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

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

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FAINTING 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 2003 by ICON Group International, Inc. Copyright 2003 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., 1960Fainting: 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: 0-597-83904-2 1. Fainting-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

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

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on fainting. 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 FAINTING .................................................................................................. 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Fainting......................................................................................... 7 E-Journals: PubMed Central ....................................................................................................... 10 The National Library of Medicine: PubMed ................................................................................ 11 CHAPTER 2. NUTRITION AND FAINTING ........................................................................................ 27 Overview...................................................................................................................................... 27 Finding Nutrition Studies on Fainting ....................................................................................... 27 Federal Resources on Nutrition ................................................................................................... 28 Additional Web Resources ........................................................................................................... 28 CHAPTER 3. ALTERNATIVE MEDICINE AND FAINTING .................................................................. 31 Overview...................................................................................................................................... 31 National Center for Complementary and Alternative Medicine.................................................. 31 Additional Web Resources ........................................................................................................... 37 General References ....................................................................................................................... 39 CHAPTER 4. DISSERTATIONS ON FAINTING .................................................................................... 41 Overview...................................................................................................................................... 41 Dissertations on Fainting ............................................................................................................ 41 Keeping Current .......................................................................................................................... 41 CHAPTER 5. CLINICAL TRIALS AND FAINTING............................................................................... 43 Overview...................................................................................................................................... 43 Recent Trials on Fainting ............................................................................................................ 43 Keeping Current on Clinical Trials ............................................................................................. 47 CHAPTER 6. PATENTS ON FAINTING ............................................................................................... 49 Overview...................................................................................................................................... 49 Patents on Fainting...................................................................................................................... 49 Patent Applications on Fainting.................................................................................................. 53 Keeping Current .......................................................................................................................... 57 CHAPTER 7. BOOKS ON FAINTING .................................................................................................. 59 Overview...................................................................................................................................... 59 Book Summaries: Federal Agencies.............................................................................................. 59 Book Summaries: Online Booksellers........................................................................................... 60 The National Library of Medicine Book Index ............................................................................. 60 Chapters on Fainting ................................................................................................................... 61 CHAPTER 8. MULTIMEDIA ON FAINTING........................................................................................ 65 Overview...................................................................................................................................... 65 Bibliography: Multimedia on Fainting ........................................................................................ 65 CHAPTER 9. PERIODICALS AND NEWS ON FAINTING..................................................................... 67 Overview...................................................................................................................................... 67 News Services and Press Releases................................................................................................ 67 Newsletter Articles ...................................................................................................................... 69 Academic Periodicals covering Fainting...................................................................................... 70 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 73 Overview...................................................................................................................................... 73 NIH Guidelines............................................................................................................................ 73 NIH Databases............................................................................................................................. 75 Other Commercial Databases....................................................................................................... 78 APPENDIX B. PATIENT RESOURCES ................................................................................................. 79 Overview...................................................................................................................................... 79

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Patient Guideline Sources............................................................................................................ 79 Associations and Fainting............................................................................................................ 84 Finding Associations.................................................................................................................... 84 APPENDIX C. FINDING MEDICAL LIBRARIES .................................................................................. 87 Overview...................................................................................................................................... 87 Preparation................................................................................................................................... 87 Finding a Local Medical Library.................................................................................................. 87 Medical Libraries in the U.S. and Canada ................................................................................... 87 ONLINE GLOSSARIES.................................................................................................................. 93 Online Dictionary Directories ..................................................................................................... 95 FAINTING DICTIONARY ............................................................................................................ 97 INDEX .............................................................................................................................................. 137

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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 fainting 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 fainting, 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 fainting, 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 fainting. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to fainting, 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 fainting. 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 FAINTING Overview In this chapter, we will show you how to locate peer-reviewed references and studies on fainting.

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

Emergencies Associated with Local Anesthetics Source: Dentistry Today. 19(10): 72-74, 76-79. October 2000. Contact: Available from Dentistry Today Inc. 26 Park Street, Montclair, NJ 07042. (973) 783-3935. Summary: Given the hundreds of thousands of injections of local anesthetic agents given each year by dentists, the infrequent occurrence of adverse reactions illustrates the safety of these drugs. However, with the very large number of routine local anesthetic injections being administered, it is possible for clinicians to become complacent and overlook certain basic aspects, resulting in an emergency. This article reviews the principles and techniques of local anesthetics, and provides illustrative case reports that can help dentists avoid, prevent, and if necessary, manage problems related to local

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anesthetic use. The authors discuss syncope (fainting), overdose, absorption, and the types of anesthetics in common use. Three case reports are presented and discussed. The article concludes with a section commenting on local anesthetic reactions with other drugs, and vasoconstrictor reactions with other drugs. The authors caution that drug reactions can occur quickly and unexpectedly and can be life threatening, especially in children. Adverse reactions can generally be avoided by staying below the recommended maximum amount of anesthetic, aspirating while administering local anesthesia, injecting the anesthetic slowly, using the medical history and appropriate questions to determine if liver or kidney dysfunction is present (which would interfere with the body's handling of the anesthesia), considering that other medications the dentist is giving the patient could interact with the local anesthetic or vasoconstrictor, and knowing about medications the patient is taking that could interact with the local anesthetic or vasoconstrictor. 1 figure. 6 references. 9 references. •

Medical Emergencies in the Dental Office Source: Journal of the CDA. Journal of the Colorado Dental Association. 72(4): 32-37. April 1994. Contact: Available from Colorado Dental Association. 3600 South Yosemite, Number 100, Denver, CO 80237. (800) 343-3010 or (303) 740-6900. Summary: Medical emergencies and their resulting complications can arise at any time in the dental office. This article outlines the recommended management of an emergency situation in the dental office. The authors focus on four categories of care: prevention, preparation, recognition, and treatment. Prevention begins with a complete medical history during the dental patient's first visit. The authors recommend a verbal review of the written history. Information obtained from the patient's medical history and physical exam can assist the practitioner in determining if further tests or consultations are required prior to dental treatment. Preparation consists of a welltrained and coordinated team working in an office with the proper emergency equipment. The authors list the recommended supplies for a basic emergency kit and for a more advanced kit (for properly trained practitioners). The practitioner and staff should be trained to recognize the different symptoms of a developing emergency situation. Correlation of symptoms and vital signs leads the practitioner to the correct diagnosis and subsequent treatment protocol. Treatment is dependent upon the diagnosis. The authors outline the general procedures for an emergency and the causes, symptoms and treatment for some common emergencies, including syncope (fainting), postural hypotension (also brief unconsciousness), hyperventilation syndrome, airway obstruction, bronchial asthma, diabetic or insulin shock, drug overdose or toxicity reaction, convulsions, adrenal insufficiency, urticaria or pruritis, angioneurotic edema, anaphylactic shock, respiratory arrest, stroke or cerebrovascular accident, angina pectoris, and myocardial infarction. 2 figures. 8 references.

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Dieter's brew make tea time a dangerous affair Source: FDA Consumer. December 1997. Contact: Superintendent of Documents, P.O. Box 37154, Pittsburgh, PA 15250-7954. (202) 512-1800. Summary: So-called dieter's teas, such as herbal teas containing senna, aloe, buckthorn, and other plant-derived laxatives, when consumed in excessive amounts, can cause diarrhea, vomiting, nausea, stomach cramps, chronic constipation, fainting and perhaps death. Kurtzweil discusses adverse effects of stimulant laxative teas.

Studies

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Syncopal Patient in the Dental Office Source: Journal of Practical Hygiene. 10(6): 39-42. November-December 2001. Contact: Available from Montage Media Corporation. 1000 Wyckoff Avenue, Mahwah, NJ 07430-3164. (201) 891-3200. Summary: Syncope (fainting) is defined as the sudden transient loss of consciousness and postural tone with spontaneous recovery, most often caused by loss of cerebral oxygenation and perfusion. Syncope is a sign rather than a primary disease process and ranges from a benign disorder to a life-threatening situation with the potential for mortality. This article discusses the various types and etiologies (causes) of syncope as well as its symptoms and suggested treatments. The author uses a case scenario of a patient who fainted just prior to injection of the dental anesthetic. The author discusses cardiac syncope, noncardiac syncope, and neurocardiac or vasodepressor syncope, signs and symptoms, and treatment strategies. The author stresses that dental professionals should prepare and rehearse responses to syncope and other emergencies that may occur in their offices. Syncope is often a symptom of more serious conditions, therefore the referral of patients to the appropriate health care provider may ultimately reduce the risk of morbidity or mortality. 1 figure. 2 tables. 20 references.

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Drugs Used to Manage Cardiovascular Disease: Part II-Adrenergic Agonists and Antagonists Source: Access. 15(3): 34-39. March 2001. Contact: Available from American Dental Hygienists' Association. 444 North Michigan Avenue, Chicago, IL 60611. Summary: This article familiarizes dental hygienists with the drugs that may be used to manage cardiovascular disease; this second entry in the ongoing series focuses on adrenergic agonists and antagonists. The series addresses the classes of medications used to manage a variety of cardiac conditions, including hypertension (HTN), angina, myocardial infarction, arrhythmias, heart murmurs, and stroke. Drug interactions, oral side effects, and general side effects of these cardiac medications are discussed, along with recommendations for client management and risk assessment strategies. In this article, the author first describes the autonomic nervous system (ANS), the component of the nervous system that controls the visceral functions of the body. There are two divisions of the ANS: the sympathetic (SNS) and the parasympathetic (PNS) nervous systems. The author describes how drugs affect these divisions of the ANS. Control of blood pressure is regulated primarily by the SNS. Stimulation of the SNS with norepinephrine (NE) increases cardiac output, blood pressure, and total peripheral resistance. Adrenergic medications are drugs that bind to receptors that respond to epinephrine or NE. These drugs are referred to as sympathomimetics, meaning that they mimic the natural actions of NE, and are classified as adrenergic agonists. Adrenergic antagonist drugs, on the other hand, are commonly referred to as the blockers, as they bind to receptors and prevent their activation. Alpha adrenergic blockers produce significant changes in blood pressure. Beta receptor blockers are used to manage coronary artery disease, angina, myocardial infarction (MI), arrhythmias, congestive heart failure, and hypertension (HTN). Drugs in this class are cardioprotective, as they reduce heart rate, contractility, and blood pressure. Dental hygienists should be aware that clients taking adrenergic agonists and antagonists may experience dizziness and orthostatic hypotension (low blood pressure) as unwanted side effects. These effects place the client at risk for fainting and falling. Caution must be used to raise the client slowly, and to allow the client to remain seated in an upright position before arising

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from the dental chair. Finally, appropriate oral hygiene interventions should be taken to address potential problems that may occur as a result of drug induced xerostomia (dry mouth. 6 tables. 4 references. •

Managing the Pregnant Dental Patient Source: Dental Assistant. 66(6): 7-9. November-December 1997. Summary: This article provides guidelines for managing the pregnant dental patient. The author notes that dental professionals are often reluctant to provide indicated care to the pregnant patient for fear of harming the mother and fetus. However, with careful attention to the special needs of these patients, the dental team can provide quality dental care while minimizing potential risks to the mother and fetus. The author covers oral complications, including pregnancy gingivitis, pregnancy tumors (pyogenic granulomas), generalized tooth mobility, dental caries, and frequent acid regurgitation. Other topics include oral hygiene and nutrition, dental treatment, and obstetrical emergencies including syncope (fainting), hyperemesis gravidarum (morning sickness), seizures, hemorrhage and cramping, and cardiopulmonary arrest. 5 references.

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Impotence Treatment Update Source: Diabetes Self-Management. 17(4): 110-111. July-August 2000. Contact: Available from R.A. Rapaport Publishing, Inc. 150 West 22nd Street, New York, NY 10011. (800) 234-0923. Website: www.diabetes-self-mgmt.com. Summary: This article provides updated information on treatments for erectile dysfunction. Many different factors can disrupt the process of male sexual arousal, including psychological barriers, heart disease, excess alcohol consumption, and diabetes. The latter contributes to erectile dysfunction because men who have diabetes are more likely to develop atherosclerosis, which makes it harder for blood to flow into the penis, and to have nerve damage, which can prevent normal transmission of nerve signals from the brain to the penis. When the drug sildenafil, commonly known as Viagra, was introduced to the United States in 1998, it was an immediate hit because it was the first impotence treatment to come in pill form. Despite its popularity, sildenafil can have dangerous and even fatal side effects, mainly when it interacts with nitratecontaining heart drugs. A second oral impotence treatment, apomorphine, may soon receive Food and Drug Administration approval. This drug, marketed under the brand name Uprima, is placed under the tongue and allowed to dissolve. The drug works by stimulating a chemical in the brain called dopamine that helps initiate erections. However, this drug also has side effects, including nausea and vomiting, dizziness, and fainting.

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Health, Functional, and Psychological Outcomes Among Older Persons with Chronic Dizziness Source: Journal of the American Geriatrics Society. 48(4): 417-421. April 2000. Contact: Available from Lippincott, Williams, and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-3030 or (301) 714-2334. Website: www.lww.com. Summary: This article reports on a study undertaken to determine the range of adverse outcomes associated with chronic dizziness. The population based prospective cohort study included a probability sample of 1,087 persons, aged 72 and older, living in the community. The following were measured: chronic dizziness, death, hospitalizations, falls, syncope, basic and instrumental activities of daily living, depressive symptoms,

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self rated health, falls self efficacy, and social activities. Of the 1,087 participants, 261 (24 percent) reported chronic dizziness. Over 1 year of follow up, chronic dizziness was not associated with mortality, hospitalization for any reason, or change in basic or instrumental activities of daily living, but was associated with risk of falling and with experiencing syncope (fainting). After adjustment for baseline level, chronic dizziness also was associated with worsening of depressive symptoms, self-rated health, falls efficacy, and social activities. These results suggest that the goals of care for older persons with chronic dizziness should be redirected from solely identifying and treating discrete diseases (an often expensive and unrewarding task) toward reducing the symptoms of chronic dizziness and alleviating the resulting physical, psychological, and social disability. 2 tables. 35 references. •

Medical Emergencies in the Dental Office: Part 2 Source: Journal of the Michigan Dental Association. 80(2): 56-59, 52. February 1998. Summary: This article, the second in a two-part series, continues to outline strategies for handing medical emergencies in the dental office. The authors first outline general principles which are appropriate for any emergency. These include stopping treatment at the first sign of distress, removing instruments and dental materials as necessary; positioning the patient; alerting the office staff and initiate the office emergency plan; and evaluating the patient. The authors note that minor medical emergencies such as syncope (fainting), mild allergic reaction, angina pectoris, postural hypotension, hyperventilation, epinephrine reaction, seizures, asthmatic attack, and hypoglycemia together comprise over 95 percent of all reported medical emergencies in the dental office. The authors describe the symptoms and treatment of each of these problems. Although all emergencies must be managed properly, none of these minor emergencies is considered life threatening. It is important that the dentist recognize the varying degrees of severity of a given medical emergency and be prepared to transport the patient for definitive treatment when indicated. In the case of major medical emergencies such as cardiac arrest, anaphylactic shock, myocardial infarction, or stroke, it is imperative that the local EMS (Emergency Medical System) be activated. The article includes a sample emergency record that dentists can use to keep records of any emergencies that occur in the office. 1 figure. 3 references.

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Water Wisdom Source: Heart and Soul. 8(3):74-75. April 2001. Summary: Water regulates body temperature, absorbs nutrients from food, cushions joints, and eliminates wastes. Inadequate water intake can lead to dry skin, dehydration, fainting spells, and a dangerous increase in body temperature. This article reviews the advantages and disadvantages of drinking bottle versus tap water, with attention to taste and water filtration systems. A chart reviews the Food and Drug Administration's (FDA) standards for spring, artesian well, mineral, purified, sparkling, and well water.

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

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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 fainting. 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 fainting. The following is typical of the type of information found when searching the CRISP database for fainting: •

Project Title: INHIBITION

CONVERGENT

CENTRAL

PATHWAYS

FOR

SYMPATHO-

Principal Investigator & Institution: Dean-Bernhoft, Caron; Anesthesiology; Medical College of Wisconsin Po Box26509 Milwaukee, Wi 532264801 Timing: Fiscal Year 2002; Project Start 15-MAR-2002; Project End 28-FEB-2006 Summary: (provided by applicant): The central nervous system coordinates appropriate behavioral and physiological events in response to imposed environmental challenges but many mechanisms remain to be determined. The present study will focus on a single component which is common to a number of behaviors and conditions to determine whether convergent central pathways exist. Sympatho-inhibition is fundamental to both the recovery phase of a defense response and also to the response to severe hemorrhage. The present proposal is designed to characterize central pathways mediating sympatho-inhibition during these conditions and determine if the sympatho-inhibition is mediated by convergence to a common central pathway. Background and preliminary data suggests that under both conditions sympathoinhibition is mediated through a final common pathway via 5-HTIA receptors in the sympatho-excitatory region of the rostroventrolateral medulla (RVLM). This would provide a novel serotonergic pathway generating sympatho-inhibition which is distinct from that mediating reflex sympatho-inhibition via GABA receptors on sympathoexcitatory neurons. The proposed studies will extend a finding that a sympathoinhibition elicited from the ventrolateral periaqueductal gray matter is mediated through activation of 5-HTIA receptors in the RVLM. Sympathetic nerve and central unit recordings combined with microinjection techniques will be utilized to investigate the pathway mediating sympatho-inhibition from the periaqueductal gray via RVLM 5HTIA receptors, and determine its involvement in the recovery phase of a defense response. Studies will also examine a putative role for activation of 5-HTIA receptors in the RVLM during extreme hemorrhage. The results of these studies will provide insight into the extent of convergence of central pathways mediating sympatho-inhibition during the recovery phase of a defense response and during extreme hemorrhage. The long-term aim of this proposal is to characterize a pathway which may mediate a specific neural response essential to multiple conditions. These novel data will be of potential significance to an array of pathologies and behaviors including emotional behaviors, analgesia, shock, sexual function and fainting. 2

Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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

Project Title: FALL BIOMECHANICS AND HIP FRACTURE RISK Principal Investigator & Institution: Hayes, Wilson C.; Professor; Exercise and Sport Sciences; Oregon State University Corvallis, or 973391086 Timing: Fiscal Year 2001; Project Start 01-FEB-1994; Project End 31-MAY-2005 Summary: (Verbatim from the application) Falls and fall-related injuries are the most serious, common costly medical problems facing the elderly. In the US each year there are about 30 millions falls, or about 1 per second, among 10 million fallers. In addition, of the approximately 300,000 hip fractures that occur each year, over 90% are associated with falls. We have shown previously that falls to the side with impact on the hip are associated with more than 20-fold increase in the risk of hip fractures (compared to a 3fold increase in risk associated with reduced bone density). Thus, when screening for interventions and fracture prevention programs (pharmaceutical agents, trochanter padding or exercise), it is far less cost effective and efficient from a public health perspective to attempt to identify the 10 million elderly who will fall each year (which can now be done using relatively simple field tests) than it is to focus on the 500,000 to 600,000 elderly subjects who will fall to the side (for which comparable validated tests are not yet available). The aims of this competitive renewal application are focused on this goal. During the previous funding period, we completed the goals of Aim 1: Dynamics of Side Falls, demonstrating that slow gait speed and the postural disturbances of slipping or fainting are associated with falls to the side and impact on the hip. We have also developed the first available multi‑segment, whole body model for falling and showed it to be a powerful tool for studying the biodynamics of falling to the side. For our previous Aim 2: Side Fall Risk Index, we completed both the development and refinement phases of the proposed index, demonstrating that a linear combination of tandem gait, hip abduction strength, step velocity asymmetry from the quick-step test, and sway variables while standing in a semi-tandem position could be used to distinguish elderly subjects who fell to the side from those who fell in all other directions. Under our new proposed Aim 1: Validation of Side Fall Risk Index (SFRI), we will determine whether the Side Fall Risk Index we have developed during the previous funding period can be used prospectively to identify elderly subjects who will fall to the side. As an extension of our previous work on the dynamics of side falls, under Aim 2: Gait Variability as a Predictor of Side Falls we will analyze the ground pressure time histories of elderly fallers ambulating on an instrumented mat. We will apply modern signal analysis theory to the ground pressure time histories. Using chaos theory and fractal analysis and noting that cardiovascular and neuromuscular pathologies are characterized by increased regularity of heartbeat and gait, respectively, we will determine if gait parameters determined from ground pressure time histories can be used to identify frail elderly subjects who fall to the side. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: NOVEL HYDROGEN SULFIDE SENSORS FOR PORTABLE MONITORS Principal Investigator & Institution: Hooker, Matthew W.; Nanomaterials Research, Llc 2021 Miller Dr, Ste B Longmont, Co 805016787 Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 31-MAR-2002 Summary: (provided by applicant): The aim of the proposed work is to develop a lowcost micro analyzer for monitoring workplace exposures to a specific, and acutely toxic,

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gas, namely hydrogen sulfide. Recent work by Nanomaterials Research Corporation has shown that a new semiconductor compound is highly responsive to low gas concentrations when held near ambient temperature. This unique discovery provides the opportunity for improved discrimination between gas species (a problem with existing metal oxide sensors, which alarm in the presence of other compounds). Furthermore, the device should operate at very low power, making it suitable for battery-powered personal exposure monitors. Finally, the interaction between the sensor and the gas is rapidly reversible, enabling continuous monitoring and the acquisition of cumulative exposure data. PROPOSED COMMERCIAL APPLICATION: Hydrogen sulfide is an extremely toxic gas, and exposure to even low concentrations can lead to respiratory system paralysis, fainting, and even death. It occurs in large amounts in natural gas and petroleum and is a common byproduct of many industrial processes. OSHA reports more than 70 occupations where workers are routinely exposed to this gas, many of which involve entering confined spaces where concentrations are often high. Personal exposure monitors can supplement existing technology, providing an added measure of worker safety in these instances. 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 “fainting” (or synonyms) into the search box. This search gives you access to fulltext articles. The following is a sample of items found for fainting in the PubMed Central database: •

Neurally Mediated Syncope. by Zaqqa M, Massumi A.; 2000; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=101078

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Right Atrial Myxoma in a Patient Presenting with Syncope. by Surabhi SK, Fasseas P, VanDecker WA, Hanau CA, Wolf NM.; 2001; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=101187

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Syncope, driving recommendations, and clinical reality: survey of patients. by Maas R, Ventura R, Kretzschmar C, Aydin A, Schuchert A.; 2003 Jan 4; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=139499

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The fainting patient: value of the head-upright tilt-table test in adult patients with orthostatic intolerance. by Lamarre-Cliche M, Cusson J.; 2001 Feb 6; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=80733

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

99mTc-HMPAO brain SPECT imaging in a case of repeated syncopal episodes associated with smoking. Author(s): Fukuda H, Kitani M, Omodani H. Source: Stroke; a Journal of Cerebral Circulation. 1997 July; 28(7): 1461-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9227701&dopt=Abstract

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A 13-year-old boy with recurrent syncopal episodes. Author(s): Listernick R. Source: Pediatric Annals. 2002 December; 31(12): 770-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12503434&dopt=Abstract

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A fainting mechanic. Author(s): Sandercock P. Source: Lancet. 2002 July 27; 360(9329): 305. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12147374&dopt=Abstract

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A prospective randomized comparison of loop recorders versus Holter monitors in patients with syncope or presyncope. Author(s): Sivakumaran S, Krahn AD, Klein GJ, Finan J, Yee R, Renner S, Skanes AC. Source: The American Journal of Medicine. 2003 July; 115(1): 1-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12867227&dopt=Abstract

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PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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A retrospective case study to assess the value of the implantable loop recorder for the investigation of undiagnosed syncope. Author(s): Ashby DT, Cehic DA, Disney PJ, Mahar LJ, Young GD. Source: Pacing and Clinical Electrophysiology : Pace. 2002 August; 25(8): 1200-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12358170&dopt=Abstract

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A standardized conventional evaluation of the mechanism of syncope in patients with bundle branch block. Author(s): Donateo P, Brignole M, Alboni P, Menozzi C, Raviele A, Del Rosso A, Dinelli M, Solano A, Bottoni N, Croci F. Source: Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology. 2002 October; 4(4): 357-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12408253&dopt=Abstract

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Ask the doctor. I am 68 years old and had a heart attack last year. I think I am doing fine and passed my last exercise test with flying colors. But about a month ago I had a fainting spell, which occurred when I went to the bathroom after a big meal. In addition, I frequently feel lightheaded for a few seconds when I stand up. I think that problem has been there for years. Do you think these spells are related to my heart? Author(s): Lee TH. Source: Harvard Heart Letter : from Harvard Medical School. 2000 December; 11(4): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11114796&dopt=Abstract

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Ask the doctor. I'm 78 years old. I've known for years that I have a narrowing of the aortic valve of my heart. My doctors are always asking me whether I have chest pain, fainting spells, or any other special symptoms. Until recently, the answer has been no. A few days ago, however, I was washing dishes in my kitchen, and I suddenly felt lightheaded and fell to the ground. I didn't black out, but I almost did. Now my doctor is saying that I should have my aortic valve replaced. Isn't this rather an extreme response to just one spell of lightheadedness? Author(s): Lee TH. Source: Harvard Heart Letter : from Harvard Medical School. 2001 February; 11(6): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11269241&dopt=Abstract

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Baroreflexes in vasovagal syncope: two types of abnormal response. Author(s): Flevari PP, Livanis EG, Theodorakis GN, Mesiskli T, Zarvalis E, Kremastinos DT. Source: Pacing and Clinical Electrophysiology : Pace. 2002 September; 25(9): 1315-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12380766&dopt=Abstract

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Cardiology patient page. Fainting. Author(s): Benditt DG, Goldstein M. Source: Circulation. 2002 August 27; 106(9): 1048-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12196326&dopt=Abstract

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Cerebral vasoconstriction in vasovagal syncope: any link with symptoms? A transcranial Doppler study. Author(s): Carey BJ, Potter JF, Panerai RB. Source: Circulation. 2002 September 24; 106(13): E54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12270874&dopt=Abstract

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Comment: syncopal episodes associated with cisapride. Author(s): Trinkle R. Source: The Annals of Pharmacotherapy. 1999 February; 33(2): 251. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10084425&dopt=Abstract

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Comparison between isoproterenol and nitroglycerin sensitized head-upright tilt in patients with unexplained syncope and negative or positive passive head-up tilt response. Author(s): Delepine S, Prunier F, Leftheriotis G, Dupuis J, Vielle B, Geslin P, Victor J. Source: The American Journal of Cardiology. 2002 September 1; 90(5): 488-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12208407&dopt=Abstract

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Comparison of automatic and patient-activated arrhythmia recordings by implantable loop recorders in the evaluation of syncope. Author(s): Ermis C, Zhu AX, Pham S, Li JM, Guerrero M, Vrudney A, Hiltner L, Lu F, Sakaguchi S, Lurie KG, Benditt DG. Source: The American Journal of Cardiology. 2003 October 1; 92(7): 815-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14516882&dopt=Abstract

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Comparison of frequency of recurrent syncope after beta-blocker therapy versus conservative management for patients with vasovagal syncope. Author(s): Alegria JR, Gersh BJ, Scott CG, Hodge DO, Hammill SC, Shen WK. Source: The American Journal of Cardiology. 2003 July 1; 92(1): 82-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12842256&dopt=Abstract

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Consultation with the specialist: palpitations, syncope, and sudden cardiac death in children: who's at risk? Author(s): Batra AS, Hohn AR. Source: Pediatrics in Review / American Academy of Pediatrics. 2003 August; 24(8): 269-75. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12897267&dopt=Abstract

