Coughing - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

COUGHING A 3-IN-1 MEDICAL REFERENCE Medical Dictionary Bibliography & Annotated Research Guide TO I NTERNET R EFERENCES...

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COUGHING A 3-IN-1 MEDICAL REFERENCE Medical Dictionary Bibliography & Annotated Research Guide TO I NTERNET

R EFERENCES

COUGHING A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R EFERENCES

J AM ES N. P ARK ER , 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 ©2004 by ICON Group International, Inc. Copyright ©2004 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., 1960Coughing: 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: 0-497-00307-4 1. Coughing-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.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International, Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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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 coughing. 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 COUGHING................................................................................................ 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Coughing....................................................................................... 7 E-Journals: PubMed Central ....................................................................................................... 16 The National Library of Medicine: PubMed ................................................................................ 17 CHAPTER 2. NUTRITION AND COUGHING ...................................................................................... 39 Overview...................................................................................................................................... 39 Finding Nutrition Studies on Coughing ..................................................................................... 39 Federal Resources on Nutrition ................................................................................................... 41 Additional Web Resources ........................................................................................................... 42 CHAPTER 3. ALTERNATIVE MEDICINE AND COUGHING ............................................................... 43 Overview...................................................................................................................................... 43 National Center for Complementary and Alternative Medicine.................................................. 43 Additional Web Resources ........................................................................................................... 48 General References ....................................................................................................................... 77 CHAPTER 4. DISSERTATIONS ON COUGHING ................................................................................. 79 Overview...................................................................................................................................... 79 Dissertations on Coughing .......................................................................................................... 79 Keeping Current .......................................................................................................................... 79 CHAPTER 5. PATENTS ON COUGHING ............................................................................................ 81 Overview...................................................................................................................................... 81 Patents on Coughing.................................................................................................................... 81 Patent Applications on Coughing.............................................................................................. 105 Keeping Current ........................................................................................................................ 115 CHAPTER 6. BOOKS ON COUGHING .............................................................................................. 117 Overview.................................................................................................................................... 117 Book Summaries: Online Booksellers......................................................................................... 117 Chapters on Coughing ............................................................................................................... 118 CHAPTER 7. MULTIMEDIA ON COUGHING ................................................................................... 125 Overview.................................................................................................................................... 125 Video Recordings ....................................................................................................................... 125 CHAPTER 8. PERIODICALS AND NEWS ON COUGHING ................................................................ 129 Overview.................................................................................................................................... 129 News Services and Press Releases.............................................................................................. 129 Newsletter Articles .................................................................................................................... 131 Academic Periodicals covering Coughing.................................................................................. 134 CHAPTER 9. RESEARCHING MEDICATIONS .................................................................................. 137 Overview.................................................................................................................................... 137 U.S. Pharmacopeia..................................................................................................................... 137 Commercial Databases ............................................................................................................... 142 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 147 Overview.................................................................................................................................... 147 NIH Guidelines.......................................................................................................................... 147 NIH Databases........................................................................................................................... 149 Other Commercial Databases..................................................................................................... 151 APPENDIX B. PATIENT RESOURCES ............................................................................................... 153 Overview.................................................................................................................................... 153 Patient Guideline Sources.......................................................................................................... 153 Finding Associations.................................................................................................................. 168

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APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 171 Overview.................................................................................................................................... 171 Preparation................................................................................................................................. 171 Finding a Local Medical Library................................................................................................ 171 Medical Libraries in the U.S. and Canada ................................................................................. 171 ONLINE GLOSSARIES................................................................................................................ 177 Online Dictionary Directories ................................................................................................... 180 COUGHING DICTIONARY ....................................................................................................... 181 INDEX .............................................................................................................................................. 235

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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 coughing 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 coughing, 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 coughing, 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 coughing. 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 coughing, 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 coughing. The Editors

1 From

the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON COUGHING Overview In this chapter, we will show you how to locate peer-reviewed references and studies on coughing.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and coughing, 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 “coughing” (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: •

Drugs Used to Manage Asthma Source: Access. 15(10): 38-41. December 2001. Contact: Available from American Dental Hygienists' Association. 444 North Michigan Avenue, Chicago, IL 60611. Summary: Asthma is a chronic disease that affects approximately five percent of the population. Asthma is characterized by shortness of breath due to bronchoconstriction and bronchospasm, with a reduced expiratory outflow. Other symptoms include wheezing, coughing, rapid breathing, and tightness of the chest. Asthmatic attacks are triggered by inhaled irritants, respiratory infections, stress, exposure to cold air, and exercise. Symptoms may subside spontaneously or may require the use of an inhaler. This article reviews the drugs used to manage asthma. The goals of asthma therapy are

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to improve airflow, reduce symptoms caused by inflammation, and prevent acute exacerbations. The author discusses beta 2 adrenergic agonists, anticholinergics, corticosteroids, methylxanthines, mast cell degranulation inhibitors, and leukotriene pathway inhibitors. The article concludes with a discussion of dental hygiene practice considerations for working with patients who have asthma. 2 tables. 8 references. •

Asthma and Reflux: When GI and Pulmonary Symptoms Are Linked Source: Consultant. 36(4): 705-707, 712-715, 719-720. April 1996. Contact: Available from Consultant. Cliggott Publishing Company. 55 Holly Hill Lane, Box 4010, Greenwich, CT 06831-0010. Summary: Gastroesophageal reflux disease (GERD) in asthmatic patients may be promoted by bronchodilator usage, supine positions, overeating, and increases in transdiaphragmatic pressures induced by asthma or coughing. In this article, the author summarizes the evidence that links asthma and GERD. Clinical features that suggest a cause-and-effect relationship between GERD and asthma include reflux symptoms that precipitate pulmonary symptoms, nocturnal asthma, laryngeal irritation, and a favorable pulmonary response to antireflux therapy. The author recommends a diagnostic approach that features five essential studies. Treatment options include longterm acid-suppression therapy and surgery. 9 figures. 3 tables. 34 references. (AA-M).

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Risk and Prevention of Transmission of Infectious Diseases in Dentistry Source: Quintessence International. 33(5): 376-382. May 2002. 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. Summary: Health care providers are at risk for infection with bloodborne pathogens, including hepatitis B virus, human immunodeficiency virus (HIV), and hepatitis C virus. This article reviews the risk and prevention of transmission of infectious diseases in dentistry. Recommended infection control practices are applicable to all settings in which dental treatment is provided. Dentists remain at low risk for occupationally acquired HIV. Dental health care workers, through occupational exposure, may have a 10 times greater risk of becoming a chronic hepatitis B carrier than the average citizen. Tuberculosis is caused by Mycobacterium tuberculosis. In general, persons suspected of having pulmonary or laryngeal tuberculosis should be considered infectious if they are coughing, are undergoing cough-inducing or aerosol-generating procedures, or have sputum smears positive for acid-fast bacilli. Although the possibility of transmission of bloodborne infections from dental health care workers to patients is considered to be small, precise risks have not been quantified by carefully designed epidemiologic studies. Emphasis should be placed on consistent adherence to recommended infection control strategies, including the use of protective barriers and appropriate methods of sterilization or disinfection. Each dental facility should develop a written protocol for instrument reprocessing, operatory cleanup, and management of injuries. Such efforts may lead to the development of safer and more effective medical devices, work practices, and personal protective equipment. 14 references.

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Patient Selection and Education for Use of the CapSure (Re/Stor) Continence Shield Source: Urologic Nursing. 19(2): 135-140. June 1999.

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Contact: Available from Society of Urologic Nurses and Associates, Inc. East Holly Avenue, Box 56, Pitman, NJ 08071-0056. (609) 256-2335. E-mail: [email protected]. Summary: Stress urinary incontinence affects millions of women, and many treatment options are available, ranging from behavioral or nonsurgical therapies to surgical intervention. This article reports the clinical findings of a multicenter trial using the CapSure (ReStor) continence shield, a study undertaken to evaluate the safety and efficacy of this device for treating women with stress urinary incontinence (SUI). Additionally, the authors discuss the role of patient education and selection. The CapSure continence shield is a limited, reuse soft suction cup made of silicone, which is placed externally over the urinary meatal area. The shield is designed so that the suction from the device creates negative pressure, which enables coaptation of the urethral walls, thereby increasing urethral resistance. The negative pressure within the device counteracts the pressure created by activities that would usually cause SUI in the female patient (such as sneezing, coughing, running), thereby keeping her dry. The device is not a reservoir that collects the urine during leakage. Overall, data indicated that patients were very satisfied with areas such as ease of placement and removal, ability of the device to remain in place during activity, improved enjoyment in life and self confidence, and degree of comfort. Sixteen of 100 patients withdrew from the study because of device irritation, inability to position the device properly, inability to keep followup appointments, or decision to undergo alternative treatment. The authors conclude with a discussion about patient selection and determining for which patients the CapSure shield would be most appropriate. 5 figures. 2 tables. 11 references. (AAM). •

Intermediate Term Failure of Pubovaginal Slings Using Cadaveric Fascia Lata: A Case Series Source: Journal of Urology. 167(3): 1356-1358. March 2002. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-3030 or (301) 714-2334. Fax (301) 824-7290. Summary: The pubovaginal sling procedure using autologous (the patient's own) fascia has become the gold standard for treating intrinsic sphincter deficiency and stress urinary incontinence (SUI, involuntary loss of urine upon coughing, laughing, jumping, etc.) in women. A recent modification has been the use of cadaveric fascia as the sling material. The authors recently reported similar results for cadaveric fascia lata in 121 women and autologous fascia lata in 46 women at a mean followup of 12 months. In this article, the authors identify 8 patients who experienced intermediate term failure at 4 to 13 months using cadaveric fascia lata. The authors retrospectively reviewed the records of 8 of 121 patients who received a pubovaginal sling using cadaveric fascia lata between February 1997 and June 1999 and who had recurrent stress incontinence after 4 to 13 months (mean of 6.5 months). Fresh frozen fascia from a local tissue bank was used and the surgical technique was identical in all cases. Postoperatively, urodynamics confirmed recurrent intrinsic sphincter deficiency. Previous incontinence surgery had been done in 7 of the 8 patients. Patient comorbidities (the presence of other illnesses) included neurological disease, diabetes mellitus, previous pelvic irradiation, and previous pelvic surgery. The authors note that the risk of intermediate term failure must be weighed against the advantages of decreased operative time and patient morbidity using cadaveric fascia lata. Longer followup and larger numbers are necessary to determine how much of a problem exists and what patient characteristics are relevant when selecting cadaver grafts. 1 table. 15 references.

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Sling Procedures for SUI: What's New in the 21 Century? Source: Contemporary Urology. 14(11): 34-36, 38,43-44,46-48. November 2002. Contact: Available from Medical Economics Publishing Inc. Montvale, NJ 07645. (800) 432-4570. Summary: The term stress urinary incontinence (SUI) is commonly used to describe the symptom of involuntary urine loss during coughing, sneezing, or other physical activities that increase abdominal pressure. 'Genuine' SUI is defined as the involuntary loss of urine per urethra with no change in detrusor pressure. This article describes the use of the vaginal sling procedure to surgically correct some of the problems that result in SUI. The author discusses the indications for this surgery, including proximal sphincter failure, proximal urethral failure with severe incontinence, and stress urinary incontinence; considers the different types of slings available, including proximal urethral slings, synthetic slings with bladder neck or proximal urethral placement, midurethral slings, autologous slings, modified autologous fascia slings, and other natural tissue materials; and describes the use of sling procedures in males. 9 figures. 21 references.

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Orofacial Pain as the Sole Manifestation of Syringobulbia-Syringomyelia Associated with Arnold-Chiari Malformation Source: Journal of Orofacial Pain. 15(2): 170-173. Spring 2001. Contact: Available from Quintessence Publishing Co, Inc. 551 Kimberly Drive, Carol Stream, IL 60188-1881. (800) 621-0387 or (630) 682-3223. Fax (630) 682-3288. Website: www.quintpub.com. Summary: This article presents a case report of a male patient (age 45 years) who presented with orofacial pain for a year as the only manifestation of syringobulbiasyringomyelia (cavitation within the spinal cord, a chronic and progressive disorder) associated with Arnold-Chiari malformation. The authors emphasize the clinical presentation and possible differential diagnoses of this case. The pain was continuous and affected the left side of the face. The pain was exacerbated by coughing and physical effort, possibly as a consequence of an increase in intracranial pressure. Paroxysymal (episodic) pain crises developed over this background of continuous pain, compatible with neurogenic trigeminal pain of the left second branch, together with pain episodes similar to cluster headache on the same side. The symptoms were resolved following neurosurgical management with amplification of the foramen magnum. Follow up MRI (magnetic resonance imaging) showed improvement of the syringomyelia. Two years later, the patient remained asymptomatic and was receiving no pharmacologic treatment. 3 figures. 8 references.

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Assessment of the Early Surgical Outcome and Urodynamic Effects of the Tensionfree Vaginal Tape (TVT) Source: International Urogynecology Journal. 11(5): 282-284. 2000. Contact: Available from Springer-Verlag New York Inc. 175 Fifth Avenue, New York, NY 10010. (212) 460-1500. Fax (212) 473-6272. Summary: This article reports on a study in which 52 women underwent a tension free vaginal tape (TVT) procedure for genuine stress incontinence (GSI, involuntary loss of urine under conditions such as laughing or coughing). Preoperative assessment included a detailed medical history, pelvic examination, a 1 hour pad test with a

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comfortably full bladder, and urinary culture. Thirteen of the 52 women were excluded for various reasons. Both before and 12 to 24 months postoperatively all patients had a full urodynamic (measurement of urinary flow during urination) investigation using microtip transducer catheters. The study subjects were instructed to maintain a 1 week baseline urinary diary before the operation, and postoperative urodynamic assessment as well. The period of followup ranged from 12 to 24 months (median 19 months). Another 1 hour pad test with a comfortably full bladder and urinary culture were carried out thereafter. Comparisons of the 39 women pre and postoperatively found a significantly improved 1 hour pad test. Analyzing the urodynamic effects of surgery revealed no significant postoperative changes except for the maximal urethral closure pressure (MUCP) at rest. An objective assessment using a pad test revealed the success rate (cure plus improved) to be 90 percent (35 out of 39 patients) and the failure rate 10 percent (4 out of 39 patients). The author concludes that TVT can thus be considered a safe and effective procedure for GSI in women. 2 tables. 10 references. •

Achalasia: Treatment Options Revisited Source: Canadian Journal of Gastroenterology. 14(5): 406-409. May 2000. Contact: Available from Pulsus Group, Inc. 2902 South Sheridan Way, Oakville, Ontario, Canada L6J 7L6. Fax (905) 829-4799. E-mail: [email protected]. Summary: This article reviews the treatment options for achalasia, (swallowing disorder) results from the inability of a muscle to relax. The aim of all forms of treatment of achalasia is to enable the patient to eat without disabling symptoms such as dysphagia (difficulty swallowing), regurgitation, coughing, or choking. Historically, this has been accomplished by mechanical disruption of the lower esophageal sphincter (LES) fibers, either by means of pneumatic dilation (PD) or by open surgical myotomy (cutting the muscle). The addition of laparoscopic myotomy and botulinum toxin (BTX) injection to the therapeutic armamentarium has triggered a recent series of reviews to determine the optimal therapeutic approach. Both PD and BTX have excellent short term (less than 3 months) efficacy in the majority of patients. New data have been published that suggest that PD and BTX (with repeat injections) can potentially obtain long term efficacy. PD is still considered the first line treatment by most physicians; its main disadvantage is risk of perforation. BTX injection is evolving as an excellent, safe option for patients who are considered high risk for more invasive procedures. Laparoscopic myotomy with combined antireflux surgery is an increasingly attractive option in younger patients with achalasia, but long term followup studies are required to establish its efficacy and the potential for reflux related sequelae. 2 figures. 1 table. 34 references.

Federally Funded Research on Coughing The U.S. Government supports a variety of research studies relating to coughing. 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. 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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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 coughing. 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 coughing. The following is typical of the type of information found when searching the CRISP database for coughing: •

Project Title: AEROSOL BASED NANOPARTICAL DRUG DELIVERY SYSTEM--TB Principal Investigator & Institution: Ng, Lawrence K.; Associate Professor; Pharmaceutical Sciences; University of Colorado Hlth Sciences Ctr P.O. Box 6508, Grants and Contracts Aurora, Co 800450508 Timing: Fiscal Year 2002; Project Start 01-APR-1999; Project End 31-MAR-2004 Summary: (Verbatim from Investigator's Abstract): Tuberculosis (TB) is a communicable infectious disease caused by inhalation of tubercle bacilli, Mycobacterium tuberculosis, in airborne droplets (< 10 um in size) emitted by the coughing pulmonary patient. Upon deposition in the alveolus, the tubercle bacilli can be phagocytosed and grow within the alveolar macrophages (AMs), and be eventually released causing widespread infections in the lungs and other body sites. Despite the fact that therapies are available for controlling the vast majority of existing cases, the incidence of TB is increasing. This is because many TB patients (AIDS patients, elderly, drug abusers and the urban poor) have significant social problems, and compliance with multi-month drug therapy is frequently difficult. Further, current therapies, which require patients to take large oral doses of drugs, such as isoniazid, can often produce significant side effects. This further compounds the compliance problem. Therefore, the major objectives of this research proposal are to improve the overall treatment rate of TB by developing specific pulmonary sustained drug delivery systems that would (1) improve patient's compliance with drug therapy, (2) reduce the manifestation of associated side effects, and (3) target the therapy to AM which plays an important role in the pathogenesis of TB. These objectives will be accomplished by pursuing the following specific aims: (1) developing drug-impregnated biodegradable nanoparticles of different size, shape, loading factor, and crystallinity and to determine the effects of these parameters on the release kinetics of the model antitubercular drug, isoniazid, (2) characterizing nanoparticle interaction with alveolar macrophages, (3) determining the pulmonary disposition of inhaled nanoparticles and nanoparticle-associated drugs in vivo, (4) identifying acute and chronic effects of inhaled nanoparticles on lung function and morphology, and (5) evaluating the ability of inhaled isoniazid-impregnated nanoparticles to arrest or reverse the progression of TB in an experimental animal model. It is expected this multidisciplinary approach will provide significant advances in the treatment of TB and other airway diseases in which sustained drug release or targeting AMs would be advantageous. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CAREGIVER COPING SKILLS TRAINING FOR LUNG CANCER Principal Investigator & Institution: Keefe, Francis J.; Professor and Associate Director; Psychiatry; Duke University Durham, Nc 27710 Timing: Fiscal Year 2002; Project Start 06-JUN-2002; Project End 31-MAY-2007

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Summary: (provided by investigator): Symptoms such as pain, fatigue, paroxysmal coughing, and dyspnea are major concerns of lung cancer patients and their caregivers. The focus in management of such symptoms traditionally has been on the patient. Studies of caregivers, however, have documented that the psychosocial impact of providing care to family members with lung cancer is profound. The ultimate goal of this research is to develop more effective ways to help patients and caregivers cope more effectively with problematic symptoms experienced by lung cancer patients. The proposed study seeks to evaluate the efficacy of a new, caregiver assisted coping skills training protocol. 500 early stage lung cancer patients (Stages I to IIIA) and their caregivers will be randomly assigned to one of two conditions: 1) Caregiver-assisted coping skills training-systematically trains caregivers in methods for guiding the patient in use of coping skills for symptom management (i.e. relaxation training, imagery, activity pacing, and communication skills), or 2) Cancer education and support-a comparison condition that provides patients and caregivers with information on the nature of lung cancer and treatment methods and controls for attention and contact. Assessment measures to be collected before and after treatment and at 4- and 14-months follow-up will include patient reports of major symptoms (pain, fatigue, coughing, and dyspnea), quality of life, depression, anxiety, self efficacy and quality of relationship with the caregiver and caregivers' ratings of mood, strain, and quality of relationship with the patient. If caregiver-assisted CST is effective, future studies could evaluate this training in other cancer populations (e.g. breast cancer, prostate cancer). Future studies could also identify the particular caregiver-assisted CST components (e.g. relaxation training, imagery training, or activity pacing methods) that contribute most to treatment effects. By isolating the active ingredients of training, one can streamline it, making it more cost-effective and more readily available to the larger population of patients having lung cancer. The proposed study rigorously evaluations methods for enhancing the effects of caregiver-assisted coping skills training in cancer patients and their caregivers. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DIAGNOSIS & PATHOGENESIS OF TUBERCULOSIS: AIDS OPPORTUNISTIC INFECTION Principal Investigator & Institution: Didier, Peter J.; Tulane University of Louisiana New Orleans, La New Orleans, La 70112 Timing: Fiscal Year 2002 Summary: The objective of this pilot project is to continue the characterization of the tuberculosis model in rhesus monkeys. We previously found that high dose inoculation (six million bacteria) of Mycobacterium tuberculosis H37Rv and Erdman strains produced lethal lung disease within five to ten weeks. Monkeys developed clinical signs of dyspnea, coughing, anorexia, and weight loss 4-6 weeks after inoculation. Skin testing with Old tuberculin became mildly positive after 5 weeks while PPD skin tests remained negative. Animals developed extensive necrotizing granulomatous lesions in the inoculated half of the lung with spread to the contralateral lung and bronchial lymph node in animals with H37Rv, and to the liver and kidney in animals with the Erdman strain. Animals vaccinated with culture filtrate from H37Rv and challenged with two million bacteria developed the same clinical disease as unvaccinated controls. However, low dosage inoculation of a pair of animals with each strain (<300 Erdma n, <30 H37Rv) failed to produce clinical disease within 18 weeks. Lesions in three of four animals were confined to the bronchial lymph node. To confirm this finding, four more animals per strain have been inoculated with low dosages of bacteria. All animals have

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strongly positive skin tests but remain clinically normal four weeks after inoculation. Characterization of this model by culture, blastogenesis, flow cytometry, and cytokine detection continues. Results contradict old literature and indicate that tuberculosis in rhesus monkeys may present as a chronic disease based on the dose of the inoculum. This suggests that future studies using low dose inoculation will be feasible in SIVinfected monkeys to study tuberculosis as an opportunistic infection. FUNDING Venture Research PUBLICATIONS Scollard DM, Didier PJ, Dietrich MA, Bohm Jr RP. Selective increases in CD45RO(+) CD38(+) T cells in 1? and 2? responses to BCG in rhesus macaques. [Abstract]. Proceedings of the 9th International Immunology Congress, San Francisco, CA, July 23-29, 1995. Scollard DL, Didier PJ, Bohm Jr RP. A method to assess changes in rhesus lymphatic T cells in vivo during local immune responses. [Abstract]. Second Annual Molecular Biology and Biotechnology Conference, Baton Rouge, LA, February 9-10, 1996. Didier PJ, Blanchard JL, Gormus BJ. Pulmonary tuberculosis in normal rhesus monkeys infected with Mycobacterium tuberculosis H37Rv. [Abstract #159]. Amer Soc Trop Med Hygiene, 57(3):156, 1997. Didier PJ, Blanchard JL. Chronic tuberculosis produced by low dosage of M. tuberculosis (Erdman) in rhesus monkeys. [Abstract #734]. Amer Soc Trop Med Hygiene 59(3):361, 1998. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FUNCTION AND MORPHOLOGY OF THE PELVIC FLOOR MUSCULATURE Principal Investigator & Institution: Johnson, Vicki; None; University of Alabama at Birmingham Uab Station Birmingham, Al 35294 Timing: Fiscal Year 2003; Project Start 01-MAR-2003; Project End 28-FEB-2005 Summary: (provided by applicant): The purpose of this study is to describe the pelvic floor musculature (PFM) characteristics in women with genuine stress urinary incontinence (GSUI) as compared to a control group of normal, health nulliparous women with no history of GSUI. The following aims will be tested: Aim 1: To describe the characteristics of pelvic bone structure (geometry) in women with GSUI as compared to nulliparous women with no history of genuine stress urinary incontinence (GSUI). Aim 2: To describe the differences in the structural anatomy (morphology) of the PFM including muscles, fascia and ligamentous structures at rest in women with GSUI as compared to healthy, normal nulliparous women. Aim 3: To describe the differences in function and contractility of the PFM in women with GSUI as compared to healthy, normal nulliparous women. Aim 4: To describe the effects of controlled PFM relaxation following contraction in regard to regress of strain subsequent to PFM contraction in women with GSUI as compared to healthy, normal nulliparous women. Background and Significance: Urinary incontinence (UI) affects approximately 14 million individuals in the United States; the majority of these are women. Genuine stress urinary incontinence is involuntary urine leakage during coughing, sneezing, or other physical activities that increase intra-abdominal pressure. Development of GSUI in women is multi-factorial including childbirth, increased age, and genetic influences. The mechanism(s) of improvement induced by rehabilitative exercises of the PFM have not been adequately described. Method: A descriptive study design will be used to describe pelvic bone structure (CT scan) and pelvic muscle structure and dynamic function (NMRI) in women with GSUI compared to nulliparous controls. Statistical Analysis: Descriptive statistical analysis will be used to obtain frequencies and percents (nominallevel variables), and means and standard deviations (interval/ratio level variables). This

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analysis will provide an estimate of effect sizes and sample size requirements for testing differences in future studies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HOST DETERMINANTS OF INFECTIOUSNESS IN TUBERCULOSIS Principal Investigator & Institution: Fennelly, Kevin P.; Assistant Professor; Medicine; Univ of Med/Dent Nj Newark Newark, Nj 07107 Timing: Fiscal Year 2002; Project Start 30-SEP-1999; Project End 31-MAY-2004 Summary: Both experimental and epidemiological data suggest that there is a wide range of infectiousness among patients with tuberculosis. Although much research has focused on the virulence of the organism, little is known of the host determinants of infectiousness. A novel Cough Aerosol Sampling System (CASS) can isolate and quantify (viable airborne Mycobacterium tuberculosis from individual patients with pulmonary tuberculosis. We hypothesize that the production of viable aerosols of M. tuberculosis determined by this method is correlated with infectiousness. Our central hypothesis is that most of the variability of infectiousness in tuberculosis is explained by non-immunological host factors including the duration of antimycobacterial therapy with drugs to which the organism is susceptible, the strength and frequency of coughing, and the physicochemical properties of the sputum. The first specific aim is to correlate viability assessed by the air sampling method used in the CASS and infectiousness using the mouse and guinea pig models. The second aim is to determine if the infectiousness of tuberculosis decreases rapidly with appropriate antimycobacterial therapy. The third aim is to assess whether cough strength and frequency are associated with the quantity of viable aerosol. The fourth aim is to determine if infectiousness is associated with physicochemical properties of sputum. These data may alter clinical practice and public health control measures. Changes in tuberculous aerosol viability associated with drug therapy may provide insight into the basic biology of the mycobacterial cell wall. Similarly, the rapid changes in cough strength and frequency may suggest mechanisms in the pathophysiology of cough. Verifying the correlation between quantitative aerosol cultures and infectiousness using animal models may validate the use of the cough aerosol sampling system at the bedside. Data obtained from patients with tuberculosis may in turn validate the use of animal models of infection. This approach may open a new field of investigation of the host determinants of infectiousness, which could be extended to other respiratory infectious agents in the future. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MAST CELL NERVE INTERACTIONS IN AIRWAYS Principal Investigator & Institution: Undem, Bradley J.; Professor; Medicine; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2003; Project Start 01-MAR-1988; Project End 30-NOV-2006 Summary: (provided by applicant): Both the irritating as well as the potentially debilitating symptoms of allergic airway disease are due in large part to perturbation is neuronal activity. Thus sneezing, non-productive coughing, increases mucus secretion, reversible bronchospasm, and inordinate sensations of dyspnea are a consequence of abnormal afferent (sensory) input to the central nervous system, alterations in signal processing within the CNS, and/or alterations in the function of parasympathetic nerves. There has been much knowledge gained in the past two decades regarding the immunological and biochemical basis of the inflammation that accompanies allergic

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airway disease. Relatively little remains known, however, about how this inflammation modulates airway sensory and autonomic innervation such that the symptoms of disease occur. The long-range goal of this proposal is to develop at a better understanding of the mechanism and mediators involved in allergen-induced neuromodulation of the airways. The effect of allergen challenge on sensory afferent nerves and autonomic parasympathetic nerves innervating the airways will be investigated. Standard electrophysiological and immunohistochemical methods on airways isolated from guinea pigs and human tissue donors to directly address the mechanisms by which antigen challenge modulates neuronal function at a single cell level in the airways. The results from this multidisciplinary approach should be of intrinsic value in providing new knowledge regarding the cellular neurophysiology of the airways. The results may also shed new light on the complex pathophysiology of allergic airway diseases such as asthma, and ultimately suggest new therapeutic strategies for treatment of these complex diseases. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MECHANISMS OF INCONTINENCE FOLLOWING VAGINAL DISTENSION Principal Investigator & Institution: Damaser, Margot S.; Research Biomedical Engineer; Urology; Loyola University Chicago Lewis Towers, 13Th Fl Chicago, Il 60611 Timing: Fiscal Year 2002; Project Start 05-APR-2000; Project End 31-MAR-2005 Summary: (Adapted from Applicant's Description): One of the most common symptoms of pelvic floor dysfunction is Stress Urinary Incontinence (SUL), the leakage of urine with increased stress, such as during laughing or coughing. The epidemiologic factors most strongly associated with the development of SUI are vaginal delivery and advanced age. In addition to other contributing factors, there is clinical evidence that the pudendal nerve is damaged during vaginal delivery and that women with SUI have greater nerve damage. Decrease in concentrations of circulating gonadal steroid hormones may be a precipitating factor for post-menopausal development of SUL. The long term goal of this project is to develop novel clinical methods for enhancing recovery of patients with SUL. Specifically, the neuro-anatomical and functional effects of vaginal distension will be investigated as well as the role of steroid hormones in enhancing recovery from incontinence. The hypotheses to be tested are 1. Vaginal distension causes traumatic injuries, including injury to the distal pudendal nerve, and leads to development of SUI, and 2. Treatment with gonadal steroid hormones will accelerate pudendal nerve regeneration and will lead to accelerated functional recovery of SUI after vaginal distension. These hypotheses will be tested by 4 Specific Aims: SAl. Demonstration that vaginal distension leads to incontinence symptoms followed by recovery, SA2. Demonstration that the SUI and recovery that results from vaginal distension is associated with a specific pattern of neural damage and regeneration, SA3. Determination if treatment with estrogen reduces the severity of and/or accelerates recovery from incontinence symptoms and nerve damage after vaginal distension, and SA4. Determination if treatment with dihydrotestosterone reduces the severity of and/or accelerates recovery from incontinence symptoms and nerve damage after vaginal distension. These Specific Aims will be tested in an established animal model of vaginal distension by urodynamic testing, histological evidence, and 3u tubulin mRNA levels in pudendal motoneurons determined using in situ hybridization. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: NEUROPHYSIOLOGY AND BIOMECHANICS OF URETHRA IN SUI Principal Investigator & Institution: Yoshimura, Naoki; Associate Professor; Pharmacology; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2004; Project Start 01-APR-2004; Project End 31-MAR-2009 Summary: (provided by applicant): Stress urinary incontinence (SUI) is defined as involuntary loss of urine secondary to an increase in abdominal pressure during events such as sneezing, coughing or laughing in the absence of bladder contractions. This disorder is a significant gynecological/urological problem currently affecting approximately 25 million American women. These SUI patients exhibit the high incidence of intrinsic sphincter deficiency, characterized by a malfunction of the urethral sphincter mechanism resulting in the low-pressure urethra. However, normal physiology and pathophysiology of the urethral continence mechanism in relation to SUI are not well elucidated. Thus, utilizing both in-vivo and ex-vivo techniques developed in our laboratory, we propose to perform systematic analyses of urethral continence mechanisms under stress conditions. First, in-vivo neurophysiological analyses will be performed in normal animals and animal models of SUI. Next, ex-vivo biomechanical analyses will be performed of the normal and SUI urethra. Finally, based on these results, we will also seek to explore potential pharmacotherapies of SUI. In this proposal, we hypothesize: 1) the detailed neurophysiological and biomechanical properties contributing to normal urethral continence mechanisms at different positions along the urethra can be identified in normal rats, 2) pathological changes in neurophysiological and biomechanical properties of urethral continence mechanisms can be identified in two different animals models of SUI, and 3) pharmacological treatments using serotonine/norepinephrine reuptake inhibitors and/or adrenoceptor agonists can improve urethral continence mechanisms in two animal models of SUL The Specific Aims of this grant are: I) to characterize the normal physiological and biomechanical properties of the urethral closure mechanisms in normal animals using: a) microtip transducer catheters to measure bladder and urethral responses in-vivo during sneezing or passive increases in intravesical pressure, b) in-vivo leak point pressure measurements during sneezing or passive increases in intravesical pressure, and c) ex-vivo whole urethra biomechanical studies; II) to investigate the pathological changes in the above measurements in two rat models of SUI (vaginal over distension or transection of the nerves to external urethral sphincter and pelvic floor muscles); and III) to investigate possible pharmacotherapies for improving the urethral closure mechanism in the two rat models of SUI. By defining the detailed urethral pathology of SUI, we can offer the hope of prevention and reversal of this potentially devastating condition. This is recognized as a high priority in the urologic/gynecologic care of SUI patients. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: REGULATION OF THE COUGH REFLEX Principal Investigator & Institution: Bolser, Donald C.; Physiological Sciences; University of Florida Gainesville, Fl 32611 Timing: Fiscal Year 2003; Project Start 01-MAY-2003; Project End 30-APR-2007 Summary: (provided by applicant): Cough is the most common reason why sick patients visit physicians in the US. The long-range goal of this research is to delineate the neurogenic mechanisms by which cough is produced and regulated. The central hypothesis of this research is that the cough motor pattern is produced by an assembly

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of components that includes a novel regulatory element responsible for controlling the behavior of a reconfigured respiratory pattern generator. Moreover, the novel regulatory components that control laryngeal and tracheobronchial cough are not identical. The rationale for the proposed research is that once the functional organization of the brainstem cough pattern generation system is established, the mechanisms responsible for the production of pathological cough can be identified. The specific aims of the project are: 1) Determine the role of modulation of the expiratory phase in the regulation of the tracheobronchial and laryngeal cough motor patterns, 2) Determine the functional organization of the central regulatory system for tracheobronchial and laryngeal cough, 3) Determine the role of brainstem expiratory motor pathways in the antitussive-sensitive regulatory system for tracheobronchial cough, 4) Determine the role of spinal expiratory motor pathways in the antitussivesensitive regulatory system for cough. In the first aim, key regulatory mechanisms controlling the frequency and magnitude of repetitive tracheobronchial and laryngeal cough will be determined by altering of the excitability of each. Our preliminary data suggest a) that the frequency of repetitive coughing is primarily controlled by modulation of the duration of the latter part of the cough expiratory phase, and b) that separate regulatory mechanisms are responsible for the control of the frequency and intensity of repetitive coughing. In support of the second aim, preliminary findings suggest differential sensitivity of tracheobronchial and laryngeal cough to antitussive drugs and thus divergent central regulatory mechanisms for each. In the third aim, we test a model that predicts the presence of a tracheobronchial cough gating mechanism that is presynaptic to medullary and spinal expiratory motor pathways. This gating mechanism is sensitive to antitussive drugs. The sensitivity of rostral and caudal medullary expiratory neurons to antitussive drugs will be determined during breathing and cough to differentiate between inhibition or disfacilitation of these neurons by these compounds. In the fourth aim, antitussive drugs will be delivered intrathecally while monitoring expiratory motor drive during cough to determine the role of spinal pathways in the suppression of expiratory motor discharge. The results of these experiments will provide an important test of the proposed functional organization of the cough pattern generator. Furthermore, this project will test the proposed roles of medullary and spinal cellular elements that contribute to the generation and control of expiratory motor discharge during cough. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SELECTION CRITERIA FOR PELVIC MUSCLE THERAPY IN SUI Principal Investigator & Institution: Miller, Janis M.; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-AUG-2007 Summary: The long-term goal is to develop an effective behavioral therapy for stress urinary incontinence (SUI). Estimated prevalence rates of urinary incontinence range from 15-43% of women, with SUI as the most prevalent. The project will test Knack therapy, a self-help treatment for SUI that teaches women a pelvic floor muscle contractions simultaneously with a event known to trigger leakage. By doing so, momentary closure pressure is imposed on the urethra and risk for leakage is immediately reduced. This proposal aims to develop and test, in a general population of women with SUI, a model for predicting who will succeed in a costly surgery and time consuming Kegel's exercises). Specific Aims are to: (1) develop a logistic regression model to predict success with the Knack, (2) validate the model by determining the proportion of people who succeed according to who is predicted to succeed, and (3)

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develop long-term effectiveness of the Knack (1-year). The project will be implemented in three phases: model development (n=160 women), model validation (n approximately 160), and long-term follow-up of women who demonstrate response. The short-term outcome of "positive response" is defined as able to reduce leakage during coughing to under 2 ml or 50% decrease from baseline (whichever is more stringent). This will be evaluated immediately and at 1 month. Leakage is evaluated in simple fashion with a paper towel test in the clinic. Long-term success (3-month and 1-year) is defined both by the paper towel test criteria and by documentation of at least 50% reduction of leakage in diary to reflect success at home. ROC curve analysis will be used to analyze model data, t-test and descriptives to analyze response. Anticipated results include that 1) the treatment group will demonstrate significantly less urine leakage than a control group immediately post-instruction and at 1-month follow-up; and 2) over time (1-, 3-, and 12months) at least 80% of women selected by the predictive model who receive the Knack intervention will reach and sustain a greater than 50% reduction in urine loss from baseline. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: THE CLOUD ADULT Principal Investigator & Institution: Sherertz, Robert J.; Professor & Section Head; Internal Medicine; Wake Forest University Health Sciences Winston-Salem, Nc 27157 Timing: Fiscal Year 2002; Project Start 01-JUL-2000; Project End 30-JUN-2004 Summary: The broad, long-term objective of this work is to obtain a better understanding of a novel mechanism of microorganism transmission. The central hypothesis is that a viral URI (rhinovirus infection) will cause nasal carriers of Staphylococcus aureus to have airborne dispersal of S.aureus secondary to nasal mucosal swelling with resultant more rapid airflow over wet surfaces. Experiments in specific Aim 1 will define the natural history of rhinovirus-associated airborne dispersal of S.aureus and whether airborne dispersal in this setting is further increased by nose breathing, coughing, or sneezing. The relationship between nasal mucosal swelling and rhinovirus infection will be evaluated using CAT scans, rhinomanometry, and acoustic rhinometry. A second important focus will be to determine the relationship between the number of S.aureus in the nose and airborne dispersal. Experiments in specific Aim 2 will be concerned with better defining the mechanism of rhinovirus-associated airborne dispersal of S.aureus. A topical decongestant will be used to test the hypothesis that reducing rhinovirus-associated mucosal swelling will prevent airborne dispersal. Stopping the medications of S.aureus nasally colonized allergic rhinitis patients will be used to evaluate whether just mucosal swelling is necessary or whether it takes mucosal swelling plus the rhinovirus. The quantitative relationship between the number of S.aureus in the nose and airborne dispersal will be tested by using tetracycline treatment to increase the number of tetracycline-resistant S.aureus in the nose and using topical mupirocin to reduce the number of S.aureus in the nose. Specific Aim 3 will determine the prevalence of single nasal S.aureus carrier-associated outbreaks, as well as identify individuals who may be studied to identify what properties make such individuals unique. S.aureus is the most important cause of nosocomial infections in the United States. S.aureus outbreaks are extremely disruptive and cause significant patient morbidity and mortality. Both "cloud babies" and "cloud adults", newborn infants or healthcare workers nasally colonized with S.aureus that airborne disperse S.aureus associated with a viral URI, have been shown to cause outbreaks. Understanding the "cloud phenomenon" may facilitate S.aureus outbreak prevention and possibly the transmission of other pathogens, as well.

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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 “coughing” (or synonyms) into the search box. This search gives you access to fulltext articles. The following is a sample of items found for coughing in the PubMed Central database: •

A 44-year-old woman with dry cough and solitary nodule. by Lagrotteria DD, Crother MA, Lee CH, Peregrine A.; 2003 Sep 30; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=202291

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Acute cough in children. by Hay AD, Schroeder K, Fahey T.; 2004 May 1; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=403852

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Antibiotics for coughing in general practice: a questionnaire study to quantify and condense the reasons for prescribing. by Coenen S, Michiels B, Van Royen P, Van der Auwera JC, Denekens J.; 2002; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=126270

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Differences in coughing and other responses to intrabronchial infection with Bordetella pertussis among strains of rats. by Hall E, Parton R, Wardlaw AC.; 1997 Nov; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=175676

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Evaluation of Chlamydia pneumoniae and Mycoplasma pneumoniae as Etiologic Agents of Persistent Cough in Adolescents and Adults. by Wadowsky RM, Castilla EA, Laus S, Kozy A, Atchison RW, Kingsley LA, Ward JI, Greenberg DP.; 2002 Feb; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=153367

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I used to hear Stan coughing in the night. by Dickson RC.; 2001 Jun 26; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=81204

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Identifying asthma and chronic obstructive pulmonary disease in patients with persistent cough presenting to general practitioners: descriptive study. by Thiadens HA, de Bock GH, Dekker FW, Huysman JA, van Houwelingen JC, Springer MP, Postma DS.; 1998 Apr 25; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28529

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Quantitative systematic review of randomised controlled trials comparing antibiotic with placebo for acute cough in adults. by Fahey T, Stocks N, Thomas T.; 1998 Mar 21; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28496

3 Adapted 4

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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Recombinant human enkephalinase (neutral endopeptidase) prevents cough induced by tachykinins in awake guinea pigs. by Kohrogi H, Nadel JA, Malfroy B, Gorman C, Bridenbaugh R, Patton JS, Borson DB.; 1989 Sep; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=329719

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Role of Autonomic Nervous System and the Cough Reflex in the Increased Responsiveness of Airways in Patients with Obstructive Airway Disease. by Simonsson BG, Jacobs FM, Nadel JA.; 1967 Nov; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=292931

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Systematic review of randomised controlled trials of over the counter cough medicines for acute cough in adults. by Schroeder K, Fahey T.; 2002 Feb 9; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=65295

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 coughing, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “coughing” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for coughing (hyperlinks lead to article summaries): •

"Coughing water": bronchial hyperreactivity induced by swimming in a chlorinated pool. Author(s): Mustchin CP, Pickering CA. Source: Thorax. 1979 October; 34(5): 682-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=515992

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A comparison of ultrasonographically detected cervical changes in response to transfundal pressure, coughing, and standing in predicting cervical incompetence. Author(s): Guzman ER, Pisatowski DM, Vintzileos AM, Benito CW, Hanley ML, Ananth CV. Source: American Journal of Obstetrics and Gynecology. 1997 September; 177(3): 660-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9322639

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 coughing policeman. Author(s): Duddridge M, West KP, Wales J, Browning MJ. Source: Lancet. 2000 March 4; 355(9206): 804. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10711929

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A coughing-belt. Author(s): Rennie H, Wilson JA. Source: Lancet. 1983 July 16; 2(8342): 138-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6134984

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A hernia has an expansile impulse on coughing except when strangulated. Author(s): Watts GT. Source: Lancet. 1986 February 1; 1(8475): 261-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2868267

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A highly mobile laryngeal tumour: inspiratory stridor and coughing attacks. Author(s): de Boer HD, van Diejen D, Gielen MJ, Eisink RJ. Source: Anaesthesia. 2002 January; 57(1): 92-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11843756

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A role for capsaicin sensitive, tachykinin containing nerves in chronic coughing and sneezing but not in asthma: a hypothesis. Author(s): Karlsson JA. Source: Thorax. 1993 April; 48(4): 396-400. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8511740

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A serologic study of organisms possibly associated with pertussis-like coughing. Author(s): Wirsing von Konig CH, Rott H, Bogaerts H, Schmitt HJ. Source: The Pediatric Infectious Disease Journal. 1998 July; 17(7): 645-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9686733

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A sudden coughing up of foul-smelling sputum: a first sign of a pancreaticobronchial fistula, a severe pulmonary complication in acute pancreatitis. Author(s): Mahlke R, Warnecke B, Lankisch PG, Elbrechtz F, Busch C. Source: The American Journal of Gastroenterology. 2001 June; 96(6): 1952-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11419870

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ACE inhibitors and unexplained coughing. Author(s): Fox L. Source: Hosp Pract (Off Ed). 1989 February 15; 24(2): 22. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2537328

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Acoustic analysis of pathological cries, stridors and coughing sounds in infancy. Author(s): Hirschberg J. Source: International Journal of Pediatric Otorhinolaryngology. 1980 November; 2(4): 287-300. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7188067

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Acute airway changes induced by coughing. Author(s): Rees PJ, Clark TJ. Source: Br J Dis Chest. 1984 January; 78(1): 55-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6691909

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Alfentanil suppresses coughing and agitation during emergence from isoflurane anesthesia. Author(s): Mendel P, Fredman B, White PF. Source: Journal of Clinical Anesthesia. 1995 March; 7(2): 114-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7598918

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Antibiotics for coughing in general practice: a qualitative decision analysis. Author(s): Coenen S, Van Royen P, Vermeire E, Hermann I, Denekens J. Source: Family Practice. 2000 October; 17(5): 380-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11021895

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Antibiotics for coughing in general practice: a questionnaire study to quantify and condense the reasons for prescribing. Author(s): Coenen S, Michiels B, Van Royen P, Van der Auwera JC, Denekens J. Source: Bmc Family Practice [electronic Resource]. 2002 September 9; 3(1): 16. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12217080

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Antitussive and side effects of meprotixol on experimentally induced coughing in man. Author(s): Winther FO. Source: Acta Pharmacol Toxicol (Copenh). 1966; 24(2): 134-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5338050

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Ask the doctor. Someone forwarded an e-mail to me about coughing during a heart attack. It said that if I am having a heart attack, coughing deeply and strongly every few seconds could save my life. Is that true? Author(s): Lee TH. Source: Harvard Heart Letter : from Harvard Medical School. 2004 January; 14(5): 8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14734301

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Assessment of the forced expiration technique, postural drainage and directed coughing in chest physiotherapy. Author(s): Sutton PP, Parker RA, Webber BA, Newman SP, Garland N, Lopez-Vidriero MT, Pavia D, Clarke SW. Source: Eur J Respir Dis. 1983 January; 64(1): 62-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6825750

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Assessment of the mechanical efficiency of coughing in healthy young adults. Author(s): Lawson TV, Harris RS. Source: Clin Sci. 1967 August; 33(1): 209-24. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6059300

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Autonomic mechanisms in the heart rate response to coughing. Author(s): Cardone C, Bellavere F, Ferri M, Fedele D. Source: Clinical Science (London, England : 1979). 1987 January; 72(1): 55-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3802722

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Behavioral treatment of hysterical coughing and mutism: a case study. Author(s): Munford PR, Reardon D, Liberman RP, Allen L. Source: Journal of Consulting and Clinical Psychology. 1976 December; 44(6): 1008-14. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11229

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Bilateral eyelid ecchymosis and subconjunctival hemorrhage associated with coughing paroxysms in pertussis infection. Author(s): Paysse EA, Coats DK. Source: Journal of Aapos : the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus / American Association for Pediatric Ophthalmology and Strabismus. 1998 April; 2(2): 116-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10530974

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By the way, doctor. I've had a bothersome cough for years, and my doctor hasn't been able to make a diagnosis. Two chest x-rays have been normal. I find that coughing can produce embarrassing interruptions when I'm on the phone or in ordinary conversations. My family is worried about what might be going on. I'm not a smoker, so this isn't a smoker's cough I am talking about. Can you help me? Author(s): Goldfinger SE. Source: Harvard Health Letter / from Harvard Medical School. 1999 July; 24(9): 8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10368535

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By the way, doctor. I've read on the Internet that people having a heart attack can keep themselves alive by coughing. Is this true? Author(s): Lee TH. Source: Harvard Health Letter / from Harvard Medical School. 2000 December; 26(2): 8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11114802

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Cardiovascular response to coughing: its value in the assessment of autonomic nervous control. Author(s): van Lieshout EJ, van Lieshout JJ, ten Harkel AD, Wieling W. Source: Clinical Science (London, England : 1979). 1989 September; 77(3): 305-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2805594

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Cerebral arterial air embolism associated with coughing on a continuous positive airway pressure circuit. Author(s): Ulyatt DB, Judson JA, Trubuhovich RV, Galler LH. Source: Critical Care Medicine. 1991 July; 19(7): 985-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2055089

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Cerebrospinal fluid pressure changes in response to coughing. Author(s): Williams B. Source: Brain; a Journal of Neurology. 1976 June; 99(2): 331-46. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=990900

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Characterization of pressure changes in the lower urinary tract during coughing with special reference to the demands on the pressure recording equipment. Author(s): Thind P, Bagi P, Lose G, Mortensen S. Source: Neurourology and Urodynamics. 1994; 13(3): 219-25. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7920678

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Chemical specificity of coughing in man. Author(s): Godden DJ, Borland C, Lowry R, Higenbottam TW. Source: Clinical Science (London, England : 1979). 1986 March; 70(3): 301-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3004799

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Circulatory responses to baroreflexes, Valsalva maneuver, coughing, swallowing, and nasal stimulation during acute cardiac sympathectomy by epidural blockade in awake humans. Author(s): Takeshima R, Dohi S. Source: Anesthesiology. 1985 November; 63(5): 500-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3931507

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Clearance by voluntary coughing and its relationship to subjective assessment and effect of intravenous bromhexine. Author(s): Mossberg B, Philipson K, Strandberg K, Camner P. Source: Eur J Respir Dis. 1981 June; 62(3): 173-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7308332

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Comparison between the prevalence and treatment of wheezing and coughing in Brampton and Mississauga children. Author(s): Kirshner B, Gold M, Zimmerman B. Source: Journal of Clinical Epidemiology. 1990; 43(8): 765-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2384765

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Comparison of intravenous and topical lidocaine as a suppressant of coughing after bronchoscopy during general anesthesia. Author(s): Jakobsen CJ, Ahlburg P, Holdgard HO, Olsen KH, Thomsen A. Source: Acta Anaesthesiologica Scandinavica. 1991 April; 35(3): 238-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2038931

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Coughing after fentanyl. Author(s): Gin T, Chui PT. Source: Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 1992 April; 39(4): 406. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1563070

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Coughing after inguinal herniorrhaphy. Author(s): Foregger R. Source: Jama : the Journal of the American Medical Association. 1983 December 23-30; 250(24): 3281. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6645020

