PELVIC
INFLAMMATORY DISEASE A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES
J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS
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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2004 by ICON Group International, Inc. Copyright 2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1
Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Pelvic Inflammatory Disease: 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: 0-597-84514-X 1. Pelvic Inflammatory Disease-Popular works. I. Title.
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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.
Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail:
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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 pelvic inflammatory disease. 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 PELVIC INFLAMMATORY DISEASE ............................................................ 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Pelvic Inflammatory Disease......................................................... 6 E-Journals: PubMed Central ....................................................................................................... 41 The National Library of Medicine: PubMed ................................................................................ 43 CHAPTER 2. NUTRITION AND PELVIC INFLAMMATORY DISEASE .................................................. 89 Overview...................................................................................................................................... 89 Finding Nutrition Studies on Pelvic Inflammatory Disease ....................................................... 89 Federal Resources on Nutrition ................................................................................................... 90 Additional Web Resources ........................................................................................................... 90 CHAPTER 3. BOOKS ON PELVIC INFLAMMATORY DISEASE ............................................................ 93 Overview...................................................................................................................................... 93 Book Summaries: Federal Agencies.............................................................................................. 93 Chapters on Pelvic Inflammatory Disease ................................................................................... 94 CHAPTER 4. MULTIMEDIA ON PELVIC INFLAMMATORY DISEASE ................................................. 97 Overview...................................................................................................................................... 97 Video Recordings ......................................................................................................................... 97 CHAPTER 5. PERIODICALS AND NEWS ON PELVIC INFLAMMATORY DISEASE .............................. 99 Overview...................................................................................................................................... 99 News Services and Press Releases................................................................................................ 99 Academic Periodicals covering Pelvic Inflammatory Disease.................................................... 101 CHAPTER 6. RESEARCHING MEDICATIONS .................................................................................. 103 Overview.................................................................................................................................... 103 U.S. Pharmacopeia..................................................................................................................... 103 Commercial Databases ............................................................................................................... 104 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 109 Overview.................................................................................................................................... 109 NIH Guidelines.......................................................................................................................... 109 NIH Databases........................................................................................................................... 111 Other Commercial Databases..................................................................................................... 113 APPENDIX B. PATIENT RESOURCES ............................................................................................... 115 Overview.................................................................................................................................... 115 Patient Guideline Sources.......................................................................................................... 115 Finding Associations.................................................................................................................. 122 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 125 Overview.................................................................................................................................... 125 Preparation................................................................................................................................. 125 Finding a Local Medical Library................................................................................................ 125 Medical Libraries in the U.S. and Canada ................................................................................. 125 ONLINE GLOSSARIES................................................................................................................ 131 Online Dictionary Directories ................................................................................................... 134 PELVIC INFLAMMATORY DISEASE DICTIONARY.......................................................... 135 INDEX .............................................................................................................................................. 181
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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 pelvic inflammatory disease 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 pelvic inflammatory disease, 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 pelvic inflammatory disease, 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 pelvic inflammatory disease. Abundant guidance is given on how to obtain free-ofcharge 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 pelvic inflammatory disease, 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 pelvic inflammatory disease. 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 PELVIC INFLAMMATORY DISEASE Overview In this chapter, we will show you how to locate peer-reviewed references and studies on pelvic inflammatory disease.
The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and pelvic inflammatory disease, 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 “pelvic inflammatory disease” (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: •
Appendicitis in Children: New Insights Into an Old Problem Source: Patient Care. 34(5): 183-188, 191-195. March 15, 2000. Contact: Available from Medical Economics. 5 Paragon Drive, Montvale, NJ 07645. (800) 432-4570. Fax (201) 573-4956. Summary: Acute appendicitis is the most common reason for emergency abdominal surgery in childhood. Despite strong emphasis on early surgical intervention, the morbidity and mortality of acute appendicitis in children remain high. This review article clarifies the symptoms to look for in the patient's history, the signs to assess during the physical examination, and the degree of confidence to place in various laboratory tests and radiologic studies. The authors reiterate that a thorough but speedy
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evaluation is essential when examining a child with possible appendicitis. Recent studies show that in ambiguous cases, computed tomography (CT scan), especially when performed with rectal contrast, is an excellent adjudicator. The authors review the anatomy and physiology of the appendix, then detail each step of the physical examination. After a discussion of the appropriate laboratory tests, the authors remind readers of the more common pediatric illnesses that mimic appendicitis, including gastroenteritis, constipation, mesenteric adenitis, urinary tract infection (UTI), inflammatory bowel disease (IBD), pelvic inflammatory disease (PID), ovarian cyst, and pneumonia. 8 figures. 2 tables. 22 references. •
Special Edition Women's Treatment Issues - Special Issue Source: Treatment Issues; Vol. 6, No. 7. Contact: Gay Mens Health Crisis, 119 W 24th St Tisch Bldg, New York, NY, 10011-1995, (212) 367-1205, http://www.gmhc.org. Summary: This journal special edition describes HIV disease in women and focuses specifically on the different manifestations of HIV and AIDS in the female. It addresses the barriers to care for women; discusses women, sex hormones, and HIV-infection; and includes information on fertility, menstruation, and birth control in HIV-positive women. The edition features articles on sexually transmitted diseases (STDs), with special emphasis on the stages, symptoms, and treatment of syphilis. It explains pelvic inflammatory disease (PID), concentrating on symptoms and treatment, and examines the relationship between human papillomavirus (HPV) and cervical cancer.
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Sexually Transmitted Diseases Treatment Guidelines 2002 Source: MMWR Morbidity and Mortality Weekly Report Recommendations and Reports May 10 2002;51(RR-6):1-84. Contact: US Government Printing Office, PO Box 371954, Pittsburgh, PA, 15250-7954, (202) 512-1800, http://www.access.gpo.gov. CDC National Prevention Information Network, PO Box 6003, Rockville, MD, 20849-6003, (800) 458-5231, http://www.cdcnpin.org. Summary: This report for health professionals provides guidelines and recommendations for the most effective treatment regimens, screening procedures, and prevention strategies for sexually transmitted diseases (STDs), which infect an estimated 15 million people each year in the United States. Some of the significant new recommendations and guidelines include (1) an expanded recommendation for chlamydia screening among women; (2) recommendations for alternative treatments for gonorrhea due to increasing drug resistance in California; (3) recommendations for health care providers to focus on risk assessment and counseling in addition to the clinical aspects of STD control, screening, and treatment; (4) findings from recent studies regarding the use of the spermicide Nonoxynol-9 (N-9); (5) expanded risk assessment and screening among gay and bisexual men; (6) new recommendations for treatment of recurrent genital herpes among persons infected with human immunodeficiency virus (HIV); and (7) a revised approach to the management of victims of sexual assault. The report also includes recommendations for screening and/or treatment of the following infections: epididymitis, pelvic inflammatory disease (PID), syphilis, trichomoniasis, human papillomavirus infection (HPV), hepatitis C, bacterial vaginosis, vulvovaginal candidiasis and scabies.
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Human Immunodeficiency Virus Infection in Women Source: Annals of Internal Medicine; Vol. 115, no. 10. Contact: Louisiana State University Medical Center, Delta Region AIDS Education and Training Center, 136 S Roman St 3rd Fl, New Orleans, LA, 70112, (504) 568-3855, http://www.lsumc.edu. Hahnemann Hospital, Department of Obstetrics/Gynecology, MS404, Broad and Vine Sts, Philadelphia, PA, 19102-1192. Summary: This reprint of a journal article examines the progression of Human immunodeficiency virus (HIV) infection in women. It points out that incidence of the disease is increasing rapidly, but says that little is known about the natural history and symptoms of HIV disease in women. It analyzes studies of gender-specific problems such as Candida Albicans and pelvic inflammatory disease (PID), and says there is a need for prospective studies of large groups of HIV-positive women.
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Introduction to STD Treatment Guidelines Source: The Provider; Vol. 19, No. 2. Contact: US Department of Health and Human Services, Public Health Service, Indian Health Service, Office of Human Resources, Clinical Support Center, 1616 E Indian School Rd, Ste 375, Phoenix, AZ, 85016, (602) 640-2140. Summary: This special issues of a journal lists the criteria for diagnosis of common sexually transmitted diseases (STDs) and discusses management strategies. It provides background information, clinical symptoms, and the latest Centers for Disease Control and Prevention (CDC) treatment recommendations. In addition, management of patients and their sex partners is discussed. When treating the following infections, HIV-positive patients are treated the same as HIV-negative: cervicitis, Urethritis, Trichomoniasis, and chlamydia. Other infections require more aggressive therapy for HIV-positive patients, including pelvic inflammatory disease (PID), herpes, and syphilis. Gonorrhea and papillomavirus infections are also examined.
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Management of the Patient with Urethritis Source: IHS Provider. 19(2): 29-40. February 1994. Contact: Available from IHS Clinical Support Center. 1616 East Indian School Road, Suite 375, Phoenix, AZ 85016. (602) 640-2140. Fax (602) 640-2138. Summary: Urethritis, or inflammation of the urethra, is caused by an infection characterized by the discharge of mucoid or purulent material and by burning during urination. This article outlines the management of the patient with urethritis. The two bacterial agents primarily responsible for urethritis among men are Neisseria gonorrhoeae and Chlamydia trachomatis. Testing to determine the specific diagnosis is recommended because both of these infections are reportable to State health departments. In addition, with a specific diagnosis, treatment compliance may be better and the likelihood of partner notification may be improved. If diagnostic tools are unavailable, health care providers should treat patients for both infections. The authors discuss patient care management, followup considerations, the management of sex partners, and special considerations for nongonococcal urethritis (NGU), mucopurulent cervicitis, chlamydial infections, gonococcal infections, human papillomavirus infection, trichomoniasis, and pelvic inflammatory disease (PID). (AA-M).
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Federally Funded Research on Pelvic Inflammatory Disease The U.S. Government supports a variety of research studies relating to pelvic inflammatory disease. 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 pelvic inflammatory disease. 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 pelvic inflammatory disease. The following is typical of the type of information found when searching the CRISP database for pelvic inflammatory disease: •
Project Title: AN INTERNET INTERVENTION TO INCREASE CHLAMYDIA SCREENING Principal Investigator & Institution: Allison, Jeroan J.; Associate Professor of Medicine; Medicine; University of Alabama at Birmingham Uab Station Birmingham, Al 35294 Timing: Fiscal Year 2002; Project Start 30-SEP-2000; Project End 29-SEP-2004 Summary: Background. Chlamydia trachomatis is the most common sexually transmitted bacterial infection in the United States, with 3 to 4 million cases occurring annually. Most cases occur in those less than 25 years old. Increased prevalence has been found in patients who live in inner cities, have a lower socioeconomic status, or are black. Up to 80 percent of women infected with Chlamydia are asymptomatic and do not seek medical care. In addition to Pelvic Inflammatory Disease (PID) and its sequelae, chlamydial infections also may facilitate acquisition of HIV. Treatment is simple, effective, and cost effective. Despite recommendations by the Centers for Disease Control and Prevention, most high-risk women are not being screened. The UAB Center for Outcomes and Effectiveness Research and Education, in collaboration with U.S. Quality Algorithms, the performance measurement subsidiary of Aetna U.S. Healthcare, proposes a controlled, group-randomized trial to increase adherence to guidelines for chlamydial screening in at-risk women. Specific Aims. (1) to increase rates of chlamydial screening for at-risk female patients; (2) to increase rates of treatment for Chlamydia; and (3) to decrease the incidence of PID. Methods. We will randomize 220 primary care physician offices and their at- risk female patients to either an intervention or control arm. Patient risk status will be defined by the specifications of HEDIS 2000. Our intervention consists of a year-long series of physician Internet learning modules that integrate case-based education with audit, feedback, and benchmarking of practice profiles. Analysis. The major comparison will be the differential improvement in screening rates of the two study arms as ascertained from administrative data. Patientlevel multivariable analyses will adjust for the extra-binomial variation resulting from patients being nested within physicians from the group randomized design.
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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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Significance. With a research team that has a proven record of collaboration, this project will produce an evidence-based and replicable intervention than can be sustained in the "real world," readily adapted by other health care organizations, and easily modified for other diseases. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: ANTICHLAMYDIAL PROTECTION BY MOLECULAR MIMCRY Principal Investigator & Institution: Whittum-Hudson, Judith A.; Professor; Internal Medicine; Wayne State University 656 W. Kirby Detroit, Mi 48202 Timing: Fiscal Year 2002; Project Start 01-JUN-1998; Project End 31-MAY-2004 Summary: (Adapted from the applicant's abstract): Chlamydia trachomatis is the leading cause worldwide of sexually transmitted disease and the most prevalent ocular pathogen. In addition to being the major cause of non-gonococcal urethritis and pelvic inflammatory disease, chlamydia are also the leading cause of preventable infectious blindness (trachoma) and are also associated with arthritis in a significant number of patients with Reiter's syndrome/Reactive arthritis. The public health costs of chlamydial infections and their sequelae are enormous. Identification of a protective antichlamydial vaccine would have important public health significance. We propose studies in a BALB/c ocular infection model induced by a human chlamydial biovar to further characterize the demonstrated long-lasting protective immunity against ocular infection induced by oral or systemic immunization with a monoclonal anti-idiotypic antibody (mAb2). The mAb2 is a functional and molecular mimic of the genus-specific chlamydial glycolipid exo-antigen, GLXA. We hypothesize that the basis for anti-id induced protection is that detrimental Th1- driven responses are shifted to Th2mediated protection and that the targeted specificity for GLXA rather than for surface proteins such as MOMP accounts for the protective responses. Since the anti-id is an immunogenic protein, it induces more effective immune responses than would be induced by the glycolipid GLXA Ag itself. Studies will be performed to test this hypothesis using primarily the mouse ocular model as a mucosal infection paradigm; immunization with the mAb, vaccine candidate will be used to (1) characterize the relative role of T and B cells in protective responses, (2) distinguish between requirements for mucosal versus systemic immunization with encapsulated vaccine, (3) determine requirements for maximal protection including adjuvants or additional chlamydial antigens in a cocktail vaccine, and (4) test for anti-id- induced protection in other chlamydial infection models including C. trachomatis and C. psittaci genital infection and arthritides. Humoral responses in sera and secretions and cytokine responses will be used to define the Th1 and Th2 components of protective immunity; immunohistochemistry, in situ hybridization, RT-PCR methods and functional assays will be used in normal and immunodeficient mice to distinguish local and systemic immune responses which correlated with reduced microbiologic and clinical disease. These studies will potentially reveal strategies to assess protection against chlamydial disease induced by other vaccine candidates. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: ANTIMICROBIALS AGAINST CHLAMYDIA AND GC INFECTION: IN VITRO STUDIES Principal Investigator & Institution: Cooper, Morris D.; Children's Hospital Med Ctr (Cincinnati) 3333 Burnet Ave Cincinnati, Oh 45229 Timing: Fiscal Year 2002
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Summary: Microbial pathogens which invade the genital mucosa have specific mechanisms which involve adherence, invasion, intracellular survival and exit as a means of production of pathogenicity. C. trachomatis is the most common sexually transmitted bacterial pathogen in this country causing about 4.5 million cases of chlamydia in men, women, and children. The majority of chlamydial infections in women are asymptomatic, sequealae of untreated infections are an important part of the pathogenesis of the disease. Infections due to N. gonorrhoeae, like those of C. trachomatis, remain a major cause of STDs. Further, they remain a major cause of pelvic inflammatory disease, tubal infertility, ectopic pregnancy and chronic pelvic pain in the United States. Epidemiologic data provide strong evidence that gonococcal infections facilitate the transmission of other STDs and studies have begun to elucidate the specific mechanisms through which this facilitation occurs(). In 1996, there were greater than 325,000 cases of gonorrhea reported in the United States. However, this rate has continued to decline since 1975 but still remains a significant cause of disease. Although adequate antimicrobial therapy exists for this infection rates are high (17 percent/100,000 population) and antimicrobial resistance is significant (29 percent of all isolates collected in 1996 were resistant to penicillin, tetracycline or both). Therefore, alternate methods of controlling the infection remains a high priority. Toward this end, we are aggressively pursuing antimicrobials which have potential as topical microbicides. Therefore, there is a critical need to find a microbicide that would interact with these pathogens either prior to or at the point of interaction with cells of the genital mucosa. We have decided to study a variety of chemical agents including detergents, bile salts and other compounds to determine their antichlamydial and antigonococcal activity in both in vitro assays using cell cultures and the human fallopian tube organ culture model. This proposal will address several questions which are central to the determination of useful microbicidal agents which will interrupt the interaction between the chlamydial elementary body and/or gonococci and receptors on the host cell surface. The specific aims of this proposal are: (1) To expand the human primary cell culture systems to evaluate in vitro the efficacy and cytotoxicity of potential topical antimicrobials to prevent infection of the genital mucosa by Chlamydia trachomatis and/or Neisseria gonorrhoeae. (2) Define the mechanism(s) by which select noncytotoxic candidate topical antimicrobials inhibit C. trachomatis and/or N. gonorrhoeae and (3) Isolate the HS glycosaminoglycans (GAGs) from human genital tract cells and organ cultures and identify fractions important for C. trachomatis adherence to cells. These studies should allow a detailed study of antimicrobials which will allow their potential as topical microbicides to be exploited. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: BACTERIAL VAGINOSIS-VAGINAL BIOFILM ANALYSIS Principal Investigator & Institution: Hedges, Spencer R.; Medicine; University of Alabama at Birmingham Uab Station Birmingham, Al 35294 Timing: Fiscal Year 2004; Project Start 05-DEC-2003; Project End 30-NOV-2005 Summary: (provided by applicant): Bacterial vaginosis (BV) is the most prevalent cause of symptomatic vaginal discharge in the U.S. and has been associated with numerous complications including pre term delivery of infants, pelvic inflammatory disease (PID), urinary tract infections (UTI) and acquisition/transmission of sexually transmitted diseases (STDs) including human immunodeficiency virus (HIV). Control of BV has been advocated as a means of decreasing the prevalence of these complications yet the etiology of BV remains unknown and the current treatment regimens are inadequate in terms of initial cure and recurrence rates. Until further insight is gained
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into the infectious etiology of BV, efforts to improve therapy and to prevent complications will be difficult. Although the bacteriology of BV has been well described using standard microbiological culture methods, it has been estimated that only <1% of microorganisms are culturable using standard techniques. Denaturing gradient gel electrophoresis (DGGE) combined with PCR is a powerful molecular technique that has been used to successfully detect microbial diversity in the gastrointestinal tract and the oral cavity. We propose to use DGGE to determine differences in the microbial biofilm of women with and without BV as well as comparing women with symptomatic and asymptomatic BV to understand more about the pathogenesis of BV. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: BIOLOGY OF CHLAMYDIA AND GONOCOCCAL LIPID A Principal Investigator & Institution: Golenbock, Douglas T.; Boston Medical Center Gambro Bldg, 2Nd Fl, 660 Harrison Ave, Ste a Boston, Ma 02118 Timing: Fiscal Year 2002 Summary: The response of phagocytic leukocytes to mucosal infection with N. gonorrhoeae (GC) and C. trichomatis (CT) is an important aspect of both the protective immune response to infection and the development of pelvic inflammatory disease (PID). We hypothesize that innate immune responses determine the extent of GC and CT invasion and the nature of histopathological changes which result from infection. Within hours to days of mucosal infection, phagocytic leukocytes populate the genital tract. The initial movement of phagocytes from the bloodstream to the tissues, and the initial stages of bacterial killing, involve complex interactions of the leukocyte integrin CR3 (CD11b/CD18) with its ligands. CRC functions as a phagocytic receptor for Gramnegative bacteria and activated complement fragments. We believe that CR3 plays a key role during the process of bacterial invasion, limiting the extent of infection, possibly at the price of exacerbating host injury. During the initial stages of invasion, LPS present in the outer membrane of GC and CT activate the production of inflammatory cytokines by both professional and non-professional phagocytic cells via LPS receptors. Thus, proteins which enable or enhance recognition of LPS may be important anti-bacterial defenses. For example, LPS binding protein (LBP) and soluble CD14 (sCD14), which are present in blood and genital tract secretions, bind Gram-negative bacteria, and have been shown to enhance the binding of bacteria to phagocytic leukocytes. We hypothesize that innate immune recognition of GC and CT is enhanced by opsonization with Scd14. We propose to address the role of innate immune responses to GC and CT infection by examining the role of these LPS receptors CR3 and CD14 in the host response to urogenital infection with thee pathogens. We will first determine the levels of LBP and sCD14 in human clinical specimens, including patients with GC and CT infection. Then, we will examine if LBP and sCD14 opsonize GC and CT both in vitro and in vivo. CR3- mediated signal transduction will be explored using newly available CD14+ cell lines with defects in the CD14 signal transduction pathway. Finally, the role of CR3 in CT mucosal infections will be examined through the use of a genetically engineered "knockout" mouse deficient in the expression of CR3. Mice will be tested in a lower tract infection model of PID in the belief that the targeted gene deletion will compromise innate immune resistance to CT. We believe these studies will add important new knowledge about the role of innate immunity in the defense of GC and CT infections. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: BV TRANSMISSION
ETIOLOGY,
NATURAL
HISTORY,
AND
SEXUAL
Principal Investigator & Institution: Wawer, Maria J.; Professor; Population and Family Health; Columbia University Health Sciences New York, Ny 10032 Timing: Fiscal Year 2002; Project Start 01-SEP-2000; Project End 31-MAY-2005 Summary: The proposed study will test hypotheses regarding microbiological, virological and behavioral risk factors for the development of bacterial vaginosis (BV), a common vaginal condition which is increasingly recognized as having serious health sequelae, including adverse pregnancy outcomes, pelvic inflammatory disease, and increased risk of HIV infection. The etiology and natural history of BV are poorly understood. The study will be conducted in Rakai District, Uganda, where approximately 50 percent in the general population of women of reproductive age have BV. We propose to conduct two complementary research activities: I, a BV natural history study in a cohort of 250 women (with and without BV, HIV and prior sexual experience), and II, a study in 50 polygamous family units which will enrol the husband, his wives and other women residing in the household. Repeated interview and sample collection in the two studies will be used to assess transition probabilities of BV onset, persistence, regression and recurrence in relation to: a) detailed sociodemographic, behavioral and health data; b) vaginal microflora, particularly Lactobacillus species (which will be characterized using DNA homology and assessed for H2O2 production) and c) the potential presence of lactobacillus bacteriophages, whose possible role in Lactobacillus depletion will be explored. In the polygamous household study, we will determine whether factors associated with normal vaginal flora or with BV (including lactobacilli, anaerobes and phages) may be transmitted sexually or via close household contact such as through the sharing of bathing utensils or water, by comparing women with a polygamous sexual network to other women within the household. The Rakai population offers a unique opportunity to assess BV. We previously enrolled and followed approximately 7,000 women in a population-based trial of STD control for AIDS prevention, have documented increased risk of HIV and adverse birth outcomes in women with BV, and have evidence of improved pregnancy outcomes with STD/BV treatment. The proposed study will provide unique epidemiological, microbiological and virological data regarding normal vaginal flora in this rural African population, the natural history of BV, and on potential causes of this prevalent condition. Such information will be critical for the design of future BV prevention, treatment and control trials, including selection of interventions to be tested, sample size requirements and definition of study end points. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: CELLULAR TRAFFICKING TO INFLAMED FEMALE GENITAL MUCOSA Principal Investigator & Institution: Kelly, Kathleen A.; Assistant Professor; Pathology and Laboratory Medicine; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, Ca 90024 Timing: Fiscal Year 2001; Project Start 01-SEP-2000; Project End 31-AUG-2004 Summary: Pelvic inflammatory disease, tubal infertility and ectopic pregnancy typically emerge in females after a chronic infection with Chlamydia trachomatis or Neisseria gonorrhoeae. Due to the insidious nature of chlamydial infections, efforts have been put forth to develop a vaccine that would enhance the clearance of organisms, avoid chronic infections, and in turn, eliminate reproductive disability. Based on the theory of a
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common mucosal immune system, lymphocyte recruitment to the genital mucosa is predicted to occur when lymphocytes are activated at distant mucosal surfaces. Studies of Chlamydia genital infection in the mouse have shown that T cells are required for protection and effector T cells are found in the genital mucosa following immunization at other mucosal sites. Currently, the degree of T cell migration to the genital mucosa following antigen delivery at other mucosal surfaces is unknown in humans. In this proposal, we will test the hypothesis that T cells activated at other mucosal surfaces can be recruited to the genital mucosa during an inflammatory process. Since T cells are not commonly recruited to the genital mucosa, we will study females infected with C. trachomatis or N. gonorrhoeae as a model to test this hypothesis. The specific aims of this proposal are to: 1) Develop a method to identify T cells that home to the genital mucosa in vivo using individuals with a sexually transmitted disease (STD). 2) Determine if immunization by a distant mucosal route promotes T cell trafficking to the genital mucosa. We will define the homing receptor expression pattern (gut mucosal, other mucosal, non-mucosal) on endocervical T cells and IFNgamma+ peripheral blood cells from STD infected volunteers using flow cytometric techniques. We will also determine which adhesion molecules are induced within the female genital mucosa during STD infection by utilizing an in vitro fallopian tube culture of living tissue followed by immunohistological staining. The candidate homing receptor: adhesion molecule pairs will be tested in a genital mucosa adhesion assay. The frequency of genital mucosa homing T cells and mature dendritic cells will be monitored in volunteers following immunization with Salmonella typhi vaccine via different routes. These studies will contribute to the design of STD vaccines that would provide lasting immunity in the female genital mucosa. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: CHEMOKINE REGULATION OF MUCOSAL IMMUNITY AGAINST GENITAL CHLAMYDIAL INFECTION Principal Investigator & Institution: Ananaba, Godwin A.; Spelman College 350 Spelman Ln Sw Atlanta, Ga 303144399 Timing: Fiscal Year 2002 Summary: Genital infection by the obligate intracellular bacterium, Chlamydia trachomatis, is the most common bacterial sexually transmitted disease (STD) in the United States, with four million annual cases that cost $2.18 billion. In women the infection can lead to serious complications, including pelvic inflammatory disease, ectopic pregnancy and infertility. Many of the infections are asymptomatic and irreversible complications may be the first symptoms. The obvious concern that Chlamydia poses a potential threat to human reproduction, well-being and national budgets has intensified research on intervention and prevention strategies, of which a vaccine is a high priority. Anti-chlamydial vaccine research include the use of animal models for studying the pathogenesis and immunobiology of the disease, and defining antigens and immune effectors mediating immunity. These studies have shown that T cell- mediated immune responses, involving the induction and recruitment of T helper type 1 (Th1) cells into the genital mucosa is crucial for chlamydial immunity. Such factors would likely influence the genital mucosal expression and regulation of chemokines released by injected epithelial cells, chemokine receptors on recruited leukocytes, adhesion molecules involved in genital mucosal lymphoepithelial interactions, and local cytokine secretion. The focus of this proposal is to use novel in vitro and in vivo models of chlamydial infection and molecular and biochemical techniques to investigate the recruitment and maintenance of immune effectors in the
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genital mucosa following an infection. Specific studies will: (a) identify the chemokines elaborated by infected epithelial cells, for recruiting Th1 cells into the genital tract; and (b) identify certain adhesion molecules that are up-regulated after chlamydial infection and play a role in the retention of effectors in the genital tract. The results from this study will contribute to a better understanding of the regulatory mechanisms of effector recruitment and retention in the genital mucosa during chlamydial infection, which may lead to the designing of rational strategies to enhance the efficacy and long-term protective immunity of a chlamydial vaccine. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: CHLAMYDIA AND GONOCOCCAL IMMUNOBIOLOGY OF FEMALE REPRODUCTIVE TRACT
INFECTION--
Principal Investigator & Institution: Brunham, Robert C.; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2002 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: CHLAMYDIA TRACHOMATIS ENVELOPE COMPONENTS AND VIRULENCE Principal Investigator & Institution: Raulston, Jane E.; Pathology; East Tennessee State University Box 70565 Johnson City, Tn 37601 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 29-SEP-2004 Summary: (provided by applicant): Chlamydia trachomatis is the leading bacterial agent of sexually transmitted infections in the United States and a major culprit in urethritis, cervicitis, endometritis, salpingitis, pelvic inflammatory disease, infertility and ectopic pregnancy. The highest chlamydial infection rates are observed in young people between 15 and 34 years of age. Throughout these peak reproductive years, the endometrial epithelial cell layer lining the uterine cavity is subject to constant changes in levels of micronutrients such as iron, due to hormonal cycling during menstruation. Endometrial epithelial cells are natural target host cells for infection by chlamydiae. The availability of iron is well-known to have a tremendous influence on the production of bacterial antigens, envelope components and virulence factors; these effects are particularly prominent for obligate intracellular pathogens such as chlamydiae. In other pathogens, virulence factors produced in response to low concentrations of iron elicit tissue damage in the host. Certain bacterial iron-regulated proteins are also immunotherapeutic targets for vaccine design. In these studies, the mechanism for regulation of chlamydial iron-responsive proteins and antigens will be examined in Specific Aim 1. Specific Aims 2 and 3 will (i) determine the identities of chlamydial ironregulated proteins, and (ii) quantitatively assess transcription of the genes encoding these components under iron-deficient growth conditions, respectively. In Specific Aim 4, an envelope transport system will be examined to determine whether or not it functions as a major iron-uptake pathway for the chlamydiae. The long-term objectives for these studies are to develop a better understanding of mechanisms for the destructive tissue pathology observed in chlamydial infections and to provide new insights on specific chlamydial proteins and antigens that could be tested for their immunotherapeutic potential. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: CHLAMYDIA TRACHOMATIS OMP1 GENOTYPE HUMORAL IMMUNITY & GENITAL TRACT CHLAMYDIA Principal Investigator & Institution: Batteiger, Byron E.; Indiana Univ-Purdue Univ at Indianapolis 620 Union Drive, Room 618 Indianapolis, in 462025167 Timing: Fiscal Year 2002 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: CHRONIC PELVIC PAIN AFTER PELVIC INFLAMMATORY DISEASE Principal Investigator & Institution: Haggerty, Catherine L.; Epidemiology; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2002; Project Start 01-AUG-2002 Summary: Pelvic Inflammatory Disease (PID), is the general term to describe clinically suspected infection of the upper pelvic tract. PID is associated with a number of morbidities, including chronic pelvic pain. However, very little is known about the etiology or consequences of chronic pelvic pain following PID. The proposed research will analyze data from an ongoing randomized clinical trial, the PID Evaluation and Clinical Health (PEACH) Study. Additionally, outpatient, emergency department, and hospital medical records will be collected and abstracted to determine PID-relatedness and primary visit diagnosis. For all PID-related visits for which medical records are obtained, billing records will also be gathered. The specific aims of this project are: 1) to examine predictors of chronic pelvic pain following an episode of PID; 2) to determine whether women with chronic pelvic pain are more likely to use the healthcare system than those without, to determine whether they use it more intensely, and to determine whether use varies with the grade of pain intensity and disability; 3) to estimate the total cost of medical care for women following PID and to determine whether the costs are higher for women with chronic pelvic pain; 4) and to determine the impact of chronic pelvic pain following pelvic inflammatory disease on quality of life. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: CLINICAL ASPECTS OF VIRUS-HARBORING TRICHOMONAS VAGINALIS Principal Investigator & Institution: Piper, Jeanna M.; University of Texas Hlth Sci Ctr San Ant 7703 Floyd Curl Dr San Antonio, Tx 78229 Timing: Fiscal Year 2002 Summary: Human suffering and health care costs due to sequellae of STDs are escalating worldwide, including pelvic inflammatory disease, chronic pelvic pain, involuntarily infertility, and ectopic pregnancies. Project 5 will correlate clinical characteristics of T. vaginalis infections (including behavioral and demographic features as well as co-infections with other STD agents) with the presence or absence of dsRNA virus in T. vaginalis isolates. These two clinical T. vaginalis isolate types (i.e., with and without dsRNA virus) exist naturally and contribute to different outcomes in clinical demographic, and behavior parameters to be evaluated. Thus, as documented in Project 1, the virus provides a marker from which to carry out comparative clinical and adverse outcome studies. Specific Aim 1 perform a comprehensive evaluation of T. vaginalis isolates with an without dsRNA virus and relate these data to various clinical parameters by a) examining characteristics (genitourinary symptoms and physical
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findings) between vaginitis caused by virus-harboring and virus-minus isolates in pregnant and non-pregnant women, b) evaluating behaviors, demographic features and partner history associated with the two isolate types of T. vaginalis, and c) establishing linkages between infection with the two isolate types and other STD agents. Specific Aim 2 will evaluate the risk of adverse outcomes in women with STDs during pregnancy by a) examining infections by T. vaginalis with and without dsRNA virus and b) simultaneously examining and identifying other current infections (gonorrhea, chlamydia, bacterial vaginosis, group B, streptococcus, syphilis, HHV8, and M. genitalium). Specific Aim 3 will facilitate collaborations with the other four Projects by a) providing fresh clinical T. vaginalis isolates from patients with trichomonosis for Project #1, b) coordinating identification and follow-up of pregnant women with the HHV8 Project #2 by collecting maternal samples and pregnancy outcome data, c) providing clinical data dn specimens for the Mycoplasma genitalium Project 3, and d) providing clinical expertise and additional infection information to Behavioral Project 4. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: CYTOKINE NETWORK IN CHLAMYDIAL DISEASE Principal Investigator & Institution: Darville, Toni; Associate Professor; Pediatrics; University of Arkansas Med Scis Ltl Rock Little Rock, Ar 72205 Timing: Fiscal Year 2002; Project Start 15-APR-1999; Project End 31-MAR-2004 Summary: (Adapted from the Applicant's Abstract): In women, the manifestations of C. trachomatis infection range from asymptomatic cervicitis to pelvic inflammatory disease, infertility, and ectopic pregnancy. Variations in outcomes suggest humans exhibit heterogeneity in host susceptibility to chlamydial disease. A genetic influence on disease susceptibility is supported by epidemiological studies in humans, and in animal models of experimental infection. The candidate has confirmed that true differences exist among three genetically defined strains of mice as regards resolution of chlamydial genital tract infection and the development of pathological sequelae. Despite these differences, extensive data reveal their acquired immune responses to be similar - CD4+ T cells of the Th 1 phenotype are critical to recovery from chlamydial infection. In contrast, comparisons of responses active during the first week of infection reveal significant differences in early cellular and cytokine response mediators. This proposal involves using the inherent differences present in these strains of mice as a tool for examining cytokine regulatory pathways important in chlamydial disease pathogenesis. The significance of the different patterns of cytokine responses determined among the three strains will be further explored with mice genetically deficient in specific cytokine mediators. Specific aims of the proposal include: 1) confirmation of the role of TNFalpha and of neutrophils in early control of chlamydial infection and determination of their role in the development of chronic pathology; 2) delineation of the contribution of other proinflammatory cytokines (interleukin-1 and interleukin-6) and of select chemokines to host defense and immunopathology; 3) determination if different kinetics of the downregulatory cytokines, TGF-beta and interleukin-10, influence the course and outcome of chlamydial genital tract infection. A determination of cytokine response patterns that promote tissue damage from those that result in benign resolution of infection is an important goal as regards the development of a safe and effective chlamydial vaccine. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: DEVELOPMENT AND CHARACTERIZATION OF CD14 DEFICIENT MICE Principal Investigator & Institution: Freeman, Mason W.; Chief; Massachusetts General Hospital 55 Fruit St Boston, Ma 02114 Timing: Fiscal Year 2002; Project Start 15-FEB-2001; Project End 31-JAN-2006 Summary: (Adapted from the applicant's abstract): CD14 is a 55 kDa glycosyl phosphatidylinositol-linked protein that is also present in a soluble form in serum. CD14 binds lipopolysaccharides (LPSs) derived from the outermost layer of Gram-negative bacteria and activates a signaling cascade that results in the production of inflammatory cytokines that include tumor necrosis factor alpha, interleukin-6, and interleukin-1. This response has been shown to be important in the pathogenesis of septic shock following Gram- negative septicemia. Recent data have also suggested that a similar response may play a role in accelerating atherosclerotic plaque development and in enhancing the formation of the macrophage foam cell, the histologic hallmark of the early atheroma. Several lines of evidence also implicate this pathway in the pathogenesis of PID, a leading cause of infertility in the developed world, and in the phagocytosis of apoptotic cells, an essential event in tissue remodeling and development. Investigators working on inflammatory bowel disease, periodontal disease, and a variety of inflammatory pulmonary disorders have also postulated an important role for CD14 in these conditions. Given the widespread interest in understanding the contributions of CD14 to normal physiology and pathologic conditions, the applicant's laboratory has generated homologous recombinant mice lacking this protein. This grant application proposes to generate a breeding colony of these animals and to distribute these mice to the many investigators that have requested them. These investigators, working on diseases supported by a diverse group of NIH Institutes, can then utilize these animals in experiments that explore the biological processes in which CD14 activity has been implicated. In addition to developing the breeding colony of CD14 deficient mice, this application proposes to characterize the utility of these animals as models for diseases that represent major human health problems in which the principal investigators of the grant have established research efforts. Thus, the CD14 deficient animals will be bred into mouse strains that are susceptible to atherosclerosis in order to explore the role of Chlamydial infections in the pathogenesis of cardiovascular disease. In addition, CD14null mice will also be used to explore the role of the endotoxin signaling pathway in mouse models of PID. This work is intended to broaden the applicability of CD14 deficient mice to research involving acute and chronic inflammatory disease and to make a critical animal resource available to the investigative community at large. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: DOUCHING AND REPRODUCTIVE TRACT INFECTIONS Principal Investigator & Institution: Funkhouser, Ellen M.; Epidemiology & Interntl Health; University of Alabama at Birmingham Uab Station Birmingham, Al 35294 Timing: Fiscal Year 2002; Project Start 01-JUN-2001; Project End 31-MAY-2004 Summary: Douching is a common practice among American women, especially in the South, among Black women, and among women who are less educated. Douching has been associated with many adverse health events including pelvic inflammatory disease and ectopic pregnancy, and to a much less well established degree, sexually transmitted diseases (STDs). The proposed project is a cross-sectional study of reproductive tract infections and douching practices in Jefferson County, AL. Women attending the County STD clinic and 2 County Family Planning Clinics will be