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Cost implications of testing strategy in patients with syncope: randomized assessment of syncope trial. Author(s): Krahn AD, Klein GJ, Yee R, Hoch JS, Skanes AC. Source: Journal of the American College of Cardiology. 2003 August 6; 42(3): 495-501. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12906979&dopt=Abstract

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Current evaluation and management of syncope. Author(s): Kapoor WN. Source: Circulation. 2002 September 24; 106(13): 1606-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12270849&dopt=Abstract

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Development and prospective validation of a risk stratification system for patients with syncope in the emergency department: the OESIL risk score. Author(s): Colivicchi F, Ammirati F, Melina D, Guido V, Imperoli G, Santini M; OESIL (Osservatorio Epidemiologico sulla Sincope nel Lazio) Study Investigators. Source: European Heart Journal. 2003 May; 24(9): 811-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12727148&dopt=Abstract

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Diagnostic implications of modified treadmill and head-up tilt tests in exerciserelated syncope: comparative studies with situational and/or vasovagal syncope. Author(s): Doi A, Tsuchihashi K, Kyuma M, Takahashi T, Shimoshige SY, Miyamoto KJ, Uno K, Nakata T, Shimamoto K. Source: The Canadian Journal of Cardiology. 2002 September; 18(9): 960-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12368930&dopt=Abstract

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Diagnostic pathway of syncope and analysis of the impact of guidelines in a district general hospital. The ECSIT study (epidemiology and costs of syncope in Trento). Author(s): Del Greco M, Cozzio S, Scillieri M, Caprari F, Scivales A, Disertori M. Source: Ital Heart J. 2003 February; 4(2): 99-106. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12762272&dopt=Abstract

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Diagnostic yield of automatic and patient-triggered ambulatory cardiac event recording in the evaluation of patients with palpitations, dizziness, or syncope. Author(s): Balmelli N, Naegeli B, Bertel O. Source: Clin Cardiol. 2003 April; 26(4): 173-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12708623&dopt=Abstract

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Effects of dietary salt on orthostatic tolerance, blood pressure and baroreceptor sensitivity in patients with syncope. Author(s): Cooper VL, Hainsworth R. Source: Clinical Autonomic Research : Official Journal of the Clinical Autonomic Research Society. 2002 August; 12(4): 236-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12357276&dopt=Abstract

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Effects of orthostatic self-training on head-up tilt testing for the prevention of tiltinduced neurocardiogenic syncope: comparison of pharmacological therapy. Author(s): Abe H, Sumiyoshi M, Kohshi K, Nakashima Y. Source: Clinical and Experimental Hypertension (New York, N.Y. : 1993). 2003 April; 25(3): 191-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12716081&dopt=Abstract

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Efficacy of implantable loop recorders in establishing symptom-rhythm correlation in young patients with syncope and palpitations. Author(s): Rossano J, Bloemers B, Sreeram N, Balaji S, Shah MJ. Source: Pediatrics. 2003 September; 112(3 Pt 1): E228-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12949317&dopt=Abstract

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Electrocardiographic monitoring in the assessment of unexplained syncope. Author(s): Sarasin FP. Source: The American Journal of Medicine. 2003 July; 115(1): 66-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12867238&dopt=Abstract

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Endogenous opioids and epinephrine in nitroglycerin provocation tilt test in patients with neurally mediated syncope. Author(s): Takase B, Matsushima Y, Umeda E, Satomura K, Katsushika S, Ohsuzu F, Sato T, Kurita A. Source: Japanese Heart Journal. 2003 July; 44(4): 493-503. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12906031&dopt=Abstract

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Extracellular fluid volume expansion in patients with posturally related syncope. Author(s): Wieling W, Van Lieshout JJ, Hainsworth R. Source: Clinical Autonomic Research : Official Journal of the Clinical Autonomic Research Society. 2002 August; 12(4): 242-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12357277&dopt=Abstract

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Fainting in the dental chair. Author(s): Palmer-Bouva C, Van R, de Vries R, Abraham RE, Groen H, Abraham-Inpijn L. Source: Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics. 1998 November; 86(5): 508-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9830639&dopt=Abstract

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Falls and syncope in elderly patients. Author(s): Kenny RA, O'Shea D. Source: Clinics in Geriatric Medicine. 2002 May; 18(2): Xiii-Xiv. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12180253&dopt=Abstract

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Flushing and syncopal episode in a 47-year-old female. Author(s): Shome GP, Nangia R, Baldwin JL. Source: Annals of Allergy, Asthma & Immunology : Official Publication of the American College of Allergy, Asthma, & Immunology. 2001 February; 86(2): 161-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11261444&dopt=Abstract

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Haemodynamic response to peripheral venous congestion in patients with unexplained recurrent syncope. Author(s): Bellard E, Fortrat JO, Dupuis JM, Victor J, Leftheriotis G. Source: Clinical Science (London, England : 1979). 2003 September; 105(3): 331-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12725642&dopt=Abstract

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Head-up tilt table testing with low dose sublingual isosorbide dinitrate in the evaluation of unexplained syncope: a comparison with isoproterenol infusion. Author(s): Aslan O, Guneri S, Badak O, Kirimli O, Goldeli O, Keskin V, Akdeniz B, Tekin U. Source: The Canadian Journal of Cardiology. 2002 August; 18(8): 853-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12215748&dopt=Abstract

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Heart rate variability and autonomic nervous system changes in children with vasovagal syncope. Author(s): Alehan D, Ayabakan C, Ozer S. Source: Pacing and Clinical Electrophysiology : Pace. 2002 September; 25(9): 1331-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12380769&dopt=Abstract

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Images in cardiovascular medicine. Malignant vasovagal syncope. Author(s): Glatter KA, Chiamvimonvat N, Whitcomb C, Bloom H. Source: Circulation. 2003 June 17; 107(23): 2987-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12814986&dopt=Abstract

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Impairment of coronary microvascular function in patients with neurally mediated syncope. Author(s): Chen JW, Yin WH, Chan WL, Young MS, Kong CW, Chang MS. Source: Pacing and Clinical Electrophysiology : Pace. 2003 February; 26(2 Pt 1): 605-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12710321&dopt=Abstract

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Incidence and prognosis of syncope. Author(s): Soteriades ES, Evans JC, Larson MG, Chen MH, Chen L, Benjamin EJ, Levy D. Source: The New England Journal of Medicine. 2002 September 19; 347(12): 878-85. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12239256&dopt=Abstract

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Increased intermittency and decreased nonstationarity of heart rates during the daytime in patients with neurocardiogenic syncope. Author(s): Yum MK, Kim JS. Source: Journal of Cardiovascular Electrophysiology. 2002 August; 13(8): 788-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12212699&dopt=Abstract

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Indapamide induced syncope in a patient with long QT syndrome. Author(s): Wang CP, Guo GB. Source: Pacing and Clinical Electrophysiology : Pace. 2002 September; 25(9): 1397-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12380780&dopt=Abstract

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Informed consent, and fainting fathers. Author(s): Gbinigie NI, Alderson ML, Barclay PM. Source: Anaesthesia. 2001 June; 56(6): 603-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11412197&dopt=Abstract

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Insulin sensitivity in young women with vasovagal syncope. Author(s): Ruiz GA, Calvar C, Hermes R, Rivadeneira D, Bengolea V, Chirife R, Tentori MC, Gelpi RJ. Source: American Heart Journal. 2003 May; 145(5): 834-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12766740&dopt=Abstract

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Intellect and somatic health: associations with hypochondriacal concerns, perceived threat and fainting. Author(s): Ferguson E. Source: Psychotherapy and Psychosomatics. 2001 November-December; 70(6): 319-27. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11598431&dopt=Abstract

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Is a syncope a syncope? Author(s): Brignole M, Thijs R, Wieling W, Benditt D, Gert van Dijk J; European Society of Cardiology. Source: Ital Heart J. 2003 March; 4(3): 145-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12784739&dopt=Abstract

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Is there an effective treatment for neurally mediated syncope? Author(s): Kapoor WN. Source: Jama : the Journal of the American Medical Association. 2003 May 7; 289(17): 2272-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12734140&dopt=Abstract

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Laparoscopic repair of a Morgagni hernia presenting with syncope in an 85-year-old woman: case report and update of the literature. Author(s): White DC, McMahon R, Wright T, Eubanks WS. Source: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A. 2002 June; 12(3): 161-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12184900&dopt=Abstract

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Learning needs of patients with vasovagal syncope. Author(s): White WD, Sheldon RS, Ritchie DA. Source: Can J Cardiovasc Nurs. 2003; 13(1): 26-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12703103&dopt=Abstract

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Long QT syndrome in children: the value of the rate corrected QT interval in children who present with fainting. Author(s): Allan WC, Timothy K, Vincent GM, Palomaki GE, Neveux LM, Haddow JE. Source: Journal of Medical Screening. 2001; 8(4): 178-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11743033&dopt=Abstract

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Long-term outcome of patients with recurrent syncope of unknown cause in the absence of organic heart disease and relation to results of baseline tilt table testing. Author(s): Gatzoulis K, Sideris S, Theopistou A, Sotiropoulos H, Stefanadis C, Toutouzas P. Source: The American Journal of Cardiology. 2003 October 1; 92(7): 876-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14516899&dopt=Abstract

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Management of vasovagal syncope: controlling or aborting faints by leg crossing and muscle tensing. Author(s): Krediet CT, van Dijk N, Linzer M, van Lieshout JJ, Wieling W. Source: Circulation. 2002 September 24; 106(13): 1684-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12270863&dopt=Abstract

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Management of vasovagal syncope: controlling or aborting faints by leg crossing and muscle tensing. Author(s): Peterson AL, Cigrang JA. Source: Circulation. 2003 May 27; 107(20): E198; Author Reply E198. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12777329&dopt=Abstract

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Meningocele-induced positional syncope and retinal hemorrhage. Author(s): Bekavac I, Halloran JI. Source: Ajnr. American Journal of Neuroradiology. 2003 May; 24(5): 838-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12748081&dopt=Abstract

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Midodrine in neurally mediated syncope: a double-blind, randomized, crossover study. Author(s): Kaufmann H, Saadia D, Voustianiouk A. Source: Annals of Neurology. 2002 September; 52(3): 342-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12205647&dopt=Abstract

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Near-infrared spectrophotometry determined brain oxygenation during fainting. Author(s): Madsen P, Pott F, Olsen SB, Nielsen HB, Burcev I, Secher NH. Source: Acta Physiologica Scandinavica. 1998 April; 162(4): 501-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9597118&dopt=Abstract

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Neurally mediated syncope manifesting during atrial fibrillation: a case report. Author(s): Shirayama T, Inoue K, Sakamoto T, Yamamura M, Mani H, Yoshida A, Imai H, Matoba Y, Nakagawa M. Source: Circulation Journal : Official Journal of the Japanese Circulation Society. 2002 September; 66(9): 866-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12224828&dopt=Abstract

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Neurocardiogenic syncope in children : current concepts in diagnosis and management. Author(s): Massin M. Source: Paediatric Drugs. 2003; 5(5): 327-34. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12716219&dopt=Abstract

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New insights into the mechanism of neurally mediated syncope. Author(s): Mercader MA, Varghese PJ, Potolicchio SJ, Venkatraman GK, Lee SW. Source: Heart (British Cardiac Society). 2002 September; 88(3): 217-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12181208&dopt=Abstract

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Nonarrhythmic syncope documented by an implantable loop recorder (an ISSUE substudy). Author(s): Brignole M, Menozzi C, Moya A, Garcia-Civera R, Donateo P, Puggioni E, Migliorini R, Navarro X; International Study on Syncope of Uncertain Etiology (ISSUE) Investigators. Source: The American Journal of Cardiology. 2002 September 15; 90(6): 654-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12231099&dopt=Abstract

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Paced breathing can prevent vasovagal syncope during head-up tilt testing. Author(s): Jauregui-Renaud K, Marquez MF, Hermosillo AG, Sobrino A, Lara JL, Kostine A, Cardenas M. Source: The Canadian Journal of Cardiology. 2003 May; 19(6): 698-700. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12772021&dopt=Abstract

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Pacemaker therapy for prevention of syncope in patients with recurrent severe vasovagal syncope: Second Vasovagal Pacemaker Study (VPS II): a randomized trial. Author(s): Connolly SJ, Sheldon R, Thorpe KE, Roberts RS, Ellenbogen KA, Wilkoff BL, Morillo C, Gent M; VPS II Investigators. Source: Jama : the Journal of the American Medical Association. 2003 May 7; 289(17): 2224-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12734133&dopt=Abstract

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Pathophysiology and management of neurocardiogenic syncope. Author(s): Nair N, Padder FA, Kantharia BK. Source: Am J Manag Care. 2003 April; 9(4): 327-34; Quiz 335-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12703677&dopt=Abstract

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Pilots with vasovagal syncope: fit to fly? Author(s): Van Dijk N, Colman N, Dambrink JH, Wieling W. Source: Aviation, Space, and Environmental Medicine. 2003 May; 74(5): 571-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12751588&dopt=Abstract

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Predictors of positive head-up tilt test in patients with suspected neurocardiogenic syncope or presyncope. Author(s): Oh JH, Kim JS, Kwon HC, Hong KP, Park JE, Seo JD, Lee WR. Source: Pacing and Clinical Electrophysiology : Pace. 2003 February; 26(2 Pt 1): 593-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12710319&dopt=Abstract

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Prevalence of orthostatic hypotension among patients presenting with syncope in the ED. Author(s): Sarasin FP, Louis-Simonet M, Carballo D, Slama S, Junod AF, Unger PF. Source: The American Journal of Emergency Medicine. 2002 October; 20(6): 497-501. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12369019&dopt=Abstract

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Prolonged ventricular asystole, sinus arrest, and paroxysmal atrial flutter-fibrillation: an uncommon presentation of vasovagal syncope. Author(s): Chou HH, Lin KH, Luqman N, Kuo CT. Source: Pacing and Clinical Electrophysiology : Pace. 2003 April; 26(4 Pt 1): 914-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12715855&dopt=Abstract

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Psychophysiologic effects of applied tension on the emotional fainting response to blood and injury. Author(s): Vogele C, Coles J, Wardle J, Steptoe A. Source: Behaviour Research and Therapy. 2003 February; 41(2): 139-55. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12547376&dopt=Abstract

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Raise your hands if you are fainting. Author(s): Simini B, Fritz-Simini Y. Source: Lancet. 1997 September 6; 350(9079): 744. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9291936&dopt=Abstract

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Recurrent fainting, dysesthesia, and impotence. Author(s): Rayder R, Brewer W, Hamilton R, Kumar A, Sebes J, Carbone L. Source: Hosp Pract (Off Ed). 1999 July 15; 34(7): 52C-52D. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10418550&dopt=Abstract

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Recurrent syncopal episodes of neurocardiogenic origin in a patient suffering from cardiac syndrome-X. Author(s): Rentoukas EI, Lazaros GA, Deftereos SG, Zacharoulis AA. Source: Acta Cardiol. 1999 April; 54(2): 89-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10378020&dopt=Abstract

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Recurrent syncope in a patient after myocardial infarction. Author(s): Credner SC, Lehmann R, Grubb BP, Hohnloser SH, Klingenheben T. Source: Pacing and Clinical Electrophysiology : Pace. 2003 April; 26(4 Pt 1): 920-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12715857&dopt=Abstract

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Reproducibility of asystole during head-up tilt testing in patients with neurally mediated syncope. Author(s): Foglia-Manzillo G, Romano M, Corrado G, Tagliagambe LM, Tadeo G, Spata M, Spinelli A, Grieco A, Santarone M. Source: Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology. 2002 October; 4(4): 365-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12408255&dopt=Abstract

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Reproducibility of sequential head-up tilt testing in patients with recent syncope, normal ECG and no structural heart disease. Author(s): Sagrista-Sauleda J, Romero B, Permanyer-Miralda G, Moya A, Soler-Soler J. Source: European Heart Journal. 2002 November; 23(21): 1706-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12398829&dopt=Abstract

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Role of echocardiography in the evaluation of syncope: a prospective study. Author(s): Sarasin FP, Junod AF, Carballo D, Slama S, Unger PF, Louis-Simonet M. Source: Heart (British Cardiac Society). 2002 October; 88(4): 363-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12231593&dopt=Abstract

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Role of vagal control in vasovagal syncope. Author(s): Suzuki M, Hori S, Nakamura I, Nagata S, Tomita Y, Aikawa N. Source: Pacing and Clinical Electrophysiology : Pace. 2003 February; 26(2 Pt 1): 571-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12710316&dopt=Abstract

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Shortened head-up tilting test guided by systolic pressure reductions in neurocardiogenic syncope. Author(s): Romano SM, Chiostri M, Olivotto J. Source: Circulation. 2002 October 8; 106(15): E69; Author Reply E69. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12370235&dopt=Abstract

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Simultaneous heart rate and blood pressure variability analysis. Insight into mechanisms underlying neurally mediated cardiac syncope in children. Author(s): Moak JP, Bailey JJ, Makhlouf FT. Source: Journal of the American College of Cardiology. 2002 October 16; 40(8): 1466-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12392838&dopt=Abstract

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Sudden fainting in an elderly woman. Author(s): Archer TP, Schaal SF, Mazzaferri EL. Source: Hosp Pract (Off Ed). 1998 October 15; 33(10): 170, 173-6, 181. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9793549&dopt=Abstract

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Swallow syncope. Author(s): Srivathsan K, Lee RW. Source: Pacing and Clinical Electrophysiology : Pace. 2003 March; 26(3): 781-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12698684&dopt=Abstract

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Syncop.aging. n. The art and science of syncope in the aged. Author(s): Sherman FT. Source: Geriatrics. 2003 May; 58(5): 12, 15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12756676&dopt=Abstract

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Syncopal episodes associated with cisapride and concurrent drugs. Author(s): Gray VS. Source: The Annals of Pharmacotherapy. 1998 June; 32(6): 648-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9640482&dopt=Abstract

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Syncopal episodes in a young amateur body builder. Author(s): Manoharan G, Campbell NP, O'Brien CJ. Source: British Journal of Sports Medicine. 2002 February; 36(1): 67-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11867497&dopt=Abstract

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Syncope and orthostatic intolerance. Author(s): Weimer LH, Williams O. Source: The Medical Clinics of North America. 2003 July; 87(4): 835-65. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12834151&dopt=Abstract

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Syncope and sudden death are the same thing, except in one you wake up. Author(s): Carey BJ. Source: Ir Med J. 2003 June; 96(6): 183-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12926763&dopt=Abstract

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Syncope in a triathlete. Author(s): Scott WA. Source: Curr Sports Med Rep. 2003 June; 2(3): 157-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12831655&dopt=Abstract

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Syncope with ST-segment abnormalities resembling Brugada syndrome due to reversible myocardial ischemia. Author(s): Indik JH, Ott P, Butman SM. Source: Pacing and Clinical Electrophysiology : Pace. 2002 August; 25(8): 1270-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12358180&dopt=Abstract

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Syncope. Identifying cardiac causes in older patients. Author(s): Pavri BB, Ho RT. Source: Geriatrics. 2003 May; 58(5): 26-31; Quiz 32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12756678&dopt=Abstract

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Syncope: treating fainting in the dental office. Author(s): Leonard M. Source: Dent Today. 1996 January; 15(1): 72-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9567129&dopt=Abstract

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Syncope--getting to the heart of the matter. Author(s): Maisel WH, Stevenson WG. Source: The New England Journal of Medicine. 2002 September 19; 347(12): 931-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12239264&dopt=Abstract

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The application of a standardized strategy of evaluation in patients with syncope referred to three syncope units. Author(s): Croci F, Brignole M, Alboni P, Menozzi C, Raviele A, Del Rosso A, Dinelli M, Solano A, Bottoni N, Donateo P. Source: Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology. 2002 October; 4(4): 351-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12408252&dopt=Abstract

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The effect of head-upright tilt table testing for vasovagal syncope on P-wave duration. Author(s): Haider J, Kalus JS, White CM, Narula DD, Guertin DC, Caron MF, Kluger J. Source: Journal of Electrocardiology. 2002 October; 35(4): 303-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12395356&dopt=Abstract

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The fainting lark. Author(s): Wieling W, van Lieshout JJ. Source: Clinical Autonomic Research : Official Journal of the Clinical Autonomic Research Society. 2002 June; 12(3): 207. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12269556&dopt=Abstract

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The fainting patient. First and foremost, a meticulous evaluation. Author(s): Paluso KA. Source: Jaapa. 2000 August; 13(8): 40-2, 48-9, 53-4 Passim. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11521616&dopt=Abstract

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The fainting patient: value of the head-upright tilt-table test in adult patients with orthostatic intolerance. Author(s): Lamarre-Cliche M, Cusson J. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 2001 February 6; 164(3): 372-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11232140&dopt=Abstract

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The molecular genetics of the long QT syndrome: genes causing fainting and sudden death. Author(s): Vincent GM. Source: Annual Review of Medicine. 1998; 49: 263-74. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9509262&dopt=Abstract

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The role of disgust and fear in blood and injection--related fainting symptoms: a structural equation model. Author(s): Kleinknecht RA, Kleinknecht EE, Thorndike RM. Source: Behaviour Research and Therapy. 1997 December; 35(12): 1075-87. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9465441&dopt=Abstract

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Tilt-induced pseudosyncope. Author(s): Luzza F, Pugliatti P, di Rosa S, Calabro D, Carerj S, Oreto G. Source: Int J Clin Pract. 2003 June; 57(5): 373-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12846340&dopt=Abstract

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Unexplained fainting, near drowning and unusual seizures in childhood: screening for long QT syndrome in New Zealand families. Author(s): Bradley T, Dixon J, Easthope R. Source: N Z Med J. 1999 August 13; 112(1093): 299-302. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10493429&dopt=Abstract

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Usefulness of intravenous metoprolol during positive isoproterenol tilt-table test in the choice of treatment for neurocardiogenic syncope. Author(s): Baran I, Gemici K, Ozdemir B, Sarac M, Gullulu S, Aydinlar A, Cordan J. Source: Indian Heart J. 2003 January-February; 55(1): 40-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12760586&dopt=Abstract

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Variability of near-fainting responses in healthy 6-16-year-old subjects. Author(s): de Jong-de Vos van Steenwijk CC, Wieling W, Harms MP, Wesseling KH. Source: Clinical Science (London, England : 1979). 1997 September; 93(3): 205-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9337634&dopt=Abstract

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Variable presentation of Brugada syndrome: lessons from three generations with syncope. Author(s): Plunkett A, Hulse JA, Mishra B, Gill J. Source: Bmj (Clinical Research Ed.). 2003 May 17; 326(7398): 1078-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12750212&dopt=Abstract

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Vasovagal syncope. Author(s): Chiocca EM. Source: Nursing. 2003 July; 33(7): 96. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12851506&dopt=Abstract

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

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

7

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

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

Recurrent fainting, dysesthesia, and impotence. Author(s): Department of Medicine, University of Tennessee, Memphis, USA. Source: Rayder, R Brewer, W Hamilton, R KuMarch, A Sebes, J Carbone, L Hosp-Pract(Off-Ed). 1999 July 15; 34(7): 52c-52d 8750-2836

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Nutrition

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

The following is a specific Web list relating to fainting; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

Minerals Iron Source: Healthnotes, Inc.; www.healthnotes.com

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CHAPTER 3. ALTERNATIVE MEDICINE AND FAINTING Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to fainting. At the conclusion of this chapter, we will provide additional sources.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to fainting and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “fainting” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to fainting: •

A novel psychophysiological treatment for vasovagal syncope. Author(s): Khurana RK, Lynch JJ, Craig FW. Source: Clinical Autonomic Research : Official Journal of the Clinical Autonomic Research Society. 1997 August; 7(4): 191-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9292245&dopt=Abstract

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A study of carotid sinus massage and head-up tilt table testing in patients with syncope and near-syncope. Author(s): von zur Muhlen F, Quan W, D'Agate DJ, Cohen TJ. Source: J Invasive Cardiol. 2002 August; 14(8): 477-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12147883&dopt=Abstract

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An abnormal neural reflex plays a role in causing syncope in sinus bradycardia. Author(s): Alboni P, Menozzi C, Brignole M, Paparella N, Lolli G, Oddone D, Dinelli M.

