7 is neutral; above it alkalinity increases and below it acidity increases. [EU] Pharmaceutical Preparations: Drugs intended for human or veterinary use, presented in their finished dosage form. Included here are materials used in the preparation and/or formulation of the finished dosage form. [NIH] Pharmacodynamic: Is concerned with the response of living tissues to chemical stimuli, that is, the action of drugs on the living organism in the absence of disease. [NIH] Pharmacokinetic: The mathematical analysis of the time courses of absorption, distribution, and elimination of drugs. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Pharynx: The hollow tube about 5 inches long that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes to the stomach). [NIH] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phentolamine: A nonselective alpha-adrenergic antagonist. It is used in the treatment of hypertension and hypertensive emergencies, pheochromocytoma, vasospasm of Raynaud's disease and frostbite, clonidine withdrawal syndrome, impotence, and peripheral vascular disease. [NIH] Phenylephrine: An alpha-adrenergic agonist used as a mydriatic, nasal decongestant, and cardiotonic agent. [NIH] Phonophoresis: Use of ultrasound to increase the percutaneous adsorption of drugs. [NIH] Phosphodiesterase: Effector enzyme that regulates the levels of a second messenger, the cyclic GMP. [NIH] Phospholipases: A class of enzymes that catalyze the hydrolysis of phosphoglycerides or glycerophosphatidates. EC 3.1.-. [NIH] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Phosphorylation: The introduction of a phosphoryl group into a compound through the formation of an ester bond between the compound and a phosphorus moiety. [NIH] Photocoagulation: Using a special strong beam of light (laser) to seal off bleeding blood vessels such as in the eye. The laser can also burn away blood vessels that should not have grown in the eye. This is the main treatment for diabetic retinopathy. [NIH] Photodynamic therapy: Treatment with drugs that become active when exposed to light. These drugs kill cancer cells. [NIH]
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Photosensitizer: A drug used in photodynamic therapy. When absorbed by cancer cells and exposed to light, the drug becomes active and kills the cancer cells. [NIH] Phototransduction: The transducing of light energy to afferent nerve impulses, such as takes place in the retinal rods and cones. After light photons are absorbed by the photopigments, the signal is transmitted to the outer segment membrane by the cyclic GMP second messenger system, where it closes the sodium channels. This channel gating ultimately generates an action potential in the inner retina. [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]
Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Physostigmine: A cholinesterase inhibitor that is rapidly absorbed through membranes. It can be applied topically to the conjunctiva. It also can cross the blood-brain barrier and is used when central nervous system effects are desired, as in the treatment of severe anticholinergic toxicity. [NIH] Picrotoxin: A noncompetitive antagonist at GABA-A receptors and thus a convulsant. Picrotoxin blocks the GABA-activated chloride ionophore. Although it is most often used as a research tool, it has been used as a CNS stimulant and an antidote in poisoning by CNS depressants, especially the barbiturates. [NIH] Pigment: A substance that gives color to tissue. Pigments are responsible for the color of skin, eyes, and hair. [NIH] Pigmentation: Coloration or discoloration of a part by a pigment. [NIH] Pilot study: The initial study examining a new method or treatment. [NIH] Pit and Fissure Sealants: Agents used to occlude dental enamel pits and fissures in the prevention of dental caries. [NIH] Placenta: A highly vascular fetal organ through which the fetus absorbs oxygen and other nutrients and excretes carbon dioxide and other wastes. It begins to form about the eighth day of gestation when the blastocyst adheres to the decidua. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plaque: A clear zone in a bacterial culture grown on an agar plate caused by localized destruction of bacterial cells by a bacteriophage. The concentration of infective virus in a fluid can be estimated by applying the fluid to a culture and counting the number of. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma expander: Artificial plasma extender. [EU] Plasma protein: One of the hundreds of different proteins present in blood plasma, including carrier proteins ( such albumin, transferrin, and haptoglobin), fibrinogen and other coagulation factors, complement components, immunoglobulins, enzyme inhibitors, precursors of substances such as angiotension and bradykinin, and many other types of proteins. [EU]
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Plasma Volume: Volume of plasma in the circulation. It is usually measured by indicator dilution techniques. [NIH] Plasticity: In an individual or a population, the capacity for adaptation: a) through gene changes (genetic plasticity) or b) through internal physiological modifications in response to changes of environment (physiological plasticity). [NIH] Platelet Activation: A series of progressive, overlapping events triggered by exposure of the platelets to subendothelial tissue. These events include shape change, adhesiveness, aggregation, and release reactions. When carried through to completion, these events lead to the formation of a stable hemostatic plug. [NIH] Platelet Aggregation: The attachment of platelets to one another. This clumping together can be induced by a number of agents (e.g., thrombin, collagen) and is part of the mechanism leading to the formation of a thrombus. [NIH] Platelets: A type of blood cell that helps prevent bleeding by causing blood clots to form. Also called thrombocytes. [NIH] Platinum: Platinum. A heavy, soft, whitish metal, resembling tin, atomic number 78, atomic weight 195.09, symbol Pt. (From Dorland, 28th ed) It is used in manufacturing equipment for laboratory and industrial use. It occurs as a black powder (platinum black) and as a spongy substance (spongy platinum) and may have been known in Pliny's time as "alutiae". [NIH]
Pleated: Particular three-dimensional pattern of amyloidoses. [NIH] Plethysmograph: An instrument for measuring swelling or expansion of the body or part of it, such as a limb or digit, commonly used for the indirect measurement of blood flow or other displacement of internal fluids. [NIH] Pleural: A circumscribed area of hyaline whorled fibrous tissue which appears on the surface of the parietal pleura, on the fibrous part of the diaphragm or on the pleura in the interlobar fissures. [NIH] Pleural cavity: A space enclosed by the pleura (thin tissue covering the lungs and lining the interior wall of the chest cavity). It is bound by thin membranes. [NIH] Plexus: A network or tangle; a general term for a network of lymphatic vessels, nerves, or veins. [EU] Point Mutation: A mutation caused by the substitution of one nucleotide for another. This results in the DNA molecule having a change in a single base pair. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Polyethylene: A vinyl polymer made from ethylene. It can be branched or linear. Branched or low-density polyethylene is tough and pliable but not to the same degree as linear polyethylene. Linear or high-density polyethylene has a greater hardness and tensile strength. Polyethylene is used in a variety of products, including implants and prostheses. [NIH]
Polymers: Compounds formed by the joining of smaller, usually repeating, units linked by covalent bonds. These compounds often form large macromolecules (e.g., polypeptides, proteins, plastics). [NIH] Polymorphism: The occurrence together of two or more distinct forms in the same population. [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together
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chemically. [NIH] Polyvinyl Alcohol: A polymer prepared from polyvinyl acetates by replacement of the acetate groups with hydroxyl groups. It is used as a pharmaceutic aid and ophthalmic lubricant as well as in the manufacture of surface coatings artificial sponges, cosmetics, and other products. [NIH] Pons: The part of the central nervous system lying between the medulla oblongata and the mesencephalon, ventral to the cerebellum, and consisting of a pars dorsalis and a pars ventralis. [NIH] Pontine: A brain region involved in the detection and processing of taste. [NIH] Port: An implanted device through which blood may be withdrawn and drugs may be infused without repeated needle sticks. Also called a port-a-cath. [NIH] Port-a-cath: An implanted device through which blood may be withdrawn and drugs may be infused without repeated needle sticks. Also called a port. [NIH] Portal Vein: A short thick vein formed by union of the superior mesenteric vein and the splenic vein. [NIH] Positive pressure ventilation: Provision of oxygen under pressure by a mechanical respirator. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postnatal: Occurring after birth, with reference to the newborn. [EU] Postoperative: After surgery. [NIH] Postoperative Complications: Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery. [NIH] Postoperative Period: The period following a surgical operation. [NIH] Postprandial: Occurring after dinner, or after a meal; postcibal. [EU] Postsynaptic: Nerve potential generated by an inhibitory hyperpolarizing stimulation. [NIH] Post-synaptic: Nerve potential generated by an inhibitory hyperpolarizing stimulation. [NIH] Postural: Pertaining to posture or position. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Potentiate: A degree of synergism which causes the exposure of the organism to a harmful substance to worsen a disease already contracted. [NIH] Potentiating: A degree of synergism which causes the exposure of the organism to a harmful substance to worsen a disease already contracted. [NIH] Potentiation: An overall effect of two drugs taken together which is greater than the sum of the effects of each drug taken alone. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH]
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Practice Management: Business management of medical and dental practices that may include capital financing, utilization management, and arrangement of capitation agreements with other parties. [NIH] Preclinical: Before a disease becomes clinically recognizable. [EU] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Preeclampsia: A toxaemia of late pregnancy characterized by hypertension, edema, and proteinuria, when convulsions and coma are associated, it is called eclampsia. [EU] Prefrontal Cortex: The rostral part of the frontal lobe, bounded by the inferior precentral fissure in humans, which receives projection fibers from the mediodorsal nucleus of the thalamus. The prefrontal cortex receives afferent fibers from numerous structures of the diencephalon, mesencephalon, and limbic system as well as cortical afferents of visual, auditory, and somatic origin. [NIH] Pregnancy in Diabetics: Previously diagnosed diabetics that become pregnant. This does not include either symptomatic diabetes or impaired glucose tolerance induced by pregnancy but resolved at the end of pregnancy (diabetes, gestational). [NIH] Pregnancy Outcome: Results of conception and ensuing pregnancy, including live birth, stillbirth, spontaneous abortion, induced abortion. The outcome may follow natural or artificial insemination or any of the various reproduction techniques, such as embryo transfer or fertilization in vitro. [NIH] Pregnancy Tests: Tests to determine whether or not an individual is pregnant. [NIH] Premedication: Preliminary administration of a drug preceding a diagnostic, therapeutic, or surgical procedure. The commonest types of premedication are antibiotics (antibiotic prophylaxis) and anti-anxiety agents. It does not include preanesthetic medication. [NIH] Prenatal: Existing or occurring before birth, with reference to the fetus. [EU] Prenatal Diagnosis: Determination of the nature of a pathological condition or disease in the postimplantation embryo, fetus, or pregnant female before birth. [NIH] Prepuce: A covering fold of skin; often used alone to designate the preputium penis. [EU] Presynaptic: Situated proximal to a synapse, or occurring before the synapse is crossed. [EU] Presynaptic Terminals: The distal terminations of axons which are specialized for the release of neurotransmitters. Also included are varicosities along the course of axons which have similar specializations and also release transmitters. Presynaptic terminals in both the central and peripheral nervous systems are included. [NIH] Priapism: Persistent abnormal erection of the penis, usually without sexual desire, and accompanied by pain and tenderness. It is seen in diseases and injuries of the spinal cord, and may be caused by vesical calculus and certain injuries to the penis. [EU] Probe: An instrument used in exploring cavities, or in the detection and dilatation of strictures, or in demonstrating the potency of channels; an elongated instrument for exploring or sounding body cavities. [NIH] Procaine: A local anesthetic of the ester type that has a slow onset and a short duration of action. It is mainly used for infiltration anesthesia, peripheral nerve block, and spinal block. (From Martindale, The Extra Pharmacopoeia, 30th ed, p1016). [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body,
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secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Projection: A defense mechanism, operating unconsciously, whereby that which is emotionally unacceptable in the self is rejected and attributed (projected) to others. [NIH] Prolapse: The protrusion of an organ or part of an organ into a natural or artificial orifice. [NIH]
Prone: Having the front portion of the body downwards. [NIH] Prophase: The first phase of cell division, in which the chromosomes become visible, the nucleus starts to lose its identity, the spindle appears, and the centrioles migrate toward opposite poles. [NIH] Prophylaxis: An attempt to prevent disease. [NIH] Propofol: A widely used anesthetic. [NIH] Proportional: Being in proportion : corresponding in size, degree, or intensity, having the same or a constant ratio; of, relating to, or used in determining proportions. [EU] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Prostaglandins: A group of compounds derived from unsaturated 20-carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway. They are extremely potent mediators of a diverse group of physiological processes. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Prostate gland: A gland in the male reproductive system just below the bladder. It surrounds part of the urethra, the canal that empties the bladder, and produces a fluid that forms part of semen. [NIH] Prostatectomy: Complete or partial surgical removal of the prostate. Three primary approaches are commonly employed: suprapubic - removal through an incision above the pubis and through the urinary bladder; retropubic - as for suprapubic but without entering the urinary bladder; and transurethral (transurethral resection of prostate). [NIH] Prostatic Hyperplasia: Enlargement or overgrowth of the prostate gland as a result of an increase in the number of its constituent cells. [NIH] Prostatitis: Inflammation of the prostate. [EU] Prosthesis: An artificial replacement of a part of the body. [NIH] Prosthodontics: A dental specialty concerned with the restoration and maintenance of oral function by the replacement of missing teeth and structures by artificial devices or prostheses. [NIH] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU]
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Protective Agents: Synthetic or natural substances which are given to prevent a disease or disorder or are used in the process of treating a disease or injury due to a poisonous agent. [NIH]
Protein Binding: The process in which substances, either endogenous or exogenous, bind to proteins, peptides, enzymes, protein precursors, or allied compounds. Specific proteinbinding measures are often used as assays in diagnostic assessments. [NIH] Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein Kinases: A family of enzymes that catalyze the conversion of ATP and a protein to ADP and a phosphoprotein. EC 2.7.1.37. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Protein Subunits: Single chains of amino acids that are the units of a multimeric protein. They can be identical or non-identical subunits. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteinuria: The presence of protein in the urine, indicating that the kidneys are not working properly. [NIH] Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychogenic: Produced or caused by psychic or mental factors rather than organic factors. [EU]
Psychological Techniques: Methods used in the diagnosis and treatment of behavioral, personality, and mental disorders. [NIH] Psychology: The science dealing with the study of mental processes and behavior in man and animals. [NIH] Psychomotor: Pertaining to motor effects of cerebral or psychic activity. [EU] Psychosis: A mental disorder characterized by gross impairment in reality testing as evidenced by delusions, hallucinations, markedly incoherent speech, or disorganized and agitated behaviour without apparent awareness on the part of the patient of the incomprehensibility of his behaviour; the term is also used in a more general sense to refer to mental disorders in which mental functioning is sufficiently impaired as to interfere grossly with the patient's capacity to meet the ordinary demands of life. Historically, the
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term has been applied to many conditions, e.g. manic-depressive psychosis, that were first described in psychotic patients, although many patients with the disorder are not judged psychotic. [EU] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Publishing: "The business or profession of the commercial production and issuance of literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing. [NIH]
Puerperium: Period from delivery of the placenta until return of the reproductive organs to their normal nonpregnant morphologic state. In humans, the puerperium generally lasts for six to eight weeks. [NIH] Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulmonary Edema: An accumulation of an excessive amount of watery fluid in the lungs, may be caused by acute exposure to dangerous concentrations of irritant gasses. [NIH] Pulmonary Ventilation: The total volume of gas per minute inspired or expired measured in liters per minute. [NIH] Pulsation: A throb or rhythmical beat, as of the heart. [EU] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]
Pupil: The aperture in the iris through which light passes. [NIH] Purpura: Purplish or brownish red discoloration, easily visible through the epidermis, caused by hemorrhage into the tissues. [NIH] Purulent: Consisting of or containing pus; associated with the formation of or caused by pus. [EU] Pyogenic: Producing pus; pyopoietic (= liquid inflammation product made up of cells and a thin fluid called liquor puris). [EU] Pyramidal Cells: Projection neurons in the cerebral cortex and the hippocampus. Pyramidal cells have a pyramid-shaped soma with the apex and an apical dendrite pointed toward the pial surface and other dendrites and an axon emerging from the base. The axons may have local collaterals but also project outside their cortical region. [NIH] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Quaternary: 1. Fourth in order. 2. Containing four elements or groups. [EU] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radiation therapy: The use of high-energy radiation from x-rays, gamma rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from
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radioactive material placed in the body in the area near cancer cells (internal radiation therapy, implant radiation, or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy. [NIH] Radicular: Having the character of or relating to a radicle or root. [NIH] Radicular Cyst: Slow-growing fluid-filled epithelial sac at the apex of a tooth with a nonvital pulp or defective root canal filling. [NIH] Radio Waves: That portion of the electromagnetic spectrum beyond the microwaves, with wavelengths as high as 30 KM. They are used in communications, including television. Short Wave or HF (high frequency), UHF (ultrahigh frequency) and VHF (very high frequency) waves are used in citizen's band communication. [NIH] Radioactive: Giving off radiation. [NIH] Radiography: Examination of any part of the body for diagnostic purposes by means of roentgen rays, recording the image on a sensitized surface (such as photographic film). [NIH] Radiolabeled: Any compound that has been joined with a radioactive substance. [NIH] Radiological: Pertaining to radiodiagnostic and radiotherapeutic procedures, and interventional radiology or other planning and guiding medical radiology. [NIH] Radiology: A specialty concerned with the use of x-ray and other forms of radiant energy in the diagnosis and treatment of disease. [NIH] Radiopharmaceutical: Any medicinal product which, when ready for use, contains one or more radionuclides (radioactive isotopes) included for a medicinal purpose. [NIH] Radiotherapy: The use of ionizing radiation to treat malignant neoplasms and other benign conditions. The most common forms of ionizing radiation used as therapy are x-rays, gamma rays, and electrons. A special form of radiotherapy, targeted radiotherapy, links a cytotoxic radionuclide to a molecule that targets the tumor. When this molecule is an antibody or other immunologic molecule, the technique is called radioimmunotherapy. [NIH] Radius: The lateral bone of the forearm. [NIH] Rage: Fury; violent, intense anger. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Randomized clinical trial: A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial. [NIH] Randomized Controlled Trials: Clinical trials that involve at least one test treatment and one control treatment, concurrent enrollment and follow-up of the test- and control-treated groups, and in which the treatments to be administered are selected by a random process, such as the use of a random-numbers table. Treatment allocations using coin flips, odd-even numbers, patient social security numbers, days of the week, medical record numbers, or other such pseudo- or quasi-random processes, are not truly randomized and trials employing any of these techniques for patient assignment are designated simply controlled clinical trials. [NIH] Rationalize: To attribute one's actions to rational and creditable motives without adequate analysis of the true and unconscious motives. [NIH]