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Coughing and bed sheet wrapping. Author(s): Cohlan SQ, Stone SM, Zimmerman SS. Source: Pediatrics. 1991 November; 88(5): 1077-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1945623

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Coughing and bronchospasm with propofol. Author(s): Thompson MC, Davies C. Source: Anaesthesia. 1990 August; 45(8): 690-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2400091

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Coughing and central venous catheter dislodgement. Author(s): Jacobs WR, Zaroukian MH. Source: Jpen. Journal of Parenteral and Enteral Nutrition. 1991 July-August; 15(4): 491-3. Erratum In: Jpen J Parenter Enteral Nutr 1992 May-June; 16(3): 298. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1823540

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Coughing and choking in motor neuron disease. Author(s): Hadjikoutis S, Eccles R, Wiles CM. Source: Journal of Neurology, Neurosurgery, and Psychiatry. 2000 May; 68(5): 601-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10766890

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Coughing and laryngospasm with the laryngeal mask. Author(s): Dasey N, Mansour N. Source: Anaesthesia. 1989 October; 44(10): 865. Erratum In: Anaesthesia 1992 March; 47(3): 284. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2521122

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Coughing and variceal bleeding. Author(s): Rose JD. Source: The British Journal of Surgery. 1983 November; 70(11): 697. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6605778

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Coughing as the sole symptom of occupational bronchial allergy. Author(s): Gorski P, Grzelewska-Rzymowska I. Source: Pol J Occup Med Environ Health. 1992; 5(2): 139-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1392659

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Coughing attacks as a cause of gastric hemorrhage in patients who have undergone percutaneous endoscopic gastrostomy: an endoscopic solution. Author(s): Ulla JL, Almohalla C, Ledo L, Lopez Viedma B, Luis JV, Vazquez-Astray E. Source: Endoscopy. 2001 September; 33(9): 821. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11558040

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Coughing blood: tuberculosis deaths and data on the Yakama Indian Reservation, 1911-64. Author(s): Trafzer CE. Source: Can Bull Med Hist. 1998; 15(2): 251-76. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11624066

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Coughing can relieve or exacerbate symptoms in asthmatic patients. Author(s): Young S, Bitsakou H, Caric D, McHardy GJ. Source: Respiratory Medicine. 1991 January; 85 Suppl A: 7-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2034840

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Coughing during induction caused by morphinomimetic drugs. Author(s): Boidin MP. Source: British Journal of Anaesthesia. 1994 May; 72(5): 610. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8198923

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Coughing frequency in patients with persistent cough: assessment using a 24 hour ambulatory recorder. Author(s): Hsu JY, Stone RA, Logan-Sinclair RB, Worsdell M, Busst CM, Chung KF. Source: The European Respiratory Journal : Official Journal of the European Society for Clinical Respiratory Physiology. 1994 July; 7(7): 1246-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7925902

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Coughing in childhood. Author(s): Shrand H. Source: The Journal of Family Practice. 1975 February; 2(1): 55-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1168238

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Coughing in children; a relaxing solution. Author(s): Ingram SJ. Source: Postgraduate Medicine. 1983 June; 73(6): 32, 34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6856538

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Coughing in infants after thickened feeds. Author(s): Orenstein S. Source: Nurs Times. 1993 April 21-27; 89(16): 54. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8483765

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Coughing in laryngectomized patients. Author(s): Fontana GA, Pantaleo T, Lavorini F, Mutolo D, Polli G, Pistolesi M. Source: American Journal of Respiratory and Critical Care Medicine. 1999 November; 160(5 Pt 1): 1578-84. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10556124

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Coughing may be hazardous to your health! Author(s): Banner MJ. Source: Critical Care Medicine. 1991 July; 19(7): 852-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2055069

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Coughing on induction with Althesin. Author(s): Thompson MC. Source: Anaesthesia. 1983 September; 38(9): 907. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6625143

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Coughing up a lung. Author(s): Hightower K, Teitelbaum JE. Source: Archives of Disease in Childhood. 2002 December; 87(6): 545. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12456564

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Coughing up a stone. What to do about broncholithiasis. Author(s): Haines JD Jr. Source: Postgraduate Medicine. 1988 February 15; 83(3): 83-4, 91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3344260

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Coughing up of metastatic tumor as the initial clinical manifestation of renal cell carcinoma. Author(s): Subramanyam NS, Fendley H, Freeman WH. Source: J Ark Med Soc. 1991 July; 88(2): 86-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1833376

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Coughing, wheezing and the diagnosis of asthma. Author(s): Jones A. Source: The Practitioner. 1990 March 22; 234(1485): 274-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2284266

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CT demonstration of spinal epidural emphysema complicating bronchial asthma and violent coughing. Author(s): Tsuji H, Takazakura E, Terada Y, Makino H, Yasuda A, Oiko Y. Source: Journal of Computer Assisted Tomography. 1989 January-February; 13(1): 38-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2910946

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Defective motor control of coughing in Parkinson's disease. Author(s): Fontana GA, Pantaleo T, Lavorini F, Benvenuti F, Gangemi S. Source: American Journal of Respiratory and Critical Care Medicine. 1998 August; 158(2): 458-64. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9700121

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Demonstration of venous return abnormalities induced by coughing during Tc-99m MAA lung perfusion imaging. Author(s): Tanabe Y, Suto Y, Ogawa T. Source: Clinical Nuclear Medicine. 1999 August; 24(8): 601-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10439183

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Depressive effect of coughing on spinal monosynaptic reflexes in conscious man. Author(s): Maillard D, Roby A, Willer JC. Source: Clinical Science (London, England : 1979). 1983 July; 65(1): 57-64. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6851419

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Development of specific immunoglobulin E in coughing toddlers: a medical records review of symptoms in general practice. Author(s): Eysink P, Bindels P, Huisman J, Bottema B, Aalberse R, Schade B. Source: Pediatric Allergy and Immunology : Official Publication of the European Society of Pediatric Allergy and Immunology. 2001 June; 12(3): 133-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11473678

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Duchenne muscular dystrophy: prolongation of life by noninvasive ventilation and mechanically assisted coughing. Author(s): Gomez-Merino E, Bach JR. Source: American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists. 2002 June; 81(6): 411-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12023596

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Dynamic modelling of a challenge-escalation cross-over study of treatment of capsaicin-induced coughing. Author(s): Lindsey JK, Stevens JW, Jones B, Jackson D. Source: Statistics in Medicine. 2002 October 30; 21(20): 3023-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12369079

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Editorial: Coughing, sneezing and mosquitoes in the transmission of leprosy. Author(s): Skinsnes OK. Source: International Journal of Leprosy and Other Mycobacterial Diseases : Official Organ of the International Leprosy Association. 1975 October-December; 43(4): 378-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6392

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Effect of cough on coronary perfusion pressure: Does coughing help clear the coronary arteries of angiographic contrast medium? Author(s): Little WC, Reeves RC, Coughlan C, Rogers EW. Source: Circulation. 1982 March; 65(3): 604-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7055881

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Effects of coughing following coronary artery contrast injections. Author(s): Little WC, Reeves RC, Rogers EW. Source: American Heart Journal. 1983 March; 105(3): 507-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6829410

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Efficacy of coughing in tetraplegic patients. Author(s): van Der Schans CP, Piers DA, Mulder GA. Source: Spine. 2000 September 1; 25(17): 2200-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10973403

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Elimination of test particles from the human tracheobronchial tract by voluntary coughing. Author(s): Camner P, Mossberg B, Philipson K, Strandberg K. Source: Scand J Respir Dis. 1979 April; 60(2): 56-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=441699

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Endobronchial tuberculosis--manifesting by coughing up of bronchial cartilage. Author(s): Memon AM, Shafi A, Thawerani H. Source: J Pak Med Assoc. 1996 April; 46(4): 86-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8991361

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Evaluation of directed coughing in cystic fibrosis. Author(s): Bain J, Bishop J, Olinsky A. Source: Br J Dis Chest. 1988 April; 82(2): 138-48. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3048363

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Evaluation of night coughing in asthmatic children. Author(s): Mascia AV. Source: J Asthma Res. 1968 March; 5(3): 163-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5238820

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Evaluation of tracheal collapsibility in patients with tracheomalacia using dynamic MR imaging during coughing. Author(s): Suto Y, Tanabe Y. Source: Ajr. American Journal of Roentgenology. 1998 August; 171(2): 393-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9694459

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Explosive coughing after bolus fentanyl injection. Author(s): Tweed WA, Dakin D. Source: Anesthesia and Analgesia. 2001 June; 92(6): 1442-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11375822

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Fentanyl-induced coughing and airway hyperresponsiveness. Author(s): Tsou CH, Luk HN, Chiang SC, Hsin ST, Wang JH. Source: Acta Anaesthesiol Sin. 2002 December; 40(4): 165-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12596614

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Fluid mechanical experiments relevant to coughing. Author(s): Scherer PW, Burtz L. Source: Journal of Biomechanics. 1978; 11(4): 183-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=690153

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Foreign body aspiration: potential cause of coughing and wheezing. Author(s): Holroyd HJ. Source: Pediatrics in Review / American Academy of Pediatrics. 1988 August; 10(2): 5963. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3065758

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Gastroesophageal reflux is chronologically correlated with coughing but not with wheezing in children with bronchial asthma and gastroesophageal reflux symptoms. Author(s): Tomomasa T, Tabata M, Tokuyama K, Mitsuhashi M, Morikawa A. Source: Pediatric Pulmonology. 1995 September; 20(3): 193-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8545173

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Habitual coughing and its associations with asthma, anxiety, and gastroesophageal reflux. Author(s): Ludviksdottir D, Bjornsson E, Janson C, Boman G. Source: Chest. 1996 May; 109(5): 1262-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8625678

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Hepatic cyst rupture after a coughing fit. Author(s): Shutsha E, Brenard R. Source: Journal of Hepatology. 2003 June; 38(6): 870. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12763385

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How much coughing is normal? Author(s): Munyard P, Bush A. Source: Archives of Disease in Childhood. 1996 June; 74(6): 531-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8758131

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How often is coughing the presenting complaint in patients with gastroesophageal reflux disease? Author(s): Adelman AM, Hall LW. Source: The Journal of Family Practice. 2002 March; 51(3): 211. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11978229

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Humidification reduces coughing and breath-holding during inhalation induction with isoflurane in children. Author(s): Cregg N, Wall C, Green D, Mannion D, Casey W. Source: Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 1996 November; 43(11): 1090-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8922762

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Hypercapnia enhances the development of coughing during continuous infusion of water into the pharynx. Author(s): Nishino T, Hasegawa R, Ide T, Isono S. Source: American Journal of Respiratory and Critical Care Medicine. 1998 March; 157(3 Pt 1): 815-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9517596

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Idiopathic pneumopericardium induced by forced coughing during coronary arteriography. Author(s): Ishii K, Koga Y, Araki K. Source: Japanese Circulation Journal. 1987 February; 51(2): 157-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3599360

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Increased serum creatine phosphokinase activity with violent coughing. Author(s): Schen RJ, Zurkowski S. Source: The New England Journal of Medicine. 1973 August 9; 289(6): 328-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4718049

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Influence of the Provox Flush, blowing and imitated coughing on voice prosthetic biofilms in vitro. Author(s): Free RH, Van der Mei HC, Elving GJ, Van Weissenbruch R, Albers FW, Busscher HJ. Source: Acta Oto-Laryngologica. 2003 May; 123(4): 547-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12797592

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Intravenous lidocaine as a suppressant of coughing during tracheal intubation in elderly patients. Author(s): Yukioka H, Hayashi M, Terai T, Fujimori M. Source: Anesthesia and Analgesia. 1993 August; 77(2): 309-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8346830

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Intravenous lidocaine as a suppressant of coughing during tracheal intubation. Author(s): Yukioka H, Yoshimoto N, Nishimura K, Fujimori M. Source: Anesthesia and Analgesia. 1985 December; 64(12): 1189-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4061901

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Intravenous lidocaine for control of coughing during standby cataract surgery. Author(s): Fenton WM. Source: Anesthesiology. 1986 June; 64(6): 847. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3717666

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Malfunction of ventriculoatrial shunts caused by the circulatory dynamics of coughing. Author(s): Natelson SE, Molnar W. Source: Journal of Neurosurgery. 1972 March; 36(3): 283-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5059966

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Massive left diaphragmatic separation and rupture due to coughing during an asthma exacerbation. Author(s): Kallay N, Crim L, Dunagan DP, Kavanagh PV, Meredith W, Haponik EF. Source: Southern Medical Journal. 2000 July; 93(7): 729-31. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10923968

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Massive subcutaneous emphysema, pneumomediastinum, and spinal epidural emphysema as complications of violent coughing: a case report. Author(s): Chiba Y, Kakuta H. Source: Auris, Nasus, Larynx. 1995; 22(3): 205-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8561704

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Measurement of chest wall forces on coughing with the use of human cadavers. Author(s): Casha AR, Yang L, Cooper GJ. Source: The Journal of Thoracic and Cardiovascular Surgery. 1999 December; 118(6): 1157-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10596005

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Mechanical aspects of coughing. Author(s): Evans JN, Jaeger MJ. Source: Pneumonologie. 1975 November 14; 152(4): 253-7. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1105469

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Mechanical insufflation-exsufflation. Comparison of peak expiratory flows with manually assisted and unassisted coughing techniques. Author(s): Bach JR. Source: Chest. 1993 November; 104(5): 1553-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8222823

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Mechanical stimulation of coughing. Author(s): Ungavarski P. Source: The American Journal of Nursing. 1971 December; 71(12): 2358-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5209461

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Monitoring of fluctuating airway obstruction and episodes of coughing by thoracic electrical impedance. Author(s): al Hatib F, Neycheva T, Shenkada MS, Popov TA, Daskalov IK. Source: Journal of Medical Engineering & Technology. 2001 March-April; 25(2): 49-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11452632

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Multiple rib fractures associated with severe coughing--a case report. Author(s): Kawahara H, Baba H, Wada M, Azuchi M, Ando M, Imura S. Source: International Orthopaedics. 1997; 21(4): 279-81. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9349970

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Multiple rib fractures caused by coughing in a young woman without bone loss. Author(s): Jamard B, Constantin A, Cantagrel A, Mazieres B, Laroche M. Source: Rev Rhum Engl Ed. 1999 April; 66(4): 237-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10339784

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Neurologic symptoms during coughing paroxysms in cystic fibrosis. Author(s): Stern RC, Horwitz SJ, Doershuk CF. Source: The Journal of Pediatrics. 1988 June; 112(6): 909-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3373396

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On coughing and the open eye. Author(s): Romano P. Source: Ophthalmic Surg. 1983 December; 14(12): 1041-2. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6672704

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On smooth extubation without coughing and bucking. Author(s): Chan PB. Source: Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 2002 March; 49(3): 324. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11861361

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Pain on coughing and numbness in sciatica: what exactly do these symptoms mean? Author(s): Walk L. Source: Archives of Surgery (Chicago, Ill. : 1960). 1989 June; 124(6): 751. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2730332

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PaO2 increases with coughing in patients with chronic lung disease. Author(s): Martinez W, Sandoval J, Perez-Padilla R, Maxwell R, Seoane M, Lupi-Herrera E. Source: Lung. 1988; 166(5): 287-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3146675

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Parental reporting of childrens' coughing is biased. Author(s): Dales RE, White J, Bhumgara C, McMullen E. Source: European Journal of Epidemiology. 1997 July; 13(5): 541-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9258566

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Possible mechanism(s) of opioid-induced coughing. Author(s): Bailey PL. Source: Anesthesiology. 1999 January; 90(1): 335. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9915357

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Postictal coughing and noserubbing coexist in temporal lobe epilepsy. Author(s): Wennberg R. Source: Neurology. 2001 January 9; 56(1): 133-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11148255

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Pressure point. When coughing up is essential. Author(s): Cooper C. Source: Health Serv J. 2000 November 30; 110(5733): Suppl 1. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11138527

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Pressures at rest and during coughing in the bladder, the uterus and the vagina at the onset of labour. A methodological study. Author(s): Soderberg G, Westin B. Source: Acta Obstetricia Et Gynecologica Scandinavica. Supplement. 1969; 9: Suppl 9: 131. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5267208

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Prevention of coughing induced by endotracheal tube during emergence from general anesthesia--a comparison between three different regimens of lidocaine filled in the endotracheal tube cuff. Author(s): Huang CJ, Hsu YW, Chen CC, Ko YP, Rau RH, Wu KH, Wei TT. Source: Acta Anaesthesiol Sin. 1998 June; 36(2): 81-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9816717

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Prevention of endotracheal tube-induced coughing during emergence from general anesthesia. Author(s): Gonzalez RM, Bjerke RJ, Drobycki T, Stapelfeldt WH, Green JM, Janowitz MJ, Clark M. Source: Anesthesia and Analgesia. 1994 October; 79(4): 792-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7943794

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Propofol-induced violent coughing. Author(s): Mitra S, Sinha PK, Anand LK, Gombar KK. Source: Anaesthesia. 2000 July; 55(7): 707-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10919448

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Psychogenic coughing: a review and case report. Author(s): Grumet GW. Source: Comprehensive Psychiatry. 1987 January-February; 28(1): 28-34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3802796

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Rectus abdominal muscles pulled by coughing. Author(s): Anderton RL. Source: Jama : the Journal of the American Medical Association. 1972 October; 222(4): 486. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4263012

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Reducing antibiotics for respiratory tract symptoms in primary care: 'why' only sore throat, 'how' about coughing? Author(s): Coenen S, van Royen P, Denekens J. Source: The British Journal of General Practice : the Journal of the Royal College of General Practitioners. 1999 May; 49(442): 400-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10736896

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Relation of respiratory water loss to coughing after exercise. Author(s): Banner AS, Green J, O'Connor M. Source: The New England Journal of Medicine. 1984 October 4; 311(14): 883-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6472400

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Relationship of peak flow rate and peak velocity time during voluntary coughing. Author(s): Singh P, Mahajan RP, Murty GE, Aitkenhead AR. Source: British Journal of Anaesthesia. 1995 June; 74(6): 714-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7640132

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Rib fractures induced by coughing: an unusual cause of acute chest pain. Author(s): De Maeseneer M, De Mey J, Debaere C, Meysman M, Osteaux M. Source: The American Journal of Emergency Medicine. 2000 March; 18(2): 194-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10750931

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Salbutamol, beclomethasone or sodium chromoglycate suppress coughing induced by iv fentanyl. Author(s): Agarwal A, Azim A, Ambesh S, Bose N, Dhiraj S, Sahu D, Singh U. Source: Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 2003 March; 50(3): 297-300. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12620955

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Severe coughing and gagging episode in an adolescent with a chronic laryngotracheal foreign body: a case report. Author(s): Pitlanish ML, Spadafore JC, Wolford RW. Source: Clinical Pediatrics. 1997 June; 36(6): 357-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9196236

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Severe coughing and pneumoperitoneum. Author(s): Brereton AG. Source: British Medical Journal (Clinical Research Ed.). 1982 November 20; 285(6353): 1501. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6814617

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Severe coughing and pneumoperitoneum. Author(s): Hillman KM. Source: British Medical Journal (Clinical Research Ed.). 1982 October 16; 285(6348): 1085. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6812757

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Severe coughing during captopril and enalapril therapy. Author(s): Burkart W. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 1986 November 15; 135(10): 1070. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3021313

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Severe coughing during captopril and enalapril therapy. Author(s): Carruthers SG. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 1986 August 1; 135(3): 217-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3015367

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Severe paroxysmal coughing and pleuritic pain in an adult. Author(s): Musher DM, Keitel WA. Source: Hosp Pract (Off Ed). 1995 December 15; 30(12): 65-7. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8522629

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Small doses of sufentanil will produce violent coughing in young children. Author(s): Yemen TA. Source: Anesthesiology. 1998 July; 89(1): 271-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9667324

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Smoking, coughing, laughing and applause: a comparative study of respiratory symbolism. Author(s): Grotjahn M. Source: The International Journal of Psycho-Analysis. 1972; 53 ( Pt 3): 345-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4143630

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Smoking, coughing, laughing and applause: a comparative study of respiratory symbolism. Author(s): Grotjahn M. Source: The International Journal of Psycho-Analysis. 1972; 53(3): 345-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4120064

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Splenic rupture from coughing. Author(s): Wergowske GL, Carmody TJ. Source: Archives of Surgery (Chicago, Ill. : 1960). 1983 October; 118(10): 1227. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6615207

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Spontaneous coughing up of a polyp. Author(s): Terashima M, Nishimura Y, Nakata H, Iwai Y, Yokoyama M. Source: Respiration; International Review of Thoracic Diseases. 2000; 67(1): 101-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10705273

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Studies on the removal of inhaled particles from the lungs by voluntary coughing. Author(s): Camner P. Source: Chest. 1981 December; 80(6 Suppl): 824-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7030658

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Tachyarrhythmia provoked by coughing and other stimuli. Author(s): Omori I, Yamada C, Inoue D, Katsume H, Ijichi H. Source: Chest. 1984 November; 86(5): 797-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6488928

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Temporal associations between coughing or wheezing and acid reflux in asthmatics. Author(s): Avidan B, Sonnenberg A, Schnell TG, Sontag SJ. Source: Gut. 2001 December; 49(6): 767-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11709509

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Terbutaline inhalation suppresses fentanyl-induced coughing. Author(s): Lui PW, Hsing CH, Chu YC. Source: Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 1996 December; 43(12): 1216-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8955969

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The coughing child. A primary care perspective. Author(s): Schneider AP 2nd, Daws WR, Adams RD. Source: Postgraduate Medicine. 1983 September; 74(3): 253-5, 258-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6889200

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The coughing child. Etiology and treatment of a common symptom. Author(s): Cloutier MM. Source: Postgraduate Medicine. 1983 March; 73(3): 169-75. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6828392

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The coughing disease. Author(s): Jones C. Source: Health Visit. 1982 December; 55(12): 648-50. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6761312

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The effect of huffing and directed coughing on energy expenditure in young asymptomatic subjects. Author(s): Pontifex E, Williams MT, Lunn R, Parsons D. Source: The Australian Journal of Physiotherapy. 2002; 48(3): 209-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12217070

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The effect of pharmacological stimulation and blockade of autonomic receptors on the urethral pressure and power generation during coughing and squeezing of the pelvic floor in healthy females. Author(s): Thind P, Lose G, Colstrup H, Andersson KE. Source: Scandinavian Journal of Urology and Nephrology. 1993; 27(4): 519-25. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8159924

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The effect of the laryngeal mask airway on coughing after eye surgery under general anesthesia. Author(s): Thomson KD. Source: Ophthalmic Surg. 1992 September; 23(9): 630-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1480375

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The effect of unproductive coughing/FET on regional mucus movement in the human lungs. Author(s): Hasani A, Pavia D, Agnew JE, Clarke SW. Source: Respiratory Medicine. 1991 January; 85 Suppl A: 23-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2034831

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The influence of posture, Valsalva manoeuvre and coughing on portal hypertension in cirrhosis. Author(s): Burcharth F, Bertheussen K. Source: Scandinavian Journal of Clinical and Laboratory Investigation. 1979 November; 39(7): 665-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=556537

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The ionic composition of airway surface liquid and coughing. Author(s): Higenbottam T. Source: Bull Eur Physiopathol Respir. 1987; 23 Suppl 10: 25S-27S. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3664022

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Thickened feedings as a cause of increased coughing when used as therapy for gastroesophageal reflux in infants. Author(s): Orenstein SR, Shalaby TM, Putnam PE. Source: The Journal of Pediatrics. 1992 December; 121(6): 913-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1447654

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Traumatic transdiaphragmatic intercostal hernia secondary to coughing: case report and review of the literature. Author(s): Rogers FB, Leavitt BJ, Jensen PE. Source: The Journal of Trauma. 1996 November; 41(5): 902-3. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8913225

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Urethral pressure and power generation during coughing and voluntary contraction of the pelvic floor in females with genuine stress incontinence. Author(s): Lose G. Source: British Journal of Urology. 1991 June; 67(6): 580-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2070201

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Urethral pressure and power generation during coughing and voluntary contraction of the pelvic floor in healthy females. Author(s): Lose G, Colstrup H. Source: British Journal of Urology. 1991 June; 67(6): 573-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2070200

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Use of coughing test to diagnose peritonitis. Author(s): Bennett DH, Tambeur LJ, Campbell WB. Source: Bmj (Clinical Research Ed.). 1994 May 21; 308(6940): 1336. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8019222

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Vertebral artery dissection from neck flexion during paroxysmal coughing. Author(s): Herr RD, Call G, Banks D. Source: Annals of Emergency Medicine. 1992 January; 21(1): 88-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1539897

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What has dry cough in common with pruritus? Treatment of dry cough with paroxetine. Author(s): Zylicz Z, Krajnik M. Source: Journal of Pain and Symptom Management. 2004 February; 27(2): 180-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15157042

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CHAPTER 2. NUTRITION AND COUGHING Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and coughing.

Finding Nutrition Studies on Coughing 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 “coughing” (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 is a typical result when searching for recently indexed consumer information on coughing: •

Ask the doctor. I have had heart failure since my heart attack a year ago. My physician initially prescribed lisinopril, an angiotensin-converting enzyme (ACE) inhibitor. Unfortunately, I was one of the unlucky people who got a cough with this drug that was so annoying I had to stop taking it. Now my doctor wants me to try a newer drug called valsartan. Is it likely to help me? Source: Lee, Thomas H Harv-Heart-Lett. 2002 July; 12(11): 8 1051-5313

The following information is typical of that found when using the “Full IBIDS Database” to search for “coughing” (or a synonym): •

An increase in the threshold of citric acid-induced cough during chest wall vibration in healthy humans. Author(s): Department of Medicine, Tokai University School of Medicine, Isehara, 2591193, Japan. [email protected] Source: Kondo, T Kobayashi, I Hayama, N Ohta, Y Jpn-J-Physiol. 1998 October; 48(5): 341-5 0021-521X

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Antitussive effect of Adhatoda vasica extract on mechanical or chemical stimulationinduced coughing in animals. Author(s): Department of Pharmacology and Toxicology, Hindustan Antibiotics Ltd., Pimpri, Pune, India. Source: Dhuley, J N J-Ethnopharmacol. 1999 November 30; 67(3): 361-5 0378-8741

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Capsaicin-induced cough in humans. Author(s): Department of Lung Medicine, University Hospital of Lund, Sweden. Source: Midgren, B Hansson, L Karlsson, J A Simonsson, B G Persson, C G Am-RevRespir-Dis. 1992 August; 146(2): 347-51 0003-0805

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Differences in the mode of cough augmentation by four angiotensin-converting enzyme inhibitors in guinea-pigs. Author(s): Department of Pharmacological Sciences, Faculty of Pharmaceutical Sciences, Kumamoto University, Japan. Source: Takahama, K Fuchikami, J Suzuki, A Tabata, T Kai, H Miyata, T J-PharmPharmacol. 1993 November; 45(11): 1003-5 0022-3573

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Inhibiting effect of ammonia on citric acid-induced cough in pigs: a possible involvement of substance P. Author(s): Department of Pharmacology, Pharmacotherapy and Toxicology, University of Liege, Belgium. Source: Moreaux, B NemMarch, A Beerens, D Gustin, P Pharmacol-Toxicol. 2000 December; 87(6): 279-85 0901-9928

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Participation of thromboxane A(2) in the cough response in guinea-pigs: antitussive effect of ozagrel. Author(s): Pharmacology Laboratory, Kissei Pharmaceutical Co. Ltd., 4365-1, Kashiwabara, Hotaka, Minamiazumi, Nagano, 399-8304, Japan. [email protected] Source: Shinagawa, K Kojima, M Ichikawa, K Hiratochi, M Aoyagi, S Akahane, M Br-JPharmacol. 2000 September; 131(2): 266-70 0007-1188

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Prostaglandin F2 alpha enhancement of capsaicin induced cough in man: modulation by beta 2 adrenergic and anticholinergic drugs. Author(s): Department of Thoracic Medicine, National Heart and Lung Institute, London. Source: Nichol, G Nix, A Barnes, P J Chung, K F Thorax. 1990 September; 45(9): 694-8 0040-6376

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Recombinant human enkephalinase (neutral endopeptidase) prevents cough induced by tachykinins in awake guinea pigs. Author(s): Cardiovascular Research Institute, University of California, San Francisco 94143. Source: Kohrogi, H Nadel, J A Malfroy, B Gorman, C Bridenbaugh, R Patton, J S Borson, D B J-Clin-Invest. 1989 September; 84(3): 781-6 0021-9738

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The difference in citric acid-induced cough in congenitally bronchial-hypersensitive (BHS) and bronchial-hyposensitive (BHR) guinea pigs. Author(s): Department of Comparative Pathophysiology, Graduate School of Agricultural and Life Sciences, University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 1138657, Japan. Source: Yagi, Y Kuwahara, M Nanji, A Birumachi, J Nishibata, R Mikami, H Tsubone, H Exp-Anim. 2001 October; 50(5): 371-8 1341-1357

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The effect of hydrochlorothiazide on the enhanced coughing associated with treatment with enalapril. Author(s): Department of Pharmacology, Faculty of Pharmaceutical Sciences, Hoshi University, Tokyo, Japan. Source: Kamei, J Kasuya, Y Eur-J-Pharmacol. 1992 March 17; 213(1): 137-9 0014-2999

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The effect of nedocromil sodium, sodium cromoglycate and codeine phosphate on citric acid-induced cough in dogs. Author(s): Fisons plc-Pharmaceutical Division, Research and Development Laboratories, Loughborough, Leicestershire. Source: Jackson, D M Br-J-Pharmacol. 1988 March; 93(3): 609-12 0007-1188

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

•

Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

•

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/

•

WebMD®Health: http://my.webmd.com/nutrition

•

WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

The following is a specific Web list relating to coughing; 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: •

Vitamins Vitamin A Source: Healthnotes, Inc.; www.healthnotes.com

•

Minerals Zinc Source: Prima Communications, Inc.www.personalhealthzone.com

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CHAPTER 3. ALTERNATIVE MEDICINE AND COUGHING Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to coughing. 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 coughing 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 “coughing” (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 coughing: •

35-year-old woman with cough, fever, and anorexia. Author(s): Ensminger SA, Regner KR, Froehling DA. Source: Mayo Clinic Proceedings. 2003 June; 78(6): 753-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12934787

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A traditional Chinese herbal medicine, banxia houpo tang, improves cough reflex of patients with aspiration pneumonia. Author(s): Iwasaki K, Cyong JC, Kitada S, Kitamura H, Ozeki J, Satoh Y, Suzuki T, Sasaki H. Source: Journal of the American Geriatrics Society. 2002 October; 50(10): 1751-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12366640

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Ability of caregivers to recognise signs of pneumonia in coughing children aged below five years. Author(s): Kambarami RA, Rusakaniko S, Mahomva LA.

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Source: Cent Afr J Med. 1996 October; 42(10): 291-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9130404 •

ACE inhibitor-associated cough lessened with iron supplementation. Author(s): Basile JN. Source: Journal of Clinical Hypertension (Greenwich, Conn.). 2002 January-February; 4(1): 49-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11821639

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Anticough and antimicrobial activities of Psidium guajava Linn. leaf extract. Author(s): Jaiarj P, Khoohaswan P, Wongkrajang Y, Peungvicha P, Suriyawong P, Saraya ML, Ruangsomboon O. Source: Journal of Ethnopharmacology. 1999 November 1; 67(2): 203-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10619385

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Antimicrobial activity of extracts of local cough mixtures on upper respiratory tract bacterial pathogens. Author(s): Adeleye IA, Opiah L. Source: The West Indian Medical Journal. 2003 September; 52(3): 188-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14649097

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Antitussive activity of Abies webbiana Lindl. leaf extract against sulphur dioxideinduced cough reflex in mice. Author(s): Nayak SS, Ghosh AK, Srikanth K, Debnath B, Jha T. Source: Phytotherapy Research : Ptr. 2003 September; 17(8): 930-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=13680827

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Antitussive effect of Adhatoda vasica extract on mechanical or chemical stimulationinduced coughing in animals. Author(s): Dhuley JN. Source: Journal of Ethnopharmacology. 1999 November 30; 67(3): 361-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10617073

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Antitussive effect of Asparagus racemosus root against sulfur dioxide-induced cough in mice. Author(s): Mandal SC, Kumar C K A, Mohana Lakshmi S, Sinha S, Murugesan T, Saha BP, Pal M. Source: Fitoterapia. 2000 December; 71(6): 686-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11077176

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Are beta2-agonists effective treatment for acute bronchitis or acute cough in patients without underlying pulmonary disease? A systematic review. Author(s): Smucny JJ, Flynn CA, Becker LA, Glazier RH.

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Source: The Journal of Family Practice. 2001 November; 50(11): 945-51. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11711010 •

Behavioral management of psychogenic cough: alternative to the “bedsheet” and other aversive techniques. Author(s): Lavigne JV, Davis AT, Fauber R. Source: Pediatrics. 1991 April; 87(4): 532-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2011431

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Case formulation and behavioral treatment of chronic cough. Author(s): Fulcher R, Cellucci T. Source: Journal of Behavior Therapy and Experimental Psychiatry. 1997 December; 28(4): 291-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9489690

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Childhood habit cough treated with self-hypnosis. Author(s): Anbar RD, Hall HR. Source: The Journal of Pediatrics. 2004 February; 144(2): 213-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14760264

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Conquering the common cough with ayurveda. Author(s): Ziment I. Source: Natl Med J India. 1996 March-April; 9(2): 53-4. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8857036

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Coughing reflex induced by electrostimulation of the trachea: a pilot study. Author(s): Dekens JL, Mastboom WJ, Bultstra G, Oostveen E, Rasker JJ. Source: Lancet. 1999 March 13; 353(9156): 902. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10093993

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Deep breathing and coughing: how to do them right. Author(s): Spearing C, Garrett M. Source: Rn. 1985 September; 48(9): 52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3849880

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Effect of Trichodesma indicum extract on cough reflex induced by sulphur dioxide in mice. Author(s): Srikanth K, Murugesan T, Kumar ChA, Suba V, Das AK, Sinha S, Arunachalam G, Manikandan L.

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Source: Phytomedicine : International Journal of Phytotherapy and Phytopharmacology. 2002 January; 9(1): 75-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11924768 •

Efficacy of breathing and coughing exercises in the prevention of pulmonary complications after coronary artery surgery. Author(s): Smith C, Fowler S. Source: Chest. 1995 February; 107(2): 587-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7842810

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Efficacy of breathing and coughing exercises in the prevention of pulmonary complications after coronary artery surgery. Author(s): Stiller K, Montarello J, Wallace M, Daff M, Grant R, Jenkins S, Hall B, Yates H. Source: Chest. 1994 March; 105(3): 741-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8131535

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Golden earth against cough: a 14th-century instruction for inhalation. Author(s): Fatovic-Ferencic S, Durrigl MA. Source: The Journal of Otolaryngology. 2000 February; 29(1): 62-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10709177

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Hypnotherapy in the treatment of childhood psychogenic coughing: a case report. Author(s): Elkins GR, Carter BD. Source: Am J Clin Hypn. 1986 July; 29(1): 59-63. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3739963

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Iron supplementation in ACE inhibition as a treatment for cough: is it really inoffensive? Author(s): Lev I, Rian AJ. Source: Hypertension. 2001 December 1; 38(6): E38-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11751745

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Iron supplementation inhibits cough associated with ACE inhibitors. Author(s): Lee SC, Park SW, Kim DK, Lee SH, Hong KP. Source: Hypertension. 2001 August; 38(2): 166-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11509470

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Outcome of habit cough in children treated with a brief session of suggestion therapy. Author(s): Lokshin B, Lindgren S, Weinberger M, Koviach J.

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Source: Ann Allergy. 1991 December; 67(6): 579-82. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1750719 •

Psychogenic cough treated with biofeedback and psychotherapy. A review and case report. Author(s): Riegel B, Warmoth JE, Middaugh SJ, Kee WG, Nicholson LC, Melton DM, Parikh DK, Rosenberg JC. Source: American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists. 1995 March-April; 74(2): 155-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7710731

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Responding to cough: Boholano illness classification and resort to care in response to childhood ARI. Author(s): McNee A, Khan N, Dawson S, Gunsalam J, Tallo VL, Manderson L, Riley I. Source: Social Science & Medicine (1982). 1995 May; 40(9): 1279-89. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7610433

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Studies on in vivo antitussive activity of Leucas lavandulaefolia using a cough model induced by sulfur dioxide gas in mice. Author(s): Saha K, Mukherjee PK, Murugesan T, Saha BP, Pal M. Source: Journal of Ethnopharmacology. 1997 July; 57(2): 89-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9254111

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TCM treatment of interstitial pneumonia with chronic cough--a case report. Author(s): Chen J, Chen S, Chen S, Chen Z. Source: J Tradit Chin Med. 2003 September; 23(3): 170-1. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14535174

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Technique of coughing. Author(s): Powers RJ. Source: Jama : the Journal of the American Medical Association. 1978 July 14; 240(2): 109. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=660823

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Testing the association between residential fungus and health using ergosterol measures and cough recordings. Author(s): Dales RE, Miller D, White J. Source: Mycopathologia. 1999; 147(1): 21-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10872512

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The precordial thump and cough techniques in advanced life support. A statement for the Advanced Life Support Working Party of the European Resuscitation Council. Author(s): Robertson C.

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Source: Resuscitation. 1992 November; 24(2): 133-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1335604 •

The role of cough and hyperventilation in perpetuating airway inflammation in asthma. Author(s): Singh V, Chowdhary R, Chowdhary N. Source: J Assoc Physicians India. 2000 March; 48(3): 343-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11229124

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Treatment of cough and dyspnea due to acute bronchitis by plaster for cough and dyspnea--a report of 735 cases. Author(s): Chen Z, Zhou W, Gao J, Sun J. Source: J Tradit Chin Med. 2002 March; 22(1): 5-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11977523

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Treatment of cough in children by cupping on back. Author(s): Liu X. Source: J Tradit Chin Med. 1996 June; 16(2): 125. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9389139

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Use of herbal preparations for intractable cough. Author(s): Gallagher R. Source: Journal of Pain and Symptom Management. 1997 July; 14(1): 1-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9223832

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Voluntary control of cough. Author(s): Lee PC, Cotterill-Jones C, Eccles R. Source: Pulmonary Pharmacology & Therapeutics. 2002; 15(3): 317-20. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12099785

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/

•

AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

•

Chinese Medicine: http://www.newcenturynutrition.com/

•

drkoop.com®: http://www.drkoop.com/InteractiveMedicine/IndexC.html

•

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/

•

MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

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Open Directory Project: http://dmoz.org/Health/Alternative/

•

HealthGate: http://www.tnp.com/

•

WebMD®Health: http://my.webmd.com/drugs_and_herbs

•

WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

•

Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

The following is a specific Web list relating to coughing; 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 Allergies and Sensitivities Source: Healthnotes, Inc.; www.healthnotes.com Anaphylaxis Source: Integrative Medicine Communications; www.drkoop.com Appendicitis Source: Integrative Medicine Communications; www.drkoop.com Ascariasis Source: Integrative Medicine Communications; www.drkoop.com Asthma Source: Healthnotes, Inc.; www.healthnotes.com Asthma Source: Integrative Medicine Communications; www.drkoop.com Bronchitis Source: Healthnotes, Inc.; www.healthnotes.com Bronchitis Source: Integrative Medicine Communications; www.drkoop.com Cardiomyopathy Source: Healthnotes, Inc.; www.healthnotes.com Chronic Obstructive Pulmonary Disease Source: Healthnotes, Inc.; www.healthnotes.com Chronic Obstructive Pulmonary Disease Source: Integrative Medicine Communications; www.drkoop.com

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Colds and Flus Source: Prima Communications, Inc.www.personalhealthzone.com Common Cold Source: Integrative Medicine Communications; www.drkoop.com Common Cold/Sore Throat Source: Healthnotes, Inc.; www.healthnotes.com Congestive Heart Failure Source: Integrative Medicine Communications; www.drkoop.com Cough Source: Healthnotes, Inc.; www.healthnotes.com Cystic Fibrosis Source: Healthnotes, Inc.; www.healthnotes.com Cystic Fibrosis Source: Integrative Medicine Communications; www.drkoop.com Diarrhea Source: Healthnotes, Inc.; www.healthnotes.com Dysphagia Source: Integrative Medicine Communications; www.drkoop.com Emphysema Source: Integrative Medicine Communications; www.drkoop.com Endocarditis Source: Integrative Medicine Communications; www.drkoop.com Epstein-Barr Virus Source: Integrative Medicine Communications; www.drkoop.com Erythema Source: Integrative Medicine Communications; www.drkoop.com Flu Source: Integrative Medicine Communications; www.drkoop.com Gastroesophageal Reflux Disease Source: Healthnotes, Inc.; www.healthnotes.com Guinea Worm Disease Source: Integrative Medicine Communications; www.drkoop.com Heartburn Source: Integrative Medicine Communications; www.drkoop.com

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High Blood Pressure Source: Integrative Medicine Communications; www.drkoop.com Histoplasmosis Source: Integrative Medicine Communications; www.drkoop.com Hookworm Source: Integrative Medicine Communications; www.drkoop.com Hypertension Source: Integrative Medicine Communications; www.drkoop.com Infection Source: Healthnotes, Inc.; www.healthnotes.com Influenza Source: Healthnotes, Inc.; www.healthnotes.com Influenza Source: Integrative Medicine Communications; www.drkoop.com Laryngitis Source: Integrative Medicine Communications; www.drkoop.com Loiasis Source: Integrative Medicine Communications; www.drkoop.com Lung Cancer Source: Healthnotes, Inc.; www.healthnotes.com Lung Cancer Source: Integrative Medicine Communications; www.drkoop.com Lymphatic Filariasis Source: Integrative Medicine Communications; www.drkoop.com Measles Source: Integrative Medicine Communications; www.drkoop.com Mononucleosis Source: Integrative Medicine Communications; www.drkoop.com Obesity Source: Integrative Medicine Communications; www.drkoop.com Parasites Source: Healthnotes, Inc.; www.healthnotes.com Pertussis Source: Integrative Medicine Communications; www.drkoop.com

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Pinworm Source: Integrative Medicine Communications; www.drkoop.com Pulmonary Edema Source: Integrative Medicine Communications; www.drkoop.com Pulmonary Hypertension Source: Integrative Medicine Communications; www.drkoop.com River Blindness Source: Integrative Medicine Communications; www.drkoop.com Roundworms Source: Integrative Medicine Communications; www.drkoop.com Rubella Source: Integrative Medicine Communications; www.drkoop.com Sarcoidosis Source: Integrative Medicine Communications; www.drkoop.com Scleroderma Source: Integrative Medicine Communications; www.drkoop.com Sinus Congestion Source: Healthnotes, Inc.; www.healthnotes.com Sinus Infection Source: Integrative Medicine Communications; www.drkoop.com Sinusitis Source: Healthnotes, Inc.; www.healthnotes.com Sinusitis Source: Integrative Medicine Communications; www.drkoop.com Sleep Apnea Source: Integrative Medicine Communications; www.drkoop.com Threadworm Source: Integrative Medicine Communications; www.drkoop.com Trichinosis Source: Integrative Medicine Communications; www.drkoop.com Tuberculosis Source: Integrative Medicine Communications; www.drkoop.com Urinary Incontinence Source: Integrative Medicine Communications; www.drkoop.com

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Urinary Tract Infection Source: Healthnotes, Inc.; www.healthnotes.com Visceral Larva Migrans Source: Integrative Medicine Communications; www.drkoop.com Water Retention Source: Integrative Medicine Communications; www.drkoop.com Whipworm Source: Integrative Medicine Communications; www.drkoop.com Whooping Cough Source: Integrative Medicine Communications; www.drkoop.com Yellow Nail Syndrome Source: Healthnotes, Inc.; www.healthnotes.com •

Alternative Therapy Acupuncture Source: Healthnotes, Inc.; www.healthnotes.com Herbal Medicine Source: Integrative Medicine Communications; www.drkoop.com

•

Chinese Medicine Baibu Alternative names: Stemona Root; Radix Stemonae Source: Chinese Materia Medica Baiguo Alternative names: Ginkgo Seed; Semen Ginkgo Source: Chinese Materia Medica Baihe Alternative names: ily Bulb; Baihe (Bai He); Bulbus Lili Source: Chinese Materia Medica Baihe Gujin Wan Alternative names: Baihe Gujin Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Baiqian Alternative names: Willowleaf Swallowwort Rhizome; Rhizome Cynanchi Stauntonii Source: Chinese Materia Medica

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Banxia Alternative names: Pinellia Tuber; Rhizoma Pinelliae Source: Chinese Materia Medica Baokening Keli Alternative names: Baokening Granules Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Bawei Tanxiang San Alternative names: Bawei Tanxiang Powder Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Beiling Jiaonang Alternative names: Beiling Capsules Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Beishashen Alternative names: Coastal Glehnia Root; Radix Glehniae Source: Chinese Materia Medica Chenpi Alternative names: Dried Tangerine Peel; Pericarpium Citri Reticulatae Source: Chinese Materia Medica Cheqiancao Alternative names: Plantain Herb; Herba Plantaginis Source: Chinese Materia Medica Cheqianzi Alternative names: Plantain Seed; Semen Plantaginis Source: Chinese Materia Medica Chuanbei Xueli Alternative names: Chuanbei Xueli Concentrated Decoction; Chuanbei Xueli Gao Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Chuanbeimu Alternative names: endrilleaf Fritillary Bulb; Chuanbeimu (Chuan Bei Mu); Buibus Fritiliariae Cirrhosa Source: Chinese Materia Medica Colla Corii Asini Alternative names: Donkey-hide Glue Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China

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Cuitang Wan Alternative names: Cuitang Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Dabuyin Wan Alternative names: Dabuyin Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Daige San Alternative names: Daige Powder Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Dangshen Alternative names: Medicinal Changium Root; Mingdangshen; Radix Changii Source: Chinese Materia Medica Dannanxing Alternative names: ile Arisaema; Dannanxing (Dan Nan Xing); Arisaema Cum Bil Source: Chinese Materia Medica Daqingye Alternative names: Dyers Woad Leaf; Folium Isatidis Source: Chinese Materia Medica Digupi Alternative names: Chinese Wolfberry Root-bark; Cortex Lycii Source: Chinese Materia Medica Dilong Alternative names: Earthworm; Pheretima Source: Chinese Materia Medica Dongchongxiacao Alternative names: Chinese Caterpillar Fungus; Cordyceps Source: Chinese Materia Medica Ebushicao Alternative names: Small Centipeda Herb; Herba Centipedae Source: Chinese Materia Medica Erchen Wan Alternative names: rchen; Erchen Wan (Er Chen Wan Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Erdong Gao Alternative names: rdong Concentrated Decoction; Erdong Gao (Er Dong Gao Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China

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Ertong Qingfei Wan Alternative names: rtong Qingfei Pills; Ertong Qingfei Wan (Er Tong Qing Fei Wan Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Fabanxia Alternative names: Prepared Pinellia Tuber; Rhizoma Pinelliae Preparata Source: Chinese Materia Medica Fengmi Alternative names: Honey; Mel Source: Chinese Materia Medica Fuzi Alternative names: Beivedere Fruit; Difuzi; Fructus Kochiae Source: Chinese Materia Medica Gancao Alternative names: Liquorice Root; Radix Glycyrrhizae Source: Chinese Materia Medica Ganjiang Alternative names: ingiber (Dried Ginger); Rhizoma Zingiberi Source: Chinese Materia Medica Ganmao Qingre Keli Alternative names: Ganmao Qingre Granules Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Geiie Dingchuan Wan Alternative names: Gejie Dingchuan Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Gejie Alternative names: Tokay Gecko; Gecko Source: Chinese Materia Medica Geqiao Alternative names: Clam Shell; Concha Meretricis seu Cyclinae Source: Chinese Materia Medica Gualou Alternative names: Snakegourd Fruit; Fructus Trichosanthis Source: Chinese Materia Medica Gualoupi Alternative names: Snakegourd Peet; Pericarpium Trichosanthis Source: Chinese Materia Medica

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Gualouzi Alternative names: Snakegourd Seed; Semen Trichosanthis Source: Chinese Materia Medica Heche Dazao Wan Alternative names: Heche Dazao Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hetaoren Alternative names: English Walnut Seed; Semen Juglandis Source: Chinese Materia Medica Hezi Alternative names: Medicine Terminalia Fruit; Fructus Chebulae Source: Chinese Materia Medica Houpo Alternative names: Officinal Magnolia Bark; Cortex Magnoliae Officinalis Source: Chinese Materia Medica Huajuhong Alternative names: Pummelo Peel; Exocarpium Citri Grandis Source: Chinese Materia Medica Huangjing Alternative names: Solomonseal Rhizome; Rhizoma Polygonati Source: Chinese Materia Medica Huangqi Alternative names: Milkvetch; Radix Astragali Source: Chinese Materia Medica Huangqin Alternative names: Baical Skullcap Root; Radix Scutellariae Source: Chinese Materia Medica Huashanshen Alternative names: Funneled Physochlaina Root; Radix Physochlainae Source: Chinese Materia Medica Huzhang Alternative names: Giant Knotweed Rhizome; Rhizoma Polygoni Cuspidati Source: Chinese Materia Medica Jiegeng Alternative names: Platycodon Root; Radix Platycodi Source: Chinese Materia Medica

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Jieji Ningsou Wan Alternative names: Jieji Ningsou Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Jiezi Alternative names: Mustard Seed; Semen Sinapis Source: Chinese Materia Medica Jindengiong Alternative names: Franchet Groundcherry Fruit; Calyx seu Fructus Physalis Source: Chinese Materia Medica Jinfeicao Alternative names: Inula Herb; Herba Inulae Source: Chinese Materia Medica Jinmengshi Alternative names: Mica-schist; Lapis Micas Aureus Source: Chinese Materia Medica Jisheng Shenqi Wan Alternative names: Jisheng Shenqi Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Jiuwei Shihuihua San Alternative names: Jiuwei Shihuihua Powder Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Juhong Alternative names: Pummelo Peel; Huajuhong; Exocarpium Citri Grandis Source: Chinese Materia Medica Juhong Wan Alternative names: Juhong Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Kongxian Wan Alternative names: Kongxian Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Kuandonghua Alternative names: Common Coltsfoot Flower; Flos Farfarae Source: Chinese Materia Medica Kuxingren Alternative names: Bitter Apricot Seed; Semen Armeniacae Amarum Source: Chinese Materia Medica