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Source: Journal of the American College of Cardiology. 1993 October; 22(4): 1130-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8409052&dopt=Abstract •

Auditory stimuli as a major cause of syncope in a patient with idiopathic long QT syndrome. Author(s): Nakajima T, Misu K, Iwasawa K, Tamiya E, Segawa K, Matsuo H, Hada K. Source: Japanese Circulation Journal. 1995 April; 59(4): 241-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7658619&dopt=Abstract

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Bradycardia, reversible panconduction defect and syncope following self-medication with a homeopathic medicine. Author(s): Guha S, Dawn B, Dutta G, Chakraborty T, Pain S. Source: Cardiology. 1999; 91(4): 268-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10545684&dopt=Abstract

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Cardiovascular syncope is the most common cause of drop attacks in the elderly. Author(s): Dey AB, Stout NR, Kenny RA. Source: Pacing and Clinical Electrophysiology : Pace. 1997 March; 20(3 Pt 2): 818-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9080517&dopt=Abstract

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Characteristics, perceived stressors, and coping strategies of patients who experience neurally mediated syncope. Author(s): Shaffer C, Jackson L, Jarecki S. Source: Heart & Lung : the Journal of Critical Care. 2001 July-August; 30(4): 244-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11449210&dopt=Abstract

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Clinical experience of a new rate drop response algorithm in the treatment of vasovagal and carotid sinus syncope. Author(s): Johansen JB, Bexton RS, Simonsen EH, Markowitz T, Erickson MK. Source: Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology. 2000 July; 2(3): 245-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11227596&dopt=Abstract

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Clinical usefulness of head-up tilt test in patients with syncope and intraventricular conduction defect. Author(s): Sagrista-Sauleda J, Romero B, Permanyer-Miralda G, Moya A, Rius-Gelabert T, Mont Girbau L, Soler-Soler J. Source: Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology. 1999 January; 1(1): 63-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11220544&dopt=Abstract

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Convulsive syncope associated with acupuncture. Author(s): Cole M, Shen J, Hommer D. Source: The American Journal of the Medical Sciences. 2002 November; 324(5): 288-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12449453&dopt=Abstract

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Deglutition syncope associated with carotid sinus hypersensitivity. Author(s): Antonelli D, Rosenfeld T. Source: Pacing and Clinical Electrophysiology : Pace. 1997 September; 20(9 Pt 1): 2282-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9309758&dopt=Abstract

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Diagnosis and management of neurally mediated syncope and related conditions in adolescents. Author(s): Boehm KE, Morris EJ, Kip KT, Karas B, Grubb BP. Source: The Journal of Adolescent Health : Official Publication of the Society for Adolescent Medicine. 2001 January; 28(1): 2-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11137899&dopt=Abstract

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Diagnostic utility of mechanical, pharmacological and orthostatic stimulation of the carotid sinus in patients with unexplained syncope. Author(s): Morillo CA, Camacho ME, Wood MA, Gilligan DM, Ellenbogen KA. Source: Journal of the American College of Cardiology. 1999 November 1; 34(5): 1587-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10551710&dopt=Abstract

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Dysaesthetic neck pain with syncope. Author(s): Butler JD, Miles J. Source: Pain. 1998 April; 75(2-3): 395-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9583777&dopt=Abstract

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Follow-up of asystolic episodes in patients with cardioinhibitory, neurally mediated syncope and VVI pacemaker. Author(s): Menozzi C, Brignole M, Lolli G, Bottoni N, Oddone D, Gianfranchi L, Gaggioli G. Source: The American Journal of Cardiology. 1993 November 15; 72(15): 1152-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8237805&dopt=Abstract

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Incidence of complications after carotid sinus massage in older patients with syncope. Author(s): Munro NC, McIntosh S, Lawson J, Morley CA, Sutton R, Kenny RA. Source: Journal of the American Geriatrics Society. 1994 December; 42(12): 1248-51. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7983286&dopt=Abstract

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Intellect and somatic health: associations with hypochondriacal concerns, perceived threat and fainting. Author(s): Ferguson E. Source: Psychotherapy and Psychosomatics. 2001 November-December; 70(6): 319-27. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11598431&dopt=Abstract

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Mechanisms of syncope caused by transient bradycardia and the diagnostic value of electrophysiologic testing and cardiovascular reflexivity maneuvers. Author(s): Brignole M, Menozzi C, Bottoni N, Gianfranchi L, Lolli G, Oddone D, Gaggioli G. Source: The American Journal of Cardiology. 1995 August 1; 76(4): 273-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7618623&dopt=Abstract

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Methods other than tilt testing for diagnosing neurocardiogenic (neurally mediated) syncope. Author(s): Brignole M, Menozzi C. Source: Pacing and Clinical Electrophysiology : Pace. 1997 March; 20(3 Pt 2): 795-800. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9080512&dopt=Abstract

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Microneurographic evidence of sudden sympathetic withdrawal in carotid sinus syncope; treatment with ergotamine. Author(s): Costa F, Biaggioni I. Source: Chest. 1994 August; 106(2): 617-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7774353&dopt=Abstract

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Myocardial ischemia detected by thallium scintigraphy is frequently related to cardiac arrest and syncope in young patients with hypertrophic cardiomyopathy. Author(s): Dilsizian V, Bonow RO, Epstein SE, Fananapazir L. Source: Journal of the American College of Cardiology. 1993 September; 22(3): 796-804. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8102625&dopt=Abstract

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Neurally mediated syncope in children: results of tilt testing, treatment, and longterm follow-up. Author(s): Levine MM. Source: Pediatric Cardiology. 1999 September-October; 20(5): 331-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10441686&dopt=Abstract

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Neurocardiogenic syncope in children with a normal heart. Author(s): Balaji S, Oslizlok PC, Allen MC, McKay CA, Gillette PC. Source: Journal of the American College of Cardiology. 1994 March 1; 23(3): 779-85. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7906701&dopt=Abstract

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Outcome of biofeedback-assisted relaxation for neurocardiogenic syncope and headache: a clinical replication series. Author(s): McGrady AV, Bush EG, Grubb BP. Source: Applied Psychophysiology and Biofeedback. 1997 March; 22(1): 63-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9287256&dopt=Abstract

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Pacing interventions for falls and syncope in the elderly. Author(s): Faddis MN, Rich MW. Source: Clinics in Geriatric Medicine. 2002 May; 18(2): 279-94. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12180248&dopt=Abstract

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Prospective evaluation of patients with syncope: a population-based study. Author(s): Sarasin FP, Louis-Simonet M, Carballo D, Slama S, Rajeswaran A, Metzger JT, Lovis C, Unger PF, Junod AF. Source: The American Journal of Medicine. 2001 August 15; 111(3): 177-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11530027&dopt=Abstract

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Recurrent fainting--an unusual reaction to acupuncture. Author(s): Verma SK, Khamesra R. Source: J Assoc Physicians India. 1989 September; 37(9): 600. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2632562&dopt=Abstract

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Role of autonomic reflexes in syncope associated with paroxysmal atrial fibrillation. Author(s): Brignole M, Gianfranchi L, Menozzi C, Raviele A, Oddone D, Lolli G, Bottoni N. Source: Journal of the American College of Cardiology. 1993 October; 22(4): 1123-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8409051&dopt=Abstract

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Role of carotid sinus syndrome and neurocardiogenic syncope in recurrent syncope and falls in patients referred to an outpatient clinic in a district general hospital. Author(s): Eltrafi A, King D, Silas JH, Currie P, Lye M. Source: Postgraduate Medical Journal. 2000 July; 76(897): 405-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10878197&dopt=Abstract

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SAFE PACE 2: Syncope and Falls in the Elderly--Pacing and Carotid Sinus Evaluation: a randomized controlled trial of cardiac pacing in older patients with falls and carotid sinus hypersensitivity. Author(s): Kenny RA. Source: Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology. 1999 January; 1(1): 69-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11220545&dopt=Abstract

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Secondary lymphoma of the heart presenting as recurrent syncope. Author(s): Manojkumar R, Sharma A, Grover A. Source: Indian Heart J. 2001 March-April; 53(2): 221-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11428484&dopt=Abstract

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Syncop.aging. n. The art and science of syncope in the aged. Author(s): Sherman FT. Source: Geriatrics. 2003 May; 58(5): 12, 15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12756676&dopt=Abstract

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Syncope after effort. Author(s): Lowe MD, Petch MC. Source: Postgraduate Medical Journal. 2000 March; 76(893): 164-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10684329&dopt=Abstract

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Syncope caused by carotid body tumor. Author(s): Vincelj J, Kirin M, Borkovic Z, Lajtman Z, Horzic M. Source: Acta Med Croatica. 1996; 50(4-5): 213-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9046120&dopt=Abstract

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Syncope in the elderly: new trends in diagnostic approach and nonpharmacologic management. Author(s): Luria DM, Shen WK. Source: The American Journal of Geriatric Cardiology. 2001 March-April; 10(2): 91-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11253466&dopt=Abstract

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The application of a standardized strategy of evaluation in patients with syncope referred to three syncope units. Author(s): Croci F, Brignole M, Alboni P, Menozzi C, Raviele A, Del Rosso A, Dinelli M, Solano A, Bottoni N, Donateo P. Source: Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology. 2002 October; 4(4): 351-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12408252&dopt=Abstract

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The Newcastle protocols for head-up tilt table testing in the diagnosis of vasovagal syncope, carotid sinus hypersensitivity, and related disorders. Author(s): Kenny RA, O'Shea D, Parry SW. Source: Heart (British Cardiac Society). 2000 May; 83(5): 564-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10768910&dopt=Abstract

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The use of an implantable loop recorder in the investigation of unexplained syncope in older people. Author(s): Armstrong VL, Lawson J, Kamper AM, Newton J, Kenny RA. Source: Age and Ageing. 2003 March; 32(2): 185-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12615562&dopt=Abstract

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Upright tilt table testing in the evaluation of syncope. Author(s): Kam RM, Teo WS, Gunawan SA, Tan SH, Tan AT. Source: Singapore Med J. 1995 February; 36(1): 68-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7570140&dopt=Abstract

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Value and limitations of noninvasive assessment of syncope. Author(s): Hammill SC. Source: Cardiology Clinics. 1997 May; 15(2): 195-218. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9164710&dopt=Abstract

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Vasodepressor syncope due to subclinical myocardial ischemia. Author(s): Ascheim DD, Markowitz SM, Lai H, Engelstein ED, Stein KM, Lerman BB. Source: Journal of Cardiovascular Electrophysiology. 1997 February; 8(2): 215-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9048251&dopt=Abstract

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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The following is a specific Web list relating to fainting; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

General Overview Anaphylaxis Source: Integrative Medicine Communications; www.drkoop.com Cardiac Arrhythmia Source: Healthnotes, Inc.; www.healthnotes.com Cardiovascular Disease Overview Source: Healthnotes, Inc.; www.healthnotes.com Fainting Source: Integrative Medicine Communications; www.drkoop.com Heat Exhaustion Source: Integrative Medicine Communications; www.drkoop.com Lyme Disease Source: Integrative Medicine Communications; www.drkoop.com Mitral Valve Prolapse Source: Healthnotes, Inc.; www.healthnotes.com Pulmonary Hypertension Source: Integrative Medicine Communications; www.drkoop.com

•

Chinese Medicine Anxixiang Alternative names: Benzoin; Anxixiang (An Xi Xiang); Benzoinum Source: Chinese Materia Medica Biejia Alternative names: Turtle Shell; Carapax Trionycis Source: Chinese Materia Medica Bingpian Alternative names: Borneol; Bingpian (Bing Pi An); Borneolum Syntheticum Source: Chinese Materia Medica Hongling San Alternative names: Hongling Powder Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China

Alternative Medicine 39

Jingjie Alternative names: Fineleaf Schizonepeta Herb; Herba Schizonepetae Source: Chinese Materia Medica Shexiang Alternative names: Musk; Moschus Source: Chinese Materia Medica •

Herbs and Supplements Bloodroot Alternative names: Sanguinaria canadensis Source: Healthnotes, Inc.; www.healthnotes.com Hawthorn Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10035,00.html Leonurus Alternative names: Motherwort; Leonurus cardiaca Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Phytolacca Alternative names: Poke root, Endod; Phytolacca dodecandra L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Sotalol Source: Healthnotes, Inc.; www.healthnotes.com

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

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CHAPTER 4. DISSERTATIONS ON FAINTING Overview In this chapter, we will give you a bibliography on recent dissertations relating to fainting. We will also provide you with information on how to use the Internet to stay current on dissertations. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical dissertations that use the generic term “fainting” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on fainting, we have not necessarily excluded non-medical dissertations in this bibliography.

Dissertations on Fainting ProQuest Digital Dissertations, the largest archive of academic dissertations available, is located at the following Web address: http://wwwlib.umi.com/dissertations. From this archive, we have compiled the following list covering dissertations devoted to fainting. You will see that the information provided includes the dissertation’s title, its author, and the institution with which the author is associated. The following covers recent dissertations found when using this search procedure: •

Affective, Coping, and Physiological Response Patterns to Bodily-injury and Scialevaluative Imagery the Impact of Fear Type, Stimulus Content, and Fainting History by Schwartz, Sandra G; PhD from Concordia University (Canada), 1988 http://wwwlib.umi.com/dissertations/fullcit/NL44884

Keeping Current Ask the medical librarian at your library if it has full and unlimited access to the ProQuest Digital Dissertations database. From the library, you should be able to do more complete searches via http://wwwlib.umi.com/dissertations.

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CHAPTER 5. CLINICAL TRIALS AND FAINTING Overview In this chapter, we will show you how to keep informed of the latest clinical trials concerning fainting.

Recent Trials on Fainting The following is a list of recent trials dedicated to fainting.8 Further information on a trial is available at the Web site indicated. •

Clinical Laboratory Evaluation of Chronic Orthostatic Intolerance Condition(s): Syncope Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Neurological Disorders and Stroke (NINDS) Purpose - Excerpt: This protocol is to identify and characterize distinct types of chronic orthostatic intolerance (COI). COI can be manifestation of primary chronic autonomic failure, which is covered under a separate protocol. The present protocol concerns patients with COI who under resting conditions have intact sympathetic neurocirculatory function. COI can reflect different pathophysiologic mechanisms; until now, few studies have attempted to distinguish these mechanisms in individual patients. We hypothesize that results of clinical assessment and physiologic, chemical, pharmacologic, and imaging tests will reveal internally consistent patterns that distinguish particular forms of COI. We wish to determine the relative frequencies of these forms in a referral population. The first phase of testing is to identify sympathetic neurocirculatory failure, baroreflex failure, and secondary causes of COI (hypovolemia, excessive orthostatic venous pooling, or excessive orthostatic extravasation). In a subsequent inpatient phase, tilt table testing is done, with concurrent hemodynamic and chemical measurements, to confirm subtypes of postural tachycardia syndrome and neurocardiogenic syncope. The results of these evaluations will be used for stratification of specific, pathophysiologically defined diagnostic groups for therapeutic protocols. Study Type: Observational

8

These are listed at www.ClinicalTrials.gov.

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Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00069693 •

Hypnosis in Autonomic Function Condition(s): Vasovagal Syncope; Postural Tachycardia Syndrome; Hypnosis Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Neurological Disorders and Stroke (NINDS) Purpose - Excerpt: This study will investigate the relationship between susceptibility to hypnosis and regulation of the autonomic nervous system (nerves that control involuntary body functions, such as heart rate and sweating). Hypnosis is a state of mind in which the individual is highly focused, relatively unaware of his or her surroundings, and possibly more able to accept and use therapeutic suggestions. People vary in their responsiveness, or susceptibility, while in hypnosis. People with certain conditions, such as chronic fatigue syndrome (CFS), chronic pain, posttraumatic stress disorder (PTSD), and generalized anxiety disorder (GAD) have altered hypnotic susceptibility. Patients with chronic orthostatic intolerance (COI) often have symptoms similar to those of individuals with CFS, chronic pain, PTSD, and GAD, and this study will examine how patients with COI respond to hypnosis as compared with healthy normal volunteers. COI is a group of disorders characterized by intolerance to prolonged standing. Among them are neurocardiogenic syncope (NCS), in which patients lose consciousness shortly after standing, and postural tachycardia syndrome (POTS), in which patients have a sustained increase in heart rate after standing. In addition to the comparison of COI and normal volunteer responses to hypnosis, the study will examine how hypnotic susceptibility is related to the ability to control autonomic functions such as blood pressure, heart rate, and sweating. The autonomic nervous system is activated when the body is stressed, not only from physical stimuli such as cold temperature, but also from mental stimuli, such as seeing a rattlesnake up close. Hypnosis may, therefore, be a useful tool to understand how the mind controls the autonomic nervous system. Healthy normal volunteers and patients with NCS or POTS who are 18 years of age or older may be eligible for this two-part study. In part 1, participants complete a questionnaire and are then tested for hypnotic susceptibility. For this test, a professionally trained physician guides the subject through a procedure to achieve a hypnotic state. The subject is asked to perform several simple tasks and is then guided back to a normal state of being. In part 2, the subject undergoes hypnosis again, during which the physician offers various suggestions to change the activity of the subject's autonomic nervous system. The subject is connected to various sensors that continuously monitor blood pressure, heart rate, blood flow, sweat response, skin electrical conduction, and brain wave activity. An intravenous catheter is inserted into an arm vein to collect blood samples. The amount of saliva produced is measured intermittently using a small wad of gauze placed in the mouth. At the end, the subject is guided back to a normal state of being. The hypnosis session in part 1 is videotaped in order to: 1) permit review by a scientist who is unaware of the subject's condition and whose judgment will not, therefore, be biased; and 2) have a record of the experimental data. Only qualified investigators will view the videotape. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00061009

Clinical Trials 45

•

PET Scan in Patients with Neurocardiologic Disorders Condition(s): Autonomic Nervous System Disease; Hypertension; Tachycardia; Vasovagal Syncope Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Neurological Disorders and Stroke (NINDS) Purpose - Excerpt: This study is designed to use PET scans in order to measure activity of the sympathetic nervous system. The sympathetic nervous system is the portion of the nervous system that maintains a normal supply of blood and fuel to organs during stressful situations. PET scan or Positron Emission Tomography is an advanced form of an X-ray. It is used to detect radioactive substances in the body. During this study researchers plan to inject small amounts of the radioactive drug fluorodopamine into patients. Fluorodopamine is very similar to the chemicals found in the sympathetic nervous system. It can attach to sympathetic nerve endings and allow researchers to view them with the aid of a PET scan. One area of the body with many sympathetic nerve endings is the heart. After giving a dose of fluorodopamine, researchers will be able to visualize all of the sympathetic nerve endings involved in the activity of the heart. In addition, this diagnostic test will help researchers detect abnormalities of the nervous system of patient's hearts. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00001418

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Propranolol to Treat Fainting due to Sympathoadrenal Imbalance Condition(s): Neurocardiogenic Syncope Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Neurological Disorders and Stroke (NINDS) Purpose - Excerpt: This study will examine the effectiveness of the drug propranolol in preventing fainting in patients with sympathoadrenal imbalance (SAI). SAI is a particular pattern of nervous system and chemical responses in which the blood vessels in skeletal muscles do not remain constricted appropriately during standing for a long time. This can lower blood pressure and cause fainting. Propranolol Inderal (registered trademark) is a Food and Drug Administration-approved drug that belongs to a class of drugs called beta-blockers. These drugs slow the heart rate and maintain blood pressure in certain situations. Patients 18 years of age and older with SAI may be eligible for this study. Screening includes a tilt table test, described below, to determine if the patient has a particular chemical pattern in the blood. Patients enrolled in the study take propranolol pills in increasing doses during the first week of the study to determine the proper dose for the individual. Then, the drug is stopped until the experimental phase of the study begins. In this phase, patients are randomly assigned to take either propranolol or placebo (look-alike pill with no active ingredient) for 4 days. On the fourth day, the patient undergoes a tilt table test to determine whether the treatment affects the patient's ability to tolerate tilt. For this test, the patient lies on a padded table with a motorized tilt mechanism that can move the patient from a flat position to an upright position in about 10 seconds. The patient remains upright for up to 45 minutes while the following measurements are taken: - Arterial blood pressure monitoring and arterial blood sampling. A catheter (thin, plastic tube) is inserted into an artery in the elbow crease area of the arm or the wrist. This catheter allows continuous blood

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pressure monitoring and sampling of arterial (oxygenated) blood during the tilt test. Venous blood sampling and measurement of epinephrine and norepineprine release. A catheter is inserted into a vein in each arm, one to collect venous (deoxygenated) blood samples, and the other to inject radioactive epinephrine (adrenaline) and norepinephrine (noradrenaline). These radioactive drugs, or ,tracers, allow measurement of the rate of release of the body's own norepineprine and epinephrine into the bloodstream. - Physiologic measurements. Blood pressure, heart rate, and EKG are measured continuously during the tilt test session, and blood flows and skin electrical conduction are measured intermittently. Blood flow is measured using sensors applied to the skin and a blood pressure cuff around the limb. For skin blood flow measurements, a laser beam scans the skin surface. The skin electrical conduction test measures how well the skin conducts electricity. This is measured through sensors placed on the fingers or other sites. The effects of the test drug are allowed to wear off for 1 week, after which the entire tilt test procedure is repeated. Patients who were given propranolol for the first test session take placebo for the repeat session, and those who were given placebo take propranolol. Phase(s): Phase IV Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00060866 •

Randomized Study of Midodrine, an Alpha Adrenergic Agonist, in Patients With Neurally Mediated Syncope Condition(s): Syncope Study Status: This study is currently recruiting patients. Sponsor(s): Mount Sinai Medical Center Purpose - Excerpt: Objectives: Determine the efficacy of midodrine, a selective alpha 1 adrenergic agonist, in preventing neurally mediated syncope. Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00004479

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Identifying High Risk Patients With Syncope Condition(s): Cardiovascular Diseases; Arrhythmia; Death, Sudden, Cardiac; Heart Diseases; Syncope Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To validate two models which categorized patients with syncope into high and low risk for either sudden death or diagnostic arrhythmias based on data available from the initial history, physical examination, and electrocardiogram. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00005202

Clinical Trials 47

Keeping Current on Clinical Trials The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to the Web site at http://www.clinicaltrials.gov/ and search by “fainting” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: •

For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/

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For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html

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For cancer trials, visit the National Cancer Institute: http://cancertrials.nci.nih.gov/

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For eye-related trials, visit and search the Web page of the National Eye Institute: http://www.nei.nih.gov/neitrials/index.htm

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For heart, lung and blood trials, visit the Web page of the National Heart, Lung and Blood Institute: http://www.nhlbi.nih.gov/studies/index.htm

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For trials on aging, visit and search the Web site of the National Institute on Aging: http://www.grc.nia.nih.gov/studies/index.htm

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For rare diseases, visit and search the Web site sponsored by the Office of Rare Diseases: http://ord.aspensys.com/asp/resources/rsch_trials.asp

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For alcoholism, visit the National Institute on Alcohol Abuse and Alcoholism: http://www.niaaa.nih.gov/intramural/Web_dicbr_hp/particip.htm

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For trials on infectious, immune, and allergic diseases, visit the site of the National Institute of Allergy and Infectious Diseases: http://www.niaid.nih.gov/clintrials/

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For trials on arthritis, musculoskeletal and skin diseases, visit newly revised site of the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health: http://www.niams.nih.gov/hi/studies/index.htm

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For hearing-related trials, visit the National Institute on Deafness and Other Communication Disorders: http://www.nidcd.nih.gov/health/clinical/index.htm

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For trials on diseases of the digestive system and kidneys, and diabetes, visit the National Institute of Diabetes and Digestive and Kidney Diseases: http://www.niddk.nih.gov/patient/patient.htm

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For drug abuse trials, visit and search the Web site sponsored by the National Institute on Drug Abuse: http://www.nida.nih.gov/CTN/Index.htm

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For trials on mental disorders, visit and search the Web site of the National Institute of Mental Health: http://www.nimh.nih.gov/studies/index.cfm

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For trials on neurological disorders and stroke, visit and search the Web site sponsored by the National Institute of Neurological Disorders and Stroke of the NIH: http://www.ninds.nih.gov/funding/funding_opportunities.htm#Clinical_Trials

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CHAPTER 6. PATENTS ON FAINTING Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.9 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “fainting” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on fainting, we have not necessarily excluded non-medical patents in this bibliography.

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

9Adapted

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

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

Device and method for detection and treatment of syncope Inventor(s): Benditt; David (Edina, MN), Buscemi; Paul J. (Long Lake, MN), Lurie; Keith G. (Minneapolis, MN), Obino; Stanislao F. (Edina, MN) Assignee(s): PharmaTarget, Inc. (Plymouth, MN) Patent Number: 5,919,210 Date filed: April 10, 1997 Abstract: The invention disclosed herein relates to an implantable medical device for detection and treatment of syncope comprising an algorithm for determining the presence of syncope based on physiological activity associated with the onset of a syncopal episode, and a means for infusion a drug. Drug infusion therapy may be used along or in combination with pacing. The physiological activities detected and used by the device are selected from the group including changes in heart rate, heart rate variability, QT interval, PR interval, pressure, blood flow, vagal nerve activity, temperature, pH, and AV conduction times, respiration rate, position, motion, and combinations thereof. Drugs which may be used with the invention include pharmaceutical compositions which are capable of both endocardial administration and treatment of syncope, such as compositions comprising beta-blockers. Excerpt(s): The invention relates to the field of implantable medical devices. In particular, the invention relates to an implantable device which detects syncope, such as vasovagal syncope, and administers treatment in response thereto by endocardial drug infusion alone or in combination with pacing. Vasovagal syncope, or neurally-mediated syncope, is a complex fainting disorder which affects a significant number of people. The degree to which individuals are affected by vasovagal syncope varies, and some individuals experience multiple episodes of vasovagal syncope. Accordingly, more aggressive treatments are required for such individuals. Several treatments for vasovagal syncope are known in the art. For example, oral pharmacological therapies, such as administration of beta-blockers, have been used. However, oral therapy alone is inadequate to prevent sudden episodes of vasovagal syncope. Further, the therapeutic efficacy of such treatments remains unclear, as it is difficult to assess efficacy of such treatments in randomized trials. Web site: http://www.delphion.com/details?pn=US05919210__

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Electrical cardiac assist for an implantable syncope monitor Inventor(s): Kroll; Kai (Minneapolis, MN) Assignee(s): Galvani, Ltd. (Minneapolis, MN) Patent Number: 6,351,670 Date filed: September 8, 1999 Abstract: A method and apparatus for monitoring syncope, and having available for use an electrical cardiac output forcing (ECOF) back up. An implantable device, including an ECOF back up, for recording the electrical activity within a human heart is provided. The device includes a power supply for operating the device and for providing the necessary output forcing signals. A monitoring or detection device is provided

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connected to the power supply. Electrodes are provided to electrically connect the power supply and the detection device to a patient's heart. A memory device is also provided connected to the detection device for recording electrical activity and/or blood pressure data of the patient's heart. The memory device may be comprised of a short term loop buffer for continuously recording the electrical data from the patient's heart and a long term storage buffer. The short term loop may be of a desired size, for example, capable of storing from 1-30 minutes of data before overriding occurs. Upon the occurrence of a predetermined event, for example, a bout of syncope, the data in the short term loop buffer is transferred to the long term storage buffer. An output control circuit is also provided which is connected to the detection device and to the power supply and to the electrodes. Upon the occurrence of a second predetermined event, such as fibrillation of the heart, the output control circuit causes the delivery of an electrical cardiac output forcing signal to the patient's heart. Excerpt(s): This invention generally relates to cardiac arrhythmia monitoring. In particular, the present invention pertains to a syncope monitor. Even more particularly, the present invention pertains to a syncope monitoring device that subcutaneously measures and records information regarding syncope. Nearly half of all Americans will have at least one episode of syncope (sudden transient loss of consciousness) in their lives. It has been estimated that as many as one million people are evaluated and treated for syncope each year in the United States at a cost to the health care industry of more than one billion dollars. More than 100,000 patients per year report to their doctors repeated episodes of syncope. Depending on the cause of the syncope, the prognosis varies from excellent to poor. There are many causes of syncope, but more than half of the episodes have a recognizable cardiovascular cause. When structural heart disease is present, syncope often signals a mechanical or electrical cardiac cause. When structural heart disease is absent, a disorder of cardiovascular reflexes is the most likely cause of syncope. Syncope can be associated with bodily injury due to falls or other accidents. Additionally, individuals who experience syncope may have a serious underlying cardiac condition and may run the risk of increased mortality or morbidity if the condition is left undiagnosed. External ambulatory monitors that record an electrocardiography (ECG) continuously or during predetermined symptoms are often prescribed. Patients may wear such devices, such as halter monitors, for one day to several months. However, for patients whose symptoms occur infrequently, the monitoring period may not be long enough to capture a diagnostic ECG. Additionally, patient compliance with long term use of such monitors is problematic and can limit or hinder normal activities such as swimming, bathing and even dressing. Another deficiency with external monitoring devices is that many patients being monitored for syncope will suffer fibrillation and die while being monitored. Web site: http://www.delphion.com/details?pn=US06351670__ •

Method and system for the unconscious or fainting protocol of an emergency medical dispatch system Inventor(s): Clawson; Jeffrey J. (4649 Farm Meadow La., Salt Lake City, UT) Assignee(s): none reported Patent Number: 5,857,966 Date filed: March 28, 1997 Abstract: A method and system for receiving, processing and responding to emergency medical calls for patients who have fainted or are unconscious is described. A