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interviewed prior to examination regarding douching practices and history of sexual activities, pregnancies, contraceptive practices, and STDs. Presence of infections and pH of vaginal secretions will be ascertained from appropriate tests. Cases will be women presenting with syphilis, gonorrhea, trichomonas, chlamydia , or bacterial vaginosis. Over a 29 month period 4,370 women, 1,400 from the STD clinic and 2,970 from the Family Planning Clinics, will be interviewed. This should provide about 935 STD cases, 577 cases of bacterial vaginosis without an STD, and 2,858 women with no infections. Douching practices among women with and without a reproductive tract infections will be compared. Logistic regression analysis will be used to assess the following: 1) whether douching is associated with increased risks of STDs or bacterial vaginosis; 2) whether douching is associated with vaginal pH; 3) whether there is a dose-response relationship regarding frequency of douching; and 4) whether the risk differs according to preparation used. We believe the similarities in socioeconomic status of women attending the clinics will be substantial making douching practices potentially one of the most distinguishing characteristics of women with and without an infection. Furthermore, the findings will be readily generalizable to a population that historically and currently has some of the highest STD rates in the nation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: DOUCHING, VAGINAL MICROBIOLOGY, AND PID Principal Investigator & Institution: Ness, Roberta B.; Professor and Chair; Epidemiology; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2002; Project Start 01-DEC-1998; Project End 30-NOV-2003 Summary: Pelvic inflammatory disease is a major or cause of reproductive morbidity worldwide. Its sequelae include tubal infertility, chronic pelvic pain, recurrent PID and ectopic pregnancy. Douching is a common and possibly modifiable potential risk factor for PID, but a handful of previous studies examining this association are retrospective and conflicting. At the same time, compelling data suggest that douching may alter the vaginal microenvironment, thereby predisposing to bacterial vaginosis and perhaps, resultant PID, but this has not been fully tested. We propose to conduct a large, multicenter, prospective cohort study to examine the independent association between douching and PID and to study the effect of douching on vaginal microbiology. We will enroll 1800 women at high risk for acquiring sexually transmitted infections. Half will be women who report douching consistently at least once per month over the past six months; half will be women who report never douching in the past six months. Enrolled women will be evaluated at baseline by interview for behavioral characteristics related to douching and STD risk and by lower genital tract microbiology for N. gonorrhoea, C. trachomatis, bacterial vaginosis, and concentrations of lactobacillus, anaerobes and facultative bacteria. During 3-4.5 years of follow-up, serial interviews will be completed and self-obtained vaginal swabs assessed for lactobacilli and other vaginal bacteria. The primary outcome of PID (symptomatic endometritis), will be compared between the douching and non-douching groups. We will also compare the following: 1) gonococcal or chlamydial cervicitis at baseline, 2) bacterial vaginosis and semi-quantitative lactobacilli concentration at baseline, 3) change during follow-up in the concentration of lactobacilli (hydrogen-peroxide producing and non-producing), as well as anaerobic and facultative bacteria. Given the paucity of information regarding the relationship between douching and reproductive outcomes, the proposed study is imperative in order to direct future public health recommendations. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: ENDOMETRIAL INFECTION BY NEISSERIA GONORRHOEAE Principal Investigator & Institution: Timmerman, Michelle M.; Microbiology; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2003; Project Start 31-OCT-2003; Project End 31-JUL-2005 Summary: (provided by applicant): The pathogenesis of gonococcal infection of human endometrium is relatively undescribed even though the endometrium is a site of bacterial persistence. Endometrial infection can progress to pelvic inflammatory disease. The human and bacterial factors involved in initial interactions are uncertain. Whether gonococci invade, traverse, or merely attach to endometrial cells is unknown. The types of endometrial cells infected have not been delineated. In this proposal, I plan to elucidate the nature of the molecular interactions between the gonococcus and human endometrial epithelia. Based on my preliminary studies, I hypothesize that gonococci are internalized by both receptor-mediated endocytosis and macropinocytosis. In order to resolve this hypothesis I propose the following specific aims: 1. Development of a primary human endometrial epithelial cell culture system. 2. Characterization of initial interactions between N. gonorrhoeae and primary endometrial epithelial cells. 3. Characterization of the endometrial receptor(s) for N. ganorrhoeae and the gonococcal ligand for these receptor(s). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: EPIDEMIOLOGY OF FEMALE PELVIC FLOOR DISORDERS Principal Investigator & Institution: Kjerulff, Kristen H.; Gynecology and Obstetrics; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2001; Project Start 01-AUG-2001; Project End 31-JUL-2004 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
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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. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: FUNCTION OF GONOCOCCAL ANAEROBICALLY INDUCED PROTEINS Principal Investigator & Institution: Clark, Virginia L.; Associate Professor; Microbiology and Immunology; University of Rochester Orpa - Rc Box 270140 Rochester, Ny 14627 Timing: Fiscal Year 2003; Project Start 01-FEB-1977; Project End 28-FEB-2008 Summary: (provided by applicant): Neisseria gonorrhoeae is the etiologic agent of gonorrhea, one of the most prevalent infectious diseases in the U.S. Complications of gonorrhea include pelvic inflammatory disease (PID), the leading cause of sterility in females in this country. Despite the ability to effectively treat gonorrhea with antibiotics, the incidence of this disease remains high, suggesting that the most likely means of controlling the epidemic in the U.S. will be by vaccination. Elimination of gonorrhea will require an understanding of the host immune response to and pathogenesis of N. gonorrhoeae. One of the central themes of microbial pathogenesis is that the pathogen may express virulence determinants in vivo that are not expressed in vitro. We have been investigating the regulation of gonococcal gene expression by anaerobiosis, an environmental condition that this pathogen is likely to encounter in vivo in females. We have identified two anaerobically induced genes, ani A and norB, that are induced anaerobically and encode nitrite reductase and nitric oxide reductase, respectively. Both of these proteins are required for anaerobic growth and their presence means that gonococci can both produce and degrade nitric oxide (NO), an important modulator of the host innate immune response. We propose 1) to perform genetic and biochemical analyses of anaerobically regulated genes; 2) to determine the role of anaerobically induced and repressed genes in gonococcal invasion via the lutropin receptor; 3) to determine steady state NO concentrations during gonococcal denitrification and the effect of environmental parameters; and 4) to determine if gonococcal production/degradation of NO and/or steady-state NO levels down regulate cytokine expression and activation of soluble guanylyl cyclase. The successful completion of these aims should provide important new information on the function of the denitrification pathway and its role in pathogenesis. In addition, significant new insights into the mechanism of gonococcal suppression of the innate immune response may be attained. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: FUNCTION OF OPA AND LOS IN GONOCOCCAL PATHOGENESIS Principal Investigator & Institution: Stein, Daniel C.; Professor; Cell Biology & Molecular Gen; University of Maryland College Pk Campus College Park, Md 20742 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 30-JUN-2004 Summary: (provided by applicant): Neisseria gonorrhoeae causes about 600,000 new infections each year in the United States, with health-care costs approaching 2 billion dollars/year. The costs and human suffering are amplified by the fact that concomitant gonococcal infections appear to facilitate HIV transmission. Gonococci preferentially infect the human urogenital tract, and its ability to enter and transcytose this mucosal
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surface is a chief cause of pelvic inflammatory disease, tubal infertility, ectopic pregnancy, and chronic pelvic pain. Various surface components, i.e., lipooligosaccharide (LOS) and opacity proteins (Opa), are important in mediating these diseases. Most studies have used tissue culture models to study the role of individual surface components in the pathogenic process, even though it is likely that multiple components are needed and/or are able to act synergistically. The fact that this pathogen manipulates its outer membrane suggests that such modifications are important in pathogenesis. Nothing is known about possible interactions between the surface molecules, because to date, we have lacked bacterial strains that have invariant, defined surfaces. This has prevented us from developing a comprehensive understanding of the pathogenesis of gonococcal disease. The objective of this proposal is to understand how gonococcal opacity proteins and Iipooligosaccharides interact in the pathogenic process. The central hypothesis of the proposed research is that different variants of these surface antigens are important for the various stages of infection and/or symptom elicitation. We intend to test our hypotheses by pursuing three specific aims: We will determine how various surface structures interact in the invasion process, we will identify which receptors are responsible for binding specific LOS molecules and we will define the signal transduction pathways that are activated in host celIs that are initiated by gonococcal adherence and/or invasion. The proposed research addresses the fundamental problem of how LOS and Opa interact in the disease process. We will define how LOS and Opa variation contribute to disease pathogenesis. The impact on human health is expected to be significant, because the new knowledge will likely make possible new approaches to the prevention and treatment of gonorrhea. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: HIV-1 SHEDDING FROM FEMALE GENITAL TRACT Principal Investigator & Institution: Coombs, Robert W.; Associate Professor; Laboratory Medicine; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2002; Project Start 23-APR-2001; Project End 31-MAR-2006 Summary: This is a new Program Project application in response to RFA-HD-00- 006 to establish a Women's HIV Pathogenesis program at the University of Washington in collaboration the University of Rochester and the University of Nairobi, Kenya. The central Program these is to explore the hypothesis that the female genital tract is a separate virological compartment from blood. As such, viral application in the genital compartment may be influenced by several factors including the host's hormonal status (i.e., menses), and both viral and microbiological cofactors that could have an important influence on the evolution of HIV- 1 (i.e., generation of viral diversity), re-seeding of the blood compartment with potentially drug-resistant, and disease pathogenesis both within the genital tract (changes from favorable to unfavorable microbiological flora) and systemically (HIV-1 disease progression). Understanding these gender-specific HIV-1 factors may provide additional insight into the control of both vertical and horizontal transmission of HIV-1. To accomplish the central Program theme, we will use three different cohorts of HIV-1-infected women recruited at the three collaborating institutions. The research activities of the Program Project will be accomplished through three Cores and three Research Projects. The infrastructure will reside within an Administrative Core (Core A) located at the University of Washington, a Clinical Core (Core B) and a Laboratory Core (Core C). Both internal and external advisory committees will review the Program's research progress and report to the Principal Investigator, Dr. Coombs. Since our hypothesis is that genital tract inflammation represents a continuum as defined by local vaginitis (bacterial vaginosis), to cervicitis
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(cytomegalovirus), to endometritis (microbial) and ultimately to pelvic inflammatory disease, each of the three research Projects are designed to capture this continuum. In Project I (HIV-1 shedding and evolution), we will characterize subjects for shedding of HIV-1, CMV and HSV-2, and definitively establish, through viral phylogenetic typing that HIV-1- re-emerges from the genital tract to re-infect the blood compartment in subjects that receive stable anti- retroviral therapy. In Project II (CMV co-shedding) we will show that CMV is an independent viral co-factor for HIV-1 shedding, whether CMV shedding from the cervix represents reactivation or re-infection, and that the suppression of CMV using valganciclovir can decrease HIV- 1 genital shedding. In Project III( Bacterial Vaginosis), we will show the effect of bacterial vaginosis as a local co-factor for HIV-1 shedding, how this local abnormal microbiological flora contributes to HIV-1 shedding through local cytokine-mediated mechanisms, and that antimicrobial treatment of bacterial vaginosis in both anti-retroviral treated and untreated women results in decreased HIV-1 genital shedding. Taken together, these studies will provide important comparative data to the male genital tract shedding of HIV-1 and may have implications for both the vertical and horizontal transmission of HIV-1. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: IMMUNITY AND LATENCY TO CHLAMYDIAL INFECTIONS Principal Investigator & Institution: Byrne, Gerald I.; Professor & Chairman; Medical Microbiol & Immunology; University of Wisconsin Madison 750 University Ave Madison, Wi 53706 Timing: Fiscal Year 2002; Project Start 01-AUG-1982; Project End 30-SEP-2002 Summary: Members of the genus Chlamydia, a group of obligate intracellular procaryotic pathogens, are important causes of human infectious diseases. Chlamydia pneumoniae recently has been implicated in the initiation and development of atherosclerosis. Chlamydia trachomatis is a major cause of preventable infectious blindness and the leading cause of bacterial sexually transmitted diseases (STD). Upper genital tract complications in females represents a significant women's health issue. Silent pelvic inflammatory disease (PID) can lead to tubal obstructive infertility. This serious disease will require extensive investigation to understand the pathogenic processes that cause irreparable damage of the reproductive tract in women during their child-bearing years. It is important to discern pathologic changes that accompany atherosclerosis, trachoma, PID and tubal obstructive disease as these events actually occur in infected people, but studies involving human populations do not lend themselves well to carefully controlled experimental conditions. Therefore we propose to continue our work using a variety of cell culture systems (human and murine) to study general features of persistent intracellular chlamydial growth which may be common to all chronic chlamydial infections and pursue the murine-C. trachomatis genital tract in vivo model to study the hypothesis that persistent chlamydiae may contribute to the development of upper genital tract disease. This hypothesis will be tested by building on our experience related to the effects of immune response regulated cytokines on chlamydial host cell activation that results in enhanced expression of chlamydial stress response proteins together with new information on the effects of stress response proteins on the disease process. We also will study how these fundamental events in the basic biology of chlamydiae relate to chronic disease as exemplified by upper genital tract infections in mice. The work plan will comprise 4 specific aims, 2 of which are intended to broaden our cell culture knowledge of persistent (stressed) chlamydial growth and 2 of which will apply this knowledge to an in vivo system. Results will lead to increased information concerning how the basic
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biology of chlamydiae directly impacts the disease process and the development of chronic chlamydial disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: IMMUNITY TO CHLAMYDIAL GENITAL INFECTION Principal Investigator & Institution: Morrison, Richard P.; Professor; Microbiology; Montana State University (Bozeman) Bozeman, Mt 59717 Timing: Fiscal Year 2002; Project Start 01-JUN-1996; Project End 31-MAY-2005 Summary: (Adapted from the Applicant's Abstract): Chlamydia trachomatis is possibly the most common sexually transmitted bacterial pathogen in the world. In the United States, 4 million new cases of C, trachomatis urogenital tract infection occur each year, and it is estimated that the cost of treating those infections approaches $4 billion annually. Urogenital infections caused by C. trachomatis result in a number of diverse clinical conditions. Infections in women range from acute self-limiting infections to more serious infections that result in pelvic inflammatory disease, infertility and ectopic pregnancy. Considerable progress has been made in the past few years to significantly broaden our understanding of immune responses that develop during the course of chlamydial infection. However, our understanding of effector mechanisms that limit chlamydial infection and prevent reinfection is insufficient. The investigator's recent data suggest that both CD4+ T cells and B cells (antibody) contribute to adaptive immunity to chlamydial genital tract infection. Thus the overall goal of this project is to use the murine model of C. trachomatis genital tract infection to study the relationship between CD4+ T cells and antibody in adaptive immunity to infection. That goal will be realized through the studies described in 4 specific aims: 1) To determine the ability of immune B cells and antibody to reconstitute protective immunity in CD4-depleted B cell deficient mice; 2) To determine if the lack of mature B cells in B cell gene knockout mice affects the development of chlamydial-specific memory T cell responses; 3) To determine the effect of simultaneous immune cell depletions on acquired immunity; and 4) To evaluate the inhibitory effects of antibodies and lymphocytes on chlamydial growth in vitro (antibody dependent cellular cytotoxicity). These studies will broaden our understanding of how the host resists chlamydial infection, and may provide new insights into the formulation and administration of an effective vaccine to control the spread of chlamydial infections or prevent the serious sequelae of disease pathogenesis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: IMMUNOLOGY GONORRHOEAE
OF
INFECTION
WITH
NEISSERIA
Principal Investigator & Institution: Rice, Peter A.; Professor & Chief; Boston Medical Center Gambro Bldg, 2Nd Fl, 660 Harrison Ave, Ste a Boston, Ma 02118 Timing: Fiscal Year 2002; Project Start 01-JAN-1993; Project End 31-MAR-2004 Summary: (Adapted from the application abstract) Neisseria gonorrhoeae is one of the two major pathogens involved in the majority of cases of bacterial sexually transmitted genital infection and pelvic inflammatory disease (PID). We have shown that the forms of C3 bound to N. gonorrhoeae at the cervical level in vivo correlate with measurements of these components in vitro and with postulated mechanisms of the resultant clinical syndromes. We have recently found that N. gonorrhoeae modulates interactions with C3 by directly binding the alternative complement pathway regulatory protein factor H to sialylated lipooligosaccharide (LOS) and to loop 5 of porin protein (Por) IA. The classical complement pathway regulator C4 binding protein (C4BP) also appears to
22
Pelvic Inflammatory Disease
directly bind N. gonorrhoeae Por, similar to Streptococcus pyogenes M protein, which binds both factor H and C4BP. This proposal will define the molecular mechanisms of these interactions. In the first Specific Aim, we propose to further define the molecule(s) on the surface of a serum resistant PorA strain (15253) of N. gonorrhoeae that mediate factor H binding, along with the specific regions of factor H that are involved in these binding interactions. We will first create isogenic strains of 15253 by moving the Por IB molecule from strain MS11 (which does not bind factor H) into strain 15253. If factor H binding is completely abrogated, hybrid Por mutants will be created to define the region of Por responsible for binding. If not, we will attempt to define a second gonococcal factor H binding site by TnMax-71 mutagenesis. Regions in factor H that bind to Por will be identified using recombinant factor H (rH) deletion mutant proteins' generated in Chinese hamster ovary (CHO) cell lines. Construction of these rH mutant proteins is integral to Specific Aim 2, which seeks to define the role of glycosylation of factor H in binding to N. gonorrhoeae. We have observed that strain FA19, which expresses PorIA but differs by one amino acid at position 181 of exposed loop 5 from strain 15253, binds human factor H but does not bind non-glycosylated rH produced in a baculovirus system. We will express fully glycosylated deletion mutant rH proteins in CHO cells using overlap extension PCR and compare binding to non-glycosylated baculovirus rH. Site directed mutagenesis of position 181 of PorIA in strain 15253 will also be done to examine whether rH binding can be regained. In Specific Aim 3, we will construct mutants by shuttle mutagenesis using strains FA19 (PorIA) and F62 (PorIB) (the latter does not bind C4BP and is genetically competent) to define the gonococcal region responsible for C4BP binding. A confirmatory approach to define the loop necessary for C4BP binding will be to use synthetic peptides encompassing the putative exposed regions of the different porin loops to inhibit C4BP binding to N. gonorrhoeae in flow cytometry. Functional correlates will also be demonstrated in bactericidal assays. Finally, Specific Aim 4 will examine a set of clinical isolates that lack the 3F11 lactosamine sialylation site yet can be sialylated and, further, appear to endogenously sialylate their LOS. We have cloned the sialyltransferase from one of these isolates and will insertionally inactivate the gene. The resultant strains will be characterized for: i) the ability to sialylate (endogenously or in the presence of exogenous CMP-NANA), ii) their serum sensitivity in bactericidal assays, and iii) their LOS structure. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: INDUCTION OF PROTECTIVE IMMUNITY AGAINST CHLAMYDIA Principal Investigator & Institution: Eko, Francis O.; Professor; Microbiology, Biochemistry & Immunology; Morehouse School of Medicine Atlanta, Ga 30310 Timing: Fiscal Year 2002; Project Start 01-SEP-1996; Project End 31-MAY-2006 Summary: (provided by the applicant): Genital infection by the obligate intracellular pathogen, Chlamydia trachomatis, is the most common bacterial sexually transmitted disease (STD) in the United States, with four million reported annual cases that cost over $2 billion. Of major pathophysiological significance is the propensity for cervical infection in women to spread into the upper genital tract, provoking serious complications such as pelvic inflammatory disease, fallopian tube scarring, ectopic pregnancy and infertility. Also, the frequently asymptomatic infections do cause severe irreversible complications to be the first evidence of an infection. There are concerns that genital chlamydial disease, like certain other STDs, such as AIDS and gonococcal disease, may pose a serious threat to human reproduction, well-being and healthcare costs. Current control and prevention strategies target frequent screening for early detection and treatment, and development of vaccines as the priority. The search for a
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chlamydial vaccine has led to extensive research to define the crucial immune effectors in anti-chlamydial immunity, identify antigens that elicit protective immunity, and design effective methods of vaccine delivery. Our research has been focused on identifying the relevant immune parameters in chlamydial immunity and elucidating the mechanism(s) of intraepithelial inhibition of chlamydiae. Our findings and reports by others have culminated in a new paradigm for designing vaccines against Chlamydia based on the induction of local mucosal TH1 response. The major challenge at this stage is to select an appropriate immunogen(s) and design an effective delivery system, to induce high levels of local genital mucosal Th1 response to maintain long-term immunity. Accordingly, this proposal uses immunological, genetic engineering, molecular, cellular and biochemical techniques to investigate the central hypothesis that protective anti-chlamydial immunity will be established if immunogenic chlamydial antigen(s) are effectively delivered to induce high frequency of specific Th1 cells in the genital mucosa. Specific studies planned will use genetically engineered and wild type mice to: (a) investigate the efficacy of genetically designed recombinant multi-subunit vaccines composed of mucosal bacterial ghosts co-expressing multiple membrane proteins of C. trachomatis; (b) assess the therapeutic benefits of an immunotherapeutic cellular vaccine based on IL-lO gene-suppressed dendritic cells presenting antigens for inducing high frequency of specific Th1 response, as an alternative therapeutic vaccine for C. trachomatis; (c) identify the major mucosal inductive sites, antigen-presenting cells and other accessory cells crucial for Th1 activation; and (d) define the molecular and cellular elements regulating Th1 activation, trafficking and recruitment into the genital mucosa following effective cellular and subunit vaccination against C. trachomatis. Results from these studies will likely lead to the development of a reliable vaccine regimen against Chlamydia, which should have major implications for the genital, ocular, and lung infections and their complications. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: INPATIENT VS OUTPATIENT THERAPY FOR ACUTE PELVIC INFLAMMATORY DISEASE Principal Investigator & Institution: Holley, Robert L.; University of Alabama at Birmingham Uab Station Birmingham, Al 35294 Timing: Fiscal Year 2002 Summary: Pelvic inflamatory disease (PID) affects women in the United States in nearepidemic proportions. Nearly 11% of American women of reproductive age reported that they received treatment for PID in 1988. The costs associated with PID and its sequelae are enormous. Annual U.S. expenditures for the acute treatment of PID have been estimated at between $700 million and $2 billion annually; indirect costs may amount to an additional $1 billion per year. Inpatient treatment is over 10 times more expensive than outpatient treatment. The primary aim of thi study is to test the effectiveness and cost-effectiveness of outpatient vs. inpatient treatment for PID in preventing involuntary infertility. Additional long-term outcomes to be compared are repeat episodes of PID, ectopic pregnancy, functional decline due to chronic pelvic pain, frequency of health service use, the occurrence of indirect costs associated with PIDrelated illness, and patient-reported quality of life. This study is a randomized clinical trial involving adult female patients. During a 5-year period, 1,380 women will be enrolled from 6 clinical sites. A total of 1,200 women in seven clinical sites will be randomized in equal numbers into one of two treatment groups: inpatient or outpatient. Non-investigational antibiotics consisting of Cefoxitin and Doxycycline will be used in
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Pelvic Inflammatory Disease
both groups, with a total treatment course of 14 days. Follow-up for each patient encompasses a period of 60 months. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: INPATIENT VS OUTPATIENT THERAPY FOR ACUTE PELVIC INFLAMMATORY DISEASE Principal Investigator & Institution: Hemsell, David L.; University of Texas Sw Med Ctr/Dallas Dallas, Tx 753909105 Timing: Fiscal Year 2002 Summary: Acute PID affects over 1 million American women a year. The highrisk group for this infection is primarily younger women and adolescents. PID may result in significant sequelae such as involuntary infertility, ectopic pregnancy, and chronic pelvic pain. Costs for the acute treatment of women have been estimated to be between $750 million and $2 billion dollars annually, and treatment for the complications of this infection may at least double these healthcare costs.The purpose of this masked, prospective, randomized, 5-center, open clinical trial is to compare inpatient versus outpatient Centers for disease Control- recommended combination antimicrobial treatment for women with the same degree of acute pelvic inflammatory disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: STUDENTS
INTERNET-BASED
STD/HIV
EDUCATION
FOR
COLLEGE
Principal Investigator & Institution: Lord, Sarah E.; Director, College Health Programs; Inflexxion, Inc. Newton, Ma 02464 Timing: Fiscal Year 2002; Project Start 15-JUL-2000; Project End 31-AUG-2003 Summary: (provided by applicant): This application proposes the development of an Internet-based college STD/HIV prevention education program called myStudentbody.com (STDs/HIV). STDs in the U.S. are of epidemic proportion. An estimated 33 percent of college-age students contract an STD at some point in their life. STDs can produce serious long-term consequences for both women and men, including damage to the heart, pelvic inflammatory disease, cervical cancer, infertility, and death. Furthermore, both ulcerative and inflammatory STDs are associated with increased susceptibility to HIV infection. There is a serious need for easily accessible and effective STD/HIV prevention education for college students. Using interactive, Web-based technology, this secondary prevention program will be supported by a number of unique features that will make it a true innovation in the area of STD and HIV prevention with college students. Phase I involved proof of concept research to demonstrate product feasibility. Phase II will involve production and usability testing of a fully operational myStudentbody.com (STDs/HIV) website, a field test to assess program efficacy, and satisfaction testing. If such a program demonstrates effectiveness over traditional education approaches for increasing practice of preventive behaviors, college administrators and health educators would likely view it as a desirable and costeffective way to offer health information to college students. PROPOSED COMMERCIAL APPLICATION: The proposed Internet-based program will provide a targeted intervention to reduce risk behaviors associated with STDs and HIV. Despite the high prevalence of STDs among college students, few programs offer a comprehensive, tailored approach to risk reduction. If effective, MyStudentbody.com (STDS/HIV) will be of enormous value in preventing STDs and associated health consequences. This program could be offered to a variety of institutions of higher
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education via publisher and/or merchandise partnerships. The commercial potential of such a program would be extraordinary, as there are over 14 million college students enrolled annually and students are among the most frequent users of the Internet. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: LIVING WITH CHRONIC PELVIC PAIN: PERSONAL/SOCIAL IMPACT Principal Investigator & Institution: Strzempko, Fran M.; Dean's Office; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 941222747 Timing: Fiscal Year 2002; Project Start 15-MAR-2003; Project End 30-NOV-2004 Summary: (provided by applicant): Chronic pelvic pain (CPP) is an ambiguous and disabling condition, affecting 10-15% of U.S. women of reproductive age. Endometriosis, a condition for which there is no effective treatment, is the most common diagnosis of CPP. Common symptoms include pelvic pain, and dyspareunia. Relationship and role disruptions in endometriosis are reported, but the woman and couple's symptom experiences and responses have not been documented. The purpose of this study is to articulate the woman and her partner's illness understanding, symptom experience, and relationship responses to living with CPP. The larger aim is to develop knowledge to support the holistic care for women with CPP, so we may provide humanistic and effective nursing interventions for women and their partners. The proposed study is a mixed-method design, with qualitative methodology as primary. Interpretive phenomenology guides the design and conduct of the study. A measurement of distress and affective response is the adjunct quantitative method. Specific aims are: 1) articulate the commonalities and differences of the lived experience of women who have CPP with a diagnosis of endometriosis, and their partners; 2) describe the symptom experience from the woman and her intimate partner's perspective; 3) compare dyadic versus individual constructions of living with endometriosis; and 4) describe the relationship between the woman and her partner's symptom experience. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: LOCAL IMMUNE RESPONSE IN CHLAMYDIA SALPINGITIS Principal Investigator & Institution: Patton, Dorothy L.; Professor; Obstetrics and Gynecology; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2002; Project Start 01-SEP-1985; Project End 30-NOV-2003 Summary: (Adapted from the Applicant's Abstract): The macaque pocket model has been used to detect cytokine production, T -cell subsets and resulting inflammation and pathology following acute and chronic chlamydial infection. The responses of macaque salpingeal tissues support earlier observation that chlamydial salpingitis is an immunopathogenic response, and that potential interventions should include specific immune modulators. They propose to test the roles of these cellular responses to chlamydiae. Due to the nature of the chlamydial infection, the host response must be to clear the organism without destroying uninfected host cells, and without inciting fibrosis and scarring. Cytokines are produced which may promote clearance of chlamydial (IFN-g, IL-2, IL-6), which may decrease clearance (IL-10) or which may cause fibrosis and scarring (TGF-b). The functional role of these cytokines will further elucidate the immunopathological mechanisms leading to chlamydial salpingitis. Utilizing cytokines that have clinical relevance are likely to lead to development of additional preventive measures or treatment in chlamydial genital tract infections. The Specific Aims will extend these studies to further elucidate the immunomodulatory
26
Pelvic Inflammatory Disease
roles of cHSP60and of cytokines in chlamydial salpingitis, providing new information which will further direct research in the usefulness of anti-cytokine therapy. 1. Test the immunomodulatory role of IFN-g in chlamydial PID. The chlamydiacidal activity of IFN-g in primate tissue in vitro or in vivo has not been tested. Direct or indirect modulation of IFN-g may provide a method for intervention in women at risk for pelvic inflammatory disease. 2. Test the immunomodulatory role of IL-10, a cytokine which down-regulates inflammatory responses, in chlamydial PID. Investigating the role of IL10 will provide a means of evaluating the importance of the pattern of cytokine production in chlamydial immunopathology. 3. Test the immunomodulatory role of IL6, which promotes proliferation of lymphocytes and recruitment of macrophages, in chlamydial PID. 4. Directly test the role of the fibrogenic cytokine TGF-b as a cause of immunomodulation, and of the tubal scarring associated with PID. Establishing the role of TGF-b will determine the feasibility of anti- TGF-b therapy in chlamydial salpingitis. 5. Test the role of major chlamydial antigens as the cause of immunopathology in C. trachomatis- induced PID. If one chlamydial antigen is the major cause of the DTH response in PID, diagnostic or immunomodulatory efforts can be directed towards that antigen. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: MECHANISMS OF HOST RESPONSES IN GONORRHEA Principal Investigator & Institution: Chen, Tie; Microbiology and Immunology; Indiana Univ-Purdue Univ at Indianapolis 620 Union Drive, Room 618 Indianapolis, in 462025167 Timing: Fiscal Year 2004; Project Start 15-DEC-2003; Project End 30-NOV-2006 Summary: (provided by applicant): Neisseria gonorrhoeae (gonococci, GC) cause gonorrhea and pelvic inflammatory disease (PID). Studies show that gonorrhea can facilitate infection of both HIV and Chlamydia trachomatis (CT). The infection results from the ability of the pathogens to adhere to and penetrate host cells. However, little is known about whether the host immune responses play a role in GC infection. To establish infection, bacteria must interact with receptors on host cells. The opacity (Opa) proteins of GC mediate adherence and phagocytosis in epithelial cells and neutrophils in part through interaction with members of the carcinoembryonic antigen family (CEA, CEACAM, or CD66), CEACAM3 (CD66d) and CEACAM1 (CD66a). CEACAM1 is an inhibitory receptor, which mediates negative signals in DT40 B cells. The biological functions of inhibitory receptors are the inhibition of phagocytic ability of cells and proliferation as well as antibody production in B cells. Neutrophils and lymphocytes play a critical role in protection against infectious bacteria. Consistent with our preliminary data that GC inhibits the production of antibodies in human B cells in vitro, local and systemic anti-GC antibody levels in gonorrhea patients with a history of prior infection are low, suggesting that GC might inhibit local host immune responses. In the proposed research, we hypothesize that local immune inhibition mediated by GC infection may be achieved through the following two events: 1). GC binds to neutrophils and inhibits their ability to phagocytose microorganisms. 2). GC enters the host and binds to CEACAM1 on B cells to activate inhibitory pathways, and consequently inhibits lymphocyte proliferation and antibody production. We expect that signal transduction is involved in these events. Therefore, we propose these specific aims to: 1. Determine whether GC inhibits the phagocytic ability of neutrophils. 2. Elucidate how the interaction of CEACAM1 with GC inhibits antibody production. 3. Identify CEACAM3 and CEACAMl-mediated signal transduction pathways following infection with GC. The proposed research will begin to unveil the potential mechanisms of
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antibody suppression, which consequently play a role in the GC induced immunosuppression during infection. We believe that these studies will uncover some mechanisms of GC infection and will help us to understand how microbial pathogens exploit host cells. This knowledge will allow us to develop novel strategies to combat other infectious diseases. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: MICROBICIDAL LACTOBACILLI FOR PREVENTION OF GENITAL INFECTION Principal Investigator & Institution: Hillier, Sharon L.; Professor; Carnegie-Mellon University 5000 Forbes Ave Pittsburgh, Pa 15213 Timing: Fiscal Year 2002 Summary: Lactobacilli function as microbicides in the human vagina through production of H2O2, acids and other products which inhibit the survival and/or growth of genital pathogens. The goal of the proposed project is to evaluate the efficacy of Lactobacillus capsule in colonizing the vagina and decreasing acquisition of bacterial vaginosis. Longitudinal cohort data supports the association between lack of vaginal lactobacilli and acquisition of bacterial vaginosis. A vaginal capsule containing Lactobacillus crispatus has been developed and shown to colonize women during a phase II study. The proposed study is a double-blind placebo-controlled trial of a Lactobacillus crispatus capsule in women attending an Adolescent Medicine Clinic (n=200), the Allegheny County Health Department (n=250). Women will be followed at 3 month intervals for 1 year. The presence of genital tract infection and vaginal lactobacilli will be determined at baseline and each follow-up visit. The hypothesis is that monthly use of exogenous lactobacilli intravaginally will decrease acquisition of bacterial vaginosis. The specific aims are 1) to assess the relationship between genital infection and lack of lactobacilli in a population of women of reproductive age; 2) to assess the effect of the Lactobacillus capsule on the vaginal ecosystem (vaginal pH, lactobacilli, other microorganisms); 3) to determine whether women randomized to receive the Lactobacillus capsule have decreased acquisition of bacterial vaginosis compared to placebo-treated women after accounting for potentially confounding behaviors; 4) to evaluate the effect of the Lactobacillus capsule on acquisition of other infections including chlamydia, trichomoniasis, vulvovaginal candiddiasis, urinary tract infections and pelvic inflammatory disease; 5) assess the immunologic response to Lactobacillus crispatus among women assigned to the L. crispatus capsule versus placebo; and 6) to assess demographic, behavioral and microbiologic factors associated with loss or acquisition of H2O2-producing and H202-negative lactobacilli. This project will yield new information on lactobacilli as endogenous microbicides and suggest new strategies for prevention of STD's and their sequelae. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: MOLECULAR PATHOGENICITY
GENETIC
ANALYSIS
OF
CHLAMYDIA
Principal Investigator & Institution: Maurelli, Anthony T.; Professor; Henry M. Jackson Fdn for the Adv Mil/Med Rockville, Md 20852 Timing: Fiscal Year 2004; Project Start 01-DEC-1998; Project End 31-MAR-2005 Summary: (provided by applicant): Bacteria of the genus Chlamydia are significant pathogens of animals and man. The diseases caused by Chlamydia spp. in man include pneumonia, endocarditis, polyarthritis, blindness, and a wide range of sexually
28
Pelvic Inflammatory Disease
transmitted diseases including cervicitis, salpingitis, pelvic inflammatory disease, and infertility in females; and non-gonococcal urethritis and acute epididymitis in males. Chlamydia has also been implicated as a cofactor in a variety of chronic diseases such as coronary heart disease. Despite many years of effort, the Chlamydia remain intractable to genetic analysis due to their obligate intracellular lifestyle and complex developmental cycle. No one has been able to introduce foreign DNA into this organism and achieve stable inheritance of and expression of the foreign genes. Our long-term goal is to apply the power of genetics to study the pathogenic mechanisms of Chlamydia. The aims of this proposal include the development of genetic tools for the analysis of Chlamydia pathogenesis and hypothesis-driven aims to address specific questions of Chlamydia biology. The specific aims are to: 1) develop a method for introduction, expression, and stable maintenance of foreign DNA in Chlamydia and a system for gene replacement in Chlamydia; 2) characterize the pathway for peptidoglycan synthesis in Chlamydia; and, 3) identify the transport system for uptake of essential constituents for Chlamydia growth, specifically the source of methyl donors for methyltransferases. We will employ genetic, biochemical and cell biology strategies to each aim. Success in achieving the first aim will have a significant impact on Chlamydia research by making new tools for genetic analysis of Chlamydia available. Rapid advances in our understanding of Chlamydia pathogenesis and biology as well as the ability to construct Chlamydia mutants for vaccine development will be made possible by these new techniques. Success in aim 2 will finally resolve the Chlamydia anomaly while aim 3 will attempt to resolve another apparent paradox of Chlamydia biology. Thus, these two aims will resolve some long-standing questions of Chlamydia biology and extend our knowledge of the intracellular lifestyle of this important pathogen. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: MYCOPLASMA GENITALIUM--PREVALENCE IN STDS AND PATHOGENESIS Principal Investigator & Institution: Baseman, Joel B.; Professor & Chair; University of Texas Hlth Sci Ctr San Ant 7703 Floyd Curl Dr San Antonio, Tx 78229 Timing: Fiscal Year 2002 Summary: Mycoplasma genitalium is a recently identified Mycoplasma species considered to be a major cause of non-gonococcal urethritis based upon epidemiological and serological studies. In addition, M. genitalium and several other Mycoplasma species have been implicated as co-factors in AIDS. Lately, a substantial percentage of women attending STD clinics exhibit M. genitalium-associated acute and chronic infections, including cervicitis, salpingitis, adnexitis, and pelvic inflammatory disease, yet the role of M. genitalium infection in women is not fully appreciated. We propose to investigate, as part of the San Antonio STDCRC proposal, the prevalence of M. genitalium infection in Mexican- and African-American women by PCR and ELISA techniques using genital tract and blood specimens. Also, we will attempt to correlate M. genitalium with pelvic inflammatory disease, infertility, and adverse outcomes of pregnancy and minority women with or without other diagnosed STDs. In collaboration with the Behavioral and Clinical Trichomonas Projects and the Statistics/Computing Core, we intend to measure the effect of behavioral modification interventions on the incidence and adverse outcomes associated with M. genitalium infections. In addition, the establishment of M. genitalium infection is achieved primarily through adherence to and invasion of eucaryotic cells. A major focus of the proposal is to uncover the regulatory mechanism(s) of cytadherence. Our preliminary observations indicate that M.
