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

CHOLECYSTECTOMY A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES J AM...

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CHOLECYSTECTOMY A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2004 by ICON Group International, Inc. Copyright 2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Cholecystectomy: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-497-00235-3 1. Cholecystectomy-Popular works. I. Title.

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

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

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on cholecystectomy. 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 CHOLECYSTECTOMY ................................................................................. 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Cholecystectomy.......................................................................... 10 E-Journals: PubMed Central ....................................................................................................... 14 The National Library of Medicine: PubMed ................................................................................ 14 CHAPTER 2. NUTRITION AND CHOLECYSTECTOMY ....................................................................... 59 Overview...................................................................................................................................... 59 Finding Nutrition Studies on Cholecystectomy .......................................................................... 59 Federal Resources on Nutrition ................................................................................................... 61 Additional Web Resources ........................................................................................................... 62 CHAPTER 3. ALTERNATIVE MEDICINE AND CHOLECYSTECTOMY ................................................. 63 Overview...................................................................................................................................... 63 National Center for Complementary and Alternative Medicine.................................................. 63 Additional Web Resources ........................................................................................................... 67 General References ....................................................................................................................... 68 CHAPTER 4. PATENTS ON CHOLECYSTECTOMY.............................................................................. 69 Overview...................................................................................................................................... 69 Patents on Cholecystectomy......................................................................................................... 69 Patent Applications on Cholecystectomy..................................................................................... 76 Keeping Current .......................................................................................................................... 77 CHAPTER 5. BOOKS ON CHOLECYSTECTOMY ................................................................................. 79 Overview...................................................................................................................................... 79 Book Summaries: Federal Agencies.............................................................................................. 79 Book Summaries: Online Booksellers........................................................................................... 82 Chapters on Cholecystectomy ...................................................................................................... 83 CHAPTER 6. MULTIMEDIA ON CHOLECYSTECTOMY ...................................................................... 85 Overview...................................................................................................................................... 85 Video Recordings ......................................................................................................................... 85 CHAPTER 7. PERIODICALS AND NEWS ON CHOLECYSTECTOMY ................................................... 89 Overview...................................................................................................................................... 89 News Services and Press Releases................................................................................................ 89 Newsletter Articles ...................................................................................................................... 91 Academic Periodicals covering Cholecystectomy......................................................................... 92 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 97 Overview...................................................................................................................................... 97 NIH Guidelines............................................................................................................................ 97 NIH Databases............................................................................................................................. 99 Other Commercial Databases..................................................................................................... 101 APPENDIX B. PATIENT RESOURCES ............................................................................................... 103 Overview.................................................................................................................................... 103 Patient Guideline Sources.......................................................................................................... 103 Finding Associations.................................................................................................................. 108 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 111 Overview.................................................................................................................................... 111 Preparation................................................................................................................................. 111 Finding a Local Medical Library................................................................................................ 111 Medical Libraries in the U.S. and Canada ................................................................................. 111 ONLINE GLOSSARIES................................................................................................................ 117

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Online Dictionary Directories ................................................................................................... 117 CHOLECYSTECTOMY DICTIONARY..................................................................................... 119 INDEX .............................................................................................................................................. 157

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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 cholecystectomy 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 cholecystectomy, 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 cholecystectomy, 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 cholecystectomy. 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 cholecystectomy, 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 cholecystectomy. 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 CHOLECYSTECTOMY Overview In this chapter, we will show you how to locate peer-reviewed references and studies on cholecystectomy.

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

Laparoscope-Guided Cholecystectomy Source: Contemporary Gastroenterology. 4(3): 39-40, 45-49. May-June 1991. Summary: As a surgical alternative to open cholecystectomy, the laparoscopic approach offers reduced pain and hospitalization time for selected patients. This article discusses patient selection, equipment and instruments, operative technique, and postoperative care for laparoscope-guided cholecystectomy. The author notes that initial experience suggests that there may be a slight increase in incidence of biliary ductal injury compared with open cholecystectomy. Finally, to achieve results comparable with those from open cholecystectomy, the author emphasizes that appropriate laparoscopic training is mandatory. 9 figures. 2 tables. 9 references. (AA-M).

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Intraoperative Cholangiography and Risk of Common Bile Duct Injury During Cholecystectomy Source: Journal of the American Medical Association. JAMA. 289(13): 1639-1644. April 2, 2003. Summary: Intraoperative cholangiography (IOC, an imaging test) may decrease the risk of common bile duct (CBD) injury during cholecystectomy (gallbladder removal) by helping to avoid misidentification of the CBD. This article reports on a study undertaken to characterize the relationship of IOC use and CBD injury while controlling for patient and surgeon characteristics. The database search identified 1,570,361 cholecystectomies and 7,911 CBD injuries (0.5 percent). Common bile duct injury was found in 2,380 (0.39 percent) of 613,706 patients undergoing cholecystectomy with IOC and in 5531 (0.58 percent) of 956,655 patients undergoing cholecystectomy without IOC. After controlling for patient level factors and surgeon level factors, the risk of injury was increased when IOC was not used. While surgeons performing IOCs routinely had a lower rate of CBD injuries than those who did not, this difference disappeared when IOC was not used. 1 figure. 3 tables. 38 references.

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Laparascopic Cholecystectomy: Complications Call for Caution Source: Practical Gastroenterology. 15(4): 31-32, 35-36, 41, 45. April 1991. Summary: Laparoscopic cholecystectomy is an exciting new procedure that will probably soon be the technique of choice for the surgical treatment of symptomatic cholelithiasis. Influenced by consumer demand, most general surgeons will want to make this technique for gallbladder removal available to their patients. This article focuses on the complications of this procedure reported to date. The management of common duct stones and the possibly greater complication rates for this procedure compared to traditional open cholecystectomy are reasons to temper present enthusiasm for the new technique. The author uses five case studies to explain the potential complications of the procedure. 10 figures. 8 references. (AA-M).

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Reimbursement for Laparoscopic Laser Cholecystectomy Source: Journal of Laparoendoscopic Surgery. 1(1): 31-32. 1990. Summary: Reimbursement for laparoscopic laser cholecystectomy (LLC) procedures is a new issue for physicians and insurance carriers. Because of the advanced skill and technical components needed, this type of procedure should be reimbursed at a higher rate than the standard cholecystectomy. This article recounts the struggle that one physician's group went through to receive reimbursement at a premium rate. The author notes that they quickly came to the conclusion that the LLC needed to be presented to the insurance carriers as a different procedure than the incisional cholecystectomy. The author advocates providing insurance carriers with early, detailed information; meeting with insurance medical directors and their staffs; using videos and lectures; and using the unlisted code number 47999 to obtain approval and reimbursement for the LLC. Rationale for each of these approaches is presented. One figure presents a flow chart for working through this issue.

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Effect of Cholecystectomy on Duodenojejunal Motility in Humans Source: Neurogastroenterology and Motility. 14(3): 279-285. June 2002.

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Contact: Available from Blackwell Science, Ltd. Journal Subscriptions, P.O. Box 88, Oxford OX2 OEL, UK. +44 1865 206180 Fax +44 1865 206219. E-mail: [email protected]. Summary: The authors of this article hypothesized that certain gastrointestinal symptoms following cholecystectomy (removal of the gallbladder) could be explained by motor disturbances. To test this hypothesis, the authors compared pre and post operative motor patterns between symptomatic and asymptomatic patients after surgery to evaluate whether some motor changes could be induced by gallbladder removal and associated with symptoms. The study evaluated 23 patients before and 3 months after cholecystectomy. After surgery, 17 patients were asymptomatic and six were symptomatic. Duodenojejunal (the first part of the small intestine, including the connection to the stomach) manometric recordings were performed for 3 hours during fasting, then 3 hours after a 750 kilocalorie meal. Patient motor results were compared to those obtained in the duodenojejunum of 20 healthy controls. After surgery, only a few modifications in duodenojejunal motility were observed compared to the preoperative period. Motor changes related to cholecystectomy were increase in phase III amplitude and the absence of progressive decrease of the duodenojejunal motor response after the meal. After surgery, symptomatic patients had a lower postprandial duodenal motility index after the mean than asymptomatic patients and had more frequent propagated clusters of contractions (PCCs). Preoperative motor patterns associated with postoperative symptoms were postprandial only and included a low duodenal motility index and a higher number of PCCs. Removal of the gallbladder has a limited effect on duodenojejunal motility. Few motor differences existed between symptomatic and asymptomatic patients after surgery. However, a low duodenal motor response to a meal and PCCs were often associated with symptoms. 3 figures. 2 tables. 19 references. •

Laparoscopic Cholecystectomy: A Remarkable Development Source: JAMA. Journal of the American Medical Association. 265(12): 1573-1574. March 27, 1991. Summary: The fundamental change in technique for cholecystectomy from open, abdominal surgery to laparoscopic methods has occurred despite very limited published data to substantiate that the laparoscopic approach is superior to the traditional procedure. This editorial contends that some concern regarding the safety of laparoscopic cholecystectomy is appropriate. The authors call for additional preparation and supervision during the learning phase for each surgeon undertaking the laparoscopic technique and careful, critical analysis and review of additional patient series in order to accurately define the risks, indications and contraindications for laparoscopic cholecystectomy. 8 references.

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Applications of Lasers in Laparoscopic Cholecystectomy Source: Journal of Laparoendoscopic Surgery. 1(1): 33-36. 1990. Summary: The meteoric growth of laparoscopic cholecystectomy has sparked intense interest in lasers. This article reviews the laser technologies available for laparoscopic use. The relative merits and liabilities for each wavelength and delivery system are discussed. Specific lasers covered are: CO2 laser; argon laser; Nd:YAG laser; and KTP laser. The author notes that laparoscopic cholecystectomy results in a dramatic enhancement of patient comfort, marked reduction in postoperative recuperation time, and the conversion of an inpatient procedure to a short stay or outpatient procedure. However, it must be recognized that the use of the laparoscope rather than a subcostal

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incision is the main reason for this striking difference in patient outcome. Proponents of laser technology list the precision of these devices and the ability to control the tissue effect at the desired target as the main advantages of these technologies over electrocautery. The author concludes that no single instrument or laser wavelength is absolutely perfect, so surgeons should select instrumentation based on their own experiences and comfort level. 12 references. (AA-M). •

Gallstones in Elderly Patients: Impact of Laparoscopic Cholecystectomy Source: Canadian Journal of Gastroenterology. 14(11): 929-932. December 2000. Contact: Available from Pulsus Group, Inc. 2902 South Sheridan Way, Oakville, Ontario, Canada L6J 7L6. Fax (905) 829-4799. E-mail: [email protected]. Summary: The use of laparoscopic cholecystectomy (LC, removal of the gallbladder) in elderly patients may pose problems because of their poor general condition, especially of cardiopulmonary (heart and lung) function. Moreover, these patients present with acute cholecystitis (inflammation of the gallbladder) and associated common bile duct stones more often than their younger counterparts. In this article, the authors report on their experience from 1990 to 1999 when they performed 943 LCs; 31 (3.2 percent) were attempted on elderly patients, 11 (35 percent) of which were on an emergency basis because of acute cholecystitis, cholangitis (bile duct inflammation) or acute biliary pancreatitis. Ten percent of LCs needed to be converted to an open cholecystectomy, most often because of an increase in the partial pressure of carbon dioxide in the blood produced by excessive operative time. A gasless procedure (LC usually uses gas to increase the abdominal cavity for access and visualization purposes) was used in the last three years of the study on eight cases; the overall rate of conversion from LC to open cholecystectomy in this group was 0 percent. Associated gallbladder and common bile duct stones were found in five (16 percent) patients. The success rate was 100 percent, overall morbidity was 29 percent and there was no mortality. The authors conclude that their results show that LC is a feasible and safe procedure for use in elderly patients. Gasless LC should be preferred in patients classified as American Society of Anesthesiologists' class III. 4 figures. 21 references.

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Laparoscopic Cholecystectomy for Severe Acute, Embedded, and Gangrenous Cholecystitis Source: Journal of Laparoendoscopic Surgery. 1(1): 37-40. 1990. Summary: This article describes the results and techniques of laparoscopic cholecystectomy for acute, embedded, and gangrenous cholecystitis. Based on experiences with 160 patients, operated on between February and September 1990, the author declares that laparoscopic cholecystectomy can be safely utilized for acutely inflamed, gangrenous, or deeply embedded gallbladders with cholecystitis. The complications are no greater than with more traditional methods, although retrograde dissection is frequently necessary to remove the deeply embedded gallbladder and to accurately identify the cystic duct-common duct junction. Drains are utilized more frequently than for chronic cholecystitis, but the postoperative course in terms of convalescence is no different than after conventional laparoscopic cholecystectomy. Most patients are discharged within 24 hours. Five photographs illustrate the procedure.

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Delineating Clinical Privileges for New Procedures: Laparoscopic Cholecystectomy Source: Quality Letter for Healthcare Leaders. p. 2-6. December 1990-January 1991.

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Summary: This article discusses issues of granting privileges to physicians for new procedures, using the example of laparoscopic cholecystectomy as a case in point. Five health care leaders from medicine and law discuss topics including: should the procedure be restricted to general surgeons?; should physicians newly credentialed to do the procedure be proctored, and if so, by whom and for how long?; and how will the performance of the procedure be monitored on a regular basis? Specific topics include the procedure of laparoscopic cholecystectomy, training to learn the procedure, privilege delineation, proctoring, and continuing performance issues. The author notes that the insights and advice given by the leaders in this article apply to many other current and future medical procedures that will require credentialing guidelines. 8 references. •

Laparoscopic Cholecystectomy Source: Practical Gastroenterology. 15(4): 16, 21, 25-27. April 1991. Summary: This article discusses the surgical technique of laparoscopic cholecystectomy and compares the results reported to date to those of conventional cholecystectomy. The author notes that the learning curve for laparoscopic cholecystectomy is not short, but once overcome, the procedure should be at least as safe and efficacious as standard open cholecystectomy. The current reviewed morbidity of 2 to 6 percent and mortality of 0.5 percent for the laparoscopic procedure during the learning curve is comparable to the open procedure of 4 to 5 percent and almost zero respectively. 3 figures. 3 tables. 9 references. (AA-M).

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Should Elective Endoscopic Sphincterotomy Replace Cholecystectomy for the Treatment of High-Risk Patients with Gallstone Pancreatitis? (editorial) Source: Journal of Clinical Gastroenterology. 13(2): 125-128. April 1991. Summary: This article notes that endoscopic sphincterotomy is currently the procedure of choice for management of retained common bile duct stones following cholecystectomy. It also is used more frequently for choledocholithiasis with an intact gallbladder in high-risk patients and in some patients with acute gallstone pancreatitis. To avoid surgery in high-risk patients, the authors propose that an elective endoscopic sphincterotomy may be a reasonable therapeutic option regardless of whether common bile duct stones are present. A prospective trial is needed to examine this issue, since, to date, there is no literature on endoscopic sphincterotomy in the absence of choledolithiasis for gallstone pancreatitis in patients with intact gallbladders. 1 table. 30 references. (AA-M).

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Endoscopic Cholecystectomy: A New Approach Source: Today's O.R. Nurse. 12(8): 17-20. August 1990. Summary: This article presents an overview of the perioperative care of patients undergoing endoscopic cholecystectomy, and the methodology, risks, and benefits associated with laparoscopic cholecystectomy as compared with laparotomy. Six sections discuss: patient selection criteria; perioperative process and methodology; specific equipment and room set-up; associated risks and complications of laparoscopy; benefits associated with the endoscopic cholecystectomy; and a summary. The focus is primarily on the medical details of the surgical procedure. The benefits of endoscopic cholecystectomy are a reduced hospital stay, early return to work, no restrictions on activity, and several small dimples instead of a large scar remaining after the surgery. The author notes that many general surgeons who want to perform this procedure must

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learn the laparoscopic technique, which has long been employed by gynecologic surgeons. The benefits associated with the laparoscopic cholecystectomy make it a procedure of choice for patients, third party payers, and employers. 8 references. •

Endoscopic Cholecystectomy Source: Gastroenterology Nursing. 13(1): 13-17. Summer 1990. Summary: This article presents the benefits, methodology, procedure, and risks associated with laparoscopic cholecystectomy. The response has been favorable as physicians and the public become more aware of the benefits and fewer risks associated with laparoscopically performed cholecystectomies. The technique leaves minimal scarring and the postoperative restrictions are similar to those for other laparascopic procedures. Numerous illustrations depict the equipment and the surgical techniques used. 11 figures. 1 table. 9 references.

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Expert Panel Endorses Laparoscopic Cholecystectomy Source: AGA News. American Gastroenterology Association News. 26(6): 1, 12. November-December 1992. Summary: This article reports on a recent endorsement by a panel of experts convened by the National Institutes of Health that determined laparoscopic cholecystectomy is a safe surgical treatment for gallbladder removal that is equally as effective as traditional open surgery. The Consensus Development Conference Panel based its recommendations on evidence presented by nearly 30 speakers from all over the world and included basic scientists, physicians, epidemiologists, surgeons, and technicians. The article reports on the recommendations in the areas of patient selection for surgery; alternatives to gallbladder removal; training and credentialing issues; complications; and cost differences. The panel's final recommendation specified that future research should focus on refining the technique of laparoscopic cholecystectomy to maximize the safety and cost effectiveness of the procedure. 1 figure.

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Asymptomatic Gallstones Revisited: Is There a Role for Laparoscopic Cholecystectomy? Source: Archives of Family Medicine. 2(9): 959-968. September 1993. Summary: This article reports on a study undertaken to compare the mortality effects of prophylactic laparoscopic cholecystectomy with that of expectant management (therapy delayed until gallstone symptoms or complications develop) in persons with asymptomatic gallstones. The study design consisted of decision analytic models of the two clinical strategies, using input data from a review of the published medical literature pertaining to the epidemiology, natural history, and treatment outcomes related to gallstone disease. Results show that the prophylactic laparoscopic cholecystectomy strategy led to fewer gallstone-related deaths than the expectant management strategy, but all of the deaths in the former group occurred earlier in life. Sensitivity analysis demonstrated the superiority of expectant management over a wide range of input assumptions. The authors conclude that prophylactic laparoscopic cholecystectomy should not be routinely recommended for individuals with asymptomatic gallstones. 6 figures. 1 table. 99 references. (AA-M).

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Diagnostic and Therapeutic Technology Assessment (DATTA): Laparoscopic Cholecystectomy Source: JAMA. Journal of the American Medical Association. 265(12): 1585-1587. March 27, 1991. Summary: This article reports the opinions of a panel of 20 physician consultants on the safety and effectiveness of laparoscopic cholecystectomy. The majority of panelists considered laparoscopic cholecystectomy to be an appropriate treatment for uncomplicated cholelithiasis. They stress that laparoscopic removal of the gallbladder is a complex endoscopic biliary procedure that requires coordinated manipulations by a well-trained team. It is acknowledged that there are no comparative trials of this technique versus open cholecystectomy and virtually no literature about complication rates. 2 figures. 5 references.

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Laparoscopic Cholecystectomy: From Gimmick to Gold Standard Source: Journal of Clinical Gastroenterology. 19(4): 325-330. December 1994. Summary: This article reviews the history of laparoscopic cholecystectomy and compares available evidence for laparoscopic and open cholecystectomy in terms of incidence and outcome. Topics covered include the operative technique of laparoscopic cholecystectomy; the incidence of its use; outcome studies, notably focusing on length of stay and overall convalescence; common bile duct injury; mortality; complications of laparoscopy; conversion to open cholecystectomy; and the National Institutes of Health consensus development conference held in September of 1992 on this topic. The authors' review supports the notion that laparoscopic cholecystectomy is safe and effective, has an acceptable complication rate, and a considerably shorter convalescence. They conclude that laparoscopic cholecystectomy is not the treatment of choice for symptomatic cholelithiasis and is becoming the new standard against which other procedures should be judged. 1 figure. 31 references. (AA-M).

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Laparascopic Cholecystectomy Source: JAMA. Journal of the American Medical Association. 266(2): 269. July 10, 1991. Summary: This article, from a questions-and-answers column, presents the views of two surgeons on laparoscopic cholecystectomy. Topics covered include the advantages of laparotomy over routine cholecystectomy, the indications and contraindications for the laparoscopic approach, and how physician and surgeon charges for this procedure differ from conventional surgery.

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Electrocautery Is Superior to Laser For Laparoscopic Cholecystectomy Source: American Journal of Surgery. 160(5): 457. November 1990. Summary: This brief article asserts that electrocautery is superior to laser for laparoscopic cholecystectomy. The authors stress that originally, laser-assisted laparoscopic cholecystectomy was supported with great enthusiasm. Only by default was the conclusion reached that the simpler electrocautery was not equal to but superior to the laser. After discussing the differences in required training level and costs, the authors note that the laser benefit that has been promoted may actually be detrimental. The availability of the procedure may be limited in hospitals with progressively limited budgets, as well as complicating the accreditation of would-be laparoscopic surgeons. The authors conclude that physicians have a responsibility not only to evaluate, endorse, and implement major improvements, but also to recognize and derail unsound

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or cost-ineffective technology, including lithotripsy and oral dissolution of gallstones as well as laser-assisted dissection of the gallbladder. •

Laparoscopic Cholecystectomy (editorial) Source: American Journal of Surgery. 159(3): 273. March 1990. Summary: This brief editorial considers recent experience with laparoscopic cholecystectomy. The authors stress that the most important advantage of laparascopic cholecystectomy is that it eliminates the trauma of access as well as the transient ileus that follows open abdominal surgery. The authors also contend that the need for preliminary gallstone lithotripsy and extraction prior to endoscopic cholecystectomy, the technique and use of intraoperative cholangiography, the optimal technique and instruments for dissection of the cystic artery and duct, and the possible use of lasergenerated energy or electrosurgery to dissect the gallbladder from the liver bed are but a few of the issues that require further evaluation. Other issues discussed include the need for proper training for surgeons performing laparascopic surgery, surgery performed in centers specializing in laparascopy, and accreditation.

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Why are Cholecystectomy Rates Increasing? (editorial) Source: JAMA. Journal of the American Medical Association. 273(20): 1621-1622. May 24-31, 1995. Summary: This editorial comments on another article in this issue that reports on the increasing number of cholecystectomies in the elderly population in Pennsylvania. The author explores the reasons for this change in practice behavior and considers whether the change is necessary. Topics include the impact of the introduction of laparoscopic cholecystectomy; lowering thresholds for patient selection for cholecystectomy; risk versus benefit; determining likelihood of recurrence of biliary pain; and the crucial nature of detailed differential diagnosis. The authors conclude with a brief discussion about two misperceptions that may affect practice patterns: first, that benefit is overestimated as persons with coincidental stones undergo operations; and second, that risk is underestimated for serious complications like bile duct injury. 10 references. (AAM).

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Cholecystectomy Made Easier Source: American Journal of Nursing. 90(12): 38-39. December 1990. Summary: Written for a nursing audience, this article discusses removing the gallbladder using a laser technique called laparoscopic laser cholecystectomy. In uncomplicated cases, laser technique allows surgeons to remove a gallbladder through tiny punctures, avoiding the postoperative risks and lengthy recovery phase of major abdominal surgery. Four sections detail the procedure itself, postoperative care, possible complications, and discharge instructions. 5 figures. 4 references.

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

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Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to cholecystectomy. 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 cholecystectomy. The following is typical of the type of information found when searching the CRISP database for cholecystectomy: •

Project Title: EPIDEMIOLOGY OF GALLBLADDER SLUDGE & STONES IN PREGNANCY Principal Investigator & Institution: Lee, Sum P.; Professor and Chief; Medicine; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2003; Project Start 01-APR-1996; Project End 28-FEB-2007 Summary: (provided by applicant): The female gender and multiparity are the two most important positive correlates of cholesterol gallstone disease. Pregnancy represents the period of time when the 'lithogenic' pressure on a woman is the highest. Biliary sludge is a precursor stage of gallstones. We studied the etiological factors associated with the development of sludge and stones during pregnancy, and our early results suggest that it is inversely related to physical activity. We also found that being overweight, a known risk factor for gallstone disease, is associated with high blood leptin levels. In addition, the risk associated with high leptin levels is partially mitigated by physical activity. In order to disentangle the effects of physical activity, leptin and gestational diabetes on gallbladder disease risk, and to understand the mechanisms behind the observed associations, we propose to conduct a randomized controlled trial. This interventional study is a logical extension of our previous observational investigation. Our Specific Aims are: 1. To evaluate whether an endurance exercise program is associated with lower risk of gallbladder disease in overweight pregnant women.2. To evaluate whether an endurance exercise intervention program changes leptin levels in pregnancy among overweight women.3. To examine the associations between gallbladder disease incidence and potential causal variables in this prospective trial. These variables include leptin levels, HDL, insulin levels, BMI (as it varies within women classified as overweight), as well as changes in these variables. Gallstone disease affects 15-20% of adult Americans. Cholecystectomy is one of the most commonly performed operations. The morbidity, and the burden of cost, incurred by gallstones are staggering. Yet there is a dearth of understanding in the epidemiology and the cause of this disease. The results of this investigation should generate new, important and useful insights into the pathogenesis, and provide a rational strategy for the prevention, of this common and costly disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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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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Project Title: EVALUATION OF MINIMALLY INVASIVE SURGERY Principal Investigator & Institution: Rogers, Stanley J.; Surgery; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 941222747 Timing: Fiscal Year 2002; Project Start 30-SEP-1999; Project End 31-AUG-2004 Summary: Major advances have been made over the past decade developing minimallyinvasive endoscopic, surgical and radiographic procedures in an attempt to decrease mortality, morbidity, hospital stay and overall health care costs in treating patients with abdominal disorders. The treatment of these common gastrointestinal disorders needs to be studied in randomized controlled clinical trials. Given my training and experience in surgical endoscopy and minimally invasive surgery (laparoscopy), I propose studying in the context of randomized controlled clinical trials three distinct areas of gastrointestinal disease in which major advances have occurred employing laparoscopy, endoscopy and interventional radiological techniques. The three principal projects for this mentored clinical research are the following: 1. Randomized controlled clinical trial of laparoscopic cholecystectomy with laparoscopic common bile duct exploration versus endoscopic retrograde cholangiopancreatography with sphincterotomy followed by laparoscopic cholecystectomy for patients with common bile duct stone disease. 2. Laparoscopic anti-reflux surgery versus long-term administration of proton pump inhibitors (lanzoprasole) for moderate to severe gastroesophageal reflux disease. 3. Intra-arterial chemoembolization alone versus intra-arterial chemoembolization plus laparoscopic, ultrasound-guided radiofrequency ablation for non-resectable hepatocellular carcinoma. All three protocols involve minimally invasive surgery and other therapies studied in a prospective randomized controlled fashion. While the technical expertise, equipment and facilities used to perform these procedures have been developed around the world, few randomized controlled clinical trials exist that critically examine outcome parameters for a sufficient period of time to document efficacy, safety, improved survival and overall cost benefits in the treatment of these disorders. These three trials will allow such an evaluation of minimally invasive procedures used to treat patients with common gastrointestinal disorders. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MEDICAL HISTORY, MEDICATIONS, AND PANCREATIC CANCER RISK Principal Investigator & Institution: Mandelson, Margaret T.; Associate Investigator; Center for Health Studies Seattle, Wa 98101 Timing: Fiscal Year 2003; Project Start 01-AUG-2003; Project End 31-JUL-2005 Summary: (provided by applicant): Risk factors for pancreatic cancer are not well established. The goal of this pilot study is to investigate the relation between medical history, medication use and pancreatic cancer in a case-control study based on medical record abstraction and electronic laboratory and pharmacy data. Our specific aims are: 1. To investigate the relation between medical conditions and pancreatic cancer risk, focusing on: a. Diabetes mellitus, including disease duration, therapy, and glycemic control. b. Pancreatic inflammation, including acute and chronic pancreatitis. c. History of peptic ulcer disease and/or infection with Helicobacter pylori (H. pylori). d. History of cholecystectomy and/or cholelithiasis. 2. To investigate the relation between the use of medications and pancreatic cancer, focusing on nonsteroidal anti-inflammatory drugs, cholesterol lowering agents including HMG-CoA reductase inhibitors and acid suppressive medications including histamine receptor antagonists and proton pump inhibitors. As a secondary specific aim we propose to examine additional medical

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conditions and medications in order to generate hypotheses for future studies of the epidemiology and prevention of pancreatic cancer. These include evaluation of medical conditions such as irritable bowel syndrome, allergies and asthma as well as medications including immunosuppressive medications and angiotensin converting enzyme inhibitors. To meet these specific aims we propose to conduct a case-control study of pancreatic cancer comprised of 250 newly diagnosed cases and 1,000 controls in the defined population of Group Health Cooperative, a large health maintenance organization. Data on prior medical conditions and medications will be collected through abstraction of traditional and computerized medical records, including electronic laboratory and pharmacy data. Study strengths include the availability of uniformly collected, long-term medical and pharmacy data and the availability of data on important covariates, including smoking. The proposed study will provide a unique opportunity to investigate the role of medical conditions and medications in pancreatic tumorigenesis and to generate new insights into the mechanisms that result in pancreatic cancer. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: OBESITY, LEPTIN AND GALLSTONE PATHOGENESIS Principal Investigator & Institution: Pitt, Henry A.; Surgery; Medical College of Wisconsin Po Box26509 Milwaukee, Wi 532260509 Timing: Fiscal Year 2002; Project Start 15-JUL-1992; Project End 31-MAR-2006 Summary: (Verbatim from Applicant's Abstract): Approximately 30,000,000 Americans have gallstones, and the vast majority are overweight. This laboratory's long-term objective is to understand the pathogenesis of cholesterol gallstone formation. Gallstone pathogenesis is related to alterations in 1) hepatic lipid metabolism, 2) cholesterol crystal nucleation, and/or 3) biliary motility. Gallstones occur most commonly in obese, middle-aged, multiparous women. Recent studies have clarified the role of gender, iron deficiency, and female hormones in gallstone pathogenesis. Similarly, the role of leptin and malformation of its receptor in the pathogenesis of obesity has been elucidated in the last few years. However, the connections between obesity, leptin and gallstone formation remain obscure. Recent data from this laboratory is congenitally obese ob/ob mice suggest that they have alterations in biliary lipids, enhanced cholesterol crystal formation and increased gallbladder volume. Leptin receptors also have been demonstrated in the liver and biliary tree of both mice and humans. Therefore, the hypothesis of this proposal is that leptin or malfunction of its receptor contribute to the increased incidence of gallstone formation in obesity by altering hepatic lipid metabolism, cholesterol crystal nucleation and biliary motility. Two related specific aims will be 1) to determine whether obesity, leptin, or leptin receptor malfunction alters a) hepatic lipid metabolism, b) cholesterol crystal nucleation, and/or c) biliary motility and 2) determine whether genetic alteration in leptin and its receptor on gallstone formation are additive. Preliminary studies in female, leptin deficient ob/ob mice suggest that these animals are prone to cholesterol gallstone formation. A series of studies in ob/ob, ob+/- (heterozygote), db/db (leptin receptor malfunction, and AY (Agouti yellow) mice as well genetically crossed ob/ob and db/db mice are proposed to dissect which pathogenic mechanisms link obesity, leptin and gallstones. Similarly, bile serum and tissue from lean and obese humans undergoing cholecystectomy will be systematically studied to establish clinical relevance. These studies should lead to unique strategies for gallstone prevention, which is the ultimate goal of this research. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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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 “cholecystectomy” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for cholecystectomy in the PubMed Central database: •

Biliary lipid secretion in cholesterol gallstone disease. The effect of cholecystectomy and obesity. by Shaffer EA, Small DM.; 1977 May; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=372291

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Concentrations of cefoxitin in gallbladder bile of cholecystectomy patients. by Hansbrough JF, Clark JE.; 1982 Oct; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=183822

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Effects of cholecystectomy on the kinetics of primary and secondary bile acids. by Berr F, Stellaard F, Pratschke E, Paumgartner G.; 1989 May; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=303859

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

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

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A 10-year experience of unsuspected gallbladder cancer after laparoscopic cholecystectomy. Author(s): Chan CP, Chang HC, Chen YL, Yang LH, Chen ST, Kuo SJ, Tsai PC. Source: Int Surg. 2003 July-September; 88(3): 175-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14584775

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A 10-year serial, prospective study of laparoscopic cholecystectomy training in a single region. Author(s): Bailey CM, Lintott P, Grogono JL. Source: Annals of the Royal College of Surgeons of England. 2003 September; 85(5): 3213. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14594536

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A metaanalysis of laparoscopic cholecystectomy in patients with cirrhosis. Author(s): Puggioni A, Wong LL. Source: Journal of the American College of Surgeons. 2003 December; 197(6): 921-6. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14644279

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A prospective randomized study of prophylactic antibiotics in elective laparoscopic cholecystectomy. Author(s): Koc M, Zulfikaroglu B, Kece C, Ozalp N. Source: Surgical Endoscopy. 2003 November; 17(11): 1716-8. Epub 2003 June 17. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12802644

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A prospective study of bile leaks after laparoscopic cholecystectomy. Author(s): Hasl DM, Ruiz OR, Baumert J, Gerace C, Matyas JA, Taylor PH, Kennedy GM. Source: Surgical Endoscopy. 2001 November; 15(11): 1299-300. Epub 2001 September 04. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11727137

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A prospective study of common bile duct calculi in patients undergoing laparoscopic cholecystectomy: natural history of choledocholithiasis revisited. Author(s): Collins C, Maguire D, Ireland A, Fitzgerald E, O'Sullivan GC. Source: Annals of Surgery. 2004 January; 239(1): 28-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14685097

