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

CRYOSURGERY A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES J AMES N...

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CRYOSURGERY A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright ©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., 1960Cryosurgery: 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: 0-497-00314-7 1. Cryosurgery-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 cryosurgery. 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 CRYOSURGERY .......................................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Cryosurgery .................................................................................. 4 The National Library of Medicine: PubMed ................................................................................ 16 CHAPTER 2. NUTRITION AND CRYOSURGERY ................................................................................ 59 Overview...................................................................................................................................... 59 Finding Nutrition Studies on Cryosurgery ................................................................................. 59 Federal Resources on Nutrition ................................................................................................... 60 Additional Web Resources ........................................................................................................... 60 CHAPTER 3. ALTERNATIVE MEDICINE AND CRYOSURGERY .......................................................... 63 Overview...................................................................................................................................... 63 National Center for Complementary and Alternative Medicine.................................................. 63 Additional Web Resources ........................................................................................................... 65 General References ....................................................................................................................... 66 CHAPTER 4. PATENTS ON CRYOSURGERY ....................................................................................... 67 Overview...................................................................................................................................... 67 Patents on Cryosurgery ............................................................................................................... 67 Patent Applications on Cryosurgery ........................................................................................... 88 Keeping Current .......................................................................................................................... 95 CHAPTER 5. BOOKS ON CRYOSURGERY .......................................................................................... 97 Overview...................................................................................................................................... 97 Book Summaries: Federal Agencies.............................................................................................. 97 Book Summaries: Online Booksellers........................................................................................... 98 Chapters on Cryosurgery ............................................................................................................. 98 CHAPTER 6. PERIODICALS AND NEWS ON CRYOSURGERY ........................................................... 101 Overview.................................................................................................................................... 101 News Services and Press Releases.............................................................................................. 101 Academic Periodicals covering Cryosurgery ............................................................................. 103 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 107 Overview.................................................................................................................................... 107 NIH Guidelines.......................................................................................................................... 107 NIH Databases........................................................................................................................... 109 Other Commercial Databases..................................................................................................... 111 APPENDIX B. PATIENT RESOURCES ............................................................................................... 113 Overview.................................................................................................................................... 113 Patient Guideline Sources.......................................................................................................... 113 Finding Associations.................................................................................................................. 115 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 117 Overview.................................................................................................................................... 117 Preparation................................................................................................................................. 117 Finding a Local Medical Library................................................................................................ 117 Medical Libraries in the U.S. and Canada ................................................................................. 117 ONLINE GLOSSARIES................................................................................................................ 123 Online Dictionary Directories ................................................................................................... 124 CRYOSURGERY DICTIONARY ................................................................................................ 125 INDEX .............................................................................................................................................. 173

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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 cryosurgery 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 cryosurgery, 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 cryosurgery, 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 cryosurgery. 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 cryosurgery, 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 cryosurgery. The Editors

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

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

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

Hemorrhoids: A Common Condition Source: Medical Times. 118(7): 39-41. July 1990. Summary: Hemorrhoids are defined as overstretched and enlarged veins in the lower rectum. The condition is common and is caused by increased pressure on the veins of the lower digestive system. Two types of hemorrhoids observed are internal and external. A doctor's visit is recommended if bleeding occurs, since the condition may or may not be a result of hemorrhoids, and could indicate colon cancer or other intestinal problem. To ease the discomfort associated with hemorrhoids, sitz baths and over the counter hemorrhoid preparations are recommended on a short-term basis. Exercise, a high-fiber diet, and the taking of laxatives under a doctor's care are suggested as means to help control and relieve pressure on the veins. Treatments to eliminate hemorrhoids

4

Cryosurgery

such as banding, cryosurgery, or injection are discussed. The type of treatment is usually dictated by the type of hemorrhoid encountered. •

Body's Skin Frontier and the Challenges of Wound Healing: Keloids Source: JADA. Journal of the American Dental Association. 131(3): 362-365. March 2000. Contact: Available from American Dental Association. ADA Publishing Co, Inc., 211 East Chicago Avenue, Chicago, IL 60611. Summary: Keloids are thick, disfiguring scars that usually result from trauma to the skin induced by injuries such as burns or piercing, acne, or surgery within subpopulations of dark skinned people. This article describes keloids, wound healing, and present research on the skin as a frontier of defense for the body. Topics include the incidence and prevalence of keloids, how molecular defects contribute to keloid scarring, growth factors and keloids, and the clinical management of keloids. The clinical management of keloids in dentistry and medicine includes dressings and pressure devices, compression therapy, corticosteroid injections, cryosurgery, excision, radiation therapy, laser therapy, interferon therapy, and other therapies directed at collagen synthesis. The author briefly reports on current research efforts to understand and treat keloids. The contact information for two resource organizations is provided. 2 figures. 26 references.

•

Minimally Invasive Ablative Approaches in the Treatment of Renal Cell Carcinoma Source: Current Urology Reports. 3(1): 13-20. February 2002. Contact: Current Science, Inc. 400 Market Street, Suite 700, Philadelphia, PA 19106 (800) 427-1796. Fax (215) 574-2225. E-mail: [email protected]. Website: http://www.current-reports.com. Summary: This article reviews the use of minimally invasive ablative approaches in the treatment of renal cell carcinoma (RCC, kidney cancer). Ablative techniques for the treatment of RCC are an extension of nephron-sparing surgery and include cryoablation, radiofrequency ablation (RFA), and high-intensity focused ultrasound (HIFU). Although experimental, these are evolving treatment modalities. The widespread use of computed tomography scans (CT scan), ultrasound, and magnetic resonance imaging (MRI) caused an increase in the diagnosis rate of small renal masses amenable to nephron-sparing surgery (surgery that leaves the filtering units of the kidney functioning). The same imaging modalities permit interactive monitoring both during the delivery of ablative measures and at postoperative followup. Cryosurgery is the most studied of the ablative approaches, and clinical studies have demonstrated promising short-term results and a remarkable safety profile. Long-term studies, however, are needed in order to determine the appropriate selection criteria and to confirm a response as durable as that for partial and radical nephrectomy (removal of the kidney). The authors conclude that more data are needed to evaluate the efficacy of RFA. Currently, preclinical results with HIFU do not justify its use for treating RCC in humans. 2 figures. 2 tables. 48 references.

Federally Funded Research on Cryosurgery The U.S. Government supports a variety of research studies relating to cryosurgery. These studies are tracked by the Office of Extramural Research at the National Institutes of

Studies

5

Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to cryosurgery. 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 cryosurgery. The following is typical of the type of information found when searching the CRISP database for cryosurgery: •

Project Title: DEVELOPING COMPUTERIZED TOOLS FOR CRYOSURGERY PLANNING Principal Investigator & Institution: Rabin, Yoed; Associate Professor; Mechanical Engineering; Carnegie-Mellon University 5000 Forbes Ave Pittsburgh, Pa 15213 Timing: Fiscal Year 2004; Project Start 01-APR-2004; Project End 31-MAR-2008 Summary: (provided by applicant): Cryosurgery has been known as an invasive surgical technique since 1961, when Cooper and Lee invented the first cryoprobe. In the 1990s, new developments in Joule-Thomson cooling (the cooling effect associated with a sudden relief of a pressurized gas) led to a dramatic decrease in the size of cryoprobes and an increase in the number of cryoprobes that could be used simultaneously. A dozen or more cryoprobes operating simultaneously in a single prostate cryosurgery is already common practice. If localized effectively, one of the primary benefits of using a large number of miniaturized cryoprobes is superior control over the freezing process. Currently, the process of selecting the correct placement of the cryoprobes for a specific procedure is an art held by the cryosurgeon, based on the surgeon's own experience and rules of thumb. Cryoprobes are typically operated in a trial-and-error fashion, until the entire target volume is thought to be frozen. Currently, there are no means to determine the optimal locations for the cryoprobes. Suboptimal cryoprobe localization may leave regions in the target volume unfrozen, may lead to cryoinjury of healthy surrounding tissues, may require an unnecessarily large number of cryoprobes, may increase the duration of the surgical procedure, and may increase the likelihood of post cryosurgery complications, all of which affect the quality and cost of the medical treatment. Computerized planning tools would help to alleviate these difficulties. The "cryoheater," a new device for cryosurgery control has recently been presented by the research team. The cryoheater is a temperature controlled electrical heater. In broad terms, cryoheaters can dramatically increase the ability to control the shape and size of the frozen region, however, to achieve the full benefits of cryoheaters, computerized planning tools for cryoheater localization are necessary. Our goal is to develop computerized planning tools for cryosurgery that are suitable for all available cooling techniques. The proposed research includes: (1) Development of an efficient numerical scheme for bioheat transfer simulations of cyroprocedures, (2) Development of an efficient optimization technique based on a force-field analogy. (3) Development of knowledge-based optimization techniques. (4) Experimental verification of the planning tool. Besides planning, another

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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Cryosurgery

important application of the proposed tool is the training of cryosurgeons. The proposed tool will provide cryosurgeons with the ability to visualize the 3D volumetric nature of the freezing process. Likewise, it will allow the surgeon to explore the performance of various configurations of cryoprobes and cryoheaters, and observe the defects that would result from each. Such visualization capabilities will provide surgeons with insights into the physics of cryosurgery that are difficult to obtain from physical experiments or surgical practice. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CRYOSURGERY

ELECTRICAL

IMPEDANCE

TOMOGRAPHY

IMAGED

Principal Investigator & Institution: Rubinsky, Boris; Professor; Mechanical Engineering; University of California Berkeley Berkeley, Ca 947205940 Timing: Fiscal Year 2002; Project Start 30-SEP-2001; Project End 31-AUG-2004 Summary: (Verbatim from Applicant's Abstract): The objective of this proposal is to develop the technique of Electrical Impedance Tomography (EIT) imaged cryosurgery. An E1T image is acquired by: a) injecting small, sinusoidal electrical currents into the body, b) measuring the resulting voltages on the surface of the body through an electrode array and c) producing an impedance image from the voltage data, using a reconstruction algorithm. EIT offers high sensitivity, fast image acquisition, and virtually no dosage concerns in a comparatively inexpensive technology. E1T has the potential for becoming an important imaging modality for monitoring minimally invasive surgery. Cryosurgery is a minimally invasive surgical technique in which undesirable tissues are frozen and then left in situ to be absorbed. It can be highly effective in treatment of solid tumors. The application of cryosurgery to deep body tissues is prevented by the inability to observe the shape of the frozen region during treatment. Because freezing modifies the electrical properties of the tissue, EIT could image the freezing of tissue inside the body during cryosurgery. This is a technology driven proposal for the development of an Electrical Impedance Tomography (EIT) system for imaging the process of freezing during cryosurgery. To achieve this goal and verify this hypothesis we will pursue the following specific aims: 1) Determine sensitivity of EIT imaged cryosurgery by solving a mathematical model for the potential that develops in tissue from electrical currents injected into the tissue. The study will examine the effect of electrode location, electrode number, injected current frequency and amplitude, tissue type, and frozen lesion geometry, 2) Develop the hardware for ISll-imaged cryosurgery, 3) Develop and verify the software for EIT-imaged cryosurgery. We will design an inverse mathematical technique to reconstruct an image of the frozen region from the externally measured currents and potentials, 4) Test the hardware and the software in vivo in animal liver, and skin cryosurgery. Completion of the project will establish EIT as effective for imaging minimally invasive surgical procedures in general and cryosurgery, in particular. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ESTABLISHMENT 0F MECHANISMS OF CRYODESTRUCTION Principal Investigator & Institution: Bischof, John C.; Associate Professor; Mechanical Engineering; University of Minnesota Twin Cities 200 Oak Street Se Minneapolis, Mn 554552070 Timing: Fiscal Year 2002; Project Start 15-JUL-1998; Project End 30-JUN-2003

Studies

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Summary: (Adapted from Applicant's Abstract): Prostate cancer is expected to be diagnosed in more that 300,000 new patients this year. There is debate as to the optimal treatment of the disease of which cryosurgery is one. Based on what is currently known about cellular level mechanisms of injury less than one half of the volume of tissue frozen in a typical cryosurgical iceball would be destroyed. Nonquantitative studies in vivo, however, suggest that the volume of tissue destroyed in vivo is closer to the total volume of the tissue frozen in the cryosurgical iceball. In order to firmly establish cryosurgery as a treatment of prostate cancer, the relationship between the iceball formed during the surgery and the ultimate damage it creates after thawing must be both controllable and reproducible. Therefore this work aims to develop a precise understanding of the mechanism of damage induced by the formation and thawing of the cryosurgical iceball at the cellular, vascular, and whole tissue (in vitro and in vivo) level. The following hypotheses and specific aims have been developed. Hypotheses: 1. Given that cryosurgery produces tissue death, the injury during cryosurgery depends on predominantly cellular mechanisms in the center of the cryosurgery iceball and predominately vascular injury at the periphery of the iceball. 2. The thermal history imposed on tissue during the cryosurgery can be used to predict the amount of tissue death by cellular and vascular mechanisms. Specific Aims: In order to test these hypotheses, the following specific aims will be accomplished: 1. Establish the thermal history during formation and thawing of a cryosurgical iceball in vitro and in vivo. 2. Quantify the relationship between biophysical and thermal changes during the formation of an iceball in vitro. 3. Establish thermally and biophysically mediated cellular injury after thawing of the iceball in vitro. 4. Establish cellular biophysical changes during the formation, and vascular injury after thawing, of the cryosurgical iceball in vivo. 5. Correlate total tissue destruction by all mechanisms to thermal history during the formation, and after thawing, of a cryosurgical iceball in vivo. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: LIVER-LUNG INTERACTIONS FOLLOWING LIVER INJURY Principal Investigator & Institution: Wudel, Leonard J.; Surgery; Vanderbilt University 3319 West End Ave. Nashville, Tn 372036917 Timing: Fiscal Year 2002; Project Start 01-MAR-2002; Project End 28-FEB-2003 Summary: There is increasing evidence that liver injury can precipitate or exaggerate lung injury. Cytokines produced in the liver and lungs, including tumor necrosis factor alpha (TNF-alpha) and interleukin-1(IL- 1), are implicated in the pathogenesis of Systemic Inflammatory Response Syndrome (SIRS). Animal experiments have demonstrated them capable of precipitating acute lung injury. Increased expression of the genes encoding these cytokines involves activation of two transcription factors, nuclear factor kappa B (NF-kappa B) and CCAAT enhancer binding protein beta (C/EBPbeta, also known as NF-IL6) and activation is well-documented in several inflammatory states. Hepatic cryoablation, a non-resectional surgical technique used to eliminated primary and metastatic liver tumors, is associated with ARDS when more than 30-35% is ablated. The mechanisms of this response remain undefined. Previous studies have shown that liver injury produced by cryoablation in experimental animals caused an early activation of NF- kappaB, followed by TNF-alpha release in the liver and then NF-kappaB activation in the lungs with histologic findings similar to those seen in Adult Respiratory Distress Syndrome; none of these events follows hepatic resection. The specific aims are to: 1) To determine the role of the proximal cytokines, TNF-alpha and IL-1 in the response to hepatic cryoablation using TNF-alpha, IL-1, and TNF-alpha/IL-1 receptor knockout transgenic mice. 2) To determine if altering NF-

8

Cryosurgery

kappaB or C/EBP (P20) activation in the liver affects the response to cryoablation. Results of these studies should lead to enhanced understanding of the liver's role in propagation of SIRS in response to direct liver injury and may permit mediator specific strategies to ameliorate deleterious events in the setting. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: LOCAL HEMORRHAGE

PROFOUND

HYPOTHERMIA

IN

INTRACRANIAL

Principal Investigator & Institution: Larnard, Donald J.; Seacoast Technologies, Inc. 38 Depot Rd Hampton Falls, Nh 03844 Timing: Fiscal Year 2002; Project Start 15-AUG-2002; Project End 14-FEB-2004 Summary: (provided by applicant): In most hemorrhagic strokes, cerebral vessels may bleed into brain tissue producing an intracranial hemorrhage (ICH). The presence of clot causes irritation of brain tissue, causing ischemia, necrosis, and edema. Currently, there is very little treatment available to a patient with ICH. Hypothermia treatment, as with whole body hypothermia, is impractical and involves significant complications. We propose to use local, profound hypothermia (15-18 C) to teat such ICH insults. This involves placement of a cooling device through a burr hole and coolinga local region of brain near the ICH to profound hypothermia levels. ICH occurs in about 85,000 cases in the US annually with poor outcomes: 58 percent of patients die within 30 days, while the majority of survivors suffer major neurological deficits. In Phase I, prototype devices will be designed, built, tested in vitro and used in a porcine animal model of ICH to test for efficacy. Functional assessment, histological measurements as well as imaging methods will be used. In clinical practice, the devices would allow for treatment of ICH patents in lobar hemorrhages, which make up about 40 percent of all ICH. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MECHANISMS DISCRETE HEPATIC INJURY

OF

LUNG

INFLAMMATION

FOLLOWING

Principal Investigator & Institution: Chapman, William C.; Vanderbilt University 3319 West End Ave. Nashville, Tn 372036917 Timing: Fiscal Year 2002; Project Start 01-JAN-2002; Project End 30-NOV-2006 Summary: There is increasing evidence that injury to the liver can precipitate or exaggerate lung injury. For example, when hepatic dysfunction accompanies acute lung injury in patients with the Systemic Inflammatory Response Syndrom (SIRS), mortality and morbidity are high. Cytokines which are produced in both the liver and the lungs, including tumor necrosis factor alpha (TNF-alpha) and interleukin (IL- 1), are implicated in the pathogenesis of SIRS and animal experiments have demonstrated them capable of precipitating acute lung injury. Increased expression of the genes encoding these cytokines involves activation of the transcription factor nuclear factor kappa B (NFkappaB) and such activation is well-documented in several inflammatory states. Hepatic cryoablation, a recently introduced non-resectional surgical technique for eliminating primary and metastatic liver tumors, is associated with acute lung injury when more than 30-35% of the liver is ablated but mechanisms of this response remain undefined. We have shown that the direct and selective liver injury produced by cryoablation in experimental animals causes an early activation of NF-kappaB in the liver, followed by TNF-alpha release from the liver and then NF-kappaB activation in the lungs with histologic findings similar to those seen in other conditions of neutrophilic lung injury; none of these events follows hepatic resection. The specific aims of this project are: 1) To

Studies

9

determine whether altering NF-kappaB activation in the liver affects the response to cryoablation induced lung injury. NF-kappaB activation will be specifically modulated by expressing transgenes in the liver which induce or inhibit NF-kappaB activity. We will also utilize the cell permeable cSN50 peptide, which contains the nuclear localization signal sequence (NLS) derived from the p50-NF-kappaB1 subunit to inhibit NF-kappaB prior to and following direct liver injury. 2) To determine the role of the proximal cytokines, TNF-alpha and IL-1, in the response to hepatic cryoablation by comparing responses in mice deficient in TNF-alpha and IL-1, in the response to hepatic cryoablation by comparing responses in mice deficient in TNF-alpha, TNF-alpha receptor 1 and/or IL-1 receptor 1. Outcome variables will include neutrophilic lung inflammation, histologically defined lung injury, NF- kappaB activation, and serum and lung lavage cytokine and eicosanoid concentrations. 3) To determine the role of eicosanoids in the response to hepatic cryoablation by altering cyclooxygenase (COX) expression and/or activity in liver or lungs. In these studies we will define COX-2 expression in response to cryoablation in lung and liver and measure prostanoid products, determine the role of COX-2 in the cryoablation response by using COX-2 inhibitors and COX-2 knockout mice, and establish whether liver COX-2 expression is critical for modulating the cryoablation response by transplantation of wild type hepatocytes into COX-2 knockout mice and by delivering transgenes to express COX-2 in these animals. Results of these studies should enhance our understanding of the role of the liver in propagation in response to direct liver injury. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: INSTRUMENT

MICRO-MACHINED

JOULE-THOMSON

CRYOSURGICAL

Principal Investigator & Institution: Gianchandani, Yogesh B.; Electrical Engr & Computer Sci; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2003; Project Start 01-JUL-2003; Project End 30-JUN-2005 Summary: The objective of the proposed work is the development of a micro-machined cryosurgical instrument that utilizes a mixed-gas Joule-Thomson thermodynamic cycle to produce cryogenic tip temperatures. The device incorporates a micro-scale active valve and a composite recuperative heat exchanger in order to overcome limitations that currently limit cryosurgical instruments. The ultimate goal of this research is to provide surgeons with a cryosurgical probe that has significant advantages in terms of thermal performance, size, flexibility, and cost relative to the current state-of-the-art. The technical developments proposed here will enable MEMS technology, with all of its inherent advantages, to be brought to bear on the problem of cryosurgery. The cryoprobe wilJbe fabricated using conventional micro-fabrication techniques resulting in a low cost device that can be batch fabricated. Instrumentation and heaters to monitor and control the temperature field may be monolithically installed on the probe. The probe structure will be primarily silicon and glass and will therefore be compatible with magnetic resonance imaging, enabling real-time monitoring of cryosurgical procedures. During the R21 Phase of the project we will design and separately fabricate the active valve and recuperative heat exchanger. These components will be tested to demonstrate that they satisfy the requirements of the cryosurgical system. The R21 phase will culminate in a system level test that demonstrates the viability of the thermodynamic cycle and the reliability of the components. The goal of the R33 Phase is to utilize this technology base in order to design, fabricate, and demonstrate an integrated microfabricated cryosurgical probe. The demonstration probe will be packaged in a manner

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Cryosurgery

that is consistent with clinical usage. The ability of the probe to withstand pressure, thermal, and bending loads that are greater than those anticipated during usage will be demonstrated. The performance of the cryoprobe will be precisely measured in a thermal vacuum environment. Subsequent, in-vivo testing will occur in a gelatin solution and later in excised animal tissue in order to quantify the time and length scales associated with the freeze zone. Control algorithms that will enable automatic implementation of surgical protocols, defined in terms of freeze zone characteristics, will be developed and demonstrated. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MULTI IMAGER COMPATIBLE ROBOT FOR PROSTATE ACCESS Principal Investigator & Institution: Stoianovici, Dan; Urology; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2002; Project Start 01-AUG-2001; Project End 31-JUL-2005 Summary: (provided by applicant): The research objective in this R2l and R33 phased application is to advance the technology utilized in the diagnosis and delivery of localized therapy in the treatment of prostate cancer through the development of instrumentation allowing for improved and reproducible navigation and controlled probe insertion into the prostate gland. The deliverable is an accurate mechanism for performing precise image-guided procedures such as biopsy, brachytherapy, cryosurgery, hyperthermia, interstitial laser therapy, focused ultrasound and microwaves, chemotherapy, gene therapy, or other novel procedures. We propose the development of a new instrument for precise image-guided intervention. Even though this proposal's application relies in the urologic field, the proposed system applies to a large variety of other specialties. This application restricts the application range to the diagnostic and treatment of the prostate since urologic applications are our main domain of interest. The centerpiece of research is a compact image-guided robotic system which can be used with standard and modern medical imaging equipment. The novelty of the system relies in its compatibility with multiple imaging modalities, such as fluoroscopy, ultrasound, computer tomography (CT), magnetic resonance imaging (MR), and spectroscopic imaging (MRSI). This allows not only for performing procedures with the imager of choice but also for using cross-platform, combined imaging modalities. An intense research effort is presently focused on the development of novel methods for advanced imaging and improved visualization. In contrast, the instrumentation used for image guided navigation and therapy delivery advanced modestly. Needle procedures are typically performed freehand or with a "template" device under transrectal ultrasound guidance. At present, no mechanical device exists for controllably and repeatedly access the prostate with a precision comparable with that of modern medical imaging systems. While the medical community is still divided about the best treatment modality of prostate cancer, there is undivided agreement about the poor specificity and predictability of the currently used prostate access techniques. Enhanced MR imagery provides uncontested tissue contrast and image quality, which ought to be used for guiding biopsy and localized therapy. This goal requires miniature, extremely high dexterity robots that are able to operate inside the magnet of MR scanners, which may be "open" or conventional closed bore systems. This task also demands a quantum leap in the current technology of mechatronic devices and clearly leads medical robotics into the next millennium. We propose to develop an instrument that could exploit the most advanced imaging methods for implementing the results obtained by urologists, oncologists, radiologists, radiotherapists, and biomedical researchers into clinical use. It creates means for measuring the local extent of the

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disease, for performing controlled biopsy and therapy delivery through advanced image-guided navigation and control. In conjunction with the recent citrate/choline ratio methods of tumor localization under MRSI, for example, this multi-application system could be used to perform precise tumor-centered biopsy procedures. The main research challenge relies in the robot compatibility with multiple imaging systems, especially the conventional MR imager. Innovative engineering research will address design miniaturization, adequate material selection and manufacturing. The mechanical part, which will operate within the conformed space of the imager in close proximity of the prostate, will be radiolucent, nonmagnetic, dielectric, and will provide means for safety and sterilization. For this, the system, including the motors, will be constructed of materials such as plastics, carbon fiber composites, ceramics, glasses, and rubbers. The use of electricity in the imager's room will be eliminated by using optical sensors and pneumatic/hydraulic motors while all control equipment will be located in the control room of the imager. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NEOADJUVANT MICROSPHERES

CYTOKINE

IMMUNOTHERAPY

BY

PLA

Principal Investigator & Institution: Sabel, Michael; Surgery; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2003; Project Start 05-SEP-2003; Project End 31-AUG-2008 Summary: (provided by applicant): Having completed my fellowship in surgical oncology, I have embarked upon a career in academic surgery, combining a clinical surgical oncology practice with basic science research in tumor immunology. I am seeking a career transition award to develop a cancer research program investigating neoadjuvant immunotherapy as an adjunct to surgical resection. I initially became interested in the anti-tumor immunity generated by in situ tumor destruction when I investigated the use of cryosurgery in the treatment of breast cancer. During a two-year NIH T32 laboratory research fellowship in the Department of Immunology at Roswell Park Cancer Institute under the mentorship of Dr. Richard Bankert, D.V.M., Ph.D., I investigated methods by which to augment anti-tumor immunity through costimulatory molecules such as 4-1BB, CTLA-4 and CD40. I also studied the systemic immune response generated by the sustained release of cytokines in the tumor microenvironment, and the effect this had on recurrence and metastases. This approach was accomplished by encapsulating biologically active cytokines with biodegradable poly-lactic acid microspheres (PLAM) and injecting them directly into the tumor. Utilizing a novel murine surgical model I developed, I was able to show that injection of tumors with IL-12 loaded PLAM prior to surgical excision resulted in decreased local recurrence, distant metastases and improved survival. These results have been improved upon further by the use of combination cytokine therapy consisting of IL-12 and GM-CSF. The clinical utilization of this approach to neoadjuvant immunotherapy, if proved effective, is more feasible and potentially more cost-effective than other attempts to harness the power of the immune system to improve survival. I plan to expand upon this novel approach by establishing the efficacy of an in situ tumor vaccination strategy that utilizes combination cytokine-loaded biodegradable microspheres to generate a tumor specific immune response, and investigate the underlying immune mechanisms of tumor rejection involved to better translate this approach to the human system. I will pursue this area of investigation as a full-time faculty member, with full commitment from the Department of General Surgery and the Division of Surgical Oncology at the University of Michigan Medical Center.

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Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NURSING SUPPORT OF DECISIONS BY MEN WITH PROSTATE CANCER Principal Investigator & Institution: Berry, Donna L.; Associate Professor; Biobehavioral Nursing and Health Systems; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2002; Project Start 01-APR-1998; Project End 31-MAR-2003 Summary: (Adapted from the Investigator's Abstract): The long-term goal of this research is to improve the quality of men's lives after a diagnosis of prostate cancer by facilitating the patient's treatment decision-making. An estimated 343,500 American men will face a diagnosis of prostate cancer in 1997. The majority of prostate cancers are diagnosed without clinical evidence of metastatic spread. Localized prostate cancer (LPC) can be treated with one or more of several modalities including observation alone, surgery, cryosurgery, hormonal therapy, brachytherapy, or external beam radiation therapy. Efficacy and complication rates vary widely even within treatment modalities. Randomized trials comparing treatments are at least a decade away from meaningful results and even then may not demonstrate significant differences in survival. Clinicians provide much information to patients, but the information provided is often heavily influenced by the specialty of the clinician. Computerized decision support aids that exist for treatment decision-making in prostate cancer assess characteristics of a man that are considered relevant by physicians, but characteristics which are personally relevant to the patient, and the process through which the patient's decisions are made, are unknown. Care providers have not developed, comprehensively investigated, nor provided data-based interventions to facilitate the insight, prioritizing, and decisionmaking that is required of a man with a diagnosis of LPC. The purpose of this study, using prospective, descriptive, qualitative and quantitative methods, is to systematically document relevant aspects of treatment decision-making in men with LPC and develop a decision support system which nurses and other clinicians can use to prepare the patient to engage in the decision-making process. Six focus groups and 20 individual indepth interviews will be conducted to evaluate the treatment decision-making aspects, information use, expectations, preferences, and process components perceived by men with LPC. Physicians will be interviewed to obtain a description of priority information given to specific patients and factors upon which the prioritizations are based. After analysis of data from the focus groups and interviews, a questionnaire packet will be designed including both standardized instruments and a new questionnaire specific to decision-making aspects, information use, expectations, and preferences of men with LPC. The questionnaire data will be collected from 300 men in the Seattle and Pittsburgh areas who have a new diagnosis of prostate cancer before treatment has been initiated and 6 months after treatment has begun. A prototype decision support aid will be developed and a pilot test conducted to guide men through the personal issues, expectations, and preferences to be considered in treatment decision-making after a diagnosis of prostate cancer. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: SAFETY AND EFFICACY OF CELLULAR CARDIOMYOPLASTY Principal Investigator & Institution: Taylor, Doris A.; Bakken Professor; Medicine; Duke University Durham, Nc 27710 Timing: Fiscal Year 2002; Project Start 01-AUG-1999; Project End 31-JUL-2004

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Summary: Description (Adapted from Applicant's Abstract): The overall goal of this project is to determine whether autotransplantation of skeletal myoblasts into scarred or failing myocardium will lead to long term survival of the myoblast and improvement in systolic and diastolic contractile function. The Principal Investigator plans to use a model of cryoablation injury to the ventricle injecting the myoblasts into the area of damage. In the first aim she will develop a method of labeling the transplanted cells so that they could be detected late and to facilitate determination of longevity. In the second aim, she will determine regional wall motion abnormalities in the area of myoblast transplantation and determine the microenvironment to which the cells are transplanted. In the third aim, she will determine whether the viability of harvested skeletal myoblasts is altered by the presence of congestive heart failure. She will also test the efficacy of myoblast transplantation in a model of coronary ischemia. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SHAPE CRYOSURGERY

CONTROL

OF

FREEZE

ZONES

IN

PROSTATE

Principal Investigator & Institution: Barry, James J.; Creare, Inc. 16 Great Hollow Road Hanover, Nh 03755 Timing: Fiscal Year 2002; Project Start 01-MAY-2002; Project End 30-APR-2004 Summary: The recent trends toward early detection, image-guided surgery, and preference for minimally invasive treatments for prostate cancer have fostered continuing interest in cryotherapeutic approaches to prostate cancer. Cryosurgical treatment has fallen in and out of favor, due at least in part to the risk of damage to sensitive tissues in the urethra and rectal wall. The availability of transrectal ultrasound and urethral warmers improves the situation markedly, but the shape of the freeze zone remains challenging to control. The proposed cryosurgical probe provides direct control over the shape of the frozen region, protecting sensitive nearby tissues from thermal damage. It also includes sensors to measure the actual temperatures achieved across the freeze zone. In Phase I, a proof-of-principle probe will be fabricated and tested in vitro. In Phase II, a prototype probe will be built and tested in vivo. PROPOSED COMMERCIAL APPLICATIONS: The proposed cryotherapy probe has strong commercial potential. Our commercialization strategy is based on licensing the technology developed under this program to an existing vendor of medical equipment. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SUBSTRATE TACHYCARDIA

MAPPING

&

ABLATION OF

VENTRICULAR

Principal Investigator & Institution: Reddy, Vivek Y.; Massachusetts General Hospital 55 Fruit St Boston, Ma 02114 Timing: Fiscal Year 2002; Project Start 15-AUG-2002; Project End 30-JUN-2007 Summary: (provided by applicant): In patients with coronary artery disease at risk for sudden cardiac death, malignant ventricular tachycardia (VT) is treated with a combination of implantable defibrillators and antiarrhythmic drugs. While effective in preventing sudden cardiac death, this strategy is plagued with medication side-effects and toxicities, and device related iatrogenic complications. The ideal treatment for VT would be eradication of the arrhythmia. This can be accomplished with greater than 90% efficacy through surgical resection of the infarcted arrhythmogenic tissue; however, this is an open surgical procedure associated with significant morbidity and mortality. Radiofrequency (RF) catheter ablation is an effective less-invasive alternative, but is

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largely limited to hemodynamically-tolerated VT-which accounts for less than 10% of all VT. However, the approach to catheter ablation of VT is undergoing a paradigm shift. Instead of trying to precisely identify the critical portions of the VT circuit during tachycardia, "substrate mapping" is performed in sinus rhythm to identify the arrhythmogenic tissue. Then, a probabilistic approach to catheter ablation is undertaken using strategically-placed linear RF lesions. While this strategy has proven to be successful in small non-randomized studies, the safest and most efficacious method to deliver the RF ablation is not known. Also, the role of substrate ablation in the primary prevention of ICD shocks is unknown. We now propose to conduct prospective randomized clinical trials: a) comparing the standard non-irrigated to the salineirrigated RF ablation catheter for substrate-mapping and ablation in the treatment of patients with multiple ICD shocks (the THERMO COOL IDE trial), and b) examining the role of substrate-mapping and RF ablation in the primary prevention of ICD shocks (the SMASH-VT trial). Furthermore, the abilitv of a new 3-dimensional mapping system to rapidly identify the arrhythmogenic substrate will be examined in a porcine model of healed myocardial infarction with inducible VT. Finally, using this advanced mapping system to identify the substrate, the effect of catheter-mediated cryoablation will be compared to RF ablation using a saline-irrigated catheter on the inducibility of VT in this animal model system. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SURGICAL TREATMENT OF CARDIAC ARRHYTHMIAS Principal Investigator & Institution: Boineau, John P.; Medical Science Service; Surgery; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130 Timing: Fiscal Year 2002; Project Start 08-AUG-1983; Project End 31-JUL-2003 Summary: This renewal application requests five years' support for work now in continuous progress for over 15 years at Washington University. Dr. John Boineau, the new PI, has replaced Dr. James Cox, the former P1, who transferred to Georgetown University Hospital. Dr. Cox remains as a special consultant. The broad aims continue to be the direct or surgical ablation of cardiac arrhythmias. The emphasis of the current renewal is focused upon the development of a new procedure, the radial incisions approach (RIA), to eradicate atrial fibrillation (AF) and restore atrial transport function and is directed primarily toward patients undergoing surgery for valvular or ischemic heart disease. Conventional valve or CABG surgery does not eliminate and may not prevent AF in these patients. The availability of an effective means of eradicating this arrhythmia in these patients at the time of surgery would permit control of rate and rhythm, limit embolic stroke, and improve cardiac performance, outcome, and the quality of life. Whereas the Maze and RIA assume randomly distributed and changing reentry which are eliminated without prior activation mapping, new data indicate that some forms of AF result from (spatially) stable reentry which can be identified by new mapping methods and focally ablated. Thus, a second project is directed toward map guided, focal cryoablation of AF. This could be performed off bypass as a more limited and rapid alternative to the more extensive and (bypass) time consuming RIA procedure. A third project is targeted at prevention and correction of postoperative atrial flutter (AFL) after the Fontan operation in congenital heart patients or after lung transplant surgery. Studies will be performed in both realistic animal models with atrial enlargement and patients with AF and AFL and will center about the use of new automated, 3-D mapping techniques and rapid numerical analysis of potentials recorded simultaneously from to 512 electrodes during the arrhythmias. Preliminary observations indicate that the proposed studies are feasible, will provide new

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information regarding the different mechanisms of AF and AFL that are related to atrial enlargement and/or atrial surgery, and this data will be used to develop the new surgical ablation techniques to control or prevent these arrhythmias. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TECHNIQUES FOR MRI-GUIDED CRYOSURGERY OF PROSTATE CANCER Principal Investigator & Institution: Daniel, Bruce L.; Radiology; Stanford University Stanford, Ca 94305 Timing: Fiscal Year 2003; Project Start 01-MAY-2003; Project End 31-MAR-2007 Summary: (provided by applicant): This year prostate cancer will afflict 189,000 new patients in the United States[l]. In many, the significant burden of tumor will be localized within a portion of the gland. New MRI techniques, including MR Spectroscopy and dynamic MRI, are becoming increasingly able to define the extent of disease in these patients. However, current therapies for prostate cancer are either systemic, or treat the entire gland. We believe advances in MRI guidance will enable minimally invasive, super-selective, targeted cryosurgery as an outpatient treatment for localized disease with minimal risk and morbidity. Potential advantages of MRI guidance over sonography are: Monitoring the entire 3D iceball boundary. Mapping tissue temperature inside the iceball non-invasively. The key to successful cryosurgery is achieving a sufficiently low freezing temperature. Determining the extent and lethality of the cryo-lesion. This would enable re-freezing of any under-treated areas during the same procedure. We will pursue two specific aims to develop MRI guidance technology for prostate cryosurgery: 1. Calibrate MRI-Thermometry during cryosurgery of prostate cancer: Refine MRI thermometry for human use. Calibrate MRIthermometry in 25 prostate cancer patients. We will also assess the efficacy, and morbidity of MRI-guided cryoablation 2. Develop advanced MRI to assess acute and chronic cryo-induced injury: Refine perfusion- and diffusion-weighted MRI for imaging immediately after cryosurgery Evaluate post-cryo perfusion- and diffusion-MRI for depicting acute ischemia and cellular injury in animals and tumor necrosis in humans. Evaluate post-cryo perfusion- and diffusion-weighted MRI for predicting ultimate volume of lethal cryoablation in an animal survival model. Completing these aims will pave the way for future clinical trials that definitively measure the efficacy of MRIguided selective cryoablation compared to other treatments for localized prostate cancer. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: TRANSIENT ENVIRONMENT

THERMAL

MODELING

AND

SIMULATION

Principal Investigator & Institution: Elkouh, Nabil A.; Creare, Inc. 16 Great Hollow Road Hanover, Nh 03755 Timing: Fiscal Year 2003; Project Start 01-JUL-2003; Project End 31-DEC-2004 Summary: (provided by applicant): Many biomedical applications involve the use of energy deposition into in homogeneous structures, such as laser surgery, cryosurgery, and RF ablation. In many cases, numerous advantages can be realized when the energy source is pulsed. No commercial software package exists to assist clinicians in determining the direction, duration, and magnitude of these energy interventions. In particular, existing predictive tools do not account for the effects associated with the laser interaction with thin tissues. While well-known approximations, such as the

