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

BLURRED VISION 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., 1960Blurred Vision: 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: 0-497-00161-6 1. Blurred Vision-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 blurred vision. 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 BLURRED VISION ...................................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Blurred Vision............................................................................... 7 The National Library of Medicine: PubMed ................................................................................ 13 CHAPTER 2. BOOKS ON BLURRED VISION ....................................................................................... 21 Overview...................................................................................................................................... 21 Chapters on Blurred Vision ......................................................................................................... 21 CHAPTER 3. MULTIMEDIA ON BLURRED VISION ............................................................................ 25 Overview...................................................................................................................................... 25 Video Recordings ......................................................................................................................... 25 CHAPTER 4. PERIODICALS AND NEWS ON BLURRED VISION ......................................................... 29 Overview...................................................................................................................................... 29 News Services and Press Releases................................................................................................ 29 Newsletter Articles ...................................................................................................................... 30 Academic Periodicals covering Blurred Vision............................................................................ 32 CHAPTER 5. RESEARCHING MEDICATIONS .................................................................................... 33 Overview...................................................................................................................................... 33 U.S. Pharmacopeia....................................................................................................................... 33 Commercial Databases ................................................................................................................. 34 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 39 Overview...................................................................................................................................... 39 NIH Guidelines............................................................................................................................ 39 NIH Databases............................................................................................................................. 41 Other Commercial Databases....................................................................................................... 43 APPENDIX B. PATIENT RESOURCES ................................................................................................. 45 Overview...................................................................................................................................... 45 Patient Guideline Sources............................................................................................................ 45 Finding Associations.................................................................................................................... 50 APPENDIX C. FINDING MEDICAL LIBRARIES .................................................................................. 53 Overview...................................................................................................................................... 53 Preparation................................................................................................................................... 53 Finding a Local Medical Library.................................................................................................. 53 Medical Libraries in the U.S. and Canada ................................................................................... 53 ONLINE GLOSSARIES.................................................................................................................. 59 Online Dictionary Directories ..................................................................................................... 59 BLURRED VISION DICTIONARY.............................................................................................. 61 INDEX .............................................................................................................................................. 101

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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 blurred vision 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 blurred vision, 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 blurred vision, 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 blurred vision. 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 blurred vision, 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 blurred vision. 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 BLURRED VISION Overview In this chapter, we will show you how to locate peer-reviewed references and studies on blurred vision.

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

Muscarinic Receptor Antagonists in the Treatment of Overactive Bladder Source: Urology. 55(Supplement 5A): 33-46. May 2000. Contact: Available from Urology. P.O. Box 2126, Marion, OH 43306-8226. (800) 215-4692. Fax (740) 382-5866. Summary: A wealth of clinical evidence supports the view that muscarinic receptor antagonists are effective in the treatment of overactive bladder. However, treatment limiting adverse effects such as dry mouth, constipation, and blurred vision have restricted the usefulness of previously available agents, such as oxybutynin. A real need therefore existed for effective and well tolerated agents for the long term management of the troublesome symptoms of overactive bladder (which include frequency, urgency, and urge incontinence). This review article outlines the various approaches that have

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been used in attempts to overcome the tolerability problems of oxybutynin. The author also describes how advances in the understanding of muscarinic receptors and bladder function has led to the potential development of either tissue or subtype selective antimuscarinic agents with improved tolerability. Drugs that have been developed in this way include tolterodine and darifenacin, each of which shows some bladder selectivity in animal models. Unlike darifenacin, however, the bladder selectivity of tolterodine has been confirmed by numerous clinical studies. Tolterodine's improved tolerability compared with oxybutynin, along with its equivalent therapeutic efficacy at recommended dosages, permits patients to experience the beneficial effects of long term treatment. Tolterodine therefore represents a real alternative for the long term management of overactive bladder. 4 figures. 4 tables. 119 references. •

Nonbladder Related Symptoms in Patients with Interstitial Cystitis Source: Journal of Urology. 166(2): 557-562. August 2001. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-3030 or (301) 714-2334. Fax: (301) 824-7290. Website: www.lippincott.com. Summary: Clinical experience and epidemiological studies suggest that patients with interstitial cystitis (IC) have multiple nonbladder related symptoms. This article reports on a study undertaken to test this hypothesis. The authors used the University of Wisconsin scale to compare the scores for patients with IC to those for control subjects. This validated questionnaire includes 7 bladder and 18 reference symptoms not related to the bladder. The study included a total of 35 female patients with IC and 35 age matched female controls. For the 7 bladder symptoms, the difference between IC and control groups was extremely significant. Patients with IC had higher scores than controls for 9 reference symptoms, including other pelvic discomfort, backache, dizziness, chest pain, aches in joints, abdominal cramps, nausea, heart pounding, and headache. However, they did not have higher scores for blind spots or blurred vision, numbness or tingling in fingers or toes, swollen ankles, feeling of suffocation, sore throat, cough, flu, nasal congestion, and ringing in ears (tinnitus). The majority of patients with IC had a 0 score for all but 2 of the reference symptoms (backache and aches in joints). Patients with IC had increased scores for 9 reference symptoms, but did not indiscriminately report high scores for generalized complaints. This result suggests that in some cases of IC, the pathophysiology may affect other organ systems besides the bladder. Alternatively, some of these symptoms may result from changes in sleep pattern or other factors associated with IC. An editorial commentary is appended to the article. 5 tables. 16 references.

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Unusual Symptom of Lidocaine Allergy Source: New York State Dental Journal. NYSDJ. 68(10): 24-25. December 2002. Contact: Available from Dental Society of the State of New York. 7 Elk Street, Albany, NY 12207. (518) 465-0044. Summary: The incidence of lidocaine allergy is rare, with only 1 percent of all reported incidents representing true antigen antibody allergic reactions. This article presents a confirmed case of antigen antibody reaction to lidocaine. These immunoglobulin Emediated responses can include anaphylaxis, urticaria, hay fever, and asthma. This case is further distinguished by the unusual presence of blurred vision in the patient. The author reviews the other reported adverse reactions to lidocaine and their causes. The author stresses that reported symptoms alone do not affirm a case of lidocaine allergy. It

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is immunological testing and the onset time of symptoms that confirm the true antigen antibody reaction. 7 references. •

Otalgia and Aversive Symptoms in Temporomandibular Disorders Source: Annals of Otology, Rhinology and Laryngology. 108(9 pt. 1): 884-892. September 1999. Contact: Available from Annals Publishing Company. 4507 Laclede Avenue, St. Louis, MO 63108. Summary: The term Costen's syndrome has been used in the dentomedical literature to describe a constellation of craniofacial symptoms. Since some of the same complaints have been reported in patients with generalized psychological distress, symptoms associated with the syndrome may not be useful in differential diagnosis of temporomandibular disorders (TMD). This article reports on a study that investigated whether some somatic complaints, particularly tinnitus (ringing or buzzing in the ears) and dizziness, were pathognomic in patients with chronic temporomandibular pain. Illness behavior and personality factors were studied for possible interrelationships with these symptoms. Factor analysis revealed that tinnitus and dizziness loaded on separate factors. Tinnitus loaded with nasal stuffiness, tearing, and itching of the eyelids and nose, while dizziness loaded with complaints of altered taste, altered smell and blurred vision. Neither was consistently related to measures of pain or to indices of illness behavior or somatic focus. 5 tables. 91 references.

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Topsy-Turvy World of Postural Hypotension Source: Diabetes Forecast. 52(3): 76-79. March 1999. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article discusses the problem of postural hypotension. The symptoms of this condition, which is low blood pressure caused by standing up, include dizziness, light-headedness, blurred vision, weakness, and fatigue. People who have diabetes may experience postural hypotension as a complication of autonomic neuropathy. As autonomic neuropathy progresses, the autonomic nervous system loses its reactive ability, so people who have this complication can experience rapidly changing highs and lows in blood pressure that make their head swim. The article explains how the body normally maintains blood pressure when a person stands and how it reacts in those who have autonomic neuropathy. Although physicians can perform some tests that will help determine if a person has postural hypotension, this condition is not something that physicians recognize well. If a diagnosis of postural hypotension is made, the next step is to figure out what is causing it and how to treat it. Regardless of whether autonomic neuropathy or other factors are the cause of postural hypotension, much of the treatment focuses on relieving the symptoms and removing factors that may aggravate the condition. Drugs may also be used to the condition. The article also addresses the issue of treating postural hypotension in people who also have hypertension and stresses the need to tailor treatment for postural hypotension to a person's specific needs.

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Magnificant Seven Source: Diabetes Forecast. 47(1): 37-39. January 1994.

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Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article emphasizes the importance of regular medical check ups and diagnostic tests in order to become aware of diabetes complications while they can still be treated. The author describes seven tests and exams and gives general guidelines on each one. The seven consist of a general physical exam; blood and urine tests to check for signs of kidney diseases; blood test for glycosylated hemoglobin (HbA1C); eye exam by an eye doctor; blood tests to check lipid levels; check-ups because of specific problems, including impotence, numbness or tingling in the legs, stomach distress, swelling of the legs, blurred vision, chest pain, or foot sores; and blood pressure checks. •

Dialysis Disequilibrium Syndrome Source: AJN. American Journal of Nursing. 100(2): 53-54. February 2000. Contact: Available from Lippincott Williams and Wilkins. AJN, P.O. Box 50480, Boulder, CO 80322-0480. (800) 627-0484 or (303) 604-1464. Summary: This article familiarizes nurses with dialysis disequilibrium syndrome, which is characterized by a change in mental status accompanied by hypotension. The syndrome is thought to result from the rapid removal of fluid and the decrease in BUN (blood urea nitrogen) during hemodialysis, which cause changes in blood osmolarity. The author offers a patient case report and describes how this patient is diagnosed with dialysis disequilibrium syndrome. Dialysis patients commonly present to the emergency department (ED) with nausea, vomiting, headache, restlessness, and a decreased level of consciousness. These symptoms may be caused by the uremic toxins that accumulate in the bloodstream as a result of the decreased glomerular filtration rate (GFR) in renal failure. In uremia, patients are often overloaded with fluid and become hypertensive. But patients can also be hypotensive (low blood pressure) as a result of the rapid removal of fluid. This fluid shift can cause cerebral edema (fluid in the brain), resulting in increased intracranial pressure and visible signs of decreasing level of consciousness. Symptoms may include sudden onset headaches, blurred vision, dizziness, nausea, vomiting, nervousness, muscle twitching, palpitations, disorientation, and seizures. If signs and symptoms are not recognized and treated immediately, coma and death can occur. The article concludes by stressing that prevention is the key to managing dialysis disequilibrium syndrome, especially in patients at higher risk (pediatric patients, older patients, patients new to hemodialysis, etc.).

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All About Hypoglycemia Source: Diabetes Self-Management. 17(1): 21-22, 24, 26-27. January-February 2000. Contact: Available from R.A. Rapaport Publishing, Inc. 150 West 22nd Street, New York, NY 10011. (800) 234-0923. Summary: This article presents an overview of hypoglycemia. When blood sugar gets too low, a condition called hypoglycemia, the body and brain are unable to function properly. Although hypoglycemia is defined as any blood sugar level under 70 milligrams per deciliter, people may treat themselves for hypoglycemia at different levels. Common causes of hypoglycemia include too much insulin or other medicine, too little food, too much physical activity, alcohol consumption, certain prescription medications, the menstrual cycle, and gastroparesis. Many symptoms accompany low blood sugar levels, but the most common symptoms are rapid heartbeat, sweating, shakiness, trembling, tingling or numbness in hands, feet, or face, difficulty thinking or

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concentrating, blurred vision, slurred speech, poor coordination, sleepiness, hunger, nausea, and headache. Hypoglycemia can also result in changes in emotions. Some people are unable to feel symptoms of low blood sugar until levels drop dangerously low, a condition known as hypoglycemia unawareness. Many people experience hypoglycemic episodes during sleep. This is a risky period to have hypoglycemia since a person is less likely to be aware of any warning symptoms. Failure to treat nighttime episodes of hypoglycemia can result in elevated blood glucose levels the following day. Hypoglycemia is a particular problem for older adults with diabetes. Treating hypoglycemia involves testing blood glucose levels, eating or drinking 10 to 15 grams of a fast-acting carbohydrate, and retesting blood glucose levels. A glucagon injection may be needed if a person is able to self treat for hypoglycemia. The article offers tips for preventing hypoglycemia.

Federally Funded Research on Blurred Vision The U.S. Government supports a variety of research studies relating to blurred vision. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to blurred vision. 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 blurred vision. The following is typical of the type of information found when searching the CRISP database for blurred vision: •

Project Title: 3D ORGANIZATION AND NEURAL PLASTICITY OF PRIMATE VOR Principal Investigator & Institution: Angelaki, Dora E.; Professor; Anatomy and Neurobiology; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130 Timing: Fiscal Year 2002; Project Start 01-JUL-1999; Project End 30-JUN-2003 Summary: The vestibulo-ocular (VORs) are an essential component of the oculomotor system since they are fundamental for gaze stabilization during both angular (angular VORs) and linear (linear VORs) head movements. Damage to the vestibular system through disease or trauma can produce profound oculomotor deficits that are often difficult to resolve clinically. Vestibular disturbances are often accompanied by nystagmus, blurred vision, dizziness and spatial disorientation. Despite years of research regarding the neural mechanisms of angular VOR function and disease states, very little is currently known about the linear VORs. Moreover, almost no information exists regarding the symptomology of otolith system damage and few, if any, practical diagnostic evaluations of otolith function are routinely performed in clinical today. The current proposal seeks to study the nature and function of the linear VORFs in primates

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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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and to investigate the deficits produced by cerebellar lesions and peripheral vestibular damage. The primary goal of these studies is to test quantitative predictions of a functional framework regarding the bilateral organization of the linear VORs across a wide stimulus repertoire in awake rhesus monkeys trained to fixate targets at different distances and vertical/horizontal eccentricities. Precisely calibrated binocular threedimensional eye movements will be recorded during both lateral and fore-act linear motion consisting of either steady-state sinusoidal or transient stimulus profiles. Data obtained from normal animals will be quantitatively compared to the eye movements generated during functional ablation of the most irregularly firing vestibular afferents, as well as both acutely and chronically after unilateral labyrinthectomy, selective semicircular canal plugging and cerebellar lesions. The results will provide for the first time quantitative data and models regarding the bilateral neural organization of the linear VORs as well as identify practical clinical tests of peripheral and central otolithocular function. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: BIOARTIFICIAL LACRIMAL GLAND Principal Investigator & Institution: Yiu, Samuel C.; Doheny Eye Institute 1450 San Pablo St, Ste 4706 Los Angeles, Ca 90033 Timing: Fiscal Year 2004; Project Start 01-MAY-2004; Project End 30-APR-2006 Summary: (provided by applicant) Millions of Americans have dry eye disease. Individuals plagued by the discomfort, burning, irritation, photophobia, and other symptoms of dry eye disease also have blurred vision, contact lens intolerance, the inability to produce emotional tears, and an increased risk of ocular surface damage and infection. In the United States alone an estimated 2 million Sjogren's Syndrome patients have dysfunctional lacrimal glands and severe dry eye and there is no satisfactory treatment. A bioartificial lacrimal gland would greatly benefit these patients. The new field of tissue engineering has built on the interface between materials science and biocompatibility to create the possibility of developing a bioartificial lacrimal gland. Our three specific aims are: 1) To identify the optimal biomaterials for use as the substrate for the growth of rabbit lacrimal epithelial cells in a three-dimensional scaffold. 2) To test the physiological properties of these bioengineered tissues, including secretory functions and electrophysiological activities. 3) To establish strategies and data for the design and development of a bioartifical lacrimal gland as the basis for a BRG grant proposal using the RO1 funding mechanism. This work will advance our understanding of how lacrimal epithelial cells function in this artificial environment and lead to the development of an RO1 proposal. Ultimately, we envision a bioengineered lacrimal gland system, to be surgically implanted in periocular tissues that will produce sufficient tear flow to maintain the health of the ocular surface. Such a device could relieve the symptoms of millions of dry eye patients; and it could possibly make obsolete the frequent daily use of lubricant eye drops, saving patients the time and effort of medication use and saving millions of dollars annually in the purchase of lubricating eye drops. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CELLULAR ANALYSIS OF THE VESTIBULOOCULAR REFLEX Principal Investigator & Institution: Du Lac, Sascha; Assistant Professor; Salk Institute for Biological Studies 10010 N Torrey Pines Rd La Jolla, Ca 920371099 Timing: Fiscal Year 2002; Project Start 01-SEP-1994; Project End 31-MAR-2004

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Summary: The long-range goal of this research is to understand how cellular and molecular mechanisms operate in the context of neuronal circuitry to mediate the normal performance and adaptive plasticity of the vestibulo- ocular reflex (VOR). The VOR prevents blurred vision during self-motion by producing eye movements that precisely compensate for motion of the head. Neuronal m3echanisms of plasticity enable the COR to perform accurately in the face of development, trauma, and disease. Although the contributions of identified classes of neurons to signal transformations and plasticity have been elucidated, little is understood about the cellular mechanisms that underlie the day-to-day performance and adaptive capabilities of the VOR. The objective of the proposed research is to elucidate how intrinsic cellular mechanisms control the firing properties of brainstem neurons that are critical for ensuring image stability during head movement. In particular, the studies aim to identify the role of distinct sources of intracellular calcium in regulating the firing properties of identified classes of neurons in the medial vestibular nucleus (MVN) and nucleus prepositus hypoglossi nuclei (NPH). The dynamic properties of spike generation (the transformation from neuronal inputs into time-varying patterns of action potentials) will be examined in NPH and MVN neurons recorded intracellularly in living brainstem slices. Specific pharmacological agonists and antagonists of voltage-sensitive calcium channels, intracellular calcium release mechanisms, and NMDA and metabotropic glutamate receptors will be used to assess how the spontaneous firing rate and the gain and dynamics of spike generation are regulated by calcium-dependent mechanisms. The correspondence between neurons recorded in vitro and cell classes that have been identified automatically and physiologically in vivo will be determined by labeling neurons intracellularly with dye, targeting neurons for recording that have been retrogradely labeled from the cerebellar flocculus and abducens nucleus, and activating synaptic inputs from the cerebellum and vestibular nerve. These studies will provide foundations for targeted investigations of the molecular mechanisms that underlie vestibulo-ocular reflex plasticity as well as for pharmacological treatments for oculomotor disorders that cause nystagmus. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GENETICS OF OCULAR ADENOVIRUSES Principal Investigator & Institution: Chodosh, James; Associate Professor; Ophthalmology; University of Oklahoma Hlth Sciences Ctr Health Sciences Center Oklahoma City, Ok 73126 Timing: Fiscal Year 2004; Project Start 01-JAN-2004; Project End 31-DEC-2006 Summary: (provided by applicant): Epidemic keratoconjunctivitis (EKC) is caused by infection with the subgroup D adenovirus serotypes 8, 19, and 37, and is one of the most common human eye infections, causing significant morbidity and economic impact. EKC in highly contagious, manifests acutely with severe conjunctivitis and epithelial keratitis, and is associated with the delayed development of stromal (subepithelial) keratitis. Secondary dry eye, light sensitivity, and blurred vision can persist indefinitely. Surprisingly, although a group D adenovirus was identified as the cause of EKC over 40 years ago, the genetics of the adenovirus serotypes that cause EKC remain largely unknown. Our long term goal is to develop novel information-based approaches to prevention and therapy of the disorder. We hypothesize that genetic analyses of the adenoviruses associated with EKC will reveal specific viral pathogenesis traits that determine in part the manifestations of the disorder. This R03 proposal therefore specifically addresses a critical lack of information with regards to the genetics of these adenoviruses, and as such fills a stated purpose of the RO3 award, in that we propose to

