HYSTERECTOMY A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R EFERENCES
J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS
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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright ©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., 1960Hysterectomy: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-83988-3 1. Hysterectomy-Popular works. I. Title.
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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.
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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on hysterectomy. 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 HYSTERECTOMY ........................................................................................ 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Hysterectomy ................................................................................ 5 E-Journals: PubMed Central ....................................................................................................... 41 The National Library of Medicine: PubMed ................................................................................ 42 CHAPTER 2. NUTRITION AND HYSTERECTOMY .............................................................................. 89 Overview...................................................................................................................................... 89 Finding Nutrition Studies on Hysterectomy............................................................................... 89 Federal Resources on Nutrition ................................................................................................... 93 Additional Web Resources ........................................................................................................... 93 CHAPTER 3. ALTERNATIVE MEDICINE AND HYSTERECTOMY........................................................ 95 Overview...................................................................................................................................... 95 National Center for Complementary and Alternative Medicine.................................................. 95 Additional Web Resources ......................................................................................................... 102 General References ..................................................................................................................... 104 CHAPTER 4. DISSERTATIONS ON HYSTERECTOMY........................................................................ 105 Overview.................................................................................................................................... 105 Dissertations on Hysterectomy.................................................................................................. 105 Keeping Current ........................................................................................................................ 106 CHAPTER 5. PATENTS ON HYSTERECTOMY .................................................................................. 107 Overview.................................................................................................................................... 107 Patents on Hysterectomy ........................................................................................................... 107 Patent Applications on Hysterectomy ....................................................................................... 118 Keeping Current ........................................................................................................................ 121 CHAPTER 6. BOOKS ON HYSTERECTOMY ...................................................................................... 123 Overview.................................................................................................................................... 123 Book Summaries: Federal Agencies............................................................................................ 123 Book Summaries: Online Booksellers......................................................................................... 127 The National Library of Medicine Book Index ........................................................................... 132 Chapters on Hysterectomy......................................................................................................... 133 CHAPTER 7. MULTIMEDIA ON HYSTERECTOMY ........................................................................... 135 Overview.................................................................................................................................... 135 Bibliography: Multimedia on Hysterectomy.............................................................................. 135 CHAPTER 8. PERIODICALS AND NEWS ON HYSTERECTOMY ........................................................ 139 Overview.................................................................................................................................... 139 News Services and Press Releases.............................................................................................. 139 Newsletter Articles .................................................................................................................... 142 Academic Periodicals covering Hysterectomy ........................................................................... 144 CHAPTER 9. RESEARCHING MEDICATIONS .................................................................................. 145 Overview.................................................................................................................................... 145 U.S. Pharmacopeia..................................................................................................................... 145 Commercial Databases ............................................................................................................... 146 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 149 Overview.................................................................................................................................... 149 NIH Guidelines.......................................................................................................................... 149 NIH Databases........................................................................................................................... 151 Other Commercial Databases..................................................................................................... 153 APPENDIX B. PATIENT RESOURCES ............................................................................................... 155 Overview.................................................................................................................................... 155
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Patient Guideline Sources.......................................................................................................... 155 Associations and Hysterectomy ................................................................................................. 160 Finding Associations.................................................................................................................. 161 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 163 Overview.................................................................................................................................... 163 Preparation................................................................................................................................. 163 Finding a Local Medical Library................................................................................................ 163 Medical Libraries in the U.S. and Canada ................................................................................. 163 ONLINE GLOSSARIES................................................................................................................ 169 Online Dictionary Directories ................................................................................................... 170 HYSTERECTOMY DICTIONARY ............................................................................................. 171 INDEX .............................................................................................................................................. 235
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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with hysterectomy 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 hysterectomy, 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 hysterectomy, 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 hysterectomy. 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 hysterectomy, 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 hysterectomy. 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 HYSTERECTOMY Overview In this chapter, we will show you how to locate peer-reviewed references and studies on hysterectomy.
The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and hysterectomy, 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 “hysterectomy” (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: •
Lower Urinary Tract Dysfunction After Total Hysterectomy Source: International Urogynecology Journal. 2(2): 108-111. June 1991. Summary: In recent years there has been increased awareness that total (simple) hysterectomy may have a deleterious effect upon the function of the urinary bladder and urethra. This article reviews the evidence linking total hysterectomy with vesicourethral dysfunction, as well as the symptomatology and types of lower urinary tract abnormalities that may be encountered. The factors that have been implicated in the etiology of post-hysterectomy voiding dysfunction are also discussed. 28 references. (AA-M).
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Incidence, Risk Factors and Morbidity of Unintended Bladder or Ureter Injury During Hysterectomy Source: International Urogynecology Journal. 13(1): 18-21. 2002. Contact: Available from Springer-Verlag New York Inc. 175 Fifth Avenue, New York, NY 10010. (212) 460-1500. Fax (212) 473-6272. Summary: This article reports on a study undertaken to determine the incidence, risk factors, and morbidity of unintended operative injury to the bladder or ureter during hysterectomy. The authors performed a retrospective case control study of women with these injuries from January 1993 to January 1998. The incidence of bladder and ureter injury, respectively, was 0.58 percent and 0.35 percent for abdominal hysterectomy, 1.86 percent and 0 percent for vaginal hysterectomy, and 5.13 percent and 1.71 percent for hysterectomies performed for obstetric indications. Women with injury during abdominal hysterectomy were found to have greater blood loss, longer operative times, longer postoperative stays, more febrile (fever) morbidity, and more frequent transfusions. Similar trends were seen for other hysterectomy types. The incidence of operative bladder or ureter injury is relatively low. However, even when recognized, these individuals experience greater operative and postoperative morbidity. This highlights the importance of surgical technique directed toward minimization of these injuries, and careful intraoperative and postoperative surveillance aimed at early detection. 4 tables. 6 references.
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Urinary Symptoms After Total Abdominal Hysterectomy: A Review Source: International Urogynecology Journal. 3(1): 61-63. March 1992. Summary: This article reviews research on the development of adverse lower urinary tract symptoms following total abdominal hysterectomy. The authors note that most evidence of a relationship between the two is circumstantial, but urodynamic and neurological changes have been demonstrated in the lower urinary tract after hysterectomy, with an associated increase in urinary symptoms. The evidence in support of and disputing such a relationship is reviewed, but more extensive studies are required before definitive conclusions can be drawn. 11 references. (AA-M).
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Hysterectomy and Bladder Control Source: Informer. 16: p.[1-3]. August 1997. Contact: Available from Canadian Continence Foundation. P.O. Box 30 Vitoria Branch, Westmount, QC, H3Z 2V4. (514) 488-8379. Fax (514) 488-1379. Website: www.continence-fdn.ca. E-mail:
[email protected]. Summary: This newsletter article helps readers understand the connections between hysterectomy (removal of the uterus) and postoperative urinary incontinence. The author first reviews the different types of hysterectomy operations, including the surgical approach used. The author also discusses how to prevent potential bladder control problems after hysterectomy and research that demonstrates no clear association between hysterectomy and bladder symptoms. The bladder problems may be brought on by menopause or by entirely different factors. Proper testing to determine the type and cause of the bladder symptoms will allow patients and health care providers to discuss appropriate treatment options. A brief glossary of terms is appended to the article. 2 figures. 2 tables.
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Federally Funded Research on Hysterectomy The U.S. Government supports a variety of research studies relating to hysterectomy. 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 hysterectomy. 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 hysterectomy. The following is typical of the type of information found when searching the CRISP database for hysterectomy: •
Project Title: A LONGITUDINAL STUDY OF THE MENOPAUSE AND FAT PATTERNING Principal Investigator & Institution: Powell, Lynda H.; Professor; Rush-Presbyterian-St Lukes Medical Ctr Chicago, Il 60612 Timing: Fiscal Year 2002; Project Start 10-APR-2002; Project End 31-MAR-2007 Summary: (provided by applicant): It was once believed that menopause-related coronary risk was associated with a gain in total body fat, but recent research has suggested that it is not total fat per se, but the location of that fat, that is a key risk factor. Indices of central adiposity, particularly intra-abdominal fat (IAF), have: (1) predicted coronary events better than indices of total fat; (2) been associated with altered glucose and lipid metabolism and elevated blood pressure; and (3) been associated with changes in menopausal status. This gives rise to the hypothesis that menopause-related changes in sex hormones accelerate the accumulation of IAF, which in turn is associated with adverse cardiovascular risk. Existing studies of this hypothesis share major limitations in that they are small, cross-sectional and primarily Caucasian, focus only on comparisons of pre-and post-menopausal status, and have minimal controls for the important covariates of age and total fat. This is a study of the natural history of the accumulation of IAF as women transverse the menopause. It will be conducted on an intact biracial cohort of 868 women (419 African Americans; 449 Caucasians) who are participating in a larger study of women undergoing the menopausal transition. This is a population-based cohort that was randomly selected from an existing census with a 72 percent participation rate, approximately equal distribution of socioeconomic status within the African American and Caucasian subgroups, and a dropout rate of only 1 percent/year. As part of the larger study, this cohort undergoes annual exams in which a variety of cardiovascular, hormonal, and lifestyle factors are tracked. For this study, 2 clinical tests will be added to the battery at the 4th or 5th annual exam for the 536 women who are expected to be eligible by virtue of not having had a hysterectomy or begun taking hormone therapy. The 2 tests will be a CT scan for the assessment of IAF, and a DEXA scan for the assessment of total body fat. These tests will be repeated on an
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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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annual basis for the next 3 years. By the end of the study, it is projected that 462 transitions in menopausal status will have taken place. Random effects models will be used to estimate longitudinal changes in level and rate of IAF as one moves from one menopausal status to another. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: ALZHEIMERS DISEASE PREVENTION TRIAL WITH ESTROGENS Principal Investigator & Institution: Sano, Mary; Professor of Neuropsychology; Gertrude H Sergievsky Center; Columbia University Health Sciences New York, Ny 10032 Timing: Fiscal Year 2001; Project Start 01-SEP-1998; Project End 31-AUG-2003 Summary: This is a randomized, double-blind, placebo-controlled clinical trial to determine if estrogen can delay the onset of Alzheimer's disease(AD) and reduce memory decline. 900 healthy, non-demented, women, 65 years of age or older, with a family history of AD will be recruited in 18 months from 3 different cities (New York, NY, Baltimore, MD and Jacksonville, FL) over an 18 month period using 4 distinct methods: 1) healthy non-demented female relatives of patients with AD seen at each of the 3 participating AD centers; 2) women with a family history of AD contacted through community service providers surrounding each medical center, 3) women with a family history of AD identified through advertisement using local media (newspaper, television and radio) and; 4) women with a family history of AD identified from a regional sample of female Medicare recipients provided by the Health Care Finance Administration (HCFA). At study entry, family history of AD in a first degree relative will be confirmed and each participant will have a physical, neurological, neuropsychological and functional assessment to insure the absence of dementia, any other degenerative neurological disease or potentially fatal disorder. Exclusions include a history of breast, uterine or ovarian cancer, history of arterial or deep vein thrombosis, a history of breast cancer in a first-degree relative. Randomization to estrogen, estrogen with progesterone or identical placebo among eligible women will be stratified by site and hysterectomy status (hysterectomized women will be randomized to unopposed estrogen or placebo; non-hysterectomized women to opposed estrogen or placebo); nonhysterectomized women to opposed estrogen or placebo). Analyses will combine opposed and unopposed estrogen treatments into a single group and compare them to placebo. Patients will be followed over a 3 year (36-month) period, and will be examined at 6 month intervals to assess compliance, adverse events and general health status. Annual complete medical, gynecological, neuropsychological and functional assessments will occur during follow-up. Outcome measures will include incident dementia and memory decline. We will use an intent-to-treat analysis from the primary analysis. Secondary analysis will examine potential co-variates. Safety evaluations will be based on finding from annual assessments and reported adverse events. Participants who become demented will be informed of standard-of-care treatment and will continue to be followed at annual intervals for the length of the study. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: ANTIVIRAL THERAPY AND HIV IN THE GENITAL TRACT OF WOMEN Principal Investigator & Institution: Cu-Uvin, Susan; Associate Professor; Miriam Hospital Providence, Ri 02906 Timing: Fiscal Year 2002; Project Start 15-APR-1997; Project End 31-JUL-2004
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Summary: (provided by applicant): About 34.3 million adults are currently living with HIV/AIDS. The predominant mode of HIV transmission worldwide is through heterosexual contact. Although many factors are associated with sexual transmission of HIV-1 (both behavioral and biologic), HIV-1 viral load has been identified as the chief predictor of the risk of sexual transmission. Levels of HIV-1 viral load have been associated with mother-to-infant transmission of HIV. Several studies have also shown a good correlation between blood plasma viral load and male and female genital tract viral load. The use of antiretoviral medications can reduce blood plasma HIV-1 RNA levels as well as genital tract HIV-1 RNA. Studies have also shown a reduction in perinatal transmission with effective antiretroviral therapy. Transmission of drug resistant HIV-1 has been reported in the US and Europe ranging from 2% to 27% among newly infected patients. There have been reports of resistant genotypic variants in both male and female genital tract that is different from those of blood. These findings underscore the risk of spreading resistant HIV-1 variants sexually as well as perinatally. Understanding the dynamics of HIV-1 in the genital tract is of great importance in strategies to control sexual and perinatal transmission of HIV. The specific aims of this study are: 1) To understand the dynamics of viral failure and viral replication in the femal genital tract, 2) To assess drug exposure and patterns of drug resistance in the female genital tract and 3) To evaluate latent reservoirs in the female genital tract. To address issues of viral failure, development of resistance and drug levels, we will enroll 50 HIV(+) women who are failing their current antiviral regimen. We will assess paired plasma and genital tract secretions at multiple time points for: viral load, genotyping, and peak and trough drug levels before and after changing therapy. To evaluate latent reservoirs in the genital tract, we will enroll 50 HIV(+) women who are fully suppressed on antiviral therapy and propose to collect endocervical cells by a swab/cytobrush technique in an attempt to recover replication competent virus. We also propose to enroll women who have undergone total hysterectomy to assess HIV dynamics in the vagina. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: BIOMARKERS AND CHEMOPREVENTION OF ENDOMETRIAL CANCER Principal Investigator & Institution: Mutter, George L.; Associate Professor; Brigham and Women's Hospital 75 Francis Street Boston, Ma 02115 Timing: Fiscal Year 2002; Project Start 01-AUG-2002; Project End 31-JUL-2007 Summary: (provided by applicant): Endometrioid endometrial adenocarcinoma is the most common gynecologic cancer in the United States, which can be prevented by early diagnosis and surgical or hormonal ablation of premalignant lesions. Poor reproducibility of precancer diagnosis by pathologists, and paucity of controlled prospective therapeutic studies have hindered uniform and effective early intervention. This project is a laboratory translational component to Gynecologic Oncology Group ongoing clinical trial (G0G167) which enrolls patients with suspected endometrial precancers into an immediate hysterectomy arm (untreated, Part A), or progestin therapy arm followed by hysterectomy (hormone treated, Part B). The first two Aims will establish the clinical cancer-predictive value of endometrial precancers diagnosed by PTEN immunohistochemistry (SA#1), or computerized morphometry of routinely stained slides (SA#2). PTEN is a tumor suppressor gene altered very early in endometrial carcinogenesis which displays decreased protein expression in 75 percent of premalignant and malignant endometrioid endometrial lesions, thereby demarcating them with unprecedented physical resolution (single glands). We will develop a
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quantitative scale for classifying size and complexity of premalignant PTEN-null endometrial lesions, thereby stratifying them as low or high risk. Computerized image analysis of routinely stained (hematoxylin and eosin) endometrial tissues and D-Score calculation will also be used to identify a class of premalignant lesions in the untreated arm (Part A) of G0G167. One of the two methods will be identified by its cancer predictive value as a preferred means of diagnosing high risk endometrial precancers. The third Aim will use one of the methods from SAl & 2 to identify a group of patients with high-risk precancers, and measure regression of those premalignant lesions in the resected uterus. Comparison of regression rates of untreated patients with those of progesterone treated patients will allow us to define efficacy of these hormonal regimens as alternatives to surgical hysterectomy. A major advantage of this proposal is that its well defined clinical setting provides contextual relevance to promising highly sensitive and reproducible methods of endometrial precancer diagnosis. If successful, we will be able to rapidly implement a rational and effective strategy for early detection and chemoprevention of endometrial carcinoma. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: CORE--PATHOLOGY Principal Investigator & Institution: Broaddus, Russell R.; University of Texas Md Anderson Can Ctr Cancer Center Houston, Tx 77030 Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 31-AUG-2008 Summary: The individual research projects comprising this Gynecological Cancer SPORE application require the procurement, processing, and analysis of histopathological material from patients with endometrial cancer, endometrial hyperplasia, and uterine smooth muscle tumors (leiomyoma). The research projects have needs for frozen and formalin-fixed, paraffin-embedded samples of tumor and normal tissue. The proposed Pathology Core augments the already established M.D. Anderson Cancer Center Gynecological Tumor Bank and the P30 sponsored M.D. Anderson Cancer Center Centralized Tissue Repository with supporting database and intranet access. The Core provides for tissue acquisition by experienced gynecological pathologists to assure high-quality tissues for the investigators participating in this SPORE as well has investigators of other SPORES. The goal of the Pathology Core is to provide frozen tissue, paraffin-embedded tissue, and histopathological expertise related to the specific needs for the research projects comprising this SPORE proposal. To achieve this goal, the Pathology Core proposes the following Specific Aims. Aim 1 is to maintain a frozen and paraffin-embedded repository of endometrial cancers, hyperplasias, and normal endometrial samples. These samples will be collected at The University of Texas M.D. Anderson Cancer Center. These specimens, along with the corresponding clinical data, will be incorporated into the overall SPORE Database with the endometrial samples. Aim 2 is to provide pathological review for all clinical specimens utilized in the SPORE projects and to provide histopathological technical services as necessary. Such technical services include immunohistochemistry, in situ hybridization, and microdissection of tissue sections. Aim 3 is to establish a blood/urine/ascites fluid repository from patients undergoing hysterectomy for endometrial cancer and endometrial hyperplasia. These fluids will provide the resources for the systemic testing of putative prognostic and diagnostic markers isolated from endometrial tissues. Furthermore, using the novel technique of phage display, novel tumor markers can be discovered from the serum or ascites fluid of endometrial cancer patients. Aim 4 is to construct various endornetrial tissue arrays using the Beecher Instruments microarray device. Such tissue arrays will provide for more rapid
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immunohistochemical analysis of protein expression. Aim 5 is to create a SPORE Database for all samples collected at both M.D. Anderson Cancer Center and UTMB. This SPORE Database will provide for a virtual tissue repository that can be electronically shared with all SPORE investigators. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: CORE--TISSUE PROCUREMENT Principal Investigator & Institution: Stern, Judy E.; Dartmouth College 11 Rope Ferry Rd. #6210 Hanover, Nh 03755 Timing: Fiscal Year 2001 Summary: The Tissue Procurement Core Facility is designed as a central tissue acquisition and distribution facility. The Core enables the efficient collection and use of patient tissues and their subsequent distribution to project investigators. Services provided by the Core Facility include making initial patient contact and gaining informed consent, acquisition of pertinent patient information from chart and patient interview, clinical/pathological evaluation of collected tissues and the initial processing and distribution of tissues. Tissues for the Program Project are obtained from reproductive tracts of patients undergoing hysterectomy or endometrial biopsy. The Core Facility identifies and enrolls patients and evaluates the appropriateness of clinical cases. In addition, the facility oversees the collection of information on endocrine condition, clinical diagnoses, and gross pathology. The second major function of the Core Facility is to coordinate tissue processing and distribution. This function includes designation of tissues for investigators as well as the preparation of cell suspensions or vibratome sections where appropriate. Cell suspensions and vibratome sections are made separately from each of the following tissues: Fallopian tube, uterus, cervix, and vagina. The third function of this Core is the collation of patient data on selected clinical parameters including the maintenance of a project database to enable rapid correlation of clinical endocrinologic and immunologic parameters of different tissue samples. This database enables investigators to easily evaluate hypothesis that arise in the course of the research. This Core combines the expertise of its members will include a Core Director, a Medical Coordinator, and a Pathologist who provide consultation and support for all of the Core services. In addition, the Core has the services of a Clinical Coordinator who oversees the case load and collects clinical information, a Nurse Coordinator who contacts the patients to obtain clinical history, and three highly trained technicians who participate in tissue dissection, fixation, and disruption. The biostatistical shared service and the Norris Cotton Cancer Center at DHMC provide consultation for the statistical evaluations and maintenance of the database. A microbiologist, in conjunction with the Clinical Microbiology laboratories, provides consultation on the diagnosis and identification of sexually transmitted diseases (STD). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: CORE--VETERINARY MEDICINE Principal Investigator & Institution: Danneman, Peggy J.; Jackson Laboratory 600 Main St Bar Harbor, Me 04609 Timing: Fiscal Year 2001; Project Start 25-AUG-1996; Project End 31-JUL-2006 Summary: (provided by applicant): The Veterinary Medicine Resource, part of the Laboratory Animal Sciences program, supports The Jackson Laboratory (TJL) Cancer Center investigators by ensuring the health and productivity of their mice. This is accomplished through: 1) a rigorous health and environmental monitoring program; 2)
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the provision of veterinary care for animals that are injured or suffering from noninfectious disease; and 3) clinical investigations into possible infectious disease problems. In addition, the Veterinary Medicine Resources provides surgically altered mice as requested by Cancer Center investigators. Over the next grant cycle, all Cancer Center mice will be brought to a uniform high health status through a program of rederivation to eliminate several opportunistic microorganisms that are harbored by many TJL research mice. Although not overt pathogens, these microorganisms represent a health threat to immune-deficient mice, and can affect the outcome of research using immunocompetent mice. Rederivation will be performed in conjunction with the Cryopreservation and Rederivation Resource using several approaches, including recovery from cryopreservation, embryo transfer, ovarian transplantation, and hysterectomy derivation. Peggy J. Danneman, V.M.D., M.S., Chief of the Veterinary Medicine Resource and Attending Veterinarian directs all Veterinary Medicine programs and will have primary oversight for the rederivation program. Abigail Smith, Ph.D., Director of Laboratory Animal Sciences, is responsible for overall coordination of the animal health programs. Funds are also requested as partial support for 3 individuals who will be responsible for the day-to-day implementation of the rederivation effort. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: DO IMPAIRMENT?
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LEVATOR
ANI
Principal Investigator & Institution: Delancey, John O.; Professor; Obstetrics and Gynecology; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2001; Project Start 10-APR-2000; Project End 31-MAR-2005 Summary: The basic mechanisms responsible for development of pelvic organ prolapse (POP) are not established. It has long been hypothesize that levator ani (LA) muscle impairment is associated with POP but this hypothesis has not been tested. This case control study will test the Null Hypothesis that levator ani muscle structure and function are the same in women with pelvic organ prolapse (cases) and women with normal support (controls). We will study 150 Cases who will be women with pelvic organ prolapse that extends more than 1 cm below the hymenal ring and 150 asymptomatic Controls with proven normal support matched for age, parity and race. Women with prior treatment for POP will be excluded. Differences in LA structure and function between cases and controls will be sought. Tests of LA structure and function: Structural abnormalities in LA muscle anatomy will be quantified in high-resolution proton density MR images. LA strength will be measured at rest and during maximum muscle contraction. Aim I: Test the null hypotheses that there are no differences in the anatomical cross-sectional area of the pubovisceral portion of the LA as seen in MR images of cases and controls. Aim 2: Test the null hypothesis that there is no difference in LA muscle strength at rest or during maximal contraction function in cases compared to controls. Sub analyses of levator anatomy and strength based on the size and type of the prolapse as well as the presence or absence of stress incontinence will also be carried out. Analysis of covariates possibly contributing to prolapse including prior hysterectomy, obesity, estrogen status, heavy lifting, and prolapse family history will be performed. Aim 3: Test the null hypothesis that muscle cross-sectional area is not correlated with LA strength for either cases or controls. The importance of this research lies in its providing fundamental insights about the specific functional and anatomical defects present in women with POP that will lead to improved research in this common
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disease. This information will guide future research as well as helping to devising more rational treatment selection. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: EARLY DIAGNOSIS OF CERVICAL CANCER Principal Investigator & Institution: Mathur, Subbi P.; Professor; Obstetrics and Gynecology; Medical University of South Carolina 171 Ashley Ave Charleston, Sc 29425 Timing: Fiscal Year 2002; Project Start 01-APR-2002; Project End 31-MAR-2004 Summary: {NCI pa: Exploratory Studies in Cancer Detection, Prognosis and Prediction (similarity to NCI-PA98-022); revised R21 application. Cervical cancer is a leading gynecologic malignancy with 14,500 new cases and 400 deaths yearly. Eighty to 90% of women with cervical cancer are infected with human papillomavirus (HPV). Cervical intra- epithelial neoplasia (CIN) markers the pre-cancerous stage. Ten to 20% of women develop cervical cancer. Paper smears and HPV testing have limitations in identifying women progressing to cancer, not helpful in the patients with ASCUS/AGUS (atypical squamous/glandular cells of undetermined significance) and for monitoring therapy efficacy (paucity of tissue after therapy) in recurrence. Our data-supported hypothesis is that progression of squamous cell cervical cancer from CIN is related to up-regulation of EGF-R and insulin-like growth factor-II (IGF-II) proteins in cervical epithelium, followed by significant increases in serum IGF-II levels (specific to cervical cancer; levels decrease after therapy. Our latter finding provides us with an excellent opportunity to develop a non-invasive screening test that gives an added value to pap smear and HPV testing. We propose that: Serum IGF-II levels can be used to identify patients who are at risk of developing cervical cancer and, more importantly, to monitor therapy efficacy in the patients with cervical cancer. We shall obtain serum levels of IGF-II (ELISA) in women with: 1. Normal Pap smear; 2. Abnormal Pap smear with no CIN; 3. Endometrial or ovarian cancer; 4. CIN-I, II or III pre-treatment; 5. CIN-I, II or III, post-treatment; 6. Invasive cervical cancer pre- treatment or at a time of hysterectomy; and, 7. Invasive cervical cancer (6 months and a year) post-treatment. We shall correlate the levels of IGF-II with clinical diagnosis of CIN or cervical cancer, size of neoplasm and resolution or recurrence of the disease and the smoking history. We believe that serum IGF-II test could compliment the Pap test to reduce deaths by cervical cancer. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: ENDOMETRIAL CANCER AND POSTMENOPAUSAL HORMONE THERAPY Principal Investigator & Institution: Weiss, Noel S.; Professor; Fred Hutchinson Cancer Research Center Box 19024, 1100 Fairview Ave N Seattle, Wa 98109 Timing: Fiscal Year 2001; Project Start 01-MAR-1998; Project End 31-DEC-2002 Summary: The increased risk of endometrial cancer associated with the use of postmenopausal estrogen therapy can be diminished by the concomitant use of progestogen on a cyclic basis. Nevertheless, it is quite uncertain whether the entirety of the increased risk is eliminated, especially in long-term users of cyclic estrogen/progestogen regimens. Additionally, the impact on endometrial cancer incidence of a now-common way of taking hormones, on a combined-continuous basis, has never been evaluated. To address these questions, a population-based case-control study of endometrial cancer is proposed for women 50-60 years of age who reside in three counties of western Washington. An attempt will be made to interview eligible cases diagnosed during 1997-1999 regarding the use of hormonal medications and other
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exposures and characteristics that bear on the incidence of endometrial cancer. As a basis of comparison for the cases who are 50-64 years of age, interviews will be sough with 50-64 year-old female residents of these counties identified through random digit dialing. Controls 65-69 years of age will be identified through the records of the Health Care Financing Administration, and they will be interviewed as well. Potential controls who have previously had a hysterectomy will be excluded. We anticipate obtaining interviews with approximately 300 cases and an equal number of controls. Exogenous hormones offer postmenopausal women substantial benefits with regard to their cardiovascular and skeletal systems. The proposed study has the potential to obtain information that can guide their choice of hormonal regimen so as to minimize the likelihood of endometrial cancer as an adverse effect of this otherwise useful therapy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: ENDOMETRIAL EFFECT OF INTRAUTER DEVICE IN NON HUMAN PRIMATE
ANTIPROGESTIN
RELEAS
Principal Investigator & Institution: Brenner, Robert M.; Senior Scientist; Oregon Health & Science University Portland, or 972393098 Timing: Fiscal Year 2001 Summary: The goal of this study is to develop an antiprogestin-releasing intrauterine device (IUD), which might be applied as a contraceptive, or to inhibit endometrial bleeding. In collaboration with Leiras OY, Finland, a subsidiary of Schering AG, we tested two types of IUDs that release the new antiprogestin ZK 230 211 (ZK211). One released a high dose (26-30.2 ?g ZK 211/day) and the other a low dose (3.3-4.5 ?g ZK 211/day). Stumptail macaques were originally considered as the most suitable species for this project as they have a cervix that is straight compared to the S-shaped cervix of other common laboratory macaques. However, we had great difficulty in cannulating the cervix of the stumptails and discovered that while the external os and the cervical canal are straight and easy to cannulate, the internal os is extremely small and is itself Sshaped. To provide information relevant to the project goals, high and low dose IUDs were inserted in stumptailed and pig tail ed macaques by hysterectomy. Our first study was designed to test whether antiprogestin IUDs could inhibit the endometrial effects of progesterone. Both the low and high dose IUDs induced menstruation within three days of inserting the IUDs. This indicated that the amount of antiprogestin produced locally by both the high and low dose IUDs was sufficient to prevent systemic progesterone from maintaining the endometrium in a progestational state. The monkeys were treated to induce artificial menstrual cycles and tissues were collected at the end of one cycle. The endometrium exposed to the blank IUD showed no major differences from a typical progestational endometrium, except that the amount of endometrial tissue was somewhat less than would be expected at the end of a normal cycle. The antiprogestin IUDs caused a severe compaction of the stroma and an inhibition of the effects of P on both glandular sacculation and spiral artery development. There was evidence of perivascular hy aline degeneration similar to that observed after long term systemic antiprogestin. These results suggest that acute administration of local antiprogestin by IUD can act to inhibit endometrial development and may represent an alternative to systemic treatment to control endometrial bleeding or as a uterine based contraceptive. FUNDING Lalor Foundation PUBLICATIONS None Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: ENDOMETRIOTIC HAPTOGLOBIN ALTERS MACROPHAGE FUNCTION Principal Investigator & Institution: Sharpe-Timms, Kathy L.; Professor; Obstetrics and Gynecology; University of Missouri Columbia 310 Jesse Hall Columbia, Mo 65211 Timing: Fiscal Year 2003; Project Start 01-APR-2003; Project End 31-MAR-2007 Summary: (provided by applicant): Endometriosis affects 5 1/2 million reproductive age women and girls in the USA and Canada, and millions more worldwide, causing pelvic pain and infertility. Diagnosis and treatment require costly, invasive surgery to identify and ablate ectopic endometrial tissue. Endometriosis is one of the three top reasons for hysterectomy in the USA; over 1/2 million hysterectomies are performed annually at an estimated cost of more than $5 billion. Yet, the pathogenesis of endometriosis remains poorly defined. The long-term objectives of this research are to develop novel methods of medical management by characterizing endometriotic secretory proteins that correlate with the cellular and molecular pathogenic mechanisms of endometriosis. This research evolves from the discovery that endometriotic lesions actually synthesize and secrete haptoglobin (Hp). Intriguingly, endometriotic haptoglobin (eHp) is differentially glycosylated compared to hepatic Hp. Preliminary data support a pathologically relevant role for eHp in the aberrant immunological phenomena that support the disease process in women with endometriosis. The hypothesis to be tested is that by expressing eHp, endometriotic tissues from women with endometriosis avoid phagocytic eradication while stimulating peritoneal macrophage inflammatory cytokine secretion. In turn, the macrophage cytokines increase endometriotic tissue eHp production, creating a local, feed-forward loop between ectopic endometrium and macrophages favoring the establishment of endometriosis. To test this hypothesis, peritoneal macrophages, and endometriotic lesions when present, will be collected from women without and with endometriosis. These immune cells and tissues will be used to investigate three specific aims: 1) Identify the effects of eHp on peritoneal macrophage phagocytosis by analyzing the five steps of macrophage function in vitro including chemotaxis, adherence, ingestion, oxidative metabolism and activation. 2) Characterize a ligand/receptor mechanism whereby eHp causes aberrant macrophage function, by selectively altering eHp glycans and/or blocking peritoneal macrophage integrins. 3) Quantify the effects of macrophage inflammatory cytokines and growth factors on eHp synthesis and secretion. These experiments will provide insight into the pathogenesis of endometriosis by determining if endometriotic tissues, peritoneal macrophages or both are responsible for this pathology, if this mechanism is unique to women with endometriosis and confirm our feedforward hypothesis. As a result, novel non-invasive strategies for early detection and innovative treatment of endometriosis may be developed that markedly reduce the health burden of this malady. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: ENVIRONMENTAL ESTROGENS AND UTERINE LEIOMYOMA Principal Investigator & Institution: Walker, Cheryl L.; Professor; Carcinogenesis; University of Texas Md Anderson Can Ctr Cancer Center Houston, Tx 77030 Timing: Fiscal Year 2002; Project Start 01-AUG-1996; Project End 31-MAR-2007 Summary: (provided by the applicant) Uterine leiomyoma is the most common gynecologic neoplasm and the major cause of hysterectomy in reproductive age women. Additionally, these tumors negatively impact reproductive function in women by contributing to infertility and complications of pregnancy. Little is known about the etiology of leiomyoma or the potential impact of environmental agents on the course of
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this disease. The goal of our research is to understand the etiology of uterine leiomyoma at the molecular level and to elucidate the molecular mechanisms by which exposure to endocrine disruptors may impact the development of these tumors. In Specific Aim 1, we will determine if loss of Tsc-2 tumor suppressor gene/tuberin function and subsequent overexpression of HMGI-C is an alternative pathway for development of leiomyoma. In Specific Aim 2, we will test the hypothesis that loss of tuberin is directly responsible for overexpression of HMGI-C and results in modulation of hormone responsiveness in tuberin deficient cells. Finally in Specific Aim 3, we will determine if the prepubertal period is a window of susceptibility for exposure to environmental xenoestrogens and determine at the molecular level whether this exposure impacts the expression of genes that may contribute to the development of leiomyoma. These experiments will yield new insights into the molecular mechanisms responsible for the altered responsiveness of uterine leiomyomas to endogenous and exogenous hormones and increase our understanding of the potential mechanisms by which exposure to endocrine disruptors could contribute to the development of this disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: EPIDEMIOLOGY OF FEMALE PELVIC FLOOR DISORDERS Principal Investigator & Institution: Kjerulff, Kristen H.; Epidemiology and Prev Medicine; University of Maryland Balt Prof School Baltimore, Md 21201 Timing: Fiscal Year 2001; Project Start 01-AUG-2001; Project End 31-AUG-2002 Summary: Female pelvic floor disorders are a significant public health problem, cause major impairments in quality of life, and impose a substantial burden on individuals and on society as a whole. Uterine prolapse is the most common indication for hysterectomy among women aged 60-79, and the second most common indication among women in their fifties. Estimates of the prevalence of urinary incontinence among women overall ages range from 10 percent to 58 percent. However, there have been surprisingly few studies of any female pelvic floor disorders conducted in the national health data sets. Consequently, even basic statistical information concerning female pelvic floor disorders among American women is not available. It is critically important that epidemiologic studies be conducted in national health data sets in order to further our understanding of the scope and nature of the problems experienced by women due to pelvic floor disorders. In this application we propose to conduct a descriptive study of the epidemiology of and recent trends in outpatient visits, inhospital stays, and surgical procedutes for female pelvic follr disorders utilizing the National Ambulatory Medical Care Survey (NAMCS), the National Hospital Ambulatory Medical Care Survey (NHAMCS), the National Hospital Discharge Survey (NHDS), the Nationwide Inpatient Sample (NIS) and the National Survey of Ambulatory Surgery (NSAS). These data sets have been specifically designed to provide objective, reliable, population-based information and could be utilized to address several key issues concerning female pelvic floor disorders including outpatient health care utilization, in- hospital and ambulatory operative treatments, physician specialty differences in treatments, characteristics of women seeking treatment and the economic burden imposed by these disorders. Utilizing these data sets we will accomplish the following specific aims: 1.)Describe hospitalizations for female pelvic floor disorders including vaginal vault prolapse, uterine prolapse, uterovaginal prolapse, vaginal enterocele, fecal incontinence, and urinary incontinence in the NHDS and NIS data sets, 2.) Describe ambulatory operative procedures used as treatment for female pelvic floor disorders in the NSAS, and 3.) Describe office-based visits for female pelvic floor disorders in the NAMCS and the NHAMCS.
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Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: ESTROGEN DEPENDENCY OF UTERINE LEIOMYOMA Principal Investigator & Institution: Al-Hendy, Ayman; Obstetrics and Gynecology; University of Texas Medical Br Galveston 301 University Blvd Galveston, Tx 77555 Timing: Fiscal Year 2003; Project Start 24-SEP-2003; Project End 31-JUL-2008 Summary: (provided by applicant): Uterine leiomyoma arise from the uterine smooth muscle compartment (myometrium) and are the most common gynecologic tumor in premenopausal women, occurring in up to 77% of all women. They are all significant cause of pelvic pain, menorrhagia, infertility, and pregnancy-related complications. These estrogen-dependent tumors are the leading indication for hysterectomy in reproductive age women. Currently, no medicinal therapy exists. Prolonged use of GnRH agonists, which can shrink tumors but induce a chemical menopause, is restricted due to serious side effects. The hormone-dependent phenotype of uterine leiomyoma suggests that interventions targeting the estrogen receptor (ER)-signaling pathway may have therapeutic efficacy. Proof-of-principal experiments have now established that treatment with anti-estrogen medications (e.g., tamoxifen and raloxifene) can significantly reduce tumor incidence, size, and proliferative index in the Eker rat, the only animal model known to acquire spontaneous uterine leiomyoma. Adenovirusmediated delivery of a mutated dominant-negative ER (Ad-ER-DN) inhibited cell proliferation and induced apoptosis in human and rat leiomyoma cell lines. In a pilot experiment, Ad-ER-DN injected directly intratumor in nude mice with pre- existing fibroids induced immediate arrest and regression of tumor growth due to extensive apoptosis. explants in nude In this project, we will (Specific Aim 1) determine if Ad-ERDN transduction inhibits endogenous ER signaling in estrogen-responsive rat and human leiomyoma cells, (Specific Aim 2) expand pilot results and evaluate the ability of Ad-ER-DN to ablate pre-established subcutaneous leiomyoma mice, and (Specific lira 3) conduct a pre-clinical trial to assess the ability of Ad-ER-DN to ablate uterine leiomyoma when delivered by direct intratumor injection in the immune-competent Eker rat. Tumor response will be correlated to proliferative and apoptotic indices, to markers of tumor angiogenesis, and to several estrogen-regulated genes. We will examine immune response and the safety of single vs. repeated recombinant adenovirus treatment alone or in combination with SERM (Raloxifene). Evident therapeutic potential aside, this project will add to our understanding of the molecular mechanisms of estrogen-dependence in this common uterine tumor. It will also show, in a wellcharacterized natural rat model, the effects of specific perturbing of ER signaling on several cellular functions (i.e., angiogenesis, apoptosis, and cell cycle). This knowledge will impact many other estrogen-related conditions (e.g., breast and endometrial cancer, cardiovascular disease, osteoporosis). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: FEMALE REPRO TRACT ARYL HYDROCARBON RECEPTOR (AHR) & NUCLEAR TRANSLOCATOR (ARNT) Principal Investigator & Institution: Golos, Thaddeus G.; Associate Professor; University of Wisconsin Madison 750 University Ave Madison, Wi 53706 Timing: Fiscal Year 2001 Summary: OBJECTIVE Evaluate the levels of the AHR and ARNT in the female reproductive tract. RESULTS Emerging evidence suggests that environmental contaminants such as dioxin can act as endocrine disrupters through inappropriate
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modulation of target responses to hormones. These compounds produce their biological and toxicological effects by binding to the AHR. Binding of AHR by agonists like dioxin initiates a series of events resulting in dissociation of hsp90, movement into the nuclear compartment and heterodimerization with another protein termed ARNT. The resulting AHR-ARNT complex binds to cis-acting DNA sequences called dioxin-response elements to modulate transcription of a number of genes such as drug metabolizing enzymes, estrogen receptor, and growth factors like IL-I?, TGF-? and TGF-?. The goal of this study was to characterize the expression of AHR/ARNT in reproductive tissues were obtained from women undergoing total hysterectomy and bilateral salpingoophorectomy for benign gynecologic disease. Ribonuclease protection assay (RPA) was used to quantify the AHR and ARNT mRNA levels. Immunohistochemistry using polyclonal antibodies to AHR and ARNT were used to determine the tissue localization of these proteins. AHR and ARNT mRNA were readily detectable in the endometrium, myometrium, ovary, fallopian tube and placenta. The highest expression of mRNA for AHR/ARNT was found in the fallopian tube followed by the placenta, ovary and uterine tissues. IHC revealed both AHR and ARNT were present predominantly in the endometrial glands in the basiglandular areas and lumina1 surface of the epithelium In the myometrium a diffuse distribution in the myocytes, and in tunica media of spiral arterioles was found. A statistically significant variation in endometrial AHR and ARNT mRNA was not found during the menstrual cycle, although there was a trend for higher AHR expression in the proliferative phase and in specimens with adenomyosis (P=0.1). Greater expression of AHR was found in the endometrium of postmenopausal women treated with continuous hormone replac ement therapy as compared to women on no hormones (P=0.01). The differential tissue specific expression of AHR/ARNT in the reproductive tract suggests a physiologic role for these proteins in reproductive processes, and in pathologic procosses such as adenomyosis. Exogenous sex steroids upregulate AHR but not ARNT in the endometrium. FUTURE DIRECTIONS To extend these studies to rhesus monkeys undergoing experimental manipulation of the uterine environment with steroid hormones, and to evaluate localization at the maternal-fetal interface. KEY WORDS Aryl hydrocarbon receptor, dioxin, uterus, endometrium FUNDING RR00167, ES09090, HD34215 Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: FEMALE PHYSIOLOGY
SEXUAL
AROUSAL:
CLITORAL
AND
VAGINAL
Principal Investigator & Institution: Traish, Abdulmaged M.; Professor; Urology; Boston University Medical Campus 715 Albany St, 560 Boston, Ma 02118 Timing: Fiscal Year 2001; Project Start 15-SEP-2000; Project End 30-JUN-2004 Summary: (Adapted from the Applicant's Abstract): Female sexuality is an desire, arousal, orgasm or pain, are estimated to afflict 30-50 percent of women in the United States. These disorders may be chronic, progressive, age-related and adversely affect quality of life and interpersonal relationships. In particular, sexual arousal disorder, has been linked to age, menopause, hysterectomy and vascular risk factors. Overall clinical management of afflicted patients has been primarily psychologically and hormonallybased. There has been limited research attention to the physiologically or medicallybased conditions which adversely affect the female sexual arousal response. Recently, increasing numbers of afflicted women are utilizing "off-label" oral vasoactive agents for treatment of diminished genital swelling/lubrication responses in the absence of such physiologic and clinical trial data, suggesting demand for improved female sexual
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health care management. There is a need to broaden understanding of the pathophysiologic mechanisms of female sexual dysfunction. The overall goal of this proposal is to define the physiological mechanisms underlying the arousal component of the female sexual response. Specifically, they will investigate the physiologic mechanisms of clitoral and vaginal smooth muscle contractility which contribute to clitoral and vaginal engorgement during genital swelling/lubrication responses. To accomplish this goal, they have developed several experimental systems including: I) an in vivo animal model to record physiologic and hemodynamic changes in the clitoris and vagina following pelvic nerve stimulation, ii) in vitro organ baths of clitoral and vaginal tissue to investigate mechanisms involved in the modulation of smooth muscle contractility and iii) primary cultures of human and animal clitoral and vaginal smooth muscle cells to examine signal transduction pathways underlying smooth muscle tone. The Specific Aims of this proposal are to investigate: 1) neurogenic mechanisms modulating clitoral and vaginal smooth muscle contractility, 2) signal transduction pathways by which alpha-adrenergic receptors, nitric oxide and VIP modulate smooth muscle function, 3) the activity, in vivo, of alpha-adrenergic antagonists, VIP and nitric oxide on clitoral and vaginal hemodynamic response to pelvic nerve stimulation and 4) the role of estrogens in modulating vaginal and clitoral smooth muscle function. These studies should lead to new and useful information concerning physiological and pathophysiological mechanisms in female sexual arousal and to potentially improve diagnostic and treatment strategies for women suffering from sexual dysfunction. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: HEALTH AND MENOPAUSE IN HISPANIC WOMEN IN PUERTO RICO Principal Investigator & Institution: Romanguera, Josefina; University of Puerto Rico Med Sciences Medical Sciences Campus San Juan, Pr 00936 Timing: Fiscal Year 2001 Summary: This proposal is for a two years cross-sectional study to monitor changes in health status during the midlife in Hispanic women living in Puerto Rico. With funding from this cross-sectional study, we propose to conduct preliminary analysis of crosssectional data to determine the average age at menopause and pattern of hysterectomy in Hispanic women in Puerto Rico. We will also estimate the prevalence of menopausal symptoms, hypertension, diabetes and osteoporosis by age in these women. The crosssectional data will come from a self- administered. questionnaire and a clinical visit offered to 300 female members of the Puerto Rican Teachers Association aged 35-80 years old, representative of six geographic sectors of Puerto Rico. We calculate to have 800 participants who will respond to the questionnaire and agree to participate in the study. The clinical exam will include measurement of blood pressure, height and weight, body composition by electrical impedance, and calcaneus DEXA to measure bone density as well as a blood draw. The blood sample will be used to measure lipids, blood glucose, glycosylated hemoglobin and follicle stimulating hormone. This study will be the first contemporary study of the health and functional status of Hispanic women living in Puerto Rico during the midlife and menopause It will have the advantage that it represents a specific Hispanic population. Most studies available to date include a diverse Spanish speaking population with different ethnic background such as Mexican, Cuban, Puerto Rican, etc. The study will include a mailed questionnaire and a clinical visit to this population in order to obtain estimates of annual disease incidence as well as to evaluate our ability to follow this population and estimate retention rates. These activities will permit us to determine the appropriate age
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groups to enroll, to determine the required sample size and make more accurate power calculations for a future longitudinal study. We will also develop the longitudinal questionnaire and manual of operations, will translate and pre-test scales which have not previously been used in this population. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: HISTOMETRIC ANALYSIS OF PREMALIGNANT ENDOMETRIAL LESIONS Principal Investigator & Institution: Garcia, Francisco Ar.; Obstetrics and Gynecology; University of Arizona P O Box 3308 Tucson, Az 857223308 Timing: Fiscal Year 2001; Project Start 01-SEP-1999; Project End 31-AUG-2004 Summary: Adenocarcinoma of the endometrium is the most common gynecologic malignancy in the United States. It accounts for about 36,000 cases of invasive cancer each year and is among the top five neoplasms affecting women. Hyperplastic abnormalities of the endometrium follow a continuum of severity, with the risk of progression to carcinoma being related to the complexity of the lesion. At this time dilation and curettage with hysteroscopy, remain the major means of diagnosis. The current management of atypical endometrial hyperplasia is limited to hysterectomy. The overall goal of this research is to establish the foundation for the objective characterization of hyperplastic endometrial lining abnormalities associated with neoplasia of the uterine corpus, based on computer histometric/karyometric analysis. We hypothesize that: 1) The orderly progression from normality, to simple hyperplasia, atypical hyperplasia, and endometrial carcinoma in the uterine lining has distinct morphometric characteristics that can be identified using computer-based histometric analysis. 2) Endometrial adenocarcinoma causes distinct identifiable changes in adjacent hyperplastic and otherwise normal endometrial surfaces, which permit its identification prior to hysterectomy. 3) The responsiveness of atypical hyperplasia to a chemopreventive regimen can be objectively quantified using histometric/karyometric analysis. Our specific aims are to: 1) Develop procedures for the automated digital processing of high resolution microscopic images of histopathologic sections of endometrial biopsies and hysterectomy specimens, including the development of a knowledge file for automated scene segmentation and karyometry. 2) Establish an objective, numeric assessment and grading system for endometrial lesions. 3) Define a nuclear signature of preneoplastic endometrial lesions. These will be accomplished within the context of an ongoing two-part study of atypical hyperplasia (GOG Protocol 167). The ubiquity of preneoplastic abnormalities of the endometrial lining of the uterus, and the potential morbidity, time loss and expense associated with their surgical therapy, require the development of novel diagnostic modalities that reliably predict malignant potential. Digital microscopy and nuclear morphometric analysis will extend the utility of the histopathologic analysis of otherwise negative endometrial biopsy material, by allowing the identification of women with synchronous endometrial carcinoma, or at risk for malignant progression of their hyperplasia. This will allow the development and testing of chemopreventive interventions in low risk patients, and facilitate efficient surgical therapy in those women with potentially aggressive disease. Such capabilities could prevent unnecessary surgery, as well as the vast majority of advanced endometrial cancers. The technique of computerized morphometric analysis has tremendous potential to increase our understanding of the biological behavior of endometrial cancer, as well as revolutionize its diagnosis and treatment endometrial cancer. This proposed research project fits within the context, of a highly structured, multi-faceted, Mentored Patient Oriented Research Career Development Plan that
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focuses on the prevention and control of preneoplastic gynecologic disease. It utilizes the unique resources available at the University of Arizona, to foster an environment in which academic productivity is optimized and the necessary supervision is received to insure a successful career in clinical investigation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: HMGI GENES IN TUMORIGENESIS Principal Investigator & Institution: Chada, Kiran K.; Professor of Biochemistry; Biochemistry; Univ of Med/Dent Nj-R W Johnson Med Sch Robert Wood Johnson Medical Sch Piscataway, Nj 08854 Timing: Fiscal Year 2001; Project Start 01-JUN-1998; Project End 31-MAR-2003 Summary: Hmgi-c is a member of a novel, developmentally regulated gene family. It is responsible for the pygmy (pg) mutation in mouse and the human homologue is disrupted in a number of tumors. Therefore, this proposal is an attempt to understand the function of Hmgi-c and its role in the interdependent processes of proliferation and tumorigenesis. Based on the human tumor studies, the first specific aim will investigate the nature of the HMGI-C gene products required in tumorigenesis. Transgenic mice will be generated that harbor various HMGI-C transgenes whose structure is similar to that seen in human tumors. Transgenic mice which express wildtype HMGI-C in an inappropriate cell type will be analyzed for tumor formation and the tumors characterized for activation of the endogenous Hmgi-c alleles. Tissue culture studies imply that HMGI-C is necessary for tumorigenesis. Therefore, the second aim will examine the susceptibility of the pg mouse mutant to tumorigenesis by different oncogenic stimuli in various tissues. The third aim will analyze the effect of Hmgi-c expression on proliferation and the cell cycle. This will be performed on pg and wildtype embryonic fibroblasts grown under different culture conditions. Finally, in order to elucidate the molecular components of the Hmgi-c pathway, putative target genes will be identified by differential display. The long term objectives are to understand the role of Hmgi-c in growth and development. This will ultimately explain the phenotype of the pygmy mouse and how its disruption or deregulation leads to tumorigenesis including uterine leiomyoma, a major cause of hysterectomy in humans. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: HORMONE REPLACEMENT PROGRESSION OF ARTHEROSCLEROSIS
THERAPY
EFFECTS
ON
Principal Investigator & Institution: Ouyang, Pamela C.; Associate Professor of Medicine; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2001; Project Start 01-DEC-2000; Project End 30-NOV-2001 Summary: Coronary atherosclerosis is the major cause of death in women in the USA. While coronary artery bypass surgery decreases symptomatic and clinical evidence of cardiac ischemia it does not alter the underlying process. Patients may develop recurrent symptoms due to saphenous vein graft occlusion, graft atherosclerosis, or progression of underlying coronary disease. Interventions that reduce the rate of coronary atherosclerosis progression would significantly benefit women following bypass surgery and possibly benefit all women with atherosclerotic disease. Some observational studies suggest that postmenopausal estrogen replacement therapy reduces cardiac morbidity by up to 50%. The benefit of estrogen and progestin therapy (HRT) in women with established coronary disease has not been studied. The efficacy of HRT to delay the development of saphenous graft atherosclerosis is unknown. This
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randomized, double-masked, placebo- controlled trial tests the hypothesis that HRT started shortly after coronary bypass surgery will delay the development of graft atherosclerosis and reduce the occurrence of graft occlusion. Women will be randomized to placebo or HRT with 17b-estradiol plus medroxyprogesterone acetate (or 17 -estradiol if post hysterectomy) within 4 months of surgery. The development of vein graft atherosclerosis will be measured using quantitative coronary angiographic and intravascular ultrasound assessment of disease severity and extent. Studies will be performed 6 months and 3.5 years after randomization. We shall determine the influence of HRT on the primary outcome variables of the change in severity and extent of atherosclerosis in vein grafts over 3.5 years of therapy. We postulate that the pathophysiologic mechanisms of platelet activation, fibrinogen binding to platelets, vascular reactivity, coagulation and fibrinolytic factors and lipoprotein composition predict the occurrence of graft occlusion and graft atherosclerosis. The effect of HRT on these factors will be measured. The proposal also tests the hypothesis that HRT exerts its beneficial effects by its effects on these risk factors in addition to more traditional risk factors including lipids and lipoprotein profile. The influence of these risk factors and the effect of HRT on the frequency of early graft closure (identified on a 6 month coronary angiogram) will be assessed. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: HRT AND CHANGES IN MAMMOGRAPHIC DENSITY Principal Investigator & Institution: Heiss, Gerardo S.; Epidemiology; University of North Carolina Chapel Hill Office of Sponsored Research Chapel Hill, Nc 27599 Timing: Fiscal Year 2001; Project Start 02-JAN-1998; Project End 31-DEC-2002 Summary: Breast parenchymal patterns are depicted on mammograms as variations in radiographic density, which correspond to the relative amounts of fatty tissue (c.f., epithelial and stromal tissues). Mammographic density is highest in women with the greatest proportion of epithelial, stromal and connective tissues. Compared to no density, high density (>50%) has been consistently associated with significantly elevated long-term breast cancer risk, independent of age, menopausal status, or other breast cancer risk factors. Recently, several small case series have suggested that postmenopausal HRT may increase density in some postmenopausal women, although selection biases and imprecise measurement of exposure and outcomes (density) detract from the validity of these results. Given the small but persistent association of HRT with increased risk of breast cancer, and the increasing prevalence of HRT use among postmenopausal women, assessing the magnitude and correlates of the effect of HRT on mammographic density may contribute to improved understanding of the aetiologic role of exogenous hormones and to public health breast cancer prevention efforts. The objectives are to: 1) reliably estimate the quantitative effect of HRT on mammographic density in postmenopausal women; and 2) determine whether HRT-related density changes differ by ethnicity, age, time since menopause, body mass, or other breast cancer risk factors. This research is ancillary to the WHI, a long-term, multi-center, randomized trial of HRT in postmenopausal women. WHI participants are assigned to HRT (estrogen only for hysterectomized women, or combined progestin-estrogen for women with a uterus) or placebo. Working with the WHI clinical centers, measurements will be made of the percentage of breast density on participants' mammograms taken at baseline, one-year and two-year follow-up intervals, and then compared for longitudinal density change among treatment groups. The sample is comprised of 1200 women with adequate numbers in four ethnic groups: European, African, Hispanic and Asian/Pacific Islander Americans.
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Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: IMMORTALIZATION OF PREGNANT HUMAN MYOMETRIAL CELLS Principal Investigator & Institution: Soloff, Melvyn S.; Obstetrics and Gynecology; University of Texas Medical Br Galveston 301 University Blvd Galveston, Tx 77555 Timing: Fiscal Year 2003; Project Start 12-MAR-2003; Project End 28-FEB-2005 Summary: (provided by applicant): Preterm birth is the leading cause of infant mortality, yet we know little of human myometrial signals that initiate of labor contractions in normal-length pregnancies, let alone preterm pregnancies. Benign tumors of the myometrium, leiomyomas, are found in up to 30% of women over 30 years of age, and are the most common cause of hysterectomy in premenopausal women. Leiomyomas frequently proliferate at a greater rate during pregnancy and can be extremely problematic. An examination of the basic cellular processes involved in myometrial function often requires the use of human myometrial cells in primary culture. However, these cells can be used only for several passages, and the magnitude of many responses changes with time in culture. Many laboratories do not have ready access to clinical material, and it would be essential to have immortalized human myometrial cells with all the properties of a low-passage phenotype. Transformed cells tend to be genetically unstable, as they can be polynucleated and can lose or gain chromosomes. However, Clontech, in collaboration with Geron Corp., has introduced several telomerase-immortalized cell lines that have the extended lifespan of transformed cells, but unlike transformed cells, maintain the appearance and behavior of normal primary cells. The purpose of this project is to develop telomeraseimmortalized cell lines from term-pregnant human myometrium to eliminate variability between passage numbers and allow genetic manipulations of myometrial cells to fully characterize signal pathways. During this grant period we will: (1) immortalize early passage human myometrial cells in primary culture by infection with a retroviral vector expressing human telomerase (hTERT, obtained by material transfer agreement from Geron Corp.) and select clonal cell lines by puromycin resistance; and (2) examine maintenance of primary culture phenotype in immortalized cells by a number of criteria, including retention of very specific signal pathways involved with several different classes of agonists. Karyotyping will also be performed to ensure the lack of chromosomal alterations in immortalized cells. Criteria to be examined include alphaactin immunocytochemistry, Akt phosphorylation in response to insulin treatment, stimulation of myometrial cell growth by lysophospholipids, quantification of oxytocin receptor ligand binding sites and upregulation by lysophosphatidic acid, oxytocin stimulation of RGS2 mRNA expression and ERK phosphorylation, EGF-stimulated phosphorylation of the EGF receptor, transactivation of EGF receptors by oxytocin, myosin light chain phosphorylation in response to uterotonic agents, and analysis of a number of signal pathways using gene array analysis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: INFLAMMATION AND OVARIAN CANCER Principal Investigator & Institution: Ness, Roberta B.; Professor and Chair; Epidemiology; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2003; Project Start 12-MAY-2003; Project End 30-APR-2008
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Summary: (provided by applicant): The cause of ovarian cancer is unclear. We have suggested that inflammation may be involved. Ovulation, endometriosis, and talc use all promote inflammation, and all increase the risk of ovarian cancer; tubal ligation and hysterectomy prevent the ovaries from being exposed to inflammants, and reduce risk. Furthermore, inflammation entails DNA damage and repair, oxidative stress, and elevations in prostaglandins and cytokines, all of which may be mutagenic. Building on our track record of success with conducting ovarian cancer case-control studies, we propose a population-based study to examine the role of inflammation in the risk for ovarian cancer. We will enroll 900 women with incident ovarian cancer (cases) from hospitals in Western Pennsylvania, Northern Ohio, and Western New York. One thousand eight hundred controls, ascertained via random digit dialing, will be frequency matched to cases on age, race, and residence. Using in-person standardized interviews and blood draws, we propose to: 1) evaluate whether non-steroidal antiinflammatory drugs (NSAIDs) protect against ovarian cancer; 2) compare in cases and controls allelic variants in inflammatory and antinflammatory cytokines and growth factors including IL-1, TNF-a, IL-10, IGF-1 and TGF-b; 3) evaluate whether markers of past PID, i.e. higher antibody titers to chlamydia and its related heat shock protein (HSP)-60, relate to ovarian cancer; 4) in a secondary aim, explore whether allelic variants in the NSAID metabolizing enzymes CYP2C9 and UGT1A6 interact with NSAID use to reduce the risk of ovarian cancer. Exploring the relationships among inflammatory predisposition, inflammatory exposures, anti-inflammatory medications, and ovarian cancer represents a novel avenue of research. In particular, NSAID use may prove to be a potentially important chemopreventative for this often-fatal disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: INTERMEDIATE ALTERNATIVES
OUTCOMES
OF
HYSTERECTOMY
AND
Principal Investigator & Institution: Kuppermann, Miriam; Ob, Gyn and Reproductive Scis; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 94122 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 29-SEP-2007 Summary: (TAKEN FROM APPLICANT): The proposed application expands on our existing prospective longitudinal study of 811 women with non-cancerous uterine conditions for which hysterectomy is a reasonable treatment option: abnormal uterine bleeding, symptomatic uterine leiomyomata, and pelvic pain/endometriosis. The principal aims of the proposed study are to 1) determine whether and how intermediate-term (4-8 year) clinical and qualityof- life outcomes differ by treatment group (hysterectomy, uterus-preserving surgery, or non-surgical treatments) for their uterine conditions; and 2) develop predictive models of treatment choice and satisfaction from a broad array of domains. The proposed expansion of the existing study is motivated by two main factors. First, by increasing the size of our cohort by an additional 700 we will extend the mean duration of follow-up from 1.7 to 4.1 years, and we will obtain at least four years of follow-up data on over 976 women. The increased sample at four years will allow us to accrue an adequate number of women undergoing hysterectomy and non-surgical treatments to support a statistically meaningful comparison. Because symptoms for women with noncancerous uterine conditions typically extend from the early 40?s to menopause, including intermediate-term, face this decision, providing useful information will help equip women and their physicians to make informed, shared decisions. Second, we will enhance our measures of sexual functioning, depression, and incontinence, and include assessments of newly available alternative treatments. These additions reflect changes in the understanding of the role
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of these factors in the management of non-cancerous uterine conditions since the inception of the original study. The results of this study are central to our long-term goal of improving decision making in the management of non-cancerous uterine conditions. The findings that emerge from the proposed study will be relevant to the development of evidence-based guidelines and the creation of decision-assisting tools to help women with non-cancerous uterine conditions make informed choices regarding their treatment during their decade of risk for hysterectomy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: LEIOMYOMATA UTERI: APOPTOSIS AND CELL SURVIVAL PATHWAYS Principal Investigator & Institution: Christman, Gregory M.; Obstetrics and Gynecology; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2003; Project Start 26-SEP-2003; Project End 31-JUL-2008 Summary: (provided by applicant): Leiomyomas are benign monoclonal proliferations of uterine smooth muscle cells occurring in one of every three women of reproductive age. Twenty to fifty percent of women with leiomyomas develop symptoms including abnormal bleeding, pelvic pain and pressure, urinary frequency, reduced fertility and miscarriage. Leiomyomas represent the leading indication for hysterectomy in the United States. The development and severity of symptoms is related to the size and position of the tumors. The proliferation of uterine leiomyoma cells exceeds the limited number of cells undergoing apoptosis resulting in tumor enlargement. Studies from our laboratory have demonstrated the effectiveness of a cytotoxic gene therapy approach known to induce apoptosis to reduce leiomyoma proliferation and volume using human leiomyocytes and leiomyoma cells derived from the Eker rat strain (ELT-3 cells). A strong bystander effect was demonstrated where transfection of a small percentage of leiomyoma cells was able to mediate marked cellular death of the non transfected cells and in vivo tumor regression of uterine leiomyomas. In vitro experiments using the dietary triphenolic stilbene resveratrol, an estrogen alpha receptor antagonist, inhibited proliferation of the ELT-3 uterine leiomyoma cell line in a hypoestrogenic environment. Uterine leiomyomas generally exhibit minimal apoptosis despite evidence that cellular mediators of both the intrinsic and extrinsic pathways of apoptosis are expressed. The anti-apoptosis factor Bcl-2 is highly expressed in leiomyoma cells in comparison to normal myometrium. Bcl-2 protein expression is reduced by estrogen exposure and increased by progesterone exposure. GnRH agonists administered in vivo cause a marked reduction in leiomyoma size without evidence of apoptosis. In contrast, in vitro exposure of leiomyoma cells to GnRH agonists causes marked apoptosis and induction of Fas and Fas ligand. We propose the following Specific Aims: Specific Aim I: To study the effect of HSV-tk/ganciclovir, the dietary ER-alpha receptor antagonist resveratrol, and GNRH agonist on cell proliferation and apoptosis in ELT-3 and human leiomyoma cells. Specific Aim II: To study the effect of HSVtk/ ganciclovir, the dietary ER-alpha receptor antagonist resveratrol, and GNRH agonist on cell proliferation and apoptosis in the ELT-3/nude mouse model of leiomyoma. Specific Aim III: To study the effect of HSV-tk/ganciclovir, the dietary ER-alpha receptor antagonist resveratrol and GNRH agonist on cell proliferation and apoptosis in a human leiomyoma xenograft model. A detailed understanding of the apoptosis and cell survival pathways active in uterine leiomyomas will allow us to better promote long term tumor regression in response to evolving minimally invasive therapies in development for uterine leiomyomas
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including vascular embolization, high intensity focused ultrasound, and evolving targeted molecular and pharmacologic therapies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: MD ANDERSON CANCER CTR. GYNECOLOGY SPORE: UTERINE CANCER Principal Investigator & Institution: Burke, Thomas W.; Gynecologic Oncology; University of Texas Md Anderson Can Ctr Cancer Center Houston, Tx 77030 Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 31-AUG-2008 Summary: (provided by applicant): The goal of the Gynecological Cancer SPORE at the University of Texas - M.D. Anderson Cancer Center is to conduct innovative translational research for the prevention and treatment of uterine tumors. Tumors arising from the epithelial (endometrium) and smooth muscle (myometrium) compartments of the uterus are important, yet under- funded, causes of morbidity and mortality in the United States. Endometrial cancer is the most common gynecological malignancy in the United States with an estimated 39,300 new cases and 6,600 deaths for 2002. Smooth muscle tumors of the uterus, especially leiomyomas, are the most common indication for hysterectomy in the United States, with an estimated 250,000 hysterectomies per year attributable to these tumors. The proposed Gynecological Cancer SPORE is a truly multidisciplinary program that includes clinicians and basic scientists with both oncologic and non-oncologic backgrounds. Such a multidisciplinary team is necessary to achieve a more thorough understanding of the pathogenesis, prevention, and treatment of these tumors. The Gynecologic SPORE consists of five research projects: Project 1, Randomized Phase II Comparison of Arzoxifene and Megace in Women with Advanced or Recurrent Endometrial Adenocarcinoma with Laboratory Correlates Designed to Identify Mechanism of Action (Thomas Burke, M.D., and Cheryl Walker, Ph.D., Co-Principal lnvestigator). Project 2, A Novel Endometrial Cancer Chemoprevention Strategy for Obese Women, an At-Risk Population (Karen Lu, M.D., and Peter Davies, M.D., Ph.D., Co-Principal Investigators). Project 3, CpG Island Methylation Profiling of Endometrial Cancer (Russell Broaddus, M.D., Ph.D., and JeanPierre Issa, M.D., Co-Principal lnvestigators). Project 4, Molecular Progression of Endometrial Cancer (David Loose-Mitchell, Ph.D., and Judith Wolf, M.D., Co-Principal Investigators). The research projects are supported by four cores: Core 1, Administration (Thomas Burke, M.D., Principal Investigators); Core 2, Pathology (Russell Broaddus, M.D., Ph.D., Principal Investigators); Core 3, Biomarkers (David Loose-Mitchell, Ph.D., Principal Investigator); and Core 4, Biostatistics and Bioinformatics (Peter Mueller, Ph.D., Principal Investigator). The Developmental Research Program (Cheryl Walker, Ph.D., Principal Investigator) will provide funding for innovative research. A Career Development Program (George Stancel, Ph.D., Principal Investigator) will encourage faculty development research. An Internal Advisory Committee and External Advisory Committee will assist in scientific and clinical planning and evaluation of projects. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: MEDICINE OR SURGERY--TREATMENT ALTERNATIVES FOR ABNORMAL UTERINE Principal Investigator & Institution: Barrett-Connor, Elizabeth L.; Professor and Chair; University of California San Diego 9500 Gilman Dr, Dept. 0934 La Jolla, Ca 92093 Timing: Fiscal Year 2001; Project Start 01-DEC-2000; Project End 30-NOV-2001 Summary: This abstract is not available.