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genitalium up-regulates the expression of the P140 adhesin and cytadherence-related proteins when co-incubated with eucaryotic cells and extracellular matrix components. This suggests that P140 may be regulated transcriptionally by an activator or repressor. We intend to identify the activator/repressor in order to clarify the regulatory mechanism(s) of cytadherence in this Mycoplasma species. Moreover, we recently developed a tool to knockout genes in M. genitalium, and disruption of the gene encoding the MG218 protein led to a cytadherence-negative phenotype. Further analysis revealed that the presence of MG218 is essential for the stability of the P140 adhesin. We plan to further delineate the interaction between MG218 and P140. The experimental approaches outlined represent novel strategies, and the results of the studies should enhance our understanding of cytadherence and virulence. Furthermore, these studies should identify functional targets for vaccine and diagnostic regents to control, monitor and prevent M. genitalium infection. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: NATURAL HISTORY OF HIV INFECTION IN INJECTION DRUG USERS Principal Investigator & Institution: Vlahov, David; Epidemiology; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2003; Project Start 01-APR-1987; Project End 30-NOV-2006 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: NATURAL HISTORY OF HIV INFECTION IN WOMEN Principal Investigator & Institution: Anastos, Kathryn M.; Montefiore Medical Center (Bronx, Ny) Bronx, Ny 104672490 Timing: Fiscal Year 2002; Project Start 01-AUG-1993; Project End 28-FEB-2003 Summary: The NYC/Bronx WIHS Consortium represents the highly successful collaboration of clinical and basic scientists at six New York institutions: Montefiore, Mount Sinai, and Beth Israel Medical Centers; Bronx Lebanon Hospital Center, The Wadsworth Research Center of the New York State Department of Health, and the Albert Einstein College of Medicine. The NYC/Bronx WIHS Consortium is one of six sites nationally conducting the Women's Interagency HIV Study (WIHS), an observational cohort study of 2055 HIV infected and 569 HIV uninfected women, investigating the natural history of HIV infection in women, including clinical, virologic, immunologic, behavioral and health care utilization parameters. The NYC/Bronx consortium has the largest number of retained WIHS subjects in active follow-up, and contributes approximately 24 percent of the core visit data. The NYC/Bronx consortium has made substantial contributions to the development of the WIHS scientific agenda, particularly in the areas of quantitative and molecular virology and in general disease progression, and to the development and support of the national WIHS administrative infrastructure. We seek to continue the core scientific activities of WIHS including delineating the relationship of HIV disease progression and mortality to viral burden, absolute and proportional CD4 cell counts, coinfections and behavioral parameters including compliance with therapy. Continuing investigation will also include determining the gynecologic manifestations of HIV disease, including the expression and sequelae of genital infection with human papillomavirus both at baseline and in the presence of highly active antiretroviral therapy (HAART). In addition we will continue our substudy of "Complete HIV-1 RNA sequences in women: CVL and plasma" through
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Pelvic Inflammatory Disease
Dr. Barbara Weiser at the Wadsworth Center, the Research Laboratory of the New York State Department of Health. We also seek to expand both the local (NYC) and national WIHS scientific agenda to include determining the impact of HAART on disease progression, viral burden, HIV related morbidity and survival, as well as additional virologic, immunologic and behavioral investigations. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: OUTPATIENT TREATMENT OF PELVIC INFLAMMATORY DISEASE (PID) Principal Investigator & Institution: Soper, David E.; Medical University of South Carolina 171 Ashley Ave Charleston, Sc 29425 Timing: Fiscal Year 2002 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: PATHOGENESIS OF PERSISTENT CHLAMYDIAL STDS Principal Investigator & Institution: Dean, Deborah A.; Assistant Professor of Medicine; Children's Hospital & Res Ctr at Oakland Research Center at Oakland Oakland, Ca 946091809 Timing: Fiscal Year 2003; Project Start 15-SEP-2003; Project End 31-DEC-2007 Summary: (provided by applicant): Chlamydia trachomatis(CT) is the leading cause of sexually transmitted diseases (STD) in the developed world. CT infections and their sequelae of pelvic inflammatory disease, ectopic pregnancy, and infertility are responsible for approximately 80% of the estimated $2.5 billion annual cost of these infections in the United States. Further, up to 50% of women become reinfected and are at increased risk for these sequelae. Many reinfections reflect persistence that likely plays an important role in pathogenesis. The major outer membrane protein is considered to be the immunodominant protein of CT. However, the discovery of open reading frames predicted to encode a nine-member polymorphic membrane protein (Prop) gene (pmp) family in the recently published genome sequence of CT serovar D suggest that these Props may also be important in chlamydial biology. Further, CT contains a partial tryptophan biosynthesis operon (trpR, trpA, trpB) not found in a CT mouse strain (MoPn) or other species of Chlamydia. Tryptophan is essential for chlamydial replication, and tryptophan depletion in vitro results in chlamydial persistence. Our hypothesis is that the prop and tryptophan genes may undergo selection that results in differential expression or activity of these proteins that: 1) consequently determine active or persistent infection; and 2) are significantly involved in pathogenesis as an outcome of persistence or outcome of other factors. By analyzing the genetic profile of prototype and serial recurrent and persistent CT STD patient strains and by correlating these data with epidemiologic and clinical findings, we hope to identify the genes, genetic/protein variation and evolution of this variation in the organism, and how these are linked to persistence and pathogenesis. Thus, this grant will answer broad questions about the genetic and protein basis for persistence and for pathogenesis, and provide important research tools including a Database and DNA microarray that will be of long-term benefit to investigators in the field of Chlamydia. The Specific Aims for this grant are to: 1) Sequence the nine pmps, and trpR, trpA, and trpB genes for the 19 prototype serovars of CT and create a DNA microarray for these genes and ompA to differentiate strains of CT, and for use in Aim 2; and 2) Identify polymorphisms in and protein expression of the nine props, specific tryptophan operon
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genes, and other constitutively expressed genes among serial cervical samples from patients with persistent versus non-persistent CT STDs; correlate the genetic and protein expression profiles of these serial samples with epidemiologic and clinical findings. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: PELVIC INFLAMMATORY DISEASE (PID) EVALUATION & CLINICAL HEALTH STUDY Principal Investigator & Institution: Charland, Diane; Case Western Reserve University 10900 Euclid Ave Cleveland, Oh 44106 Timing: Fiscal Year 2002 Summary: This study is the first randomized, multi-center clinical trial to compare the efficacy of inpatient versus outpatient treatment of PID in preventing involuntary infertility. The study population will include non-pregnant women ages 14 years to 37 years with the recent diagnosis of PID. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: PID EVALUATION AND CLINICAL HEALTH STUDY--PEACH Principal Investigator & Institution: Randall, Hugh W.; Emory University 1784 North Decatur Road Atlanta, Ga 30322 Timing: Fiscal Year 2002 Summary: The primary aim of this study is to test the effectiveness and cost effectiveness of standard outpatient vs standard inpatient treatment for pelvic inflammatory disease (PID) in preventing involuntary infertility. The investigators will also determine effects on: time to clinical improvement, microbiologic cure, patient satisfaction, endometrial clearing, treatment adherence, PID recurrence, ectopic pregnancy, diminished functionality, and quality of life. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: PILOT--CHLAMYDIA SCREENING IN PRIMARY CARE SETTING Principal Investigator & Institution: Jumping Eagle, Sara; University of Colorado Hlth Sciences Ctr P.O. Box 6508, Grants and Contracts Aurora, Co 800450508 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 29-SEP-2008 Summary: Minorities are disproportionately affected by most sexually transmitted diseases ($TDs). One STD, chlamydia, may result in pelvic inflammatory disease, infertility, ectopic pregnancy, urethdtis, and cervical cancer. Chlamydia infection also signals unprotected sex and is strongly associated with the spread of HIV. Rates of chlamydia infection among American Indians (AIs) nationally have increased 133% from 1997-2001 and chlamydia infection among AIs is 6 times more common than among the US White population. This epidemic of chlamydia infection is of great concern to AI communities not only because it increases the risk of HIV acquisition, but because of the associated potential for rapid transmission of HIV in the population. Although the number of AIs with HIV/AIDS is low, these concerns are not unfounded since Als have experienced a >10-fold increase in HIV/AIDS since 1990. Reducing STD rates requires understanding patterns of acquisition and transmission of chlamydia among both AI men and women. The female predominance in documented Chlamydia infection has been attributed to distinct but related factors: differential use of health services, in part because women have symptoms substantially more often than men, and challenges to effective partner tracing posed by economic, cultural, and geographic
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Pelvic Inflammatory Disease
constraints. However, effective partner tracing is a criticalcomponent in reducing the burden of chlamydia since it contributes substantially to reducing its prevalence in the population. In this project, we propose to 1) implement a chlamydia screening program for all males, ages 14-35, who present for care at an IHS facility in a Northern Plains reservation; the data from a bdef questionnaire and the test results will be used to estimate the burden of chlamydia infection by age, gender, presence of symptoms, and clinical history, and to determine infection reduction achieved with universal screening; 2) assess the completeness and yield of partner tracing; and 3) examine rates of reinfection using a test-of-cure strategy. We also will blend these epidemiological data with qualitative data gathered from key informants and focus groups about our brief questionnaire and the partner notification process. Our confidential study database will track demographic data, symptoms, partner follow-up, number of partners, laboratory tests results (re-infection status), and treatment. To accomplish these aims, we have brought together an interdisciplinary team of highly respected, experienced, researchers and clinicians. This project promises to provide the information needed to develop the recommendations for community- and clinic-based strategies to improve screening, partner tracing, and treatment. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: POLYMORPHIC TRACHOMATIS
MEMBRANE
PROTEINS
OF
CHLAMYDIA
Principal Investigator & Institution: Hsia, Ru-Ching; Oral & Craniofacial Biol Scis; University of Maryland Balt Prof School Baltimore, Md 21201 Timing: Fiscal Year 2003; Project Start 01-MAY-2003; Project End 30-APR-2005 Summary: (provided by applicant): Chlamydial polymorphic membrane proteins (Pmps) are a newly identified family of Chlamydia-specific membrane proteins, whose role in chlamydial biology and pathogenesis is unknown. Genomic analysis of the prop family of C. pneumoniae has revealed frameshift mutations, deletions and gene duplications. Studies of the larger pmp families of C. pneumoniae and C. psittaci have also revealed that Pmp proteins are expressed in vitro, that some can be detected at the elementary body surface, and that some are dominant antigens during infection and may be targets for vaccine design. The emerging evidence is consistent with a role of the prop gene family in pathogenesis and immune evasion. The purpose of this project is to characterize the smallest pmp gene family identified to date: the 9-member family of C. trachomatis. In preliminary studies using the 9 partially purified recombinant Pmps as target antigens, I have observed differential Pmp-specific antibody responses in archived sera from patients with pelvic inflammatory disease. This analysis will be expanded through cross-sectional and longitudinal comparisons of Pmp-specific responses in a well-characterized patient population with genital C. trachomatis infection. This analysis may identify direct relationships between Pmp-specific responses and disease outcome. A second focus of this project will be to identify and characterize genetic and molecular determinants of Pmp expression in C. trachomatis. Polymorphisms will be identified and compared in the pmp families of selected study isolates. Experiments will be performed to characterize developmental patterns of pmp expression in these isolates. Using a panel of Pmp-specific monoclonal and polyclonal antibodies generated in this project, I will examine Pmp protein expression and eventual translocation to the surface of the outer membrane along development and at the single cell level using laser scanning confocal fluorescence microscopy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: PREVENTION OF INFERTILITY IN WOMEN WITH SUBCLINICAL PID Principal Investigator & Institution: Wiesenfeld, Harold C.; Magee-Women's Health Corporation 204 Craft Ave Pittsburgh, Pa 152133180 Timing: Fiscal Year 2003; Project Start 01-MAY-1998; Project End 31-JAN-2008 Summary: (provided by applicant): The broad, long-term goals of this study are to evaluate whether longer course antibiotic therapy for women at-risk for subclinical PID prevents subsequent infertility better than currently used short course antibiotic regimens for lower genital tract infections. Subclinical pelvic inflammatory disease (PID) is an important yet overlooked cause of infertility, responsible for more cases of post-infectious tubal infertility than acute PID. Subclinical PID is present in 25% of women with gonorrhea or chlamydia, and one in seven women with bacterial vaginosis, despite the absence of symptoms of acute PID. Most importantly, there is a doubling in infertility among women with subclinical PID compared to women without PID. Current treatment strategies for cervicitis and vaginitis do not address ongoing upper genital tract inflammation. Our hypothesis is that the preservation of fertility is greater among women with subclinical PID treated with a long-course antibiotic regimen compared to women receiving standard single-dose regimens for uncomplicated lower genital tract infections. The proposed application describes a randomized, double-blind, comparative phase III clinical trial studying a novel treatment regimen that incorporates azithromycin, an antimicrobial with potent immunomodulatory properties, on fertility outcomes in women at-risk for post-infectious fallopian tube damage. The specific aims are to 1) compare fertility rate of women with subclinical PID receiving two weeks of broad-spectrum antibiotic therapy with the fertility rate of women with subclinical PID receiving single-dose antibiotic regimen, 2) determine whether the resolution of endometritis is more common in women treated with the enhanced antimicrobial regimens utilized for acute PID compared to currently recommended single-dose regimens for lower genital tract infections, 3) characterize the inflammatory response in the lower genital tract in women with and without subclinical PID, and 4) evaluate whether women with subclinical PID have evidence of fallopian tube inflammation. During this study, very real public health questions will be asked and answered which will affect the way that lower genital tract infections are routinely managed, potentially enhancing fertility among American women. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: RISK FACTORS AS PREDICTORS OF ECTOPIC PREGNANCY Principal Investigator & Institution: Barnhart, Kurt T.; Assistant Professor; Obstetrics and Gynecology; University of Pennsylvania 3451 Walnut Street Philadelphia, Pa 19104 Timing: Fiscal Year 2002; Project Start 01-MAY-1999; Project End 30-APR-2004 Summary: Ectopic pregnancy (EP) is the leading pregnancy - related cause of death in the first trimester of pregnancy and a major contributor to maternal morbidity. As the tubal pregnancy progresses, it erodes into blood vessels and can cause massive intraabdominal bleeding. There are limitations in the strategies currently employed to diagnose EP. Even with the use of diagnostic algorithms that systematically evaluate all women at risk for an EP, only 50 percent of women with an EP can be diagnosed upon presentation to an Emergency Department (ED). Diagnosis in the remaining 50 percent represents a clinical conundrum and can take up to 6 weeks. If the diagnosis of EP is delayed, the abnormal gestation will continue to grow in the fallopian tube with potential rupture resulting in greater risks of morbidity, and mortality. Moreover, an EP
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Pelvic Inflammatory Disease
of large size is not amenable to medical therapy, may require major surgery (laparotomy) instead of laparoscopy and can cause greater damage to fallopian tube (and greater impairment of fertility), even if treated before rupture. The aims of this proposal focus on this clinically relevant subpopulation of women at risk for an EP butwhose diagnosis cannot be confirmed during their initial presentation to the ED, and is thus delayed. The University of Pennsylvania Medical Center has used a systematic, validated, protocol to diagnose pregnant women who are at risk for EP since 1989. An existing electronic database chronicles the clinical course and contains the results of the diagnostic tests used to definitively diagnose women at risk for EP but not diagnosed upon presentation to the ED. We plan to use the information in this database to: 1) identify factors predictive of EP in this subgroup of pregnant women and derive a clinical prediction rule to help identify those at highest risk for EP in an attempt to shorten the time needed for diagnosis. And 2) to evaluate the serial betahcg determinations to assess the clinical utility defining deviations from the curves characteristic of a viable intrauterine pregnancy (IUP) or spontaneous miscarriage (SAB) to diagnose an EP. For these aims, we will use a retrospective cohort study design of greater than 2100 subjects. We also plan to perform a prospective cohort study, in the same study population to: 3) evaluate the utility of novel strong predictors of EP including the endometrial stripe thickness and chlamydia serology, independently, and in context with the derived prediction rule. And 4) to validate our derived prediction rule using a prospectively collected sample of women at high risk of EP. Finally, we plan for the first time, 5) to investigate if the different clinical situations in which a woman with EP are diagnosed represent differences in the natural history of EP. This proposal represents a unique opportunity to use large amounts of existing data, combined with the efficient prospective collection of data, to understand and improve upon important limitations in our ability to diagnose a reproductive disorder with important public health consequences. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: ROLES GONORRHOEAE
OF
PILIN
GLYCAN
IN
PATHOGENESIS
OF
N.
Principal Investigator & Institution: Banerjee, Asesh; Biology; Catholic University of America 620 Michigan Ave Ne Washington, Dc 20064 Timing: Fiscal Year 2002; Project Start 01-JUL-2001; Project End 31-MAY-2006 Summary: Neisseria gonorrhoeae (gonococcus, GC) not only causes uncomplicated gonorrhea but also complications like pelvic inflammatory disease and disseminated gonococcal infection. Pilus is an important pathogenicity factor of GC and is a polymer of the glycoprotein pilin. Glycans of pilin were proposed to play important role in GC pathogenesis. We have cloned a pilin galactosyl transferase (pgtA), that adds an alpha galactosyl. In most complicated disease strains, pgtA contains a poly-G tract like the other phase-variable genes that are frequently turned on and off to presumably provide GC with selective advantage in different niches of human body. However, in uncomplicated gonorrheal isolates, this poly- G is generally not present in pgtA. Hence, we hypothesize that the poly-G mediated high-frequency phase-variation of pgtA plays an important role in conversion of uncomplicated gonorrhea to more complex systemic diseases. In addition, our High pH Anion Exchange Chromatographic analysis of GC pilin glycans suggests presence of sugars that were not reported before. These observations lead to the hypothesis that GC pilin glycans are considerably more complex than the current models and some of these glycans can be associated with certain disease phenotypes or with particular sites of the human body. To test the stated
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hypotheses, the following specific aims are proposed: 1) Characterization of GC pilin glycans from selective strains and pilus glycosylation mutants and identification of novel pilin glycosylation genes; and 2) Examination of the role of pilin glycans in GC pathogenesis. These studies will further elucidate the mechanism of gonococcal infections. Additionally, glycosylation of many surface proteins, including pilins, of several pathogenic bacteria is being reported. Therefore, the study of the role of pilin glycans in GC pathogenesis is likely to provide important leads into the mechanisms of pathogenesis of other bacteria as well. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: STD IN PATHOGENESIS OF SUBCLINICAL PID Principal Investigator & Institution: Sweet, Richard L.; Professor and Chair; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2002 Summary: This study will investigate the role of unrecognized PID in the development of tubal factor infertility over a four year period. 1500 women at risk for PID will be enrolled in this prospective study, and those with unrecognized PID, as defined by endometrial histology, will undergo a hysterosalpingogram 12 weeks after enrollment to document tubal patency. Participants will be contacted by telephone every three months for at least one year to monitor for reproductive events. A large body of retrospective data associate tubal factor infertility with prior unknown or silent upper genital tract infection. The proposed study will be the first prospective trial to comprehensively study the microbiology and histology of unrecognized PID, and its impact on fertility. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: TARGETED TRACHOMATIS
GENETIC
MODIFICATIONS
OF
CHLAMYDIA
Principal Investigator & Institution: De Mars, Robert I.; Professor; Medical Genetics; University of Wisconsin Madison 750 University Ave Madison, Wi 53706 Timing: Fiscal Year 2003; Project Start 01-JUL-2003; Project End 30-JUN-2005 Summary: (provided by applicant): Chlamydia trachomatis is the most common cause of bacterial sexually transmitted disease and of preventable blindness in humans. Antibiotics (not inexpensive) are used to control ongoing infections but common reinfection frequently causes serious pathology, e.g. pelvic inflammatory disease, infertility and blindness. Despite growing evidence of versatile human B cell and T cell immune responses to Ct antigens, there is little evidence of long-lasting protective immunity following infection; somehow, the organism evades repulse or elimination by the immune system. Current inability to genetically manipulate Ct has impeded analysis that might increase understanding of how Ct infections work and how the immune system might be better engaged in the management of Ct infection. The proposed work is aimed at developing a method of introducing planned genetic modifications into many targeted Ct genes following a three step work plan: (i) Demonstrate how to genetically transform Ct by means of homologous recombination between cloned Ct DNA that is transferred into Ct and chromosomal DNA of recipient Ct. A cloned mutant gyr A gene that renders Ct resistant to ofloxacin (OFX) will be transferred into sensitive Ct and resistant transformants will be isolated by selection with OFX. (ii) Demonstrate how to use the results of (i) to replace a normal Ct gene with a cloned mutant allele by the use of a model 'homologous recombination vector' (HRV). The same mutant gyr A gene used for (i) will be used, but transformants will be isolated by selection for a
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Pelvic Inflammatory Disease
different, non Ct- derived 'selection marker' that is part of the HRV. Homologus recombination in Ct-derived parts of the HRV will incorporate the selection marker and closely linked Ct DNA into the Ct chromosome, thereby replacing the indigenous gene with the mutant trans-gene. (iii) Use the results of (ii) to create model knockout mutant Ct strains that can be studied in animal models. A knockout mutant allele of the folA gene will be used for this model because folA - deficient transformants that normally would be unviable can be isolated by supplementation of the culture medium with reduced folic acid. A multitude of mutation/function investigations that could be based on these model demonstrations includes the possible development of attenuated strains of Ct that might be useful protective vaccines. Pairs of mutants used in (i) - (iii) above will also be used to detect genetic recombination in mixedly infected human host cells. There is clinical evidence that such recombination occurs in humans and may contribute to Ct evasion of protective immune responses. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: THE ACQUISITION OF BACTERIAL VAGINOSIS IN LESBIANS Principal Investigator & Institution: Marrazzo, Jeanne M.; Medicine; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2002; Project Start 15-SEP-2002; Project End 31-AUG-2007 Summary: (provided by applicant): Bacterial vaginosis (BV) results from a shift in the microbial ecosystem of the vagina from Lactobacillus predominance to overgrowth by anaerobic and facultative species, and has been associated with postpartum/postabortal endometritis, preterm birth, pelvic inflammatory disease, and human immunodeficiency virus acquisition. The etiology of BV is unclear, as is the role of sexual transmission of an undefined precipitant. BV frequently recurs in women who initially respond to standard antibiotic therapy. More effective interventions to prevent and treat BV require an understanding of the role of sexual transmission. Relative to most heterosexual women, lesbians have a two to three-fold higher BV prevalence (25 percent-52 percent). Preliminary evidence strongly implicates sexual transmission of vaginal secretions between women as a risk for BV. The proposed work will define the temporal association between sexual practices that transfer vaginal secretions and BV acquisition, and design an intervention to prevent this transfer and test its efficacy in reducing BV recurrence. Specific aims are: (1) prospectively define risk factors associated with acquisition of BV in a cohort of lesbians, including sexual practices that transfer vaginal secretions, sex with men, lubricant use, douching, menses, and changes in vaginal lactobacilli. The hypothesis is that BV in lesbians occurs after sexual transmission of vaginal fluid from a woman with BV to a woman without BV; that women not colonized with vaginal hydrogen peroxide-producing lactobacilli will be at highest risk for BV acquisition by this mechanism; and that comparative analyses of vaginal flora in sex partners will show similar microbial profiles. (2) Test the efficacy of an intervention to reduce transfer of vaginal fluid between female sex partners in reducing recurrence of BV following treatment with metronidazole in a prospective, randomized trial. The hypothesis is that the intervention will improve knowledge, attitudes, beliefs, and intention about BV prevention, reduce sexual exposures that increase risk of transfer of vaginal fluid, and reduce rates of BV recurrence. Lesbian couples provide a unique opportunity to conduct comparative studies of vaginal microbial ecology in sex partners, and to directly analyze determinants of transmission. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: THE ROLE OF IGA IN CPAF-INDUCED PROTECTION AGAINST C. TRACHOMATIS INFECTION Principal Investigator & Institution: Arulanandam, Bernard P.; University of Texas San Antonio San Antonio, Tx 78249 Timing: Fiscal Year 2003; Project Start 01-AUG-2003; Project End 31-JUL-2006 Summary: Chlamydia trachomatis is an obligate intracellular pathogen that is a leading cause of sexually transmitted disease. C. trachomatis infections have a high prevalence of morbidity and are also associated with pelvic inflammatory disease that often result in infertility. Despite considerable effort in the understanding of the pathogenesis of the disease, an efficacious chlamydial vaccine has not been attained. Chlamydia has evolved various strategies for evading defense mechanisms that have contributed to frequently asymptomatic and persistent infections in the host. It has been recently shown that C. trachomatis uses proteasome-like activity factor (CPAF) secreted intracellularly to evade adaptive immunity by inhibiting transcription factors required for major histocompatibility complex (MHC) expression. Therefore, neutralization of CPAF activity would normalize MHC expression and unmask the infected cells to immune surveillance and clearance. We have provided evidence to demonstrate the use of soluble interleukin (IL)-12 as a potent vaccine adjuvant for mucosal vaccination. IL-12 delivered non-invasively intranasally (i.n.) with recombinant CPAF greatly enhances protection against subsequent C. trachomatis infection. Secretory IgA is the principal immunoglobulin at mucosal surfaces. Importantly, IgA, unlike IgG, is translocated across epithelial tissue and been shown to neutralize pathogens intracellularly. Since C. trachomatis is an intracellular pathogen and produces CPAF to evade host defenses, vaccination strategies to enhance CPAF specific-secretory IgA production will be beneficial to the host. This proposal is designed to test several important aspects of the hypothesis by using animals with a targeted disruption in IgA gene expression (IgA-/mice), and polymeric Ig receptor (plgR-/- mice), that have defective IgA transport into mucosal secretions. Specifically, we will optimize an intranasal vaccination approach using CPAF. Based on these studies, we will characterize cellular and humoral immune responses and determine the role of IgA in CPAF-induced immunity using IgA-/- mice. Finally, we will directly investigate the functional role of IgA in intracellular neutralization of CPAF activity during C. trachomatis infection. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: THERAPY AND PREVENTION FOR BACTERIAL VAGINOSIS Principal Investigator & Institution: Schwebke, Jane R.; Professor; Medicine; University of Alabama at Birmingham Uab Station Birmingham, Al 35294 Timing: Fiscal Year 2002; Project Start 01-JAN-2002; Project End 31-DEC-2007 Summary: Bacterial vaginosis (BV) is a sexually associated disease caused by a complex mixture or anaerobic bacteria. BV is the most prevalent cause of symptomatic vaginal discharge in the U.S. and is associated with numerous complications including pre term delivery of infants, pelvic inflammatory disease, urinary tract infections and acquisition/transmission of sexually transmitted diseases including human immunodeficiency virus. Widespread control of BV has been suggested as a possible means for decreasing the incidence of HIV in the developing world, however, current achievable cure rates combined with high recurrence rates makes this solution impractical. Further, half of all women who meet the clinical diagnostic criteria for BV are asymptomatic and the appropriate management of these women is unknown. Although the microbiological changes which occur in women with symptomatic and
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Pelvic Inflammatory Disease
asymptomatic BV appear by culture techniques to be identical, the clinical significance of asymptomatic BV is unclear. The current therapy for BV consists of seven days of oral or topical metronidazole or clindamycin. However, there is a growing concern that eradication of organisms from the lower genital tract may be inadequate to prevent recurrences or complications and that more intensive therapy may be required for eradication of upper tract infection/colonization. Further, some of the key organisms associated with BV such as Mobiluncus and mycoplasmas are resistant to the standard therapies. Lastly, although BV has epidemiological characteristics of an STD, the role of the male partner in its pathogenesis remains unknown. We propose to conduct clinical trials which will assess enhanced therapy for BV, including longer duration of therapy and combination therapy as well as increased use of condoms to improve initial cure rates and decrease recurrences. We will also utilize specimens from these prospective studies to further study the association of Mobiluncus, an organism strongly associated with BV using sensitive PCR technology. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: TRANSLATING CHLAMYDIA SCREENING GUIDELINES INTO PRACTICE Principal Investigator & Institution: Thompson, Robert S.; Group Health Cooperative of Puget Sound 200 15Th Ave E Seattle, Wa 98112 Timing: Fiscal Year 2002; Project Start 30-SEP-2000; Project End 30-JUN-2004 Summary: Sexually transmitted Chlamydia trachomatis infections in women, often asymptomatic, have serious consequences if left untreated. However, studies from Group Health Cooperative (GHC) have shown the impact can be decreased (i.e., a 56 percent decrease in PID) if at-risk women receive screening and treatment. Over the last two years, GHC has developed an evidence-based chlamydia screening guideline to initiate translation of the evidence into practice. Objective: To evaluate the effectiveness of several multifaceted strategies for guideline implementation. Site: Thirty staff model outpatient clinics at GHC. Methods: This is a randomized trial of guideline implementation strategies carried out at the provider and patient levels. Using a 2x2 factorial design, we will compare standard guideline implementation to three other strategies: one with only provider-specific components, one with only patient-specific components and one with both provider- and patient-specific components. Providerspecific strategies (with randomization occurring at the clinic level) include the use of opinion leaders, measurement and feedback, and prompts placed in Pap test kits. The patient- specific strategy (with randomization of individual enrollees) consists of a prompt placed in the chart of 14-20 year-old females as a paper-based test to establish the case for a future computerized automated prompt system. Outcomes: Outcomes will be measured at baseline and post-implementation. The primary outcome is the rate of appropriate chlamydia screening among 14- 25 year-old females. Other primary outcomes are 1) the rate of chlamydia screening as defined by a new HEDIS measure; 2) changes in provider knowledge, attitudes/beliefs, self-efficacy, practices, and perceived barriers and supports; 3) the cost per woman appropriately screened and the marginal cost-effectiveness of each intervention arm. Secondary outcomes include changes in the rates of positive chlamydia tests, PID and ectopic pregnancy. Major study benefits: To our knowledge this will be the first study to evaluate conceptually-based guideline implementation strategies in a defined HMO clinical population. In order to further enhance generalizability, we will test selected implementation strategies in a networkmodel managed care setting. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: TRANSMISSIBILITY OF GC AND CT DIAGNOSED USING NAAT Principal Investigator & Institution: Rogers, Susan M.; Senior Scientist; Research Triangle Institute Box 12194, 3040 Cornwallis Rd Research Triangle Park, Nc 27709 Timing: Fiscal Year 2002; Project Start 27-SEP-2001; Project End 28-FEB-2005 Summary: (provided by applicant) Infections with Neisseria gonorrhoeae (GC) and Chiamydia trachornatis (Ct) are known to facilitate HIV transmission. It is estimated, for example, that the presence of untreated chiamydial infection increases the likelihood per contact of HIV transmission by a relative risk of 3 about6. These STDs have other important health consequences, including pelvic inflammatory disease, perinatal complications, and subsequent risks of infertility and ectopic pregnancy in women. The development of nucleic acid amplification tests (NAAT) that can be used with urine specimens has permitted a new paradigm for epidemiological research on these STDs. Urine specimens for STD detection can easily be obtained in population surveys and public health programs to enable generalizations about the prevalence of symptomatic and asymptomatic infections in the population at large and among hard to reach at-risk populations. Results of these studies are disturbing. In one major U.S. city, for example, it is estimated that 8.3 percent of adults ages 18-35 has an untreated GC or Ct infection. Most of these infections were diagnosed among adults who report no recent symptoms and who do not present the classic STD behavioral risk profile. These results could indicate a large and hidden epidemic of asymptomatic infections that are unlikely to be detected and treated without vigorous public health interventions. However, it is also possible that NAAT testing is identifying clinically inconsequential infections because of the assay's ability to detect extremely low levels of viable organisms (i.e., below the infectious inoculum) or amplifiable DNA (or RNA) from residual pathogens (i.e., nonviable organisms) of past infections that are well on their way to being cleared. We propose to explore this issue by testing a sample of 8,000 adults, ages 18-35, attending the Johns Hopkins Adult Emergency Department. Subjects testing positive for GC or Ct will be re-evaluated using traditional diagnostic tests for these infections and be treated. Recent sexual partners of infected subjects and a random subsample of partners from uninfected subjects will also be contacted and tested. The proposed research will allow us to: (1) determine whether the probabilities of infection transmission are equivalent for GC and Ct infections detectable only by NAAT versus infections detectable by traditional testing procedures; (2) determine whether asymptomatic infections have an equivalent probability of transmission as symptomatic infections; (3) determine whether infections that can only be detected by NAAT testing have the same clinical consequences as infections that are detectable by traditional assays; and (4) examine the correlates of infections detected by NAAT versus traditional diagnostic tests. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: TYPE IV SECRETION BY NEISSERIA GONORRHOEAE Principal Investigator & Institution: Dillard, Joseph P.; Medical Microbiol & Immunology; University of Wisconsin Madison 750 University Ave Madison, Wi 53706 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 30-JUN-2006 Summary: (provided by applicant): Neisseria gonorrhoeae causes the sexually transmitted disease gonorrhea, the more serious infections pelvic inflammatory disease (PID) and disseminated gonococcal infection (DGI). We identified a 57 kb genetic island present in N. gonorrhoeae that shows the characteristics of a pathogenicity island. Several forms of the gonococcal genetic island (GGI) are present among disease isolates, with approximately 80 percent of gonococcal strains carrying some form of the GGI. We
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identified a peptidoglycan hydrolase (atlA) encoded in the GGI and found that it is involved in the production of an unusual cytotoxin derived from the bacterial cell wall. This peptidoglycan-derived cytotoxin (PG-cytotoxin) is identical to the tracheal cytotoxin of Bordetella pertussis and is an important virulence factor in gonococcal infections. PG-cytotoxin causes the death of ciliated fallopian tube cells in organ culture, induces arthritis in rats, and induces IL-1 and IL-6 in cultured cells. The presence of atlA in the genetic island is significantly correlated with strains that cause DOT. DNA sequencing revealed that the GGI encodes a putative type IV secretion system. Type IV secretion systems include plasmid conjugation systems and virulence factor export systems and some type IV secretion systems carry out both processes. Mutations in the putative type IV secretion genes in the GGI result in loss of DNA secretion. These mutants also show delayed adherence to primary cervical cells and exhibit an unusual microcolony phenotype upon binding to cells. Mutations in atlA result in the same phenotypes as the other type IV secretion mutations as well as showing decreased PGcytotoxin production. Thus AtlA is necessary for type IV secretion and is either directly or indirectly involved in PG-cytotoxin production. These results suggest that the GGI encodes an active type IV secretion system important in interaction of N. gonorrhoeae with the host. The goals of this proposal are contained in two specific aims. 1) We will make mutations designed to affect type IV secretion and test these mutants for secretion of proteins, DNA, and PG-cytotoxin. 2) We will test mutants with defects in secretion for phenotypes relevant to virulence, i.e., epithelial cell adherence and invasion, intracellular survival, and microcolony formation. Overall, these studies are designed to reveal the molecular mechanisms of this novel secretion system and identify previously unrecognized virulence factors important in gonococcal infection which may serve as new targets for chemotherapy or immunoprotection. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: VIRULENCE FACTORS OF CHLAMYDIAE Principal Investigator & Institution: Wyrick, Priscilla B.; Professor; Microbiology; East Tennessee State University Box 70565 Johnson City, Tn 37601 Timing: Fiscal Year 2002; Project Start 01-APR-1995; Project End 31-MAR-2005 Summary: Chlamydia trachomatis serovars D-K are the most common cause, in the USA and worldwide, of bacterially-acquired sexually transmitted diseases and their sequelae, including prostatitis, epididymitis, pelvic inflammatory disease, ectopic pregnancy and sterility. Chlamydial diseases are insidious and they constitute significant primary, secondary and tertiary health concerns in which women bear a special burden because of their increased risk of adverse reproductive consequences. The goal of this laboratory for 25 years has been to try to understand the basic biology of chlamydial growth in its host epithelial cell in order to understand the infectious process and to permit dissection of the cellular and molecular consequences of persistent infection, since the majority of chlamydial tubal disease appears to result from chronic subclinical, persistent infection. This proposal is a continuation of on-going efforts to understand the crucial attachment/entry steps, the signals in chlamydiae-infected epithelial cells which trigger neutrophil chemotaxis--since a prolonged inflammatory response to persistent chlamydial antigens is believed to be responsible for the damage and sequelae, and hormone modulation of entry and signaling of neutrophils. In Aim 1, the chlamydial envelope-associated hsp70 and its co- chaperonins GrpE and DnaJ will be incorporated into liposomes, along with known and suspected adhesins, to define the role of hsp70 in entry and, in Aim 2, help identify the receptor which functions with newly identified, estrogen-responsive receptor accessory proteins. Also in Aim 2, the swine C.