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Laifuzi Alternative names: Radish Seed; Semen Raphani Source: Chinese Materia Medica Liaodaqingye Alternative names: Indigoplant Leaf; Folium Polygoni Tinctorii Source: Chinese Materia Medica Lingyang Qingfei Wan Alternative names: Lingyang Qingfei Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Lugen Alternative names: Reed Rhizome; Rhizoma Phragmitis Source: Chinese Materia Medica Luohanguo Alternative names: Grosvenor Momordica Fruit; Fructus Momordicae Source: Chinese Materia Medica Lusika Wan Alternative names: Lusika Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Luxiancao Alternative names: Pyrola Herb; Herba Pyrolae Source: Chinese Materia Medica Mabo Alternative names: Puff-ball; Lasiosphaera seu Calvatia Source: Chinese Materia Medica Madouling Alternative names: Dutohmanspipe Fruit; Fructus Aristolochiae Source: Chinese Materia Medica Mahuang Alternative names: Ephedra; Herba EphedraeHerba Ephedrae Source: Chinese Materia Medica Maidong Alternative names: Liriope Root Tuber; Shanmaidong; Radix Liriopes Source: Chinese Materia Medica Mengshi Guntan Wan Alternative names: Mengshi Guntan Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China

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Mingdangshen Alternative names: Medicinal Changium Root; Radix Changii Source: Chinese Materia Medica Muhudie Alternative names: Indian Trumpetflower Seed; Semen Oroxyli Source: Chinese Materia Medica Mujingye Alternative names: Hempleaf Negundo Chastetree Leaf; Folium Viticis Negundo Source: Chinese Materia Medica Mujingyou Alternative names: Negundo Chastetree Oil; Oleum Viticis Negundo Source: Chinese Materia Medica Nanshashen Alternative names: Fourleaf Ladybell Root; Radix Adenophorae Source: Chinese Materia Medica Niubangzi Alternative names: Great Burdock Achene; Fructus Arctii Source: Chinese Materia Medica Pangdahai Alternative names: Boat-fruited Sterculia Seed; Semen Sterculiae Lychnophorae Source: Chinese Materia Medica Pingbeimu Alternative names: ssuri Fritillary Bulb; Pingbeimu (Ping Bei Mu); Bulbus Fritillariae Ussuriensi Source: Chinese Materia Medica Pipaye Alternative names: Loquat Leaf; Folium Eriobotryae Source: Chinese Materia Medica Qiancao Alternative names: Longtube Ground Ivy Herb; Lianqiancao; Herba Glechomae Source: Chinese Materia Medica Qianhu Alternative names: Hogfennel Root; Radix Peucedani Source: Chinese Materia Medica Qianniuzi Alternative names: Pharbitis Seed; Semen Pharbitidis Source: Chinese Materia Medica

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Qingfei Yihuo Wan Alternative names: Qingfei Yihuo Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Qingguo Alternative names: Chinese White Olive; Fructus Canarii Source: Chinese Materia Medica Qingguo Wan Alternative names: Qingguo Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Qingmengshi Alternative names: Chlorite Schist; Lapis Chloriti Source: Chinese Materia Medica Qingqi Huatan Wan Alternative names: Qingqi Huatan Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Qiwei Duqi Wan Alternative names: Qiwei Duqi Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Qiwei Putao San Alternative names: Qiwei Putao Powder Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Quanshen Alternative names: Bistort Rhizome; Rhizoma Bistortae Source: Chinese Materia Medica Renshen Alternative names: inseng Leaf; Renshenye (Ren Shen Ye); Folium Ginsen Source: Chinese Materia Medica Renshenye Alternative names: inseng Leaf; Renshenye (Ren Shen Ye); Folium Ginsen Source: Chinese Materia Medica Reyanning Keli Alternative names: eyanning Granules; Reyanning Keli (Rey Yan Ning Ke Li Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China

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Sangbaipi Alternative names: White Mulberry Root-bark; Cortex Mori Source: Chinese Materia Medica Sangye Alternative names: Mulberry Leaf; Folium Mori Source: Chinese Materia Medica Shaii Alternative names: Seabuckthorn Fruit; Fructus Hippophae Source: Chinese Materia Medica Shanmaidong Alternative names: Liriope Root Tuber; Radix Liriopes Source: Chinese Materia Medica Shanyao Alternative names: Common Yam Rhizome; Rhizoma Dioscoreae Source: Chinese Materia Medica Shedan Chenpi San Alternative names: hedan Chenpi Powder; Shedan Chenpi San (She Dan Chen Pi San Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Shedan Chuanbei San Alternative names: hedan Chuanbei Powder; Shedan Chuanbei San (She Dan Chu An Bei San Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Shegan Alternative names: Blackberrylily Rhizome; Rhizoma Belamcandae Source: Chinese Materia Medica Shengjiang Alternative names: Fresh Ginger; Rhizoma Zingiberis Recens Source: Chinese Materia Medica Shenling Baizhu San Alternative names: henling Baizhu Powder; Shenling Baizhu San (Shen Ling Bai Zhu San Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Shensu Wan Alternative names: hensu Pills; Shensu Wan (Shen Su Wan Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China

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Shigao Alternative names: Gypsum; Gypsum Fibrosum Source: Chinese Materia Medica Shiwei Alternative names: Shearer's Pyrrosia Leaf; Folium Pyrrosiae Source: Chinese Materia Medica Shiwuwei Chenxiang Wan Alternative names: hiwuwei Chenxiang Pills; Shiwuwei Chenxiang Wan (Shi Wu Wei Chen Xiang Wan Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Siwei Tumuxiang San Alternative names: iwei Tumuxiang Powder; Siwei Tumuxiang San (Si Wei Tu Mu Xiang San Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Taizishen Alternative names: Heterophylly Falsestarwort Root; Radix Pseudostellariae Source: Chinese Materia Medica Taoren Alternative names: English Walnut Seed; Hetaoren; Semen Juglandis Source: Chinese Materia Medica Tiandong Alternative names: Cochinchinese Asparagus Root; Radix Asparagi Source: Chinese Materia Medica Tianhuafen Alternative names: Snakegourd Root; Radix Trichosanthis Source: Chinese Materia Medica Tiannanxing Alternative names: Jackinthepulpit Tuber; Rhizoma Arisaematis Source: Chinese Materia Medica Tianxianzi Alternative names: Henbane Seed; Semen Hyoscyami Source: Chinese Materia Medica Tinglizi Alternative names: Pepperweed Seed; Semen Lepidii Source: Chinese Materia Medica Wubeizi Alternative names: Chinese Gall; Galla Chinensis Source: Chinese Materia Medica

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Wumei Alternative names: Smoked Plum; Fructus Mume Source: Chinese Materia Medica Wuweizi Alternative names: Chinese Magnoliavine Fruit; Fructus Schisandrae Source: Chinese Materia Medica Xiangyuan Alternative names: Citron Fruit; Fructus Citri Source: Chinese Materia Medica Xiebai Alternative names: ongstamen Onion Bulb; Xiebai (Xie Bai); Bulbus Aiiii Macrostem Source: Chinese Materia Medica Xixin Alternative names: Manchurian Wildginger; Herba Asari Source: Chinese Materia Medica Xuanfuhua Alternative names: Inula Flower; Flos Inulae Source: Chinese Materia Medica Xuanshen Alternative names: Figwort Root; Radix Scrophulariae Source: Chinese Materia Medica Yangjinhua Alternative names: Datura Flower; Flos Daturae Source: Chinese Materia Medica Yibeimu Alternative names: inkiang Fritillary Bulb; Yibeimu (Yi Bei Mu); Buibus Fritillariae Pallidiflora Source: Chinese Materia Medica Yuanzhi Alternative names: Thinleaf Milkwort Root; Radix Polygalae Source: Chinese Materia Medica Yuanzhi Liujingao Alternative names: Thinleaf Milkwort Liquid Extract; Yuanzhi Liujingao Extractum Polygalae Liquidum Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Yuganzi Alternative names: Emblic Leafflower Fruit; Fructus Phylianthi Source: Chinese Materia Medica

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Yuxingcao Alternative names: Heartleaf Houttuynia Herb; Herba Houttuyniae Source: Chinese Materia Medica Yuzhu Alternative names: Fragrant Solomonseal Rhizome; Rhizoma Polygonati Odorati Source: Chinese Materia Medica Zhebeimu Alternative names: hunberg Fritillary Bulb; Zhebeimu (Zhe Bei Mu); Bulbus Fritillariae Thunbergi Source: Chinese Materia Medica Zhimu Alternative names: Common Anemarrhena Rhizome; Rhizoma Anemarrhenae Source: Chinese Materia Medica Zhongrushi Alternative names: Stalactite; Stalactitum Source: Chinese Materia Medica Zhujieshen Alternative names: Japanese Ginseng; Rhizoma Panacis Japonici Source: Chinese Materia Medica Zhuru Alternative names: Bamboo Shavings; Caulis Bambusae in Taeniam Source: Chinese Materia Medica Zhuyazao Alternative names: Chinese Honeylocust Abnormal Fruit; Fructus Gleditsiae Abnormalis Source: Chinese Materia Medica Zhuzishen Alternative names: Largeleaf Japanese Ginseng Rhizome; Rhizoma Panacis Majoris Source: Chinese Materia Medica Ziheche Alternative names: Human Placenta; Placenta Hominis Source: Chinese Materia Medica Zishiyin Alternative names: Fluorite; Fluoritum Source: Chinese Materia Medica Zisuye Alternative names: Perilla Leaf; Folium Perillae Source: Chinese Materia Medica

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Zisuzi Alternative names: Perilia Fruit; Fructus Perillae Source: Chinese Materia Medica Ziwan Alternative names: Tatarian Aster Root; Radix Asteris Source: Chinese Materia Medica •

Homeopathy Aconitum Napellus Source: Healthnotes, Inc.; www.healthnotes.com Belladonna Source: Healthnotes, Inc.; www.healthnotes.com Bryonia Source: Healthnotes, Inc.; www.healthnotes.com Chamomilla Source: Healthnotes, Inc.; www.healthnotes.com Ferrum Phosphoricum Source: Healthnotes, Inc.; www.healthnotes.com Ipecac Source: Healthnotes, Inc.; www.healthnotes.com Phosphorus Source: Healthnotes, Inc.; www.healthnotes.com Pulsatilla Source: Healthnotes, Inc.; www.healthnotes.com Rumex Crispus Source: Healthnotes, Inc.; www.healthnotes.com Spongia Tosta Source: Healthnotes, Inc.; www.healthnotes.com Sulphur Source: Healthnotes, Inc.; www.healthnotes.com

•

Herbs and Supplements Althaea Officinalis Source: Integrative Medicine Communications; www.drkoop.com Ananas Comosus Source: Integrative Medicine Communications; www.drkoop.com

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Angelica Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Anise Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Arctium Alternative names: Burdock, Gobo; Arctium lappa L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Australian Fevertree Source: Integrative Medicine Communications; www.drkoop.com Benzonatate Source: Healthnotes, Inc.; www.healthnotes.com Black Cohosh Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10009,00.html Bloodroot Alternative names: Sanguinaria canadensis Source: Healthnotes, Inc.; www.healthnotes.com Bloodroot Source: Prima Communications, Inc.www.personalhealthzone.com Bromelain Alternative names: Ananas comosus, Bromelainum Source: Integrative Medicine Communications; www.drkoop.com Bromelain Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,760,00.html Bromelainum Source: Integrative Medicine Communications; www.drkoop.com Bugleweed Alternative names: Lycopus virginicus Source: Healthnotes, Inc.; www.healthnotes.com Capsaicin Alternative names: Cayenne Source: Integrative Medicine Communications; www.drkoop.com

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Capsicum Frutescens Alternative names: Cayenne Source: Integrative Medicine Communications; www.drkoop.com Catnip Alternative names: Nepeta cataria Source: Healthnotes, Inc.; www.healthnotes.com Cayenne Alternative names: Capsaicin Source: Integrative Medicine Communications; www.drkoop.com Cayenne Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,765,00.html Chili Pepper Alternative names: Cayenne Source: Integrative Medicine Communications; www.drkoop.com Codeine Source: Healthnotes, Inc.; www.healthnotes.com Coltsfoot Alternative names: Tussilago farfara Source: Healthnotes, Inc.; www.healthnotes.com Comfrey Alternative names: Symphytum officinale Source: Healthnotes, Inc.; www.healthnotes.com Dextromethorphan Source: Healthnotes, Inc.; www.healthnotes.com Diphenhydramine Source: Healthnotes, Inc.; www.healthnotes.com Echinacea Alternative names: Echinacea angustifolia, Echinacea pallida, Echinacea purpurea, Purple Coneflower Source: Integrative Medicine Communications; www.drkoop.com Echinacea Source: Prima Communications, Inc.www.personalhealthzone.com Echinacea angustifolia Source: Integrative Medicine Communications; www.drkoop.com Echinacea pallida Source: Integrative Medicine Communications; www.drkoop.com

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Echinacea purpurea Source: Integrative Medicine Communications; www.drkoop.com Elderberry Alternative names: Sambucus nigra Source: Healthnotes, Inc.; www.healthnotes.com Elecampane Alternative names: Inula helenium Source: Healthnotes, Inc.; www.healthnotes.com Elecampane Source: Prima Communications, Inc.www.personalhealthzone.com Elecampane Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Ephedra Alternative names: Ephedra sinica, Ephedra intermedia, Ephedra equisetina 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 Eucalyptus Alternative names: Eucalyptus globulus Source: Healthnotes, Inc.; www.healthnotes.com Eucalyptus Alternative names: Eucalyptus globulus, Eucalyptus fructicetorum, polybractea, smithii, Australian Fevertree Source: Integrative Medicine Communications; www.drkoop.com Eucalyptus Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,778,00.html Eucalyptus globulus Source: Integrative Medicine Communications; www.drkoop.com Eyebright Alternative names: Euphrasia officinalis Source: Healthnotes, Inc.; www.healthnotes.com

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Fennel Alternative names: Foeniculum vulgare Source: Healthnotes, Inc.; www.healthnotes.com Fennel Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Fennel Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,849,00.html German Chamomile Alternative names: Matricaria recutita Source: Integrative Medicine Communications; www.drkoop.com Ginger Alternative names: Zingiber officinale Source: Healthnotes, Inc.; www.healthnotes.com Ginger Source: Prima Communications, Inc.www.personalhealthzone.com Glycyrrhiza glabra Source: Integrative Medicine Communications; www.drkoop.com Gotu Kola Alternative names: Centella asiatica Source: Healthnotes, Inc.; www.healthnotes.com Grindelia Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Guaifenesin Source: Healthnotes, Inc.; www.healthnotes.com Gymnema Sylvestre Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10034,00.html Horehound Alternative names: Marrubium vulgare Source: Healthnotes, Inc.; www.healthnotes.com Horehound Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca

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Horehound Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10036,00.html Horse Chestnut Alternative names: Aesculus hippocastanum Source: Healthnotes, Inc.; www.healthnotes.com Horseradish Alternative names: Cochlearia armoracia Source: Healthnotes, Inc.; www.healthnotes.com Hydrocodone Source: Healthnotes, Inc.; www.healthnotes.com Hyssop Alternative names: Hyssopus officinalis Source: Healthnotes, Inc.; www.healthnotes.com Hyssop Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Indian Tobacco Source: Integrative Medicine Communications; www.drkoop.com Ivy Leaf Alternative names: Hedera helix Source: Healthnotes, Inc.; www.healthnotes.com Ivy Leaf Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10112,00.html Jamaica Dogwood Alternative names: Piscidia erythrina, Piscidia piscipula Source: Integrative Medicine Communications; www.drkoop.com Licorice Alternative names: Glycyrrhiza glabra, Glycyrrhiza uralensis Source: Healthnotes, Inc.; www.healthnotes.com Licorice Alternative names: Glycyrrhiza glabra, Spanish Licorice Source: Integrative Medicine Communications; www.drkoop.com Licorice Source: Prima Communications, Inc.www.personalhealthzone.com

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Licorice Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,801,00.html Limetree Source: Integrative Medicine Communications; www.drkoop.com Linden Alternative names: Tilia spp. Source: Healthnotes, Inc.; www.healthnotes.com Linden Alternative names: Tilia cordata, Tilia platyphyllos, Limetree Source: Integrative Medicine Communications; www.drkoop.com Lobelia Alternative names: Lobelia inflata Source: Healthnotes, Inc.; www.healthnotes.com Lobelia Alternative names: Lobelia inflata, Indian Tobacco Source: Integrative Medicine Communications; www.drkoop.com Lobelia Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Lobelia Inflata Source: Integrative Medicine Communications; www.drkoop.com Ma huang Source: Integrative Medicine Communications; www.drkoop.com Ma huang Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Marshmallow Alternative names: Althea officinalis Source: Healthnotes, Inc.; www.healthnotes.com Marshmallow Alternative names: Althaea officinalis Source: Integrative Medicine Communications; www.drkoop.com Marshmallow Source: Prima Communications, Inc.www.personalhealthzone.com Marshmallow Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca

Alternative Medicine 73

Marshmallow Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10042,00.html Matricaria Recutita Source: Integrative Medicine Communications; www.drkoop.com Mentha Alternative names: Pennyroyal; Mentha/Hedeoma pulegium Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Mullein Alternative names: Verbascum thapsus Source: Healthnotes, Inc.; www.healthnotes.com Mullein Source: Prima Communications, Inc.www.personalhealthzone.com Mullein Flower Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,865,00.html NAC (N-Acetyl Cysteine) Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,809,00.html Nettle Alternative names: Urtica dioica Source: Healthnotes, Inc.; www.healthnotes.com Osha Source: Prima Communications, Inc.www.personalhealthzone.com Pennyroyal Alternative names: Hedeoma pulegoides, Mentha pulegium Source: Healthnotes, Inc.; www.healthnotes.com Peppermint Source: Prima Communications, Inc.www.personalhealthzone.com Peppermint Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,812,00.html Phenylpropanolamine Source: Healthnotes, Inc.; www.healthnotes.com

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Pimpinella Alternative names: Anise; Pimpinella anisum (L) Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Piscidia Erythrina Source: Integrative Medicine Communications; www.drkoop.com Piscidia Piscipula Source: Integrative Medicine Communications; www.drkoop.com Plantago Major Alternative names: Plantain; Plantago major/lanceolata Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Plantain Alternative names: Plantago lanceolata, Plantago major Source: Healthnotes, Inc.; www.healthnotes.com Plantain Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Promethazine Source: Healthnotes, Inc.; www.healthnotes.com Purple Coneflower Source: Integrative Medicine Communications; www.drkoop.com Red Clover Alternative names: Trifolium pratense Source: Healthnotes, Inc.; www.healthnotes.com Red Clover Alternative names: Trifolium pratense , beebread, cow clover, cow grass, meadow clover, purple clover Source: Integrative Medicine Communications; www.drkoop.com Red Clover Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Red Elm Source: Integrative Medicine Communications; www.drkoop.com Red Pepper Alternative names: Cayenne Source: Integrative Medicine Communications; www.drkoop.com Reishi Alternative names: Ganoderma lucidum Source: Healthnotes, Inc.; www.healthnotes.com

Alternative Medicine 75

Rue Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Sage Alternative names: Salvia officinalis Source: Healthnotes, Inc.; www.healthnotes.com Saw Palmetto Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,819,00.html Schisandra Alternative names: Schisandra chinensis Source: Healthnotes, Inc.; www.healthnotes.com Skunk Cabbage Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Slippery Elm Alternative names: Ulmus rubra, Ulmus fulva Source: Healthnotes, Inc.; www.healthnotes.com Slippery Elm Alternative names: Ulmus fulva, Red Elm, Sweet Elm Source: Integrative Medicine Communications; www.drkoop.com Slippery Elm Source: Prima Communications, Inc.www.personalhealthzone.com Slippery Elm Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10056,00.html Spanish Licorice Source: Integrative Medicine Communications; www.drkoop.com Sundew Alternative names: Drosera rotundifolia, Drosera ramentacea, Drosera intermedia, Drosera anglica Source: Healthnotes, Inc.; www.healthnotes.com Sweet Elm Source: Integrative Medicine Communications; www.drkoop.com Thyme Alternative names: Thymus vulgaris Source: Healthnotes, Inc.; www.healthnotes.com

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Thyme Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Thymus Alternative names: Thyme; Thymus vulgaris Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Tilia Cordata Source: Integrative Medicine Communications; www.drkoop.com Tilia Platyphyllos Source: Integrative Medicine Communications; www.drkoop.com Turmeric Alternative names: Curcuma longa Source: Healthnotes, Inc.; www.healthnotes.com Ulmus Fulva Source: Integrative Medicine Communications; www.drkoop.com Usnea Alternative names: Usnea barbata Source: Healthnotes, Inc.; www.healthnotes.com Wild Cherry Alternative names: Prunus serotina Source: Healthnotes, Inc.; www.healthnotes.com Wild Cherry Source: Prima Communications, Inc.www.personalhealthzone.com Wild Cherry Bark Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Wild Yam Alternative names: Dioscorea villosa Source: Healthnotes, Inc.; www.healthnotes.com Wild Yam Source: Prima Communications, Inc.www.personalhealthzone.com Yerba Santa Source: Prima Communications, Inc.www.personalhealthzone.com Yohimbe Alternative names: Pausinystalia yohimbe Source: Healthnotes, Inc.; www.healthnotes.com

Alternative Medicine 77

Zingiber Alternative names: Ginger; Zingiber officinale Roscoe Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org

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 COUGHING Overview In this chapter, we will give you a bibliography on recent dissertations relating to coughing. 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 “coughing” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on coughing, we have not necessarily excluded non-medical dissertations in this bibliography.

Dissertations on Coughing 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 coughing. 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: •

Antibiotics for coughing in general practice: Exploring, describing and optimising prescribing by Coenen, Samuel, PhD from UNIVERSITAIRE INSTELLING ANTWERPEN (BELGIUM), 2003, 168 pages http://wwwlib.umi.com/dissertations/fullcit/3095437

•

Brainstem control of cough and expiration reflex in the cat by Baekey, David Mark, PhD from UNIVERSITY OF SOUTH FLORIDA, 2003, 90 pages http://wwwlib.umi.com/dissertations/fullcit/3096695

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. PATENTS ON COUGHING 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.8 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 “coughing” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on coughing, we have not necessarily excluded non-medical patents in this bibliography.

Patents on Coughing By performing a patent search focusing on coughing, 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

8Adapted from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

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will tell you how to obtain this information later in the chapter. The following is an example of the type of information that you can expect to obtain from a patent search on coughing: •

5-HT.sub.3 receptor antagonists for treatment of cough and bronchoconstriction Inventor(s): Williams; Andrew J. (Epsom, GB2) Assignee(s): Beecham Group, p.l.c. (Middlesex, GB2) Patent Number: 5,098,909 Date filed: July 10, 1989 Abstract: A method of treatment of cough and/or bronchoconstriction in mammals, including humans, which method comprises the administration to the mammal in need of such treatment, an effective amount of a 5-HT.sub.3 receptor antagonist. Excerpt(s): This invention relates to a method of treatment of cough and/or bronchoconstriction in mammals, including humans, and to the use of compounds in the preparation of a medicament for the treatment of cough and/or bronchoconstriction. It has now been discovered that 5HT.sub.3 receptor antagonists, such as certain of the above classes of compounds, are of potential use in the treatment of cough and/or bronchoconstriction, such as that arising as a result of asthma. Cough is useful when it effectively expels secretions i.e. when it is a productive cough. Dry or unproductive cough has no useful effect. Unproductive cough may arise from effects such as cancer (primary or secondary) affecting sensory nerves in the larynx or larger bronchi, from asthma--especially childhood asthma--and in the early or later stages of coryza. Unproductive cough may also occur due to infiltration of the cough centre in the brain by tumour. Cough may also occur without known cause. Web site: http://www.delphion.com/details?pn=US05098909__

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Abdominal binder for effectuating cough stimulation Inventor(s): Linder; Steven H. (5093 Woodbrae Ct., Saratoga, CA 95070) Assignee(s): none reported Patent Number: 5,190,036 Date filed: February 28, 1991 Abstract: An apparatus for stimulating coughing in quadriplegic patients comprises an electrode belt that is attached in close contact and located in a given area of the abdomen of a patient. Pulse trains of specified duration and frequency having specified amplitudes and pulse widths are applied to the belt electrodes to provide momentary spasm-inducing stimulation to effectuate coughing and to clear the respiratory channels of the patient. Excerpt(s): This invention relates to a method and means for stimulating coughing and in particular for electrical stimulation of coughing in quadriplegia patients. Quadriplegics, by definition, have impairment of all four limbs, depending on the level and the extent of the spinal cord injury. Even though there may be some residual upper limb or hand function, the chest and abdominal wall muscles below the shoulders are generally paralyzed. Respiratory impairment is caused by loss of supraspinal control of respiratory muscles below the lesion. Normally ventilation is a complex interaction between the muscles of the chest, abdominal wall, and diaphragm. Spinal cord injury

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leads to paralysis of inspiratory and expiratory muscles. Loss of abdominal and chest wall expiratory muscles reduce ability to cough and clear secretions. Web site: http://www.delphion.com/details?pn=US05190036__ •

Agent for prevention and suppression of dry coughing caused by angiotensin converting enzyme inhibitors Inventor(s): Nakashima; Mitsuyoshi (Shizuoka, JP), Umemura; Kazuo (Shizuoka, JP) Assignee(s): Kissei Pharmaceutical Co., Ltd. (Nagano, JP), Ono Pharmaceutical Co., Ltd. (Osaka, JP) Patent Number: 6,028,094 Date filed: June 15, 1998 Abstract: The present invention is to provide an agent for the prevention and depression of dry coughing caused by angiotensin converting enzyme inhibitors which comprises a thromboxane synthetase inhibitor or thromboxane receptor antagonist as the active ingredient. Administering the drug is effective in preventing and depressing dry coughing caused by angiotensin converting enzyme inhibitors. For example, the use of the drug in combination with ozagrel hydrochloride was found to be effective in significantly dry coughing in hypertonic patients suffering from dry coughing attributable to the administration of captopril. Excerpt(s): The present invention relates to an agent for the prevention and depression of dry coughing caused by angiotensin converting enzyme inhibitors, characterized in comprising a thromboxane synthetase inhibitor or thromboxane receptor antagonist as the active ingredient. Angiotensin converting enzyme inhibitors are effective antihypertensive drugs and also have preventive effects on the development into cardiac insufficiency and hypertrophy of the heart in hypertensive disease. Therefore, these drugs have been extensively used in the world as one of the first choice drugs for the treatment of hypertension and are very highly useful medicaments. However, the angiotensin converting enzyme inhibitors, for example, captopril and enalapril have been reported to cause dry coughing as one of their side effects with an incidence of 1520% and 10-33%, respectively (Arch. Intern. Med., Vol. 145, p. 1524 (1985); Arch. Intern. Med., Vol. 148, p. 249(1988); American Heart Journal, Vol. 116, p. 1658(1988); N. Z. Med. J., Vol. 100, pp. 161-163 (1987); British Medical Journal, Vol. 294, pp. 1521-1523 (1987); British Medical Journal, Vol. 299, pp. 12-16 (1989)). Thus, the use of these drugs become impossible in many patients from the above reason, and the treatment for hypertension in such patients is not sufficient. Web site: http://www.delphion.com/details?pn=US06028094__

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Airway treatment apparatus with cough inducement Inventor(s): Van Brunt; Nicholas P. (White Bear Lake, MN) Assignee(s): American Biosystems, Inc. (St. Paul, MN) Patent Number: 6,415,791 Date filed: October 4, 1999 Abstract: An airway clearance system and method produces high frequency chest wall oscillations (HFCWO) and increased airflow velocities through the air passages to clear

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the lungs of mucus. The system includes a chest wall force applicator to produce the HFCWO, and an air pressure input mouthpiece system that enhances airflow to and from the patient's lungs and a simulated cough inducer that causes a cough-like airflow pattern during each oscillatory cycle. Excerpt(s): The present invention relates to an airway clearance system and in particular to a system that includes a chest compression device for high frequency chest wall oscillation and a subsystem which induces simulated coughs and enhances airflow velocity through the air passages caused by the high frequency chest wall oscillations. Chest compression devices have been developed to produce high frequency chest wall oscillation (HFCWO). HFCWO is the most successful method used for removing excess mucus from the lungs caused by a variety of diseases such as cystic fibrosis, emphysema, asthma, chronic obstructive pulmonary disease (COPD), and chronic bronchitis. The device most widely used to produce HFCWO is the ABI Vest.TM. Airway Clearance System by American Biosystems, the assignee of the present application. A description of the pneumatically driven system can be found in the Van Brunt et al. patent, U.S. Pat. No. 5,769,797, which is assigned to American Biosystems. Another example of a pneumatic chest compression vest has been described by Warwick et al., U.S. Pat. No. 4,838,263. Web site: http://www.delphion.com/details?pn=US06415791__ •

Antisiphoning valve Inventor(s): Magram; Gary (Greenville, DE) Assignee(s): The Nemours Foundation (Wilmington, DE) Patent Number: 5,634,894 Date filed: December 1, 1995 Abstract: A valve for preventing excessive cerebrospinal fluid flow in ventriculoperitoneal shunt, known as "siphoning", which occurs when a patient rapidly moves from a recumbent to an upright position, is described. The valve includes at least one valve unit containing within a cerebrospinal fluid (CSF)-filled cavity, a freely moveable float which is buoyant in CSF. The valve is subcutaneously implanted in the patient in an upright orientation in which the entrance port of the valve unit is elevated higher than the cavity while the patient is upright. In this orientation, the float rises to the top of the CSF-filled cavity where it seals against a seat of the entrance port. The float thus stops flow until intracranial pressure sufficiently exceeds the buoyant force. The casing generally has a contoured sectional profile. When the patient reclines, the valve orients so that the float rises to a high region of the casing which is away from the entrance seat thereby allowing CSF to flow through. The contour of the casing is selected to increase hydrodynamic force on the float in the direction of flow when flow rate increases. This causes the float to contact a seat of the valve unit exit port when flow exceeds a predetermined amount. The novel valve thus provides the capability to prevent excessive drainage even when the patient is recumbent, for example, caused by coughing or sneezing. Excerpt(s): This invention relates to ventriculoperitoneal shunts, and more specifically, to a valve to moderate cerebrospinal fluid flow when the patient changes between recumbent and upright positions. Treatment of certain medical conditions and diseases such as hydrocephalus frequently includes implanting a subcutaneous ventriculoperitoneal (VP) shunt to drain cerebrospinal fluid (CSF) from a ventricle of the

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brain to a receiving cavity, such as the heart or peritoneum. A VP shunt typically includes a catheter which extends from the ventricle, through a burr hole in the skull located behind the ear, and along the side of the body to the abdomen. Early VP shunts exhibited a performance characteristic known as "siphoning" which refers to surging of CSF drainage when the patient changes from a recumbent to a sitting or standing position. Siphoning is caused by the rapid increase in hydrostatic pressure differential in the catheter due to the sudden change in height of the head above the abdomen. In addition to temporary discomfort, excessive CSF drainage might cause other adverse consequences, for example, distention of the brain, or rupture of the blood vessels leading to potentially serious brain hematoma. Web site: http://www.delphion.com/details?pn=US05634894__ •

Chewing gum containing cough suppressing agent Inventor(s): Bakal; Abraham I. (Parsippany, NJ), Cash; Penny A. (Denville, NJ), Eisenstadt; Barbara (Neponsit, NY) Assignee(s): Cumberland Packing Corporation (Brooklyn, NY) Patent Number: 5,846,557 Date filed: June 30, 1997 Abstract: The present invention pertains to chewing gum compositions containing cough suppressing agents. The compositions include a taste-masking mixture containing a flavoring agent, an intense sweetening agent and menthol. This combination nullifies the taste or off-note of the cough suppressant. The present invention also pertains to a method preparing the chewing gum composition and methods of treatment which include administering the cough suppressant-containing chewing gum to a patient in need thereof. Excerpt(s): The present invention is directed to medicament-containing chewing gum compositions. In particular, the present invention is directed to chewing gum compositions which effectively mask the unpleasant tastes of the medicaments contained therein over extended chewing periods. People suffering from throat irritation or experiencing coughing commonly take throat lozenges, cough syrups or cough drops for symptomatic relief. Special cases, however, require prescription drugs to control the symptoms. It is commonly accepted that throat irritation and coughing can be reduced by lubrication with sweet and viscous syrups and/or by sustained lubrication with such materials. Thus, for example, cough drops or lozenges often contain sugar and/or honey. Active ingredients can also be interdispersed or incorporated in the sweet vehicles used to prepare the syrups or lozenges. These active ingredients include, for example, dextromethorphan, menthol, peppermint oil and the like. Over the years, the most widely used dosage forms for dispensing these medicaments have been syrups, hard candy lozenges and chewable candies. Chewing gums have not been successfully used to deliver most active ingredients. It has been shown that it is difficult to extract a sufficient amount of the active ingredient from the chewing gum in the oral cavity during the usual three to five minute chewing period when the flavors and/or sweetener(s) are extracted from the gum. Web site: http://www.delphion.com/details?pn=US05846557__

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Composition for treating cough induced by angiotensin converting enzyme inhibitors Inventor(s): Dicpinigaitis; Peter (Woodhaven, NY) Assignee(s): Montefiore Medical Center (Bronx, NY) Patent Number: 6,194,460 Date filed: May 31, 1995 Abstract: The claims define a method which is based on the use of baclofen to suppress the cough of a patient who is afflicted with a cough that is induced by the administration of an ACE inhibitor. The usual dose of baclofen is from 10 to 30 mg daily. A pharmaceutical composition which comprises an effective amount of an ACE inhibitor is also disclosed which is a combination of an ACE inhibitor and an amount of baclofen which is effective to suppress the cough which is caused by the administration of the therapeutic dose of an ACE inhibitor. Excerpt(s): Angiotensin converting enzyme (ACE) inhibitors are widely used in the treatment of hypertension, congestive heart failure, acute myocardial infarction and diabetic nephropathy. One of the side effects that is often observed in patients who are taking ACE inhibitors is a persistent, dry cough that is refractory to most commonly prescribed cough suppressants. The cough is sometimes so severe that therapy with the ACE inhibitor must be discontinued. Even those patients who respond to conventional cough suppressants are subject to the disadvantages associated with long term use of opiates and other non-opiate cough suppressants. In the prior art, baclofen has been described as a GABA.sub.beta. agonist which has antitussive effects. Br. J. Pharmacol.(1993)110, 491-495) These effects have been demonstrated by counting the number of coughs elicited during a 4 minute or 30 minute period against capsaicin challenge by subcutaneous administration or by inhalation when baclofen and other antitussives were administered. Web site: http://www.delphion.com/details?pn=US06194460__

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Cough muffler Inventor(s): Copeland; Derrick (115 Cherry Rd., Madison, AL 35758), Copeland; Glen (13338 Market St., Moulton, AL 35650), Copeland; Lucian (4854 Brashiers Chapel Rd., Arab, AL 35016) Assignee(s): none reported Patent Number: 6,085,864 Date filed: September 17, 1999 Abstract: A cough muffler for muffling the vocal sounds of a human. The muffler is especially designed for deadening or silencing vocal sounds, particularly coughing, of hunters and the like to avoid possible frightening away of the game being hunted. The cough muffler generally comprises four components, namely: a mouthpiece, a cupshaped casing which defines a cavity, a first absorbent material, and a second absorbent material. Excerpt(s): The present invention relates to a device for effectively muffling vocal sounds, particularly coughing, with a particular utility in deadening such coughing sounds involuntarily made by hunters and the like, wherein the game being hunted may be easily frightened away by such coughing noise. There are several prior art devices for muffling vocal sounds, particularly coughing, sneezing, talking, singing, and

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even shouting. The following U.S. patents reflect the state of the art of which the applicants are aware insofar as they are somewhat germane and pertinent to their invention: U.S. Pat. Nos. 2,572,547 to Webb; 2,625,615 to Webb; 2,745,911 to Webb; 4,396,089 to Scully; 4,792,013 to Boynton; 4,834,212 to Figone et al.; 4,932,495 to Chapman; and 5,413,094 to McBrearty. Each of the three Webb patents discloses devices or masks for use in court reporting, assemblies, or other gatherings to receive directly the uttered or other sounds in such a manner as to be non-disturbing to adjacent or surrounding participants, spectators, or other persons, each of which incorporates an absorbing mass. In use, the devices disclosed by each of the Webb patents is held by one hand of the user and pressed against the user's face to surround the chin, mouth, and nose of the user. The Scully patent discloses a sound muffling cup into which an enraged person can shout to release tension while at the same time avoiding disturbing other persons. In use, the device disclosed by Scully is held by one hand of the user and pressed against the user's face to completely surround the mouth of the user. The Boynton patent discloses a globe-like device with a valve mechanism and internal baffles for muffling the cries of a baby. In use, the device disclosed by Boynton is placed over an infant's mouth and held in place by an attending person. The patent to Figone et al. discloses a human sound muffler and indicator to be held by a person for placement around that person's mouth and which includes a microphone and an associated electric circuit for receiving unabsorbed sound and providing an indication of the intensity of the unabsorbed sound which provides feedback to the user. The patent to Chapman discloses a device for muffling vocal sounds, particularly coughing or sneezing sounds, and has particular utility for deadening such sounds involuntarily made by hunters and the like, wherein the game being hunted is easily frightened away by such noises, and which also accommodates fluid flow volume. In use, the device disclosed by Chapman covers both the nose and mouth of the user. The patent to McBrearty discloses a device which is held in one hand and fits over a user's mouth and nose and which incorporates a core made of a noise reducing material for reducing the noise of coughs and sneezes. These prior art devices suffer from numerous deficiencies and disadvantages. The present invention overcomes these deficiencies and disadvantages in that it provides an improved device that fills the need for a simple, inexpensive, cough or muffler that can be easily assembled and disassembled for cleaning and maintenance purposes. Web site: http://www.delphion.com/details?pn=US06085864__ •

Cough silencer device Inventor(s): Ellington; R. Craig (Loganville, GA), Ellington; Stephen D. (Social Circle, GA), Rush; Rhett P. (Lula, GA) Assignee(s): Ellington & Rush Hunting Products, Inc. (Lula, GA) Patent Number: 6,401,860 Date filed: October 18, 2000 Abstract: A cough silencer device comprising a body having a cavity therein with a mouth portion on a first end and an open second end. An internal muffling baffling system is placed within the cavity of the body and is fluidly connected to the mouth portion. An end cap is attachable to the open second end of the body to retain the internal muffling baffling system within the cavity. A person can insert the mouth portion into their mouth and cough allowing the internal muffling baffling system to silence the cough. The cough silencer device can further include an elongate tube having a first end attached to the mouth portion of the body. A mouthpiece is affixed to a

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second end of the elongate tube, so that the mouth of the person can engage the mouthpiece. Excerpt(s): The present invention relates generally to the field of sound deadening equipment. More particularly, the invention comprises a cough silencer device. In general, a first field of use of the disclosed invention is by hunters, as the most likely benefactors of the unique advantages of the instant invention. However, many other fields, such as for use by enraged persons, bird watchers, audience members and the like, could find potentially beneficial uses of this invention. Thus, it can be seen that the potential fields of use for this invention are myriad and the particular preferred embodiments described herein is in no way meant to limit the use of the invention to the particular field chosen for exposition of the details of the invention. Web site: http://www.delphion.com/details?pn=US06401860__ •

External cerebrospinal fluid drain apparatus Inventor(s): Magram; Gary (Apt. 108, 1 Gristmill Ct., Baltimore, MD 21208) Assignee(s): none reported Patent Number: 5,683,357 Date filed: December 1, 1995 Abstract: An apparatus is disclosed for draining cerebrospinal fluid from within a patient's body to a location outside the patient's body. The novel apparatus features a fluid accumulator located serially between the ventricular catheter and the external location. The accumulator holds an amount of fluid which can flow bidirectionally between the patient and the accumulator so as to replenish any excess fluid that surges from the patient due to sudden, unexpected movements, such as sneezing, coughing, suddenly changing from recumbent to upright position and systolic contractions. The accumulator serves to maintain the height of the fluid column in the apparatus at a steady level, despite the sudden movements. Thus the hydrostatic pressure exerted on the cerebrospinal spaces by the fluid, which controls intracranial pressure, remains substantially constant. Excerpt(s): This invention relates to a device for draining cerebrospinal fluid from a patient. More specifically, it relates to the use of an accumulator to drain cerebrospinal fluid from within the subarachnoid space to a container outside the body. The ventricles in the brain of an average human produce approximately 20 cm.sup.3 of cerebrospinal fluid (CSF) per hour. In healthy individuals, CSF drains from the ventricles into the subarachnoid space and is absorbed by the arachnoid villi into the venous sinuses. The sinuses return the CSF mixed with blood to the heart. Some individuals suffer from disorders, such as hydrocephalus, in which the fluid stops absorbing normally and accumulates in the cranial cavity. Unless the fluid drains from the ventricles, intracranial pressure can build to life threatening levels. Often a shunt, e.g. a ventriculoperitoneal (VP) shunt, is implanted to drain excess CSF to another location inside the body. Occasionally, proper treatment calls for draining the fluid to an external receiver. Historically, coughing or sneezing, sudden body movements, such as changing from recumbent to uptight position, and repetitive systolic contractions presented a significant problem for maintaining a desired intracranial pressure in a patient with a shunt or drain. These activities briefly compress organs within the cranial cavity which raises the fluid pressure in the subarachnoid space. For a short time high pressure produces high discharge flow which exceeds the rate at which the ventricles produce

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CSF. In a normal individual, CSF temporarily flows into the cervical subarachnoid space which can expand to accommodate the excess. Shortly thereafter, CSF flows back into the cranial cavity following the compression. However, in a shunt or drain patient, surplus CSF is drained from the cranial cavity and cannot be returned. Over time, a deficiency of CSF volume results and intracranial pressure generally declines to unhealthy levels. Web site: http://www.delphion.com/details?pn=US05683357__ •

External pulmonary brace and method for using same Inventor(s): Levy; Aaron I. (Chicago, IL) Assignee(s): Baffes; Thomas G. (Skokie, IL) Patent Number: 4,576,155 Date filed: November 9, 1983 Abstract: An external pulmonary brace has a pair of spaced brackets receiving and surrounding the tricep area of a user's upper arms, the brackets being connected to a central brace portion which extends across and substantially covers the user's chest. The central section and the brackets may be in the form of a unitary element, or the central section may be of elastic material joined to the brackets. By undertaking a downward movement of the upper arms toward the sides of the body, the patient may apply selected amounts of pressure to the chest area as needed to assist coughing or expectoration. Excerpt(s): The present invention generally relates to medical braces, and more particularly relative to an external pulmonary brace for permitting a patient to apply selected pressure to the chest area to assist the patient in coughing or expectorating. Postoperative patients who have undergone chest surgery generally experience pain when engaging in postoperative pulmonary ventilation, such as coughing or expectorating, and are additionally subject to the danger of disrupting the chest incision by such action. Standard postoperative procedures for assisting the postoperative patient generally involve the use of applied pressure by the nursing staff, such as by placing a pillow over the patient's chest and pressing downwardly. This method is burdensome to the hospital staff in that nurses must be removed from their other duties to assist the patient, and moreover the method is somewhat uncomfortable to the patient in that he or she does not have control over the exact amount of pressure being applied. Various types of surgical restraints and braces are known, each of which exhibit a central section placed in contact with a portion of a patient's body, the central section being connected at opposite sides to brackets. Such a restraint is disclosed, for example, in U. S. Pat. No. 4,321,890 for use with an anesthetized animal during surgery. The animals limbs extend through V-shaped legs at opposite sides of the restraint with the body of the animal resting in a supine position therebetween to prevent the animal from rolling over during surgery and during postoperative recovery. A leg support is disclosed in U.S. Pat. No. 3,496,935 having an adjustable central section extending across a user's thighs, and to depending side members surrounding the sides of the user's legs to maintain the user's legs adjacent to each other. Web site: http://www.delphion.com/details?pn=US04576155__

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Intranasal codeine for the rapid suppression of cough and rapid relief of pain Inventor(s): Al-Ghananeem; Abeer M. (Lexington, KY), Dittert; Lewis W. (Lexington, KY), Hussain; Anwar A. (Lexington, KY) Assignee(s): New Millennium Pharmaceutical Research, Inc. (Lexington, KY) Patent Number: 6,608,073 Date filed: October 1, 1999 Abstract: This invention provides a method of rapidly and reliably delivering codeine, alone or in combination with other compounds, to the systemic circulation by administration via the nasal route to produce rapid onset of beneficial effects in the treatment of pain or cough. The present invention further provides pharmaceutical compositions comprising codeine, and/or pharmaceutically acceptable salts thereof in a variety of unique pharmaceutical dosage forms, with and without other analgesic and/or antitussive compounds. Excerpt(s): This invention relates to a method for greatly accelerating the rate of delivery of codeine, and derivatives thereof, to the central nervous system by administration via the nasal route to provide extremely rapid response in the prevention or treatment of pain or relief of cough in a patient in need of such prevention or treatment. This invention relates to a method for greatly accelerating the rate of delivery of codeine, and derivatives thereof, to the central nervous system by administration via the nasal route to provide extremely rapid response in the prevention or treatment of cough in a patient in need of such prevention or treatment. This method also provides for direct absorption of codeine into the central nervous system, bypassing the metabolic enzymes circulating in the bloodstream that would otherwise destroy codeine administered by another route. Opioid analgesics are the most potent pain-relieving drugs currently available. Furthermore, of all analgesics, they have the broadest range of efficacy, providing the most reliable method for rapidly relieving pain. However, side effects, including respiratory depression, are common. Opioids produce analgesia by actions in the central nervous system. They activate pain-inhibitory neurons and directly inhibit paintransmission neurons. Most of the commercially available opioid analgesics act at the same opiate receptor (the.mu.receptor), differing mainly in potency, speed of onset, duration of action, and optimal route of administration. Web site: http://www.delphion.com/details?pn=US06608073__

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Medical pillow Inventor(s): Lagin; Herbert (31 Deer Park Rd., Great Neck, NY 11021) Assignee(s): none reported Patent Number: 4,683,601 Date filed: September 22, 1986 Abstract: A medical pillow for use by patients who have recently undergone an open heart surgical type operation which facilitates and eases the pain associated with coughing for the expectoration of phlegm from their lungs. The medical pillow comprises a central chest supporting and contacting area having a pair of laterally extending arm engaging wings connected thereto. A sleeve is provided on the outer surface of the chest contacting area. The patient's hands, after the patient's arms are first folded across the patient, are slid into the open ends of the sleeve and this enables the

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patient to grip and hold the medical pillow and easily pull the same against their chest to facilitate the coughing procedure. The medical pillow is also provided with arm cutout areas so that the individual's arms can easily be folded across their chest without discomfort and simultaneously the upper portions of the patient's arms when placed over the wings of the pillow bring the wings flush against the patient's sides. In an alternate use of the medical pillow, the pillow can be inverted with the otherwise neck supporting surface being placed between the patient's legs, the wings folding around the patient's waist or hips with the cut-out areas providing a spot for the patient's legs. In this manner, the medical pillow can be used for general comfort by patients who have recently undergone abdominal surgery. Excerpt(s): The present invention relates to a medical pillow which is extremely useful in post operative care of patients who have undergone open heart and/or abdominal type surgery. The medical pillow allows the patient to place a flat and firm object against the patient's chest and gently grip, hold and/or pull the pillow against the chest while allowing the patient to cough, as desired or as required, and thereby bring up phlegm for expectoration. This is a voluntary "exercise" which for proper recuperation by the patient is performed to clear the lungs. The medical pillow is provided with a central chest contacting portion which is intended to be placed flush on the chest of the patient. The pillow is also provided with side or laterally extending wing portions which extend around the side of the patient and are held thereagainst by the upper portions of the patient's arms. The forearms of the patient are then folded across his or her front and the hands are placed within an open ended sleeve so that the patient can easily grip, hold and/or pull the chest pillow against his or her chest and thereby facilitate the voluntary coughing and subsequent patient expectoration of phlegm to clear the lungs or simply the pillow serves to relieve the pain associated with post operative care. In addition, the pillow can be flipped over, i.e., turned upside down so that the otherwise neck contacting surface of the chest contacting portion (when the pillow is used subsequent to open heart surgery) is placed between the wearer's legs and the otherwise chest contacting surface (when the pillow is used after open heart surgery) is placed against the abdominal area of the patient. In this use of the medical pillow, the cut-out portions of the laterally extending side wings now conform over the patient's legs. Thus the pillow is placed against the abdominal area of the patient with the wings held against the patient's sides or hips to again relieve or alleviate the pain associated with post-operative surgery, in this case, abdominal surgery. Again, the patient's hands can be slid within the open ends of the sleeve to facilitate the placement, holding and gripping of the cardiac pillow against the selected area of the patient. In addition, the medical pillow has yet another post operative use. Subsequent to the operation and after minimum of recuperation in the hospital, the patient can more comfortably and, certainly less expensively, fully recover at home. To facilitate transportation of the patient, either from hospital to home, home to wherever, etc. The patient can place the pillow against his or her chest or abdominal area (depending on the surgical operation performed) to provide additional cushioning within an automobile or other vehicle. The sleeve of the medical pillow is adapted to have the free end of the seatbelt pass therethrough and the seat belt can then be connected or buckled to the fixed point or hold down position of the vehicle. In this manner, the pillow is held over the patient's chest and an additional cushioning layer is provided to the patient which, again, provides relief to the patient; allows him to travel without fear and yet the pillow is held in relative position by the seatbelt passing through the open ended sleeve. The medical pillow has many other uses which should be readily apparent. Web site: http://www.delphion.com/details?pn=US04683601__