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A retrospective analysis of patients with gallbladder cancer treated with radical resection versus cholecystectomy plus external radiotherapy. Author(s): Mondragon-Sanchez R, Gonzalez-Geroniz M, Onate-Ocana LF, GardunoLopez AL, Mondragon-Sanchez A, Bernal-Maldonado R, Ruiz-Molina JM. Source: Hepatogastroenterology. 2003 November-December; 50(54): 1806-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14696410

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A simple technique for decompression of distended gallbladder during laparoscopic cholecystectomy. Author(s): Hodgson WJ. Source: Surgical Endoscopy. 2003 August; 17(8): 1330. Epub 2003 June 13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15039869

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A simple technique for delivery of bulky gallbladder during laparoscopic cholecystectomy. A cautionary note. Author(s): Ng WT. Source: Surgical Endoscopy. 2000 April; 14(4): 407. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10790565

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A simple way to retrieve the gallbladder in '5-mm' laparoscopic cholecystectomy. Author(s): Quah HM, Hadi HI, Hay DJ, Maw A. Source: Annals of the Royal College of Surgeons of England. 2003 July; 85(4): 282-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12908472

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Abdominal symptoms: do they disappear after cholecystectomy? Author(s): Berger MY, Olde Hartman TC, Bohnen AM. Source: Surgical Endoscopy. 2003 November; 17(11): 1723-8. Epub 2003 June 17. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12802649

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Abdominal wall lift versus positive-pressure capnoperitoneum for laparoscopic cholecystectomy: randomized controlled trial. Author(s): Alijani A, Hanna GB, Cuschieri A. Source: Annals of Surgery. 2004 March; 239(3): 388-94. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15075657

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Acute congestive heart failure after laparoscopic cholecystectomy: a case report. Author(s): Giaquinto D, Swigar K, Johnson MD. Source: Aana Journal. 2003 February; 71(1): 17-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12776645

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Alcohol consumption in relation to risk of cholecystectomy in women. Author(s): Leitzmann MF, Tsai CJ, Stampfer MJ, Rimm EB, Colditz GA, Willett WC, Giovannucci EL. Source: The American Journal of Clinical Nutrition. 2003 August; 78(2): 339-47. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12885719

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Analysis of procedure time in robot-assisted surgery: comparative study in laparoscopic cholecystectomy. Author(s): Ruurda JP, Visser PL, Broeders IA. Source: Computer Aided Surgery : Official Journal of the International Society for Computer Aided Surgery. 2003; 8(1): 24-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14708755

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Anesthesia related complications of laparoscopic cholecystectomy. Author(s): Qureshi FA. Source: J Coll Physicians Surg Pak. 2003 July; 13(7): 369-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12887833

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Anomalous insertion of the right hepatic duct into the cystic duct: report of a case diagnosed before laparoscopic cholecystectomy. Author(s): Nomura T, Shirai Y, Sasagawa M, Wakai T, Hatakeyama K. Source: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques. 1999 June; 9(3): 211-2. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10804003

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Antibiotic prophylaxis in elective cholecystectomy: a randomized, double blinded study comparing ciprofloxacin and cefuroxime. Author(s): Agrawal CS, Sehgal R, Singh RK, Gupta AK. Source: Indian J Physiol Pharmacol. 1999 October; 43(4): 501-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10776469

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Applying robotic assistance to laparoscopic cholecystectomy. Author(s): Donias HW, Karamanoukian HL, D'Ancona G, Hoover EL. Source: Annals of Surgery. 2002 March; 235(3): 446; Author Reply 446-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11917168

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Audit of laparoscopic cholecystectomy in a single center. Author(s): Cheung MT, Yuen CH, Tse CW, Chia NH, Chiu WY. Source: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques. 1999 June; 9(3): 181-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10803995

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Balloon blunt-tip trocar for laparoscopic cholecystectomy: improvement over the traditional Hasson and Veress needle methods. Author(s): Bernik TR, Trocciola SM, Mayer DA, Patane J, Czura CJ, Wallack MK. Source: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A. 2001 April; 11(2): 73-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11327130

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Bare bones laparoscopy: a randomized prospective trial of cost savings in laparoscopic cholecystectomy. Author(s): Brackman MR, Foley E, Esquivel J, Boisvert ME, Davis S, Daza E, Kirkpatrick JR, Finelli FC. Source: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A. 2002 December; 12(6): 411-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12590721

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Benign cystic mesothelioma in a 60-year-old woman after cholecystectomy. Author(s): Petrou G, Macindoe R, Deane S. Source: Anz Journal of Surgery. 2001 October; 71(10): 615-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11552941

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Bilateral eye hemorrhage after laparoscopic cholecystectomy. Author(s): Calenda E, Muraine M, Zerzour H, Sambo B, Siahmed K. Source: Acta Anaesthesiologica Scandinavica. 2001 September; 45(8): 1045. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11576060

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Bile duct injuries 12 years after the introduction of laparoscopic cholecystectomy. Author(s): Chapman WC, Abecassis M, Jarnagin W, Mulvihill S, Strasberg SM. Source: Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract. 2003 March-April; 7(3): 412-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12654568

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Bile duct injuries during laparoscopic cholecystectomy: an audit of 1522 cases. Author(s): Mahatharadol V. Source: Hepatogastroenterology. 2004 January-February; 51(55): 12-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15011821

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Bile duct injury after laparoscopic cholecystectomy: resection of the entire extrahepatic biliary tree. Author(s): Dixon E, Sutherland FR, Vollmer CM Jr, Greig PD. Source: Journal of the American College of Surgeons. 2003 November; 197(5): 862-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14585428

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Bile duct injury during cholecystectomy and survival in medicare beneficiaries. Author(s): Flum DR, Cheadle A, Prela C, Dellinger EP, Chan L. Source: Jama : the Journal of the American Medical Association. 2003 October 22; 290(16): 2168-73. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14570952

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Bile duct injury during laparoscopic cholecystectomy: results of a national survey. Author(s): Archer SB, Brown DW, Smith CD, Branum GD, Hunter JG. Source: Annals of Surgery. 2001 October; 234(4): 549-58; Discussion 558-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11573048

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Bile duct injury during laparoscopic cholecystectomy: risk factors, mechanisms, type, severity and immediate detection. Author(s): Gigot JF. Source: Acta Chir Belg. 2003 April; 103(2): 154-60. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12768857

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Bile duct injury following laparoscopic cholecystectomy: a cause for continued concern. Author(s): Wudel LJ Jr, Wright JK, Pinson CW, Herline A, Debelak J, Seidel S, Revis K, Chapman WC. Source: The American Surgeon. 2001 June; 67(6): 557-63; Discussion 563-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11409804

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Bile duct of Luschka leading to bile leak after cholecystectomy--revisiting the biliary anatomy. Author(s): Sharif K, de Ville de Goyet J. Source: Journal of Pediatric Surgery. 2003 November; 38(11): E21-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14614740

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Bile leak from the accessory biliary duct following laparascopic cholecystectomy. Author(s): Pisanu A, Altana ML, Piu S, Uccheddu A. Source: G Chir. 2003 April; 24(4): 115-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12886748

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Bile leak from the hepatic bed after laparoscopic cholecystectomy. Author(s): Rossi P, Servili S, Contine A, Lucaroni Elena, Graziosi L, Carbone E, Annesi M, Framarini M, Tristaino B. Source: Chir Ital. 2002 July-August; 54(4): 507-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12239760

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Biliary complications associated with laparoscopic cholecystectomy--an analysis of common misconceptions. Author(s): Bingham J, McKie LD, McLoughlin J, Diamond T. Source: Ulster Med J. 2000 November; 69(2): 106-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11196720

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Biliary leaks after laparoscopic cholecystectomy. Results of the endoscopic treatment. Author(s): De Palma GD, Iuliano GP, Puzziello A, Manfredini S, Masone S, Persico G. Source: Minerva Chir. 2002 April; 57(2): 123-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11941287

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Biliary mishaps in laparoscopic cholecystectomy. Author(s): Verma GR, Bose SM, Singh R, Singh G. Source: Trop Gastroenterol. 2002 January-March; 23(1): 38-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12170923

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Biliary peritonitis complicating percutaneous nephrolithomy requiring laparoscopic cholecystectomy. Author(s): Fisher MB, Bianco FJ Jr, Carlin AM, Triest JA. Source: The Journal of Urology. 2004 February; 171(2 Pt 1): 791-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14713813

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Biliary tract injury in laparoscopic cholecystectomy: results of a single unit. Author(s): Miroshnik M, Saafan A, Koh S, Farlow J, Neophyton J, Lizzio J, Yee F, Ethell T, Bean A, Fenton-Lee D. Source: Anz Journal of Surgery. 2002 December; 72(12): 867-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12485222

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Bowel habits and bile acid malabsorption in the months after cholecystectomy. Author(s): Sauter GH, Moussavian AC, Meyer G, Steitz HO, Parhofer KG, Jungst D. Source: The American Journal of Gastroenterology. 2002 July; 97(7): 1732-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12135027

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Canadian Association of General Surgeons Evidence Based Reviews in Surgery. 7. Quality of life after bile duct injury during laparoscopic cholecystectomy. Author(s): Taylor MC, Hart R; CAGS Evidence Based Reviews in Surgery Group. Source: Canadian Journal of Surgery. Journal Canadien De Chirurgie. 2003 October; 46(5): 380-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14577713

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Cardiac arrest associated with use of an argon beam coagulator during laparoscopic cholecystectomy. Author(s): Kono M, Yahagi N, Kitahara M, Fujiwara Y, Sha M, Ohmura A. Source: British Journal of Anaesthesia. 2001 October; 87(4): 644-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11878741

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Cholecystectomy after treatment of choledocholithiasis: on firmer ground. Author(s): Jonnalagadda S. Source: Gastroenterology. 2003 August; 125(2): 617-8; Discussion 618. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12891568

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Cholecystectomy and duodenogastric reflux. Author(s): Smith RC. Source: Anz Journal of Surgery. 2003 June; 73(6): 369-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12801324

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Cholecystectomy in patients with Crohn's ileitis. Author(s): Chew SS, Ngo TQ, Douglas PR, Newstead GL, Selby W, Solomon MJ. Source: Diseases of the Colon and Rectum. 2003 November; 46(11): 1484-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14605566

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Cholecystectomy, lesser omentectomy, and stripping of the omental bursa: a peritonectomy procedure. Author(s): Vazquez Vde L, Sugarbaker PH. Source: Journal of Surgical Oncology. 2003 September; 84(1): 45-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12949991

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Cholecystitis after cholecystectomy. Author(s): King NK, Siriwardana HP, Siriwardena AK. Source: Journal of the Royal Society of Medicine. 2002 March; 95(3): 138-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11872767

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Choledocholithiasis caused by migration of a surgical clip after video laparoscopic cholecystectomy. Author(s): Dell'Abate P, Del Rio P, Soliani P, Colla G, Sianesi M. Source: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A. 2003 June; 13(3): 203-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12855105

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Clip choledocholithiasis after laparoscopic cholecystectomy. Author(s): Angel R, Abisambra N, Marin JC. Source: Endoscopy. 2004 March; 36(3): 251. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14986232

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Color Doppler ultrasonographic assessment of the risk of injury to major branch of the middle hepatic vein during laparoscopic cholecystectomy. Author(s): Shen BY, Li HW, Chen M, Zheng MH, Zang L, Jiang SM, Li JW, Jiang Y. Source: Hepatobiliary Pancreat Dis Int. 2003 February; 2(1): 126-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14607664

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Combined intrahepatic and extrahepatic biliary tree abnormality in the era of laparoscopic cholecystectomy. Author(s): Hashimoto M, Okuda C, Nagashima N, Nagao G, Matsuda M, Tsutsumi K, Watanabe G. Source: Surgery. 2004 March; 135(3): 355-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14976487

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Combined needlescopic cholecystectomy and laparoscopic splenectomy for the treatment of thalassaemic splenomegaly and cholelithiasis. Author(s): Jasmi AY, Thambidorai CR, Khairussalleh J. Source: Med J Malaysia. 2003 August; 58(3): 443-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14750388

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Comment on "A comparison of the effects of droperidol and the combination of droperidol and ondansetron on postoperative nausea and vomiting for patients undergoing laparoscopic cholecystectomy". Author(s): Vaidya JS. Source: Journal of Clinical Anesthesia. 2003 November; 15(7): 570. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14698374

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Comparison of single dose and three dose antibiotic prophylaxis with cefotaxime sodium in cholecystectomy. Author(s): Zahid MA, Bakhsh R, Dar FS, Akhter N, Malik ZI. Source: J Ayub Med Coll Abbottabad. 2003 January-March; 15(1): 38-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12870316

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Complications of laparoscopic cholecystectomy and their management. Author(s): Panpimanmas S, Kanyaprasit K. Source: Hepatogastroenterology. 2004 January-February; 51(55): 9-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15011820

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Concomitant open cholecystectomy and mammary reconstruction with bipedicled TRAM flap. Author(s): Sen M, Inan A, Yenidunya MO. Source: Plastic and Reconstructive Surgery. 2004 March; 113(3): 1087-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15108924

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Controlled-release codeine is equivalent to acetaminophen plus codeine for postcholecystectomy analgesia. Author(s): Chung F, Tong D, Miceli PC, Reiz J, Harsanyi Z, Darke AC, Payne LW. Source: Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 2004 March; 51(3): 216-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15010401

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Conversion of laparoscopic cholecystectomy to open cholecystectomy in acute cholecystitis: artificial neural networks improve the prediction of conversion. Author(s): Eldar S, Siegelmann HT, Buzaglo D, Matter I, Cohen A, Sabo E, Abrahamson J. Source: World Journal of Surgery. 2002 January; 26(1): 79-85. Epub 2001 November 26. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11898038

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Culdolaparoscopic cholecystectomy during vaginal hysterectomy. Author(s): Tsin DA, Sequeria RJ, Giannikas G. Source: Jsls. 2003 April-June; 7(2): 171-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12856851

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Cystic duct remnant and the 'post-cholecystectomy syndrome'. Author(s): Shaw C, O'Hanlon DM, Fenlon HM, McEntee GP. Source: Hepatogastroenterology. 2004 January-February; 51(55): 36-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15011827

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Damage to extrahepatic bile ducts during laparoscopic cholecystectomy--own experience. Author(s): Paczynski A, Koziarski T, Stanowski E, Krupa J. Source: Medical Science Monitor : International Medical Journal of Experimental and Clinical Research. 2001 May; 7 Suppl 1: 102-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12211701

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Day-case laparoscopic cholecystectomy: a prospective evaluation of a 6-year experience. Author(s): Ammori BJ, Davides D, Vezakis A, Martin IG, Larvin M, Smith S, Gibson JS, McMahon MJ. Source: Journal of Hepato-Biliary-Pancreatic Surgery. 2003; 10(4): 303-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14598151

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Day-only laparoscopic cholecystectomy in a regional teaching hospital. Author(s): Blatt A, Chen S. Source: Anz Journal of Surgery. 2003 May; 73(5): 321-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12752289

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Cholecystectomy

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Deep venous thrombosis after laparoscopic cholecystectomy and prevention with nadroparin. Author(s): Schaepkens Van Riempst JT, Van Hee RH, Weyler JJ. Source: Surgical Endoscopy. 2002 January; 16(1): 184-7. Epub 2001 October 05. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11961636

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Detection of common bile duct stones before laparoscopic cholecystectomy. Evaluation with MR cholangiography. Author(s): Boraschi P, Gigoni R, Braccini G, Lamacchia M, Rossi M, Falaschi F. Source: Acta Radiologica (Stockholm, Sweden : 1987). 2002 November; 43(6): 593-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12485257

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Devastating and fatal complications associated with combined vascular and bile duct injuries during cholecystectomy. Author(s): Buell JF, Cronin DC, Funaki B, Koffron A, Yoshida A, Lo A, Leef J, Millis JM. Source: Archives of Surgery (Chicago, Ill. : 1960). 2002 June; 137(6): 703-8; Discussion 708-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12049542

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Development of explicit criteria for cholecystectomy. Author(s): Quintana JM, Cabriada J, de Tejada IL, Varona M, Oribe V, Barrios B, Arostegui I, Bilbao A. Source: Quality & Safety in Health Care. 2002 December; 11(4): 320-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12468691

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Dexamethasone 8 mg in combination with ondansetron 4 mg appears to be the optimal dose for the prevention of nausea and vomiting after laparoscopic cholecystectomy. Author(s): Elhakim M, Nafie M, Mahmoud K, Atef A. Source: Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 2002 November; 49(9): 922-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12419717

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Dexamethasone in combination with dolasetron for prophylaxis in the ambulatory setting: effect on outcome after laparoscopic cholecystectomy. Author(s): Coloma M, White PF, Markowitz SD, Whitten CW, Macaluso AR, Berrisford SB, Thornton KC. Source: Anesthesiology. 2002 June; 96(6): 1346-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12170046

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Differentiating massive carbon dioxide embolism from tension pneumothorax during laparoscopic cholecystectomy. Author(s): Carrero-Cardenal EJ. Source: European Journal of Anaesthesiology. 2002 June; 19(6): 459-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12094923

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Do complications related to laparoscopic cholecystectomy influence the prognosis of gallbladder cancer? Author(s): Wullstein C, Woeste G, Barkhausen S, Gross E, Hopt UT. Source: Surgical Endoscopy. 2002 May; 16(5): 828-32. Epub 2002 February 08. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11997831

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Does gallbladder ejection fraction predict outcome after cholecystectomy for suspected chronic acalculous gallbladder dysfunction? A systematic review. Author(s): DiBaise JK, Oleynikov D. Source: The American Journal of Gastroenterology. 2003 December; 98(12): 2605-11. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14687804

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Does gallbladder ejection fraction predict pathology after elective cholecystectomy for symptomatic cholelithiasis? Author(s): Nakano KJ, Waxman K, Rimkus D, Blaustein J. Source: The American Surgeon. 2002 December; 68(12): 1052-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12516807

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Does ischemia occur during laparoscopic cholecystectomy? Author(s): Polat C, Yilmaz S, Gokce O. Source: Surgical Endoscopy. 2003 August; 17(8): 1337; Author Reply 1338. Epub 2003 June 13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15039876

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Does splanchnic ischemia occur during laparoscopic cholecystectomy? Author(s): Ozmen MM, Kessaf Aslar A, Besler HT, Cinel I. Source: Surgical Endoscopy. 2002 March; 16(3): 468-71. Epub 2001 November 16. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11928030

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Does the laparoscopic cholecystectomy accelerate the intraperitoneal dissemination of previously unrecognized gallbladder cancer. Author(s): Wysocki A, Krzywon J. Source: International Journal of Surgical Investigation. 2000; 2(4): 313-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12678534

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Does using a laparoscopic approach to cholecystectomy decrease the risk of surgical site infection? Author(s): Richards C, Edwards J, Culver D, Emori TG, Tolson J, Gaynes R; National Nosocomial Infections Surveillance (NNIS) System, Centers for Disease Control and Prevention. Source: Annals of Surgery. 2003 March; 237(3): 358-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12616119

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Dolasetron, but not metoclopramide prevents nausea and vomiting in patients undergoing laparoscopic cholecystectomy. Author(s): Piper SN, Suttner SW, Rohm KD, Maleck WH, Larbig E, Boldt J. Source: Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 2002 December; 49(10): 1021-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12477671

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Double cystic duct: a rare biliary anomaly encountered at laparoscopic cholecystectomy. Author(s): Shivhare R, Sikora SS. Source: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A. 2002 October; 12(5): 391-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12470416

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Dropped gallstones post laparoscopic cholecystectomy mimicking peritoneal seeding: CT and ultrasound features. Author(s): Atri M, Bonifacio A, Ryan M, Pilleul FL, Hanbidge A, Clark J, Murphy J. Source: Journal of Computer Assisted Tomography. 2002 November-December; 26(6): 1000-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12488750

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Early minilaparoscopic cholecystectomy in patients with acute cholecystitis. Author(s): Hsieh CH. Source: American Journal of Surgery. 2003 April; 185(4): 344-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12657387

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Early scheduled laparoscopic cholecystectomy following percutaneous transhepatic gallbladder drainage for patients with acute cholecystitis. Author(s): Chikamori F, Kuniyoshi N, Shibuya S, Takase Y. Source: Surgical Endoscopy. 2002 December; 16(12): 1704-7. Epub 2002 September 06. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12209324

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Early versus delayed management for acute calculous cholecystitis: when should cholecystectomy be performed? Author(s): de la Fuente SG. Source: The American Journal of Gastroenterology. 2004 January; 99(1): 156-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14687157

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Effect of drainage on postoperative nausea, vomiting, and pain after laparoscopic cholecystectomy. Author(s): Nursal TZ, Yildirim S, Tarim A, Noyan T, Poyraz P, Tuna N, Haberal M. Source: Langenbeck's Archives of Surgery / Deutsche Gesellschaft Fur Chirurgie. 2003 April; 388(2): 95-100. Epub 2003 April 02. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12684804

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Effect of laparoscopic cholecystectomy on platelet aggregation. Author(s): Yol S, Kartal A, Caliskan U, Tavli S, Sahin M, Bozer M. Source: World Journal of Surgery. 2000 June; 24(6): 734-7; Discussion 738. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10773128

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Effective treatment of laparoscopic cholecystectomy pain with intravenous followed by oral COX-2 specific inhibitor. Author(s): Joshi GP, Viscusi ER, Gan TJ, Minkowitz H, Cippolle M, Schuller R, Cheung RY, Fort JG. Source: Anesthesia and Analgesia. 2004 February; 98(2): 336-42, Table of Contents. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14742366

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Effects of remifentanil infusion bis-titrated on early recovery for obese outpatients undergoing laparoscopic cholecystectomy. Author(s): Paventi S, Santevecchi A, Perilli V, Sollazzi L, Grio M, Ranieri R. Source: Minerva Anestesiol. 2002 September; 68(9): 651-7. English, Italian. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12370681

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Efficacy and safety of elective laparoscopic cholecystectomy in elderly: a casecontrolled comparison with the open approach. Author(s): Fisichella PM, Di Stefano A, Di Carlo I, La Greca G, Russello D, Latteri F. Source: Ann Ital Chir. 2002 March-April; 73(2): 149-53; Discussion 153-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12197288

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Efficacy of absorbable clips compared with metal clips for cystic duct ligation in laparoscopic cholecystectomy. Author(s): Yano H, Okada K, Kinuta M, Nakano Y, Tono T, Matsui S, Iwazawa T, Kanoh T, Monden T. Source: Surgery Today. 2003; 33(1): 18-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12560902

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Elective cholecystectomy during laparoscopic Roux-en-Y gastric bypass: is it worth the wait? Author(s): Hamad GG, Ikramuddin S, Gourash WF, Schauer PR. Source: Obesity Surgery : the Official Journal of the American Society for Bariatric Surgery and of the Obesity Surgery Society of Australia and New Zealand. 2003 February; 13(1): 76-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12630618

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Elective laparoscopic cholecystectomy: implications of prolonged waiting times for surgery. Author(s): Lawrentschuk N, Hewitt PM, Pritchard MG. Source: Anz Journal of Surgery. 2003 November; 73(11): 890-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14616563

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Embolization for right hepatic artery pseudoaneurysm following laparoscopic cholecystectomy. Author(s): Yahchouchy-Chouillard E, Limot O, Ghiles E, Etienne JC, De Baer T, Picone O, Lopez Y, Fingerhut A. Source: Anz Journal of Surgery. 2003 January-February; 73(1-2): 82-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12534751

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Endoscopic diagnosis and treatment of post-cholecystectomy syndrome. Author(s): Zhou PH, Liu FL, Yao LQ, Qin XY. Source: Hepatobiliary Pancreat Dis Int. 2003 February; 2(1): 117-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14607662

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Endoscopic sphincterotomy in 100 patients scheduled for laparoscopic cholecystectomy: ultrasound evaluation. Author(s): Cwik G, Wallner G, Ciechanski A, Zinkiewicz K, Zgodzinski W, Polkowski W. Source: Hepatogastroenterology. 2003 September-October; 50(53): 1225-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14571705

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Endoscopic sphincterotomy prior to laparoscopic cholecystectomy for the treatment of cholelithiasis. Author(s): Hamy A, Hennekinne S, Pessaux P, Lada P, Randriamananjo S, Lermite E, Boyer J, Arnaud JP. Source: Surgical Endoscopy. 2003 June; 17(6): 872-5. Epub 2003 March 14. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12632131

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Epidemiology of gallbladder cancer and trends in cholecystectomy rates in Scotland, 1968-1998. Author(s): Wood R, Fraser LA, Brewster DH, Garden OJ. Source: European Journal of Cancer (Oxford, England : 1990). 2003 September; 39(14): 2080-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12957463

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Evaluation of oxidative stress in laparoscopic cholecystectomy. Author(s): Zulfikaroglu B, Koc M, Soran A, Isman FK, Cinel I. Source: Surgery Today. 2002; 32(10): 869-74. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12376782

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Evaluation of preoperative sonography in acute cholecystitis to predict technical difficulties during laparoscopic cholecystectomy. Author(s): Cho KS, Baek SY, Kang BC, Choi HY, Han HS. Source: Journal of Clinical Ultrasound : Jcu. 2004 March-April; 32(3): 115-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14994251

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Evolution of virtual CT laparoscopy for preoperative imaging in laparoscopic cholecystectomy. Author(s): Uchida M, Ishibashi M, Nishimura H, Hayabuchi N. Source: Kurume Med J. 2002; 49(1-2): 47-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12235872

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Factors determining convalescence after uncomplicated laparoscopic cholecystectomy. Author(s): Bisgaard T, Klarskov B, Rosenberg J, Kehlet H. Source: Archives of Surgery (Chicago, Ill. : 1960). 2001 August; 136(8): 917-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11485527

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Factors influencing wound infection following laparoscopic cholecystectomy. Author(s): Shindholimath VV, Seenu V, Parshad R, Chaudhry R, Kumar A. Source: Trop Gastroenterol. 2003 April-June; 24(2): 90-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14603831

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Failure of endoscopic removal of common bile duct stones due to endo-clip migration following laparoscopic cholecystectomy. Author(s): Tsumura H, Ichikawa T, Kagawa T, Nishihara M, Yoshikawa K, Yamamoto G. Source: Journal of Hepato-Biliary-Pancreatic Surgery. 2002; 9(2): 274-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12140620

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Failure of ERCP to identify biliary leak after laparoscopic cholecystectomy. Author(s): Moloney MM, Owen WJ, Wilkinson ML. Source: Gastrointestinal Endoscopy. 2001 August; 54(2): 262-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11474410

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False aneurysm of the hepatic artery after laparoscopic cholecystectomy. Author(s): Bulut T, Yamaner S, Bugra D, Akyuz A, Acarli K, Poyanli A. Source: Acta Chir Belg. 2002 December; 102(6): 459-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12561154

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Fascioliasis observed during laparoscopic cholecystectomy. Author(s): Bengisun U, Ozbas S, Sarioglu U. Source: Langenbeck's Archives of Surgery / Deutsche Gesellschaft Fur Chirurgie. 1999 February; 384(1): 84-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10367636

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Fatal mediastinitis after routine laparoscopic cholecystectomy. Author(s): Hejjel L, Mecseky L, Szabo Z, Gal I. Source: Surgical Endoscopy. 2000 March; 14(3): 296. Epub 2000 February 12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10854519

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Fatal pulmonary thromboembolism after laparoscopic cholecystectomy. Author(s): Abad C, Caceres JJ, Alonso A. Source: Surgical Endoscopy. 2001 November; 15(11): 1360. Epub 2001 September 04. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11727155

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Feasibility and safety of day care laparoscopic cholecystectomy in a developing country. Author(s): Bal S, Reddy LG, Parshad R, Guleria R, Kashyap L. Source: Postgraduate Medical Journal. 2003 May; 79(931): 284-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12782776

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Feasibility of day-care open cholecystectomy: evaluation in an inpatient model. Author(s): Thomas S, Singh J, Bishnoi PK, Kumar A. Source: Anz Journal of Surgery. 2001 February; 71(2): 93-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11413600

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Feasibility of laparoscopic cholecystectomy in situs inversus. Author(s): Yaghan RJ, Gharaibeh KI, Hammori S. Source: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A. 2001 August; 11(4): 233-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11569514

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Feasibility of laparoscopic cholecystectomy with miniaturized instrumentation in 50 consecutive cases. Author(s): Reardon PR, Kamelgard JI, Applebaum B, Rossman L, Brunicardi FC. Source: World Journal of Surgery. 1999 February; 23(2): 128-31; Discussion 131-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9880420

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Fibrinolytic activity in laparoscopic cholecystectomy. Author(s): Martinez-Ramos C, Lopez-Pastor A, Nunez-Pena JR, Ruiz-Caravaca ML, Ruiz de Gopegui M, Sanz-Lopez R, Jorgensen TW, Tamames-Escobar S. Source: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A. 1998 December; 8(6): 417-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9916595

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Finding bile duct injuries using record linkage: a validated study of complications following cholecystectomy. Author(s): Valinsky LJ, Hockey RL, Hobbs MS, Fletcher DR, Pikora TJ, Parsons RW, Tan P. Source: Journal of Clinical Epidemiology. 1999 September; 52(9): 893-901. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10529030

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Five-year prospective audit of routine intravenous cholangiography and selective endoscopic retrograde cholangiography with or without intraoperative cholangiography in patients undergoing laparoscopic cholecystectomy. Author(s): Pietra N, Sarli L, Maccarini PU, Sabadini G, Costi R, Gobbi S. Source: World Journal of Surgery. 2000 March; 24(3): 345-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10658071

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Follow-up of selective endoscopic ultrasonography and/or endoscopic retrograde cholangiography prior to laparoscopic cholecystectomy: a prospective study of 300 patients. Author(s): Berdah SV, Orsoni P, Bege T, Barthet M, Grimaud JC, Picaud R. Source: Endoscopy. 2001 March; 33(3): 216-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11293752

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Foreign body reaction to a metal clip causing a benign bile duct stricture 16 years after open cholecystectomy: report of a case. Author(s): Bayar S, Saxena R, Salem RR. Source: Surgery Today. 2000; 30(6): 534-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10883466

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Functional impairment of the abdominal wall following laparoscopic and open cholecystectomy. Author(s): Balogh B, Zauner-Dung A, Nicolakis P, Armbruster C, Kriwanek S, PizaKatzer H. Source: Surgical Endoscopy. 2002 March; 16(3): 481-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11928033

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Functional liver damage during laparoscopic cholecystectomy as the sign of the late common bile duct stricture development. Author(s): Hochstadetr H, Bekavac-Beslin M, Doko M, Kopljar M, Cupic H, Glavan E, Mijic A, Zovak M, Salic D. Source: Hepatogastroenterology. 2003 May-June; 50(51): 676-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12828058

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Fundus-first laparoscopic cholecystectomy. Author(s): Mahmud S, Masaud M, Canna K, Nassar AH. Source: Surgical Endoscopy. 2002 April; 16(4): 581-4. Epub 2001 December 17. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11972192

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Gallbladder cancer: laparoscopic and classic cholecystectomy. Author(s): Darabos N, Stare R. Source: Surgical Endoscopy. 2004 January; 18(1): 144-7. Epub 2003 November 21. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14625757

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Gallstone empyema complicating laparoscopic cholecystectomy. Author(s): DeVincenzo R, Haramati LB, Wolf EL, Klapper PJ. Source: Journal of Thoracic Imaging. 2001 July; 16(3): 174-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11428417

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Gallstone expectoration following laparoscopic cholecystectomy. Author(s): Yadav RK, Yadav VS, Garg P, Yadav SP, Goel V. Source: Indian J Chest Dis Allied Sci. 2002 April-June; 44(2): 133-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12026254

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Gallstone granuloma: a rare complication of laparoscopic cholecystectomy. Author(s): Tham CH, Ng BK. Source: Singapore Med J. 2001 April; 42(4): 174-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11465318

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Gallstone ileus after cholecystectomy. Author(s): Ali-Hassan F, Farr P, Frere D. Source: Jbr-Btr. 2003 May-June; 86(3): 132-3. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12880150

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Gallstone in abdominal wall--a complication of laparoscopic cholecystectomy. Author(s): Battaglia DM, Fornasier VL, Mamazza J. Source: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques. 2001 February; 11(1): 50-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11269557

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Gallstones and cholecystectomy in modern Britain. Author(s): Bateson MC. Source: Postgraduate Medical Journal. 2000 November; 76(901): 700-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11060144

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Gallstones and laparoscopic cholecystectomy in hepatitis C patients. Author(s): O'Sullivan MJ, Evoy D, O'Donnell C, Rajpal PK, Cannon B, Kenny-Walsh L, Whelton MJ, Redmond HP, Kirwan WO. Source: Ir Med J. 2001 April; 94(4): 114-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11440047

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Gallstones in elderly patients: impact of laparoscopic cholecystectomy. Author(s): Montori A, Boscaini M, Gasparrini M, Miscusi G, Masoni L, Onorato M, Montori J. Source: Canadian Journal of Gastroenterology = Journal Canadien De Gastroenterologie. 2000 December; 14(11): 929-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11125183

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Gallstones, cholecystectomy, and the risk for developing pancreatic cancer. Author(s): Schernhammer ES, Michaud DS, Leitzmann MF, Giovannucci E, Colditz GA, Fuchs CS. Source: British Journal of Cancer. 2002 April 8; 86(7): 1081-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11953853