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Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: MOLECULAR AND CYTOGENETIC STUDIES OF UTERINE LEIOMYOMATA Principal Investigator & Institution: Morton, Cynthia C.; Professor; Brigham and Women's Hospital 75 Francis Street Boston, Ma 02115 Timing: Fiscal Year 2001; Project Start 30-SEP-1992; Project End 31-MAR-2003 Summary: Uterine leiomyomata, or fibroids, are the most common pelvic tumors in females and occur in 20-25 percent of women of reproductive age. Although benign neoplasms, they constitute a major health problem as 25-50 percent of affected women experience debilitating symptoms including excessive menstrual bleeding and pelvic discomfort as well as reproductivefailure. Fibroids are the major indication for hysterectomy accounting for over 200,000 procedures annually in the United States. It is highly likely that there is a genetic liability to develop uterine leiomyomata; these tumors are at least three times more frequent in Black than Caucasian women and the twin pair correlations for hysterectomy in monozygotic twins are about twice that observed in dizygous twins. Despite these findings, relatively little is known about this racial predisposition or specific genes involved in the pathogenesis of fibroids. Also of particular interest is the observation that these tumors rarely; if ever, proceed to their malignant counterparts. Uterine leiomyomata may serve as an important model system to study the genetic events which distinguish benign and malignant neoplasms. Consistent chromosome aberrations have been observed in fibroids indicating the location of genes involved in these tumors. At least six cytogenetic subgroups have been identified and we have been successful in using positional candidate gene approaches in determining that two high mobility protein genes, HMGIC and HMGlY, located on chromosomes 12 and 6, respectively participate in the pathobiology of uterine leiomyomata. The major goal of this proposed renewal applicaiton is to further our understanding of the biology of uterine leiomyomata. We will use molecular and cytogenetic studies to characterize further the expression and mechanism of the two high mobility group protein genes, HMGiC and HMGlY. Additional experiments will be focused on the identification, isolation and characterization of othe genes involved in the pathogenesis and pathobiology of uterine leiomyomata. Two positional cloning projects already underway are focused on genes consistently involved in rearrangements in these tumors. Identification and molecular characterization of genes at these sites will contribute to understianding the role of these genes in normal cellular processes, and may facilitate developments in the clinical management of leiomyomate and other solid tumors. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: MOUSE MODEL OF ENDOMETRIAL TUMORIGENESIS Principal Investigator & Institution: Ellenson, Hedrick Lora.; Associate Professor; Pathology and Laboratory Medicine; Weill Medical College of Cornell Univ New York, Ny 10021 Timing: Fiscal Year 2003; Project Start 01-AUG-2003; Project End 31-JUL-2008 Summary: (provided by applicant): The long-term goal of our laboratory is to develop a biologically relevant mouse model of endometrial carcinoma for the purpose of addressing clinically important questions. Endometrial carcinoma is the most common malignancy of the female genital tract in the United States, and uterine endometrioid carcinoma (UEC) is the most prevalent subtype. UEC arises from proliferative
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endometrium, in the setting of unopposed estrogen, via a continuum of histopathological precursor lesions called hyperplasias. The direct precursor of UEC, complex atypical hyperplasia (CAH), closely resembles UEC with the exception that it lacks stromal invasion. Because of the inability to predict which precursor lesions may progress and the morphologic ambiguities of distinguishing between CAH and UEC on endometrial sampling, numerous women undergo hysterectomy for benign, noninvasive disease. Thus, a more thorough understanding of the differences between CAH and UEC, and the role of both hormonal and genetic factors on the development and progression of endometrial tumorigenesis would have a substantial impact on the diagnosis and management of women with proliferative endometrial lesions. The two most common molecular genetic abnormalities yet identified in UEC are mutations in the PTEN tumor suppressor gene and microsatellite instability (MI) which are present in 30-50% and 20% of tumors, respectively. PTEN mutations and MI have also been detected in a subset of CAH suggesting that both alterations occur relatively early in the pathogenesis of UEC. Recently it has been reported that CAH develops in 100% of female Pten mice and progresses to carcinoma in approximately 20% of mice at 40 weeks of age. In this proposal we will further develop and exploit this model through the following specific aims: 1. To identify differentially expressed genes between noninvasive and invasive endometrial lesions in Pten/Mlh1-/- mice with Affymetrix oligonucleotides microarrays. 2. To ascertain if selected candidate genes found to be differentially expressed in complex atypical hyperplasia and endometrioid carcinoma in the mouse model (Aim 1) are useful markers of invasive disease in humans. 3. To determine the effect of exogenous estrogen and progestational compounds on endometrial tumorigenesis in Pten mice using light microscopy, immunohistochemistry and molecular techniques. 4. To evaluate the role of the estrogen receptor alpha on endometrial tumorigenesis in Pten +/- mice. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: MUCOSAL IMMUNITY IN THE HUMAN FEMALE REPRODUCTIVE TRACT Principal Investigator & Institution: Wira, Charles R.; Professor of Physiology; Physiology; Dartmouth College 11 Rope Ferry Rd. #6210 Hanover, Nh 03755 Timing: Fiscal Year 2001; Project Start 01-NOV-1993; Project End 28-FEB-2003 Summary: The overall goal of our multi-disciplinary Program Project is to understand the mucosal immune system in the human reproductive tract (FRT). The Program Project brings together endocrinologists and immunologists to characterize epithelial cell, myeloid cell and lymphocyte functions in the reproductive tract and obtain an integrated understanding of endocrine and cytokine control of the mucosal immune system in FRT. Our overall hypothesis is that the FRT is fully immunocompetent, and is regulated throughout the menstrual cycle and following menopause by sex hormones, cytokines and growth factors. The proposed studies focus on the presence and function of immune cells in reproductive tract issues from women undergoing hysterectomy. Sex hormone and cytokine regulation of reproductive architecture, antigen presentation, and myeloid cell and lymphocyte function will be investigated to obtain an integrated understanding of mucosal immune function in the Fallopian tube, uterus, cervix and vagina. Support the for 3 research projects will provided by 3 cores: Administrative, Tissue Procurement and Technical Support. The first Project will determine whether immune cell organization in the FRT varies with the stage of menstrual cycle and menopause. We will test the hypothesis that steroid hormones and cytokines differentially regulate the organization and function of immune cells with
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microenvironments of FRT tissues. The second Project will assess the inductive arm of the mucosal immune system in the FRT. The hypothesis to be tested is that epithelial cells, macrophages, dendritic cells and B cells throughout the FRT present antigen. We will assess how antigen presentation is influenced by endocrine balance and whether FRT antigen presentation can be enhanced by receptor (pIgR and FcR) targeting. The third project will define the response arm of the mucosal immune system in the FRT. The hypothesis to be tested is that lymphocytes provide protection against pathogens while maintain reproductive function. These studies will determine whether selective loss of CTL function in the uterus during the secretory phase of the menstrual cycle is down-regulated by FRT leukocytes. These studies will increase our presently limited understanding of immune protection of the female reproductive tract and should provide the basis of knowledge essential for the prevention of local infection in the genital mucosa, the management of sexually transmitted diseases, and insight into the heterosexual transmission of HIV-1. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: OPIOID INDUCED POSTOPERATIVE SLEEP DISTURBANCES Principal Investigator & Institution: Cronin, Arthur; Pennsylvania State Univ Hershey Med Ctr 500 University Dr Hershey, Pa 17033 Timing: Fiscal Year 2001 Summary: This study will test the hypothesis that opioids contribute to postoperative sleep disturbance. Additionally, this study will determine whether the adverse effects of sleep disturbance on the cardiovascular, respiratory and central nervous systems are less pronounced in patients treated with regional local anesthetic instead of opioids for postoperative pain control. Finally the hormone condition corresponding to sleep disruption will be examined to evaluate the influence of stress hormones and the response of melatonin, a hormone controlled by the circadian rhythym. The primary aim is to determine if opioids contribute to postoperative sleep disturbance. Patients undergoing abdominal hysterectomy will be randomly assigned to receive epidural opioid or local anesthetic for postoperative pain control. The patients' sleep will be monitored on the night before surgery and on the first three posoperative nights by recording the electroencephalogram and electromyogram. For each patient the amount of REM sleep and NREM sleep on the preoperative night will be compared with the amounts on the postoperative nights. We expect to observe greater differences before and after surgery in theses sleep stages in the opioid group, We expect preservation of a more normal sleep cycle in the local anesthetic group. Because surgical stress and pain are potential contributers to sleep disruption, we will measure stress hormones in the urine (catecholamines and cortisol) and blood (interleukin-1) as well as record the patients' subjective rating of their pain. The second aim is to determine if postoperative sleep disturbance is clinically significant. Studies have shown that sleep deprivation with consequent REM rebound can cause impaired cognitive performance, breathing disturbance, and hemodynamic instability. Daily tests of cognitive function and overnight recordings of respiratory rate, arterial oxygen saturation, blood pressure and the electrocardiogram will be performed. We hypothesize that the complications of sleep deprivation demonstrated in normal volunteers will occur in postoperative patients who are already under intense physiologic stress. The final aim is to test the hypothesis that melatonin, a hormone controlled by the circadian rhythym, will be supressed during the nights of sleep deprivation. Abnormally low levels of melatonin have been measured in elderly insomniacs, and administration of melatonin to these patients has improved their sleep. If postoperative sleep distruption is associated with
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abnormally low levels of melatonin in the blood, then administration of melatonin might be a potential treatment for postoperative sleep disturbance. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: OVARIAN HYPOGONADISM
CANCER
RISK
AND
HYPERGONADOTROPIC
Principal Investigator & Institution: Cramer, Daniel W.; Professor; Brigham and Women's Hospital 75 Francis Street Boston, Ma 02115 Timing: Fiscal Year 2001; Project Start 17-APR-1992; Project End 28-FEB-2003 Summary: (Adapted from Investigator's Abstract) In 1992, the investigators began a population-based case-control study of ovarian cancer in eastern Massachusetts and New Hampshire to identify factors affecting risk through a pathway of oocyte-depletion and gonadotropin stimulation. Consumption and metabolism of milk sugar (galactose) was of interest based on evidence that this sugar is toxic to oocytes. Homozygosity for a mutation known as N314D of galactose transferase (GALT) or heterozygosity for mutations that more severely affect activity such as Q188R are found to increase risk for ovarian cancer, especially for endometrioid and clear cell (E/CC) types. Risk factors for these cancers also included earlier onset of, more regular, and shorter cycles--a pattern indicative of greater opportunity for retrograde menstruation and endometriosis, a possible precursor of E/CC cancers. Their search for other genetic factors revealed that 20% of ovarian cancers occurring in Jewish women at any age and 37.5% in Jewish women diagnosed
Project Title: OVARIAN FAILURE AMONG HYSTERECTOMIZED WOMEN Principal Investigator & Institution: Moorman, Patricia G.; Assistant Professor; Community and Family Medicine; Duke University Durham, Nc 27706
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Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-AUG-2008 Summary: (provided by applicant): Early menopause may increase the risk of osteoporosis, cardiovascular disease, and all-cause mortality. For approximately 20% of the female population, age at menopause is unknown because they had a hysterectomy without bilateral oophorectomy before their menstrual periods ended. There is some evidence to suggest that hysterectomized women who retain their ovaries are likely to experience ovarian failure earlier that women who go through natural menopause, however most prior studies had important limitations, including small sample size, lack of comparison group, and imprecise measures of menopausal status. In the proposed 5year study, we will investigate whether hysterectomized women who retain at least one ovary are more likely to experience ovarian failure than women of similar age who have an intact uterus and ovaries. We will recruit 500 premenopausal women aged 30 to 47 years who are undergoing hysterectomy without bilateral oophorectomy at Duke University Medical Center or Durham Regional Hospital, and 500 non-hysterectomized, premenopausal women frequency matched on age and race from gynecology practices in the Durham, North Carolina area. At baseline, all women will have a blood sample drawn and complete an interview focusing on reproductive, hormonal, and lifestyle characteristics that may be related to ovarian function. Serum samples will be analyzed for follicle stimulating hormone (FSH), luteinizing hormone (LH), and estradiol. Women will be recontacted annually to have another blood sample drawn and update questionnaire information, particularly menopausal symptoms and hormone use. Menopausal status at each follow-up will be determined for all women using an algorithm based on measurements of FSH, estradiol, and LH. The primary goals of the study are: 1) to determine whether the risk of ovarian failure during the approximate 4 years of follow-up is greater for hysterectomized women than non-hysterectomized women, and 2) to evaluate the associations between medical, reproductive, and lifestyle characteristics and early ovarian failure. Hysterectomy is the most common nonobstetrical surgery in the United States, with over 600,000 procedures performed each year. The proposed study will contribute greatly to our understanding of the long-term effects of hysterectomy on ovarian function. It should have considerable public health impact given the high frequency of the procedure and the important health consequences of early ovarian failure. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: PHYSICAL ACTIVITY, OVARIAN AND ENDOMETRIAL CANCER RISK Principal Investigator & Institution: Bernstein, Leslie; Senior Associate Dean, Faculty Affairs/; Preventive Medicine; University of Southern California 2250 Alcazar Street, Csc-219 Los Angeles, Ca 90033 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-AUG-2004 Summary: (provided by applicant): Physical activity has numerous health benefits including a reduction in risk of colon and breast cancer. Physical activity may also alter the risk of endometrial cancer and epithelial ovarian cancer. Few studies have examined these potential relationships. Most prior studies have been case-control studies or record linkage studies that have used surrogate measures of activity. We propose to utilize data collected as part of the California Teachers Study (CTS), a cohort study of 133,479 female teachers and school administrators that was initiated in 1995, to address whether 1. Women who engage in moderate and strenuous physical activity for 4 or more hours per week on average, have a reduced risk of endometrial cancer and of ovarian cancer; 2. Strenuous physical activity provides greater protection against endometrial cancer
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and ovarian cancer than does moderate physical activity. Additionally we propose to analyze data collected from a group of population-based control subjects to compare their responses to the self-completed, mailed CTS questionnaire on physical activity to their responses to an in-depth, in-person interview that collected lifetime history of physical activity to determine whether the two types of questionnaires measure the same or different aspects of physical activity and to determine whether demographic or other factors affect the comparability of information derived from the two questionnaire approaches. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: PITTSBURGH COLLAB RECONSTRUCTIVE PELVIC SURGERY PROGRAM Principal Investigator & Institution: Zyczynski, Halina M.; Associate Professor; MageeWomen's Health Corporation 204 Craft Ave Pittsburgh, Pa 15213 Timing: Fiscal Year 2001; Project Start 01-SEP-2001; Project End 30-JUN-2006 Summary: The faculty of the University of Pittsburgh School of Medicine Departments of Gynecology, Urology, Geriatric Medicine, Gastroenterology and Colon and Rectal Surgery have collaborated to form the UPMC Center for Continence and Pelvic Floor Disorders. Our health care system with over 25 hospitals and outpatients facilities is an outstanding resource for research subject recruitment. Our proven ability to hold leadership positions in the NIH sponsored multicenter surgical trials and to perform a large number of reconstructive pelvic surgeries per year make us a valuable contributor to the Clinical Trials Network for Female Pelvic Floor Disorders. We propose a study protocol assessing two commonly performed reconstructive approaches to posthysterectomy pelvic organ prolapse PH-POP: the transabdominal abdominal sacral colpopexy with paravaginal defect repair and Burch vs. the transvaginal sacrospinous ligament suspension of the vaginal apex with colporrhaphies and sling. Surgical success will be determined by a satisfactory and sustained support of the prolapsing vagina and pelvic visceral function. This proposed randomized trial with three year follow-up will 1) assess the short and long-term outcomes of the two approaches, 2) determine specific patient characteristics that predispose patients to surgical failure, 3) assess the components of an optimal cost effective preoperative workup. In addition, we will study the impact of adjuvant Pelvic Floor Muscle Exercises on postoperative support and continence, improvement in quality of life and patient satisfaction with the surgical procedure. This data will yield valuable clinical information and will help address the regional and specialty variation in the evaluation and treatment of women with PHPOP. We are committed to adhering to the final protocol of the network. Our investigators have unique expertise in assessment of bladder dysfunction and pelvic floor physical therapy. The surgical team is proficient in both surgical approaches and comfortable with the concept of a randomized surgical trial. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: PREEMPTIVE ANALGESIA IN RECOVERY FROM HYSTERECTOMY Principal Investigator & Institution: Ochroch, Edward A.; Anesthesia; University of Pennsylvania 3451 Walnut Street Philadelphia, Pa 19104 Timing: Fiscal Year 2001; Project Start 11-SEP-2001; Project End 31-AUG-2006 Summary: (provided by applicant): Over half of the over 23 million surgical procedures are accompanied by inadequately treated pain. Pain interferes with bodily functions such as breathing, blood pressure regulation, digestion etc. It inhibits the patient s
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ability to participate in postoperative care regimens, and clearly increases the risk of postoperative respiratory complications. After discharge, the poorly controlled pain continues to plague patients. The pain associated with surgery can lead to chronic pain syndromes due to sensitization of the central nervous system (CNS). We have chosen to use trans-abdominal hysterectomy (TAH) as a model operation because 600,000 women a year have hysterectomies, and women are more prone to suffering chronic painful syndromes. Preemptive analgesia is an intervention designed to decrease pain and improve patient recovery from surgery by initiating an analgesic regimen prior to the onset of the painful stimuli. There is clear animal based research and a growing body of human clinical research that preemptive analgesia can reduce pain and analgesic needs following surgery. Recent work has extended the proof of benefits in the form of decreased pain and increased activity to well after discharge from the hospital. This research application proposes to examine the short- and long-term benefits of aggressive preemptive epidural analgesia in patients undergoing TAR Pain during hospitalization and after discharge, activity levels, and return to preoperative function will be quantitatively assessed with validated outcome measures. Dr. Ochroch, an Assistant Professor of Anesthesiology at the University of Pennsylvania, is applying for a Clinical Investigator Award (K23) to pursue an academic career focusing on improving recovery from surgery. He has a serious interest in this area as evidenced by his involvement in current and proposed research. This application requests support to allow him to undertake a comprehensive career development program including: 1) a Masters in Biostatistics and Epidemiology under the mentorship of Dr. Brian Strom, 2) a research preceptor ship with Drs. John Farrar and Allan Gottschalk and Mark Morgan, and 3) the proposed research project. These activities will provide him with the skills and experience to pursue a successful career of meaningful funded research as an independent investigator. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: PSYCHOSOCIAL HYSTERECTOMY
INTERVENTION
PROGRAM
FOR
Principal Investigator & Institution: Caldwell-Andrews, Alison A.; Anesthesiology; Yale University 47 College Street, Suite 203 New Haven, Ct 065208047 Timing: Fiscal Year 2003; Project Start 15-JAN-2003; Project End 31-DEC-2004 Summary: (provided by applicant): Many reviews of research in the area of preparation for surgery have concluded that psychological preparation for surgery results in an improved postoperative recovery. Although some studies have involved patients undergoing hysterectomy, and there are existing information-based programs specific to hysterectomy patients, at this time there are no empirically validated psychological preparation programs specifically designed for women undergoing hysterectomy. The goal of this study is to refine an already-developed cognitive-behavioral preparation program for women undergoing hysterectomy, and to evaluate the efficacy of this program in terms of its ability to lower preoperative anxiety. A manual and psychological preparation program for women undergoing hysterectomy has been developed by our study group. Pilot study data suggests that there is some evidence that this program is an effective one. Our study group's experience with this pilot study and the preparation program will help inform refinement of the intervention and methods for evaluating this intervention in a more powerful and thorough study. After this investigation is completed and if the psychological preparation program has been shown to reliably reduce preoperative anxiety in women undergoing hysterectomy, this program will be used as part of a larger study (not a part of this small grant application)
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which wilt examine reduction of preoperative anxiety and its impact on various important physiological and psychological postoperative recovery outcomes. The primary aim, therefore, of this small grant application is to evaluate the effects of this psychological preparation program for women undergoing hysterectomy on preoperative anxiety. The proposed study design is a randomized controlled trial (2 condition by 2 assessment-interval factorial design) examining two conditions: women who receive the psychological preparation program (PPP group) and women who receive preparation that is standard of care (SC group). In this proposed study, 158 women scheduled to undergo hysterectomy at Yale-New Haven Hospital will be assigned to the PPP or SC group. Participants will be 20-60 years of age and in good health. Both groups will complete a baseline questionnaire packet measuring state anxiety 2-3 weeks prior to their operation. The psychological preparation program will be administered one week before surgery, and both groups of women will complete a measure of their state anxiety on the evening before surgery, and undergo sleep assessment via actigraphy on the night before surgery. The primary endpoint of this study is patient's state anxiety the evening before surgery. The secondary endpoint is the patient's quality of sleep the night before surgery. We hypothesize that women in the PPP group will have lower state anxiety and higher quality of sleep the evening before surgery than women in the SC group. Data will be analyzed using repeated measures analysis of covariance. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: RDNA METHYLATION AND PROGNOSIS IN ENDOMETRIAL CANCERS Principal Investigator & Institution: Goodfellow, Paul J.; Professor; Surgery; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130 Timing: Fiscal Year 2003; Project Start 01-AUG-2003; Project End 31-JUL-2004 Summary: (provided by applicant) Endometrial cancer is the most common primary gynecologic malignancy in the United States, with over 39,000 new cases diagnosed each year. Most women in the US present with endometrioid endometrial carcinoma. This histologic subtype carries a favorable prognosis, with an overall 5-year survival that approaches 90%. Despite the fact that most patients are cured with surgery, recurrent endometrioid adenocarcinoma is a significant cause of mortality. Adjuvant radiation therapy, given in an attempt to eliminate any remaining tumor cells, is often a part of the treatment plan for women who are at increased risk for recurrent disease. In women with early stage (I and II) endometrial carcinoma, the use and benefits of adjuvant therapy are controversial. Radiation therapy carries a significant risk for complications. Furthermore, the costs for radiation therapy are considerable. In a large multicenter randomized trial of adjuvant therapy for intermediate risk endometrioid adenocarcinoma, it was demonstrated that pelvic radiation significantly decreased recurrences but brought about only a small, non-statistically significant improvement in overall survival. There is a need to find a balance between the increased cost and morbidity that comes with adjuvant radiation therapy, and the reduction in the recurrences for women with intermediate risk disease. A molecular marker to identify those patients who are at very low-risk for recurrence could help avoid unnecessary adjuvant therapy and by doing so, lessen the morbidity and expense associated with treating endometrial cancer. Conversely, a marker for high-risk disease could help target the use of adjuvant therapy. Furthermore, the ability to recognize those women at higher risk for aggressive or deadly disease prior to hysterectomy could have a positive effect on how this group of women is cared for. The long-term goal for the marker
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studies proposed here is to combine molecular stratification and conventional risk assessment in prospective randomized trials. In this application we propose to develop a new method to analyze methylation of rDNA sequences in clinical tumor specimens. We previously demonstrated that rDNA methylation was an independent prognostic marker in patients with endometrioid endometrial adenocarcinoma. We will develop 1) Pyrosequencing TM methods to assess rDNA methylation in tumor DNAs, 2) apply the rDNA Pyrosequencing TM methylation analyses to clinical specimens (paraffinembedded, formalin-fixed hysterectomy and pre-hysterectomy, biopsies) and 3) in the R33 phase of the application, we will use these methods to assess the prognostic and diagnostic significance of Pyrosequencing TM rDNA methylation in a consecutive series of women with endometrioid adenocarcinoma. These studies are designed to determine whether tumor rDNA methylation could serve as a prognostic and diagnostic marker in both pre-hysterectomy and hysterectomy specimens from women with endometrial cancer, rDNA methylation analyses could ultimately be used to help guide the treatment of endometrial cancer patients Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: REACTIVE OXYGEN SPECIES REGULATE SMOOTH MUSCLE GROWTH* Principal Investigator & Institution: Nowak, Romana A.; Animal Sciences and Veterinary Pathobiology; University of Illinois Urbana-Champaign Henry Administration Bldg Champaign, Il 61820 Timing: Fiscal Year 2003; Project Start 26-SEP-2003; Project End 31-JUL-2008 Summary: (provided by applicant): Uterine leiomyomas, or fibroids, are the most common pelvic tumors in women and are the primary indication for hysterectomy in the US. The incidence of symptomatic leiomyomas is 3-6 times higher in African American women than in other groups. While there may be a genetic component to this increased incidence we believe other factors may play a role. African-Americans show an increased incidence of hypertension, obesity and diabetes. Studies have shown that factors such as angiotensin II, serotonin and oleic acid, which are elevated in the bloodstream of patients with hypertension or obesity, have significant effects on proliferation and matrix production by vascular smooth muscle cells (SMCs) in response to injury. These factors, along with growth factors, regulate growth and differentiation of SMCs via a signaling pathway involving the production of reactive oxygen species (ROS). We hypothesize that similar ROS-dependent mechanisms are involved in the regulation of leiomyoma SMCs. The specific aims of this proposal are: 1. To determine whether ROS are a critical component of the EGF and PDGF signalling pathways in leiomyoma SMCs. 2. To determine whether angiotensin II, serotonin and oleic acid regulate proliferation and extra-cellular matrix production by leiomyoma SMCs and to determine whether these molecules act through their own receptors and/or by transactivating EGF or PDGF receptors. We will also determine the role of ROS in both of these activation pathways. 3. To determine whether halofuginone inhibits growth factor-stimulated proliferation and collagen production by leiomyoma SMCs by either inhibiting the increase in intracellular ROS or one of the downstream targets of ROS. The efficacy of halofuginone in an animal model of leiomyomas will also be assessed. The overall goal of this proposal is to elucidate the role of ROS in the signaling pathways that regulate growth and differentiation of leiomyoma SMCs. Molecules that inhibit ROS production or inhibit downstream targets of ROS may prove to be useful therapeutic agents for the treatment of leiomyomas. Halofuginorle has been shown to inhibit neointimal formation by vascular SMCs in rats undergoing angioplasty and
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tumor formation in nude mice. We believe halofuginone may act by inhibiting ROSdependent signaling pathways in these cells as well as in leiomyoma SMCs. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: REGULATION OF UTERINE FIBROIDS BY CCN5 Principal Investigator & Institution: Castellot, John J.; Anatomy and Cellular Biology; Tufts University Boston Boston, Ma 02111 Timing: Fiscal Year 2003; Project Start 26-SEP-2003; Project End 31-JUL-2008 Summary: (provided by applicant): The long-term goal of this project is to elucidate the cellular, molecular, and biochemical mechanisms regulating the proliferation and motility of human uterine smooth muscle cells (UtSMC). UtSMC hyperproliferation is the cause of fibroids, a condition that afflicts 20-25% of all women and 75% of AfricanAmerican women. Fibroids cause severe pain and bleeding, impair fertility, and result in >200,000 hysterectomies annually in the U.S. There is no known treatment--medical or surgical--that permanently reduces or eliminates fibroids, other than hysterectomy. Clearly, a detailed understanding of the mechanisms and molecules that regulate UtSMC mitogenesis and migration will provide a therapeutic rationale for controlling fibroids, and may provide important insights into the pathophysiologic basis for fibroid formation. Our laboratory has provided strong evidence that CCN5, an estrogeninduced growth-arrest specific gene, inhibits proliferation and motility in cultured UtSMC. Furthermore, we have demonstrated that human leiomyomas have greatly reduced levels of CCN5 mRNA and protein compared to normal myometrium from the same uterus. Based on this evidence the following hypothesis will be tested: CCN5 is an autocrine regulator of UtSMC proliferation and motility in culture and in vivo, and exerts it anti-proliferative and anti-motility effects, at least in part, through regulation of extracellular matrix synthesis and composition. To test this hypothesis, we will: 1) Continue our functional analysis of CCN5 and its regulation by estrogen on proliferation, motility, and extracellular matrix in SMC cultured from matched pairs of normal and fibroid human uterine tissue. To do this we will use adenovirus vectors, recombinant CCN5, and small inhibitory RNA approaches. 2) Examine the physiologic functions and estrogen regulation of CCN5 in animal models, including normal cycling rats, ovariectomized rats, pregnant rats, wild-type mice, and genetically manipulated mice that either under- or over-express CCN5. Quantitative PCR, Western blot analysis, and immunohistochemistry will be used to determine the spatial and temporal expression pattern and estrogen regulation of CCN5 in each of these animal models. We will also explore the possibility that CCN5 gene or protein therapy might be a useful approach for suppressing human fibroids in a novel nude mouse model system. The experiments proposed in this application should provide new and important insights into UtSMC pathophysiology in humans. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: REPRODUCTIVE AND HORMONAL RISK FACTORS FOR ADENOMYOSIS Principal Investigator & Institution: Holt, Victoria L.; Professor; Fred Hutchinson Cancer Research Center Box 19024, 1100 Fairview Ave N Seattle, Wa 98109 Timing: Fiscal Year 2002; Project Start 01-MAR-2002; Project End 31-JAN-2007 Summary: Adenomyosis, also known as internal endometriosis, is the progressive invasion of endometrial glands and stroma from the uterine endometrial lining down into the myometrium, the inner muscle wall of the uterus. This condition is diagnosed in
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over 150,000 women in the U.S. annually, can be associated with severe pelvic and menstrual pain and excessive bleeding, and almost always requires hysterectomy for definitive treatment. Clinical observations have raised the hypothesis that multiparity and excessive estrogen may increase disease risk; however, there is little epidemiologic data to confirm or deny this hypothesis. Consequently, we propose to conduct a casecontrol study to investigate the relationships between adenomyosis and reproductive and hormonally-related exposures, including polymorphisms in genes involved in steroid hormone synthesis and metabolism. The study will be conducted at Group Health Cooperative of Puget Sound (GHC), a health maintenance organization serving approximately 500,000 people in western Washington State. Cases will be 500 female GHC enrollees 18-59 years of age diagnosed with adenomyosis between March 1, 2001 and Feb. 28, 2006. Two control groups will be used: 1) 500 women undergoing hysterectomy during the study period who are found to have a condition other than adenomyosis, endometriosis, or leiomyoma, frequency matched to cases on age, and 2) 500 women randomly selected from computerized enrollment files, also frequency matched to cases on age. Data will be obtained from cases and controls by in-person interview, anthropometric measurement and collection of a blood sample for DNA analysis; and these data will be linked with the GHC computerized pharmacy database. Subjects will be interviewed regarding factors known or suspected to be associated with uterine trauma or steroid hormone levels (including reproductive, contraceptive, and menstrual histories; obesity; exercise; diet; cigarette smoking) as well as other potential risk factors for adenomyosis. Blood samples will be analyzed for two polymorphic genes coding enzymes active in estrogen metabolism (CYP17, COMT). Analyses comparing cases and controls with respect to reproductive and hormonal risk factors and their interactions with genetic polymorphisms will be conducted to address the specific aims. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: REPRODUCTIVE RISK FACTORS FOR PELVIC ORGAN PROLAPSE Principal Investigator & Institution: Brown, Jeanette S.; Professor and Director; Ob, Gyn and Reproductive Scis; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 94122 Timing: Fiscal Year 2001; Project Start 25-SEP-2001; Project End 31-AUG-2005 Summary: (provided by applicant): Pelvic organ prolapse is a common problem among middle-aged and older women and risk factors for the development of pelvic organ prolapse are not well defined. While childbirth has been identified as a risk factor for pelvic organ prolapse, there has been limited research on the relationship between specific parturition events and the occurrence of pelvic organ prolapse in later life. Currently, we are conducting the Reproductive Risk factors for urinary Incontinence Study at Kaiser (RRISK), a 4-year funded study to determine the association between specific childbirth events, hysterectomy, hormone use and subsequent urinary incontinence. This retrospective cohort study will enroll 2100 community-dwelling, ethnically diverse women ages 40 to 69 on which there are continuous medical records since the age of 18. All participants had extensive assessment of urinary incontinence and potential risk factors using self-report, in-person interview, and chart abstraction of labor and delivery and surgical records. We propose randomiy selecting a 1100 participant subsample of the RRISK cohort to objectively assess pelvic organ prolapse using the Pelvic Organ Prolapse Quantitation staging system. Our specific aims over the next 4 years are to detennine the prevalence of prolapse by vaginal segment and severity (Stage I- IV), and age group. The ethmc diversity of study subjects will allow comparison of prevalence estimates between major ethnic groups; to determine the
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association between specific aspects of parturition and development of prolapse in later life; to ascertain the association between hysterectomy (type and indication) and subsequent prolapse; To identify other potential risk factors (heavy lifting, obesity, medical illness, etc.) for prolapse, especially those that are preventable or modifiable; and to describe the associations of pelvic organ prolapse with urinary and fecal incontinence and to compare risk factors for each of these conditions. Our proposed study of reproductive risk factors for prolapse in a well- characterized representative cohort of community-dwelling women will provide an adequate sample size, excellent outcome measures, and extensive reliable data on a range of risk factors for pelvic organ prolapse, including chart abstracted information on important aspects of reproductive history. Identification of risk factors for prolapse will help guide the development of preventive intervention trials to test the efficacy of modifying risk factors for pelvic organ prolapse. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: SLEEP IN OLDER WOMEN--EFFECTS OF ESTROGEN Principal Investigator & Institution: Moe, Karen E.; Psychiatry and Behavioral Scis; University of Washington Seattle, Wa 98195 Timing: Fiscal Year 2001; Project Start 01-MAY-1998; Project End 31-OCT-2003 Summary: (adapted from investigator's abstract): Sleep complaints increase significantly with age in both men and women, but the increase is especially striking in women. Older women experience more nighttime awakenings, longer sleep onset latencies, and "lighter" sleep. Insomnia, disrupted sleep, and consequent daytime drowsiness are associated with an increased risk of accidents, increased utilization of health care and sedative-hypnotic medications, and a reduced quality of life. Older women receive a disproportionate number of prescriptions for sedative-hypnotics, which can exacerbate sleep apnea and lead to daytime carryover effects such as sedation, falls and subsequent fractures, and cognitive impairment. A better understanding of the sleep changes experienced by older women is sorely needed. One contributing factor may be agerelated changes in sex steroids such as estrogen. The very low levels of estrogen that occur post-menopause have wide-ranging chronic effects, from increased cardiovascular risk factors to possible effects on memory. Sleep changes in older women may also be related to this dramatic change in hormonal milieu. Several studies have shown that ERT can improve the sleep of peri-menopausal women, and our preliminary data shows that the use of ERT is associated with better sleep in older post-menopausal women. Estrogen acts on several brain areas important for sleep and circadian rhythms (e.g., the suprachiasmatic nucleus, the hypothalamic pre-optic area, and the pineal gland). Previous studies of ERT effects on sleep were based on peri-menopausal women who were experiencing hot flashes and/or other menopausal symptoms including depression. All but a few of these studies were based on brief subjective sleep ratings. No published studies have examined the effect of ERT on the sleep of post-menopausal women., i.e., women who are several years past menopause, menopausal symptoms, and menopause-related hormone fluctuations. The proposed study will employ laboratory-based polysomnography and a randomized, placebo-controlled withinsubjects design to assess the effect of six months ERT or placebo on the sleep and circadian rhythms of post-menopausal women. The results will help determine the role of age-related estrogen decline in the decreased sleep quality of older women. This study is the first step in a research program investigating the relationship between sex steroids and sleep in older individuals. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: SOYFOOD, GENE POLYMORPHISMS AND ENDOMETRIAL CANCER RISK Principal Investigator & Institution: Shu, Xiao O.; Professor of Medicine; Medicine; Vanderbilt University 3319 West End Ave. Nashville, Tn 372036917 Timing: Fiscal Year 2001; Project Start 25-SEP-2001; Project End 31-AUG-2006 Summary: (provided by applicants): Estrogen plays a central role in the etiology of endometrial cancer. The association of exogenous estrogen use and high endogenous hormone exposure with endometrial cancer has been well characterized. The effect of soyfoods, rich source of phytoestrogens that have both weak estrogenic and antiestrogenic effects, has only been studied in two studies and results were inconsistent. Given the dual effect of phyotoestrogens, we hypothesize that the effect of phytoestrogens on endometrimum depends on the levels of endogenous estrogens. The level and biological effect of estrogens are determined by multiple genes and thus the risk of endometrial cancer may be associated with genetic polymorphisms of genes involved in estrogen biosynthesis, metabolism, binding and signaling, and their joint effect with soyfood intake and other lifestyle factors. To evaluate the above hypotheses, we propose to conduct a population-based case-control study including 1150 incidence cases and 1150 age-matched controls in urban Shanghai. In-person interviews will be conducted to collect dietary and other exposure information. A 10-ml peripheral blood sample (or a buccal cell sample if blood sample could not be obtained) will be collected from all cases and controls. Genomic DNA will be analyzed for the genotypes of the genes involved in estrogen biosynthesis (CYPI7, CYP19, and HSD17B1), inactivation (SUTL1AI, UGT1, and COMT), binding (SHBG), and signal transduction (ER-a and ERb). Associations of endometrial cancer with soyfood intake and polymorphisms of above-mentioned genes will be evaluated separately, jointly and in conjunction with conditions related to estrogen levels (e.g., obesity, physical activity, dietary fat intake, and menopausal status). Incidence rate and prevalence rates of traditional risk factors (e.g., estrogen replacement therapy, obesity, nulliparity) of endometrial cancer are considerable low among women in Shanghai than their counterparts in the US, and this will minimize potential confounding effects in testing new hypotheses. Consumption level of soyfood is high and hysterectomy rates are extremely low among Chinese women, providing a unique opportunity to test the hypotheses posed in the application that are difficult to be evaluated in the U.S. population. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: STUDY OF ESTROGEN REPLACEMENT IN PATIENTS WITH ALZHEIMER'S DISEASE Principal Investigator & Institution: Growdon, John H.; Massachusetts General Hospital 55 Fruit St Boston, Ma 02114 Timing: Fiscal Year 2001 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: SURGICAL TREATMENTS OUTCOME PROJECT FOR DUB FOLLOWUP Principal Investigator & Institution: Dickersin, Kay P.; Associate Professor; Community Health; Brown University Providence, Ri 02912 Timing: Fiscal Year 2003; Project Start 30-SEP-1996; Project End 29-SEP-2004
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Summary: (provided by applicant): The overall objective of the Surgical Treatments Outcomes Project for Dysfunctional Uterine Bleeding Follow-up Study (STOP-DUB/FS) is to assess the long-term effectiveness of hysterectomy versus endometrial ablation (EA) in women with dysfunctional uterine bleeding (DUB). The primary outcomes of STOP-DUB/FS are bleeding, pain, fatigue, and whether the problem that led the women to seek care is solved at 4 years post-surgery. Additional outcomes include health related quality of life, sexual function, urinary incontinence, adverse events, reoperation rate and costs. STOP-DUB will continue to involve Clinical Centers in the US and Canada, as well as the American College of Obstetricians and Gynecologists. STOPDUB is the only US-based randomized clinical trial that compares surgical alternatives to hysterectomy for patient-based outcomes and costs associated with treatment. STOPDUB was funded in 1996 under a Request For Applications that proposed patient follow-up for 2 years. Extension of STOP-DUB follow-up to at least 4 years is essential to confirm recent results from a UK randomized trial. The UK trial found that while hysterectomy and EA both result in similar short term patient satisfaction, EA is associated with re-operation rates of nearly 40 percent by 4 years post-surgery. Thus, EA may not be a cost effective alternative. STOP-DUB randomized and collected baseline data on 237 patients recruited at 25 Clinical Centers. As of June 7, 2002, 213/237 (90 percent) patients re-consented to extended follow-up, 206/213 (97 percent) remain enrolled, and the median length of follow-up is 24 months. By 1 year post-surgery, 16.5 percent of STOP-DUB randomized patients who received EA had reported additional surgery for DUB. This re-operation rate is considerably less than that of 29 percent rate at 1 year post-surgery reported by the UK trial. Data collected in STOP-DUB/FS will involve telephone interviews every 6 months and notification by Clinical Centers of reoperation, intercurrent visits, and adverse events. Hospital bills will continue to be requested and abstracted every 6 months. Our efforts in all years will focus on patient follow-up, data processing and analysis, and publication. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: TRIAL TO REDUCE ANTIMICROBIAL PROPHYLAXIS ERRORS Principal Investigator & Institution: Kritchevsky, Stephen B.; Preventive Medicine; University of Tennessee Health Sci Ctr Health Science Center Memphis, Tn 38163 Timing: Fiscal Year 2002; Project Start 16-AUG-2002; Project End 31-JUL-2006 Summary: (APPLICATION ABSTRACT): Both epidemiologic studies and randomized trials have shown that many surgical site infections (SSI) are preventable with appropriately timed antimicrobial prophylaxis. Patients receiving prophylaxis either well before or well after surgery are up to five times more likely to develop an SSI than those receiving appropriate therapy (Classen et al., 1992). Unfortunately, errors in antimicrobial prophylaxis timing are extremely common, with error rates typically reported to be between 35 and 40 percent. Given that errors in antimicrobial prophylaxis are so common and the consequences of error so grave, identifying methods to assist hospitals in improving prophylaxis must be a high priority. We propose to evaluate a multifaceted, theory-based intervention to assist hospitals in progressing through stages of organizational change to improve the prophylaxis process. We will test the impact of the intervention using a rigorous group-randomized, nested, pretest-posttest design (Murray, 1998). Our specific aims over the four-year project period are: 1) Determine the incidence of medication errors related to antimicrobial prophylaxis for cardiovascular surgery, joint replacement surgery, and hysterectomy in 40 hospitals recruited to participate in the study; 2) identify organizational and system factors associated with error rates; and 3) randomize the 40 hospitals to evaluate the effectiveness of a
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multifaceted intervention. The intervention consists of a) the promotion of two specific process changes (the elimination of "on-call" ordering and the use of preprinted prophylaxis orders); b) a site visit; c) customized process feedback; d) facilitated benchmarking; and e) peer consultation. The 20 intervention hospitals will be compared with 20 hospitals that receive written feedback of their error rates only. The study has 80-percent power to detect a 12- to 15-percent improvement in the timing of prophylaxis in the full intervention group compared with the group that receives written feedback only. Data collection will be done at each participating hospital, and the medical records of 100 surgical patients before and after the intervention will be abstracted at each hospital to establish performance rates. Changes in the processes of care and the evolution through stages of organizational change will also be assessed. This application represents the combined efforts of three organizations devoted to improving patient care through error reduction: the Society for Healthcare Epidemiology of America, the Joint Commission on Accreditation of Healthcare Organizations, and the Centers for Disease Control and Prevention. Health Care Quality & Effectiveness Research SS KRITCHEVSKY, STEPHEN B. Each organization is providing unique abilities and expertise to address the important issue of antimicrobial prophylaxis errors. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: ULTRASOUND ARRAY SYSTEM FOR UTERINE TUMOR THERAPY Principal Investigator & Institution: Keilman, George W.; Sonic Concepts, Inc. 20018 163Rd Ave Ne Woodinville, Wa 98072 Timing: Fiscal Year 2002; Project Start 01-APR-2002; Project End 31-JAN-2004 Summary: High Intensity Focused Ultrasound (HIFU) offers a non-invasive, nonsurgical, bloodless, outpatient treatment option for uterine fibroid tumors. These tumors develop in over half of all women, and account for approximately 30% of all hysterectomies. This proposal will develop an array-based transvaginal HIFU probe with electronic beam control as an optimal method of fibroid treatment. The proximal transvaginal position facilitates optimal penetration control, improved focusing and minimized risk of complication. Phase I focuses on researching aspects of HIFU not yet understood. A combined HIFU array with an imaging array in the center is envisioned, however it could exhibit adverse side lobe energy distributions due to non-linear effects. This issue will be researched with the development of new high intensity hydrophone/thermocouple combination needle probes. Properties will be evaluated in a water tank, gel phantom and animal uterus. The effect of tissue orientation will be investigated and the heating pattern will be visualized with a new clear gel that opacities with heat. In Phase II the arrays will be integrated into an ergonomic probe in preparation for clinical studies in Phase III. Dramatic improvements in patient treatment, reduction in health care costs, reduced recovery time and preservation of women's fertility are the potential results. PROPOSED COMMERCIAL APPLICATION: The goal of this research is to develop a non-surgical, outpatient treatment system for uterine fibroid tumors based upon high intensity focused ultrasound (HIFU). It is anticipated that this treatment will improve patient care, facilitate an alternative to hysterectomy, and result in significantly lower treatment cost. Ultimately, this treatment approach may also provide an option to preserve fertility and improve reproductive outcomes in patients with fibroid tumors. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: URINARY INCONTINENCE--REPRODUCTIVE/HORMONAL RISK FACTORS Principal Investigator & Institution: Thom, David H.; Assistant Professor; Family and Community Medicine; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 94122 Timing: Fiscal Year 2001; Project Start 29-SEP-1998; Project End 31-JUL-2004 Summary: (Adapted from Investigator's Abstract) The proposed epidemiologic study will assemble a retrospective cohort of long-term female members of a large health maintenance organization to determine the association between specific childbirth (parturition) events, hysterectomy, hormone use and urinary incontinence (UI) in later life. The study will also provide important descriptive information on UI by type, age group, ethnicity, severity and age of onset. Childbirth, hysterectomy and hormone use have all been implicated as risk factors for UI based on previous epidemiologic studies. Physiologic studies suggest that pelvic nerve and muscle damage during parturition may be associated with an increased risk for UI in the post-partum period. While UI is relatively uncommon after the immediate post-partum period, its prevalence increases with age. Apparently, however, no study has examined the relationship between specific reproductive events and UI in later life. The proposed study will enroll 2,100 ethnically diverse women ages 40 to 69 who have been members of a large health maintenance organization, Kaiser Permanente Medical Care Program (KPMCP) of Northern California, continuously since age 18. KPMCP has archived medical records for all members since 1946. Onset of UI, as well as lifetime reproductive history and hormone use, will be assessed using life event calendar methods. Type of UI (stress, urge and mixed) will be determined by in-person interviews. The primary outcome variable will be time to onset, by type, of "regular" UI, defined as UI occurring at least once per month for at least 3 consecutive months, exclusive of pregnancy and the first 3 post-partum months. Severity of UI will also be assessed and examined as an outcome. Specific potential risk factors associated with parturition, including use of forceps, episiotomy, oxytocin, perineal tears, anesthesia, length of labor and infant birth weight will be abstracted from the labor and delivery records. Detailed descriptions of hysterectomy/oophorectomy will be abstracted from surgical records. Multivariate analysis will be used to estimate the risk of UI associated with each of the exposure variables of interest independent of other exposure variables and covariables. The investigators note that because UI is a common condition with substantial economic and quality of life impact, identifying modifiable risk factors for UI would have a potentially large impact on public health. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: UTERINE TUMOR TREATMENT USING HIGH INTENSITY ULTRASOUND Principal Investigator & Institution: Vaezy, Shahram; Associate Professor; Sonic Concepts, Inc. 20018 163Rd Ave Ne Woodinville, Wa 98072 Timing: Fiscal Year 2002; Project Start 01-JUN-2000; Project End 30-APR-2004 Summary: (provided by the applicant): High Intensity Focused Ultrasound (HIFU) offers a non-invasive, non-surgical, bloodless, outpatient treatment for uterine fibroid tumors. These tumors develop in over half of all women, and account for approximately 30 percent of all hysterectomies. This proposal will develop an integrated transvaginal HIFU probe and imaging transducer for fibroid treatment. The proximal transvaginal approach facilitates optimal HIFU control, improves aiming and minimizes
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complications. Phase I of this grant successfully constructed a lab prototype HIFU/Imaging unit, measured the speed and attenuation of sound in excised human fibroids, and established optimal treatment parameters (frequency, intensity and dose). Phase II will utilize several imaging modalities to map numerous in-situ fibroid tumors and evaluate the range of uterine and intervening tissue structures in women, develop an anatomically correct integrated HIFU/Imaging clinical prototype probe, evaluate the safety and efficacy of this treatment in sheep studies and evaluate this probe?s placement and imaging characteristics in humans. This grant will develop the properly shaped HIFU probe and investigate the safety and efficacy of HIFU to treat fibroids in Phase Ill human clinical studies. Dramatic improvements in patient treatment, reduced complication rate, reduction in health care costs, reduced recovery time and preservation of a women?s fertility are the potential results. PROPOSED COMMERCIAL APPLICATION: The goal of this research is to develop a non-surgical, outpatient treatment system for uterine fibroid tumors based upon high intensity focused ultrasound (HIFU). It is anticipated that this treatment will improve patient care, facilitate an alternative to hysterectomy, and result in significantly lower treatment cost. Ultimately, this treatment approach may also provide an option to preserve fertility and improve reproductive outcomes in patients with fibroid tumors. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: WOMEN'S HEALTH INITIATIVE Principal Investigator & Institution: Lane, Dorothy S.; State University New York Stony Brook Stony Brook, Ny 11794 Timing: Fiscal Year 2001 Summary: The Clinical trial (CT) will evaluate the benefits and risks of Hormone Replacement Therapy (HRT), Dietary Modification (DM), and supplementation with calcium/vitamin D (CaD) on the overall health of postmenopausal women. Health will be assessed on the basis of quality of life measurements, cause-specific morbidity and mortality, and total mortality. It is hypothesized that estrogen replacement therapy (ERT) and combined progestin and estrogen replacement therapy (PERT) will reduce the risk of coronary heart disease (CHD) and of osteoporosis-related fractures. Women who are post-hysterectomy will be randomized to ERT or placebo, while women with a uterus will be randomized to PERT or placebo. The incidence of endometrial cancer and breast cancer will be monitored during and after the trial. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, 3 4
Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.
With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print.
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and type “hysterectomy” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for hysterectomy in the PubMed Central database: •
Hysterectomy and sexual wellbeing: prospective observational study of vaginal hysterectomy, subtotal abdominal hysterectomy, and total abdominal hysterectomy. by Roovers JP, van der Bom JG, van der Vaart CH, Heintz AP.; 2003 Oct 4; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=214074
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Open randomised study of use of levonorgestrel releasing intrauterine system as alternative to hysterectomy. by Lahteenmaki P, Haukkamaa M, Puolakka J, Riikonen U, Sainio S, Suvisaari J, Nilsson CG.; 1998 Apr 11; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28513
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Socioeconomic variation in hysterectomy up to age 52: national, population based, prospective cohort study. by Marshall SF, Hardy RJ, Kuh D.; 2000 Jun 10; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=27403
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Supracervical hysterectomy versus total abdominal hysterectomy: perceived effects on sexual function. by Saini J, Kuczynski E, Gretz HF III, Sills ES.; 2002; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=65528
The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with hysterectomy, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “hysterectomy” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for hysterectomy (hyperlinks lead to article summaries): •
A 27-year review of obstetric hysterectomy. Author(s): Roopnarinesingh R, Fay L, McKenna P. Source: Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology. 2003 May; 23(3): 252-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12850853&dopt=Abstract
6 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.