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Method and apparatus for assisting expulsional movement of pulmonary secretions via supramaximal flows Inventor(s): Cardinal; Pierre (Gatineau, CA), Carscallen; William E. (Ottawa, CA), Ireland; Robert (Ramsay, CA) Assignee(s): National Research Council Canada Intellectual Property Services Office (Ottawa, CA) Patent Number: 5,345,930 Date filed: February 10, 1992 Abstract: There is described a non-invasive device designed to assist expectoration pulmonary secretions in humans, particularly in those whose natural exhalation and natural coughing ability are impaired. The device has a valve that opens fully in not more than 10 milliseconds, a pressure sensing means generating a signal indicative of a pressure in the upper part of the subject's respiratory tract, detecting means indicating the imminent collapse of the subject's respiratory tract or a part thereof, and control means opening or closing the valve respectively in response to the signals from the sensing means and the detecting means so as to create supramaximal flows in the respiratory tract in order to stimulate the movement of secretions towards the mouth of the subject. The valve opening/closing sequence is totally subject-controlled in accordance with a method of the invention which comprises the step of inducing supramaximal flows by determining a pressure threshold for the subject to be able to effect multiple openings and closings of the valve during a single respiratory cycle, determining a subject-specified parameter indicative of a substantial collapse of the subject's respiratory tract, and having the subject exhale against the valve to effect a rapid sequence of valve opening/closing cycles which cause the supramaximal flows and resulting movement of secretions towards the mouth of the subject. Excerpt(s): This invention relates to a non-invasive device designed to assist expectoration of pulmonary secretions in humans whose natural exhalation and natural coughing ability are impaired. Physicians have long realized that patients who are unable to clear their lungs of secretions are at a much greater risk of developing pneumonia or atelectasis. These patients often die prematurely of respiratory failure. The inability to expectorate secretions is considered, by physicians, a prime contributor to the demise of patients suffering from neuromuscular disorders, cystic fibrosis, bronchiectasis, pneumonia and obstructive lung diseases. In addition, the excessive morbidity and mortality of critically ill patients requiring mechanical ventilation or patients recovering from abdominal or thoracic surgery has been attributed in part to their inability to effectively expectorate airway secretions. Patients with spinal cord injuries are also at a greater risk of respiratory failure and death because of the effect of the injury on inspiratory and/or expiratory muscles. Such patients are often unable to generate adequately high pleural pressures during coughing to achieve expectoration of secretions. Secretions that are not removed from the respiratory tract in a natural manner not only obstruct the airways thereby interfering with breathing but also become contaminated with pathogenic bacteria. This leads to an inflammatory reaction which may damage the lungs irreversibly. As secretions can be moved from lower parts of the respiratory tract towards the upper airways (upper bronchi, trachea and mouth) by a high expiratory flow rate of air from the lungs, research work has been undertaken to induce enhanced air flow rates from the patient's lungs. Certain methods typically employ a cyclic manoeuvre in which the lungs of the patient are over pressured prior to the patient exhaling into a source of vacuum. This approach is termed "exsufflation with

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negative pressure" (E.W.N.P.). Note, pressures denoted negative and positive refer respectively to sub-atmospheric and super-atmospheric pressure. Web site: http://www.delphion.com/details?pn=US05345930__ •

Method and apparatus for cough sound analysis Inventor(s): Afshari; Aliakbar (Morgantown, WV), Frazer; David (Fairmont, WV), Friend; Kimberly (Morgantown, WV), Goldsmith; William T. (Masontown, WV), McKinney; Walter (Morgantown, WV), Reynolds; Jeffrey (Morgantown, WV) Assignee(s): The United States of America as represented by the Department of Health and (Washington, DC) Patent Number: 6,436,057 Date filed: April 21, 2000 Abstract: A fast, simple, and reliable method and apparatus for recording cough sounds for diagnosing pulmonary disorders and diseases is provided. This method uses signal analysis techniques to extract quantitative information from recorded cough sound pressure waves. The generated data can be used to diagnose pulmonary disorders and diseases as well as track the effectiveness of treatment regimes over time. The method can also be used to quickly and reliably screen individuals at risk of pulmonary disorders and diseases. A system according to one embodiment includes a mouthpiece connected to the proximal end of a tube. The distal end of the tube is connected to a flexible tube. A microphone is attached to the tube between the distal and proximal ends therof for recording sound pressure waves. A calculated cough sound index (CSI) can be used in diagnostic applications. Excerpt(s): This invention relates to methods and apparatuses for the analysis of patient's coughs. More specifically, this invention relates to methods and apparatuses for the analysis of patient's coughs to aid in diagnosing pulmonary disorders and diseases. This method uses signal analysis techniques to extract quantitative information from recorded cough sound pressure waves. Moreover, the method allows the recordation of cough sound waves while avoiding distortions caused by reflections. The generated data can be used to diagnose pulmonary disorders and diseases as well as track the effectiveness of treatment regimes over time. The method can also be used for screening the general population, or populations at higher risk, so that such pulmonary disorders and diseases can be detected as early as possible so that appropriate treatment can be started as soon as possible. Cough is associated with well over 100 different pulmonary diseases and is one of the most common signs or symptoms of respiratory disease. Even though cough may be an unwanted complication of a pulmonary disease, it has often been used by physicians as an effective diagnostic tool. Since cough sounds are composed of acoustic information which can be altered by lung disease and since cough has essentially the same acoustical characteristics whether performed voluntarily or involuntarily, analysis of voluntary cough sounds has the potential to become a useful noninvasive tool for screening large populations of workers to evaluate their pulmonary function. The use of cough sound analysis to aid in the identification of lung disease has several distinct advantages since testing can be quickly and easily administered while requiring only a minimum amount of technician or patient training. In order to describe the events that occur during a cough, physiologists have subdivided a cough into 4 different phases (Leith et al., Cough, In: The Handbook of Physiology, The Respiratory System edited by A. Fishman, P. T. Macklem and J. Mead, Bethesda, Md., Am. Physiological Society, Sec(3) Chapter 20, 315-336 (1987)). During the initial

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phase, called the inspiration phase, a variable volume of air is inhaled into the lungs. The second phase, referred to as the compression phase, begins as the glottis closes and the muscles of expiration begin to contract increasing thoracic pressure. The third phase is called the expulsion phase. At the start of the third phase, the glottis opens and gas flows rapidly from the lung. During the fourth and final phase, called the cessation phase, muscle activity is reduced and airflow is diminished. Web site: http://www.delphion.com/details?pn=US06436057__ •

Method and apparatus for electrical activation of the expiratory muscles to restore cough Inventor(s): DiMarco; Anthony F. (37490 Hunters Ridge, Solon, OH 44139) Assignee(s): none reported Patent Number: 5,999,855 Date filed: December 30, 1998 Abstract: A method and apparatus are provided for electrical stimulation of the expiratory muscles in a human or other mammal to produce cough in patients with spinal cord injuries resulting in paralysis of their expiratory muscles. The method of electrically activating expiratory muscles of a human patient or other mammal includes positioning a first epidural electrode at a first location on the dorsal surface of a spinal cord of a patient and a second epidural electrode, if necessary, at a second location on the dorsal surface of the patient's spinal cord. The first epidural electrode is positioned on the spinal cord dorsal surface in the region of the T.sub.9 -T.sub.10 spinal root level, while the second epidural electrode is positioned in the region of the lower thoracic spinal root, at the T.sub.12 -L.sub.1 spinal cord level. Electrical stimulation pulses are selectively passed to the first and second epidural electrodes from an implanted radiofrequency receiver and stimulation pulse generator to activate expiratory muscles of the patient to produce cough. The invention provides a safe, effective, and portable means by which spinal cord injured patients are able to clear secretions more easily and thereby improve their lifestyle and reduce the morbidity and mortality due to respiratory complications. Excerpt(s): The present invention relates to electrical stimulation of the expiratory muscles to produce cough in human patients and other mammals with spinal cord injuries resulting in paralysis of their expiratory muscles. The invention will allow human patients with such spinal cord injuries to cough periodically or as needed to prevent the occurrence of respiratory infections which have heretofore been a frequent cause of illness and even death among this patient population. Human patients with spinal cord injury often have paralysis of a major portion or virtually all of their expiratory muscles and, therefore, lack a normal cough mechanism. As a consequence, many of these patients suffer from a markedly reduced ability to clear airway secretions. This factor contributes to the development of recurrent respiratory tract infections, a major cause of morbidity and mortality in this patient population. Although mechanical methods exist which can increase peak expiratory air flow to improve cough effort, the degree of improvement with these methods is small. For example, the abdominal push assist maneuver involves assisting a patient's expiratory effort by applying pressure with both hands to the upper abdomen in a posterior and cephalad direction. If abdominal pressure is applied following spontaneous inspiration and glottic closure, an adequate cough pattern may be achievable. This procedure has been found to result in

Patents 95

modest increments in peak expiratory flow (in the range of approximately 14%) over that achieved without assist and no change in total volume during the cough. Web site: http://www.delphion.com/details?pn=US05999855__ •

Method and apparatus of artifically stimulating cough reflex Inventor(s): Jaeger; Robert J. (548 N. Garfield, Hinsdale, IL 60521), Roth; Elliot J. (216 Carter Ct., Northbrook, IL 60062) Assignee(s): none reported Patent Number: 5,314,454 Date filed: April 2, 1992 Abstract: A method and apparatus for eliciting a physiologically significant cough reflex, such as in a quadriplegic patient. The apparatus preferably at least one pair of electrodes which are positioned about or near the abdominal muscles. A pushbutton switch is preferably used to generate an input signal. An oscillator is preferably used to generate a stimulus pulse signal. The input signal and the stimulus pulse signal are computed into an output signal. The output signal is transformed into a pulse electrical voltage which is delivered across each pair of electrodes. Such pulse electrical voltage activates the lower motor neurons and thereby contracts the abdominal muscles to elicit a physiologically significant cough reflex. Excerpt(s): This invention relates to a method and apparatus for artificially and electrically stimulating cough reflex for improving the life span of individuals with higher level spinal cord injuries, and perhaps other individuals with impaired cough. This invention is a neural prosthetic apparatus and method for artificially restoring the ability to volitionally cough in a higher level spinal cord injured individual. Pulmonary complications presently account for the majority of morbidity and morality of spinal cord injured individuals. Polatty, R. Crystal, M.D. et al., Pulmonary Complications in the Spinal Cord Injury Patient, Physical Medicine and Rehabilitation, Vol. 1, No. 3, p. 353-373, August 1987; and Reines, H. David, M.D. et al., Pulmonary Complications of Acute Spinal Cord Injuries, Neurosurgery, Vol. 21, No. 2, p. 193-196, 1987. Two elements contribute to the high incidence of pulmonary morbidity in patients with acute spinal cord injuries. First, there is a restrictive effect of spinal cord injury on pulmonary function, and second, there is morbidity associated with immobilization required in the management of these injuries as well as the diminished active mobility. Retention of secretions, atelectasis, and pneumonia are the most commonly occurring complications and can lead to premature death. Individuals with cervical spinal cord injuries are frequently impaired in their ability to cough. This deficit has traditionally been approached with the conventional assistive cough that requires physical assistance from a caregiver. Kirby, Nell A., R.N. et al., An Evaluation of Assisted Cough in Quadriparetic Patients, Archives of Physical Medicine & Rehabilitation, Vol. 47, p. 705710, 1966; and Braun, Sheldon R., M.D. et al., Improving the Cough in Patients with Spinal Cord Injury, American Journal of Physical Medicine, Vol. 63, No. 1, p. 1-10, 1984. It is likely that under these circumstances, the frequency of coughing in these individuals is reduced. Inability to cough is primarily due to paralysis of abdominal muscles. Web site: http://www.delphion.com/details?pn=US05314454__

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Method for mitigating pain when coughing following surgery Inventor(s): Gerhard; Harvey (416 Mt. Airy Rd., Basking Ridge, NJ 07920) Assignee(s): none reported Patent Number: 5,843,008 Date filed: December 10, 1996 Abstract: A device and method are provided for mitigating the pain experienced by a patient, after surgery to portions of the patient's torso, when the patient coughs, and for increasing the effectiveness of the patient's cough. The device may include a back portion and two wing portion for compressing a portion of the patient's torso with inward and downward forces. A vest shaped device is also possible. Methods are also described for use of the aforementioned devices. Excerpt(s): The present invention relates generally to devices and methods for mitigating the pain associated with surgical incisions, and particularly to devices and methods for compressing or constricting at least a portion of a patient's torso to mitigate the post-operative pain associated with surgical incisions, when a patient is coughing, as well as to improve the effectiveness of the patient's coughing. It is vitally important after surgery that a patient continually clear his or her trachea (i.e., airway) of phlegm or mucus to avoid clogging their airway. This clearing is generally accomplished by initiating and completing a cough. A physiological cough is generally initiated by a deep inspiration followed shortly by a forced expiration. The exparatory phase will occur against a closed glottis. This is known as the compressive phase of the cough. After a full inspiration, the thoracic muscles begin to compress the chest in order to provide pressure against the closed glottis. The glottis will then open, allowing for the rapid expiration of airflow. This is known as the expulsive phase of the cough. As one may readily imagine, a larger lung volume provides for better mechanical efficiency of the exparatory muscles during a cough. This is due, in part, to an improvement in the elastic recoil of the lungs, as well as increased mechanical leverage of the intercostal muscles and ribs. The effectiveness of a cough will depend, to a great degree, on the peak airflow that is generated. The greater the exparatory force of the intercostal muscles and ribs, the higher the peak airflow during a cough. Since the efficiency of a cough in clearing the airway is a function of the velocity of air passing through the airway, the greater the rate of exparatory airflow, the more effective the cough. An effective cough means one which clears a patient's airway of phlegm or mucus. Web site: http://www.delphion.com/details?pn=US05843008__

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Method of treating patients suffering from chronic pain or chronic cough Inventor(s): Kreek; Mary J. (New York, NY) Assignee(s): The Rockefeller University (New York, NY) Patent Number: 4,769,372 Date filed: June 18, 1986 Abstract: A method of treating patients in chronic pain or suffering from chronic cough over a prolonged period to provide systemic analgesia or central antitussive effect while simultaneously avoiding the onset of intestinal hypomotility. The method includes the oral administration to the patient of dosage units comprising in combination opioid

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analgesics or antitussives and selected opioid antagonists which are substantially devoid of systemic antagonist activity when administered orally. Excerpt(s): This invention relates to methods of treating patients suffering from chronic pain or chronic cough without provoking intestinal dysmotility. The treatment of patients suffering from severe, chronic pain or chronic cough presents a number of serious clinical difficulties. Narcotic or opioid analgesic agents, such as morphine, methadone, codeine, meperidine and oxycodone are often administered to such patients, e.g. patients suffering from progressive cancer, pulmonary diseases, degenerative joint disease and chronic abdominal pain. However, apart from other undesirable side effects of long-term opioid administration, it is well known that chronic usage of long-acting opioid analgesics results in severe constipation and other symptoms of intestinal hypomotility. Although it is believed that tolerance to the constipating effects of chronic narcotic administration does eventually develop, it develops extremely slowly. Indeed, development of tolerance may be of little significance in the case of many elderly or terminal patients because of the limiting time factors or because doses of analgesic must normally be increased as tolerance develops to their analgesic effects. The constipation and other symptoms of intestinal hypomotility caused by administration of opioid analgesics for chronic pain or cough not only create discomfort for the patient but may also complicate both the treatment program and the patient's underlying condition. In fact, chronic constipation may cause new health risks in and of itself, such as for cardiac patients and geriatric patients. Web site: http://www.delphion.com/details?pn=US04769372__ •

Patient-activated body immobilizer and method of use Inventor(s): Williams, Jr.; Glenn A. (795 Carmel Ave. #3, Sunnyvale, CA 94086) Assignee(s): none reported Patent Number: 4,641,642 Date filed: July 19, 1984 Abstract: A temporarily immobilizing harness is loosely positioned about the chest or other body part and closely spaced handles are squeezed using one or both hands to tighten the harness about the body. The harness is useful, for example, for restraining the chest against expansion during bouts of coughing or sneezing following open heart surgery. Excerpt(s): The present invention relates to a harness or restraint, and to a method of using same, for temporarily immobilizing a patient's chest cavity or abdomen (or other body part) to relieve the strain which orrurs, for example, during periods of chest expansion or other movement. Specifically, the harness of the invention (1) is designed to provide a comfortable, snug fit during periods of relaxation, yet (2) is readily gripped and tightened using one or both hands to firmly encase the body during periods of movement or expansion such as those caused by coughing or sneezing. The use of the harness involves squeezably engaging mating end grips to temporarily tighten the harness about the effected body part. Operations or injuries to the abdomen or upper body cavity frequently involve great trauma to muscle, tissue and/or bone. For example, merely gaining access to the heart cavity for heart surgery may involve cutting the sternum lengthwise using a power saw, in addition to cutting through tissue. This is in addition to the possibly extensive surgery to the heart muscle and connecting arteries and veins. After the operation, the sternum is wired together, but for approximately 3 to

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6 weeks, the patient suffers considerable pain. The pain is even worse when the patient moves, for example, when the chest expands during coughing or sneezing. Unfortunately, considerable congestion occurs during the recovery period and it is recommended that the patient cough as much as possible in order to remove fluid from the lungs, since post-operative pneumonia is a danger. Thus, the problem is that the patient must cough to avoid pneumonia, but coughing or sneezing causes excruciating pain due to the expansion of the chest cavity and the stress and strain on the healing sternum and tissue. Web site: http://www.delphion.com/details?pn=US04641642__ •

Powder filled cough product Inventor(s): Forester; Mark (8 Oak Park Dr., Convent Station, NJ 07961) Assignee(s): none reported Patent Number: 4,762,719 Date filed: August 7, 1986 Abstract: A cough drop is provided comprising a hard candy outer shell and a powdered centerfill containing a rapidly-dissolving powder such as dextrose monohydrate and an active ingredient such as menthol and eucalyptus which is preferably in the form of a liquid blend and a spray-dried powder. The hard candy outer shell also contains menthol and eucalyptus as a liquid blend.When the outer shell is dissolved in the mouth or the centerfill is bitten into, the rapidly-dissolving powder acts to enhance the active-ingredient's activity in the mouth so that a discernible vaporization of active-ingredient is felt. Excerpt(s): This invention is concerned with a cough drop having a center powder filling which permits the active-ingredients in the cough drop to be rapidly released, thus yielding a perceptible vaporization in the mouth. Cough drops are generally comprised of a hard candy matrix comprised of sucrose and corn syrup and active ingredients such as menthol and eucalyptus which are sealed in the hard candy matrix. As the hard candy matrix ages in the mouth the sucrose portion begins to crystallize or "grain" allowing some of the active ingredient to escape from the hard candy matrix. The present invention, on the other hand, provides a cough drop product which is center-filled with a fast-dissolving powder and active ingredient. When the cough drop outer shell is dissolved in the mouth or bitten to its center to expose the center-filling the fast-dissolving powder during dissolution in the mouth releases the active ingredient producing a markedly perceivable feeling of vaporization of active ingredient into the oral and nasal cavities. Web site: http://www.delphion.com/details?pn=US04762719__

Patents 99

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Process for the purification, solubilization and/or detoxification of protein antigens of bacteria of the Bordetella genus using a carbonate buffer and an acellular antiwhooping cough vaccine Inventor(s): Arminjon; Francois (Lyons, FR), Quentin-Millet; Marie-Jose B. (Villeurbanne, FR) Assignee(s): Institut Merieux (Lyons, FR) Patent Number: 4,774,086 Date filed: April 15, 1987 Abstract: A method for the purification, solubilization and/or detoxification of protein antigens of bacteria of the Bordetella genus involves the use of a carbonate buffer having a pH of 8.3 to 11.6. An acellular anti-whooping cough vaccine containing active principles in this carbonate buffer is also disclosed. Excerpt(s): The present invention relates to a process for purifying protein antigens of bacteria belonging to the Bordetella genus so as to obtain an acellular vaccine. It is known that the culture of bacteria of the Bordetella genus, for example, Bordetella pertussis, Bordetella parapertussis and Bordetella bronchiseptica produces the F-HA protein (Filamentous Hemagglutinin); also, the culture of B. pertussis yields an exotoxin protein: pertussis toxin (also called LPF or LPF-HA: Leukocytosis Promoting FactorHemagglutinin). The bacteria of the Bordetella genus are known pathogen agents. It is known in particular that Bordetella pertussis bacterium is the pathogen agent of whooping cough and that its industrial culture is used in the production of an antiwhooping cough vaccine. Web site: http://www.delphion.com/details?pn=US04774086__

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Process of making cough syrup with masked noscapine Inventor(s): Bianculli; Virgil D. (Fort Lauderdale, FL) Assignee(s): Fisons Corporation (Bedford, MA) Patent Number: 4,029,797 Date filed: June 20, 1973 Abstract: A process of utilizing the drug noscapine in a palatable cough syrup which masks the characteristic unpalatable taste of the drug comprising the steps of preparing an alkaline carrier and adding noscapine in a form which is a non-acidic solution, but rather in suspension which is finely dispersed. Excerpt(s): This invention relates to a process and the product of the process for making the taste of noscapine, a cough depressant, in a palatable cough syrup. In the past, the benefits of noscapine have been recognized as an effective antitussive or cough depressant. The problem has been, however, that noscapine in salt form is characterized by a bitter taste, rendering it unpalatable and for the most part unused in liquid form for treating persons with severe coughing spells. In the past, the usual procedure for processing noscapine has been to either use the salt of noscapine, which is a soluble compound in aqueous solution or to acidify the noscapine alkaloid base in order to render it more soluble by conversion to the salt; however, in either event, the characteristic bad taste remains in the resulting mixture or solution. The present invention has as a several object the provision of a method of formulation of noscapine to obtain a liquid suspension in which the noscapine is maintained in the alkaloid form,

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which is relatively tasteless, therefore resulting in a more palatable preparation for use in treating coughs. Web site: http://www.delphion.com/details?pn=US04029797__ •

Pulmonary sampling chamber Inventor(s): Blau; Anthony D. (314 W. 14th St., New York, NY 10014) Assignee(s): none reported Patent Number: 5,372,126 Date filed: September 14, 1992 Abstract: A pulmonary sample collection apparatus and method are provided for the sanitary collection of pulmonary sputum samples otherwise referred to as sputum induction, without allowing escape of infectious pathogenic microbes into the ambient air. The present invention is conveniently and safely usable in outpatient settings, such as doctors' offices and laboratories. The apparatus entirely encloses the patient in a chamber. The chamber is equipped with an air exchange blower which produces within the closed chamber controlled negative air pressure. The chamber is equipped with a replacable exhaust filter unit with which to trap airborne pathogens and other potentially harmful particles. The negative internal air pressure acts to facilitate sealing the chamber to prevent escape of substantially all airborne infectious particles from the chamber. The chamber is further provided with a novel hollow three terminal tube arrangement, one arm of which connects through an aperture in the chamber wall to an external aerosol source. The externally positioned aerosol source supplies a copious stream of cough inducing aerosol. A second cross arm of the novel three terminal tube, positioned within the chamber, is terminated in a disposable patient mouthpiece through which the patient inhales and exhales, and the remaining terminal of the three terminal tube is openly vented into the chamber. The patient situated within the negative air pressure of the sealed chamber breaths in a normal manner inhaling externally nebulized aerosol mist introduced through one terminal of the three terminal tube arrangement while coughing and exhaling only into the interior of the sealed chamber. The contaminated air within the chamber is cleared of pathogens and exhausted through disposable filters, the air within the chamber being changed rapidly many times per minute. Excerpt(s): Sputum induction [SI] is a technique for obtaining a deep sample of secretions from the lungs in a non-invasive manner for diagnostic purposes from patients who are unable to spontaneously expectorate such material on demand. The sputum can be examined in a variety of ways, according to the judgment of the clinician, for bacteria, fungi, viruses, parasites, or malignant cells. Alternatively, in recent years, patients undergo an invasive procedure known as fiber optic bronchoscopy in which a thin, flexible tube is guided into the patients lungs allowing for suctioning of material. Bronchoscopy is somewhat uncomfortable, costly, occasionally hazardous, time consuming and usually requires a hospital environment to be accomplished safely. Sputum induction is a long standing procedure traditionally used to obtain material to confirm the diagnoses of pulmonary tuberculosis, a bacterial infection of the lungs. It is also used to follow, in a serial manner, the effectiveness of therapy for this condition. Web site: http://www.delphion.com/details?pn=US05372126__

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Respiratory filter apparatus and method Inventor(s): Choate; Thomas V. (P.O. Box 87, East Sandwich, MA 02537) Assignee(s): none reported Patent Number: 5,253,641 Date filed: October 3, 1991 Abstract: A respiratory filter apparatus and method to reduce the risk of any transmission of airborne disease from a patient's respiratory effluent or sputum. The apparatus includes a housing having an air inlet and an air outlet, a motor blower to draw air into the inlet and to discharge air from the outlet, a high efficiency particulate filter within the housing to filter air between the air inlet and outlet, a flexible tube having a one and the other end, one end connected to the air inlet in the housing and the other end being a disposable, truncated face cone adapted to fit about the face of a patient, and optionally at the other end, a holder to hold a nebulizing fluid to be dispensed into the lungs of the patient whereby any respiratory effluent or sputum from the patient and nebulizing fluid are drawn into the disposable face cone by the air flow from the air inlet to the air outlet by reducing the germ transmission of disease by patient coughing to others, such as airborne tuberculosis. Excerpt(s): It has been reported that extensive airborne tuberculosis transmission is associated with the treatment of patients in the process of sputum induction. In particular, extensive TB transmission has been associated with the employment of pentamadine aerosol treatments. HIV-infected patients tend to be at an increased risk of reacting to tuberculosis by virtue of aerosol airborne transmission. The transmission of the diseases to unsuspecting infected patients and to medical staff is enhanced by the coughing induced by aerosol treatments, such as pentamadine, wherein a nebulizer is connected to a free standing air compressor to generate aerosol particles of the chemical. In addition, aerosols produced by sputum induction, bronchoscopy and suctioning patients with artificial airways also may lead to the airborne transmission of diseases to other persons and staff breathing the same air. Therefore, it is desirable to remove an infectious aerosol produced by patients and also to remove airborne drug particles which may be produced when patients are treated with aerosolized forms of drugs. Typically, the medical treatments involving enhanced coughing or aerosol drug treatment of patients is carried out in rooms of adequate fresh air ventilation so as to decrease the probability of transmission. However, adequate ventilation alone cannot eliminate the risk of airborne transmission. Other techniques include carrying out the procedures in high level, ventilated areas with the air exhausted safely to the outside with negative room air pressure relative to the outside together with properly installed and maintained UV lights and with extensive and regular treatments and testing of the staff for airborne disease infection. The hazards of airborne transmission and the occupational exposure for example to hepatitis B virus in human immunology and to other viruses has been recognized as a growing problem in occupational medicine, since the transmission of hepatitis or AIDS through sputum and saliva of a patient. One technique for reducing the risk of airborne transmission of disease is to provide a booth approach, such as a enclosed chamber, designed to remove any infectious aerosols produced by the coughing of a patient which booth usually comprises an enclosed chamber having a seat for the patient and a back panel wall against which the patient sits and includes a prefilter, a blower and a high efficiency particulate filter. The back panel includes on its back portion a UV tube light to enclose a duct-like space and whereby on activation of the air blower, the air is drawn through the prefilter into the chamber while the patient is undergoing the aerosol treatment up over the back panel

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and through the duct-like space and exposed to the UV rays and through the hepafilter and then discharged into the environment. Web site: http://www.delphion.com/details?pn=US05253641__ •

Snoring prevention apparatus Inventor(s): Thomas; Thomas (1110 Breezy Meadow La., Spencer, IA 51301) Assignee(s): none reported Patent Number: 5,988,170 Date filed: May 22, 1997 Abstract: A snoring prevention apparatus for depressing a person's tongue during sleep is provided which includes a base plate, a tongue depressing member, an opening through which air may flow and a flexible band or strap to secure the apparatus to the person's mouth. The tongue depressing member is preferably a substantially flat member that extends from the base plate for disposition against the upper surface of the tongue such that the person's tongue is depressed which opens the airway of the person and prevents snoring. The flexible band is connected to the base plate and is disposed against the person's head for maintaining the apparatus in place. The tongue depressing member is resilient and flexible between a first tongue depressing position and a second upper position such that the tongue depressing member flexes from the first position to the second position in response to a normal body function which requires the tongue to raise during sleep, such as swallowing, coughing or sneezing. After the body function is accommodated, the tongue depressing member flexes back to the first tongue depressing position. Excerpt(s): This invention relates generally to the field of snoring prevention devices. This invention relates more particularly to depressing the tongue as a means for treating snoring. Snoring is a condition that occurs during sleep when inhaled or exhaled air vibrates the soft palate, uvula and adjacent structures, thereby causing a loud noise. In extreme cases it can cause sleep apnea, a temporary cessation of breathing during sleep. A number of devices are known in the prior art to address the problem of snoring. Unfortunately, these devices have significant drawbacks in terms of comfort, durability, reliability and effectiveness. U.S. Pat. No. 5,046,512 to Murchie discloses an apparatus for treating snoring by regulating the air flow into the person's mouth. Unfortunately this device must be held by a person's teeth and can easily fall out of the mouth in the middle of the night. Also, in the event the person needs to swallow, cough or sneeze in the middle of the night the device will be dislodged from its functional location. Web site: http://www.delphion.com/details?pn=US05988170__

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Tracheostomy cannula Inventor(s): Fauza; Dario (Rua Marcond/e/ ssia No. 301, 04645 - Sao Paulo SP, BR) Assignee(s): none reported Patent Number: 4,791,920 Date filed: May 8, 1987 Abstract: The present invention relates to a tracheostomy cannula with a small balloon or cuff (2) positioned posteriorly (or cranially) to the tube (1) which is consequently

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shorter. This tube (1) has a collar (5) that encircles the tube on its proximal portion and prevents air leakage through the stoma. The "cuff" (2) also may communicate with the environmental air by means of conduits (6) that may be flexible. Since the component structures of a cannula so formed progress only a small distance caudally into the trachea, some complications, if not completely avoided, are better guarded against. Thus, there is when using the present invention less stimulus to a coughing reflex. Moreover, its cleaning and that of the trachea are simpler, and a tracheo-innominate fistula will rarely occur. Excerpt(s): The present invention relates to a tracheostomy cannula with the format and distribution of its components designed so as to prevent the so-called tracheoinnominate fistula and the smallest stimulus to the coupling reflex, and to allow the cannula to be easily cleaned. For a better understanding of the development of the present invention, it should be noted that many complications of a tracheostomy depend on irritations caused by the tube itself and/or by the small balloon. Thus, the longer the cannula tube, the greater the stimulus to coughing and the harder it is to clean both the cannula and the trachea. However, the greatest aggravating factor of such cannulas are the lesions to the trachea walls and/or to structures contiguous to the trachea which are produced by the possible compression exerted on these tissues by the tube, mainly in its caudal extremity and/or by the small balloon, especially if the pressure in the trachea's interior is very high. Such lesions range from a simple ischaemia to real perforations, with resulting secondary complications that are essentially obstructive, infectious and/or hemorrhagic. Among the latter can be noted the so-called tracheo-innominate fistual - an abnormal passage between the trachea and the innominate artery through such perforations. This fearful intercurrent process may cause severe hemorrhages which, when they do occur, lead to a case fatality rate of over 92%. Its occurrence is intimately related to the dimensions of the cannula: the longer it is, the greater the risk to the patient. This risk is already uncommonly high since the distance from the upper limit of the second cartilagineous trachial ring-cranial limit of the great majority of tracheostomies, up to the upper crossing point of the trachea with the innominate artery is, on the average for adults, about 3.3 cm, whereas the same distance measured on the cannula to its caudal extremity is approximately between 4 and 5.5 cm, as mentioned above. Another "inconvenience", not properly a complication, in the use of these tracheostomy cannulas of the prior art is the need for a tape to be fitted around the neck of the patient and tied to the proximal extremity of the cannula in order to hold and fix it in place. However, there is a known model on the North American market which, among other small improvements, does away with the use of tapes around the neck and lends itself to the prevention of this tracheo-innominate fistula. It consists of a simple tube placed between the skin of the neck and the anterior wall of the trachea, and it is fixed there by its proximal and distal edges. Since it does not progress caudally along the interior of the trachea, if it does not do away with, it greatly reduces the risk of the onset of this complication. This cannula only hides the tracheal stoma without, however, allowing the use of positive inspiratory pressure through artificial respirators, which renders its use impossible in various patients to be tracheostomized. Besides, it is difficult to remove them from the tracheal stoma and these may, although on a smaller scale, lead to infectious, obstructive or hemorrhagic complications. Web site: http://www.delphion.com/details?pn=US04791920__

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Trachostoma valve and tissue connector and housing for use as a part thereof Inventor(s): Verkerke; Gijsbertus Jacob (EP Haren, NL), Rakhorst; Gerhard (SN Groningen, NL) Assignee(s): Adeva Medical, Gesellschaft fur Entwicklung und Vertrieb von (DE) Patent Number: 5,765,560 Date filed: June 28, 1996 Abstract: A tracheostoma valve includes a shut-off valve member (1) capable of shutting off the valve in response to an egressive air thrust. The valve includes a blow-off valve member (2) of a design such that the valve can open in response to an overpressure in the trachea which exceeds a given value. This blow-off valve member limits the maximum achievable overpressure behind the valve. Coughing is possible without prior operation of the valve and leakage due to excessive overpressure in the trachea is prevented. The valve may contain a tissue connector and a housing to be connected thereto. Excerpt(s): The invention relates to a tracheostoma valve with a shut-off valve member capable of shutting off the valve in response to an air displacement. In patients with disorders involving the closure or at any rate a reduction of the connection between the trachea and the pharynx, it is known to have the trachea terminate at the throat via a stoma (opening in the skin). Such a connection of the trachea to the environment is for instance fitted in patients who have been treated for an extensive malignant tumor in the larynx by removing the larynx (including vocal chords and epiglottis) and in whom the trachea has been closed at the former larynx. Web site: http://www.delphion.com/details?pn=US05765560__

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Use of a cytochrome oxidase inhibitor to increase the cough-suppressing activity of dextromorphan Inventor(s): Smith; Richard A. (7569 Cabrillo Ave., La Jolla, CA 92037) Assignee(s): none reported Patent Number: 5,350,756 Date filed: May 28, 1992 Abstract: This invention discloses a method for increasing the effectiveness of dextromethorphan (DM) as an antitussive agent (i.e., as a cough suppressant). This method involves the concurrent administration of DM and a second agent which inhibits the oxidative activity of debrisoquin hydroxylase, a cytochrome P450 oxidase enzyme. Effective anti-oxidant compounds include quinidine, yohimbine, and fluoxetine. Excerpt(s): This invention relates to pharmacology, and to the use of dextromethorphan as a cough suppressant. Dextromethorphan (frequently abbreviated as DM) is the common name for (+)-3-methoxy-N-methylmorphinan. It widely used as a cough syrup, and is described in references such as Rodd 1960 (full citations to articles are provided below) and Goodman and Gilman's Pharmacological Basis of Therapeutics. Briefly, DM is a non-addictive opioid comprising a dextrorotatory enantiomer (mirror image) of the morphinan ring structure which forms the molecular core of most opiates. The coughsuppressing activity of DM is believed to be due primarily to its activity at a class of neuronal receptors known as sigma receptors. These are often referred to as sigma

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opiate receptors, but there is some question as to whether they are opiate receptors, so many researchers refer to them simply as sigma receptors, or as high-affinity dextromethorphan receptors. They are inhibitory receptors, which means that their activation by DM or other sigma agonists causes the suppression of certain types of nerve signals, apparently including the signals that mediate coughing. Web site: http://www.delphion.com/details?pn=US05350756__ •

Whooping cough vaccine comprising a fimbria protein Inventor(s): Mooi; Frederik Robert (Utrecht, NL) Assignee(s): De Staat der Nerderlanden Vertegenwoordigd Door de Minister Van Welzijn, (Rijswijk, NL) Patent Number: 5,798,103 Date filed: January 8, 1993 Abstract: The invention relates to acellular vaccines being effective against whooping cough and is based on a functional component of the fimbriae of Bordetella pertussis i.e. the actual adhesin molecule being a "minor" component in the fimbriae. The vaccines according to the invention have the advantage that both they may induce an effective immune respons against all B. pertussis strains and--most likely--also against Bordetella paratertussis being the second important causative agent of whooping cough. Further, the vaccines may also be used for veterinary applications, to protect against Bordetella bronchiseptica infections. Excerpt(s): The invention relates to a whooping cough vaccine. Whooping cough or pertussis is caused by two closely related bacteria, Bordetella pertussis and Bordetella parapertussis ›Preston N. W. (1988). Pertussis Today. In:Pathogenesis and Immunity in Pertussis (Eds. Wardlaw A. C., and Parton R.). John Wiley and Sons, 1-18!. B. pertussis is most frequently isolated from whooping cough patients (in 70 to 97% of the cases), so most research is focused on this organism. B. pertussis attaches to the ciliated cells of the respiratory tract, where it proliferates and produces a number of toxins. Locally, the infection results in destruction of the ciliated cells, which can result in obstruction of the respiratory tract, paroxysmal cough, apnoea and encephalopathy, sometimes accompanied by fever. Whooping cough can occur in any age group, however, morbidity is highest in the age group below 2 years. Although B. pertussis is sensitive for a number of antibiotics, treatment with antibiotics is generally not effective after whooping cough has been diagnosed, presumably because toxins produced by the bacteria have already damaged the respiratory tract. Thus prevention of whooping cough by means of vaccination is highly desirable. Web site: http://www.delphion.com/details?pn=US05798103__

Patent Applications on Coughing As of December 2000, U.S. patent applications are open to public viewing.9 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take

9 This

has been a common practice outside the United States prior to December 2000.

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several years.) The following patent applications have been filed since December 2000 relating to coughing: •

Bronchiopulmonary occulsion devices and lung volume reduction methods Inventor(s): Shaw, David Peter; (Christchurch, NZ) Correspondence: Stephanie Seidman; Heller Ehrman White & Mcauliffe; 7th Floor; 4350 LA Jolla Village Drive; San Diego; CA; 92122-1246; US Patent Application Number: 20030164168 Date filed: April 7, 2003 Abstract: Lung volume reduction is performed by the placement of a device (2) into a branch of the airway (34) to prevent air from entering that portion of lung. This will result in adsorption atelectasis of the distal portion of lung. The physiological response in this portion of lung is hypoxic vaso-constriction. The net effect is for a portion of lung to be functionally removed, i.e. a selected portion of lung is removed from both the circulation and ventilation. The build up of secretions is accommodated by using a valve (5, 15, 29) in the obstructive device, the valve opening upon coughing etc. Excerpt(s): The present invention relates to devices for bronchiopulmonary occlusion, inter alia for inducing lung volume reduction, and surgical procedures using such devices, including methods of lung volume reduction. Emphysematous lungs are characterised by abnormally large air spaces. Lung compliance characteristics are such that the lung is `too large` for its pleural cavity. Lung volume reduction surgery (LVRS) was developed as an intervention procedure to alleviate respiratory distress in a patient with a minimal reserve. In this procedure, a portion of less efficient lung is removed under general anaesthetic, allowing the remaining lung to expand. The net effect is, paradoxically to improve respiratory function by excising a section of lung. LVRS is associated with moderate mortality, approximately 5% and frequently high morbidity such as prolonged air leakage. To optimiise patient outcome, selection criteria are strict and an extensive pre- and postoperative physiotherapy programme is undertaken. The length of hospitalisation for the surgery and initial postoperative care can be in the order of threemonths. The intervention, as a whole, is a very expensive procedure and generally is7 not covered by insurance schemes. In the USA, this high cost has resulted in the procedure being substantially funded within FDA approved trials. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Cough depressant composition containing iron for angiotensin-converting enzyme inhibitor inducing cough Inventor(s): Hong, Kyung-Pyo; (Seoul, KR), Lee, Sang-Chol; (Kyungki-do, KR), Park, Seung-Won; (Seoul, KR) Correspondence: Alston & Bird Llp; Bank OF America Plaza; 101 South Tryon Street, Suite 4000; Charlotte; NC; 28280-4000; US Patent Application Number: 20030190372 Date filed: March 13, 2003 Abstract: The present invention relates to a cough depressant composition containing iron for angiotensin-converting enzyme inhibitor inducing cough. The cough depressant composition of the present invention comprises 0.01-100% by weight of Fe.sup.2+(ferrous) or Fe.sup.3+(ferric). Furthermore, the cough depressant composition

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of the present invention can comprise an angiotensin-converting enzyme inhibitor. The cough depressant composition of the present invention relieves the pain of the patient by reducing continuous dry cough. Excerpt(s): The present invention relates to a cough depressant composition containing iron for inhibiting a dry cough, more specifically a cough depressant composition containing iron to treat a dry cough shown in patients who take an angiotensinconverting enzyme inhibitor. Angiotensin is a material causing blood vessel contraction and blood pressure elevation in the body and is synthesized from angiotensinogen. Angiotensinogen converts to angiotensin I by renin that is synthesized in the kidney, angiotensin I converts to angiotensin II by an angiotensin converting enzyme (ACE) and angiotensin II has a very strong blood vessel contraction effect so that it elevates blood pressure. Angiotensin II maintains high blood vessel resistance in essential hypertension as well as hypertension accompanying high blood serum renin activity shown in renal artery stenosis, partial endogenous kidney diseases, and malignant hypertension. Thus, in order to treat hypertension, angiotensin -converting- enzyme inhibitor (`ACEI`) is used as a medication. The ACEIs are widely used for the treatment of hypertension and after-treatment of congestive heart failure and myocardial infarction. However, ACEI use is limited due to its various side effects, of which the most troublesome and frequent is persistent dry cough (Sebastian J L, McKinney W P, Kaufman J, Young M J. Angiotensin-converting enzyme inhibitors and cough. Prevalence in an outpatient medical clinic population. Chest 1991;99:36-9; Israili Z H, Hall W D. Cough and angioneurotic edema associated with angiotensin-converting enzyme inhibitor therapy. Ann Intern Med 1992;117:234-42; Simon S R, Black H R, Moser M, Berland W E. Cough and ACE inhibitors. Arch Intern Med 1992;152:1698-700). Dry cough has been reported to occur in 5 to 25% of patients that are subject to ACEI use and some of them have severe dry cough so that they stop taking the ACEIs (Sebastian J L, McKinney W P, Kaufman J, Young M J. Angiotensin-converting enzyme inhibitors and cough. Prevalence in an outpatient medical clinic population. Chest 1991;99:36-9). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Cough suppressant composition Inventor(s): Behzadpour, Mostafa K.; (San Rafael, CA) Correspondence: Kaardal & Associates, PC; Attn: Ivar M. Kaardal; Suite 250; 3500 South First AVE. Circle; Sioux Falls; SD; 57105-5802; US Patent Application Number: 20020081342 Date filed: December 26, 2000 Abstract: A cough suppressant composition for successfully treating coughs. The cough suppressant composition includes black pepper and at least one flavorant diluted in an aqueous solution. Excerpt(s): The present invention relates to a cough suppressant and more particularly pertains to a new cough suppressant composition for successfully treating coughs. The use of a cough suppressant is known in the prior art. More specifically, a cough suppressant heretofore devised and utilized are known to consist basically of familiar, expected and obvious structural configurations, notwithstanding the myriad of designs encompassed by the crowded prior art which have been developed for the fulfillment of countless objectives and requirements. Known prior art includes U.S. Pat. No. 5,376,374;

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U.S. Pat. No. 6,004,560; U.S. Pat. No. 5,035,882; U.S. Pat. No. 5,897,897; U.S. Pat. No. 5,736,144; and U.S. Pat. No. 4,311,720. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Cough treatment Inventor(s): Hull, John David; (Bracknell Berkshire, GB), Rennie, Paul John; (Godalming Surrey, GB) Correspondence: The Procter & Gamble Company; Intellectual Property Division; Winton Hill Technical Center - Box 161; 6110 Center Hill Avenue; Cincinnati; OH; 45224; US Patent Application Number: 20030104038 Date filed: January 6, 2003 Abstract: The present invention relates to methods and devices for treating cough, in particular in which a person in need of cough treatment is provided with a buccally adherent patch and is instructed to stimulate the patch when feeling a need to cough. The invention works through triggering natural physiological control mechanisms in human cerebral cortex to control the cough reflex. Excerpt(s): This is a continuation of International Application PCT/US01/20495 with an international filing date of Jun. 27, 2001. The present invention relates to methods and devices for treating cough, in particular in which a person in need of cough treatment is provided with a buccally adherent patch and is instructed to stimulate the patch when feeling a need to cough. Cough is a protective mechanism to guard the airways from irritants. However, pathological cough can be irritating, stressful and non-beneficial both physiologically and socially. People suffering from coughing commonly take cough syrups, drops or lozenges, for symptomatic relief. In some cases, prescription drugs may be used to control the symptoms. It is commonly accepted that coughing, and the throat irritation associated with it, can be treated by lubrication with sweet and viscous syrups. Thus, for example, cough drops or lozenges often contain sugar or honey. Active ingredients can also be incorporated into the syrups or lozenges. These active ingredients include, for example, antitussives, which can act to suppress the cough reflex, such as dextromethorphan and its hydrobromide salt; expectorants, such as guaifenesin, which make the cough more productive; and other agents such as coolants which may act by relieving the throat irritation, menthol, peppermint oil and the like are well known in this regard, other physiological coolants such as menthane carboxamides are also useful in this regard. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Development of an anti-cough, anti-tussive and throat soothing herbal formulation Inventor(s): Madhavan, Vijayakumar; (Uttar Pradesh, IN), Mehrotra, Shanta; (Uttar Pradesh, IN), Pushpangadan, Palpu; (Uttar Pradesh, IN), Raghavan, Govindarajan; (Uttar Pradesh, IN), Rao, Chandana Venkateshwara; (Uttar Pradesh, IN), Singh, Rawat Ajay Kumar; (Uttar Pradesh, IN) Correspondence: Merchant & Gould PC; P.O. Box 2903; Minneapolis; MN; 55402-0903; US Patent Application Number: 20040126441 Date filed: June 9, 2003 Abstract: An anti-cough, anti-tussive, and throat soothing synergistic herbal formulation comprising of an extract of Piper cubeba, Glycyrrhiza glabra, Acorus calamus Alpinia galanga, Zingiber officinale and pharmaceutically acceptable additives as a syrup, lozenges or chewable tablets for preventing cracking of voice, dryness of mouth and toning of voice, vocal cord; the present invention also provides a method of preparation of this formulation. Excerpt(s): The present invention relates to development of an anti-cough, anti-tussive and throat soothing herbal formulation(s). Anti-tussives are substances that specifically inhibit or suppress the act of coughing. Such inhibition may be due to (1) depression of medullary center or associated higher centers (2) increased threshold of periphery reflexogenous zones (3) interruption of tussal impulses in the afferent limb of cough reflex (4) inhibition of conduction along the motor pathways and (5) removal of irritants by facilitating bronchial drainage and mucociliary activity. Wide arrays of antitussive combinations are commercially available. The combinations can consist of two to four active ingredients and include any combination of an antitussive plus sympathomimetics, antihistamines, expectorants and/or analgesics. These cough products are very controversial and rarely offer an advantage. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Double-headed, closed-mouth cough suppressant and cold relief device Inventor(s): Huntley, James Benjamin; (Washington, DC) Correspondence: Arent Fox Kintner Plotkin & Kahn, Pllc; Suite 400; 1050 Connecticut Avenue, N.W.; Washington; DC; 20036-5339; US Patent Application Number: 20030077319 Date filed: October 18, 2001 Abstract: A double-headed, closed-mouth cough suppressant and cold relief device in which an individual having the symptoms of a cough is able to suppress the cough by inserting the device into an open mouth, and by sucking on one end of the device, is able to release a menthol medicament disposed within the device to thereby suppress a cough. Additionally, by sucking on another end of the device a eucalyptus medicament is released to thereby relieve a sore throat. By suppressing the cough, the device prevents the spread of germs to the immediate environment. Excerpt(s): Coughing is the body's way of getting foreign substances, phlegm and mucus out of the respiratory tract. Coughs are generally useful and preferably not eliminated. However, in many instances, coughs can be severe enough to impair breathing or prevent rest. Water and other liquids, such as fruit juice, have been

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traditionally used to soothe an irritated throat as a result of severe coughing. Liquids also moisten and thin the mucus in the throat so that it can be coughed up and expelled more easily. The cough suppressant controls or suppresses an irritating or nagging cough as it subdues the body's coughing reflex. Cough suppressants of the prior art include freestanding lozenges that can be removed from a wrapper and placed in the mouth. However, when a cough arises during the course of releasing the substance from the lozenge, the mouth naturally opens. As a result, the lozenge may be abruptly expelled from the mouth during a cough. In addition, germs are also released from the mouth during the resulting open-mouthed cough. Thus, current cough suppressants have the disadvantage of not preventing the spread of germs, and the tendency to be abruptly released from the mouth, and thereby becoming unsanitary and no longer usable. Liquid cough suppressants are contained within a bottle and contain a medicament in a fluid. The liquid is dispensed by means of cups or spoons. The bottle generally is available with a cap and a small cup into which a small dosage of the liquid is poured. After use, the bottle must be capped and the cup must be cleaned and placed back on the cap in an inverted position. As a result of the dispensable liquid cough suppressant of the prior art, it is generally difficult to make use of the bottle and liquid cough suppressant in an urgent situation, because a number of steps must be performed before and after the use of the liquid cough suppressant. It is also difficult to make use of the bottled liquid cough suppressant in a public venue as the user must be able to clean the cup, or risk the remaining fluid in the cup running down the side of the bottle when placed back in the designated location. Furthermore, those bottles that do not come with cups require spoons to dispense the medicament, also leading to an unsanitary and messy situation when used away from sanitizing facilities. Moreover, the liquid medicaments are prone to accidental spilling. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Herbal cough formulations and process for the preparation thereof Inventor(s): Doshi, Madhukat Mansukhlal; (Maharashtra, IN), Joshi, Milind Dattatraya; (Maharashtra, IN), Mody, Shirish Bhagwanlal; (Maharashtra, IN), Vasavada, Shashikant Avantilal; (Gujarat, IN) Correspondence: Lackenbach Siegel; One Chase Road; Scarsdale; NY; 10583; US Patent Application Number: 20030228383 Date filed: June 6, 2002 Abstract: The present invention relates to herbal composition for the treatment of chronic respiratory disorders such as cold, cough, allergic asthma, seasonal allergic rhinitis, pharyngitis, laryngitis and the like and a process for preparing the same. The composition comprises extracts derived from Ayurvedic plants selected from the following group: 1 Botanical name Quantity in % Ocimum sanctum 10-40% Glycerrhiza glabra 10-25% Curcuma longa 2-20% Zingiber officinale 1-10% Adhatoda vasika 10-25% Solanum indicum 1-10% Saussurea lappa 1-5% Piper cubeba 1-5% Terminalia belerica 110% Aloe barbadensis 10-30% Inula racemosa 2-10% Clerodendrum serratum 1-5% Solanum xanthocorpum 1-5% Pipper longum 1-5% Alpinia galanga 1-5% Terminalia chebula 5-15% Embelica officinalis 5-15%The process for preparing the herbal composition of the present invention comprises procuring, cleaning, grading of specified herbal plants as per the standard specification, disintegrating and pulverizing separately to form the coarse powder, then macerating individual powders separately with aqueous solution of preservatives and then extracting, filtering, concentrating and

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spray drying to make dry extract powder or semisolid soft extract. Further dissolving each of the extracts separately in aqueous solution containing preservatives and then allowing to maturate after mixing. Then adding filtered extracts to the sugar syrup containing preservatives, glycerin and appropriate excipients to obtain a homogenous cough syrup. The herbal composition of the present invention is non alcoholic, non sedating and non-freezing in nature and the process of preparation as described above does not employ pharmaceutically unacceptable organic solvents. Excerpt(s): The present invention relates to herbal formulation and a method for preparation thereof for providing treatment in chronic respiratory disorders such as cold, cough, allergic asthma, seasonal allergic rhinitis, pharyngitis, laryngitis, whooping cough and the like and which is non alcoholic, non sedating and non-freezing in nature. During the last two decades there has been an increasing interest in utilization of Indian Medicinal plants for treating chronic respiratory disorders as some of these plants are known to be used in traditional medicine for at least alleviating the symptoms associated with them. Ayurvedic System of Medicine originated in India more than 5000 years ago, utilizes the curative properties of plants for treating diseases. Ayurveda recognizes three different humors, Vata, Pitta and Kapha, which control the body metabolism. Vata controls all the movements of the body as it releases energy mainly from the catabolic reactions, while Pitta is responsible for the enzymatic reactions responsible for both anabolic and catabolic pathways. However, Kapha is responsible for anabolic reactions, which are responsible for all synthetic compounds deposited in the body. A harmonious working of the above three humors in a balanced manner is responsible for the optimum functioning of a healthy individual. Any imbalance in the harmonious working of the three humors leads to imbalance of body metabolism as well as body functions, which ultimately result, into different ailments. The primary purpose of Ayurvedic System of Medicine is to bring about a balanced state of three humors and to exert prophylactic or curative effects. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Non-target barge-in detection Inventor(s): Crane, Matthew D.; (Charlestown, MA), Holthouse, Mark Arthur; (Newtonville, MA), Nguyen, John Ngoc; (Arlington, MA), Phillips, Michael Stuart; (Belmont, MA), Springer, Stephen Richard; (Needham, MA) Correspondence: Hale And Dorr, Llp; 60 State Street; Boston; MA; 02109 Patent Application Number: 20030083874 Date filed: October 26, 2001 Abstract: A speech recognition system plays prompts to a user in order to obtain information from the user. If the user begins to speak, the prompt should stop. However, the system may receive sounds other than speech from the user while playing a prompt, in which case the prompt should continue. The system temporarily stops a prompt when it detects a sound or when it preliminarily determines that a detected sound may be a target sound (such as words from the user). The system then determines whether the received sound is a target sound or some other sound (such as coughing or a door shutting). If the received sound is not determined to be a target sound, then the prompt is resumed. The prompt can be resumed at any appropriate point, such as the point where it was stopped, a prior phrase boundary, or the beginning of the prompt.