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trachomatis S45 isolate- swine genital tissue model of infection will be developed to dissect hormone modulation of entry and neutrophil signaling (Aim 3). In Aim 3, a comparison will be made of chlamydial and chemokine signals triggering neutrophil chemotaxis to polarized HeLa cells normally and persistently infected with noninvasive, asymptomatic serovar E versus invasive, symptomatic serovar L2. Finally, in Aim 4, cryo-electron microscopy and density gradients will be used to show that chlamydial antigen secretion and trafficking can occur via vesicles pinched off from the chlamydial inclusion. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: WOMENS INTERAGENCY HIV STUDY Principal Investigator & Institution: Minkoff, Howard L.; Professor; Obstetrics and Gynecology; Suny Downstate Medical Center 450 Clarkson Ave New York, Ny 11203 Timing: Fiscal Year 2002; Project Start 01-MAR-1992; Project End 28-FEB-2003 Summary: The State University of New York Health Science Center at Brooklyn (SUNYHSCB), in collaboration with the five other WIHS sites, has successfully responded to the evolving epidemic of HIV infection among women by rapidly establishing research protocols, developing and piloting instruments and recruiting a national cohort highly representative of the population of HIV infected women in this country. The SUNY cohort reached, and surpassed, its original recruitment goal in June 1995 and currently has 398 women entered (311 seropositive; 87 seronegative). As of visit three our loss to follow-up rate was only 5.1 percent (4.2 percent for the seropositive cohort). We are now proposing to combine continued follow-up of this cohort with new scientific investigations and comprehensive, detailed analyses. These analyses will bring state of the art technologies to bear on a cohort which reflects the current "face" of the HIV epidemic, an epidemic which has changed in three basic ways in the decade since the first AIDS cohorts were assembled - gender, risk groups and therapeutic interventions. Our cohort is positioned to address the emerging scientific questions which those changes will engender. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “pelvic inflammatory disease” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for pelvic inflammatory disease in the PubMed Central database:
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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Antibiotic susceptibilities and auxotypes of Neisseria gonorrhoeae strains from women with pelvic inflammatory disease or uncomplicated infections. by Jacques M, Turgeon PL, deRepentigny J, Mathieu LG.; 1983 Dec; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=185415
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Association of Ureaplasma urealyticum biovars with clinical outcome for neonates, obstetric patients, and gynecological patients with pelvic inflammatory disease. by Abele-Horn M, Wolff C, Dressel P, Pfaff F, Zimmermann A.; 1997 May; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=232729
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Beta-lactam susceptibility of Neisseria gonorrhoeae isolates from pelvic inflammatory disease. by Pinon G, Quentin R, Laudat P, Vargues R.; 1981 Aug; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=181675
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Campylobacter fetus septicemia with concurrent salpingitis. by Brown WJ, Sautter R.; 1977 Jul; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=274701
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Cefotaxime Treatment of Pelvic Inflammatory Disease. by Monson TP, Miller TT, Nolan CM.; 1981 Dec; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=181812
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Detection of serum antibodies to Chlamydia trachomatis in patients with chlamydial and nonchlamydial pelvic inflammatory disease by the IPAzyme Chlamydia and enzyme immunoassay. by Mattila A, Miettinen A, Heinonen PK, Teisala K, Punnonen R, Paavonen J.; 1993 Apr; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=263603
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Effects of quinolone analog CI-960 in a monkey model of Chlamydia trachomatis salpingitis. by Patton DL, Cosgrove YT, Kuo CC, Campbell LA.; 1993 Jan; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=187596
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Evidence of genetic susceptibility to Chlamydia trachomatis-induced pelvic inflammatory disease in the pig-tailed macaque. by Lichtenwalner AB, Patton DL, Cosgrove Sweeney YT, Gaur LK, Stamm WE.; 1997 Jun; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=175311
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Pelvic inflammatory disease isolates of Neisseria gonorrhoeae are distinguished by C1q-dependent virulence for newborn rats and by the sac-4 region. by Nowicki S, Ram P, Pham T, Goluszko P, Morse S, Anderson GD, Nowicki B.; 1997 Jun; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=175289
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Persistence of chlamydial antibodies after pelvic inflammatory disease. by Puolakkainen M, Vesterinen E, Purola E, Saikku P, Paavonen J.; 1986 May; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=268751
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Protection against infertility in a BALB/c mouse salpingitis model by intranasal immunization with the mouse pneumonitis biovar of Chlamydia trachomatis. by Pal S, Fielder TJ, Peterson EM, de la Maza LM.; 1994 Aug; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=302966
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Role of L3T4-bearing T-cell populations in experimental murine chlamydial salpingitis. by Landers DV, Erlich K, Sung M, Schachter J.; 1991 Oct; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=258950
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Roxithromycin treatment of mouse chlamydial salpingitis and protective effect on fertility. by Zana J, Muffat-Joly M, Thomas D, Orfila J, Salat-Baroux J, Pocidalo JJ.; 1991 Mar; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=245027
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Susceptibilities of Chlamydia trachomatis isolates causing uncomplicated female genital tract infections and pelvic inflammatory disease. by Rice RJ, Bhullar V, Mitchell SH, Bullard J, Knapp JS.; 1995 Mar; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=162620
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Susceptibility of Neisseria gonorrhoeae associated with pelvic inflammatory disease to cefoxitin, ceftriaxone, clindamycin, gentamicin, doxycycline, azithromycin, and other antimicrobial agents. by Rice RJ, Knapp JS.; 1994 Jul; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=284620
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Treatment of acute pelvic inflammatory disease in the ambulatory setting: trial of cefoxitin and doxycycline versus ampicillin-sulbactam. by Kosseim M, Ronald A, Plummer FA, D'Costa L, Brunham RC.; 1991 Aug; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=245235
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 pelvic inflammatory disease, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “pelvic inflammatory disease” (or synonyms) into the search box, and click “Go.” The following is 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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the type of output you can expect from PubMed for pelvic inflammatory disease (hyperlinks lead to article summaries): •
A comparison of parenteral sulbactam/ampicillin versus clindamycin/gentamicin in the treatment of pelvic inflammatory disease. Author(s): Gunning J. Source: Drugs. 1986; 31 Suppl 2: 14-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3013567
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A randomized controlled trial of coil removal prior to treatment of pelvic inflammatory disease. Author(s): Altunyurt S, Demir N, Posaci C. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2003 March 26; 107(1): 81-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12593901
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A refined estimate of the average lifetime cost of pelvic inflammatory disease. Author(s): Yeh JM, Hook EW 3rd, Goldie SJ. Source: Sexually Transmitted Diseases. 2003 May; 30(5): 369-78. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12916126
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A study of bacterial pathogens in acute pelvic inflammatory disease. Author(s): Baveja G, Saini S, Sangwan K, Arora DR. Source: J Commun Dis. 2001 June; 33(2): 121-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12170931
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Accuracy of five different diagnostic techniques in mild-to-moderate pelvic inflammatory disease. Author(s): Gaitan H, Angel E, Diaz R, Parada A, Sanchez L, Vargas C. Source: Infectious Diseases in Obstetrics and Gynecology. 2002; 10(4): 171-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12648310
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Acute exacerbation of recurrent pelvic inflammatory disease. Laparoscopic findings in 141 women with a clinical diagnosis. Author(s): Cibula D, Kuzel D, Fucikova Z, Svabik K, Zivny J. Source: J Reprod Med. 2001 January; 46(1): 49-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11209632
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Acute pelvic inflammatory disease in a gynecological casualty setting. Author(s): Wagaarachchi PT, Fernando L, Fernando DJ. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 2000 February; 68(2): 155-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10717823
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Acute pelvic inflammatory disease. Author(s): Freij BJ. Source: Semin Adolesc Med. 1986 June; 2(2): 143-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3602634
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Adolescent girls and pelvic inflammatory disease: experience and practices of emergency department pediatricians. Author(s): Benaim J, Pulaski M, Coupey SM. Source: Archives of Pediatrics & Adolescent Medicine. 1998 May; 152(5): 449-54. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9605027
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Age-specific risks of syphilis, gonorrhea, and hospitalized pelvic inflammatory disease in sexually experienced U. S. women. Author(s): Bell TA, Holmes KK. Source: Sexually Transmitted Diseases. 1984 October-December; 11(4): 291-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6523311
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An assessment of the value of the menstrual history in differentiating acute appendicitis from pelvic inflammatory disease. Author(s): Robinson JA, Burch BH. Source: Surg Gynecol Obstet. 1984 August; 159(2): 149-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6463825
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An audit of outpatient management of pelvic inflammatory disease. Author(s): Piyadigamage A, Wilson JD. Source: International Journal of Std & Aids. 2002 August; 13(8): 577-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12194744
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An update on pelvic inflammatory disease. Author(s): Ross JD. Source: Sexually Transmitted Infections. 2002 February; 78(1): 18-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11872852
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Anaerobes in pelvic inflammatory disease: implications for the Centers for Disease Control and Prevention's guidelines for treatment of sexually transmitted diseases. Author(s): Walker CK, Workowski KA, Washington AE, Soper D, Sweet RL. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 1999 January; 28 Suppl 1: S29-36. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10028108
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Appendicitis versus pelvic inflammatory disease. A diagnostic dilemma. Author(s): Najem AZ, Barillo DJ, Spillert CR, Kerr JC, Lazaro EJ. Source: The American Surgeon. 1985 April; 51(4): 217-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3985488
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Are oral contraceptives masking symptoms of chlamydial cervicitis and pelvic inflammatory disease? Author(s): Mardh PA, Hogg B. Source: The European Journal of Contraception & Reproductive Health Care : the Official Journal of the European Society of Contraception. 1998 March; 3(1): 41-3. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9678072
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Assessment of risk for pelvic inflammatory disease in an urban sexual health population. Author(s): Marks C, Tideman RL, Estcourt CS, Berry G, Mindel A. Source: Sexually Transmitted Infections. 2000 December; 76(6): 470-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11221131
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Associations between Mycoplasma genitalium, Chlamydia trachomatis and pelvic inflammatory disease. Author(s): Simms I, Eastick K, Mallinson H, Thomas K, Gokhale R, Hay P, Herring A, Rogers PA. Source: Journal of Clinical Pathology. 2003 August; 56(8): 616-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12890814
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Associations between Mycoplasma genitalium, Chlamydia trachomatis, and pelvic inflammatory disease. Author(s): Simms I, Eastick K, Mallinson H, Thomas K, Gokhale R, Hay P, Herring A, Rogers PA. Source: Sexually Transmitted Infections. 2003 April; 79(2): 154-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12690141
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Azithromycin and pelvic inflammatory disease in the Northern Territory. Author(s): Bowden FJ, Jacups S, Huffman S, Savage J, O'Brien M. Source: The Medical Journal of Australia. 2001 April 2; 174(7): 366-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11346115
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Back pain in women with chronic pelvic inflammatory disease and inflammatory sacroiliac disease. Author(s): Celinska E, Spring J, Denham A, Seldrup J, Chapman M, Welsh KI, Panayi GS. Source: British Journal of Rheumatology. 1989 October; 28(5): 456-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2551449
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Bacterial cultures from intrauterine devices removed from patients with pelvic inflammatory disease. Author(s): Nilsson CG, Vartiainen E, Widholm O. Source: Acta Obstetricia Et Gynecologica Scandinavica. 1981; 60(6): 563-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7039215
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Bacterial synergy in pelvic inflammatory disease. Author(s): Brook I. Source: Archives of Gynecology and Obstetrics. 1987; 241(3): 133-43. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3324977
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Bacteriologic aspects of pelvic inflammatory disease in gynecologic patients. Author(s): Creatsas GK, Pavlatos MP, Koumantakis E, Zolotas J, Kaskarelis DB. Source: Gynecologic and Obstetric Investigation. 1982; 13(1): 2-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7056502
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Bacteriological cultures of removed intrauterine devices and pelvic inflammatory disease. Author(s): Tsanadis G, Kalantaridou SN, Kaponis A, Paraskevaidis E, Zikopoulos K, Gesouli E, Dalkalitsis N, Korkontzelos I, Mouzakioti E, Lolis DE. Source: Contraception. 2002 May; 65(5): 339-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12057785
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Bacteriology of acute pelvic inflammatory disease. Suboptimal survival of Neisseria gonorrhoeae in a nonbuffered transport system. Author(s): Chow AW, Patten V, Marshall JR. Source: American Journal of Obstetrics and Gynecology. 1979 February 15; 133(4): 362-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=107802
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Barrier-method contraceptives and pelvic inflammatory disease. Author(s): Kelaghan J, Rubin GL, Ory HW, Layde PM. Source: Jama : the Journal of the American Medical Association. 1982 July 9; 248(2): 1847. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7087109
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Benign hepatic adenoma associated with oral contraceptive use mimicking pelvic inflammatory disease. A case report. Author(s): Jenks JE, McMahon EB. Source: J Reprod Med. 1984 March; 29(3): 200-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6327978
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Beta-lactam susceptibility of Neisseria gonorrhoeae isolates from pelvic inflammatory disease. Author(s): Pinon G, Quentin R, Laudat P, Vargues R. Source: Antimicrobial Agents and Chemotherapy. 1981 August; 20(2): 260-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6792983
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Better diagnosis could aid battle against pelvic inflammatory disease. Author(s): Golden WE. Source: Jama : the Journal of the American Medical Association. 1980 June 27; 243(24): 2471-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6103966
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Bilateral meralgia paresthetica associated with pelvic inflammatory disease. Author(s): Rotenberg AS. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 1990 January 1; 142(1): 42-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2360924
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Blood cultures for women hospitalized with acute pelvic inflammatory disease. Are they necessary? Author(s): Apuzzio JJ, Hessami S, Rodriguez P. Source: J Reprod Med. 2001 September; 46(9): 815-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11584483
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Carcinoma of the fallopian tube presenting as acute pelvic inflammatory disease. Author(s): Romagosa C, Torne A, Iglesias X, Cardesa A, Ordi J. Source: Gynecologic Oncology. 2003 April; 89(1): 181-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12694675
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Case report: abdominal cocoon associated with tuberculous pelvic inflammatory disease. Author(s): Lalloo S, Krishna D, Maharajh J. Source: The British Journal of Radiology. 2002 February; 75(890): 174-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11893642
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Chlamydia trachomatis in pelvic inflammatory disease. Author(s): Shrikhande SN, Joshi SG, Zodpey SP, Saoji AM. Source: Indian J Pathol Microbiol. 1995 April; 38(2): 181-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8919106
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Chlamydia trachomatis in subfertile women undergoing uterine instrumentation. How we can help in the avoidance of iatrogenic pelvic inflammatory disease? Author(s): Thomas K, Simms I. Source: Human Reproduction (Oxford, England). 2002 June; 17(6): 1431-2. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12042255
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Chlamydia trachomatis: a major cause of mucopurulent cervicitis and pelvic inflammatory disease in women. Author(s): Paavonen J. Source: Current Problems in Dermatology. 1996; 24: 110-22. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8743261
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Chlamydial pelvic inflammatory disease. Author(s): Paavonen J, Lehtinen M. Source: Human Reproduction Update. 1996 November-December; 2(6): 519-29. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9111185
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Clarification of institutional position on the generation of pelvic inflammatory disease. Author(s): Livengood CH 3rd. Source: American Journal of Obstetrics and Gynecology. 1984 December 1; 150(7): 898-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6507520
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Clinical aspects of pelvic inflammatory disease. Author(s): Munday PE. Source: Human Reproduction (Oxford, England). 1997 November; 12(11 Suppl): 121-6. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9433968
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Clinical diagnosis of pelvic inflammatory disease in a developing country. Author(s): De Muylder X. Source: Ann Soc Belg Med Trop. 1986; 66(4): 339-42. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3566368
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Clinical predictors of endometritis in women with symptoms and signs of pelvic inflammatory disease. Author(s): Peipert JF, Ness RB, Blume J, Soper DE, Holley R, Randall H, Sweet RL, Sondheimer SJ, Hendrix SL, Amortegui A, Trucco G, Bass DC; Pelvic Inflammatory Disease Evaluation and Clinical Health Study Investigators. Source: American Journal of Obstetrics and Gynecology. 2001 April; 184(5): 856-63; Discussion 863-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11303192
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Clinical utility of CA125 levels in predicting laparoscopically confirmed salpingitis in patients with clinically diagnosed pelvic inflammatory disease. Author(s): Moore E, Soper DE. Source: Infectious Diseases in Obstetrics and Gynecology. 1998; 6(4): 182-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9812251
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Commonly used diagnostic criteria for pelvic inflammatory disease have poor sensitivity for plasma cell endometritis. Author(s): Korn AP, Hessol N, Padian N, Bolan G, Muzsnai D, Donegan E, Jonte J, Schachter J, Landers DV. Source: Sexually Transmitted Diseases. 1995 November-December; 22(6): 335-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8578403
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Comparison of clinical and laparascopic features of infertile women suffering from genital tuberculosis (TB) or pelvic inflammatory disease (PID) or endometriosis. Author(s): Avan BI, Fatmi Z, Rashid S. Source: J Pak Med Assoc. 2001 November; 51(11): 393-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11840606
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Comparison of endometrial biopsy and peritoneal fluid cytologic testing with laparoscopy in the diagnosis of acute pelvic inflammatory disease. Author(s): Paavonen J, Aine R, Teisala K, Heinonen PK, Punnonen R. Source: American Journal of Obstetrics and Gynecology. 1985 March 1; 151(5): 645-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3156502
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Compliance with doxycycline therapy for outpatient treatment of pelvic inflammatory disease. Author(s): Brookoff D. Source: Southern Medical Journal. 1994 November; 87(11): 1088-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7973890
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Concerns regarding the Centers for Disease Control's published guidelines for pelvic inflammatory disease. Author(s): Hemsel DL, Ledger WJ, Martens M, Monif GR, Osborne NG, Thomason JL. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 2001 January; 32(1): 103-7. Epub 2000 December 15. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11118388
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Consequences of incomplete antibacterial treatment for chlamydial pelvic inflammatory disease. Author(s): Rosenberg MJ, Waugh MS. Source: Drugs. 1995; 49 Suppl 2: 504-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8549417
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Contraceptives do not protect against pelvic inflammatory disease. Author(s): Larkin M. Source: Lancet. 2001 April 21; 357(9264): 1270. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11418158
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Control of Chlamydia trachomatis infections in female army recruits: cost-effective screening and treatment in training cohorts to prevent pelvic inflammatory disease. Author(s): Howell MR, Gaydos JC, McKee KT Jr, Quinn TC, Gaydos CA. Source: Sexually Transmitted Diseases. 1999 October; 26(9): 519-26. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10534206
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C-reactive protein and the treatment of pelvic inflammatory disease. Author(s): Reljic M, Gorisek B. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 1998 February; 60(2): 143-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9509952
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Decreasing incidences of gonorrhea- and chlamydia-associated acute pelvic inflammatory disease. A 25-year study from an urban area of central Sweden. Author(s): Kamwendo F, Forslin L, Bodin L, Danielsson D. Source: Sexually Transmitted Diseases. 1996 September-October; 23(5): 384-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8885069
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Delayed care of pelvic inflammatory disease as a risk factor for impaired fertility. Author(s): Hillis SD, Joesoef R, Marchbanks PA, Wasserheit JN, Cates W Jr, Westrom L. Source: American Journal of Obstetrics and Gynecology. 1993 May; 168(5): 1503-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8498436
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Detection of Chlamydia trachomatis antigen by enzyme immunoassay in patients with pelvic inflammatory disease. Author(s): Lal H, Rathee S, Sharma D, Chaudhary S. Source: The Indian Journal of Medical Research. 1992 March; 95: 77-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1601474
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Detection of herpes simplex virus in women with acute pelvic inflammatory disease. Author(s): Lehtinen M, Rantala I, Teisala K, Heinonen PK, Lehtinen T, Aine R, Miettinen A, Gronroos P, Punnonen R, Leinikki P, et al. Source: The Journal of Infectious Diseases. 1985 July; 152(1): 78-82. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2989388
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Detection of serum antibodies to Chlamydia trachomatis in patients with chlamydial and nonchlamydial pelvic inflammatory disease by the IPAzyme Chlamydia and enzyme immunoassay. Author(s): Mattila A, Miettinen A, Heinonen PK, Teisala K, Punnonen R, Paavonen J. Source: Journal of Clinical Microbiology. 1993 April; 31(4): 998-1000. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8463409
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Diagnosis and management of pelvic inflammatory disease in adolescents. Author(s): Eissa MA, Cromwell PF. Source: Journal of Pediatric Health Care : Official Publication of National Association of Pediatric Nurse Associates & Practitioners. 2003 May-June; 17(3): 145-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12734462
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Diagnosis of pelvic inflammatory disease with 99mtechnetiumhexamethylpropylenamine-oxime-labeled autologous leukocytes and pelvic radionuclide scintigraphy. Author(s): Mozas J, Castilla JA, Alarcon JL, Ruiz J, Jimena P, Herruzo AJ. Source: Obstetrics and Gynecology. 1993 May; 81(5 ( Pt 1)): 797-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8469475
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Diagnosis of pelvic inflammatory disease: time for a rethink. Author(s): Simms I, Warburton F, Westrom L. Source: Sexually Transmitted Infections. 2003 December; 79(6): 491-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14663128
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Differential diagnosis of abdominal pain in women of childbearing age. Appendicitis or pelvic inflammatory disease? Author(s): Dahlberg DL, Lee C, Fenlon T, Willoughby D. Source: Adv Nurse Pract. 2004 January; 12(1): 40-5; Quiz 45-6. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14730835
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Differential diagnosis of appendicitis and pelvic inflammatory disease. A prospective analysis. Author(s): Bongard F, Landers DV, Lewis F. Source: American Journal of Surgery. 1985 July; 150(1): 90-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3160252
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Differentiating acute appendicitis from pelvic inflammatory disease in women of childbearing age. Author(s): Webster DP, Schneider CN, Cheche S, Daar AA, Miller G. Source: The American Journal of Emergency Medicine. 1993 November; 11(6): 569-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8240553
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Differentiation of tubo-ovarian abscess from pelvic inflammatory disease, and recent trends in the management of tubo-ovarian abscess. Author(s): Murthy JH, Hiremagalur SR. Source: J Tenn Med Assoc. 1995 April; 88(4): 136-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7723328
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Difficulties in treating adolescents with pelvic inflammatory disease with the revised treatment guidelines. Author(s): Seitz ML. Source: Archives of Pediatrics & Adolescent Medicine. 1999 January; 153(1): 94. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9895012
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Direct medical cost of pelvic inflammatory disease and its sequelae: decreasing, but still substantial. Author(s): Rein DB, Kassler WJ, Irwin KL, Rabiee L. Source: Obstetrics and Gynecology. 2000 March; 95(3): 397-402. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10711551
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Do women with pelvic inflammatory disease receive adequate treatment? Author(s): Reid S, Glucksman E, Blott M, Welch J. Source: International Journal of Std & Aids. 1997 July; 8(7): 466-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9228598
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Does payment improve follow-up of pelvic inflammatory disease? Author(s): Schwab RA, Radakovich R, Tate K. Source: Mo Med. 2002 July; 99(7): 286-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12198999
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Does pelvic inflammatory disease increase the risk for acquisition of human immunodeficiency virus type 1? Author(s): Irwin K, Ellerbrock T. Source: The Journal of Infectious Diseases. 1995 September; 172(3): 898-900. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7658094
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Doppler flow characteristics in patients with pelvic inflammatory disease: responders versus nonresponders to therapy. Author(s): Tepper R, Aviram R, Cohen N, Cohen I, Holtzinger M, Beyth Y. Source: Journal of Clinical Ultrasound : Jcu. 1998 June; 26(5): 247-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9608367
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Doppler ultrasound findings in female infertility. With special reference to pelvic inflammatory disease and endocrinological factors. Author(s): Tinkanen H. Source: Acta Obstetricia Et Gynecologica Scandinavica. 1995 October; 74(9): 762-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7572118
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Drug treatment of common STDs: Part II. Vaginal infections, pelvic inflammatory disease and genital warts. Author(s): Woodward C, Fisher MA. Source: American Family Physician. 1999 October 15; 60(6): 1716-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10537386
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Early- and late-onset pelvic inflammatory disease among women with cervical Chlamydia trachomatis infection at the time of induced abortion--a follow-up study. Author(s): Sorensen JL, Thranov I, Hoff G, Dirach J. Source: Infection. 1994 July-August; 22(4): 242-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8002083
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Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease. Author(s): Ledger WJ. Source: American Journal of Obstetrics and Gynecology. 2003 February; 188(2): 598; Author Reply 599-600. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12592280
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Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease: results from the Pelvic Inflammatory Disease Evaluation and Clinical Health (PEACH) Randomized Trial. Author(s): Ness RB, Soper DE, Holley RL, Peipert J, Randall H, Sweet RL, Sondheimer SJ, Hendrix SL, Amortegui A, Trucco G, Songer T, Lave JR, Hillier SL, Bass DC, Kelsey SF. Source: American Journal of Obstetrics and Gynecology. 2002 May; 186(5): 929-37. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12015517
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Effects of human immunodeficiency virus 1 infection on microbial origins of pelvic inflammatory disease and on efficacy of ambulatory oral therapy. Author(s): Bukusi EA, Cohen CR, Stevens CE, Sinei S, Reilly M, Grieco V, Eschenbach DA, Holmes KK, Bwayo J, Ndinya-Achola JO, Kreiss J. Source: American Journal of Obstetrics and Gynecology. 1999 December; 181(6): 1374-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10601915
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Efficacy and safety of azithromycin as monotherapy or combined with metronidazole compared with two standard multidrug regimens for the treatment of acute pelvic inflammatory disease. Author(s): Bevan CD, Ridgway GL, Rothermel CD. Source: J Int Med Res. 2003 January-February; 31(1): 45-54. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12635534
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Efficacy of single-agent therapy for the treatment of acute pelvic inflammatory disease with ciprofloxacin. Author(s): Crombleholme WR, Schachter J, Ohm-Smith M, Luft J, Whidden R, Sweet RL. Source: The American Journal of Medicine. 1989 November 30; 87(5A): 142S-147S. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2589358
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Endometritis does not predict reproductive morbidity after pelvic inflammatory disease. Author(s): Haggerty CL, Ness RB, Amortegui A, Hendrix SL, Hillier SL, Holley RL, Peipert J, Randall H, Sondheimer SJ, Soper DE, Sweet RL, Trucco G. Source: American Journal of Obstetrics and Gynecology. 2003 January; 188(1): 141-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12548208
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Epidemiologic and clinical characteristics of pelvic inflammatory disease associated with Mycoplasma hominis, Chlamydia trachomatis, and Neisseria gonorrhoeae. Author(s): Miettinen A, Saikku P, Jansson E, Paavonen J. Source: Sexually Transmitted Diseases. 1986 January-March; 13(1): 24-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3082018
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Epidemiology and trends in hospital discharges for pelvic inflammatory disease in England, 1975 to 1985. Author(s): Buchan H, Vessey M. Source: British Journal of Obstetrics and Gynaecology. 1989 October; 96(10): 1219-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2590659
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Epidemiology of ectopic pregnancy during a 28 year period and the role of pelvic inflammatory disease. Author(s): Kamwendo F, Forslin L, Bodin L, Danielsson D. Source: Sexually Transmitted Infections. 2000 February; 76(1): 28-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10817065
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Epidemiology of pelvic inflammatory disease at University Medical Center, Jacksonville. Author(s): Shannon J, Benrubi GI. Source: J Fla Med Assoc. 1991 March; 78(3): 158-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2037832
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Epidemiology of pelvic inflammatory disease in parous women with special reference to intrauterine device use. Author(s): Buchan H, Villard-Mackintosh L, Vessey M, Yeates D, McPherson K. Source: British Journal of Obstetrics and Gynaecology. 1990 September; 97(9): 780-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2242362
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Epidemiology of pelvic inflammatory disease. Author(s): Grodstein F, Rothman KJ. Source: Epidemiology (Cambridge, Mass.). 1994 March; 5(2): 234-42. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8172999
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Etiology and outcome of acute pelvic inflammatory disease. Author(s): Brunham RC, Binns B, Guijon F, Danforth D, Kosseim ML, Rand F, McDowell J, Rayner E. Source: The Journal of Infectious Diseases. 1988 September; 158(3): 510-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3045213
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Etiology of acute pelvic inflammatory disease proven by laparoscopy. Author(s): Dan M, Samra Z, Katz A, Debby A, Gutman R, Zakut H. Source: Sexually Transmitted Diseases. 1993 May-June; 20(3): 158-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8511710
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European guideline for the management of pelvic inflammatory disease and perihepatitis. Author(s): Ross JD; European Branch of the International Union against Sexually Transmitted Infection and the European Office of the World Health Organization. Source: International Journal of Std & Aids. 2001 October; 12 Suppl 3: 84-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11589804
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Evaluation of new anti-infective drugs for the treatment of acute pelvic inflammatory disease. Infectious Diseases Society of America and the Food and Drug Administration. Author(s): Sweet RL, Bartlett JG, Hemsell DL, Solomkin JS, Tally F. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 1992 November; 15 Suppl 1: S53-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1477252
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Evaluation of ofloxacin in the treatment of laparoscopically documented acute pelvic inflammatory disease (salpingitis). Author(s): Peipert JF, Sweet RL, Walker CK, Kahn J, Rielly-Gauvin K. Source: Infectious Diseases in Obstetrics and Gynecology. 1999; 7(3): 138-44. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10371472
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Evidence against tailstrings increasing the rate of pelvic inflammatory disease among IUD users. Author(s): Ebi KL, Piziali RL, Rosenberg M, Wachob HF. Source: Contraception. 1996 January; 53(1): 25-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8631186
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Evidence of infection with Chlamydia trachomatis in patients with pelvic inflammatory disease: value of partner investigation. Author(s): Moss TR, Hawkswell J. Source: Fertility and Sterility. 1986 March; 45(3): 429-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3949045
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Factors predicting abnormal hysterosalpingographic findings in patients treated for acute pelvic inflammatory disease. Author(s): Paavonen J, Vesterinen E, Aantaa K, Rasanen J. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 1985 June; 23(3): 171-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2865177
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Factors that might influence the outcome of studies on the aetiology and epidemiology of acute pelvic inflammatory disease. Author(s): Mardh PA, Westrom L. Source: Scandinavian Journal of Gastroenterology. Supplement. 1984; 91: 73-86. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6377473
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Familial Mediterranean fever presenting as recurrent acute pelvic inflammatory disease. Author(s): Adair R, Colon JM, McGovern PG. Source: Obstetrics and Gynecology. 2003 May; 101(5 Pt 2): 1098-100. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12738114
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Fecundity and morbidity following acute pelvic inflammatory disease treated with doxycycline and metronidazole. Author(s): Heinonen PK, Leinonen M. Source: Archives of Gynecology and Obstetrics. 2003 October; 268(4): 284-8. Epub 2002 October 26. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14504870
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Fibrinolysis in the peritoneal fluid during adhesions, endometriosis and ongoing pelvic inflammatory disease. Author(s): Edelstam G, Lecander I, Larsson B, Astedt B. Source: Inflammation. 1998 August; 22(4): 341-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9675606
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Fitz-Hugh-Curtis Syndrome: pelvic inflammatory disease with an unusual CT presentation. Author(s): Romo LV, Clarke PD. Source: Journal of Computer Assisted Tomography. 1992 September-October; 16(5): 8323. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1522282
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Follicular myometritis: a previously undescribed component of pelvic inflammatory disease. Author(s): Ismail SM. Source: Histopathology. 1990 January; 16(1): 91-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2307422
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Frequency and distribution of salpingitis and pelvic inflammatory disease in shortstay hospitals in the United States. Author(s): Jones OG, Zaidi AA, St John RK. Source: American Journal of Obstetrics and Gynecology. 1980 December 1; 138(7 Pt 2): 905-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7468679
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Genital mycoplasmas and chlamydiae in pelvic inflammatory diseases. Author(s): Cracea E, Mocanu I, Popa M, Constantinescu S, Vizitiu O. Source: Arch Roum Pathol Exp Microbiol. 1984 April-June; 43(2): 121-6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6534326
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Gonococcal infection in women with pelvic inflammatory disease in Lusaka, Zambia. Author(s): Ratnam AV, Din SN, Chatterjee TK. Source: American Journal of Obstetrics and Gynecology. 1980 December 1; 138(7 Pt 2): 965-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7468683
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Gonococcal pelvic inflammatory disease, oral contraceptives, and cervical mucus. Author(s): Griffiths M, Hindley D. Source: Genitourinary Medicine. 1985 February; 61(1): 67. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4086027
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Gonococcal pelvic inflammatory disease. Author(s): Eschenbach DA, Holmes KK. Source: American Journal of Obstetrics and Gynecology. 1977 November 15; 129(6): 7102. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=411375
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Gonococcal pelvic inflammatory disease. Economic impact in New York, Medicaid 1975. Author(s): Pulice RT, Lyman DO. Source: N Y State J Med. 1979 October; 79(11): 1728-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=386180
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Gonococcal pelvic inflammatory disease: case-finding observations. Author(s): Potterat JJ, Phillips L, Rothenberg RB, Darrow WW. Source: American Journal of Obstetrics and Gynecology. 1980 December 1; 138(7 Pt 2): 1101-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7468670
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Gonorrhea, genital chlamydial infection, and nonspecific urethritis in male partners of women hospitalized and treated for acute pelvic inflammatory disease. Author(s): Kamwendo F, Johansson E, Moi H, Forslin L, Danielsson D. Source: Sexually Transmitted Diseases. 1993 May-June; 20(3): 143-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8511708
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Group A streptococcal sepsis secondary to peritonitis and acute pelvic inflammatory disease. Author(s): Borgia SM, Low DE, Andrighetti S, Rau NV. Source: European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology. 2001 June; 20(6): 437-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11476452
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Hemodynamic assessment in pelvic inflammatory disease by transvaginal color Doppler ultrasonography. Author(s): Alatas C, Aksoy E, Akarsu C, Yakin K, Bahceci M. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 1996 December; 70(1): 75-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9031924
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High prevalence of cervical intra-epithelial neoplasia in women treated for pelvic inflammatory disease. Author(s): Giraud J, Coiffic J, Poulain P, Kerisit J. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 1998 October; 81(1): 51-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9846714
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High quality, cost-effective care for adolescents with pelvic inflammatory disease. Author(s): Rich M. Source: Journal of Pediatric and Adolescent Gynecology. 1998 November; 11(4): 193-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9806132
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HIV infection among patients with acute pelvic inflammatory disease at the Kenyatta National Hospital, Nairobi, Kenya. Author(s): Ojwang AW, Lema VM, Wanjala SH. Source: East Afr Med J. 1993 August; 70(8): 506-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8261972
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Hodgkin's lymphoma of the uterus presenting as refractory pelvic inflammatory disease. A case report. Author(s): Raggio ML, Bostrom SG, Harden EA. Source: J Reprod Med. 1988 October; 33(10): 827-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3193414
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Hormonal contraception and pelvic inflammatory disease. Author(s): Henry-Suchet J. Source: The European Journal of Contraception & Reproductive Health Care : the Official Journal of the European Society of Contraception. 1997 December; 2(4): 263-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9678084
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Hormonal contraception, immune responses, and pelvic inflammatory disease. Author(s): Savaris R. Source: Fertility and Sterility. 2003 December; 80(6): 1539; Author Reply 1539-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14667914
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Hospitalizations for pelvic inflammatory disease in Canada, 1983/84-1993/94. Author(s): Kurtz R, Doherty J. Source: Can Commun Dis Rep. 1998 January 1; 24(1): 1-5. English, French. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9494222
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Hospitalizations for pelvic inflammatory disease. Epidemiology and trends in the United States, 1975 to 1981. Author(s): Washington AE, Cates W Jr, Zaidi AA. Source: Jama : the Journal of the American Medical Association. 1984 May 18; 251(19): 2529-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6716580
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How well is pelvic inflammatory disease managed in general practice? A postal questionnaire survey. Author(s): Huengsberg M, Ip CB, Radcliffe KW. Source: Sexually Transmitted Infections. 1998 October; 74(5): 361-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10195033
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HTLV-I/II infection in women with acute pelvic inflammatory disease. Author(s): Safrin S, Ng VL, McGrath MS, Dattel BJ, Hauer L, Sweet RL. Source: Jama : the Journal of the American Medical Association. 1990 April 25; 263(16): 2181. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2319682
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Humoral immune response to conserved epitopes of Chlamydia trachomatis and human 60-kDa heat-shock protein in women with pelvic inflammatory disease. Author(s): Domeika M, Domeika K, Paavonen J, Mardh PA, Witkin SS. Source: The Journal of Infectious Diseases. 1998 March; 177(3): 714-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9498452
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If I suffered from pelvic inflammatory disease. Author(s): Barnes J. Source: Br J Clin Pract. 1987 October; 41(10): 945-6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3505178
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Imaging pelvic inflammatory disease with Tc-99m ciprofloxacin. Author(s): Choe W, Im MW, Chung JK, Jeong JM. Source: Clinical Nuclear Medicine. 2000 October; 25(10): 842-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11043738
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Incidence of pelvic inflammatory disease after first-trimester legal abortion in women with bacterial vaginosis after treatment with metronidazole: a double-blind, randomized study. Author(s): Larsson PG, Platz-Christensen JJ, Thejls H, Forsum U, Pahlson C. Source: American Journal of Obstetrics and Gynecology. 1992 January; 166(1 Pt 1): 100-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1733176
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Incidence of pelvic inflammatory disease. Author(s): Sturtevant FM. Source: The British Journal of General Practice : the Journal of the Royal College of General Practitioners. 1990 February; 40(331): 84. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2107861
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Infertility following pelvic inflammatory disease. Author(s): Pavletic AJ, Wolner-Hanssen P, Paavonen J, Hawes SE, Eschenbach DA. Source: Infectious Diseases in Obstetrics and Gynecology. 1999; 7(3): 145-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10371473
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Influence of human immunodeficiency virus infection on pelvic inflammatory disease. Author(s): Irwin KL, Moorman AC, O'Sullivan MJ, Sperling R, Koestler ME, Soto I, Rice R, Brodman M, Yasin S, Droese A, Zhang D, Schwartz DA, Byers RH. Source: Obstetrics and Gynecology. 2000 April; 95(4): 525-34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10725484
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Interferon-gamma in the diagnosis and pathogenesis of pelvic inflammatory disease. Author(s): Grifo JA, Jeremias J, Ledger WJ, Witkin SS. Source: American Journal of Obstetrics and Gynecology. 1989 January; 160(1): 26-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2492149
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Intrauterine contraceptive device and pelvic inflammatory disease. Author(s): Toivonen J. Source: Annals of Medicine. 1993 April; 25(2): 171-3. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8489756
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Intrauterine device and pelvic inflammatory disease. Author(s): Khomassuridze AG, Tsertsvadze GL, Tsereteli TG. Source: Advances in Contraception : the Official Journal of the Society for the Advancement of Contraception. 1997 March; 13(1): 71-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9181187
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Intrauterine devices and pelvic inflammatory disease. Author(s): Gareen IF. Source: Curr Womens Health Rep. 2003 August; 3(4): 280-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12844450
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Intrauterine devices and pelvic inflammatory disease: an international perspective. Author(s): Farley TM, Rosenberg MJ, Rowe PJ, Chen JH, Meirik O. Source: Lancet. 1992 March 28; 339(8796): 785-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1347812
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Intrauterine devices and pelvic inflammatory disease: evolving perspectives on the data. Author(s): Burkman RT. Source: Obstetrical & Gynecological Survey. 1996 December; 51(12 Suppl): S35-41. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8972501
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Intrauterine devices and pelvic inflammatory disease: meta-analyses of published studies, 1974-1990. Author(s): Gareen IF, Greenland S, Morgenstern H. Source: Epidemiology (Cambridge, Mass.). 2000 September; 11(5): 589-97. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10955413
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Intrauterine devices and pelvic inflammatory disease--a reanalysis of the literature. Author(s): Beck E. Source: The Western Journal of Medicine. 1991 March; 154(3): 328-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2028601
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Intravenous and oral ciprofloxacin in the treatment of proven pelvic inflammatory disease. A comparison with doxycycline and metronidazole. Author(s): Heinonen PK, Teisala K, Aine R, Miettinen A. Source: The American Journal of Medicine. 1989 November 30; 87(5A): 152S-156S. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2589360
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Introductory address: microbial etiology of pelvic inflammatory disease. Author(s): Mardh P. Source: Sexually Transmitted Diseases. 1984 October-December; 11(4 Suppl): 428-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6523323
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Introductory address: treatment of pelvic inflammatory disease in view of etiology and risk factors. Author(s): Westrom L. Source: Sexually Transmitted Diseases. 1984 October-December; 11(4 Suppl): 437-40. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6395378
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Investigating the microbial aetiology of pelvic inflammatory disease. Author(s): Taylor-Robinson D. Source: Sexually Transmitted Infections. 2003 October; 79(5): 424-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14573844
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Is pelvic inflammatory disease an indication for treatment with ciprofloxacin? Author(s): Hagele D, Chysky V. Source: Infection. 1988; 16 Suppl 1: S48-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3286515
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IUDs and pelvic inflammatory disease. Author(s): Rossing MA, Weiss NS. Source: Lancet. 1992 July 25; 340(8813): 248-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1353177
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Laparoscopic diagnosis of acute pelvic inflammatory disease. Author(s): Allen LA, Schoon MG. Source: British Journal of Obstetrics and Gynaecology. 1983 October; 90(10): 966-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6226310
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Laparoscopic management of suspected acute pelvic inflammatory disease. Author(s): Molander P, Cacciatore B, Sjoberg J, Paavonen J. Source: The Journal of the American Association of Gynecologic Laparoscopists. 2000 February; 7(1): 107-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10648748
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Laparoscopic study on the microbiology and severity of acute pelvic inflammatory disease. Author(s): Heinonen PK, Miettinen A. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 1994 November; 57(2): 85-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7859910
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Laparoscopic versus clinical diagnosis of acute pelvic inflammatory disease. Author(s): Morcos R, Frost N, Hnat M, Petrunak A, Caldito G. Source: J Reprod Med. 1993 January; 38(1): 53-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8441133
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Laparoscopy for the confirmation and prognostic evaluation of pelvic inflammatory disease. Author(s): Chaparro MV, Ghosh S, Nashed A, Poliak A. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 1978; 15(4): 307-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=25803
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Laparoscopy in suspected pelvic inflammatory disease. Author(s): Belsky DH. Source: J Am Osteopath Assoc. 1984 April; 83(8): 582-4. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6233240
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Laparoscopy in the diagnosis and treatment of pelvic inflammatory disease with abscess formation. Author(s): Adducci JE. Source: Int Surg. 1981 October-December; 66(4): 359-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6212560
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Laparoscopy in the diagnosis and treatment of pelvic inflammatory disease: a review and discussion. Author(s): Binstock M, Muzsnai D, Apodaca L, Goldman N, Keith L. Source: Int J Fertil. 1986 November-December; 31(5): 341-51. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2898435
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Large bowel obstruction due to intrauterine device: associated pelvic inflammatory disease. Author(s): Antonelli D, Kustrup JF Jr. Source: The American Surgeon. 1999 December; 65(12): 1165-6. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10597067
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Lethal outcome of pelvic inflammatory disease in five women who were seropositive for HIV. Author(s): Quazi MA. Source: The European Journal of Surgery = Acta Chirurgica. 1996 January; 162(1): 67-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8679767
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Letter: Douching and pelvic inflammatory disease. Author(s): Neumann HH, DeCherney A. Source: The New England Journal of Medicine. 1976 September 30; 295(14): 789. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=958272
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Localization of Chlamydia trachomatis infection by direct immunofluorescence and culture in pelvic inflammatory disease. Author(s): Kiviat NB, Wolner-Hanssen P, Peterson M, Wasserheit J, Stamm WE, Eschenbach DA, Paavonen J, Lingenfelter J, Bell T, Zabriskie V, et al. Source: American Journal of Obstetrics and Gynecology. 1986 April; 154(4): 865-73. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3515947
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Long-term sequelae of acute pelvic inflammatory disease. A retrospective cohort study. Author(s): Safrin S, Schachter J, Dahrouge D, Sweet RL. Source: American Journal of Obstetrics and Gynecology. 1992 April; 166(4): 1300-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1566789
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Low risk of pelvic inflammatory disease in young never-pregnant women using Gravigard. Author(s): Larsson B, Hagstrom B, Viberg L, Anker C, Hamberger L, Lindhe BA. Source: Contraception. 1979 September; 20(3): 291-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=509955