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A clinical pathway for laparoscopically assisted vaginal hysterectomy. Impact on costs and clinical outcome. Author(s): Chang WC, Lin CC. Source: J Reprod Med. 2003 April; 48(4): 247-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12746988&dopt=Abstract
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A controlled trial of psycho-educational interventions in preparing Chinese women for elective hysterectomy. Author(s): Cheung LH, Callaghan P, Chang AM. Source: International Journal of Nursing Studies. 2003 February; 40(2): 207-16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12559144&dopt=Abstract
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A double-blind, randomized study comparing postoperative pain management using epidural ropivacaine with intravenous ketorolac or intravenous ketorolac alone following transabdominal hysterectomy. Author(s): Chinachoti T, Niruthisard S, Tuntisirin O, Thienthong S, Khunsongkiet P, Payawal F, Camagay I, De Castro R. Source: J Med Assoc Thai. 2002 September; 85 Suppl 3: S837-47. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12452220&dopt=Abstract
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A general practice pilot audit study to assess advice and treatment offered to women following hysterectomy. Author(s): Drew SV, Rowe R, Panay N, Studd JW. Source: Climacteric : the Journal of the International Menopause Society. 1999 September; 2(3): 212-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11910599&dopt=Abstract
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A nerve-sparing radical hysterectomy: guidelines and feasibility in Western patients. Author(s): Murakami G, Yabuki Y, Kato T. Source: International Journal of Gynecological Cancer : Official Journal of the International Gynecological Cancer Society. 2002 May-June; 12(3): 319-21; Author Reply 321. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12164138&dopt=Abstract
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A nerve-sparing radical hysterectomy: guidelines and feasibility in Western patients. Author(s): Barton DP, Butler-Manuel SA, Buttery LD, A'Hern RP, Polak JM. Source: International Journal of Gynecological Cancer : Official Journal of the International Gynecological Cancer Society. 2002 May-June; 12(3): 319; Author Reply 321. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12060457&dopt=Abstract
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A phase II study of multimodality treatment for locally advanced cervical cancer: neoadjuvant carboplatin and paclitaxel followed by radical hysterectomy and adjuvant cisplatin chemoradiation. Author(s): Duenas-Gonzalez A, Lopez-Graniel C, Gonzalez-Enciso A, Cetina L, Rivera L, Mariscal I, Montalvo G, Gomez E, de la Garza J, Chanona G, Mohar A. Source: Annals of Oncology : Official Journal of the European Society for Medical Oncology / Esmo. 2003 August; 14(8): 1278-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12881393&dopt=Abstract
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A prospective randomized study comparing retroperitoneal drainage with no drainage and no peritonization following radical hysterectomy and pelvic lymphadenectomy for invasive cervical cancer. Author(s): Srisomboon J, Phongnarisorn C, Suprasert P, Cheewakriangkrai C, Siriaree S, Charoenkwan K. Source: The Journal of Obstetrics and Gynaecology Research. 2002 June; 28(3): 149-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12214830&dopt=Abstract
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A prospective study of the short-term outcomes of hysterectomy with and without oophorectomy. Author(s): Farquhar CM, Sadler L, Harvey S, McDougall J, Yazdi G, Meuli K. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 2002 May; 42(2): 197-204. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12069150&dopt=Abstract
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A randomised comparison and economic evaluation in laparoscopic assisted hysterectomy and abdominal hysterectomy. Author(s): Rosenberg D. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2002 December; 109(12): 1429; Author Reply 1429. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12505005&dopt=Abstract
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A randomised comparison and economic evaluation in laparoscopic assisted hysterectomy and abdominal hysterectomy. Author(s): Brolmann HA, Bongers MY, Bremer GL, van der Salm PC. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2002 December; 109(12): 1427-8; Author Reply 1428. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12505003&dopt=Abstract
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A randomised comparison and economic evaluation of laparoscopic-assisted hysterectomy and abdominal hysterectomy. Author(s): Rowlands DJ. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2002 December; 109(12): 1429-30; Author Reply 1430. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12505006&dopt=Abstract
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A randomised comparison and economic evaluation of laparoscopic-assisted hysterectomy and abdominal hysterectomy. Author(s): Garry R. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2002 December; 109(12): 1428; Author Reply 1429. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12505004&dopt=Abstract
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A randomized comparison of total or supracervical hysterectomy: surgical complications and clinical outcomes. Author(s): Learman LA, Summitt RL Jr, Varner RE, McNeeley SG, Goodman-Gruen D, Richter HE, Lin F, Showstack J, Ireland CC, Vittinghoff E, Hulley SB, Washington AE; Total or Supracervical Hysterectomy (TOSH) Research Group. Source: Obstetrics and Gynecology. 2003 September; 102(3): 453-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12962924&dopt=Abstract
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A randomized trial comparing changes in psychological well-being and sexuality after laparoscopic and abdominal hysterectomy. Author(s): Ellstrom MA, Astrom M, Moller A, Olsson JH, Hahlin M. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2003 September; 82(9): 871-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12911451&dopt=Abstract
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A randomized, placebo-controlled, dose-ranging trial comparing fulvestrant with goserelin in premenopausal patients with uterine fibroids awaiting hysterectomy. Author(s): Donnez J, Hervais Vivancos B, Kudela M, Audebert A, Jadoul P. Source: Fertility and Sterility. 2003 June; 79(6): 1380-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12798886&dopt=Abstract
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A study of non-closure of the peritoneum at vaginal hysterectomy. Author(s): Janschek EC, Hohlagschwandtner M, Nather A, Schindl M, Joura EA. Source: Archives of Gynecology and Obstetrics. 2003 February; 267(4): 213-6. Epub 2002 July 03. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12592421&dopt=Abstract
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A survey of vaginal hysterectomy ending in laparotomy. Author(s): Furuhashi M, Suganuma N. Source: Archives of Gynecology and Obstetrics. 2002 December; 267(2): 57-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12439546&dopt=Abstract
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Abdominal or vaginal hysterectomy for enlarged uteri: a randomized clinical trial. Author(s): Benassi L, Rossi T, Kaihura CT, Ricci L, Bedocchi L, Galanti B, Vadora E. Source: American Journal of Obstetrics and Gynecology. 2002 December; 187(6): 1561-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12501064&dopt=Abstract
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Adnexectomy for benign pathology at vaginal hysterectomy without laparoscopic assistance. Author(s): Sheth SS. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2002 December; 109(12): 1401-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12504979&dopt=Abstract
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Alteration of sexual function after classic intrafascial supracervical hysterectomy and total hysterectomy. Author(s): Kim DH, Lee YS, Lee ES. Source: The Journal of the American Association of Gynecologic Laparoscopists. 2003 February; 10(1): 60-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12554996&dopt=Abstract
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An alternative to hysterectomy. Author(s): Todd A. Source: Rn. 2002 March; 65(3): 30-4; Quiz 35. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11961867&dopt=Abstract
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An unusual case of bilateral ureteric obstruction after anterior colporrhaphy and vaginal hysterectomy for pelvic organ prolapse. Author(s): Pang MW, Wong WS, Yip SK, Law LW. Source: Gynecologic and Obstetric Investigation. 2003; 55(2): 125-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12771462&dopt=Abstract
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An unusual cause of 'incontinence' after hysterectomy. Author(s): Robinson D, Savvas M, Cardozo L. Source: Bju International. 2003 May; 91(7): 727-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12699495&dopt=Abstract
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Analgesic effects of parecoxib following total abdominal hysterectomy. Author(s): Ng A, Smith G, Davidson AC. Source: British Journal of Anaesthesia. 2003 June; 90(6): 746-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12765890&dopt=Abstract
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Analgesic efficacy of continuous delivery of bupivacaine by an elastomeric balloon infusor after abdominal hysterectomy: a prospective randomised controlled trial. Author(s): Leong WM, Lo WK, Chiu JW. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 2002 November; 42(5): 515-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12495098&dopt=Abstract
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Application of ovarian transposition during hysterectomy. Author(s): Guo Y, Shen W, Jiang Y, Liu W, Li X. Source: Chinese Medical Journal. 2003 May; 116(5): 688-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12875681&dopt=Abstract
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Are in-dwelling catheters necessary for 24 hours after hysterectomy? Author(s): Dunn TS, Shlay J, Forshner D. Source: American Journal of Obstetrics and Gynecology. 2003 August; 189(2): 435-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14520213&dopt=Abstract
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Autologous blood transfusion in radical hysterectomy with and without erythropoietin therapy. Author(s): Hyllner M, Avall A, Swolin B, Bengtson JP, Bengtsson A. Source: Obstetrics and Gynecology. 2002 May; 99(5 Pt 1): 757-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11978284&dopt=Abstract
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Beliefs and perceptions of African American women who have had hysterectomy. Author(s): Augustus CE. Source: Journal of Transcultural Nursing : Official Journal of the Transcultural Nursing Society / Transcultural Nursing Society. 2002 October; 13(4): 296-302. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12325244&dopt=Abstract
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Bowel function and hysterectomy--a review. Author(s): Thakar R, Manyonda R, Stanton SL, Clarkson P, Robinson G. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 2001; 12(5): 337-41. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11716002&dopt=Abstract
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Can intermediate-risk node-negative patients with stage I corpus cancer do without posthysterectomy radiotherapy? Review of a 13-year experience. Author(s): Ampil FL, Caldito G, Unger J, Connor P, Pelser R. Source: Eur J Gynaecol Oncol. 2001; 22(4): 269-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11695807&dopt=Abstract
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Capsicum plaster at the korean hand acupuncture point reduces postoperative nausea and vomiting after abdominal hysterectomy. Author(s): Kim KS, Koo MS, Jeon JW, Park HS, Seung IS. Source: Anesthesia and Analgesia. 2002 October; 95(4): 1103-7, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12351304&dopt=Abstract
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Cervical stump carcinoma following subtotal hysterectomy. Author(s): Shah AN, Olah KS. Source: Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology. 2002 November; 22(6): 701. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12554282&dopt=Abstract
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Changes in blood volume and hematocrit during acute preoperative volume loading with 5% albumin or 6% hetastarch solutions in patients before radical hysterectomy. Author(s): Rehm M, Haller M, Orth V, Kreimeier U, Jacob M, Dressel H, Mayer S, Brechtelsbauer H, Finsterer U. Source: Anesthesiology. 2001 October; 95(4): 849-56. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11605923&dopt=Abstract
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Changes in vesicourethral function following laparoscopic hysterectomy versus abdominal hysterectomy. Author(s): Long CY, Jang MY, Chen SC, Chen YH, Su JH, Hsu SC. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 2002 August; 42(3): 259-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12230059&dopt=Abstract
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Characteristics and management of large bowel injury in laparoscopic-assisted vaginal hysterectomy. Author(s): Shen CC, Lu HM, Chang SY. Source: The Journal of the American Association of Gynecologic Laparoscopists. 2002 February; 9(1): 35-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11821604&dopt=Abstract
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Choriocarcinoma and epithelial trophoblastic tumor: successful treatment of relapse with hysterectomy and high-dose chemotherapy with peripheral stem cell support: a case report. Author(s): Knox S, Brooks SE, Wong-You-Cheong J, Ioffe O, Meisenberg B, Goldstein DP. Source: Gynecologic Oncology. 2002 April; 85(1): 204-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11925147&dopt=Abstract
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Clinical evaluation of laparoscopic-assisted radical vaginal hysterectomy with pelvic and/or paraaortic lymphadenectomy. Author(s): Park CT, Lim KT, Chung HW, Lee KH, Seong SJ, Shim JU, Kim TJ. Source: The Journal of the American Association of Gynecologic Laparoscopists. 2002 February; 9(1): 49-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11821606&dopt=Abstract
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Clinical outcome, inflammatory response and tissue trauma in total laparoscopic hysterectomy: comparison to laparoscopically-assisted vaginal hysterectomy. Author(s): Holub Z, Jabor A, Sprongl L, Fischlova D, Urbanek S. Source: Ceska Gynekol. 2002 November; 67(6): 315-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12661367&dopt=Abstract
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Clinical performance indicators at hysterectomy. Author(s): Attilakos G, Sastry A, Quinn MJ, Maulik TG. Source: Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology. 2002 January; 22(1): 68-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12521733&dopt=Abstract
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Combined spinal-epidural technique for total hysterectomy in a patient with advanced, progressive multiple sclerosis. Author(s): Vadalouca A, Moka E, Sykiotis C. Source: Regional Anesthesia and Pain Medicine. 2002 September-October; 27(5): 540-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12373717&dopt=Abstract
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Commentary on: “Posterior culdeplasty: surgical correction of enterocele during vaginal hysterectomy: A preliminary report”. 1957. Author(s): Pitkin RM. Source: Obstetrics and Gynecology. 2003 April; 101(4): 625. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12681861&dopt=Abstract
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Comparative study of bulky stage IB and IA cervical cancer patients treated by radical hysterectomy with and without neoadjuvant chemotherapy: long-term follow-up. Author(s): Manusirivithaya S, Chareoniam V, Pantusart A, Isariyodom P, Srisomboon J. Source: J Med Assoc Thai. 2001 November; 84(11): 1550-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11853297&dopt=Abstract
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Comparison of hysteroscopic and hysterectomy findings for assessing the diagnostic accuracy of office hysteroscopy. Author(s): Ceci O, Bettocchi S, Pellegrino A, Impedovo L, Di Venere R, Pansini N. Source: Fertility and Sterility. 2002 September; 78(3): 628-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12215345&dopt=Abstract
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Comparison of the results of radical hysterectomy: sequential observations in each period. Author(s): Kobamatsu Y, Yamamoto R, Kaneuchi M, Mitamura T, Minobe S, Todo Y, Takeda M, Okamoto K, Nomura E, Negishi H, Sakuragi N, Fujimoto S. Source: Japanese Journal of Clinical Oncology. 2002 March; 32(3): 103-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11956305&dopt=Abstract
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Comparison of total laparoscopic hysterectomy and laparoscopically assisted vaginal hysterectomy. Author(s): Long CY, Fang JH, Chen WC, Su JH, Hsu SC. Source: Gynecologic and Obstetric Investigation. 2002; 53(4): 214-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12186986&dopt=Abstract
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Comparison of two procedures for laparoscopic-assisted vaginal hysterectomy of large myomatous uteri. Author(s): Yen YK, Liu WM, Yuan CC, Ng HT. Source: The Journal of the American Association of Gynecologic Laparoscopists. 2002 February; 9(1): 63-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11821608&dopt=Abstract
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Complete bilateral crossed ureteral duplication observed during a radical hysterectomy with pelvic lymphadenectomy for ovarian cancer. A case report. Author(s): Mylonas I, Briese V, Vogt-Weber B, Friese K. Source: Archives of Gynecology and Obstetrics. 2003 February; 267(4): 250-1. Epub 2002 November 07. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12592431&dopt=Abstract
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Complications of laparoscopic hysterectomy: the Monash experience. Author(s): Tsaltas J, Lawrence A, Michael M, Pearce S. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 2002 August; 42(3): 295-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12230068&dopt=Abstract
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Concordance of FIGO grade of endometrial adenocarcinomas in biopsy and hysterectomy specimens. Author(s): Mitchard J, Hirschowitz L. Source: Histopathology. 2003 April; 42(4): 372-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12653949&dopt=Abstract
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Cone biopsy and pathologic findings at radical hysterectomy in stage I cervical carcinoma. Author(s): Holcomb K, Dimaio TM, Nicastri AD, Matthews RP, Lee YC, Buhl A. Source: Obstetrics and Gynecology. 2001 November; 98(5 Pt 1): 779-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11704168&dopt=Abstract
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Conization, frozen section examination, and planned hysterectomy in the treatment of high-grade cervical intraepithelial neoplasia. Author(s): Carvalho JP, Carvalho FM, Pincerato KM, Pereyra EA. Source: Revista Do Hospital Das Clinicas. 2001 November-December; 56(6): 169-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11836539&dopt=Abstract
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Continuation of hormone replacement therapy after hysterectomy. Author(s): Domoney C, Studd JW, Mocroft A. Source: Climacteric : the Journal of the International Menopause Society. 2003 March; 6(1): 58-66. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12725666&dopt=Abstract
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Cost analysis of myomectomy, hysterectomy, and uterine artery embolization. Author(s): Al-Fozan H, Dufort J, Kaplow M, Valenti D, Tulandi T. Source: American Journal of Obstetrics and Gynecology. 2002 November; 187(5): 1401-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12439538&dopt=Abstract
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Cost effectiveness of pre-operative gonadotrophin releasing analogues for women with uterine fibroids undergoing hysterectomy or myomectomy. Author(s): Sharma M, Buck L, Mastrogamvrakis G, Kontos K, Magos A, Taylor A. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2003 July; 110(7): 712; Author Reply 712-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12842071&dopt=Abstract
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Cost effectiveness of pre-operative gonadotrophin releasing analogues for women with uterine fibroids undergoing hysterectomy or myomectomy. Author(s): Farquhar C, Brown PM, Furness S. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2002 November; 109(11): 1273-80. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12452466&dopt=Abstract
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Culdolaparoscopic cholecystectomy during vaginal hysterectomy. Author(s): Tsin DA, Sequeria RJ, Giannikas G. Source: Jsls. 2003 April-June; 7(2): 171-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12856851&dopt=Abstract
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Culdolaparoscopic oophorectomy with vaginal hysterectomy: an optional minimalaccess surgical technique. Author(s): Tsin DA, Bumaschny E, Helman M, Colombero LT. Source: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A. 2002 August; 12(4): 269-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12269495&dopt=Abstract
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Current knowledge of risks and benefits of prophylactic oophorectomy at hysterectomy for benign disease in United Kingdom and Republic of Ireland. Author(s): Das N, Kay VJ, Mahmood TA. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2003 July 1; 109(1): 76-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12818449&dopt=Abstract
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Current practice of hysterectomy and oophorectomy in the United Kingdom and Republic of Ireland. Author(s): Kay VJ, Das N, Mahmood TA, Smith A. Source: Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology. 2002 November; 22(6): 672-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12554262&dopt=Abstract
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Danish gynecologists' opinion about hysterectomy on benign indication: results of a survey. Author(s): Gimbel H, Ottesen B, Tabor A. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2002 December; 81(12): 1123-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12519108&dopt=Abstract
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Definitive radiotherapy for patients with isolated vaginal recurrence of endometrial carcinoma after hysterectomy. Author(s): Jhingran A, Burke TW, Eifel PJ. Source: International Journal of Radiation Oncology, Biology, Physics. 2003 August 1; 56(5): 1366-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12873682&dopt=Abstract
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Development and preliminary evaluation of a clinical guidance programme for the decision about prophylactic oophorectomy in women undergoing a hysterectomy. Author(s): Pell I, Dowie J, Clarke A, Kennedy A, Bhavnani V. Source: Quality & Safety in Health Care. 2002 March; 11(1): 32-8; Discussion 38-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12078367&dopt=Abstract
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Development of antibodies to topical bovine thrombin after abdominal hysterectomy. A case report. Author(s): Adams JD, Jones S, Brost BC. Source: J Reprod Med. 2001 October; 46(10): 909-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11725736&dopt=Abstract
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Difference in prognostic factors between stage IB and II uterine cervical carcinoma patients treated with radical hysterectomy and postoperative radiation therapy. Author(s): Niibe Y, Karasawa K, Kaizu T, Mizutani K, Ozaki Y, Nagano H, Ueda K, Murakami A, Tanaka Y. Source: Radiat Med. 2002 July-August; 20(4): 161-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12296431&dopt=Abstract
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Differences in uterine innervation at hysterectomy. Author(s): Quinn MJ, Kirk N. Source: American Journal of Obstetrics and Gynecology. 2002 December; 187(6): 1515-9; Discussion 1519-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12501055&dopt=Abstract
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Different types of hysterectomy in the radio-surgical treatment of early cervical cancer (FIGO Ib-IIa). Author(s): Zola P, Ferrero A, Fuso L, Jacomuzzi ME, Magistris A, Spanu P, Mazzola S, Sinistrero G, Sismondi P. Source: Eur J Gynaecol Oncol. 2002; 23(3): 236-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12094962&dopt=Abstract
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Distribution of cervical glandular intraepithelial neoplasia: are hysterectomy specimens sampled appropriately? Author(s): Heatley MK. Source: Journal of Clinical Pathology. 2002 August; 55(8): 629-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12147662&dopt=Abstract
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Does hysterectomy with ovarian conservation affect bone metabolism and density? Author(s): Cheng S, Sievanen H, Heinonen A, Uusi-Rasi K, Carbone L, Tylavsky F, Halleen J, Kannus P. Source: Journal of Bone and Mineral Metabolism. 2003; 21(1): 12-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12491088&dopt=Abstract
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Does hysterectomy without adnexectomy in patients with prior tubal interruption increase the risk of subsequent hydrosalpinx? Author(s): Morse AN, Hammer RA, Walter AJ, Baker S, Magtibay PM. Source: American Journal of Obstetrics and Gynecology. 2002 December; 187(6): 1483-5; Discussion 1485-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12501050&dopt=Abstract
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Does mode of hysterectomy influence micturition and defecation? Author(s): Roovers JP, van der Bom JG, Huub van der Vaart C, Fousert DM, Heintz AP. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2001 October; 80(10): 945-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11580740&dopt=Abstract
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Does pre- and postoperative metronidazole treatment lower vaginal cuff infection rate after abdominal hysterectomy among women with bacterial vaginosis? Author(s): Larsson PG, Carlsson B. Source: Infectious Diseases in Obstetrics and Gynecology. 2002; 10(3): 133-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12625969&dopt=Abstract
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Does the cardinal ligament of the uterus contain a nerve that should be preserved in radical hysterectomy? Author(s): Barton DP. Source: Anatomical Science International / Japanese Association of Anatomists. 2003 June; 78(2): 120; Author Reply 120-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12828426&dopt=Abstract
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Does the cardinal ligament of the uterus contain a nerve that should be preserved in radical hysterectomy? Author(s): Kato T, Murakami G, Yabuki Y. Source: Anatomical Science International / Japanese Association of Anatomists. 2002 September; 77(3): 161-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12422408&dopt=Abstract
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Does the opioid-sparing effect of rectal diclofenac following total abdominal hysterectomy benefit the patient? Author(s): Ng A, Parker J, Toogood L, Cotton BR, Smith G. Source: British Journal of Anaesthesia. 2002 May; 88(5): 714-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12067012&dopt=Abstract
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Early physician experience with laparoscopically assisted vaginal hysterectomy and rates of surgical complications and conversion to laparotomy. Author(s): Visco AG, Barber MD, Myers ER. Source: American Journal of Obstetrics and Gynecology. 2002 October; 187(4): 1008-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12388997&dopt=Abstract
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Ectopic pregnancy after cesarean hysterectomy. Author(s): Brown WD, Burrows L, Todd CS. Source: Obstetrics and Gynecology. 2002 May; 99(5 Pt 2): 933-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11975964&dopt=Abstract
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Effect of hysterectomy on conserved ovarian function. Author(s): Ahn EH, Bai SW, Song CH, Kim JY, Jeong KA, Kim SK, Lee JS, Kwon JY, Park KH. Source: Yonsei Medical Journal. 2002 February; 43(1): 53-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11854933&dopt=Abstract
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Effect of hysterectomy status on polyp detection rates at screening flexible sigmoidoscopy. Author(s): Adams C, Cardwell C, Cook C, Edwards R, Atkin WS, Morton DG. Source: Gastrointestinal Endoscopy. 2003 June; 57(7): 848-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12776031&dopt=Abstract
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Effect of laparoscopic hysterectomy on bladder neck and urinary symptoms. Author(s): Long CY, Hsu SC, Wu TP, Fu JC, Hsu YS, Su JH. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 2003 February; 43(1): 65-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12755352&dopt=Abstract
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Effect of peri- and postoperative epidural anaesthesia on pain and gastrointestinal function after abdominal hysterectomy. Author(s): Jorgensen H, Fomsgaard JS, Dirks J, Wetterslev J, Andreasson B, Dahl JB. Source: British Journal of Anaesthesia. 2001 October; 87(4): 577-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11878727&dopt=Abstract
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Effect of pre-operative anxiolysis on postoperative pain response in patients undergoing total abdominal hysterectomy. Author(s): Caumo W, Hidalgo MP, Schmidt AP, Iwamoto CW, Adamatti LC, Bergmann J, Ferreira MB. Source: Anaesthesia. 2002 August; 57(8): 740-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12133084&dopt=Abstract
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Effects of closed suction drainage in reducing pain after laparoscopic-assisted vaginal hysterectomy. Author(s): Shen CC, Wu MP, Lu CH, Kung FT, Huang FJ, Huang EY, Chang HW, Yang LC, Hsu TY, Chang SY. Source: The Journal of the American Association of Gynecologic Laparoscopists. 2003 May; 10(2): 210-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12732774&dopt=Abstract
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Efficacy of pre-operative gonadotrophin hormone releasing analogues for women with uterine fibroids undergoing hysterectomy or myomectomy: a systematic review. Author(s): Lethaby A, Vollenhoven B, Sowter M. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2002 October; 109(10): 1097-108. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12387461&dopt=Abstract
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Elective hysterectomy at Tikur Anbessa Teaching Hospital, Addis Ababa. Author(s): Gaym A. Source: Ethiop Med J. 2002 July; 40(3): 217-26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12602245&dopt=Abstract
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Embolization versus myomectomy versus hysterectomy: which is best, when? Author(s): Lumsden MA. Source: Human Reproduction (Oxford, England). 2002 February; 17(2): 253-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11821260&dopt=Abstract
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Emergency obstetric hysterectomy. Author(s): Baskett TF. Source: Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology. 2003 July; 23(4): 353-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12881069&dopt=Abstract
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Emergency peripartum hysterectomy. Author(s): Sebitloane MH, Moodley J. Source: East Afr Med J. 2001 February; 78(2): 70-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11682949&dopt=Abstract
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Emergency peripartum hysterectomy: experience at a community teaching hospital. Author(s): Kastner ES, Figueroa R, Garry D, Maulik D. Source: Obstetrics and Gynecology. 2002 June; 99(6): 971-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12052583&dopt=Abstract
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Endometrial ablation as an alternative to hysterectomy. Author(s): League DD. Source: Aorn Journal. 2003 February; 77(2): 322-4, 327-338; Quiz 341, 343-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12619849&dopt=Abstract
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Endometriotic cyst after subtotal abdominal hysterectomy mimicking carcinoma of the cervical stump. Author(s): Fuchs IB, Henrich W, Schmider A, Lichtenegger W. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2003 June; 110(6): 637-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12798488&dopt=Abstract
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Endovascular management of postpartum massive vaginal bleeding. A case presenting with a pseudoaneurysm following subtotal hysterectomy. Author(s): Cantasdemir M, Yilmaz MH, Kantarci F, Mihmanli I, Numan F, Mihmanli V. Source: Archives of Gynecology and Obstetrics. 2002 December; 267(2): 104-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12439558&dopt=Abstract
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Evaluation of a device for objective determination of cervical consistency: a pilot study of device's validity on uterine specimens obtained by total abdominal hysterectomy for benign uterine disease. Author(s): Predanic M. Source: Journal of Perinatal Medicine. 2002; 30(5): 364-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12442598&dopt=Abstract
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Factors influencing the choice of hysterectomy. Author(s): Shao JB, Wong F. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 2001 August; 41(3): 303-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11592545&dopt=Abstract
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Gasless laparoscopic hysterectomy: a comparative study with total abdominal hysterectomy. Author(s): Tintara H, Choobun T, Geater A. Source: The Journal of Obstetrics and Gynaecology Research. 2003 February; 29(1): 3844. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12696626&dopt=Abstract
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Guidelines for the selection of the route of hysterectomy: application in a resident clinic population. Author(s): Kovac SR, Barhan S, Lister M, Tucker L, Bishop M, Das A. Source: American Journal of Obstetrics and Gynecology. 2002 December; 187(6): 1521-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12501056&dopt=Abstract
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Health status of users of hormone replacement therapy by hysterectomy status in Western Australia. Author(s): Lambert LJ, Straton JA, Knuiman MW, Bartholomew HC. Source: Journal of Epidemiology and Community Health. 2003 April; 57(4): 294-300. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12646547&dopt=Abstract
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High dose-rate intracavitary brachytherapy for carcinoma in situ of the vagina occurring after hysterectomy: a rational prescription of radiation dose. Author(s): Teruya Y, Sakumoto K, Moromizato H, Toita T, Ogawa K, Murayama S, Kanazawa K. Source: American Journal of Obstetrics and Gynecology. 2002 August; 187(2): 360-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12193925&dopt=Abstract
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Hospital costs of uterine artery embolization and hysterectomy for uterine fibroid tumors. Author(s): Beinfeld MT, Bosch JL, Gazelle GS. Source: Academic Radiology. 2002 November; 9(11): 1300-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12449362&dopt=Abstract
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Hysterectomy and ovarian function: levels of follicle stimulating hormone and incidence of menopausal symptoms are not affected by hysterectomy in women under age 45 years. Author(s): Chalmers C, Lindsay M, Usher D, Warner P, Evans D, Ferguson M. Source: Climacteric : the Journal of the International Menopause Society. 2002 December; 5(4): 366-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12626216&dopt=Abstract
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Hysterectomy and patterns of osteoarthritis. The Ulm Osteoarthritis Study. Author(s): Stove J, Sturmer T, Kessler S, Brenner H, Puhl W, Gunther KP. Source: Scandinavian Journal of Rheumatology. 2001; 30(6): 340-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11846052&dopt=Abstract
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Hysterectomy and sexual wellbeing: prospective observational study of vaginal hysterectomy, subtotal abdominal hysterectomy, and total abdominal hysterectomy. Author(s): Roovers JP, van der Bom JG, van der Vaart CH, Heintz AP. Source: Bmj (Clinical Research Ed.). 2003 October 4; 327(7418): 774-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14525872&dopt=Abstract
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Hysterectomy and socioeconomic position in Rome, Italy. Author(s): Materia E, Rossi L, Spadea T, Cacciani L, Baglio G, Cesaroni G, Arca M, Perucci CA. Source: Journal of Epidemiology and Community Health. 2002 June; 56(6): 461-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12011206&dopt=Abstract
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Hysterectomy for complications after uterine artery embolization for leiomyoma: results of a Canadian multicenter clinical trial. Author(s): Pron G, Mocarski E, Cohen M, Colgan T, Bennett J, Common A, Vilos G, Kung R. Source: The Journal of the American Association of Gynecologic Laparoscopists. 2003 February; 10(1): 99-106. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12555002&dopt=Abstract
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Hysterectomy for the massive leiomyomatous uterus. Author(s): Unger JB, Paul R, Caldito G. Source: Obstetrics and Gynecology. 2002 December; 100(6): 1271-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12468173&dopt=Abstract
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Hysterectomy for the transsexual. Author(s): Gerli S, Rossetti D, Pacifici A, Aviles E, Dominici C, Mattei A, Di Renzo GC. Source: The Journal of the American Association of Gynecologic Laparoscopists. 2001 November; 8(4): 613-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11677349&dopt=Abstract
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Hysterectomy in Denmark. An analysis of postoperative hospitalisation, morbidity and readmission. Author(s): Moller C, Kehlet H, Utzon J, Ottesen B. Source: Dan Med Bull. 2002 November; 49(4): 353-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12553170&dopt=Abstract
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Hysterectomy options. Total and subtotal surgical procedures prove comparable. Author(s): Runowicz CD. Source: Health News. 2002 December; 8(12): 4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12523267&dopt=Abstract
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Hysterectomy prevalence by Hispanic ethnicity: evidence from a national survey. Author(s): Brett KM, Higgins JA. Source: American Journal of Public Health. 2003 February; 93(2): 307-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12554591&dopt=Abstract
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Hysterectomy rates in the United States 1990-1997. Author(s): Farquhar CM, Steiner CA. Source: Obstetrics and Gynecology. 2002 February; 99(2): 229-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11814502&dopt=Abstract
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Hysterectomy status and life satisfaction in older women. Author(s): Kritz-Silverstein D, Wingard DL, Barrett-Connor E. Source: Journal of Women's Health & Gender-Based Medicine. 2002 March; 11(2): 18190. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11975866&dopt=Abstract
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Hysterectomy, menopause, and estrogen use preceding Parkinson's disease: an exploratory case-control study. Author(s): Benedetti MD, Maraganore DM, Bower JH, McDonnell SK, Peterson BJ, Ahlskog JE, Schaid DJ, Rocca WA. Source: Movement Disorders : Official Journal of the Movement Disorder Society. 2001 September; 16(5): 830-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11746612&dopt=Abstract
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Hysterectomy, oophorectomy, and cognitive function in older women. Author(s): Kritz-Silverstein D, Barrett-Connor E. Source: Journal of the American Geriatrics Society. 2002 January; 50(1): 55-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12028247&dopt=Abstract
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Hysterectomy. Author(s): Walsgrove H. Source: Nursing Standard : Official Newspaper of the Royal College of Nursing. 2001 April 4-10; 15(29): 47-53; Quiz 54-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12216289&dopt=Abstract
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Hysterectomy: beliefs and attitudes expressed by African-American women. Author(s): Shelton AJ, Lees E, Groff JY. Source: Ethn Dis. 2001 Fall; 11(4): 732-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11763296&dopt=Abstract
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Hysterectomy: nursing the physical and emotional wounds. Author(s): Moreira V. Source: Nurs Times. 2000 May 18-24; 96(20): 41-2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11962828&dopt=Abstract
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Hysterectomy: surgical route and complications. Author(s): Davies A, Hart R, Magos A, Hadad E, Morris R. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2002 September 10; 104(2): 148-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12206928&dopt=Abstract
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Hysterectomy: the right to choose. Author(s): Lefebvre G. Source: J Obstet Gynaecol Can. 2003 March; 25(3): 178-9, 180-1. English, French. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12610667&dopt=Abstract
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Hysterectomy--still a useful operation. Author(s): Schaffer JI, Word A. Source: The New England Journal of Medicine. 2002 October 24; 347(17): 1360-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12397196&dopt=Abstract
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Hysteroscopic and laparoscopic guided miniaccess hemihysterectomy for noncommunicating uterine horn. Author(s): Kriplani A, Agarwal N. Source: Archives of Gynecology and Obstetrics. 2001 August; 265(3): 162-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11561748&dopt=Abstract
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Hysteroscopic endometrial resection versus laparoscopic supracervical hysterectomy for menorrhagia: a prospective randomized trial. Author(s): Zupi E, Zullo F, Marconi D, Sbracia M, Pellicano M, Solima E, Sorrenti G. Source: American Journal of Obstetrics and Gynecology. 2003 January; 188(1): 7-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12548189&dopt=Abstract
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IGFBP-1 and glycodelin serum levels before and after hysterectomy with and without bilateral oophorectomy in premenopausal women. Author(s): Foth D, Meisel M, Nawroth F, Straube W, Romer T. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2001 December 10; 100(1): 55-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11728658&dopt=Abstract
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Images in clinical medicine. Intraabdominal pregnancy after hysterectomy. Author(s): Wiesenfeld HC, Guido RS. Source: The New England Journal of Medicine. 2003 October 16; 349(16): 1534. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14561796&dopt=Abstract
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Immediate and associated complications of hysterectomy for benign disease. Author(s): Tamizian O, Symonds JG, Cust MP, Arulkumaran S. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 2002 August; 42(3): 292-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12230067&dopt=Abstract
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Improving treatment outcomes with a clinical pathway for hysterectomy and myomectomy. Author(s): Broder MS, Bovone S. Source: J Reprod Med. 2002 December; 47(12): 999-1003. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12516317&dopt=Abstract
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Inadvertent bladder injury due to tumour infiltration during radical hysterectomy procedure for cervical cancer: complete healing with postoperative chemotherapy. Author(s): Bafna UD, Tasneem R. Source: Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology. 2002 November; 22(6): 703. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12554284&dopt=Abstract
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Incidence of positive peritoneal cytology in low-risk endometrial cancer treated by laparoscopically assisted vaginal hysterectomy. Author(s): Vergote I, De Smet I, Amant F. Source: Gynecologic Oncology. 2002 March; 84(3): 537-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11855893&dopt=Abstract
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Incidence, risk factors and morbidity of unintended bladder or ureter injury during hysterectomy. Author(s): Carley ME, McIntire D, Carley JM, Schaffer J. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 2002; 13(1): 18-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11999200&dopt=Abstract
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Inevitable hysterectomy despite conservative surgical management in advanced cervical pregnancy: a case report. Author(s): Tuncer R, Uygur D, Kis S, Kayin S, Bebitoglu I, Erkaya S. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2001 December 10; 100(1): 102-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11728669&dopt=Abstract
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Infectious urinary tract morbidity with prolonged bladder catheterization after radical hysterectomy. Author(s): Cardosi RJ, Cardosi RP, Grendys EC Jr, Fiorica JV, Hoffman MS. Source: American Journal of Obstetrics and Gynecology. 2003 August; 189(2): 380-3; Discussion 383-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14520200&dopt=Abstract
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Inflammatory response and tissue trauma in laparoscopic hysterectomy: comparison of electrosurgery and harmonic scalpel. Author(s): Holub Z, Jabor A, Sprongl L, Kliment L, Fischlova D, Urbanek S. Source: Clin Exp Obstet Gynecol. 2002; 29(2): 105-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12171309&dopt=Abstract
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Influence of early discharge after hysterectomy on patient outcome and GP workloads. Author(s): Easton K, Read MD, Woodman NM. Source: Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology. 2003 May; 23(3): 271-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12850859&dopt=Abstract
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Infundibulopelvic colpopexy with partial resection of vagina for repair of posthysterectomy vault prolapse. Author(s): Papp Z. Source: American Journal of Obstetrics and Gynecology. 2001 October; 185(4): 1009. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11641693&dopt=Abstract
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Intrafascial hysterectomy: the third way? Author(s): Slack MC, Quinn MJ. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2003 January; 110(1): 83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12504945&dopt=Abstract
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Intraoperative measurements to determine the extent of radical hysterectomy. Author(s): Hoffman MS, Cardosi RJ. Source: Gynecologic Oncology. 2002 December; 87(3): 281-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12468326&dopt=Abstract
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Is microscopic assessment of macroscopically normal hysterectomy specimens necessary? Author(s): Salmon HA, Smith JH, Balsitis M. Source: Journal of Clinical Pathology. 2002 January; 55(1): 67-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11825929&dopt=Abstract
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Ischemic uterine rupture and hysterectomy 3 months after uterine artery embolization. Author(s): Shashoua AR, Stringer NH, Pearlman JB, Behmaram B, Stringer EA. Source: The Journal of the American Association of Gynecologic Laparoscopists. 2002 May; 9(2): 217-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11960052&dopt=Abstract
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Italian randomized trial among women with hysterectomy: tamoxifen and hormonedependent breast cancer in high-risk women. Author(s): Veronesi U, Maisonneuve P, Rotmensz N, Costa A, Sacchini V, Travaglini R, D'Aiuto G, Lovison F, Gucciardo G, Muraca MG, Pizzichetta MA, Conforti S, Decensi A, Robertson C, Boyle P; Italian Tamoxifen Study Group. Source: Journal of the National Cancer Institute. 2003 January 15; 95(2): 160-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12529349&dopt=Abstract
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Laparoscopic assisted Doderlein hysterectomy: initial experience in a provincial Australian centre. Author(s): Craig S, Giltrap S. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 2001 August; 41(3): 311-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11592547&dopt=Abstract
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Laparoscopic hysterectomy using a computer-enhanced surgical robot. Author(s): Diaz-Arrastia C, Jurnalov C, Gomez G, Townsend C Jr. Source: Surgical Endoscopy. 2002 September; 16(9): 1271-3. Epub 2002 June 27. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12085153&dopt=Abstract
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Laparoscopic hysterectomy versus abdominal hysterectomy: a controlled study of clinical and functional outcomes. Author(s): Loh FH, Koa RC. Source: Singapore Med J. 2002 August; 43(8): 403-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12507025&dopt=Abstract
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Laparoscopic hysterectomy. Author(s): Wattiez A, Cohen SB, Selvaggi L. Source: Current Opinion in Obstetrics & Gynecology. 2002 August; 14(4): 417-22. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12151832&dopt=Abstract
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Laparoscopic lymphadenectomy and laparoscopic-assisted vaginal hysterectomy. Author(s): Hatch KD. Source: Gynecologic Oncology. 2003 September; 90(3): 503-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=13678716&dopt=Abstract
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Laparoscopic radical hysterectomy (type III) with aortic and pelvic lymphadenectomy in patients with stage I cervical cancer: surgical morbidity and intermediate followup. Author(s): Spirtos NM, Eisenkop SM, Schlaerth JB, Ballon SC. Source: American Journal of Obstetrics and Gynecology. 2002 August; 187(2): 340-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12193922&dopt=Abstract
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Laparoscopic radical parametrectomy including paraaortic and pelvic lymphadenectomy in women after prior hysterectomy: three cases. Author(s): Lee YS, Lee TH, Koo TB, Cho YL, Park I. Source: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A. 2003 April; 13(2): 123-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12737729&dopt=Abstract
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Laparoscopic sacrocolpopexy, hysterectomy, and burch colposuspension: feasibility and short-term complications of 77 procedures. Author(s): Cosson M, Rajabally R, Bogaert E, Querleu D, Crepin G. Source: Jsls. 2002 April-June; 6(2): 115-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12113413&dopt=Abstract
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Laparoscopic subtotal hysterectomy and bilateral adnexectomy in a child with congenital adrenal hyperplasia. Author(s): Weiss A, Bustan M, Rakover Y, Shalev E. Source: Fertility and Sterility. 2001 December; 76(6): 1267-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11730764&dopt=Abstract
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Laparoscopic treatment of hemorrhage after vaginal hysterectomy or laparoscopically assisted vaginal hysterectomy (LAVH). Author(s): Wilke I, Merker A, Schneider A. Source: Surgical Endoscopy. 2001 October; 15(10): 1144-6. Epub 2001 July 05. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11727088&dopt=Abstract
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Laparoscopically assisted vaginal hysterectomy versus abdominal hysterectomy in stage I endometrial cancer. Author(s): Fram KM. Source: International Journal of Gynecological Cancer : Official Journal of the International Gynecological Cancer Society. 2002 January-February; 12(1): 57-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11860536&dopt=Abstract
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Laparoscopically assisted vaginal hysterectomy versus total abdominal hysterectomy: a study of 100 cases on light-endorsed transvaginal section. Author(s): Tsai EM, Chen HS, Long CY, Yang CH, Hsu SC, Wu CH, Lee JN. Source: Gynecologic and Obstetric Investigation. 2003; 55(2): 105-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12771457&dopt=Abstract
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Laparoscopically-assisted vaginal hysterectomy (LAVH)--an alternative to abdominal hysterectomy. Author(s): Devendra K, Tay SK. Source: Singapore Med J. 2002 March; 43(3): 138-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12005340&dopt=Abstract
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Laparoscopic-assisted radical vaginal hysterectomy (LARVH): prospective evaluation of 200 patients with cervical cancer. Author(s): Hertel H, Kohler C, Michels W, Possover M, Tozzi R, Schneider A. Source: Gynecologic Oncology. 2003 September; 90(3): 505-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=13678717&dopt=Abstract
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Laparoscopic-assisted vaginal hysterectomy and the hyperglycemic response to surgery: an observational study. Author(s): Lattermann R, Schricker T, Wachter U, Georgieff M, Schreiber M. Source: Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 2001 October; 48(9): 871-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11606343&dopt=Abstract
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Laparoscopic-assisted vaginal hysterectomy in women of all weights and the effects of weight on complications. Author(s): Shen CC, Hsu TY, Huang FJ, Huang EY, Huang HW, Chang HY, Chang CY, Weng HH, Chang HW, Chang SY. Source: The Journal of the American Association of Gynecologic Laparoscopists. 2002 November; 9(4): 468-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12386358&dopt=Abstract
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Laparoscopic-assisted vaginal hysterectomy with lateral transsection of the uterine vessels. Author(s): Kohler C, Hasenbein K, Klemm P, Tozzi R, Schneider A. Source: Surgical Endoscopy. 2003 March; 17(3): 485-90. Epub 2002 November 06. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12415337&dopt=Abstract
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Laparoscopic-assisted vaginal hysterectomy: American Association of Gynecologic Laparoscopists' 2000 membership survey. Author(s): Kives SL, Levy BS, Levine RL; American Association of Gynecologic Laparoscopists. Source: The Journal of the American Association of Gynecologic Laparoscopists. 2003 May; 10(2): 135-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12732759&dopt=Abstract
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Late intracaval and intracardiac leiomyomatosis following hysterectomy for benign myomas treated by surgery and GnRH agonist. Author(s): Morice P, Chapelier A, Dartevelle P, Castaigne D, Lhomme C. Source: Gynecologic Oncology. 2001 November; 83(2): 422-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11606110&dopt=Abstract
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Leiomyoma remaining after vaginal hysterectomy for symptomatic leiomyomas. A case report. Author(s): Agostini A, Banet J, Bretelle F, Cravello L, Blanc B. Source: J Reprod Med. 2003 February; 48(2): 119-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12621796&dopt=Abstract
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Long term outcome following laparoscopic supracervical hysterectomy. Author(s): Okaro EO, Jones KD, Sutton C. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2001 October; 108(10): 1017-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11702830&dopt=Abstract
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Longterm followup of posthysterectomy vaginal vault prolapse abdominal repair: a report of 85 cases. Author(s): Lefranc JP, Atallah D, Camatte S, Blondon J. Source: Journal of the American College of Surgeons. 2002 September; 195(3): 352-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12229942&dopt=Abstract
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L-thyroxine therapy attenuates the decline in serum triiodothyronine in nonthyroidal illness induced by hysterectomy. Author(s): Karga HJ, Papapetrou PD, Karpathios SE, Papandroulaki FE, Tsompos CN, Papaioannou GP, Aloumanis KP, Papaioannou PL. Source: Metabolism: Clinical and Experimental. 2003 October; 52(10): 1307-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14564683&dopt=Abstract
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Lymphatic mapping and sentinel node identification in patients with cervix cancer undergoing radical hysterectomy and pelvic lymphadenectomy. Author(s): Levenback C, Coleman RL, Burke TW, Lin WM, Erdman W, Deavers M, Delpassand ES. Source: Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 2002 February 1; 20(3): 688-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11821449&dopt=Abstract
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Major complications associated with laparoscopic-assisted vaginal hysterectomy: tenyear experience. Author(s): Shen CC, Wu MP, Kung FT, Huang FJ, Hsieh CH, Lan KC, Huang EY, Hsu TY, Chang SY. Source: The Journal of the American Association of Gynecologic Laparoscopists. 2003 May; 10(2): 147-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12732762&dopt=Abstract
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Management of early-stage cervical carcinoma by modified (Type II) radical hysterectomy. Author(s): Michalas S, Rodolakis A, Voulgaris Z, Vlachos G, Giannakoulis N, Diakomanolis E. Source: Gynecologic Oncology. 2002 June; 85(3): 415-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12051867&dopt=Abstract
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Mass closure: a new technique for closure of the vaginal vault at vaginal hysterectomy. Author(s): Miskry T, Magos A. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2001 December; 108(12): 1295-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11843394&dopt=Abstract
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Menorrhagia and adenomyosis in a patient with hyperhomocysteinemia, recurrent pelvic vein thromboses and extensive uterine collateral circulation treatment by supracervical hysterectomy. Author(s): Nawroth F, Schmidt T, Foth D, Landwehr P, Romer T. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2001 October; 98(2): 240-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11574139&dopt=Abstract
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Menorrhagia and hysterectomy. Author(s): Curry H. Source: The American Journal of Nursing. 2002 January; 102(1): 14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11839900&dopt=Abstract
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Menorrhagia: endometrial ablation or hysterectomy? Author(s): Paddison K. Source: Nursing Standard : Official Newspaper of the Royal College of Nursing. 2003 September 17-23; 18(1): 33-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14533249&dopt=Abstract
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Minilaparotomy-assisted vaginal hysterectomy. Author(s): Ahmed AA, Stachurski J, Aziz EA, Bone C. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 2002 January; 76(1): 33-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11818092&dopt=Abstract
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Modified radical vaginal hysterectomy with or without laparoscopic nerve-sparing dissection: a comparative study. Author(s): Querleu D, Narducci F, Poulard V, Lacaze S, Occelli B, Leblanc E, Cosson M. Source: Gynecologic Oncology. 2002 April; 85(1): 154-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11925136&dopt=Abstract
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Morbidity of vaginal hysterectomy for benign tumors as a function of uterine weight. Author(s): Deval B, Rafii A, Soriano D, Samain E, Levardon M, Darai E. Source: J Reprod Med. 2003 June; 48(6): 435-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12856514&dopt=Abstract
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Multivariate analysis of histopathologic prognostic factors for invasive cervical cancer treated with radical hysterectomy and systematic retroperitoneal lymphadenectomy. Author(s): Takeda N, Sakuragi N, Takeda M, Okamoto K, Kuwabara M, Negishi H, Oikawa M, Yamamoto R, Yamada H, Fujimoto S. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2002 December; 81(12): 1144-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12519111&dopt=Abstract
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Neuropathic uterine pain after hysterectomy. A case report. Author(s): Chavez NF, Zweizig SL, Stewart EA. Source: J Reprod Med. 2003 June; 48(6): 466-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12856521&dopt=Abstract
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Neurourological changes before and after radical hysterectomy in patients with cervical cancer. Author(s): Chuang TY, Yu KJ, Penn IW, Chang YC, Lin PH, Tsai YA. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2003 October; 82(10): 954-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12956847&dopt=Abstract
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Non-closure of visceral peritoneum at abdominal hysterectomy. Author(s): Kucuk M, Okman TK. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 2001 December; 75(3): 317-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11728498&dopt=Abstract
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Non-pharmacological relief of acute pain following total abdominal hysterectomy. Author(s): Singh M, Khan RM, Bano S, Huda W, Hakim S, Grover N. Source: Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 2002 May; 49(5): 530-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11983680&dopt=Abstract
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Normovolemic hemodilution before cesarean hysterectomy for placenta percreta. Author(s): Estella NM, Berry DL, Baker BW, Wali AT, Belfort MA. Source: Obstetrics and Gynecology. 1997 October; 90(4 Pt 2): 669-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11770589&dopt=Abstract
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Obstetric hysterectomy: fifteen years' experience in a Nigerian tertiary centre. Author(s): Okogbenin SA, Gharoro EP, Otoide VO, Okonta PI. Source: Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology. 2003 July; 23(4): 356-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12881070&dopt=Abstract
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Outcomes after total versus subtotal abdominal hysterectomy. Author(s): Severyn KM. Source: The New England Journal of Medicine. 2003 February 27; 348(9): 856-7; Author Reply 856-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12608396&dopt=Abstract
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Outcomes after total versus subtotal abdominal hysterectomy. Author(s): Maas CP, Kenter GG, Trimbos B. Source: The New England Journal of Medicine. 2003 February 27; 348(9): 856-7; Author Reply 856-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12606743&dopt=Abstract
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Outcomes after total versus subtotal abdominal hysterectomy. Author(s): Thakar R, Ayers S, Clarkson P, Stanton S, Manyonda I. Source: The New England Journal of Medicine. 2002 October 24; 347(17): 1318-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12397189&dopt=Abstract
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Ovarian cancer in women with prior hysterectomy. Author(s): Davis R, Unger JB. Source: J La State Med Soc. 2003 March-April; 155(2): 113-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12778998&dopt=Abstract
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Parametrial tumor spreading patterns in cervix cancer patients treated by radical hysterectomy. Author(s): Yen MS, Yuan CC, Wang PH, Ng HT, Twu NF, Juang CM. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 2003 February; 80(2): 145-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12566187&dopt=Abstract
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Percentage of hysterectomy for pelvic organ prolapse in five ethnic groups. Author(s): Brizzolara S, Grandinetti A, Mor J. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 2002 November; 13(6): 372-6; Discussion 376. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12466908&dopt=Abstract
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Peripartum hysterectomy and associated factors. Author(s): Bai SW, Lee HJ, Cho JS, Park YW, Kim SK, Park KH. Source: J Reprod Med. 2003 March; 48(3): 148-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12698770&dopt=Abstract
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Physician-patient interaction and hysterectomy decision making: the ENDOW study. Ethnicity, Needs, and Decisions of Women. Author(s): Richter DL, Kenzig MJ, Greaney ML, McKeown RE, Saunders RP, Corwin SJ. Source: American Journal of Health Behavior. 2002 November-December; 26(6): 431-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12437018&dopt=Abstract
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Placebo-controlled, double-blind, randomized study of prophylactic antibiotics in elective abdominal hysterectomy. Author(s): Chongsomchai C, Lumbiganon P, Thinkhamrop J, Ounchai J, Vudhikamraksa N. Source: The Journal of Hospital Infection. 2002 December; 52(4): 302-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12473477&dopt=Abstract
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Platelet aggregation response and adenosine triphosphate secretion after abdominal total hysterectomy. Author(s): Hayashi M, Kiumi F, Hoshimoto K, Ohkura T. Source: Int J Clin Pract. 2003 July-August; 57(6): 461-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12918883&dopt=Abstract
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Postcoital vaginal cuff rupture 10 months after a total vaginal hysterectomy. A case report. Author(s): Joy SD, Phelan M, McNeill HW. Source: J Reprod Med. 2002 March; 47(3): 238-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11933691&dopt=Abstract
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Posterior intravaginal slingplasty (infracoccygeal sacropexy) for severe posthysterectomy vaginal vault prolapse--a preliminary report on efficacy and safety. Author(s): Farnsworth BN. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 2002; 13(1): 4-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11999204&dopt=Abstract
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Post-hysterectomy fallopian tube prolapse. Author(s): Piacenza JM, Salsano F. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2001 October; 98(2): 253-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11574143&dopt=Abstract
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Posthysterectomy vault eversion with a large retroperitoneal mass. Author(s): Handa VL, Jain K, McCue K, Schneider PD. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 2001; 12(4): 279-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11569659&dopt=Abstract
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Postoperative analgesic effects of intravenous lornoxicam and morphine with preemtive ropivacaine skin infiltration and preperitoneal instillation after transabdominal hysterectomy. Author(s): Visalyaputra S, Sanansilp V, Pechpaisit N, Choavarartana R, Sritisarn S, Ungpinitpong W, Permpolprasert L, Apidechakul P. Source: J Med Assoc Thai. 2002 September; 85 Suppl 3: S1010-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12452243&dopt=Abstract
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Postpartum hemorrhage and emergency hysterectomy in a patient with mitochondrial myopathy: a case report. Author(s): Dessole S, Capobianco G, Ambrosini G, Battista Nardelli G. Source: Archives of Gynecology and Obstetrics. 2003 February; 267(4): 247-9. Epub 2002 September 26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12592430&dopt=Abstract
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Pre-emptive effect of epidural sufentanil in abdominal hysterectomy. Author(s): Akural EI, Salomaki TE, Tekay AH, Bloigu AH, Alahuhta SM. Source: British Journal of Anaesthesia. 2002 June; 88(6): 803-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12173197&dopt=Abstract
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Preliminary results of laparoscopic modified radical hysterectomy in early invasive cervical cancer. Author(s): Lin YS. Source: The Journal of the American Association of Gynecologic Laparoscopists. 2003 February; 10(1): 80-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12554999&dopt=Abstract
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Preoperative CT diagnosis of primary fallopian tube carcinoma in a patient with a history of total abdominal hysterectomy. Author(s): Santana P, Desser TS, Teng N. Source: Journal of Computer Assisted Tomography. 2003 May-June; 27(3): 361-3. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12794600&dopt=Abstract
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Preoperative teaching and hysterectomy outcomes. Author(s): Oetker-Black SL, Jones S, Estok P, Ryan M, Gale N, Parker C. Source: Aorn Journal. 2003 June; 77(6): 1215-8, 1221-31. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12817743&dopt=Abstract
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Previous tubal ligation is a risk factor for hysterectomy after rollerball endometrial ablation. Author(s): McCausland VM, McCausland AM. Source: Obstetrics and Gynecology. 2003 April; 101(4): 818-9; Author Reply 819. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12681901&dopt=Abstract
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Prolapse of the uterine tube after subtotal hysterectomy. Author(s): de Kroon CD, Bergman I, Westenberg S, van Eyk H, Thurkow AL. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2003 March; 110(3): 333-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12628281&dopt=Abstract
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Prolonged survival in two cases of carcinoma of the fallopian tube presenting after hysterectomy: case reports. Author(s): Alarab M, Foley M, Fennelly D. Source: Eur J Gynaecol Oncol. 2003; 24(1): 91-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12691329&dopt=Abstract
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Prospective randomized comparison of laparoscopic-assisted vaginal hysterectomy (LAVH) with abdominal hysterectomy (AH) for the treatment of the uterus weighing >200 g. Author(s): Schutz K, Possover M, Merker A, Michels W, Schneider A. Source: Surgical Endoscopy. 2002 January; 16(1): 121-5. Epub 2001 September 04. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11961621&dopt=Abstract
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Pulmonary metastases from a low-grade endometrial stromal sarcoma confirmed by chromosome aberration and fluorescence in-situ hybridization approaches: a case of recurrence 13 years after hysterectomy. Author(s): Satoh Y, Ishikawa Y, Miyoshi T, Mukai H, Okumura S, Nakagawa K. Source: Virchows Archiv : an International Journal of Pathology. 2003 February; 442(2): 173-8. Epub 2002 November 26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12596070&dopt=Abstract
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Quality of hysterectomy care in rural Gujarat: the role of community-based health insurance. Author(s): Ranson MK, John KR. Source: Reproductive Health Matters. 2002 November; 10(20): 70-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12557644&dopt=Abstract
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Quality of hysterectomy care in rural Gujarat: the role of community-based health insurance. Author(s): Ranson MK, John KR. Source: Health Policy and Planning. 2001 December; 16(4): 395-403. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11739364&dopt=Abstract
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Quality of life studies in unselected gynaecological outpatients and inpatients before and after hysterectomy. Author(s): Davies JE, Doyle PM. Source: Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology. 2002 September; 22(5): 523-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12521422&dopt=Abstract
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Radiation therapy with and without extrafascial hysterectomy for bulky stage IB cervical carcinoma: a randomized trial of the Gynecologic Oncology Group. Author(s): Keys HM, Bundy BN, Stehman FB, Okagaki T, Gallup DG, Burnett AF, Rotman MZ, Fowler WC Jr; Gynecologic Oncology Group. Source: Gynecologic Oncology. 2003 June; 89(3): 343-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12798694&dopt=Abstract
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Radiation-induced atypical glandular cells mimicking recurrent adenocarcinoma in a posthysterectomy vaginal smear. Author(s): Tabatabai ZL, Krishnamurthy S. Source: Acta Cytol. 2003 January-February; 47(1): 106-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12585042&dopt=Abstract
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Radical hysterectomy alone or combined with neoadjuvant chemotherapy in the treatment of early stage bulky cervical carcinoma. Author(s): Chen CA, Cheng WF, Wei LH, Su YN, Hsieh CY. Source: J Formos Med Assoc. 2002 March; 101(3): 195-202. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12051015&dopt=Abstract
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Radical vaginal trachelectomy after supracervical hysterectomy. Author(s): Mendez LE, Penalver M, McCreath W, Bejarano P, Angioli R. Source: Gynecologic Oncology. 2002 June; 85(3): 545-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12051890&dopt=Abstract
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Radiofrequency bipolar coagulation for radical hysterectomy: technique, feasibility and complications. Author(s): Ercoli A, Fagotti A, Malzoni M, Ferrandina G, Susini T, Malzoni C, Scambia G. Source: International Journal of Gynecological Cancer : Official Journal of the International Gynecological Cancer Society. 2003 March-April; 13(2): 187-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12657122&dopt=Abstract
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Randomized clinical trial of total vs. subtotal hysterectomy: validity of the trial questionnaire. Author(s): Gimbel H, Zobbe V, Ottesen BS, Tabor A. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2002 October; 81(10): 968-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12366489&dopt=Abstract
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Randomized trial of suture versus electrosurgical bipolar vessel sealing in vaginal hysterectomy. Author(s): Levy B, Emery L. Source: Obstetrics and Gynecology. 2003 July; 102(1): 147-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12850621&dopt=Abstract
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Randomized, double-blind, placebo-controlled study of the effect of rectal paracetamol on morphine consumption after abdominal hysterectomy. Author(s): Kvalsvik O, Borchgrevink PC, Hagen L, Dale O. Source: Acta Anaesthesiologica Scandinavica. 2003 April; 47(4): 451-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12694145&dopt=Abstract
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Randomized, prospective, double-blind comparison of abdominal and vaginal hysterectomy in women without uterovaginal prolapse. Author(s): Miskry T, Magos A. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2003 April; 82(4): 351-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12716320&dopt=Abstract
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Re: Italian randomized trial among women with hysterectomy: tamoxifen and hormone-dependent breast cancer in high-risk women. Author(s): Narasimhadevara R, Pollak MN, Foulkes WD. Source: Journal of the National Cancer Institute. 2003 June 18; 95(12): 917; Author Reply 918-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12813177&dopt=Abstract
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Re: Italian randomized trial among women with hysterectomy: tamoxifen and hormone-dependent breast cancer in high-risk women. Author(s): Menard S, Casalini P, Tagliabue E, Pupa SM, Balsari A. Source: Journal of the National Cancer Institute. 2003 June 18; 95(12): 917-8; Author Reply 918-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12813176&dopt=Abstract
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Recurrence of endometriosis in women with bilateral adnexectomy (with or without total hysterectomy) who received hormone replacement therapy. Author(s): Matorras R, Elorriaga MA, Pijoan JI, Ramon O, Rodriguez-Escudero FJ. Source: Fertility and Sterility. 2002 February; 77(2): 303-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11821087&dopt=Abstract
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Repeat hysteroscopic surgery reduces the hysterectomy rate after endometrial and myoma resection. Author(s): Istre O, Langebrekke A. Source: The Journal of the American Association of Gynecologic Laparoscopists. 2003 May; 10(2): 247-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12732779&dopt=Abstract
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Resolution of a leg ulcer after hysterectomy for huge uterine myoma. Author(s): Ohtani T, Tanita M, Tagami H. Source: The Journal of Dermatology. 2003 July; 30(7): 530-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12928542&dopt=Abstract
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Resource utilization for patients undergoing hysterectomy with or without lymph node dissection for endometrial cancer. Author(s): Brooks SE, Mullins CD, Guo C, Chen TT, Gardner JF, Baquet CR. Source: Gynecologic Oncology. 2002 May; 85(2): 242-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11972382&dopt=Abstract
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Risk factors for hysterectomy among Mexican-American women in the US southwest. Author(s): Hautaniemi SI, Leidy Sievert L. Source: American Journal of Human Biology : the Official Journal of the Human Biology Council. 2003 January-February; 15(1): 38-47. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12552577&dopt=Abstract
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Risk of mesh erosion with sacral colpopexy and concurrent hysterectomy. Author(s): Brizzolara S, Pillai-Allen A. Source: Obstetrics and Gynecology. 2003 August; 102(2): 306-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12907104&dopt=Abstract
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Role of hysterectomy in management of gestational trophoblastic disease. Author(s): Pisal N, North C, Tidy J, Hancock B. Source: Gynecologic Oncology. 2002 November; 87(2): 190-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12477450&dopt=Abstract
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Role of wide/radical hysterectomy and pelvic lymph node dissection in endometrial cancer with cervical involvement. Author(s): Mariani A, Webb MJ, Keeney GL, Calori G, Podratz KC. Source: Gynecologic Oncology. 2001 October; 83(1): 72-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11585416&dopt=Abstract
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Route of delivery as a risk factor for emergent peripartum hysterectomy: a casecontrol study. Author(s): Kacmar J, Bhimani L, Boyd M, Shah-Hosseini R, Peipert J. Source: Obstetrics and Gynecology. 2003 July; 102(1): 141-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12850620&dopt=Abstract
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Satisfaction with hysterectomy: low-income underinsured teaching hospital patients versus insured patients at a private hospital. Author(s): Unger JB, Caldito G, Sams J, Perrone JF, Byrd E. Source: American Journal of Obstetrics and Gynecology. 2002 December; 187(6): 1528-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12501057&dopt=Abstract
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Sensitivity and specificity of the RAND/UCLA Appropriateness Method to identify the overuse and underuse of coronary revascularization and hysterectomy. Author(s): Shekelle PG, Park RE, Kahan JP, Leape LL, Kamberg CJ, Bernstein SJ. Source: Journal of Clinical Epidemiology. 2001 October; 54(10): 1004-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11576811&dopt=Abstract
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Serum estradiol and follicle-stimulating hormone levels in Thai women post total abdominal hysterectomy and bilateral oophorectomy using oral 17 beta-estradiol. Author(s): Bunyavejchevin S, Panthong C, Limpaphayom KK. Source: J Med Assoc Thai. 2002 January; 85(1): 58-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12075721&dopt=Abstract
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Sexual functioning in patients following radical hysterectomy for stage IB cancer of the cervix. Author(s): Grumann M, Robertson R, Hacker NF, Sommer G. Source: International Journal of Gynecological Cancer : Official Journal of the International Gynecological Cancer Society. 2001 September-October; 11(5): 372-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11737468&dopt=Abstract
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Sexuality after hysterectomy. Author(s): Katz A. Source: Journal of Obstetric, Gynecologic, and Neonatal Nursing : Jognn / Naacog. 2002 May-June; 31(3): 256-62. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12033538&dopt=Abstract
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Sexuality after hysterectomy: a review of the literature and discussion of nurses' role. Author(s): Katz A. Source: Journal of Advanced Nursing. 2003 May; 42(3): 297-303. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12680974&dopt=Abstract
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Short and long term complications of abdominal and vaginal hysterectomy for benign disease. Author(s): Al-Kadri HM, Al-Turki HA, Saleh AM. Source: Saudi Med J. 2002 July; 23(7): 806-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12174230&dopt=Abstract
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Short- and long-term clinical results of laparoscopic-assisted vaginal hysterectomy and total abdominal hysterectomy. Author(s): Shen CC, Wu MP, Lu CH, Huang EY, Chang HW, Huang FJ, Hsu TY, Chang SY. Source: The Journal of the American Association of Gynecologic Laparoscopists. 2003 February; 10(1): 49-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12554994&dopt=Abstract
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Should pelvic examination be continued after hysterectomy? Author(s): Smith C. Source: American Family Physician. 2003 July 15; 68(2): 223-4; Author Reply 224. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12892342&dopt=Abstract
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Should the presence of lymphvascular space involvement be used to assign patients to adjuvant therapy following hysterectomy for unstaged endometrial cancer? Author(s): Cohn DE, Horowitz NS, Mutch DG, Kim SM, Manolitsas T, Fowler JM. Source: Gynecologic Oncology. 2002 December; 87(3): 243-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12468320&dopt=Abstract
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Simple hysterectomy in the presence of invasive cervical cancer in Iran. Author(s): Behtash N, Mousavi A, Mohit M, Modares M, Khanafshar N, Hanjani P. Source: International Journal of Gynecological Cancer : Official Journal of the International Gynecological Cancer Society. 2003 March-April; 13(2): 177-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12657120&dopt=Abstract
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Slow-transit constipation after radical hysterectomy type III. Author(s): Possover M, Schneider A. Source: Surgical Endoscopy. 2002 May; 16(5): 847-50. Epub 2002 February 08. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11997835&dopt=Abstract
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Small bowel obstruction associated with post-hysterectomy vaginal vault prolapse. Author(s): Carley ME, Gonzalez Bosquet J, Stanhope CR. Source: Obstetrics and Gynecology. 2003 September; 102(3): 524-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12962936&dopt=Abstract
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SOGC clinical guidelines. Hysterectomy. Author(s): Lefebvre G, Allaire C, Jeffrey J, Vilos G, Arneja J, Birch C, Fortier M; Clinical Practice Gynaecology Committee and Executive Committeee and Council, Society of Obstetricians and Gynaecologists of Canada. Source: J Obstet Gynaecol Can. 2002 January; 24(1): 37-61; Quiz 74-6. English, French. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12196887&dopt=Abstract
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Spontaneous rupture of the spleen following abdominal hysterectomy. Author(s): Habek D, Cerkez Habek J. Source: Zentralblatt Fur Gynakologie. 2001 October; 123(10): 588-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11753814&dopt=Abstract
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Successful balloon tamponade of post cesarean hysterectomy pelvic bleeding: a case report. Author(s): Fahy U, Sved A, Burke G. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2003 January; 82(1): 97-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12580850&dopt=Abstract
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Supracervical hysterectomy in Trinidad. Author(s): Roopnarinesingh S, Bassaw B, Roopnarinesingh A, Sirjusingh A. Source: Clin Exp Obstet Gynecol. 2001; 28(4): 255-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11838753&dopt=Abstract
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Surrogate pregnancy in a patient who underwent radical hysterectomy and bilateral transposition of ovaries. Author(s): Azem F, Yovel I, Wagman I, Kapostiansky R, Lessing JB, Amit A. Source: Fertility and Sterility. 2003 May; 79(5): 1229-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12738524&dopt=Abstract
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Symptom experience in women after hysterectomy. Author(s): Kim KH, Lee KA. Source: Journal of Obstetric, Gynecologic, and Neonatal Nursing : Jognn / Naacog. 2001 September-October; 30(5): 472-80. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11572527&dopt=Abstract
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Technical modification of the nerve-sparing laparoscopy-assisted vaginal radical hysterectomy type 3 for better reproducibility of this procedure. Author(s): Possover M. Source: Gynecologic Oncology. 2003 August; 90(2): 245-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12893183&dopt=Abstract
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The contribution of hysterectomy to the occurrence of urge and stress urinary incontinence symptoms. Author(s): van der Vaart CH, van der Bom JG, de Leeuw JR, Roovers JP, Heintz AP. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2002 February; 109(2): 149-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11911100&dopt=Abstract
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The effect of hysterectomy on urinary symptoms and residual bladder volume. Author(s): Prasad M, Sadhukhan M, Tom B, Al-Taher H. Source: Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology. 2002 September; 22(5): 544-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12521427&dopt=Abstract
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The effect of IVPCA morphine on post-hysterectomy bowel function. Author(s): Chan KC, Cheng YJ, Huang GT, Wen YJ, Lin CJ, Chen LK, Sun WZ. Source: Acta Anaesthesiol Sin. 2002 June; 40(2): 61-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12194392&dopt=Abstract
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The effects on vesicourethral function following laparoscopic hysterectomy. Author(s): Long CY, Hsu SC, Chen YH, Chen SC, Chen WC, Su JH. Source: Kaohsiung J Med Sci. 2001 November; 17(11): 564-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11852463&dopt=Abstract
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The presence of residual disease in the cervix of hysterectomy specimens from women in whom there has been a previous diagnosis of cervical carcinoma. Author(s): Heatley MK. Source: Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology. 2002 January; 22(1): 45-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12521728&dopt=Abstract
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The relationship between movement-evoked versus spontaneous pain and peak expiratory flow after abdominal hysterectomy. Author(s): Gilron I, Tod D, Goldstein DH, Parlow JL, Orr E. Source: Anesthesia and Analgesia. 2002 December; 95(6): 1702-7, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12456443&dopt=Abstract
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The role of hysterectomy in the therapy of gestational trophoblastic tumor. Author(s): Xiang Y, Yang X, Du J, Song H. Source: Chinese Medical Sciences Journal = Chung-Kuo I Hsueh K'o Hsueh Tsa Chih / Chinese Academy of Medical Sciences. 2000 March; 15(1): 45-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12899400&dopt=Abstract
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The role of radical hysterectomy and neoadjuvant chemotherapy in carcinoma of the cervix. Author(s): Moore DH. Source: Current Oncology Reports. 2002 March; 4(2): 145-51. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11822986&dopt=Abstract
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The sexual and psychological implications of hysterectomy. Author(s): Azadeh-Ghamsari A, Gill R, Moerdyk N, Oberleitner B, Rademeyer K. Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 2002 July; 92(7): 517-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12197189&dopt=Abstract
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The VALUE national hysterectomy study: description of the patients and their surgery. Author(s): Maresh MJ, Metcalfe MA, McPherson K, Overton C, Hall V, Hargreaves J, Bridgman S, Dobbins J, Casbard A. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2002 March; 109(3): 302-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11950186&dopt=Abstract
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Thirty-day postoperative mortality after hysterectomy in women with liver cirrhosis: a Danish population-based cohort study. Author(s): Nielsen IL, Thulstrup AM, Nielsen GL, Larsen H, Vilstrup H, Sorensen HT. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2002 May 10; 102(2): 202-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11950492&dopt=Abstract
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Three cases of vaginal cuff recurrence of endometrial cancer after laparoscopic assisted vaginal hysterectomy. Author(s): Querleu D, Occelli B, Leblanc E, Narducci F. Source: Gynecologic Oncology. 2003 August; 90(2): 495-6; Author Reply 496-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12934588&dopt=Abstract
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Torsion of a non-gravid leiomyomatous uterus in a patient with myotonic dystrophy complaining of acute urinary retention: anaesthetic management for total abdominal hysterectomy. Author(s): Varras M, Polyzos D, Alexopoulos Ch, Pappa P, Akrivis Ch. Source: Clin Exp Obstet Gynecol. 2003; 30(2-3): 147-50. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12854863&dopt=Abstract
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Total hysterectomy for a nonprolapsed, benign uterus in women without vaginal deliveries. Author(s): Chauveaud A, de Tayrac R, Gervaise A, Anquetil C, Fernandez H. Source: J Reprod Med. 2002 January; 47(1): 4-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11838309&dopt=Abstract
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Total laparoscopic hysterectomy for very enlarged uteri. Author(s): Wattiez A, Soriano D, Fiaccavento A, Canis M, Botchorishvili R, Pouly J, Mage G, Bruhat MA. Source: The Journal of the American Association of Gynecologic Laparoscopists. 2002 May; 9(2): 125-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11960035&dopt=Abstract
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Total laparoscopic hysterectomy: a new option for removal of the large myomatous uterus. Author(s): O'Shea RT, Cook JR, Seman EI. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 2002 August; 42(3): 282-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12230064&dopt=Abstract
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Total versus subtotal hysterectomy: a survey of gynecologists. Author(s): Zekam N, Oyelese Y, Goodwin K, Colin C, Sinai I, Queenan JT. Source: Obstetrics and Gynecology. 2003 August; 102(2): 301-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12907103&dopt=Abstract
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Transvaginal evisceration after radical abdominal hysterectomy. Author(s): Kim SM, Choi HS, Byun JS, Kim YS, Kim HR. Source: Gynecologic Oncology. 2002 June; 85(3): 543-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12051889&dopt=Abstract
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Type III radical hysterectomy induction chemotherapy for patients with locally advanced cervical carcinoma. Author(s): Narayan K. Source: International Journal of Gynecological Cancer : Official Journal of the International Gynecological Cancer Society. 2002 March-April; 12(2): 232; Author Reply 232-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11975688&dopt=Abstract
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Understanding pre- and post-hysterectomy levels of negative affect: a stress moderation model approach. Author(s): Donoghue AP, Jackson HJ, Pagano R. Source: Journal of Psychosomatic Obstetrics and Gynaecology. 2003 June; 24(2): 99-109. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12854394&dopt=Abstract
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Urinary incontinence and hysterectomy in a large prospective cohort study in American women. Author(s): Kjerulff KH, Langenberg PW, Greenaway L, Uman J, Harvey LA. Source: The Journal of Urology. 2002 May; 167(5): 2088-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11956446&dopt=Abstract
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Urinary retention after hysterectomy for benign disease: extended diagnostic evaluation and treatment with sacral nerve stimulation. Author(s): Everaert K, De Muynck M, Rimbaut S, Weyers S. Source: Bju International. 2003 April; 91(6): 497-501. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12656902&dopt=Abstract
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Urinary tract dysfunction after radical hysterectomy for cervical cancer. Author(s): Chen GD, Lin LY, Wang PH, Lee HS. Source: Gynecologic Oncology. 2002 May; 85(2): 292-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11972390&dopt=Abstract
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Urodynamic profile after Wertheim's hysterectomy. Author(s): Gulati N, Kumar VJ, Barsaul M, Yadav SP. Source: Indian Journal of Cancer. 2001 June-December; 38(2-4): 96-102. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12593447&dopt=Abstract
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Usefulness of a pediatric colonoscope for routine colonoscopy in women who have undergone hysterectomy. Author(s): Marshall JB, Perez RA, Madsen RW. Source: Gastrointestinal Endoscopy. 2002 June; 55(7): 838-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12024137&dopt=Abstract
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Usefulness of prior hysterectomy as an independent predictor of Framingham risk score (The Women's Health Initiative). Author(s): Hsia J, Barad D, Margolis K, Rodabough R, McGovern PG, Limacher MC, Oberman A, Smoller S; Women's Health Initiative Research Group. Source: The American Journal of Cardiology. 2003 August 1; 92(3): 264-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12888128&dopt=Abstract
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Uterine compression sutures as an alternative to hysterectomy for severe postpartum hemorrhage. Author(s): Thomas JM. Source: J Obstet Gynaecol Can. 2003 June; 25(6): 456; Author Reply 458. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12806446&dopt=Abstract
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Uterine compression sutures as an alternative to hysterectomy for severe postpartum hemorrhage. Author(s): Smith KL, Baskett TF. Source: J Obstet Gynaecol Can. 2003 March; 25(3): 197-200. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12610671&dopt=Abstract
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Uterine fibroid embolization fares well against hysterectomy, study says. Author(s): Levenson D. Source: Rep Med Guidel Outcomes Res. 2002 April 19; 13(8): 1-2, 5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12467267&dopt=Abstract
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Uterine fibroid: clinical presentation and relative morbidity of abdominal myomectomy and total abdominal hysterectomy, in a teaching hospital of Karachi, Pakistan. Author(s): Mohammed NB, NoorAli R, AnandaKumar C. Source: Singapore Med J. 2002 June; 43(6): 289-95. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12380725&dopt=Abstract
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Uterine fibroids: uterine artery embolization versus abdominal hysterectomy for treatment--a prospective, randomized, and controlled clinical trial. Author(s): Pinto I, Chimeno P, Romo A, Paul L, Haya J, de la Cal MA, Bajo J. Source: Radiology. 2003 February; 226(2): 425-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12563136&dopt=Abstract
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Uterine preservation or hysterectomy at sacrospinous colpopexy for uterovaginal prolapse? Author(s): Maher CF, Cary MP, Slack MC, Murray CJ, Milligan M, Schluter P. Source: International Urogynecology Journal and Pelvic Floor Dysfunction. 2001; 12(6): 381-4; Discussion 384-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11795641&dopt=Abstract
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Vaginal cuff recurrence of endometrial cancer treated by laparoscopic-assisted vaginal hysterectomy. Author(s): Holub Z. Source: Gynecologic Oncology. 2003 August; 90(2): 495; Author Reply 496-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12893231&dopt=Abstract
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Vaginal cuff recurrence of endometrial cancer treated by laparoscopic-assisted vaginal hysterectomy. Author(s): Chu CS, Randall TC, Bandera CA, Rubin SC. Source: Gynecologic Oncology. 2003 January; 88(1): 62-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12504629&dopt=Abstract
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Vaginal dysplastic lesions in women with hysterectomy and receiving radiotherapy are linked to high-risk human papillomavirus. Author(s): Barzon L, Pizzighella S, Corti L, Mengoli C, Palu G. Source: Journal of Medical Virology. 2002 July; 67(3): 401-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12116034&dopt=Abstract
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Vaginal evisceration after hysterectomy: a literature review. Author(s): Ramirez PT, Klemer DP. Source: Obstetrical & Gynecological Survey. 2002 July; 57(7): 462-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12172223&dopt=Abstract
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Vaginal evisceration after hysterectomy: the repair by a laparoscopic and vaginal approach with a omental flap. Author(s): Narducci F, Sonoda Y, Lambaudie E, Leblanc E, Querleu D. Source: Gynecologic Oncology. 2003 June; 89(3): 549-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12798729&dopt=Abstract
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Vaginal evisceration long after vaginal hysterectomy. Author(s): Feiner B, Lissak A, Kedar R, Lefel O, Lavie O. Source: Obstetrics and Gynecology. 2003 May; 101(5 Pt 2): 1058-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12738100&dopt=Abstract
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Vaginal hysterectomy after previous ventral scar hernia repair. Author(s): Sheth SS, Ghoshal AA. Source: Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology. 2002 July; 22(4): 430-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12521472&dopt=Abstract
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Vaginal hysterectomy allied with Kelly-Kennedy surgery and perineal repair for the treatment of patients with a prolapsed uterus and urinary stress incontinence. Author(s): Kayano CE, Sartori MG, Baracat EC, de Lima GR, Girao MJ. Source: Clin Exp Obstet Gynecol. 2002; 29(1): 27-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12013087&dopt=Abstract
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Vaginal hysterectomy for the large uterus. Author(s): Teoh TG. Source: Med J Malaysia. 2001 December; 56(4): 460-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12014766&dopt=Abstract
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Vaginal hysterectomy in nulliparous women without prolapse: a prospective comparative study. Author(s): Agostini A, Bretelle F, Cravello L, Maisonneuve AS, Roger V, Blanc B. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2003 May; 110(5): 515-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12742338&dopt=Abstract
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Vaginal infection with methicillin-resistant Staphylococcus aureus after laparoscopic supracervical hysterectomy. Author(s): Olesen A, Rudnicki M. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2002 July; 81(7): 676-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12190844&dopt=Abstract
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Vaginal uterine artery ligation avoids high blood loss and puerperal hysterectomy in postpartum hemorrhage. Author(s): Baggish MS. Source: Obstetrics and Gynecology. 2003 February; 101(2): 416-7; Author Reply 417-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12576269&dopt=Abstract
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Vaginal uterine artery ligation avoids high blood loss and puerperal hysterectomy in postpartum hemorrhage. Author(s): Palacios Jaraquemada JM. Source: Obstetrics and Gynecology. 2003 February; 101(2): 416; Author Reply 417-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12576268&dopt=Abstract
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Vaginal uterine artery ligation avoids high blood loss and puerperal hysterectomy in postpartum hemorrhage. Author(s): Hebisch G, Huch A. Source: Obstetrics and Gynecology. 2002 September; 100(3): 574-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12220781&dopt=Abstract
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Venous thromboembolic diseases associated with uterine myomas diagnosed before hysterectomy: a report of two cases. Author(s): Tanaka H, Umekawa T, Kikukawa T, Nakamura M, Toyoda N. Source: The Journal of Obstetrics and Gynaecology Research. 2002 December; 28(6): 3003. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12512926&dopt=Abstract
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Vesicocutaneous fistula mimicking an abdominal wall abscess 2 years after radical abdominal hysterectomy. Author(s): Petru E, Herzog K, Kurschel S, Tamussino K, Winter R. Source: Gynecologic Oncology. 2003 August; 90(2): 494. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12893230&dopt=Abstract
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Vulvar angiokeratoma following radical hysterectomy and radiotherapy. Author(s): Haidopoulos DA, Rodolakis AJ, Elsheikh AH, Papaspirou I, Diakomanolis E. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2002 May; 81(5): 466-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12027822&dopt=Abstract
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Which is the appropriate hormone replacement therapy after sub-total hysterectomy? Author(s): Imoh-Ita F, Morgan P, Rymer J. Source: Climacteric : the Journal of the International Menopause Society. 2000 March; 3(1): 65-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11910612&dopt=Abstract
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Women awaiting hysterectomy: a qualitative study of issues involved in decisions about oophorectomy. Author(s): Bhavnani V, Clarke A. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2003 February; 110(2): 168-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12618161&dopt=Abstract
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Women's decision making regarding hysterectomy. Author(s): Lindberg CE, Nolan LB. Source: Journal of Obstetric, Gynecologic, and Neonatal Nursing : Jognn / Naacog. 2001 November-December; 30(6): 607-16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11724196&dopt=Abstract
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CHAPTER 2. NUTRITION AND HYSTERECTOMY Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and hysterectomy.