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Reagent: A substance employed to produce a chemical reaction so as to detect, measure, produce, etc., other substances. [EU] Reality Testing: The individual's objective evaluation of the external world and the ability to differentiate adequately between it and the internal world; considered to be a primary ego function. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Receptors, Adrenergic: Cell-surface proteins that bind epinephrine and/or norepinephrine with high affinity and trigger intracellular changes. The two major classes of adrenergic receptors, alpha and beta, were originally discriminated based on their cellular actions but now are distinguished by their relative affinity for characteristic synthetic ligands. Adrenergic receptors may also be classified according to the subtypes of G-proteins with which they bind; this scheme does not respect the alpha-beta distinction. [NIH] Receptors, Glutamate: Cell-surface proteins that bind glutamate and trigger changes which influence the behavior of cells. Glutamate receptors include ionotropic receptors (AMPA, kainate, and N-methyl-D-aspartate receptors), which directly control ion channels, and metabotropic receptors which act through second messenger systems. Glutamate receptors are the most common mediators of fast excitatory synaptic transmission in the central nervous system. They have also been implicated in the mechanisms of memory and of many diseases. [NIH] Recombinant: A cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Recombination: The formation of new combinations of genes as a result of segregation in crosses between genetically different parents; also the rearrangement of linked genes due to crossing-over. [NIH] Recovery of Function: A partial or complete return to the normal or proper physiologic activity of an organ or part following disease or trauma. [NIH] Recovery Room: Hospital unit providing continuous monitoring of the patient following anesthesia. [NIH] Rectal: By or having to do with the rectum. The rectum is the last 8 to 10 inches of the large intestine and ends at the anus. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recur: To occur again. Recurrence is the return of cancer, at the same site as the original (primary) tumor or in another location, after the tumor had disappeared. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Reductase: Enzyme converting testosterone to dihydrotestosterone. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reflex: An involuntary movement or exercise of function in a part, excited in response to a stimulus applied to the periphery and transmitted to the brain or spinal cord. [NIH] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive error (myopia, hyperopia, or astigmatism). [NIH] Refractory: Not readily yielding to treatment. [EU] Regeneration: The natural renewal of a structure, as of a lost tissue or part. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH]
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Regression Analysis: Procedures for finding the mathematical function which best describes the relationship between a dependent variable and one or more independent variables. In linear regression (see linear models) the relationship is constrained to be a straight line and least-squares analysis is used to determine the best fit. In logistic regression (see logistic models) the dependent variable is qualitative rather than continuously variable and likelihood functions are used to find the best relationship. In multiple regression the dependent variable is considered to depend on more than a single independent variable. [NIH]
Regurgitation: A backward flowing, as the casting up of undigested food, or the backward flowing of blood into the heart, or between the chambers of the heart when a valve is incompetent. [EU] Relapse: The return of signs and symptoms of cancer after a period of improvement. [NIH] Relaxant: 1. Lessening or reducing tension. 2. An agent that lessens tension. [EU] Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Renal failure: Progressive renal insufficiency and uremia, due to irreversible and progressive renal glomerular tubular or interstitial disease. [NIH] Renal pelvis: The area at the center of the kidney. Urine collects here and is funneled into the ureter, the tube that connects the kidney to the bladder. [NIH] Renal tubular: A defect in the kidneys that hinders their normal excretion of acids. Failure to excrete acids can lead to weak bones, kidney stones, and poor growth in children. [NIH] Renin: An enzyme which is secreted by the kidney and is formed from prorenin in plasma and kidney. The enzyme cleaves the Leu-Leu bond in angiotensinogen to generate angiotensin I. EC 3.4.23.15. (Formerly EC 3.4.99.19). [NIH] Renin-Angiotensin System: A system consisting of renin, angiotensin-converting enzyme, and angiotensin II. Renin, an enzyme produced in the kidney, acts on angiotensinogen, an alpha-2 globulin produced by the liver, forming angiotensin I. The converting enzyme contained in the lung acts on angiotensin I in the plasma converting it to angiotensin II, the most powerful directly pressor substance known. It causes contraction of the arteriolar smooth muscle and has other indirect actions mediated through the adrenal cortex. [NIH] Renovascular: Of or pertaining to the blood vessels of the kidneys. [EU] Reperfusion: Restoration of blood supply to tissue which is ischemic due to decrease in normal blood supply. The decrease may result from any source including atherosclerotic obstruction, narrowing of the artery, or surgical clamping. It is primarily a procedure for treating infarction or other ischemia, by enabling viable ischemic tissue to recover, thus limiting further necrosis. However, it is thought that reperfusion can itself further damage the ischemic tissue, causing reperfusion injury. [NIH] Reperfusion Injury: Functional, metabolic, or structural changes, including necrosis, in ischemic tissues thought to result from reperfusion to ischemic areas of the tissue. The most common instance is myocardial reperfusion injury. [NIH] Reproduction Techniques: Methods pertaining to the generation of new individuals. [NIH] Reproductive system: In women, this system includes the ovaries, the fallopian tubes, the uterus (womb), the cervix, and the vagina (birth canal). The reproductive system in men includes the prostate, the testes, and the penis. [NIH] Research Design: A plan for collecting and utilizing data so that desired information can be
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obtained with sufficient precision or so that an hypothesis can be tested properly. [NIH] Resection: Removal of tissue or part or all of an organ by surgery. [NIH] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Respirator: A mechanical device that helps a patient breathe; a mechanical ventilator. [NIH] Respiratory failure: Inability of the lungs to conduct gas exchange. [NIH] Respiratory Paralysis: Complete or severe weakness of the muscles of respiration. This condition may be associated with motor neuron diseases; peripheral nerve disorders; neuromuscular junction diseases; spinal cord diseases; injury to the phrenic nerve; and other disorders. [NIH] Respiratory Physiology: Functions and activities of the respiratory tract as a whole or of any of its parts. [NIH] Respiratory System: The tubular and cavernous organs and structures, by means of which pulmonary ventilation and gas exchange between ambient air and the blood are brought about. [NIH] Restoration: Broad term applied to any inlay, crown, bridge or complete denture which restores or replaces loss of teeth or oral tissues. [NIH] Resuscitation: The restoration to life or consciousness of one apparently dead; it includes such measures as artificial respiration and cardiac massage. [EU] Reticular: Coarse-fibered, netlike dermis layer. [NIH] Reticular Formation: A region extending from the pons & medulla oblongata through the mesencephalon, characterized by a diversity of neurons of various sizes and shapes, arranged in different aggregations and enmeshed in a complicated fiber network. [NIH] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Retinal: 1. Pertaining to the retina. 2. The aldehyde of retinol, derived by the oxidative enzymatic splitting of absorbed dietary carotene, and having vitamin A activity. In the retina, retinal combines with opsins to form visual pigments. One isomer, 11-cis retinal combines with opsin in the rods (scotopsin) to form rhodopsin, or visual purple. Another, all-trans retinal (trans-r.); visual yellow; xanthopsin) results from the bleaching of rhodopsin by light, in which the 11-cis form is converted to the all-trans form. Retinal also combines with opsins in the cones (photopsins) to form the three pigments responsible for colour vision. Called also retinal, and retinene1. [EU] Retinal Detachment: Separation of the inner layers of the retina (neural retina) from the pigment epithelium. Retinal detachment occurs more commonly in men than in women, in eyes with degenerative myopia, in aging and in aphakia. It may occur after an uncomplicated cataract extraction, but it is seen more often if vitreous humor has been lost during surgery. (Dorland, 27th ed; Newell, Ophthalmology: Principles and Concepts, 7th ed, p310-12). [NIH] Retinitis: Inflammation of the retina. It is rarely limited to the retina, but is commonly associated with diseases of the choroid (chorioretinitis) and of the optic nerve (neuroretinitis). The disease may be confined to one eye, but since it is generally dependent
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on a constitutional factor, it is almost always bilateral. It may be acute in course, but as a rule it lasts many weeks or even several months. [NIH] Retinol: Vitamin A. It is essential for proper vision and healthy skin and mucous membranes. Retinol is being studied for cancer prevention; it belongs to the family of drugs called retinoids. [NIH] Retinopathy: 1. Retinitis (= inflammation of the retina). 2. Retinosis (= degenerative, noninflammatory condition of the retina). [EU] Retrobulbar: Behind the pons. [EU] Retrograde: 1. Moving backward or against the usual direction of flow. 2. Degenerating, deteriorating, or catabolic. [EU] Retroperitoneal: Having to do with the area outside or behind the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH] Retropubic: A potential space between the urinary bladder and the symphisis and body of the pubis. [NIH] Retrospective: Looking back at events that have already taken place. [NIH] Retrospective study: A study that looks backward in time, usually using medical records and interviews with patients who already have or had a disease. [NIH] Rheumatism: A group of disorders marked by inflammation or pain in the connective tissue structures of the body. These structures include bone, cartilage, and fat. [NIH] Rheumatoid: Resembling rheumatism. [EU] Rheumatoid arthritis: A form of arthritis, the cause of which is unknown, although infection, hypersensitivity, hormone imbalance and psychologic stress have been suggested as possible causes. [NIH] Ribose: A pentose active in biological systems usually in its D-form. [NIH] Rigidity: Stiffness or inflexibility, chiefly that which is abnormal or morbid; rigor. [EU] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Rod: A reception for vision, located in the retina. [NIH] Root Planing: A procedure for smoothing of the roughened root surface or cementum of a tooth after subgingival curettage or scaling, as part of periodontal therapy. [NIH] Rubber: A high-molecular-weight polymeric elastomer derived from the milk juice (latex) of Hevea brasiliensis and other trees. It is a substance that can be stretched at room temperature to atleast twice its original length and after releasing the stress, retractrapidly, and recover its original dimensions fully. Synthetic rubber is made from many different chemicals, including styrene, acrylonitrile, ethylene, propylene, and isoprene. [NIH] Ryanodine: Insecticidal alkaloid isolated from Ryania speciosa; proposed as a myocardial depressant. [NIH] Saline: A solution of salt and water. [NIH] Saliva: The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptylin. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Salivation: 1. The secretion of saliva. 2. Ptyalism (= excessive flow of saliva). [EU] Sanitation: The development and establishment of environmental conditions favorable to
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the health of the public. [NIH] Saphenous: Applied to certain structures in the leg, e. g. nerve vein. [NIH] Saphenous Vein: The vein which drains the foot and leg. [NIH] Saponins: Sapogenin glycosides. A type of glycoside widely distributed in plants. Each consists of a sapogenin as the aglycon moiety, and a sugar. The sapogenin may be a steroid or a triterpene and the sugar may be glucose, galactose, a pentose, or a methylpentose. Sapogenins are poisonous towards the lower forms of life and are powerful hemolytics when injected into the blood stream able to dissolve red blood cells at even extreme dilutions. [NIH] Sarcoplasmic Reticulum: A network of tubules and sacs in the cytoplasm of skeletal muscles that assist with muscle contraction and relaxation by releasing and storing calcium ions. [NIH] Saturate: Means fatty acids without double bond. [NIH] Saxitoxin: Poison found in certain edible mollusks at certain times; elaborated by Gonyaulax species (Dinoflagellate protozoans) and consumed by mollusks, fishes, etc. without ill effects; it is neurotoxic and causes respiratory paralysis and other effects in mammals, known as paralytic shellfish poisoning. [NIH] Schizoid: Having qualities resembling those found in greater degree in schizophrenics; a person of schizoid personality. [NIH] Schizophrenia: A mental disorder characterized by a special type of disintegration of the personality. [NIH] Schizophrenia, Catatonic: A type of schizophrenia characterized by abnormality of motor behavior which may involve particular forms of stupor, rigidity, excitement or inappropriate posture. [NIH] Schizotypal Personality Disorder: A personality disorder in which there are oddities of thought (magical thinking, paranoid ideation, suspiciousness), perception (illusions, depersonalization), speech (digressive, vague, overelaborate), and behavior (inappropriate affect in social interactions, frequently social isolation) that are not severe enough to characterize schizophrenia. [NIH] Sclera: The tough white outer coat of the eyeball, covering approximately the posterior fivesixths of its surface, and continuous anteriorly with the cornea and posteriorly with the external sheath of the optic nerve. [EU] Sclerosis: A pathological process consisting of hardening or fibrosis of an anatomical structure, often a vessel or a nerve. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Scrotum: In males, the external sac that contains the testicles. [NIH] Second Messenger Systems: Systems in which an intracellular signal is generated in response to an intercellular primary messenger such as a hormone or neurotransmitter. They are intermediate signals in cellular processes such as metabolism, secretion, contraction, phototransduction, and cell growth. Examples of second messenger systems are the adenyl cyclase-cyclic AMP system, the phosphatidylinositol diphosphate-inositol triphosphate system, and the cyclic GMP system. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Secretory: Secreting; relating to or influencing secretion or the secretions. [NIH]
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Sedative: 1. Allaying activity and excitement. 2. An agent that allays excitement. [EU] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Semicircular canal: Three long canals of the bony labyrinth of the ear, forming loops and opening into the vestibule by five openings. [NIH] Seminal vesicles: Glands that help produce semen. [NIH] Senile: Relating or belonging to old age; characteristic of old age; resulting from infirmity of old age. [NIH] Sensibility: The ability to receive, feel and appreciate sensations and impressions; the quality of being sensitive; the extend to which a method gives results that are free from false negatives. [NIH] Sensitization: 1. Administration of antigen to induce a primary immune response; priming; immunization. 2. Exposure to allergen that results in the development of hypersensitivity. 3. The coating of erythrocytes with antibody so that they are subject to lysis by complement in the presence of homologous antigen, the first stage of a complement fixation test. [EU] Sensor: A device designed to respond to physical stimuli such as temperature, light, magnetism or movement and transmit resulting impulses for interpretation, recording, movement, or operating control. [NIH] Sepsis: The presence of bacteria in the bloodstream. [NIH] Sequencing: The determination of the order of nucleotides in a DNA or RNA chain. [NIH] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Serous: Having to do with serum, the clear liquid part of blood. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Seton: A thin strand of linen or silk drawn through a cutaneus wound in order to lay down the foundations of a drain. [NIH] Sex Characteristics: Those characteristics that distinguish one sex from the other. The primary sex characteristics are the ovaries and testes and their related hormones. Secondary sex characteristics are those which are masculine or feminine but not directly related to reproduction. [NIH] Shave biopsy: A procedure in which the parts of a mole that are above and just below the surface of the skin are removed with a small blade. There is no need for stitches with this procedure. [NIH] Shivering: Involuntary contraction or twitching of the muscles. It is a physiologic method of heat production in man and other mammals. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral
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upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]
Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Sigmoid: 1. Shaped like the letter S or the letter C. 2. The sigmoid colon. [EU] Sigmoid Colon: The lower part of the colon that empties into the rectum. [NIH] Signal Transduction: The intercellular or intracellular transfer of information (biological activation/inhibition) through a signal pathway. In each signal transduction system, an activation/inhibition signal from a biologically active molecule (hormone, neurotransmitter) is mediated via the coupling of a receptor/enzyme to a second messenger system or to an ion channel. Signal transduction plays an important role in activating cellular functions, cell differentiation, and cell proliferation. Examples of signal transduction systems are the GABA-postsynaptic receptor-calcium ion channel system, the receptor-mediated T-cell activation pathway, and the receptor-mediated activation of phospholipases. Those coupled to membrane depolarization or intracellular release of calcium include the receptormediated activation of cytotoxic functions in granulocytes and the synaptic potentiation of protein kinase activation. Some signal transduction pathways may be part of larger signal transduction pathways; for example, protein kinase activation is part of the platelet activation signal pathway. [NIH] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Skin graft: Skin that is moved from one part of the body to another. [NIH] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Sleep apnea: A serious, potentially life-threatening breathing disorder characterized by repeated cessation of breathing due to either collapse of the upper airway during sleep or absence of respiratory effort. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]
Sneezing: Sudden, forceful, involuntary expulsion of air from the nose and mouth caused by irritation to the mucous membranes of the upper respiratory tract. [NIH] Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH]
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Sodium Channels: Cell membrane glycoproteins selective for sodium ions. Fast sodium current is associated with the action potential in neural membranes. [NIH] Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Solvent: 1. Dissolving; effecting a solution. 2. A liquid that dissolves or that is capable of dissolving; the component of a solution that is present in greater amount. [EU] Soma: The body as distinct from the mind; all the body tissue except the germ cells; all the axial body. [NIH] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Sound wave: An alteration of properties of an elastic medium, such as pressure, particle displacement, or density, that propagates through the medium, or a superposition of such alterations. [NIH] Spasm: An involuntary contraction of a muscle or group of muscles. Spasms may involve skeletal muscle or smooth muscle. [NIH] Spasmodic: Of the nature of a spasm. [EU] Spastic: 1. Of the nature of or characterized by spasms. 2. Hypertonic, so that the muscles are stiff and the movements awkward. 3. A person exhibiting spasticity, such as occurs in spastic paralysis or in cerebral palsy. [EU] Spasticity: A state of hypertonicity, or increase over the normal tone of a muscle, with heightened deep tendon reflexes. [EU] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] Spectrometer: An apparatus for determining spectra; measures quantities such as wavelengths and relative amplitudes of components. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Specula: Any instrument used in the inspection of a normally closed tube or passage. [NIH] Speculum: An instrument used to widen an opening of the body to make it easier to look inside. [NIH] Sperm: The fecundating fluid of the male. [NIH] Spermatozoa: Mature male germ cells that develop in the seminiferous tubules of the testes. Each consists of a head, a body, and a tail that provides propulsion. The head consists mainly of chromatin. [NIH] Sphenoid: An unpaired cranial bone with a body containing the sphenoid sinus and forming the posterior part of the medial walls of the orbits. [NIH]
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Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU] Spike: The activation of synapses causes changes in the permeability of the dendritic membrane leading to changes in the membrane potential. This difference of the potential travels along the axon of the neuron and is called spike. [NIH] Spina bifida: A defect in development of the vertebral column in which there is a central deficiency of the vertebral lamina. [NIH] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spinal Cord Injuries: Penetrating and non-penetrating injuries to the spinal cord resulting from traumatic external forces (e.g., wounds, gunshot; whiplash injuries; etc.). [NIH] Spinal Nerves: The 31 paired peripheral nerves formed by the union of the dorsal and ventral spinal roots from each spinal cord segment. The spinal nerve plexuses and the spinal roots are also included. [NIH] Spleen: An organ that is part of the lymphatic system. The spleen produces lymphocytes, filters the blood, stores blood cells, and destroys old blood cells. It is located on the left side of the abdomen near the stomach. [NIH] Splenectomy: An operation to remove the spleen. [NIH] Splenic Vein: Vein formed by the union (at the hilus of the spleen) of several small veins from the stomach, pancreas, spleen and mesentery. [NIH] Splint: A rigid appliance used for the immobilization of a part or for the correction of deformity. [NIH] Spontaneous Abortion: The non-induced birth of an embryo or of fetus prior to the stage of viability at about 20 weeks of gestation. [NIH] Sporadic: Neither endemic nor epidemic; occurring occasionally in a random or isolated manner. [EU] Sprains and Strains: A collective term for muscle and ligament injuries without dislocation or fracture. A sprain is a joint injury in which some of the fibers of a supporting ligament are ruptured but the continuity of the ligament remains intact. A strain is an overstretching or overexertion of some part of the musculature. [NIH] Squamous: Scaly, or platelike. [EU] Squamous Epithelium: Tissue in an organ such as the esophagus. Consists of layers of flat, scaly cells. [NIH] Staging: Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. [NIH]
Stasis: A word termination indicating the maintenance of (or maintaining) a constant level; preventing increase or multiplication. [EU] Statistically significant: Describes a mathematical measure of difference between groups. The difference is said to be statistically significant if it is greater than what might be expected to happen by chance alone. [NIH] Status Asthmaticus: A sudden intense and continuous aggravation of a state of asthma, marked by dyspnea to the point of exhaustion and collapse and not responding to the usual therapeutic efforts. [NIH] Status Epilepticus: Repeated and prolonged epileptic seizures without recovery of consciousness between attacks. [NIH]
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Steatosis: Fatty degeneration. [EU] Steel: A tough, malleable, iron-based alloy containing up to, but no more than, two percent carbon and often other metals. It is used in medicine and dentistry in implants and instrumentation. [NIH] Stem Cells: Relatively undifferentiated cells of the same lineage (family type) that retain the ability to divide and cycle throughout postnatal life to provide cells that can become specialized and take the place of those that die or are lost. [NIH] Stents: Devices that provide support for tubular structures that are being anastomosed or for body cavities during skin grafting. [NIH] Stereotyped Behavior: Relatively invariant mode of behavior elicited or determined by a particular situation; may be verbal, postural, or expressive. [NIH] Sterile: Unable to produce children. [NIH] Sterilization: The destroying of all forms of life, especially microorganisms, by heat, chemical, or other means. [NIH] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stillbirth: The birth of a dead fetus or baby. [NIH] Stimulant: 1. Producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. An agent or remedy that produces stimulation. [EU]
Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Strand: DNA normally exists in the bacterial nucleus in a helix, in which two strands are coiled together. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stress incontinence: An involuntary loss of urine that occurs at the same time that internal abdominal pressure is increased, such as with laughing, sneezing, coughing, or physical activity. [NIH] Stress urinary: Leakage of urine caused by actions--such as coughing, laughing, sneezing, running, or lifting--that place pressure on the bladder from inside the body. Stress urinary incontinence can result from either a fallen bladder or weak sphincter muscles. [NIH] Stria: 1. A streak, or line. 2. A narrow bandlike structure; a general term for such longitudinal collections of nerve fibres in the brain. [EU] Stricture: The abnormal narrowing of a body opening. Also called stenosis. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Stroke Volume: The amount of blood pumped out of the heart per beat not to be confused with cardiac output (volume/time). [NIH]
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Stromal: Large, veil-like cell in the bone marrow. [NIH] Stromal Cells: Connective tissue cells of an organ found in the loose connective tissue. These are most often associated with the uterine mucosa and the ovary as well as the hematopoietic system and elsewhere. [NIH] Stupor: Partial or nearly complete unconsciousness, manifested by the subject's responding only to vigorous stimulation. Also, in psychiatry, a disorder marked by reduced responsiveness. [EU] Styrene: A colorless, toxic liquid with a strong aromatic odor. It is used to make rubbers, polymers and copolymers, and polystyrene plastics. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subarachnoid: Situated or occurring between the arachnoid and the pia mater. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Subiculum: A region of the hippocampus that projects to other areas of the brain. [NIH] Sublingual: Located beneath the tongue. [EU] Submaxillary: Four to six lymph glands, located between the lower jaw and the submandibular salivary gland. [NIH] Substance P: An eleven-amino acid neurotransmitter that appears in both the central and peripheral nervous systems. It is involved in transmission of pain, causes rapid contractions of the gastrointestinal smooth muscle, and modulates inflammatory and immune responses. [NIH]
Substrate: A substance upon which an enzyme acts. [EU] Sudden cardiac death: Cardiac arrest caused by an irregular heartbeat. [NIH] Sudden death: Cardiac arrest caused by an irregular heartbeat. The term "death" is somewhat misleading, because some patients survive. [NIH] Sufentanil: An opioid analgesic that is used as an adjunct in anesthesia, in balanced anesthesia, and as a primary anesthetic agent. [NIH] Sulfur: An element that is a member of the chalcogen family. It has an atomic symbol S, atomic number 16, and atomic weight 32.066. It is found in the amino acids cysteine and methionine. [NIH] Supplementation: Adding nutrients to the diet. [NIH] Support group: A group of people with similar disease who meet to discuss how better to cope with their cancer and treatment. [NIH] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Sympathomimetic: 1. Mimicking the effects of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. 2. An agent that produces effects similar to those of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. Called also adrenergic. [EU] Symphysis: A secondary cartilaginous joint. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH]
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Synapses: Specialized junctions at which a neuron communicates with a target cell. At classical synapses, a neuron's presynaptic terminal releases a chemical transmitter stored in synaptic vesicles which diffuses across a narrow synaptic cleft and activates receptors on the postsynaptic membrane of the target cell. The target may be a dendrite, cell body, or axon of another neuron, or a specialized region of a muscle or secretory cell. Neurons may also communicate through direct electrical connections which are sometimes called electrical synapses; these are not included here but rather in gap junctions. [NIH] Synapsis: The pairing between homologous chromosomes of maternal and paternal origin during the prophase of meiosis, leading to the formation of gametes. [NIH] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Synaptic Transmission: The communication from a neuron to a target (neuron, muscle, or secretory cell) across a synapse. In chemical synaptic transmission, the presynaptic neuron releases a neurotransmitter that diffuses across the synaptic cleft and binds to specific synaptic receptors. These activated receptors modulate ion channels and/or secondmessenger systems to influence the postsynaptic cell. Electrical transmission is less common in the nervous system, and, as in other tissues, is mediated by gap junctions. [NIH] Synaptic Vesicles: Membrane-bound compartments which contain transmitter molecules. Synaptic vesicles are concentrated at presynaptic terminals. They actively sequester transmitter molecules from the cytoplasm. In at least some synapses, transmitter release occurs by fusion of these vesicles with the presynaptic membrane, followed by exocytosis of their contents. [NIH] Synaptosomes: Pinched-off nerve endings and their contents of vesicles and cytoplasm together with the attached subsynaptic area of the membrane of the post-synaptic cell. They are largely artificial structures produced by fractionation after selective centrifugation of nervous tissue homogenates. [NIH] Synergistic: Acting together; enhancing the effect of another force or agent. [EU] Synovial: Of pertaining to, or secreting synovia. [EU] Synovial Fluid: The clear, viscous fluid secreted by the synovial membrane. It contains mucin, albumin, fat, and mineral salts and serves to lubricate joints. [NIH] Synovial Membrane: The inner membrane of a joint capsule surrounding a freely movable joint. It is loosely attached to the external fibrous capsule and secretes synovial fluid. [NIH] Systemic: Affecting the entire body. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Tachycardia: Excessive rapidity in the action of the heart, usually with a heart rate above 100 beats per minute. [NIH] Temporal: One of the two irregular bones forming part of the lateral surfaces and base of the skull, and containing the organs of hearing. [NIH] Temporal Lobe: Lower lateral part of the cerebral hemisphere. [NIH] Terminalis: A groove on the lateral surface of the right atrium. [NIH] Testicles: The two egg-shaped glands found inside the scrotum. They produce sperm and male hormones. Also called testes. [NIH]
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Testicular: Pertaining to a testis. [EU] Testis: Either of the paired male reproductive glands that produce the male germ cells and the male hormones. [NIH] Testosterone: A hormone that promotes the development and maintenance of male sex characteristics. [NIH] Tetani: Causal agent of tetanus. [NIH] Tetanic: Having the characteristics of, or relating to tetanus. [NIH] Tetanus: A disease caused by tetanospasmin, a powerful protein toxin produced by Clostridium tetani. Tetanus usually occurs after an acute injury, such as a puncture wound or laceration. Generalized tetanus, the most common form, is characterized by tetanic muscular contractions and hyperreflexia. Localized tetanus presents itself as a mild condition with manifestations restricted to muscles near the wound. It may progress to the generalized form. [NIH] Tetany: 1. Hyperexcitability of nerves and muscles due to decrease in concentration of extracellular ionized calcium, which may be associated with such conditions as parathyroid hypofunction, vitamin D deficiency, and alkalosis or result from ingestion of alkaline salts; it is characterized by carpopedal spasm, muscular twitching and cramps, laryngospasm with inspiratory stridor, hyperreflexia and choreiform movements. 2. Tetanus. [EU] Tetracaine: A potent local anesthetic of the ester type used for surface and spinal anesthesia. [NIH]
Tetrodotoxin: Octahydro-12-(hydroxymethyl)-2-imino-5,9:7,10a-dimethano10aH(1,3)dioxocino(6,5-a)pyrimidine-4,7,10,11,12-pentol. An aminoperhydroquinazoline poison found mainly in the liver and ovaries of fishes in the order Tetradontiformes (pufferfish, globefish, toadfish), which are eaten. The toxin causes paresthesia and paralysis through interference with neuromuscular conduction. [NIH] Thalamic: Cell that reaches the lateral nucleus of amygdala. [NIH] Thalamus: Paired bodies containing mostly gray substance and forming part of the lateral wall of the third ventricle of the brain. The thalamus represents the major portion of the diencephalon and is commonly divided into cellular aggregates known as nuclear groups. [NIH]
Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thermal: Pertaining to or characterized by heat. [EU] Thigh: A leg; in anatomy, any elongated process or part of a structure more or less comparable to a leg. [NIH] Third Ventricle: A narrow cleft inferior to the corpus callosum, within the diencephalon, between the paired thalami. Its floor is formed by the hypothalamus, its anterior wall by the lamina terminalis, and its roof by ependyma. It communicates with the fourth ventricle by the cerebral aqueduct, and with the lateral ventricles by the interventricular foramina. [NIH] Thoracic: Having to do with the chest. [NIH] Thoracic Surgery: A surgical specialty concerned with diagnosis and treatment of disorders of the heart, lungs, and esophagus. Two major types of thoracic surgery are classified as pulmonary and cardiovascular. [NIH] Thoracoscopy: Endoscopic examination, therapy or surgery of the pleural cavity. [NIH] Thoracotomy: Surgical incision into the chest wall. [NIH] Thorax: A part of the trunk between the neck and the abdomen; the chest. [NIH]
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Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombin: An enzyme formed from prothrombin that converts fibrinogen to fibrin. (Dorland, 27th ed) EC 3.4.21.5. [NIH] Thrombocytes: Blood cells that help prevent bleeding by causing blood clots to form. Also called platelets. [NIH] Thrombosed: A localized clot that either forms in the vein of a hemorrhoid or arises from a ruptured hemorrhoidal blood vessel. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thromboxanes: Physiologically active compounds found in many organs of the body. They are formed in vivo from the prostaglandin endoperoxides and cause platelet aggregation, contraction of arteries, and other biological effects. Thromboxanes are important mediators of the actions of polyunsaturated fatty acids transformed by cyclooxygenase. [NIH] Thrombus: An aggregation of blood factors, primarily platelets and fibrin with entrapment of cellular elements, frequently causing vascular obstruction at the point of its formation. Some authorities thus differentiate thrombus formation from simple coagulation or clot formation. [EU] Thymus: An organ that is part of the lymphatic system, in which T lymphocytes grow and multiply. The thymus is in the chest behind the breastbone. [NIH] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Thyroid Gland: A highly vascular endocrine gland consisting of two lobes, one on either side of the trachea, joined by a narrow isthmus; it produces the thyroid hormones which are concerned in regulating the metabolic rate of the body. [NIH] Thyrotropin: A peptide hormone secreted by the anterior pituitary. It promotes the growth of the thyroid gland and stimulates the synthesis of thyroid hormones and the release of thyroxine by the thyroid gland. [NIH] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Tidal Volume: The volume of air inspired or expired during each normal, quiet respiratory cycle. Common abbreviations are TV or V with subscript T. [NIH] Tin: A trace element that is required in bone formation. It has the atomic symbol Sn, atomic number 50, and atomic weight 118.71. [NIH] Tinnitus: Sounds that are perceived in the absence of any external noise source which may take the form of buzzing, ringing, clicking, pulsations, and other noises. Objective tinnitus refers to noises generated from within the ear or adjacent structures that can be heard by other individuals. The term subjective tinnitus is used when the sound is audible only to the affected individual. Tinnitus may occur as a manifestation of cochlear diseases; vestibulocochlear nerve diseases; intracranial hypertension; craniocerebral trauma; and other conditions. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tissue Culture: Maintaining or growing of tissue, organ primordia, or the whole or part of an organ in vitro so as to preserve its architecture and/or function (Dorland, 28th ed). Tissue culture includes both organ culture and cell culture. [NIH]
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Tissue Survival: The span of viability of a tissue or an organ. [NIH] Tolerance: 1. The ability to endure unusually large doses of a drug or toxin. 2. Acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU] Tomography: Imaging methods that result in sharp images of objects located on a chosen plane and blurred images located above or below the plane. [NIH] Tonic: 1. Producing and restoring the normal tone. 2. Characterized by continuous tension. 3. A term formerly used for a class of medicinal preparations believed to have the power of restoring normal tone to tissue. [EU] Tonicity: The normal state of muscular tension. [NIH] Tonsils: Small masses of lymphoid tissue on either side of the throat. [NIH] Tonus: A state of slight tension usually present in muscles even when they are not undergoing active contraction. [NIH] Tooth Preparation: Procedures carried out with regard to the teeth or tooth structures preparatory to specified dental therapeutic and surgical measures. [NIH] Topical: On the surface of the body. [NIH] Torsion: A twisting or rotation of a bodily part or member on its axis. [NIH] Tourniquet: A device, band or elastic tube applied temporarily to press upon an artery to stop bleeding; a device to compress a blood vessel in order to stop bleeding. [NIH] Toxaemia: 1. The condition resulting from the spread of bacterial products (toxins) by the bloodstream. 2. A condition resulting from metabolic disturbances, e.g. toxaemia of pregnancy. [EU] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Trabecular Meshwork: A porelike structure surrounding the entire circumference of the anterior chamber through which aqueous humor circulates to the canal of Schlemm. [NIH] Trabeculectomy: Any surgical procedure for treatment of glaucoma by means of puncture or reshaping of the trabecular meshwork. It includes goniotomy, trabeculotomy, and laser perforation. [NIH] Trace element: Substance or element essential to plant or animal life, but present in extremely small amounts. [NIH] Trachea: The cartilaginous and membranous tube descending from the larynx and branching into the right and left main bronchi. [NIH] Tracheotomy: Surgical incision of the trachea. [NIH] Traction: The act of pulling. [NIH] Transaminases: A subclass of enzymes of the transferase class that catalyze the transfer of an amino group from a donor (generally an amino acid) to an acceptor (generally a 2-keto
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acid). Most of these enzymes are pyridoxyl phosphate proteins. (Dorland, 28th ed) EC 2.6.1. [NIH]
Transcutaneous: Transdermal. [EU] Transduction: The transfer of genes from one cell to another by means of a viral (in the case of bacteria, a bacteriophage) vector or a vector which is similar to a virus particle (pseudovirion). [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transfer Factor: Factor derived from leukocyte lysates of immune donors which can transfer both local and systemic cellular immunity to nonimmune recipients. [NIH] Transfusion: The infusion of components of blood or whole blood into the bloodstream. The blood may be donated from another person, or it may have been taken from the person earlier and stored until needed. [NIH] Transgenes: Genes that are introduced into an organism using gene transfer techniques. [NIH]
Transient Ischemic Attacks: Focal neurologic abnormalities of sudden onset and brief duration that reflect dysfunction in the distribution of the internal carotid-middle cerebral or the vertebrobasilar arterial system. [NIH] Translational: The cleavage of signal sequence that directs the passage of the protein through a cell or organelle membrane. [NIH] Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [NIH] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Transurethral: Performed through the urethra. [EU] Transurethral Resection of Prostate: Resection of the prostate using a cystoscope passed through the urethra. [NIH] Transurethral resection of the prostate: Surgical procedure to remove tissue from the prostate using an instrument inserted through the urethra. Also called TURP. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Trees: Woody, usually tall, perennial higher plants (Angiosperms, Gymnosperms, and some Pterophyta) having usually a main stem and numerous branches. [NIH] Tremor: Cyclical movement of a body part that can represent either a physiologic process or a manifestation of disease. Intention or action tremor, a common manifestation of cerebellar diseases, is aggravated by movement. In contrast, resting tremor is maximal when there is no attempt at voluntary movement, and occurs as a relatively frequent manifestation of Parkinson disease. [NIH] Tricyclic: Containing three fused rings or closed chains in the molecular structure. [EU] Trigeminal: Cranial nerve V. It is sensory for the eyeball, the conjunctiva, the eyebrow, the skin of face and scalp, the teeth, the mucous membranes in the mouth and nose, and is motor to the muscles of mastication. [NIH] Trigeminal Nerve: The 5th and largest cranial nerve. The trigeminal nerve is a mixed motor and sensory nerve. The larger sensory part forms the ophthalmic, mandibular, and maxillary nerves which carry afferents sensitive to external or internal stimuli from the skin, muscles, and joints of the face and mouth and from the teeth. Most of these fibers originate
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from cells of the trigeminal ganglion and project to the trigeminal nucleus of the brain stem. The smaller motor part arises from the brain stem trigeminal motor nucleus and innervates the muscles of mastication. [NIH] Trisomy: The possession of a third chromosome of any one type in an otherwise diploid cell. [NIH]
Trophoblast: The outer layer of cells of the blastocyst which works its way into the endometrium during ovum implantation and grows rapidly, later combining with mesoderm. [NIH] Tropomyosin: A protein found in the thin filaments of muscle fibers. It inhibits contraction of the muscle unless its position is modified by troponin. [NIH] Troponin: One of the minor protein components of skeletal muscle. Its function is to serve as the calcium-binding component in the troponin-tropomyosin B-actin-myosin complex by conferring calcium sensitivity to the cross-linked actin and myosin filaments. [NIH] Truncal: The bilateral dissection of the abdominal branches of the vagus nerve. [NIH] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of Mycobacterium. [NIH] Tubocurarine: A neuromuscular blocker and active ingredient in curare; plant based alkaloid of Menispermaceae. [NIH] Tumor model: A type of animal model which can be used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Tumour: 1. Swelling, one of the cardinal signs of inflammations; morbid enlargement. 2. A new growth of tissue in which the multiplication of cells is uncontrolled and progressive; called also neoplasm. [EU] Tungsten: A metallic element with the atomic symbol W, atomic number 74, and atomic weight 183.85. It is used in many manufacturing applications, including increasing the hardness, toughness, and tensile strength of steel; manufacture of filaments for incandescent light bulbs; and in contact points for automotive and electrical apparatus. [NIH] Tunica Intima: The innermost coat of blood vessels, consisting of a thin lining of endothelial cells longitudinally oriented and continuous with the endothelium of capillaries on the one hand and the endocardium of the heart on the other. [NIH] Tympanic membrane: A thin, tense membrane forming the greater part of the outer wall of the tympanic cavity and separating it from the external auditory meatus; it constitutes the boundary between the external and middle ear. [NIH] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Ulcer: A localized necrotic lesion of the skin or a mucous surface. [NIH] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Uncompensated Care: Medical services for which no payment is received. Uncompensated care includes charity care and bad debts. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Universal Precautions: Prudent standard preventive measures to be taken by professional
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and other health personnel in contact with persons afflicted with a communicable disease, to avoid contracting the disease by contagion or infection. Precautions are especially applicable in the diagnosis and care of AIDS patients. [NIH] Uremia: The illness associated with the buildup of urea in the blood because the kidneys are not working effectively. Symptoms include nausea, vomiting, loss of appetite, weakness, and mental confusion. [NIH] Ureter: One of a pair of thick-walled tubes that transports urine from the kidney pelvis to the bladder. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]
Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary Retention: Inability to urinate. The etiology of this disorder includes obstructive, neurogenic, pharmacologic, and psychogenic causes. [NIH] Urinary tract: The organs of the body that produce and discharge urine. These include the kidneys, ureters, bladder, and urethra. [NIH] Urinate: To release urine from the bladder to the outside. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Urodynamics: The mechanical laws of fluid dynamics as they apply to urine transport. [NIH] Urogenital: Pertaining to the urinary and genital apparatus; genitourinary. [EU] Urolithiasis: Stones in the urinary system. [NIH] Urology: A surgical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in both sexes and the genital tract in the male. It includes the specialty of andrology which addresses both male genital diseases and male infertility. [NIH] Urothelium: The epithelial lining of the urinary tract. [NIH] Urticaria: A vascular reaction of the skin characterized by erythema and wheal formation due to localized increase of vascular permeability. The causative mechanism may be allergy, infection, or stress. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vagal: Pertaining to the vagus nerve. [EU] Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Vaginal: Of or having to do with the vagina, the birth canal. [NIH] Vagotomy: The interruption or removal of any part of the vagus (10th cranial) nerve. Vagotomy may be performed for research or for therapeutic purposes. [NIH] Vagus Nerve: The 10th cranial nerve. The vagus is a mixed nerve which contains somatic afferents (from skin in back of the ear and the external auditory meatus), visceral afferents (from the pharynx, larynx, thorax, and abdomen), parasympathetic efferents (to the thorax and abdomen), and efferents to striated muscle (of the larynx and pharynx). [NIH] Valine: A branched-chain essential amino acid that has stimulant activity. It promotes muscle growth and tissue repair. It is a precursor in the penicillin biosynthetic pathway.