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consistent, standard and systematic process is provided which in combination with adequate training, supervision and quality assurance serves to provide a method for gathering emergency medical information regarding providing emergency medical dispatch services to patients who are unconscious or have fainted, categorizing such information into various determinant levels for appropriate response, and for giving qualified emergency medical information to callers thereby permitting "zero time" response by those at the scene. By using this invention properly a dispatcher is guided through the interrogation of callers concerned with patients who are unconscious or have fainted, gathering critical information and giving the appropriate guidance to the caller. This invention specifically guides the dispatcher through the steps of the unconsciousness protocol, thereby identifying the degree of urgency of such complaints and appropriately dispatching emergency medical responders. Excerpt(s): This application is based on Provisional Application Ser. No. 60/014,741, which was filed on Mar. 29, 1996, and priority is claimed thereto. This invention relates to methods and systems for processing and responding to emergency medical inquiries. Specifically, this invention relates to the process or method of managing the dispatch of emergency medical care to callers or patients with complaints related to unconsciousness or fainting. Providing adequate emergency medical care presents several critical challenges to medical care providers. These challenges include: the proximity to the care provider, the time required for help to arrive, the identification of the criticality of the emergency, the appropriate level of care provided, the variances in training of emergency medical dispatcher personnel, and limited nature of emergency care resources. This invention addresses these challenges by providing a consistent and proven system for: First, gathering necessary medical complaint information from emergency medical inquiry callers and providing emergency verbal instructions to individuals at the scene. Second, prioritizing the complaint to determine the criticality of the emergency. Third, assisting dispatched responders to be prepared for each emergency situation. Fourth, advising those on the way to provide care at the scene of specific problems or potential hazards. When used correctly this invention decreases the effective response time, while increasing the professionalism and control of emergency medical dispatchers, increases the accuracy and appropriateness of patient interrogation and well as the quality of gathered information, reduces the number of multiple unit responses thereby reducing the risk of emergency medical vehicular collisions, improves patient care, reduces burn-out and stress of dispatchers by improving their quality of training, decreases the risk of responder injury or mistake by providing responders with improved knowledge of the situation, and provides an means for continuously improving the quality of emergency patient care. While being included within a greater invention that addresses all of the above issues, this invention specifically addresses the unconscious or fainting medical emergency protocol or procedure. Unconsciousness and/or fainting constitute some of the most common emergency medical calls. Moreover, such calls often are the first indication of extremely serious medical problems. Accurate, efficient and systematic responses to these calls can and does make the difference in the successful resolution of such incidents. This invention specifically addresses the emergency medical problems and the procedures for dealing with patients who are having episodes of unconsciousness and/or fainting, especially as such episodes are related to the dispatch of emergency medical responders. Web site: http://www.delphion.com/details?pn=US05857966__

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Pacemaker with vasovagal syncope detection Inventor(s): Hess; Michael F. (Minneapolis, MN), Riff; Kenneth M. (Plymouth, MN), Shelton; Michael B. (Minneapolis, MN) Assignee(s): Medtronic, Inc. (Minneapolis, MN) Patent Number: 5,441,525 Date filed: May 20, 1994 Abstract: A rate-responsive cardiac pacemaker implements a novel scheme which detects incipient vasovagal syncope (or other episodes caused by a vasodepressive or cardioinhibitory disorder) when a) the heart rate drops below a programmable minimum size, and b) the rate after said drop is below a programmable maximum drop ending rate. The pacemaker implements a stability and intervention procedure upon the detection of an episode, in which it ignores transient drops in rate, and paces at a predetermined high rate if the drops are stable. The pacemaker then gradually reduces the pacing rate over a predetermined time to the pre-episodic level. A sleep disable feature disables the vasovagal syncope detection and therapy features during the patient's sleeping hours to reduce or eliminate false positive responses. Excerpt(s): The present invention generally relates to artificial cardiac pacemakers, and the treatment of patients who have vasodepressor or cardioinhibitory disorders. More specifically, the present invention relates to the treatment of patients who experience vasovagal syncope episodes. Generally speaking, a cardiac pacemaker is an electrical device used to supplant some or all of an abnormal heart's natural pacing function, by delivering appropriately timed electrical stimulation signals designed to cause the myocardium of the heart to contract or "beat". Vasovagal syncope is a condition marked by a sudden drop in blood pressure resulting in fainting. It is not only unpleasant for a patient, but potentially dangerous, as fainting may lead to injuries from falls. Web site: http://www.delphion.com/details?pn=US05441525__

Patent Applications on Fainting As of December 2000, U.S. patent applications are open to public viewing.10 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to fainting: •

Implantable cardiac stimulation device with detection and therapy for patients with vasovagal syncope Inventor(s): Bornzin, Gene A.; (Simi Valley, CA), Florio, Joseph J.; (La Canada, CA), Hauck, Gregory; (Valencia, CA) Correspondence: Pacesetter, INC.; 15900 Valley View Court; Sylmar; CA; 91392-9221; US Patent Application Number: 20020004670 Date filed: May 3, 2001 Abstract: A pacemaker or other implantable cardiac stimulation device is configured with both a rate hysteresis mode and a vasovagal syncope prevention mode. Within the

10

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

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rate hysteresis mode, the pacemaker detects when the intrinsic heart rate of the patient is below an escape rate, then paces the heart at a Base Rate until an intrinsic beat is detected. When programmed in the vasovagal syncope prevention mode, upon detecting the intrinsic rate falling below the Hysteresis Escape Rate, the pacemaker paces the heart at a Vasovagal Syncope Response Rate, which is considerably higher than the Base Rate. The pacemaker is preferably set to the syncope prevention mode for patients prone to recurrent vasovagal syncope. By pacing the heart at the higher Vasovagal Syncope Response Rate, the pacemaker thereby helps prevent a significant drop in blood pressure which might otherwise cause a loss of consciousness in the patient. System and method embodiments are described. Excerpt(s): This application claims the benefit of U.S. provisional application Ser. No. 60/204,353, filed May 15, 2000. The invention generally relates to cardiac pacing techniques and in particular to techniques for preventing vasovagal syncope using cardiac pacing. Syncope is a sudden loss of strength or consciousness caused by reduced cerebral circulation, itself typically the result of vasodilation. Vasovagal syncope is a type of syncope referred to as a neurocardiogenic syncope wherein the syncope is triggered by an interaction between the heart and nerve tissue connected to the heart. Neurocardiogenic syncope may also be referred to as neuromediated syncope, neurally mediated syncope, cardioinhibitory syncope, cardioneurogenic syncope, vasodepressor syncope, malignant vasovagal syndrome, neurally mediated hypotension/bradycardia and cardiovascular neurogenic syncope. For vasovagal syncope, the interaction occurs between the heart and the vagus nerve. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

IMPLANTABLE SYNCOPE MONITOR AND METHOD OF USING THE SAMEN Inventor(s): Lade, Kipton P.; (Stevenson Ranch, CA) Correspondence: Pacesetter, INC.; 15900 Valley View Court; Sylmar; CA; 91392-9221; US Patent Application Number: 20030144595 Date filed: January 28, 2002 Abstract: An implantable monitor and method to acquire, store, and display physiological data for the diagnosis of vasovagal syncope or intermittent cardiac arrhythmias. Physiological data monitored preferably comprises heart rate, blood pressure, and body posture. Physiological signals are monitored until detection of an event that triggers the storage of data. A storage-triggering event may be a maximum or minimum heart rate or blood pressure, a dramatic change in heart rate or blood pressure, or a patient-activated signal. In one embodiment, confirmed detection of vasovagal syncope by the monitor causes a telemetric command to enable a syncope therapy. Storage of physiologic data is triggered by predetermined arrhythmia or syncope detection criteria and appropriate stimulation therapy for the detected condition may be enabled. Excerpt(s): This application is related to commonly-assigned, copending U.S. application Ser. No. 09/457,451, filed Dec. 8, 1999, titled "An AC/DC Multi Axis Accelerometer For Determining Patient Activity And Body Position," and to U.S. application Ser. No. 09/543,832, filed Apr. 5, 2000, titled "System And Method For Prevention Of Recurrent Vasovagal Syncope Using Cardiac Pacing," both of which applications are incorporated herein by reference. The present invention relates generally to an implantable medical device for monitoring physiological signals. More specifically, the present invention is

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directed at providing a device and method for storing physiological signals during episodes of syncope or cardiac arrhythmias for use in the diagnosis of syncope or intermittent arrhythmias. Syncope, or fainting, as a result of inadequate cerebral blood flow may be caused by a number of neurocardiogenic or cardiac-related factors. A common form of syncope is vasovagal syncope, a type of neurocardiogenic syncope, that is believed to be precipitated by a reflex of the vagal nerves of the left ventricle that causes hypotension and can be accompanied by a sudden drop in heart rate. Though normally not life-threatening, vasovagal syncope may have serious consequences on a patient's quality of life and can result in injury and hospitalization. Syncope as a result of underlying cardiac dysfunction is a more serious form since the cardiac-related cause may be a life-threatening cardiac illness or arrhythmia. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Method and system for treatment of neurocardiogenic syncope Inventor(s): Spinelli, Julio C.; (Shoreview, MN), Zhu, Qingsheng; (Little Canada, MN) Correspondence: Schwegman, Lundberg, Woessner & Kluth, P.A.; P.O. Box 2938; Minneapolis; MN; 55402; US Patent Application Number: 20030023279 Date filed: July 27, 2001 Abstract: A method and apparatus for treating or preventing neurocardiogenic syncope is disclosed. Upon detection of bradycardia or a drop in blood pressure indicating the onset of syncope, electrostimulation pulses are delivered during the heart's refractory period. The pulses are non-excitatory but increase myocardial contractility and thereby increase cardiac output. Excerpt(s): This invention pertains to implantable medical devices and to methods for treating syncopal episodes. Syncope, or fainting, is a transient loss of consciousness and postural tone that may be due a number of etiologies, both cardiovascular and noncardiovascular. The most common pathophysiogical basis of syncope is an acute decrease in cerebral blood flow secondary to a decrease in cardiac output, thereby causing cerebral hypoxia. Such a decrease in cardiac output can be due to, for example, cardiac arrhythmias or cardiac outflow obstructions. Neurocardiogenic syncope is a relatively benign condition in which dysfunction of the autonomic nervous system causes an inappropriate slowing of the heart (bradycardia) to result in hypotension. Classic neurogenic syncope (vasovagal syncope) occurs when inappropriate reflex inhibition of the sympathetic nervous system and increased parasympathetic activity causes both bradycardia and peripheral vasodilation. Vasovagal syncope may occur in otherwise healthy individuals and in patients with a variety of underlying diseases. A number of factors may precipitate vasovagal syncope, including a hot or crowded environment, alcohol, extreme fatigue, hunger, chronic recumbency, prolonged standing, and emotional or stressful situations. Another type of neurocardiogenic syncope involves failure of the baroreceptor reflex to transiently increase the heart rate when an individual rises to an upright position, causing venous pooling in the lower extremities and decreased venous return to the right side of the heart. Even if the cause of the syncope is benign, however, its consequences may not be. Falls during syncope can result in fractures, and episodes that occur while driving can be extremely dangerous. Chronic and recurring syncope can create a level of functional impairment similar to that produced by other chronic debilitating disorders.

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Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Methods and apparatus for detection and treatment of syncope Inventor(s): Erickson, Mark K.; (Brooklyn Park, MN), Markowitz, Harold Toby; (Roseville, MN), Sahakian, Alan V.; (Northbrook, IL), Schuler, Andreas; (Pewaukee, WI) Correspondence: Medtronic, INC.; 710 Medtronic Parkway NE; Ms-lc340; Minneapolis; MN; 55432-5604; US Patent Application Number: 20030139780 Date filed: January 22, 2002 Abstract: The present invention relates to methods and apparatus for detection and treatment of syncope in an implantable medical device, and particularly to detection of syncope as a function of a predetermined increase in one or more respiration parameter and drop in heart rate and optionally delivering a pacing therapy in response thereto. The onset of a syncopal episode is declared when the patient's respiration rate and/or tidal volume and/or minute ventilation increases by a predetermined increment or threshold and a heart rate drops below a threshold heart rate drop. The threshold heart rate drop is preferably established as a function of the change in the respiration parameter. Excerpt(s): The present invention relates to methods and apparatus for detection and treatment of syncope in an implantable medical device, and particularly to detection of syncope as a function of a predetermined change in respiration and heart rate and optionally delivering a pacing therapy in response thereto. Vasovagal syncope is a condition marked by a sudden drop in heart rate and blood pressure, resulting in fainting. It is not only unpleasant for a patient, but potentially dangerous, as fainting may lead to injuries from falls and increase the risk of motor vehicle accidents. The condition affects many thousands of patients, and particularly, the elderly. Many such patients present at emergency rooms with a wide variety of injuries due to falling. A cardiac pacing system is disclosed in U.S. Pat. No. 5,284,491 that is specifically adapted to treat patients suffering from vasovagal syncope. In particular, the pacemaker detects when the patient's heart rate drops below a lower "hysteresis" rate and determines whether the average rate of decrease in the patient's heart rate, over a defined number of heartbeats or a defined time interval prior to reaching the "hysteresis" rate, is greater than a preset value. If so, the pacing rate is set equal to the "hysteresis" rate and thereafter increased to an "intermediate" rate substantially higher than the "hysteresis" rate. The pacing rate remains at the "intermediate" rate for a preset time period and thereafter gradually declines to a lower pacing rate. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Nitroglycerin-menthol potentiation for treatment of angina Inventor(s): Busiashvili, Yuri; (Pacific Palisades, CA) Correspondence: Ralph D Chabot; 2310 E Ponderosa DR; Suite 4; Camarillo; CA; 93010; US Patent Application Number: 20020193435 Date filed: March 21, 2002

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Abstract: The strength of a nitroglycerin dosage to be administered to patients suffering from angina can be reduced when a portion of the dosage is replaced with menthol containing substances (MCS). MCS and specifically 1% Menthol has been found to potentate the effect of nitroglycerin. Accordingly, MCS can be used as a substitute for a portion of the nitroglycerin dosage administered to a patient. Side-effects common to nitroglycerin usage such as headache and fainting are significantly reduced when a nitroglycerin/MCS solution is used which has 50% of the nitroglycerin dosage per spray commonly used without sacrificing treatment effectiveness. Excerpt(s): This application claims the priority of U.S. Provisional Application bearing serial No. 60/279,154 filed on Mar. 27, 2001. This invention pertains to cardiac medication and specifically to the treatment of angina with a mixture of nitroglycerin (NTG) and menthol containing substances (MCS). Nitroglycerin spray is widely used in patients with coronary artery disease and angina. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Keeping Current In order to stay informed about patents and patent applications dealing with fainting, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “fainting” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on fainting. You can also use this procedure to view pending patent applications concerning fainting. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 7. BOOKS ON FAINTING Overview This chapter provides bibliographic book references relating to fainting. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on fainting 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 “fainting” (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 fainting: •

Medical Emergencies in the Dental Office. 5th ed Source: St. Louis, MO: Mosby, Inc. 2000. 540 p. Contact: Available from Mosby, Inc. 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 426-4545. E-mail: [email protected]. Website: www.mosby.com. PRICE: $52.95 plus shipping and handling. ISBN: 1556644205. Summary: Maintaining a high level of skill in the prevention, recognition, and management of medical emergencies is important in the field of dentistry. This textbook covers the management of medical emergencies in the dental office. Thirty chapters are offered in eight sections: prevention, unconsciousness, respiratory distress, altered consciousness, seizures, drug related emergencies, chest pain, and cardiac arrest. Specific topics include medicolegal considerations, vasodepressor syncope (fainting), postural hypotension (low blood pressure and feeling faint upon getting up from a prone or semi prone position), acute adrenal insufficiency, differential diagnosis, airway

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obstruction, hyperventilation, asthma, heart failure, acute pulmonary edema (fluid in the lungs), diabetes mellitus, thyroid gland dysfunction, cerebrovascular accident (stroke), drug overdose reactions, allergy, angina pectoris, acute myocardial infarction, and cardiac arrest and cardiopulmonary resuscitation. The text concludes with a quick reference section to life threatening situations (offered in algorithm format) and a subject index. Each chapter includes black and white photographs and extensive references. •

Keep Yourself Healthy at Home: A Guide for Adults with Diabetes Source: South Deerfield, MA: Channing L. Bete Co., Inc. 2000. 60 p. Contact: Available from Channing L. Bete, Co., Inc. 200 State Road, South Deerfield, MA 01373-0200. (800) 628-7733. Fax (800) 499-6464. PRICE: $3.50 each; plus shipping and handling; quantity discounts available. Order number 97915. Summary: This illustrated handbook provides adults who have diabetes with information on health care. Section one provides general information about health care, the prevention of health problems, and the use of diabetes and general medications. Section two discusses specific problems and their treatment, focusing on allergies, appendicitis, asthma; back pain; bites and stings; bronchitis; bruises, cuts, and scrapes; burns and sunburns; chest pain; colds, flu, and cough; constipation; diarrhea; dizziness and fainting; fever; foot and leg problems; headaches; heartburn; mouth problems; nausea and vomiting; sexual concerns; sexually transmitted diseases; skin problems; sprains and strains; urinary tract infections; and vaginitis. Section three focuses on conditions of special concern for people who have diabetes, including heart disease and stroke and eye, kidney, and nerve diseases. Section four explains how to deal with hypoglycemia and hyperglycemia and provides space for writing down emergency numbers and other emergency information.

Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “fainting” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “fainting” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “fainting” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •

The Fainting Phenomenon: Understanding Why People Faint and What Can Be Done About It by Blair P. Grubb, Mary Carole McMann; ISBN: 0879934913; http://www.amazon.com/exec/obidos/ASIN/0879934913/icongroupinterna

The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “fainting” (or synonyms) into the search box, and select “books only.”

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From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:11 •

Fainting. Author: Engel, George Libman,; Year: 1978; Springfield, Ill., Thomas [c1962]

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Fainting; physiological and psychological considerations. Author: Engel, George Libman,; Year: 1962; Springfield, Ill., C. C. Thomas [c1950]

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

Neurological Disorders Source: in Scully, C. and Cawson, R.A. Medical Problems in Dentistry. 4th ed. Woburn, MA: Butterworth-Heinemann. 1998. p. 336-373. Contact: Available from Butterworth-Heinemann. 225 Wildwood Avenue, Woburn, MA 01801-2041. (800) 366-2665 or (781) 904-2500. Fax (800) 446-6520 or (781) 933-6333. E-mail: [email protected]. Website: www.bh.com. PRICE: $110.00. ISBN: 0723610568. Summary: Dental staff should be able to recognize abnormalities involving the cranial nerves, especially the trigeminal, facial, glossopharyngeal, vagal and hypoglossal nerves. This chapter on neurologic disorders is from a text that covers the general medical and surgical conditions relevant to the oral health care sciences. Topics include congenital neurological disorders, including cerebral palsy (CP), neural tube defects (spina bifida), syringomyelia, Huntington's chorea, and Friedreich's ataxia; acquired neurological disorders, including the examination and lesions of the cranial nerves, facial sensory loss (facial pain is covered in a separate chapter), facial paralysis, Bell's palsy, trigeminal motor neuropathy, abnormal facial movements (dystonias, dyskinesias, facial tics, Tourette syndrome), multiple cranial nerve palsies, blindness and visual impairment, deafness and hearing impairment, Meniere's disease, autonomic dysfunction, epilepsy, syncope (fainting), raised intracranial pressure, hypoxic encephalopathy, infections of the nervous system (including HIV and syphilis), cerebrovascular accidents (stroke), Parkinson's disease, multiple sclerosis, Guillain-Barre syndrome (infective or idiopathic polyneuritis), motor neurone disease, mercury intoxication, tumors of the central nervous system (CNS), myasthenia gravis, patients with respiratory paralysis, and peripheral neuropathies. For each condition, the authors

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In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is currently adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a "Books" button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.

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discuss general aspects, diagnosis and management issues, dental aspects, and patient care strategies. The chapter includes a summary of the points covered. 1 appendix. 4 figures. 15 tables. 52 references. •

Medical Emergencies Source: in Pinkham, J.R., et al., eds. Pediatric Dentistry: Infancy Through Adolescence. 3rd ed. Philadelphia, PA: W.B. Saunders Company. 1999. p. 113-125. Contact: Available from W.B. Saunders Company. Book Orders Fulfillment Department, Harcourt Health Sciences, 11830 Westline Industrial Drive, Saint Louis, MO 63146-9988. (800) 545-2522. Website: www.wbsaunders.com. PRICE: $69.00 plus shipping and handling. ISBN: 0721682383. Summary: Dentistry is an invasive surgical specialty that is often associated with high levels of patient anxiety. These factors combine to produce a situation that may be conducive to medical emergencies, especially those that are induced or aggravated by stress. Also, pharmacologic agents are used routinely in the dental office. All drugs, whether local anesthetics, antibiotics, sedatives, or analgesics (pain killers), carry the potential of producing toxicity or allergy. This chapter on medical emergencies in the dental setting is from a textbook on pediatric dentistry. Topics covered include the prevention of medical emergencies, incorporating the patient history and physical examination, and the role of medical consultation; preparation for emergencies, including personal, staff, and office preparation; emergency equipment; emergency drugs, including drugs to treat allergy, benzodiazepine antagonists, anticonvulsants, narcotic antagonists, steroids, antihypoglycemics, vasopressors, analgesics, and advanced cardiac life support (ACLS) drugs; and the management of medical emergencies, including position, airway (A), breathing (B), circulation (C), and definitive therapy (D). Specific conditions discussed include syncope (fainting), allergic reaction, seizures, hyperventilation, asthma, and diabetes mellitus. 1 figure. 1 table. 3 references.

•

History and Physical Examination of a Patient with Dizziness Source: in Canalis, R.F. and Lambert, P.R., eds. Ear: Comprehensive Otology. Philadelphia, PA: Lippincott Williams and Wilkins. 2000. p. 167-179. Contact: Available from Lippincott Williams and Wilkins. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-3030. Fax (301) 223-2300. Website: www.lww.com. PRICE: $179.00 plus shipping and handling. ISBN: 078171558X. Summary: Disequilibrium (dizziness) is a common disability that affects all age groups, especially the elderly. This chapter is from a textbook that offers complete coverage of the field of clinical otology (study of the ear). The book is oriented to serve both the otolaryngology resident as a practical learning tool and the practicing otolaryngologist as an updated reference source of clinical and basic information. This chapter outlines a systematic approach to the evaluation of patients with dizziness. Such an approach meets three objectives: to identify serious pathologic conditions, such as central nervous system lesions, brainstem ischemia, or cardiac arrhythmia; to recognize diseases that can be treated medically or surgically, such as endocrine abnormality, middle ear infection, Meniere's disease, or drug reaction; and to provide reassurance or rehabilitation to patients excluded from the first two objectives. The chapter covers anatomy and physiology; the patient history, including description of the problem, severity, temporal pattern, precipitating and exacerbating (worsening) factors, associated symptoms, initial event, medications and toxins, and the presence of other diseases; the physical examination, nystagmus, otologic examination, vascular system examination, and

Books

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neurologic examination; and diseases and disorders to be considered, including benign paroxysmal positional vertigo (BPPV), Meniere's disease, labyrinthitis, vestibular schwannoma (acoustic tumor), vertebral basilar insufficiency, presyncopal lightheadedness (before fainting), perilymph fistula, ototoxicity, trauma, the disequilibrium of aging, and central nervous system lesions. For each of these disorders and diseases, the authors discuss pathophysiology and patient evaluation. 8 figures. 2 tables. 25 references. •

Pheochromocytoma Source: in Graham, S.D., Jr., et al., eds. Glenn's Urologic Surgery. 5th ed. Philadelphia, PA: Lippincott Williams and Wilkins. 1998. p. 27-37. Contact: Available from Lippincott Williams and Wilkins. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-3030 or (301) 714-2300. Fax (301) 824-7390. Website: lww.com. PRICE: $199.00 plus shipping and handling. ISBN: 0397587376. Summary: Pheochromocytomas are tumors that arise from chromaffin cells of the adrenal medulla. Pheochromocytomas may be familial in 10 percent of cases and are associated with a variety of other conditions, including von Hippel Lindau disease and von Recklinghausen's disease; the malignancy rate is thought to be between 10 and 20 percent. This chapter on pheochromocytomas is from an exhaustive textbook on urologic surgery. The development of computed tomography in the 1970s provided an accurate, noninvasive method of imaging the adrenal glands and localizing these tumors, as has the later development of magnetic resonance imaging. Symptoms of pheochromocytomas include paroxysmal symptoms (headache, diaphoresis, pallor, palpitations, and apprehension) in over 50 percent of patients; hypertension in more than 90 percent of patients; and nausea, trembling, weakness, epigastric pain, and syncope (fainting). Indications for surgery are an adrenal mass or extraadrenal mass that meets the biochemical criteria for a pheochromocytoma. There is no acceptable alternative therapy to the management of pheochromocytoma except surgery. The authors review the preoperative management, anesthesia considerations, surgical approach, thoracoabdominal and transabdominal approaches, and postoperative care and specific complications. Specific complications seen during both the intra and postoperative period include profound hemodynamic instability, which requires precise monitoring and adequate preoperative preparation. Postoperatively, large boluses of intravenous fluids with pressor support may be necessary to maintain stability. 11 figures. 11 references.

•

Balancing Act Source: in Blakley, B.W.; Siegel, M.E. Feeling Dizzy: Understanding and Treating Dizziness, Vertigo, and Other Balancing Disorders. New York, NY: Macmillan Publishing. 1995. p. 7-25. Contact: Available from Macmillan Publishing. 201 West 103rd Street, Indianapolis, IN 46290. (800) 428-5331; Fax (800) 882-8583. PRICE: $21.95 plus shipping and handling. ISBN: 0028600096. Summary: This chapter is from a layperson's guide to vertigo, imbalance, fainting, and other balance disorders. This chapter describes the physiology of the healthy balance system. Topics covered include the brain's role in balance; the proprioceptive system; visual input; the optokinetic and pursuit systems; the muscles, joints and skin; the role of the outer, middle and inner ear in balance; the role of the cochlea; and the vestibular apparatus. 6 figures.

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CHAPTER 8. MULTIMEDIA ON FAINTING Overview In this chapter, we show you how to keep current on multimedia sources of information on fainting. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.

Bibliography: Multimedia on Fainting The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in fainting (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on fainting: •

Syncope [videorecording] Source: [presented by] Marshfield Clinic, Saint Joseph's Hospital, Marshfield Medical Research Foundation; a presentation of the Marshfield Video Network; Year: 1990; Format: Videorecording; Marshfield, WI: The Clinic, [1990]

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CHAPTER 9. PERIODICALS AND NEWS ON FAINTING Overview In this chapter, we suggest a number of news sources and present various periodicals that cover fainting.

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

Automatic arrhythmia recording aids syncope evaluation Source: Reuters Industry Breifing Date: November 06, 2003

•

Isometric arm contraction can abort impending vasovagal syncope Source: Reuters Medical News Date: December 23, 2002

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Some fainting episodes tied to higher death risk Source: Reuters Health eLine Date: September 18, 2002

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Physical maneuver prevents or delays vasovagal syncope Source: Reuters Medical News Date: September 04, 2002

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Crossing the legs can prevent fainting spells Source: Reuters Health eLine Date: September 02, 2002

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Argentine schools try to feed fainting children Source: Reuters Health eLine Date: May 13, 2002

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Nitric oxide to blame for astronaut fainting spells Source: Reuters Health eLine Date: July 12, 2000

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Fainting linked to soft drink consumption Source: Reuters Health eLine Date: June 24, 1999

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Eton "fainting game" death alarms UK authorities Source: Reuters Health eLine Date: March 19, 1999

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Permanent pacing lowers risk of recurrent syncope Source: Reuters Medical News Date: January 05, 1999

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Pacemaker prevents frequent fainting Source: Reuters Health eLine Date: January 01, 1999

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Fainting Risk For Some Defib Patients Source: Reuters Health eLine Date: March 13, 1998

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Syncope Linked To Hysterical Laughter Reported Source: Reuters Medical News Date: October 29, 1997

•

'Seinfeld Syncope' - Laughs Lead to Faints Source: Reuters Health eLine Date: October 29, 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.

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

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

Pulmonary Arterial Hypertension in Scleroderma: A New Treatment Source: Scleroderma Voice. Number 2: 9-10,23. 2002.