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Gasless laparoscopic cholecystectomy is not more time-consuming. Author(s): Ortiz-Oshiro E, Mayol J, Aparicio Medrano JC, Rabadan Ruiz L, Sanjuan Garcia MA, Alvarez Fdez-Represa J. Source: Surgical Endoscopy. 2001 December; 15(12): 1448-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11965463

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Gastric air tonometry during laparoscopic cholecystectomy: a comparison of two PaCO2 levels. Author(s): Makinen MT, Heinonen PO, Klemola UM, Yli-Hankala A. Source: Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 2001 February; 48(2): 121-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11220419

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Gastric outlet obstruction secondary to post cholecystectomy biloma: case report and review of the literature. Author(s): Dev V, Shah D, Gaw F, Lefor AT. Source: Jsls. 1998 April-June; 2(2): 185-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9876736

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Gastric pathology in cholecystectomy patients: role of Helicobacter pylori and bile reflux. Author(s): Zullo A, Rinaldi V, Hassan C, Lauria V, Attili AF. Source: Journal of Clinical Gastroenterology. 1998 December; 27(4): 335-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9855264

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Gastroduodenal artery pseudo-aneurysm after cholecystectomy. Author(s): Lo bue S, Denoel A. Source: Acta Chir Belg. 2003 August; 103(4): 416-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14524165

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Gastrointestinal quality of life in patients with symptomatic or asymptomatic cholelithiasis before and after laparoscopic cholecystectomy. Author(s): Mentes BB, Akin M, Irkorucu O, Tatlicioglu E, Ferahkose Z, Yildinm A, Maral I. Source: Surgical Endoscopy. 2001 November; 15(11): 1267-72. Epub 2001 September 04. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11727131

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General anesthesia mode does not influence endocrine or immunologic profile after open or laparoscopic cholecystectomy. Author(s): Delogu G, Famularo G, Luzzi S, Rubcich P, Giardina A, Masciangelo R, Antonucci A, Signore L. Source: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques. 1999 October; 9(5): 326-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10803394

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Granisetron/dexamethasone combination for the prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy. Author(s): Fujii Y, Saitoh Y, Tanaka H, Toyooka H. Source: European Journal of Anaesthesiology. 2000 January; 17(1): 64-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10758447

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Grasper trauma during laparoscopic cholecystectomy. Author(s): Marucci DD, Shakeshaft AJ, Cartmill JA, Cox MR, Adams SG, Martin CJ. Source: The Australian and New Zealand Journal of Surgery. 2000 August; 70(8): 578-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10945551

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Hand-assisted laparoscopic cholecystectomy at cesarean section. Author(s): Pelosi MA, Pelosi MA 3rd, Villalona E. Source: The Journal of the American Association of Gynecologic Laparoscopists. 1999 November; 6(4): 491-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10548711

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Hemobilia due to hepatic artery pseudoaneurysm thirteen months after laparoscopic cholecystectomy. Author(s): Ribeiro A, Williams H, May G, Fulmer JT, Spivey JR. Source: Journal of Clinical Gastroenterology. 1998 January; 26(1): 50-3. Review. Erratum In: J Clin Gastroenterol 1998 June; 26(4): 359. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9492864

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Hemodynamic and pulmonary changes during and after laparoscopic cholecystectomy. A comparison with traditional surgery. Author(s): Volpino P, Cangemi V, D'Andrea N, Cangemi B, Piat G. Source: Surgical Endoscopy. 1998 February; 12(2): 119-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9479724

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Hemodynamic and pulmonary changes during open, carbon dioxide pneumoperitoneum and abdominal wall-lifting cholecystectomy. A prospective, randomized study. Author(s): Galizia G, Prizio G, Lieto E, Castellano P, Pelosio L, Imperatore V, Ferrara A, Pignatelli C. Source: Surgical Endoscopy. 2001 May; 15(5): 477-83. Epub 2000 December 21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11353965

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Hemodynamic changes during gaseous and gasless laparoscopic cholecystectomy. Author(s): Korkmaz A, Alkis M, Hamamci O, Besim H, Erverdi N. Source: Surgery Today. 2002; 32(8): 685-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12181717

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Hemodynamic consequences of high- and low-pressure capnoperitoneum during laparoscopic cholecystectomy. Author(s): Fletcher SJ. Source: Surgical Endoscopy. 2000 June; 14(6): 596-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10890974

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Hemodynamic consequences of high- and low-pressure capnoperitoneum during laparoscopic cholecystectomy. Author(s): Dexter SP, Vucevic M, Gibson J, McMahon MJ. Source: Surgical Endoscopy. 1999 April; 13(4): 376-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10094751

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Hepatic artery angiography and embolization for hemobilia following laparoscopic cholecystectomy. Author(s): Nicholson T, Travis S, Ettles D, Dyet J, Sedman P, Wedgewood K, Royston C. Source: Cardiovascular and Interventional Radiology. 1999 January; 22(1): 20-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9929540

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Hepatic artery pseudoaneurysm following laparoscopic cholecystectomy. Author(s): Chigot V, Lallier M, Alvarez F, Dubois J. Source: Pediatric Radiology. 2003 January; 33(1): 24-6. Epub 2002 July 18. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12497232

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Hepatic blood flow and function in elderly patients undergoing laparoscopic cholecystectomy. Author(s): Sato K, Kawamura T, Wakusawa R. Source: Anesthesia and Analgesia. 2000 May; 90(5): 1198-202. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10781479

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Hepatic subcapsular biloma: a rare complication of laparoscopic cholecystectomy and common bile duct exploration. Author(s): Braithwaite BM, Cabanilla LT, Lilly M. Source: Current Surgery. 2003 March-April; 60(2): 196-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14972295

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Hernioplasty and simultaneous laparoscopic cholecystectomy: a prospective randomized study of open tension-free versus laparoscopic inguinal hernia repair. Author(s): Sarli L, Villa F, Marchesi F. Source: Surgery. 2001 May; 129(5): 530-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11331444

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Hospital credentialing for laparoscopic cholecystectomy: is stricter better? Author(s): Conover CJ, Sloan FA, Provenzale D, Oddone E, Jowell PS, Mah ML. Source: Clinical Performance and Quality Health Care. 1998 October-December; 6(4): 155-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10351281

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How do bile duct injuries sustained during laparoscopic cholecystectomy differ from those during open cholecystectomy? Author(s): Chaudhary A, Manisegran M, Chandra A, Agarwal AK, Sachdev AK. Source: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A. 2001 August; 11(4): 187-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11569506

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How managed care may choose hospitals for contracts for laparoscopic cholecystectomy. Author(s): Weiland DE, Caruso DM, Wesche DE, Bay RC. Source: Jsls. 1997 July-September; 1(3): 285-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9876690

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How to proceed in patients with carcinoma detected after laparoscopic cholecystectomy. Author(s): Frauenschuh D, Greim R, Kraas E. Source: Langenbeck's Archives of Surgery / Deutsche Gesellschaft Fur Chirurgie. 2000 December; 385(8): 495-500. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11201004

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How to secure the cystic duct at laparoscopic cholecystectomy. Author(s): Mann DV, Leow CK, Lai PB, Lau JW. Source: The British Journal of Surgery. 1998 March; 85(3): 345. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9529489

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How, when, and why bile duct injury occurs. A comparison between open and laparoscopic cholecystectomy. Author(s): Targarona EM, Marco C, Balague C, Rodriguez J, Cugat E, Hoyuela C, Veloso E, Trias M. Source: Surgical Endoscopy. 1998 April; 12(4): 322-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9543521

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Hydro-Jet-assisted laparoscopic cholecystectomy: a prospective randomized clinical study. Author(s): Shekarriz H, Shekarriz B, Kujath P, Eckmann C, Burk C, Comman A, Bruch HP. Source: Surgery. 2003 June; 133(6): 635-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12796731

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Hypovolemic shock induced by laparoscopic cholecystectomy--a case report. Author(s): Tseng YH, Ho WM, Hung WT. Source: Acta Anaesthesiol Sin. 1997 December; 35(4): 247-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9553242

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Images of interest. Hepatobiliary and pancreatic: a woman who underwent cholecystectomy. Author(s): Mosca S, Galasso G, Ragozzino A, Uomo G. Source: Journal of Gastroenterology and Hepatology. 2000 March; 15(3): 326, 337. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10764037

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Impact of magnetic resonance cholangiography on endoscopic therapy before and after laparoscopic cholecystectomy. Author(s): Contractor QQ, Karkaria AK, Contractor TQ, Dubian MK. Source: Indian J Gastroenterol. 2004 January-February; 23(1): 8-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15106707

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Impact of the case payment reimbursement method on the utilization and costs of laparoscopic cholecystectomy. Author(s): Lang HC, Chi C, Liu CM. Source: Health Policy (Amsterdam, Netherlands). 2004 February; 67(2): 195-206. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14720637

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Impaired quality of life 5 years after bile duct injury during laparoscopic cholecystectomy: a prospective analysis. Author(s): Boerma D, Rauws EA, Keulemans YC, Bergman JJ, Obertop H, Huibregtse K, Gouma DJ. Source: Annals of Surgery. 2001 December; 234(6): 750-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11729381

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Implementation of robotic laparoscopic cholecystectomy in a university hospital. Author(s): Vuilleumier H, Halkic N. Source: Swiss Medical Weekly : Official Journal of the Swiss Society of Infectious Diseases, the Swiss Society of Internal Medicine, the Swiss Society of Pneumology. 2003 June 14; 133(23-24): 347-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12923686

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Incidence and management of Mirizzi syndrome during laparoscopic cholecystectomy. Author(s): Schafer M, Schneiter R, Krahenbuhl L. Source: Surgical Endoscopy. 2003 August; 17(8): 1186-90; Discussion 1191-2. Epub 2003 May 13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12739118

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Incidental cholecystectomy in the elderly. Author(s): Agalar F, Kaynaroglu V. Source: Int Surg. 1998 April-June; 83(2): 181. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9851342

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Incidental finding of gallbladder carcinoma detected during or after laparoscopic cholecystectomy. Author(s): Antonakis P, Alexakis N, Mylonaki D, Leandros E, M Konstadoulakis M, Zografos G, Androulakis G. Source: European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2003 May; 29(4): 358-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12711289

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Influence of laparoscopic cholecystectomy on the prevalence of operations for gallstones in Norway. Author(s): Pedersen G, Hoem D, Andren-Sandberg A. Source: The European Journal of Surgery = Acta Chirurgica. 2002; 168(8-9): 464-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12549686

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Insufficient cholecystectomy diagnosed by endoscopic ultrasonography. Author(s): Hassan H, Vilmann P. Source: Endoscopy. 2004 March; 36(3): 236-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14986224

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Intestinal volvulus following laparoscopic cholecystectomy. Author(s): Lin PH, Koffron AJ, Heilizer TJ, Lujan HJ. Source: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques. 1999 April; 9(2): 140-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11757542

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Intraabdominal infection several months following laparoscopic cholecystectomy. Author(s): Berney CR. Source: Annals of Surgery. 2002 April; 235(4): 606. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11923623

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Intraoperative cholangiography and risk of common bile duct injury during cholecystectomy. Author(s): Flum DR, Dellinger EP, Cheadle A, Chan L, Koepsell T. Source: Jama : the Journal of the American Medical Association. 2003 April 2; 289(13): 1639-44. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12672731

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Intraperitoneal application of bupivacaine plus morphine for pain relief after laparoscopic cholecystectomy. Author(s): Hernandez-Palazon J, Tortosa JA, Nuno de la Rosa V, Gimenez-Viudes J, Ramirez G, Robles R. Source: European Journal of Anaesthesiology. 2003 November; 20(11): 891-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14649341

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Intraperitoneal normal saline and bupivacaine infusion for reduction of postoperative pain after laparoscopic cholecystectomy. Author(s): Tsimoyiannis EC, Glantzounis G, Lekkas ET, Siakas P, Jabarin M, Tzourou H. Source: Surgical Laparoscopy & Endoscopy. 1998 December; 8(6): 416-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9864106

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Is cholecystectomy effective treatment for symptomatic gallstones? Clinical outcome after long-term follow-up. Author(s): al Rawi MA, Lewis MH. Source: Annals of the Royal College of Surgeons of England. 1998 September; 80(5): 372. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9849345

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Is male gender a risk factor for bile duct injury during laparoscopic cholecystectomy? Author(s): Gronroos JM, Hamalainen MT, Karvonen J, Gullichsen R, Laine S. Source: Langenbeck's Archives of Surgery / Deutsche Gesellschaft Fur Chirurgie. 2003 September; 388(4): 261-4. Epub 2003 August 09. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12910421

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Is routine cholecystectomy required during laparoscopic gastric bypass? Author(s): Villegas L, Schneider B, Provost D, Chang C, Scott D, Sims T, Hill L, Hynan L, Jones D. Source: Obesity Surgery : the Official Journal of the American Society for Bariatric Surgery and of the Obesity Surgery Society of Australia and New Zealand. 2004 January; 14(1): 60-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14980035

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Is there an association between lipid-lowering drugs and cholecystectomy? Author(s): Mamdani MM, van Walraven C, Bica A, Williams JI, Naylor CD. Source: The American Journal of Medicine. 2000 April 1; 108(5): 418-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10759099

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Itemized bill: novel method to audit the process of laparoscopic cholecystectomy. Author(s): Pal KM, Ahmed M. Source: World Journal of Surgery. 2003 June; 27(6): 666-70. Epub 2003 May 02. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12724825

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Jaundice following laparoscopic cholecystectomy. An unusual complication of spilled stones. Author(s): Petit F, Vons C, Tahrat M, Coulomb-L'Hermine A, Capron F, Franco D. Source: Surgical Endoscopy. 1998 May; 12(5): 450-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9569369

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Jejunal limb obstruction caused by a cholesterol stone 15 years after a total gastrectomy and 20 years after a cholecystectomy: report of a case. Author(s): Wada N, Seki M, Saikawa Y, Satoh M, Toizumi A, Tamura Y, Kageyama T, Otani Y, Kubota T, Kumai K, Kitajima M. Source: Surgery Today. 2000; 30(2): 181-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10664345

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Laparoscopic cholecystectomy and renal transplantation. Author(s): Maio R, Carraca J, Batista L, Aldeia F, Costa P, Guerra J, Vale JM. Source: Transplantation Proceedings. 2003 May; 35(3): 1100-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12947875

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Laparoscopic cholecystectomy at the Aga Khan Hospital, Nairobi. Author(s): Patel SC, Bhatt JR. Source: East Afr Med J. 2000 April; 77(4): 194-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12858902

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Laparoscopic cholecystectomy for gallbladder lymphangiomas. Author(s): Yang HR, Jan YY, Huang SF, Yeh TS, Tseng JH, Chen MF. Source: Surgical Endoscopy. 2003 October; 17(10): 1676. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14702968

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Cholecystectomy

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Laparoscopic cholecystectomy for symptoms of biliary colic in the absence of gallstones. Author(s): Brosseuk D, Demetrick J. Source: American Journal of Surgery. 2003 July; 186(1): 1-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12842737

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Laparoscopic cholecystectomy for triple gallbladder. Author(s): Schroeder C, Draper KR. Source: Surgical Endoscopy. 2003 August; 17(8): 1322. Epub 2003 June 13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12799895

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Laparoscopic cholecystectomy in a patient with situs inversus. Author(s): Jesudason SR, Vyas FL, Jesudason MR, Govil S, Muthusami JC. Source: Indian J Gastroenterol. 2004 March-April; 23(2): 79-80. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15176549

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Laparoscopic cholecystectomy in patients with previous upper or lower abdominal surgery. Author(s): Karayiannakis AJ, Polychronidis A, Perente S, Botaitis S, Simopoulos C. Source: Surgical Endoscopy. 2004 January; 18(1): 97-101. Epub 2003 October 23. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14569455

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Laparoscopic cholecystectomy in situs inversus totalis: The importance of being lefthanded. Author(s): Oms LM, Badia JM. Source: Surgical Endoscopy. 2003 November; 17(11): 1859-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14959744

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Laparoscopic cholecystectomy under spinal anesthesia with nitrous oxide pneumoperitoneum: a feasibility study. Author(s): Hamad MA, El-Khattary OA. Source: Surgical Endoscopy. 2003 September; 17(9): 1426-8. Epub 2003 June 17. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12802665

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Laparoscopic cholecystectomy versus mini-laparotomy cholecystectomy: a prospective, randomized, single-blind study. Author(s): Ros A, Gustafsson L, Krook H, Nordgren CE, Thorell A, Wallin G, Nilsson E. Source: Annals of Surgery. 2001 December; 234(6): 741-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11729380

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Laparoscopic cholecystectomy. Author(s): Curet MJ, Contreras M, Weber DM, Albrecht R. Source: Surgical Endoscopy. 2002 March; 16(3): 453-7. Epub 2001 November 16. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11928027

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Laparoscopic cholecystectomy: a report on 2000 cases. Author(s): Fathy O, Zeid MA, Abdallah T, Fouad A, Eleinien AA, el-Hak NG, Eleibiedy G, el-Wahab MA, Sultan A, Anwar N, Ezzat F. Source: Hepatogastroenterology. 2003 July-August; 50(52): 967-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12845960

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Laparoscopic cholecystectomy: an Indian experience of 1233 cases. Author(s): Kaushik R, Sharma R, Batra R, Yadav TD, Attri AK, Kaushik SP. Source: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A. 2002 February; 12(1): 21-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11905858

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Laparoscopic left hepatic lobe cholecystectomy. Author(s): Hopper N, Ryder JM, Swarnkar K, Stephenson BM. Source: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A. 2003 December; 13(6): 405-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14733706

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Laparoscopic subtotal cholecystectomy for severe cholecystitis. Author(s): Beldi G, Glattli A. Source: Surgical Endoscopy. 2003 September; 17(9): 1437-9. Epub 2003 June 13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12799885

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Laparoscopic ultrasonography and operative cholangiography prevent residual common bile duct stones in laparoscopic cholecystectomy. Author(s): Kimura T, Umehara Y, Yoshida M, Sakuramachi S, Kawabe A, Suzuki K. Source: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques. 1999 April; 9(2): 124-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11757539

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Long-term follow-up after endoscopic biliary stent placement for bile duct strictures from laparoscopic cholecystectomy. Author(s): De Palma GD, Galloro G, Romano G, Sottile R, Puzziello A, Persico F, Masone S, Labianca O, Persico G. Source: Hepatogastroenterology. 2003 September-October; 50(53): 1229-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14571706

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Cholecystectomy

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Long-term results of major bile duct injury associated with laparoscopic cholecystectomy. Author(s): Huang CS, Lein HH, Tai FC, Wu CH. Source: Surgical Endoscopy. 2003 September; 17(9): 1362-7. Epub 2003 June 17. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12802669

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Low-cost laparoscopic cholecystectomy (Br J Surg 2002; 89: 1602-1607). Author(s): Udwadia TE. Source: The British Journal of Surgery. 2003 June; 90(6): 761. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12808636

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Major vessel injuries during laparoscopic cholecystectomy: a case report. Author(s): Battaglia L, Bartolucci R, Berni A, Leo E, De Antoni E. Source: Chir Ital. 2003 March-April; 55(2): 291-4. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12744110

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Management of aberrant bile duct during laparoscopic cholecystectomy. Author(s): Li JH, Zheng CZ, Ke CW, Yin K. Source: Hepatobiliary Pancreat Dis Int. 2002 August; 1(3): 438-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14607723

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Management of unsuspected gallbladder carcinoma discovered during or following laparoscopic cholecystectomy. Author(s): Yeh CN, Jan YY, Chen MF. Source: The American Surgeon. 2004 March; 70(3): 256-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15055850

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Metabolic and stress responses of the body to trauma: produced by the laparoscopic and open cholecystectomy. Author(s): Haque Z, Rahman M, Siddique MA, Roy RK, Chowdhury RA, Rahman MM, Rabbi MA. Source: Mymensingh Med J. 2004 January; 13(1): 48-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14747786

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Microlaparoscopic cholecystectomy. Less invasive gallbladder surgery. Author(s): Unger SW, Paramo JC, Perez M. Source: Surgical Endoscopy. 2000 April; 14(4): 336-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10790550

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Microlaparoscopic vs conventional laparoscopic cholecystectomy: a prospective randomized double-blind trial. Author(s): Bisgaard T, Klarskov B, Trap R, Kehlet H, Rosenberg J. Source: Surgical Endoscopy. 2002 March; 16(3): 458-64. Epub 2001 November 16. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11928028

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Mini-cholecystectomy is often used in gallbladder surgery. Author(s): Johnson AG, Majeed AW. Source: Bmj (Clinical Research Ed.). 2002 March 30; 324(7340): 790. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11923171

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Minilaparoscopic and laparoscopic cholecystectomy: a comparative study. Author(s): Huang MT, Wang W, Wei PL, Chen RJ, Lee WJ. Source: Archives of Surgery (Chicago, Ill. : 1960). 2003 September; 138(9): 1017-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12963662

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Mini-laparotomy cholecystectomy in the era of laparoscopic cholecystectomy: a community-based hospital perspective. Author(s): Oyogoa SO, Komenaka IK, Ilkhani R, Wise L. Source: The American Surgeon. 2003 July; 69(7): 604-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12889625

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Mortality after open cholecystectomy in patients with cirrhosis of the liver: a population-based study in Denmark. Author(s): Thulstrup AM, Sorensen HT, Vilstrup H. Source: The European Journal of Surgery = Acta Chirurgica. 2001 September; 167(9): 679-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11759738

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Nasobiliary drainage for biliary leaks after laparoscopic cholecystectomy. Author(s): Besser P. Source: Medical Science Monitor : International Medical Journal of Experimental and Clinical Research. 2001 May; 7 Suppl 1: 118-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12211705

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National Survey of Bile Duct Injury Associated with Cholecystectomy. Big Brother in the operating room versus another EBM tool for critical assessment of surgical innovation? Author(s): Michel L. Source: Acta Chir Belg. 2003 April; 103(2): 181-6. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12768861

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National survey on cholecystectomy related bile duct injury--public health and financial aspects in Belgian hospitals--1997. Author(s): Van de Sande S, Bossens M, Parmentier Y, Gigot JF. Source: Acta Chir Belg. 2003 April; 103(2): 168-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12768860

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Necrotizing fasciitis with Clostridium perfringens after laparoscopic cholecystectomy. Author(s): Mittermair RP, Schobersberger W, Hasibeder W, Allerberger F, Peer R, Bonatti H. Source: Surgical Endoscopy. 2002 April; 16(4): 716. Epub 2001 November 30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11972228

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Needlescopic cholecystectomy: prospective study of 150 patients. Author(s): Lai EC, Fok M, Chan AS. Source: Hong Kong Medical Journal = Xianggang Yi Xue Za Zhi / Hong Kong Academy of Medicine. 2003 August; 9(4): 238-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12904609

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No increased risk of breast cancer after cholecystectomy. Author(s): Lagergren J, Ye W, Ekbom A. Source: International Journal of Cancer. Journal International Du Cancer. 2000 November 15; 88(4): 679-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11058889

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Non-biliary mishaps during laparoscopic cholecystectomy. Author(s): Singh R, Kaushik R, Sharma R, Attri AK. Source: Indian J Gastroenterol. 2004 March-April; 23(2): 47-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15176534

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Non-image diagnosis of bile duct injury during laparoscopic cholecystectomy. Author(s): Luo D, Chen XR, Li SH, Mao JX, Yu SM. Source: Hepatobiliary Pancreat Dis Int. 2002 February; 1(1): 106-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14607636

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Non-linear evaluation of respiratory mechanics during laparoscopic cholecystectomy. Author(s): Vassiliou MP, Rizzoti L, Laopodis V, Amygdalou A, Psarakis C, Leontaridi C, Koubaniou C, Behrakis PK. Source: Hepatogastroenterology. 2003 July-August; 50(52): 934-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12845953

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Nonspecific ulcerated jejunitis as an unusual complication of laparoscopic cholecystectomy: report of a case. Author(s): Akkus MA, Cetinkaya Z, Ilhan YS, Caboglu SA, Bulbuller N. Source: Surgery Today. 2000; 30(3): 277-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10752783

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Occult gallbladder carcinoma diagnosed by a laparoscopic cholecystectomy. Author(s): Matsusaka S, Yamasaki H, Kitayama Y, Okada T, Maeda S. Source: Surgery Today. 2003; 33(10): 740-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14513320

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Ondansetron in the prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy: a prospective randomized study. Author(s): So JB, Cheong KF, Sng C, Cheah WK, Goh P. Source: Surgical Endoscopy. 2002 February; 16(2): 286-8. Epub 2001 November 12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11967679

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Open versus laparoscopic cholecystectomy for gallbladder carcinoma. Author(s): Lundberg O, Kristoffersson A. Source: Journal of Hepato-Biliary-Pancreatic Surgery. 2001; 8(6): 525-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11956903

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Operative stress response and energy metabolism after laparoscopic cholecystectomy compared to open surgery. Author(s): Luo K, Li JS, Li LT, Wang KH, Shun JM. Source: World Journal of Gastroenterology : Wjg. 2003 April; 9(4): 847-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12679946

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Oral clonidine premedication preserves heart rate variability for patients undergoing larparoscopic cholecystectomy. Author(s): Yu HP, Hseu SS, Yien HW, Teng YH, Chan KH. Source: Acta Anaesthesiologica Scandinavica. 2003 February; 47(2): 185-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12631048

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Outcome after laparoscopic cholecystotomy and cholecystectomy in children with symptomatic cholecystolithiasis: a preliminary report. Author(s): Ure BM, de Jong MM, Bax KN, van der Zee DC. Source: Pediatric Surgery International. 2001 July; 17(5-6): 396-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11527174

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Outcome of endoscopic sphincterotomy in post cholecystectomy patients with sphincter of Oddi dysfunction as predicted by manometry and quantitative choledochoscintigraphy. Author(s): Cicala M, Habib FI, Vavassori P, Pallotta N, Schillaci O, Costamagna G, Guarino MP, Scopinaro F, Fiocca F, Torsoli A, Corazziari E. Source: Gut. 2002 May; 50(5): 665-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11950813

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Outpatient laparoscopic cholecystectomy. Author(s): Ng WT, Cheng PW, Wan T. Source: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques. 2002 April; 12(2): 139-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11948305

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Outpatient laparoscopic cholecystectomy: a reality. Author(s): Maggiore D. Source: Jsls. 2002 October-December; 6(4): 369-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12500838

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Outpatient laparoscopic cholecystectomy: patient and nursing perspective. Author(s): Talamini MA, Coleman J, Sauter P, Stanfield C, Fleisher LA. Source: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques. 1999 October; 9(5): 333-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10803395

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Patients awaiting laparoscopic cholecystectomy--can preoperative complications be predicted? Author(s): Thornton DJ, Robertson A, Alexander DJ. Source: Annals of the Royal College of Surgeons of England. 2004 March; 86(2): 87-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15005924

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Percutaneous management of bile duct strictures and injuries associated with laparoscopic cholecystectomy: a decade of experience. Author(s): Misra S, Melton GB, Geschwind JF, Venbrux AC, Cameron JL, Lillemoe KD. Source: Journal of the American College of Surgeons. 2004 February; 198(2): 218-26. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14759778

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Persistent dyspepsia after laparoscopic cholecystectomy. The influence of psychological factors. Author(s): Lorusso D, Porcelli P, Pezzolla F, Lantone G, Zivoli G, Guerra V, Misciagna G, Demma I. Source: Scandinavian Journal of Gastroenterology. 2003 June; 38(6): 653-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12825875

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Postoperative pain relief after laparoscopic cholecystectomy: a randomised prospective double-blind clinical trial. Author(s): Lepner U, Goroshina J, Samarutel J. Source: Scand J Surg. 2003; 92(2): 121-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12841551

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Predictors of improvement in health-related quality of life in patients undergoing cholecystectomy (Br J Surg 2003; 90: 1549-1545). Author(s): Aggarwal S, Senapati PS. Source: The British Journal of Surgery. 2004 April; 91(4): 510. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15048761

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Predictors of improvement in health-related quality of life in patients undergoing cholecystectomy. Author(s): Quintana JM, Arostegui I, Cabriada J, Lopez de Tejada I, Perdigo L. Source: The British Journal of Surgery. 2003 December; 90(12): 1549-55. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14648735

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Pre-operative endoscopic ultrasonography can optimise the management of patients undergoing laparoscopic cholecystectomy with abnormal liver function tests as the sole risk factor for choledocholithiasis: a prospective study. Author(s): Meroni E, Bisagni P, Bona S, Fumagalli U, Zago M, Rosati R, Malesci A. Source: Dig Liver Dis. 2004 January; 36(1): 73-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14971819

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Prevalence of bile duct injury following cholecystectomy. Author(s): Bertrand C. Source: Acta Chir Belg. 2003 April; 103(2): 143-50. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12768855

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Prevention of bile duct injury (BDI) during cholecystectomy. Author(s): Navez B. Source: Acta Chir Belg. 2003 April; 103(2): 151-3. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12768856

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Prospective evaluation of magnetic resonance cholangiography in patients with suspected common bile duct stones before laparoscopic cholecystectomy. Author(s): Ke ZW, Zheng CZ, Li JH, Yin K, Hua JD. Source: Hepatobiliary Pancreat Dis Int. 2003 November; 2(4): 576-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14627523

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QT interval and QT dispersion increase in the elderly during laparoscopic cholecystectomy: a preliminary study. Author(s): Egawa H, Minami J, Fujii K, Hamaguchi S, Okuda Y, Kitajima T. Source: Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 2002 October; 49(8): 805-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12374708

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Quality of life after cholecystectomy and after successful lithotripsy for gallbladder stones: a matched-pairs comparison. Author(s): Carrilho-Ribeiro L, Serra D, Pinto-Correia A, Velosa J, De Moura MC. Source: European Journal of Gastroenterology & Hepatology. 2002 July; 14(7): 741-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12169982

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Quality-of-life assessment of surgical reconstruction after laparoscopic cholecystectomy-induced bile duct injuries: what happens at 5 years and beyond? Author(s): Sarmiento JM, Farnell MB, Nagorney DM, Hodge DO, Harrington JR. Source: Archives of Surgery (Chicago, Ill. : 1960). 2004 May; 139(5): 483-8; Discussion 488-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15136347

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Randomized clinical trial comparing an oral carbohydrate beverage with placebo before laparoscopic cholecystectomy. Author(s): Bisgaard T, Kristiansen VB, Hjortso NC, Jacobsen LS, Rosenberg J, Kehlet H. Source: The British Journal of Surgery. 2004 February; 91(2): 151-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14760661

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Randomized clinical trial of laparoscopic cholecystectomy performed with miniinstruments (Br J Surg 2003; 90: 1345-1348). Author(s): Ng WT. Source: The British Journal of Surgery. 2004 April; 91(4): 509-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15048758

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Randomized clinical trial of laparoscopic cholecystectomy performed with miniinstruments. Author(s): Sarli L, Iusco D, Gobbi S, Porrini C, Ferro M, Roncoroni L. Source: The British Journal of Surgery. 2003 November; 90(11): 1345-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14598412

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Randomized clinical trial of ultrasonic versus electrocautery dissection of the gallbladder in laparoscopic cholecystectomy (Br J Surg 2003; 90: 799-803). Author(s): Devalia H. Source: The British Journal of Surgery. 2003 October; 90(10): 1306. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14515306

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Randomized clinical trial of ultrasonic versus electrocautery dissection of the gallbladder in laparoscopic cholecystectomy (Br J Surg 2003; 90: 799-803). Author(s): Morino M. Source: The British Journal of Surgery. 2003 October; 90(10): 1306. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14515305

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Recurrent asystolic cardiac arrest and laparoscopic cholecystectomy: a case report and review of the literature. Author(s): Valentin MD, Tulsyan N, Dolgin C. Source: Jsls. 2004 January-March; 8(1): 65-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14974667

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Right hemihepatectomy for bile duct injury following laparoscopic cholecystectomy. Author(s): Heinrich S, Seifert H, Krahenbuhl L, Fellbaum C, Lorenz M. Source: Surgical Endoscopy. 2003 September; 17(9): 1494-5. Epub 2003 June 25. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12820055

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Risk of emergency admission while awaiting elective cholecystectomy. Author(s): Sobolev B, Mercer D, Brown P, FitzGerald M, Jalink D, Shaw R. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 2003 September 30; 169(7): 662-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14517123

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Robotic versus telerobotic laparoscopic cholecystectomy: duration of surgery and outcomes. Author(s): Hourmont K, Chung W, Pereira S, Wasielewski A, Davies R, Ballantyne GH. Source: The Surgical Clinics of North America. 2003 December; 83(6): 1445-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14712878

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Routine day-case laparoscopic cholecystectomy. Author(s): Leeder PC, Matthews T, Krzeminska K, Dehn TC. Source: The British Journal of Surgery. 2004 March; 91(3): 312-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14991631

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Scoring system to predict asymptomatic choledocholithiasis before laparoscopic cholecystectomy. A matched case-control study. Author(s): Sarli L, Costi R, Gobbi S, Iusco D, Sgobba G, Roncoroni L. Source: Surgical Endoscopy. 2003 September; 17(9): 1396-403. Epub 2003 June 17. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12802652

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Selective cholangiography in 600 patients undergoing cholecystectomy with 5-year follow-up for residual bile duct stones. Author(s): Charfare H, Cheslyn-Curtis S. Source: Annals of the Royal College of Surgeons of England. 2003 May; 85(3): 167-73. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12831488