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Cryosurgery

Diffusion Model, adequately account for interactions with thick tissue samples, they do not accurately model the effects associated with thin tissues where interactions with boundaries becomes important. Furthermore, when pulsed energy is deposited in tissue at ultra-high frequency, the subsequent conduction in the tissue no longer adheres to Fourier's conduction law, further complicating simulations. The specific aim of this project is to develop a general, commercial software modeling and simulation environment that will enable accurate assessment of heat transfer for biomedical applications involving energy deposition in tissues across the spectrums of thin to thick tissue layers and ultra-fast to continuous wave lasers, including those situations when non-Fourier heat conduction is important. Our thermal modeling and simulation environment will provide an easy-to-use tool for clinicians and biomedical researchers to plan accurately and understand a wide variety of pulsed and non-pulsed energy deposition-based clinical procedures. In Phase I, we will develop the general framework for a stand-alone software package that will be demonstrated with comparisons to experimental data, analytic solutions, and Monte Carlo simulations. In Phase II, we will develop a complete and robust package with an intuitive graphical user interface, refined models, and greatly expanded property data base developed in conjunction with our collaborators. We will also conduct appropriate experiments and work closely with clinicians to verify the underlying models and numerical schemes and gather additional required material properties. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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

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A breakthrough in cryosurgery. Author(s): Sikma MA, Coenen JL, Kloosterziel C, Hasselt BA, Ruers TJ. Source: Surgical Endoscopy. 2002 May; 16(5): 870. Epub 2002 February 28. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11997844

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 case report: reconstruction of a damaged knee following treatment of giant cell tumor of the proximal tibia with cryosurgery and cementation. Author(s): Wakitani S, Imoto K, Saito M, Yamamoto T, Kawabata H. Source: Osteoarthritis and Cartilage / Oars, Osteoarthritis Research Society. 2002 May; 10(5): 402-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12027541

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A comparative laboratory study of liquid nitrogen and argon gas cryosurgery systems. Author(s): Hewitt PM, Zhao J, Akhter J, Morris DL. Source: Cryobiology. 1997 December; 35(4): 303-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9425653

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A comparison of partial inferior turbinectomy and cryosurgery for hypertrophic inferior turbinates. Author(s): Rakover Y, Rosen G. Source: The Journal of Laryngology and Otology. 1996 August; 110(8): 732-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8869604

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A comparison of percutaneous cryosurgery and percutaneous radiofrequency for unresectable hepatic malignancies. Author(s): Adam R, Hagopian EJ, Linhares M, Krissat J, Savier E, Azoulay D, Kunstlinger F, Castaing D, Bismuth H. Source: Archives of Surgery (Chicago, Ill. : 1960). 2002 December; 137(12): 1332-9; Discussion 1340. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12470093

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A finite element model for ice ball evolution in a multi-probe cryosurgery. Author(s): Liu Z, Muldrew K, Wan R, Rewcastle J. Source: Computer Methods in Biomechanics and Biomedical Engineering. 2003 June; 6(3): 197-208. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12888431

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A general model for the propagation of uncertainty in measurements into heat transfer simulations and its application to cryosurgery. Author(s): Rabin Y. Source: Cryobiology. 2003 April; 46(2): 109-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12686201

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A microscale model for prediction of breast cancer cell damage during cryosurgery. Author(s): Zhang A, Xu LX, Sandison GA, Zhang J. Source: Cryobiology. 2003 October; 47(2): 143-54. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14580848

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A modification of cryosurgery for the management of elevated bleb. Author(s): Susanna R Jr. Source: Ophthalmic Surg. 1994 January; 25(1): 57-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8152736

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A reappraisal of cryosurgery for eyelid basal cell carcinomas. Author(s): Buschmann W. Source: The British Journal of Ophthalmology. 2002 April; 86(4): 453-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11914217

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A semi-empirical treatment planning model for optimization of multiprobe cryosurgery. Author(s): Baissalov R, Sandison GA, Donnelly BJ, Saliken JC, McKinnon JG, Muldrew K, Rewcastle JC. Source: Physics in Medicine and Biology. 2000 May; 45(5): 1085-98. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10843092

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Acanthamoeba keratitis with live isolates treated with cryosurgery and fluconazole. Author(s): Amoils SP, Heney C. Source: American Journal of Ophthalmology. 1999 June; 127(6): 718-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10372884

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Acute renal failure with thrombocytopenia after cryosurgery of the prostate. Author(s): Kohn IJ, Heifets M, Fisher S, Seidmon EJ. Source: Tech Urol. 1996 Winter; 2(4): 230-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9085545

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Adrenal-preserving minimally invasive surgery: the role of laparoscopic partial adrenalectomy, cryosurgery, and radiofrequency ablation of the adrenal gland. Author(s): Munver R, Del Pizzo JJ, Sosa RE. Source: Curr Urol Rep. 2003 February; 4(1): 87-92. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12537947

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Advances in cryosurgery during the past decade. Author(s): Graham GF. Source: Cutis; Cutaneous Medicine for the Practitioner. 1993 December; 52(6): 365-72. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8293679

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Amelanotic malignant melanoma following cryosurgery for atypical lentigo maligna. Author(s): McKenna DB, Cooper EJ, Kavanagh GM, Davie RM, McLaren KM, Tidman MJ. Source: Clinical and Experimental Dermatology. 2000 November; 25(8): 600-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11167970

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An in vivo study of antifreeze protein adjuvant cryosurgery. Author(s): Pham L, Dahiya R, Rubinsky B. Source: Cryobiology. 1999 March; 38(2): 169-75. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10191041

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Angiography in the evaluation of cryosurgery efficiency in the treatment of a haemangioma of the face. A case report. Author(s): Rozylo TK, Jarzab G. Source: J Maxillofac Surg. 1980 May; 8(2): 115-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6929869

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Angiolymphoid hyperplasia with eosinophilia treated by cryosurgery. Author(s): Cooper SM, Dawber RP, Millard P. Source: Journal of the European Academy of Dermatology and Venereology : Jeadv. 2001 September; 15(5): 489-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11763402

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Argon supper-cryosurgery for patients with middle and late stage liver cancer. Author(s): Dou KF, Yue SQ, Li HM, Yang YL, Tao KS, Guan WX, Chen Y, Sun K. Source: Hepatobiliary Pancreat Dis Int. 2003 August; 2(3): 354-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14599938

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Basal-cell carcinomas of eyelids: experience with cryosurgery. Author(s): Biro L, Price E. Source: J Dermatol Surg Oncol. 1979 May; 5(5): 397-401. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=458007

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Basic concepts and an overview of cryosurgery in ophthalmic plastic surgery. Author(s): Soll DB, Harrison SE. Source: Ophthalmic Surg. 1979 August; 10(8): 31-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=492667

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Bile duct warmer in hepatic cryosurgery--a pig liver model. Author(s): Seifert JK, Dutkowski P, Junginger T, Morris DL. Source: Cryobiology. 1997 November; 35(3): 299-302. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9367617

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Biophysical and engineering aspects of cryosurgery. Author(s): Orpwood RD. Source: Physics in Medicine and Biology. 1981 July; 26(4): 555-75. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7019936

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Biopsy and clinical course after cryosurgery for prostatic cancer. Author(s): Petersen DS, Milleman LA, Rose EF, Bonney WW, Schmidt JD, Hawtrey CE, Culp DA. Source: The Journal of Urology. 1978 September; 120(3): 308-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=682248

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Biphasic effect of cryosurgery of the prostate on lymphocyte proliferation. Author(s): Ablin RJ, Sadoughi N, Guinan P, Bruns GR, Bush IM. Source: Cryobiology. 1977 February; 14(1): 60-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=837710

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Blood flow response to cryosurgery on basal cell carcinomas. Author(s): Bircher AJ, Buchner SA. Source: Acta Dermato-Venereologica. 1991; 71(6): 531-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1685837

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Blood loss following cryosurgery of the prostate. Author(s): Walker D, Jordan WP Jr, Drylie DM, Miller GH Jr. Source: The Journal of Urology. 1968 August; 100(2): 188-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5658663

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Bone marrow embolism following cryosurgery of bone: an experimental study. Author(s): de Vries J, Oosterhuis JW, Oldhoff J. Source: The Journal of Surgical Research. 1989 March; 46(3): 200-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2921858

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Comparison of trichloroacetic acid solution and cryosurgery in the treatment of solar lentigines. Author(s): Lugo-Janer A, Lugo-Somolinos A, Sanchez JL. Source: International Journal of Dermatology. 2003 October; 42(10): 829-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14521703

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Confocal microscopy oriented cryosurgery. Author(s): Abramovits W, Goldstein AM, Gonzalez S. Source: International Journal of Dermatology. 2002 May; 41(5): 284-5. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12100705

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Cryosurgery - a review of recent advances and current issues. Author(s): Gage AA, Baust JG. Source: Cryo Letters. 2002 March-April; 23(2): 69-78. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12050774

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Cryosurgery after chemoembolization for hepatocellular carcinoma in patients with cirrhosis. Author(s): Clavien PA, Kang KJ, Selzner N, Morse MA, Suhocki PV. Source: Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract. 2002 January-February; 6(1): 95-101. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11986024

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Cryosurgery as primary treatment for localized prostate cancer: a community hospital experience. Author(s): Ellis DS. Source: Urology. 2002 August; 60(2 Suppl 1): 34-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12206846

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Cryosurgery for common skin conditions. Author(s): Andrews MD. Source: American Family Physician. 2004 May 15; 69(10): 2365-72. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15168956

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Cryosurgery for primary and metastatic liver tumors. Author(s): Peacock JL. Source: Cancer Treat Res. 2001; 109: 269-77. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11775441

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Cryosurgery for prostate cancer. Author(s): Rees J, Patel B, MacDonagh R, Persad R. Source: Bju International. 2004 April; 93(6): 710-4. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15049977

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Cryosurgery for prostate cancer. Author(s): Fahmy WE, Bissada NK. Source: Archives of Andrology. 2003 September-October; 49(5): 397-407. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12893518

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Cryosurgery for prostate cancer: new technology and indications. Author(s): Benoit RM, Cohen JK, Miller RJ Jr. Source: Curr Urol Rep. 2000 May; 1(1): 41-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12084340

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Cryosurgery for recurrent prostate cancer following radiation therapy. Author(s): Erlichman M, Handelsman H, Hotta SS. Source: Health Technol Assess (Rockv). 1999; (13): I-V, 1-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11977805

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Cryosurgery for skin cancer: 30-year experience and cure rates. Author(s): Kuflik EG. Source: Dermatologic Surgery : Official Publication for American Society for Dermatologic Surgery [et Al.]. 2004 February; 30(2 Pt 2): 297-300. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14871224

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Cryosurgery in fibrous dysplasia: good result of a multimodality protocol in 16 patients. Author(s): Segev E, Kollender Y, Bickels J, Flusser G, Issakov J, Wientroub S, Meller I. Source: Acta Orthopaedica Scandinavica. 2002 August; 73(4): 483-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12358128

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Cryosurgery in the management of cutaneous malignancies. Author(s): Graham GF. Source: Clinics in Dermatology. 2001 May-June; 19(3): 321-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11479044

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Cryosurgery of close or positive margins after hepatic resection for primary and metastatic hepatobiliary malignancies. Author(s): Shen P, Hoffman A, Howerton R, Loggie BW. Source: The American Surgeon. 2002 August; 68(8): 695-703; Discussion 703. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12206604

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Cryosurgery plus adjuvant systemic alpha2-interferon for HPV-associated lesions. Author(s): Scala M, Bonelli G, Gipponi M, Margarino G, Muzza A. Source: Anticancer Res. 2002 March-April; 22(2B): 1171-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12168920

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Cryosurgery. Author(s): Rubinsky B. Source: Annual Review of Biomedical Engineering. 2000; 2: 157-87. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11701510

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Cryosurgery: unapproved uses, dosages, or indications. Author(s): Dawber R. Source: Clinics in Dermatology. 2002 September-October; 20(5): 563-70. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12435527

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Current developments and uses of cryosurgery in the treatment of keloids and hypertrophic scars. Author(s): Zouboulis CC, Zouridaki E, Rosenberger A, Dalkowski A. Source: Wound Repair and Regeneration : Official Publication of the Wound Healing Society [and] the European Tissue Repair Society. 2002 March-April; 10(2): 98-102. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12028522

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Debulking of skin cancers with radio frequency before cryosurgery. Author(s): Goncalves JC, Martins C. Source: Dermatologic Surgery : Official Publication for American Society for Dermatologic Surgery [et Al.]. 1997 April; 23(4): 253-6; Discussion 256-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9149791

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Depth dose in cryosurgery. Author(s): Torre D. Source: J Dermatol Surg Oncol. 1983 March; 9(3): 219-25. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6826876

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Destruction of the endometrium by cryosurgery. Author(s): Droegemueller W, Makowski E, Macsalka R. Source: American Journal of Obstetrics and Gynecology. 1971 June 15; 110(4): 467-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5582002

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Detection of locally recurrent prostate cancer after cryosurgery: evaluation by transrectal ultrasound, magnetic resonance imaging, and three-dimensional proton magnetic resonance spectroscopy. Author(s): Parivar F, Hricak H, Shinohara K, Kurhanewicz J, Vigneron DB, Nelson SJ, Carroll PR. Source: Urology. 1996 October; 48(4): 594-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8886066

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Dilantin induced hyperplastic gingiva as a model for experimental cryosurgery. Author(s): Tal H, Altini M. Source: Diastema. 1982; 10: 27-30. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6959938

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Discoid lupus erythematosus lesions treated with cryosurgery. Author(s): Molin L. Source: Advances in Experimental Medicine and Biology. 1999; 455: 375-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10599372

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Does cryosurgery have a place in the treatment of papillomata or carcinoma of the larynx? Author(s): Miller D. Source: The Annals of Otology, Rhinology, and Laryngology. 1973 September-October; 82(5): 656-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4743395

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Early results of a modified technique of cryosurgery. Author(s): Dabak N, Tomak Y, Piskin A, Gulman B, Ozcan H. Source: International Orthopaedics. 2003; 27(4): 249-53. Epub 2003 May 20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12756502

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Effect of cryosurgery of the prostate in serum gonadotropin levels in prostatic cancer. Author(s): Washida H, Jinno H, Fushimi N, Watanabe H. Source: Cryobiology. 1982 June; 19(3): 237-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6809427

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Effect of thermal variables on human breast cancer in cryosurgery. Author(s): Rui J, Tatsutani KN, Dahiya R, Rubinsky B. Source: Breast Cancer Research and Treatment. 1999 January; 53(2): 185-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10326796

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Efficacy of cryosurgery alone for refractory monomorphic sustained ventricular tachycardia due to inferior wall infarction. Author(s): Caceres J, Werner P, Jazayeri M, Akhtar M, Tchou P. Source: Journal of the American College of Cardiology. 1988 June; 11(6): 1254-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3366999

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Endobronchial cryosurgery. Author(s): Maiwand MO. Source: Chest Surg Clin N Am. 2001 November; 11(4): 791-811. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11780296

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Endoscopic cryosurgery of prostate and bladder tumors. Author(s): Reuter HJ. Source: The Journal of Urology. 1972 March; 107(3): 389-93. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4110842

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Eosinophilic granuloma of bone: results of treatment with curettage, cryosurgery, and bone grafting. Author(s): Schreuder HW, Pruszczynski M, Lemmens JA, Veth RP. Source: Journal of Pediatric Orthopaedics. Part B / European Paediatric Orthopaedic Society, Pediatric Orthopaedic Society of North America. 1998 October; 7(4): 253-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9810523

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Erosive adenomatosis of the nipple treated with cryosurgery. Author(s): Kuflik EG. Source: Journal of the American Academy of Dermatology. 1998 February; 38(2 Pt 1): 270-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9486687

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Erosive lichen planus of the tongue treated by cryosurgery. Author(s): Loitz GA, O'Leary JP. Source: Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons. 1986 July; 44(7): 580-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3459845

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Evaluation of cellular immunologic responsiveness in the clinical management of patients with prostatic cancer. II. Effect of oestrogen, cryosurgery and transurethral resection on thymic-dependent lymphocytic blastogenesis. Author(s): Ablin RJ, Guinan PD, Bruns GR, Sheik HI, Sadoughi N, Bush IM. Source: Urologia Internationalis. 1976; 31(5): 383-400. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1087494

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Evaluation of insulating materials used during cryosurgery. Author(s): Keenan JP, Snyder GG 3rd, Ruiz JW, Carpenter RJ 3rd. Source: American Journal of Otolaryngology. 1980 August; 1(4): 302-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7446849

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Evaluation of the impedance technique for cryosurgery in a theoretical model of the head. Author(s): Radai MM, Abboud S, Rubinsky B. Source: Cryobiology. 1999 February; 38(1): 51-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10079129

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Evidence-based review of the use of cryosurgery in treatment of basal cell carcinoma. Author(s): Kokoszka A, Scheinfeld N. Source: Dermatologic Surgery : Official Publication for American Society for Dermatologic Surgery [et Al.]. 2003 June; 29(6): 566-71. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12786697

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Excision and cryosurgery in the treatment of conjunctival malignant epithelial tumours. Author(s): Peksayar G, Altan-Yaycioglu R, Onal S. Source: Eye (London, England). 2003 March; 17(2): 228-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12640411

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Excision and cryosurgery of conjunctival malignant epithelial tumours. Author(s): Singh AD. Source: Eye (London, England). 2003 March; 17(2): 125-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12640396

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Experiences with cryosurgery in the management of benign prostatic obstruction. Author(s): Green NA. Source: The Australian and New Zealand Journal of Surgery. 1977 August; 47(4): 477-85. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=271495

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Experimental and clinical observations on hepatic cryosurgery for colorectal metastases. Author(s): Ravikumar TS, Steele G Jr, Kane R, King V. Source: Cancer Research. 1991 December 1; 51(23 Pt 1): 6323-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1933894

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Experimental combination of electroresection and cryosurgery for prostatectomy. Clinical appliance of cryosurgery as a tool for better prostatic electroresections. Author(s): Rouvalis PJ. Source: The Journal of Urology. 1971 June; 105(6): 826-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5091713

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Experimental study of differences in human sole skin between one cycle method and two cycle method after spray cryosurgery: an ultrastructural investigation. Author(s): Ueda K, Komori Y, Wakabayashi S. Source: The Journal of Dermatology. 1982 April; 9(2): 93-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7050207

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Experiments on cryosurgery of tumors at the great blood vessels in the neck. Author(s): Ganz H. Source: Minerva Med. 1974 October 6; 65(70): 3645-7. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4423819

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Facial tumescent solution for cryosurgery: subtract the epinephrine, add a steroid, and avoid spinal needles. Author(s): Field LM. Source: Dermatologic Surgery : Official Publication for American Society for Dermatologic Surgery [et Al.]. 2001 January; 27(1): 98-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11231265

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Fatal meningitis complicating cryosurgery for haemorrhoids. Author(s): Anderson J, Steger A. Source: British Medical Journal (Clinical Research Ed.). 1984 March 17; 288(6420): 826. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6423099

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Fertility after cryosurgery of the cervix. Author(s): Weed JC Jr, Curry SL, Duncan ID, Parker RT, Creasman WT. Source: Obstetrics and Gynecology. 1978 August; 52(2): 245-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=683667

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First experience with endoscopic cryosurgery of prostatic adenoma and carcinoma. Author(s): Reuter HJ. Source: International Urology and Nephrology. 1971; 3(1): 31-43. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4117492

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Five year survival after cryosurgery for carcinoma of the mouth. Author(s): Gage AA. Source: Surg Gynecol Obstet. 1977 August; 145(2): 189-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=877836

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Five years of cryosurgery in the ophthalmological clinic of the University of Catania. Author(s): Gorgone G, Musumeci M. Source: Minerva Med. 1974 October 6; 65(70): 3669. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4607471

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Five-year results of curettage-cryosurgery for 100 consecutive auricular nonmelanoma skin cancers. Author(s): Nordin P, Stenquist B. Source: The Journal of Laryngology and Otology. 2002 November; 116(11): 893-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12487665

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Five-year results of curettage-cryosurgery of selected large primary basal cell carcinomas on the nose: an alternative treatment in a geographical area underserved by Mohs' surgery. Author(s): Nordin P, Larko O, Stenquist B. Source: The British Journal of Dermatology. 1997 February; 136(2): 180-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9068728

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Five-year survival following cryosurgery for oral cancer. Author(s): Gage AA. Source: Archives of Surgery (Chicago, Ill. : 1960). 1976 September; 111(9): 990-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=949263

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Focal "nerve-sparing" cryosurgery for treatment of primary prostate cancer: a new approach to preserving potency. Author(s): Onik G, Narayan P, Vaughan D, Dineen M, Brunelle R. Source: Urology. 2002 July; 60(1): 109-14. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12100934

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For cluster headaches: cryosurgery. Author(s): Chadduck WM, Madonia EC. Source: Va Med. 1981 September; 108(9): 622-4. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7293391

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Fractional cryosurgery. A new technique for basal cell carcinoma of the eyelids and periorbital area. Author(s): Goncalves JC. Source: Dermatologic Surgery : Official Publication for American Society for Dermatologic Surgery [et Al.]. 1997 June; 23(6): 475-81. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9217800

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Freezing index in cryosurgery on the prostate gland. Author(s): Shiraiwa Y, Hirai T, Date T, Ichijo S. Source: The Tohoku Journal of Experimental Medicine. 1977 September; 123(1): 49-56. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=72438

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Further experience using cryosurgery in otolaryngology. Author(s): Hanckel RW. Source: Int Surg. 1969 October; 52(4): 287-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4310457

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Further experience with cryosurgery in treatment of intractable epistaxis. Author(s): Finney D, Kerr S. Source: The Medical Journal of Australia. 1974 May 11; 1(19): 763-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4843482

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Further experiences with cryosurgery in otolaryngology. Author(s): Hanckel RW. Source: The Laryngoscope. 1967 April; 77(4): 544-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4290328

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Future directions for cryosurgery computer treatment planning. Author(s): Sandison GA. Source: Urology. 2002 August; 60(2 Suppl 1): 50-5. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12206848

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Giant cell tumor of metacarpal treated by cryosurgery. Author(s): Meals RA, Mirra JM, Bernstein AJ. Source: The Journal of Hand Surgery. 1989 January; 14(1): 130-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2723361

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Giant cell tumor of the hand: superior results with curettage, cryosurgery, and cementation. Author(s): Wittig JC, Simpson BM, Bickels J, Kellar-Graney KL, Malawer MM. Source: The Journal of Hand Surgery. 2001 May; 26(3): 546-55. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11418922

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Giant cell tumors with intraarticular fracture. Two-stage local excision, cryosurgery and cementation in 5 patients with distal femoral tumor followed for 2-4 years. Author(s): Alkalay D, Kollender Y, Mozes M, Meller I. Source: Acta Orthopaedica Scandinavica. 1996 June; 67(3): 291-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8686472

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Giant-cell tumor of the second cervical vertebra treated by cryosurgery and irradiation. Author(s): Mirra JM, Rand F, Rand R, Calcaterra T, Dawson E. Source: Clinical Orthopaedics and Related Research. 1981 January-February; (154): 22833. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7471562

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Giant-cell tumors treated by cryosurgery. A report of twenty-five cases. Author(s): Marcove RC, Lyden JP, Huvos AG, Bullough PB. Source: The Journal of Bone and Joint Surgery. American Volume. 1973 December; 55(8): 1633-44. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4804985

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Glycogen content in regenerated epithelium following cryosurgery on oral leukoplakia. Author(s): Tal H. Source: J Oral Med. 1984 October-December; 39(4): 246-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6594466

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Good things still come in old packages: cryosurgery vs LEEP. Loop electrosurgical excision procedure. Author(s): Pfenninger JL. Source: The Journal of the American Board of Family Practice / American Board of Family Practice. 1999 September-October; 12(5): 416-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10534094

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Healing experiences after cervical cryosurgery. Author(s): Harper DM, Mayeaux EJ Jr, Daaleman TP, Johnson CA. Source: The Journal of Family Practice. 2000 August; 49(8): 701-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10947135

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Heat exchange in cryosurgery of Meniere's disease. Experimental and clinical studies. Author(s): Harly S, Aastrup JE, Elbrond O. Source: Acta Oto-Laryngologica. 1976 September-October; 82(3-4): 308-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=983696

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Hemobilia complicating hepatic cryosurgery. Author(s): Frank JL, Navab F, Ly K, Reed WP Jr. Source: Journal of Surgical Oncology. 1998 February; 67(2): 130-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9486786

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Hemorrhagic bullae after cryosurgery in a patient with hemophilia A. Author(s): Hancox JG, Graham GF, Yosipovitch G. Source: Dermatologic Surgery : Official Publication for American Society for Dermatologic Surgery [et Al.]. 2003 October; 29(10): 1084-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12974713

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Hepatic cryosurgery for liver metastases. Long-term follow-up. Author(s): Korpan NN. Source: Annals of Surgery. 1997 February; 225(2): 193-201. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9065296

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Hepatic cryosurgery for metastatic colorectal carcinoma. Author(s): Brandt BT, DeAntonio P, Dezort MA, Eyman LM. Source: Oncology Nursing Forum. 1996 January-February; 23(1): 29-36; Quiz 37-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8628709

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Hepatic cryosurgery for recurrent hepatocellular carcinoma after hepatectomy: a preliminary report. Author(s): Lam CM, Yuen WK, Fan ST. Source: Journal of Surgical Oncology. 1998 June; 68(2): 104-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9624039

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Hepatic cryosurgery in treating colorectal metastases. Author(s): Weaver ML, Atkinson D, Zemel R. Source: Cancer. 1995 July 15; 76(2): 210-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8625093

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Hepatic cryosurgery with and without the Bair Hugger. Author(s): Onik GM, Chambers N, Chernus SA, Zemel R, Atkinson D, Weaver ML. Source: Journal of Surgical Oncology. 1993 March; 52(3): 185-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8441278

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Hepatic cryosurgery with intraoperative US guidance. Author(s): Lee FT Jr, Mahvi DM, Chosy SG, Onik GM, Wong WS, Littrup PJ, Scanlan KA. Source: Radiology. 1997 March; 202(3): 624-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9051005

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Hepatic cryosurgery. Author(s): Ravikumar TS, Steele GD Jr. Source: The Surgical Clinics of North America. 1989 April; 69(2): 433-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2648623

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Hepatic cryosurgery: biological and clinical considerations. Author(s): Ross WB, Morris DL. Source: Journal of the Royal College of Surgeons of Edinburgh. 1993 August; 38(4): 266. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7693938

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Hepatic cryosurgery: biological and clinical considerations. Author(s): Bayjoo P, Jacob G. Source: Journal of the Royal College of Surgeons of Edinburgh. 1992 December; 37(6): 369-72. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1283409

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Hepatic cryosurgery: early experience in Hawaii. Author(s): Wong LL, Limm WM, Cheung AH, Fan FL, Wong LM. Source: Hawaii Med J. 1995 December; 54(12): 811-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8582815

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Hepatic tumors treated by cryosurgery: normal CT appearance. Author(s): Kuszyk BS, Choti MA, Urban BA, Chambers TP, Bluemke DA, Sitzmann JV, Fishman EK. Source: Ajr. American Journal of Roentgenology. 1996 February; 166(2): 363-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8553949

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High-res ultrasound guides cryosurgery. Author(s): Downey D. Source: Diagn Imaging (San Franc). 1996 December; 18(12): 73-4, 77-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10163652

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Histologic cure of basal cell carcinoma treated with cryosurgery. Author(s): Giuffrida TJ, Jimenez G, Nouri K. Source: Journal of the American Academy of Dermatology. 2003 September; 49(3): 483-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12963913

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Histopathology of cryosurgery for Meniere's disease. Author(s): Belal A Jr, House WF, Antunez JC. Source: The American Journal of Otology. 1980 January; 1(3): 147-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7457576

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History of cryosurgery. Author(s): Gage AA. Source: Seminars in Surgical Oncology. 1998 March; 14(2): 99-109. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9492880

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Hyperkeratotic varicella zoster virus infection in an HIV-infected patient. Successful treatment of persistent lesions with cryosurgery. Author(s): Schofer H, Baur SI, Gregel C, Wolter M, Milbradt R. Source: The British Journal of Dermatology. 1998 April; 138(4): 714-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9640393

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Ileovaginal fistula following cryosurgery for vaginal dysplasia. Author(s): Dini MM, Jafari K. Source: American Journal of Obstetrics and Gynecology. 1980 March 1; 136(5): 692-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7355950

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Image-guided prostate cryosurgery: state of the art. Author(s): Onik G. Source: Cancer Control : Journal of the Moffitt Cancer Center. 2001 NovemberDecember; 8(6): 522-31. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11807422

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In vivo interstitial temperature mapping of the human prostate during cryosurgery with correlation to histopathologic outcomes. Author(s): Larson TR, Rrobertson DW, Corica A, Bostwick DG. Source: Urology. 2000 April; 55(4): 547-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10736499

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Induced current impedance technique for monitoring brain cryosurgery in a twodimensional model of the head. Author(s): Zlochiver S, Radai MM, Rosenfeld M, Abboud S. Source: Annals of Biomedical Engineering. 2002; 30(9): 1172-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12502228

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Infectious complications of hepatic cryosurgery. Author(s): Riley DK, Babinchak TJ, Zemel R, Weaver ML, Rotheram EB. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 1997 May; 24(5): 1001-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9142812

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Inflammatory changes after cryosurgery-induced necrosis in human melanoma xenografted in nude mice. Author(s): Gazzaniga S, Bravo A, Goldszmid SR, Maschi F, Martinelli J, Mordoh J, Wainstok R. Source: The Journal of Investigative Dermatology. 2001 May; 116(5): 664-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11348453

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Initial experience of percutaneous renal cryosurgery under the guidance of a horizontal open MRI system. Author(s): Harada J, Dohi M, Mogami T, Fukuda K, Miki K, Furuta N, Kishimoto K, Simizu T, Miyasaka K. Source: Radiat Med. 2001 November-December; 19(6): 291-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11837579

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Intracranial cryosurgery in a canine model: a pilot study. Author(s): Stellar S. Source: Surgical Neurology. 1993 April; 39(4): 331-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8488455

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Intralesional cryosurgery using lumbar puncture and/or hypodermic needles for large, bulky, recalcitrant keloids. Author(s): Gupta S, Kumar B. Source: International Journal of Dermatology. 2001 May; 40(5): 349-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11555001

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Intralesional cryosurgery. A new technique using cryoneedles. Author(s): Weshahy AH. Source: J Dermatol Surg Oncol. 1993 February; 19(2): 123-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8429137

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Intraoperative monitoring and postoperative imaging of hepatic cryosurgery. Author(s): Brewer WH, Austin RS, Capps GW, Neifeld JP. Source: Seminars in Surgical Oncology. 1998 March; 14(2): 129-55. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9492884

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Intraoperative ultrasonography of liver: detection of occult liver tumors and treatment by cryosurgery. Author(s): Ravikumar TS, Buenaventura S, Salem RR, D'Andrea B. Source: Cancer Detection and Prevention. 1994; 18(2): 131-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8025895

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Investigation into the temperature field produced during endometrial cryosurgery of the perfused human uterus. Author(s): Waldron HA. Source: Physics in Medicine and Biology. 1980 March; 25(2): 323-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7384218

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Is cryosurgery appropriate treatment for hepatic malignancies? Author(s): Neifeld JP. Source: Journal of Surgical Oncology. 1999 February; 70(2): 69-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10084646

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Is it cost-effective to use a mucosal or paracervical block to relieve the pain and cramping from cryosurgery? A decision model. Author(s): Harper DM, Cobb JL. Source: The Journal of Family Practice. 1999 April; 48(4): 285-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10229253

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Is laser surgery superior to cryosurgery for the treatment of high grade CIN? Con. Author(s): Sokoll WC, Creasman WT. Source: J Gynecol Surg. 1991 Spring; 7(1): 57-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10149775

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Is laser surgery superior to cryosurgery for the treatment of high grade CIN? Pro. Author(s): Burke L. Source: J Gynecol Surg. 1991 Spring; 7(1): 53-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10149774

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IVth International Symposium on the Locoregional Treatment of Tumors. IV. Cryosurgery: Rapporteur's introduction. Author(s): Dogo G. Source: Panminerva Medica. 1975 November-December; 17(11-12): 357-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1228548

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Labyrinthine cryosurgery for Meniere's disease--present status. Author(s): Wolfson RJ. Source: Otolaryngology and Head and Neck Surgery. 1984 April; 92(2): 221-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6425778

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Laparoscopic cryosurgery for hepatic tumors. Experimental observations and a case report. Author(s): Tandan VR, Litwin D, Asch M, Margolis M, Gallinger S. Source: Surgical Endoscopy. 1997 November; 11(11): 1115-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9348387

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Laparoscopic renal cryosurgery: the Northwestern experience. Author(s): Nadler RB, Kim SC, Rubenstein JN, Yap RL, Campbell SC, User HM. Source: The Journal of Urology. 2003 October; 170(4 Pt 1): 1121-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14501705

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Late results following cryosurgery of the prostate in 107 high risk patients. Author(s): Nagel R, Marquardt H. Source: Prog Clin Biol Res. 1976; 6: 67-72. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=66696

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Late results following cryosurgery of the prostate in 111 high-risk patients. Author(s): Nagel R, Marquardt H. Source: European Urology. 1976; 2(2): 79-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=61116

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Late results following cryosurgery of the prostate in 97 high risk patients. Author(s): Nagel R, Marquardt H. Source: Minerva Med. 1974 October 6; 65(70): 3694-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4138075

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Laugier-Hunziker syndrome: treatment with cryosurgery. Author(s): Sheridan AT, Dawber RP. Source: Journal of the European Academy of Dermatology and Venereology : Jeadv. 1999 September; 13(2): 146-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10568501

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Letter: Cryosurgery for piles. Author(s): Schofield PF, Wilson M. Source: British Medical Journal. 1975 November 29; 4(5995): 520. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1192156

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Letter: Cryosurgery for prostatic carcinoma. Author(s): Ablin RJ, Gonder MJ, Soanes WA. Source: Urology. 1975 January; 5(1): 159-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=46647

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Lid splitting and posterior lamella cryosurgery for congenital and acquired distichiasis. Author(s): Anderson RL, Harvey JT. Source: Archives of Ophthalmology. 1981 April; 99(4): 631-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7224935

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Ligation and cryosurgery of all hemorrhoids. An office procedure. Author(s): Rudd WW. Source: Int Surg. 1989 July-September; 74(3): 148-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2606615

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Liquid nitrogen cryosurgery and immediate bone grafting in the management of aggressive primary jaw lesions. Author(s): Salmassy DA, Pogrel MA. Source: Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons. 1995 July; 53(7): 784-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7595793

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Liver cryosurgery with curative intent: can we realize the promise? Author(s): Saliken JC, McKinnon G, Gray RR, So CB, Rewcastle J. Source: Canadian Association of Radiologists Journal = Journal L'association Canadienne Des Radiologistes. 1999 October; 50(5): 295-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10555500

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Liver cryosurgery. Author(s): McMasters KM, Edwards MJ. Source: J Ky Med Assoc. 1996 June; 94(6): 222-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8800010

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Local anesthesia for cryosurgery on the cervix. Author(s): Sammarco MJ, Hartenbach EM, Hunter VJ. Source: J Reprod Med. 1993 March; 38(3): 170-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8487231

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Long term effects of cryosurgery on cutaneous sensation. Author(s): Sonnex TS, Jones RL, Weddell AG, Dawber RP. Source: British Medical Journal (Clinical Research Ed.). 1985 January 19; 290(6463): 18890. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3917746

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Long-term follow-up of cryosurgery of basal cell carcinoma of the eyelid. Author(s): Lindgren G, Larko O. Source: Journal of the American Academy of Dermatology. 1997 May; 36(5 Pt 1): 742-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9146537

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Long-term results of treating hepatic colorectal metastases with cryosurgery. Author(s): Ruers TJ, Joosten J, Jager GJ, Wobbes T. Source: The British Journal of Surgery. 2001 June; 88(6): 844-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11412256

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Long-term survival after hepatic cryosurgery versus surgical resection for metastatic colorectal carcinoma: a critical review of the literature. Author(s): Tandan VR, Harmantas A, Gallinger S. Source: Canadian Journal of Surgery. Journal Canadien De Chirurgie. 1997 June; 40(3): 175-81. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9194777

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Lymphocytoma cutis: a series of five patients successfully treated with cryosurgery. Author(s): Kuflik AS, Schwartz RA. Source: Journal of the American Academy of Dermatology. 1992 March; 26(3 Pt 2): 44952. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1564152

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Management of keratosis and carcinoma in situ with cryosurgery. Author(s): Miller D. Source: Can J Otolaryngol. 1974; 3(4): 557-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4429891

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Management of solid ameloblastoma of the jaws with liquid nitrogen spray cryosurgery. Author(s): Curi MM, Dib LL, Pinto DS. Source: Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics. 1997 October; 84(4): 339-44. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9347494

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Managing digital mucoid cysts by cryosurgery with liquid nitrogen: preliminary report. Author(s): Bardach HG. Source: J Dermatol Surg Oncol. 1983 June; 9(6): 455-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6853812

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Maxillary sinus angiofibroma treated with cryosurgery. Author(s): Maniglia AJ, Mazzarella LA, Minkowitz S, Moskowitz H. Source: Arch Otolaryngol. 1969 March; 89(3): 527-32. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4303494

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Measurement of intratissue bioelectrical low frequency impedance: a new method to predict per-operatively the destructive effect of cryosurgery. Author(s): Le Pivert PJ, Binder P, Ougier T. Source: Cryobiology. 1977 April; 14(2): 245-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=862420

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Mechanism of retinal attachment after cryosurgery. Author(s): Kreissig I, Lincoff H. Source: Trans Ophthalmol Soc U K. 1975 April; 95(1): 148-57. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1064196

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Mechanisms of tissue destruction following cryosurgery. Author(s): Whittaker DK. Source: Annals of the Royal College of Surgeons of England. 1984 September; 66(5): 3138. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6435496

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Mechanisms of tissue injury in cryosurgery. Author(s): Gage AA, Baust J. Source: Cryobiology. 1998 November; 37(3): 171-86. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9787063

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Medical considerations in pituitary cryosurgery. Author(s): Dashe AM. Source: Int Surg. 1968 February; 49(2): 110-6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4866188

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Milia en plaque: treatment with open spray cryosurgery. Author(s): Noto G, Dawber R. Source: Acta Dermato-Venereologica. 2001 October-November; 81(5): 370-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11800150

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Millenium paper: history of dermatologic cryosurgery. Author(s): Kuflik EG, Gage AA, Lubritz RR, Graham GF. Source: Dermatologic Surgery : Official Publication for American Society for Dermatologic Surgery [et Al.]. 2000 August; 26(8): 715-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10940055

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Minilaparotomy vs the percutaneous approach for minimally invasive hepatic cryosurgery. Author(s): Pistorius G, Menger MD, Feifel G. Source: Surgical Endoscopy. 2000 February; 14(2): 207-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10656966

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Minimally invasive cryosurgery--technological advances. Author(s): Baust J, Gage AA, Ma H, Zhang CM. Source: Cryobiology. 1997 June; 34(4): 373-84. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9200822

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Misconceptions about cryosurgery in warts of the nail unit. Author(s): Kuflik EG. Source: Dermatologic Surgery : Official Publication for American Society for Dermatologic Surgery [et Al.]. 2002 March; 28(3): 301. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11928698