Finding Nutrition Studies on Hysterectomy The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “hysterectomy” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.
7 Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.
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The following information is typical of that found when using the “Full IBIDS Database” to search for “hysterectomy” (or a synonym): •
A comparison of 25 mg and 50 mg oestradiol implants in the control of climacteric symptoms following hysterectomy and bilateral salpingo-oophorectomy. Author(s): Department of Obstetrics and Gynaecology, University Hospital Lewisham, London. Source: Panay, N Versi, E Savvas, M BJOG. 2000 August; 107(8): 1012-6
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A double-blind randomised trial of leuprorelin acetate prior to hysterectomy for dysfunctional uterine bleeding. Author(s): Department of Obstetrics and Gynaecology, St James's Hospital, Leeds, UK. Source: Weeks, A D Duffy, S R Walker, J J BJOG. 2000 March; 107(3): 323-8
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Adenocarcinoma from endometriosis causing urinary tract obstruction in a patient on oestrogen replacement therapy after hysterectomy. A case report. Author(s): Department of Obstetrics and Gynaecology, Johannesburg Hospital. Source: Frohlich, E P Koller, A B van Blerk, P J Margolius, K A S-Afr-Med-J. 1988 December 17; 74(12): 638-9 0038-2469
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Adjuvant progestagen therapy improves survival in patients with endometrial cancer after hysterectomy. Results of one-institutional prospective clinical trial. Author(s): Department of Gynaecological Oncology, Maria Sklodowska-Curie Memorial, Cancer Center and Institute of Oncology, Cracow, Poland. Source: Urbanski, K Karolewski, K Kojs, Z Klimek, M Dyba, T Eur-J-Gynaecol-Oncol. 1993; 14 Suppl98-104 0392-2936
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Adrenalin versus terlipressin: blood loss and cardiovascular side-effects in the vaginal part of laparoscopically-assisted vaginal hysterectomy or vaginal hysterectomy. Author(s): Department of Anaesthesiology, Na Homolce Hospital, Prague, Czech Republic. Source: Bartos, P Popelka, P Adamcova, P Struppl, D Clin-Exp-Obstet-Gynecol. 2000; 27(3-4): 182-4 0390-6663
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Comparative study of bulky stage IB and IA cervical cancer patients treated by radical hysterectomy with and without neoadjuvant chemotherapy: long-term follow-up. Author(s): Department of Obstetrics and Gynecology, Bangkok Metropolitan Medical College and Vajira Hospital, Thailand. Source: Manusirivithaya, S Chareoniam, V Pantusart, A Isariyodom, P Srisomboon, J JMed-Assoc-Thai. 2001 November; 84(11): 1550-7 0125-2208
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Effects of feeding regimens on bodyweight, composition and condition score in cats following ovariohysterectomy. Author(s): Waltham Centre for Pet Nutrition, Waltham-on-the-Wolds, Melton, Mowbray, Leicestershire. Source: Harper, E J Stack, D M Watson, T D Moxham, G J-Small-Anim-Pract. 2001 September; 42(9): 433-8 0022-4510
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Hysterectomy, ovarian failure, and depression. Author(s): Department of Obstetrics and Gynaecology, Chelsea & Westminster Hospital, London, United Kingdom. Source: Khastgir, G Studd, J Menopause. 1998 Summer; 5(2): 113-22 1072-3714
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Hysteroscopic endometrial ablation is an effective alternative to hysterectomy in women with menorrhagia and large uteri. Author(s): Department of Obstetrics and Gynecology, St. Joseph's Health Center, 268 Grosvenor Street, London, Ontario, Canada. Source: Eskandar, M A Vilos, G A Aletebi, F A Tummon, I S J-Am-Assoc-GynecolLaparosc. 2000 August; 7(3): 339-45 1074-3804
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I am 59 years old and recently had a complete hysterectomy for endometrial cancer. The pathology report showed no migration of cancer cells outside the endometrium. Is it safe for me to take estrogen as hormone replacement therapy? Source: Robb Nicholson, C Harv-Womens-Health-Watch. 1998 September; 6(1): 8 1070910X
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I had a hysterectomy and my ovaries were also removed in 1986, when I was 46. After combinations of estrogen in tablets and patches failed to relieve my hot flashes, my doctor tried monthly estrogen injections. They controlled my symptoms beautifully, and I have been taking them ever since. I have not been able to find much information about estrogen injections. is there any harm in taking the hormone this way? Source: Robb Nicholson, C Harv-Womens-Health-Watch. 1999 March; 6(7): 8 1070-910X
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I recently had a hysterectomy in which my cervix was not removed. What is the correct hormone replacement therapy for me? Do I have to take progesterone? Will the estrogen increase my risk of cervical cancer? Source: Robb Nicholson, C Harv-Womens-Health-Watch. 1998 September; 6(1): 8 1070910X
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In 1992 I had a hysterectomy. I was 46 years old at the time. My gynecologist prescribed Premarin 1.25 mg and would like me to continue this dose. Recently, my internist recommended that I take 0.625 mg per day. Who is right? Source: Anonymous Harv-Womens-Health-Watch. 1998 April; 5(8): 8 1070-910X
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Laparoscopy-assisted vaginal hysterectomy: report of seventy-five consecutive cases. Author(s): Creighton University School of Medicine, Omaha, Nebraska. Source: Garcia Padial, J Sotolongo, J Casey, M J Johnson, C Osborne, N G J-GynecolSurg. 1992 Summer; 8(2): 81-5 1042-4067
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Metastatic carcinoma in a transposed ovary after radical hysterectomy for a stage 1B cervical adenosquamous cell carcinoma. Case report. Author(s): Department of Obstetrics and Gynecology, Miyazaki Prefectural Hospital, Japan. Source: Shigematsu, T Ohishi, Y Fujita, T Higashihara, J Irie, T Hayashi, T Eur-JGynaecol-Oncol. 2000; 21(4): 383-6 0392-2936
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Nalbuphine by PCA-pump for analgesia following hysterectomy: bolus application versus continuous infusion with bolus application. Author(s): Department of Anaesthesia and Intensive Care, City of Vienna Hospital Lainz, Austria. [email protected] Source: Krenn, H Oczenski, W Jellinek, H Krumpl Stroher, M Schweitzer, E Fitzgerald, R D Eur-J-Pain. 2001; 5(2): 219-26 1090-3801
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Oestradiol and testosterone implants after hysterectomy for endometriosis. Author(s): Dulwich Hospital Menopause Clinic, Dulwich Hospital, London, England. Source: Montgomery, J C Studd, J W Contrib-Gynecol-Obstet. 1987; 16241-6 0304-4246
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Perceptions of alternative therapies available for women facing hysterectomy or menopause. Author(s): Department of Health Promotion and Education, The Norman J. Arnold School of Public Health, University of South Carolina, Columbia 29208, USA. [email protected] Source: Richter D, L Corwin S, J Rheaume C, E McKeown R, E J-Women-Aging. 2001; 13(4): 21-37 0895-2841
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Randomized trial of neoadjuvant cisplatin, vincristine, bleomycin, and radical hysterectomy versus radiation therapy for bulky stage IB and IIA cervical cancer. Author(s): Departments of Obstetrics and Gynecology (Division of Gynecologic Oncology), Pathology, Radiation Oncology, and Diagnostic Radiology, and Biostatistics Consulting Center, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan. Source: Chang, T C Lai, C H Hong, J H Hsueh, S Huang, K G Chou, H H Tseng, C J Tsai, C S Chang, J T Lin, C T Chang, H H Chao, P J Ng, K K Tang, S G Soong, Y K J-ClinOncol. 2000 April; 18(8): 1740-7 0732-183X
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Regulation of hysterectomy induced derangements in ovarian carbohydrate metabolism in albino rats. II. Role of prostaglandin F2 alpha. Author(s): Department of Zoology, Sri Venkateswara University, Tirupati, India. Source: Umadevi, G Changamma, C Govindappa, S Indian-J-Exp-Biol. 1991 November; 29(11): 1067-70 0019-5189
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Serum estradiol and follicle-stimulating hormone levels in Thai women post total abdominal hysterectomy and bilateral oophorectomy using oral 17 beta-estradiol. Author(s): Department of Obstetrics & Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. Source: Bunyavejchevin, Suvit Panthong, Chareonchai Limpaphayom, Khunying Kobchitt J-Med-Assoc-Thai. 2002 January; 85(1): 58-62 0125-2208
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Testosterone supplemental therapy after hysterectomy with or without concomitant oophorectomy: estrogen alone is not enough. Author(s): [email protected] Source: Rako, S J-Womens-Health-Gend-Based-Med. 2000 October; 9(8): 917-23 15246094
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The effect of IVPCA morphine on post-hysterectomy bowel function. Author(s): Department of Anesthesiology, National Taiwan University, College of Medicine and Hospital, Taipei, Taiwan, R.O.C. Source: Chan, K C Cheng, Y J Huang, G T Wen, Y J Lin, C J Chen, L K Sun, W Z ActaAnaesthesiol-Sin. 2002 June; 40(2): 61-4 0529-5769
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Which is the appropriate hormone replacement therapy after sub-total hysterectomy? Author(s): Department of Obstetrics and Gynaecology, Farnborough Hospital, Kent, UK. Source: Imoh Ita, F Morgan, P Rymer, J Climacteric. 2000 March; 3(1): 65-7 1369-7137
Nutrition
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Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •
healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0
•
The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov
•
The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov
•
The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/
•
The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/
•
Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/
•
Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/
•
Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/
Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •
AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats
•
Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html
•
Google: http://directory.google.com/Top/Health/Nutrition/
•
Healthnotes: http://www.healthnotes.com/
•
Open Directory Project: http://dmoz.org/Health/Nutrition/
•
Yahoo.com: http://dir.yahoo.com/Health/Nutrition/
•
WebMD®Health: http://my.webmd.com/nutrition
•
WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html
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The following is a specific Web list relating to hysterectomy; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •
Food and Diet Soy Source: Healthnotes, Inc.; www.healthnotes.com
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CHAPTER 3. HYSTERECTOMY
ALTERNATIVE
MEDICINE
AND
Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to hysterectomy. At the conclusion of this chapter, we will provide additional sources.
National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to hysterectomy and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “hysterectomy” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to hysterectomy: •
A behavioral technique for recovery from the psychological trauma of hysterectomy. Author(s): Lobb ML, Shannon MC, Recer SL, Allen JB. Source: Percept Mot Skills. 1984 October; 59(2): 677-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6151167&dopt=Abstract
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A phase II study of multimodality treatment for locally advanced cervical cancer: neoadjuvant carboplatin and paclitaxel followed by radical hysterectomy and adjuvant cisplatin chemoradiation. Author(s): Duenas-Gonzalez A, Lopez-Graniel C, Gonzalez-Enciso A, Cetina L, Rivera L, Mariscal I, Montalvo G, Gomez E, de la Garza J, Chanona G, Mohar A. Source: Annals of Oncology : Official Journal of the European Society for Medical Oncology / Esmo. 2003 August; 14(8): 1278-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12881393&dopt=Abstract
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A phase II trial of neoadjuvant chemotherapy prior to radical hysterectomy and/or radiation therapy in the management of advanced carcinoma of the uterine cervix. Author(s): Bloss JD, Lucci JA 3rd, DiSaia PJ, Manetta A, Schiano MA, Ramsinghani N, Berman ML. Source: Gynecologic Oncology. 1995 October; 59(1): 105-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7557594&dopt=Abstract
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Abdominal hysterectomy versus supravaginal uterine amputation: psychic factors. Author(s): Kilkku P, Lehtinen V, Hirvonen T, Gronroos M. Source: Ann Chir Gynaecol Suppl. 1987; 202: 62-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3477989&dopt=Abstract
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Adjuvant chemotherapy after radical hysterectomy for cervical carcinoma. Author(s): Lai CH, Lin TS, Soong YK, Chen HF. Source: Gynecologic Oncology. 1989 November; 35(2): 193-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2478428&dopt=Abstract
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Adjuvant chemotherapy after radical hysterectomy for cervical carcinoma: a comparison with effects of adjuvant radiotherapy. Author(s): Iwasaka T, Kamura T, Yokoyama M, Matsuo N, Nakano H, Sugimori H. Source: Obstetrics and Gynecology. 1998 June; 91(6): 977-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9611008&dopt=Abstract
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Adjuvant cytotoxic chemotherapy following Wertheim radical hysterectomy for cervical cancer. Author(s): Sivanesaratnam V, Sen DK, Jayalakshmi P. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 1987 August; 27(3): 231-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2449159&dopt=Abstract
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Adjuvant hysterectomy in low-risk gestational trophoblastic disease. Author(s): Suzuka K, Matsui H, Iitsuka Y, Yamazawa K, Seki K, Sekiya S. Source: Obstetrics and Gynecology. 2001 March; 97(3): 431-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11239651&dopt=Abstract
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Behavioural treatment (biofeedback) for constipation following hysterectomy. Author(s): Roy AJ, Emmanuel AV, Storrie JB, Bowers J, Kamm MA. Source: The British Journal of Surgery. 2000 January; 87(1): 100-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10606919&dopt=Abstract
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Brief acute psychosis following hysterectomy in ethnopsychiatric context. Author(s): Tsoh JM, Leung HC, Ungvari GS, Lee DT.
Alternative Medicine 97
Source: Singapore Med J. 2000 July; 41(7): 359-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11026805&dopt=Abstract •
Capsicum plaster at the korean hand acupuncture point reduces postoperative nausea and vomiting after abdominal hysterectomy. Author(s): Kim KS, Koo MS, Jeon JW, Park HS, Seung IS. Source: Anesthesia and Analgesia. 2002 October; 95(4): 1103-7, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12351304&dopt=Abstract
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Choriocarcinoma and epithelial trophoblastic tumor: successful treatment of relapse with hysterectomy and high-dose chemotherapy with peripheral stem cell support: a case report. Author(s): Knox S, Brooks SE, Wong-You-Cheong J, Ioffe O, Meisenberg B, Goldstein DP. Source: Gynecologic Oncology. 2002 April; 85(1): 204-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11925147&dopt=Abstract
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Clinical evaluation of electrostimulation anaesthesia for hysterectomy. Author(s): Bohrer H, Quintel M, Fischer MV. Source: Acta Anaesthesiologica Scandinavica. 1991 August; 35(6): 529-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1897349&dopt=Abstract
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Comparative study of bulky stage IB and IA cervical cancer patients treated by radical hysterectomy with and without neoadjuvant chemotherapy: long-term follow-up. Author(s): Manusirivithaya S, Chareoniam V, Pantusart A, Isariyodom P, Srisomboon J. Source: J Med Assoc Thai. 2001 November; 84(11): 1550-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11853297&dopt=Abstract
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Discussion group for posthysterectomy patients. Author(s): Keith C. Source: Health & Social Work. 1980 February; 5(1): 59-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7364339&dopt=Abstract
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Double-blind, placebo-controlled, randomized clinical trial of homoeopathic arnica C30 for pain and infection after total abdominal hysterectomy. Author(s): Hart O, Mullee MA, Lewith G, Miller J. Source: Journal of the Royal Society of Medicine. 1997 February; 90(2): 73-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9068434&dopt=Abstract
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Early discharge schemes for hysterectomy patients. Author(s): Read C.
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Source: Nursing Standard : Official Newspaper of the Royal College of Nursing. 1996 July 10; 10(42): 43-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8718285&dopt=Abstract •
Electroacupuncture in anaesthesia for hysterectomy. Author(s): Christensen PA, Rotne M, Vedelsdal R, Jensen RH, Jacobsen K, Husted C. Source: British Journal of Anaesthesia. 1993 December; 71(6): 835-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8280549&dopt=Abstract
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Endometrial adenocarcinoma arising during estrogenic treatment 17 years after total abdominal hysterectomy and bilateral salpingo-oophorectomy: a case report. Author(s): Debus G, Schuhmacher I. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2001 June; 80(6): 589-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11380300&dopt=Abstract
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Endoscopic ovariohysterectomy in two lions (Panthera leo). Author(s): Aguilar RF, Mikota SK, Smith J, Munson L, Freeman LJ, Kolata R. Source: J Zoo Wildl Med. 1997 September; 28(3): 290-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9365942&dopt=Abstract
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Home visiting for a posthysterectomy population. Author(s): Thomas JS, Graff BM, Hollingsworth AO, Cohen SM, Rubin MM. Source: Home Healthcare Nurse. 1992 May-June; 10(3): 47-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1607287&dopt=Abstract
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Hypnoanesthesia for cesarean section and hysterectomy. Author(s): DELEE ST, KROGER WS. Source: J Am Med Assoc. 1957 February 9; 163(6): 442-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=13398289&dopt=Abstract
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Hysterectomy in the United States, 1988-1990. Author(s): Wilcox LS, Koonin LM, Pokras R, Strauss LT, Xia Z, Peterson HB. Source: Obstetrics and Gynecology. 1994 April; 83(4): 549-55. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8134065&dopt=Abstract
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Hysterectomy: holistic care is key. Author(s): Mazmanian CM. Source: Rn. 1999 June; 62(6): 32-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10504991&dopt=Abstract
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Hysterectomy:a psychosomatic case study. Author(s): ASSAEL M, AVROUSKINE M.
Alternative Medicine 99
Source: Acta Neurol Belg. 1962 October; 62: 927-38. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=13965272&dopt=Abstract •
Intra-operative suggestions reduce incidence of post hysterectomy emesis. Author(s): Maroof M, Ahmed SM, Khan RM, Bano SJ, Haque AW. Source: J Pak Med Assoc. 1997 August; 47(8): 202-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9339615&dopt=Abstract
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Metastatic carcinoma in a transposed ovary after radical hysterectomy for a stage 1B cervical adenosquamous cell carcinoma. Case report. Author(s): Shigematsu T, Ohishi Y, Fujita T, Higashihara J, Irie T, Hayashi T. Source: Eur J Gynaecol Oncol. 2000; 21(4): 383-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11055489&dopt=Abstract
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Neoadjuvant chemotherapy with vincristine and cisplatin followed by radical hysterectomy and pelvic lymphadenectomy for FIGO stage IB bulky cervical cancer: a Gynecologic Oncology Group pilot study. Author(s): Eddy GL, Manetta A, Alvarez RD, Williams L, Creasman WT. Source: Gynecologic Oncology. 1995 June; 57(3): 412-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7774847&dopt=Abstract
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Nerve stimulation in patients undergoing hysterectomy under general anaesthesia. Author(s): Fassoulaki A, Sarantopoulos C, Papilas K, Zotou M. Source: Anaesthesiol Reanim. 1994; 19(2): 49-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8185744&dopt=Abstract
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Non-pharmacological relief of acute pain following total abdominal hysterectomy. Author(s): Singh M, Khan RM, Bano S, Huda W, Hakim S, Grover N. Source: Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 2002 May; 49(5): 530-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11983680&dopt=Abstract
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Perceptions of alternative therapies available for women facing hysterectomy or menopause. Author(s): Richter DL, Corwin SJ, Rheaume CE, McKeown RE. Source: J Women Aging. 2001; 13(4): 21-37. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11876431&dopt=Abstract
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Postoperative fatigue negatively impacts the daily lives of patients recovering from hysterectomy. Author(s): DeCherney AH, Bachmann G, Isaacson K, Gall S.
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Source: Obstetrics and Gynecology. 2002 January; 99(1): 51-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11777510&dopt=Abstract •
Prognostic factors in patients with bulky stage IB or IIA cervical carcinoma undergoing neoadjuvant chemotherapy and radical hysterectomy. Author(s): Lai CH, Hsueh S, Chang TC, Tseng CJ, Huang KG, Chou HH, Chen SM, Chang MF, Shum HC. Source: Gynecologic Oncology. 1997 March; 64(3): 456-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9062150&dopt=Abstract
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Randomized trial of neoadjuvant cisplatin, vincristine, bleomycin, and radical hysterectomy versus radiation therapy for bulky stage IB and IIA cervical cancer. Author(s): Chang TC, Lai CH, Hong JH, Hsueh S, Huang KG, Chou HH, Tseng CJ, Tsai CS, Chang JT, Lin CT, Chang HH, Chao PJ, Ng KK, Tang SG, Soong YK. Source: Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 2000 April; 18(8): 1740-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10764435&dopt=Abstract
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Robotically assisted laparoscopic hysterectomy and adnexal surgery. Author(s): Margossian H, Falcone T. Source: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A. 2001 June; 11(3): 161-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11441994&dopt=Abstract
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Sensory changes and pain after abdominal hysterectomy: a comparison of anesthetic supplementation with fentanyl versus magnesium or ketamine. Author(s): Wilder-Smith OH, Arendt-Nielsen L, Gaumann D, Tassonyi E, Rifat KR. Source: Anesthesia and Analgesia. 1998 January; 86(1): 95-101. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9428859&dopt=Abstract
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Sexuality after hysterectomy. Author(s): Farrell SA, Kieser K. Source: Obstetrics and Gynecology. 2000 June; 95(6 Pt 2): 1045-51. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10808032&dopt=Abstract
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Soy product intake and premenopausal hysterectomy in a follow-up study of Japanese women. Author(s): Nagata C, Takatsuka N, Kawakami N, Shimizu H. Source: European Journal of Clinical Nutrition. 2001 September; 55(9): 773-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11528492&dopt=Abstract
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Successful laparoscopy assisted ovariohysterectomy in two dogs with pyometra. Author(s): Minami S, Okamoto Y, Eguchi H, Kato K.
Alternative Medicine 101
Source: The Journal of Veterinary Medical Science / the Japanese Society of Veterinary Science. 1997 September; 59(9): 845-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9342715&dopt=Abstract •
Technique for total abdominal hysterectomy: historical and clinical perspective. Author(s): Miyazawa K. Source: Obstetrical & Gynecological Survey. 1992 July; 47(7): 433-47. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1620524&dopt=Abstract
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Ten-year survival of patients with locally advanced, stage ib-iib cervical cancer after neoadjuvant chemotherapy and radical hysterectomy. Author(s): Hwang YY, Moon H, Cho SH, Kim KT, Moon YJ, Kim SR, Kim DS. Source: Gynecologic Oncology. 2001 July; 82(1): 88-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11426967&dopt=Abstract
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The control of postoperative pain by EMG biofeedback in patients undergoing hysterectomy. Author(s): Moon MH, Gibbs JM. Source: N Z Med J. 1984 September 26; 97(764): 643-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6382079&dopt=Abstract
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The effect of dietary fiber on bowel function following radical hysterectomy: a randomized trial. Author(s): Griffenberg L, Morris M, Atkinson N, Levenback C. Source: Gynecologic Oncology. 1997 September; 66(3): 417-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9299255&dopt=Abstract
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The persistent challenge of hysterectomy. Author(s): ISRAEL SL. Source: Southern Medical Journal. 1965 May; 58: 608-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14280784&dopt=Abstract
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Therapeutic suggestions during general anaesthesia in patients undergoing hysterectomy. Author(s): Liu WH, Standen PJ, Aitkenhead AR. Source: British Journal of Anaesthesia. 1992 March; 68(3): 277-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1547052&dopt=Abstract
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Transcutaneous electrical nerve stimulation reduces the incidence of vomiting after hysterectomy. Author(s): Fassoulaki A, Papilas K, Sarantopoulos C, Zotou M.
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Source: Anesthesia and Analgesia. 1993 May; 76(5): 1012-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8484499&dopt=Abstract •
Treatment of a uterine adenocarcinoma in a domestic rabbit by ovariohysterectomy. Author(s): Sommerville LM. Source: The Veterinary Record. 1998 May 16; 142(20): 550-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9637385&dopt=Abstract
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Urinary retention after hysterectomy for benign disease: extended diagnostic evaluation and treatment with sacral nerve stimulation. Author(s): Everaert K, De Muynck M, Rimbaut S, Weyers S. Source: Bju International. 2003 April; 91(6): 497-501. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12656902&dopt=Abstract
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Use of relaxation training to reduce pain following vaginal hysterectomy. Author(s): Perri KD, Perri MG. Source: Percept Mot Skills. 1979 April; 48(2): 478. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=379793&dopt=Abstract
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Vaginal radical hysterectomy for uterine cervical cancer. Author(s): Zhang QB. Source: Chinese Medical Journal. 1990 September; 103(9): 743-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2123775&dopt=Abstract
•
Wertheim's hysterectomy after neoadjuvant carboplatin-based chemotherapy in patients with cervical cancer stage IIB and IIIB. Author(s): Meden H, Fattahi-Meibodi A, Osmers R, Krauss T, Kuhn W. Source: Anticancer Res. 1998 November-December; 18(6B): 4575-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9891521&dopt=Abstract
Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •
Alternative Medicine Foundation, Inc.: http://www.herbmed.org/
•
AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats
•
Chinese Medicine: http://www.newcenturynutrition.com/
•
drkoop.com®: http://www.drkoop.com/InteractiveMedicine/IndexC.html
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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm
•
Google: http://directory.google.com/Top/Health/Alternative/
Alternative Medicine 103
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Healthnotes: http://www.healthnotes.com/
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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine
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Open Directory Project: http://dmoz.org/Health/Alternative/
•
HealthGate: http://www.tnp.com/
•
WebMD®Health: http://my.webmd.com/drugs_and_herbs
•
WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html
•
Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/
The following is a specific Web list relating to hysterectomy; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •
General Overview Abnormal Pap Smear Source: Healthnotes, Inc.; www.healthnotes.com Amenorrhea Source: Integrative Medicine Communications; www.drkoop.com Breast Cancer Source: Healthnotes, Inc.; www.healthnotes.com Endometriosis Source: Healthnotes, Inc.; www.healthnotes.com Endometriosis Source: Integrative Medicine Communications; www.drkoop.com Menopause Source: Integrative Medicine Communications; www.drkoop.com Pms Source: Integrative Medicine Communications; www.drkoop.com Premenstrual Syndrome Source: Integrative Medicine Communications; www.drkoop.com Urinary Incontinence Source: Integrative Medicine Communications; www.drkoop.com
•
Herbs and Supplements Cimicifuga Alternative names: Black Cohosh; Cimicifuga racemosa (NUTT.) Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org
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Progesterone Source: Healthnotes, Inc.; www.healthnotes.com
General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.
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CHAPTER 4. DISSERTATIONS ON HYSTERECTOMY Overview In this chapter, we will give you a bibliography on recent dissertations relating to hysterectomy. We will also provide you with information on how to use the Internet to stay current on dissertations. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical dissertations that use the generic term “hysterectomy” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on hysterectomy, we have not necessarily excluded nonmedical dissertations in this bibliography.
Dissertations on Hysterectomy ProQuest Digital Dissertations, the largest archive of academic dissertations available, is located at the following Web address: http://wwwlib.umi.com/dissertations. From this archive, we have compiled the following list covering dissertations devoted to hysterectomy. You will see that the information provided includes the dissertation’s title, its author, and the institution with which the author is associated. The following covers recent dissertations found when using this search procedure: •
A Cognitive Approach to Facilitating Psychological Adjustment to Hysterectomy by Handman, Michael David; PhD from University of Alberta (Canada), 1983 http://wwwlib.umi.com/dissertations/fullcit/NK64004
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Exploratory Study of Pastoral Care Intervention with Hysterectomy Patients by Graham Mcnair, Alice Marie, PhD from Northwestern University, 1983, 155 pages http://wwwlib.umi.com/dissertations/fullcit/8400709
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Hysterectomy: the Relationship between Occupational Role and Emotional, Behavioral, and Attitudinal Outcomes. by Baron, Enid Levien, PhD from Northwestern University, 1976, 189 pages http://wwwlib.umi.com/dissertations/fullcit/7709999
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Medical Power Relations and Elective Hysterectomy by Lorentzen, Jeanne M.; PhD from Michigan State University, 2000, 300 pages http://wwwlib.umi.com/dissertations/fullcit/9985423
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Non-clinical Risk Factors of Hysterectomy by Lee, Chung-won; PhD from Utah State University, 2001, 163 pages http://wwwlib.umi.com/dissertations/fullcit/3029021
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Self-reported Perception of Physical and Psychosocial Variables Post-hysterectomy by Henderson, Judith Ann, EDD from University of South Dakota, 1995, 266 pages http://wwwlib.umi.com/dissertations/fullcit/9535507
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The Effects of Preoperative Education, Attitude toward Having Children and Sex-role Socialization on Posthysterectomy Depression and Self-esteem in Young Women by Palmer, Deanette Lynne, PhD from Washington State University, 1984, 187 pages http://wwwlib.umi.com/dissertations/fullcit/8423010
Keeping Current Ask the medical librarian at your library if it has full and unlimited access to the ProQuest Digital Dissertations database. From the library, you should be able to do more complete searches via http://wwwlib.umi.com/dissertations.
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CHAPTER 5. PATENTS ON HYSTERECTOMY Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.8 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “hysterectomy” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on hysterectomy, we have not necessarily excluded nonmedical patents in this bibliography.
Patents on Hysterectomy By performing a patent search focusing on hysterectomy, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an 8Adapted
from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.
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example of the type of information that you can expect to obtain from a patent search on hysterectomy: •
Hysterectomy drain appliance Inventor(s): Houts; Richard E. (Santa Ynez, CA), Seder; Edmund V. (Santa Barbara, CA) Assignee(s): Helix Medical, Inc. (Santa Barbara, CA) Patent Number: 5,041,101 Date filed: June 5, 1989 Abstract: A hollow, T-shaped body is connected to an extroducer rod by a flexible drain tube. The extroducer rod is longer than a human female vagina, sufficiently stiff to be passed therethrough when the vagina is in a collapsed state, and has a smooth rounded end to facilitate insertion through the vaginal cuff and passage through the vagina during an abdominal hysterectomy. The extroducer rod is also larger in diameter than a Foley catheter which is used to drain the bladder, and formed with external flutes which make it easily distinguishable from the catheter by feel. The T-shaped body has a leg which is connected to the drain tube, and two perpendicular arms. Drain holes are formed through the arms which open in a direction away from the leg. The innermost drain hole of each arm is cut away to a sufficient depth that the arms can collapse to positions parallel to the leg and drain tube to facilitate withdrawal of the body through the vagina. Notches having smooth, rounded walls are formed at desired spacings in the arms to facilitate trimming the arms to fit the patient's anatomy. The rounded walls of the notches and the location of the drain holes which face inwardly toward each other in the collapsed position of the arms prevents irritation of the vaginal wall by sharp edges during withdrawal. Excerpt(s): The present invention relates to a device for postoperative draining of fluids from a patient and, more particularly, this invention relates to an improved drain for placement in the retroperitoneal space after hysterectomy. Hysterectomy is routinely performed in a potentially contaminated field due to the inability to completely sterilize the vagina. After removal of the uterus in either abdominal or vaginal hysterectomies, serum and blood collect in the retroperitoneal space. To lower the incidence of infection, most gynecologic surgeons insert a drain tube in this space, typically a Jackson-Pratt drain tube, to drain this fluid for about 72 hours after surgery. The tube is then removed by pulling the tube through the vagina. The Jackson-Pratt tube is in the form of a soft flexible T having a short top arm with drain holes and a long leg extending through the vagina, the end of which is connected to a drain pump. Though effective in removing fluid from the retroperitoneal space, the Jackson-Pratt drain tube is difficult to insert and can cause irritation to sensitive tissue in the retroperitoneal space and the walls of the vagina, especially with older patients. Though the vaginal cuff differs from patient to patient, the Jackson-Pratt drain tube has a fixed geometry. If the upper arm is too short it can slip into the vaginal cuff. If it is too long, it can irritate tissue that it contacts. If the ends of the arms are trimmed, the sharp edges can irritate the vaginal walls when the drain tube is removed by pulling it through the vagina. Web site: http://www.delphion.com/details?pn=US05041101__
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Instrument set for laparoscopic hysterectomy Inventor(s): Koninckx; Philippe Robert (Bierbeek, BE) Assignee(s): K.U. Leuven Research & Development (Leuven, BE) Patent Number: 5,662,676 Date filed: March 7, 1995 Abstract: The invention relates to an instrument set for laparoscopic vaginal hysterectomy which comprises a uterine rotator comprising a rod with a uterine end for insertion into the uterus and a control end, and with at least one wing moveable in and out of the uterine end which in a folded-out position makes contact with the inner wall of the uterus and which is connected via coupling means to a control member located at the control end, wherein the rod is preferably provided with two wings, and more preferably the rod is provided with a hinge, and with optionally at least one artery forceps provided with a handle and mutually reciprocating jaws. Excerpt(s): The present invention relates to an instrument set for laparoscopic hysterectomy, including laparoscope-assisted sub-total and total hysterectomy, and to a uterine rotator and an artery forceps therefor. Hysterectomy is one of the surgical operations most frequently performed on women. On average the uterus is removed in one of three women. Abdominal hysterectomy is generally performed in particular when the uterine volume is large, when extensive pelvic adhesions are present or expected, and when other pathology such as ovarian cysts, extensive endometriosis or cancer are present. Web site: http://www.delphion.com/details?pn=US05662676__
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Medical instrument for manipulation of the uterus Inventor(s): Boebel; Manfred (Otisheim, DE), Messroghli; Hossein (Gross -Gerau, DE), Prestel; Stephan (Rheinstetten-Morsch, DE), Reich; Harry (Kingston, PA) Assignee(s): Richard Wolf GmbH (Knittlingen, DE) Patent Number: 5,746,750 Date filed: February 5, 1997 Abstract: A medical instrument is provided for manipulation of the uterus, in particular for laparascopic complete hysterectomy. It comprises a handle at the proximal instrument part and a manipulator probe at the distal instrument part, these being connected to one another via an elongate shank. Furthermore a holding device is arranged at the distal instrument part for fastening the uterus subject to therapy relative to the manipulator probe. In order to prevent the pneomoperitoneum from being destroyed during the operation to remove the uterus, the invention provides for a sealing device in the form of a closed tube insertable into the vagina, in which the shank of the instrument is axially displaceably arranged. Excerpt(s): The invention relates to a medical instrument for manipulation of the uterus, in particular for laparascopic complete. Instruments of this type are for example used in laparascopic complete hysterectomy. With this, the instrument for manipulation of the uterus serves to tilt the uterus in various directions in order for example to be able to carry out the free dissecting of the uterus from blood vessels, ligaments and likewise. With such operation techniques an absolute as possible gas impermeability must be present. It is therefore necessary to provide a sealing mechanism on the vaginal side. An
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instrument according to the preamble is known from WO 94/00061 which also describes the operation procedure per se in more detail. The instrument disclosed in WO 94/00061 comprises a round cross section of which the distal end is formed as a splaying device. After introducing the manipulator into the cavum uteri, the distal splaying device is splayed by operating the proximal handle and thus the uterus and manipulator are fixed to one another. In the distal region the manipulator comprises a bending device so that by bending the distal region and also by rotation of the instrument, the uterus is pivoted and turned into just that position required by the operator. During the laparascopic free dissection, the vagina is sealed to the outside using a flexible sealing device by which means the pneumoperitoneum may be maintained. After the free clerarance of the uterus, the sealing device is removed and with appropriately designed scissors, the freely dissected uterus is cut from the rear vaginal fornix and pulled out via the vagina. With this the pneumoperitoneum is lost and must be re-established after a renewed sealing on the vaginal side has been effected. Web site: http://www.delphion.com/details?pn=US05746750__ •
Post hysterectomy fluid drainage tube Inventor(s): Swartz; William H. (8335 Sugarman Dr., La Jolla, CA 92037) Assignee(s): none reported Patent Number: 4,072,153 Date filed: March 3, 1976 Abstract: A flexible surgical T tube for use as a post hysterectomy fluid drainage tube having a plurality of drain ports extending across the top of the cross tube having open ends thereof and the ports extending around the periphery of the tube and with a top central port designed for tube removal after implantation thereof by simple non-surgical withdrawal. Excerpt(s): Two factors necessary for the establishment of a pelvic infection are bacteria and a culture medium suitable for its growth. It has been demonstrated that despite the use of local and/or systemic antibiotics, virulent bacteria are present the operative site following hysterectomy. It has also been demonstrated at 10-200cc (average 40cc) of a fluid containing blood, serum, and necrotic debris, inevitably accumulates in the retroperitoneal space following either abdominal or vaginal hysterectomy. Furthermore, it has been shown that pathogenic bacteria can be cultured from this fluid in 62% of the cases. Thus, two major factors necessary for the establishment of a surgical infection, i.e., pathogenic bacteria and a suitable culture medium, are routinely present following either abdominal or vaginal hysterectomy. Considerable efforts are given to reducing the numbers of bacteria present at the operative site, e.g., local cleansing, application of antiseptic or antibiotic creams, suppositories, and douches, as well as the prophylactic administration of systemic antibiotics. However, less effort is expended in reducing the amount of culture medium available for bacterial growth. Suction drainage can effectively remove this fluid which normally collects in the retroperitoneal space following hysterectomy and also maintain collapse of this potential dead space. Routine removal of this fluid using this technique was associated with a significant reduction (p= <0.01) in febrile morbidity from 26 to 11% for abdominal hysterectomy and from 32 to 8% for vaginal hysterectomy. The effectiveness of this technique has been confirmed. The suction drainage tube utilized in this technique consists of a T-shaped drainage tube, a standard 200cc constant suction evacuator, and an appropriate connecting tube, specifically designed to effectively drain the surgical pedicles of the retroperitoneal
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space following hysterectomy. An average 40cc (range 10-200cc) can suction from the pelvic retroperitoneal space following hysterectomy. The pelvic retroperitoneal space where this fluid collection routinely occurs is the space which remains following removal of the uterus. It is anatomically bordered by the bladder in front, the peritoneum forming the roof and back of the space, the sutured vaginal cuff forming the floor of the space, while the sutured pedicles and pelvic walls form the sides. In a subsequent study it has been demonstrated that this fluid is routinely contaminated with pathogenic bacteria. Effective removal of this bacteriologically contaminated fluid via T tube suction drainage is associated with a statistically significant reduction in pelvic infection and febrile morbidity following either abdominal or vaginal hysterectomy. Web site: http://www.delphion.com/details?pn=US04072153__ •
Surgical instruments Inventor(s): Sinnreich; Manfred (160 Ft. Hill Rd., Scarsdale, NY 10583) Assignee(s): none reported Patent Number: 4,083,369 Date filed: July 2, 1976 Abstract: The invention relates to surgical instruments having particular application to the field of gynecology. The disclosure includes an inflatable packing and continuous suction device suitable for use following hysterectomy procedures to assist in normal draining while maintaining the bowel in properly elevated condition. There is also disclosed an improved trocar shield useful in performing various procedures. Both embodiments are characterized in the provision of a relatively rigid hollow tube element having mounted thereon an expandable balloon element in which portions thereof are of differential thickness whereby the configuration attained at equilibrium may be predetermined. Excerpt(s): In my prior U.S. Pat. No. 3,882,852 granted Apr. 13, 1975, there is disclosed a device for dilating the uterus comprising a hollow rigid tube upon which an inflatable balloon is mounted in coaxial relation. The tube serves as a conduit-forming member for the introduction of an endoscope or other surgical instrument, and the balloon serves to dilate the uterine cavity so that the surgical procedure may be performed by structure disposed at the distal end of the tube element. So-called Foley catheters are also known in the art, and are used for dilation purposes. But owing to the absence of a rigid element, they do not have useful application in the field of gynecological surgery. Briefly stated, the invention contemplates the provision of an improved device resembling to some degree that described in the above mentioned patent, including an axially disposed rigid tube element, and a surrounding balloon-like inflatable element in which the configuration of the balloon has been modified to enable the same be used as a pneumatic packing and drainage device following a hysterectomy procedure. The axially disposed tube element serves to interconnect the cavity with a source of gentle suction applied to the proximal end of the tube element whereby drained matter is continuously removed. One half of the inflatable element expands at a greater rate than the other, and is positioned to face the spine and pelvis of the patient, whereby the tube may be axially aligned with the vagina when positioned in the surgical cavity. The thinner section of the inflatable element may be suitably coated with an antiseptic emollient which directly contacts the raw tissue exposed with partial removal of the peritoneum. Another embodiment in the form of an improved trocar shield is provided
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with an inflatable element which, on inflation, assumes the contour of a torus thereby distending the cavity in which it is placed, and allowing adequate space on the distal side of the tubular member to perform surgical procedures. This is accomplished by making the inflatable element in such manner that it includes three coaxially aligned portions, the outer two of which are relatively thicker in cross section that the centrally disposed portion. In the drawing, to which reference will be made in the specification, similar reference characters have been employed to designate corresponding parts throughout the several views. Web site: http://www.delphion.com/details?pn=US04083369__ •
Surgical pad Inventor(s): Hunt; James R. (Carencro, LA) Assignee(s): Will Ross, Inc. (Milwaukee, WI) Patent Number: 4,040,424 Date filed: May 14, 1976 Abstract: An absorbent surgical pad, useful after delivery, hysterectomy, or hemorrhoidectomy procedures and having a uniquely-shaped adhesive configuration, is described. There further is described a novel pad pack of such configuration that the adhesive can be removed with minimal danger of inadvertent contamination of the absorbent pad. Excerpt(s): The present invention is concerned generally with absorbent surgical pads. More particularly it is concerned with a novel absorbent pad having a uniquely-shaped, e.g. "T"-shaped, adhesive configuration. Additionally, the novel configuration of the pad permits packging in a folded configuration such that the adhesive can be exposed and the pad applied to a patient with minimal danger of inadvertent contamination of the absorbent portion of the pad. It is standard procedure after certain delivery, hysterectomy, plastic or reconstructive surgery or hemorrhoidectomy procedures to apply an absorbent pad to the affected area before the patient is removed from surgery to the hospital recovery area. Generally such pads are applied about the rectal-genital area and retained thereon by a belt passing around the patient's midsection. Such belts and pads are cumbersome to apply and are difficult to maintain at the proper position during subsequent movement of the patient. It is thus an object of this invention to provide a disposable absorbent surgical pad which is conveniently applied and secured to a patient. It further is an object of this invention to provide an absorbent pad having pressure-sensitive adhesive thereon which will retain the pad in the desired configuration and yet permit removal with a minimum discomfort to the patient. Additionally, it is an object to provide a novel, folded pad, suitable for rapid application to the patient with minimal danger of contaminating the absorbent surgical pad itself. Web site: http://www.delphion.com/details?pn=US04040424__
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Therapeutic body suit Inventor(s): Gollestani; Maria (P.O. Box 2388, Kailua-Kona, HI 96745) Assignee(s): none reported Patent Number: 4,802,469 Date filed: August 3, 1987 Abstract: The invention is a therapeutic body suit designed to produce therapeutic pressure on the abdominal and lower abdominal body areas as an aid to healing after certain types of surgery including: liposuction abdominal plasty; hysterectomy; cesarean section; mastectomy and breast surgery; and hernia. This invention may be utilized on women and men. The invention consists of three major components. The first component is a body suit designed to provide theraputic pressure. The second component is an elastic binding surrounding the body suit with detachable and adjustable ends designed to enhance the therapeutic pressure of the body suit. The third component is a breathing elastic crotch therapeutically supporting binding attached in a removable manner to the second component. Excerpt(s): This device pertains to field of medical equipment; to subclass of artificial abdominal supporting prosthesis designed to temporarily exert pressure as an aid to medical and post-surgical healing. Certain types of surgery including liposuction; abdominal plasty; hysterectomy; mastectomy; cesarean section & breast surgery; and hernia repairs result in the separation of certain soft body tissue and swelling. Postsurgical healing for this tissue is promoted with the use of devices designed to exert certain therapeutic pressure externally about the affected body area. Present day devices consist of elastic bands of one of the three following types: (1) all elastic bands attached in an adjustable manner about the circumference of the abdomen capable of stretching about the length and width of the band; (2) all adjustable elastic bands attached as in 1, but containing attached restrictions permitting stretching about the length only, not the width; (3) bands as cited in 1 and 2 further including separate elastic crotch supporting bands. Limitations of the prior art cited above include (1) inability of the devices to consistently remain in position with body movements occurring during daily living; (2) inability of the devices to comfortably transition from areas of the desired therapeutic pressure, to surrounding areas of non-pressure. Web site: http://www.delphion.com/details?pn=US04802469__
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Thread carrier plate device and method Inventor(s): Yu; Ken-Jen (Tazpei, TW) Assignee(s): Veterans General Hospital-Taipei, VACRS (Taipei, TW) Patent Number: 6,110,181 Date filed: February 10, 1999 Abstract: A device and method for helping surgeons pass the sutures through the vagina into the abdominal cavity during an operation of laparoscopic assisted vaginal hysterectomy (LAVH). The device utilizes two long plates having a pair of small holes on both ends. The plates are used to pass the thread into the abdominal cavity through the opening of the colpotomy at fornices of the vagina. Excerpt(s): The present invention assists the surgeon in a laparoscopic assisted vaginal hysterectomy (LAVH). The thread carrier device makes it easier to suture through the
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vagina into the abdominal cavity during the operation. This tool improves the accessibility and safety factors of the operation. All over the world, LAVH is a very common procedure applied in gynecologic laparoscopic surgery. However, a large uterus is not easy to be pulled down into the vagina to divide the uterine cardinal ligaments during the LAVH operation. A hypertrophied cervix narrows the limited space of the vagina, and also increases the level of difficulty in the operation. Additional objects, advantages and novel features of the invention will be set forth in part in the description as follows, and in part will become apparent to those skilled in the art upon examination of the following, or may be learned by practice of the invention. The objects and advantages of the invention may be realized and attained by means of the instrumentalities and combinations particularly pointed out in the appended claims. The main goal of the present invention, "Thread Carrier Plate Device and Method", is to make an assisted approach to secure ligation and cutting of the uterine cardinal ligaments in the procedure of LAVH. The implementation of the present invention, "Thread Carrier Plate Device and Method", is to use a long plate to carry the thread which leads the thread from the vagina into the cardinal ligaments on both sides of uterus. This is done so that the uterine cardinal ligaments can be tied securely. Web site: http://www.delphion.com/details?pn=US06110181__ •
Transvaginal tube as an aid to laparoscopic surgery Inventor(s): McCartney; Anthony John (Swanbourne, AU) Assignee(s): Gynetech Pty Ltd. (AU) Patent Number: 6,572,631 Date filed: November 19, 1999 Abstract: A transvaginal tube adapted for insertion into the vaginal tract of a patient for use during performance of a laparoscopic hysterectomy or other laparoscopic surgery on the patient. The tube has a diameter greater than the patient's cervix opening and has a distal end and a proximal end. The proximal end is cut in a plane non-normal to its tubular axis being adapted to define the patient's cervico-vaginal junction. The tube further includes a sealing structure capable of forming a seal at the distal end of the tube during the surgery. The tube is capable of maintaining the pneumoperitoneum when inserted into the vaginal tract of the patient with the seal formed at the distal end of the tube. Excerpt(s): This invention relates to transvaginal tube which is particularly useful in laparoscopic surgery, and also to a procedure for the use of such a tube. Modern advances in laparoscopic surgical equipment have meant that surgeons are able to remove the uterus and/or ovaries laparoscopically, removing the need for a long abdominal incision. A laparoscopic radical hysterectomy for cancer has evolved from the efforts of a few oncology centres with an interest in minimising invasive surgery. The operative technique is analogous to a modification of the operation originally described by Wertheim and Meigs. The laparoscope surgeon passes a 10 mm laparoscope trans-abdominally through a sub-umbilical incision after establishing a pneumoperitineum. Using two lateral portals the ovarian pedicles are divided down to the level of the uterine arteries. The ureter is isolated and protected and the uterine vessels and parametrium are divided after mobilising the bladder. The next stage is to remove the uterus and close the vaginal vault so the pneumoperitoneum can be reestablished for the lymphadenectomy. The lymph nodes are removed by plucking them
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from their bed and dragging them out of the abdomen through the trans-abdominal wall port used for the grasping forceps. Web site: http://www.delphion.com/details?pn=US06572631__ •
Use of low levels of mifepristone to treat leiomyomata Inventor(s): Yen; Samuel S. C. (La Jolla, CA) Assignee(s): The Regents of the University of California (Oakland, CA) Patent Number: 5,468,741 Date filed: May 28, 1993 Abstract: This invention provides for novel unit doses of mifepristone to treat leiomyomata. Compared to unit dosages taught by the prior art, the claimed dosages are low and surprisingly effective. Furthermore, because higher dosages had undesired side effects, the prior art suggested that mifepristone was not suitable for long term clinical uses which are needed to treat leiomyomata. The advantages of this invention include a reduction of surgical morbidity, circumvent the need of a hysterectomy, and costeffectiveness. Excerpt(s): Leiomyomata are common pelvic fibroid tumors occurring in up to 20% of women over 30 years of age. Leiomyomata represent one of the most frequent indications of operative procedures in woman of reproductive age. Symptoms are reported in twenty to fifty percent of cases of leiomyomata. Symptoms include pelvic pain, excessive duration or amount of menstruation, infertility and pelvic masses. Although the mechanisms of tumorigenesis are unknown, evidence suggests that leiomyomata are ovarian steroid dependent, Buttram, V. C., et al. (1981), Fertil. Steril., 36:433, incorporated herein by reference. Estrogen and growth hormone are thought to act synergistically to stimulate leiomyomata growth as the two are elevated during pregnancy when the growth of leiomyomata is rapid. That progesterone may play a role in Leiomyomata growth is suggested by the finding of increased mitotic count in leiomyomata obtained during the secretory phase than in proliferative phase of the menstrual cycle; Kawaguchi, et al. (1988) Am. J. Obstet. Gynecol., 160:637. Additionally, when the GnRH-agonist and a progesterone were co-administered, the expected regression of leiomyomata size seen with GnRH-agonist alone is not achieved, Friedman et al (1988) Fertil. Steril. 49:404. Wilson, E. R., et al. (1980) Obstet. Gynecol., 55:22 and Soules, M. R., et al. (1982) Am. J. Obstet. Gynecol., 143:6 have identified receptors for both estrogen (ER) and progesterone (PR) leiomyomata tissue. Web site: http://www.delphion.com/details?pn=US05468741__
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Uterine manipulating assembly for laparoscopic hysterectomy Inventor(s): Blair; Kerry L. (Olathe, KS), Heaton; John E. (Kansas City, MO), Koh; Charles H. (Mequon, WI), Rowden; Jimmy M. (Olathe, KS) Assignee(s): Blairden Precision Instruments, Inc. (Lenexa, KS) Patent Number: 5,840,077 Date filed: October 17, 1995 Abstract: A colpotomy assembly 10 is adapted for insertion into a vaginal cavity for use in female pelvic surgical procedures employing the inflation of an abdominal cavity
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with a gas to facilitate the accessability to and visibility of female pelvic organs. The assembly has a vaginal extender 20, a uterine manipulator 16 and a flexible occluder. The occluder being mounted on a shaft of the uterine manipulator such that it permits relative movement of the shaft 26 during use. Excerpt(s): The present invention relates to a vaginal extender for use in performing various female pelvic surgeries, including laparoscopic hysterectomy, laparoscopically assisted vaginal hysterectomy, and other female pelvic laparoscopic procedures where removal of tissue specimens through a colpotomy incision is indicated. Conventional hysterectomy surgical procedures typically involve one of four approaches--vaginal hysterectomy, total abdominal hysterectomy (TAH), total laparoscopic hysterectomy (TLH), and laparoscopically assisted vaginal hysterectomy (LAVH). Vaginal, TLH and LAVH have become more popular among surgeons because these approaches are less invasive than TAH, with TLH being the least invasive approach. TLH is less invasive than LAVH because it avoids the trauma normally caused by the expansion induced to the vaginal area to permit access of the surgeons hands to the cervical area. Unless medical indications require TAH (such as in the case of tumor removal and the associated need to avoid cell spillage), vaginal, TLH and LAVH are usually viewed as more preferable because each is less invasive when compared to major abdominal surgery. Thus, TLH and LAVH approaches usually result in shorter hospitalization and recovery times. Difficulty, however, is encountered when employing vaginal, TLH and LAVH techniques due to inherent limitations on visibility, anatomical identification, and the ability to manipulate organs (especially the uterus). In the case of TLH, these limitations are particularly pronounced because of higher degree of difficulty in securing the uterine arteries and cardinal ligaments associated with this approach. A higher degree of surgical difficulty has been found empirically to give rise to an increased risk of inadvertent damage to or dissection into the bladder, ureters, uterine vessels and uterosacral and cardinal ligaments during the surgical procedure. Although the risk of inadvertent damage, for example, to the ureters can be minimized by the insertion of ureteral stints and/or peritoneal dissection to delineate ureter location, such techniques increase the complexity and the cost of the hysterectomy. Web site: http://www.delphion.com/details?pn=US05840077__ •
Uterine retractor for an abdominal hysterectomy and method of its use Inventor(s): Boyle; Gary C. (Rte. 2, Box 14-A, Blountville, TN 37617) Assignee(s): none reported Patent Number: 4,976,717 Date filed: April 24, 1989 Abstract: A uterine retractor for an abdominal hysterectomy includes elongate shaft means having first and second opposite ends, piercing means located on the first end of the shaft means for piercing through the fundus of the uterus, and engagement means located on the second end for engaging the cervix. In use, the first end of the shaft means is guided up through the vaginal canal and inserted into the interior space of the uterus through the cervical canal. The retractor is then urged forwardly to cause the piercing means to pierce through the fundus of the uterus to position the first end of the shaft means outside the uterus in the abdominal cavity. The projecting first end of the shaft means is accessed through an incision formed in the lower abdominal wall, whereupon the retractor is pulled through the interior space of the uterus until the engagement means engages the cervix. In this position, the retractor is used to move the
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cervix to a desired position facilitating separation of the uterus from attached body structure including the vagina. After the uterus is separated, the retractor may be used to lift the uterus out of the abdominal cavity through the incision. Excerpt(s): The present invention relates to surgical instruments and methods for performing hysterectomies and related procedures, and more particularly relates to a uterine retractor for an abdominal hysterectomy and a method of its use. In an abdominal hysterectomy procedure, the uterus and often the adnexa are separated from their attachments in the abdominal cavity, and removed through an incision made across and through the lower abdominal wall. The separation is performed at the base of the uterus adjacent the cervix in the anterior and posterior cul-de-sac regions where there is a very close arrangement of the uterus relative to critical adjacent structure, particularly the rectum, bladder and ureter. Because of this arrangement, considerable skill and careful attention are required on the part of the surgeon during the procedure to avoid undesired involvement or contact with the adjacent structure as access is gained to the various connective tissue and separation and reconstruction procedures are performed. The close arrangement of the base of the uterus relative to critical adjacent structure also makes it difficult to use modern adjunct surgical techniques such as stapling and lasering, for example, in abdominal hysterectomies. The typical procedure for an abdominal hysterectomy involves traction of the uterus cranially in order to lessen the difficulties presented by the uterine arrangement. However, any traction o other movement that can be achieved using conventional surgical instruments and techniques is not particularly effective for this purpose. Web site: http://www.delphion.com/details?pn=US04976717__ •
Uterine-ring hysterectomy clamp Inventor(s): Lally; James J. (5760 Windsor Cir., Shawnee Mission, KS 66205) Assignee(s): none reported Patent Number: 5,108,408 Date filed: April 20, 1990 Abstract: A surgical tool for use in abdominal hysterectomies includes an inner uterinering assembly having a ring for insertion into the vagina at the juncture of the cervix and vagina. An outer clamping assembly insertable through a surgically opened abdominal cavity is clamped about the inner ring with the vaginal tissue interposed therebetween. The combination presents a scalpel guide for surgical circumcision of the interposed tissue as well as controls undesirable bleeding from the circumcised tissue. Excerpt(s): This invention relates to a surgical device, and more particularly, to a surgical tool for use in performing abdominal hysterectomies. The basic technique of an abdominal hysterectomy is well known in the medical art. Reference is made to U. S. medical references in which the steps in performing a hysterectomy are set forth therein. One such reference is "An Atlas of Pelvic Operations" published by W. B. Saunders Company and written by Langdon Parsons, M. D. and Howard Ulfelder, M. D. in 1968. Basically, an incision is made in the abdominal wall and underlying peritoneum so as to expose the abdominal cavity and the various organs therein including the uterus. The uterus is to be removed at its cervical juncture with the vagina commonly referred to as the fornix. Upon identifying such juncture, surrounding blood vessels are ligated and circumcision is made about the vaginal wall at this fornix area. Upon removal of the uterus, the resulting vaginal edges are sewn shut.