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Selective operative cholangiography and Perioperative endoscopic retrograde cholangiopancreatography (ERCP) during laparoscopic cholecystectomy: a viable option for choledocholithiasis. Author(s): Williams GL, Vellacott KD. Source: Surgical Endoscopy. 2002 March; 16(3): 465-7. Epub 2001 November 16. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11928029

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Should cholecystectomy be performed for asymptomatic cholelithiasis in transplant patients? Author(s): Kao LS, Kuhr CS, Flum DR. Source: Journal of the American College of Surgeons. 2003 August; 197(2): 302-12. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12892816

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Spilled gall stones during laparoscopic cholecystectomy: a review of the literature. Author(s): Sathesh-Kumar T, Saklani AP, Vinayagam R, Blackett RL. Source: Postgraduate Medical Journal. 2004 February; 80(940): 77-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14970293

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Spontaneous bile leak 6 years after uneventful cholecystectomy. Author(s): Kaffes AJ, Alrubaie A, Hollands M, Williams SJ, Bourke MJ. Source: Gastrointestinal Endoscopy. 2003 June; 57(7): 985-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12776065

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Successful treatment of common bile duct stricture after laparoscopic cholecystectomy by percutaneous transhepatic balloon dilatation. Author(s): Yano H, Yasue A, Matsushita M, Monden T. Source: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques. 2003 August; 13(4): 271-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12960792

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Surgical clip found in duodenal ulcer after laparoscopic cholecystectomy. Author(s): Wasserberg N, Gal E, Fuko Z, Niv Y, Lelcuk S, Rubin M. Source: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques. 2003 December; 13(6): 387-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14712101

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Surgical management of bile duct stricture following laparoscopic cholecystectomy. Author(s): Bismuth H. Source: Acta Chir Belg. 2003 April; 103(2): 140-2. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12768854

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Systematic review and meta-analysis: does gall-bladder ejection fraction on cholecystokinin cholescintigraphy predict outcome after cholecystectomy in suspected functional biliary pain? Author(s): Delgado-Aros S, Cremonini F, Bredenoord AJ, Camilleri M. Source: Alimentary Pharmacology & Therapeutics. 2003 July 15; 18(2): 167-74. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12869076

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Techniques and clinical outcomes of laparoscopic cholecystectomy in adult patients with beta-thalassemias. Author(s): Kok KY, Yapp SK. Source: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques. 2003 June; 13(3): 168-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12819500

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The added cost of urgent cholecystectomy to health systems. Author(s): Chen SL, Comstock MC, Taheri PA. Source: Journal of the American College of Surgeons. 2003 July; 197(1): 16-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12831919

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The effects of laparascopic cholecystectomy operation on C-reactive protein, hormones, and cytokines. Author(s): Sari R, Sevinc A. Source: J Endocrinol Invest. 2004 February; 27(2): 106-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15129803

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The effects of sevoflurane and desflurane on lipid peroxidation during laparoscopic cholecystectomy. Author(s): Koksal GM, Sayilgan C, Aydin S, Uzun H, Oz H. Source: European Journal of Anaesthesiology. 2004 March; 21(3): 217-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15055896

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The role of cholecystectomy in reducing recurrent gallstone pancreatitis. Author(s): Hui CK, Lai KC, Yuen MF, Wong WM, Chan AO, Ng M, Chan CK, Cheung WW, Lam SK, Lai CL, Wong BC. Source: Endoscopy. 2004 March; 36(3): 206-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14986217

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The role of intraoperative cholangiography in detecting and preventing bile duct injury during laparoscopic cholecystectomy. Author(s): Detry O, De Roover A, Detroz B, Honore P. Source: Acta Chir Belg. 2003 April; 103(2): 161-2. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12768858

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Therapeutic efficacy of laparoscopic cholecystectomy in the treatment of biliary dyskinesia. Author(s): Patel NA, Lamb JJ, Hogle NJ, Fowler DL. Source: American Journal of Surgery. 2004 February; 187(2): 209-12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14769306

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Three-port vs standard four-port laparoscopic cholecystectomy. Author(s): Trichak S. Source: Surgical Endoscopy. 2003 September; 17(9): 1434-6. Epub 2003 June 13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12799892

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Timing of laparoscopic cholecystectomy in acute cholecystitis. Author(s): Cheema S, Brannigan AE, Johnson S, Delaney PV, Grace PA. Source: Ir J Med Sci. 2003 July-September; 172(3): 128-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14700115

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Timing of urgent laparoscopic cholecystectomy does not influence conversion rate. Author(s): Knight JS, Mercer SJ, Somers SS, Walters AM, Sadek SA, Toh SK. Source: The British Journal of Surgery. 2004 May; 91(5): 601-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15122612

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UDP-glucuronosyltransferase 1 gene promoter polymorphism is associated with increased serum bilirubin levels and cholecystectomy in patients with sickle cell anemia. Author(s): Fertrin KY, Melo MB, Assis AM, Saad ST, Costa FF. Source: Clinical Genetics. 2003 August; 64(2): 160-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12859413

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Uncommon left hepatic duct injury during laparoscopic cholecystectomy. Author(s): Santini L, Conzo G, Giordano A, Caraco C, Candela G. Source: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques. 2000 April; 10(2): 89-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10789580

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Unexpected bile duct carcinoma presenting with port-site metastasis after laparoscopic cholecystectomy for cholecystolithiasis. Author(s): Sakata N, Suzuki M, Shibuya K, Takeda K, Matsuno S. Source: Journal of Hepato-Biliary-Pancreatic Surgery. 2002; 9(4): 511-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12483275

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Unique features of laparoscopic cholecystectomy in Beta thalassemia patients. Author(s): Katz R, Goldfarb A, Muggia M, Gimmon Z. Source: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques. 2003 October; 13(5): 318-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14571167

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Urgent versus interval laparoscopic cholecystectomy for acute cholecystitis: a comparative study. Author(s): Bhattacharya D, Senapati PS, Hurle R, Ammori BJ. Source: Journal of Hepato-Biliary-Pancreatic Surgery. 2002; 9(5): 538-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12541036

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Urinary catheter in laparoscopic cholecystectomy: is it necessary? Author(s): Liu SK, Rassai H, Krasner C, Braun J, Matolo NM. Source: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques. 1999 June; 9(3): 184-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10803996

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Urinary retention after elective cholecystectomy. Author(s): Kulacoglu H, Dener C, Kama NA. Source: American Journal of Surgery. 2001 September; 182(3): 226-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11587682

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Use of the laryngeal mask is not contraindicated for laparoscopic cholecystectomy. Author(s): Maltby JR, Beriault MT, Watson NC. Source: Anaesthesia. 2001 August; 56(8): 800-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11494427

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Using a risk score for conversion from laparoscopic to open cholecystectomy in resident training. Author(s): Kologlu M, Tutuncu T, Yuksek YN, Gozalan U, Daglar G, Kama NA. Source: Surgery. 2004 March; 135(3): 282-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14976478

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Value and consequences of routine intraoperative cholangiography during cholecystectomy. Author(s): Ludwig K, Bernhardt J, Lorenz D. Source: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques. 2002 June; 12(3): 154-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12080254

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Value of intravenous cholangiography prior to laparoscopic cholecystectomy. Author(s): Jansen M, Truong S, Treutner KH, Neuerburg J, Schraven C, Schumpelick V. Source: World Journal of Surgery. 1999 July; 23(7): 693-6; Discussion 697. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10390588

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Value of liver biopsy combined with cholecystectomy. Author(s): Zuegel NP, Hehl JA, Auerbach-Heber K, Eberl T. Source: Hepatogastroenterology. 1999 November-December; 46(30): 3095-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10626168

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Value of magnetic resonance cholangiopancreatography in demonstrating major bile duct injuries following laparoscopic cholecystectomy. Author(s): Yeh TS, Jan YY, Tseng JH, Hwang TL, Jeng LB, Chen MF. Source: The British Journal of Surgery. 1999 February; 86(2): 181-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10100783

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Variation in the use of laparoscopic cholecystectomy for elderly patients with acute cholecystitis. Author(s): Laycock WS, Siewers AE, Birkmeyer CM, Wennberg DE, Birkmeyer JD. Source: Archives of Surgery (Chicago, Ill. : 1960). 2000 April; 135(4): 457-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10768712

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Videolaparoscopic cholecystectomy induces a hemostasis activation of lower grade than does open surgery. Author(s): Prisco D, De Gaudio AR, Carla R, Gori AM, Fedi S, Cella AP, Gensini GF, Abbate R. Source: Surgical Endoscopy. 2000 February; 14(2): 170-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10656954

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Videolaparoscopic cholecystectomy. Analysis of the clinical and functional aspects of mechanical lifting of the abdominal wall. Author(s): Santo MA, Domene CE, Nasi A, Onari P, Volpe P, Pinotti HW. Source: Arquivos De Gastroenterologia. 2001 January-March; 38(1): 32-9. Epub 2001 December 05. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11582962

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Visual identification of the cystic duct-CBD junction during laparoscopic cholecystectomy (visual cholangiography): an additional step for prevention of CBD injuries. Author(s): Katkhouda N, Mavor E, Mason RJ. Source: Surgical Endoscopy. 2000 January; 14(1): 88-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10653245

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Volume kinetics of glucose 2.5% solution during laparoscopic cholecystectomy. Author(s): Sjostrand F, Hahn RG. Source: British Journal of Anaesthesia. 2004 April; 92(4): 485-92. Epub 2004 February 20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14977794

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Volvulus of the small bowel: an uncommon complication after laparoscopic cholecystectomy. Author(s): Lay PS, Tsang TK, Caprini J, Gardner A, Pollack J, Norman E. Source: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A. 1997 February; 7(1): 59-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9453866

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Wait-and-see policy or laparoscopic cholecystectomy after endoscopic sphincterotomy for bile-duct stones: a randomised trial. Author(s): Boerma D, Rauws EA, Keulemans YC, Janssen IM, Bolwerk CJ, Timmer R, Boerma EJ, Obertop H, Huibregtse K, Gouma DJ. Source: Lancet. 2002 September 7; 360(9335): 761-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12241833

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Warmed insufflation carbon dioxide gas for laparoscopic cholecystectomy. Author(s): Jacobs VR, Morrison JE Jr. Source: Surgical Endoscopy. 2001 October; 15(10): 1244-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11727124

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What happens to the lost gallstone during laparoscopic cholecystectomy? Author(s): Zulfikaroglu B, Ozalp N, Mahir Ozmen M, Koc M. Source: Surgical Endoscopy. 2003 January; 17(1): 158. Epub 2002 October 29. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12399867

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Why is it necessary to retrieve small bile duct stones at cholecystectomy? Author(s): Vracko J, Wiechel KL. Source: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques. 1999 April; 9(2): 119-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11757538

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Why mini-laparoscopic cholecystectomy? Author(s): Reardon PR, Kamelgard JI, Applebaum BA, Brunicardi FC. Source: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A. 1999 June; 9(3): 313. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10414553

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Wound recurrence from gallbladder cancer after open cholecystectomy. Author(s): Lundberg O, Kristoffersson A. Source: Surgery. 2000 March; 127(3): 296-300. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10715985

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Xenon anaesthesia for laparoscopic cholecystectomy in a patient with Eisenmenger's syndrome. Author(s): Hofland J, Gultuna I, Tenbrinck R. Source: British Journal of Anaesthesia. 2001 June; 86(6): 882-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11573602

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

Finding Nutrition Studies on Cholecystectomy 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 “cholecystectomy” (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 “cholecystectomy” (or a synonym): •

Coagulation activation after laparoscopic cholecystectomy in spite of thromboembolism prophylaxis. Author(s): Department of Surgery, Skelleftea County Hospital, SE-931 86 Skelleftea, Sweden. Source: Lindberg, F Rasmussen, I Siegbahn, A Bergqvist, D Surg-Endosc. 2000 September; 14(9): 858-61 0930-2794

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Combined laparoscopic cholecystectomy and selective vagotomy. Author(s): Department of Surgery, University of Maryland, School of Medicine, Baltimore 21201. Source: Bailey, R W Flowers, J L Graham, S M Zucker, K A Surg-Laparosc-Endosc. 1991 March; 1(1): 45-9 1051-7200

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Comparison of laparoscopic cholecystectomy versus elective open cholecystectomy. Author(s): Saginaw Cooperative Hospitals, Inc., MI. Source: Smith, J F Boysen, D Tschirhart, J Williams, T Vasilenko, P J-Laparoendosc-Surg. 1992 December; 2(6): 311-7 1052-3901

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Comparison of N2O and CO2 pneumoperitoneums during laparoscopic cholecystectomy with special reference to postoperative pain. Author(s): Department of Surgery, Tampere University Hospital and Medical School, University of Tampere, Finland. Source: Aitola, P Airo, I Kaukinen, S Ylitalo, P Surg-Laparosc-Endosc. 1998 April; 8(2): 140-4 1051-7200

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Control of port-site bleeding from smaller incisions after laparoscopic cholecystectomy surgery: a new, innovative, and easier technique. Author(s): Department of Surgery, Easton Hospital, 250 21st Street, Easton, PA 18042, USA. [email protected] Source: Rastogi, V Dy, V Surg-Laparosc-Endosc-Percutan-Tech. 2002 August; 12(4): 2246 1530-4515

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Is outpatient laparoscopic cholecystectomy wise? Author(s): Department of Surgery, University of California, Davis, Sacramento 95817, USA. Source: Saunders, C J Leary, B F Wolfe, B M Surg-Endosc. 1995 December; 9(12): 1263-8 0930-2794

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Laparoscopic cholecystectomy for patients who have had previous abdominal surgery. Author(s): Second Department of Surgery, General Hospital Salzburg, Austria. Source: Miller, K Holbling, N Hutter, J Junger, W Moritz, E Speil, T Surg-Endosc. 1993 Sep-October; 7(5): 400-3 0930-2794

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Laparoscopy: the preferred method of cholecystectomy in the morbidly obese. Author(s): Department of Surgery, Loyola University Medical Center, Maywood, IL 60153. Source: Miles, R H Carballo, R E Prinz, R A McMahon, M Pulawski, G Olen, R N Dahlinghaus, D L Surgery. 1992 October; 112(4): 818-22; discussion 822-3 0039-6060

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Laser laparoscopic cholecystectomy in the ambulatory setting. Source: Haicken, B N J-Post-Anesth-Nurs. 1991 February; 6(1): 33-9 0883-9433

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Morphine responders with unexplained pain after cholecystectomy may have sympathetic overactivity. Author(s): Department of Gastroenterology, Queen Elizabeth Hospital, Woodville, SA. Source: Roberts Thomson, I C Jonsson, J R Pannall, P R Frewin, D B Clin-Auton-Res. 1991 March; 1(1): 59-62 0959-9851

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Risks and benefits of laparoscopic cholecystectomy in the community hospital setting. Author(s): Saginaw Cooperative Hospitals, Inc., MI. Source: Smith, J F Boysen, D Tschirhart, J Williams, T J-Laparoendosc-Surg. 1991 December; 1(6): 325-32 1052-3901

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The fate of retained gallstones following laparoscopic cholecystectomy in a prairie dog model. Author(s): Department of Surgery, David Grant USAF Medical Center, Travis Air Force Base, California, USA. Source: Bonar, J P Bowyer, M W Welling, D R Hirsch, K J-Soc-Laparoendosc-Surg. 1998 Jul-September; 2(3): 263-8 1086-8089

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The judgement of adhesion formation following laparoscopic and conventional cholecystectomy in an animal model. Author(s): Department of Surgery, Haynal Imre University for Health Sciences, Budapest, Hungary. Source: Gamal, E M Metzger, P Miko, I Szabo, G Brath, E Kiss, J Furka, I Acta-ChirHung. 1999; 38(2): 169-72 0231-4614

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Timing of endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy in the treatment of choledocholithiasis. Author(s): Department of Surgery, Brown University, Rhode Island Hospital, Providence, USA. Source: Ng, T Amaral, J F J-Laparoendosc-Adv-Surg-Tech-A. 1999 February; 9(1): 31-7 1092-6429

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

•

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

•

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

•

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

•

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

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

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

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

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CHAPTER 3. ALTERNATIVE CHOLECYSTECTOMY

MEDICINE

AND

Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to cholecystectomy. 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 cholecystectomy 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 “cholecystectomy” (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 cholecystectomy: •

A case-control study of postoperative pulmonary complications after laparoscopic and open cholecystectomy. Author(s): Hall JC, Tarala RA, Hall JL. Source: J Laparoendosc Surg. 1996 April; 6(2): 87-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8735045

•

Absence of benefit of incentive spirometry in low-risk patients undergoing elective cholecystectomy. A controlled randomized study. Author(s): Schwieger I, Gamulin Z, Forster A, Meyer P, Gemperle M, Suter PM. Source: Chest. 1986 May; 89(5): 652-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3698694

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•

Acupressure and ondansetron for postoperative nausea and vomiting after laparoscopic cholecystectomy. Author(s): Agarwal A, Bose N, Gaur A, Singh U, Gupta MK, Singh D. Source: Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 2002 JuneJuly; 49(6): 554-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12067865

•

Balneologic treatment of patients with post-cholecystectomy syndrome] Author(s): Tomashevskii IaI, Samoilenko EM. Source: Vrach Delo. 1966 March; 3: 133-4. Russian. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5990012

•

Cholecystectomy with self-hypnosis. Author(s): Rausch V. Source: Am J Clin Hypn. 1980 January; 22(3): 124-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7386401

•

Cholecystectomy: the gold standard. Author(s): McSherry CK. Source: American Journal of Surgery. 1989 September; 158(3): 174-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2672837

•

Circulatory and respiratory function in relation to physical activity in female patients before and after cholecystectomy. Author(s): Adolfsson G. Source: Acta Chir Scand Suppl. 1969; 401: 1-106. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5275175

•

Diaphragmatic breathing maneuvers and movement of the diaphragm after cholecystectomy. Author(s): Chuter TA, Weissman C, Mathews DM, Starker PM. Source: Chest. 1990 May; 97(5): 1110-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2331905

•

Effect of acupressure on postoperative nausea and vomiting in laparoscopic cholecystectomy. Author(s): Samad K, Afshan G, Kamal R. Source: J Pak Med Assoc. 2003 February; 53(2): 68-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12705488

•

Failure of transcutaneous electrical nerve stimulation and indomethacin to reduce opiate requirement following cholecystectomy. Author(s): Laitinen J, Nuutinen L.

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Source: Acta Anaesthesiologica Scandinavica. 1991 November; 35(8): 700-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1763589 •

Gingko biloba: a case report of herbal medicine and bleeding postoperatively from a laparoscopic cholecystectomy. Author(s): Fessenden JM, Wittenborn W, Clarke L. Source: The American Surgeon. 2001 January; 67(1): 33-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11206893

•

Increased cholecystectomy rates in Saudi Arabia. Author(s): Tamimi TM, Wosornu L, al-Khozaim A, Abdul-Ghani A. Source: Lancet. 1990 November 17; 336(8725): 1235-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1978082

•

Nursing management of postoperative pain: use of relaxation techniques with female cholecystectomy patients. Author(s): Levin RF, Malloy GB, Hyman RB. Source: Journal of Advanced Nursing. 1987 July; 12(4): 463-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3308992

•

Persisting pain after cholecystectomy. A prospective investigation. Author(s): Jorgensen T, Teglbjerg JS, Wille-Jorgensen P, Bille T, Thorvaldsen P. Source: Scandinavian Journal of Gastroenterology. 1991 January; 26(1): 124-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2006393

•

Pharmacokinetics of silybin in bile following administration of silipide and silymarin in cholecystectomy patients. Author(s): Schandalik R, Gatti G, Perucca E. Source: Arzneimittel-Forschung. 1992 July; 42(7): 964-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1329780

•

Recovery profile and side effects of remifentanil-based anaesthesia with desflurane or propofol for laparoscopic cholecystectomy. Author(s): Grundmann U, Silomon M, Bach F, Becker S, Bauer M, Larsen B, Kleinschmidt S. Source: Acta Anaesthesiologica Scandinavica. 2001 March; 45(3): 320-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11207468

•

Studies of the variability in expiratory efforts before and after cholecystectomy. Author(s): Finer B.

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Source: Acta Anaesthesiologica Scandinavica. Supplementum. 1970 September; 38: 1-68. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4920455 •

Successful resuscitation after catastrophic carbon dioxide embolism during laparoscopic cholecystectomy. Author(s): Haroun-Bizri S, ElRassi T. Source: European Journal of Anaesthesiology. 2001 February; 18(2): 118-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11270021

•

Successful use of subcutaneous recombinant human erythropoietin before cholecystectomy in an anemic patient with religious objections to transfusion therapy. Author(s): Fletcher JL Jr, Perez JC, Jones DH. Source: The American Surgeon. 1991 November; 57(11): 697-700. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1746777

•

The effect of transcutaneous nerve stimulation on intraductal biliary pressure in postcholecystectomy patients with T-drainage. Author(s): Blaut U, Marecik J, Hartwich A, Herman RM, Laskiewicz J, Thor PJ. Source: European Journal of Gastroenterology & Hepatology. 2003 January; 15(1): 21-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12544690

•

The postcholecystectomy syndrome: psychogenic and physiologic factors. Author(s): HANSKY J, DREILING DA. Source: Geriatrics. 1963 September; 18: 721-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14057015

•

Transcutaneous electrical nerve stimulation for pain control after cholecystectomy: lack of expected benefits. Author(s): Reuss R, Cronen P, Abplanalp L. Source: Southern Medical Journal. 1988 November; 81(11): 1361-3. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3055321

•

Treatment of suspected postcholecystectomy diarrhea with psyllium hydrophilic mucilloid. Author(s): Strommen GL, Dorworth TE, Walker PR, Crawford KW, Pucino F. Source: Clin Pharm. 1990 March; 9(3): 206-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2318022

•

Using contrast-enhanced MR cholangiography with IV mangafodipir trisodium (Teslascan) to evaluate bile duct leaks after cholecystectomy: a prospective study of 11 patients.

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Author(s): Vitellas KM, El-Dieb A, Vaswani KK, Bennett WF, Fromkes J, Ellison C, Bova JG. Source: Ajr. American Journal of Roentgenology. 2002 August; 179(2): 409-16. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12130442

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/

•


•

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

•

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

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

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

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

•

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

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

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

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

•

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

•

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

The following is a specific Web list relating to cholecystectomy; 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 Gallstones Source: Healthnotes, Inc.; www.healthnotes.com Viral Hepatitis Source: Prima Communications, Inc.www.personalhealthzone.com

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Herbs and Supplements Silybum Alternative names: Milk Thistle; Silybum marianum (L.) Gaertn. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org

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. PATENTS ON CHOLECYSTECTOMY Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.8 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “cholecystectomy” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on cholecystectomy, we have not necessarily excluded non-medical patents in this bibliography.

Patents on Cholecystectomy By performing a patent search focusing on cholecystectomy, 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. 8Adapted

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

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The following is an example of the type of information that you can expect to obtain from a patent search on cholecystectomy: •

Apparatus for applying surgical clips Inventor(s): Aranyi; Ernie (Easton, CT), Cuny; Douglas J. (Bethel, CT), Kappel; Gary S. (Stamford, CT), Peyser; Mark S. (Monroe, CT), Phillips; Paul J. (Middlebury, CT), Pratt; James R. (Wolcott, CT), Tovey; H. Jonathan (Milford, CT) Assignee(s): United States Surgical Corporation (Norwalk, CT) Patent Number: 5,607,436 Date filed: October 8, 1993 Abstract: An apparatus is provided for applying surgical clips which includes provisions for applying a partially closed clip to ducts or shunts during a surgical procedure such as cholecystectomy procedures. The apparatus includes means for effecting a partial closing stroke of the handle mechanism to correspond to a partial closure of the jaw members, and permits a partial opening stroke to release the partially closed clip in the jaw mechanism. Other features of the invention include means for preventing over advancement of a clip to the jaw mechanism, means for cradling the clip as it is advanced from the clip supply to the jaw mechanism, means for preventing splaying of the jaws in the event of a clip-over-clip application, and a novel rotation collar. The instrument of the present invention provides the surgeon with visual, audible, and tactile indication of the positioning of the jaw members to effect the application of a partially closed clip. Excerpt(s): This invention relates to an apparatus for applying surgical clips to body tissue during laparoscopic or endoscopic procedures, and more particularly, to a surgical clip applier adapted to apply fully crimped clips as well as a partially formed clip during surgical procedures. In laparoscopic and endoscopic surgical procedures, a small incision is made in the patient's body to provide access for a robe or cannula device. Once extended into the patient's body, the cannula provides an access port which allows insertion of various surgical instruments through the cannula for acting on organs, blood vessels, ducts, or body tissue far removed from the incision. Often during these procedures, it is necessary to apply hemostatic clips to blood vessels or various ducts to prevent the flow of body fluids therethrough during the procedure. Many limes, the surgical procedure may necessitate the temporary implantation of shunts or tubes into ducts or vessels. Such procedures, such as gall bladder surgery, often require the placement of a shunt into the ducts during excision of the organ. To secure the shunt, a clip must be applied which is partially closed so as to avoid occluding the shunt. While instruments for performing surgical clip application are known in the art, none provide indication of the successful application of a partially crimped clip, such as is necessary to secure the shunt. Fully crimping a clip over a shunt will obviously occlude the shunt and defeat its purpose. One clip applier known well in the art is described in U.S. Pat. No. 5,084,057, the disclosure of which is incorporated herein by reference. This instrument includes a mechanism for sequentially advancing a plurality of surgical clips towards a pair of distal jaw members. Through actuation of handle structure, the jaw members are closed to advantageously crimp the clip. The instrument does not provide an indication of the spacing between the jaws during the closing of the jaw members, other than through visual examination of the jaw members through an endoscope. Thus, when attempting to detachably secure a shunt to tissue, e.g., for

Patents 71

cholangiography, it can be difficult to ascertain whether the jaw members have closed to an appropriate gap for securing the shunt. Web site: http://www.delphion.com/details?pn=US05607436__ •

Cholecystectomy dissector instrument Inventor(s): Brown; Michael A. (Bluemont, VA), McWhinney; Joseph (Millwood, VA) Assignee(s): Pod, Inc. (Boyce, VA) Patent Number: 5,201,752 Date filed: September 27, 1990 Abstract: A specialty surgical instrument for engaging, spreading and removing tissue surrounding an exposed cystic duct and artery in an endo cholecystectomy dissection procedure is provided by this invention. An ergonomically superior scissors action handle extends perpendicular to a cylindrical body for receiving the thumb and two fingers of a surgeon for better control in manipulating a coaxial rod inside the body to operate double action forceps jaws of special design for the dissection of the cystic duct and artery from liver bed tissue, with the feel of the surgeon as if the balance of the instrument and its jaws are an extension of the surgeon's fingers. The jaws have a shape and roughened exterior finish for frictionally engaging tissue in the vicinity of the cystic duct and adjacent artery and spreading it during the dissection procedure. The interior of the jaws are serrated and mated in mutual contact surfaces in closed position to frictionally grasp tissue and bladder for removal. The jaws are specially curved for fitting the anatomical shape of the gall bladder tissue terrain for producing a planar surface in the gall bladder tissue from which the cystic duct and artery are dissected and for cradling the cystic duct during dissection. The length of the jaws permits tissue to be spread significant distances apart for prying tissue surfaces apart. The general exterior jaw shape prevents traumatic damage to the tissue during the dissection procedure and thus bleeding during the procedure. Excerpt(s): This invention relates to surgical instruments and more particularly it relates to a specialty cholecystectomy dissector instrument for grasping, spreading and removing tissue surrounding a cystic duct and adjacent artery of the gall bladder. This forcep is used by introduction into the abdominal cavity through a trocar sleeve for the explicit purpose of dissecting an exposed cystic duct and artery in the process of an endo cholecystectomy. The present invention provides a specialty instrument of this type with improved features facilitating surgical treatment of gallbladder disorders. General types of surgical forceps are known in the art such as disclosed in U.S. Pat. No. 2,113,246, F. C. Wappler, Apr. 5, 1938, wherein forcep jaws are manipulated by means of scissor type handles extending laterally from a tubular housing with an enclosed reciprocating actuating rod connected respectively with the scissor lever arms. Various linkages for operating the forcep jaws are described for example in U.S. Pat. No. 4,669,471, S. Hayashi, Jun. 2, 1987. These jaws may be either spring biased or double acting to move freely in both opening and closing directions by means of surgeon's fingers in the scissor handles. Web site: http://www.delphion.com/details?pn=US05201752__

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Combination surgical retractor, light source, spreader, and suction apparatus Inventor(s): Tyagi; Narendra S. (4209 Margate, Bloomfield Hills, MI 48302) Assignee(s): none reported Patent Number: 5,755,660 Date filed: October 31, 1995 Abstract: An apparatus and method of performing a cholecystectomy procedure through a 3-centimeter incision in the minimum stress triangle through the falciform ligament which provides for direct vertical view of the biliary ducts during dissection. Special tools are provided for this type and other types of surgical operations including obtuse-angled retractors having optionally fixed thereto lighting devices and/or suction devices. Excerpt(s): This invention relates to a combination surgical retractor, light source, spreader, and suction apparatus; a finger-controllable securement apparatus; and a minimally invasive cholecystectomy surgical procedure. With the introduction of laparoscopic cholecystectomy, a minimally invasive procedure, cholecystectomy has evolved to an outpatient procedure. Patients are able to return to preoperative functional status rapidly with minimal postoperative morbidity and pain. The laparoscopic procedure has gained acceptance because of the cosmetic desirability of the small size of the scar. However, there have been reports of various complications, including damage to the abdominal blood vessels, bowel laceration, and common bile duct injuries, associated with this technique. Biliary leakage and complications, including thermal injury to the common bile duct and the porta hepatis and ductal injury caused by blunt and sharp dissection near the cystohepatic angle, are associated with laparoscopic cholecystectomy. Conversion to open conventional cholecystectomy is required for patients who are undergoing laparoscopic procedures who have acute cholecystitis, densely adherent gallbladders, and large stones that require added manipulations. Patients with severe chronic obstructive pulmonary disease and aneurysms of the abdominal aorta are not candidates for laparoscopic cholecystectomies. It is a desideratum of the present invention to avoid the animadversions of prior equipment and techniques. The microceliotomy approach for cholecystectomy of the present invention was designed to provide the advantages of a minimally invasive procedure, while requiring the minimum of persons to assist the surgeon and offering the potential for minimizing complications associated with laparoscopic cholecystectomy. Web site: http://www.delphion.com/details?pn=US05755660__

•

Laparoscopic cholangiogram catheter and method of using same Inventor(s): Wettermann; Peter H. (Pomfret, CT) Assignee(s): International Medical, Inc. (Danielson, CT) Patent Number: 5,183,470 Date filed: March 4, 1991 Abstract: A cholangiogram catheter for use in a laparoscopic cholecystectomy has a rigid tubular outer sheath dimensioned to slide within an associated trocar sleeve, and an outer tubular catheter is slidably seated within the outer sheath with its distal end portion formed into a 90.degree. bend and is resiliently deflectable for withdrawal into

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the sheath. A flexible inner tubular catheter is readily slidable within the outer catheter and is longitudinally dimensioned to extend outwardly of both ends of the outer catheter. The distal end of the inner catheter has a closed tip and a discharge aperture along its side adjacent the tip. Luer connectors are attached to the proximal ends of the several elements. Excerpt(s): The present invention relates to catheters and, more particularly, to a cholangiogram catheter and the method of using the same. Recently, a new surgical technique has been developed whereby the gall bladder is surgically removed by use of a telescopic device called a laparoscope. This procedure is called a laparoscopic cholecystectomy and is performed by making a tiny incision at the umbilicus and inserting the telescopic device to which a small video camera is attached. By utilizing several monitors, the surgeons are able to view the abdominal cavity as the distal end of the telescopic device is moved thereabout. Three other small incisions are made through which various grasping and cutting forceps are inserted, and these are used to grasp and manipulate the gall bladder so as to separate it from the liver bed. Once the gall bladder is detached from the liver bed, it is pulled through one of the small incisions. Prior to resecting the gall bladder from the liver, the surgeon determines whether the patient has stones in the common duct and at the cystic-common duct junction. This is done with a procedure called a cholangiogram. Web site: http://www.delphion.com/details?pn=US05183470__ •

Laparoscopic cholangiogram device Inventor(s): Rydell; Mark A. (Golden Valley, MN) Assignee(s): Everest Medical Corporation (Minneapolis, MN) Patent Number: 5,269,754 Date filed: January 31, 1992 Abstract: A surgical instrument for facilitating the injection of a contrast fluid into the cystic duct during the course of a laparoscopic cholecystectomy procedure comprises an elongated, rigid outer tubular member whose outer diameter permits it to pass through the lumen of a trocar penetrating the patient's abdominal wall and of a length allowing the distal end of the instrument to abut the patient's cystic duct. Affixed to the proximal end of the outer tubular shaft is a grip that includes a plunger which can be reciprocally moved in the longitudinal direction and joined to the plunger is an inner tube which can be joined at its proximal end to a source of contrast fluid and which extends through the lumen of the outer tubular shaft. Affixed to the distal end of the inner tube is a hollow hook-shaped needle which is in fluid communication with the lumen of the inner tube and which has a sharpened distal end for piercing through the wall of the cystic duct when the plunger is depressed to thereby hook and hold the instrument with the open end of the needle in the cystic duct. By injecting contrast fluid into the proximal end of the instrument, it flows through the inner tubular member and the hollow needle into the cystic duct. Excerpt(s): This invention relates generally to instruments to be used during the performance of a laparoscopic cholecystectomy procedure, and more particularly to an instrument for carrying out a laparoscopic cholangiogram. Fairly recently, with the introduction of improved laparoscopes, allowing the viewing of a surgical site on video screens, and the development of improved dissecting instruments, including electrocautery and laser instruments, laparoscopy has become a more popular

