LOOD LOTS 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., 1960Blood Clots: 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: 0-597-83794-5 1. Blood Clots-Popular works. I. Title.
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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.
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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on blood clots. 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 BLOOD CLOTS ........................................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Blood Clots .................................................................................... 7 E-Journals: PubMed Central ....................................................................................................... 18 The National Library of Medicine: PubMed ................................................................................ 19 CHAPTER 2. NUTRITION AND BLOOD CLOTS ................................................................................. 35 Overview...................................................................................................................................... 35 Finding Nutrition Studies on Blood Clots................................................................................... 35 Federal Resources on Nutrition ................................................................................................... 37 Additional Web Resources ........................................................................................................... 37 CHAPTER 3. ALTERNATIVE MEDICINE AND BLOOD CLOTS ........................................................... 41 Overview...................................................................................................................................... 41 National Center for Complementary and Alternative Medicine.................................................. 41 Additional Web Resources ........................................................................................................... 48 General References ....................................................................................................................... 57 CHAPTER 4. CLINICAL TRIALS AND BLOOD CLOTS........................................................................ 59 Overview...................................................................................................................................... 59 Recent Trials on Blood Clots........................................................................................................ 59 Keeping Current on Clinical Trials ............................................................................................. 64 CHAPTER 5. PATENTS ON BLOOD CLOTS ........................................................................................ 67 Overview...................................................................................................................................... 67 Patents on Blood Clots ................................................................................................................. 67 Patent Applications on Blood Clots ............................................................................................. 88 Keeping Current ........................................................................................................................ 115 CHAPTER 6. BOOKS ON BLOOD CLOTS ......................................................................................... 117 Overview.................................................................................................................................... 117 Book Summaries: Federal Agencies............................................................................................ 117 Book Summaries: Online Booksellers......................................................................................... 118 The National Library of Medicine Book Index ........................................................................... 118 Chapters on Blood Clots............................................................................................................. 119 CHAPTER 7. MULTIMEDIA ON BLOOD CLOTS............................................................................... 121 Overview.................................................................................................................................... 121 Video Recordings ....................................................................................................................... 121 Bibliography: Multimedia on Blood Clots.................................................................................. 122 CHAPTER 8. PERIODICALS AND NEWS ON BLOOD CLOTS............................................................ 125 Overview.................................................................................................................................... 125 News Services and Press Releases.............................................................................................. 125 Newsletter Articles .................................................................................................................... 128 Academic Periodicals covering Blood Clots ............................................................................... 131 CHAPTER 9. RESEARCHING MEDICATIONS .................................................................................. 133 Overview.................................................................................................................................... 133 U.S. Pharmacopeia..................................................................................................................... 133 Commercial Databases ............................................................................................................... 135 Researching Orphan Drugs ....................................................................................................... 136 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 141 Overview.................................................................................................................................... 141 NIH Guidelines.......................................................................................................................... 141 NIH Databases........................................................................................................................... 143 Other Commercial Databases..................................................................................................... 145
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APPENDIX B. PATIENT RESOURCES ............................................................................................... 147 Overview.................................................................................................................................... 147 Patient Guideline Sources.......................................................................................................... 147 Finding Associations.................................................................................................................. 158 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 161 Overview.................................................................................................................................... 161 Preparation................................................................................................................................. 161 Finding a Local Medical Library................................................................................................ 161 Medical Libraries in the U.S. and Canada ................................................................................. 161 ONLINE GLOSSARIES................................................................................................................ 167 Online Dictionary Directories ................................................................................................... 168 BLOOD CLOTS DICTIONARY.................................................................................................. 169 INDEX .............................................................................................................................................. 233
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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 blood clots 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 blood clots, 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 blood clots, 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 blood clots. 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 blood clots, 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 blood clots. 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 BLOOD CLOTS Overview In this chapter, we will show you how to locate peer-reviewed references and studies on blood clots.
The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and blood clots, 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 “blood clots” (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: •
E's on Down the Road Source: Walking. p. 36-38. November/December 2000. Summary: A National Institute of Medicine (NIM) expert panel raised the recommended daily intake (RDI) of vitamin E from 12 milligrams (mgs) to 15 mgs based on research citing its importance in disease prevention. The panel recommended that the daily intake come from foods rather than supplements. Foods rich in vitamin E include canola, olive, safflower, and corn oils as well as leafy green vegetables, wheat germ, nuts, olives, and seeds. The intake of 400 to 1,000 mgs recommended by some is far in excess of the amount that can be acquired through diet alone. Although evidence links diets rich in vitamin E to good health, the evidence is not so clear cut for supplements. Vitamin E found in foods consists of a complex group of chemicals called tocopherols. Some tocopherols work as antioxidants while others prevent blood clots from forming
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too readily. Supplements usually contain only a single form, alpha- tocopherol. The author suggests getting the first 15 mgs of vitamin E from food. If a person decides to add more through daily vitamin E supplements, there is little harm as long as the dosage is below 1,000 mgs. At high doses, vitamin E may cause stroke or bleeding problems in some people. The article provides a high-in-vitamin E recipe containing spinach and walnuts. The nutritional analysis of the recipe is also given. •
Managing Patients on Warfarin Therapy: A Case Report Source: SCD. Special Care in Dentistry. 21(3): 109-112. May-June 2001. Contact: Available from Special Care Dentistry. 211 East Chicago Avenue, Chicago, IL 60611. (312) 440-2660. Summary: Coagulotherapy is a common therapeutic regimen most frequently utilizing the drug called warfarin. This therapy may have important dental ramifications. As understanding of the mechanisms of action and drug interactions may help avoid problems. Questions commonly arise as to what dental procedures may be safely considered when a patient is on anticoagulant therapy. This article offers a case report that illustrates some of the dental and oral health concerns for managing patients on warfarin therapy. Coagutherapy level is measured in values of the International Normalized Ratio (INR). Any question about the appropriateness of dental procedures should be referred to the physician prescriber of the anticoagulant therapy. Generally, controlling bleeding is less of a problem than the management of thrombi (blood clots) and vascular occlusion (blockage) from decreased coagutherapy. The case presented includes the situation where INR reached a critical value as the result of drug interactions (antibiotics) and miscommunications. The authors remind readers that dental treatment for patients on anticoagulant therapy should be considered on an individual basis in consultation with the patient's physician to determine a level of anticoagulation that will provide minimum thrombosis (blood clot) risk and yet achieve workable hemostasis for the dental procedure. 3 tables. 27 references.
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Floss or Die: Implications for Dental Professionals Source: Dentistry Today. 17(7): 76,78,80-82. July 1998. Contact: Available from Dentistry Today, Inc. 26 Park Street, Montclair, NJ 07042. (973) 783-3935. Summary: 'Floss or die' is a phrase coined by Dr. Raul Garcia, a research periodontist from Boston, Massachusetts, at a recent dental research conference. Since the original media attention, a number of newspapers and magazines have run related stories on the possible association of periodontal disease with a series of potentially life-threatening disorders. This article reviews current research in this area, summarizing the implications for practicing dental professionals. One study pointed to the possible causal relationship between certain plaque bacteria and aberrant blood platelet activity; such an interaction could result in an increased risk for blood clots, which are associated with myocardial infarction. A great deal of circumstantial evidence links untreated periodontal disease to endocarditis and lung infections in patients with chronic obstructive pulmonary disease. Furthermore, periodontal infection can affect the stability of type 1 diabetes and can weaken the host immune system. The authors report briefly on research that is looking for strategies to determine risk assessment for disease activity at susceptible sites in periodontal patients. Although there is much happening on the research front, the primary tool and most effective clinical treatment concept for periodontal disease management is still control of dental plaque. By suppressing plaque
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formation, the risk of destructive periodontal infection, with its attendant loss of supporting structure, is lowered. In addition, according to current research, dentists may also be lowering the risk of several potentially fatal diseases. The remainder of the article briefly reviews the equipment and supplies available for this plaque-fighting effort, including the role of toothbrushing and flossing. Statistics estimate that only 2 to 10 percent of the population flosses regularly and effectively; this patient noncompliance is an overriding consideration in establishing therapy. 9 figures. 13 references. •
Hemorrhoids and More: Common Causes of Blood in the Stool Source: Digestive Health and Nutrition. 3(4): 24-26. July-August 2001. Contact: Available from American Gastroenterological Association. 7910 Woodmont Avenue, 7th Floor, Bethesda, MD 20814. (877) DHN-4YOU or (301) 654-2055, ext. 650. Email:
[email protected]. Summary: Most rectal bleeding is caused by hemorrhoids, which usually can be simply and effectively treated. This article reviews the many other conditions, including some serious disorders, that can cause blood in the stool. The author reminds readers that bleeding from any part of the nearly 40 foot long digestive tract can cause blood in the stool. Accurate and timely diagnostic tests are important to determine the cause of any bleeding. Bleeding higher up in the gut, from the esophagus or stomach, can result in stools with a black, tarry appearance. Bleeding from the lower end, such as the colon, or in large amounts, can appear as pure blood, blood clots, or as blood mixed with or streaking the stool. Another kind of blood, occult or hidden blood, may not be visible at all. A number of prescription and over the counter (OTC) medications can cause bleeding in the stomach and small intestine. The blood thinning drug warfarin also can induce bleeding in the intestine, as can some antibiotics. Other causes of bleeding can include ulcers, gastritis (inflammation of the stomach lining), ulcerative colitis, Crohn's disease, polyps (small growths inside the intestine), diverticular disease, abnormalities in the blood vessels (vascular anomalies), anal fissures (tears) and fistulas (abnormal openings between the anal canal and other organs, such as the bladder), and abscesses (pockets of infection. The author reiterates the importance of timely diagnosis, including a thorough patient history and evaluation of symptoms. Diagnostic tests can include blood tests, digital rectal examination, endoscopy, colonoscopy, sigmoidoscopy, fecal occult blood test, barium x rays, angiography (x rays of blood vessels), and nuclear scanning. Treatment depends on the source and extent of the bleeding.
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Hormone Replacement: More Than Just Estrogen Source: Diabetes Self-Management. 15(2): 58, 60-62. March-April 1998. Contact: Available from R.A. Rapaport Publishing, Inc. 150 West 22nd Street, New York, NY 10011. (800) 234-0923. Summary: This article focuses on the use of hormone replacement therapy following menopause to reduce the risk of heart disease in women, particularly women with diabetes. It describes the normal body changes that occur during menopause. Early signs of menopause include irregular periods, hot flashes, and night sweats. Menopause can also weaken the muscles and tissues of the vagina and the base of the bladder. The article identifies the potential benefits of hormone replacement therapy, including reducing the risk of heart disease and preventing osteoporosis. It highlights potential concerns about hormone replacement therapy, including impairing blood glucose control, affecting blood pressure, and increasing the risk of developing blood clots and
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breast and endometrial cancer. The article discusses the available choices for hormone replacement and stresses the need for women with diabetes to talk with a doctor about hormone replacement therapy. It also includes a list of organizations and books that provide information about menopause and the pros and cons of hormone replacement therapy. •
Stroke! Source: Diabetes Forecast. 53(9): 58-62. September 2000. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article presents steps that people who have diabetes can take to significantly reduce their risk of stroke. Most strokes result from a blockage or rupture of a blood vessel in the brain. The blockages that cause stroke usually occur because blood clots have formed or fatty deposits have built up inside blood vessels. Strokes that occur when blood vessels burst open and bleed inside the head are less common than those caused by a blockage. Symptoms of stroke usually occur suddenly and may include weakness or numbness on one side of the body, loss of vision or dimness in one or both eyes, and difficulty talking or understanding speech. Some people experience mini strokes known as transient ischemic attacks. The symptoms for this type of stroke are the same as the symptoms of major stroke, but they last only a few minutes or hours. Although diabetes is considered a nonmodifiable risk factor for stroke, scientists are not sure why people who have diabetes are more likely to suffer a stroke. Prevention involves knowing one's individual risk factors and controlling or eliminating the modifiable ones. Modifiable risk factors include high blood pressure, high cholesterol, atrial fibrillation, cigarette smoking, heavy alcohol consumption, lack of physical activity, and obesity. The article presents suggestions for modifying these risk factors and provides a list of organizations that offer information about stroke.
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Shiatsu Source: Positive Health. Number 24: 61-64. December-January 1998. Summary: This journal article presents a general overview of Shiatsu, which is a physical therapy applied at floor level with minimum physical effort by the therapist. Shiatsu uses Oriental Medicine as its theoretical framework and is a method of selfdevelopment that has the effect of focusing the mind and grounding the body and the mind. The history, environment, tools, and theoretical basis of Shiatsu are discussed. Three broad categories of Shiatsu technique are detailed: tonification, dispersal, and calming. According to the author, there are several essential techniques of Shiatsu: motivation; steadiness of breath; keeping a low center of gravity; relaxation and comfort; empty mind; support rather than force; positive connection; correctly angled pressure; technical ability, continuity, and fluency; and empathy. The article also lists contraindications to Shiatsu, including acute fevers; contagious diseases; internal bleeding; blood clots; touch phobia; severe burns; bruises or swellings; fracture sites and areas of acute muscle or ligament injuries; cuts, local inflammation, and infection; twisted intestines; and varicose veins during pregnancy. This journal article contains 4 photographs and details on 2 resources.
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Federally Funded Research on Blood Clots The U.S. Government supports a variety of research studies relating to blood clots. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to blood clots. 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 blood clots. The following is typical of the type of information found when searching the CRISP database for blood clots: •
Project Title: AGING VENOUS THROMBI WITH ULTRASOUND ELASTICITY IMAGING Principal Investigator & Institution: Rubin, Jonathan M.; Professor and Director/ Ultrasound; Radiology; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2002; Project Start 01-AUG-2002; Project End 30-JUN-2006 Summary: Deep venous thrombosis (DVT) remains a significant clinical problem today with over 250,000 patients per year affected. Unfortunately, the gold standard diagnostic technique, duplex venous ultrasound, can only diagnose but not characterize these clots. This inability to determine clot maturity has major implications regarding which anticoagulation therapy, with its associated morbidity and mortality, one would use in treatment. The sine qua non of clot maturity is increasing hardness of thrombi, and in this regard, there exists an ultrasound technique, known as reconstructive ultrasound elasticity imaging, that is a very sensitive and well-defined way to estimate tissue hardness. In addition, elasticity imaging has the very attractive property that it would require no change in the standard diagnostic ultrasound technique, i.e. pushing on the leg veins and simultaneously imaging. We are proposing to use elasticity imaging to determine the maturity/age of DVTs. We will attack this problem in three ways: 1) We will create theoretical models of clot in veins for optimizing speckle tracking algorithms, for modeling the vessel boundary response to deformations when clots of varying hardness lie within a vein, and for estimating the non-linearities in Young's modulus, the measure of hardness, as a function of strain. 2) We will study the ability of elasticity imaging to distinguish differences in clot maturity in a well-developed model of thrombosis in ligated rat inferior vena cavas. This model will be used to determine if elasticity imaging can detect the day-to-day changes in thrombus hardness over a nineday maturation period, where clots will change from acute, softer clots to subacute to chronic, hard thrombi. Further, we will correlate these hardness estimates with the clot fibrin concentration, the primary cause of hardening, over time. 3) We will validate elasticity imaging in two patient populations, one with known acute DVT in which the
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Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).
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precise onset of thrombosis is known, and a second population with known longstanding, chronic DVT. We will accurately determine the ability of elasticity imaging to distinguish between the thrombi in these two groups. We believe that elasticity imaging is a natural solution to the clot characterization problem, and in this proposal, we will fully test the ability of the ultrasound elasticity imaging to address this important clinical issue. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: ARE SUBARACHNOID BLOOD CLOTS VISIBLE ON FLAIR MRI?: STROKE Principal Investigator & Institution: Busch, Elmar; Stanford University Stanford, Ca 94305 Timing: Fiscal Year 2001 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: BIOBEHAVIORAL PREDICTORS OF CORONARY ANGIOPLASTY OUTCOMEN Principal Investigator & Institution: Kop, Willem J.; Assistant Professor; Henry M. Jackson Fdn for the Adv Mil/Med Rockville, Md 20852 Timing: Fiscal Year 2001; Project Start 01-FEB-1999; Project End 31-JAN-2003 Summary: Percutaneous coronary revascularization procedures are increasingly used in the treatment of coronary artery disease, with approximately 300,000 interventions performed each year. Despite new developments in cardiology such as infra-coronary stents and anticoagulant pharmacological treatments a major problem remains the frequent occurrence of coronary restenosis and new cardiac events within six months after the intervention. These adverse outcomes occur in one out of four patients and have substantial impact on the costs of medical care and patients' quality of life. Research indicates that hemostatic factors (e.g., fibrinogen, von Willebrand factor, and plasminogen activator inhibitor) promote the formation of blood clots and that these factors predict coronary restenosis. Moreover, prior longitudinal studies have also demonstrated that the psychosocial traits of hostility and depression affect clinical progression of coronary disease. These psychosocial factors significantly predict adverse long-term outcome after revascularization and both hostility and depression are known to affect blood clotting factors. In addition, acute mental and physical stress are reported to affect blood clotting factors (coagulation and fibrinolysis) and responses to stress are reported to be more pronounced in hostile individuals. However, previous research on predictors of adverse clinical outcome after percutaneous coronary revascularization has not examined stress-induced changes in hemostatic factors and the consequences of these responses for progression of coronary artery disease. Therefore, the present study will investigate whether psychosocial factors and responses to acute mental stress affect measures of the blood clotting process that are involved in progression of coronary disease, thereby increasing the risk of an adverse prognosis following percutaneous coronary revascularization. This study may improve the identification of patients at risk for recurrent cardiac events and provide further understanding of the pathophysiological mechanisms involved in the progression of coronary artery disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: CEREBRAL MICROVASCULAR ENDOTHELIN PRODUCTION Principal Investigator & Institution: Yakubu, Momoh A.; Ctr/Cardiovascular Diseases; Texas Southern University 3201 Wheeler Ave Houston, Tx 77004 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 29-SEP-2004 Summary: (provided by the applicant): Cerebral hemorrhage is the main cause of abnormal cerebral arteriolar constriction resulting in cerebral ischemia that leads to paralysis, mental and physical disabilities, and deaths. Despite progress in the diagnosis of subarachnoid hemorrhage (SAH), SAH-induced cerebral vasospasm remains one of treatable causes of morbidity and mortality in patients. The mechanism(s) by which cerebral arterial narrowing occurs following hemorrhage remain largely unknown, but modification of cerebral microvascular responses is prominent, and characterized by impaired vasodilator and increased vasoconstrictor mechanisms in cerebral arteries. Several factors may contribute to the observed alterations of pial arteriolar reactivity. Increased endothelin-1 (ET-1) production has been consistently observed and ET-1 has been implicated as a possible mediator of cerebral hemorrhage-induced vasospasm. However, the mechanism(s) by which increased ET-1 production occurs are not known. The proposed experiments are designed to test the hypothesis that by-products of hemolyzed blood clots {oxyhemoglobin (OxyHb), lysophosphatidic acid (LPA), or serotonin (5-HT)} stimulate ET-1 production via activation of protein kinase C (PKC). To test this hypothesis, two specific aims will be addressed using primary culture of cerebral microvascular endothelial cells. 1) To characterize the effects of OxyHb, LPA, or 5-HT on El-I production and 2) to determine the cellular mechanism(s) by which these vasospasmogenic agents released from blood clots stimulate El-I production. To accomplish these aims, primary cell culture, molecular biological, immunoblotting, and immunoprecipitation techniques will be employed to investigate the mechanism(s) involved in the regulation of ET-1 production by these blood by-products. The results from the proposed research will have important therapeutic implications for survivors of SAH, who experience complications that include paralysis, mental and physical derangement, loss of sight and hearing. Our understanding of the mechanisms underlying the consequences of SAH will make it possible for early and appropriate intervention to prevent or reduce these complications from hemorrhagic stroke. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: CORE--MOLECULAR GENETICS Principal Investigator & Institution: Shields, Peter G.; Professor & Chief; Georgetown University Washington, Dc 20057 Timing: Fiscal Year 2001 Summary: The Molecular Genetics Core Laboratory (MGCL) will provide an important resource to the TTURC based upon existing sample handling, biorepository and high throughput assay procedures. This core will be within Dr. Shields' Molecular Epidemiology Section the Laboratory of Human Carcinogenesis (LHC) within NCI. The MGCL is uniquely suited to provide the laboratory genetic support for existing hypotheses and to develop assays for new hypotheses. Our specific aims are: (1) to provide a certified Molecular Genetics Core Laboratory (MGCL) that ensures consistent and high quality sample handling, analysis and reporting for samples generated by the TTURC; (2) to provide sample receipt, sample processing and biorepository procedures for all TTURC samples; (3) to provide existing consistent methods for DNA extraction and genetic polymorphism analysis; and (4) to provide accurate reporting, quality control and quality assurance procedures. The MGCL will maintain CLIA certification
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for quality control and quality assurance, among existing procedures for accurate determination of assay results and reporting. Performing large-scale molecular epidemiology studies require experience and expertise. Our laboratory has done DNA extractions. from blood (white blood cells, blood clots and serum), buccal swabs, oral rinses, frozen human organ tissue (lung, liver, colon. breast), urine and paraffinembedded tissues. During the last five years, this constitutes DNA from more than 2,000 persons. Our success rates are greater than 98%. In calendar years 1996, 1997 and 1998, we performed 21 different genotyping assays for a total of 24,315 individual assays. There are different ways for laboratories to perform quality research. Ours is to maintain Clinical Laboratory Improvement Amendments (CLIA) certification. This is a government-mandated quality control and quality assurance monitoring program for clinical laboratories. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: CRYSTAL STRUCTURE OF HUMAN FIBRINOGEN FRAGMENT D Principal Investigator & Institution: Doolittle, Russell F.; Stanford University Stanford, Ca 94305 Timing: Fiscal Year 2001 Summary: Fibrinogen is the precursor of fibrin, the material of which blood clots are composed. It is a large molecular weight complicated protein composed of two pairs of three non-identical polypeptide chains. A genuine X-ray structure has never been obtained. Now we are determining the structures of the principal fragments of human fibrinogen, the largest of which is called fragment D. We have collected data on crystals of this fragment out to 3.8 E on an area detector, and data from several isomorphous derivatives have provided a preliminary if somewhat ambiguous electron density map. We hope that synchrotron data would allow better resolution. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: IN VIVO EVALUATION OF STROKE ULTRASOUND CATHETER Principal Investigator & Institution: Hansmann, Douglas R.; Ekos Corporation 22122 20Th Ave Se, Ste 148 Bothell, Wa 98021 Timing: Fiscal Year 2001; Project Start 01-DEC-2000; Project End 30-NOV-2003 Summary: Stroke is a deadly and debilitating disease striking 700,000 Americans each year. Nearly 75% of these strokes are ischemic or caused by blood clots which stop blood flow to areas of the brain resulting in brain cell death. Once a patient seeks medical care, the largest challenge to preventing stroke-related disability is rapidly achieving lysis of the clot that is blocking blood flow. The faster the blood supply can be restored to the oxygen starved portions of the brain the less disability suffered by the patient. Locally directed ultrasound energy can enhance blood clot lysis resulting in a faster return of blood flow to the ischemic brain tissues. The goal of this project is to demonstrate that ultrasound energy radiating from the end of a catheter can enhance the lysis of blood clots in the neurovascular system for the treatment of stroke. The specific aims of this Phase I project are to: 1. Downsize the current EKOS ultrasound catheter to a 3.5 French product. 2. Demonstrate the ability of small ultrasound transducers to lyse plasma clots in vitro. 3. Demonstrate the ability of the downsized ultrasound catheters to lyse blood clots in vivo. PROPOSED COMMERCIAL APPLICATIONS: Our product will be an ultrasound microcatheter which will be used in the treatment of stroke. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: INTEGRIN/CYTOSKELETON INTERACTIONS IN PLATELETS Principal Investigator & Institution: Burridge, Keith W T.; Professor; University of North Carolina Chapel Hill Office of Sponsored Research Chapel Hill, Nc 27599 Timing: Fiscal Year 2001; Project Start 01-JUL-2001; Project End 30-JUN-2002 Summary: Platelets play a critical role in the development of blood clots. This is an important physiological event in normal hemostasis, but the pathological development of blood clots can lead to heart attacks and strokes. During the formation of a blood clot, platelets become activated and rapidly assemble their actin cytoskeletons. These become linked to the major transmembrane integrin alphaIIb/beta3, which mediates adhesion to fibrin on the outside of the platelet. The coupling of alphaIIb/beta3 to the cytoskeleton allows platelets to contract clots. The first aim of this grant is to determine how the cytoplasmic domains of alphaIIb/beta3 interact with specific cytoskeletal components. Several strategies will be used to identify cytoskeletal proteins that associate with alphaIIb/beta3 in vivo. The interactions of alphaIIb/beta3 mutated in the cytoplasmic domains will be investigated, as will the interactions of integrin chimeras, in which the cytoplasmic domains are ligated onto the transmembrane and extracellular domains of other proteins. A scheme is proposed to permit analysis of the cytoskeletal links to individual cytoplasmic domains of other proteins. A scheme is proposed to permit analysis of the cytoskeletal links to individual cytoplasmic domain chimeras as well to chimeras to have been induced to dimerize. The role of specific proteins, such as talin, vinculin and alpha-actinin, will be explored in cells from which vinculin has been deleted and in which talin or alpha-actinin have been functionally disrupted. Many agents which prevent platelet activation raise cyclic nucleotide levels and stimulate protein kinase A or G. A prominent substrate for these kinases in platelets in the vasodilator-stimulated phosphoprotein (VASP). We will explore the function of VASP and the consequence of its phosphorylation in relation both to actin polymerization and the activation of alphaIIb/beta3. In response to platelet activation and aggregation, several tyrosine kinases become activated. We will investigate the regulation of platelet tyrosine phosphorylation by tyrosine phosphatases (PTPs). Specifically, we will look for PTPs that associate with and regulate tyrosine kinases, and PTPs that associate with alphaIIb/beta3. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: NMR STUDIES OF PLASMINOGEN AND RELATED GENOMIC DOMAINS Principal Investigator & Institution: Llinas, Miguel; Professor; Chemistry; CarnegieMellon University 5000 Forbes Ave Pittsburgh, Pa 15213 Timing: Fiscal Year 2001; Project Start 01-JUL-1982; Project End 31-MAR-2005 Summary: (Investigator's abstract) We propose to investigate via NMR spectroscopy the structure and function of genomic protein modules and multimodular arrays related to plasminogen (Pgn) and its activators urokinase (uPA) and tissue Pgnactivator (tPA). These proteins are found both in blood plasma and in the extracellular matrix (ECM) where they play crucial roles in the fibrinolytic dissolution of blood clots, cell proliferation and migration, embryogenesis, tissue remodeling metastasis, etc. Pgn, tPA and uPA contain kringle (K) domains that mediate their binding to specific substrates. The Pgn kringles interact with the inhibitor a2-antiplasmin C- and the Pgn N-terminal peptide domains. Interestingly, the Pgn KI, K2, K3, K5, their tandem arrays K123, K1234 (angiostatin), and K12345, as well as the uPA peptide KPSSPPEE 143 inhibit endothelial cell growth and migration, thus tissue and tumor vascularization. Antiangiogenic
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activities also are displayed by the blood plasma/ECM proteins kininogen D5 (a Zn2+binding domain) and thrombospondin 2nd type-1 domain. Implicated in tissue remodeling is the matrix metalloproteinase 2, which digests denatured collagen (gelatin) via adhesion through three fibronectin type II domains. Activation of Pgn by uPA, a key step in metastatic cell propagation, involves a membrane-anchored receptor (uPAR) which contains three snake neurotoxin-type modules. Related to uPA activity is the receptor associated protein (RAP), a chaperon that stabilizes newly synthesized low density lipoprotein receptor-related protein and the very low density lipoprotein receptor, presumably via its C-terminal domain (ctRAP). Pgn and tPA also are found in brain where their presence correlates with memory processes. In addition, in brain is neurotrypsin, a novel kringle containing proteinase. Of related neurological interest is the SEA module of agrin, a protein produced by motoneurons that induces the aggregation of nicotinic acetylcholine receptors. Functional in nerve tissue extension are various transmembrane protein tyrosine kinase receptors which contain kringle and frizzled (cysteine-rich) domains, likely to be involved in ligand binding. A main thrust of the project will be the development of CLOUDS, a relaxation matrix approach that avoids the assignment bottleneck and aims at high throughput structural analysis of protein NMR data. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: PLASMINOGEN ACTIVATION & SK: STRUCTURE-FUNCTION Principal Investigator & Institution: Reed, Guy L.; Associate Professor; Medicine; Harvard University (Medical School) Medical School Campus Boston, Ma 02115 Timing: Fiscal Year 2002; Project Start 01-JUL-1998; Project End 30-JUN-2006 Summary: (provided by applicant): The plasminogen (Pg) system dissolves the thrombi (blood clots) that cause heart attacks and strokes. The Pg system is tightly regulated by protein-protein interactions with inhibitors, activators, substrates, etc. The cleavage of Pg to plasmin by streptokinase (SK), and other Pg activators, initiates fibrinolysis (clot dissolution) which saves the lives of heart attack patients. Recent studies have suggested that mechanistic insights into the regulation of the Pg system could further reduce the mortality from heart attacks, and improve the treatment of strokes, pulmonary embolism, etc. Because of its physiologic and therapeutic importance, our long term goal is to help elucidate the protein-protein interactions that regulate and modify the activity of the Pg system. The interactions between Pg and the indirect Pg activator SK are among the most biologically and medically important of these contacts. Studies performed in the first phase of this grant have helped to delineate the elegant interactions through which SK converts Pg (without cleavage) into the most catalytically efficient Pg activator, Insights have been made into defining the mechanisms through which: 1) SK forms a tight stable 'activator complex' with Pg (or plasmin), 2) SK nonproteolytically generates the latent active site in Pg creating a 'virgin enzyme' (Pg*), and 3) SK modifies the substrate specificity of Pg* or plasmin so that the complex can cleave Pg molecules. This continuation proposal is directed towards further dissecting the process of indirect Pg activation, in order to determine the novel mechanisms by which SK becomes a fibrin-dependent (or t-PA-like enzyme), to define whether fibrindependent SKs have the potential to be superior fibrinolytic agents, to understand the role of the Pg kringle domains in indirect Pg activation and, to define the intermolecular interactions that occur in the SK-Pg complex which are required for a SK-type of mechanism. In a broad scientific sense, insights into this unique process of indirect Pg activation should enlarge our understanding of how the catalytic activity and specificity
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of Pg system is regulated, and could suggest rational ways to alter the indirect Pg activators so as to improve their therapeutic value for patients with thrombosis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: PREVENTION OF BIOFILMS IN MEDICAL DEVICES Principal Investigator & Institution: Shenoy, Bhami C.; Altus Biologics, Inc. 625 Putnam Ave Cambridge, Ma 021394807 Timing: Fiscal Year 2003; Project Start 01-AUG-2003; Project End 31-JAN-2004 Summary: (provided by applicant): Design of new efficient drug delivery systems for proteins is one of the major themes of modern biotechnology and biopharmaceutical industry. We found that cross-linked enzyme crystals (CLECs) show remarkable stability at various pHs, on storage, against proteolysis and organic solvents. These properties make them ideal for treatment against biofilm formation on medical devices /implants such as urethral catheters, ureteric and prostatic stents, penile and testicular implants, artificial urinary sphincters, prostheses for hip and knee replacements, shunts for hydrocephalus, vascular grafts, heart valves, vascular access devices, voice prostheses, etc. In addition, the CLECS can be used for the prevention of blood clot formation, for example, in venous catheters. The CLEC agent will be used to coat the medical devices for the prevention of formation of bacterial biofilms on these devices as well as the prevention of blood clots. The biofilms form on the above medical devices by colonization of bacteria embedded in a matrix, which become resistant to commonly used antibiotics. In this Phase I study, we propose to develop two prototypes of CLECs of enzyme - Serratiopeptidase and Streptokinase for prevention of biofilms by Pseudomonas aeruginosa and Staphylococcus aureus microorganisms. The coating will prevent the adherence of these bacteria to medical devices. Currently, there are more than 850,000 case infections associated with aid devices annually in the United States. These may be associated with as many as 100,000 deaths per year. The CLECs of Serratiopeptidase and Streptokinase have enormous commercial potential over the currently available treatment for the prevention of contamination of medical devices by minimizing the need for replacement once they are implanted. The CLECs of Serratiopeptidase and Streptokinase will also be important in preventing biofilm-related infections which are resistant to commercially available antibiotics. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: PRIMARY STRUCTURE OF PROTHROMBIN Principal Investigator & Institution: Mann, Kenneth G.; Professor and Chair; Biochemistry; University of Vermont & St Agric College 340 Waterman Building Burlington, Vt 05405 Timing: Fiscal Year 2001; Project Start 01-JAN-1994; Project End 31-DEC-2003 Summary: Factor V is a central participant in the blood clotting process. In its activated form (factor Va), when bound to a membrane, it serves as a factor Xa receptor and an effector of catalytic activity in the activation of prothrombin to thrombin. Studies of the prothrombinase complex and its components have provided not only significant information with respect to this complex, but also insights into the overall mechanism by which blood clots. The participation of factor V in the prothrombinase complex function is a consequence of both positive and negative regulatory processes which influence both the receptor and effector functions of the molecule. The activation of the procofactor, factor V, to the cofactor, factor Va, can be elicited by a number of proteolytic mechanisms, with the most important being thrombin. The negative
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regulation of factor Va occurs as a consequence of proteolytic cleavage by activated protein C (APC), an anticoagulant enzyme activated paradoxically by thrombin. In recent times, defects in the protein C system involving defects in protein C, protein S, thrombomodulin, and factor Va have been associated with significant thromboembolic events. During the past decade, the primary structure of factor V, its posttranslational modifications, its cleavage during activation and inactivation, and its biosynthesis and catabolism have been described. The present application seeks to extend our knowledge of the functions of factor V and factor Va using extensions of the approaches that have proved valuable in the past. These include: (a) the evaluation of the structure and function of the protein using the proteolytic fragments derived from natural factor V, factor Va and factor Vai, (b) the development an utilization of recombinant cofactor V and factor Va fragments to develop an understanding of the activity and the regulation of this important molecule, (c) the development of practical immunologic and genetic measurements of factor V fragments which may be used to evaluate hypercoagulable states and provide predictive information regarding the nature of genetic alterations which influence factor V structure and function. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: REACTION AND TRANSPORT DYNAMICS IN HUMAN BLOOD Principal Investigator & Institution: Diamond, Scott L.; Associate Professor; Chemical Engineering; University of Pennsylvania 3451 Walnut Street Philadelphia, Pa 19104 Timing: Fiscal Year 2001; Project Start 15-JUL-1996; Project End 31-MAR-2005 Summary: (Verbatim from Applicant's Abstract): In the context of a given genotype and phenotype, the dynamics of blood clot assembly ultimately dictate: thrombosis; thrombolytic susceptibility of clots; stroke during cardiopulmonary bypass; restenosis after angioplasty; wound healing/inflammation; and pathogenesis of deep vein thrombosis or pulmonary embolism. During blood coagulation, activated platelets and neutrophils from homotypic and heterotypic aggregates through over ten receptormediated pathways while triggering thrombin formation and fibrin polymerization. Yet less is known quantitatively about the strengths and kinetics of platelet-platelet and platelet-neutrophil bonding that leads to aggregation or deposition under coagulating whole blood flow conditions or the biochemical reactivity of these aggregates. Furthermore, temporal resolution of events lasting only a few milliseconds is rarely achieved in most experiments. In vitro high speed imaging experiments will utilize human blood cells and proteins for kinetic studies of these interactions under controlled hemodynamic and coagulation conditions. Probability distributions and kinetic data from these experiments will be used to gain improved mechanistic understanding of human blood phenomena from receptor dynamics to vessel occlusion, in the hemodynamic setting. By defining the molecular dynamics of how blood clots are assembled under flow conditions as well as defining the flow regulation of various clotting scenarios, the risks of unregulated clotting, bleeding, and embolism will be more quantitatively understood for a given disease progression. Specific aims are: Aim 1 High speed imaging of platelet bonding dynamics that regulate thrombosis in clotting blood with emphasis on bond life dynamics. Aim 2 High speed imaging of neutrophil bonding dynamics that enhance cellular deposition with emphasis on selectin mediated pathways, erythrocyte interactions and membrane tethering. Aim 3 Quantifying mechanisms by which neutrophils act as procoagulant participants during clot assembly under defined flow conditions. Aim 4 Develop a set of generalized computational tools for the study of heterotypically aggregating-reacting blood. Overall, these studies seek
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to provide fundamental insight into cell-cell interactions and coagulation biochemistry that occur under flow. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: REPAIR & PREVENTION OF DNA DAMAGE & BREAST CANCER RISK Principal Investigator & Institution: Shore, Roy E.; Professor; Environmental Medicine; New York University School of Medicine 550 1St Ave New York, Ny 10016 Timing: Fiscal Year 2003; Project Start 02-JUN-2003; Project End 31-MAY-2006 Summary: (provided by applicant): Dysfunction of pathways that maintain DNA genomic integrity may account for a significant fraction of breast cancer. A study of breast cancer susceptibility in relation to polymorphisms in genes that prevent or repair DNA damage is proposed. Specifically, it is hypothesized that women are at heightened risk for breast cancer when they have a gene allelic variant of functional significance in a pathway for carcinogen/pro-oxidant detoxification or DNA-repair. Having multiple gene variants in a pathway is expected to elevate breast cancer risk further. A cohort (New York University Women's Health Study) of 14,000 women who contributed blood 11-17 years ago has been followed up for breast cancer incidence; 622 incident, invasive breast cancers have been identified. A case-control study (1:2 matching) nested within the cohort will be conducted. DNA will be obtained from stored blood clots, buccal cells, or serum samples. Data on potential confounders were collected at entry and are updated on a regular basis. The DNA pathways selected for study pertain to DNADamage Prevention, Base Excison Repair (BER) and Nucleotide Excision Repair (NER). The repair pathways are complementary, in that BER fixes the ubiquitous damage that occurs in one or a few nucleotides while NER repairs larger lesions, such as bulky DNA adducts and DNA crosslinks. Both types of DNA damage, if unrepaired and occurring in a key gene, may cause a permanent mutation that promotes cancer development. The 13 genetic polymorphisms to be studied in the three pathways were selected on the basis of high allelic frequencies of the variants (10-50%) and evidence of their functional significance. Polymorphic variants in 3 genes that help prevent DNA damage (GSTP1, MnSOD, catalase) and 9 genes in the DNA nucleotide-excision repair pathway (XPC, XPD, XPF, XPG) or base-excision repair pathway (XRCC1, APE1, LIG3, POLD1, hOGG1) will be studied in relation to breast cancer risk. The polymorphisms either have not been studied previously in relation to breast cancer risk, or their contribution to risk is uncertain because of limitations in previous studies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: SITE DIRECTED THROMBOLYTIC AGENT Principal Investigator & Institution: Mcgowan, Eleanor B.; Aurazyme Pharmaceuticals, Inc. 2121 New Market Pky, Ste 124 Marietta, Ga 30067 Timing: Fiscal Year 2003; Project Start 24-FEB-2003; Project End 31-AUG-2004 Summary: (provided by applicant): Clot formation and dissolution are essential to human survival. Abnormal clot formation and occlusion of blood vessels of the heart, lung, brain, and peripheral circulation can result in death, incapacitation, and limb amputation. Rapid treatment with thrombolytic agents to dissolve clots and restore blood flow is a means to minimize morbidity and mortality in these patients. In the USA, more than 1 million patients are affected annually by blood clots in the heart, brain, lung or peripheral vessels, with more than 600,000 deaths occurring from myocardial infarction and ischemic stroke. This costs the US economy in excess of $40
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billion per year. This proposal is to assess the pre-clinical efficacy of a direct thrombolytic agent delivered locally in a rabbit model of abdominal aorta thrombosis. Active plasmin is generated from a stable depot form of plasmin, AZ-plasmin, by exposure to energy (light, sound waves). Plasmin is a proteolytic enzyme that digests fibrin and degrades clots, releasing trapped blood cells and re-establishing circulation. Local delivery of plasmin and its rapid inhibition by alpha2 antiplasmin distal to the clot site will limit bleeding side effects. Current thrombolytic therapies infuse protein activators (streptokinase, tissue plasminogen activator) to convert plasminogen to plasmin; plasminogen concentrations become limiting in areas of diminished blood flow. These therapies do not achieve their full potential due to significant side effects, including increased risk of hemorrhage and stroke. The proposed specific aims are (1) to optimize the preparation of AZ-plasmin from human plasmin and a proprietary inhibitor, AZ-nu, and determine the properties of AZ-plasmin and light-reactivated plasmin, using a synthetic substrate; (2) to characterize delivery and activation parameters for AZ-plasmin in plasma clots and blood clots in vitro, using catheters and fiber optic light or shock wave energy sources to activate AZ-plasmin to plasmin; and (3) to determine safety and efficacy of AZ-plasmin activated to plasmin for restoring blood flow in vivo in rabbits with abdominal aorta thrombosis, a model for peripheral arterial occlusion. These experiments will establish the utility of AZ-plasmin as a stable, effective source of the direct thrombolytic agent plasmin for treatment of occlusive thrombi, with the potential for a better safety profile and fewer side effects than current therapies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: SITOSTANOL & N-3 FATTY ACIDS ON STEROLS, FATTY ACIDS, LIPOPROTEINS, CHOLESTEROL Principal Investigator & Institution: Connor, William E.; Professor of Medicine; Oregon Health & Science University Portland, or 972393098 Timing: Fiscal Year 2001 Summary: Participants in this research study will consist of 2 groups. One group will have a moderately high blood cholesterol level. The purpose of this study is to provide a nutritional, non-drug therapy to lower blood cholesterol levels and reduce the risk for heart disease. A substance in plants called sitostanol has been shown to block the absorption of dietary cholesterol that leads to a lower blood cholesterol level. Several companies have developed sitostanol-containing products. They have put sitostanol into margarine for use in this study. Another food that has been shown to decrease the risk of heart disease is fish oil. Fish oil contains omega-3 fatty acids. These fatty acids lower the blood triglyceride level, decrease the formation of blood clots that can block an artery and cause a heart attack and keep the heart beating in a normal rhythm. This study will show if sitostanol and fish oil are a good combination therapy to decrease the risk of heart disease. The second group of participants in this research study include those with an inherited disorder, sitosterolemia. The purpose of this study is to provide a nutritional, non-drug therapy to lower blood cholesterol and sitosterol levels and reduce the risk for heart disease. A substance in plants called sitostanol has been shown to block the absorption of dietary cholesterol that leads to a lower blood cholesterol level. This study will determine if sitostanol will also lower the blood sitosterol level. Several companies have developed sitostanol-containing products. They have put sitostanol into margarine for use in this study. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: STRUCTURAL DETERMINATION OF FACTOR IXA: BLOOD COAGULATION Principal Investigator & Institution: Lanzo, Cheryl; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 94122 Timing: Fiscal Year 2001 Summary: Bleeding disorders can be characterized by excessive blood clotting known as thrombosis, or by the inability to form blood clots termed hemophilia. Blood clotting is a tightly regulated process involving exquisite control of the many proteins in the blood clotting cascade including factor IXa, factor VIIIa, factor Xa, and factor VIIa. We are working to understand the structural determinants of the regulation of factor IXa, a central protein in the clotting cascade. The activation of factor IXa results in clotting whereas the inhibition prevents clotting. Better understanding of the structure of factor IXa will lead to the design of small protein mimetics to treat blood clotting disorders. The catalytic activity of factor IXa is dependent on a cofactor called factor VIIIa. We are working on determining the structure of factor IXa with factor VIIIa in order to elucidate the structural determinants leading to the activation of factor IXa. Further, ecotin, a serine protease inhibitor, will be derivatized to specifically inhibit factor IXa. Inhibition of factor IXa is expected to protect against thrombosis without resulting bleeding complications which is expected from inhibiting factor Xa or factor VIIa. The crystallographic analysis of factor IXa-ecotin derivatives will facilitate our understanding of the region(s) of ecotin which are important for the inhibition of factor IXa. I am using the Computer Graphics Laboratory and MidasPlus to structurally model factor IXa with factor VIIIa and ecotin derivatives. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: THROMBOMODULIN FUNCTION IN CELLULAR PHYSIOLOGY Principal Investigator & Institution: Weiler-Guettler, Hartmut; Blood Center of Southeastern Wisconsin Milwaukee, Wi 532012178 Timing: Fiscal Year 2001; Project Start 01-APR-1999; Project End 31-MAR-2004 Summary: Thrombomodulin (TM) has been defined in the context of the blood coagulation system as an endothelial thrombin receptor that suppresses the activation of the blood clotting mechanism. Formation of a thrombin- TM complex alters the substrate specificity of thrombin to generate the natural anticoagulant, activated protein C. In humans, genetic deficiencies leading to the reduced function of the TM-protein C pathway are commonly inherited risk factors for thrombotic disease. The complete ablation of TM function in mice via gene targeting results in early embryonic lethality, before the establishment of a functional cardiovascular system. Biochemical and genetic evidence indicates that the receptor's survival function in development does not involve the known anticoagulant mechanisms of protein C activation or thrombin binding, but a potentially novel activity that is absolutely required for a normal interaction between the developing fetus and the maternal environment. These findings suggest that TM has additional functions not related to blood coagulation that may fulfil important roles in yet other physiological processes, as suggested by the highly regulated expression pattern of the receptor in the developing lung, bone forming tissue, and in other nonendothelial cell types of adult mice. The objective of the proposed studies is to describe in precise molecular terms the mechanism underlying TM function in development and to delineate the physiological consequences of complete receptor deficiency in different stages of embryogenesis and in adult mice. Specifically, the survival of TM deficient mice will be examined in the complete absence of fibrin or fibrinolytic mechanisms to
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ascertain whether the death of TM null mice involves the formation or dissolution of blood clots. Critical structural domains of TM required for survival and interaction with intracellular pathways will be delineated by testing receptor mutants for their ability to support embryonic viability. Components interacting with these domains will eventually be identified with biochemical methods. The suspected role of TM in later stages of development will be determined by prolonging the survival of TM knock- out mice via a stage- and cell type-restricted restoration of TM expression in selected embryonic tissues. The cell type restricted ablation of the receptor gene will be employed to evaluate the proposed role of TM in lung morphogenesis and to examine in vivo the consequences of complete receptor deficiency in vascular endothelium and vascular smooth muscle cells. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: THROMBOSIS TARGETED MRI CONTRAST AGENT Principal Investigator & Institution: Danilich, Michael J.; Luna Innovations, Inc. 2851 Commerce St Blacksburg, Va 24060 Timing: Fiscal Year 2003; Project Start 22-AUG-2003; Project End 29-FEB-2004 Summary: (provided by applicant): This proposal addresses the need for a minimally invasive diagnostic assay for the evaluation of pathological blood clots in patients suspected of developing intravascular blood clots that may manifest themselves as pulmonary embolism (PE), deep vein thrombosis (DVT) or thrombotic stroke. Indeed, thrombosis (the formation of blood clots) remains the leading cause of morbidity and mortality in the United States. Luna Innovations proposes to develop a trimetasphere based magnetic resonance imaging contrast agent for site directed thrombosis imaging. Luna Innovations will manufacture an appropriate trimetasphere nanomaterial (such as like Gd2ScN@C80) and functionalize it in preparation for conjugation to a monoclonal antibody with the highest specificity to a neo-epitope on the blood clot. Following this the trimetasphere-antibody complex will be evaluated in vitro experiments for the capability of the complex to target, image and destroy the blood clot. In phase I, Luna will demonstrate the ability of this complex to perform this task and optimize the complex for in vivo diagnostic imaging for phase II 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 “blood clots” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for blood clots in the PubMed Central database: 3 4
Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.
With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print.