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Molluscum contagiosum and cryosurgery: triggering factors for Wells' syndrome? Author(s): Stavropoulos PG, Kostakis PG, Panagiotopoulos AK, Papakonstantinou AM, Petridis AP, Georgala S. Source: Acta Dermato-Venereologica. 2003; 83(5): 380-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14609112

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Monitoring during cryosurgery of bone tumors. Author(s): Schreuder HW, van Egmond J, van Beem HB, Veth RP. Source: Journal of Surgical Oncology. 1997 May; 65(1): 40-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9179266

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MR image-guided control of cryosurgery. Author(s): Pease GR, Wong ST, Roos MS, Rubinsky B. Source: Journal of Magnetic Resonance Imaging : Jmri. 1995 November-December; 5(6): 753-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8748498

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MR imaging assisted temperature calculations during cryosurgery. Author(s): Hong JS, Wong S, Pease G, Rubinsky B. Source: Magnetic Resonance Imaging. 1994; 12(7): 1021-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7997089

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Mucometra: a rare complication of cryosurgery. Author(s): Guijon FB. Source: American Journal of Obstetrics and Gynecology. 1988 July; 159(1): 26. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3394744

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Myxoid cysts of the finger: treatment by liquid nitrogen spray cryosurgery. Author(s): Dawber RP, Sonnex T, Leonard J, Ralfs I. Source: Clinical and Experimental Dermatology. 1983 March; 8(2): 153-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6851237

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Nasal cryosurgery and cautery: should the septum be treated and is a diagnosis relevant? Author(s): Haight JS, Gardiner GW. Source: The Journal of Otolaryngology. 1989 June; 18(4): 144-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2738997

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Neurological complications of cryosurgery. Author(s): Millns JL, Fenske NA, Pierce D. Source: J Dermatol Surg Oncol. 1980 March; 6(3): 207-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6245118

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Neuropathy after cryosurgery. Author(s): Zacarian SA. Source: Journal of the American Academy of Dermatology. 1983 March; 8(3): 422. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6833545

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New instruments and technique for cataract cryosurgery. Author(s): Worst JG. Source: American Journal of Ophthalmology. 1968 April; 65(4): 587-97. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5642915

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New iris retractor for use in cryosurgery. Author(s): Maclure GM. Source: The British Journal of Ophthalmology. 1967 June; 51(6): 426-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6026602

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New strategies for the placement of cryoprobes in malignant tumors of the liver for reducing the probability of recurrences after hepatic cryosurgery. Author(s): Berger WK, Poledna J. Source: International Journal of Colorectal Disease. 2001 September; 16(5): 331-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11686533

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Nitrogen embolus as a complication of hepatic cryosurgery. Author(s): Schlinkert RT, Chapman TP. Source: Archives of Surgery (Chicago, Ill. : 1960). 1990 September; 125(9): 1214. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2400313

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Nitrous oxide contamination during out-patient cryosurgery. Author(s): Shepherd JP, Jones DC. Source: International Journal of Oral and Maxillofacial Surgery. 1988 February; 17(1): 45. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3127489

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Nitrous oxide cryosurgery applied to skin cancers. Author(s): Boullie MC. Source: Dermatologic Surgery : Official Publication for American Society for Dermatologic Surgery [et Al.]. 1997 August; 23(8): 714-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9256923

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Nitrous oxide levels during retinal cryosurgery. Author(s): Marcus DF, Gawecki S. Source: Archives of Ophthalmology. 1981 March; 99(3): 457-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7213165

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Non-invasive monitoring of the mechanical properties of keloids during cryosurgery. Author(s): Dobrev H. Source: Acta Dermato-Venereologica. 1999 November; 79(6): 487-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10598775

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Notes on the development of cryosurgery in ophthalmology. Author(s): Bietti GB. Source: Trans Ophthalmol Soc U K. 1969; 88: 79-97. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4917753

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Numerical solution of the multidimensional freezing problem during cryosurgery. Author(s): Rabin Y, Shitzer A. Source: Journal of Biomechanical Engineering. 1998 February; 120(1): 32-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9675678

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Obstetrical experience following cervical cryosurgery. Author(s): Laubstein MB, Petrie SJ. Source: Minerva Med. 1974 October 6; 65(70): 3672-3. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4420382

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Office diagnosis and management of cervical dysplasia (colposcopy and cryosurgery in 32 patients). Author(s): Crapanzano JT. Source: J La State Med Soc. 1978 May; 130(5): 101-4. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=659955

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On measuring depth of freezing in cryosurgery. Author(s): Zacarian SA. Source: J Dermatol Surg Oncol. 1978 April; 4(4): 276-7. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=632391

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Ophthalmic cryosurgery. Author(s): Rubinstein K. Source: Nurs Times. 1967 December 8; 63(49): 1640-2. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6074094

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Ophthalmo-cryosurgery. An international panel reports. Author(s): Craig PC. Source: Int Surg. 1968 June; 49(6): 509-12. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5657246

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Orf nodule: treatment with cryosurgery. Author(s): Ocampo Candiani J, Gonzalez Soto R, Welsh Lozano O. Source: Journal of the American Academy of Dermatology. 1993 August; 29(2 Pt 1): 2567. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8335746

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Outcome of cryosurgery for cervical intraepithelial neoplasia in a developing country. Author(s): Olatunbosun OA, Okonofua FE, Ayangade SO. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 1992 August; 38(4): 305-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1358689

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Outcomes of cryosurgery in keloids and hypertrophic scars. A prospective consecutive trial of case series. Author(s): Zouboulis CC, Blume U, Buttner P, Orfanos CE. Source: Archives of Dermatology. 1993 September; 129(9): 1146-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8363398

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Outpatient cervical cryosurgery. Author(s): Peck JE. Source: Nurs Times. 1975 February 20; 71(8): 314-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1121458

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Out-patient cervical cryosurgery. Author(s): Young C, Malvern J, Chamberlain G. Source: J Obstet Gynaecol Br Commonw. 1972 August; 79(8): 753-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5070891

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Palliative cryosurgery for rectal carcinoma. Author(s): Meijer S, Rahusen FD, van der Plas LG. Source: International Journal of Colorectal Disease. 1999 August; 14(3): 177-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10460910

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Panniculitis due to alpha 1-antitrypsin deficiency induced by cryosurgery. Author(s): Linares-Barrios M, Conejo-Mir IS, Artola Igarza JL, Navarrete M. Source: The British Journal of Dermatology. 1998 March; 138(3): 552-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9580825

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Paracervical block diminishes cramping associated with cryosurgery. Author(s): Harper DM. Source: The Journal of Family Practice. 1997 January; 44(1): 71-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9010373

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Percutaneous cryosurgery for renal tumours. Author(s): Uchida M, Imaide Y, Sugimoto K, Uehara H, Watanabe H. Source: British Journal of Urology. 1995 February; 75(2): 132-6; Discussion 136-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7850315

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Percutaneous, transperineal cryosurgery of the prostate as salvage therapy for post radiation recurrence of adenocarcinoma. Author(s): Miller RJ Jr, Cohen JK, Shuman B, Merlotti LA. Source: Cancer. 1996 April 15; 77(8): 1510-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8608536

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Perineal cryosurgery of prostate cancer. Author(s): Loening S, Hawtrey C, Bonney W, Lubaroff D, Fallon B, Narayana A, Gerber W, Culp D. Source: Urology. 1981 April; 17(4 Suppl): 12-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7210391

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Perinodal cryosurgery for atrioventricular node reentry tachycardia in 23 patients. Author(s): Cox JL, Ferguson TB Jr, Lindsay BD, Cain ME. Source: The Journal of Thoracic and Cardiovascular Surgery. 1990 March; 99(3): 440-9; Discussion 449-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2308362

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Peripheral tissue freezing in cryosurgery. Author(s): Song WJ, Jiji LM. Source: Cryobiology. 1988 April; 25(2): 153-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3371060

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Personality factors as predictors of therapeutic response to cryosurgery in patients with warts. Author(s): Kalivas L, Penick E, Kalivas J. Source: Journal of the American Academy of Dermatology. 1989 March; 20(3): 429-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2918114

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Photodynamic therapy vs. cryosurgery of basal cell carcinomas: results of a phase III clinical trial. Author(s): Wang I, Bendsoe N, Klinteberg CA, Enejder AM, Andersson-Engels S, Svanberg S, Svanberg K. Source: The British Journal of Dermatology. 2001 April; 144(4): 832-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11298545

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Place of cryosurgery in the treatment of malignant liver tumors. Author(s): Adam R, Akpinar E, Johann M, Kunstlinger F, Majno P, Bismuth H. Source: Annals of Surgery. 1997 January; 225(1): 39-8; Discussion 48-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8998119

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Postoperative tetanus following cryosurgery for haemorrhoids. Author(s): Singh K, Chhina RS, Kaul TK. Source: Trop Doct. 1992 July; 22(3): 135-6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1641899

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Practical cryosurgery. Author(s): Young R, Sinclair R. Source: Aust Fam Physician. 1997 September; 26(9): 1045-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9382718

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Principles of cutaneous cryosurgery: an update. Author(s): Zouboulis CC. Source: Dermatology (Basel, Switzerland). 1999; 198(2): 111-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10325454

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Progress in cryosurgery. Author(s): Gage AA. Source: Cryobiology. 1992 April; 29(2): 300-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1582235

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Prospects for cryosurgery. Author(s): Breitbart EW, Dachow-Siwiec E. Source: Clinics in Dermatology. 1990 January-March; 8(1): 115-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2393840

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Prostate cancer: metabolic response to cryosurgery as detected with 3D H-1 MR spectroscopic imaging. Author(s): Kurhanewicz J, Vigneron DB, Hricak H, Parivar F, Nelson SJ, Shinohara K, Carroll PR. Source: Radiology. 1996 August; 200(2): 489-96. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8685346

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Prostate carcinoma: MR imaging findings after cryosurgery. Author(s): Kalbhen CL, Hricak H, Shinohara K, Chen M, Parivar F, Kurhanewicz J, Vigneron DB, Carroll PR. Source: Radiology. 1996 March; 198(3): 807-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8628875

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Prostatic cryosurgery: use of MR imaging in evaluation of success and technical modifications. Author(s): Vellet AD, Saliken J, Donnelly B, Raber E, McLaughlin RF, Wiseman D, AliRidha NH. Source: Radiology. 1997 June; 203(3): 653-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9169684

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Pyogenic granuloma as a complication of cryosurgery for venous lake. Author(s): Cecchi R, Giomi A. Source: The British Journal of Dermatology. 1999 February; 140(2): 373-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10233249

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Q-tip cryosurgery for the treatment of senile sebaceous hyperplasia. Author(s): Wheeland RG, Wiley MD. Source: J Dermatol Surg Oncol. 1987 July; 13(7): 729-30. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3597970

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Quality of life and sexuality of men with prostate cancer 3 years after cryosurgery. Author(s): Robinson JW, Donnelly BJ, Saliken JC, Weber BA, Ernst S, Rewcastle JC. Source: Urology. 2002 August; 60(2 Suppl 1): 12-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12206843

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Quality-of-life outcomes for men treated with cryosurgery for localized prostate carcinoma. Author(s): Robinson JW, Saliken JC, Donnelly BJ, Barnes P, Guyn L. Source: Cancer. 1999 November 1; 86(9): 1793-801. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10547553

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Rational use of cryosurgery and cold knife conization for treatment of cervical intraepithelial neoplasia. Author(s): Loizzi P, Carriero C, Di Gesu A, Resta L, Nappi R. Source: Eur J Gynaecol Oncol. 1992; 13(6): 507-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1473532

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Re: Evidence-based review of the use of cryosurgery in treatment of basal cell carcinoma. Author(s): Kuflik EG. Source: Dermatologic Surgery : Official Publication for American Society for Dermatologic Surgery [et Al.]. 2004 March; 30(3): 478. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15008890

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Reactive lentiginous hyperpigmentation after cryosurgery for lentigo maligna. Author(s): Bohler-Sommeregger K, Schuller-Petrovic S, Knobler R, Neumann PR. Source: Journal of the American Academy of Dermatology. 1992 October; 27(4): 523-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1401302

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Rectal protection during prostate cryosurgery: design and characterization of an insulating probe. Author(s): Bischof JC, Merry N, Hulbert J. Source: Cryobiology. 1997 February; 34(1): 80-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9028918

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Recurrent aneurysmal bone cyst of the proximal phalanx treated with cryosurgery: a case report. Author(s): Athanasian EA, McCormack RR. Source: The Journal of Hand Surgery. 1999 March; 24(2): 405-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10194029

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Recurrent basal cell carcinoma treated with cryosurgery. Author(s): Garcia C, Poletti E. Source: Journal of the American Academy of Dermatology. 1998 July; 39(1): 134. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9674412

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Recurrent basal cell carcinoma treated with cryosurgery. Author(s): Kuflik EG, Gage AA. Source: Journal of the American Academy of Dermatology. 1997 July; 37(1): 82-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9216527

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Rehabilitation of patients with bone tumors treated by various methods including cryosurgery. Author(s): Russe W, Siorpaes R. Source: Bol Asoc Med P R. 1983 February; 75(2): 66-72. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6575786

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Renal ablative cryosurgery in selected patients with peripheral renal masses. Author(s): Rodriguez R, Chan DY, Bishoff JT, Chen RB, Kavoussi LR, Choti MA, Marshall FF. Source: Urology. 2000 January; 55(1): 25-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10654889

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Renal cryosurgery. Author(s): Gill IS, Novick AC. Source: Urology. 1999 August; 54(2): 215-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10443713

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Renal cryosurgery. Author(s): Cozzi P. Source: Urology. 1999 March; 53(3): 660. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10096408

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Reparative process of benign erosion of the uterine cervix following cryosurgery. Author(s): Kashimura M. Source: Gynecologic Oncology. 1980 June; 9(3): 334-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7380348

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Residents' corner: cryosurgery of clear cell acanthoma. Author(s): Fernandez-Obregon AC. Source: J Dermatol Surg Oncol. 1986 July; 12(7): 689-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3722579

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Response of leiomyosarcoma to cryosurgery: clinicopathological and ultrastructural study. Author(s): Montes LF, Ocampo J, Garcia NJ, Vaccaro F, Arra A, Abulafia J, Wilborn WH, Lembrande RG. Source: Clinical and Experimental Dermatology. 1995 January; 20(1): 22-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7671391

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Response to the article 'An organic refrigerant for cryosurgery: fact or fiction?'. Author(s): DerKinderen DJ. Source: The Australasian Journal of Dermatology. 1998 February; 39(1): 59. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9529695

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Rhinophyma-treatment by liquid nitrogen spray cryosurgery. Author(s): Sonnex TS, Dawber RP. Source: Clinical and Experimental Dermatology. 1986 May; 11(3): 284-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2943539

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Role of adjuvant cryosurgery in intralesional treatment of sacral tumors. Author(s): Kollender Y, Meller I, Bickels J, Flusser G, Issakov J, Merimsky O, Marouani N, Nirkin A, Weinbroum AA. Source: Cancer. 2003 June 1; 97(11): 2830-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12767097

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Role of cryosurgery and MRI for Parkinson's disease. Author(s): Rand RW. Source: Stereotactic and Functional Neurosurgery. 1995; 65(1-4): 18-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8916324

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Role of cryosurgery in the treatment of intraepithelial neoplasia of the uterine cervix. Author(s): Javaheri G, Balin M, Meltzer RM. Source: Obstetrics and Gynecology. 1981 July; 58(1): 83-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7243149

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Safe placement of large cryoprobes during cryosurgery of deep liver metastases. Author(s): Rivoire ML, Kaemmerien P, Molina G. Source: Journal of Surgical Oncology. 1996 September; 63(1): 61-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8841469

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Salvage cryosurgery for recurrent prostate cancer after radiation therapy: a seven-year follow-up. Author(s): Bahn DK, Lee F, Silverman P, Bahn E, Badalament R, Kumar A, Greski J, Rewcastle JC. Source: Clin Prostate Cancer. 2003 September; 2(2): 111-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15040872

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Salvage external beam radiotherapy for clinical failure after cryosurgery for prostate cancer. Author(s): McDonough MJ, Feldmeier JJ, Parsai I, Dobelbower RR Jr, Selman SH. Source: International Journal of Radiation Oncology, Biology, Physics. 2001 November 1; 51(3): 624-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11597801

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Sensory loss following cryosurgery of skin lesions. Author(s): Faber WR, Naafs B, Smitt JH. Source: The British Journal of Dermatology. 1987 September; 117(3): 343-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3676082

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Separation of a foreign body following cryosurgery. Report of a case. Author(s): Shepherd JP. Source: Oral Surg Oral Med Oral Pathol. 1980 April; 49(4): 301-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6928574

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Serum protein, enzyme and immunoglobulin responses following perineal cryosurgery for carcinoma of the prostate. Author(s): Milleman LA, Weissman WD, Culp DA. Source: The Journal of Urology. 1980 May; 123(5): 710-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7420561

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Serum proteins in prostatic cancer VI. Reduction of the suppressive ("blocking"?) properties of serum on in vitro parameters of cell-mediated immunologic responsiveness following cryosurgery. Author(s): Ablin RJ. Source: Urologia Internationalis. 1977; 32(1): 65-73. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=70099

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Serum response of hepatocyte growth factor, insulin-like growth factor-I, interleukin6, and acute phase proteins in patients with colorectal liver metastases treated with partial hepatectomy or cryosurgery. Author(s): de Jong KP, von Geusau BA, Rottier CA, Bijzet J, Limburg PC, de Vries EG, Fidler V, Slooff MJ. Source: Journal of Hepatology. 2001 March; 34(3): 422-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11322204

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Should cryosurgery be considered a therapeutic option in localized prostate cancer? Author(s): Connolly JA, Shinohara K, Presti JC Jr, Carroll PR. Source: The Urologic Clinics of North America. 1996 November; 23(4): 623-31. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8948416

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Simultaneous optimization of cryoprobe placement and thermal protocol for cryosurgery. Author(s): Baissalov R, Sandison GA, Reynolds D, Muldrew K. Source: Physics in Medicine and Biology. 2001 July; 46(7): 1799-814. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11474926

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Skin cryosurgery for the family physician. Author(s): Hocutt JE Jr. Source: American Family Physician. 1993 September 1; 48(3): 445-52, 455-6. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8155114

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Specific immunological stimulation induced by cryosurgery in patients with squamous-cell carcinoma of the oral cavity. Author(s): Fazio M, Airoldi M, Negri L, Marchesa P, Gandolfo S. Source: J Maxillofac Surg. 1984 August; 12(4): 153-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6590713

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Specific indications for cryosurgery of the nail unit. Myxoid cysts and periungual verrucae. Author(s): Kuflik EG. Source: J Dermatol Surg Oncol. 1992 August; 18(8): 702-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1644942

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Statistical analysis in cryosurgery of skin cancer. Author(s): Graham GF, Clark LC. Source: Clinics in Dermatology. 1990 January-March; 8(1): 101-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2393839

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Successful treatment of solar lentigines by brief gentle cryosurgery using a Kryomed device. Author(s): Almond-Roesler B, Zouboulis CC. Source: The British Journal of Dermatology. 2000 July; 143(1): 216-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10886179

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Superiority of Nd:YAG laser to cryosurgery in the treatment of rectal carcinoma. Author(s): Zaman A, Vassilev S, Mateev M, Mazgalov L, Filev F. Source: Journal of Clinical Laser Medicine & Surgery. 1994 April; 12(2): 79-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10147183

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Surgery for atrioventricular node reentry tachycardia. Results with surgical skeletonization of the atrioventricular node and discrete perinodal cryosurgery. Author(s): Mahomed Y, King RD, Zipes D, Miles WM, Klein LS, Brown JW. Source: The Journal of Thoracic and Cardiovascular Surgery. 1992 October; 104(4): 103544. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1405661

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Surgical correction of the Wolff-Parkinson-White syndrome in the closed heart using cryosurgery: a simplified approach. Author(s): Klein GJ, Guiraudon GM, Perkins DG, Jones DL, Yee R, Jarvis E. Source: Journal of the American College of Cardiology. 1984 February; 3(2 Pt 1): 405-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6693628

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Surgical management of colorectal metastases to the liver: role of resection and cryosurgery. Author(s): Redlich PN, Baker EJ, McAuliffe TL, Quebbeman EJ. Source: Wis Med J. 1996 December; 95(12): 859-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8993224

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The evolution and state of modern technology for prostate cryosurgery. Author(s): Saliken JC, Donnelly BJ, Rewcastle JC. Source: Urology. 2002 August; 60(2 Suppl 1): 26-33. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12206845

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The extent of cryosurgery increases the complication rate after hepatic cryoablation. Author(s): Sohn RL, Carlin AM, Steffes C, Tyburski JG, Wilson RF, Littrup PJ, Weaver DW. Source: The American Surgeon. 2003 April; 69(4): 317-22; Discussion 322-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12716090

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The Health Care Financing Administration cryosurgery decision: a timely response to new data. Author(s): Whyte JJ, Bagley GP, Kang JL. Source: The Journal of Urology. 1999 October; 162(4): 1386-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10492209

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The history of cryosurgery. Author(s): Cooper SM, Dawber RP. Source: Journal of the Royal Society of Medicine. 2001 April; 94(4): 196-201. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11317629

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The role and biology of cryosurgery in the treatment of bone tumors. A review. Author(s): Bickels J, Meller I, Shmookler BM, Malawer MM. Source: Acta Orthopaedica Scandinavica. 1999 June; 70(3): 308-15. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10429612

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The role of cryosurgery in palliation of tracheo-bronchial carcinoma. Author(s): Maiwand MO. Source: European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery. 1999 June; 15(6): 764-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10431856

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The thermal activity of normal and malignant tissues. Microcalorimetric response of liver cancer to hepatic artery ligation, cryosurgery, adriamycin and norcantharidin. Author(s): Mack P, Cheng LY. Source: Hpb Surg. 1998; 11(2): 75-86. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9893237

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The thermal effect of urethral warming during cryosurgery. Author(s): Rabin Y, Stahovich TF. Source: Cryo Letters. 2002 November-December; 23(6): 361-74. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12522506

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Third-generation cryosurgery for primary and recurrent prostate cancer. Author(s): Han KR, Belldegrun AS. Source: Bju International. 2004 January; 93(1): 14-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14678360

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Total cryosurgery of the prostate versus standard cryosurgery versus radical prostatectomy: comparison of early results and the role of transurethral resection in cryosurgery. Author(s): Gould RS. Source: The Journal of Urology. 1999 November; 162(5): 1653-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10524891

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Traumatic neuroma in the lower lip arising following laser/cryosurgery to treat a mucocele. Author(s): Zhang M, Hayashi H, Fukuyama H, Nakamura T, Kurokawa H, Takahashi T. Source: Oral Diseases. 2003 May; 9(3): 160-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12945599

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Treatment of capillary hemangiomas of early childhood with a new method of cryosurgery. Author(s): Reischle S, Schuller-Petrovic S. Source: Journal of the American Academy of Dermatology. 2000 May; 42(5 Pt 1): 809-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10775859

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Treatment of chromomycosis by cryosurgery with liquid nitrogen: 15 years' experience. Author(s): Castro LG, Pimentel ER, Lacaz CS. Source: International Journal of Dermatology. 2003 May; 42(5): 408-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12755986

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Treatment of organ confined prostate cancer with third generation cryosurgery: preliminary multicenter experience. Author(s): Han KR, Cohen JK, Miller RJ, Pantuck AJ, Freitas DG, Cuevas CA, Kim HL, Lugg J, Childs SJ, Shuman B, Jayson MA, Shore ND, Moore Y, Zisman A, Lee JY, Ugarte R, Mynderse LA, Wilson TM, Sweat SD, Zincke H, Belldegrun AS. Source: The Journal of Urology. 2003 October; 170(4 Pt 1): 1126-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14501706

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Treatment of solar lentigo with cryosurgery. Author(s): Zouboulis CC, Rosenberger AD, Adler Y, Orfanos CE. Source: Acta Dermato-Venereologica. 1999 November; 79(6): 489-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10598776

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Treatment of verrucous hyperplasia and verrucous carcinoma by shave excision and simple cryosurgery. Author(s): Yeh CJ. Source: International Journal of Oral and Maxillofacial Surgery. 2003 June; 32(3): 280-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12767875

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Two freezing cycles ensure interface sterilization by cryosurgery during bone tumor resection. Author(s): Robinson D, Halperin N, Nevo Z. Source: Cryobiology. 2001 August; 43(1): 4-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11812046

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Ultrasound in cryosurgery. Author(s): Kimmig W, Hicks R, Breitbart EW. Source: Clinics in Dermatology. 1990 January-March; 8(1): 65-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2203513

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Ultrasound-guided hepatic cryosurgery in the treatment of metastatic colon carcinoma. Preliminary results. Author(s): Onik G, Rubinsky B, Zemel R, Weaver L, Diamond D, Cobb C, Porterfield B. Source: Cancer. 1991 February 15; 67(4): 901-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1991262

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Ultrasound-guided thermocouple placement for cryosurgery. Author(s): Abramovits W, Pruiksma R, Bose S. Source: Dermatologic Surgery : Official Publication for American Society for Dermatologic Surgery [et Al.]. 1996 September; 22(9): 771-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8874524

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Ultrastructural changes in normal human ectocervical epithelium immediately following cryosurgery. Author(s): Norum ML, Moyer DL, Townsend DL, Hirose FM. Source: Laboratory Investigation; a Journal of Technical Methods and Pathology. 1969 July; 21(1): 11-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5794290

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Unanticipated posterior freezing. A hazard in retinal cryosurgery. Author(s): Banks WS 3rd, Havener WH. Source: Trans Am Acad Ophthalmol Otolaryngol. 1970 January-February; 74(1): 80-4. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5436624

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Unusual skin depigmentation following eyelid cryosurgery. Author(s): Zabriskie NA, Nordlund JJ, Nerad JA. Source: Ophthalmic Plastic and Reconstructive Surgery. 1996 December; 12(4): 296-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8944392

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Use of a combination of an anti-inflammatory corticosteroid, an antibacterial agent and an antifungal in the local post-operative treatment of cutaneo-mucosal diseases following cryosurgery. Author(s): Gini M. Source: Int J Clin Pharmacol Ther Toxicol. 1985 July; 23(7): 373-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4030167

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Use of thermocouples in cryosurgery. Author(s): Price E, Biro L. Source: J Dermatol Surg Oncol. 1983 March; 9(3): 215-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6826875

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Uses of dextranomer absorbent pads after cryosurgery of cutaneous malignancies. Author(s): Hersle K, Mobacken H. Source: J Dermatol Surg Oncol. 1982 January; 8(1): 35-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6173405

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Uterine abscess formation secondary to endometrial cryosurgery. Author(s): Burke L, Rubin HW, Kim I. Source: Obstetrics and Gynecology. 1973 February; 41(2): 224-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4684206

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Vanderbilt experience with cryosurgery for 25 advanced hepatic tumors. Author(s): Haddad FF, Wright JK, Blair TK, Chapman WC, Pinson CW. Source: Tenn Med. 1998 September; 91(9): 357-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9737181

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Venous gas embolism during cryosurgery for bone tumors. Author(s): Schreuder HW, van Beem HB, Veth RP. Source: Journal of Surgical Oncology. 1995 November; 60(3): 196-200. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7475071

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Venous lakes treated by liquid nitrogen cryosurgery. Author(s): Suhonen R, Kuflik EG. Source: The British Journal of Dermatology. 1997 December; 137(6): 1018-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9470931

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Verrucous carcinoma of the penis treated with cryosurgery. Author(s): Michelman FA, Filho AC, Moraes AM. Source: The Journal of Urology. 2002 September; 168(3): 1096-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12187233

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Verrucous carcinoma of the penis. Successful treatment with cryosurgery and topical fluorouracil therapy. Author(s): Carson TE. Source: Archives of Dermatology. 1978 October; 114(10): 1546-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=718199

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Von Hippel-Lindau disease: the recognition and treatment of early angiomatosis retinae and the use of cryosurgery as an adjunct to therapy. Author(s): Welch RB. Source: Trans Am Ophthalmol Soc. 1970; 68: 367-424. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5535648

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X-ray CT high-density artefact suppression in cryosurgery. Author(s): Wei J, Sandison GA, Chen L, Liang Y, Xu LX. Source: Physics in Medicine and Biology. 2002 December 21; 47(24): N319-26. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12539984

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X-ray CT monitoring of iceball growth and thermal distribution during cryosurgery. Author(s): Sandison GA, Loye MP, Rewcastle JC, Hahn LJ, Saliken JC, McKinnon JG, Donnelly BJ. Source: Physics in Medicine and Biology. 1998 November; 43(11): 3309-24. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9832018

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

Finding Nutrition Studies on Cryosurgery 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.4 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 “cryosurgery” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

4

Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

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

Systemic irinotecan or regional floxuridine chemotherapy prolongs survival after hepatic cryosurgery in patients with metastatic colon cancer refractory to 5fluorouracil. Author(s): John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, CA, USA. [email protected] Source: Bilchik, A J Wood, T F Chawla, S P Rose, D M Chung, M H Stern, S S Foshag, L J Ramming, K P Clin-Colorectal-Cancer. 2001 May; 1(1): 36-42 1533-0028

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

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

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Google: http://directory.google.com/Top/Health/Nutrition/

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Healthnotes: http://www.healthnotes.com/

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

Nutrition

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

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

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

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

“No-touch” cryosurgical enucleation: a minimal trauma technique for eyes harboring intraocular malignancy. Author(s): Wilson RS, Fraunfelder FT. Source: Ophthalmology. 1978 November; 85(11): 1170-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=733167

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Cryosurgery and needle ablation of renal lesions. Author(s): Johnson DB, Nakada SY. Source: Journal of Endourology / Endourological Society. 2001 May; 15(4): 361-8; Discussion 375-6. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11394447

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Cryosurgery and podophyllum in combination for condylomata. Author(s): McDow RA.

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Source: American Family Physician. 1996 May 1; 53(6): 1987-8, 1993. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8623710 •

Cryosurgery of genital warts in cases in which podophyllin treatment failed or was contraindicated. Author(s): Ghosh AK. Source: Br J Vener Dis. 1977 February; 53(1): 49-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=843897

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Cryosurgery of the prostate in a hyperbaric chamber. Author(s): Soanes WA, Gonder MJ. Source: The Journal of Urology. 1969 September; 102(3): 338-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4185528

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Cryosurgery versus dilation and massage for the treatment of recurrent urethral syndrome. Author(s): Sand PK, Bowen LW, Ostergard DR, Bent A, Panganiban R. Source: J Reprod Med. 1989 August; 34(8): 499-504. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2810238

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Improved image contrast with mangafodipir trisodium (MnDPDP) during MRguided percutaneous cryosurgery of the liver. Author(s): Traore AS, Godbout MJ, Serre D, Younan R, Dionne G, Dufour M, Morin J, Moisan C. Source: Magnetic Resonance Imaging. 2003 July; 21(6): 609-15. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12915191

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Intraarterial chemotherapy adjuvant to cryosurgery of oral cancer. Author(s): Meyza JW. Source: Panminerva Medica. 1975 November-December; 17(11-12): 369-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1084509

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Results in labyrinthine cryosurgery monitored by evoked response. Author(s): Tabor JR, Best L, Donohoe RW. Source: The Laryngoscope. 1972 August; 82(8): 1431-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5053983

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Systemic irinotecan or regional floxuridine chemotherapy prolongs survival after hepatic cryosurgery in patients with metastatic colon cancer refractory to 5fluorouracil. Author(s): Bilchik AJ, Wood TF, Chawla SP, Rose DM, Chung MH, Stern SS, Foshag LJ, Ramming KP.

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Source: Clinical Colorectal Cancer. 2001 May; 1(1): 36-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12445377 •

Ten years experience on prostate cryosurgery. Author(s): Rouvalis P. Source: Minerva Med. 1974 October 6; 65(70): 3701-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4138922

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The management of intralenticular foreign bodies with special reference to cryosurgery. Author(s): Haik GM, Coles WH, Pollard JB, Haik HM. Source: Trans Am Acad Ophthalmol Otolaryngol. 1970 July-August; 74(4): 804-10. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5432992

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

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

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

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

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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

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Google: http://directory.google.com/Top/Health/Alternative/

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Healthnotes: http://www.healthnotes.com/

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

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

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

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

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

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

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The following is a specific Web list relating to cryosurgery; 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 Warts Source: Integrative Medicine Communications; www.drkoop.com

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

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CHAPTER 4. PATENTS ON CRYOSURGERY 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.5 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 “cryosurgery” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on cryosurgery, we have not necessarily excluded nonmedical patents in this bibliography.

Patents on Cryosurgery By performing a patent search focusing on cryosurgery, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an 5Adapted

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

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example of the type of information that you can expect to obtain from a patent search on cryosurgery: •

Apparatus and method for computer controlled cryosurgery Inventor(s): Barken; Israel (6823 Deer Hollow Pl., San Diego, CA 92120) Assignee(s): none reported Patent Number: 5,531,742 Date filed: January 15, 1992 Abstract: A surgical system and method for destroying unwanted internal structures including a cryosurgery probe or probes, an ultrasonic or MRI robe and a computer system is described. The ultrasonic or MRI probe provides data signals that are processed by the computer system to provide an image of the structures involved in the freezing procedure. The cryosurgery probes can be inserted in the body and activated manually or by the computer system to provide freezing capable of destroying internal tissue. By calibrating the effects of the cryosurgery probe or probes as a function of power and duration, the surgical procedure can be controlled by including overlaying images of the regions already affected by the cryosurgery probe or probes on the images previously provided by the ultrasonic or MRI probe. This image reconstruction can be performed in real time providing immediate feedback to the attending physician. The computer system can also monitor system parameters such a freezing power and duration. This system has particular application to procedures involving the prostate gland where the cryosurgery probe or probes can be inserted intra-perineally and the ultrasonic probe or MRI can be inserted intra-perineally or trans-rectally. Excerpt(s): The invention relates generally to cryosurgery and more particularly to an automated and integrated system including a cryosurgery device, an imaging probe and a computer system for use in performing internal surgery. The attending physician provides input either directly or through the computer while watching a displayed image generated by the imaging probe onto a screen in "real-time." The real-time image will display the extent of tissue freezing with special attention to the border and limits of the desired tissue to be frozen. The physician may directly control, or have the computer system control the duration and the intensity of freezing with passible linkage to shutting of the process if certain predetermined criteria are not met. The use of cryosurgery dates back to 1964 when Geonder et al. published "Experimental Prostatic Cryosurgery" in Investigative Urology 1:610-619. There is vast clinical accumulation of data on cryosurgery for cancer of the prostate as published by Dr. Loening from Iowa Medical School in the "UROLOGICAL CLINICS OF NORTH AMERICA" 1988. A key advantage of cryosurgery is that it creates some immune response. Tissue destroyed by cryosurgery can typically be removed from the interior of the body by normal bodily processes. The freezing can be applied by established endo-techniques, such as those utilized in endo-urology, thus avoiding open surgery and enabling tissue destruction in areas where there is no easy access, or where opening of the skin and tissues is not desired. Web site: http://www.delphion.com/details?pn=US05531742__

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Biopsy needle insertion guide and method of use in prostate cryosurgery Inventor(s): Cohen; Jeffrey (Pittsburgh, PA), Onik; Gary (Allison Park, PA), Pottorff; Larry (Candor, NY), Reyes; George (Pittsburgh, PA) Assignee(s): Cryomedical Sciences, Inc. (Rockville, MD) Patent Number: 5,494,039 Date filed: July 16, 1993 Abstract: A biopsy needle insertion guide and method of use with an ultrasound probe in medical procedures to accurately position biopsy needles in internal tissues. The insertion guide comprises a body which is removably mountable on an ultrasound probe and which comprises a clamp affixable about the probe and an elongated adjustment guide extending from the clamp in a direction perpendicular to the probe. A slide block engages the adjustment guide and is slidably adjustable therealong and a biopsy needle holder and guide assembly is carried by the slide block and is adjustably extendable from the slide block in a direction parallel to the probe. A method of use is described wherein the insertion guide is used to accurately place biopsy needles in a human prostate, the needles being then used to accurately place cryoprobes in the prostate for cryogenic surgery of the gland. Excerpt(s): This invention relates to prostate cryosurgery and more particularly to a guide for use in achieving accurate placement of cryoprobes within the prostate. Most particularly the invention relates to a biopsy needle insertion guide which is securely mountable on and useable with a rectally inserted ultrasound probe to insert biopsy needles into the prostate at specific target points identified on an ultrasound image of the prostate. The needles provide guidance for placement of cryoprobes within the prostate at those points for cryosurgical treatment of the prostate. Prior treatment of an enlarged and/or tumorous prostate has involved transurethral or transrectal resection of the prostate tissue with the attendant problems associated with such procedures. In recent years, cryosurgical techniques have been applied to tumorous tissues with considerable success. These techniques succeed in reducing the tissue while avoiding the attendant complications of more conventional surgical techniques. The principal difficulty in applying cryosurgery to internal organs is accurate placement of cryosurgical probes. Generally, imaging techniques are used to provide a visual representation of the desired organ and the surgeon observes the image while he guides probes into place. A popular imaging technique is ultrasound wherein a transducer is placed against the body and transabdominal scans are made to image the internal organs. The image resolution of such scans is limited due to the intervening abdominal tissues, so ultrasound probes which can be inserted into natural body orifices or through cannulas so as to be closer to the target organs are used for deep tissue imaging. Web site: http://www.delphion.com/details?pn=US05494039__

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Cauterizing probes for cryosurgery Inventor(s): van Gerven; Hans (Tubingen, DE) Assignee(s): Erbe Elektromedizin KG (Tubingen, DE) Patent Number: 4,202,336 Date filed: January 3, 1978

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Abstract: A heating coil close to the freezing tip of a cryosurgical probe operates through a highly heat conductive portion of the probe wall so as to cauterize previously frozen tissues. The liquid nitrogen supply is continued long enough to cool the cauterizing surface to body temperature after the heating winding is switched off, after which the probe is withdrawn. An insulating spacer member on the end of the tip prevents unintended freezing of the bladder wall when the instrument is used for an operation on the prostate gland. The use of general anesthesis in such an operation is avoided by the use of the new probe. A probe for cauterizing only, for use after freezing by a conventional cryosurgical probe has the same kind of heater, temperature sensor and insulating tip but is equipped for circulating cooling water rather than cryogenic flow in the cooling space. Excerpt(s): This invention relates to a cryosurgery using a probe of the kind having a tubular shaft with channels within the shaft for circulating a cryogenic medium to and from the tip of the shaft which is the refrigerating tip of the probe and has a thermometric sensor in the tip from which leads are brought out through the shaft for connection for appropriate instrumentation. Such probes are generally provided with a heating winding for thawing (defrosting) the probe at the end of a surgical freezing operation. The invention particularly concerns means for cauterizing tissues and includes both such means built into a cryosurgical probe and a special cauterizing probe for use after withdrawal, of a cryosurgical probe. Known cryosurgical apparatus with probes of this type, as disclosed in published German application (OS) No. 24 22 103, are particularly used in surgical practice to freeze the prostate gland of a patient transurethrally for a maximum period of five minutes at -180.degree. C. under local anesthesia. Thereafter, by use of general anesthesia, a transurethral resection can be performed. In contrast to this procedure, it is an object of the present invention to avoid, if possible, the use of any general anesthesia in such operations. It is accordingly an object of the invention to improve cryosurgical probes of the kinds described above and to provide one of such characteristics that the tissue regions frozen by the probe can be cauterized by the probe itself. It is also an object of the invention to provide a cauterizing probe for obtaining the same effect following the use of a cryosurgical probe that is not equipped for cauterizing. Web site: http://www.delphion.com/details?pn=US04202336__ •