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acquire "a body of data that has a potentially high impact on vision research". Recent similar efforts to elucidate the genetic code for other human pathogens have been received by the scientific community as seminal. The proposed collaboration between the principal investigator, a clinician-scientist with extensive expertise in virology and ocular infectious disorders, and the co-investigator, a microbial geneticist who has devoted his professional career to just the sort of study we propose, will likely result in highly significant and medically relevant interpretations of the resulting sequence data. Most importantly, successful completion of the proposed work will allow the study of the virology of ocular adenovirus infection in a fashion not currently possible. We propose a single specific aim: to determine and compare the genetic sequences of clinical adenovirus isolates from patients with EKC. To this end, adenoviruses will be collected from three major centers of clinical ophthalmology and sequenced. To other scientists, access to our data will be free and unencumbered via our web site. Genome-wide comparisons with other subgroup D adenoviruses for differences in nucleotide and predicted amino acid sequences will be performed using sequence alignment and analysis software, and are expected to reveal potential pathogenesis traits for future study. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GENETICS STUDIES OF MYOPIA Principal Investigator & Institution: Stambolian, Dwight E.; Assoicate Professor; Ophthalmology; University of Pennsylvania 3451 Walnut Street Philadelphia, Pa 19104 Timing: Fiscal Year 2003; Project Start 01-AUG-1999; Project End 31-JUL-2004 Summary: Myopia is a disorder in which the eye is relatively long for the power of the cornea and lens resulting in blurred vision. Because myopia is the most common eye condition in the world, it is an enormous public health problem with a large economic impact on the population at large. Its contribution to acquired blindness varies from 319% depending on the study. Although very common, nothing secure is known about its pathogenesis despite studies of various animal models. A number of different studies provide compelling evidence indicating that myopia is inherited. The complexity of the genetics of this disorder requires a broad based collaborative effort to adequately locate the gene(s) for this disorder. The goal of this proposal is to contain the loci responsible for this disorder. Using uniform clinical criteria, pedigrees affected with myopia will be collected from two separate geographic regions. Blood samples from suitable families will be collected for DNA extraction which will be used for genetic mapping. Microsatellite repeat markers located at 10 cM intervals through the genome will be used for genotype generation. The genotype data will be utilized to create databases for linkage analysis. Potential areas suggestive of linkage will be further examined with additional markers from the potential region. The results of this investigation will (1) identify specific genetic loci for myopia, (2) permit an estimate of the relative importance of environmental exposure on myopia, and (3) provide a more rational framework for the classification of myopia based on genetic locus. Findings from this study may also provide further understanding of the pathogenesis of myopia and may have public health implications if there are some segments of the population in which preventing environmental exposures may alter the onset of disease or its further progression. This will have an even greater relevance if we are successful at defining the refractive component(s) of the eye which is responsible for the development of myopia. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: GUSTATORY AND OLFACTORY CHANGES WITH AGE Principal Investigator & Institution: Schiffman, Susan S.; Professor; Psychiatry; Duke University Durham, Nc 27710 Timing: Fiscal Year 2002; Project Start 01-DEC-1979; Project End 31-JAN-2007 Summary: (provided by applicant): Adverse sensory and cognitive side effects from prescription medications can lead to noncompliance and thus jeopardize the health and well-being of older individuals. However, the prevalence of these effects in the population, their severity, their time course, their specificity, their reversibility, and their underlying causes/mechanisms has not been quantified in prospective studies. This hypothesis-driven study will investigate the role of anticholinergic activity as a mechanism for sensory and cognitive side-effects of medications. Over 250 drugs (including 47.5 percent of the 131 most frequently prescribed medications as measured by IMS America's National Prescription Audit) have been reported clinically to impair the senses of taste and/or smell. Most of these drugs are also associated clinically with impaired vision, audition, somesthesis and/or cognition. Of the drugs that cause taste, smell and other sensory/cognitive distortions, a significant proportion has anticholinergic activity (e.g. reduced salivary secretion/dry mouth, dilated pupils/blurred vision, altered cognitive function including memory loss and contusion), and these adverse drug reactions are reported more frequently in older individuals. This prospective study will determine the effects of medications taken systemically on the chemical senses as well as vision, audition, somesthesis, and cognition. Three hypotheses will be tested: a) Medications that exhibit anticholinergic activity (group 1) will impair all the senses (taste, smell, vision, audition, somesthesis) and cognition. For these drugs, the magnitude of loss will be related to the level of anticholinergic activity as measured by total salivary flow. The degree of sensory impairment will also be correlated with the degree of cognitive dysfunction. The magnitude of loss is expected to increase with the number of anticholinergic drugs taken. b) Medications that are reported clinically to cause taste and smell impairments but have no anticholinergic side-effects (group 2) are predicted to impair taste and smell as measured psychophysically but will not impair cognitive function. They may or may not alter the senses of vision and audition. c) Changes in taste and smell sensitivity will be found for medications in groups I and 2 both over time and in comparison to a control group not on medications. These studies will provide evidence-based data for physicians and patients on relative risks, magnitude, progression, and potential reversibility of druginduced sensory and cognitive side-effects of medications in elderly people. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PHOTOPHYSICAL PROPERTIES OF TRICYCLIC ANTIEPILEPTIC DRUGS Principal Investigator & Institution: Garcia, Carmelo; University of Puerto Rico at Humacao Box 428, Barrio Tejas Humacao, Pr 00791 Timing: Fiscal Year 2003; Project Start 01-APR-2003; Project End 31-MAR-2007 Summary: The intense research devoted over the last few years to the study of epilepsy and antiepileptic drugs (AEDs) has only dealt with the physiology of the disease. This quality research has been aimed to replace the older AEDs with broad activity profiles and several severe side effects with new AEDs with better defined mechanism of action and fewer side effects. Nevertheless, most of these drugs still produce serious adverse reactions, including among others, dizziness, ataxia, somnolence, headache, blurred vision, nausea, vomiting, skin, allergy and photosensitization. The molecular

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Blurred Vision

photochemical mechanisms for the photosensitizing ability of some AEDs has never been studied, even through it was reported over ten years ago. Recent studies on the laser flash phototysis of related neuroleptic drugs (imipramine) showed that the triplet state can be efficiently quenched by the protons in the solution. The effectiveness of the quenching is very sensitive to the structure of the drug and seems to be involve in their phototoxicity. We propose to perfor the same set of experiments on several phototoxic antiepileptics. The goal of this project is to measure the photophysicat properties of a selected group of tricydic antiepileptic drugs and to study their short-lived transients. Special attention will be given to those transients associated with adverse effects in vivo: the cation radical, the first triplet excited state and singlet oxygen, Basic UV-Vis and luminescence techniques will be employed to study their absorption/emission properties. The transients will be characterized using optical absorption measurements with a Nd-YAG laser set-up. For the triplet state of these compounds, the extinction coefficient and the quantum yield will be determined using a comparative method and the triplet-triplet energy transfer principle, respectively. The triplet state will be bleached with a second delayed pulse to elucidate the reaction mechanism of these u'ansients. Combined MM+/PM3/RHF theoretical calculations will be performed with HyperCHEM (TM) 7.0 on the whole set ofphotophysical parameters, The theoretical values will be correlated with the experimental ones. The major goal of this project is to find a molecular/photophysical descriptor for the phototoxic side effect of tricydic antiepileptics. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: VERTIGO

TREATMENTS

FOR

BENIGN

PAROXYSMAL

POSITIONAL

Principal Investigator & Institution: Cohen, Helen S.; Associate Professor; Otorhinolaryn & Communica Scis; Baylor College of Medicine 1 Baylor Plaza Houston, Tx 77030 Timing: Fiscal Year 2002; Project Start 01-AUG-1998; Project End 31-JUL-2003 Summary: (Adapted from the Applicant's Abstract) Benign paroxysmal positional vertigo (BPPV), characterized by episodes of intense vertigo cause nausea, blurred vision, and falls. The most effective treatments have not yet been determined. No studies have systematically compared the accepted treatments to sham treatments while comparing systematic in treatment parameters or the influence of co- morbidity from other medical conditions. The clinical studies detailed in this application examine these accepted treatments and a control treatment to determine the immediate short-and longterm effectiveness of treatments for BPPV. The following specific aims will be addressed: 1) Determine the relative effectiveness of the Eply maneuver, the Semont maneuver, and Brandt-Daroff exercises compared to each other and to sham treatment in reducing the intensity and frequency of vertigo episodes and oculomotor responses to Dix-Hallpike maneuvers, and in increasing independence in activities of daily living; 2) Determine the relative effectiveness of habituation exercises designed to facilitate central habituation of vertigo, exercises designed to remove otoconial matter from the semicircular canals and the sham treatment; 3) Determine the relative contributions of variations on the most effective treatment from Specific Aim 2; 4) Determine the effect of co-morbid conditions on short-and long- term response to treatment. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.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 blurred vision, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “blurred vision” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for blurred vision (hyperlinks lead to article summaries): •

"Fatigue on rest" and associated symptoms (headache, vertigo, blurred vision, nausea, tension and irritability) due to locally symptomatic, unerupted, impacted teeth. Author(s): Eidelman D. Source: Medical Hypotheses. 1979 March; 5(3): 339-46. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=459987

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14-year-old boy with blurred vision and diplopia. Author(s): Worrell GA, McBride KL, Buchhalter JR. Source: Mayo Clinic Proceedings. 1999 November; 74(11): 1157-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10560605

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25-year-old man with headaches and blurred vision. Author(s): Murtagh B, Kumar R. Source: Mayo Clinic Proceedings. 2001 April; 76(4): 419-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11322358

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A 15-year-old with blurred vision, nausea, back pain, and abdominal pain. Author(s): Kuensting LL. Source: Journal of Emergency Nursing: Jen : Official Publication of the Emergency Department Nurses Association. 2003 April; 29(2): 171-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12660705

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A case of blurred vision. Author(s): Seaman WB. Source: Hosp Pract (Off Ed). 1983 April; 18(4): 39-40. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6404783

3

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 method of testing and evaluating blurred vision in cerebral lesions. Author(s): Bodis-Wollner I, Diamond SP. Source: Trans Am Neurol Assoc. 1973; 98: 57-60. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4784975

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A young woman with blurred vision. Author(s): Murray BJ. Source: Hosp Pract (Off Ed). 1989 May 30; 24(5A): 44, 49. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2498354

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Blurred vision and headaches in a patient positive for HBsAg. Author(s): Ohmart RH, Cook GC, Paull D, Cherrill DC, Horsley WW, Schlinkert R, Levy JM. Source: The Western Journal of Medicine. 1988 March; 148(3): 339-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2896412

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Blurred vision and high blood pressure in a young woman. Author(s): Flanagan DE, Cole C, Crick MD, Kerr D. Source: Postgraduate Medical Journal. 1998 October; 74(876): 614-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10211361

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Blurred vision and systemic medication. Author(s): Manchester PT Jr. Source: J Med Assoc Ga. 1966 January; 55(1): 8-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5974857

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Blurred vision as chief complaint in nephropathia epidemica. Author(s): Braun JR, Herting J, Kisters K, Winterberg B. Source: Clinical Nephrology. 2001 January; 55(1): 89-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11200877

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Blurred vision associated with melanoma of the ciliary body. Author(s): Weissman BA, Foos RY, Straatsma BR. Source: J Am Optom Assoc. 1985 May; 56(5): 396-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3998370

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Blurred vision during airline flight reveals prolactinoma. Author(s): Bodack MI. Source: Optometry. 2003 March; 74(3): 159-72. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12645849

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Blurred vision during exacerbation of ulcerative colitis. Author(s): Alcalde M, Lopez-Bernal I, Galvan A, Pecellin I, Narvaez I, Herrera JM. Source: Postgraduate Medical Journal. 1998 September; 74(875): 551-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10211333

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Blurred vision during sexual arousal associated with narrow-angle glaucoma. Author(s): Friedberg DN, Fox LE. Source: American Journal of Ophthalmology. 1999 November; 128(5): 647-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10577541

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Blurred vision from ipratropium bromide inhalation. Author(s): Kizer KM, Bess DT, Bedford NK. Source: American Journal of Health-System Pharmacy : Ajhp : Official Journal of the American Society of Health-System Pharmacists. 2000 May 15; 57(10): 996. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10832501

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Blurred vision from ipratropium bromide inhalation. Author(s): Kizer KM, Bess DT, Bedford NK. Source: American Journal of Health-System Pharmacy : Ajhp : Official Journal of the American Society of Health-System Pharmacists. 1999 May 1; 56(9): 914. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10344619

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Blurred vision, epistaxis, and fever in a young man. Author(s): Binder WD, Brown DF, Nadel ES. Source: The Journal of Emergency Medicine. 2002 October; 23(3): 275-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12426019

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Blurred vision, left bundle-branch block and cardiac failure. Author(s): Paelinck BP, De Raedt H, Conraads V. Source: Acta Cardiol. 2001 February; 56(1): 39-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11315123

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Blurred vision. Author(s): White I. Source: Nursing Standard : Official Newspaper of the Royal College of Nursing. 2001 June 27-July 3; 15(41): 26. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12205844

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Blurred vision. Author(s): Brewer S. Source: Nursing Standard : Official Newspaper of the Royal College of Nursing. 2001 January 31-February 6; 15(20): 24-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12211861

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Blurred vision. Author(s): Shingleton BJ, O'Donoghue MW. Source: The New England Journal of Medicine. 2000 August 24; 343(8): 556-62. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10954765

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Blurred vision. Author(s): George M. Source: Nursing Standard : Official Newspaper of the Royal College of Nursing. 1998 May 20-26; 12(35): 26-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9687694

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Blurred vision. Author(s): Oppenheim EB. Source: Compr Ther. 1988 October; 14(10): 3-4. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3180709

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Blurred vision. Author(s): Gregor ZJ. Source: Br J Hosp Med. 1985 February; 33(2): 105-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3971084

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Blurred vision: an overlooked initial presenting symptom of insulin-dependent diabetes mellitus. Author(s): Koffler M, Raskin P, Geyer O, Yust I. Source: Isr J Med Sci. 1990 July; 26(7): 393-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2387711

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Blurred vision: problems of auditing elective surgery, as seen in an audit of lens extraction for cataract. Author(s): Cohen DN. Source: Qrb Qual Rev Bull. 1978 May; 4(5): 13-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=104233

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Cold injury to corneal epithelium. A cause of blurred vision in cross-country skiers. Author(s): Kolstad A, Opsahl R Jr. Source: Acta Ophthalmol (Copenh). 1969; 47(3): 656-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5394629

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Community care. Blurred vision. Author(s): Drennan V, Levenson R. Source: Health Serv J. 1999 August 12; 109(5667): 22-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10621302

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Diagnostic and therapeutic challenges. A 56-year-old man, had a 1-year history of blurred vision in his left eye. Author(s): McDonald HR. Source: Retina (Philadelphia, Pa.). 2000; 20(3): 294-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10872936

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Haptic dominance in form perception with blurred vision. Author(s): Heller MA. Source: Perception. 1983; 12(5): 607-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6676712

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Hematuria, headache and blurred vision. Author(s): Chung EB, Hosten AO. Source: Journal of the National Medical Association. 1972 January; 64(1): 87-91 Passim. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5061432

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Instilling ocular ointments without blurred vision. Author(s): Putterman AM. Source: Archives of Ophthalmology. 1985 September; 103(9): 1276. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4038111

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Intermittent blurred vision and trichomegaly due to latanoprost. Author(s): Woo TL, Francis IC. Source: Clinical & Experimental Ophthalmology. 2001 August; 29(4): 272-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11545432

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Intermittent headaches and blurred vision. Author(s): Jenckers GA 3rd, Robinson ML. Source: Hosp Pract (Off Ed). 1989 March 15; 24(3): 131-2, 134. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2522098

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Malignant hypertension presenting as blurred vision in a 43 year old intravenous drug abuser. Author(s): Walters G, Dabbs TR. Source: Journal of Accident & Emergency Medicine. 1997 May; 14(3): 182-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9193991

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Multiple sclerosis. Blurred vision. Author(s): Bryan J. Source: Health Serv J. 1998 June 25; 108(5610): Suppl 21-4. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10180426

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Painless blurred vision. Author(s): Karia N, Watts P. Source: Postgraduate Medical Journal. 1998 May; 74(871): 281-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9713610

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Prolonged blurred vision following coelenterate envenomation. Author(s): Burnett HW, Burnett JW. Source: Toxicon : Official Journal of the International Society on Toxinology. 1990; 28(6): 731-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1976280

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Rapid technique for detecting "blurred vision" in diseases of primary visual pathways. Author(s): Della Sala S, Somazzi L, Wilkins AJ. Source: Lancet. 1985 November 2; 2(8462): 1015-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2865491

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Sudden onset of blurred vision in a thirteen-year-old girl. Author(s): Maxwell SM. Source: The Pediatric Infectious Disease Journal. 1995 November; 14(11): 1016, 1019. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8584347

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The blurred vision mystery. Idiopathic intracranial hypertension. Author(s): Mishriki YY. Source: Postgraduate Medicine. 1998 April; 103(4): 101-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9553590

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The impact of blurred vision on functioning and well-being. Author(s): Lee PP, Spritzer K, Hays RD. Source: Ophthalmology. 1997 March; 104(3): 390-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9082261

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The measurement of spatial contrast sensitivity in cases of blurred vision associated with cerebral lesions. Author(s): Bodis-Wollner I, Diamond SP. Source: Brain; a Journal of Neurology. 1976 December; 99(4): 695-710. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1030654

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Transient blurred vision after interferon for chronic hepatitis C. Author(s): Ene L, Gehenot M, Horsmans Y, Detry-Morel M, Geubel AP. Source: Lancet. 1994 September 17; 344(8925): 827-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7916109

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Transient cerebrospinal fluid rhinorrhea, blurred vision, and headache as presenting symptoms of pituitary adenoma. Author(s): Bell MM. Source: The Journal of the American Board of Family Practice / American Board of Family Practice. 1991 September-October; 4(5): 347-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1746305

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Treating blurred vision associated with antipsychotic medication. Author(s): Carter JG, Schmidt R, Carter PA. Source: The American Journal of Psychiatry. 1977 August; 134(8): 941. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=879373

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Unilateral blurred vision and dilated retinal veins. Author(s): Gittinger JW Jr, Miller NR, Keltner JL, Burde RM. Source: Survey of Ophthalmology. 1987 January-February; 31(4): 270-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3576443

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Vertical oscillopsia and blurred vision. Author(s): Quencer RM. Source: J Clin Neuroophthalmol. 1981 June; 1(2): 161-7. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6213656

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CHAPTER 2. BOOKS ON BLURRED VISION Overview This chapter provides bibliographic book references relating to blurred vision. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on blurred vision include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

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

Diagnosis of Diabetes and the Metabolic Syndrome Source: in Edelman, S.V. and Henry, R.R. Diagnosis and Management of Type 2 Diabetes. Caddo, OK: Professional Communications, Inc. 2002. p. 39-50. Contact: Available from Professional Communications, Inc., Fulfillment Center, PO Box 10, Caddo, OK 74729-0010. (800)337-9838. Fax (580)367-9989. E-mail: [email protected]. ISBN: 1884735754. PRICE: $21.95, plus shipping and handling. Summary: A diagnosis of diabetes can be suspected in the presence of the following signs and symptoms of hyperglycemia (high blood glucose levels): polydipsia (increased thirst), polyuria (increased urinary frequency with increased volume), fatigue, polyphagia (increased appetite), weight loss, abnormal healing, blurred vision, and increased occurrence of infections, particularly those caused by yeast. This chapter on the diagnosis of diabetes and the metabolic syndrome is from a handbook for primary care providers that offers a concise overview of the diagnosis and management of type 2

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diabetes. The authors discuss risk factors, diagnostic tests, symptoms, cardiovascular disease risk assessment, and the metabolic or dysmetabolic syndrome. 1 figure. 4 tables. 5 references. •

Ocular Manifestations of Inflammatory Bowel Disease Source: in Bayless, T.M. and Hanauer, S.B. Advanced Therapy of Inflammatory Bowel Disease. Hamilton, Ontario: B.C. Decker Inc. 2001. p. 275-277. Contact: Available from B.C. Decker Inc. 20 Hughson Street South, P.O. Box 620, L.C.D. 1 Hamilton, Ontario L8N 3K7. (905) 522-7017 or (800) 568-7281. Fax (905) 522-7839. Email: [email protected]. Website: www.bcdecker.com. PRICE: $129.00 plus shipping and handling. ISBN: 1550091220. Summary: This chapter on ocular (eye) manifestations of inflammatory bowel disease (IBD) is from the second edition of a book devoted to the details of medical, surgical, and supportive management of patients with Crohn's disease (CD) and ulcerative colitis (UC), together known as IBD. Historically, IBD related ocular inflammation could result in blindness, although blindness is less likely today due to better treatments. Ocular inflammation in patients with IBD has a reported range of frequency from as low as 1.9 percent to as high as 13 percent of patients. Ulcerative colitis appears to be less likely to have associated ocular inflammation than does Crohn's disease. Although a large number of inflammatory conditions have been reported with IBD, including uveitis, episcleritis, scleritis, keratitis, conjunctivitis, retinitis, retinal vasculitis, choroiditis, optic neuritis, orbital myositis, and orbital pseudotumor, lesions that appear to be more clearly associated with IBD include anterior uveitis, scleritis, keratitis, and retinal vasculitis and/or posterior uveitis. Of these, anterior uveitis is the most common and the primary focus of this chapter. Most patients with the serious ocular manifestations of IBD will be symptomatic, although the symptoms may need to be elicited. Any ocular symptoms should be evaluated by an ophthalmologist, as there are no symptoms that are specific for IBD related eye disease, and the symptoms of several problems are similar. Acute problems often are manifested by pain, redness, photophobia (sensitivity to light), and sometimes blurred vision, whereas chronic problems may present with blurred vision. Typical treatment involves topical prednisolone acetate 1 percent every hour while awake, and once inflammation is controlled, the frequency of administration is slowly tapered off. 8 references.