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procedure. Rather than making a long incision through the abdominal wall, surgical operations are conducted through small puncture sites in the anterior abdominal wall. Surgeons have used laparoscopic techniques to evaluate tumors, lyse adhesions and conduct biopsies on internal organs. Because the laparoscopy obviates the need for large incisions made through the abdominal muscles, procedures that once required hospitalization for a week or more can now be performed on an out-patient basis. Relatively recently, laparoscopy has been used in performing cholecystectomy surgery. Here, a video guidance tube is inserted through an incision in the navel and the gallbladder is removed through three other tiny incisions made in the upper abdomen. More particularly, in carrying out such surgery, a small 2-3 cm skin incision is placed just below the umbilicus to allow passage of a 11 mm trocar that will house the diagnostic laparoscope. This site is ideal because the peritoneum is firmly attached to the fascia and skin. Hence, it is less likely that a properitoneal insufflation will take place. Web site: http://www.delphion.com/details?pn=US05269754__ •

Laparoscopy organ retrieval apparatus and procedure Inventor(s): Buckley; Edwin L. (208 Phlox, Lakeway, TX 78734), Cochran; Christopher S. (3500 Greenbrier, Dallas, TX 75225), Cochran; James C. (3500 Greenbrier, Dallas, TX 75225) Assignee(s): none reported Patent Number: 5,215,521 Date filed: November 26, 1991 Abstract: Laparoscopy organ retrieval apparatus and procedures are presented for minimum invasion surgery inclusive of laparoscopic nephrectomy, cholecystectomy and other organ dissection, morsellation removal from the abdomen through a keyhole incision. The apparatus and procedures permit the safe and total removal of an organ from a body cavity in a morsellated condition through the combination utilization of an entrapment envelope sheath. The entrapment envelope having an apparatus for opening and closing, the apparatus controlled from an exterior position of the body cavity wherein the entrapment envelope after entry of the sheath is extruded from the sheath which has been inserted through a laparoscopic port in place in a keyhole surgical opening. The entrapment envelope is constructed of flexible, relatively low bulk fluid impermeable materials having sufficient strength to contain morsellator entry, organ fragmentation and removal. Excerpt(s): The invention relates to laparoscopic organ retrieval apparati and procedures for minimally invasive surgery dealing with intra-abdominal or other body cavity surgery. In another aspect the invention relates to an improved method and apparatus of organ entrapment and effective fragmentation-evacuation of the dissected and entrapped organ. In yet another aspect, the invention relates to laparascopic organ retrieval apparati and procedures for containment, dissection, morsellation of substantially solid organs such as kidneys utilizing minimal invasive surgery. Surgical disciplines dealing with minimally invasive surgery addressing intra-abdominal surgery have been impacted by the laparoscope. Laparoscopic procedures for gynecology, for which the laparoscope was originally designed, include removal of small uterine myomata, tubal ligation, and ovariectomy. In general surgery, cholecystectomy, the diagnosis of the acute abdomen, herniorrhaphy, and appendectomy all can be done laparoscopically. In urology, the diagnosis of the

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cryptochide testicle and more recently pelvic node dissection have been accomplished using a laparoscopic approach. Laparoscopic cholecystectomy, like open incisional surgery, removes the gall bladder in order to cure gall bladder disease such as gall stones, i.e. pebble size globs of cholesterol that accumulate in the organ and cause painful attacks when they clog certain digestive passageways. Patients who undergo laparoscopic surgery not only endure less pain and scarring, also experience substantially reduced hospital bed recovery time and return to active lives much sooner than patients experiencing open cavity surgery. Web site: http://www.delphion.com/details?pn=US05215521__ •

Percutaneous laparoscopic cholecystectomy instrument Inventor(s): Berhow; Steven W. (Brooklyn Center, MN), Parins; David J. (Columbia Heights, MN), Rydell; Mark A. (Golden Valley, MN) Assignee(s): Everest Medical Corporation (Minneapolis, MN) Patent Number: 5,071,419 Date filed: April 30, 1990 Abstract: An instrument for performing a percutaneous laparoscopic cholecystectomy includes a generally rigid, tubular body with a proximal end, a distal end and a lumen extending between these two ends and with a pair of bipolar electrodes projecting from the distal end of the tubular body and a handle member affixed to its proximal end. The outside diameter of the tubular body is sufficiently small that it can readily pass through a cannula inserted through a puncture made through the abdominal wall. A pair of conductors, connected at one end to the bipolar electrodes and at their other end to a source of radio frequency voltage, extend through the tube's lumen and a handle. Moreover, a fluid port may be formed through the handle so as to be in fluid communication with the lumen of the tube whereby fluids may be perfused through the instrument during its use or a suction may be applied to the proximal port for aspirating the surgical site. In one embodiment of the invention, the bipolar electrodes may be formed as conductive traces extending along the peripheral edges of a thin ceramic blade. In an alternative arrangement, the bipolar electrodes comprise first and second closely spaced J-shaped conductive hook members. Excerpt(s): This invention relates generally to electrosurgical instruments, and more particularly to a bipolar electrosurgical cutting instrument specifically designed for use in the performance of percutaneous laparoscopic cholecystectomy procedures. The conventional treatment for a diseased gallbladder has been a total cholecystectomy involving cutting a fairly large incision through the abdominal wall and, using a scalpel, to dissect the gallbladder from its bed and to cut the cystic artery and cystic duct to thereby release the organ and allow it to be extracted through the incision. According to National Inpatient Profile, Healthcare Knowledge Systems, Ann Arbor, Mich., 1989:360, the average postoperative stay following gallbladder removal surgery of this type in 1988, on a nationwide basis, was 6.1 days and full recovery to normal activities required four to six weeks recuperation. A relatively new procedure referred to as "laparoscopic laser cholecystectomy" has been devised and it is significantly less invasive than the heretofore conventional approach for gallbladder removal. Rather than working through a major incision in the abdominal wall, a first small puncture would is made in the umbilicus. A needle is inserted and a pneumoperitoneum is established with CO.sub.2 gas to distend the abdomen. Next, a trocar and cannula are inserted through the umbilical incision and following removal of the trocar, a 10 mm, 0.degree. diagnostic

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laparoscope is inserted. Rather than direct visualization through the laparoscope, the scene may be viewed on a CRT screen. Web site: http://www.delphion.com/details?pn=US05071419__ •

Spatula-hook instrument for laparoscopic cholecystectomy Inventor(s): Doresey, III; James H. (2117 NE. 44th St., Lighthouse Point, FL 33064) Assignee(s): none reported Patent Number: 5,261,905 Date filed: September 4, 1992 Abstract: An improved electro-surgical laparoscopic cholecystectomy instrument having a housing (12) formed from an elongated rigid tube for suction and irrigation functionality wherein a distal end (16) of the housing (12) is placed an electrode (18) in the shape of a spatula with an arcuate placed notch (28) therein. The tip (30) of the spatula facilitates the blunt dissection at the electrode (18) and the notch allows for retracting dissection. The electrode (18) available to accept the requisite energy of electrocautery for coagulating and cauterizing. Excerpt(s): This invention relates generally to electro-surgical instruments, and more particularly, to a combination spatula and hook instrument for laparoscopic cholecystectomy. Treatment of diseased gallbladders can be performed by a number of methods, cholecystectomy being a conclusive act. Conventional removal of the gallbladder requires a moderately large abdominal incision. The gallbladder is normally removed by blunt dissection of the gallbladder from the liver bed via electro surgery techniques. Once released, the dissected gallbladder can be easily removed through the incision. More recently, the method of laparoscopic cholecystectomy has revolutionized the surgery procedure by eliminating the large abdominal incision previously required. The result is that gallbladder surgery can be performed on a near out-patient mode requiring only small incisions be made in the umbilicus, lower and upper abdomen. A trocar is inserted into the umbilicus incision with a removable stylet to provide for insertion of a laparoscope allowing viewing on a video screen. Web site: http://www.delphion.com/details?pn=US05261905__

Patent Applications on Cholecystectomy As of December 2000, U.S. patent applications are open to public viewing.9 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to cholecystectomy:

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

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Luminal clip applicator with sensor Inventor(s): Altieri, Greig E.; (Laguna Beach, CA), Burbank, Fred H.; (Laguna Niguel, CA), Jones, Michael L.; (San Clemente, CA), Serra, R. J.; (Irvine, CA), Uyeno, Jill; (Mission Viejo, CA), Werneth, Randy; (Poway, CA), Wong, Yu-Tung; (Irvine, CA) Correspondence: Coudert Brothers; 3rd Floor; 600 Beach Street; San Francisco; CA; 94109; US Patent Application Number: 20030120286 Date filed: November 19, 2002 Abstract: Medical devices, systems and methods for applying a luminal clip to occlude a body lumen, such as a blood vessel, duct, or lymph node are provided. Devices embodying features of the invention include an elongated pressure-applying member having a handle portion and a jaw portion with a clip-receiving surface; a sensor disposed on a jaw portion; and an energy transmission element connected to the sensor. The sensor may detect and/or locate a body lumen, and may be used to differentiate between a blood vessel and other body lumens. The device can apply a luminal clip to a body lumen to compress and to occlude the lumen. Occlusion may be partial or complete, and may be temporary or permanent. Occlusion of the uterine arteries may treat uterine fibroids, dysfunctional uterine bleeding, and other uterine disorders and conditions; clips may also be applied in cholecystectomy procedures, and in other medical procedures. Excerpt(s): This application is a continuation-in-part of patent application Ser. No. 10/113,096, filed Mar. 28, 2002, which claims the benefit of provisional patent application Ser. No. 60/279,477, filed Mar. 28, 2001, which applications are hereby incorporated by reference in their entirety and from which priority is hereby claimed under 35 U.S.C.sctn. 119(e) and 35 U.S.C.sctn. 120. The invention relates generally to the field of medical devices and treatments of diseases and conditions by the detection and occlusion of internal body lumens such as blood vessels and ducts by application of luminal clips. Many surgical procedures, including tubal ligation, cholecystectomy, appendectomy, liver biopsy, and other procedures, often require the placement of a luminal clip, typically to occlude a blood vessel, duct, or other vessel, or to close an incision. For example, removal of a gall bladder requires that the cystic duct and the cystic artery feeding the gall bladder be cut and then closed, typically with a luminal clip, to prevent leakage of blood or bile, and to promote healing of the cut artery and duct. However, it is often difficult to distinguish between blood vessels, ducts, and other tissues, and to identify the proper tissue to which to apply a luminal clip. 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 cholecystectomy, 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 “cholecystectomy” (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 cholecystectomy.

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You can also use this procedure to view pending patent applications concerning cholecystectomy. 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 5. BOOKS ON CHOLECYSTECTOMY Overview This chapter provides bibliographic book references relating to cholecystectomy. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on cholecystectomy 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 “cholecystectomy” (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 cholecystectomy: •

Laparoscopy in Children Source: Heidelberg, Germany: Springer-Verlag. 2003. 147 p. Contact: Available from Springer-Verlag. Tiergartenstr. 17, D-69121 Heidelberg, Germany. (49)6221-487-0. Website: www.springer.de. E-mail: [email protected]. PRICE: $69.95 plus shipping and handling. ISBN: 3540429751. Summary: Most surgeons are familiar with the techniques of laparoscopic surgery, however, in children there are variations in size and technical approach. This book describes the differences and characteristic aspects of laparoscopy in small children. The book is an atlas of numerous drawings, accompanied by textual descriptions. Technical guidelines are given on how to perform laparoscopy safely, even in small children. Topics include patient selection, anesthesia, insufflation, trocar insertion, instruments, ligating, needle insertion, suturing, adhesiolysis, appendectomy, cholecystectomy

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(gallbladder removal), cryptorchidism, fundoplication, inguinal hernia, intussusception, liver biopsy, Meckel's diverticulum, ovary, pyloromyotomy, sigmoid resection, splenectomy, varicocele, thoracoscopy, and postoperative care. The aim of the book is to provide surgeons with the knowledge to extend their expertise in adult laparoscopy to children. A subject index concludes the textbook. •

Gallbladder and Biliary Tract Diseases Source: New York, NY: Marcel Dekker, Inc. 2000. 928 p. Contact: Available from Marcel Dekker, Inc. Cimarron Road, P.O. Box 5005, Monticello, NY 12701. (800) 228-1160 or (845) 796-1919. Fax (845) 796-1772. E-mail: [email protected]. International E-mail: [email protected]. Website: www.dekker.com. PRICE: $250.00 plus shipping and handling. ISBN: 0824703111. Summary: The gallbladder and biliary tract are the 'orphan' organs of the digestive system, falling between the realms of the solid organ liver specialist and the hollow organ intestinal expert. This comprehensive text covers the gallbladder and biliary tract disease, noting that the management of gallbladder and biliary disease is truly multidisciplinary, involving gastroenterologists, surgeons, endoscopists, and radiologists. The text attempts to translate advances in basic science into clinically relevant treatment and to bridge the gap between clinical disciplines. Parts I and II focus on important physiological and pathophysiological principles, with a special emphasis on gallstones. In Parts III to V, the authors focus on clinical disorders of the gallbladder and biliary tree, with input on management from surgeons, endoscopists, and radiologists. New imaging techniques, such as magnetic resonance cholangiography and endoscopic ultrasound, are discussed from both the radiologist's and endoscopist's perspective, and their role in disease management is defined. The 37 chapters cover the neurobiology of the gallbladder, gallbladder mucosal function, gallbladder smooth muscle function and dysfunction, canalicular lipid secretion, bile ductal secretion and its regulation, the pathogenesis of gallstones, pigment gallstones, cholesterol crystallization in bile, normal gallbladder motor functions, gallbladder motility and gallstones, the role of intestinal transit, prevention of gallstones, the gallbladder and biliary tree in cystic fibrosis, the silent gallstone, biliary crystals and sludge, biliary colic and acute cholecystitis (gallbladder infection), laparoscopic cholecystectomy (removal of the gallbladder), nonsurgical therapy of gallstones, biliary lithotripsy, topical contact dissolution of gallbladder stones, common bile duct stones, acalculous cholecystitis, gallbladder cancer, primary sclerosing cholangitis, vanishing bile duct syndrome, cholangiocarcinoma (bile duct cancer), ampullary tumors, infections of the bile ducts, and bile duct injuries. Each chapter includes extensive references and the text concludes with a detailed subject index.

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Gastroenterology and Hepatology: The Comprehensive Visual Reference. Volume 6: Gallbladder and Bile Ducts Source: Philadelphia, PA: Current Medicine. 1997. [200 p.]. Contact: Available from Current Medicine. 400 Market Street, Suite 700, Philadelphia, PA 19106. (800) 427-1796 or (215) 574-2266. Fax (215) 574-2270. E-mail: [email protected]. Website: current-medicine.com. PRICE: $125.00 plus shipping and handling. ISBN: 0443078580. Summary: This atlas is one in an 8-volume collection of images that pictorially displays the gastrointestinal tract, liver, biliary tree, and pancreas in health and disease, both in children and adults. This volume includes 10 chapters on the gallbladder and bile ducts,

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each written by experts in their respective fields. Topics covered include normal anatomy, biliary tract neoplasms, adult cholangiopathies, laparoscopic cholecystectomy (gallbladder removal), gallbladder motility in health and disease, the pathogenesis of gallstones, the nonsurgical treatment of gallstones (including dissolution), endoscopic approaches to choledocholithiasis (bile duct stones), and biliary tract infections. The format of the atlas is visual images supported by relatively brief text. Tables, charts, diagrams, and photomicrographs are used extensively. A subject index concludes the volume. •

Guide to Laparoscopic Surgery Source: Malden, MA: Blackwell Science, Inc. 1998. 169 p. Contact: Available from Blackwell Science, Inc. 350 Main Street, Commerce Place, Malden, MA 02148. (800) 215-1000 or (617) 388-8250. Fax (617) 388-8270. E-mail: [email protected]. Website: www.blackwell-science.com. PRICE: $54.95. ISBN: 086542649X. Summary: This book reviews the important aspects of laparoscopy that every surgeon needs to know. The authors address the needs of trainees in all surgical disciplines, as well as the concerns of qualified surgeons, urologists, and gynecologists. The emphasis is on procedures and practical approaches; four sections are included. In the introduction, the authors review the advantages and disadvantages of laparoscopy, risk factors, combined laparoscopy and open surgery, physiological changes during laparoscopy, anesthesia during the procedures, and postoperative management. The second section on equipment, instruments, basic techniques, problems and solutions includes: imaging and viewing, sterilization and maintenance of optics and the camera, creation of the pneumoperitoneum access, gasless laparoscopy, Veress needle procedures, primary cannula insertion, open cannulation (Hasson's technique), secondary cannula, extraperitoneal laparoscopy, instruments for dissection, diathermy and electrocautery, hemostasis, laser, ultrasound, high velocity water jet, ligation and suturing, and specimen extraction. The section on setting up in the operating theater covers hand instruments, equipment, patient position and preparation, and setting up for the procedure. The final section on laparoscopic procedures themselves, covers diagnostic laparoscopy, laparoscopic ultrasonography, adhesiolysis, cholecystectomy (gallbladder removal), management of common bile duct stones, appendectomy, laparoscopic Nissen's fundoplication, gastroenterostomy, truncal vagotomy, laparoscopy for perforated duodenal ulcer, splenectomy, laparoscopy for undescended testicles, varicocele, laparoscopic simple nephrectomy (kidney removal), and inguinal hernia repair. The book is illustrated with numerous line drawings of the equipment and procedures being discussed. A subject index concludes the book.

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Clinical Practice of Gastroenterology. Volume Two Source: Philadelphia, PA: Current Medicine. 1999. 861 p. Contact: Available from W.B. Saunders Company. Order Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887. (800) 545-2522. Fax (800) 874-6418 or (407) 352-3445. Website: www.wbsaunders.com. PRICE: $235.00 plus shipping and handling. ISBN: 0443065209 (two volume set); 0443065217 (volume 1); 0443065225 (volume 2). Summary: This lengthy textbook brings practitioners up to date on the complexities of gastroenterology practice, focusing on the essentials of patient care. This second volume includes 113 chapters in five sections: liver, gallbladder and biliary tract, pancreas, pediatric gastroenterology, and special topics. Specific topics include hepatic (liver)

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structure and function, jaundice, viral hepatitis, alcoholic liver injury, liver tumors, parasitic diseases of the liver, Wilson's disease, hemochromatosis, the pregnancy patient with liver disease, portal hypertension, hepatic encephalopathy, fulminant hepatic failure, liver transplantation, the anatomy of the gallbladder and biliary tract, gallstones, laparoscopic cholecystectomy (gallbladder removal), cholecystitis (gallbladder infection), primary sclerosing cholangitis, biliary obstruction, pancreatic anatomy and physiology, acute pancreatitis, pancreatic fistulas and ascites (fluid accumulation), chronic pancreatitis, cancer of the pancreas, endoscopic retrograde cholangiopancreatography, esophageal atresia, gastroesophageal reflux in infants and children, achalasia and esophageal motility disorders, caustic and foreign body ingestion, vomiting, chronic abdominal pain, gastritis and peptic ulcer disease in children, malabsorption syndromes in children, inflammatory bowel disease in children and adolescents, acute appendicitis, cystic fibrosis, constipation and fecal soiling (incontinence), hepatitis in children, liver transplantation in children, failure to thrive, pediatric AIDS, the gastrointestinal manifestations of AIDS, the evaluation and management of acute upper gastrointestinal bleeding, principles of endoscopy, eating disorders, nutritional assessment, enteral and parenteral nutrition, gastrointestinal diseases in the elderly and in pregnancy, nosocomial infections, and the psychosocial aspects of gastroenterology (doctor patient interactions). The chapters include figures, algorithms, charts, graphs, radiographs, endoscopic pictures, intraoperative photographs, photomicrographs, tables, and extensive references. The volume concludes with a detailed subject index and a section of color plates. •

Surgical Laparoscopy Source: St. Louis, MO: Quality Medical Publishing, Inc. 1991. 359 p. Contact: Available from Quality Medical Publishing, Inc. 2086 Craigshire Drive, St. Louis, MO 63146. (314) 878-7808. PRICE: $110, shipping and handling free with prepaid orders. ISBN: 094221921X. Summary: This textbook is a guide to the burgeoning field of surgical laparoscopy. It is intended to introduce surgeons to the principles of laparoscopic surgery and to familiarize those already performing laparoscopic cholecystectomy with the newer procedures and instruments that have been developed. Seventeen chapters cover topics including the history of laparoscopy, laparoscopic equipment and instrumentation, practical anesthesia, open laparoscopy, and clinical applications, including those for preoperative diagnosis and staging for gastrointestinal cancers, for gallstone disease, cholecystectomy, cholangiography and management of choledocholithiasis, appendectomy, pelvic lymphadenectomy, truncal and selective vagotomy, inguinal hernia repair, and intestinal surgery. Two final chapters cover the complications of laparoscopic general surgery and training and credentialing for laparoscopic surgery. One appendix provides a partial listing of manufacturers of surgical laparoscopy equipment. A detailed subject index concludes the volume.

Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical

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books. When searching for “cholecystectomy” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “cholecystectomy” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “cholecystectomy” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •

Gallstones and laparoscopic cholecystectomy (SuDoc HE 20.3046:10/3) by U.S. Dept of Health and Human Services; ISBN: B00010FE9G; http://www.amazon.com/exec/obidos/ASIN/B00010FE9G/icongroupinterna

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Gallstones and laparoscopic cholecystectomy : Janaury 1989 through August 1992 : 683 citations (SuDoc HE 20.3615/2:92-4) by Peggie S. Tillman; ISBN: B00010BAQM; http://www.amazon.com/exec/obidos/ASIN/B00010BAQM/icongroupinterna

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Laparoscopic Cholecystectomy (Digestive Surgery) by J.J. Jakimowicz, T.J.M. Ruers; ISBN: 3805554397; http://www.amazon.com/exec/obidos/ASIN/3805554397/icongroupinterna

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Laparoscopic Cholecystectomy and New Techniques in Biliary Stone Disease by Warren S. Grundfest; ISBN: 007025088X; http://www.amazon.com/exec/obidos/ASIN/007025088X/icongroupinterna

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

Complications of Laparoscopic Cholecystectomy Source: in Coggins, C.H., Hancock, E.W., and Levitt, L.J., eds. Annual Review of Medicine: Selected Topics in the Clinical Sciences. Palo Alto, CA: Annual Reviews Inc. 1996. Volume 47: 31-44. Contact: Available from Annual Reviews Inc. 4139 El Camino Way, P.O. Box 10139, Palo Alto, CA 94303-0139. (800) 523-8635. Fax (415) 424-0910. PRICE: $52.00. ISBN: 0824305477. ISSN: 00664219. Individual article reprints available from Annual Reviews Preprints and Reprints. (800) 347-8007 or (415) 259-5017. Base price $13.50 per article. Summary: In this entry from the Annual Review of Medicine, the authors review laparoscopic cholecystectomy. They note that, compared to the same operation performed via laparotomy, laparoscopic cholecystectomy is deemed the standard. The majority of iatrogenic injuries can be avoided if the surgeon appreciates the limitations and pitfalls of laparoscopic surgery, and carefully dissects the hepatocystic triangle before dividing any structure. The early identification and management of complications can minimize the potentially devastating complications of small, unrecognized injuries. The authors encourage physicians to advise patients of the proposed advantages and potential problems of laparoscopic cholecystectomy before referring them to a surgeon. 4 figures. 45 references. (AA-M).

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Cholecystectomy (With or Without Clips) Source: in Schier, F. Laparoscopy in Children. Heidelberg, Germany: Springer-Verlag. 2003. p.48-55. Contact: Available from Springer-Verlag. Tiergartenstr. 17, D-69121 Heidelberg, Germany. (49)6221-487-0. Website: www.springer.de. E-mail: [email protected]. PRICE: $69.95 plus shipping and handling. ISBN: 3540429751. Summary: Most surgeons are familiar with the techniques of laparoscopic surgery, however, in children there are variations in size and technical approach. This section on laparoscopic cholecystectomy (removal of the gallbladder) is from a book that describes the differences and characteristic aspects of laparoscopy in small children. The book is an atlas of numerous drawings, accompanied by textual descriptions. Technical guidelines are given on how to perform the laparoscopic cholecystectomy safely, with or without clips, even in small children. Illustrations depict trocar placement, the instruments used, the technique of locating and isolating the gallbladder, ligation techniques, and the use of laparoscopy to remove gallstones (without removing the gallbladder). The aim of the book is to provide surgeons with the knowledge to extend their expertise in adult laparoscopy to children. 11 figures.

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Sphincter of Oddi Dysfunction (Postcholecystectomy Syndrome) Source: in Textbook of Gastroenterology. 4th ed. [2-volume set]. Hagerstown, MD: Lippincott Williams and Wilkins. 2003. p. 2251-2262. Contact: Available from Lippincott Williams and Wilkins. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-6423. Fax: (301) 223-2400. Website: www.lww.com. PRICE: $289.00. ISBN: 781728614. Summary: Sphincter of Oddi dysfunction (SOD) is a major consideration in patients with postcholecystectomy syndromes, which may be broadly defined as persistence or recurrence of upper abdominal symptoms, especially right upper quadrant pain, after cholecystectomy (removal of the gallbladder). This chapter on SOD is from a comprehensive gastroenterology textbook that provides an encyclopedic discussion of virtually all the disease states encountered in a gastroenterology practice. In this chapter, the authors cover definitions, anatomy, physiology, pathophysiology, epidemiology and frequency, typical clinical presentation, diagnostic methods (noninvasive and invasive), therapy for SOD, SOD in recurrent pancreatitis, and failure to achieve symptomatic improvement after biliary sphincterotomy. The chapter is illustrated with black-and-white radiographs and drawings. 3 figures. 4 tables. 71 references.

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CHAPTER 6. MULTIMEDIA ON CHOLECYSTECTOMY Overview In this chapter, we show you how to keep current on multimedia sources of information on cholecystectomy. 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 cholecystectomy is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “cholecystectomy” 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 “cholecystectomy” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on cholecystectomy: •

Laparoscopic Cholecystectomy: A Patient Education Program Source: New York, NY: American Journal Nursing Company. 1991. Contact: Available from AJN Company. Multimedia Products Division, 555 West 57th Street, New York, NY 10019-2961. (800) CALL-AJN. Fax (212) 586-5462. PRICE: $250 (purchase); $95 (rental). Summary: Laparoscopic cholecystectomy is rapidly supplanting traditional gallbladder removal. This patient education videotape is designed to answer common patient questions about gallstones and the procedure. The program discusses who is at risk for and describes gallstones; the symptoms of gallstones; and the laparoscopic procedure. The videotape includes actual views of the gallbladder through the laparoscope. The program also discusses laparoscopic cholecystectomy's advantages over open cholecystectomy and postoperative guidelines.

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Short Stay Cholecystectomy Source: New York, NY: SK and F Health Media Center. 1990. Contact: Available from SK and F Health Media Center. c/o West Glen, 1430 Broadway, New York, NY 10018. (800) 223-2342 or (212) 764-8815. PRICE: Free loan; requestor responsible for postage costs. Order Number 1312. Summary: Since 1980, Dr. Gerald Moss of the Rensselaer Polytechnic Institute has sent home 240 cholecystectomy patients the day after surgery. This videotape program presents a detailed review of his procedure to minimize postoperative bowel dysfunction. This procedure includes minimizing surgical trauma with a short midline incision, the use of early enteral nutrition, early ambulation, prophylactic cephalosporin antibiotics, and unique closure techniques.

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Reddick on Laparoscopic Cholecystectomy Source: Prairie Village, KS: Medical Education Technologies, Inc. 199x. Contact: Available from Medical Education Technologies, Inc. P.O. Box 8396, Prairie Village, KS 66208. (800) 647-8600. PRICE: Varies, $965 to $1,155. Summary: This comprehensive videotape series on laparoscopic cholecystectomy features Dr. Eddie Joe Reddick performing a wide variety of live cases, selected and edited for teaching use. Subjects covered include the patient selection, the indications and contraindications for the procedure, setting up the surgical suite, training the operating room team and surgical assistants, equipment selection and demonstrations of their use, anatomic details including numerous variations, management of these potential anatomical variations, technical challenges and complications, procedural mortality and morbidity, indications for open cholecystectomy, postoperative care, and reimbursement issues.

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Laparoscopic Cholecystectomy: Gallbladder Removal by Laparoscopy Source: Camp Hill, PA: Chek-Med Systems, Inc. 1994. (videocassette). Contact: Available from Chek-Med Systems, Inc. 200 Grandview Avenue, Camp Hill, PA 17011. (800) 451-5797 or (717) 761-1170. Fax (717) 761-0216. PRICE: $120.00 each; $215.00 for two in series of 3; $295.00 for whole series. Summary: This patient education videotape provides a brief overview of the use of laparoscopy for the removal of the gallbladder (laparoscopic cholecystectomy). The videotape features a general introduction to the procedure of laparoscopy, noting that it usually results in less patient discomfort, a quicker recovery time, and lower cost. The program shows a series of patients expressing their concerns and the results they obtained with laparoscopy. The program then defines the role of the gallbladder, the development of gallstones, typical symptoms of gallbladder disease, and diagnostic considerations. After mention of the standard 'open' surgery previously used for gallbladder removal, the program covers the advantages, risk factors and patient selection issues for laparoscopic cholecystectomy. The program then uses graphics to show how the actual laparoscopic procedure is conducted. The program concludes by showing one patient's postoperative recovery period. The program features Dr. Paul Kunkel.

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Laparoscopic Cholecystectomy: Two-Handed Technique Source: Research Triangle Park, NC: Glaxo, Inc. 199x.

Multimedia 87

Contact: Available from Glaxo Video Library. 5 Moore Drive, Research Triangle Park, NC 27709. (800) 824-2896. PRICE: Single copy free; available to health care professionals only. Item Number GVL207. Summary: This professional education videotape presents Dr. J. Barry McKernan demonstrating the two-handed technique for laparoscopic cholecystectomy. Dr. McKernan demonstrates cholecystectomy, operative cholangiogram, and common duct exploration using a flexible choledochoscope via the cystic duct. (AA-M).

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CHAPTER 7. PERIODICALS CHOLECYSTECTOMY

AND

NEWS

ON

Overview In this chapter, we suggest a number of news sources and present various periodicals that cover cholecystectomy.

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

Remote laparoscopic cholecystectomy looks promising in pilot trial Source: Reuters Industry Breifing Date: August 07, 2001

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•

Laparoscopic cholecystectomy does not "seed" unsuspected gallbladder cancer Source: Reuters Medical News Date: November 15, 2000

•

Physical activity associated with lower risk of cholecystectomy in women Source: Reuters Medical News Date: September 09, 1999

•

Weight cycling increases risk of cholecystectomy in women Source: Reuters Medical News Date: March 16, 1999

•

Outpatient care recommended for laparoscopic cholecystectomy patients Source: Reuters Medical News Date: December 23, 1998

•

Prophylactic Cholecystectomy Unnecessary In Patients Treated With Octreotide Source: Reuters Medical News Date: February 19, 1997

•

Advantages Of Laparoscopic Cholecystectomy Questioned Source: Reuters Medical News Date: April 15, 1996

•

Laparoscopic Cholecystectomy May Disseminate In Situ Gallbladder Carcinoma Source: Reuters Medical News Date: December 11, 1995 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 “cholecystectomy” (or synonyms) into the search box, and click on “Search News.” As this

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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 “cholecystectomy” (or synonyms). If you know the name of a company that is relevant to cholecystectomy, 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 “cholecystectomy” (or synonyms).

Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “cholecystectomy” (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 cholecystectomy: •

Gallstones: What to Do? Source: Digestive Health Matters. 4(1): 1-3. Spring 2002. Contact: Available from International Foundation for Functional Gastrointestinal Disorders (IFFGD). P.O. Box 170864, Milwaukee, WI 53217. (888) 964-2001 or (414) 9641799. Fax (414) 964-7176. Website: www.iffgd.org. Summary: This article helps readers who are diagnosed with gallstones determine their own best course of action. Although gallstones are present in 20 percent of women and 8 percent of men over the age of 40, most people are unaware of their presence and the consensus is that if they are not causing trouble, they should be left in place. Nevertheless, gallbladder removal (cholecystectomy) is one of the most common surgical procedures. The author reviews gallstones and their development, the prognosis of gallstones, how gallstones can cause symptoms, the symptoms they cause, other digestive tract symptoms that are not due to gallstones, complications of gallstones, diagnostic tests that may be used to confirm the presence or type of gallstones, and treatment options. 2 figures. 6 references.