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Web site: http://www.delphion.com/details?pn=US05108408__
Patent Applications on Hysterectomy As of December 2000, U.S. patent applications are open to public viewing.9 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to hysterectomy: •
Device and method for facilitating a laparascopic supracervical hysterectomy Inventor(s): Dennis, Martin E.; (Minot, ND) Correspondence: Timothy E Siegel; 1868 Knapps Alley; Suite 206; West Linn; OR; 97068; US Patent Application Number: 20030216731 Date filed: May 16, 2002 Abstract: A method of severing the uterine body from the cervix during the performance of a laparascopic supracervical hysterectomy. A laparascopic instrument having an expandable and contractible thin wire loop at its distal end is provided. The operation starts with the opening of at least one port into the abdomen of the patient. The distal end of the instrument is passed through the port and into the abdominal cavity and the thin wire loop is expanded and passed over the top of the uterus. The thin wire loop is positioned at the boundary between the cervix and the body of the uterus and contracted together, to sever the body of the uterus from the cervix. Excerpt(s): In a laparascopic supracervical hysterectomy, the body of the uterus must be detached from the cervix. Presently this is done by using a bipolar needle electrode, which must be inserted through a laparascopic port and manipulated at a distance to repeatedly detach a portion of the cervix a time. This takes between 5 and 10 minutes and may result in damage to neighboring tissue. The process of unipolar cautery is currently used to, among other functions, removing polyps from the intestines. A number of endoscopic devices made for this purpose have loops that may be pushed outwardly from a lumen, thereby expanding outwardly about the polyp. The loop is then withdrawn into the lumen, causing the portion remaining outside the lumen to contract. Unfortunately, it appears that none of the currently available devices are adaptable for severing the cervix from the uterine body. This is because the uterine body is typically far larger than an intestinal polyp, measuring approximately 5 cm high, from 4-5 cm from back to front and from 5-6 cm from side to side. U.S. Pat. No. 6,176,858 discloses a device and method for separating the uterine body from the cervix during a laparascopic supracervical hysterectomy. Unfortunately, this device is needlessly complex and its use is quite time consuming. A wire segment must be placed around the cervix inside the body. Then one end of the wire segment must be mated to the other (fasteners are provided) before the loop is pulled to remove the cervix from the uterine body. As the loop cannot be cinched, the cutting operation requires that the wire loop must all be pulled forward, thereby potentially contacting other tissue. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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This has been a common practice outside the United States prior to December 2000.
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Method and apparatus for creating intrauterine adhesions Inventor(s): Duchon, Douglas J.; (Chanhassen, MN), Presthus, James; (Edina, MN) Correspondence: Oppenheimer Wolff & Donnelly Llp; 840 Newport Center Drive; Suite 700; Newport Beach; CA; 92660; US Patent Application Number: 20020010457 Date filed: April 24, 2001 Abstract: An apparatus and method of use or treatment are disclosed for creating intrauterine adhesions resulting in amenorrhea. In particular, the apparatus relates to an easily deployed intrauterine implant that readily and consistently reduces or eliminates abnormal intrauterine bleeding. In addition, the apparatus is also used as a uterine marker device for visualizing endometrial tissue thickness and potential changes. The method of the present invention serves as a supplement to or a replacement for conventional hysterectomy or ablation/resection procedures used to treat menorrhagia. Excerpt(s): The present application claims priority of U.S. Provisional Application Ser. No. 60/256,529, filed Dec. 18, 2000, and U.S. Provisional Application Ser. No. 60/199,736, filed Apr. 25, 2000, whose contents are fully incorporated herein by reference. Menstrual bleeding is a part of normal life for women. The onset of menstruation, termed menarche, usually occurs at the age of 12 or 13. The length of a woman's monthly cycle may be irregular during the first one to two years. Once the menstrual cycle stabilizes, a normal cycle may range from 20 to 40 days, with 28 days commonly being an average. Age, weight, athletic activity and alcohol consumption are several factors that affect menstrual cycles. For example, younger women (under the age of 21) and older women (over the age of 49) tend to have longer cycle times, generally averaging 31 days and over. Similarly, women who are very thin or athletic also have longer cycles. In contrast, women who consume alcohol on a regular basis tend to have shorter cycle times. Nearly all women, at some time during their reproductive life, experience some type of menstrual disorder. These disorders range from mild to severe, often resulting in numerous lost work hours and the disruption of personal/family life each month. In general, physical symptoms such as bloating, breast tenderness, severe cramping (dysmenorrhea) and slight, temporary weight gain frequently occur during most menstrual cycles. In addition to physical symptoms, emotional hypersensitivity is also very common. Women report a wide range of emotional symptoms, including depression, anxiety, anger, tension and irritability. These symptoms are worse a week or so before a woman's menstrual period, generally resolving afterward. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Method for performing a hysterectomy Inventor(s): Samimi, M.D., Darius; (Corona Del Mar, CA) Correspondence: Richard E. Bee; P.O. Box 10544; Costa Mesa; CA; 92627; US Patent Application Number: 20020096181 Date filed: January 19, 2001 Abstract: An improved method for performing a hysterectomy wherein the cardinal ligaments and the uterosacral ligaments attached to a uterus are not severed. Also, the wall of the vaginal apex is not cut. This is accomplished by coring through the cervical stroma of the uterus close to the wall of the endocervical canal and transformation zone
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and removing the endocervical canal and transformation zone from the cervical stroma. The opening left in the cervical stroma after removal of the endocervical canal and transformation zone is closed with sutures. This technique is practically bloodless. The nerve plexuses and the support system of the female internal organs are preserved. The chance of future cervical cancer is substantially eliminated. This is truly a technique for the 21.sup.st century. Excerpt(s): This invention relates to surgical methods for performing hysterectomies on female patients. A hysterectomy involves the removal of the uterus from the abdomen of a female patient. The traditional method of performing a hysterectomy is to sever the uterosacral ligaments, the cardinal ligaments and the uterine vessels attached to the uterus before entering the vaginal fornix. The uterus is then severed from the vagina in a circular fashion at the cervico-vaginal junction. To access this area, the bladder is pushed down and, if necessary, dissected free of any attachments to the uterus. This traditional procedure causes significant damage to the nerves in the Frankenhauser nerve plexus, the vesical nerve plexus and various regional nerves such as the nerves to the clitoris, the urethra and the vestibular bulbs. This traditional procedure also causes a major impairment of the pelvic support system for the vagina and other major complications. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
METHOD OF DETERMINING ALZHEIMER'S DISEASE RISK USING APOLIPOPROTEIN E4 GENOTYPE ANALYSIS IN COMBINATION WITH DECREASED ESTROGEN LEVELS Inventor(s): EINSTEIN, GILLIAN; (Bethesda, MD), SCHMECHEL, DONALD E.; (Durham, NC), SHAUGHNESSY, LAURA W.; (Durham, NC) Correspondence: Myers Bigel Sibley & Sajovec; PO Box 37428; Raleigh; NC; 27627; US Patent Application Number: 20020098481 Date filed: October 22, 1999 Abstract: A method of screening a subject for risk of developing Alzheimer's disease comprises determining the presence of at least one ApoE4 allele in a subject, and determining the presence or absence of decreased estrogen levels in said subject (e.g., due to previous or impending menopause or hysterectomy). The presence of at least one ApoE4 allele (and particularly two ApoE4 alleles) in combination with decreased estrogen levels in said subject indicating said subject is at greater risk of developing Alzheimer's disease (e.g., as compared to subjects with at corresponding number of ApoE4 alleles, but who do not have decreased estrogen levels), and that the subject will receive greater benefit from estrogen replacement therapy in treating Alzheimer's disease than a subject who does not carry one or two ApoE4 alleles. Excerpt(s): The present invention concerns methods of screening for Alzheimer's disease susceptibility in subjects, along with methods of classifying susceptible individuals for treatment and methods of treating Alzheimer's disease. Alzheimer's disease (AD) is marked by a devastating decrease in cognitive ability which is correlated with a decline in the number of synapses in the hippocampus and neocortex. One of the risk factors for development of AD is the gene coding for the E4 allele of a lipid carrier protein, apolipoprotein E (APOE, gene). The APOE E4 allele is a risk factor for late-onset, familial and sporadic AD while the APOE3 and E2 alleles are either neutral (E3) or protective (E2). Another risk factor is sex; both the incidence and prevalence of AD is greater in females than in males. U.S. Pat. No. 5,508,167 to A. Roses et al., assigned to
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Duke University, discloses methods of diagnosing or prognosing Alzheimer's disease in a subject. The methods involve directly or indirectly detecting the presence or absence of an apolipoprotein E type 4 (ApoE4) isoform or DNA, encoding ApoE4 in the subject. The presence of ApoE4 indicates the subject is afflicted with Alzheimer's disease or at risk of developing Alzheimer's disease. This basic finding has led to a number of developments in the Alzheimer's disease field. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Use of a preparation of cimicifuga racemosa Inventor(s): Gessler, Andrea C; (Gleichen-Reinhausen, DE), Nisslein, Thomas; (Gottingen, DE) Correspondence: Whitham, Curtis & Christofferson, P.C.; 11491 Sunset Hills Road; Suite 340; Reston; VA; 20190; US Patent Application Number: 20030049340 Date filed: September 26, 2002 Abstract: A preparation of Cimicifuga racemosa can be used to successfully treat urinary incontinence in female mammals following an ovariohysterectomy. Positive results can be expected for the treatment of women following a hysterectomy or after the menopause. Excerpt(s): The invention relates to the use of a preparation of Cimicifuga racemosa (Black Snakeroot), in particular an extract thereof, and more particularly an extract of the rhizome (Rhizoma cimicifugae racemosae). Extracts of Cimicifuga racemosa are used in gyniatrics for the treatment of menopause complaints, such as hot flushes, sweating, sleep disorders, irritability, and depressive disgruntlement. The extract is regarded as a phytosubstitute for oestrogen replacement therapy. Extracts of Cimicifuga racemosa play no significant role in allopathic veterinary medicine. It has been found, surprisingly, that preparations of Cimicifuga racemosa are therapeutically effective against urinary incontinence. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
Keeping Current In order to stay informed about patents and patent applications dealing with hysterectomy, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “hysterectomy” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on hysterectomy. You can also use this procedure to view pending patent applications concerning hysterectomy. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.
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CHAPTER 6. BOOKS ON HYSTERECTOMY Overview This chapter provides bibliographic book references relating to hysterectomy. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on hysterectomy include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.
Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “hysterectomy” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on hysterectomy: •
The new ourselves, growing older: Women aging with knowledge and power. (Rev. ed.) Source: New York, NY: Touchstone. 1994. 531 pp. Contact: Available from Touchstone Books, Rockefeller Center, 1230 Avenue of the Americas, New York, NY 10020. $24.00. Summary: This book covers health, family, and social issues for women over the age of forty. The first section discusses aging and well-being, weight, nutrition, and physical fitness. Topics included in the second section are sexuality, birth control, childbearing, menopause, relationships, housing alternatives, work and retirement, the economics of aging, and caregiving. Section three covers women's health and the medical care system, nursing homes, arthritis, osteoporosis and related conditions, dental health, urinary incontinence, hysterectomy and oophorectomy, hypertension, heart disease, and stroke, cancer, diabetes, gallstones and gallbladder disease, sensory and memory loss
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associated with aging, dying and death, and changing society and ourselves. Extensive resources for each topic are included along with an index. •
Evaluating women's health messages: A resource book Source: Thousand Oaks, CA: Sage Publications. 1996. 445 pp. Contact: Available from Sage Publications, 2455 Teller Road, Thousand Oaks, CA 913202218. Telephone: (805) 499-9774 / fax: (805) 499-0871 / e- mail: [email protected] / Web site: http://www.sagepub.com. $90, hardcover; $46 paperback. Summary: This book examines medical, social scientific, and public messages about women's health care. Consistencies and inconsistencies are identified and gaps in the research and general understanding are highlighted. The book is divided into the following six sections in relation to agendas and women's reproductive health: political agendas, historical issues, fetal and maternal health approach, campaign perspectives, social support framework, and contemporary priorities. The section on political agendas examines abortion and illicit drug use by pregnant women. The section on historical issues reviews birth control and childbirth. The fetal and maternal health section examines women and smoking, and women and alcohol use. The section devoted to campaign perspectives looks at prenatal care, and cervical, ovarian and uterine cancers. The social support section considers research associated with breast cancer, menstruation and menopause. The final section evaluates reproductive health in terms of women and reproductive technologies, hysterectomy, and HIV/AIDS. Notes and references are included at the end of each chapter.
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Men who control women's health: The miseducation of obstetrician-gynecologists Source: New York, NY: Teachers College Press. 1994. 275 pp. Contact: Available from Teachers College Press, P.O. Box 20, Williston, VT 05495-0020. Telephone: (800) 575-6566 / fax: (802) 864-7626. Summary: This book is a reissue of the original 1980 edition with a new introduction written by the author and a new forward. The book examines how men have dominated the field of medicine in general and obstetrics and gynecology in particular. As a result, the author argues that medicine as a discipline views women's bodies and their functions as abnormal. Some of the specific topics addressed are sexism in medicine; nineteenth century medicine; female castration; clitoridectomy; childbirth; women physicians; hysterectomy; medical education; cesarean sections; unnecessary surgery; and strategies for change. A glossary of medical terms is provided in the appendix.
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Good Bones: The Complete Guide To Building and Maintaining the Healthiest Bones Source: Palo Alto, CA: Bull Publishing Company. 1999. 184 p. Contact: Available from Bull Publishing Company. P.O. Box 208, Palo Alto, CA 943020208. (650) 322-2855. Fax (650) 327-3300. Website: www.bullpub.com. PRICE: $14.95 plus shipping and handling. ISBN 0923521445. Summary: This book provides women with guidelines on building and maintaining healthy bones. By examining 17 major risk factors for bone health, the book helps women assess their overall risk for osteoporosis. A chapter on normal bone physiology is followed by a chapter that discusses risk factors in the prenatal and infancy periods, childhood, adolescence, young adulthood, middle age, and older adulthood. Chapter three examines hereditary risk factors: race, ethnicity, and family history. The next
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chapter is devoted to factors affecting women: age at menarche, menstrual cycles, age at menopause, and total reproductive years. Other topics include oral contraceptives, treatments for endometriosis, pregnancy and breast feeding, and hysterectomy. The fifth chapter evaluates the role of body build, weight, and fat in bone health. Chapter six focuses on the effect of exercise and physical activity on bone health and presents an example of an exercise routine that includes both endurance and strength training. The next chapter discusses the impact of hormones, prescription medications, and calcium supplements on bone health, and presents the advantages and disadvantages of hormone replacement therapy (HRT), highlights alternatives to HRT, and explains how to select the best calcium supplements and use them most effectively. Other chapters examine lifestyle factors, such as alcohol and caffeine consumption and smoking that affects bone health; identify factors influencing calcium absorption; present calcium requirements for various age groups; and discuss the importance of good nutrition in building strong bones. The final chapter applies the 17 risk factors to case studies presented in the previous chapters. A glossary of terms and a list of suggested readings and resources are included. 15 figures, 21 tables, and numerous references. •
Coping With Loss: A Guide for Caregivers Source: Springfield, IL: Charles C. Thomas, Publisher. 1994. 237 p. Contact: Available from Charles C. Thomas, 2600 South First Street, Springfield, IL 62794-9265. (217) 789-8980, (217) 789-9130 (Fax). $51.95, hardback; $35.95, paperback, plus $5.50 shipping and handling. ISBN 0-398-05912-8. Summary: This book, written as a resource for health caregivers in acute and long-term care settings, is intended to help them understand the nature of loss, recognize it in the health-care setting, and help affected patients and their survivors through the grieving process. There may be a tendency on the part of caregivers to treat the loss of health as a physical problem without acknowledging its vast emotional, psychological, spiritual, and somatic repercussions. Chapter 1 presents the author's personal experience with the losses associated with multiple sclerosis and how she has coped with them. Chapter 2 reviews the concept of attachment and its relationship to loss, describes the characteristics of loss, discusses the losses associated with hospitalization, and offers caregivers guidelines for assessing loss in hospitalized patients. Chapter 3 defines 'grief,' 'mourning,' and 'bereavement'; discusses the tasks and rituals of mourning; delineates the benefits of the funeral ritual; and looks at different types of grief, including delayed, inhibited, abbreviated, chronic, unresolved, and unremitting grief. Chapter 4 identifies five specific categories of loss as they are encountered by physicians, nurses, social workers, and chaplains in the emergency department, including the sudden and unexplained death of an apparently healthy infant. For each category of loss, the needs of patient and family, the tasks confronting the caregiver, and suggestions for bereavement followup are provided. Chapter 5 examines the manifestations of loss as experienced by patients and family members within the context of life-threatening illness and suggests helpful caregiver responses. Chapter 6 explores losses associated with reproduction that caregivers encounter with women and their partners, including losses related to infertility, hysterectomy, menopause, miscarriage, recurrent miscarriage, induced abortion, perinatal death, congenital abnormality, and maternal death. Chapter 7 summarizes children's understanding of death, discusses the characteristics of child bereavement in various situations, and suggests ways in which caregivers can respond. Chapter 8 presents a case study of the losses experienced by an elderly man over a 9-year period. The case study reviews the man's responses to the loss of his health, the death of his wife, the loss of his home, and a move to the hospital. An
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assessment protocol and suggested caregiver responses to his losses are included. Vignettes and case studies are interspersed throughout the book. Numerous references. •
Glenn's Urologic Surgery. 5th ed Source: Philadelphia, PA: Lippincott Williams and Wilkins. 1998. 1149 p. Contact: Available from Lippincott Williams and Wilkins. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-3030 or (301) 714-2300. Fax (301) 824-7390. Website: lww.com. PRICE: $199.00 plus shipping and handling. ISBN: 0397587376. Summary: This massive textbook on urologic surgery offers 137 chapters on every aspect of anesthesia, antibiosis, medical techniques, diagnostics, and the fundamental considerations and technical aspects of urologic surgery. The chapters are organized into 14 sections: adrenal, kidney, ureter and pelvis, bladder, prostate, urethra, vas deferens and seminal vesicle, testes, penis and scrotum, urinary diversion, pediatric urology, endoscopy, laparoscopy, and frontiers (future developments). Some specific topics covered are Cushing's disease, primary aldosteronism, nephrectomy (removal of the kidney), renovascular disease, renal trauma, kidney transplantation, ureteral reconstruction, cystectomy (bladder removal), bladder augmentation, fistula, interstitial cystitis, prostatectomy (removal of the prostate), prostatic ultrasound and needle biopsy, bladder neck suspension techniques, pelvic floor relaxation, cystocele, female urethral diverticula, vaginal hysterectomy, urethral stricture, vasectomy, simple orchiectomy (removal of the testes), scrotal trauma and reconstruction, Peyronie's disease, priapism, penile prosthesis, penile trauma, urinary diversion techniques, bladder replacement, congenital anomalies, patient selection, circumcision, cystoscopy, kidney stone treatment, urinary stone treatment, stents, and thermotherapy. Each chapter includes diagrams, tables, and a list of references. A detailed subject index concludes the textbook.
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Female Pelvic Health and Reconstructive Surgery Source: New York, NY: Marcel Dekker, Inc. 2003. 503 p. Contact: Available from Marcel Dekker, Inc. 270 Madison Avenue, New York, NY 10016. (212) 696-9000. Fax (212) 685-4540. Website: www.dekker.com. PRICE: $185.00 plus shipping and handling. ISBN: 0824708229. Summary: This textbook provides comprehensive, authoritative coverage of female pelvic health and reconstructive surgery. The editors compiled contributions from many experts who specialize in the treatment of pelvic floor disorders. The text includes 27 chapters on the epidemiology and etiology of incontinence and voiding dysfunction; diagnostic evaluation of the female patient; bladder physiology and neurophysiological evaluation; diagnosis and assessment of female voiding function; radiological evaluation; urodynamic evaluation of pelvic floor dysfunction; injectable agents for the treatment of stress urinary incontinence in females; transabdominal procedures for the treatment of stress urinary incontinence; transvaginal surgery for stress urinary incontinence; laparoscopic approaches to female incontinence, voiding dysfunction, and prolapse; diagnosis and management of obstruction following anti-incontinence surgery; pediatric dysfunctional voiding in females; nonsurgical treatment of urinary incontinence; sacral nerve root neuromodulation or electrical stimulation; musculoskeletal evaluation for pelvic pain; diagnosis and management of interstitial cystitis (IC); abdominal approach to apical prolapse; the types and choice of operation for repair of vaginal prolapse; colpocleisis for the treatment of vaginal vault prolapse; technique of vaginal hysterectomy; urethral diverticulum; evaluation and management
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of urinary fistulas; iatrogenic urological trauma; surgical treatment of rectovaginal fistulas and complex perineal defects; pessaries; menopause and hormone replacement therapy; and diagnosis of female sexual dysfunction. Each chapter includes black and white photographs and charts and concludes with a list of references. A subject index concludes the volume.
Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print®). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “hysterectomy” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “hysterectomy” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “hysterectomy” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •
Abdominal and vaginal hysterectomy : new techniques based on time and motion studies by S. Joel-Cohen; ISBN: 0397582064; http://www.amazon.com/exec/obidos/ASIN/0397582064/icongroupinterna
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All about hysterectomy : the first comprehensive explanation of the symptoms, the surgery, the risks, and the recovery of this medical procedure : with a special section for men only by Harry C. Huneycutt; ISBN: 0883491508; http://www.amazon.com/exec/obidos/ASIN/0883491508/icongroupinterna
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Am I Still a Woman: Hysterectomy and Gender Identity by Jean Elson (2003); ISBN: 1592132103; http://www.amazon.com/exec/obidos/ASIN/1592132103/icongroupinterna
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Coping With a Hysterectomy: Your Own Choice, Your Own Solutions by Susanne Morgan; ISBN: 0385272154; http://www.amazon.com/exec/obidos/ASIN/0385272154/icongroupinterna
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Do You Really Need Surgery: A Sensible Guide to Hysterectomy and Other Procedures for Women by Michele Moore, Caroline M. De Costa (2004); ISBN: 0813533929; http://www.amazon.com/exec/obidos/ASIN/0813533929/icongroupinterna
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Every Woman's Guide to Hysterectomy: Taking Charge of Your Own Body by Deedee Jameson; ISBN: 0132928213; http://www.amazon.com/exec/obidos/ASIN/0132928213/icongroupinterna
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Experiences of Hysterectomy (Optima) by Ann Webb; ISBN: 0356141411; http://www.amazon.com/exec/obidos/ASIN/0356141411/icongroupinterna
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Gynecological operative anatomy : the simple and radical hysterectomy atlas : appendix, the radioisotope radical operation by Eduard Gitsch; ISBN: 3110066912; http://www.amazon.com/exec/obidos/ASIN/3110066912/icongroupinterna
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Health, Happiness & Hormones: One Woman's Journey Towards Health After a Hysterectomy by Arlene Swaney; ISBN: 0914984721; http://www.amazon.com/exec/obidos/ASIN/0914984721/icongroupinterna
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How to Avoid a Hysterectomy: Indispensable Guide to Exploring Options by Lynn Payer; ISBN: 0679721428; http://www.amazon.com/exec/obidos/ASIN/0679721428/icongroupinterna
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Hysterectomy by Suzie Hayman (2002); ISBN: 085969870X; http://www.amazon.com/exec/obidos/ASIN/085969870X/icongroupinterna
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Hysterectomy by Anne Dickson, Nikki Henriques (1994); ISBN: 0704302144; http://www.amazon.com/exec/obidos/ASIN/0704302144/icongroupinterna
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Hysterectomy (1986); ISBN: 0935576177; http://www.amazon.com/exec/obidos/ASIN/0935576177/icongroupinterna
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Hysterectomy by Michael Diamond (Editor), et al; ISBN: 0865423555; http://www.amazon.com/exec/obidos/ASIN/0865423555/icongroupinterna
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Hysterectomy (Current Topics in Obstetrics and Gynecology) by Thomas G. Stovall (Editor) (1993); ISBN: 0412046814; http://www.amazon.com/exec/obidos/ASIN/0412046814/icongroupinterna
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Hysterectomy : a Guide for Women by Mitchel S. Hoffman; ISBN: 188527419X; http://www.amazon.com/exec/obidos/ASIN/188527419X/icongroupinterna
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Hysterectomy and HRT - pocketbook by John Studd, Gautam Khastgir (1998); ISBN: 1853174084; http://www.amazon.com/exec/obidos/ASIN/1853174084/icongroupinterna
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Hysterectomy and the Alternatives: How to Ask the Right Questions and Explore Other Options by Jan Clark; ISBN: 0091832012; http://www.amazon.com/exec/obidos/ASIN/0091832012/icongroupinterna
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Hysterectomy and Vaginal Repair by Sally Haslett SRN, et al; ISBN: 090658423X; http://www.amazon.com/exec/obidos/ASIN/090658423X/icongroupinterna
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Hysterectomy Before & After : A Comprehensive Guide to Preventing, Preparing For, and Maximizing Health by Winnifred B. Cutler (Author) (1990); ISBN: 006091629X; http://www.amazon.com/exec/obidos/ASIN/006091629X/icongroupinterna
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Hysterectomy Hoax: Truce @ Bakura by West (1995); ISBN: 0517154854; http://www.amazon.com/exec/obidos/ASIN/0517154854/icongroupinterna
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HYSTERECTOMY PB; ISBN: 0859694801; http://www.amazon.com/exec/obidos/ASIN/0859694801/icongroupinterna
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Hysterectomy/Alternatives by Jan Clark (1993); ISBN: 1853815845; http://www.amazon.com/exec/obidos/ASIN/1853815845/icongroupinterna
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Hysterectomy: A Complete, Up-To-Date Guide to Everything About It and Why It May Be Needed by Nancy Nugent; ISBN: 0385038879; http://www.amazon.com/exec/obidos/ASIN/0385038879/icongroupinterna
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Hysterectomy: A Guide to Menstrual Disorders (Your Operation) by Alison Bigrigg, Jane Smith; ISBN: 0340620463; http://www.amazon.com/exec/obidos/ASIN/0340620463/icongroupinterna
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Hysterectomy: A Literature Review and Rating of Appropriateness by Bernstein (1992); ISBN: 0833012312; http://www.amazon.com/exec/obidos/ASIN/0833012312/icongroupinterna
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Hysterectomy: A Reassuring Guide to Surgery, Recovery, and Your Choices (Thorson's Women's Health) by Jane Butterworth; ISBN: 0722530978; http://www.amazon.com/exec/obidos/ASIN/0722530978/icongroupinterna
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Hysterectomy: A Review of the Literature on Indications, Effectiveness, and Risks by Steven Bernstein (Editor), et al (1998); ISBN: 0833023470; http://www.amazon.com/exec/obidos/ASIN/0833023470/icongroupinterna
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Hysterectomy: Clinical Recommendations and Indications for Use by Steven Hysterectomy, Indications, Effectiveness, and Risks Bernstein (Editor), et al (1997); ISBN: 0833025740; http://www.amazon.com/exec/obidos/ASIN/0833025740/icongroupinterna
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Hysterectomy: Exploring Your Options (Johns Hopkins Press Health Book) by Edward E., Md. Wallach, Esther, Md. Eisenberg (2003); ISBN: 0801876230; http://www.amazon.com/exec/obidos/ASIN/0801876230/icongroupinterna
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Hysterectomy: How to Deal With the Physical and Emotional Aspects by Lorraine Dennerstein, et al (1983); ISBN: 0195543718; http://www.amazon.com/exec/obidos/ASIN/0195543718/icongroupinterna
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Hysterectomy: Learning the Facts, Coping With the Feelings, Facing the Future by Wanda Wigfall-Williams, Williams Wanda Wigfall; ISBN: 0935576150; http://www.amazon.com/exec/obidos/ASIN/0935576150/icongroupinterna
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Hysterectomy: Making a Choice by Martin D., M.D. Greenberg, Niels H. Laverson; ISBN: 0399518061; http://www.amazon.com/exec/obidos/ASIN/0399518061/icongroupinterna
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Hysterectomy: New Options and Advances by Lorraine Dennerstein, et al; ISBN: 019551033X; http://www.amazon.com/exec/obidos/ASIN/019551033X/icongroupinterna
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Hysterectomy: Ratings of Appropriateness by Steven Bernstein, et al (1998); ISBN: 0833025716; http://www.amazon.com/exec/obidos/ASIN/0833025716/icongroupinterna
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Hysterectomy: The Positive Recovery Plan by Anne Dickson, Nikki Henriques; ISBN: 0722521626; http://www.amazon.com/exec/obidos/ASIN/0722521626/icongroupinterna
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Hysterectomy: Woman to Woman by Sue Ellen Barber; ISBN: 1885221150; http://www.amazon.com/exec/obidos/ASIN/1885221150/icongroupinterna
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Hysterectomy? The Best or Worst Thing That Ever Happened to Me?: A Collection of Women's Personal Experiences by Elizabeth Plourde; ISBN: 0966173546; http://www.amazon.com/exec/obidos/ASIN/0966173546/icongroupinterna
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Just As Much a Woman: Your Personal Guide to Hysterectomy and Beyond by Nancy Rosenfeld (Introduction), Dianna W. Bolen; ISBN: 0761518207; http://www.amazon.com/exec/obidos/ASIN/0761518207/icongroupinterna
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Just Take It Out! : The Ethics and Economics of Cesarean Section and Hysterectomy by D. Campbell Walters, Edward Quillinan; ISBN: 0966716205; http://www.amazon.com/exec/obidos/ASIN/0966716205/icongroupinterna
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Laparoscopic Hysterectomy by Ray Garry (Editor), Harry Reich (Editor); ISBN: 0632034653; http://www.amazon.com/exec/obidos/ASIN/0632034653/icongroupinterna
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Laparoscopic Hysterectomy - A CD-ROM course for physicians and others with an interest in women's healthcare. by Camran Nezhat MD, et al; ISBN: 0966491548; http://www.amazon.com/exec/obidos/ASIN/0966491548/icongroupinterna
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Laparoscopic Hysterectomy and Oophorectomy: A Practical Manual and Colour Atlas by Jeffrey H. Phipps, et al (1993); ISBN: 0443049297; http://www.amazon.com/exec/obidos/ASIN/0443049297/icongroupinterna
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Laparoscopic Hysterectomy and Pelvic Floor Reconstruction (Minimally Invasive Gynecology Series) by C. Y., Md. Liu (Editor); ISBN: 0865423830; http://www.amazon.com/exec/obidos/ASIN/0865423830/icongroupinterna
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Medical Record Abstraction Form and Guidelines for Assessing the Appropriateness of Hysterectomy/Mr-239-Hf by Marjorie J. Sherwood, et al; ISBN: 0833013947; http://www.amazon.com/exec/obidos/ASIN/0833013947/icongroupinterna
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Misinformed Consent: Women's Stories About Unnecessary Hysterectomy by Lise Cloutier-Steele (2003); ISBN: 0970090862; http://www.amazon.com/exec/obidos/ASIN/0970090862/icongroupinterna
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Out With It: The Diary of My Hysterectomy by Carolyn Kent Bailey, Carolyn Kent Bailey (2002); ISBN: 1930693990; http://www.amazon.com/exec/obidos/ASIN/1930693990/icongroupinterna
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PMS and Menopause and Hysterectomy (Dr. Donsbach Tells You) by Kurt W. Donsbach (1993); ISBN: 1569595712; http://www.amazon.com/exec/obidos/ASIN/1569595712/icongroupinterna
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Recovering from a Hysterectomy (Recovering from) by Dena E., M.C. Harris, Helene MacLean (Contributor); ISBN: 006104136X; http://www.amazon.com/exec/obidos/ASIN/006104136X/icongroupinterna
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Slide Atlas of Total Laparoscopic Hysterectomy by Ray Garry FRCOG MD, Harry Reich FACOG MD; ISBN: 0865429812; http://www.amazon.com/exec/obidos/ASIN/0865429812/icongroupinterna
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So You're Having a Hysterectomy by Togas Tulandi (Author), Barbara R. Levy (Author) (2004); ISBN: 0470833459; http://www.amazon.com/exec/obidos/ASIN/0470833459/icongroupinterna
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The British Medical Association Family Doctor Guide to Hysterectomy and the Alternatives (BMA Family Doctor) by Christine West; ISBN: 075130817X; http://www.amazon.com/exec/obidos/ASIN/075130817X/icongroupinterna
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The Case Against Hysterectomy (Pandora Soap Box Series) by Sandra Simkin (1998); ISBN: 0044409788; http://www.amazon.com/exec/obidos/ASIN/0044409788/icongroupinterna
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The Castrated Woman: What Your Doctor Won't Tell You About Hysterectomy by Naomi Miller Stokes, Naomi Miller; ISBN: 0531150038; http://www.amazon.com/exec/obidos/ASIN/0531150038/icongroupinterna
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The Difficult Vaginal Hysterectomy: A Surgical Atlas by M.S. Hoffman, W.N. Spellacy; ISBN: 3540942734; http://www.amazon.com/exec/obidos/ASIN/3540942734/icongroupinterna
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The Hysterectomy Hoax by Dr. Stanley West; ISBN: 0970618107; http://www.amazon.com/exec/obidos/ASIN/0970618107/icongroupinterna
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The Hysterectomy Hoax: The Truth About Why Many Hysterectomies Are Unnecessary and How to Avoid Them by Stanley West, Paula Dranov (2002); ISBN: 0970090811; http://www.amazon.com/exec/obidos/ASIN/0970090811/icongroupinterna
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The No-Hysterectomy Option: Your Body--Your Choice, Revised and Updated by Herbert A. Goldfarb (Author); ISBN: 0471165573; http://www.amazon.com/exec/obidos/ASIN/0471165573/icongroupinterna
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The Well-Informed Patient's Guide to Hysterectomy; ISBN: 9992383356; http://www.amazon.com/exec/obidos/ASIN/9992383356/icongroupinterna
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The Well-Informed Patient's Guide to Hysterectomy (Dell Surgical Library) by Kathryn Cox, Judith Schwartz (Contributor); ISBN: 0440207150; http://www.amazon.com/exec/obidos/ASIN/0440207150/icongroupinterna
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The Woman's Guide to Hysterectomy: Expectations & Options by Adelaide Haas, Susan L. Puretz (2002); ISBN: 1587611058; http://www.amazon.com/exec/obidos/ASIN/1587611058/icongroupinterna
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Understanding Hysterectomy by C. West; ISBN: 1898205809; http://www.amazon.com/exec/obidos/ASIN/1898205809/icongroupinterna
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Understanding Hysterectomy and Alternatives by Christine West; ISBN: 1898205582; http://www.amazon.com/exec/obidos/ASIN/1898205582/icongroupinterna
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Understanding Hysterectomy: A Woman's Guide by F.G Giustini; ISBN: 0802706339; http://www.amazon.com/exec/obidos/ASIN/0802706339/icongroupinterna
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Vaginal Hysterectomy (1983); ISBN: 0398007217; http://www.amazon.com/exec/obidos/ASIN/0398007217/icongroupinterna
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Vaginal Hysterectomy by Shirish Sheth (Editor), et al; ISBN: 1901865436; http://www.amazon.com/exec/obidos/ASIN/1901865436/icongroupinterna
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Vaginal Hysterectomy: Contemporary Techniques, A Step-by-Step Approach by Robert Summitt; ISBN: 1850705534; http://www.amazon.com/exec/obidos/ASIN/1850705534/icongroupinterna
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Vaginal Hysterectomy: Indications, Technique, and Complications by Laman Alexander Gray; ISBN: 0398048533; http://www.amazon.com/exec/obidos/ASIN/0398048533/icongroupinterna
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What every woman should know about hysterectomy by W. Gifford-Jones; ISBN: 0889024219; http://www.amazon.com/exec/obidos/ASIN/0889024219/icongroupinterna
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What Your Doctor May Not Tell You About Fibroids: New Techniques and Therapies--Including Breakthrough Alternatives to Hysterectomy by Goodwin/Broder (Author); ISBN: 0446678538; http://www.amazon.com/exec/obidos/ASIN/0446678538/icongroupinterna
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Women on Hysterectomy or How Long Before I Can Hang Glide by Nikki Henreques, Anne Dickson; ISBN: 0722511647; http://www.amazon.com/exec/obidos/ASIN/0722511647/icongroupinterna
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You Donªt Need a Hysterectomy: New and Effective Ways of Avoiding Surgery by Ivan K. Strausz, et al (2003); ISBN: 0756762847; http://www.amazon.com/exec/obidos/ASIN/0756762847/icongroupinterna
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You Don't Need a Hysterectomy by Ivan K. Strausz (2001); ISBN: 0738204498; http://www.amazon.com/exec/obidos/ASIN/0738204498/icongroupinterna
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Your Guide to Hysterectomy, Ovary Removal, & Hormone Replacement: What All Women Need to Know by Elizabeth L. Plourde (2001); ISBN: 0966173511; http://www.amazon.com/exec/obidos/ASIN/0966173511/icongroupinterna
The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “hysterectomy” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:10 •
Abdominal and vaginal hysterectomy; new techniques based on time and motion studies. Author: Joel-Cohen, S.; Year: 1973; London, Heinemann [1972]; ISBN: 0433061901 http://www.amazon.com/exec/obidos/ASIN/0433061901/icongroupinterna
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Elective hysterectomy, costs, risks, and benefits Author: Korenbrot, Carol Cleaves.; Year: 1963; Washington, D.C.: Congress of the United States, Office of Technology Assessment, 1981
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How to avoid a hysterectomy: an indispensable guide to exploring all your options-before you consent to a hysterectomy Author: Payer, Lynn.; Year: 1961; New York: Pantheon Books, 1987; ISBN: 0394555112 http://www.amazon.com/exec/obidos/ASIN/0394555112/icongroupinterna
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Hysterectomy? Author: Gifford-Jones, W.; Year: 1966; [New York] Nelson [1961]
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Laparoscopic panhysterectomy with reconstructive posterior culdeplasty and vaginal vault suspension Author: Ostrzenski, Adam.; Year: 1982; Port Washington, NY, USA: Ivy Books, c1993; ISBN: 0963821008 http://www.amazon.com/exec/obidos/ASIN/0963821008/icongroupinterna
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Mitra operation for cancer of the cervix; extraperitoneal pelvic lymphadenectomy and radical vaginal hysterectomy. Author: Mitra, Subodh.; Year: 1967; Springfield, Ill., Thomas [c1960]
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Surgical sterilization surveillance: hysterectomy in women aged 15-44, summary, 1976-1978 Author: Center for Health Promotion and Education (U.S.). Family Planning Evaluation Division.; Year: 1977; Atlanta, Ga.: U.S. Dept. of Health and Human Services, Public Health Service, 1981
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The difficult vaginal hysterectomy: a surgical atlas Author: Hoffman, Mitchel S.; Year: 1981; New York: Springer-Verlag, c1995; ISBN: 0387942734
10
In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is currently adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a "Books" button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.
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http://www.amazon.com/exec/obidos/ASIN/0387942734/icongroupinterna •
The Intestinal tract in relation to obstetrics and gynecology, volume II; guest editor: Douglas J. Marchant. Abdominal and vaginal hysterectomy; guest editor: Henry C. Falk. Special article: Laminaria: an underutilized clinical adjunct [by] Ralph W. Hale and Ronald J. Pion. Author: Falk, Henry C. (Henry Charles), Abdominal and vaginal hysterectomy.; Year: 1972; [New York] Harper; Row [1972]
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The no-hysterectomy option: your body, your choice Author: Goldfarb, Herbert A.; Year: 1983; New York: Wiley, c1990; ISBN: 0471532320 http://www.amazon.com/exec/obidos/ASIN/0471532320/icongroupinterna
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Three gynecologic surgical techniques; radical hysterectomy for cancer of the cervix, myomectomy, operation of stress incontinence. Author: Louros, N. C. (Nikolaos C¯onstantines); Year: 1956; Springfield, Ill., Thomas [c1966]
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Vaginal hysterectomy and genital prolapse repair; a contribution to the vaginal approach in operative gynaecology. Author: Krige, Christiaan Frederik.; Year: 1969; Johannesburg, Witwatersrand Univ. Press, 1965
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What every woman should know about hysterectomy Author: Gifford-Jones, W.; Year: 1965; New York: Funk; Wagnalls, c1977; ISBN: 0308102754 http://www.amazon.com/exec/obidos/ASIN/0308102754/icongroupinterna
Chapters on Hysterectomy In order to find chapters that specifically relate to hysterectomy, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and hysterectomy 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 “hysterectomy” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on hysterectomy: •
Technique of Vaginal Hysterectomy Source: in Carlin, B.I. and Leong, F.C., eds. Female Pelvic Health and Reconstructive Surgery. New York, NY: Marcel Dekker, Inc. 2003. p. 329-350. Contact: Available from Marcel Dekker, Inc. 270 Madison Avenue, New York, NY 10016. (212) 696-9000. Fax (212) 685-4540. Website: www.dekker.com. PRICE: $185.00 plus shipping and handling. ISBN: 0824708229. Summary: This chapter on the technique of vaginal hysterectomy is from a textbook that provides comprehensive, authoritative coverage of female pelvic health and reconstructive surgery. The author does not deal with laparoscopic-assisted vaginal hysterectomy. Topics covered include preoperative preparation or prophylactic antibiotics, anesthesia, positioning, preoperative evaluation, preparation, operative technique, the enlarged uterus, adnexal removal, and support techniques (to prevent vaginal vault prolapse). The author concludes that vaginal hysterectomy has the lowest morbidity and cost of the various types of hysterectomy and can be successfully completed in most well-selected patients. 13 figures. 46 references.
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CHAPTER 7. MULTIMEDIA ON HYSTERECTOMY Overview In this chapter, we show you how to keep current on multimedia sources of information on hysterectomy. 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.
Bibliography: Multimedia on Hysterectomy The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in hysterectomy (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on hysterectomy: •
A Vaginal hysterectomy simplified [videorecording] Source: Walter G. Bishop; produced by the Health Communications Network, Division of Continuing Education of the Medical University of South Carolina; Year: 1976; Format: Videorecording; Charleston: The University, [1976]
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Abdominal hysterectomy [motion picture] Source: David N. Danforth; produced by Davis & Geck; Year: 1969; Format: Motion picture; Danbury, Conn.: Davis & Geck, 1969
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Abdominal hysterectomy [motion picture] Source: Frederick J. Hofmeister, Leslie Williams, Hugh Wynter; produced by Davis & Geck; Year: 1971; Format: Motion picture; Danbury, Conn.: Davis & Geck, [1971]
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Abdominal hysterectomy and sigmoid colon resection [videorecording] Source: Videosurgery; Year: 1977; Format: Videorecording; Don Mills, Ont.: Southam Business Publications, c1977
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Complete uterine prolapse in geriatic gynecology treated with vaginal hysterectomy and vaginectomy [motion picture] Source: Marquette University; produced by F. J. Hoffmeister; Year: 1961; Format: Motion picture; Milwaukee, [Wis.]: Marquette Univ.; [Chicago: for loan by American Medical Association, Motion Picture Library, 1961]
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Hysterectomy for diffuse ovarian endometriosis [videorecording] Source: American College of Surgeons; produced by DG, Davis & Geck; Year: 1983; Format: Videorecording; Danbury, Conn.: American Cyanamid, c1983
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Hysterectomy for uterine cancer [filmstrip] Source: Concept Media; Year: 1972; Format: Filmstrip; [Costa Mesa, Calif.]: Concept Media, c1972
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Ovarian tumor resection and abdominal hysterectomy [videorecording] Source: Videosurgery; Year: 1977; Format: Videorecording; Don Mills, Ont.: Southam Business Publications, c1977
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Posthysterectomy vaginal vault prolapse [motion picture]: a recommended surgical treatment Source: Mayo Clinic; Year: 1974; Format: Motion picture; [Rochester, Minn.]: The Clinic: [for loan by Mayo Foundation, Audiovisual Center], 1964
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Radical hysterectomy and pelvic lymphadenectomy for the management of early invasive carcinoma of the cervix [videorecording] Source: Academy of Health Sciences; Year: 1975; Format: Videorecording; Fort Sam Houston, Tex.: The Academy: [for loan by its Health Sciences Media Division, 1975]
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Radical hysterectomy assisted by chromo-lymphography [motion picture] Source: by James Henry Ferguson, Hervy Evans Averette; [made by] Dept. of Medical Illustration, University of Miami, School of Medicine, Miami, Florida; Year: 1963; Format: Motion picture; Miami: Ferguson, [1963]
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Selection of patients for hysterectomy [sound recording] Source: American College of Surgeons; Year: 1976; Format: Sound recording; Chicago, Ill.: The College, c1976
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Sudden changes, post-hysterectomy syndrome [videorecording] Source: produced, photographed, and edited by Barbara Costa and Denisce Diianni; Year: 1985; Format: Videorecording; [S.l.]: D. Diianni and B. Costa, c1985
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Technic of total abdominal hysterectomy [motion picture] Source: Mayo Clinic; Year: 1962; Format: Motion picture; Rochester, Minn.: The Clinic, [1962]
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The Abdominal surgical anatomy of vaginal hysterectomy [videorecording] Source: produced by Medical Television, Southern Illinois University; Year: 1982; Format: Videorecording; Springfield, Ill.: Medical Television, [1982]
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The Psychology of hysterectomy [videorecording] Source: presented by the Department of Gynecology/Obstetrics, Emory University, School of Medicine; Year: 1985; Format: Videorecording; Atlanta, Ga.: Emory Medical Television Network, 1985
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The Wertheim Meigs hysterectomy with bilateral pelvic lymphadenectomy [motion picture] Source: Langdon Parsons, Charles W. Robertson; produced by Davis & Geck; Year: 1970; Format: Motion picture; Danbury, Conn.: Davis & Geck, 1970
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Total hysterectomy [motion picture]: technique and safeguards Source: a Billy Burke production; Year: 1951; Format: Motion picture; United States: B. Burke, [1951]
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Vaginal hysterectomy [motion picture] Source: Frederick J. Hofmeister, Mavis Anderson, Barbara Neol; produced by Davis & Geck; Year: 1971; Format: Motion picture; Danbury, Conn.: Davis & Geck, [1971]
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Vaginal hysterectomy [motion picture] Source: [Davis and Geck]; Year: 1936; Format: Motion picture; [S.l.: s.n., 1936]
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Vaginal hysterectomy [motion picture]: a simplified anatomic technique Source: Robert H. Barter; produced by Davis & Geck; Year: 1970; Format: Motion picture; Danbury, Conn.: Davis & Geck; [Atlanta: for loan by National Medical Audiovisual Center], 1970
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Vaginal hysterectomy for the enlarged uterus [videorecording] Source: presented by Southern California Permanente Medical Group and Kaiser Foundation Hospital, Panorama City: [produced by] Billy Burke; Year: 1977; Format: Videorecording; [Los Angeles]: The Group, [1977]
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CHAPTER 8. PERIODICALS AND NEWS ON HYSTERECTOMY Overview In this chapter, we suggest a number of news sources and present various periodicals that cover hysterectomy.
News Services and Press Releases One of the simplest ways of tracking press releases on hysterectomy 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 “hysterectomy” (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 hysterectomy. 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 “hysterectomy” (or synonyms). The following was recently listed in this archive for hysterectomy: •
Radical hysterectomy for early cervical cancer tied to lasting sexual problems Source: Reuters Medical News Date: November 17, 2003
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Hysterectomy for benign disease improves sexual pleasure Source: Reuters Medical News Date: October 03, 2003
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Hysterectomy does not reduce sexual pleasure Source: Reuters Health eLine Date: October 03, 2003
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NICE rejects routine use of laparoscopic total hysterectomy Source: Reuters Medical News Date: September 30, 2003
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Outcomes similar for total and supracervical hysterectomy Source: Reuters Medical News Date: September 02, 2003
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Cervix can be preserved during hysterectomy Source: Reuters Health eLine Date: September 02, 2003
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Few physicians discuss pros and cons of total vs. subtotal hysterectomy Source: Reuters Medical News Date: August 11, 2003
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Few doctors fully explain hysterectomy procedures Source: Reuters Health eLine Date: August 11, 2003
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Replacing hysterectomy with endometrial ablation would save money Source: Reuters Medical News Date: July 21, 2003
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Intrastromal abdominal hysterectomy shortens hospital stay, reduces blood loss Source: Reuters Medical News Date: April 29, 2003
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Laparoscopic hysterectomy preferred over hysteroscopic ablation for menorrhagia Source: Reuters Medical News Date: February 25, 2003
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Higher chance of thyroid cancer after hysterectomy Source: Reuters Health eLine Date: February 10, 2003
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Hysterectomy linked to early increased risk of thyroid cancer Source: Reuters Medical News Date: February 05, 2003
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Vaginal hysterectomy valid for fibroid management, even for enlarged uteri Source: Reuters Medical News Date: January 14, 2003
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Nurse counseling helps lower rate of hysterectomy Source: Reuters Health eLine Date: December 03, 2002
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Outcomes similar after total, partial hysterectomy Source: Reuters Health eLine Date: October 24, 2002
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Subtotal hysterectomy has no major advantages over the total procedure Source: Reuters Medical News Date: October 23, 2002
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MRI-guided laser ablation of fibroids may provide alternative to hysterectomy Source: Reuters Medical News Date: September 27, 2002
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Less affluent Italian women more likely to undergo hysterectomy Source: Reuters Medical News Date: May 17, 2002
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Italy: Poor women more likely to get hysterectomy Source: Reuters Health eLine Date: May 17, 2002
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BioSphere uterine fibroid embolization device comparable to hysterectomy in study Source: Reuters Industry Breifing Date: April 08, 2002
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Hysterectomy associated with urge incontinence Source: Reuters Medical News Date: March 29, 2002
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US hysterectomy rates changed little from 1990 to 1997 Source: Reuters Medical News Date: January 31, 2002
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US hysterectomy rate held steady through 1990s Source: Reuters Health eLine Date: January 31, 2002
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Estrogen replacement linked to urinary incontinence following hysterectomy Source: Reuters Medical News Date: October 08, 2001
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Hysterectomy, early menopause linked to Parkinson's disease Source: Reuters Industry Breifing Date: September 26, 2001
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Pap smears overused in women with history of hysterectomy Source: Reuters Medical News Date: August 01, 2001
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Vasopressin injection significantly reduces blood loss during hysterectomy Source: Reuters Industry Breifing Date: May 03, 2001
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LigaSure vessel sealer safe and effective for total abdominal hysterectomy Source: Reuters Industry Breifing Date: May 03, 2001
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Hormone device may help women avoid hysterectomy Source: Reuters Health eLine Date: February 01, 2001 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
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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 “hysterectomy” (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 “hysterectomy” (or synonyms). If you know the name of a company that is relevant to hysterectomy, 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 “hysterectomy” (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 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 “hysterectomy” (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 hysterectomy:
Periodicals and News
•
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Laparoscopic Bladder Neck Suspension Source: American Uro-Gynecologic Society Quarterly Report. 13(1): 1-3. January 1995. Contact: Available from American Uro-Gynecologic Society (AUGS) Headquarters. 401 North Michigan Avenue, Chicago, IL 60611-4267. (312) 644-6610. Summary: This article, from a professional newsletter, describes the laparoscopic bladder neck suspension procedures currently used for genuine stress incontinence (GSI), along with related controversies. The author reviews the literature in this area, discussing topics including the Marshall-Marchetti-Kranz (MMK) suspension; the Burch procedure; bladder neck suspension in patients undergoing laparoscopic hysterectomy; the use of polyglactin mesh sewn between the bladder neck and Cooper's ligament; the use of an extraperitoneal approach that uses a balloon to distend the preperitoneal space; the advantages of minimally invasive surgery; and postoperative patient followup. 10 references.