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Thrombin-activatable fibrinolysis inhibitor (TAFI) deficiency is compatible with murine life. by Nagashima M, Yin ZF, Zhao L, White K, Zhu Y, Lasky N, Halks-Miller M, Broze GJ Jr, Fay WP, Morser J.; 2002 Jan 1; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=150816
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Tsetse thrombin inhibitor: Bloodmeal-induced expression of an anticoagulant in salivary glands and gut tissue of Glossina morsitans morsitans. by Cappello M, Li S, Chen X, Li CB, Harrison L, Narashimhan S, Beard CB, Aksoy S.; 1998 Nov 24; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=24366
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 blood clots, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “blood clots” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for blood clots (hyperlinks lead to article summaries): •
A method for removing blood clots from the upper urinary tract. Author(s): Mungas J, Lebowitz JM, Sylora H. Source: The Journal of Urology. 1972 December; 108(6): 948-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5082753&dopt=Abstract
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A simple method for isolation of DNA from blood clots suited for use in PCR. Author(s): Zeillinger R, Schneeberger C, Speiser P, Kury F. Source: Biotechniques. 1993 February; 14(2): 202-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8431280&dopt=Abstract
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Acquisition of typing serum from post partum blood clots. Author(s): Gazit E, Efter T, Mizrachi Y, Mashiach I, Mashiach S, Serr D. Source: Tissue Antigens. 1977 January; 9(1): 66-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=850920&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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Acute thromboembolic events associated with intravenous immunoglobulin infusion in antibody-deficient patients. Author(s): Brown HC, Ballas ZK. Source: The Journal of Allergy and Clinical Immunology. 2003 October; 112(4): 797-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14564366&dopt=Abstract
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Adenovirus in blood clots from cases of infectious hepatitis. Author(s): Hartwell WV, Love GJ, Eidenbock MP. Source: Science. 1966 June 3; 152(727): 1390. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5937134&dopt=Abstract
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Alcohol levels in intracranial blood clots. Author(s): Freireich AW, Bidanset JH, Lukash L. Source: J Forensic Sci. 1975 January; 20(1): 83-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1117275&dopt=Abstract
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An efficient extraction method from blood clots for studies requiring both host and viral DNA. Author(s): Basuni AA, Butterworth LA, Cooksley G, Locarnini S, Carman WF. Source: Journal of Viral Hepatitis. 2000 May; 7(3): 241-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10849268&dopt=Abstract
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Antiphospholipid antibody. Babies, blood clots, biology. Author(s): Lockshin MD. Source: Jama : the Journal of the American Medical Association. 1997 May 21; 277(19): 1549-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9153370&dopt=Abstract
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Anuria due to intrarenal blood clots in solitary kidney after change of ureteral stent: resolution with minimally invasive evacuation. Author(s): Roth S, Semjonow A, Waldner M, Hertle L. Source: The Journal of Urology. 1995 July; 154(1): 195-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7776422&dopt=Abstract
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Ask the doctor. I have atherosclerosis in the arteries of my heart and neck, and my doctors want me to take aspirin. I also have arthritis and take Naprosyn for it every day. I have heard that Naprosyn can prevent blood clots, just like aspirin does. Can I just take Naprosyn, or do I still need to take aspirin, too, to protect my heart and brain from blood clots? Author(s): Lee TH. Source: Harvard Heart Letter : from Harvard Medical School. 2002 August; 12(12): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12217848&dopt=Abstract
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Binding and lysing of blood clots using MRX-408. Author(s): Wu Y, Unger EC, McCreery TP, Sweitzer RH, Shen D, Wu G, Vielhauer MD. Source: Investigative Radiology. 1998 December; 33(12): 880-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9851822&dopt=Abstract
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Binding of human tissue plasminogen activator (t-PA) to blood clots and clot-lytic activity of clot-bound t-PA. Author(s): Kimata H, Nakajima K, Yamamoto S, Hasegawa A. Source: J Pharmacobiodyn. 1990 December; 13(12): 745-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2129127&dopt=Abstract
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Block of epidural needle by blood clots. Author(s): Hendley BJ. Source: Anaesthesia. 1991 November; 46(11): 996. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1750622&dopt=Abstract
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Block of epidural needle by blood clots. Author(s): Lim ET, Teh TS, Li YH. Source: Anaesthesia. 1991 July; 46(7): 597-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1862920&dopt=Abstract
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Blood clots in vessels surrounding symptomatic nerve roots in disc herniation patients: a pilot study. Author(s): Habtemariam A, Gronblad M, Virri J, Korkala O. Source: European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2002 October; 11(5): 447-51. Epub 2002 January 30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12384752&dopt=Abstract
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Blood clots mimicking peripheral intrabronchial tumors in patients with hemoptysis: CT and bronchoscopic findings. Author(s): Eisenhuber E, Brunner C, Bankier AA. Source: Journal of Computer Assisted Tomography. 2000 January-February; 24(1): 47-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10667657&dopt=Abstract
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Blood clots: the nineteenth-century debate over the substance and means of transfusion in Britain. Author(s): Pelis K. Source: Annals of Science. 1997 July; 54(4): 331-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11619383&dopt=Abstract
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B-mode sonography of blood clots. Author(s): Coelho JC, Sigel B, Ryva JC, Machi J, Renigers SA. Source: Journal of Clinical Ultrasound : Jcu. 1982 September; 10(7): 323-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6815230&dopt=Abstract
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Cardiology patient pages. Treatment of blood clots. Author(s): Goldhaber SZ, Grasso-Correnti N. Source: Circulation. 2002 November 12; 106(20): E138-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12427663&dopt=Abstract
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Cellularity and fibrin mesh properties as a basis for ultrasonic tissue characterization of blood clots and thrombi. Author(s): Loiacono LA, Sigel B, Feleppa EJ, Swami VK, Parsons RE, Justin J, Yaremko MM, Rorke M, Kodama I, Golub RM, et al. Source: Ultrasound in Medicine & Biology. 1992; 18(4): 399-410. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1509615&dopt=Abstract
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Cerebral blood flow velocities after subarachnoid haemorrhage in relation to the amount of blood clots in the initial computed tomography. Author(s): Boecher-Schwarz HG, Fries G, Mueller-Forell W, Kessel G, Perneczky A. Source: Acta Neurochirurgica. 1998; 140(6): 573-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9755324&dopt=Abstract
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Cholesterol crystal embolization (CCE) after cardiac catheterization: a case report and a review of 36 cases in the Japanese literature. Author(s): Funabiki K, Masuoka H, Shimizu H, Emi Y, Mori T, Ito M, Nakano T. Source: Japanese Heart Journal. 2003 September; 44(5): 767-74. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14587658&dopt=Abstract
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Coagulolysis: mechanism of formation and lysis of dilute whole blood clots and application of this assay into study of certain hypercoagulable states. Author(s): Taylor FB Jr, Nilsson UR, Creech RH, Carroll ET, Beisswenger JG. Source: Ser Haematol. 1973; 6(4): 528-48. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4277409&dopt=Abstract
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Comparison of ximelagatran with warfarin for the prevention of venous thromboembolism after total knee replacement. Author(s): Francis CW, Berkowitz SD, Comp PC, Lieberman JR, Ginsberg JS, Paiement G, Peters GR, Roth AW, McElhattan J, Colwell CW Jr; EXULT A Study Group. Source: The New England Journal of Medicine. 2003 October 30; 349(18): 1703-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14585938&dopt=Abstract
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Correlation between progressive adsorption of plasminogen to blood clots and their sensitivity to lysis. Author(s): Sabovic M, Lijnen HR, Keber D, Collen D. Source: Thrombosis and Haemostasis. 1990 November 30; 64(3): 450-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2096491&dopt=Abstract
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Correlation of scanning electron microscope and light microscope images of individual cells in human blood and blood clots. Author(s): McDonald LW, Hayes TL. Source: Experimental and Molecular Pathology. 1969 April; 10(2): 186-98. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5777796&dopt=Abstract
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Dangerous seats? Crammed into airline economy class, you may be risking blood clots. Here's what you can do. Author(s): Smith IK. Source: Time. 2000 November 6; 156(19): 136. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11186856&dopt=Abstract
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Detection of anti-nuclear antibodies from filter paper blood clots using indirect immunoenzyme technique: preliminary experience and results. Author(s): Chopra A, Anuradha V, Edmonds J. Source: J Assoc Physicians India. 2000 May; 48(5): 493-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11273141&dopt=Abstract
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Dissolution of blood clots in the biliary ducts with a thrombolytic agent infused through nasobiliary catheter. Author(s): Moparty RK, Brown RD, Layden TJ, Chirravuri V, Wiley T, Venu RP. Source: Gastrointestinal Endoscopy. 2002 September; 56(3): 436-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12196791&dopt=Abstract
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DNA extraction from urea-preserved blood or blood clots for use in PCR. Author(s): Gelhaus A, Urban B, Pirmez C. Source: Trends in Genetics : Tig. 1995 February; 11(2): 41. Erratum In: Trends Genet 1995 April; 11(4): 129. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7716806&dopt=Abstract
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Effect of protein concentration and blood clots on the “in vitro” anti-Pseudomonas aeruginosa activity of cefoperazone. Author(s): Frongillo RF, Moretti MV, Bittarelli C, Moretti A. Source: Boll Ist Sieroter Milan. 1983 November 30; 62(5): 417-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6422956&dopt=Abstract
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Effect of thiol derivatives on mixed mucus and blood clots in vitro. Author(s): Risack LE, Vandevelde ME, Gobert JG. Source: Resuscitation. 1978; 6(1): 9-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=97741&dopt=Abstract
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Efficacy of alteplase thrombolysis for ED treatment of pulmonary embolism with shock. Author(s): Le Conte P, Huchet L, Trewick D, Longo C, Vial I, Batard E, Yatim D, Touze MD, Baron D. Source: The American Journal of Emergency Medicine. 2003 September; 21(5): 438-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14523886&dopt=Abstract
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Elasticity and fracture strain of whole blood clots. Author(s): Riha P, Wang X, Liao R, Stoltz JF. Source: Clinical Hemorheology and Microcirculation. 1999; 21(1): 45-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10517487&dopt=Abstract
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Elusive blood clots and fluctuating ventricular dilatation after neonatal intraventricular haemorrhage. Author(s): Fawer CL, Levene MI. Source: Archives of Disease in Childhood. 1982 February; 57(2): 158-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7065715&dopt=Abstract
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Endobronchial streptokinase for bronchial obstruction by blood clots. Author(s): Cole RP, Grossman GJ. Source: The New England Journal of Medicine. 1983 April 14; 308(15): 905-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6835292&dopt=Abstract
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Endobronchial streptokinase for relief of tracheobronchial obstruction by blood clots. Author(s): Maxwell SL, Stauffer JL. Source: Chest. 1992 June; 101(6): 1738-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1600809&dopt=Abstract
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Endobronchial thrombolysis with streptokinase for airway obstruction due to blood clots. Author(s): Vajo Z, Parish JM. Source: Mayo Clinic Proceedings. 1996 June; 71(6): 595-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8642889&dopt=Abstract
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Enhancement of red cell washout from blood clots by alteration of gel pore size and red cell flexibility. Author(s): Carr ME Jr, Hauge Y. Source: The American Journal of Physiology. 1990 November; 259(5 Pt 2): H1527-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1700633&dopt=Abstract
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Evaluation of monoclonal antifibrin antibodies by their binding to human blood clots. Author(s): Liau CS, Haber E, Matsueda GR. Source: Thrombosis and Haemostasis. 1987 February 3; 57(1): 49-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3590080&dopt=Abstract
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Factors influencing lysis of whole blood clots. Author(s): Taylor FB, Muller-Eberhard HJ. Source: Nature. 1967 December 9; 216(119): 1023-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4169258&dopt=Abstract
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Femoral signal intensity: a new method for prediction of embolic risk. Author(s): Ercan E, Baris N, Tengiz I, Ercan HE, Onbasili OA, Duman C, Cinar CS. Source: Japanese Heart Journal. 2003 September; 44(5): 705-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14587652&dopt=Abstract
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Fibrinogen-fibrin related antigen pattern in human blood. Incomplete lysis of whole blood clots by urokinase. Author(s): Jacobsen CD, Fry GL, Wu KK, Southers NJ. Source: Thrombosis Research. 1975 April; 6(4): 327-36. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1079637&dopt=Abstract
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Finger-like lysing patterns of blood clots. Author(s): Zidansek A, Blinc A, Lahajnar G, Keber D, Blinc R. Source: Biophysical Journal. 1995 September; 69(3): 803-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8519981&dopt=Abstract
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Further studies on ultrasonic properties of blood clots. Author(s): Shung KK, Fei DY, Ballard JO 3rd. Source: Journal of Clinical Ultrasound : Jcu. 1986 May; 14(4): 269-75. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3084583&dopt=Abstract
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Heparinized saline to aid aspiration of blood clots during laparoscopy. Author(s): Nduka CC, Darzi A. Source: The British Journal of Surgery. 1993 August; 80(8): 1082-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8402082&dopt=Abstract
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Importance of factor Xa in determining the procoagulant activity of whole-blood clots. Author(s): Eisenberg PR, Siegel JE, Abendschein DR, Miletich JP. Source: The Journal of Clinical Investigation. 1993 May; 91(5): 1877-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8486759&dopt=Abstract
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In vitro interaction between venous blood clots and radiopharmaceuticals. Author(s): Kempi V, Persson BR. Source: Nuklearmedizin. 1985 August; 24(4): 173-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4080561&dopt=Abstract
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Influence of blood clots in the cumulus complex on oocyte fertilization and cleavage. Author(s): Daya S, Kohut J, Gunby J, Younglai E. Source: Human Reproduction (Oxford, England). 1990 August; 5(6): 744-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2254410&dopt=Abstract
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Inherited and acquired risk factors for venous thromboembolic disease among women taking tamoxifen to prevent breast cancer. Author(s): Duggan C, Marriott K, Edwards R, Cuzick J. Source: Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 2003 October 1; 21(19): 3588-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14512389&dopt=Abstract
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Intracameral urokinase for dissolution of fibrin or blood clots after glaucoma surgery. Author(s): WuDunn D. Source: American Journal of Ophthalmology. 1997 November; 124(5): 693-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9372728&dopt=Abstract
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Low daily aspirin doses reduce risk of blood clots as effectively as higher doses. Author(s): Rollins G. Source: Rep Med Guidel Outcomes Res. 2001 February 22; 12(4): 5-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11767795&dopt=Abstract
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Low dose, long-term warfarin safely prevents blood clots. Author(s): Levenson D. Source: Rep Med Guidel Outcomes Res. 2003 March 21; 14(6): 1-2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12838964&dopt=Abstract
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Lysing patterns of retracted blood clots with diffusion or bulk flow transport of plasma with urokinase into clots--a magnetic resonance imaging study in vitro. Author(s): Blinc A, Keber D, Lahajnar G, Stegnar M, Zidansek A, Demsar F. Source: Thrombosis and Haemostasis. 1992 December 7; 68(6): 667-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1287880&dopt=Abstract
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Magnetic relaxation in blood and blood clots. Author(s): Bryant RG, Marill K, Blackmore C, Francis C. Source: Magnetic Resonance in Medicine : Official Journal of the Society of Magnetic Resonance in Medicine / Society of Magnetic Resonance in Medicine. 1990 January; 13(1): 133-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2319929&dopt=Abstract
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Magnetic resonance imaging of retracted and nonretracted blood clots during fibrinolysis in vitro. Author(s): Blinc A, Keber D, Lahajnar G, Zupancic I, Zorec-Karlovsek M, Demsar F. Source: Haemostasis. 1992; 22(4): 195-201. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1468722&dopt=Abstract
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Mechanism of accelerated lysis of blood clots from heparinised blood. Author(s): Morris CJ, Williamson N, Wolf P. Source: Haemostasis. 1981; 10(5): 245-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7274777&dopt=Abstract
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Molecular masking and unmasking of the paramagnetic effect of iron on the proton spin-lattice (T1) relaxation time in blood and blood clots. Author(s): Finnie M, Fullerton GD, Cameron IL. Source: Magnetic Resonance Imaging. 1986; 4(4): 305-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3669945&dopt=Abstract
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Near-fatal air embolism: fibrin sheath as the portal of air entry. Author(s): Roberts S, Johnson M, Davies S. Source: Southern Medical Journal. 2003 October; 96(10): 1036-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14570352&dopt=Abstract
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New insights into how blood clots: implications for the use of APTT and PT as coagulation screening tests and in monitoring of anticoagulant therapy. Author(s): Bajaj SP, Joist JH. Source: Seminars in Thrombosis and Hemostasis. 1999; 25(4): 407-18. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10548073&dopt=Abstract
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Obliteration of the left atrial appendage for prevention of thromboembolism. Author(s): Halperin JL, Gomberg-Maitland M. Source: Journal of the American College of Cardiology. 2003 October 1; 42(7): 1259-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14522492&dopt=Abstract
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Observations on optimal conditions for lysis of whole blood clots and use of this assay as a screening assay in clinical investigation. Author(s): Lockhart MS, Lee ET, Taylor FB Jr. Source: Thrombosis Research. 1982 December 1; 28(5): 625-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6820194&dopt=Abstract
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Opacification of formed blood clots by water-soluble radiopaque contrast media. Author(s): Reich SB, Dorsay RH. Source: Radiology. 1972 August; 104(2): 291-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5044983&dopt=Abstract
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Penicillin--the duration of its activity in blood clots. Author(s): Juniper RP. Source: Br J Oral Surg. 1972 March; 9(3): 222-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4505409&dopt=Abstract
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Plasminogen activation and lysis of blood clots induced by cells in vitro. Author(s): Knox P, Crooks S. Source: Journal of Cellular Physiology. 1988 June; 135(3): 467-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2456288&dopt=Abstract
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Positional shift of intraventricular blood clots demonstrated by computed tomography. Author(s): Vermess M, Di Chiro G, Newby NR, Herdt JR. Source: Radiology. 1976 February; 118(2): 341-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=766057&dopt=Abstract
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Pregnancy-associated venous thromboembolism (VTE) in combined heterozygous factor V Leiden (FVL) and prothrombin (FII) 20210 A mutation and in heterozygous FII single gene mutation alone. Author(s): Samama MM, Rached RA, Horellou MH, Aquilanti S, Mathieux VG, PluBureau G, Elalamy I, Conard J. Source: British Journal of Haematology. 2003 October; 123(2): 327-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14531916&dopt=Abstract
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Preventing air embolism when removing CVCs: an evidence-based approach to changing practice. Author(s): Peter DA, Saxman C. Source: Medsurg Nursing : Official Journal of the Academy of Medical-Surgical Nurses. 2003 August; 12(4): 223-8; Quiz 229. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14515601&dopt=Abstract
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Preventing blood clots with drugs. Author(s): Miller CA. Source: Geriatric Nursing (New York, N.Y.). 1999 March-April; 20(2): 108-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10382429&dopt=Abstract
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Prospective and retrospective studies of zinc concentrations in serum, blood clots, hair and urine in young patients with insulin-dependent diabetes mellitus. Author(s): Hagglof B, Hallmans G, Holmgren G, Ludvigsson J, Falkmer S. Source: Acta Endocrinol (Copenh). 1983 January; 102(1): 88-95. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6337453&dopt=Abstract
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Proton NMR study of the state of water in fibrin gels, plasma, and blood clots. Author(s): Blinc A, Lahajnar G, Blinc R, Zidansek A, Sepe A. Source: Magnetic Resonance in Medicine : Official Journal of the Society of Magnetic Resonance in Medicine / Society of Magnetic Resonance in Medicine. 1990 April; 14(1): 105-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2161980&dopt=Abstract
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Qualitative description of factors involved in the retraction and lysis of dilute whole blood clots and in the aggregation and retraction of platelets. Author(s): Taylor FB Jr, Muller-Eberhard HJ. Source: The Journal of Clinical Investigation. 1970 November; 49(11): 2068-85. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4248913&dopt=Abstract
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Release and activation of platelet latent TGF-beta in blood clots during dissolution with plasmin. Author(s): Grainger DJ, Wakefield L, Bethell HW, Farndale RW, Metcalfe JC. Source: Nature Medicine. 1995 September; 1(9): 932-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7585220&dopt=Abstract
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Removal of subarachnoid blood clots after subarachnoid hemorrhage. Author(s): Wakabayashi T, Fujita S. Source: Surgical Neurology. 1984 June; 21(6): 553-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6719326&dopt=Abstract
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Results of removal of blood clots after massive anterior chamber haemorrhage with secondary glaucoma following ocular contusion through a large 90 degrees limbal incision. Author(s): Mortada A. Source: Bull Ophthalmol Soc Egypt. 1974; 67: 57-61. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4466555&dopt=Abstract
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Retrograde trypsin instillation into the renal pelvis for the dissolution of obstructive blood clots. Author(s): Grabe M, Forsberg B. Source: European Urology. 1986; 12(1): 69-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3948901&dopt=Abstract
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Right-sided chest-lead abnormalities on EKG in acute pulmonary embolism. Author(s): Cheng TO. Source: Journal of the National Medical Association. 2003 September; 95(9): 862. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14527054&dopt=Abstract
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Risk assessment for venous thromboembolism in acute medical illness. Author(s): Hampton KK, Walker I. Source: Hosp Med. 2003 September; 64(9): 508-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14521063&dopt=Abstract
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Role of thrombin compared with factor Xa in the procoagulant activity of whole blood clots. Author(s): Prager NA, Abendschein DR, McKenzie CR, Eisenberg PR. Source: Circulation. 1995 August 15; 92(4): 962-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7641380&dopt=Abstract
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Roles of subarachnoid blood clots and norepinephrine in cerebral vasospasm. Author(s): Shigeno T, Saito I, Sano K, Takakura K, Brock M. Source: Acta Neurochirurgica. 1982; 63(1-4): 277-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7102419&dopt=Abstract
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Secondary prevention of venous thromboembolism with the oral direct thrombin inhibitor ximelagatran. Author(s): Schulman S, Wahlander K, Lundstrom T, Clason SB, Eriksson H; THRIVE III Investigators. Source: The New England Journal of Medicine. 2003 October 30; 349(18): 1713-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14585939&dopt=Abstract
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Streptokinase for endobronchial blood clots. Author(s): Bansal A. Source: Chest. 1999 August; 116(2): 587. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10453905&dopt=Abstract
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Studies on thrombolysis with streptokinase. II. The influence of changes due to age in thrombi and whole blood clots. Author(s): Gottlob R, Blumel G, Piza F, Brucke R, Bohmig HJ. Source: Thromb Diath Haemorrh. 1968 July 31; 19(3): 516-25. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5751633&dopt=Abstract
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Subcutaneous fondaparinux versus intravenous unfractionated heparin in the initial treatment of pulmonary embolism. Author(s): Buller HR, Davidson BL, Decousus H, Gallus A, Gent M, Piovella F, Prins MH, Raskob G, van den Berg-Segers AE, Cariou R, Leeuwenkamp O, Lensing AW; Matisse Investigators. Source: The New England Journal of Medicine. 2003 October 30; 349(18): 1695-702. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14585937&dopt=Abstract
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Suction curettage for removal of retained intrathoracic blood clots and pleural lesions. Author(s): Redan JA, Palmer MT, Tylutki FJ. Source: Jsls. 1999 April-June; 3(2): 117-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10444010&dopt=Abstract
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The effect of heparin on the viscoelasticity of whole blood clots. Author(s): Overholser KA, Itin JP, Brown DR, Harris TR. Source: Biorheology. 1975 August; 12(5): 309-16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1203534&dopt=Abstract
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The incidence of thromboembolism in the surgical intensive care unit. Author(s): Major KM, Wilson M, Nishi GK, Farber A, Chopra R, Chung A, McVay C, Spivak J, Shabot MM. Source: The American Surgeon. 2003 October; 69(10): 857-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14570363&dopt=Abstract
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The influence of various plasma components on the lysis of dilute human blood clots. Author(s): Gallimore MJ, Shaw JT. Source: Thromb Diath Haemorrh. 1969 November 15; 22(2): 223-33. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5380946&dopt=Abstract
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The relationship between cerebral blood flow velocities and the amount of blood clots in computed tomography after subarachnoid haemorrhage. Author(s): Jarus-Dziedzic K, Zub W, Wronski J, Juniewicz H, Kasper E. Source: Acta Neurochirurgica. 2000; 142(3): 309-18. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10819262&dopt=Abstract
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The role of histopathologic examination of intracranial blood clots removed for hemorrhage of unknown etiology: a clinical pathologic analysis of 31 cases. Author(s): Abrahams NA, Prayson RA. Source: Annals of Diagnostic Pathology. 2000 December; 4(6): 361-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11149966&dopt=Abstract
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There is synergism between high-intensity, low-frequency ultrasound and streptokinase but not with eptifibatide, heparin, and aspirin. Differential effects on fresh and aged blood clots. An in vitro study. Author(s): Wyshelesky A, Iakobishvili Z, Matz I, Golovchiner G, Vaturi M, Siegel RJ, Birnbaum Y. Source: Thrombosis Research. 2001 August 15; 103(4): 337-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11562343&dopt=Abstract
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Transvaginal sonography in the treatment of acute urinary retention due to intravesical blood clots. Author(s): Yang JM, Huang WC. Source: Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine. 2003 August; 22(8): 851-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12901416&dopt=Abstract
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Ultrasonic tissue characterization of blood clots. Author(s): Sigel B, Feleppa EJ, Swami V, Justin J, Consigny M, Machi J, Kikuchi T, Lizzi FL, Kurohiji T, Hui J. Source: The Surgical Clinics of North America. 1990 February; 70(1): 13-29. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2406962&dopt=Abstract
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Ultrasound of the traumatized spleen: left butterfly sign in lesions masked by echogenic blood clots. Author(s): Weill F, Rohmer P, Didier D, Coche G. Source: Gastrointest Radiol. 1988; 13(2): 169-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3282965&dopt=Abstract
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Unusual echocardiographic presentations of pulmonary embolism in transit. Author(s): Leitman M, Sidenko S, Peleg E, Wolf R, Sucher E, Rosenblath S, Vered Z. Source: Isr Med Assoc J. 2003 September; 5(9): 675-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14509165&dopt=Abstract
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Use of blood clots as enzyme source in gel electrophoresis. Author(s): Koen AL. Source: Biochemical Genetics. 1971 October; 5(5): 449-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5520792&dopt=Abstract
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Use of natriuretic peptides in guiding treatment decisions for acute pulmonary embolism. Author(s): Smithline H. Source: Circulation. 2003 September 30; 108(13): E93; Author Reply E93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14517155&dopt=Abstract
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Use of streptokinase for lysing blood clots in the pelvis of a renal allograft. Author(s): Fares JA, Nahas WC, Campagnari JC, Ianhez LE, Sabbaga E, Arap S. Source: Transplantation. 1989 November; 48(5): 879-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2815262&dopt=Abstract
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Utility of brain natriuretic peptide to predict right ventricular dysfunction and clinical outcome in patients with acute pulmonary embolism. Author(s): Kruger S, Merx MW, Graf J. Source: Circulation. 2003 September 30; 108(13): E94-5; Author Reply E94-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14517156&dopt=Abstract
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Venous thromboembolism associated with long-term use of central venous catheters in cancer patients. Author(s): Verso M, Agnelli G. Source: Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 2003 October 1; 21(19): 3665-75. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14512399&dopt=Abstract
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CHAPTER 2. NUTRITION AND BLOOD CLOTS Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and blood clots.
Finding Nutrition Studies on Blood Clots 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 “blood clots” (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 “blood clots” (or a synonym): •
Activated human protein C prevents thrombin-induced thromboembolism in mice. Evidence that activated protein c reduces intravascular fibrin accumulation through the inhibition of additional thrombin generation. Author(s): Institute of Internal and Vascular Medicine, University of Perugia, 06126 Perugia, Italy.
[email protected] Source: Gresele, P Momi, S Berrettini, M Nenci, G G Schwarz, H P Semeraro, N Colucci, M J-Clin-Invest. 1998 February 1; 101(3): 667-76 0021-9738
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Cardiology patient pages. Treatment of blood clots. Author(s): Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass 02115, USA.
[email protected] Source: Goldhaber, S Z Grasso Correnti, N Circulation. 2002 November 12; 106(20): e13840 1524-4539
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Dermatan sulfate is a more potent inhibitor of clot-bound thrombin than unfractionated and low molecular weight heparins. Author(s): Laboratoire d'Hemostase, Hopital de Rangueil, Toulouse, France. Source: Bendayan, P Boccalon, H Dupouy, D Boneu, B Thromb-Haemost. 1994 May; 71(5): 576-80 0340-6245
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Effect of thrombin-induced hemostasis on the efficacy of an absorbable adhesion barrier. Author(s): Department of Obstetrics and Gynecology, Yale University Medical Center, New Haven, Connecticut. Source: Wiseman, D M Gottlick, L E Diamond, M P J-Reprod-Med. 1992 September; 37(9): 766-70 0024-7758
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Enhancement of red cell washout from blood clots by alteration of gel pore size and red cell flexibility. Author(s): Department of Pathology, Medical College of Virginia, Richmond. Source: Carr, M E Hauge, Y Am-J-Physiol. 1990 November; 259(5 Pt 2): H1527-32 00029513
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Inhibition of thrombin abrogates the instant blood-mediated inflammatory reaction triggered by isolated human islets: possible application of the thrombin inhibitor melagatran in clinical islet transplantation. Author(s): Department of Radiology, Oncology and Clinical Immunology, Division of Clinical Immunology, the Rudbeck Laboratory, University Hospital, Uppsala, Sweden. Source: Ozmen, Lisa Ekdahl, Kristina Nilsson Elgue, Graciela Larsson, Rolf Korsgren, Olle Nilsson, Bo Diabetes. 2002 June; 51(6): 1779-84 0012-1797
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Mechanisms for the anticoagulant effects of synthetic antithrombins. Author(s): Canadian Red Cross Society, Blood Transfusion Service, Hamilton, Ontario. Source: Ofosu, F A Adv-Exp-Med-Biol. 1993; 340213-26 0065-2598
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Pharmacologic modulation of thrombin generation associated with human clots by human purified antithrombin alone or in the presence of low molecular weight heparin or unfractionated heparin. Author(s): Laboratoire de Thrombose Experimentale, Institut des Cordeliers, Universite Pierre et Marie Curie, Paris VI, France. Source: Meddahi, S Bara, L Fessi, H Samama, M M Blood-Coagul-Fibrinolysis. 2000 January; 11(1): 51-9 0957-5235
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Summaries for patients. Ximelagatran versus warfarin to prevent blood clots after knee replacement surgery. Source: Anonymous Ann-Intern-Med. 2002 October 15; 137(8): I38 1539-3704
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Thrombin activatable fibrinolysis inhibitor (TAFI) does not inhibit in vitro thrombolysis by pharmacological concentrations of t-PA. Author(s): Department of Biomedical Sciences, University of Bari, Italy.
[email protected] Source: Colucci, M D'Aprile, A M Italia, A Gresele, P Morser, J Semeraro, N ThrombHaemost. 2001 Apr; 85(4): 661-6 0340-6245
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Thrombin infusion in endotoxin-treated rabbits reduces the plasma levels of plasminogen activator inhibitor: evidence for a protein-C-mediated mechanism. Author(s): Istituto di Patologia Generale, Universita di Bari, Italy. Source: Colucci, M Triggiani, R Cavallo, L G Semeraro, N Blood. 1989 November 1; 74(6): 1976-82 0006-4971
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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WebMDHealth: http://my.webmd.com/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 blood clots; 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: •
Vitamins Vitamin E Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,906,00.html Vitamin K Source: Healthnotes, Inc.; www.healthnotes.com Vitamin K Alternative names: Menadione, Menaphthone, Menaquinone, Phylloquinone Source: Integrative Medicine Communications; www.drkoop.com Vitamin K Source: Prima Communications, Inc.www.personalhealthzone.com Vitamin K Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10068,00.html
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Minerals Calcium Source: Healthnotes, Inc.; www.healthnotes.com Calcium Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,884,00.html Magnesium Source: Prima Communications, Inc.www.personalhealthzone.com
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Magnesium Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,890,00.html Vanadium Alternative names: Vanadate Source: Integrative Medicine Communications; www.drkoop.com •
Food and Diet Brazil Nuts Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,115,00.html Chondroitin Sulfate Source: Healthnotes, Inc.; www.healthnotes.com Garlic Alternative names: Allium sativum Source: Integrative Medicine Communications; www.drkoop.com Garlic Source: Prima Communications, Inc.www.personalhealthzone.com Garlic Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,21,00.html Mushrooms Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10046,00.html Omega-3 Fatty Acids Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,992,00.html Soybeans Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,105,00.html
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CHAPTER 3. ALTERNATIVE MEDICINE AND BLOOD CLOTS Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to blood clots. 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 blood clots 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 “blood clots” (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 blood clots: •
A novel degradation pathway of tissue factor pathway inhibitor: incorporation into fibrin clot and degradation by thrombin. Author(s): Ohkura N, Enjyoji K, Kamikubo Y, Kato H. Source: Blood. 1997 September 1; 90(5): 1883-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9292521&dopt=Abstract
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Activities of trovafloxacin, gatifloxacin, clinafloxacin, sparfloxacin, levofloxacin, and ciprofloxacin against penicillin-resistant Streptococcus pneumoniae in an in vitro infection model. Author(s): Hershberger E, Rybak MJ. Source: Antimicrobial Agents and Chemotherapy. 2000 March; 44(3): 598-601. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10681324&dopt=Abstract
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Anticoagulant albumin fragments that bind to fibrinogen/fibrin: possible implications. Author(s): Galanakis DK. Source: Seminars in Thrombosis and Hemostasis. 1992 January; 18(1): 44-52. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1574716&dopt=Abstract
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Bactericidal activities of teicoplanin, vancomycin, and gentamicin alone and in combination against Staphylococcus aureus in an in vitro pharmacodynamic model of endocarditis. Author(s): McGrath BJ, Kang SL, Kaatz GW, Rybak MJ. Source: Antimicrobial Agents and Chemotherapy. 1994 September; 38(9): 2034-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7811015&dopt=Abstract
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Cerastotin, a serine protease from Cerastes cerastes venom, with platelet-aggregating and agglutinating properties. Author(s): Marrakchi N, Barbouche R, Guermazi S, Karoui H, Bon C, El Ayeb M. Source: European Journal of Biochemistry / Febs. 1997 July 1; 247(1): 121-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9249017&dopt=Abstract
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Changes in regional ventilation after autologous blood clot pulmonary embolism. Author(s): Vidal Melo MF, Harris RS, Layfield D, Musch G, Venegas JG. Source: Anesthesiology. 2002 September; 97(3): 671-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12218535&dopt=Abstract
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Characterization of a membrane protease from rat submaxillary-gland mitochondria that possess thrombin-like activity. Author(s): Bharadwaj M, Bharadwaj D, Hati RN. Source: The Biochemical Journal. 1996 January 1; 313 ( Pt 1): 193-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8546683&dopt=Abstract
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Characterization of a thrombin-like enzyme from the venom of Trimeresurus jerdonii. Author(s): Lu QM, Jin Y, Li DS, Wang WY, Xiong YL. Source: Toxicon : Official Journal of the International Society on Toxinology. 2000 September; 38(9): 1225-36. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10736476&dopt=Abstract
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China: a new medicine born of tradition. Author(s): Wen W. Source: Unesco Cour. 1979 July; 7: 25-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12309932&dopt=Abstract
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Coagulation-dependent inhibition of fibrinolysis: role of carboxypeptidase-U and the premature lysis of clots from hemophilic plasma. Author(s): Broze GJ Jr, Higuchi DA. Source: Blood. 1996 November 15; 88(10): 3815-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8916945&dopt=Abstract
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Colcemid but not taxol modulates the migratory behavior of human T lymphocytes within 3-D collagen lattices. Author(s): Nikolai G, Niggemann B, Werner M, Zanker KS. Source: Immunobiology. 1999 September; 201(1): 107-19. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10532284&dopt=Abstract
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Cold induced retraction of reptilase clots. Author(s): Kubisz P. Source: Scand J Haematol. 1974; 13(3): 175-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4218358&dopt=Abstract
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EDTA-induced changes in platelet structure and function: clot retraction. Author(s): White JG. Source: Platelets. 2000 February; 11(1): 49-55. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10938882&dopt=Abstract
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Effect of clot removal and surgical manipulation on regional cerebral blood flow and delayed vasospasm in early aneurysm surgery for subarachnoid hemorrhage. Author(s): Hosoda K, Fujita S, Kawaguchi T, Shose Y, Hamano S, Iwakura M. Source: Surgical Neurology. 1999 January; 51(1): 81-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9952128&dopt=Abstract
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Effect of crosslinking on the structure of solubilized fibrin degradation products in whole plasma. Author(s): Carroll RC, Lockhart MS, Taylor FB Jr. Source: The Journal of Laboratory and Clinical Medicine. 1984 May; 103(5): 695-703. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6232329&dopt=Abstract
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Effect of tPA on regional lung perfusion in unilobar canine pulmonary thromboembolism. Author(s): Ikeda T, Nakatani S, Takata H, Nosaka M, Yoshikawa A, Tanaka H, Yukawa S. Source: American Journal of Respiratory and Critical Care Medicine. 1997 November; 156(5): 1483-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9372664&dopt=Abstract
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Effects of a phytotherapeutic agent, PC-SPES, on prostate cancer: a preliminary investigation on human cell lines and patients. Author(s): de la Taille A, Hayek OR, Buttyan R, Bagiella E, Burchardt M, Katz AE. Source: Bju International. 1999 November; 84(7): 845-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10532984&dopt=Abstract
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Effects of colchicine and vinblastine on platelet contractility and release. Author(s): Kuntamukkula MS, Moake JL, McIntire LV, Cimo PL. Source: Thrombosis Research. 1982 June 1; 26(5): 329-39. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7164026&dopt=Abstract
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Effects of fish-oil constituents and plasma lipids on fibrinolysis in vitro. Author(s): al-Awadhi AM, Dunn CD. Source: British Journal of Biomedical Science. 2000; 57(4): 273-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11204855&dopt=Abstract
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Effects of serum versus plasma on agglutination of antibody-coated indicator cells by human rheumatoid factors. Author(s): Faulk WP, Torry DS, McIntyre JA. Source: Clinical Immunology and Immunopathology. 1988 February; 46(2): 169-76. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3338191&dopt=Abstract
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Examination of irreversible platelet-fibrinogen interactions. Author(s): Peerschke EI, Wainer JA. Source: The American Journal of Physiology. 1985 May; 248(5 Pt 1): C466-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3158213&dopt=Abstract
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Expelling clots. Author(s): McLean MT. Source: Midwifery Today Childbirth Educ. 1995 Summer; (34): 38. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7787906&dopt=Abstract
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Fibrin-blood platelet interaction in a contracting clot. Author(s): Cohen I, Gabbay J, Glaser T, Oplatka A. Source: British Journal of Haematology. 1975 September; 31(1): 45-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=813758&dopt=Abstract
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Fibrinolysis and coagulation. I. Effect of calcium on lysis of euglobulin clots. Author(s): Helle I.
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Source: Scand J Haematol. 1967; 4(1): 21-32. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4961989&dopt=Abstract •
Flow cytometric immunophenotyping of leukemia cells in clotted blood and bone marrow. Author(s): De Vis J, Renmans W, Segers E, Jochmans K, De Waele M. Source: Journal of Immunological Methods. 1991 March 21; 137(2): 193-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2013696&dopt=Abstract
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Histo-chemical studies on the anti-ulcer effect of bamboo grass in rats. Author(s): Otani K, Yanaura S, Yuda Y, Kawaoto H, Kajita T, Hirano F, Osawa F, Inouye S. Source: Int J Tissue React. 1990; 12(6): 319-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2151721&dopt=Abstract
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Influence of NA2-EDTA and some compounds used for dissolution of fibrin clots on the physiochemical properties of fibrinogen and fibrin. Author(s): Godal HC, Brosstad F, Kierulf P. Source: Bibl Haematol. 1977; 44: 151-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=104706&dopt=Abstract
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Interactions of human fibrinogens with factor XIII: roles of calcium and the gamma' peptide. Author(s): Moaddel M, Farrell DH, Daugherty MA, Fried MG. Source: Biochemistry. 2000 June 6; 39(22): 6698-705. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10828988&dopt=Abstract
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Massive subchorionic hematoma (Breus' mole) complicated by intrauterine growth retardation. Author(s): Nishida N, Suzuki S, Hamamura Y, Igarashi K, Hayashi Z, Sawa R, Yoneyama Y, Asakura H, Kawabata K, Shima Y, Shin S, Araki T. Source: Journal of Nippon Medical School = Nihon Ika Daigaku Zasshi. 2001 February; 68(1): 54-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11180702&dopt=Abstract
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Mechanism of plasma clotting by Erysipelothrix rhusiopathiae. Author(s): Takahashi T, Takahashi I, Tamura Y, Sawada T, Yoshida T, Suzuki S, Muramatsu M. Source: Journal of Clinical Microbiology. 1990 October; 28(10): 2161-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2229337&dopt=Abstract
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Observations on optimal conditions for lysis of whole blood clots and use of this assay as a screening assay in clinical investigation. Author(s): Lockhart MS, Lee ET, Taylor FB Jr. Source: Thrombosis Research. 1982 December 1; 28(5): 625-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6820194&dopt=Abstract
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Ocular massage in a case of central retinal artery occlusion the successful treatment of a hitherto undescribed type of embolism. Author(s): Schmidt D. Source: European Journal of Medical Research. 2000 April 19; 5(4): 157-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10799350&dopt=Abstract
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Orthodontics and dentistry for the hemophilic patient. Author(s): Grossman RC. Source: Am J Orthod. 1975 October; 68(4): 391-403. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1101695&dopt=Abstract
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Pharmacodynamics of once- or twice-daily levofloxacin versus vancomycin, with or without rifampin, against Staphylococcus aureus in an in vitro model with infected platelet-fibrin clots. Author(s): Palmer SM, Rybak MJ. Source: Antimicrobial Agents and Chemotherapy. 1996 March; 40(3): 701-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8851596&dopt=Abstract
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Phase I trial of paclitaxel plus megestrol acetate in patients with paclitaxel-refractory ovarian cancer. Author(s): Markman M, Kennedy A, Webster K, Kulp B, Peterson G, Belinson J. Source: Clinical Cancer Research : an Official Journal of the American Association for Cancer Research. 2000 November; 6(11): 4201-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11106232&dopt=Abstract
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Platelet microtubules in clot structure formation and contractile force generation: investigation of a controversy. Author(s): Jen CJ, McIntire LV. Source: Thrombosis and Haemostasis. 1986 August 20; 56(1): 23-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2877507&dopt=Abstract
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Proteoglycan degradation in hemarthrosis. Intraarticular, autologous blood injection in rat knees. Author(s): Niibayashi H, Shimizu K, Suzuki K, Yamamoto S, Yasuda T, Yamamuro T. Source: Acta Orthopaedica Scandinavica. 1995 February; 66(1): 73-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7863774&dopt=Abstract
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Purification and characterization of a fibrinolytic enzyme from venom of the southern copperhead snake (Agkistrodon contortrix contortrix). Author(s): Guan AL, Retzios AD, Henderson GN, Markland FS Jr. Source: Archives of Biochemistry and Biophysics. 1991 September; 289(2): 197-207. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1898066&dopt=Abstract
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Quantitation of genomic DNA in plasma and serum samples: higher concentrations of genomic DNA found in serum than in plasma. Author(s): Lee TH, Montalvo L, Chrebtow V, Busch MP. Source: Transfusion. 2001 February; 41(2): 276-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11239235&dopt=Abstract
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Quantitation of the three normally-occurring plasma fibrinogens in health and during so-called “acute phase” by SDS electrophoresis of fibrin obtained from EDTA-plasma. Author(s): Holm B, Godal HC. Source: Thrombosis Research. 1984 August 1; 35(3): 279-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6431629&dopt=Abstract
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Reperfusion after thrombolytic therapy of embolic stroke in the rat: magnetic resonance and biochemical imaging. Author(s): Busch E, Kruger K, Allegrini PR, Kerskens CM, Gyngell ML, Hoehn-Berlage M, Hossmann KA. Source: Journal of Cerebral Blood Flow and Metabolism : Official Journal of the International Society of Cerebral Blood Flow and Metabolism. 1998 April; 18(4): 407-18. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9538906&dopt=Abstract
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Soluble fibrin complexes and fibrinogen heterogeneity in diabetes mellitus. Author(s): Tsianos EB, Stathakis NE. Source: Thrombosis and Haemostasis. 1980 December 19; 44(3): 130-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6162208&dopt=Abstract
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Stabilization of platelet-fibrinogen interactions: modulation by divalent cations. Author(s): Peerschke EI. Source: The Journal of Laboratory and Clinical Medicine. 1993 January; 121(1): 135-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8426076&dopt=Abstract
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The combined role of atheroma, cholesterol, platelets, the endothelium and fibrin in heart attacks and strokes. Author(s): Martin W. Source: Medical Hypotheses. 1984 November; 15(3): 305-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6521675&dopt=Abstract
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The structural properties and contractile force of a clot. Author(s): Jen CJ, McIntire LV. Source: Cell Motil. 1982; 2(5): 445-55. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6891618&dopt=Abstract
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U-46619, a stable analogue of prostaglandin H2, induces retraction of human plateletrich plasma clots. Author(s): Bertele V, Di Minno G, de Gaetano G. Source: Thrombosis Research. 1980 May 1-15; 18(3-4): 543-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6774436&dopt=Abstract
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Ultra-early clot aspiration after lysis with tissue plasminogen activator in a porcine model of intracerebral hemorrhage: edema reduction and blood-brain barrier protection. Author(s): Wagner KR, Xi G, Hua Y, Zuccarello M, de Courten-Myers GM, Broderick JP, Brott TG. Source: Journal of Neurosurgery. 1999 March; 90(3): 491-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10067918&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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WebMDHealth: 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 blood clots; 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 Alzheimer's Disease Source: Integrative Medicine Communications; www.drkoop.com Arteriosclerosis Source: Integrative Medicine Communications; www.drkoop.com Atherosclerosis Source: Integrative Medicine Communications; www.drkoop.com Atherosclerosis and Heart Disease Prevention Source: Prima Communications, Inc.www.personalhealthzone.com Blood Clots Source: Integrative Medicine Communications; www.drkoop.com Bone Loss Source: Integrative Medicine Communications; www.drkoop.com Breast Cancer Source: Integrative Medicine Communications; www.drkoop.com Cancer Prevention (reducing the Risk) Source: Prima Communications, Inc.www.personalhealthzone.com Cataracts (prevention) Source: Prima Communications, Inc.www.personalhealthzone.com Cirrhosis Source: Integrative Medicine Communications; www.drkoop.com Coronary Artery Disease Source: Integrative Medicine Communications; www.drkoop.com Diabetes Mellitus Source: Integrative Medicine Communications; www.drkoop.com Edema Source: Integrative Medicine Communications; www.drkoop.com Heart Attack Source: Healthnotes, Inc.; www.healthnotes.com Hemophilia Source: Integrative Medicine Communications; www.drkoop.com
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Hemorrhoids Source: Healthnotes, Inc.; www.healthnotes.com High Cholesterol Source: Integrative Medicine Communications; www.drkoop.com High Cholesterol Source: Prima Communications, Inc.www.personalhealthzone.com High Homocysteine Source: Healthnotes, Inc.; www.healthnotes.com High Triglycerides Source: Healthnotes, Inc.; www.healthnotes.com Hypercholesterolemia Source: Integrative Medicine Communications; www.drkoop.com Hypoparathyroidism Source: Integrative Medicine Communications; www.drkoop.com Inflammatory Bowel Disease Source: Integrative Medicine Communications; www.drkoop.com Liver Disease Source: Integrative Medicine Communications; www.drkoop.com Menopause Source: Integrative Medicine Communications; www.drkoop.com Miscarriage Source: Integrative Medicine Communications; www.drkoop.com Nail Disorders Source: Integrative Medicine Communications; www.drkoop.com Nausea Source: Prima Communications, Inc.www.personalhealthzone.com Osteoporosis Source: Integrative Medicine Communications; www.drkoop.com Phenylketonuria Source: Healthnotes, Inc.; www.healthnotes.com Prostate Cancer Source: Healthnotes, Inc.; www.healthnotes.com Prostate Cancer Source: Integrative Medicine Communications; www.drkoop.com
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Pulmonary Hypertension Source: Integrative Medicine Communications; www.drkoop.com Shock Source: Integrative Medicine Communications; www.drkoop.com Spontaneous Abortion Source: Integrative Medicine Communications; www.drkoop.com Stroke Source: Healthnotes, Inc.; www.healthnotes.com Stroke Source: Integrative Medicine Communications; www.drkoop.com Tias Source: Integrative Medicine Communications; www.drkoop.com Transient Ischemic Attacks Source: Integrative Medicine Communications; www.drkoop.com Ulcerative Colitis Source: Integrative Medicine Communications; www.drkoop.com Varicose Veins Source: Integrative Medicine Communications; www.drkoop.com Varicose Veins Source: Prima Communications, Inc.www.personalhealthzone.com Water Retention Source: Integrative Medicine Communications; www.drkoop.com •
Alternative Therapy Chelation Therapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,679,00.html Reflexology Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,730,00.html Shiatsu Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,733,00.html Trager Approach Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com
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Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,741,00.html •
Herbs and Supplements Alfalfa Alternative names: Medicago sativa Source: Healthnotes, Inc.; www.healthnotes.com Allium Sativum Source: Integrative Medicine Communications; www.drkoop.com Alpha-linolenic Acid Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,1025,00.html Aminoglycoside Antibiotics Source: Healthnotes, Inc.; www.healthnotes.com Amoxicillin Source: Healthnotes, Inc.; www.healthnotes.com Ampicillin Source: Healthnotes, Inc.; www.healthnotes.com Anthocyanins Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,1026,00.html Antibiotic Combination: Sulfa Drugs Source: Integrative Medicine Communications; www.drkoop.com Antibiotics Source: Healthnotes, Inc.; www.healthnotes.com Antibiotics (general) Source: Prima Communications, Inc.www.personalhealthzone.com Antioxidants Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10004,00.html Aortic Glycosaminoglycans Source: Prima Communications, Inc.www.personalhealthzone.com Azithromycin Source: Healthnotes, Inc.; www.healthnotes.com
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Bilberry Alternative names: Vaccinium myrtillus, European Blueberry, Huckleberry Source: Integrative Medicine Communications; www.drkoop.com Bilberry Source: Prima Communications, Inc.www.personalhealthzone.com Cephalosporins Source: Healthnotes, Inc.; www.healthnotes.com Cephalosporins Source: Integrative Medicine Communications; www.drkoop.com Chlorhexidine Source: Healthnotes, Inc.; www.healthnotes.com Ciprofloxacin Source: Healthnotes, Inc.; www.healthnotes.com Clarithromycin Source: Healthnotes, Inc.; www.healthnotes.com Clindamycin Oral Source: Healthnotes, Inc.; www.healthnotes.com Clindamycin Topical Source: Healthnotes, Inc.; www.healthnotes.com Coenzyme Q Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,768,00.html Dapsone Source: Healthnotes, Inc.; www.healthnotes.com Dicloxacillin Source: Healthnotes, Inc.; www.healthnotes.com Dipyridamole Source: Healthnotes, Inc.; www.healthnotes.com Docosahexaenoic Acid Source: Healthnotes, Inc.; www.healthnotes.com Doxycycline Source: Healthnotes, Inc.; www.healthnotes.com Erythromycin Source: Healthnotes, Inc.; www.healthnotes.com
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European Blueberry Source: Integrative Medicine Communications; www.drkoop.com Feverfew Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,780,00.html Flavonoids Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,782,00.html General Anesthetics Source: Healthnotes, Inc.; www.healthnotes.com Gentamicin Source: Healthnotes, Inc.; www.healthnotes.com Ginger Alternative names: Zingiber officinale Source: Integrative Medicine Communications; www.drkoop.com Ginkgo Source: Prima Communications, Inc.www.personalhealthzone.com Ginkgo Biloba Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,788,00.html Glutathione Source: Healthnotes, Inc.; www.healthnotes.com Glycyrrhiza1 Alternative names: Licorice; Glycyrrhiza glabra L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Grape Seed Extract Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,793,00.html Green Tea Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10032,00.html Heparin Source: Healthnotes, Inc.; www.healthnotes.com
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Huckleberry Source: Integrative Medicine Communications; www.drkoop.com Lapacho Source: Integrative Medicine Communications; www.drkoop.com Levofloxacin Source: Healthnotes, Inc.; www.healthnotes.com Loracarbef Source: Healthnotes, Inc.; www.healthnotes.com Macrolides Source: Healthnotes, Inc.; www.healthnotes.com Macrolides Source: Integrative Medicine Communications; www.drkoop.com Menadione Source: Integrative Medicine Communications; www.drkoop.com Menaphthone Source: Integrative Medicine Communications; www.drkoop.com Menaquinone Source: Integrative Medicine Communications; www.drkoop.com Minocycline Source: Healthnotes, Inc.; www.healthnotes.com Neomycin Source: Healthnotes, Inc.; www.healthnotes.com Nitrofurantoin Source: Healthnotes, Inc.; www.healthnotes.com Nitrous Oxide Source: Healthnotes, Inc.; www.healthnotes.com Panax Alternative names: Ginseng; Panax ginseng Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Pau D'arco Alternative names: Tabebuia avellanedae, Lapacho Source: Integrative Medicine Communications; www.drkoop.com Penicillin Derivatives Source: Integrative Medicine Communications; www.drkoop.com Penicillin V Source: Healthnotes, Inc.; www.healthnotes.com
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Penicillins Source: Healthnotes, Inc.; www.healthnotes.com Phosphatidylserine Source: Prima Communications, Inc.www.personalhealthzone.com Phylloquinone Source: Integrative Medicine Communications; www.drkoop.com Quinolones Source: Healthnotes, Inc.; www.healthnotes.com Quinolones Source: Integrative Medicine Communications; www.drkoop.com Ribes Alternative names: Black Currant; Ribes nigrum L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Ruta Alternative names: Rue; Ruta graveolens L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Sulfamethoxazole Source: Healthnotes, Inc.; www.healthnotes.com Sulfasalazine Source: Healthnotes, Inc.; www.healthnotes.com Sulfonamides Source: Healthnotes, Inc.; www.healthnotes.com Tabebuia Avellanedae Source: Integrative Medicine Communications; www.drkoop.com Tanacetum Alternative names: Feverfew; Tanacetum parthenium (L.) Schultz-Bip. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Tetracycline Source: Healthnotes, Inc.; www.healthnotes.com Tetracycline Derivatives Source: Integrative Medicine Communications; www.drkoop.com Tetracyclines Source: Healthnotes, Inc.; www.healthnotes.com Tobramycin Source: Healthnotes, Inc.; www.healthnotes.com
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Trimethoprim Source: Healthnotes, Inc.; www.healthnotes.com Trimethoprim/sulfamethoxazole Source: Healthnotes, Inc.; www.healthnotes.com Vaccinium Myrtillus Source: Integrative Medicine Communications; www.drkoop.com Vanadate Alternative names: Vanadium Source: Integrative Medicine Communications; www.drkoop.com Vanadyl Alternative names: Vanadium Source: Integrative Medicine Communications; www.drkoop.com Warfarin Source: Healthnotes, Inc.; www.healthnotes.com Zanthoxylum Alternative names: Prickly Ash; Zanthoxylum sp. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Zingiber Alternative names: Ginger; Zingiber officinale Roscoe Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Zingiber Officinale Source: Integrative Medicine Communications; www.drkoop.com
General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.
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CHAPTER 4. CLINICAL TRIALS AND BLOOD CLOTS Overview In this chapter, we will show you how to keep informed of the latest clinical trials concerning blood clots.
Recent Trials on Blood Clots The following is a list of recent trials dedicated to blood clots.8 Further information on a trial is available at the Web site indicated. •
A safety and efficacy trial evaluating the use of SanOrg34006 compared to placebo in patients who have completed 6 months of treatment for symptomatic pulmonary embolism or deep vein thrombosis Condition(s): Pulmonary Embolism; Deep Vein Thrombosis Study Status: This study is currently recruiting patients. Sponsor(s): Organon Purpose - Excerpt: Patients diagnosed with pulmonary embolism (blood clot in the lung) or deep vein thrombosis (blood clot in a leg vein) are at risk for these blood clots to reoccur. Anticoagulant (blood-thinning) drugs are normally given immediately after the clot is discovered and are continued for a period of 3 or 6 months during which time the risk for recurrence is highest. Research has shown that when oral anticoagulants are used appropriately during this period, patients are less at risk for a recurrent blood clot and this risk reduction outweighs the potential for bleeding to occur. In this study, patients who had a blood clot in the lung or in a leg vein and completed 6 months of treatment with daily oral vitamin K antagonists (acenocoumarol or warfarin) or onceweekly injections of SanOrg34006 (a new anticoagulant drug) will receive an additional 6 months of once-weekly SanOrg34006 injections or injections of a solution containing no drug (placebo). This trial will evaluate whether patients treated for an additional 6 months with SanOrg34006 have fewer recurrences of blood clots when compared to patients treated with placebo. Assignment to either SanOrg34006 or placebo will be
8
These are listed at www.ClinicalTrials.gov.
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purely by chance. Neither the patients nor their doctors will know which treatment is being given. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00071279 •
A safety and efficacy trial evaluating the use of SanOrg34006 in the treatment of pulmonary embolism Condition(s): Pulmonary Embolism Study Status: This study is currently recruiting patients. Sponsor(s): Organon Purpose - Excerpt: Patients who have a pulmonary embolism (blood clot in the lung) will be treated in this study. The purpose of the study is to compare the safety and effectiveness of a new injectable anticoagulant (blood-thinning) drug, SanOrg34006, with the standard way of treating a pulmonary embolism. The standard treatment includes injections or infusions of an anticoagulant drug, (LMW)heparin, for about a week followed by anticoagulant tablets (warfarin or acenocoumarol) which are taken by mouth. Assignment to either SanOrg34006 or (LMW)heparin plus warfarin or acenocoumarol will be purely by chance and will be known by both patients and their doctors. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00062803
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Gemcitabine With or Without Dalteparin in Treating Patients With Unresectable or Metastatic Pancreatic Cancer Condition(s): adenocarcinoma of the pancreas; Pancreatic Cancer; Quality of Life; Thromboembolism Study Status: This study is currently recruiting patients. Sponsor(s): University of Rochester; National Cancer Institute (NCI) Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Anticoagulants such as dalteparin may help prevent blood clots in patients being treated with gemcitabine for unresectable or metastatic pancreatic cancer. PURPOSE: Randomized phase III trial to determine the effectiveness of gemcitabine with or without dalteparin in treating patients who have unresectable or metastatic pancreatic cancer. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00031837
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Low-Dose rtPA to Treat Blood Clots in Major Arm or Neck Veins Condition(s): Thrombosis Study Status: This study is currently recruiting patients. Sponsor(s): Warren G Magnuson Clinical Center (CC) Purpose - Excerpt: This study will test the effectiveness of low-dose recombinant tissue plasminogen activator (rtPA, or alteplase) in dissolving blood clots in major arm or neck veins. rtPA is given to patients with heart attacks to dissolve blood clots in blocked coronary arteries. Blood clots that develop in major arm or neck veins usually develop after a venous access device (VAD) or catheter has been placed in the vein. The clot often causes arm, shoulder or neck swelling and pressure or discomfort. Current treatments include removing the VAD, using blood thinners such as heparin and warfarin, or using rtPA to dissolve the clot. All these options have disadvantages, however, including the risk of abnormal bleeding. This study will evaluate whether lower doses of rtPA can effectively dissolve clots without requiring an extended hospital stay, as is needed with the current higher-dose regimen. Patients 18 years of age and older who are enrolled in or are being evaluated for a Clinical Center study and who have a blocked jugular, axillary, subclavian, or brachiocephalic vein may be eligible for this study. The blockage may or may not be associated with use of a VAD. Participants will have one or two treatments with a low dose of rtPA, followed by a blood thinner taken by mouth or by injection for 5 to 7 weeks. On the first treatment day, the patient has a venogram, in which a catheter is placed in an arm vein and passed up to and through the blood clot that is blocking the blood flow in the vein. This is done under an x-ray machine so the radiologist can see exactly where the tube is going. Then, rtPA is injected into the clot about every 30 seconds for 15 to 30 minutes. The catheter is kept in place to maintain access to the vein for additional treatment the next day, if needed. The patient then begins treatment with heparin, either as an outpatient or an inpatient. A second venogram is done the next day. If the venogram shows that the vein is open, anti-clotting treatment with heparin or warfarin continues. If the venogram shows that the vein is still blocked, the rtPA treatment is repeated while the blood thinner treatment continues. The patient has a third venogram the following day. If the vein has opened, heparin and warfarin treatment continues. If the vein is still blocked, the patient's participation in the study ends. Although the patient is no longer formally in the study, he or she may choose to receive additional treatments with rtPA in higher doses at NIH or to continue using blood thinners under the direction of the primary physician. Blood tests are done during blood thinning therapy to monitor and adjust the dosage. Additional blood samples are taken before and at timed intervals after each rtPA treatment to measure the response to therapy. Patients who benefit from rtPA treatment remain on blood thinners for 5 to 7 weeks and then return to NIH for a follow-up venogram to see if the vein is still open. During warfarin therapy, blood tests are done every few days during the first week or two and every 2 weeks thereafter to ensure the optimal drug dose is being administered. If the repeat venogram at 5 to 7 weeks shows that the vein has closed, the blood thinners (warfarin or heparin) will be stopped and the patient's participation in this study will end. If the vein has remained open, the patient's doctor will decide whether or not to continue anti-clotting therapy. Phase(s): Phase I Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00055159
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Risk Factors for Venous Thromboembolism Condition(s): Deep Venous Thrombosis; Pulmonary Embolism Study Status: This study is currently recruiting patients. Sponsor(s): Department of Veterans Affairs Medical Research Service Purpose - Excerpt: Deep venous thrombosis is the presence of blood clots, usually in the legs that lead to either local problems or breathing problems if the clot moves to the lungs. This study is designed to assess both clinical conditions as well as common genetic factors that lead to more risk of deep venous thrombosis. Clinical conditions of venous thrombosis include: stroke, malignancy, and situations such as surgery, pregnancy, trauma, or travel. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00018772
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Study of Abnormal Blood Clotting in Children with Stroke Condition(s): Abnormalities; Blood Coagulation Cerebrovascular Accident; Vascular Disease
Disorder;
Brain
Disease;
Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Neurological Disorders and Stroke (NINDS) Purpose - Excerpt: A stroke is a sudden neurological condition caused by an abnormality in blood flow to the brain. Studies on strokes in children estimate that 2.5 out of 100,000 children will suffer a stroke. Pediatric strokes occur more frequently in children less than 2 years old. The causes of strokes in children are often undetermined. Effective treatment and prevention plans for childhood strokes can only be developed once the causes are understood. There is increasing evidence that blood-clotting abnormalities alone or in combination with environmental factors may be responsible for blood clots in arteries and veins. There are many compounds that play a role in the normal pathway of blood clotting in the body. Abnormalities in any one of these compounds can account for the development of stroke-causing blood clots. Presently, there is very little information on these abnormalities in children. This study is designed to measure the frequency of several specific blood-clotting abnormalities in children with a history of stroke and porencephaly (pockets/cavities within the brain). Data collected from this study will be compared to statistics of these conditions in the rest of the population. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00001927 •
Treatment for Blood Clots in the Veins of the Legs Condition(s): Embolism; Thrombophlebitis Study Status: This study is currently recruiting patients. Sponsor(s): Warren G Magnuson Clinical Center (CC) Purpose - Excerpt: Acute deep venous thrombosis (ADVT) of the lower extremity is a common disorder. Traditional treatment with anticoagulation therapy is effective in reducing the associated risk of pulmonary embolism, but is ineffective in restoring
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patency of the venous system of the lower extremity. While systemic thrombolytic therapy has been shown to be more effective than anticoagulation, catheter directed local thrombolytic therapy is the most effective treatment in restoring venous patency. Current treatment regimens are based on use of urokinase, infused continuously through catheters imbedded into the thrombus. These treatment regimens require doses on the order of 10,000,000 units of urokinase, resulting in significant bleeding complications and prohibitive costs. Experience at NIH with pulse-spray treatment of axillary subclavian venous thrombosis with rtPA indicates that this is a highly effective and safe alternative thrombolytic regimen. The proposed protocol is designed to evaluate the efficiency, safety, and doses of rtPA associated with pulse spray directed rtPA treatment of the more extensive venous thrombosis encountered in the lower extremity. Phase(s): Phase I Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00001713 •
Warfarin in Preventing Blood Clots in Cancer Patients With Central Venous Catheters Condition(s): Thromboembolism Study Status: This study is currently recruiting patients. Sponsor(s): Cancer Research Campaign Clinical Trials Centre Purpose - Excerpt: RATIONALE: Warfarin may be effective in preventing the formation of blood clots in patients with central venous catheters. PURPOSE: Randomized clinical trial to study the effectiveness of warfarin in preventing blood clots in cancer patients who have central venous catheters. Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00024297
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Combination Chemotherapy Plus Warfarin in Treating Patients With Prostate Cancer Condition(s): stage III prostate cancer; stage IV prostate cancer; Thromboembolism; recurrent prostate cancer Study Status: This study is no longer recruiting patients. Sponsor(s): National Cancer Institute (NCI); Memorial Sloan-Kettering Cancer Center Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining more than one drug may kill more tumor cells. Anticoagulant drugs such as warfarin may reduce the risk of blood clots. PURPOSE: Phase II trial to study the effectiveness of combination chemotherapy plus warfarin in treating patients who have prostate cancer. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00014352
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ThromboEmbolism Prevention Efficacy and Safety Trial (TEMPEST) Condition(s): Thromboembolism; Deep Vein Thrombosis; Venous Thromboembolism; Pulmonary Embolism Study Status: This study is no longer recruiting patients. Sponsor(s): (Sponsor Name Pending) Purpose - Excerpt: The purpose of this study is to gain additional safety information as well as to determine after the study drug has been given to patients who have undergone total hip replacement surgery, whether the study drug is effective in preventing late deep vein thrombosis (blood clots in legs) or pulmonary embolism (blood clots in lungs). Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00041509
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Effect of Indinavir Plus Two Other Anti-HIV Drugs on Blood Clotting in HIVPositive Males with Hemophilia Condition(s): HIV Infections; Hemophilia A Study Status: This study is completed. Sponsor(s): Merck Research Laboratories Purpose - Excerpt: The purpose of this study is to see if indinavir plus two other antiHIV drugs affect blood clotting in HIV-positive patients with hemophilia. Phase(s): Phase IV Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00002386
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 “blood clots” (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:
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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 5. PATENTS ON BLOOD CLOTS 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 “blood clots” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on blood clots, we have not necessarily excluded non-medical patents in this bibliography.
Patents on Blood Clots By performing a patent search focusing on blood clots, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an 9Adapted
from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.