Combination stereotactic surgical guide and ultrasonic probe Inventor(s): Chinn; Douglas O. (1366 N. Santa Anita Ave., Arcadia, CA 91006) Assignee(s): none reported Patent Number: 5,976,092 Date filed: June 15, 1998 Abstract: A stereotactic surgical guide to be coupled to the shaft of a conventional ultrasonic probe for use during cryosurgery to enable a surgeon to easily, efficiently and accurately position one or more cryosurgical probes in the body of the patient for producing iceballs to kill cancer cells at a localized tissue area. The stereotactic surgical guide includes a laser carrying plate that carries a laser and is coupled to a worm drive. The distance between the ultrasonic probe and the organ in need of treatment is visually determined on the monitor of an ultrasound machine, and the worm drive is rotated to cause the laser carrying plate to move a corresponding distance, whereby the laser will be positioned in spaced opposing alignment with the organ. The laser is then energized

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and a light beam aimed towards the patient's body to establish a target through which the cryosurgical probe will be inserted to penetrate the body. Excerpt(s): This invention relates to a stereotactic surgical guide to be detachably coupled to a conventional ultrasonic probe for use during cryosurgery to provide a laser generated aiming beam and thereby enable the accurate placement of a cryosurgical probe for producing iceballs at a localized tissue area within the body of a patient undergoing treatment for cancer. Techniques are known by which to cryosurgically destroy cancer cells in the tissue of a patient undergoing treatment. In general, a liquid or gas cryogen is used to generate extremely low temperatures sufficient to kill malignant cells. In some cases, a cryosurgical probe penetrates the patient's tissue (e.g. the prostate, liver, breast and brain) to deliver the cryogen and thereby form an iceball adjacent to the organ to be treated. However, the size and shape of human organs vary from one patient to the next. Therefore, a significant problem faced by surgeons who practice cryosurgery is the accurate location of the iceball within the body of the patient. For example, should an iceball be misplaced relative to a patient's prostate, there is the risk that the neighboring sphincter will become frozen leading to the possibility of incontinence. Moreover, there may be an incomplete freezing of the cancerous cells in the prostate gland or an undesirable freezing beyond the prostate and into the bladder or rectum which could cause a urethral-fistula. Web site: http://www.delphion.com/details?pn=US05976092__ •

Confocal microscope for facilitating cryosurgery of tissue Inventor(s): Zavislan; James M. (Pittsford, NY) Assignee(s): Lucid, Inc. (Rochester, NY) Patent Number: 6,413,252 Date filed: February 24, 1999 Abstract: A confocal microscope is provided including a confocal imaging system having an objective lens, and a device which can be an attachment to the confocal imaging system, or a part thereof. The device has a housing with an interior cavity and two opposite ends, where one end of the housing receives the objective lens, and at the other end of the housing which is attached to, or is a part of, the housing which forms that other end. The chamber has first and second plates presenting two opposing sides of the chamber, where the first plate lies adjacent the tissue to be treated, and the second plate is attached to the housing. The interior cavity of the housing has a window defining a first volume between the window and the objective lens, and a second volume between the window and the chamber. The first volume has an immersion liquid optically matched to the objective lens, and the second volume is approximately evacuated. The confocal imaging system, via the device, focuses light into the tissue and collects returned light from the tissue to produce images representing one or more sections of the tissue. To freeze the tissue, the chamber receives a cryogenic fluid, such as liquid nitrogen, thereby cryosurgically treating the tissue below the chamber which includes the imaged tissue. The chamber has an input port to receive the cryogenic fluid and an output port to vent the cryogenic fluid. The confocal microscope can provide images of the tissue before, during and after cryosurgical treatment. Excerpt(s): The present invention relates to a confocal microscope (apparatus, method, and system) for in-vivo examinations of tissue, and particularly to a confocal microscope which facilitates cryosurgical treatment of tissue being imaged by the microscope. This

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invention is especially suitable for providing an instrument to examine tissue having a lesion to be treated, to cryosurgically treat the lesion, and then to examine the tissue to evaluate the effectiveness of such treatment. The term tissue herein refers to naturally or surgically exposed tissue, and the term lesion refers to an abnormality in the tissue or diseased tissue. Confocal microscopes for scanning tissue can produce microscopic images of tissue sections. Such microscopic image sections may be made in-vivo in tissue without requiring a biopsy specimen of a lesion in the tissue. An example of a confocal microscope is the "Vivascope" manufactured by Lucid Technologies, Inc. of Henrietta, New York. Other examples of confocal microscopes are found in U.S. Pat. No. 5,788,639 and Published International Application WO96/21938. Confocal scanning microscopes are also described in Milind Rajadhyaksha et al., "In vivo Confocal Scanning Laser Microscopy of Human Skin: Melanin provides strong contrast," The Journal of Investigative Dermatology, Volume 104, No. 6, June 1995, pages 1-7, and Milind Rajadhyaksha et al., "Confocal laser microscope images tissue in vivo," Laser Focus World, February 1997, pages 119-127. These confocal microscopes have confocal optics which direct light to the patient's tissue and image the returned light. Although these confocal microscopes are useful for examination of lesions or other diseased tissue, they have no capability for facilitating cryosurgical treatment of imaged tissue. Cryosurgery involves the freezing of tissue, such as performed for treating dermal lesions, for example, lentigos (freckles), or papillomas (warts). Accordingly, the principal object of the present invention is to provide an improved confocal microscope system which facilitates cryosurgical treatment of the tissue being imaged by the microscope. Web site: http://www.delphion.com/details?pn=US06413252__ •

Control system for cryosurgery Inventor(s): Kudaravalli; Ravikumar V. (San Diego, CA), Li; Hong (San Diego, CA) Assignee(s): CryoGen, Inc. (San Diego, CA) Patent Number: 6,471,694 Date filed: August 9, 2000 Abstract: An apparatus and method for automatic operation of a refrigeration system to provide refrigeration power to a catheter for tissue ablation or mapping. The primary refrigeration system can be open loop or closed loop, and a precool loop will typically be closed loop. Equipment and procedures are disclosed for bringing the system to the desired operational state, for controlling the operation by controlling refrigerant flow rate, for performing safety checks, and for achieving safe shutdown. Excerpt(s): This invention is in the field of methods and apparatus used to generate and control the delivery of cryosurgical refrigeration power to a probe or catheter. In a cryosurgical system, contaminants such as oil, moisture, and other impurities are often deposited in the impedance tubing or other restriction through which the refrigerant is pumped. In the impedance tubing, the temperature is very low, and the flow diameter is very small. Deposit of these impurities can significantly restrict the flow of the cooling medium, thereby significantly reducing the cooling power. A cryosurgical catheter used in a cardiac tissue ablation process should be able to achieve and maintain a low, stable, temperature. Stability is even more preferable in a catheter used in a cardiac signal mapping process. When the working pressure in a cryosurgery system is fixed, the flow rate can vary significantly when contaminants are present, thereby varying the temperature to which the probe and its surrounding tissue can be cooled. For a given

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cryosurgery system, there is an optimum flow rate at which the lowest temperature can be achieved, with the highest possible cooling power. Therefore, maintaining the refrigerant flow rate at substantially this optimum level is beneficial. Web site: http://www.delphion.com/details?pn=US06471694__ •

Cryo-probe Inventor(s): Longsworth; Ralph C. (Allentown, PA) Assignee(s): APD Cryogenics, Inc. (Allentown, PA) Patent Number: 5,452,582 Date filed: July 6, 1994 Abstract: In the cryo-probe, refrigerant is furnished from a high pressure, room temperature supply. Insulation of the refrigerant lines is unnecessary. Refrigerant flows through a pre-cooling heat exchanger in the probe and through a restrictor wherein the pressure drops. In accordance with the Joule-Thompson effect, the refrigerant expands and becomes cold and liquid is applied in the region of the cryo-tip to provide rapid cooling thereof. Expanded refrigerant gas at low pressure reverses direction and flows back from the cold tip in counterflow arrangement through the aforementioned heat exchanger to give a pre-cooling effect to the refrigerant incoming from the external supply. A second tube for conveying warm-up gas is located in the probe and extends to the cold tip. After cryosurgery is complete, the high pressure flow is stopped and warm gas is delivered to the tip in the probe at reduced pressure through the second tube from the same refrigerant supply as is used for cooling. Accordingly, the tip is rapidly warmed. Excerpt(s): The present invention relates to cryosurgical probes, and more particularly to a cryo-probe construction that provides rapid defrost of an ice ball that is formed during use of the probe for cell necrosis. Cryosurgical probes have been built that use direct expansion of liquid refrigerant R12, carbon dioxide, nitrous oxide and other materials having two phase characteristics in a desired temperature range. The mentioned materials, stored at room temperature can produce temperatures in a range from 29.degree. C. to -88.degree. C. for the purpose of killing tissue in surgical procedures. Liquid nitrogen has also been used as a refrigerant in probes. This refrigerant has a boiling point at atmospheric pressure of -196.degree. C. Some probes provide very small cold surfaces for surgical procedures in the eye, brain or heart, and other probes require larger surface areas, and more cooling power for operation on larger tissue volumes and areas. These cryo-probes generally have at least two circuits, one for delivering refrigerant to the active or distal end of the probe where cryosurgery is performed, and the other circuit for returning refrigerant from the active cold end to a vent port. The refrigerant generally is a superheated vapor at discharge. Probes of the prior art differ from each other generally in the means that are employed to keep the outside surfaces of the cryo-probe warm, except for the active end, and in the means for warming the cryoprobe after the surgical procedure is completed. Rapid warming is especially important when an ice ball forms on the cold working end of the probe during surgery, and it is not possible to safely move or remove the probe until the probe is separated from the ice ball or the ball is melted. It is desirable that the apparatus, i.e., the refrigerant supply and control system for a cryo-probe be located outside the sterile field where cryosurgery is performed. Accordingly, conduits of extended length are required between the control and supply apparatus and the probe itself. It is also desired that any vented refrigerant be disposed outside of the sterile field. These logistical matters must

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be accommodated with the least inconvenience and impediment to the surgeon. Thus, long, flexible and small gauge conduits are desirable between the supply and the probe. Web site: http://www.delphion.com/details?pn=US05452582__ •

Cryosurgical instrument and related techniques Inventor(s): Jarvinen; Philip O. (Amherst, NH) Assignee(s): Massachusetts Institute of Technology (Cambridge, MA) Patent Number: 6,190,378 Date filed: November 16, 1998 Abstract: A cryosurgical instrument includes a cryoprobe operative to form an ice ball in tissue of a patient targeted for cryosurgery upon activation, a sheath disposed over the cryoprobe and at least one measuring device supported by the sheath for measuring a parameter of the tissue of the patient. The instrument includes a processor for predicting formation of the ice ball by the cryoprobe over time and a display for displaying the prediction of ice ball formation. The processor is responsive to an output signal provided by the measuring device and a model of the effective thermal conductivity of the tissue of the patient targeted for surgery. In one embodiment, the measuring device is embedded in the sheath and measures temperature, thermal conductivity, blood perfusion rate and/or thermal diffusivity. The processor may be further responsive to an impedance measurement circuit for verifying the prediction. Excerpt(s): Cryosurgery, a surgical procedure in which a target area of a patient is frozen, is known for treating various medical conditions. Most often, cryosurgery is used in the treatment of cancer, in which a cancerous mass or tumor is destroyed during the freezing process. Over time, the frozen mass deteriorates and is consumed by the body. One application for cryosurgery is in the treatment of prostate cancer. Prostate cancer is one of the most frequently diagnosed malignancies in American males and is the second leading cause of cancer related deaths. Successful treatment requires confining the cancer to the prostate gland and surrounding tissue, referred to as the prostatic capsule, in order to prevent the spread and metastasizing of the cancer. In addition to cryosurgery, other conventional treatment therapies for prostate cancer include radical prostatectomy, radiation therapy and medical or surgical castration. In radical prostatectomy, the prostate gland and a margin of the surrounding tissue are surgically removed. However, a relatively high rate of recurrent, or residual tumors have been reported following radical prostatectomy. Further, this form of treatment suffers from a relatively high rate of impotence and/or incontinence. Web site: http://www.delphion.com/details?pn=US06190378__

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Cryosurgical instrument and system and method of cryosurgery Inventor(s): Finkelstein; J. J. (Washington, DC), Jones; Steve (Monroeville, PA), Neu; Dan (Pittsburgh, PA), Onik; Gary (Wexford, PA), Rubinsky; Boris (Albany, CA) Assignee(s): Cryomedical Sciences, Inc. (Rockville, MD) Patent Number: 5,674,218 Date filed: February 16, 1995

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Abstract: An improved cryosurgical system includes means for cooling the cryoprobe instrument to temperatures below the normal boiling point of liquid nitrogen as well as means for recovering the sub-cooled liquid coolant. A unique cryoprobe instrument of simplified construction uses an active vacuum for thermal insulation. Means are provided for controllably adjusting the length of the freezing zone of the cryoprobe to allow the freezing zone to be adjusted for different sizes and shapes of tumors which may be "observed" before surgery by ultrasound imaging. Multiple, disposable cryoprobe instruments can be individually controlled for both operating temperature and freeze zone length. A preferred refrigeration system for sub-cooling liquid nitrogen refrigerant or other cryogenic liquid refrigerant is based on the principles of evaporative cooling. Excerpt(s): This invention relates to a cryosurgical instrument suitable for use in destroying living tissues, such as solid malignant or benign tumors. More particularly, the invention relates to a surgical system including one or more cryoprobe instruments capable of producing very low temperatures and which is highly effective in the surgical treatment of various disorders, especially for destroying tumors. Even more specifically, the invention relates to a surgical system, including at least one cryoprobe, with means for producing at the probe tip temperatures below the freezing temperature of tissue (0.57.degree. C.), using liquid nitrogen as the coolant, which coolant temperatures can be lower than the normal boiling temperature of nitrogen. The invention also relates to cryoprobe instruments which have variable controlled active cooling region (freezing zone) as well as cryoprobe instruments and connecting lines with active vacuum thermal insulation, as well as to a cryosurgical operating method in which the surgeon may adjust the freezing zone length in one or more cryoprobe instruments in response to images taken of the tumor prior to or during cryosurgery. Cryosurgery is a surgical procedure that uses freezing temperatures to destroy tissue. James Arnott, an English physician, was the first to introduce this method in 1865 for treatment of cancer of the skin. Between 1920 and 1940, the commercialization of liquid air led a number of surgeons to employ freezing to accomplish the destruction of nondesirable tissue. By 1930 the first monograph on the method was published (Lortat-Jacobs and Solente, 1930). Modern cryosurgery started with the work of a New York surgeon, I. Cooper, who in 1961 developed a new apparatus for cryosurgery. This apparatus consisted of a hollow metal tube which was vacuum insulated, except at the tip, through which liquid nitrogen was circulated. Cooper was able to localize the freezing and, thereby, treat the tissue in a controlled way. The method was used first for treatment of Parkinsonism, and later extended to the destruction of nondesirable tissue in other areas, such as dermatology, proctology, gynecology. The applications of cryosurgery are numerous and have been described in several texts and review papers, (Rand, et al., 1968; Albin 1980; Gage 1982; Zacarian, 1985; Gage, "Cryosurgery For Cancer", Compr. Ther. January 1984; 10(1):61-69; Gage and Torre, 1988; Onik and Rubinsky, 1988). Web site: http://www.delphion.com/details?pn=US05674218__

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Fluorochemical liquid augmented cryosurgery Inventor(s): Shaffer; Thomas H. (Lansdowne, PA), Stern; Robert G. (Philadelphia, PA), Wolfson; Marla R. (Philadelphia, PA) Assignee(s): Temple University-of the Commonwealth System of Higher Education (Philadelphia, PA) Patent Number: 5,741,248 Date filed: June 7, 1995 Abstract: A method for cryogenic treatment of a lesion which includes the steps of delivering a fluorochemical liquid to the lesion, placing at least one cryoprobe into the lesion, and circulating cryogenic fluid through the cryoprobe, the cryogenic fluid causing an ice ball to form in a vicinity around the cryoprobe, wherein the ice ball obliterates at least a portion of the lesion. The fluorochemical liquid is utilized to augment the cryosurgical procedure and is perfused or injected into and/or around the lesioned site prior and/or during the application of a cryoprobe to the site. In one embodiment of the invention, the fluorochemical liquid acts as a contrast agent to enhance real-time medical imaging of the lesioned area and modifies the environment in and around the lesioned area. In another embodiment of the invention, the fluorochemical liquid augments cryosurgical procedures by controlling the size and shape of ice balls formed during the cryosurgical procedures. In this embodiment, a fluorochemical liquid with a properly chosen thermal conductivity and freezing point is utilized. Depending on the thermal properties chosen, the liquid either augments freezing of the target area and/or promotes thermal conduction to freeze larger areas, or limits the freezing of the target area and reduces thermal conduction. In a noncryoprobe embodiment, the liquid is cooled to a temperature below the freezing point of the biological tissue. The cooled liquid is then infused into or around the cystic lesion to produce ablation. Excerpt(s): This invention relates to methods and processes for performing cryosurgery using fluorochemical liquids in and around biological lesions, cysts, organs and tissue. Cryosurgery is the in situ destruction of living tissues through the application of low temperatures and has been used extensively in humans for a wide variety of malignancies and inflammatory disorders. The medical literature includes, but is not limited to, the following tumors and conditions that have been treated cryosurgically: carcinoma of the skin, melanoma, orbital tumors (retinoblastoma, squamous cell, melanoma), oral carcinoma, pharyngeal carcinoma, laryngeal carcinoma, tracheobronchial carcinoma, lung carcinoma, esophageal carcinoma, hepatic carcinoma, carcinoma of the uterus, vulva, vagina, rectum, anus, prostate, urinary bladder, penis, breast and maxillary sinus, malignant bone tumors, spinal tumors and brain tumors. Most cryosurgery is performed using a cryoprobe or hollow tube within which a cryogenic agent (e.g., liquid nitrogen) flows in a closed loop manner. The probe is inserted into the tumor and the cryogenic agent causes circumferential freezing to occur around the probe, incorporating a given volume of frozen tissue. This creates an "ice ball" which forms to a certain size, depending upon the total time of application and the local thermal gradients. These gradients are heavily dependent on local blood flow, vascularity, adjacent structures, and other factors. Web site: http://www.delphion.com/details?pn=US05741248__

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Freezing method for controlled removal of fatty tissue by liposuction Inventor(s): Rubinsky; Boris (1619 Sonoma Ave., Albany, CA 94707) Assignee(s): none reported Patent Number: 6,032,675 Date filed: March 17, 1998 Abstract: A method for removing fatty tissue in a body combines cryosurgery and liposuction. Cryosurgery first destroys fatty tissue to be removed by controllably freezing the tissue, and facilitates removal of the fatty tissue. Liposuction subsequently removes the destroyed fatty tissue by aspiration. Excerpt(s): The invention relates to liposuction and, more specifically, relates to an apparatus and method for destroying and removing fatty tissue in a body. The skin insulates and protects the entire body from mechanical, chemical and thermal damage. Beneath the dermis is the subcutaneous tissue which contains many fat cells. The subcutaneous tissue serves as a "shock absorber" and insulates the deeper tissues from extreme temperature changes. The subcutaneous tissue is also responsible for the outer appearance of the body surface. Another major function of the fat cells is to accumulate fat, as a means for storing food. However, for cosmetic or aesthetic reasons, it may be desirable to reduce the volume of fatty tissue in the body. Exercise and diet can sometimes reduce accumulation of fat in the fat cells, but they cannot reduce the number of fat cells or their distribution. The number of fat cells in the subcutaneous tissue is relatively constant. Furthermore, fat accumulation persists despite diet or exercise for many people. Liposuction is a surgical procedure that permanently removes localized deposits of fat cells, thereby producing a desirable shape of the body or the face through sculpturing. In a typical liposuction, a catheter connected to a high vacuum device is introduced into the fatty tissue through an incision in the skin, and the fat is removed by aspiration. This procedure requires general anesthesia, involves significant blood loss, and has relatively high morbidity and mortality. This problem has been resolved to some extent with the more recent tumescent liposuction. In tumescent liposuction, large volumes of dilute lidocaine and epinephrine are infiltrated into the subcutaneous fatty tissue before the suction stage. Lidocaine and epinephrine are delivered through a canulated hollow tube inserted through a small skin incision into the fatty tissue between the skin and the muscle. Lidocaine is a local anesthetic, and epinephrine causes lipolysis and vasoconstriction. Lipolysis is destruction of fatty structures. Following the infiltration of the mixture of lidocaine and epinephrine, a catheter connected to a high vacuum device is introduced to the fatty tissue and moved rapidly through the tissue to break up the fat cells that are aspired through the catheter. This procedure has significantly less morbidity and has no reported mortality. Web site: http://www.delphion.com/details?pn=US06032675__

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Impedance-based method and apparatus for monitoring cryodestruction in controlled cryosurgery Inventor(s): Savic; Michael I. (4 Saw Mill Dr., Wilbraham, MA 01095), Zacarian; Setrag A. (154 Colony Rd., Longmeadow, MA 01106) Assignee(s): none reported Patent Number: 4,140,109 Date filed: October 17, 1977

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Abstract: An impedance-based method for the controlled cryosurgery of a patient's malignant tumor consisting of the steps: placing a contact electrode electrically connected to an impedance meter in electric contact with a body site spaced away from the tumor target, inserting a needle electrode electrically connected to the impedance meter through the tumor target with the tip of the needle electrode penetrating the immediately underlying normal tissue therebelow, and monitoring during cryosurgery the impedance between the two electrodes as a reflection of the eutectic state of the tissue circumadjacent the tip of the needle electrode. Excerpt(s): This invention relates to cryogenic techniques in medical and surgical practice involving the monitoring of cryodestructive temperatures by means of measuring the electrical characteristic of impedance in the case of biological tissue of either humans or animals. The desideratum in controlled cryonecrosis is to destroy the abnormal tissue while yet preserving the healthy tissue surrounding the area of the tumoral target. One of the major problems in destructive cryosurgery is to know the exact temperature of the tissue targeted to obtain cryonecrosis in the preselected area. The risks of either insufficient or excessive freezing are obviously to be avoided. Web site: http://www.delphion.com/details?pn=US04140109__ •

Magnetic resonance imaging assisted cryosurgery Inventor(s): Gilbert; John (Berkeley, CA), Pease; Grant (Oakland, CA), Roos; Mark (San Francisco, CA), Rubinsky; Boris (Albany, CA), Wong; Sam (Emeryville, CA) Assignee(s): The Regents of the University of California (Oakland, CA) Patent Number: 5,433,717 Date filed: March 23, 1993 Abstract: Methods and apparatus for magnetic resonance imaging (MRI) assisted cryosurgery. Optimal probe placements and cooling parameters are calculated prior to cryosurgery using MRI data. A MRI compatible cryoprobe and a stereotactic probe positioning device are provided. The resolution of MR images is enhanced by mounting a radio frequency MR coil on the intracorporeal end of a cryoprobe. During cryosurgery the temperature distribution in the frozen region is solved by determining the boundary of the frozen region and solving the heat equation for the known boundary conditions. During cryosurgery the temperature distribution in the unfrozen region is determined by T1 measurements. The process of freezing is controled using information from the solution of the energy equation in the frozen region and temperature measurements in the unfrozen region. After cryosurgery the extent of the tissue damage may be ascertained using phosphorus-31 and/or sodium-23 spectroscopy with a special coil set on the cryosurgical probe. Excerpt(s): Cryosurgery is a common and effective surgical procedure in which freezing is used to destroy undesirable tissue. The procedure is used in many areas of medicine such as dermatology, gynecology, otolaryngology, proctology, veterinary medicine. In cryosurgery, freezing is usually accomplished by placing a metallic cryosurgical probe, insulated except at its tip, in contact with the subject tissue to be frozen. As the probe is cooled internally (by either circulating a refrigerant (cryogen), Joule Thompson effects, Peltier effects, or by means of heat pipes) heat is removed from the tissue by conduction and a region of frozen tissue grows outward from the probe. When an adequate amount of tissue has been frozen, the flow of cryogen is stopped and the tissue is allowed to thaw. One of the advantages of cryosurgery is that it can treat tumors focally. Small

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volumes can be destroyed using a thin needle-like cryosurgical probe, while larger volumes can be destroyed with larger probes or multiple probes. Multiple sites may be treated in this manner and irregularly-shaped volumes can be treated using multiple probes. Retreatment is possible if the disease recurs. Because tissues can be treated focally, cryosurgery has the potential to spare more adjacent healthy tissue than resection, radiotherapy, or hyperthermia. Another advantage of cryosurgery is that it is easy to control because the freezing process is relatively slow, usually on the order of 1 mm/min. If the therapy is adequately monitored, freezing can be halted before the freezing interface reaches sensitive tissues. An additional advantage of the slow freezing rate of cryosurgery is that capillaries freeze while larger vessels, which act as local heat sources, remain undamaged. Cryosurgery is therefore effective in treating otherwise unresectable solid tumors abutting large blood vessels. Web site: http://www.delphion.com/details?pn=US05433717__ •

Method and apparatus for cryosurgery Inventor(s): Julian; Thomas Benjamin (Pittsburgh, PA), Rabin; Yoed (Pittsburgh, PA), Wolmark; Norman (Pittsburgh, PA) Assignee(s): Allegheny-Singer Research Institute (Pittsburgh, PA) Patent Number: 6,039,730 Date filed: June 24, 1996 Abstract: The present invention pertains to an apparatus for cryosurgery. The apparatus comprises a cryoneedle having a diameter less than 3.2 mm. The apparatus is also comprised of a thermal insulation shell disposed about a portion of the cryoneedle for reduction of heat transfer from surrounding tissues or freezing prevention of surrounding tissues during application of the cryoneedle with the shell. The cryoneedle and shell are configured for insertion into a body of a patient. The present invention pertains to a method for freezing tissues. The method comprises the steps of bringing into contact a cryoneedle having a diameter of less than 3.2 mm with a patient's body. Next, there is the step of flowing the cryofluid through the cryoneedle. Excerpt(s): The present invention is related to cryosurgery. More specifically, the present invention is related to a method and apparatus for cryosurgery involving a cryoneedle having an outlet tube adjacent an inlet tube for cryofluid which cools the cryoneedle. This invention relates to minimally invasive cryosurgery. More particularly, this invention concerns the structure and the method of operation of a cryosurgical apparatus, which consists of one or more cryoprobes and a pressurized cryofluid source. Cryosurgery, or the destruction of undesired biological tissues by freezing, has long been accepted as an important alternative technique of surgery (Orpwood, 1981; Rubinsky and Onik, 1991; Gage, 1992). Compared with conventional means of destroying tissues, such as surgical excision, radiotherapy and chemotherapy, visceral cryosurgery (especially minimal-invasive cryosurgery) offers the following potential advantages: simplicity of the procedure, minimal bleeding, anaesthetic effect of low temperatures, short period of patient recovery, low cost, minimal scarring, and possible stimulation of the body's immune system. Web site: http://www.delphion.com/details?pn=US06039730__

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Method and apparatus for heating during cryosurgery Inventor(s): Julian; Thomas Benjamin (Pittsburgh, PA), Rabin; Yoed (Pittsburgh, PA), Wolmark; Norman (Pittsburgh, PA) Assignee(s): Allegheny-Singer Research Institute (Pittsburgh, PA) Patent Number: 5,899,897 Date filed: September 25, 1997 Abstract: The system includes a mechanism for freezing tissue in a patient. Additionally, the system includes a mechanism for heating other tissue near the tissue being frozen by the freezing mechanism such that essentially only desired region is frozen by the freezing mechanism and heat from the heating mechanism prevents the other tissue from being frozen. The heating mechanism is disposed adjacent to but separate and apart from the freezing mechanism. Alternatively, the mechanism for heating can be used with tissue already frozen by the freezing mechanism. A method for performing cryosurgery on a patient. The method includes the steps of inserting a cryoprobe into a patient. Next, there is the step of placing a cryoheater in contact with the patient adjacent the cryoprobe. Then, there is the step of activating the cryoprobe and the cryoheater so the cryoprobe freezes desired tissue in the patient and the cryoheater heats other tissue around the desired tissue so the other tissue is not frozen by the cryoprobe. Alternatively, there can be the step of activating the cryoheater after the cryoprobe has frozen the desired tissue to thaw the frozen tissue. Excerpt(s): The present invention relates generally to cryosurgical devices and procedures. More particularly, the invention concerns a cryosurgical apparatus that has the abilities to either control the thawing stage of a cryosurgical procedure; prevent the freezing front from propagation into undesired directions; or, protect tissues from freezing within the cryotreated region or nearby. The mainstay of the new invention is a temperature controlled electrical heater which will be termed cryoheater from hereon. Cryosurgery, or the destruction of undesired biological tissues by freezing, has long been accepted as an important alternative technique of surgery (Orpwood, 1981; Rubinsky and Onik, 1991; Gage, 1992). Compared with conventional means of destroying tissues, such as surgical excision, radiotherapy and immunotherapy, visceral cryosurgery (especially minimally invasive cryosurgery) offers the following potential advantages: simplicity of the procedure, minimal bleeding, anaesthetic effect of low temperatures, short period of patient recovery, low cost, minimal scarring, and possible stimulation of the body's immune system. James Arnott, an English physician, was the first to introduce the technique of destruction of biological tissues by freezing in 1865. Since Arnott's first report, numerous cryodevices and techniques have been suggested. These have included pre-cooled metal blocks, spray/pour freezing with liquefied gases, refrigeration systems, thermoelectric methods, dry ice applications, cryogenic heat pipes, Joule-Thompson effect based cryoprobes and boiling effect based cryoprobes. However, as a result of the high cooling power usually needed for cryosurgery, and especially of internal organs, the boiling effect and the Joule-Thompson effect have been found to be the preferable cooling technique by most cryosurgeons. Web site: http://www.delphion.com/details?pn=US05899897__

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Method and device for transmyocardial cryo revascularization Inventor(s): Ammar; Rony (Haifa, IL), Bliweis; Mordechai (Haifa, IL), Ofer; Glinka (Kiryat Bialik, IL), Sturlesi; Gideon Even (Cammon, IL) Assignee(s): Galil Medical Ltd. (Yokneam, IL) Patent Number: 5,885,276 Date filed: December 2, 1997 Abstract: Cryosurgery method and device for performing trans myocardial revascularization are provided. The method includes: forming trans myocardial channels by cryoablating selected portions of the myocardial tissue. The cryosurgery device includes:(a) an operating member having an operating surface and a hollow; and a housing member connected thereto; (b) a first passageway extending along the device for providing high pressure gas to the operating member, the first passageway including a primary Joule Thomson heat exchanger in the form of a primary orifice located on the first passageway for enabling expansion of gas within the hollow of the operating member, thereby providing a desired temperature to the surface of the operating member; (c) a second passageway extending through the length of the housing member for evacuating gas from the operating tip to atmosphere; (d) a third passageway extending along a portion of the device and including a secondary Joule Thomson heat exchanger for providing a desired temperature to gas flowing through the first passageway. Method and device according to the present invention enable to form durable transmyocardial channels without causing considerable trauma to the myocardial tissue. Excerpt(s): The present invention relates to method and device for trans myocardial cryo revascularization. More particularly, the present invention relates to a method of conducting trans myocardial revascularization by means of a cryosurgery device. Further, the present invention relates to a cryosurgery device including a plurality of Joule-Thomson heat exchangers which enables to effectively conduct such revascularization procedure. Trans myocardial revascularization (TMR) procedures including the formation of transmyocardial channels extending from the epicardium to the left ventricular cavity are well known in the art. Such TMR procedures are currently performed by using CO.sub.2 laser or Holmium:YAG laser and are generally known as TMLR procedures. Various studies have been conducted so as to determine whether such TMLR channels provide significant myocardial perfusion by allowing blood to flow therethrough from the left ventricular chamber into the myocardium. Web site: http://www.delphion.com/details?pn=US05885276__

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Methods and apparatus of applying intra-lesional cryotherapy Inventor(s): Weshahy; Ahmed H. A. G. (11 Harrun St., Dokki, Cairo, EG) Assignee(s): none reported Patent Number: 4,802,475 Date filed: June 22, 1987 Abstract: There is described a method of performing intra-lesional cryosurgery utilizing a specifically shaped tubular needle having a front piercing surface coextensive with an opening. The needle is introduced into the skin from one point and runs through deeper tissues based on the surface orientation of the needle. The piercing surface of the needle

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is directed through a second point where it emerges from the skin. The needle as indicated is a hollow tubular member and has one end which is adapted to receive a source of a cryrogen gas. The gas is passed through the needle and produces a lowering of the needle temperature. This low temperature is directed to the surrounding tissues to form an ice cylinder about the imbedded part of the needle in the deeper tissues. This ice cylinder affords to selectively freeze the tissue and thereby destroys the lesion being treated. A plurality of different shaped needles are shown to accommodate different types and different depth lesions. Some needles are also selectively insulated at various portions to cause the uninsulated portion of the needle to selectively apply freezing temperatures to tissues in selective directions. Excerpt(s): This invention relates to a method and apparatus for applying cryotherapy and more particularly to apparatus and methods employing specifically shaped elongated tubular needles inserted through the skin of a patient to destroy lesions by passing a cryogen through the needle. Cryogenics are primarily concerned with the development of freezing temperatures within a biological system. Thus use of cryogenics in medicine dates back to the ancient Egyptians of 2500 BC as they found that the application of cold soothes sites of trauma and reduces inflammation. See a text entitled "Cryosurgery-For Skin Cancer and Cutaneous Disorders" edited by Setrag A. Zacarian, published by The C. V. Mosby Company (1985), St. Louis, Toronto, Princeton. Web site: http://www.delphion.com/details?pn=US04802475__ •

Methods for treating prostate cancer with LHRH-R antagonists Inventor(s): Garnick; Marc B. (Brookline, MA), Gefter; Malcolm L. (Lincoln, MA), Molineaux; Christopher J. (Brookline, MA) Assignee(s): Praecis Pharmaceuticals Incorporated (Cambridge, MA) Patent Number: 5,780,435 Date filed: December 15, 1995 Abstract: Methods for treating prostate cancer are disclosed. The methods of the invention generally feature administration to a subject of an LHRH-R antagonist, in combination with a second therapy. In one embodiment, this second therapy is performance of a procedure that removes or destroys prostatic tumor tissue, such as a radical prostatectomy, cryosurgery or X-ray therapy (external or interstitial). In another embodiment, the second therapy is treatment with an LHRH-R agonist, either simultaneous with or subsequent to LHRH-R antagonist therapy. The methods of the invention can further involve administering an antiandrogen and/or an inhibitor of sex steroid biosynthesis to the subject in combination with the LHRH-R antagonist. Excerpt(s): Prostate cancer is a serious condition that affects increasing numbers of men worldwide. About one-third of all men have at least some cancerous prostatic cells at age 50, with the incidence increasing to as many as 90 percent of men at age 90. In the United States alone, about 40,000 men die each year from prostate cancer. Prostate cancer is a sex hormone dependent cancer; that is, the growth of the cancer is promoted by male hormones (e.g., androgens such as testosterone and dihydrotestosterone). Removal of the testes (castration) was for many years the standard method of preventing the secretion of male hormones by the gonads, as a means for reducing growth of the cancer. More recently, secretion of male hormones has been perturbed by chemical means by interfering with production of luteinizing hormone (LH), which regulates the synthesis of male hormones. Luteinizing hormone releasing hormone

Patents 83

(LHRH) is a natural hormone produced by the hypothalamus that interacts with luteinizing hormone releasing hormone receptor (LHRH-R) in the pituitary to stimulate production of LH. To decrease LH production, superagonists of the luteinizing hormone releasing hormone receptor (LHRH-R), such as leuprolide and goserelin, have been used. However, such LHRH-R superagonists initially act to stimulate LH release and only after prolonged treatment act to desensitize LHRH-R such that LH is no longer produced. The initial stimulation of LH production by the superagonist leads to an initial surge in the production of male hormones such that the initial response to superagonist therapy is aggravation, rather than amelioration, of the patient's condition (e.g., tumor growth increases). This phenomenon, known as the "flare reaction", can last for two to four weeks. Additionally, each successive administration of the superagonist can cause a small LH surge (known as the "acute-on chronic" phenomenon) that again can worsen the condition. The "flare reaction" prohibits the use of LHRH-R superagonists in the treatment of late stage prostatic cancer patients where the cancer has metastasized to the spinal cord, since the initial stimulation of cancer growth would cause nerve trunk compression and damage. To ensure that a candidate patient for superagonist therapy does not have spinal cord metastasis, additional diagnostic tests must be conducted, such as magnetic resonance imaging or a spinal CAT scan, which adds to the cost of superagonist therapy. One approach that has been taken to avoid the "flare reaction" has been to combine administration of an LHRH-R superagonist with an antiandrogen, such as flutamide, known as total androgen ablation therapy (AAT). Hormonal therapy with an LHRH-R superagonist in combination with an antiandrogen has been used as a pre-treatment prior to radical prostatectomy, known as neoadjuvant therapy. The use of antiandrogens, however, is associated with serious hepatic and gastrointestinal side effects. Web site: http://www.delphion.com/details?pn=US05780435__ •

Miniature, thin-film, solid state cryogenic cooler Inventor(s): McGrew; Stephen P. (9715 W. Sunrise Hwy., Spokane, WA 99224) Assignee(s): none reported Patent Number: 6,346,668 Date filed: October 12, 2000 Abstract: The invention provides a solid-state cooler that provides counter-current electricity flow through a device that includes Peltier junctions interconnecting the opposing flow of current through the device. The combination of counter-current flow with the Thompson,Peltier, and Seebeck thermoelectric effects provides an apparatus having the advantages of high energy efficiency, very small size and the ability to reach very low temperatures (near liquid nitrogen temperatures) with minimal energy input. The cooling apparatus is suitable for use in variety of applications, including superconductive devices such a superconductive Quantum Interference Devices (SQUID's) used in medical imaging to increase the sensitivity and resolution of NMR techniques. It is also provides a useful tool for cryosurgery apllications without the risks associated with the use and storage of liquid nitrogen. In addition, the device can be operated in the reverse to generate current from small gradients of temperature. Excerpt(s): The invention relates to the field of thermoelectric cooling devices, and more particularly, to solid-state cooling devices that include Peltier junctions to aid in the cooling process. Temperature is a crucial parameter in an enormous number of physical, chemical and biochemical processes and particularly in a variety of medical and

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electronic devices that can be operated more effectively at very cold temperatures. While thermoelectric coolers currently in use can readily reach and maintain temperatures in a range of 300 K (room temperature) to 230 K, there is no solid-state cooler capable of reaching temperatures below 160 K. Several conflicting processes are at work in this type of Peltier cooler. The current flow pumps heat as a result of the Peltier effect, but heat is generated by the I.sup.2 R resistive heating. As heat is pumped, a temperature difference builds between the two faces of the device, so the Seebeck effect generates a voltage which opposes the current creating the temperature difference. Ordinary thermal conduction also allows some heat to flow back toward the cold side. The Thompson effects nearly cancel out in this device, so the Thompson effect is usually ignored. Web site: http://www.delphion.com/details?pn=US06346668__ •

Silicone mask for cryosurgery and method Inventor(s): Gon.cedilla.alves; J.C. d'Almeida (Santerem, PT) Assignee(s): HPL Biomedical, Inc. (Las Vegas, NV) Patent Number: 5,901,707 Date filed: May 19, 1995 Abstract: A cryosurgery mask permits the continuous application of coolant during cryosurgery. Cryosurgery employs the application of a coolant, such as liquid nitrogen (LN), to a target tissue to effect the removal thereof. The target tissue normally includes diseased tissue, along with a safety margin of adjacent tissue. The cryosurgery mask includes a flexible sheet having a non-adhesive upper surface and a lower skin-facing surface of a silicone gel composition which remains adherent to skin at cryosurgery temperature. A release film is releasably affixed to the skin-facing surface to protect against contamination. In operation, a hole, dimensioned to encircle both the diseased tissue and a safety margin of adjacent normal tissue, is removed from the sheet. The release film is removed and the hole is positioned over the target tissue. The gel layer adjacent to and surrounding the hole is pressed against the skin. A constant spray of LN may then be applied to the target tissue to effect freezing. The gel surface adheres to the skin forming a barrier and preventing LN from freezing non-target tissue. The mask permits the rapid cooling of diseased tissue to a desired depth, while minimizing damage to non-target tissue. Excerpt(s): This invention relates to an improved method for performing cryosurgery and, more particularly, to a mask or drape having a silicone gel surface which adheres to the skin at low temperatures. Cryotherapy is a well established procedure for removing unwanted tissue (target tissue) from the skin. The advantages of treating target tissue such as a tumor with cryosurgery include a higher cure rate and reduced cost per procedure. Small tumors take less than 20 minutes to freeze while larger cancers (i.e. breast and vulva) can take up to 3 hours. In addition, healthy skin can tolerate temperatures down to -12.degree. centigrade. Problems occur when the temperature gets below -20.degree. C. In cryosurgery, an area of the skin incorporating the unwanted or diseased tissue is frozen to reduce the temperature of the tissue to a lethal temperature causing cell death in the diseased tissue which is subsequently rejected by the body. A safety margin consisting of normal tissue adjacent to and surrounding the diseased tissue is also frozen to prevent any diseased tissue cells from remaining behind. When performing cryosurgery it is desirable to "freeze quickly and thaw slowly." In accordance with this dictum, liquid nitrogen is a preferred coolant and is

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widely employed for freezing unwanted target tissue. Liquid nitrogen (LN) is relatively inexpensive and easy to handle. The disadvantage of using liquid nitrogen is that when LN is applied to the surface of the skin it freezes the outermost layer before cooling the target tissue to a depth sufficient to kill all diseased cells. The frozen layer of skin forms a barrier to heat conduction causing additional LN applied to the target tissue to run off the frozen surface surrounding nontarget tissue before it can evaporate. To prevent such damage to nontarget tissue, practitioners use intermittent spraying of coolant onto the target tissue. This enables the heat to be conducted from the deeper tissue to the outer layer where the caloric content is expended vaporizing the liquid nitrogen and equilibrating the tissue temperature to a desired depth. Thus, in order to prevent inadvertent burning of nontarget tissue, an intermittent spray is employed. Web site: http://www.delphion.com/details?pn=US05901707__ •

System and method for MRI-guided cryosurgery Inventor(s): Bliweis; Mordechai (Haifa, IL), Maytal; Ben-Zion (Atlit, IL), Sturlesi; Gideon Even (Cammon, IL) Assignee(s): Galil Medical Ltd. (Yokneam, IL) Patent Number: 5,978,697 Date filed: January 5, 1998 Abstract: System and method for performing MRI-guided cryosurgery are provided. The system includes: (a) an MRI magnet for accommodating a patient, the MRI magnet having at least one opening for enabling access of a surgeon to the patient, the MRI magnet including at least one channel extending therethrough for receiving a line member of a surgical device; (b) a surgical device, including: (i) an operating member for operating the patient; (ii) a control member for controlling the operating member, the control member being positioned externally to the MRI room; (iii) a line member having a first end connectable to the operating member and a second end connectable to said control member, wherein at least a portion of the line member is received within the channel of the MRI magnet. Preferably, the line member includes an underground portion extending through an underground channel. The MRI magnet may include an interface member for connecting the operating member thereto. Preferably, the operating member is a cryogenic probe including a Joule-Thomson heat exchanger, the line member is a gas tube, and the control member includes a gas container for providing high pressure gas to the cryogenic probe via the gas tube. Preferably, the control member includes a microprocessor for controlling the operation of said surgical device. Excerpt(s): The present invention relates to system and method for MRI (Magnetic Resonance Imaging)-monitored and guided cryosurgery. More particularly, the present invention relates to system and method which enable a surgeon to safely and conveniently perform a relatively complicated cryosurgery procedure under the influence of an open MRI magnet, and to obtain accurate and artifacts-free imaging results, thereby enabling effective guidance of the cryosurgery procedure. However, the surgical process within such MRI environment is susceptible to the strong magnetic field of the MRI magnet (about 0.5-2 Tesla). Therefore, the range of surgical tools which may be used within he MRI room is substantially limited. Various attempts have been made to provide surgical methods and devices which are unsusceptible to the magnetic field of the MRI magnet o as to enable a surgeon to perform substantially complicated surgical procedures within the MRI room.