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Lower genital tract infection and endometritis: insight into subclinical pelvic inflammatory disease. Author(s): Clin Evid. 2002 Dec;(8):1649-54 Source: Obstetrics and Gynecology. 2002 September; 100(3): 456-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12603962
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Lower quality of life among women with chronic pelvic pain after pelvic inflammatory disease. Author(s): Haggerty CL, Schulz R, Ness RB; PID Evaluation and Clinical Health Study Investigators. Source: Obstetrics and Gynecology. 2003 November; 102(5 Pt 1): 934-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14672466
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Management of chronic pelvic inflammatory disease with shortwave diathermy. A case report. Author(s): Balogun JA, Okonofua FE. Source: Physical Therapy. 1988 October; 68(10): 1541-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2459722
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Management of pelvic inflammatory disease by primary care physicians. A comparison with Centers for Disease Control and Prevention guidelines. Author(s): Hessol NA, Priddy FH, Bolan G, Baumrind N, Vittinghoff E, Reingold AL, Padian NS. Source: Sexually Transmitted Diseases. 1996 March-April; 23(2): 157-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8919744
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Management of pelvic inflammatory disease. Author(s): Johal B, Ridgway GL, Siddle NC. Source: International Journal of Std & Aids. 1990 November; 1(6): 401-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2094401
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Massive ascites as a complication to subclinical perihepatitis and pelvic inflammatory disease. Author(s): Urnes A, Stray-Pedersen B, Raknerud N. Source: Acta Obstetricia Et Gynecologica Scandinavica. 1986; 65(3): 277-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3739636
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Massive ascites produced by chronic pelvic inflammatory disease. A case report. Author(s): Sobel MI, Ridgik JH, Davis GH. Source: J Reprod Med. 1990 May; 35(5): 555-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2352252
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Measurement of IgG antibodies to Chlamydia trachomatis by commercial enzyme immunoassays and immunofluorescence in sera from pregnant women and patients with infertility, pelvic inflammatory disease, ectopic pregnancy, and laboratory diagnosed Chlamydia psittaci/Chlamydia pneumoniae infection. Author(s): Jones CS, Maple PA, Andrews NJ, Paul ID, Caul EO. Source: Journal of Clinical Pathology. 2003 March; 56(3): 225-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12610104
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Measures of sexual behavior and the risk of pelvic inflammatory disease. Author(s): Lee NC, Rubin GL, Grimes DA. Source: Obstetrics and Gynecology. 1991 March; 77(3): 425-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1992411
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Medically sound, cost-effective treatment for pelvic inflammatory disease and tuboovarian abscess. Author(s): McNeeley SG, Hendrix SL, Mazzoni MM, Kmak DC, Ransom SB. Source: American Journal of Obstetrics and Gynecology. 1998 June; 178(6): 1272-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9662312
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Metastatic cervical cancer and pelvic inflammatory disease in an AIDS patient. Author(s): Singh GS, Aikins JK, Deger R, King S, Mikuta JJ. Source: Gynecologic Oncology. 1994 September; 54(3): 372-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8088616
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Microbial causes of proven pelvic inflammatory disease and efficacy of clindamycin and tobramycin. Author(s): Wasserheit JN, Bell TA, Kiviat NB, Wolner-Hanssen P, Zabriskie V, Kirby BD, Prince EC, Holmes KK, Stamm WE, Eschenbach DA. Source: Annals of Internal Medicine. 1986 February; 104(2): 187-93. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3004276
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Microbial profile of pelvic inflammatory disease. Author(s): Arora U, Mohan U. Source: Indian Journal of Medical Sciences. 1997 October; 51(10): 386-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9567514
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Microbiological and histopathological findings in acute pelvic inflammatory disease. Author(s): Paavonen J, Teisala K, Heinonen PK, Aine R, Laine S, Lehtinen M, Miettinen A, Punnonen R, Gronroos P. Source: British Journal of Obstetrics and Gynaecology. 1987 May; 94(5): 454-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3580330
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Microlaparoscopy with conscious sedation in adolescents with suspected pelvic inflammatory disease. Author(s): Kahn JA, Chiang VW, Shrier LA, Emans SJ, Fishman SJ, Goodman E, Laufer MR. Source: Journal of Pediatric and Adolescent Gynecology. 1999 August; 12(3): 149-54. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10546907
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Minority women with sexually transmitted diseases: sexual abuse and risk for pelvic inflammatory disease. Author(s): Champion JD, Piper J, Shain RN, Perdue ST, Newton ER. Source: Research in Nursing & Health. 2001 February; 24(1): 38-43. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11260584
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Morbidity associated with pelvic inflammatory disease. Author(s): Adler MW, Belsey EH, O'Connor BH. Source: Br J Vener Dis. 1982 June; 58(3): 151-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7082978
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Morbidity following pelvic inflammatory disease. Author(s): Buchan H, Vessey M, Goldacre M, Fairweather J. Source: British Journal of Obstetrics and Gynaecology. 1993 June; 100(6): 558-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8334091
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MR imaging in pelvic inflammatory disease: comparison with laparoscopy and US. Author(s): Tukeva TA, Aronen HJ, Karjalainen PT, Molander P, Paavonen T, Paavonen J. Source: Radiology. 1999 January; 210(1): 209-16. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9885610
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Multicenter randomized trial of ofloxacin versus cefoxitin and doxycycline in outpatient treatment of pelvic inflammatory disease. Ambulatory PID Research Group. Author(s): Martens MG, Gordon S, Yarborough DR, Faro S, Binder D, Berkeley A. Source: Southern Medical Journal. 1993 June; 86(6): 604-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8506477
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Mycoplasma hominis in patients with pelvic inflammatory disease. Author(s): Miettinen A. Source: Isr J Med Sci. 1987 June; 23(6): 713-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3312109
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Mycoplasma hominis in pelvic inflammatory disease. Author(s): Prabhakar K, Subramanian S, Thyagarajan SP. Source: Indian J Pathol Microbiol. 1994 July; 37(3): 293-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7814061
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Need for precise terminology in pelvic inflammatory disease. Author(s): Fribourg S. Source: American Journal of Obstetrics and Gynecology. 1981 June 15; 140(4): 482. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7246677
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Neisseria meningitidis. Probable pathogen in two related cases of urethritis, epididymitis, and acute pelvic inflammatory disease. Author(s): William DC, Felman YM, Corsaro MC. Source: Jama : the Journal of the American Medical Association. 1979 October 12; 242(15): 1653-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=113569
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New directions in the diagnosis and treatment of pelvic inflammatory disease. Author(s): Abbott M. Source: The Journal of Antimicrobial Chemotherapy. 1994 February; 33(2): 352-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8182020
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New directions in the diagnosis and treatment of pelvic inflammatory disease. Author(s): Witkin SS, Ledger WJ. Source: The Journal of Antimicrobial Chemotherapy. 1993 February; 31(2): 197-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8463166
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Nimesulide in the treatment of pelvic inflammatory diseases. A multicentre clinical trial conducted in Campania and Sicily. Author(s): Chiantera A, Tesauro R, Di Leo S, Meli MT, Scaricabarozzi I. Source: Drugs. 1993; 46 Suppl 1: 134-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7506152
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Noncontraceptive effects of hormonal contraceptives: bone mass, sexually transmitted disease and pelvic inflammatory disease, cardiovascular disease, menstrual function, and future fertility. Author(s): Burkman RT Jr. Source: American Journal of Obstetrics and Gynecology. 1994 May; 170(5 Pt 2): 1569-75. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8178908
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Nongonococcal pelvic inflammatory disease. Author(s): Grimes DA. Source: Clinical Obstetrics and Gynecology. 1981 December; 24(4): 1227-43. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7037257
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Observer agreement with laparoscopic diagnosis of pelvic inflammatory disease using photographs. Author(s): Molander P, Finne P, Sjoberg J, Sellors J, Paavonen J. Source: Obstetrics and Gynecology. 2003 May; 101(5 Pt 1): 875-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12738143
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Oestrogen deficiency following pelvic inflammatory disease. Author(s): Cattanach JF. Source: The Medical Journal of Australia. 1990 October 1; 153(7): 433-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2215321
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Office management of sexually transmitted disease and management of pelvic inflammatory disease in the ambulatory patient. Author(s): Nesse RE. Source: Primary Care. 1988 September; 15(3): 489-515. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3054960
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On “Pelvic inflammatory disease in patients seropositive for HIV”. Author(s): Oosterhuis JW. Source: The European Journal of Surgery = Acta Chirurgica. 1996 August; 162(8): 669. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8891629
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On the causation of pelvic inflammatory disease. Author(s): Keith LG, Berger GS, Edelman DA, Newton W, Fullan N, Bailey R, Friberg J. Source: American Journal of Obstetrics and Gynecology. 1984 May 15; 149(2): 215-24. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6372489
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Operative and conservative treatment of tubo-ovarian abscess due to pelvic inflammatory disease. Author(s): Roberts W, Dockery JL. Source: Southern Medical Journal. 1984 July; 77(7): 860-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6740355
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Optimum therapy for acute pelvic inflammatory disease. Author(s): Dodson MG. Source: Drugs. 1990 April; 39(4): 511-22. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2190794
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Oral clindamycin and ciprofloxacin versus intramuscular ceftriaxone and oral doxycycline in the treatment of mild-to-moderate pelvic inflammatory disease in outpatients. Author(s): Arredondo JL, Diaz V, Gaitan H, Maradiegue E, Oyarzun E, Paz R, Reynal JL, Stamm W, Zambrano D. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 1997 February; 24(2): 170-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9114143
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Oral contraceptive use modifies the manifestations of pelvic inflammatory disease. Author(s): Wolner-Hanssen P. Source: British Journal of Obstetrics and Gynaecology. 1986 June; 93(6): 619-24. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3730330
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Oral contraceptives and pelvic inflammatory disease. Author(s): Rubin GL, Ory HW, Layde PM. Source: American Journal of Obstetrics and Gynecology. 1982 November 15; 144(6): 6305. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7137247
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Oral contraceptives, Chlamydia trachomatis infection, and pelvic inflammatory disease. A word of caution about protection. Author(s): Washington AE, Gove S, Schachter J, Sweet RL. Source: Jama : the Journal of the American Medical Association. 1985 April 19; 253(15): 2246-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3974117
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Outpatient antibiotics for pelvic inflammatory disease. Author(s): Ross JD. Source: Bmj (Clinical Research Ed.). 2001 February 3; 322(7281): 251-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11157512
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Outpatient management of pelvic inflammatory disease. Author(s): Price B, Martens M. Source: Curr Womens Health Rep. 2001 August; 1(1): 36-40. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12112950
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Outpatient parenteral antibiotic therapy. Management of serious infections, Part II: Amenable infections and models for delivery. Pelvic inflammatory disease. Author(s): Sweet RL. Source: Hosp Pract (Off Ed). 1993 July; 28 Suppl 2: 25-30; Discussion 58-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8325924
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Outpatient pelvic inflammatory disease treatment as effective as inpatient care, study finds. Author(s): Levenson D. Source: Rep Med Guidel Outcomes Res. 2002 June 14; 13(11): 9-10, 12. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12498174
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Outpatient treatment of pelvic inflammatory disease with cefoxitin and doxycycline. Author(s): Wolner-Hanssen P, Paavonen J, Kiviat N, Young M, Eschenbach DA, Holmes KK. Source: Obstetrics and Gynecology. 1988 April; 71(4): 595-600. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3353051
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Ovarian cancer antigen CA 125 levels in pelvic inflammatory disease and pregnancy. Author(s): Halila H, Stenman UH, Seppala M. Source: Cancer. 1986 April 1; 57(7): 1327-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3456253
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Ovarian histology in pelvic inflammatory disease. Author(s): Margolis RC. Source: J Am Osteopath Assoc. 1976 February; 75(6): 602-%. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1044332
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Ovarian histology in pelvic inflammatory disease. Author(s): Weiner S, Wallach EE. Source: Obstetrics and Gynecology. 1974 March; 43(3): 431-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4814461
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Ovarian pathology in chronic pelvic inflammatory disease. Author(s): Bychkov V. Source: Gynecologic and Obstetric Investigation. 1990; 30(1): 31-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2227609
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Pelvic inflammatory disease after hysterosalpingography associated with Chlamydia trachomatis and Mycoplasma hominis. Author(s): Moller BR, Allen J, Toft B, Hansen KB, Taylor-Robinson D. Source: British Journal of Obstetrics and Gynaecology. 1984 December; 91(12): 1181-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6518153
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Pelvic inflammatory disease and Actinomyces. Author(s): Bhardwaj G. Source: American Journal of Obstetrics and Gynecology. 1984 July 15; 149(6): 697. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6742061
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Pelvic inflammatory disease and contraceptive practice. Author(s): Edelman DA. Source: Advances in Contraception : the Official Journal of the Society for the Advancement of Contraception. 1986 June; 2(2): 141-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3776741
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Pelvic inflammatory disease and its sequelae in adolescents. Author(s): Washington AE, Sweet RL, Shafer MA. Source: J Adolesc Health Care. 1985 July; 6(4): 298-310. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3891700
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Pelvic inflammatory disease and the Dalkon Shield. Author(s): Edelman DA, Berger GS, Keith L. Source: Obstetrics and Gynecology. 1984 August; 64(2): 297-300. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6738964
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Pelvic inflammatory disease and the general surgeon. Author(s): Boyd ME. Source: Canadian Journal of Surgery. Journal Canadien De Chirurgie. 1985 January; 28(1): 11-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3971216
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Pelvic inflammatory disease in patients infected with Chlamydia trachomatis: in vitro cell mediated immune response to chlamydial antigens. Author(s): Hallberg T, Wolner-Hanssen P, Mardh PA. Source: Genitourinary Medicine. 1985 August; 61(4): 247-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4018805
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Pelvic inflammatory disease is a risk factor for cervical cancer. Author(s): Skapinyecz J, Smid I, Horvath A, Jeney C, Kardos L, Kovacs P. Source: Eur J Gynaecol Oncol. 2003; 24(5): 401-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14584656
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Pelvic inflammatory disease, intrauterine contraception, and the conduct of epidemiologic studies. Author(s): Struthers BJ. Source: Advances in Contraception : the Official Journal of the Society for the Advancement of Contraception. 1985 March; 1(1): 63-76. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3916040
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Pelvic inflammatory disease. Author(s): Denham I. Source: Aust Fam Physician. 1986 March; 15(3): 254-6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3754740
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Pelvic inflammatory disease. Author(s): Torrington J. Source: Journal of Obstetric, Gynecologic, and Neonatal Nursing : Jognn / Naacog. 1985 November-December; 14(6 Suppl): 21S-31S. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2934523
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Pelvic inflammatory disease. Author(s): Hare MJ. Source: The Practitioner. 1985 November; 229(1409): 997-1000. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2933644
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Pelvic inflammatory disease: a review with emphasis on antimicrobial therapy. Author(s): Burnakis TG, Hildebrandt NB. Source: Reviews of Infectious Diseases. 1986 January-February; 8(1): 86-116. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2937130
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Pelvic inflammatory disease: new diagnostic criteria and treatment. Author(s): Beigi RH, Wiesenfeld HC. Source: Obstetrics and Gynecology Clinics of North America. 2003 December; 30(4): 77793. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14719850
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Pelvic inflammatory disease: sonographic-pathologic correlation. Author(s): Swayne LC, Love MB, Karasick SR. Source: Radiology. 1984 June; 151(3): 751-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6718737
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Pelvic inflammatory disease--use of appropriate antibiotics. Author(s): Mead PB. Source: Clinical Obstetrics and Gynecology. 1985 June; 28(2): 405-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2990785
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Peroperative penicillins, bacteremia, and pelvic inflammatory disease in association with induced first-trimester abortion. Author(s): Heisterberg L, Sonne-Holm S, Thorup Andersen J, Sebbesen O, Hebjorn S. Source: Dan Med Bull. 1985 March; 32(1): 73-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3886311
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Persistence of chlamydial antibodies after pelvic inflammatory disease. Author(s): Puolakkainen M, Vesterinen E, Purola E, Saikku P, Paavonen J. Source: Journal of Clinical Microbiology. 1986 May; 23(5): 924-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3711278
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Predictive value of clinical diagnostic codes for the CDC case definition of pelvic inflammatory disease (PID): implications for surveillance. Author(s): Ratelle S, Yokoe D, Blejan C, Whelan M, Tang Y, Platt R, Blair R, Tao G, Irwin K. Source: Sexually Transmitted Diseases. 2003 November; 30(11): 866-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14603097
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Psychiatric side effects of ofloxacin used in the treatment of pelvic inflammatory disease. Author(s): Hall CE, Keegan H, Rogstad KE. Source: International Journal of Std & Aids. 2003 September; 14(9): 636-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14511503
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Quantitative determination of the serum antibody response to the capsular polysaccharide of Bacteroides fragilis subspecies fragilis in women with pelvic inflammatory disease. Author(s): Kasper DL, Eschenbach DA, Hayes ME, Holmes KK. Source: The Journal of Infectious Diseases. 1978 July; 138(1): 74-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=98597
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Randomized comparison of ampicillin-sulbactam to cefoxitin and doxycycline or clindamycin and gentamicin in the treatment of pelvic inflammatory disease or endometritis. Author(s): McGregor JA, Crombleholme WR, Newton E, Sweet RL, Tuomala R, Gibbs RS. Source: Obstetrics and Gynecology. 1994 June; 83(6): 998-1004. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8190448
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Randomized field trial of vaginal douching, pelvic inflammatory disease and pregnancy. Author(s): Rothman KJ, Funch DP, Alfredson T, Brady J, Dreyer NA. Source: Epidemiology (Cambridge, Mass.). 2003 May; 14(3): 340-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12859036
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Rapid diagnosis of chlamydial infection in patients with pelvic inflammatory disease and infertility by immunoperoxidase assay. Author(s): Chaudhry R, Goel N, Dhawan B, Aggarwal R. Source: Indian J Pathol Microbiol. 1997 October; 40(4): 499-502. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9444861
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Recognition of tubo-ovarian abscess in adolescents with pelvic inflammatory disease. Author(s): Slap GB, Forke CM, Cnaan A, Bellah RD, Kreider ME, Hanissian JA, Gallagher PR, Driscoll DA. Source: The Journal of Adolescent Health : Official Publication of the Society for Adolescent Medicine. 1996 June; 18(6): 397-403. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8803731
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Recovery of cytomegalovirus and herpes simplex virus from upper and lower genital tract specimens obtained from women with pelvic inflammatory disease. Author(s): Clarke LM, Duerr A, Yeung KH, Brockman S, Barbosa C, Macasaet M. Source: The Journal of Infectious Diseases. 1997 July; 176(1): 286-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9207384
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Recurrent chlamydial infections increase the risks of hospitalization for ectopic pregnancy and pelvic inflammatory disease. Author(s): Hillis SD, Owens LM, Marchbanks PA, Amsterdam LF, Mac Kenzie WR. Source: American Journal of Obstetrics and Gynecology. 1997 January; 176(1 Pt 1): 103-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9024098
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Reduced levels of gamma-interferon secretion in response to chlamydial 60 kDa heat shock protein amongst women with pelvic inflammatory disease and a history of repeated Chlamydia trachomatis infections. Author(s): Debattista J, Timms P, Allan J, Allan J. Source: Immunology Letters. 2002 May 1; 81(3): 205-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11947926
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Reduced risk of pelvic inflammatory disease with injectable contraceptives. Author(s): Gray RH. Source: Lancet. 1985 May 4; 1(8436): 1046. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2859496
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Relationship between use of the intrauterine device and pelvic inflammatory disease. Author(s): Sarma S. Source: Archives of Family Medicine. 1999 May-June; 8(3): 197. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10333811
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Residues of pelvic inflammatory disease in intrauterine device users: a result of the intrauterine device or Chlamydia trachomatis infection? Author(s): Guderian AM, Trobough GE. Source: American Journal of Obstetrics and Gynecology. 1986 March; 154(3): 497-503. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3513579
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Results of microsurgical treatment of tubal infertility and early second-look laparoscopy in the post-pelvic inflammatory disease patient: implications for in vitro fertilization. Author(s): Luber K, Beeson CC, Kennedy JF, Villanueva B, Young PE. Source: American Journal of Obstetrics and Gynecology. 1986 June; 154(6): 1264-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2940868
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Risk factors and protective factors of pelvic inflammatory disease: a case-control study. Author(s): Shrikhande SN, Zodpey SP, Kulkarni HR. Source: Indian J Public Health. 1998 April-June; 42(2): 42-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10389508
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Risk factors for a complicated clinical course among women hospitalized with pelvic inflammatory disease. Author(s): Jamieson DJ, Duerr A, Macasaet MA, Peterson HB, Hillis SD. Source: Infectious Diseases in Obstetrics and Gynecology. 2000; 8(2): 88-93. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10805363
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Risk factors for Chlamydia trachomatis pelvic inflammatory disease among sex workers in Nairobi, Kenya. Author(s): Kimani J, Maclean IW, Bwayo JJ, MacDonald K, Oyugi J, Maitha GM, Peeling RW, Cheang M, Nagelkerke NJ, Plummer FA, Brunham RC. Source: The Journal of Infectious Diseases. 1996 June; 173(6): 1437-44. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8648217
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Risk factors for laparoscopically confirmed pelvic inflammatory disease: findings from Mumbai (Bombay), India. Author(s): Gogate A, Brabin L, Nicholas S, Gogate S, Gaonkar T, Naidu A, Divekar A, Karande A, Hart CA. Source: Sexually Transmitted Infections. 1998 December; 74(6): 426-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10195052
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Risk factors for pelvic inflammatory disease in inner-city adolescents. Author(s): Suss AL, Homel P, Hammerschlag M, Bromberg K. Source: Sexually Transmitted Diseases. 2000 May; 27(5): 289-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10821603
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Risk factors for pelvic inflammatory disease. A case control study. Author(s): Jossens MO, Eskenazi B, Schachter J, Sweet RL. Source: Sexually Transmitted Diseases. 1996 May-June; 23(3): 239-47. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8724516
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Risk of clinical pelvic inflammatory disease attributable to an intrauterine device. Author(s): Shelton JD. Source: Lancet. 2001 February 10; 357(9254): 443. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11273068
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Role of bacterial vaginosis in pelvic inflammatory disease. Author(s): Sweet RL. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 1995 June; 20 Suppl 2: S271-5. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7548573
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Role of sexual behavior in the development of pelvic inflammatory disease. Author(s): Newton W, Keith LG. Source: J Reprod Med. 1985 February; 30(2): 82-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3884805
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Salpingitis and pelvic inflammatory disease. Author(s): Swinker ML. Source: American Family Physician. 1985 January; 31(1): 143-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3966303
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Screening for chlamydia to prevent pelvic inflammatory disease. Author(s): Pittrof R. Source: The New England Journal of Medicine. 1996 November 14; 335(20): 1532; Author Reply 1532-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8927092
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Screening for chlamydia to prevent pelvic inflammatory disease. Author(s): Perez JA Jr, Arsura EL, Abraham JJ. Source: The New England Journal of Medicine. 1996 November 14; 335(20): 1532; Author Reply 1532-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8927091
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Screening for chlamydia to prevent pelvic inflammatory disease. Author(s): Sellors J, Paavonen J. Source: The New England Journal of Medicine. 1996 November 14; 335(20): 1531-2; Author Reply 1532-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8927090
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Screening for chlamydia to prevent pelvic inflammatory disease. Author(s): Abter EI, Mahmud MA. Source: The New England Journal of Medicine. 1996 November 14; 335(20): 1531; Author Reply 1532-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8927089
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Screening for chlamydia--a key to the prevention of pelvic inflammatory disease. Author(s): Hillis SD, Wasserheit JN. Source: The New England Journal of Medicine. 1996 May 23; 334(21): 1399-401. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8614429
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Self-reported pelvic inflammatory disease in the US: a common occurrence. Author(s): Aral SO, Mosher WD, Cates W Jr. Source: American Journal of Public Health. 1985 October; 75(10): 1216-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4037167
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Serological evidence implicating Mycoplasma genitalium in pelvic inflammatory disease. Author(s): Moller BR, Taylor-Robinson D, Furr PM. Source: Lancet. 1984 May 19; 1(8386): 1102-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6144831
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Serum C-reactive protein determination in acute pelvic inflammatory disease. Author(s): Lehtinen M, Laine S, Heinonen PK, Teisala K, Miettinen A, Aine R, Punnonen R, Gronroos P, Paavonen J. Source: American Journal of Obstetrics and Gynecology. 1986 January; 154(1): 158-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2936244
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Serum tetranectin in patients with acute pelvic inflammatory disease (PID). Correlation to clinical and laboratory findings. Author(s): Hogdall CK, Christiansen M, Brihmer C. Source: Acta Obstetricia Et Gynecologica Scandinavica. 1995 March; 74(3): 203-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7534970
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Severity of pelvic inflammatory disease as a predictor of the probability of live birth. Author(s): Lepine LA, Hillis SD, Marchbanks PA, Joesoef MR, Peterson HB, Westrom L. Source: American Journal of Obstetrics and Gynecology. 1998 May; 178(5): 977-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9609570
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Silent pelvic inflammatory disease: is it overstated? Author(s): Wolner-Hanssen P. Source: Obstetrics and Gynecology. 1995 September; 86(3): 321-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7651634
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Small bowel obstruction in an adolescent with pelvic inflammatory disease due to Chlamydia trachomatis. Author(s): Harel Z, Tracy TF Jr, Bussey JG 3rd. Source: Journal of Pediatric and Adolescent Gynecology. 2003 June; 16(3): 125-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12804934
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Small cell carcinoma of the endometrium with concomitant pelvic inflammatory disease. Author(s): Chuang J, Chu CC, Hwang JL, Cheng WC. Source: Archives of Gynecology and Obstetrics. 2002 July; 266(3): 178-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12197562
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Social and behavioral correlates of pelvic inflammatory disease. Author(s): Aral SO, Wasserheit JN. Source: Sexually Transmitted Diseases. 1998 August; 25(7): 378-85. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9713919
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Spectrum of CT findings in acute pyogenic pelvic inflammatory disease. Author(s): Sam JW, Jacobs JE, Birnbaum BA. Source: Radiographics : a Review Publication of the Radiological Society of North America, Inc. 2002 November-December; 22(6): 1327-34. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12432105
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Streptococcus pneumoniae pelvic inflammatory disease. A case report. Author(s): Chudacoff RM, Taylor RR. Source: J Reprod Med. 1995 September; 40(9): 649-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8576882
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Successful pregnancy outcome following first trimester pelvic inflammatory disease. Author(s): Stitely ML, Gherman RB. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 2000 May; 40(2): 200-2. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10925910
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Susceptibilities of Chlamydia trachomatis isolates causing uncomplicated female genital tract infections and pelvic inflammatory disease. Author(s): Rice RJ, Bhullar V, Mitchell SH, Bullard J, Knapp JS. Source: Antimicrobial Agents and Chemotherapy. 1995 March; 39(3): 760-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7793888
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Susceptibility of Neisseria gonorrhoeae associated with pelvic inflammatory disease to cefoxitin, ceftriaxone, clindamycin, gentamicin, doxycycline, azithromycin, and other antimicrobial agents. Author(s): Rice RJ, Knapp JS. Source: Antimicrobial Agents and Chemotherapy. 1994 July; 38(7): 1688-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7979312
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Tc-99m Infecton scan in possible pelvic inflammatory disease. Author(s): Sharma R, Mondal A, Sharma M, Popli M, Chopra MK, Sawroop K, Kashyap R. Source: Clinical Nuclear Medicine. 2001 March; 26(3): 208-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11245111
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Teaching and communication strategies: working with the hospitalized adolescent with pelvic inflammatory disease. Author(s): Bob PS, Famolare NE. Source: Pediatric Nursing. 1998 January-February; 24(1): 17-20. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9555440
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The association of interleukin 6 with clinical and laboratory parameters of acute pelvic inflammatory disease. Author(s): Richter HE, Holley RL, Andrews WW, Owen J, Miller KB. Source: American Journal of Obstetrics and Gynecology. 1999 October; 181(4): 940-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10521758
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The economic cost of pelvic inflammatory disease. Author(s): Washington AE, Arno PS, Brooks MA. Source: Jama : the Journal of the American Medical Association. 1986 April 4; 255(13): 1735-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3951103
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The effect of laser radiation on the metabolic processes of cellular membranes in pelvic inflammatory disease. Author(s): Kattakhodjaeva MH, Rakhimova LS. Source: Alaska Med. 1999 January-March; 41(1): 13-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10224679
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The influence of demographic change and cumulative risk of pelvic inflammatory disease on the incidence of ectopic pregnancy. Author(s): Simms I, Rogers PA, Nicoll A. Source: Epidemiology and Infection. 1997 August; 119(1): 49-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9287943
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The management of pelvic inflammatory disease in the Central Region of Ghana is not standardized. Author(s): Bosu WK, Annan JJ, Mabey D. Source: International Journal of Std & Aids. 1998 July; 9(7): 408-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9696197
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The polymicrobial etiology of acute pelvic inflammatory disease and treatment regimens. Author(s): Dodson MG, Faro S. Source: Reviews of Infectious Diseases. 1985 November-December; 7 Suppl 4: S696-702. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3909326
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The prevalence of Chlamydia trachomatis in patients with pelvic inflammatory disease. Author(s): Ravindran J, Tan YI, Ngeow YF. Source: Med J Malaysia. 1998 March; 53(1): 16-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10968132
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The rate of diagnosis and demography of pelvic inflammatory disease in general practice: England and Wales. Author(s): Simms I, Rogers P, Charlett A. Source: International Journal of Std & Aids. 1999 July; 10(7): 448-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10454179
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The role of antibiotics after dilatation and curettage in women with metrorrhagia in the prevention of pelvic inflammatory disease. Author(s): Makris N, Iatrakis G, Sakellaropoulos G, Rodolakis A, Michalas S. Source: Clin Exp Obstet Gynecol. 2000; 27(1): 27-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10758794
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The similarities and differences of endometritis and pelvic inflammatory disease. Author(s): Scott LD, Hasik KJ. Source: Journal of Obstetric, Gynecologic, and Neonatal Nursing : Jognn / Naacog. 2001 May-June; 30(3): 332-41. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11383957
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Three years of a clinical practice guideline for uncomplicated pelvic inflammatory disease in adolescents. Author(s): Shrier LA, Moszczenski SA, Emans SJ, Laufer MR, Woods ER. Source: The Journal of Adolescent Health : Official Publication of the Society for Adolescent Medicine. 2000 July; 27(1): 57-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10867353
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Time to conception after IUD removal: importance of duration of use, IUD type, pelvic inflammatory disease and age. Author(s): Andolsek L, Teeter RA, Kozuh-Novak M, Wheeler R, Fortney JA, Rosenberg MJ. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 1986 June; 24(3): 217-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2880761
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Transvaginal power Doppler findings in laparoscopically proven acute pelvic inflammatory disease. Author(s): Molander P, Sjoberg J, Paavonen J, Cacciatore B. Source: Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2001 March; 17(3): 233-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11309174
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Transvaginal salpingosonography for assessing tubal patency in women previously treated for pelvic inflammatory disease and benign ovarian tumors. Author(s): Spalding H, Martikainen H, Tekay A, Jouppila P. Source: Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology. 1999 September; 14(3): 205-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10550882
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Treatment of acute pelvic inflammatory disease with aztreonam, a new monocyclic beta-lactam antibiotic, and clindamycin. Author(s): Dodson MG, Faro S, Gentry LO. Source: Obstetrics and Gynecology. 1986 May; 67(5): 657-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3083313
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Treatment of acute pelvic inflammatory disease with penicillin and chloramphenicol in a developing country. Author(s): De Muylder X. Source: Ann Soc Belg Med Trop. 1986; 66(2): 177-82. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3753054
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Trichomonas vaginalis is associated with pelvic inflammatory disease in women infected with human immunodeficiency virus. Author(s): Moodley P, Wilkinson D, Connolly C, Moodley J, Sturm AW. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 2002 February 15; 34(4): 519-22. Epub 2002 January 07. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11797180
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Ultrasonographic evaluation of pelvic inflammatory disease. Author(s): Hata K, Hata T, Aoki S, Takamiya O, Kitao M. Source: Nippon Sanka Fujinka Gakkai Zasshi. 1989 July; 41(7): 895-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2677171
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Ultrasonographically guided transvaginal aspiration of tuboovarian abscesses and pyosalpinges: an optional treatment for acute pelvic inflammatory disease. Author(s): Aboulghar MA, Mansour RT, Serour GI. Source: American Journal of Obstetrics and Gynecology. 1995 May; 172(5): 1501-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7755062
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Ultrasound findings in perihepatitis associated with pelvic inflammatory disease. Author(s): Schoenfeld A, Fisch B, Cohen M, Vardy M, Ovadia J. Source: Journal of Clinical Ultrasound : Jcu. 1992 June; 20(5): 339-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1316376
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Unilateral tubo-ovarian involvement in pelvic inflammatory disease. Author(s): Norman RJ, Brown IM. Source: Cent Afr J Med. 1980 October; 26(10): 213-6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7261048
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Unsuspected chronic pelvic inflammatory disease in the infertile female. Author(s): Rosenfeld DL, Seidman SM, Bronson RA, Scholl GM. Source: Fertility and Sterility. 1983 January; 39(1): 44-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6217087
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Upper and lower reproductive tract bacteria in 126 women with acute pelvic inflammatory disease. Microbial susceptibility and clinical response to four therapeutic regimens. Author(s): Hemsell DL, Nobles BJ, Heard MC, Hemsell PG. Source: J Reprod Med. 1988 October; 33(10): 799-805. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3193409
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Urinary mucopolysaccharide excretion in women with pelvic inflammatory disease. Author(s): Gorodeski IG, Neri A, Wasserman L, Bahari CM. Source: Gynecologic and Obstetric Investigation. 1982; 13(4): 261-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6212299
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Uterine devices and pelvic inflammatory disease. Author(s): Kessel E. Source: Lancet. 1992 May 23; 339(8804): 1306. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1349712
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Uterine devices and pelvic inflammatory disease. Author(s): Higgins SP, Shen RN, Bingham JS, Bradbeer CS. Source: Lancet. 1992 May 23; 339(8804): 1306. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1349711
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Vaginal douching and pelvic inflammatory disease. Author(s): Ringrose CA. Source: The New England Journal of Medicine. 1976 December 2; 295(23): 1319. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=980067
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Vaginal douching as a possible risk factor for pelvic inflammatory disease. Author(s): Forrest KA, Washington AE, Daling JR, Sweet RL. Source: Journal of the National Medical Association. 1989 February; 81(2): 159-65. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2659806
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Vaginal douching as a risk factor for acute pelvic inflammatory disease. Author(s): Scholes D, Daling JR, Stergachis A, Weiss NS, Wang SP, Grayston JT. Source: Obstetrics and Gynecology. 1993 April; 81(4): 601-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8459976
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Vaginal flora and pelvic inflammatory disease. Author(s): Faro S, Martens M, Maccato M, Hammill H, Pearlman M. Source: American Journal of Obstetrics and Gynecology. 1993 August; 169(2 Pt 2): 470-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8357048
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Vaginal polymorphonuclear leukocytes and bacterial vaginosis as markers for histologic endometritis among women without symptoms of pelvic inflammatory disease. Author(s): Yudin MH, Hillier SL, Wiesenfeld HC, Krohn MA, Amortegui AA, Sweet RL. Source: American Journal of Obstetrics and Gynecology. 2003 February; 188(2): 318-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12592233
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Vulvovaginitis, vulvar skin disease, and pelvic inflammatory disease. Author(s): Altchek A. Source: Pediatric Clinics of North America. 1981 May; 28(2): 397-432. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7243370
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When to suspect--and how to manage--pelvic inflammatory disease. Author(s): Messner M. Source: Jaapa. 2003 May; 16(5): 18-22, 25. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14968508
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When to treat adolescents with pelvic inflammatory disease as outpatients. Author(s): Shrier LA. Source: Journal of Pediatric and Adolescent Gynecology. 1998 November; 11(4): 191-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9806131
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CHAPTER 2. NUTRITION AND PELVIC INFLAMMATORY DISEASE Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and pelvic inflammatory disease.
Finding Nutrition Studies on Pelvic Inflammatory Disease 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 “pelvic inflammatory disease” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.
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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 “pelvic inflammatory disease” (or a synonym): •
Clinical observation and experimental studies on the effectiveness of fu yan kang on chronic pelvic inflammatory diseases. Source: Li, H Dong, K Q Qu, X H Qi, G J Kong, L J Li, W Wang, G Z Liu, A J Cui, J C Wang, B X J-Tradit-Chin-Med. 1987 June; 7(2): 109-12 0254-6272
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Ruptured tubo-ovarian abscess complicating transcervical cryopreserved embryo transfer. Author(s): Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical School, Ein Kereum, Jerusalem. Source: Friedler, S Ben Shachar, I Abramov, Y Schenker, J G Lewin, A Fertil-Steril. 1996 May; 65(5): 1065-6 0015-0282
Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •
healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0
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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov
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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov
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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/
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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/
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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/
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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/
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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/
Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •
AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats
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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html
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Google: http://directory.google.com/Top/Health/Nutrition/
Nutrition
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Healthnotes: http://www.healthnotes.com/
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Open Directory Project: http://dmoz.org/Health/Nutrition/
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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/
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WebMDHealth: http://my.webmd.com/nutrition
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html
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CHAPTER 3. BOOKS ON PELVIC INFLAMMATORY DISEASE Overview This chapter provides bibliographic book references relating to pelvic inflammatory disease. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on pelvic inflammatory disease 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 “pelvic inflammatory disease” (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 pelvic inflammatory disease: •
Reproductive Tract Infections in Mozambique: A Case Study of Integrated Services Source: Reproductive Tract Infections. Contact: Plenum Publishing Corporation, Plenum Medical Book Company, 233 Spring St, New York, NY, 10013-1578, (888) 640-7378, http://www.wkap.nl. Summary: This book chapter describes a model of a sexually transmitted diseases (STDs) and AIDS control program integrated into the structure of primary health care in Mozambique. The STD consultations focused on the surveillance and monitoring of reproductive tract infection (RTI) syndromes, HIV, and their complications. The chapter discusses the planning and management structure, the creation of an expert unit of various medical specialists and researchers, training, procurement of supplies, and organization of clinical services and cost recovery. It also examines activities in the areas of surveillance, monitoring and evaluation, mandatory prevention, and counseling and
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partner notification. The discussion concludes that the joint STD/AIDS control program is beneficial and feasible. The planning process was found to be very important, as was quality control for laboratory services, and clinical and educational management of patients and partners. Suggestions are made for drug management, changes in syndromic management strategies, and behavior modification activities. Appendixes provide flow charts outlining case management for urethritis, vaginal discharge, pelvic inflammatory disease or lower abdominal pain, and genital ulcer disease. •
Sexually Transmissible Diseases Source: Guidelines for Women's Health Care; 1996. Contact: American College of Obstetricians and Gynecologists, PO Box 96920, Washington, DC, 20090-6920, (202) 638-5577, http://www.acog.com. Summary: This book chapter reviews the assessment, evaluation, diagnosis, and treatment of sexually transmitted diseases (STDs). The chapter provides an overview and history of the more common STDs followed by guidelines for the treatment of gonorrhea, pelvic inflammatory disease, chlamydia, syphilis, trichomoniasis, herpes simplex virus, human papillomavirus, bacterial vaginosis, candidal vaginitis, hepatitis B, and HIV.
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20 common problems in women's health care Source: New York, NY: McGraw Hill. 2000. 686 pp. Contact: Available from McGraw-Hill Publishing, 11 West 19th Street, Fourth Floor, New York, NY 10011. Telephone: (212) 337-5961. $49.95. Summary: This five-part textbook for health profession students focuses on women's health care issues throughout the life cycle;each chapter includes an overview, summary, and reference list. Part one addresses issues in preventive care/health maintenance such as examinations and screening, delivery of health care services, family planning, prenatal care, and menopause. Topics included in part two are sexuality, obesity, and eating disorders. Part three covers abuse of women, substance abuse, depression and anxiety, and relational problems. Part four discusses gynecological concerns such as vulvar and vaginal disease, urinary incontinence, menstrual disorders, sexually transmitted diseases, pelvic inflammatory disease, miscarriage, and breast disorders. The final part covers other health concerns such as hypertension and ischemic heart disease, gastrointestinal disorders, gallbladder disease, and osteoporosis. The book concludes with an index.
Chapters on Pelvic Inflammatory Disease In order to find chapters that specifically relate to pelvic inflammatory disease, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and pelvic inflammatory disease 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 “pelvic inflammatory disease” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on pelvic inflammatory disease:
Books
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Radiation Enterocolitis Source: in Bayless, T.M. and Hanauer, S.B. Advanced Therapy of Inflammatory Bowel Disease. Hamilton, Ontario: B.C. Decker Inc. 2001. p. 635-638. Contact: Available from B.C. Decker Inc. 20 Hughson Street South, P.O. Box 620, L.C.D. 1 Hamilton, Ontario L8N 3K7. (905) 522-7017 or (800) 568-7281. Fax (905) 522-7839. Email:
[email protected]. Website: www.bcdecker.com. PRICE: $129.00 plus shipping and handling. ISBN: 1550091220. Summary: Management of radiation injury to the small and large intestine continues to present challenges to gastroenterologists, radiation oncologists, and surgeons alike. This chapter on radiation enterocolitis is from the second edition of a book devoted to the details of medical, surgical, and supportive management of patients with Crohn's disease (CD) and ulcerative colitis (UC), together known as inflammatory bowel disease (IBD). With many oncology (cancer therapy) protocols now employing radiation therapy either as adjuvant or curative therapy, the collateral effects of radiation on rapidly proliferating tissues are increasingly important issues. The normal intestinal mucosa and, to a lesser extent, intestinal vascular and interstitial connective tissue compartments are sensitive to ionizing radiation. Consequently, this may be especially problematic in tissues already affected by IBD, because of the varying amount of coincident injury and inflammation as well as the hyperproliferative state of the epithelium. Small and large intestinal complications are dependent on radiation therapy techniques and better use of the modality should enable further reductions in adverse events. Acute complications are correlated with the amount of irradiated bowel and the fraction size. Acute radiation enterocolitis symptoms include diarrhea, nausea, abdominal cramps, and tenesmus (fecal urgency) of varying severity. These conditions usually are transient and resolve within a few weeks of completion of radiation treatment. Chronic events also are dependent on the total surface area of bowel irradiated, fraction size, and the total amount of radiation. Prior abdominal surgeries, cholecystectomy, pelvic inflammatory disease (PID), hypertension (high blood pressure), and diabetes mellitus have been documented as risk factors increasing the likelihood of the development of chronic events. The authors conclude with a brief discussion of strategies to prevent radiation enterocolitis. 1 table. 6 references.
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Dysuria in Women Source: in Reisman, A.B.; Setevens, D.L., eds. Telephone Medicine: A Guide for the Practicing Physician. Philadelphia, PA: American College of Physicians. 2002. p. 163-174. Contact: Available from American College of Physicians (ACP). 190 N. Independence Mall West, Philadelphia, PA 19106-1572. (800) 523-1546 or (215) 351-2600. Website: www.acponline.org. PRICE: $40.00 plus shipping and handling. ISBN: 0943126878. Summary: This chapter on dysuria (painful urination) in women is from a reference book for practicing physicians who are providing information for their patients over the telephone. Though most cases of dysuria are caused by uncomplicated cystitis, dysuria may also be one of the presenting signs in more serious infection, including pyelonephritis and pelvic inflammatory disease (PID). The chapter summarizes key points, then outlines an approach to the patient who calls with dysuria. The author addresses how the physician on the telephone can separate women with cystitis or vaginitis from those at risk of serious infection, and under what circumstances antibiotics should be initiated without an office visit. Topics include epidemiology, utility of early diagnosis, the general approach to the telephone evaluation, determining whether the patient requires emergency evaluation, determining whether the patient
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require nonemergency evaluation (an office visit), the indications for urinalysis and urine culture, empiric treatment for patients who are not pregnant, managing women with recurrent infections, what to tell the patient, and what to document. A patient care diagnostic algorithm is provided. 1 figure. 25 references.