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example of the type of information that you can expect to obtain from a patent search on blood clots: •
Aneurysm embolization device Inventor(s): Jones; Donald K. (Lauderhill, FL), Mitelberg; Vladimir (Aventura, FL) Assignee(s): Cordis Corporation (Miami Lakes, FL) Patent Number: 6,428,558 Date filed: February 16, 2000 Abstract: An aneurysm embolization device which may be used to occlude a blood vessel or aneurysm. The device has a plurality of support struts which form a substantially ellipsoidal shape. The support struts are preferably formed from a nickeltitanium alloy, such as nitinol, which has superelastic characteristics. A mesh sleeve is disposed over the support struts. The mesh sleeve is preferably formed of a thrombogenic material, such as polyurethane, so as to encourage the formation of blood clots and scar tissue to permanently occlude the vessel. Excerpt(s): This invention relates generally to vascular occlusion devices and particularly to a vascular occlusion device which self-expands to occlude a blood vessel or an aneurysm. Medical devices adapted for implantation in the vasculature of the human body are well known and commercially available. Such devices are typically used to permanently occlude blood flow in a blood vessel or seal an aneurysm to prevent the catastrophic results of it rupturing. A variety of occlusion devices are known to the art. U.S. Pat. No. 4,517,979 to Pecenka discloses a detachable balloon catheter. The balloon catheter is inserted into a blood vessel and inflated with a fluid. When the catheter is withdrawn, the balloon section detaches and an internal mechanism seals the balloon to prevent the outflow of fluid. The balloon is typically fabricated from either latex or silicone rubber. Web site: http://www.delphion.com/details?pn=US06428558__
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Antibodies that bind to.alpha.2-antiplasmin crosslinked to fibrin which do not inhibit plasma.alpha.2-antiplasmin Inventor(s): Haber; Edgar (Salisbury, NH), Matsueda; Gary R. (Princeton, NJ), Reed; Guy L. (Winchester, MA) Assignee(s): The General Hospital Corporation (Boston, MA) Patent Number: 6,280,730 Date filed: November 24, 1997 Excerpt(s): The present invention relates to a treatment for myocardial infarction and blood clots within a patient, and more specifically to a therapy which enhances clot lysis comprising administering to a patient an antibody directed to.alpha.2-antiplasmin crosslinked to fibrin (.alpha.2AP-Fx) which does not inhibit plasma.alpha.2-antiplasmin (.alpha.2AP). The invention also relates to a treatment for enhancing clot lysis comprising administering an antibody directed toward.alpha.2-antiplasmin crosslinked to fibrin which does not inhibit plasma.alpha.2AP together with a thrombolytic agent. The initiating event of many myocardial infarctions (heart attacks) is the hemorrhage into atherosclerotic plaque. Such hemorrhage often results in the formation of a thrombus (or blood clot) in the coronary artery which supplies the infarct zone (i.e., an
Patents 69
area of coagulation necrosis which results from an obstruction of blood circulation). This thrombus is composed of a combination of fibrin and blood platelets. The formation of a fibrin-platelet clot has serious clinical ramifications. The degree and duration of the occlusion caused by the fibrin-platelet clot determines the mass of the infarct zone and the extent of damage. The primary goal of current treatment for myocardial infarction involves the rapid dissolution of the occluding thrombus and the restoration of blood flow ("reperfusion"). An agent which is capable of selectively binding to and affecting may enhance thrombolysis and may decrease the risk of general hemorrhage to the patient. A successful therapy must be capable of sustained effect so that reformation of the clot does not occur after the cessation of therapy. If the fibrin-platelet clot is able to reform, then the affected artery may become reoccluded. Web site: http://www.delphion.com/details?pn=US06280730__ •
Bacterial fibrin-dependent plasminogen activator Inventor(s): Reed; Guy L. (Winchester, MA) Assignee(s): The President and Fellows of Harvard College (Cambridge, MA) Patent Number: 6,210,667 Date filed: December 15, 1998 Abstract: A pharmaceutical composition in a preferred embodiment comprises an isolated bacterial protein that induces fibrin-dependent plasminogen activation, and methods for dissolving blood clots in a subject use such a composition. Embodiments also include a nucleic acid encoding such a bacterial protein, a nucleic acid encoding such a bacterial protein as a fusion to another protein, an expression vector with the nucleic acid, and a host cell transformed with the expression vector. Excerpt(s): The present invention relates to modifications of streptokinase and other microbial enzymes for use to activate plasminogen in the presence of fibrin, to efficiently dissolve an unwanted blood clot in a subject. Clinical studies of acute coronary thrombosis have established that administration of plasminogen (Pg) activators such as recombinant tissue plasminogen activator (t-PA) and streptokinase (SK) saves lives and reduces morbidity. Comparison of the efficacy of SK (administered according to a 30 year old dosing regimen) and t-PA (administered by a variety of different protocols), in the presence and absence of heparin, showed that SK is markedly cheaper and can cause less cerebral bleeding than t-PA, whereas t-PA appears to be slightly better at reducing mortality than SK, at least as it is currently administered (e.g. GUSTO, New Engl. J. Med. 329:1615-1622, 1993). However, problems with administration of these thrombolytic agents remain. For example, acute myocardial infarction patients receiving early administration of either t-PA or SK failed to show reperfusion within 90 min, and reperfusion was not observed in 45-67% of patients (Karagounis L., Amer. Coll. Cardiol. 19:1-10 (1992), Lincoff A., et al. Am J Cardio; 75(14):871-766 (1995); Simes R., et al. Circulation 91(7):1905-1907 (1995)). Failed reperfusion is associated with an approximately double mortality rate from myocardial infarction compared to successful reperfusion, and significantly increases morbidity in surviving patients. The results of thrombolytic therapy as a treatment for venous thromboembolism are also relatively disappointing. Further, the mortality rate for pulmonary embolism appears not to have changed in.about.30 years, and no Pg activator has been shown to change the death rate in these patients (Goldhaber S., Chest 107:45S-51S (1995)). When administered to patients with pulmonary embolism, t-PA restores blood flow to only.about.33% of occluded lung segments within 24 hours (Goldhaber S., Lancet 2:886-889 (1986)). Similar
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results have been described with other agents (UPET, Circulation 47:1-108, 1973). In cases of deep venous thrombosis, about two-thirds of patients treated with SK or t-PA have minimal or no lysis of the clot on repeat venography after 24 hours (Salzman E., et al. Basic Principles and Clinical Practice; 3rd Ed. Uppincott, Philadelphia (1994); Goldhaber S. Am J Med 88:235-240 (1990)), thus neither SK nor t-PA treatments are optimal for thrombotic disease in patients. Web site: http://www.delphion.com/details?pn=US06210667__ •
Bag for use in the intravascular treatment of saccular aneurysms Inventor(s): Greenhalgh; E. Skott (Wyndmoor, PA) Assignee(s): Prodesco, Inc. (Perkasie, PA) Patent Number: 6,346,117 Date filed: March 2, 2000 Abstract: A bag for use in the intravascular treatment of saccular aneurysms and a method of forming the bag are disclosed. The bag is formed from a plurality of flexible, resilient filamentary members braided into a tubular sleeve and biased into a first shape having an expanded first diameter sized to substantially fill the aneurysm. The bag is resiliently deformable into a second shape having a diameter smaller than the first and sized to slidingly interfit within the lumen of a catheter. An opening is provided in the bag to receive a clotting medium, such as a platinum wire, on which blood clots can be induced to form by mechanical or electrolytic means. A closure is provided by biasing the filamentary members to form a constriction around the opening. In use the, bag is inserted into a saccular aneurysm via the catheter and expands to its first diameter upon release therefrom. Interstices between the interbraided filamentary members provide pores allowing blood from the aneurysm to enter the bag when the bag is positioned within the aneurysm. The clotting medium wire is packed into the bag, blood clots on the wire and occludes the aneurysm, sealing it off from the blood stream and preventing rupture. The wire is released from the catheter and is contained within the bag in the aneurysm. Excerpt(s): This invention relates to an intravascular device used in the treatment of aneurysms, and especially in the occlusion of cerebrovascular saccular aneurysms. Saccular aneurysms occur at the branching of arteries in the body and comprise a sacklike formation of the artery wall which extends outwardly from the bifurcation point between the arterial branches. The aneurysm has a neck forming the juncture with the artery and is capped by a dome. During formation of the aneurysm, the arterial internal elastic lamina disappears at the base of the neck, the sack wall thins and weakens and connective tissue replaces smooth-muscle cells. The aneurysm tends to rupture at the dome and bleeding ensues. Rupture of a cerebrovascular saccular aneurysm is especially serious due to the associated high mortality rate (10% within the first day of rupture, 25% within three months) and the major neurological deficits experienced by those who survive the initial hemorrhage. Naturally, therapeutic treatment of cerebrovascular aneurysms emphasizes preventing the initial rupture. Web site: http://www.delphion.com/details?pn=US06346117__
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Blood filtering device having improved permeability Inventor(s): Chevillon; Gerard (Montrouge, FR), Nadal; Guy (Poitiers, FR) Assignee(s): B. Braun Celsa (FR) Patent Number: 5,968,071 Date filed: December 22, 1997 Abstract: The invention relates to a blood filter that is to be positioned within a blood vessel to trap blood clots. The filter includes a head to which there are attached and from which there extend several legs comprising at least one elongated element having two opposite ends. The legs are radially movable and the elongated element of at least some of these legs has a shape folded back upon itself, substantially in the form of a loop. According to the invention, one of the ends of at least some of these elongated elements is disposed at a distance from the inside of the head of the filter. Excerpt(s): The invention relates to a blood filter that is to be positioned within a blood vessel to trap blood clots carried along by the flow of blood. It should be noted at this point that the filter according to the invention can be both a "definitive" (or permanent) filter and a "temporary" filter, that is a filter which can be implanted in a vessel and which can be left there permanently, or removed after a given period of implantation (nowadays typically of the order of a fortnight). Conventionally, a filter known as a "definitive" implantation filter is provided with means for fastening or attachment to the wall of the vessel in which it is implanted. Some examples of such filters are described in U.S. Pat. No. 5,059,205, U.S. Pat. No. 5,133,733 or U.S. Pat. No. 5,344,427. However, some such blood filters are also known which have hooks for attachment to the wall of the vessel and which are nevertheless defined as being removable or repositionable, as long as the period for which they have been positioned in a specific location within a vessel has not been too long and cellular development does not in practice prevent them from being moved. U.S. Pat. No. 5,324,304 describes such a filter whose head has a hook enabling the filter to be caught. Web site: http://www.delphion.com/details?pn=US05968071__
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Continuous autotransfusion filtration system Inventor(s): Swisher; David Rork (St. Charles, MO) Assignee(s): Sherwood Services, AG (LU) Patent Number: 6,099,493 Date filed: May 6, 1997 Abstract: A progressive filtration system for a chest drainage unit during continuous autrotransfusion comprising a gross filter for filtering incoming blood at the inlet portion of a collection chamber of a chest drainage unit and a conventional fine micron filter assembly located at the bottom portion of the collection chamber for refiltering collected blood prior to reinfusion of that blood back to the patient. The micron filter assembly includes a valve cap at the top portion of the assembly that functions as a plug to seal the top portion of the assembly and as a one way valve that permits reflux of later developing blood clots that might clog the tubing once the blood has already passed through the assembly.The valve cap is also adapted for sealing engagement with a drop tube that places the filter assembly in fluid flow communication with an outlet of the collection chamber located at the top portion of the chamber.
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Excerpt(s): The present invention relates to a system for draining shed blood from the body cavity of a patient and reinfusing clean, filtered blood back to the patient, and more specifically to a chest drainage unit (CDU) that includes a progressive filtration system for filtering out blood clots and other contaminants at both the inlet and outlet ports inside the CDU's collection chamber. More particularly, this invention relates to a high flow, micron filter assembly that refilters blood that collects at the bottom portion of the collection chamber prior to reinfusion to the patient with the assembly further including a drop tube that permits the refiltered blood to exit at an outlet port located at the top portion of the CDU. A CDU is an apparatus for suctioning gases and liquids from the pleural cavity of patients. The pleural cavity lies within the rib cage above the diaphragm and is surrounded by the pleural membrane. The pleural cavity contains both lungs, which in their normal expanded state fill the pleural cavity. Several conditions and diseases such as interventional surgery, trauma, emphysema and various infections can cause a build up of liquid and gases around the lungs in the intrapleural space. When this happens, it causes the lungs to collapse to a volume much less than that of the pleural cavity, thereby severely impairing breathing functions of the patient. The lungs can be re-expanded to their normal state to fill the pleural cavity by draining the liquid and gases from the intrapleural space using a CDU. Various devices have been developed to drain and collect fluids such as blood from the intrapleural space for subsequent autotransfusion. U.S. Pat. No. 4,114,416 to Karwoski et al. illustrates the prior art development of autotransfusion CDUs. The device includes a collection chamber for the collection of fluid from the pleural cavity, a water seal chamber for preventing passage of gas from the atmosphere into the patient's pleural and mediastinal cavities, and a manometer chamber for regulating the degree of vacuum in the system. An inlet port of the collection chamber is connected to the patient's pleural cavity via a thoracotomy tube that deposits shed blood and gases into the collection chamber. As the shed blood enters the inlet portion of the collection chamber, a large area gross filter, such as a fabric or an open-pore sponge filter, is used to remove blood clots and gross particles from incoming fluids. Once filtered, the blood collects at the bottom portion of the collection chamber until reinfusion is effected and the blood is drained through an outlet port located at the bottom portion of the collection chamber. The Karwoski et al. device is also placed in fluid flow communication with a blood compatible pump set through tubing that connects the pump to the outlet port and permits the collected blood to drain therethrough for reinfusion to the patient. Web site: http://www.delphion.com/details?pn=US06099493__ •
Crustacean and fish derived multifunctional enzyMen Inventor(s): de Faire; Johan R. (Vattholma, SE), Franklin; Richard L. (London, GB), Kay; John (Cardiff, GB), Lindblom; Ragnvald (Muang Rayong, TH) Assignee(s): Phairson Medical Inc. (London, GB) Patent Number: 5,945,102 Date filed: February 8, 1995 Abstract: The invention relates to a multifunctional enzyme that can be derived from crustaceans or fish. The enzyme has at least one of a chymotrypsin, trypsin, elastase, collagenase and exo peptidase activity, and a molecular weight between about 20 kd and about 40 kd. Preferably, the multifunctional enzyme has substantial anti cell-cell adhesion activity. Preferably, the multifunctional enzyme has substantial homology with the krill multifunctional enzyme. These enzymes are useful for treating viral
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infections such as herpes outbreaks, fungal, bacterial or parasitic infections, including the primary and secondary infections of leprosy, colitis, ulcers, hemorrhoids, corneal scarring, dental plaque, acne, cystic fibrosis, blood clots, wounds, immune disorders including autoimmune disease and cancer. Additionally, the invention relates to a method of purifying the multifunctional enzyme, and to a preparation of essentially purified multifunctional enzyme. Excerpt(s): The present invention relates to the discovery that there exists a family of crustacean and fish derived enzymes having substantial structural similarity to an enzyme derived from antarctic krill. The krill enzyme is the subject of U.S. patent application Ser. No. 08/338,501, filed Nov. 22, 1994, which is the national-stage application for PCT/SE93/00455, filed May 21, 1993, which claims the priority Swedish Application No. 9201628-6, filed May 22, 1992. The entire disclosure of U.S. patent application Ser. No. 08/338,501, is incorporated herein by reference. These related enzymes are believed to have the same utility as the krill enzyme. In particular, these enzymes are useful for treating viral infections such as herpes outbreaks, fungal, bacterial or parasitic infections, including the primary and secondary infections of leprosy, colitis, ulcers, hemorrhoids, corneal scarring, dental plaque, acne, cystic fibrosis, blood clots, wounds, immune disorders including autoimmune disease and cancer. Additionally, the invention relates to a method of purifying the multifunctional enzyme, and to a preparation of essentially purified multifunctional enzyme. U.S. Pat. Nos. 4,801,451 and 4,963,491 disclose a mixture of exo- and endopeptidases isolated from antarctic krill (Euphasia superba) and the use of the mixture as cleaning solutions. U.S. Pat. No. 4,801,451 discloses the use of such enzymes to remove foreign matter and dead tissue from wounds. Patent Application WO 85/04809 discloses the use of krill enzymes as a digestion promotor. European Application EP-A1-0170115 discloses the use of krill enzymes to dissolve blood clots. Web site: http://www.delphion.com/details?pn=US05945102__ •
Endovascular electrolytically detachable wire and tip for the formation of thrombus in arteries, veins, aneurysms, vascular malformations and arteriovenous fistulas Inventor(s): Guglielmi; Guido (Santa Monica, CA), Sepetka; Ivan (Redwood City, CA) Assignee(s): The Regents of the University of California (Oakland, CA) Patent Number: 5,925,037 Date filed: October 6, 1997 Abstract: An artery, vein, aneurysm, vascular malformation or arterial fistula is occluded through endovascular occlusion by the endovascular insertion of a platinum wire and/or tip into the vascular cavity. The vascular cavity is packed with the tip to obstruct blood flow or access of blood in the cavity such that the blood clots in the cavity and an occlusion if formed. The tip may be elongate and flexible so that it packs the cavity by being folded upon itself a multiple number of times, or may pack the cavity by virtue of a filamentary or fuzzy structure of the tip. The tip is then separated from the wire mechanically or by electrolytic separation of the tip from the wire. The wire and the microcatheter are thereafter removed leaving the tip embedded in the thrombus formed within the vascular cavity. Movement of wire in the microcatheter is more easily tracked by providing a radioopaque proximal marker on the microcatheter and a corresponding indicator marker on the wire. Electrothrombosis is facilitate by placing the ground electrode on the distal end of the microcatheter and flowing current between the microcatheter electrode and the tip.
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Excerpt(s): The invention relates to a method and apparatus for endovascular electrothrombic formation of thrombi in arteries, veins, aneurysms, vascular malformations and arteriovenous fistulas. Approximately 25,000 intracranial aneurysms rupture every year in North America The primary purpose of treatment for ruptured intracranial aneurysm is to prevent rebleeding. At the present time, three general methods of treatment exist, namely an extravascular, endovascular and extraendovascular approach. The extravascular approach is comprised of surgery or microsurgery of the aneurysm or treatment site for the purpose of preserving the parent artery. This treatment is common with intracranial berry aneurysms. The methodology comprises the step of clipping the neck of the aneurysm, performing a suture-ligation of the neck, or wrapping the entire aneurysm. Each of these surgical procedures is performed by intrusive invasion into the body and performed from outside the aneurysm or target site. General anesthesia, craniotomy, brain retraction and arachnoid dissection around the neck of the aneurysm and placement of a clip are typically required in these surgical procedures. Surgical treatment of vascular intracranial aneurysm can expect a mortality rate of 4-8% with a morbidity rate of 18-20%. Because of the mortality and morbidity rate expected, the surgical procedure is often delayed while waiting for the best surgical time with the result that an additional percentage of patients will die from the underlying disease or defect prior to surgery. For this reason the prior art has sought alternative means of treatment. Web site: http://www.delphion.com/details?pn=US05925037__ •
Filter system and methods for removing blood clots and biological material Inventor(s): Tu; Hosheng (2151 Palermo, Tustin, CA 92782) Assignee(s): none reported Patent Number: 6,068,645 Date filed: June 7, 1999 Abstract: A filter system and methods for removing blood clots and/or emboli by collecting them in a filtering element and thermally treating same by delivering therapeutic energy through a bipolar electrode members to the collected blood clots and emboli. Other alternate energy may also be applied to the collected blood clots and emboli for treating them in situ. Excerpt(s): The present invention generally relates to improved medical system and methods for treating blood vessels, and more particularly, to such a filter system and methods for removing blood clots and emboli by collecting them in a filtering element and thermally treat same by delivering therapeutic RF energy through a bipolar electrode means to the collected blood clots and emboli. Other alternate energy may also be applied to the collected blood clots, emboli or biological debris for treating them in situ. Blood vessel embolism is referred to hereby as an obstruction of a blood vessel by blood clots, emboli, or other foreign substances. This is a major cause of mortality and morbidity in the United States, particularly when blood vessel embolism occurs in a pulmonary vein or a coronary artery. To prevent embolism from occurring, patients are commonly treated with anticoagulants or with thrombolytic agents. In some situations, reliance on drugs may be inappropriate where a patient has high risk of internal bleeding or sensitive to a particular drug. A blood filtration device has been widely used to collect and remove the blood clots, emboli and foreign substance from a blood vessel. Nadal in U.S. Pat. No. 5,725,550 discloses a blood filtration unit that is to be implanted in a vessel of a patient's body, especially for the purposes of retaining blood clots. The
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implanted filtration unit, either permanently or temporarily, continues to collect blood clots or emboli. The collected junk, including blood emboli, blood clots, debris and any foreign substance, should be removed and disposed of out of the body. Alternately, the junk should be treated in situ so that the treated blood emboli or clots are so small that they do not pose any harm to the blood vessel or to the patient. A permanently implanted filter system may need frequent junk removal when the accumulation of clots or emboli is excessive. Web site: http://www.delphion.com/details?pn=US06068645__ •
Gross filter for a drainage device Inventor(s): Lewis; Anthony K. (St. Charles, MO), Swisher; David Rork (St. Charles, MO), Weilbacher; Eugene E. (Ellisville, MO), Yam; Jacky S. (St. Louis, MO) Assignee(s): Sherwood Services AG (Schaffhausen, CH) Patent Number: 6,280,429 Date filed: December 4, 1998 Abstract: A gross filter in a drainage device for filtering fluids drained from the pleural cavity of a patient comprising a filter body having a first side panel, second side panel, back panel and bottom panel that assemble to form a generally box-shape filter with open front and top portions. The gross filter is located in the first of two subchambers that comprise the collection chamber. The filter body further comprises a filter screen sized for filtering gross particulates, such as blood clots, that may become entrained in fluid drained from a patient. The gross body is configured so as to permit the further filtering of fluids when blood clots have formed and blocked the filter screen of the filter's bottom panel from fluid flow therethrough, thereby allowing uninterrupted filtering of blood into the collection chamber through the first and second side panels instead. To further facilitate the filtering of blood through the filter body when a blocked state exists at the bottom panel portion thereof, the first and second side panels are angled toward each other at their bottom ends and gradually spaced apart from the collection chamber walls in order to permit unimpeded filtering of fluid through the side panels. The open front portion of the gross filter permits clear viewing by medical personnel of the amount of blood clots being retained inside the filter body so that measuring indicia may be provided on the drainage unit's front panel as an indication of the amount and rate of blood clot retention inside the filter. An overflow filter portion is also provided at the top portion of one of the side panels for filtering fluid when the rest of the filter body is clogged and blocked by blood clots or when the first subchamber is filled to capacity. Excerpt(s): Gross filters for use in filtering out large particulate matter entrained in body fluids drained from a patient during convalescence or post-operative recovery are well known in the art. Typically, gross filters of this kind are incorporated in a drainage device, for example a Chest Drainage Unit (CDU), for filtering blood clots and other gross contaminates from body fluids before reinfusing such fluids back to the patient. A CDU is an apparatus for suctioning gases and liquids from the pleural cavity of a patient in order to re-expand the patient's lungs. The pleural cavity lies within the rib cage above the diaphragm and is surrounded by the pleural membrane. The pleural cavity contains both lungs, which in their normal expanded state fill the pleural cavity. Several conditions and diseases such as interventional surgery, trauma, emphysema and various infections can cause a build up of liquid and gases around the lungs in the intrapleural space. When this happens, it causes the lungs to collapse to a volume much less than
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that of the pleural cavity, thereby severely impairing breathing functions of the patient. The lungs can be re-expanded to their normal state to fill the pleural cavity by draining the liquid and gases from the intrapleural space using the CDU. A typical CDU and its operation is disclosed in U.S. patent application Ser. No. 08/810,056 to Swisher et al. entitled "Chest Drainage Unit with Controlled Automatic Excess Negativity Relief Feature", assigned to the assignee, and is herein incorporated by reference in its entirety. During the draining of fluid from a patient's pleural cavity blood clots may develop and become entrained in the fluid as it enters the collection chamber of the CDU for eventual reinfusion to the patient. During reinfusion of blood, it is desirable that the collected blood be free of any large particulate matter or other kinds of gross contaminants before entering and collecting at the bottom portion of the collection chamber. In order to screen out these undesirable contaminants a gross filter is provided near the inlet to the collection chamber for filtering out large particulate matter as fluid enters the CDU. The Swisher et al. device referenced above is generally exemplary of medical drainage devices that incorporate a gross filter for filtering out blood clots and other large particulate matter from fluid drained from a patient's pleural cavity. The gross filter used in the Swisher et al. device comprises a porous filtering material placed near the inlet of the collection chamber in a horizontal orientation so that all incoming fluid must pass through the gross filter before collecting in a pooling area located at the bottom portion of the collection chamber. In this manner, incoming fluid is filtered prior to entering the pooling area so that blood clots and other large particulate matter are retained on top of the filter. Web site: http://www.delphion.com/details?pn=US06280429__ •
Method and apparatus for determining anticoagulant therapy factors Inventor(s): Carroll; Wallace E. (1556 San Leandro La., Santa Barbara, CA 93108), Jackson; R. David (1556 San Leandro La., Santa Barbara, CA 93108) Assignee(s): none reported Patent Number: 5,981,285 Date filed: July 31, 1998 Abstract: A method and apparatuses are disclosed for determining an anticoagulant therapy factor (ATF), a corrected anticoagulant therapy factor (CATF), and a modified anticoagulant therapy factor (MATF), all selectively used for monitoring oral anticoagulant therapy to help prevent excessive bleeding or deleterious blood clots that might otherwise occur before, during or after surgery. The anticoagulant therapy factor (ATF), the corrected anticoagulant therapy factor (CATF), and a modified anticoagulant therapy factor (MATF) are based upon disclosed methods for determining the fibrinogen transformation rate (FTR) which, in turn, is dependent on a maximum acceleration point for fibrinogen (FBG) conversion. The ATF, CATF, and MATF quantities are also based upon the prothrombin time (PT), but have no need for the difficulty to obtain prior art International Normalized Ratio (INR) and International Sensitivity Index (ISI) parameters. The International Normalized Ratio (INR) was created to relate all species' clotting material to human clotting material. The AFT, CATF, and MATF quantities embody only human clotting material. The ATF, CATF, and MATF quantities and International Normalized Ratio (INR) are, hereby, species specific and provide the same results. Excerpt(s): This invention relates to a relatively simple, yet accurate method and apparatus for monitoring oral anticoagulant therapy that takes into account varying
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prothrombin times caused by different sensitivities of various thromboplastin formed from rabbit brain, bovine brain, or other sources all used for oral anticoagulant therapy. To prevent excessive bleeding or deleterious blood clots, a patient may receive oral anticoagulant therapy before, during and after surgery. To assure that the oral anticoagulant therapy is properly administered, strict monitoring is accomplished and is more fully described in various medical technical literature, such as the articles entitled "PTs, PR, ISIs and INRs: A Primer on Prothrombin Time Reporting Parts I and II" respectively published November, 1993 and December, 1993 issues of Clinical Hemostasis Review, and herein incorporated by reference. These technical articles disclose anticoagulant therapy monitoring that takes into account three parameters which are: International Normalized Ratio (INR), International Sensitivity Index (ISI) and prothrombin time (PT), reported in seconds. The prothrombin time (PT) indicates the level of prothrombin in a plasma sample and is a measure of the coagulation response of a patient. The INR and ISI parameters are needed so as to take into account various differences in instrumentation, methodologies and in thromboplastins' (Tps) sensitivities used in anticoagulant therapy. In general, thromboplastins (Tps) used in North America are derived from rabbit brain, those previously used in Great Britain from human brain, and those used in Europe from either rabbit brain or bovine brain. The INR and ISI parameters take into account all of these various different factors, such as the differences in thromboplastins (Tps), to provide a standardized system for monitoring oral anticoagulant therapy to reduce serious problems related to prior, during and after surgery, such as excessive bleeding or the formation of blood clots. Web site: http://www.delphion.com/details?pn=US05981285__ •
Method and apparatus for removing blood clots and other objects Inventor(s): Samuels; Shaun Lawrence Wilkie (1055 Sonoma Ave., Menlo Park, CA 94025) Assignee(s): none reported Patent Number: 5,947,995 Date filed: August 6, 1998 Abstract: A catheter has a central lumen so that it may be positioned by a guidewire within a tubular structure of the human body. The catheter has attached to its distal end an inflatable cuff featuring an inflation space with a ring-like cross section. A pouch is circumferentially attached to the cuff The catheter features an inflation lumen that is in communication with the inflatable cuff. The proximal port of the inflation lumen receives a syringe so that the cuff may be inflated when the cuff and pouch are positioned within a tubular structure. A filament passes through the inflation space of the cuff and the inflation lumen and exits the proximal port of the inflation lumen. As a result, the cuff may be cinched so that the pouch is closed in a purse-string fashion to capture an object in the tubular structure. The object may then be removed from the patient's body. Excerpt(s): Many medical procedures involve the removal of undesirable material from various tubular structures within the human body. Such materials may be of the body's origin or man-made. Examples include, but are not limited to, blood clots in the arteries and veins, foreign bodies introduced by surgery that have migrated or become dysfunctional and stones in the biliary or urinary systems. While these unwanted objects may be removed by surgical procedures, interventional radiological techniques have been developed to provide a less-invasive alternative. One type of interventional
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radiological technique involves the use of a snaring device that is introduced into the tubular structure by a catheter or sheath and positioned by a guidewire with endoscopic or fluoroscopic guidance. The snaring devices commonly feature a wire cage-like structure positioned upon their distal end portions that may be flexed to receive the target object. Once the snaring device is in position, it is operated remotely by the physician to capture, and in some instances crush, the target object. The object may then be withdrawn from the body through the catheter or sheath insertion site or left to be ultimately washed out of the body by normal body fluids. Examples of such devices are presented in U.S. Pat. No. 4,198,960 to Utsugi, U.S. Pat. No. 4,927,426 to Dretler and U.S. Pat. No. 5,496,330 to Bates et al. While such devices are effective, they do not feature a means for affirmatively trapping an object. As a result, there is always a danger that an object will become unintentionally dislodged from the snare prior to its removal. The object would then be free to migrate through the tubular structure which could cause severe medical complications. Web site: http://www.delphion.com/details?pn=US05947995__ •
Method of making a blood-compatible antimicrobial surface Inventor(s): Anders; Christine (Haltern, DE), Hoecker; Hartwig (Aachen, DE), Lorenz; Guenter (Marl, DE) Assignee(s): Huels Aktiengesellschaft (Marl, DE) Patent Number: 6,022,553 Date filed: April 21, 1998 Abstract: A method for making antimicrobial, blood-compatible surfaces is provided, articles having surfaces made by this method, and the use of these articles in fields where controlling the spread of microbes and blood-compatibility are important. Such fields include the medical field, where it is critical to eliminate infection causing microbes and reduce the number of dangerous blood clots in patients. Excerpt(s): The present invention relates to a method of making blood-compatible, antimicrobial surfaces. Microbial growth can pose serious threats to human health. Microbes able to grow on the surfaces of medical articles can put patients at risk for developing uncontrollable infections. Increasing numbers of antibiotic resistant microbes are creating an urgent need to develop methods of inhibiting microbial growth on surfaces. The rapidly growing biotechnology industry is especially sensitive to the dangers of microbial contamination and growth. In the laboratory, uncontrolled microbial growth can contaminate experiments and ruin their results. In a pharmaceutical plant, unwanted microbial growth in a reactor can taint drugs and disrupt production. Web site: http://www.delphion.com/details?pn=US06022553__
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Multifunctional protein and DNA sequence encoding saMen Inventor(s): Kay; John (1 Sycamore Tree Close, Radyr, Cardiff CF4 8RT, GB), Kille; Peter (9 Lisvane Street, Cathays, Cardiff CF2 4LH, GB) Assignee(s): none reported Patent Number: 6,040,155 Date filed: August 28, 1996 Abstract: The present invention provides nucleic acid and corresponding amino acid sequences of a multifunctional protein that has been found to be useful in numerous medical and cosmetic contexts. A protein having "multifunctional activity," is defined herein as including at least one of a chymotrypsin, trypsin, collagenase, elastase or exo peptidase activity or asialo GM.sub.1 ceramide binding activity. These proteins are useful for multiple purposes, including treating viral infections such as herpes outbreaks, fungal, bacterial or parasitic infections, including the primary and secondary infections of leprosy, colitis, ulcers, hemorrhoids, corneal scarring, dental plaque, acne, cystic fibrosis, blood clots, wounds, immune disorders including autoimmune disease and cancer. Excerpt(s): The present invention relates to purified nucleic acids encoding a krillderived multifunctional protein and to purified polypeptides having multifunctional activity. A protein having "multifunctional activity," is defined herein as including at least one of a chymotrypsin, trypsin, collagenase, elastase or exo peptidase activity, or asialo GM.sub.1 ceramide binding activity. Multifunctional proteins are useful for multiple purposes, including treating viral infections such as herpes outbreaks, fungal, bacterial or parasitic infections, including the primary and secondary infections of leprosy, colitis, ulcers, hemorrhoids, corneal scarring, dental plaque, acne, cystic fibrosis, blood clots, wounds, immune disorders including autoimmune disease, such as lupus erythematosus and multiple sclerosis, and cancer. Purified polypeptides having multifunctional activity and purified nucleic acids encoding such polypeptides are desirable to provide pharmaceutically useful products. One preferred embodiment of the present invention is a substantially pure nucleic acid comprising a nucleic acid encoding a polypeptide having at least about 70% homology to a krill-derived multifunctional protein, such as the polypeptide of SEQ ID NO:4, SEQ ID NO:5, SEQ ID NO:6, SEQ ID NO:8 or SEQ ID NO:10, and especially SEQ ID NO:4, SEQ ID NO:6 or SEQ ID NO:10, and more preferably, at least about 80% homology, and most preferably, at least about 90% homology. Even more preferably, the nucleic acid comprises a nucleic acid encoding a polypeptide sharing at least about 70% amino acid identity with a krillderived multifunctional protein, and yet more preferably, at least about 80% identity, and most preferably, at least about 90% identity. Web site: http://www.delphion.com/details?pn=US06040155__
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Perfusion-isolation catheter apparatus and method Inventor(s): Ashby; Mark (10 Bellcrest, Laguna Niguel, CA 92677), Brustad; John R. (34056 Formosa Dr., Dana Point, CA 92629), Hansen; Paul D. (2226 SE. 55th Ave., Portland, OR 97215), Hart; Charles C. (8252 Mandeville, Huntington Beach, CA 92646), Hilal; Said (25291 Spindlewood, Laguna Niguel, CA 92677), Pravongviengkham; Bounsavanh (450 Wilson Cir., Corona, CA 91719), Swanstrom; Lee L. (1405 NW. 24th Ave., Portland, OR 97227) Assignee(s): none reported Patent Number: 6,183,492 Date filed: August 27, 1998 Abstract: A catheter includes an introducer and a flow isolator adapted for disposition in a primary conduit to facilitate flow in the primary conduit while inhibiting flow and intersecting secondary conduits. The flow isolator may include a tubular mesh and surrounding balloon structure. Alternatively, a sleeve can be provided with a primary opening and a secondary opening which are sized to inflate the sleeve with the body fluid. Structures for deploying the sleeve between a low-profile state and high-profile state may include expandable fingers, or pneumatic chambers inflatable from an external source. In operation the sleeve can be forced by the body fluid against the intersection with the secondary conduits to achieve isolation. Alternatively, the pneumatic chambers can be inflated to form seals with the primary conduit. A blood filter or snare is contemplated to filter any blood clots which may develop around the flow isolator. Excerpt(s): This invention relates generally to devices for controlling the flow of body fluids in body conduits and more specifically to such devices which can be remotely controlled in a less-invasive procedure. The human body is composed of a labyrinth of body conduits generally organized into various systems of the body. By way of example, a labyrinth of body conduits including the urethra, form the urinary system of the body. Various blood vessels, including the inferior vena cava, are interconnected to form the vascular system of the body. Regardless of the system involved or the particular conduits forming that system, there are many surgical procedures which can benefit from a flow isolator to control flow of a body fluid within the particular system. In general, the flow isolator might function to facilitate the flow of the body fluid in a primary conduit, while inhibiting the flow of that fluid into a secondary conduit. By way of example, hepatic surgery generally requires that the portal vein and hepatic veins be occluded. In the past, this occlusion has been accomplished with cross-clamps which stop the back-flow of blood into the hepatic veins after the portal vein has been clamped. Unfortunately, there is a significant risk involved in total occlusion of the inferior vena cava. For this reason, this surgery in the past has required that the vena cava be dissected above and below the liver, with the placement of clamps on both sides of the dissection. This has been a time-consuming and a technically challenging part of the procedure. Shunts have also been used to isolate the hepatic veins in similar procedures involving hepatic resection or liver trauma, for example. This procedure is merely representative of many surgical procedures where it is desirable to maintain flow within one body conduit while inhibiting flow in an intersecting conduit. Web site: http://www.delphion.com/details?pn=US06183492__
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Photoacoustic removal of occlusions from blood vessels Inventor(s): Celliers; Peter M. (Berkeley, CA), Da Silva; Luiz B. (Danville, CA), Esch; Victor C. (San Francisco, CA), London; Richard A. (Orinda, CA), Maitland, IV; Duncan J. (Lafayette, CA), Visuri; Steven R. (Livermore, CA) Assignee(s): Endovasix, Inc. (Belmont, CA), The Regents of the University of California (Oakland, CA) Patent Number: 6,428,531 Date filed: June 27, 2000 Abstract: Partial or total occlusions of fluid passages within the human body are removed by positioning an array of optical fibers in the passage and directing treatment radiation pulses along the fibers, one at a time, to generate a shock wave and hydrodynamics flows that strike and emulsify the occlusions. A preferred application is the removal of blood clots (thrombin and embolic) from small cerebral vessels to reverse the effects of an ischemic stroke. The operating parameters and techniques are chosen to minimize the amount of heating of the fragile cerebral vessel walls occurring during this photo acoustic treatment. One such technique is the optical monitoring of the existence of hydrodynamics flow generating vapor bubbles when they are expected to occur and stopping the heat generating pulses propagated along an optical fiber that is not generating such bubbles. Excerpt(s): This invention relates generally to the removal of a partial or total occlusion from a blood vessel by generating pressure waves within the vessel through optical fiber media, and, more specifically, to the removal of a blood clot from a vessel within the human brain. The term "clot" is used herein to refer to a thrombus, embolus or some other total occlusion of a vessel. Medical procedures to open a partially or totally blocked blood vessel are available. Angioplasty has long been used to restore full blood flow in a coronary artery by mechanically deforming deposits on the arterial walls but has been less successful to open a totally occluded vessel. Laser techniques have been proposed to directly ablate obstructing material from arteries, such as plaque and certain types of clots, by inserting optical fibers into the artery to the point of the obstructing material but these techniques have enjoyed only limited success in practice. Various uses of ultrasonic energy to generate acoustic waves directed against plaque or a clot within an artery to mechanically break up the obstructing material have also been proposed but medical procedures utilizing these techniques have not enjoyed widespread acceptance. Photo acoustic techniques have been proposed for vasodilation and the break-up of plaque and clots in arteries, wherein one or more optical fibers are inserted into the vessel and pulses of radiation delivered to the vessel through the fibers generate a pressure or acoustic wave directed against the obstruction. Major blood vessels within the brain are very small, generally not exceeding three millimeters in diameter and being much smaller than that in most places. Most cerebral blood vessels decrease in diameter along their lengths until becoming capillaries. Besides being small, the walls of cerebral vessels are more fragile than those of vessels in other parts of the body and are more loosely connected to surrounding tissue. Web site: http://www.delphion.com/details?pn=US06428531__
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Plasminogen activator from saliva of the vampire bat Inventor(s): Alagon; Alejandro (Mor., MX), Baldus; Berthold (Berlin, DE), Boidol; Werner (Berlin, DE), Donner; Peter (Berlin, DE), Haendler; Bernard Jacques (Berlin, DE), Kratzschmar; Jorn Reiner (Berlin, DE), Langer; Gernot (Berlin, DE), Schleuning; WolfDieter (Berlin, DE) Assignee(s): Schering Aktiengesellschaft (Berlin, DE) Patent Number: 6,008,019 Date filed: June 1, 1995 Abstract: The present invention relates to novel thrombolitic v-PA's which dissolve blood clots in the human body and thus are suitable for the treatment of cardial infarction, for example. Excerpt(s): The present invention relates to a novel thrombolytic, processes for its isolation, and its pharmaceutical usage. Thromboses are produced by the formation of a blood clot in blood vessels. One distinguishes between venous thromboses including pulmonary embolisms and arterial thromboses including acute myocardial infarction. Pulmonary embolism and cardiac infarction are life-threatening events requiring immediate medical intervention. Web site: http://www.delphion.com/details?pn=US06008019__
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Retrievable umbrella sieve and method of use Inventor(s): Lowery; Samuel R. (400 N. Main St. Apt. 7, Fostoria, OH 44830) Assignee(s): none reported Patent Number: 6,245,088 Date filed: August 14, 1999 Abstract: The present invention is a retrievable umbrella sieve for removing blood clots and other debris in blood vessels. The umbrella sieve also functions to prevent blood clots and other derbies from reaching the heart of a human or animal. One of the main uses of the umbrella sieve is for the insertion of the Inferior Vena Cava to prevent and remove blot clots before the clots reach the heart. There are two embodiments of the umbrella sieve. The umbrella sieve provides a method and apparatus for used during the medical surgical treatment phase of thrombophlebitis and venous thrombosos in the precautionary prevention of pulmonary emboli. The umbrella sieve provides a method and apparatus for routinely placing a preventive device in lower extremity fractures, especially that of the hip, in anticipation of preventing pulmonary emboli. The umbrella sieve provides a method and apparatus that is retrievable. Excerpt(s): The medical community is in constant search for new ways to prevent blood clots from reaching the heart of humans and animals, as well as other objects or debris in the blood flow which may cause health problems. It is an object of the present invention to provide a method and apparatus for catching any blood clots, or other debris, that might dislodge from their origin of the veins in the pelvic or femoral systems. Another object of the present invention is to provide a method and apparatus for used during the medical surgical treatment phase of thrombophlebitis and venous thrombosos in the precautionary prevention of pulmonary emboli. Another object of the present invention is to provide a method and apparatus for routinely placing a preventive device in lower extremity fractures, especially that of the hip, in anticipation
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of preventing pulmonary emboli. Another object of the present invention is to provide a method and apparatus for a non-permanent manner of accomplishing the foregoing, whereby the apparatus is retrievable. The present invention is an umbrella sieve for capturing objects in a blood vessel which includes an inserter tube having a top; an umbrella cap having a lower peripheral circumference edge and an ability to fold like a rain umbrella; the umbrella cap having a perforated surface to allow the passage of fluids of the blood vessel; the umbrella cap being attached to the top of the inserter tube; an inflatable circumfrential balloon attached to the lower peripheral circumference edge for extending the umbrella cap when inflated; a first inflation line connected to the circumfrential balloon for inflating the circumfrential balloon. The umbrella sieve also includes an occlusive membrane attached to the inserter tube and below the umbrella cap; and wherein the membrane is extendible around the inserter tube to form a treatment compartment. The method of using the umbrella sieve includes inserting the umbrella sieve into the blood vessel; inflating the circumfrential balloon to extend the umbrella cap; capturing objects in flow of the blood vessel; removing any objects captured; deflating the circumfrential balloon; and removing the umbrella sieve. The method also includes extending the membrane around the inserter tube to form a treatment compartment by inflating the occlusive balloon attached to the membrane from a second inflation line after capturing of the objects to form a treatment compartment and further including before removal of the umbrella sieve, the deflation of the occlusive balloon to retract the occlusive membrane. After treatment, the occlusive balloon 20 is deflated to resume normal blood flow through the Vena Cava 26. Upon decision that the umbrella sieve 10 is no longer required, the circumfrential balloon 14 is deflated and the entire umbrella sieve 10 is retrieved from the Vena Cava 26. The umbrella cap 12 is flexible enough so that the as the umbrella sieve 10 is retrieved, the cap 12 inverts and folds down like a reversed rain umbrella in the wind, as shown in FIGS. 6 and 7. Web site: http://www.delphion.com/details?pn=US06245088__ •
Self-centering, self-expanding and retrievable vena cava filter Inventor(s): Kim; Hannah S. (Stow, MA), Nott; Sepideh H. (Melrose, MA), Sandock; David Lee (late of Littleton, MA), Suon; Naroun (Lawrence, MA), Thistle; Robert (Brockton, MA), Yampolsky; Iiya (West Roxbury, MA) Assignee(s): Boston Scientific Corporation (Natick, MA) Patent Number: 6,214,025 Date filed: October 27, 1999 Abstract: A self-centering blood clot filter is provided. The filter includes an anchoring portion including a generally cylindrical radially expandable body including an axial lumen extending therethrough. The filter further includes a filtering portion including a conical body concentrically aligned within the axial lumen of the anchoring portion. The conical body of the filtering portion is tapered to form a distal tip. As such, the blood clot filter can be properly centered within the lumen of a vessel for effective lysing of blood clots. Excerpt(s): This invention relates to blood clot filtering. Blood clots that form in the lower part of the body may migrate to the heart and may be subsequently pumped to the lungs. Small clots can be absorbed by the body without adverse effect. However, larger clots (e.g., on the order of 3 mm in diameter and 10-30 cm in length) can interfere with the oxygenation of blood and can possibly cause shock or sudden death. Many
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transvenous filtering devices have been developed for installation in the vena cava to prevent especially large clots from reaching the lungs. These filters have fine wires positioned in the blood flow to catch and hold clots for effective lysing in the blood stream. Some of these devices are inserted into the vena cava by dissecting the internal jugular vein in the neck or the femoral vein in the groin, inserting a metallic capsule containing a filtering device to the proper position in the vena cava, and releasing the filtering device into the vena cava. More recently, filters have been designed for percutaneous introduction into the vasculature. Web site: http://www.delphion.com/details?pn=US06214025__ •
Site-specific 13C-enriched reagents for diagnostic medicine by magnetic resonance imaging Inventor(s): Stein; Stanley (East Brunswick, NJ) Assignee(s): University of Medicine & Dentistry of NJ (Newark, NJ) Patent Number: 6,210,655 Date filed: June 18, 1997 Abstract: The present invention relates to site-specific.sup.13 C-enriched reagents for diagnostic medicine for magnetic resonance imaging. The site-specific.sup.13 C-enriched reagents may be represented by the formula: T-L-R. T is a site-specific targeting group which selectively binds to a disease-related target in an animal or human, R is an inert polymer containing repeating.sup.13 C reporting groups which provide a magnetic resonance imaging signal, and L is a linker group which connects the site-specific targeting group to the inert polymer. The site-specific.sup.13 C-enriched reagents are targeted to and capable of identifying, quantifying, and localizing disease-specific loci, such as blood clots,.beta.-amyloid plaques of Alzheimer's disease, and tumors through the use of magnetic resonance imaging. The present invention also pertains to a method for employing the site-specific.sup.13 C-enriched reagents in a living mammal. Excerpt(s): Many diagnostic and therapeutic medical procedures for visualizing internal organs for the early detection and treatment of many diseases require the administration of contrast enhancing agents to improve the quality of the procedure. Contrastenhancing agents are used in Magnetic Resonance Imaging (MRI), Computerized Tomography (CT), and X-ray procedures. Computerized Tomography provides a more sophisticated visualization of tissues and organs than does conventional X-ray techniques. Magnetic Resonance Imaging provides a superior soft tissue differentiation than does Computerized Tomography. Magnetic Resonance Imaging procedures generally employ the nuclear magnetic resonance of hydrogen (.sup.1 H) or fluorine (.sup.19 F). The nuclear magnetic resonance sensitivity of.sup.19 F is nearly equivalent to that of.sup.1 H but the biological background of.sup.19 F is negligible. The usefulness of a contrast enhancing agent depends upon the ease of the synthesis of the agent, the site-specificity of the agent, the resistance to in vivo hydrolysis of the agent, and a sufficient amount of signal from the agent along with a high signal-to-noise ratio. In radioscintigraphy, a radioactive monoclonal antibody is typically injected into a patient for identifying and localizing a tumor, (reviewed in Bischof Delaloye, A. and Delaloye, B.: Tumor imaging with monoclonal antibodies. Seminars in Nuclear Medicine 25(2):144-164, 1995). Web site: http://www.delphion.com/details?pn=US06210655__
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Thermodilution catheter method using a safe, flexible heating element Inventor(s): Quinn; Michael D. (Plano, TX), Yelderman; Mark L. (Plano, TX) Assignee(s): Edwards Lifesciences Corporation (Irvine, CA) Patent Number: 6,355,001 Date filed: May 13, 1996 Abstract: A thermodilution catheter having a heating filament which is fabricated so as to be thin and flexible enough to avoid contact with the patient's blood. The heating filament is either inserted in a preformed catheter lumen, incorporated into a wall of the catheter body itself, or wrapped around the catheter body wall and surrounded by an external sheath. Generally, the covering of the heating filament is minimally thin so as to allow the heat from the heating filament to be transferred to the surrounding blood and to minimally increase the overall cross-sectional area. Since the heating filament does not directly touch the patient's blood, the outer surface may be made smooth so as to prevent inducement of blood clots. In addition, the heating filament may be maintained at a safe temperature by forming the heating element of a flexible material having a high temperature coefficient of resistance, low thermal capacitance and high thermal conductivity. Preferably, the temperature coefficient of resistance of the material forming the heater filament is greater than 0.001.OMEGA./.OMEGA.-.degree. C. and the resistance of the heating filament is proportional or inversely proportional to its temperature. By monitoring this resistance, the application of power to the heating filament may be regulated to prevent overheating of the heating filament. Calibration techniques are also disclosed whereby a memory containing encoded calibration information is disposed within or connected to a connector of the catheter. This memory may also include a program segment used by a cardiac output computer having a cardiac output calculation program, whereby the portion of code stored in the memory must be input into the cardiac output computer before the determination of the cardiac output can be performed. As a result of these improvements, the invention enables the thermodilution cardiac output calculation to be performed quite safely and accurately in a clinical setting. Excerpt(s): The present invention relates to a thermodilution catheter, and more particularly, to a thermodilution catheter having a flexible heating filament disposed therein for applying heat to the patient's blood for purposes of measuring cardiac output, volumetric blood flow, blood pressure, blood volume, blood components and the like. As is well known, catheters have been developed for purposes of applying physiologic preparations directly into the blood streams of animals or humans or for measuring cardiovascular parameters such as cardiac output, blood pressure, blood volume, blood components and the like. Conventional catheters are made from various materials including plastics and are typically inserted into various body compartments, cavities and vessels to either deliver therapeutic agents, diagnostic agents, or to measure directly various physiologic parameters. Numerous techniques have been disclosed in the prior art for measuring blood flow using catheters. For example, in U.S. Pat. No. 4,507,974, Yelderman describes a technique for measuring blood flow by applying a stochastic excitation signal to a system inlet and measuring the output signal at a downstream system outlet. The blood flow rate is then extracted by cross-correlating the excitation signal and the measured output signal. The problem addressed by systems of this type is particularly difficult since the physiologic blood vessels are elastic, thereby making classic fluid measuring techniques unacceptably inaccurate. In fact, because the blood vessels are elastic, blood flow cannot be measured unless (1) the physical heart dimensions are measured simultaneously with the blood velocity, (2) a technique is
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used which is independent of the vessel geometry or (3) a blood velocity technique is used which is calibrated by some other technique. Examples of each of these techniques may be found in the prior art. Web site: http://www.delphion.com/details?pn=US06355001__ •
Thrombolytic agents with antithrombotic activity Inventor(s): Bush; Larry R. (Exeter, NH), Markland, Jr.; Francis S. (Manhattan Beach, CA), Sanchez; Eladio Flores (Belo Horizonte-ma, BR), Swenson; Stephen (Arcadia, CA) Assignee(s): Diatide, Inc. (Londonderry, NH) Patent Number: 5,951,981 Date filed: December 2, 1996 Abstract: This invention provides thrombolytic agents and methods for making and using thrombolytic agents. Specifically, the invention provides thrombolytic agents comprising a thrombolytic proteinase and a specific binding peptide that specifically binds at the site of blood clots and thrombi in vivo. The invention particularly provides chemically crosslinked conjugates of a thrombolytic proteinase and a plurality of specific binding peptide. Methods for producing such chemically crosslinked conjugates and methods for using such conjugates for eliminating thrombi in vivo to alleviate pathological conditions caused thereby are also provided. The preferred thrombolytic proteinase in the conjugate is fibrolase obtainable from Agkistrodon contortrix confortrix venom. Excerpt(s): This invention relates to thrombolytic agents and methods for making and using thrombolytic agents. Specifically, the invention relates to thrombolytic agents comprising a thrombolytic proteinase and a specific binding peptide that specifically binds at the site of blood clots and thrombi in vivo. The invention particularly provides chemically crosslinked conjugates of a thrombolytic proteinase and a plurality of specific binding peptides. Methods for producing such chemically crosslinked conjugates and methods for using such conjugates for eliminating thrombi in vivo to alleviate pathological conditions caused thereby are also provided by the invention. Thrombosis and thromboembolism, the occurrence of occlusive thrombi in the vasculature of human patients, poses a significant clinical problem and is a significant cause of morbidity and mortality. Arterial thrombi are responsible for myocardial infarction (MI) and ischemia (stroke), while venous thrombi cause deep vein thrombosis (DVT) and pulmonary embolism (PE). The magnitude of the clinical challenge created by thrombi is reflected in morbidity and mortality statistics. One of the leading causes of death in men over the age of 50 is acute MI, and stroke remains a debilitating and unpredictable disease. It has been estimated that in the U.S. approximately 5 million patients experience one or more episodes of DVT per year and that over 500,000 cases of PE occur, resulting in 100,000 deaths (Seabold, Society of Nuclear Medicine Annual Meeting 1990). Anticoagulant therapy can effectively treat these conditions in many cases, if applied early enough. However, such treatment is associated with risks (e.g. internal bleeding) that preclude unnecessary prophylactic application. More advanced techniques of thrombolytic intervention (such as the administration of recombinant tissue plasminogen activator or streptokinase) can be used in acute cases, but these techniques carry even greater risks, due in large part to systemic side effects. In addition, particularly in arterial thrombi, rethrombosis and reocclusion of blood vessels at the thrombus site is a significant (10-30%) clinical outcome. Even using these
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advanced methodologies, 25-30% of acute MI patients fail to restore perfusion to the thrombus-occluded coronary artery that are the proximal cause of the heart attack. Web site: http://www.delphion.com/details?pn=US05951981__ •
Two-planar vena cava filter with self-centering capabilities Inventor(s): Suon; Naroun (Lawrence, MA), Weldon; James (Roslindale, MA) Assignee(s): SciMed Life Systems, Inc. (Maple Grove, MN) Patent Number: 6,468,290 Date filed: June 5, 2000 Abstract: A self-centering filter is useful for trapping blood clots, reducing their size and arresting their further migration from the vena cava into pulmonary circulation. The two-planar filter design is formed from a conical array of filter wires wherein two sets of filter wires are included, each set differing in length from the other. The filter wires diverge from a common apex at one end and extend radially outwardly therefrom to an attachment end attachable to the wall of a blood vessel such that the attachment ends of the first set of wires are anchored at a location spaced apart from the location of anchoring of the attachment ends of the second set, effecting a two-planar filter design. This establishes a single filtering element having two planes of contact with the vein wall which also provides for centering of the filtering element. At least one of the sets of wires contains barbs, e.g. hooks, for anchoring the filter to the inner venal wall. Excerpt(s): This invention relates generally to filter devices useful for trapping blood clots and controlling embolization and thrombosis in blood vessels. More specifically, the present invention is directed to a blood clot filter, which has improved self-centering capabilities. Blood clots (emboli) which are carried in the blood stream often pose serious threats to a person's health and may lead to death. For that reason, the reduction of such clots and their stabilization and arrest against further migration from the vena cava into the pulmonary circulation are necessary. A number of types of permanent filters have been designed for this purpose. Generally, these filters are in the form of a frustoconical basket which is attached to the interior of a vein downstream of the area sought to be filtered. One type includes a plurality of wire legs of the same length extending in a generally conical array from a common apex to their free ends which attach to the wall of the vessel, thus forming a cone of revolution with a single plane of contact with the vessel wall. A filter of this type is described in U.S. Pat. No. 3,952,747. The filter shown therein includes sharpened hooks at the free wire ends to permanently anchor the filter by impaling the hooks in the blood vessel. If the hooks engage the cava in a plane perfectly perpendicular to the vena cava, the filter, in theory, would be centered. In reality such perfect deployments rarely occur and so the filter is often deployed in a tipped position, with its apex not coincident with the apex of the vessel. Web site: http://www.delphion.com/details?pn=US06468290__
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Vascular filtering device Inventor(s): Kanesaka; Nozomu (81 Greenwoods Rd., Old Tappan, NJ 07675) Assignee(s): none reported Patent Number: 6,340,364 Date filed: January 26, 2001 Abstract: A vascular filtering device is formed of a flexible shaft having a passageway extending inside the shaft, an inflatable member communicating with the passageway and having a spiral form, and a filter member fixed to the distal end portion of the shaft. The inflatable member is attached at an inner side thereof to a distal end portion of the shaft. The filter member is attached to the shaft and fixed onto the outer side surface of the inflatable member along the entire length thereof. When the inflatable member is inflated, the filter member is enlarged to allow a blood containing debris or blood clots to flow through the filter member. Thus, the debris or blood clots are captured by the filter member. When the inflatable member is deflated, the filter member is disposed close to the side surface of the shaft. Thus, the filter member with the debris or clots can be easily removed from the blood vessel. Excerpt(s): The present invention relates to a device for capturing a debris or blood clots in a blood vessel, and more particularly, it relates to a vascular filtering device for capturing and removing the debris or blood clots used in, e.g. percutaneous transluminal coronary angioplasty (PTCA) procedure. In recent years, an inter-vascular treatment, such as PTCA, has been widely practiced for a treatment of stenosis in the artery. In the PTCA procedure, a catheter which is provided with a balloon at a distal end thereof is inserted into a blood vessel which has a stenosis, and the balloon is inflated to enlarge the stenosis. Also, after enlarging the stenosis, a stent may be provided for preventing re-stenosis. In performing the PTCA procedure, however, it may cause other problems. Namely, debris or blood clots formed at the stenosis may be separated from the portion at the stenosis and migrate to other critical area, such as brain and pulmonary arteries, while the PTCA procedure is being performed. Web site: http://www.delphion.com/details?pn=US06340364__
Patent Applications on Blood Clots 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 blood clots:
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This has been a common practice outside the United States prior to December 2000.