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Web site: http://www.delphion.com/details?pn=US05978697__ •

Thermally insulating surgical probe Inventor(s): Bischof; John C. (1838 Sargent Ave., St. Paul, MN 55105), Hulbert; John (7721 Tara Rd., Edina, MN 55435), Merry; Nir (1727 Cherrytree La., Mountain View, CA 94040) Assignee(s): none reported Patent Number: 5,720,743 Date filed: June 7, 1996 Abstract: A surgical probe having the ability to thermally insulate adjacent healthy tissue from cooling or heating effects at adjacent tissue being subjected to thermal destruction by cryosurgery, electrosurgery and hyperthermia. The probe includes a spatula shaped thermally insulating member that is mounted at the distal end of an elongated rigid member of a width sized for insertion through a small cutaneous incision. The insulating spatula is of a material transparent to ultrasound thus allowing ultrasonic imaging of tissue through the thermal insulator without substantial image deterioration. Excerpt(s): The present invention generally to a device in use in cryosurgical, electrosurgical and hyperthermia situations. More particularly, the invention involves a surgical instrument that has the ability to thermally insulate bodily tissue from exposure to extreme temperature imposed by surgical procedures such as cryosurgery, electrosurgery and hyperthermia. Treatment of tissue affected by cancer can be performed by multiple means such as cryosurgery and electrosurgery. Cryosurgical apparatus such as described in U.S. Pat. No. 4,946,460 which uses liquid nitrogen cryogenic is refrigerant and cryosurgical apparatus described in U.S. Pat. No. 4,519,389 which uses semiconductor cooling elements are used for hypothermic tissue destruction in the treatment of cancer and other non-desirable tissue. Electrosurgical apparatus such as described in U.S. Pat. No. 4,936,301 and in U.S. Pat. No. 4,943,290 are used for hyperthermic tissue destruction. A common problem encountered during surgical procedures involving cryosurgery, electrosurgery and hyperthermia is the unwanted destruction of adjacent healthy tissue. Such side effects can lead to medical complications and result in longer hospitalization and/or a need for further surgical correction. As an example, during cryosurgical treatment of prostate cancer, the entire prostate is cooled to temperatures well below the freezing point of tissue. It is observed that the rectal wall which is typically in contact with the frozen prostate can suffer tissue damage such as the formation of rectal fistulas. Web site: http://www.delphion.com/details?pn=US05720743__

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Tissue destruction in cryosurgery by use of thermal hysteresis Inventor(s): Koushafar; Amir-Homayoon (Richmond, CA), Rubinsky; Boris (Albany, CA) Assignee(s): The Regents of the University of California (Oakland, CA) Patent Number: 5,654,279 Date filed: March 29, 1996

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Abstract: Cell and tissue destruction by cryoablation is enhanced by the perfusion of the cells with thermal hysteresis proteins prior to the cryogenic freezing. The effect of the proteins is to promote the growth of spicular ice crystals in the intracellular fluid which destroy the cell by piercing the cell membrane. This decreases the incidence of cell preservation by freezing, thereby permitting a more uniform and controllable destruction of undesirable tissue by the cryoablation technique. Excerpt(s): This invention lies in the heretofore unrelated fields of cryosurgery and the properties and uses of thermal hysteresis proteins. Cryosurgery has achieved wide acceptance as a clinical procedure and is proving useful for a rapidly increasing range of applications. Among these are the extraction of cataractous lenses of the eye, the repair of detached retinas, the ablation of heart tissue to correct cardiac arrhythmias, and the destruction of tumors in the prostate, liver, brain, and other internal organs. Cryosurgery involves the insertion of a cryoprobe to destroy undesired tissue by highly localized freezing. Once the tissue is frozen, it is allowed to thaw. The body's immune system then gradually decomposes the destroyed tissue and removes it from the body. Cryosurgery offers a number of advantages, including the fact that it is only minimally invasive yet highly controllable, and not dose limited. Cryoprobes are thin, cylindrical devices that are cooled internally with a cryogen and insulated except at the tip. As the cryogen is circulated through the probe, freezing of the tissue occurs from the tip outward, producing a moving freezing front, or interface between frozen and nonfrozen tissue, that is sharply defined and propagates slowly through the tissue (at rates on the order of millimeters per minute). Relatively large regions can be treated with small probes; a 3-mm diameter probe for example can produce an ice ball 3.5 cm in diameter. When the region of pathological tissue is large and complex in shape, a frozen region corresponding closely to the tissue of interest can be generated by using several probes simultaneously. Multiple sites can be treated either separately or together. Since the insertion of the cryoprobes is the only physical invasion of the tissue, the complications entailed by the procedure and patient morbidity are reduced, and the procedure entails less distress to and disfiguration of the patient, all while achieving the therapeutic result at a lower cost than traditional invasive surgery. Web site: http://www.delphion.com/details?pn=US05654279__ •

Use of cryoprotective agent compounds during cryosurgery Inventor(s): Rubinsky; Boris (1619 Sonoma Ave., Albany, CA 94707) Assignee(s): none reported Patent Number: 6,041,787 Date filed: March 17, 1998 Abstract: The invention features an apparatus and method for protecting tissue from freeze damage during cryosurgery. According to the method, a cryoprotective agent is introduced to a tissue to be protected in an amount sufficient to protect the tissue from damage during cryosurgery, and cryosurgery is performed on tissue to be destroyed. Excerpt(s): The invention relates to cryosurgery and, more specifically, relates to an apparatus and method for protecting tissue from damage during cryosurgery. Cryosurgery is a procedure for destroying tissue. In cryosurgery, undesirable tissues are frozen and destroyed. The technique is minimally invasive, usually requiring an insertion of one or more thin, cylindrical, cryosurgical probes into the undesirable tissue. The probes are cooled internally with a cryogen and are insulated except at the

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tip. The uninsulated tip is inserted in a tumor or other undesirable tissue, and the tissue is frozen from the probe surface outward. When the desired amount of tissue has been frozen, cryogen is prevented from flowing to the probe, and the tissue is allowed to thaw. After cryosurgery, the frozen tissue is left in situ to be reabsorbed by the immune system over time. Since freezing originates from the small uninsulated tip of a probe, cryosurgery can be confined to a region of the diseased tissue, thereby sparing surrounding healthy tissue. The freezing process can be precise and controlled, as the freezing interface is sharp and propagates slowly (in the order of mm/min). A small probe having a diameter of around 3 mm can produce a 3.5 cm ice ball, and therefore treat a relatively large tissue region. When the shape of the pathological tissue is large and complex, several probes can be used simultaneously to generate a frozen region of a desired shape. For example, prostate and liver cryosurgery is currently performed with five 3 mm diameter probes. Multiple sites can be treated separately or together. Because the only physical invasion of the tissue is the insertion of the cryoprobes, cryosurgery does not create a lot of complications, and patient morbidity is low. Cryosurgery can produce excellent medical results with less distress and disfiguration at a lower cost. In addition, cryosurgery is not dose limited, therefore retreatment is possible. Web site: http://www.delphion.com/details?pn=US06041787__

Patent Applications on Cryosurgery As of December 2000, U.S. patent applications are open to public viewing.6 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to cryosurgery: •

Apparatus and method for compressing a gas, and cryosurgery system and method utilizing same Inventor(s): Zvuloni, Roni; (Haifa, IL) Correspondence: G.E. Ehrlich (1995) LTD.; C/o Anthony Castorina; Suite 207; 2001 Jefferson Davis Highway; Arlington; VA; 22202; US Patent Application Number: 20020068929 Date filed: November 15, 2001 Abstract: An apparatus for compressing a gas and its uses are disclosed. The apparatus comprises a fixed-volume container having a hollow and a moveable element subdividing said hollow into a first variable-volume portion and a second variablevolume portion, the second variable-volume portion having an opening for introducing therein a hydraulic and/or pneumatic fluid under pressure, for causing an increase in the volume of said second variable-portion by moving said moveable element, thereby, consequently, decreasing the volume of the first variable-volume portion and compressing a gas contained therein. Excerpt(s): This is a continuation-in-part of U.S. patent application Ser. No. 09/860,486, filed May 21, 2001, which claims the benefit of priority from U.S. Provisional Patent Application No. US 60/242,455, filed Oct. 24, 2000, now expired. The present invention relates to apparatus and method for compressing and/or re-compressing gas and

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

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further to the use of in situ gas compression as a source of compressed gas to a compressed gas utilizing application, such as a cryoablation apparatus. Many methods are known in the art for mechanically compressing (pressurizing) gas, for storing compressed (pressurized) gas in containers, for transporting compressed gas to sites where the compressed gas is to be used, and for utilizing compressed gasses for a variety of purposes in a variety of utility applications. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Apparatus and method for cryosurgery Inventor(s): Lewis, James D.; (Flagstaff, AZ), Myers, David J.; (Camp Verde, AZ) Correspondence: David J. Johns; W. L. Gore & Associates, INC.; 551 Paper Mill Road; P.O. Box 9206; Newark; DE; 19714-9206; US Patent Application Number: 20040024392 Date filed: August 5, 2002 Abstract: An improved apparatus for delivery of cryosurgery fluid in a surgical or other medical environment is disclosed. The preferred apparatus comprises a multiplelayered expanded polytetrafluoroethylene conduit that has a low profile, has low thermal conductivity, and provides exceptional flexibility. A wide variety of treatment instrumentalities may be employed on the end of the conduit to provide medical treatments ranging from direct topical application of cryosurgery fluid to open or closed-system surgical or endosurgical uses. Excerpt(s): The present invention relates to apparatus and method for use in handling and controlled delivery of cold fluids. In particular, the present invention relates to apparatus and methods for using cold fluids in a medical environment. Cold to extremely cold fluids, both as gases and liquids, are used in various surgical procedures today. Typically, such fluids, such as liquid nitrogen or liquid air, are applied in a focused manner to a patient's tissue to kill unwanted cells, such as cancerous tissue, or to freeze tissue or an entire organ for later use. Such uses include procedures referred to as "cryoablation" and "cryotherapy." Applications for these materials include topical use to treat skin defects, ablation of cancer or other malfunctioning cells, cardiac ablation, prostate and inter-uterine treatments, and intravascular treatments, such as for prevention of stenosis. In cryosurgery in its simplest form, such as for topical applications, physicians generally use a metal nozzle directly attached to a canister of cryogenic fluid. The nozzle sprays cryogenic fluid onto the patient to freeze the target site. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Apparatus and method for cryosurgery within a body cavity Inventor(s): McGlone, James; (Garden City, NY), Moore, Yan; (Woodmere, NY), Sofer, Paul; (Zofit, IL), Zvuloni, Roni; (Haifa, IL) Correspondence: G.E. Ehrlich (1995) LTD.; C/o Anthony Castorina; Suite 207; 2001 Jefferson Davis Highway; Arlington; VA; 22202; US Patent Application Number: 20020188287 Date filed: May 21, 2002

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Abstract: Apparatus and method for cryosurgery within a body cavity are disclosed. The apparatus includes a trocar installable in an external passageway opened in a wall of a body cavity of a patient, the trocar having a portal serving to maintain and control the external passageway after installation of the trocar, the portal being useable for transmitting therethrough at least one surgical instrument for use during a surgical procedure. The apparatus further includes at least one cryoprobe deployable through the portal of the trocar into a body cavity. The cryoprobe is operable to be positioned in the body cavity in a selected orientation and position, and to cryoablate a tissue within the body cavity when in that selected orientation and position. Excerpt(s): This application claims the benefit of priority from U.S. Provisional Patent Application No. 60/291,990, filed May 21, 2001, and U.S. Provisional Patent Application No. 60/300,097, filed Jun. 25, 2001 the disclosure thereof is incorporated herein by reference. The present invention relates to an apparatus and method for cryosurgery within a body cavity. More particularly, the present invention relates to an apparatus including a trocar having an edge shaped for penetrating an external wall of a body cavity, thereby opening an external passageway into that body cavity, and also having a portal serving to maintain and control that external passageway after installation of the trocar, the portal being useable for transmitting therethrough at least one surgical instrument for use during a surgical procedure. The apparatus further includes at least one cryoprobe deployable through a portal of the trocar into the body cavity, which cryoprobe is operable to be positioned in the body cavity in a selected orientation and position, and is further operable to cryoablate a tissue within said body cavity when in said selected orientation and position. Cryosurgical procedures involve deep tissue freezing which results in tissue destruction due to rupture of cells and or cell organelles within the tissue. Deep tissue freezing is effected by insertion of a tip of a cryosurgical device into the tissue, and formation of, what is known in the art as, an ice-ball around the tip. Deep freezing of tissues has come to be seen as a minimally invasive surgical technique of choice for a variety of conditions requiring ablation of tissues, having the advantage of minimal destruction of healthy tissues outside the pathological site. In this respect, cryosurgery has been found to be superior to other tissue ablation techniques, for a variety of conditions. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Apparatus and method for cryosurgical treatment of tumors of the breast Inventor(s): Amir, Uri; (Or Yehuda, IL), Barkama, Ravit; (Raanana, IL), Schechter, Doris; (Zikhron, IL), Zvuloni, Roni; (Haifa, IL) Correspondence: Antonhy Castorina; G E Ehrlich; Suite 207; 2001 Jefferson Davis Highway; Arlington; VA; 22202; US Patent Application Number: 20030181896 Date filed: December 27, 2002 Abstract: The present invention relates to system, device, and method utilizing cryosurgery to treat a tumor of the breast. More particularly, the present invention relates to treating a breast tumor by inserting into a breast, at a selected site known to be a locus of a tumor, an introducer having at least one access port, operating a biopsy needle through an access port to perform a biopsy of tissues at the selected site, and operating a cryoprobe through an access port to cool body tissues to cryoablation temperatures, thereby ablating or downsizing the tumor. The present invention further

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relates to use of cryoablation to downsize a large malignant tumor as pre-operative preparation for conventional excision surgery. Excerpt(s): Breast cancer is the most common type of malignancy occurring in women worldwide. Thus, there is a widely felt need for, and it would be highly advantageous to have, a therapeutic approach to benign and malignant breast tumors which speeds, shortens and simplifies clinical treatment of breast tumors tentatively diagnosed as benign, and which speeds, shortens, and simplifies pre-operative treatment of tumors thought to be malignant. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Computer Guided cryosurgery Inventor(s): Eum, Jay; (Irvine, CA), Mikus, Paul W.; (Irvine, CA), Wong, Wilson S.; (Alhambra, CA) Correspondence: Lawrence N. Ginsberg; Endocare; 7 Studebaker; Irvine; CA; 92618; US Patent Application Number: 20020016540 Date filed: September 20, 2001 Abstract: The present invention is a system for placing cryoprobes in a treatment area of a human patient. The system includes a computer system for displaying an image of a treatment area, a template of suggested cryoprobe placements in the treatment area and images of actual cryoprobes placed within the treatment area. The computer system is programmed to perform the steps of: acquiring the image of the treatment area, determining desired dimensions of the treatment area based on the image of the treatment area, determining the optimal cryoprobe placements in the treatment area based on the determined desired dimensions to provide the template of suggested cryoprobe placements, acquiring the images of actual cryoprobes placed within the treatment area, and overlaying the template of suggested cryoprobe placements on the acquired images of actual cryoprobes. The resulting overlaying is provided on a display of the computer system, thereby allowing the surgeon to compare the actual cryoprobe placements with the optimal cryoprobe placements as determined by the computer system. Excerpt(s): The inventions described herein relate to the field of cryosurgery and ablative surgery. The system and methods described below enhance the accuracy and effectiveness of cryosurgery of the prostate and other treatment areas of a human patient. Cryosurgery of prostate is an effective treatment for prostate cancer and benign prostate hyperplasia, conditions which affect many men. The use of cryosurgical probes for cryoablation of prostate is described in Onik, Ultrasound-Guided Crvosurgery, Scientific American at 62 (January 1996) and Onik, Cohen, et al., Transrectal UltrasoundGuided Percutaneous Radial Cryosurgical Ablation Of The Prostate, 72 Cancer 1291 (1993). In this procedure, generally referred to as cryoablation of the prostate, several cryosurgical probes are inserted through the skin in the perineal area (between the scrotum and the anus) which provides the easiest access to the prostate. The probes are pushed into the prostate gland through previously placed cannulas. Placement of the probes within the prostate gland is visualized with an ultrasound imaging probe placed in the rectum. The probes are quickly cooled to temperatures typically below -120 C. The prostate tissue is killed by the freezing, and any tumor or cancer within the prostate is also killed. The body will absorb some of the dead tissue over a period of several weeks. Other necrosed tissue may slough off through the urethra. The urethra, bladder neck

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sphincter and external sphincter are protected from freezing by a warming catheter placed in the urethra and continuously flushed with warm saline to keep the urethra from freezing. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Cryosurgery compositions and methods Inventor(s): Bischof, John C.; (St. Paul, MN), Han, Bumsoo; (Minneapolis, MN) Correspondence: Mueting, Raasch & Gebhardt, P.A.; P.O. Box 581415; Minneapolis; MN; 55458; US Patent Application Number: 20040039381 Date filed: June 13, 2003 Abstract: A eutectic changing composition, including a system and method of its use. The eutectic changing composition can be used in a localized area of a biological material, such as in a mammal, where the eutectic changing composition includes as an active ingredient at least one solute effective to change a tissue eutectic freezing point at the localized area of biological material. The solute can be effective to increase the tissue eutectic freezing point of the biological material. Excerpt(s): This application claims priority from U.S. Provisional Application Serial No. 60/388,223, filed Jun. 13, 2002, the entire content of which is incorporated herein by reference. The present invention relates generally to cryosurgery. Cryosurgery is a minimally invasive surgery technique in which malignant tissue is destroyed by freezing. During a cryosurgery, freezing of malignant tissue is achieved with either single or multiple fine surgical probes which can be cooled to extremely low temperatures (less than minus one-hundred twenty degrees Celsius (-120.degree. C.). The probes are inserted to the tissue with the guidance of imaging techniques like ultrasound. After the insertion, the probes are cooled. Ice balls form and grow from the surface of the cooled probes. Due to its minimally invasive characteristics and recent advances in monitoring technology during a surgery, cryosurgery is emerging as a promising treatment modality for prostate, liver and breast cancers. However, the understanding and precise control of the mechanism of freezing injury needs to be addressed for improved treatment efficacy. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Entry position grid for computer guided cryosurgery Inventor(s): Eum, Jay J.; (Irvine, CA), Mikus, Paul W.; (Irvine, CA), Wong, Wilson S.; (Alhambra, CA) Correspondence: Lawrence N. Ginsberg; Endocare, INC.; 201 Technology Drive; Irvine; CA; 92618; US Patent Application Number: 20020198518 Date filed: April 11, 2002 Abstract: An entry position grid for aiding a user in locating the approximate entry points of a plurality of cryoprobes into a patient, wherein the cryoprobes are inserted into the perineal area of the patient and then into the prostate, the entry position grid including a frame portion having a center longitudinal axis, a grid portion extending

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across the frame portion, the grid portion defining a plurality of evenly spaced discrete openings, identifying indicia located on the frame that identifies each discrete opening, each discrete opening being adapted to allow the user to position the cryoprobes through the entry position grid and into the patient at an angle that is not parallel to the center axis, the grid portion comprising a continuous strand of flexible material that is attached to the frame portion. Excerpt(s): This application is a continuation-in-part patent application of U.S. application Ser. No. 09/699,938 filed on Oct. 30, 2000. Cryosurgical probes are used to destroy living tissue by thermally manipulating a cryoprobe to extreme temperatures by using freezing and heating cycles. Current cryosurgical probes are incorporated into computer guided cryosurgery systems wherein the system calculates the optimal placement for the cryoprobes into diseased tissue. However, current computer guided cryosurgical systems restrict the user to a single insertion angle. As a result, collateral and healthy tissue may be frozen and damaged as a result of the current insertion angle limitations of the cryoprobes. Therefore, what is needed is a computer guided cryosurgical apparatus, system, and method that allow the user to introduce cryosurgical probes into the patient with a wide variety of insertion angles. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Fiber optic probe for temperature measurements in biological media Inventor(s): Ellingsen, Reinold; (Heimdal, NO) Correspondence: Rothwell, Figg, Ernst & Manbeck, P.C.; 1425 K Street, N.W.; Suite 800; Washington; DC; 20005; US Patent Application Number: 20020147394 Date filed: March 11, 2002 Abstract: The invention relates to an insertion probe for sensing distributed temperature comprising a tube containing at least one optical fiber being inscribed with at least one Bragg grating, the tube being sealed at its distal end. The probe is characterized in that it consists of materials having low magnetic susceptibility. The invention also relates to the use of such a probe in cryosurgery to allow the use of magnetic resonance imaging. Excerpt(s): This application is a continuation-in-part of International application no. PCT/NO00/00291, filed Sep. 7, 2000. This invention relates to an insertion probe and the use of this for sensing temperature, particularly during cryosurgery. Thermal energy in interaction with biological matter is being used both in medicine and in the food processing industry. Exchange of thermal energy inside any system or between systems involves heat transfer processes that in turn affect the local temperature and its temporal and spatial distribution. Bioheat transfer analysis in living systems is generally complicated by the fact that the thermal properties are generally nonhomogeneous and anisotropic with considerable variations intra and inter specimen samples. Biological matter responds to the exposure of temperature changes in different ways. Consequently it might be argued that in situ monitoring of the thermal profile inside some confined volume during these procedures is of interest in a variety of applications. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Hand-held, heat sink cryoprobe, system for heat extraction thereof, and method therefore Inventor(s): Bailey, Richard; (Mandeville, LA), Haas, Michael; (Covington, LA), Krentel, Jerome F.; (Covington, LA) Correspondence: Joseph T. Regard, Ltd Plc; PO Drawer 429; Madisonville; LA; 704470429; US Patent Application Number: 20030024250 Date filed: August 1, 2002 Abstract: A cryoprobe system utilizing a monolithic, insulated, hand-held thermal mass having an exposed tip for cryosurgical applications and the like, as well as a heat extraction base configured to interface with the thermal mass to quickly and efficiently reduce the heat of the thermal mass to cryogenic temperatures. The heat extraction base of the preferred embodiment of the present invention is configured to interface with the tip of the thermal mass, such that the tip plugs in securely to the base, to permit an efficient thermal transfer of heat from the thermal mass through the base via a heat exchange system communicating with the base which employs a low temperature cryorefrigeration unit. The cryo-refrigeration unit may comprise a single low temperature cooling unit to reduce the temperature of the base to around minus one hundred degrees Centigrade utilizing off-the-shelf cryogenic refrigeration methods, or may utilize a series of more conventional refrigeration units in a primary and secondary heat extraction arrangement, which method may further utilize thermocouple or Peltier effect device assist to further reduce the temperature of the heat extraction base to the required temperature. Also claimed is the method of cryosurgery employing the device(s) of the present invention, and a heat pipe appliance to engage a remote treatment area. Excerpt(s): The present application is a continuation-in-part of U.S. patent application Ser. No. 09/858,083, filed May 15, 2001 entitled "Hand-Held, Heat Sink Cryoprobe, System for Heat Extraction Thereof, and Method Therefore". The cryo-refrigeration unit may comprise a single low temperature compressor to reduce the temperature of the base to around minus one hundred degrees Centigrade utilizing off-the-shelf cryogenic refrigeration methods, or may utilize a series of more conventional refrigeration units in a primary and secondary heat extraction arrangement, which method may further utilize thermocouple or Peltier effect device assist to further reduce the temperature of the heat extraction base to the required temperature. Cryosurgery, or cryo-ablation, employs the technique of destructively freezing, or ablating, targeted biological tissue to destroy same. A large array of systems for cryosurgery have been developed since its inception utilizing low and high pressure cryogenic liquid refrigerants, closed refrigeration systems, to solid state thermoelectric devices. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Multiple cryoprobe apparatus and method Inventor(s): Schatzberger, Shaike; (Haifa, IL), Zvuloni, Roni; (Haifa, IL) Correspondence: G.E. Ehrlich (1995) LTD.; C/o Anthony Castorina; Suite 207; 2001 Jefferson Davis Highway; Arlington; VA; 22202; US Patent Application Number: 20020049436 Date filed: May 21, 2001

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Abstract: A cryosurgery apparatus is disclosed. The cryosurgery apparatus an introducer having a hollow and a distal portion, the distal portion being sufficiently sharp so as to penetrate into a body, the hollow of the introducer being designed and constructed for containing a plurality of cryoprobes each of the cryoprobes being for effecting cryoablation, such that each of the plurality of cryoprobes is deployable through the distal portion of the introducer when the distal portion is positioned with respect to a tissue to be cryoablated. Excerpt(s): This Application claims the benefit of priority from U.S. Provisional Patent Application No. 60/242,455, filed Oct. 24, 2000, the disclosure thereof is incorporated herein by reference. The present invention relates to an apparatus and method of cryoablation, and more particularly for cryoablation using multiple probes introduced into the body of a patient through a common introducer, so as to perform cryoablation of a particular volume of tissue while minimizing damage to adjacent healthy tissues. A variety of medical conditions are preferentially treated by ablation of tissues within the body. Classically, ablation was performed using invasive surgical procedures requiring cutting or destroying tissues between the exterior of the body and the particular site whose ablation is desired. More recently, less invasive procedures have been developed, which bring about the destruction of selected tissues using a probe or probes which penetrate to the area to be operated, and destroy the selected tissue by transferring energy to those tissues; RF energy, light (laser) energy, microwave energy, and highfrequency ultra-sound energy are among the forms which have been used. However all such methods have the common disadvantage that while transferring energy to the tissues whose destruction is intended, they tend also to transfer energy, through conduction, convection, and other natural processes, to nearby healthy tissues as well. All such energy transfer methods ultimately result in heat release, causing complications and adverse effects. Noticeable pain results, the functioning of nearby healthy tissues is impaired, and the healthy tissues are often damaged or destroyed. Moreover, in some cases tissues exposed to thermal energy or other forms of energy that raise their temperatures secrete substances that may be toxic to adjacent healthy tissues. 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 cryosurgery, 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 “cryosurgery” (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 cryosurgery. You can also use this procedure to view pending patent applications concerning cryosurgery. 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 5. BOOKS ON CRYOSURGERY Overview This chapter provides bibliographic book references relating to cryosurgery. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on cryosurgery include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “cryosurgery” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on cryosurgery: •

Inner Ear Surgeries: Meant to Control Vertigo-Disequilibrium Source: Portland, OR: Vestibular Disorders Association (VEDA). 1996. 36 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: $10.00 plus shipping and handling. Order number B-5. Summary: This document from the Vestibular Disorders Association (VEDA) describes inner ear surgeries used to control vertigo or disequilibrium. The author stresses that most individuals who develop vestibular problems will never need to consider surgical treatment. The majority of those people will have either a spontaneous resolution of the symptoms or will respond satisfactorily to medical management such as dietary changes, vestibular rehabilitation, or medication. However, surgical procedures exist for many vestibular problems including acoustic neuroma, endolymphatic hydrops,

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Meniere's disease, vascular compression syndrome, benign paroxysmal positional vertigo (BPPV) and benign paroxysmal positional nystagmus (BPPN), cholesteatoma, perilymph fistula, and otosclerosis. The author notes that some of the procedures described in this document may also be meant to preserve or improve hearing; however, they have been included because of their intended control of vertigo or disequilibrium. Descriptions of surgical treatments include information about intended outcomes and possible bad outcomes. Procedures described include general surgery, such as mastoidectomy and tympanotomy; procedures for inner-ear problems, including labyrinthectomy, gentamicin ear treatment, vestibular nerve section, and PE (pneumatic equalization) tubes; procedures for problems other than Meniere's disease or endolymphatic hydrops, including perilymph fistula repair, posterior canal partitioning, microvascular decompression, stapedectomy, acoustic neuroma removal, and cholesteatoma removal; procedures some times used for Meniere's disease and endolymphatic hydrops, including endolymphatic sac decompression procedures and cochleosacculotomy; and procedures less often used for Meniere's disease or endolymphatic hydrops, including sacculotomy (tack procedure or Cody tack), cryosurgery, ultrasound surgery (done in Sweden), and cochlear dialysis. 36 references.

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 “cryosurgery” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “cryosurgery” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “cryosurgery” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •

Advances in cryosurgery (Clinics in dermatology); ISBN: 0444015388; http://www.amazon.com/exec/obidos/ASIN/0444015388/icongroupinterna

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Advances in Cryosurgery: 7th International Congress of Cryosurgery October 11-14, 1989, Beijing, China by China) International Congress of Cryosurgery 1989 Beijing, China Chinese Association of Refrigeration : Peking; ISBN: 0080375030; http://www.amazon.com/exec/obidos/ASIN/0080375030/icongroupinterna

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Handbook of cryosurgery (Science and practice of surgery); ISBN: 0824769813; http://www.amazon.com/exec/obidos/ASIN/0824769813/icongroupinterna

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

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Liver Cancer: Are You at Risk? Source: in Everson, G.T.; Weinberg, H. Living with Hepatitis B: A Survivor's Guide. Long Island, NY: Hatherleigh Press. 2002. p.198- 209. Contact: Available from Hatherleigh Press. 5-22 46th Avenue Suite 200, Long Island City, NY 11101. (800) 528-2550. E-mail: [email protected]. Website: http://store.yahoo.com/hatherleighpress/index.html. PRICE: $15.95 plus shipping and handling. ISBN: 1578260841. Summary: Chronic hepatitis B can lead to cirrhosis (liver scarring), liver cancer, and the need for liver transplantation. This chapter on liver cancer is from a book that helps readers diagnosed with hepatitis B virus (HBV) infection educate themselves about the disease and its treatment. Primary liver cancer is an extremely serious, life threatening complication of chronic hepatitis B. The authors discuss risk factors, warning signs, screening and diagnostic tests for liver cancer, and results of current treatment. Specific topics include primary liver cancer, secondary liver cancer, stage of hepatitis B as a risk factor, duration of infection as a risk factor, other liver disease, warning signs (asymptomatic but with underlying cirrhosis, deterioration in liver function, pain, sudden development of portal hypertension), testing, early screening guidelines, diagnostic tests, treatment options, cancer staging, hepatic (liver) resection, transplantation, chemoembolization, high frequency radio waves (radiofrequency tumor ablation), alcohol injection, cryosurgery, and chemotherapy. Throughout the chapter the authors include quotes from real people who are living with hepatitis.

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Cryosurgical Ablation of the Prostate Source: in Graham, S.D., Jr., et al., eds. Glenn's Urologic Surgery. 5th ed. Philadelphia, PA: Lippincott Williams and Wilkins. 1998. p. 1101-1104. 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: Cryosurgery (freezing) for the treatment of prostate cancer has currently received renewed enthusiasm. This chapter on cryosurgical ablation of the prostate is from an exhaustive textbook on urologic surgery. Significant innovations include a new liquid nitrogen delivery system, which allows the delivery of super cooled liquid nitrogen or argon gas through small (3 mm) probes; percutaneous access technique; and the ability to evaluate the extent of freezing by transrectal ultrasound imaging. The ideal candidate for cryosurgical ablation of the prostate is an individual with local recurrence after treatment with radiation therapy because there is no other successful definitive therapy, other than palliation (treatment that soothes or relieves), for these patients. The author details the surgical procedure used, including the equipment and supplies. The procedure is carried out under general or regional anesthesia. The patient goes home on the first postoperative day. In addition to some scrotal and perineal edema (fluid accumulation) and ecchymosis (bruising), many patients will experience some sloughing of urethral tissue. Urinary incontinence has been reported in as many as 5 percent of patients after cryoablation; in most patients this resolves without intervention. Urinary tract infection has also been reported, especially in patients who are experiencing significant amounts of sloughing of urethral tissue. The majority of centers performing cryoablation of the prostate report promising results, with negative biopsy results of 70 to 80 percent 6 months after the procedure. When cryoablation has been successfully performed, the PSA in patients drops rapidly to the undetectable level and remains there. 4 figures. 4 references.

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Hemorrhoids Source: in Corman, M.L.; Allison, S.I.; Kuehne, J.P. Handbook of Colon and Rectal Surgery. Philadelphia, PA: Lippincott Williams and Wilkins. 2002. p.83-136. Contact: Available from Lippincott Williams and Wilkins. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-3030 or (301) 223-2300. Fax (301) 223-2365. PRICE: $79.00 plus shipping and handling. ISBN: 0781725860. Summary: Hemorrhoidal disease affects more than 1 million Americans per year. This chapter on hemorrhoids is from a handbook that addresses the entire range of diseases affecting the colon, rectum, and anus. The authors review factors that may contribute to the development of hemorrhoids, then discuss etiology and anatomy, portal hypertension and rectal varices, physiology, classification, differential diagnosis, signs and symptoms, examination, general principles of treatment (for bleeding, prolapse, and pain), ambulatory treatment (rubber band ligation, sclerotherapy, cryosurgery, infrared coagulation, ultroid, Lord's dilatation, bipolar diathermy), treatment of thrombosed hemorrhoids, treatment of gangrenous, prolapsed, edematous hemorrhoids, surgical hemorrhoidectomy, anoplasty, hemorrhoids in inflammatory bowel disease (IBD), hemorrhoidectomy in the HIV-positive patient, and hemorrhoidectomy during pregnancy. For each technique, the authors cover patient selection, preoperative care, surgical techniques, and postoperative complications. 21 figures.

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CHAPTER 6. PERIODICALS AND NEWS ON CRYOSURGERY Overview In this chapter, we suggest a number of news sources and present various periodicals that cover cryosurgery.