•
Urinary Incontinence and Sexuality Source: Quality Care. 16(3): 5. Summer 1998. Contact: Available from National Association for Continence. P.O. Box 8310, Spartanburg, SC 29305-8310. (800) 252-3337 or (864) 579-7900. Fax (864) 579-7902. Summary: This brief newsletter article reviews the problem of urinary incontinence and its impact on the patient's sexuality. The impact of incontinence may upset an established love life or create particular difficulties with a new relationship. Intimacy is about being close, and incontinence or the fear of leakage might be an obstacle, both mentally and physically. Problems may be greatest for those who have known continence but have lost it as a result of a difficult childbirth or surgery. This surgery can include hysterectomy or prolapse surgeries for women and prostatectomy for men. Loss of orgasm can also occur after surgery. There is often embarrassment, anger, and frustration with these adverse outcomes. Some causes for leakage include pelvic floor muscle weakness, overactive bladder contractions, or incomplete bladder emptying. The author notes that incontinence episodes with sex can sometimes be cured, often improved, but always managed by optimal care. The author briefly summarizes the principles of successful management: make sure the bladder and bowel are empty before sexual activity, use warmed lubricating gel, avoid a position that may provoke leakage, and share concerns with the sexual partner. The author encourages readers to work with their health care providers to manage urinary incontinence problems.
•
Chronic Pelvic Pain in Women Source: Quality Care. 20(4): 1, 5. Fourth Quarter 2002. Contact: Available from National Association for Continence. P.O. Box 8310, Spartanburg, SC 29305-8310. (800) BLADDER OR (800) 252-3337 or (864) 579-7900. Fax (864) 579-7902. Website: www.nafc.org. Summary: This newsletter article discusses chronic pelvic pain (CPP) in women, a complex and debilitating problem that can significantly impair many aspects of the quality of life of women. Typical characteristics of chronic pain are incomplete relief by previous treatments, pain out of proportion to tissue damage, loss of physical function, signs of depression, and altered family dynamics. The author considers factors that can lead to CPP, including hysterectomy, uterine fibroids, endometriosis, interstitial cystitis
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(IC), vulvodynea, and vulvar vestibulitis. For each, the author briefly outlines potential treatment options. •
Pelvic Muscle Rehabilitation Source: Quality Care. 16(3): 1-2. Summer 1998. Contact: Available from National Association for Continence. P.O. Box 8310, Spartanburg, SC 29305-8310. (800) 252-3337 or (864) 579-7900. Fax (864) 579-7902. Summary: This newsletter article reviews the use of pelvic floor muscle exercises (Kegel exercises) to prevent or treat urinary incontinence. The author notes that exercising the muscles of the pelvic floor on a regular basis should be as much a part of a woman's preventive health care routine as an annual Pap smear and monthly breast self examination. Pelvic muscles are frequently damaged during childbirth and sometimes by surgery in the pelvic area (hysterectomy or prolapse surgeries for women and prostatectomy for men). The author describes the purpose of pelvic muscle rehabilitation and then details how the exercises are done. The author notes that some people may only need written directions to undertake these exercises, but some people may need help from a health care professional to locate and exercise the pelvic muscles. Biofeedback, electrical stimulation, and vaginal weights are the most common methods used to help individuals locate and begin to use their pelvic muscles. The author concludes that, whichever method is prescribed, successful pelvic muscle rehabilitation depends on a consistent effort by the individual. 1 figure.
Academic Periodicals covering Hysterectomy Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to hysterectomy. In addition to these sources, you can search for articles covering hysterectomy 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 9. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.
U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for hysterectomy. 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 hysterectomy. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The
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following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to hysterectomy: Conjugated Estrogens and Medroxyprogesterone for Ovarian Hormone Therapy (Oht) •
Systemic - U.S. Brands: Note: http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/209441.html
Penicillins and Beta-Lactamase Inhibitors •
Systemic - U.S. Brands: Augmentin; Timentin; Unasyn; Zosyn http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202705.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. Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee. If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.
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APPENDICES
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APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.
NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute11: •
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/
11
These publications are typically written by one or more of the various NIH Institutes.
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•
National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm
•
National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/
•
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm
•
National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm
•
National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/
•
National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/
•
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm
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National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html
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National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm
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National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm
•
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
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National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm
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Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp
•
National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/
•
National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp
•
Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html
•
Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm
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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.12 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:13 •
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
12
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). 13 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 Gateway14 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.15 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “hysterectomy” (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 22438 575 72 61 12 23158
HSTAT16 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.17 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.18 Simply search by “hysterectomy” (or synonyms) at the following Web site: http://text.nlm.nih.gov.
14
Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.
15
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). 16 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 17 18
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 Biologists19 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.20 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.21 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/.
19 Adapted 20
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. 21 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.
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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on hysterectomy 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 hysterectomy. 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 hysterectomy. 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 “hysterectomy”:
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•
Other guides Cervical Cancer http://www.nlm.nih.gov/medlineplus/cervicalcancer.html Endometriosis http://www.nlm.nih.gov/medlineplus/endometriosis.html Uterine Cancer http://www.nlm.nih.gov/medlineplus/uterinecancer.html Uterine Diseases http://www.nlm.nih.gov/medlineplus/uterinediseases.html Uterine Fibroids http://www.nlm.nih.gov/medlineplus/uterinefibroids.html
Within the health topic page dedicated to hysterectomy, the following was listed: •
General/Overviews About Hysterectomy: Surgical Removal of the Uterus, or Womb http://www.facs.org/public_info/operation/hysterectomy.pdf Hysterectomy http://www.nlm.nih.gov/medlineplus/tutorials/hysterectomyloader.html Hysterectomy Source: National Women's Health Information Center http://www.4woman.gov/faq/hysterectomy.htm Hysterectomy: Benefits and Alternatives Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=HQ00905
•
Specific Conditions/Aspects Laparoscopically Assisted Vaginal Hysterectomy Source: American College of Obstetricians and Gynecologists http://www.medem.com/MedLB/article_detaillb.cfm?article_ID=ZZZPBJA9AEC &sub_cat=8 Pap Test: Needed after a Hysterectomy? Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=AN00013
•
Latest News Menopause Equals Extra Munching Source: 11/13/2003, Reuters Health http://www.nlm.nih.gov//www.nlm.nih.gov/medlineplus/news/fullstory_14668 .html
Patient Resources
•
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Organizations American College of Obstetricians and Gynecologists http://www.acog.org/ National Women's Health Information Center Source: Dept. of Health and Human Services http://www.4woman.gov/
•
Research Pap Tests on Women with Hysterectomies Cost Millions of Dollars Source: American College of Obstetricians and Gynecologists http://www.acog.org/from_home/publications/press_releases/nr07-31-01.cfm
•
Statistics Hysterectomy Statistics Source: National Uterine Fibroids Foundation http://www.nuff.org/health_statistics.htm Hysterectomy Status by State and Age 1998-2000 Source: National Uterine Fibroids Foundation http://www.nuff.org/health_hysterectomystatistics.htm
You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on hysterectomy. 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: •
PID : Pelvic Inflammatory Disease Contact: Education Training and Research Associates, PO Box 1830, Santa Cruz, CA, 95061-1830, (800) 321-4407, http://www.etr.org. Summary: This brochure provides information about the sexually transmitted disease (STD), pelvic inflammatory disease (PID). PID is an infection of a woman's pelvic and sexual organs such as the uterus, fallopian tubes, and ovaries. Untreated chlamydia and gonorrhea are the two most common causes of PID. STD germs travel up the vagina and cervix to the other organs, thus developing into PID. PID can also be caused by intrauterine devices (IUDs), douching, or some forms of vaginitis. The common
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symptoms of PID are listed. PID can cause infertility, tubal pregnancies, and painful scarring, which may require a hysterectomy. PID is common in women who contract gonorrhea or chlamydia, have an untreated STD, use an IUD for birth control, and douche. A pelvic examination and lab tests are used to check for PID. Individuals can help to protect themselves from PID by practicing safer sex with condoms during each sexual encounter, avoiding douching, getting tested for STDs regularly, avoiding sex with people they suspect may be infected, and avoiding substance abuse, which can lead to the practice of high-risk behaviors. Individuals with PID should take all of their medications, ask their health care providers when they can have sex after treatment, inform their sex partner(s) so that they can also get tested for STDs, and get re-tested after completing treatment. •
What Is PID? Contact: California Department of Health Services, Office of AIDS, California AIDS Clearinghouse, 1443 N Martel Ave, Los Angeles, CA, 90046, (323) 845-4180, http://www.hivinfo.org. Summary: This fact sheet provides a general overview of pelvic inflammatory disease (PID). PID is a serious infection usually caused by gonorrhea, chlamydia, or other sexually transmitted disease (STD) bacteria. PID is passed from men, who are often asymptomatic carriers, to women during vaginal sex. Some of the symptoms that women may exhibit include pain in the lower abdomen, fever, chills, vomiting, unusual bleeding or vaginal discharge, pain during sexual intercourse, and/or pain in the lower back. Some women have no symptoms. Some of the risk factors for women contracting PID include having unprotected vaginal sex, having multiple sex partners in a short period of time, having a previous PID infection, and douching. PID can cause even more serious health problems such as pus in the fallopian tubes, scarring in the pelvic organs, tubal blockages leading to sterility or tubal pregnancies, life-long pain in the abdomen especially during sex, and conditions that may necessitate a total hysterectomy. PID is treated with antibiotic injections and pills; hospital visits may be part of the follow-up care. During treatment, persons with PID should avoid sex for two weeks to allow their organs to heal, stop all exercise for two weeks, take hot baths to speed healing, and complete their medical regimens. Practicing safer sex with condoms during each sexual encounter and getting regular STD check-ups can help to prevent the transmission of PID. The fact sheet provides contact information for services from which individuals can learn more about STDs and the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS).
•
Human Papillomavirus (HPV) Contact: Heritage House, 919 South Main St, Snowflake, AZ, 85937, (800) 858-3040, http://www.heritagehouse76.com. Summary: This fact sheet provides information about the human papillomavirus (HPV), a sexually transmitted disease (STD). HPV is linked to the deaths of many women each year and is more contagious than the human immunodeficiency virus (HIV). HPV is a group of viruses that cause warts on various parts of the body. Many types of these viruses are incurable and are passed through sexual contact. HPV is the leading cause of all cervical cancer in the United States; however, not all of the viruses categorized as HPV cause cancer. The low-risk HPVs are often those that cause warts, whereas the high-risk viruses are those most often linked to cancer and are usually asymptomatic. If caught early enough, cervical cancer can be cured. The cure for cervical cancer usually involves a hysterectomy, the removal of the uterus, which leaves the woman unable to
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bear children. Condoms are not very effective against HPV because it is transmitted during skin-to-skin contact during sex or through casual contact. Sexually active individuals should get tested for HPV by their health care providers, and women should undergo regular Pap smears. The only way to effectively prevent HPV is to practice sexual abstinence. The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search this site located at http://www.guideline.gov/ by using the keyword “hysterectomy” (or synonyms). The following was recently posted: •
Guideline for determining the route and method of hysterectomy for benign conditions Source: Society of Pelvic Reconstructive Surgeons - Medical Specialty Society; 1999; 3 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2153&nbr=1379&a mp;string=hysterectomy Healthfinder™
Healthfinder™ is sponsored by the U.S. Department of Health and Human Services and offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: •
Alternatives to Hysterectomy: New Technologies, More Options Summary: This FDA Consumer article covers alternatives to hysterectomy such as endometrial ablation, myomectomy, and uterine fibroid embolization. Source: U.S. Food and Drug Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=7261
•
Hysterectomy: Know Your Options Summary: Answers to women's concerns about this medical procedure that is frequently recommended as a solution to relieve chronic pain and/or heavy bleeding that is caused by fibroids, endometriosis, and other Source: National Women's Health Resource Center http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=2596
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•
Uterine Fibroid Treatment Options Summary: This patient information from the Society of Interventional Radiology explores treatment options for uterine fibroids: drug therapy, myomectomy, hysterectomy, and uterine fibroid embolization. Source: Society of Interventional Radiology http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=7264 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 hysterectomy. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •
AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats
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Family Village: http://www.familyvillage.wisc.edu/specific.htm
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Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/
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Med Help International: http://www.medhelp.org/HealthTopics/A.html
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Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/
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Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/
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WebMD®Health: http://my.webmd.com/health_topics
Associations and Hysterectomy The following is a list of associations that provide information on and resources relating to hysterectomy: •
Hysterectomy Educational Resources and Services Foundation Telephone: (610) 667-7757 Toll-free: (888) 570-4377 Fax: (610) 667-8096 Email: [email protected] Web Site: www.herfoundation.com; www.uterinearteryembolization.com
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Background: The Hysterectomy Educational Resources and Services Foundation (HERS) is a non-profit organization dedicated to the ideal that every woman should have complete, accurate information available to her about the alternatives to and consequences of hysterectomy. Established in 1982, HERS provides an initial free packet of information, counseling by telephone appointment, assistance in determining whether proper, complete evaluation of symptoms has been obtained, referral to physicians, and legal counseling as needed. HERS also networks women on a one-toone basis worldwide. Educational materials include a newsletter, a resource list, and a HERS publication list. All languages: translaters available as needed. Relevant area(s) of interest: Hysterectomy
Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to hysterectomy. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with hysterectomy. 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 hysterectomy. 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 “hysterectomy” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information.
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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 “hysterectomy”. 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 “hysterectomy” (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 “hysterectomy” (or a synonym) into the search box, and click “Submit Query.”
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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.
Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.22
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
22
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)23: •
Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/
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Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)
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Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm
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California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html
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California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html
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California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html
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California: Gateway Health Library (Sutter Gould Medical Foundation)
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California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/
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California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp
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California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html
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California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/
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California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/
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California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/
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California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html
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California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/
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Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/
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Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/
•
Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/
23
Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.
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•
Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml
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Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm
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Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html
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Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm
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Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp
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Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/
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Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm
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Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html
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Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/
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Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm
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Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/
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Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/
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Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/
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Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm
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Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html
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Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm
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Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/
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Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/
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Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10
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Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/
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•
Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html
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Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp
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Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp
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Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/
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Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html
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Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm
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Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp
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Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/
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Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html
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Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/
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Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm
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Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/
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Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html
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Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm
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Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330
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Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)
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National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html
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National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/
•
National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/
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Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm
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New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/
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New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm
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New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm
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New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/
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New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html
•
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). The NIH suggests the following Web sites in the ADAM Medical Encyclopedia when searching for information on hysterectomy: •
Basic Guidelines for Hysterectomy Hysterectomy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002915.htm
•
Signs & Symptoms for Hysterectomy Problems breathing Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003075.htm Vaginal bleeding Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003156.htm
•
Background Topics for Hysterectomy Bleeding Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000045.htm Blood clots Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001124.htm
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Cervix Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002317.htm Chronic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002312.htm Vagina Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002342.htm
Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •
Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical
•
MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html
•
Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/
•
Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine
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HYSTERECTOMY DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abdominal fat: Fat (adipose tissue) that is centrally distributed between the thorax and pelvis and that induces greater health risk. [NIH] Aberrant: Wandering or deviating from the usual or normal course. [EU] Ablate: In surgery, is to remove. [NIH] Ablation: The removal of an organ by surgery. [NIH] Abscess: A localized, circumscribed collection of pus. [NIH] Acetaminophen: Analgesic antipyretic derivative of acetanilide. It has weak antiinflammatory properties and is used as a common analgesic, but may cause liver, blood cell, and kidney damage. [NIH] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Actin: Essential component of the cell skeleton. [NIH] Acyl: Chemical signal used by bacteria to communicate. [NIH] Adaptability: Ability to develop some form of tolerance to conditions extremely different from those under which a living organism evolved. [NIH] Adenine: A purine base and a fundamental unit of adenine nucleotides. [NIH] Adenocarcinoma: A malignant epithelial tumor with a glandular organization. [NIH] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adenosine Triphosphate: Adenosine 5'-(tetrahydrogen triphosphate). An adenine nucleotide containing three phosphate groups esterified to the sugar moiety. In addition to its crucial roles in metabolism adenosine triphosphate is a neurotransmitter. [NIH] 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] Adhesions: Pathological processes consisting of the union of the opposing surfaces of a wound. [NIH] Adipose Tissue: Connective tissue composed of fat cells lodged in the meshes of areolar tissue. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU]
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Adjuvant Therapy: Treatment given after the primary treatment to increase the chances of a cure. Adjuvant therapy may include chemotherapy, radiation therapy, or hormone therapy. [NIH]
Adnexa: The appendages of the eye, as the lacrimal apparatus, the eyelids, and the extraocular muscles. [NIH] Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Adrenergic Antagonists: Drugs that bind to but do not activate adrenergic receptors. Adrenergic antagonists block the actions of the endogenous adrenergic transmitters epinephrine and norepinephrine. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Aerobic: In biochemistry, reactions that need oxygen to happen or happen when oxygen is present. [NIH] Aerobic Metabolism: A chemical process in which oxygen is used to make energy from carbohydrates (sugars). Also known as aerobic respiration, oxidative metabolism, or cell respiration. [NIH] Aerobic Respiration: A chemical process in which oxygen is used to make energy from carbohydrates (sugars). Also known as oxidative metabolism, cell respiration, or aerobic metabolism. [NIH] Aerosol: A solution of a drug which can be atomized into a fine mist for inhalation therapy. [EU]
Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Age Groups: Persons classified by age from birth (infant, newborn) to octogenarians and older (aged, 80 and over). [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] Aged, 80 and Over: A person 80 years of age and older. [NIH] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Airway: A device for securing unobstructed passage of air into and out of the lungs during
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general anesthesia. [NIH] Albumin: 1. Any protein that is soluble in water and moderately concentrated salt solutions and is coagulable by heat. 2. Serum albumin; the major plasma protein (approximately 60 per cent of the total), which is responsible for much of the plasma colloidal osmotic pressure and serves as a transport protein carrying large organic anions, such as fatty acids, bilirubin, and many drugs, and also carrying certain hormones, such as cortisol and thyroxine, when their specific binding globulins are saturated. Albumin is synthesized in the liver. Low serum levels occur in protein malnutrition, active inflammation and serious hepatic and renal disease. [EU] Alertness: A state of readiness to detect and respond to certain specified small changes occurring at random intervals in the environment. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alkaline: Having the reactions of an alkali. [EU] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Alleles: Mutually exclusive forms of the same gene, occupying the same locus on homologous chromosomes, and governing the same biochemical and developmental process. [NIH] Allergen: An antigenic substance capable of producing immediate-type hypersensitivity (allergy). [EU] Alpha Particles: Positively charged particles composed of two protons and two neutrons, i.e., helium nuclei, emitted during disintegration of very heavy isotopes; a beam of alpha particles or an alpha ray has very strong ionizing power, but weak penetrability. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Amebiasis: Infection with any of various amebae. It is an asymptomatic carrier state in most individuals, but diseases ranging from chronic, mild diarrhea to fulminant dysentery may occur. [NIH] Amenorrhea: Absence of menstruation. [NIH] Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Ampulla: A sac-like enlargement of a canal or duct. [NIH] Amputation: Surgery to remove part or all of a limb or appendage. [NIH] Anaerobic: 1. Lacking molecular oxygen. 2. Growing, living, or occurring in the absence of
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molecular oxygen; pertaining to an anaerobe. [EU] Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Anaesthetic: 1. Pertaining to, characterized by, or producing anaesthesia. 2. A drug or agent that is used to abolish the sensation of pain. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Analogous: Resembling or similar in some respects, as in function or appearance, but not in origin or development;. [EU] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Angiogenesis: Blood vessel formation. Tumor angiogenesis is the growth of blood vessels from surrounding tissue to a solid tumor. This is caused by the release of chemicals by the tumor. [NIH] Angiogram: An x-ray of blood vessels; the person receives an injection of dye to outline the vessels on the x-ray. [NIH] Angiokeratoma: A vascular, horny neoplasm of the skin characterized by telangiectasis and secondary epithelial changes including acanthosis and hyperkeratosis. [NIH] Angioplasty: Endovascular reconstruction of an artery, which may include the removal of atheromatous plaque and/or the endothelial lining as well as simple dilatation. These are procedures performed by catheterization. When reconstruction of an artery is performed surgically, it is called endarterectomy. [NIH] Animal model: An animal with a disease either the same as or like a disease in humans. Animal models are used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Anions: Negatively charged atoms, radicals or groups of atoms which travel to the anode or positive pole during electrolysis. [NIH] Anomalies: Birth defects; abnormalities. [NIH] Antagonism: Interference with, or inhibition of, the growth of a living organism by another living organism, due either to creation of unfavorable conditions (e. g. exhaustion of food supplies) or to production of a specific antibiotic substance (e. g. penicillin). [NIH] Antibiosis: A property of microorganisms which enables one microorganism to kill, injure, or inhibit the growth of a different microorganism. [NIH] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]
Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH]
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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] Anticoagulant: A drug that helps prevent blood clots from forming. Also called a blood thinner. [NIH] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antigen-presenting cell: APC. A cell that shows antigen on its surface to other cells of the immune system. This is an important part of an immune response. [NIH] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Anti-Inflammatory Agents: Substances that reduce or suppress inflammation. [NIH] Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Antineoplastic: Inhibiting or preventing the development of neoplasms, checking the maturation and proliferation of malignant cells. [EU] Antioxidant: A substance that prevents damage caused by free radicals. Free radicals are highly reactive chemicals that often contain oxygen. They are produced when molecules are split to give products that have unpaired electrons. This process is called oxidation. [NIH] Antipyretic: An agent that relieves or reduces fever. Called also antifebrile, antithermic and febrifuge. [EU] Antiseptic: A substance that inhibits the growth and development of microorganisms without necessarily killing them. [EU] Antiviral: Destroying viruses or suppressing their replication. [EU] Anus: The opening of the rectum to the outside of the body. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Aorta: The main trunk of the systemic arteries. [NIH] Apnea: A transient absence of spontaneous respiration. [NIH] Apolipoproteins: The protein components of lipoproteins which remain after the lipids to which the proteins are bound have been removed. They play an important role in lipid transport and metabolism. [NIH] Apoptosis: One of the two mechanisms by which cell death occurs (the other being the pathological process of necrosis). Apoptosis is the mechanism responsible for the physiological deletion of cells and appears to be intrinsically programmed. It is characterized by distinctive morphologic changes in the nucleus and cytoplasm, chromatin cleavage at regularly spaced sites, and the endonucleolytic cleavage of genomic DNA (DNA fragmentation) at internucleosomal sites. This mode of cell death serves as a balance to mitosis in regulating the size of animal tissues and in mediating pathologic processes associated with tumor growth. [NIH] Approximate: Approximal [EU] Aqueous: Having to do with water. [NIH]
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Arachidonic Acid: An unsaturated, essential fatty acid. It is found in animal and human fat as well as in the liver, brain, and glandular organs, and is a constituent of animal phosphatides. It is formed by the synthesis from dietary linoleic acid and is a precursor in the biosynthesis of prostaglandins, thromboxanes, and leukotrienes. [NIH] Arginine: An essential amino acid that is physiologically active in the L-form. [NIH] Arnica: Genus of composite-flowered plants in the family Asteraceae. The dried flower heads of Arnica montana are used externally as a counterirritant and tincture for sprains and bruises. Arnica contains volatile oils, arnicin, arnisterol, flavonoids, tannins, and resin. [NIH]
Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Articular: Of or pertaining to a joint. [EU] Ascites: Accumulation or retention of free fluid within the peritoneal cavity. [NIH] Aseptic: Free from infection or septic material; sterile. [EU] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Asymptomatic: Having no signs or symptoms of disease. [NIH] Attenuation: Reduction of transmitted sound energy or its electrical equivalent. [NIH] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Atypical hyperplasia: A benign (noncancerous) condition in which cells have abnormal features and are increased in number. [NIH] Autoimmune disease: A condition in which the body recognizes its own tissues as foreign and directs an immune response against them. [NIH] Autosuggestion: Suggestion coming from the subject himself. [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] Bacteriophage: A virus whose host is a bacterial cell; A virus that exclusively infects bacteria. It generally has a protein coat surrounding the genome (DNA or RNA). One of the coliphages most extensively studied is the lambda phage, which is also one of the most important. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Basement Membrane: Ubiquitous supportive tissue adjacent to epithelium and around smooth and striated muscle cells. This tissue contains intrinsic macromolecular components such as collagen, laminin, and sulfated proteoglycans. As seen by light microscopy one of its subdivisions is the basal (basement) lamina. [NIH] Basophils: Granular leukocytes characterized by a relatively pale-staining, lobate nucleus and cytoplasm containing coarse dark-staining granules of variable size and stainable by basic dyes. [NIH]
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Baths: The immersion or washing of the body or any of its parts in water or other medium for cleansing or medical treatment. It includes bathing for personal hygiene as well as for medical purposes with the addition of therapeutic agents, such as alkalines, antiseptics, oil, etc. [NIH] Benchmarking: Method of measuring performance against established standards of best practice. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]
Benign tumor: A noncancerous growth that does not invade nearby tissue or spread to other parts of the body. [NIH] Bereavement: Refers to the whole process of grieving and mourning and is associated with a deep sense of loss and sadness. [NIH] Bilateral: Affecting both the right and left side of body. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bile Ducts: Tubes that carry bile from the liver to the gallbladder for storage and to the small intestine for use in digestion. [NIH] Bilirubin: A bile pigment that is a degradation product of heme. [NIH] Binding Sites: The reactive parts of a macromolecule that directly participate in its specific combination with another molecule. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biological therapy: Treatment to stimulate or restore the ability of the immune system to fight infection and disease. Also used to lessen side effects that may be caused by some cancer treatments. Also known as immunotherapy, biotherapy, or biological response modifier (BRM) therapy. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biosynthesis: The building up of a chemical compound in the physiologic processes of a living organism. [EU] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Bladder: The organ that stores urine. [NIH] Blastocyst: The mammalian embryo in the post-morula stage in which a fluid-filled cavity, enclosed primarily by trophoblast, contains an inner cell mass which becomes the embryonic disc. [NIH] Bleomycin: A complex of related glycopeptide antibiotics from Streptomyces verticillus consisting of bleomycin A2 and B2. It inhibits DNA metabolism and is used as an antineoplastic, especially for solid tumors. [NIH] Bloating: Fullness or swelling in the abdomen that often occurs after meals. [NIH] Blood Cell Count: A count of the number of leukocytes and erythrocytes per unit volume in
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a sample of venous blood. A complete blood count (CBC) also includes measurement of the hemoglobin, hematocrit, and erythrocyte indices. [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 Platelets: Non-nucleated disk-shaped cells formed in the megakaryocyte and found in the blood of all mammals. They are mainly involved in blood coagulation. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood transfusion: The administration of blood or blood products into a blood vessel. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Blood Viscosity: The internal resistance of the blood to shear forces. The in vitro measure of whole blood viscosity is of limited clinical utility because it bears little relationship to the actual viscosity within the circulation, but an increase in the viscosity of circulating blood can contribute to morbidity in patients suffering from disorders such as sickle cell anemia and polycythemia. [NIH] Blood Volume: Volume of circulating blood. It is the sum of the plasma volume and erythrocyte volume. [NIH] Blot: To transfer DNA, RNA, or proteins to an immobilizing matrix such as nitrocellulose. [NIH]
Body Composition: The relative amounts of various components in the body, such as percent body fat. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Bolus: A single dose of drug usually injected into a blood vessel over a short period of time. Also called bolus infusion. [NIH] Bolus infusion: A single dose of drug usually injected into a blood vessel over a short period of time. Also called bolus. [NIH] Bone Density: The amount of mineral per square centimeter of bone. This is the definition used in clinical practice. Actual bone density would be expressed in grams per milliliter. It is most frequently measured by photon absorptiometry or x-ray computed tomography. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Brachytherapy: A collective term for interstitial, intracavity, and surface radiotherapy. It uses small sealed or partly-sealed sources that may be placed on or near the body surface or within a natural body cavity or implanted directly into the tissues. [NIH] Bradykinin: A nonapeptide messenger that is enzymatically produced from kallidin in the
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blood where it is a potent but short-lived agent of arteriolar dilation and increased capillary permeability. Bradykinin is also released from mast cells during asthma attacks, from gut walls as a gastrointestinal vasodilator, from damaged tissues as a pain signal, and may be a neurotransmitter. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]
Breakdown: A physical, metal, or nervous collapse. [NIH] Breast Feeding: The nursing of an infant at the mother's breast. [NIH] Buccal: Pertaining to or directed toward the cheek. In dental anatomy, used to refer to the buccal surface of a tooth. [EU] Bupivacaine: A widely used local anesthetic agent. [NIH] Bypass: A surgical procedure in which the doctor creates a new pathway for the flow of body fluids. [NIH] Caffeine: A methylxanthine naturally occurring in some beverages and also used as a pharmacological agent. Caffeine's most notable pharmacological effect is as a central nervous system stimulant, increasing alertness and producing agitation. It also relaxes smooth muscle, stimulates cardiac muscle, stimulates diuresis, and appears to be useful in the treatment of some types of headache. Several cellular actions of caffeine have been observed, but it is not entirely clear how each contributes to its pharmacological profile. Among the most important are inhibition of cyclic nucleotide phosphodiesterases, antagonism of adenosine receptors, and modulation of intracellular calcium handling. [NIH] Calcaneus: The largest of the tarsal bones and is situated at the lower and back part of the foot forming the heel. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Carboplatin: An organoplatinum compound that possesses antineoplastic activity. [NIH] Carcinogen: Any substance that causes cancer. [NIH] Carcinogenesis: The process by which normal cells are transformed into cancer cells. [NIH] Carcinogenic: Producing carcinoma. [EU] Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs. [NIH]
Carcinoma in Situ: A malignant tumor that has not yet invaded the basement membrane of the epithelial cell of origin and has not spread to other tissues. [NIH] Cardiac: Having to do with the heart. [NIH] Cardiopulmonary: Having to do with the heart and lungs. [NIH]
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Cardiopulmonary Bypass: Diversion of the flow of blood from the entrance of the right atrium directly to the aorta (or femoral artery) via an oxygenator thus bypassing both the heart and lungs. [NIH] 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] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Case series: A group or series of case reports involving patients who were given similar treatment. Reports of case series usually contain detailed information about the individual patients. This includes demographic information (for example, age, gender, ethnic origin) and information on diagnosis, treatment, response to treatment, and follow-up after treatment. [NIH] Case-Control Studies: Studies which start with the identification of persons with a disease of interest and a control (comparison, referent) group without the disease. The relationship of an attribute to the disease is examined by comparing diseased and non-diseased persons with regard to the frequency or levels of the attribute in each group. [NIH] Castration: Surgical removal or artificial destruction of gonads. [NIH] Catecholamines: A general class of ortho-dihydroxyphenylalkylamines derived from tyrosine. [NIH] Catheterization: Use or insertion of a tubular device into a duct, blood vessel, hollow organ, or body cavity for injecting or withdrawing fluids for diagnostic or therapeutic purposes. It differs from intubation in that the tube here is used to restore or maintain patency in obstructions. [NIH] Catheters: A small, flexible tube that may be inserted into various parts of the body to inject or remove liquids. [NIH] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [EU] Causal: Pertaining to a cause; directed against a cause. [EU] Cause of Death: Factors which produce cessation of all vital bodily functions. They can be analyzed from an epidemiologic viewpoint. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Adhesion: Adherence of cells to surfaces or to other cells. [NIH] Cell Cycle: The complex series of phenomena, occurring between the end of one cell division and the end of the next, by which cellular material is divided between daughter cells. [NIH] Cell Death: The termination of the cell's ability to carry out vital functions such as metabolism, growth, reproduction, responsiveness, and adaptability. [NIH] Cell Differentiation: Progressive restriction of the developmental potential and increasing specialization of function which takes place during the development of the embryo and leads to the formation of specialized cells, tissues, and organs. [NIH] Cell Division: The fission of a cell. [NIH]
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Cell proliferation: An increase in the number of cells as a result of cell growth and cell division. [NIH] Cell Respiration: The metabolic process of all living cells (animal and plant) in which oxygen is used to provide a source of energy for the cell. [NIH] Cell Survival: The span of viability of a cell characterized by the capacity to perform certain functions such as metabolism, growth, reproduction, some form of responsiveness, and adaptability. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Centrifugation: A method of separating organelles or large molecules that relies upon differential sedimentation through a preformed density gradient under the influence of a gravitational field generated in a centrifuge. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] 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] Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH] Cervical intraepithelial neoplasia: CIN. A general term for the growth of abnormal cells on the surface of the cervix. Numbers from 1 to 3 may be used to describe how much of the cervix contains abnormal cells. [NIH] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH] Cesarean Section: Extraction of the fetus by means of abdominal hysterotomy. [NIH] Character: In current usage, approximately equivalent to personality. The sum of the relatively fixed personality traits and habitual modes of response of an individual. [NIH] Check-up: A general physical examination. [NIH] Chemoprevention: The use of drugs, vitamins, or other agents to try to reduce the risk of, or delay the development or recurrence of, cancer. [NIH] Chemopreventive: Natural or synthetic compound used to intervene in the early precancerous stages of carcinogenesis. [NIH] Chemotaxis: The movement of cells or organisms toward or away from a substance in response to its concentration gradient. [NIH] Chemotherapy: Treatment with anticancer drugs. [NIH] Chlamydia: A genus of the family Chlamydiaceae whose species cause a variety of diseases in vertebrates including humans, mice, and swine. Chlamydia species are gram-negative and produce glycogen. The type species is Chlamydia trachomatis. [NIH] Cholecystectomy: Surgical removal of the gallbladder. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Cholesterol Esters: Fatty acid esters of cholesterol which constitute about two-thirds of the cholesterol in the plasma. The accumulation of cholesterol esters in the arterial intima is a characteristic feature of atherosclerosis. [NIH]
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Choriocarcinoma: A malignant tumor of trophoblastic epithelium characterized by secretion of large amounts of chorionic gonadotropin. It usually originates from chorionic products of conception (i.e., hydatidiform mole, normal pregnancy, or following abortion), but can originate in a teratoma of the testis, mediastinum, or pineal gland. [NIH] Chromatin: The material of chromosomes. It is a complex of DNA, histones, and nonhistone proteins (chromosomal proteins, non-histone) found within the nucleus of a cell. [NIH] Chromosomal: Pertaining to chromosomes. [EU] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chromosome Aberrations: Deviations from the normal number or structure of chromosomes, not necessarily associated with disease. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chylomicrons: A class of lipoproteins that carry dietary cholesterol and triglycerides from the small intestines to the tissues. [NIH] Circadian: Repeated more or less daily, i. e. on a 23- to 25-hour cycle. [NIH] Circadian Rhythm: The regular recurrence, in cycles of about 24 hours, of biological processes or activities, such as sensitivity to drugs and stimuli, hormone secretion, sleeping, feeding, etc. This rhythm seems to be set by a 'biological clock' which seems to be set by recurring daylight and darkness. [NIH] Circumcision: Excision of the prepuce or part of it. [NIH] CIS: Cancer Information Service. The CIS is the National Cancer Institute's link to the public, interpreting and explaining research findings in a clear and understandable manner, and providing personalized responses to specific questions about cancer. Access the CIS by calling 1-800-4-CANCER, or by using the Web site at http://cis.nci.nih.gov. [NIH] Cisplatin: An inorganic and water-soluble platinum complex. After undergoing hydrolysis, it reacts with DNA to produce both intra and interstrand crosslinks. These crosslinks appear to impair replication and transcription of DNA. The cytotoxicity of cisplatin correlates with cellular arrest in the G2 phase of the cell cycle. [NIH] Clamp: A u-shaped steel rod used with a pin or wire for skeletal traction in the treatment of certain fractures. [NIH] Climacteric: Physiologic period, characterized by endocrine, somatic, and psychic changes with the termination of ovarian function in the female. It may also accompany the normal diminution of sexual activity in the male. [NIH] Clinical Medicine: The study and practice of medicine by direct examination of the patient. [NIH]
Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Clitoral: Pertaining to the clitoris. [EU] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Coagulation: 1. The process of clot formation. 2. In colloid chemistry, the solidification of a
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sol into a gelatinous mass; an alteration of a disperse phase or of a dissolved solid which causes the separation of the system into a liquid phase and an insoluble mass called the clot or curd. Coagulation is usually irreversible. 3. In surgery, the disruption of tissue by physical means to form an amorphous residuum, as in electrocoagulation and photocoagulation. [EU] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Cohort Studies: Studies in which subsets of a defined population are identified. These groups may or may not be exposed to factors hypothesized to influence the probability of the occurrence of a particular disease or other outcome. Cohorts are defined populations which, as a whole, are followed in an attempt to determine distinguishing subgroup characteristics. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Collapse: 1. A state of extreme prostration and depression, with failure of circulation. 2. Abnormal falling in of the walls of any part of organ. [EU] Collateral Circulation: Maintenance of blood flow to an organ despite obstruction of a principal vessel. Blood flow is maintained through small vessels. [NIH] Colloidal: Of the nature of a colloid. [EU] Colonoscope: A thin, lighted tube used to examine the inside of the colon. [NIH] Colonoscopy: Endoscopic examination, therapy or surgery of the luminal surface of the colon. [NIH] Colpotomy: An incision in the vagina. [NIH] Combination Therapy: Association of 3 drugs to treat AIDS (AZT + DDC or DDI + protease inhibitor). [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the
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alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] 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] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Concomitant: Accompanying; accessory; joined with another. [EU] Condoms: A sheath that is worn over the penis during sexual behavior in order to prevent pregnancy or spread of sexually transmitted disease. [NIH] Cone: One of the special retinal receptor elements which are presumed to be primarily concerned with perception of light and color stimuli when the eye is adapted to light. [NIH] Confounding: Extraneous variables resulting in outcome effects that obscure or exaggerate the "true" effect of an intervention. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] 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] Constriction: The act of constricting. [NIH] Consultation: A deliberation between two or more physicians concerning the diagnosis and the proper method of treatment in a case. [NIH] Consumption: Pulmonary tuberculosis. [NIH] Contamination: The soiling or pollution by inferior material, as by the introduction of organisms into a wound, or sewage into a stream. [EU] Continence: The ability to hold in a bowel movement or urine. [NIH] Continuous infusion: The administration of a fluid into a blood vessel, usually over a prolonged period of time. [NIH]
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Continuum: An area over which the vegetation or animal population is of constantly changing composition so that homogeneous, separate communities cannot be distinguished. [NIH]
Contraception: Use of agents, devices, methods, or procedures which diminish the likelihood of or prevent conception. [NIH] Contraceptive: An agent that diminishes the likelihood of or prevents conception. [EU] Contractility: Capacity for becoming short in response to a suitable stimulus. [EU] 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] Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works. [NIH] Controlled clinical trial: A clinical study that includes a comparison (control) group. The comparison group receives a placebo, another treatment, or no treatment at all. [NIH] Controlled study: An experiment or clinical trial that includes a comparison (control) group. [NIH]
Coordination: Muscular or motor regulation or the harmonious cooperation of muscles or groups of muscles, in a complex action or series of actions. [NIH] 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 Artery Bypass: Surgical therapy of ischemic coronary artery disease achieved by grafting a section of saphenous vein, internal mammary artery, or other substitute between the aorta and the obstructed coronary artery distal to the obstructive lesion. [NIH] Coronary Disease: Disorder of cardiac function due to an imbalance between myocardial function and the capacity of the coronary vessels to supply sufficient flow for normal function. It is a form of myocardial ischemia (insufficient blood supply to the heart muscle) caused by a decreased capacity of the coronary vessels. [NIH] Coronary heart disease: A type of heart disease caused by narrowing of the coronary arteries that feed the heart, which needs a constant supply of oxygen and nutrients carried by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by fat and cholesterol deposits and cannot supply enough blood to the heart, CHD results. [NIH] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Coronary Vessels: The veins and arteries of the heart. [NIH] Corpus: The body of the uterus. [NIH] Corpus Luteum: The yellow glandular mass formed in the ovary by an ovarian follicle that has ruptured and discharged its ovum. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Cortisol: A steroid hormone secreted by the adrenal cortex as part of the body's response to stress. [NIH] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans)
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end of the body. [EU] Cross-Sectional Studies: Studies in which the presence or absence of disease or other health-related variables are determined in each member of the study population or in a representative sample at one particular time. This contrasts with longitudinal studies which are followed over a period of time. [NIH] Cryofixation: Fixation of a tissue by localized cooling at very low temperature. [NIH] Cryopreservation: Preservation of cells, tissues, organs, or embryos by freezing. In histological preparations, cryopreservation or cryofixation is used to maintain the existing form, structure, and chemical composition of all the constituent elements of the specimens. [NIH]
Curative: Tending to overcome disease and promote recovery. [EU] Curettage: Removal of tissue with a curette, a spoon-shaped instrument with a sharp edge. [NIH]
Curette: A spoon-shaped instrument with a sharp edge. [NIH] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cyst: A sac or capsule filled with fluid. [NIH] Cystathionine beta-Synthase: A multifunctional pyridoxal phosphate enzyme. In the second stage of cysteine biosynthesis it catalyzes the reaction of homocysteine with serine to form cystathionine with the elimination of water. Deficiency of this enzyme leads to hyperhomocysteinemia and homocystinuria. EC 4.2.1.22. [NIH] Cystectomy: Used for excision of the urinary bladder. [NIH] Cystitis: Inflammation of the urinary bladder. [EU] Cystocele: Fallen bladder. When the bladder falls or sags from its normal position down to the pelvic floor, it can cause either urinary leakage or urinary retention. [NIH] Cystoscopy: Endoscopic examination, therapy or surgery of the urinary bladder. [NIH] Cytokine: Small but highly potent protein that modulates the activity of many cell types, including T and B cells. [NIH] Cytomegalovirus: A genus of the family Herpesviridae, subfamily Betaherpesvirinae, infecting the salivary glands, liver, spleen, lungs, eyes, and other organs, in which they produce characteristically enlarged cells with intranuclear inclusions. Infection with Cytomegalovirus is also seen as an opportunistic infection in AIDS. [NIH] Cytomegalovirus Infections: Infection with Cytomegalovirus, characterized by enlarged cells bearing intranuclear inclusions. Infection may be in almost any organ, but the salivary glands are the most common site in children, as are the lungs in adults. [NIH] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Cytoskeleton: The network of filaments, tubules, and interconnecting filamentous bridges which give shape, structure, and organization to the cytoplasm. [NIH] Cytotoxic: Cell-killing. [NIH] Cytotoxic chemotherapy: Anticancer drugs that kill cells, especially cancer cells. [NIH] Cytotoxicity: Quality of being capable of producing a specific toxic action upon cells of special organs. [NIH] Databases, Bibliographic: Extensive collections, reputedly complete, of references and
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citations to books, articles, publications, etc., generally on a single subject or specialized subject area. Databases can operate through automated files, libraries, or computer disks. The concept should be differentiated from factual databases which is used for collections of data and facts apart from bibliographic references to them. [NIH] Decidua: The epithelial lining of the endometrium that is formed before the fertilized ovum reaches the uterus. The fertilized ovum embeds in the decidua. If the ovum is not fertilized, the decidua is shed during menstruation. [NIH] Decision Making: The process of making a selective intellectual judgment when presented with several complex alternatives consisting of several variables, and usually defining a course of action or an idea. [NIH] Defecation: The normal process of elimination of fecal material from the rectum. [NIH] Defense Mechanisms: Unconscious process used by an individual or a group of individuals in order to cope with impulses, feelings or ideas which are not acceptable at their conscious level; various types include reaction formation, projection and self reversal. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Deletion: A genetic rearrangement through loss of segments of DNA (chromosomes), bringing sequences, which are normally separated, into close proximity. [NIH] Delivery of Health Care: The concept concerned with all aspects of providing and distributing health services to a patient population. [NIH] Delusions: A false belief regarding the self or persons or objects outside the self that persists despite the facts, and is not considered tenable by one's associates. [NIH] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH] Dendrites: Extensions of the nerve cell body. They are short and branched and receive stimuli from other neurons. [NIH] Dendritic: 1. Branched like a tree. 2. Pertaining to or possessing dendrites. [EU] Dendritic cell: A special type of antigen-presenting cell (APC) that activates T lymphocytes. [NIH]
Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Dentate Gyrus: Gray matter situated above the gyrus hippocampi. It is composed of three layers. The molecular layer is continuous with the hippocampus in the hippocampal fissure. The granular layer consists of closely arranged spherical or oval neurons, called granule cells, whose axons pass through the polymorphic layer ending on the dendrites of pyramidal cells in the hippocampus. [NIH] Depolarization: The process or act of neutralizing polarity. In neurophysiology, the reversal of the resting potential in excitable cell membranes when stimulated, i.e., the tendency of the cell membrane potential to become positive with respect to the potential outside the cell. [EU] Deprivation: Loss or absence of parts, organs, powers, or things that are needed. [EU] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diaphragm: The musculofibrous partition that separates the thoracic cavity from the
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abdominal cavity. Contraction of the diaphragm increases the volume of the thoracic cavity aiding inspiration. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Diclofenac: A non-steroidal anti-inflammatory agent (NSAID) with antipyretic and analgesic actions. It is primarily available as the sodium salt, diclofenac sodium. [NIH] Diclofenac Sodium: The sodium form of diclofenac. It is used for its analgesic and antiinflammatory properties. [NIH] 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] Diffusion: The tendency of a gas or solute to pass from a point of higher pressure or concentration to a point of lower pressure or concentration and to distribute itself throughout the available space; a major mechanism of biological transport. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Dilatation: The act of dilating. [NIH] Dilate: Relax; expand. [NIH] Dilation: A process by which the pupil is temporarily enlarged with special eye drops (mydriatic); allows the eye care specialist to better view the inside of the eye. [NIH] Dilation and curettage: D&C. A minor operation in which the cervix is expanded enough (dilation) to permit the cervical canal and uterine lining to be scraped with a spoon-shaped instrument called a curette (curettage). [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Disease Progression: The worsening of a disease over time. This concept is most often used for chronic and incurable diseases where the stage of the disease is an important determinant of therapy and prognosis. [NIH] Disease Susceptibility: A constitution or condition of the body which makes the tissues react in special ways to certain extrinsic stimuli and thus tends to make the individual more than usually susceptible to certain diseases. [NIH] Dissection: Cutting up of an organism for study. [NIH] Dissociation: 1. The act of separating or state of being separated. 2. The separation of a molecule into two or more fragments (atoms, molecules, ions, or free radicals) produced by the absorption of light or thermal energy or by solvation. 3. In psychology, a defense mechanism in which a group of mental processes are segregated from the rest of a person's mental activity in order to avoid emotional distress, as in the dissociative disorders (q.v.), or in which an idea or object is segregated from its emotional significance; in the first sense it is roughly equivalent to splitting, in the second, to isolation. 4. A defect of mental integration in which one or more groups of mental processes become separated off from normal consciousness and, thus separated, function as a unitary whole. [EU] Dissociative Disorders: Sudden temporary alterations in the normally integrative functions of consciousness. [NIH] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Diuresis: Increased excretion of urine. [EU] Diverticula: Plural form of diverticulum. [NIH] Diverticulum: A pathological condition manifested as a pouch or sac opening from a
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tubular or sacular organ. [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] Dose-rate: The strength of a treatment given over a period of time. [NIH] Douche: A procedure in which water or a medicated solution is used to clean the vagina and cervix. [NIH] Douching: A jet or current of water, sometimes a dissolved medicating or cleansing agent, applied to a body part, organ or cavity for medicinal or hygienic purposes. [EU] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Drug Resistance: Diminished or failed response of an organism, disease or tissue to the intended effectiveness of a chemical or drug. It should be differentiated from drug tolerance which is the progressive diminution of the susceptibility of a human or animal to the effects of a drug, as a result of continued administration. [NIH] Drug Tolerance: Progressive diminution of the susceptibility of a human or animal to the effects of a drug, resulting from its continued administration. It should be differentiated from drug resistance wherein an organism, disease, or tissue fails to respond to the intended effectiveness of a chemical or drug. It should also be differentiated from maximum tolerated dose and no-observed-adverse-effect level. [NIH] Duct: A tube through which body fluids pass. [NIH] Duodenum: The first part of the small intestine. [NIH] Dysmenorrhea: Painful menstruation. [NIH] Dyspareunia: Painful sexual intercourse. [NIH] Ectopic: Pertaining to or characterized by ectopia. [EU] 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] Elastin: The protein that gives flexibility to tissues. [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] Electrocardiogram: Measurement of electrical activity during heartbeats. [NIH] Electrocoagulation: Electrosurgical procedures used to treat hemorrhage (e.g., bleeding ulcers) and to ablate tumors, mucosal lesions, and refractory arrhythmias. [NIH] Electrode: Component of the pacing system which is at the distal end of the lead. It is the interface with living cardiac tissue across which the stimulus is transmitted. [NIH] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the latter being a high-energy biproduct of nuclear decay. [NIH] Emboli: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] Embolization: The blocking of an artery by a clot or foreign material. Embolization can be