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Antibodies that bind to alpha2-antiplasmin crosslinked to fibrin which do not inhibit plasma alpha2-antiplasmin Inventor(s): Haber, Edgar; (Salisbury, NH), Matsueda, Gary R.; (Princeton, NJ), Reed, Guy L.; (Winchester, MA) Correspondence: Sterne, Kessler, Goldstein & Fox Pllc; 1100 New York Avenue, N.W., Suite 600; Washington; DC; 20005-3934; US Patent Application Number: 20020086025 Date filed: August 16, 2001 Excerpt(s): This application is a Continuation-In-Part of U.S. application Ser. No. 07/589,003 filed Sep. 27, 1990 which is a Continuation-In-Part of U.S. application Ser. No. 07/177,222 filed Apr. 4, 1988, now abandoned, the contents of both of which are incorporated herein by reference. The present invention relates to a treatment for myocardial infarction and blood clots within a patient, and more specifically to a therapy which enhances clot lysis comprising administering to a patient an antibody directed to.alpha.2-antiplasmin crosslinked to fibrin (.alpha.2AP-FX) which does not inhibit plasma.alpha.2-antiplasmin (.alpha.2AP). The invention also relates to a treatment for enhancing clot lysis comprising administering an antibody directed toward.alpha.2-antiplasmin crosslinked to fibrin which does not inhibit plasma.alpha.2AP together with a thrombolytic agent. The initiating event of many myocardial infarctions (heart attacks) is the hemorrhage into atherosclerotic plaque. Such hemorrhage often results in the formation of a thrombus (or blood clot) in the coronary artery which supplies the infarct zone (i.e., an area of coagulation necrosis which results from an obstruction of blood circulation). This thrombus is composed of a combination of fibrin and blood platelets. The formation of a fibrin-platelet clot has serious clinical ramifications. The degree and duration of the occlusion caused by the fibrin-platelet clot determines the mass of the infarct zone and the extent of damage. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Apparatus and methods for aspirating emboli Inventor(s): Krolik, Jeffrey; (Campbell, CA), Salahieh, Amr; (Saratoga, CA) Correspondence: Glenn M. Seager; Crompton, Seager & Tufte, Llc; Suite 895; 331 Second Avenue South; Minneapolis; MN; 55401-2246; US Patent Application Number: 20030023263 Date filed: July 24, 2001 Abstract: Apparatus and methods for aspirating emboli from a vascular filter or stent within a patient's circulatory system are provided. A filter sac of the vascular filter permits blood flow and captures emboli from the flow. The aspiration device removes emboli from within or proximal to the vascular filter or stent to reduce the risk to the ischemia during retrieval of the vascular filter and during a treatment procedure. Retrieval of the vascular filter may be accomplished using either the aspiration catheter or a separate retrieval catheter. Excerpt(s): The present invention relates to apparatus and methods for aspirating emboli. More particularly, the present invention provides apparatus useful for aspirating emboli from a vascular device such as a vascular filter used to prevent embolization associated with diagnostic or therapeutic interventional procedures,
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thrombectomy and embolectomy. Percutaneous interventional procedures to treat occlusive vascular disease, such as angioplasty, atherectomy, and stenting, often dislodge material from the vessel walls. This dislodged material, known as emboli, enters the bloodstream and may be large enough to occlude smaller downstream vessels, potentially blocking blood flow to tissue. The resulting ischemia poses a serious threat to the health or life of a patient if the blockage occurs in critical tissue, such as the heart, lungs, or brain. The deployment of stents and stent-grafts to treat vascular disease, such as aneurysms, involves the introduction of foreign objects into the bloodstream, and also may result in the formation of clots or release of emboli. Such particulate matter, if released into the bloodstream, also may cause infarction or stroke. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Apparatus and methods for removing emboli during a surgical procedure Inventor(s): Hogendijk, Michael; (Palo Alto, CA), Parodi, Juan Carlos; (Buenos Aires, AR) Correspondence: Fish & Neave; 1251 Avenue OF The Americas; 50th Floor; New York; NY; 10020-1105; US Patent Application Number: 20020151922 Date filed: March 14, 2002 Abstract: Methods and apparatus for removing emboli during an endarterectomy procedure are provided. The present invention provides a proximal catheter disposed proximal to a stenosis and a distal catheter disposed distal to the stenosis. Each catheter may selectively communicate with a venous return catheter via a manifold having a setting controlled by a physician. Blood flows into an aspiration lumen of the distal catheter and is reperfused into a remote vein via the venous return catheter. Additionally, emboli generated during the procedure are removed via an aspiration lumen of the proximal catheter, and filtered blood then is reperfused into the remote vein. Excerpt(s): The present application is a continuation-in-part of U.S. patent application Ser. No. 09/418,727, filed Oct. 15, 1999, which is a continuation-in-part of U.S. patent application Ser. No. 09/333,074, filed Jun. 14, 1999, now U.S. Pat. No. 6,206,868, which is a continuation-in-part of International Application PCT/US99/05469, filed Mar. 12, 1999, which is a continuation-in-part of U.S. patent application Ser. No. 09/078,263, filed Mar. 5, 1998. This invention relates to apparatus and methods to protect against embolization during vascular interventions, such as endarterectomy. More particularly, the present invention reperfuses blood into a patient's venous vasculature and removes emboli using natural aspirational techniques. Carotid artery stenoses typically manifest in the common carotid artery, internal carotid artery or external carotid artery as a pathologic narrowing of the vascular wall, for example, caused by the deposition of plaque, that inhibits normal blood flow. Endarterectomy, an open surgical procedure, traditionally has been used to treat such stenosis of the carotid artery. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Barrier device for ostium of left atrial appendage Inventor(s): Hauser, Robert G.; (Long Lake, MN), Van Tassel, Robert A.; (Excelsior, MN) Correspondence: Fish & Neave; 1251 Avenue OF The Americas; 50th Floor; New York; NY; 10020-1105; US Patent Application Number: 20030120337 Date filed: December 3, 2002 Abstract: A membrane applied to the ostium of an atrial appendage for blocking blood from entering the atrial appendage which can form blood clots therein is disclosed. The membrane also prevents blood clots in the atrial appendage from escaping therefrom and entering the blood stream which can result in a blocked blood vessel, leading to strokes and heart attacks. The membranes are percutaneously installed in patients experiencing atrial fibrillations and other heart conditions where thrombosis may form in the atrial appendages. A variety of means for securing the membranes in place are disclosed. The membranes may be held in place over the ostium of the atrial appendage or fill the inside of the atrial appendage. The means for holding the membranes in place over the ostium of the atrial appendages include prongs, stents, anchors with tethers or springs, disks with tethers or springs, umbrellas, spiral springs filling the atrial appendages, and adhesives. After the membrane is in place a filler substance may be added inside the atrial appendage to reduce the volume, help seal the membrane against the ostium or clot the blood in the atrial appendage. The membranes may have anticoagulants to help prevent thrombosis. The membranes be porous such that endothelial cells cover the membrane presenting a living membrane wall to prevent thrombosis. The membranes may have means to center the membranes over the ostium. Sensors may be attached to the membrane to provide information about the patient. Excerpt(s): The invention relates to a membrane or plug structure applied to the ostium of an atrial appendage for preventing blood flow and physical connection between an atrium of the heart and the associated atrial appendage or appendages to isolate an atrial appendage and prevent thrombus leaving therefrom. There are a number of heart diseases (e.g. coronary artery disease, mitral valve disease) that have various adverse effects on the heart. An adverse effect of certain cardiac diseases, such as mitral valve disease, is atrial (or auricular) fibrillation. Atrial fibrillation may result in pooling of blood in the left atrial appendage. Blood pooling may also be spontaneous. When blood pools in the atrial appendage, blood clots can form and accumulate therein, build upon themselves, and propagate out from the atrial appendage into the atrium. These blood clots can then enter the systemic or pulmonary circulations and cause serious problems if they migrate from the atrial appendage and become free in the blood stream and embolize distally into the arterial system. Similar problems also occur when a blood clot extending from an atrial appendage into an atrium breaks off and enters the blood supply. Since blood from the left atrium and ventricle supply the heart and brain, blood clots from the atrial appendages can obstruct blood flow therein causing heart attacks, strokes or other organ ischemia. It is therefore necessary to find a means of preventing blood clots from forming in the atrial appendages and to prevent these blood clots, once formed, from leaving the atrial appendages to the heart, lungs, brain or other circulations of the patient which can cause heart attacks or strokes or other organ ischemia. U.S. Pat. No. 5,865,791 relates to the reduction of regions of blood stasis and ultimately thrombus formation in such regions, particularly in the atrial appendages of patients with atrial fibrillation. More specifically, the invention relates to procedures and devices for affixing the atrial appendages in an orientation that prevents subsequent formation of thrombus. The invention removes the appendage from the atrium by
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pulling on it and putting a loop around it to form a sack of the atrial appendage and then cut off from the rest of the heart. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Bladder dialysis urinary catheter Inventor(s): McGuckin, James F. JR.; (Radnor, PA) Correspondence: Rex Medical, L.P.; 585 County Line Road; Radnor; PA; 19087; US Patent Application Number: 20020029057 Date filed: August 1, 2001 Abstract: An irrigating bladder dethrombulator for removing blood clots in the urine. The device includes a housing having an outflow conduit insertable into the bladder through the urethra for transporting bodily fluid from the bladder and a bladder pressurization conduit for transporting fluid into the bladder to increase the internal pressure of the bladder. Connected to the housing is a structure for mechanically reducing the size of the blood clots in the urine. The mechanism for driving the reducing structure can be a magnetic drive or a fluid drive. Excerpt(s): This patent application is based on and claims the benefit of the filing date of U.S. provisional patent application 60/053,557 filed Jul. 24, 1997 by James F. McGuckin, Jr., M.D. and entitled "Method and Apparatus for Bladder Irrigation Mechanical Thrombolysis". One of the side effects of many urological procedures is formation of blood clots in the urine within the bladder. Typically after urological procedures the patient will be fitted with a catheter to facilitate bladder drainage. Clots forming in the urine within the bladder tend to clog the inlet orifice for a catheter thereby preventing effective voiding of the bladder. This is a particular problem subsequent to urological procedures such as transectional prostatectomies, radial prostatectomies and nephrolithotomies. Magnetic coupling in surgical devices is known, being disclosed in U.S. Pat. No. 5,609,602. However, '602 is concerned with a magnetic couple which limits rotation of one element when driven by a second element, incorporating a mechanical stop for the first element allegedly to produce high frequency oscillations in one of the magnetically coupled pair of elements. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Blood clot filtering system Inventor(s): Goldberg, Mark; (Sharon, MA), Mallick, Ron; (Wilmette, IL), Melinyshyn, Lev; (Buffalo Grove, IL) Correspondence: Laff, Whitesel & Saret, LTD.; 401 North Michigan Avenue; Chicago; IL; 60611; US Patent Application Number: 20020116024 Date filed: February 20, 2001 Abstract: A blood clot filtering system including an anchor which is permanently affixed in a blood vessel, and a filter which is removably attached to the anchor. Excerpt(s): This invention relates generally to devices and methods for trapping blood clots and controlling embolization and some of the complications of thrombosis in blood
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vessels. More particularly, this invention relates to a blood filtering system that comprises two separable independent parts: a permanent anchor, and a filter removably attached to the anchor. The two parts of the system are attached in such a way that, once emplaced, the filter is continuously maintained along the central axis of the blood vessel to ensure that the filter operates at optimal efficiency. If and when it is necessary or desirable to remove the filter, it may readily be separated from the anchor and withdrawn, leaving a permanently attached anchor that does not interfere with blood flow within the blood vessel. The presence of thrombus within the body's circulatory system presents significant health hazards, as manifested by potential acute venous thrombosis and chronic deep vein thrombosis. Acute venous thrombosis can lead to pulmonary emboli, a potentially lethal condition when an embolus travels into the pulmonary arteries. Currently, the most widespread treatment is the administration of systemic and oral anticoagulants such as heparin and coumadin, and thrombolytic agents such as TPA, urokinase and streptokinase. Unfortunately, conventional drug therapy is ineffective or inappropriate for controlling emboli within the circulatory system of some patients. In particular, since most pulmonary emboli originate in veins of the lower limbs, pelvis or inferior vena cava, it has been recognized that lifethreatening pulmonary emboli can be prevented from reaching the lungs by mechanically interrupting the inferior vena cava to filter out emboli. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Blood pump Inventor(s): Palmer, Arthur; (Chicago, IL) Correspondence: Greer, Burns & Crain, LTD.; Suite 2500; 300 South Wacker Drive; Chicago; IL; 60606; US Patent Application Number: 20030032854 Date filed: August 13, 2001 Abstract: A pump especially designed for pumping blood comprises a bladder, the interior surface area and volume of which is changeable, i.e., it stretches and expands during the filling phase, and elastically contracts to its normal relaxed size during the ejection phase. The bladder has a fluid inlet and a fluid outlet. A device, such as a vacuum pump, alternately expands and contracts the interior surface area and volume of the bladder. Most of the interior surface area of the bladder expands and contracts in each cycle. One or more check valves or other means for causing substantially one-way fluid flow through the bladder are also provided. The pump of the invention decreases the likelihood of blood clots forming in the pump, decreases the risk of damage to blood cells, improves the pumping characteristics of the device, and decreases or eliminates the chance of foreign fluids passing into the blood stream should a tear or break occur in the bladder. Excerpt(s): The present invention relates to pumps and more specifically to blood pumps, ventricular assist devices, and artificial hearts. The natural heart functions in a fashion similar to a positive displacement pump. Each of the two pumping chambers in the natural heart has two check valves (an inlet and an outlet valve). The walls of the natural heart are made of contractile muscle that provide the power to pump the blood. Each pumping cycle consists of a filling or diastolic phase of the pumping cycle and an ejection or systolic phase of the pumping cycle. During the filling phase, the muscle fibers making up the walls of the heart relax allowing the chamber they surround to fill with blood. During the ejection phase of the cycle the muscle making up the walls of the
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heart contracts ejecting a portion of the blood from the chamber. The check valves assure one-way flow. Mechanical blood pumps have been developed for use as artificial hearts to replace or assist the natural heart. Present blood pumps which are available to assist or replace the heart fall into two general categories. One category uses a rotary impeller and includes centrifugal pumps and axial flow pumps. The other category is pulsatile pumps, the diaphragm type pump being the most common. Blood pumps may also be classified as internal (intracorporeal) or external (extracorporeal) to the body. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Blood purifier featuring micro-euthanasia of undesirable blood organisms Inventor(s): Kling, Carl C.; (Cos Cob, CT) Correspondence: Carl C. Kling; PO Box 305; Hawthorne; NY; 10532-0305; US Patent Application Number: 20020120223 Date filed: February 20, 2001 Abstract: A blood purifying system, in which a patient is connected to a blood centrifuge, and certain components of the patient's blood are forwarded and further treated at a purifying station by a microscopic automatic review to identify undesirable organisms, and with a controlled laser blast focused on such identified undesirable organisms to destroy them as they pass through the purifying station. A patient having a suspected condition involving blood clots or undesirable organisms in the patient's bloodstream is connected so that the blood flows slowly through a purifying station where the stream is spread across a significant area in a very smooth layer enabling inspection by a laser scanner and pattern recognition system. When an undesired particle is detected, there is a double check of the pattern recognition, and, assuming recognition as undesirable, the organism is destroyed by a focused laser blast. Wherever the destruction particulates are expected to be appropriately heavier or lighter, the bloodstream portion is diverted to another centrifuge to remove the resulting particles before returning the blood to the patient. Excerpt(s): This invention relates to a blood purifying system, and particularly relates to a blood purifying system in which a patient is connected to a blood centrifuge, and certain components of the patient's blood are forwarded and further treated by a microscopic automatic review to identify undesirable organisms, with a controlled laser blast focused on such identified undesirable organisms to destroy them as they pass through the purifying station. Dialysis is the most common procedure in which a patient is connected to a blood system for a period of time while the blood itself is purified, essentially by differential osmotic pressure across a semi-permeable membrane. Dialysis mimics the purifying technique of the human kidneys, by a sort of mechanical kidney. Another blood purifying procedure is the multiple-transfusion procedure used in treating the "blue-baby" syndrome in which maternal antibodies have improperly passed through a wound in the placenta and are attacking the bay's blood. The baby's blood is replaced by progressively greater dispersion of new blood into the baby's circulatory system--until the antibodies are so diminished in number that they no longer present a risk to the baby. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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CARDIAC STIMULATING APPARATUS HAVING A BLOOD CLOT FILTER AND ATRIAL PACER Inventor(s): Pappu, Ramesh; (Cherry Hill, NJ) Correspondence: Dann Dorfman Herrell & Skillman; Suite 720; 1601 Market Street; Philadelphia; PA; 19103-2307; US Patent Application Number: 20020183823 Date filed: June 4, 2002 Abstract: An apparatus is provided for reducing the formation and migration of blood clots from an atrial appendage, such as the left atrial appendage, to the blood vessel system of a patient. The apparatus comprises an atrial pacer to treat non-rheumatic atrial fibrillation (NRAF) of an atrial appendage so that the formation blood clots within the atrial appendage is decreased or eliminated. In addition, the apparatus includes a blood clot filter supported by the atrial pacer proximate the atrial appendage and the atrium to reduce the migration of blood clots from the atrial appendage into the blood vessel system of a patient. Excerpt(s): The present invention relates generally to a device that deters migration of emboli from an atrial appendage into the vascular system of a patient, and more particularly to a device that includes a filter to deter such migration and a pacer to deter the formation of emboli such as blood clots within the atrial appendage. Non-rheumatic atrial fibrillation (NRAF) is associated with thromboembolic complications such as strokes. For example, when a thrombus or embolus occludes a vessel supplying blood to the brain, a stroke may result causing temporary or lasting paralysis of a part of the body or, in severe cases, death. Blockage of other blood vessels can occur as well causing attendant health concerns, including heart attack or gangrene. Presently, a five percent risk of stroke per year in a largely aging population causes NRAF to be a significant health concern. Given the potentially irreversible and destructive nature of such blood vessel occlusion, safe and effective methods are needed to eliminate embolic material like blood clots from the vascular system, some of which may be formed within an atrial appendage of the heart. The left atrial appendage forms a small protrusion which is attached to the lateral wall of the left atrium between the mitral valve and the root of the left pulmonary vein and normally contracts along with the left atrium. Atrial fibrillation is a cardiac condition wherein the atria beat faster than the ventricles, causing the ventricles to contract irregularly and consequently eject less blood into the vascular system. A major problem associated with atrial fibrillation is pooling of blood in the left atrial appendage. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Catheter composition and uses thereof Inventor(s): Semba, Charles P.; (Palo Alto, CA) Correspondence: Genentech, INC.; 1 Dna Way; South San Francisco; CA; 94080; US Patent Application Number: 20030206906 Date filed: November 25, 2002 Abstract: A composition useful for removal of fibrin-bound blood clots from a catheter comprises water, a fibrinolytically effective amount of a plasminogen activator, and a
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preservatively effective amount of a bacteriostatic organic alcohol. The composition does not comprise a chelating agent. Excerpt(s): This application is a non-provisional application filed under 37 CFR 1.53(b)(1), claiming priority under 35 USC 119(e) to provisional application No. 60.backslash.333,369 filed Nov. 26, 2001, the contents of which are incorporated herein by reference. The present invention relates to the field of indwelling medical devices, in particular catheters, as well as to the field of methods and compositions for flushing, locking, priming, and coating these medical devices. The invention also relates to pharmaceutical preparations useful in increasing catheter flow and preventing infection in catheters with the potential for fibrin deposition or with preexisting fibrin-bound clots. Delivery systems are widely used in medicine as a means for introducing liquid material that might include medicaments, nutrition, or other active agents to a particular locus in a patient. Such systems frequently involve the use of catheters, which, for many applications, are surgically or intravenously located and stitched into place for longterm administration of the desired material. Typical systems include central catheters such as may be used for total parenteral nutrition (TPN) used in, e.g., short bowel syndrome (for the duration of life), with the risk of sepsis or endocarditis. Such systems also include catheters and drains that are involved in peritoneal dialysis for those with terminal kidney failure, which, if infected, can lead to peritonitis with serious consequences. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Catheter for removing emboli from saphenous vein grafts and native coronary arteries Inventor(s): Bates, Mark C.; (Charleston, WV), Boucher, Ryan P.; (San Francisco, CA), Hogendijk, Michael; (Palo Alto, CA) Correspondence: Fish & Neave; 1251 Avenue OF The Americas; 50th Floor; New York; NY; 10020-1105; US Patent Application Number: 20020107479 Date filed: July 19, 2001 Abstract: Methods and apparatus are provided for removing emboli generated during a surgical procedure comprising a catheter having proximal and distal ends, a lumen extending therethrough, an occlusive member affixed to the distal end, and at least one blood intake port disposed in a lateral surface of the catheter. The occlusive member preferably is disposed in a treatment vessel, and the blood intake port, when uncovered, permits a portion of the antegrade flow from a host vessel to be diverted into the lumen of the catheter. A pressure differential caused by the blood intake from the host vessel establishes a venturi-effect suitable for manipulating flow in the treatment vessel. The flow characteristics may be manipulated via the intake port to direct emboli into the lumen of the catheter for subsequent removal. Excerpt(s): The present application is a continuation-in-part of U.S. patent application Ser. No. 09/418,727, filed Oct. 15, 1999, which is a continuation-in-part of U.S. patent application Ser. No. 09/333,074, filed Jun. 14, 1999, which claims the benefit of priority of International Application PCT/US99/05469, filed Mar. 12, 1999. The present invention relates to apparatus and methods for removal of emboli from within a vascular system. More particularly, the present invention provides a catheter having at least one blood intake port and an occlusive member through which venturi flow may
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be induced to remove emboli generated during an interventional procedure. Today there is a growing realization that steps must be taken to reduce the release of emboli during interventional procedures such as stenting, atherectomy and angioplasty. These procedures generally present a high risk for the release of embolic material that may occlude downstream portions of the vascular bed and cause ischemia. The resulting ischemia may pose a serious threat to the health or life of a patient if the blockage forms in a critical area, such as the heart, lungs, or brain. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
CATHETER SYSTEM FOR EMBOLI CONTAINMENT Inventor(s): BAGAOISAN, CELSO J.; (UNION CITY, CA), MUNI, KETAN P.; (SAN JOSE, CA), ZADNO-AZIZI, GHOLAM-REZA; (NEWARK, CA) Correspondence: Knobbe Martens Olson & Bear Llp; 620 Newport Center Drive; Sixteenth Floor; Newport Beach; CA; 92660; US Patent Application Number: 20020016565 Date filed: May 18, 1999 Abstract: A multi-catheter emboli containment system is disclosed which is adapted to provide at least one pair of optimized paths for irrigation and aspiration fluid flow. Through careful design of the cross-sectional area of these paths, the present system is able to be compactly utilized in even the smaller size blood vessels. The catheter system itself is provided with occlusive devices to form an emboli containment chamber in which irrigation and aspiration occur. The catheter system of the present invention provides an improved emboli containment and removal system which can be utilized in a wide range of vessel diameters. The system is easy to use and can quickly and efficiently evacuate the containment chamber. Excerpt(s): This application is a continuation-in-part of U.S. patent application Ser. No. 08/650,464 filed May 30, 1996, the entirety of which is hereby incorporated by reference. The present invention relates generally to medical devices, and, in particular, to a system of improved irrigation and aspiration catheters used in the containment and removal of emboli resulting from therapeutic treatment of occlusions within blood vessels. Human blood vessels often become occluded or blocked by plaque, thrombi, other deposits, or emboli which reduce the blood carrying capacity of the vessel. Should the blockage occur at a critical place in the circulatory system, serious and permanent injury, and even death, can occur. To prevent this, some form of medical intervention is usually performed when significant occlusion is detected. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Convertible blood clot filter Inventor(s): Appling, William M.; (Hartford, NY), Moresco, Kenneth P.; (Alexandria, VA), Patel, Nilesh H.; (Fishers, IN) Correspondence: Daniel P. Lent; Reed Smith Llp; 29th Floor; 599 Lexington Avenue; New York; NY; 10022; US Patent Application Number: 20030139765 Date filed: February 7, 2003
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Abstract: A vena cava blood clot filter is described that is attached to the walls of the vena cava by barbed anchors. In its filtering state, the filter is cone shaped which causes the blood to be filtered. The cone shape is formed by an appropriate restraining mechanism. When it is desired to stop filtering, the restraining mechanism is released and the filter takes a cylindrical shape. The cylindrical shaped filter will then line the vena cava wall and cease filtration of the blood. Excerpt(s): The following invention relates to a clot filter and more specifically to a convertible vena cava blood clot filter. Vena cava blood clot filters are generally placed in the inferior vena cava, introduced either through the femoral or jugular vein. These filters trap blood clots that have arisen from the peripheral veins and that travel through the vena cava. By trapping the blood clots, the filter prevents the clots from lodging in the pulmonary bed, which can lead to a condition known as pulmonary embolus. Pulmonary embolus (PE) has long been recognized as a major health care concern. Untreated PE is associated with a high mortality rate, widely held to be approximately 30%, although the exact rate is unknown. Symptomatic PE, however, represents only one manifestation of a more protean disorder, venous thromboembolic disease (VTD), which includes both deep venous thrombosis (DVT) and PE. Understanding of the interrelationship of these disorders has increased in recent years, as has the extent to which VTD contributes to patient mortality. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Doppler ultrasound method and apparatus for monitoring blood flow and detecting emboli Inventor(s): Moehring, Mark A.; (Seattle, WA), Myers, Timothy R.; (Snohomish, WA) Correspondence: Kimton N. Eng, ESQ.; Dorsey & Whitney Llp; Suite 3400; 1420 Fifth Avenue; Seattle; WA; 98101; US Patent Application Number: 20020091319 Date filed: December 6, 2000 Abstract: A pulse Doppler ultrasound system and associated methods are described for monitoring blood flow and detecting emboli. A graphical information display includes simultaneously displayed depth-mode and spectrogram displays. The depth-mode display indicates the various positions along the ultrasound beam axis at which blood flow is detected. These positions are indicated as one or more colored regions, with the color indicating direction of blood flow and varying in intensity as a function of detected Doppler ultrasound signal amplitude or detected blood flow velocity. The depth-mode display also includes a pointer whose position may be selected by a user. The spectrogram displayed corresponds to the location identified by the pointer. Embolus detection is also provided. Excerpt(s): This application is a continuation-in-part of U.S. patent application Ser. No. 09/190,402, filed Nov. 11, 1998, now pending. The invention relates generally to medical monitoring and diagnostic procedures and devices, and more particularly to a Doppler ultrasound method and apparatus for monitoring blood flow. Doppler ultrasound has been used to measure blood flow velocity for many years. The well-known Doppler shift phenomenon provides that ultrasonic signals reflected from moving targets will have a shift in frequency directly proportional to the target velocity component parallel to the direction of the ultrasound beam. The frequency shift is the same for any object moving at a given velocity, whereas the amplitude of the detected signal is a function of the
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acoustic reflectivity of the moving object reflecting the ultrasound. Pulse Doppler ultrasound systems commonly produce a spectrogram of the detected return signal frequency (i.e., velocity) as a function of time in a particular sample volume, with the spectrogram being used by a physician to determine blood flow characteristics of a patient. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Electrical stimulation device and methods of treatment of various body conditions Inventor(s): Mellen, Craig R.; (Salt Lake City, UT) Correspondence: Mallinckrodt & Mallinckrodt; 10 Exchange Place, Suite 510; Salt Lake City; UT; 84111; US Patent Application Number: 20030114900 Date filed: December 14, 2002 Abstract: An electrical stimulation device for applying electrical stimulus to a living body includes a pair of applicators adapted to each contact the living body. The applicators each include electrically conductive material covered by electrically insulating material whereby the electrically conductive material is separated from the living body by the electrically insulating material when the applicators contact the living body. A preferred applicator is formed of flat cable having a plurality of conductors therein that form a plurality of antennas for transmitting electrical signals to the body. A signal generator generates a series of positive electrical pulses to be applied to the living body through the applicators. The applicators of the invention allow much more power to be applied to the body than is possible with prior art devices and the signal generator allows a user a wide range of power adjustment so that the intensity of the signal applied to the body can adjusted over a wide range to obtain desired intensity effects. The device can be used for treating and creating a wide range of body conditions such as treating pain and related stress and bleeding and blood clots, stimulating muscles, finding microorganisms, and treating UV skin damage. Excerpt(s): The invention is in the field of devices for applying electrical signals to a living body and to methods of treating body conditions and producing reactions and conditions in living bodies by means of applying electrical signals to such bodies. There are currently various kinds of electric stimulators and methods of applying electrical signals to a body available for the purpose of managing pain and its associated stress, stimulating muscle function, and for treating various medical and other body conditions and/or the symptoms thereof. The stimulators and methods of the prior art are usually referred to in catagories recognized by the acronyms: TENS (Transcutaneous Electrical Nerve Stimulation), MENS (Microvolt Electrical Nerve Stimulation), and EMS (Electric Muscle Stimulation). When the application of electrical signals are directed to the treatment of pain, the equipment and methods used are usually referred to as TENS (Transcutaneous Electrical Nerve Stimulation) systems. It is claimed that such systems are able to stimulate specific nerves to ease pain at a specific point in a body. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Emboli capturing device Inventor(s): Fisher, John S.; (Belleair, FL) Correspondence: Smith & Hopen PA; 15950 Bay Vista Drive; Suite 220; Clearwater; FL; 33760 Patent Application Number: 20020156456 Date filed: April 18, 2001 Abstract: An apparatus used in balloon angioplasty and/or stenting in a first embodiment includes a guide wire, a balloon catheter that ensleeves the guide wire, and a guide catheter that ensleeves the balloon catheter. The balloon catheter has a plurality of longitudinally-extending, circumferentially spaced apart slots formed in it to define a plurality of elongate members between the slots. A joint is formed at the proximal, distal, and mid-point of each elongate member. Displacing the respective proximal and distal joints toward one another causes the respective middle joints to displace radially outwardly, and radial inward travel of the middle joints is caused by increasing the distance between the proximal and distal joints. A bead is formed in the distal end of the guide wire and retraction of the guide wire causes the bead to abut the distal end of the balloon catheter and displace it in a distal-to-proximal direction, opening the elongate, jointed members. A mesh that captures emboli while allowing blood perfusion partially overlies the jointed members and is opened when the jointed members are opened and closed when they are closed. The guide catheter is used to close the jointed members and the emboli-capturing mesh at the conclusion of the angioplasty procedure. In a second embodiment, the jointed members are formed in an inner lumen received within a delivery catheter. In a variation of the second embodiment, a predetermined extent of the inner lumen is enlarged to facilitate the formation of the jointed members. In a third embodiment, a guide wire having an outer coil and an inner rod that is slideably received within it is modified so that the jointed members are formed in the outer coil and the mesh is opened and closed by axially retracting and advancing the inner rod with respect to the outer coil, respectively. Excerpt(s): This invention relates, generally, to endovascular surgical tools. More particularly, it relates to a tool used in balloon angioplasty and stenting of blood vessel narrowings (stenoses). Percutaneous angioplasty is an efficacious treatment for improving the blood carrying capacity of an artery that has become occluded by plaque, calcification, and other deposits. There are several ways of performing the procedure and the type and number of catheters and other tools used may vary between differing procedures. Typically, a needle puncture is made into an artery and an elongate guide wire is fed through the puncture site until it has traversed the stenotic lesion (the area where the plaque has built up). A guide catheter having a relatively large diameter is then introduced into the artery, using the guide wire to guide it. A balloon-carrying catheter is then fed through the guide catheter, also using the guide wire as a guide. The guide catheter is then advanced to a preselected point so that its distal end is downstream of the stenotic lesion, and the balloon catheter is positioned so that the balloon is in registration with said lesion, also known as a stenosis. The guide catheter is withdrawn a relatively short distance to expose the balloon catheter. The balloon is then inflated to permanently dilate and tear the two inner layers of the artery, thereby enlarging its diameter, breaking up the stenosis, thereby increasing the blood-carrying capacity of the artery. An expandable stent may be carried on the outer surface of the balloon and left in place after the balloon is deflated and withdrawn. Alternatively, a self-expanding stent may be deployed over the treated lesion using a different delivery catheter. The stent holds the arterial walls in their expanded condition. After the balloon
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is deflated, the balloon catheter is withdrawn into the guide catheter, and both of said catheters and the guide wire are withdrawn to conclude the procedure. The primary drawback to balloon angioplasty or stenting is the creation of debris and thrombus that can clog blood vessels downstream of the treatment site. The stretching of the two inner arterial walls breaks up the stenotic lesion and creates debris known as emboli. Accordingly, when the balloon is deflated, the emboli flow downstream with the blood. If the stenotic lesion is in the iliac or femoral arteries, the emboli may flow to the feet; this may or may not be problematic. However, if the stenotic lesion is in the carotid artery, the emboli can flow into various brain vessels and cause permanent brain damage. Similarly, kidney damage can ensue from dilating a lesion in the main renal artery. For this reason, balloon angioplasty carries a higher risk of embolic complications for stenotic lesions in the carotid, renal, and coronary arteries unless means are provided for preventing the flow of emboli to the blood vessels of the brain, kidney, or heart, respectively. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Emboli extraction catheter and vascular filter system Inventor(s): Johnson, Kirk; (Weston, FL), O'Neill, Patrick; (Doylestown, PA) Correspondence: Audley A. Ciamporcero JR.; Johnson & Johnson; One Johnson & Johnson Plaza; New Brunswick; NJ; 08933-7003; US Patent Application Number: 20020188313 Date filed: June 12, 2001 Abstract: An emboli extraction catheter and vascular filter system comprising a guidewire, a vascular filter attached near the distal end of the guidewire, and an emboli extraction catheter. The vascular filter has a smaller first diameter for insertion into the lumen of a vessel, and a second larger diameter for expanding to substantially equal the diameter of the lumen and to be placed in generally sealing relationship with the lumen. The emboli extraction catheter is a flexible catheter comprising a hub attached to the proximal end of the catheter. The hub further comprises a sideport and means for maintaining a seal on the guidewire. The emboli extraction catheter can be used to aspirate embolic particulates, so as to avoid their accidental release after they are captured in a vascular filter, and can also be used to empty full vascular filters of embolic particulates which may block distal flow. Excerpt(s): The present invention relates to the treatment of vascular disease, and more particularly to an emboli extraction catheter and vascular filter system for use during medical procedures. Percutaneous transluminal coronary angioplasty (PTCA), stenting and atherectomy are therapeutic medical procedures used to increase blood flow through the coronary arteries. These procedures can often be performed as alternatives to coronary bypass surgery. Percutaneous transluminal angioplasty (PTA) and stenting can often be performed as alternatives to carotid endarterectomy, and femoral-popliteal bypass procedures. In PTCA or PTA procedures, the angioplasty balloon is inflated within the stenosed vessel, at the location of an occlusion, in order to shear and disrupt the wall components of the vessel to obtain an enlarged lumen. In stenting, an endoluminal prosthesis is implanted in the vessel to maintain patency following the procedure. In atherectomy, a rotating blade is used to shear plaque from the arterial wall. One of the complications associated with all these techniques is the accidental dislodgment of plaque, thrombus or other embolic particulates generated during manipulation of the vessel, thereby causing occlusion of the narrower vessels
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downstream and ischemia or infarct of the organ which the vessel supplies. Such emboli may be extremely dangerous to the patient, and may result in myocardial infarction, stroke or limb ischemia. In 1995, Waksman et al. disclosed that distal embolization is common after directional atherectomy in coronary arteries and saphenous vein grafts. See Waksman et al., American Heart Journal 129(3): 430-5 (1995). This study found that distal embolization occurs in 28% (31 out of 111) of the patients undergoing atherectomy. In January 1999, Jordan, Jr. et al. disclosed that treatment of carotid stenosis using percutaneous angioplasty with stenting procedure is associated with more than eight times the rate of microemboli seen using carotid endarterectomy. See Jordan, Jr. et al. Cardiovascular Surgery 7(1): 33-8 (1999). Microemboli, as detected by transcranial Doppler monitoring in this study, have been shown to be a potential cause of stroke. The embolic materials include calcium, intimal debris, atheromatous plaque, and thrombi. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Emboli filter Inventor(s): Blackledge, Victor R.; (Cologne, MN), Hall, Todd A.; (Goshen, KY), Morris, Benjamin E.; (Louisville, KY), Reuss, William A. JR.; (Louisville, KY), Whatley, Charles H. JR.; (Louisville, KY) Correspondence: Merchant & Gould PC; P.O. Box 2903; Minneapolis; MN; 55402-0903; US Patent Application Number: 20030125765 Date filed: January 2, 2003 Abstract: An emboli filter for deployment in a body lumen to capture emboli entrained in a fluid flowing through the lumen includes a flexible elongated member sized to be passed through the lumen. A filter media is carried on and substantially surrounding the elongated member. The filter media has a first end secured to the elongated member adjacent the distal end. A second end of the filter media has a periphery movable toward and away from the elongated member. Opposing internal surfaces of the filter media define a volume into which emboli may flow through the second end when the periphery is moved away from the elongated member. The emboli are trapped within the volume when the periphery is moved toward the elongated member. An actuator moves the periphery toward and way from the elongated member. The actuator includes a plurality of elastic loops. The loops are biased to an open loop configuration with the loops urging the periphery away from the elongated member. The actuator is adapted to be manipulated by an operator to urge the loops against the bias to a closed position permitting movement of the periphery toward the elongated member without interference from the loops. Excerpt(s): This invention pertains to a medical apparatus for passage into a body lumen of a patient. More particularly, this invention pertains to an emboli filter for deployment in a patient's body lumen to capture emboli entrained in fluid flowing through the lumen. There are numerous medical procedures for introducing tools into a patient's body lumen. For example, occlusion treatment tools (such as angioplasty balloon-tipped catheters, stents or ablation catheters) may be admitted into a lumen of an artery to treat an occluded site within the artery. A balloon tipped catheter may be expanded at the site to urge the occlusion against the walls of the artery to improve patency of the arterial lumen. A stent may be expanded at the site to maintain lumen patency. Alternatively, or in combination with other procedures, an ablation tool may be used to mechanical
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remove the occluding material. The manipulation and use of tools within a lumen of a body passage may cause the release of emboli in the lumen. In arteries, such emboli become entrained within blood flow within the artery. Such emboli can contribute to morbidity. For example, emboli can be transported to the brain and contribute to cranial ischemia (stroke). In treating occlusions in coronary arteries, emboli may flow to occlude distal, micro-vessels contributing to myocardial ischemia. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Emboli filtration system and methods of use Inventor(s): Bates, Mark C.; (Charleston, WV), Hogendijk, Michael; (Palo Alto, CA) Correspondence: Fish & Neave; 1251 Avenue OF The Americas; 50th Floor; New York; NY; 10020-1105; US Patent Application Number: 20030150821 Date filed: October 21, 2002 Abstract: An emboli filtration apparatus is provided comprising a guide wire having a filter element captured thereon, so that the guide wire is free to rotate and translate while the filter element remains stationary. The apparatus allows for movement and rotation of the guide wire as devices are advanced over it to treat occlusive disease, substantially without dislodging the filter element. In a preferred embodiment, the guide wire comprises a proximal stop configured to reposition the filter element during a medical procedure without having to remove or insert additional interventional devices. Excerpt(s): The present application is a continuation-in-part of U.S. patent application Ser. No. 09/774,197, filed Jan. 29, 2001, which is a continuation-in-part of U.S. patent application Ser. No. 09/354,897, filed Jul. 16, 1999, now U.S. Pat. No. 6,179,859. The present invention relates to apparatus and methods for removing emboli from the blood stream that are generated during treatment of vascular disease, such as angioplasty, atherectomy or stenting. More particularly, an emboli filtration device and methods are provided having a captured filter that enables movement of a guide wire associated with the filter without displacing the filter. Atherosclerosis and other vascular occlusive diseases are becoming prevalent today in many developed countries. In such diseases, the flow areas of blood vessels become narrowed or occluded by the buildup of plaque on the walls of the vessels, leading to ischemia, and depending upon the location of the vessel, damage to the organ or limb. A number of surgical and percutaneous procedures have been developed for treating stenosis in the coronary arteries and carotid arteries, including endarterectomy, angioplasty, atherectomy and stenting. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Exchange method for emboli containment Inventor(s): Zadno-Azizi, Gholam-Reza; (Newark, CA) Correspondence: Knobbe Martens Olson & Bear Llp; 620 Newport Center Drive; Sixteenth Floor; Newport Beach; CA; 92660; US Patent Application Number: 20020065507 Date filed: January 22, 2001
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Abstract: The present invention provides a method for exchanging catheters while containing emboli within a blood vessel such as a saphenous vein graft, coronary artery, carotid artery, or other similar vessels. A guidewire is inserted through the vasculature of a patient until it reaches a desired treatment site. A therapy catheter is then inserted over the guidewire until the distal end of the therapy catheter reaches the treatment site. The guidewire has a distally mounted balloon which is inflated to occlude the blood vessel. Then, the therapy catheter provides means for treating the vessel at the treatment site. After treatment, the therapy catheter is removed from the guidewire and exchanged with an aspiration catheter which rides over the guidewire until the distal end of the aspiration catheter reaches the treatment site. The aspiration catheter applies negative pressure to remove any emboli formed by the treatment procedure. Excerpt(s): This application is a continuation-in-part of application Ser. No. ______, entitled LOW PROFILE CATHETER VALVE AND INFLATION ADAPTOR, filed Nov. 20, 1997 (Attorney Docket No. PERCUS.006CP1), the entirety of which is hereby incorporated by reference. The present invention relates to medical catheters used in treating saphenous vein grafts, coronary arteries, and other blood vessels, and more particularly, to a method for exchanging catheters during emboli containment in such vessels. Guidewires are conventionally used to guide the insertion of various medical instruments, such as catheters, to a desired treatment location within a patient's vasculature. In a typical procedure, the clinician forms an access point for the guidewire by creating an opening in a peripheral blood vessel, such as the femoral artery. The highly flexible guidewire is then introduced through the opening into the peripheral blood vessel, and is then advanced by the clinician through the patient's blood vessels until the guidewire extends across the vessel segment to be treated. Various treatment catheters, such as a balloon dilatation catheter for a percutaneous transluminal coronary angioplasty, may then be inserted over the guidewire and similarly advanced through vasculature until they reach the treatment site. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Low profile emboli capture device Inventor(s): Chin, Yem; (Burlington, MA), Griego, John; (Blackstone, MA), Stanford, Ulf Harry; (Incline Village, NV), Zhong, Sheng-Ping; (Northborough, MA) Correspondence: Bruce H. Johnsonbaugh; Eckhoff, Hoppe, Slick, Mitchell & Anderson; Suite 3125; 333 Market Street; San Francisco; CA; 94105; US Patent Application Number: 20020115942 Date filed: February 20, 2001 Abstract: A low profile emboli capture device is provided for use in angioplasty and other intravascular procedures. A standard guidewire is utilized having a reduced cross-sectional area formed near its distal end. A filter and self-expanding stent are packaged on the reduced cross-sectional area of the guidewire. A movable sleeve extends over the guidewire and holds the self-expanding stent and filter in their retracted positions while the device is being positioned in the artery. The sheath is moved relative to the self-expanding stent and filter, whereupon the self-expanding stent and filter become deployed. Excerpt(s): The present invention relates generally to an emboli capture device for use in conjunction with angioplasty and other intravascular surgeries. More particularly, the present invention provides a low profile emboli capture device (i.e. approximately 0.020
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inch diameter or less in its retracted position) capable of being used in smaller diameter blood vessels than prior art emboli capture devices, as well as reducing the risk of dislodging plaque in larger vessels. The present invention provides an emboli capture device carried by a standard guidewire; a catheter is not required to insert and deploy the emboli capture device. The invention is capable of use in carotid angioplasty without occluding blood flow to the brain, and can be used in saphenous vein grafts, native coronary arteries and arteries as small as 1 mm. diameter. As angioplasty and other intravascular surgical procedures progress, it becomes increasingly important to be able to use an emboli capture device in smaller and smaller arteries, requiring the use of lower profile devices. In accordance with the present invention, an emboli capture device is provided which in its preferred form includes three main components that cooperate with a standard guidewire; a self-expanding stent (or other expansion means), a filter and a sleeve. The filter and self-expanding stent in the preferred embodiment are carried directly on a reduced cross-sectional mounting region of the guidewire so that those components of the device in their retracted form have essentially the same crosssectional profile as the guidewire, itself. The present invention also provides a thin sleeve which holds the filter and self-expanding stent against the guidewire. The thin sleeve is then retracted proximally relative to the guidewire, allowing the filter and selfexpanding stent (or other expansion means) of the present invention to expand. The same guidewire which is used to place the emboli capture device of the present invention is used to guide the surgical catheter into place for performing the angioplasty or other intravascular surgery. The catheter, itself, is utilized to retract and retrieve the emboli capture device at the conclusion of the procedure. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Method and apparatus for emboli containment Inventor(s): Bagaoisan, Celso J.; (Union City, CA), Ha, Hung V.; (San Jose, CA), Patel, Mukund R.; (San Jose, CA), Zadno-Azizi, Gholam-Reza; (Newark, CA) Correspondence: Knobbe Martens Olson & Bear Llp; 620 Newport Center Drive; Sixteenth Floor; Newport Beach; CA; 92660; US Patent Application Number: 20020026145 Date filed: November 30, 2000 Abstract: Disclosed herein is a catheter for use in an emboli containment system. In one embodiment, the catheter has a tubular body with a metallic braid construction. Two lumens extend through the tubular body, the lumen being in a side-by-side configuration. One of the lumens functions as an inflation lumen, and is in fluid communication with an inflatable balloon mounted on the distal end of the catheter. The second lumen is adapted to receive other therapeutic catheters which comprise the emboli containment system. In another embodiment, apparatus is provided for treatment of a stenosis in a lumen in a blood-carrying vessel comprising a main catheter and a therapeutic catheter. The main catheter comprises a first flexible elongate tubular member having proximal and distal extremities. A sealing element is carried on the distal extremity of the first flexible elongate tubular member. The first flexible elongate tubular member has a main lumen therein extending from the proximal extremity to the distal extremity and exits through the distal extremity. An adapter is mounted on the proximal extremity of the first flexible elongate tubular member. The therapeutic catheter comprises a second flexible elongate tubular member having proximal and distal extremities. An element for performing work is mounted on the distal extremity
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of the second flexible elongate tubular member. An adapter is mounted on the proximal extremity of the second flexible elongate tubular member. The second flexible elongate tubular member is slidably mounted in the main lumen of the first elongate tubular member. A mechanism is carried by the first flexible elongate tubular member for causing the sealing element to form an occlusion in the vessel proximal of the stenosis to provide a working space distal of the sealing element. A mechanism is coupled to the attachment of the therapeutic catheter for causing operation of the element for performing work in the working space adjacent the stenosis. Excerpt(s): This application is a continuation of application Ser. No. 08/813,023, filed on Mar. 6, 1997, which is a continuation-in-part of application Ser. No. 08/650,464 filed on May 20, 1996, the entirety of which is incorporated herein by reference, which is a continuation-in-part of application Ser. No. 08/464,579, filed Jun. 5, 1995, now U.S. Pat. No. 5,833,650. The present invention generally relates to medical devices, and in particular, to catheters which can be used in an emboli containment system. This invention also relates to an apparatus and method for treating occluded vessels in living bodies and more particularly balloon catheters and balloon guide wires for treating occlusions in vessels in human bodies, as for example carotid arteries. Balloon angioplasty, and other transluminal medical treatments, are well-known, and have been proven efficacious in the treatment of stenotic lesions in blood vessels. The application of such medical procedures to certain blood vessels, however, has been limited, due to the risks associated with creation of emboli during the procedure. For example, angioplasty is not the currently preferred treatment for lesions in the carotid artery, because of the possibility of dislodging plaque from the lesion, which can enter the various arterial vessels of the brain and cause permanent brain damage. Instead, surgical procedures are currently used, but these procedures present substantial risks. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Method and apparatus for medical device for aspiration of thromboembolic debris Inventor(s): Wholey, Mark H.; (Oakmont, PA), Wholey, Michael; (San Antonio, TX), Wholey, Petra; (San Antonio, TX) Correspondence: Pietragallo, Bosick & Gordon; One Oxford Centre, 38th Floor; 301 Grant Street; Pittsburgh; PA; 15219-6404; US Patent Application Number: 20020026212 Date filed: March 15, 2001 Abstract: An apparatus for collecting blood clots, plaque, and other debris in arteries or veins, said apparatus comprising: a filter assembly having a chamber with a paddle assembly and a porous floor disposed therein; and tubes for coupling said filter assembly to an artery and to a vein. Excerpt(s): This application claims the benefit of U.S. Provisional Patent Application Serial No. 60/190,513, filed Mar. 15, 2000. This invention relates to an apparatus and method for collecting blood clots, pieces of plaque and other material that may be accidentally dislodged during interventional procedures in the human vasculature such as arterial and venous angioplasty and stent placement. The invention utilizes a chamber that collects the blood from one sheath or catheter through an aspirating force where the blood can be filtered with removal of thromboembolic debris. The blood can then be recirculated back into the bloodstream through a second access. It is common practice today to open occluded (i.e. blocked) or stenotic (i.e. narrowed) blood vessels by
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inserting a guidewire and then a catheter carrying a balloon shaped distal end and inflating the balloon, which exerts radial force, to press the stenosis outward against the wall of the vessel. This procedure is called balloon angioplasty. Frequently, an implantable metallic stent will be used additionally to provide greater radial strength and longer-term patency. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Method and compositions for inhibiting thrombin-induced coagulation Inventor(s): Davis, Stacey; (College Station, TX), Hook, Magnus A.O.; (Houston, TX) Correspondence: Larson & Taylor, Plc; 1199 North Fairfax Street; Suite 900; Alexandria; VA; 22314; US Patent Application Number: 20030044418 Date filed: May 13, 2002 Abstract: A method of achieving safe and effective treatment or prevention of potentially harmful blood clots, or in inhibiting the coagulation of blood when so desired such as during a wide array of disease conditions including stroke, myocardial infarction, sickle-cell crisis and venous thrombosis, is provided by the administration of a fibrinogen-binding protein capable of binding at the N-terminal B.beta. chain of fibrinogen, such as SdrG or Fbe, or their respective binding regions such as the A domain. In addition, compositions comprising effective amounts of the fibrinogenbinding proteins are also provided. The present anti-coagulation compositions have been shown to inhibit thrombin-induced fibrin clot formation by interfering with the release of fibrinopeptide B and the resulting anti-coagulation effects can be achieved without potential for causing or exacerbating unwanted side effects such as thrombocytopenia associated with prior art anticoagulants such as heparin. Excerpt(s): This application claims the benefit of U.S. Provisional Patent Application No. 60/290,072, filed May 11, 2001. The present invention relates in general to SdrG, a fibrinogen-binding bacterial adhesin, and in particular to the use of SdrG or its binding region as an anti-coagulation agent by virtue of its ability to inhibit thrombin-induced fibrin clot formation by interfering with the release of fibrinopeptide B. In addition, the invention relates to methods and compositions utilizing SdrG or its binding region for treating or preventing thrombin-induced coagulation and conditions associated therewith. Coagulase-negative staphylococci (CNS) are important opportunistic pathogens that are particularly associated with foreign body infections in humans. Staphylococcus epidermidis is the most common pathogenic species of CNS and accounts for 74-92% of the infections caused by this group of staphylococci (1). The molecular pathogenesis of most infections is complex and involves multiple microbial factors and host components, but is generally initiated by the adherence of the microbe to host tissues. Bacterial adherence involves specific surface components called adhesins, and bacterial pathogens, such as staphylococci that live in the extracellular space of the host, target extracellular matrix (ECM) components, including fibrinogen (Fg) and fibronectin, for adherence and colonization. This process is mediated by a subfamily of adhesins that have been termed MSCRAMM.RTM.s (microbial surface components recognizing adhesive matrix molecules) (2). Staphylococcus aureus expresses multiple MSCRAMM.RTM.s of which several have been characterized in some detail (For a recent review see Ref. 3), and various MSCRAMM.RTM.s have been the subject of U.S. Patents, including fibronectin binding proteins such as disclosed in U.S. Pat. Nos. 5,175,096; 5,320,951; 5,416,021; 5,440,014; 5,571,514; 5,652,217; 5,707,702;
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5,789,549; 5,840,846; 5,980,908; and 6,086,895; fibrinogen binding proteins such as disclosed in U.S. Pat. Nos. 6,008,341 and 6,177,084; and collagen binding proteins as disclosed in 5,851,794 and 6,288,214; all of these patents incorporated herein by reference. In addition, other information concerning SdrG and other MSCRAMM.RTM.s can be found in U.S. Ser. No. 09/810,428, filed Mar. 19, 2001, incorporated herein by reference; and U.S. Ser. No. 09/386,962, filed Aug. 31, 1999, incorporated herein by reference. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Method for treating a prosthesis having an apertured structure and associated devices Inventor(s): Giannetti, Arnaldo; (Crescentino, IT), Pasquino, Enrico; (Torino, IT), Rinaldi, Stefano; (Parma, IT) Correspondence: Terry L. Wiles, ESQ.; Popovich & Wiles, PA; Ids Center, Suite 1902; 80 South 8th Street; Minneapolis; MN; 55402; US Patent Application Number: 20020117264 Date filed: April 30, 2002 Abstract: A prosthesis having an apertured structure is located in a chamber (11) which is taken to sub-atmospheric pressure. Once sub-atmospheric pressure has been reached, a liquid, optionally containing pharmacological agents, is introduced into the chamber. Drawn by the sub-atmospheric pressure, the liquid saturates the apertured structure of the prosthesis. In this way, the invention eliminates the risk of air being trapped in the apertured structure that could give rise to the formation of blood clots after implantation of the prosthesis. The liquid can contain drugs that penetrate the prosthesis, performing their therapeutic action locally and over time after implantation. Excerpt(s): The present invention generally relates to a method for treating prostheses having an apertured structure. In particular, this invention relates to a method and a device for saturating a prosthesis with a liquid. The term "apertured structure" refers to those prostheses (such as, for example, so-called vascular grafts or the suture rings of cardiac valve prostheses) comprising, entirely or in part, from tissue structures, spongy masses and/or having elaborate geometries with slits, cavities and spaces, i.e., apertures. In use, such prostheses tend to hold air inside them with a consequent risk of the formation of blood clots in the period following implantation, due to the presence of air bubbles contained or otherwise held by the prosthesis. The simple solution, sometimes adopted during the implantation operation, of immersing the prosthesis in, for example, a physiological saline bath, does not satisfactorily solve the problem, both because the results can depend, possibly significantly, on the time dedicated to this treatment and the ability of the person conducting it, and because it is in any case difficult to remove all the air from the prosthesis. The present invention therefore aims to eliminate in a radical manner the risk of the occurrence of these negative phenomena. The invention also concerns devices which can be used in the performance of this method. An important advantage of the invention is that the liquid such as, for example, physiological saline that is introduced into the pores, even the deep pores, to replace the air that is naturally present, can be supplemented with drugs such as, for example, antibiotics, anti-thrombotic drugs, drugs that promote the integration between the prosthesis and the surrounding biological tissues, or growth factors. Because the liquid is held in the pores, the drug or drugs can exert their action locally and extended over time. It is noted that the word "drug", as used herein, also includes the possible use of a binding agent applied to the prosthesis in order to attract thereto, with a binder-ligand
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association mechanism, pharmacologically active agents introduced into the patient's body. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
METHOD OF REMOVING THROMBOSIS IN FISTULAE Inventor(s): CARTER, ROBERT E.; (ARLINGTON, MA), SIEGEL, ROBERT J.; (VENICE, CA) Correspondence: Walter A Hackler; 2372 S E Bristol Suite B; Newport Beach; CA; 92660 Patent Application Number: 20020007141 Date filed: November 9, 1998 Abstract: Apparatus and methods are provided for utilizing a combination of ultrasonic energy and an echo contrast agent containing microbubbles, for substantially dissolving blood clots or other fistula obstructions. One embodiment of the present invention alternatively utilizes a selected dose of thrombolytic agent in combination with an echo contrast agent, for enhancing the thrombolytic action of a thrombolytic agent and removing a thrombosis from a fistula. Excerpt(s): The present application is a continuation-in-part of U.S. Ser. No. 08/441,127 now U.S. Pat. No. ______, which is a continuation-in-part of U.S. Ser. No. 08/303,858 now U.S. Pat. No. 5,509,896. The present invention is generally related to the use of ultrasonic energy and is more particularly directed to the use of ultrasound with ultrasound imaging agents, alone or in combination with thrombolytic agents, to dissolve thrombosis in fistula. It is known that ultrasound imaging can be used to locate intravascular thrombi and it has been demonstrated that the utilization of ultrasonic waves can improve the diffusion and penetration of medicinal fluids or the like into the vascular system (see U.S. Pat. No. 5,197,946 to Tachibana). Tachibana teaches that in order to effectively enhance or improve the diffusion and penetration or a medicinal fluid, the oscillating element must be disposed at the point of injection of the medicinal fluid. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Multifunctional electrosurgical instrument Inventor(s): Luigi, Giancarlo; (Aguadilla, PR) Correspondence: Eugenio J. Torres; Ferramar Building, Suite 1; 1060 Ashford Avenue; San Juan; PR; 00907; US Patent Application Number: 20030135208 Date filed: January 15, 2002 Abstract: A multifunctional electrosurgical instrument for performing various oropharyngeal operative procedures comprises a serrated chisel tip for various dissecting methods; an electrocautherium, for coagulation of blood vessels or for use as a particular dissection method; a variable speed suctioning feature to remove undesired blood in the surgical area, or to serve as irrigation source; and an irrigation feature, for ease in the identification of blood vessels and for removal of dangerous blood clots from the surgical area.
