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

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

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

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

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2003 by ICON Group International, Inc. Copyright 2003 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Dizziness: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-83893-3 1. Dizziness-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 dizziness. 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 DIZZINESS ................................................................................................. 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Dizziness..................................................................................... 17 E-Journals: PubMed Central ....................................................................................................... 35 The National Library of Medicine: PubMed ................................................................................ 35 CHAPTER 2. NUTRITION AND DIZZINESS ....................................................................................... 51 Overview...................................................................................................................................... 51 Finding Nutrition Studies on Dizziness...................................................................................... 51 Federal Resources on Nutrition ................................................................................................... 53 Additional Web Resources ........................................................................................................... 53 CHAPTER 3. ALTERNATIVE MEDICINE AND DIZZINESS ................................................................. 57 Overview...................................................................................................................................... 57 National Center for Complementary and Alternative Medicine.................................................. 57 Additional Web Resources ........................................................................................................... 61 General References ....................................................................................................................... 78 CHAPTER 4. DISSERTATIONS ON DIZZINESS ................................................................................... 79 Overview...................................................................................................................................... 79 Dissertations on Dizziness........................................................................................................... 79 Keeping Current .......................................................................................................................... 79 CHAPTER 5. CLINICAL TRIALS AND DIZZINESS .............................................................................. 81 Overview...................................................................................................................................... 81 Recent Trials on Dizziness........................................................................................................... 81 Keeping Current on Clinical Trials ............................................................................................. 82 CHAPTER 6. PATENTS ON DIZZINESS .............................................................................................. 85 Overview...................................................................................................................................... 85 Patents on Dizziness.................................................................................................................... 85 Patent Applications on Dizziness ................................................................................................ 98 Keeping Current ........................................................................................................................ 105 CHAPTER 7. BOOKS ON DIZZINESS ............................................................................................... 107 Overview.................................................................................................................................... 107 Book Summaries: Federal Agencies............................................................................................ 107 Book Summaries: Online Booksellers......................................................................................... 108 The National Library of Medicine Book Index ........................................................................... 112 Chapters on Dizziness................................................................................................................ 113 Directories.................................................................................................................................. 117 CHAPTER 8. MULTIMEDIA ON DIZZINESS ..................................................................................... 121 Overview.................................................................................................................................... 121 Video Recordings ....................................................................................................................... 121 Bibliography: Multimedia on Dizziness .................................................................................... 122 CHAPTER 9. PERIODICALS AND NEWS ON DIZZINESS .................................................................. 125 Overview.................................................................................................................................... 125 News Services and Press Releases.............................................................................................. 125 Newsletter Articles .................................................................................................................... 127 Academic Periodicals covering Dizziness .................................................................................. 129 CHAPTER 10. RESEARCHING MEDICATIONS................................................................................. 131 Overview.................................................................................................................................... 131 U.S. Pharmacopeia..................................................................................................................... 131 Commercial Databases ............................................................................................................... 134 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 137

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Overview.................................................................................................................................... 137 NIH Guidelines.......................................................................................................................... 137 NIH Databases........................................................................................................................... 139 Other Commercial Databases..................................................................................................... 141 APPENDIX B. PATIENT RESOURCES ............................................................................................... 143 Overview.................................................................................................................................... 143 Patient Guideline Sources.......................................................................................................... 143 Associations and Dizziness........................................................................................................ 152 Finding Associations.................................................................................................................. 153 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 155 Overview.................................................................................................................................... 155 Preparation................................................................................................................................. 155 Finding a Local Medical Library................................................................................................ 155 Medical Libraries in the U.S. and Canada ................................................................................. 155 ONLINE GLOSSARIES................................................................................................................ 161 Online Dictionary Directories ................................................................................................... 164 DIZZINESS DICTIONARY ......................................................................................................... 165 INDEX .............................................................................................................................................. 225

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

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

How Common Are Various Causes of Dizziness?: A Critical Review Source: Southern Medical Journal. 93(2): 160-167. February 2000. Contact: Available from Southern Medical Association. Journal Department, P.O. Box 190088, Birmingham, AL 35219-0088. (800) 423-4992. Fax (205) 945-1548. E-mail: [email protected]. Website: www.sma.org/smj. Summary: Although dizziness is a common symptom in both primary care and referral practices, the relative frequency of various causes has not been well delineated. This article reports on a critical review study in which a MEDLINE search identified 12 articles containing original data on the etiology of dizziness in consecutive patients. Study sites included primary care offices (n = 2), emergency room (n = 4), and referral clinics (n = 6). Each study's strength of design was graded using nine quality criteria.

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Dizziness was attributed to a peripheral vestibulopathy in 44 percent of patients, a central vestibulopathy in 11 percent, psychiatric causes in 16 percent, other conditions in 26 percent, and an unknown cause in 13 percent. Certain serious causes were relatively uncommon, including cerebrovascular disease (6 percent), cardiac arrhythmia (1.5 percent), and brain tumor (less than 1 percent). The authors summarize that dizziness is due to vestibular or psychiatric causes in more than 70 percent of cases. Since serious treatable causes appear uncommon, diagnostic testing can probably be reserved for a small subset of patients. 4 tables. 40 references. •

Otolaryngologic Management of Dizziness in the Older Patient Source: Clinics in Geriatric Medicine. 15(1): 179-191. February 1999. Contact: Available from W.B. Saunders. Periodicals Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452. Website: www.wbsaunders.com. Summary: As the interest in geriatric medicine rises, so does the amount of literature concerning balance difficulties and prevention of falls in older adults. This article reviews the otolaryngologic management of dizziness in the older patient. The authors note that imbalance and dizziness are risk factors for both functional decline and falls in older adults. The article reviews the basic physiology of balance and the changes that occur with aging. The article describes the authors' approach to the patient with dizziness, focusing on the special needs of older adults. Also reviewed are diagnostic tests, common pathologic entities, and current treatment recommendations. The difficulty in managing this disorder stems from its multiple causes and varying presenting symptoms. The goal of the authors is to relieve the primary care physician of the uncertainty experienced when evaluating these patients. 51 references.

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Dizzy Patient: Presence of Vertigo Points to Vestibular Cause Source: Postgraduate Medicine. 105(2): 161-164, 167-172. February 1999. Contact: Available from Postgraduate Medicine. P.O. Box 459, Hightstown, NJ 085209201. (609) 426-7070. Fax (609) 426-7087. Summary: Depending on the physiologic mechanism at fault, dizziness can represent several overlapping sensations, all of them uncomfortable. In cases with a vestibular cause (perhaps about half the cases of dizziness), vertigo is the predominant symptom, so patients have the unsettling feeling that their environment is spinning around them or that they are moving in space. This article discusses pertinent findings to seek on history taking that may help establish the cause of the dizziness. The author also describes additional workup, treatment, and prognosis. In dizziness with a vestibular cause (benign positional vertigo, vestibular neuritis, Meniere's disease, migraine, vertebrobasilar insufficiency), patients often describe their world as spinning, whirling, or tilting. Treatment should be directed at the underlying cause whenever possible, and various antivertiginous and antiemetic medications can be used to suppress symptoms. Initiation of a vestibular exercise program as soon as possible after injury helps ensure the best compensation possible. 1 figure. 4 tables. 20 references. (AA-M).

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Benign Paroxysmal Positional Vertigo: Diagnosis and Treatment in the Emergency Department: A Review of the Literature and Discussion of Canalith-Repositioning Maneuvers Source: Annals of Emergency Medicine. 37(4): 392-398. April 2001.

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Contact: Available from Mosby, Inc. Subscription Customer Service, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452. Fax (407) 363-9661. Website: www.harcourthealth.com. Summary: Dizziness is a frequent presenting complaint in emergency department (ED) patients. Although seen in patients of all ages, it is more prevalent in patients older than 50. Vertigo represents a subset of dizziness and is defined as an illusion of movement, usually rotational, of the patient or the patient's surroundings. The illusion of motion may be of oneself (subjective vertigo) or of external objects (objective vertigo). This article reviews the literature on benign paroxysmal positional vertigo (BPPV) and discusses the use of canalith repositioning maneuvers to treat patients with BPPV. The authors emphasize that BPPV is not uncommon and most emergency physicians will see several cases per year. Although it is not a life threatening condition, BPPV causes debilitating nausea and vertigo, and patients are usually quite distressed by their symptoms. Most patients experience relief from their symptoms with the canalith repositioning maneuvers. Up to half of these patients have a recurrence of their symptoms; the recurrence also usually responds to repeat repositioning. The authors conclude that a working knowledge of BPPV and its treatment is important to an emergency physician, even if the repositioning maneuvers are not attempted or are unsuccessful in the ED. An accurate diagnosis and prompt referral to an otorhinolaryngologist (ENT specialist) will provide the patient with reassurance and prevent the prolongation of the condition by the use of vestibular suppressants alone. 2 figures. 42 references. •

Clinical Research and Geriatric Dizziness: The Blind Men and the Elephant (editorial) Source: Journal of the American Geriatrics Society. 47(1): 113-114. January 1999. Summary: Dizziness is one of the most common complaints of older persons presenting to primary care physicians and emergency departments. This commentary article addresses the problems encountered in the diagnosis of dizziness. The authors comment on a related article published in the same issue, in which researchers conclude that many of the diagnostic tests used for dizziness are of little value, at least in the population studied. The authors of the commentary note that the research does alert the clinician that several related cardiovascular conditions may be responsible for many cases of dizziness in older persons. The related conditions (orthostatic hypotension, vasodepressor carotid sinus hypersensitivity, cardioinhibitory carotid sinus hypersensitivity, and vasovagal syncope) share the common mechanism of transient cerebral hypoperfusion. The authors conclude that it is especially challenging to manage older patients with chronic and recurrent dizziness in a way that improves outcomes and reduces disability, for empirical data are especially scarce in this area. The most important first step for the clinician is to understand the clinical epidemiology of the problem in his or her patient population: what diagnoses are common, what is the prognosis of various dizziness syndromes, and which serious, life threatening problems are likely. 15 references.