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

Modern cryosurgery effective treatment for renal and prostatic tumors Source: Reuters Medical News Date: October 07, 2003

•

Radiofrequency appears superior to cryosurgery in preventing liver metastases Source: Reuters Medical News Date: January 02, 2003

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•

Nerve-sparing cryosurgery for prostate cancer can preserve potency Source: Reuters Medical News Date: August 09, 2002

•

Endocare wins US clearance for thoracoscopic cryosurgery system Source: Reuters Industry Breifing Date: February 06, 2002

•

Focused cryosurgery preserves potency in prostate cancer patients Source: Reuters Industry Breifing Date: November 28, 2001

•

Healing, discomfort after cervical cryosurgery more prolonged than recognized Source: Reuters Medical News Date: August 29, 2000

•

Mild cryosurgery safely resolves capillary hemangiomas in infants Source: Reuters Medical News Date: June 01, 2000

•

Breast Cancer Cryosurgery Successful In Animals And First Human Source: Reuters Medical News Date: February 06, 1997 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 “cryosurgery” (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.

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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 “cryosurgery” (or synonyms). If you know the name of a company that is relevant to cryosurgery, 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 “cryosurgery” (or synonyms).

Academic Periodicals covering Cryosurgery Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to cryosurgery. In addition to these sources, you can search for articles covering cryosurgery that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

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APPENDICES

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APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute7: •

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/

7

These publications are typically written by one or more of the various NIH Institutes.

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National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

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

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

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

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

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

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

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National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

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National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

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

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National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

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

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

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

•

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

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Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.8 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:9 •

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

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Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

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

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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

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

•

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

8

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). 9 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 Gateway10 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.11 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “cryosurgery” (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 8561 183 20 9 1 8774

HSTAT12 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.13 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.14 Simply search by “cryosurgery” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

10

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

11

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). 12 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 13 14

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 Biologists15 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.16 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.17 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/.

15 Adapted 16

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. 17 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 cryosurgery 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 cryosurgery. 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 cryosurgery. 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 “cryosurgery”:

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Cervical Cancer http://www.nlm.nih.gov/medlineplus/cervicalcancer.html Liver Cancer http://www.nlm.nih.gov/medlineplus/livercancer.html Prostate Cancer http://www.nlm.nih.gov/medlineplus/prostatecancer.html Scars http://www.nlm.nih.gov/medlineplus/scars.html 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 cryosurgery. 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: •

HPV and Cervical Cancer Screening Contact: American Social Health Association, PO Box 13827, Research Triangle Park, NC, 27709, (919) 361-8400. Summary: This brochure presents women with information about the human papillomavirus (HPV) and its relationship to cervical cancer. HPV includes a group of viruses generally known to cause warts on the body. Genital HPV types are sexually transmitted and cause genital warts or cause cell changes on the cervix that increase a woman's risk for cervical cancer. The brochure makes recommendations about how to cope with and prevent HPV. HPV is generally detected using a Pap smear. When Pap smears detect abnormal cells, further exams are usually needed such as a biopsy, colposcopy, or endocervical curettage. The types of HPV that cause genital warts are categorized by their risks for cervical cancer. The brochure provides a table to help individuals understand the meaning of their Pap smear results. The HPV testing process is discussed. Some of the options available to women to help them to manage growths of genital warts include cryosurgery, laser removal, electro-cauterization, and a cone biopsy. The brochure provides contact information for services from which individuals can learn more about HPV and other sexually transmitted diseases (STDs).

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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: •

Questions and Answers About Cryosurgery in Cancer Treatment Summary: Answers to questions about the use of cryosurgery to treat internal cancer tumors, including tumors of the prostate. Source: National Cancer Institute, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=2026 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 cryosurgery. 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

•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

•

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

•

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

•

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

•

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 cryosurgery. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with cryosurgery.

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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 cryosurgery. 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 “cryosurgery” (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 “cryosurgery”. 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 “cryosurgery” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “cryosurgery” (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.18

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

18

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)19: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

•

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

•

California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

•

California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

•

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

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

•

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

•

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

•

California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

•

California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

•

California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

•

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

•

California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

•

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

•

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

19

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

•

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

•

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

•

Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

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Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

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Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

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Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

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Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

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Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

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Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

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Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

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Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

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Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

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Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

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Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

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Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

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Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

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Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

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Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

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Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

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Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

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Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

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Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

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Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

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Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

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Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

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Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

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Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

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Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

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Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

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Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

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Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

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Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

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Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

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Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

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Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

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National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

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National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

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National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

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Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

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New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

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New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

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New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

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New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

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New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

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New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

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New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

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New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

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Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

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Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

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Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

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Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

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Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

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Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

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Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

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Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

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Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

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Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

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Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

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South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

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Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

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Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

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Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

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MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

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Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

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Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

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

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

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Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). The NIH suggests the following Web sites in the ADAM Medical Encyclopedia when searching for information on cryosurgery: •

Basic Guidelines for Cryosurgery Cryosurgery Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002322.htm

•

Background Topics for Cryosurgery Bleeding Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000045.htm Liquid nitrogen Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002246.htm

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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

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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

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CRYOSURGERY DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. 3-dimensional: 3-D. A graphic display of depth, width, and height. Three-dimensional radiation therapy uses computers to create a 3-dimensional picture of the tumor. This allows doctors to give the highest possible dose of radiation to the tumor, while sparing the normal tissue as much as possible. [NIH] Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Ablate: In surgery, is to remove. [NIH] Ablation: The removal of an organ by surgery. [NIH] Abscess: A localized, circumscribed collection of pus. [NIH] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Acne: A disorder of the skin marked by inflammation of oil glands and hair glands. [NIH] Acoustic: Having to do with sound or hearing. [NIH] Acrylonitrile: A highly poisonous compound used widely in the manufacture of plastics, adhesives and synthetic rubber. [NIH] Adaptability: Ability to develop some form of tolerance to conditions extremely different from those under which a living organism evolved. [NIH] Adenocarcinoma: A malignant epithelial tumor with a glandular organization. [NIH] Adenoma: A benign epithelial tumor with a glandular organization. [NIH] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [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]

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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. [EU]

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] Agar: A complex sulfated polymer of galactose units, extracted from Gelidium cartilagineum, Gracilaria confervoides, and related red algae. It is used as a gel in the preparation of solid culture media for microorganisms, as a bulk laxative, in making emulsions, and as a supporting medium for immunodiffusion and immunoelectrophoresis. [NIH]

Aggravation: An increasing in seriousness or severity; an act or circumstance that intensifies, or makes worse. [EU] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alpha 1-Antitrypsin: Plasma glycoprotein member of the serpin superfamily which inhibits trypsin, neutrophil elastase, and other proteolytic enzymes. Commonly referred to as alpha 1-proteinase inhibitor (A1PI), it exists in over 30 different biochemical variant forms known collectively as the PI (protease inhibitor) system. Hereditary A1PI deficiency is associated with pulmonary emphysema. [NIH] Alpha 1-Antitrypsin Deficiency: A disease caused by single gene defects. [NIH] Alpha Particles: Positively charged particles composed of two protons and two neutrons, i.e., helium nuclei, emitted during disintegration of very heavy isotopes; a beam of alpha particles or an alpha ray has very strong ionizing power, but weak penetrability. [NIH] 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] Ameloblastoma: An epithelial tumor of the jaw originating from the epithelial rests of Malassez or from other epithelial remnants of the developing period of the enamel. [NIH] Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Amino 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]

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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] Ampulla: A sac-like enlargement of a canal or duct. [NIH] 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] Anal Fissure: A small tear in the anus that may cause itching, pain, or bleeding. [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] Androgens: A class of sex hormones associated with the development and maintenance of the secondary male sex characteristics, sperm induction, and sexual differentiation. In addition to increasing virility and libido, they also increase nitrogen and water retention and stimulate skeletal growth. [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] Animal model: An animal with a disease either the same as or like a disease in humans. Animal models are used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Anterior chamber: The space in front of the iris and behind the cornea. [NIH] Antiallergic: Counteracting allergy or allergic conditions. [EU] Antiandrogens: Drugs used to block the production or interfere with the action of male sex hormones. [NIH] Antiarrhythmic: An agent that prevents or alleviates cardiac arrhythmia. [EU] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] 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] Antifungal: Destructive to fungi, or suppressing their reproduction or growth; effective against fungal infections. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue

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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] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Anti-Inflammatory Agents: Substances that reduce or suppress inflammation. [NIH] Antimetabolite: A chemical that is very similar to one required in a normal biochemical reaction in cells. Antimetabolites can stop or slow down the reaction. [NIH] Antineoplastic: Inhibiting or preventing the development of neoplasms, checking the maturation and proliferation of malignant cells. [EU] Anus: The opening of the rectum to the outside of the body. [NIH] Aorta: The main trunk of the systemic arteries. [NIH] Approximate: Approximal [EU] Aqueous: Having to do with water. [NIH] Arachidonic Acid: An unsaturated, essential fatty acid. It is found in animal and human fat as well as in the liver, brain, and glandular organs, and is a constituent of animal phosphatides. It is formed by the synthesis from dietary linoleic acid and is a precursor in the biosynthesis of prostaglandins, thromboxanes, and leukotrienes. [NIH] Argon: A noble gas with the atomic symbol Ar, atomic number 18, and atomic weight 39.948. It is used in fluorescent tubes and wherever an inert atmosphere is desired and nitrogen cannot be used. [NIH] Arrhythmogenic: Producing or promoting arrhythmia. [EU] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] 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] Arthroplasty: Surgical reconstruction of a joint to relieve pain or restore motion. [NIH] Artifacts: Any visible result of a procedure which is caused by the procedure itself and not by the entity being analyzed. Common examples include histological structures introduced by tissue processing, radiographic images of structures that are not naturally present in living tissue, and products of chemical reactions that occur during analysis. [NIH] Artificial Organs: Devices intended to replace non-functioning organs. They may be temporary or permanent. Since they are intended always to function as the natural organs they are replacing, they should be differentiated from prostheses and implants and specific types of prostheses which, though also replacements for body parts, are frequently cosmetic (artificial eye) as well as functional (artificial limbs). [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] Asymptomatic: Having no signs or symptoms of disease. [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] Atrial: Pertaining to an atrium. [EU] Atrial Fibrillation: Disorder of cardiac rhythm characterized by rapid, irregular atrial

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impulses and ineffective atrial contractions. [NIH] Atrial Flutter: Rapid, irregular atrial contractions due to an abnormality of atrial excitation. [NIH]

Atrioventricular: Pertaining to an atrium of the heart and to a ventricle. [EU] Atrioventricular Node: A small nodular mass of specialized muscle fibers located in the interatrial septum near the opening of the coronary sinus. It gives rise to the atrioventricular bundle of the conduction system of the heart. [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] Attenuation: Reduction of transmitted sound energy or its electrical equivalent. [NIH] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Auricular: Pertaining to an auricle or to the ear, and, formerly, to an atrium of the heart. [EU] Autosuggestion: Suggestion coming from the subject himself. [NIH] Axillary: Pertaining to the armpit area, including the lymph nodes that are located there. [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] Basal cell carcinoma: A type of skin cancer that arises from the basal cells, small round cells found in the lower part (or base) of the epidermis, the outer layer of the skin. [NIH] Basal cells: Small, round cells found in the lower part (or base) of the epidermis, the outer layer of the skin. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Basement Membrane: Ubiquitous supportive tissue adjacent to epithelium and around smooth and striated muscle cells. This tissue contains intrinsic macromolecular components such as collagen, laminin, and sulfated proteoglycans. As seen by light microscopy one of its subdivisions is the basal (basement) lamina. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Benign tumor: A noncancerous growth that 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] Biliary: Having to do with the liver, bile ducts, and/or gallbladder. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biological response modifier: BRM. A substance that stimulates the body's response to infection and disease. [NIH] Biological therapy: Treatment to stimulate or restore the ability of the immune system to

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fight infection and disease. Also used to lessen side effects that may be caused by some cancer treatments. Also known as immunotherapy, biotherapy, or biological response modifier (BRM) therapy. [NIH] Biological Transport: The movement of materials (including biochemical substances and drugs) across cell membranes and epithelial layers, usually by passive diffusion. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biopsy specimen: Tissue removed from the body and examined under a microscope to determine whether disease is present. [NIH] Biosynthesis: The building up of a chemical compound in the physiologic processes of a living organism. [EU] 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] Blood Platelets: Non-nucleated disk-shaped cells formed in the megakaryocyte and found in the blood of all mammals. They are mainly involved in blood coagulation. [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 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] 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] 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 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] Bronchi: The larger air passages of the lungs arising from the terminal bifurcation of the trachea. [NIH]

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Bronchial: Pertaining to one or more bronchi. [EU] Buccal: Pertaining to or directed toward the cheek. In dental anatomy, used to refer to the buccal surface of a tooth. [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] Callus: A callosity or hard, thick skin; the bone-like reparative substance that is formed round the edges and fragments of broken bone. [NIH] Camptothecin: An alkaloid isolated from the stem wood of the Chinese tree, Camptotheca acuminata. This compound selectively inhibits the nuclear enzyme DNA topoisomerase. Several semisynthetic analogs of camptothecin have demonstrated antitumor activity. [NIH] Candidiasis: Infection with a fungus of the genus Candida. It is usually a superficial infection of the moist cutaneous areas of the body, and is generally caused by C. albicans; it most commonly involves the skin (dermatocandidiasis), oral mucous membranes (thrush, def. 1), respiratory tract (bronchocandidiasis), and vagina (vaginitis). Rarely there is a systemic infection or endocarditis. Called also moniliasis, candidosis, oidiomycosis, and formerly blastodendriosis. [EU] Capillary: Any one of the minute vessels that connect the arterioles and venules, forming a network in nearly all parts of the body. Their walls act as semipermeable membranes for the interchange of various substances, including fluids, between the blood and tissue fluid; called also vas capillare. [EU] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Carcinogenic: Producing carcinoma. [EU] Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs. [NIH]

Carcinoma in Situ: A malignant tumor that has not yet invaded the basement membrane of the epithelial cell of origin and has not spread to other tissues. [NIH] Cardiac: Having to do with the heart. [NIH] Carotene: The general name for a group of pigments found in green, yellow, and leafy vegetables, and yellow fruits. The pigments are fat-soluble, unsaturated aliphatic hydrocarbons functioning as provitamins and are converted to vitamin A through enzymatic processes in the intestinal wall. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Case series: A group or series of case reports involving patients who were given similar treatment. Reports of case series usually contain detailed information about the individual patients. This includes demographic information (for example, age, gender, ethnic origin) and information on diagnosis, treatment, response to treatment, and follow-up after treatment. [NIH]

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Castration: Surgical removal or artificial destruction of gonads. [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] Catheter Ablation: Removal of tissue with electrical current delivered via electrodes positioned at the distal end of a catheter. Energy sources are commonly direct current (DCshock) or alternating current at radiofrequencies (usually 750 kHz). The technique is used most often to ablate the AV junction and/or accessory pathways in order to interrupt AV conduction and produce AV block in the treatment of various tachyarrhythmias. [NIH] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [EU] Caustic: An escharotic or corrosive agent. Called also cauterant. [EU] Cauterization: The destruction of tissue with a hot instrument, an electrical current, or a caustic substance. [NIH] Celiac Artery: The arterial trunk that arises from the abdominal aorta and after a short course divides into the left gastric, common hepatic and splenic arteries. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Death: The termination of the cell's ability to carry out vital functions such as metabolism, growth, reproduction, responsiveness, and adaptability. [NIH] Cell Division: The fission of a cell. [NIH] Cell membrane: Cell membrane = plasma membrane. The structure enveloping a cell, enclosing the cytoplasm, and forming a selective permeability barrier; it consists of lipids, proteins, and some carbohydrates, the lipids thought to form a bilayer in which integral proteins are embedded to varying degrees. [EU] Cell motility: The ability of a cell to move. [NIH] Cell Survival: The span of viability of a cell characterized by the capacity to perform certain functions such as metabolism, growth, reproduction, some form of responsiveness, and adaptability. [NIH] Cementation: The joining of objects by means of a cement (e.g., in fracture fixation, such as in hip arthroplasty for joining of the acetabular component to the femoral component). In dentistry, it is used for the process of attaching parts of a tooth or restorative material to a natural tooth or for the attaching of orthodontic bands to teeth by means of an adhesive. [NIH]

Cerebral: Of or pertaining of the cerebrum or the brain. [EU] 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] 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]

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Cervical intraepithelial neoplasia: CIN. A general term for the growth of abnormal cells on the surface of the cervix. Numbers from 1 to 3 may be used to describe how much of the cervix contains abnormal cells. [NIH] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH] Chemoembolization: A procedure in which the blood supply to the tumor is blocked surgically or mechanically, and anticancer drugs are administered directly into the tumor. This permits a higher concentration of drug to be in contact with the tumor for a longer period of time. [NIH] Chemotherapy: Treatment with anticancer drugs. [NIH] Cholesteatoma: A non-neoplastic keratinizing mass with stratified squamous epithelium, frequently occurring in the meninges, central nervous system, bones of the skull, and most commonly in the middle ear and mastoid region. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Choline: A basic constituent of lecithin that is found in many plants and animal organs. It is important as a precursor of acetylcholine, as a methyl donor in various metabolic processes, and in lipid metabolism. [NIH] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Cicatrix: The formation of new tissue in the process of wound healing. [NIH] Cicatrix, Hypertrophic: An elevated scar, resembling a keloid, but which does not spread into surrounding tissues. It is formed by enlargement and overgrowth of cicatricial tissue and regresses spontaneously. [NIH] Cirrhosis: A type of chronic, progressive liver disease. [NIH] CIS: Cancer Information Service. The CIS is the National Cancer Institute's link to the public, interpreting and explaining research findings in a clear and understandable manner, and providing personalized responses to specific questions about cancer. Access the CIS by calling 1-800-4-CANCER, or by using the Web site at http://cis.nci.nih.gov. [NIH] Clamp: A u-shaped steel rod used with a pin or wire for skeletal traction in the treatment of certain fractures. [NIH] 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] Coagulation: 1. The process of clot formation. 2. In colloid chemistry, the solidification of a sol into a gelatinous mass; an alteration of a disperse phase or of a dissolved solid which causes the separation of the system into a liquid phase and an insoluble mass called the clot or curd. Coagulation is usually irreversible. 3. In surgery, the disruption of tissue by physical means to form an amorphous residuum, as in electrocoagulation and photocoagulation. [EU] 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.

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[NIH]

Cochlear: Of or pertaining to the cochlea. [EU] Colitis: Inflammation of the colon. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Colon: The long, coiled, tubelike organ that removes water from digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus. [NIH] Colorectal: Having to do with the colon or the rectum. [NIH] Colposcopy: The examination, therapy or surgery of the cervix and vagina by means of a specially designed endoscope introduced vaginally. [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, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Compress: A plug used to occludate an orifice in the control of bleeding, or to mop up

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secretions; an absorbent pad. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Computed tomography: CT scan. A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized tomography and computerized axial tomography (CAT) scan. [NIH] Computerized axial tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called CAT scan, computed tomography (CT scan), or computerized tomography. [NIH] Computerized tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized axial tomography (CAT) scan and computed tomography (CT scan). [NIH] Conduction: The transfer of sound waves, heat, nervous impulses, or electricity. [EU] Cone biopsy: Surgery to remove a cone-shaped piece of tissue from the cervix and cervical canal. Cone biopsy may be used to diagnose or treat a cervical condition. Also called conization. [NIH] Cones: One type of specialized light-sensitive cells (photoreceptors) in the retina that provide sharp central vision and color vision. [NIH] Congestive heart failure: Weakness of the heart muscle that leads to a buildup of fluid in body tissues. [NIH] Conization: The excision of a cone of tissue, especially of the cervix uteri. [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] Constriction: The act of constricting. [NIH] Constriction, Pathologic: The condition of an anatomical structure's being constricted beyond normal dimensions. [NIH] Contamination: The soiling or pollution by inferior material, as by the introduction of organisms into a wound, or sewage into a stream. [EU] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Conventional treatment: A currently accepted and widely used treatment for a certain type of disease, based on the results of past research. Also called conventional therapy. [NIH] Cornea: The transparent part of the eye that covers the iris and the pupil and allows light to enter the inside. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a

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myocardial infarction. [NIH] Corpus: The body of the uterus. [NIH] Corticosteroid: Any of the steroids elaborated by the adrenal cortex (excluding the sex hormones of adrenal origin) in response to the release of corticotrophin (adrenocorticotropic hormone) by the pituitary gland, to any of the synthetic equivalents of these steroids, or to angiotensin II. They are divided, according to their predominant biological activity, into three major groups: glucocorticoids, chiefly influencing carbohydrate, fat, and protein metabolism; mineralocorticoids, affecting the regulation of electrolyte and water balance; and C19 androgens. Some corticosteroids exhibit both types of activity in varying degrees, and others exert only one type of effect. The corticosteroids are used clinically for hormonal replacement therapy, for suppression of ACTH secretion by the anterior pituitary, as antineoplastic, antiallergic, and anti-inflammatory agents, and to suppress the immune response. Called also adrenocortical hormone and corticoid. [EU] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Cryoprotective: Any substance added to a living tissue for improving its survival during frozen preservation. [NIH] Cryotherapy: Any method that uses cold temperature to treat disease. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Curettage: Removal of tissue with a curette, a spoon-shaped instrument with a sharp edge. [NIH]

Curette: A spoon-shaped instrument with a sharp edge. [NIH] Cutaneous: Having to do with the skin. [NIH] Cyproterone: An anti-androgen that, in the form of its acetate, also has progestational properties. It is used in the treatment of hypersexuality in males, as a palliative in prostatic carcinoma, and, in combination with estrogen, for the therapy of severe acne and hirsutism in females. [NIH] Cyst: A sac or capsule filled with fluid. [NIH] Cytokine: Small but highly potent protein that modulates the activity of many cell types, including T and B cells. [NIH] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Cytotoxic: Cell-killing. [NIH] Data Collection: Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data. [NIH] Decompression: Decompression external to the body, most often the slow lessening of external pressure on the whole body (especially in caisson workers, deep sea divers, and persons who ascend to great heights) to prevent decompression sickness. It includes also sudden accidental decompression, but not surgical (local) decompression or decompression applied through body openings. [NIH] Decompression Sickness: A condition occurring as a result of exposure to a rapid fall in ambient pressure. Gases, nitrogen in particular, come out of solution and form bubbles in body fluid and blood. These gas bubbles accumulate in joint spaces and the peripheral circulation impairing tissue oxygenation causing disorientation, severe pain, and potentially

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death. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Depigmentation: Removal or loss of pigment, especially melanin. [EU] Dermatology: A medical specialty concerned with the skin, its structure, functions, diseases, and treatment. [NIH] Dermis: A layer of vascular connective tissue underneath the epidermis. The surface of the dermis contains sensitive papillae. Embedded in or beneath the dermis are sweat glands, hair follicles, and sebaceous glands. [NIH] Dexterity: Ability to move the hands easily and skillfully. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diastole: Period of relaxation of the heart, especially the ventricles. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Diathermy: The induction of local hyperthermia by either short radio waves or highfrequency sound waves. [NIH] Diffusion: The tendency of a gas or solute to pass from a point of higher pressure or concentration to a point of lower pressure or concentration and to distribute itself throughout the available space; a major mechanism of biological transport. [NIH] Diffusivity: Of a reverberant sound field. The degree to which the directions of propagation of waves are random from point to point. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Dihydrotestosterone: Anabolic agent. [NIH] 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] Dilator: A device used to stretch or enlarge an opening. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Discrete: Made up of separate parts or characterized by lesions which do not become blended; not running together; separate. [NIH] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [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] Drive: A state of internal activity of an organism that is a necessary condition before a given stimulus will elicit a class of responses; e.g., a certain level of hunger (drive) must be present before food will elicit an eating response. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity

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of another drug. [NIH] Dry Ice: A solid form of carbon dioxide used as a refrigerant. [NIH] Duct: A tube through which body fluids pass. [NIH] Duodenum: The first part of the small intestine. [NIH] Dura mater: The outermost, toughest, and most fibrous of the three membranes (meninges) covering the brain and spinal cord; called also pachymeninx. [EU] Dysplasia: Cells that look abnormal under a microscope but are not cancer. [NIH] 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] 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] Eicosanoids: A class of oxygenated, endogenous, unsaturated fatty acids derived from arachidonic acid. They include prostaglandins, leukotrienes, thromboxanes, and hydroxyeicosatetraenoic acid compounds (HETE). They are hormone-like substances that act near the site of synthesis without altering functions throughout the body. [NIH] Elastin: The protein that gives flexibility to tissues. [NIH] Electrocoagulation: Electrosurgical procedures used to treat hemorrhage (e.g., bleeding ulcers) and to ablate tumors, mucosal lesions, and refractory arrhythmias. [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] Elementary Particles: Individual components of atoms, usually subatomic; subnuclear particles are usually detected only when the atomic nucleus decays and then only transiently, as most of them are unstable, often yielding pure energy without substance, i.e., radiation. [NIH] Embolism: Blocking of a blood vessel by a blood clot or foreign matter that has been transported from a distant site by the blood stream. [NIH] Embolus: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Emphysema: A pathological accumulation of air in tissues or organs. [NIH] Empirical: A treatment based on an assumed diagnosis, prior to receiving confirmatory laboratory test results. [NIH] Enamel: A very hard whitish substance which covers the dentine of the anatomical crown of

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a tooth. [NIH] Endocervical curettage: The scraping of the mucous membrane of the cervical canal using a spoon-shaped instrument called a curette. [NIH] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Endogenous: Produced inside an organism or cell. The opposite is external (exogenous) production. [NIH] Endolymphatic Duct: Duct connecting the endolymphatic sac with the membranous labyrinth. [NIH] Endolymphatic Sac: The blind pouch at the end of the endolymphatic duct. [NIH] Endometrial: Having to do with the endometrium (the layer of tissue that lines the uterus). [NIH]

Endometrium: The layer of tissue that lines the uterus. [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] Endotoxin: Toxin from cell walls of bacteria. [NIH] Enhancer: Transcriptional element in the virus genome. [NIH] Enucleation: Removal of the nucleus from an eucaryiotic cell. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Eosinophilia: Abnormal increase in eosinophils in the blood, tissues or organs. [NIH] Eosinophils: Granular leukocytes with a nucleus that usually has two lobes connected by a slender thread of chromatin, and cytoplasm containing coarse, round granules that are uniform in size and stainable by eosin. [NIH] Epidermal: Pertaining to or resembling epidermis. Called also epidermic or epidermoid. [EU] Epidermis: Nonvascular layer of the skin. It is made up, from within outward, of five layers: 1) basal layer (stratum basale epidermidis); 2) spinous layer (stratum spinosum epidermidis); 3) granular layer (stratum granulosum epidermidis); 4) clear layer (stratum lucidum epidermidis); and 5) horny layer (stratum corneum epidermidis). [NIH] 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] Epistaxis: Bleeding from the nose. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelial Cells: Cells that line the inner and outer surfaces of the body. [NIH] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] Equalization: The reduction of frequency and/or phase distortion, or modification of gain

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and or phase versus frequency characteristics of a transducer, by the use of attenuation circuits whose loss or delay is a function of frequency. [NIH] Equipment and Supplies: Expendable and nonexpendable equipment, supplies, apparatus, and instruments that are used in diagnostic, surgical, therapeutic, scientific, and experimental procedures. [NIH] Erectile: The inability to get or maintain an erection for satisfactory sexual intercourse. Also called impotence. [NIH] Esophageal: Having to do with the esophagus, the muscular tube through which food passes from the throat to the stomach. [NIH] Esophageal Varices: Stretched veins in the esophagus that occur when the liver is not working properly. If the veins burst, the bleeding can cause death. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Estrogens: A class of sex hormones associated with the development and maintenance of secondary female sex characteristics and control of the cyclical changes in the reproductive cycle. They are also required for pregnancy maintenance and have an anabolic effect on protein metabolism and water retention. [NIH] Eukaryotic Cells: Cells of the higher organisms, containing a true nucleus bounded by a nuclear membrane. [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] 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] Extraction: The process or act of pulling or drawing out. [EU] Eye socket: One of the two cavities in the skull which contains an eyeball. Each eye is located in a bony socket or orbit. [NIH] 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] Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH] Femoral: Pertaining to the femur, or to the thigh. [EU] Femur: The longest and largest bone of the skeleton, it is situated between the hip and the knee. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibroblasts: Connective tissue cells which secrete an extracellular matrix rich in collagen and other macromolecules. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Fibula: The bone of the lower leg lateral to and smaller than the tibia. In proportion to its length, it is the most slender of the long bones. [NIH] Fistula: Abnormal communication most commonly seen between two internal organs, or between an internal organ and the surface of the body. [NIH]

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Flatus: Gas passed through the rectum. [NIH] Flexor: Muscles which flex a joint. [NIH] Floxuridine: An antineoplastic antimetabolite that is metabolized to fluorouracil when administered by rapid injection; when administered by slow, continuous, intra-arterial infusion, it is converted to floxuridine monophosphate. It has been used to treat hepatic metastases of gastrointestinal adenocarcinomas and for palliation in malignant neoplasms of the liver and gastrointestinal tract. [NIH] Fluconazole: Triazole antifungal agent that is used to treat oropharyngeal candidiasis and cryptococcal meningitis in AIDS. [NIH] Fluoroscopy: Production of an image when X-rays strike a fluorescent screen. [NIH] Fluorouracil: A pyrimidine analog that acts as an antineoplastic antimetabolite and also has immunosuppressant. It interferes with DNA synthesis by blocking the thymidylate synthetase conversion of deoxyuridylic acid to thymidylic acid. [NIH] Flutamide: An antiandrogen with about the same potency as cyproterone in rodent and canine species. [NIH] Focus Groups: A method of data collection and a qualitative research tool in which a small group of individuals are brought together and allowed to interact in a discussion of their opinions about topics, issues, or questions. [NIH] Foetoplacental: Pertaining to the fetus and placenta. [EU] Fracture Fixation: The use of metallic devices inserted into or through bone to hold a fracture in a set position and alignment while it heals. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gamma Rays: Very powerful and penetrating, high-energy electromagnetic radiation of shorter wavelength than that of x-rays. They are emitted by a decaying nucleus, usually between 0.01 and 10 MeV. They are also called nuclear x-rays. [NIH] Ganglion: 1. A knot, or knotlike mass. 2. A general term for a group of nerve cell bodies located outside the central nervous system; occasionally applied to certain nuclear groups within the brain or spinal cord, e.g. basal ganglia. 3. A benign cystic tumour occurring on a aponeurosis or tendon, as in the wrist or dorsum of the foot; it consists of a thin fibrous capsule enclosing a clear mucinous fluid. [EU] 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] Gastric: Having to do with the stomach. [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]

Gastrointestinal: Refers to the stomach and intestines. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Gene Expression: The phenotypic manifestation of a gene or genes by the processes of gene action. [NIH] Gene Therapy: The introduction of new genes into cells for the purpose of treating disease by restoring or adding gene expression. Techniques include insertion of retroviral vectors,

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transfection, homologous recombination, and injection of new genes into the nuclei of single cell embryos. The entire gene therapy process may consist of multiple steps. The new genes may be introduced into proliferating cells in vivo (e.g., bone marrow) or in vitro (e.g., fibroblast cultures) and the modified cells transferred to the site where the gene expression is required. Gene therapy may be particularly useful for treating enzyme deficiency diseases, hemoglobinopathies, and leukemias and may also prove useful in restoring drug sensitivity, particularly for leukemia. [NIH] Genital: Pertaining to the genitalia. [EU] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glomerular: Pertaining to or of the nature of a glomerulus, especially a renal glomerulus. [EU]

Glucocorticoids: A group of corticosteroids that affect carbohydrate metabolism (gluconeogenesis, liver glycogen deposition, elevation of blood sugar), inhibit corticotropin secretion, and possess pronounced anti-inflammatory activity. They also play a role in fat and protein metabolism, maintenance of arterial blood pressure, alteration of the connective tissue response to injury, reduction in the number of circulating lymphocytes, and functioning of the central nervous system. [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] Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Gonadal: Pertaining to a gonad. [EU] Gonadorelin: A decapeptide hormone released by the hypothalamus. It stimulates the synthesis and secretion of both follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from the pituitary gland. [NIH] Gonadotropin: The water-soluble follicle stimulating substance, by some believed to originate in chorionic tissue, obtained from the serum of pregnant mares. It is used to supplement the action of estrogens. [NIH] Gonads: The gamete-producing glands, ovary or testis. [NIH] Goserelin: 6-(O-(1,1-Dimethylethyl)-D-serine)-10-deglycinamideluteinizing hormonereleasing factor (pig) 2-(aminocarbonyl)hydrazide. A long-acting gonadorelin agonist. It is used in the treatment of malignant neoplasms of the prostate, uterine fibromas, and metastatic breast cancer. [NIH] 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] Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Graft Rejection: An immune response with both cellular and humoral components, directed against an allogeneic transplant, whose tissue antigens are not compatible with those of the recipient. [NIH] Grafting: The operation of transfer of tissue from one site to another. [NIH]

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Granuloma: A relatively small nodular inflammatory lesion containing grouped mononuclear phagocytes, caused by infectious and noninfectious agents. [NIH] Growth factors: Substances made by the body that function to regulate cell division and cell survival. Some growth factors are also produced in the laboratory and used in biological therapy. [NIH] Gynecology: A medical-surgical specialty concerned with the physiology and disorders primarily of the female genital tract, as well as female endocrinology and reproductive physiology. [NIH] Hair Cells: Mechanoreceptors located in the organ of Corti that are sensitive to auditory stimuli and in the vestibular apparatus that are sensitive to movement of the head. In each case the accessory sensory structures are arranged so that appropriate stimuli cause movement of the hair-like projections (stereocilia and kinocilia) which relay the information centrally in the nervous system. [NIH] Hair follicles: Shafts or openings on the surface of the skin through which hair grows. [NIH] Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, breathlessness, and excess fluid accumulation in body tissues. [NIH] Heartbeat: One complete contraction of the heart. [NIH] Hematoma: An extravasation of blood localized in an organ, space, or tissue. [NIH] Hemoglobinopathies: A group of inherited disorders characterized by structural alterations within the hemoglobin molecule. [NIH] Hemophilia: Refers to a group of hereditary disorders in which affected individuals fail to make enough of certain proteins needed to form blood clots. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemorrhagic stroke: A disorder involving bleeding within ischemic brain tissue. Hemorrhagic stroke occurs when blood vessels that are damaged or dead from lack of blood supply (infarcted), located within an area of infarcted brain tissue, rupture and transform an "ischemic" stroke into a hemorrhagic stroke. Ischemia is inadequate tissue oxygenation caused by reduced blood flow; infarction is tissue death resulting from ischemia. Bleeding irritates the brain tissues, causing swelling (cerebral edema). Blood collects into a mass (hematoma). Both swelling and hematoma will compress and displace brain tissue. [NIH] Hemorrhoid: An enlarged or swollen blood vessel, usually located near the anus or the rectum. [NIH] Hemorrhoidectomy: An operation to remove hemorrhoids. [NIH] Hepatic: Refers to the liver. [NIH] Hepatic Artery: A branch of the celiac artery that distributes to the stomach, pancreas, duodenum, liver, gallbladder, and greater omentum. [NIH] Hepatitis: Inflammation of the liver and liver disease involving degenerative or necrotic alterations of hepatocytes. [NIH] Hepatobiliary: Pertaining to the liver and the bile or the biliary ducts. [EU] Hepatocellular: Pertaining to or affecting liver cells. [EU] Hepatocellular carcinoma: A type of adenocarcinoma, the most common type of liver tumor. [NIH] Hepatocyte: A liver cell. [NIH] Hepatocyte Growth Factor: Multifunctional growth factor which regulates both cell growth and cell motility. It exerts a strong mitogenic effect on hepatocytes and primary epithelial

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cells. Its receptor is proto-oncogene protein C-met. [NIH] Hereditary: Of, relating to, or denoting factors that can be transmitted genetically from one generation to another. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Homogeneous: Consisting of or composed of similar elements or ingredients; of a uniform quality throughout. [EU] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormonal therapy: Treatment of cancer by removing, blocking, or adding hormones. Also called hormone therapy or endocrine therapy. [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] Hormone therapy: Treatment of cancer by removing, blocking, or adding hormones. Also called endocrine therapy. [NIH] Human papillomavirus: HPV. A virus that causes abnormal tissue growth (warts) and is often associated with some types of cancer. [NIH] Hybridomas: Cells artificially created by fusion of activated lymphocytes with neoplastic cells. The resulting hybrid cells are cloned and produce pure or "monoclonal" antibodies or T-cell products, identical to those produced by the immunologically competent parent, and continually grow and divide as the neoplastic parent. [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] Hydrolysis: The process of cleaving a chemical compound by the addition of a molecule of water. [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] Hyperbaric: Characterized by greater than normal pressure or weight; applied to gases under greater than atmospheric pressure, as hyperbaric oxygen, or to a solution of greater specific gravity than another taken as a standard of reference. [EU] Hyperbaric oxygen: Oxygen that is at an atmospheric pressure higher than the pressure at sea level. Breathing hyperbaric oxygen to enhance the effectiveness of radiation therapy is being studied. [NIH] Hyperpigmentation: Excessive pigmentation of the skin, usually as a result of increased melanization of the epidermis rather than as a result of an increased number of melanocytes. Etiology is varied and the condition may arise from exposure to light, chemicals or other substances, or from a primary metabolic imbalance. [NIH] Hyperplasia: An increase in the number of cells in a tissue or organ, not due to tumor formation. It differs from hypertrophy, which is an increase in bulk without an increase in

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the number of cells. [NIH] Hyperreflexia: Exaggeration of reflexes. [EU] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hyperthermia: A type of treatment in which body tissue is exposed to high temperatures to damage and kill cancer cells or to make cancer cells more sensitive to the effects of radiation and certain anticancer drugs. [NIH] 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] Hypodermic: Applied or administered beneath the skin. [EU] Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH] Hypothermia: Lower than normal body temperature, especially in warm-blooded animals; in man usually accidental or unintentional. [NIH] Iatrogenic: Resulting from the activity of physicians. Originally applied to disorders induced in the patient by autosuggestion based on the physician's examination, manner, or discussion, the term is now applied to any adverse condition in a patient occurring as the result of treatment by a physician or surgeon, especially to infections acquired by the patient during the course of treatment. [EU] Illusion: A false interpretation of a genuine percept. [NIH] Immersion: The placing of a body or a part thereof into a liquid. [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] Immunity: Nonsusceptibility to the invasive or pathogenic microorganisms or to the toxic effect of antigenic substances. [NIH]

effects

of

foreign

Immunization: Deliberate stimulation of the host's immune response. Active immunization involves administration of antigens or immunologic adjuvants. Passive immunization involves administration of immune sera or lymphocytes or their extracts (e.g., transfer factor, immune RNA) or transplantation of immunocompetent cell producing tissue (thymus or bone marrow). [NIH] Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Immunology: The study of the body's immune system. [NIH] Immunosuppressant: An agent capable of suppressing immune responses. [EU] Immunosuppressive: Describes the ability to lower immune system responses. [NIH] Immunosuppressive therapy: Therapy used to decrease the body's immune response, such as drugs given to prevent transplant rejection. [NIH] Immunotherapy: Manipulation of the host's immune system in treatment of disease. It includes both active and passive immunization as well as immunosuppressive therapy to prevent graft rejection. [NIH] Implant radiation: A procedure in which radioactive material sealed in needles, seeds,