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Contact: Available from Scleroderma Foundation. 12 Kent Way, Suite 101, Byfield, MA 01922. (800) 722-HOPE or (978) 463-5843. Fax (978) 463-5809. E-mail: [email protected]. Website: www.scleroderma.org. Summary: This newsletter article provides health professionals and people who have scleroderma with information on the diagnosis and treatment of pulmonary arterial hypertension (PAH). This serious condition occurs when the blood vessels that supply the lungs constrict, making it more difficult for blood to get through to the lungs. As time passes, scarring makes the vessels stiffer and thicker. The extra stress on the heart causes it to enlarge and become less flexible. As a result, less and less blood flows out of the heart, through the lungs, and into the body. PAH can occur by itself or in association with another disease. Scleroderma is the most common disease associated with PAH. It is more common in patients with limited scleroderma. The exact cause of PAH is unknown. However, many factors may have a role in the process of blood vessel thickening and stiffening, including the elevation of a substance in the body called endothelin, a potent vasoconstrictor. Symptoms of PAH include shortness of breath during exercise and at rest, chest pain, dizziness, and fainting. Diagnosis of PAH related to scleroderma is based on the results of a series of tests given to determine the specific cause of shortness of breath, including pulmonary function tests, chest x rays, high resolution computed tomography scans, scans for blood clots, and bronchoscopy. Doppler echocardiogram is the best screening tool for PAH. A right heart catheterization can confirm a diagnosis. Medications that relax and open up blood vessels are the mainstay of treatment for PAH; they include calcium channel blockers such as nifedifine or diltiazem, water pills, blood thinners, and drugs that block endothelin such as bosentan. Bosentan is the first oral medication approved by the Food and Drug Administration to block endothelin receptors. The drug is generally well tolerated, and it may have additional treatment applications in patients with scleroderma. 5 references.

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

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APPENDICES

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

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute12: •

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

•

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

12

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.13 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:14 •

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

•

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

•

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

•

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

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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

13

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). 14 See http://www.nlm.nih.gov/databases/databases.html.

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Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

•

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html The Combined Health Information Database

A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to one of the following: Brochure/Pamphlet, Fact Sheet, or Information Package, and “fainting” using the “Detailed Search” option. Go directly to the following hyperlink: 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 the publication date, select “All Years.” Select your preferred language and the format option “Fact Sheet.” Type “fainting” (or synonyms) into the “For these words:” box. The following is a sample result: •

Dying at Home: Making the Transition Easier for Patients, Family, and Caregivers Contact: Volunteer Home Support, 16-100 Roslyn Rd, Winnipeg, Manitoba. Summary: This practical manual provides information and guidelines to support the decision of a terminally ill person such as an AIDS patient to die at home. The author compares death to birth in order to provide caregivers with some understanding of the death process. He discusses the patient's personal space and the issue of control. The manual continues with specific nursing care guidelines. These include how to give a bed bath, how to change an occupied bed, and how to avoid and care for bed sores. It also discusses diet, oxygen therapy, and mouth and skin care. In addition, the manual covers common medical emergencies including unconsciousness, fainting, seizures, vomiting and diarrhea, urination, and bleeding. The grieving process and the approach of death are explained. The book concludes with a list of more practical suggestions, important definitions, and further resources.

The NLM Gateway15 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.16 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “fainting” (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.

15 16

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

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).

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Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 6388 85 712 7 0 7192

HSTAT17 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.18 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.19 Simply search by “fainting” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

Coffee Break: Tutorials for Biologists20 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.21 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.22 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/.

17

Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html.

18

The HSTAT URL is http://hstat.nlm.nih.gov/.

19

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. 20 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. 21

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. 22 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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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/.

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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 fainting 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 fainting. 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 fainting. 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 “fainting”:

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Other guides Arrhythmia http://www.nlm.nih.gov/medlineplus/arrhythmia.html Chronic Fatigue Syndrome http://www.nlm.nih.gov/medlineplus/chronicfatiguesyndrome.html Congenital Heart Disease http://www.nlm.nih.gov/medlineplus/congenitalheartdisease.html Heart Failure http://www.nlm.nih.gov/medlineplus/heartfailure.html

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

General/Overviews Fainting (Syncope) Source: North American Society of Pacing and Electrophysiology http://www.naspe-patients.org/patients/signs_symptoms/fainting/index.html Syncope Source: American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=4749

•

Diagnosis/Symptoms Fainting: What Causes It Source: American Academy of Family Physicians http://familydoctor.org/handouts/065.html Tilt-Table Test Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=AN00268

•

Treatment First-Aid Guide: Fainting Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=FA00052

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Specific Conditions/Aspects Adams-Stokes Disease Source: American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=4418 Simple Faint (Vasovagal Syncope) Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=AN00103

Patient Resources

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Children Ask the Pediatric Cardiologist -- Fainting Spells Source: American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=12089

•

From the National Institutes of Health Syncope Source: National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov/health_and_medical/disorders/syncope_doc.htm

•

Organizations American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=1200000 National Heart, Lung, and Blood Institute http://www.nhlbi.nih.gov/ National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov/ North American Society of Pacing and Electrophysiology http://www.naspe.org/

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 fainting. 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: •

Early Pregnancy Loss: Miscarriage, Ectopic Pregnancy, and Molar Pregnancy Source: Washington, DC: American College of Obstetricians and Gynecologists. 1998. 6 p. Contact: Available from American College of Obstetricians and Gynecologists, Distribution Center, P.O. Box 4500, Kearneysville, WV 25430-4500. (800) 762-2264, ext. 931 (orders), (304) 725-8410, ext. 339 (orders), (800) 525-5562 (Fax), [email protected] (Email), http://www.acog.org (Web Site). $17.50 for a package of 50 brochures. Order No. AP090.

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Summary: This pamphet addresses the problem of early pregnancy loss, which is defined as the loss of a pregnancy before 20 weeks' gestation. Most often this kind of loss is a miscarriage, but ectopic pregnancy and molar pregnancy also can be causes of early pregnancy loss. Miscarriages occur in 15 to 20 percent of all pregnancies, and most occur in the first 13 weeks. A woman can miscarry without even being aware that she is pregnant. More than half of miscarriages in the first trimester of pregnancy are caused by abnormalities in the chromosomes of the fetus. Most chromosomal abnormalities are not inherited, but happen by chance and are not likely to occur again in a later pregnancy. Other causes of miscarriage are problems with the mother's health, such as an abnormally shaped uterus, an incompetent cervix, chronic disease, and genital tract infections. Lifestyle factors also can cause miscarriage, notably, smoking, heavy alcohol use, and use of illegal drugs. Bleeding is the most common sign of miscarriage. When a miscarriage occurs early in pregnancy, tissue may remain in the uterus. If this happens, the tissue will have to be removed by dilation and curettage. Generally, this does not require a hospital stay. Recovery may take some time, but a woman can ovulate and become pregnant as soon as 2 weeks after an early miscarriage. Ectopic pregnancy occurs when the fertilized egg doesn't reach the uterus and begins to grow in the fallopian tube or, rarely, attaches to an ovary or other organ in the stomach. About 1 in 60 pregnancies is ectopic. Most ectopic pregnancies occur in the fallopian tube. The tube is narrow, so the pregnancy can only grow to the size of a walnut before rupture occurs. If the tube bursts it will cause major bleeding, which is why ectopic pregnancy must be treated promptly. The symptoms of ectopic pregnancy are vaginal bleeding, abdominal pain, shoulder pain, weakness, dizziness, or fainting. Treatment for ectopic pregnancy depends on the size of the pregnancy, whether the tube has ruptured, and the amount of bleeding. If the tube bursts, there will be heavy bleeding inside the stomach and emergency surgery will be required. In many cases, a ruptured tube will have to be removed. If the tubes have been left in place, there is a good chance that the woman can have a normal pregnancy in the future. But women who have experienced ectopic pregnancy are at higher risk for having another one. In molar pregnancy, the pregnancy is not an embryo but a mass of abnormal tissue. This type of pregnancy occurs in only 1 of 1,000 to 1,200 pregnancies. A genetic error causes the abnormal cells to grow. The most common symptom of this condition is vaginal bleeding during the first trimester. Other signs, an enlarged uterus or ovaries, can only be detected by a doctor. The doctor can test for molar pregnancy by analyzing the blood for a specific hormone or doing an ultrasound. Treatment for molar pregnancy is dilation of the cervix and removal of the mole. Careful followup treatment is necessary, as abnormal cells may remain. Women who have molar pregnancies should wait 6 months to a year before getting pregnant again. For many women the emotional healing after a pregnancy loss takes longer than the physical healing. They should not blame themselves for early pregnancy loss because most early losses cannot be prevented. Most women who suffer early pregnancy loss have a healthy pregnancy later. It is important that they allow enough time for physical and emotional healing before trying to get pregnant again. •

Mastocytosis: What It Is and How It's Diagnosed and Treated Source: American Family Physician. 59(11): 3059-3060. June 1999. Contact: American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237 or (913) 906-6000. E-mail: [email protected]. Website: www.aafp.org. Summary: This patient information sheet uses a question and answer format to provide people who have mastocytosis with information on the diagnosis and treatment of this

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disease, which is characterized by an excessive number of mast cells. These cells produce histamine and are made by bone marrow. As part of the immune system, they help fight off infections. Although the cause of mastocytosis is unknown, symptoms may be triggered by cold, heat, certain medications, emotional stress, or insect bites. Symptoms include a red, itchy rash; a rash that looks like freckles; hives; one large lump on the skin; diarrhea; stomach pain; fainting; or difficulty breathing. Diagnostic tests may include a skin biopsy, a bone marrow biopsy, and blood or urine tests. Treatment options include taking antihistamines and avoiding triggers. 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 “fainting” (or synonyms). The following was recently posted: •

Clinical policy: critical issues in the evaluation and management of patients presenting with syncope Source: American College of Emergency Physicians - Medical Specialty Society; 2001; 6 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3299&nbr=2525&a mp;string=fainting

•

Guidelines on management (diagnosis and treatment) of syncope Source: European Society of Cardiology - Medical Specialty Society; 2001 August; 51 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2974&nbr=2200&a mp;string=fainting 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 fainting. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html.

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

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

•

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

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

•

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/

•

WebMDHealth: http://my.webmd.com/health_topics

Associations and Fainting The following is a list of associations that provide information on and resources relating to fainting: •

Syncope Trust and Reflex Anoxic Seizures Telephone: 44-1789-450564 Toll-free: 0800 0286362 Fax: 44-1789-450682 Email: [email protected] Web Site: http://www.stars.org.uk Background: Syncope Trust and Reflex Anoxic Seizures is an information and support group that exists to bring about public and professional awareness of Reflex Anoxic Seizures (RAS). These are seizures that can occur at any age, but are most common in young children and tend to be clustered in 'batches' of attacks. In an RAS episode, an unexpected stimulus, such as pain, shock, or fright, causes the heart to stop, the eyes to roll up into the head, the complexion to become deathly white, and the body to stiffen. After several seconds, the body relaxes and the heart starts beating, but the sufferer loses consciousness and may remain unconscious for an hour or longer. Established in 1993, this organization provides educational materials for patients and health professionals, gathers information to aid research into RAS, and provides support groups and other services for families. It offers information on all types of syncopes including reflex anoxic seizures, for adults and children.

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to fainting. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with fainting.

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The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about fainting. 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 “fainting” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “fainting”. 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 “fainting” (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 “fainting” (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.23

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

23

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)24: •

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/

24

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/

•

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/

•

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

•

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

•

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

•

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

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

•

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

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

•

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

•

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

•

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

•

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

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•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

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

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

•

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

•

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

•

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

•

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

•

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

•

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

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

Basic Guidelines for Fainting Fainting Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003092.htm

•

Signs & Symptoms for Fainting Anxiety Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003211.htm Coughing Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003072.htm Dizziness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003093.htm Hyperventilation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003071.htm

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Hypotension Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003083.htm Loss of consciousness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003202.htm Low blood pressure Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003083.htm Muscle Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003193.htm Nausea Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm Pallor Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003244.htm Shortness of breath Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003075.htm Vertigo Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003093.htm Weakness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003174.htm •

Diagnostics and Tests for Fainting Blood pressure Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003398.htm ECG Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003868.htm Echocardiogram Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003869.htm Heart rate Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003399.htm Holter monitor Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003877.htm X-ray of the chest Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003804.htm

•

Background Topics for Fainting Central nervous system Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002311.htm

Online Glossaries 95

Exercise Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001941.htm Head injury Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000028.htm Physical examination Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002274.htm Stimulus Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002309.htm

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

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

•

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

•

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

•

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

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FAINTING DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abdominal Pain: Sensation of discomfort, distress, or agony in the abdominal region. [NIH] Abduction: Forcible pulling of a limb away from its natural position, a risk in road accidents and disasters; move outwards away from middle line. [NIH] Acoustic: Having to do with sound or hearing. [NIH] Activities of Daily Living: The performance of the basic activities of self care, such as dressing, ambulation, eating, etc., in rehabilitation. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adrenal Glands: Paired glands situated in the retroperitoneal tissues at the superior pole of each kidney. [NIH] Adrenal insufficiency: The reduced secretion of adrenal glands. [NIH] Adrenal Medulla: The inner part of the adrenal gland; it synthesizes, stores and releases catecholamines. [NIH] Adrenaline: A hormone. Also called epinephrine. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Adrenergic Agonists: Drugs that bind to and activate adrenergic receptors. [NIH] Advanced Cardiac Life Support: The use of sophisticated methods and equipment to treat cardiopulmonary arrest. Advanced Cardiac Life Support (ACLS) includes the use of specialized equipment to maintain the airway, early defibrilation and pharmacological therapy. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Aerobic: In biochemistry, reactions that need oxygen to happen or happen when oxygen is present. [NIH] Afferent: Concerned with the transmission of neural impulse toward the central part of the nervous system. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association

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constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Age Groups: Persons classified by age from birth (infant, newborn) to octogenarians and older (aged, 80 and over). [NIH] Aged, 80 and Over: A person 80 years of age and older. [NIH] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Airway: A device for securing unobstructed passage of air into and out of the lungs during general anesthesia. [NIH] Airway Obstruction: Any hindrance to the passage of air into and out of the lungs. [NIH] Albumin: 1. Any protein that is soluble in water and moderately concentrated salt solutions and is coagulable by heat. 2. Serum albumin; the major plasma protein (approximately 60 per cent of the total), which is responsible for much of the plasma colloidal osmotic pressure and serves as a transport protein carrying large organic anions, such as fatty acids, bilirubin, and many drugs, and also carrying certain hormones, such as cortisol and thyroxine, when their specific binding globulins are saturated. Albumin is synthesized in the liver. Low serum levels occur in protein malnutrition, active inflammation and serious hepatic and renal disease. [EU] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alkaline: Having the reactions of an alkali. [EU] Aloe: A genus of the family Liliaceae containing anthraquinone glycosides such as aloinemodin or aloe-emodin (emodin). [NIH] Alpha-1: A protein with the property of inactivating proteolytic enzymes such as leucocyte collagenase and elastase. [NIH] Alprenolol: 1-((1-Methylethyl)amino)-3-(2-(2-propenyl)phenoxy)-2-propanol. Adrenergic beta-blocker used as an antihypertensive, anti-anginal, and anti-arrhythmic agent. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Alveoli: Tiny air sacs at the end of the bronchioles in the lungs. [NIH] Amine: An organic compound containing nitrogen; any member of a group of chemical compounds formed from ammonia by replacement of one or more of the hydrogen atoms by organic (hydrocarbon) radicals. The amines are distinguished as primary, secondary, and tertiary, according to whether one, two, or three hydrogen atoms are replaced. The amines include allylamine, amylamine, ethylamine, methylamine, phenylamine, propylamine, and many other compounds. [EU] Ammonia: A colorless alkaline gas. It is formed in the body during decomposition of organic materials during a large number of metabolically important reactions. [NIH] Analgesics: Compounds capable of relieving pain without the loss of consciousness or without producing anesthesia. [NIH]

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Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Anaphylactic: Pertaining to anaphylaxis. [EU] Anaphylaxis: An acute hypersensitivity reaction due to exposure to a previously encountered antigen. The reaction may include rapidly progressing urticaria, respiratory distress, vascular collapse, systemic shock, and death. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Anesthetics: Agents that are capable of inducing a total or partial loss of sensation, especially tactile sensation and pain. They may act to induce general anesthesia, in which an unconscious state is achieved, or may act locally to induce numbness or lack of sensation at a targeted site. [NIH] Aneurysm: A sac formed by the dilatation of the wall of an artery, a vein, or the heart. [NIH] Angina: Chest pain that originates in the heart. [NIH] Angina Pectoris: The symptom of paroxysmal pain consequent to myocardial ischemia usually of distinctive character, location and radiation, and provoked by a transient stressful situation during which the oxygen requirements of the myocardium exceed the capacity of the coronary circulation to supply it. [NIH] Angioneurotic: Denoting a neuropathy affecting the vascular system; see angioedema. [EU] Angioneurotic Edema: Recurring attacks of transient edema suddenly appearing in areas of the skin or mucous membranes and occasionally of the viscera, often associated with dermatographism, urticaria, erythema, and purpura. [NIH] Antagonism: Interference with, or inhibition of, the growth of a living organism by another living organism, due either to creation of unfavorable conditions (e. g. exhaustion of food supplies) or to production of a specific antibiotic substance (e. g. penicillin). [NIH] Antibiotics: Substances produced by microorganisms that can inhibit or suppress the growth of other microorganisms. [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] Anticonvulsants: Drugs used to prevent seizures or reduce their severity. [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] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Aorta: The main trunk of the systemic arteries. [NIH] Aortic Valve: The valve between the left ventricle and the ascending aorta which prevents backflow into the left ventricle. [NIH] Apomorphine: A derivative of morphine that is a dopamine D2 agonist. It is a powerful

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emetic and has been used for that effect in acute poisoning. It has also been used in the diagnosis and treatment of parkinsonism, but its adverse effects limit its use. [NIH] Appendicitis: Acute inflammation of the vermiform appendix. [NIH] Arrhythmia: Any variation from the normal rhythm or rate of the heart beat. [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] Astringents: Agents, usually topical, that cause the contraction of tissues for the control of bleeding or secretions. [NIH] Asystole: Cardiac standstill or arrest; absence of a heartbeat; called also Beau's syndrome. [EU]

Ataxia: Impairment of the ability to perform smoothly coordinated voluntary movements. This condition may affect the limbs, trunk, eyes, pharnyx, larnyx, and other structures. Ataxia may result from impaired sensory or motor function. Sensory ataxia may result from posterior column injury or peripheral nerve diseases. Motor ataxia may be associated with cerebellar diseases; cerebral cortex diseases; thalamic diseases; basal ganglia diseases; injury to the red nucleus; and other conditions. [NIH] Atrial: Pertaining to an atrium. [EU] Atrial Fibrillation: Disorder of cardiac rhythm characterized by rapid, irregular atrial impulses and ineffective atrial contractions. [NIH] Atrial Flutter: Rapid, irregular atrial contractions due to an abnormality of atrial excitation. [NIH]

Atrium: A chamber; used in anatomical nomenclature to designate a chamber affording entrance to another structure or organ. Usually used alone to designate an atrium of the heart. [EU] Auditory: Pertaining to the sense of hearing. [EU] Auscultation: Act of listening for sounds within the body. [NIH] Autoimmune disease: A condition in which the body recognizes its own tissues as foreign and directs an immune response against them. [NIH] Autonomic: Self-controlling; functionally independent. [EU] Autonomic Nervous System: The enteric, parasympathetic, and sympathetic nervous systems taken together. Generally speaking, the autonomic nervous system regulates the internal environment during both peaceful activity and physical or emotional stress. Autonomic activity is controlled and integrated by the central nervous system, especially the hypothalamus and the solitary nucleus, which receive information relayed from visceral afferents; these and related central and sensory structures are sometimes (but not here) considered to be part of the autonomic nervous system itself. [NIH] Back Pain: Acute or chronic pain located in the posterior regions of the trunk, including the thoracic, lumbar, sacral, or adjacent regions. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Baroreflex: A negative feedback system which buffers short-term changes in blood pressure. Increased pressure stretches blood vessels which activates pressoreceptors (baroreceptors) in the vessel walls. The net response of the central nervous system is a reduction of central

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sympathetic outflow. This reduces blood pressure both by decreasing peripheral vascular resistance and by lowering cardiac output. Because the baroreceptors are tonically active, the baroreflex can compensate rapidly for both increases and decreases in blood pressure. [NIH]

Basal Ganglia: Large subcortical nuclear masses derived from the telencephalon and located in the basal regions of the cerebral hemispheres. [NIH] Basal Ganglia Diseases: Diseases of the basal ganglia including the putamen; globus pallidus; claustrum; amygdala; and caudate nucleus. Dyskinesias (most notably involuntary movements and alterations of the rate of movement) represent the primary clinical manifestations of these disorders. Common etiologies include cerebrovascular disease; neurodegenerative diseases; and craniocerebral trauma. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Bifida: A defect in development of the vertebral column in which there is a central deficiency of the vertebral lamina. [NIH] Bilateral: Affecting both the right and left side of body. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] 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] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Bone Density: The amount of mineral per square centimeter of bone. This is the definition used in clinical practice. Actual bone density would be expressed in grams per milliliter. It is most frequently measured by photon absorptiometry or x-ray computed tomography. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists

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mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bone marrow biopsy: The removal of a sample of tissue from the bone marrow with a needle for examination under a microscope. [NIH] Bone scan: A technique to create images of bones on a computer screen or on film. A small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it collects in the bones and is detected by a scanner. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Bradycardia: Excessive slowness in the action of the heart, usually with a heart rate below 60 beats per minute. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Breakdown: A physical, metal, or nervous collapse. [NIH] Bronchi: The larger air passages of the lungs arising from the terminal bifurcation of the trachea. [NIH] Bronchial: Pertaining to one or more bronchi. [EU] Bronchitis: Inflammation (swelling and reddening) of the bronchi. [NIH] Bronchodilator: A drug that relaxes the smooth muscles in the constricted airway. [NIH] Bronchoscopy: Endoscopic examination, therapy or surgery of the bronchi. [NIH] Buffers: A chemical system that functions to control the levels of specific ions in solution. When the level of hydrogen ion in solution is controlled the system is called a pH buffer. [NIH]

Burns: Injuries to tissues caused by contact with heat, steam, chemicals (burns, chemical), electricity (burns, electric), or the like. [NIH] Burns, Electric: Burns produced by contact with electric current or from a sudden discharge of electricity. [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] Calcium channel blocker: A drug used to relax the blood vessel and heart muscle, causing pressure inside blood vessels to drop. It also can regulate heart rhythm. [NIH] Calcium Channel Blockers: A class of drugs that act by selective inhibition of calcium influx through cell membranes or on the release and binding of calcium in intracellular pools. Since they are inducers of vascular and other smooth muscle relaxation, they are used in the drug therapy of hypertension and cerebrovascular spasms, as myocardial protective agents, and in the relaxation of uterine spasms. [NIH] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Cardiac: Having to do with the heart. [NIH]

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Cardiac arrest: A sudden stop of heart function. [NIH] Cardiac Output: The volume of blood passing through the heart per unit of time. It is usually expressed as liters (volume) per minute so as not to be confused with stroke volume (volume per beat). [NIH] Cardiomyopathy: A general diagnostic term designating primary myocardial disease, often of obscure or unknown etiology. [EU] Cardiopulmonary: Having to do with the heart and lungs. [NIH] Cardiopulmonary Resuscitation: The artificial substitution of heart and lung action as indicated for heart arrest resulting from electric shock, drowning, respiratory arrest, or other causes. The two major components of cardiopulmonary resuscitation are artificial ventilation and closed-chest cardiac massage. [NIH] Cardiopulmonary Resuscitation: The artificial substitution of heart and lung action as indicated for heart arrest resulting from electric shock, drowning, respiratory arrest, or other causes. The two major components of cardiopulmonary resuscitation are artificial ventilation and closed-chest cardiac massage. [NIH] Cardioselective: Having greater activity on heart tissue than on other tissue. [EU] 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] Carotene: The general name for a group of pigments found in green, yellow, and leafy vegetables, and yellow fruits. The pigments are fat-soluble, unsaturated aliphatic hydrocarbons functioning as provitamins and are converted to vitamin A through enzymatic processes in the intestinal wall. [NIH] Carotid Body: A small cluster of chemoreceptive and supporting cells located near the bifurcation of the internal carotid artery. The carotid body, which is richly supplied with fenestrated capillaries, senses the pH, carbon dioxide, and oxygen concentrations in the blood and plays a crucial role in their homeostatic control. [NIH] Carotid Sinus: The dilated portion of the common carotid artery at its bifurcation into external and internal carotids. It contains baroreceptors which, when stimulated, cause slowing of the heart, vasodilatation, and a fall in 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] Catecholamine: A group of chemical substances manufactured by the adrenal medulla and secreted during physiological stress. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell membrane: Cell membrane = plasma membrane. The structure enveloping a cell, enclosing the cytoplasm, and forming a selective permeability barrier; it consists of lipids, proteins, and some carbohydrates, the lipids thought to form a bilayer in which integral proteins are embedded to varying degrees. [EU] Cell Respiration: The metabolic process of all living cells (animal and plant) in which oxygen is used to provide a source of energy for the cell. [NIH] Central Nervous System: The main information-processing organs of the nervous system,

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consisting of the brain, spinal cord, and meninges. [NIH] Central Nervous System Infections: Pathogenic infections of the brain, spinal cord, and meninges. DNA virus infections; RNA virus infections; bacterial infections; mycoplasma infections; Spirochaetales infections; fungal infections; protozoan infections; helminthiasis; and prion diseases may involve the central nervous system as a primary or secondary process. [NIH] Cerebellar: Pertaining to the cerebellum. [EU] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebral Aqueduct: Narrow channel in the mesencephalon that connects the third and fourth ventricles. [NIH] Cerebral Palsy: Refers to a motor disability caused by a brain dysfunction. [NIH] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH] Chaos: Complex behavior that seems random but actually has some hidden order. [NIH] Character: In current usage, approximately equivalent to personality. The sum of the relatively fixed personality traits and habitual modes of response of an individual. [NIH] Chest Pain: Pressure, burning, or numbness in the chest. [NIH] Chorea: Involuntary, forcible, rapid, jerky movements that may be subtle or become confluent, markedly altering normal patterns of movement. Hypotonia and pendular reflexes are often associated. Conditions which feature recurrent or persistent episodes of chorea as a primary manifestation of disease are referred to as choreatic disorders. Chorea is also a frequent manifestation of basal ganglia diseases. [NIH] Choreatic Disorders: Acquired and hereditary conditions which feature chorea as a primary manifestation of the disease process. [NIH] Choriocarcinoma: A malignant tumor of trophoblastic epithelium characterized by secretion of large amounts of chorionic gonadotropin. It usually originates from chorionic products of conception (i.e., hydatidiform mole, normal pregnancy, or following abortion), but can originate in a teratoma of the testis, mediastinum, or pineal gland. [NIH] Chromaffin Cells: Cells that store epinephrine secretory vesicles. During times of stress, the nervous system signals the vesicles to secrete their hormonal content. Their name derives from their ability to stain a brownish color with chromic salts. Characteristically, they are located in the adrenal medulla and paraganglia (paraganglia, chromaffin) of the sympathetic nervous system. [NIH] Chromic: Catgut sterilized and impregnated with chromium trioxide. [NIH] Chromosomal: Pertaining to chromosomes. [EU] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic Disease: Disease or ailment of long duration. [NIH] Chronic Fatigue Syndrome: Fatigue caused by the combined effects of different types of