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done as treatment to block the flow of blood to a tumor. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Embryo Transfer: Removal of a mammalian embryo from one environment and replacement in the same or a new environment. The embryo is usually in the pre-nidation phase, i.e., a blastocyst. The process includes embryo or blastocyst transplantation or transfer after in vitro fertilization and transfer of the inner cell mass of the blastocyst. It is not used for transfer of differentiated embryonic tissue, e.g., germ layer cells. [NIH] Emesis: Vomiting; an act of vomiting. Also used as a word termination, as in haematemesis. [EU]
Emollient: Softening or soothing; called also malactic. [EU] Emulsion: A preparation of one liquid distributed in small globules throughout the body of a second liquid. The dispersed liquid is the discontinuous phase, and the dispersion medium is the continuous phase. When oil is the dispersed liquid and an aqueous solution is the continuous phase, it is known as an oil-in-water emulsion, whereas when water or aqueous solution is the dispersed phase and oil or oleaginous substance is the continuous phase, it is known as a water-in-oil emulsion. Pharmaceutical emulsions for which official standards have been promulgated include cod liver oil emulsion, cod liver oil emulsion with malt, liquid petrolatum emulsion, and phenolphthalein in liquid petrolatum emulsion. [EU] Endarterectomy: Surgical excision, performed under general anesthesia, of the atheromatous tunica intima of an artery. When reconstruction of an artery is performed as an endovascular procedure through a catheter, it is called atherectomy. [NIH] Endemic: Present or usually prevalent in a population or geographical area at all times; said of a disease or agent. Called also endemial. [EU] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Endometrial: Having to do with the endometrium (the layer of tissue that lines the uterus). [NIH]
Endometriosis: A condition in which tissue more or less perfectly resembling the uterine mucous membrane (the endometrium) and containing typical endometrial granular and stromal elements occurs aberrantly in various locations in the pelvic cavity. [NIH] Endometrium: The layer of tissue that lines the uterus. [NIH] Endoscope: A thin, lighted tube used to look at tissues inside the body. [NIH] Endoscopic: A technique where a lateral-view endoscope is passed orally to the duodenum for visualization of the ampulla of Vater. [NIH] Endoscopy: Endoscopic examination, therapy or surgery performed on interior parts of the body. [NIH] Endothelium: A layer of epithelium that lines the heart, blood vessels (endothelium, vascular), lymph vessels (endothelium, lymphatic), and the serous cavities of the body. [NIH] Endothelium-derived: Small molecule that diffuses to the adjacent muscle layer and relaxes it. [NIH] Enhancer: Transcriptional element in the virus genome. [NIH] Enterocele: A hernia in the intestine. [NIH] Entorhinal Cortex: Cortex where the signals are combined with those from other sensory systems. [NIH] Environmental Exposure: The exposure to potentially harmful chemical, physical, or
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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]
Environmental Monitoring: The monitoring of the level of toxins, chemical pollutants, microbial contaminants, or other harmful substances in the environment or workplace by measuring the amounts of these toxicants in the bodies of people and animals in that environment, among other methods. It also includes the measurement of environmental exposure. Levels in humans and animals are used as indicators of toxic levels of undesirable chemicals. [NIH] Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Eosinophils: Granular leukocytes with a nucleus that usually has two lobes connected by a slender thread of chromatin, and cytoplasm containing coarse, round granules that are uniform in size and stainable by eosin. [NIH] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other healthrelated event occurring in such outbreaks. [EU] Epidemiologic Studies: Studies designed to examine associations, commonly, hypothesized causal relations. They are usually concerned with identifying or measuring the effects of risk factors or exposures. The common types of analytic study are case-control studies, cohort studies, and cross-sectional studies. [NIH] Epidermal: Pertaining to or resembling epidermis. Called also epidermic or epidermoid. [EU] Epidural: The space between the wall of the spinal canal and the covering of the spinal cord. An epidural injection is given into this space. [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Episiotomy: An incision of the posterior vaginal wall and a portion of the pudenda which enlarges the vaginal introitus to facilitate delivery and prevent lacerations. [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] Epithelial ovarian cancer: Cancer that occurs in the cells lining the ovaries. [NIH] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] Erectile: The inability to get or maintain an erection for satisfactory sexual intercourse. Also called impotence. [NIH] Erection: The condition of being made rigid and elevated; as erectile tissue when filled with blood. [EU] Erythrocyte Volume: Volume of circulating erythrocytes. It is usually measured by radioisotope dilution technique. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH]
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Erythropoietin: Glycoprotein hormone, secreted chiefly by the kidney in the adult and the liver in the fetus, that acts on erythroid stem cells of the bone marrow to stimulate proliferation and differentiation. [NIH] Estradiol: The most potent mammalian estrogenic hormone. It is produced in the ovary, placenta, testis, and possibly the adrenal cortex. [NIH] Estrogen: One of the two female sex hormones. [NIH] Estrogen receptor: ER. Protein found on some cancer cells to which estrogen will attach. [NIH]
Estrogen Replacement Therapy: The use of hormonal agents with estrogen-like activity in postmenopausal or other estrogen-deficient women to alleviate effects of hormone deficiency, such as vasomotor symptoms, dyspareunia, and progressive development of osteoporosis. This may also include the use of progestational agents in combination therapy. [NIH]
Ethnic Groups: A group of people with a common cultural heritage that sets them apart from others in a variety of social relationships. [NIH] Eukaryotic Cells: Cells of the higher organisms, containing a true nucleus bounded by a nuclear membrane. [NIH] Evacuation: An emptying, as of the bowels. [EU] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Expiration: The act of breathing out, or expelling air from the lungs. [EU] Expiratory: The volume of air which leaves the breathing organs in each expiration. [NIH] Extender: Any of several colloidal substances of high molecular weight, used as a blood or plasma substitute in transfusion for increasing the volume of the circulating blood. [NIH] External-beam radiation: Radiation therapy that uses a machine to aim high-energy rays at the cancer. Also called external radiation. [NIH] Extracellular: Outside a cell or cells. [EU] Extracellular Matrix: A meshwork-like substance found within the extracellular space and in association with the basement membrane of the cell surface. It promotes cellular proliferation and provides a supporting structure to which cells or cell lysates in culture dishes adhere. [NIH] Extracellular Space: Interstitial space between cells, occupied by fluid as well as amorphous and fibrous substances. [NIH] Extraocular: External to or outside of the eye. [NIH] 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] Fallopian Tubes: Two long muscular tubes that transport ova from the ovaries to the uterus. They extend from the horn of the uterus to the ovaries and consist of an ampulla, an infundibulum, an isthmus, two ostia, and a pars uterina. The walls of the tubes are composed of three layers: mucosal, muscular, and serosal. [NIH] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH]
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Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]
Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH] Febrile: Pertaining to or characterized by fever. [EU] Fecal Incontinence: Failure of voluntary control of the anal sphincters, with involuntary passage of feces and flatus. [NIH] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Fentanyl: A narcotic opioid drug that is used in the treatment of pain. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibrin: A protein derived from fibrinogen in the presence of thrombin, which forms part of the blood clot. [NIH] Fibrinogen: Plasma glycoprotein clotted by thrombin, composed of a dimer of three nonidentical pairs of polypeptide chains (alpha, beta, gamma) held together by disulfide bonds. Fibrinogen clotting is a sol-gel change involving complex molecular arrangements: whereas fibrinogen is cleaved by thrombin to form polypeptides A and B, the proteolytic action of other enzymes yields different fibrinogen degradation products. [NIH] Fibrinolytic: Pertaining to, characterized by, or causing the dissolution of fibrin by enzymatic action [EU] Fibroblasts: Connective tissue cells which secrete an extracellular matrix rich in collagen and other macromolecules. [NIH] Fibroid: A benign smooth muscle tumor, usually in the uterus or gastrointestinal tract. Also called leiomyoma. [NIH] Fine-needle aspiration: The removal of tissue or fluid with a needle for examination under a microscope. Also called needle biopsy. [NIH] Fistula: Abnormal communication most commonly seen between two internal organs, or between an internal organ and the surface of the body. [NIH] Fixation: 1. The act or operation of holding, suturing, or fastening in a fixed position. 2. The condition of being held in a fixed position. 3. In psychiatry, a term with two related but distinct meanings : (1) arrest of development at a particular stage, which like regression (return to an earlier stage), if temporary is a normal reaction to setbacks and difficulties but if protracted or frequent is a cause of developmental failures and emotional problems, and (2) a close and suffocating attachment to another person, especially a childhood figure, such as one's mother or father. Both meanings are derived from psychoanalytic theory and refer to 'fixation' of libidinal energy either in a specific erogenous zone, hence fixation at the oral, anal, or phallic stage, or in a specific object, hence mother or father fixation. 4. The use of a fixative (q.v.) to preserve histological or cytological specimens. 5. In chemistry, the process whereby a substance is removed from the gaseous or solution phase and localized, as in carbon dioxide fixation or nitrogen fixation. 6. In ophthalmology, direction of the gaze so that the visual image of the object falls on the fovea centralis. 7. In film processing, the chemical removal of all undeveloped salts of the film emulsion, leaving only the developed silver to form a permanent image. [EU] Flatus: Gas passed through the rectum. [NIH] Fluorescence: The property of emitting radiation while being irradiated. The radiation emitted is usually of longer wavelength than that incident or absorbed, e.g., a substance can
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be irradiated with invisible radiation and emit visible light. X-ray fluorescence is used in diagnosis. [NIH] Foetoplacental: Pertaining to the fetus and placenta. [EU] Forearm: The part between the elbow and the wrist. [NIH] Fornix: A bundle of nerves connected to the hippocampus. [NIH] Fovea: The central part of the macula that provides the sharpest vision. [NIH] Friction: Surface resistance to the relative motion of one body against the rubbing, sliding, rolling, or flowing of another with which it is in contact. [NIH] Fundus: The larger part of a hollow organ that is farthest away from the organ's opening. The bladder, gallbladder, stomach, uterus, eye, and cavity of the middle ear all have a fundus. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gallstones: The solid masses or stones made of cholesterol or bilirubin that form in the gallbladder or bile ducts. [NIH] Gamma Rays: Very powerful and penetrating, high-energy electromagnetic radiation of shorter wavelength than that of x-rays. They are emitted by a decaying nucleus, usually between 0.01 and 10 MeV. They are also called nuclear x-rays. [NIH] Ganciclovir: Acyclovir analog that is a potent inhibitor of the Herpesvirus family including cytomegalovirus. Ganciclovir is used to treat complications from AIDS-associated cytomegalovirus infections. [NIH] Gap Junctions: Connections between cells which allow passage of small molecules and electric current. Gap junctions were first described anatomically as regions of close apposition between cells with a narrow (1-2 nm) gap between cell membranes. The variety in the properties of gap junctions is reflected in the number of connexins, the family of proteins which form the junctions. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]
Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gelatin: A product formed from skin, white connective tissue, or bone collagen. It is used as a protein food adjuvant, plasma substitute, hemostatic, suspending agent in pharmaceutical preparations, and in the manufacturing of capsules and suppositories. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]
Genetic Engineering: Directed modification of the gene complement of a living organism by such techniques as altering the DNA, substituting genetic material by means of a virus, transplanting whole nuclei, transplanting cell hybrids, etc. [NIH] Genital: Pertaining to the genitalia. [EU] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Germ Cells: The reproductive cells in multicellular organisms. [NIH] Gestation: The period of development of the young in viviparous animals, from the time of
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fertilization of the ovum until birth. [EU] Gestational: Psychosis attributable to or occurring during pregnancy. [NIH] Gestational trophoblastic disease: A rare cancer in women of child-bearing age in which cancer cells grow in the tissues that are formed in the uterus after conception. Also called gestational trophoblastic tumor, gestational trophoblastic neoplasia, molar pregnancy, or choriocarcinoma. [NIH] Gestational trophoblastic neoplasia: A rare cancer in women of child-bearing age in which cancer cells grow in the tissues that are formed in the uterus after conception. Also called gestational trophoblastic disease, gestational trophoblastic tumor, molar pregnancy, or choriocarcinoma. [NIH] Gestational trophoblastic tumor: A rare cancer in women of child-bearing age in which cancer cells grow in the tissues that are formed in the uterus after conception. Also called gestational trophoblastic disease, gestational trophoblastic neoplasia, molar pregnancy, or choriocarcinoma. [NIH] Giardiasis: An infection of the small intestine caused by the flagellated protozoan Giardia lamblia. It is spread via contaminated food and water and by direct person-to-person contact. [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] 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] Glycogen: A sugar stored in the liver and muscles. It releases glucose into the blood when cells need it for energy. Glycogen is the chief source of stored fuel in the body. [NIH] Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Gonadal: Pertaining to a gonad. [EU] Gonadorelin: A decapeptide hormone released by the hypothalamus. It stimulates the synthesis and secretion of both follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from the pituitary gland. [NIH] Gonadotropin: The water-soluble follicle stimulating substance, by some believed to originate in chorionic tissue, obtained from the serum of pregnant mares. It is used to supplement the action of estrogens. [NIH] Gonads: The gamete-producing glands, ovary or testis. [NIH] Gonorrhea: Acute infectious disease characterized by primary invasion of the urogenital tract. The etiologic agent, Neisseria gonorrhoeae, was isolated by Neisser in 1879. [NIH] Goserelin: 6-(O-(1,1-Dimethylethyl)-D-serine)-10-deglycinamideluteinizing hormonereleasing factor (pig) 2-(aminocarbonyl)hydrazide. A long-acting gonadorelin agonist. It is used in the treatment of malignant neoplasms of the prostate, uterine fibromas, and metastatic breast cancer. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH]
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Grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer. [NIH] Grading: A system for classifying cancer cells in terms of how abnormal they appear when examined under a microscope. The objective of a grading system is to provide information about the probable growth rate of the tumor and its tendency to spread. The systems used to grade tumors vary with each type of cancer. Grading plays a role in treatment decisions. [NIH]
Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Grafting: The operation of transfer of tissue from one site to another. [NIH] Gram-negative: Losing the stain or decolorized by alcohol in Gram's method of staining, a primary characteristic of bacteria having a cell wall composed of a thin layer of peptidoglycan covered by an outer membrane of lipoprotein and lipopolysaccharide. [EU] Granulocytes: Leukocytes with abundant granules in the cytoplasm. They are divided into three groups: neutrophils, eosinophils, and basophils. [NIH] Gravidity: Pregnancy; the condition of being pregnant, without regard to the outcome. [EU] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Growth factors: Substances made by the body that function to regulate cell division and cell survival. Some growth factors are also produced in the laboratory and used in biological therapy. [NIH] Guanylate Cyclase: An enzyme that catalyzes the conversion of GTP to 3',5'-cyclic GMP and pyrophosphate. It also acts on ITP and dGTP. (From Enzyme Nomenclature, 1992) EC 4.6.1.2. [NIH] Gynaecological: Pertaining to gynaecology. [EU] Gynecologic cancer: Cancer of the female reproductive tract, including the cervix, endometrium, fallopian tubes, ovaries, uterus, and vagina. [NIH] Gynecology: A medical-surgical specialty concerned with the physiology and disorders primarily of the female genital tract, as well as female endocrinology and reproductive physiology. [NIH] Haematemesis: The vomiting of blood. [EU] 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] Health Care Costs: The actual costs of providing services related to the delivery of health care, including the costs of procedures, therapies, and medications. It is differentiated from health expenditures, which refers to the amount of money paid for the services, and from fees, which refers to the amount charged, regardless of cost. [NIH] Health Expenditures: The amounts spent by individuals, groups, nations, or private or public organizations for total health care and/or its various components. These amounts may or may not be equivalent to the actual costs (health care costs) and may or may not be shared among the patient, insurers, and/or employers. [NIH] Health Status: The level of health of the individual, group, or population as subjectively
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assessed by the individual or by more objective measures. [NIH] Heart attack: A seizure of weak or abnormal functioning of the heart. [NIH] Hematocrit: Measurement of the volume of packed red cells in a blood specimen by centrifugation. The procedure is performed using a tube with graduated markings or with automated blood cell counters. It is used as an indicator of erythrocyte status in disease. For example, anemia shows a low hematocrit, polycythemia, high values. [NIH] Hematoxylin: A dye obtained from the heartwood of logwood (Haematoxylon campechianum Linn., Leguminosae) used as a stain in microscopy and in the manufacture of ink. [NIH] Hemodilution: Reduction of blood viscosity usually by the addition of cell free solutions. Used clinically l) in states of impaired microcirculation, 2) for replacement of intraoperative blood loss without homologous blood transfusion, and 3) in cardiopulmonary bypass and hypothermia. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemoglobin A: Normal adult human hemoglobin. The globin moiety consists of two alpha and two beta chains. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemorrhoidectomy: An operation to remove hemorrhoids. [NIH] Hemorrhoids: Varicosities of the hemorrhoidal venous plexuses. [NIH] Hemostasis: The process which spontaneously arrests the flow of blood from vessels carrying blood under pressure. It is accomplished by contraction of the vessels, adhesion and aggregation of formed blood elements, and the process of blood or plasma coagulation. [NIH]
Hepatic: Refers to the liver. [NIH] Hereditary: Of, relating to, or denoting factors that can be transmitted genetically from one generation to another. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Hernia: Protrusion of a loop or knuckle of an organ or tissue through an abnormal opening. [NIH]
Hetastarch: A derivative of starch used as a plasma substitute in the treatment of hemorrhage. [NIH] Heterodimers: Zippered pair of nonidentical proteins. [NIH] Hippocampus: A curved elevation of gray matter extending the entire length of the floor of the temporal horn of the lateral ventricle (Dorland, 28th ed). The hippocampus, subiculum, and dentate gyrus constitute the hippocampal formation. Sometimes authors include the entorhinal cortex in the hippocampal formation. [NIH] Histology: The study of tissues and cells under a microscope. [NIH]
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Homogeneous: Consisting of or composed of similar elements or ingredients; of a uniform quality throughout. [EU] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hormone Replacement Therapy: Therapeutic use of hormones to alleviate the effects of hormone deficiency. [NIH] Hormone therapy: Treatment of cancer by removing, blocking, or adding hormones. Also called endocrine therapy. [NIH] Human papillomavirus: HPV. A virus that causes abnormal tissue growth (warts) and is often associated with some types of cancer. [NIH] Hybrid: Cross fertilization between two varieties or, more usually, two species of vines, see also crossing. [NIH] Hybridization: The genetic process of crossbreeding to produce a hybrid. Hybrid nucleic acids can be formed by nucleic acid hybridization of DNA and RNA molecules. Protein hybridization allows for hybrid proteins to be formed from polypeptide chains. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrolysis: The process of cleaving a chemical compound by the addition of a molecule of water. [NIH] Hydrophobic: Not readily absorbing water, or being adversely affected by water, as a hydrophobic colloid. [EU] Hydroxylysine: A hydroxylated derivative of the amino acid lysine that is present in certain collagens. [NIH] Hydroxyproline: A hydroxylated form of the imino acid proline. A deficiency in ascorbic acid can result in impaired hydroxyproline formation. [NIH] Hygienic: Pertaining to hygiene, or conducive to health. [EU] Hyperhomocysteinemia: An inborn error of methionone metabolism which produces an excess of homocysteine in the blood. It is often caused by a deficiency of cystathionine betasynthase and is a risk factor for coronary vascular disease. [NIH] Hyperkeratosis: 1. Hypertrophy of the corneous layer of the skin. 2a. Any of various conditions marked by hyperkeratosis. 2b. A disease of cattle marked by thickening and wringling of the hide and formation of papillary outgrowths on the buccal mucous membranes, often accompanied by watery discharge from eyes and nose, diarrhoea, loss of condition, and abortion of pregnant animals, and now believed to result from ingestion of the chlorinated naphthalene of various lubricating oils. [EU] Hyperplasia: An increase in the number of cells in a tissue or organ, not due to tumor formation. It differs from hypertrophy, which is an increase in bulk without an increase in the number of cells. [NIH] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions
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upon subsequent exposure to that particular antigen. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH] Hypnotic: A drug that acts to induce sleep. [EU] Hypothalamic: Of or involving the hypothalamus. [EU] Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH] Hypothermia: Lower than normal body temperature, especially in warm-blooded animals; in man usually accidental or unintentional. [NIH] Hysterectomy: Excision of the uterus. [NIH] Hysteroscopy: Endoscopic examination, therapy or surgery of the interior of the uterus. [NIH]
Hysterotomy: An incision in the uterus, performed through either the abdomen or the vagina. [NIH] Iatrogenic: Resulting from the activity of physicians. Originally applied to disorders induced in the patient by autosuggestion based on the physician's examination, manner, or discussion, the term is now applied to any adverse condition in a patient occurring as the result of treatment by a physician or surgeon, especially to infections acquired by the patient during the course of treatment. [EU] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Immersion: The placing of a body or a part thereof into a liquid. [NIH] Immune function: Production and action of cells that fight disease or infection. [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] Immunization: Deliberate stimulation of the host's immune response. Active immunization involves administration of antigens or immunologic adjuvants. Passive immunization involves administration of immune sera or lymphocytes or their extracts (e.g., transfer factor, immune RNA) or transplantation of immunocompetent cell producing tissue (thymus or bone marrow). [NIH] Immunodeficiency: The decreased ability of the body to fight infection and disease. [NIH] Immunoglobulin: A protein that acts as an antibody. [NIH] Immunohistochemistry: Histochemical localization of immunoreactive substances using labeled antibodies as reagents. [NIH] Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Immunology: The study of the body's immune system. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH]
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Implant radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called [NIH] Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU] Impotence: The inability to perform sexual intercourse. [NIH] In situ: In the natural or normal place; confined to the site of origin without invasion of neighbouring tissues. [EU] In Situ Hybridization: A technique that localizes specific nucleic acid sequences within intact chromosomes, eukaryotic cells, or bacterial cells through the use of specific nucleic acid-labeled probes. [NIH] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incision: A cut made in the body during surgery. [NIH] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infancy: The period of complete dependency prior to the acquisition of competence in walking, talking, and self-feeding. [NIH] Infant Mortality: Perinatal, neonatal, and infant deaths in a given population. [NIH] Infant, Newborn: An infant during the first month after birth. [NIH] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]
Infertility: The diminished or absent ability to conceive or produce an offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Informed Consent: Voluntary authorization, given to the physician by the patient, with full comprehension of the risks involved, for diagnostic or investigative procedures and medical and surgical treatment. [NIH]
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Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] Ingestion: Taking into the body by mouth [NIH] Innervation: 1. The distribution or supply of nerves to a part. 2. The supply of nervous energy or of nerve stimulus sent to a part. [EU] Inorganic: Pertaining to substances not of organic origin. [EU] Inpatients: Persons admitted to health facilities which provide board and room, for the purpose of observation, care, diagnosis or treatment. [NIH] Insight: The capacity to understand one's own motives, to be aware of one's own psychodynamics, to appreciate the meaning of symbolic behavior. [NIH] Instillation: . [EU] Insulator: Material covering the metal conductor of the lead. It is usually polyurethane or silicone. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Insulin-like: Muscular growth factor. [NIH] Integrins: A family of transmembrane glycoproteins consisting of noncovalent heterodimers. They interact with a wide variety of ligands including extracellular matrix glycoproteins, complement, and other cells, while their intracellular domains interact with the cytoskeleton. The integrins consist of at least three identified families: the cytoadhesin receptors, the leukocyte adhesion receptors, and the very-late-antigen receptors. Each family contains a common beta-subunit combined with one or more distinct alpha-subunits. These receptors participate in cell-matrix and cell-cell adhesion in many physiologically important processes, including embryological development, hemostasis, thrombosis, wound healing, immune and nonimmune defense mechanisms, and oncogenic transformation. [NIH] Interleukin-1: A soluble factor produced by monocytes, macrophages, and other cells which activates T-lymphocytes and potentiates their response to mitogens or antigens. IL-1 consists of two distinct forms, IL-1 alpha and IL-1 beta which perform the same functions but are distinct proteins. The biological effects of IL-1 include the ability to replace macrophage requirements for T-cell activation. The factor is distinct from interleukin-2. [NIH] Interleukin-2: Chemical mediator produced by activated T lymphocytes and which regulates the proliferation of T cells, as well as playing a role in the regulation of NK cell activity. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Internal radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called brachytherapy, implant radiation, or interstitial radiation therapy. [NIH] Interpersonal Relations: The reciprocal interaction of two or more persons. [NIH] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intestinal: Having to do with the intestines. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of
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digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intoxication: Poisoning, the state of being poisoned. [EU] Intracellular: Inside a cell. [NIH] Intraepithelial: Within the layer of cells that form the surface or lining of an organ. [NIH] Intravascular: Within a vessel or vessels. [EU] Intravenous: IV. Into a vein. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Intubation: Introduction of a tube into a hollow organ to restore or maintain patency if obstructed. It is differentiated from catheterization in that the insertion of a catheter is usually performed for the introducing or withdrawing of fluids from the body. [NIH] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]
Invasive cervical cancer: Cancer that has spread from the surface of the cervix to tissue deeper in the cervix or to other parts of the body. [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] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [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] Ketamine: A cyclohexanone derivative used for induction of anesthesia. Its mechanism of action is not well understood, but ketamine can block NMDA receptors (receptors, NMethyl-D-Aspartate) and may interact with sigma receptors. [NIH] Ketorolac: A drug that belongs to a family of drugs called nonsteroidal anti-inflammatory agents. It is being studied in cancer prevention. [NIH] Kidney Pelvis: The flattened, funnel-shaped expansion connecting the ureter to the kidney calices. [NIH] Kidney stone: A stone that develops from crystals that form in urine and build up on the inner surfaces of the kidney, in the renal pelvis, or in the ureters. [NIH] Kidney Transplantation: The transference of a kidney from one human or animal to another. [NIH] Lacerations: Torn, ragged, mangled wounds. [NIH] Lacrimal: Pertaining to the tears. [EU] Lacrimal Apparatus: The tear-forming and tear-conducting system which includes the lacrimal glands, eyelid margins, conjunctival sac, and the tear drainage system. [NIH] Lactation: The period of the secretion of milk. [EU] Laparoscopy: Examination, therapy or surgery of the abdomen's interior by means of a
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laparoscope. [NIH] Laparotomy: A surgical incision made in the wall of the abdomen. [NIH] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Latent: Phoria which occurs at one distance or another and which usually has no troublesome effect. [NIH] Leg Ulcer: Ulceration of the skin and underlying structures of the lower extremity. About 90% of the cases are due to venous insufficiency (varicose ulcer), 5% to arterial disease, and the remaining 5% to other causes. [NIH] Leiomyoma: A benign tumor derived from smooth muscle tissue, also known as a fibroid tumor. They rarely occur outside of the uterus and the gastrointestinal tract but can occur in the skin and subcutaneous tissues, probably arising from the smooth muscle of small blood vessels in these tissues. [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] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Levonorgestrel: A progestational hormone with actions similar to those of progesterone and about twice as potent as its racemic or (+-)-isomer (norgestrel). It is used for contraception, control of menstrual disorders, and treatment of endometriosis. [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]
Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Ligands: A RNA simulation method developed by the MIT. [NIH] Ligation: Application of a ligature to tie a vessel or strangulate a part. [NIH] Linkage: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Lipid: Fat. [NIH] Lipid Peroxidation: Peroxidase catalyzed oxidation of lipids using hydrogen peroxide as an electron acceptor. [NIH] Lipoprotein: Any of the lipid-protein complexes in which lipids are transported in the blood; lipoprotein particles consist of a spherical hydrophobic core of triglycerides or cholesterol esters surrounded by an amphipathic monolayer of phospholipids, cholesterol, and apolipoproteins; the four principal classes are high-density, low-density, and very-lowdensity lipoproteins and chylomicrons. [EU] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Liver Cirrhosis: Liver disease in which the normal microcirculation, the gross vascular anatomy, and the hepatic architecture have been variably destroyed and altered with fibrous septa surrounding regenerated or regenerating parenchymal nodules. [NIH]
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Lobe: A portion of an organ such as the liver, lung, breast, or brain. [NIH] Localization: The process of determining or marking the location or site of a lesion or disease. May also refer to the process of keeping a lesion or disease in a specific location or site. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Longitudinal study: Also referred to as a "cohort study" or "prospective study"; the analytic method of epidemiologic study in which subsets of a defined population can be identified who are, have been, or in the future may be exposed or not exposed, or exposed in different degrees, to a factor or factors hypothesized to influence the probability of occurrence of a given disease or other outcome. The main feature of this type of study is to observe large numbers of subjects over an extended time, with comparisons of incidence rates in groups that differ in exposure levels. [NIH] Long-Term Care: Care over an extended period, usually for a chronic condition or disability, requiring periodic, intermittent, or continuous care. [NIH] Loop: A wire usually of platinum bent at one end into a small loop (usually 4 mm inside diameter) and used in transferring microorganisms. [NIH] Low-density lipoprotein: Lipoprotein that contains most of the cholesterol in the blood. LDL carries cholesterol to the tissues of the body, including the arteries. A high level of LDL increases the risk of heart disease. LDL typically contains 60 to 70 percent of the total serum cholesterol and both are directly correlated with CHD risk. [NIH] Lubricants: Oily or slippery substances. [NIH] Lubrication: The application of a substance to diminish friction between two surfaces. It may refer to oils, greases, and similar substances for the lubrication of medical equipment but it can be used for the application of substances to tissue to reduce friction, such as lotions for skin and vaginal lubricants. [NIH] Lumen: The cavity or channel within a tube or tubular organ. [EU] Luteal Phase: The period of the menstrual cycle that begins with ovulation and ends with menstruation. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]
Lymphadenectomy: A surgical procedure in which the lymph nodes are removed and examined to see whether they contain cancer. Also called lymph node dissection. [NIH] Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphatic system: The tissues and organs that produce, store, and carry white blood cells that fight infection and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes and a network of thin tubes that carry lymph and white blood cells. These tubes branch, like blood vessels, into all the tissues of the body. [NIH] 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] Lymphography: Radiographic study of the lymphatic system following injection of dye or
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contrast medium. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Lysophospholipids: Derivatives of phosphatidic acids that lack one of its fatty acyl chains due to its hydrolytic removal. [NIH] Lytic: 1. Pertaining to lysis or to a lysin. 2. Producing lysis. [EU] Macrophage: A type of white blood cell that surrounds and kills microorganisms, removes dead cells, and stimulates the action of other immune system cells. [NIH] Malignancy: A cancerous tumor that can invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malignant tumor: A tumor capable of metastasizing. [NIH] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]
Mammary: Pertaining to the mamma, or breast. [EU] Manic: Affected with mania. [EU] Manic-depressive psychosis: One of a group of psychotic reactions, fundamentally marked by severe mood swings and a tendency to remission and recurrence. [NIH] Mastectomy: Surgery to remove the breast (or as much of the breast tissue as possible). [NIH] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Medical Records: Recording of pertinent information concerning patient's illness or illnesses. [NIH] Medicament: A medicinal substance or agent. [EU] Medication Errors: Errors in prescribing, dispensing, or administering medication with the result that the patient fails to receive the correct drug or the indicated proper drug dosage. [NIH]
MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Medroxyprogesterone: (6 alpha)-17-Hydroxy-6-methylpregn-4-ene-3,20-dione. A synthetic progestational hormone used in veterinary practice as an estrus regulator. [NIH] Medroxyprogesterone Acetate: An injectable contraceptive, generally marketed under the name Depo-Provera. [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] Menarche: The establishment or beginning of the menstrual function. [EU] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH]
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Menopause: Permanent cessation of menstruation. [NIH] Menorrhagia: Excessive menstrual flow. [NIH] Menstrual Cycle: The period of the regularly recurring physiologic changes in the endometrium occurring during the reproductive period in human females and some primates and culminating in partial sloughing of the endometrium (menstruation). [NIH] Menstruation: The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus. [NIH] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH] Mental Processes: Conceptual functions or thinking in all its forms. [NIH] Mesentery: A layer of the peritoneum which attaches the abdominal viscera to the abdominal wall and conveys their blood vessels and nerves. [NIH] Metastatic: Having to do with metastasis, which is the spread of cancer from one part of the body to another. [NIH] Metronidazole: Antiprotozoal used in amebiasis, trichomoniasis, giardiasis, and as treponemacide in livestock. It has also been proposed as a radiation sensitizer for hypoxic cells. According to the Fourth Annual Report on Carcinogens (NTP 85-002, 1985, p133), this substance may reasonably be anticipated to be a carcinogen (Merck, 11th ed). [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] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microcirculation: The vascular network lying between the arterioles and venules; includes capillaries, metarterioles and arteriovenous anastomoses. Also, the flow of blood through this network. [NIH] Microorganism: An organism that can be seen only through a microscope. Microorganisms include bacteria, protozoa, algae, and fungi. Although viruses are not considered living organisms, they are sometimes classified as microorganisms. [NIH] Microscopy: The application of microscope magnification to the study of materials that cannot be properly seen by the unaided eye. [NIH] Microtubules: Slender, cylindrical filaments found in the cytoskeleton of plant and animal cells. They are composed of the protein tubulin. [NIH] Micturition: The passage of urine; urination. [EU] Mifepristone: A progestational and glucocorticoid hormone antagonist. Its inhibition of progesterone induces bleeding during the luteal phase and in early pregnancy by releasing endogenous prostaglandins from the endometrium or decidua. As a glucocorticoid receptor antagonist, the drug has been used to treat hypercortisolism in patients with nonpituitary Cushing syndrome. [NIH] Migration: The systematic movement of genes between populations of the same species, geographic race, or variety. [NIH] Milliliter: A measure of volume for a liquid. A milliliter is approximately 950-times smaller than a quart and 30-times smaller than a fluid ounce. A milliliter of liquid and a cubic centimeter (cc) of liquid are the same. [NIH]
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Miscarriage: Spontaneous expulsion of the products of pregnancy before the middle of the second trimester. [NIH] Mitosis: A method of indirect cell division by means of which the two daughter nuclei normally receive identical complements of the number of chromosomes of the somatic cells of the species. [NIH] Mitotic: Cell resulting from mitosis. [NIH] Mobility: Capability of movement, of being moved, or of flowing freely. [EU] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molar pregnancy: A rare cancer in women of child-bearing age in which cancer cells grow in the tissues that are formed in the uterus after conception. Also called gestational trophoblastic disease, gestational trophoblastic neoplasia, gestational trophoblastic tumor, or choriocarcinoma. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monoclonal: An antibody produced by culturing a single type of cell. It therefore consists of a single species of immunoglobulin molecules. [NIH] Monocytes: Large, phagocytic mononuclear leukocytes produced in the vertebrate bone marrow and released into the blood; contain a large, oval or somewhat indented nucleus surrounded by voluminous cytoplasm and numerous organelles. [NIH] Morphine: The principal alkaloid in opium and the prototype opiate analgesic and narcotic. Morphine has widespread effects in the central nervous system and on smooth muscle. [NIH] Morphological: Relating to the configuration or the structure of live organs. [NIH] Motility: The ability to move spontaneously. [EU] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH] Mucinous: Containing or resembling mucin, the main compound in 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] Multimodality treatment: Therapy that combines more than one method of treatment. [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] Muscle Contraction: A process leading to shortening and/or development of tension in muscle tissue. Muscle contraction occurs by a sliding filament mechanism whereby actin filaments slide inward among the myosin filaments. [NIH]
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Muscle Fibers: Large single cells, either cylindrical or prismatic in shape, that form the basic unit of muscle tissue. They consist of a soft contractile substance enclosed in a tubular sheath. [NIH] Mutagenic: Inducing genetic mutation. [EU] Mydriatic: 1. Dilating the pupil. 2. Any drug that dilates the pupil. [EU] Myelin: The fatty substance that covers and protects nerves. [NIH] Myocardial Ischemia: A disorder of cardiac function caused by insufficient blood flow to the muscle tissue of the heart. The decreased blood flow may be due to narrowing of the coronary arteries (coronary arteriosclerosis), to obstruction by a thrombus (coronary thrombosis), or less commonly, to diffuse narrowing of arterioles and other small vessels within the heart. Severe interruption of the blood supply to the myocardial tissue may result in necrosis of cardiac muscle (myocardial infarction). [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Myometrium: The smooth muscle coat of the uterus, which forms the main mass of the organ. [NIH] Myopathy: Any disease of a muscle. [EU] Myosin: Chief protein in muscle and the main constituent of the thick filaments of muscle fibers. In conjunction with actin, it is responsible for the contraction and relaxation of muscles. [NIH] Myotonic Dystrophy: A condition presenting muscle weakness and wasting which may be progressive. [NIH] Narcotic: 1. Pertaining to or producing narcosis. 2. An agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Needle biopsy: The removal of tissue or fluid with a needle for examination under a microscope. Also called fine-needle aspiration. [NIH] Neocortex: The largest portion of the cerebral cortex. It is composed of neurons arranged in six layers. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Neoplasia: Abnormal and uncontrolled cell growth. [NIH] Neoplasm: A new growth of benign or malignant tissue. [NIH]
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Nephrectomy: Surgery to remove a kidney. Radical nephrectomy removes the kidney, the adrenal gland, nearby lymph nodes, and other surrounding tissue. Simple nephrectomy removes only the kidney. Partial nephrectomy removes the tumor but not the entire kidney. [NIH]
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] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Networks: Pertaining to a nerve or to the nerves, a meshlike structure of interlocking fibers or strands. [NIH] Neurogenic: Loss of bladder control caused by damage to the nerves controlling the bladder. [NIH] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light hydrogen; the mass is equal to that of the proton and electron combined and they are unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal, and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier nuclei during their decay. [NIH] Neutrophils: Granular leukocytes having a nucleus with three to five lobes connected by slender threads of chromatin, and cytoplasm containing fine inconspicuous granules and stainable by neutral dyes. [NIH] Nidation: Implantation of the conceptus in the endometrium. [EU] Nitric Oxide: A free radical gas produced endogenously by a variety of mammalian cells. It is synthesized from arginine by a complex reaction, catalyzed by nitric oxide synthase. Nitric oxide is endothelium-derived relaxing factor. It is released by the vascular endothelium and mediates the relaxation induced by some vasodilators such as acetylcholine and bradykinin. It also inhibits platelet aggregation, induces disaggregation of aggregated platelets, and inhibits platelet adhesion to the vascular endothelium. Nitric oxide activates cytosolic guanylate cyclase and thus elevates intracellular levels of cyclic GMP. [NIH]
Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Node-negative: Cancer that has not spread to the lymph nodes. [NIH] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Norgestrel: (+-)-13-Ethyl-17-hydroxy-18,19-dinorpregn-4-en-20-yn-3-one. A progestational agent with actions similar to those of progesterone. This racemic or (+-)-form has about half the potency of the levo form (levonorgestrel). Norgestrel is used as a contraceptive and ovulation inhibitor and for the control of menstrual disorders and endometriosis. [NIH] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH]
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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] Nucleic Acid Hybridization: The process whereby two single-stranded polynucleotides form a double-stranded molecule, with hydrogen bonding between the complementary bases in the two strains. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nulliparous: Having never given birth to a viable infant. [EU] Observational study: An epidemiologic study that does not involve any intervention, experimental or otherwise. Such a study may be one in which nature is allowed to take its course, with changes in one characteristic being studied in relation to changes in other characteristics. Analytical epidemiologic methods, such as case-control and cohort study designs, are properly called observational epidemiology because the investigator is observing without intervention other than to record, classify, count, and statistically analyze results. [NIH] Obstetrics: A medical-surgical specialty concerned with management and care of women during pregnancy, parturition, and the puerperium. [NIH] Oestradiol: Growth hormone. [NIH] Oestrogen: A generic term for oestrus-producing steroid compounds; the female sex hormones. In humans, oestrogen is formed in the ovary, possibly the adrenal cortex, the testis, and the foetoplacental unit; it has various functions in both sexes. It is responsible for the development of the female secondary sex characteristics, and during the menstrual cycle it acts on the female genitalia to produce an environment suitable for the fertilization, implantation, and nutrition of the early embryo. Oestrogen is used in oral contraceptives and as a palliative in cancer of the breast after menopause and cancer of the prostate; other uses include the relief of the discomforts of menopause, inhibition of lactation, and treatment of osteoporosis, threatened abortion, and various functional ovarian disorders. [EU]
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] Oncogenic: Chemical, viral, radioactive or other agent that causes cancer; carcinogenic. [NIH] Oncology: The study of cancer. [NIH] Oocytes: Female germ cells in stages between the prophase of the first maturation division and the completion of the second maturation division. [NIH] Oophorectomy: Surgery to remove one or both ovaries. [NIH] Opacity: Degree of density (area most dense taken for reading). [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] Opium: The air-dried exudate from the unripe seed capsule of the opium poppy, Papaver somniferum, or its variant, P. album. It contains a number of alkaloids, but only a few morphine, codeine, and papaverine - have clinical significance. Opium has been used as an analgesic, antitussive, antidiarrheal, and antispasmodic. [NIH] Optic Chiasm: The X-shaped structure formed by the meeting of the two optic nerves. At the optic chiasm the fibers from the medial part of each retina cross to project to the other
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side of the brain while the lateral retinal fibers continue on the same side. As a result each half of the brain receives information about the contralateral visual field from both eyes. [NIH]
Orchiectomy: The surgical removal of one or both testicles. [NIH] Orderly: A male hospital attendant. [NIH] Orgasm: The crisis of sexual excitement in either humans or animals. [NIH] Osmotic: Pertaining to or of the nature of osmosis (= the passage of pure solvent from a solution of lesser to one of greater solute concentration when the two solutions are separated by a membrane which selectively prevents the passage of solute molecules, but is permeable to the solvent). [EU] Osteoarthritis: A progressive, degenerative joint disease, the most common form of arthritis, especially in older persons. The disease is thought to result not from the aging process but from biochemical changes and biomechanical stresses affecting articular cartilage. In the foreign literature it is often called osteoarthrosis deformans. [NIH] Osteoporosis: Reduction of bone mass without alteration in the composition of bone, leading to fractures. Primary osteoporosis can be of two major types: postmenopausal osteoporosis and age-related (or senile) osteoporosis. [NIH] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Ovarian Cysts: General term for cysts and cystic diseases of the ovary. [NIH] Ovaries: The pair of female reproductive glands in which the ova, or eggs, are formed. The ovaries are located in the pelvis, one on each side of the uterus. [NIH] Ovary: Either of the paired glands in the female that produce the female germ cells and secrete some of the female sex hormones. [NIH] Overactive bladder: A condition in which the patient experiences two or all three of the following conditions: [NIH] Overall survival: The percentage of subjects in a study who have survived for a defined period of time. Usually reported as time since diagnosis or treatment. Often called the survival rate. [NIH] Ovum: A female germ cell extruded from the ovary at ovulation. [NIH] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]
Oxidative metabolism: A chemical process in which oxygen is used to make energy from carbohydrates (sugars). Also known as aerobic respiration, cell respiration, or aerobic metabolism. [NIH] Oxidative Stress: A disturbance in the prooxidant-antioxidant balance in favor of the former, leading to potential damage. Indicators of oxidative stress include damaged DNA bases, protein oxidation products, and lipid peroxidation products (Sies, Oxidative Stress, 1991, pxv-xvi). [NIH] Oxytocin: A nonapeptide posterior pituitary hormone that causes uterine contractions and stimulates lactation. [NIH] Paclitaxel: Antineoplastic agent isolated from the bark of the Pacific yew tree, Taxus
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brevifolia. Paclitaxel stabilizes microtubules in their polymerized form and thus mimics the action of the proto-oncogene proteins c-mos. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Papillomavirus: A genus of Papovaviridae causing proliferation of the epithelium, which may lead to malignancy. A wide range of animals are infected including humans, chimpanzees, cattle, rabbits, dogs, and horses. [NIH] Paraffin: A mixture of solid hydrocarbons obtained from petroleum. It has a wide range of uses including as a stiffening agent in ointments, as a lubricant, and as a topical antiinflammatory. It is also commonly used as an embedding material in histology. [NIH] Parietal: 1. Of or pertaining to the walls of a cavity. 2. Pertaining to or located near the parietal bone, as the parietal lobe. [EU] Parity: The number of offspring a female has borne. It is contrasted with gravidity, which refers to the number of pregnancies, regardless of outcome. [NIH] Particle: A tiny mass of material. [EU] Parturition: The act or process of given birth to a child. [EU] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]
Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathologic Processes: The abnormal mechanisms and forms involved in the dysfunctions of tissues and organs. [NIH] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]
Patient Satisfaction: The degree to which the individual regards the health care service or product or the manner in which it is delivered by the provider as useful, effective, or beneficial. [NIH] Patient Selection: Criteria and standards used for the determination of the appropriateness of the inclusion of patients with specific conditions in proposed treatment plans and the criteria used for the inclusion of subjects in various clinical trials and other research protocols. [NIH] Pelvic: Pertaining to the pelvis. [EU] Pelvic inflammatory disease: A bacteriological disease sometimes associated with intrauterine device (IUD) usage. [NIH] Penile Prosthesis: Rigid, semi-rigid, or inflatable cylindric hydraulic devices, with either combined or separate reservoir and pumping systems, implanted for the surgical treatment of organic impotence. [NIH] Penis: The external reproductive organ of males. It is composed of a mass of erectile tissue enclosed in three cylindrical fibrous compartments. Two of the three compartments, the corpus cavernosa, are placed side-by-side along the upper part of the organ. The third compartment below, the corpus spongiosum, houses the urethra. [NIH]
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Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Perinatal: Pertaining to or occurring in the period shortly before and after birth; variously defined as beginning with completion of the twentieth to twenty-eighth week of gestation and ending 7 to 28 days after birth. [EU] Perineal: Pertaining to the perineum. [EU] Perineum: The area between the anus and the sex organs. [NIH] Peripheral blood: Blood circulating throughout the body. [NIH] Peripheral stem cell support: A method of replacing blood-forming cells destroyed by cancer treatment. Immature blood cells (stem cells) in the circulating blood that are similar to those in the bone marrow are removed from the blood before treatment and given back after treatment. Also called peripheral stem cell transplantation. [NIH] Peripheral stem cell transplantation: A method of replacing blood-forming cells destroyed by cancer treatment. Immature blood cells (stem cells) in the circulating blood that are similar to those in the bone marrow are given after treatment to help the bone marrow recover and continue producing healthy blood cells. Transplantation may be autologous (an individual's own blood cells saved earlier), allogeneic (blood cells donated by someone else), or syngeneic (blood cells donated by an identical twin). Also called peripheral stem cell support. [NIH] Peritoneal: Having to do with the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH] Peritoneal Cavity: The space enclosed by the peritoneum. It is divided into two portions, the greater sac and the lesser sac or omental bursa, which lies behind the stomach. The two sacs are connected by the foramen of Winslow, or epiploic foramen. [NIH] Peritoneum: Endothelial lining of the abdominal cavity, the parietal peritoneum covering the inside of the abdominal wall and the visceral peritoneum covering the bowel, the mesentery, and certain of the organs. The portion that covers the bowel becomes the serosal layer of the bowel wall. [NIH] Perivascular: Situated around a vessel. [EU] Petroleum: Naturally occurring complex liquid hydrocarbons which, after distillation, yield combustible fuels, petrochemicals, and lubricants. [NIH] PH: The symbol relating the hydrogen ion (H+) concentration or activity of a solution to that of a given standard solution. Numerically the pH is approximately equal to the negative logarithm of H+ concentration expressed in molarity. pH 7 is neutral; above it alkalinity increases and below it acidity increases. [EU] Phagocytosis: The engulfing of microorganisms, other cells, and foreign particles by phagocytic cells. [NIH] Phallic: Pertaining to the phallus, or penis. [EU] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phosphatidic Acids: Fatty acid derivatives of glycerophosphates. They are composed of glycerol bound in ester linkage with 1 mole of phosphoric acid at the terminal 3-hydroxyl group and with 2 moles of fatty acids at the other two hydroxyl groups. [NIH] Phospholipases: A class of enzymes that catalyze the hydrolysis of phosphoglycerides or
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glycerophosphatidates. EC 3.1.-. [NIH] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Phosphorylation: The introduction of a phosphoryl group into a compound through the formation of an ester bond between the compound and a phosphorus moiety. [NIH] Photocoagulation: Using a special strong beam of light (laser) to seal off bleeding blood vessels such as in the eye. The laser can also burn away blood vessels that should not have grown in the eye. This is the main treatment for diabetic retinopathy. [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physical Fitness: A state of well-being in which performance is optimal, often as a result of physical conditioning which may be prescribed for disease therapy. [NIH] Physical Therapy: The restoration of function and the prevention of disability following disease or injury with the use of light, heat, cold, water, electricity, ultrasound, and exercise. [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] Pilot study: The initial study examining a new method or treatment. [NIH] Pineal Body: A small conical midline body attached to the posterior part of the third ventricle and lying between the superior colliculi, below the splenium of the corpus callosum. [NIH] Pineal gland: A tiny organ located in the cerebrum that produces melatonin. Also called pineal body or pineal organ. [NIH] Placenta: A highly vascular fetal organ through which the fetus absorbs oxygen and other nutrients and excretes carbon dioxide and other wastes. It begins to form about the eighth day of gestation when the blastocyst adheres to the decidua. [NIH] Plague: An acute infectious disease caused by Yersinia pestis that affects humans, wild rodents, and their ectoparasites. This condition persists due to its firm entrenchment in sylvatic rodent-flea ecosystems throughout the world. Bubonic plague is the most common form. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plaque: A clear zone in a bacterial culture grown on an agar plate caused by localized destruction of bacterial cells by a bacteriophage. The concentration of infective virus in a fluid can be estimated by applying the fluid to a culture and counting the number of. [NIH]
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Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma cells: A type of white blood cell that produces antibodies. [NIH] Plasma protein: One of the hundreds of different proteins present in blood plasma, including carrier proteins ( such albumin, transferrin, and haptoglobin), fibrinogen and other coagulation factors, complement components, immunoglobulins, enzyme inhibitors, precursors of substances such as angiotension and bradykinin, and many other types of proteins. [EU] Plasma Volume: Volume of plasma in the circulation. It is usually measured by indicator dilution techniques. [NIH] Platelet Activation: A series of progressive, overlapping events triggered by exposure of the platelets to subendothelial tissue. These events include shape change, adhesiveness, aggregation, and release reactions. When carried through to completion, these events lead to the formation of a stable hemostatic plug. [NIH] Platelet Aggregation: The attachment of platelets to one another. This clumping together can be induced by a number of agents (e.g., thrombin, collagen) and is part of the mechanism leading to the formation of a thrombus. [NIH] Platelets: A type of blood cell that helps prevent bleeding by causing blood clots to form. Also called thrombocytes. [NIH] Platinum: Platinum. A heavy, soft, whitish metal, resembling tin, atomic number 78, atomic weight 195.09, symbol Pt. (From Dorland, 28th ed) It is used in manufacturing equipment for laboratory and industrial use. It occurs as a black powder (platinum black) and as a spongy substance (spongy platinum) and may have been known in Pliny's time as "alutiae". [NIH]
Plexus: A network or tangle; a general term for a network of lymphatic vessels, nerves, or veins. [EU] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Polymorphic: Occurring in several or many forms; appearing in different forms at different stages of development. [EU] Polyp: A growth that protrudes from a mucous membrane. [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] Port: An implanted device through which blood may be withdrawn and drugs may be infused without repeated needle sticks. Also called a port-a-cath. [NIH] Port-a-cath: An implanted device through which blood may be withdrawn and drugs may be infused without repeated needle sticks. Also called a port. [NIH] 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] Postmenopausal: Refers to the time after menopause. Menopause is the time in a woman's life when menstrual periods stop permanently; also called "change of life." [NIH] Postoperative: After surgery. [NIH] Postpartum Hemorrhage: The presence of abnormal uterine bleeding immediately after labor or childbirth. [NIH]
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Postsynaptic: Nerve potential generated by an inhibitory hyperpolarizing stimulation. [NIH] Potentiates: A degree of synergism which causes the exposure of the organism to a harmful substance to worsen a disease already contracted. [NIH] Potentiation: An overall effect of two drugs taken together which is greater than the sum of the effects of each drug taken alone. [NIH] Practicability: A non-standard characteristic of an analytical procedure. It is dependent on the scope of the method and is determined by requirements such as sample throughout and costs. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Precancerous: A term used to describe a condition that may (or is likely to) become cancer. Also called premalignant. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Premalignant: A term used to describe a condition that may (or is likely to) become cancer. Also called precancerous. [NIH] Premenopausal: Refers to the time before menopause. Menopause is the time of life when a women's menstrual periods stop permanently; also called "change of life." [NIH] Prenatal: Existing or occurring before birth, with reference to the fetus. [EU] Prenatal Care: Care provided the pregnant woman in order to prevent complications, and decrease the incidence of maternal and prenatal mortality. [NIH] Prepuce: A covering fold of skin; often used alone to designate the preputium penis. [EU] Presynaptic: Situated proximal to a synapse, or occurring before the synapse is crossed. [EU] 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] Priapism: Persistent abnormal erection of the penis, usually without sexual desire, and accompanied by pain and tenderness. It is seen in diseases and injuries of the spinal cord, and may be caused by vesical calculus and certain injuries to the penis. [EU] Primary endpoint: The main result that is measured at the end of a study to see if a given treatment worked (e.g., the number of deaths or the difference in survival between the treatment group and the control group). What the primary endpoint will be is decided before the study begins. [NIH] Probe: An instrument used in exploring cavities, or in the detection and dilatation of strictures, or in demonstrating the potency of channels; an elongated instrument for exploring or sounding body cavities. [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
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antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Progestogen: A term applied to any substance possessing progestational activity. [EU] Prognostic factor: A situation or condition, or a characteristic of a patient, that can be used to estimate the chance of recovery from a disease, or the chance of the disease recurring (coming back). [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Prolapse: The protrusion of an organ or part of an organ into a natural or artificial orifice. [NIH]
Proline: A non-essential amino acid that is synthesized from glutamic acid. It is an essential component of collagen and is important for proper functioning of joints and tendons. [NIH] Promotor: In an operon, a nucleotide sequence located at the operator end which contains all the signals for the correct initiation of genetic transcription by the RNA polymerase holoenzyme and determines the maximal rate of RNA synthesis. [NIH] Prone: Having the front portion of the body downwards. [NIH] Prophase: The first phase of cell division, in which the chromosomes become visible, the nucleus starts to lose its identity, the spindle appears, and the centrioles migrate toward opposite poles. [NIH] Prophylactic oophorectomy: Surgery intended to reduce the risk of ovarian cancer by removing the ovaries before disease develops. [NIH] Prophylaxis: An attempt to prevent disease. [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] Prostaglandin: Any of a group of components derived from unsaturated 20-carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway that are extremely potent mediators of a diverse group of physiologic processes. The abbreviation for prostaglandin is PG; specific compounds are designated by adding one of the letters A through I to indicate the type of substituents found on the hydrocarbon skeleton and a subscript (1, 2 or 3) to indicate the number of double bonds in the hydrocarbon skeleton e.g., PGE2. The predominant naturally occurring prostaglandins all have two double bonds and are synthesized from arachidonic acid (5,8,11,14-eicosatetraenoic acid) by the pathway shown in the illustration. The 1 series and 3 series are produced by the same pathway with fatty acids having one fewer double bond (8,11,14-eicosatrienoic acid or one more double bond (5,8,11,14,17-eicosapentaenoic acid) than arachidonic acid. The subscript a or ß indicates the configuration at C-9 (a denotes a substituent below the plane of the ring, ß, above the plane). The naturally occurring PGF's have the a configuration, e.g., PGF2a. All of the prostaglandins act by binding to specific cell-surface receptors causing an increase in the level of the intracellular second messenger cyclic AMP (and in some cases cyclic GMP also). The effect produced by the cyclic AMP increase depends on the specific cell type. In some cases there is also a positive feedback effect. Increased cyclic AMP increases prostaglandin synthesis leading to further increases in cyclic AMP. [EU] Prostaglandins A: (13E,15S)-15-Hydroxy-9-oxoprosta-10,13-dien-1-oic acid (PGA(1)); (5Z,13E,15S)-15-hydroxy-9-oxoprosta-5,10,13-trien-1-oic acid (PGA(2)); (5Z,13E,15S,17Z)-15hydroxy-9-oxoprosta-5,10,13,17-tetraen-1-oic acid (PGA(3)). A group of naturally occurring