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wires, or catheters is placed directly into or near the tumor. Also called [NIH] Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU] Impotence: The inability to perform sexual intercourse. [NIH] In situ: In the natural or normal place; confined to the site of origin without invasion of neighbouring tissues. [EU] In 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] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [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] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

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] Inflammatory bowel disease: A general term that refers to the inflammation of the colon and rectum. Inflammatory bowel disease includes ulcerative colitis and Crohn's disease. [NIH]

Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] 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] 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] Insulator: Material covering the metal conductor of the lead. It is usually polyurethane or silicone. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as

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a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Insulin-like: Muscular growth factor. [NIH] Interferon: A biological response modifier (a substance that can improve the body's natural response to disease). Interferons interfere with the division of cancer cells and can slow tumor growth. There are several types of interferons, including interferon-alpha, -beta, and gamma. These substances are normally produced by the body. They are also made in the laboratory for use in treating cancer and other diseases. [NIH] Interferon-alpha: One of the type I interferons produced by peripheral blood leukocytes or lymphoblastoid cells when exposed to live or inactivated virus, double-stranded RNA, or bacterial products. It is the major interferon produced by virus-induced leukocyte cultures and, in addition to its pronounced antiviral activity, it causes activation of NK cells. [NIH] Interleukin-1: A soluble factor produced by monocytes, macrophages, and other cells which activates T-lymphocytes and potentiates their response to mitogens or antigens. IL-1 consists of two distinct forms, IL-1 alpha and IL-1 beta which perform the same functions but are distinct proteins. The biological effects of IL-1 include the ability to replace macrophage requirements for T-cell activation. The factor is distinct from interleukin-2. [NIH] Interleukin-2: Chemical mediator produced by activated T lymphocytes and which regulates the proliferation of T cells, as well as playing a role in the regulation of NK cell activity. [NIH] Interleukin-6: Factor that stimulates the growth and differentiation of human B-cells and is also a growth factor for hybridomas and plasmacytomas. It is produced by many different cells including T-cells, monocytes, and fibroblasts. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [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] Intestinal: Having to do with the intestines. [NIH] Intestines: The section of the alimentary canal from the stomach to the anus. It includes the large intestine and small intestine. [NIH] Intoxication: Poisoning, the state of being poisoned. [EU] Intracellular: Inside a cell. [NIH] Intraepithelial: Within the layer of cells that form the surface or lining of an organ. [NIH] Intraocular: Within the eye. [EU] Intravascular: Within a vessel or vessels. [EU] 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] Ionizing: Radiation comprising charged particles, e. g. electrons, protons, alpha-particles, etc., having sufficient kinetic energy to produce ionization by collision. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a

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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] Irinotecan: An anticancer drug that belongs to a family of anticancer drugs called topoisomerase inhibitors. It is a camptothecin analogue. Also called CPT 11. [NIH] Iris: The most anterior portion of the uveal layer, separating the anterior chamber from the posterior. It consists of two layers - the stroma and the pigmented epithelium. Color of the iris depends on the amount of melanin in the stroma on reflection from the pigmented epithelium. [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] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] 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] Keloid: A sharply elevated, irregularly shaped, progressively enlarging scar resulting from formation of excessive amounts of collagen in the dermis during connective tissue repair. It is differentiated from a hypertrophic scar (cicatrix, hypertrophic) in that the former does not spread to surrounding tissues. [NIH] Keratitis: Inflammation of the cornea. [NIH] Keratosis: Any horny growth such as a wart or callus. [NIH] Labyrinth: The internal ear; the essential part of the organ of hearing. It consists of an osseous and a membranous portion. [NIH] Labyrinthine: A vestibular nystagmus resulting from stimulation, injury, or disease of the labyrinth. [NIH] Laceration: 1. The act of tearing. 2. A torn, ragged, mangled wound. [EU] Lactation: The period of the secretion of milk. [EU] Lamella: A layer of the iris containing the fibrils of the dilator pupillae muscle, exclusive of their cell bodies, located between the anterior pigment layer of Fuchs and the stroma. [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] Larynx: An irregularly shaped, musculocartilaginous tubular structure, lined with mucous membrane, located at the top of the trachea and below the root of the tongue and the hyoid bone. It is the essential sphincter guarding the entrance into the trachea and functioning secondarily as the organ of voice. [NIH] Laser Surgery: The use of a laser either to vaporize surface lesions or to make bloodless cuts in tissue. It does not include the coagulation of tissue by laser. [NIH] Laser therapy: The use of an intensely powerful beam of light to kill cancer cells. [NIH]

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Leiomyosarcoma: A tumor of the muscles in the uterus, abdomen, or pelvis. [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] Lentigo: Small circumscribed melanoses resembling, but differing histologically from, freckles. The concept includes senile lentigo ('liver spots') and nevoid lentigo (nevus spilus, lentigo simplex) and may also occur in association with multiple congenital defects or congenital syndromes (e.g., Peutz-Jeghers syndrome). [NIH] Lesion: An area of abnormal tissue change. [NIH] Lethal: Deadly, fatal. [EU] Leukemia: Cancer of blood-forming tissue. [NIH] Leukoplakia: A white patch that may develop on mucous membranes such as the cheek, gums, or tongue and may become cancerous. [NIH] Leukotrienes: A family of biologically active compounds derived from arachidonic acid by oxidative metabolism through the 5-lipoxygenase pathway. They participate in host defense reactions and pathophysiological conditions such as immediate hypersensitivity and inflammation. They have potent actions on many essential organs and systems, including the cardiovascular, pulmonary, and central nervous system as well as the gastrointestinal tract and the immune system. [NIH] Leuprolide: A potent and long acting analog of naturally occurring gonadotropin-releasing hormone (gonadorelin). Its action is similar to gonadorelin, which regulates the synthesis and release of pituitary gonadotropins. [NIH] Libido: The psychic drive or energy associated with sexual instinct in the broad sense (pleasure and love-object seeking). It may also connote the psychic energy associated with instincts in general that motivate behavior. [NIH] Lichen Planus: An inflammatory, pruritic disease of the skin and mucous membranes, which can be either generalized or localized. It is characterized by distinctive purplish, flattopped papules having a predilection for the trunk and flexor surfaces. The lesions may be discrete or coalesce to form plaques. Histologically, there is a "saw-tooth" pattern of epidermal hyperplasia and vacuolar alteration of the basal layer of the epidermis along with an intense upper dermal inflammatory infiltrate composed predominantly of T-cells. Etiology is unknown. [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] Ligation: Application of a ligature to tie a vessel or strangulate a part. [NIH] Linkage: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Lip: Either of the two fleshy, full-blooded margins of the mouth. [NIH] Lipid: Fat. [NIH] Lipolysis: The hydrolysis of lipids. [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 cancer: A disease in which malignant (cancer) cells are found in the tissues of the liver.

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[NIH]

Liver metastases: Cancer that has spread from the original (primary) tumor to the liver. [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] Liver Transplantation: The transference of a part of or an entire liver from one human or animal to another. [NIH] Localization: The process of determining or marking the location or site of a lesion or disease. May also refer to the process of keeping a lesion or disease in a specific location or site. [NIH] Localized: Cancer which has not metastasized yet. [NIH] 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] Lumbar: Pertaining to the loins, the part of the back between the thorax and the pelvis. [EU] Lumbar puncture: A procedure in which a needle is put into the lower part of the spinal column to collect cerebrospinal fluid or to give anticancer drugs intrathecally. Also called a spinal tap. [NIH] Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [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] Lymphocytic: Referring to lymphocytes, a type of white blood cell. [NIH] Macrophage: A type of white blood cell that surrounds and kills microorganisms, removes dead cells, and stimulates the action of other immune system cells. [NIH] Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. [NIH] Magnetic Resonance Spectroscopy: Spectroscopic method of measuring the magnetic moment of elementary particles such as atomic nuclei, protons or electrons. It is employed in

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clinical applications such as NMR Tomography (magnetic resonance imaging). [NIH] Malignancy: A cancerous tumor that can invade and destroy nearby tissue and spread to other parts of the body. [NIH] 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] Maxillary: Pertaining to the maxilla : the irregularly shaped bone that with its fellow forms the upper jaw. [EU] Maxillary Sinus: One of the paired paranasal sinuses, located in the body of the maxilla, communicating with the middle meatus of the nasal cavity. [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] Medial: Lying near the midsaggital plane of the body; opposed to lateral. [NIH] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Melanin: The substance that gives the skin its color. [NIH] Melanocytes: Epidermal dendritic pigment cells which control long-term morphological color changes by alteration in their number or in the amount of pigment they produce and store in the pigment containing organelles called melanosomes. Melanophores are larger cells which do not exist in mammals. [NIH] Melanoma: A form of skin cancer that arises in melanocytes, the cells that produce pigment. Melanoma usually begins in a mole. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Meningitis: Inflammation of the meninges. When it affects the dura mater, the disease is termed pachymeningitis; when the arachnoid and pia mater are involved, it is called leptomeningitis, or meningitis proper. [EU] Menopause: Permanent cessation of menstruation. [NIH] Menstrual Cycle: The period of the regularly recurring physiologic changes in the endometrium occurring during the reproductive period in human females and some primates and culminating in partial sloughing of the endometrium (menstruation). [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH] 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

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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] Microscopy: The application of microscope magnification to the study of materials that cannot be properly seen by the unaided eye. [NIH] Microspheres: Small uniformly-sized spherical particles frequently radioisotopes or various reagents acting as tags or markers. [NIH]

labeled

with

Microwaves: That portion of the electromagnetic spectrum lying between UHF (ultrahigh frequency) radio waves and heat (infrared) waves. Microwaves are used to generate heat, especially in some types of diathermy. They may cause heat damage to tissues. [NIH] Mineralocorticoids: A group of corticosteroids primarily associated with the regulation of water and electrolyte balance. This is accomplished through the effect on ion transport in renal tubules, resulting in retention of sodium and loss of potassium. Mineralocorticoid secretion is itself regulated by plasma volume, serum potassium, and angiotensin II. [NIH] Mitochondria: Parts of a cell where aerobic production (also known as cell respiration) takes place. [NIH] Mitochondrial Swelling: Increase in volume of mitochondria due to an influx of fluid; it occurs in hypotonic solutions due to osmotic pressure and in isotonic solutions as a result of altered permeability of the membranes of respiring mitochondria. [NIH] Modeling: A treatment procedure whereby the therapist presents the target behavior which the learner is to imitate and make part of his repertoire. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monoclonal: An antibody produced by culturing a single type of cell. It therefore consists of a single species of immunoglobulin molecules. [NIH] Monocytes: Large, phagocytic mononuclear leukocytes produced in the vertebrate bone marrow and released into the blood; contain a large, oval or somewhat indented nucleus surrounded by voluminous cytoplasm and numerous organelles. [NIH] Mononuclear: A cell with one nucleus. [NIH] Monophosphate: So called second messenger for neurotransmitters and hormones. [NIH] Morphology: The science of the form and structure of organisms (plants, animals, and other forms of life). [NIH]

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Mucosa: A mucous membrane, or tunica mucosa. [EU] Muscle Fibers: Large single cells, either cylindrical or prismatic in shape, that form the basic unit of muscle tissue. They consist of a soft contractile substance enclosed in a tubular sheath. [NIH] Mydriatic: 1. Dilating the pupil. 2. Any drug that dilates the pupil. [EU] 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] 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] 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] Neoadjuvant Therapy: Preliminary cancer therapy (chemotherapy, radiation therapy, hormone/endocrine therapy, immunotherapy, hyperthermia, etc.) that precedes a necessary second modality of treatment. [NIH] Neoplasia: Abnormal and uncontrolled cell growth. [NIH] Neoplasms: New abnormal growth of tissue. Malignant neoplasms show a greater degree of anaplasia and have the properties of invasion and metastasis, compared to benign neoplasms. [NIH] Nephrectomy: Surgery to remove a kidney. Radical nephrectomy removes the kidney, the adrenal gland, nearby lymph nodes, and other surrounding tissue. Simple nephrectomy removes only the kidney. Partial nephrectomy removes the tumor but not the entire kidney. [NIH]

Nephron: A tiny part of the kidneys. Each kidney is made up of about 1 million nephrons, which are the working units of the kidneys, removing wastes and extra fluids from the blood. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neuroma: A tumor that arises in nerve cells. [NIH] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] 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] Neutrophil: A type of white blood cell. [NIH] Nevus: A benign growth on the skin, such as a mole. A mole is a cluster of melanocytes and surrounding supportive tissue that usually appears as a tan, brown, or flesh-colored spot on

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the skin. The plural of nevus is nevi (NEE-vye). [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]

Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nuclear Localization Signal: Short, predominantly basic amino acid sequences identified as nuclear import signals for some proteins. These sequences are believed to interact with specific receptors at nuclear pores. [NIH] Nuclear Pore: An opening through the nuclear envelope formed by the nuclear pore complex which transports nuclear proteins or RNA into or out of the cell nucleus and which, under some conditions, acts as an ion channel. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the next. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nystagmus: An involuntary, rapid, rhythmic movement of the eyeball, which may be horizontal, vertical, rotatory, or mixed, i.e., of two varieties. [EU] Occult: Obscure; concealed from observation, difficult to understand. [EU] Oestrogen: A generic term for oestrus-producing steroid compounds; the female sex hormones. In humans, oestrogen is formed in the ovary, possibly the adrenal cortex, the testis, and the foetoplacental unit; it has various functions in both sexes. It is responsible for the development of the female secondary sex characteristics, and during the menstrual cycle it acts on the female genitalia to produce an environment suitable for the fertilization, implantation, and nutrition of the early embryo. Oestrogen is used in oral contraceptives and as a palliative in cancer of the breast after menopause and cancer of the prostate; other uses include the relief of the discomforts of menopause, inhibition of lactation, and treatment of osteoporosis, threatened abortion, and various functional ovarian disorders. [EU]

Omentum: A fold of the peritoneum (the thin tissue that lines the abdomen) that surrounds the stomach and other organs in the abdomen. [NIH] Oncogene: A gene that normally directs cell growth. If altered, an oncogene can promote or allow the uncontrolled growth of cancer. Alterations can be inherited or caused by an environmental exposure to carcinogens. [NIH] Oncology: The study of cancer. [NIH] Oophorectomy: Surgery to remove one or both ovaries. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH] Ophthalmic: Pertaining to the eye. [EU]

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Ophthalmology: A surgical specialty concerned with the structure and function of the eye and the medical and surgical treatment of its defects and diseases. [NIH] Opsin: A protein formed, together with retinene, by the chemical breakdown of metarhodopsin. [NIH] Optic Chiasm: The X-shaped structure formed by the meeting of the two optic nerves. At the optic chiasm the fibers from the medial part of each retina cross to project to the other side of the brain while the lateral retinal fibers continue on the same side. As a result each half of the brain receives information about the contralateral visual field from both eyes. [NIH]

Optic Nerve: The 2nd cranial nerve. The optic nerve conveys visual information from the retina to the brain. The nerve carries the axons of the retinal ganglion cells which sort at the optic chiasm and continue via the optic tracts to the brain. The largest projection is to the lateral geniculate nuclei; other important targets include the superior colliculi and the suprachiasmatic nuclei. Though known as the second cranial nerve, it is considered part of the central nervous system. [NIH] Orbit: One of the two cavities in the skull which contains an eyeball. Each eye is located in a bony socket or orbit. [NIH] Orbital: Pertaining to the orbit (= the bony cavity that contains the eyeball). [EU] Orchiectomy: The surgical removal of one or both testicles. [NIH] Organelles: Specific particles of membrane-bound organized living substances present in eukaryotic cells, such as the mitochondria; the golgi apparatus; endoplasmic reticulum; lysomomes; plastids; and vacuoles. [NIH] Ossicles: The hammer, anvil and stirrup, the small bones of the middle ear, which transmit the vibrations from the tympanic membrane to the oval window. [NIH] Osteoporosis: Reduction of bone mass without alteration in the composition of bone, leading to fractures. Primary osteoporosis can be of two major types: postmenopausal osteoporosis and age-related (or senile) osteoporosis. [NIH] Otolaryngology: A surgical specialty concerned with the study and treatment of disorders of the ear, nose, and throat. [NIH] Otosclerosis: The formation of spongy bone in the labyrinth capsule. The ossicles can become fixed and unable to transmit sound vibrations, thereby causing deafness. [NIH] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Ovaries: The pair of female reproductive glands in which the ova, or eggs, are formed. The ovaries are located in the pelvis, one on each side of the uterus. [NIH] Ovary: Either of the paired glands in the female that produce the female germ cells and secrete some of the female sex hormones. [NIH] Oxygenation: The process of supplying, treating, or mixing with oxygen. No:1245 oxygenation the process of supplying, treating, or mixing with oxygen. [EU] Pachymeningitis: Inflammation of the dura mater of the brain, the spinal cord or the optic nerve. [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]

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Papillomavirus: A genus of Papovaviridae causing proliferation of the epithelium, which may lead to malignancy. A wide range of animals are infected including humans, chimpanzees, cattle, rabbits, dogs, and horses. [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]

Paroxysmal: Recurring in paroxysms (= spasms or seizures). [EU] Patch: A piece of material used to cover or protect a wound, an injured part, etc.: a patch over the eye. [NIH] Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] 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] 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] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Peptic Ulcer: An ulceration of the mucous membrane of the esophagus, stomach or duodenum, caused by the action of the acid gastric juice. [NIH] Peptic Ulcer Hemorrhage: Bleeding from a peptic ulcer. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [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] 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] Perilymph: The fluid contained within the space separating the membranous from the osseous labyrinth of the ear. [NIH] Perineal: Pertaining to the perineum. [EU] Perineum: The area between the anus and the sex organs. [NIH] Periorbital: Situated around the orbit, or eye socket. [EU] Petechia: A pinpoint, nonraised, perfectly round, purplish red spot caused by intradermal or submucous haemorrhage. [EU] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived

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from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Photocoagulation: Using a special strong beam of light (laser) to seal off bleeding blood vessels such as in the eye. The laser can also burn away blood vessels that should not have grown in the eye. This is the main treatment for diabetic retinopathy. [NIH] Photoreceptors: Cells specialized to detect and transduce light. [NIH] Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pigment: A substance that gives color to tissue. Pigments are responsible for the color of skin, eyes, and hair. [NIH] Pigmentation: Coloration or discoloration of a part by a pigment. [NIH] Pilot study: The initial study examining a new method or treatment. [NIH] Pituitary Gland: A small, unpaired gland situated in the sella turcica tissue. It is connected to the hypothalamus by a short stalk. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plaque: A clear zone in a bacterial culture grown on an agar plate caused by localized destruction of bacterial cells by a bacteriophage. The concentration of infective virus in a fluid can be estimated by applying the fluid to a culture and counting the number of. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plastids: Self-replicating cytoplasmic organelles of plant and algal cells that contain pigments and may synthesize and accumulate various substances. Plastids are used in phylogenetic studies. [NIH] Pneumonia: Inflammation of the lungs. [NIH] Podophyllin: Caustic extract from the roots of Podophyllum peltatum and P. emodi. It contains podophyllotoxin and its congeners and is very irritating to mucous membranes and skin. Podophyllin is a violent purgative that may cause CNS damage and teratogenesis. It is used as a paint for warts, skin neoplasms, and senile keratoses. [NIH] Podophyllotoxin: The main active constituent of the resin from the roots of may apple or mandrake (Podophyllum peltatum and P. emodi). It is a potent spindle poison, toxic if taken internally, and has been used as a cathartic. It is very irritating to skin and mucous membranes, has keratolytic actions, has been used to treat warts and keratoses, and may have antineoplastic properties, as do some of its congeners and derivatives. [NIH] Podophyllum: A genus of poisonous American herbs, family Berberidaceae. The roots yield

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podophyllotoxins and other pharmacologically important agents. The plant was formerly used as a cholagogue and cathartic. It is different from the European Mandrake (Mandragora). [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] Polytetrafluoroethylene: Homopolymer of tetrafluoroethylene. Nonflammable, tough, inert plastic tubing or sheeting; used to line vessels, insulate, protect or lubricate apparatus; also as filter, coating for surgical implants or as prosthetic material. Synonyms: Fluoroflex; Fluoroplast; Ftoroplast; Halon; Polyfene; PTFE; Tetron. [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] Postoperative Complications: Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery. [NIH] Potentiates: A degree of synergism which causes the exposure of the organism to a harmful substance to worsen a disease already contracted. [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] Preclinical: Before a disease becomes clinically recognizable. [EU] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Preoperative: Preceding an operation. [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] Primary Prevention: Prevention of disease or mental disorders in susceptible individuals or populations through promotion of health, including mental health, and specific protection, as in immunization, as distinguished from the prevention of complications or after-effects of existing disease. [NIH] Probe: An instrument used in exploring cavities, or in the detection and dilatation of strictures, or in demonstrating the potency of channels; an elongated instrument for

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exploring or sounding body cavities. [NIH] Procaine: A local anesthetic of the ester type that has a slow onset and a short duration of action. It is mainly used for infiltration anesthesia, peripheral nerve block, and spinal block. (From Martindale, The Extra Pharmacopoeia, 30th ed, p1016). [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, 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] 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] Prophylaxis: An attempt to prevent disease. [NIH] Prostaglandins: A group of compounds derived from unsaturated 20-carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway. They are extremely potent mediators of a diverse group of physiological processes. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Prostate gland: A gland in the male reproductive system just below the bladder. It surrounds part of the urethra, the canal that empties the bladder, and produces a fluid that forms part of semen. [NIH] Prostatectomy: Complete or partial surgical removal of the prostate. Three primary approaches are commonly employed: suprapubic - removal through an incision above the pubis and through the urinary bladder; retropubic - as for suprapubic but without entering the urinary bladder; and transurethral (transurethral resection of prostate). [NIH] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] 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] Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH]

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Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Pruritic: Pertaining to or characterized by pruritus. [EU] Psychoactive: Those drugs which alter sensation, mood, consciousness or other psychological or behavioral functions. [NIH] 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] 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] 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] Purgative: 1. Cathartic (def. 1); causing evacuation of the bowels. 2. A cathartic, particularly one that stimulates peristaltic action. [EU] 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] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radiation therapy: The use of high-energy radiation from x-rays, gamma rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from 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] Radical prostatectomy: Surgery to remove the entire prostate. The two types of radical prostatectomy are retropubic prostatectomy and perineal prostatectomy. [NIH] Radio Waves: That portion of the electromagnetic spectrum beyond the microwaves, with wavelengths as high as 30 KM. They are used in communications, including television. Short Wave or HF (high frequency), UHF (ultrahigh frequency) and VHF (very high frequency) waves are used in citizen's band communication. [NIH] Radioactive: Giving off radiation. [NIH] Radiofrequency ablation: The use of electrical current to destroy tissue. [NIH] Radioimmunotherapy: Radiotherapy where cytotoxic radionuclides are linked to antibodies in order to deliver toxins directly to tumor targets. Therapy with targeted radiation rather than antibody-targeted toxins (immunotoxins) has the advantage that adjacent tumor cells, which lack the appropriate antigenic determinants, can be destroyed by radiation cross-fire. Radioimmunotherapy is sometimes called targeted radiotherapy, but this latter term can also refer to radionuclides linked to non-immune molecules (radiotherapy). [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] Radiolucent: Partly or wholly permeable to X-rays or other forms of radiation contrasted with radiopaque. [NIH]

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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] Randomized clinical trial: A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial. [NIH] 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] Recombination: The formation of new combinations of genes as a result of segregation in crosses between genetically different parents; also the rearrangement of linked genes due to crossing-over. [NIH] Rectal: By or having to do with the rectum. The rectum is the last 8 to 10 inches of the large intestine and ends at the anus. [NIH] Rectal Fistula: Abnormal passage communicating with the rectum. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Reentry: Reexcitation caused by continuous propagation of the same impulse for one or more cycles. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Refractory: Not readily yielding to treatment. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [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]

Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Renal cell carcinoma: A type of kidney cancer. [NIH] Renal failure: Progressive renal insufficiency and uremia, due to irreversible and progressive renal glomerular tubular or interstitial disease. [NIH] Reproductive system: In women, this system includes the ovaries, the fallopian tubes, the uterus (womb), the cervix, and the vagina (birth canal). The reproductive system in men includes the prostate, the testes, and the penis. [NIH] Resection: Removal of tissue or part or all of an organ by surgery. [NIH] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary,

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4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [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] Retinae: A congenital notch or cleft of the retina, usually located inferiorly. [NIH] Retinal: 1. Pertaining to the retina. 2. The aldehyde of retinol, derived by the oxidative enzymatic splitting of absorbed dietary carotene, and having vitamin A activity. In the retina, retinal combines with opsins to form visual pigments. One isomer, 11-cis retinal combines with opsin in the rods (scotopsin) to form rhodopsin, or visual purple. Another, all-trans retinal (trans-r.); visual yellow; xanthopsin) results from the bleaching of rhodopsin by light, in which the 11-cis form is converted to the all-trans form. Retinal also combines with opsins in the cones (photopsins) to form the three pigments responsible for colour vision. Called also retinal, and retinene1. [EU] Retinoblastoma: An eye cancer that most often occurs in children younger than 5 years. It occurs in hereditary and nonhereditary (sporadic) forms. [NIH] Retinol: Vitamin A. It is essential for proper vision and healthy skin and mucous membranes. Retinol is being studied for cancer prevention; it belongs to the family of drugs called retinoids. [NIH] Retractor: An instrument designed for pulling aside tissues to improve exposure at operation; an instrument for drawing back the edge of a wound. [NIH] Retreatment: The therapy of the same disease in a patient, with the same agent or procedure repeated after initial treatment, or with an additional or alternate measure or follow-up. It does not include therapy which requires more than one administration of a therapeutic agent or regimen. Retreatment is often used with reference to a different modality when the original one was inadequate, harmful, or unsuccessful. [NIH] Retropubic: A potential space between the urinary bladder and the symphisis and body of the pubis. [NIH] Retropubic prostatectomy: Surgery to remove the prostate through an incision made in the abdominal wall. [NIH] Retroviral vector: RNA from a virus that is used to insert genetic material into cells. [NIH] Reverberant: The sound field prevailing in a large enclosure with moderately reflecting surfaces. [NIH] Rhodopsin: A photoreceptor protein found in retinal rods. It is a complex formed by the binding of retinal, the oxidized form of retinol, to the protein opsin and undergoes a series of complex reactions in response to visible light resulting in the transmission of nerve impulses to the brain. [NIH] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Risk patient: Patient who is at risk, because of his/her behaviour or because of the type of person he/she is. [EU] Robotics: The application of electronic, computerized control systems to mechanical devices designed to perform human functions. Formerly restricted to industry, but nowadays applied to artificial organs controlled by bionic (bioelectronic) devices, like automated insulin pumps and other prostheses. [NIH]

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Rod: A reception for vision, located in the retina. [NIH] Rubber: A high-molecular-weight polymeric elastomer derived from the milk juice (latex) of Hevea brasiliensis and other trees. It is a substance that can be stretched at room temperature to atleast twice its original length and after releasing the stress, retractrapidly, and recover its original dimensions fully. Synthetic rubber is made from many different chemicals, including styrene, acrylonitrile, ethylene, propylene, and isoprene. [NIH] Saline: A solution of salt and water. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Salvage Therapy: A therapeutic approach, involving chemotherapy, radiation therapy, or surgery, after initial regimens have failed to lead to improvement in a patient's condition. Salvage therapy is most often used for neoplastic diseases. [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] Schizoid: Having qualities resembling those found in greater degree in schizophrenics; a person of schizoid personality. [NIH] Schizophrenia: A mental disorder characterized by a special type of disintegration of the personality. [NIH] Schizotypal Personality Disorder: A personality disorder in which there are oddities of thought (magical thinking, paranoid ideation, suspiciousness), perception (illusions, depersonalization), speech (digressive, vague, overelaborate), and behavior (inappropriate affect in social interactions, frequently social isolation) that are not severe enough to characterize schizophrenia. [NIH] Sclerotherapy: Treatment of varicose veins, hemorrhoids, gastric and esophageal varices, and peptic ulcer hemorrhage by injection or infusion of chemical agents which cause localized thrombosis and eventual fibrosis and obliteration of the vessels. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Scrotum: In males, the external sac that contains the testicles. [NIH] Sebaceous: Gland that secretes sebum. [NIH] Sebaceous gland: Gland that secretes sebum. [NIH] Sebum: The oily substance secreted by sebaceous glands. It is composed of keratin, fat, and cellular debris. [NIH] Secondary tumor: Cancer that has spread from the organ in which it first appeared to another organ. For example, breast cancer cells may spread (metastasize) to the lungs and

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cause the growth of a new tumor. When this happens, the disease is called metastatic breast cancer, and the tumor in the lungs is called a secondary tumor. Also called secondary cancer. [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] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Semicircular canal: Three long canals of the bony labyrinth of the ear, forming loops and opening into the vestibule by five openings. [NIH] Senile: Relating or belonging to old age; characteristic of old age; resulting from infirmity of old age. [NIH] Sensor: A device designed to respond to physical stimuli such as temperature, light, magnetism or movement and transmit resulting impulses for interpretation, recording, movement, or operating control. [NIH] Septal: An abscess occurring at the root of the tooth on the proximal surface. [NIH] Septum: A dividing wall or partition; a general term for such a structure. The term is often used alone to refer to the septal area or to the septum pellucidum. [EU] Septum Pellucidum: A triangular double membrane separating the anterior horns of the lateral ventricles of the brain. It is situated in the median plane and bounded by the corpus callosum and the body and columns of the fornix. [NIH] Serine: A non-essential amino acid occurring in natural form as the L-isomer. It is synthesized from glycine or threonine. It is involved in the biosynthesis of purines, pyrimidines, and other amino acids. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Sex Characteristics: Those characteristics that distinguish one sex from the other. The primary sex characteristics are the ovaries and testes and their related hormones. Secondary sex characteristics are those which are masculine or feminine but not directly related to reproduction. [NIH] Sexually Transmitted Diseases: Diseases due to or propagated by sexual contact. [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]

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] Silicon: A trace element that constitutes about 27.6% of the earth's crust in the form of

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silicon dioxide. It does not occur free in nature. Silicon has the atomic symbol Si, atomic number 14, and atomic weight 28.09. [NIH] Silicon Dioxide: Silica. Transparent, tasteless crystals found in nature as agate, amethyst, chalcedony, cristobalite, flint, sand, quartz, and tridymite. The compound is insoluble in water or acids except hydrofluoric acid. [NIH] Sitz Bath: A special plastic tub. A person sits in a few inches of warm water to help relieve discomfort of hemorrhoids or anal fissures. [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] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Solid tumor: Cancer of body tissues other than blood, bone marrow, or the lymphatic system. [NIH] Sonogram: A computer picture of areas inside the body created by bouncing sound waves off organs and other tissues. Also called ultrasonogram or ultrasound. [NIH] 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] 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] Spectroscopic: The recognition of elements through their emission spectra. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sperm: The fecundating fluid of the male. [NIH] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural

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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 tap: A procedure in which a needle is put into the lower part of the spinal column to collect cerebrospinal fluid or to give anticancer drugs intrathecally. Also called a lumbar puncture. [NIH] Sporadic: Neither endemic nor epidemic; occurring occasionally in a random or isolated manner. [EU] Squamous: Scaly, or platelike. [EU] Squamous Epithelium: Tissue in an organ such as the esophagus. Consists of layers of flat, scaly cells. [NIH] Staging: Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. [NIH]

Steel: A tough, malleable, iron-based alloy containing up to, but no more than, two percent carbon and often other metals. It is used in medicine and dentistry in implants and instrumentation. [NIH] Stenosis: Narrowing or stricture of a duct or canal. [EU] Stereotactic: Radiotherapy that treats brain tumors by using a special frame affixed directly to the patient's cranium. By aiming the X-ray source with respect to the rigid frame, technicians can position the beam extremely precisely during each treatment. [NIH] Sterile: Unable to produce children. [NIH] Sterilization: The destroying of all forms of life, especially microorganisms, by heat, chemical, or other means. [NIH] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Strand: DNA normally exists in the bacterial nucleus in a helix, in which two strands are coiled together. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stricture: The abnormal narrowing of a body opening. Also called stenosis. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Stroma: The middle, thickest layer of tissue in the cornea. [NIH] Styrene: A colorless, toxic liquid with a strong aromatic odor. It is used to make rubbers, polymers and copolymers, and polystyrene plastics. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU]

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Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] 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] Sudden cardiac death: Cardiac arrest caused by an irregular heartbeat. [NIH] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Suppressive: Tending to suppress : effecting suppression; specifically : serving to suppress activity, function, symptoms. [EU] Suppurative: Consisting of, containing, associated with, or identified by the formation of pus. [NIH] Surgical castration: Surgical removal of the testicles (orchiectomy) or ovaries (oophorectomy) to stop the production of sex hormones. Decreasing the levels of hormones may stop the growth of certain cancers. [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] 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] Systemic: Affecting the entire body. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Tachycardia: Excessive rapidity in the action of the heart, usually with a heart rate above 100 beats per minute. [NIH] Talus: The second largest of the tarsal bones and occupies the middle and upper part of the tarsus. [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] Teratogenesis: Production of monstrous growths or fetuses. [NIH] Testicles: The two egg-shaped glands found inside the scrotum. They produce sperm and male hormones. Also called testes. [NIH] Testis: Either of the paired male reproductive glands that produce the male germ cells and the male hormones. [NIH]

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Testosterone: A hormone that promotes the development and maintenance of male sex characteristics. [NIH] Tetani: Causal agent of tetanus. [NIH] Tetanic: Having the characteristics of, or relating to tetanus. [NIH] Tetanus: A disease caused by tetanospasmin, a powerful protein toxin produced by Clostridium tetani. Tetanus usually occurs after an acute injury, such as a puncture wound or laceration. Generalized tetanus, the most common form, is characterized by tetanic muscular contractions and hyperreflexia. Localized tetanus presents itself as a mild condition with manifestations restricted to muscles near the wound. It may progress to the generalized form. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thermal: Pertaining to or characterized by heat. [EU] Thigh: A leg; in anatomy, any elongated process or part of a structure more or less comparable to a leg. [NIH] Third Ventricle: A narrow cleft inferior to the corpus callosum, within the diencephalon, between the paired thalami. Its floor is formed by the hypothalamus, its anterior wall by the lamina terminalis, and its roof by ependyma. It communicates with the fourth ventricle by the cerebral aqueduct, and with the lateral ventricles by the interventricular foramina. [NIH] Thrombocytopenia: A decrease in the number of blood platelets. [NIH] Thrombosed: A localized clot that either forms in the vein of a hemorrhoid or arises from a ruptured hemorrhoidal blood vessel. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thromboxanes: Physiologically active compounds found in many organs of the body. They are formed in vivo from the prostaglandin endoperoxides and cause platelet aggregation, contraction of arteries, and other biological effects. Thromboxanes are important mediators of the actions of polyunsaturated fatty acids transformed by cyclooxygenase. [NIH] Tibia: The second longest bone of the skeleton. It is located on the medial side of the lower leg, articulating with the fibula laterally, the talus distally, and the femur proximally. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tomography: Imaging methods that result in sharp images of objects located on a chosen plane and blurred images located above or below the plane. [NIH] Topical: On the surface of the body. [NIH] Topoisomerase inhibitors: A family of anticancer drugs. The topoisomerase enzymes are responsible for the arrangement and rearrangement of DNA in the cell and for cell growth and replication. Inhibiting these enzymes may kill cancer cells or stop their growth. [NIH] Torsion: A twisting or rotation of a bodily part or member on its axis. [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]

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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 organisms. Such substances are differentiated from the simple chemical poisons and the vegetable alkaloids by their high molecular weight and antigenicity. [EU] Trace element: Substance or element essential to plant or animal life, but present in extremely small amounts. [NIH] Trachea: The cartilaginous and membranous tube descending from the larynx and branching into the right and left main bronchi. [NIH] Traction: The act of pulling. [NIH] Transcription Factors: Endogenous substances, usually proteins, which are effective in the initiation, stimulation, or termination of the genetic transcription process. [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transgenes: Genes that are introduced into an organism using gene transfer techniques. [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] Transrectal ultrasound: A procedure used to examine the prostate. An instrument is inserted into the rectum, and sound waves bounce off the prostate. These sound waves create echoes, which a computer uses to create a picture called a sonogram. [NIH] Transurethral: Performed through the urethra. [EU] Transurethral resection: Surgery performed with a special instrument inserted through the urethra. Also called TUR. [NIH] Transurethral Resection of Prostate: Resection of the prostate using a cystoscope passed through the urethra. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Trees: Woody, usually tall, perennial higher plants (Angiosperms, Gymnosperms, and some Pterophyta) having usually a main stem and numerous branches. [NIH] Trichloroacetic Acid: A strong acid used as a protein precipitant in clinical chemistry and also as a caustic for removing warts. [NIH] Trypsin: A serine endopeptidase that is formed from trypsinogen in the pancreas. It is converted into its active form by enteropeptidase in the small intestine. It catalyzes hydrolysis of the carboxyl group of either arginine or lysine. EC 3.4.21.4. [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] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of Mycobacterium. [NIH] Tumor Necrosis Factor: Serum glycoprotein produced by activated macrophages and other mammalian mononuclear leukocytes which has necrotizing activity against tumor cell lines and increases ability to reject tumor transplants. It mimics the action of endotoxin but differs from it. It has a molecular weight of less than 70,000 kDa. [NIH] Turbinates: The scroll-like bony plates with curved margins on the lateral wall of the nasal

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cavity. [NIH] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Unresectable: Unable to be surgically removed. [NIH] Uremia: The illness associated with the buildup of urea in the blood because the kidneys are not working effectively. Symptoms include nausea, vomiting, loss of appetite, weakness, and mental confusion. [NIH] 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] 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] 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] 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] Vacuoles: Any spaces or cavities within a cell. They may function in digestion, storage, secretion, or excretion. [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] Varicella: Chicken pox. [EU] Varices: Stretched veins such as those that form in the esophagus from cirrhosis. [NIH] Varicose: The common ulcer in the lower third of the leg or near the ankle. [NIH] Varicose vein: An abnormal swelling and tortuosity especially of the superficial veins of the legs. [EU] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasoconstriction: Narrowing of the blood vessels without anatomic change, for which constriction, pathologic is used. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [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]