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CHAPTER 4. MULTIMEDIA ON PELVIC INFLAMMATORY DISEASE Overview In this chapter, we show you how to keep current on multimedia sources of information on pelvic inflammatory disease. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.
Video Recordings An excellent source of multimedia information on pelvic inflammatory disease is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “pelvic inflammatory disease” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” Type “pelvic inflammatory disease” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on pelvic inflammatory disease: •
STDs and Safer Sex: Your Risk and Responsibility Contact: Family Care Communications Incorporated, 9226 Amsden Way, Eden Prairie, MN, 55347, (612) 944-5350. Summary: This video, aimed at 18- to 24-year-olds, describes sexually transmitted diseases (STD's) and discusses safer sexual practices. It provides the viewer with facts, statistics, symptoms, and warning signs of HIV, chlamydia, pelvic inflammatory disease (PID), HPV, syphilis, and gonorrhea. It illustrates condom do's and don'ts, talks about the use of vaginal spermicides, and urges viewers to be screened for HIV infection. The numbers of several hotlines, including those for Spanish speaking viewers and the hearing impaired, are listed at the end of the video.
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CHAPTER 5. PERIODICALS AND NEWS ON PELVIC INFLAMMATORY DISEASE Overview In this chapter, we suggest a number of news sources and present various periodicals that cover pelvic inflammatory disease.
News Services and Press Releases One of the simplest ways of tracking press releases on pelvic inflammatory disease 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 “pelvic inflammatory disease” (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 pelvic inflammatory disease. 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 “pelvic inflammatory disease” (or synonyms). The following was recently listed in this archive for pelvic inflammatory disease: •
Risk of pelvic inflammatory disease from IUD low even when STD risk is high Source: Reuters Medical News Date: February 08, 2001
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•
Infectious disease society questions CDC guidelines on pelvic inflammatory disease Source: Reuters Medical News Date: February 02, 2001
•
Hypertension, pelvic inflammatory disease increase the risk of uterine leiomyoma Source: Reuters Medical News Date: January 05, 2001
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Pelvic inflammatory disease undertreated by UK generalists Source: Reuters Medical News Date: November 04, 1998
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Detection, treatment of cervical infections key to preventing pelvic inflammatory disease Source: Reuters Medical News Date: August 28, 1998
•
CMV May Contribute To Pathogenesis Of Pelvic Inflammatory Disease Source: Reuters Medical News Date: July 01, 1997 The NIH
Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “pelvic inflammatory disease” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests.
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Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “pelvic inflammatory disease” (or synonyms). If you know the name of a company that is relevant to pelvic inflammatory disease, 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 “pelvic inflammatory disease” (or synonyms).
Academic Periodicals covering Pelvic Inflammatory Disease Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to pelvic inflammatory disease. In addition to these sources, you can search for articles covering pelvic inflammatory disease 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 6. 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 pelvic inflammatory disease. 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 pelvic inflammatory disease. 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,
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etc.). The following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to pelvic inflammatory disease: Azithromycin •
Systemic - U.S. Brands: Zithromax http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202642.html
Clindamycin •
Systemic - U.S. Brands: Cleocin http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202145.html
•
Topical - U.S. Brands: Clinda-Derm http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202146.html
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Vaginal - U.S. Brands: Cleocin http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202700.html
Doxycycline •
Dental - U.S. Brands: Atridox http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203716.html
Gentamicin •
Ophthalmic - U.S. Brands: Garamycin; Gentacidin; Gentafair; Gentak; OcuMycin; Spectro-Genta http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202604.html
•
Topical - U.S. Brands: Garamycin; Gentamar; G-Myticin http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202258.html
Metronidazole •
Systemic - U.S. Brands: Flagyl; Protostat http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202365.html
•
Vaginal - U.S. Brands: MetroGel-Vaginal http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202704.html
Ofloxacin •
Ophthalmic - U.S. Brands: Ocuflox http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202687.html
Probenecid •
Systemic - U.S. Brands: Benemid; Probalan http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202480.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.
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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 Institute8: •
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
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National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/
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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html
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National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25
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National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm
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National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm
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National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375
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National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/
8
These publications are typically written by one or more of the various NIH Institutes.
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•
National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm
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National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/
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National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm
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National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm
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National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/
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National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/
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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm
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National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html
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National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm
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National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm
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National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm
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National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html
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National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm
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Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp
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National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/
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National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp
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Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html
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Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm
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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.9 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:10 •
Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html
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HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html
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NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html
•
Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/
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Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html
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Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html
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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/
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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html
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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html
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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html
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MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html
9 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). 10 See http://www.nlm.nih.gov/databases/databases.html.
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Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html
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Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html
The NLM Gateway11 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.12 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “pelvic inflammatory disease” (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 8460 702 928 78 12 10180
HSTAT13 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.14 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.15 Simply search by “pelvic inflammatory disease” (or synonyms) at the following Web site: http://text.nlm.nih.gov.
11
Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.
12
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). 13 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 14 15
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 Biologists16 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.17 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.18 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/.
16 Adapted 17
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. 18 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 pelvic inflammatory disease 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 pelvic inflammatory disease. 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 pelvic inflammatory disease. 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 “pelvic inflammatory disease”:
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Arthritis http://www.nlm.nih.gov/medlineplus/arthritis.html Chlamydia Infections http://www.nlm.nih.gov/medlineplus/chlamydiainfections.html Gonorrhea http://www.nlm.nih.gov/medlineplus/gonorrhea.html Ovarian Cancer http://www.nlm.nih.gov/medlineplus/ovariancancer.html Pelvic Inflammatory Disease http://www.nlm.nih.gov/medlineplus/pelvicinflammatorydisease.html Pelvic Support Problems http://www.nlm.nih.gov/medlineplus/pelvicsupportproblems.html Sexually Transmitted Diseases http://www.nlm.nih.gov/medlineplus/sexuallytransmitteddiseases.html Sickle Cell Anemia http://www.nlm.nih.gov/medlineplus/sicklecellanemia.html Uterine Cancer http://www.nlm.nih.gov/medlineplus/uterinecancer.html Vaginal Diseases http://www.nlm.nih.gov/medlineplus/vaginaldiseases.html
Within the health topic page dedicated to pelvic inflammatory disease, the following was listed: •
General/Overviews Pelvic Inflammatory Disease Source: American College of Obstetricians and Gynecologists http://www.medem.com/MedLB/article_detaillb.cfm?article_ID=ZZZAB51P97C& sub_cat=9 Pelvic Inflammatory Disease Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=DS00402 Pelvic Inflammatory Disease Source: National Women's Health Information Center http://www.4woman.gov/faq/stdpids.htm
•
Diagnosis/Symptoms Genital Problems in Women Source: American Academy of Family Physicians http://familydoctor.org/537.xml
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Specific Conditions/Aspects Chronic Pelvic Pain: Puzzling, Frustrating Condition Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=HQ00432 Pelvic Pain Source: American College of Obstetricians and Gynecologists http://www.medem.com/MedLB/article_detaillb.cfm?article_ID=ZZZEOJAM97C &sub_cat=9
•
Children Pelvic Inflammatory Disease Source: Nemours Foundation http://kidshealth.org/parent/infections/std/pelvic_inflammatory_disease.html
•
From the National Institutes of Health Pelvic Inflammatory Disease Source: National Institute of Allergy and Infectious Diseases http://www.niaid.nih.gov/factsheets/stdpid.htm
•
Organizations American Social Health Association http://www.ashastd.org/ National Center for HIV, STD, and TB Prevention, Division of Sexually Transmitted Diseases Source: Centers for Disease Control and Prevention http://www.cdc.gov/nchstp/dstd/dstdp.html National Institute of Allergy and Infectious Diseases http://www.niaid.nih.gov/
•
Prevention/Screening Having a Pelvic Exam and Pap Test Source: National Cancer Institute http://www.cancer.gov/cancerinfo/having-a-pelvic-exam New CDC Treatment Guidelines Critical to Preventing Health Consequences of Sexually Transmitted Diseases Source: Centers for Disease Control and Prevention http://www.cdc.gov/od/oc/media/pressrel/fs020509.htm Screening and Prevention of Sexually Transmitted Diseases Source: American Medical Association http://www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZZO6I53AKC& sub_cat=292
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Teenagers Pelvic Inflammatory Disease Source: Nemours Foundation http://kidshealth.org/teen/sexual_health/stds/std_pid.html
You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on pelvic inflammatory disease. 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: •
Particularly Important Directions About Pelvic Inflammatory Disease Contact: Texas Department of Health Warehouse, Attn: Literature and Forms, 1100 W 49th St, Austin, TX, 78756, (512) 458-7761. Summary: This brochure for women discusses pelvic inflammatory disease (PID). PID is an infection that is often asymptomatic, but some women may experience symptoms such as lower stomach cramps and/or pain, fever, chills, nausea, vaginal discharge, burning during urination, and/or painful sexual intercourse. PID is an infection that is often caused by a lack of treatment for sexually transmitted diseases (STDs) such as gonorrhea and chlamydia. PID can cause complications if left untreated, such as scarring of the fallopian tubes, sterility, tubal pregnancy, miscarriage, pelvic abscesses, abnormal menstrual periods, and continual pelvic pain. The brochure recommends that women with PID avoid having sex until they and their partners have taken all of their medications and have stopped exhibiting symptoms. It advises women about medications used in treatment, their side effects, and specific dosing requirements. The brochure also contains information for those women who use intrauterine device (IUDs) for birth control and recommends condom use to help prevent PID.
•
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
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intrauterine devices (IUDs), douching, or some forms of vaginitis. The common 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. •
Understanding Pelvic Inflammatory Disease : A Threat to Your Reproductive Health Contact: StayWell Company, 1100 Grundy Ln, San Bruno, CA, 94066-3030, (650) 7420400, http://www.staywell.com. Summary: This brochure provides women with general and prevention information concerning pelvic inflammatory disease (PID). The brochure describes PID, its symptoms, and the high-risk behaviors that may lead to its transmission. It examines the female reproductive system and the effects that PID may have on it in different stages. It explains the diagnostic test that are used to identify PID and the treatments that are available. The brochure recommends that the readers, in order to prevent PID, choose their partners carefully to avoid contracting an STD, communicate with them about sex, and use protection against STDs such as a condom. It advises the readers about how to notify their partners if they have PID, to convince their partner to get screened for STDs, to not engage in sex to avoid infecting their partners with bacteria, and to negotiate condom use with their partners.
•
PID (Pelvic Inflammatory Disease) : What You Need to Know Contact: California Family Health Council Incorporated, Education Programs Associates Division, Health Education Resource Center, 1 W Campbell Ave Ste 45, Campbell, CA, 95008, (408) 374-3720, http://epa.cfhc.org. Summary: This brochure, for women, discusses pelvic inflammatory disease (PID); an infection of the fallopian tubes, uterus, or ovaries. The symptoms of PID include pain or cramping in the abdomen, smelly vaginal discharge, bleeding between periods or after sex, pain during sex, fever or chills, nausea, and/or vomiting. PID develops when women have contracted a sexually transmitted disease (STD) and do not receive medical treatment with antibiotic injections or pills. Individuals with PID need to protect themselves by ensuring that partners are treated, taking all of the prescribed medication even if symptoms disappear, avoiding sex during care, reporting any drug side effects or new symptoms immediately to a health care provider, and undergoing follow-up treatment after the antibiotic regimen has been completed. If left untreate, PID can result in the infection of others, severe abdominal pain, sterility, tubal pregnancy, or death. Pregnant women with PID can infect their infants, damaging their eyes and lungs. To help prevent STDs, individuals should practice safer sex with condoms and foam during each sexual encounter. The brochure provides contact information for services from which individuals can learn more about PID.
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PID: Pelvic Inflammatory Disease (Tube Infection) Contact: Washington Department of Social and Health Services, Office of Disease Prevention and Control, Office on AIDS, Airdustrial Pk, Olympia, WA, 98504-0095, (360) 586-3887. Summary: This fact sheet, for women, presents information about pelvic inflammatory disease (PID). PID develops when a sexually transmitted disease (STD) moves from the opening of the uterus to the upper part of a woman's sex organs, which can lead to sterility or the development of ectopic (tubal) pregnancies. The symptoms, diagnosis, and treatment of PID are discussed. Since it is easy for PID to reoccur, individuals are urged to take preventative steps such as practicing safer sex with condoms.
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Pelvic Inflammatory Disease Contact: US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Allergy and Infectious Diseases, Division of Microbiology and Infectious Diseases, 6700-B Rockledge Dr, Bethesda, MD, 20892-7630, (301) 496-1884, http://www.niaid.nih.gov. Summary: This information sheet provides information about the sexually transmitted disease (STD), pelvic inflammatory disease (PID). The information sheet discusses PID transmission, symptoms, diagnosis, treatment, its possible long-term effects, prevention, and ongoing research.
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Gynecologic Problems: Pelvic Inflammatory Disease (PID) Contact: American College of Obstetricians and Gynecologists, PO Box 96920, Washington, DC, 20090-6920, (202) 638-5577, http://www.acog.com. Summary: This pamphlet addresses the causes, symptoms, diagnosis, and treatment of pelvic inflammatory disease (PID). Most cases of PID develop as a result of sexually transmitted diseases (STDs) such as gonorrhea and chlamydia. PID is normally treated with a combination of two or more antibiotics, such as ampicillin and tetracycline, to combat the wide variety of organisms associated with PID. The pamphlet recommends prevention strategies that include barrier contraception, spermicides, and limiting the number of sexual partners.
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PID Pelvic Inflammatory Disease: Some Questions and Answers Contact: American Social Health Association, PO Box 13827, Research Triangle Park, NC, 27709, (919) 361-8400. CDC National Prevention Information Network, PO Box 6003, Rockville, MD, 20849-6003, (800) 458-5231, http://www.cdcnpin.org. Summary: This pamphlet discusses pelvic inflammatory disease (PID) a serious infection of a woman's reproductive organs. PID results when a sexually transmitted disease, usually gonorrhea or chlamydia, is not treated and the infection spreads throughout the female reproductive organs. The pamphlet describes the symptoms of PID, but PID can be asymptomatic. It can cause scarring in the fallopian tubes, which can lead to a tubal pregnancy or to sterility. The pamphlet advises women to get tested if they suspect PID, as PID can be cured with antibiotics. Prevention of PID involves prevention of STDs. The pamphlet also provides national hotline numbers for additional information.
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What You Should Know About PID: Pelvic Inflammatory Disease Contact: Texas Department of Health Warehouse, Attn: Literature and Forms, 1100 W 49th St, Austin, TX, 78756, (512) 458-7761. Summary: This pamphlet explains pelvic inflammatory disease (PID), a serious infection of the female reproductive organs. The pamphlet discusses the transmission of PID, its symptoms, its effect on the body, diagnosis and testing, treatment, and prevention.
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Pelvic Inflammatory Disease (PID) Contact: Channing L. Bete Company Incorporated, 200 State Rd, South Deerfield, MA, 01373-0200, (800) 477-4776, http://www.channing-bete.com. Summary: This pamphlet presents information about pelvic inflammatory disease (PID). The pamphlet explains PID, its symptoms, how it affects women, and what women can do to prevent sexually transmitted diseases (STDs) which are often the cause of PID. 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 “pelvic inflammatory disease” (or synonyms). The following was recently posted: •
Pelvic inflammatory disease. Sexually transmitted diseases treatment guidelines 2002 Source: Centers for Disease Control and Prevention - Federal Government Agency [U.S.]; 1993 (revised 2002 May 10); 5 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3238&nbr=2464&a mp;string=pelvic+AND+inflammatory+AND+disease 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 pelvic inflammatory disease. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html.
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Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •
AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats
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Family Village: http://www.familyvillage.wisc.edu/specific.htm
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Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/
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Med Help International: http://www.medhelp.org/HealthTopics/A.html
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Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/
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Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/
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WebMDHealth: http://my.webmd.com/health_topics
Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to pelvic inflammatory disease. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with pelvic inflammatory disease. 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 pelvic inflammatory disease. 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 “pelvic inflammatory disease” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received
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your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “pelvic inflammatory disease”. 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 “pelvic inflammatory disease” (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 “pelvic inflammatory disease” (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.19
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
19
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)20: •
Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/
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Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)
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Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm
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California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html
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California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html
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California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html
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California: Gateway Health Library (Sutter Gould Medical Foundation)
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California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/
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California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp
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California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html
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California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/
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California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/
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California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/
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California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html
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California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/
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Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/
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Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/
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Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/
20
Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.
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Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml
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Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm
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Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html
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Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm
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Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp
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Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/
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Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm
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Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html
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Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/
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Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm
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Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/
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Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/
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Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/
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Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm
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Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html
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Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm
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Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/
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Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/
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Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10
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Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/
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Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html
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Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp
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Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp
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Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/
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Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html
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Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm
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Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp
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Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/
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Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html
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Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/
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Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm
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Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/
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Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html
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Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm
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Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330
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Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)
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National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html
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National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/
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National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/
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Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm
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New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/
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New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm
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New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm
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New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/
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New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html
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New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/
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New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html
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New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/
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Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm
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Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp
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Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/
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Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/
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Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml
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Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html
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Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html
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Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml
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Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp
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Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm
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Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/
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South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp
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Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/
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Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/
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Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72
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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •
ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html
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MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp
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Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/
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Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html
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On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/
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Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp
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Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm
Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). The NIH suggests the following Web sites in the ADAM Medical Encyclopedia when searching for information on pelvic inflammatory disease: •
Basic Guidelines for Pelvic Inflammatory Disease Chlamydia Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001345.htm Pelvic inflammatory disease (PID) Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000888.htm Urinary tract infection Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000521.htm
•
Signs & Symptoms for Pelvic Inflammatory Disease Abdominal pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003120.htm Abdominal tenderness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003120.htm
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Back pain, low Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003108.htm Dyspareunia Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003157.htm Dysuria Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003145.htm Fatigue Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003088.htm Fever Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003090.htm Frequent urination Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003140.htm Lack of appetite Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003121.htm Menstrual cramping Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003150.htm Menstruation, absent Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003149.htm Nausea Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm Nausea and vomiting Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm Pain with urination Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003145.htm Point tenderness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003273.htm Sexual intercourse, painful Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003157.htm Spotting Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003156.htm Vaginal discharge Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003158.htm Vomiting Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm
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•
Diagnostics and Tests for Pelvic Inflammatory Disease Biopsy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003416.htm C-reactive protein Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003356.htm ECT Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003324.htm Endocervical culture Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003754.htm Endometrial biopsy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003917.htm ESR Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003638.htm Laparoscopy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003918.htm MRI Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003335.htm Pregnancy test Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003432.htm Sed rate Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003638.htm Serum HCG Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003509.htm Transvaginal ultrasound Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003779.htm Ultrasound Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003336.htm WBC Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003643.htm Wet prep Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003916.htm
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Surgery and Procedures for Pelvic Inflammatory Disease Abortion Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002912.htm
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Background Topics for Pelvic Inflammatory Disease Bleeding Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000045.htm Cervix Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002317.htm Condoms Web site: http://www.nlm.nih.gov/medlineplus/ency/article/004001.htm Intrauterine Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002389.htm Intravenous Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002383.htm Renal Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002289.htm Safer sex behaviors Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001949.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
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MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html
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Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/
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Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine
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PELVIC INFLAMMATORY DISEASE 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 Cramps: Abdominal pain due to spasmodic contractions of the bowel. [NIH] Abdominal Pain: Sensation of discomfort, distress, or agony in the abdominal region. [NIH] Abortion: 1. The premature expulsion from the uterus of the products of conception - of the embryo, or of a nonviable fetus. The four classic symptoms, usually present in each type of abortion, are uterine contractions, uterine haemorrhage, softening and dilatation of the cervix, and presentation or expulsion of all or part of the products of conception. 2. Premature stoppage of a natural or a pathological process. [EU] Abscess: A localized, circumscribed collection of pus. [NIH] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Acetylgalactosamine: The N-acetyl derivative of galactosamine. [NIH] Acetylglucosamine: The N-acetyl derivative of glucosamine. [NIH] Adenitis: Inflammation of a gland. [EU] Adenoma: A benign epithelial tumor with a glandular organization. [NIH] Adhesions: Pathological processes consisting of the union of the opposing surfaces of a wound. [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] Adnexa: The appendages of the eye, as the lacrimal apparatus, the eyelids, and the extraocular muscles. [NIH] Adnexa Uteri: The appendages of the uterus: the fallopian tubes, ovaries, and supporting ligaments of the uterus. [NIH] Adnexitis: Inflammation of the adnexa uteri. [EU] Adverse Effect: An unwanted side effect of treatment. [NIH] Aetiology: Study of the causes of disease. [EU] Agar: A complex sulfated polymer of galactose units, extracted from Gelidium cartilagineum, Gracilaria confervoides, and related red algae. It is used as a gel in the preparation of solid culture media for microorganisms, as a bulk laxative, in making emulsions, and as a supporting medium for immunodiffusion and immunoelectrophoresis. [NIH]
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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] 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] Amino acid: Any organic compound containing an amino (-NH2 and a carboxyl (- COOH) group. The 20 a-amino acids listed in the accompanying table are the amino acids from which proteins are synthesized by formation of peptide bonds during ribosomal translation of messenger RNA; all except glycine, which is not optically active, have the L configuration. Other amino acids occurring in proteins, such as hydroxyproline in collagen, are formed by posttranslational enzymatic modification of amino acids residues in polypeptide chains. There are also several important amino acids, such as the neurotransmitter y-aminobutyric acid, that have no relation to proteins. Abbreviated AA. [EU] Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Ampicillin: Semi-synthetic derivative of penicillin that functions as an orally active broadspectrum antibiotic. [NIH] Amplification: The production of additional copies of a chromosomal DNA sequence, found as either intrachromosomal or extrachromosomal DNA. [NIH] Anaerobic: 1. Lacking molecular oxygen. 2. Growing, living, or occurring in the absence of molecular oxygen; pertaining to an anaerobe. [EU] Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] 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] Anaphylatoxins: The family of peptides C3a, C4a, C5a, and C5a des-arginine produced in the serum during complement activation. They produce smooth muscle contraction, mast cell histamine release, affect platelet aggregation, and act as mediators of the local inflammatory process. The order of anaphylatoxin activity from strongest to weakest is C5a, C3a, C4a, and C5a des-arginine. The latter is the so-called "classical" anaphylatoxin but shows no spasmogenic activity though it contains some chemotactic ability. [NIH] 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]
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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] 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] Anorexia: Lack or loss of appetite for food. Appetite is psychologic, dependent on memory and associations. Anorexia can be brought about by unattractive food, surroundings, or company. [NIH] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]
Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antigen-Antibody Complex: The complex formed by the binding of antigen and antibody molecules. The deposition of large antigen-antibody complexes leading to tissue damage causes immune complex diseases. [NIH] Antigen-presenting cell: APC. A cell that shows antigen on its surface to other cells of the immune system. This is an important part of an immune response. [NIH] Anti-infective: An agent that so acts. [EU] 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] 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] Appendicitis: Acute inflammation of the vermiform appendix. [NIH] Applicability: A list of the commodities to which the candidate method can be applied as presented or with minor modifications. [NIH] Aqueous: Having to do with water. [NIH] Archaea: One of the three domains of life (the others being bacteria and Eucarya), formerly
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called Archaebacteria under the taxon Bacteria, but now considered separate and distinct. They are characterized by: 1) the presence of characteristic tRNAs and ribosomal RNAs; 2) the absence of peptidoglycan cell walls; 3) the presence of ether-linked lipids built from branched-chain subunits; and 4) their occurrence in unusual habitats. While archaea resemble bacteria in morphology and genomic organization, they resemble eukarya in their method of genomic replication. The domain contains at least three kingdoms: crenarchaeota, euryarchaeota, and korarchaeota. [NIH] Arginine: An essential amino acid that is physiologically active in the L-form. [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] Aseptic: Free from infection or septic material; sterile. [EU] Aspiration: The act of inhaling. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Asymptomatic: Having no signs or symptoms of disease. [NIH] Auditory: Pertaining to the sense of hearing. [EU] Autologous: Taken from an individual's own tissues, cells, or DNA. [NIH] Azithromycin: A semi-synthetic macrolide antibiotic structurally related to erythromycin. It has been used in the treatment of Mycobacterium avium intracellulare infections, toxoplasmosis, and cryptosporidiosis. [NIH] Aztreonam: A monocyclic beta-lactam antibiotic originally isolated from Chromobacterium violaceum. It is resistant to beta-lactamases and is used in gram-negative infections, especially of the meninges, bladder, and kidneys. It may cause a superinfection with grampositive organisms. [NIH] Bacteremia: The presence of viable bacteria circulating in the blood. Fever, chills, tachycardia, and tachypnea are common acute manifestations of bacteremia. The majority of cases are seen in already hospitalized patients, most of whom have underlying diseases or procedures which render their bloodstreams susceptible to invasion. [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] Bactericidal: Substance lethal to bacteria; substance capable of killing bacteria. [NIH] Bacteriophage: A virus whose host is a bacterial cell; A virus that exclusively infects bacteria. It generally has a protein coat surrounding the genome (DNA or RNA). One of the coliphages most extensively studied is the lambda phage, which is also one of the most important. [NIH] Bacterium: Microscopic organism which may have a spherical, rod-like, or spiral unicellular or non-cellular body. Bacteria usually reproduce through asexual processes. [NIH] Bacteriuria: The presence of bacteria in the urine with or without consequent urinary tract infection. Since bacteriuria is a clinical entity, the term does not preclude the use of urine/microbiology for technical discussions on the isolation and segregation of bacteria in the urine. [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
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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] Base Sequence: The sequence of purines and pyrimidines in nucleic acids and polynucleotides. It is also called nucleotide or nucleoside sequence. [NIH] 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] 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]
Beta-Lactamases: Enzymes found in many bacteria which catalyze the hydrolysis of the amide bond in the beta-lactam ring. Well known antibiotics destroyed by these enzymes are penicillins and cephalosporins. EC 3.5.2.6. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bile Acids: Acids made by the liver that work with bile to break down fats. [NIH] Bile Acids and Salts: Steroid acids and salts. The primary bile acids are derived from cholesterol in the liver and usually conjugated with glycine or taurine. The secondary bile acids are further modified by bacteria in the intestine. They play an important role in the digestion and absorption of fat. They have also been used pharmacologically, especially in the treatment of gallstones. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Bladder: The organ that stores urine. [NIH] 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] Blennorrhoea: A general term including any inflammatory process of the external eye which gives a mucoid discharge, more exactly, a discharge of mucus. [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]
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Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [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] 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 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]
Breeding: The science or art of changing the constitution of a population of plants or animals through sexual reproduction. [NIH] Broad Ligament: A broad fold of peritoneum that extends from the side of the uterus to the wall of the pelvis. [NIH] Broad-spectrum: Effective against a wide range of microorganisms; said of an antibiotic. [EU] Bronchiseptica: A small, gram-negative, motile bacillus. A normal inhabitant of the respiratory tract in man, dogs, and pigs, but is also associated with canine infectious tracheobronchitis and atrophic rhinitis in pigs. [NIH] Budgets: Detailed financial plans for carrying out specific activities for a certain period of time. They include proposed income and expenditures. [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] Candidiasis: Infection with a fungus of the genus Candida. It is usually a superficial infection of the moist cutaneous areas of the body, and is generally caused by C. albicans; it most commonly involves the skin (dermatocandidiasis), oral mucous membranes (thrush, def. 1), respiratory tract (bronchocandidiasis), and vagina (vaginitis). Rarely there is a systemic infection or endocarditis. Called also moniliasis, candidosis, oidiomycosis, and formerly blastodendriosis. [EU] Candidosis: An infection caused by an opportunistic yeasts that tends to proliferate and become pathologic when the environment is favorable and the host resistance is weakened. [NIH]