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prolonged fatigue. [NIH] Circulatory system: The system that contains the heart and the blood vessels and moves blood throughout the body. This system helps tissues get enough oxygen and nutrients, and it helps them get rid of waste products. The lymph system, which connects with the blood system, is often considered part of the circulatory system. [NIH] CIS: Cancer Information Service. The CIS is the National Cancer Institute's link to the public, interpreting and explaining research findings in a clear and understandable manner, and providing personalized responses to specific questions about cancer. Access the CIS by calling 1-800-4-CANCER, or by using the Web site at http://cis.nci.nih.gov. [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Cochlea: The part of the internal ear that is concerned with hearing. It forms the anterior part of the labyrinth, is conical, and is placed almost horizontally anterior to the vestibule. [NIH]

Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the

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standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Computed tomography: CT scan. A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized tomography and computerized axial tomography (CAT) scan. [NIH] Computerized axial tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called CAT scan, computed tomography (CT scan), or computerized tomography. [NIH] Computerized tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized axial tomography (CAT) scan and computed tomography (CT scan). [NIH] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Conduction: The transfer of sound waves, heat, nervous impulses, or electricity. [EU] Cones: One type of specialized light-sensitive cells (photoreceptors) in the retina that provide sharp central vision and color vision. [NIH] Confined Spaces: A space which has limited openings for entry and exit combined with unfavorable natural ventilation such as caves, refrigerators, deep tunnels, pipelines, sewers, silos, tanks, vats, mines, deep trenches or pits, vaults, manholes, chimneys, etc. [NIH] Congestion: Excessive or abnormal accumulation of blood in a part. [EU] Congestive heart failure: Weakness of the heart muscle that leads to a buildup of fluid in body tissues. [NIH] Conjunctiva: The mucous membrane that lines the inner surface of the eyelids and the anterior part of the sclera. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Constitutional: 1. Affecting the whole constitution of the body; not local. 2. Pertaining to the constitution. [EU] Constrict: Tighten; narrow. [NIH] Constriction: The act of constricting. [NIH] Constriction, Pathologic: The condition of an anatomical structure's being constricted beyond normal dimensions. [NIH]

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Consultation: A deliberation between two or more physicians concerning the diagnosis and the proper method of treatment in a case. [NIH] Consumption: Pulmonary tuberculosis. [NIH] Contractility: Capacity for becoming short in response to a suitable stimulus. [EU] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Convulsions: A general term referring to sudden and often violent motor activity of cerebral or brainstem origin. Convulsions may also occur in the absence of an electrical cerebral discharge (e.g., in response to hypotension). [NIH] Coordination: Muscular or motor regulation or the harmonious cooperation of muscles or groups of muscles, in a complex action or series of actions. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Arteriosclerosis: Thickening and loss of elasticity of the coronary arteries. [NIH] Coronary Circulation: The circulation of blood through the coronary vessels of the heart. [NIH]

Coronary heart disease: A type of heart disease caused by narrowing of the coronary arteries that feed the heart, which needs a constant supply of oxygen and nutrients carried by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by fat and cholesterol deposits and cannot supply enough blood to the heart, CHD results. [NIH] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Corpus: The body of the uterus. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Cortical: Pertaining to or of the nature of a cortex or bark. [EU] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Cranial Nerves: Twelve pairs of nerves that carry general afferent, visceral afferent, special afferent, somatic efferent, and autonomic efferent fibers. [NIH] Craniocerebral Trauma: Traumatic injuries involving the cranium and intracranial structures (i.e., brain; cranial nerves; meninges; and other structures). Injuries may be classified by whether or not the skull is penetrated (i.e., penetrating vs. nonpenetrating) or whether there is an associated hemorrhage. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Curettage: Removal of tissue with a curette, a spoon-shaped instrument with a sharp edge. [NIH]

Curette: A spoon-shaped instrument with a sharp edge. [NIH] Databases, Bibliographic: Extensive collections, reputedly complete, of references and citations to books, articles, publications, etc., generally on a single subject or specialized subject area. Databases can operate through automated files, libraries, or computer disks. The concept should be differentiated from factual databases which is used for collections of data and facts apart from bibliographic references to them. [NIH]

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Decarboxylation: The removal of a carboxyl group, usually in the form of carbon dioxide, from a chemical compound. [NIH] Decubitus: An act of lying down; also the position assumed in lying down. [EU] Decubitus Ulcer: An ulceration caused by prolonged pressure in patients permitted to lie too still for a long period of time. The bony prominences of the body are the most frequently affected sites. The ulcer is caused by ischemia of the underlying structures of the skin, fat, and muscles as a result of the sustained and constant pressure. [NIH] Dehydration: The condition that results from excessive loss of body water. [NIH] Dendrites: Extensions of the nerve cell body. They are short and branched and receive stimuli from other neurons. [NIH] Dental Care: The total of dental diagnostic, preventive, and restorative services provided to meet the needs of a patient (from Illustrated Dictionary of Dentistry, 1982). [NIH] Dental Caries: Localized destruction of the tooth surface initiated by decalcification of the enamel followed by enzymatic lysis of organic structures and leading to cavity formation. If left unchecked, the cavity may penetrate the enamel and dentin and reach the pulp. The three most prominent theories used to explain the etiology of the disase are that acids produced by bacteria lead to decalcification; that micro-organisms destroy the enamel protein; or that keratolytic micro-organisms produce chelates that lead to decalcification. [NIH]

Dental Hygienists: Persons trained in an accredited school or dental college and licensed by the state in which they reside to provide dental prophylaxis under the direction of a licensed dentist. [NIH] Dental Materials: Materials used in the production of dental bases, restorations, impressions, prostheses, etc. [NIH] Dentists: Individuals licensed to practice dentistry. [NIH] 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] Diaphoresis: Perspiration, especially profuse perspiration. Called also sudoresis. [EU] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Dilatation: The act of dilating. [NIH] Dilatation, Pathologic: The condition of an anatomical structure's being dilated beyond normal dimensions. [NIH] Dilation: A process by which the pupil is temporarily enlarged with special eye drops

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(mydriatic); allows the eye care specialist to better view the inside of the eye. [NIH] Dilation and curettage: D&C. A minor operation in which the cervix is expanded enough (dilation) to permit the cervical canal and uterine lining to be scraped with a spoon-shaped instrument called a curette (curettage). [NIH] Dilator: A device used to stretch or enlarge an opening. [NIH] Diltiazem: A benzothiazepine derivative with vasodilating action due to its antagonism of the actions of the calcium ion in membrane functions. It is also teratogenic. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Discrimination: The act of qualitative and/or quantitative differentiation between two or more stimuli. [NIH] Dislocation: The displacement of any part, more especially of a bone. Called also luxation. [EU]

Diuretic: A drug that increases the production of urine. [NIH] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Dopamine: An endogenous catecholamine and prominent neurotransmitter in several systems of the brain. In the synthesis of catecholamines from tyrosine, it is the immediate precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. A family of dopaminergic receptor subtypes mediate its action. Dopamine is used pharmacologically for its direct (beta adrenergic agonist) and indirect (adrenergic releasing) sympathomimetic effects including its actions as an inotropic agent and as a renal vasodilator. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Drug Tolerance: Progressive diminution of the susceptibility of a human or animal to the effects of a drug, resulting from its continued administration. It should be differentiated from drug resistance wherein an organism, disease, or tissue fails to respond to the intended effectiveness of a chemical or drug. It should also be differentiated from maximum tolerated dose and no-observed-adverse-effect level. [NIH] Duodenum: The first part of the small intestine. [NIH] Dyskinesia: Impairment of the power of voluntary movement, resulting in fragmentary or incomplete movements. [EU] Echocardiography: Ultrasonic recording of the size, motion, and composition of the heart and surrounding tissues. The standard approach is transthoracic. [NIH] Ectopic: Pertaining to or characterized by ectopia. [EU] Ectopic Pregnancy: The pregnancy occurring elsewhere than in the cavity of the uterus. [NIH]

Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Electric shock: A dangerous patho-physiological effect resulting from an electric current passing through the body of a human or animal. [NIH] Electrocardiogram: Measurement of electrical activity during heartbeats. [NIH]

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Electrocardiography: Recording of the moment-to-moment electromotive forces of the heart as projected onto various sites on the body's surface, delineated as a scalar function of time. [NIH]

Embolus: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Emetic: An agent that causes vomiting. [EU] Emodin: Purgative anthraquinone found in several plants, especially Rhamnus frangula. It was formerly used as a laxative, but is now used mainly as tool in toxicity studies. [NIH] Enamel: A very hard whitish substance which covers the dentine of the anatomical crown of a tooth. [NIH] Encephalocele: Cerebral tissue herniation through a congenital or acquired defect in the skull. The majority of congenital encephaloceles occur in the occipital or frontal regions. Clinical features include a protuberant mass that may be pulsatile. The quantity and location of protruding neural tissue determines the type and degree of neurologic deficit. Visual defects, psychomotor developmental delay, and persistent motor deficits frequently occur. [NIH]

Encephalopathy: A disorder of the brain that can be caused by disease, injury, drugs, or chemicals. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Epigastric: Having to do with the upper middle area of the abdomen. [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Erectile: The inability to get or maintain an erection for satisfactory sexual intercourse. Also called impotence. [NIH] Erection: The condition of being made rigid and elevated; as erectile tissue when filled with blood. [EU] Ergot: Cataract due to ergot poisoning caused by eating of rye cereals contaminated by a fungus. [NIH] Ergotamine: A vasoconstrictor found in ergot of Central Europe. It is an alpha-1 selective adrenergic agonist and is commonly used in the treatment of migraine headaches. [NIH] Erythema: Redness of the skin produced by congestion of the capillaries. This condition may result from a variety of causes. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Ethanolamine: A viscous, hygroscopic amino alcohol with an ammoniacal odor. It is widely

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distributed in biological tissue and is a component of lecithin. It is used as a surfactant, fluorimetric reagent, and to remove CO2 and H2S from natural gas and other gases. [NIH] Evacuation: An emptying, as of the bowels. [EU] Evoke: The electric response recorded from the cerebral cortex after stimulation of a peripheral sense organ. [NIH] Excitation: An act of irritation or stimulation or of responding to a stimulus; the addition of energy, as the excitation of a molecule by absorption of photons. [EU] Excitatory: When cortical neurons are excited, their output increases and each new input they receive while they are still excited raises their output markedly. [NIH] Exercise Test: Controlled physical activity, more strenuous than at rest, which is performed in order to allow assessment of physiological functions, particularly cardiovascular and pulmonary, but also aerobic capacity. Maximal (most intense) exercise is usually required but submaximal exercise is also used. The intensity of exercise is often graded, using criteria such as rate of work done, oxygen consumption, and heart rate. Physiological data obtained from an exercise test may be used for diagnosis, prognosis, and evaluation of disease severity, and to evaluate therapy. Data may also be used in prescribing exercise by determining a person's exercise capacity. [NIH] Expiration: The act of breathing out, or expelling air from the lungs. [EU] Extrapyramidal: Outside of the pyramidal tracts. [EU] Extravasation: A discharge or escape, as of blood, from a vessel into the tissues. [EU] Facial: Of or pertaining to the face. [EU] Facial Pain: Pain in the facial region including orofacial pain and craniofacial pain. Associated conditions include local inflammatory and neoplastic disorders and neuralgic syndromes involving the trigeminal, facial, and glossopharyngeal nerves. Conditions which feature recurrent or persistent facial pain as the primary manifestation of disease are referred to as facial pain syndromes. [NIH] Facial Paralysis: Severe or complete loss of facial muscle motor function. This condition may result from central or peripheral lesions. Damage to CNS motor pathways from the cerebral cortex to the facial nuclei in the pons leads to facial weakness that generally spares the forehead muscles. Facial nerve diseases generally results in generalized hemifacial weakness. Neuromuscular junction diseases and muscular diseases may also cause facial paralysis or paresis. [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] Fathers: Male parents, human or animal. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]

Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Femoral: Pertaining to the femur, or to the thigh. [EU] Femoral Neck Fractures: Fractures of the short, constricted portion of the thigh bone between the femur head and the trochanters. It excludes intertrochanteric fractures which are hip fractures. [NIH] Femur: The longest and largest bone of the skeleton, it is situated between the hip and the

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knee. [NIH] Fetal Development: Morphologic and physiologic growth and development of the mammalian embryo or fetus. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibrillation: A small, local, involuntary contraction of muscle, invisible under the skin, resulting from spontaneous activation of single muscle cells or muscle fibres. [EU] Filtration: The passage of a liquid through a filter, accomplished by gravity, pressure, or vacuum (suction). [EU] Fistula: Abnormal communication most commonly seen between two internal organs, or between an internal organ and the surface of the body. [NIH] Flatus: Gas passed through the rectum. [NIH] Fold: A plication or doubling of various parts of the body. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Frail Elderly: Older adults or aged individuals who are lacking in general strength and are unusually susceptible to disease or to other infirmity. [NIH] Gait: Manner or style of walking. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gas exchange: Primary function of the lungs; transfer of oxygen from inhaled air into the blood and of carbon dioxide from the blood into the lungs. [NIH] Gastric: Having to do with the stomach. [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]

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

Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Genital: Pertaining to the genitalia. [EU] 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] Gestational: Psychosis attributable to or occurring during pregnancy. [NIH] Gestational trophoblastic disease: A rare cancer in women of child-bearing age in which cancer cells grow in the tissues that are formed in the uterus after conception. Also called gestational trophoblastic tumor, gestational trophoblastic neoplasia, molar pregnancy, or choriocarcinoma. [NIH] Gestational trophoblastic neoplasia: A rare cancer in women of child-bearing age in which cancer cells grow in the tissues that are formed in the uterus after conception. Also called

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gestational trophoblastic disease, gestational trophoblastic tumor, molar pregnancy, or choriocarcinoma. [NIH] Gestational trophoblastic tumor: A rare cancer in women of child-bearing age in which cancer cells grow in the tissues that are formed in the uterus after conception. Also called gestational trophoblastic disease, gestational trophoblastic neoplasia, molar pregnancy, or choriocarcinoma. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Gliosis: The production of a dense fibrous network of neuroglia; includes astrocytosis, which is a proliferation of astrocytes in the area of a degenerative lesion. [NIH] Glossopharyngeal Nerve: The 9th cranial nerve. The glossopharyngeal nerve is a mixed motor and sensory nerve; it conveys somatic and autonomic efferents as well as general, special, and visceral afferents. Among the connections are motor fibers to the stylopharyngeus muscle, parasympathetic fibers to the parotid glands, general and taste afferents from the posterior third of the tongue, the nasopharynx, and the palate, and afferents from baroreceptors and chemoreceptors of the carotid sinus. [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] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Granulomas: Small lumps in tissues caused by inflammation. [NIH] Gravis: Eruption of watery blisters on the skin among those handling animals and animal products. [NIH] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] Headache Disorders: Common conditions characterized by persistent or recurrent headaches. Headache syndrome classification systems may be based on etiology (e.g., vascular headache, post-traumatic headaches, etc.), temporal pattern (e.g., cluster headache, paroxysmal hemicrania, etc.), and precipitating factors (e.g., cough headache). [NIH] Heart Arrest: Sudden and usually momentary cessation of the heart beat. This sudden cessation may, but not usually, lead to death, sudden, cardiac. [NIH] Heart attack: A seizure of weak or abnormal functioning of the heart. [NIH] Heart Catheterization: Procedure which includes placement of catheter, recording of intracardiac and intravascular pressure, obtaining blood samples for chemical analysis, and cardiac output measurement, etc. Specific angiographic injection techniques are also involved. [NIH]

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Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, breathlessness, and excess fluid accumulation in body tissues. [NIH] Heart Murmurs: Abnormal heart sounds heard during auscultation caused by alterations in the flow of blood into a chamber, through a valve, or by a valve opening or closing abnormally. They are classified by the time of occurrence during the cardiac cycle, the duration, and the intensity of the sound on a scale of I to V. [NIH] Heart Sounds: The sounds heard over the cardiac region produced by the functioning of the heart. There are four distinct sounds: the first occurs at the beginning of systole and is heard as a "lubb" sound; the second is produced by the closing of the aortic and pulmonary valves and is heard as a "dupp" sound; the third is produced by vibrations of the ventricular walls when suddenly distended by the rush of blood from the atria; and the fourth is produced by atrial contraction and ventricular filling but is rarely audible in the normal heart. The physiological concept of heart sounds is differentiated from the pathological heart murmurs. [NIH]

Heartbeat: One complete contraction of the heart. [NIH] Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [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]

Hip Fractures: Fractures of the femur head, the femur neck, the trochanters, or the inter- or subtrochanteric region. Excludes fractures of the acetabulum and fractures of the femoral shaft below the subtrochanteric region. For the fractures of the femur neck the specific term femoral neck fractures is available. [NIH] Histamine: 1H-Imidazole-4-ethanamine. A depressor amine derived by enzymatic decarboxylation of histidine. It is a powerful stimulant of gastric secretion, a constrictor of bronchial smooth muscle, a vasodilator, and also a centrally acting neurotransmitter. [NIH] Histidine: An essential amino acid important in a number of metabolic processes. It is required for the production of histamine. [NIH] 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] Hydrocephalus: Excessive accumulation of cerebrospinal fluid within the cranium which may be associated with dilation of cerebral ventricles, intracranial hypertension; headache; lethargy; urinary incontinence; and ataxia (and in infants macrocephaly). This condition may be caused by obstruction of cerebrospinal fluid pathways due to neurologic abnormalities, intracranial hemorrhages; central nervous system infections; brain neoplasms; craniocerebral trauma; and other conditions. Impaired resorption of cerebrospinal fluid from the arachnoid villi results in a communicating form of hydrocephalus. Hydrocephalus ex-vacuo refers to ventricular dilation that occurs as a result of brain substance loss from cerebral infarction and other conditions. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive

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isotope tritium. [NIH] Hygienic: Pertaining to hygiene, or conducive to health. [EU] Hyperemesis: Excessive vomiting. [EU] Hyperglycemia: Abnormally high blood sugar. [NIH] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hyperthyroidism: Excessive functional activity of the thyroid gland. [NIH] Hypertrophic cardiomyopathy: Heart muscle disease that leads to thickening of the heart walls, interfering with the heart's ability to fill with and pump blood. [NIH] Hyperventilation: A pulmonary ventilation rate faster than is metabolically necessary for the exchange of gases. It is the result of an increased frequency of breathing, an increased tidal volume, or a combination of both. It causes an excess intake of oxygen and the blowing off of carbon dioxide. [NIH] Hypnotic: A drug that acts to induce sleep. [EU] Hypoglossal Nerve: The 12th cranial nerve. The hypoglossal nerve originates in the hypoglossal nucleus of the medulla and supplies motor innervation to all of the muscles of the tongue except the palatoglossus (which is supplied by the vagus). This nerve also contains proprioceptive afferents from the tongue muscles. [NIH] Hypoglycemia: Abnormally low blood sugar [NIH] Hypotension: Abnormally low blood pressure. [NIH] Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH] Hypovolemia: An abnormally low volume of blood circulating through the body. It may result in hypovolemic shock. [NIH] Hypoxia: Reduction of oxygen supply to tissue below physiological levels despite adequate perfusion of the tissue by blood. [EU] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Idiopathic: Describes a disease of unknown cause. [NIH] Illusion: A false interpretation of a genuine percept. [NIH] Immersion: The placing of a body or a part thereof into a liquid. [NIH] Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Impotence: The inability to perform sexual intercourse. [NIH] Incision: A cut made in the body during surgery. [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Infant, Newborn: An infant during the first month after birth. [NIH] Infarction: A pathological process consisting of a sudden insufficient blood supply to an

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area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] Inner ear: The labyrinth, comprising the vestibule, cochlea, and semicircular canals. [NIH] Innervation: 1. The distribution or supply of nerves to a part. 2. The supply of nervous energy or of nerve stimulus sent to a part. [EU] Inotropic: Affecting the force or energy of muscular contractions. [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] Insulator: Material covering the metal conductor of the lead. It is usually polyurethane or silicone. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Intestines: The section of the alimentary canal from the stomach to the anus. It includes the large intestine and small intestine. [NIH] Intoxication: Poisoning, the state of being poisoned. [EU] Intracellular: Inside a cell. [NIH] Intracranial Pressure: Pressure within the cranial cavity. It is influenced by brain mass, the circulatory system, CSF dynamics, and skull rigidity. [NIH] Intravascular: Within a vessel or vessels. [EU] Intravenous: IV. Into a vein. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

Involuntary: Reaction occurring without intention or volition. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a

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gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Isoproterenol: Isopropyl analog of epinephrine; beta-sympathomimetic that acts on the heart, bronchi, skeletal muscle, alimentary tract, etc. It is used mainly as bronchodilator and heart stimulant. [NIH] Isosorbide: 1,4:3,6-Dianhydro D-glucitol. Chemically inert osmotic diuretic used mainly to treat hydrocephalus; also used in glaucoma. [NIH] Isosorbide Dinitrate: A vasodilator used in the treatment of angina. Its actions are similar to nitroglycerin but with a slower onset of action. [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] Keratolytic: An agent that promotes keratolysis. [EU] Labyrinth: The internal ear; the essential part of the organ of hearing. It consists of an osseous and a membranous portion. [NIH] Labyrinthitis: Inflammation of the inner ear. [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] Larynx: An irregularly shaped, musculocartilaginous tubular structure, lined with mucous membrane, located at the top of the trachea and below the root of the tongue and the hyoid bone. It is the essential sphincter guarding the entrance into the trachea and functioning secondarily as the organ of voice. [NIH] Laxative: An agent that acts to promote evacuation of the bowel; a cathartic or purgative. [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]

Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Lipid: Fat. [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] Liver scan: An image of the liver created on a computer screen or on film. A radioactive substance is injected into a blood vessel and travels through the bloodstream. It collects in the liver, especially in abnormal areas, and can be detected by the scanner. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Loop: A wire usually of platinum bent at one end into a small loop (usually 4 mm inside

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diameter) and used in transferring microorganisms. [NIH] Lordosis: The anterior concavity in the curvature of the lumbar and cervical spine as viewed from the side. The term usually refers to abnormally increased curvature (hollow back, saddle back, swayback). It does not include lordosis as normal mating posture in certain animals ( = posture + sex behavior, animal). [NIH] Lubricants: Oily or slippery substances. [NIH] Lumbar: Pertaining to the loins, the part of the back between the thorax and the pelvis. [EU] 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] 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] Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. [NIH] Malignancy: A cancerous tumor that can invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Mastication: The act and process of chewing and grinding food in the mouth. [NIH] Mastocytosis: A group of diseases resulting from proliferation of mast cells. [NIH] Meatus: A canal running from the internal auditory foramen through the petrous portion of the temporal bone. It gives passage to the facial and auditory nerves together with the auditory branch of the basilar artery and the internal auditory veins. [NIH] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Menopause: Permanent cessation of menstruation. [NIH] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH] Menthol: An alcohol produced from mint oils or prepared synthetically. [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]

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Metoprolol: Adrenergic beta-1-blocking agent with no stimulatory action. It is less bound to plasma albumin than alprenolol and may be useful in angina pectoris, hypertension, or cardiac arrhythmias. [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] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Micro-organism: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Midodrine: An ethanolamine derivative that is an adrenergic alpha agonist. It is used as a vasoconstrictor agent in the treatment of hypotension. [NIH] Milliliter: A measure of volume for a liquid. A milliliter is approximately 950-times smaller than a quart and 30-times smaller than a fluid ounce. A milliliter of liquid and a cubic centimeter (cc) of liquid are the same. [NIH] Miscarriage: Spontaneous expulsion of the products of pregnancy before the middle of the second trimester. [NIH] Mobility: Capability of movement, of being moved, or of flowing freely. [EU] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molar pregnancy: A rare cancer in women of child-bearing age in which cancer cells grow in the tissues that are formed in the uterus after conception. Also called gestational trophoblastic disease, gestational trophoblastic neoplasia, gestational trophoblastic tumor, or choriocarcinoma. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Morphine: The principal alkaloid in opium and the prototype opiate analgesic and narcotic. Morphine has widespread effects in the central nervous system and on smooth muscle. [NIH] Morphological: Relating to the configuration or the structure of live organs. [NIH] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH] Motor Activity: The physical activity of an organism as a behavioral phenomenon. [NIH] Movement Disorders: Syndromes which feature dyskinesias as a cardinal manifestation of the disease process. Included in this category are degenerative, hereditary, post-infectious, medication-induced, post-inflammatory, and post-traumatic conditions. [NIH] Mucins: A secretion containing mucopolysaccharides and protein that is the chief constituent of mucus. [NIH] Multiple sclerosis: A disorder of the central nervous system marked by weakness, numbness, a loss of muscle coordination, and problems with vision, speech, and bladder control. Multiple sclerosis is thought to be an autoimmune disease in which the body's

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immune system destroys myelin. Myelin is a substance that contains both protein and fat (lipid) and serves as a nerve insulator and helps in the transmission of nerve signals. [NIH] Muscular Diseases: Acquired, familial, and congenital disorders of skeletal muscle and smooth muscle. [NIH] Musculature: The muscular apparatus of the body, or of any part of it. [EU] Myasthenia: Muscular debility; any constitutional anomaly of muscle. [EU] Mydriatic: 1. Dilating the pupil. 2. Any drug that dilates the pupil. [EU] Myelin: The fatty substance that covers and protects nerves. [NIH] Myocardial infarction: Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Myocardial Ischemia: A disorder of cardiac function caused by insufficient blood flow to the muscle tissue of the heart. The decreased blood flow may be due to narrowing of the coronary arteries (coronary arteriosclerosis), to obstruction by a thrombus (coronary thrombosis), or less commonly, to diffuse narrowing of arterioles and other small vessels within the heart. Severe interruption of the blood supply to the myocardial tissue may result in necrosis of cardiac muscle (myocardial infarction). [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Narcosis: A general and nonspecific reversible depression of neuronal excitability, produced by a number of physical and chemical aspects, usually resulting in stupor. [NIH] Narcotic: 1. Pertaining to or producing narcosis. 2. An agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Narcotic Antagonists: Agents inhibiting the effect of narcotics on the central nervous system. [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] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] Near Drowning: Non-fatal immersion or submersion in water. The subject is resuscitable. [NIH]

Neck Pain: Discomfort or more intense forms of pain that are localized to the cervical region. This term generally refers to pain in the posterior or lateral regions of the neck. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with