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When Your Patient Complains of Dizziness: Part 1 Source: IM. Internal Medicine. 20(6): 22-29. June 1999. Contact: Available from Medical Economics. 5 Paragon Drive, Montvale, NJ 07645. (800) 432-4570.

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Summary: Dizziness is the third most common complaint encountered among outpatients in internal medicine clinics (only chest pain and fatigue are more common). This article, the first in a two part series, reviews the possible causes of acute and chronic dizziness. The author summarizes diagnostic clues to look for and the proper management of these common conditions. A thorough patient history is important in evaluating any complaint of dizziness. Topics include the importance of establishing a common vocabulary, detecting a vestibular defect, stance and stepping tests, acute dizziness, vestibular neuritis and labyrinthitis, bedside tests of the vestibular ocular reflex, the role of hearing impairment, distinguishing peripheral from central causes of vertigo, medications for treating dizziness, and the etiology of chronic dizziness. The author notes that the most common cause of chronic dizziness in the elderly is not vestibular loss but disuse disequilibrium. The patient stops walking and exercising because of recent surgery, fatigue, or chronic illness, or for some other reason. He or she then becomes frailer and eventually develops a fear of falling, which leads to further deterioration in balance. Appended to the article is a recertification review self test on the material covered in the article. 5 tables. 8 references. •

Dizziness Among Older Adults: A Possible Geriatric Syndrome Source: Annals of Internal Medicine. 132(5): 337-344. March 7, 2000. Contact: Available from American College of Physicians-American Society of Internal Medicine. 190 North Independence Mall West, Philadelphia, PA 19106-1572. Summary: In previous studies of dizziness, the prevalence and identification of specific causes has varied widely. This article reports on a study undertaken to determine the predisposing characteristics and situational factors associated with dizziness. The authors suggest that dizziness might be better considered a geriatric syndrome that results from impairment or disease in multiple systems. The cross sectional study featured a probability sample of 1,087 community living persons (aged at least 72 years), residing in New Haven, Connecticut. Of the participants, 261 (24 percent) reported dizziness. Of the persons reporting dizziness, 56 percent described several sensations and 74 percent reported several activities that triggered their dizziness. Characteristics associated with dizziness included anxiety, depressive symptoms, impaired hearing, five or more medications, postural hypotension (low blood pressure), impaired balance, and past myocardial infarction. The authors conclude that the association among characteristics in multiple domains (cardiovascular, neurologic, sensory, psychological, and medication related) and dizziness, coupled with the multiplicity of sensations and triggering activities, suggests that dizziness may be a geriatric syndrome, similar to delirium and falling. If this is so, an impairment reduction strategy, proven effective for other geriatric syndromes, may be effective in reducing the symptoms and disabilities associated with dizziness. 5 tables. 43 references.

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A Practical Assessment Algorithm for Diagnosis of Dizziness Source: Otolaryngology-Head and Neck Surgery. 2003;128:54-9. Contact: Send requests to: Steven D. Rauch, MD. Massachussetts Eye and ear Infirmary, 243 Charles Street, Boston, MA 02114. E-mail: [email protected]. Summary: In this article the authors report on a prospective blinded study, the objective of which was to test a 3-parameter model for diagnosis of dizziness based on the type and temporal characteristics of the dizziness and on hearing status.

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Dizzy Patient: Stepwise Workup of a Common Complaint Source: Geriatrics. 50(6): 42-49. June 1995. Summary: In this article, an audiologist and a primary care physician discuss their workup of an older patient with dizziness. They describe the clinical evaluation, differential diagnosis, and treatment. Topics covered include the prevalence of dizziness among older patients; taking the patient history; possible causes of dizziness, including benign positional vertigo (BPV), vestibular neuronitis, Meniere's disease, acoustic neuroma, vertebrobasilar ischemia, cardiovascular diseases, and psychiatric diagnoses; referral considerations, including for an auditory and vestibular workup; and treatment and outcome issues. Readers can qualify for continuing medical education credits by taking the posttest following the article. 1 figure. 3 tables. 15 references.

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Approach to the Evaluation of the Dizzy Patient Source: Otolaryngology-Head and Neck Surgery. 112(1): 3-7. January 1995. Summary: In this article, the author discusses the approach to the evaluation of the dizzy patient. Topics covered include distinguishing between vertigo and other types of dizziness; distinguishing among common causes of vertigo; tests of balance; spontaneous nystagmus; positional testing; and the bedside assessment of vestibuloocular reflex, with the use of the doll's eye, dynamic visual acuity, and ice water caloric tests. The author notes that each test provides different information about vestibular function. 1 figure. 3 tables. 7 references. (AA-M).

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Dizzy? Source: Hearing Health. 11(2): 12-14, 41. February-March 1995. Contact: Available from Voice International Publications, Inc. P.O. Drawer V, Ingleside, TX 78362-0500. Voice/TTY (361) 776-7240. Fax (361) 776-3278. Website: www.hearinghealthmag.com. Summary: In this article, the author familiarizes readers with some of the common causes of and treatments for dizziness. Written in a question-and-answer format, the article describes how the vestibular system works; the causes of vestibular disorders, including benign paroxysmal positional vertigo (BPPV), perilymph fistulas, labyrinthitis, neuronitis, endolymphatic hydrops, and Meniere's disease; obtaining an accurate diagnosis; the prognosis for inner ear disorders that cause dizziness, hearing loss, and vertigo; the types of treatments available; and current research in these areas. One sidebar presents practical suggestions for living with dizziness. 1 figure.

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Does this Dizzy Patient Have a Form of Vertigo? Source: Journal of the American Medical Association. JAMA. 271(5): 385-388. February 2, 1994. Summary: In this article, the authors present two illustrative case studies as an introduction to a discussion about diagnosing vertigo and its causes. Topics covered include the importance of evaluating vertigo; the origins of vertigo; the pathophysiology of vertigo and nystagmus; how to elicit the symptoms and signs of vertigo; the role of proper history-taking from patients with vertigo; and accuracy of the symptoms and signs of vertigo. The authors conclude with two recommendations on the evaluation of patients with dizziness. They note that, in combination with other data (including a brief neurological examination) in an emergency department setting, the presence of

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positional nystagmus can be useful in identifying serious causes of dizziness. 1 figure. 3 tables. 43 references. •

Migraine-Associated Dizziness Source: Headache Journal. 32(6): 300-304. June 1992. Summary: In this article, the authors report on their review of the clinical histories, examinations, and results of quantitative vestibular testing in 91 patients with migraineassociated dizziness. Nausea and vomiting, hypersensitivity to motion, and postural instability accompanied the dizziness. The authors note that, in the majority of patients, the temporal profile of the dizziness was more typical of the headache phase of migraine than of the aura phase. The authors propose two separate pathophysiologic mechanisms for the production of dizziness with migraine; differentiating on the basis of duration of the vertigo attack. 1 figure. 2 tables. 28 references. (AA-M).

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When Your Patient Complains of Dizziness: Part 2 Source: IM. Internal Medicine. 20(7): 28-35. July 1999. Contact: Available from Medical Economics. 5 Paragon Drive, Montvale, NJ 07645. (800) 432-4570. Summary: In this article, the second of two parts, the author guides physicians in the diagnosis of the cause of spells of dizziness. The author notes that determining the average duration of a dizzy spell is crucial to the diagnosis. Spells that last for only a few seconds are characteristic of benign paroxysmal positional vertigo (BPPV), perilymphatic fistula, orthostatic hypotension (low blood pressure), and panic attacks with hyperventilation. Spells that last for minutes may be caused by migraine or transient ischemic attacks (TIAs). Meniere's disease, hydrops, and vestibular neuritis can induce dizzy spells that last for hours. Also, the circumstances that seem to provoke dizziness will also offer clues to the diagnosis. The author provides an illustrative case report and discusses each of these potential diagnoses. All patients should be checked for BPPV with the Hallpike Dix test. A battery of bedside tests should be conducted to test for vestibular hypofunction. Patients with acute vertigo also need to be checked for spontaneous nystagmus. If the physical exam is completely normal and the patient complains of spells of dizziness, he or she should be asked to return to the clinic the next time a spell occurs. Appended to the article is a recertification review self test (with the answers). 2 figures. 2 tables. 5 references.