Capsular: Cataract which is initiated by an opacification at the surface of the lens. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the
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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] Carcinoembryonic Antigen: A glycoprotein that is secreted into the luminal surface of the epithelia in the gastrointestinal tract. It is found in the feces and pancreaticobiliary secretions and is used to monitor the respone to colon cancer treatment. [NIH] Carcinogen: Any substance that causes cancer. [NIH] Carcinogenic: Producing carcinoma. [EU] Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs. [NIH]
Cardiac: Having to do with the heart. [NIH] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cardiovascular disease: Any abnormal condition characterized by dysfunction of the heart and blood vessels. CVD includes atherosclerosis (especially coronary heart disease, which can lead to heart attacks), cerebrovascular disease (e.g., stroke), and hypertension (high blood pressure). [NIH] 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] 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] Cecum: The beginning of the large intestine. The cecum is connected to the lower part of the small intestine, called the ileum. [NIH] Cefoxitin: Semisynthetic cephamycin antibiotic resistant to beta-lactamase. [NIH] Ceftriaxone: Broad-spectrum cephalosporin antibiotic with a very long half-life and high penetrability to usually inaccessible infections, including those involving the meninges, eyes, inner ears, and urinary tract. [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 Count: A count of the number of cells of a specific kind, usually measured per unit volume of sample. [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] Cell proliferation: An increase in the number of cells as a result of cell growth and cell division. [NIH] Cell Size: The physical dimensions of a cell. It refers mainly to changes in dimensions correlated with physiological or pathological changes in cells. [NIH] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH]
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Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH] Chaperonin 10: Members of the chaperonin heat-shock protein family. Chaperonin 10 purified from bacteria, plastids, or mitochondria occurs as an oligomer of seven identical subunits arranged in a single ring. [NIH] Chaperonin 60: Members of the chaperonin heat-shock protein family. Chaperonin 60 purified from bacteria, plastids, or mitochondria is an oligomeric protein with a distinctive structure of fourteen subunits, arranged in two rings of seven subunits each. [NIH] Chaperonins: A class of sequence-related molecular chaperones found in bacteria, mitochondria, and plastids. Chaperonins are abundant constitutive proteins that increase in amount after stresses such as heat shock, bacterial infection of macrophages, and an increase in the cellular content of unfolded proteins. Bacterial chaperonins are major immunogens in human bacterial infections because of their accumulation during the stress of infection. Two members of this class of chaperones are chaperonin 10 and chaperonin 60. [NIH] Chemokines: Class of pro-inflammatory cytokines that have the ability to attract and activate leukocytes. They can be divided into at least three structural branches: C (chemokines, C), CC (chemokines, CC), and CXC (chemokines, CXC), according to variations in a shared cysteine motif. [NIH] Chemotactic Factors: Chemical substances that attract or repel cells or organisms. The concept denotes especially those factors released as a result of tissue injury, invasion, or immunologic activity, that attract leukocytes, macrophages, or other cells to the site of infection or insult. [NIH] 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] 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] Chromosomal: Pertaining to chromosomes. [EU] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic Disease: Disease or ailment of long duration. [NIH] Ciprofloxacin: A carboxyfluoroquinoline antimicrobial agent that is effective against a wide range of microorganisms. It has been successfully and safely used in the treatment of resistant respiratory, skin, bone, joint, gastrointestinal, urinary, and genital infections. [NIH] Clindamycin: An antibacterial agent that is a semisynthetic analog of lincomycin. [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Codons: Any triplet of nucleotides (coding unit) in DNA or RNA (if RNA is the carrier of primary genetic information as in some viruses) that codes for particular amino acid or signals the beginning or end of the message. [NIH]
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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] Colitis: Inflammation of the colon. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Colloidal: Of the nature of a colloid. [EU] Colon: The long, coiled, tubelike organ that removes water from digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus. [NIH] 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 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] Compliance: Distensibility measure of a chamber such as the lungs (lung compliance) or bladder. Compliance is expressed as a change in volume per unit change in pressure. [NIH] 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
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biological problems including manipulation of models and datasets. [NIH] Computed tomography: CT scan. A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized tomography and computerized axial tomography (CAT) scan. [NIH] Computerized tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized axial tomography (CAT) scan and computed tomography (CT scan). [NIH] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Concomitant: Accompanying; accessory; joined with another. [EU] Condoms: A sheath that is worn over the penis during sexual behavior in order to prevent pregnancy or spread of sexually transmitted disease. [NIH] Confounding: Extraneous variables resulting in outcome effects that obscure or exaggerate the "true" effect of an intervention. [NIH] Conjugated: Acting or operating as if joined; simultaneous. [EU] Conjugation: 1. The act of joining together or the state of being conjugated. 2. A sexual process seen in bacteria, ciliate protozoa, and certain fungi in which nuclear material is exchanged during the temporary fusion of two cells (conjugants). In bacterial genetics a form of sexual reproduction in which a donor bacterium (male) contributes some, or all, of its DNA (in the form of a replicated set) to a recipient (female) which then incorporates differing genetic information into its own chromosome by recombination and passes the recombined set on to its progeny by replication. In ciliate protozoa, two conjugants of separate mating types exchange micronuclear material and then separate, each now being a fertilized cell. In certain fungi, the process involves fusion of two gametes, resulting in union of their nuclei and formation of a zygote. 3. In chemistry, the joining together of two compounds to produce another compound, such as the combination of a toxic product with some substance in the body to form a detoxified product, which is then eliminated. [EU] Conjunctiva: The mucous membrane that lines the inner surface of the eyelids and the anterior part of the sclera. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue Cells: A group of cells that includes fibroblasts, cartilage cells, adipocytes, smooth muscle cells, and bone cells. [NIH] Conscious Sedation: An alternative to general anesthesia in patients for whom general anesthesia is refused or considered inadvisable. It involves the administering of an antianxiety drug (minor tranquilizer) and an analgesic or local anesthetic. This renders the patient free of anxiety and pain while allowing the patient to remain in verbal contact with the physician or dentist. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Consumption: Pulmonary tuberculosis. [NIH] Continuum: An area over which the vegetation or animal population is of constantly changing composition so that homogeneous, separate communities cannot be distinguished. [NIH]
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Contraception: Use of agents, devices, methods, or procedures which diminish the likelihood of or prevent conception. [NIH] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Contrast medium: A substance that is introduced into or around a structure and, because of the difference in absorption of x-rays by the contrast medium and the surrounding tissues, allows radiographic visualization of the structure. [EU] Cornea: The transparent part of the eye that covers the iris and the pupil and allows light to enter the inside. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary heart disease: A type of heart disease caused by narrowing of the coronary arteries that feed the heart, which needs a constant supply of oxygen and nutrients carried by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by fat and cholesterol deposits and cannot supply enough blood to the heart, CHD results. [NIH] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Crossing-over: The exchange of corresponding segments between chromatids of homologous chromosomes during meiosia, forming a chiasma. [NIH] Cross-Sectional Studies: Studies in which the presence or absence of disease or other health-related variables are determined in each member of the study population or in a representative sample at one particular time. This contrasts with longitudinal studies which are followed over a period of time. [NIH] Cryptosporidiosis: Parasitic intestinal infection with severe diarrhea caused by a protozoan, Cryptosporidium. It occurs in both animals and humans. [NIH] Cultured cells: Animal or human cells that are grown in the laboratory. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Curette: A spoon-shaped instrument with a sharp edge. [NIH] Cutaneous: Having to do with the skin. [NIH] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cyst: A sac or capsule filled with fluid. [NIH] Cystitis: Inflammation of the urinary bladder. [EU] Cytokine: Small but highly potent protein that modulates the activity of many cell types, including T and B cells. [NIH] Cytomegalovirus: A genus of the family Herpesviridae, subfamily Betaherpesvirinae, infecting the salivary glands, liver, spleen, lungs, eyes, and other organs, in which they produce characteristically enlarged cells with intranuclear inclusions. Infection with Cytomegalovirus is also seen as an opportunistic infection in AIDS. [NIH] Cytotoxic: Cell-killing. [NIH] Cytotoxicity: Quality of being capable of producing a specific toxic action upon cells of special organs. [NIH] Data Collection: Systematic gathering of data for a particular purpose from various sources,
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including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data. [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] Demography: Statistical interpretation and description of a population with reference to distribution, composition, or structure. [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] 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] Detergents: Purifying or cleansing agents, usually salts of long-chain aliphatic bases or acids, that exert cleansing (oil-dissolving) and antimicrobial effects through a surface action that depends on possessing both hydrophilic and hydrophobic properties. [NIH] Deuterium: Deuterium. The stable isotope of hydrogen. It has one neutron and one proton in the nucleus. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diarrhoea: Abnormal frequency and liquidity of faecal discharges. [EU] Diastolic: Of or pertaining to the diastole. [EU] Diathermy: The induction of local hyperthermia by either short radio waves or highfrequency sound waves. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Dihydrotestosterone: Anabolic agent. [NIH] Dilatation: The act of dilating. [NIH] Dilatation and Curettage: Dilatation of the cervix uteri followed by a scraping of the endometrium with a curette. [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
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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] Double-blind: Pertaining to a clinical trial or other experiment in which neither the subject nor the person administering treatment knows which treatment any particular subject is receiving. [EU] 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] Doxycycline: A synthetic tetracycline derivative with a range of antimicrobial activity and mode of action similar to that of tetracycline, but more effective against many species. Animal studies suggest that it may cause less tooth staining than other tetracyclines. [NIH] 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] Duodenum: The first part of the small intestine. [NIH] Dyspareunia: Painful sexual intercourse. [NIH] Dysuria: Painful or difficult urination. [EU] Eating Disorders: A group of disorders characterized by physiological and psychological disturbances in appetite or food intake. [NIH] Ecosystem: A dynamic complex of plant, animal and micro-organism communities and their non-living environment interacting as a functional unit. [NIH] Ectopic: Pertaining to or characterized by ectopia. [EU] Ectopic Pregnancy: The pregnancy occurring elsewhere than in the cavity of the uterus. [NIH]
Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Electrolytes: Substances that break up into ions (electrically charged particles) when they are dissolved in body fluids or water. Some examples are sodium, potassium, chloride, and calcium. Electrolytes are primarily responsible for the movement of nutrients into cells, and the movement of wastes out of cells. [NIH]
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Electrophoresis: An electrochemical process in which macromolecules or colloidal particles with a net electric charge migrate in a solution under the influence of an electric current. [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] Empiric: Empirical; depending upon experience or observation alone, without using scientific method or theory. [EU] Encapsulated: Confined to a specific, localized area and surrounded by a thin layer of tissue. [NIH]
Endocarditis: Exudative and proliferative inflammatory alterations of the endocardium, characterized by the presence of vegetations on the surface of the endocardium or in the endocardium itself, and most commonly involving a heart valve, but sometimes affecting the inner lining of the cardiac chambers or the endocardium elsewhere. It may occur as a primary disorder or as a complication of or in association with another disease. [EU] Endocardium: The innermost layer of the heart, comprised of endothelial cells. [NIH] Endocytosis: Cellular uptake of extracellular materials within membrane-limited vacuoles or microvesicles. Endosomes play a central role in endocytosis. [NIH] Endogenous: Produced inside an organism or cell. The opposite is external (exogenous) production. [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] 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] Endotoxin: Toxin from cell walls of bacteria. [NIH] Enterocele: A hernia in the intestine. [NIH] Enterocolitis: Inflammation of the intestinal mucosa of the small and large bowel. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]
Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] 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
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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] Epidemiological: Relating to, or involving epidemiology. [EU] Epidermal: Pertaining to or resembling epidermis. Called also epidermic or epidermoid. [EU] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelial Cells: Cells that line the inner and outer surfaces of the body. [NIH] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] Epitopes: Sites on an antigen that interact with specific antibodies. [NIH] Erythromycin: A bacteriostatic antibiotic substance produced by Streptomyces erythreus. Erythromycin A is considered its major active component. In sensitive organisms, it inhibits protein synthesis by binding to 50S ribosomal subunits. This binding process inhibits peptidyl transferase activity and interferes with translocation of amino acids during translation and assembly of proteins. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]
Estrogen: One of the two female sex hormones. [NIH] 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] Excitation: An act of irritation or stimulation or of responding to a stimulus; the addition of energy, as the excitation of a molecule by absorption of photons. [EU] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] External-beam radiation: Radiation therapy that uses a machine to aim high-energy rays at the cancer. Also called external radiation. [NIH] Extracellular: Outside a cell or cells. [EU] 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] Fallopian tube: The oviduct, a muscular tube about 10 cm long, lying in the upper border of the broad ligament. [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] 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
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from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Fertilization in Vitro: Fertilization of an egg outside the body when the egg is normally fertilized in the body. [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] 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] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Flagellum: A whiplike appendage of a cell. It can function either as an organ of locomotion or as a device for moving the fluid surrounding the cell. [NIH] Flatus: Gas passed through the rectum. [NIH] Flow Cytometry: Technique using an instrument system for making, processing, and displaying one or more measurements on individual cells obtained from a cell suspension. Cells are usually stained with one or more fluorescent dyes specific to cell components of interest, e.g., DNA, and fluorescence of each cell is measured as it rapidly transverses the excitation beam (laser or mercury arc lamp). Fluorescence provides a quantitative measure of various biochemical and biophysical properties of the cell, as well as a basis for cell sorting. Other measurable optical parameters include light absorption and light scattering, the latter being applicable to the measurement of cell size, shape, density, granularity, and stain uptake. [NIH] Fluorescence: The property of emitting radiation while being irradiated. The radiation emitted is usually of longer wavelength than that incident or absorbed, e.g., a substance can be irradiated with invisible radiation and emit visible light. X-ray fluorescence is used in diagnosis. [NIH] Fluorescent Dyes: Dyes that emit light when exposed to light. The wave length of the emitted light is usually longer than that of the incident light. Fluorochromes are substances that cause fluorescence in other substances, i.e., dyes used to mark or label other compounds with fluorescent tags. They are used as markers in biochemistry and immunology. [NIH] Focus Groups: A method of data collection and a qualitative research tool in which a small group of individuals are brought together and allowed to interact in a discussion of their opinions about topics, issues, or questions. [NIH] Folate: A B-complex vitamin that is being studied as a cancer prevention agent. Also called folic acid. [NIH] Fold: A plication or doubling of various parts of the body. [NIH] Folic Acid: N-(4-(((2-Amino-1,4-dihydro-4-oxo-6-pteridinyl)methyl)amino)benzoyl)-Lglutamic acid. A member of the vitamin B family that stimulates the hematopoietic system. It is present in the liver and kidney and is found in mushrooms, spinach, yeast, green leaves, and grasses. Folic acid is used in the treatment and prevention of folate deficiencies and megaloblastic anemia. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Frameshift: A type of mutation which causes out-of-phase transcription of the base sequence; such mutations arise from the addition or delection of nucleotide(s) in numbers
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other than 3 or multiples of 3. [NIH] Frameshift Mutation: A type of mutation in which a number of nucleotides not divisible by three is deleted from or inserted into a coding sequence, thereby causing an alteration in the reading frame of the entire sequence downstream of the mutation. These mutations may be induced by certain types of mutagens or may occur spontaneously. [NIH] Fungi: A kingdom of eukaryotic, heterotrophic organisms that live as saprobes or parasites, including mushrooms, yeasts, smuts, molds, etc. They reproduce either sexually or asexually, and have life cycles that range from simple to complex. Filamentous fungi refer to those that grow as multicelluar colonies (mushrooms and molds). [NIH] Fungus: A general term used to denote a group of eukaryotic protists, including mushrooms, yeasts, rusts, moulds, smuts, etc., which are characterized by the absence of chlorophyll and by the presence of a rigid cell wall composed of chitin, mannans, and sometimes cellulose. They are usually of simple morphological form or show some reversible cellular specialization, such as the formation of pseudoparenchymatous tissue in the fruiting body of a mushroom. The dimorphic fungi grow, according to environmental conditions, as moulds or yeasts. [EU] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gamma Rays: Very powerful and penetrating, high-energy electromagnetic radiation of shorter wavelength than that of x-rays. They are emitted by a decaying nucleus, usually between 0.01 and 10 MeV. They are also called nuclear x-rays. [NIH] Gamma-interferon: Interferon produced by T-lymphocytes in response to various mitogens and antigens. Gamma interferon appears to have potent antineoplastic, immunoregulatory and antiviral activity. [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] 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]
Gastroenteritis: An acute inflammation of the lining of the stomach and intestines, characterized by anorexia, nausea, diarrhoea, abdominal pain, and weakness, which has various causes, including food poisoning due to infection with such organisms as Escherichia coli, Staphylococcus aureus, and Salmonella species; consumption of irritating food or drink; or psychological factors such as anger, stress, and fear. Called also enterogastritis. [EU] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gels: Colloids with a solid continuous phase and liquid as the dispersed phase; gels may be unstable when, due to temperature or other cause, the solid phase liquifies; the resulting colloid is called a sol. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]
Gene Deletion: A genetic rearrangement through loss of segments of DNA or RNA, bringing sequences which are normally separated into close proximity. This deletion may be
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detected using cytogenetic techniques and can also be inferred from the phenotype, indicating a deletion at one specific locus. [NIH] Gene Duplication: It encodes the major envelope protein and includes all the specifications for HBsAg. [NIH] Gene Expression: The phenotypic manifestation of a gene or genes by the processes of gene action. [NIH] Genetic Code: The specifications for how information, stored in nucleic acid sequence (base sequence), is translated into protein sequence (amino acid sequence). The start, stop, and order of amino acids of a protein is specified by consecutive triplets of nucleotides called codons (codon). [NIH] 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] Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Genital: Pertaining to the genitalia. [EU] Genitourinary: Pertaining to the genital and urinary organs; urogenital; urinosexual. [EU] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Germ Cells: The reproductive cells in multicellular organisms. [NIH] Gestation: The period of development of the young in viviparous animals, from the time of fertilization of the ovum until birth. [EU] 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] Glomeruli: Plural of glomerulus. [NIH] Glottis: The vocal apparatus of the larynx, consisting of the true vocal cords (plica vocalis) and the opening between them (rima glottidis). [NIH] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucose Intolerance: A pathological state in which the fasting plasma glucose level is less than 140 mg per deciliter and the 30-, 60-, or 90-minute plasma glucose concentration following a glucose tolerance test exceeds 200 mg per deciliter. This condition is seen frequently in diabetes mellitus but also occurs with other diseases. [NIH] Glutamic Acid: A non-essential amino acid naturally occurring in the L-form. Glutamic acid (glutamate) is the most common excitatory neurotransmitter in the central nervous system. [NIH]
Glycine: A non-essential amino acid. It is found primarily in gelatin and silk fibroin and used therapeutically as a nutrient. It is also a fast inhibitory neurotransmitter. [NIH] Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Glycosaminoglycans: Heteropolysaccharides which contain an N-acetylated hexosamine in a characteristic repeating disaccharide unit. The repeating structure of each disaccharide
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involves alternate 1,4- and 1,3-linkages consisting of either N-acetylglucosamine or Nacetylgalactosamine. [NIH] Glycosylation: The chemical or biochemical addition of carbohydrate or glycosyl groups to other chemicals, especially peptides or proteins. Glycosyl transferases are used in this biochemical reaction. [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] Gonorrhoea: Infection due to Neisseria gonorrhoeae transmitted sexually in most cases, but also by contact with infected exudates in neonatal children at birth, or by infants in households with infected inhabitants. It is marked in males by urethritis with pain and purulent discharge, but is commonly asymptomatic in females, although it may extend to produce suppurative salpingitis, oophoritis, tubo-ovarian abscess, and peritonitis. Bacteraemia occurs in both sexes, resulting in cutaneous lesions, arthritis, and rarely meningitis or endocarditis. Formerly called blennorrhagia and blennorrhoea. [EU] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer. [NIH] 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] Gram-negative: Losing the stain or decolorized by alcohol in Gram's method of staining, a primary characteristic of bacteria having a cell wall composed of a thin layer of peptidoglycan covered by an outer membrane of lipoprotein and lipopolysaccharide. [EU] Gram-positive: Retaining the stain or resisting decolorization by alcohol in Gram's method of staining, a primary characteristic of bacteria whose cell wall is composed of a thick layer of peptidologlycan with attached teichoic acids. [EU] Granulocytes: Leukocytes with abundant granules in the cytoplasm. They are divided into three groups: neutrophils, eosinophils, and basophils. [NIH] Grasses: A large family, Gramineae, of narrow-leaved herbaceous monocots. Many grasses produce highly allergenic pollens and are hosts to cattle parasites and toxic fungi. [NIH] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Guanylate Cyclase: An enzyme that catalyzes the conversion of GTP to 3',5'-cyclic GMP and pyrophosphate. It also acts on ITP and dGTP. (From Enzyme Nomenclature, 1992) EC 4.6.1.2. [NIH] Haemorrhage: The escape of blood from the vessels; bleeding. Small haemorrhages are classified according to size as petechiae (very small), purpura (up to 1 cm), and ecchymoses (larger). The massive accumulation of blood within a tissue is called a haematoma. [EU] Half-Life: The time it takes for a substance (drug, radioactive nuclide, or other) to lose half of its pharmacologic, physiologic, or radiologic activity. [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
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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 Services: Services for the diagnosis and treatment of disease and the maintenance of health. [NIH] Heart attack: A seizure of weak or abnormal functioning of the heart. [NIH] Hepatic: Refers to the liver. [NIH] Hepatitis: Inflammation of the liver and liver disease involving degenerative or necrotic alterations of hepatocytes. [NIH] Hepatocytes: The main structural component of the liver. They are specialized epithelial cells that are organized into interconnected plates called lobules. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Hernia: Protrusion of a loop or knuckle of an organ or tissue through an abnormal opening. [NIH]
Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU] Herpes Zoster: Acute vesicular inflammation. [NIH] Heterogeneity: The property of one or more samples or populations which implies that they are not identical in respect of some or all of their parameters, e. g. heterogeneity of variance. [NIH]
Histology: The study of tissues and cells under a microscope. [NIH] 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] Host: Any animal that receives a transplanted graft. [NIH] Human papillomavirus: HPV. A virus that causes abnormal tissue growth (warts) and is often associated with some types of cancer. [NIH] Humoral: Of, relating to, proceeding from, or involving a bodily humour - now often used of endocrine factors as opposed to neural or somatic. [EU] Humour: 1. A normal functioning fluid or semifluid of the body (as the blood, lymph or bile) especially of vertebrates. 2. A secretion that is itself an excitant of activity (as certain hormones). [EU] Hybrid: Cross fertilization between two varieties or, more usually, two species of vines, see also crossing. [NIH] Hybridomas: Cells artificially created by fusion of activated lymphocytes with neoplastic cells. The resulting hybrid cells are cloned and produce pure or "monoclonal" antibodies or T-cell products, identical to those produced by the immunologically competent parent, and continually grow and divide as the neoplastic parent. [NIH]
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Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrogen Peroxide: A strong oxidizing agent used in aqueous solution as a ripening agent, bleach, and topical anti-infective. It is relatively unstable and solutions deteriorate over time unless stabilized by the addition of acetanilide or similar organic materials. [NIH] Hydrophilic: Readily absorbing moisture; hygroscopic; having strongly polar groups that readily interact with water. [EU] Hydrophobic: Not readily absorbing water, or being adversely affected by water, as a hydrophobic colloid. [EU] 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] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hyperthermia: A type of treatment in which body tissue is exposed to high temperatures to damage and kill cancer cells or to make cancer cells more sensitive to the effects of radiation and certain anticancer drugs. [NIH] Hypoxic: Having too little oxygen. [NIH] Hysterectomy: Excision of the uterus. [NIH] Hysterosalpingography: Radiography of the uterus and fallopian tubes after the injection of a contrast medium. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]
Immune Sera: Serum that contains antibodies. It is obtained from an animal that has been immunized either by antigen injection or infection with microorganisms containing the antigen. [NIH] Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunity: Nonsusceptibility to the invasive or pathogenic microorganisms or to the toxic effect of antigenic substances. [NIH]
effects
of
foreign
Immunization: Deliberate stimulation of the host's immune response. Active immunization involves administration of antigens or immunologic adjuvants. Passive immunization involves administration of immune sera or lymphocytes or their extracts (e.g., transfer factor, immune RNA) or transplantation of immunocompetent cell producing tissue (thymus or bone marrow). [NIH] Immunoassay: Immunochemical assay or detection of a substance by serologic or immunologic methods. Usually the substance being studied serves as antigen both in antibody production and in measurement of antibody by the test substance. [NIH] Immunodeficiency: The decreased ability of the body to fight infection and disease. [NIH] Immunofluorescence: A technique for identifying molecules present on the surfaces of cells or in tissues using a highly fluorescent substance coupled to a specific antibody. [NIH]
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Immunogen: A substance that is capable of causing antibody formation. [NIH] Immunogenic: Producing immunity; evoking an immune response. [EU] 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] 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] 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] Incubated: Grown in the laboratory under controlled conditions. (For instance, white blood cells can be grown in special conditions so that they attack specific cancer cells when returned to the body.) [NIH] Incubation: The development of an infectious disease from the entrance of the pathogen to the appearance of clinical symptoms. [EU] Incubation period: The period of time likely to elapse between exposure to the agent of the disease and the onset of clinical symptoms. [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic
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clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]
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] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Inflammatory bowel disease: A general term that refers to the inflammation of the colon and rectum. Inflammatory bowel disease includes ulcerative colitis and Crohn's disease. [NIH]
Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH] Inner ear: The labyrinth, comprising the vestibule, cochlea, and semicircular canals. [NIH] Inoculum: The spores or tissues of a pathogen that serve to initiate disease in a plant. [NIH] Inorganic: Pertaining to substances not of organic origin. [EU] Insight: The capacity to understand one's own motives, to be aware of one's own psychodynamics, to appreciate the meaning of symbolic behavior. [NIH] Interferon: A biological response modifier (a substance that can improve the body's natural response to disease). Interferons interfere with the division of cancer cells and can slow tumor growth. There are several types of interferons, including interferon-alpha, -beta, and gamma. These substances are normally produced by the body. They are also made in the laboratory for use in treating cancer and other diseases. [NIH] 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-10: Factor that is a coregulator of mast cell growth. It is produced by T-cells and B-cells and shows extensive homology with the Epstein-Barr virus BCRFI gene. [NIH] Interleukin-2: Chemical mediator produced by activated T lymphocytes and which regulates the proliferation of T cells, as well as playing a role in the regulation of NK cell activity. [NIH] Interleukin-6: Factor that stimulates the growth and differentiation of human B-cells and is also a growth factor for hybridomas and plasmacytomas. It is produced by many different cells including T-cells, monocytes, and fibroblasts. [NIH] Internal radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called brachytherapy, implant radiation, or interstitial radiation therapy. [NIH] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intestinal: Having to do with the intestines. [NIH] Intestinal Mucosa: The surface lining of the intestines where the cells absorb nutrients. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intracellular: Inside a cell. [NIH] Intracellular Membranes: Membranes of subcellular structures. [NIH]
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Intraepithelial: Within the layer of cells that form the surface or lining of an organ. [NIH] Intramuscular: IM. Within or into muscle. [NIH] Intravenous: IV. Into a vein. [NIH] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]
Involuntary: Reaction occurring without intention or volition. [NIH] Ionization: 1. Any process by which a neutral atom gains or loses electrons, thus acquiring a net charge, as the dissociation of a substance in solution into ions or ion production by the passage of radioactive particles. 2. Iontophoresis. [EU] 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] 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] Kinetic: Pertaining to or producing motion. [EU] Labile: 1. Gliding; moving from point to point over the surface; unstable; fluctuating. 2. Chemically unstable. [EU] Lactobacillus: A genus of gram-positive, microaerophilic, rod-shaped bacteria occurring widely in nature. Its species are also part of the many normal flora of the mouth, intestinal tract, and vagina of many mammals, including humans. Pathogenicity from this genus is rare. [NIH] Laparoscopy: Examination, therapy or surgery of the abdomen's interior by means of a laparoscope. [NIH] Laparotomy: A surgical incision made in the wall of the abdomen. [NIH] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Least-Squares Analysis: A principle of estimation in which the estimates of a set of parameters in a statistical model are those quantities minimizing the sum of squared differences between the observed values of a dependent variable and the values predicted by the model. [NIH] Lectin: A complex molecule that has both protein and sugars. Lectins are able to bind to the outside of a cell and cause biochemical changes in it. Lectins are made by both animals and plants. [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]
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Lethal: Deadly, fatal. [EU] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]
Life cycle: The successive stages through which an organism passes from fertilized ovum or spore to the fertilized ovum or spore of the next generation. [NIH] Ligaments: Shiny, flexible bands of fibrous tissue connecting together articular extremities of bones. They are pliant, tough, and inextensile. [NIH] Ligands: A RNA simulation method developed by the MIT. [NIH] Likelihood Functions: Functions constructed from a statistical model and a set of observed data which give the probability of that data for various values of the unknown model parameters. Those parameter values that maximize the probability are the maximum likelihood estimates of the parameters. [NIH] Lincomycin: (2S-trans)-Methyl 6,8-dideoxy-6-(((1-methyl-4-propyl-2pyrrolidinyl)carbonyl)amino)-1-thio-D-erythro-alpha-D-galacto-octopyranoside. An antibiotic produced by Streptomyces lincolnensis var. lincolnensis. It has been used in the treatment of staphylococcal, streptococcal, and Bacteroides fragilis infections. [NIH] Linear Models: Statistical models in which the value of a parameter for a given value of a factor is assumed to be equal to a + bx, where a and b are constants. The models predict a linear regression. [NIH] Linkages: 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] Lipopolysaccharides: Substance consisting of polysaccaride and lipid. [NIH] Liposomes: Artificial, single or multilaminar vesicles (made from lecithins or other lipids) that are used for the delivery of a variety of biological molecules or molecular complexes to cells, for example, drug delivery and gene transfer. They are also used to study membranes and membrane proteins. [NIH] Liquor: 1. A liquid, especially an aqueous solution containing a medicinal substance. 2. A general term used in anatomical nomenclature for certain fluids of the body. [EU] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [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] Logistic Models: Statistical models which describe the relationship between a qualitative dependent variable (that is, one which can take only certain discrete values, such as the presence or absence of a disease) and an independent variable. A common application is in epidemiology for estimating an individual's risk (probability of a disease) as a function of a given risk factor. [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] Lymph: The almost colorless fluid that travels through the lymphatic system and carries
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cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]
Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphocyte: A white blood cell. Lymphocytes have a number of roles in the immune system, including the production of antibodies and other substances that fight infection and diseases. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Lymphoma: A general term for various neoplastic diseases of the lymphoid tissue. [NIH] 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] Major Histocompatibility Complex: The genetic region which contains the loci of genes which determine the structure of the serologically defined (SD) and lymphocyte-defined (LD) transplantation antigens, genes which control the structure of the immune responseassociated (Ia) antigens, the immune response (Ir) genes which control the ability of an animal to respond immunologically to antigenic stimuli, and genes which determine the structure and/or level of the first four components of complement. [NIH] Malignancy: A cancerous tumor that can invade and destroy nearby tissue and spread to other parts of the body. [NIH] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] Medical Records: Recording of pertinent information concerning patient's illness or illnesses. [NIH] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Megaloblastic: A large abnormal red blood cell appearing in the blood in pernicious anaemia. [EU] Membrane: A very thin layer of tissue that covers a surface. [NIH] Membrane Proteins: Proteins which are found in membranes including cellular and intracellular membranes. They consist of two types, peripheral and integral proteins. They include most membrane-associated enzymes, antigenic proteins, transport proteins, and drug, hormone, and lectin receptors. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Meningitis: Inflammation of the meninges. When it affects the dura mater, the disease is termed pachymeningitis; when the arachnoid and pia mater are involved, it is called leptomeningitis, or meningitis proper. [EU] Menopause: Permanent cessation of menstruation. [NIH] Menstruation: The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus. [NIH]
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Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Mental Health: The state wherein the person is well adjusted. [NIH] Mercury: A silver metallic element that exists as a liquid at room temperature. It has the atomic symbol Hg (from hydrargyrum, liquid silver), atomic number 80, and atomic weight 200.59. Mercury is used in many industrial applications and its salts have been employed therapeutically as purgatives, antisyphilitics, disinfectants, and astringents. It can be absorbed through the skin and mucous membranes which leads to mercury poisoning. Because of its toxicity, the clinical use of mercury and mercurials is diminishing. [NIH] Mesenteric: Pertaining to the mesentery : a membranous fold attaching various organs to the body wall. [EU] Mesentery: A layer of the peritoneum which attaches the abdominal viscera to the abdominal wall and conveys their blood vessels and nerves. [NIH] Methyltransferases: A subclass of enzymes of the transferase class that catalyze the transfer of a methyl group from one compound to another. (Dorland, 28th ed) EC 2.1.1. [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] Metrorrhagia: Uterine bleeding, usually irregular or acyclic, between periods. [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] Microbicide: Any substance (gels, creams, suppositories, etc.) that can reduce transmission of sexually transmitted infections. [NIH] Microbiological: Pertaining to microbiology : the science that deals with microorganisms, including algae, bacteria, fungi, protozoa and viruses. [EU] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Micronutrients: Essential dietary elements or organic compounds that are required in only small quantities for normal physiologic processes to occur. [NIH] Microorganism: An organism that can be seen only through a microscope. Microorganisms include bacteria, protozoa, algae, and fungi. Although viruses are not considered living organisms, they are sometimes classified as microorganisms. [NIH] Micro-organism: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microscopy: The application of microscope magnification to the study of materials that cannot be properly seen by the unaided eye. [NIH] Migration: The systematic movement of genes between populations of the same species, geographic race, or variety. [NIH] Miscarriage: Spontaneous expulsion of the products of pregnancy before the middle of the second trimester. [NIH] Mitochondria: Parts of a cell where aerobic production (also known as cell respiration) takes place. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH]
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Modulator: A specific inductor that brings out characteristics peculiar to a definite region. [EU]
Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecular Chaperones: A family of cellular proteins that mediate the correct assembly or disassembly of other polypeptides, and in some cases their assembly into oligomeric structures, but which are not components of those final structures. It is believed that chaperone proteins assist polypeptides to self-assemble by inhibiting alternative assembly pathways that produce nonfunctional structures. Some classes of molecular chaperones are the nucleoplasmins, the chaperonins, the heat-shock proteins 70, and the heat-shock proteins 90. [NIH] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monoclonal: An antibody produced by culturing a single type of cell. It therefore consists of a single species of immunoglobulin molecules. [NIH] Monocytes: Large, phagocytic mononuclear leukocytes produced in the vertebrate bone marrow and released into the blood; contain a large, oval or somewhat indented nucleus surrounded by voluminous cytoplasm and numerous organelles. [NIH] Mononuclear: A cell with one nucleus. [NIH] Monotherapy: A therapy which uses only one drug. [EU] Morphological: Relating to the configuration or the structure of live organs. [NIH] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH] Mucopurulent: Containing both mucus and pus. [EU] 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] Mutagens: Chemical agents that increase the rate of genetic mutation by interfering with the function of nucleic acids. A clastogen is a specific mutagen that causes breaks in chromosomes. [NIH] Mycoplasma: A genus of gram-negative, facultatively anaerobic bacteria bounded by a plasma membrane only. Its organisms are parasites and pathogens, found on the mucous membranes of humans, animals, and birds. [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] Nebramycin: A complex of antibiotic substances produced by Streptomyces tenebrarius. [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]
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Neonatal: Pertaining to the first four weeks after birth. [EU] Neoplasia: Abnormal and uncontrolled cell growth. [NIH] Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Neutralization: An act or process of neutralizing. [EU] Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light hydrogen; the mass is equal to that of the proton and electron combined and they are unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal, and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier nuclei during their decay. [NIH] Neutrophil: A type of white blood cell. [NIH] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [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] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the next. [NIH] Nursing Care: Care given to patients by nursing service personnel. [NIH] Ocular: 1. Of, pertaining to, or affecting the eye. 2. Eyepiece. [EU] Odds Ratio: The ratio of two odds. The exposure-odds ratio for case control data is the ratio
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of the odds in favor of exposure among cases to the odds in favor of exposure among noncases. The disease-odds ratio for a cohort or cross section is the ratio of the odds in favor of disease among the exposed to the odds in favor of disease among the unexposed. The prevalence-odds ratio refers to an odds ratio derived cross-sectionally from studies of prevalent cases. [NIH] Ofloxacin: An orally administered broad-spectrum quinolone antibacterial drug active against most gram-negative and gram-positive bacteria. [NIH] Oncologist: A doctor who specializes in treating cancer. Some oncologists specialize in a particular type of cancer treatment. For example, a radiation oncologist specializes in treating cancer with radiation. [NIH] Oncology: The study of cancer. [NIH] Oophoritis: Inflammation of an ovary. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH] Open Reading Frames: Reading frames where successive nucleotide triplets can be read as codons specifying amino acids and where the sequence of these triplets is not interrupted by stop codons. [NIH] Operon: The genetic unit consisting of a feedback system under the control of an operator gene, in which a structural gene transcribes its message in the form of mRNA upon blockade of a repressor produced by a regulator gene. Included here is the attenuator site of bacterial operons where transcription termination is regulated. [NIH] Organ Culture: The growth in aseptic culture of plant organs such as roots or shoots, beginning with organ primordia or segments and maintaining the characteristics of the organ. [NIH] Ornithosis: Infection with Chlamydophila psittaci (formerly Chlamydia psittaci), transmitted to man by inhalation of dust-borne contaminated nasal secretions or excreta of infected birds. This infection results in a febrile illness characterized by pneumonitis and systemic manifestations. [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] 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] Ovum: A female germ cell extruded from the ovary at ovulation. [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] Parasite: An animal or a plant that lives on or in an organism of another species and gets at