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Excerpt(s): The invention relates to speech recognition and in particular to handling barge-in sounds in interactive voice recognition systems. Interactive Voice Recognition (IVR) systems interact with users by playing prompts and listening for responses from users. The systems attempt to recognize responses. Various actions can be performed in response to recognized speech. While a speech recognition system is playing a prompt for a user, sounds may be received by the system. These sounds are known as barge-in sounds or simply barge-in and can be from a variety of both target sources and nontarget sources. The target sources could be, for example, target speech sources, such as from the user that is interacting with the system. The non-target sources could be, for example, non-target speech (such as background speech from someone other than the user) or non-speech, such as the user making a noise such as coughing, a door shutting, and cars or other vehicles making traffic-related noises. These non-target sources may incorrectly be identified by the IVR system as an intended barge-in by the user, inhibiting the effectiveness of the IVR system. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Novel treatment for cough Inventor(s): Piomelli, Daniele; (Irvine, CA) Correspondence: MI K. Kim; Fish & Richardson P.C.; 4350 LA Jolla Village Drive, Suite 500; San Diego; CA; 92122; US Patent Application Number: 20020035150 Date filed: May 23, 2001 Abstract: The invention discloses the existence of cannabinoid receptors in the airways, which are functionally linked to inhibition of cough. Locally acting cannabinoid agents can be administered to the airways of a subject to ameliorate cough, without causing the psychoactive effects characteristic of systemically administered cannabinoids. In addition, locally or systemically administered cannabinoid inactivation inhibitors can also be used to ameliorate cough. The present invention also defines conditions under which cannabinoid agents can be administered to produce anti-tussive effects devoid of bronchial constriction. Excerpt(s): This application claims the benefit of priority under 35 U.S.C.sctn. 119(e) to U.S. Provisional Application No. 60/206,591, filed May 23, 2000. The aforementioned application is explicitly incorporated herein by reference in its entirety and for all purposes. This invention relates to pharmaceutical compositions for preventing the initiation of cough and methods for using the compositions for the treatment of cough. More particularly, the invention relates to the local administration of a therapeutically effective amount of a pharmaceutical composition comprising at least one direct or indirect cannabinoid receptor agonist to produce an anti-tussive effect without significant delivery of the agonist(s) to the systemic circulation. Administration of the main active constituent of the cannabis plant,.DELTA.sup.9-tetrahydrocannabinol (.DELTA.sup.9-THC), produces in animals and humans alleviation of cough and bronchospasm, which suggest a possible application of cannabis-like (cannabinoid) compounds for the treatment of cough. The potential therapeutic value of this observation is hindered, however, by two factors. First, the systemic administration of cannabinoid compounds produces significant psychoactive effects (for example, memory impairment, dysphoria, alteration in the perception of time, and habit formation). Second, some asthmatic patients who receive.DELTA.sup.9-THC respond to this compound with a paradoxical bronchial constriction. Therefore, there exists a need

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for compounds, or pharmaceutical preparations thereof, which can prevent or alleviate cough in animals and humans without producing significant psychoactive effects. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Plant extracts and alkaloids having antitussive activity Inventor(s): But, Paul P.H.; (Hong Kong, CN), Chung, Hoi Sing; (Hong Kong, CN), Dong, Hui; (Hong Kong, CN), Hon, Po Ming; (Hong Kong, CN), Lin, Ge; (Hong Kong, CN) Correspondence: Townsend And Townsend And Crew, Llp; Two Embarcadero Center; Eighth Floor; San Francisco; CA; 94111-3834; US Patent Application Number: 20030229071 Date filed: April 24, 2002 Abstract: The present invention provides plant extracts, isolated alkaloids, synthetic alkaloids and compositions having antitussive activity. In some preferred embodiments, the plant extracts and the isolated alkaloids are from a plant of a genus in the family Stemonaceae. In other preferred embodiments, the plant extracts and the isolated alkaloids are from a plant of the genus Stemona, Croomia, or Stichoneuron. In especially preferred embodiments, the plant extracts and the isolated alkaloids are from the plant Stemona tuberosa. The present invention further provides methods for isolating such plant extracts and alkaloids. In addition, the present invention provides methods for reducing or suppressing coughing by administering plant extracts, alkaloids and compositions having antitussive activity. Excerpt(s): This invention pertains to the field of plant extracts, isolated plant alkaloids, and synthetic alkaloids that have antitussive activity and which are useful as pharmaceutical agents for reducing or suppressing coughing. Coughing provides a means for clearing the tracheal and bronchial trees of a accumulated secretions and/or foreign bodies. The mechanism of coughing is initiated by an appropriate stimulus which elicits a deep inspiration, followed by closure of the epiglottis and relaxation of the diaphragm. Thereafter, a sharp muscle contraction against the closed epiglottis occurs, thereby, producing increased pressure in the intra-thoracic and intra-airway passages. The positive intra-thoracic pressure causes a narrowing of the trachea due to enfolding of its compliant posterior membrane and opens the epiglottis. When the epiglottis opens, the combination of the large pressure differential between the thoracic cavity and the atmosphere, coupled with the narrowing of the trachea, produces a massively increased rate of air flow through the trachea. The force created by this increased rate of air flow can effect the clearance of expectorate mucus and foreign materials from the airway. Coughing is caused by a variety of stimuli, including physiological, mechanical, or chemical stimuli. For example, coughing is produced by inflammatory mechanisms, mechanical disorders, and chemical and thermal stimulation. Also for example, inflammatory stimuli can be initiated by edema of the mucosal membranes. The edema, in turn, can be from any etiology, for example, bacterial or viral infection, the common cold, or excessive cigarette smoking. Inflammatory stimuli may also be elicited by irritation from exudative processes such as post-nasal drip and gastric reflux. Such stimuli may arise in the airways, for example as in laryngitis, bronchitis, pneumonia or an abscess in the lungs. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Speech communication apparatus Inventor(s): Miyamaru, Yukio; (Saitama, JP), Tabata, Hajime; (Saitama, JP) Correspondence: Birch Stewart Kolasch & Birch; PO Box 747; Falls Church; VA; 220400747; US Patent Application Number: 20020059064 Date filed: November 9, 2001 Abstract: A speech communication apparatus which is used with a microphone being fixed to a predetermined position in the vicinity of the mouth in such a manner as to prevent the transmission of uncomfortable noise such as sneezing, coughing or throatclearing noise to a partner. There is provided a speech communication apparatus including a speech communication microphone, a speaker and a communication unit for amplifying an output signal from the speech communication microphone, the speech communication apparatus includes the communication unit having an amplifier for amplifying an input signal and outputting the input signal so amplified, and a controller for controlling the gain of the amplifier in response to an excessive input signal, wherein the controller controls the gain of the amplifier such that a reproduced sound of an excessive input signal is reduced to a predetermined level only for a predetermined period of time when the excessive input signal is detected. Excerpt(s): The present application claims priority under 35 USC 119 to Japanese Patent Application No. 2000-343519 filed on Nov. 10, 2000 the entire contents thereof is hereby incorporated by reference. The present invention relates to a speech communication apparatus, and more particularly to a speech communication apparatus in which a speech communication microphone is mounted on a speech communicator in such a manner as to be fixed in the vicinity of the mouth of said speech communicator. A communication system (an intercom) is known in which in order to establish speech communication between a rider or a driver of a riding type vehicle such as a motorcycle and a passenger of said riding type vehicle a speaker or a rider or driver of another vehicle, a speech communication microphone and an electric contact between them are mounted in a helmet for the driver, the passenger and the driver of another vehicle, respectively, and a communication unit mounted on the vehicle side is connected to the helmet for the driver, the passenger and the driver of another vehicle, respectively. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Treatment of colds and cough with a combination of a cyclooxygenase-2 selective inhibitor and a colds and cough active ingredient and compositions thereof Inventor(s): MacMillan, Stephen P.; (Newtown, PA) Correspondence: Charles E. Dunlap; Keenan Building; Third Floor; 1330 Lady Street; Columbia; SC; 29201; US Patent Application Number: 20040029864 Date filed: February 4, 2003 Abstract: A method for the treatment, prevention and amelioration of colds and/or cough in a subject in need of such treatment, prevention and amelioration, comprises administering to the subject a cyclooxygenase-2 selective inhibitor or prodrug thereof and one or more colds and cough active ingredient. Compositions, pharmaceutical compositions and kits for practicing the method are also disclosed.

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Excerpt(s): The subject matter of the present invention is related to and claims the benefit of co-pending and commonly assigned U.S. Provisional Patent Application Serial No. 60/354,135, filed on Feb. 4, 2002, which application is hereby incorporated herein by reference in its entirety. The present invention relates to the treatment of colds and coughs, and more particularly to the treatment of colds and coughs by administering to a subject a combination of a cyclooxygenase-2 selective inhibitor and a colds and cough active ingredient. The common cold is an acute viral infection of the mucous membranes of the nose and throat, often involving the sinuses. The typical sore throat, sneezing, and fatigue can be accompanied by body aches, headache, low fever, and chills. The congested and discharging mucous membrane may become a fertile ground for s secondary bacterial infection that can spread to the larynx, bronchi, lungs, or ears. Uncomplicated infections usually last from three to ten days. 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 coughing, 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 “coughing” (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 coughing. You can also use this procedure to view pending patent applications concerning coughing. 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 6. BOOKS ON COUGHING Overview This chapter provides bibliographic book references relating to coughing. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on coughing 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: 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 Print®). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “coughing” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “coughing” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “coughing” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •

Codeine and Its Alternatives for Pain and Cough Relief (1923081) by N. B. Eddy; ISBN: 924056005X; http://www.amazon.com/exec/obidos/ASIN/924056005X/icongroupinterna

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European OTC cough and cold remedies markets: Companies explore niche opportunities as delisting redefines the industry; ISBN: 0788901419; http://www.amazon.com/exec/obidos/ASIN/0788901419/icongroupinterna

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French Cough Syrup by Jeff Cdtrpx 51209 Dahl; ISBN: 6304088957; http://www.amazon.com/exec/obidos/ASIN/6304088957/icongroupinterna

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Pediatric Cough and Fever by Hoffer; ISBN: 0683168614; http://www.amazon.com/exec/obidos/ASIN/0683168614/icongroupinterna

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Smoker's Cough (Linford Mystery Library) [LARGE PRINT] by Alan Sewart; ISBN: 0708968988; http://www.amazon.com/exec/obidos/ASIN/0708968988/icongroupinterna

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The 2000-2005 Outlook for Cough and Cold Remedies in the Middle East by Inc. Icon Group International; ISBN: 0757684211; http://www.amazon.com/exec/obidos/ASIN/0757684211/icongroupinterna

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The 2000-2005 World Outlook for Cough and Cold Remedies (Strategic Planning Series) by The Research Group, et al; ISBN: 0757652085; http://www.amazon.com/exec/obidos/ASIN/0757652085/icongroupinterna

Chapters on Coughing In order to find chapters that specifically relate to coughing, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and coughing 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 “coughing” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on coughing: •

Dysphagia Source: in Gines, D.J., ed. Nutrition Management in Rehabilitation. Frederick, MD: Aspen Publishers, Inc. 1990. p. 141-157. Contact: Available from Aspen Publishers, Inc. 7201 McKinney Circle, Frederick, MD 21701-9782-9782. (800) 638-8437 or (301) 417-7500. PRICE: $46. Summary: Dysphagia is defined as inability or difficulty in swallowing and is most commonly associated with neurologic or structural damage. The anatomy of the swallow, consisting of the action of 29 muscles and six cranial nerves is described, as are the four phases comprising swallowing action (oral preparatory, oral, pharyngeal, and esophageal). Conditions contributing to the development of dysphagia are presented, as are the signs and symptoms of the disorder. A group of health professionals, including a physician, speech/language pathologist, occupational therapist, dietitian, nurse, and radiologist, use a multidisciplinary approach to planning and implementing treatment of dysphagia. A detailed clinical evaluation is conducted and focuses on muscle control in the mouth, experiences in swallowing, eating, and coughing. In addition, a videofluoroscopic swallow evaluation is conducted. Methods of treating this disorder include: determining safest position for swallowing, dietary manipulation, and patient and family education. The dietitian's role is extremely important in treating patients with dysphagia, not only to monitor on-going nutritional status, but also to educate patients and their families on dietary practices that are the most feasible. 5 figures, 2 tables, 7 references.

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Stress Urinary Incontinence Source: in Seal, G.M. Patient's Guide to Urology: Plumbing Problems in Layman's Terms. Toledo, OH: High Oaks Publishing Company. 1995. p. 79-90. Contact: Available from bookstores and libraries and, at the wholesale level, from Baker and Taylor, (908) 722-8000. Also available in orders of 10 or more copies from High Oaks Publishing Company, Center Urology of Toledo, Inc. 3425 Executive Parkway, Suite 214,

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Toledo, OH 43606. (419) 531-1700. PRICE: $21.95 (cloth); $12.95 (paperback). ISBN: 0964577305 (cloth), 0964577313 (paper). Summary: In this chapter, from a patient's guide to urology, the author discusses stress urinary incontinence, or urine leakage associated with coughing, lifting, and straining. After the presentation of two case studies, the author discusses patient evaluation, including diagnostic tests such as urodynamics; and treatment regimens in three categories: behavior modification, medication, and surgery. The author notes that these treatment options allow a progressive treatment based upon the severity of the condition and the particular type of bladder and support which the patient possesses. The book concludes with a detailed glossary and brief subject index. 3 figures. •

Leak Point Pressure Source: in Corcos, J.; Schick, E., eds. Urinary Sphincter. New York, NY: Marcel Dekker, Inc. 2001. p. 303-310. Contact: Available from Marcel Dekker, Inc. Cimarron Road, P.O. Box 5005, Monticello, NY 12701. (800) 228-1160 or (845) 796-1919. Fax (845) 796-1772. E-mail: [email protected]. International E-mail: [email protected]. Website: www.dekker.com. PRICE: $225.00 plus shipping and handling. ISBN: 0824704770. Summary: Leak point pressure (LPP) is the value of bladder detrusor pressure when urine leakage occurs, in the absence of a rise in abdominal pressure (such as that which may occur during coughing, sneezing, or lifting). If the patient is straining or coughing to provoke urine leakage, the test is called Valsalva leak point pressure (VLPP) or cough leak point pressure (CLPP), respectively. This chapter on LPP is from a textbook that presents a detailed and systematic account of the current knowledge on the anatomy, physiology, functional relationships, and range of dysfunctions that affect the urinary sphincter. The authors stress the importance of adequate patient prepartion; LPP measurement is usually done during urodynamic testing, after cystometrography with an interurethral catheter. Catheter size significantly affects LPP results. Examination can be done in a supine (lying down), sitting, or standing position. Several study conditions have to be specified when reporting LPP: the position of the patient, type of LPP, bladder volume in milliliters or percentage of maximal cystometric capacity, location and type of pressure transducer, type of catheter, and proving maneuvers. LPP can be used to help assess neurogenic bladder, stress urinary incontinence (SUI) in women, urinary diversion functioning, and incontinence in men. The authors conclude that LPP testing is useful in evaluating patients with suspected intrinsic sphincteric deficiency (ISD), and in monitoring or predicting treatment outcomes. As with any urodynamic test, however, LPP results have to be interpreted in conjunction with the patient's clinical status. 1 figure. 46 references.

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Intravaginal and Intraurethral Devices for Stress Incontinence Source: in Corcos, J.; Schick, E., eds. Urinary Sphincter. New York, NY: Marcel Dekker, Inc. 2001. p. 535-540. Contact: Available from Marcel Dekker, Inc. Cimarron Road, P.O. Box 5005, Monticello, NY 12701. (800) 228-1160 or (845) 796-1919. Fax (845) 796-1772. E-mail: [email protected]. International E-mail: [email protected]. Website: www.dekker.com. PRICE: $225.00 plus shipping and handling. ISBN: 0824704770. Summary: Recent technological advances and the adaptation of products that have traditionally been employed for other purposes have provided interesting options for

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the nonsurgical management of urinary loss in female patients. These devices include those that are placed externally to the urethral meatus (outside the urinary opening), and accomplish urinary collection; intravaginally beneath the bladder neck, and give anatomical support; or outside or within the urethra, and occlude the exit of urine either at the external meatus or within the urethra. This chapter on intravaginal and intraurethral devices for stress incontinence (involuntary loss of urine in conjunction with a stress such as coughing, sneezing, or laughing) is from a textbook that presents a detailed and systematic account of the current knowledge on the anatomy, physiology, functional relationships, and range of dysfunctions that affect the urinary sphincter. The authors report that many devices currently in use have not been investigated objectively, especially those employed traditionally for other purposes. The most common external collection devices are diapers, pads, and incontinence pads. Several occlusive devices are currently marketed, but their success and presence in the peer reviewed literature are limited. Support of the bladder neck to improve stress urinary incontinence has been achieved, with varying degrees of success, with tampons, pessaries, contraceptive diaphragms, and intravaginal devices not specifically designed for such support. Again, the research data to support the use of these devices is limited and of varying quality. Intraurethral inserts have demonstrated their effectiveness in the control of urinary incontinence. However, the morbidity (complications, problems) associated with their use varies with the design. The authors conclude by calling for more long term outcome research to identify which device or devices provide optimal convenience and effectiveness and the lowest morbidity in the nonsurgical correction of genuine stress incontinence. 26 references. •

Gilles de la Tourette Syndrome Source: in Gilbert, P. A-Z Reference Book of Syndromes and Inherited Disorders. 2nd ed. London, England: Chapman and Hall. p. 134-136. Contact: Available from Singular Publishing Group, Inc. 401 West 'A' Street, Suite 325, San Diego, CA 92101-7904. (800) 521-8545 or (619) 238-6777. Fax (800) 774-8398 or (619) 238-6789. E-mail: [email protected]. Website: www.singpub.com. PRICE: $42.95 plus shipping and handling. ISBN: 0412641208. Summary: This chapter on Gilles de la Tourette syndrome is from a practical reference book that describes inherited disorders and syndromes in both children and adults. Tourette syndrome features motor and vocal tics, obsessive behavior, and reduced attention span. Vocal tics can include coughing, sneezing, sucking, throat-clearing, sniffing, and other unusual noises. At times, the involuntary shouting of inappropriate words or phrases, including obscenities, can make life extremely difficult for parents and companions of the affected child. Topics include alternative names for the condition, incidence, history, causation, characteristics, management implications, prognosis, and self-help groups. Education for these children may be necessary in a small unit, where a variety of difficult behavior patterns can be contained. The chapter concludes with a list of support groups and organizations that can be found in England.

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Spasmodic Dysphonia Source: in Sataloff, R.T., ed. Professional Voice: The Science and Art of Clinical Care. 2nd ed. San Diego, CA: Singular Publishing Group, Inc. 1997. p. 499-505. Contact: Available from Singular Publishing Group, Inc. 401 West 'A' Street, Suite 325, San Diego, CA 92101-7904. (800) 521-8545 or (619) 238-6777. Fax (800) 774-8398 or (619)

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238-6789. E-mail: [email protected]. Website: www.singpub.com. PRICE: $325.00 plus shipping and handling. ISBN: 1565937287. Summary: This chapter on spasmodic dysphonia is from a book on the clinical care of the professional voice. Spasmodic dysphonia is a dystonia characterized by spasm during phonation. Many types of interruptions in vocal fluency are incorrectly diagnosed as spasmodic dysphonia. Spasmodic dysphonia is encountered only occasionally in professional voice users, but can be quite debilitating when it does occur. Generally considered a focal laryngeal dystonia, the severity of spasmodic dysphonia varies substantially among patients and over time. In many cases, the voice may be normal or more normal during laughing, coughing, crying, or other involuntary vocal activities or during singing. Topics include diagnostic strategies, treatment options including the use of botulinum toxin (Botox), and the problem of respiratory dystonia. Voice therapy reduces the effort of speaking and counterproductive compensation. 2 tables. 25 references. •

Transabdominal Procedures for the Treatment of Stress Urinary Incontinence Source: in Carlin, B.I. and Leong, F.C., eds. Female Pelvic Health and Reconstructive Surgery. New York, NY: Marcel Dekker, Inc. 2003. p. 121-136. Contact: Available from Marcel Dekker, Inc. 270 Madison Avenue, New York, NY 10016. (212) 696-9000. Fax (212) 685-4540. Website: www.dekker.com. PRICE: $185.00 plus shipping and handling. ISBN: 0824708229. Summary: This chapter on transabdominal procedures for the treatment of stress urinary incontinence (SUI) is from a textbook that provides comprehensive, authoritative coverage of female pelvic health and reconstructive surgery. If the patient is continent at rest (sitting or lying down), the ideal treatment will be to simulate this situation while the patient is active (walking, coughing, sneezing, etc.). Transabdominal procedures can achieve this by stabilizing the anterior vaginal wall and, especially, the tissue next to and around the urethra. Starting with the Kelly plication, this chapter follows the evolution from the Marshall-Marchetti-Kranz (MMK) to the Burch procedure, along with some of its common modifications, and ends with a description of the paravaginal repair. While success rates vary from one operation to another, surgical technique is a factor in the eventual outcome of a procedure, making comparison between two different approaches difficult. With the advent of better surgical instruments and materials, and better understanding of the physiology of incontinence, overall success rates in the range of 85 to 95 percent can be expected. 10 figures. 36 references.

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Management of Vocal Hyperfunction Source: in Stemple, J.C. Voice Therapy: Clinical Studies. St. Louis, MO: Mosby-Year Book, Inc. 1993. p. 18-75. Contact: Available from Mosby-Year Book, Inc. 11830 Westline Industrial Drive, P.O. Box 46908, St. Louis, MO 63146. (800) 426-4545; Fax (800) 535-9935; E-mail: [email protected].; http://www.mosby.com. PRICE: $33.95 plus shipping and handling. ISBN: 0801647630. Summary: This chapter, from a textbook on clinical voice therapy, discusses the management of vocal hyperfunction. Many voice disorders and associated laryngeal pathologic conditions are caused by hyperfunction of the laryngeal mechanisms. This hyperfunction can be simply behavioral, causing harmful mechanical impact to the

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tissue lining of the vocal folds; examples include shouting, loud talking, screaming, vocal noises, coughing, throat clearing, and inappropriate singing technique. Inappropriate use of the components of voice production such as respiration, phonation, resonation, pitch, loudness, and rate may also lead to a hyperfunctional voice disorder. The author discusses management approaches for vocal nodules, contact ulcer, vocal polyps, vocal fold edema or erythema, vocal abuse and misuse, pitch modification, loudness modification, glottal fry phonation, poor breath support, low tone focus, chronic throat clearing, vocal psychodynamics, and laryngeal tension. The author explores a variety of management strategies including vocal hygiene counseling, environmental manipulation, changing pitch and loudness, vocal function exercises, reduction of caffeine, hydration program, esophageal reflux treatment, elimination of chronic throat clearing and coughing, patient and parent education, modification of children's vocal noises, ear training, charting for behavior modification, psychosocial communication strategies, respiratory training, tension reduction and relaxation, easy phonation onset, inflection training, increasing articulatory precision, voice use journal, voice time out or recovery time, accent method, and instrumental biofeedback. The chapter utilizes case studies extensively. 13 figures. 4 tables. 49 references. (AA-M). •

Abdominal Approaches to Surgery for Female Incontinence Source: in Graham, S.D., Jr., et al., eds. Glenn's Urologic Surgery. 5th ed. Philadelphia, PA: Lippincott Williams and Wilkins. 1998. p. 319-327. 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: Urinary incontinence in women is common. This chapter on abdominal approaches to surgery for female incontinence is from an exhaustive textbook on urologic surgery. The incidence of urinary incontinence rises after vaginal delivery, apparently as a result of nerve stretch, which can also occur after prolonged straining from constipation. The second major cause of urinary incontinence is detrusor instability, characterized by the occurrence of detrusor contractions during the filling phase or provoked by coughing or posture change. Detrusor instability is often associated with symptoms of frequency, nocturia, urgency, and urge incontinence. Urinary incontinence can be classified on the basis of radiologic findings and the degree of bladder base descent. If conservative measures have not succeeded, patients who have genuine stress incontinence, who are bothered by the symptom, and who are appropriate candidates should be offered surgery. The authors detail the surgical techniques used, including Burch colposuspension, the Marshall Marchetti Krantz procedure, suburethral slings, laparoscopic Burch colposuspension, and anticipated outcomes. Urethral obstruction after successful surgery occurs in about 10 percent of cases. Postoperative voiding difficulties may be predicted by preoperative voiding problems. Dyspareunia (pain during sexual intercourse) following pelvic floor surgery is not uncommon. The authors caution that obtaining information about the true results of this surgery can be difficult. Patients with persistent or recurrent urinary incontinence should be thoroughly reassessed. 5 figures. 3 tables. 12 references.

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Genuine Stress Incontinence: An Overview Source: in Ostergard, D.R. and Bent, A.E., eds. Urogynecology and Urodynamics: Theory and Practice. Baltimore, MD: Williams and Wilkins. 1996. p. 493-504.

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Contact: Available from Williams and Wilkins. 351 West Camden Street, Baltimore, MD 21201-2436. (800) 638-0672 or (410) 528-4223. Fax (800) 447-8438 or (410) 528-8550. E-mail: [email protected]. PRICE: $112.00. ISBN: 068306648X. Summary: Urinary incontinence, whether present in the elderly or young woman, can have devastating effects on self-esteem, psychological well being, and overall physical health. This chapter on genuine stress incontinence is from a textbook on urogynecology and urodynamics that is designed to promote a more active role for the obstetrician, gynecologist, urologist, and other physicians in the evaluation of the female lower urinary tract. This chapter provides an overview of genuine stress incontinence, defined as a symptom, a sign, and a condition. The symptom is the patient's complaint of involuntary urine loss with physical exercise. The sign is the observation of urine loss from the urethra immediately upon increasing intra-abdominal pressure (e.g., coughing). The condition genuine stress incontinence is the involuntary loss of urine that occurs when intravesical pressure exceeds maximal urethral pressure in the absence of detrusor activity. The authors provide a historical background, then discuss the mechanism of continence, the urodynamic assessment of stress incontinence, the mechanism of stress incontinence, the scope of the problem, the diagnosis of stress incontinence, and management indications. The primary components that prevent urinary stress incontinence in the female include an internal urethral sphincteric mechanism, an external urethral sphincter, and proper anatomic support of the urethra and urethrovesical junction. Genuine stress incontinence is a consequence primarily from a defect in pelvic support of the urethrovesical junction. Individualized therapies directed toward these defects can correct or improve urodynamically measured parameters that correlate with stress incontinence. 2 figures. 2 tables. 50 references. (AAM).

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CHAPTER 7. MULTIMEDIA ON COUGHING Overview In this chapter, we show you how to keep current on multimedia sources of information on coughing. 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 coughing is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “coughing” 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 “coughing” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on coughing: •

AIDS: A Nursing Perspective Contact: University of Iowa Hospitals and Clinics, Department of Nursing, Medicine/Nursing Division, University of Iowa, Iowa City, IA, 52242, (319) 356-8133. Summary: From this videorecording, nurses learn about the importance of providing humane care to persons with Human immunodeficiency virus (HIV) infection or Acquired immunodeficiency syndrome (AIDS). The narrator, JoAnne Bennett, a registered nurse, begins by saying that to understand nursing care for Persons with AIDS (PWA's), it is necessary to understand the disease itself. She gives background information on how HIV destroys the immune system, explains transmission, and discusses risky behaviors. The use of condoms and sterilization of needles as HIVprevention methods are explained. She emphasizes that HIV cannot by spread by casual contact in hospital settings, and says that the primary purpose of infection control is to isolate the pathogen and not the patient. Nurses are told to follow standard sterilization procedures, the most important of which is handwashing. She suggests other infectioncontrol procedures, which follow the guidelines issued by the Centers for Disease

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Control and Prevention (CDC). These include placing patients in private rooms if they do not follow proper hygiene, or if they have pulmonary tuberculosis; wearing masks around a coughing patient; wearing gowns when there is a likelihood of clothes becoming soiled; wearing gloves whenever there is a likelihood of touching blood or other body fluids, and washing hands immediately after removing them; disposing of all sharps, especially syringes; placing linens and lab specimens in special containers; wearing protective eyewear whenever splattering is likely; and sterilizing all instruments and equipment. The videorecording suggests not placing PWA's in rooms with patients with other communicable diseases, for the PWA's protection. It also says that HIV-infected health-care workers may be removed from patient care for their own protection from the patients' illnesses. •

Universal Precautions for Health - Care Workers Contact: Syntex USA, Incorporated, Public Policy Department, 3401 Hillview Ave, A1290, Palo Alto, CA, 94304, (415) 855-5048. Summary: This videorecording answers questions about Acquired immunodeficiency syndrome (AIDS) and provides an overview of a new approach to infection control. The basic concept of Body Substance Precautions is the treatment of all body fluids as infectious; this protects patients as well as health-care workers. After giving some background information on the Human immunodeficiency virus (HIV), the videorecording says that blood is the only body fluid known to have transmitted HIV in a hospital setting. Since HIV is fragile, it is killed by routine hospital disinfection, and it is not transmitted by casual contact. Hepatitis B is much more infectious than HIV, and although it is not usually fatal, about 200 health-care workers die each year from liver complications. Therefore, all health-care workers should be vaccinated against Hepatitis B. The videorecording also says that health-care workers should take care not to carry infections from one patient to another. The infection-control procedures are outlined. They include using gloves whenever body fluid contact is possible; discarding all needles and other sharps promptly; washing hands before and after each contact with patients or specimens; wearing gowns whenever clothing might become soiled; wearing masks near coughing patients; using eyewear whenever a spray of blood, or other body fluids, is possible; never reaching into garbage; and cleaning and disinfecting all spills. However, the videorecording emphasizes, fear should not lead to the use of overprotection.

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How to Stay Dry: Seven Activities You Can Do to Stay or Become Dry Source: Milwaukee, WI: University of Wisconsin-Milwaukee School of Nursing. 1995. (videocassette). Contact: Available from Health Sciences Consortium. Distribution Department, 201 Silver Cedar Court, Chapel Hill, NC 27514-1517. (919) 942-8731. Fax (919) 942-3689. Email: [email protected]. PRICE: $195.00 (nonmembers) or $146.25 (members). HSC catalog number N951-VI-072. Summary: This videotape program is designed to help adults with urinary incontinence reduce or eliminate the possibility of a wetting accident. The viewer is introduced to seven activities that have been proven to help incontinence, none of which involve the use of instruments or medical procedures. The suggestions are to make environmental feature adjustments, such as using a raised toilet seat and wearing easy-to-remove clothing; drinking adequate liquids; making dietary changes for constipation, such as adding bran or prunes to the diet; emptying the bladder five to eight times daily;

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exercising the pelvic floor muscles as described in the program; stopping smoking, as coughing can cause wetting accidents; and taking vitamin E and vitamin B complex. (AA-M).

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CHAPTER 8. PERIODICALS AND NEWS ON COUGHING Overview In this chapter, we suggest a number of news sources and present various periodicals that cover coughing.

News Services and Press Releases One of the simplest ways of tracking press releases on coughing 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 “coughing” (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 coughing. 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 “coughing” (or synonyms). The following was recently listed in this archive for coughing: •

High BMI associated with wheeze and cough in children Source: Reuters Medical News Date: December 10, 2003

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UK's Celltech gets US approval for cough treatment Source: Reuters Industry Breifing Date: June 23, 2004

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Classic asthma is common in children with cough variant asthma Source: Reuters Medical News Date: July 03, 2003 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 “coughing” (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 “coughing” (or synonyms). If you know the name of a company that is relevant to coughing, 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 “coughing” (or synonyms).

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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 “coughing” (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 coughing: •

When Exercise Takes Your Breath Away Source: University of California, Berkeley Wellness Letter. 20(1):6. October 2003. Contact: Health Letter Associates, P.O. Box 412, Prince Street Station, New York, New York. 10012-0007. www.wellnessletter.com. Summary: About 10 percent of Americans are affected to some degree by exerciseinduced asthma (EIA). Symptoms include tightness in the chest, shortness of breath, coughing, and wheezing. Symptoms usually begin during exercise or within 20 minutes following exercise. Aerobic exercise, such as running, is likely to set off an attack, particularly when the air is dry and cold. Some people can continue to exercise after an EIA attack is over, but others have to end their workout or take medication. Some individuals get discouraged or scared and give up on exercise. Reasons why EIA occurs are reviewed in the article, as are the advantages and disadvantages of swimming with EIA. Strategies for exercising with EIA are provided.

•

When BOTOX Doesn't Work Source: NSDA Newsletter. National Spasmodic Dysphonia Association Newsletter. 10(1): 10-11. January 2001. Contact: Available from National Spasmodic Dysphonia Association. 1 East Wacker Drive, Suite 2430, Chicago, IL 60601. (800) 795-6732. Fax (312) 803-0138. Summary: In this newsletter article, an otolaryngologist answers readers questions about the clinical use of BOTOX (botulinum toxin) for spasmodic dysphonia, focusing on strategies to undertake when botulinum therapy seems to fail. The author first encourages readers to clarify what they mean when they think the drug has 'failed' for them, noting the differences between no effects at all, and effects that are less than desirable or unacceptable. The author then describes the reasons that may explain each of these situations. In patients who experienced no effect at all from the injection, the author postulates three explanations: miss of the target muscle, immunity to BOTOX, and marked insensitivity to BOTOX. The author then describes patients who get some response, but cannot tolerate the side effects, which include initial breathiness, coughing on liquids, and shortness of breath. The author concludes that BOTOX therapy provides dramatic benefit to the majority of persons with spasmodic dysphonia and encourages patients to work closely with their health care team when difficulties are encountered. 1 reference.

•

Surgery for Stress Urinary Incontinence Source: Informer, The. 14(1): 1,3. Fall 2002.

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Contact: Available from Simon Foundation for Continence. P.O. Box 835-F, Wilmette, IL 60091. (800) 23SIMON or (800) 237-4666 or (847) 864-3913. Fax (847) 864-9758. E-mail: [email protected]. Website: www.simonfoundation.org. Summary: Stress urinary incontinence (SUI) is the uncontrolled loss of urine caused when abdominal pressure overrides the closure mechanism of the bladder, allowing urine to leak out. Most women experiencing this type of leakage do so when coughing, sneezing, laughing, exercising, or lifting. One of the treatment options for SUI is surgical correction of this loss of support. This article describes this type of surgery, noting that a thorough evaluation needs to be done before surgery to consider non-surgical options and design the best surgical procedure if surgery is the treatment of choice. Topics include the goals of surgery, the surgical procedures that may be used, other support problems, what to expect after surgery, and the importance of making an informed choice about surgical options. •

Understanding Biofeedback Source: Informer, The. 14(1): 2. Fall 2002. Contact: Available from Simon Foundation for Continence. P.O. Box 835-F, Wilmette, IL 60091. (800) 23SIMON or (800) 237-4666 or (847) 864-3913. Fax (847) 864-9758. E-mail: [email protected]. Website: www.simonfoundation.org. Summary: This brief article explains how biofeedback can be useful for patients coping with urinary incontinence. Kegel exercises may be prescribed to strengthen the pelvic floor muscles and help the closure mechanism of the bladder to protect from stress urinary leakage when sneezing, coughing, or lifting. These exercises also help relieve urgency and urge incontinence symptoms. Many people have difficulty learning these exercises successfully, because of weakness, disuse, and injury. Biofeedback can help identify the correct muscles, determine the degree of weakness in order to prescribe an exercise level, and determine that the exercises are being done correctly. Biofeedback measures pelvic muscle activity and translates this activity into images on a computer screen, or into light or sound. This visual or auditory feedback allows the patient to learn to perform pelvic muscle exercises properly. The article covers how biofeedback works, how biofeedback can be used to improve incontinence, biofeedback for stress urinary incontinence, biofeedback for urge incontinence, and when to expect results.

•

New Approaches to Stress Incontinence Source: Harvard Women's Health Watch. 4(2): 7. October 1996. Contact: Available from Harvard Women's Health Watch. P.O. Box 420234, Palm Coast, FL 32142-0234. (800) 829-5921. Summary: This brief newsletter article reports on two recently approved devices for managing stress incontinence. Stress incontinence is the leakage of urine caused by increased pressure on the bladder from laughing, coughing, or exertion. Both devices are expected to be available by prescription within the next few months. The Miniguard, which received FDA clearance in May 1996, is a contoured adhesive-backed foam patch about the size of a postage stamp that fits over the opening of the urethra. The Reliance Urinary Control Insert, which was approved by the FDA in August 1996, is designed for women who have moderate to severe incontinence. It is a balloon-tipped plug about one-fifth the diameter of a tampon that is inserted into the urethra with an applicator. The force of insertion inflates the balloon so that it obstructs the neck of the bladder. The

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device should be removed and discarded before intercourse or urination by pulling the string. •

Pelvic Muscle Exercises with Vaginal Weight Therapy Source: Quality Care. 15(3): 7. Summer 1997. Contact: Available from National Association for Continence. P.O. Box 8310, Spartanburg, SC 29305-8310. (800) 252-3337 or (864) 579-7900. Fax (864) 579-7902. Summary: This newsletter article describes the use of vaginal weight therapy with pelvic muscle exercises in the treatment of stress urinary incontinence (UI). Stress incontinence is the leakage of urine when pressure from inside the body is exerted on the bladder. Most people with stress incontinence complain of leaking urine with coughing, laughing, sneezing, or exercising. Vaginal weights are a set of five reusable cone-shaped weights. Each cone is shaped like a small tampon with an attached cord for removal. The cones are all identical in shape and size but vary in weight. The weights are designed to exercise the pelvic muscle. As the strength of the pelvic muscle increases, the patient progresses to the next heavier weighted cone. The vaginal cone remains in place for 15 minutes while doing normal activities. The benefit of this versus a traditional pelvic muscle exercise routine is the ability to exercise this muscle while engaged in activities that can trigger the stress incontinence. The author briefly describes the contraindications to vaginal cone use. Studies have shown that 70 percent of patients who have used vaginal weights reported cure or improvement after 4 to 6 weeks. 1 figure.

•

What Is Urodynamic Testing? Source: Quality Care. 17(3): 1-3. Summer 1999. Contact: Available from National Association for Continence. P.O. Box 8310, Spartanburg, SC 29305-8310. (800) 252-3337 or (864) 579-7900. Fax (864) 579-7902. Summary: This newsletter article from the National Association for Continence reviews the use of urodynamic testing, a diagnostic technique used to establish an understanding of how urine moves through the patient's lower urinary system. Urination takes place only when the associated muscles and nerves are working correctly. The author briefly reviews the anatomy and physiology of the lower urinary tract and the potential reasons for urinary problems. The author then describes what the patient can expect from the urodynamics testing procedure, which takes about 1 hour. During the test, the patient will be asked to empty the bladder into a special commode. One small tube called a catheter will be inserted into the bladder; this tube is used to fill the bladder with water and measure the change in bladder pressure as it fills and empties. A very small tube inserted into the rectum or vagina measures the pressure in the abdomen when straining or coughing. Two tiny electrodes are placed at the rectum or the opening of the urethra to monitor the sphincter muscle and its ability to work properly when the patient wishes to urinate. The entire test will be recorded on a computer, and the patient may even be able to watch it on a screen as it is occurring. The catheters will be removed when the test is over; patients may experience brief discomfort where the catheters were placed. After the test, the health provider will explain the findings and discuss treatment options with the patient.

•

Sexual Function and Urinary Incontinence Source: Quality Care. 19(4): 1,5. Fall 2001.

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Contact: Available from National Association for Continence. P.O. Box 8310, Spartanburg, SC 29305-8310. (800) 252-3337 or (864) 579-7900. Fax (864) 579-7902. Summary: This newsletter article helps women with urinary incontinence (UI) understand the impact of UI on sexual function. Some women experience loss of urine during sexual activity. Causes of leakage can include pelvic floor muscle weakness, overactive bladder contractions, or incomplete bladder emptying. With minimal arousal, the pelvic muscles can relax and allow drops of leakage. With penetration (intercourse) a woman may experience bladder contractions, or with orgasm, involuntary relaxation may cause a flood. When this happens, women may avoid sexual activity altogether. In addition, constant wetness from UI may lead to irritation in the vulvar area, and this can cause discomfort with sexual activity. This author offers strategies to prevent these problems, focusing on the surgical options. Surgery is an effective treatment option for some women with UI, particularly the stress type of incontinence (leaking provoked by physical stress such as coughing, sneezing, running, or jumping). Stress incontinence can occur in combination with pelvic organ prolapse (when the vagina, uterus, or bladder have lost support and dropped down). The author briefly describes the surgical techniques that are usually used for UI. The article concludes with four suggestions to help manage UI during sexual activity. •

Facts about Pessaries Source: Quality Care. 14(4): 6-7. Fall 1996. Contact: Available from National Association for Continence. P.O. Box 8310, Spartanburg, SC 29305-8310. (800) BLADDER or (864) 579-7900. Fax (864) 579-7902. Web site: http://www.nafc.org. Summary: This newsletter article reviews the facts about pessaries, devices used inside the vagina for prolapse, cystocele, or rectocele. The article informs patients about different types of pessaries, including the donut style, the cube style, the inflato ball style, and incontinence ring and dish style. The article also describes a bladder neck support prosthesis called the Introl. The Introl is shaped like a ring with supports which fit up and behind the urethra. It can be used to help with managing incontinence caused by coughing, laughing, lifting, or other activities. The author also comments on the use of a tampon as a simple type of pessary for mild stress incontinence. One sidebar reviews important practical tips about pessary use. The author concludes that although their use may not be for everyone, pessaries provide conservative, nonsurgical choices for women with the problems of prolapse, cystocele, rectocele, or incontinence. The author stresses the importance of finding health care providers with whom one feels comfortable enough to discuss thoughts and concerns. (AA-M).

Academic Periodicals covering Coughing Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to coughing. In addition to these sources, you can search for articles covering coughing 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.”