•

Effects of Hypoglycemia on Nerves and Vision Source: in Lincoln, T.A.; Eaddy, J.A. Beating the Blood Sugar Blues. Alexandria, VA: American Diabetes Association. 2001. p.128-132. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. Website: www.diabetes.org. PRICE: $12.95 plus shipping and handling. ISBN: 1580400485. Summary: This chapter on the effects of hypoglycemia (low blood glucose levels) on nerves and vision is from a book that offers first hand knowledge from two doctors who have more than 100 years of combined experienced with the day-to-day balancing act of blood glucose (sugar) and diabetes. The authors, both of whom have type 1 diabetes, share their own stories as well as those of over 40 of their patients. In this chapter, the authors describe how certain brain functions may temporarily work poorly during hypoglycemia and cause alarming symptoms, varying from widespread stroke-like effects to weakness in just one group of muscles. Convulsions or uncontrollable jerking

Books

23

motions of the body occur in 10 to 20 percent of adults and even more frequently in children when they have a severe hypoglycemic episode. The authors discuss other neurologic problems that can be associated with hypoglycemia, including double vision, problems reading, and impaired color vision. People with diabetes under poor control and with resulting consistently high blood glucose levels may also develop blurred vision. •

What Type of Diabetes Do You Have? Source: in Rubin, A.L. Diabetes for Dummies. Foster City, CA: IDG Books Worldwide, Inc. 1999. p. 25-42. Contact: Available from IDG Books Worldwide, Inc. 919 E. Hillsdale Blvd., Suite 400, Foster City, CA 94404-2112. (800) 762-2974 or (416) 293-8464. Website: www.idgbooks.com. PRICE: $19.99 plus shipping and handling. ISBN: 076455154X. Summary: This chapter provides people who have diabetes with information on the functions of the pancreas and the symptoms, causes, and prevention of type 1 and type 2 diabetes. Type 1 diabetes is an autoimmune disease. In some genetically predisposed people, an environmental trigger may be needed to cause type 1 diabetes, whereas in others, the disease is an entirely autoimmune destruction of the beta cells. Symptoms of type 1 diabetes include frequent urination, increased thirst, weight loss, increased hunger, and weakness. Although primary methods for preventing type 1 diabetes are still being investigated, some of the more promising secondary prevention approaches include steroid drugs, cytotoxic drugs, nicotinamide, and insulin. Type 2 diabetes is a disease of gradual onset in which the body resists the normal, healthy functioning of insulin. Symptoms may be mild at first, so they may be ignored. Symptoms include fatigue; frequent urination and thirst; blurred vision; slow healing of skin, gum, and urinary tract infections; genital itching; numbness in the feet or legs; heart disease; and obesity. Although genetic inheritance causes type 2 diabetes, environmental factors trigger it. Major environmental factors include high body mass index, physical inactivity, central distribution of fat, and low intake of dietary fiber. Type 1 and type 2 diabetes differ with regard to age of onset, body weight, level of glucose, and severity of onset. Pregnant women may develop gestational diabetes. In addition, other types of diabetes include diabetes due to loss or disease of pancreatic tissue, diabetes due to other diseases, diabetes due to hormone treatments for other diseases, and diabetes due to medications. 1 figure.

•

Who, What, Where, Why, and How of Type II Diabetes Source: in Magee, E. Tell Me What to Eat If I Have Diabetes. Franklin Lakes, NJ: Career Press, Inc. 1999. p. 7-13. Contact: Available from Career Press, Inc. 3 Tice Road, P.O. Box 687, Franklin Lakes, NJ 07417. (800) 227-3371. Website: www.careerpress.com or www.newpagebooks.com. PRICE: $10.99 plus shipping and handling. Summary: This introductory chapter is from a book that offers eating and nutrition guidelines for people who have been diagnosed with diabetes mellitus. The author focuses on type 2 diabetes, noting that diabetes can manifest differently in different patients and sometimes even changing throughout its course within one person. The author encourages readers to learn as much as they can about their disease and to utilize nutrition as an adjunct therapy and a vital component of their diabetes care. Type 2 diabetes is a metabolic disorder resulting from the body's inability to make or properly use insulin. Most people (90 to 95 percent) with diabetes have type 2. The warning signs

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Blurred Vision

of type 2 diabetes include frequent infections, blurred vision, cuts and bruises that are slow to heal, tingling or numbness in the hands or feet, unusual thirst, frequent urination, extreme hunger, unusual weight loss, extreme fatigue, and irritability. The author outlines the three keys to diabetes management success: monitoring blood glucose levels, exercising regularly, and following a personalized eating plan. The author emphasizes the importance of following a personalized eating plan that helps keep blood glucose (sugar) levels normal, and helps protect against heart disease and weight gain without making the patient feel deprived. The chapter concludes with a brief section of sources for additional information, including the American Association of Certified Diabetes Educators (800-832-6874), the American Dietetic Association's National Center for Nutrition and Dietetics (800-366-1655), and the American Diabetes Association (800-342-2383). •

Complications During Hemodialysis Source: in Nissenson, A.R.; Fine, R.N. Dialysis Therapy. Philadelphia, PA: Hanley and Belfus, Inc. 2002. p. 171-179. Contact: Available from Hanley and Belfus, Inc. Medical Publishers, 210 South 13th Street, Philadelphia, PA 19107. (215) 546-7293 or (215) 546-4995. (800) 962-1892. Fax: (215) 790-9330. Website: www.hanleyandbelfus.com. PRICE: $59.95; plus shipping and handling. ISBN: 1560534265. Summary: With improving outcomes, replacement of renal (kidney) function by hemodialysis (HD) is a well established therapy, but it is not free of complications. This chapter is one part of a section on complications during hemodialysis, from a textbook on dialysis therapy. The chapter covers hypotension (low blood pressure), muscle cramps, dialyzer reactions, hypoxemia (low levels of oxygen in the blood), febrile (fever) reactions, dialysis disequilibrium syndrome (DDS, a neurologic disorder characterized by headaches and nausea in the mild form and confusion, blurred vision, seizures and even coma in the more severe forms), bleeding, pruritus (itching), heart rate disturbances, cardiopulmonary arrest (heart stopping) during dialysis, air embolism (a rare complication), hemolysis (the breakdown of red blood cells), and electrolyte disturbances. The author concludes that the incidence of clinical problems during HD has been greatly reduced, thanks to technological advances and to higher standards in the routine delivery of therapy. Despite these advances, clinical problems may still occur, especially in elderly or unstable patients, or in individuals with underlying comorbid (other illness present at the same time) conditions. Accurate supervision and physical examination of the patient may prevent several of these problems. Hemodialysis can be better tolerated and done more smoothly when potential clinical problems are anticipated and appropriate countermeasures are instituted in a timely fashion. 3 figures.

25

CHAPTER 3. MULTIMEDIA ON BLURRED VISION Overview In this chapter, we show you how to keep current on multimedia sources of information on blurred vision. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.

Video Recordings An excellent source of multimedia information on blurred vision is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “blurred vision” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” Type “blurred vision” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on blurred vision: •

Diabetes: From Detection to Treatment Source: Calhoun, KY: NIMCO. 1994. (videocassette). Contact: Available from NIMCO. P.O. Box 9, 117 Highway 815, Calhoun, KY 423270009. (800) 962-6662 or (502) 273-5050. Fax (502) 273-5844. PRICE: $89.95. Order number: NIM-SM-CD1-V. Summary: This video takes the viewer through the medical detection of diabetes. The model it presents of the cause of diabetes hypothesizes that an environmental trigger in a genetically susceptible person causes inflammation that eventually destroys the cells of the pancreas and leads to a reduction in insulin. The video highlights diabetes symptoms, including polyuria, polydipsia, polyphagia, weight loss, and blurred vision. It explains why people with diabetes consume so much fluid and why they have increased urination. Among the other topics covered are diabetes education, medications and their side effects, diabetic retinopathy, cardiovascular disease,

26

Blurred Vision

atherosclerosis, foot problems and neuropathy, and renal failure. The video includes numerous comments from physicians and patients. •

Diabetes: Multiple Ways to Gain Control Source: Calhoun, KY: NIMCO. 1994. (videocassette). Contact: Available from NIMCO. P.O. Box 9, 117 Highway 815, Calhoun, KY 423270009. (800) 962-6662 or (502) 273-5050. Fax (502) 273-5844. PRICE: $39.95. Order number: NIM-SM-CD2-V. Summary: This video which focuses on new developments in the treatment of diabetes, explains what diabetes is and reviews common symptoms and risk factors. Symptoms include excessive thirst, hunger, fatigue, blurred vision, frequent urination, and tingling in the hands and feet. Risk factors include being overweight and over 40 years old, having a family history of diabetes, and experiencing stress. The video then explains the team concept of care, which involves the patient interacting with a physician, dietitian, diabetes educator, pharmacist, and podiatrist. In addition, the video stresses meal planning, physical activity, medications, education, and self monitoring as ways to gain control of the disease.

•

Living with Diabetes: Making the Diagnosis Source: Madison, WI: University of Wisconsin Hospitals and Clinics, Department of Outreach Education. 1999. (videocassette). Contact: Available from University of Wisconsin Hospital and Clinics. Picture of Health, 702 North Blackhawk Avenue, Suite 215, Madison, WI 53705-3357. (800) 757-4354 or (608) 263-6510. Fax (608) 262-7172. PRICE: $19.95 plus shipping and handling; bulk copies available. Order number 071899A. Summary: This videotape, part of a series on living with diabetes, focuses on the diagnosis of diabetes. A moderator discusses the new criteria for the diagnosis and classification of diabetes, the rise in the incidence of diabetes, the symptoms of diabetes, and the prevention of diabetes with an endocrinologist. The videotape begins with a discussion of what diabetes is, how insulin works, the types of diabetes, and risk factors for diabetes. Type 1 diabetes, which was formerly known as insulin dependent diabetes, usually develops quickly, whereas type 2 diabetes, which was formerly known as noninsulin dependent diabetes, usually has a gradual onset. The symptoms of diabetes, which are generally the same regardless of the type, are related to high blood sugar. They include excessive urination and thirst, fatigue, hunger, weight loss, and blurred vision. Risk factors for type 1 diabetes include a genetic predisposition for developing the disease. Risk factors for type 2 diabetes include being overweight, sedentary, and over 45 years old; having a history of stillbirth or gestational diabetes; having high blood pressure and high cholesterol; being African American, Hispanic, or Native American; and having previously been identified with impaired glucose tolerance. The acute complications of diabetes include ketoacidosis, nonketotic hyperosmolar syndrome, and hypoglycemia. The chronic complications are divided into microvascular and macrovascular complications. Microvascular complications include retinopathy, neuropathy, and nephropathy. Macrovascular complications include heart attack, stroke, and peripheral vascular disease. Early diagnosis is important in preventing complications. Diagnosis is based on blood sugar levels obtained from a blood glucose test, a fasting plasma glucose test, or an oral glucose tolerance test. The risk of developing type 2 diabetes may be reduced by eating properly, maintaining an ideal

Multimedia 27

weight, and exercising. The videotape includes a self test that viewers can take to assess their risk of developing type 2 diabetes.

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CHAPTER 4. PERIODICALS AND NEWS ON BLURRED VISION Overview In this chapter, we suggest a number of news sources and present various periodicals that cover blurred vision.

News Services and Press Releases One of the simplest ways of tracking press releases on blurred vision 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 “blurred vision” (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 blurred vision. 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 “blurred vision” (or synonyms).

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Blurred Vision

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 “blurred vision” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “blurred vision” (or synonyms). If you know the name of a company that is relevant to blurred vision, 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 “blurred vision” (or synonyms).

Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly

Periodicals and News

31

to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “blurred vision” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months. The following is a typical result when searching for newsletter articles on blurred vision: •

Sicca Syndrome and Sjogren's Syndrome in Lupus Source: Lupus News. 23(1): 14-18. Spring 2003. Contact: Available from Lupus Foundation of America. 1300 Piccard Drive, Suite 200, Rockville, MD 20850-4303. (800) 558-0121 or (301) 670-9486. Website: www.lupus.org/lupus. Summary: This newsletter article discusses sicca syndrome and Sjogren's syndrome, two syndromes that cause dryness in the eyes and mouth and are common to patients with lupus. Sicca syndrome is very common in the general population as well as in patients with connective tissue disorders and is often caused by Sjogren's syndrome, a chronic autoimmune disorder in which immune cells attack and destroy the glands that produce tears. Other conditions that may cause sicca syndrome include side effects from medications, low humidity environments, dehydration, and surface irritants. The chronic dry mouth caused by Sjogren's syndrome may cause dental caries, periodontal disease, oral candidiasis, mouth pain, halitosis, and difficulty swallowing. Complications of dry eyes caused by Sjogren's syndrome include a gritty feeling in the eye, blurred vision, infection, corneal abrasions and ulcerations, and vision loss. Other systemic complications may occur in Sjogren's syndrome but not sicca syndrome. Patients may relieve dry mouth symptoms by sipping water, stimulating the salivary glands, using artificial saliva, and maintaining a high level of dental hygiene. Treatments for dry eyes include artificial tears, ophthalmic ointments, and punctal occlusion. Precautions for laser vision correction, which may cause temporary dryness in the eyes, are listed. Other complications of sicca syndrome are dry skin, vaginal dryness, and a dry cough. Prescription medicines are available for patients with severe sicca symptoms. Side effects include sweating, nausea, and diarrhea. Immune suppression therapy is used only in cases of Sjogren's syndrome with severe autoimmune manifestations. 2 tables.

•

Vertigo: Taking the Spin Out of Life Source: Mayo Clinic Health Letter. 18(7): 1-3. July 2000. Contact: Available from Mayo Foundation for Medical Education and Research. 200 First Street SW, Rochester, MN 55905. Summary: This newsletter article explores the issue of vertigo (a spinning type of dizziness) and what can be done to manage or prevent it. True vertigo, the most common form of dizziness, can result from a number of different causes. The author reviews the anatomy and structures of the inner ear and the balance system, including the role of the eyes, sensory nerves, and inner ear. The article also explains the canalith repositioning procedure, a common office procedure used to help relieve benign paroxysmal positional vertigo (BPPV). The author explores some of the causes of dizziness, including BPPV, Meniere's disease, inflammation of the inner ear (labyrinthitis or acute vestibular neuronitis); and some of the treatment options, including dietary changes, diuretics, sedatives, and antihistamines. One sidebar reviews the symptoms that should trigger a visit to the health care provider; these symptoms

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Blurred Vision

include vertigo or dizziness along with any of the following: new, different or severe headache, blurred vision, hearing loss, speech impairment, leg or arm weakness, loss of consciousness, falling or difficulty with walking, numbness or tingling, and chest pain or rapid or slow heart rate. 2 figures.

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

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CHAPTER 5. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.

U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for blurred vision. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DI Advice for the Patient can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with blurred vision. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The

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Blurred Vision

following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to blurred vision: Antiglaucoma Agents, Cholinergic, Long-Acting •

Ophthalmic - U.S. Brands: Humorsol; Phospholine Iodide http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202059.html

Clomiphene •

Systemic - U.S. Brands: Clomid; Milophene; Serophene http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202151.html

Ipratropium •

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

•

Nasal - U.S. Brands: Atrovent http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202713.html

Ipratropium and Albuterol •

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

Midodrine •

Systemic - U.S. Brands: ProAmatine http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203640.html

Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.

Mosby’s Drug Consult Mosby’s Drug Consult database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/. PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html.

Researching Medications

35

Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee. If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.

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APPENDICES

39

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 Institute4: •

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/

4

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

40

Blurred Vision

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

Physician Resources

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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.5 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:6 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

•

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

•

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

•

Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

•

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

•

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

•

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

•

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

•

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

•

MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

5 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). 6 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 Gateway7 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.8 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “blurred vision” (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 1577 8 987 17 509 3098

HSTAT9 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.10 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.11 Simply search by “blurred vision” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

7

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

8

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). 9 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 10 11

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 Biologists12 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.13 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.14 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/.

12 Adapted 13

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. 14 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.

45

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 blurred vision 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 blurred vision. 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 blurred vision. 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 “blurred vision”:

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Eye Diseases http://www.nlm.nih.gov/medlineplus/eyediseases.html Laser Eye Surgery http://www.nlm.nih.gov/medlineplus/lasereyesurgery.html Macular Degeneration http://www.nlm.nih.gov/medlineplus/maculardegeneration.html Refractive Errors http://www.nlm.nih.gov/medlineplus/refractiveerrors.html Vision Impairment and Blindness http://www.nlm.nih.gov/medlineplus/visionimpairmentandblindness.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 blurred vision. 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: •

Don't Let Diabetes Get a Foothold on Your Life Source: Bethesda, MD: Foot Health Foundation of America, American Podiatric Medical Association. 1997. 4 p. Contact: Available from Foot Health Foundation of America. American Podiatric Medical Association, 9312 Old Georgetown Road, Bethesda, MD 20814-1698. (800) 6150807 or (301) 571-9200. Fax (301) 530-2752. PRICE: Single copy free. Summary: This brochure provides information specific to foot care for people with diabetes, as well as general information about diabetes. The brochure points out that any of the following symptoms can be connected with diabetes: diuretic symptoms, increased infections, abnormal weight loss, blurred vision, excessive thirst, tingling or numbness of the feet or hands, extreme hunger, and slow-to-heal wounds. Because nerves damaged by diabetes are not as sensitive to pain and extreme temperatures, people with diabetes can injure their feet without knowing it and develop infections. Thus, proper care, hygiene, and inspection of the feet are critical. Six characteristics that point to a higher risk for possible amputation include tingling, numbness, or the loss of sensation in the feet; restricted blood flow to the legs and feet; foot deformities; stiff joints; calluses on the soles of the feet; and a history of open sores on the feet or a previous lower extremity amputation. The brochure notes that more than half of the

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lower extremity amputations among people with diabetes could be prevented with strict adherence to diet, exercise, medication, and hygiene. •

Diabetes: Should I Worry? Source: Santa Cruz, CA: ETR Associates. 1997. 2 p. Contact: Available from ETR Associates. 4 Carbonero Way, Scotts Valley, CA 950664200. (800) 321-4407. Fax (800) 435-8433. Website: www.etr.org. PRICE: Single copy free; $16.00 for 50 copies, discounts for larger orders. Order number: R300. Summary: This brochure provides introductory information about diabetes. Diabetes symptoms may include frequent urination; tiredness and weakness; an ill feeling; unusual thirst; weight loss; blurred vision; slow healing of cuts, sores, or infections; hunger most of the time; and dry, itchy skin. Topics include insulin, risk factors, the three types of diabetes, prevention, and monitoring. The author notes that the risk for developing diabetes increases if a person has an immediate family member with diabetes; is 20 percent or more over ideal weight; is over 40; is Native American, African American, Asian American, or Hispanic; or has had gestational diabetes. In order to reduce the risk for developing diabetes, a person should maintain body weight in the normal range; lose weight if he or she is 20 percent over ideal weight; exercise to control weight and more effectively use insulin; and get regular health checkups. Health care professionals should help people with diabetes monitor ideal weight, diet, exercise, blood glucose levels, medication, and regular health care. Contact information for four diabetes organizations concludes the brochure. (AA-M).