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Vertigo: An illusion of movement; a sensation as if the external world were revolving around the patient (objective vertigo) or as if he himself were revolving in space (subjective vertigo). The term is sometimes erroneously used to mean any form of dizziness. [EU] 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] Vestibular Nerve: The vestibular part of the 8th cranial nerve (vestibulocochlear nerve). The vestibular nerve fibers arise from neurons of Scarpa's ganglion and project peripherally to vestibular hair cells and centrally to the vestibular nuclei of the brain stem. These fibers mediate the sense of balance and head position. [NIH] Vestibule: A small, oval, bony chamber of the labyrinth. The vestibule contains the utricle and saccule, organs which are part of the balancing apparatus of the ear. [NIH] Vestibulocochlear Nerve: The 8th cranial nerve. The vestibulocochlear nerve has a cochlear part (cochlear nerve) which is concerned with hearing and a vestibular part (vestibular nerve) which mediates the sense of balance and head position. The fibers of the cochlear nerve originate from neurons of the spiral ganglion and project to the cochlear nuclei (cochlear nucleus). The fibers of the vestibular nerve arise from neurons of Scarpa's ganglion and project to the vestibular nuclei. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] 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] Visceral: , from viscus a viscus) pertaining to a viscus. [EU] Vitreous: Glasslike or hyaline; often used alone to designate the vitreous body of the eye (corpus vitreum). [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] Vulva: The external female genital organs, including the clitoris, vaginal lips, and the opening to the vagina. [NIH] Wart: A raised growth on the surface of the skin or other organ. [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]

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] 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

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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] Zoster: A virus infection of the Gasserian ganglion and its nerve branches, characterized by discrete areas of vesiculation of the epithelium of the forehead, the nose, the eyelids, and the cornea together with subepithelial infiltration. [NIH]

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INDEX 3 3-dimensional, 14, 125 A Abdomen, 125, 130, 149, 154, 156, 166 Abdominal, 69, 125, 132, 155, 162 Ablate, 125, 132, 138 Ablation, 14, 15, 63, 72, 76, 83, 87, 89, 90, 91, 94, 95, 99, 125 Abscess, 56, 125, 164 Acetylcholine, 125, 133 Acne, 4, 125, 136 Acoustic, 97, 125 Acrylonitrile, 125, 163 Adaptability, 125, 132 Adenocarcinoma, 44, 125, 143 Adenoma, 27, 125 Adenosine, 125, 157 Adjustment, 69, 125 Adjuvant, 19, 22, 49, 64, 125 Adrenal Cortex, 125, 136, 154, 159 Adrenal Medulla, 125, 139 Adrenergic, 125, 139, 167 Adverse Effect, 95, 126, 164 Aerosol, 126, 154 Affinity, 126, 165 Agar, 126, 157 Aggravation, 83, 126 Agonist, 82, 126, 142 Algorithms, 10, 126, 130 Alpha 1-Antitrypsin, 44, 126 Alpha 1-Antitrypsin Deficiency, 44, 126 Alpha Particles, 126, 160 Alternative medicine, 102, 126 Ameloblastoma, 38, 126 Amino Acid Sequence, 126, 154 Amino Acids, 126, 127, 156, 158, 159, 164 Ampulla, 127, 139 Anaesthesia, 127, 146 Anaesthetic, 79, 80, 127 Anal, 16, 127, 165 Anal Fissure, 127, 165 Analgesic, 127, 154 Analog, 127, 141, 149 Androgens, 82, 125, 127, 136 Anesthesia, 37, 70, 77, 99, 127, 159 Anesthetics, 127, 139 Animal model, 8, 14, 127 Anterior chamber, 127, 148

Antiallergic, 127, 136 Antiandrogens, 83, 127 Antiarrhythmic, 13, 127 Antibacterial, 56, 127, 165 Antibody, 126, 127, 134, 144, 145, 146, 148, 151, 152, 160, 161, 165, 172 Antifungal, 56, 127, 141 Antigen, 126, 127, 134, 144, 145, 146, 151 Anti-inflammatory, 56, 128, 136, 142 Anti-Inflammatory Agents, 128, 136 Antimetabolite, 128, 141 Antineoplastic, 128, 136, 141, 157 Anus, 76, 91, 100, 127, 128, 130, 134, 143, 147, 156, 161 Aorta, 128, 132, 170 Approximate, 92, 128 Aqueous, 128, 129, 136, 149 Arachidonic Acid, 128, 138, 149, 159 Argon, 17, 19, 99, 128 Arrhythmogenic, 13, 128 Arterial, 128, 132, 141, 142, 145, 159, 167 Arteries, 128, 130, 132, 135, 153, 168 Arterioles, 128, 130, 131 Artery, 13, 128, 135, 138, 151, 160 Arthroplasty, 128, 132 Artifacts, 85, 128 Artificial Organs, 128, 162 Asphyxia, 128, 154 Aspiration, 77, 128 Asymptomatic, 99, 128 Atmospheric Pressure, 73, 128, 144 Atrial, 14, 128, 129 Atrial Fibrillation, 14, 128 Atrial Flutter, 14, 129 Atrioventricular, 44, 52, 129 Atrioventricular Node, 44, 52, 129 Atrium, 128, 129, 170 Attenuation, 129, 140 Atypical, 19, 129 Auricular, 27, 129 Autosuggestion, 129, 145 Axillary, 129 B Bacteria, 127, 129, 138, 139, 152, 165, 169, 170 Basal cell carcinoma, 18, 20, 25, 28, 32, 37, 45, 47, 48, 129 Basal cells, 129

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Base, 9, 16, 94, 129, 148, 167 Basement Membrane, 129, 131 Benign, 26, 48, 75, 91, 98, 125, 129, 141, 153, 161 Benign tumor, 75, 129 Bile, 19, 129, 141, 143, 149, 166 Biliary, 129, 143 Biochemical, 83, 126, 128, 129, 130 Biological response modifier, 129, 130, 147 Biological therapy, 129, 143 Biological Transport, 130, 137 Biopsy, 10, 20, 69, 72, 90, 99, 114, 130, 135, 156 Biopsy specimen, 72, 130 Biosynthesis, 82, 128, 130, 164 Biotechnology, 16, 102, 109, 130 Bladder, 24, 70, 71, 76, 91, 130, 146, 159, 162, 170 Blood Platelets, 130, 168 Blood pressure, 130, 142, 145, 152, 158, 165 Blood vessel, 26, 79, 130, 138, 143, 148, 150, 156, 157, 166, 168, 170 Body Fluids, 130, 131, 138, 165 Bone Marrow, 130, 142, 145, 150, 152, 165 Bone scan, 130, 163 Bowel, 127, 130, 137, 146, 166 Bowel Movement, 130, 137, 166 Brachytherapy, 10, 12, 130, 147, 148, 160, 172 Brain Stem, 130, 171 Bronchi, 130, 131, 139, 169 Bronchial, 53, 76, 131 Buccal, 131, 150 Bupivacaine, 131, 149 Bypass, 14, 131 C Callus, 131, 148 Camptothecin, 131, 148 Candidiasis, 131, 141 Capillary, 54, 102, 131, 170 Carbohydrate, 131, 136, 142 Carbon Dioxide, 73, 131, 138, 161 Carcinogenic, 131, 146, 166 Carcinoma, 4, 24, 27, 31, 36, 38, 44, 46, 47, 50, 51, 52, 53, 54, 55, 56, 57, 76, 131, 136 Carcinoma in Situ, 38, 131 Cardiac, 13, 14, 72, 87, 89, 127, 128, 131, 138, 139, 149, 153, 166, 167 Carotene, 131, 162 Case report, 17, 19, 35, 47, 131 Case series, 43, 131 Castration, 82, 132

Cataract, 41, 132 Catheter, 13, 72, 77, 92, 132 Catheter Ablation, 13, 132 Caudal, 132, 145, 158 Caustic, 132, 157, 169 Cauterization, 114, 132 Celiac Artery, 132, 143 Cell Death, 84, 132, 153 Cell Division, 129, 132, 143, 157 Cell membrane, 87, 130, 132, 157 Cell motility, 132, 143 Cell Survival, 132, 143 Cementation, 17, 29, 132 Cerebral, 8, 130, 132, 139, 143, 168 Cerebrospinal, 132, 150, 166 Cerebrospinal fluid, 132, 150, 166 Cerebrum, 132 Cervical, 29, 30, 42, 43, 47, 102, 114, 132, 133, 135, 139 Cervical intraepithelial neoplasia, 43, 47, 133 Cervix, 27, 37, 48, 49, 114, 132, 133, 134, 135, 161 Chemoembolization, 21, 99, 133 Chemotherapy, 10, 60, 64, 79, 99, 133, 153, 163 Cholesteatoma, 98, 133 Cholesterol, 129, 133, 166 Choline, 11, 133 Chromosome, 133, 149 Chronic, 15, 83, 99, 133, 146, 166 Cicatrix, 133, 148 Cicatrix, Hypertrophic, 133, 148 Cirrhosis, 21, 99, 133, 158, 170 CIS, 133, 162 Clamp, 69, 133 Clinical trial, 5, 15, 45, 109, 133, 156, 159, 161 Cloning, 130, 133 Coagulation, 100, 130, 133, 148 Cochlea, 133, 134, 146 Cochlear, 98, 134, 171 Colitis, 134, 146 Collagen, 4, 129, 134, 140, 148, 159 Colon, 3, 55, 60, 64, 100, 134, 146, 148 Colorectal, 26, 31, 37, 38, 41, 44, 51, 52, 60, 65, 134 Colposcopy, 42, 114, 134 Complement, 134 Complementary and alternative medicine, 63, 66, 134 Complementary medicine, 63, 134

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Compress, 134, 143 Computational Biology, 109, 135 Computed tomography, 4, 135, 163 Computerized axial tomography, 135, 163 Computerized tomography, 135 Conduction, 16, 76, 78, 84, 85, 95, 129, 132, 135 Cone biopsy, 114, 135 Cones, 135, 162 Congestive heart failure, 13, 135 Conization, 47, 135 Connective Tissue, 130, 134, 135, 137, 140, 142, 148, 150 Constriction, 135, 148, 170 Constriction, Pathologic, 135, 170 Contamination, 41, 84, 135 Contraindications, ii, 135 Conventional treatment, 74, 135 Cornea, 127, 135, 148, 166, 172 Coronary, 13, 129, 135, 153 Coronary Thrombosis, 135, 153 Corpus, 136, 156, 159, 164, 168, 171 Corticosteroid, 4, 56, 136 Cranial, 136, 155, 156, 171 Cryoprotective, 87, 136 Cryotherapy, 13, 81, 82, 84, 89, 136 Curative, 37, 136, 168 Curettage, 25, 27, 28, 29, 136 Curette, 136, 139 Cutaneous, 18, 22, 37, 45, 56, 82, 86, 131, 136, 150 Cyproterone, 136, 141 Cyst, 47, 136 Cytokine, 9, 11, 136 Cytoplasm, 132, 136, 139, 150, 152 Cytotoxic, 136, 160, 161 D Data Collection, 136, 141 Decompression, 98, 136 Decompression Sickness, 136 Degenerative, 137, 143 Depigmentation, 55, 137 Dermis, 77, 137, 148, 167 Dexterity, 10, 137 Diagnostic procedure, 67, 102, 137 Diastole, 137 Diastolic, 13, 137, 145 Diathermy, 100, 137, 152 Diffusion, 15, 16, 130, 137, 146 Diffusivity, 74, 137 Digestion, 129, 130, 137, 149, 156, 166, 170 Digestive system, 3, 137

Dihydrotestosterone, 82, 137 Dilation, 64, 137 Dilator, 137, 148 Direct, iii, 8, 13, 14, 72, 73, 89, 132, 137, 158, 161 Discrete, 52, 93, 137, 149, 172 Distal, 29, 73, 86, 93, 95, 132, 137, 138, 160 Dizziness, 137, 171 Dorsal, 137, 158 Drive, ii, vi, 59, 70, 137, 149 Drug Interactions, 137 Dry Ice, 80, 138 Duct, 19, 127, 138, 139, 163, 166, 167 Duodenum, 129, 138, 139, 143, 156, 166 Dura mater, 138, 151, 155 Dysplasia, 22, 33, 42, 138 E Ecchymosis, 99, 138 Edema, 8, 99, 138, 143 Efficacy, 4, 8, 11, 12, 13, 15, 24, 92, 138 Eicosanoids, 9, 138 Elastin, 134, 138 Electrocoagulation, 133, 138 Electrode, 6, 78, 138 Electrolyte, 136, 138, 152, 165 Electrons, 129, 138, 147, 148, 150, 160, 161 Elementary Particles, 138, 150, 153, 159 Embolism, 20, 56, 138 Embolus, 41, 138, 146 Embryo, 138, 146, 154 Emphysema, 126, 138 Empirical, 18, 138 Enamel, 126, 138 Endocervical curettage, 114, 139 Endocrinology, 139, 143 Endogenous, 138, 139, 169 Endolymphatic Duct, 139 Endolymphatic Sac, 98, 139 Endometrial, 34, 56, 139 Endometrium, 23, 139, 151 Endoscope, 134, 139 Endoscopic, 24, 27, 139 Endotoxin, 139, 169 Enhancer, 7, 139 Enucleation, 63, 139 Environmental Health, 108, 110, 139 Enzymatic, 131, 134, 139, 162 Enzyme, 50, 131, 139, 142, 159, 167, 171 Eosinophilia, 19, 139 Eosinophils, 139 Epidermal, 139, 149, 151 Epidermis, 129, 137, 139, 144, 149

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Epinephrine, 27, 77, 125, 139 Epistaxis, 29, 139 Epithelial, 26, 125, 126, 130, 131, 139, 143 Epithelial Cells, 139, 144 Epithelium, 30, 55, 129, 139, 148, 156, 172 Equalization, 98, 139 Equipment and Supplies, 99, 140 Erectile, 140, 156 Esophageal, 76, 140, 163 Esophageal Varices, 140, 163 Esophagus, 137, 140, 156, 166, 170 Estrogens, 140, 142 Eukaryotic Cells, 140, 155 Excitation, 129, 140 External-beam radiation, 140, 148, 160, 172 Extracellular, 135, 140, 165 Extraction, 87, 94, 140 Eye socket, 140, 156 F Family Planning, 109, 140 Fat, 77, 128, 130, 131, 136, 138, 140, 142, 149, 163 Fatty acids, 138, 140, 159, 168 Femoral, 29, 132, 140 Femur, 140, 168 Fetus, 140, 141, 170 Fibroblasts, 140, 147 Fibrosis, 140, 163 Fibula, 140, 168 Fistula, 33, 71, 98, 140 Flatus, 141 Flexor, 141, 149 Floxuridine, 60, 64, 141 Fluconazole, 18, 141 Fluoroscopy, 10, 141 Fluorouracil, 57, 60, 64, 141 Flutamide, 83, 141 Focus Groups, 12, 141 Foetoplacental, 141, 154 Fracture Fixation, 132, 141 G Gallbladder, 125, 129, 137, 141, 143 Gamma Rays, 141, 160, 161 Ganglion, 141, 155, 171, 172 Gangrenous, 100, 141 Gas, 5, 9, 17, 56, 71, 73, 81, 82, 85, 88, 99, 128, 131, 136, 137, 141, 144, 154, 167 Gastric, 132, 141, 156, 163 Gastrin, 141, 144 Gastrointestinal, 21, 83, 139, 141, 149, 167 Gene, 10, 126, 130, 141, 154, 169

Gene Expression, 141 Gene Therapy, 10, 141 Genital, 64, 114, 142, 143, 171 Gland, 15, 18, 69, 74, 91, 125, 142, 150, 153, 155, 157, 159, 163, 164, 166, 167 Glomerular, 142, 161 Glucocorticoids, 125, 136, 142 Glucose, 142, 146, 147, 163 Glycoprotein, 126, 142, 169 Gonadal, 142, 166 Gonadorelin, 142, 149 Gonadotropin, 24, 142, 149 Gonads, 82, 132, 142 Goserelin, 83, 142 Governing Board, 142, 158 Grade, 35, 142 Graft, 142, 145 Graft Rejection, 142, 145 Grafting, 25, 37, 142, 146 Granuloma, 25, 46, 143 Growth factors, 4, 143 Gynecology, 23, 27, 33, 40, 49, 56, 75, 78, 143 H Hair Cells, 143, 171 Hair follicles, 137, 143 Heart failure, 143 Heartbeat, 143, 167 Hematoma, 143 Hemoglobinopathies, 142, 143 Hemophilia, 30, 143 Hemorrhage, 8, 138, 143, 166 Hemorrhagic stroke, 8, 143 Hemorrhoid, 3, 143, 168 Hemorrhoidectomy, 100, 143 Hepatic Artery, 53, 143 Hepatitis, 99, 143 Hepatobiliary, 19, 22, 143 Hepatocellular, 21, 31, 143 Hepatocellular carcinoma, 21, 31, 143 Hepatocyte, 51, 143 Hepatocyte Growth Factor, 51, 143 Hereditary, 126, 143, 144, 162 Heredity, 141, 144 Homogeneous, 15, 144 Homologous, 142, 144 Hormonal, 12, 83, 136, 144 Hormonal therapy, 12, 83, 144 Hormone, 82, 136, 138, 139, 141, 142, 144, 146, 149, 153, 159, 168 Hormone therapy, 144 Human papillomavirus, 114, 144

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Hybridomas, 144, 147 Hydrogen, 129, 131, 144, 152, 153, 159 Hydrolysis, 144, 149, 158, 159, 169 Hydroxylysine, 134, 144 Hydroxyproline, 134, 144 Hyperbaric, 64, 144 Hyperbaric oxygen, 144 Hyperpigmentation, 47, 144 Hyperplasia, 19, 46, 54, 91, 144, 149 Hyperreflexia, 145, 168 Hypertension, 145, 158 Hyperthermia, 10, 79, 86, 137, 145, 153 Hypertrophy, 144, 145 Hypodermic, 34, 145 Hypothalamus, 83, 142, 145, 157, 168 Hypothermia, 8, 145 I Iatrogenic, 13, 145 Illusion, 145, 171 Immersion, 71, 145 Immune response, 11, 68, 125, 127, 136, 142, 145, 167, 170, 171 Immune system, 11, 79, 80, 87, 88, 129, 145, 149, 150, 170, 171 Immunity, 11, 145 Immunization, 145, 158 Immunologic, 25, 50, 145, 161 Immunology, 11, 125, 126, 145 Immunosuppressant, 141, 145 Immunosuppressive, 145 Immunosuppressive therapy, 145 Immunotherapy, 11, 80, 130, 145, 153 Implant radiation, 145, 147, 148, 160, 172 Implantation, 146, 154 Impotence, 74, 140, 146 In situ, 6, 11, 76, 88, 89, 93, 146 In vitro, 7, 8, 13, 50, 142, 146 In vivo, 6, 7, 13, 19, 33, 72, 142, 146, 168 Incision, 77, 86, 146, 147, 159, 162 Incontinence, 71, 74, 99, 146 Induction, 127, 137, 146 Infarction, 24, 143, 146 Infection, 33, 99, 129, 130, 131, 146, 150, 167, 171, 172 Infiltration, 77, 146, 159, 172 Inflammation, 9, 82, 125, 128, 134, 140, 141, 143, 146, 148, 149, 151, 155, 157 Inflammatory bowel disease, 100, 146 Infusion, 141, 146, 163 Initiation, 146, 169 Inner ear, 97, 146 Insight, 12, 146

Insulator, 86, 146 Insulin, 51, 146, 147, 162 Insulin-dependent diabetes mellitus, 147 Insulin-like, 51, 147 Interferon, 4, 22, 147 Interferon-alpha, 147 Interleukin-1, 7, 147 Interleukin-2, 147 Interleukin-6, 51, 147 Intermittent, 85, 147 Internal radiation, 147, 148, 160, 172 Interstitial, 10, 33, 82, 130, 147, 148, 161, 172 Intestinal, 3, 131, 147 Intestines, 125, 141, 147 Intoxication, 147, 171 Intracellular, 87, 146, 147 Intraepithelial, 49, 147 Intraocular, 63, 147 Intravascular, 89, 147 Invasive, 4, 5, 6, 13, 15, 18, 39, 42, 79, 80, 87, 90, 92, 95, 145, 147, 150 Involuntary, 147, 153, 154 Ionizing, 126, 147, 161 Ions, 129, 138, 144, 147 Irinotecan, 60, 64, 148 Iris, 41, 127, 135, 148, 160 Irradiation, 29, 148, 172 Ischemia, 8, 13, 15, 143, 148 K Kb, 108, 148 Keloid, 4, 133, 148 Keratitis, 18, 148 Keratosis, 38, 148 L Labyrinth, 133, 139, 146, 148, 155, 156, 164, 171 Labyrinthine, 35, 64, 148 Laceration, 148, 168 Lactation, 148, 154 Lamella, 36, 148 Large Intestine, 137, 147, 148, 161, 165 Laryngeal, 76, 148 Larynx, 24, 148, 169 Laser Surgery, 15, 35, 148 Laser therapy, 4, 10, 148 Leiomyosarcoma, 49, 149 Lens, 71, 132, 149 Lentigo, 19, 47, 54, 149 Lesion, 6, 15, 72, 76, 82, 143, 149, 150 Lethal, 15, 84, 149 Leukemia, 142, 149

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Leukoplakia, 30, 149 Leukotrienes, 128, 138, 149 Leuprolide, 83, 149 Libido, 127, 149 Lichen Planus, 25, 149 Lidocaine, 77, 149 Ligament, 149, 159 Ligation, 36, 53, 100, 149 Linkage, 68, 149 Lip, 54, 149 Lipid, 133, 146, 149 Lipolysis, 77, 149 Liver cancer, 19, 53, 99, 149 Liver metastases, 31, 49, 51, 101, 150 Liver scan, 150, 163 Liver Transplantation, 99, 150 Localization, 5, 11, 150 Localized, 5, 10, 12, 15, 21, 47, 51, 70, 71, 77, 87, 92, 125, 143, 146, 149, 150, 157, 163, 168 Loop, 30, 72, 76, 150 Lumbar, 34, 150, 166 Lumbar puncture, 34, 150, 166 Lupus, 24, 150 Lymph, 129, 132, 150, 153 Lymph node, 129, 132, 150, 153 Lymphatic, 146, 150, 165 Lymphatic system, 150, 165 Lymphocytes, 127, 142, 144, 145, 147, 150, 171 Lymphocytic, 25, 150 M Macrophage, 147, 150 Magnetic Resonance Imaging, 4, 9, 10, 23, 40, 64, 78, 83, 85, 93, 150, 151, 163 Magnetic Resonance Spectroscopy, 23, 150 Malignancy, 63, 91, 151, 156 Malignant, 13, 19, 26, 41, 45, 53, 71, 75, 76, 78, 91, 92, 125, 128, 131, 141, 142, 149, 151, 153, 161 Malignant tumor, 41, 78, 91, 131, 151 Maxillary, 38, 76, 151, 156 Maxillary Sinus, 76, 151 Meatus, 151 Medial, 151, 155, 168 Mediate, 151, 171 Mediator, 8, 147, 151 MEDLINE, 109, 151 Melanin, 72, 137, 148, 151 Melanocytes, 144, 151, 153 Melanoma, 19, 27, 33, 76, 151

Membrane, 132, 134, 139, 140, 148, 151, 153, 155, 156, 157, 162, 164 Meninges, 133, 138, 151 Meningitis, 27, 141, 151 Menopause, 151, 154 Menstrual Cycle, 151, 154, 159 Mental, iv, 5, 108, 110, 151, 158, 163, 170 Mental Disorders, 151, 158 Mental Health, iv, 5, 108, 110, 151, 158 Metastasis, 83, 151, 152, 153 Metastatic, 7, 8, 12, 21, 22, 31, 38, 55, 60, 64, 142, 152, 164 Microbiology, 129, 152 Microorganism, 152, 171 Microscopy, 20, 72, 129, 152 Microspheres, 11, 152 Microwaves, 10, 152, 160 Mineralocorticoids, 125, 136, 152 Mitochondria, 152, 155 Mitochondrial Swelling, 152, 153 Modeling, 16, 152 Modification, 18, 139, 152, 160 Molecular, 4, 109, 111, 130, 135, 152, 163, 169 Molecule, 128, 129, 134, 140, 143, 144, 152, 161 Monitor, 9, 68, 70, 152, 154 Monoclonal, 144, 148, 152, 160, 172 Monocytes, 147, 152 Mononuclear, 143, 152, 169 Monophosphate, 141, 152 Morphology, 132, 152 Mucosa, 150, 153 Muscle Fibers, 129, 153 Mydriatic, 137, 153 Myocardial infarction, 14, 136, 153 Myocardium, 13, 81, 153 N Narcotic, 153, 154 Nasal Cavity, 151, 153, 156, 170 Necrosis, 8, 15, 33, 73, 146, 153 Neoadjuvant Therapy, 83, 153 Neoplasia, 49, 153 Neoplasms, 128, 141, 142, 153, 157, 161 Nephrectomy, 4, 153 Nephron, 4, 153 Nervous System, 125, 133, 141, 142, 143, 149, 151, 153, 155, 167 Neuroma, 54, 97, 153 Neurons, 153, 171 Neutrons, 126, 148, 153, 160 Neutrophil, 126, 153

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Nevus, 149, 153 Nitrous Oxide, 73, 154 Nuclear, 7, 8, 131, 138, 140, 141, 153, 154 Nuclear Localization Signal, 9, 154 Nuclear Pore, 154 Nuclei, 126, 138, 142, 150, 153, 154, 155, 159, 171 Nucleic acid, 154 Nucleus, 136, 138, 139, 140, 141, 150, 152, 153, 154, 159, 166, 171 Nystagmus, 98, 148, 154 O Occult, 34, 154 Oestrogen, 25, 154 Omentum, 143, 154 Oncogene, 144, 154 Oncology, 11, 30, 31, 32, 34, 35, 40, 48, 49, 50, 56, 154 Oophorectomy, 154, 167 Opacity, 132, 154 Ophthalmic, 18, 19, 43, 55, 154 Ophthalmology, 18, 36, 41, 42, 63, 155 Opsin, 155, 162 Optic Chiasm, 145, 155 Optic Nerve, 155, 162 Orbit, 140, 155, 156 Orbital, 76, 155 Orchiectomy, 155, 167 Organelles, 90, 136, 151, 152, 155, 157 Ossicles, 155 Osteoporosis, 154, 155 Otolaryngology, 25, 28, 29, 35, 41, 78, 155 Otosclerosis, 98, 155 Outpatient, 15, 43, 155 Ovaries, 154, 155, 161, 164, 167 Ovary, 142, 154, 155 Oxygenation, 136, 143, 155 P Pachymeningitis, 151, 155 Palliative, 44, 136, 154, 155, 168 Pancreas, 125, 137, 143, 146, 155, 169 Papillomavirus, 156 Paranasal Sinuses, 151, 156 Paroxysmal, 98, 156 Patch, 138, 149, 156 Pathologic, 130, 135, 156, 158 Patient Education, 114, 118, 120, 124, 156 Patient Selection, 100, 156 Pelvic, 156, 159 Pelvis, 125, 149, 150, 155, 156, 170 Penis, 56, 57, 76, 156, 161 Peptic, 156, 163

Peptic Ulcer, 156, 163 Peptic Ulcer Hemorrhage, 156, 163 Peptide, 9, 156, 158, 159 Percutaneous, 17, 34, 39, 44, 64, 91, 99, 156 Perfusion, 15, 74, 81, 87, 156 Perilymph, 98, 156 Perineal, 44, 50, 91, 92, 99, 156, 160 Perineum, 156 Periorbital, 28, 156 Petechia, 138, 156 Pharmacologic, 127, 156, 168 Phospholipids, 140, 156 Phosphorus, 78, 157 Photocoagulation, 133, 157 Photoreceptors, 135, 157 Physiologic, 126, 130, 151, 157, 161 Physiology, 100, 139, 143, 157 Pigment, 137, 148, 151, 157 Pigmentation, 144, 157 Pilot study, 34, 157 Pituitary Gland, 136, 142, 157 Plants, 131, 133, 142, 152, 157, 163, 169 Plaque, 39, 157 Plasma, 126, 132, 152, 157, 164 Plastids, 155, 157 Pneumonia, 135, 157 Podophyllin, 64, 157 Podophyllotoxin, 157 Podophyllum, 63, 157 Polypeptide, 126, 134, 158 Polytetrafluoroethylene, 89, 158 Port, 71, 73, 90, 158 Port-a-cath, 158 Portal Hypertension, 99, 100, 158 Portal Vein, 158 Posterior, 36, 55, 98, 127, 137, 148, 155, 158 Postoperative, 4, 14, 34, 45, 99, 100, 158 Postoperative Complications, 100, 158 Potentiates, 147, 158 Practice Guidelines, 110, 158 Preclinical, 4, 158 Precursor, 128, 133, 139, 158, 169 Preoperative, 100, 158 Prevalence, 4, 158 Primary Prevention, 14, 158 Probe, 9, 10, 13, 17, 47, 68, 69, 70, 71, 72, 73, 75, 76, 78, 85, 86, 87, 88, 91, 93, 95, 158 Procaine, 149, 159 Progesterone, 159, 166 Progression, 127, 159 Progressive, 133, 153, 159, 161

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Prolapse, 100, 159 Proline, 134, 144, 159 Prophylaxis, 159, 170 Prostaglandins, 128, 138, 159 Prostate gland, 10, 28, 68, 70, 71, 74, 91, 159 Prostatectomy, 26, 74, 159, 160 Protease, 126, 159 Protein S, 130, 159 Proteins, 50, 51, 87, 126, 127, 132, 134, 143, 147, 152, 154, 156, 157, 159, 164, 169 Proteolytic, 126, 134, 159 Protocol, 22, 51, 159 Protons, 126, 144, 147, 150, 159, 160 Proximal, 7, 9, 17, 47, 137, 153, 160, 164 Pruritic, 149, 160 Psychoactive, 160, 171 Public Policy, 109, 160 Pulmonary, 126, 130, 149, 160, 170 Pulmonary Artery, 130, 160, 170 Pulse, 152, 160 Pupil, 135, 137, 153, 160 Purgative, 157, 160 Q Quality of Life, 14, 160 R Radiation therapy, 4, 12, 22, 50, 74, 99, 125, 140, 144, 147, 148, 153, 160, 163, 172 Radical prostatectomy, 54, 74, 82, 83, 160 Radio Waves, 99, 137, 152, 160 Radioactive, 130, 144, 145, 146, 147, 148, 150, 154, 160, 163, 172 Radiofrequency ablation, 4, 18, 160 Radioimmunotherapy, 160, 161 Radiolabeled, 148, 160, 172 Radiological, 156, 160 Radiolucent, 11, 160 Radiotherapy, 50, 79, 80, 130, 148, 160, 161, 166, 172 Randomized, 12, 14, 138, 161 Randomized clinical trial, 14, 161 Receptor, 7, 9, 83, 128, 144, 161 Recombination, 142, 161 Rectal, 13, 44, 47, 52, 86, 100, 161 Rectal Fistula, 86, 161 Rectum, 3, 71, 76, 91, 100, 128, 130, 134, 137, 141, 143, 146, 148, 159, 161, 169 Recurrence, 11, 44, 99, 161 Reentry, 14, 44, 52, 161 Refer, 1, 131, 134, 137, 150, 153, 160, 161, 164, 169, 171 Refractory, 24, 60, 64, 138, 161

Regimen, 138, 161, 162 Reliability, 9, 161 Remission, 161 Renal cell carcinoma, 4, 161 Renal failure, 18, 161 Reproductive system, 159, 161 Resection, 7, 8, 11, 13, 22, 38, 52, 55, 69, 79, 99, 161, 169 Respiration, 131, 152, 161 Retina, 135, 149, 155, 162, 163 Retinae, 57, 162 Retinal, 39, 42, 55, 155, 162 Retinoblastoma, 76, 162 Retinol, 162 Retractor, 41, 162 Retreatment, 79, 88, 162 Retropubic, 159, 160, 162 Retropubic prostatectomy, 160, 162 Retroviral vector, 141, 162 Reverberant, 137, 162 Rhodopsin, 155, 162 Risk factor, 99, 162 Risk patient, 36, 162 Robotics, 10, 162 Rod, 133, 163 Rubber, 100, 125, 163 S Saline, 14, 92, 163 Salivary, 137, 163 Salivary glands, 137, 163 Salvage Therapy, 44, 163 Saponins, 163, 166 Scans, 4, 69, 163 Schizoid, 163, 171 Schizophrenia, 163, 171 Schizotypal Personality Disorder, 163, 171 Sclerotherapy, 100, 163 Screening, 99, 114, 133, 163 Scrotum, 91, 163, 167 Sebaceous, 46, 137, 163 Sebaceous gland, 137, 163 Sebum, 163 Secondary tumor, 151, 163 Secretion, 82, 136, 142, 147, 148, 152, 164, 170 Seizures, 156, 164 Semen, 159, 164 Semicircular canal, 146, 164 Senile, 46, 149, 155, 157, 164 Sensor, 70, 164 Septal, 164 Septum, 41, 129, 153, 164

181

Septum Pellucidum, 164 Serine, 142, 164, 169 Serum, 9, 24, 50, 51, 134, 142, 152, 164, 169 Sex Characteristics, 127, 140, 154, 164, 168 Sexually Transmitted Diseases, 114, 164 Shock, 77, 132, 164, 169 Side effect, 83, 86, 126, 130, 164, 168 Signs and Symptoms, 100, 161, 164 Silicon, 9, 164, 165 Silicon Dioxide, 165 Sitz Bath, 3, 165 Skeletal, 13, 127, 133, 165 Skeleton, 140, 165, 168 Skull, 133, 140, 155, 165, 167 Small intestine, 138, 144, 147, 165, 169 Social Environment, 160, 165 Sodium, 78, 152, 165, 167 Solid tumor, 6, 79, 165 Sonogram, 165, 169 Sound wave, 135, 137, 165, 169 Specialist, 116, 137, 165 Species, 139, 141, 152, 165, 169, 171 Specificity, 10, 126, 165 Spectroscopic, 10, 46, 150, 165 Spectrum, 152, 160, 165 Sperm, 127, 133, 165, 167 Sphincter, 71, 92, 148, 165 Spinal cord, 83, 130, 132, 133, 138, 141, 151, 153, 155, 166 Spinal tap, 150, 166 Sporadic, 162, 166 Squamous, 51, 76, 133, 166 Squamous Epithelium, 133, 166 Staging, 99, 163, 166 Steel, 133, 166 Stenosis, 89, 166 Stereotactic, 49, 70, 71, 78, 166 Sterile, 73, 166 Sterilization, 11, 55, 166 Steroid, 27, 82, 154, 163, 166 Stimulus, 137, 138, 140, 166 Stomach, 125, 137, 140, 141, 143, 144, 147, 154, 156, 165, 166 Stool, 134, 146, 148, 166 Strand, 93, 166 Stress, 163, 166 Stricture, 166 Stroke, 14, 108, 143, 166 Stroma, 148, 166 Styrene, 163, 166 Subacute, 146, 166 Subclinical, 146, 164, 167

Subcutaneous, 77, 138, 141, 167 Substance P, 164, 167 Substrate, 14, 167 Suction, 77, 167 Sudden cardiac death, 13, 167 Suppression, 57, 136, 167 Suppressive, 50, 167 Suppurative, 141, 167 Surgical castration, 74, 167 Sweat, 54, 137, 167 Sweat Glands, 137, 167 Sympathomimetic, 139, 167 Symphysis, 159, 167 Systemic, 7, 8, 11, 15, 22, 60, 64, 128, 130, 131, 139, 146, 148, 160, 167, 172 Systolic, 13, 145, 167 T Tachycardia, 13, 24, 44, 52, 167 Talus, 167, 168 Temporal, 93, 151, 167 Teratogenesis, 157, 167 Testicles, 155, 163, 167 Testis, 142, 154, 167 Testosterone, 82, 168 Tetani, 168 Tetanic, 168 Tetanus, 45, 168 Therapeutics, 168 Thermal, 7, 9, 13, 16, 24, 51, 53, 57, 74, 75, 76, 77, 79, 84, 86, 87, 89, 93, 94, 95, 153, 168 Thigh, 140, 168 Third Ventricle, 145, 168 Thrombocytopenia, 18, 168 Thrombosed, 100, 168 Thrombosis, 159, 163, 166, 168 Thromboxanes, 128, 138, 168 Tibia, 17, 140, 168 Tissue, 6, 7, 8, 10, 13, 15, 16, 23, 39, 44, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 80, 81, 82, 84, 86, 87, 89, 90, 91, 92, 93, 94, 95, 99, 125, 127, 128, 129, 130, 131, 132, 133, 135, 136, 138, 139, 140, 141, 142, 143, 144, 145, 146, 147, 148, 149, 150, 151, 153, 154, 156, 157, 160, 161, 162, 164, 166, 168, 169, 171 Tomography, 6, 10, 151, 168 Topical, 57, 89, 168 Topoisomerase inhibitors, 148, 168 Torsion, 146, 168 Toxic, iv, 95, 145, 157, 166, 168, 169 Toxicity, 137, 168

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Toxicology, 110, 168 Toxin, 139, 168, 169 Trace element, 164, 169 Trachea, 130, 148, 169 Traction, 133, 169 Transcription Factors, 7, 169 Transfection, 130, 142, 169 Transgenes, 9, 169 Transmitter, 125, 151, 169 Transplantation, 9, 13, 99, 145, 169 Transrectal ultrasound, 10, 13, 23, 99, 169 Transurethral, 25, 54, 69, 70, 159, 169 Transurethral resection, 25, 54, 70, 159, 169 Transurethral Resection of Prostate, 159, 169 Trauma, 4, 63, 81, 82, 153, 169 Trees, 163, 169 Trichloroacetic Acid, 20, 169 Trypsin, 126, 169 Tryptophan, 134, 169 Tuberculosis, 150, 169 Tumor Necrosis Factor, 7, 8, 169 Turbinates, 17, 169 U Ultrasonography, 34, 170 Unresectable, 17, 79, 170 Uremia, 161, 170 Urethra, 13, 91, 156, 159, 169, 170 Urinary, 76, 99, 146, 159, 162, 170 Urine, 130, 146, 170 Uterus, 34, 76, 132, 133, 136, 139, 149, 155, 159, 161, 170 V Vaccination, 11, 170 Vaccine, 125, 159, 170 Vacuoles, 155, 170 Vagina, 76, 131, 133, 134, 161, 170, 171 Vaginal, 33, 170, 171

Varicella, 33, 170 Varices, 100, 170 Varicose, 163, 170 Varicose vein, 163, 170 Vascular, 7, 98, 137, 146, 170 Vasoconstriction, 77, 139, 170 Vein, 154, 158, 168, 170 Venous, 46, 56, 159, 170 Ventricle, 13, 129, 160, 167, 168, 170 Ventricular, 13, 24, 81, 170 Venules, 130, 131, 170 Vertebrae, 166, 170 Vertigo, 97, 171 Vestibular, 97, 143, 148, 171 Vestibular Nerve, 98, 171 Vestibule, 133, 146, 164, 171 Vestibulocochlear Nerve, 171 Veterinary Medicine, 78, 109, 171 Viral, 171 Virus, 33, 99, 139, 144, 147, 157, 162, 171, 172 Visceral, 79, 80, 171 Vitreous, 149, 162, 171 Vitro, 7, 171 Vivo, 7, 10, 71, 171 Vulva, 76, 84, 171 W Wart, 148, 171 White blood cell, 127, 150, 153, 171 Withdrawal, 70, 171 Womb, 161, 170, 171 Wound Healing, 4, 23, 133, 171 X Xenograft, 127, 171 X-ray, 57, 82, 135, 141, 148, 154, 160, 161, 163, 166, 171, 172 X-ray therapy, 82, 148, 172 Z Zoster, 33, 172

183

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Cryosurgery

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