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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 9. 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 coughing. 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 DI® Advice for the Patient® 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 coughing. 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 coughing: Acetylcysteine •

Inhalation - U.S. Brands: Mucomyst; Mucomyst-10; Mucosil http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500403.html

Antihistamines •

Systemic - U.S. Brands: Alavert; Allegra; Aller-Chlor; AllerMax Caplets; Allermed; Atarax; Banophen; Banophen Caplets; Benadryl; Benadryl Allergy; Bromphen; Calm X; Chlo-Amine; Chlorate; Chlor-Trimeton; Chlor-Trimeton Allergy; Chlor-Trimeton Repetabs; Clarinex; Claritin; Claritin Reditabs; Compoz; Contac 12 Hour Allergy; Cophene-B; Dexchlor; Dimetapp Allergy Liqui-Gels; Dinate; Diphen Cough; Diphenhist; Diphenhist Captabs; Dormarex 2; Dramamine; Dramanate; Genahist; Gen-Allerate; Hydrate; Hyrexin; Hyzine-50; Nasahist B; Nervine Nighttime Sleep-Aid; Nolahist; Nytol QuickCaps; Nytol QuickGels; Optimine; PediaCare Allergy Formula; Periactin; Phenetron; Polaramine; Polaramine Repetabs; Siladryl; Sleep-Eze D; Sleep-Eze D Extra Strength; Sominex; Tavist; Tavist-1; Telachlor; Teldrin; Triptone Caplets; Twilite Caplets; Unisom Nighttime Sleep Aid; Unisom SleepGels Maximum Strength; Vistaril; Zyrtec http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202060.html

Antihistamines, Decongestants, and Analgesics •

Systemic - U.S. Brands: Actifed Cold & Sinus Caplets; Alka-Seltzer Plus Cold Medicine Liqui-Gels; Benadryl Allergy/Sinus Headache Caplets; Children's Tylenol Cold Multi-Symptom; Comtrex Allergy-Sinus; Comtrex Allergy-Sinus Caplets; Contac Allergy/Sinus Night Caplets; Dimetapp Cold & Fever Suspension; Dristan Cold Multi-Symptom Formula; Drixoral Allergy-Sinus; Drixoral Cold and Flu; Kolephrin Caplets; ND-Gesic; Scot-Tussin Original 5Action Cold Formula; Sinarest; Sine-Off Sinus Medicine Caplets; Singlet for Adults; TheraFlu/Flu and Cold Medicine; TheraFlu/Flu and Cold Medicine for Sore Throat; Tylenol Allergy Sinus Medication Maximum Strength Caplets; Tylenol Allergy Sinus Medication Maximum Strength Gelcaps; Tylenol Allergy Sinus Medication Maximum Strength Geltabs; Tylenol Allergy Sinus Night Time Medicine Maximum Strength Caplets; Tylenol Flu NightTime Hot Medication Maximum Strength; Tylenol Flu NightTime Medication Maximum Strength Gelcaps http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202062.html

Benzonatate •

Systemic - U.S. Brands: Tessalon http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202085.html

Bronchodilators, Adrenergic •

Oral/Injection - U.S. Brands: Adrenalin; Alupent; Ana-Guard; Brethine; Bricanyl; EpiPen Auto-Injector; EpiPen Jr. Auto-Injector; Isuprel; Proventil; Proventil Repetabs; Ventolin; Volmax http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202096.html

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Bronchodilators, Theophylline •

Systemic - U.S. Brands: Aerolate Sr; Asmalix; Choledyl; Choledyl SA; Elixophyllin; Lanophyllin; Phyllocontin; Quibron-T Dividose; Quibron-T/SR Dividose; Respbid; Slo-Bid Gyrocaps; Slo-Phyllin; Theo-24; Theobid Duracaps; Theochron; Theo-Dur; Theolair; Theolair-SR; Theo-Time; Theovent Long-Acting; Theo-X; T-Phyl; Truphylline; Truxophyllin; Uni-Dur; Uniphyl http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/201945.html

Cough/Cold Combinations •

Systemic - U.S. Brands: Alka-Seltzer Plus Cold and Cough; Alka-Seltzer Plus Cold and Cough Medicine Liqui-Gels; Alka-Seltzer Plus Night-Time Cold LiquiGels; Ami-Tex LA; Anatuss LA; Benylin Expectorant; Bromfed-DM; Broncholate; Carbinoxamine Compound-Drops; Cardec DM; Children's Tylenol Cold Plus Cough Multi Symptom; Co-Apap; Comtrex Daytime Maximum Strength Cold and Flu Relief; Comtrex Daytime Maximum Strength Cold, Cough, and Flu Relief; Comtrex Multi-Symptom Maximum Strength Non-Drowsy Caplets; Comtrex Nighttime Maximum Strength Cold and Flu Relief; Congestac Caplets; Contac Cold/Flu Day Caplets; Contac Severe Cold and Flu Caplets; Co-Tuss V; Deconsal II; Despec; Despec-SR Caplets; Donatussin; Donatussin DC; Duratuss; Duratuss HD; ED Tuss HC; ED-TLC; Endagen-HD; Endal Expectorant; Entex LA; Father John's Medicine Plus; Genatuss DM; GP-500; Guaifed; Guaifenex PSE 120; Guaifenex PSE 60; GuaiMAX-D; Guai-Vent/PSE; Guiatuss A.C.; Guiatuss CF; Guiatuss DAC; Guiatuss PE; Histinex HC; Histinex PV; Hycodan; Hycomine Compound; Hydropane; Iobid DM; Iodal HD; Iosal II; Iotussin HC; Kolephrin GG/DM; Kolephrin/DM Cough and Cold Medication; Kwelcof Liquid; Mapap Cold Formula; Marcof Expectorant; Nalex DH; Novahistine DH Liquid; Nucofed Expectorant; Nucofed Pediatric Expectorant; Nucotuss Expectorant; Nucotuss Pediatric Expectorant; Nytcold Medicine; Nytime Cold Medicine Liquid; Ornex Severe Cold No Drowsiness Caplets; PanMist-JR; PediaCare Cough-Cold; PediaCare Night Rest Cough-Cold Liquid; Pediacof Cough; Phanatuss; Phenameth VC; Phenergan VC with Codeine; Phenergan with Codeine; Phenergan with Dextromethorphan; Pneumotussin HC; Poly-Histine; Primatuss Cough Mixture 4; Primatuss Cough Mixture 4D; Profen II; Prometh VC with Codeine; Promethazine DM; Promethazine VC w/Codeine; Protuss-D; PseudoCar DM; P-V-Tussin; Quelidrine Cough; Rentamine Pediatric; Rescon-DM; Rescon-GG; Respa-1st; Respa-DM; Respaire-120 SR; Respaire-60 SR; RhinosynDM; Rhinosyn-DMX Expectorant; Rhinosyn-X; Robafen AC Cough; Robafen DAC; Robafen DM; Robitussin A-C; Robitussin Cold and Cough Liqui-Gels; Robitussin Cold, Cough and Flu Liqui-Gels; Robitussin Night Relief; Robitussin Night-Time Cold Formula; Robitussin Pediatric Cough and Cold; Robitussin Severe Congestion Liqui-Gels; Robitussin-DAC; Robitussin-DM; Robitussin-PE; Rondamine-DM Drops; Rondec-DM; Rondec-DM Drops; Ru-Tuss DE; Ru-Tuss Expectorant; Ryna-C Liquid; Ryna-CX Liquid; Rynatuss; Rynatuss Pediatric; Safe Tussin 30; Scot-Tussin DM; Scot-Tussin Senior Clear; Sildec-DM; Silexin Cough; Siltussin DM; Sinufed Timecelles; Sinutab Non-Drying No Drowsiness Liquid Caps; S-T Forte 2; Stamoist E; Statuss Green; Sudafed Children's Cold and Cough; Sudafed Children's Non-Drowsy Cold and Cough; Sudafed Cold and Cough Liquid Caps; Sudal 60/500; Syracol CF; TheraFlu Flu, Cold and Cough Medicine; TheraFlu Maximum Strength Non-Drowsy Formula Flu, Cold and Cough Medicine; TheraFlu Maximum Strength Non-Drowsy Formula Flu, Cold and Cough Medicine Caplets; TheraFlu Nighttime Maximum Strength Flu, Cold

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and Cough; Tolu-Sed DM; Touro DM; Touro LA Caplets; Triacin C Cough; Triafed w/Codeine; Triaminic AM Non-Drowsy Cough and Decongestant; Triaminic Night Time; Triaminic Sore Throat Formula; Tri-Tannate Plus Pediatric; Tussafed; Tussafed Drops; Tussar DM; Tussigon; Tussionex Pennkinetic; Tussi-Organidin DM NR Liquid; Tussi-Organidin DM-S NR Liquid; Tussi-Organidin NR Liquid; Tussi-Organidin-S NR Liquid; Tussirex; Tuss-LA; Tusso-DM; Tylenol Cold and Flu No Drowsiness Powder; Tylenol Cold Medication; Tylenol Cold Medication Caplets; Tylenol Cold Medication, NonDrowsy Caplets; Tylenol Cold Medication, Non-Drowsy Gelcaps; Tylenol Cold Multi-Symptom; Tylenol Maximum Strength Flu Gelcaps; Tylenol MultiSymptom Cough; Uni-tussin DM; Vanex-HD; V-Dec-M; Versacaps; Vicks 44 Cough and Cold Relief Non-Drowsy LiquiCaps; Vicks 44D Cough and Head Congestion; Vicks 44E Cough and Chest Congestion; Vicks 44M Cough, Cold and Flu Relief; Vicks Children's Cough Syrup; Vicks Children's NyQuil Cold/Cough Relief; Vicks DayQuil Multi-Symptom Cold/Flu LiquiCaps; Vicks DayQuil Multi-Symptom Cold/Flu Relief; Vicks NyQuil Hot Therapy; Vicks NyQuil Multi-Symptom Cold/Flu LiquiCaps; Vicks NyQuil Multi-Symptom Cold/Flu Relief; Vicks Pediatric 44D Cough and Head Decongestion; Vicks Pediatric 44M Multi-Symptom Cough and Cold; Vicodin Tuss; Zephrex; Zephrex-LA http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202165.html Dextromethorphan •

Systemic - U.S. Brands: Benylin Adult Formula Cough Syrup; Benylin Pediatric Cough Suppressant; Cough-X; Creo-Terpin; Delsym Cough Formula; DiabeTUSS DM Syrup; Hold DM; Pertussin DM Extra Strength; Pertussin CS Children's Strength; Robitussin Maximum Strength Cough Suppressant; Robitussin Pediatric Cough Suppressant; Sucrets 4 Hour Cough Suppressant; Trocal; Vicks 44 Cough Relief http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202187.html

Diphtheria and Tetanus Toxoids and Pertussis Vaccine Adsorbed •

Systemic - U.S. Brands: Acel-Imune; Certiva; Infanrix; Tripedia http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202201.html

Diphtheria and Tetanus Toxoids and Pertussis Vaccine Adsorbed and Haemophilus B Conjugate Vaccine •

Systemic - U.S. Brands: Tetramune http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202911.html

Diphtheria, Tetanus, Pertussis, Hepatitis B, Poliovirus Vaccine •

Systemic - U.S. Brands: Pediarix http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500447.html

Disulfiram •

Systemic - U.S. Brands: Antabuse http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202603.html

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Dornase Alfa •

Inhalation - U.S. Brands: Pulmozyme http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202710.html

Enfuvirtide •

Systemic - U.S. Brands: Fuzeon http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500467.html

Guaifenesin •

Systemic - U.S. Brands: Anti-Tuss; Breonesin; Diabetic Tussin EX; Fenesin; GeeGee; Genatuss; Glycotuss; Glytuss; Guiatuss; Halotussin; Humibid L.A.; Humibid Sprinkle; Hytuss; Hytuss-2X; Naldecon Senior EX; Organidin NR; Pneumomist; Robitussin; Scot-tussin Expectorant; Sinumist-SR; Touro EX; Unitussin http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202270.html

Influenza Virus Vaccine •

Systemic - U.S. Brands: FluMist; FluShield; Fluvirin; Fluzone http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202297.html

Ipratropium •

Inhalation - U.S. Brands: Atrovent http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202304.html

Ipratropium and Albuterol •

Inhalation-Local - U.S. Brands: Combivent; DuoNeb http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203487.html

Measles and Rubella Virus Vaccine Live •

Systemic - U.S. Brands: M-R-VAX II http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202904.html

Measles Virus Vaccine Live •

Systemic - U.S. Brands: Attenuvax http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202338.html

Measles, Mumps, and Rubella Virus Vaccine Live •

Systemic - U.S. Brands: M-M-R II http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202903.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; Oramorph SR; OxyContin; PP-Cap; Rescudose; RMS Uniserts; Roxanol; Roxanol 100; Roxanol UD; Roxicodone; Roxicodone Intensol; Stadol; Talwin; Talwin-Nx http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202390.html

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Oseltamivir •

Systemic - U.S. Brands: Tamiflu http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500062.html

Oxtriphylline and Guaifenesin •

Systemic - U.S. Brands: Brondelate http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202430.html

Theophylline and Guaifenesin •

Systemic - U.S. Brands: Bronchial; Broncomar GG; Ed-Bron G; Elixophyllin-GG; Equibron G; Glyceryl-T; Quibron; Quibron-300; Slo-Phyllin GG; Theocon; Theolate http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202557.html

Theophylline, Ephedrine, and Hydroxyzine •

Systemic - U.S. Brands: Marax; Marax-DF http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202555.html

Zanamivir •

Inhalationâ€”Systemic - U.S. Brands: Relenza http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500004.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 Consult™ Mosby’s Drug Consult™ 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.

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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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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 Institute10: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

•

National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

•

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

•

National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

•

National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

•

National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

•

National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

•

National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

10

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

•

National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

•

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

•

National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

•

National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

•

National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

•

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

•

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

•

National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

•

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

•

National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

•

National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

•

Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

•

National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

•

National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

•

Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

•

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.11 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:12 •

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

•

HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

•

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

•

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/

•

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

•

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/

•

Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

•

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

•

Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

•

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

11

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). 12 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

•

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 NLM Gateway13 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.14 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “coughing” (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 9405 246 811 70 553 11085

HSTAT15 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.16 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.17 Simply search by “coughing” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

13

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

14

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). 15 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 16 17

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.

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Coffee Break: Tutorials for Biologists18 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 staff.19 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.20 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/.

18 Adapted 19

from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.

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. 20 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 coughing 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 coughing. 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 coughing. 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 “coughing”:

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Guides on coughing Whooping Cough http://www.nlm.nih.gov/medlineplus/whoopingcough.html

•

Other guides Asthma http://www.nlm.nih.gov/medlineplus/asthma.html Asthma in Children http://www.nlm.nih.gov/medlineplus/asthmainchildren.html Common Cold http://www.nlm.nih.gov/medlineplus/commoncold.html

Within the health topic page dedicated to coughing, the following was listed: •

Children Pertussis (Whooping Cough) Source: Nemours Foundation http://kidshealth.org/parent/infections/bacterial_viral/whooping_cough.html Woes of Whooping Cough Source: Nemours Foundation http://kidshealth.org/kid/health_problems/heart/whooping_cough.html

•

Organizations Centers for Disease Control and Prevention, National Immunization Program Source: National Immunization Program http://www.cdc.gov/nip/ National Institute of Allergy and Infectious Diseases http://www.niaid.nih.gov/

•

Pictures/Diagrams Pertussis Source: Immunization Action Coalition http://www.immunize.org/images/ca.d/ipcd1861/img0007.htm

•

Prevention/Screening Diphtheria, Tetanus, and Pertussis Vaccines Source: Centers for Disease Control and Prevention http://www.cdc.gov/nip/publications/VIS/vis-dtp.pdf Improved Pertussis Vaccines: Enhancing Protection Source: National Institute of Allergy and Infectious Diseases http://www.niaid.nih.gov/publications/discovery/tpertus.htm

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Preventing Whooping Cough Source: American Academy of Pediatrics http://www.medem.com/search/article_display.cfm?path=n:&mstr=/ZZZT3AWT EDC.html&soc=AAP&srch_typ=NAV_SERCH •

Research Measles and Pertussis Risk Higher for Children with Personal Exemptions From Immunizations Source: American Medical Association http://www.medem.com/MedLB/article_detaillb.cfm?article_ID=ZZZL66641HC& sub_cat=620

•

Statistics FASTATS: Whooping Cough Source: National Center for Health Statistics http://www.cdc.gov/nchs/fastats/whooping.htm

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. 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 coughing. 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: •

Tube Feeding: A Step-by-Step Guide Source: San Bruno, CA: StayWell Company. 1999. 16 p. Contact: Available from StayWell Company. Order Department, 1100 Grundy Lane, San Bruno, CA 94066-9821. (800) 333-3032. Fax (650) 244-4512. PRICE: $1.50 plus shipping and handling; bulk copies available. Order number 11165. Summary: A feeding tube is used when a person cannot swallow food safely or when there is a blockage in the esophagus or stomach. The tube can also be used if a person cannot take enough food by mouth. The feeding tube lets food bypass the mouth and esophagus and go directly into the stomach or small intestine. This brochure outlines the strategy of tube feeding and how it can be used in various medical conditions. Topics covered include the anatomy and function of the digestive system, the basics of tube feeding, preparation, equipment and supplies, continuous feeding, bolus feeding, flushing the feeding tube, caring for the skin and mouth, and complications. Written for caregivers, the booklet can be used as a step by step guide for setting up the supplies,

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giving the liquid food, and cleaning the feeding tube. The feeding tube can be placed in the stomach (G tube) or in the small intestine (J tube). Medications can also be given through a feeding tube. With continuous feeding, liquid food drips slowly through the feeding tube. With bolus feeding, the food is put through the tube three or more times a day. The feeding tube must be flushed with warm water after each feeding and after giving medications. The skin around the feeding tube must be kept dry and clean in order to prevent soreness and infection. Mouth care should also be provided, even though the person is not taking food by mouth. Common problems or complications include clogged feeding tubes, diarrhea, gas or bloating, vomiting or coughing, and food staying too long in the stomach. The brochure explains how to know when to contact the health care provider. The brochure concludes with a reminder to caregivers of the importance of taking care of their own needs, in order to stay healthy and continue caring for their loved one. The brochure is illustrated with full color line drawings. 34 figures. •

Pediatric Sinusitis Source: Alexandria, VA: American Academy of Otolaryngology-Head and Neck Surgery. 2003. Contact: Available from American Academy of Otolaryngology-Head and Neck Surgery. One Prince St., Alexandria, VA 22314-3357. (703) 836-4444. TTY: (703) 519-1585. Web site: www.entnet.org/kidsent. PRICE: Available free online. Summary: Sinusitis, or sinus infection, in children is marked by such symptoms as coughing, bad breath, crankiness, low energy, and swelling around the eyes, along with thick, yellow nasal drainage. This fact sheet tells parents how to know if their child has sinusitis, how sinusitis is diagnosed by a doctor, and possible treatments for both chronic and acute forms of sinusitis.

•

Same Day Surgery: Hernia Repair Source: Waco, TX: Health Edco. 1991. 2 p. Contact: Available from Health Edco. P.O. Box 21207, Waco, TX 76702-1207. (800) 2993366, ext. 295. Fax (817) 751-0221. PRICE: $2.00 each for 1-99 copies, $0.43 each for 100199 copies. Summary: This brochure describes hernia conditions that can be corrected by same day surgery. The symptoms of a hernia are usually a bulge under the skin and pain when lifting, coughing, or straining in some way. A hernia happens when a torn or weakened wall, usually in the abdominal cavity, lets the inner structure, such as a loop of intestine, slip through into a hernial sac. This causes pain, and can be quite serious if not taken care of promptly; the hernia can become strangulated and gangrenous. In hernia repair, the doctor returns the contents of the hernial sac to the body cavity, and repairs the torn or weakened wall. The brochure outlines recommended preoperative care strategies, what to expect the day of the surgery, the types of surgical techniques used to treat each hernia condition, and postoperative healing at home. The tissues surrounding the incision may be tender and discolored, which is normal. However, the patient should contact the doctor if there is bleeding from the incision site, a fever of 101 degrees or higher, severe pain, or inability to urinate. Full color line drawings illustrate a common hernia and the surgery used to treat it. 4 figures.

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Bloodborne Pathogens : A Lesson to Live By Contact: Coastal Training Technologies Corporation, 500 Studio Dr, Virgina Beach, VA, 23542, (800) 725-3418, http://www.coastal.com. Summary: This brochure for school personnel discusses the bloodborne diseases hepatitis B virus (HBV) and the human immunodeficiency virus (HIV), their transmission and prevention in the workplace, and approaches to help students deal with their fears about these diseases. HIV and HBV are primarily spread by blood, vaginal secretions, and semen. This usually occurs through having sex with an infected person or sharing needles to inject drugs. HIV and HBV are not spread through touching, coughing, sneezing, kissing on the cheek, sharing telephones or bathrooms, having contact with someone's sweat, or being exposed to someone's saliva. The brochure discusses other myths of transmission. To transmit HIV or HBV at school, there must be contact between broken skin or mucous membranes and infected blood. Even though persons in a school are at low risk of getting a bloodborne disease, they should be aware of how they might be exposed at work. The brochure discusses three ways persons can protect themselves: use protective barriers to avoid contact with blood, dispose of waste carefully, and use caution when cleaning-up blood or body fluid spills. It also lists steps that persons who come into contact the student fear about bloodborne diseases and discusses topics about which students should be educated. The brochure includes a true-or-false quiz to test the readers' knowledge.

•

Hepatitis C Prevention: Almost 4 Million Americans Have Been Infected With Hepatitis C Virus Contact: CDC National Prevention Information Network, PO Box 6003, Rockville, MD, 20849-6003, (800) 458-5231, http://www.cdcnpin.org. Summary: This brochure for the general public discusses the prevention and transmission of hepatitis C and who is at risk of having the disease. Hepatitis C is a liver disease caused by the hepatitis C virus (HCV). The infection is spread by contact with blood infected by the virus. Some persons carry hepatitis C and do not feel sick from the disease. Others with liver damage due to HCV may develop cirrhosis (scarring) of the liver and liver failure. To aid in the prevention of hepatitis C, the brochure suggests not shooting drugs; using clean syringes, water, and drug works if persons do shoot drugs; not sharing toothbrushes, razors, or other items that may have blood on them; using routine barrier precautions and safely handling needles and sharps if persons are health care workers; and considering the health risks associated with tattooing and body piercing. HCV can be spread by sex, but this does not occur often. Persons having sex with more than one partner can get other diseases, should use latex condoms, should be vaccinated against hepatitis B, and may want to consider abstinence from sex. HCV is not spread by breast feeding, casual contact, food or water, sneezing, coughing, or sharing eating utensils or drinking glasses. Many people who are at risk for hepatitis C are at risk for hepatitis A and B. Persons should ask their doctors for a blood test for HCV if they have ever injected street drugs, were treated for clotting problems with a blood product made before 1987, received a blood transfusion or solid organ transplant before July 1992, were notified that they received blood that possibly contained HCV, or were ever on long-term kidney dialysis. Early diagnosis is important so persons can be checked for liver disease, get treatment if indicated, learn how to protect their livers from further harm, and learn how they can prevent spreading HCV to others.

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Asian and Pacific Islander Women and AIDS Contact: Asian and Pacific Islander Coalition on HIV/AIDS, 150 Lafayette St 6th Fl, New York, NY, 10013, (212) 334-7940, http://www.apicha.org. Summary: This brochure informs Asian and Pacific-Islander women about the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) and provides contact information for the Asian and Pacific Islander Coalition on HIV/AIDS (APICHA), an organization that provides services for Asians and Pacific Islanders in the greater New York City (NYC) metropolitan area. HIV/AIDS is growing among Asian and Pacific-Islander women and has become the leading killer of minority women aged 25-44 years in NYC. HIV is a virus that attacks the immune system, weakens it, and eventually develops into AIDS. The virus cannot be spread through casual contact such as through sneezing, coughing, using public toilets, sharing food and drink, or shaking hands. Symptoms of HIV infection may include painful or irregular periods, extreme weight loss, white spots in the mouth, and tuberculosis (TB). The brochure explains that HIV can be prevented through safer sex (e.g., condom use) and that women need to discuss safer sex with their partners. It briefly describes the HIV antibody test, and states that pregnant women with HIV may pass the virus to their unborn infants.

•

Black People Do Get AIDS, But Not By. Contact: Minority AIDS Project, 5149 W Jefferson Blvd, Los Angeles, CA, 90016-3800, (323) 936-4949, http://members.aol.com/map5149/map.html. Summary: This brochure lists ways in which Black people, or anyone else, cannot get Acquired immunodeficiency syndrome (AIDS). These include donating blood, coughing, sneezing, spitting, shaking hands with someone who has AIDS, and hugging. The brochure points out that no cases of AIDS have ever been linked to saliva, tears, or sweat, nor to eating food prepared by someone who has AIDS. Also included is a statement that the Human immunodeficiency virus (HIV) is sensitive and can be destroyed through sterilization methods.

•

Getting TB, Getting Rid of TB Contact: World Health Organization, Joint United Nations Programme on HIV/AIDS, 20 Avenue Appia, CH-1211 Geneva, http://www.unaids.org. Summary: This brochure presents the basic facts and statistics about tuberculosis (TB). It begins with an explanation of TB exposure and transmission, and defines the multidrug resistant TB strains. Nearly 5 million people who are infected with TB are also infected with HIV. The symptoms of TB, such as coughing, exhaustion, night sweats, weight loss, and chest pain are described. The death rate and high contagion rate are also addressed. The brochure also highlights international efforts to eradicate TB. These efforts include prevention, monitoring, treatment, diagnosis, program organization, and financial support to governments committed to long-term TB control. The role of the World Health Organization in these efforts is explained.

•

Black People Do Get AIDS, But Not By Contact: Minority AIDS Project, 5149 W Jefferson Blvd, Los Angeles, CA, 90016-3800, (323) 936-4949, http://members.aol.com/map5149/map.html. Summary: This brochure presents ways in which Black people or anyone else cannot get AIDS. These include donating blood, coughing, sneezing, spitting, shaking hands with someone who has AIDS, and hugging. The brochure points out that no cases of AIDS

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have ever been linked to saliva, tears, or sweat, nor by eating food prepared by someone who has AIDS. Also included is a statement that the AIDS virus is sensitive and can be destroyed. •

TB and HIV Contact: Chinese-American Planning Council Incorporated, 150 Elizabeth St, New York, NY, 10012-4603, (212) 941-0030, http://www.chinatownweb.com/cpc. Summary: This brochure provides Chinese Americans with information about tuberculosis (TB) and how it relates to the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). TB is an infection/disease that usually attacks the lungs but may affect other parts of the body. TB, which is an airborne virus, is spread by infected persons through coughing, sneezing, talking, singing, or spitting. The symptoms of TB include coughing, which may last for weeks and contain bloody sputum, night sweats, chest pain, fever, and weight loss. If left untreated, half of all persons with TB will die within five years. The majority of those who live longer than five year will be seriously debilitated. People can be infected with TB although they may not appear to be ill. Person with the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) have a greater risk of becoming ill with TB (i.e., having active TB) because their immune systems are weakened and cannot fight off infections as easily as that of a healthy individual. Person who are HIV-positive should get a TB skin test to determine if they have TB; if they do have TB, these persons should undergo medical treatment immediately and remain on their medication for the duration of their treatment. Children are at a higher risk than most adults for contracting TB and, therefore, should receive a skin test if they are HIV-positive or have been in contact with a person who has active TB. Hotline telephone numbers for HIV/AIDS and TB information services in New York City are provided.

•

TB + HIV = Double Trouble Contact: Family and Medical Counseling Service Incorporated, 2041 MLK Jr Ave SE Ste M2, Washington, DC, 20020-7025, (202) 889-7900, http://www.npcclinics.org/members/fmcs.htm. Summary: This brochure provides information on tuberculosis (TB), emphasizing the particularly high risk to persons with HIV. It presents facts about TB transmission, prevention, symptoms, and testing. The brochure lists persons at high risk, specifies that those with HIV are particularly vulnerable, and indicates that those who have HIV and a positive TB skin test should seek preventive therapy. Addresses and phone numbers for sources of testing and information in the Washington, DC, area are included. The illustrations consist of two line drawings, one of an African American woman sneezing into a man's face, and another of an African American woman sneezing or coughing into a handkerchief.

•

Gastroesophageal Reflux Disease (GERD) Source: Camp Hill, PA: Chek-Med Systems, Inc. 199x. [2 p.]. Contact: Available from Chek-Med Systems, Inc. 200 Grandview Avenue, Camp Hill, PA 17011-1706. (800) 451-5797 or (717) 761-1170. Fax (717) 761-0216. PRICE: $22.00 per pack of 50 brochures; 3 pack minimum. Summary: This brochure provides patients with a simple explanation of gastroesophageal reflux disease (GERD), the reflux or return of gastric (stomach) acid

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up the esophagus. Constant exposure to stomach acid can irritate the lining of the esophagus and cause other medical problems. At the lower end of the esophagus, where it enters the stomach, is a strong muscular ring called the lower esophageal sphincter (LES). The LES should remain tightly closed, except to allow food and liquid to pass into the stomach. The severity of GERD is determined by how weakened the LES is, and the amount and duration of acid refluxed into the esophagus. Frequent heartburn is the most common symptom; other symptoms can include sour or bitter taste in the mouth, hoarseness, repeated need to clear the throat, wheezing or coughing (especially at night), and worsening of symptoms after eating, or when bending over or lying down. Complications occur when GERD is severe or longstanding, and can include inflammation, ulcers, bleeding, anemia, narrowing of the esophagus, and Barrett's esophagus. Endoscopy is the most important test for patients with GERD; other tests that may be useful include esophageal manometry, and 24 hour pH testing. Initial treatment is with lifestyle changes, including diet and weight loss; drug therapy is used for patients who still have symptoms after lifestyle changes are implemented. Some patients will need surgery to strengthen the LES. The brochure concludes that a good medical program can almost always be developed to successfully treat the patient with GERD. 2 figures. •

Disorders of Vocal Abuse and Misuse Source: Bethesda, MD: National Institute on Deafness and Other Communication Disorders (NIDCD), National Institutes of Health (NIH). May 1999. [4 p.]. Contact: Available from NIDCD Information Clearinghouse. 1 Communication Avenue, Bethesda, MD 20892-3456. Voice (800) 241-1044. TTY (800) 241-1055. Fax (301) 907-8830. E-mail: [email protected]. Website: www.nidcd.nih.gov. PRICE: Single copy free. NIH Publication Number 99-4375. Summary: This fact sheet describes disorders of vocal abuse and misuse and how to prevent and manage them. Vocal abuse is any behavior or occurrence that strains or injures the vocal folds (or vocal cords). This may include excessive talking, throat clearing, coughing, inhaling irritants, smoking, screaming, or yelling. Vocal misuse is inappropriate voice usage such as speaking too loudly or at an abnormally high or low pitch. Frequent vocal abuse and misuse can damage the vocal cords and cause temporary or permanent changes in vocal function, voice quality, and even loss of voice. Written in a question and answer format, the fact sheet covers the physiology and anatomy of the voice; risk factors and populations at risk for these disorders; types of disorders of vocal abuse and misuse, including laryngitis, vocal nodules, vocal polyps, and contact ulcers; the diagnosis of these disorders, including the role of the otolaryngologist; treatment options, including the identification and elimination of damaging vocal behaviors, voice therapy, and surgery; and research on disorders of vocal abuse and misuse. The fact sheet concludes with a list of resource organizations through which readers can obtain additional information, including information about laryngeal cancer. 1 figure.

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Lifestyle Solutions for the 'Happy Spitter' to Help Reduce Baby's Spitting Up Source: Milwaukee, WI: International Foundation for Functional Gastrointestinal Disorders (IFFGD). 2002. [2 p.]. Contact: Available from International Foundation for Functional Gastrointestinal Disorders (IFFGD). P.O. Box 170864, Milwaukee, WI 53217-8076. (888) 964-2001 or (414)

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964-1799. E-mail: [email protected]. Website: www.iffgd.org. PRICE: $1.00 for nonmembers; single copy free to members. Summary: This fact sheet helps parents understand spitting up (regurgitation) in infants and how to manage and possibly prevent this common problem. Besides being messy and bothersome, spitting up can be worrisome to new parents who are concerned their babies are not getting proper nutrition or may choke. In the vast majority of cases, however, there is no need to be concerned. The fact sheet offers a series of lifestyle recommendations that may help with the problem: provide a relaxed approach to mealtimes, use thickened feedings (thickened with rice cereal), use frequent small feedings, and try different positions for feeding the infant (and for just after feeding). Gastroesophageal reflux (the technical term for spitting up) usually resolves within 1 to 2 years after birth. Lifestyle changes and medical management control symptoms in the great majority of infants and children until the reflux resolves by itself. Surgery is uncommon and only considered in special circumstances. The fact sheet includes a side bar of special circumstances that indicate the child needs medical attention. These signs include refusal to eat, failure to grow at the expected rate, coughing, choking, gagging, or wheezing, or blood in either the regurgitated material or in the stool. The fact sheet includes the contact information for the International Foundation for Functional Gastrointestinal Disorders (IFFGD, www.iffgd.org). •

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.

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Aerosol Pentamidine (AP) Contact: National AIDS Treatment Information Project, Beth Israel Deaconess Medical Center, Beth Israel Hospital, 330 Brookline Ave Libby Bldg 317, Boston, MA, 02215, (617) 667-5520, http://www.natip.org. Summary: This fact sheet, for persons with the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), discusses aerosol pentamidine (AP), a drug used to prevent pneumocystis carinii pneumonia (PCP), an illness that can be severe or fatal if not promptly treated. HIV-positive persons at risk for PCP include those with a CD4 count of less than 200, thrush, or unexplained fever; and those previously diagnosed with PCP. AP is recommended for PCP prophylaxis only for

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patients who cannot tolerate either trimethoprim-sulfamethoxazole (TMP-SMX) or daspone. AP is generally administered in a medical clinic or doctor's office, although home treatment can also be arranged. The most common side effects of AP include wheezing, coughing, a metallic taste in the mouth, irritation of the mouth or sinuses, abdominal pain, nausea, and vomiting. Potential risks posed by AP to a fetus during pregnancy are probably small but are largely unknown. In general, breastfeeding is not recommended in HIV-infected mothers. Financial issues regarding AP are discussed. •

Hepatitis C : Know the Facts Contact: Hepatitis Foundation International, 30 Sunrise Terr, Cedar Grove, NJ, 07009, (800) 857-0707. Summary: This fact sheet, written for the general public, discusses the modes by which the hepatitis C virus (HCV) is transmitted. HCV is not airborne, and it cannot be spread through sneezing, coughing, holding hands, closed mouth kissing or kissing on the cheek, sharing a bathroom, having someone over for dinner, or holding a child. HCV is in the blood of an infected person. HCV can be spread by using something with infected blood on it such as razors, nail clippers, scissors, toothbrushes, water pics, tattoo or body piercing needles, injection drug needles, tampons, or sanitary napkins. The virus must enter the body through the skin or mucous membrane. Many of the people who are infected with HCV are unaware that they have the virus. Anyone who has shared any of the items listed above in the past twenty years should get tested for HCV.

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Hagase la Prueba de la Hepatitis C Contact: CDC National Prevention Information Network, PO Box 6003, Rockville, MD, 20849-6003, (800) 458-5231, http://www.cdcnpin.org. Summary: This pamphlet discusses who should be tested for hepatitis C and the effects, treatment, transmission, and prevention of hepatitis C. Persons should be tested if they were notified that they received blood that possibly contained hepatitis C virus (HCV) or if they received blood before July 1992. Persons may have received this blood before tests to identify blood donors with hepatitis C were available or when tests were less precise than they are now. Hepatitis C is a liver disease caused by infection with HCV, which is found in the blood of persons who have this disease. If persons test positive for hepatitis C, they will need to see a doctor to determine if they have liver disease and how severe it is, to determine if they should be treated for the liver disease, to learn how they can protect their livers from further harm, and to learn how they can prevent spreading HCV to others. Persons should not donate blood as a means of being tested. Whether persons feel sick or not, they should have a blood test for hepatitis C. To take care of their livers, persons with HCV should see their doctors regularly, not drink alcohol, tell their doctor about all medicines they are taking, and be vaccinated against hepatitis A if there is liver damage. Antiviral medicines are approved for the treatment of persons with chronic hepatitis C. Treatment is effective in about 2-3 out of every 10 persons treated. Others at risk of getting hepatitis C are persons who have ever injected street drugs, healthcare workers exposed to blood in the workplace, and babies born to infected mothers. HCV also can be spread by sex, but this does not occur very often. To prevent the spread of HCV, persons with hepatitis C should not donate blood, body organs, other tissue, or sperm; should not share personal care articles that might have blood on them; should cover cuts and open sores; and may consider using barrier precautions during sex. Sexual practices involving one steady partner do not need to change, and persons with HCV do not need to avoid pregnancy or breast feeding. HCV is not spread by breast feeding, casual contact, food or water, sneezing, coughing, or

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sharing eating utensils or drinking glasses. Injection drug users should seek treatment, use clean drug works, and get vaccinated against hepatitis A and B. Persons having sex with more than one partner can get other diseases, should use latex condoms, should be vaccinated against hepatitis B, and may want to consider abstinence from sex. •

Learn About Tuberculosis Contact: US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Allergy and Infectious Diseases, Division of Microbiology and Infectious Diseases, 6700-B Rockledge Dr, Bethesda, MD, 20892-7630, (301) 496-1884, http://www.niaid.nih.gov/dmid. Summary: This pamphlet for persons who have tested positive for tuberculosis (TB) provides information about the disease. TB can be determined through a skin test or a chest x-ray and is a germ usually found in the lungs. TB is spread through the air when an infected person coughs or laughs. Persons with TB should not go to school or work until they are cured of TB and should take precautions to cover their mouths when coughing or laughing. A doctor or local health department will provide antibiotics to persons with TB. All of the medication must be taken. Local health departments may offer directly observed therapy (DOT) to ensure patient adherence. While undergoing treatment, good nutrition and proper rest are recommended.

•

Hepatitis C Prevention Contact: CDC National Prevention Information Network, PO Box 6003, Rockville, MD, 20849-6003, (800) 458-5231, http://www.cdcnpin.org. Summary: This pamphlet for the general public discusses the prevention and transmission of hepatitis C and who is at risk of having the disease. Hepatitis C is a liver disease caused by the hepatitis C virus (HCV). The infection is spread by contact with blood infected by the virus. Some persons carry hepatitis C and do not feel sick from the disease. Others with liver damage due to HCV may develop cirrhosis (scarring) of the liver and liver failure. To aid in the prevention of hepatitis C, the pamphlet suggests not shooting drugs; using clean syringes, water, and drug works if persons do shoot drugs; not sharing toothbrushes, razors, or other items that may have blood on them; using routine barrier precautions and safely handling needles and sharps if persons are health care workers; and considering the health risks associated with tattooing and body piercing. HCV can be spread by sex, but this does not occur often. Persons having sex with more than one partner can get other diseases, should use latex condoms, should be vaccinated against hepatitis B, and may want to consider abstinence from sex. HCV is not spread by breast feeding, casual contact, food or water, sneezing, coughing, or sharing eating utensils or drinking glasses. Many people who are at risk for hepatitis C are at risk for hepatitis A and B. Persons should ask their doctors for a blood test for HCV if they have ever injected street drugs, were treated for clotting problems with a blood product made before 1987, received a blood transfusion or solid organ transplant before July 1992, were notified that they received blood that possibly contained HCV, or were ever on long-term kidney dialysis. Early diagnosis is important so persons can be checked for liver disease, get treatment if indicated, learn how to protect their livers from further harm, and learn how they can prevent spreading HCV to others.

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If You Have Hepatitis C Contact: CDC National Prevention Information Network, PO Box 6003, Rockville, MD, 20849-6003, (800) 458-5231, http://www.cdcnpin.org.

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Summary: This pamphlet for the persons with hepatitis C provides information on the effects, treatment, transmission, and prevention of hepatitis C. Hepatitis C is a liver disease caused by the hepatitis C virus (HCV), which is spread by contact with blood of persons infected with the virus. Some persons carry hepatitis C and do not feel sick from the disease. Others with liver damage due to HCV may develop cirrhosis (scarring) of the liver and liver failure. Persons who test positive for HCV should contact their doctors, as additional tests may be needed. Many persons with hepatitis C have no symptoms and feel well, but should still see their doctors. To take care of their livers, persons with HCV should see their doctors regularly, not drink alcohol, tell their doctor about all medicines they are taking, and be vaccinated against hepatitis A if there is liver damage. Drugs are licensed for the treatment of long-term hepatitis C. However, there is no vaccination against hepatitis C. Hepatitis C may have been acquired if persons injected street drugs, were treated for clotting problems with a blood product made before 1987, received a blood transfusion or solid organ transplant from an infected donor, were ever on long-term kidney dialysis, were health care workers and had frequent contact with blood in the work place, had mothers who had hepatitis C, had sex with a person infected with HCV, or lived with someone who was infected with HCV and shared items that might have had blood on them. To prevent the spread of HCV, persons with hepatitis C should not donate blood, body organs, other tissue, or sperm; should not share personal care articles that might have blood on them; should cover cuts and open sores; and may consider using barrier precautions during sex, although there is a low chance of transmitting HCV to a partner through sexual activity. About five out of every 100 infants born to women with HCV become infected; there is no preventable treatment. HCV is not spread by breast feeding, casual contact, food or water, sneezing, coughing, or sharing eating utensils or drinking glasses. Injection drug users should seek treatment, use clean drug works, and get vaccinated against hepatitis A and B. Persons having sex with more than one partner can get other diseases, should use latex condoms, should be vaccinated against hepatitis B, and may want to consider abstinence from sex. •

Prevent Hepatitis B: Get Vaccinated Summary: This pamphlet promotes prevention of hepatitis B virus (HBV) infection by getting vaccinated. The pamphlet explains the symptoms of HBV infection, the seriousness of the disease, the truth and myths about transmission, and various ways of preventing infection. It advises persons practicing high-risk behaviors, as well as everyone under nineteen years of age, to get vaccinated against HBV. Each year, thousands of people of all ages get hepatitis B and about 5,000 die of chronic (life-long) liver problems caused by HBV infection. HBV is spread by contact with the blood of an infected person or by having sex with an infected person, and a woman who has hepatitis B can spread the virus to her baby during birth. HBV is not spread through sneezing or coughing, kissing or hugging, the sharing of eating utensils, glasses, breast feeding, food or water, or casual contact. Only a blood test can tell for sure if an individual is infected with HBV. To prevent HBV infection, individuals should get vaccinated, practice "safer" sex, not share anything that might have blood on it, think about the health risks associated with getting a tattoo or body piercing, and follow standard precautions when working in healthcare settings. Most individuals do not need to get their blood tested after getting the vaccine. Individuals who should get a blood test one to two months after completing the vaccination series include those whose sex partner has chronic hepatitis B, whose immune system is not working well, or whose job exposes them to human blood.

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Hiatal Hernia: Understanding a Common Problem Source: San Bruno, CA: StayWell Company. 2003. [2 p.]. Contact: StayWell Company: Krames Health and Safety Education. 780 Township Line Road, Yardley, PA 19067. (800) 333-3032. Fax (415) 244-4512. E-mail: [email protected]. Website: www.staywell.com. PRICE: $20.95 for pack of 50; plus shipping and handling. Summary: This patient education brochure describes hiatal hernia and its treatment. Written in nontechnical language, the brochure first describes hiatal hernia as a common problem that occurs when the stomach bulges into the chest. Most hiatal hernias cause no symptoms and need no treatment. Sometimes, hiatal hernias can cause reflux (return) of the gastric acid in the stomach back up into the esophagus. In these cases, symptoms can include heartburn or other chest discomfort; frequent burping; acid taste in the mouth; problems swallowing; and nighttime choking, coughing, or wheezing. Often a hiatal hernia is found during an examination or tests for another health problem. Diagnosis will include the patient's medical history and some diagnostic tests such as upper GI barium x ray, endoscopy, esophageal manometry, and 24 hour acid (pH) monitoring. Most treatment plans focus on lifestyle and behavior changes including: lose excess weight, avoid LES (lower esophageal sphincter) relaxers, avoid foods or drinks that cause symptoms, and try acid reducing medications. The brochure notes that surgery is rarely needed to treat hiatal hernias. One section of the brochure illustrates and describes the physiology of the connection between the esophagus and stomach (the LES) and what happens in hiatal hernia. The last page of the brochure summarizes strategies for coping with a hiatal hernia. The brochure is illustrated with full color line drawings. 8 figures.

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Incontinence: Patient Education Source: Tarrytown, NY: Bayer Corporation. 1999. 11 p. Contact: Available from Bayer Corporation. Diagnostics Division, 511 Benedict Avenue, Tarrytown, NY 10591-5097. (800) 445-5901. PRICE: Single copy free. Summary: This patient education brochure reviews urinary incontinence, involuntary or unwanted leakage of urine. The brochure defines the condition, describes risk factors and causes, outlines the diagnostic approaches that may be used, reviews treatment options, and offers suggestions for prevention. The brochure first reviews the anatomy of the male and female urinary tract, noting that women are twice as likely as men to experience urinary incontinence. Incontinence occurs when there are problems with the muscles or nerves of the urinary system. Both men and women can become incontinent as a result of strokes, multiple sclerosis, diabetes, or other underlying health conditions; incontinence is not an inevitable part of aging, however. Urinary leakage associated with coughing, sneezing, or laughing is called stress urinary incontinence (SUI); causes of SUI include heavy lifting, previous surgery, spinal cord injury, a lack of estrogen, and pregnancy. Urge incontinence is associated with a feeling of lower abdominal pressure and a difficulty in delaying urination; this is usually caused by a spasm of the bladder muscle (detrusor). The brochure stresses that almost all cases of incontinence can be controlled or cured. Exercises specifically designed to strengthen the urinary muscles are called Kegel exercises; the brochure explains how to perform the exercises and how they can be used to help restore bladder control, particularly after pregnancy. Other treatment options include behavior modification and some medications. Readers are encouraged to first consider all nonsurgical treatments; if they do not cure the incontinence, the health care provider may evaluate the patient for surgery. The brochure concludes with a brief glossary of terms and a short list of resources for

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readers wishing to obtain additional information. A tear-off section lists the topics covered in the booklet; readers are encouraged to check off the items corresponding to issues they would like to discuss with their health care provider, to use the checklist as a reminder tool. 3 figures. •

Urinary Incontinence Source: Postgraduate Medicine. 108(1): 211-212. July 2000. Contact: Available from McGraw-Hill, Inc. 1221 Avenue of the Americas, New York, NY 10020. (612) 832-7869. Summary: This patient education handout on urinary incontinence (involuntary loss of urine) is designed to be photocopied and distributed to patients. The handout notes that bladder control is a very common problem but, when left untreated, can be debilitating and can lead to social isolation, psychological distress, skin problems, and even premature admission to a nursing home. The handout first outlines the four types of incontinence: stress incontinence, or leaking of urine during physical activities that cause sudden increases in abdominal pressure (such as coughing, laughing, or sneezing); urge incontinence, an uncontrollable need to urinate that may occur during the day and at night; overflow incontinence, which causes frequent or constant dribbling of urine because the bladder is unable to empty completely and overfills; and mixed incontinence, a combination of urge and stress incontinence. Treatment can include weight loss (for overweight patients), quitting smoking, the elimination of drugs that aggravate the situation, Kegel exercises (to make the pelvic floor muscles stronger), bladder retraining, drug therapy, catheterization, and surgery. One sidebar explains how to perform Kegel exercises. Blank lines are available for patient notes. 3 figures.

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Continence Facts: Injectable Implants: A Treatment For Stress Incontinence Source: Quebec, Canada: Simon Foundation for Continence. 1996. 2 p. Contact: Available from Simon Foundation for Continence Canada. P.O. Box 66524, Cavendish Mall P.O., Cote St. Luc, Quebec, Canada H4W3J6. (514) 923-6060. Fax: (514) 923-6060. Website: www.simonfoundation.org. PRICE: contact organization for print copies. Summary: Urinary incontinence (UI) is the loss of bladder control; stress incontinence refers to leakage of urine when coughing, sneezing, laughing, lifting, jogging, or doing anything that causes the abdominal pressure to override the bladder's closure mechanism. This fact sheet outlines the use of injectable implants as a treatment option for stress incontinence. Topics include patient selection for the procedure, what to expect during and after the procedure, the different types of implants used for stress incontinence (collagen, PTFE paste or Teflon, and autologous fat), and side effects or risks associated with injectable implants. Readers are encouraged to work closely with their health care providers to find solutions for their UI problems. The fact sheet includes the contact information for the Simon Foundation for Continence Canada (800265-9575). 3 figures. 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

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located at http://www.guideline.gov/ by using the keyword “coughing” (or synonyms). The following was recently posted: •

Prolonged cough in children Source: Finnish Medical Society Duodecim - Professional Association; 2000 April 17 (revised 2001 November 17); Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3376&nbr=2602&a mp;string=cough 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 located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: •

Phenylpropanolamine (PPA) Information Page Summary: This web site offers advisories, bulletins and news reports about phenylpropanolamine (PPA), an ingredient which is used in many over-the-counter and prescription cough and cold medicines. Source: Center for Drug Evaluation and Research, U.S. Food and Drug Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=5738 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 coughing. 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. 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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WebMD®Health: 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 coughing. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with coughing.

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 coughing. 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 “coughing” (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 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 “coughing”. 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 “coughing” (or synonyms) into the “For these

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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 “coughing” (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.21

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

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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)22: •

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/

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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/

•

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

•

On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

•

Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

•

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). The NIH suggests the following Web sites in the ADAM Medical Encyclopedia when searching for information on coughing: •

Basic Guidelines for Coughing Cough Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003072.htm Coughing up blood Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003073.htm

•

Signs & Symptoms for Coughing Abdominal swelling Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003122.htm Airway obstruction Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003075.htm Chest pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003079.htm

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Confused Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003205.htm Cough Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003072.htm Coughing Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003072.htm Coughing up blood Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003073.htm Difficulty breathing Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003075.htm Epistaxis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003106.htm Fever Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003090.htm Hemoptysis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003073.htm Postnasal drip Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003051.htm Runny nose Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003051.htm Shortness of breath Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003075.htm Stress Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003211.htm Stridor Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003074.htm Vomiting Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm Weight loss Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003107.htm •

Diagnostics and Tests for Coughing Bronchoscopy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003857.htm Chest X-ray Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003804.htm

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Complete blood count Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003642.htm Lung biopsy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003860.htm Lung scan Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003824.htm Mediastinoscopy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003864.htm PT Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003652.htm PTT Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003653.htm Pulmonary arteriography Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003813.htm Pulmonary function tests Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003853.htm Spirometry Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003853.htm Sputum analysis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003723.htm Sputum culture Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003723.htm Upper airway biopsy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003856.htm X-ray of the chest Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003804.htm X-rays of the chest Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003804.htm •

Surgery and Procedures for Coughing Tonsillectomy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003013.htm

•

Background Topics for Coughing Aspiration Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002216.htm

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Bleeding Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000045.htm Chronic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002312.htm Dental hygiene Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001957.htm Foreign object aspiration or ingestion Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000036.htm Laryngoscopy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003851.htm Physical examination Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002274.htm Relieved by Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002288.htm Respiratory Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002290.htm Second-hand smoke Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002032.htm Smoking Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002032.htm

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

•

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

•

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

•

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

181

COUGHING DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. 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] Abscess: A localized, circumscribed collection of pus. [NIH] Acoustic: Having to do with sound or hearing. [NIH] Actin: Essential component of the cell skeleton. [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] 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] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adrenal Glands: Paired glands situated in the retroperitoneal tissues at the superior pole of each kidney. [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] Adrenergic Agonists: Drugs that bind to and activate adrenergic receptors. [NIH] Adsorption: The condensation of gases, liquids, or dissolved substances on the surfaces of solids. It includes adsorptive phenomena of bacteria and viruses as well as of tissues treated with exogenous drugs and chemicals. [NIH] Adsorptive: It captures volatile compounds by binding them to agents such as activated carbon or adsorptive resins. [NIH] Advanced Life Support: The medical care given by medical doctors and nurses trained in critical care medicine with the use of specialized technical equipment, infusion of fluids and drugs aimed to stabilize or restore vital functions. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Aerosol: A solution of a drug which can be atomized into a fine mist for inhalation therapy.