•

Eye Care Source: New York, NY: Pfizer Pratt Pharmaceuticals. October 1991. 4 p. Contact: Available from Pfizer Pratt Pharmaceuticals. Attn: Marketing, 235 East 42nd Street, New York, NY 10017. (212) 573-2551. PRICE: Single copy free. Order Number RGA025X91D. Summary: This chart-like brochure briefly presents information about eye care for people with diabetes. Topics include diabetic retinopathy, diagnostic tests used, cataracts and glaucoma, blurred vision, and everyday health care that can help avoid eye problems. Simple line drawings on each page help to reiterate the concepts presented.

•

Diabetes: What Is It? Source: Lexington, KY: Lexington-Fayette County Health Department. 1995. 4 p. Contact: Available from Lexington-Fayette County Health Department. Division of Nutrition and Health Education, 650 Newtown Pike, Lexington, KY 40508. (606) 2882333. Fax (606) 288-2359. PRICE: $15.00 per 50 copies plus shipping. Summary: This general introduction to diabetes is one in a series of 22 diabetes education materials that combine practical tips and humorous drawings with current diabetes information. The series is written at a sixth grade reading level and is designed to teach and motivate patients to take care of themselves. The fact sheet provides a description of how insulin helps the body use glucose for energy and what happens when the insulin is missing or when the body doesn't use the available insulin. The fact sheet illustrates the symptoms of diabetes, including excessive thirst and hunger, tiredness, frequent urination, blurred vision, weight loss, and sores that won't heal. The

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fact sheet continues by defining Type 1 and Type 2 diabetes and describing how each is treated. The fact sheet concludes with a brief section on impaired glucose tolerance (IGT). •

Call for an Eye Test Today! For People with Diabetes Source: South Deerfield, MA: Channing L. Bete Co., Inc. 1999. [4 p.]. Contact: Available from Channing L. Bete Co., Inc. 200 State Road, South Deerfield, MA 01373. (800) 628-7733. Fax (800) 499-6464. Website: www.channing-bete.com. PRICE: $1.05 each for 1-99 copies; discounts available for larger quantities. Order number 31207A0999. Summary: This pamphlet offers eye care tips for people who have diabetes. Proper eye care is important to living well with diabetes. Diabetes can lead to diabetic retinopathy and other diseases that harm eyesight such as cataracts and glaucoma. Common reasons for avoiding eye examinations include not knowing who to go to, not having the time for an examination, not being able to afford an examination, and not liking eye tests. Regular eye examinations are important because many eye problems start before any symptoms appear. Symptoms that require a call to a health care provider include having blurred vision or redness, seeing dark or floating spots, and feeling pressure in one or both eyes. The pamphlet provides a space for recording information about an eye test.

•

Dealing with Diabetes Source: Gaithersburg, MD: National Institute on Aging (NIA). 2000. 10 p. Contact: Available from National Institute on Aging. Information Center, P.O. Box 8057, Gaithersburg, MD 20898-8057. (800) 222-2225. TTY (800) 222-4225. Website: www.nih.gov/nia. PRICE: Single copy free. Summary: This pamphlet presents information on the types, symptoms, detection, and treatment of diabetes. Diabetes is a chronic disease in which the body cannot make or properly use insulin. As a result, glucose builds up in the blood and causes many symptoms of diabetes, including feeling tired and thirsty, urinating frequently, losing weight, having blurred vision, getting skin infections, and having slow wound healing. Type 1 and type 2 are the major forms of diabetes. Type 1, which usually occurs in children and adults under age 30, develops when the body's immune system attacks the insulin producing cells of the pancreas. Type 2, which is most common in adults over age 40, occurs when the cells do not use insulin properly and the pancreas does not produce enough insulin. Risk factors for type 2 include obesity, inactivity, family history of diabetes, and ethnic heritage. Diabetes may be detected through a fasting blood glucose test. Treatment for type 1 diabetes involves injecting insulin and self monitoring of blood glucose. People who have type 2 diabetes can usually control their blood glucose with diet, exercise, and oral drugs. Insulin may sometimes be needed. People who have diabetes need to give extra attention to foot, skin, and oral health care. The pamphlet includes a list of helpful resources.

•

You Can Prevent CMV (Cytomegalovirus): A Guide for People With HIV Infection Contact: CDC National Prevention Information Network, PO Box 6003, Rockville, MD, 20849-6003, (800) 458-5231, http://www.cdcnpin.org. Summary: This pamphlet, for persons with the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), provides information on the cytomegalovirus (CMV). It discusses the consequences of CMV infection for people with

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HIV/AIDS including blurred vision and blindness, painful swallowing, diarrhea, pain, weakness, and numbness in the legs; how CMV is transmitted from person to person through saliva, semen, vaginal secretions, blood, urine, and breast milk, during sexual contact, breastfeeding, blood transfusions, and organ transplants; how it may be prevented by frequent hand washing, using condoms, talking to a doctor before undergoing a blood transfusion; and its symptoms including fatigue, swollen glands, fever, and sore throat; testing; and treatment. The pamphlet makes recommendations for individuals who work in day care centers including frequent hand washing after contact with urine or saliva, avoiding oral contact with saliva or objects covered with saliva, and talking to a doctor about whether to continue working in a day care center. Sources for locating referrals, materials, and information on HIV/AIDS treatment, clinical trials, and social security benefits are provided. •

Answers to Frequently Asked Questions About Low Blood Glucose Source: Diabetes Spectrum. 10(1): 71-72. 1997. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This patient education fact sheet provides information about low blood glucose levels (hypoglycemia). Although hypoglycemia happens most often in people with diabetes who use insulin, it can also be a problem for people who take medication for noninsulin-dependent diabetes mellitus (NIDDM). The fact sheet notes the symptoms of hypoglycemia, including shakiness, sweating, irritability, rapid heartbeat, light headedness, nervousness, impatience, chills, anxiety, and hunger; as the hypoglycemia worsens, symptoms can include sleepiness, anger, blurred vision, lack of coordination, headaches, personality change, confusion, and unconsciousness. However, the author notes that the only sure way to know if hypoglycemia is present is to test blood glucose levels. The author outlines the common causes of hypoglycemia, then describes hypoglycemia unawareness, or the situation where the person with diabetes cannot feel the early symptoms of low blood glucose. The author notes that avoiding even mild hypoglycemia can help restore awareness of symptoms. The author also addresses concerns that hypoglycemia will be present more often if tight control of blood glucose is attempted (through intensive diabetes management). The fact sheet continues with a discussion of treating hypoglycemia and what happens when the hypoglycemic reaction has gone too far for the person to treat themselves. The fact sheet concludes with a set of suggestions for preventing low blood glucose levels. One sidebar lists a variety of foods containing 15 grams of easily absorbed carbohydrate. 2 references. (AA-M). 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 blurred vision. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html.

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Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

•

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 blurred vision. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with blurred vision. 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 blurred vision. 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 “blurred vision” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received

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your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “blurred vision”. 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 “blurred vision” (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 “blurred vision” (or a synonym) into the search box, and click “Submit Query.”

53

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.15

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

15

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)16: •

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/

16

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

Finding Medical Libraries

55

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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/

•

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

Finding Medical Libraries

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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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

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

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

•

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

•

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

•

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

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BLURRED VISION DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abdominal Cramps: Abdominal pain due to spasmodic contractions of the bowel. [NIH] Abdominal Pain: Sensation of discomfort, distress, or agony in the abdominal region. [NIH] Abducens: A striated, extrinsic muscle of the eyeball that originates from the annulus of Zinn. [NIH] Abducens Nerve: The 6th cranial nerve. The abducens nerve originates in the abducens nucleus of the pons and sends motor fibers to the lateral rectus muscles of the eye. Damage to the nerve or its nucleus disrupts horizontal eye movement control. [NIH] Abducens Nerve Diseases: Diseases of the sixth cranial (abducens) nerve or its nucleus in the pons. The nerve may be injured along its course in the pons, intracranially as it travels along the base of the brain, in the cavernous sinus, or at the level of superior orbital fissure or orbit. Dysfunction of the nerve causes lateral rectus muscle weakness, resulting in horizontal diplopia that is maximal when the affected eye is abducted and esotropia. Common conditions associated with nerve injury include intracranial hypertension; craniocerebral trauma; ischemia; and infratentorial neoplasms. [NIH] Ablation: The removal of an organ by surgery. [NIH] Accommodation: Adjustment, especially that of the eye for various distances. [EU] Acidosis: A pathologic condition resulting from accumulation of acid or depletion of the alkaline reserve (bicarbonate content) in the blood and body tissues, and characterized by an increase in hydrogen ion concentration. [EU] Action Potentials: The electric response of a nerve or muscle to its stimulation. [NIH] Activities of Daily Living: The performance of the basic activities of self care, such as dressing, ambulation, eating, etc., in rehabilitation. [NIH] Adaptation: 1. The adjustment of an organism to its environment, or the process by which it enhances such fitness. 2. The normal ability of the eye to adjust itself to variations in the intensity of light; the adjustment to such variations. 3. The decline in the frequency of firing of a neuron, particularly of a receptor, under conditions of constant stimulation. 4. In dentistry, (a) the proper fitting of a denture, (b) the degree of proximity and interlocking of restorative material to a tooth preparation, (c) the exact adjustment of bands to teeth. 5. In microbiology, the adjustment of bacterial physiology to a new environment. [EU] Adenoma: A benign epithelial tumor with a glandular organization. [NIH] Adenovirus: A group of viruses that cause respiratory tract and eye infections. Adenoviruses used in gene therapy are altered to carry a specific tumor-fighting gene. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Adverse Effect: An unwanted side effect of treatment. [NIH]

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Afferent: Concerned with the transmission of neural impulse toward the central part of the nervous system. [NIH] Age of Onset: The age or period of life at which a disease or the initial symptoms or manifestations of a disease appear in an individual. [NIH] Agonists: Drugs that trigger an action from a cell or another drug. [NIH] Agoraphobia: Obsessive, persistent, intense fear of open places. [NIH] Air Embolism: Occurs when the lungs over expand to the point that air bubbles are forced through the air sacs of the lungs into the circulatory system. [NIH] Air Sacs: Thin-walled sacs or spaces which function as a part of the respiratory system in birds, fishes, insects, and mammals. [NIH] Akathisia: 1. A condition of motor restlessness in which there is a feeling of muscular quivering, an urge to move about constantly, and an inability to sit still, a common extrapyramidal side effect of neuroleptic drugs. 2. An inability to sit down because of intense anxiety at the thought of doing so. [EU] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alkaline: Having the reactions of an alkali. [EU] Allergens: Antigen-type substances (hypersensitivity, immediate). [NIH]

that

produce

immediate

hypersensitivity

Allergic Rhinitis: Inflammation of the nasal mucous membrane associated with hay fever; fits may be provoked by substances in the working environment. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Amenorrhea: Absence of menstruation. [NIH] Amino acid: Any organic compound containing an amino (-NH2 and a carboxyl (- COOH) group. The 20 a-amino acids listed in the accompanying table are the amino acids from which proteins are synthesized by formation of peptide bonds during ribosomal translation of messenger RNA; all except glycine, which is not optically active, have the L configuration. Other amino acids occurring in proteins, such as hydroxyproline in collagen, are formed by posttranslational enzymatic modification of amino acids residues in polypeptide chains. There are also several important amino acids, such as the neurotransmitter y-aminobutyric acid, that have no relation to proteins. Abbreviated AA. [EU] Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Amputation: Surgery to remove part or all of a limb or appendage. [NIH] Anaphylaxis: An acute hypersensitivity reaction due to exposure to a previously encountered antigen. The reaction may include rapidly progressing urticaria, respiratory distress, vascular collapse, systemic shock, and death. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] 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

Dictionary 63

new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Antiarrhythmic: An agent that prevents or alleviates cardiac arrhythmia. [EU] Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticholinergic: An agent that blocks the parasympathetic nerves. Called also parasympatholytic. [EU] Antiemetic: An agent that prevents or alleviates nausea and vomiting. Also antinauseant. [EU]

Antiepileptic: An agent that combats epilepsy. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Antipsychotic: Effective in the treatment of psychosis. Antipsychotic drugs (called also neuroleptic drugs and major tranquilizers) are a chemically diverse (including phenothiazines, thioxanthenes, butyrophenones, dibenzoxazepines, dibenzodiazepines, and diphenylbutylpiperidines) but pharmacologically similar class of drugs used to treat schizophrenic, paranoid, schizoaffective, and other psychotic disorders; acute delirium and dementia, and manic episodes (during induction of lithium therapy); to control the movement disorders associated with Huntington's chorea, Gilles de la Tourette's syndrome, and ballismus; and to treat intractable hiccups and severe nausea and vomiting. Antipsychotic agents bind to dopamine, histamine, muscarinic cholinergic, a-adrenergic, and serotonin receptors. Blockade of dopaminergic transmission in various areas is thought to be responsible for their major effects : antipsychotic action by blockade in the mesolimbic and mesocortical areas; extrapyramidal side effects (dystonia, akathisia, parkinsonism, and tardive dyskinesia) by blockade in the basal ganglia; and antiemetic effects by blockade in the chemoreceptor trigger zone of the medulla. Sedation and autonomic side effects (orthostatic hypotension, blurred vision, dry mouth, nasal congestion and constipation) are caused by blockade of histamine, cholinergic, and adrenergic receptors. [EU] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Apathy: Lack of feeling or emotion; indifference. [EU] Aqueous: Having to do with water. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Ataxia: Impairment of the ability to perform smoothly coordinated voluntary movements.

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This condition may affect the limbs, trunk, eyes, pharnyx, larnyx, and other structures. Ataxia may result from impaired sensory or motor function. Sensory ataxia may result from posterior column injury or peripheral nerve diseases. Motor ataxia may be associated with cerebellar diseases; cerebral cortex diseases; thalamic diseases; basal ganglia diseases; injury to the red nucleus; and other conditions. [NIH] Atropine: A toxic alkaloid, originally from Atropa belladonna, but found in other plants, mainly Solanaceae. [NIH] Audition: The sense of hearing. [NIH] Autoimmune disease: A condition in which the body recognizes its own tissues as foreign and directs an immune response against them. [NIH] Autonomic: Self-controlling; functionally independent. [EU] Autonomic Nervous System: The enteric, parasympathetic, and sympathetic nervous systems taken together. Generally speaking, the autonomic nervous system regulates the internal environment during both peaceful activity and physical or emotional stress. Autonomic activity is controlled and integrated by the central nervous system, especially the hypothalamus and the solitary nucleus, which receive information relayed from visceral afferents; these and related central and sensory structures are sometimes (but not here) considered to be part of the autonomic nervous system itself. [NIH] Autonomic Neuropathy: A disease of the nerves affecting mostly the internal organs such as the bladder muscles, the cardiovascular system, the digestive tract, and the genital organs. These nerves are not under a person's conscious control and function automatically. Also called visceral neuropathy. [NIH] Back Pain: Acute or chronic pain located in the posterior regions of the trunk, including the thoracic, lumbar, sacral, or adjacent regions. [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 Ganglia: Large subcortical nuclear masses derived from the telencephalon and located in the basal regions of the cerebral hemispheres. [NIH] Basal Ganglia Diseases: Diseases of the basal ganglia including the putamen; globus pallidus; claustrum; amygdala; and caudate nucleus. Dyskinesias (most notably involuntary movements and alterations of the rate of movement) represent the primary clinical manifestations of these disorders. Common etiologies include cerebrovascular disease; neurodegenerative diseases; and craniocerebral trauma. [NIH] Base Sequence: The sequence of purines and pyrimidines in nucleic acids and polynucleotides. It is also called nucleotide or nucleoside sequence. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Bewilderment: Impairment or loss of will power. [NIH] Bilateral: Affecting both the right and left side of body. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bioluminescence: The emission of light by living organisms such as the firefly, certain mollusks, beetles, fish, bacteria, fungi and protozoa. [NIH] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived

Dictionary 65

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] Blind spot: (1) A small area of the retina where the optic nerve enters the eye; occurs normally in all eyes.(2) Any gap in the visual field corresponding to an area of the retina where no visual cells are present; associated with eye disease. [NIH] Bloating: Fullness or swelling in the abdomen that often occurs after meals. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood Glucose: Glucose in blood. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood transfusion: The administration of blood or blood products into a blood vessel. [NIH] Blood urea: A waste product in the blood that comes from the breakdown of food protein. The kidneys filter blood to remove urea. As kidney function decreases, the BUN level increases. [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 Mass Index: One of the anthropometric measures of body mass; it has the highest correlation with skinfold thickness or body density. [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] 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] 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] 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] Bundle-Branch Block: A form of heart block in which one ventricle is excited before the other because of absence of conduction in one of the branches of the bundle of His. [NIH] Bupivacaine: A widely used local anesthetic agent. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in

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many enzymatic processes. [NIH] Calcium Channels: Voltage-dependent cell membrane glycoproteins selectively permeable to calcium ions. They are categorized as L-, T-, N-, P-, Q-, and R-types based on the activation and inactivation kinetics, ion specificity, and sensitivity to drugs and toxins. The L- and T-types are present throughout the cardiovascular and central nervous systems and the N-, P-, Q-, & R-types are located in neuronal tissue. [NIH] 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] Candidosis: An infection caused by an opportunistic yeasts that tends to proliferate and become pathologic when the environment is favorable and the host resistance is weakened. [NIH]

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] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carcinogenic: Producing carcinoma. [EU] Cardiac: Having to do with the heart. [NIH] Cardiopulmonary: Having to do with the heart and lungs. [NIH] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cardiovascular disease: Any abnormal condition characterized by dysfunction of the heart and blood vessels. CVD includes atherosclerosis (especially coronary heart disease, which can lead to heart attacks), cerebrovascular disease (e.g., stroke), and hypertension (high blood pressure). [NIH] Cardiovascular System: The heart and the blood vessels by which blood is pumped and circulated through the body. [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] 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] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of

Dictionary 67

reference; same as inferior, in human anatomy. [EU] Causal: Pertaining to a cause; directed against a cause. [EU] Cavernous Sinus: An irregularly shaped venous space in the dura mater at either side of the sphenoid bone. [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 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] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Central Nervous System Infections: Pathogenic infections of the brain, spinal cord, and meninges. DNA virus infections; RNA virus infections; bacterial infections; mycoplasma infections; Spirochaetales infections; fungal infections; protozoan infections; helminthiasis; and prion diseases may involve the central nervous system as a primary or secondary process. [NIH] Cerebellar: Pertaining to the cerebellum. [EU] Cerebellum: Part of the metencephalon that lies in the posterior cranial fossa behind the brain stem. It is concerned with the coordination of movement. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebral Cortex: The thin layer of gray matter on the surface of the cerebral hemisphere that develops from the telencephalon and folds into gyri. It reaches its highest development in man and is responsible for intellectual faculties and higher mental functions. [NIH] 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] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] 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] Check-up: A general physical examination. [NIH] Chemoreceptor: A receptor adapted for excitation by chemical substances, e.g., olfactory and gustatory receptors, or a sense organ, as the carotid body or the aortic (supracardial) bodies, which is sensitive to chemical changes in the blood stream, especially reduced oxygen content, and reflexly increases both respiration and blood pressure. [EU] Chest Pain: Pressure, burning, or numbness in the chest. [NIH] Chin: The anatomical frontal portion of the mandible, also known as the mentum, that contains the line of fusion of the two separate halves of the mandible (symphysis menti). This line of fusion divides inferiorly to enclose a triangular area called the mental protuberance. On each side, inferior to the second premolar tooth, is the mental foramen for the passage of blood vessels and a nerve. [NIH] Cholera: An acute diarrheal disease endemic in India and Southeast Asia whose causative agent is vibrio cholerae. This condition can lead to severe dehydration in a matter of hours unless quickly treated. [NIH]