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[NIH]
Valves: Flap-like structures that control the direction of blood flow through the heart. [NIH] Varicocele: A complex of dilated veins which surround the testicle, usually on the left side. [NIH]
Varicose: The common ulcer in the lower third of the leg or near the ankle. [NIH] Varicose vein: An abnormal swelling and tortuosity especially of the superficial veins of the legs. [EU] Vas Deferens: The excretory duct of the testes that carries spermatozoa. It rises from the scrotum and joins the seminal vesicles to form the ejaculatory duct. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vascular Resistance: An expression of the resistance offered by the systemic arterioles, and to a lesser extent by the capillaries, to the flow of blood. [NIH] Vasculitis: Inflammation of a blood vessel. [NIH] Vasectomy: An operation to cut or tie off the two tubes that carry sperm out of the testicles. [NIH]
Vasoactive: Exerting an effect upon the calibre of blood vessels. [EU] Vasoconstriction: Narrowing of the blood vessels without anatomic change, for which constriction, pathologic is used. [NIH] Vasodilation: Physiological dilation of the blood vessels without anatomic change. For dilation with anatomic change, dilatation, pathologic or aneurysm (or specific aneurysm) is used. [NIH] Vasodilator: An agent that widens blood vessels. [NIH] Vector: Plasmid or other self-replicating DNA molecule that transfers DNA between cells in nature or in recombinant DNA technology. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Venous blood: Blood that has given up its oxygen to the tissues and carries carbon dioxide back for gas exchange. [NIH] Ventilation: 1. In respiratory physiology, the process of exchange of air between the lungs and the ambient air. Pulmonary ventilation (usually measured in litres per minute) refers to the total exchange, whereas alveolar ventilation refers to the effective ventilation of the alveoli, in which gas exchange with the blood takes place. 2. In psychiatry, verbalization of one's emotional problems. [EU] Ventilator: A breathing machine that is used to treat respiratory failure by promoting ventilation; also called a respirator. [NIH] Ventral: 1. Pertaining to the belly or to any venter. 2. Denoting a position more toward the belly surface than some other object of reference; same as anterior in human anatomy. [EU] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Ventricular: Pertaining to a ventricle. [EU] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Vertebrae: A bony unit of the segmented spinal column. [NIH]
Dictionary 351
Vertebral: Of or pertaining to a vertebra. [EU] Vertigo: An illusion of movement; a sensation as if the external world were revolving around the patient (objective vertigo) or as if he himself were revolving in space (subjective vertigo). The term is sometimes erroneously used to mean any form of dizziness. [EU] Vesicoureteral: An abnormal condition in which urine backs up into the ureters, and occasionally into the kidneys, raising the risk of infection. [NIH] Vestibular: Pertaining to or toward a vestibule. In dental anatomy, used to refer to the tooth surface directed toward the vestibule of the mouth. [EU] Vestibule: A small, oval, bony chamber of the labyrinth. The vestibule contains the utricle and saccule, organs which are part of the balancing apparatus of the ear. [NIH] Vestibulocochlear Nerve: The 8th cranial nerve. The vestibulocochlear nerve has a cochlear part (cochlear nerve) which is concerned with hearing and a vestibular part (vestibular nerve) which mediates the sense of balance and head position. The fibers of the cochlear nerve originate from neurons of the spiral ganglion and project to the cochlear nuclei (cochlear nucleus). The fibers of the vestibular nerve arise from neurons of Scarpa's ganglion and project to the vestibular nuclei. [NIH] Vestibulocochlear Nerve Diseases: Diseases of the vestibular and/or cochlear (acoustic) nerves, which join to form the vestibulocochlear nerve. Vestibular neuritis, cochlear neuritis, and acoustic neuromas are relatively common conditions that affect these nerves. Clinical manifestations vary with which nerve is primarily affected, and include hearing loss, vertigo, and tinnitus. [NIH] Veterinarians: Individuals with a degree in veterinary medicine that provides them with training and qualifications to treat diseases and injuries of animals. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Viscera: Any of the large interior organs in any one of the three great cavities of the body, especially in the abdomen. [NIH] Visceral: , from viscus a viscus) pertaining to a viscus. [EU] Viscosity: A physical property of fluids that determines the internal resistance to shear forces. [EU] Visual Cortex: Area of the occipital lobe concerned with vision. [NIH] Vitamin A: A substance used in cancer prevention; it belongs to the family of drugs called retinoids. [NIH] Vitreous Body: The transparent, semigelatinous substance that fills the cavity behind the crystalline lens of the eye and in front of the retina. It is contained in a thin hyoid membrane and forms about four fifths of the optic globe. [NIH] Vitreous Hemorrhage: Hemorrhage into the vitreous body. [NIH] Vitreous Humor: The transparent, colorless mass of gel that lies behind the lens and in front of the retina and fills the center of the eyeball. [NIH]
352 Anesthesia
Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Void: To urinate, empty the bladder. [NIH] Voltage-gated: It is opened by the altered charge distribution across the cell membrane. [NIH]
Wakefulness: A state in which there is an enhanced potential for sensitivity and an efficient responsiveness to external stimuli. [NIH] Weight Gain: Increase in body weight over existing weight. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]
Whooping Cough: A respiratory infection caused by Bordetella pertussis and characterized by paroxysmal coughing ending in a prolonged crowing intake of breath. [NIH] Whooping Cough: A respiratory infection caused by Bordetella pertussis and characterized by paroxysmal coughing ending in a prolonged crowing intake of breath. [NIH] Windpipe: A rigid tube, 10 cm long, extending from the cricoid cartilage to the upper border of the fifth thoracic vertebra. [NIH] Withdrawal: 1. A pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) A substance-specific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU] Womb: A hollow, thick-walled, muscular organ in which the impregnated ovum is developed into a child. [NIH] Wounds, Gunshot: Disruption of structural continuity of the body as a result of the discharge of firearms. [NIH] Xenograft: The cells of one species transplanted to another species. [NIH] Xenon: A noble gas with the atomic symbol Xe, atomic number 54, and atomic weight 131.30. It is found in the earth's atmosphere and has been used as an anesthetic. [NIH] Xerostomia: Decreased salivary flow. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH] Xylazine: An adrenergic alpha-agonist used as a sedative, analgesic, and muscle relaxant in veterinary medicine. [NIH] Yeasts: A general term for single-celled rounded fungi that reproduce by budding. Brewers' and bakers' yeasts are Saccharomyces cerevisiae; therapeutic dried yeast is dried yeast. [NIH]
353
INDEX 3 3-dimensional, 26, 251 A Abdominal, 29, 53, 71, 109, 174, 190, 195, 212, 251, 267, 301, 319, 322, 335, 341, 348 Abdominal Pain, 251, 301 Ablate, 19, 59, 251 Ablation, 17, 251 Abscess, 80, 251 Acceptor, 251, 319, 346 Accommodation, 251, 278, 312 Acetylcholine, 17, 45, 107, 179, 251, 268, 314, 315, 316 Achlorhydria, 178, 251 Acidosis, 40, 123, 193, 251, 277 Acoustic, 31, 163, 251, 351 Acrylonitrile, 251, 335 Actin, 251, 311, 312, 348 Action Potentials, 12, 31, 44, 60, 251 Activities of Daily Living, 30, 251, 278 Acupuncture Analgesia, 111, 251 Acute renal, 130, 251 Adaptability, 252, 266 Adaptation, 37, 46, 252, 325 Adenine, 149, 252 Adenoma, 148, 252 Adenosine, 17, 29, 36, 54, 55, 107, 149, 252, 264, 323 Adenosine Triphosphate, 29, 149, 252, 323 Adjustment, 186, 187, 193, 251, 252 Adjuvant, 85, 252, 289 Adolescence, 147, 198, 208, 252 Adrenal Medulla, 252, 266, 283, 316 Adrenergic, 83, 133, 134, 166, 252, 254, 256, 279, 283, 323, 332, 342, 352 Adverse Effect, 25, 61, 237, 252, 338 Aerobic, 252, 309 Aerosol, 127, 252, 316 Afferent, 19, 46, 252, 286, 324, 327 Affinity, 26, 32, 63, 66, 252, 253, 332, 338 Agar, 253, 324 Aggravation, 253, 340 Airway, 8, 9, 25, 45, 79, 127, 138, 145, 164, 253, 338 Alanine, 155, 253, 254 Albumin, 35, 253, 324, 343 Alertness, 48, 253, 264 Alfentanil, 83, 108, 253
Algorithms, 59, 163, 253, 261 Alimentary, 253, 320, 321 Alkaline, 251, 253, 254, 264, 344 Alkaloid, 253, 259, 261, 269, 310, 316, 335, 348 Allergen, 253, 277, 337 Allylamine, 253, 254 Alpha Particles, 253, 330 Alpha-1, 253, 254 Alternative medicine, 217, 254 Alum, 254, 269 Alveoli, 254, 276, 350 Ameliorating, 144, 181, 182, 254 Ameloblastoma, 254, 276, 317 Amenorrhea, 254, 256 Amine, 179, 254, 294 Amino Acid Sequence, 254, 257, 285 Amino Acid Substitution, 155, 254 Amino Acids, 254, 256, 285, 321, 325, 329, 342 Aminopropionitrile, 254, 303 Amitriptyline, 26, 254 Ammonia, 170, 254 Amnesia, 20, 64, 132, 254 Amnestic, 169, 254, 308, 309 Amnion, 254, 255 Amniotic Fluid, 35, 254, 255, 290 Amphetamines, 255, 269 Ampulla, 255, 282 Amputation, 12, 255 Amygdala, 62, 64, 255, 304, 344 Anaerobic, 123, 255 Anaesthesia, 91, 122, 177, 213, 255, 298 Anaesthetic, 177, 255 Anal, 255, 287, 297 Analog, 10, 58, 255 Analogous, 63, 255, 280, 347 Anaphylatoxins, 255, 271 Anaphylaxis, 75, 255 Anatomical, 5, 43, 44, 58, 74, 163, 212, 255, 259, 262, 272, 278, 282, 297, 336 Anemia, 21, 255, 262, 269, 288 Anesthesia, Local, 11, 255 Aneurysm, 256, 258, 350 Angina, 19, 128, 130, 134, 193, 256 Angioplasty, 128, 256, 259, 312 Angiotensinogen, 256, 333 Animal Husbandry, 23, 24, 256
354 Anesthesia
Animal model, 18, 22, 23, 27, 34, 49, 141, 256, 348 Anions, 253, 256, 301 Ankle, 256, 350 Anomalies, 5, 194, 199, 256, 318 Anorexia, 178, 255, 256 Anorexia Nervosa, 178, 256 Anoxia, 145, 156, 182, 183, 256 Antagonism, 45, 55, 83, 256, 264 Anterior Cerebral Artery, 256, 267 Anterograde, 179, 256 Anthelmintics, 180, 256 Anthracycline, 256, 284 Anti-Anxiety Agents, 256, 327 Antibacterial, 35, 180, 256, 339 Antibiosis, 194, 256 Antibiotic, 196, 256, 257, 279, 284, 321, 327, 339 Antibiotic Prophylaxis, 196, 257, 327 Antibodies, 257, 292, 297, 306 Antibody, 67, 73, 253, 257, 270, 292, 294, 297, 298, 307, 310, 331, 337, 339 Anticholinergic, 254, 257, 324 Anticonvulsants, 140, 182, 256, 257 Antidepressant, 195, 254, 257 Antidote, 257, 324 Antiemetic, 179, 257 Antigen, 25, 252, 255, 257, 270, 276, 294, 295, 297, 298, 307, 337 Antigen-Antibody Complex, 257, 270 Antigen-presenting cell, 257, 276 Antihypertensive, 193, 257 Anti-inflammatory, 28, 257, 277, 290, 302 Anti-Inflammatory Agents, 257, 302 Antineoplastic, 49, 257, 279 Antioxidant, 150, 257 Antiproliferative, 29, 257 Antipyretic, 257, 277 Antispasmodic, 257, 277, 291, 317 Antiviral, 123, 180, 257 Anus, 255, 257, 263, 293, 300, 321, 322, 332 Anxiety, 5, 6, 143, 144, 155, 181, 183, 185, 208, 218, 236, 237, 256, 258, 268, 272 Anxiolytic, 258, 288, 309 Aorta, 160, 258, 265, 273, 350 Aortic Aneurysm, 71, 258 Aortic Valve, 83, 258 Apathy, 147, 258 Aperture, 158, 258, 330 Aphakia, 258, 334 Aphasia, 254, 258 Apnea, 103, 258
Aponeurosis, 258, 289 Apoptosis, 27, 258, 265 Appendectomy, 189, 191, 198, 258 Applicability, 54, 149, 258 Aqueous, 258, 260, 275, 303, 346 Arachidonic Acid, 258, 281, 303, 328 Arginine, 255, 258, 316 Arrhythmia, 9, 18, 130, 258 Arterial, 19, 30, 34, 40, 53, 84, 95, 197, 253, 258, 263, 267, 295, 300, 329, 343, 347 Arteries, 15, 134, 200, 258, 262, 267, 273, 305, 308, 311, 345 Arteriolar, 258, 263, 333 Arterioles, 41, 258, 262, 264, 309, 311, 350 Arteriovenous, 43, 190, 197, 258, 267, 309 Arteriovenous Fistula, 190, 197, 258 Arthroplasty, 52, 136, 219, 259 Arthroscopy, 68, 259 Articular, 259, 318 Aspartate, 17, 51, 144, 155, 160, 182, 183, 259, 301, 332 Asphyxia, 156, 183, 259, 316 Aspiration, 174, 259 Assay, 17, 32, 140, 154, 259 Asymptomatic, 60, 259 Atelectasis, 53, 259 Atherectomy, 128, 259, 282 Atrial, 54, 70, 93, 259 Atrium, 259, 265, 343, 350 Atrophy, 145, 182, 259, 314 Atropine, 17, 102, 259, 260 Attenuated, 47, 64, 259 Attenuation, 31, 259 Atypical, 147, 259 Auditory, 31, 62, 69, 74, 109, 147, 167, 259, 280, 285, 307, 327, 348, 349 Auditory Cortex, 31, 259 Autoimmune disease, 259, 310 Autologous, 22, 64, 197, 259 Autonomic, 18, 19, 30, 33, 251, 259, 260, 290, 316, 322 Autonomic Nervous System, 259, 260, 322 Avoidance Learning, 64, 259 Axilla, 260, 263 Axonal, 64, 260 Axons, 12, 159, 260, 276, 299, 311, 314, 317, 322, 327, 330 B Bacteria, 256, 257, 260, 261, 276, 281, 289, 305, 308, 309, 337, 339, 347, 349 Bacterial Physiology, 252, 260 Bactericidal, 260, 284
Index 355