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Excerpt(s): The present invention relates generally to surgical procedures and instruments and, more particularly, to a multifunctional electrosurgical instrument primarily intended for oropharyngeal surgical procedures having a serrated chisel tip at its distal end for sharp or cutting dissection, electrocautherium for coagulation of blood vessels or cutting dissection, suction features in the serrated chisel tip for removal of blood or irrigation solution from the surgical field, irrigation feature to move blood clots from the surgical field and to make easier the identification of bleeding blood vessels. The oropharyngeal cavity is heavily irrigated by blood vessels such as arteries and capillaries. It is therefore not surprising that one of the main problems during surgical procedures in that area is controlling bleeding. Surgeons generally employ electrosurgical tools to cut tissue and to coagulate bleeding blood vessels in a process known as cautery. Electrically powered instruments such as coagulation forceps, suction cauteries, electrode cautery tips and blade electrodes are well known in the prior art. Such medical instruments are used in procedures that involve cutting and other contact with flesh or tissue. For instance, surgical blade electrodes are utilized to reduce bleeding by cauterizing the exposed tissue. Typically, a blade electrode is affixed to a handpiece activated for passing electrical energy into the blade electrode to transmit radio-frequency electrical energy to the flesh or tissue to cauterize the site. Other electrosurgical devices are similarly designed. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Novel nucleic acid molecules and polypeptides encoding baboon TAFI Inventor(s): Hsu, Mei-Yin; (Hillsboro, NJ), Matsueda, Gary R.; (Princeton, NJ), Nayeem, Akbar; (Newtown, PA), Tamura, James K.; (Yardley, PA) Correspondence: Stephen B. Davis; Bristol-myers Squibb Company; Patent Department; P O Box 4000; Princeton; NJ; 08543-4000; US Patent Application Number: 20030215850 Date filed: March 4, 2003 Abstract: The present invention relates to the isolation and identification of novel baboon nucleic acid molecules and proteins and polypeptides encoded by such nucleic acid molecules, or degenerate variants thereof, which proteins and polypeptides comprise novel baboon thrombin-activatable fibrinolysis inhibitors or "TAFI" enzyme molecules. Because the novel baboon TAFI proteins and polypeptides of the invention inhibit the breakdown of blood clots, they may be therapeutically useful for the treatment of blood disorders wherein clotting needs to be regulated or promoted, such as hemophilia or von Willebrand's disease or in other situations, such as trauma, wherein blood clotting or coagulation needs to be regulated or promoted. The sequences of the invention are also useful in screening methods for the identification of compounds that modulate the expression of the baboon TAFI nucleic acids and/or the activity of the baboon TAFI proteins and polypeptides of the invention. Such agonist or antagonist compounds may be useful in the treatment of various blood clotting disorders and conditions requiring hemostatic control such as hemophilia or various thrombotic diseases such as deep venous thrombosis, coronary artery disease, stroke associated with atrial fibrillation and recurrent thrombosis following stroke or myocardial infarction. Excerpt(s): This application is a continuation-in-part Application of and claims benefit to provisional application U.S. Serial No. 60/361,523 filed Mar. 4, 2002, under 35 U.S.C. 119(e). The entire teachings of the referenced application are incorporated herein by
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reference. The sequences of the invention are also useful in screening methods for the identification of compounds that modulate the expression of the baboon TAFI nucleic acids and/or the activity of the baboon TAFI proteins and polypeptides of the invention. Such agonist or antagonist compounds may be useful in the treatment of various blood clotting disorders and conditions requiring hemostatic control such as hemophilia or various thrombotic diseases such as deep venous thrombosis, coronary artery disease, stroke associated with atrial fibrillation and recurrent thrombosis following stroke or myocardial infarction. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Process for graphic visualization and diagnosis of thrombi by means of nuclear spin tomography with use of particulate contrast media Inventor(s): Kresse, Mayk; (Berlin, DE), Schmitz, Stephen; (Berlin, DE), Wagner, Susanne; (Berlin, DE) Correspondence: Millen, White, Zelano & Branigan, P.C.; 2200 Clarendon BLVD.; Suite 1400; Arlington; VA; 22201; US Patent Application Number: 20020087071 Date filed: September 14, 2001 Abstract: The invention relates to a new process for graphic visualization and diagnosis of thrombi as well as the use of particle suspensions for the production of contrast media for the visualization of thrombi with use of nuclear spin tomography. Excerpt(s): This application claims the benefit of the filing date of U.S. Provisional Application Serial No. 60/235,553 filed Sep. 27, 2000. The invention relates to a new process for graphic visualization and diagnosis of thrombi as well as the use of particle suspensions for the production of contrast media for the visualization of thrombi by means of nuclear spin tomography. A thrombus is a circumscribed blood solidification that forms in arteries or veins by intravascular clotting. A thrombosis, i.e., a partial or complete obstruction of arteries or veins by a thrombus, can result in anemia and tissue death of an organ (infarction). A typical example of an arterial thrombosis is that of the coronary arteries (coronary thrombosis). If a thrombus detaches from the vessel wall, it is borne away by the blood stream. In terms of a thromboembolism, this thrombus can obstruct a downstream smaller vessel. The brain-supplying arteries are a typical example of thromboembolisms in arteries. The very common thromboses of the pelvic veins and leg veins typically result in a thromboembolism of the lung arteries. The lung artery embolism is especially feared since it is difficult to detect and often leads to a fatal outcome. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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System for, and method of, blocking the passage of emboli through a vessel Inventor(s): Boylan, John F.; (Murrieta, CA), Simpson, John A.; (Carlsbad, CA) Correspondence: Fulwider Patton Lee & Utecht, Llp; Tenth Floor; 6060 Center Drive; Los Angeles; CA; 90045; US Patent Application Number: 20020156520 Date filed: June 19, 2002
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Abstract: A self-expanding filter has a deployable resilient distal portion with properties of passing fluid (e.g. blood) in a vessel (e.g. an artery) and blocking the passage of emboli in the fluid. The self-expanding filter is disposed in the vessel, in the direction of fluid flow in the vessel, with its resilient proximal and distal ends at positions past a lesion in the vessel. The distal end of the self-expanding filter is then deployed against the vessel wall. An interventional device, such as an expandable member (e.g. balloon) and expandable stent are disposed in the vessel at the position of the lesion in the vessel. The expandable member is then dilated to expand the expandable stent against the vessel wall and open the vessel at the lesion position. Fluid (blood) flows through the deployed distal end of the self-expanding filter and emboli created during the procedure are trapped by the deployed distal end of the filter. The expandable member is then collapsed after all of the emboli have been trapped by the deployed distal end of the self-expanding filter. The resilient proximal end of the self-expanding filter is thereafter deployed against the vessel wall. This causes the emboli to be trapped between the vessel wall and the proximal and distal ends of the self-expanding filter. Alternatively, the expandable member may be deflated and withdrawn from the vessel after the proximal end of the filter has been deployed against the wall of the vessel. Excerpt(s): This invention relates to a system for, and a method of, treating occluded vessels (e.g. an artery) and capturing friable emboli which may break away from the lesion in the vessel during an interventional procedure. The system and method of the present invention are especially useful when performing carotid interventional procedures in order to prevent embolic debris from entering and occluding downstream blood vessels leading to the brain which, if blocked, may cause a stroke. However, the system and method of this invention can be adapted by a person of ordinary skill in the art for use in numerous other vascular interventional procedures. In recent years, numerous procedures have been adapted for expanding blood vessels (e.g. arteries), at the positions of lesions in the blood vessels, so that blood can flow through the blood vessels without obstruction from the lesions. In the process of expanding such blood vessels at the positions of the lesions, emboli may become detached from the lesions and enter the bloodstream and subsequently migrate through the patient's vasculature to block blood vessels leading to sensitive organs such as the brain, where they may induce trauma. Procedures have been adapted in recent years for preventing embolic debris from flowing through the vessels in the direction of the blood flow. For example, filters have been provided for trapping the emboli. When lesions develop in the carotid artery of a patient, the placement of a filter in the patient's vasculature can somewhat reduce the movement of the embolito the patient's brain thereby preventing strokes from occurring. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Thrombus treatment with emboli management Inventor(s): Knudson, Mark B.; (Shoreview, MN), Conrad, Timothy R.; (Eden Prairie, MN) Correspondence: Merchant & Gould PC; P.O. Box 2903; Minneapolis; MN; 55402-0903; US Patent Application Number: 20030199865 Date filed: May 31, 2002 Abstract: A method for treating a body lumen having a pathologic occlusion at least partially occluding a flow of body fluid in the lumen includes obstructing the lumen
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with an artificial occlusion distal to the pathologic occlusion. The pathologic occlusion is ablated in a process which may create a plurality of emboli of the pathologic occlusion on a proximal side of the artificial occlusion. The emboli are removed from the lumen and, subsequently, the artificial occlusion is removed. Excerpt(s): This patent application is a continuation-in-part application of U.S. pat. No. Ser. No. 10/128,120 filed Apr. 22, 2002 and titled the same and naming the same inventors as the present application. This invention pertains to a method and apparatus for protecting body tissue during the removal of obstructions from a body lumen. More particularly, this invention pertains to methods and apparatus for reducing the possibility of emboli migrating distal to an obstruction when removing the obstruction from a body lumen. From time to time, a body lumen may develop a pathologic occlusion restricting fluid flow through the lumen. For example, blood vessels such as arteries may develop blockages for a variety of reasons. Plaque formation on an interior wall of the artery may result in thrombus formation. Such thrombus may fully or partially occlude the artery. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Tissue monitoring system for intravascular infusion Inventor(s): Jersey-Willuhn, Karen; (Olivenhain, CA), Soleimani, Manuchehr; (Manchester, GB) Correspondence: Koestner Bertani Llp; 18662 Macarthur Blvd; Suite 400; Irvine; CA; 92612; US Patent Application Number: 20030216663 Date filed: August 23, 2002 Abstract: An infusion system has a capability to monitor infusion complications such as extravasation, tissue necrosis, infiltration, phlebitis, and blood clots. The infusion system has at least partially transparent flexible film barrier dressing in a flexible membrane that incorporates a plurality of sensors capable of detecting tissue condition and a control unit capable of coupling to the film barrier dressing that monitors signals from the sensors. A device is capable of executing non-invasive physiological measurements to characterize physiologic information from cross-sectional surface and subcutaneous tissue to detect the presence or absence of tissue conditions such as infiltration or extravasation during intravascular infusion. In some examples, the device utilizes depth-selective methods to sense, detect, quantify, monitor, and generate an alert notification of tissue parameters. Excerpt(s): This application is related to U.S. patent application Ser. No. 60/351,094, filed on Jan. 25, 2002. 2. U.S. patent application Ser. No. xx/xxx,xxx entitled "Conductivity Reconstruction Based on Inverse Finite Element Measurements in a Tissue Monitoring System", naming Karen JerseyWilluhn and Manuchehr Soleimani as inventors and filed on even date herewith. The invention relates generally to physiological monitoring devices and, more particularly, to tissue monitoring devices and methods for detecting harmful conditions including conditions that occur during intravascular infusion. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Ultrasonic catheter drug delivery method and device Inventor(s): Babaev, Eilaz; (Minnetonka, MN) Correspondence: William H. Dippert; Cowan, Liebowitz & Latman, P.C.; 1133 Avenue OF The Americas; New York; NY; 10036-6799; US Patent Application Number: 20020138036 Date filed: March 21, 2001 Abstract: An ultrasonic catheter drug delivery device comprises an ultrasound transducer to produce ultrasonic waves, which transducer is mechanically attached to a catheter body or chamber. The ultrasonic transducer has a distal tip with a distal radiation surface, and when a therapeutic agent from a fluid source is directed to the catheter body or chamber, the radiation surface creates ultrasonic pressure and delivers liquid and simultaneously ultrasonic energy to a patient's vascularity or a selected body lumen. The method applies therapeutic agent and ultrasonic waves to the vascular area, lung or any body lumen without requiring direct contact between ultrasound transducer and body, dissolves blood clots, and stimulates tissue cells. Excerpt(s): The present invention generally relates to medical devices and methods. More particularly, the present invention relates to apparatus and methods for the ultrasonically enhanced delivery of therapeutic or contrast agents within the vascular and lung areas or other corporeal lumens. Despite the significant progress of medical technology, vascular and lung diseases, as well as arterial thrombosis (blood clots in arteries), remain frequent, costly and serious problems in health care. Current methods of treatment such as drugs, interventional devices, and/or bypass surgery are usually expensive and not always effective, even sometimes causing additional problems. For example, drugs can also dissolve beneficial clots or interventional devices can injure healthy tissue to cause potentially fatal bleeding complications or to form scarring or cellular growth which may itself eventually become a serious obstruction in, for example, a blood vessel (a process known as restenosis). Ultrasonic energy has been used for enhancing the intravascular delivery of drug, to dissolve clot acoustically, disrupt mechanically and inhibit restenosis. Such energy can be delivered intravascularly using specialized catheters having ultrasonically vibrating surface at or near their distal ends. One type of ultrasonic catheter delivery system uses a wire or other axial transmission element to deliver energy from an ultrasonic energy source, located outside the patient to the internal organs, to desired corporeal lumens. (See, for example, U.S. Pat. Nos. 5,002,059, 5,324,255, 5,345,940, and 5,699,805, each of which is incorporated herein by reference.) Such catheters are rigid and cannot be easily inserted through narrow and tortuous vessels and may cause serious damage to vascular walls. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Vascular protection devices and methods of use Inventor(s): Adams, Daniel O.; (Long Lake, MN), Anderson, Kent D.; (N. Champlin, MN), Kusleika, Richard S.; (Eden Prairie, MN), Oslund, John; (NE. Blaine, MN) Correspondence: Terry L. Wiles; Popovich & Wiles, PA; Ids Center, Suite 1902; 80 South 8th Street; Minneapolis; MN; 55402-2111; US Patent Application Number: 20030171771 Date filed: April 25, 2002
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Abstract: An embolic protection device or system for use in a lumen of a vessel in a patient's vascular system. The device filters debris and blood clots in a body lumen and/or prevents them from moving distally from a treatment site in a vessel and causing emboli. The device may include a filter placed distally of the treatment site. The device may include an occlusive element placed either distally or proximally of the treatment site. Excerpt(s): This application is a continuation-in-part of U.S. patent application Ser. No. 10/093,572 filed Mar. 8, 2002, the disclosure of which is incorporated in its entirety herein by reference. This invention relates to devices used in a blood vessel or other lumen in a patient's body. During vascular surgery or endovascular treatment of vessels including atherectomy, balloon angioplasty, and/or stent deployment, debris such as plaque and blood clots can move from the treatment site through a vein or artery, thus compromising the flow of blood at a location distal from the treatment site. Various distal protection systems have been developed to prevent such debris from embolizing in the vessel. Such distal protection devices include filters and occlusive devices, (e.g., balloons) placed distally of the treatment site. 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 blood clots, 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 “blood clots” (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 blood clots. You can also use this procedure to view pending patent applications concerning blood clots. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.
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CHAPTER 6. BOOKS ON BLOOD CLOTS Overview This chapter provides bibliographic book references relating to blood clots. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on blood clots 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 “blood clots” (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 blood clots: •
Diabetes and Your Heart: Self Care Handbook Source: South Deerfield, MA: Channing L. Bete Co., Inc. 2000. 31 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: $2.73 each; plus shipping and handling; quantity discounts available. Order number 97964. Summary: This illustrated handbook provides people who have type 2 diabetes with information on the relationship between diabetes and heart disease. Higher than normal levels of blood glucose may lead to unhealthy blood lipid levels and increase the risk of blood clots. Cardiovascular disease puts people at increased risk for angina, heart attacks, stroke, and poor blood flow to the extremities. People who have diabetes should focus on their blood glucose level, blood pressure, blood lipids, and body weight. A diabetes health care team can help a person who has diabetes to set goals, learn important skills, and become more informed about diabetes and its management. The
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handbook includes interactive worksheets that show readers how to prevent or control heart disease by encouraging them to monitor their blood glucose and blood pressure, establish and track their lipid profile, develop exercise and healthy eating plans, quit smoking, and monitor their medications. In addition, the handbook offers suggestions for coping with the psychological aspects of living with a chronic illness. The handbook includes a list of organizations that can provide additional information about diabetes and heart disease.
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 “blood clots” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “blood clots” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “blood clots” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •
Air Travel & Blood Clots: Risks and Preventability (Medric Pocket Purse Series) by Robert N. Richards; ISBN: 0969474644; http://www.amazon.com/exec/obidos/ASIN/0969474644/icongroupinterna
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Blood Clots & Strokes: A Guide for Parents & Little Folks by Maureen Andrew (1998); ISBN: 155009064X; http://www.amazon.com/exec/obidos/ASIN/155009064X/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 “blood clots” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:11 •
11
The activation of prothrombin, investigation of the mode of action of human brain thromboplastin and of Russell viper venom. [Tr. by L. James Brown]. Author: Wenckert, Anders.; Year: 1959; Stockholm, 1955
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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Chapters on Blood Clots In order to find chapters that specifically relate to blood clots, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and blood clots 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 “blood clots” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on blood clots: •
Surveillance, Revision, and Outcome of Vascular Access Procedures for Hemodialysis Source: in Wilson, S.E. Vascular Access: Principles and Practice. 4th ed. St. Louis, MO: Mosby, Inc. 2002. p. 149-154. Contact: Available from Elsevier, Health Sciences Division, 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 325-4177. Website: www.us.elsevierhealth.com. PRICE: $99.00. ISBN: 0323011888. Summary: Chronic hemodialysis patients undergo revision of a thrombosed graft or placement of a temporary central venous catheter an average of once a year. This chapter on surveillance, revision, and outcome of vascular access (VA) procedures for hemodialysis (HD) is from a text that reviews the principles and practice of vascular access, including that used for hemodialysis and for critical care, chemotherapy, and nutrition. The authors discuss patency rates, site selection, prediction of access failure, venous return pressure, graft revision and thrombectomy (removal of blood clots), and anticipated outcome. The authors conclude that the goals of establishing and maintaining long term hemodialysis access in end stage renal disease (ESRD) patients have remained elusive. The authors recommend a collaborative effort among the vascular surgeon, interventional radiologists, and dialysis staff that is aimed at standardizing graft surveillance and optimizing function. 1 table. 25 references.
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CHAPTER 7. MULTIMEDIA ON BLOOD CLOTS Overview In this chapter, we show you how to keep current on multimedia sources of information on blood clots. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.
Video Recordings An excellent source of multimedia information on blood clots is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “blood clots” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” Type “blood clots” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on blood clots: •
Bottom Line on Hemorrhoids Source: Madison, WI: University of Wisconsin Hospitals and Clinics, Department of Outreach Education. 1996. (videocassette). Contact: Available from University of Wisconsin Hospital and Clinics. Picture of Health, 702 North Blackhawk Avenue, Suite 215, Madison, WI 53705-3357. (800) 757-4354 or (608) 263-6510. Fax (608) 262-7172. PRICE: $19.95 plus shipping and handling; bulk copies available. Order number 051997A. Summary: Straining when going to the bathroom, constipation, prolonged sitting, and infection can all contribute to hemorrhoids, defined as enlarged veins around the anus. This videotape is one in a series of health promotion programs called 'Picture of Health,' produced by the University of Wisconsin. In this program, moderated by Mary Lee and featuring gastroenterologist John Wyman, the common symptoms, diagnosis, and management of hemorrhoids are covered. Dr. Wyman explains the difference between internal and external hemorrhoids (merely an anatomical distinction), and prolapsed
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hemorrhoids, which are enlarged internal hemorrhoids that drop (prolapse) outside the anus. Symptoms include pain and bleeding; pain because of blood clots and bleeding due to trauma to the thin walled veins in that area. The causes of hemorrhoids include straining during defecation, pregnancy, prolonged sitting, constipation, childbirth, and obesity. Dr. Wyman recommends that anyone over the age of 40 who experiences rectal bleeding should consult a physician; younger people who experience recurrent bleeding should also see their physician (to rule out inflammatory bowel disease). Treatment options for hemorrhoids include changes in habits, such as not straining, not wiping vigorously, softening the stool with dietary changes (usually the addition of dietary fiber), and not prolonging sitting on the toilet. Surgery is used for external hemorrhoids, to remove the veins and tributaries; for internal hemorrhoids, rubber band ligation is very effective. The program also explores the problem of perianal dermatitis, including its risk factors and treatment options (which focus on keeping the area clean and dry, and not using over the counter creams that are petroleum based). The program reiterates the importance of having any rectal bleeding investigated by one's health care provider. The program concludes by referring viewers to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). •
Aging Brain Source: Sacramento, CA: Department of Aging. 1987. (videocassette, 6 handouts and 6 page training manual.). Contact: California Department of Aging, Training and Education Section. 1600 K Street, Sacramento, CA 95814. (916) 322-3110. PRICE: $10.00. Summary: This tape contains seven training segments designed for administrators and staff working in residential facilities for the aged. It reviews commonly held beliefs about aging that may negatively influence the care given to aging residents and how these myths developed. According to the tape, many believe that aged people are naturally "senile". Aged people can either accept this belief and act accordingly, creating a self-fulfilling prophecy in which they relinquish their independence to those caring for them, or they can rebel against their caregivers. Several studies related to aging are reviewed that suggest that there are only minor differences between the mental capacities of the young and aged. Treatable diseases that can affect the aged person's mental abilities are described including drug overdoses, malnutrition, dehydration, blood clots, brain tumors, depression, alcoholism, liver failure, kidney failure, drastic environmental changes, thyroid problems, heart failure, infections, diabetes, constipation, and emphysema. Organic brain syndromes, incurable diseases that affect mental capability, also are reviewed, including multi-infarct dementia, Pick's disease, Creutzfeldt-Jakob disease, Korsakoff's syndrome, Parkinson's disease, and Alzheimer's disease. Specific attention is given to changes in the brain that occur as the disease progresses, the symptoms, and possible risk factors and causes of the disease. Contact points for the Alzheimer's Association are provided for further information.
Bibliography: Multimedia on Blood Clots 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 blood clots (or synonyms). Then, in
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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 blood clots: •
Pulmonary embolectomy for acute pulmonary embolism [motion picture] Source: produced by Biological Film Center, the Methodist Hospital, Houston, Texas; from the Cora and Webb Mading Department of Surgery, Baylor University, College of Medicine; Year: 1961; Format: Motion picture; United States: The Department, [1961]
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CHAPTER 8. PERIODICALS AND NEWS ON BLOOD CLOTS Overview In this chapter, we suggest a number of news sources and present various periodicals that cover blood clots.
News Services and Press Releases One of the simplest ways of tracking press releases on blood clots 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 “blood clots” (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 blood clots. 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 “blood clots” (or synonyms). The following was recently listed in this archive for blood clots: •
Akzo Nobel up after report on anti-blood clot drug Source: Reuters Industry Breifing Date: October 30, 2003
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Agency alerts UK doctors on Cypher stent blood clot risk Source: Reuters Industry Breifing Date: September 09, 2003
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Blood clot victims appeal UK airline decision Source: Reuters Health eLine Date: July 01, 2003
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Blood clot risk not related to low oxygen on planes Source: Reuters Health eLine Date: June 27, 2003
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Memorial for airline blood clot victims held in UK Source: Reuters Health eLine Date: June 02, 2003
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Edwards buys embolic management system Source: Reuters Industry Breifing Date: May 01, 2003
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Leg blood clots linked to clogged neck arteries Source: Reuters Health eLine Date: April 09, 2003
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Less-invasive surgery shrinks blood clots in brain Source: Reuters Health eLine Date: March 20, 2003
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Agenix shares jump as blood clot trial begins Source: Reuters Industry Breifing Date: March 17, 2003
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UK blood clot victims lodge appeal in airline case Source: Reuters Health eLine Date: February 26, 2003
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Preventable embolisms kill thousands in US annually Source: Reuters Medical News Date: February 26, 2003
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Bandage made of blood clotting factor on horizon Source: Reuters Health eLine Date: February 12, 2003
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Airlines accused of hindering key blood clot study Source: Reuters Health eLine Date: January 29, 2003
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UK court set for key ruling on airline blood clots Source: Reuters Health eLine Date: December 20, 2002
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AstraZeneca drug beats Aventis in blood clot trial Source: Reuters Industry Breifing Date: October 28, 2002
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Heart patient relatives have bulkier blood clots Source: Reuters Health eLine Date: September 26, 2002
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Type of fatigue may up potential for blood clots Source: Reuters Health eLine Date: September 25, 2002
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Type of fatigue may increase risk for blood clots Source: Reuters Medical News Date: September 25, 2002 The NIH
Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “blood clots” (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 “blood clots” (or synonyms). If you know the name of a company that is relevant to blood clots, 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 “blood clots” (or synonyms).
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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 “blood clots” (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 blood clots: •
Should You Be Eating More Fat and Fewer Carbohydrates? Source: Tufts University Health and Nutrition Letter. 16(12):1,4,5. February 1999. Contact: Tufts University Health and Nutrition Letter, 53 Park Place, New York, NY 10007. Summary: This article discusses a condition called syndrome X, or hyperinsulinemia, a condition in which the pancreas secretes too much insulin. Therefore, consumption of carbohydrates actually increases the levels of triglycerides, lowers HDL cholesterol, and increases the risk of high blood pressure and blood clots. It is more common in individuals who are overweight, according to the authors. For this reason, the authors stress that individuals should not increase their fat intake. On the contrary, according to experts cited in the article, Americans should reduce their total fat intake, not only saturated fat. The authors list the normal readings for several indicators such as blood pressure, LDL cholesterol, triglycerides, and blood sugar. For those whose readings are not within that normal range, options are suggested. For those with Syndrome X, suggestions are also made for controlling their insulin levels.
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Understanding Antiphospholipid Antibodies Source: Lupus News. 17(1):4-5; Spring 1997. Contact: Lupus Foundation of America, Inc., 1300 Piccard Drive, Suite 200, Rockville, MD 20850. (301) 670-9292. (301) 670-9486 (fax). Summary: This newsletter article for individuals with systemic lupus erythematosus (SLE) presents information on antiphospholipid antibodies (aPL). The discovery of antibodies to phospholipids in individuals with lupus is briefly reviewed. The effect of elevated levels of aPL in the blood is explained, focusing on the formation of blood clots. The article also presents the features defining antiphospholipid syndrome, discusses the paradox between the anticoagulant effects of aPL in the test and the procoagulant effect of aPL in the body, and identifies other diseases in which increased antiphospholipid antibodies may be present.
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Pulmonary Arterial Hypertension in Scleroderma: A New Treatment Source: Scleroderma Voice. Number 2: 9-10,23. 2002. 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
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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. •
Total Hip Replacement: Relieve Pain, Improve Mobility Source: Mayo Clinic Newsletter. April 18, 2003. 7 p. Contact: Available from Mayo Foundation for Medical Education and Research. Website: www.mayoclinic.com. Summary: This newsletter article provides information to patients considering hip replacement surgery. Hip replacements are performed for many reasons including injury, rheumatoid arthritis, avascular necrosis, and osteoarthritis. Weight, bone density, age, and overall health need to be considered before having surgery. Doctors usually recommend that patients be older than 60 years of age, as the replaced joint lasts an average of 15 to 20 years. Patients should discuss the surgical procedure, risks, postsurgery medications, and possible complications of the surgery with their doctor. Patients should also plan for their return home. The surgery itself takes 2 to 3 hours and is performed under general or regional anesthesia. The femoral head of the thighbone is replaced with a metal ball and is attached to a metal stem fitting into the thighbone. Possible complications include dislocation, infection, and blood clots. Some patients may have long-term complications including loosening, breaking the prosthesis, and an inflammatory reaction. It takes approximately 6 to 8 weeks to recover from this surgery and during that time the patient's activities will be limited. After a follow-up with the surgeon to ensure that the hip is healing properly, most patients are able to resume their usual activities.
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Joint Replacement: Help for When Pain Changes Your Lifestyle Source: Mayo Clinic Health Letter. 19(2-Supplement): 1-8. February 2001. Contact: Available from Mayo Clinic Health Letter, 200 First Street SW, Rochester, MN 55905. (800) 333-9037 or (303) 604-1465. Email:
[email protected]. Summary: This newsletter article provides people who have arthritis with information on joint replacement. This type of surgery is used to help people regain physical
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function and eliminate joint pain. Arthritis may damage cartilage and cause joints to become stiff and painful to use. In addition to arthritis, other conditions that damage joints include inflammatory type arthritis conditions, posttraumatic arthritis, osteonecrosis, and certain medical conditions. Different joints present different challenges to surgeons because they have different stresses or loads applied to them. Although the hip and knee are the most commonly replaced joints, implants can also replace joints in the shoulder, elbow, finger, and other locations. The most common reason for joint replacement is pain that limits function. Age and activity level are factors that the patient and doctor should consider. Hip and knee replacement surgeries are usually performed under general anesthesia or special anesthesia that takes away feeling only in the lower part of the body. Hip replacement surgery usually takes 2 to 3 hours, and other types of joint replacement surgeries may take more or less time, depending on the problems that need to be corrected. The length of the hospital stay will depend on the type of joint operation performed, patient age and health status, and any complications. In addition to the usual risks of major surgery and anesthesia, potential complications include infection; blood clots; prosthetic loosening, dislocation, or breakage; excessive wear; and nerve injury. People who undergo joint replacement need to have regular, ongoing followup care. The article also includes sidebars that provide information on types of joints, the history of joint replacement surgery, finger implants, forms of arthritis, types of implant devices, infection prevention, air travel following joint replacement, and sources of additional information. 4 figures. •
Totally Hip: What To Know About and Expect From Hip Replacement Surgery Source: Mayo Clinic Women's HealthSource. 4(11): 4-5. November 2000. Contact: Available from Mayo Clinic Women's HealthSource, 200 First Street SW, Rochester, MN 55905. (800) 876-8633 or (303) 604-1465. Email:
[email protected]. Summary: This newsletter article provides women who need hip replacement surgery with information on this procedure. People who are candidates for this surgery include those who have severe pain resulting from osteoarthritis, rheumatoid arthritis, injury, or bone tumors. A physician may suggest that a patient try other less invasive options before considering hip replacement surgery. If these options fail, surgery may be recommended. The procedure involves removing the head of the femur and the socket, inserting a metal ball and stem into the femur, and placing a cup made of metal and plastic in the socket. The artificial hip is then fixed in place, muscles and tendons are returned to their proper position, and the incision is closed. The article explains postoperative care procedures and highlights possible complications, including infection, hip dislocation, blood clots, prosthetic loosening or breakage, and inflammation. The article also includes precautions that patients should take following surgery. 3 figures.
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Musculoskeletal Aspects of Systemic Lupus Erythematosus (SLE) -Part 2 Source: Lupus News. 19(4): 10-11. Fall 1999. Contact: Available from Lupus Foundation of America. 1300 Piccard Drive, Suite 200, Rockville, MD 20850-4303. (800) 558-0121 or (301) 670-9292. Fax (301) 670-9486. Website: www.lupus.org/lupus. Summary: This newsletter article, the second of two parts, provides health professionals with information on the musculoskeletal aspects of systemic lupus erythematosus (SLE). Besides arthritis, osteonecrosis is the other major skeletal problem in SLE. Osteonecrosis involves the death of bone as a result of loss of blood flow, followed by death of all other
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cellular elements. The condition has four pathological stages. Imaging studies are used to clinically detect osteonecrosis, and five radiologic stages have been established. Although the cause of osteonecrosis in people who have SLE is unknown, the use of high doses of glucocorticosteroids may have a role in its etiology. Other hypothesized but unproven potential factors include an increased tendency for blood clots, fatty emboli, increased pressure inside the joint capsule, increased bone marrow pressure, and swelling inside the bone cavity. Although any joint may be involved, the femoral head is the most common location for osteonecrosis, making the hip the most commonly involved joint. The most commonly recommended procedure to treat osteonecrosis of the femoral head is decompression of the femoral head. Joint replacement is also another option. Fibromyalgia and osteoporosis are two conditions that may co-occur with SLE.
Academic Periodicals covering Blood Clots Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to blood clots. In addition to these sources, you can search for articles covering blood clots that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”
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CHAPTER 9. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.
U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for blood clots. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DI Advice for the Patient can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with blood clots. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The
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following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to blood clots: Anabolic Steroids •
Systemic - U.S. Brands: Anadrol-50; Deca-Durabolin; Durabolin; Durabolin-50; Hybolin Decanoate; Hybolin-Improved; Kabolin; Oxandrin; Winstrol http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202035.html
Anagrelide •
Systemic - U.S. Brands: Agrylin http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203493.html
Anticoagulants •
Systemic - U.S. Brands: Coumadin; Miradon http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202050.html
Ardeparin •
Systemic - U.S. Brands: Normiflo http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203494.html
Ascorbic Acid (Vitamin C) •
Systemic - U.S. Brands: Ascorbicap; Cecon; Cee-500; Cemill; Cenolate; Cetane; Cevi-Bid; Flavorcee; Ortho/CS; Sunkist http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202071.html
Clopidogrel •
Systemic - U.S. Brands: Plavix http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203403.html
Dalteparin •
Systemic - U.S. Brands: Fragmin http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202910.html
Danaparoid •
Systemic - U.S. Brands: Orgaran http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203583.html
Dipyridamole and Aspirin •
Systemic - U.S. Brands: Aggrenox http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500072.html
Dipyridamole Therapeutic •
Systemic - U.S. Brands: Persantine http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202624.html
Enoxaparin •
Systemic - U.S. Brands: Lovenox http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202686.html
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Headache Medicines, Ergot Derivative-Containing •
Systemic - U.S. Brands: Cafergot; Cafertine; Cafetrate; D.H.E. 45; Ercaf; ErgoCaff; Ergomar; Ergostat; Gotamine; Migergot; Wigraine http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202216.html
Heparin •
Systemic - U.S. Brands: Calciparine; Liquaemin http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202280.html
Hepatitis B Vaccine Recombinant •
Systemic - U.S. Brands: Engerix-B http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202281.html
Salicylates •
Systemic - U.S. Brands: Acuprin 81; Amigesic; Anacin Caplets; Anacin Maximum Strength; Anacin Tablets; Anaflex 750; Arthritis Pain Ascriptin; Arthritis Pain Formula; Arthritis Strength Bufferin; Arthropan; Aspergum; Aspirin Regimen Bayer Adult Low Dose; Aspirin Regimen Bayer R http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202515.html
Tenecteplase •
Systemic - U.S. Brands: TNKase http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500145.html
Thrombolytic Agents •
Systemic - U.S. Brands: Abbokinase; Abbokinase Open-Cath; Activase; Eminase; Retavase; Streptase http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202565.html
Ticlopidine •
Systemic - U.S. Brands: Ticlid http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202637.html
Tinzaparin •
Systemic - U.S. Brands: Innohep http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500175.html
Vitamin K •
Systemic - U.S. Brands: Note: http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202599.html
Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.
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Mosby’s Drug Consult Mosby’s Drug Consult database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/. PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html. Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee.
Researching Orphan Drugs Although the list of orphan drugs is revised on a daily basis, you can quickly research orphan drugs that might be applicable to blood clots by using the database managed by the National Organization for Rare Disorders, Inc. (NORD), at http://www.rarediseases.org/. Scroll down the page, and on the left toolbar, click on “Orphan Drug Designation Database.” On this page (http://www.rarediseases.org/search/noddsearch.html), type “blood clots” (or synonyms) into the search box, and click “Submit Query.” When you receive your results, note that not all of the drugs may be relevant, as some may have been withdrawn from orphan status. Write down or print out the name of each drug and the relevant contact information. From there, visit the Pharmacopeia Web site and type the name of each orphan drug into the search box at http://www.nlm.nih.gov/medlineplus/druginformation.html. You may need to contact the sponsor or NORD for further information. NORD conducts “early access programs for investigational new drugs (IND) under the Food and Drug Administration’s (FDA’s) approval ‘Treatment INDs’ programs which allow for a limited number of individuals to receive investigational drugs before FDA marketing approval.” If the orphan product about which you are seeking information is approved for marketing, information on side effects can be found on the product’s label. If the product is not approved, you may need to contact the sponsor. The following is a list of orphan drugs currently listed in the NORD Orphan Drug Designation Database for blood clots: •
Reviparin sodium (trade name: Clivarine) http://www.rarediseases.org/nord/search/nodd_full?code=1200
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Recombinant human atithrombin III http://www.rarediseases.org/nord/search/nodd_full?code=1039
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Reviparin Sodium (trade name: Clivarine) http://www.rarediseases.org/nord/search/nodd_full?code=1124
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Reviparin Sodium (trade name: Clivarine) http://www.rarediseases.org/nord/search/nodd_full?code=1125
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Reviparin sodium (trade name: Clivarine) http://www.rarediseases.org/nord/search/nodd_full?code=1202
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Protein C concentrate (trade name: Protein C Concentrate (human) Vapor Heated, Immuno) http://www.rarediseases.org/nord/search/nodd_full?code=439
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Antithrombin III Concentrate IV (trade name: Kybernin) http://www.rarediseases.org/nord/search/nodd_full?code=662
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Antithrombin III human (trade name: Atnativ) http://www.rarediseases.org/nord/search/nodd_full?code=664
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Antithrombin III (human) (trade name: Thrombate III) http://www.rarediseases.org/nord/search/nodd_full?code=658
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CY-1503 (trade name: Cylexin) http://www.rarediseases.org/nord/search/nodd_full?code=694
If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.
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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
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National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/
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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
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HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html
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NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html
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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
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Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html
The NLM 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 “blood clots” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total
Items Found 2251 56 959 2 0 3268
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 “blood clots” (or synonyms) at the following Web site: http://text.nlm.nih.gov.
15
Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.
16
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). 17 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 18 19
The HSTAT URL is http://hstat.nlm.nih.gov/.
Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.
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Coffee Break: Tutorials for 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/.
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/.
20 Adapted 21
from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.
The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 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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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 blood clots 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 blood clots. 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 blood clots. 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 “blood clots”:
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Other guides Bleeding Disorders http://www.nlm.nih.gov/medlineplus/bleedingdisorders.html Blood Transfusion and Donation http://www.nlm.nih.gov/medlineplus/bloodtransfusionanddonation.html Circulatory Disorders http://www.nlm.nih.gov/medlineplus/circulatorydisorders.html Heart Diseases http://www.nlm.nih.gov/medlineplus/heartdiseases.html Hip Injuries and Disorders http://www.nlm.nih.gov/medlineplus/hipinjuriesanddisorders.html Pulmonary Embolism http://www.nlm.nih.gov/medlineplus/pulmonaryembolism.html Stroke http://www.nlm.nih.gov/medlineplus/stroke.html Thrombophlebitis http://www.nlm.nih.gov/medlineplus/thrombophlebitis.html Traveler's Health http://www.nlm.nih.gov/medlineplus/travelershealth.html Uterine Fibroids http://www.nlm.nih.gov/medlineplus/uterinefibroids.html Varicose Veins http://www.nlm.nih.gov/medlineplus/varicoseveins.html
Within the health topic page dedicated to blood clots, the following was listed: •
General/Overviews JAMA Patient Page: Pulmonary Embolism Source: American Medical Association http://www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZZDQHMZUIC &sub_cat=575 Pulmonary Embolism Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=DS00429 Pulmonary Embolism and Deep Vein Thrombosis http://circ.ahajournals.org/cgi/reprint/106/12/1436.pdf
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Diagnosis/Symptoms Cough: Self-Care Flowcharts Source: American Academy of Family Physicians http://familydoctor.org/flowcharts/516.html
Patient Resources
Radiography -- Chest (Chest X-ray) Source: American College of Radiology, Radiological Society of North America http://www.radiologyinfo.org/content/chest_radiography.htm Shortness of Breath: Self-Care Flowchart Source: American Academy of Family Physicians http://familydoctor.org/flowcharts/521.html Vascular Diseases Diagnosis Source: Society of Interventional Radiology http://www.sirweb.org/patPub/vascularDiagnosis.shtml •
Treatment Pulmonary Thromboendarterectomy for Chronic Pulmonary Embolism Source: Society of Thoracic Surgeons http://www.ctsnet.org/doc/5595 Treatment of Blood Clots http://circ.ahajournals.org/cgi/reprint/106/20/e138.pdf Vascular Diseases Treatments Source: Society of Interventional Radiology http://www.sirweb.org/patPub/vascularTreatments.shtml What Are Anticoagulants and Antiplatelet Agents? Source: American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=84
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Specific Conditions/Aspects Flight-Related Deep Vein Thrombosis (DVT) - “Economy Class Syndrome” Source: National Aeronautics and Space Administration http://ohp.nasa.gov/alerts/dvt.html New Perspective on Deep Vein Thrombosis Source: American Venous Forum http://www.dvt-info.com/education/newpers.html
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Organizations National Heart, Lung, and Blood Institute http://www.nhlbi.nih.gov/
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Prevention/Screening Aspirin: From Pain Relief to Preventive Medicine Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=HQ00269
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Research Comparison of Two Methods of Starting the Anticoagulant Drug Warfarin Source: American College of Physicians http://www.annals.org/cgi/content/full/138/9/I-50
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Detecting Clots in the Lungs Source: American College of Physicians http://www.annals.org/cgi/content/full/138/4/I-58 Excluding Pulmonary Embolism Safely Source: American College of Physicians http://www.annals.org/cgi/content/full/138/12/I-18 How Long Should Blood Thinners Be Given to Patients Who Have Had a Pulmonary Embolism? Source: American College of Physicians http://www.annals.org/cgi/content/full/139/1/I-51 Low Dose Warfarin Prevents Recurrence of Blood Clots - NHLBI Stops Study Source: National Heart, Lung, and Blood Institute http://www.nih.gov/news/pr/feb2003/nhlbi-24.htm You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on blood clots. 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: •
What Chinese-Americans and Their Families Should Know About Lupus Source: New York, NY: Hospital for Special Surgery. 2003. 20 p. Contact: Available from LANtern (Lupus Asian Network) Program. (212) 774-2508. (866) 505-2253 (toll free). PRICE: Single copy free. Summary: This booklet (in both English and Chinese) is written for Chinese-American women with lupus. Chinese American women are twice as likely to contract lupus as white women. This booklet provides information on the symptoms, precautions, and both western and traditional Chinese treatment methods for lupus. Symptoms include a red rash across the nose and cheeks, sensitivity to the sun, mouth or nose sores, pain or swelling in the joints, chest pains, seizures or psychosis, kidney or blood problems, fatigue, hair loss, fever, muscle weakness, blood clots, or recurrent miscarriages. When many of these symptoms occur at once it is called a 'flare'. Symptoms can range from mild to severe. There is no cure for lupus but symptoms can be managed using western medications such as steroids or Cytoxan (prescribed by a rheumatologist) or traditional herbal medicines (prescribed by a Chinese doctor). Other traditional treatments include acupuncture and tai chi. Patients should have their lupus under control for at least 6
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months before attempting to conceive and should be under the care of both a rheumatologist and an obstetrician. Exposure to the sun should be avoided and sunblock and clothing that covers as much of the skin as possible should be worn, even on cloudy days. It is important to express fears and concerns to the doctor and if necessary an interpreter or family member/friend should be brought along on the office visit to help translate. It is important for family members to be supportive and to learn as much about the disease as possible. A list of organizations that can provide information on lupus is included. •
Understanding Transurethral Resection of the Prostate (TURP): Surgery to Relieve Your BPH Symptoms Source: San Bruno, CA: StayWell Company. 1999. 7 p. Contact: Available from Staywell Company. Order Department, 1100 Grundy Lane, San Bruno, CA 94066-9821. (800) 333-3032. Fax (650) 244-4512. PRICE: $1.25 per copy; plus shipping and handling. Order number 11211. Summary: This booklet describes benign prostatic hyperplasia (BPH) and the use of transurethral resection of the prostate (TURP) to treat this condition. The booklet begins with an overview of prostate anatomy and the types of symptoms that may be experienced with BPH. If left untreated, BPH can cause urinary retention (inability to pass urine), urinary tract infections, incontinence (loss of control over the release of urine), damage to the bladder itself, damage to the kidneys, and hematuria (blood in the urine). The booklet then describes the TURP procedure in detail, including preoperative care, the possible risks and complications, what happens during the surgery itself, postoperative care in the hospital, and recovery at home, including followup visits to the physician. The booklet reminds readers of the postoperative symptoms that would necessitate a call to the physician, including inability to urinate, fever over 101 degrees Fahreheit, bleeding that does not stop within 12 hours, severe pain, pain in the testicles or scrotum, or blood clots in the urine. The brochure concludes with a brief list of resource organizations, including the Prostate Health Council and the National Kidney and Urologic Diseases Information Clearinghouse. The brochure is illustrated with full color line drawings. 11 figures.
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Cystoscopy: A Direct Look at Your Bladder and Urethra Source: San Bruno, CA: StayWell Company. 2000. [2 p.]. Contact: Available from Staywell Company. Order Department, 1100 Grundy Lane, San Bruno, CA 94066-9821. (800) 333-3032. Fax (650) 244-4512. PRICE: $0.40 each; $20.00 per pack of 50; plus shipping and handling. Order number 911231. Summary: This brochure describes cystoscopy, a procedure that lets the physician look directly inside the patient's urethra and bladder. Cystoscopy is used to diagnose problems with the urethra, bladder, or kidneys. The procedure can also be used to take a sample (biopsy) of bladder or urethral tissue. The brochure describes the equipment used (cystoscope), preparation, the procedure itself and what the patient can expect, postprocedure care, and when the patient can expect to find out the results of the test. One section reviews the anatomy and physiology of the urinary tract. Cystoscopy is usually done in the doctor's office or hospital; it takes only a few minutes, longer if a biopsy, x ray, or treatment needs to be done. Patients are instructed to contact their physician after the procedure if they have heavy bleeding or blood clots, burning that lasts more than a day, a fever over 101 degrees Fahrenheit, or trouble urinating. The brochure is illustrated with full color illustrations. 6 figures.
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Safer Injection Practice: Reducing the Risk of Injection Drug Use Contact: Positive Health Project Incorporated, 301 W 37 St 2nd Fl, New York, NY, 10016, (212) 465-8304. Summary: This brochure informs injection drug users (IDUs) about how they can prevent bad cuts, abscesses, nerve damage, embolisms, overdoses, collapsed veins, and injection-related diseases. Precautions include using a new set for each injection; never sharing water, ties, cookers, spoons, sets, or points, all of which can pass diseases; and cleaning the injection site with an alcohol-dosed pad before injection. Other suggestions include shooting below the collar bone and above the wrists; not shooting the back of the hands, wrists, legs, neck, groin, eyes, forehead, tongue, or genitals; avoiding arteries by choosing a blood vessel without a pulse; rotating veins to avoid vein calluses, which may cause collapses; and moving shots toward the heart to avoid breaking free existing scabs or blood clots, which may travel to the lungs or heart causing complications or death. The brochure also suggests injecting at a 45 degree angle with the hole in the needle pointing up to lessen tearing to the vein; 'tieing off,' which will raise the vein and slow the flow of blood; and not 'slamming' shots, which may be more pure than the user thought or cut with poisonous substances, thus increasing the chance of overdosing. Instead, IDUs should slowly push the plunger in or do a test shot. A list of services and schedules for needle exchange and support groups is provided.
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Total Joint Replacement Source: Chicago, IL: American Academy of Orthopaedic Surgeons. 1996. 8 p. Contact: Available from American Academy of Orthopaedic Surgeons (AAOS). P.O. Box 75838, Chicago, IL 60675-5838. (800) 626-6726. Fax (for credit card or institutional purchase orders) (800) 823-8025. http://www.aaos.org. PRICE: Single copy free; bulk prices available. Summary: This brochure uses a question and answer format to provide people with arthritis or other conditions with information on total joint replacement. It explains what a joint is and why total joint replacement may be necessary, describes the process of replacing a joint, offers tips on preparing for replacement, and discusses the recovery period. It then identifies possible complications, including infection, blood clots, prosthetic loosening or breakage, dislocation, wear, and nerve injury, and comments on how long a total joint replacement lasts. 2 figures.
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Total Knee Replacement Source: American Academy of Orthopaedic Surgeons. July 2001. 11 p. Contact: American Academy of Orthopedic Surgeons. 6300 North River Road, Rosemont, IL 60018-4262. (800) 346-2267 or (847) 823-7186. Website: http://www.aaos.org. Summary: This fact sheet discusses total knee replacement for patients who have knee damage due to arthritis or disability. The first knee replacement was performed in 1968. Many improvements have been made since then, and now 267,000 total knee replacements are performed in the US each year. The decision to have knee replacement surgery should be made by the patient, family physician, and orthopedic surgeon. Reasons to have knee replacement include knee deformity or stiffness, inability to tolerate medications, moderate to severe pain when the knee is at rest, and ineffectiveness of pain medications. An orthopedic evaluation consists of a medical history, physical exam and x-rays. Knee replacements can last may years although some
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activities may need to be avoided such as jogging and some sport activities. Before surgery the patient should have a medical evaluation, blood work, and other tests. Home planning after the surgery is necessary. The surgical procedure takes about two hours. The surgeon will remove the damaged bone and cartilage and replace it with a metal and plastic joint. There are three components to the replacement joint: the metal femoral component, the plastic tibial component, and the plastic patellar component. After surgery the patient needs to follow the surgeon's instructions to avoid blood clots. Some warning signs of blood clots are the sudden onset of chest pain, shortness of breath, and coughing. Knee replacements are successful in 90 percent of patients, significantly reducing pain and improving the patient's ability to perform activities of daily living. •
Osteoporosis and Raloxifene Source: American Academy of Family Physicians. May 2002. 2 p. Contact: Available online from American Academy of Family Physicians. Website: http://familydoctor.org. Summary: This fact sheet discusses using the drug raloxifene to prevent and treat osteoporosis. Raloxifene is a drug related to estrogen and should only be used by patients after menopause. Raloxifene helps slow bone loss and increases bone growth. It also lowers total and LDL ('bad') cholesterol levels. Side effects include hot flushes, leg cramps, and in rare instances blood clots. Raloxifene should not be used in conjunction with other cholesterol lowering drugs or with estrogen.
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Antiphospholipid Syndrome (APL) Source: Detroit, MI: American Autoimmune Related Diseases Association, Inc. 199x. 2 p. Contact: Available from American Autoimmune Related Diseases Association, Inc. (AARDA). Michigan National Bank Building, 15475 Gratiot Avenue, Detroit, MI 48205. (313) 371-8600. Website: www.aarda.org. PRICE: Single copy free; send self-addressed, stamped envelope. Summary: This fact sheet for people with antiphospholipid (APL) syndrome discusses the affected population, complications, and treatment of this autoimmune syndrome. Although APL antibodies were thought to occur only in patients with lupus, it is now known that they can also constitute a primary syndrome. There is most likely a genetic predisposition , and people most at risk are those with high-titer immunoglobulin G APL antibodies. Patients with these antibodies tend to form blood clots in the legs, brain, and other parts of the body, and they may experience other cardiovascular problems as well. In addition, patients may have false positive test results for syphilis. About 33 percent of patients with lupus have APL antibodies, up to 20 percent of patients with rheumatic arthritis also have them, and 10 to 20 percent of patients with other forms of vasculitis have them as well. The goal of treatment is to prevent problems. Patients with APL antibodies are frequently told to take one baby aspirin a day as a preventive measure. Treatment may also consist of using medications such as antimalarials, blood thinners, or anticoagulants. The fact sheet explains what autoimmunity is, lists other common autoimmune diseases, and outlines the activities of the American Autoimmune Related Diseases Association.
•
Aspirin and Tinnitus Source: London, England: Royal National Institute for Deaf People. 1999. 3 p.
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Contact: Available from RNID Helpline. P.O. Box 16464, London EC1Y 8TT, United Kingdom. 0870 60 50 123. Fax 0171-296 8199. E-mail:
[email protected]. Website: www.rnid.org.uk. Also available from RNID Tinnitus Helpline. Castle Cavendish Works, Norton Street, Radford, Nottingham NG7 5PN, United Kingdom. 0345 090210. Fax 0115-978 5012. E-mail:
[email protected]. PRICE: Single copy free. Summary: This fact sheet from the Royal National Institute for Deaf People (RNID) considers the impact of aspirin on tinnitus (ringing or other noises in the ears). Aspirin has been used for over 80 years as an analgesic to relieve pain, reduce fever, and alleviate arthritis symptoms; it can also help prevent blood clots from forming. Aspirin contains salicylate which temporarily aggravates or causes tinnitus. This effect has been known for many years. Salicylate can cause reversible hearing loss and tinnitus, probably by its action on the outer hair cell system of the cochlea (inner ear). The fact sheet encourages readers to consult their health care providers about any concerns over the impact of aspirin on their tinnitus. The fact sheet discusses the use of aspirin as a treatment for a small number of people with tinnitus who have spontaneous otoacoustic emissions; aspirin may be useful in these cases. The fact sheet concludes with information on the RNID Tinnitus Helpline (in Nottingham, UK), which is also accessible online at
[email protected]. The RIND website is at 5www.rnid.org.uk. •
Questions and Answers About Behcet's Disease Source: Bethesda, MD: National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Information Clearinghouse. 1998. 12 p. Contact: Available from National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Information Clearinghouse. 1 AMS Circle, Bethesda, MD 20892-3675. (877) 226-4267 or (301) 495-4484. Fax (301) 718-6366. TTY (301) 565-2966. E-mail:
[email protected]. Website: www.niams.nih.gov. PRICE: 1 to 25 copies free. Order Number: AR-69 QA (fact sheet), or AR-69L QA (large print). Summary: This fact sheet uses a question and answer format to provide people who have Behcet's disease with information on the cause, symptoms, diagnosis, treatment, and prognosis of this chronic condition that causes sores or ulcers in the mouth and on the genitals as well as inflammation in parts of the eye. This disease is common in the Middle East, Asia, and Japan but rare in the United States. Although the exact cause of Behcet's disease is unknown, most of the symptoms are caused by inflammation of the blood vessels. Factors that are probably important in its development are abnormalities of the immune system and environmental triggers. Symptoms of Behcet's disease vary among patients, but the most common ones are mouth sores, genital sores, inflammation of parts of the eye, and arthritis. The disease may also cause other skin problems, blood clots, and inflammation of the central nervous system. Diagnosis is made on the basis of the patient's symptoms. There are no specific tests for this disease, and the physician must rule out other conditions with similar symptoms. Treatment options include topical medicine; oral medications such as corticosteroids and the immunosuppressive drugs azathioprine, chlorambucil, cyclosporine, and colchicine; and rest and exercise. Most people who have Behcet's disease can lead normal lives and control their symptoms with medication, rest, and exercise. Researchers are exploring possible genetic, bacterial, and viral causes of Behcet's disease and improved treatments for it. The fact sheet includes a list of additional sources of information and a list of key words to help readers understand the terms used.
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Surgery for Stress Urinary Incontinence Source: San Bruno, CA: StayWell Company. 1998. 15 p. Contact: Available from Staywell Company. Order Department, 1100 Grundy Lane, San Bruno, CA 94066-9821. (800) 333-3032. Fax (650) 244-4512. PRICE: $1.35 per copy; plus shipping and handling. Order number 11121. Summary: This patient education booklet reviews the surgical treatment for stress urinary incontinence (SUI). SUI is the problem of leaking urine when there is physical stress (pressure) put on the bladder; this can happen when the patient lifts something heavy, exercises, coughs, sneezes, or laughs, or gets up from a bed or chair. The booklet reviews the anatomy of the pelvis, then discusses preoperative care and preparation, the abdominal surgical procedure, the vaginal surgical procedures, the sling surgical procedure, other problems that may need repair, postoperative recovery in the hospital, and continued recovery at home. The booklet describes in clear, nontechnical language what the patient can expect to happen at each stage of the surgery, including before and after the actual procedure. The booklet lists the risks and possible complications of surgery for SUI, which can include infection; bleeding; the risks of anesthesia; damage to nerves, muscles, or nearby pelvic structures; and blood clots. The booklet reviews other problems that may need repair, including cystocele, uterine prolapse, rectocele, and vaginal vault prolapse. Each surgical procedure is illustrated with simple line drawings. One sidebar lists the postoperative problems that would require a call to the physician. The booklet is illustrated with full color line drawings. 30 figures. 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 “blood clots” (or synonyms). The following was recently posted: •
ACR Appropriateness Criteriaâ„¢ for acute chest pain--suspected pulmonary embolism Source: American College of Radiology - Medical Specialty Society; 1995 (revised 1999); 7 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2381&nbr=1607&a mp;string=emboli
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Antithrombotic therapy for venous thromboembolic disease. In: Sixth ACCP Consensus Conference on Antithrombotic Therapy Source: American College of Chest Physicians - Medical Specialty Society; 2001 January; 18 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2725&nbr=1951&a mp;string=blood+AND+clots
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Clinical policy: critical issues in the evaluation and management of adult patients presenting with suspected pulmonary embolism Source: American College of Emergency Physicians - Medical Specialty Society; 2003 February; 14 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3692&nbr=2918&a mp;string=emboli
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Guidelines on diagnosis and management of acute pulmonary embolism Source: European Society of Cardiology - Medical Specialty Society; 2000 August; 36 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2592&nbr=1818&a mp;string=emboli
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Practice management guidelines for the management of venous thromboembolism in trauma patients Source: Eastern Association for the Surgery of Trauma - Professional Association; 1998 (revised 2001); 63 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3189&nbr=2415&a mp;string=blood+AND+clots
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Practice parameters for the prevention of venous thromboembolism Source: American Society of Colon and Rectal Surgeons - Medical Specialty Society; 2000 August; 11 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2593&nbr=1819&a mp;string=blood+AND+clots
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Prevention of thromboembolism in spinal cord injury Source: Consortium for Spinal Cord Medicine - Private Nonprofit Organization; 1997 February (updated 1999 Sep); 29 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2965&nbr=2191&a mp;string=blood+AND+clots
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Prevention of venous thromboembolism. In: Sixth ACCP Consensus Conference on Antithrombotic Therapy Source: American College of Chest Physicians - Medical Specialty Society; 2001 January; 43 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2724&nbr=1950&a mp;string=blood+AND+clots
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Prophylaxis of venous thromboembolism. A national clinical guideline Source: Scottish Intercollegiate Guidelines Network - National Government Agency [Non-U.S.]; 2002 October; 47 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3485&nbr=2711&a mp;string=blood+AND+clots
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Venous thromboembolism (VTE) Source: University of Michigan Health System - Academic Institution; 1998 June http://www.guideline.gov/summary/summary.aspx?doc_id=1789&nbr=1015&a mp;string=blood+AND+clots Healthfinder™
Healthfinder™ is sponsored by the U.S. Department of Health and Human Services and offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: •
Excessive Blood Clotting (Hypercoagulation) Summary: This consumer health information brochure provides a general overview on blood clotting and includes information about medication. Source: American Academy of Family Physicians http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=4175
•
Thrombolysis, Thrombosis, Thrombus, and Embolus Summary: This web site provides short definitions for the terms thrombolysis, thrombosis and thrombus -- all associated with blood clots. Source: American Heart Association http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=3855 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 blood clots. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html.