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other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nerve Endings: Specialized terminations of peripheral neurons. Nerve endings include neuroeffector junction(s) by which neurons activate target organs and sensory receptors which transduce information from the various sensory modalities and send it centrally in the nervous system. Presynaptic nerve endings are presynaptic terminals. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neural tube defects: These defects include problems stemming from fetal development of the spinal cord, spine, brain, and skull, and include birth defects such as spina bifida, anencephaly, and encephalocele. Neural tube defects occur early in pregnancy at about 4 to 6 weeks, usually before a woman knows she is pregnant. Many babies with neural tube defects have difficulty walking and with bladder and bowel control. [NIH] Neuroeffector Junction: The synapse between a neuron (presynaptic) and an effector cell other than another neuron (postsynaptic). Neuroeffector junctions include synapses onto muscles and onto secretory cells. [NIH] Neurogenic: Loss of bladder control caused by damage to the nerves controlling the bladder. [NIH] Neurologic: Having to do with nerves or the nervous system. [NIH] Neuromuscular: Pertaining to muscles and nerves. [EU] Neuromuscular Junction: The synapse between a neuron and a muscle. [NIH] Neuromuscular Junction Diseases: Conditions characterized by impaired transmission of impulses at the neuromuscular junction. This may result from disorders that affect receptor function, pre- or postsynaptic membrane function, or acetylcholinesteraseactivity. The majority of diseases in this category are associated with autoimmune, toxic, or inherited conditions. [NIH] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropathy: A problem in any part of the nervous system except the brain and spinal cord. Neuropathies can be caused by infection, toxic substances, or disease. [NIH] Nitroglycerin: A highly volatile organic nitrate that acts as a dilator of arterial and venous smooth muscle and is used in the treatment of angina. It provides relief through improvement of the balance between myocardial oxygen supply and demand. Although total coronary blood flow is not increased, there is redistribution of blood flow in the heart when partial occlusion of coronary circulation is effected. [NIH] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH]

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Nursing Care: Care given to patients by nursing service personnel. [NIH] Nystagmus: Rhythmical oscillation of the eyeballs, either pendular or jerky. [NIH] Ointments: Semisolid preparations used topically for protective emollient effects or as a vehicle for local administration of medications. Ointment bases are various mixtures of fats, waxes, animal and plant oils and solid and liquid hydrocarbons. [NIH] Opsin: A visual pigment protein found in the retinal rods. It combines with retinaldehyde to form rhodopsin. [NIH] Oral Health: The optimal state of the mouth and normal functioning of the organs of the mouth without evidence of disease. [NIH] Oral Hygiene: The practice of personal hygiene of the mouth. It includes the maintenance of oral cleanliness, tissue tone, and general preservation of oral health. [NIH] Orofacial: Of or relating to the mouth and face. [EU] Orthostatic: Pertaining to or caused by standing erect. [EU] Osmotic: Pertaining to or of the nature of osmosis (= the passage of pure solvent from a solution of lesser to one of greater solute concentration when the two solutions are separated by a membrane which selectively prevents the passage of solute molecules, but is permeable to the solvent). [EU] Otolaryngologist: A doctor who specializes in treating diseases of the ear, nose, and throat. Also called an ENT doctor. [NIH] Otolaryngology: A surgical specialty concerned with the study and treatment of disorders of the ear, nose, and throat. [NIH] Otology: The branch of medicine which deals with the diagnosis and treatment of the disorders and diseases of the ear. [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] Overdose: An accidental or deliberate dose of a medication or street drug that is in excess of what is normally used. [NIH] Ovum: A female germ cell extruded from the ovary at ovulation. [NIH] Oxygen Consumption: The oxygen consumption is determined by calculating the difference between the amount of oxygen inhaled and exhaled. [NIH] Oxygenation: The process of supplying, treating, or mixing with oxygen. No:1245 oxygenation the process of supplying, treating, or mixing with oxygen. [EU] Pacemaker: An object or substance that influences the rate at which a certain phenomenon occurs; often used alone to indicate the natural cardiac pacemaker or an artificial cardiac pacemaker. In biochemistry, a substance whose rate of reaction sets the pace for a series of interrelated reactions. [EU] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pallor: A clinical manifestation consisting of an unnatural paleness of the skin. [NIH] Palsies: Disease of the peripheral nervous system occurring usually after many years of increased lead absorption. [NIH]

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Palsy: Disease of the peripheral nervous system occurring usually after many years of increased lead absorption. [NIH] 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] Paraganglia, Chromaffin: Small bodies containing chromaffin cells occurring outside of the adrenal medulla, most commonly near the sympathetic ganglia and in organs such as the kidney, liver, heart and gonads. [NIH] Paralysis: Loss of ability to move all or part of the body. [NIH] Paresis: A general term referring to a mild to moderate degree of muscular weakness, occasionally used as a synonym for paralysis (severe or complete loss of motor function). In the older literature, paresis often referred specifically to paretic neurosyphilis. "General paresis" and "general paralysis" may still carry that connotation. Bilateral lower extremity paresis is referred to as paraparesis. [NIH] Parkinsonism: A group of neurological disorders characterized by hypokinesia, tremor, and muscular rigidity. [EU] Paroxysmal: Recurring in paroxysms (= spasms or seizures). [EU] Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathologies: The study of abnormality, especially the study of diseases. [NIH] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Patient Compliance: Voluntary cooperation of the patient in following a prescribed regimen. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Pediatric Dentistry: The practice of dentistry concerned with the dental problems of children, proper maintenance, and treatment. The dental care may include the services provided by dental specialists. [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] Perfusion: Bathing an organ or tissue with a fluid. In regional perfusion, a specific area of the body (usually an arm or a leg) receives high doses of anticancer drugs through a blood vessel. Such a procedure is performed to treat cancer that has not spread. [NIH] Periaqueductal Gray: Central gray matter surrounding the cerebral aqueduct in the mesencephalon. Physiologically it is probably involved in rage reactions, the lordosis reflex, feeding responses, bladder tonus, and pain. [NIH] Perilymph: The fluid contained within the space separating the membranous from the osseous labyrinth of the ear. [NIH] Peripheral Nervous System: The nervous system outside of the brain and spinal cord. The peripheral nervous system has autonomic and somatic divisions. The autonomic nervous system includes the enteric, parasympathetic, and sympathetic subdivisions. The somatic nervous system includes the cranial and spinal nerves and their ganglia and the peripheral

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sensory receptors. [NIH] Personal Space: Invisible boundaries surrounding the individual's body which are maintained in relation to others. [NIH] Perspiration: Sweating; the functional secretion of sweat. [EU] Petroleum: Naturally occurring complex liquid hydrocarbons which, after distillation, yield combustible fuels, petrochemicals, and lubricants. [NIH] PH: The symbol relating the hydrogen ion (H+) concentration or activity of a solution to that of a given standard solution. Numerically the pH is approximately equal to the negative logarithm of H+ concentration expressed in molarity. pH 7 is neutral; above it alkalinity increases and below it acidity increases. [EU] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Pharynx: The hollow tube about 5 inches long that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes to the stomach). [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Phrenic Nerve: The motor nerve of the diaphragm. The phrenic nerve fibers originate in the cervical spinal column (mostly C4) and travel through the cervical plexus to the diaphragm. [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] Pigments: Any normal or abnormal coloring matter in plants, animals, or micro-organisms. [NIH]

Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] 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]

Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Pons: The part of the central nervous system lying between the medulla oblongata and the mesencephalon, ventral to the cerebellum, and consisting of a pars dorsalis and a pars ventralis. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU]

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Postoperative: After surgery. [NIH] Postoperative Period: The period following a surgical operation. [NIH] Postural: Pertaining to posture or position. [EU] 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] Prenatal: Existing or occurring before birth, with reference to the fetus. [EU] Pressoreceptors: Receptors in the vascular system, particularly the aorta and carotid sinus, which are sensitive to stretch of the vessel walls. [NIH] Presynaptic: Situated proximal to a synapse, or occurring before the synapse is crossed. [EU] Presynaptic Terminals: The distal terminations of axons which are specialized for the release of neurotransmitters. Also included are varicosities along the course of axons which have similar specializations and also release transmitters. Presynaptic terminals in both the central and peripheral nervous systems are included. [NIH] Projection: A defense mechanism, operating unconsciously, whereby that which is emotionally unacceptable in the self is rejected and attributed (projected) to others. [NIH] Prone: Having the front portion of the body downwards. [NIH] Prone Position: The posture of an individual lying face down. [NIH] Prophylaxis: An attempt to prevent disease. [NIH] Propranolol: A widely used non-cardioselective beta-adrenergic antagonist. Propranolol is used in the treatment or prevention of many disorders including acute myocardial infarction, arrhythmias, angina pectoris, hypertension, hypertensive emergencies, hyperthyroidism, migraine, pheochromocytoma, menopause, and anxiety. [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] Protective Agents: Synthetic or natural substances which are given to prevent a disease or disorder or are used in the process of treating a disease or injury due to a poisonous agent. [NIH]

Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH]

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Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH] Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Publishing: "The business or profession of the commercial production and issuance of literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing. [NIH]

Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulmonary Edema: An accumulation of an excessive amount of watery fluid in the lungs, may be caused by acute exposure to dangerous concentrations of irritant gasses. [NIH] Pulmonary Ventilation: The total volume of gas per minute inspired or expired measured in liters per minute. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]

Pupil: The aperture in the iris through which light passes. [NIH] Purgative: 1. Cathartic (def. 1); causing evacuation of the bowels. 2. A cathartic, particularly one that stimulates peristaltic action. [EU] Purpura: Purplish or brownish red discoloration, easily visible through the epidermis, caused by hemorrhage into the tissues. [NIH] Purulent: Consisting of or containing pus; associated with the formation of or caused by pus. [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] 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] Radioactive: Giving off radiation. [NIH] Rage: Fury; violent, intense anger. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH]

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Reassurance: A procedure in psychotherapy that seeks to give the client confidence in a favorable outcome. It makes use of suggestion, of the prestige of the therapist. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Red Nucleus: A pinkish-yellow portion of the midbrain situated in the rostral mesencephalic tegmentum. It receives a large projection from the contralateral half of the cerebellum via the superior cerebellar peduncle and a projection from the ipsilateral motor cortex. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reflex: An involuntary movement or exercise of function in a part, excited in response to a stimulus applied to the periphery and transmitted to the brain or spinal cord. [NIH] Refractory: Not readily yielding to treatment. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Regurgitation: A backward flowing, as the casting up of undigested food, or the backward flowing of blood into the heart, or between the chambers of the heart when a valve is incompetent. [EU] 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] Respiratory Paralysis: Complete or severe weakness of the muscles of respiration. This condition may be associated with motor neuron diseases; peripheral nerve disorders; neuromuscular junction diseases; spinal cord diseases; injury to the phrenic nerve; and other disorders. [NIH] Respiratory Physiology: Functions and activities of the respiratory tract as a whole or of any of its parts. [NIH] Respiratory System: The tubular and cavernous organs and structures, by means of which pulmonary ventilation and gas exchange between ambient air and the blood are brought about. [NIH] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Retinal: 1. Pertaining to the retina. 2. The aldehyde of retinol, derived by the oxidative enzymatic splitting of absorbed dietary carotene, and having vitamin A activity. In the retina, retinal combines with opsins to form visual pigments. One isomer, 11-cis retinal combines with opsin in the rods (scotopsin) to form rhodopsin, or visual purple. Another, all-trans retinal (trans-r.); visual yellow; xanthopsin) results from the bleaching of rhodopsin by light, in which the 11-cis form is converted to the all-trans form. Retinal also combines with opsins in the cones (photopsins) to form the three pigments responsible for colour vision. Called also retinal, and retinene1. [EU] Retinal Hemorrhage: Bleeding from the vessels of the retina. [NIH] Retinol: Vitamin A. It is essential for proper vision and healthy skin and mucous

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membranes. Retinol is being studied for cancer prevention; it belongs to the family of drugs called retinoids. [NIH] Retroperitoneal: Having to do with the area outside or behind the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH] Retrospective: Looking back at events that have already taken place. [NIH] Rigidity: Stiffness or inflexibility, chiefly that which is abnormal or morbid; rigor. [EU] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Rods: One type of specialized light-sensitive cells (photoreceptors) in the retina that provide side vision and the ability to see objects in dim light (night vision). [NIH] Saliva: The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptylin. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Scans: Pictures of structures inside the body. Scans often used in diagnosing, staging, and monitoring disease include liver scans, bone scans, and computed tomography (CT) or computerized axial tomography (CAT) scans and magnetic resonance imaging (MRI) scans. In liver scanning and bone scanning, radioactive substances that are injected into the bloodstream collect in these organs. A scanner that detects the radiation is used to create pictures. In CT scanning, an x-ray machine linked to a computer is used to produce detailed pictures of organs inside the body. MRI scans use a large magnet connected to a computer to create pictures of areas inside the body. [NIH] Schizoid: Having qualities resembling those found in greater degree in schizophrenics; a person of schizoid personality. [NIH] Schizophrenia: A mental disorder characterized by a special type of disintegration of the personality. [NIH] Schizotypal Personality Disorder: A personality disorder in which there are oddities of thought (magical thinking, paranoid ideation, suspiciousness), perception (illusions, depersonalization), speech (digressive, vague, overelaborate), and behavior (inappropriate affect in social interactions, frequently social isolation) that are not severe enough to characterize schizophrenia. [NIH] Schwannoma: A tumor of the peripheral nervous system that begins in the nerve sheath (protective covering). It is almost always benign, but rare malignant schwannomas have been reported. [NIH] Scleroderma: A chronic disorder marked by hardening and thickening of the skin. Scleroderma can be localized or it can affect the entire body (systemic). [NIH] Sclerosis: A pathological process consisting of hardening or fibrosis of an anatomical structure, often a vessel or a nerve. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] 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] Secretory Vesicles: Vesicles derived from the golgi apparatus containing material to be released at the cell surface. [NIH]

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Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Self Care: Performance of activities or tasks traditionally performed by professional health care providers. The concept includes care of oneself or one's family and friends. [NIH] Semicircular canal: Three long canals of the bony labyrinth of the ear, forming loops and opening into the vestibule by five openings. [NIH] Senna: Preparations of Cassia senna L. and C. angustifolia of the Leguminosae. They contain sennosides, which are anthraquinone type cathartics and are used in many different preparations as laxatives. [NIH] Sensor: A device designed to respond to physical stimuli such as temperature, light, magnetism or movement and transmit resulting impulses for interpretation, recording, movement, or operating control. [NIH] Sensory loss: A disease of the nerves whereby the myelin or insulating sheath of myelin on the nerves does not stay intact and the messages from the brain to the muscles through the nerves are not carried properly. [NIH] Sexually Transmitted Diseases: Diseases due to or propagated by sexual contact. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Shoulder Pain: Unilateral or bilateral pain of the shoulder. It is often caused by physical activities such as work or sports participation, but may also be pathologic in origin. [NIH] Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Skin Care: Maintenance of the hygienic state of the skin under optimal conditions of cleanliness and comfort. Effective in skin care are proper washing, bathing, cleansing, and the use of soaps, detergents, oils, etc. In various disease states, therapeutic and protective solutions and ointments are useful. The care of the skin is particularly important in various occupations, in exposure to sunlight, in neonates, and in decubitus ulcer. [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]

Soaps: Sodium or potassium salts of long chain fatty acids. These detergent substances are obtained by boiling natural oils or fats with caustic alkali. Sodium soaps are harder and are used as topical anti-infectives and vehicles in pills and liniments; potassium soaps are soft,

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used as vehicles for ointments and also as topical antimicrobials. [NIH] Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Solitary Nucleus: Gray matter located in the dorsomedial part of the medulla oblongata associated with the solitary tract. The solitary nucleus receives inputs from most organ systems including the terminations of the facial, glossopharyngeal, and vagus nerves. It is a major coordinator of autonomic nervous system regulation of cardiovascular, respiratory, gustatory, gastrointestinal, and chemoreceptive aspects of homeostasis. The solitary nucleus is also notable for the large number of neurotransmitters which are found therein. [NIH] Soma: The body as distinct from the mind; all the body tissue except the germ cells; all the axial body. [NIH] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] 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] Spatial disorientation: Loss of orientation in space where person does not know which way is up. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] 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] Spectrophotometry: The art or process of comparing photometrically the relative intensities of the light in different parts of the spectrum. [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] Spina bifida: A defect in development of the vertebral column in which there is a central deficiency of the vertebral lamina. [NIH] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spinal Cord Diseases: Pathologic conditions which feature spinal cord damage or dysfunction, including disorders involving the meninges and perimeningeal spaces surrounding the spinal cord. Traumatic injuries, vascular diseases, infections, and inflammatory/autoimmune processes may affect the spinal cord. [NIH]

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Spirochete: Lyme disease. [NIH] Sprains and Strains: A collective term for muscle and ligament injuries without dislocation or fracture. A sprain is a joint injury in which some of the fibers of a supporting ligament are ruptured but the continuity of the ligament remains intact. A strain is an overstretching or overexertion of some part of the musculature. [NIH] Staging: Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. [NIH]

Steroids: Drugs used to relieve swelling and inflammation. [NIH] Stimulant: 1. Producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. An agent or remedy that produces stimulation. [EU]

Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] 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] 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] Stroke Volume: The amount of blood pumped out of the heart per beat not to be confused with cardiac output (volume/time). [NIH] Stupor: Partial or nearly complete unconsciousness, manifested by the subject's responding only to vigorous stimulation. Also, in psychiatry, a disorder marked by reduced responsiveness. [EU] Subacute: Somewhat acute; between acute and chronic. [EU] Subarachnoid: Situated or occurring between the arachnoid and the pia mater. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Sublingual: Located beneath the tongue. [EU] 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] Subtrochanteric: Below a trochanter. [NIH] Suction: The removal of secretions, gas or fluid from hollow or tubular organs or cavities by means of a tube and a device that acts on negative pressure. [NIH] Sudden cardiac death: Cardiac arrest caused by an irregular heartbeat. [NIH] Sudden death: Cardiac arrest caused by an irregular heartbeat. The term "death" is somewhat misleading, because some patients survive. [NIH] Support group: A group of people with similar disease who meet to discuss how better to cope with their cancer and treatment. [NIH] Sweat: The fluid excreted by the sweat glands. It consists of water containing sodium chloride, phosphate, urea, ammonia, and other waste products. [NIH]

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Sweat Glands: Sweat-producing structures that are embedded in the dermis. Each gland consists of a single tube, a coiled body, and a superficial duct. [NIH] Sympathetic Nervous System: The thoracolumbar division of the autonomic nervous system. Sympathetic preganglionic fibers originate in neurons of the intermediolateral column of the spinal cord and project to the paravertebral and prevertebral ganglia, which in turn project to target organs. The sympathetic nervous system mediates the body's response to stressful situations, i.e., the fight or flight reactions. It often acts reciprocally to the parasympathetic system. [NIH] Sympathomimetic: 1. Mimicking the effects of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. 2. An agent that produces effects similar to those of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. Called also adrenergic. [EU] Syncope: A temporary suspension of consciousness due to generalized cerebral schemia, a faint or swoon. [EU] Syphilis: A contagious venereal disease caused by the spirochete Treponema pallidum. [NIH]

Syringomyelia: The presence in the spinal cord of elongated central fluid containing cavities surrounded by gliosis. [NIH] Systemic: Affecting the entire body. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Systolic pressure: The highest pressure to which blood pressure rises with the contraction of the ventricles. [NIH] Tachycardia: Excessive rapidity in the action of the heart, usually with a heart rate above 100 beats per minute. [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] Teratogenic: Tending to produce anomalies of formation, or teratism (= anomaly of formation or development : condition of a monster). [EU] Thalamic: Cell that reaches the lateral nucleus of amygdala. [NIH] Thalamic Diseases: Disorders of the centrally located thalamus, which integrates a wide range of cortical and subcortical information. Manifestations include sensory loss, movement disorders; ataxia, pain syndromes, visual disorders, a variety of neuropsychological conditions, and coma. Relatively common etiologies include cerebrovascular disorders; craniocerebral trauma; brain neoplasms; brain hypoxia; intracranial hemorrhages; and infectious processes. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thoracic: Having to do with the chest. [NIH] 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] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thrombus: An aggregation of blood factors, primarily platelets and fibrin with entrapment of cellular elements, frequently causing vascular obstruction at the point of its formation.

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Some authorities thus differentiate thrombus formation from simple coagulation or clot formation. [EU] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Thyroid Gland: A highly vascular endocrine gland consisting of two lobes, one on either side of the trachea, joined by a narrow isthmus; it produces the thyroid hormones which are concerned in regulating the metabolic rate of the body. [NIH] Thyroid Hormones: Hormones secreted by the thyroid gland. [NIH] Tidal Volume: The volume of air inspired or expired during each normal, quiet respiratory cycle. Common abbreviations are TV or V with subscript T. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tolerance: 1. The ability to endure unusually large doses of a drug or toxin. 2. Acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU] 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] Tonus: A state of slight tension usually present in muscles even when they are not undergoing active contraction. [NIH] Torsion: A twisting or rotation of a bodily part or member on its axis. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Trachea: The cartilaginous and membranous tube descending from the larynx and branching into the right and left main bronchi. [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Trigeminal: Cranial nerve V. It is sensory for the eyeball, the conjunctiva, the eyebrow, the skin of face and scalp, the teeth, the mucous membranes in the mouth and nose, and is motor to the muscles of mastication. [NIH] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of Mycobacterium. [NIH] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH]

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Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Urea: A compound (CO(NH2)2), formed in the liver from ammonia produced by the deamination of amino acids. It is the principal end product of protein catabolism and constitutes about one half of the total urinary solids. [NIH] Ureters: Tubes that carry urine from the kidneys to the bladder. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary tract: The organs of the body that produce and discharge urine. These include the kidneys, ureters, bladder, and urethra. [NIH] Urinary tract infection: An illness caused by harmful bacteria growing in the urinary tract. [NIH]

Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Urticaria: A vascular reaction of the skin characterized by erythema and wheal formation due to localized increase of vascular permeability. The causative mechanism may be allergy, infection, or stress. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] 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] Vagal: Pertaining to the vagus nerve. [EU] Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Vaginal: Of or having to do with the vagina, the birth canal. [NIH] Vaginitis: Inflammation of the vagina characterized by pain and a purulent discharge. [NIH] Vagus Nerve: The 10th cranial nerve. The vagus is a mixed nerve which contains somatic afferents (from skin in back of the ear and the external auditory meatus), visceral afferents (from the pharynx, larynx, thorax, and abdomen), parasympathetic efferents (to the thorax and abdomen), and efferents to striated muscle (of the larynx and pharynx). [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vascular Resistance: An expression of the resistance offered by the systemic arterioles, and to a lesser extent by the capillaries, to the flow of blood. [NIH] Vasoconstriction: Narrowing of the blood vessels without anatomic change, for which constriction, pathologic is used. [NIH] Vasodilatation: A state of increased calibre of the blood vessels. [EU] Vasodilation: Physiological dilation of the blood vessels without anatomic change. For dilation with anatomic change, dilatation, pathologic or aneurysm (or specific aneurysm) is used. [NIH] Vasodilator: An agent that widens blood vessels. [NIH] VE: The total volume of gas either inspired or expired in one minute. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH]

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Venereal: Pertaining or related to or transmitted by sexual contact. [EU] Venous: Of or pertaining to the veins. [EU] Ventilation: 1. In respiratory physiology, the process of exchange of air between the lungs and the ambient air. Pulmonary ventilation (usually measured in litres per minute) refers to the total exchange, whereas alveolar ventilation refers to the effective ventilation of the alveoli, in which gas exchange with the blood takes place. 2. In psychiatry, verbalization of one's emotional problems. [EU] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Ventricular: Pertaining to a ventricle. [EU] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Vertebral: Of or pertaining to a vertebra. [EU] Vertigo: An illusion of movement; a sensation as if the external world were revolving around the patient (objective vertigo) or as if he himself were revolving in space (subjective vertigo). The term is sometimes erroneously used to mean any form of dizziness. [EU] Vestibular: Pertaining to or toward a vestibule. In dental anatomy, used to refer to the tooth surface directed toward the vestibule of the mouth. [EU] Vestibule: A small, oval, bony chamber of the labyrinth. The vestibule contains the utricle and saccule, organs which are part of the balancing apparatus of the ear. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] 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] Viscera: Any of the large interior organs in any one of the three great cavities of the body, especially in the abdomen. [NIH] Visceral: , from viscus a viscus) pertaining to a viscus. [EU] Visceral Afferents: The sensory fibers innervating the viscera. [NIH] Volition: Voluntary activity without external compulsion. [NIH] Windpipe: A rigid tube, 10 cm long, extending from the cricoid cartilage to the upper border of the fifth thoracic vertebra. [NIH] Withdrawal: 1. A pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) A substance-specific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU] Womb: A hollow, thick-walled, muscular organ in which the impregnated ovum is developed into a child. [NIH] Xerostomia: Decreased salivary flow. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH]

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INDEX A Abdominal, 82, 97, 123, 128 Abdominal Pain, 82, 97 Abduction, 9, 97 Acoustic, 63, 97 Activities of Daily Living, 6, 97 Adjustment, 7, 97 Adrenal Glands, 63, 97 Adrenal insufficiency, 4, 59, 97 Adrenal Medulla, 63, 97, 103, 104, 110, 121, 123 Adrenaline, 46, 97 Adrenergic, 5, 46, 97, 98, 109, 110, 119, 125, 132 Adrenergic Agonists, 5, 97 Advanced Cardiac Life Support, 62, 97 Adverse Effect, 4, 97, 100, 129 Aerobic, 97, 111 Afferent, 97, 107 Affinity, 97, 98, 130 Age Groups, 62, 98 Aged, 80 and Over, 98 Agonist, 46, 98, 99, 109, 110, 119 Airway, 4, 59, 62, 97, 98, 102 Airway Obstruction, 4, 60, 98 Albumin, 98, 119 Algorithms, 98, 101 Alimentary, 98, 116, 117 Alkaline, 98, 102 Aloe, 4, 98 Alpha-1, 98, 110 Alprenolol, 98, 119 Alternative medicine, 69, 98 Alveoli, 98, 135 Amine, 98, 114 Ammonia, 98, 131, 134 Analgesics, 62, 98 Analog, 99, 117 Anaphylactic, 4, 7, 99 Anaphylaxis, 38, 99 Anatomical, 99, 100, 106, 108, 110, 115, 117, 128 Anesthesia, 4, 63, 98, 99 Anesthetics, 3, 62, 99, 110 Aneurysm, 99, 134 Angina, 4, 5, 7, 56, 57, 60, 99, 117, 119, 121, 125 Angina Pectoris, 4, 7, 60, 99, 119, 125

Angioneurotic, 4, 99 Angioneurotic Edema, 4, 99 Antagonism, 99, 109 Antibiotics, 62, 99 Antibody, 98, 99, 105, 116 Anticonvulsants, 62, 99 Antigen, 97, 99, 105, 115, 116 Anxiety, 44, 62, 93, 99, 125 Aorta, 99, 125, 135 Aortic Valve, 12, 99 Apomorphine, 6, 99 Appendicitis, 60, 100 Arrhythmia, 13, 38, 46, 51, 54, 55, 62, 67, 80, 100 Arterial, 45, 69, 70, 100, 115, 121, 125, 132 Arteries, 99, 100, 101, 107, 119, 120 Arterioles, 100, 101, 120, 134 Astringents, 100, 118 Asystole, 20, 21, 100 Ataxia, 61, 100, 114, 132 Atrial, 10, 19, 20, 35, 100, 114 Atrial Fibrillation, 19, 35, 100 Atrial Flutter, 20, 100 Atrium, 100, 135 Auditory, 32, 100, 118, 134 Auscultation, 100, 114 Autoimmune disease, 100, 119 Autonomic, 5, 14, 15, 16, 24, 31, 35, 43, 44, 45, 55, 61, 100, 107, 113, 121, 123, 130, 132 Autonomic Nervous System, 5, 16, 44, 45, 55, 100, 123, 130, 132 B Back Pain, 60, 100 Bacteria, 99, 100, 108, 110, 111, 119, 130, 134 Baroreflex, 43, 100 Basal Ganglia, 100, 101, 104 Basal Ganglia Diseases, 100, 101, 104 Base, 54, 101, 117, 132 Benign, 5, 55, 63, 101, 113, 128 Bifida, 101 Bilateral, 101, 123, 129 Bile, 101, 112, 117 Biochemical, 63, 101 Biopsy, 83, 101 Biotechnology, 10, 11, 61, 69, 75, 101 Bladder, 101, 119, 121, 123, 134