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Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Cholinergic: Resembling acetylcholine in pharmacological action; stimulated by or releasing acetylcholine or a related compound. [EU] Chorea: Involuntary, forcible, rapid, jerky movements that may be subtle or become confluent, markedly altering normal patterns of movement. Hypotonia and pendular reflexes are often associated. Conditions which feature recurrent or persistent episodes of chorea as a primary manifestation of disease are referred to as choreatic disorders. Chorea is also a frequent manifestation of basal ganglia diseases. [NIH] Chorioretinitis: Inflammation of the choroid in which the sensory retina becomes edematous and opaque. The inflammatory cells and exudate may burst through the sensory retina to cloud the vitreous body. [NIH] Choroid: The thin, highly vascular membrane covering most of the posterior of the eye between the retina and sclera. [NIH] Choroiditis: Inflammation of the choroid. [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] Chronic Disease: Disease or ailment of long duration. [NIH] Ciliary: Inflammation or infection of the glands of the margins of the eyelids. [NIH] Ciliary Body: A ring of tissue extending from the scleral spur to the ora serrata of the retina. It consists of the uveal portion and the epithelial portion. The ciliary muscle is in the uveal portion and the ciliary processes are in the epithelial portion. [NIH] Ciliary processes: The extensions or projections of the ciliary body that secrete aqueous humor. [NIH] Circulatory system: The system that contains the heart and the blood vessels and moves blood throughout the body. This system helps tissues get enough oxygen and nutrients, and it helps them get rid of waste products. The lymph system, which connects with the blood system, is often considered part of the circulatory system. [NIH] 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] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Cochlea: The part of the internal ear that is concerned with hearing. It forms the anterior part of the labyrinth, is conical, and is placed almost horizontally anterior to the vestibule. [NIH]

Cochlear: Of or pertaining to the cochlea. [EU] Cochlear Diseases: Diseases of the cochlea, the part of the inner ear that is concerned with hearing. [NIH] Codon: A set of three nucleotides in a protein coding sequence that specifies individual

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amino acids or a termination signal (codon, terminator). Most codons are universal, but some organisms do not produce the transfer RNAs (RNA, transfer) complementary to all codons. These codons are referred to as unassigned codons (codons, nonsense). [NIH] Cognition: Intellectual or mental process whereby an organism becomes aware of or obtains knowledge. [NIH] Colitis: Inflammation of the colon. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Collagen disease: A term previously used to describe chronic diseases of the connective tissue (e.g., rheumatoid arthritis, systemic lupus erythematosus, and systemic sclerosis), but now is thought to be more appropriate for diseases associated with defects in collagen, which is a component of the connective tissue. [NIH] Collapse: 1. A state of extreme prostration and depression, with failure of circulation. 2. Abnormal falling in of the walls of any part of organ. [EU] 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] 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] Concretion: Minute, hard, yellow masses found in the palpebral conjunctivae of elderly people or following chronic conjunctivitis, composed of the products of cellular degeneration retained in the depressions and tubular recesses in the conjunctiva. [NIH] Condoms: A sheath that is worn over the penis during sexual behavior in order to prevent pregnancy or spread of sexually transmitted disease. [NIH] Conduction: The transfer of sound waves, heat, nervous impulses, or electricity. [EU] Cones: One type of specialized light-sensitive cells (photoreceptors) in the retina that provide sharp central vision and color vision. [NIH] Confusion: A mental state characterized by bewilderment, emotional disturbance, lack of clear thinking, and perceptual disorientation. [NIH] Congestion: Excessive or abnormal accumulation of blood in a part. [EU] Conjunctiva: The mucous membrane that lines the inner surface of the eyelids and the anterior part of the sclera. [NIH] Conjunctivitis: Inflammation of the conjunctiva, generally consisting of conjunctival hyperaemia associated with a discharge. [EU] 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]

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Connective Tissue Cells: A group of cells that includes fibroblasts, cartilage cells, adipocytes, smooth muscle cells, and bone cells. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Constitutional: 1. Affecting the whole constitution of the body; not local. 2. Pertaining to the constitution. [EU] 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] Contrast Sensitivity: The ability to detect sharp boundaries (stimuli) and to detect slight changes in luminance at regions without distinct contours. Psychophysical measurements of this visual function are used to evaluate visual acuity and to detect eye disease. [NIH] Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works. [NIH] Contusion: A bruise; an injury of a part without a break in the skin. [EU] Coordination: Muscular or motor regulation or the harmonious cooperation of muscles or groups of muscles, in a complex action or series of actions. [NIH] Cornea: The transparent part of the eye that covers the iris and the pupil and allows light to enter the inside. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary heart disease: A type of heart disease caused by narrowing of the coronary arteries that feed the heart, which needs a constant supply of oxygen and nutrients carried by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by fat and cholesterol deposits and cannot supply enough blood to the heart, CHD results. [NIH] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Cortical: Pertaining to or of the nature of a cortex or bark. [EU] 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] Craniocerebral Trauma: Traumatic injuries involving the cranium and intracranial structures (i.e., brain; cranial nerves; meninges; and other structures). Injuries may be classified by whether or not the skull is penetrated (i.e., penetrating vs. nonpenetrating) or

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whether there is an associated hemorrhage. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cutaneous: Having to do with the skin. [NIH] Cystitis: Inflammation of the urinary bladder. [EU] Cytomegalovirus: A genus of the family Herpesviridae, subfamily Betaherpesvirinae, infecting the salivary glands, liver, spleen, lungs, eyes, and other organs, in which they produce characteristically enlarged cells with intranuclear inclusions. Infection with Cytomegalovirus is also seen as an opportunistic infection in AIDS. [NIH] Cytotoxic: Cell-killing. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dehydration: The condition that results from excessive loss of body water. [NIH] Delirium: (DSM III-R) an acute, reversible organic mental disorder characterized by reduced ability to maintain attention to external stimuli and disorganized thinking as manifested by rambling, irrelevant, or incoherent speech; there are also a reduced level of consciousness, sensory misperceptions, disturbance of the sleep-wakefulness cycle and level of psychomotor activity, disorientation to time, place, or person, and memory impairment. Delirium may be caused by a large number of conditions resulting in derangement of cerebral metabolism, including systemic infection, poisoning, drug intoxication or withdrawal, seizures or head trauma, and metabolic disturbances such as hypoxia, hypoglycaemia, fluid, electrolyte, or acid-base imbalances, or hepatic or renal failure. Called also acute confusional state and acute brain syndrome. [EU] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH] Dendrites: Extensions of the nerve cell body. They are short and branched and receive stimuli from other neurons. [NIH] Dendritic: 1. Branched like a tree. 2. Pertaining to or possessing dendrites. [EU] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Dental Caries: Localized destruction of the tooth surface initiated by decalcification of the enamel followed by enzymatic lysis of organic structures and leading to cavity formation. If left unchecked, the cavity may penetrate the enamel and dentin and reach the pulp. The three most prominent theories used to explain the etiology of the disase are that acids produced by bacteria lead to decalcification; that micro-organisms destroy the enamel protein; or that keratolytic micro-organisms produce chelates that lead to decalcification. [NIH]

Diabetes Insipidus: A metabolic disorder due to disorders in the production or release of vasopressin. It is characterized by the chronic excretion of large amounts of low specific gravity urine and great thirst. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diabetic Retinopathy: Retinopathy associated with diabetes mellitus, which may be of the background type, progressively characterized by microaneurysms, interretinal punctuate macular edema, or of the proliferative type, characterized by neovascularization of the retina and optic disk, which may project into the vitreous, proliferation of fibrous tissue, vitreous

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hemorrhage, and retinal detachment. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Dialysate: A cleansing liquid used in the two major forms of dialysis--hemodialysis and peritoneal dialysis. [NIH] Dialyzer: A part of the hemodialysis machine. (See hemodialysis under dialysis.) The dialyzer has two sections separated by a membrane. One section holds dialysate. The other holds the patient's blood. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Dietary Fiber: The remnants of plant cell walls that are resistant to digestion by the alimentary enzymes of man. It comprises various polysaccharides and lignins. [NIH] Dietitian: An expert in nutrition who helps people plan what and how much food to eat. [NIH]

Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive tract: The organs through which food passes when food is eaten. These organs are the mouth, esophagus, stomach, small and large intestines, and rectum. [NIH] Diplopia: A visual symptom in which a single object is perceived by the visual cortex as two objects rather than one. Disorders associated with this condition include refractive errors; strabismus; oculomotor nerve diseases; trochlear nerve diseases; abducens nerve diseases; and diseases of the brain stem and occipital lobe. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Discrimination: The act of qualitative and/or quantitative differentiation between two or more stimuli. [NIH] Disorientation: The loss of proper bearings, or a state of mental confusion as to time, place, or identity. [EU] Diuretic: A drug that increases the production of urine. [NIH] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Dominance: In genetics, the full phenotypic expression of a gene in both heterozygotes and homozygotes. [EU] Dopamine: An endogenous catecholamine and prominent neurotransmitter in several systems of the brain. In the synthesis of catecholamines from tyrosine, it is the immediate precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. A family of dopaminergic receptor subtypes mediate its action. Dopamine is used pharmacologically for its direct (beta adrenergic agonist) and indirect (adrenergic releasing) sympathomimetic effects including its actions as an inotropic agent and as a renal vasodilator. [NIH] Dorsal: 1. Pertaining to the back or to any dorsum. 2. Denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Duct: A tube through which body fluids pass. [NIH] Duodenum: The first part of the small intestine. [NIH]

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Dyskinesia: Impairment of the power of voluntary movement, resulting in fragmentary or incomplete movements. [EU] Eccentricities: Oddness of behavior or conduct without insanity. [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] Ejaculation: The release of semen through the penis during orgasm. [NIH] Elective: Subject to the choice or decision of the patient or physician; applied to procedures that are advantageous to the patient but not urgent. [EU] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electrophysiological: Pertaining to electrophysiology, that is a branch of physiology that is concerned with the electric phenomena associated with living bodies and involved in their functional activity. [EU] 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] Emollient: Softening or soothing; called also malactic. [EU] Enamel: A very hard whitish substance which covers the dentine of the anatomical crown of a tooth. [NIH] Endocarditis: Exudative and proliferative inflammatory alterations of the endocardium, characterized by the presence of vegetations on the surface of the endocardium or in the endocardium itself, and most commonly involving a heart valve, but sometimes affecting the inner lining of the cardiac chambers or the endocardium elsewhere. It may occur as a primary disorder or as a complication of or in association with another disease. [EU] Endocrinologist: A doctor that specializes in diagnosing and treating hormone disorders. [NIH]

Environmental Exposure: The exposure to potentially harmful chemical, physical, or biological agents in the environment or to environmental factors that may include ionizing radiation, pathogenic organisms, or toxic chemicals. [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] Epidemiological: Relating to, or involving epidemiology. [EU] Epigastric: Having to do with the upper middle area of the abdomen. [NIH] Episcleritis: Inflammation of the episclera and/or the outer layers of the sclera itself. [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

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covers the inner or outer surfaces of the body. [NIH] Erythema: Redness of the skin produced by congestion of the capillaries. This condition may result from a variety of causes. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Evacuation: An emptying, as of the bowels. [EU] Evoke: The electric response recorded from the cerebral cortex after stimulation of a peripheral sense organ. [NIH] Excitability: Property of a cardiac cell whereby, when the cell is depolarized to a critical level (called threshold), the membrane becomes permeable and a regenerative inward current causes an action potential. [NIH] Exocrine: Secreting outwardly, via a duct. [EU] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Extracellular: Outside a cell or cells. [EU] Extracellular Matrix: A meshwork-like substance found within the extracellular space and in association with the basement membrane of the cell surface. It promotes cellular proliferation and provides a supporting structure to which cells or cell lysates in culture dishes adhere. [NIH] Extraction: The process or act of pulling or drawing out. [EU] Extrapyramidal: Outside of the pyramidal tracts. [EU] Extremity: A limb; an arm or leg (membrum); sometimes applied specifically to a hand or foot. [EU] Eye Infections: Infection, moderate to severe, caused by bacteria, fungi, or viruses, which occurs either on the external surface of the eye or intraocularly with probable inflammation, visual impairment, or blindness. [NIH] Eye Movements: Voluntary or reflex-controlled movements of the eye. [NIH] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fasting Blood Glucose Test: A method for finding out how much glucose (sugar) is in the blood. The test can show if a person has diabetes. A blood sample is taken in a lab or doctor's office. The test is usually done in the morning before the person has eaten. The normal, nondiabetic range for blood glucose is from 70 to 110 mg/dl, depending on the type of blood being tested. If the level is 126 mg/dl or greater, it means the person has diabetes (except for newborns and some pregnant women). [NIH] Fat: Total lipids including phospholipids. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]

Febrile: Pertaining to or characterized by fever. [EU] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ,

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usually as a consequence of inflammation or other injury. [NIH] Foot Care: Taking special steps to avoid foot problems such as sores, cuts, bunions, and calluses. Good care includes daily examination of the feet, toes, and toenails and choosing shoes and socks or stockings that fit well. People with diabetes have to take special care of their feet because nerve damage and reduced blood flow sometimes mean they will have less feeling in their feet than normal. They may not notice cuts and other problems as soon as they should. [NIH] Foot Deformities: Alterations or deviations from normal shape or size which result in a disfigurement of the foot. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Form Perception: The sensory discrimination of a pattern shape or outline. [NIH] Fossa: A cavity, depression, or pit. [NIH] Fungi: A kingdom of eukaryotic, heterotrophic organisms that live as saprobes or parasites, including mushrooms, yeasts, smuts, molds, etc. They reproduce either sexually or asexually, and have life cycles that range from simple to complex. Filamentous fungi refer to those that grow as multicelluar colonies (mushrooms and molds). [NIH] Fungus: A general term used to denote a group of eukaryotic protists, including mushrooms, yeasts, rusts, moulds, smuts, etc., which are characterized by the absence of chlorophyll and by the presence of a rigid cell wall composed of chitin, mannans, and sometimes cellulose. They are usually of simple morphological form or show some reversible cellular specialization, such as the formation of pseudoparenchymatous tissue in the fruiting body of a mushroom. The dimorphic fungi grow, according to environmental conditions, as moulds or yeasts. [EU] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] 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] Gastric Emptying: The evacuation of food from the stomach into the duodenum. [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]

Gastroparesis: Nerve or muscle damage in the stomach. Causes slow digestion and emptying, vomiting, nausea, or bloating. Also called delayed gastric emptying. [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 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, 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

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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] Genetic Code: The specifications for how information, stored in nucleic acid sequence (base sequence), is translated into protein sequence (amino acid sequence). The start, stop, and order of amino acids of a protein is specified by consecutive triplets of nucleotides called codons (codon). [NIH] Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Genital: Pertaining to the genitalia. [EU] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Gestational: Psychosis attributable to or occurring during pregnancy. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glomerular: Pertaining to or of the nature of a glomerulus, especially a renal glomerulus. [EU]

Glomerular Filtration Rate: The volume of water filtered out of plasma through glomerular capillary walls into Bowman's capsules per unit of time. It is considered to be equivalent to inulin clearance. [NIH] Glomerulus: A tiny set of looping blood vessels in the nephron where blood is filtered in the kidney. [NIH] Glucocorticoid: A compound that belongs to the family of compounds called corticosteroids (steroids). Glucocorticoids affect metabolism and have anti-inflammatory and immunosuppressive effects. They may be naturally produced (hormones) or synthetic (drugs). [NIH] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucose Intolerance: A pathological state in which the fasting plasma glucose level is less than 140 mg per deciliter and the 30-, 60-, or 90-minute plasma glucose concentration following a glucose tolerance test exceeds 200 mg per deciliter. This condition is seen frequently in diabetes mellitus but also occurs with other diseases. [NIH] Glucose tolerance: The power of the normal liver to absorb and store large quantities of glucose and the effectiveness of intestinal absorption of glucose. The glucose tolerance test is a metabolic test of carbohydrate tolerance that measures active insulin, a hepatic function based on the ability of the liver to absorb glucose. The test consists of ingesting 100 grams of glucose into a fasting stomach; blood sugar should return to normal in 2 to 21 hours after ingestion. [NIH] Glucose Tolerance Test: Determination of whole blood or plasma sugar in a fasting state before and at prescribed intervals (usually 1/2 hr, 1 hr, 3 hr, 4 hr) after taking a specified amount (usually 100 gm orally) of glucose. [NIH] Glutamate: Excitatory neurotransmitter of the brain. [NIH] Glycine: A non-essential amino acid. It is found primarily in gelatin and silk fibroin and used therapeutically as a nutrient. It is also a fast inhibitory neurotransmitter. [NIH]

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Glycoproteins: Conjugated protein-carbohydrate compounds including mucins, mucoid, and amyloid glycoproteins. [NIH] Gonadal: Pertaining to a gonad. [EU] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer. [NIH] Habituation: Decline in response of an organism to environmental or other stimuli with repeated or maintained exposure. [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] Halitosis: An offensive, foul breath odor resulting from a variety of causes such as poor oral hygiene, dental or oral infections, or the ingestion of certain foods. [NIH] Hay Fever: A seasonal variety of allergic rhinitis, marked by acute conjunctivitis with lacrimation and itching, regarded as an allergic condition triggered by specific allergens. [NIH]

Head Movements: Voluntary or involuntary motion of head that may be relative to or independent of body; includes animals and humans. [NIH] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] Headache Disorders: Common conditions characterized by persistent or recurrent headaches. Headache syndrome classification systems may be based on etiology (e.g., vascular headache, post-traumatic headaches, etc.), temporal pattern (e.g., cluster headache, paroxysmal hemicrania, etc.), and precipitating factors (e.g., cough headache). [NIH] Heart attack: A seizure of weak or abnormal functioning of the heart. [NIH] Heartbeat: One complete contraction of the heart. [NIH] Hemodialysis: The use of a machine to clean wastes from the blood after the kidneys have failed. The blood travels through tubes to a dialyzer, which removes wastes and extra fluid. The cleaned blood then flows through another set of tubes back into the body. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemolysis: The destruction of erythrocytes by many different causal agents such as antibodies, bacteria, chemicals, temperature, and changes in tonicity. [NIH]

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Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hepatic: Refers to the liver. [NIH] Hepatitis: Inflammation of the liver and liver disease involving degenerative or necrotic alterations of hepatocytes. [NIH] Hepatocytes: The main structural component of the liver. They are specialized epithelial cells that are organized into interconnected plates called lobules. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Heterozygotes: Having unlike alleles at one or more corresponding loci on homologous chromosomes. [NIH] Histamine: 1H-Imidazole-4-ethanamine. A depressor amine derived by enzymatic decarboxylation of histidine. It is a powerful stimulant of gastric secretion, a constrictor of bronchial smooth muscle, a vasodilator, and also a centrally acting neurotransmitter. [NIH] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Homozygotes: An individual having a homozygous gene pair. [NIH] 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] Hydrocephalus: Excessive accumulation of cerebrospinal fluid within the cranium which may be associated with dilation of cerebral ventricles, intracranial hypertension; headache; lethargy; urinary incontinence; and ataxia (and in infants macrocephaly). This condition may be caused by obstruction of cerebrospinal fluid pathways due to neurologic abnormalities, intracranial hemorrhages; central nervous system infections; brain neoplasms; craniocerebral trauma; and other conditions. Impaired resorption of cerebrospinal fluid from the arachnoid villi results in a communicating form of hydrocephalus. Hydrocephalus ex-vacuo refers to ventricular dilation that occurs as a result of brain substance loss from cerebral infarction and other conditions. [NIH] 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] Hydroxyproline: A hydroxylated form of the imino acid proline. A deficiency in ascorbic acid can result in impaired hydroxyproline formation. [NIH] Hyperaemia: An excess of blood in a part; engorgement. [EU] Hyperglycemia: Abnormally high blood sugar. [NIH] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hypoglycemia: Abnormally low blood sugar [NIH] Hypoglycemic: An orally active drug that produces a fall in blood glucose concentration. [NIH]

Hypotension: Abnormally low blood pressure. [NIH]

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Hypotensive: Characterized by or causing diminished tension or pressure, as abnormally low blood pressure. [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] Hypoxemia: Deficient oxygenation of the blood; hypoxia. [EU] Hypoxia: Reduction of oxygen supply to tissue below physiological levels despite adequate perfusion of the tissue by blood. [EU] Illusion: A false interpretation of a genuine percept. [NIH] Imipramine: The prototypical tricyclic antidepressant. It has been used in major depression, dysthymia, bipolar depression, attention-deficit disorders, agoraphobia, and panic disorders. It has less sedative effect than some other members of this therapeutic group. [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] Immunodeficiency: The decreased ability of the body to fight infection and disease. [NIH] Immunoglobulin: A protein that acts as an antibody. [NIH] Immunosuppressive: Describes the ability to lower immune system responses. [NIH] Immunosuppressive Agents: Agents that suppress immune function by one of several mechanisms of action. Classical cytotoxic immunosuppressants act by inhibiting DNA synthesis. Others may act through activation of suppressor T-cell populations or by inhibiting the activation of helper cells. While immunosuppression has been brought about in the past primarily to prevent rejection of transplanted organs, new applications involving mediation of the effects of interleukins and other cytokines are emerging. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Impotence: The inability to perform sexual intercourse. [NIH] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] 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