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Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •
AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats
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Family Village: http://www.familyvillage.wisc.edu/specific.htm
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Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/
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Med Help International: http://www.medhelp.org/HealthTopics/A.html
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Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/
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Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/
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WebMDHealth: http://my.webmd.com/health_topics
Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to blood clots. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with blood clots. 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 blood clots. 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 “blood clots” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received
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your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “blood clots”. 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 “blood clots” (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 “blood clots” (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/
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Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html
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Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm
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Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp
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Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/
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Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html
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Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/
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Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm
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Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/
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Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html
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Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm
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Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330
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Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)
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National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html
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National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/
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National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/
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Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm
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New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/
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New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm
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New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm
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New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/
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New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html
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New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/
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New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html
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New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/
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Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm
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Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp
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Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/
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Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/
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Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml
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Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html
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Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html
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Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml
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Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp
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Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm
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Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/
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South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp
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Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/
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Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/
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Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72
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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •
ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html
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MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp
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Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/
•
Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html
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On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/
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Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp
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Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm
Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). The NIH suggests the following Web sites in the ADAM Medical Encyclopedia when searching for information on blood clots: •
Basic Guidelines for Blood Clots Blood clots Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001124.htm
•
Nutrition for Blood Clots Fat Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002468.htm
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Background Topics for Blood Clots Necrosis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002266.htm
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Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •
Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical
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MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html
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Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/
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Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine
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BLOOD CLOTS DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abdominal Pain: Sensation of discomfort, distress, or agony in the abdominal region. [NIH] Aberrant: Wandering or deviating from the usual or normal course. [EU] Ablate: In surgery, is to remove. [NIH] Ablation: The removal of an organ by surgery. [NIH] Acatalasia: A rare autosomal recessive disorder resulting from the absence of catalase activity. Though usually asymptomatic, a syndrome of oral ulcerations and gangrene may be present. [NIH] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Acne: A disorder of the skin marked by inflammation of oil glands and hair glands. [NIH] Acoustic: Having to do with sound or hearing. [NIH] Acrylonitrile: A highly poisonous compound used widely in the manufacture of plastics, adhesives and synthetic rubber. [NIH] Actin: Essential component of the cell skeleton. [NIH] Actinin: A protein factor that regulates the length of R-actin. It is chemically similar, but immunochemically distinguishable from actin. [NIH] Activities of Daily Living: The performance of the basic activities of self care, such as dressing, ambulation, eating, etc., in rehabilitation. [NIH] Adaptability: Ability to develop some form of tolerance to conditions extremely different from those under which a living organism evolved. [NIH] Adenocarcinoma: A malignant epithelial tumor with a glandular organization. [NIH] Adhesives: Substances that cause the adherence of two surfaces. They include glues (properly collagen-derived adhesives), mucilages, sticky pastes, gums, resins, or latex. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Adrenal Glands: Paired glands situated in the retroperitoneal tissues at the superior pole of each kidney. [NIH] Adrenal Medulla: The inner part of the adrenal gland; it synthesizes, stores and releases
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catecholamines. [NIH] Adsorption: The condensation of gases, liquids, or dissolved substances on the surfaces of solids. It includes adsorptive phenomena of bacteria and viruses as well as of tissues treated with exogenous drugs and chemicals. [NIH] Adsorptive: It captures volatile compounds by binding them to agents such as activated carbon or adsorptive resins. [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] Aerosol: A solution of a drug which can be atomized into a fine mist for inhalation therapy. [EU]
Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Agar: A complex sulfated polymer of galactose units, extracted from Gelidium cartilagineum, Gracilaria confervoides, and related red algae. It is used as a gel in the preparation of solid culture media for microorganisms, as a bulk laxative, in making emulsions, and as a supporting medium for immunodiffusion and immunoelectrophoresis. [NIH]
Age of Onset: The age or period of life at which a disease or the initial symptoms or manifestations of a disease appear in an individual. [NIH] 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] Agoraphobia: Obsessive, persistent, intense fear of open places. [NIH] Agrin: A protein component of the synaptic basal lamina. It has been shown to induce clustering of acetylcholine receptors on the surface of muscle fibers and other synaptic molecules in both synapse regeneration and development. [NIH] Air Embolism: Occurs when the lungs over expand to the point that air bubbles are forced through the air sacs of the lungs into the circulatory system. [NIH] Air Sacs: Thin-walled sacs or spaces which function as a part of the respiratory system in birds, fishes, insects, and mammals. [NIH] 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,
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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] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Alkylating Agents: Highly reactive chemicals that introduce alkyl radicals into biologically active molecules and thereby prevent their proper functioning. Many are used as antineoplastic agents, but most are very toxic, with carcinogenic, mutagenic, teratogenic, and immunosuppressant actions. They have also been used as components in poison gases. [NIH]
Allograft: An organ or tissue transplant between two humans. [NIH] Alpha Particles: Positively charged particles composed of two protons and two neutrons, i.e., helium nuclei, emitted during disintegration of very heavy isotopes; a beam of alpha particles or an alpha ray has very strong ionizing power, but weak penetrability. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Alveoli: Tiny air sacs at the end of the bronchioles in the lungs. [NIH] Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] 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] Ampulla: A sac-like enlargement of a canal or duct. [NIH] Amputation: Surgery to remove part or all of a limb or appendage. [NIH] Amyloid: A general term for a variety of different proteins that accumulate as extracellular fibrils of 7-10 nm and have common structural features, including a beta-pleated sheet conformation and the ability to bind such dyes as Congo red and thioflavine (Kandel, Schwartz, and Jessel, Principles of Neural Science, 3rd ed). [NIH] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Anal Fissure: A small tear in the anus that may cause itching, pain, or bleeding. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU]
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Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Androgens: A class of sex hormones associated with the development and maintenance of the secondary male sex characteristics, sperm induction, and sexual differentiation. In addition to increasing virility and libido, they also increase nitrogen and water retention and stimulate skeletal growth. [NIH] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] 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] Angiogenesis: Blood vessel formation. Tumor angiogenesis is the growth of blood vessels from surrounding tissue to a solid tumor. This is caused by the release of chemicals by the tumor. [NIH] Angiography: Radiography of blood vessels after injection of a contrast medium. [NIH] Angiopathy: Disease of the blood vessels (arteries, veins, and capillaries) that occurs when someone has diabetes for a long time. There are two types of angiopathy: macroangiopathy and microangiopathy. In macroangiopathy, fat and blood clots build up in the large blood vessels, stick to the vessel walls, and block the flow of blood. In microangiopathy, the walls of the smaller blood vessels become so thick and weak that they bleed, leak protein, and slow the flow of blood through the body. Then the cells, for example, the ones in the center of the eye, do not get enough blood and may be damaged. [NIH] Angioplasty: Endovascular reconstruction of an artery, which may include the removal of atheromatous plaque and/or the endothelial lining as well as simple dilatation. These are procedures performed by catheterization. When reconstruction of an artery is performed surgically, it is called endarterectomy. [NIH] Anions: Negatively charged atoms, radicals or groups of atoms which travel to the anode or positive pole during electrolysis. [NIH] Ankle: That part of the lower limb directly above the foot. [NIH] Anomalies: Birth defects; abnormalities. [NIH] Antagonism: Interference with, or inhibition of, the growth of a living organism by another living organism, due either to creation of unfavorable conditions (e. g. exhaustion of food supplies) or to production of a specific antibiotic substance (e. g. penicillin). [NIH] Anterior chamber: The space in front of the iris and behind the cornea. [NIH] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]
Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibodies, Anticardiolipin: Antiphospholipid antibodies found in association with systemic lupus erythematosus (lupus erythematosus, systemic), antiphospholipid syndrome, and in a variety of other diseases as well as in healthy individuals. The antibodies are detected by solid-phase immunoassay employing the purified phospholipid antigen cardiolipin. [NIH] Antibodies, Antiphospholipid: Autoantibodies directed against phospholipids. These
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antibodies are characteristically found in patients with systemic lupus erythematosus, antiphospholipid syndrome, related autoimmune diseases, some non-autoimmune diseases, and also in healthy individuals. [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] Anticoagulant: A drug that helps prevent blood clots from forming. Also called a blood thinner. [NIH] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Anti-Inflammatory Agents: Substances that reduce or suppress inflammation. [NIH] Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Antioxidants: Naturally occurring or synthetic substances that inhibit or retard the oxidation of a substance to which it is added. They counteract the harmful and damaging effects of oxidation in animal tissues. [NIH] Antiphospholipid Syndrome: The presence of antibodies directed against phospholipids (antibodies, antiphospholipid). The condition is associated with a variety of diseases, notably systemic lupus erythematosus and other connective tissue diseases, thrombopenia, and arterial or venous thromboses. In pregnancy it can cause abortion. Of the phospholipids, the cardiolipins show markedly elevated levels of anticardiolipin antibodies (antibodies, anticardiolipin). Present also are high levels of lupus anticoagulant (lupus coagulation inhibitor). [NIH] Antiplasmin: A member of the serpin superfamily found in human plasma that inhibits the lysis of fibrin clots which are induced by plasminogen activator. It is a glycoprotein, molecular weight approximately 70,000 that migrates in the alpha 2 region in immunoelectrophoresis. It is the principal plasmin inactivator in blood, rapidly forming a very stable complex with plasmin. [NIH] Antithrombins: An endogenous family of proteins belonging to the serpin superfamily that neutralizes the action of thrombin. Six naturally occuring antithrombins have been identified and are designated by Roman numerals I to VI. Of these, Antithrombin I and antithrombin III appear to be of major importance. [NIH] Antithrombotic: Preventing or interfering with the formation of thrombi; an agent that so acts. [EU] Antiviral: Destroying viruses or suppressing their replication. [EU] Anuria: Inability to form or excrete urine. [NIH] Anus: The opening of the rectum to the outside of the body. [NIH] Aorta: The main trunk of the systemic arteries. [NIH] Apolipoproteins: The protein components of lipoproteins which remain after the lipids to
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which the proteins are bound have been removed. They play an important role in lipid transport and metabolism. [NIH] Aqueous: Having to do with water. [NIH] Arachidonic Acid: An unsaturated, essential fatty acid. It is found in animal and human fat as well as in the liver, brain, and glandular organs, and is a constituent of animal phosphatides. It is formed by the synthesis from dietary linoleic acid and is a precursor in the biosynthesis of prostaglandins, thromboxanes, and leukotrienes. [NIH] Arginine: An essential amino acid that is physiologically active in the L-form. [NIH] Aromatic: Having a spicy odour. [EU] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arteriolar: Pertaining to or resembling arterioles. [EU] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Arteriovenous: Both arterial and venous; pertaining to or affecting an artery and a vein. [EU] Arteriovenous Fistula: An abnormal communication between an artery and a vein. [NIH] Articular: Of or pertaining to a joint. [EU] Aspartic: The naturally occurring substance is L-aspartic acid. One of the acidic-amino-acids is obtained by the hydrolysis of proteins. [NIH] Aspartic Endopeptidases: A sub-subclass of endopeptidases that depend on an aspartic acid residue for their activity. EC 3.4.23. [NIH] Aspirate: Fluid withdrawn from a lump, often a cyst, or a nipple. [NIH] Aspiration: The act of inhaling. [NIH] Aspirin: A drug that reduces pain, fever, inflammation, and blood clotting. Aspirin belongs to the family of drugs called nonsteroidal anti-inflammatory agents. It is also being studied in cancer prevention. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [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] Atherectomy: Endovascular procedure in which atheromatous plaque is excised by a cutting or rotating catheter. It differs from balloon and laser angioplasty procedures which enlarge vessels by dilation but frequently do not remove much plaque. If the plaque is removed by surgical excision under general anesthesia rather than by an endovascular procedure through a catheter, it is called endarterectomy. [NIH] Atmospheric Pressure: The pressure at any point in an atmosphere due solely to the weight of the atmospheric gases above the point concerned. [NIH] Atrial: Pertaining to an atrium. [EU] Atrial Fibrillation: Disorder of cardiac rhythm characterized by rapid, irregular atrial impulses and ineffective atrial contractions. [NIH]
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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] Auricular: Pertaining to an auricle or to the ear, and, formerly, to an atrium of the heart. [EU] Autoimmune disease: A condition in which the body recognizes its own tissues as foreign and directs an immune response against them. [NIH] Autoimmunity: Process whereby the immune system reacts against the body's own tissues. Autoimmunity may produce or be caused by autoimmune diseases. [NIH] Autologous: Taken from an individual's own tissues, cells, or DNA. [NIH] Autonomic: Self-controlling; functionally independent. [EU] Axillary: Pertaining to the armpit area, including the lymph nodes that are located there. [NIH]
Axillary Vein: The venous trunk of the upper limb; a continuation of the basilar and brachial veins running from the lower border of the teres major muscle to the outer border of the first rib where it becomes the subclavian vein. [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] Bacterial Infections: Infections by bacteria, general or unspecified. [NIH] Bacteriophage: A virus whose host is a bacterial cell; A virus that exclusively infects bacteria. It generally has a protein coat surrounding the genome (DNA or RNA). One of the coliphages most extensively studied is the lambda phage, which is also one of the most important. [NIH] Bacteriostatic: 1. Inhibiting the growth or multiplication of bacteria. 2. An agent that inhibits the growth or multiplication of bacteria. [EU] Bacterium: Microscopic organism which may have a spherical, rod-like, or spiral unicellular or non-cellular body. Bacteria usually reproduce through asexual processes. [NIH] Balloon Dilatation: Nonoperative repair of occluded vessels, ducts, or valves by insertion of a balloon catheter. It is used, amoung other things, to treat varices, torn retinas, renal and biliary calculi, gastric, bronchial and rectal stenoses, and heart valves, and includes catheterization with Fogarty and Foley catheters. [NIH] Barium: An element of the alkaline earth group of metals. It has an atomic symbol Ba, atomic number 56, and atomic weight 138. All of its acid-soluble salts are poisonous. [NIH] Basal Ganglia: Large subcortical nuclear masses derived from the telencephalon and located in the basal regions of the cerebral hemispheres. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Basement Membrane: Ubiquitous supportive tissue adjacent to epithelium and around smooth and striated muscle cells. This tissue contains intrinsic macromolecular components such as collagen, laminin, and sulfated proteoglycans. As seen by light microscopy one of its subdivisions is the basal (basement) lamina. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]
Benign prostatic hyperplasia: A benign (noncancerous) condition in which an overgrowth
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of prostate tissue pushes against the urethra and the bladder, blocking the flow of urine. Also called benign prostatic hypertrophy or BPH. [NIH] Beta-pleated: Particular three-dimensional pattern of amyloidoses. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bile Ducts: Tubes that carry bile from the liver to the gallbladder for storage and to the small intestine for use in digestion. [NIH] Biliary: Having to do with the liver, bile ducts, and/or gallbladder. [NIH] Bilirubin: A bile pigment that is a degradation product of heme. [NIH] Binding agent: A substance that makes a loose mixture stick together. For example, binding agents can be used to make solid pills from loose powders. [NIH] Bioavailability: The degree to which a drug or other substance becomes available to the target tissue after administration. [EU] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biofilms: Films of bacteria or other microbial organisms, usually embedded in extracellular polymers such as implanted medical devices, which adhere to surfaces submerged in, or subjected to, aquatic environments (From Singleton & Sainsbury, Dictionary of Microbiology and Molecular Biology, 2d ed). Biofilms consist of multilayers of microbial cells glued together to form microbial communities which are highly resistant to both phagocytes and antibiotics. [NIH] Biological therapy: Treatment to stimulate or restore the ability of the immune system to fight infection and disease. Also used to lessen side effects that may be caused by some cancer treatments. Also known as immunotherapy, biotherapy, or biological response modifier (BRM) therapy. [NIH] Biological Transport: The movement of materials (including biochemical substances and drugs) across cell membranes and epithelial layers, usually by passive diffusion. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biosynthesis: The building up of a chemical compound in the physiologic processes of a living organism. [EU] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Bladder: The organ that stores urine. [NIH] Blastocyst: The mammalian embryo in the post-morula stage in which a fluid-filled cavity, enclosed primarily by trophoblast, contains an inner cell mass which becomes the embryonic disc. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood Coagulation Factors: Endogenous substances, usually proteins, that are involved in the blood coagulation process. [NIH]
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Blood Flow Velocity: A value equal to the total volume flow divided by the cross-sectional area of the vascular bed. [NIH] Blood Glucose: Glucose in blood. [NIH] Blood Platelets: Non-nucleated disk-shaped cells formed in the megakaryocyte and found in the blood of all mammals. They are mainly involved in blood coagulation. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Blood Volume: Volume of circulating blood. It is the sum of the plasma volume and erythrocyte volume. [NIH] Blood-Brain Barrier: Specialized non-fenestrated tightly-joined endothelial cells (tight junctions) that form a transport barrier for certain substances between the cerebral capillaries and the brain tissue. [NIH] Blot: To transfer DNA, RNA, or proteins to an immobilizing matrix such as nitrocellulose. [NIH]
Blotting, Western: Identification of proteins or peptides that have been electrophoretically separated by blotting and transferred to strips of nitrocellulose paper. The blots are then detected by radiolabeled antibody probes. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Body Mass Index: One of the anthropometric measures of body mass; it has the highest correlation with skinfold thickness or body density. [NIH] Bone Density: The amount of mineral per square centimeter of bone. This is the definition used in clinical practice. Actual bone density would be expressed in grams per milliliter. It is most frequently measured by photon absorptiometry or x-ray computed tomography. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bone metastases: Cancer that has spread from the original (primary) tumor to the bone. [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] Brain Neoplasms: Neoplasms of the intracranial components of the central nervous system, including the cerebral hemispheres, basal ganglia, hypothalamus, thalamus, brain stem, and cerebellum. Brain neoplasms are subdivided into primary (originating from brain tissue) and secondary (i.e., metastatic) forms. Primary neoplasms are subdivided into benign and malignant forms. In general, brain tumors may also be classified by age of onset, histologic type, or presenting location in the brain. [NIH]
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Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]
Breakdown: A physical, metal, or nervous collapse. [NIH] Broad-spectrum: Effective against a wide range of microorganisms; said of an antibiotic. [EU] 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] Bronchoscopy: Endoscopic examination, therapy or surgery of the bronchi. [NIH] Buccal: Pertaining to or directed toward the cheek. In dental anatomy, used to refer to the buccal surface of a tooth. [EU] 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] Bypass: A surgical procedure in which the doctor creates a new pathway for the flow of body fluids. [NIH] Calcification: Deposits of calcium in the tissues of the breast. Calcification in the breast can be seen on a mammogram, but cannot be detected by touch. There are two types of breast calcification, macrocalcification and microcalcification. Macrocalcifications are large deposits and are usually not related to cancer. Microcalcifications are specks of calcium that may be found in an area of rapidly dividing cells. Many microcalcifications clustered together may be a sign of cancer. [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] Calculi: An abnormal concretion occurring mostly in the urinary and biliary tracts, usually composed of mineral salts. Also called stones. [NIH] Callus: A callosity or hard, thick skin; the bone-like reparative substance that is formed round the edges and fragments of broken bone. [NIH] Capillary: Any one of the minute vessels that connect the arterioles and venules, forming a network in nearly all parts of the body. Their walls act as semipermeable membranes for the interchange of various substances, including fluids, between the blood and tissue fluid; called also vas capillare. [EU] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrates: The largest class of organic compounds, including starches, glycogens,
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cellulose, gums, and simple sugars. Carbohydrates are composed of carbon, hydrogen, and oxygen in a ratio of Cn(H2O)n. [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] Carcinogen: Any substance that causes cancer. [NIH] Cardiac: Having to do with the heart. [NIH] Cardiac catheterization: A procedure in which a thin, hollow tube is inserted into a blood vessel. The tube is then advanced through the vessel into the heart, enabling a physician to study the heart and its pumping activity. [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] Cardiology: The study of the heart, its physiology, and its functions. [NIH] Cardiopulmonary: Having to do with the heart and lungs. [NIH] Cardiopulmonary Bypass: Diversion of the flow of blood from the entrance of the right atrium directly to the aorta (or femoral artery) via an oxygenator thus bypassing both the heart and lungs. [NIH] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cardiovascular System: The heart and the blood vessels by which blood is pumped and circulated through the body. [NIH] Carotid Arteries: Either of the two principal arteries on both sides of the neck that supply blood to the head and neck; each divides into two branches, the internal carotid artery and the external carotid artery. [NIH] Carotid Artery, Internal: Branch of the common carotid artery which supplies the anterior part of the brain, the eye and its appendages, the forehead and nose. [NIH] Carotid Stenosis: The constriction or narrowing of an orifice or the lumen of a hollow or tubular organ. [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] Catabolism: Any destructive metabolic process by which organisms convert substances into excreted compounds. [EU] Catalase: An oxidoreductase that catalyzes the conversion of hydrogen peroxide to water and oxygen. It is present in many animal cells. A deficiency of this enzyme results in acatalasia. EC 1.11.1.6. [NIH] Catheterization: Use or insertion of a tubular device into a duct, blood vessel, hollow organ, or body cavity for injecting or withdrawing fluids for diagnostic or therapeutic purposes. It differs from intubation in that the tube here is used to restore or maintain patency in obstructions. [NIH] Catheters: A small, flexible tube that may be inserted into various parts of the body to inject or remove liquids. [NIH] Cathode: An electrode, usually an incandescent filament of tungsten, which emits electrons in an X-ray tube. [NIH] Cations: Postively charged atoms, radicals or groups of atoms which travel to the cathode or negative pole during electrolysis. [NIH]
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Causal: Pertaining to a cause; directed against a cause. [EU] Cefoperazone: Semisynthetic broad-spectrum cephalosporin with a tetrazolyl moiety that is resistant to beta-lactamase. It has been proposed especially against Pseudomonas infections. [NIH]
Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Adhesion: Adherence of cells to surfaces or to other cells. [NIH] Cell Death: The termination of the cell's ability to carry out vital functions such as metabolism, growth, reproduction, responsiveness, and adaptability. [NIH] Cell Division: The fission of a cell. [NIH] Cell membrane: Cell membrane = plasma membrane. The structure enveloping a cell, enclosing the cytoplasm, and forming a selective permeability barrier; it consists of lipids, proteins, and some carbohydrates, the lipids thought to form a bilayer in which integral proteins are embedded to varying degrees. [EU] Cell proliferation: An increase in the number of cells as a result of cell growth and cell division. [NIH] Cell Respiration: The metabolic process of all living cells (animal and plant) in which oxygen is used to provide a source of energy for the cell. [NIH] Cell Survival: The span of viability of a cell characterized by the capacity to perform certain functions such as metabolism, growth, reproduction, some form of responsiveness, and adaptability. [NIH] Cellulose: A polysaccharide with glucose units linked as in cellobiose. It is the chief constituent of plant fibers, cotton being the purest natural form of the substance. As a raw material, it forms the basis for many derivatives used in chromatography, ion exchange materials, explosives manufacturing, and pharmaceutical preparations. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Central Nervous System Infections: Pathogenic infections of the brain, spinal cord, and meninges. DNA virus infections; RNA virus infections; bacterial infections; mycoplasma infections; Spirochaetales infections; fungal infections; protozoan infections; helminthiasis; and prion diseases may involve the central nervous system as a primary or secondary process. [NIH] Central retinal artery: The blood vessel that carries blood into eye; supplies nutrition to the retina. [NIH] Ceramide: A type of fat produced in the body. It may cause some types of cells to die, and is being studied in cancer treatment. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebral Arteries: The arteries supplying the cerebral cortex. [NIH] Cerebral Hemorrhage: Bleeding into a cerebral hemisphere of the brain, including lobar, subcortical white matter, and basal ganglia hemorrhages. Commonly associated conditions include hypertension; intracranial arteriosclerosis; intracranial aneurysm; craniocerebral trauma; intracranial arteriovenous malformations; cerebral amyloid angiopathy; and cerebral infarction. [NIH] Cerebral Infarction: The formation of an area of necrosis in the cerebrum caused by an insufficiency of arterial or venous blood flow. Infarcts of the cerebrum are generally classified by hemisphere (i.e., left vs. right), lobe (e.g., frontal lobe infarction), arterial
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distribution (e.g., infarction, anterior cerebral artery), and etiology (e.g., embolic infarction). [NIH]
Cerebrospinal: Pertaining to the brain and spinal cord. [EU] Cerebrospinal fluid: CSF. The fluid flowing around the brain and spinal cord. Cerebrospinal fluid is produced in the ventricles in the brain. [NIH] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH] Chemotherapy: Treatment with anticancer drugs. [NIH] Chest cavity: Space in body surrounding the lungs. [NIH] Chest Pain: Pressure, burning, or numbness in the chest. [NIH] Chest wall: The ribs and muscles, bones, and joints that make up the area of the body between the neck and the abdomen. [NIH] Chimeras: Organism that contains a mixture of genetically different cells. [NIH] Chlorambucil: An anticancer drug that belongs to the family of drugs called alkylating agents. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Cholesterol Esters: Fatty acid esters of cholesterol which constitute about two-thirds of the cholesterol in the plasma. The accumulation of cholesterol esters in the arterial intima is a characteristic feature of atherosclerosis. [NIH] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic Obstructive Pulmonary Disease: Collective term for chronic bronchitis and emphysema. [NIH] Chylomicrons: A class of lipoproteins that carry dietary cholesterol and triglycerides from the small intestines to the tissues. [NIH] Chymotrypsin: A serine endopeptidase secreted by the pancreas as its zymogen, chymotrypsinogen and carried in the pancreatic juice to the duodenum where it is activated by trypsin. It selectively cleaves aromatic amino acids on the carboxyl side. [NIH] Ciprofloxacin: A carboxyfluoroquinoline antimicrobial agent that is effective against a wide range of microorganisms. It has been successfully and safely used in the treatment of resistant respiratory, skin, bone, joint, gastrointestinal, urinary, and genital infections. [NIH] 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] Clear cell carcinoma: A rare type of tumor of the female genital tract in which the inside of the cells looks clear when viewed under a microscope. [NIH] Cleave: A double-stranded cut in DNA with a restriction endonuclease. [NIH]
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Clinical Medicine: The study and practice of medicine by direct examination of the patient. [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] Clot Retraction: Retraction of a clot resulting from contraction of platelet pseudopods attached to fibrin strands that is dependent on the contractile protein thrombosthenin. Used as a measure of platelet function. [NIH] Coagulation: 1. The process of clot formation. 2. In colloid chemistry, the solidification of a sol into a gelatinous mass; an alteration of a disperse phase or of a dissolved solid which causes the separation of the system into a liquid phase and an insoluble mass called the clot or curd. Coagulation is usually irreversible. 3. In surgery, the disruption of tissue by physical means to form an amorphous residuum, as in electrocoagulation and photocoagulation. [EU] Cochlea: The part of the internal ear that is concerned with hearing. It forms the anterior part of the labyrinth, is conical, and is placed almost horizontally anterior to the vestibule. [NIH]
Cochlear: Of or pertaining to the cochlea. [EU] Cochlear Diseases: Diseases of the cochlea, the part of the inner ear that is concerned with hearing. [NIH] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Colchicine: A major alkaloid from Colchicum autumnale L. and found also in other Colchicum species. Its primary therapeutic use is in the treatment of gout, but it has been used also in the therapy of familial Mediterranean fever (periodic disease). [NIH] Colitis: Inflammation of the colon. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Collapse: 1. A state of extreme prostration and depression, with failure of circulation. 2. Abnormal falling in of the walls of any part of organ. [EU] Colloidal: Of the nature of a colloid. [EU] Colonoscopy: Endoscopic examination, therapy or surgery of the luminal surface of the colon. [NIH] Combination chemotherapy: Treatment using more than one anticancer drug. [NIH] Combination Therapy: Association of 3 drugs to treat AIDS (AZT + DDC or DDI + protease inhibitor). [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector
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not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Compress: A plug used to occludate an orifice in the control of bleeding, or to mop up secretions; an absorbent pad. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Computed tomography: CT scan. A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized tomography and computerized axial tomography (CAT) scan. [NIH] Computerized axial tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called CAT scan, computed tomography (CT scan), or computerized tomography. [NIH] Computerized tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized axial tomography (CAT) scan and computed tomography (CT scan). [NIH] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the
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formation of a viable zygote. [EU] Cone: One of the special retinal receptor elements which are presumed to be primarily concerned with perception of light and color stimuli when the eye is adapted to light. [NIH] Conjugated: Acting or operating as if joined; simultaneous. [EU] Conjugation: 1. The act of joining together or the state of being conjugated. 2. A sexual process seen in bacteria, ciliate protozoa, and certain fungi in which nuclear material is exchanged during the temporary fusion of two cells (conjugants). In bacterial genetics a form of sexual reproduction in which a donor bacterium (male) contributes some, or all, of its DNA (in the form of a replicated set) to a recipient (female) which then incorporates differing genetic information into its own chromosome by recombination and passes the recombined set on to its progeny by replication. In ciliate protozoa, two conjugants of separate mating types exchange micronuclear material and then separate, each now being a fertilized cell. In certain fungi, the process involves fusion of two gametes, resulting in union of their nuclei and formation of a zygote. 3. In chemistry, the joining together of two compounds to produce another compound, such as the combination of a toxic product with some substance in the body to form a detoxified product, which is then eliminated. [EU] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue Cells: A group of cells that includes fibroblasts, cartilage cells, adipocytes, smooth muscle cells, and bone cells. [NIH] Connective Tissue Diseases: A heterogeneous group of disorders, some hereditary, others acquired, characterized by abnormal structure or function of one or more of the elements of connective tissue, i.e., collagen, elastin, or the mucopolysaccharides. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Constrict: Tighten; narrow. [NIH] Constriction: The act of constricting. [NIH] Consultation: A deliberation between two or more physicians concerning the diagnosis and the proper method of treatment in a case. [NIH] Consumption: Pulmonary tuberculosis. [NIH] Contamination: The soiling or pollution by inferior material, as by the introduction of organisms into a wound, or sewage into a stream. [EU] 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] Contrast Media: Substances used in radiography that allow visualization of certain tissues. [NIH]
Contusion: A bruise; an injury of a part without a break in the skin. [EU] Convalescence: The period of recovery following an illness. [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] Corn Oil: Oil from corn or corn plant. [NIH] Cornea: The transparent part of the eye that covers the iris and the pupil and allows light to
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enter the inside. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Arteriosclerosis: Thickening and loss of elasticity of the coronary arteries. [NIH] Coronary Disease: Disorder of cardiac function due to an imbalance between myocardial function and the capacity of the coronary vessels to supply sufficient flow for normal function. It is a form of myocardial ischemia (insufficient blood supply to the heart muscle) caused by a decreased capacity of the coronary vessels. [NIH] Coronary heart disease: A type of heart disease caused by narrowing of the coronary arteries that feed the heart, which needs a constant supply of oxygen and nutrients carried by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by fat and cholesterol deposits and cannot supply enough blood to the heart, CHD results. [NIH] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Coronary Vessels: The veins and arteries of the heart. [NIH] 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] Corticosteroids: Hormones that have antitumor activity in lymphomas and lymphoid leukemias; in addition, corticosteroids (steroids) may be used for hormone replacement and for the management of some of the complications of cancer and its treatment. [NIH] Cortisol: A steroid hormone secreted by the adrenal cortex as part of the body's response to stress. [NIH] Coumarins: Synthetic or naturally occurring substances related to coumarin, the deltalactone of coumarinic acid. Coumarin itself occurs in the tonka bean. The various coumarins have a wide range of proposed actions and uses including as anticoagulants, pharmaceutical aids, indicators and reagents, photoreactive substances, and antineoplastic agents. [NIH] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Craniocerebral Trauma: Traumatic injuries involving the cranium and intracranial structures (i.e., brain; cranial nerves; meninges; and other structures). Injuries may be classified by whether or not the skull is penetrated (i.e., penetrating vs. nonpenetrating) or whether there is an associated hemorrhage. [NIH] Craniotomy: An operation in which an opening is made in the skull. [NIH] Critical Care: Health care provided to a critically ill patient during a medical emergency or crisis. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Curettage: Removal of tissue with a curette, a spoon-shaped instrument with a sharp edge. [NIH]
Curette: A spoon-shaped instrument with a sharp edge. [NIH] Cutaneous: Having to do with the skin. [NIH] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU]
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Cyclosporine: A drug used to help reduce the risk of rejection of organ and bone marrow transplants by the body. It is also used in clinical trials to make cancer cells more sensitive to anticancer drugs. [NIH] Cyst: A sac or capsule filled with fluid. [NIH] Cysteine: A thiol-containing non-essential amino acid that is oxidized to form cystine. [NIH] Cysteine Endopeptidases: Endopeptidases which have a cysteine involved in the catalytic process. This group of enzymes is inactivated by sulfhydryl reagents. EC 3.4.22. [NIH] Cystine: A covalently linked dimeric nonessential amino acid formed by the oxidation of cysteine. Two molecules of cysteine are joined together by a disulfide bridge to form cystine. [NIH]
Cystocele: Fallen bladder. When the bladder falls or sags from its normal position down to the pelvic floor, it can cause either urinary leakage or urinary retention. [NIH] Cystoscope: A thin, lighted instrument used to look inside the bladder and remove tissue samples or small tumors. [NIH] Cystoscopy: Endoscopic examination, therapy or surgery of the urinary bladder. [NIH] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Cytoskeletal Proteins: Major constituent of the cytoskeleton found in the cytoplasm of eukaryotic cells. They form a flexible framework for the cell, provide attachment points for organelles and formed bodies, and make communication between parts of the cell possible. [NIH]
Cytoskeleton: The network of filaments, tubules, and interconnecting filamentous bridges which give shape, structure, and organization to the cytoplasm. [NIH] Dairy Products: Raw and processed or manufactured milk and milk-derived products. These are usually from cows (bovine) but are also from goats, sheep, reindeer, and water buffalo. [NIH] Dalteparin: A drug that helps prevent the formation of blood clots; it belongs to the family of drugs called anticoagulants. [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] Deamination: The removal of an amino group (NH2) from a chemical compound. [NIH] Decidua: The epithelial lining of the endometrium that is formed before the fertilized ovum reaches the uterus. The fertilized ovum embeds in the decidua. If the ovum is not fertilized, the decidua is shed during menstruation. [NIH] Decompression: Decompression external to the body, most often the slow lessening of external pressure on the whole body (especially in caisson workers, deep sea divers, and persons who ascend to great heights) to prevent decompression sickness. It includes also sudden accidental decompression, but not surgical (local) decompression or decompression applied through body openings. [NIH] Decompression Sickness: A condition occurring as a result of exposure to a rapid fall in ambient pressure. Gases, nitrogen in particular, come out of solution and form bubbles in body fluid and blood. These gas bubbles accumulate in joint spaces and the peripheral circulation impairing tissue oxygenation causing disorientation, severe pain, and potentially
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death. [NIH] Defecation: The normal process of elimination of fecal material from the rectum. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dehydration: The condition that results from excessive loss of body water. [NIH] Delusions: A false belief regarding the self or persons or objects outside the self that persists despite the facts, and is not considered tenable by one's associates. [NIH] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Dental Caries: Localized destruction of the tooth surface initiated by decalcification of the enamel followed by enzymatic lysis of organic structures and leading to cavity formation. If left unchecked, the cavity may penetrate the enamel and dentin and reach the pulp. The three most prominent theories used to explain the etiology of the disase are that acids produced by bacteria lead to decalcification; that micro-organisms destroy the enamel protein; or that keratolytic micro-organisms produce chelates that lead to decalcification. [NIH]
Dental Plaque: A film that attaches to teeth, often causing dental caries and gingivitis. It is composed of mucins, secreted from salivary glands, and microorganisms. [NIH] Dentists: Individuals licensed to practice dentistry. [NIH] Dermatitis: Any inflammation of the skin. [NIH] DES: Diethylstilbestrol. A synthetic hormone that was prescribed from the early 1940s until 1971 to help women with complications of pregnancy. DES has been linked to an increased risk of clear cell carcinoma of the vagina in daughters of women who used DES. DES may also increase the risk of breast cancer in women who used DES. [NIH] Detoxification: Treatment designed to free an addict from his drug habit. [EU] Deuterium: Deuterium. The stable isotope of hydrogen. It has one neutron and one proton in the nucleus. [NIH] Developed Countries: Countries that have reached a level of economic achievement through an increase of production, per capita income and consumption, and utilization of natural and human resources. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diagnostic Imaging: Any visual display of structural or functional patterns of organs or tissues for diagnostic evaluation. It includes measuring physiologic and metabolic responses to physical and chemical stimuli, as well as ultramicroscopy. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Dialyzer: A part of the hemodialysis machine. (See hemodialysis under dialysis.) The dialyzer has two sections separated by a membrane. One section holds dialysate. The other holds the patient's blood. [NIH] Diaphragm: The musculofibrous partition that separates the thoracic cavity from the abdominal cavity. Contraction of the diaphragm increases the volume of the thoracic cavity aiding inspiration. [NIH]
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Diastole: Period of relaxation of the heart, especially the ventricles. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Dietary Fiber: The remnants of plant cell walls that are resistant to digestion by the alimentary enzymes of man. It comprises various polysaccharides and lignins. [NIH] Diffusion: The tendency of a gas or solute to pass from a point of higher pressure or concentration to a point of lower pressure or concentration and to distribute itself throughout the available space; a major mechanism of biological transport. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] 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] Digestive tract: The organs through which food passes when food is eaten. These organs are the mouth, esophagus, stomach, small and large intestines, and rectum. [NIH] Digital rectal examination: DRE. An examination in which a doctor inserts a lubricated, gloved finger into the rectum to feel for abnormalities. [NIH] Dilatation: The act of dilating. [NIH] Dilatation, Pathologic: The condition of an anatomical structure's being dilated beyond normal dimensions. [NIH] Dilate: Relax; expand. [NIH] Dilation: A process by which the pupil is temporarily enlarged with special eye drops (mydriatic); allows the eye care specialist to better view the inside of the eye. [NIH] 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] Dimness: A result of alcohol's toxic effect on the optic nerve. [NIH] Diploid: Having two sets of chromosomes. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Disease Progression: The worsening of a disease over time. This concept is most often used for chronic and incurable diseases where the stage of the disease is an important determinant of therapy and prognosis. [NIH] Dislocation: The displacement of any part, more especially of a bone. Called also luxation. [EU]
Disposition: A tendency either physical or mental toward certain diseases. [EU] Dissection: Cutting up of an organism for study. [NIH] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Drive: A state of internal activity of an organism that is a necessary condition before a given stimulus will elicit a class of responses; e.g., a certain level of hunger (drive) must be present before food will elicit an eating response. [NIH] Drug Delivery Systems: Systems of administering drugs through controlled delivery so that an optimum amount reaches the target site. Drug delivery systems encompass the carrier,
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route, and target. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Duct: A tube through which body fluids pass. [NIH] Duodenum: The first part of the small intestine. [NIH] Dyes: Chemical substances that are used to stain and color other materials. The coloring may or may not be permanent. Dyes can also be used as therapeutic agents and test reagents in medicine and scientific research. [NIH] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Elasticity: Resistance and recovery from distortion of shape. [NIH] Elastin: The protein that gives flexibility to tissues. [NIH] Electrocoagulation: Electrosurgical procedures used to treat hemorrhage (e.g., bleeding ulcers) and to ablate tumors, mucosal lesions, and refractory arrhythmias. [NIH] Electrode: Component of the pacing system which is at the distal end of the lead. It is the interface with living cardiac tissue across which the stimulus is transmitted. [NIH] Electrolysis: Destruction by passage of a galvanic electric current, as in disintegration of a chemical compound in solution. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electron microscope: A microscope (device used to magnify small objects) that uses electrons (instead of light) to produce an enlarged image. An electron microscopes shows tiny details better than any other type of microscope. [NIH] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the latter being a high-energy biproduct of nuclear decay. [NIH] Electrophoresis: An electrochemical process in which macromolecules or colloidal particles with a net electric charge migrate in a solution under the influence of an electric current. [NIH]
Embolectomy: Surgical removal of an obstructing clot or foreign material which has been transported from a distant vessel by the bloodstream. Removal of a clot at its original site is called thrombectomy. [NIH] Emboli: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] Embolism: Blocking of a blood vessel by a blood clot or foreign matter that has been transported from a distant site by the blood stream. [NIH] Embolization: The blocking of an artery by a clot or foreign material. Embolization can be
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done as treatment to block the flow of blood to a tumor. [NIH] 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] Embryogenesis: The process of embryo or embryoid formation, whether by sexual (zygotic) or asexual means. In asexual embryogenesis embryoids arise directly from the explant or on intermediary callus tissue. In some cases they arise from individual cells (somatic cell embryoge). [NIH] Emphysema: A pathological accumulation of air in tissues or organs. [NIH] Emulsify: To convert or to be converted into an emulsion. [EU] Emulsion: A preparation of one liquid distributed in small globules throughout the body of a second liquid. The dispersed liquid is the discontinuous phase, and the dispersion medium is the continuous phase. When oil is the dispersed liquid and an aqueous solution is the continuous phase, it is known as an oil-in-water emulsion, whereas when water or aqueous solution is the dispersed phase and oil or oleaginous substance is the continuous phase, it is known as a water-in-oil emulsion. Pharmaceutical emulsions for which official standards have been promulgated include cod liver oil emulsion, cod liver oil emulsion with malt, liquid petrolatum emulsion, and phenolphthalein in liquid petrolatum emulsion. [EU] Endarterectomy: Surgical excision, performed under general anesthesia, of the atheromatous tunica intima of an artery. When reconstruction of an artery is performed as an endovascular procedure through a catheter, it is called atherectomy. [NIH] Endocarditis: Exudative and proliferative inflammatory alterations of the endocardium, characterized by the presence of vegetations on the surface of the endocardium or in the endocardium itself, and most commonly involving a heart valve, but sometimes affecting the inner lining of the cardiac chambers or the endocardium elsewhere. It may occur as a primary disorder or as a complication of or in association with another disease. [EU] Endocardium: The innermost layer of the heart, comprised of endothelial cells. [NIH] Endometrial: Having to do with the endometrium (the layer of tissue that lines the uterus). [NIH]
Endometrium: The layer of tissue that lines the uterus. [NIH] Endopeptidases: A subclass of peptide hydrolases. They are classified primarily by their catalytic mechanism. Specificity is used only for identification of individual enzymes. They comprise the serine endopeptidases, EC 3.4.21; cysteine endopeptidases, EC 3.4.22; aspartic endopeptidases, EC 3.4.23, metalloendopeptidases, EC 3.4.24; and a group of enzymes yet to be assigned to any of the above sub-classes, EC 3.4.99. EC 3.4.-. [NIH] Endoscope: A thin, lighted tube used to look at tissues inside the body. [NIH] Endoscopic: A technique where a lateral-view endoscope is passed orally to the duodenum for visualization of the ampulla of Vater. [NIH] Endoscopy: Endoscopic examination, therapy or surgery performed on interior parts of the body. [NIH] Endothelial cell: The main type of cell found in the inside lining of blood vessels, lymph vessels, and the heart. [NIH] Endothelium: A layer of epithelium that lines the heart, blood vessels (endothelium, vascular), lymph vessels (endothelium, lymphatic), and the serous cavities of the body. [NIH]
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Endothelium, Lymphatic: Unbroken cellular lining (intima) of the lymph vessels (e.g., the high endothelial lymphatic venules). It is more permeable than vascular endothelium, lacking selective absorption and functioning mainly to remove plasma proteins that have filtered through the capillaries into the tissue spaces. [NIH] Endothelium, Vascular: Single pavement layer of cells which line the luminal surface of the entire vascular system and regulate the transport of macromolecules and blood components from interstitium to lumen; this function has been most intensively studied in the blood capillaries. [NIH] Endotoxin: Toxin from cell walls of bacteria. [NIH] Enteropeptidase: A specialized proteolytic enzyme secreted by intestinal cells. It converts trypsinogen into its active form trypsin by removing the N-terminal peptide. EC 3.4.21.9. [NIH]
Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]
Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Epidemiological: Relating to, or involving epidemiology. [EU] Epidural: The space between the wall of the spinal canal and the covering of the spinal cord. An epidural injection is given into this space. [NIH] 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] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] Epitope: A molecule or portion of a molecule capable of binding to the combining site of an antibody. For every given antigenic determinant, the body can construct a variety of antibody-combining sites, some of which fit almost perfectly, and others which barely fit. [NIH]
Equipment and Supplies: Expendable and nonexpendable equipment, supplies, apparatus, and instruments that are used in diagnostic, surgical, therapeutic, scientific, and experimental procedures. [NIH] Erysipeloid: An infection caused by Erysipelothrix rhusiopathiae that is almost wholly restricted to persons who in their occupation handle infected fish, shellfish, poultry, or meat. Three forms of this condition exist: a mild localized form manifested by local swelling and redness of the skin; a diffuse form that might present with fever; and a rare systemic form associated with endocarditis. [NIH] Erythrocyte Volume: Volume of circulating erythrocytes. It is usually measured by radioisotope dilution technique. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]
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Estrogen: One of the two female sex hormones. [NIH] Eukaryotic Cells: Cells of the higher organisms, containing a true nucleus bounded by a nuclear membrane. [NIH] Euthanasia: The act or practice of putting to death people or animals suffering from incurable conditions or diseases. [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] Excrete: To get rid of waste from the body. [NIH] Exocrine: Secreting outwardly, via a duct. [EU] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Extracellular: Outside a cell or cells. [EU] Extracellular Matrix: A meshwork-like substance found within the extracellular space and in association with the basement membrane of the cell surface. It promotes cellular proliferation and provides a supporting structure to which cells or cell lysates in culture dishes adhere. [NIH] Extracellular Matrix Proteins: Macromolecular organic compounds that contain carbon, hydrogen, oxygen, nitrogen, and usually, sulfur. These macromolecules (proteins) form an intricate meshwork in which cells are embedded to construct tissues. Variations in the relative types of macromolecules and their organization determine the type of extracellular matrix, each adapted to the functional requirements of the tissue. The two main classes of macromolecules that form the extracellular matrix are: glycosaminoglycans, usually linked to proteins (proteoglycans), and fibrous proteins (e.g., collagen, elastin, fibronectins and laminin). [NIH] Extracellular Space: Interstitial space between cells, occupied by fluid as well as amorphous and fibrous substances. [NIH] Extracorporeal: Situated or occurring outside the body. [EU] Extraction: The process or act of pulling or drawing out. [EU] Extravasation: A discharge or escape, as of blood, from a vessel into the tissues. [EU] Extravascular: Situated or occurring outside a vessel or the vessels. [EU] Extremity: A limb; an arm or leg (membrum); sometimes applied specifically to a hand or foot. [EU] 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] Fatal Outcome: Death resulting from the presence of a disease in an individual, as shown by a single case report or a limited number of patients. This should be differentiated from death, the physiological cessation of life and from mortality, an epidemiological or statistical concept. [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]
Fatty acids: A major component of fats that are used by the body for energy and tissue
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development. [NIH] Fecal occult blood test: A test to check for blood in stool. (Fecal refers to stool; occult means hidden.) [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 Artery: The main artery of the thigh, a continuation of the external iliac artery. [NIH] Femoral Vein: The vein accompanying the femoral artery in the same sheath; it is a continuation of the popliteal vein and becomes the external iliac vein. [NIH] Femur: The longest and largest bone of the skeleton, it is situated between the hip and the knee. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibrillation: A small, local, involuntary contraction of muscle, invisible under the skin, resulting from spontaneous activation of single muscle cells or muscle fibres. [EU] Fibrin: A protein derived from fibrinogen in the presence of thrombin, which forms part of the blood clot. [NIH] Fibrinogen: Plasma glycoprotein clotted by thrombin, composed of a dimer of three nonidentical pairs of polypeptide chains (alpha, beta, gamma) held together by disulfide bonds. Fibrinogen clotting is a sol-gel change involving complex molecular arrangements: whereas fibrinogen is cleaved by thrombin to form polypeptides A and B, the proteolytic action of other enzymes yields different fibrinogen degradation products. [NIH] Fibrinolysis: The natural enzymatic dissolution of fibrin. [NIH] Fibrinolytic: Pertaining to, characterized by, or causing the dissolution of fibrin by enzymatic action [EU] Fibrinolytic Agents: Fibrinolysin or agents that convert plasminogen to fibrinolysin (plasmin). [NIH] Fibronectin: An adhesive glycoprotein. One form circulates in plasma, acting as an opsonin; another is a cell-surface protein which mediates cellular adhesive interactions. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Fibula: The bone of the lower leg lateral to and smaller than the tibia. In proportion to its length, it is the most slender of the long bones. [NIH] Filler: An inactive substance used to make a product bigger or easier to handle. For example, fillers are often used to make pills or capsules because the amount of active drug is too small to be handled conveniently. [NIH] 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] Flow Cytometry: Technique using an instrument system for making, processing, and displaying one or more measurements on individual cells obtained from a cell suspension. Cells are usually stained with one or more fluorescent dyes specific to cell components of interest, e.g., DNA, and fluorescence of each cell is measured as it rapidly transverses the excitation beam (laser or mercury arc lamp). Fluorescence provides a quantitative measure
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of various biochemical and biophysical properties of the cell, as well as a basis for cell sorting. Other measurable optical parameters include light absorption and light scattering, the latter being applicable to the measurement of cell size, shape, density, granularity, and stain uptake. [NIH] Fluorine: A nonmetallic, diatomic gas that is a trace element and member of the halogen family. It is used in dentistry as flouride to prevent dental caries. [NIH] Flushing: A transient reddening of the face that may be due to fever, certain drugs, exertion, stress, or a disease process. [NIH] Fold: A plication or doubling of various parts of the body. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Fungi: A kingdom of eukaryotic, heterotrophic organisms that live as saprobes or parasites, including mushrooms, yeasts, smuts, molds, etc. They reproduce either sexually or asexually, and have life cycles that range from simple to complex. Filamentous fungi refer to those that grow as multicelluar colonies (mushrooms and molds). [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gallstones: The solid masses or stones made of cholesterol or bilirubin that form in the gallbladder or bile ducts. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Gangrene: Death and putrefaction of tissue usually due to a loss of blood supply. [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]
Gastritis: Inflammation of the stomach. [EU] Gastroenterologist: A doctor who specializes in diagnosing and treating disorders of the digestive system. [NIH] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gelatin: A product formed from skin, white connective tissue, or bone collagen. It is used as a protein food adjuvant, plasma substitute, hemostatic, suspending agent in pharmaceutical preparations, and in the manufacturing of capsules and suppositories. [NIH] Gels: Colloids with a solid continuous phase and liquid as the dispersed phase; gels may be unstable when, due to temperature or other cause, the solid phase liquifies; the resulting colloid is called a sol. [NIH] Gemcitabine: An anticancer drug that belongs to the family of drugs called antimetabolites. [NIH]
Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]
Gene Targeting: The integration of exogenous DNA into the genome of an organism at sites
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where its expression can be suitably controlled. This integration occurs as a result of homologous recombination. [NIH] Generator: Any system incorporating a fixed parent radionuclide from which is produced a daughter radionuclide which is to be removed by elution or by any other method and used in a radiopharmaceutical. [NIH] Genetic Code: The specifications for how information, stored in nucleic acid sequence (base sequence), is translated into protein sequence (amino acid sequence). The start, stop, and order of amino acids of a protein is specified by consecutive triplets of nucleotides called codons (codon). [NIH] Genetic transcription: The process by which the genetic information encoded in the gene, represented as a linear sequence of deoxyribonucleotides, is copied into an exactly complementary sequence of ribonucleotides known as messenger RNA. [NIH] Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Genital: Pertaining to the genitalia. [EU] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Gestation: The period of development of the young in viviparous animals, from the time of fertilization of the ovum until birth. [EU] Ginseng: An araliaceous genus of plants that contains a number of pharmacologically active agents used as stimulants, sedatives, and tonics, especially in traditional medicine. [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] 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] Glucuronic Acid: Derivatives of uronic acid found throughout the plant and animal kingdoms. They detoxify drugs and toxins by conjugating with them to form glucuronides in the liver which are more water-soluble metabolites that can be easily eliminated from the body. [NIH] Glycerol: A trihydroxy sugar alcohol that is an intermediate in carbohydrate and lipid metabolism. It is used as a solvent, emollient, pharmaceutical agent, and sweetening agent. [NIH]
Glycerophospholipids: Derivatives of phosphatidic acid in which the hydrophobic regions are composed of two fatty acids and a polar alcohol is joined to the C-3 position of glycerol through a phosphodiester bond. They are named according to their polar head groups, such as phosphatidylcholine and phosphatidylethanolamine. [NIH] Glycine: A non-essential amino acid. It is found primarily in gelatin and silk fibroin and used therapeutically as a nutrient. It is also a fast inhibitory neurotransmitter. [NIH] Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Gout: Hereditary metabolic disorder characterized by recurrent acute arthritis, hyperuricemia and deposition of sodium urate in and around the joints, sometimes with
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formation of uric acid calculi. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Gp120: 120-kD HIV envelope glycoprotein which is involved in the binding of the virus to its membrane receptor, the CD4 molecule, found on the surface of certain cells in the body. [NIH]
Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Grafting: The operation of transfer of tissue from one site to another. [NIH] Gram-positive: Retaining the stain or resisting decolorization by alcohol in Gram's method of staining, a primary characteristic of bacteria whose cell wall is composed of a thick layer of peptidologlycan with attached teichoic acids. [EU] Gram-Positive Bacteria: Bacteria which retain the crystal violet stain when treated by Gram's method. [NIH] Granulocytes: Leukocytes with abundant granules in the cytoplasm. They are divided into three groups: neutrophils, eosinophils, and basophils. [NIH] Groin: The external junctural region between the lower part of the abdomen and the thigh. [NIH]
Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Growth factors: Substances made by the body that function to regulate cell division and cell survival. Some growth factors are also produced in the laboratory and used in biological therapy. [NIH] Haematoma: A localized collection of blood, usually clotted, in an organ, space, or tissue, due to a break in the wall of a blood vessel. [EU] Haemorrhage: The escape of blood from the vessels; bleeding. Small haemorrhages are classified according to size as petechiae (very small), purpura (up to 1 cm), and ecchymoses (larger). The massive accumulation of blood within a tissue is called a haematoma. [EU] Haploid: An organism with one basic chromosome set, symbolized by n; the normal condition of gametes in diploids. [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] Health Promotion: Encouraging consumer behaviors most likely to optimize health potentials (physical and psychosocial) through health information, preventive programs, and access to medical care. [NIH] Health Status: The level of health of the individual, group, or population as subjectively assessed by the individual or by more objective measures. [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] Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue,
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breathlessness, and excess fluid accumulation in body tissues. [NIH] Heart Valves: Flaps of tissue that prevent regurgitation of blood from the ventricles to the atria or from the pulmonary arteries or aorta to the ventricles. [NIH] Heartbeat: One complete contraction of the heart. [NIH] Hemarthrosis: Bleeding into the joints. It may arise from trauma or spontaneously in patients with hemophilia. [NIH] Hematoma: An extravasation of blood localized in an organ, space, or tissue. [NIH] Hematuria: Presence of blood in the urine. [NIH] Hemodialysis: The use of a machine to clean wastes from the blood after the kidneys have failed. The blood travels through tubes to a dialyzer, which removes wastes and extra fluid. The cleaned blood then flows through another set of tubes back into the body. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemolytic: A disease that affects the blood and blood vessels. It destroys red blood cells, cells that cause the blood to clot, and the lining of blood vessels. HUS is often caused by the Escherichia coli bacterium in contaminated food. People with HUS may develop acute renal failure. [NIH] Hemoptysis: Bronchial hemorrhage manifested with spitting of blood. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemorrhagic stroke: A disorder involving bleeding within ischemic brain tissue. Hemorrhagic stroke occurs when blood vessels that are damaged or dead from lack of blood supply (infarcted), located within an area of infarcted brain tissue, rupture and transform an "ischemic" stroke into a hemorrhagic stroke. Ischemia is inadequate tissue oxygenation caused by reduced blood flow; infarction is tissue death resulting from ischemia. Bleeding irritates the brain tissues, causing swelling (cerebral edema). Blood collects into a mass (hematoma). Both swelling and hematoma will compress and displace brain tissue. [NIH] Hemorrhoid: An enlarged or swollen blood vessel, usually located near the anus or the rectum. [NIH] Hemostasis: The process which spontaneously arrests the flow of blood from vessels carrying blood under pressure. It is accomplished by contraction of the vessels, adhesion and aggregation of formed blood elements, and the process of blood or plasma coagulation. [NIH]
Heparin: Heparinic acid. A highly acidic mucopolysaccharide formed of equal parts of sulfated D-glucosamine and D-glucuronic acid with sulfaminic bridges. The molecular weight ranges from six to twenty thousand. Heparin occurs in and is obtained from liver, lung, mast cells, etc., of vertebrates. Its function is unknown, but it is used to prevent blood clotting in vivo and vitro, in the form of many different salts. [NIH] Hepatic: Refers to the liver. [NIH] Hepatic Veins: Veins which drain the liver. [NIH]
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Hepatitis: Inflammation of the liver and liver disease involving degenerative or necrotic alterations of hepatocytes. [NIH] Hepatocytes: The main structural component of the liver. They are specialized epithelial cells that are organized into interconnected plates called lobules. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU] Herpes Zoster: Acute vesicular inflammation. [NIH] Heterogeneity: The property of one or more samples or populations which implies that they are not identical in respect of some or all of their parameters, e. g. heterogeneity of variance. [NIH]
High blood cholesterol: Cholesterol is the most abundant steroid in animal tissues, especially in bile and gallstones. The relationship between the intake of cholesterol and its manufacture by the body to its utilization, sequestration, or excretion from the body is called the cholesterol balance. When cholesterol accumulates, the balance is positive; when it declines, the balance is negative. In 1993, the NHLBI National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults issued an updated set of recommendations for monitoring and treatment of blood cholesterol levels. The NCEP guidelines recommended that total cholesterol levels and subfractions of high-density lipoprotein (HDL) cholesterol be measured beginning at age 20 in all adults, with subsequent periodic screenings as needed. Even in the group of patients at lowest risk for coronary heart disease (total cholesterol 200 mg/dL and HDL 35 mg/dL), the NCEP recommended that rescreening take place at least once every 5 years or upon physical examination. [NIH] Histology: The study of tissues and cells under a microscope. [NIH] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Homotypic: Adhesion between neutrophils. [NIH] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hormone Replacement Therapy: Therapeutic use of hormones to alleviate the effects of hormone deficiency. [NIH] Hormone therapy: Treatment of cancer by removing, blocking, or adding hormones. Also called endocrine therapy. [NIH] Host: Any animal that receives a transplanted graft. [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]
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Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrogen Peroxide: A strong oxidizing agent used in aqueous solution as a ripening agent, bleach, and topical anti-infective. It is relatively unstable and solutions deteriorate over time unless stabilized by the addition of acetanilide or similar organic materials. [NIH] Hydrolysis: The process of cleaving a chemical compound by the addition of a molecule of water. [NIH] Hydrophobic: Not readily absorbing water, or being adversely affected by water, as a hydrophobic colloid. [EU] Hydroxylysine: A hydroxylated derivative of the amino acid lysine that is present in certain collagens. [NIH] Hydroxyproline: A hydroxylated form of the imino acid proline. A deficiency in ascorbic acid can result in impaired hydroxyproline formation. [NIH] 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] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Iliac Artery: Either of two large arteries originating from the abdominal aorta; they supply blood to the pelvis, abdominal wall and legs. [NIH] Iliac Vein: A vein on either side of the body which is formed by the union of the external and internal iliac veins and passes upward to join with its fellow of the opposite side to form the inferior vena cava. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]
Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunity: Nonsusceptibility to the invasive or pathogenic microorganisms or to the toxic effect of antigenic substances. [NIH]
effects
of
foreign
Immunoblotting: Immunologic methods for isolating and quantitatively measuring immunoreactive substances. When used with immune reagents such as monoclonal antibodies, the process is known generically as western blot analysis (blotting, western). [NIH]
Immunoelectrophoresis: A technique that combines protein electrophoresis and double immunodiffusion. In this procedure proteins are first separated by gel electrophoresis (usually agarose), then made visible by immunodiffusion of specific antibodies. A distinct elliptical precipitin arc results for each protein detectable by the antisera. [NIH] Immunoglobulin: A protein that acts as an antibody. [NIH] Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large
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amounts of antibody. [NIH] Immunophenotyping: Process of classifying cells of the immune system based on structural and functional differences. The process is commonly used to analyze and sort Tlymphocytes into subsets based on CD antigens by the technique of flow cytometry. [NIH] Immunosuppressive: Describes the ability to lower immune system responses. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU] In situ: In the natural or normal place; confined to the site of origin without invasion of neighbouring tissues. [EU] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incision: A cut made in the body during surgery. [NIH] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Indinavir: A potent and specific HIV protease inhibitor that appears to have good oral bioavailability. [NIH] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]
Inferior vena cava: A large vein that empties into the heart. It carries blood from the legs and feet, and from organs in the abdomen and pelvis. [NIH] Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Inflammatory bowel disease: A general term that refers to the inflammation of the colon and rectum. Inflammatory bowel disease includes ulcerative colitis and Crohn's disease. [NIH]
Infuse: To pour (a liquid) into something. [EU] Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called
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intravenous infusion. [NIH] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH] Inlay: In dentistry, a filling first made to correspond with the form of a dental cavity and then cemented into the cavity. [NIH] Inner ear: The labyrinth, comprising the vestibule, cochlea, and semicircular canals. [NIH] Inorganic: Pertaining to substances not of organic origin. [EU] Insight: The capacity to understand one's own motives, to be aware of one's own psychodynamics, to appreciate the meaning of symbolic behavior. [NIH] Instillation: . [EU] Insulator: Material covering the metal conductor of the lead. It is usually polyurethane or silicone. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Integrins: A family of transmembrane glycoproteins consisting of noncovalent heterodimers. They interact with a wide variety of ligands including extracellular matrix glycoproteins, complement, and other cells, while their intracellular domains interact with the cytoskeleton. The integrins consist of at least three identified families: the cytoadhesin receptors, the leukocyte adhesion receptors, and the very-late-antigen receptors. Each family contains a common beta-subunit combined with one or more distinct alpha-subunits. These receptors participate in cell-matrix and cell-cell adhesion in many physiologically important processes, including embryological development, hemostasis, thrombosis, wound healing, immune and nonimmune defense mechanisms, and oncogenic transformation. [NIH] Intensive Care: Advanced and highly specialized care provided to medical or surgical patients whose conditions are life-threatening and require comprehensive care and constant monitoring. It is usually administered in specially equipped units of a health care facility. [NIH]
Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intracellular: Inside a cell. [NIH] Intracranial Aneurysm: A saclike dilatation of the walls of a blood vessel, usually an artery. [NIH]
Intracranial Arteriosclerosis: Vascular diseases characterized by thickening, hardening, and remodeling of the walls of intracranial arteries. There are three subtypes: (1) atherosclerosis, marked by fatty depositions in the innermost layer of the arterial walls, (2) Monckeberg's sclerosis, which features calcium deposition in the media and (3) arteriolosclerosis, which refers to sclerosis of small caliber arteries. Clinically, this process may be associated with transient ischemic attack, brain infarction, intracranial embolism and thrombosis, or intracranial aneurysm. [NIH] Intracranial Hemorrhages: Bleeding within the intracranial cavity, including hemorrhages in the brain and within the cranial epidural, subdural, and subarachnoid spaces. [NIH]
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Intracranial Hypertension: Increased pressure within the cranial vault. This may result from several conditions, including hydrocephalus; brain edema; intracranial masses; severe systemic hypertension; pseudotumor cerebri; and other disorders. [NIH] Intramuscular: IM. Within or into muscle. [NIH] Intravascular: Within a vessel or vessels. [EU] Intravenous: IV. Into a vein. [NIH] Intravesical: Within the bladder. [NIH] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]
Involuntary: Reaction occurring without intention or volition. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Iris: The most anterior portion of the uveal layer, separating the anterior chamber from the posterior. It consists of two layers - the stroma and the pigmented epithelium. Color of the iris depends on the amount of melanin in the stroma on reflection from the pigmented epithelium. [NIH] Irrigation: The washing of a body cavity or surface by flowing solution which is inserted and then removed. Any drug in the irrigation solution may be absorbed. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Ischemic stroke: A condition in which the blood supply to part of the brain is cut off. Also called "plug-type" strokes. Blocked arteries starve areas of the brain controlling sight, speech, sensation, and movement so that these functions are partially or completely lost. Ischemic stroke is the most common type of stroke, accounting for 80 percent of all strokes. Most ischemic strokes are caused by a blood clot called a thrombus, which blocks blood flow in the arteries feeding the brain, usually the carotid artery in the neck, the major vessel bringing blood to the brain. When it becomes blocked, the risk of stroke is very high. [NIH] Islet: Cell producing insulin in pancreas. [NIH] Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Joint Capsule: The sac enclosing a joint. It is composed of an outer fibrous articular capsule and an inner synovial membrane. [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] Kidney Failure: The inability of a kidney to excrete metabolites at normal plasma levels under conditions of normal loading, or the inability to retain electrolytes under conditions of normal intake. In the acute form (kidney failure, acute), it is marked by uremia and usually by oliguria or anuria, with hyperkalemia and pulmonary edema. The chronic form (kidney failure, chronic) is irreversible and requires hemodialysis. [NIH] Kidney Failure, Acute: A clinical syndrome characterized by a sudden decrease in glomerular filtration rate, often to values of less than 1 to 2 ml per minute. It is usually associated with oliguria (urine volumes of less than 400 ml per day) and is always associated with biochemical consequences of the reduction in glomerular filtration rate such as a rise in blood urea nitrogen (BUN) and serum creatinine concentrations. [NIH]
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Kidney Failure, Chronic: An irreversible and usually progressive reduction in renal function in which both kidneys have been damaged by a variety of diseases to the extent that they are unable to adequately remove the metabolic products from the blood and regulate the body's electrolyte composition and acid-base balance. Chronic kidney failure requires hemodialysis or surgery, usually kidney transplantation. [NIH] Kinetic: Pertaining to or producing motion. [EU] Kringles: Triple-looped protein domains linked by disulfide bonds. These common structural domains, so-named for their resemblance to Danish pastries known as kringlers, play a role in binding membranes, proteins, and phospholipids as well as in regulating proteolysis. Kringles are also present in coagulation-related and fibrinolytic proteins and other plasma proteinases. [NIH] Labyrinth: The internal ear; the essential part of the organ of hearing. It consists of an osseous and a membranous portion. [NIH] Laparoscopy: Examination, therapy or surgery of the abdomen's interior by means of a laparoscope. [NIH] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Latent: Phoria which occurs at one distance or another and which usually has no troublesome effect. [NIH] Leprosy: A chronic granulomatous infection caused by Mycobacterium leprae. The granulomatous lesions are manifested in the skin, the mucous membranes, and the peripheral nerves. Two polar or principal types are lepromatous and tuberculoid. [NIH] Lesion: An area of abnormal tissue change. [NIH] Lethal: Deadly, fatal. [EU] Lethargy: Abnormal drowsiness or stupor; a condition of indifference. [EU] Leukemia: Cancer of blood-forming tissue. [NIH] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Levofloxacin: A substance used to treat bacterial infections. It belongs to the family of drugs called quinolone antibiotics. [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] Ligation: Application of a ligature to tie a vessel or strangulate a part. [NIH] Light microscope: A microscope (device to magnify small objects) in which objects are lit directly by white light. [NIH] Linkages: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Lipid: Fat. [NIH] Lipoprotein: Any of the lipid-protein complexes in which lipids are transported in the blood; lipoprotein particles consist of a spherical hydrophobic core of triglycerides or
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cholesterol esters surrounded by an amphipathic monolayer of phospholipids, cholesterol, and apolipoproteins; the four principal classes are high-density, low-density, and very-lowdensity lipoproteins and chylomicrons. [EU] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Liver 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] Locomotion: Movement or the ability to move from one place or another. It can refer to humans, vertebrate or invertebrate animals, and microorganisms. [NIH] Longitudinal Studies: Studies in which variables relating to an individual or group of individuals are assessed over a period of time. [NIH] Loop: A wire usually of platinum bent at one end into a small loop (usually 4 mm inside diameter) and used in transferring microorganisms. [NIH] Low-density lipoprotein: Lipoprotein that contains most of the cholesterol in the blood. LDL carries cholesterol to the tissues of the body, including the arteries. A high level of LDL increases the risk of heart disease. LDL typically contains 60 to 70 percent of the total serum cholesterol and both are directly correlated with CHD risk. [NIH] Lubricants: Oily or slippery substances. [NIH] Lumen: The cavity or channel within a tube or tubular organ. [EU] Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [NIH] Luxation: The displacement of the particular surface of a bone from its normal joint, without fracture. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]
Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphatic system: The tissues and organs that produce, store, and carry white blood cells that fight infection and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes and a network of thin tubes that carry lymph and white blood cells. These tubes branch, like blood vessels, into all the tissues of the body. [NIH] Lymphocyte: A white blood cell. Lymphocytes have a number of roles in the immune system, including the production of antibodies and other substances that fight infection and diseases. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Lysine: An essential amino acid. It is often added to animal feed. [NIH] Lytic: 1. Pertaining to lysis or to a lysin. 2. Producing lysis. [EU] Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy
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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] Malabsorption: Impaired intestinal absorption of nutrients. [EU] Malabsorption syndrome: A group of symptoms such as gas, bloating, abdominal pain, and diarrhea resulting from the body's inability to properly absorb nutrients. [NIH] Malformation: A morphologic developmental process. [EU]
defect
resulting
from
an
intrinsically
abnormal
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] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]
Mammary: Pertaining to the mamma, or breast. [EU] Mammogram: An x-ray of the breast. [NIH] Manic: Affected with mania. [EU] Manic-depressive psychosis: One of a group of psychotic reactions, fundamentally marked by severe mood swings and a tendency to remission and recurrence. [NIH] Manifest: Being the part or aspect of a phenomenon that is directly observable : concretely expressed in behaviour. [EU] Man-made: Ionizing radiation emitted by artificial or concentrated natural, radioactive material or resulting from the operation of high voltage apparatus, such as X-ray apparatus or particle accelerators, of nuclear reactors, or from nuclear explosions. [NIH] Matrix metalloproteinase: A member of a group of enzymes that can break down proteins, such as collagen, that are normally found in the spaces between cells in tissues (i.e., extracellular matrix proteins). Because these enzymes need zinc or calcium atoms to work properly, they are called metalloproteinases. Matrix metalloproteinases are involved in wound healing, angiogenesis, and tumor cell metastasis. [NIH] Meat: The edible portions of any animal used for food including domestic mammals (the major ones being cattle, swine, and sheep) along with poultry, fish, shellfish, and game. [NIH]
Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Megestrol: 17-Hydroxy-6-methylpregna-3,6-diene-3,20-dione. A progestational hormone used most commonly as the acetate ester. As the acetate, it is more potent than progesterone both as a progestagen and as an ovulation inhibitor. It has also been used in the palliative treatment of breast cancer. [NIH] Megestrol Acetate: A drug that belongs to the group of hormones called progestins, used as hormone therapy to block estrogen and to suppress the effects of estrogen and androgens.