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Paroxysmal Vertigo in Children: An Epidemiological Study Source: International Journal of Pediatric Otorhinolaryngology. 49(Supplement 1): S105S107. October 1999. Contact: Available from Elsevier Science. P.O. Box 945, New York, NY 10159-0945. (888) 437-4636. Fax (212) 633-3680. E-mail: [email protected]. Summary: Little is currently known about the prevalence of vertigo in children. This article reports on a study of paroxysmal vertigo in children. In a questionnaire designed to examine the prevalence of migraine and migraine equivalents in children of school age, the researchers included an item on 'attacks of dizziness in the past year.' The questionnaire was given to 2,165 children (10 percent of the school population in the city of Aberdeen, Scotland). Results showed that 314 children had experienced at least one episode of dizziness in the previous year, unexplained in 44 percent of cases. A total of 57 children with three attacks, either unexplained or attributed to migraine, were

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interviewed and examined. Of these, 45 children fulfilled the criteria for benign paroxysmal vertigo. Other symptoms suggestive of migraine were found in a small majority, but in 47 percent, paroxysmal vertigo was an isolated symptom. The age of onset peaked at 12 years, but it was seen in all age groups. Paroxysmal vertigo was commonly accompanied by features that are common in migraine, i.e., pallor, nausea, phonophobia and photophobia (heightened sensitivity to sounds and light, respectively), and migraine was twice as common in first degree relatives compared to controls. The authors conclude that paroxysmal vertigo is common in children and although it is seldom diagnosed, it appears to cause few major problems to the affected children. In common with previous studies, the authors found that it appears to be related to migraine. 3 figures. 4 references. •

Managing Dizzy Patients: An Opportunity for Audiologists Source: Hearing Journal. 53(7): 21-22, 24-25. July 2000. Contact: Available from Lippincott Williams and Wilkins. Customer Service, P.O. Box 1175, Lowell, MA 01853. Summary: Most audiologists agree that managing the dizzy patient is well within their scope of practice. But finding practitioners who are truly committed to this segment of care and have actually incorporated it into their daily practice is another matter altogether. The author of this article encourages audiologists to seize on the care of dizzy patients as an opportunity to increase their practice and offer additional services. The author reports on the work of a vestibular task force of the American Academy of Audiology (AAA) which is working to raise awareness of the role audiologists can play in this area. Audiologists have a key role to play in the diagnosis and treatment of many vestibular problems, although the author recommends that audiologists work as part of a multidisciplinary team serving this patient population. The author outlines the types of diagnostic testing that the audiologist may utilize, including electronystagmography (ENG), computerized rotational testing, and computerized dynamic posturography (CDP). The author recommends that before making an investment in equipment and office redesign, audiologists interested in assessment and treatment of vestibular problems should first conduct market research in their service area.

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Anxiety in the First Attack of Vertigo Source: Otolaryngology-Head and Neck Surgery. June 2003. 128:829-34. Contact: Available from Department of Neurology, The Assaf Harofeh Medical Center, Tel Aviv University, and Mental Hospital, Beer Yaakov. Israel. E-mail: [email protected]. Summary: The authors of this article report on the findings of a comparative questionnaire study in 30 patients with a first attack of vestibular dysfunction and 35 patients with a non-vestibular neurologic deficit of acute onset. The purpose of the study was to measure the psychological impact of an acute vertigo attack.

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Diagnosis and Treatment of Dizziness Source: Medical Clinics of North America. 83(1): 163-177. January 1999. Contact: Available from W.B. Saunders. Periodicals Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452. Website: www.wbsaunders.com.

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Summary: The evaluation of the dizzy patient, one of the most common complaints for which medical attention is sought, is often both challenging and frustrating for the clinician. This article gives an overview of the historical and physical findings that help guide diagnosis of the underlying cause of the symptom of dizziness. The types of dizziness are outlined, including vertigo, presyncope, dysequilibrium, and ill defined lightheadedness. The author reviews the common causes of dizziness, as well as the tests that may be useful in the diagnosis. Common vestibular syndromes include benign paroxysmal positional vertigo, vestibular neuronitis, Meniere's syndrome, other peripheral causes, central causes of vertigo, cervical dizziness, and multiple neurosensory impairments. The author then describes the medical and surgical treatment options for dizziness. One appendix offers a dizziness questionnaire that may be useful in pinpointing patient symptoms. 41 references. •

Diagnosis and Initiating Treatment for Peripheral System Disorders: Imbalance and Dizziness with Normal Hearing Source: Otolaryngologic Clinics of North America. 33(3): 563-577. June 2000. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 32887-4800. Summary: There are a number of disorders that selectively involve the peripheral vestibular (balance) system, causing dizziness without hearing loss. This article reviews the diagnosis and treatment for patients with these types of disorders. These disorders include benign paroxysmal positional vertigo (BPPV), vestibular neuritis, recurrent vestibulopathy, familial vestibulopathy, and bilateral idiopathic vestibulopathy. The authors stress that a careful and thorough history is the most important part of the clinical work up of patients complaining of dizziness. History should include mode of onset and description of the first episode of dizziness; frequency and duration of individual episodes; whether the episodes are spontaneous or provoked by certain factors like head movements or specific positions; associated auditory symptoms such as hearing loss or tinnitus (ringing or other noises in the ears); head trauma; and concomitant ear disease or previous ear surgery. The authors cover pathogenesis, diagnostic tests, and treatment options for the disorders listed above. 6 figures. 44 references.

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Stabilizing the Effects of Vertigo: Spin Control Source: Advance for Speech-Language Pathologists [and] Audiologists. 7(38): 8, 46. September 22, 1997. Contact: Available from Merion Publications, Inc. 650 Park Avenue, Box 61556, King of Prussia, PA 19406-0956. (800) 355-1088 or (610) 265-7812. Summary: This article describes how the canalith repositioning maneuver may provide relief to patients with benign paroxysmal positional vertigo (BPPV). Patients with BPPV experience a repetitive spell of vertigo that usually lasts about a minute. The disorder is accompanied by benign paroxysmal positional nystagmus (BPPN), which causes the eye to shake and undergo a rotatory movement. The repositioning maneuver stabilizes floating otoconia in the inner ear. Eighty to ninety percent of patients usually respond to one or two maneuvers. For patients who do not respond to the movements and who feel their vertigo is disabling, two surgical options are available; the author describes singular neurectomy and posterior semicircular canal occlusion techniques used for this problem. The article concludes with the contact information for the physician interviewed in the article.

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Cure for Benign Positional Vertigo Source: Bailliere's Clinical Neurology. 3(3): 537-545. November 1994. Summary: This article discusses the treatment for benign positional vertigo (BPV), notably non-invasive treatment procedures that involve a specific sequence of headposition changes. Topics covered include the evidence for posterior semicircular canal involvement in BPV; particle repositioning maneuvers, including the Semont liberatory maneuver, the Elpey canalith repositioning procedure, the Parnes particle repositioning maneuver, and the McClure maneuver; the important 48-hour time period immediately following any of the particle-repositioning maneuvers; success rates; and the conversion to horizontal canal benign positional vertigo. 19 references.

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Overview of Psychologic Effects of Chronic Dizziness and Balance Disorders Source: Otolaryngologic Clinics of North America. 33(3): 603-616. June 2000. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 32887-4800. Summary: This article offers an overview of psychological effects of chronic dizziness and balance disorders. The first part of the article describes the common psychological effects of dizziness and imbalance, outlines factors that contribute to negative psychological reactions to dizziness, and explains how psychological responses to dizziness actually can retard recovery, maintaining a vicious cycle of chronic dizziness, handicap, and distress. The author stresses that attention to the psychological effects of dizziness is not simply a matter of relieving distress, but is often an integral part of the management of dizziness itself. Consequently, the second part of the article discusses how to detect psychological disturbance in patients with dizziness and how the physician can help to prevent negative psychological reactions from developing. The state of fearful uncertainty and passive dependence in which many people with dizziness find themselves trapped can be prevented in many cases by supplying convincing explanations for their symptoms. Comprehensible information about how the balance system functions, and about the process of adaptation following balance disorder, reduces anxiety by helping patients to understand the causes, significance, and control of their various symptoms. Appended to the article is the Vertigo Symptom Scale, an instrument used to help quantify the patient's experiences. 1 figure. 2 tables. 24 references.