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Gallbladder Disease: What to Do About Troublesome Stones Source: Mayo Clinic Women's Healthsource. 3(9): 6. September 1999. Contact: Available from Mayo Foundation for Medical Education and Research. 200 First Street SW, Rochester, MN 55905. Summary: This health newsletter article offers guidelines to identifying and managing a gallstone attack. The author notes the risk factors for gallstones, including female gender, family history, being moderately overweight, losing weight rapidly, and taking estrogen pills. The author then briefly reviews the placement and function of the gallbladder, notably as the storage facility for liver bile (which helps the small intestine digest fat). Gallstones can be tiny or big and about 80 percent of the time, stones cause no problems. However, gallstones can block the exit from the gallbladder which is when the pain (biliary colic) begins. Gallbladder attacks are infrequent, occurring weeks, months, even years apart, and last from 30 minutes to several hours. Pain is the main symptom of gallstone disease. If the pain is severe and continuous in the upper abdomen and lasts for at least half an hour, the health care provider may recommend an ultrasound to confirm the presence of stones or other signs of gallbladder disease. The treatment for gallstones is usually cholecystectomy (gallbladder removal). Most often, the surgery is performed laparoscopically, which requires only three small incisions. Readers are reassured that gallstone attacks are usually infrequent, but if surgery is required, the cholecystectomy is a safe, common procedure. 2 figures.

•

Gallbladder Surgery: A Second Look at a First-Line Treatment Source: Harvard Health Letter. 22(1): 6-8. November 1996. Contact: Available from Harvard Health Letter. P.O. Box 420300, Palm Coast, FL 321420300. (800) 829-9045. Summary: This newsletter article reviews the differences between laparoscopy and open surgery for treating gallbladder disease. Unlike open gallbladder surgery, in which the surgeon makes an incision in the abdomen, the laparoscopic method requires only several tiny punctures in the belly to allow for the insertion of a small video camera and surgical instruments. The author reports results of a recent British study of 200 patients that showed that laparoscopic cholecystectomy (gallbladder removal) takes longer to do than mini-incision open surgery and offers no added benefit in recovery time, length of hospital stay, and time back to work. These results were in contrast to earlier evidence showing that people who undergo laparoscopy recover more quickly and with less pain and scarring than those treated with conventional open surgery. The author discusses the incidence of gallstones, the indications for cholecystectomy, rising rates of gallbladder removal, malpractice claims for bile duct injuries from laparoscopic cholecystectomy, and the differential diagnosis of gallbladder disease. The author stresses that the decision to have surgery is an individual one. People with infrequent gallstone attacks may be able to live with the prospect of having another down the road, while those whose episodes are more common or severe may find that laparoscopic cholecystectomy greatly improves the quality of their lives. 1 figure.

Academic Periodicals covering Cholecystectomy Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to cholecystectomy. In addition

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to these sources, you can search for articles covering cholecystectomy 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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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 Institute10: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

•

National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

•

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

•

National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

•

National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

•

National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

•

National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

•

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

10

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/

•

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

•

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

•

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

•

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

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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/

•

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

•

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

•

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

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.11 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:12 •

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

•

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

•

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

•

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

•

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

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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/

•

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

•

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

•

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

•

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

11

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

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•

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

•

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

The NLM Gateway13 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.14 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “cholecystectomy” (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 21473 152 946 65 15 22651

HSTAT15 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.16 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.17 Simply search by “cholecystectomy” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

13

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

14

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). 15 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 16 17

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 Biologists18 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.19 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.20 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/.

18 Adapted 19

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. 20 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 cholecystectomy 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 cholecystectomy. 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 cholecystectomy. 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 “cholecystectomy”:

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Bile Duct Diseases http://www.nlm.nih.gov/medlineplus/bileductdiseases.html Cirrhosis http://www.nlm.nih.gov/medlineplus/cirrhosis.html Digestive Diseases http://www.nlm.nih.gov/medlineplus/digestivediseases.html Gallbladder Diseases http://www.nlm.nih.gov/medlineplus/gallbladderdiseases.html Liver Diseases http://www.nlm.nih.gov/medlineplus/liverdiseases.html Open and Laparoscopic http://www.nlm.nih.gov/medlineplus/tutorials/cholecystectomyloader.html

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

Diagnosis/Symptoms ERCP (Endoscopic Retrograde Cholangiopancreatography) Source: National Digestive Diseases Information Clearinghouse http://digestive.niddk.nih.gov/ddiseases/pubs/ercp/index.htm GGT (Gamma-Glutamyl Transferase) Test Source: American Association for Clinical Chemistry http://labtestsonline.org/understanding/analytes/ggt/test.html How Is Gallbladder Cancer Diagnosed? Source: American Cancer Society http://www.cancer.org/docroot/cri/content/cri_2_4_3x_how_is_gall_bladder_can cer_diagnosed_68.asp?sitearea=cri Ultrasound-Abdomen Source: American College of Radiology, Radiological Society of North America http://www.radiologyinfo.org/content/ultrasound-abdomen.htm What Is a HIDA (Hepatobiliary Iminodiacetic Acid) Scan (Cholescintigraphy)? Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=AN00424

•

Treatment About Cholecystectomy : Surgical Removal of the Gallbladder Source: American College of Surgeons http://www.facs.org/public_info/operation/cholesys.pdf Cholecystectomy: Open and Laparoscopic http://www.nlm.nih.gov/medlineplus/tutorials/cholecystectomyloader.html Gallbladder Cancer (PDQ): Treatment Source: National Cancer Institute http://www.cancer.gov/cancerinfo/pdq/treatment/gallbladder/patient/

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Gallbladder Removal: Laparoscopic Method Source: American Academy of Family Physicians http://familydoctor.org/114.xml Radiation Therapy for Gallbladder Cancer Source: American Cancer Society http://www.cancer.org/docroot/CRI/content/CRI_2_4_4X_Radiation_Therapy_68 .asp?rnav=cri Surgery for Gallbladder Cancer Source: American Cancer Society http://www.cancer.org/docroot/CRI/content/CRI_2_4_4X_Surgery_68.asp?rnav= cri •

Organizations American Gastroenterological Association http://www.gastro.org/ American Liver Foundation http://www.liverfoundation.org/ National Digestive Diseases Information Clearinghouse http://digestive.niddk.nih.gov/ National Institute of Diabetes and Digestive and Kidney Diseases http://www.niddk.nih.gov/

•

Prevention/Screening Can Gallbladder Cancer Be Prevented? Source: American Cancer Society http://www.cancer.org/docroot/cri/content/cri_2_4_2x_can_gall_bladder_cancer _be_prevented_68.asp?sitearea=cri

•

Research What's New in Gallbladder Cancer Research and Treatment? Source: American Cancer Society http://www.cancer.org/docroot/CRI/content/CRI_2_4_6X_Whats_new_in_gall_b ladder_cancer_research_and_treatment_68.asp?rnav=cri

•

Statistics What Are the Key Statistics for Gallbladder Cancer? Source: American Cancer Society http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_are_the_key_sta tistics_for_gall_bladder_cancer_68.asp?sitearea=

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

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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 cholecystectomy. 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: •

Evaluation of the 'Postcholecystectomy Syndrome' Source: Washington, DC: Georgetown University Hospital. 199x. 2 p. Contact: Available from Georgetown University Hospital. Biliary Evaluation Program, 3800 Reservoir Road, N.W., Washington, DC 20007-2197. (202) 687-8696. PRICE: Single copy free. Summary: In this country more than 500,000 patients each year undergo cholecystectomy, surgical removal of the gallbladder. Approximately 30 percent of these patients suffer from postcholecystectomy syndrome. This brochure describes the differential diagnosis of postcholecystectomy syndrome, its evaluation, and therapy. The author notes that a thorough patient evaluation must include diverse, sophisticated tests because blood tests frequently show normal results even in patients with significant disease. Topics mentioned include choledocholithiasis, bile duct strictures, ultrasonography, hepatobiliary scanning (nuclear medicine imaging), endoscopic retrograde cholangiopancreatography, balloon dilation of strictures, sphincterotomy, and bile duct stone removal.

•

Gallstones and Laparoscopic Cholecystectomy Source: JAMA. Journal of the American Medical Association. 269(8): 1018-1024. February 1993. Contact: Also available in booklet form (Volume 10, Number 3, September 14-16 1992) from the Office of Medical Applications of Research, National Institutes of Health, Federal Building, Room 618, Bethesda, MD 20892. Summary: This article presents the NIH consensus statement on Gallstones and Laparoscopic Cholecystectomy, as developed at the NIH Consensus Development Conference held in September 1992. The specific problems and patient issues that must be evaluated in dealing with this disease were addressed by surgeons, endoscopists, hepatologists, gastroenterologists, radiologists, epidemiologists, and representatives of the general public. After 2 days of presentations by medical experts and discussion by the audience, the consensus panel addressed six topics: which patients with gallstones should be treated, which patients should be treated with laparoscopic cholecystectomy, the alternative medical and surgical treatments of gallstone disease, the comparative results of laparoscopic cholecystectomy with open cholecystectomy and other available treatments, how bile duct stones should be detected and treated, and future directions for research in the prevention and management of gallstone disease and in laparoscopic

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surgery. The article concludes with a listing of the names and affiliations of the panel members, the speakers, and the planning committee. •

When You Need an Operation: About Cholecystectomy (Surgical Removal of the Gallbladder) Source: Chicago, IL: American College of Surgeons. 1994. 4 p. Contact: Available from American College of Surgeons. 55 East Erie Street, Chicago, IL 60611. (312) 664-4050. PRICE: $14 for 50 copies, $27 for 100 copies. Summary: This brochure provides information for patients scheduled to undergo cholecystectomy, the surgical removal of the gallbladder. Written in a question-andanswer format, the brochure explains why the procedure may be recommended; the anatomy and function of the gallbladder; symptoms, diagnoses, and treatment of gallbladder disease; laparoscopic cholecystectomy; and conventional cholecystectomy. For each surgical technique, the brochure covers preparation for surgery, the surgical procedure, recovery from the operation, and possible complications. The brochure includes a description of the specialized training required for surgeons and for certification as a Fellow of the American College of Surgeons. 2 figures.

•

Gallstones and Laparoscopic Cholecystectomy: Summary of the NIH Consensus Source: Bethesda, MD: Office of Medical Applications of Research, National Institutes of Health. 1992. 2 p. Contact: Available from Office of Medical Applications of Research, National Institutes of Health. Federal Building, Room 618, Bethesda, MD 20892. (301) 496-1143. PRICE: Single copy free. Summary: This fact sheet summarizes the NIH consensus statement on Gallstones and Laparoscopic Cholecystectomy, as developed at the NIH Consensus Development Conference held in September 1992. After a brief review of the problem of gallstones in the United States and the history of their treatment, the consensus panel addressed six topics: which patients with gallstones should be treated, which patients should be treated with laparoscopic cholecystectomy, the alternative medical and surgical treatments for gallstone disease, the comparative results of laparoscopic cholecystectomy with open cholecystectomy and other available treatments, how bile duct stones should be detected and treated, and the future directions for research in the prevention and management of gallstone disease and in laparoscopic surgery. 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 cholecystectomy. 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: •


•

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

•

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

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

•

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

•

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

•

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

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to cholecystectomy. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with cholecystectomy. 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 cholecystectomy. 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 “cholecystectomy” (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 “cholecystectomy”. 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 “cholecystectomy” (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 “cholecystectomy” (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.21

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

21

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)22: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

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Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

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Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

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California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

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California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

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California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

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California: Gateway Health Library (Sutter Gould Medical Foundation)

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California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

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California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

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California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

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California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

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California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

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California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

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California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

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California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

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Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

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Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

22

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

•

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

•

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

•

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

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

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

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

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

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

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

•

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

•

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

•

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

•

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

•

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

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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

•

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

•

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

•

Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

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South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

•

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

•

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

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

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

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

•

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

•

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

•

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

•

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

•

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

•

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

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

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

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

•

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

•

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

•

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

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CHOLECYSTECTOMY 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] Ablation: The removal of an organ by surgery. [NIH] Acceptor: A substance which, while normally not oxidized by oxygen or reduced by hydrogen, can be oxidized or reduced in presence of a substance which is itself undergoing oxidation or reduction. [NIH] Acetaminophen: Analgesic antipyretic derivative of acetanilide. It has weak antiinflammatory properties and is used as a common analgesic, but may cause liver, blood cell, and kidney damage. [NIH] Adenocarcinoma: A malignant epithelial tumor with a glandular organization. [NIH] Adhesions: Pathological processes consisting of the union of the opposing surfaces of a wound. [NIH] Adipocytes: Fat-storing cells found mostly in the abdominal cavity and subcutaneous tissue. Fat is usually stored in the form of tryglycerides. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Aerosol: A solution of a drug which can be atomized into a fine mist for inhalation therapy. [EU]

Afferent: Concerned with the transmission of neural impulse toward the central part of the nervous system. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association 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] 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] 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]

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Alleles: Mutually exclusive forms of the same gene, occupying the same locus on homologous chromosomes, and governing the same biochemical and developmental process. [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] Amine: An organic compound containing nitrogen; any member of a group of chemical compounds formed from ammonia by replacement of one or more of the hydrogen atoms by organic (hydrocarbon) radicals. The amines are distinguished as primary, secondary, and tertiary, according to whether one, two, or three hydrogen atoms are replaced. The amines include allylamine, amylamine, ethylamine, methylamine, phenylamine, propylamine, and many other compounds. [EU] Ampulla: A sac-like enlargement of a canal or duct. [NIH] Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Analytes: A component of a test sample the presence of which has to be demonstrated. The term "analyte" includes where appropriate formed from the analyte during the analyses. [NIH]

Anastomosis: A procedure to connect healthy sections of tubular structures in the body after the diseased portion has been surgically removed. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anemic: Hypoxia due to reduction of the oxygen-carrying capacity of the blood as a result of a decrease in the total hemoglobin or an alteration of the hemoglobin constituents. [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] Angiography: Radiography of blood vessels after injection of a contrast medium. [NIH] Angiotensin converting enzyme inhibitor: A drug used to decrease pressure inside blood vessels. [NIH] Animal model: An animal with a disease either the same as or like a disease in humans. Animal models are used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Anti-Anxiety Agents: Agents that alleviate anxiety, tension, and neurotic symptoms, promote sedation, and have a calming effect without affecting clarity of consciousness or neurologic conditions. Some are also effective as anticonvulsants, muscle relaxants, or anesthesia adjuvants. Adrenergic beta-antagonists are commonly used in the symptomatic treatment of anxiety but are not included here. [NIH]

Dictionary 121

Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Antibiotic Prophylaxis: Use of antibiotics before, during, or after a diagnostic, therapeutic, or surgical procedure to prevent infectious complications. [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] Antiemetic: An agent that prevents or alleviates nausea and vomiting. Also antinauseant. [EU]

Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Antioxidant: A substance that prevents damage caused by free radicals. Free radicals are highly reactive chemicals that often contain oxygen. They are produced when molecules are split to give products that have unpaired electrons. This process is called oxidation. [NIH] Antipyretic: An agent that relieves or reduces fever. Called also antifebrile, antithermic and febrifuge. [EU] Anus: The opening of the rectum to the outside of the body. [NIH] Anxiolytic: An anxiolytic or antianxiety agent. [EU] Aorta: The main trunk of the systemic arteries. [NIH] Appendectomy: An operation to remove the appendix. [NIH] Appendicitis: Acute inflammation of the vermiform appendix. [NIH] Argon: A noble gas with the atomic symbol Ar, atomic number 18, and atomic weight 39.948. It is used in fluorescent tubes and wherever an inert atmosphere is desired and nitrogen cannot be used. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Asbestos: Fibrous incombustible mineral composed of magnesium and calcium silicates with or without other elements. It is relatively inert chemically and used in thermal insulation and fireproofing. Inhalation of dust causes asbestosis and later lung and gastrointestinal neoplasms. [NIH] Ascites: Accumulation or retention of free fluid within the peritoneal cavity. [NIH] Asphyxia: A pathological condition caused by lack of oxygen, manifested in impending or actual cessation of life. [NIH]

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Asymptomatic: Having no signs or symptoms of disease. [NIH] Autacoids: A chemically diverse group of substances produced by various tissues in the body that cause slow contraction of smooth muscle; they have other intense but varied pharmacologic activities. [NIH] Autodigestion: Autolysis; a condition found in disease of the stomach: the stomach wall is digested by the gastric juice. [NIH] Autosuggestion: Suggestion coming from the subject himself. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] 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] Balloon dilation: A treatment for benign prostatic hyperplasia or prostate enlargement. A tiny balloon is inflated inside the urethra to make it wider so urine can flow more freely from the bladder. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Benign prostatic hyperplasia: A benign (noncancerous) condition in which an overgrowth of prostate tissue pushes against the urethra and the bladder, blocking the flow of urine. Also called benign prostatic hypertrophy or BPH. [NIH] Beta-Thalassemia: A disorder characterized by reduced synthesis of the beta chains of hemoglobin. There is retardation of hemoglobin A synthesis in the heterozygous form (thalassemia minor), which is asymptomatic, while in the homozygous form (thalassemia major, Cooley's anemia, Mediterranean anemia, erythroblastic anemia), which can result in severe complications and even death, hemoglobin A synthesis is absent. [NIH] Bilateral: Affecting both the right and left side of body. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bile Acids: Acids made by the liver that work with bile to break down fats. [NIH] Bile Acids and Salts: Steroid acids and salts. The primary bile acids are derived from cholesterol in the liver and usually conjugated with glycine or taurine. The secondary bile acids are further modified by bacteria in the intestine. They play an important role in the digestion and absorption of fat. They have also been used pharmacologically, especially in the treatment of gallstones. [NIH] Bile duct: A tube through which bile passes in and out of the liver. [NIH] Bile Pigments: Pigments that give a characteristic color to bile including: bilirubin, biliverdine, and bilicyanin. [NIH] Bile Reflux: Reflux of bile mainly into the upper digestive tract, but also into the pancreas. [NIH]

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Biliary: Having to do with the liver, bile ducts, and/or gallbladder. [NIH] Biliary Tract: The gallbladder and its ducts. [NIH] Biliary Tract Neoplasms: Tumors or cancer of the biliary tract. [NIH] Bilirubin: A bile pigment that is a degradation product of heme. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Bladder: The organ that stores urine. [NIH] Bloating: Fullness or swelling in the abdomen that often occurs after meals. [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] 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] Body Regions: Anatomical areas of the body. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Broad-spectrum: Effective against a wide range of microorganisms; said of an antibiotic. [EU] Bronchial: Pertaining to one or more bronchi. [EU] Bronchitis: Inflammation (swelling and reddening) of the bronchi. [NIH] Budgets: Detailed financial plans for carrying out specific activities for a certain period of time. They include proposed income and expenditures. [NIH] Bupivacaine: A widely used local anesthetic agent. [NIH] Calculi: An abnormal concretion occurring mostly in the urinary and biliary tracts, usually composed of mineral salts. Also called stones. [NIH] Cannula: A tube for insertion into a duct or cavity; during insertion its lumen is usually occupied by a trocar. [EU] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the

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pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] 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] Carcinogenic: Producing carcinoma. [EU] Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs. [NIH]

Cardiac: Having to do with the heart. [NIH] Cardiac arrest: A sudden stop of heart function. [NIH] Cardiopulmonary: Having to do with the heart and lungs. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Case series: A group or series of case reports involving patients who were given similar treatment. Reports of case series usually contain detailed information about the individual patients. This includes demographic information (for example, age, gender, ethnic origin) and information on diagnosis, treatment, response to treatment, and follow-up after treatment. [NIH] Catheter: A flexible tube used to deliver fluids into or withdraw fluids from the body. [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] Causal: Pertaining to a cause; directed against a cause. [EU] Caustic: An escharotic or corrosive agent. Called also cauterant. [EU] Cefotaxime: Semisynthetic broad-spectrum cephalosporin. [NIH] Cefoxitin: Semisynthetic cephamycin antibiotic resistant to beta-lactamase. [NIH] Cefuroxime: Broad-spectrum cephalosporin antibiotic resistant to beta-lactamase. It has been proposed for infections with gram-negative and gram-positive organisms, gonorrhea, and haemophilus. [NIH] Celiac Artery: The arterial trunk that arises from the abdominal aorta and after a short course divides into the left gastric, common hepatic and splenic arteries. [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] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [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] Cesarean Section: Extraction of the fetus by means of abdominal hysterotomy. [NIH] Chemoembolization: A procedure in which the blood supply to the tumor is blocked surgically or mechanically, and anticancer drugs are administered directly into the tumor. This permits a higher concentration of drug to be in contact with the tumor for a longer

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period of time. [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] Cholangiography: Radiographic examination of the bile ducts. [NIH] Cholangitis: Inflammation of a bile duct. [NIH] Cholecystitis: Inflammation of the gallbladder. [NIH] Cholecystokinin: A 33-amino acid peptide secreted by the upper intestinal mucosa and also found in the central nervous system. It causes gallbladder contraction, release of pancreatic exocrine (or digestive) enzymes, and affects other gastrointestinal functions. Cholecystokinin may be the mediator of satiety. [NIH] Choledocholithiasis: Gallstones in the bile ducts. [NIH] Cholelithiasis: Presence or formation of gallstones. [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] 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] 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] Cirrhosis: A type of chronic, progressive liver disease. [NIH] Cisplatin: An inorganic and water-soluble platinum complex. After undergoing hydrolysis, it reacts with DNA to produce both intra and interstrand crosslinks. These crosslinks appear to impair replication and transcription of DNA. The cytotoxicity of cisplatin correlates with cellular arrest in the G2 phase of the cell cycle. [NIH] Clinical Medicine: The study and practice of medicine by direct examination of the patient. [NIH]

Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Coagulation: 1. The process of clot formation. 2. In colloid chemistry, the solidification of a 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] Codeine: An opioid analgesic related to morphine but with less potent analgesic properties

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and mild sedative effects. It also acts centrally to suppress cough. [NIH] Colic: Paroxysms of pain. This condition usually occurs in the abdominal region but may occur in other body regions as well. [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] Colon: The long, coiled, tubelike organ that removes water from digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus. [NIH] Common Bile Duct: The largest biliary duct. It is formed by the junction of the cystic duct and the hepatic duct. [NIH] Common Bile Duct Calculi: Gallstones that are present in the common bile duct, but are usually formed in the gallbladder. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as

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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] Congestive heart failure: Weakness of the heart muscle that leads to a buildup of fluid in body tissues. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Constriction: The act of constricting. [NIH] Contractility: Capacity for becoming short in response to a suitable stimulus. [EU] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Contrast medium: A substance that is introduced into or around a structure and, because of the difference in absorption of x-rays by the contrast medium and the surrounding tissues, allows radiographic visualization of the structure. [EU] Controlled clinical trial: A clinical study that includes a comparison (control) group. The comparison group receives a placebo, another treatment, or no treatment at all. [NIH] Convalescence: The period of recovery following an illness. [NIH] Conventional treatment: A currently accepted and widely used treatment for a certain type of disease, based on the results of past research. Also called conventional therapy. [NIH] Cortisone: A natural steroid hormone produced in the adrenal gland. It can also be made in the laboratory. Cortisone reduces swelling and can suppress immune responses. [NIH] Cost Savings: Reductions in all or any portion of the costs of providing goods or services. Savings may be incurred by the provider or the consumer. [NIH] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Credentialing: The recognition of professional or technical competence through registration, certification, licensure, admission to association membership, the award of a diploma or degree, etc. [NIH] Cryptorchidism: A condition in which one or both testicles fail to move from the abdomen, where they develop before birth, into the scrotum. Cryptorchidism may increase the risk for development of testicular cancer. Also called undescended testicles. [NIH] Crystallization: The formation of crystals; conversion to a crystalline form. [EU] Curative: Tending to overcome disease and promote recovery. [EU]

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Cyanosis: A bluish or purplish discoloration of the skin and mucous membranes due to an increase in the amount of deoxygenated hemoglobin in the blood or a structural defect in the hemoglobin molecule. [NIH] Cystic Duct: The tube that carries bile from the gallbladder into the common bile duct and the small intestine. [NIH] Cytokines: Non-antibody proteins secreted by inflammatory leukocytes and some nonleukocytic cells, that act as intercellular mediators. They differ from classical hormones in that they are produced by a number of tissue or cell types rather than by specialized glands. They generally act locally in a paracrine or autocrine rather than endocrine manner. [NIH] Cytotoxic: Cell-killing. [NIH] Cytotoxic chemotherapy: Anticancer drugs that kill cells, especially cancer cells. [NIH] Decarboxylation: The removal of a carboxyl group, usually in the form of carbon dioxide, from a chemical compound. [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 death. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Delivery of Health Care: The concept concerned with all aspects of providing and distributing health services to a patient population. [NIH] Dexamethasone: (11 beta,16 alpha)-9-Fluoro-11,17,21-trihydroxy-16-methylpregna-1,4diene-3,20-dione. An anti-inflammatory glucocorticoid used either in the free alcohol or esterified form in treatment of conditions that respond generally to cortisone. [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] 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] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diathermy: The induction of local hyperthermia by either short radio waves or highfrequency sound waves. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] 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

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the mouth, esophagus, stomach, small and large intestines, and rectum. [NIH] Dihydrotestosterone: Anabolic agent. [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] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [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] Diverticulum: A pathological condition manifested as a pouch or sac opening from a tubular or sacular organ. [NIH] Dopamine: An endogenous catecholamine and prominent neurotransmitter in several systems of the brain. In the synthesis of catecholamines from tyrosine, it is the immediate precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. A family of dopaminergic receptor subtypes mediate its action. Dopamine is used pharmacologically for its direct (beta adrenergic agonist) and indirect (adrenergic releasing) sympathomimetic effects including its actions as an inotropic agent and as a renal vasodilator. [NIH] Double-blind: Pertaining to a clinical trial or other experiment in which neither the subject nor the person administering treatment knows which treatment any particular subject is receiving. [EU] 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] Duodenal Ulcer: An ulcer in the lining of the first part of the small intestine (duodenum). [NIH]

Duodenogastric Reflux: Reflux of duodenal contents into the stomach. [NIH] Duodenum: The first part of the small intestine. [NIH] Dyskinesia: Impairment of the power of voluntary movement, resulting in fragmentary or incomplete movements. [EU] Dyspepsia: Impaired digestion, especially after eating. [NIH] Dyspnea: Difficult or labored breathing. [NIH] Early Ambulation: Procedure characterized by a shorter period of hospitalization or recumbency or by more rapid mobilization than is normally practiced. [NIH] Eating Disorders: A group of disorders characterized by physiological and psychological disturbances in appetite or food intake. [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] Ejection fraction: A measure of ventricular contractility, equal to normally 65 8 per cent; lower values indicate ventricular dysfunction. [EU] Elective: Subject to the choice or decision of the patient or physician; applied to procedures that are advantageous to the patient but not urgent. [EU] 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]

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Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the latter being a high-energy biproduct of nuclear decay. [NIH] Emboli: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] 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 done as treatment to block the flow of blood to a tumor. [NIH] Emphysema: A pathological accumulation of air in tissues or organs. [NIH] Empyema: Presence of pus in a hollow organ or body cavity. [NIH] Endocrine Glands: Ductless glands that secrete substances which are released directly into the circulation and which influence metabolism and other body functions. [NIH] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [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] Endoscopic retrograde cholangiopancreatography: ERCP. A procedure to x-ray the pancreatic duct, hepatic duct, common bile duct, duodenal papilla, and gallbladder. In this procedure, a thin, lighted tube (endoscope) is passed through the mouth and down into the first part of the small intestine (duodenum). A smaller tube (catheter) is then inserted through the endoscope into the bile and pancreatic ducts. A dye is injected through the catheter into the ducts, and an x-ray is taken. [NIH] Endoscopy: Endoscopic examination, therapy or surgery performed on interior parts of the body. [NIH] Energy balance: Energy is the capacity of a body or a physical system for doing work. Energy balance is the state in which the total energy intake equals total energy needs. [NIH] Enteral Nutrition: Nutritional support given via the alimentary canal or any route connected to the gastrointestinal system (i.e., the enteral route). This includes oral feeding, sip feeding, and tube feeding using nasogastric, gastrostomy, and jejunostomy tubes. [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] Eosinophilia: Abnormal increase in eosinophils in the blood, tissues or organs. [NIH] Epigastric: Having to do with the upper middle area of the abdomen. [NIH] ERCP: Endoscopic retrograde cholangiopancreatography (en-do-SKAH-pik RET-ro-grade ko-LAN-jee-o-PAN-kree-a-TAW-gra-fee). A procedure to x-ray the bile and pancreatic

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ducts. In this procedure, a thin, lighted tube (endoscope) is passed through the mouth and down into the first part of the small intestine (duodenum). A smaller tube (catheter) is then inserted through the endoscope into the bile and pancreatic ducts. A dye is injected through the catheter into the ducts, and an x-ray is taken. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Erythropoietin: Glycoprotein hormone, secreted chiefly by the kidney in the adult and the liver in the fetus, that acts on erythroid stem cells of the bone marrow to stimulate proliferation and differentiation. [NIH] Esophageal: Having to do with the esophagus, the muscular tube through which food passes from the throat to the stomach. [NIH] Esophageal Atresia: Congenital failure of the full esophageal lumen to develop that commonly occurs with tracheoesophageal fistula. Symptoms include excessive salivation, gagging, cyanosis, and dyspnea. [NIH] Esophageal Motility Disorders: Disorders affecting the motor function of the upper or lower esophageal sphincters, the esophageal body, or a combination of these parts. The failure of the sphincters to maintain a tonic pressure may result in the impeding of the passage of food, regurgitation of food, or reflux of gastric acid into the esophagus. [NIH] Esophagitis: Inflammation, acute or chronic, of the esophagus caused by bacteria, chemicals, or trauma. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Estrogen: One of the two female sex hormones. [NIH] Evacuation: An emptying, as of the bowels. [EU] Exocrine: Secreting outwardly, via a duct. [EU] Expiration: The act of breathing out, or expelling air from the lungs. [EU] Expiratory: The volume of air which leaves the breathing organs in each expiration. [NIH] Extracellular: Outside a cell or cells. [EU] Extraction: The process or act of pulling or drawing out. [EU] Extrahepatic Biliary Tree: The bile ducts located outside the liver. [NIH] Failure to Thrive: A condition in which an infant or child's weight gain and growth are far below usual levels for age. [NIH] Fallopian tube: The oviduct, a muscular tube about 10 cm long, lying in the upper border of the broad ligament. [NIH] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fasciitis: Inflammation of the fascia. There are three major types: 1) Eosinophilic fasciitis, an inflammatory reaction with eosinophilia, producing hard thickened skin with an orangepeel configuration suggestive of scleroderma and considered by some a variant of scleroderma; 2) Necrotizing fasciitis, a serious fulminating infection (usually by a beta hemolytic Streptococcus) causing extensive necrosis of superficial fascia; 3) Nodular/Pseudosarcomatous/Proliferative fasciitis, characterized by a rapid growth of fibroblasts with mononuclear inflammatory cells and proliferating capillaries in soft tissue, often the forearm; it is not malignant but is sometimes mistaken for fibrosarcoma. [NIH] Fat: Total lipids including phospholipids. [NIH]

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Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibrin: A protein derived from fibrinogen in the presence of thrombin, which forms part of the blood clot. [NIH] Fibroblasts: Connective tissue cells which secrete an extracellular matrix rich in collagen and other macromolecules. [NIH] Fibrosarcoma: A type of soft tissue sarcoma that begins in fibrous tissue, which holds bones, muscles, and other organs in place. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Flatus: Gas passed through the rectum. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Fulminant Hepatic Failure: Liver failure that occurs suddenly in a previously healthy person. The most common causes of FHF are acute hepatitis, acetaminophen overdose, and liver damage from prescription drugs. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gamma Rays: Very powerful and penetrating, high-energy electromagnetic radiation of shorter wavelength than that of x-rays. They are emitted by a decaying nucleus, usually between 0.01 and 10 MeV. They are also called nuclear x-rays. [NIH] Gangrenous: A circumscribed, deep-seated, suppurative inflammation of the subcutaneous tissue of the eyelid discharging pus from several points. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gastrectomy: An operation to remove all or part of the stomach. [NIH] Gastric: Having to do with the stomach. [NIH] Gastric Acid: Hydrochloric acid present in gastric juice. [NIH] Gastric Bypass: Surgical procedure in which the stomach is transected high on the body. The resulting proximal remnant is joined to a loop of the jejunum in an end-to-side anastomosis. This procedure is used frequently in the treatment of morbid obesity. [NIH] Gastric Juices: Liquids produced in the stomach to help break down food and kill bacteria. [NIH]

Gastritis: Inflammation of the stomach. [EU] Gastroenterology: A subspecialty of internal medicine concerned with the study of the physiology and diseases of the digestive system and related structures (esophagus, liver, gallbladder, and pancreas). [NIH] Gastroenterostomy: Surgical construction of a channel between the stomach and intestines. [NIH]

Gastroesophageal Reflux: Reflux of gastric juice and/or duodenal contents (bile acids, pancreatic juice) into the distal esophagus, commonly due to incompetence of the lower esophageal sphincter. Gastric regurgitation is an extension of this process with entry of fluid into the pharynx or mouth. [NIH] Gastroesophageal Reflux Disease: Flow of the stomach's contents back up into the esophagus. Happens when the muscle between the esophagus and the stomach (the lower