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microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [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] Ingestion: Taking into the body by mouth [NIH] Inhalation: The drawing of air or other substances into the lungs. [EU] Inner ear: The labyrinth, comprising the vestibule, cochlea, and semicircular canals. [NIH] Inorganic: Pertaining to substances not of organic origin. [EU] Inositol: An isomer of glucose that has traditionally been considered to be a B vitamin although it has an uncertain status as a vitamin and a deficiency syndrome has not been identified in man. (From Martindale, The Extra Pharmacopoeia, 30th ed, p1379) Inositol phospholipids are important in signal transduction. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] 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] 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] Intracellular: Inside a cell. [NIH] Intracranial Hypertension: Increased pressure within the cranial vault. This may result from several conditions, including hydrocephalus; brain edema; intracranial masses; severe systemic hypertension; pseudotumor cerebri; and other disorders. [NIH] Intracranial Pressure: Pressure within the cranial cavity. It is influenced by brain mass, the circulatory system, CSF dynamics, and skull rigidity. [NIH] Intravenous: IV. Into a vein. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU]

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Inulin: A starch found in the tubers and roots of many plants. Since it is hydrolyzable to fructose, it is classified as a fructosan. It has been used in physiologic investigation for determination of the rate of glomerular function. [NIH] Invertebrates: Animals that have no spinal column. [NIH] 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 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] Ipratropium: A muscarinic antagonist structurally related to atropine but often considered safer and more effective for inhalation use. It is used for various bronchial disorders, in rhinitis, and as an antiarrhythmic. [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] Irritants: Drugs that act locally on cutaneous or mucosal surfaces to produce inflammation; those that cause redness due to hyperemia are rubefacients; those that raise blisters are vesicants and those that penetrate sebaceous glands and cause abscesses are pustulants; tear gases and mustard gases are also irritants. [NIH] 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] Keratitis: Inflammation of the cornea. [NIH] Keratoconjunctivitis: Simultaneous inflammation of the cornea and conjunctiva. [NIH] Keratoconjunctivitis Sicca: Drying and inflammation of the conjunctiva as a result of insufficient lacrimal secretion. When found in association with xerostomia and polyarthritis, it is called Sjogren's syndrome. [NIH] Keratolytic: An agent that promotes keratolysis. [EU] Ketoacidosis: Acidosis accompanied by the accumulation of ketone bodies (ketosis) in the body tissues and fluids, as in diabetic acidosis. [EU] Ketone Bodies: Chemicals that the body makes when there is not enough insulin in the blood and it must break down fat for its energy. Ketone bodies can poison and even kill body cells. When the body does not have the help of insulin, the ketones build up in the blood and then "spill" over into the urine so that the body can get rid of them. The body can also rid itself of one type of ketone, called acetone, through the lungs. This gives the breath a fruity odor. Ketones that build up in the body for a long time lead to serious illness and coma. [NIH] Ketosis: A condition of having ketone bodies build up in body tissues and fluids. The signs of ketosis are nausea, vomiting, and stomach pain. Ketosis can lead to ketoacidosis. [NIH] Kidney Disease: Any one of several chronic conditions that are caused by damage to the cells of the kidney. People who have had diabetes for a long time may have kidney damage. Also called nephropathy. [NIH] Kinetics: The study of rate dynamics in chemical or physical systems. [NIH] Labyrinth: The internal ear; the essential part of the organ of hearing. It consists of an osseous and a membranous portion. [NIH]

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Labyrinthitis: Inflammation of the inner ear. [NIH] Lacrimal: Pertaining to the tears. [EU] Lacrimal gland: The small almond-shaped structure that produces tears; located just above the outer corner of the eye. [NIH] Latent: Phoria which occurs at one distance or another and which usually has no troublesome effect. [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] Lesion: An area of abnormal tissue change. [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] 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] Lipid: Fat. [NIH] Lithium: An element in the alkali metals family. It has the atomic symbol Li, atomic number 3, and atomic weight 6.94. Salts of lithium are used in treating manic-depressive disorders. [NIH]

Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Lumbar: Pertaining to the loins, the part of the back between the thorax and the pelvis. [EU] Luminescence: The property of giving off light without emitting a corresponding degree of heat. It includes the luminescence of inorganic matter or the bioluminescence of human matter, invertebrates and other living organisms. For the luminescence of bacteria, bacterial luminescence is available. [NIH] Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [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] Lymphocyte: A white blood cell. Lymphocytes have a number of roles in the immune system, including the production of antibodies and other substances that fight infection and diseases. [NIH] Manic: Affected with mania. [EU] Manifest: Being the part or aspect of a phenomenon that is directly observable : concretely expressed in behaviour. [EU] Mastitis: Inflammatory disease of the breast, or mammary gland. [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] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Meiosis: A special method of cell division, occurring in maturation of the germ cells, by means of which each daughter nucleus receives half the number of chromosomes

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characteristic of the somatic cells of the species. [NIH] Melanocytes: Epidermal dendritic pigment cells which control long-term morphological color changes by alteration in their number or in the amount of pigment they produce and store in the pigment containing organelles called melanosomes. Melanophores are larger cells which do not exist in mammals. [NIH] 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] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] 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] 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] Mesolimbic: Inner brain region governing emotion and drives. [NIH] Metabolic disorder: A condition in which normal metabolic processes are disrupted, usually because of a missing enzyme. [NIH] Metabotropic: A glutamate receptor which triggers an increase in production of 2 intracellular messengers: diacylglycerol and inositol 1, 4, 5-triphosphate. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Micro-organism: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [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] Morphology: The science of the form and structure of organisms (plants, animals, and other forms of life). [NIH] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH] Motor nerve: An efferent nerve conveying an impulse that excites muscular contraction. [NIH]

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Mucins: A secretion containing mucopolysaccharides and protein that is the chief constituent of mucus. [NIH] Mucosa: A mucous membrane, or tunica mucosa. [EU] Mucus: The viscous secretion of mucous membranes. It contains mucin, white blood cells, water, inorganic salts, and exfoliated cells. [NIH] Multiple sclerosis: A disorder of the central nervous system marked by weakness, numbness, a loss of muscle coordination, and problems with vision, speech, and bladder control. Multiple sclerosis is thought to be an autoimmune disease in which the body's immune system destroys myelin. Myelin is a substance that contains both protein and fat (lipid) and serves as a nerve insulator and helps in the transmission of nerve signals. [NIH] Mustard Gas: Severe irritant and vesicant of skin, eyes, and lungs. It may cause blindness and lethal lung edema and was formerly used as a war gas. The substance has been proposed as a cytostatic and for treatment of psoriasis. It has been listed as a known carcinogen in the Fourth Annual Report on Carcinogens (NTP-85-002, 1985) (Merck, 11th ed). [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Myopia: That error of refraction in which rays of light entering the eye parallel to the optic axis are brought to a focus in front of the retina, as a result of the eyeball being too long from front to back (axial m.) or of an increased strength in refractive power of the media of the eye (index m.). Called also nearsightedness, because the near point is less distant than it is in emmetropia with an equal amplitude of accommodation. [EU] Myositis: Inflammation of a voluntary muscle. [EU] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] Nearsightedness: The common term for myopia. [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] Nephropathy: Disease of the kidneys. [EU] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nerve Fibers: Slender processes of neurons, especially the prolonged axons that conduct nerve impulses. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Nervousness: Excessive excitability and irritability, with mental and physical unrest. [EU] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neuritis: A general term indicating inflammation of a peripheral or cranial nerve. Clinical manifestation may include pain; paresthesias; paresis; or hypesthesia. [NIH] Neuroleptic: A term coined to refer to the effects on cognition and behaviour of antipsychotic drugs, which produce a state of apathy, lack of initiative, and limited range of emotion and in psychotic patients cause a reduction in confusion and agitation and normalization of psychomotor activity. [EU]

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Neurologic: Having to do with nerves or the nervous system. [NIH] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropathy: A problem in any part of the nervous system except the brain and spinal cord. Neuropathies can be caused by infection, toxic substances, or disease. [NIH] Neuroretinitis: Inflammation of the optic nerve head and adjacent retina. [NIH] Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] 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] 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] Occipital Lobe: Posterior part of the cerebral hemisphere. [NIH] Ocular: 1. Of, pertaining to, or affecting the eye. 2. Eyepiece. [EU] Oculomotor: Cranial nerve III. It originate from the lower ventral surface of the midbrain and is classified as a motor nerve. [NIH] Oculomotor Nerve: The 3d cranial nerve. The oculomotor nerve sends motor fibers to the levator muscles of the eyelid and to the superior rectus, inferior rectus, and inferior oblique muscles of the eye. It also sends parasympathetic efferents (via the ciliary ganglion) to the muscles controlling pupillary constriction and accommodation. The motor fibers originate in the oculomotor nuclei of the midbrain. [NIH] Odds Ratio: The ratio of two odds. The exposure-odds ratio for case control data is the ratio of the odds in favor of exposure among cases to the odds in favor of exposure among noncases. The disease-odds ratio for a cohort or cross section is the ratio of the odds in favor of disease among the exposed to the odds in favor of disease among the unexposed. The prevalence-odds ratio refers to an odds ratio derived cross-sectionally from studies of prevalent cases. [NIH] Ointments: Semisolid preparations used topically for protective emollient effects or as a vehicle for local administration of medications. Ointment bases are various mixtures of fats, waxes, animal and plant oils and solid and liquid hydrocarbons. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH]

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Ophthalmic: Pertaining to the eye. [EU] Ophthalmologist: A medical doctor specializing in the diagnosis and medical or surgical treatment of visual disorders and eye disease. [NIH] 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 disc: The circular area (disc) where the optic nerve connects to the retina. [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] Optic Neuritis: Inflammation of the optic nerve. Commonly associated conditions include autoimmune disorders such as multiple sclerosis, infections, and granulomatous diseases. Clinical features include retro-orbital pain that is aggravated by eye movement, loss of color vision, and contrast sensitivity that may progress to severe visual loss, an afferent pupillary defect (Marcus-Gunn pupil), and in some instances optic disc hyperemia and swelling. Inflammation may occur in the portion of the nerve within the globe (neuropapillitis or anterior optic neuritis) or the portion behind the globe (retrobulbar neuritis or posterior optic neuritis). [NIH] Oral Health: The optimal state of the mouth and normal functioning of the organs of the mouth without evidence of disease. [NIH] Oral Hygiene: The practice of personal hygiene of the mouth. It includes the maintenance of oral cleanliness, tissue tone, and general preservation of oral health. [NIH] 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] Orthostatic: Pertaining to or caused by standing erect. [EU] Osmolarity: The concentration of osmotically active particles expressed in terms of osmoles of solute per litre of solution. [EU] Osmoles: The standard unit of osmotic pressure. [NIH] Otolith: A complex calcareous concretion in the inner ear which controls man's sense of balance and reactions to acceleration. [NIH] Overactive bladder: A condition in which the patient experiences two or all three of the following conditions: [NIH] Overweight: An excess of body weight but not necessarily body fat; a body mass index of 25 to 29.9 kg/m2. [NIH] Oxygenation: The process of supplying, treating, or mixing with oxygen. No:1245 oxygenation the process of supplying, treating, or mixing with oxygen. [EU] 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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Pancreatic: Having to do with the pancreas. [NIH] Panic: A state of extreme acute, intense anxiety and unreasoning fear accompanied by disorganization of personality function. [NIH] Panic Disorder: A type of anxiety disorder characterized by unexpected panic attacks that last minutes or, rarely, hours. Panic attacks begin with intense apprehension, fear or terror and, often, a feeling of impending doom. Symptoms experienced during a panic attack include dyspnea or sensations of being smothered; dizziness, loss of balance or faintness; choking sensations; palpitations or accelerated heart rate; shakiness; sweating; nausea or other form of abdominal distress; depersonalization or derealization; paresthesias; hot flashes or chills; chest discomfort or pain; fear of dying and fear of not being in control of oneself or going crazy. Agoraphobia may also develop. Similar to other anxiety disorders, it may be inherited as an autosomal dominant trait. [NIH] Parkinsonism: A group of neurological disorders characterized by hypokinesia, tremor, and muscular rigidity. [EU] Paroxysmal: Recurring in paroxysms (= spasms or seizures). [EU] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]

Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

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] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Periodontal disease: Disease involving the supporting structures of the teeth (as the gums and periodontal membranes). [NIH] Periodontal disease: Disease involving the supporting structures of the teeth (as the gums and periodontal membranes). [NIH] Peripheral Vascular Disease: Disease in the large blood vessels of the arms, legs, and feet. People who have had diabetes for a long time may get this because major blood vessels in their arms, legs, and feet are blocked and these limbs do not receive enough blood. The signs of PVD are aching pains in the arms, legs, and feet (especially when walking) and foot sores that heal slowly. Although people with diabetes cannot always avoid PVD, doctors say they have a better chance of avoiding it if they take good care of their feet, do not smoke, and keep both their blood pressure and diabetes under good control. [NIH] Pharmacist: A person trained to prepare and distribute medicines and to give information about them. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH]

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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] Photophobia: Abnormal sensitivity to light. This may occur as a manifestation of eye diseases; migraine; subarachnoid hemorrhage; meningitis; and other disorders. Photophobia may also occur in association with depression and other mental disorders. [NIH] Photosensitization: The development of abnormally heightened reactivity of the skin to sunlight. [EU] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pigment: A substance that gives color to tissue. Pigments are responsible for the color of skin, eyes, and hair. [NIH] Plant Oils: Oils derived from plants or plant products. [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] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasticity: In an individual or a population, the capacity for adaptation: a) through gene changes (genetic plasticity) or b) through internal physiological modifications in response to changes of environment (physiological plasticity). [NIH] Pneumonia: Inflammation of the lungs. [NIH] Podiatrist: A doctor who treats and takes care of people's feet. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Polyarthritis: An inflammation of several joints together. [EU] Polydipsia: Chronic excessive thirst, as in diabetes mellitus or diabetes insipidus. [EU] 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] Polyphagia: Great hunger; a sign of diabetes. People with this great hunger often lose weight. [NIH] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] Polyuria: Urination of a large volume of urine with an increase in urinary frequency, commonly seen in diabetes. [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] Postural: Pertaining to posture or position. [EU]

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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] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Prednisolone: A glucocorticoid with the general properties of the corticosteroids. It is the drug of choice for all conditions in which routine systemic corticosteroid therapy is indicated, except adrenal deficiency states. [NIH] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Procaine: A local anesthetic of the ester type that has a slow onset and a short duration of action. It is mainly used for infiltration anesthesia, peripheral nerve block, and spinal block. (From Martindale, The Extra Pharmacopoeia, 30th ed, p1016). [NIH] 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] Prolactin: Pituitary lactogenic hormone. A polypeptide hormone with a molecular weight of about 23,000. It is essential in the induction of lactation in mammals at parturition and is synergistic with estrogen. The hormone also brings about the release of progesterone from lutein cells, which renders the uterine mucosa suited for the embedding of the ovum should fertilization occur. [NIH] Prolactinoma: A pituitary adenoma which secretes prolactin, leading to hyperprolactinemia. Clinical manifestations include amenorrhea; galactorrhea; impotence; headache; visual disturbances; and cerebrospinal fluid rhinorrhea. [NIH] Prophase: The first phase of cell division, in which the chromosomes become visible, the nucleus starts to lose its identity, the spindle appears, and the centrioles migrate toward opposite poles. [NIH] Prospective Studies: Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group. [NIH] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein Conformation: The characteristic 3-dimensional shape of a protein, including the secondary, supersecondary (motifs), tertiary (domains) and quaternary structure of the

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peptide chain. Quaternary protein structure describes the conformation assumed by multimeric proteins (aggregates of more than one polypeptide chain). [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] 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] Pruritus: An intense itching sensation that produces the urge to rub or scratch the skin to obtain relief. [NIH] Pseudotumor Cerebri: A condition marked by raised intracranial pressure and characterized clinically by headaches; nausea; papilledema, peripheral constriction of the visual fields, transient visual obscurations, and pulsatile tinnitus. Obesity is frequently associated with this condition, which primarily affects women between 20 and 44 years of age. Chronic papilledema may lead to optic nerve injury (optic nerve diseases) and visual loss (blindness). [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychomotor: Pertaining to motor effects of cerebral or psychic activity. [EU] Psychosis: A mental disorder characterized by gross impairment in reality testing as evidenced by delusions, hallucinations, markedly incoherent speech, or disorganized and agitated behaviour without apparent awareness on the part of the patient of the incomprehensibility of his behaviour; the term is also used in a more general sense to refer to mental disorders in which mental functioning is sufficiently impaired as to interfere grossly with the patient's capacity to meet the ordinary demands of life. Historically, the term has been applied to many conditions, e.g. manic-depressive psychosis, that were first described in psychotic patients, although many patients with the disorder are not judged psychotic. [EU] Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [NIH] 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] 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] 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]

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Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Red blood cells: RBCs. Cells that carry oxygen to all parts of the body. Also called erythrocytes. [NIH] Red Nucleus: A pinkish-yellow portion of the midbrain situated in the rostral mesencephalic tegmentum. It receives a large projection from the contralateral half of the cerebellum via the superior cerebellar peduncle and a projection from the ipsilateral motor cortex. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reflex: An involuntary movement or exercise of function in a part, excited in response to a stimulus applied to the periphery and transmitted to the brain or spinal cord. [NIH] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive error (myopia, hyperopia, or astigmatism). [NIH] Refractive Errors: Deviations from the average or standard indices of refraction of the eye through its dioptric or refractive apparatus. [NIH] Refractive Power: The ability of an object, such as the eye, to bend light as light passes through it. [NIH] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Relative risk: The ratio of the incidence rate of a disease among individuals exposed to a specific risk factor to the incidence rate among unexposed individuals; synonymous with risk ratio. Alternatively, the ratio of the cumulative incidence rate in the exposed to the cumulative incidence rate in the unexposed (cumulative incidence ratio). The term relative risk has also been used synonymously with odds ratio. This is because the odds ratio and relative risk approach each other if the disease is rare ( 5 percent of population) and the number of subjects is large. [NIH] Renal failure: Progressive renal insufficiency and uremia, due to irreversible and progressive renal glomerular tubular or interstitial disease. [NIH] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Retinal: 1. Pertaining to the retina. 2. The aldehyde of retinol, derived by the oxidative enzymatic splitting of absorbed dietary carotene, and having vitamin A activity. In the retina, retinal combines with opsins to form visual pigments. One isomer, 11-cis retinal combines with opsin in the rods (scotopsin) to form rhodopsin, or visual purple. Another, all-trans retinal (trans-r.); visual yellow; xanthopsin) results from the bleaching of rhodopsin by light, in which the 11-cis form is converted to the all-trans form. Retinal also combines with opsins in the cones (photopsins) to form the three pigments responsible for colour vision. Called also retinal, and retinene1. [EU] Retinal Vein: Central retinal vein and its tributaries. It runs a short course within the optic

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nerve and then leaves and empties into the superior ophthalmic vein or cavernous sinus. [NIH]