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Office Management of the Dizzy Patient Source: Otolaryngologic Clinics of North America. 25(4): 745-780. August 1992. Summary: This article on office management of the dizzy patient is from a special issue on otolaryngologic office evaluation and management. Topics covered include taking the medical history; symptoms; characteristics and etiology; associated auditory symptoms; associated neurologic symptoms; functional inquiry; the physical examination; nystagmus; clinical tests of balance testing; laboratory tests, including electronystagmography, posturography, harmonic acceleration, and audiometric tests; radiographic imaging; blood studies; differential diagnosis, including Meniere's disease (endolymphatic hydrops), vestibular neuritis, benign positional vertigo, perilymph fistula, labyrinthitis, autoimmune vestibular dysfunction, ototoxicity, cerebellopontine angle tumors, central lesions, temporal lobe epilepsy, multiple sclerosis, paraneoplastic cerebellar degeneration syndrome, vascular lesions, cervical disorders, otosyphilis, hypoglycemia, hypothyroidism, and autoimmune diseases; medical treatment options,

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including dietary restrictions, the use of diuretics, the restriction of stimulants, sedatives, exercise therapy, chemical ablation of vestibular function, and allergic treatment; and surgical treatment. 8 figures. 48 references. •

Practical Approach to Dizziness: Questions to Bring Vertigo and Other Causes into Focus Source: Postgraduate Medicine. 97(3): 70, 72, 75-78, 81. March 1995. Summary: This article presents a method of evaluating patients with dizziness. Topics covered include the importance of adequate patient history-taking; the types of dizziness, including nonvertiginous dizziness, orthostatic hypotension, psychogenic dizziness, and vertiginous dizziness; determining whether the vertigo is central or peripheral in origin; establishing the duration of actual vertigo; Meniere's disease; recurrent vestibulopathy; labyrinthitis; cholesteatoma; perilymphatic fistula; trauma and ototoxicity; acoustic neuroma; and diagnostic tests used to confirm these conditions. The author concludes that referral should be contemplated when significant central disease is suspected and when vertigo of peripheral origin is persistent or atypical. 12 references. (AA-M).

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Health, Functional, and Psychological Outcomes Among Older Persons with Chronic Dizziness Source: Journal of the American Geriatrics Society. 48(4): 417-421. April 2000. Contact: Available from Lippincott, Williams, and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-3030 or (301) 714-2334. Website: www.lww.com. Summary: This article reports on a study undertaken to determine the range of adverse outcomes associated with chronic dizziness. The population based prospective cohort study included a probability sample of 1,087 persons, aged 72 and older, living in the community. The following were measured: chronic dizziness, death, hospitalizations, falls, syncope, basic and instrumental activities of daily living, depressive symptoms, self rated health, falls self efficacy, and social activities. Of the 1,087 participants, 261 (24 percent) reported chronic dizziness. Over 1 year of follow up, chronic dizziness was not associated with mortality, hospitalization for any reason, or change in basic or instrumental activities of daily living, but was associated with risk of falling and with experiencing syncope (fainting). After adjustment for baseline level, chronic dizziness also was associated with worsening of depressive symptoms, self-rated health, falls efficacy, and social activities. These results suggest that the goals of care for older persons with chronic dizziness should be redirected from solely identifying and treating discrete diseases (an often expensive and unrewarding task) toward reducing the symptoms of chronic dizziness and alleviating the resulting physical, psychological, and social disability. 2 tables. 35 references.

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Evaluating the Dizzy Patient: Establishing Clinical Pathways Source: Hearing Review. 6(6): 45-46,48. June 1999. Contact: Available from Fladmark Publishing Company. P.O. Box 6004, Duluth, MN 55806-9851. (218) 723-9558. Fax (218) 723-9437. Summary: This article reviews the clinical evaluation of the patient presenting to the hearing health practitioner with dizziness. While the author doesn't recommend that every hearing health practitioner invest in establishing a comprehension vestibular laboratory, he suggests that simplified screening techniques can be used to help identify

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and treat vestibular patients in a diagnostically efficient and financially responsible manner. The author discusses the use of clinical pathways (algorithms) for diagnosis and referral, the history and symptoms of balance disorders, tests of postural stability, visualizing nystagmus (benign paroxysmal positioning vertigo or BPPV), and the role of gaze, positional and high frequency headshake in identifying nystagmus. The author concludes that this Level I Diagnostic Vestibular Screening Protocol does not take the place of a thorough medical or comprehensive diagnostic evaluation. However, this type of screening can provide practitioners with important early warning indicators of a more serious underlying cochleovestibular, retrocochlear, or central nervous system (CNS) type involvement. One sidebar presents a vestibular case study of a patient who went through a community screening and subsequently was diagnosed with an acoustic neuroma. 3 figures. 5 references. •

Dizzy Patient Source: AJN. American Journal of Nursing. 99(9): 61-65. September 1999. Summary: This article reviews the nonpharmacologic management of benign paroxysmal positional vertigo (BPPV), a common cause of dizziness. The author uses a sample case example to demonstrate the evaluation and diagnosis of patients with dizziness. BPPV is a form of positional vertigo that is characterized by brief, recurring episodes that come in clusters. The author discusses terminology, the etiology of vertigo, the importance of taking an accurate patient history to help with diagnosis, and treatment options. Traditionally, BPPV has been treated with drug therapy to control symptoms like vertigo induced nausea. The author also describes two nonpharmacologic treatments, habituation and the canalith repositioning procedure (CRP); both are designed to move debris away from sensitive vestibular areas and have proven successful in decreasing or eliminating symptoms for about 80 percent of patients. The author concludes by reviewing the nurse's role in the care and treatment of people with BPPV. 2 figures. 9 references.

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Approach to the Dizzy Patient Source: Bailliere's Clinical Neurology. 3(3): 453-465. November 1994. Summary: This article reviews the recommended approach to patients who experience dizziness. Topics covered include common types of dizziness; differentiating vestibular from non-vestibular dizziness; differentiating central from peripheral causes of vertigo; common vestibular syndromes, including benign positional vertigo, acute peripheral vestibulopathy, chronic bilateral vestibulopathy, Meniere's syndrome, migraine, and vertebrobasilar insufficiency; and the treatment of vertigo. The author notes that because dizziness can be caused by so many different pathophysiological mechanisms, it is crucial to determine the type of dizziness before proceeding with the diagnostic evaluation. 5 tables. 30 references.

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Dizzy Patients: The Varieties of Vertigo Source: Hospital Practice. 33(6): 55-58, 61-63, 67-68, 74-77. June 15, 1998. Summary: This article uses case presentations to describe the varieties of vertigo (a type of dizziness, characterized by a spinning sensation). Some vertigo results from acute viral labyrinthitis or a cerebrovascular event; many cases are due to loose particulate matter within the semicircular canals. The author stresses that in the vast majority of patients, a careful history and appropriate clinical tests will suffice to identify the cause of the vertigo. With benign paroxysmal positional vertigo, a simple clinical maneuver

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can provide a cure. The author uses three case presentations to illustrate the differential diagnosis in patients who present with dizziness. The initial investigation in the patient who complains of dizziness may involve carefully sorting through the historical data in an attempt to determine whether the problem results from generalized cerebral hypoperfusion, focal cerebrovascular disturbances, or disorders of the inner ear or its connections. Positional maneuvers (Dix Hallpike testing and the modified Epley maneuver) are illustrated. 5 figures. 6 references. •

Dizziness in Children Source: Otolaryngologic Clinics of North America. 27(3): 557-571. June 1994. Summary: This article, from a special issue on pediatric otology, discusses dizziness in children. The author stresses that in order to understand the etiology of dizziness or vertigo, a systematic search for abnormalities affecting the vestibular, visual, proprioceptive, pyramidal, and extrapyramidal systems is essential. Topics covered include the evaluation of a patient complaining of dizziness, including history, general physical examination, neurologic examination adapted to the patient's age, ear, nose and throat examination, and electronystagmography (ENG); postural and equilibrium reaction; differential diagnosis and management for vertigo, including paroxysmal vertigo with and without hearing loss, vertigo with loss of postural control or loss of consciousness but without hearing loss; unremitting vertigo or dizziness with neurologic signs; and unremitting dizziness without neurologic abnormalities. 26 references.

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Vertigo (correspondence) Source: Lancet. 353(9152): 591. February 13, 1999. Summary: This brief letter in a medical journal describes hyperlipidemia as a common, treatable cause of vertigo (a spinning type of dizziness) among elderly people. The author reports that 31 patients over 5 years were seen in an internal medicine practice; these patients each had idiopathic vertigo and hyperlipidemia (mean age 58 years, vertigo duration 20 months, vertigo frequency 10 episodes per month). Clinically, the vertigo was heterogeneous in duration and features. In 26 patients, antilipidemic therapy (statins or gemfibrozil) progressively and completely resolved the vertigo within one year. The author notes that the association between hyperlipidemia and inner ear disease was first noted in 1932. Since then, dietary therapy has been found to improve vertigo, hearing loss, and Meniere's disease. In addition, among elderly people, vertigo may carry a prognosis similar to that of transient ischemic attacks. Epidemiological evidence suggests that treating hyperlipidemia reduces the incidence of ischemic cerebrovascular disease. The author concludes that older patients with idiopathic vertigo and hyperlipidemia should be offered a therapeutic trial with appropriate lipid lowering treatment. 5 references.