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[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 antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [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] Air Embolism: Occurs when the lungs over expand to the point that air bubbles are forced through the air sacs of the lungs into the circulatory system. [NIH] Air Sacs: Thin-walled sacs or spaces which function as a part of the respiratory system in birds, fishes, insects, and mammals. [NIH] Airway: A device for securing unobstructed passage of air into and out of the lungs during general anesthesia. [NIH] Airway Obstruction: Any hindrance to the passage of air into and out of the lungs. [NIH] Alertness: A state of readiness to detect and respond to certain specified small changes occurring at random intervals in the environment. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] 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] Allergic Rhinitis: Inflammation of the nasal mucous membrane associated with hay fever; fits may be provoked by substances in the working environment. [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] Alveoli: Tiny air sacs at the end of the bronchioles in the lungs. [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

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proteins. [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] Amplification: The production of additional copies of a chromosomal DNA sequence, found as either intrachromosomal or extrachromosomal DNA. [NIH] Ampulla: A sac-like enlargement of a canal or duct. [NIH] Anabolic: Relating to, characterized by, or promoting anabolism. [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] 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] 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] Angioedema: A vascular reaction involving the deep dermis or subcutaneous or submucal tissues, representing localized edema caused by dilatation and increased permeability of the capillaries, and characterized by development of giant wheals. [EU] Angioneurotic: Denoting a neuropathy affecting the vascular system; see angioedema. [EU] Angioneurotic Edema: Recurring attacks of transient edema suddenly appearing in areas of the skin or mucous membranes and occasionally of the viscera, often associated with dermatographism, urticaria, erythema, and purpura. [NIH] Angiotensin converting enzyme inhibitor: A drug used to decrease pressure inside blood vessels. [NIH] Angiotensin-Converting Enzyme Inhibitors: A class of drugs whose main indications are the treatment of hypertension and heart failure. They exert their hemodynamic effect mainly by inhibiting the renin-angiotensin system. They also modulate sympathetic nervous system activity and increase prostaglandin synthesis. They cause mainly vasodilation and mild natriuresis without affecting heart rate and contractility. [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 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

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or other tissues are called xenograft models. [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] 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] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [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] Antidepressant: A drug used to treat depression. [NIH] 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] Antihypertensive: An agent that reduces high blood pressure. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [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] Antitussive: An agent that relieves or prevents cough. [EU] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Aorta: The main trunk of the systemic arteries. [NIH] Apnea: A transient absence of spontaneous respiration. [NIH] Apnoea: Cessation of breathing. [EU] Aqueous: Having to do with water. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arteriography: A procedure to x-ray arteries. The arteries can be seen because of an injection of a dye that outlines the vessels on an x-ray. [NIH]

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Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] 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] Astringents: Agents, usually topical, that cause the contraction of tissues for the control of bleeding or secretions. [NIH] Asymptomatic: Having no signs or symptoms of disease. [NIH] Ataxia: Impairment of the ability to perform smoothly coordinated voluntary movements. This condition may affect the limbs, trunk, eyes, pharnyx, larnyx, and other structures. Ataxia may result from impaired sensory or motor function. Sensory ataxia may result from posterior column injury or peripheral nerve diseases. Motor ataxia may be associated with cerebellar diseases; cerebral cortex diseases; thalamic diseases; basal ganglia diseases; injury to the red nucleus; and other conditions. [NIH] Atelectasis: Incomplete expansion of the lung. [NIH] Atmospheric Pressure: The pressure at any point in an atmosphere due solely to the weight of the atmospheric gases above the point concerned. [NIH] 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] Auditory: Pertaining to the sense of hearing. [EU] Auditory nerve: The eight cranial nerve; also called vestibulocochlear nerve or acoustic nerve. [NIH] Autodigestion: Autolysis; a condition found in disease of the stomach: the stomach wall is digested by the gastric juice. [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] Bacillus: A genus of Bacillaceae that are spore-forming, rod-shaped cells. Most species are saprophytic soil forms with only a few species being pathogenic. [NIH] Baclofen: A GABA derivative that is a specific agonist at GABA-B receptors. It is used in the treatment of spasticity, especially that due to spinal cord damage. Its therapeutic effects result from actions at spinal and supraspinal sites, generally the reduction of excitatory transmission. [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] Bacterium: Microscopic organism which may have a spherical, rod-like, or spiral unicellular or non-cellular body. Bacteria usually reproduce through asexual processes. [NIH] Barium: An element of the alkaline earth group of metals. It has an atomic symbol Ba, atomic number 56, and atomic weight 138. All of its acid-soluble salts are poisonous. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form

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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] Basilar Artery: The artery formed by the union of the right and left vertebral arteries; it runs from the lower to the upper border of the pons, where it bifurcates into the two posterior cerebral arteries. [NIH] Beclomethasone: An anti-inflammatory, synthetic glucocorticoid. It is used topically as an anti-inflammatory agent and in aerosol form for the treatment of asthma. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the 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] Biliary: Having to do with the liver, bile ducts, and/or gallbladder. [NIH] Biliary Tract: The gallbladder and its ducts. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biofilms: Films of bacteria or other microbial organisms, usually embedded in extracellular polymers such as implanted medical devices, which adhere to surfaces submerged in, or subjected to, aquatic environments (From Singleton & Sainsbury, Dictionary of Microbiology and Molecular Biology, 2d ed). Biofilms consist of multilayers of microbial cells glued together to form microbial communities which are highly resistant to both phagocytes and antibiotics. [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] Bladder: The organ that stores urine. [NIH] Bloating: Fullness or swelling in the abdomen that often occurs after meals. [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] 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] Bolus: A single dose of drug usually injected into a blood vessel over a short period of time. Also called bolus infusion. [NIH]

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Bolus infusion: A single dose of drug usually injected into a blood vessel over a short period of time. Also called bolus. [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] Bone scan: A technique to create images of bones on a computer screen or on film. A small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it collects in the bones and is detected by a scanner. [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] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Brace: Any form of splint or appliance used to support the limbs or trunk. [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] Brain Diseases: Pathologic conditions affecting the brain, which is composed of the intracranial components of the central nervous system. This includes (but is not limited to) the cerebral cortex; intracranial white matter; basal ganglia; thalamus; hypothalamus; brain stem; and cerebellum. [NIH] Brain Neoplasms: Neoplasms of the intracranial components of the central nervous system, including the cerebral hemispheres, basal ganglia, hypothalamus, thalamus, brain stem, and cerebellum. Brain neoplasms are subdivided into primary (originating from brain tissue) and secondary (i.e., metastatic) forms. Primary neoplasms are subdivided into benign and malignant forms. In general, brain tumors may also be classified by age of onset, histologic type, or presenting location in the brain. [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] Breast Feeding: The nursing of an infant at the mother's breast. [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] Bronchial Hyperreactivity: Tendency of the smooth muscle of the tracheobronchial tree to contract more intensely in response to a given stimulus than it does in the response seen in normal individuals. This condition is present in virtually all symptomatic patients with asthma. The most prominent manifestation of this smooth muscle contraction is a decrease in airway caliber that can be readily measured in the pulmonary function laboratory. [NIH] Bronchiectasis: Persistent abnormal dilatation of the bronchi. [NIH] 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] Bronchitis: Inflammation (swelling and reddening) of the bronchi. [NIH] Bronchoconstriction: Diminution of the caliber of a bronchus physiologically or as a result of pharmacological intervention. [NIH]

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Bronchodilator: A drug that relaxes the smooth muscles in the constricted airway. [NIH] Bronchoscopy: Endoscopic examination, therapy or surgery of the bronchi. [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] Bulbar: Pertaining to a bulb; pertaining to or involving the medulla oblongata, as bulbar paralysis. [EU] Bupivacaine: A widely used local anesthetic agent. [NIH] Bypass: A surgical procedure in which the doctor creates a new pathway for the flow of body fluids. [NIH] Cadaver: A dead body, usually a human body. [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] Cannabidiol: Compound isolated from Cannabis sativa extract. [NIH] Cannabinoids: Compounds extracted from Cannabis sativa L. and metabolites having the cannabinoid structure. The most active constituents are tetrahydrocannabinol, cannabinol, and cannabidiol. [NIH] Cannabinol: A physiologically inactive constituent of Cannabis sativa L. [NIH] Cannabis: The hemp plant Cannabis sativa. Products prepared from the dried flowering tops of the plant include marijuana, hashish, bhang, and ganja. [NIH] Cannula: A tube for insertion into a duct or cavity; during insertion its lumen is usually occupied by a trocar. [EU] Capsaicin: Cytotoxic alkaloid from various species of Capsicum (pepper, paprika), of the Solanaceae. [NIH] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Captopril: A potent and specific inhibitor of peptidyl-dipeptidase A. It blocks the conversion of angiotensin I to angiotensin II, a vasoconstrictor and important regulator of arterial blood pressure. Captopril acts to suppress the renin-angiotensin system and inhibits pressure responses to exogenous angiotensin. [NIH] 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] Carcinogenic: Producing carcinoma. [EU] Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs.

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[NIH]

Cardiac: Having to do with the heart. [NIH] Cardiovascular: Having to do with the heart and blood vessels. [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] 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] Catheter: A flexible tube used to deliver fluids into or withdraw fluids from the body. [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] 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] 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 Division: The fission of a cell. [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] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Central Nervous System Infections: Pathogenic infections of the brain, spinal cord, and meninges. DNA virus infections; RNA virus infections; bacterial infections; mycoplasma infections; Spirochaetales infections; fungal infections; protozoan infections; helminthiasis; and prion diseases may involve the central nervous system as a primary or secondary process. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebral Cortex: The thin layer of gray matter on the surface of the cerebral hemisphere that develops from the telencephalon and folds into gyri. It reaches its highest development in man and is responsible for intellectual faculties and higher mental functions. [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]

Cerebrospinal: Pertaining to the brain and spinal cord. [EU] Cerebrospinal fluid: CSF. The fluid flowing around the brain and spinal cord. Cerebrospinal fluid is produced in the ventricles in the brain. [NIH]

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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] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [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] Chest cavity: Space in body surrounding the lungs. [NIH] Chest Pain: Pressure, burning, or numbness in the chest. [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] Chin: The anatomical frontal portion of the mandible, also known as the mentum, that contains the line of fusion of the two separate halves of the mandible (symphysis menti). This line of fusion divides inferiorly to enclose a triangular area called the mental protuberance. On each side, inferior to the second premolar tooth, is the mental foramen for the passage of blood vessels and a nerve. [NIH] Chlorophyll: Porphyrin derivatives containing magnesium that act to convert light energy in photosynthetic organisms. [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] Chromosomal: Pertaining to chromosomes. [EU] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic Disease: Disease or ailment of long duration. [NIH] Chronic Obstructive Pulmonary Disease: Collective term for chronic bronchitis and emphysema. [NIH] Ciliary: Inflammation or infection of the glands of the margins of the eyelids. [NIH] Ciliated cells: Epithelial cells with fine hair-like strands on their free borders. [NIH] Circulatory system: The system that contains the heart and the blood vessels and moves 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] Cirrhosis: A type of chronic, progressive liver disease. [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] 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] 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]

Codeine: An opioid analgesic related to morphine but with less potent analgesic properties

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and mild sedative effects. It also acts centrally to suppress cough. [NIH] Cohort Studies: Studies in which subsets of a defined population are identified. These groups may or may not be exposed to factors hypothesized to influence the probability of the occurrence of a particular disease or other outcome. Cohorts are defined populations which, as a whole, are followed in an attempt to determine distinguishing subgroup characteristics. [NIH] Colchicine: A major alkaloid from Colchicum autumnale L. and found also in other Colchicum species. Its primary therapeutic use is in the treatment of gout, but it has been used also in the therapy of familial Mediterranean fever (periodic disease). [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] 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 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,

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megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Compliance: Distensibility measure of a chamber such as the lungs (lung compliance) or bladder. Compliance is expressed as a change in volume per unit change in pressure. [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] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Condoms: A sheath that is worn over the penis during sexual behavior in order to prevent pregnancy or spread of sexually transmitted disease. [NIH] 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] Congestion: Excessive or abnormal accumulation of blood in a part. [EU] Congestive heart failure: Weakness of the heart muscle that leads to a buildup of fluid in body tissues. [NIH] 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] Consciousness: Sense of awareness of self and of the environment. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Constriction: The act of constricting. [NIH] Continence: The ability to hold in a bowel movement or urine. [NIH] Continuous infusion: The administration of a fluid into a blood vessel, usually over a prolonged period of time. [NIH] Contraceptive: An agent that diminishes the likelihood of or prevents conception. [EU] Contractility: Capacity for becoming short in response to a suitable stimulus. [EU]

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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] Contrast medium: A substance that is introduced into or around a structure and, because of the difference in absorption of x-rays by the contrast medium and the surrounding tissues, allows radiographic visualization of the structure. [EU] 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] Coordination: Muscular or motor regulation or the harmonious cooperation of muscles or groups of muscles, in a complex action or series of actions. [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 Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] 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] Coryza: Profuse discharge from the mucous membrane of the nose. [NIH] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Cranial Nerves: Twelve pairs of nerves that carry general afferent, visceral afferent, special afferent, somatic efferent, and autonomic efferent fibers. [NIH] 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] Creatine: An amino acid that occurs in vertebrate tissues and in urine. In muscle tissue, creatine generally occurs as phosphocreatine. Creatine is excreted as creatinine in the urine. [NIH]

Creatinine: A compound that is excreted from the body in urine. Creatinine levels are measured to monitor kidney function. [NIH] Critical Care: Health care provided to a critically ill patient during a medical emergency or crisis. [NIH] Cross-Sectional Studies: Studies in which the presence or absence of disease or other health-related variables are determined in each member of the study population or in a representative sample at one particular time. This contrasts with longitudinal studies which are followed over a period of time. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cutaneous: Having to do with the skin. [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] Cysteine: A thiol-containing non-essential amino acid that is oxidized to form cystine. [NIH]

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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] 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] Debrisoquin: An adrenergic neuron-blocking drug similar in effects to guanethidine. It is also noteworthy in being a substrate for a polymorphic cytochrome P-450 enzyme. Persons with certain isoforms of this enzyme are unable to properly metabolize this and many other clinically important drugs. They are commonly referred to as having a debrisoquin 4hydroxylase polymorphism. [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] Dendrites: Extensions of the nerve cell body. They are short and branched and receive stimuli from other neurons. [NIH] Detoxification: Treatment designed to free an addict from his drug habit. [EU] Dextromethorphan: The d-isomer of the codeine analog of levorphanol. Dextromethorphan shows high affinity binding to several regions of the brain, including the medullary cough center. This compound is a NMDA receptor antagonist (receptors, N-methyl-D-aspartate) and acts as a non-competitive channel blocker. It is used widely as an antitussive agent, and is also used to study the involvement of glutamate receptors in neurotoxicity. [NIH] Dextrorotatory: Turning towards the right hand. [NIH] Diabetes Insipidus: A metabolic disorder due to disorders in the production or release of vasopressin. It is characterized by the chronic excretion of large amounts of low specific gravity urine and great thirst. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diaphragm: The musculofibrous partition that separates the thoracic cavity from the abdominal cavity. Contraction of the diaphragm increases the volume of the thoracic cavity aiding inspiration. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Dietitian: An expert in nutrition who helps people plan what and how much food to eat. [NIH]

Diffusion: The tendency of a gas or solute to pass from a point of higher pressure or

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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] Digestive tract: The organs through which food passes when food is eaten. These organs are the mouth, esophagus, stomach, small and large intestines, and rectum. [NIH] Dihydrotestosterone: Anabolic agent. [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] 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] Disinfection: Rendering pathogens harmless through the use of heat, antiseptics, antibacterial agents, etc. [NIH] Disposition: A tendency either physical or mental toward certain diseases. [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 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] 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] Distention: The state of being distended or enlarged; the act of distending. [EU] Diuresis: Increased excretion of urine. [EU] Diuretic: A drug that increases the production of urine. [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] Dosage Forms: Completed forms of the pharmaceutical preparation in which prescribed doses of medication are included. They are designed to resist action by gastric fluids, prevent vomiting and nausea, reduce or alleviate the undesirable taste and smells associated with oral administration, achieve a high concentration of drug at target site, or produce a delayed or long-acting drug effect. They include capsules, liniments, ointments, pharmaceutical solutions, powders, tablets, etc. [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

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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, route, and target. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [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] Duodenum: The first part of the small intestine. [NIH] Dysphagia: Difficulty in swallowing. [EU] Dysphonia: Difficulty or pain in speaking; impairment of the voice. [NIH] Dysphoria: Disquiet; restlessness; malaise. [EU] Dyspnea: Difficult or labored breathing. [NIH] Dystonia: Disordered tonicity of muscle. [EU] Dystrophy: Any disorder arising from defective or faulty nutrition, especially the muscular dystrophies. [EU] Ecchymosis: Extravasation of blood into the skin, resulting in a nonelevated, rounded or irregular, blue or purplish patch, larger than a petechia. [NIH] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Efferent: Nerve fibers which conduct impulses from the central nervous system to muscles and glands. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Ejaculation: The release of semen through the penis during orgasm. [NIH] Elastic: Susceptible of resisting and recovering from stretching, compression or distortion applied by a force. [EU] Elastin: The protein that gives flexibility to tissues. [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] 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] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH]

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Emphysema: A pathological accumulation of air in tissues or organs. [NIH] Enalapril: An angiotensin-converting enzyme inhibitor that is used to treat hypertension. [NIH]

Encephalopathy: A disorder of the brain that can be caused by disease, injury, drugs, or chemicals. [NIH] Endocrine Glands: Ductless glands that secrete substances which are released directly into the circulation and which influence metabolism and other body functions. [NIH] Endogenous: Produced inside an organism or cell. The opposite is external (exogenous) production. [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] 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] Epidemiologic Factors: Events, characteristics, or other definable entities that have the potential to bring about a change in a health condition or other defined outcome. [NIH] Epidemiologic Studies: Studies designed to examine associations, commonly, hypothesized causal relations. They are usually concerned with identifying or measuring the effects of risk factors or exposures. The common types of analytic study are case-control studies, cohort studies, and cross-sectional studies. [NIH] Epidemiological: Relating to, or involving epidemiology. [EU] 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] Epiglottis: Thin leaf-shaped cartilage, covered with mucous membrane, at the root of the tongue, which folds back over the entrance to the larynx, covering it, during the act of swallowing. [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 and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Equipment and Supplies: Expendable and nonexpendable equipment, supplies, apparatus, and instruments that are used in diagnostic, surgical, therapeutic, scientific, and experimental procedures. [NIH] Erythema: Redness of the skin produced by congestion of the capillaries. This condition may result from a variety of causes. [NIH]

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Erythrina: A genus of leguminous shrubs or trees, mainly tropical, yielding certain alkaloids, lectins, and other useful compounds. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Escalation: Progressive use of more harmful drugs. [NIH] Esophageal: Having to do with the esophagus, the muscular tube through which food passes from the throat to the stomach. [NIH] Esophageal Manometry: A test to measure muscle tone inthe esophagus. [NIH] Esophagitis: Inflammation, acute or chronic, of the esophagus caused by bacteria, chemicals, or trauma. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Estrogen: One of the two female sex hormones. [NIH] Eucalyptus: A genus of Australian trees of the Myrtaceae family that yields gums, oils, and resins which are used as flavoring agents, astringents, and aromatics, and formerly to treat diarrhea, asthma, bronchitis, and respiratory tract infections. [NIH] Eukaryotic Cells: Cells of the higher organisms, containing a true nucleus bounded by a nuclear membrane. [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] Excipients: Usually inert substances added to a prescription in order to provide suitable consistency to the dosage form; a binder, matrix, base or diluent in pills, tablets, creams, salves, etc. [NIH] 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] Exhaustion: The feeling of weariness of mind and body. [NIH] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Exotoxin: Toxic substance excreted by living bacterial cells. [NIH] Expectorants: Agents that increase mucous excretion. Mucolytic agents, that is drugs that liquefy mucous secretions, are also included here. [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] External-beam radiation: Radiation therapy that uses a machine to aim high-energy rays at the cancer. Also called external radiation. [NIH] Extracellular: Outside a cell or cells. [EU] Extravasation: A discharge or escape, as of blood, from a vessel into the tissues. [EU] Extremity: A limb; an arm or leg (membrum); sometimes applied specifically to a hand or foot. [EU]

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Eye Movements: Voluntary or reflex-controlled movements of the eye. [NIH] Facial: Of or pertaining to the face. [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]

Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Fentanyl: A narcotic opioid drug that is used in the treatment of pain. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibrin: A protein derived from fibrinogen in the presence of thrombin, which forms part of the blood clot. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Fistula: Abnormal communication most commonly seen between two internal organs, or between an internal organ and the surface of the body. [NIH] Flatus: Gas passed through the rectum. [NIH] Flavoring Agents: Substances added to foods and medicine to improve the quality of taste. [NIH]

Flexion: In gynaecology, a displacement of the uterus in which the organ is bent so far forward or backward that an acute angle forms between the fundus and the cervix. [EU] 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 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] Fluoxetine: The first highly specific serotonin uptake inhibitor. It is used as an antidepressant and often has a more acceptable side-effects profile than traditional antidepressants. [NIH] Flushing: A transient reddening of the face that may be due to fever, certain drugs, exertion, stress, or a disease process. [NIH] Fold: A plication or doubling of various parts of the body. [NIH]

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Foramen: A natural hole of perforation, especially one in a bone. [NIH] Forearm: The part between the elbow and the wrist. [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] Fundus: The larger part of a hollow organ that is farthest away from the organ's opening. The bladder, gallbladder, stomach, uterus, eye, and cavity of the middle ear all have a fundus. [NIH] Fungus: A general term used to denote a group of eukaryotic protists, including mushrooms, yeasts, rusts, moulds, smuts, etc., which are characterized by the absence of chlorophyll and by the presence of a rigid cell wall composed of chitin, mannans, and sometimes cellulose. They are usually of simple morphological form or show some reversible cellular specialization, such as the formation of pseudoparenchymatous tissue in the fruiting body of a mushroom. The dimorphic fungi grow, according to environmental conditions, as moulds or yeasts. [EU] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Gangrenous: A circumscribed, deep-seated, suppurative inflammation of the subcutaneous tissue of the eyelid discharging pus from several points. [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 Acid: Hydrochloric acid present in gastric juice. [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] Gastroesophageal Reflux Disease: Flow of the stomach's contents back up into the esophagus. Happens when the muscle between the esophagus and the stomach (the lower esophageal sphincter) is weak or relaxes when it shouldn't. May cause esophagitis. Also called esophageal reflux or reflux esophagitis. [NIH] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrostomy: Creation of an artificial external opening into the stomach for nutritional support or gastrointestinal compression. [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]

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] Geriatric: Pertaining to the treatment of the aged. [EU]

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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] Gliosis: The production of a dense fibrous network of neuroglia; includes astrocytosis, which is a proliferation of astrocytes in the area of a degenerative lesion. [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 (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] Glutamate: Excitatory neurotransmitter of the brain. [NIH] Gonad: A sex organ, such as an ovary or a testicle, which produces the gametes in most multicellular animals. [NIH] Gonadal: Pertaining to a gonad. [EU] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer. [NIH] Grading: A system for classifying cancer cells in terms of how abnormal they appear when examined under a microscope. The objective of a grading system is to provide information about the probable growth rate of the tumor and its tendency to spread. The systems used to grade tumors vary with each type of cancer. Grading plays a role in treatment decisions. [NIH]

Gram-negative: Losing the stain or decolorized by alcohol in Gram's method of staining, a primary characteristic of bacteria having a cell wall composed of a thin layer of peptidoglycan covered by an outer membrane of lipoprotein and lipopolysaccharide. [EU] Gram-positive: Retaining the stain or resisting decolorization by alcohol in Gram's method of staining, a primary characteristic of bacteria whose cell wall is composed of a thick layer of peptidologlycan with attached teichoic acids. [EU] Groin: The external junctural region between the lower part of the abdomen and the thigh. [NIH]

Guanethidine: An antihypertensive agent that acts by inhibiting selectively transmission in post-ganglionic adrenergic nerves. It is believed to act mainly by preventing the release of norepinephrine at nerve endings and causes depletion of norepinephrine in peripheral sympathetic nerve terminals as well as in tissues. [NIH] Habitat: An area considered in terms of its environment, particularly as this determines the type and quality of the vegetation the area can carry. [NIH] Hair follicles: Shafts or openings on the surface of the skin through which hair grows. [NIH]

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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] Haploid: An organism with one basic chromosome set, symbolized by n; the normal condition of gametes in diploids. [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] Hay Fever: A seasonal variety of allergic rhinitis, marked by acute conjunctivitis with lacrimation and itching, regarded as an allergic condition triggered by specific allergens. [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] 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] Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Hematoma: An extravasation of blood localized in an organ, space, or tissue. [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] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hepatitis: Inflammation of the liver and liver disease involving degenerative or necrotic alterations of hepatocytes. [NIH] Hepatocytes: The main structural component of the liver. They are specialized epithelial cells that are organized into interconnected plates called lobules. [NIH] 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] 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]

Hiatal Hernia: A small opening in the diaphragm that allows the upper part of the stomach

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to move up into the chest. Causes heartburn from stomach acid flowing back up through the opening. [NIH] Hoarseness: An unnaturally deep or rough quality of voice. [NIH] 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] Hydration: Combining with water. [NIH] Hydrocephalus: Excessive accumulation of cerebrospinal fluid within the cranium which may be associated with dilation of cerebral ventricles, intracranial hypertension; headache; lethargy; urinary incontinence; and ataxia (and in infants macrocephaly). This condition may be caused by obstruction of cerebrospinal fluid pathways due to neurologic abnormalities, intracranial hemorrhages; central nervous system infections; brain neoplasms; craniocerebral trauma; and other conditions. Impaired resorption of cerebrospinal fluid from the arachnoid villi results in a communicating form of hydrocephalus. Hydrocephalus ex-vacuo refers to ventricular dilation that occurs as a result of brain substance loss from cerebral infarction and other conditions. [NIH] Hydrochlorothiazide: A thiazide diuretic often considered the prototypical member of this class. It reduces the reabsorption of electrolytes from the renal tubules. This results in increased excretion of water and electrolytes, including sodium, potassium, chloride, and magnesium. It has been used in the treatment of several disorders including edema, hypertension, diabetes insipidus, and hypoparathyroidism. [NIH] Hydrogel: A network of cross-linked hydrophilic macromolecules used in biomedical applications. [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] Hydroxylysine: A hydroxylated derivative of the amino acid lysine that is present in certain collagens. [NIH] Hydroxyproline: A hydroxylated form of the imino acid proline. A deficiency in ascorbic acid can result in impaired hydroxyproline formation. [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] 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] Hyperventilation: A pulmonary ventilation rate faster than is metabolically necessary for the exchange of gases. It is the result of an increased frequency of breathing, an increased tidal volume, or a combination of both. It causes an excess intake of oxygen and the blowing off of carbon dioxide. [NIH] Hypoxic: Having too little oxygen. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH]

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Immunity: Nonsusceptibility to the invasive or pathogenic microorganisms or to the toxic effect of antigenic substances. [NIH]

effects

of

foreign

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]

Immunology: The study of the body's immune system. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [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] 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] Incision: A cut made in the body during surgery. [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] Incontinence Pads: Absorbent pads made of various materials used for personal hygiene usually in urinary incontinence and usually in the elderly. They may be worn as underpants or as pants liners. They are made of absorbent materials such as fluff wood pulp and hydrogel absorbent with viscose rayon, polyester, polypropylene, or polyethylene coverstock. [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] 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] Infancy: The period of complete dependency prior to the acquisition of competence in walking, talking, and self-feeding. [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

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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]

Infection Control: Programs of disease surveillance, generally within health care facilities, designed to investigate, prevent, and control the spread of infections and their causative microorganisms. [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] 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] 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] 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] Inoculum: The spores or tissues of a pathogen that serve to initiate disease in a plant. [NIH] Inorganic: Pertaining to substances not of organic origin. [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] 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] Intercostal: Situated between the ribs. [EU] 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] 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] 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] Intracellular: Inside a cell. [NIH] Intracranial Hemorrhages: Bleeding within the intracranial cavity, including hemorrhages in the brain and within the cranial epidural, subdural, and subarachnoid spaces. [NIH]

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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] Intravenous: IV. Into a 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] 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]

Involuntary: Reaction occurring without intention or volition. [NIH] 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] Irradiation: The use of high-energy radiation from x-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 from materials called radioisotopes. Radioisotopes produce radiation and can be placed in or near the tumor or in the area near cancer cells. This type of radiation treatment is called internal radiation therapy, implant radiation, interstitial radiation, or brachytherapy. Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Irradiation is also called radiation therapy, radiotherapy, and x-ray therapy. [NIH] Irritants: Drugs that act locally on cutaneous or mucosal surfaces to produce inflammation; those that cause redness due to hyperemia are rubefacients; those that raise blisters are vesicants and those that penetrate sebaceous glands and cause abscesses are pustulants; tear gases and mustard gases are also irritants. [NIH] Isoflurane: A stable, non-explosive inhalation anesthetic, relatively free from significant side effects. [NIH] Isoniazid: Antibacterial agent used primarily as a tuberculostatic. It remains the treatment of choice for tuberculosis. [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] 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] Kinetics: The study of rate dynamics in chemical or physical systems. [NIH] Labyrinth: The internal ear; the essential part of the organ of hearing. It consists of an osseous and a membranous portion. [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] Laryngitis: Inflammation of the larynx. This condition presents itself with dryness and

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soreness of the throat, difficulty in swallowing, cough, and hoarseness. [NIH] 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] Lectins: Protein or glycoprotein substances, usually of plant origin, that bind to sugar moieties in cell walls or membranes and thereby change the physiology of the membrane to cause agglutination, mitosis, or other biochemical changes in the cell. [NIH] Leishmaniasis: A disease caused by any of a number of species of protozoa in the genus Leishmania. There are four major clinical types of this infection: cutaneous (Old and New World), diffuse cutaneous, mucocutaneous, and visceral leishmaniasis. [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] Levorphanol: A narcotic analgesic that may be habit-forming. It is nearly as effective orally as by injection. [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] Lipid: Fat. [NIH] Lisinopril: An orally active angiotensin-converting enzyme inhibitor that has been used in the treatment of hypertension and congestive heart failure. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Liver scan: An image of the liver created on a computer screen or on film. A radioactive substance is injected into a blood vessel and travels through the bloodstream. It collects in the liver, especially in abnormal areas, and can be detected by the scanner. [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] 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] 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

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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] Lung volume: The amount of air the lungs hold. [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]

Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph 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] Lymphocytes: White blood cells formed in the body's lymphoid tissue. The nucleus is round or ovoid with coarse, irregularly clumped chromatin while the cytoplasm is typically pale blue with azurophilic (if any) granules. Most lymphocytes can be classified as either T or B (with subpopulations of each); those with characteristics of neither major class are called null cells. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Lytic: 1. Pertaining to lysis or to a lysin. 2. Producing lysis. [EU] 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] Malaise: A vague feeling of bodily discomfort. [EU] 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 tumor: A tumor capable of metastasizing. [NIH] Mandible: The largest and strongest bone of the face constituting the lower jaw. It supports the lower teeth. [NIH] Mannans: Polysaccharides consisting of mannose units. [NIH] Mastication: The act and process of chewing and grinding food in the mouth. [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] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] Medical Records: Recording of pertinent information concerning patient's illness or

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illnesses. [NIH] Medical Staff: Professional medical personnel who provide care to patients in an organized facility, institution or agency. [NIH] Medicament: A medicinal substance or agent. [EU] 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] Membrane: A very thin layer of tissue that covers a surface. [NIH] 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] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Mental Health: The state wherein the person is well adjusted. [NIH] Mental Processes: Conceptual functions or thinking in all its forms. [NIH] Menthol: An alcohol produced from mint oils or prepared synthetically. [NIH] Meperidine: 1-Methyl-4-phenyl-4-piperidinecarboxylic acid ethyl ester. A narcotic analgesic that can be used for the relief of most types of moderate to severe pain, including postoperative pain and the pain of labor. Prolonged use may lead to dependence of the morphine type; withdrawal symptoms appear more rapidly than with morphine and are of shorter duration. [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] Mesentery: A layer of the peritoneum which attaches the abdominal viscera to the abdominal wall and conveys their blood vessels and nerves. [NIH] Metabolite: Any substance produced by metabolism or by a metabolic process. [EU] Metastasis: The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors" and contain cells that are like those in the original (primary) tumor. The plural is metastases. [NIH] Metastatic: Having to do with metastasis, which is the spread of cancer from one part of the body to another. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [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] Mobility: Capability of movement, of being moved, or of flowing freely. [EU] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU]

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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] 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] Morphinomimetic: Marked by simulation of (body processes induced by) morphine. [EU] 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] 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 Neurons: Neurons which activate muscle cells. [NIH] Mucins: A secretion containing mucopolysaccharides and protein that is the chief constituent of mucus. [NIH] Mucociliary: Pertaining to or affecting the mucus membrane and hairs (including eyelashes, nose hair, .): mucociliary clearing: the clearance of mucus by ciliary movement ( particularly in the respiratory system). [EU] Mucus: The viscous secretion of mucous membranes. It contains mucin, white blood cells, water, inorganic salts, and exfoliated cells. [NIH] 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 (lipid) and serves as a nerve insulator and helps in the transmission of nerve signals. [NIH] Mupirocin: A topically used antibiotic from a strain of Pseudomonas fluorescens. It has shown excellent activity against gram-positive staphylococci and streptococci. The antibiotic is used primarily for the treatment of primary and secondary skin disorders, nasal infections, and wound healing. [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] Muscular Diseases: Acquired, familial, and congenital disorders of skeletal muscle and smooth muscle. [NIH] Musculature: The muscular apparatus of the body, or of any part of it. [EU] Mustard Gas: Severe irritant and vesicant of skin, eyes, and lungs. It may cause blindness and lethal lung edema and was formerly used as a war gas. The substance has been proposed as a cytostatic and for treatment of psoriasis. It has been listed as a known carcinogen in the Fourth Annual Report on Carcinogens (NTP-85-002, 1985) (Merck, 11th ed). [NIH]

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Mutism: Inability or refusal to speak. [EU] Mydriatic: 1. Dilating the pupil. 2. Any drug that dilates the pupil. [EU] Myelin: The fatty substance that covers and protects nerves. [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] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] 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] 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 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] Natriuresis: The excretion of abnormal amounts of sodium in the urine. [EU] 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] 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] Neoplasm: A new growth of benign or malignant tissue. [NIH] Nephropathy: Disease of the kidneys. [EU] Nerve Regeneration: Renewal or physiological repair of damaged nerve tissue. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [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] 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] Neuromuscular: Pertaining to muscles and nerves. [EU] Neuromuscular Diseases: A general term encompassing lower motor neuron disease; peripheral nervous system diseases; and certain muscular diseases. Manifestations include muscle weakness; fasciculation; muscle atrophy; spasm; myokymia; muscle hypertonia, myalgias, and musclehypotonia. [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,

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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] Neurotoxicity: The tendency of some treatments to cause damage to the nervous system. [NIH]

Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [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, and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier nuclei during their decay. [NIH] Niche: The ultimate unit of the habitat, i. e. the specific spot occupied by an individual organism; by extension, the more or less specialized relationships existing between an organism, individual or synusia(e), and its environment. [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]

Nonverbal Communication: Transmission of emotions, ideas, and attitudes between individuals in ways other than the spoken language. [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] Noscapine: A naturally occurring opium alkaloid that is a centrally acting antitussive agent. [NIH]

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] 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]

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Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nulliparous: Having never given birth to a viable infant. [EU] Nursing Care: Care given to patients by nursing service personnel. [NIH] Nursing Staff: Personnel who provide nursing service to patients in an organized facility, institution, or agency. [NIH] Nutritional Status: State of the body in relation to the consumption and utilization of nutrients. [NIH] Nutritional Support: The administration of nutrients for assimilation and utilization by a patient by means other than normal eating. It does not include fluid therapy which normalizes body fluids to restore water-electrolyte balance. [NIH] Obsessive Behavior: Persistent, unwanted idea or impulse which is considered normal when it does not markedly interfere with mental processes or emotional adjustment. [NIH] Occupational Exposure: The exposure to potentially harmful chemical, physical, or biological agents that occurs as a result of one's occupation. [NIH] Occupational Medicine: Medical specialty concerned with the promotion and maintenance of the physical and mental health of employees in occupational settings. [NIH] Ointments: Semisolid preparations used topically for protective emollient effects or as a vehicle for local administration of medications. Ointment bases are various mixtures of fats, waxes, animal and plant oils and solid and liquid hydrocarbons. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH] Opiate: A remedy containing or derived from opium; also any drug that induces sleep. [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] Orgasm: The crisis of sexual excitement in either humans or animals. [NIH] Orofacial: Of or relating to the mouth and face. [EU] Otolaryngologist: A doctor who specializes in treating diseases of the ear, nose, and throat. Also called an ENT doctor. [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] Overactive bladder: A condition in which the patient experiences two or all three of the following conditions: [NIH] Overweight: An excess of body weight but not necessarily body fat; a body mass index of 25 to 29.9 kg/m2. [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]

Oxycodone: Semisynthetic derivative of codeine that acts as a narcotic analgesic more potent and addicting than codeine. [NIH] Oxygen Consumption: The oxygen consumption is determined by calculating the difference

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between the amount of oxygen inhaled and exhaled. [NIH] 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 Juice: The fluid containing digestive enzymes secreted by the pancreas in response to food in the duodenum. [NIH] Pancreatitis: Acute or chronic inflammation of the pancreas, which may be asymptomatic or symptomatic, and which is due to autodigestion of a pancreatic tissue by its own enzymes. It is caused most often by alcoholism or biliary tract disease; less commonly it may be associated with hyperlipaemia, hyperparathyroidism, abdominal trauma (accidental or operative injury), vasculitis, or uraemia. [EU] Paradoxical: Occurring at variance with the normal rule. [EU] 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]

Parietal: 1. Of or pertaining to the walls of a cavity. 2. Pertaining to or located near the parietal bone, as the parietal lobe. [EU] Paroxetine: A serotonin uptake inhibitor that is effective in the treatment of depression. [NIH]

Paroxysmal: Recurring in paroxysms (= spasms or seizures). [EU] Particle: A tiny mass of material. [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] 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] Pathologist: A doctor who identifies diseases by studying cells and tissues under a microscope. [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 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]

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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] Pelvis: The lower part of the abdomen, located between the hip bones. [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] Pentamidine: Antiprotozoal agent effective in trypanosomiasis, leishmaniasis, and some fungal infections; used in treatment of Pneumocystis carinii pneumonia in HIV-infected patients. It may cause diabetes mellitus, central nervous system damage, and other toxic effects. [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] Perennial: Lasting through the year of for several years. [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] 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 Nervous System Diseases: Diseases of the peripheral nerves external to the brain and spinal cord, which includes diseases of the nerve roots, ganglia, plexi, autonomic nerves, sensory nerves, and motor nerves. [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] Peritonitis: Inflammation of the peritoneum; a condition marked by exudations in the peritoneum of serum, fibrin, cells, and pus. It is attended by abdominal pain and tenderness, constipation, vomiting, and moderate fever. [EU] 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

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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 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] Pessary: 1. An instrument placed in the vagina to support the uterus or rectum or as a contraceptive device. 2. A medicated vaginal suppository. [EU] Petechia: A pinpoint, nonraised, perfectly round, purplish red spot caused by intradermal or submucous haemorrhage. [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] Pharmaceutical Solutions: Homogeneous liquid preparations that contain one or more chemical substances dissolved, i.e., molecularly dispersed, in a suitable solvent or mixture of mutually miscible solvents. For reasons of their ingredients, method of preparation, or use, they do not fall into another group of products. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Pharyngitis: Inflammation of the throat. [NIH] 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] Phenyl: Ingredient used in cold and flu remedies. [NIH] Phenylpropanolamine: A sympathomimetic that acts mainly by causing release of norepinephrine but also has direct agonist activity at some adrenergic receptors. It is most commonly used as a nasal vasoconstrictor and an appetite depressant. [NIH] Phonation: The process of producing vocal sounds by means of vocal cords vibrating in an expiratory blast of air. [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] Photoreceptors: Cells specialized to detect and transduce light. [NIH] Physicochemical: Pertaining to physics and chemistry. [EU] 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] Pilot study: The initial study examining a new method or treatment. [NIH] Pitch: The subjective awareness of the frequency or spectral distribution of a sound. [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

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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] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Pleura: The thin serous membrane enveloping the lungs and lining the thoracic cavity. [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] Pneumonia: Inflammation of the lungs. [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] Polymorphic: Occurring in several or many forms; appearing in different forms at different stages of development. [EU] Polymorphism: The occurrence together of two or more distinct forms in the same population. [NIH] Polyp: A growth that protrudes from a mucous membrane. [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 chemically. [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 Hypertension: High blood pressure in the portal vein. This vein carries blood into the liver. Portal hypertension is caused by a blood clot. This is a common complication of cirrhosis. [NIH] Portal Vein: A short thick vein formed by union of the superior mesenteric vein and the splenic vein. [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] Postoperative: After surgery. [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,

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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] Practicability: A non-standard characteristic of an analytical procedure. It is dependent on the scope of the method and is determined by requirements such as sample throughout and costs. [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] Precordial: Pertaining to the precordium (= region over the heart and lower part of the thorax). [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] Preoperative: Preceding an operation. [EU] Presynaptic: Situated proximal to a synapse, or occurring before the synapse is crossed. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [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] Prodrug: A substance that gives rise to a pharmacologically active metabolite, although not itself active (i. e. an inactive precursor). [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, 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]

Proline: A non-essential amino acid that is synthesized from glutamic acid. It is an essential component of collagen and is important for proper functioning of joints and tendons. [NIH] Prone: Having the front portion of the body downwards. [NIH] Prophylaxis: An attempt to prevent disease. [NIH] Propofol: A widely used anesthetic. [NIH] Prostaglandin: Any of a group of components derived from unsaturated 20-carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway that are extremely potent mediators of a diverse group of physiologic processes. The abbreviation for prostaglandin is

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PG; specific compounds are designated by adding one of the letters A through I to indicate the type of substituents found on the hydrocarbon skeleton and a subscript (1, 2 or 3) to indicate the number of double bonds in the hydrocarbon skeleton e.g., PGE2. The predominant naturally occurring prostaglandins all have two double bonds and are synthesized from arachidonic acid (5,8,11,14-eicosatetraenoic acid) by the pathway shown in the illustration. The 1 series and 3 series are produced by the same pathway with fatty acids having one fewer double bond (8,11,14-eicosatrienoic acid or one more double bond (5,8,11,14,17-eicosapentaenoic acid) than arachidonic acid. The subscript a or ß indicates the configuration at C-9 (a denotes a substituent below the plane of the ring, ß, above the plane). The naturally occurring PGF's have the a configuration, e.g., PGF2a. All of the prostaglandins act by binding to specific cell-surface receptors causing an increase in the level of the intracellular second messenger cyclic AMP (and in some cases cyclic GMP also). The effect produced by the cyclic AMP increase depends on the specific cell type. In some cases there is also a positive feedback effect. Increased cyclic AMP increases prostaglandin synthesis leading to further increases in cyclic AMP. [EU] 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] Prosthesis: An artificial replacement of a part of the body. [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] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] 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] Protozoa: A subkingdom consisting of unicellular organisms that are the simplest in the animal kingdom. Most are free living. They range in size from submicroscopic to macroscopic. Protozoa are divided into seven phyla: Sarcomastigophora, Labyrinthomorpha, Apicomplexa, Microspora, Ascetospora, Myxozoa, and Ciliophora. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Pruritus: An intense itching sensation that produces the urge to rub or scratch the skin to obtain relief. [NIH] 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] Psychoactive: Those drugs which alter sensation, mood, consciousness or other psychological or behavioral functions. [NIH] Psychogenic: Produced or caused by psychic or mental factors rather than organic factors. [EU]

Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH] Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [NIH]

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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]

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 Ventilation: The total volume of gas per minute inspired or expired measured in liters per minute. [NIH] 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] Purifying: Respiratory equipment whose function is to remove contaminants from otherwise wholesome air. [NIH] Purpura: Purplish or brownish red discoloration, easily visible through the epidermis, caused by hemorrhage into the tissues. [NIH] Quadriplegia: Severe or complete loss of motor function in all four limbs which may result from brain diseases; spinal cord diseases; peripheral nervous system diseases; neuromuscular diseases; or rarely muscular diseases. The locked-in syndrome is characterized by quadriplegia in combination with cranial muscle paralysis. Consciousness is spared and the only retained voluntary motor activity may be limited eye movements. This condition is usually caused by a lesion in the upper brain stem which injures the descending cortico-spinal and cortico-bulbar tracts. [NIH] Quality of Health Care: The levels of excellence which characterize the health service or health care provided based on accepted standards of quality. [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] Quinidine: An optical isomer of quinine, extracted from the bark of the Cinchona tree and similar plant species. This alkaloid dampens the excitability of cardiac and skeletal muscles by blocking sodium and potassium currents across cellular membranes. It prolongs cellular action potential, and decreases automaticity. Quinidine also blocks muscarinic and alphaadrenergic neurotransmission. [NIH] Quinine: An alkaloid derived from the bark of the cinchona tree. It is used as an antimalarial drug, and is the active ingredient in extracts of the cinchona that have been used for that purpose since before 1633. Quinine is also a mild antipyretic and analgesic and has been used in common cold preparations for that purpose. It was used commonly and as a bitter and flavoring agent, and is still useful for the treatment of babesiosis. Quinine is also useful in some muscular disorders, especially nocturnal leg cramps and myotonia congenita, because of its direct effects on muscle membrane and sodium channels. The mechanisms of its antimalarial effects are not well understood. [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,

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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 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] Radiculopathy: Disease involving a spinal nerve root (see spinal nerve roots) which may result from compression related to intervertebral disk displacement; spinal cord injuries; spinal diseases; and other conditions. Clinical manifestations include radicular pain, weakness, and sensory loss referable to structures innervated by the involved nerve root. [NIH]

Radioactive: Giving off radiation. [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] Radiologist: A doctor who specializes in creating and interpreting pictures of areas inside the body. The pictures are produced with x-rays, sound waves, or other types of energy. [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] 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] Reabsorption: 1. The act or process of absorbing again, as the selective absorption by the kidneys of substances (glucose, proteins, sodium, etc.) already secreted into the renal tubules, and their return to the circulating blood. 2. Resorption. [EU] 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] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recuperation: The recovery of health and strength. [EU] 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] Reflux: The term used when liquid backs up into the esophagus from the stomach. [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] 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] Rehabilitative: Instruction of incapacitated individuals or of those affected with some

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mental disorder, so that some or all of their lost ability may be regained. [NIH] Reliability: Used technically, in a statistical sense, of consistency of a test with itself, i. e. the extent to which we can assume that it will yield the same result if repeated a second time. [NIH]

Renal Artery: A branch of the abdominal aorta which supplies the kidneys, adrenal glands and ureters. [NIH] Renal cell carcinoma: A type of kidney cancer. [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] Resorption: The loss of substance through physiologic or pathologic means, such as loss of dentin and cementum of a tooth, or of the alveolar process of the mandible or maxilla. [EU] 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 Muscles: These include the muscles of the diaphragm and the intercostal muscles. [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] 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] Rhinitis: Inflammation of the mucous membrane of the nose. [NIH] Rhinovirus: A genus of Picornaviridae inhabiting primarily the respiratory tract of mammalian hosts. It includes the human strains associated with common colds. [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] 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]

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Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Sanitary: Relating or belonging to health and hygiene; conductive to the restoration or maintenance of health. [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] Scans: Pictures of structures inside the body. Scans often used in diagnosing, staging, and monitoring disease include liver scans, bone scans, and computed tomography (CT) or computerized axial tomography (CAT) scans and magnetic resonance imaging (MRI) scans. In liver scanning and bone scanning, radioactive substances that are injected into the bloodstream collect in these organs. A scanner that detects the radiation is used to create pictures. In CT scanning, an x-ray machine linked to a computer is used to produce detailed pictures of organs inside the body. MRI scans use a large magnet connected to a computer to create pictures of areas inside the body. [NIH] Sciatica: A condition characterized by pain radiating from the back into the buttock and posterior/lateral aspects of the leg. Sciatica may be a manifestation of sciatic neuropathy; radiculopathy (involving the L4, L5, S1 or S2 spinal nerve roots; often associated with intervertebral disk displacement); or lesions of the cauda equina. [NIH] 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] Sebaceous: Gland that secretes sebum. [NIH] Sebaceous gland: Gland that secretes sebum. [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] Sedative: 1. Allaying activity and excitement. 2. An agent that allays excitement. [EU] Sedimentation: The act of causing the deposit of sediment, especially by the use of a centrifugal machine. [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] Self-Help Groups: Organizations which provide an environment encouraging social interactions through group activities or individual relationships especially for the purpose of rehabilitating or supporting patients, individuals with common health problems, or the elderly. They include therapeutic social clubs. [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]

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Serologic: Analysis of a person's serum, especially specific immune or lytic serums. [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] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral 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]

Shunt: A surgically created diversion of fluid (e.g., blood or cerebrospinal fluid) from one area of the body to another area of the body. [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] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Sinusitis: An inflammatory process of the mucous membranes of the paranasal sinuses that occurs in three stages: acute, subacute, and chronic. Sinusitis results from any condition causing ostial obstruction or from pathophysiologic changes in the mucociliary transport mechanism. [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 test: A test for an immune response to a compound by placing it on or under the skin. [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] Snoring: Rough, noisy breathing during sleep, due to vibration of the uvula and soft palate. [NIH]

Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Social Isolation: The separation of individuals or groups resulting in the lack of or minimizing of social contact and/or communication. This separation may be accomplished

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by physical separation, by social barriers and by psychological mechanisms. In the latter, there may be interaction but no real communication. [NIH] Social Problems: Situations affecting a significant number of people, that are believed to be sources of difficulty or threaten the stability of the community, and that require programs of amelioration. [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] 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] 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] 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] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU] 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 Diseases: Pathologic conditions which feature spinal cord damage or dysfunction, including disorders involving the meninges and perimeningeal spaces surrounding the spinal cord. Traumatic injuries, vascular diseases, infections, and inflammatory/autoimmune processes may affect the spinal cord. [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 Nerve Roots: The paired bundles of nerve fibers entering and leaving the spinal cord at each segment. The dorsal and ventral nerve roots join to form the mixed segmental spinal

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nerves. The dorsal roots are generally afferent, formed by the central projections of the spinal (dorsal root) ganglia sensory cells, and the ventral roots efferent, comprising the axons of spinal motor and autonomic preganglionic neurons. There are, however, some exceptions to this afferent/efferent rule. [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] Splint: A rigid appliance used for the immobilization of a part or for the correction of deformity. [NIH] Spores: The reproductive elements of lower organisms, such as protozoa, fungi, and cryptogamic plants. [NIH] Sputum: The material expelled from the respiratory passages by coughing or clearing the throat. [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]

Stenosis: Narrowing or stricture of a duct or canal. [EU] Sterile: Unable to produce children. [NIH] Sterilization: The destroying of all forms of life, especially microorganisms, by heat, chemical, or other means. [NIH] Sternum: Breast bone. [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] 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] Stoma: A surgically created opening from an area inside the body to the outside. [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] Street Drugs: Drugs obtained and often manufactured illegally for the subjective effects they are said to produce. They are often distributed in urban areas, but are also available in suburban and rural areas, and tend to be grossly impure and may cause unexpected toxicity. [NIH]

Streptococci: A genus of spherical Gram-positive bacteria occurring in chains or pairs. They are widely distributed in nature, being important pathogens but often found as normal commensals in the mouth, skin, and intestine of humans and other animals. [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

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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] Stricture: The abnormal narrowing of a body opening. Also called stenosis. [NIH] Stridor: The loud, harsh, vibrating sound produced by partial obstruction of the larynx or trachea. [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] 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] Subconjunctival: Situated or occurring beneath the conjunctiva. [EU] Subcutaneous: Beneath the skin. [NIH] Subcutaneous Emphysema: Presence of air or gas in the subcutaneous tissues of the body. [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] Suction: The removal of secretions, gas or fluid from hollow or tubular organs or cavities by means of a tube and a device that acts on negative pressure. [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] Sulfur Dioxide: A highly toxic, colorless, nonflammable gas. It is used as a pharmaceutical aid and antioxidant. It is also an environmental air pollutant. [NIH] Supine: Having the front portion of the body upwards. [NIH] Supine Position: The posture of an individual lying face up. [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] Suppository: A medicated mass adapted for introduction into the rectal, vaginal, or urethral orifice of the body, suppository bases are solid at room temperature but melt or dissolve at body temperature. Commonly used bases are cocoa butter, glycerinated gelatin, hydrogenated vegetable oils, polyethylene glycols of various molecular weights, and fatty acid esters of polyethylene glycol. [EU] Suppression: A conscious exclusion of disapproved desire contrary with repression, in

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which the process of exclusion is not conscious. [NIH] Suppurative: Consisting of, containing, associated with, or identified by the formation of pus. [NIH] Supraspinal: Above the spinal column or any spine. [NIH] Surgical Instruments: Hand-held tools or implements used by health professionals for the performance of surgical tasks. [NIH] Sweat: The fluid excreted by the sweat glands. It consists of water containing sodium chloride, phosphate, urea, ammonia, and other waste products. [NIH] Sweat Glands: Sweat-producing structures that are embedded in the dermis. Each gland consists of a single tube, a coiled body, and a superficial duct. [NIH] Sympathectomy: The removal or interruption of some part of the sympathetic nervous system for therapeutic or research purposes. [NIH] Sympathetic Nervous System: The thoracolumbar division of the autonomic nervous system. Sympathetic preganglionic fibers originate in neurons of the intermediolateral column of the spinal cord and project to the paravertebral and prevertebral ganglia, which in turn project to target organs. The sympathetic nervous system mediates the body's response to stressful situations, i.e., the fight or flight reactions. It often acts reciprocally to the parasympathetic system. [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] Synapse: The region where the processes of two neurons come into close contiguity, and the nervous impulse passes from one to the other; the fibers of the two are intermeshed, but, according to the general view, there is no direct contiguity. [NIH] Synergistic: Acting together; enhancing the effect of another force or agent. [EU] Syringomyelia: The presence in the spinal cord of elongated central fluid containing cavities surrounded by gliosis. [NIH] Systemic: Affecting the entire body. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Tear Gases: Gases that irritate the eyes, throat, or skin. Severe lacrimation develops upon irritation of the eyes. [NIH] Telencephalon: Paired anteriolateral evaginations of the prosencephalon plus the lamina terminalis. The cerebral hemispheres are derived from it. Many authors consider cerebrum a synonymous term to telencephalon, though a minority include diencephalon as part of the cerebrum (Anthoney, 1994). [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] Tetracycline: An antibiotic originally produced by Streptomyces viridifaciens, but used mostly in synthetic form. It is an inhibitor of aminoacyl-tRNA binding during protein synthesis. [NIH]