138 Fainting

Blood Coagulation, 101, 102 Blood pressure, 5, 14, 22, 44, 45, 51, 53, 54, 55, 56, 59, 94, 100, 101, 103, 115, 119, 130, 132 Blood vessel, 45, 70, 100, 101, 102, 103, 104, 105, 117, 123, 129, 130, 131, 132, 134 Bone Density, 9, 101 Bone Marrow, 83, 101, 102, 118 Bone marrow biopsy, 83, 102 Bone scan, 102, 128 Bowel, 102, 108, 117, 121 Bowel Movement, 102, 108 Bradycardia, 31, 32, 34, 54, 55, 102 Branch, 12, 91, 102, 118, 122, 123, 126, 130, 132 Breakdown, 102, 108, 112 Bronchi, 102, 110, 117, 133 Bronchial, 4, 102, 114 Bronchitis, 60, 102 Bronchodilator, 102, 117 Bronchoscopy, 70, 102 Buffers, 100, 102 Burns, 60, 102 Burns, Electric, 102 C Calcium, 70, 102, 105, 109 Calcium channel blocker, 70, 102 Calcium Channel Blockers, 70, 102 Carbon Dioxide, 102, 103, 108, 112, 115, 127 Cardiac arrest, 7, 34, 59, 103, 131 Cardiac Output, 5, 50, 55, 101, 103, 113, 131 Cardiomyopathy, 103 Cardiopulmonary, 6, 60, 97, 103 Cardiopulmonary Resuscitation, 60, 103 Cardioselective, 103, 125 Cardiovascular, 5, 9, 16, 17, 32, 34, 37, 38, 46, 51, 54, 55, 103, 111, 130 Cardiovascular disease, 5, 103 Carotene, 103, 127 Carotid Body, 36, 103 Carotid Sinus, 31, 32, 33, 34, 35, 36, 103, 113, 125 Case report, 3, 18, 19, 103 Catecholamine, 103, 109 Cell, 98, 100, 101, 102, 103, 105, 108, 116, 118, 120, 121, 122, 124, 127, 128, 132, 133 Cell membrane, 102, 103 Cell Respiration, 103, 127 Central Nervous System, 8, 61, 62, 100, 103, 104, 112, 113, 114, 119, 120, 124

Central Nervous System Infections, 104, 113, 114 Cerebellar, 100, 104, 127 Cerebral, 5, 11, 13, 54, 55, 61, 100, 101, 104, 107, 110, 111, 114, 123, 132 Cerebral Aqueduct, 104, 123 Cerebral Palsy, 61, 104 Cerebrovascular, 4, 60, 61, 101, 102, 103, 104, 132 Cerebrum, 104 Cervical, 104, 109, 118, 120, 124 Cervix, 82, 104, 109 Chaos, 9, 104 Character, 99, 104 Chest Pain, 12, 59, 60, 70, 104 Chorea, 61, 104 Choreatic Disorders, 104 Choriocarcinoma, 104, 112, 113, 119 Chromaffin Cells, 63, 104, 123 Chromic, 104 Chromosomal, 82, 104 Chronic, 4, 6, 43, 44, 55, 80, 82, 100, 104, 116, 128, 131 Chronic Disease, 82, 104 Chronic Fatigue Syndrome, 44, 80, 104 Circulatory system, 105, 116 CIS, 105, 127 Clinical trial, 8, 43, 47, 75, 105, 125, 126 Cloning, 101, 105 Cochlea, 63, 105, 116 Cofactor, 105, 125 Complement, 105 Complementary and alternative medicine, 31, 39, 105 Complementary medicine, 31, 105 Computational Biology, 75, 106 Computed tomography, 63, 70, 101, 106, 128 Computerized axial tomography, 106, 128 Computerized tomography, 106 Conception, 104, 106, 112, 113, 119 Conduction, 32, 44, 46, 50, 106 Cones, 106, 127 Confined Spaces, 10, 106 Congestion, 16, 106, 110 Congestive heart failure, 5, 106 Conjunctiva, 106, 133 Connective Tissue, 102, 106, 112 Consciousness, 5, 44, 51, 54, 55, 59, 84, 94, 98, 106, 132 Constipation, 4, 60, 106 Constitutional, 106, 120

Index 139

Constrict, 70, 106 Constriction, 106, 117, 134 Constriction, Pathologic, 106, 134 Consultation, 13, 62, 107 Consumption, 6, 68, 107, 122 Contractility, 5, 55, 107 Contraindications, ii, 107 Convulsions, 4, 107 Coordination, 107, 119 Coronary, 5, 16, 57, 99, 103, 107, 119, 120, 121 Coronary Arteriosclerosis, 107, 120 Coronary Circulation, 99, 107, 121 Coronary heart disease, 103, 107 Coronary Thrombosis, 107, 119, 120 Corpus, 107, 123 Cortex, 100, 107, 111, 127 Cortical, 107, 111, 129, 132 Cranial, 61, 107, 113, 115, 116, 123, 133, 134 Cranial Nerves, 61, 107 Craniocerebral Trauma, 101, 107, 113, 114, 132 Curative, 107, 132 Curettage, 107, 109 Curette, 107, 109 D Databases, Bibliographic, 75, 107 Decarboxylation, 108, 114 Decubitus, 108, 129 Decubitus Ulcer, 108, 129 Dehydration, 7, 108 Dendrites, 108, 121 Dental Care, 6, 108, 123 Dental Caries, 6, 108 Dental Hygienists, 5, 108 Dental Materials, 7, 108 Dentists, 3, 7, 108 Detergents, 108, 129 Deuterium, 108, 114 Diabetes Mellitus, 60, 62, 108, 113 Diagnostic procedure, 49, 69, 108 Diaphoresis, 63, 108 Diarrhea, 4, 60, 76, 83, 108 Diastolic, 108, 115 Digestion, 98, 101, 102, 108, 117, 131 Digestive system, 47, 108 Dilatation, 99, 108, 134 Dilatation, Pathologic, 108, 134 Dilation, 82, 108, 109, 114, 134 Dilation and curettage, 82, 109 Dilator, 109, 121

Diltiazem, 70, 109 Direct, iii, 109, 127 Discrimination, 10, 109 Dislocation, 109, 131 Diuretic, 109, 117 Dizziness, 5, 6, 14, 60, 62, 63, 70, 82, 93, 109, 135 Dopamine, 6, 99, 109 Drug Interactions, 109 Drug Tolerance, 109, 133 Duodenum, 101, 109, 131 Dyskinesia, 109 E Echocardiography, 21, 109 Ectopic, 81, 82, 109 Ectopic Pregnancy, 81, 82, 109 Edema, 99, 109 Efficacy, 7, 15, 46, 50, 109 Electric shock, 103, 109 Electrocardiogram, 46, 109 Electrocardiography, 51, 110 Embolus, 110, 116 Embryo, 82, 110, 112 Emetic, 100, 110 Emodin, 98, 110 Enamel, 108, 110 Encephalocele, 110, 121 Encephalopathy, 61, 110 Environmental Health, 74, 76, 110 Enzymatic, 102, 103, 105, 108, 110, 114, 127 Epigastric, 63, 110, 123 Epinephrine, 5, 7, 15, 46, 97, 104, 109, 110, 117, 121, 133 Erectile, 6, 110, 123 Erection, 110 Ergot, 110 Ergotamine, 34, 110 Erythema, 99, 110, 134 Erythrocytes, 102, 110 Esophagus, 108, 110, 114, 124, 131 Ethanolamine, 110, 119 Evacuation, 106, 111, 117, 126 Evoke, 111, 131 Excitation, 100, 111 Excitatory, 8, 55, 111 Exercise Test, 12, 111 Expiration, 111, 127 Extrapyramidal, 109, 111 Extravasation, 43, 111 F Facial, 61, 111, 118, 130 Facial Pain, 61, 111

140 Fainting

Facial Paralysis, 61, 111 Family Planning, 75, 111 Fat, 102, 103, 107, 108, 110, 111, 117, 120, 130 Fathers, 17, 111 Fatigue, 55, 104, 111, 114 Feces, 106, 111 Femoral, 111, 114 Femoral Neck Fractures, 111, 114 Femur, 111, 114 Fetal Development, 112, 121 Fetus, 6, 82, 112, 125, 134 Fibrillation, 20, 51, 112 Filtration, 7, 112 Fistula, 63, 112 Flatus, 112 Fold, 9, 112 Forearm, 101, 112 Frail Elderly, 9, 112 G Gait, 9, 112 Gallbladder, 97, 108, 112 Ganglia, 101, 112, 121, 123, 132 Gas, 10, 98, 102, 111, 112, 114, 126, 127, 131, 134, 135 Gas exchange, 112, 127, 135 Gastric, 112, 114 Gastrin, 112, 114 Gastrointestinal, 110, 112, 130 Gene, 53, 61, 101, 112 Genetics, 24, 112 Genital, 82, 112 Germ Cells, 112, 122, 130 Gestation, 82, 112 Gestational, 112, 113, 119 Gestational trophoblastic disease, 112, 113, 119 Gestational trophoblastic neoplasia, 112, 113, 119 Gestational trophoblastic tumor, 112, 113, 119 Gland, 97, 104, 113, 123, 128, 131, 132, 133 Gliosis, 113, 132 Glossopharyngeal Nerve, 111, 113 Glucose, 108, 113, 116 Glucose Intolerance, 108, 113 Governing Board, 113, 125 Granulomas, 6, 113 Gravis, 61, 113 Growth, 99, 112, 113, 118, 120, 124, 133 H Headache, 35, 57, 63, 113, 114

Headache Disorders, 113 Heart Arrest, 103, 113 Heart attack, 12, 103, 113 Heart Catheterization, 70, 113 Heart failure, 60, 114 Heart Murmurs, 5, 114 Heart Sounds, 114 Heartbeat, 9, 100, 114, 131 Heartburn, 60, 114 Hemorrhage, 6, 8, 107, 113, 114, 126, 131 Heredity, 112, 114 Hernia, 18, 114 Hip Fractures, 9, 111, 114 Histamine, 83, 114 Histidine, 114 Hormonal, 104, 114 Hormone, 82, 97, 110, 112, 114, 116, 133 Hydrocephalus, 114, 117 Hydrogen, 10, 98, 101, 102, 108, 114, 119, 124, 126 Hygienic, 115, 129 Hyperemesis, 6, 115 Hyperglycemia, 60, 115 Hypersensitivity, 33, 35, 36, 99, 115 Hypertension, 5, 15, 38, 45, 63, 69, 70, 102, 103, 113, 114, 115, 119, 125 Hyperthyroidism, 115, 125 Hypertrophic cardiomyopathy, 34, 115 Hyperventilation, 4, 7, 60, 62, 93, 115 Hypnotic, 44, 115 Hypoglossal Nerve, 61, 115 Hypoglycemia, 7, 60, 115 Hypotension, 4, 5, 7, 20, 54, 55, 59, 94, 107, 115, 119 Hypothalamus, 100, 115 Hypovolemia, 43, 115 Hypoxia, 55, 115, 132 I Id, 28, 37, 80, 83, 84, 90, 92, 115 Idiopathic, 32, 61, 115 Illusion, 115, 135 Immersion, 115, 120 Immune system, 83, 115, 120, 134 Impairment, 16, 55, 61, 100, 109, 115, 118 Impotence, 6, 21, 28, 110, 115 Incision, 115, 116 Indicative, 60, 115, 123, 134 Infant, Newborn, 98, 115 Infarction, 5, 114, 115 Infection, 62, 116, 118, 121, 131, 134 Inflammation, 98, 100, 102, 113, 116, 117, 126, 131, 134

Index 141

Infusion, 16, 50, 116 Inner ear, 63, 116, 117 Innervation, 115, 116 Inotropic, 109, 116 Insight, 8, 22, 116 Insulator, 116, 120 Insulin, 4, 17, 116 Insulin-dependent diabetes mellitus, 116 Intermittent, 54, 55, 116 Intestines, 97, 111, 112, 116 Intoxication, 61, 116, 135 Intracellular, 102, 116 Intracranial Pressure, 61, 116 Intravascular, 113, 116 Intravenous, 25, 44, 63, 116 Intrinsic, 54, 98, 116 Invasive, 31, 62, 116, 118 Involuntary, 44, 101, 104, 112, 116, 120, 127 Ions, 101, 102, 114, 116 Ischemia, 34, 62, 108, 117 Isoproterenol, 13, 16, 25, 117 Isosorbide, 16, 117 Isosorbide Dinitrate, 16, 117 J Joint, 117, 131 K Kb, 74, 117 Keratolytic, 108, 117 L Labyrinth, 105, 116, 117, 123, 129, 135 Labyrinthitis, 63, 117 Large Intestine, 108, 116, 117, 127, 129 Larynx, 117, 133, 134 Laxative, 4, 110, 117 Leukocytes, 102, 117 Library Services, 90, 117 Ligament, 117, 131 Lipid, 116, 117, 120 Liquor, 117, 126 Liver, 4, 97, 98, 101, 108, 111, 112, 117, 123, 128, 134 Liver scan, 117, 128 Localized, 108, 116, 117, 120, 124, 128, 134 Loop, 11, 12, 13, 15, 19, 37, 51, 114, 117 Lordosis, 118, 123 Lubricants, 118, 124 Lumbar, 100, 118 Lymphatic, 116, 118 Lymphoid, 118 Lymphoma, 36, 118

M Magnetic Resonance Imaging, 63, 118, 128 Malignancy, 63, 118 Malignant, 16, 54, 104, 118, 128 Mastication, 118, 133 Mastocytosis, 82, 118 Meatus, 118, 134 Mediate, 8, 109, 118 MEDLINE, 75, 118 Membrane, 103, 105, 106, 109, 117, 118, 121, 122, 127 Memory, 51, 118 Meninges, 104, 107, 118, 130 Menopause, 118, 125 Mental Disorders, 48, 118, 126 Mental Health, iv, 8, 48, 74, 77, 118, 126 Menthol, 56, 57, 118 Mercury, 61, 118 Metoprolol, 25, 119 MI, 5, 82, 95, 119 Microbe, 119, 133 Micro-organism, 108, 119, 124 Midodrine, 19, 46, 119 Milliliter, 101, 119 Miscarriage, 81, 82, 119 Mobility, 6, 119 Modification, 119, 126 Molar pregnancy, 82, 112, 113, 119 Molecular, 24, 75, 77, 101, 106, 119 Molecule, 99, 101, 105, 111, 119, 127 Monitor, 44, 50, 51, 54, 94, 119 Morphine, 99, 119, 120 Morphological, 110, 119 Motion Sickness, 119, 120 Motor Activity, 107, 119 Movement Disorders, 119, 132 Mucins, 119, 128 Multiple sclerosis, 61, 119 Muscular Diseases, 111, 120 Musculature, 120, 131 Myasthenia, 61, 120 Mydriatic, 109, 120 Myelin, 120, 129 Myocardial infarction, 4, 5, 7, 21, 60, 107, 119, 120, 125 Myocardial Ischemia, 23, 37, 99, 120 Myocardium, 53, 99, 119, 120 N Narcosis, 120 Narcotic, 62, 119, 120 Narcotic Antagonists, 62, 120 Nausea, 4, 6, 60, 63, 94, 120

142 Fainting

NCI, 1, 47, 73, 105, 120 Near Drowning, 25, 120 Neck Pain, 33, 120 Necrosis, 116, 119, 120 Need, 3, 59, 61, 69, 76, 85, 97, 120, 133 Neoplastic, 111, 118, 120 Nerve Endings, 45, 121 Nervous System, 5, 44, 45, 61, 63, 94, 97, 100, 103, 104, 120, 121, 123, 132 Neural, 8, 31, 61, 97, 110, 121 Neural tube defects, 61, 121 Neuroeffector Junction, 121 Neurogenic, 54, 55, 121 Neurologic, 61, 63, 110, 114, 121 Neuromuscular, 9, 111, 121, 127 Neuromuscular Junction, 121, 127 Neuromuscular Junction Diseases, 121, 127 Neurons, 8, 108, 111, 112, 121, 132 Neuropathy, 61, 99, 121 Nitroglycerin, 13, 15, 56, 57, 117, 121 Norepinephrine, 5, 46, 97, 109, 121 Nuclei, 111, 118, 121, 126 Nucleus, 101, 108, 115, 121, 126, 130, 132 Nursing Care, 76, 122 Nystagmus, 62, 122 O Ointments, 122, 129, 130 Opsin, 122, 127 Oral Health, 61, 122 Oral Hygiene, 6, 122 Orofacial, 111, 122 Orthostatic, 5, 10, 14, 15, 20, 23, 24, 33, 43, 44, 122 Osmotic, 98, 117, 122 Otolaryngologist, 62, 122 Otolaryngology, 62, 122 Otology, 62, 122 Outpatient, 35, 122 Ovaries, 82, 122 Ovary, 82, 122 Overdose, 4, 60, 122 Ovum, 112, 122, 135 Oxygen Consumption, 111, 122, 127 Oxygenation, 5, 19, 122 P Pacemaker, 20, 33, 53, 56, 68, 122 Palliative, 122, 132 Pallor, 63, 94, 122 Palsies, 61, 122 Palsy, 61, 123 Pancreas, 97, 108, 116, 123

Paraganglia, Chromaffin, 104, 123 Paralysis, 10, 111, 123 Paresis, 111, 123 Parkinsonism, 100, 123 Paroxysmal, 20, 35, 63, 99, 113, 123 Pathologic, 62, 101, 107, 115, 123, 129, 130 Pathologies, 8, 9, 123 Pathophysiology, 20, 63, 123 Patient Compliance, 51, 123 Patient Education, 81, 88, 90, 95, 123 Pediatric Dentistry, 62, 123 Penis, 6, 123 Perfusion, 5, 115, 123 Periaqueductal Gray, 8, 123 Perilymph, 63, 123 Peripheral Nervous System, 122, 123, 125, 128 Personal Space, 76, 124 Perspiration, 108, 124 Petroleum, 10, 124 PH, 101, 124 Pharmacologic, 43, 62, 99, 124, 133 Pharynx, 124, 134 Phosphorus, 102, 124 Phrenic Nerve, 124, 127 Physical Examination, 46, 62, 124 Physiologic, 43, 46, 54, 98, 112, 124, 127 Physiology, 62, 63, 124 Pigments, 103, 124, 127 Plants, 102, 110, 113, 121, 124, 133 Plasma, 98, 103, 113, 119, 124 Platinum, 117, 124 Poisoning, 100, 110, 116, 118, 120, 124 Pons, 111, 124 Posterior, 100, 113, 120, 123, 124 Postoperative, 63, 125 Postoperative Period, 63, 125 Postural, 4, 5, 7, 9, 43, 44, 55, 59, 125 Potentiation, 56, 125 Practice Guidelines, 77, 83, 125 Precursor, 109, 110, 121, 125, 133 Prenatal, 110, 125 Pressoreceptors, 100, 125 Presynaptic, 121, 125 Presynaptic Terminals, 121, 125 Projection, 121, 125, 127 Prone, 54, 59, 125 Prone Position, 59, 125 Prophylaxis, 108, 125 Propranolol, 45, 125 Prospective study, 21, 125 Protective Agents, 102, 125

Index 143

Protein S, 61, 101, 125 Proteins, 99, 103, 105, 119, 124, 125, 133 Protocol, 4, 43, 51, 52, 125 Protons, 114, 126 Psychiatry, 126, 131, 135 Psychic, 126, 129 Psychotherapy, 17, 34, 126, 127 Public Health, 9, 77, 126 Public Policy, 75, 126 Publishing, 6, 10, 63, 126 Pulmonary, 38, 60, 69, 70, 101, 107, 111, 114, 115, 126, 127, 135 Pulmonary Artery, 101, 126, 135 Pulmonary Edema, 60, 126 Pulmonary Ventilation, 115, 126, 127 Pulse, 119, 126 Pupil, 108, 120, 126 Purgative, 110, 117, 126 Purpura, 99, 126 Purulent, 126, 134 Pyogenic, 6, 126 Q Quality of Life, 55, 126 R Radiation, 99, 126, 128, 135 Radioactive, 45, 46, 102, 114, 117, 126, 128 Rage, 123, 126 Randomized, 11, 13, 19, 20, 35, 46, 50, 109, 126 Reassurance, 62, 127 Receptor, 5, 99, 109, 121, 127 Rectum, 102, 108, 112, 117, 127 Red Nucleus, 100, 127 Refer, 1, 105, 109, 127, 135 Reflex, 8, 31, 55, 84, 123, 127 Refractory, 55, 127 Regimen, 109, 123, 127 Regurgitation, 6, 114, 127 Respiration, 50, 56, 102, 119, 127 Respiratory Paralysis, 61, 127 Respiratory Physiology, 127, 135 Respiratory System, 10, 127 Retina, 106, 127, 128 Retinal, 18, 122, 127 Retinal Hemorrhage, 18, 127 Retinol, 127 Retroperitoneal, 97, 128 Retrospective, 12, 128 Rigidity, 116, 123, 124, 128 Risk factor, 125, 128 Rods, 122, 127, 128

S Saliva, 44, 128 Salivary, 108, 128, 135 Salivary glands, 108, 128 Scans, 45, 46, 70, 128 Schizoid, 128, 135 Schizophrenia, 128, 135 Schizotypal Personality Disorder, 128, 135 Schwannoma, 63, 128 Scleroderma, 69, 70, 128 Sclerosis, 119, 128 Screening, 9, 18, 25, 45, 70, 105, 128 Secretion, 97, 104, 114, 116, 119, 124, 128 Secretory, 104, 121, 128 Secretory Vesicles, 104, 128 Seizures, 6, 7, 25, 59, 62, 76, 84, 99, 123, 129 Self Care, 97, 129 Semicircular canal, 116, 129 Senna, 4, 129 Sensor, 10, 129 Sensory loss, 61, 129, 132 Sexually Transmitted Diseases, 60, 129 Shock, 4, 7, 8, 84, 99, 115, 129, 133 Shoulder Pain, 82, 129 Side effect, 5, 6, 97, 129, 133 Signs and Symptoms, 5, 129 Skeletal, 45, 117, 120, 129 Skeleton, 111, 117, 129 Skin Care, 76, 129 Skull, 107, 110, 116, 121, 129, 132 Small intestine, 109, 114, 116, 129 Smooth muscle, 102, 114, 119, 120, 121, 129 Soaps, 129 Social Environment, 126, 130 Sodium, 129, 130, 131 Soft tissue, 101, 129, 130 Solitary Nucleus, 100, 130 Soma, 130 Somatic, 17, 34, 107, 113, 123, 130, 134 Sound wave, 106, 130 Spatial disorientation, 109, 130 Specialist, 13, 85, 109, 130 Species, 10, 110, 130, 131, 133, 135 Spectrophotometry, 19, 130 Spectrum, 130 Spina bifida, 61, 121, 130 Spinal cord, 104, 118, 121, 123, 127, 130, 132 Spinal Cord Diseases, 127, 130 Spirochete, 131, 132 Sprains and Strains, 60, 131

144 Fainting

Staging, 128, 131 Steroids, 62, 131 Stimulant, 4, 114, 117, 131 Stimulus, 41, 84, 95, 107, 111, 116, 127, 131, 132 Stomach, 4, 82, 83, 97, 108, 110, 112, 114, 116, 120, 124, 129, 131 Stress, 44, 52, 62, 70, 83, 100, 103, 104, 120, 131, 134 Stroke, 4, 5, 7, 11, 43, 44, 45, 48, 60, 61, 74, 81, 103, 131 Stroke Volume, 103, 131 Stupor, 120, 131 Subacute, 116, 131 Subarachnoid, 113, 131 Subclinical, 37, 116, 129, 131 Sublingual, 16, 131 Subspecies, 130, 131 Subtrochanteric, 114, 131 Suction, 112, 131 Sudden cardiac death, 13, 131 Sudden death, 23, 24, 46, 131 Support group, 84, 131 Sweat, 44, 124, 131, 132 Sweat Glands, 131, 132 Sympathetic Nervous System, 45, 55, 100, 104, 132 Sympathomimetic, 109, 110, 117, 121, 132 Syphilis, 61, 132 Syringomyelia, 61, 132 Systemic, 99, 101, 110, 116, 128, 132, 134 Systolic, 22, 115, 132 Systolic pressure, 22, 132 T Tachycardia, 43, 44, 45, 132 Temporal, 62, 113, 118, 132 Teratogenic, 109, 132 Thalamic, 100, 132 Thalamic Diseases, 100, 132 Therapeutics, 132 Thoracic, 100, 132, 135 Thorax, 118, 132, 134 Threshold, 56, 115, 132 Thrombosis, 125, 131, 132 Thrombus, 107, 116, 120, 132 Thyroid, 60, 115, 133 Thyroid Gland, 60, 115, 133 Thyroid Hormones, 133 Tidal Volume, 56, 115, 133 Tolerance, 14, 113, 133 Tomography, 45, 133 Tonus, 123, 133

Torsion, 116, 133 Toxic, iv, 9, 121, 133 Toxicity, 4, 62, 109, 110, 118, 133 Toxicology, 76, 133 Toxins, 62, 99, 116, 133 Trachea, 102, 117, 124, 133 Transfection, 101, 133 Transmitter, 109, 121, 133 Trauma, 63, 120, 133 Trigeminal, 61, 111, 133 Tuberculosis, 107, 133 Tyrosine, 109, 133 U Unconscious, 51, 52, 84, 99, 115, 134 Urea, 131, 134 Ureters, 134 Urethra, 123, 134 Urinary, 60, 114, 134 Urinary tract, 60, 134 Urinary tract infection, 60, 134 Urine, 83, 101, 109, 134 Urticaria, 4, 99, 134 Uterus, 82, 104, 107, 109, 112, 113, 119, 122, 134 V Vaccine, 125, 134 Vagal, 22, 50, 55, 61, 134 Vagina, 104, 134 Vaginal, 82, 134 Vaginitis, 60, 134 Vagus Nerve, 54, 130, 134 Vascular, 62, 99, 101, 102, 113, 116, 125, 130, 132, 133, 134 Vascular Resistance, 101, 134 Vasoconstriction, 13, 110, 134 Vasodilatation, 103, 134 Vasodilation, 54, 55, 134 Vasodilator, 109, 114, 117, 134 VE, 12, 134 Vein, 44, 46, 99, 116, 134 Venereal, 132, 135 Venous, 16, 43, 46, 55, 121, 125, 135 Ventilation, 56, 103, 106, 135 Ventricle, 55, 99, 115, 126, 132, 135 Ventricular, 20, 114, 135 Venules, 101, 135 Vertebral, 63, 101, 130, 135 Vertigo, 63, 94, 135 Vestibular, 63, 135 Vestibule, 105, 116, 129, 135 Veterinary Medicine, 75, 135 Virulence, 133, 135

Index 145

Viscera, 99, 130, 135 Visceral, 5, 100, 107, 113, 134, 135 Visceral Afferents, 100, 113, 134, 135 Volition, 116, 135 W Windpipe, 124, 133, 135

Withdrawal, 34, 135 Womb, 134, 135 X Xerostomia, 6, 135 X-ray, 45, 94, 101, 106, 128, 135

146 Fainting

Index 147

148 Fainting

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