Retinitis: Inflammation of the retina. It is rarely limited to the retina, but is commonly associated with diseases of the choroid (chorioretinitis) and of the optic nerve (neuroretinitis). The disease may be confined to one eye, but since it is generally dependent on a constitutional factor, it is almost always bilateral. It may be acute in course, but as a rule it lasts many weeks or even several months. [NIH] Retinol: Vitamin A. It is essential for proper vision and healthy skin and mucous membranes. Retinol is being studied for cancer prevention; it belongs to the family of drugs called retinoids. [NIH] Retinopathy: 1. Retinitis (= inflammation of the retina). 2. Retinosis (= degenerative, noninflammatory condition of the retina). [EU] Retrobulbar: Behind the pons. [EU] Rhinitis: Inflammation of the mucous membrane of the nose. [NIH] Rhinorrhea: The free discharge of a thin nasal mucus. [EU] 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] Rods: One type of specialized light-sensitive cells (photoreceptors) in the retina that provide side vision and the ability to see objects in dim light (night vision). [NIH] Saliva: The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptylin. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] 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] Sclera: The tough white outer coat of the eyeball, covering approximately the posterior fivesixths of its surface, and continuous anteriorly with the cornea and posteriorly with the external sheath of the optic nerve. [EU] Scleritis: Refers to any inflammation of the sclera including episcleritis, a benign condition affecting only the episclera, which is generally short-lived and easily treated. Classic scleritis, on the other hand, affects deeper tissue and is characterized by higher rates of visual acuity loss and even mortality, particularly in necrotizing form. Its characteristic symptom is severe and general head pain. Scleritis has also been associated with systemic collagen disease. Etiology is unknown but is thought to involve a local immune response. Treatment is difficult and includes administration of anti-inflammatory and immunosuppressive agents such as corticosteroids. Inflammation of the sclera may also be secondary to inflammation of adjacent tissues, such as the conjunctiva. [NIH] Sclerosis: A pathological process consisting of hardening or fibrosis of an anatomical structure, often a vessel or a nerve. [NIH]

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Screening: Checking for disease when there are no symptoms. [NIH] Sebaceous: Gland that secretes sebum. [NIH] Sebaceous gland: Gland that secretes sebum. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Secretory: Secreting; relating to or influencing secretion or the secretions. [NIH] Sedative: 1. Allaying activity and excitement. 2. An agent that allays excitement. [EU] Sedentary: 1. Sitting habitually; of inactive habits. 2. Pertaining to a sitting posture. [EU] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Self Care: Performance of activities or tasks traditionally performed by professional health care providers. The concept includes care of oneself or one's family and friends. [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] Septicaemia: A term originally used to denote a putrefactive process in the body, but now usually referring to infection with pyogenic micro-organisms; a genus of Diptera; the severe type of infection in which the blood stream is invaded by large numbers of the causal. [NIH] Sequence Alignment: The arrangement of two or more amino acid or base sequences from an organism or organisms in such a way as to align areas of the sequences sharing common properties. The degree of relatedness or homology between the sequences is predicted computationally or statistically based on weights assigned to the elements aligned between the sequences. This in turn can serve as a potential indicator of the genetic relatedness between the organisms. [NIH] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Serotypes: A cause of haemorrhagic septicaemia (in cattle, sheep and pigs), fowl cholera of birds, pasteurellosis of rabbits, and gangrenous mastitis of ewes. It is also commonly found in atrophic rhinitis of pigs. [NIH] Serrata: The serrated anterior border of the retina located approximately 8.5 mm from the limbus and adjacent to the pars plana of the ciliary body. [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]

Sicca: Failure of lacrimal secretion, keratoconjunctivitis sicca, failure of secretion of the salivary glands and mucous glands of the upper respiratory tract and polyarthritis. [NIH]

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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] 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 Security: Government sponsored social insurance programs. [NIH] Solitary Nucleus: Gray matter located in the dorsomedial part of the medulla oblongata associated with the solitary tract. The solitary nucleus receives inputs from most organ systems including the terminations of the facial, glossopharyngeal, and vagus nerves. It is a major coordinator of autonomic nervous system regulation of cardiovascular, respiratory, gustatory, gastrointestinal, and chemoreceptive aspects of homeostasis. The solitary nucleus is also notable for the large number of neurotransmitters which are found therein. [NIH] Soma: The body as distinct from the mind; all the body tissue except the germ cells; all the axial body. [NIH] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Somnolence: Sleepiness; also unnatural drowsiness. [EU] Spasmodic: Of the nature of a spasm. [EU] Spatial disorientation: Loss of orientation in space where person does not know which way is up. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] 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] Spermatozoa: Mature male germ cells that develop in the seminiferous tubules of the testes. Each consists of a head, a body, and a tail that provides propulsion. The head consists mainly of chromatin. [NIH] Spike: The activation of synapses causes changes in the permeability of the dendritic membrane leading to changes in the membrane potential. This difference of the potential travels along the axon of the neuron and is called spike. [NIH] 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] Spleen: An organ that is part of the lymphatic system. The spleen produces lymphocytes, filters the blood, stores blood cells, and destroys old blood cells. It is located on the left side of the abdomen near the stomach. [NIH] Stabilization: The creation of a stable state. [EU] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stillbirth: The birth of a dead fetus or baby. [NIH]

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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] Strabismus: Deviation of the eye which the patient cannot overcome. The visual axes assume a position relative to each other different from that required by the physiological conditions. The various forms of strabismus are spoken of as tropias, their direction being indicated by the appropriate prefix, as cyclo tropia, esotropia, exotropia, hypertropia, and hypotropia. Called also cast, heterotropia, manifest deviation, and squint. [EU] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [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] Stromal: Large, veil-like cell in the bone marrow. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subarachnoid: Situated or occurring between the arachnoid and the pia mater. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] 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] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Sympathetic Nervous System: The thoracolumbar division of the autonomic nervous system. Sympathetic preganglionic fibers originate in neurons of the intermediolateral column of the spinal cord and project to the paravertebral and prevertebral ganglia, which in turn project to target organs. The sympathetic nervous system mediates the body's response to stressful situations, i.e., the fight or flight reactions. It often acts reciprocally to the parasympathetic system. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Synapse: The region where the processes of two neurons come into close contiguity, and the nervous impulse passes from one to the other; the fibers of the two are intermeshed, but, according to the general view, there is no direct contiguity. [NIH] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Systemic: Affecting the entire body. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of

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the heart. [EU] Tardive: Marked by lateness, late; said of a disease in which the characteristic lesion is late in appearing. [EU] Tear Gases: Gases that irritate the eyes, throat, or skin. Severe lacrimation develops upon irritation of the eyes. [NIH] Thalamic: Cell that reaches the lateral nucleus of amygdala. [NIH] Thalamic Diseases: Disorders of the centrally located thalamus, which integrates a wide range of cortical and subcortical information. Manifestations include sensory loss, movement disorders; ataxia, pain syndromes, visual disorders, a variety of neuropsychological conditions, and coma. Relatively common etiologies include cerebrovascular disorders; craniocerebral trauma; brain neoplasms; brain hypoxia; intracranial hemorrhages; and infectious processes. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thoracic: Having to do with the chest. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thrush: A disease due to infection with species of fungi of the genus Candida. [NIH] Tinnitus: Sounds that are perceived in the absence of any external noise source which may take the form of buzzing, ringing, clicking, pulsations, and other noises. Objective tinnitus refers to noises generated from within the ear or adjacent structures that can be heard by other individuals. The term subjective tinnitus is used when the sound is audible only to the affected individual. Tinnitus may occur as a manifestation of cochlear diseases; vestibulocochlear nerve diseases; intracranial hypertension; craniocerebral trauma; and other conditions. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tolerance: 1. The ability to endure unusually large doses of a drug or toxin. 2. Acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU] Tonicity: The normal state of muscular tension. [NIH] Topical: On the surface of the body. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH]

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Transfusion: The infusion of components of blood or whole blood into the bloodstream. The blood may be donated from another person, or it may have been taken from the person earlier and stored until needed. [NIH] Translation: The process whereby the genetic information present in the linear sequence of ribonucleotides in mRNA is converted into a corresponding sequence of amino acids in a protein. It occurs on the ribosome and is unidirectional. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Tricyclic: Containing three fused rings or closed chains in the molecular structure. [EU] Trigger zone: Dolorogenic zone (= producing or causing pain). [EU] Trochlear Nerve: The 4th cranial nerve. The trochlear nerve carries the motor innervation of the superior oblique muscles of the eye. [NIH] Trochlear Nerve Diseases: Diseases of the fourth cranial (trochlear) nerve or its nucleus in the midbrain. The nerve crosses as it exits the midbrain dorsally and may be injured along its course through the intracranial space, cavernous sinus, superior orbital fissure, or orbit. Clinical manifestations include weakness of the superior oblique muscle which causes vertical diplopia that is maximal when the affected eye is adducted and directed inferiorly. Head tilt may be seen as a compensatory mechanism for diplopia and rotation of the visual axis. Common etiologies include craniocerebral trauma and infratentorial neoplasms. [NIH] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of Mycobacterium. [NIH] Type 2 diabetes: Usually characterized by a gradual onset with minimal or no symptoms of metabolic disturbance and no requirement for exogenous insulin. The peak age of onset is 50 to 60 years. Obesity and possibly a genetic factor are usually present. [NIH] Ulcerative colitis: Chronic inflammation of the colon that produces ulcers in its lining. This condition is marked by abdominal pain, cramps, and loose discharges of pus, blood, and mucus from the bowel. [NIH] Urea: A compound (CO(NH2)2), formed in the liver from ammonia produced by the deamination of amino acids. It is the principal end product of protein catabolism and constitutes about one half of the total urinary solids. [NIH] 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] Ureters: Tubes that carry urine from the kidneys to the bladder. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary tract: The organs of the body that produce and discharge urine. These include the kidneys, ureters, bladder, and urethra. [NIH] Urinary tract infection: An illness caused by harmful bacteria growing in the urinary tract. [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] Urticaria: A vascular reaction of the skin characterized by erythema and wheal formation due to localized increase of vascular permeability. The causative mechanism may be allergy,

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infection, or stress. [NIH] Uvea: The middle coat of the eyeball, consisting of the choroid in the back of the eye and the ciliary body and iris in the front of the eye. [NIH] Uveitis: An inflammation of part or all of the uvea, the middle (vascular) tunic of the eye, and commonly involving the other tunics (the sclera and cornea, and the retina). [EU] Vaccines: Suspensions of killed or attenuated microorganisms (bacteria, viruses, fungi, protozoa, or rickettsiae), antigenic proteins derived from them, or synthetic constructs, administered for the prevention, amelioration, or treatment of infectious and other diseases. [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] Vaginitis: Inflammation of the vagina characterized by pain and a purulent discharge. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasculitis: Inflammation of a blood vessel. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Ventral: 1. Pertaining to the belly or to any venter. 2. Denoting a position more toward the belly surface than some other object of reference; same as anterior in human anatomy. [EU] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] 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] Vestibular Neuronitis: That due to a lesion in the labyrinth or vestibule. [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] Vestibulocochlear Nerve Diseases: Diseases of the vestibular and/or cochlear (acoustic) nerves, which join to form the vestibulocochlear nerve. Vestibular neuritis, cochlear neuritis, and acoustic neuromas are relatively common conditions that affect these nerves. Clinical manifestations vary with which nerve is primarily affected, and include hearing loss, vertigo, and tinnitus. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and

Dictionary 99

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] Viscera: Any of the large interior organs in any one of the three great cavities of the body, especially in the abdomen. [NIH] Visceral: , from viscus a viscus) pertaining to a viscus. [EU] Visceral Afferents: The sensory fibers innervating the viscera. [NIH] Visual Acuity: Acuteness or clearness of vision, especially of form vision, which is dependent mainly on the sharpness of the retinal focus. [NIH] Visual Cortex: Area of the occipital lobe concerned with vision. [NIH] Visual field: The entire area that can be seen when the eye is forward, including peripheral vision. [NIH] Visual Pathways: Set of cell bodies and nerve fibers conducting impulses from the eyes to the cerebral cortex. It includes the retina, optic nerve, optic tract, and geniculocalcarine tract. [NIH]

Vitreous: Glasslike or hyaline; often used alone to designate the vitreous body of the eye (corpus vitreum). [EU] Vitreous Hemorrhage: Hemorrhage into the vitreous body. [NIH] 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] 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]

Wound Healing: Restoration of integrity to traumatized tissue. [NIH] Xenograft: The cells of one species transplanted to another species. [NIH]

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INDEX A Abdominal, 4, 13, 61, 86, 87, 97 Abdominal Cramps, 4, 61 Abdominal Pain, 13, 61, 97 Abducens, 9, 61, 72 Abducens Nerve, 61, 72 Abducens Nerve Diseases, 61, 72 Ablation, 8, 61 Accommodation, 61, 84, 85 Acidosis, 61, 81 Action Potentials, 9, 61 Activities of Daily Living, 12, 61 Adaptation, 61, 88 Adenoma, 19, 61, 89 Adenovirus, 9, 61 Adrenergic, 61, 63, 72 Adverse Effect, 3, 12, 61, 94 Afferent, 62, 86 Age of Onset, 23, 62, 97 Agonists, 9, 62 Agoraphobia, 62, 79, 87 Air Embolism, 24, 62 Air Sacs, 62 Akathisia, 62, 63 Algorithms, 62, 65 Alimentary, 62, 72, 80 Alkaline, 61, 62, 65 Allergens, 62, 77 Allergic Rhinitis, 62, 77 Alternative medicine, 30, 62 Amenorrhea, 62, 89 Amino acid, 10, 62, 63, 69, 76, 87, 88, 90, 93, 95, 97 Amino Acid Sequence, 10, 62, 63, 76 Amputation, 46, 62 Anaphylaxis, 4, 62 Anatomical, 62, 67, 73, 79, 92 Animal model, 4, 10, 62 Antiarrhythmic, 63, 81 Antibodies, 63, 77, 82 Antibody, 4, 63, 78, 79, 94 Anticholinergic, 11, 63 Antiemetic, 63 Antiepileptic, 11, 63 Antigen, 4, 62, 63, 78, 79 Anti-inflammatory, 63, 70, 76, 92 Antipsychotic, 19, 63, 84 Anxiety, 49, 62, 63, 87

Apathy, 63, 84 Aqueous, 63, 68, 82 Arterial, 63, 78, 90, 95 Arteries, 63, 65, 70, 83 Artery, 63, 70, 90 Ataxia, 11, 63, 78, 96 Atropine, 64, 81 Audition, 11, 64 Autoimmune disease, 23, 64, 84 Autonomic, 5, 63, 64, 94, 95 Autonomic Nervous System, 5, 64, 94, 95 Autonomic Neuropathy, 5, 64 B Back Pain, 13, 64 Bacteria, 63, 64, 71, 74, 77, 82, 83, 97, 98 Basal Ganglia, 63, 64, 68, 75 Basal Ganglia Diseases, 64, 68 Base Sequence, 64, 76, 93 Benign, 12, 31, 61, 64, 75, 77, 92 Bewilderment, 64, 69 Bilateral, 8, 64, 92 Bile, 64, 75, 82, 94 Bioluminescence, 64, 82 Biotechnology, 13, 30, 41, 64 Bladder, 3, 4, 64, 65, 71, 79, 84, 97 Blind spot, 4, 65 Bloating, 65, 75 Blood Coagulation, 65 Blood Glucose, 7, 21, 22, 24, 26, 47, 48, 49, 65, 74, 77, 78, 80 Blood pressure, 5, 6, 14, 24, 26, 65, 66, 67, 78, 79, 83, 87 Blood transfusion, 49, 65 Blood urea, 6, 65 Blood vessel, 65, 66, 67, 68, 76, 87, 95, 96, 98 Body Mass Index, 23, 65, 86 Bone Marrow, 65, 76, 82, 95 Bowel, 22, 61, 65, 80, 95, 97 Brain Stem, 65, 67, 72, 98 Bronchial, 65, 78, 81 Buccal, 65, 82 Bundle-Branch Block, 15, 65 Bupivacaine, 65, 82 C Calcium, 9, 65, 66 Calcium Channels, 9, 66 Candidiasis, 31, 66

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Candidosis, 66 Capillary, 66, 76 Capsules, 66, 76 Carbohydrate, 7, 49, 66, 70, 76, 77, 88 Carcinogenic, 66, 94 Cardiac, 15, 63, 66, 73, 74, 82, 84, 94 Cardiopulmonary, 24, 66 Cardiovascular, 22, 25, 64, 66, 93, 94 Cardiovascular disease, 22, 25, 66 Cardiovascular System, 64, 66 Carotene, 66, 91 Case report, 6, 66 Cataract, 16, 66 Caudal, 66, 79, 88 Causal, 67, 77, 93 Cavernous Sinus, 61, 67, 92, 97 Cell, 9, 62, 64, 66, 67, 68, 71, 72, 74, 75, 79, 80, 82, 84, 85, 87, 88, 89, 91, 95, 96, 99 Cell membrane, 66, 67, 87 Central Nervous System, 64, 66, 67, 75, 77, 78, 84, 86, 93 Central Nervous System Infections, 67, 77, 78 Cerebellar, 8, 9, 64, 67, 91 Cerebellum, 9, 67, 91 Cerebral, 6, 14, 19, 64, 65, 67, 71, 74, 78, 85, 90, 99 Cerebral Cortex, 64, 67, 74, 99 Cerebrospinal, 19, 67, 78, 89 Cerebrospinal fluid, 19, 67, 78, 89 Cerebrovascular, 64, 66, 67, 96 Cerebrum, 67 Check-up, 6, 67 Chemoreceptor, 63, 67 Chest Pain, 4, 6, 32, 67 Chin, 67, 83 Cholera, 67, 93 Cholesterol, 26, 64, 68, 70, 94 Cholinergic, 34, 63, 68 Chorea, 63, 68 Chorioretinitis, 68, 92 Choroid, 68, 91, 92, 98 Choroiditis, 22, 68 Chromosome, 68, 82 Chronic, 5, 19, 22, 26, 31, 48, 64, 68, 69, 71, 79, 81, 88, 90, 95, 97 Chronic Disease, 48, 68, 69 Ciliary, 14, 68, 85, 93, 98 Ciliary Body, 14, 68, 93, 98 Ciliary processes, 68 Circulatory system, 62, 68, 80 CIS, 68, 91

Clinical trial, 7, 41, 49, 68, 70, 90 Cloning, 65, 68 Cochlea, 68, 80 Cochlear, 68, 96, 98 Cochlear Diseases, 68, 96 Codon, 68, 76 Cognition, 11, 69, 84 Colitis, 22, 69 Collagen, 62, 69, 92 Collagen disease, 69, 92 Collapse, 62, 69 Colon, 69, 80, 97 Computational Biology, 41, 69 Concretion, 69, 86 Condoms, 49, 69 Conduction, 65, 69 Cones, 69, 91 Confusion, 24, 49, 69, 72, 84, 97 Congestion, 4, 63, 69, 74 Conjunctiva, 69, 81, 92 Conjunctivitis, 9, 22, 69, 77 Connective Tissue, 31, 65, 69, 70, 74 Connective Tissue Cells, 69, 70 Consciousness, 6, 32, 70, 71 Constipation, 3, 63, 70 Constitutional, 70, 92 Contraindications, ii, 70 Contrast Sensitivity, 19, 70, 86 Control group, 4, 11, 70 Contusion, 11, 70 Coordination, 7, 49, 67, 70, 84 Cornea, 10, 70, 81, 92, 98 Coronary, 66, 70, 83 Coronary heart disease, 66, 70 Coronary Thrombosis, 70, 83 Cortical, 70, 93, 96 Corticosteroid, 70, 89 Cranial, 61, 67, 70, 77, 80, 84, 85, 86, 97, 98 Craniocerebral Trauma, 61, 64, 70, 77, 78, 96, 97 Curative, 71, 96 Cutaneous, 66, 71, 81, 82 Cystitis, 4, 71 Cytomegalovirus, 48, 71 Cytotoxic, 23, 71, 79 D Degenerative, 71, 78, 92 Dehydration, 31, 67, 71 Delirium, 63, 71 Dementia, 63, 71 Dendrites, 71, 85 Dendritic, 71, 83, 94

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Density, 65, 71, 85 Dental Caries, 31, 71 Diabetes Insipidus, 71, 88 Diabetes Mellitus, 23, 49, 71, 76, 77, 88 Diabetic Retinopathy, 25, 47, 48, 71 Diagnostic procedure, 30, 72 Dialysate, 72 Dialyzer, 24, 72, 77 Diarrhea, 31, 49, 72 Diastolic, 72, 78 Dietary Fiber, 23, 72 Dietitian, 26, 72 Digestion, 62, 64, 65, 72, 75, 82, 95 Digestive tract, 64, 72, 94 Diplopia, 13, 61, 72, 97 Direct, iii, 33, 72, 91, 95 Discrimination, 72, 75 Disorientation, 6, 69, 71, 72 Diuretic, 46, 72 Dizziness, 4, 5, 6, 7, 11, 31, 72, 87, 98 Dominance, 17, 72 Dopamine, 63, 72, 85 Dorsal, 72, 88 Drug Interactions, 34, 72 Duct, 72, 74, 92 Duodenum, 64, 72, 75, 95 Dyskinesia, 63, 73 E Eccentricities, 8, 73 Edema, 6, 71, 73, 80, 84 Efficacy, 4, 73 Ejaculation, 73, 93 Elective, 16, 73 Electrolyte, 24, 70, 71, 73 Electrophysiological, 8, 73 Elementary Particles, 73, 90 Emollient, 73, 85 Enamel, 71, 73 Endocarditis, 66, 73 Endocrinologist, 26, 73 Environmental Exposure, 10, 73 Environmental Health, 40, 42, 73 Enzymatic, 62, 66, 71, 73, 78, 91 Enzyme, 73, 76, 83, 95, 99 Epidemiological, 4, 73 Epigastric, 73, 86 Episcleritis, 22, 73, 92 Epistaxis, 15, 73 Epithelial, 8, 9, 61, 68, 73, 78 Epithelial Cells, 8, 73, 78 Epithelium, 17, 73, 81 Erythema, 74, 97