Bacteriophage, 260, 324, 347 Barbiturate, 176, 260, 272 Basal Ganglia, 260, 263, 289, 304 Base, 21, 42, 44, 50, 94, 135, 178, 205, 213, 252, 260, 275, 276, 301, 325, 330, 343 Basement Membrane, 260, 286 Basophil, 260, 294 Baths, 45, 260 Belladonna, 259, 260 Benign, 10, 134, 148, 252, 260, 289, 292, 313, 331 Benign prostatic hyperplasia, 10, 134, 260 Benzene, 260, 261 Benzocaine, 95, 260 Benzodiazepines, 150, 186, 261 Benzyl Alcohol, 13, 140, 261 Bereavement, 49, 261 Bewilderment, 261, 271 Bicuculline, 64, 261 Bifida, 261 Bilateral, 64, 74, 261, 335, 348 Bile, 200, 261, 268, 274, 288, 289, 304, 341 Bile Acids, 261, 289, 341 Bile Acids and Salts, 261 Bile Ducts, 261, 268 Biliary, 200, 261, 270, 277 Biliary Tract, 200, 261 Bilirubin, 123, 253, 261 Binding Sites, 16, 26, 128, 170, 261 Biochemical, 33, 176, 261, 288, 318, 337 Biological Transport, 261, 278 Bioluminescence, 261, 305 Biopsy, 125, 158, 190, 195, 196, 216, 261, 321 Biotechnology, 38, 66, 68, 207, 217, 229, 261 Bladder, 29, 124, 193, 194, 195, 199, 212, 260, 262, 274, 298, 299, 300, 310, 314, 321, 328, 333, 335, 341, 349, 352 Blastocyst, 22, 262, 271, 281, 324, 348 Bloating, 262, 298, 301 Blood Coagulation, 262, 264 Blood Flow Velocity, 75, 262 Blood Glucose, 193, 262, 293, 296, 299 Blood pressure, 9, 19, 25, 30, 37, 149, 180, 257, 262, 265, 295, 296, 310, 316, 322, 338 Blood transfusion, 213, 262, 293 Blood Viscosity, 41, 262, 293 Blood Volume, 34, 130, 262 Blood-Brain Barrier, 36, 147, 178, 262, 313, 324 Blot, 22, 262
Body Fluids, 262, 264, 280, 338 Body Mass Index, 53, 262, 319 Body Regions, 57, 262 Bone Density, 219, 262 Bone Marrow, 64, 155, 260, 262, 297, 305, 306, 310, 342 Bottle Feeding, 4, 262 Bowel, 98, 255, 262, 263, 278, 300, 314, 322, 341 Bowel Movement, 263, 278, 341 Brachial, 83, 263, 307 Brachial Plexus, 83, 263, 307 Brachytherapy, 168, 263, 299, 331 Bradycardia, 18, 93, 149, 263 Bradykinin, 263, 316, 324 Brain Infarction, 176, 263 Brain Ischemia, 263, 267 Brain Stem, 28, 263, 266, 267, 272, 348 Brain Stem Infarctions, 263 Branch, 131, 139, 171, 247, 263, 281, 290, 306, 307, 320, 339, 344 Breakdown, 263, 277, 278, 289, 317 Breeding, 23, 256, 263 Bronchi, 159, 263, 283, 346 Bronchial, 263, 294 Bronchiseptica, 263, 322 Bronchoconstriction, 45, 263 Bronchospasm, 45, 216, 263 Bronchus, 263 Buccal, 135, 263 Bupivacaine, 75, 84, 264, 303 Butorphanol, 102, 264 Bypass, 49, 127, 264, 312 C Caffeine, 103, 264 Calcium, 14, 15, 16, 27, 28, 62, 66, 130, 264, 270, 312, 320, 336, 338, 344, 348 Calcium Channels, 16, 28, 62, 264 Calmodulin, 15, 264 Camping, 198, 264 Cannula, 162, 191, 264 Capillary, 40, 123, 263, 264, 290, 350 Capital Financing, 264, 327 Capsules, 264, 289, 290 Carbohydrate, 264, 291, 325 Carbon Dioxide, 75, 96, 137, 138, 213, 264, 275, 276, 287, 289, 295, 324, 334, 350 Carboxy, 178, 264, 301 Carcinogenic, 260, 264, 299, 341 Carcinogens, 23, 265 Cardiac arrest, 25, 75, 145, 156, 182, 183, 265, 342
356 Anesthesia
Cardiac catheterization, 72, 265 Cardiac Output, 54, 265, 341 Cardiopulmonary, 265, 293 Cardiopulmonary Bypass, 265, 293 Cardiorespiratory, 265, 309 Cardiotonic, 265, 323 Cardiotoxicity, 265, 284 Cardiovascular disease, 155, 265 Carotene, 265, 334 Carrier Proteins, 265, 324 Case report, 69, 78, 85, 94, 95, 265, 269 Case series, 106, 265, 269 Caspase, 27, 265 Catalytic Domain, 155, 265 Cataract, 72, 76, 87, 89, 90, 258, 265, 334 Catecholamine, 79, 266, 279 Catheterization, 69, 256, 266, 300, 312 Catheters, 35, 123, 151, 159, 190, 266, 297, 299 Cations, 266, 301 Cauda Equina, 160, 266 Caudal, 92, 200, 218, 266, 278, 296, 326 Causal, 27, 183, 266, 344 Cause of Death, 176, 266 Cell Death, 27, 258, 266, 313 Cell Differentiation, 266, 338 Cell membrane, 144, 182, 261, 264, 265, 266, 268, 276, 285, 289, 311, 323, 339, 352 Cell proliferation, 266, 338 Cell Respiration, 266, 309, 334 Cell Size, 266, 288 Cellobiose, 266 Cellulose, 135, 266, 324 Central Nervous System Diseases, 177, 185, 266 Central Nervous System Infections, 266, 292 Centrifugation, 267, 343 Cerebellum, 65, 263, 266, 267, 326 Cerebral Aqueduct, 267, 321, 344 Cerebral hemispheres, 260, 263, 266, 267 Cerebral Infarction, 156, 183, 263, 267 Cerebral Palsy, 9, 12, 208, 267, 339 Cerebrovascular, 96, 117, 155, 183, 265, 267 Cerebrovascular Disorders, 155, 183, 267 Cerebrum, 267 Cervical, 110, 263, 267, 305, 307 Cesarean Section, 75, 94, 114, 267 Character, 42, 59, 267, 275, 331 Checkup, 194, 267 Chemotactic Factors, 267, 271
Chemotherapy, 49, 192, 197, 267 Chest wall, 267, 344 Child Behavior, 209, 268 Chimeras, 57, 268 Chloral Hydrate, 56, 268 Chloride Channels, 51, 268 Cholangiography, 198, 268 Cholecystectomy, 72, 189, 191, 198, 268 Cholecystokinin, 61, 268 Choledocholithiasis, 198, 268 Cholesteatoma, 211, 268 Cholesterol, 261, 268, 273, 280, 295, 304, 305, 341 Cholinergic, 18, 36, 39, 115, 254, 268, 316 Chorioretinitis, 268, 334 Choroid, 268, 334 Chromaffin System, 268, 282 Chromatin, 258, 268, 283, 316, 339 Chromosomal, 33, 268 Chromosome, 268, 304, 348 Chronic renal, 197, 207, 268 Circadian, 58, 150, 268 Circadian Rhythm, 150, 268 Circulatory system, 268, 282 Circumcision, 125, 194, 269 CIS, 178, 269, 334 Clamp, 26, 57, 61, 63, 269 Clear cell carcinoma, 269, 276 Clinical Medicine, 103, 269, 327 Clinical Protocols, 22, 269 Clinical study, 60, 106, 269 Clinical trial, 12, 42, 44, 52, 117, 118, 229, 269, 272, 279, 320, 329, 331 Clitoral, 134, 269 Cloaca, 200, 269 Clonic, 269, 272 Cloning, 261, 269 Coagulation, 262, 269, 293, 303, 324, 345 Cobalt, 155, 269 Coca, 82, 269 Cocaine, 239, 269 Cochlea, 270, 299 Cochlear, 270, 345, 351 Cochlear Diseases, 270, 345 Cofactor, 270, 329 Cognition, 144, 155, 181, 183, 270 Colitis, 270, 301 Collagen, 260, 270, 289, 325 Collapse, 147, 151, 157, 255, 263, 270, 338, 340 Colloidal, 253, 270, 285 Colonoscopy, 77, 270
Index 357
Combination Therapy, 193, 270 Common Bile Duct, 191, 270, 274 Communicable disease, 270, 349 Complement, 63, 105, 255, 270, 271, 324, 337 Complementary and alternative medicine, 105, 112, 271 Complementary medicine, 105, 271 Complete remission, 271, 333 Compress, 271, 293, 346 Computational Biology, 229, 271 Computed tomography, 72, 262, 271 Computerized axial tomography, 271 Computerized tomography, 271 Conception, 271, 287, 327 Concomitant, 13, 97, 178, 271 Conduction, 12, 129, 151, 159, 171, 255, 271, 311, 314, 344 Cones, 271, 324, 334 Confounding, 18, 32, 34, 77, 271 Confusion, 30, 271, 278, 296, 349 Congestive heart failure, 130, 134, 193, 271 Conjugated, 261, 272, 274 Conjunctiva, 272, 298, 324, 347 Connective Tissue, 262, 270, 272, 287, 288, 289, 305, 308, 322, 335, 342 Conscious Sedation, 7, 11, 197, 234, 237, 272 Consolidation, 58, 272 Constipation, 272, 301 Constitutional, 272, 311, 335 Constrict, 239, 272 Constriction, 45, 166, 272, 301, 350 Constriction, Pathologic, 272, 350 Consultation, 23, 272 Consumption, 67, 87, 272, 319 Contamination, 138, 185, 272, 294 Contractility, 30, 66, 272 Contraindications, ii, 272 Contralateral, 5, 28, 272, 308 Control group, 22, 53, 55, 272 Controlled study, 86, 272 Convulsants, 46, 272 Convulsions, 144, 155, 177, 181, 183, 213, 260, 261, 272, 280, 296, 315, 327 Convulsive, 183, 185, 272, 281, 314, 315 Coordination, 267, 273, 310 Cornea, 88, 273, 336 Coronary, 18, 19, 54, 71, 77, 90, 128, 147, 265, 273, 308, 311 Coronary Arteriosclerosis, 273, 311 Coronary Artery Bypass, 71, 273
Coronary heart disease, 265, 273 Coronary Thrombosis, 273, 308, 311 Corpus, 52, 125, 273, 321, 328, 344 Cortex, 14, 17, 34, 44, 45, 62, 65, 273, 283, 284, 285, 287, 313, 318, 327, 328, 330, 333 Cortical, 17, 31, 34, 46, 48, 273, 285, 327, 330, 337 Corticosteroids, 42, 273, 290 Cortisol, 253, 273 Cost Savings, 131, 171, 273 Cranial, 163, 267, 273, 284, 286, 290, 292, 300, 306, 317, 319, 322, 339, 347, 349, 351 Craniocerebral Trauma, 273, 292, 345 Craniofacial Abnormalities, 196, 273 Credentialing, 198, 273 Cricoid Cartilage, 273, 352 Criterion, 29, 31, 273 Critical Care, 21, 46, 82, 86, 197, 201, 203, 204, 273 Crowns, 5, 274 Cryptorchidism, 189, 199, 274 Curare, 274, 311, 348 Curative, 54, 124, 195, 274, 344 Curettage, 274, 335 Cutaneous, 27, 70, 92, 193, 274, 320 Cyanide, 145, 182, 274 Cyclic, 264, 274, 292, 316, 323, 324, 336 Cyst, 274, 276, 317 Cystectomy, 194, 195, 274 Cysteine, 63, 274, 342 Cystic Duct, 270, 274 Cystine, 274 Cystitis, 29, 145, 182, 194, 195, 274 Cystocele, 194, 274 Cystoscopy, 125, 194, 274 Cytochrome, 27, 34, 274 Cytokine, 35, 274 Cytomegalovirus, 213, 274 Cytoplasm, 56, 66, 258, 266, 275, 282, 283, 291, 310, 316, 336, 343 Cytotoxic, 123, 275, 331, 338 D Dantrolene, 15, 222, 275 Data Collection, 24, 44, 53, 275 Databases, Bibliographic, 229, 275 Decarboxylation, 275, 294 Decompensation, 49, 253, 275 Decompression, 82, 275 Decompression Sickness, 275 Decongestant, 275, 323 Degenerative, 144, 155, 182, 183, 275, 294, 318, 334, 335
358 Anesthesia
Deletion, 67, 258, 275 Delirium, 30, 275 Delusion, 147, 275 Dementia, 7, 11, 33, 145, 182, 276, 308 Demethylation, 154, 276 Demyelinating Diseases, 276, 311 Dendrites, 276, 315, 330 Dendritic, 25, 39, 276, 307, 340 Dendritic cell, 25, 276 Density, 40, 262, 267, 276, 280, 288, 304, 317, 325, 339 Dental Care, 4, 5, 7, 8, 9, 70, 87, 230, 236, 238, 276, 320 Dental Caries, 4, 199, 276, 324 Dental Materials, 199, 276 Dentate Gyrus, 276, 294 Dentigerous Cyst, 276, 317 Dentists, 6, 73, 138, 166, 193, 197, 208, 236, 237, 276 Dentition, 3, 4, 276 Depolarization, 46, 63, 276, 315, 338 Dermal, 146, 276 DES, 71, 160, 255, 276 Desensitization, 32, 277 Detoxification, 51, 72, 98, 123, 143, 277 Deuterium, 277, 295 Dexmedetomidine, 277, 307 Diabetes Mellitus, 193, 277, 291, 293 Diabetes, Gestational, 193, 277, 327 Diabetic Ketoacidosis, 193, 198, 277 Diabetic Retinopathy, 40, 155, 277, 323 Diagnostic Errors, 277, 307 Diagnostic Imaging, 196, 277 Diagnostic procedure, 28, 121, 195, 217, 277 Diagnostic Services, 23, 277 Dialyzer, 277, 293 Diarrhea, 277, 301 Diarrhoea, 179, 277 Diastolic, 277, 295 Diathermy, 191, 277 Diclofenac, 103, 277 Diclofenac Sodium, 277 Dicyclomine, 277 Diencephalon, 266, 267, 278, 296, 327, 344 Diffusion, 40, 41, 151, 261, 278, 298 Digestion, 253, 261, 262, 278, 280, 298, 300, 304, 321, 341 Digestive system, 119, 278, 289 Dihydrotestosterone, 278, 332 Dilatation, 256, 278, 327, 350 Dilatation, Pathologic, 278, 350
Dilate, 123, 278 Dilation, 54, 123, 134, 259, 263, 278, 350 Dimethyl, 195, 278 Diploid, 278, 324, 348 Direct, iii, 15, 20, 26, 27, 38, 60, 64, 66, 77, 123, 221, 269, 278, 279, 295, 326, 332, 343 Disabled Children, 9, 278 Discrimination, 163, 278 Disease Transmission, 213, 278 Disease Transmission, Horizontal, 278 Disease Transmission, Vertical, 278 Disinfectant, 278, 284 Dislocation, 219, 220, 258, 278, 340 Disorientation, 271, 275, 278, 279 Dissection, 22, 191, 278, 305, 348 Dissociation, 41, 252, 278, 301 Dissociative Disorders, 279 Distal, 5, 134, 142, 151, 156, 157, 159, 164, 165, 174, 184, 260, 273, 279, 281, 289, 327, 329 Diuresis, 130, 264, 279 Diuretic, 130, 279 Diverticula, 194, 279 Diverticulum, 190, 279 Dizziness, 279, 351 Dominance, 34, 48, 279 Dopamine, 20, 61, 173, 270, 279 Dorsal, 27, 47, 279, 326, 340 Dorsum, 279, 289 Dose-dependent, 48, 279 Dose-rate, 24, 279 Dosimetry, 24, 279 Double-blinded, 75, 279 Doxorubicin, 279, 284 Drip, 83, 279 Drive, ii, vi, 8, 9, 53, 101, 186, 192, 196, 197, 198, 208, 209, 212, 279 Drug Delivery Systems, 159, 185, 279 Drug Design, 26, 280 Drug Interactions, 196, 223, 280 Drug Monitoring, 185, 280 Drug Tolerance, 280, 346 Duct, 200, 255, 264, 266, 270, 280, 285, 335, 350 Duodenal Ulcer, 191, 280 Duodenum, 261, 280, 282, 289, 319, 341 Dyslipidemia, 193, 280 Dyspepsia, 280, 298 Dyspnea, 275, 280, 340 Dystrophy, 208, 280 E Earache, 167, 280
Index 359
Eardrum, 122, 280 Eating Disorders, 198, 280 Echocardiography, 52, 70, 280 Eclampsia, 280, 327 Edema, 131, 275, 277, 280, 293, 300, 312, 327 Effector, 15, 35, 41, 251, 270, 280, 314, 315, 323 Effector cell, 280, 314, 315 Efficacy, 22, 26, 29, 41, 49, 54, 63, 79, 102, 149, 280 Eicosanoids, 50, 281 Elasticity, 191, 273, 281 Elective, 11, 29, 49, 53, 60, 89, 94, 103, 115, 238, 281 Electrocardiograph, 196, 281 Electrode, 43, 57, 126, 161, 164, 281 Electrolyte, 35, 130, 275, 281, 326, 338 Electromyography, 127, 281 Electrons, 257, 260, 281, 301, 319, 330, 331 Electrophysiological, 14, 19, 48, 56, 161, 281 Electroretinogram, 40, 281 Electroshock, 281, 314, 315 Emboli, 44, 281, 300 Embolization, 44, 281 Embolus, 281, 298, 300 Embryo, 37, 254, 262, 266, 281, 287, 298, 310, 327, 340 Embryo Transfer, 281, 327 Embryology, 192, 281, 287, 315 Emesis, 67, 282 Emollient, 282, 291 Enamel, 254, 276, 282, 324 Encephalitis, 282, 308 Encephalocele, 282, 314 Endarterectomy, 86, 91, 97, 256, 259, 282 Endocrine Glands, 282, 320 Endocrine System, 132, 282 Endometrium, 124, 282, 348 Endorphin, 114, 282 Endoscope, 282, 302 Endoscopic, 8, 84, 88, 259, 270, 274, 282, 309, 344 Endoscopy, 8, 37, 77, 103, 194, 282 Endothelial cell, 262, 282, 348 Endothelium, 133, 134, 282, 316, 348 Endothelium, Lymphatic, 282 Endothelium, Vascular, 282 Endothelium-derived, 133, 134, 282, 316 Endotoxins, 270, 282, 301 Endotracheal intubation, 73, 85, 141, 283
End-stage renal, 268, 283 Enflurane, 56, 57, 76, 130, 283 Enhancer, 159, 283 Entorhinal Cortex, 283, 294 Enucleation, 148, 283 Environmental Health, 228, 230, 283 Enzymatic, 155, 264, 265, 270, 276, 283, 294, 334 Enzyme Inhibitors, 283, 324 Eosinophils, 283, 291, 303 Epidemic, 138, 283, 340 Epidermal, 29, 283, 307 Epidermal Growth Factor, 29, 283 Epidermis, 283, 295, 330 Epidural block, 151, 283 Epigastric, 283, 319 Epilepsia, 185, 283 Epinephrine, 102, 160, 166, 252, 279, 283, 316, 332, 348 Epirubicin, 93, 284 Episode of Care, 53, 284 Epithelial, 176, 252, 254, 261, 283, 284, 294, 331, 349 Epithelial Cells, 283, 284, 294 Epithelium, 48, 260, 282, 284, 289, 317, 322, 334 Erectile, 134, 193, 284, 321 Erection, 134, 284, 327 Erythrocyte Volume, 262, 284 Erythrocytes, 255, 262, 284, 293, 337 Esophageal, 160, 284 Esophagus, 145, 164, 174, 278, 284, 289, 292, 305, 323, 340, 341, 344 Estradiol, 30, 284 Estrogen, 30, 284 Ethanol, 32, 284 Ether, 56, 140, 214, 284 Ethmoid, 284, 319 Eukaryotic Cells, 284, 297, 318 Euphoria, 147, 284 Eustachian tube, 167, 284 Evacuation, 272, 285, 289 Evoke, 285, 341 Evoked Potentials, 69, 171, 285 Excipient, 129, 285 Excitability, 17, 285, 312 Excitation, 15, 46, 66, 155, 183, 255, 275, 285, 288 Excitatory Amino Acid Agonists, 285, 301 Excitatory Amino Acids, 144, 155, 181, 182, 183, 285, 315 Excitotoxicity, 144, 182, 183, 285