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secondary prostaglandins derived from PGE. PGA(1) and PGA(2) as well as their 19hydroxy derivatives are found in many organs and tissues. [NIH] Prostaglandins D: Physiologically active prostaglandins found in many tissues and organs. They show pressor activity, are mediators of inflammation, and have potential antithrombotic effects. [NIH] Prostaglandins F: (9 alpha,11 alpha,13E,15S)-9,11,15-Trihydroxyprost-13-en-1-oic acid (PGF(1 alpha)); (5Z,9 alpha,11,alpha,13E,15S)-9,11,15-trihydroxyprosta-5,13-dien-1-oic acid (PGF(2 alpha)); (5Z,9 alpha,11 alpha,13E,15S,17Z)-9,11,15-trihydroxyprosta-5,13,17-trien-1oic acid (PGF(3 alpha)). A family of prostaglandins that includes three of the six naturally occurring prostaglandins. All naturally occurring PGF have an alpha configuration at the 9carbon position. They stimulate uterine and bronchial smooth muscle and are often used as oxytocics. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Prostatectomy: Complete or partial surgical removal of the prostate. Three primary approaches are commonly employed: suprapubic - removal through an incision above the pubis and through the urinary bladder; retropubic - as for suprapubic but without entering the urinary bladder; and transurethral (transurethral resection of prostate). [NIH] Prosthesis: An artificial replacement of a part of the body. [NIH] Prosthesis Design: The plan and delineation of prostheses in general or a specific prosthesis. [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 S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Prothrombin: A plasma protein that is the inactive precursor of thrombin. It is converted to thrombin by a prothrombin activator complex consisting of factor Xa, factor V, phospholipid, and calcium ions. Deficiency of prothrombin leads to hypoprothrombinemia. [NIH]
Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] 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] Proto-Oncogene Proteins: Products of proto-oncogenes. Normally they do not have oncogenic or transforming properties, but are involved in the regulation or differentiation of cell growth. They often have protein kinase activity. [NIH]
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Proto-Oncogene Proteins c-mos: Cellular proteins encoded by the c-mos genes. They function in the cell cycle to maintain maturation promoting factor in the active state and have protein-serine/threonine kinase activity. Oncogenic transformation can take place when c-mos proteins are expressed at the wrong time. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychogenic: Produced or caused by psychic or mental factors rather than organic factors. [EU]
Psychology: The science dealing with the study of mental processes and behavior in man and animals. [NIH] 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] Psychosomatic: Pertaining to the mind-body relationship; having bodily symptoms of psychic, emotional, or mental origin; called also psychophysiologic. [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] Publishing: "The business or profession of the commercial production and issuance of literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing. [NIH]
Puerperium: Period from delivery of the placenta until return of the reproductive organs to their normal nonpregnant morphologic state. In humans, the puerperium generally lasts for six to eight weeks. [NIH] Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] 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] Puromycin: An antibiotic from Streptomyces alboniger that inhibits protein synthesis by binding to RNA. It is a antineoplastic and antitrypanosomal agent and is used in research as an inhibitor of protein synthesis. [NIH]
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Purulent: Consisting of or containing pus; associated with the formation of or caused by pus. [EU] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radiation therapy: The use of high-energy radiation from x-rays, gamma rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body in the area near cancer cells (internal radiation therapy, implant radiation, or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy. [NIH] Radioactive: Giving off radiation. [NIH] Radioimmunotherapy: Radiotherapy where cytotoxic radionuclides are linked to antibodies in order to deliver toxins directly to tumor targets. Therapy with targeted radiation rather than antibody-targeted toxins (immunotoxins) has the advantage that adjacent tumor cells, which lack the appropriate antigenic determinants, can be destroyed by radiation cross-fire. Radioimmunotherapy is sometimes called targeted radiotherapy, but this latter term can also refer to radionuclides linked to non-immune molecules (radiotherapy). [NIH] Radioisotope: An unstable element that releases radiation as it breaks down. Radioisotopes can be used in imaging tests or as a treatment for cancer. [NIH] Radiolabeled: Any compound that has been joined with a radioactive substance. [NIH] Radiological: Pertaining to radiodiagnostic and radiotherapeutic procedures, and interventional radiology or other planning and guiding medical radiology. [NIH] Radiology: A specialty concerned with the use of x-ray and other forms of radiant energy in the diagnosis and treatment of disease. [NIH] Radiotherapy: The use of ionizing radiation to treat malignant neoplasms and other benign conditions. The most common forms of ionizing radiation used as therapy are x-rays, gamma rays, and electrons. A special form of radiotherapy, targeted radiotherapy, links a cytotoxic radionuclide to a molecule that targets the tumor. When this molecule is an antibody or other immunologic molecule, the technique is called radioimmunotherapy. [NIH] Raloxifene: A second generation selective estrogen receptor modulator (SERM) used to prevent osteoporosis in postmenopausal women. It has estrogen agonist effects on bone and cholesterol metabolism but behaves as a complete estrogen antagonist on mammary gland and uterine tissue. [NIH] Random Allocation: A process involving chance used in therapeutic trials or other research endeavor for allocating experimental subjects, human or animal, between treatment and control groups, or among treatment groups. It may also apply to experiments on inanimate objects. [NIH] Randomization: Also called random allocation. Is allocation of individuals to groups, e.g., for experimental and control regimens, by chance. Within the limits of chance variation, random allocation should make the control and experimental groups similar at the start of
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an investigation and ensure that personal judgment and prejudices of the investigator do not influence allocation. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Randomized clinical trial: A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial. [NIH] Reactive Oxygen Species: Reactive intermediate oxygen species including both radicals and non-radicals. These substances are constantly formed in the human body and have been shown to kill bacteria and inactivate proteins, and have been implicated in a number of diseases. Scientific data exist that link the reactive oxygen species produced by inflammatory phagocytes to cancer development. [NIH] Reality Testing: The individual's objective evaluation of the external world and the ability to differentiate adequately between it and the internal world; considered to be a primary ego function. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Receptors, Serotonin: Cell-surface proteins that bind serotonin and trigger intracellular changes which influence the behavior of cells. Several types of serotonin receptors have been recognized which differ in their pharmacology, molecular biology, and mode of action. [NIH] Recombinant: A cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Rectal: By or having to do with the rectum. The rectum is the last 8 to 10 inches of the large intestine and ends at the anus. [NIH] Rectovaginal Fistula: Abnormal communication between the rectum and the vagina. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Relapse: The return of signs and symptoms of cancer after a period of improvement. [NIH] Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Renal pelvis: The area at the center of the kidney. Urine collects here and is funneled into the ureter, the tube that connects the kidney to the bladder. [NIH] Renovascular: Of or pertaining to the blood vessels of the kidneys. [EU] Resected: Surgical removal of part of an organ. [NIH] Resection: Removal of tissue or part or all of an organ by surgery. [NIH] Residual disease: Cancer cells that remain after attempts have been made to remove the cancer. [NIH]
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Resolving: The ability of the eye or of a lens to make small objects that are close together, separately visible; thus revealing the structure of an object. [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] Response Elements: Nucleotide sequences, usually upstream, which are recognized by specific regulatory transcription factors, thereby causing gene response to various regulatory agents. These elements may be found in both promotor and enhancer regions. [NIH]
Restoration: Broad term applied to any inlay, crown, bridge or complete denture which restores or replaces loss of teeth or oral tissues. [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] Retractor: An instrument designed for pulling aside tissues to improve exposure at operation; an instrument for drawing back the edge of a wound. [NIH] Retrograde: 1. Moving backward or against the usual direction of flow. 2. Degenerating, deteriorating, or catabolic. [EU] Retroperitoneal: Having to do with the area outside or behind the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH] Retroperitoneal Space: An area occupying the most posterior aspect of the abdominal cavity. It is bounded laterally by the borders of the quadratus lumborum muscles and extends from the diaphragm to the brim of the true pelvis, where it continues as the pelvic extraperitoneal space. [NIH] Retropubic: A potential space between the urinary bladder and the symphisis and body of the pubis. [NIH] Retrospective: Looking back at events that have already taken place. [NIH] Retroviral vector: RNA from a virus that is used to insert genetic material into cells. [NIH] Ribose: A pentose active in biological systems usually in its D-form. [NIH] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Risk patient: Patient who is at risk, because of his/her behaviour or because of the type of person he/she is. [EU] Rod: A reception for vision, located in the retina. [NIH] Rotator: A muscle by which a part can be turned circularly. [NIH] Salpingo-oophorectomy: Surgical removal of the fallopian tubes and ovaries. [NIH] Saphenous: Applied to certain structures in the leg, e. g. nerve vein. [NIH] Saphenous Vein: The vein which drains the foot and leg. [NIH] Saponins: Sapogenin glycosides. A type of glycoside widely distributed in plants. Each consists of a sapogenin as the aglycon moiety, and a sugar. The sapogenin may be a steroid or a triterpene and the sugar may be glucose, galactose, a pentose, or a methylpentose. Sapogenins are poisonous towards the lower forms of life and are powerful hemolytics
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when injected into the blood stream able to dissolve red blood cells at even extreme dilutions. [NIH] Sarcoma: A connective tissue neoplasm formed by proliferation of mesodermal cells; it is usually highly malignant. [NIH] Scalpel: A small pointed knife with a convex edge. [NIH] Schizoid: Having qualities resembling those found in greater degree in schizophrenics; a person of schizoid personality. [NIH] Schizophrenia: A mental disorder characterized by a special type of disintegration of the personality. [NIH] Schizotypal Personality Disorder: A personality disorder in which there are oddities of thought (magical thinking, paranoid ideation, suspiciousness), perception (illusions, depersonalization), speech (digressive, vague, overelaborate), and behavior (inappropriate affect in social interactions, frequently social isolation) that are not severe enough to characterize schizophrenia. [NIH] Sclerosis: A pathological process consisting of hardening or fibrosis of an anatomical structure, often a vessel or a nerve. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Scrotum: In males, the external sac that contains the testicles. [NIH] 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] Segmentation: The process by which muscles in the intestines move food and wastes through the body. [NIH] Selection Bias: The introduction of error due to systematic differences in the characteristics between those selected and those not selected for a given study. In sampling bias, error is the result of failure to ensure that all members of the reference population have a known chance of selection in the sample. [NIH] Selective estrogen receptor modulator: SERM. A drug that acts like estrogen on some tissues, but blocks the effect of estrogen on other tissues. Tamoxifen and raloxifene are SERMs. [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] Seminal vesicles: Glands that help produce semen. [NIH] Senile: Relating or belonging to old age; characteristic of old age; resulting from infirmity of old age. [NIH] Sensibility: The ability to receive, feel and appreciate sensations and impressions; the quality of being sensitive; the extend to which a method gives results that are free from false negatives. [NIH] Sensitization: 1. Administration of antigen to induce a primary immune response; priming; immunization. 2. Exposure to allergen that results in the development of hypersensitivity. 3. The coating of erythrocytes with antibody so that they are subject to lysis by complement in the presence of homologous antigen, the first stage of a complement fixation test. [EU]
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Serine: A non-essential amino acid occurring in natural form as the L-isomer. It is synthesized from glycine or threonine. It is involved in the biosynthesis of purines, pyrimidines, and other amino acids. [NIH] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Serous: Having to do with serum, the clear liquid part of blood. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Sex Characteristics: Those characteristics that distinguish one sex from the other. The primary sex characteristics are the ovaries and testes and their related hormones. Secondary sex characteristics are those which are masculine or feminine but not directly related to reproduction. [NIH] Sexual Abstinence: Refraining from sexual intercourse. [NIH] Sexually Transmitted Diseases: Diseases due to or propagated by sexual contact. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]
Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Sigmoid: 1. Shaped like the letter S or the letter C. 2. The sigmoid colon. [EU] Sigmoid Colon: The lower part of the colon that empties into the rectum. [NIH] Sigmoidoscopy: Endoscopic examination, therapy or surgery of the sigmoid flexure. [NIH] Signal Transduction: The intercellular or intracellular transfer of information (biological activation/inhibition) through a signal pathway. In each signal transduction system, an activation/inhibition signal from a biologically active molecule (hormone, neurotransmitter) is mediated via the coupling of a receptor/enzyme to a second messenger system or to an ion channel. Signal transduction plays an important role in activating cellular functions, cell differentiation, and cell proliferation. Examples of signal transduction systems are the GABA-postsynaptic receptor-calcium ion channel system, the receptor-mediated T-cell activation pathway, and the receptor-mediated activation of phospholipases. Those coupled to membrane depolarization or intracellular release of calcium include the receptormediated activation of cytotoxic functions in granulocytes and the synaptic potentiation of protein kinase activation. Some signal transduction pathways may be part of larger signal transduction pathways; for example, protein kinase activation is part of the platelet activation signal pathway. [NIH] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH]
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Skin graft: Skin that is moved from one part of the body to another. [NIH] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Sleep apnea: A serious, potentially life-threatening breathing disorder characterized by repeated cessation of breathing due to either collapse of the upper airway during sleep or absence of respiratory effort. [NIH] Sleep Deprivation: The state of being deprived of sleep under experimental conditions, due to life events, or from a wide variety of pathophysiologic causes such as medication effect, chronic illness, psychiatric illness, or sleep disorder. [NIH] Sleep Stages: Periods of sleep manifested by changes in EEG activity and certain behavioral correlates; includes Stage 1: sleep onset, drowsy sleep; Stage 2: light sleep; Stages 3 and 4: delta sleep, light sleep, deep sleep, telencephalic sleep. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]
Smooth Muscle Tumor: A tumor composed of smooth muscle tissue, as opposed to leiomyoma, a tumor derived from smooth muscle. [NIH] Sneezing: Sudden, forceful, involuntary expulsion of air from the nose and mouth caused by irritation to the mucous membranes of the upper respiratory tract. [NIH] Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Social Support: Support systems that provide assistance and encouragement to individuals with physical or emotional disabilities in order that they may better cope. Informal social support is usually provided by friends, relatives, or peers, while formal assistance is provided by churches, groups, etc. [NIH] Social Work: The use of community resources, individual case work, or group work to promote the adaptive capacities of individuals in relation to their social and economic environments. It includes social service agencies. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Solid tumor: Cancer of body tissues other than blood, bone marrow, or the lymphatic system. [NIH] 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] Somatic mutations: Alterations in DNA that occur after conception. Somatic mutations can occur in any of the cells of the body except the germ cells (sperm and egg) and therefore are not passed on to children. These alterations can (but do not always) cause cancer or other diseases. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH]
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Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] Sperm: The fecundating fluid of the male. [NIH] Spermatozoa: Mature male germ cells that develop in the seminiferous tubules of the testes. Each consists of a head, a body, and a tail that provides propulsion. The head consists mainly of chromatin. [NIH] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] 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] Sporadic: Neither endemic nor epidemic; occurring occasionally in a random or isolated manner. [EU] Squamous: Scaly, or platelike. [EU] Staging: Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. [NIH]
Statistically significant: Describes a mathematical measure of difference between groups. The difference is said to be statistically significant if it is greater than what might be expected to happen by chance alone. [NIH] Steel: A tough, malleable, iron-based alloy containing up to, but no more than, two percent carbon and often other metals. It is used in medicine and dentistry in implants and instrumentation. [NIH] Stem Cells: Relatively undifferentiated cells of the same lineage (family type) that retain the ability to divide and cycle throughout postnatal life to provide cells that can become specialized and take the place of those that die or are lost. [NIH] Stents: Devices that provide support for tubular structures that are being anastomosed or for body cavities during skin grafting. [NIH] Sterility: 1. The inability to produce offspring, i.e., the inability to conceive (female s.) or to induce conception (male s.). 2. The state of being aseptic, or free from microorganisms. [EU] Sterilization: The destroying of all forms of life, especially microorganisms, by heat, chemical, or other means. [NIH] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stimulant: 1. Producing stimulation; especially producing stimulation by causing tension on
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muscle fibre through the nervous tissue. 2. An agent or remedy that produces stimulation. [EU]
Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stress incontinence: An involuntary loss of urine that occurs at the same time that internal abdominal pressure is increased, such as with laughing, sneezing, coughing, or physical activity. [NIH] Stress urinary: Leakage of urine caused by actions--such as coughing, laughing, sneezing, running, or lifting--that place pressure on the bladder from inside the body. Stress urinary incontinence can result from either a fallen bladder or weak sphincter muscles. [NIH] Stricture: The abnormal narrowing of a body opening. Also called stenosis. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Stroma: The middle, thickest layer of tissue in the cornea. [NIH] Stromal: Large, veil-like cell in the bone marrow. [NIH] Stump: The end of the limb after amputation. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Subiculum: A region of the hippocampus that projects to other areas of the brain. [NIH] Subspecies: A category intermediate in rank between species and variety, based on a smaller number of correlated characters than are used to differentiate species and generally conditioned by geographical and/or ecological occurrence. [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]
Suction: The removal of secretions, gas or fluid from hollow or tubular organs or cavities by means of a tube and a device that acts on negative pressure. [NIH] Sufentanil: An opioid analgesic that is used as an adjunct in anesthesia, in balanced anesthesia, and as a primary anesthetic agent. [NIH] Supplementation: Adding nutrients to the diet. [NIH] Suppositories: A small cone-shaped medicament having cocoa butter or gelatin at its basis and usually intended for the treatment of local conditions in the rectum. [NIH] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Suprachiasmatic Nucleus: An ovoid densely packed collection of small cells of the anterior
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hypothalamus lying close to the midline in a shallow impression of the optic chiasm. [NIH] Surgical Equipment: Nonexpendable apparatus used during surgical procedures. They are differentiated from surgical instruments, usually hand-held and used in the immediate operative field. [NIH] Surgical Instruments: Hand-held tools or implements used by health professionals for the performance of surgical tasks. [NIH] Survival Rate: The proportion of survivors in a group, e.g., of patients, studied and followed over a period, or the proportion of persons in a specified group alive at the beginning of a time interval who survive to the end of the interval. It is often studied using life table methods. [NIH] Suspensions: Colloids with liquid continuous phase and solid dispersed phase; the term is used loosely also for solid-in-gas (aerosol) and other colloidal systems; water-insoluble drugs may be given as suspensions. [NIH] Symphysis: A secondary cartilaginous joint. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Symptomatology: 1. That branch of medicine with treats of symptoms; the systematic discussion of symptoms. 2. The combined symptoms of a disease. [EU] Synapses: Specialized junctions at which a neuron communicates with a target cell. At classical synapses, a neuron's presynaptic terminal releases a chemical transmitter stored in synaptic vesicles which diffuses across a narrow synaptic cleft and activates receptors on the postsynaptic membrane of the target cell. The target may be a dendrite, cell body, or axon of another neuron, or a specialized region of a muscle or secretory cell. Neurons may also communicate through direct electrical connections which are sometimes called electrical synapses; these are not included here but rather in gap junctions. [NIH] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Synaptic Vesicles: Membrane-bound compartments which contain transmitter molecules. Synaptic vesicles are concentrated at presynaptic terminals. They actively sequester transmitter molecules from the cytoplasm. In at least some synapses, transmitter release occurs by fusion of these vesicles with the presynaptic membrane, followed by exocytosis of their contents. [NIH] Systemic: Affecting the entire body. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Talc: A native magnesium silicate. [NIH] Tamoxifen: A first generation selective estrogen receptor modulator (SERM). It acts as an agonist for bone tissue and cholesterol metabolism but is an estrogen antagonist in mammary and uterine. [NIH] Tamponade: The inserting of a tampon; a dressing is inserted firmly into a wound or body cavity, as the nose, uterus or vagina, principally for stopping hemorrhage. [NIH] Tarsal Bones: The seven bones which form the tarsus - namely, calcaneus, talus, cuboid, navicular, and first, second and third cuneiforms. The tarsus is a skeletal part of the foot. [NIH]
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Telomerase: Essential ribonucleoprotein reverse transcriptase that adds telomeric DNA to the ends of eukaryotic chromosomes. Telomerase appears to be repressed in normal human somatic tissues but reactivated in cancer, and thus may be necessary for malignant transformation. EC 2.7.7.-. [NIH] Temporal: One of the two irregular bones forming part of the lateral surfaces and base of the skull, and containing the organs of hearing. [NIH] Testicles: The two egg-shaped glands found inside the scrotum. They produce sperm and male hormones. Also called testes. [NIH] Testis: Either of the paired male reproductive glands that produce the male germ cells and the male hormones. [NIH] Testosterone: A hormone that promotes the development and maintenance of male sex characteristics. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thermal: Pertaining to or characterized by heat. [EU] Thorax: A part of the trunk between the neck and the abdomen; 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] Thrombin: An enzyme formed from prothrombin that converts fibrinogen to fibrin. (Dorland, 27th ed) EC 3.4.21.5. [NIH] Thrombocytes: Blood cells that help prevent bleeding by causing blood clots to form. Also called platelets. [NIH] Thrombomodulin: A cell surface glycoprotein of endothelial cells that binds thrombin and serves as a cofactor in the activation of protein C and its regulation of blood coagulation. [NIH]
Thromboses: The formation or presence of a blood clot within a blood vessel during life. [NIH]
Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Thyroid Gland: A highly vascular endocrine gland consisting of two lobes, one on either side of the trachea, joined by a narrow isthmus; it produces the thyroid hormones which are concerned in regulating the metabolic rate of the body. [NIH] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Time and Motion Studies: The observation and analysis of movements in a task with an emphasis on the amount of time required to perform the task. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tomography: Imaging methods that result in sharp images of objects located on a chosen plane and blurred images located above or below the plane. [NIH] Topical: On the surface of the body. [NIH] Total hysterectomy: Surgery to remove the entire uterus. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances
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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] Trachea: The cartilaginous and membranous tube descending from the larynx and branching into the right and left main bronchi. [NIH] Traction: The act of pulling. [NIH] Transcriptase: An enzyme which catalyses the synthesis of a complementary mRNA molecule from a DNA template in the presence of a mixture of the four ribonucleotides (ATP, UTP, GTP and CTP). [NIH] Transcription Factors: Endogenous substances, usually proteins, which are effective in the initiation, stimulation, or termination of the genetic transcription process. [NIH] Transduction: The transfer of genes from one cell to another by means of a viral (in the case of bacteria, a bacteriophage) vector or a vector which is similar to a virus particle (pseudovirion). [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transfer Agreement: A written agreement for the transfer of patients and their medical records from one health care institution to another. [NIH] Transfusion: The infusion of components of blood or whole blood into the bloodstream. The blood may be donated from another person, or it may have been taken from the person earlier and stored until needed. [NIH] Transgenes: Genes that are introduced into an organism using gene transfer techniques. [NIH]
Translational: The cleavage of signal sequence that directs the passage of the protein through a cell or organelle membrane. [NIH] Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [NIH] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Transurethral: Performed through the urethra. [EU] Transurethral Resection of Prostate: Resection of the prostate using a cystoscope passed through the urethra. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Treatment Outcome: Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, practicability, etc., of these interventions in individual cases or series. [NIH]
Trichomoniasis: An infection with the protozoan parasite Trichomonas vaginalis. [NIH]
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Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tubal ligation: An operation to tie the fallopian tubes closed. This procedure prevents pregnancy by blocking the passage of eggs from the ovaries to the uterus. [NIH] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of Mycobacterium. [NIH] Tumor marker: A substance sometimes found in an increased amount in the blood, other body fluids, or tissues and which may mean that a certain type of cancer is in the body. Examples of tumor markers include CA 125 (ovarian cancer), CA 15-3 (breast cancer), CEA (ovarian, lung, breast, pancreas, and gastrointestinal tract cancers), and PSA (prostate cancer). Also called biomarker. [NIH] Tumor suppressor gene: Genes in the body that can suppress or block the development of cancer. [NIH] Tumour: 1. Swelling, one of the cardinal signs of inflammations; morbid enlargement. 2. A new growth of tissue in which the multiplication of cells is uncontrolled and progressive; called also neoplasm. [EU] Tunica Media: The middle coat of blood vessel walls, composed principally of thin, cylindrical, smooth muscle cells and elastic tissue. It accounts for the bulk of the wall of most arteries. The smooth muscle cells are arranged in circular layers around the vessel, and the thickness of the coat varies with the size of the vessel. [NIH] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Ulcer: A localized necrotic lesion of the skin or a mucous surface. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Ureter: One of a pair of thick-walled tubes that transports urine from the kidney pelvis to the bladder. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]
Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary Fistula: An abnormal passage in any organ of the urinary tract or between urinary organs and other organs. [NIH] Urinary Retention: Inability to urinate. The etiology of this disorder includes obstructive, neurogenic, pharmacologic, and psychogenic causes. [NIH] Urinary tract: The organs of the body that produce and discharge urine. These include the kidneys, ureters, bladder, and urethra. [NIH] Urinate: To release urine from the bladder to the outside. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Urodynamic: Measures of the bladder's ability to hold and release urine. [NIH] Urogenital: Pertaining to the urinary and genital apparatus; genitourinary. [EU] Urology: A surgical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in both sexes and the genital tract in the male. It includes the specialty of andrology which addresses both male genital diseases and male infertility. [NIH]
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Uterine Contraction: Contraction of the uterine muscle. [NIH] Uterine Prolapse: Downward displacement of the uterus. It is classified in various degrees: in the first degree the cervix is within the vaginal orifice; in the second degree the cervix is outside the orifice; in the third degree the entire uterus is outside the orifice. [NIH] Uterine Rupture: A tearing of uterine tissue; it may be traumatic or spontaneous due to multiple pregnancy, large fetus, previous scarring, or obstruction. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] 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] Vaginal Discharge: A common gynecologic disorder characterized by an abnormal, nonbloody discharge from the genital tract. [NIH] Vaginitis: Inflammation of the vagina characterized by pain and a purulent discharge. [NIH] Vaginosis: A condition caused by the overgrowth of anaerobic bacteria (e. g., Gardnerella vaginalis), resulting in vaginal irritation and discharge. [NIH] Varicose: The common ulcer in the lower third of the leg or near the ankle. [NIH] Vas Deferens: The excretory duct of the testes that carries spermatozoa. It rises from the scrotum and joins the seminal vesicles to form the ejaculatory duct. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasectomy: An operation to cut or tie off the two tubes that carry sperm out of the testicles. [NIH]
Vasoactive: Exerting an effect upon the calibre of blood vessels. [EU] Vasodilators: Any nerve or agent which induces dilatation of the blood vessels. [NIH] Vasomotor: 1. Affecting the calibre of a vessel, especially of a blood vessel. 2. Any element or agent that effects the calibre of a blood vessel. [EU] Vector: Plasmid or other self-replicating DNA molecule that transfers DNA between cells in nature or in recombinant DNA technology. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] 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] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Vestibular: Pertaining to or toward a vestibule. In dental anatomy, used to refer to the tooth surface directed toward the vestibule of the mouth. [EU] Vestibule: A small, oval, bony chamber of the labyrinth. The vestibule contains the utricle and saccule, organs which are part of the balancing apparatus of the ear. [NIH]
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Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Vinca Alkaloids: A class of alkaloids from the genus of apocyanaceous woody herbs including periwinkles. They are some of the most useful antineoplastic agents. [NIH] Vincristine: An anticancer drug that belongs to the family of plant drugs called vinca alkaloids. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Viral Load: The quantity of measurable virus in the blood. Change in viral load, measured in plasma, is used as a surrogate marker in HIV disease progression. [NIH] Virulent: A virus or bacteriophage capable only of lytic growth, as opposed to temperate phages establishing the lysogenic response. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Viscera: Any of the large interior organs in any one of the three great cavities of the body, especially in the abdomen. [NIH] Visceral: , from viscus a viscus) pertaining to a viscus. [EU] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Warts: Benign epidermal proliferations or tumors; some are viral in origin. [NIH] Weight Gain: Increase in body weight over existing weight. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]
Windpipe: A rigid tube, 10 cm long, extending from the cricoid cartilage to the upper border of the fifth thoracic vertebra. [NIH] Withdrawal: 1. A pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) A substance-specific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU] Womb: A hollow, thick-walled, muscular organ in which the impregnated ovum is developed into a child. [NIH] Wound Healing: Restoration of integrity to traumatized tissue. [NIH] Xenograft: The cells of one species transplanted to another species. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH] Yeasts: A general term for single-celled rounded fungi that reproduce by budding. Brewers' and bakers' yeasts are Saccharomyces cerevisiae; therapeutic dried yeast is dried yeast. [NIH] Zymogen: Inactive form of an enzyme which can then be converted to the active form, usually by excision of a polypeptide, e. g. trypsinogen is the zymogen of trypsin. [NIH]
235
INDEX A Abdomen, 113, 115, 118, 120, 158, 171, 177, 178, 199, 201, 202, 203, 213, 222, 226, 227, 229, 233 Abdominal fat, 5, 171 Aberrant, 13, 171 Ablate, 13, 15, 171, 189 Ablation, 7, 38, 56, 68, 73, 91, 119, 140, 141, 159, 171 Abscess, 87, 171 Acetaminophen, 28, 171 Acetylcholine, 171, 209 Actin, 21, 171, 207, 208 Acyl, 171, 205 Adaptability, 171, 180, 181 Adenine, 171 Adenocarcinoma, 7, 18, 24, 32, 74, 90, 98, 102, 171 Adenosine, 71, 171, 179, 214 Adenosine Triphosphate, 71, 171, 214 Adenovirus, 15, 34, 171 Adhesions, 109, 119, 171 Adipose Tissue, 171 Adjuvant, 30, 32, 44, 78, 90, 95, 96, 171, 172, 194 Adjuvant Therapy, 32, 78, 172 Adnexa, 117, 172 Adolescence, 124, 172 Adrenal Cortex, 172, 185, 192, 210, 216 Adrenergic, 17, 172, 191 Adrenergic Antagonists, 17, 172 Adverse Effect, 12, 27, 172, 224 Aerobic, 172, 211 Aerobic Metabolism, 172, 211 Aerobic Respiration, 172, 211 Aerosol, 172, 228 Affinity, 172, 225 Age Groups, 18, 125, 172 Age of Onset, 40, 172 Aged, 80 and Over, 172 Agonist, 23, 66, 115, 172, 195, 220, 228 Airway, 172, 225 Albumin, 48, 173, 215 Alertness, 173, 179 Algorithms, 173, 177 Alimentary, 173, 188 Alkaline, 173, 179 Alkaloid, 173, 207
Alleles, 19, 120, 173 Allergen, 173, 223 Alpha Particles, 173, 220 Alternative medicine, 142, 173 Amebiasis, 173, 206 Amenorrhea, 103, 119, 173 Amino Acid Sequence, 173, 174 Amino Acids, 173, 213, 215, 218, 224 Ampulla, 173, 190, 192 Amputation, 96, 173, 227 Anaerobic, 173, 232 Anaesthesia, 46, 54, 55, 65, 69, 72, 91, 97, 98, 99, 101, 174, 200 Anaesthetic, 82, 174 Anal, 174, 191, 193, 204 Analgesic, 28, 31, 46, 72, 171, 174, 188, 207, 210, 227 Analog, 174, 194 Analogous, 114, 174, 230 Anatomical, 10, 54, 116, 174, 199, 223 Anemia, 174, 178, 197 Anesthesia, 30, 40, 47, 49, 81, 97, 100, 102, 126, 133, 173, 174, 190, 202, 227 Angiogenesis, 15, 174 Angiogram, 20, 174 Angiokeratoma, 87, 174 Angioplasty, 33, 174 Animal model, 15, 17, 33, 34, 174 Anions, 173, 174, 202 Anomalies, 126, 174 Antagonism, 174, 179 Antibiosis, 126, 174 Antibiotic, 110, 158, 174, 219 Antibodies, 16, 52, 174, 175, 199, 204, 215, 220 Antibody, 22, 172, 175, 183, 198, 199, 200, 205, 207, 220, 223, 226 Anticoagulant, 175, 218 Antigen, 26, 172, 174, 175, 183, 187, 198, 199, 200, 201, 205, 223 Antigen-presenting cell, 175, 187 Anti-inflammatory, 22, 171, 175, 188, 195, 202, 212 Anti-Inflammatory Agents, 175, 202 Antimicrobial, 38, 175 Antineoplastic, 175, 177, 179, 211, 219, 233 Antioxidant, 175, 211 Antipyretic, 171, 175, 188
236 Hysterectomy
Antiseptic, 110, 111, 175 Antiviral, 7, 175 Anus, 174, 175, 178, 213, 221 Anxiety, 31, 119, 175 Aorta, 175, 180, 185, 232 Apnea, 175 Apolipoproteins, 175, 203 Apoptosis, 15, 23, 175 Approximate, 29, 175 Aqueous, 175, 176, 186, 190, 203 Arachidonic Acid, 176, 217 Arginine, 176, 209 Arnica, 97, 176 Arterial, 6, 27, 176, 181, 199, 203, 218, 228 Arteries, 114, 116, 175, 176, 178, 185, 204, 206, 208, 231 Arterioles, 16, 176, 178, 206, 208 Articular, 176, 211 Ascites, 8, 176 Aseptic, 176, 226 Assay, 16, 176 Asymptomatic, 10, 158, 173, 176 Attenuation, 41, 176 Atypical, 11, 18, 26, 74, 176 Atypical hyperplasia, 18, 26, 176 Autoimmune disease, 176, 207 Autosuggestion, 176, 199 B Bacteria, 110, 158, 171, 174, 175, 176, 189, 192, 193, 196, 206, 221, 230, 232 Bacteriophage, 176, 214, 230, 233 Base, 117, 171, 176, 187, 202, 229 Basement Membrane, 176, 179, 192 Basophils, 176, 196, 203 Baths, 17, 158, 177 Benchmarking, 39, 177 Benign tumor, 21, 68, 177, 203 Bereavement, 125, 177 Bilateral, 16, 29, 46, 50, 61, 64, 76, 77, 79, 90, 92, 98, 136, 177 Bile, 177, 194, 203, 226 Bile Ducts, 177, 194 Bilirubin, 173, 177, 194 Binding Sites, 21, 177 Biochemical, 34, 173, 177, 211, 224 Biological therapy, 177, 196 Biopsy, 9, 18, 50, 177 Biosynthesis, 37, 176, 177, 186, 224 Biotechnology, 41, 42, 132, 142, 151, 177 Blastocyst, 177, 184, 190, 214 Bleomycin, 92, 100, 177 Bloating, 119, 177
Blood Cell Count, 177, 197 Blood Coagulation, 178, 179, 229 Blood Glucose, 17, 178, 197, 201 Blood Platelets, 178, 224 Blood pressure, 5, 17, 27, 30, 178, 180, 199, 207, 225 Blood transfusion, 47, 178, 197 Blood Viscosity, 178, 197 Blood Volume, 48, 178 Blot, 34, 178 Body Composition, 17, 178 Body Fluids, 178, 179, 189, 225, 231 Bolus, 91, 178 Bolus infusion, 178 Bone Density, 17, 178 Bone Marrow, 178, 192, 199, 204, 207, 213, 225, 227 Bowel, 47, 48, 79, 80, 92, 101, 111, 143, 174, 178, 184, 202, 213, 227 Bowel Movement, 178, 184, 227 Brachytherapy, 57, 178, 201, 220 Bradykinin, 178, 209, 215 Branch, 4, 167, 179, 204, 212, 219, 225, 228, 229 Breakdown, 179, 188, 194 Breast Feeding, 125, 179 Buccal, 37, 179, 198 Bupivacaine, 46, 179 Bypass, 19, 179 C Caffeine, 125, 179 Calcaneus, 17, 179, 228 Calcium, 41, 125, 179, 183, 218, 224 Carbohydrate, 92, 179, 215 Carbon Dioxide, 179, 193, 214, 222 Carboplatin, 44, 95, 102, 179 Carcinogen, 179, 206 Carcinogenesis, 7, 13, 179, 181 Carcinogenic, 179, 210, 226 Carcinoma, 8, 18, 25, 32, 48, 50, 52, 56, 57, 67, 72, 73, 74, 80, 81, 83, 91, 96, 99, 100, 136, 179 Carcinoma in Situ, 57, 179 Cardiac, 19, 179, 185, 189, 191, 208, 226 Cardiopulmonary, 179, 180, 197 Cardiopulmonary Bypass, 180, 197 Cardiovascular, 5, 12, 15, 27, 29, 36, 38, 90, 180, 224 Cardiovascular disease, 15, 29, 180 Case report, 48, 50, 52, 62, 66, 69, 71, 72, 73, 79, 90, 91, 97, 98, 99, 180, 182 Case series, 20, 180, 182
Index 237
Case-Control Studies, 22, 29, 180, 191 Castration, 124, 180 Catecholamines, 27, 180 Catheterization, 62, 174, 180, 202 Catheters, 47, 111, 180, 200, 201 Caudal, 180, 199, 215 Causal, 180, 191 Cause of Death, 19, 180 Cell Adhesion, 180, 201 Cell Cycle, 15, 19, 180, 182, 219 Cell Death, 175, 180, 208 Cell Differentiation, 180, 224 Cell Division, 176, 180, 181, 196, 207, 214, 217 Cell proliferation, 15, 23, 181, 224 Cell Respiration, 172, 181, 211, 222 Cell Survival, 23, 181, 196 Central Nervous System, 27, 31, 171, 179, 181, 196, 207, 224 Centrifugation, 181, 197 Cerebral, 181, 191, 208 Cerebrovascular, 180, 181 Cerebrum, 181, 214 Cervical intraepithelial neoplasia, 50, 181 Cesarean Section, 98, 113, 124, 129, 181 Character, 181, 187 Check-up, 158, 181 Chemoprevention, 8, 24, 181 Chemopreventive, 18, 181 Chemotaxis, 13, 181 Chemotherapy, 48, 49, 61, 74, 81, 83, 90, 96, 97, 99, 100, 101, 102, 172, 181 Chlamydia, 22, 157, 158, 181 Cholecystectomy, 51, 181 Cholesterol, 177, 181, 182, 185, 194, 203, 204, 220, 226, 228 Cholesterol Esters, 181, 203 Choriocarcinoma, 48, 97, 182, 195, 207 Chromatin, 175, 182, 191, 209, 226 Chromosomal, 21, 182 Chromosome, 25, 73, 182, 203 Chromosome Aberrations, 25, 182 Chronic, 16, 31, 36, 125, 143, 159, 170, 173, 182, 188, 200, 204, 225, 227 Chylomicrons, 182, 203 Circadian, 27, 36, 182 Circadian Rhythm, 36, 182 Circumcision, 117, 126, 182 CIS, 16, 182 Cisplatin, 44, 92, 95, 99, 100, 182 Clamp, 117, 182 Climacteric, 43, 51, 58, 87, 90, 92, 182
Clinical Medicine, 61, 182, 216 Clinical study, 182, 185 Clinical trial, 5, 7, 15, 16, 41, 58, 90, 151, 182, 185, 212, 218, 221 Clitoral, 17, 182 Cloning, 25, 177, 182 Coagulation, 20, 75, 178, 182, 197, 215 Cofactor, 183, 218, 229 Cohort Studies, 183, 191 Collagen, 33, 176, 183, 193, 194, 215, 217 Collapse, 108, 110, 179, 183, 225 Collateral Circulation, 68, 183 Colloidal, 173, 183, 192, 228 Colonoscope, 83, 183 Colonoscopy, 83, 183 Colpotomy, 113, 115, 116, 183 Combination Therapy, 183, 192 Complement, 183, 184, 194, 201, 215, 223 Complementary and alternative medicine, 95, 104, 184 Complementary medicine, 95, 184 Computational Biology, 151, 184 Conception, 182, 184, 185, 193, 195, 207, 225, 226 Concomitant, 11, 92, 184 Condoms, 158, 159, 184 Cone, 50, 184, 227 Confounding, 37, 184 Connective Tissue, 20, 117, 178, 183, 184, 194, 204, 223 Connective Tissue Cells, 184 Consciousness, 174, 184, 187, 188 Constipation, 79, 96, 184 Constriction, 184, 202 Consultation, 9, 39, 184 Consumption, 28, 37, 75, 119, 125, 184, 222 Contamination, 28, 112, 184 Continence, 4, 30, 143, 144, 184 Continuous infusion, 91, 184 Continuum, 18, 26, 185 Contraception, 185, 203 Contraceptive, 12, 28, 35, 185, 205, 209 Contractility, 17, 185 Contraindications, ii, 185 Control group, 35, 185, 216, 220 Controlled clinical trial, 6, 84, 185 Controlled study, 64, 75, 185 Coordination, 10, 185, 207 Cornea, 185, 227 Coronary, 5, 19, 41, 77, 180, 185, 198, 206, 208 Coronary Artery Bypass, 19, 185
238 Hysterectomy
Coronary Disease, 19, 185 Coronary heart disease, 41, 180, 185 Coronary Thrombosis, 185, 206, 208 Coronary Vessels, 185 Corpus, 18, 47, 185, 212, 214, 216 Corpus Luteum, 185, 216 Cortex, 185, 190, 208 Cortisol, 27, 173, 185 Cranial, 117, 185, 196 Cross-Sectional Studies, 186, 191 Cryofixation, 186 Cryopreservation, 10, 186 Curative, 186, 229 Curettage, 186, 188 Curette, 186, 188 Cyclic, 11, 179, 186, 196, 209, 217 Cyst, 56, 186 Cystathionine beta-Synthase, 186, 198 Cystectomy, 126, 186 Cystitis, 126, 143, 186 Cystocele, 126, 186 Cystoscopy, 126, 186 Cytokine, 13, 26, 186 Cytomegalovirus, 186, 194 Cytomegalovirus Infections, 186, 194 Cytoplasm, 175, 176, 186, 191, 196, 207, 209, 228 Cytoskeleton, 186, 201, 206 Cytotoxic, 23, 96, 186, 220, 224 Cytotoxic chemotherapy, 96, 186 Cytotoxicity, 182, 186 D Databases, Bibliographic, 151, 186 Decidua, 187, 206, 214 Decision Making, 23, 70, 87, 187 Defecation, 53, 187 Defense Mechanisms, 187, 201 Degenerative, 6, 187, 211 Deletion, 175, 187 Delivery of Health Care, 187, 196 Delusions, 187, 219 Dementia, 6, 187 Dendrites, 187, 209 Dendritic, 27, 187 Dendritic cell, 27, 187 Density, 10, 20, 53, 178, 181, 187, 203, 210 Dentate Gyrus, 187, 197 Depolarization, 187, 224 Deprivation, 27, 187 Diabetes Mellitus, 187, 197 Diagnostic procedure, 107, 142, 187 Diaphragm, 187, 222
Diastolic, 188, 199 Diclofenac, 54, 188 Diclofenac Sodium, 188 Dietary Fiber, 101, 188 Diffusion, 188, 200 Digestion, 30, 173, 177, 178, 188, 202, 203, 227 Dilatation, 174, 188, 216, 232 Dilate, 111, 188 Dilation, 18, 111, 179, 188 Dilation and curettage, 18, 188 Direct, iii, 15, 26, 145, 182, 188, 195, 221, 228 Disease Progression, 188, 233 Disease Susceptibility, 120, 188 Dissection, 9, 68, 76, 77, 110, 116, 188, 204 Dissociation, 16, 172, 188 Dissociative Disorders, 188 Distal, 109, 110, 111, 114, 118, 185, 188, 189, 219 Diuresis, 179, 188 Diverticula, 126, 188 Diverticulum, 126, 188 Dorsal, 189, 215 Dose-rate, 57, 189 Douche, 158, 189 Douching, 157, 158, 189 Drug Interactions, 146, 189 Drug Resistance, 7, 189 Drug Tolerance, 189 Duct, 173, 180, 189, 232 Duodenum, 177, 189, 190, 227 Dysmenorrhea, 119, 189 Dyspareunia, 189, 192 E Ectopic, 13, 54, 189 Efficacy, 8, 11, 15, 19, 31, 33, 36, 41, 46, 55, 71, 189, 230 Elastin, 183, 189 Elective, 43, 55, 71, 105, 132, 189 Electrocardiogram, 27, 189 Electrocoagulation, 183, 189 Electrode, 118, 189 Electrons, 175, 176, 189, 202, 211, 220 Emboli, 24, 51, 55, 57, 58, 63, 84, 141, 159, 160, 189 Embolization, 24, 51, 55, 57, 58, 63, 84, 141, 159, 160, 189 Embryo, 10, 177, 180, 190, 200, 210 Embryo Transfer, 10, 190 Emesis, 99, 190 Emollient, 111, 190, 210
Index 239
Emulsion, 190, 193 Endarterectomy, 174, 190 Endemic, 190, 226 Endocrinology, 190, 196 Endometriosis, 13, 22, 28, 34, 76, 90, 91, 103, 109, 125, 136, 143, 156, 159, 190, 203, 209 Endometrium, 12, 13, 16, 18, 24, 26, 91, 187, 190, 196, 206, 209 Endoscope, 111, 190 Endoscopic, 98, 118, 183, 186, 190, 199, 224 Endoscopy, 54, 63, 65, 66, 73, 79, 83, 126, 190 Endothelium, 190, 209 Endothelium-derived, 190, 209 Enhancer, 190, 222 Enterocele, 14, 49, 190 Entorhinal Cortex, 190, 197 Environmental Exposure, 190, 191 Environmental Health, 150, 152, 191 Environmental Monitoring, 9, 191 Enzymatic, 179, 183, 191, 193 Enzyme, 28, 186, 191, 196, 215, 218, 224, 229, 230, 233 Eosinophils, 191, 196, 203 Epidemic, 191, 226 Epidemiologic Studies, 14, 28, 38, 40, 191 Epidermal, 191, 233 Epidural, 27, 31, 43, 49, 55, 72, 191 Epinephrine, 172, 191, 209, 231 Episiotomy, 40, 191 Epithelial, 11, 20, 24, 26, 29, 48, 97, 171, 174, 179, 187, 191 Epithelial Cells, 27, 191 Epithelial ovarian cancer, 29, 191 Epithelium, 11, 16, 176, 182, 190, 191, 212 Erectile, 191, 212 Erection, 191, 216 Erythrocyte Volume, 178, 191 Erythrocytes, 174, 177, 178, 191, 223 Erythropoietin, 47, 192 Estradiol, 20, 29, 77, 92, 192 Estrogen receptor, 15, 16, 26, 192 Estrogen Replacement Therapy, 19, 37, 41, 120, 192 Ethnic Groups, 20, 35, 70, 192 Eukaryotic Cells, 192, 200 Evacuation, 184, 192 Exogenous, 12, 14, 16, 20, 26, 37, 192 Expiration, 192, 222 Expiratory, 81, 192 Extender, 116, 192
External-beam radiation, 192, 220 Extracellular, 34, 184, 192, 193, 201, 225 Extracellular Matrix, 34, 184, 192, 193, 201 Extracellular Space, 192 Extraocular, 172, 192 Extremity, 192, 203 Eye Infections, 171, 192 F Fallopian Tubes, 157, 158, 192, 196, 222, 231 Family Planning, 132, 151, 192 Fat, 5, 37, 125, 171, 176, 178, 185, 189, 192, 203, 207 Fatigue, 38, 99, 193 Fatty acids, 173, 193, 213, 217 Febrile, 4, 110, 193 Fecal Incontinence, 14, 36, 193, 200 Feces, 184, 193, 227 Fentanyl, 100, 193 Fetus, 181, 192, 193, 194, 214, 216, 232 Fibrin, 178, 193, 229 Fibrinogen, 20, 193, 215, 229 Fibrinolytic, 20, 193 Fibroblasts, 19, 184, 193 Fibroid, 34, 39, 40, 57, 84, 115, 140, 141, 159, 160, 193, 203 Fine-needle aspiration, 193, 208 Fistula, 87, 126, 193 Fixation, 9, 186, 193, 223 Flatus, 193, 194 Fluorescence, 73, 193 Foetoplacental, 194, 210 Forearm, 178, 194 Fornix, 110, 117, 120, 194 Fovea, 193, 194 Friction, 194, 204 Fundus, 116, 194 G Gallbladder, 123, 171, 177, 181, 194 Gallstones, 123, 194 Gamma Rays, 194, 220 Ganciclovir, 23, 194 Gap Junctions, 194, 228 Gas, 109, 116, 179, 188, 193, 194, 198, 209, 227, 228 Gastrin, 194, 198 Gastrointestinal, 54, 55, 83, 179, 191, 193, 194, 203, 224, 227, 231 Gastrointestinal tract, 193, 194, 203, 224, 231 Gelatin, 194, 227
240 Hysterectomy
Gene, 19, 21, 23, 25, 28, 34, 120, 132, 171, 173, 177, 194, 222, 230 Genetic Engineering, 177, 182, 194 Genital, 7, 16, 25, 27, 28, 112, 133, 194, 196, 231, 232 Genotype, 194, 213 Germ Cells, 194, 210, 211, 225, 226, 229 Gestation, 194, 213, 214 Gestational, 77, 81, 96, 195, 207 Gestational trophoblastic disease, 77, 96, 195, 207 Gestational trophoblastic neoplasia, 195, 207 Gestational trophoblastic tumor, 81, 195, 207 Giardiasis, 195, 206 Gland, 172, 195, 204, 209, 212, 218, 220, 223, 227, 229 Glucocorticoid, 195, 206 Glucose, 5, 178, 187, 195, 197, 201, 222 Glycogen, 181, 195 Glycoprotein, 192, 193, 195, 229 Gonadal, 195, 226 Gonadorelin, 195 Gonadotropin, 28, 182, 195 Gonads, 180, 195 Gonorrhea, 157, 158, 195 Goserelin, 45, 195 Governing Board, 195, 216 Grade, 50, 73, 196 Grading, 18, 196 Graft, 19, 196 Grafting, 185, 196, 200 Gram-negative, 181, 196 Granulocytes, 196, 224, 233 Gravidity, 196, 212 Growth factors, 13, 16, 22, 26, 33, 196 Guanylate Cyclase, 196, 209 Gynaecological, 74, 90, 196 Gynecologic cancer, 7, 196 H Haematemesis, 190, 196 Headache, 179, 196 Health Care Costs, 39, 41, 196 Health Expenditures, 196 Health Status, 6, 10, 17, 196 Heart attack, 180, 197 Hematocrit, 48, 178, 197 Hematoxylin, 8, 197 Hemodilution, 69, 197 Hemoglobin, 17, 174, 178, 191, 197 Hemoglobin A, 17, 197
Hemorrhage, 65, 72, 189, 196, 197, 227, 228 Hemorrhoidectomy, 112, 197 Hemorrhoids, 197 Hemostasis, 197, 201, 224 Hepatic, 13, 28, 173, 197, 203 Hereditary, 124, 197 Heredity, 194, 197 Hernia, 86, 113, 190, 197 Hetastarch, 48, 197 Heterodimers, 197, 201 Hippocampus, 120, 187, 194, 197, 227 Histology, 197, 212 Homogeneous, 185, 198 Homologous, 173, 197, 198, 223, 228 Hormonal, 5, 7, 11, 26, 29, 35, 36, 192, 198 Hormone Replacement Therapy, 41, 51, 57, 76, 87, 91, 92, 125, 127, 198 Hormone therapy, 5, 172, 198 Human papillomavirus, 11, 85, 158, 198 Hybrid, 198 Hybridization, 73, 198 Hydrogen, 176, 179, 198, 203, 207, 209, 210, 211, 213, 218 Hydrolysis, 182, 198, 213, 215, 218 Hydrophobic, 198, 203 Hydroxylysine, 183, 198 Hydroxyproline, 183, 198 Hygienic, 189, 198 Hyperhomocysteinemia, 68, 186, 198 Hyperkeratosis, 174, 198 Hyperplasia, 8, 18, 26, 64, 198 Hypersensitivity, 119, 173, 198, 223 Hypertension, 17, 33, 123, 180, 196, 199 Hypertrophy, 198, 199 Hypnotic, 36, 199 Hypothalamic, 36, 199 Hypothalamus, 195, 199, 228 Hypothermia, 197, 199 Hysteroscopy, 18, 49, 199 Hysterotomy, 181, 199 I Iatrogenic, 127, 199 Id, 93, 102, 156, 159, 160, 166, 168, 199 Immersion, 177, 199 Immune function, 26, 199 Immune response, 15, 171, 175, 176, 199, 223, 227, 233 Immune system, 26, 175, 177, 199, 204, 205, 207, 232, 233 Immunization, 199, 223 Immunodeficiency, 158, 199 Immunoglobulin, 174, 199, 207
Index 241
Immunohistochemistry, 7, 8, 16, 26, 34, 199 Immunologic, 9, 199, 220 Immunology, 171, 172, 199 Impairment, 10, 36, 120, 192, 199, 206, 219 Implant radiation, 200, 201, 220 Implantation, 110, 184, 200, 209, 210 Impotence, 191, 200, 212 In situ, 8, 200 In Situ Hybridization, 8, 200 In vitro, 13, 17, 23, 178, 190, 200 In vivo, 17, 23, 34, 200 Incision, 114, 116, 117, 183, 191, 199, 200, 202, 203, 218 Incontinence, 4, 14, 22, 35, 38, 40, 46, 80, 83, 103, 121, 123, 126, 141, 143, 144, 200, 227 Indicative, 28, 127, 200, 212, 232 Induction, 23, 83, 200, 202 Infancy, 124, 200 Infant Mortality, 21, 200 Infant, Newborn, 172, 200 Infarction, 185, 200, 206, 208 Infertility, 13, 15, 115, 125, 158, 200, 231 Infiltration, 61, 72, 200 Inflammation, 22, 173, 175, 186, 192, 200, 218, 232 Informed Consent, 9, 200 Infusion, 201, 230 Ingestion, 13, 198, 201, 215 Innervation, 53, 201 Inorganic, 182, 201, 207 Inpatients, 74, 201 Insight, 13, 27, 201 Instillation, 72, 201 Insulator, 201, 207 Insulin, 11, 21, 201 Insulin-dependent diabetes mellitus, 201 Insulin-like, 11, 201 Integrins, 13, 201 Interleukin-1, 27, 201 Interleukin-2, 201 Intermittent, 201, 204 Internal radiation, 201, 220 Interpersonal Relations, 16, 201 Interstitial, 126, 143, 178, 192, 201 Intestinal, 118, 133, 201 Intestine, 178, 190, 201, 203 Intoxication, 202, 233 Intracellular, 33, 179, 200, 201, 202, 209, 217, 221, 224 Intraepithelial, 53, 202
Intravascular, 20, 202 Intravenous, 43, 72, 201, 202 Intrinsic, 23, 172, 176, 202 Intubation, 180, 202 Invasive, 11, 13, 18, 23, 26, 39, 40, 44, 68, 72, 78, 114, 116, 130, 136, 143, 202 Invasive cervical cancer, 11, 44, 68, 72, 78, 202 Involuntary, 193, 202, 208, 225, 227 Ionizing, 173, 191, 202, 220 Ions, 176, 188, 198, 202, 218 Ischemia, 19, 202 J Joint, 37, 38, 176, 202, 211, 228 K Kb, 150, 202 Ketamine, 100, 202 Ketorolac, 43, 202 Kidney Pelvis, 202, 231 Kidney stone, 126, 202 Kidney Transplantation, 126, 202 L Lacerations, 191, 202 Lacrimal, 172, 202 Lacrimal Apparatus, 172, 202 Lactation, 202, 210, 211 Laparoscopy, 80, 91, 100, 126, 202 Laparotomy, 45, 54, 203 Large Intestine, 202, 203, 221, 225 Latent, 7, 203, 216 Leg Ulcer, 76, 203 Leiomyoma, 8, 13, 15, 19, 23, 33, 35, 58, 66, 193, 203, 225 Lens, 203, 222 Lesion, 18, 185, 203, 204, 231 Leukocytes, 27, 176, 177, 178, 191, 196, 203, 207, 209 Levonorgestrel, 42, 203, 209 Library Services, 166, 203 Ligament, 30, 54, 143, 203, 218 Ligands, 201, 203 Ligation, 86, 87, 114, 203 Linkage, 29, 203, 213 Lipid, 5, 120, 175, 201, 203, 207, 211 Lipid Peroxidation, 203, 211 Lipoprotein, 20, 196, 203, 204 Liver, 81, 171, 173, 176, 177, 186, 190, 192, 193, 194, 195, 197, 203, 204 Liver Cirrhosis, 81, 203 Lobe, 39, 204, 212 Localization, 16, 199, 204 Localized, 171, 186, 193, 200, 204, 214, 231
242 Hysterectomy
Longitudinal study, 18, 22, 204 Long-Term Care, 125, 204 Loop, 13, 118, 197, 204 Low-density lipoprotein, 203, 204 Lubricants, 204, 213 Lubrication, 16, 204 Lumen, 118, 204 Luteal Phase, 204, 206 Lymph, 76, 77, 114, 181, 190, 204, 209 Lymph node, 76, 77, 114, 181, 204, 209 Lymphadenectomy, 44, 48, 50, 64, 67, 68, 99, 114, 132, 136, 204 Lymphatic, 67, 190, 200, 204, 215, 225, 226 Lymphatic system, 204, 225, 226 Lymphocyte, 26, 175, 204, 205 Lymphography, 136, 204 Lymphoid, 174, 205 Lysophospholipids, 21, 205 Lytic, 205, 233 M Macrophage, 13, 201, 205 Malignancy, 11, 18, 24, 25, 32, 205, 212 Malignant, 7, 18, 25, 171, 175, 179, 182, 195, 205, 208, 220, 223, 229 Malignant tumor, 179, 182, 205 Malnutrition, 173, 205 Mammary, 185, 205, 220, 228 Manic, 205, 219 Manic-depressive psychosis, 205, 219 Mastectomy, 113, 205 Mediate, 23, 205 Mediator, 201, 205, 224 Medical Records, 35, 39, 40, 205, 230 Medicament, 205, 227 Medication Errors, 38, 205 MEDLINE, 151, 205 Medroxyprogesterone, 20, 146, 205 Medroxyprogesterone Acetate, 20, 205 Membrane, 184, 187, 190, 192, 196, 205, 207, 211, 214, 215, 222, 224, 228, 230 Memory, 6, 36, 123, 187, 205 Menarche, 119, 125, 205 Meninges, 181, 205 Menorrhagia, 15, 61, 68, 91, 119, 140, 206 Menstrual Cycle, 12, 16, 26, 115, 119, 125, 204, 206, 210, 217 Menstruation, 12, 28, 115, 119, 124, 173, 187, 189, 204, 206 Mental Disorders, 206, 219 Mental Health, iv, 5, 150, 152, 206, 219 Mental Processes, 188, 206, 219 Mesentery, 206, 213
Metastatic, 91, 99, 195, 206 Metronidazole, 53, 206 MI, 26, 170, 206 Microbiology, 9, 176, 206 Microcirculation, 197, 203, 206 Microorganism, 174, 183, 206, 233 Microscopy, 18, 26, 176, 197, 206 Microtubules, 206, 212 Micturition, 53, 206 Mifepristone, 115, 206 Migration, 34, 91, 206 Milliliter, 178, 206 Miscarriage, 23, 125, 207 Mitosis, 175, 207 Mitotic, 115, 207 Mobility, 25, 207 Modification, 41, 80, 114, 194, 207, 220 Molar pregnancy, 195, 207 Molecular, 13, 14, 15, 19, 24, 25, 26, 32, 34, 151, 153, 173, 177, 184, 187, 192, 193, 207, 221 Molecule, 175, 176, 177, 183, 188, 190, 198, 207, 210, 211, 220, 221, 224, 230, 232 Monitor, 11, 17, 207, 209 Monoclonal, 23, 207, 220 Monocytes, 201, 203, 207 Morphine, 72, 75, 80, 92, 207, 208, 210 Morphological, 190, 207 Motility, 34, 207, 224 Motion Sickness, 207, 208 Mucinous, 28, 207 Mucosa, 27, 207 Mucus, 207 Multimodality treatment, 44, 95, 207 Multiple sclerosis, 49, 125, 207 Muscle Contraction, 10, 207 Muscle Fibers, 208 Mutagenic, 22, 208 Mydriatic, 188, 208 Myelin, 207, 208 Myocardial Ischemia, 185, 208 Myocardium, 206, 208 Myometrium, 15, 16, 21, 23, 24, 34, 208 Myopathy, 72, 208 Myosin, 21, 207, 208 Myotonic Dystrophy, 82, 208 N Narcotic, 193, 207, 208 Nausea, 47, 97, 208 NCI, 1, 11, 149, 182, 208 Necrosis, 175, 200, 206, 208
Index 243
Need, 3, 17, 32, 114, 115, 116, 123, 127, 131, 132, 133, 142, 144, 162, 172, 195, 208 Needle biopsy, 126, 193, 208 Neocortex, 120, 208 Neonatal, 78, 80, 87, 200, 208 Neoplasia, 11, 18, 53, 208 Neoplasm, 11, 13, 174, 208, 223, 231 Nephrectomy, 126, 209 Nervous System, 181, 205, 209, 227 Networks, 161, 209 Neurogenic, 17, 209, 231 Neurons, 187, 208, 209, 228 Neutrons, 173, 209, 220 Neutrophils, 196, 203, 209 Nidation, 190, 209 Nitric Oxide, 17, 209 Nitrogen, 173, 193, 209, 231 Node-negative, 47, 209 Norepinephrine, 172, 209 Norgestrel, 203, 209 Nuclear, 16, 18, 189, 192, 194, 208, 209 Nucleic acid, 198, 200, 209, 210 Nucleic Acid Hybridization, 198, 210 Nucleus, 175, 176, 182, 186, 191, 192, 194, 207, 209, 210, 217, 218 Nulliparous, 86, 210 O Observational study, 42, 58, 65, 210 Oestradiol, 90, 91, 210 Oestrogen, 90, 121, 210 Ointments, 210, 212 Oncogenic, 19, 201, 210, 218, 219 Oocytes, 28, 210 Oophorectomy, 29, 40, 44, 51, 52, 59, 61, 77, 87, 92, 123, 130, 210 Opacity, 187, 210 Ophthalmology, 193, 210 Opium, 207, 210 Optic Chiasm, 199, 210, 228 Orchiectomy, 126, 211 Orderly, 18, 211 Orgasm, 16, 143, 211 Osmotic, 173, 211 Osteoarthritis, 58, 211 Osteoporosis, 15, 17, 29, 41, 123, 124, 192, 210, 211, 220 Outpatient, 14, 39, 40, 211 Ovarian Cysts, 109, 211 Ovaries, 22, 29, 79, 91, 114, 157, 191, 192, 196, 210, 211, 217, 222, 224, 231 Ovary, 16, 29, 91, 99, 132, 185, 192, 195, 210, 211
Overactive bladder, 143, 211 Overall survival, 32, 211 Ovum, 185, 187, 195, 211, 216, 233 Oxidation, 175, 203, 211 Oxidative metabolism, 13, 172, 211 Oxidative Stress, 22, 211 Oxytocin, 21, 40, 211 P Paclitaxel, 44, 95, 211 Palliative, 210, 212, 229 Pancreas, 171, 201, 212, 231 Papillomavirus, 158, 212 Paraffin, 8, 33, 212 Parietal, 212, 213 Parity, 10, 212 Particle, 212, 230 Parturition, 35, 40, 210, 212 Pathogenesis, 13, 24, 25, 26, 28, 212 Pathologic, 16, 50, 175, 177, 185, 198, 212 Pathologic Processes, 175, 212 Pathophysiology, 34, 212 Patient Education, 157, 164, 166, 170, 212 Patient Satisfaction, 30, 38, 212 Patient Selection, 126, 212 Pelvic inflammatory disease, 157, 158, 212 Penile Prosthesis, 126, 212 Penis, 126, 184, 212, 213, 216 Peptide, 213, 215, 218 Perinatal, 7, 56, 125, 200, 213 Perineal, 40, 86, 127, 213 Perineum, 213 Peripheral blood, 37, 213 Peripheral stem cell support, 48, 97, 213 Peripheral stem cell transplantation, 213 Peritoneal, 13, 61, 116, 176, 213 Peritoneal Cavity, 176, 213 Peritoneum, 45, 69, 111, 117, 206, 213, 222 Perivascular, 12, 213 Petroleum, 212, 213 PH, 30, 69, 70, 83, 178, 213 Phagocytosis, 13, 213 Phallic, 193, 213 Pharmacologic, 24, 174, 213, 230, 231 Phenotype, 15, 19, 21, 213 Phosphatidic Acids, 205, 213 Phospholipases, 213, 224 Phospholipids, 192, 203, 214 Phosphorus, 179, 214 Phosphorylation, 21, 214 Photocoagulation, 183, 214 Physical Examination, 181, 214 Physical Fitness, 123, 214
244 Hysterectomy
Physical Therapy, 30, 214 Physiologic, 16, 27, 34, 40, 172, 177, 182, 206, 214, 217, 221 Physiology, 26, 124, 126, 190, 196, 214 Pilot study, 31, 56, 99, 214 Pineal Body, 214 Pineal gland, 36, 182, 214 Placenta, 16, 69, 192, 194, 214, 216, 219 Plague, 31, 214 Plants, 173, 176, 179, 195, 209, 214, 222, 230 Plaque, 174, 214 Plasma, 7, 173, 174, 178, 181, 192, 193, 194, 197, 215, 218, 223, 233 Plasma cells, 174, 215 Plasma protein, 173, 215, 218 Plasma Volume, 178, 215 Platelet Activation, 20, 215, 224 Platelet Aggregation, 209, 215 Platelets, 20, 209, 215, 229 Platinum, 182, 204, 215 Plexus, 120, 215 Poisoning, 202, 208, 215 Polymorphic, 35, 187, 215 Polyp, 54, 118, 215 Polypeptide, 173, 183, 193, 198, 215, 233 Polysaccharide, 175, 215 Port, 110, 115, 118, 132, 215 Port-a-cath, 215 Posterior, 49, 71, 117, 132, 174, 189, 191, 211, 212, 214, 215, 222 Postmenopausal, 11, 16, 19, 20, 41, 192, 211, 215, 220 Postoperative, 4, 27, 30, 31, 43, 47, 52, 53, 55, 59, 61, 72, 81, 97, 99, 101, 108, 143, 215 Postpartum Hemorrhage, 84, 86, 87, 215 Postsynaptic, 216, 224, 228 Potentiates, 201, 216 Potentiation, 216, 224 Practicability, 216, 230 Practice Guidelines, 152, 159, 216 Precancerous, 181, 216 Precursor, 26, 28, 176, 191, 209, 216, 218, 231 Predisposition, 22, 25, 216 Premalignant, 7, 216 Premenopausal, 15, 21, 29, 45, 61, 100, 216 Prenatal, 124, 190, 216 Prenatal Care, 124, 216 Prepuce, 182, 216 Presynaptic, 216, 228
Prevalence, 14, 17, 20, 35, 37, 40, 59, 120, 216 Priapism, 126, 216 Primary endpoint, 32, 216 Probe, 39, 40, 109, 216 Progesterone, 6, 8, 12, 23, 91, 104, 115, 203, 206, 209, 216, 226 Progestogen, 11, 217 Prognostic factor, 52, 68, 100, 217 Progression, 11, 18, 19, 24, 26, 174, 217 Progressive, 16, 34, 49, 180, 187, 189, 192, 196, 208, 211, 215, 217, 231 Prolapse, 10, 14, 30, 35, 46, 62, 67, 70, 71, 73, 75, 79, 85, 86, 126, 133, 136, 143, 144, 217 Proline, 183, 198, 217 Promotor, 217, 222 Prone, 31, 217 Prophase, 210, 217, 228 Prophylactic oophorectomy, 51, 52, 217 Prophylaxis, 38, 217 Prospective study, 44, 204, 217 Prostaglandin, 92, 217 Prostaglandins A, 22, 217 Prostaglandins D, 218 Prostaglandins F, 206, 218 Prostate, 126, 195, 210, 218, 230, 231 Prostatectomy, 126, 143, 144, 218 Prosthesis, 113, 218 Prosthesis Design, 113, 218 Protein C, 34, 173, 175, 176, 203, 218 Protein S, 132, 177, 218, 219 Proteolytic, 183, 193, 218 Prothrombin, 218, 229 Protocol, 18, 30, 126, 218 Protons, 173, 198, 202, 218, 220 Proto-Oncogene Proteins, 212, 218, 219 Proto-Oncogene Proteins c-mos, 212, 219 Proximal, 39, 40, 109, 110, 111, 114, 188, 216, 219 Psychiatric, 206, 219, 225 Psychiatry, 36, 193, 219 Psychic, 96, 182, 219 Psychogenic, 219, 231 Psychology, 136, 188, 219 Psychosis, 96, 195, 219 Psychosomatic, 83, 98, 219 Public Health, 14, 20, 29, 40, 59, 92, 132, 152, 219 Public Policy, 151, 219 Publishing, 41, 124, 219 Puerperium, 210, 219
Index 245
Pulmonary, 73, 178, 184, 219, 232 Pulmonary Artery, 178, 219, 232 Pulse, 207, 219 Pupil, 185, 188, 208, 219 Puromycin, 21, 219 Purulent, 220, 232 Q Quality of Life, 14, 16, 30, 36, 38, 40, 41, 143, 220 R Race, 10, 22, 29, 124, 203, 206, 209, 220 Radiation, 32, 52, 57, 74, 92, 96, 100, 172, 191, 192, 193, 194, 201, 202, 206, 220, 233 Radiation therapy, 32, 52, 74, 92, 96, 100, 172, 192, 201, 220 Radioactive, 198, 200, 201, 209, 210, 220 Radioimmunotherapy, 220 Radioisotope, 127, 191, 220 Radiolabeled, 220 Radiological, 126, 220 Radiology, 57, 84, 92, 160, 220 Radiotherapy, 47, 52, 85, 87, 96, 178, 220 Raloxifene, 15, 220, 223 Random Allocation, 220 Randomization, 6, 20, 220 Randomized clinical trial, 38, 45, 75, 97, 221 Reactive Oxygen Species, 33, 221 Reality Testing, 219, 221 Receptor, 13, 16, 21, 23, 27, 175, 184, 206, 221, 224 Receptors, Serotonin, 221, 224 Recombinant, 15, 34, 221, 232 Rectal, 30, 54, 75, 112, 221 Rectovaginal Fistula, 127, 221 Rectum, 117, 175, 178, 187, 193, 194, 200, 203, 218, 221, 224, 227 Recurrence, 11, 32, 52, 73, 76, 82, 85, 181, 182, 205, 221 Refer, 1, 179, 183, 193, 204, 209, 219, 220, 221, 232 Regimen, 7, 12, 18, 31, 189, 221 Relapse, 48, 97, 221 Remission, 205, 221 Renal pelvis, 202, 221 Renovascular, 126, 221 Resected, 8, 221 Resection, 61, 62, 76, 119, 135, 136, 221, 230 Residual disease, 80, 221 Resolving, 119, 222 Respiration, 175, 179, 207, 222
Response Elements, 16, 222 Restoration, 214, 222, 233 Retina, 203, 210, 222 Retractor, 116, 117, 222 Retrograde, 28, 222 Retroperitoneal, 44, 68, 71, 108, 110, 222 Retroperitoneal Space, 108, 110, 222 Retropubic, 218, 222 Retrospective, 4, 35, 40, 222 Retroviral vector, 21, 222 Ribose, 171, 222 Risk factor, 4, 5, 16, 20, 28, 35, 36, 37, 40, 62, 73, 76, 77, 120, 124, 158, 191, 198, 217, 222 Risk patient, 18, 222 Rod, 108, 109, 182, 222 Rotator, 109, 222 S Salpingo-oophorectomy, 90, 98, 222 Saphenous, 19, 185, 222 Saphenous Vein, 19, 185, 222 Saponins, 222, 226 Sarcoma, 73, 223 Scalpel, 62, 117, 223 Schizoid, 223, 233 Schizophrenia, 223, 233 Schizotypal Personality Disorder, 223, 233 Sclerosis, 207, 223 Screening, 11, 54, 120, 182, 223 Scrotum, 126, 223, 229, 232 Secretion, 13, 71, 182, 195, 201, 202, 207, 223 Secretory, 13, 27, 115, 223, 228 Sedative, 36, 223 Segmentation, 18, 223 Selection Bias, 20, 223 Selective estrogen receptor modulator, 220, 223, 228 Semen, 218, 223 Seminal vesicles, 223, 232 Senile, 211, 223 Sensibility, 174, 223 Sensitization, 31, 223 Serine, 186, 195, 219, 224 Serotonin, 33, 221, 224, 231 Serous, 28, 190, 224 Serum, 8, 11, 29, 61, 67, 77, 92, 108, 110, 173, 183, 195, 204, 224 Sex Characteristics, 172, 210, 224, 229 Sexual Abstinence, 159, 224 Sexually Transmitted Diseases, 9, 27, 224 Shock, 22, 224, 230
246 Hysterectomy
Side effect, 15, 115, 145, 172, 177, 224, 230 Sigmoid, 135, 224 Sigmoid Colon, 135, 224 Sigmoidoscopy, 54, 224 Signal Transduction, 17, 37, 224 Signs and Symptoms, 221, 224 Skeletal, 12, 182, 224, 228 Skeleton, 171, 202, 217, 224, 225 Skin graft, 225, 226 Skull, 225, 229 Sleep apnea, 36, 225 Sleep Deprivation, 27, 225 Sleep Stages, 27, 225 Small intestine, 177, 182, 189, 195, 198, 202, 225 Smooth muscle, 8, 15, 17, 23, 24, 33, 34, 179, 184, 193, 203, 207, 208, 218, 225, 227, 231 Smooth Muscle Tumor, 8, 193, 225 Sneezing, 225, 227 Social Environment, 220, 225 Social Support, 124, 225 Social Work, 97, 125, 225 Sodium, 188, 225 Solid tumor, 25, 174, 177, 225 Soma, 225 Somatic, 28, 125, 172, 182, 207, 225, 229 Somatic mutations, 28, 225 Specialist, 161, 188, 225 Species, 12, 181, 191, 198, 206, 207, 220, 221, 226, 227, 230, 231, 233 Specificity, 77, 172, 226 Sperm, 182, 225, 226, 229, 232 Spermatozoa, 223, 226, 232 Sphincter, 226, 227 Spinal cord, 181, 191, 205, 209, 216, 226 Spleen, 79, 186, 204, 226 Sporadic, 120, 226 Squamous, 11, 226 Staging, 35, 226 Statistically significant, 16, 32, 111, 226 Steel, 182, 226 Stem Cells, 192, 213, 226 Stents, 126, 226 Sterility, 45, 49, 64, 76, 79, 158, 200, 226 Sterilization, 132, 226 Steroid, 16, 26, 35, 115, 185, 210, 222, 226 Stimulant, 179, 226 Stimulus, 185, 189, 201, 227, 229 Stomach, 171, 194, 198, 208, 213, 225, 226, 227 Stool, 200, 203, 227
Stress, 10, 27, 40, 80, 83, 86, 126, 133, 143, 185, 208, 211, 216, 227 Stress incontinence, 10, 86, 133, 143, 227 Stress urinary, 80, 126, 227 Stricture, 126, 227 Stroke, 123, 150, 180, 227 Stroma, 12, 34, 119, 227 Stromal, 20, 26, 73, 190, 227 Stump, 48, 56, 227 Subacute, 200, 227 Subclinical, 200, 227 Subcutaneous, 15, 203, 227 Subiculum, 197, 227 Subspecies, 226, 227 Substance P, 217, 223, 227 Suction, 55, 110, 111, 227 Sufentanil, 72, 227 Supplementation, 41, 100, 227 Suppositories, 110, 194, 227 Suppression, 28, 227 Suprachiasmatic Nucleus, 36, 227 Surgical Equipment, 114, 228 Surgical Instruments, 111, 117, 228 Survival Rate, 211, 228 Suspensions, 9, 228 Symphysis, 218, 228 Symptomatic, 19, 22, 33, 66, 228 Symptomatology, 3, 228 Synapses, 120, 228 Synaptic, 224, 228 Synaptic Vesicles, 228 Systemic, 8, 12, 110, 146, 175, 178, 191, 200, 220, 228 Systolic, 199, 228 T Talc, 22, 28, 228 Tamoxifen, 15, 63, 75, 76, 223, 228 Tamponade, 79, 228 Tarsal Bones, 179, 228 Telomerase, 21, 229 Temporal, 34, 197, 229 Testicles, 211, 223, 229, 232 Testis, 182, 192, 195, 210, 229 Testosterone, 91, 92, 229 Therapeutics, 146, 229 Thermal, 188, 209, 229 Thorax, 171, 229 Threshold, 199, 229 Thrombin, 52, 193, 215, 218, 229 Thrombocytes, 215, 229 Thrombomodulin, 218, 229 Thromboses, 68, 229
Index 247
Thrombosis, 6, 201, 218, 227, 229 Thyroid, 140, 229, 231 Thyroid Gland, 229 Thyroxine, 67, 173, 229 Time and Motion Studies, 127, 132, 229 Tomography, 72, 178, 229 Topical, 52, 212, 229 Total hysterectomy, 3, 7, 16, 46, 49, 71, 76, 82, 87, 92, 109, 136, 140, 158, 229 Toxic, iv, 28, 186, 191, 229, 230 Toxicity, 189, 230 Toxicology, 152, 230 Toxins, 175, 191, 200, 220, 230 Trachea, 229, 230 Traction, 117, 182, 230 Transcriptase, 229, 230 Transcription Factors, 222, 230 Transduction, 15, 17, 224, 230 Transfection, 23, 177, 230 Transfer Agreement, 21, 230 Transfusion, 192, 230 Transgenes, 19, 230 Translational, 7, 24, 230 Transmitter, 171, 205, 209, 228, 230 Transplantation, 10, 190, 199, 213, 230 Transurethral, 218, 230 Transurethral Resection of Prostate, 218, 230 Trauma, 35, 49, 62, 95, 116, 126, 127, 196, 208, 230 Treatment Outcome, 61, 230 Trichomoniasis, 206, 230 Tryptophan, 183, 224, 231 Tubal ligation, 22, 28, 73, 231 Tuberculosis, 184, 231 Tumor marker, 8, 231 Tumor suppressor gene, 7, 14, 26, 231 Tumour, 61, 231 Tunica Media, 16, 231 Tyrosine, 180, 231 U Ulcer, 203, 231, 232 Unconscious, 187, 199, 231 Ureter, 4, 62, 114, 116, 117, 126, 202, 221, 231 Urethra, 3, 120, 126, 212, 218, 230, 231 Urinary Fistula, 127, 231 Urinary Retention, 82, 186, 231 Urinary tract, 3, 4, 62, 83, 90, 231 Urinate, 231 Urine, 8, 27, 177, 184, 188, 200, 202, 206, 221, 227, 231
Urodynamic, 4, 83, 126, 231 Urogenital, 195, 231 Urology, 16, 30, 83, 126, 231 Uterine Contraction, 211, 232 Uterine Prolapse, 14, 135, 232 Uterine Rupture, 63, 232 V Vaccine, 171, 218, 232 Vaginal Discharge, 158, 232 Vaginitis, 157, 232 Vaginosis, 53, 232 Varicose, 203, 232 Vas Deferens, 126, 232 Vascular, 16, 20, 24, 33, 174, 190, 198, 200, 203, 206, 209, 214, 229, 232 Vasectomy, 126, 232 Vasoactive, 16, 232 Vasodilators, 209, 232 Vasomotor, 192, 232 Vector, 230, 232 Vein, 6, 20, 68, 202, 209, 222, 232 Venous, 87, 178, 197, 203, 218, 232 Ventral, 86, 199, 232 Ventricle, 197, 199, 214, 219, 228, 232 Venules, 178, 206, 232 Vestibular, 120, 232 Vestibule, 232 Veterinary Medicine, 9, 121, 151, 233 Vinca Alkaloids, 233 Vincristine, 92, 99, 100, 233 Viral, 7, 210, 230, 233 Viral Load, 7, 233 Virulent, 110, 233 Virus, 7, 158, 176, 190, 194, 198, 214, 222, 230, 233 Viscera, 206, 225, 233 Visceral, 30, 69, 213, 233 Vitro, 23, 233 Vivo, 17, 23, 233 W Warts, 158, 198, 233 Weight Gain, 119, 233 White blood cell, 175, 203, 204, 205, 207, 215, 233 Windpipe, 229, 233 Withdrawal, 108, 110, 233 Womb, 156, 232, 233 Wound Healing, 201, 233 X Xenograft, 23, 174, 233 X-ray, 174, 178, 194, 209, 220, 233
248 Hysterectomy
Y Yeasts, 213, 233
Z Zymogen, 218, 233
Index 249
250 Hysterectomy
Index 251
252 Hysterectomy