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esophageal sphincter) is weak or relaxes when it shouldn't. May cause esophagitis. Also called esophageal reflux or reflux esophagitis. [NIH] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gastrostomy: Creation of an artificial external opening into the stomach for nutritional support or gastrointestinal compression. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Genital: Pertaining to the genitalia. [EU] Germ Cells: The reproductive cells in multicellular organisms. [NIH] Gestational: Psychosis attributable to or occurring during pregnancy. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glucocorticoid: A compound that belongs to the family of compounds called corticosteroids (steroids). Glucocorticoids affect metabolism and have anti-inflammatory and immunosuppressive effects. They may be naturally produced (hormones) or synthetic (drugs). [NIH] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Gonad: A sex organ, such as an ovary or a testicle, which produces the gametes in most multicellular animals. [NIH] Gonorrhea: Acute infectious disease characterized by primary invasion of the urogenital tract. The etiologic agent, Neisseria gonorrhoeae, was isolated by Neisser in 1879. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer. [NIH] Grafting: The operation of transfer of tissue from one site to another. [NIH] Gram-negative: Losing the stain or decolorized by alcohol in Gram's method of staining, a primary characteristic of bacteria having a cell wall composed of a thin layer of peptidoglycan covered by an outer membrane of lipoprotein and lipopolysaccharide. [EU] 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] Granuloma: A relatively small nodular inflammatory lesion containing grouped mononuclear phagocytes, caused by infectious and noninfectious agents. [NIH] Groin: The external junctural region between the lower part of the abdomen and the thigh. [NIH]

Gynecology: A medical-surgical specialty concerned with the physiology and disorders

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primarily of the female genital tract, as well as female endocrinology and reproductive physiology. [NIH] Health Care Costs: The actual costs of providing services related to the delivery of health care, including the costs of procedures, therapies, and medications. It is differentiated from health expenditures, which refers to the amount of money paid for the services, and from fees, which refers to the amount charged, regardless of cost. [NIH] Health Expenditures: The amounts spent by individuals, groups, nations, or private or public organizations for total health care and/or its various components. These amounts may or may not be equivalent to the actual costs (health care costs) and may or may not be shared among the patient, insurers, and/or employers. [NIH] Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, 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] Hemobilia: Hemorrhage in or through the biliary tract, due to trauma, inflammation, cholelithiasis, vascular disease, or neoplasms. [NIH] Hemochromatosis: A disease that occurs when the body absorbs too much iron. The body stores the excess iron in the liver, pancreas, and other organs. May cause cirrhosis of the liver. Also called iron overload disease. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemoglobin C: A commonly occurring abnormal hemoglobin in which lysine replaces a glutamic acid residue at the sixth position of the beta chains. It results in reduced plasticity of erythrocytes. [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] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemostasis: The process which spontaneously arrests the flow of blood from vessels carrying blood under pressure. It is accomplished by contraction of the vessels, adhesion and aggregation of formed blood elements, and the process of blood or plasma coagulation. [NIH]

Hepatic: Refers to the liver. [NIH] Hepatic Artery: A branch of the celiac artery that distributes to the stomach, pancreas, duodenum, liver, gallbladder, and greater omentum. [NIH] Hepatic Duct, Common: Predominantly extrahepatic bile duct which is formed by the junction of the right and left hepatic ducts, which are predominantly intrahepatic, and, in turn, joins the cystic duct to form the common bile duct. [NIH] Hepatic Encephalopathy: A condition that may cause loss of consciousness and coma. It is

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usually the result of advanced liver disease. Also called hepatic coma. [NIH] Hepatitis: Inflammation of the liver and liver disease involving degenerative or necrotic alterations of hepatocytes. [NIH] Hepatobiliary: Pertaining to the liver and the bile or the biliary ducts. [EU] Hepatocellular: Pertaining to or affecting liver cells. [EU] Hepatocellular carcinoma: A type of adenocarcinoma, the most common type of liver tumor. [NIH] Hepatocytes: The main structural component of the liver. They are specialized epithelial cells that are organized into interconnected plates called lobules. [NIH] Hereditary: Of, relating to, or denoting factors that can be transmitted genetically from one generation to another. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Hernia: Protrusion of a loop or knuckle of an organ or tissue through an abnormal opening. [NIH]

Herniorrhaphy: An operation to repair a hernia. [NIH] Heterozygote: An individual having different alleles at one or more loci in homologous chromosome segments. [NIH] Histamine: 1H-Imidazole-4-ethanamine. A depressor amine derived by enzymatic decarboxylation of histidine. It is a powerful stimulant of gastric secretion, a constrictor of bronchial smooth muscle, a vasodilator, and also a centrally acting neurotransmitter. [NIH] Histidine: An essential amino acid important in a number of metabolic processes. It is required for the production of histamine. [NIH] 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] 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] 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] Hydrophilic: Readily absorbing moisture; hygroscopic; having strongly polar groups that readily interact with water. [EU] Hyperbilirubinemia: Pathologic process consisting of an abnormal increase in the amount of bilirubin in the circulating blood, which may result in jaundice. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hyperthermia: A type of treatment in which body tissue is exposed to high temperatures to

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damage and kill cancer cells or to make cancer cells more sensitive to the effects of radiation and certain anticancer drugs. [NIH] Hysterectomy: Excision of the uterus. [NIH] Hysterotomy: An incision in the uterus, performed through either the abdomen or the vagina. [NIH] Iatrogenic: Resulting from the activity of physicians. Originally applied to disorders induced in the patient by autosuggestion based on the physician's examination, manner, or discussion, the term is now applied to any adverse condition in a patient occurring as the result of treatment by a physician or surgeon, especially to infections acquired by the patient during the course of treatment. [EU] Ileitis: Inflammation of the ileum. [EU] Ileum: The lower end of the small intestine. [NIH] Ileus: Obstruction of the intestines. [EU] Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] 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] Incision: A cut made in the body during surgery. [NIH] Incisional: The removal of a sample of tissue for examination under a microscope. [NIH] Incompetence: Physical or mental inadequacy or insufficiency. [EU] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Indigestion: Poor digestion. Symptoms include heartburn, nausea, bloating, and gas. Also called dyspepsia. [NIH] Indomethacin: A non-steroidal anti-inflammatory agent (NSAID) that inhibits the enzyme cyclooxygenase necessary for the formation of prostaglandins and other autacoids. It also inhibits the motility of polymorphonuclear leukocytes. [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] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the

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microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Inflammatory bowel disease: A general term that refers to the inflammation of the colon and rectum. Inflammatory bowel disease includes ulcerative colitis and Crohn's disease. [NIH]

Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] Ingestion: Taking into the body by mouth [NIH] Inguinal: Pertaining to the inguen, or groin. [EU] Inguinal Hernia: A small part of the large or small intestine or bladder that pushes into the groin. May cause pain and feelings of pressure or burning in the groin. Often requires surgery. [NIH] Insufflation: The act of blowing a powder, vapor, or gas into any body cavity for experimental, diagnostic, or therapeutic purposes. [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] Insurance Carriers: Organizations which assume the financial responsibility for the risks of policyholders. [NIH] Internal Medicine: A medical specialty concerned with the diagnosis and treatment of diseases of the internal organ systems of adults. [NIH] Intestinal: Having to do with the intestines. [NIH] Intestinal Mucosa: The surface lining of the intestines where the cells absorb nutrients. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intoxication: Poisoning, the state of being poisoned. [EU] Intracellular: Inside a cell. [NIH] Intrahepatic: Within the liver. [NIH] Intramuscular: IM. Within or into muscle. [NIH] Intraocular: Within the eye. [EU] Intraocular pressure: Pressure of the fluid inside the eye; normal IOP varies among individuals. [NIH] Intraperitoneal: IP. Within the peritoneal cavity (the area that contains the abdominal organs). [NIH] Intravenous: IV. Into a vein. [NIH] Intussusception: A rare disorder. A part of the intestines folds into another part of the intestines, causing blockage. Most common in infants. Can be treated with an operation. [NIH]

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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]

Ionizing: Radiation comprising charged particles, e. g. electrons, protons, alpha-particles, etc., having sufficient kinetic energy to produce ionization by collision. [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] Irritable Bowel Syndrome: A disorder that comes and goes. Nerves that control the muscles in the GI tract are too active. The GI tract becomes sensitive to food, stool, gas, and stress. Causes abdominal pain, bloating, and constipation or diarrhea. Also called spastic colon or mucous colitis. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Jaundice: A clinical manifestation of hyperbilirubinemia, consisting of deposition of bile pigments in the skin, resulting in a yellowish staining of the skin and mucous membranes. [NIH]

Jejunostomy: Surgical formation of an opening through the abdominal wall into the jejunum, usually for enteral hyperalimentation. [NIH] Jejunum: That portion of the small intestine which extends from the duodenum to the ileum; called also intestinum jejunum. [EU] 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] Keyhole: A carrier molecule. [NIH] Kinetics: The study of rate dynamics in chemical or physical systems. [NIH] Laceration: 1. The act of tearing. 2. A torn, ragged, mangled wound. [EU] Laparoscopes: Endoscopes for examining the interior of the abdomen. [NIH] Laparoscopy: Examination, therapy or surgery of the abdomen's interior by means of a laparoscope. [NIH] Laparotomy: A surgical incision made in the wall of the abdomen. [NIH] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Laryngeal: Having to do with the larynx. [NIH] Larynx: An irregularly shaped, musculocartilaginous tubular structure, lined with mucous membrane, located at the top of the trachea and below the root of the tongue and the hyoid bone. It is the essential sphincter guarding the entrance into the trachea and functioning secondarily as the organ of voice. [NIH] Length of Stay: The period of confinement of a patient to a hospital or other health facility. [NIH]

Leptin: A 16-kD peptide hormone secreted from white adipocytes and implicated in the regulation of food intake and energy balance. Leptin provides the key afferent signal from fat cells in the feedback system that controls body fat stores. [NIH] Lesion: An area of abnormal tissue change. [NIH] Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and

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strengthen joints. [EU] Ligation: Application of a ligature to tie a vessel or strangulate a part. [NIH] Linkage: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Lip: Either of the two fleshy, full-blooded margins of the mouth. [NIH] Lipid: Fat. [NIH] Lipid Peroxidation: Peroxidase catalyzed oxidation of lipids using hydrogen peroxide as an electron acceptor. [NIH] Lithotripsy: The destruction of a calculus of the kidney, ureter, bladder, or gallbladder by physical forces, including crushing with a lithotriptor through a catheter. Focused percutaneous ultrasound and focused hydraulic shock waves may be used without surgery. Lithotripsy does not include the dissolving of stones by acids or litholysis. Lithotripsy by laser is laser lithotripsy. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Liver Transplantation: The transference of a part of or an entire liver from one human or animal to another. [NIH] Lobe: A portion of an organ such as the liver, lung, breast, or brain. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Loop: A wire usually of platinum bent at one end into a small loop (usually 4 mm inside diameter) and used in transferring microorganisms. [NIH] Lower Esophageal Sphincter: The muscle between the esophagus and stomach. When a person swallows, this muscle relaxes to let food pass from the esophagus to the stomach. It stays closed at other times to keep stomach contents from flowing back into the esophagus. [NIH]

Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]

Lymphadenectomy: A surgical procedure in which the lymph nodes are removed and examined to see whether they contain cancer. Also called lymph node dissection. [NIH] Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphatic system: The tissues and organs that produce, store, and carry white blood cells that fight infection and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes and a network of thin tubes that carry lymph and white blood cells. These tubes branch, like blood vessels, into all the tissues of the body. [NIH] Lymphocytes: White blood cells formed in the body's lymphoid tissue. The nucleus is round or ovoid with coarse, irregularly clumped chromatin while the cytoplasm is typically pale blue with azurophilic (if any) granules. Most lymphocytes can be classified as either T or B (with subpopulations of each); those with characteristics of neither major class are called null cells. [NIH] Malabsorption: Impaired intestinal absorption of nutrients. [EU]

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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

Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malignant mesothelioma: A rare type of cancer in which malignant cells are found in the sac lining the chest or abdomen. Exposure to airborne asbestos particles increases one's risk of developing malignant mesothelioma. [NIH] Mammary: Pertaining to the mamma, or breast. [EU] Manometry: Tests that measure muscle pressure and movements in the GI tract. [NIH] Mechanoreceptors: Cells specialized to transduce mechanical stimuli and relay that information centrally in the nervous system. Mechanoreceptors include hair cells, which mediate hearing and balance, and the various somatosensory receptors, often with nonneural accessory structures. [NIH] Mediastinitis: Inflammation of the mediastinum, the area between the pleural sacs. [NIH] Mediastinum: The area between the lungs. The organs in this area include the heart and its large blood vessels, the trachea, the esophagus, the bronchi, and lymph nodes. [NIH] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Medical Records: Recording of pertinent information concerning patient's illness or illnesses. [NIH] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Membrane Proteins: Proteins which are found in membranes including cellular and intracellular membranes. They consist of two types, peripheral and integral proteins. They include most membrane-associated enzymes, antigenic proteins, transport proteins, and drug, hormone, and lectin receptors. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Mental Health: The state wherein the person is well adjusted. [NIH] Mesentery: A layer of the peritoneum which attaches the abdominal viscera to the abdominal wall and conveys their blood vessels and nerves. [NIH] Mesothelioma: A benign (noncancerous) or malignant (cancerous) tumor affecting the lining of the chest or abdomen. Exposure to asbestos particles in the air increases the risk of developing malignant mesothelioma. [NIH] Meta-Analysis: A quantitative method of combining the results of independent studies (usually drawn from the published literature) and synthesizing summaries and conclusions which may be used to evaluate therapeutic effectiveness, plan new studies, etc., with application chiefly in the areas of research and medicine. [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]

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Metoclopramide: A dopamine D2 antagonist that is used as an antiemetic. [NIH] Migration: The systematic movement of genes between populations of the same species, geographic race, or variety. [NIH] Milk Thistle: The plant Silybum marianum in the family Asteraceae containing the bioflavonoid complex silymarin. For centuries this has been used traditionally to treat liver disease. [NIH] Mobilization: The process of making a fixed part or stored substance mobile, as by separating a part from surrounding structures to make it accessible for an operative procedure or by causing release into the circulation for body use of a substance stored in the body. [EU] 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] Mononuclear: A cell with one nucleus. [NIH] Morphine: The principal alkaloid in opium and the prototype opiate analgesic and narcotic. Morphine has widespread effects in the central nervous system and on smooth muscle. [NIH] Motility: The ability to move spontaneously. [EU] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH] Multiparous: 1. Having had two or more pregnancies which resulted in viable fetuses. 2. Producing several ova or offspring at one time. [EU] Narcotic: 1. Pertaining to or producing narcosis. 2. An agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Nasogastric: The process of passing a small, flexible plastic tube through the nose or mouth into the stomach or small intestine. [NIH] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] 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] Neoplasms: New abnormal growth of tissue. Malignant neoplasms show a greater degree of anaplasia and have the properties of invasion and metastasis, compared to benign

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neoplasms. [NIH] Nephrectomy: Surgery to remove a kidney. Radical nephrectomy removes the kidney, the adrenal gland, nearby lymph nodes, and other surrounding tissue. Simple nephrectomy removes only the kidney. Partial nephrectomy removes the tumor but not the entire kidney. [NIH]

Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Networks: Pertaining to a nerve or to the nerves, a meshlike structure of interlocking fibers or strands. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neuroleptic: A term coined to refer to the effects on cognition and behaviour of antipsychotic drugs, which produce a state of apathy, lack of initiative, and limited range of emotion and in psychotic patients cause a reduction in confusion and agitation and normalization of psychomotor activity. [EU] Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Nitrous Oxide: Nitrogen oxide (N2O). A colorless, odorless gas that is used as an anesthetic and analgesic. High concentrations cause a narcotic effect and may replace oxygen, causing death by asphyxia. It is also used as a food aerosol in the preparation of whipping cream. [NIH]

Nosocomial: Pertaining to or originating in the hospital, said of an infection not present or incubating prior to admittance to the hospital, but generally occurring 72 hours after admittance; the term is usually used to refer to patient disease, but hospital personnel may also acquire nosocomial infection. [EU] 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] Nuclear Medicine: A specialty field of radiology concerned with diagnostic, therapeutic, and investigative use of radioactive compounds in a pharmaceutical form. [NIH] Omentum: A fold of the peritoneum (the thin tissue that lines the abdomen) that surrounds the stomach and other organs in the abdomen. [NIH] Omeprazole: A highly effective inhibitor of gastric acid secretion used in the therapy of gastric ulcers and Zollinger-Ellison syndrome. The drug inhibits the H(+)-K(+)-ATPase (H(+)-K(+)-exchanging ATPase) in a pH-dependent manner. This ATPase is considered the proton pump in the secretory membrane of the parietal cell. [NIH] Ondansetron: A competitive serotonin type 3 receptor antagonist. It is effective in the treatment of nausea and vomiting caused by cytotoxic chemotherapy drugs, including cisplatin, and it has reported anxiolytic and neuroleptic properties. [NIH] On-line: A sexually-reproducing population derived from a common parentage. [NIH]

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Opiate: A remedy containing or derived from opium; also any drug that induces sleep. [EU] Opium: The air-dried exudate from the unripe seed capsule of the opium poppy, Papaver somniferum, or its variant, P. album. It contains a number of alkaloids, but only a few morphine, codeine, and papaverine - have clinical significance. Opium has been used as an analgesic, antitussive, antidiarrheal, and antispasmodic. [NIH] 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] Ovariectomy: The surgical removal of one or both ovaries. [NIH] Ovaries: The pair of female reproductive glands in which the ova, or eggs, are formed. The ovaries are located in the pelvis, one on each side of the uterus. [NIH] Ovary: Either of the paired glands in the female that produce the female germ cells and secrete some of the female sex hormones. [NIH] Overdose: An accidental or deliberate dose of a medication or street drug that is in excess of what is normally used. [NIH] Overweight: An excess of body weight but not necessarily body fat; a body mass index of 25 to 29.9 kg/m2. [NIH] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]

Oxidative Stress: A disturbance in the prooxidant-antioxidant balance in favor of the former, leading to potential damage. Indicators of oxidative stress include damaged DNA bases, protein oxidation products, and lipid peroxidation products (Sies, Oxidative Stress, 1991, pxv-xvi). [NIH] 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 Ducts: Ducts that collect pancreatic juice from the pancreas and supply it to the duodenum. [NIH] Pancreatic Fistula: Abnormal passage communicating with the pancreas. [NIH] Pancreatic Juice: The fluid containing digestive enzymes secreted by the pancreas in response to food in the duodenum. [NIH] Pancreatitis: Acute or chronic inflammation of the pancreas, which may be asymptomatic or symptomatic, and which is due to autodigestion of a pancreatic tissue by its own enzymes. It is caused most often by alcoholism or biliary tract disease; less commonly it may be associated with hyperlipaemia, hyperparathyroidism, abdominal trauma (accidental or operative injury), vasculitis, or uraemia. [EU] Papilla: A small nipple-shaped elevation. [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]

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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] Parasitic Diseases: Infections or infestations with parasitic organisms. They are often contracted through contact with an intermediate vector, but may occur as the result of direct exposure. [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 parietal bone, as the parietal lobe. [EU] Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Patient Selection: Criteria and standards used for the determination of the appropriateness of the inclusion of patients with specific conditions in proposed treatment plans and the criteria used for the inclusion of subjects in various clinical trials and other research protocols. [NIH] PDQ: Physician Data Query. PDQ is an online database developed and maintained by the National Cancer Institute. Designed to make the most current, credible, and accurate cancer information available to health professionals and the public, PDQ contains peer-reviewed summaries on cancer treatment, screening, prevention, genetics, and supportive care; a registry of cancer clinical trials from around the world; and directories of physicians, professionals who provide genetics services, and organizations that provide cancer care. Most of this information is available on the CancerNet Web site, and more specific information about PDQ can be found at http://cancernet.nci.nih.gov/pdq.html. [NIH] Pelvic: Pertaining to the pelvis. [EU] Pelvis: The lower part of the abdomen, located between the hip bones. [NIH] Pepsin: An enzyme made in the stomach that breaks down proteins. [NIH] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Peptic Ulcer: An ulceration of the mucous membrane of the esophagus, stomach or duodenum, caused by the action of the acid gastric juice. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [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] Perforation: 1. The act of boring or piercing through a part. 2. A hole made through a part or substance. [EU] Perioperative: Around the time of surgery; usually lasts from the time of going into the hospital or doctor's office for surgery until the time the patient goes home. [NIH]

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Perioperative Care: Interventions to provide care prior to, during, and immediately after surgery. [NIH] Peritoneal: Having to do with the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH] Peritoneal Cavity: The space enclosed by the peritoneum. It is divided into two portions, the greater sac and the lesser sac or omental bursa, which lies behind the stomach. The two sacs are connected by the foramen of Winslow, or epiploic foramen. [NIH] Peritoneum: Endothelial lining of the abdominal cavity, the parietal peritoneum covering the inside of the abdominal wall and the visceral peritoneum covering the bowel, the mesentery, and certain of the organs. The portion that covers the bowel becomes the serosal layer of the bowel wall. [NIH] 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] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Pharynx: The hollow tube about 5 inches long that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes to the stomach). [NIH] 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] Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pigment: A substance that gives color to tissue. Pigments are responsible for the color of skin, eyes, and hair. [NIH] Pilot study: The initial study examining a new method or treatment. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Platelet Aggregation: The attachment of platelets to one another. This clumping together can be induced by a number of agents (e.g., thrombin, collagen) and is part of the mechanism leading to the formation of a thrombus. [NIH] Platelets: A type of blood cell that helps prevent bleeding by causing blood clots to form. Also called thrombocytes. [NIH] 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

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interior wall of the chest cavity). It is bound by thin membranes. [NIH] Pneumonia: Inflammation of the lungs. [NIH] Pneumothorax: Accumulation of air or gas in the space between the lung and chest wall, resulting in partial or complete collapse of the lung. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [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] 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 Hypertension: High blood pressure in the portal vein. This vein carries blood into the liver. Portal hypertension is caused by a blood clot. This is a common complication of cirrhosis. [NIH] Portal Vein: A short thick vein formed by union of the superior mesenteric vein and the splenic vein. [NIH] Postcholecystectomy Syndrome: A condition that occurs after gallbladder removal. The muscle between the gallbladder and the small intestine does not work properly, causing pain, nausea, and indigestion. Also called biliary dyskinesia. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postoperative: After surgery. [NIH] Postoperative Nausea and Vomiting: Emesis and queasiness occurring after anesthesia. [NIH]

Postprandial: Occurring after dinner, or after a meal; postcibal. [EU] Practicability: A non-standard characteristic of an analytical procedure. It is dependent on the scope of the method and is determined by requirements such as sample throughout and costs. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] 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] Premedication: Preliminary administration of a drug preceding a diagnostic, therapeutic, or surgical procedure. The commonest types of premedication are antibiotics (antibiotic prophylaxis) and anti-anxiety agents. It does not include preanesthetic medication. [NIH] Preoperative: Preceding an operation. [EU] Prevalence: The total number of cases of a given disease in a specified population at a

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designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Primary Sclerosing Cholangitis: Irritation, scarring, and narrowing of the bile ducts inside and outside the liver. Bile builds up in the liver and may damage its cells. Many people with this condition also have ulcerative colitis. [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] Promoter: A chemical substance that increases the activity of a carcinogenic process. [NIH] Prone: Having the front portion of the body downwards. [NIH] Prophylaxis: An attempt to prevent disease. [NIH] Propofol: A widely used anesthetic. [NIH] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Prostaglandins: A group of compounds derived from unsaturated 20-carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway. They are extremely potent mediators of a diverse group of physiological processes. [NIH] 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] 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] Proton Pump: Integral membrane proteins that transport protons across a membrane against a concentration gradient. This transport is driven by hydrolysis of ATP by H(+)transporting ATP synthase. [NIH] Proton Pump Inhibitors: Medicines that stop the stomach's acid pump. Examples are omeprazole (oh-MEH-prah-zol) (Prilosec) and lansoprazole (lan-SOH-prah-zol) (Prevacid). [NIH]

Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychoactive: Those drugs which alter sensation, mood, consciousness or other psychological or behavioral functions. [NIH]

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Psychogenic: Produced or caused by psychic or mental factors rather than organic factors. [EU]

Psyllium: Dried, ripe seeds of Plantago psyllium, P. indica, and P. ovata (Plantaginaceae). Plantain seeds swell in water and are used as demulcents and bulk laxatives. [NIH] Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Publishing: "The business or profession of the commercial production and issuance of literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing. [NIH]

Pulmonary: Relating to the lungs. [NIH] Punctures: Incision of tissues for injection of medication or for other diagnostic or therapeutic procedures. Punctures of the skin, for example may be used for diagnostic drainage; of blood vessels for diagnostic imaging procedures. [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] Radio Waves: That portion of the electromagnetic spectrum beyond the microwaves, with wavelengths as high as 30 KM. They are used in communications, including television. Short Wave or HF (high frequency), UHF (ultrahigh frequency) and VHF (very high frequency) waves are used in citizen's band communication. [NIH] Radioactive: Giving off radiation. [NIH] Radiofrequency ablation: The use of electrical current to destroy tissue. [NIH] Radioimmunotherapy: Radiotherapy where cytotoxic radionuclides are linked to antibodies in order to deliver toxins directly to tumor targets. Therapy with targeted radiation rather than antibody-targeted toxins (immunotoxins) has the advantage that adjacent tumor cells, which lack the appropriate antigenic determinants, can be destroyed by radiation cross-fire. Radioimmunotherapy is sometimes called targeted radiotherapy, but this latter term can also refer to radionuclides linked to non-immune molecules (radiotherapy). [NIH] 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] Radiotherapy: The use of ionizing radiation to treat malignant neoplasms and other benign conditions. The most common forms of ionizing radiation used as therapy are x-rays, gamma rays, and electrons. A special form of radiotherapy, targeted radiotherapy, links a

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cytotoxic radionuclide to a molecule that targets the tumor. When this molecule is an antibody or other immunologic molecule, the technique is called radioimmunotherapy. [NIH] 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] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Recombinant: A cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] 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] Recuperation: The recovery of health and strength. [EU] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Red blood cells: RBCs. Cells that carry oxygen to all parts of the body. Also called erythrocytes. [NIH] Reductase: Enzyme converting testosterone to dihydrotestosterone. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reflex: An involuntary movement or exercise of function in a part, excited in response to a stimulus applied to the periphery and transmitted to the brain or spinal cord. [NIH] Reflux: The term used when liquid backs up into the esophagus from the stomach. [NIH] 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] Relaxation Techniques: The use of muscular relaxation techniques in treatment. [NIH] Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Resection: Removal of tissue or part or all of an organ by surgery. [NIH] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Respiratory Mechanics: The physical or mechanical action of the lungs, diaphragm, ribs, and chest wall during respiration. It includes airflow, lung volume, neural and reflex controls, mechanoreceptors, breathing patterns, etc. [NIH] Resuscitation: The restoration to life or consciousness of one apparently dead; it includes such measures as artificial respiration and cardiac massage. [EU] 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]

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Retractor: An instrument designed for pulling aside tissues to improve exposure at operation; an instrument for drawing back the edge of a wound. [NIH] Retrograde: 1. Moving backward or against the usual direction of flow. 2. Degenerating, deteriorating, or catabolic. [EU] Retrospective: Looking back at events that have already taken place. [NIH] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Risk patient: Patient who is at risk, because of his/her behaviour or because of the type of person he/she is. [EU] Rod: A reception for vision, located in the retina. [NIH] Saline: A solution of salt and water. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Salivation: 1. The secretion of saliva. 2. Ptyalism (= excessive flow of saliva). [EU] Scalpel: A small pointed knife with a convex edge. [NIH] Schizoid: Having qualities resembling those found in greater degree in schizophrenics; a person of schizoid personality. [NIH] Schizophrenia: A mental disorder characterized by a special type of disintegration of the personality. [NIH] Schizotypal Personality Disorder: A personality disorder in which there are oddities of thought (magical thinking, paranoid ideation, suspiciousness), perception (illusions, depersonalization), speech (digressive, vague, overelaborate), and behavior (inappropriate affect in social interactions, frequently social isolation) that are not severe enough to characterize schizophrenia. [NIH] 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] 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] Sedative: 1. Allaying activity and excitement. 2. An agent that allays excitement. [EU] Sensibility: The ability to receive, feel and appreciate sensations and impressions; the quality of being sensitive; the extend to which a method gives results that are free from false negatives. [NIH] Sensor: A device designed to respond to physical stimuli such as temperature, light, magnetism or movement and transmit resulting impulses for interpretation, recording, movement, or operating control. [NIH] 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,

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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] 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]

Shunt: A surgically created diversion of fluid (e.g., blood or cerebrospinal fluid) from one area of the body to another area of the body. [NIH] Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Sigmoid: 1. Shaped like the letter S or the letter C. 2. The sigmoid colon. [EU] Sigmoid Colon: The lower part of the colon that empties into the rectum. [NIH] Silymarin: A mixture of flavonoids extracted from seeds of the milk thistle, Silybum marianum. It consists primarily of three isomers: silicristin, silidianin, and silybin, its major component. Silymarin displays antioxidant and membrane stabilizing activity. It protects various tissues and organs against chemical injury, and shows potential as an antihepatoxic agent. [NIH] Sludge: A clump of agglutinated red blood cells. [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]

Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] 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] Spastic: 1. Of the nature of or characterized by spasms. 2. Hypertonic, so that the muscles are stiff and the movements awkward. 3. A person exhibiting spasticity, such as occurs in spastic paralysis or in cerebral palsy. [EU] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a

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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] 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] Spermatozoa: Mature male germ cells that develop in the seminiferous tubules of the testes. Each consists of a head, a body, and a tail that provides propulsion. The head consists mainly of chromatin. [NIH] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spirometry: Measurement of volume of air inhaled or exhaled by the lung. [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] Splenectomy: An operation to remove the spleen. [NIH] Splenomegaly: Enlargement of the spleen. [NIH] Staging: Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. [NIH]

Stem Cells: Relatively undifferentiated cells of the same lineage (family type) that retain the ability to divide and cycle throughout postnatal life to provide cells that can become specialized and take the place of those that die or are lost. [NIH] Stenosis: Narrowing or stricture of a duct or canal. [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] Sterilization: The destroying of all forms of life, especially microorganisms, by heat, chemical, or other means. [NIH] Stimulant: 1. Producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. An agent or remedy that produces stimulation. [EU]

Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stricture: The abnormal narrowing of a body opening. Also called stenosis. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH]

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Subacute: Somewhat acute; between acute and chronic. [EU] Subcapsular: Situated below a capsule. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Substance P: An eleven-amino acid neurotransmitter that appears in both the central and peripheral nervous systems. It is involved in transmission of pain, causes rapid contractions of the gastrointestinal smooth muscle, and modulates inflammatory and immune responses. [NIH]

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] Supportive care: Treatment given to prevent, control, or relieve complications and side effects and to improve the comfort and quality of life of people who have cancer. [NIH] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Suppressive: Tending to suppress : effecting suppression; specifically : serving to suppress activity, function, symptoms. [EU] Suppurative: Consisting of, containing, associated with, or identified by the formation of pus. [NIH] Surgical Instruments: Hand-held tools or implements used by health professionals for the performance of surgical tasks. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Systemic: Affecting the entire body. [NIH] Testicle: The male gonad where, in adult life, spermatozoa develop; the testis. [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] Testosterone: A hormone that promotes the development and maintenance of male sex characteristics. [NIH] Thalassemia: A group of hereditary hemolytic anemias in which there is decreased synthesis of one or more hemoglobin polypeptide chains. There are several genetic types with clinical pictures ranging from barely detectable hematologic abnormality to severe and fatal anemia. [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] Thoracic: Having to do with the chest. [NIH] Thoracoscopy: Endoscopic examination, therapy or surgery of the pleural cavity. [NIH] Thrombin: An enzyme formed from prothrombin that converts fibrinogen to fibrin. (Dorland, 27th ed) EC 3.4.21.5. [NIH] Thromboembolism: Obstruction of a vessel by a blood clot that has been transported from a distant site by the blood stream. [NIH]

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Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tone: 1. The normal degree of vigour and tension; in muscle, the resistance to passive elongation or stretch; tonus. 2. A particular quality of sound or of voice. 3. To make permanent, or to change, the colour of silver stain by chemical treatment, usually with a heavy metal. [EU] Tonic: 1. Producing and restoring the normal tone. 2. Characterized by continuous tension. 3. A term formerly used for a class of medicinal preparations believed to have the power of restoring normal tone to tissue. [EU] Tonometry: The standard to determine the fluid pressure inside the eye (intraocular pressure). [NIH] Tonus: A state of slight tension usually present in muscles even when they are not undergoing active contraction. [NIH] Topical: On the surface of the body. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Tracheoesophageal Fistula: Abnormal communication between the esophagus and the trachea, acquired or congenital, often associated with esophageal atresia. [NIH] Transcutaneous: Transdermal. [EU] 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] 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] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Treatment Outcome: Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, practicability, etc., of these interventions in individual cases or series. [NIH]

Truncal: The bilateral dissection of the abdominal branches of the vagus nerve. [NIH] Tubal ligation: An operation to tie the fallopian tubes closed. This procedure prevents pregnancy by blocking the passage of eggs from the ovaries to the uterus. [NIH] Ulcer: A localized necrotic lesion of the skin or a mucous surface. [NIH]

Dictionary 155

Ulceration: 1. The formation or development of an ulcer. 2. An ulcer. [EU] Ulcerative colitis: Chronic inflammation of the colon that produces ulcers in its lining. This condition is marked by abdominal pain, cramps, and loose discharges of pus, blood, and mucus from the bowel. [NIH] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Umbilical Cord: The flexible structure, giving passage to the umbilical arteries and vein, which connects the embryo or fetus to the placenta. [NIH] Umbilicus: The pit in the center of the abdominal wall marking the point where the umbilical cord entered in the fetus. [NIH] Uraemia: 1. An excess in the blood of urea, creatinine, and other nitrogenous end products of protein and amino acids metabolism; more correctly referred to as azotemia. 2. In current usage the entire constellation of signs and symptoms of chronic renal failure, including nausea, vomiting anorexia, a metallic taste in the mouth, a uraemic odour of the breath, pruritus, uraemic frost on the skin, neuromuscular disorders, pain and twitching in the muscles, hypertension, edema, mental confusion, and acid-base and electrolyte imbalances. [EU]