360 Anesthesia
Excrete, 285, 302, 333 Exhaustion, 256, 285, 340 Exocrine, 268, 285, 319 Exocytosis, 285, 294, 343 Exogenous, 69, 150, 173, 285, 289, 329 Exon, 56, 285 Expander, 285 Expiration, 139, 285, 334 Expiratory, 143, 173, 285 Extender, 285, 324 External-beam radiation, 285, 330 Extracellular, 19, 20, 27, 46, 65, 136, 149, 272, 286, 309, 338, 344 Extracellular Matrix, 136, 272, 286 Extracellular Space, 286, 309 Extracorporeal, 49, 90, 123, 286 Extracorporeal Circulation, 49, 90, 286 Extraction, 5, 9, 138, 191, 196, 197, 258, 267, 286, 334 Extrapyramidal, 279, 286 Extravascular, 24, 286 Extremity, 27, 193, 263, 286, 307 F Facial, 71, 126, 127, 146, 163, 190, 191, 196, 199, 209, 273, 286, 307 Facial Injuries, 209, 286 Facial Nerve, 126, 163, 286 Facial Pain, 190, 286 Faecal, 277, 286 Family Planning, 229, 286 Fat, 258, 261, 262, 265, 273, 281, 286, 302, 304, 310, 319, 335, 339, 343 Fatigue, 163, 286, 292 Fatty acids, 253, 277, 281, 286, 328, 336, 345 Fatty Liver, 200, 286 Febrile, 123, 177, 286 Femoral, 219, 265, 286 Femur, 286 Fentanyl, 77, 96, 111, 253, 286 Fertilization in Vitro, 287, 327 Fetal Development, 287, 314 Fetal Heart, 91, 287 Fetus, 37, 49, 267, 287, 324, 327, 340, 341, 349 Fibrillation, 18, 287 Fibrin, 262, 287, 345 Fibrinogen, 128, 287, 324, 345 Fibronectin, 128, 287 Fibrosis, 208, 253, 287, 336 Fine-needle aspiration, 287, 313 Fissure, 5, 276, 287, 327
Fistula, 194, 287 Fixation, 287, 337 Flatus, 287, 289 Flow Cytometry, 23, 27, 287 Fluorescence, 24, 27, 32, 34, 41, 60, 287, 288, 309 Fluorescent Dyes, 287, 288 Flutter, 48, 288 Folate, 154, 288 Fold, 27, 43, 63, 287, 288, 308, 319, 327 Folic Acid, 288 Foot Ulcer, 193, 288 Foramen, 5, 288, 307, 322 Forearm, 81, 118, 262, 288, 307, 331 Fossa, 267, 288 Fractionation, 288, 343 Friction, 288, 305 Frontal Lobe, 256, 267, 288, 327 Frostbite, 288, 323 Functional magnetic resonance imaging, 34, 44, 288 G Gallbladder, 19, 189, 191, 251, 261, 268, 274, 278, 288, 289 Gamma Rays, 288, 330, 331 Gamma-hydroxybutyrate, 147, 288 Ganglia, 251, 288, 314, 322 Ganglion, 27, 28, 289, 317, 348, 351 Gap Junctions, 289, 343 Gas exchange, 124, 289, 334, 350 Gastric, 80, 174, 178, 179, 251, 283, 284, 289, 292, 294, 295, 321 Gastric Emptying, 179, 289 Gastric Juices, 289, 321 Gastric Mucosa, 289, 321 Gastrin, 289, 294 Gastritis, 179, 289 Gastroenterology, 8, 37, 88, 91, 289 Gastroenterostomy, 191, 289 Gastroesophageal Reflux, 178, 179, 289 Gastrointestinal Hemorrhage, 131, 289 Gastrointestinal tract, 8, 174, 179, 284, 289, 291, 303, 321, 337 Gelatin, 289, 291 Gene, 13, 17, 22, 33, 43, 62, 184, 207, 261, 279, 289, 294, 325, 347 Gene Expression, 22, 289 Gene Targeting, 22, 289 General practitioner, 212, 290 Generator, 131, 290 Genetic Counseling, 193, 290 Genetic Markers, 33, 290
Index 361
Genetics, 58, 199, 279, 290 Genital, 124, 134, 148, 269, 290, 349 Genitourinary, 290, 349 Genotype, 22, 33, 290, 323 Geriatric, 49, 80, 81, 193, 207, 290 Germ Cells, 290, 307, 317, 319, 339, 344 Gestation, 37, 53, 71, 290, 321, 324, 340 Gestational, 35, 290 Gestational Age, 35, 290 Gland, 191, 196, 252, 268, 290, 305, 313, 319, 320, 328, 336, 341, 342, 345 Glomerular, 54, 290, 300, 333 Glomerular Filtration Rate, 54, 290 Glomerulus, 290 Glossopharyngeal Nerve, 286, 290 Glottis, 290, 323 Glucocorticoid, 162, 290 Glucose, 193, 262, 266, 277, 291, 293, 296, 299, 327, 336 Glucose Intolerance, 277, 291 Glucose tolerance, 277, 291, 327 Glucuronic Acid, 291, 293 Glutamate, 14, 17, 47, 55, 61, 62, 65, 155, 183, 285, 291, 301, 308, 332 Glutamic Acid, 288, 291, 293 Glycerol, 140, 291, 323 Glycine, 26, 47, 57, 261, 291 Glycoprotein, 90, 287, 291 Glycopyrrolate, 102, 291 Gonadal, 291, 341 Goniotomy, 291, 346 Governing Board, 291, 326 Graft, 291, 295, 297, 312 Grafting, 64, 71, 196, 273, 291, 297 Granulocytes, 260, 291, 338, 352 Gravis, 72, 291, 313 Groin, 71, 291, 298, 299 Guanylate Cyclase, 292, 316 H Habitual, 267, 292 Haematemesis, 282, 292 Halitosis, 191, 292 Hallucination, 147, 292 Handwashing, 213, 292 Haptens, 252, 292 Headache, 74, 114, 155, 183, 264, 292, 296, 298 Headache Disorders, 292 Health Behavior, 4, 198, 292 Health Services, iv, 12, 37, 103, 230, 231, 292 Health Status, 220, 292
Heart attack, 265, 292 Heart failure, 130, 292 Heartbeat, 292, 342 Heartburn, 178, 179, 292, 298 Helminthiasis, 256, 267, 292 Hematoma, 292, 293 Hematuria, 199, 292 Heme, 261, 274, 292 Hemodialysis, 123, 197, 207, 277, 293, 302 Hemodialyzer, 123, 293 Hemodilution, 22, 41, 293 Hemodynamics, 37, 132, 293 Hemoglobin, 22, 40, 54, 255, 284, 292, 293, 319 Hemoglobin C, 54, 293 Hemorrhage, 33, 43, 196, 273, 292, 293, 312, 330, 341, 351 Hemorrhagic stroke, 156, 183, 293 Hemorrhoid, 81, 293, 345 Hemorrhoidectomy, 80, 293 Hemostasis, 21, 191, 293, 337 Heparin, 29, 97, 293 Hepatic, 92, 102, 130, 145, 182, 200, 253, 270, 275, 291, 293 Hepatic Encephalopathy, 145, 182, 293 Hepatitis, 200, 213, 294 Hepatitis A, 200, 294 Hepatocytes, 294 Hepatology, 200, 294 Hepatovirus, 294 Heredity, 289, 290, 294 Hernia, 71, 86, 192, 200, 294 Herniorrhaphy, 75, 195, 294 Heterodimer, 41, 294 Heterogeneity, 11, 252, 294 Heterozygotes, 279, 294 Hippocampus, 14, 59, 65, 276, 294, 304, 330, 342 Histamine, 45, 255, 294 Histamine Release, 45, 255, 294 Histidine, 294 Histology, 40, 294 Homeostasis, 16, 49, 130, 149, 294 Homologous, 41, 290, 293, 294, 337, 343 Homozygotes, 279, 294 Hormonal, 134, 259, 294 Hormone, 147, 150, 268, 273, 276, 281, 283, 284, 289, 294, 299, 327, 335, 336, 338, 344, 345 Hospice, 49, 295 Hospital Charges, 138, 295 Host, 35, 260, 295, 297, 303, 351
362 Anesthesia
Hydration, 128, 295 Hydrochloric Acid, 251, 295 Hydrogen, 32, 178, 251, 254, 260, 264, 277, 295, 310, 315, 319, 323, 329 Hydrogen Bonding, 32, 295 Hydrolysis, 144, 182, 266, 295, 323, 325, 329 Hydrophilic, 159, 295 Hydrophobic, 159, 295, 304 Hygienic, 91, 295 Hyperalgesia, 36, 47, 57, 92, 295 Hypercapnia, 78, 295 Hypercholesterolemia, 280, 295 Hyperglycemia, 193, 295 Hyperlipidemia, 280, 295 Hyperoxia, 40, 295 Hyperpigmentation, 191, 295 Hypersensitivity, 253, 255, 277, 295, 303, 335, 337 Hypertension, 9, 19, 130, 134, 147, 197, 265, 295, 300, 323, 327 Hyperthermia, 15, 123, 277, 295 Hypertriglyceridemia, 280, 295 Hypertrophy, 148, 260, 296 Hypnotic, 19, 50, 54, 56, 107, 132, 169, 177, 180, 260, 268, 296, 309 Hypodermic, 153, 296 Hypoglycaemia, 275, 296 Hypoglycemia, 144, 145, 155, 181, 182, 183, 193, 296 Hypoglycemic, 193, 296 Hypoglycemic Agents, 193, 296 Hypospadias, 199, 296 Hypotension, 18, 19, 78, 89, 95, 114, 149, 160, 193, 272, 296 Hypotensive, 149, 296 Hypothalamic, 31, 296 Hypothalamus, 251, 259, 278, 296, 304, 344 Hypothermia, 90, 128, 149, 293, 296 Hypothyroidism, 9, 296 Hypoxemia, 77, 78, 296 Hypoxia, 65, 123, 145, 182, 263, 267, 275, 296 Hysterectomy, 194, 296 Hysterotomy, 267, 296 I Id, 104, 109, 173, 234, 238, 240, 246, 248, 296 Ileal, 195, 296 Ileum, 296 Illusion, 296, 351 Immersion, 260, 296
Immune adjuvant, 36, 254, 296 Immune response, 25, 252, 254, 257, 259, 292, 297, 337, 342, 351 Immune Sera, 297 Immune system, 257, 280, 296, 297, 303, 306, 310, 312, 349, 352 Immunity, 253, 297, 347 Immunization, 191, 213, 297, 337 Immunization Schedule, 191, 297 Immunodeficiency, 183, 213, 297 Immunodeficiency syndrome, 213, 297 Immunoglobulins, 297, 324 Immunologic, 33, 267, 290, 297, 331 Immunology, 38, 252, 288, 297 Immunosuppressive, 290, 297 Immunotherapy, 277, 297 Impairment, 11, 19, 31, 33, 37, 39, 96, 130, 261, 267, 275, 297, 300, 308, 329 Imperforate Anus, 200, 297 Implant radiation, 297, 299, 331 Implantation, 42, 90, 271, 297, 348 Impotence, 284, 297, 321, 323 In situ, 15, 23, 28, 196, 297 In Situ Hybridization, 23, 28, 297 In vitro, 21, 25, 26, 27, 29, 35, 37, 45, 46, 62, 71, 90, 173, 262, 281, 297, 345 Incision, 53, 90, 122, 148, 160, 291, 296, 298, 300, 302, 328, 344, 346 Incisor, 208, 298 Incompetence, 289, 298 Incontinence, 76, 124, 134, 144, 145, 155, 179, 181, 182, 183, 184, 212, 277, 298, 341 Incubation, 298, 322 Incubation period, 298, 322 Indicative, 170, 200, 283, 298, 320, 350 Indigestion, 178, 179, 298 Infant Behavior, 268, 298 Infarction, 55, 130, 176, 267, 293, 298, 333 Infertility, 298, 349 Infiltration, 69, 106, 126, 160, 298, 327 Inflammation, 122, 133, 149, 253, 257, 268, 270, 274, 282, 287, 288, 289, 294, 298, 303, 312, 315, 318, 321, 322, 328, 330, 334, 335, 350 Influenza, 35, 298 Informed Consent, 11, 298 Infusion, 130, 180, 298, 312, 347 Ingestion, 291, 292, 298, 303, 325, 344 Inguinal, 75, 189, 191, 192, 198, 298, 299 Inguinal Hernia, 189, 191, 192, 198, 299 Inhalation, 9, 125, 160, 170, 197, 214, 222, 223, 252, 283, 299, 301, 325
Index 363
Initiation, 77, 162, 197, 299 Inlay, 299, 334 Inner ear, 212, 237, 270, 299 Innervation, 5, 27, 263, 286, 299, 307 Inorganic, 299, 305 Inositol, 45, 299, 308, 336 Inotropic, 279, 299 Insight, 72, 192, 299 Insomnia, 110, 143, 268, 299 Instillation, 127, 195, 299 Insufflation, 189, 299 Insulator, 299, 311 Insulin, 193, 198, 277, 291, 299, 302 Insulin-dependent diabetes mellitus, 299 Intensive Care, 82, 103, 174, 177, 186, 299 Intermittent, 160, 299, 305, 322 Internal Medicine, 30, 289, 299 Internal radiation, 299, 331 Interneurons, 31, 299 Interstitial, 29, 130, 194, 195, 263, 286, 299, 300, 333 Intervertebral, 83, 300, 305 Intervertebral Disk Displacement, 300, 305 Intestinal, 174, 198, 265, 268, 269, 291, 300, 311 Intestinal Obstruction, 174, 300 Intestine, 261, 262, 300, 302 Intoxication, 275, 300, 352 Intracellular, 14, 15, 16, 46, 61, 62, 66, 264, 298, 300, 308, 316, 326, 332, 336, 338 Intracranial Embolism, 267, 300 Intracranial Embolism and Thrombosis, 267, 300 Intracranial Hypertension, 292, 300, 345 Intramuscular, 9, 300, 320 Intraoperative Complications, 9, 54, 300 Intrathecal, 27, 160, 176, 300 Intravascular, 24, 40, 128, 300 Intravenous Anesthetics, 50, 300 Intravesical, 195, 300 Intrinsic, 24, 26, 41, 46, 63, 253, 260, 300 Intubation, 45, 53, 79, 95, 266, 300 Intussusception, 189, 300 Inulin, 290, 300 Invasive, 6, 34, 37, 82, 161, 170, 297, 300, 306, 319 Invertebrates, 300, 305 Involuntary, 287, 301, 312, 332, 337, 338, 339, 341 Ion Channels, 26, 41, 46, 55, 61, 129, 301, 315, 332, 343
Ion Exchange, 266, 301 Ionization, 301 Ions, 46, 66, 260, 264, 268, 278, 281, 295, 301, 310, 336, 339 Iontophoresis, 70, 86, 301 Irritable Bowel Syndrome, 57, 92, 301 Isoenzyme, 179, 301 Isoflurane, 14, 16, 39, 56, 57, 61, 64, 67, 84, 102, 107, 130, 301 Isozymes, 65, 301 J Joint, 21, 52, 136, 194, 196, 218, 219, 259, 275, 301, 305, 318, 340, 342, 343 K Kainate, 160, 301, 332 Kainic Acid, 144, 182, 301 Kb, 228, 301 Keratolytic, 276, 301 Ketamine, 7, 9, 90, 102, 140, 208, 301 Keto, 301, 346 Ketone Bodies, 277, 302 Ketorolac, 106, 302 Ketosis, 198, 277, 302 Kidney Disease, 8, 119, 193, 195, 228, 302 Kidney Failure, 283, 293, 302 Kidney Pelvis, 302, 349 Kidney stone, 194, 302, 333 Kidney Transplantation, 194, 302 Kinetic, 32, 302 Kink, 151, 302 L Labile, 270, 302 Labyrinth, 85, 270, 299, 302, 337, 351 Laceration, 302, 344 Lacrimal, 286, 302 Laparoscopy, 84, 88, 189, 191, 194, 195, 198, 302 Laparotomy, 35, 302 Large Intestine, 278, 300, 302, 332, 338 Laryngeal, 70, 85, 102, 145, 203, 273, 302 Laryngoscope, 84, 164, 302 Laryngoscopy, 98, 302 Larynx, 145, 192, 290, 302, 303, 346, 349 Laser Surgery, 8, 122, 303 Laser therapy, 98, 303 Latency, 36, 303 Latent, 303, 327 Lathyrism, 155, 183, 303 Lavage, 136, 303 Least-Squares Analysis, 303, 333 Length of Stay, 53, 303 Lens, 90, 258, 265, 303, 351
364 Anesthesia
Leprosy, 288, 303 Lesion, 58, 273, 283, 288, 303, 304, 348 Lethal, 260, 274, 303 Lethargy, 296, 303 Leukemia, 279, 284, 303 Leukocytes, 129, 262, 267, 283, 291, 303, 310, 316 Leukotrienes, 258, 281, 303 Library Services, 246, 303 Lidocaine, 6, 26, 27, 75, 81, 85, 86, 93, 96, 106, 107, 166, 222, 261, 303 Ligament, 303, 328, 340 Ligands, 129, 183, 303, 332 Ligation, 19, 191, 304 Likelihood Functions, 304, 333 Limbic, 255, 304, 327 Limbic System, 255, 304, 327 Linear Models, 304, 333 Linkage, 63, 127, 266, 290, 304 Lip, 166, 192, 199, 304, 307 Lipid, 178, 291, 299, 302, 304, 309, 311 Lipoprotein, 280, 304, 305 Liver Transplantation, 84, 304 Lobe, 256, 267, 304 Localization, 47, 163, 164, 304 Localized, 67, 134, 148, 154, 162, 263, 276, 287, 292, 298, 304, 318, 324, 344, 345, 348, 349 Locomotion, 31, 304, 324 Locomotor, 31, 48, 304 Locoregional, 82, 97, 304 Logistic Models, 304, 333 Long-Term Care, 49, 305 Loop, 125, 294, 305 Lordosis, 305, 321 Low Back Pain, 104, 106, 110, 305 Low-density lipoprotein, 280, 304, 305 Lower Esophageal Sphincter, 289, 305 Lubricants, 305 Lubrication, 134, 305 Luciferase, 166, 175, 305 Lumbar, 79, 82, 266, 300, 305 Lumen, 159, 264, 282, 305 Luminescence, 166, 175, 305 Luxation, 278, 305 Lymph, 158, 216, 267, 269, 282, 305, 306, 313, 342 Lymph node, 158, 216, 267, 305, 306, 313 Lymphadenectomy, 195, 198, 305 Lymphatic, 282, 298, 305, 306, 308, 325, 340, 345 Lymphatic system, 305, 306, 340, 345