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[NIH]
Melanin: The substance that gives the skin its color. [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] Menstruation: The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus. [NIH] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mesenteric: Pertaining to the mesentery : a membranous fold attaching various organs to the body wall. [EU] Metalloendopeptidases: Endopeptidases which use a metal, normally zinc, in the catalytic mechanism. This group of enzymes is inactivated by metal chelators. EC 3.4.24. [NIH] Metastasis: The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors" and contain cells that are like those in the original (primary) tumor. The plural is metastases. [NIH] Metastatic: Having to do with metastasis, which is the spread of cancer from one part of the body to another. [NIH] 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] Microcalcifications: Tiny deposits of calcium in the breast that cannot be felt but can be detected on a mammogram. A cluster of these very small specks of calcium may indicate that cancer is present. [NIH] Microorganism: An organism that can be seen only through a microscope. Microorganisms include bacteria, protozoa, algae, and fungi. Although viruses are not considered living organisms, they are sometimes classified as microorganisms. [NIH] Microsurgery: Surgical procedures on the cellular level; a light microscope and miniaturized instruments are used. [NIH] Microtubules: Slender, cylindrical filaments found in the cytoskeleton of plant and animal cells. They are composed of the protein tubulin. [NIH] Migration: The systematic movement of genes between populations of the same species, geographic race, or variety. [NIH] Milliliter: A measure of volume for a liquid. A milliliter is approximately 950-times smaller than a quart and 30-times smaller than a fluid ounce. A milliliter of liquid and a cubic centimeter (cc) of liquid are the same. [NIH] Mitochondria: Parts of a cell where aerobic production (also known as cell respiration) takes place. [NIH] Mitochondrial Swelling: Increase in volume of mitochondria due to an influx of fluid; it
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occurs in hypotonic solutions due to osmotic pressure and in isotonic solutions as a result of altered permeability of the membranes of respiring mitochondria. [NIH] Mitotic: Cell resulting from mitosis. [NIH] Mitral Valve: The valve between the left atrium and left ventricle of the heart. [NIH] Modeling: A treatment procedure whereby the therapist presents the target behavior which the learner is to imitate and make part of his repertoire. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monoclonal: An antibody produced by culturing a single type of cell. It therefore consists of a single species of immunoglobulin molecules. [NIH] Monoclonal antibodies: Laboratory-produced substances that can locate and bind to cancer cells wherever they are in the body. Many monoclonal antibodies are used in cancer detection or therapy; each one recognizes a different protein on certain cancer cells. Monoclonal antibodies can be used alone, or they can be used to deliver drugs, toxins, or radioactive material directly to a tumor. [NIH] Morphogenesis: The development of the form of an organ, part of the body, or organism. [NIH]
Motility: The ability to move spontaneously. [EU] Mucins: A secretion containing mucopolysaccharides and protein that is the chief constituent of mucus. [NIH] Mucosa: A mucous membrane, or tunica mucosa. [EU] Mucus: The viscous secretion of mucous membranes. It contains mucin, white blood cells, water, inorganic salts, and exfoliated cells. [NIH] Multiple sclerosis: A disorder of the central nervous system marked by weakness, numbness, a loss of muscle coordination, and problems with vision, speech, and bladder control. Multiple sclerosis is thought to be an autoimmune disease in which the body's immune system destroys myelin. Myelin is a substance that contains both protein and fat (lipid) and serves as a nerve insulator and helps in the transmission of nerve signals. [NIH] Muscle Fibers: Large single cells, either cylindrical or prismatic in shape, that form the basic unit of muscle tissue. They consist of a soft contractile substance enclosed in a tubular sheath. [NIH] 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
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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] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [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] Neurosis: Functional derangement due to disorders of the nervous system which does not affect the psychic personality of the patient. [NIH] Neurotoxin: A substance that is poisonous to nerve tissue. [NIH] Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light hydrogen; the mass is equal to that of the proton and electron combined and they are unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal, and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier nuclei during their decay. [NIH] Neutrophil: A type of white blood cell. [NIH] Nickel: A trace element with the atomic symbol Ni, atomic number 28, and atomic weight 58.69. It is a cofactor of the enzyme urease. [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] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH]
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Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the next. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Occult: Obscure; concealed from observation, difficult to understand. [EU] Occult Blood: Chemical, spectroscopic, or microscopic detection of extremely small amounts of blood. [NIH] Ocular: 1. Of, pertaining to, or affecting the eye. 2. Eyepiece. [EU] Ointments: Semisolid preparations used topically for protective emollient effects or as a vehicle for local administration of medications. Ointment bases are various mixtures of fats, waxes, animal and plant oils and solid and liquid hydrocarbons. [NIH] Oliguria: Clinical manifestation of the urinary system consisting of a decrease in the amount of urine secreted. [NIH] Omega-3 fatty acid: A type of fat obtained in the diet and involved in immunity. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH] Operon: The genetic unit consisting of a feedback system under the control of an operator gene, in which a structural gene transcribes its message in the form of mRNA upon blockade of a repressor produced by a regulator gene. Included here is the attenuator site of bacterial operons where transcription termination is regulated. [NIH] Optic Nerve: The 2nd cranial nerve. The optic nerve conveys visual information from the retina to the brain. The nerve carries the axons of the retinal ganglion cells which sort at the optic chiasm and continue via the optic tracts to the brain. The largest projection is to the lateral geniculate nuclei; other important targets include the superior colliculi and the suprachiasmatic nuclei. Though known as the second cranial nerve, it is considered part of the central nervous system. [NIH] Oral Health: The optimal state of the mouth and normal functioning of the organs of the mouth without evidence of disease. [NIH] Organelles: Specific particles of membrane-bound organized living substances present in eukaryotic cells, such as the mitochondria; the golgi apparatus; endoplasmic reticulum; lysomomes; plastids; and vacuoles. [NIH] Osmosis: Tendency of fluids (e.g., water) to move from the less concentrated to the more concentrated side of a semipermeable membrane. [NIH] Osmotic: Pertaining to or of the nature of osmosis (= the passage of pure solvent from a solution of lesser to one of greater solute concentration when the two solutions are separated by a membrane which selectively prevents the passage of solute molecules, but is permeable to the solvent). [EU] Osteoarthritis: A progressive, degenerative joint disease, the most common form of arthritis, especially in older persons. The disease is thought to result not from the aging process but from biochemical changes and biomechanical stresses affecting articular cartilage. In the foreign literature it is often called osteoarthrosis deformans. [NIH] Osteonecrosis: Death of a bone or part of a bone, either atraumatic or posttraumatic. [NIH] Osteoporosis: Reduction of bone mass without alteration in the composition of bone, leading to fractures. Primary osteoporosis can be of two major types: postmenopausal osteoporosis and age-related (or senile) osteoporosis. [NIH]
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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] Overweight: An excess of body weight but not necessarily body fat; a body mass index of 25 to 29.9 kg/m2. [NIH] Ovulation: The discharge of a secondary oocyte from a ruptured graafian follicle. [NIH] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]
Oxygenation: The process of supplying, treating, or mixing with oxygen. No:1245 oxygenation the process of supplying, treating, or mixing with oxygen. [EU] Oxygenator: An apparatus by which oxygen is introduced into the blood during circulation outside the body, as during open heart surgery. [NIH] Pacer: Device that delivers battery-supplied electrical stimuli over leads with electrodes in contact with the heart. Virtually all leads are inserted transvenously. Electronic circuitry regulates the timing and characteristics of the stimuli. [NIH] Paclitaxel: Antineoplastic agent isolated from the bark of the Pacific yew tree, Taxus brevifolia. Paclitaxel stabilizes microtubules in their polymerized form and thus mimics the action of the proto-oncogene proteins c-mos. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Pancreatic: Having to do with the pancreas. [NIH] Pancreatic cancer: Cancer of the pancreas, a salivary gland of the abdomen. [NIH] Pancreatic Juice: The fluid containing digestive enzymes secreted by the pancreas in response to food in the duodenum. [NIH] Paraffin: A mixture of solid hydrocarbons obtained from petroleum. It has a wide range of uses including as a stiffening agent in ointments, as a lubricant, and as a topical antiinflammatory. It is also commonly used as an embedding material in histology. [NIH] Paralysis: Loss of ability to move all or part of the body. [NIH] Parasite: An animal or a plant that lives on or in an organism of another species and gets at least some of its nutrition from that other organism. [NIH] Parasitic: Having to do with or being a parasite. A parasite is an animal or a plant that lives on or in an organism of another species and gets at least some of its nutrients from it. [NIH] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Parenteral Nutrition: The administering of nutrients for assimilation and utilization by a patient who cannot maintain adequate nutrition by enteral feeding alone. Nutrients are administered by a route other than the alimentary canal (e.g., intravenously, subcutaneously). [NIH] Parietal: 1. Of or pertaining to the walls of a cavity. 2. Pertaining to or located near the
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parietal bone, as the parietal lobe. [EU] Particle: A tiny mass of material. [EU] Particle Accelerators: Devices which accelerate electrically charged atomic or subatomic particles, such as electrons, protons or ions, to high velocities so they have high kinetic energy. [NIH] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]
Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]
Pelvic: Pertaining to the pelvis. [EU] Penicillin: An antibiotic drug used to treat infection. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Peptide Hydrolases: A subclass of enzymes from the hydrolase class that catalyze the hydrolysis of peptide bonds. Exopeptidases and endopeptidases make up the sub-subclasses for this group. EC 3.4. [NIH] Peptide T: N-(N-(N(2)-(N-(N-(N-(N-D-Alanyl L-seryl)-L-threonyl)-L-threonyl) L-threonyl)L-asparaginyl)-L-tyrosyl) L-threonine. Octapeptide sharing sequence homology with HIV envelope protein gp120. It is potentially useful as antiviral agent in AIDS therapy. The core pentapeptide sequence, TTNYT, consisting of amino acids 4-8 in peptide T, is the HIV envelope sequence required for attachment to the CD4 receptor. [NIH] Perception: The ability quickly and accurately to recognize similarities and differences among presented objects, whether these be pairs of words, pairs of number series, or multiple sets of these or other symbols such as geometric figures. [NIH] Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] Perfusion: Bathing an organ or tissue with a fluid. In regional perfusion, a specific area of the body (usually an arm or a leg) receives high doses of anticancer drugs through a blood vessel. Such a procedure is performed to treat cancer that has not spread. [NIH] Perianal: Located around the anus. [EU] Pericardium: The fibroserous sac surrounding the heart and the roots of the great vessels. [NIH]
Periodontal disease: Disease involving the supporting structures of the teeth (as the gums and periodontal membranes). [NIH] Periodontist: A specialist in the treatment of diseases of the gums. [NIH] Peripheral blood: Blood circulating throughout the body. [NIH] Peripheral Nerves: The nerves outside of the brain and spinal cord, including the autonomic, cranial, and spinal nerves. Peripheral nerves contain non-neuronal cells and connective tissue as well as axons. The connective tissue layers include, from the outside to the inside, the epineurium, the perineurium, and the endoneurium. [NIH] Peritoneal: Having to do with the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH]
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Peritoneal Cavity: The space enclosed by the peritoneum. It is divided into two portions, the greater sac and the lesser sac or omental bursa, which lies behind the stomach. The two sacs are connected by the foramen of Winslow, or epiploic foramen. [NIH] Peritoneal Dialysis: Dialysis fluid being introduced into and removed from the peritoneal cavity as either a continuous or an intermittent procedure. [NIH] Peritoneum: Endothelial lining of the abdominal cavity, the parietal peritoneum covering the inside of the abdominal wall and the visceral peritoneum covering the bowel, the mesentery, and certain of the organs. The portion that covers the bowel becomes the serosal layer of the bowel wall. [NIH] Peritonitis: Inflammation of the peritoneum; a condition marked by exudations in the peritoneum of serum, fibrin, cells, and pus. It is attended by abdominal pain and tenderness, constipation, vomiting, and moderate fever. [EU] Petechiae: Pinpoint, unraised, round red spots under the skin caused by bleeding. [NIH] 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] Pharmaceutical Preparations: Drugs intended for human or veterinary use, presented in their finished dosage form. Included here are materials used in the preparation and/or formulation of the finished dosage form. [NIH] Pharmacodynamic: Is concerned with the response of living tissues to chemical stimuli, that is, the action of drugs on the living organism in the absence of disease. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phenylalanine: An aromatic amino acid that is essential in the animal diet. It is a precursor of melanin, dopamine, noradrenalin, and thyroxine. [NIH] Phlebitis: Inflammation of a vein. [NIH] Phobia: A persistent, irrational, intense fear of a specific object, activity, or situation (the phobic stimulus), fear that is recognized as being excessive or unreasonable by the individual himself. When a phobia is a significant source of distress or interferes with social functioning, it is considered a mental disorder; phobic disorder (or neurosis). In DSM III phobic disorders are subclassified as agoraphobia, social phobias, and simple phobias. Used as a word termination denoting irrational fear of or aversion to the subject indicated by the stem to which it is affixed. [EU] Phobic Disorders: Anxiety disorders in which the essential feature is persistent and irrational fear of a specific object, activity, or situation that the individual feels compelled to avoid. The individual recognizes the fear as excessive or unreasonable. [NIH] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH]
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Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Phosphorylation: The introduction of a phosphoryl group into a compound through the formation of an ester bond between the compound and a phosphorus moiety. [NIH] Photocoagulation: Using a special strong beam of light (laser) to seal off bleeding blood vessels such as in the eye. The laser can also burn away blood vessels that should not have grown in the eye. This is the main treatment for diabetic retinopathy. [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physical Therapy: The restoration of function and the prevention of disability following disease or injury with the use of light, heat, cold, water, electricity, ultrasound, and exercise. [NIH]
Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]
Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pilot study: The initial study examining a new method or treatment. [NIH] Placenta: A highly vascular fetal organ through which the fetus absorbs oxygen and other nutrients and excretes carbon dioxide and other wastes. It begins to form about the eighth day of gestation when the blastocyst adheres to the decidua. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plaque: A clear zone in a bacterial culture grown on an agar plate caused by localized destruction of bacterial cells by a bacteriophage. The concentration of infective virus in a fluid can be estimated by applying the fluid to a culture and counting the number of. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma cells: A type of white blood cell that produces antibodies. [NIH] Plasma protein: One of the hundreds of different proteins present in blood plasma, including carrier proteins ( such albumin, transferrin, and haptoglobin), fibrinogen and other coagulation factors, complement components, immunoglobulins, enzyme inhibitors, precursors of substances such as angiotension and bradykinin, and many other types of proteins. [EU] Plasma Volume: Volume of plasma in the circulation. It is usually measured by indicator dilution techniques. [NIH] Plasmin: A product of the lysis of plasminogen (profibrinolysin) by plasminogen activators. It is composed of two polypeptide chains, light (B) and heavy (A), with a molecular weight of 75,000. It is the major proteolytic enzyme involved in blood clot retraction or the lysis of fibrin and quickly inactivated by antiplasmins. EC 3.4.21.7. [NIH] Plasminogen: Precursor of fibrinolysin (plasmin). It is a single-chain beta-globulin of molecular weight 80-90,000 found mostly in association with fibrinogen in plasma; plasminogen activators change it to fibrinolysin. It is used in wound debriding and has been
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investigated as a thrombolytic agent. [NIH] Plasminogen Activators: A heterogeneous group of proteolytic enzymes that convert plasminogen to plasmin. They are concentrated in the lysosomes of most cells and in the vascular endothelium, particularly in the vessels of the microcirculation. EC 3.4.21.-. [NIH] Platelet Activation: A series of progressive, overlapping events triggered by exposure of the platelets to subendothelial tissue. These events include shape change, adhesiveness, aggregation, and release reactions. When carried through to completion, these events lead to the formation of a stable hemostatic plug. [NIH] Platelets: A type of blood cell that helps prevent bleeding by causing blood clots to form. Also called thrombocytes. [NIH] Platinum: Platinum. A heavy, soft, whitish metal, resembling tin, atomic number 78, atomic weight 195.09, symbol Pt. (From Dorland, 28th ed) It is used in manufacturing equipment for laboratory and industrial use. It occurs as a black powder (platinum black) and as a spongy substance (spongy platinum) and may have been known in Pliny's time as "alutiae". [NIH]
Pleura: The thin serous membrane enveloping the lungs and lining the thoracic cavity. [NIH] Pleural: A circumscribed area of hyaline whorled fibrous tissue which appears on the surface of the parietal pleura, on the fibrous part of the diaphragm or on the pleura in the interlobar fissures. [NIH] Pleural cavity: A space enclosed by the pleura (thin tissue covering the lungs and lining the interior wall of the chest cavity). It is bound by thin membranes. [NIH] Polymerase: An enzyme which catalyses the synthesis of DNA using a single DNA strand as a template. The polymerase copies the template in the 5'-3'direction provided that sufficient quantities of free nucleotides, dATP and dTTP are present. [NIH] Polymers: Compounds formed by the joining of smaller, usually repeating, units linked by covalent bonds. These compounds often form large macromolecules (e.g., polypeptides, proteins, plastics). [NIH] Polymorphism: The occurrence together of two or more distinct forms in the same population. [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] Popliteal: Compression of the nerve at the neck of the fibula. [NIH] Popliteal Vein: The vein formed by the union of the anterior and posterior tibial veins; it courses through the popliteal space and becomes the femoral vein. [NIH] Port: An implanted device through which blood may be withdrawn and drugs may be infused without repeated needle sticks. Also called a port-a-cath. [NIH] Port-a-cath: An implanted device through which blood may be withdrawn and drugs may be infused without repeated needle sticks. Also called a port. [NIH] Portal Vein: A short thick vein formed by union of the superior mesenteric vein and the splenic vein. [NIH] Post partum: After childbirth, or after delivery. [EU] 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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Postmenopausal: Refers to the time after menopause. Menopause is the time in a woman's life when menstrual periods stop permanently; also called "change of life." [NIH] Postoperative: After surgery. [NIH] 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] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Progeny: The offspring produced in any generation. [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Projection: A defense mechanism, operating unconsciously, whereby that which is emotionally unacceptable in the self is rejected and attributed (projected) to others. [NIH] Prolapse: The protrusion of an organ or part of an organ into a natural or artificial orifice. [NIH]
Proline: A non-essential amino acid that is synthesized from glutamic acid. It is an essential component of collagen and is important for proper functioning of joints and tendons. [NIH] Promotor: In an operon, a nucleotide sequence located at the operator end which contains all the signals for the correct initiation of genetic transcription by the RNA polymerase holoenzyme and determines the maximal rate of RNA synthesis. [NIH] Prophylaxis: An attempt to prevent disease. [NIH] Proportional: Being in proportion : corresponding in size, degree, or intensity, having the same or a constant ratio; of, relating to, or used in determining proportions. [EU] Prostaglandin: Any of a group of components derived from unsaturated 20-carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway that are extremely potent mediators of a diverse group of physiologic processes. The abbreviation for prostaglandin is PG; specific compounds are designated by adding one of the letters A through I to indicate the type of substituents found on the hydrocarbon skeleton and a subscript (1, 2 or 3) to indicate the number of double bonds in the hydrocarbon skeleton e.g., PGE2. The predominant naturally occurring prostaglandins all have two double bonds and are synthesized from arachidonic acid (5,8,11,14-eicosatetraenoic acid) by the pathway shown in the illustration. The 1 series and 3 series are produced by the same pathway with fatty acids having one fewer double bond (8,11,14-eicosatrienoic acid or one more double bond (5,8,11,14,17-eicosapentaenoic acid) than arachidonic acid. The subscript a or ß indicates the configuration at C-9 (a denotes a substituent below the plane of the ring, ß, above the plane). The naturally occurring PGF's have the a configuration, e.g., PGF2a. All of the
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prostaglandins act by binding to specific cell-surface receptors causing an increase in the level of the intracellular second messenger cyclic AMP (and in some cases cyclic GMP also). The effect produced by the cyclic AMP increase depends on the specific cell type. In some cases there is also a positive feedback effect. Increased cyclic AMP increases prostaglandin synthesis leading to further increases in cyclic AMP. [EU] Prostaglandins A: (13E,15S)-15-Hydroxy-9-oxoprosta-10,13-dien-1-oic acid (PGA(1)); (5Z,13E,15S)-15-hydroxy-9-oxoprosta-5,10,13-trien-1-oic acid (PGA(2)); (5Z,13E,15S,17Z)-15hydroxy-9-oxoprosta-5,10,13,17-tetraen-1-oic acid (PGA(3)). A group of naturally occurring secondary prostaglandins derived from PGE. PGA(1) and PGA(2) as well as their 19hydroxy derivatives are found in many organs and tissues. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Prostatic Hyperplasia: Enlargement or overgrowth of the prostate gland as a result of an increase in the number of its constituent cells. [NIH] Prosthesis: An artificial replacement of a part of the body. [NIH] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] 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 C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein Conformation: The characteristic 3-dimensional shape of a protein, including the secondary, supersecondary (motifs), tertiary (domains) and quaternary structure of the peptide chain. Quaternary protein structure describes the conformation assumed by multimeric proteins (aggregates of more than one polypeptide chain). [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Prothrombin: A plasma protein that is the inactive precursor of thrombin. It is converted to thrombin by a prothrombin activator complex consisting of factor Xa, factor V, phospholipid, and calcium ions. Deficiency of prothrombin leads to hypoprothrombinemia. [NIH]
Prothrombin Time: Measurement of clotting time of plasma recalcified in the presence of excess tissue thromboplastin. Factors measured are fibrinogen, prothrombin, and factors V, VII, and X. It is used for monitoring anticoagulant therapy with coumarins. [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] Proto-Oncogene Proteins: Products of proto-oncogenes. Normally they do not have oncogenic or transforming properties, but are involved in the regulation or differentiation of cell growth. They often have protein kinase activity. [NIH] Proto-Oncogene Proteins c-mos: Cellular proteins encoded by the c-mos genes. They function in the cell cycle to maintain maturation promoting factor in the active state and have protein-serine/threonine kinase activity. Oncogenic transformation can take place when c-mos proteins are expressed at the wrong time. [NIH] Protozoa: A subkingdom consisting of unicellular organisms that are the simplest in the animal kingdom. Most are free living. They range in size from submicroscopic to macroscopic. Protozoa are divided into seven phyla: Sarcomastigophora, Labyrinthomorpha, Apicomplexa, Microspora, Ascetospora, Myxozoa, and Ciliophora. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychogenic: Produced or caused by psychic or mental factors rather than organic factors. [EU]
Psychosis: A mental disorder characterized by gross impairment in reality testing as evidenced by delusions, hallucinations, markedly incoherent speech, or disorganized and agitated behaviour without apparent awareness on the part of the patient of the incomprehensibility of his behaviour; the term is also used in a more general sense to refer to mental disorders in which mental functioning is sufficiently impaired as to interfere grossly with the patient's capacity to meet the ordinary demands of life. Historically, the term has been applied to many conditions, e.g. manic-depressive psychosis, that were first described in psychotic patients, although many patients with the disorder are not judged psychotic. [EU] Public 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 Circulation: The circulation of blood through 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 Embolism: Embolism in the pulmonary artery or one of its branches. [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]
Purifying: Respiratory equipment whose function is to remove contaminants from otherwise wholesome air. [NIH]
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Purines: A series of heterocyclic compounds that are variously substituted in nature and are known also as purine bases. They include adenine and guanine, constituents of nucleic acids, as well as many alkaloids such as caffeine and theophylline. Uric acid is the metabolic end product of purine metabolism. [NIH] Purpura: Purplish or brownish red discoloration, easily visible through the epidermis, caused by hemorrhage into the tissues. [NIH] Putrefaction: The process of decomposition of animal and vegetable matter by living organisms. [NIH] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radioactive: Giving off radiation. [NIH] Radiography: Examination of any part of the body for diagnostic purposes by means of roentgen rays, recording the image on a sensitized surface (such as photographic film). [NIH] Radiological: Pertaining to radiodiagnostic and radiotherapeutic procedures, and interventional radiology or other planning and guiding medical radiology. [NIH] Radiologist: A doctor who specializes in creating and interpreting pictures of areas inside the body. The pictures are produced with x-rays, sound waves, or other types of energy. [NIH]
Radiology: A specialty concerned with the use of x-ray and other forms of radiant energy in the diagnosis and treatment of disease. [NIH] Radiopharmaceutical: Any medicinal product which, when ready for use, contains one or more radionuclides (radioactive isotopes) included for a medicinal purpose. [NIH] Raloxifene: A second generation selective estrogen receptor modulator (SERM) used to prevent osteoporosis in postmenopausal women. It has estrogen agonist effects on bone and cholesterol metabolism but behaves as a complete estrogen antagonist on mammary gland and uterine tissue. [NIH] 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] Reality Testing: The individual's objective evaluation of the external world and the ability to differentiate adequately between it and the internal world; considered to be a primary ego function. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Receptors, Serotonin: Cell-surface proteins that bind serotonin and trigger intracellular changes which influence the behavior of cells. Several types of serotonin receptors have been recognized which differ in their pharmacology, molecular biology, and mode of action. [NIH] Recombinant: A cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Recombination: The formation of new combinations of genes as a result of segregation in crosses between genetically different parents; also the rearrangement of linked genes due to
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crossing-over. [NIH] Rectal: By or having to do with the rectum. The rectum is the last 8 to 10 inches of the large intestine and ends at the anus. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reflux: The term used when liquid backs up into the esophagus from the stomach. [NIH] Refractory: Not readily yielding to treatment. [EU] Regeneration: The natural renewal of a structure, as of a lost tissue or part. [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] Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Renal Artery: A branch of the abdominal aorta which supplies the kidneys, adrenal glands and ureters. [NIH] Renal pelvis: The area at the center of the kidney. Urine collects here and is funneled into the ureter, the tube that connects the kidney to the bladder. [NIH] Reperfusion: Restoration of blood supply to tissue which is ischemic due to decrease in normal blood supply. The decrease may result from any source including atherosclerotic obstruction, narrowing of the artery, or surgical clamping. It is primarily a procedure for treating infarction or other ischemia, by enabling viable ischemic tissue to recover, thus limiting further necrosis. However, it is thought that reperfusion can itself further damage the ischemic tissue, causing reperfusion injury. [NIH] Reperfusion Injury: Functional, metabolic, or structural changes, including necrosis, in ischemic tissues thought to result from reperfusion to ischemic areas of the tissue. The most common instance is myocardial reperfusion injury. [NIH] Resection: Removal of tissue or part or all of an organ by surgery. [NIH] Residential Facilities: Long-term care facilities which provide supervision and assistance in activities of daily living with medical and nursing services when required. [NIH] Resorption: The loss of substance through physiologic or pathologic means, such as loss of dentin and cementum of a tooth, or of the alveolar process of the mandible or maxilla. [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 Physiology: Functions and activities of the respiratory tract as a whole or of any of its parts. [NIH] Restoration: Broad term applied to any inlay, crown, bridge or complete denture which restores or replaces loss of teeth or oral tissues. [NIH]
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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 Artery: Central retinal artery and its branches. It arises from the ophthalmic artery, pierces the optic nerve and runs through its center, enters the eye through the porus opticus and branches to supply the retina. [NIH] Retrospective: Looking back at events that have already taken place. [NIH] Retrospective Studies: Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons. [NIH] Rheumatism: A group of disorders marked by inflammation or pain in the connective tissue structures of the body. These structures include bone, cartilage, and fat. [NIH] Rheumatoid: Resembling rheumatism. [EU] Rheumatoid arthritis: A form of arthritis, the cause of which is unknown, although infection, hypersensitivity, hormone imbalance and psychologic stress have been suggested as possible causes. [NIH] Rhusiopathiae: Causal agent of the anthropozoonosis called erysipeloid. [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] Ristocetin: An antibiotic mixture of two components, A and B, obtained from Nocardia lurida (or the same substance produced by any other means). It is no longer used clinically because of its toxicity. It causes platelet agglutination and blood coagulation and is used to assay those functions in vitro. [NIH] Rod: A reception for vision, located in the retina. [NIH] Rubber: A high-molecular-weight polymeric elastomer derived from the milk juice (latex) of Hevea brasiliensis and other trees. It is a substance that can be stretched at room temperature to atleast twice its original length and after releasing the stress, retractrapidly, and recover its original dimensions fully. Synthetic rubber is made from many different chemicals, including styrene, acrylonitrile, ethylene, propylene, and isoprene. [NIH] Salicylate: Non-steroidal anti-inflammatory drugs. [NIH] Saline: A solution of salt and water. [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]
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Salivary glands: Glands in the mouth that produce saliva. [NIH] Saphenous: Applied to certain structures in the leg, e. g. nerve vein. [NIH] Saphenous Vein: The vein which drains the foot and leg. [NIH] Saturated fat: A type of fat found in greatest amounts in foods from animals, such as fatty cuts of meat, poultry with the skin, whole-milk dairy products, lard, and in some vegetable oils, including coconut, palm kernel, and palm oils. Saturated fat raises blood cholesterol more than anything else eaten. On a Step I Diet, no more than 8 to 10 percent of total calories should come from saturated fat, and in the Step II Diet, less than 7 percent of the day's total calories should come from saturated fat. [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] 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] Scrotum: In males, the external sac that contains the testicles. [NIH] Secondary tumor: Cancer that has spread from the organ in which it first appeared to another organ. For example, breast cancer cells may spread (metastasize) to the lungs and cause the growth of a new tumor. When this happens, the disease is called metastatic breast cancer, and the tumor in the lungs is called a secondary tumor. Also called secondary cancer. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Selective estrogen receptor modulator: SERM. A drug that acts like estrogen on some tissues, but blocks the effect of estrogen on other tissues. Tamoxifen and raloxifene are SERMs. [NIH] Self Care: Performance of activities or tasks traditionally performed by professional health care providers. The concept includes care of oneself or one's family and friends. [NIH] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Semicircular canal: Three long canals of the bony labyrinth of the ear, forming loops and opening into the vestibule by five openings. [NIH] Senile: Relating or belonging to old age; characteristic of old age; resulting from infirmity of
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old age. [NIH] Sepsis: The presence of bacteria in the bloodstream. [NIH] Sequence Homology: The degree of similarity between sequences. Studies of amino acid and nucleotide sequences provide useful information about the genetic relatedness of certain species. [NIH] Serine: A non-essential amino acid occurring in natural form as the L-isomer. It is synthesized from glycine or threonine. It is involved in the biosynthesis of purines, pyrimidines, and other amino acids. [NIH] Serine Endopeptidases: Any member of the group of endopeptidases containing at the active site a serine residue involved in catalysis. EC 3.4.21. [NIH] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Serous: Having to do with serum, the clear liquid part of blood. [NIH] Serrated: Having notches or teeth on the edge as a saw has. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [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]
Short Bowel Syndrome: A malabsorption syndrome resulting from extensive operative resection of small bowel. [NIH] Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Sigmoid: 1. Shaped like the letter S or the letter C. 2. The sigmoid colon. [EU] Sigmoidoscopy: Endoscopic examination, therapy or surgery of the sigmoid flexure. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]
Sneezing: Sudden, forceful, involuntary expulsion of air from the nose and mouth caused by irritation to the mucous membranes of the upper respiratory tract. [NIH] Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH]
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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] Solvent: 1. Dissolving; effecting a solution. 2. A liquid that dissolves or that is capable of dissolving; the component of a solution that is present in greater amount. [EU] 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] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] Spectrogram: The record or display of a 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] Sperm: The fecundating fluid of the male. [NIH] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spirochete: Lyme disease. [NIH] Spleen: An organ that is part of the lymphatic system. The spleen produces lymphocytes, filters the blood, stores blood cells, and destroys old blood cells. It is located on the left side of the abdomen near the stomach. [NIH] Splenic Vein: Vein formed by the union (at the hilus of the spleen) of several small veins from the stomach, pancreas, spleen and mesentery. [NIH] Stabilization: The creation of a stable state. [EU] Staging: Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. [NIH]
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Stasis: A word termination indicating the maintenance of (or maintaining) a constant level; preventing increase or multiplication. [EU] Stent: A device placed in a body structure (such as a blood vessel or the gastrointestinal tract) to provide support and keep the structure open. [NIH] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stimulants: Any drug or agent which causes stimulation. [NIH] Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Streptococci: A genus of spherical Gram-positive bacteria occurring in chains or pairs. They are widely distributed in nature, being important pathogens but often found as normal commensals in the mouth, skin, and intestine of humans and other animals. [NIH] Streptokinase: Streptococcal fibrinolysin . An enzyme produced by hemolytic streptococci. It hydrolyzes amide linkages and serves as an activator of plasminogen. It is used in thrombolytic therapy and is used also in mixtures with streptodornase (streptodornase and streptokinase). EC 3.4.-. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stress urinary: Leakage of urine caused by actions--such as coughing, laughing, sneezing, running, or lifting--that place pressure on the bladder from inside the body. Stress urinary incontinence can result from either a fallen bladder or weak sphincter muscles. [NIH] 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] Styrene: A colorless, toxic liquid with a strong aromatic odor. It is used to make rubbers, polymers and copolymers, and polystyrene plastics. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subarachnoid: Situated or occurring between the arachnoid and the pia mater. [EU] Subclavian: The direct continuation of the axillary vein at the lateral border of the first rib. It passes medially to join the internal jugular vein and form the brachiocephalic vein on each side. [NIH] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Submandibular: Four to six lymph glands, located between the lower jaw and the submandibular salivary gland. [NIH]
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Submaxillary: Four to six lymph glands, located between the lower jaw and the submandibular salivary gland. [NIH] Subspecies: A category intermediate in rank between species and variety, based on a smaller number of correlated characters than are used to differentiate species and generally conditioned by geographical and/or ecological occurrence. [NIH] Substrate: A substance upon which an enzyme acts. [EU] Substrate Specificity: A characteristic feature of enzyme activity in relation to the kind of substrate on which the enzyme or catalytic molecule reacts. [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 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] Suppositories: A small cone-shaped medicament having cocoa butter or gelatin at its basis and usually intended for the treatment of local conditions in the rectum. [NIH] Suspensions: Colloids with liquid continuous phase and solid dispersed phase; the term is used loosely also for solid-in-gas (aerosol) and other colloidal systems; water-insoluble drugs may be given as suspensions. [NIH] Sympathomimetic: 1. Mimicking the effects of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. 2. An agent that produces effects similar to those of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. Called also adrenergic. [EU] Symphysis: A secondary cartilaginous joint. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Synchrotron: An accelerator in which the particles are guided by an increasing magnetic field while they are accelerated several times in an approximately circular path by electric fields produced by a high-frequency generator. [NIH] Synovial: Of pertaining to, or secreting synovia. [EU] Synovial Membrane: The inner membrane of a joint capsule surrounding a freely movable joint. It is loosely attached to the external fibrous capsule and secretes synovial fluid. [NIH] Syphilis: A contagious venereal disease caused by the spirochete Treponema pallidum. [NIH]
Systemic: Affecting the entire body. [NIH] Systemic lupus erythematosus: SLE. A chronic inflammatory connective tissue disease marked by skin rashes, joint pain and swelling, inflammation of the kidneys, inflammation of the fibrous tissue surrounding the heart (i.e., the pericardium), as well as other problems. Not all affected individuals display all of these problems. May be referred to as lupus. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU]
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Talin: A 235-kDa cytoplasmic protein that is also found in platelets. It has been localized to regions of cell-substrate adhesion. It binds to integrins, vinculin, and actins and appears to participate in generating a transmembrane connection between the extracellular matrix and the cytoskeleton. [NIH] Tamoxifen: A first generation selective estrogen receptor modulator (SERM). It acts as an agonist for bone tissue and cholesterol metabolism but is an estrogen antagonist in mammary and uterine. [NIH] Teicoplanin: Glycopeptide antibiotic complex from Actinoplanes teichomyceticus active against gram-positive bacteria. It consists of five major components each with a different fatty acid moiety. [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] Testicles: The two egg-shaped glands found inside the scrotum. They produce sperm and male hormones. Also called testes. [NIH] Testicular: Pertaining to a testis. [EU] Testis: Either of the paired male reproductive glands that produce the male germ cells and the male hormones. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thermal: Pertaining to or characterized by heat. [EU] Thermodilution: Measurement of blood flow based on induction at one point of the circulation of a known change in the intravascular heat content of flowing blood and detection of the resultant change in temperature at a point downstream. [NIH] Thigh: A leg; in anatomy, any elongated process or part of a structure more or less comparable to a leg. [NIH] Thoracic: Having to do with the chest. [NIH] Thoracotomy: Surgical incision into the chest wall. [NIH] Threonine: An essential amino acid occurring naturally in the L-form, which is the active form. It is found in eggs, milk, gelatin, and other proteins. [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] Thrombectomy: Surgical removal of an obstructing clot or foreign material from a blood vessel at the point of its formation. Removal of a clot arising from a distant site is called embolectomy. [NIH] Thrombin: An enzyme formed from prothrombin that converts fibrinogen to fibrin. (Dorland, 27th ed) EC 3.4.21.5. [NIH] Thrombocytes: Blood cells that help prevent bleeding by causing blood clots to form. Also called platelets. [NIH] Thrombocytopenia: A decrease in the number of blood platelets. [NIH] Thromboembolism: Obstruction of a vessel by a blood clot that has been transported from a distant site by the blood stream. [NIH] Thrombolytic: 1. Dissolving or splitting up a thrombus. 2. A thrombolytic agent. [EU]
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Thrombolytic Therapy: Use of infusions of fibrinolytic agents to destroy or dissolve thrombi in blood vessels or bypass grafts. [NIH] Thrombomodulin: A cell surface glycoprotein of endothelial cells that binds thrombin and serves as a cofactor in the activation of protein C and its regulation of blood coagulation. [NIH]