Erythrocytes, 65, 74, 77, 91 Esophagus, 72, 74, 95 Evacuation, 70, 74, 75 Evoke, 74, 95 Excitability, 74, 84 Exocrine, 74, 86 Exogenous, 74, 97 Extracellular, 69, 74 Extracellular Matrix, 69, 74 Extraction, 10, 16, 74 Extrapyramidal, 62, 63, 72, 74 Extremity, 46, 74 Eye Infections, 9, 61, 74 Eye Movements, 8, 9, 74 F Family Planning, 41, 74 Fasting Blood Glucose Test, 48, 74 Fat, 23, 65, 66, 70, 74, 81, 82, 84, 86 Fatigue, 5, 13, 21, 23, 24, 26, 49, 74 Febrile, 24, 74 Feces, 70, 74, 95 Fetus, 74, 94 Fibrosis, 74, 92 Foot Care, 46, 75 Foot Deformities, 46, 75 Forearm, 65, 75 Form Perception, 17, 75 Fossa, 67, 75 Fungi, 64, 74, 75, 83, 96, 98 Fungus, 66, 75 G Gallbladder, 61, 75 Ganglion, 75, 85, 86, 98 Gangrenous, 75, 93 Gas, 75, 78, 84, 85 Gastric, 75, 78 Gastric Emptying, 75 Gastrin, 75, 78 Gastroparesis, 6, 75 Gene, 10, 61, 65, 72, 75, 78, 88 Gene Therapy, 61, 75 Genetic Code, 10, 76, 85 Genetics, 9, 10, 72, 76 Genital, 23, 64, 76 Genotype, 10, 76 Gestational, 23, 26, 47, 76 Gland, 8, 70, 76, 82, 86, 93, 95 Glomerular, 6, 76, 81, 91 Glomerular Filtration Rate, 6, 76 Glomerulus, 76 Glucocorticoid, 76, 89

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Glucose, 7, 22, 23, 24, 26, 47, 48, 49, 65, 71, 74, 76, 77, 80, 92 Glucose Intolerance, 71, 76 Glucose tolerance, 26, 48, 76 Glucose Tolerance Test, 26, 76 Glutamate, 9, 76, 83 Glycine, 62, 76, 85 Glycoproteins, 66, 77 Gonadal, 77, 94 Governing Board, 77, 89 Grade, 47, 77 H Habituation, 12, 77 Hair Cells, 77, 98 Halitosis, 31, 77 Hay Fever, 4, 62, 77 Head Movements, 7, 77 Headache, 4, 6, 7, 11, 13, 17, 19, 32, 77, 78, 89 Headache Disorders, 77 Heart attack, 26, 66, 77 Heartbeat, 6, 49, 77 Hemodialysis, 6, 24, 72, 77 Hemoglobin, 6, 74, 77 Hemolysis, 24, 77 Hemorrhage, 71, 77, 78, 88, 95, 99 Hepatic, 71, 76, 78 Hepatitis, 19, 78 Hepatocytes, 78 Heredity, 75, 76, 78 Heterozygotes, 72, 78 Histamine, 63, 78 Homologous, 75, 78, 95 Homozygotes, 72, 78 Hormone, 23, 70, 73, 75, 78, 80, 89 Hydrocephalus, 78, 80 Hydrogen, 61, 66, 78, 83, 90 Hydroxyproline, 62, 69, 78 Hyperaemia, 69, 78 Hyperglycemia, 21, 78 Hypersensitivity, 62, 78 Hypertension, 5, 18, 66, 78, 80 Hypoglycemia, 6, 22, 26, 49, 78 Hypoglycemic, 7, 23, 49, 78 Hypotension, 5, 6, 24, 63, 78 Hypotensive, 6, 79 Hypothalamus, 64, 79 Hypoxemia, 24, 79 Hypoxia, 71, 79, 96 I Illusion, 79, 98 Imipramine, 12, 79

Immune response, 63, 64, 70, 79, 92, 95, 99 Immune system, 48, 79, 82, 84, 99 Immunodeficiency, 48, 79 Immunoglobulin, 4, 63, 79 Immunosuppressive, 76, 79, 92 Immunosuppressive Agents, 79, 92 Impairment, 11, 32, 46, 63, 64, 71, 73, 74, 79, 83, 90 Impotence, 6, 79, 89 In vitro, 9, 76, 79 In vivo, 9, 12, 76, 79 Incontinence, 3, 78, 79 Induction, 63, 79, 89 Infarction, 70, 78, 79, 83 Infection, 8, 9, 31, 48, 66, 68, 71, 74, 79, 82, 85, 93, 95, 96, 98, 99 Inflammation, 22, 25, 31, 62, 63, 68, 69, 71, 73, 74, 75, 78, 80, 81, 82, 83, 84, 85, 86, 88, 92, 97, 98 Inflammatory bowel disease, 22, 80 Infusion, 80, 97 Ingestion, 76, 77, 80, 88 Inhalation, 15, 34, 80, 81, 88 Inner ear, 31, 68, 80, 82, 86 Inorganic, 80, 82, 84 Inositol, 80, 83 Insulin, 6, 16, 23, 25, 26, 47, 48, 49, 76, 80, 81, 97 Insulin-dependent diabetes mellitus, 16, 80 Interferon, 19, 80 Interferon-alpha, 80 Interstitial, 4, 80, 91 Intestinal, 66, 76, 80 Intestines, 61, 72, 74, 80 Intracellular, 9, 79, 80, 83 Intracranial Hypertension, 18, 61, 77, 78, 80, 96 Intracranial Pressure, 6, 80, 90 Intravenous, 18, 80 Intrinsic, 9, 80 Inulin, 76, 81 Invertebrates, 81, 82 Involuntary, 64, 68, 77, 81, 84, 85, 91 Ionizing, 73, 81 Ions, 66, 73, 78, 81 Ipratropium, 15, 34, 81 Iris, 70, 81, 90, 98 Irritants, 31, 81 K Kb, 40, 81 Keratitis, 9, 22, 81

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Keratoconjunctivitis, 9, 81, 93 Keratoconjunctivitis Sicca, 81, 93 Keratolytic, 71, 81 Ketoacidosis, 26, 81 Ketone Bodies, 81 Ketosis, 81 Kidney Disease, 6, 40, 81 Kinetics, 66, 81 L Labyrinth, 68, 80, 81, 93, 98 Labyrinthitis, 31, 82 Lacrimal, 8, 81, 82, 93 Lacrimal gland, 8, 82 Latent, 82, 89 Lens, 8, 10, 16, 66, 82 Lesion, 82, 96, 98 Lidocaine, 4, 82 Linkage, 10, 82 Lipid, 6, 80, 82, 84 Lithium, 63, 82 Liver, 61, 64, 71, 74, 75, 76, 78, 82, 97 Localized, 71, 79, 82, 88, 97 Lumbar, 64, 82 Luminescence, 12, 82 Lupus, 31, 69, 82 Lymphatic, 80, 82, 94 Lymphocyte, 63, 82 M Manic, 63, 82, 90 Manifest, 23, 82, 95 Mastitis, 82, 93 Medial, 9, 82 Mediate, 9, 72, 82, 98 MEDLINE, 41, 82 Meiosis, 82, 95 Melanocytes, 83 Melanoma, 14, 83 Membrane, 62, 67, 68, 69, 72, 74, 83, 84, 87, 91, 92, 94 Memory, 11, 71, 83 Meningitis, 83, 88 Mental, iv, 6, 7, 40, 42, 67, 69, 71, 72, 74, 83, 84, 88, 90, 97 Mental Disorders, 83, 88, 90 Mental Health, iv, 7, 40, 42, 83, 90 Mesolimbic, 63, 83 Metabolic disorder, 23, 71, 83 Metabotropic, 9, 83 MI, 14, 59, 83 Micro-organism, 71, 83, 93 Modification, 62, 83 Molecular, 9, 11, 41, 43, 65, 69, 83, 89, 97

Molecule, 63, 83, 91 Monitor, 47, 83 Morphology, 66, 83 Motion Sickness, 83, 84 Motor nerve, 83, 85 Mucins, 77, 84, 92 Mucosa, 82, 84, 89 Mucus, 84, 92, 97 Multiple sclerosis, 18, 84, 86 Mustard Gas, 81, 84 Myocardium, 83, 84 Myopia, 10, 84, 91 Myositis, 22, 84 N Nausea, 4, 6, 7, 11, 12, 13, 24, 31, 63, 75, 81, 84, 87, 90, 97 Nearsightedness, 84 Necrosis, 79, 83, 84 Nephropathy, 26, 81, 84 Nerve, 61, 64, 67, 71, 75, 83, 84, 85, 86, 89, 90, 92, 95, 97, 98, 99 Nerve Fibers, 84, 98, 99 Nervous System, 62, 64, 67, 77, 84, 85, 95 Nervousness, 6, 49, 84 Neural, 7, 62, 84 Neuritis, 84, 86, 98 Neuroleptic, 12, 62, 63, 84 Neurologic, 23, 24, 78, 85 Neuronal, 9, 66, 85 Neurons, 9, 71, 84, 85, 95, 98 Neuropathy, 5, 26, 64, 85 Neuroretinitis, 85, 92 Neurotransmitter, 62, 72, 76, 78, 85, 95 Nitrogen, 6, 85 Nuclei, 9, 75, 85, 86, 90, 98 Nucleic acid, 64, 76, 85 Nucleus, 9, 61, 64, 73, 82, 85, 89, 90, 94, 96, 97, 98 Nystagmus, 7, 9, 85 O Occipital Lobe, 72, 85, 99 Ocular, 7, 8, 9, 10, 17, 22, 85 Oculomotor, 7, 9, 12, 72, 85 Oculomotor Nerve, 72, 85 Odds Ratio, 85, 91 Ointments, 17, 31, 85 Opacity, 66, 71, 85 Ophthalmic, 31, 34, 86, 92 Ophthalmologist, 22, 86 Ophthalmology, 9, 10, 15, 17, 18, 19, 86 Opsin, 86, 91, 92 Optic disc, 86

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Optic Nerve, 65, 85, 86, 90, 91, 92, 99 Optic Neuritis, 22, 86 Oral Health, 48, 86 Oral Hygiene, 77, 86 Orbit, 61, 86, 97 Orbital, 22, 61, 86, 97 Orthostatic, 63, 86 Osmolarity, 6, 86 Osmoles, 86 Otolith, 7, 86 Overactive bladder, 3, 86 Overweight, 26, 86 Oxygenation, 79, 86 P Palliative, 86, 96 Pancreas, 23, 25, 48, 61, 80, 86, 87 Pancreatic, 23, 87 Panic, 79, 87 Panic Disorder, 79, 87 Parkinsonism, 63, 87 Paroxysmal, 12, 31, 77, 87 Pathogenesis, 9, 10, 87 Pathophysiology, 4, 87 Patient Education, 46, 49, 54, 56, 59, 87 Pelvic, 4, 87 Pelvis, 82, 87 Penis, 69, 73, 87 Peptide, 62, 87, 88, 90 Periodontal disease, 31, 87 Peripheral Vascular Disease, 26, 87 Pharmacist, 26, 87 Pharmacologic, 87, 96 Phospholipids, 74, 80, 87 Phosphorus, 65, 88 Photophobia, 8, 22, 88 Photosensitization, 11, 88 Physical Examination, 24, 67, 88 Physiologic, 81, 88, 91 Physiology, 11, 61, 73, 88 Pigment, 83, 88 Plant Oils, 85, 88 Plants, 64, 76, 81, 83, 88, 92, 96 Plasma, 26, 63, 67, 76, 77, 88, 93 Plasticity, 9, 88 Pneumonia, 70, 88 Podiatrist, 26, 88 Poisoning, 71, 84, 88 Polyarthritis, 81, 88, 93 Polydipsia, 21, 25, 88 Polypeptide, 62, 69, 88, 89, 90 Polyphagia, 21, 25, 88 Polysaccharide, 63, 88

Polyuria, 21, 25, 88 Posterior, 22, 64, 67, 68, 72, 81, 85, 86, 88, 92 Postural, 5, 88 Practice Guidelines, 42, 89 Predisposition, 26, 89 Prednisolone, 22, 89 Prevalence, 11, 85, 89 Procaine, 82, 89 Progesterone, 89, 94 Progression, 10, 11, 62, 89 Progressive, 71, 84, 89, 91 Prolactin, 89 Prolactinoma, 14, 89 Prophase, 89, 95 Prospective Studies, 11, 89 Prospective study, 11, 89 Protein C, 62, 68, 89, 97 Protein Conformation, 62, 89 Protein S, 65, 76, 90 Proteins, 62, 63, 67, 69, 83, 85, 87, 88, 90, 96, 98 Protons, 12, 78, 81, 90 Pruritus, 24, 90 Pseudotumor Cerebri, 80, 90 Psychic, 83, 90, 93 Psychomotor, 71, 84, 90 Psychosis, 63, 76, 90 Public Health, 10, 42, 90 Public Policy, 41, 90 Pulmonary, 65, 90, 98 Pulmonary Artery, 65, 90, 98 Pulse, 12, 83, 90 Pupil, 70, 86, 90 R Radiation, 73, 81, 90 Randomized, 73, 90 Receptor, 3, 61, 63, 67, 72, 83, 91, 93 Rectum, 69, 72, 75, 79, 80, 91 Red blood cells, 24, 74, 91, 92 Red Nucleus, 64, 91 Refer, 1, 65, 72, 75, 84, 90, 91, 98 Reflex, 9, 74, 91 Refraction, 84, 91 Refractive Errors, 46, 72, 91 Refractive Power, 84, 91 Regimen, 73, 91 Relative risk, 11, 91 Renal failure, 6, 26, 71, 91 Respiration, 67, 83, 91 Retina, 17, 65, 68, 69, 71, 82, 84, 85, 86, 91, 92, 93, 98, 99

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Retinal, 19, 22, 72, 86, 91, 92, 99 Retinal Vein, 19, 91 Retinitis, 22, 92 Retinol, 91, 92 Retinopathy, 26, 71, 92 Retrobulbar, 86, 92 Rhinitis, 81, 92, 93 Rhinorrhea, 19, 89, 92 Rhodopsin, 86, 91, 92 Risk factor, 22, 26, 47, 48, 89, 91, 92 Rods, 91, 92 S Saliva, 31, 49, 92 Salivary, 11, 31, 71, 92, 93 Salivary glands, 31, 71, 92, 93 Saponins, 92, 94 Sclera, 68, 69, 73, 92, 98 Scleritis, 22, 92 Sclerosis, 69, 84, 92 Screening, 68, 93 Sebaceous, 81, 93 Sebaceous gland, 81, 93 Secretion, 11, 70, 78, 80, 81, 84, 93 Secretory, 8, 93 Sedative, 79, 93 Sedentary, 26, 93 Seizures, 6, 24, 71, 87, 93 Self Care, 61, 93 Semen, 49, 73, 93 Semicircular canal, 8, 12, 80, 93 Septicaemia, 93 Sequence Alignment, 10, 93 Serotonin, 63, 85, 93 Serotypes, 9, 93 Serrata, 68, 93 Shock, 62, 93, 97 Sicca, 31, 93 Side effect, 11, 25, 31, 33, 61, 62, 63, 94, 96 Signs and Symptoms, 6, 21, 94 Skull, 70, 80, 86, 94 Small intestine, 72, 78, 80, 94 Social Security, 49, 94 Solitary Nucleus, 64, 94 Soma, 94 Somatic, 5, 83, 94 Somnolence, 11, 94 Spasmodic, 61, 94 Spatial disorientation, 7, 72, 94 Specialist, 50, 94 Specificity, 11, 66, 94 Spermatozoa, 93, 94 Spike, 9, 94

Spinal cord, 65, 67, 68, 75, 84, 85, 91, 94, 95 Spleen, 71, 82, 94 Stabilization, 7, 94 Steroid, 23, 92, 94 Stillbirth, 26, 94 Stimulus, 8, 91, 95, 96 Stomach, 6, 61, 72, 74, 75, 76, 78, 80, 81, 84, 94, 95 Stool, 69, 79, 95 Strabismus, 72, 95 Stress, 26, 64, 84, 89, 95, 98 Stroke, 22, 26, 40, 66, 95 Stromal, 9, 95 Subacute, 79, 95 Subarachnoid, 77, 88, 95 Subclinical, 79, 93, 95 Subcutaneous, 73, 75, 95 Substance P, 93, 95 Substrate, 8, 95 Suppression, 31, 70, 95 Sympathetic Nervous System, 64, 95 Symptomatic, 13, 22, 95 Synapse, 61, 95 Synaptic, 9, 85, 95 Systemic, 14, 31, 34, 62, 65, 66, 69, 71, 79, 80, 89, 92, 95 Systolic, 78, 95 T Tardive, 63, 96 Tear Gases, 81, 96 Thalamic, 64, 96 Thalamic Diseases, 64, 96 Therapeutics, 35, 96 Thoracic, 64, 96 Threshold, 74, 78, 96 Thrombosis, 90, 95, 96 Thrush, 66, 96 Tinnitus, 4, 5, 90, 96, 98 Tolerance, 76, 96 Tonicity, 77, 96 Topical, 22, 96 Toxic, iv, 64, 73, 85, 96 Toxicity, 72, 96 Toxicology, 42, 96 Toxins, 6, 63, 66, 79, 96 Transfection, 65, 75, 96 Transfusion, 49, 97 Translation, 62, 97 Trauma, 7, 9, 71, 84, 97 Tricyclic, 79, 97 Trigger zone, 63, 97 Trochlear Nerve, 72, 97

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Blurred vision

Trochlear Nerve Diseases, 72, 97 Tuberculosis, 82, 97 Type 2 diabetes, 22, 23, 26, 48, 97 U Ulcerative colitis, 15, 22, 80, 97 Urea, 65, 97 Uremia, 6, 91, 97 Ureters, 97 Urethra, 87, 97 Urinary, 21, 23, 71, 78, 79, 88, 97 Urinary tract, 23, 97 Urinary tract infection, 23, 97 Urine, 6, 49, 65, 71, 72, 79, 81, 88, 97 Urticaria, 4, 62, 97 Uvea, 98 Uveitis, 22, 98 V Vaccines, 98, 99 Vagina, 66, 98 Vaginal, 31, 49, 98 Vaginitis, 66, 98 Vascular, 62, 68, 77, 79, 80, 97, 98 Vasculitis, 22, 98 Vein, 80, 91, 98 Ventral, 79, 85, 98 Ventricle, 65, 79, 90, 95, 98

Vertigo, 12, 13, 31, 98 Vestibular, 7, 9, 31, 77, 98 Vestibular Nerve, 9, 98 Vestibular Neuronitis, 31, 98 Vestibule, 68, 80, 93, 98 Vestibulocochlear Nerve, 96, 98 Vestibulocochlear Nerve Diseases, 96, 98 Veterinary Medicine, 41, 98 Viral, 9, 99 Virus, 48, 67, 80, 99 Viscera, 94, 99 Visceral, 64, 99 Visceral Afferents, 64, 99 Visual Acuity, 70, 92, 99 Visual Cortex, 72, 99 Visual field, 65, 90, 99 Visual Pathways, 18, 99 Vitreous, 68, 71, 82, 91, 99 Vitreous Hemorrhage, 72, 99 Vitro, 99 Vivo, 99 W White blood cell, 63, 82, 84, 99 Wound Healing, 48, 99 X Xenograft, 63, 99