Lymphocele, 195, 306 Lymphocyte, 257, 306, 307 Lymphoid, 102, 257, 273, 306, 346 Lymphoma, 80, 306 Lysine, 293, 306 M Magnetic Resonance Imaging, 43, 52, 71, 94, 306 Malformation, 94, 306 Malignant, 15, 235, 239, 257, 276, 306, 313, 317, 331 Malignant Hyperthermia, 235, 239, 306 Malnutrition, 144, 181, 253, 259, 306 Mammary, 273, 306 Mandible, 5, 306 Mandibular Nerve, 5, 306 Manic, 306, 330 Manic-depressive psychosis, 306, 330 Manifest, 260, 306 Mastectomy, 55, 306 Mastication, 306, 347, 348 Maternal Mortality, 73, 306 Maxillary, 208, 209, 306, 319, 347 Maxillary Nerve, 306, 347 Meatus, 280, 307, 319, 348, 349 Mechanical ventilation, 53, 70, 84, 128, 307 Medetomidine, 102, 277, 307 Medial, 17, 60, 284, 307, 339 Median Nerve, 19, 307 Mediate, 19, 29, 32, 61, 63, 64, 144, 182, 279, 307 Mediator, 64, 268, 307, 337 Medical Errors, 37, 307 Medical Records, 9, 307, 335 Medical Staff, 279, 307 Medication Errors, 185, 307 MEDLINE, 229, 307 Medullary, 52, 307 Meiosis, 307, 343 Melanocytes, 295, 307 Membrane Glycoproteins, 307 Memory, 10, 14, 17, 19, 39, 44, 45, 58, 59, 64, 107, 185, 254, 256, 275, 276, 308, 309, 332 Memory Disorders, 185, 308 Meninges, 266, 268, 273, 308 Menorrhagia, 124, 308 Mental Disorders, 119, 308, 329 Mental Processes, 278, 308, 329 Mental Retardation, 9, 308 Mentors, 52, 308 Mercury, 288, 308
Index 365
Mesencephalic, 31, 308 Mesenchymal, 64, 283, 308 Mesenteric, 308, 326 Metabolic disorder, 200, 308 Metabolite, 278, 308 Metabotropic, 41, 144, 182, 308, 332 Methionine, 154, 278, 308, 342 Methyltransferase, 154, 308 MI, 53, 85, 128, 155, 158, 183, 249, 308 Microbe, 308, 346 Microbiology, 38, 252, 259, 308 Microcirculation, 40, 293, 309 Microcomputers, 23, 309 Microdialysis, 17, 309 Microorganism, 256, 270, 309, 320, 352 Micro-organism, 276, 309 Microscopy, 23, 27, 65, 260, 309 Microscopy, Confocal, 23, 309 Micturition, 80, 199, 309 Midazolam, 14, 77, 80, 86, 87, 309 Migration, 65, 309 Milliliter, 262, 309 Millimeter, 34, 309 Minicomputers, 309 Mitochondria, 27, 309, 312, 318 Mitochondrial Swelling, 309, 313 Mitosis, 258, 309 Mobility, 53, 219, 310 Modeling, 26, 37, 40, 87, 280, 310 Modification, 19, 65, 208, 310, 330 Modulator, 15, 310 Molecular Structure, 310, 347 Molecule, 257, 260, 261, 270, 278, 280, 282, 285, 295, 310, 319, 325, 331, 332, 338, 350 Monitor, 24, 49, 98, 109, 126, 127, 131, 152, 161, 163, 170, 174, 310, 316 Monoclonal, 310, 331 Monocytes, 303, 310 Morphine, 178, 310, 313, 317 Morphological, 281, 307, 310 Morphology, 23, 37, 197, 199, 265, 310 Morula, 262, 310 Motility, 179, 310, 337 Motion Sickness, 310, 313 Motor Activity, 272, 310 Motor nerve, 163, 310, 311, 317 Mucinous, 289, 310 Mucins, 310, 335 Mucosa, 191, 268, 289, 310, 313, 342 Multiple sclerosis, 12, 208, 310 Muscle Contraction, 311, 314, 315, 336 Muscle Fibers, 311, 312, 348
Muscle relaxant, 15, 50, 91, 170, 256, 275, 311, 313, 315, 352 Muscle Relaxation, 15, 132, 177, 311, 314, 315 Muscle tension, 311 Muscular Dystrophies, 280, 311 Mutagenesis, 25, 38, 56, 311 Mutagenic, 13, 311 Mutagens, 311 Myalgia, 298, 311 Myasthenia, 72, 311, 313 Mydriatic, 278, 311, 323 Myelin, 154, 276, 310, 311, 317 Myelin Sheath, 154, 311, 317 Myenteric, 179, 311 Myocardial infarction, 128, 130, 147, 193, 273, 308, 311 Myocardial Ischemia, 19, 30, 311 Myocardial Reperfusion, 311, 312, 333 Myocardial Reperfusion Injury, 312, 333 Myocardium, 18, 308, 311, 312 Myoclonus, 144, 181, 182, 312 Myometrium, 124, 312 Myopia, 312, 332, 334 Myosin, 15, 311, 312, 348 Myositis, 10, 312 Myositis Ossificans, 10, 312 N Naive, 13, 25, 312 Naloxone, 143, 312 Naltrexone, 51, 102, 143, 312 Narcolepsy, 140, 147, 179, 312 Narcosis, 312 Narcotic, 49, 222, 264, 286, 310, 312, 316 Nasal Cavity, 164, 192, 313, 319 Nasal Mucosa, 298, 313 Nasal Septum, 313 Nasogastric, 53, 174, 313 Nausea, 54, 110, 172, 178, 179, 237, 257, 298, 302, 313, 349 NCI, 1, 118, 227, 269, 313 Nebulizer, 127, 313 Necrosis, 27, 87, 123, 131, 219, 258, 263, 267, 298, 308, 311, 312, 313, 333 Needle biopsy, 194, 287, 313 Neocortex, 46, 313 Neonatal, 13, 94, 139, 193, 197, 238, 313 Neoplasms, 257, 265, 313, 331 Neoplastic, 268, 286, 306, 313 Neostigmine, 17, 313 Nephrectomy, 191, 194, 195, 313 Nephropathy, 193, 302, 313
366 Anesthesia
Nerve Endings, 19, 126, 260, 313, 343 Nerve Fibers, 13, 27, 129, 251, 260, 263, 314 Nerve Growth Factor, 28, 314, 315 Nervous System, 5, 9, 32, 47, 57, 61, 65, 131, 132, 140, 145, 149, 150, 155, 168, 178, 182, 183, 185, 251, 252, 253, 255, 259, 260, 264, 266, 267, 268, 269, 285, 288, 289, 291, 303, 307, 310, 311, 312, 313, 314, 315, 317, 322, 324, 326, 332, 337, 342, 343 Networks, 22, 31, 46, 314 Neural, 13, 19, 21, 22, 28, 30, 34, 44, 55, 59, 62, 108, 144, 155, 163, 181, 252, 282, 314, 334, 339 Neural tube defects, 155, 314 Neuroanatomy, 97, 304, 314 Neurodegenerative Diseases, 144, 155, 181, 183, 314 Neuroeffector Junction, 313, 314 Neurogenic, 199, 314, 349 Neurologic, 27, 33, 74, 123, 144, 154, 160, 176, 182, 208, 256, 282, 314, 347 Neurology, 28, 43, 82, 98, 312, 314 Neuroma, 12, 163, 314 Neuromuscular, 7, 9, 45, 50, 75, 76, 96, 132, 251, 275, 314, 315, 334, 344, 348 Neuromuscular Blockade, 75, 76, 132, 314 Neuromuscular Blocking Agents, 45, 314 Neuromuscular Depolarizing Agents, 314, 315 Neuromuscular Junction, 132, 251, 314, 315, 334 Neuromuscular Nondepolarizing Agents, 314, 315 Neuropathy, 145, 178, 182, 197, 315 Neurophysiology, 59, 79, 276, 315 Neuroprotective Agents, 176, 183, 315 Neuroretinitis, 315, 334 Neurosciences, 52, 315 Neurosecretory Systems, 282, 315 Neurosis, 147, 315 Neurotic, 147, 256, 315 Neurotoxic, 27, 176, 315, 336 Neurotoxicity, 27, 301, 315 Neurotransmitters, 57, 154, 155, 176, 183, 254, 285, 315, 327 Neurotrophins, 28, 315 Neutralization, 36, 315 Neutrons, 253, 315, 330 Neutrophils, 291, 303, 316 Nicotine, 143, 316 Nitric Oxide, 17, 33, 133, 134, 316
Nitrogen, 124, 253, 254, 275, 287, 316 Nitrous Oxide, 3, 39, 60, 96, 98, 108, 112, 130, 154, 197, 208, 237, 316 Noble Gases, 124, 316 Norepinephrine, 61, 95, 252, 254, 279, 316, 332 Normotensive, 50, 53, 316 Nosocomial, 35, 128, 316 Nuclear, 39, 47, 131, 260, 269, 281, 284, 288, 289, 304, 313, 316, 344 Nuclei, 253, 255, 256, 281, 304, 306, 309, 315, 316, 317, 329, 351 Nucleic acid, 297, 311, 316 Nurse Anesthetists, 8, 234, 235, 317 Nursing Care, 190, 192, 317 O Obstetrics, 71, 73, 75, 76, 79, 134, 201, 205, 222, 317 Occipital Lobe, 317, 351 Ocular, 34, 193, 204, 317 Oculomotor, 308, 317 Odontogenic Cysts, 192, 317 Oligodendroglia, 311, 317 Oncology, 21, 49, 200, 317 On-line, 24, 249, 317 Oocytes, 51, 57, 317 Opacity, 265, 276, 317 Operating Rooms, 142, 150, 317 Ophthalmic, 68, 72, 204, 317, 326, 347 Opium, 310, 317 Opsin, 317, 334 Optic Disk, 277, 317 Optic Nerve, 315, 317, 334, 336 Oral Health, 3, 7, 197, 199, 209, 230, 317 Oral Hygiene, 5, 197, 199, 292, 317 Oral Surgical Procedures, 196, 318 Orchiectomy, 194, 318 Organ Culture, 318, 345 Organ Transplantation, 9, 318 Organelles, 267, 275, 307, 310, 318 Orgasm, 134, 318 Orofacial, 190, 191, 286, 318 Oropharynx, 174, 318 Orthodontics, 193, 318 Osmolality, 130, 318 Osmoles, 318 Osmosis, 318 Osmotic, 35, 253, 309, 318 Ossification, 312, 318 Osteoarthritis, 136, 145, 182, 194, 218, 219, 318 Osteomyelitis, 92, 318
Index 367
Osteonecrosis, 219, 318 Otitis, 110, 122, 167, 212, 318 Otitis Media, 110, 122, 167, 318 Otitis Media with Effusion, 168, 318 Otolaryngologist, 212, 318 Otolaryngology, 82, 85, 98, 211, 213, 318 Outer ear, 168, 319 Outpatient, 3, 10, 49, 52, 68, 70, 77, 92, 124, 148, 196, 212, 284, 319 Ovaries, 319, 333, 337, 344 Ovary, 190, 284, 319, 342 Overactive bladder, 134, 319 Overdose, 272, 319 Overweight, 104, 179, 319 Ovum, 290, 310, 319, 328, 348, 352 Oxidation, 251, 257, 274, 277, 319 Oximetry, 34, 319 Oxygen Consumption, 319, 334 Oxygenation, 34, 40, 41, 84, 96, 141, 275, 293, 296, 319 P Palate, 199, 290, 319 Palliative, 48, 319, 344 Pancreas, 158, 251, 278, 289, 299, 319, 340 Pancreatic, 268, 284, 289, 319 Pancreatic cancer, 284, 319 Pancreatic Juice, 289, 319 Paralysis, 126, 127, 132, 147, 191, 274, 308, 319, 339, 344 Paranasal Sinuses, 192, 319 Parasitic, 256, 292, 320 Parathyroid, 192, 320, 344 Parathyroid Glands, 192, 320 Parathyroid hormone, 320 Parenteral, 196, 320 Paresthesia, 6, 69, 320, 344 Paroxysmal, 292, 320, 322, 352 Partial remission, 320, 333 Particle, 320, 339, 347 Parturition, 317, 320 Patch, 56, 61, 63, 65, 93, 143, 320 Pathogen, 22, 298, 320 Pathogenesis, 36, 93, 128, 155, 195, 320 Pathologic, 170, 195, 251, 258, 261, 273, 295, 320, 326 Pathologic Processes, 258, 320 Pathophysiology, 29, 50, 65, 320 Patient Education, 198, 211, 212, 236, 237, 239, 244, 246, 249, 320 Patient Satisfaction, 81, 113, 320 Patient Selection, 189, 194, 320 Peak flow, 10, 320
Pediatric Dentistry, 7, 11, 197, 199, 208, 209, 236, 320 Pediatric Gastroenterologist, 37, 321 Peer Review, 50, 101, 321 Pelvic, 29, 194, 195, 198, 215, 274, 321, 328 Penicillin, 256, 321, 349 Penile Prosthesis, 194, 321 Penis, 134, 194, 199, 296, 321, 327, 333 Pentosan polysulfate, 195, 321 Pepsin, 321 Pepsin A, 321 Peptic, 174, 321 Peptic Ulcer, 174, 321 Peptide, 38, 268, 321, 325, 328, 329, 345 Perception, 31, 152, 292, 321, 336 Percutaneous, 197, 321, 323 Perforation, 128, 258, 288, 321, 346 Perfusion, 22, 41, 43, 296, 321 Perianal, 98, 321 Periaqueductal Gray, 19, 321 Perinatal, 103, 156, 183, 321 Perineal, 195, 322 Perineum, 296, 322 Periodontal Cyst, 317, 322 Periodontal disease, 4, 199, 322 Periodontal Ligament, 74, 322 Periodontitis, 133, 322 Perioperative, 6, 22, 33, 52, 56, 81, 82, 97, 196, 201, 205, 238, 322 Peripheral Nerves, 12, 149, 303, 322, 340 Peripheral Nervous System, 36, 276, 311, 314, 322, 327, 342 Peripheral Vascular Disease, 110, 193, 322, 323 Peritoneal, 190, 197, 322 Peritoneal Cavity, 322 Peritoneal Dialysis, 190, 197, 322 Peritoneum, 322, 335 Pertussis, 55, 322, 352 PH, 262, 323 Pharmaceutical Preparations, 266, 284, 289, 323 Pharmacodynamic, 50, 323 Pharmacokinetic, 50, 323 Pharmacologic, 19, 54, 61, 90, 149, 154, 199, 208, 255, 323, 346, 349 Pharynx, 145, 192, 289, 298, 313, 318, 323, 349 Phenotype, 33, 37, 64, 323 Phentolamine, 167, 323 Phenylephrine, 80, 323 Phonophoresis, 301, 323
368 Anesthesia
Phosphodiesterase, 67, 178, 179, 323 Phospholipases, 323, 338 Phospholipids, 286, 299, 304, 323 Phosphorus, 264, 320, 323 Phosphorylation, 15, 39, 65, 323 Photocoagulation, 40, 269, 323 Photodynamic therapy, 323, 324 Photosensitizer, 24, 324 Phototransduction, 324, 336 Physical Examination, 7, 194, 195, 196, 199, 267, 290, 324 Physiologic, 15, 20, 34, 208, 253, 277, 287, 300, 312, 324, 332, 337, 347 Physiology, 7, 31, 35, 37, 38, 59, 102, 197, 199, 281, 289, 315, 324 Physostigmine, 313, 324 Picrotoxin, 64, 186, 324 Pigment, 261, 307, 324, 334 Pigmentation, 295, 324 Pilot study, 83, 324 Pit and Fissure Sealants, 199, 324 Placenta, 284, 324, 328, 330 Plants, 253, 259, 260, 261, 263, 264, 269, 291, 300, 303, 310, 316, 324, 336, 346, 347 Plaque, 128, 256, 259, 324 Plasma expander, 40, 324 Plasma protein, 54, 253, 282, 324 Plasma Volume, 262, 325 Plasticity, 27, 39, 62, 64, 293, 325 Platelet Activation, 128, 325, 338 Platelet Aggregation, 128, 255, 316, 325, 345 Platelets, 128, 316, 325, 337, 345 Platinum, 305, 325 Pleated, 156, 157, 325 Plethysmograph, 25, 325 Pleural, 325, 344 Pleural cavity, 325, 344 Plexus, 179, 263, 325 Point Mutation, 47, 325 Poisoning, 145, 182, 275, 300, 308, 313, 324, 325, 336 Polyethylene, 40, 325 Polymers, 147, 148, 325, 329, 342 Polymorphism, 154, 155, 325 Polypeptide, 254, 270, 283, 287, 321, 325 Polysaccharide, 257, 266, 325 Polyvinyl Alcohol, 135, 326 Pons, 17, 173, 263, 326, 334, 335 Pontine, 17, 107, 326 Port, 127, 164, 165, 326 Port-a-cath, 326
Portal Vein, 200, 326 Positive pressure ventilation, 164, 326 Posterior, 199, 255, 267, 268, 273, 279, 290, 317, 319, 326, 336, 339 Postnatal, 326, 341 Postoperative Complications, 106, 326 Postoperative Period, 133, 326 Postprandial, 178, 179, 326 Postsynaptic, 14, 61, 62, 144, 182, 314, 326, 338, 343 Post-synaptic, 19, 326, 343 Postural, 193, 326, 341 Potassium, 15, 130, 195, 326 Potentiate, 45, 57, 326 Potentiating, 123, 254, 326 Potentiation, 14, 26, 45, 51, 326, 338 Practice Guidelines, 231, 238, 326 Practice Management, 199, 327 Preclinical, 65, 327 Precursor, 102, 256, 258, 279, 280, 283, 316, 327, 348, 349 Predisposition, 33, 327 Preeclampsia, 89, 94, 327 Prefrontal Cortex, 17, 327 Pregnancy in Diabetics, 277, 327 Pregnancy Outcome, 42, 327 Pregnancy Tests, 290, 327 Premedication, 9, 327 Prenatal, 54, 199, 281, 327 Prenatal Diagnosis, 199, 327 Prepuce, 269, 327 Presynaptic, 60, 61, 314, 327, 343 Presynaptic Terminals, 314, 327, 343 Priapism, 194, 327 Probe, 24, 48, 164, 167, 309, 327 Procaine, 303, 327 Progesterone, 327, 341 Progression, 43, 60, 128, 195, 256, 328, 348 Progressive, 57, 266, 268, 276, 280, 291, 311, 313, 314, 318, 325, 328, 333, 348 Projection, 115, 299, 316, 317, 327, 328, 330 Prolapse, 76, 328 Prone, 57, 328 Prophase, 317, 328, 343 Prophylaxis, 9, 179, 191, 196, 328 Proportional, 139, 162, 318, 328 Prospective study, 52, 328 Prostaglandins, 258, 281, 328 Prostate, 10, 148, 194, 260, 328, 333, 347 Prostate gland, 148, 328 Prostatectomy, 194, 328 Prostatic Hyperplasia, 328
Index 369
Prostatitis, 29, 328 Prosthesis, 194, 219, 328 Prosthodontics, 57, 197, 328 Protease, 270, 328 Protective Agents, 155, 329 Protein Binding, 32, 329 Protein C, 253, 254, 260, 304, 329, 348 Protein Kinases, 61, 329 Protein S, 41, 185, 207, 261, 329 Protein Subunits, 41, 185, 329 Proteinuria, 327, 329 Proteolytic, 253, 270, 287, 329 Protocol, 3, 22, 81, 123, 136, 196, 239, 329 Protons, 253, 295, 329, 330 Proximal, 134, 151, 156, 159, 164, 165, 174, 184, 279, 313, 327, 329 Psychiatry, 51, 287, 329, 342, 350 Psychic, 315, 329, 337 Psychogenic, 329, 349 Psychological Techniques, 218, 329 Psychology, 37, 48, 278, 329 Psychomotor, 168, 275, 282, 329 Psychosis, 144, 155, 181, 183, 290, 329 Public Policy, 229, 330 Publishing, 6, 66, 190, 196, 197, 198, 237, 330 Puerperium, 317, 330 Pulmonary, 9, 49, 53, 130, 156, 173, 183, 262, 272, 302, 303, 330, 334, 344, 350 Pulmonary Artery, 262, 330, 350 Pulmonary Edema, 130, 302, 330 Pulmonary Ventilation, 330, 334 Pulsation, 288, 330 Pulse, 42, 70, 118, 122, 281, 283, 310, 319, 330 Pupil, 273, 278, 311, 330 Purpura, 191, 330 Purulent, 251, 330 Pyogenic, 318, 330 Pyramidal Cells, 31, 276, 330 Q Quality of Life, 10, 33, 330 Quaternary, 26, 330 R Race, 84, 91, 277, 309, 330 Radiation, 146, 147, 172, 173, 192, 251, 285, 288, 295, 299, 321, 330, 331, 352 Radiation therapy, 192, 251, 285, 288, 299, 321, 330 Radicular, 317, 331 Radicular Cyst, 317, 331 Radio Waves, 277, 331