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least some of its nutrition from that other organism. [NIH] Parasitic: Having to do with or being a parasite. A parasite is an animal or a plant that lives on or in an organism of another species and gets at least some of its nutrients from it. [NIH] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Paroxysmal: Recurring in paroxysms (= spasms or seizures). [EU] Pathogen: Any disease-producing microorganism. [EU] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]
Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Patient Care Management: Generating, planning, organizing, and administering medical and nursing care and services for patients. [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] Pelvic: Pertaining to the pelvis. [EU] Pelvic inflammatory disease: A bacteriological disease sometimes associated with intrauterine device (IUD) usage. [NIH] Pelvis: The lower part of the abdomen, located between the hip bones. [NIH] Penicillin: An antibiotic drug used to treat infection. [NIH] Penis: The external reproductive organ of males. It is composed of a mass of erectile tissue enclosed in three cylindrical fibrous compartments. Two of the three compartments, the corpus cavernosa, are placed side-by-side along the upper part of the organ. The third compartment below, the corpus spongiosum, houses the urethra. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] 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] Periodontal disease: Disease involving the supporting structures of the teeth (as the gums and periodontal membranes). [NIH] Periodontal disease: Disease involving the supporting structures of the teeth (as the gums and periodontal membranes). [NIH] Peripheral blood: Blood circulating throughout the body. [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] 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]
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Peritonitis: Inflammation of the peritoneum; a condition marked by exudations in the peritoneum of serum, fibrin, cells, and pus. It is attended by abdominal pain and tenderness, constipation, vomiting, and moderate fever. [EU] Peroxide: Chemical compound which contains an atom group with two oxygen atoms tied to each other. [NIH] Pertussis: An acute, highly contagious infection of the respiratory tract, most frequently affecting young children, usually caused by Bordetella pertussis; a similar illness has been associated with infection by B. parapertussis and B. bronchiseptica. It is characterized by a catarrhal stage, beginning after an incubation period of about two weeks, with slight fever, sneezing, running at the nose, and a dry cough. In a week or two the paroxysmal stage begins, with the characteristic paroxysmal cough, consisting of a deep inspiration, followed by a series of quick, short coughs, continuing until the air is expelled from the lungs; the close of the paroxysm is marked by a long-drawn, shrill, whooping inspiration, due to spasmodic closure of the glottis. This stage lasts three to four weeks, after which the convalescent stage begins, in which paroxysms grow less frequent and less violent, and finally cease. Called also whooping cough. [EU] Phagocytosis: The engulfing of microorganisms, other cells, and foreign particles by phagocytic cells. [NIH] 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] Phospholipases: A class of enzymes that catalyze the hydrolysis of phosphoglycerides or glycerophosphatidates. EC 3.1.-. [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]
Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plaque: A clear zone in a bacterial culture grown on an agar plate caused by localized destruction of bacterial cells by a bacteriophage. The concentration of infective virus in a fluid can be estimated by applying the fluid to a culture and counting the number of. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma cells: A type of white blood cell that produces antibodies. [NIH] Plasmid: An autonomously replicating, extra-chromosomal DNA molecule found in many bacteria. Plasmids are widely used as carriers of cloned genes. [NIH] Plastids: Self-replicating cytoplasmic organelles of plant and algal cells that contain pigments and may synthesize and accumulate various substances. Plastids are used in phylogenetic studies. [NIH]
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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]
Pneumonia: Inflammation of the lungs. [NIH] Pneumonitis: A disease caused by inhaling a wide variety of substances such as dusts and molds. Also called "farmer's disease". [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Polyarthritis: An inflammation of several joints together. [EU] Polymerase: An enzyme which catalyses the synthesis of DNA using a single DNA strand as a template. The polymerase copies the template in the 5'-3'direction provided that sufficient quantities of free nucleotides, dATP and dTTP are present. [NIH] Polymorphic: Occurring in several or many forms; appearing in different forms at different stages of development. [EU] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] 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] 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] 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] 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] Pregnancy Outcome: Results of conception and ensuing pregnancy, including live birth, stillbirth, spontaneous abortion, induced abortion. The outcome may follow natural or artificial insemination or any of the various reproduction techniques, such as embryo
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transfer or fertilization in vitro. [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] 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] Progeny: The offspring produced in any generation. [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Projection: A defense mechanism, operating unconsciously, whereby that which is emotionally unacceptable in the self is rejected and attributed (projected) to others. [NIH] Prolapse: The protrusion of an organ or part of an organ into a natural or artificial orifice. [NIH]
Prophylaxis: An attempt to prevent disease. [NIH] Proportional: Being in proportion : corresponding in size, degree, or intensity, having the same or a constant ratio; of, relating to, or used in determining proportions. [EU] Prospective Studies: Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group. [NIH] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] 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] Prostatitis: Inflammation of the prostate. [EU] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus
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of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Protozoa: A subkingdom consisting of unicellular organisms that are the simplest in the animal kingdom. Most are free living. They range in size from submicroscopic to macroscopic. Protozoa are divided into seven phyla: Sarcomastigophora, Labyrinthomorpha, Apicomplexa, Microspora, Ascetospora, Myxozoa, and Ciliophora. [NIH] Protozoan: 1. Any individual of the protozoa; protozoon. 2. Of or pertaining to the protozoa; protozoal. [EU] Pruritic: Pertaining to or characterized by pruritus. [EU] Psittaci: Causal agent of ornithosis. [NIH] Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]
Purulent: Consisting of or containing pus; associated with the formation of or caused by pus. [EU] Pyelonephritis: Inflammation of the kidney and its pelvis, beginning in the interstitium and rapidly extending to involve the tubules, glomeruli, and blood vessels; due to bacterial infection. [EU] Pyogenic: Producing pus; pyopoietic (= liquid inflammation product made up of cells and a thin fluid called liquor puris). [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 oncologist: A doctor who specializes in using radiation to treat cancer. [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] Radio Waves: That portion of the electromagnetic spectrum beyond the microwaves, with wavelengths as high as 30 KM. They are used in communications, including television. Short Wave or HF (high frequency), UHF (ultrahigh frequency) and VHF (very high frequency)
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waves are used in citizen's band communication. [NIH] Radioactive: Giving off radiation. [NIH] Radiolabeled: Any compound that has been joined with a radioactive substance. [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] 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 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] Reactivation: The restoration of activity to something that has been inactivated. [EU] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Recombinant: A cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Recombination: The formation of new combinations of genes as a result of segregation in crosses between genetically different parents; also the rearrangement of linked genes due to crossing-over. [NIH] Rectal: By or having to do with the rectum. The rectum is the last 8 to 10 inches of the large intestine and ends at the anus. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Reductase: Enzyme converting testosterone to dihydrotestosterone. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Refractory: Not readily yielding to treatment. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Regression Analysis: Procedures for finding the mathematical function which best describes the relationship between a dependent variable and one or more independent variables. In linear regression (see linear models) the relationship is constrained to be a straight line and least-squares analysis is used to determine the best fit. In logistic regression
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(see logistic models) the dependent variable is qualitative rather than continuously variable and likelihood functions are used to find the best relationship. In multiple regression the dependent variable is considered to depend on more than a single independent variable. [NIH]
Reinfection: A second infection by the same pathogenic agent, or a second infection of an organ such as the kidney by a different pathogenic agent. [EU] Relative risk: The ratio of the incidence rate of a disease among individuals exposed to a specific risk factor to the incidence rate among unexposed individuals; synonymous with risk ratio. Alternatively, the ratio of the cumulative incidence rate in the exposed to the cumulative incidence rate in the unexposed (cumulative incidence ratio). The term relative risk has also been used synonymously with odds ratio. This is because the odds ratio and relative risk approach each other if the disease is rare ( 5 percent of population) and the number of subjects is large. [NIH] 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] Repressor: Any of the specific allosteric protein molecules, products of regulator genes, which bind to the operator of operons and prevent RNA polymerase from proceeding into the operon to transcribe messenger RNA. [NIH] Reproduction Techniques: Methods pertaining to the generation of new individuals. [NIH] Reproductive system: In women, this system includes the ovaries, the fallopian tubes, the uterus (womb), the cervix, and the vagina (birth canal). The reproductive system in men includes the prostate, the testes, and the penis. [NIH] 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] Restoration: Broad term applied to any inlay, crown, bridge or complete denture which restores or replaces loss of teeth or oral tissues. [NIH] Retrospective: Looking back at events that have already taken place. [NIH] Ribosome: A granule of protein and RNA, synthesized in the nucleolus and found in the cytoplasm of cells. Ribosomes are the main sites of protein synthesis. Messenger RNA attaches to them and there receives molecules of transfer RNA bearing amino acids. [NIH] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Rod: A reception for vision, located in the retina. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Salpingitis: 1. Inflammation of the uterine tube. 2. Inflammation of the auditory tube. [EU] Scabies: A contagious cutaneous inflammation caused by the bite of the mite Sarcoptes scabiei. It is characterized by pruritic papular eruptions and burrows and affects primarily the axillae, elbows, wrists, and genitalia, although it can spread to cover the entire body. [NIH]
Screening: Checking for disease when there are no symptoms. [NIH]
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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] Sediment: A precipitate, especially one that is formed spontaneously. [EU] Segregation: The separation in meiotic cell division of homologous chromosome pairs and their contained allelomorphic gene pairs. [NIH] Semisynthetic: Produced by chemical manipulation of naturally occurring substances. [EU] Senile: Relating or belonging to old age; characteristic of old age; resulting from infirmity of old age. [NIH] Sepsis: The presence of bacteria in the bloodstream. [NIH] Septic: Produced by or due to decomposition by microorganisms; putrefactive. [EU] Septicemia: Systemic disease associated with the presence and persistence of pathogenic microorganisms or their toxins in the blood. Called also blood poisoning. [EU] Sequencing: The determination of the order of nucleotides in a DNA or RNA chain. [NIH] Serologic: Analysis of a person's serum, especially specific immune or lytic serums. [NIH] Serology: The study of serum, especially of antigen-antibody reactions in vitro. [NIH] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Sex Behavior: Sexual activities of humans. [NIH] Sexual Partners: Married or single individuals who share sexual relations. [NIH] Sexually Transmitted Diseases: Diseases due to or propagated by sexual contact. [NIH] Shedding: Release of infectious particles (e. g., bacteria, viruses) into the environment, for example by sneezing, by fecal excretion, or from an open lesion. [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] 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
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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] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]
Sneezing: Sudden, forceful, involuntary expulsion of air from the nose and mouth caused by irritation to the mucous membranes of the upper respiratory tract. [NIH] Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Sound wave: An alteration of properties of an elastic medium, such as pressure, particle displacement, or density, that propagates through the medium, or a superposition of such alterations. [NIH] Spasmodic: Of the nature of a spasm. [EU] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sperm: The fecundating fluid of the male. [NIH] Spermicide: An agent that is destructive to spermatozoa. [EU] Sphincters: Any annular muscle closing an orifice. [NIH] Spirochete: Lyme disease. [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] Spontaneous Abortion: The non-induced birth of an embryo or of fetus prior to the stage of viability at about 20 weeks of gestation. [NIH]
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Spores: The reproductive elements of lower organisms, such as protozoa, fungi, and cryptogamic plants. [NIH] Steady state: Dynamic equilibrium. [EU] 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] Stillbirth: The birth of a dead fetus or baby. [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] Streptococcal: Caused by infection due to any species of streptococcus. [NIH] Streptococcus: A genus of gram-positive, coccoid bacteria whose organisms occur in pairs or chains. No endospores are produced. Many species exist as commensals or parasites on man or animals with some being highly pathogenic. A few species are saprophytes and occur in the natural environment. [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] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Stromal: Large, veil-like cell in the bone marrow. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] 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] 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]
Sulbactam: A beta-lactamase inhibitor with very weak antibacterial action. The compound prevents antibiotic destruction of beta-lactam antibiotics by inhibiting beta-lactamases, thus extending their spectrum activity. Combinations of sulbactam with beta-lactam antibiotics have been used successfully for the therapy of infections caused by organisms resistant to the antibiotic alone. [NIH] Superinfection: A frequent complication of drug therapy for microbial infection. It may result from opportunistic colonization following immunosuppression by the primary pathogen and can be influenced by the time interval between infections, microbial physiology, or host resistance. Experimental challenge and in vitro models are sometimes used in virulence and infectivity studies. [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]
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Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [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] Syphilis: A contagious venereal disease caused by the spirochete Treponema pallidum. [NIH]
Systemic: Affecting the entire body. [NIH] Systemic disease: Disease that affects the whole body. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Tachycardia: Excessive rapidity in the action of the heart, usually with a heart rate above 100 beats per minute. [NIH] Tachypnea: Rapid breathing. [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] Tenesmus: Straining, especially ineffectual and painful straining at stool or in urination. [EU] Testosterone: A hormone that promotes the development and maintenance of male sex characteristics. [NIH] Tetracycline: An antibiotic originally produced by Streptomyces viridifaciens, but used mostly in synthetic form. It is an inhibitor of aminoacyl-tRNA binding during protein synthesis. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] 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] Thrush: A disease due to infection with species of fungi of the genus Candida. [NIH] Thymus: An organ that is part of the lymphatic system, in which T lymphocytes grow and multiply. The thymus is in the chest behind the breastbone. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tissue Culture: Maintaining or growing of tissue, organ primordia, or the whole or part of an organ in vitro so as to preserve its architecture and/or function (Dorland, 28th ed). Tissue culture includes both organ culture and cell culture. [NIH] Tobramycin: An aminoglycoside, broad-spectrum antibiotic produced by Streptomyces tenebrarius. It is effective against gram-negative bacteria, especially the Pseudomonas species. It is a 10% component of the antibiotic complex, nebramycin, produced by the same species. [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]
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Topical: On the surface of the body. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Toxoplasmosis: The acquired form of infection by Toxoplasma gondii in animals and man. [NIH]
Trachoma: A chronic infection of the conjunctiva and cornea caused by Chlamydia trachomatis. [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 Factor: Factor derived from leukocyte lysates of immune donors which can transfer both local and systemic cellular immunity to nonimmune recipients. [NIH] Transferases: Transferases are enzymes transferring a group, for example, the methyl group or a glycosyl group, from one compound (generally regarded as donor) to another compound (generally regarded as acceptor). The classification is based on the scheme "donor:acceptor group transferase". (Enzyme Nomenclature, 1992) EC 2. [NIH] Translation: The process whereby the genetic information present in the linear sequence of ribonucleotides in mRNA is converted into a corresponding sequence of amino acids in a protein. It occurs on the ribosome and is unidirectional. [NIH] Translocation: The movement of material in solution inside the body of the plant. [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] Trichomonas: A genus of parasitic flagellate protozoans distinguished by the presence of four anterior flagella, an undulating membrane, and a trailing flagellum. [NIH] Trichomoniasis: An infection with the protozoan parasite Trichomonas vaginalis. [NIH] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tumor Necrosis Factor: Serum glycoprotein produced by activated macrophages and other mammalian mononuclear leukocytes which has necrotizing activity against tumor cell lines and increases ability to reject tumor transplants. It mimics the action of endotoxin but differs from it. It has a molecular weight of less than 70,000 kDa. [NIH] Tunica: A rather vague term to denote the lining coat of hollow organs, tubes, or cavities. [NIH]
TYPHI: The bacterium that gives rise to typhoid fever. [NIH]
Dictionary 177
Typhoid fever: The most important member of the enteric group of fevers which also includes the paratyphoids. [NIH] Typhoid fever: The most important member of the enteric group of fevers which also includes the paratyphoids. [NIH] Ulcer: A localized necrotic lesion of the skin or a mucous surface. [NIH] Ulcerative colitis: Chronic inflammation of the colon that produces ulcers in its lining. This condition is marked by abdominal pain, cramps, and loose discharges of pus, blood, and mucus from the bowel. [NIH] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Ureters: Tubes that carry urine from the kidneys to the bladder. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]
Urethritis: Inflammation of the urethra. [EU] Urinalysis: Examination of urine by chemical, physical, or microscopic means. Routine urinalysis usually includes performing chemical screening tests, determining specific gravity, observing any unusual color or odor, screening for bacteriuria, and examining the sediment microscopically. [NIH] Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary tract: The organs of the body that produce and discharge urine. These include the kidneys, ureters, bladder, and urethra. [NIH] Urinary tract infection: An illness caused by harmful bacteria growing in the urinary tract. [NIH]
Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Urogenital: Pertaining to the urinary and genital apparatus; genitourinary. [EU] 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] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Vaccination: Administration of vaccines to stimulate the host's immune response. This includes any preparation intended for active immunological prophylaxis. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vaccine adjuvant: A substance added to a vaccine to improve the immune response so that less vaccine is needed. [NIH] Vacuoles: Any spaces or cavities within a cell. They may function in digestion, storage, secretion, or excretion. [NIH]
178
Pelvic Inflammatory Disease
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] Valganciclovir: An antiviral agent that is being studied as a treatment for AIDS-related cytomegalovirus. It is converted in the body to ganciclovir. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasodilators: Any nerve or agent which induces dilatation of the blood vessels. [NIH] Vector: Plasmid or other self-replicating DNA molecule that transfers DNA between cells in nature or in recombinant DNA technology. [NIH] Veins: The vessels carrying blood toward the heart. [NIH] Venereal: Pertaining or related to or transmitted by sexual contact. [EU] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] 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] Volition: Voluntary activity without external compulsion. [NIH] Warts: Benign epidermal proliferations or tumors; some are viral in origin. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]
Whooping Cough: A respiratory infection caused by Bordetella pertussis and characterized by paroxysmal coughing ending in a prolonged crowing intake of breath. [NIH] Whooping Cough: A respiratory infection caused by Bordetella pertussis and characterized by paroxysmal coughing ending in a prolonged crowing intake of breath. [NIH] Womb: A hollow, thick-walled, muscular organ in which the impregnated ovum is developed into a child. [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'
Dictionary 179
and bakers' yeasts are Saccharomyces cerevisiae; therapeutic dried yeast is dried yeast. [NIH] Zygote: The fertilized ovum. [NIH]
181
INDEX A Abdomen, 119, 135, 140, 157, 158, 159, 165, 173, 174, 175 Abdominal, 3, 33, 48, 52, 94, 95, 119, 131, 135, 151, 161, 164, 165, 166, 177 Abdominal Cramps, 95, 135 Abdominal Pain, 52, 94, 119, 135, 151, 166, 177 Abortion, 54, 62, 75, 133, 135, 167 Abscess, 53, 65, 68, 71, 77, 90, 135, 153 Acetylcholine, 135, 163 Acetylgalactosamine, 135, 153 Acetylglucosamine, 135, 153 Adenitis, 4, 135 Adenoma, 48, 135 Adhesions, 58, 135 Adjuvant, 95, 135 Adnexa, 135 Adnexa Uteri, 135 Adnexitis, 28, 135 Adverse Effect, 135, 172 Aetiology, 58, 64, 135 Agar, 135, 166 Algorithms, 6, 33, 136, 139 Alimentary, 136, 165 Alpha Particles, 136, 169 Alternative medicine, 100, 136 Amebiasis, 136, 161 Amino acid, 22, 136, 137, 138, 142, 149, 152, 164, 165, 168, 171, 172, 174, 176 Amino Acid Sequence, 136, 137, 152 Ampicillin, 43, 44, 76, 120, 136 Amplification, 39, 136 Anaerobic, 16, 18, 36, 37, 136, 162 Anaesthesia, 136, 156 Anal, 136, 149 Analgesic, 136, 144 Analog, 42, 136, 142, 151 Anaphylatoxins, 136, 143 Anatomical, 136, 156, 159 Anemia, 116, 136, 150 Anesthesia, 137, 144 Animal model, 11, 14, 36, 137 Anorexia, 137, 151 Antibacterial, 51, 137, 142, 164, 173, 174 Antibodies, 21, 26, 32, 42, 52, 67, 76, 137, 149, 154, 155, 156, 160, 166
Antibody, 7, 21, 26, 32, 76, 137, 143, 154, 155, 156, 162, 169, 170, 172, 173 Antigen, 7, 11, 23, 26, 41, 52, 73, 137, 143, 146, 149, 154, 155, 156, 172 Antigen-Antibody Complex, 137, 143 Antigen-presenting cell, 23, 137, 146 Anti-infective, 57, 137, 155 Antimicrobial, 8, 24, 33, 43, 48, 70, 75, 82, 137, 142, 146, 147 Antineoplastic, 137, 151 Antiviral, 137, 151, 178 Anus, 136, 137, 143, 170 Anxiety, 94, 137, 144 Appendicitis, 3, 45, 46, 52, 53, 137 Applicability, 15, 137 Aqueous, 137, 138, 155, 158, 159 Archaea, 137, 161 Arginine, 136, 138, 163 Arterial, 138, 155, 168, 175 Arteries, 138, 139, 140, 145, 161 Arterioles, 138, 140 Aseptic, 138, 164, 174 Aspiration, 85, 138 Assay, 11, 39, 77, 138, 155 Asymptomatic, 6, 8, 9, 11, 14, 22, 37, 38, 39, 41, 118, 120, 136, 138, 153 Auditory, 138, 171 Autologous, 52, 138 Azithromycin, 33, 43, 46, 55, 82, 104, 138 Aztreonam, 84, 138 B Bacteremia, 75, 138 Bactericidal, 22, 138 Bacteriophage, 138, 166, 176 Bacterium, 11, 138, 144, 176 Bacteriuria, 138, 177 Base, 138, 139, 146, 150, 152, 158, 175 Base Sequence, 139, 150, 152 Basement Membrane, 139, 149 Basophils, 139, 153, 159 Benchmarking, 6, 139 Benign, 14, 48, 84, 135, 139, 150, 158, 170, 178 Beta-Lactamases, 138, 139, 174 Bile, 8, 139, 151, 154, 159 Bile Acids, 139 Bile Acids and Salts, 139
182
Pelvic Inflammatory Disease
Biochemical, 11, 18, 23, 28, 139, 150, 153, 158, 172 Biopsy, 50, 133, 139 Biotechnology, 41, 43, 100, 111, 139 Bladder, 138, 139, 143, 145, 156, 168, 177 Blastocyst, 139, 144, 148 Blennorrhoea, 139, 153 Blood pressure, 95, 139, 141, 155, 162 Blood vessel, 33, 139, 140, 141, 148, 158, 161, 169, 173, 174, 178 Bone Marrow, 140, 155, 160, 162, 174 Bowel, 66, 81, 95, 135, 136, 140, 148, 157, 165, 174, 177 Brachytherapy, 140, 157, 169 Bradykinin, 140, 163 Branch, 57, 129, 140, 165, 169, 173, 175 Breeding, 15, 140 Broad Ligament, 140, 149 Broad-spectrum, 33, 136, 140, 141, 164, 175 Bronchiseptica, 140, 166 Budgets, 11, 140 C Calcium, 140, 143, 147, 172 Candidiasis, 4, 140 Candidosis, 140 Capsular, 76, 140 Carbohydrate, 140, 153, 167 Carcinoembryonic Antigen, 26, 141 Carcinogen, 141, 161 Carcinogenic, 141, 157 Carcinoma, 48, 81, 141 Cardiac, 141, 148, 162 Cardiovascular, 15, 70, 141, 172 Cardiovascular disease, 15, 70, 141 Case report, 48, 60, 67, 81, 141 Causal, 141, 149, 169 Cause of Death, 33, 141 Cecum, 141, 158 Cefoxitin, 23, 43, 69, 73, 76, 82, 141 Ceftriaxone, 43, 72, 82, 141 Cell Count, 29, 141 Cell Differentiation, 141, 172 Cell Division, 138, 141, 166, 172 Cell proliferation, 141, 172 Cell Size, 141, 150 Cerebrovascular, 141 Cervical, 4, 21, 22, 24, 31, 40, 54, 59, 60, 68, 74, 100, 141 Cervix, 20, 118, 134, 135, 141, 142, 146, 147, 171, 177 Chaperonin 10, 142 Chaperonin 60, 142
Chaperonins, 40, 142, 162 Chemokines, 11, 14, 142 Chemotactic Factors, 142, 143 Chemotaxis, 40, 142 Chemotherapy, 40, 48, 70, 82, 142 Cholecystectomy, 95, 142 Cholesterol, 139, 142, 145 Chromosomal, 35, 136, 142, 166 Chromosome, 36, 142, 144, 159, 172 Chronic Disease, 20, 28, 142 Ciprofloxacin, 55, 62, 64, 72, 142 Clindamycin, 38, 43, 44, 68, 72, 76, 82, 84, 104, 142 Clinical trial, 6, 24, 31, 33, 38, 70, 111, 142, 147, 168, 170 Cloning, 139, 142 Codons, 142, 152, 164 Cofactor, 28, 143, 168 Cohort Studies, 143, 149 Colitis, 143 Collagen, 136, 139, 143, 150, 167 Colloidal, 143, 148 Colon, 58, 141, 143, 157, 158, 177 Combination Therapy, 38, 143 Complement, 9, 21, 136, 143, 152, 160 Compliance, 5, 29, 50, 143 Computational Biology, 111, 143 Computed tomography, 4, 144 Computerized tomography, 144 Conception, 84, 135, 144, 145, 150, 167, 174 Concomitant, 18, 81, 144 Condoms, 38, 119, 120, 134, 144 Confounding, 27, 144 Conjugated, 139, 144 Conjugation, 40, 144 Conjunctiva, 144, 176 Connective Tissue, 95, 140, 143, 144, 150, 160 Connective Tissue Cells, 144 Conscious Sedation, 68, 144 Constipation, 4, 144, 166 Consumption, 144, 151, 171 Continuum, 19, 144 Contraception, 46, 47, 57, 61, 63, 66, 74, 120, 145 Contraindications, ii, 145 Contrast medium, 145, 155 Cornea, 145, 176 Coronary, 28, 141, 145, 161 Coronary heart disease, 28, 141, 145 Coronary Thrombosis, 145, 161 Crossing-over, 145, 170
Index 183
Cross-Sectional Studies, 145, 149 Cryptosporidiosis, 138, 145 Cultured cells, 40, 145 Curative, 95, 145, 163, 175 Curette, 145, 146 Cutaneous, 140, 145, 153, 171 Cyclic, 145, 153, 163 Cyst, 4, 145 Cystitis, 95, 145 Cytokine, 7, 11, 14, 18, 20, 25, 145 Cytomegalovirus, 20, 77, 145, 151, 178 Cytotoxic, 8, 145, 170, 173 Cytotoxicity, 8, 21, 145 D Data Collection, 145, 150 Defense Mechanisms, 37, 146 Degenerative, 146, 154 Deletion, 22, 146, 151 Delivery of Health Care, 94, 146, 153 Demography, 83, 146 Dendrites, 146 Dendritic, 11, 23, 146 Dendritic cell, 11, 23, 146 Density, 41, 146, 150, 164, 173 Depolarization, 146, 173 Detergents, 8, 146 Deuterium, 146, 155 Diabetes Mellitus, 95, 146, 152 Diagnostic procedure, 100, 146 Diarrhea, 95, 136, 145, 146 Diarrhoea, 146, 151 Diastolic, 146, 155 Diathermy, 67, 146 Digestion, 136, 139, 140, 146, 157, 159, 174, 177 Dihydrotestosterone, 146, 170 Dilatation, 83, 135, 146, 178 Dilatation and Curettage, 83, 146 Direct, iii, 16, 26, 32, 53, 66, 103, 146, 152, 170 Disease Progression, 19, 29, 146 Disease Susceptibility, 14, 147 Dissection, 40, 147 Double-blind, 27, 33, 62, 147 Douche, 119, 147 Douching, 15, 16, 36, 66, 76, 86, 119, 147 Doxycycline, 23, 43, 50, 58, 64, 69, 72, 73, 76, 82, 104, 147 Drug Interactions, 105, 147 Drug Resistance, 4, 147 Drug Tolerance, 147 Duodenum, 139, 147, 174
Dyspareunia, 25, 132, 147 Dysuria, 95, 132, 147 E Eating Disorders, 94, 147 Ecosystem, 27, 36, 147 Ectopic Pregnancy, 8, 10, 11, 12, 14, 15, 16, 19, 21, 22, 23, 24, 30, 31, 38, 39, 40, 56, 67, 77, 83, 147 Effector, 11, 12, 21, 135, 143, 147 Efficacy, 8, 12, 23, 24, 27, 31, 36, 38, 55, 68, 147 Electrolytes, 139, 147 Electrophoresis, 9, 148 Embryo, 90, 135, 139, 141, 148, 156, 167, 173 Embryo Transfer, 90, 148, 168 Empiric, 96, 148 Encapsulated, 7, 148 Endocarditis, 27, 140, 148, 153 Endocardium, 148 Endocytosis, 17, 148 Endogenous, 27, 148, 176 Endometrial, 12, 17, 31, 34, 35, 50, 133, 148 Endometriosis, 25, 50, 58, 148 Endometrium, 17, 81, 146, 148, 163 Endothelium, 148, 163 Endothelium-derived, 148, 163 Endotoxin, 15, 148, 176 Enterocele, 18, 148 Enterocolitis, 95, 148 Environmental Health, 110, 112, 148 Enzymatic, 136, 140, 143, 148 Enzyme, 42, 52, 67, 147, 148, 153, 167, 168, 170, 172, 176, 178 Eosinophils, 148, 153, 159 Epidemic, 18, 23, 24, 31, 39, 41, 148 Epidemiologic Studies, 17, 74, 149 Epidemiological, 10, 14, 28, 32, 38, 39, 149 Epidermal, 149, 178 Epithelial, 11, 12, 17, 26, 37, 40, 60, 135, 149, 154 Epithelial Cells, 11, 12, 17, 26, 40, 149, 154 Epithelium, 95, 139, 148, 149, 164 Epitopes, 61, 149 Erythromycin, 138, 149 Esophagus, 149, 174 Estrogen, 40, 71, 149 Eukaryotic Cells, 149, 156 Evacuation, 144, 149 Excitation, 149, 150, 163 Exogenous, 22, 27, 148, 149 External-beam radiation, 149, 169
184
Pelvic Inflammatory Disease
Extracellular, 29, 144, 148, 149, 150 Extracellular Matrix, 29, 144, 149, 150 Extracellular Space, 149 F Fallopian tube, 8, 11, 22, 33, 40, 48, 118, 119, 120, 135, 149, 155, 171 Family Planning, 15, 94, 111, 149 Fat, 139, 140, 145, 149, 159 Fecal Incontinence, 18, 149, 156 Feces, 141, 144, 149, 174 Fertilization in Vitro, 150, 168 Fetus, 42, 135, 150, 168, 173, 174, 177 Fibrin, 150, 166 Fibroblasts, 144, 150, 157 Fibroid, 150, 158 Fibrosis, 25, 150 Flagellum, 150, 176 Flatus, 149, 150, 151 Flow Cytometry, 22, 150 Fluorescence, 32, 150 Fluorescent Dyes, 150 Focus Groups, 32, 150 Folate, 150 Fold, 31, 36, 140, 150, 161 Folic Acid, 36, 150 Forearm, 139, 150 Frameshift, 32, 150, 151 Frameshift Mutation, 32, 151 Fungi, 144, 151, 153, 161, 174, 175, 178 Fungus, 140, 151 G Gallbladder, 94, 135, 142, 151 Gamma Rays, 151, 169, 170 Gamma-interferon, 77, 151 Ganciclovir, 151, 178 Gas, 150, 151, 155, 163 Gastrin, 151, 154 Gastroenteritis, 4, 151 Gastrointestinal, 9, 94, 140, 141, 142, 150, 151, 158, 172, 174 Gastrointestinal tract, 9, 141, 150, 151, 158, 172 Gels, 151, 161 Gene, 9, 18, 21, 22, 23, 28, 29, 30, 32, 35, 37, 39, 139, 151, 152, 157, 159, 164, 172 Gene Deletion, 9, 151 Gene Duplication, 32, 152 Gene Expression, 18, 37, 152 Genetic Code, 152, 163 Genetic Engineering, 23, 139, 142, 152 Genetics, 28, 35, 144, 152 Genitourinary, 13, 59, 74, 152, 177
Genotype, 152, 166 Germ Cells, 152, 164 Gestation, 33, 152, 165, 173 Giardiasis, 152, 161 Gland, 135, 152, 160, 164, 168, 172 Glomeruli, 152, 169 Glottis, 152, 166 Glucose, 146, 152 Glucose Intolerance, 146, 152 Glutamic Acid, 150, 152, 163 Glycine, 136, 139, 152, 163 Glycoprotein, 34, 141, 152, 176 Glycosaminoglycans, 8, 152 Glycosylation, 22, 35, 153 Gonorrhea, 4, 5, 8, 14, 16, 18, 19, 26, 33, 34, 39, 45, 51, 60, 94, 97, 116, 118, 120, 153 Gonorrhoea, 16, 153 Governing Board, 153, 167 Grade, 13, 153 Graft, 153, 154 Gram-negative, 9, 15, 138, 140, 153, 162, 164, 175 Gram-positive, 138, 153, 158, 164, 174 Granulocytes, 153, 173, 178 Grasses, 150, 153 Growth, 12, 18, 20, 21, 27, 28, 40, 137, 141, 153, 154, 157, 163, 164, 166, 176 Guanylate Cyclase, 153, 163 H Haemorrhage, 135, 153 Half-Life, 141, 153 Health Care Costs, 13, 153, 154 Health Expenditures, 153 Health Services, 31, 120, 146, 154 Heart attack, 141, 154 Hepatic, 48, 154 Hepatitis, 4, 94, 154 Hepatocytes, 154 Heredity, 151, 152, 154 Hernia, 148, 154 Herpes, 4, 5, 52, 77, 94, 154 Herpes Zoster, 154 Heterogeneity, 14, 154 Histology, 35, 73, 154 Homogeneous, 144, 154 Homologous, 15, 35, 145, 154, 172, 175 Hormonal, 12, 19, 61, 70, 154 Hormone, 40, 151, 154, 160, 172, 175 Host, 8, 9, 12, 14, 18, 19, 20, 21, 25, 26, 36, 37, 40, 138, 140, 154, 155, 174, 177, 178 Human papillomavirus, 4, 5, 29, 94, 154 Humoral, 7, 37, 61, 154
Index 185
Humour, 154 Hybrid, 22, 154 Hybridomas, 154, 157 Hydrogen, 16, 36, 139, 141, 146, 155, 162, 163, 169 Hydrogen Peroxide, 36, 155 Hydrophilic, 146, 155 Hydrophobic, 146, 155 Hydroxyproline, 136, 143, 155 Hygienic, 147, 155 Hypertension, 94, 95, 100, 141, 155 Hyperthermia, 146, 155 Hypoxic, 155, 161 Hysterectomy, 17, 119, 155 Hysterosalpingography, 73, 155 I Id, 7, 90, 116, 117, 121, 122, 128, 130, 155 Immune Sera, 155 Immune system, 11, 35, 137, 155, 156, 160, 177, 178 Immunity, 7, 9, 11, 21, 23, 35, 37, 155, 156, 176 Immunization, 7, 11, 43, 155 Immunoassay, 42, 52, 155 Immunodeficiency, 4, 5, 8, 36, 37, 54, 55, 62, 85, 155 Immunofluorescence, 66, 67, 155 Immunogen, 23, 156 Immunogenic, 7, 23, 156 Immunoglobulin, 37, 137, 156, 162 Immunohistochemistry, 7, 156 Immunologic, 27, 29, 142, 155, 156, 170 Immunology, 18, 20, 22, 26, 39, 77, 135, 150, 156 Impairment, 34, 156 Implant radiation, 156, 157, 169 Implantation, 144, 156, 163 In situ, 7, 156 In Situ Hybridization, 7, 156 In vitro, 8, 9, 11, 18, 21, 26, 30, 32, 74, 78, 148, 156, 172, 174, 175 In vivo, 9, 11, 18, 20, 21, 26, 156 Incision, 156, 158 Incontinence, 17, 94, 156 Incubated, 29, 156 Incubation, 156, 166 Incubation period, 156, 166 Indicative, 156, 165, 178 Induction, 11, 23, 146, 156 Infarction, 145, 156, 161
Infertility, 8, 10, 11, 12, 13, 14, 15, 16, 19, 20, 21, 22, 23, 24, 28, 30, 31, 33, 35, 37, 39, 43, 54, 62, 67, 77, 78, 119, 157 Inflammatory bowel disease, 4, 15, 95, 157 Initiation, 20, 157, 176 Inner ear, 141, 157 Inoculum, 39, 157 Inorganic, 157, 162 Insight, 8, 19, 66, 157 Interferon, 62, 151, 157 Interleukin-1, 14, 15, 157 Interleukin-10, 14, 157 Interleukin-2, 157 Interleukin-6, 14, 15, 157 Internal radiation, 157, 169 Interstitial, 95, 140, 149, 157 Intestinal, 95, 145, 148, 157, 158 Intestinal Mucosa, 95, 148, 157 Intestine, 139, 140, 148, 157, 158 Intracellular, 8, 11, 12, 20, 22, 28, 37, 40, 156, 157, 160, 163, 172 Intracellular Membranes, 157, 160 Intraepithelial, 23, 158 Intramuscular, 72, 158, 165 Intravenous, 64, 134, 158, 165 Invasive, 41, 155, 158 Involuntary, 23, 24, 31, 149, 158, 162, 173 Ionization, 158 Ionizing, 95, 136, 158, 170 Ions, 138, 147, 155, 158 J Joint, 94, 142, 158 K Kb, 39, 110, 158 Kinetic, 158 L Labile, 143, 158 Lactobacillus, 10, 16, 27, 36, 158 Laparoscopy, 34, 50, 56, 65, 69, 78, 133, 158 Laparotomy, 34, 158 Large Intestine, 95, 141, 157, 158, 170, 173 Least-Squares Analysis, 158, 170 Lectin, 158, 160 Leiomyoma, 100, 150, 158 Lens, 140, 158 Lethal, 66, 138, 159 Leukocytes, 9, 11, 52, 87, 139, 140, 142, 148, 153, 159, 162, 176 Library Services, 128, 159 Life cycle, 94, 151, 159 Ligaments, 135, 145, 159
186
Pelvic Inflammatory Disease
Ligands, 9, 159 Likelihood Functions, 159, 171 Lincomycin, 142, 159 Linear Models, 159, 170 Linkages, 14, 153, 159 Lipid, 159 Lipopolysaccharides, 15, 159 Liposomes, 40, 159 Liquor, 159, 169 Liver, 135, 139, 145, 150, 151, 154, 159 Localization, 66, 156, 159 Localized, 135, 148, 156, 159, 166, 177 Logistic Models, 159, 171 Loop, 21, 154, 159 Lymph, 141, 148, 154, 159, 160 Lymph node, 141, 160 Lymphatic, 148, 157, 159, 160, 173, 175 Lymphocyte, 11, 26, 137, 160 Lymphoid, 137, 160 Lymphoma, 60, 160 M Macrophage, 15, 157, 160 Major Histocompatibility Complex, 37, 160 Malignancy, 160, 164 Mediate, 22, 26, 160, 162 Medical Records, 13, 160 MEDLINE, 111, 160 Megaloblastic, 150, 160 Membrane, 9, 19, 23, 30, 32, 143, 144, 146, 148, 149, 153, 159, 160, 162, 173, 176 Membrane Proteins, 23, 32, 159, 160 Memory, 21, 137, 160 Meninges, 138, 141, 160 Meningitis, 153, 160 Menopause, 94, 160, 167 Menstruation, 4, 12, 132, 160 Mental, iv, 6, 110, 112, 160, 161, 169 Mental Health, iv, 6, 110, 112, 161, 169 Mercury, 150, 161 Mesenteric, 4, 161 Mesentery, 161, 165 Methyltransferases, 28, 161 Metronidazole, 36, 38, 55, 58, 62, 64, 104, 161 Metrorrhagia, 83, 161 MI, 67, 134, 161 Microbicide, 8, 161 Microbiological, 9, 10, 19, 37, 68, 161 Microbiology, 16, 17, 18, 21, 22, 26, 35, 40, 52, 60, 65, 76, 120, 138, 161 Micronutrients, 12, 161
Microorganism, 143, 161, 165, 178 Micro-organism, 147, 161 Microscopy, 32, 41, 139, 161 Migration, 11, 161 Miscarriage, 34, 94, 118, 161 Mitochondria, 142, 161 Modification, 28, 94, 136, 152, 161, 169 Modulator, 18, 162 Molecular, 7, 9, 11, 17, 18, 22, 23, 29, 32, 40, 111, 113, 136, 139, 142, 143, 159, 162, 176 Molecular Chaperones, 142, 162 Molecule, 11, 22, 137, 139, 143, 147, 148, 149, 158, 162, 166, 170, 172, 178 Monitor, 29, 35, 141, 162, 163 Monoclonal, 7, 32, 154, 162, 169 Monocytes, 157, 159, 162 Mononuclear, 162, 176 Monotherapy, 55, 162 Morphological, 148, 151, 162 Motion Sickness, 162 Mucopurulent, 5, 49, 162 Mucosa, 8, 11, 23, 162 Mucus, 59, 139, 162, 177 Mutagens, 151, 162 Mycoplasma, 14, 28, 38, 46, 55, 59, 69, 73, 80, 162 Myocardium, 161, 162 N Nausea, 95, 118, 119, 132, 151, 162 Nebramycin, 162, 175 Need, 3, 5, 8, 24, 70, 93, 94, 97, 119, 123, 162 Neonatal, 75, 84, 153, 163 Neoplasia, 60, 163 Neoplastic, 154, 160, 163 Neural, 154, 163 Neurotransmitter, 135, 136, 140, 152, 163, 172, 174 Neutralization, 37, 163 Neutrons, 136, 163, 169 Neutrophil, 40, 163 Niacin, 163, 176 Nidation, 148, 163 Nitric Oxide, 18, 163 Nitrogen, 163, 176 Nuclear, 62, 82, 144, 149, 151, 163 Nuclei, 136, 144, 152, 163, 168 Nucleic acid, 39, 139, 152, 156, 162, 163 Nursing Care, 163, 165 O Ocular, 7, 23, 163
Index 187
Odds Ratio, 163, 171 Ofloxacin, 35, 57, 69, 76, 104, 164 Oncologist, 164 Oncology, 48, 68, 95, 164 Oophoritis, 153, 164 Opacity, 19, 26, 146, 164 Open Reading Frames, 30, 164 Operon, 30, 164, 171 Organ Culture, 8, 40, 164, 175 Ornithosis, 164, 169 Osteoporosis, 94, 164 Outpatient, 13, 17, 23, 24, 31, 38, 45, 50, 54, 55, 69, 72, 73, 164 Ovaries, 118, 119, 135, 164, 171 Ovary, 22, 164 Ovum, 152, 159, 164, 178, 179 P Palliative, 164, 175 Pancreas, 135, 164 Papillomavirus, 5, 164 Parasite, 164, 165, 176 Parasitic, 145, 165, 176 Parenteral, 44, 72, 165 Paroxysmal, 165, 166, 178 Pathogen, 7, 8, 18, 19, 21, 22, 28, 37, 70, 156, 157, 165, 174 Pathogenesis, 8, 9, 11, 14, 15, 17, 18, 19, 21, 28, 30, 32, 34, 37, 38, 62, 100, 165 Pathologic, 15, 20, 75, 139, 140, 145, 165 Patient Care Management, 5, 165 Patient Education, 118, 126, 128, 134, 165 Patient Satisfaction, 31, 165 Pelvis, 135, 140, 164, 165, 169, 177 Penicillin, 8, 85, 136, 165 Penis, 144, 165, 171 Peptide, 136, 165, 168 Perinatal, 39, 165 Periodontal disease, 15, 165 Peripheral blood, 11, 165 Peritoneal, 50, 58, 165 Peritoneum, 140, 161, 165, 166 Peritonitis, 60, 153, 166 Peroxide, 16, 166 Pertussis, 40, 166, 178 Phagocytosis, 15, 26, 166 Pharmacologic, 137, 153, 166, 176 Phenotype, 14, 29, 40, 152, 166 Phospholipases, 166, 172 Physical Examination, 3, 166 Physiologic, 153, 160, 161, 166, 170 Physiology, 4, 15, 166, 174 Plants, 140, 152, 158, 166, 174, 176
Plaque, 15, 166 Plasma, 29, 50, 137, 152, 162, 166 Plasma cells, 137, 166 Plasmid, 40, 166, 178 Plastids, 142, 166 Platelet Activation, 167, 173 Platelet Aggregation, 136, 163, 167 Platelets, 163, 167, 172 Platinum, 159, 167 Pneumonia, 4, 27, 145, 167 Pneumonitis, 43, 164, 167 Poisoning, 151, 161, 162, 167, 172 Polyarthritis, 27, 167 Polymerase, 167, 171 Polymorphic, 30, 32, 167 Polysaccharide, 76, 137, 167 Postmenopausal, 164, 167 Postsynaptic, 167, 172 Potentiates, 157, 167 Potentiation, 167, 173 Practice Guidelines, 112, 121, 167 Precursor, 147, 148, 167, 176 Pregnancy Outcome, 10, 14, 82, 167 Prenatal, 94, 148, 168 Prenatal Care, 94, 168 Prevalence, 6, 8, 17, 24, 28, 32, 36, 37, 39, 60, 83, 164, 168 Progeny, 144, 168 Progression, 5, 29, 137, 168 Progressive, 141, 147, 153, 167, 168 Projection, 146, 168 Prolapse, 17, 168 Prophylaxis, 168, 177 Proportional, 29, 168 Prospective Studies, 5, 38, 168 Prospective study, 35, 168 Prostate, 168, 171 Prostatitis, 40, 168 Protease, 143, 168 Protein S, 139, 149, 152, 168, 171, 175 Proteolytic, 143, 168 Protocol, 34, 168 Protons, 136, 155, 158, 168, 169 Protozoa, 144, 161, 169, 174 Protozoan, 145, 152, 169, 176 Pruritic, 169, 171 Psittaci, 7, 32, 67, 164, 169 Public Health, 5, 7, 16, 17, 33, 34, 39, 78, 80, 112, 120, 169 Public Policy, 111, 169 Pulmonary, 15, 139, 144, 169 Pulmonary Artery, 139, 169
188
Pelvic Inflammatory Disease
Pulse, 162, 169 Purulent, 5, 153, 169, 178 Pyelonephritis, 95, 169 Pyogenic, 81, 169 Q Quality of Life, 13, 17, 23, 31, 67, 169 R Race, 161, 169 Radiation, 83, 95, 149, 150, 151, 155, 157, 158, 161, 164, 169, 170, 178 Radiation oncologist, 95, 164, 169 Radiation therapy, 95, 149, 157, 169 Radio Waves, 146, 169 Radioactive, 153, 155, 156, 157, 158, 163, 169, 170 Radiolabeled, 169, 170 Radiotherapy, 140, 169, 170 Random Allocation, 170 Randomization, 38, 170 Randomized, 6, 13, 23, 24, 27, 31, 33, 36, 38, 44, 55, 62, 69, 76, 147, 170 Randomized clinical trial, 13, 23, 170 Reactivation, 20, 170 Receptor, 9, 11, 17, 18, 26, 37, 40, 137, 170, 172 Recombinant, 15, 22, 23, 32, 37, 170, 178 Recombination, 35, 144, 170 Rectal, 4, 170 Rectum, 137, 143, 150, 151, 156, 157, 158, 168, 170, 174 Recurrence, 8, 10, 31, 36, 37, 170 Reductase, 18, 170 Refer, 1, 143, 151, 154, 159, 163, 170 Refractory, 60, 170 Regimen, 23, 33, 119, 147, 170 Regression Analysis, 16, 170 Reinfection, 21, 171 Relative risk, 39, 171 Remission, 170, 171 Repressor, 29, 164, 171 Reproduction Techniques, 167, 171 Reproductive system, 119, 171 Respiration, 161, 162, 171 Restoration, 170, 171 Retrospective, 16, 34, 35, 66, 171 Ribosome, 171, 176 Risk factor, 10, 16, 36, 51, 64, 74, 78, 79, 86, 95, 149, 159, 168, 171 Rod, 138, 158, 171 S Salivary, 145, 171 Salivary glands, 145, 171
Salpingitis, 12, 25, 28, 42, 43, 50, 57, 59, 79, 153, 171 Scabies, 4, 171 Screening, 4, 6, 22, 32, 38, 51, 79, 80, 94, 117, 142, 171, 177 Secretion, 11, 40, 41, 77, 154, 162, 172, 177 Secretory, 37, 172 Sediment, 172, 177 Segregation, 138, 170, 172 Semisynthetic, 141, 142, 172 Senile, 164, 172 Sepsis, 60, 172 Septic, 15, 138, 172 Septicemia, 15, 42, 172 Sequencing, 40, 172 Serologic, 155, 172 Serology, 34, 172 Serotonin, 163, 172, 176 Serum, 15, 22, 42, 52, 76, 80, 133, 136, 143, 155, 166, 172, 176 Sex Behavior, 134, 172 Sexual Partners, 39, 120, 172 Shedding, 20, 172 Shock, 15, 61, 77, 142, 162, 172 Side effect, 76, 103, 118, 119, 135, 172, 176 Signal Transduction, 9, 19, 26, 172 Skeleton, 158, 173 Skull, 173, 175 Small intestine, 141, 147, 152, 154, 157, 173 Smooth muscle, 136, 144, 150, 158, 173, 174 Sneezing, 166, 172, 173 Social Environment, 169, 173 Somatic, 154, 173 Sound wave, 146, 173 Spasmodic, 135, 166, 173 Specialist, 122, 173 Species, 10, 28, 30, 36, 147, 151, 154, 158, 161, 162, 164, 165, 169, 173, 174, 175, 176, 178 Specificity, 7, 173 Spectrum, 81, 169, 173, 174 Sperm, 97, 120, 142, 173 Spermicide, 4, 173 Sphincters, 149, 173 Spirochete, 173, 175 Spleen, 145, 160, 173 Spontaneous Abortion, 167, 173 Spores, 157, 174 Steady state, 18, 174 Sterility, 18, 40, 57, 61, 85, 118, 119, 120, 157, 174
Index 189
Stillbirth, 167, 174 Stomach, 118, 135, 149, 151, 154, 162, 173, 174 Stool, 143, 156, 158, 174, 175 Streptococcal, 60, 159, 174 Streptococcus, 14, 22, 81, 174 Stress, 20, 142, 151, 162, 174 Stroke, 110, 141, 174 Stromal, 148, 174 Subacute, 156, 174 Subclinical, 33, 40, 66, 67, 156, 174 Subcutaneous, 158, 165, 174 Subspecies, 76, 173, 174 Substance P, 149, 172, 174 Sulbactam, 43, 44, 76, 174 Superinfection, 138, 174 Supplementation, 36, 174 Suppositories, 161, 174 Suppression, 18, 20, 27, 175 Symptomatic, 8, 16, 37, 39, 41, 175 Synaptic, 163, 173, 175 Syphilis, 4, 5, 14, 16, 45, 94, 97, 175 Systemic, 7, 26, 34, 104, 139, 140, 157, 164, 169, 172, 175, 176 Systemic disease, 34, 172, 175 Systolic, 155, 175 T Tachycardia, 138, 175 Tachypnea, 138, 175 Temporal, 36, 175 Tenesmus, 95, 175 Testosterone, 170, 175 Tetracycline, 8, 120, 147, 175 Therapeutics, 105, 175 Thorax, 135, 175 Threshold, 155, 175 Thrush, 140, 175 Thymus, 155, 160, 175 Tissue Culture, 19, 175 Tobramycin, 68, 175 Tomography, 58, 144, 175 Topical, 8, 38, 104, 155, 176 Toxic, iv, 144, 145, 153, 155, 176 Toxicity, 147, 161, 176 Toxicology, 112, 176 Toxins, 137, 156, 172, 176 Toxoplasmosis, 138, 176 Trachoma, 7, 20, 176 Transcription Factors, 37, 176 Transduction, 9, 26, 172, 176 Transfection, 139, 176 Transfer Factor, 155, 176
Transferases, 153, 176 Translation, 38, 136, 149, 176 Translocation, 32, 149, 176 Transplantation, 148, 155, 160, 176 Trichomonas, 16, 28, 85, 176 Trichomoniasis, 4, 5, 27, 94, 161, 176 Tryptophan, 30, 143, 172, 176 Tumor Necrosis Factor, 15, 176 Tunica, 162, 176 TYPHI, 11, 176 Typhoid fever, 176, 177 U Ulcer, 94, 177 Ulcerative colitis, 95, 157, 177 Ultrasonography, 60, 177 Unconscious, 146, 155, 177 Ureters, 177 Urethra, 5, 165, 168, 177 Urethritis, 5, 7, 12, 28, 60, 70, 94, 153, 177 Urinalysis, 96, 177 Urinary, 4, 8, 17, 27, 37, 86, 94, 131, 138, 141, 142, 145, 152, 156, 177 Urinary tract, 4, 8, 27, 37, 131, 138, 141, 177 Urinary tract infection, 4, 8, 27, 37, 131, 138, 177 Urine, 39, 96, 138, 139, 156, 177 Urogenital, 9, 18, 21, 152, 153, 177 Uterine Contraction, 135, 177 Uterine Prolapse, 17, 177 Uterus, 60, 118, 119, 120, 135, 140, 141, 142, 147, 148, 150, 155, 158, 160, 164, 171, 177, 178 V Vaccination, 18, 23, 37, 177 Vaccine, 7, 10, 11, 12, 14, 21, 23, 28, 29, 32, 37, 135, 168, 177 Vaccine adjuvant, 37, 177 Vacuoles, 148, 177 Vagina, 27, 36, 118, 140, 142, 147, 158, 160, 171, 178 Vaginal, 8, 10, 16, 17, 27, 36, 37, 54, 76, 86, 87, 94, 97, 104, 116, 118, 119, 132, 177, 178 Vaginal Discharge, 8, 37, 94, 118, 119, 178 Vaginitis, 14, 19, 33, 94, 95, 119, 140, 178 Valganciclovir, 20, 178 Vascular, 95, 148, 156, 157, 163, 178 Vasodilators, 163, 178 Vector, 35, 176, 178 Veins, 140, 178 Venereal, 175, 178
190
Pelvic Inflammatory Disease
Venules, 140, 178 Veterinary Medicine, 111, 178 Viral, 19, 29, 176, 178 Virulence, 12, 18, 29, 40, 42, 174, 176, 178 Virus, 4, 5, 8, 13, 36, 37, 52, 54, 55, 62, 77, 85, 94, 138, 152, 154, 157, 166, 176, 178 Vitro, 8, 178 Vivo, 18, 20, 178 Volition, 158, 178 W Warts, 54, 154, 178
White blood cell, 137, 156, 159, 160, 162, 163, 166, 178 Whooping Cough, 166, 178 Womb, 171, 177, 178 X Xenograft, 137, 178 X-ray, 144, 145, 150, 151, 163, 169, 170, 178 Y Yeasts, 140, 151, 166, 178 Z Zygote, 144, 179
Index 191
192
Pelvic Inflammatory Disease