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Rethinking Treatment of Dizzy Patients and Balance Disorders Source: Hearing Review. 6(4): 8, 10, 12. April 1999. Contact: Available from Fladmark Publishing Company. P.O. Box 6004, Duluth, MN 55806-9851. (218) 723-9558. Fax (218) 723-9437. Summary: This is the first of three articles that provide an overview of vestibular problems and management of balance disorders. The author discusses prevailing attitudes about the patient with dizziness as well as practical professional

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considerations. Topics include the development of vestibular and balance centers, managed care reimbursement issues, the opportunities for evaluation and treatment of dizziness and balance disorders, the health care team, managing the complicated care of the patient with dizziness, testing equipment, treatment options, the interrelationship (or lack thereof) of hearing loss and dizziness, vestibular disorders, and the problem of finding an appropriate physician to care for the dizzy patient. The author pitches the article towards a hypothetical, reluctant health care provider. The author stresses that many of these patients do not require excessive amounts of initial electrophysiological testing, but can be first evaluated with a screening protocol using limited instrumentation. 1 table. 8 references. •

Dysphagia, Headache, and Dizziness as Symptoms of Cervical Spine Disorders Source: Revue du Rhumatisme (English Edition). 65(5): 346-351. May 1998. Summary: This journal article provides health professionals with information on recognizing dysphagia, headache, and dizziness as symptoms of cervical spine disorders. Much evidence points to the causal relationship between dysphagia and lesions of the cervical spine. In many cases, dysphagia is caused by a lesion or bony excrescence arising from the anterior aspect of the cervical spine. Sometimes, dysphagia is caused by anterior cervical disk herniation. Other causes include spondylolisthesis, discal calcification, and trauma-related hyperlordosis of the cervical spine. Conservative treatment is usually recommended. Corticosteroids, nonsteroidal anti-inflammatory drugs, spasm-relieving agents, and precautions during meals are helpful. Evidence that lesions of the cervical spine cause headaches is unclear, although lesions of the atlantooccipital, atlantoaxoidal, and C2-C3 joints resulting from osteoarthritis have been shown to cause headaches. Occipital neuralgia has been reported in patients who have septic or rheumatoid arthritis and ankylosing spondylitis. Cervicogenic headache refers to unilateral pain originating in the neck and radiating to the oculofrontotemporal area. There is no evidence that this type of headache originates in the cervical spine. Dizziness not attributable to vertebrobasilar insufficiency may be caused by cervical spine lesions in some patients; however, an extensive search for other causes is needed. 54 references.

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When Life's a Balancing Act: A Discussion of Dizziness Source: House Ear Institute Review. 30(1): 1, 4. Spring 1997. Summary: This newsletter article provides basic information about dizziness and vertigo. The author stresses that dizziness is a symptom and not a disease in and of itself. In the balance system, the brain acts as a central computer receiving information in the form of nerve impulses from its three input terminals: the eyes, the inner ear, and the nerve receptors in the muscles and joints of the body (especially those in the head and neck, and lower extremities). The author describes the various conditions that can interrupt the balance system and result in dizziness. Causes of dizziness include inner ear infection, calcium in the ear canals (causing positional vertigo), Meniere's disease, allergic or metabolic disturbances, inner ear fluid fistulas, autoimmune inner ear disease, tumors, and complete loss of vestibular function due to the toxic effects of disease or medications. The remainder of the article focuses on Meniere's disease, its impact on the vestibular system, and its treatment options. 2 figures. (AA-M).

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Benign Paroxysmal Positional Vertigo: The Canalith Repositioning Procedure Source: American Family Physician. 53(8): 2613-2616. June 1996.

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Summary: Up to as many as 20 percent of patients who show symptoms of dizziness may have benign paroxysmal positional vertigo (BPPV). This condition, which may be caused by otoliths lodged in the semicircular canals of the ear, tends to be persistent or recurrent. Traditionally, the condition has been treated symptomatically with medication. This article describes the canalith repositioning procedures, a series of defined head positions designed to shift the location of the otoliths. This can afford relief from the nausea, vomiting and dizziness often experienced by patients with BPPV. The author includes an illustrative case report of a patient with BPPV. The article also provides a brief discussion of the diagnosis of BPPV. (AA-M). •

Management Options for Acute Versus Chronic Vertigo Source: Otolaryngologic Clinics of North America. 33(3): 483-493. June 2000. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 32887-4800. Summary: Vertigo (a spinning sensation) is one of the most frequent and disturbing sensations that the practicing otolaryngologist is called upon to treat. This article deals with the treatment options for acute versus chronic vertigo. Vertigo is defined as a false illusion of motion with a distinct rotational component. Acute attacks are well defined isolated spells of vertigo with a distinct onset and offset, whereas chronic vertigo is defined as a continuous or chronic sensation. Recurrent attacks of vertigo are addressed as chronic vertigo. The author points out the differences in peripheral sensory input and central compensation in the acute versus chronic cases. Diagnostic methods are reviewed, including patient history, physical examination, laboratory tests, radiographic studies, audiologic studies, and vestibular function tests. The author then offers suggestions for targeted therapy for a number of chronic ailments, including Meniere's disease, benign paroxysmal positional vertigo (BPPV), and migraine. Treatment of acute vertigo usually entails suppression of nausea and vomiting with central acting medications, which are to be discontinued as soon as possible. Medical therapy for chronic or recurrent vertigo is more preventive in nature. 1 table. 11 references.

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Vertigo Source: Lancet. 352(9143): 1841-1846. December 5, 1998. Summary: Vertigo is a subtype of dizziness, which results from an imbalance within the vestibular system. Vertigo is defined as an illusion of movement, usually a sense of rotation. Autonomic symptoms such as sweating, pallor, nausea, and vomiting are commonly associated with vertigo, but are rare with other types of dizziness. This article focuses on three common presentations of vertigo: prolonged spontaneous vertigo, recurrent attacks of vertigo, and positional vertigo. The patient's history is usually the key to differentiation of peripheral and central causes of vertigo. The most common cause of vertigo, benign paroxysmal positional vertigo, can be cured with a simple positional maneuver. Other common causes of vertigo include vestibular neuritis, Meniere's syndrome, migraine, and vertebrobasilar insufficiency. Treatment should be directed at the underlying cause whenever possible, but antivertiginous and antiemetic drugs can suppress symptoms when a specific cause cannot be found. These drugs are generally not indicated for long term daily use, however, since they may interfere with the normal compensation process. 1 figure. 2 tables. 27 references.

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Central Causes of Dizziness Source: Physical Therapy. 80(2): 179-187. February 2000.

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Contact: Available from American Physical Therapy Association. 1111 North Fairfax Street, Alexandria, VA 22314-1488. (703) 684-2782, ext. 3124. Summary: Vestibular physical therapy has become a mainstay in the management of patients with balance disorders manifesting as dizziness and disequilibrium. This article updates physical therapists on current research in this field, focusing on one aspect of balance function, namely, central nervous system abnormalities that cause dizziness directly or that affect a patient's response to or recovery from an inner ear abnormality. Topics include the etiologies of dizziness, the prevalence of dizziness in patients reporting to emergency departments and primary care physicians, and benign paroxysmal positional vertigo (BPPV). The authors then focus on 4 disease entities that affect the central vestibular system: migraine, head trauma, brainstem stroke and vertobrobasilar insufficiency, and cerebellar degeneration. Each of the disorders is discussed primarily in terms of diagnosis; where possible, implications regarding physical therapy intervention is provided. The authors chose these diseases partly because they include a range of underlying pathophysiologies and a diversity of signs and symptoms. Although numerous case studies of patients with central vestibular disorders suggest that such patients can improve with physical therapy intervention, controlled randomized studies remain to be performed. 8 tables. 121 references. •

Effects of Vestibular Rehabilitation on Dizziness and Imbalance Source: Otolaryngology: Head and Neck Surgery. 106(2): 175-180. February 1992. Summary: Vestibular rehabilitation is a specific approach to physical therapy aimed at reducing dizziness and imbalance by facilitating central nervous system compensation for peripheral vestibular dysfunction. This article reports preliminary results of studies concerning the relative effectiveness of vestibular rehabilitation, general conditioning exercises, and vestibular suppressant medication on dizziness and imbalance in patients with chronic vestibular symptoms of at least 6 months duration. Patients with positional and/or movement-related dizziness and abnormal posturography were randomly assigned to the three treatment groups. Preliminary results suggest that although all three treatment approaches reduce dizziness, only vestibular rehabilitation also improves balance. 3 figures. 1 tables. 16 references. (AA-M).

Federally Funded Research on Dizziness The U.S. Government supports a variety of research studies relating to dizziness. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to dizziness.