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] 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] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] 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] Vagotomy: The interruption or removal of any part of the vagus (10th cranial) nerve. Vagotomy may be performed for research or for therapeutic purposes. [NIH] Vagus Nerve: The 10th cranial nerve. The vagus is a mixed nerve which contains somatic afferents (from skin in back of the ear and the external auditory meatus), visceral afferents (from the pharynx, larynx, thorax, and abdomen), parasympathetic efferents (to the thorax and abdomen), and efferents to striated muscle (of the larynx and pharynx). [NIH] Valves: Flap-like structures that control the direction of blood flow through the heart. [NIH] Varices: Stretched veins such as those that form in the esophagus from cirrhosis. [NIH] Varicocele: A complex of dilated veins which surround the testicle, usually on the left side. [NIH]

Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasculitis: Inflammation of a blood vessel. [NIH] Vasodilator: An agent that widens blood vessels. [NIH] Vector: Plasmid or other self-replicating DNA molecule that transfers DNA between cells in nature or in recombinant DNA technology. [NIH]

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Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Venous Thrombosis: The formation or presence of a thrombus within a vein. [NIH] Ventricular: Pertaining to a ventricle. [EU] Ventricular Dysfunction: A condition in which the ventricles of the heart exhibit a decreased functionality. [NIH] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Viral Hepatitis: Hepatitis caused by a virus. Five different viruses (A, B, C, D, and E) most commonly cause this form of hepatitis. Other rare viruses may also cause hepatitis. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Visceral: , from viscus a viscus) pertaining to a viscus. [EU] Volvulus: A twisting of the stomach or large intestine. May be caused by the stomach being in the wrong position, a foreign substance, or abnormal joining of one part of the stomach or intestine to another. Volvulus can lead to blockage, perforation, peritonitis, and poor blood flow. [NIH] Withdrawal: 1. A pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) A substance-specific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU] Wound Infection: Invasion of the site of trauma by pathogenic microorganisms. [NIH] Xenograft: The cells of one species transplanted to another species. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH]

157

INDEX A Abdominal Pain, 82, 119, 138, 140, 145, 155 Aberrant, 44, 119 Ablation, 119 Acceptor, 119, 139, 143 Acetaminophen, 23, 119, 132 Adenocarcinoma, 119, 135 Adhesions, 74, 119 Adipocytes, 119, 138 Adverse Effect, 119, 151 Aerosol, 119, 142 Afferent, 119, 138 Affinity, 119, 151 Algorithms, 82, 119, 123 Alimentary, 18, 53, 119, 130, 144 Alkaloid, 119, 141 Alleles, 120, 135 Alternative medicine, 90, 120 Amine, 120, 135 Ampulla, 120, 130 Anaesthesia, 20, 23, 24, 26, 34, 50, 55, 57, 58, 64, 65, 120, 136 Anal, 8, 120 Analgesic, 119, 120, 125, 141, 142, 143 Analytes, 104, 120 Anastomosis, 120, 132 Anatomical, 71, 86, 120, 123, 136 Anemia, 54, 120, 122, 153 Anemic, 66, 120 Anesthesia, 17, 22, 27, 34, 36, 42, 79, 81, 82, 120, 146 Aneurysm, 30, 34, 120 Angiography, 36, 120 Angiotensin converting enzyme inhibitor, 13, 120 Animal model, 61, 120 Anti-Anxiety Agents, 120, 146 Antibiotic, 17, 22, 121, 123, 124, 146, 152 Antibiotic Prophylaxis, 22, 121, 146 Antibody, 119, 121, 126, 128, 135, 136, 140, 148, 149 Antiemetic, 121, 141 Antigen, 119, 121, 126, 135, 136, 140 Anti-inflammatory, 12, 119, 121, 128, 133, 136 Antimicrobial, 121, 125 Antioxidant, 121, 143, 151

Antipyretic, 119, 121 Anus, 120, 121, 123, 126, 149 Anxiolytic, 121, 142 Aorta, 72, 121, 124, 134 Appendectomy, 74, 77, 79, 81, 82, 121 Appendicitis, 82, 121 Argon, 5, 20, 121 Arterial, 12, 121, 124, 135, 147 Arteries, 77, 121, 123, 124, 134, 155 Arterioles, 121, 123 Artery, 10, 34, 36, 71, 75, 77, 120, 121, 123, 130 Asbestos, 121, 140 Ascites, 82, 121 Asphyxia, 121, 142 Asymptomatic, 5, 8, 34, 51, 52, 122, 143 Autacoids, 122, 136 Autodigestion, 122, 143 Autosuggestion, 122, 136 B Bacteria, 121, 122, 130, 131, 132, 133, 152 Balloon Dilatation, 52, 122 Balloon dilation, 106, 122 Base, 61, 83, 122, 138, 155 Benign, 18, 31, 122, 140, 141, 148 Benign prostatic hyperplasia, 122 Beta-Thalassemia, 53, 122 Bilateral, 18, 122, 154 Bile Acids, 14, 122, 132 Bile Acids and Salts, 122 Bile duct, 4, 6, 7, 10, 12, 18, 19, 20, 23, 24, 31, 37, 38, 40, 43, 44, 46, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 66, 72, 80, 92, 106, 107, 122, 123, 125, 126, 130, 131, 134, 147 Bile Pigments, 122, 138 Bile Reflux, 34, 122 Biliary Tract, 80, 81, 123, 134, 143 Biliary Tract Neoplasms, 81, 123 Bilirubin, 54, 122, 123, 135 Biopsy, 56, 77, 80, 123, 144 Biotechnology, 14, 90, 99, 123 Bladder, 53, 70, 71, 73, 75, 77, 104, 105, 122, 123, 136, 137, 139, 147, 155 Bloating, 123, 136, 138, 140 Blood pressure, 123, 135, 141, 146, 151 Blood vessel, 70, 72, 77, 120, 123, 124, 130, 134, 138, 139, 140, 148, 151, 152, 154, 155 Body Fluids, 70, 123, 129, 151

158

Cholecystectomy

Body Mass Index, 123, 143 Body Regions, 123, 126 Bone Marrow, 123, 131, 139 Bowel, 20, 57, 72, 86, 120, 123, 128, 137, 145, 152, 155 Bowel Movement, 123, 128, 152 Broad-spectrum, 123, 124 Bronchial, 122, 123, 135 Bronchitis, 123, 125 Budgets, 9, 123 Bupivacaine, 40, 123 C Calculi, 122, 123 Cannula, 70, 75, 81, 123 Carbohydrate, 50, 123 Carbon Dioxide, 6, 25, 35, 57, 66, 124, 128, 149 Carcinogenic, 124, 147 Carcinoma, 37, 39, 44, 47, 55, 90, 124 Cardiac, 20, 51, 124, 129, 149 Cardiac arrest, 20, 51, 124 Cardiopulmonary, 6, 124 Case report, 16, 34, 38, 44, 51, 65, 124, 125 Case series, 124, 125 Catheter, 55, 72, 73, 122, 124, 130, 131, 139 Catheterization, 122, 124 Causal, 11, 124 Caustic, 82, 124 Cefotaxime, 22, 124 Cefoxitin, 14, 124 Cefuroxime, 17, 124 Celiac Artery, 124, 134 Cell, 54, 119, 122, 123, 124, 125, 126, 128, 131, 133, 137, 141, 142, 145, 149 Central Nervous System, 124, 125, 141, 150 Cerebrospinal, 124, 151 Cerebrospinal fluid, 124, 151 Cesarean Section, 35, 124 Chemoembolization, 12, 124 Chest wall, 125, 146, 149 Cholangiography, 4, 10, 24, 31, 38, 40, 43, 49, 52, 54, 56, 57, 66, 71, 80, 82, 125 Cholangitis, 6, 125 Cholecystitis, 6, 21, 23, 26, 27, 29, 43, 54, 55, 56, 72, 80, 82, 125 Cholecystokinin, 53, 125 Choledocholithiasis, 7, 15, 21, 49, 51, 52, 61, 81, 82, 106, 125 Cholelithiasis, 4, 9, 12, 22, 25, 28, 34, 52, 125, 134

Cholesterol, 11, 12, 13, 14, 41, 75, 80, 122, 125 Chromosome, 125, 135, 139 Chronic, 6, 12, 25, 72, 82, 125, 131, 136, 143, 150, 153, 155 Chronic Obstructive Pulmonary Disease, 72, 125 Ciprofloxacin, 17, 125 Cirrhosis, 15, 45, 104, 125, 134, 146, 155 Cisplatin, 125, 142 Clinical Medicine, 125, 146 Clinical study, 38, 125, 127 Clinical trial, 11, 12, 49, 50, 51, 99, 125, 129, 144, 149 Cloning, 123, 125 Coagulation, 60, 125, 134 Codeine, 23, 125, 143 Colic, 42, 80, 92, 126 Colitis, 126, 138 Collagen, 126, 132, 145 Collapse, 126, 146 Colon, 21, 126, 137, 138, 151, 155 Common Bile Duct, 4, 6, 7, 9, 12, 15, 24, 29, 32, 36, 40, 43, 49, 52, 72, 80, 81, 126, 128, 134 Common Bile Duct Calculi, 15, 126 Complement, 126, 127 Complementary and alternative medicine, 63, 68, 126 Complementary medicine, 63, 126 Compress, 77, 127 Computational Biology, 99, 127 Congestive heart failure, 16, 127 Connective Tissue, 123, 126, 127, 132, 139 Consciousness, 120, 127, 134, 147, 149 Constipation, 82, 127, 138, 145 Constriction, 127, 138 Contractility, 127, 129 Contraindications, ii, 5, 9, 86, 127 Contrast medium, 120, 127 Controlled clinical trial, 12, 127 Convalescence, 6, 9, 29, 127 Conventional treatment, 75, 127 Cortisone, 127, 128 Cost Savings, 18, 127 Cranial, 127, 155 Credentialing, 7, 8, 37, 82, 127 Cryptorchidism, 80, 127 Crystallization, 80, 127 Curative, 127, 153 Cyanosis, 128, 131

159

Cystic Duct, 6, 17, 26, 27, 37, 57, 71, 73, 75, 77, 87, 126, 128, 134 Cytokines, 53, 128 Cytotoxic, 128, 142, 148, 149 Cytotoxic chemotherapy, 128, 142 D Decarboxylation, 128, 135 Decompression, 16, 128 Decompression Sickness, 128 Degenerative, 128, 135 Delivery of Health Care, 128, 134 Dexamethasone, 24, 35, 128 Diagnostic Imaging, 128, 148 Diagnostic procedure, 69, 91, 128 Diaphragm, 64, 128, 145, 149 Diarrhea, 66, 128, 138, 140 Diathermy, 81, 128 Digestion, 119, 122, 123, 128, 129, 136, 137, 139, 144, 152 Digestive system, 80, 128, 132 Digestive tract, 91, 122, 128, 151 Dihydrotestosterone, 129, 149 Dilation, 129 Direct, iii, 72, 76, 125, 129, 144, 149 Dissection, 6, 10, 50, 51, 71, 72, 74, 76, 81, 129, 139, 154 Distal, 70, 72, 73, 75, 76, 129, 132, 147 Diverticulum, 80, 129 Dopamine, 129, 141, 142 Double-blind, 45, 49, 129 Drug Interactions, 129 Duodenal Ulcer, 52, 81, 129 Duodenogastric Reflux, 21, 129 Duodenum, 122, 129, 130, 131, 134, 138, 143, 144, 152 Dyskinesia, 54, 129, 146 Dyspepsia, 48, 129, 136 Dyspnea, 129, 131 E Early Ambulation, 86, 129 Eating Disorders, 82, 129 Efficacy, 12, 27, 54, 129, 154 Ejection fraction, 25, 53, 129 Elective, 7, 15, 17, 25, 27, 28, 51, 52, 55, 60, 63, 129 Electrode, 76, 129 Electrolyte, 130, 151, 155 Electrons, 121, 122, 130, 138, 143, 148 Emboli, 28, 36, 130 Embolism, 25, 66, 130 Embolization, 28, 36, 130 Emphysema, 125, 130

Empyema, 32, 130 Endocrine Glands, 130 Endocrinology, 130, 134 Endoscope, 70, 130, 131 Endoscopic retrograde cholangiopancreatography, 12, 52, 61, 82, 106, 130 Energy balance, 130, 138 Enteral Nutrition, 86, 130 Environmental Health, 98, 100, 130 Enzymatic, 126, 130, 135 Enzyme, 130, 136, 144, 149, 153 Eosinophilia, 130, 131 Epigastric, 130, 143 ERCP, 30, 52, 104, 130 Erythrocytes, 120, 123, 131, 134, 149 Erythropoietin, 66, 131 Esophageal, 82, 131, 133, 154 Esophageal Atresia, 82, 131, 154 Esophageal Motility Disorders, 82, 131 Esophagitis, 131, 133 Esophagus, 128, 129, 131, 132, 139, 140, 144, 145, 149, 152, 154, 155 Estrogen, 92, 131 Evacuation, 74, 127, 131 Exocrine, 125, 131, 143 Expiration, 131, 149 Expiratory, 65, 131 Extracellular, 127, 131, 132, 151 Extraction, 10, 81, 124, 131 Extrahepatic Biliary Tree, 18, 22, 131 F Failure to Thrive, 82, 131 Fallopian tube, 131, 154 Family Planning, 99, 131 Fasciitis, 46, 131 Fat, 92, 119, 122, 123, 130, 131, 138, 139, 143, 151 Feces, 127, 132, 152 Fetus, 124, 131, 132, 155 Fibrin, 132, 145, 153 Fibroblasts, 131, 132 Fibrosarcoma, 131, 132 Fibrosis, 80, 82, 132 Flatus, 132 Forearm, 123, 131, 132 Fulminant Hepatic Failure, 82, 132 G Gamma Rays, 132, 148 Gangrenous, 6, 132 Gas, 6, 57, 75, 121, 124, 128, 132, 135, 136, 137, 138, 140, 142, 146, 153

160

Cholecystectomy

Gastrectomy, 41, 132 Gastric, 28, 34, 40, 122, 124, 131, 132, 135, 142, 144 Gastric Acid, 131, 132, 142 Gastric Bypass, 28, 40, 132 Gastric Juices, 132, 144 Gastritis, 82, 132 Gastroenterostomy, 81, 132 Gastroesophageal Reflux, 12, 82, 132 Gastroesophageal Reflux Disease, 12, 132 Gastrointestinal, 5, 12, 18, 30, 34, 52, 80, 82, 91, 121, 125, 130, 133, 151, 152, 153 Gastrointestinal tract, 80, 133, 151, 152 Gastrostomy, 130, 133 Gene, 54, 120, 123, 133 Genetics, 54, 133, 144 Genital, 125, 133, 134 Germ Cells, 133, 143, 152, 153 Gestational, 11, 133 Gland, 127, 133, 139, 142, 143, 147, 150, 152 Glucocorticoid, 128, 133 Glucose, 57, 133, 134, 137 Gonad, 133, 153 Gonorrhea, 124, 133 Governing Board, 133, 146 Grade, 56, 130, 133 Grafting, 133, 136 Gram-negative, 124, 133 Gram-positive, 124, 133 Granuloma, 32, 133 Groin, 133, 137 Gynecology, 74, 133 H Health Care Costs, 12, 134 Health Expenditures, 134 Heart failure, 134 Heart Valves, 122, 134 Hemobilia, 35, 36, 134 Hemochromatosis, 82, 134 Hemoglobin, 120, 122, 128, 131, 134, 153 Hemoglobin C, 120, 134 Hemolytic, 131, 134, 153 Hemorrhage, 18, 134, 152 Hemostasis, 56, 81, 134, 151 Hepatic, 13, 17, 19, 22, 28, 30, 35, 36, 43, 54, 81, 124, 126, 130, 134 Hepatic Artery, 28, 30, 35, 134 Hepatic Duct, Common, 130, 134 Hepatic Encephalopathy, 82, 134 Hepatitis, 33, 82, 132, 135, 156

Hepatobiliary, 22, 28, 38, 44, 46, 49, 104, 106, 135 Hepatocellular, 12, 135 Hepatocellular carcinoma, 12, 135 Hepatocytes, 135 Hereditary, 135, 153 Heredity, 133, 135 Hernia, 135 Herniorrhaphy, 74, 135 Heterozygote, 13, 135 Histamine, 12, 135 Histidine, 135 Homologous, 120, 135 Hormone, 127, 131, 135, 137, 138, 140, 153 Hydrogen, 119, 120, 122, 124, 135, 139, 141, 143, 147 Hydrogen Peroxide, 135, 139 Hydrolysis, 125, 135, 146, 147 Hydrophilic, 66, 135 Hyperbilirubinemia, 135, 138 Hypertension, 135, 146, 155 Hyperthermia, 128, 135 Hysterectomy, 23, 136 Hysterotomy, 124, 136 I Iatrogenic, 83, 136 Ileitis, 21, 136 Ileum, 136, 138 Ileus, 10, 33, 136 Immune system, 136 Immunologic, 34, 136, 149 Immunosuppressive, 13, 133, 136 Impairment, 32, 129, 136 Implantation, 70, 136 In situ, 30, 42, 136 Incision, 6, 70, 72, 73, 74, 75, 76, 77, 86, 92, 136, 138, 148 Incisional, 4, 75, 136 Incompetence, 132, 136 Incontinence, 82, 136 Indigestion, 136, 146 Indomethacin, 64, 136 Induction, 128, 136 Infection, 12, 26, 39, 80, 82, 131, 136, 139, 142, 153 Inflammation, 6, 12, 121, 123, 125, 126, 131, 132, 134, 135, 136, 137, 140, 143, 145, 146, 155 Inflammatory bowel disease, 82, 137 Infusion, 27, 40, 137, 154 Ingestion, 82, 137, 146 Inguinal, 36, 80, 81, 82, 137

161

Inguinal Hernia, 36, 80, 81, 82, 137 Insufflation, 57, 74, 79, 137 Insulin, 11, 137 Insulin-dependent diabetes mellitus, 137 Insurance Carriers, 4, 137 Internal Medicine, 38, 130, 132, 137 Intestinal, 39, 80, 82, 125, 137, 139 Intestinal Mucosa, 125, 137 Intestine, 122, 123, 137, 138, 156 Intoxication, 137, 156 Intracellular, 136, 137, 140 Intrahepatic, 22, 134, 137 Intramuscular, 137, 144 Intraocular, 137, 154 Intraocular pressure, 137, 154 Intraperitoneal, 25, 40, 137 Intravenous, 27, 31, 56, 137, 144 Intussusception, 80, 137 Invasive, 12, 44, 72, 74, 75, 84, 138 Ionizing, 138, 148 Irrigation, 76, 138 Irritable Bowel Syndrome, 13, 138 Ischemia, 25, 138 J Jaundice, 41, 82, 135, 138 Jejunostomy, 130, 138 Jejunum, 132, 138 K Kb, 98, 138 Keyhole, 74, 138 Kinetics, 14, 57, 138 L Laceration, 72, 138 Laparoscopes, 73, 138 Laparotomy, 7, 9, 42, 45, 83, 138 Large Intestine, 128, 129, 137, 138, 149, 151, 156 Laryngeal, 55, 138 Larynx, 138, 155 Length of Stay, 9, 138 Leptin, 11, 13, 138 Lesion, 133, 138, 154 Ligament, 72, 131, 138, 147 Ligation, 27, 81, 84, 139 Linkage, 31, 139 Lip, 21, 139 Lipid, 13, 14, 41, 53, 80, 137, 139, 143 Lipid Peroxidation, 53, 139, 143 Lithotripsy, 10, 50, 80, 139 Liver Transplantation, 82, 139 Lobe, 43, 139, 144 Localized, 136, 139, 145, 150, 154

Loop, 132, 135, 139 Lower Esophageal Sphincter, 131, 132, 133, 139 Lymph, 77, 139, 140, 142 Lymph node, 77, 139, 140, 142 Lymphadenectomy, 82, 139 Lymphatic, 137, 139, 152 Lymphatic system, 139, 152 Lymphocytes, 121, 139, 152 M Malabsorption, 20, 82, 139, 140 Malabsorption syndrome, 82, 140 Malformation, 13, 140 Malignant, 119, 131, 140, 141, 148 Malignant mesothelioma, 140 Mammary, 22, 140 Manometry, 48, 140 Mechanoreceptors, 140, 149 Mediastinitis, 30, 140 Mediastinum, 140 Mediator, 125, 140, 151 Medical Records, 13, 140 MEDLINE, 99, 140 Membrane, 126, 133, 138, 140, 142, 144, 145, 147, 149, 151 Membrane Proteins, 140, 147 Mental, iv, 11, 98, 100, 136, 140, 147, 148, 150, 155 Mental Health, iv, 11, 98, 100, 140, 148 Mesentery, 140, 145 Mesothelioma, 18, 140 Meta-Analysis, 53, 140 Metastasis, 55, 140, 141 Metoclopramide, 26, 141 Migration, 21, 29, 141 Milk Thistle, 68, 141, 151 Mobilization, 129, 141 Modification, 141, 148 Molecular, 99, 101, 123, 127, 141 Molecule, 121, 122, 126, 128, 135, 138, 141, 143, 149, 155 Monitor, 23, 45, 141, 142 Mononuclear, 131, 133, 141 Morphine, 40, 61, 125, 141, 143 Motility, 4, 5, 13, 80, 81, 136, 141, 151 Motion Sickness, 141 Multiparous, 13, 141 N Narcotic, 141, 142 Nasogastric, 130, 141 Nausea, 24, 26, 27, 121, 136, 141, 142, 146, 155

162

Cholecystectomy

NCI, 1, 97, 141, 144 Necrosis, 131, 141 Neoplasms, 121, 134, 141, 148 Nephrectomy, 74, 81, 142 Nervous System, 119, 124, 140, 142, 153 Networks, 23, 142 Neural, 23, 119, 140, 142, 149 Neuroleptic, 142 Neurotransmitter, 129, 135, 142, 153 Nitrogen, 119, 120, 121, 128, 142 Nitrous Oxide, 42, 142 Nosocomial, 26, 82, 142 Nuclear, 106, 130, 132, 141, 142 Nuclear Medicine, 106, 142 O Omentum, 134, 142 Omeprazole, 142, 147 Ondansetron, 22, 24, 47, 64, 142 On-line, 46, 117, 142 Opiate, 64, 141, 143 Opium, 141, 143 Outpatient, 5, 48, 60, 72, 90, 143 Ovariectomy, 74, 143 Ovaries, 143, 154 Ovary, 80, 133, 143 Overdose, 132, 143 Overweight, 11, 13, 61, 92, 143 Oxidation, 119, 121, 139, 143 Oxidative Stress, 29, 143 P Palliative, 143, 153 Pancreas, 80, 81, 119, 122, 128, 132, 134, 137, 143 Pancreatic, 12, 23, 29, 33, 38, 47, 55, 82, 125, 130, 132, 143 Pancreatic cancer, 12, 33, 143 Pancreatic Ducts, 130, 131, 143 Pancreatic Fistula, 82, 143 Pancreatic Juice, 132, 143 Pancreatitis, 6, 7, 12, 53, 82, 84, 143 Papilla, 130, 143 Parasite, 143, 144 Parasitic, 82, 144 Parasitic Diseases, 82, 144 Parenteral, 82, 144 Parenteral Nutrition, 82, 144 Parietal, 142, 144, 145 Pathologic, 123, 135, 144 Pathophysiology, 84, 144 Patient Education, 85, 86, 106, 112, 114, 117, 144 Patient Selection, 3, 7, 8, 10, 79, 86, 144

PDQ, 104, 144 Pelvic, 75, 82, 144, 147 Pelvis, 119, 143, 144, 155 Pepsin, 144 Peptic, 12, 82, 144 Peptic Ulcer, 12, 82, 144 Peptide, 125, 138, 144, 146, 147 Percutaneous, 17, 20, 26, 33, 34, 39, 43, 48, 52, 53, 54, 55, 56, 57, 75, 139, 144 Perforation, 144, 156 Perioperative, 7, 52, 144, 145 Perioperative Care, 7, 145 Peritoneal, 26, 121, 137, 145 Peritoneal Cavity, 121, 137, 145 Peritoneum, 74, 140, 142, 145 Peritonitis, 20, 145, 156 Pharmacologic, 120, 122, 145, 154 Pharynx, 132, 145, 155 Phospholipids, 131, 145 Physiologic, 66, 128, 145, 149 Physiology, 82, 84, 130, 132, 133, 145 Pigment, 80, 123, 145 Pilot study, 12, 145 Plants, 119, 124, 133, 145, 154 Plasma, 134, 145 Platelet Aggregation, 27, 145 Platelets, 145, 151 Pleural, 140, 145, 153 Pleural cavity, 145, 153 Pneumonia, 127, 146 Pneumothorax, 25, 146 Poisoning, 137, 141, 146 Polymorphism, 54, 146 Polypeptide, 126, 146, 153 Port, 54, 55, 60, 70, 74, 75, 146 Port-a-cath, 146 Portal Hypertension, 82, 146 Portal Vein, 146 Postcholecystectomy Syndrome, 66, 84, 106, 146 Posterior, 120, 143, 146 Postoperative, 3, 5, 6, 8, 10, 22, 27, 35, 40, 47, 49, 60, 63, 64, 65, 72, 75, 80, 81, 85, 86, 146 Postoperative Nausea and Vomiting, 22, 35, 47, 64, 146 Postprandial, 5, 146 Practicability, 146, 154 Practice Guidelines, 100, 146 Precursor, 11, 129, 130, 146 Premedication, 47, 146 Preoperative, 5, 29, 48, 72, 82, 146

163

Prevalence, 39, 49, 146 Primary Sclerosing Cholangitis, 80, 82, 147 Progression, 120, 147 Progressive, 5, 125, 141, 147 Promoter, 54, 147 Prone, 13, 147 Prophylaxis, 17, 24, 60, 147 Propofol, 65, 147 Prospective study, 15, 31, 46, 49, 66, 147 Prostaglandins, 136, 147 Prostaglandins A, 136, 147 Prostate, 122, 147 Protein S, 123, 147 Proteins, 121, 126, 128, 140, 141, 142, 144, 145, 147, 151, 154 Proton Pump, 12, 142, 147 Proton Pump Inhibitors, 12, 147 Protons, 135, 138, 147, 148 Proximal, 73, 75, 129, 132, 147 Psychic, 140, 147, 148 Psychoactive, 147, 156 Psychogenic, 66, 148 Psyllium, 66, 148 Public Health, 46, 100, 148 Public Policy, 99, 148 Publishing, 14, 82, 148 Pulmonary, 30, 35, 63, 123, 134, 148 Punctures, 10, 92, 148 Q Quality of Life, 34, 38, 49, 148, 153 R Race, 141, 148 Radiation, 105, 132, 136, 138, 148, 156 Radio Waves, 128, 148 Radioactive, 135, 136, 142, 148 Radiofrequency ablation, 12, 148 Radioimmunotherapy, 148, 149 Radiological, 12, 104, 144, 148 Radiologist, 80, 148 Radiology, 36, 104, 142, 148 Radiotherapy, 15, 148 Randomized, 11, 12, 15, 16, 17, 18, 35, 36, 38, 42, 45, 47, 50, 51, 63, 129, 149 Receptor, 12, 13, 121, 129, 142, 149, 151 Recombinant, 66, 149, 155 Rectal, 122, 149 Rectum, 21, 121, 123, 126, 128, 129, 132, 136, 137, 138, 147, 149, 151 Recuperation, 5, 75, 149 Recurrence, 10, 58, 84, 149 Red blood cells, 131, 134, 149, 151

Reductase, 12, 149 Refer, 1, 126, 142, 148, 149 Reflex, 149 Reflux, 12, 122, 129, 131, 132, 133, 149 Regimen, 129, 149 Regurgitation, 131, 132, 134, 149 Relaxation Techniques, 65, 149 Remission, 149 Resection, 15, 18, 80, 149 Respiration, 124, 141, 149 Respiratory Mechanics, 46, 149 Resuscitation, 66, 149 Retina, 149, 150 Retractor, 72, 150 Retrograde, 6, 31, 104, 150 Retrospective, 15, 150 Risk factor, 11, 12, 19, 40, 49, 81, 86, 92, 147, 150 Risk patient, 7, 63, 150 Rod, 71, 150 S Saline, 40, 150 Salivary, 128, 143, 150 Salivary glands, 128, 150 Salivation, 131, 150 Scalpel, 75, 150 Schizoid, 150, 156 Schizophrenia, 150, 156 Schizotypal Personality Disorder, 150, 156 Scleroderma, 131, 150 Screening, 105, 125, 144, 150 Scrotum, 127, 150 Secondary tumor, 140, 150 Secretion, 14, 80, 135, 137, 142, 150 Sedative, 126, 150 Sensibility, 120, 150 Sensor, 77, 150 Serotonin, 142, 150 Serrated, 71, 151 Serum, 13, 54, 126, 145, 151 Shock, 38, 139, 151, 154 Shunt, 70, 151 Side effect, 65, 119, 151, 153, 154 Sigmoid, 80, 151 Sigmoid Colon, 151 Silymarin, 65, 141, 151 Sludge, 11, 80, 151 Small intestine, 5, 92, 128, 129, 130, 131, 135, 136, 137, 138, 141, 146, 151 Smooth muscle, 80, 122, 135, 141, 151, 153 Social Environment, 148, 151 Sodium, 22, 151

164

Cholecystectomy

Soft tissue, 123, 131, 132, 151 Sound wave, 128, 148, 151 Spastic, 138, 151 Specialist, 80, 108, 129, 151 Species, 141, 143, 144, 148, 151, 154, 156 Spectrum, 148, 152 Spermatozoa, 152, 153 Sphincter, 48, 84, 138, 152 Spinal cord, 124, 125, 142, 149, 152 Spirometry, 63, 152 Spleen, 139, 152 Splenectomy, 22, 80, 81, 152 Splenomegaly, 22, 152 Staging, 82, 152 Stem Cells, 131, 152 Stenosis, 152 Stent, 43, 152 Sterilization, 81, 152 Stimulant, 135, 152 Stimulus, 127, 129, 149, 152 Stool, 126, 136, 138, 152 Stress, 9, 10, 44, 47, 72, 138, 141, 143, 152 Stricture, 31, 32, 52, 53, 152 Stroke, 70, 98, 152 Subacute, 136, 153 Subcapsular, 36, 153 Subclinical, 136, 153 Subcutaneous, 66, 119, 132, 144, 153 Substance P, 150, 153 Suction, 72, 75, 76, 153 Supportive care, 144, 153 Suppression, 153 Suppressive, 12, 153 Suppurative, 132, 153 Surgical Instruments, 70, 71, 76, 92, 153 Symptomatic, 4, 5, 9, 25, 34, 40, 47, 84, 120, 143, 153 Systemic, 121, 123, 136, 150, 153 T Testicle, 75, 133, 153, 155 Testicular, 127, 153 Testis, 153 Testosterone, 149, 153 Thalassemia, 55, 122, 153 Therapeutics, 53, 153 Thermal, 72, 121, 153 Thoracic, 32, 128, 153 Thoracoscopy, 80, 153 Thrombin, 132, 145, 153 Thromboembolism, 30, 60, 153 Thrombosis, 147, 152, 154 Tone, 12, 154

Tonic, 131, 154 Tonometry, 34, 154 Tonus, 154 Topical, 80, 135, 154 Toxic, iv, 154 Toxicity, 129, 154 Toxicology, 100, 154 Toxins, 121, 136, 148, 154 Tracheoesophageal Fistula, 131, 154 Transcutaneous, 64, 66, 154 Transfection, 123, 154 Transfusion, 66, 154 Transplantation, 41, 82, 154 Trauma, 10, 35, 44, 86, 131, 134, 141, 143, 154, 156 Treatment Outcome, 8, 154 Truncal, 81, 82, 154 Tubal ligation, 74, 77, 154 U Ulcer, 129, 154, 155 Ulceration, 144, 155 Ulcerative colitis, 137, 147, 155 Ultrasonography, 31, 39, 43, 49, 81, 106, 155 Umbilical Cord, 155 Umbilicus, 73, 74, 75, 76, 155 Uraemia, 143, 155 Urethra, 122, 147, 155 Urinary, 55, 123, 125, 136, 155 Urine, 122, 123, 136, 155 Uterus, 136, 143, 154, 155 V Vagina, 136, 155 Vaginal, 23, 155 Vagotomy, 60, 81, 82, 155 Vagus Nerve, 154, 155 Valves, 122, 155 Varices, 122, 155 Varicocele, 80, 81, 155 Vascular, 24, 134, 137, 155 Vasculitis, 143, 155 Vasodilator, 129, 135, 155 Vector, 144, 155 Vein, 22, 120, 137, 142, 146, 155, 156 Venous, 24, 147, 156 Venous Thrombosis, 24, 156 Ventricular, 129, 156 Ventricular Dysfunction, 129, 156 Venules, 123, 156 Veterinary Medicine, 99, 156 Viral, 67, 82, 156 Viral Hepatitis, 67, 82, 156

165

Virus, 156 Visceral, 145, 155, 156 Volvulus, 39, 57, 156 W Withdrawal, 72, 156

Wound Infection, 29, 156 X Xenograft, 120, 156 X-ray, 127, 130, 132, 142, 148, 156

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Cholecystectomy

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Cholecystectomy

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