Thrombopenia: Reduction in the number of platelets in the blood. [NIH] Thrombophlebitis: Inflammation of a vein associated with thrombus formation. [NIH] Thromboplastin: Constituent composed of protein and phospholipid that is widely distributed in many tissues. It serves as a cofactor with factor VIIa to activate factor X in the extrinsic pathway of blood coagulation. [NIH] Thrombosed: A localized clot that either forms in the vein of a hemorrhoid or arises from a ruptured hemorrhoidal blood vessel. [NIH] Thromboses: The formation or presence of a blood clot within a blood vessel during life. [NIH]
Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] 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. 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] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Tin: A trace element that is required in bone formation. It has the atomic symbol Sn, atomic number 50, and atomic weight 118.71. [NIH] Tinnitus: Sounds that are perceived in the absence of any external noise source which may take the form of buzzing, ringing, clicking, pulsations, and other noises. Objective tinnitus refers to noises generated from within the ear or adjacent structures that can be heard by other individuals. The term subjective tinnitus is used when the sound is audible only to the affected individual. Tinnitus may occur as a manifestation of cochlear diseases; vestibulocochlear nerve diseases; intracranial hypertension; craniocerebral trauma; and other conditions. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tissue Plasminogen Activator: A proteolytic enzyme in the serine protease family found in many tissues which converts plasminogen to plasmin. It has fibrin-binding activity and is immunologically different from urinary plasminogen activator. The primary sequence, composed of 527 amino acids, is identical in both the naturally occurring and synthetic proteases. EC 3.4.21.68. [NIH] Tomography: Imaging methods that result in sharp images of objects located on a chosen plane and blurred images located above or below the plane. [NIH] Topical: On the surface of the body. [NIH] 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
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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] Trace element: Substance or element essential to plant or animal life, but present in extremely small amounts. [NIH] Trachea: The cartilaginous and membranous tube descending from the larynx and branching into the right and left main bronchi. [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transfusion: The infusion of components of blood or whole blood into the bloodstream. The blood may be donated from another person, or it may have been taken from the person earlier and stored until needed. [NIH] Transient Ischemic Attacks: Focal neurologic abnormalities of sudden onset and brief duration that reflect dysfunction in the distribution of the internal carotid-middle cerebral or the vertebrobasilar arterial system. [NIH] Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [NIH] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Transurethral: Performed through the urethra. [EU] Transurethral resection of the prostate: Surgical procedure to remove tissue from the prostate using an instrument inserted through the urethra. Also called TURP. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Trees: Woody, usually tall, perennial higher plants (Angiosperms, Gymnosperms, and some Pterophyta) having usually a main stem and numerous branches. [NIH] Triglyceride: A lipid carried through the blood stream to tissues. Most of the body's fat tissue is in the form of triglycerides, stored for use as energy. Triglycerides are obtained primarily from fat in foods. [NIH] Trypsin: A serine endopeptidase that is formed from trypsinogen in the pancreas. It is converted into its active form by enteropeptidase in the small intestine. It catalyzes hydrolysis of the carboxyl group of either arginine or lysine. EC 3.4.21.4. [NIH] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of Mycobacterium. [NIH] Tubulin: A microtubule subunit protein found in large quantities in mammalian brain. It has also been isolated from sperm flagella, cilia, and other sources. Structurally, the protein is a dimer with a molecular weight of approximately 120,000 and a sedimentation coefficient of 5.8S. It binds to colchicine, vincristine, and vinblastine. [NIH] Tunica Intima: The innermost coat of blood vessels, consisting of a thin lining of endothelial cells longitudinally oriented and continuous with the endothelium of capillaries on the one
Dictionary 229
hand and the endocardium of the heart on the other. [NIH] Type 2 diabetes: Usually characterized by a gradual onset with minimal or no symptoms of metabolic disturbance and no requirement for exogenous insulin. The peak age of onset is 50 to 60 years. Obesity and possibly a genetic factor are usually present. [NIH] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Ulcer: A localized necrotic lesion of the skin or a mucous surface. [NIH] Ulcerative colitis: Chronic inflammation of the colon that produces ulcers in its lining. This condition is marked by abdominal pain, cramps, and loose discharges of pus, blood, and mucus from the bowel. [NIH] Ultrasound energy: A form of therapy being studied as an anticancer treatment. Intensified ultrasound energy can be directed at cancer cells to heat them and kill them. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Unresectable: Unable to be surgically removed. [NIH] Urea: A compound (CO(NH2)2), formed in the liver from ammonia produced by the deamination of amino acids. It is the principal end product of protein catabolism and constitutes about one half of the total urinary solids. [NIH] Uremia: The illness associated with the buildup of urea in the blood because the kidneys are not working effectively. Symptoms include nausea, vomiting, loss of appetite, weakness, and mental confusion. [NIH] Ureter: One of a pair of thick-walled tubes that transports urine from the kidney pelvis to the bladder. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]
Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary Plasminogen Activator: A proteolytic enzyme that converts plasminogen to plasmin where the preferential cleavage is between arginine and valine. It was isolated originally from human urine, but is found in most tissues of most vertebrates. EC 3.4.21.73. [NIH]
Urinary Retention: Inability to urinate. The etiology of this disorder includes obstructive, neurogenic, pharmacologic, and psychogenic causes. [NIH] Urinary tract: The organs of the body that produce and discharge urine. These include the kidneys, ureters, bladder, and urethra. [NIH] Urinary tract infection: An illness caused by harmful bacteria growing in the urinary tract. [NIH]
Urinate: To release urine from the bladder to the outside. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Urokinase: A drug that dissolves blood clots or prevents them from forming. [NIH] Uterine Prolapse: Downward displacement of the uterus. It is classified in various degrees: in the first degree the cervix is within the vaginal orifice; in the second degree the cervix is outside the orifice; in the third degree the entire uterus is outside the orifice. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in
230
Blood Clots
which a fetus develops. Also called the womb. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Vaginal: Of or having to do with the vagina, the birth canal. [NIH] Valves: Flap-like structures that control the direction of blood flow through the heart. [NIH] Vancomycin: Antibacterial obtained from Streptomyces orientalis. It is a glycopeptide related to ristocetin that inhibits bacterial cell wall assembly and is toxic to kidneys and the inner ear. [NIH] Varices: Stretched veins such as those that form in the esophagus from cirrhosis. [NIH] Varicose: The common ulcer in the lower third of the leg or near the ankle. [NIH] Varicose vein: An abnormal swelling and tortuosity especially of the superficial veins of the legs. [EU] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasculitis: Inflammation of a blood vessel. [NIH] 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] Vector: Plasmid or other self-replicating DNA molecule that transfers DNA between cells in nature or in recombinant DNA technology. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Vena: A vessel conducting blood from the capillary bed to the heart. [NIH] Venereal: Pertaining or related to or transmitted by sexual contact. [EU] Venom: That produced by the poison glands of the mouth and injected by the fangs of poisonous snakes. [NIH] Venous: Of or pertaining to the veins. [EU] Venous blood: Blood that has given up its oxygen to the tissues and carries carbon dioxide back for gas exchange. [NIH] Venous Thrombosis: The formation or presence of a thrombus within a vein. [NIH] 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] Ventricular Dysfunction: A condition in which the ventricles of the heart exhibit a decreased functionality. [NIH]
Dictionary 231
Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Vertebrae: A bony unit of the segmented spinal column. [NIH] Vestibule: A small, oval, bony chamber of the labyrinth. The vestibule contains the utricle and saccule, organs which are part of the balancing apparatus of the ear. [NIH] Vestibulocochlear Nerve: The 8th cranial nerve. The vestibulocochlear nerve has a cochlear part (cochlear nerve) which is concerned with hearing and a vestibular part (vestibular nerve) which mediates the sense of balance and head position. The fibers of the cochlear nerve originate from neurons of the spiral ganglion and project to the cochlear nuclei (cochlear nucleus). The fibers of the vestibular nerve arise from neurons of Scarpa's ganglion and project to the vestibular nuclei. [NIH] Vestibulocochlear Nerve Diseases: Diseases of the vestibular and/or cochlear (acoustic) nerves, which join to form the vestibulocochlear nerve. Vestibular neuritis, cochlear neuritis, and acoustic neuromas are relatively common conditions that affect these nerves. Clinical manifestations vary with which nerve is primarily affected, and include hearing loss, vertigo, and tinnitus. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Villi: The tiny, fingerlike projections on the surface of the small intestine. Villi help absorb nutrients. [NIH] Vinblastine: An anticancer drug that belongs to the family of plant drugs called vinca alkaloids. It is a mitotic inhibitor. [NIH] Vinca Alkaloids: A class of alkaloids from the genus of apocyanaceous woody herbs including periwinkles. They are some of the most useful antineoplastic agents. [NIH] Vinculin: A cytoskeletal protein associated with cell-cell and cell-matrix interactions. The amino acid sequence of human vinculin has been determined. The protein consists of 1066 amino acid residues and its gene has been assigned to chromosome 10. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Warfarin: An anticoagulant that acts by inhibiting the synthesis of vitamin K-dependent coagulation factors. Warfarin is indicated for the prophylaxis and/or treatment of venous thrombosis and its extension, pulmonary embolism, and atrial fibrillation with embolization. It is also used as an adjunct in the prophylaxis of systemic embolism after myocardial infarction. Warfarin is also used as a rodenticide. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]
Windpipe: A rigid tube, 10 cm long, extending from the cricoid cartilage to the upper border of the fifth thoracic vertebra. [NIH] Wound Healing: Restoration of integrity to traumatized tissue. [NIH]
232
Blood Clots
X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH] Yeasts: A general term for single-celled rounded fungi that reproduce by budding. Brewers' and bakers' yeasts are Saccharomyces cerevisiae; therapeutic dried yeast is dried yeast. [NIH] Zygote: The fertilized ovum. [NIH] Zymogen: Inactive form of an enzyme which can then be converted to the active form, usually by excision of a polypeptide, e. g. trypsinogen is the zymogen of trypsin. [NIH]
233
INDEX A Abdomen, 169, 177, 181, 191, 196, 200, 201, 203, 204, 210, 211, 223, 224 Abdominal, 16, 155, 169, 187, 199, 205, 210, 211, 212, 219, 229 Abdominal Pain, 169, 205, 212, 229 Aberrant, 4, 169 Ablate, 81, 169, 189 Ablation, 17, 102, 169 Acatalasia, 169, 179 Acetylcholine, 12, 169, 170 Acne, 73, 79, 169 Acoustic, 81, 99, 169, 231 Acrylonitrile, 169, 220 Actin, 11, 169 Actinin, 11, 169 Activities of Daily Living, 153, 169, 219 Adaptability, 169, 180 Adenocarcinoma, 60, 169 Adhesives, 91, 169 Adjustment, 99, 169 Adjuvant, 169, 194 Adrenal Glands, 169, 219 Adrenal Medulla, 169, 191, 208 Adsorption, 23, 170 Adsorptive, 170 Adverse Effect, 83, 91, 170, 222 Aerobic, 170, 206 Aerosol, 170, 225 Affinity, 170, 223 Agar, 170, 213 Age of Onset, 170, 177, 229 Agonist, 110, 111, 170, 218, 226 Agoraphobia, 170, 212 Agrin, 12, 170 Air Embolism, 27, 29, 170 Air Sacs, 170, 171 Airway, 24, 170 Airway Obstruction, 24, 170 Albumin, 42, 170, 213 Algorithms, 7, 171, 176 Alimentary, 171, 188, 210 Alkaline, 171, 175, 178 Alkaloid, 171, 182 Alkylating Agents, 171, 181 Allograft, 33, 171 Alpha Particles, 171, 218 Alternative medicine, 127, 171
Alveoli, 171, 230 Amino Acid Sequence, 79, 171, 172, 195, 231 Amino Acids, 171, 181, 195, 211, 214, 216, 222, 227, 229 Ammonia, 171, 229 Ampulla, 171, 190 Amputation, 15, 171 Amyloid, 84, 171, 180 Anal, 5, 171 Anal Fissure, 5, 171 Analgesic, 154, 171 Anatomical, 121, 172, 175, 188, 200, 221 Androgens, 172, 205 Anemia, 111, 172 Anesthesia, 74, 129, 130, 155, 170, 172, 174, 190 Aneurysm, 43, 68, 70, 73, 74, 172, 230 Angina, 117, 172 Angiogenesis, 172, 205 Angiography, 5, 172 Angiopathy, 172, 180 Angioplasty, 14, 81, 88, 90, 97, 100, 101, 102, 103, 104, 106, 115, 172, 174 Anions, 170, 172, 202 Ankle, 172, 230 Anomalies, 5, 172, 226 Antagonism, 172, 188 Anterior chamber, 30, 172, 202 Antibiotic, 52, 78, 172, 178, 211, 220, 223, 226 Antibodies, 23, 25, 68, 89, 94, 128, 153, 172, 173, 199, 204, 207, 213 Antibodies, Anticardiolipin, 172, 173 Antibodies, Antiphospholipid, 172, 173 Antibody, 18, 20, 44, 68, 84, 89, 170, 173, 177, 182, 191, 198, 199, 200, 205, 207, 223 Anticoagulant, 4, 8, 14, 17, 19, 27, 36, 42, 59, 60, 63, 76, 86, 128, 149, 173, 216, 231 Antigen, 25, 170, 172, 173, 183, 198, 199, 200, 201, 205 Anti-inflammatory, 173, 174, 210, 220 Anti-Inflammatory Agents, 173, 174 Antimicrobial, 41, 42, 46, 78, 173, 181 Antioxidants, 3, 52, 173 Antiphospholipid Syndrome, 128, 153, 172, 173 Antiplasmin, 11, 16, 68, 89, 173
234
Blood Clots
Antithrombins, 36, 173 Antithrombotic, 86, 155, 156, 173 Antiviral, 173, 211 Anuria, 20, 173, 202 Anus, 121, 171, 173, 177, 197, 211, 219 Aorta, 16, 173, 179, 197, 199, 219, 230 Apolipoproteins, 173, 204 Aqueous, 174, 175, 186, 190, 199 Arachidonic Acid, 174, 215 Arginine, 174, 228, 229 Aromatic, 174, 181, 212, 224 Arteriolar, 9, 174 Arterioles, 174, 177, 178, 208 Arteriovenous, 73, 74, 174, 180 Arteriovenous Fistula, 73, 74, 174 Articular, 174, 202, 209 Aspartic, 174, 190 Aspartic Endopeptidases, 174, 190 Aspirate, 101, 174 Aspiration, 25, 48, 89, 90, 97, 104, 106, 174 Aspirin, 20, 26, 32, 134, 135, 149, 153, 154, 174 Assay, 9, 18, 22, 28, 46, 174, 220 Ataxia, 174, 198 Atherectomy, 90, 97, 101, 103, 115, 174, 190 Atmospheric Pressure, 108, 174 Atrial, 6, 28, 91, 95, 110, 111, 174, 231 Atrial Fibrillation, 6, 91, 95, 110, 111, 174, 231 Atrium, 91, 95, 174, 175, 179, 207, 230 Auricular, 91, 175 Autoimmune disease, 73, 79, 153, 173, 175, 207 Autoimmunity, 153, 175 Autologous, 42, 46, 175 Autonomic, 169, 175, 208, 211 Axillary, 61, 63, 175, 224 Axillary Vein, 175, 224 B Bacterial Infections, 175, 180, 203 Bacteriophage, 175, 213 Bacteriostatic, 96, 175 Bacterium, 175, 184, 197 Balloon Dilatation, 104, 175 Barium, 5, 175 Basal Ganglia, 174, 175, 177, 180 Base, 5, 15, 70, 175, 187, 195, 202, 203, 226 Basement Membrane, 175, 192 Benign, 151, 175, 177, 196 Benign prostatic hyperplasia, 151, 175 Beta-pleated, 171, 176
Bile, 176, 194, 198, 204, 224 Bile Ducts, 176, 194 Biliary, 23, 77, 175, 176, 178 Bilirubin, 170, 176, 194 Binding agent, 108, 176 Bioavailability, 176, 200 Biochemical, 14, 17, 33, 42, 47, 176, 194, 202, 209, 222 Biofilms, 13, 176 Biological therapy, 176, 196 Biological Transport, 176, 188 Biopsy, 151, 176, 211 Biosynthesis, 14, 174, 176, 222 Biotechnology, 13, 18, 19, 78, 118, 127, 143, 176 Bladder, 5, 92, 93, 151, 155, 176, 186, 200, 202, 207, 208, 216, 219, 224, 229 Blastocyst, 176, 183, 213 Blood Coagulation, 14, 17, 62, 176, 177, 178, 220, 227 Blood Coagulation Factors, 176 Blood Flow Velocity, 98, 177 Blood Glucose, 5, 117, 177, 197, 201 Blood Platelets, 69, 89, 177, 222, 226 Blood pressure, 5, 6, 85, 117, 128, 177, 199, 207, 223 Blood Volume, 85, 177 Blood-Brain Barrier, 48, 177 Blot, 82, 177, 199 Blotting, Western, 177, 199 Body Fluids, 75, 78, 80, 177, 178, 189, 223 Body Mass Index, 177, 210 Bone Density, 129, 177 Bone Marrow, 45, 131, 177, 186, 204 Bone metastases, 177 Bone scan, 177, 221 Bowel, 50, 171, 177, 188, 200, 201, 212, 222, 224, 229 Bowel Movement, 177, 188, 224 Brain Neoplasms, 177, 198 Branch, 165, 178, 179, 204, 211, 219, 223, 226 Breakdown, 110, 178, 188, 194 Broad-spectrum, 178, 180 Bronchi, 178, 191, 228 Bronchial, 24, 175, 178, 197 Bronchitis, 178, 181 Bronchoscopy, 129, 178 Buccal, 10, 15, 178, 204 Burns, 6, 178 Burns, Electric, 178 Bypass, 101, 114, 178, 227
Index 235
C Calcification, 100, 178 Calcium, 38, 44, 45, 102, 129, 178, 183, 188, 201, 205, 206, 216 Calcium channel blocker, 129, 178 Calcium Channel Blockers, 129, 178 Calculi, 175, 178, 196 Callus, 178, 190 Capillary, 178, 230, 231 Capsules, 178, 193, 194 Carbohydrates, 128, 178, 180 Carbon Dioxide, 179, 194, 213, 219, 230 Carcinogen, 15, 179 Cardiac, 8, 22, 82, 85, 91, 95, 108, 174, 179, 185, 189, 190, 191, 196, 207, 208, 224, 225 Cardiac catheterization, 22, 179 Cardiac Output, 85, 179, 196, 224 Cardiology, 8, 22, 28, 36, 156, 179 Cardiopulmonary, 14, 179 Cardiopulmonary Bypass, 14, 179 Cardiovascular, 9, 17, 36, 85, 102, 117, 153, 179, 222 Cardiovascular System, 17, 179 Carotid Arteries, 103, 106, 179 Carotid Artery, Internal, 90, 179 Carotid Stenosis, 102, 179 Case report, 4, 22, 179, 192 Catabolism, 14, 179 Catalase, 15, 169, 179 Catheterization, 172, 175, 179 Catheters, 10, 13, 16, 33, 63, 85, 96, 97, 100, 102, 104, 105, 106, 114, 175, 179 Cathode, 179, 189 Cations, 47, 179, 202 Causal, 4, 180, 220 Cefoperazone, 23, 180 Cell Adhesion, 72, 180, 201 Cell Death, 10, 180, 208 Cell Division, 175, 180, 196, 213 Cell membrane, 176, 178, 180, 212 Cell proliferation, 11, 180 Cell Respiration, 180, 206, 219 Cell Survival, 180, 196 Cellulose, 179, 180, 213 Central Nervous System, 154, 169, 177, 180, 194, 196, 198, 207, 209, 222 Central Nervous System Infections, 180, 196, 198 Central retinal artery, 46, 180, 220 Ceramide, 79, 180 Cerebral, 9, 22, 30, 32, 43, 47, 69, 81, 174, 175, 177, 180, 181, 191, 192, 197, 198, 228
Cerebral Arteries, 9, 180 Cerebral Hemorrhage, 9, 180 Cerebral Infarction, 180, 198 Cerebrospinal, 181, 198 Cerebrospinal fluid, 181, 198 Cerebrovascular, 62, 70, 178, 181 Cerebrum, 180, 181 Cervix, 181, 229 Chemotherapy, 41, 42, 46, 60, 63, 119, 181 Chest cavity, 181, 214 Chest Pain, 129, 150, 153, 155, 181 Chest wall, 181, 226 Chimeras, 11, 181 Chlorambucil, 154, 181 Cholesterol, 6, 16, 22, 47, 50, 128, 153, 176, 181, 185, 194, 198, 204, 218, 221, 224, 226 Cholesterol Esters, 181, 204 Chromosome, 181, 184, 196, 203, 231 Chronic, 4, 7, 93, 118, 119, 149, 154, 181, 188, 200, 202, 203, 221, 224, 225, 229 Chronic Obstructive Pulmonary Disease, 4, 181 Chylomicrons, 181, 204 Chymotrypsin, 72, 79, 181 Ciprofloxacin, 41, 53, 181 Circulatory system, 89, 93, 94, 97, 170, 181 Clear cell carcinoma, 181, 187 Cleave, 12, 181 Clinical Medicine, 43, 47, 182, 215 Clinical trial, 7, 59, 63, 64, 143, 182, 186, 216, 218 Cloning, 176, 182 Clot Retraction, 43, 182, 213 Cochlea, 154, 182, 201 Cochlear, 182, 227, 231 Cochlear Diseases, 182, 227 Cofactor, 13, 17, 182, 208, 216, 227 Colchicine, 44, 154, 182, 228 Colitis, 51, 73, 79, 182 Collagen, 12, 43, 108, 169, 175, 182, 184, 192, 194, 205, 215 Collapse, 72, 75, 178, 182 Colloidal, 170, 182, 189, 225 Colonoscopy, 5, 182 Combination chemotherapy, 63, 182 Combination Therapy, 16, 182 Complement, 182, 183, 201, 213 Complementary and alternative medicine, 41, 57, 183 Complementary medicine, 41, 183 Compress, 183, 197 Computational Biology, 143, 183
236
Blood Clots
Computed tomography, 22, 28, 32, 129, 177, 183, 221 Computerized axial tomography, 183, 221 Computerized tomography, 183 Conception, 183, 193 Cone, 87, 98, 184, 225 Conjugated, 184 Conjugation, 18, 184 Connective Tissue, 70, 173, 177, 182, 184, 193, 194, 204, 211, 220, 225 Connective Tissue Cells, 184 Connective Tissue Diseases, 173, 184 Consciousness, 171, 184, 187 Constipation, 121, 122, 184, 212 Constrict, 129, 184 Constriction, 9, 70, 179, 184, 202 Consultation, 4, 184 Consumption, 6, 128, 184, 187, 219 Contamination, 13, 78, 184 Contractility, 44, 184 Contraindications, ii, 6, 184 Contrast Media, 28, 111, 184 Contusion, 30, 184 Convalescence, 75, 184 Coordination, 184, 207 Corn Oil, 3, 184 Cornea, 172, 184 Coronary Arteriosclerosis, 185, 207 Coronary Disease, 8, 185 Coronary heart disease, 185, 198 Coronary Thrombosis, 69, 111, 185, 206, 207, 208 Coronary Vessels, 185 Cortex, 174, 180, 185, 192, 215 Cortical, 185, 221 Corticosteroids, 154, 185 Cortisol, 171, 185 Coumarins, 185, 216 Cranial, 103, 185, 196, 201, 202, 209, 211, 231 Craniocerebral Trauma, 180, 185, 196, 198, 227 Craniotomy, 74, 185 Critical Care, 43, 119, 185 Curative, 185, 226 Curettage, 31, 185 Curette, 185 Cutaneous, 185, 204 Cyclic, 11, 185, 216 Cyclosporine, 154, 186 Cyst, 174, 186 Cysteine, 12, 186, 190
Cysteine Endopeptidases, 186, 190 Cystine, 186 Cystocele, 155, 186 Cystoscope, 151, 186 Cystoscopy, 151, 186 Cytoplasm, 180, 186, 196 Cytoskeletal Proteins, 11, 186 Cytoskeleton, 11, 186, 201, 206, 226 D Dairy Products, 186, 221 Dalteparin, 60, 134, 186 Databases, Bibliographic, 143, 186 Deamination, 186, 229 Decidua, 186, 213 Decompression, 131, 186 Decompression Sickness, 186 Defecation, 122, 187 Degenerative, 187, 198, 209 Dehydration, 122, 187 Delusions, 187, 217 Dementia, 122, 187 Density, 10, 12, 177, 187, 194, 198, 204, 209, 223 Dental Caries, 187, 194 Dental Plaque, 4, 73, 79, 187 Dentists, 5, 187 Dermatitis, 122, 187 DES, 36, 187 Detoxification, 15, 187 Deuterium, 187, 199 Developed Countries, 103, 187 Diabetes Mellitus, 47, 49, 187, 195, 197 Diagnostic Imaging, 18, 187 Diagnostic procedure, 67, 98, 127, 187 Dialyzer, 187, 197 Diaphragm, 72, 75, 94, 187, 214 Diastole, 188 Diastolic, 93, 188, 199 Dietary Fiber, 122, 188 Diffusion, 27, 109, 176, 188, 200 Digestion, 73, 171, 176, 177, 188, 201, 204, 224 Digestive system, 65, 188, 194 Digestive tract, 5, 188, 222 Digital rectal examination, 5, 188 Dilatation, 24, 172, 188, 201, 230 Dilatation, Pathologic, 188, 230 Dilate, 100, 188 Dilation, 174, 188, 198, 230 Diltiazem, 129, 188 Dimness, 6, 188 Diploid, 188, 213
Index 237
Direct, iii, 16, 30, 96, 114, 133, 151, 182, 188, 219, 224 Disease Progression, 14, 188 Dislocation, 129, 130, 152, 188 Disposition, 80, 188 Dissection, 74, 80, 109, 110, 188 Dizziness, 129, 188 Drive, ii, vi, 35, 92, 119, 128, 130, 188 Drug Delivery Systems, 13, 188 Drug Interactions, 4, 136, 189 Duct, 171, 179, 189, 192, 220 Duodenum, 176, 181, 189, 190, 210, 224 Dyes, 171, 189, 193 E Edema, 48, 49, 189, 197, 202 Effector, 13, 169, 182, 189 Efficacy, 16, 24, 36, 59, 60, 64, 69, 189 Elasticity, 7, 24, 185, 189 Elastin, 182, 184, 189, 192 Electrocoagulation, 182, 189 Electrode, 73, 74, 110, 179, 189 Electrolysis, 172, 179, 189 Electrolyte, 189, 203, 223 Electron microscope, 23, 189 Electrons, 175, 179, 189, 202, 210, 211, 218 Electrophoresis, 33, 47, 189, 199 Embolectomy, 90, 123, 189, 226 Emboli, 22, 68, 74, 82, 87, 89, 90, 92, 95, 96, 97, 98, 100, 101, 102, 103, 104, 105, 106, 111, 112, 113, 115, 131, 155, 156, 189, 231 Embolism, 12, 14, 18, 24, 30, 31, 32, 33, 42, 46, 59, 60, 62, 64, 69, 74, 82, 86, 111, 123, 148, 149, 150, 155, 156, 189, 201, 217, 231 Embolization, 22, 68, 87, 89, 90, 92, 102, 189, 231 Embolus, 81, 93, 95, 98, 157, 190, 200 Embryo, 176, 190, 200 Embryogenesis, 11, 17, 190 Emphysema, 72, 75, 122, 181, 190 Emulsify, 81, 190 Emulsion, 190 Endarterectomy, 90, 101, 103, 172, 174, 190 Endocarditis, 4, 42, 96, 190, 191 Endocardium, 190, 229 Endometrial, 6, 190 Endometrium, 186, 190 Endopeptidases, 73, 174, 186, 190, 206, 211, 222 Endoscope, 190 Endoscopic, 78, 178, 182, 186, 190, 222 Endoscopy, 5, 23, 190
Endothelial cell, 9, 11, 17, 91, 177, 190, 227, 228 Endothelium, 18, 47, 190, 191, 214, 228 Endothelium, Lymphatic, 190, 191 Endothelium, Vascular, 190, 191 Endotoxin, 37, 191 Enteropeptidase, 191, 228 Environmental Health, 142, 144, 191 Enzymatic, 178, 183, 187, 191, 193, 220 Epidemiological, 191, 192 Epidural, 21, 191, 201 Epigastric, 191, 210 Epinephrine, 191, 208, 229 Epithelial, 169, 176, 186, 191, 198 Epithelium, 175, 190, 191, 202 Epitope, 18, 191 Equipment and Supplies, 5, 191 Erysipeloid, 191, 220 Erythrocyte Volume, 177, 191 Erythrocytes, 172, 177, 191 Esophagus, 5, 188, 191, 219, 224, 230 Estrogen, 5, 153, 192, 205, 218, 221, 226 Eukaryotic Cells, 186, 192, 209 Euthanasia, 94, 192 Evacuation, 20, 184, 192 Evoke, 192, 224 Excitation, 85, 192, 193 Excrete, 173, 192, 202 Exocrine, 192, 210 Exogenous, 170, 192, 194, 229 Extracellular, 11, 107, 171, 176, 184, 192, 201, 205, 223, 226 Extracellular Matrix, 11, 107, 184, 192, 201, 205, 226 Extracellular Matrix Proteins, 192, 205 Extracellular Space, 107, 192 Extracorporeal, 94, 192 Extraction, 9, 20, 23, 101, 192 Extravasation, 113, 192, 197 Extravascular, 74, 192 Extremity, 62, 82, 105, 192 F Family Planning, 143, 192 Fat, 128, 167, 172, 174, 177, 180, 185, 189, 190, 192, 203, 207, 209, 210, 220, 221, 223, 228 Fatal Outcome, 111, 192 Fatigue, 126, 127, 150, 192, 196 Fatty acids, 16, 170, 192, 195, 215 Fecal occult blood test, 5, 193 Feces, 184, 193, 224
238
Blood Clots
Femoral, 25, 82, 84, 98, 101, 104, 129, 131, 153, 179, 193, 214 Femoral Artery, 104, 179, 193 Femoral Vein, 84, 193, 214 Femur, 130, 193 Fetus, 17, 193, 213, 230 Fibrillation, 91, 95, 193 Fibrinogen, 8, 10, 25, 42, 44, 45, 47, 76, 107, 193, 213, 216, 226 Fibrinolysis, 8, 12, 19, 27, 36, 37, 43, 44, 110, 193 Fibrinolytic, 11, 12, 17, 47, 193, 203, 227 Fibrinolytic Agents, 12, 193, 227 Fibronectin, 12, 107, 193 Fibrosis, 73, 79, 193, 221 Fibula, 193, 214 Filler, 91, 193 Filtration, 71, 72, 74, 98, 103, 193, 202 Fistula, 73, 109, 193 Flatus, 193, 194 Flow Cytometry, 193, 200 Fluorine, 84, 194 Flushing, 96, 194 Fold, 83, 194, 206 Forearm, 177, 194 Fungi, 184, 194, 206, 232 G Gallbladder, 169, 176, 188, 194 Gallstones, 194, 198 Ganglia, 169, 194, 208 Gangrene, 95, 169, 194 Gas, 72, 171, 179, 186, 188, 193, 194, 199, 205, 225, 230 Gas exchange, 194, 230 Gastric, 175, 194 Gastrin, 194, 198 Gastritis, 5, 194 Gastroenterologist, 121, 194 Gastrointestinal, 23, 181, 191, 194, 222, 224 Gastrointestinal tract, 194, 222, 224 Gelatin, 12, 194, 195, 225, 226 Gels, 29, 194 Gemcitabine, 60, 194 Gene, 15, 17, 28, 118, 176, 194, 195, 209, 231 Gene Targeting, 17, 194 Generator, 99, 195, 225 Genetic Code, 195, 209 Genetic transcription, 195, 215 Genetics, 9, 23, 33, 184, 195 Genital, 154, 181, 195 Genotype, 14, 195, 212
Gestation, 195, 213 Ginseng, 55, 195 Gland, 42, 169, 195, 204, 210, 216, 218, 221, 224, 225, 227 Glucose, 117, 177, 180, 187, 195, 197, 201 Glucose Intolerance, 187, 195 Glucuronic Acid, 195, 197 Glycerol, 195, 212 Glycerophospholipids, 195, 212 Glycine, 195, 222 Glycoprotein, 173, 193, 195, 196, 227 Gout, 182, 195 Governing Board, 196, 215 Gp120, 196, 211 Graft, 104, 119, 196, 198 Grafting, 196, 200 Gram-positive, 196, 224, 226 Gram-Positive Bacteria, 196, 226 Granulocytes, 196, 231 Groin, 84, 152, 196 Growth, 11, 45, 78, 108, 114, 153, 172, 173, 175, 180, 196, 205, 213, 217, 221, 227, 228 Growth factors, 108, 196 H Haematoma, 196 Haemorrhage, 22, 24, 30, 32, 196 Haploid, 196, 213 Headache, 135, 196, 198 Health Promotion, 121, 196 Health Status, 130, 196 Heart attack, 11, 12, 16, 47, 61, 68, 87, 89, 91, 95, 117, 196 Heart Catheterization, 129, 196 Heart failure, 122, 196 Heart Valves, 13, 175, 197 Heartbeat, 197, 225 Hemarthrosis, 46, 197 Hematoma, 45, 197 Hematuria, 151, 197 Hemodialysis, 119, 187, 197, 202, 203 Hemoglobin, 172, 191, 197 Hemolytic, 197, 224 Hemoptysis, 21, 197 Hemorrhage, 9, 16, 29, 32, 43, 48, 68, 70, 89, 185, 189, 196, 197, 218, 224 Hemorrhagic stroke, 9, 197 Hemorrhoid, 197, 227 Hemostasis, 4, 11, 27, 36, 42, 77, 197, 201, 222 Heparin, 31, 32, 36, 54, 60, 61, 69, 93, 107, 135, 197 Hepatic, 80, 171, 197
Index 239
Hepatic Veins, 80, 197 Hepatitis, 20, 135, 198 Hepatocytes, 198 Heredity, 194, 195, 198 Herpes, 73, 79, 198 Herpes Zoster, 198 Heterogeneity, 47, 170, 198 High blood cholesterol, 16, 198 Histology, 198, 210 Homologous, 195, 198, 225 Homotypic, 14, 198 Hormone, 5, 185, 187, 191, 194, 198, 201, 205, 215, 220, 227 Hormone Replacement Therapy, 5, 198 Hormone therapy, 198, 205 Host, 4, 20, 69, 96, 107, 175, 198 Hydrocephalus, 13, 198, 202 Hydrogen, 84, 175, 179, 187, 192, 199, 207, 208, 210, 212, 217 Hydrogen Peroxide, 179, 199 Hydrolysis, 84, 174, 199, 211, 214, 216, 228 Hydrophobic, 195, 199, 203 Hydroxylysine, 182, 199 Hydroxyproline, 182, 199 Hypersensitivity, 199, 220 Hypertension, 51, 128, 129, 178, 180, 199, 202 Hypertrophy, 176, 199 I Id, 37, 48, 148, 149, 155, 156, 157, 158, 164, 166, 199 Iliac Artery, 193, 199 Iliac Vein, 193, 199 Immune response, 169, 173, 175, 199, 231 Immune system, 4, 154, 175, 176, 199, 200, 204, 207, 230, 231 Immunity, 199, 209 Immunoblotting, 9, 199 Immunoelectrophoresis, 170, 173, 199 Immunoglobulin, 20, 153, 172, 199, 207 Immunologic, 14, 199 Immunophenotyping, 45, 200 Immunosuppressive, 154, 200 Impairment, 174, 200, 206, 217 Implantation, 68, 71, 108, 183, 200 In situ, 74, 200 In vitro, 10, 14, 16, 18, 23, 24, 26, 27, 28, 32, 37, 41, 42, 44, 46, 200, 220 In vivo, 10, 11, 16, 18, 84, 86, 197, 200 Incision, 30, 130, 200, 202, 226 Incontinence, 151, 155, 198, 200, 224 Indicative, 118, 200, 211, 230
Indinavir, 64, 200 Induction, 172, 200, 226 Infarction, 69, 82, 90, 111, 180, 197, 200, 201, 219 Inferior vena cava, 7, 80, 93, 98, 199, 200 Infiltration, 113, 200 Inflammation, 5, 6, 14, 130, 154, 169, 171, 173, 174, 178, 182, 187, 193, 194, 198, 200, 212, 220, 225, 227, 229, 230 Inflammatory bowel disease, 122, 200 Infuse, 16, 200 Infusion, 20, 37, 113, 200, 228 Initiation, 201, 215 Inlay, 201, 219 Inner ear, 154, 182, 201, 230 Inorganic, 201, 207 Insight, 15, 201 Instillation, 30, 201 Insulator, 201, 207 Insulin, 29, 128, 201, 202, 229 Insulin-dependent diabetes mellitus, 29, 201 Integrins, 201, 226 Intensive Care, 31, 201 Intermittent, 201, 212 Intestine, 5, 177, 201, 203, 224 Intracellular, 18, 178, 200, 201, 216, 218 Intracranial Aneurysm, 74, 180, 201 Intracranial Arteriosclerosis, 180, 201 Intracranial Hemorrhages, 198, 201 Intracranial Hypertension, 196, 198, 202, 227 Intramuscular, 202, 210 Intravascular, 18, 36, 70, 104, 109, 111, 113, 114, 196, 202, 226 Intravenous, 20, 31, 201, 202, 210 Intravesical, 32, 202 Invasive, 15, 18, 20, 77, 80, 113, 126, 130, 199, 202, 204 Involuntary, 193, 202, 208, 222 Ions, 175, 189, 199, 202, 211, 216 Iris, 172, 184, 202 Irrigation, 92, 97, 109, 110, 202 Ischemia, 9, 86, 89, 90, 91, 97, 102, 103, 197, 202, 219 Ischemic stroke, 15, 81, 202 Islet, 36, 202 J Joint, 100, 129, 131, 152, 153, 174, 181, 186, 202, 204, 209, 225 Joint Capsule, 131, 202, 225
240
Blood Clots
K Kb, 142, 202 Kidney Failure, 96, 122, 202, 203 Kidney Failure, Acute, 202 Kidney Failure, Chronic, 202, 203 Kinetic, 14, 203, 211 Kringles, 11, 203 L Labyrinth, 80, 182, 201, 203, 221, 231 Laparoscopy, 25, 203 Large Intestine, 188, 201, 203, 219, 222 Latent, 12, 29, 203, 215 Leprosy, 73, 79, 203 Lesion, 100, 106, 112, 203, 229 Lethal, 93, 203 Lethargy, 198, 203 Leukemia, 45, 203 Leukocytes, 177, 196, 203 Levofloxacin, 41, 46, 55, 203 Library Services, 164, 203 Ligament, 6, 203, 216 Ligation, 74, 122, 203 Light microscope, 23, 203, 206 Linkages, 197, 203, 224 Lipid, 117, 174, 195, 201, 203, 207, 228 Lipoprotein, 12, 198, 203, 204 Liver, 10, 50, 80, 122, 169, 171, 174, 176, 188, 190, 193, 194, 195, 197, 198, 204, 221, 229 Liver scan, 204, 221 Localized, 187, 191, 196, 197, 200, 204, 213, 221, 226, 227, 229 Locomotion, 204, 213 Longitudinal Studies, 8, 204 Loop, 71, 92, 102, 204 Low-density lipoprotein, 204 Lubricants, 204, 212 Lumen, 70, 77, 83, 85, 90, 96, 100, 101, 102, 105, 112, 113, 114, 115, 179, 191, 204 Lupus, 79, 128, 130, 150, 153, 172, 173, 204, 225 Luxation, 188, 204 Lymph, 175, 181, 190, 191, 204, 224, 225 Lymph node, 175, 204 Lymphatic, 191, 200, 204, 223 Lymphatic system, 204, 223 Lymphocyte, 173, 204, 205 Lymphoid, 172, 185, 204 Lysine, 199, 204, 228 Lytic, 21, 204
M Magnetic Resonance Imaging, 18, 27, 84, 204, 221 Malabsorption, 205, 222 Malabsorption syndrome, 205, 222 Malformation, 73, 205 Malignancy, 62, 205 Malignant, 169, 177, 205 Malnutrition, 122, 171, 205 Mammary, 205, 218, 226 Mammogram, 178, 205, 206 Manic, 205, 217 Manic-depressive psychosis, 205, 217 Manifest, 18, 90, 205 Man-made, 77, 205 Matrix metalloproteinase, 12, 205 Meat, 191, 205, 221 Mediate, 11, 205 Mediator, 9, 205, 222 MEDLINE, 143, 205 Megestrol, 46, 205 Megestrol Acetate, 46, 205 Melanin, 202, 206, 212, 229 Memory, 12, 85, 187, 206 Meninges, 180, 185, 206 Menopause, 5, 50, 153, 206, 215 Menstruation, 186, 206 Mental Disorders, 65, 206, 217 Mesenteric, 206, 214 Metalloendopeptidases, 190, 206 Metastasis, 11, 205, 206 Metastatic, 12, 60, 177, 206, 221 MI, 24, 86, 150, 153, 168, 206 Microbe, 107, 206, 228 Microcalcifications, 178, 206 Microorganism, 182, 206, 231 Microsurgery, 74, 206 Microtubules, 46, 206, 210 Migration, 11, 87, 95, 206 Milliliter, 177, 206 Mitochondria, 42, 206, 209 Mitochondrial Swelling, 206, 208 Mitotic, 207, 231 Mitral Valve, 91, 95, 207 Modeling, 7, 207 Modification, 9, 207, 218 Molecule, 13, 173, 175, 183, 189, 191, 192, 196, 199, 207, 210, 218, 225, 230 Monitor, 61, 113, 118, 207, 208 Monoclonal, 18, 25, 84, 199, 207 Monoclonal antibodies, 84, 199, 207 Morphogenesis, 18, 207
Index 241
Motility, 207, 222 Mucins, 187, 207, 220 Mucosa, 204, 207 Mucus, 24, 207, 229 Multiple sclerosis, 79, 207 Muscle Fibers, 93, 170, 207 Myelin, 207 Myocardial infarction, 4, 15, 68, 69, 82, 86, 89, 102, 107, 110, 111, 185, 206, 207, 208, 231 Myocardial Ischemia, 103, 185, 207 Myocardium, 206, 207, 208 N NCI, 1, 9, 60, 63, 65, 141, 208 Necrosis, 69, 89, 113, 129, 167, 180, 200, 206, 207, 208, 219 Neonatal, 24, 208 Nerve, 12, 21, 99, 130, 152, 172, 174, 205, 207, 208, 209, 214, 221, 224, 228, 231 Nervous System, 180, 205, 208, 225 Neurogenic, 208, 229 Neurologic, 198, 208, 228 Neuromuscular, 169, 208 Neuromuscular Junction, 169, 208 Neurosis, 208, 212 Neurotoxin, 12, 208 Neutrons, 171, 208, 218 Neutrophil, 14, 208 Nickel, 68, 208 Norepinephrine, 30, 208 Nuclear, 5, 23, 84, 86, 111, 175, 184, 189, 192, 205, 208 Nuclei, 171, 184, 189, 205, 208, 209, 217, 231 Nucleic acid, 69, 79, 110, 111, 195, 209, 218 Nucleus, 174, 185, 186, 187, 192, 208, 209, 217, 231 O Occult, 5, 193, 209 Occult Blood, 209 Ocular, 30, 46, 209 Ointments, 209, 210 Oliguria, 202, 209 Omega-3 fatty acid, 16, 209 Opacity, 187, 209 Operon, 209, 215 Optic Nerve, 188, 209, 220 Oral Health, 4, 209 Organelles, 186, 209 Osmosis, 209 Osmotic, 94, 170, 207, 209 Osteoarthritis, 129, 130, 209
Osteonecrosis, 130, 209 Osteoporosis, 5, 50, 131, 153, 209, 218 Outpatient, 61, 210 Overweight, 37, 128, 210 Ovulation, 205, 210 Oxidation, 173, 186, 210 Oxygenation, 83, 186, 197, 210 Oxygenator, 179, 210 P Pacer, 95, 210 Paclitaxel, 46, 210 Palliative, 205, 210, 226 Pancreas, 60, 128, 169, 181, 188, 201, 202, 210, 223, 228 Pancreatic, 60, 181, 210 Pancreatic cancer, 60, 210 Pancreatic Juice, 181, 210 Paraffin, 10, 210 Paralysis, 9, 95, 210 Parasite, 210 Parasitic, 73, 79, 210 Parenteral, 96, 210 Parenteral Nutrition, 96, 210 Parietal, 210, 212, 214 Particle, 94, 111, 205, 211, 223 Particle Accelerators, 205, 211 Pathogenesis, 14, 107, 211 Pathologic, 32, 90, 112, 113, 176, 185, 199, 211, 219 Patient Education, 150, 155, 162, 164, 168, 211 Pelvic, 82, 111, 155, 186, 211, 216 Penicillin, 28, 41, 55, 172, 211 Peptide, 11, 33, 45, 86, 190, 191, 211, 214, 216 Peptide Hydrolases, 190, 211 Peptide T, 33, 86, 211 Perception, 184, 211 Percutaneous, 8, 84, 88, 90, 100, 101, 103, 104, 211 Perfusion, 43, 80, 87, 100, 211 Perianal, 122, 211 Pericardium, 211, 225 Periodontal disease, 4, 211 Periodontist, 4, 211 Peripheral blood, 104, 211 Peripheral Nerves, 203, 211 Peritoneal, 96, 211, 212 Peritoneal Cavity, 212 Peritoneal Dialysis, 96, 212 Peritoneum, 211, 212 Peritonitis, 96, 212
242
Blood Clots
Petechiae, 196, 212 Petroleum, 122, 210, 212 PH, 151, 177, 212 Pharmaceutical Preparations, 96, 180, 194, 212 Pharmacodynamic, 42, 212 Pharmacologic, 36, 172, 212, 228, 229 Phenotype, 14, 212 Phenylalanine, 212, 229 Phlebitis, 113, 212 Phobia, 6, 212 Phobic Disorders, 212 Phospholipids, 128, 172, 173, 192, 203, 204, 212 Phosphorus, 178, 213 Phosphorylation, 11, 213 Photocoagulation, 182, 213 Physical Examination, 198, 213 Physical Therapy, 6, 213 Physiologic, 12, 85, 113, 170, 176, 187, 206, 213, 215, 218, 219 Physiology, 25, 28, 44, 151, 179, 213 Pilot study, 21, 213 Placenta, 94, 213, 215 Plants, 16, 171, 179, 195, 208, 213, 228 Plaque, 4, 68, 81, 89, 90, 97, 100, 101, 103, 105, 106, 113, 115, 172, 174, 213 Plasma, 10, 11, 16, 27, 29, 31, 37, 43, 44, 45, 47, 48, 68, 77, 89, 170, 172, 173, 177, 180, 181, 191, 193, 194, 195, 197, 202, 203, 213, 216, 221 Plasma cells, 172, 213 Plasma protein, 170, 191, 203, 213, 216 Plasma Volume, 177, 213 Plasmin, 12, 16, 29, 173, 193, 213, 214, 227, 229 Plasminogen, 8, 11, 12, 16, 23, 28, 37, 69, 82, 95, 173, 193, 213, 214, 224, 227, 229 Plasminogen Activators, 213, 214 Platelet Activation, 11, 214 Platelets, 11, 14, 29, 43, 47, 214, 226, 227 Platinum, 70, 73, 204, 214 Pleura, 214 Pleural, 31, 72, 75, 214 Pleural cavity, 72, 75, 214 Polymerase, 214, 215 Polymers, 176, 214, 216, 224 Polymorphism, 9, 214 Polypeptide, 10, 79, 171, 182, 193, 213, 214, 216, 232 Polysaccharide, 173, 180, 214 Popliteal, 101, 193, 214
Popliteal Vein, 193, 214 Port, 72, 77, 96, 214 Port-a-cath, 214 Portal Vein, 80, 214 Post partum, 19, 214 Posterior, 171, 174, 202, 210, 214 Postmenopausal, 209, 215, 218 Postoperative, 130, 151, 155, 215 Practice Guidelines, 144, 155, 215 Precursor, 10, 174, 189, 191, 208, 212, 213, 215, 216, 228, 229 Predisposition, 153, 215 Progeny, 184, 215 Progesterone, 205, 215, 224 Progression, 8, 215 Progressive, 23, 71, 72, 187, 196, 203, 208, 209, 214, 215 Projection, 208, 209, 215 Prolapse, 122, 155, 215 Proline, 182, 199, 215 Promotor, 73, 215 Prophylaxis, 157, 215, 231 Proportional, 85, 98, 215 Prostaglandin, 48, 215 Prostaglandins A, 215, 216 Prostate, 44, 50, 63, 151, 176, 216, 228 Prostatic Hyperplasia, 216 Prosthesis, 101, 108, 129, 216 Protease, 17, 42, 182, 200, 216, 227 Protective Agents, 178, 216 Protein C, 10, 23, 36, 107, 137, 170, 171, 173, 175, 203, 216, 229, 231 Protein Conformation, 171, 216 Protein S, 118, 176, 195, 216 Proteolytic, 13, 16, 183, 191, 193, 213, 214, 216, 227, 229 Prothrombin, 13, 28, 76, 77, 118, 216, 226 Prothrombin Time, 76, 77, 216 Protocol, 63, 216 Protons, 171, 199, 211, 217, 218 Proto-Oncogene Proteins, 210, 217 Proto-Oncogene Proteins c-mos, 210, 217 Protozoa, 184, 206, 217 Proximal, 73, 77, 87, 89, 90, 96, 100, 101, 103, 105, 112, 113, 188, 217 Psychiatry, 217, 230 Psychic, 208, 217, 221 Psychogenic, 217, 229 Psychosis, 150, 217 Public Policy, 143, 217 Publishing, 5, 18, 217 Pulmonary Artery, 177, 217, 230
Index 243
Pulmonary Circulation, 87, 91, 217 Pulmonary Edema, 202, 217 Pulse, 63, 98, 99, 152, 207, 217 Purifying, 73, 94, 217 Purines, 218, 222 Purpura, 196, 218 Putrefaction, 194, 218 Q Quality of Life, 8, 60, 218 R Race, 206, 218 Radiation, 81, 114, 205, 218, 221, 232 Radioactive, 84, 177, 199, 200, 204, 205, 207, 208, 218, 221 Radiography, 149, 172, 184, 218 Radiological, 77, 149, 211, 218 Radiologist, 61, 218 Radiology, 7, 21, 28, 36, 149, 155, 218 Radiopharmaceutical, 195, 218 Raloxifene, 153, 218, 221 Randomized, 60, 63, 189, 218 Reality Testing, 217, 218 Receptor, 12, 13, 14, 17, 173, 184, 196, 211, 218, 222 Receptors, Serotonin, 218, 222 Recombinant, 14, 61, 69, 86, 135, 137, 218, 230 Recombination, 184, 195, 218 Rectal, 5, 122, 156, 175, 219 Rectum, 173, 177, 187, 188, 193, 194, 197, 200, 203, 216, 219, 225 Recurrence, 59, 150, 205, 219 Refer, 1, 81, 178, 182, 188, 194, 198, 204, 208, 217, 219 Reflux, 71, 219 Refractory, 46, 189, 219 Regeneration, 170, 219 Regimen, 4, 61, 63, 69, 135, 189, 219 Regurgitation, 197, 219 Remission, 205, 219 Renal Artery, 101, 219 Renal pelvis, 30, 219 Reperfusion, 47, 69, 219 Reperfusion Injury, 219 Resection, 80, 151, 219, 222 Residential Facilities, 122, 219 Resorption, 198, 219 Respiration, 179, 207, 219 Respiratory Physiology, 219, 230 Restoration, 18, 69, 213, 219, 231 Retina, 180, 209, 220 Retinal, 184, 209, 220
Retinal Artery, 220 Retrospective, 29, 220 Retrospective Studies, 29, 220 Rheumatism, 220 Rheumatoid, 44, 129, 130, 220 Rheumatoid arthritis, 129, 130, 220 Rhusiopathiae, 45, 191, 220 Rigidity, 213, 220 Risk factor, 6, 17, 26, 122, 220 Ristocetin, 220, 230 Rod, 100, 175, 220 Rubber, 68, 122, 169, 220 S Salicylate, 154, 220 Saline, 25, 108, 220 Saliva, 82, 220, 221 Salivary, 19, 187, 188, 210, 220, 221, 224, 225 Salivary glands, 19, 187, 188, 220, 221 Saphenous, 96, 102, 104, 105, 221 Saphenous Vein, 96, 102, 104, 105, 221 Saturated fat, 128, 221 Scans, 129, 221 Scleroderma, 128, 221 Sclerosis, 201, 207, 221 Screening, 27, 28, 46, 110, 111, 129, 182, 221 Scrotum, 151, 221, 226 Secondary tumor, 206, 221 Secretion, 201, 207, 221 Seizures, 150, 221 Selective estrogen receptor modulator, 218, 221, 226 Self Care, 117, 169, 221 Semen, 216, 221 Semicircular canal, 201, 221 Senile, 122, 209, 221 Sepsis, 96, 222 Sequence Homology, 211, 222 Serine, 17, 42, 181, 190, 217, 222, 227, 228 Serine Endopeptidases, 190, 222 Serotonin, 9, 218, 222, 228 Serous, 190, 214, 222 Serrated, 109, 110, 222 Serum, 10, 15, 19, 29, 44, 47, 170, 182, 202, 204, 212, 222 Shock, 16, 24, 51, 81, 83, 222, 228 Short Bowel Syndrome, 96, 222 Side effect, 16, 86, 92, 107, 133, 136, 153, 170, 176, 222, 227 Sigmoid, 222 Sigmoidoscopy, 5, 222
244
Blood Clots
Skeletal, 130, 172, 222 Skeleton, 169, 193, 202, 215, 222 Skull, 185, 222, 226 Small intestine, 5, 176, 181, 189, 198, 201, 222, 228, 231 Smooth muscle, 18, 178, 184, 222 Sneezing, 222, 224 Social Environment, 218, 222 Sodium, 136, 137, 195, 223 Soft tissue, 84, 177, 222, 223 Solvent, 195, 209, 223 Somatic, 190, 223 Sound wave, 16, 218, 223 Spatial disorientation, 188, 223 Specialist, 158, 188, 211, 223 Species, 76, 107, 182, 191, 206, 207, 210, 218, 222, 223, 225, 228 Specificity, 12, 18, 84, 170, 190, 223 Spectrogram, 98, 99, 223 Spectrum, 223 Sperm, 172, 181, 223, 226, 228 Sphincter, 223, 224 Spinal cord, 156, 180, 181, 191, 206, 208, 211, 223 Spirochete, 223, 225 Spleen, 32, 204, 223 Splenic Vein, 214, 223 Stabilization, 47, 87, 223 Staging, 221, 223 Stasis, 91, 224 Stent, 20, 88, 89, 90, 100, 102, 104, 105, 106, 112, 115, 125, 224 Steroid, 185, 198, 224 Stimulants, 195, 224 Stimulus, 99, 184, 188, 189, 192, 212, 224, 226 Stomach, 5, 169, 188, 191, 194, 198, 212, 219, 222, 223, 224 Stool, 5, 122, 193, 200, 203, 224 Streptococci, 224 Streptokinase, 12, 13, 16, 24, 31, 32, 33, 69, 86, 93, 224 Stress, 8, 99, 128, 129, 155, 185, 194, 215, 220, 224 Stress urinary, 155, 224 Stroke Volume, 179, 224 Styrene, 220, 224 Subacute, 7, 200, 224 Subarachnoid, 9, 22, 29, 30, 32, 43, 196, 201, 224 Subclavian, 61, 63, 175, 224 Subclinical, 200, 221, 224
Subcutaneous, 31, 113, 189, 210, 224 Submandibular, 224, 225 Submaxillary, 42, 225 Subspecies, 223, 225 Substrate, 11, 12, 16, 17, 225, 226 Substrate Specificity, 12, 17, 225 Suction, 31, 110, 193, 225 Sudden death, 83, 225 Support group, 152, 225 Suppositories, 194, 225 Suspensions, 111, 225 Sympathomimetic, 191, 208, 225 Symphysis, 216, 225 Symptomatic, 21, 59, 98, 225 Synaptic, 170, 225 Synchrotron, 10, 225 Synovial, 202, 225 Synovial Membrane, 202, 225 Syphilis, 153, 225 Systemic, 63, 86, 91, 93, 128, 130, 134, 135, 172, 173, 177, 191, 200, 202, 221, 225, 231 Systemic lupus erythematosus, 128, 130, 172, 173, 225 Systolic, 93, 199, 225 T Talin, 11, 226 Tamoxifen, 26, 221, 226 Teicoplanin, 42, 226 Temporal, 14, 226 Teratogenic, 171, 188, 226 Testicles, 151, 221, 226 Testicular, 13, 226 Testis, 226 Therapeutics, 136, 226 Thermal, 85, 208, 226 Thermodilution, 85, 226 Thigh, 193, 196, 226 Thoracic, 149, 187, 214, 226, 231 Thoracotomy, 72, 226 Threonine, 211, 217, 222, 226 Threshold, 199, 226 Thrombectomy, 90, 119, 189, 226 Thrombin, 13, 14, 17, 19, 30, 36, 37, 41, 42, 81, 107, 110, 173, 193, 216, 226, 227 Thrombocytes, 214, 226 Thrombocytopenia, 107, 226 Thromboembolism, 22, 28, 30, 31, 33, 36, 43, 60, 62, 63, 64, 69, 86, 111, 156, 157, 226 Thrombolytic, 14, 15, 23, 47, 63, 68, 69, 74, 82, 86, 89, 93, 109, 135, 214, 224, 226, 227 Thrombolytic Therapy, 47, 63, 69, 224, 227
Index 245
Thrombomodulin, 14, 17, 216, 227 Thrombopenia, 173, 227 Thrombophlebitis, 62, 82, 148, 227 Thromboplastin, 77, 118, 216, 227 Thrombosed, 119, 227 Thromboses, 82, 111, 173, 227 Thyroid, 122, 227, 229 Thyroxine, 171, 212, 227 Tin, 214, 227 Tinnitus, 153, 154, 227, 231 Tissue, 7, 10, 11, 16, 17, 19, 21, 22, 32, 41, 45, 48, 61, 68, 69, 73, 81, 86, 90, 108, 110, 111, 113, 114, 151, 171, 172, 173, 175, 176, 177, 178, 182, 184, 185, 186, 189, 190, 191, 192, 194, 196, 197, 200, 203, 204, 205, 206, 207, 208, 211, 214, 216, 218, 219, 220, 222, 223, 225, 226, 227, 228, 231 Tissue Plasminogen Activator, 16, 21, 48, 61, 69, 86, 227 Tomography, 21, 84, 111, 227 Topical, 53, 154, 199, 210, 227 Torsion, 200, 227 Toxic, iv, 171, 184, 188, 199, 224, 227, 228, 230 Toxicity, 189, 220, 227 Toxicology, 144, 228 Toxins, 173, 195, 200, 207, 228 Trace element, 194, 208, 227, 228 Trachea, 178, 227, 228 Transfection, 176, 228 Transfusion, 21, 36, 47, 94, 148, 228 Transient Ischemic Attacks, 6, 51, 228 Transmitter, 169, 205, 208, 228 Transplantation, 33, 36, 203, 228 Transurethral, 151, 228 Transurethral resection of the prostate, 151, 228 Trauma, 62, 72, 75, 80, 110, 112, 122, 156, 197, 208, 228 Trees, 220, 228 Triglyceride, 16, 228 Trypsin, 30, 72, 79, 181, 191, 228, 232 Tryptophan, 182, 222, 228 Tuberculosis, 184, 204, 228 Tubulin, 206, 228 Tunica Intima, 190, 228 Type 2 diabetes, 117, 229 Tyrosine, 11, 12, 229 U Ulcer, 45, 229, 230 Ulcerative colitis, 5, 200, 229
Ultrasound energy, 10, 229 Unconscious, 199, 229 Unresectable, 60, 229 Urea, 23, 202, 229 Uremia, 202, 229 Ureter, 219, 229 Urethra, 80, 92, 151, 176, 216, 228, 229 Urinary, 13, 19, 32, 77, 80, 92, 151, 155, 178, 181, 186, 198, 200, 209, 224, 227, 229 Urinary Plasminogen Activator, 227, 229 Urinary Retention, 32, 151, 186, 229 Urinary tract, 19, 151, 229 Urinary tract infection, 151, 229 Urinate, 151, 229 Urine, 10, 29, 92, 151, 155, 173, 176, 197, 200, 202, 209, 219, 224, 229 Urokinase, 11, 25, 26, 27, 63, 93, 229 Uterine Prolapse, 155, 229 Uterus, 181, 186, 190, 206, 215, 229, 230 V Vaccine, 135, 169, 216, 230 Vagina, 5, 181, 187, 206, 230 Vaginal, 155, 229, 230 Valves, 93, 175, 230 Vancomycin, 42, 46, 230 Varices, 175, 230 Varicose, 6, 51, 148, 230 Varicose vein, 6, 230 Vasculitis, 153, 230 Vasodilation, 81, 230 Vasodilator, 9, 11, 230 VE, 70, 230 Vector, 69, 230 Vena, 80, 82, 83, 84, 87, 93, 98, 230 Venereal, 225, 230 Venom, 42, 47, 86, 118, 230 Venous blood, 26, 180, 230 Venous Thrombosis, 7, 62, 70, 93, 98, 107, 110, 111, 230, 231 Ventilation, 42, 230 Ventricle, 91, 207, 217, 225, 230 Ventricular, 24, 33, 93, 198, 230 Ventricular Dysfunction, 33, 230 Venules, 177, 178, 191, 231 Vertebrae, 223, 231 Vestibule, 182, 201, 221, 231 Vestibulocochlear Nerve, 227, 231 Vestibulocochlear Nerve Diseases, 227, 231 Veterinary Medicine, 143, 231 Villi, 198, 231 Vinblastine, 44, 228, 231
246
Blood Clots
Vinca Alkaloids, 231 Vinculin, 11, 226, 231 Viral, 20, 72, 73, 79, 154, 231 Virus, 175, 180, 196, 213, 231 Vitro, 197, 231 Vivo, 86, 231 W Warfarin, 4, 5, 22, 26, 37, 57, 59, 60, 61, 63, 149, 150, 231 White blood cell, 10, 173, 203, 204, 207, 208, 213, 231
Windpipe, 227, 231 Wound Healing, 14, 201, 205, 231 X X-ray, 10, 61, 84, 149, 152, 177, 179, 183, 205, 208, 218, 221, 232 Y Yeasts, 194, 212, 232 Z Zygote, 184, 232 Zymogen, 181, 216, 232
Index 247
248
Blood Clots