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

Project Title: 3D ORGANIZATION AND NEURAL PLASTICITY OF PRIMATE VOR Principal Investigator & Institution: Angelaki, Dora E.; Professor; Anatomy and Neurobiology; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130 Timing: Fiscal Year 2001; Project Start 01-JUL-1999; Project End 30-JUN-2003 Summary: The vestibulo-ocular (VORs) are an essential component of the oculomotor system since they are fundamental for gaze stabilization during both angular (angular VORs) and linear (linear VORs) head movements. Damage to the vestibular system through disease or trauma can produce profound oculomotor deficits that are often difficult to resolve clinically. Vestibular disturbances are often accompanied by nystagmus, blurred vision, dizziness and spatial disorientation. Despite years of research regarding the neural mechanisms of angular VOR function and disease states, very little is currently known about the linear VORs. Moreover, almost no information exists regarding the symptomology of otolith system damage and few, if any, practical diagnostic evaluations of otolith function are routinely performed in clinical today. The current proposal seeks to study the nature and function of the linear VORFs in primates and to investigate the deficits produced by cerebellar lesions and peripheral vestibular damage. The primary goal of these studies is to test quantitative predictions of a functional framework regarding the bilateral organization of the linear VORs across a wide stimulus repertoire in awake rhesus monkeys trained to fixate targets at different distances and vertical/horizontal eccentricities. Precisely calibrated binocular threedimensional eye movements will be recorded during both lateral and fore-act linear motion consisting of either steady-state sinusoidal or transient stimulus profiles. Data obtained from normal animals will be quantitatively compared to the eye movements generated during functional ablation of the most irregularly firing vestibular afferents, as well as both acutely and chronically after unilateral labyrinthectomy, selective semicircular canal plugging and cerebellar lesions. The results will provide for the first time quantitative data and models regarding the bilateral neural organization of the linear VORs as well as identify practical clinical tests of peripheral and central otolithocular function. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ADAPTATION TO CONTROLLED VESTIBULAR STIMULATION Principal Investigator & Institution: Merfeld, Daniel M.; Director; Massachusetts Eye and Ear Infirmary 243 Charles St Boston, Ma 02114 Timing: Fiscal Year 2001; Project Start 01-SEP-1996; Project End 31-AUG-2006 Summary: Over 90 million Americans (greater than 40 percent) will seek medical attention for dizziness or some other balance disorder sometime in their life. A NIH working committee recently reported that at least 2 million Americans experience chronic impairment due to dizziness or other balance disorders, causing medical expenses in excess of 1 billion dollars per year. Many of these chronically impaired patients could benefit from vestibular rehabilitation, and some of these patients could benefit from a vestibular prosthesis (similar to the cochlear implant for profound sensorineural hearing loss). This proposal directly addresses both of these health care needs. Specifically, the proposed studies develop and test a prototype neural prosthesis.

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Furthermore, to enhance our understanding of vestibular adaptation, the proposed studies use this prototype device to investigate adaptation to changes in peripheral vestibular stimulation. This study will be the first to comprehensively investigate adaptation to changes in chronic, peripheral stimulation of the vestibular system. A better understanding of vestibular adaptation will lead to improved vestibular rehabilitation. These general scientific goals will be achieved by investigating the following specific aims: 1. Study the importance of bilateral versus unilateral cues. 2. Study how the nervous system adapts to changes in peripheral stimulation of the branch of the vestibular (VIIIth) nerve that innervates the lateral semicircular canal. 3. Study how the nervous system combines sensory information from the otolith organs and semicircular canals when the rotational cues are provided via electrical stimulation. 4. Study how the nervous system adapts to yaw rotational cues delivered to a nerve branch innervating one of the vertical canals that does not normally include yaw rotational information. 5. Study how the nervous system adapts to constant-rate electrical stimulation while stationary, with and without visual cues. All of these proposed specific aims will be investigated by measuring changes in the vestibuloocular responses induced by changes in chronic, patterned, electrical stimulation of the peripheral vestibular system. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: AGE, HYPOTENSIO

EXERCISE,

THERMOGENESIS

AND

POSTPRANDIAL

Principal Investigator & Institution: Seals, Douglas R.; Professor; Integrative Physiology; University of Colorado at Boulder Boulder, Co 80309 Timing: Fiscal Year 2001; Project Start 01-FEB-2000; Project End 31-JAN-2005 Summary: In young adult humans, acute energy intake (feeding) evokes an integrative "postprandial" physiological response which includes an increase in metabolic rate (thermic effect of food intake--TEF) and a number of autonomic nervous system (ANS) and cardiovascular adjustments aimed at providing increased blood flow for digestion (splanchnic vasodilation) while maintaining arterial blood pressure (BP) at preprandial levels. Some older adults with chronic diseases demonstrate a reduced TEF and/or a postprandial fall in BP ("postprandial hypotension"), but it is unknown whether this occurs with age in healthy adults. If the latter is true, some evidence suggests that these changes may not occur with age in adult humans who exercise regularly. The specific aims of the present proposal are to determine if: (1) TEF is lower and postprandial BP declines occur in middle-aged and/or older sedentary adults compared with young adult controls; (2) the lower TEF is due to attenuated postprandial increases in sympathetic nervous system (SNS) activity associated with reduced CNS sympathoexcitatory responsiveness to acute hyperinsulinemia; (3) the postprandial hypotension also is associated with: a) an attenuated or absent whole-limb and skeletal muscle vasoconstriction; b) a smaller reduction in cardiac vagal modulation of heart rate and an attenuated tachycardia; and c) a lower baseline cardiac vagal tone and arterial baroreflex sensitivity; (4) middle-aged and older adults who exercise regularly do not demonstrate the lower TEF and postprandial hypotension observed with age in sedentary humans, and whether this is associated with augmented SNS responses, CNS sympathetic responsiveness to circulating insulin, limb vasoconstriction, vagallymediated tachycardia, baseline cardiac vagal tone and baroreflex sensitivity; and (5) the reduced TEF and postprandial hypotension associated with sedentary aging are related to elevated adiposity. Because TEF contributes significantly to daily energy expenditure and, therefore, energy balance, the expected results should provide new and clinically

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important information concerning the effects of sedentary aging, regular exercise and adiposity on TEF in the context of age-related obesity and its metabolic and cardiovascular co-morbidities. Moreover, postprandial hypotension is associated with post-meal dizziness, weakness, syncope, cerebrovascular ischemia, and angina pectoris. As such, the expected results should provide new insight into the effects of sedentary aging, habitual exercise and body fatness on this clinically-important cardiovascular disorder. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: AMINO ACID THERAPY FOR HOT FLASHES/POSTMENOPAUSAL WOMEN Principal Investigator & Institution: Guttuso, Thomas J.; Neurology; State University of New York at Buffalo Suite 211 Ub Commons Amherst, Ny 14228 Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 31-AUG-2008 Summary: (provided by applicant): Hot flashes affect approximately 75% of postmenopausal women. Although hormone replacement therapy (HRT) is highly effective in reducing hot flashes, long-term HRT is associated with increased rates of breast cancer and heart disease. Safe, effective, and well-tolerated hot flash alternative therapies are needed. We have shown the anticonvulsant gabapentin to be effective in the treatment of hot flashes in postmenopausal women; however, 50% of patients receiving gabapentin reported side effects of sleepiness or dizziness. Gabapentin is known to bind to the alpha2delta subunit of voltage-gated calcium channels (VGCCs) in the central nervous system (CNS). The amino acids L-methionine and L-norleucine also bind to the alpha2delta subunit with high affinity. Recently, we have noted a 75-100% reduction in hot flash frequency among 5 women after initiating either open-label oral L-methionine or L-norleucine therapy. Long-term L-methionine therapy may carry increased cardiovascular risks by increasing serum homocysteine levels while Lnorleucine therapy will not increase homocysteine levels. Over the 5-year career development award, the applicant will principally pursue clinical research examining the safety, tolerability, and efficacy of L-norleucine therapy in hot flash treatment. The clinical research will be performed in the University's General Clinical Research Center under the mentorship of Drs. Kieburtz and Guzick. In addition to this clinical work, the applicant will concurrently pursue basic science training in the laboratory of co mentor Dr. Richfield on better elucidating the mechanism of action of L-norleucine therapy in the treatment of hot flashes and on optimizing future hot flash therapies. Direct mentored training will occur throughout the 5-year award. The applicant will participate in one clinical research meeting and one basic science journal club meeting every week. In addition, formal didactic training in epidemiology and neuroscience will occur at the University. The applicant will also attend two didactic training seminars in complementary & alternative medicine at The Osher Institute at Harvard Medical School and at the Duke Center for Integrative Medicine. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ANTIBIOTIC THERAPY FOR RHEUMATOID ARTHRITIS (ATRA TRIAL) Principal Investigator & Institution: St Clair, Eugene W.; Duke University Durham, Nc 27706 Timing: Fiscal Year 2001