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Tetrahydrocannabinol: A psychoactive compound extracted from the resin of Cannabis sativa (marihuana, hashish). The isomer delta-9-tetrahydrocannabinol (THC) is considered the most active form, producing characteristic mood and perceptual changes associated with this compound. Dronabinol is a synthetic form of delta-9-THC. [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] 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] 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] Thrush: A disease due to infection with species of fungi of the genus Candida. [NIH] 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] 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] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tissue Donors: Individuals suppling living tissue, organs, cells, blood or blood components for transfer or transplantation to histocompatible recipients. [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] Tone: 1. The normal degree of vigour and tension; in muscle, the resistance to passive elongation or stretch; tonus. 2. A particular quality of sound or of voice. 3. To make permanent, or to change, the colour of silver stain by chemical treatment, usually with a heavy metal. [EU] Tonicity: The normal state of muscular tension. [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] 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] Toxin: A poison; frequently used to refer specifically to a protein produced by some higher plants, certain animals, and pathogenic bacteria, which is highly toxic for other living

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organisms. Such substances are differentiated from the simple chemical poisons and the vegetable alkaloids by their high molecular weight and antigenicity. [EU] Trachea: The cartilaginous and membranous tube descending from the larynx and branching into the right and left main bronchi. [NIH] Tracheostomy: Surgical formation of an opening into the trachea through the neck, or the opening so created. [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [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] 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] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Treatment Outcome: Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, practicability, etc., of these interventions in individual cases or series. [NIH]

Trees: Woody, usually tall, perennial higher plants (Angiosperms, Gymnosperms, and some Pterophyta) having usually a main stem and numerous branches. [NIH] 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] Trimethoprim-sulfamethoxazole: An antibiotic drug used to treat infection and prevent pneumocystis carinii pneumonia. [NIH] Trypanosomiasis: Infection with protozoa of the genus Trypanosoma. [NIH] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tubercle: A rounded elevation on a bone or other structure. [NIH] Tuberculin: A sterile liquid containing the growth products of, or specific substances extracted from, the tubercle bacillus; used in various forms in the diagnosis of tuberculosis. [NIH]

Tuberculosis: Any of the infectious diseases of man and other animals caused by species of Mycobacterium. [NIH] Tuberculostatic: Inhibiting the growth of Mycobacterium tuberculosis. [EU] Tubulin: A microtubule subunit protein found in large quantities in mammalian brain. It has also been isolated from sperm flagella, cilia, and other sources. Structurally, the protein is a dimer with a molecular weight of approximately 120,000 and a sedimentation coefficient of 5.8S. It binds to colchicine, vincristine, and vinblastine. [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] Ulcer: A localized necrotic lesion of the skin or a mucous surface. [NIH]

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Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Uraemia: 1. An excess in the blood of urea, creatinine, and other nitrogenous end products of protein and amino acids metabolism; more correctly referred to as azotemia. 2. In current usage the entire constellation of signs and symptoms of chronic renal failure, including nausea, vomiting anorexia, a metallic taste in the mouth, a uraemic odour of the breath, pruritus, uraemic frost on the skin, neuromuscular disorders, pain and twitching in the muscles, hypertension, edema, mental confusion, and acid-base and electrolyte imbalances. [EU]

Urea: A compound (CO(NH2)2), formed in the liver from ammonia produced by the deamination of amino acids. It is the principal end product of protein catabolism and constitutes about one half of the total urinary solids. [NIH] Ureters: Tubes that carry urine from the kidneys 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] Urodynamic: Measures of the bladder's ability to hold and release urine. [NIH] Urologist: A doctor who specializes in diseases of the urinary organs in females and the urinary and sex organs in males. [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] Uvula: Uvula palatinae; specifically, the tongue-like process which projects from the middle of the posterior edge of the soft palate. [NIH] Vaccination: Administration of vaccines to stimulate the host's immune response. This includes any preparation intended for active immunological prophylaxis. [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] 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] Valves: Flap-like structures that control the direction of blood flow through the heart. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasculitis: Inflammation of a blood vessel. [NIH] Vasodilation: Physiological dilation of the blood vessels without anatomic change. For

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dilation with anatomic change, dilatation, pathologic or aneurysm (or specific aneurysm) is used. [NIH] VE: The total volume of gas either inspired or expired in one minute. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] 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] 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] 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] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Villi: The tiny, fingerlike projections on the surface of the small intestine. Villi help absorb nutrients. [NIH] Vinblastine: An anticancer drug that belongs to the family of plant drugs called vinca alkaloids. It is a mitotic inhibitor. [NIH] Vincristine: An anticancer drug that belongs to the family of plant drugs called vinca alkaloids. [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] 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] Vocal cord: The vocal folds of the larynx. [NIH]

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Voice Disorders: Disorders of voice pitch, loudness, or quality. Dysphonia refers to impaired utterance of sounds by the vocal folds. [NIH] Voice Quality: Voice quality is that component of speech which gives the primary distinction to a given speaker's voice when pitch and loudness are excluded. It involves both phonatory and resonatory characteristics. Some of the descriptions of voice quality are harshness, breathiness and nasality. [NIH] Volition: Voluntary activity without external compulsion. [NIH] Vulgaris: An affection of the skin, especially of the face, the back and the chest, due to chronic inflammation of the sebaceous glands and the hair follicles. [NIH] Wheezing: Breathing with a rasp or whistling sound; a sign of airway constriction or obstruction. [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] Wound Healing: Restoration of integrity to traumatized tissue. [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] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH] X-ray therapy: The use of high-energy radiation from x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy) or from materials called radioisotopes. Radioisotopes produce radiation and can be placed in or near the tumor or in the area near cancer cells. This type of radiation treatment is called internal radiation therapy, implant radiation, interstitial radiation, or brachytherapy. Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. X-ray therapy is also called radiation therapy, radiotherapy, and irradiation. [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] Yohimbine: A plant alkaloid with alpha-2-adrenergic blocking activity. Yohimbine has been used as a mydriatic and in the treatment of impotence. It is also alleged to be an aphrodisiac. [NIH]

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INDEX A Abdomen, 82, 85, 94, 97, 133, 181, 186, 187, 190, 201, 205, 207, 215, 226, 232 Abdominal Pain, 97, 162, 181, 215 Abscess, 113, 181 Acoustic, 15, 19, 93, 181, 185 Actin, 181, 210, 211 Adaptation, 119, 181 Adenosine, 181, 188 Adjustment, 181, 213 Adrenal Glands, 181, 222 Adrenal Medulla, 181, 197, 212 Adrenergic, 4, 41, 138, 181, 194, 197, 201, 216, 220, 228, 233 Adrenergic Agonists, 4, 181 Adsorption, 106, 181 Adsorptive, 181 Advanced Life Support, 47, 181 Adverse Effect, 161, 181, 224 Aerosol, 4, 11, 100, 101, 161, 181, 186, 212 Afferent, 11, 109, 182, 193, 226 Affinity, 105, 182, 194, 225 Agonist, 86, 112, 182, 185, 216 Air Embolism, 21, 182 Air Sacs, 182 Airway Obstruction, 31, 182 Alertness, 182, 188 Algorithms, 182, 186 Alkaline, 99, 182, 183, 185, 188 Alkaloid, 99, 182, 188, 191, 210, 212, 220, 233 Allergen, 12, 182 Allergic Rhinitis, 15, 110, 111, 182, 202 Alternative medicine, 130, 182 Alveoli, 182, 232 Amino Acids, 182, 183, 217, 219, 227, 231 Ammonia, 40, 183, 228, 231 Amplification, 6, 183 Ampulla, 183, 197 Anabolic, 111, 183, 195 Anaesthesia, 18, 22, 23, 24, 25, 29, 31, 33, 34, 36, 183, 204 Anaesthetic, 106, 183 Anal, 183, 197 Analgesic, 90, 97, 183, 190, 207, 209, 210, 212, 213, 220, 227 Analog, 183, 194 Anatomical, 12, 120, 183, 185, 190, 204, 223

Anemia, 160, 183 Anesthesia, 19, 22, 27, 29, 30, 33, 37, 161, 182, 183, 218, 227 Anesthetics, 161, 183, 197 Angioedema, 183 Angioneurotic, 107, 183 Angioneurotic Edema, 107, 183 Angiotensin converting enzyme inhibitor, 83, 86, 183 Angiotensin-Converting Enzyme Inhibitors, 40, 183 Angiotensinogen, 107, 183, 222 Animal model, 8, 11, 12, 13, 183 Anorexia, 9, 43, 184, 231 Antagonism, 184, 188 Antibacterial, 184, 195, 206 Antibiotic, 16, 184, 210, 228, 230 Antibodies, 184, 202 Antibody, 158, 182, 184, 191, 202, 204, 206, 210, 221, 225, 233 Anticholinergic, 41, 184 Antidepressant, 184, 199 Antigen, 12, 182, 184, 191, 203, 204 Antihypertensive, 83, 184, 201 Anti-inflammatory, 184, 186, 201 Antimicrobial, 44, 184 Antioxidant, 184, 227 Antitussive, 14, 19, 40, 44, 47, 86, 90, 96, 99, 104, 109, 113, 184, 194, 212, 213 Anxiety, 9, 28, 184 Aorta, 184, 222, 232 Apnea, 52, 184 Apnoea, 105, 184 Aqueous, 99, 107, 110, 184, 186, 207 Arterial, 21, 184, 188, 189, 203, 219, 228 Arteries, 26, 97, 184, 185, 186, 193, 211 Arteriography, 29, 179, 184 Arterioles, 185, 186 Artery, 27, 38, 46, 103, 184, 185, 186, 189, 193, 220 Aspartate, 185, 194 Asphyxia, 185, 212 Aspiration, 28, 43, 179, 180, 185 Astringents, 185, 198, 209 Asymptomatic, 6, 36, 185, 214 Ataxia, 185, 203 Atelectasis, 92, 95, 106, 185 Atmospheric Pressure, 93, 185

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Atrium, 185, 232 Auditory, 132, 185, 208 Auditory nerve, 185, 208 Autodigestion, 185, 214 Autoimmune disease, 185, 210 Autologous, 5, 6, 166, 185 B Bacillus, 185, 187, 230 Baclofen, 86, 185 Bacteria, 9, 92, 99, 100, 105, 181, 184, 185, 186, 198, 199, 201, 209, 226, 229, 231 Bacterial Physiology, 181, 185 Bacterium, 99, 185 Barium, 165, 185 Base, 99, 102, 122, 185, 198, 206, 228, 231 Basilar Artery, 186, 208 Beclomethasone, 34, 186 Benign, 186, 187, 202, 211, 221 Bile, 186, 200, 207, 226 Bile Acids, 186, 200, 226 Biliary, 186, 214 Biliary Tract, 186, 214 Biochemical, 11, 186, 199, 207, 224 Biofilms, 29, 186 Biopsy, 179, 186, 215 Biotechnology, 10, 16, 17, 130, 149, 186 Bloating, 156, 186 Blood pressure, 107, 184, 186, 188, 203, 210, 217, 225 Blood transfusion, 157, 163, 164, 186 Blood vessel, 85, 107, 183, 186, 187, 189, 190, 192, 207, 208, 209, 215, 224, 231 Body Fluids, 126, 186, 188, 196, 213, 225 Body Mass Index, 186, 213 Bolus, 27, 155, 186, 187 Bolus infusion, 186, 187 Bone Marrow, 187, 208 Bone scan, 187, 223 Bowel, 183, 187, 192, 195, 205, 215, 226 Bowel Movement, 187, 192, 195, 226 Brace, 89, 187 Brachytherapy, 187, 205, 206, 221, 233 Brain Diseases, 187, 220 Brain Neoplasms, 187, 203 Brain Stem, 187, 220 Breast Feeding, 157, 162, 163, 164, 187 Bronchi, 82, 92, 115, 187, 188, 197, 230 Bronchial, 9, 17, 23, 25, 27, 28, 41, 109, 112, 113, 142, 187 Bronchial Hyperreactivity, 17, 187 Bronchiectasis, 92, 187 Bronchiseptica, 99, 105, 187, 216

Bronchitis, 44, 48, 49, 84, 113, 187, 190, 198 Bronchoconstriction, 3, 82, 187 Bronchodilator, 4, 188 Bronchoscopy, 22, 100, 101, 178, 188 Bronchospasm, 3, 11, 22, 112, 188 Bronchus, 187, 188 Bulbar, 188, 220 Bupivacaine, 188, 207 Bypass, 155, 188 C Cadaver, 5, 188 Caffeine, 122, 188 Calcium, 188, 191 Cannabidiol, 188 Cannabinoids, 112, 188 Cannabinol, 188 Cannabis, 112, 188, 229 Cannula, 102, 103, 188 Capsaicin, 18, 26, 40, 41, 67, 68, 86, 188 Capsules, 54, 188, 195 Captopril, 34, 35, 83, 188 Carbon Dioxide, 188, 200, 203, 222 Carcinogenic, 188, 205, 226 Carcinoma, 188 Cardiac, 21, 83, 91, 97, 188, 189, 196, 197, 198, 207, 211, 220, 226 Cardiovascular, 21, 30, 41, 189, 224, 229 Case report, 6, 30, 31, 33, 34, 37, 46, 47, 189 Cataract, 30, 189 Catheter, 23, 85, 88, 119, 133, 189, 206 Catheterization, 166, 189, 206 Cauda Equina, 189, 223 Caudal, 14, 103, 189, 217 Causal, 189, 197 Cell Division, 185, 189, 217 Cell Respiration, 189, 222 Cell Size, 189, 199 Central Nervous System, 11, 90, 187, 188, 189, 196, 200, 202, 203, 210, 215, 224 Central Nervous System Infections, 189, 202, 203 Cerebral, 21, 108, 185, 186, 187, 189, 190, 197, 198, 203, 228 Cerebral Cortex, 108, 185, 187, 189, 198 Cerebral Infarction, 189, 203 Cerebrospinal, 21, 84, 88, 189, 203, 224 Cerebrospinal fluid, 21, 84, 88, 189, 203, 224 Cerebrum, 189, 190, 228 Cervical, 17, 89, 95, 190 Cervix, 190, 199 Character, 190, 194

237

Chest cavity, 97, 190, 217 Chest Pain, 34, 158, 159, 190 Chest wall, 30, 40, 83, 84, 190 Chin, 47, 48, 87, 190, 209 Chlorophyll, 190, 200 Cholesterol, 186, 190, 226 Chromosomal, 183, 190 Chronic, 3, 4, 6, 8, 10, 16, 18, 32, 34, 45, 47, 49, 84, 96, 97, 110, 111, 122, 156, 162, 164, 180, 190, 194, 198, 204, 206, 207, 214, 224, 227, 231, 233 Chronic Disease, 3, 10, 190 Chronic Obstructive Pulmonary Disease, 16, 49, 84, 190 Ciliary, 190, 210 Ciliated cells, 105, 190 Circulatory system, 182, 190 Cirrhosis, 37, 157, 163, 164, 190, 217 Clinical trial, 8, 149, 190, 193, 214, 219, 221 Cloning, 186, 190 Cochlea, 190, 205 Codeine, 41, 68, 90, 97, 117, 139, 190, 194, 213 Cohort Studies, 191, 197 Colchicine, 191, 230 Collagen, 166, 191, 218 Collapse, 92, 191, 224 Communicable disease, 126, 191 Complement, 191 Complementary and alternative medicine, 43, 77, 191 Complementary medicine, 43, 191 Compliance, 8, 106, 192 Compress, 88, 96, 192 Computational Biology, 149, 192 Computed tomography, 192, 223 Computerized axial tomography, 192, 223 Conception, 192, 199 Condoms, 125, 157, 163, 164, 192 Conduction, 109, 192 Cones, 133, 192 Congestion, 52, 98, 139, 192, 194, 197 Congestive heart failure, 86, 107, 192, 207 Conjugated, 192, 194 Conjunctiva, 192, 227, 230 Connective Tissue, 187, 191, 192, 199, 200, 208, 215 Consciousness, 183, 192, 195, 219, 220 Constipation, 97, 122, 126, 192, 215 Constriction, 106, 112, 192, 233 Continence, 4, 5, 13, 123, 132, 133, 134, 166, 192

Continuous infusion, 29, 192 Contraceptive, 120, 192, 216 Contractility, 10, 183, 192 Contraindications, ii, 133, 193 Contralateral, 9, 193 Contrast medium, 26, 193 Control group, 10, 15, 193 Coordination, 193, 210 Coronary, 26, 27, 29, 46, 193, 211 Coronary Thrombosis, 193, 211 Corticosteroids, 4, 193, 201 Coryza, 82, 193 Cranial, 88, 102, 103, 118, 185, 193, 202, 205, 206, 214, 215, 220, 230 Cranial Nerves, 118, 193 Craniocerebral Trauma, 193, 202, 203 Creatine, 29, 193 Creatinine, 193, 231 Critical Care, 21, 24, 25, 29, 181, 193 Cross-Sectional Studies, 193, 197 Curative, 111, 193, 229 Cutaneous, 193, 206, 207 Cyclic, 92, 188, 193, 219 Cyst, 28, 193 Cysteine, 73, 193, 227 Cystocele, 134, 194 Cytochrome, 104, 194 Cytokine, 10, 194 D Debrisoquin, 104, 194 Decongestant, 15, 140, 194 Degenerative, 97, 194, 201, 202 Dendrites, 194, 212 Detoxification, 99, 194 Dextromethorphan, 68, 85, 104, 108, 139, 140, 194 Dextrorotatory, 104, 194 Diabetes Insipidus, 194, 203 Diabetes Mellitus, 5, 194, 201, 202, 215 Diagnostic procedure, 81, 130, 194 Diaphragm, 82, 113, 194, 202, 217, 222 Diarrhea, 50, 156, 194, 198 Diastolic, 194, 203 Dietitian, 118, 194 Diffusion, 194, 205 Digestion, 186, 187, 195, 205, 207, 226 Digestive system, 155, 195 Digestive tract, 195, 224 Dihydrotestosterone, 12, 195 Dilation, 7, 195, 203, 231 Diploid, 195, 217

238

Coughing

Direct, iii, 90, 112, 137, 195, 216, 220, 221, 228 Disinfection, 4, 126, 195 Disposition, 8, 102, 195 Dissection, 38, 195 Dissociation, 182, 195 Distal, 12, 93, 103, 106, 195, 196, 200, 219 Distention, 85, 195 Diuresis, 188, 195 Diuretic, 195, 203 Dorsal, 94, 195, 217, 225 Dorsum, 195 Dosage Forms, 85, 90, 195 Drip, 113, 178, 195 Drive, ii, vi, 4, 6, 14, 39, 121, 131, 195 Drug Delivery Systems, 8, 196 Drug Interactions, 142, 196 Drug Tolerance, 196, 229 Duct, 101, 183, 188, 189, 196, 223, 226, 228 Duodenum, 186, 196, 197, 214, 226 Dysphagia, 7, 50, 118, 196 Dysphonia, 120, 121, 131, 196, 233 Dysphoria, 112, 196 Dyspnea, 9, 11, 48, 196 Dystonia, 121, 196 Dystrophy, 26, 196 E Ecchymosis, 20, 196 Edema, 52, 113, 122, 183, 196, 203, 206, 210, 231 Efferent, 193, 196, 226 Efficacy, 5, 7, 9, 27, 46, 90, 196, 230 Ejaculation, 196, 223 Elastic, 89, 96, 196, 225 Elastin, 191, 196 Electrode, 82, 94, 196 Electrolyte, 196, 213, 218, 225, 231 Electrons, 184, 186, 196, 206, 213, 220, 221 Embryo, 196, 204 Emphysema, 25, 30, 50, 84, 190, 197 Enalapril, 34, 35, 41, 83, 197 Encephalopathy, 105, 197 Endocrine Glands, 197 Endogenous, 107, 197 Endoscope, 197 Endoscopic, 23, 188, 197 Endoscopy, 23, 160, 165, 197 Environmental Health, 148, 150, 197 Enzymatic, 111, 188, 191, 197 Enzyme, 40, 83, 86, 104, 106, 107, 194, 197, 207, 222, 227, 232 Enzyme Inhibitors, 83, 107, 197

Epidemiologic Factors, 12, 197 Epidemiologic Studies, 4, 197 Epidemiological, 11, 197 Epidural, 21, 25, 30, 94, 197, 205 Epidural block, 21, 197 Epiglottis, 104, 113, 197 Epinephrine, 181, 197, 212 Equipment and Supplies, 155, 197 Erythema, 50, 122, 183, 197, 231 Erythrina, 71, 74, 198 Erythrocytes, 183, 187, 198 Escalation, 26, 198 Esophageal, 118, 122, 160, 165, 198, 200 Esophageal Manometry, 160, 165, 198 Esophagitis, 198, 200 Esophagus, 155, 160, 165, 195, 198, 200, 202, 207, 216, 221, 226, 229 Estrogen, 12, 165, 198 Eucalyptus, 69, 98, 109, 198 Eukaryotic Cells, 198, 204 Evacuation, 192, 198 Evoke, 198, 226 Excipients, 111, 198 Excitability, 14, 198, 211, 220 Excitation, 198, 199, 212 Excitatory, 185, 198, 201 Exhaustion, 158, 184, 198 Exogenous, 181, 188, 197, 198 Exotoxin, 99, 198 Expectorants, 108, 109, 198 Expiration, 20, 79, 94, 96, 198, 222 Expiratory, 3, 14, 31, 83, 92, 94, 198, 216 External-beam radiation, 198, 206, 221, 233 Extracellular, 186, 192, 198, 225 Extravasation, 196, 198, 202 Extremity, 103, 198 Eye Movements, 199, 220 F Facial, 199, 208 Family Planning, 149, 199 Fat, 166, 187, 199, 207, 210, 213 Fatigue, 9, 115, 199, 202 Feces, 192, 199, 226 Fentanyl, 22, 27, 28, 34, 36, 199 Fetus, 162, 199, 231 Fibrin, 199, 215 Fibrosis, 27, 31, 50, 84, 92, 199, 223 Fistula, 18, 103, 199 Flatus, 199, 200 Flavoring Agents, 198, 199 Flexion, 38, 199

239

Flow Cytometry, 10, 199 Fluorescence, 199 Fluorescent Dyes, 199 Fluoxetine, 104, 199 Flushing, 155, 199 Fold, 122, 199 Foramen, 6, 190, 200, 208 Forearm, 186, 200 Friction, 200, 207 Fundus, 199, 200 Fungus, 47, 55, 200 G Gallbladder, 181, 186, 195, 200 Ganglia, 185, 187, 200, 211, 215, 226, 228 Gangrenous, 156, 200 Gas, 47, 94, 156, 183, 188, 194, 199, 200, 203, 205, 210, 212, 220, 222, 227, 232 Gas exchange, 200, 222, 232 Gastric, 23, 113, 159, 165, 185, 195, 200, 202 Gastric Acid, 165, 200 Gastroesophageal Reflux, 28, 29, 37, 50, 159, 200 Gastroesophageal Reflux Disease, 29, 50, 159, 200 Gastrointestinal, 160, 161, 197, 200, 224, 227 Gastrostomy, 23, 200 Gene, 186, 200 General practitioner, 16, 200 Generator, 14, 94, 200 Geriatric, 97, 200 Gland, 181, 201, 208, 214, 219, 223, 226, 228 Gliosis, 201, 228 Glottis, 94, 96, 201, 216 Glucocorticoid, 186, 201 Glucose, 194, 201, 202, 221, 223 Glucose Intolerance, 194, 201 Glutamate, 194, 201 Gonad, 201 Gonadal, 12, 201, 226 Governing Board, 201, 218 Grade, 201 Grading, 110, 201 Gram-negative, 187, 201 Gram-positive, 201, 210, 226 Groin, 201, 205 Guanethidine, 194, 201 H Habitat, 201, 212 Hair follicles, 201, 233 Handwashing, 125, 202

Haploid, 202, 217 Haptens, 182, 202 Hay Fever, 182, 202 Headache, 6, 115, 138, 188, 202, 203 Headache Disorders, 202 Heart attack, 19, 21, 40, 202 Heart failure, 40, 183, 202 Heartburn, 50, 160, 165, 202, 203 Hematoma, 85, 202 Hemoglobin, 183, 198, 202 Hemorrhage, 20, 23, 193, 202, 220 Hepatitis, 4, 101, 126, 140, 157, 162, 163, 164, 202 Hepatocytes, 202 Hernia, 18, 37, 156, 165, 202 Herniorrhaphy, 22, 202 Heterogeneity, 182, 202 Hiatal Hernia, 165, 202 Hoarseness, 160, 203, 207 Hormone, 193, 197, 203, 218 Hydration, 122, 203 Hydrocephalus, 84, 88, 203, 206 Hydrochlorothiazide, 41, 203 Hydrogel, 203, 204 Hydrogen, 186, 203, 210, 212, 213 Hydroxylysine, 191, 203 Hydroxyproline, 191, 203 Hypersensitivity, 182, 203 Hypertension, 44, 46, 51, 52, 83, 86, 107, 183, 197, 203, 206, 207, 217, 231 Hypertrophy, 83, 203 Hyperventilation, 48, 203 Hypoxic, 106, 203 I Immune response, 10, 184, 185, 202, 203, 204, 224, 227, 231, 232 Immune system, 125, 158, 159, 164, 203, 204, 210, 231, 233 Immunity, 105, 131, 204 Immunodeficiency, 4, 125, 126, 157, 158, 159, 161, 204 Immunodeficiency syndrome, 125, 126, 158, 204 Immunology, 10, 26, 101, 182, 199, 204 Impairment, 82, 112, 185, 196, 204 Implant radiation, 204, 205, 206, 221, 233 Impotence, 204, 233 In situ, 12, 204 In Situ Hybridization, 12, 204 In vitro, 29, 204 In vivo, 8, 10, 47, 204 Incision, 89, 156, 204, 206

240

Coughing

Incompetence, 17, 200, 204 Incontinence Pads, 120, 204 Incubation, 204, 216 Incubation period, 204, 216 Induction, 24, 25, 29, 100, 101, 204 Infancy, 19, 204 Infarction, 189, 204 Infection Control, 4, 125, 126, 205 Infiltration, 82, 205, 218 Infusion, 181, 205, 230 Ingestion, 180, 205, 217 Inguinal, 22, 205 Inhalation, 8, 29, 36, 46, 86, 138, 141, 181, 205, 206, 217 Initiation, 112, 205 Inner ear, 161, 205 Innervation, 12, 205 Inoculum, 10, 205 Inorganic, 205, 210 Insight, 11, 205 Insufflation, 31, 205 Insulator, 205, 210 Intercostal, 37, 96, 205, 222 Internal radiation, 205, 206, 221, 233 Interstitial, 47, 187, 205, 206, 233 Intervertebral, 205, 221, 223 Intervertebral Disk Displacement, 205, 221, 223 Intestinal, 96, 97, 205 Intestine, 156, 187, 205, 206, 226 Intracellular, 188, 204, 205, 218, 219 Intracranial Hemorrhages, 203, 205 Intracranial Hypertension, 202, 203, 206 Intravenous, 22, 29, 30, 205, 206 Intravesical, 13, 123, 206 Intrinsic, 5, 12, 13, 119, 182, 206 Intubation, 29, 30, 189, 206 Invasive, 7, 92, 100, 204, 206, 208 Involuntary, 5, 6, 10, 13, 120, 121, 123, 134, 165, 166, 206, 211, 221, 224, 225, 226 Ions, 186, 195, 196, 203, 206 Irradiation, 5, 206, 233 Irritants, 3, 108, 109, 160, 206 Isoflurane, 19, 29, 206 Isoniazid, 8, 206 K Kb, 148, 206 Kidney Disease, 107, 148, 206 Kinetics, 8, 206 L Labyrinth, 190, 205, 206, 223, 232 Large Intestine, 195, 205, 206, 221, 224

Laryngeal, 4, 14, 18, 23, 37, 121, 160, 206 Laryngitis, 51, 110, 111, 113, 160, 206 Larynx, 30, 82, 104, 115, 197, 201, 206, 207, 227, 230, 232 Lectins, 198, 207 Leishmaniasis, 207, 215 Lens, 189, 207 Leprosy, 26, 207 Lesion, 82, 201, 207, 220, 230 Lethal, 9, 207, 210 Lethargy, 203, 207 Levorphanol, 194, 207 Lidocaine, 22, 29, 30, 33, 207 Ligament, 207, 219 Lipid, 207, 210 Lisinopril, 40, 207 Liver, 9, 126, 157, 162, 163, 164, 181, 186, 190, 195, 199, 200, 202, 207, 217, 222, 223, 231 Liver scan, 207, 223 Localized, 181, 183, 202, 204, 207, 216, 230, 231 Locomotion, 207, 217 Loop, 156, 202, 207 Lower Esophageal Sphincter, 7, 160, 165, 200, 207 Lubricants, 207, 208 Lubrication, 85, 108, 207 Lung volume, 96, 106, 208 Lymph, 9, 190, 208 Lymph node, 9, 190, 208 Lymphatic, 10, 51, 205, 208, 226, 229 Lymphatic system, 208, 226, 229 Lymphocytes, 184, 208, 226, 229, 233 Lymphoid, 184, 193, 208 Lytic, 208, 224 M Magnetic Resonance Imaging, 6, 208, 223 Malaise, 196, 208 Malformation, 6, 208 Malignant, 100, 104, 107, 187, 208, 211, 221 Malignant tumor, 104, 208 Mandible, 190, 208, 222 Mannans, 200, 208 Mastication, 208, 230 Meatus, 120, 208 Mechanical ventilation, 92, 208 Mediate, 105, 208 Medical Records, 26, 208 Medical Staff, 101, 209 Medicament, 82, 85, 109, 110, 209 MEDLINE, 149, 209

241

Medullary, 14, 109, 194, 209 Memory, 112, 184, 209 Meninges, 189, 193, 209, 225 Mental, iv, 7, 148, 150, 189, 190, 195, 199, 204, 209, 213, 219, 222, 231 Mental Health, iv, 7, 148, 150, 209, 213, 219 Mental Processes, 195, 209, 213 Menthol, 85, 98, 108, 109, 209 Meperidine, 97, 209 Mercury, 199, 209 Mesentery, 209, 215 Metabolite, 209, 218 Metastasis, 209 Metastatic, 25, 187, 209 Microbiology, 163, 181, 186, 209 Microorganism, 15, 209, 214, 232 Mobility, 95, 209 Modification, 5, 119, 122, 165, 209, 220 Molecular, 10, 104, 149, 151, 186, 192, 209, 227, 230 Molecule, 105, 184, 186, 191, 195, 198, 210, 213, 221 Monitor, 118, 133, 193, 210 Monoclonal, 206, 210, 221, 233 Morphine, 97, 190, 209, 210, 211, 213 Morphinomimetic, 24, 210 Morphological, 196, 200, 210 Morphology, 8, 10, 189, 210 Motion Sickness, 210, 211 Motor Activity, 210, 220 Motor Neurons, 95, 210 Mucins, 210, 222 Mucociliary, 109, 210, 224 Mucus, 11, 37, 84, 96, 109, 113, 210 Multiple sclerosis, 165, 210 Mupirocin, 15, 210 Muscle Contraction, 14, 113, 187, 210 Muscular Diseases, 210, 211, 220 Musculature, 10, 210 Mustard Gas, 206, 210 Mutism, 20, 211 Mydriatic, 195, 211, 233 Myelin, 210, 211 Myocardial infarction, 86, 107, 193, 211 Myocardium, 211 Myosin, 210, 211 N Narcosis, 211 Narcotic, 97, 141, 199, 207, 209, 210, 211, 212, 213 Nasal Cavity, 211, 214

Nasal Mucosa, 15, 211 Natriuresis, 183, 211 Nausea, 161, 162, 195, 211, 231 Nebulizer, 101, 211 Necrosis, 189, 204, 211 Neoplasm, 211, 230 Nephropathy, 86, 206, 211 Nerve Regeneration, 12, 211 Nervous System, 17, 90, 182, 189, 211, 212, 215, 228 Neural, 12, 95, 182, 211 Neurogenic, 6, 13, 119, 211, 231 Neurologic, 31, 118, 203, 211 Neuromuscular, 92, 211, 220, 231 Neuromuscular Diseases, 211, 220 Neuronal, 11, 104, 211, 215 Neurons, 14, 90, 194, 198, 200, 210, 211, 226, 228 Neuropathy, 183, 212, 223 Neurophysiology, 12, 212 Neurotoxicity, 194, 212 Neurotransmitter, 181, 201, 212, 227 Neutrons, 206, 212, 220 Niche, 117, 212 Nitrogen, 182, 212, 230 Nitrous Oxide, 161, 212 Nonverbal Communication, 212, 219 Norepinephrine, 13, 181, 201, 212, 216 Noscapine, 99, 212 Nosocomial, 15, 212 Nuclei, 196, 208, 212 Nucleic acid, 204, 212 Nucleus, 185, 193, 198, 205, 208, 212, 213 Nulliparous, 10, 213 Nursing Care, 125, 213 Nursing Staff, 89, 213 Nutritional Status, 118, 213 Nutritional Support, 200, 213 O Obsessive Behavior, 120, 213 Occupational Exposure, 4, 101, 213 Occupational Medicine, 101, 213 Ointments, 195, 213 Opacity, 189, 213 Opiate, 86, 90, 105, 210, 213 Opium, 210, 212, 213 Orgasm, 134, 196, 213 Orofacial, 6, 213 Otolaryngologist, 131, 160, 213 Outpatient, 100, 107, 213 Overactive bladder, 134, 213 Overweight, 41, 166, 213

242

Coughing

Oxidation, 184, 194, 213 Oxycodone, 97, 213 Oxygen Consumption, 213, 222 P Palate, 102, 214, 224, 231 Palliative, 214, 229 Pancreas, 181, 195, 214 Pancreatic, 200, 214 Pancreatic Juice, 200, 214 Pancreatitis, 18, 214 Paradoxical, 112, 214 Paralysis, 83, 94, 95, 188, 214, 220 Paranasal Sinuses, 214, 224 Parietal, 214, 215, 217 Paroxetine, 38, 214 Paroxysmal, 9, 35, 38, 105, 202, 214, 216, 233 Particle, 214, 225 Patch, 108, 132, 196, 214 Pathogen, 99, 125, 204, 205, 214 Pathologic, 121, 186, 187, 193, 203, 214, 222, 225, 232 Pathologist, 118, 214 Pathophysiology, 11, 12, 13, 41, 214 Patient Education, 5, 155, 165, 166, 172, 174, 180, 214 Patient Selection, 4, 5, 166, 214 Peak flow, 34, 214 Peer Review, 39, 120, 215 Pelvic, 5, 6, 10, 12, 13, 14, 37, 38, 121, 122, 123, 127, 132, 133, 134, 166, 194, 215, 219 Pelvis, 181, 215, 231 Penis, 192, 196, 215 Pentamidine, 161, 215 Perception, 112, 215 Percutaneous, 23, 215 Perennial, 215, 230 Perforation, 7, 200, 215 Perfusion, 26, 215 Peripheral Nerves, 207, 215 Peripheral Nervous System, 211, 212, 215, 220, 227 Peripheral Nervous System Diseases, 211, 215, 220 Peritoneum, 85, 209, 215 Peritonitis, 38, 215 Pertussis, 16, 18, 20, 51, 99, 105, 140, 154, 155, 215, 233 Pessary, 134, 216 Petechia, 196, 216 Pharmaceutical Preparations, 113, 216 Pharmaceutical Solutions, 195, 216

Pharmacologic, 6, 183, 216, 229, 231 Pharyngitis, 110, 111, 216 Pharynx, 29, 104, 200, 211, 216 Phenyl, 209, 216 Phenylpropanolamine, 73, 167, 216 Phonation, 121, 122, 216 Phospholipids, 199, 216 Photoreceptors, 192, 216 Physicochemical, 11, 216 Physiologic, 182, 216, 218, 221, 222 Physiology, 13, 93, 119, 120, 121, 133, 160, 165, 207, 212, 216 Pilot study, 45, 216 Pitch, 122, 160, 216, 233 Plants, 110, 111, 182, 188, 201, 210, 212, 216, 223, 226, 229, 230 Plasma, 184, 201, 202, 217, 222, 223 Pleura, 217 Pleural, 92, 106, 217 Pleural cavity, 106, 217 Pneumonia, 43, 47, 92, 95, 98, 113, 161, 193, 215, 217, 230 Poisoning, 209, 211, 217 Polyethylene, 204, 217, 227 Polymers, 186, 217, 219 Polymorphic, 194, 217 Polymorphism, 194, 217 Polyp, 35, 217 Polypeptide, 191, 217 Polysaccharide, 184, 217 Port, 84, 217 Port-a-cath, 217 Portal Hypertension, 37, 217 Portal Vein, 217 Posterior, 94, 113, 183, 185, 186, 195, 214, 217, 223, 231 Postoperative, 7, 89, 106, 122, 156, 209, 217 Postural, 20, 217 Potassium, 203, 217, 220 Practicability, 218, 230 Practice Guidelines, 150, 166, 218 Precordial, 47, 218 Precursor, 183, 197, 212, 218, 230 Preoperative, 6, 122, 156, 218 Presynaptic, 14, 212, 218 Prevalence, 14, 15, 22, 107, 218 Procaine, 207, 218 Prodrug, 114, 218 Progesterone, 218, 226 Progression, 8, 183, 218 Progressive, 6, 97, 119, 190, 196, 198, 211, 218, 230

243

Projection, 212, 218 Prolapse, 134, 218 Proline, 191, 203, 218 Prone, 110, 218 Prophylaxis, 161, 218, 231 Propofol, 22, 33, 218 Prostaglandin, 41, 183, 218 Prostate, 9, 219 Prosthesis, 134, 219 Protein S, 186, 219, 228 Proteins, 182, 183, 184, 191, 210, 212, 217, 219, 221, 224 Protocol, 4, 9, 219 Protozoa, 207, 209, 219, 226, 230 Proximal, 6, 93, 103, 195, 211, 218, 219 Pruritus, 38, 219, 231 Psychiatry, 8, 23, 33, 45, 219, 227, 232 Psychic, 209, 219, 223 Psychoactive, 112, 219, 229, 233 Psychogenic, 33, 45, 46, 47, 219, 231 Psychotherapy, 47, 219 Public Health, 11, 150, 163, 219 Public Policy, 126, 149, 220 Publishing, 4, 6, 16, 118, 120, 220 Pulmonary Artery, 186, 220, 232 Pulmonary Ventilation, 89, 203, 220, 222 Pulse, 82, 94, 95, 210, 220 Pupil, 195, 211, 220 Purifying, 99, 220 Purpura, 183, 220 Q Quadriplegia, 82, 220 Quality of Health Care, 215, 220 Quality of Life, 9, 220 Quinidine, 104, 220 Quinine, 220 R Radiation, 198, 199, 205, 206, 220, 221, 223, 233 Radiation therapy, 198, 205, 206, 220, 233 Radiculopathy, 221, 223 Radioactive, 187, 203, 204, 205, 206, 207, 221, 223, 233 Radiolabeled, 206, 221, 233 Radiological, 215, 221 Radiologist, 118, 221 Radiopharmaceutical, 200, 221 Radiotherapy, 187, 206, 221, 233 Randomized, 196, 221 Reabsorption, 203, 221 Receptor, 82, 83, 90, 112, 181, 184, 194, 221, 224

Rectum, 133, 187, 195, 199, 200, 204, 206, 216, 219, 221 Recuperation, 91, 221 Refer, 1, 93, 105, 191, 207, 208, 212, 221, 229, 232 Reflex, 17, 43, 44, 45, 79, 95, 103, 108, 109, 110, 199, 221 Reflux, 4, 7, 28, 36, 113, 122, 159, 161, 165, 200, 221 Refractory, 86, 221 Regeneration, 12, 221 Regimen, 196, 221 Regurgitation, 7, 161, 200, 202, 221 Rehabilitative, 10, 221 Reliability, 102, 222 Renal Artery, 107, 222 Renal cell carcinoma, 25, 222 Renin, 107, 183, 188, 222 Renin-Angiotensin System, 183, 188, 222 Resorption, 203, 221, 222 Respiration, 35, 122, 184, 188, 210, 222 Respirator, 208, 222 Respiratory failure, 92, 222 Respiratory Muscles, 82, 222 Respiratory Physiology, 24, 222, 232 Respiratory System, 93, 182, 210, 222 Retina, 192, 207, 222 Rhinitis, 187, 222 Rhinovirus, 15, 222 Rigidity, 217, 222 Risk factor, 160, 165, 197, 222 Rod, 185, 222 S Saliva, 101, 157, 158, 159, 222, 223 Salivary, 195, 222, 223 Salivary glands, 195, 222, 223 Sanitary, 100, 162, 223 Saponins, 223, 226 Scans, 15, 223 Sciatica, 32, 223 Sclerosis, 210, 223 Screening, 93, 154, 190, 223 Sebaceous, 206, 223, 233 Sebaceous gland, 206, 223, 233 Secretion, 11, 210, 223 Sedative, 191, 223 Sedimentation, 223, 230 Seizures, 214, 223 Self-Help Groups, 120, 223 Semen, 53, 54, 57, 58, 59, 60, 63, 157, 196, 219, 223 Semicircular canal, 205, 223

244

Coughing

Serologic, 18, 224 Serotonin, 199, 212, 214, 224, 230 Serum, 29, 107, 191, 215, 224 Shock, 224, 230 Shunt, 84, 88, 224 Side effect, 8, 19, 83, 86, 90, 97, 107, 131, 137, 162, 166, 181, 206, 224, 229 Signs and Symptoms, 118, 224, 231 Sinusitis, 52, 156, 224 Skeletal, 210, 220, 224, 225 Skeleton, 181, 219, 224 Skin test, 9, 159, 163, 224 Skull, 85, 193, 224, 228 Sleep apnea, 102, 224 Small intestine, 155, 196, 203, 205, 224, 232 Smooth muscle, 187, 188, 210, 222, 224, 225, 227 Snoring, 102, 224 Social Environment, 220, 224 Social Isolation, 166, 224 Social Problems, 8, 225 Sodium, 34, 41, 203, 211, 220, 221, 225, 228 Somatic, 193, 215, 225 Sound wave, 93, 192, 221, 225 Spasm, 82, 121, 165, 211, 225 Spasmodic, 120, 121, 131, 188, 216, 225 Spasticity, 185, 225 Specialist, 168, 195, 225 Species, 185, 188, 191, 197, 207, 210, 220, 225, 229, 230, 232, 233 Specificity, 21, 182, 225 Sperm, 162, 164, 225, 230 Spermatozoa, 223, 225 Sphincter, 5, 6, 13, 119, 120, 123, 133, 207, 225, 227 Spinal Cord Diseases, 220, 225 Spinal Cord Injuries, 92, 94, 95, 221, 225 Spinal Nerve Roots, 221, 223, 225 Spleen, 208, 226 Splint, 187, 226 Spores, 205, 226 Sputum, 4, 11, 18, 100, 101, 159, 179, 226 Staging, 223, 226 Stenosis, 107, 226, 227 Sterile, 226, 230 Sterilization, 4, 125, 158, 226 Sternum, 97, 226 Steroid, 12, 223, 226 Stimulant, 188, 226 Stimulus, 95, 103, 113, 187, 192, 196, 198, 205, 221, 226, 229 Stoma, 103, 104, 226

Stomach, 155, 159, 165, 181, 185, 195, 198, 200, 202, 203, 207, 211, 216, 221, 224, 226 Stool, 161, 204, 206, 226 Street Drugs, 157, 162, 163, 164, 226 Streptococci, 210, 226 Stress, 3, 5, 6, 10, 12, 13, 14, 38, 98, 118, 119, 120, 121, 122, 123, 131, 132, 133, 134, 165, 166, 178, 199, 211, 226, 227, 231 Stress incontinence, 5, 6, 38, 120, 122, 123, 132, 133, 134, 166, 226 Stress urinary, 5, 6, 10, 13, 14, 119, 120, 121, 132, 133, 165, 227 Stricture, 226, 227 Stridor, 18, 178, 227 Stupor, 207, 211, 227 Subacute, 204, 224, 227 Subarachnoid, 88, 202, 205, 227 Subclinical, 204, 223, 227 Subconjunctival, 20, 227 Subcutaneous, 30, 84, 86, 183, 196, 200, 227 Subcutaneous Emphysema, 30, 227 Substance P, 126, 209, 223, 227 Substrate, 194, 197, 227 Suction, 5, 227 Sufentanil, 35, 227 Sulfur, 44, 47, 227 Sulfur Dioxide, 44, 47, 227 Supine, 4, 89, 119, 227 Supine Position, 4, 89, 227 Supplementation, 44, 46, 227 Support group, 120, 161, 227 Suppository, 216, 227 Suppression, 4, 14, 83, 90, 105, 227 Suppurative, 200, 228 Supraspinal, 82, 185, 228 Surgical Instruments, 121, 228 Sweat, 157, 158, 159, 228 Sweat Glands, 228 Sympathectomy, 21, 228 Sympathetic Nervous System, 183, 228 Sympathomimetic, 197, 212, 216, 228 Symphysis, 190, 219, 228 Symptomatic, 85, 108, 187, 214, 228 Synapse, 181, 218, 228, 230 Synergistic, 109, 228 Syringomyelia, 6, 228 Systemic, 90, 96, 112, 138, 139, 140, 141, 142, 184, 186, 197, 205, 206, 221, 228, 233 Systolic, 88, 203, 228 T Tear Gases, 206, 228 Telencephalon, 189, 228

245

Temporal, 32, 36, 202, 208, 228 Temporal Lobe, 32, 228 Tetracycline, 15, 228 Tetrahydrocannabinol, 112, 188, 229 Therapeutics, 48, 104, 143, 229 Thermal, 113, 195, 212, 229 Thoracic, 30, 31, 35, 41, 92, 94, 96, 113, 194, 217, 229, 233 Thoracic Surgery, 92, 229 Threshold, 40, 92, 109, 198, 203, 229 Thrush, 161, 229 Thymus, 75, 76, 208, 229 Tidal Volume, 203, 229 Tissue Donors, 12, 229 Tolerance, 97, 201, 229 Tone, 122, 198, 225, 229 Tonicity, 196, 229 Tonus, 229 Tooth Preparation, 181, 229 Topical, 15, 22, 185, 229 Toxic, iv, 198, 204, 212, 215, 227, 229 Toxicity, 196, 209, 226, 229 Toxicology, 40, 150, 229 Toxin, 7, 99, 121, 131, 229 Trachea, 45, 92, 96, 103, 104, 113, 187, 188, 207, 216, 227, 230 Tracheostomy, 102, 103, 230 Transfection, 186, 230 Transfusion, 230 Transmitter, 212, 230 Transplantation, 229, 230 Trauma, 37, 97, 198, 211, 214, 230 Treatment Outcome, 119, 230 Trees, 113, 198, 230 Trigeminal, 6, 230 Trimethoprim-sulfamethoxazole, 162, 230 Trypanosomiasis, 215, 230 Tryptophan, 191, 224, 230 Tubercle, 8, 230 Tuberculin, 9, 230 Tuberculosis, 4, 8, 9, 11, 23, 27, 52, 100, 101, 126, 158, 159, 163, 206, 230 Tuberculostatic, 206, 230 Tubulin, 12, 230 Tumour, 18, 82, 230 U Ulcer, 122, 230 Unconscious, 183, 231 Uraemia, 214, 231 Urea, 228, 231 Ureters, 222, 231

Urethra, 6, 13, 14, 120, 121, 123, 132, 133, 134, 215, 219, 231 Urinary, 5, 6, 7, 10, 12, 14, 21, 52, 53, 118, 119, 120, 121, 122, 123, 126, 131, 132, 133, 134, 165, 166, 194, 203, 204, 227, 231 Urinary Retention, 194, 231 Urinary tract, 21, 123, 133, 165, 231 Urinate, 133, 156, 166, 231 Urodynamic, 6, 7, 12, 119, 123, 133, 231 Urologist, 123, 231 Urticaria, 183, 231 Uterus, 32, 134, 190, 199, 200, 216, 218, 231 Uvula, 102, 224, 231 V Vaccination, 105, 164, 231 Vaccine, 99, 105, 140, 141, 164, 219, 231 Vagina, 32, 133, 134, 190, 216, 231 Vaginal, 6, 12, 13, 121, 122, 133, 157, 208, 216, 227, 231 Valves, 231 Vascular, 183, 202, 204, 205, 225, 231 Vasculitis, 214, 231 Vasodilation, 183, 231 VE, 20, 21, 232 Vein, 206, 217, 232 Venous, 23, 26, 88, 189, 219, 232 Ventilation, 26, 82, 101, 106, 232 Ventricle, 84, 220, 228, 232 Ventricular, 88, 203, 232 Venules, 186, 232 Vertebrae, 205, 225, 232 Vestibular, 161, 232 Vestibule, 190, 205, 223, 232 Veterinary Medicine, 149, 232 Villi, 88, 203, 232 Vinblastine, 230, 232 Vincristine, 230, 232 Viral, 15, 113, 115, 154, 232 Virulence, 11, 229, 232 Virus, 4, 50, 101, 125, 126, 141, 157, 158, 159, 161, 162, 163, 164, 189, 232 Viscera, 183, 209, 225, 232 Visceral, 53, 193, 207, 215, 232 Vitro, 232 Vivo, 13, 232 Vocal cord, 109, 160, 201, 216, 232 Voice Disorders, 121, 233 Voice Quality, 160, 233 Volition, 206, 233 Vulgaris, 75, 76, 233

246

Coughing

W Wheezing, 3, 22, 25, 28, 36, 131, 160, 161, 162, 165, 233 White blood cell, 184, 208, 210, 233 Whooping Cough, 53, 99, 105, 111, 154, 155, 216, 233 Windpipe, 188, 216, 233 Withdrawal, 209, 233 Womb, 231, 233 Wound Healing, 210, 233

Wounds, Gunshot, 225, 233 X Xenograft, 184, 233 X-ray, 20, 163, 178, 179, 184, 192, 193, 199, 206, 220, 221, 223, 233 X-ray therapy, 206, 233 Y Yeasts, 200, 233 Yohimbine, 104, 233

247

248

Coughing

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