Radioactive, 295, 297, 299, 301, 316, 331 Radiography, 290, 331 Radiolabeled, 331 Radiological, 321, 331 Radiology, 20, 190, 213, 331 Radiopharmaceutical, 290, 331 Radiotherapy, 263, 331 Radius, 156, 331 Rage, 321, 331 Randomized, 10, 29, 42, 54, 60, 67, 68, 75, 78, 84, 86, 91, 98, 281, 331 Randomized clinical trial, 42, 54, 331 Randomized Controlled Trials, 78, 331 Rationalize, 26, 331 Reagent, 254, 295, 305, 332 Reality Testing, 329, 332 Receptors, Adrenergic, 277, 307, 332 Receptors, Glutamate, 16, 332 Recombinant, 15, 16, 25, 332, 350 Recombination, 290, 332 Recovery of Function, 64, 332 Recovery Room, 54, 332 Rectal, 92, 123, 332 Rectum, 81, 257, 263, 278, 287, 289, 293, 298, 302, 328, 332, 338 Recur, 46, 332 Recurrence, 268, 306, 332 Reductase, 154, 332 Refer, 1, 263, 270, 279, 287, 299, 304, 305, 309, 312, 316, 329, 332, 351 Reflex, 18, 19, 30, 170, 199, 321, 332 Refraction, 312, 332, 339 Refractory, 28, 95, 332 Regeneration, 64, 332 Regimen, 30, 60, 269, 280, 332 Regression Analysis, 53, 333 Regurgitation, 289, 292, 333 Relapse, 143, 195, 333 Relaxant, 333 Remission, 195, 306, 332, 333 Renal failure, 130, 199, 208, 275, 333 Renal pelvis, 302, 333 Renal tubular, 131, 333 Renin, 54, 95, 256, 333 Renin-Angiotensin System, 95, 333 Renovascular, 194, 333 Reperfusion, 55, 312, 333 Reperfusion Injury, 55, 333 Reproduction Techniques, 327, 333 Reproductive system, 328, 333 Research Design, 37, 52, 333 Resection, 160, 163, 190, 334, 347
370 Anesthesia
Respiration, 27, 139, 142, 147, 171, 173, 186, 207, 258, 264, 272, 274, 310, 334 Respirator, 124, 186, 307, 326, 334, 350 Respiratory failure, 334, 350 Respiratory Paralysis, 334, 336 Respiratory Physiology, 334, 350 Respiratory System, 142, 334 Restoration, 9, 65, 274, 311, 328, 333, 334 Resuscitation, 50, 334 Reticular, 17, 107, 334 Reticular Formation, 17, 107, 334 Retina, 40, 268, 271, 277, 303, 312, 315, 317, 324, 334, 335, 351 Retinal, 40, 277, 317, 324, 334 Retinal Detachment, 40, 277, 334 Retinitis, 144, 155, 181, 183, 334, 335 Retinol, 334, 335 Retinopathy, 40, 277, 335 Retrobulbar, 87, 335 Retrograde, 28, 335 Retroperitoneal, 195, 335 Retropubic, 328, 335 Retrospective, 4, 5, 7, 10, 81, 335 Retrospective study, 4, 335 Rheumatism, 335 Rheumatoid, 194, 218, 219, 335 Rheumatoid arthritis, 194, 218, 219, 335 Ribose, 252, 335 Rigidity, 306, 324, 335, 336 Risk factor, 7, 10, 30, 43, 52, 53, 90, 191, 192, 305, 328, 335 Rod, 153, 269, 335 Root Planing, 84, 335 Rubber, 145, 251, 335 Ryanodine, 15, 335 S Saline, 161, 166, 335 Saliva, 135, 191, 335 Salivary, 191, 192, 196, 274, 278, 286, 319, 335, 342, 352 Salivary glands, 192, 274, 278, 286, 335 Salivation, 291, 335 Sanitation, 23, 335 Saphenous, 273, 336 Saphenous Vein, 273, 336 Saponins, 336, 341 Sarcoplasmic Reticulum, 14, 15, 336 Saturate, 141, 336 Saxitoxin, 133, 336 Schizoid, 336, 352 Schizophrenia, 9, 144, 147, 179, 181, 182, 308, 336, 352
Schizophrenia, Catatonic, 147, 336 Schizotypal Personality Disorder, 336, 352 Sclera, 87, 268, 272, 336 Sclerosis, 65, 144, 145, 155, 181, 182, 183, 310, 336 Screening, 37, 43, 140, 198, 269, 336 Scrotum, 194, 199, 274, 336, 343, 350 Second Messenger Systems, 61, 315, 332, 336 Secretion, 128, 179, 251, 268, 277, 283, 294, 296, 299, 310, 335, 336, 337 Secretory, 65, 180, 314, 336, 343 Sedative, 3, 19, 50, 108, 149, 176, 180, 254, 260, 268, 277, 307, 309, 337, 352 Seizures, 25, 28, 46, 63, 130, 145, 147, 182, 257, 275, 320, 337, 340 Semen, 328, 337 Semicircular canal, 299, 337 Seminal vesicles, 337, 350 Senile, 11, 337 Sensibility, 255, 295, 337 Sensitization, 57, 337 Sensor, 122, 137, 139, 170, 174, 186, 337 Sepsis, 131, 337 Sequencing, 17, 38, 337 Serotonin, 254, 337 Serous, 282, 337 Serum, 123, 155, 253, 255, 270, 297, 305, 337 Seton, 98, 337 Sex Characteristics, 252, 337, 344 Shave biopsy, 86, 337 Shivering, 128, 337 Shock, 41, 50, 132, 149, 255, 281, 312, 337, 347 Side effect, 6, 11, 13, 14, 26, 32, 54, 57, 63, 130, 141, 160, 167, 178, 221, 252, 301, 338, 346 Sigmoid, 190, 338 Sigmoid Colon, 338 Signal Transduction, 55, 299, 338 Signs and Symptoms, 52, 143, 147, 333, 338 Skeletal, 15, 269, 274, 275, 311, 314, 315, 336, 338, 339, 348 Skeleton, 251, 286, 301, 338 Skin graft, 338, 341 Skull, 42, 118, 268, 273, 282, 314, 338, 343 Sleep apnea, 83, 338 Small intestine, 261, 274, 280, 294, 296, 299, 300, 313, 338
Index 371
Smooth muscle, 15, 45, 134, 147, 179, 253, 255, 263, 264, 294, 310, 312, 333, 338, 339, 342 Sneezing, 184, 211, 322, 338, 341 Social Environment, 330, 338 Sodium, 13, 27, 63, 93, 130, 133, 136, 195, 277, 324, 338, 339 Sodium Channels, 27, 324, 339 Soft tissue, 167, 191, 197, 199, 209, 219, 262, 286, 338, 339 Solvent, 13, 260, 284, 291, 318, 339 Soma, 330, 339 Somatic, 19, 143, 252, 290, 304, 307, 310, 322, 327, 339, 349 Sound wave, 271, 277, 339 Spasm, 77, 144, 181, 183, 257, 272, 308, 339, 344 Spasmodic, 263, 323, 339 Spastic, 301, 339 Spasticity, 12, 275, 339 Specialist, 67, 194, 212, 240, 278, 339 Species, 260, 274, 278, 283, 307, 309, 310, 318, 320, 330, 336, 339, 347, 348, 351, 352 Specificity, 18, 29, 44, 253, 264, 339 Spectrometer, 34, 339 Spectrum, 169, 331, 339 Specula, 122, 339 Speculum, 122, 339 Sperm, 268, 339, 343, 350 Spermatozoa, 337, 339, 350 Sphenoid, 319, 339 Sphincter, 124, 303, 340, 341 Spike, 31, 59, 340 Spina bifida, 208, 314, 340 Spinal Cord Injuries, 208, 340 Spinal Nerves, 322, 340 Spleen, 274, 305, 306, 340 Splenectomy, 190, 191, 340 Splenic Vein, 326, 340 Splint, 219, 340 Spontaneous Abortion, 327, 340 Sporadic, 314, 340 Sprains and Strains, 305, 340 Squamous, 268, 340 Squamous Epithelium, 268, 340 Staging, 198, 340 Stasis, 178, 340 Statistically significant, 10, 340 Status Asthmaticus, 102, 340 Status Epilepticus, 156, 183, 340 Steatosis, 286, 341 Steel, 5, 126, 197, 269, 341, 348
Stem Cells, 64, 341 Stents, 194, 341 Stereotyped Behavior, 58, 341 Sterile, 35, 320, 341 Sterilization, 138, 191, 341 Steroid, 16, 51, 261, 273, 336, 341 Stillbirth, 327, 341 Stimulant, 141, 264, 294, 324, 341, 349 Stool, 298, 301, 302, 341 Strand, 337, 341 Stress incontinence, 184, 212, 341 Stress urinary, 76, 184, 341 Stria, 64, 341 Stricture, 194, 341 Stroke, 12, 28, 33, 78, 117, 119, 139, 144, 145, 155, 176, 181, 182, 183, 228, 265, 293, 315, 341 Stroke Volume, 265, 341 Stromal, 64, 342 Stromal Cells, 64, 342 Stupor, 303, 312, 313, 336, 342 Styrene, 335, 342 Subacute, 298, 342 Subarachnoid, 78, 172, 292, 342 Subclinical, 60, 298, 337, 342 Subcutaneous, 146, 280, 320, 342 Subiculum, 294, 342 Sublingual, 135, 342 Submaxillary, 283, 342 Substance P, 308, 336, 342 Substrate, 133, 134, 135, 162, 265, 283, 342 Sudden cardiac death, 18, 342 Sudden death, 18, 342 Sufentanil, 90, 108, 342 Sulfur, 308, 342 Supplementation, 253, 342 Support group, 237, 342 Suppression, 16, 36, 47, 79, 98, 132, 150, 161, 173, 342 Sympathomimetic, 279, 283, 316, 342 Symphysis, 328, 342 Symptomatic, 10, 148, 256, 277, 327, 342 Synapses, 14, 46, 60, 62, 314, 315, 340, 343 Synapsis, 343 Synaptic, 14, 39, 47, 51, 60, 61, 62, 144, 182, 316, 332, 338, 343 Synaptic Transmission, 14, 51, 60, 61, 144, 182, 316, 332, 343 Synaptic Vesicles, 343 Synaptosomes, 61, 343 Synergistic, 36, 343 Synovial, 136, 343
372 Anesthesia
Synovial Fluid, 136, 343 Synovial Membrane, 343 Systolic, 295, 343 T Tachycardia, 18, 343 Temporal, 31, 34, 40, 44, 58, 59, 95, 255, 259, 283, 292, 294, 307, 343 Temporal Lobe, 255, 259, 283, 343 Terminalis, 64, 343, 344 Testicles, 191, 274, 318, 336, 343, 350 Testicular, 274, 344 Testis, 284, 344 Testosterone, 332, 344 Tetani, 344 Tetanic, 344 Tetanus, 191, 344 Tetany, 320, 344 Tetracaine, 68, 344 Tetrodotoxin, 133, 344 Thalamic, 17, 344 Thalamus, 17, 62, 278, 304, 327, 344 Therapeutics, 105, 106, 140, 223, 344 Thermal, 36, 58, 122, 123, 131, 278, 315, 344 Thigh, 194, 286, 291, 344 Third Ventricle, 296, 344 Thoracic, 33, 68, 71, 73, 77, 83, 90, 97, 160, 206, 263, 307, 344, 352 Thoracic Surgery, 77, 344 Thoracoscopy, 190, 344 Thoracotomy, 18, 344 Thorax, 251, 305, 344, 349 Threshold, 17, 128, 163, 176, 285, 295, 345 Thrombin, 287, 325, 329, 345 Thrombocytes, 325, 345 Thrombosed, 81, 345 Thrombosis, 125, 197, 300, 329, 341, 345 Thromboxanes, 258, 281, 345 Thrombus, 129, 273, 298, 311, 312, 325, 345 Thymus, 297, 305, 306, 345 Thyroid, 108, 192, 216, 296, 320, 345, 348 Thyroid Gland, 320, 345 Thyrotropin, 296, 345 Thyroxine, 253, 345 Tidal Volume, 139, 345 Tin, 6, 320, 325, 345 Tinnitus, 179, 318, 345, 351 Tissue Culture, 22, 345 Tissue Survival, 41, 346 Tolerance, 33, 81, 155, 183, 252, 291, 346 Tomography, 346 Tonic, 265, 272, 346
Tonicity, 140, 346 Tonsils, 212, 346 Tonus, 321, 346 Tooth Preparation, 252, 346 Topical, 10, 68, 70, 76, 81, 90, 95, 98, 103, 126, 133, 158, 208, 209, 222, 237, 284, 346 Torsion, 298, 346 Tourniquet, 81, 86, 125, 346 Toxaemia, 327, 346 Toxic, iv, 27, 61, 63, 162, 163, 200, 259, 260, 274, 284, 293, 297, 315, 316, 342, 346 Toxicity, 150, 209, 265, 280, 308, 324, 346 Toxicology, 147, 230, 346 Toxins, 257, 264, 282, 291, 298, 346 Trabecular Meshwork, 346 Trabeculectomy, 103, 346 Trace element, 269, 345, 346 Trachea, 45, 164, 165, 192, 263, 303, 323, 345, 346 Tracheotomy, 9, 346 Traction, 269, 346 Transaminases, 123, 346 Transcutaneous, 68, 93, 347 Transduction, 55, 338, 347 Transfection, 261, 347 Transfer Factor, 297, 347 Transfusion, 21, 285, 347 Transgenes, 13, 22, 58, 347 Transient Ischemic Attacks, 128, 347 Translational, 56, 347 Transmitter, 60, 61, 167, 251, 279, 285, 301, 307, 316, 343, 347 Transplantation, 64, 190, 201, 207, 268, 281, 297, 347 Transurethral, 10, 148, 328, 347 Transurethral Resection of Prostate, 328, 347 Transurethral resection of the prostate, 148, 347 Trees, 335, 347 Tremor, 308, 347 Tricyclic, 148, 149, 254, 347 Trigeminal, 28, 286, 306, 347 Trigeminal Nerve, 28, 347 Trisomy, 9, 348 Trophoblast, 262, 348 Tropomyosin, 348 Troponin, 30, 66, 348 Truncal, 191, 198, 348 Tuberculosis, 272, 348 Tubocurarine, 313, 348 Tumor model, 24, 348
Index 373
Tumour, 289, 348 Tungsten, 34, 348 Tunica Intima, 282, 348 Tympanic membrane, 167, 168, 348 Tyrosine, 279, 348 U Ulcer, 280, 321, 348, 350 Ultrasonography, 191, 290, 348 Uncompensated Care, 295, 348 Unconscious, 13, 20, 145, 255, 296, 331, 348 Universal Precautions, 213, 348 Uremia, 302, 333, 349 Ureter, 194, 302, 333, 349 Urethra, 148, 184, 194, 199, 212, 260, 296, 321, 328, 347, 349 Urinary Retention, 80, 148, 160, 274, 349 Urinary tract, 199, 278, 349 Urinate, 148, 349, 352 Urine, 10, 35, 130, 148, 184, 260, 262, 279, 283, 292, 298, 302, 309, 329, 333, 341, 349, 351 Urodynamics, 195, 349 Urogenital, 200, 290, 349 Urolithiasis, 200, 349 Urology, 10, 194, 195, 199, 218, 349 Urothelium, 29, 349 Urticaria, 255, 349 Uterus, 134, 267, 273, 282, 296, 312, 319, 328, 333, 349 V Vaccine, 252, 254, 329, 349 Vagal, 18, 45, 349 Vagina, 134, 276, 296, 333, 349 Vaginal, 76, 79, 97, 134, 194, 212, 305, 349 Vagotomy, 191, 198, 349 Vagus Nerve, 348, 349 Valine, 155, 349 Valves, 127, 138, 199, 350 Varicocele, 190, 191, 199, 350 Varicose, 103, 350 Varicose vein, 103, 350 Vas Deferens, 194, 350 Vascular Resistance, 49, 350 Vasculitis, 234, 267, 350 Vasectomy, 194, 350 Vasoactive, 133, 134, 350 Vasoconstriction, 40, 283, 350 Vasodilation, 123, 134, 350 Vasodilator, 263, 279, 294, 312, 350 Vector, 347, 350 Vein, 190, 197, 256, 258, 300, 316, 326, 336, 340, 345, 350
Venous, 134, 190, 197, 258, 263, 267, 275, 300, 329, 350 Venous blood, 263, 267, 350 Ventilation, 77, 128, 141, 156, 157, 159, 164, 212, 350 Ventilator, 9, 127, 128, 132, 156, 160, 307, 334, 350 Ventral, 19, 296, 317, 326, 340, 350 Ventricle, 255, 258, 294, 330, 343, 344, 350 Ventricular, 9, 312, 350 Venules, 262, 264, 282, 309, 350 Vertebrae, 300, 340, 350 Vertebral, 261, 340, 351 Vertigo, 212, 318, 351 Vesicoureteral, 199, 351 Vestibular, 237, 351 Vestibule, 270, 299, 337, 351 Vestibulocochlear Nerve, 345, 351 Vestibulocochlear Nerve Diseases, 345, 351 Veterinarians, 177, 351 Veterinary Medicine, 102, 229, 307, 351, 352 Viral, 35, 282, 298, 347, 351 Virulence, 259, 346, 351 Virus, 183, 213, 260, 266, 283, 324, 347, 351 Viscera, 339, 351 Visceral, 19, 92, 259, 290, 304, 322, 349, 351 Viscosity, 41, 262, 351 Visual Cortex, 34, 67, 351 Vitamin A, 299, 335, 351 Vitreous Body, 268, 334, 351 Vitreous Hemorrhage, 277, 351 Vitreous Humor, 334, 351 Vitro, 46, 62, 293, 352 Vivo, 12, 14, 17, 24, 25, 26, 33, 34, 35, 37, 40, 45, 46, 47, 55, 62, 64, 147, 149, 166, 173, 175, 178, 293, 297, 309, 345, 352 Void, 10, 145, 148, 352 Voltage-gated, 25, 129, 352 W Wakefulness, 275, 352 Weight Gain, 143, 352 White blood cell, 257, 260, 303, 306, 352 Whooping Cough, 323, 352 Windpipe, 145, 263, 283, 323, 345, 352 Withdrawal, 36, 51, 102, 143, 147, 155, 183, 275, 323, 352 Womb, 333, 349, 352 Wounds, Gunshot, 340, 352 X Xenograft, 256, 348, 352
374 Anesthesia
Xenon, 124, 352 Xerostomia, 191, 352 X-ray, 199, 262, 271, 288, 316, 330, 331, 352
Xylazine, 102, 140, 352 Y Yeasts, 323, 352
Index 375
376 Anesthesia