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Summary: Previous randomized, controlled clinical trials suggest that oral tetracyclines may reduce the symptoms of joint inflammation in rheumatoid arthritis (RA). This class of antibiotics has well-described antimicrobial effects as well as anti-collagenase activity. Collagenase is an enzyme that degrades cartilage and bone and is believed to be important in the pathogenesis of RA. This study evaluated the safety and potential clinical efficacy of I.V. doxycycline therapy in 31 patients with RA and explored whether any improvements in arthritis from the doxycycline were due to its antibacterial actions or ability to reduce the activity of collagenase. The three objectives of this study were: 1) To determine the feasibility, safety, and potential clinical efficacy of I.V. doxycycline therapy in RA and explore whether this agent ameliorates clinical manifestations of this disease by suppressing bacterial infection or matrix metalloproteinases (MMP) activity; 2) To determine whether daily and weekly treatment with I.V. doxycycline can reduce urinary excretion of collagen crosslinks in patients with RA and potentially retard joint damage; and 3) To explore the potential effects of daily and weekly I.V. doxcycline therapy on biochemical markers of cartilage proteoglycan degradation; and 4) to determine whether IV doxycycline can reduce expression of nitric oxide synthase type 2 expressed by circulatory monocytes. Patients were randomized into 3 groups: Group I received I.V. doxycycline and oral placebo, Group II will received I.V. placebo and oral azithromycin, and Group III received I.V. and oral placebo. The I.V. therapy was delivered through a peripheral long-line catheter. The initial treatment phase consisted of daily infusions and oral therapy for 21 days. The second treatment phase consisted of weekly infusions administered from week 4 through 11. Results: The study is closed and a Final Report was submitted to the NIH on December 29, 1998. Thirty-one patients were enrolled between April of 1995 and February 1998. The study population included various ethnic backgrounds, such as African- American, Caucasian, and Native American and was predominantly female (24/7). Only 4 patients withdrew from the trial before the day 112 visit. Three patients discontinued the study drug after day 28 because of worsening arthritis and one patient withdrew at day 56 when she was diagnosed with breast cancer. Thirteen (42%) of the patients experienced at least one infusion-related event during the trial. These events included catheter site tenderness/pain/redness, symptoms of burning during the infusion, site-related skin rash from adhesive tape, catheter infiltration, signs of localized infection at the catheter site, clotting of the catheter or line, and thrombophlebitis. None of these events were classified as serious. Most of the patients experienced at least 1 adverse event, which were most commonly gastrointestinal or neurologic in origin. The most frequent adverse events apart from the infusion-related complications included headache (8 patients), abdominal pain (6 patients), fatigue (6 patients), nausea/vomiting (5 patients, vaginitis (5 patients), loose stools/diarrhea 93 patients), dizziness/lightheadedness (3 patients), and decreased appetite (3 patients). The results of the present study do not provide evidence that i.v. doxycycline therapy reduces the signs or symptoms of RA. These data must be interpreted with caution because the study was not designed to provide adequate statistical power to answer this question. The present study does show that this treatment approach is feasible and does not cause unacceptable toxicities. However, no significant differences were noted among treatment groups in the primary endpoints. The tender joint count dropped only slightly in all of the 3 treatment groups. This result is compatible with little or no immediate clinical effect from the 3 weeks of i.v. doxycycline therapy. Significance: There are no future plans since doxycycline did not improve the primary endpoints. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: BUILDING A NEW MODEL FOR DIAGNOSIS OF ED DIZZY PATIENTS Principal Investigator & Institution: Newman-Toker, David E.; Neurology and Neurosurgery; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2003; Project Start 01-DEC-2002; Project End 30-NOV-2007 Summary: (provided by applicant): The goal of the investigators proposed research is to improve diagnosis of patients presenting to the ED with dizziness, some of whom are misdiagnosed with potentially grave medical consequences. The prevailing diagnostic paradigm for the evaluation of the dizzy patient is based upon a 'pathophysiologic' approach. This approach begins a search for etiology with the assumption that the quality of symptoms (vertigo, presyncope, imbalance, or nonspecific dizziness) reflects the underlying pathophysiologic mechanism (vertigo = vestibular, presyncope = cardiovascular, imbalance = neurologic, and nonspecific = psychiatric). Although this assumption often holds true, the 'pathophysiologic' approach mandates a thorough etiologic search in each organ system, not only the one suggested by symptom quality. This strategy is well suited to the referral clinic setting where it was developed, but poorly suited to the time-pressured environment of the ED, where the high index of illness severity demands effective triage rather than diagnostic certainty. The candidate hypothesizes that: 1) potentially serious misdiagnoses of dizzy patients are uncommon but not rare events in the ED and may result from an over-reliance on the diagnostic importance on symptom quality; 2) a novel 'triage' approach to diagnosis would reduce misdiagnoses and improve outcomes in an 'in vitro' computer model of the diagnostic approach to dizziness; and 3) a clinical decision-support system based on this approach would reduce misdiagnoses under simulated patient conditions. To test these hypotheses, the candidate has designed three specific aims to: 1) measure the frequency, potential severity, and possible cause of misdiagnosis of dizzy patients in the ED (by gathering extensive case data on each ED dizzy patient and referencing ED physician [EP] diagnoses against those of a multidisciplinary expert panel); 2) design a computerized decision model to test a new 'triage' approach to diagnosis (by comparing 'in vitro' simulations of the two diagnostic approaches using hypothetical case scenarios); and 3) 'pilot' a web-based decision support system to reduce misdiagnosis of simulated ED dizzy patients (by comparing EP performance on a video-case-based examination with or without the use of the decision support system, using a randomized trial design). Results of this study will form the foundation for subsequent research into the effectiveness of error-reduction interventions among dizzy patients. The research career award candidate has devoted himself to acquiring the clinical and research skills required to complete this project and launch a successful career as an independent investigator. He has garnered the support and enthusiasm of both his clinical department and a large, multidisciplinary team that will enable him to complete the stated objectives. This research project and the research paradigms derived from it will form the nucleus of a career devoted to research in medical decision-making, causes of diagnostic errors, and methods to prevent them. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CELLULAR MECHANISMS OF THE VESTIBULAR SYSTEM Principal Investigator & Institution: Goldberg, Jay M.; Professor of Physiology; Neurology; University of Chicago 5801 S Ellis Ave Chicago, Il 60637 Timing: Fiscal Year 2001; Project Start 01-JUL-1993; Project End 30-NOV-2002

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Summary: The long-term goal of this work is to understand how vestibular organs work. The proper function of these organs is crucial to a healthy existence; damage can lead to debilitating vertigo, dizziness and inability to maintain study gaze. Mamammal, birds and reptiles have similar vestibular organs, with two classes of sensory receptor cell, the type I and type II hair cells. These cells transduce head movements into electrochemical signals that are transmitted across synapses to the terminals of afferent nerve fibers, which convey the signals to the brain in the form of electrical discharges. Efferent nerve fibers from the brain make synapses on h air cells and afferent nerve terminals, through which they influence afferent signals by unknown mechanisms. The specific aims are to characterize: 1) afferent synaptic transmission from the hair cells to the neurons; 2) the cellular mechanisms responsible for discharge regularity and maximum evoked discharge rates of afferent neurons; 3) efferent actions. In vitro preparations of the posterior semicircular canal organ of the turtle will be used. This organ lends itself to comparison of type I and type II hair cells, shows richly diverse efferent actions on afferent nerve fiber discharges, and is robust in vitro. Depending on the specific experiment, stimuli will be mechanical (displacement of the canal fluid), manipulations of membrane voltage or current in hair cells or afferent neurons, or electrical stimulation of efferent nerve fibers. The membrane voltage or current responses of hair cells and afferent neurons to these stimuli will be recorded intra cellularly with sharp micropipettes or patch pipettes. Both conventional (vesicular, orthograde) and unusual forms of transmission between the type I hair cell and afferent neuron will be characterized. Whether afferent discharge regularity is due to presynaptic (hair cell) or postsynaptic (afferent neuron) mechanisms will be tested. whether stages following mechanoelectrical traduction determine saturation of afferent discharge rates will be investigated. Efferent-evoked synaptic potentials and the neurotransmitter receptors responsible will be characterized. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CERVICAL INFLUENCES ON BALANCE Principal Investigator & Institution: Furman, Joseph M.; Professor; Otolaryngology; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-AUG-2004 Summary: (provided by applicant): Vestibular, proprioceptive and visual inputs are integrated by the central nervous system to produce appropriate ocular motor and postural responses. Cervical afferents provide unique information that enable headreferenced signals from the visual and vestibular systems to be transformed into trunkreferenced signals. Many patients with balance disorders note an association between a worsening of their dizziness and neck discomfort. The basis for this association is unknown. The long-term objective of this research is to develop a rational approach to the diagnosis of cervicogenic dizziness and to the assessment of cervical influences on vestibular disorders. Each of the three specific aims of this exploratory research proposal relates to improving our understanding of cervical influences on balance. In particular, the goal of the experiments proposed herein is to generate testable hypotheses regarding objective measures of cervical influences on vestibulo-ocular and vestibular-spinal responses, and on visually induced postural sway. The specific aims of this proposal are to explore three different aspects of the cervical influences on balance: 1. The influence of roll head-on-trunk position on the orientation of Listing's plane with respect to the head, 2. The influence of yaw head-on-trunk position on postural sway induced by sinusoidal interaural galvanic vestibular stimulation, and 3. The influence of yaw headon-trunk position on postural sway induced by naso-occipital optic flow. To address

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specific aim #1, three-dimensional eye positions will be monitored during various combinations of head and trunk roll tilt using dual-scleral search coils. To address specific aim #2, postural sway induced by sinusoidal, bipolar, binaural galvanic vestibular stimulation during several yaw head-on-trunk positions will be measured. To address specific aim #3, postural sway will be measured in response to naso-occipital optic flow within a virtual reality environment during several yaw head-on-trunk positions. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CORRELATING DRUG EFFECTS ON THE VOR AND MOTION SICKNESS Principal Investigator & Institution: Kramer, Phillip D.; Instructor; Jfk Medical Center 65 James St Edison, Nj 08820 Timing: Fiscal Year 2002; Project Start 20-SEP-2002; Project End 31-AUG-2005 Summary: (provided by applicant): Correlate diazeparn and meclizine's effects on the vestibular ocular reflex (VOR) with their ability to suppress motion sickness. Study design and methodology: Thirty subjects will have their vestibular (VOR gain, time constant, and reversal phase) and oculomotor function (gaze holding in the dark, OKN, and OKAN) tested at baseline and again two hours later. Immediately following the first set of tests the subject will ingest placebo, diazepam, meclizine, or nothing (randomized double blind order). After the second set of tests subjects will be exposed to a stimulus that promotes motion sickness. The subjects will make head movements while rotating at 120 deg/sec until they have reached a predetermined level of motion sickness defined by the Massachusetts Institute of Technology's modification of the Pensacola Diagnostic Index as Malaise III and note the number of head movements made until that point. Data will be examined for the correlation between the magnitude of the changes (with and without medication) of the VOR measurements and the difference in motion sickness susceptibility. The coefficients of a linear control system model of the vestibular and oculomotor systems will be manipulated to simulate the test results. The changes to the model may reflect functional localization of drug effects on the VOR, which may imply anatomical localization. Objectives: The vestibular system is a central component of both motion sickness and vestibular dizziness (vertigo) and both are treated with many of same medications including diazeparn and meclizine. Little is known, however, about their mechanisms of action in either motion sickness or vertigo. The objective of this study is to determine if diazeparn and meclizine's ability to prevent motion sickness is related to their ability to affect the VOR. This information is intended to help health care providers better treat patients with vertigo. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: DIZZINESS IN OLDER PEOPLE Principal Investigator & Institution: Baloh, Robert W.; Professor; None; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, Ca 90024 Timing: Fiscal Year 2001; Project Start 01-APR-1991; Project End 31-MAR-2006 Summary: Complaints of dizziness and disequilibrium are common in older people yet it is often difficult to determine the cause. Associated falls and fear of falling affect the quality of their lives and limit their daily activities. We hypothesize that dizziness and disequilibrium are not a result of normal aging but rather the result of specific pathophysiologic changes involving the inner ear and brain. Our goal is to better understand the causes of dizziness and disequilibrium in older people. We propose to

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continue a longitudinal study of patients complaining of dizziness and disequilibrium and age-matched controls with yearly examinations including quantitative visualvestibular testing and posturography. The goal of the first specific aim is to a) document changes in vestibular function and balance associated with normal aging; b) define the natural history of the common causes of dizziness and disequilibrium in older people; and c) document the clinical course in patients with dizziness and disequilibrium of unknown cause. The second aim is to correlate function with morphology in normal subjects and patients who come to postmortem examination with the goal of explaining changes in balance in terms of identifiable changes within the inner ear and brain. How accurate were the clinical diagnoses? Do patients with dizziness and disequilibrium of unknown cause show changes in the inner ear or brain different from those of agematched controls? The unique features of this research are a) the longitudinal design and b) the correlation of histopathologic findings at the time of postmortem examination with the results of quantitative test information obtained during life. There have been few prior longitudinal studies of dizziness and imbalance in older people and none that includes serial measurements of auditory and vestibular function, and quantitative measurements of balance, semiquantitative neuro-logical examinations and serial magnetic resonance images (MRI's) of the brain. Prior histopathological studies in older people with balance dysfunction have focused on the temporal bone or brain but not both, have lacked detailed clinical data, and rarely have contained quantitative information regarding vestibular function during life. By continuing this longitudinal study of carefully studied older patients and controls, our multidisciplinary research team is in a good position to achieve our goals. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GENE EXPRESSION AND DIAGNOSIS OF AUTOIMMUNE DISEASE Principal Investigator & Institution: Aune, Thomas M.; President; Arthrochip, Llc 117 Bromley Park Ln Franklin, Tn 37069 Timing: Fiscal Year 2003; Project Start 15-FEB-2003; Project End 14-FEB-2004 Summary: (provided by the applicant): Autoimmune diseases, such as systemic lupus erythematosus, rheumatoid arthritis, type I diabetes, and multiple sclerosis, are thought to arise from abnormalities of innate or adaptive immune responses. Autoimmune diseases are often difficult to diagnose, as the symptoms can be typical of other conditions and quite vague, such as musculoskeletal complaints and pain, headaches or dizziness. No available blood test can accurately exclude the possibility of an autoimmune disease in a subject with these symptoms. At best, a battery of tests and a period of observation are usually required to establish that a patient does in fact have an autoimmune disorder. Thus, a single test that could readily exclude the possibility of an autoimmune disease would allow physicians to focus their efforts on patients who have the greatest likelihood of serious disease. Using microarray technology, we have compared differences in gene expression in peripheral blood mononuclear cells among individuals with four distinct autoimmune diseases, normal control individuals before and after immunization, and individuals with other chronic diseases. Surprisingly, we find that each individual with autoimmune disease has a common gene expression signature that is independent of the specific autoimmune disease but is totally distinct from the normal immune response and is not observed in individuals with other chronic diseases. Based upon these observations, we have developed a simple test for excluding the possibility that a subject has an autoimmune disorder. The main advantage of this test is that it is a quicker and more accurate test than those currently available. This test has thus far predicted autoimmune patients from normal patients with 100 percent

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accuracy. The first goal of this proposal is to collect gene expression data from a sufficient number of individuals to design a test with optimal predictive power. The second goal is to validate the test by examining a cohort of individuals who do not yet carry a clear-cut diagnosis of an autoimmune disease. Long-term goals are to use results from microarray experiments to develop tests that have predictive value for the therapeutic management of individuals with autoimmune diseases. These include tests that classify diseases, predict severity, and predict the best therapeutic options. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: INFLUENCE OF MENSTRUAL CYCLE ON ORTHOSTATIC TOLERANCE Principal Investigator & Institution: Low, Phillip A.; Professor; Mayo Clinic Rochester 200 1St St Sw Rochester, Mn 55905 Timing: Fiscal Year 2001 Summary: The goal of this study is to determine if there is an underlying hormonal basis for the variations in orthostatic tolerance in a subset of women who are orthostatically intolerant. Based on the hypothesis, supported by anecdotal reports and preliminary data that some female subjects are orthostatically much more intolerant during certain phases of their menstrual cycle, we plan to study the influence of the menstrual cycle in a subset of 10 orthostatically intolerant women, 20 orthostatically tolerant women, and 10 female patients with POTS. The female patients will undergo autonomic testing at 3 phases of their menstrual cycle for 3 months resulting in 9 evaluations. The phases will be menstrual (second or third day of the cycle), follicular pre-ovulatory (1 day before the expected day of ovulation), pre-menstrual luteal (7 days prior to day of ovulation), premenstrual luteal (7 day sprior to menstruation). The oral temperature will be measured each morning at the same time before arising. The last low point in the temperature curve before the rise towards the hyperthermic plateau started is considered the day of ovulation. Serum levels of 17 beta-estradiol, progesterone, serum luteinizing hormone, and follicule stimulating hormone will be measured on the morning of these 9 times. The hormone levels provide distinctive profiles of these times. We will study 17 bestradiol, progesterone, serum luteinizing hormone and follicular stimulating hormone using RIA. Women to be evaluated must have a regular and predictable menstrual cycle and must not be taking oral contraceptive agents. The evaluation on each occasion consists of the response to tilt of 20 minutes during (cardiovascular indices), the HR response to 8 cycles of deep breathing at a rate of 6 breaths/minute and the HR and BP response to Valsalva maneuvers performed while supine. The study will be done over 3 months for each subject. On each visit, the subject, clothed in a light hospital gown, is weighed. A QSART (quantitative sudomotor axon reflex) will be performed after in the 3 visits of the fist month. A semiquantitative symptoms scale will be obtained during tilt. Patients will be graded on dizziness, tremulousness, and anxiety. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: LASER TACHYCARDIA

CATHER

FOR

ABLATION

OF

VENTRICULAR

Principal Investigator & Institution: Gowda, Ashok; Biotex, Inc. 8018 El Rio Houston, Tx 770544104 Timing: Fiscal Year 2001; Project Start 28-SEP-1999; Project End 31-JUL-2003 Summary: (provided by applicant): Ventricular Tachycardia (VT) is a life-threatening condition characterized by an abnormally high rate of ventricular contraction. During

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VT, the ventricles lack sufficient time to fill with blood prior to each contraction often resulting in dizziness, loss of consciousness and sudden cardiac arrest. Catheter ablation has been shown to be an effective means for curing many arrhythmias, but current approaches are not able to coagulate tissue in the midmyocardium or subepicardial regions where foci responsible for VT often originate. We have developed a cooled-tip laser catheter (CTLC) capable of creating large lesions that extend into these regions with little to no thermal damage to the endocardium. In our phase I study we designed, built, and tested prototypes of the CTLC system. The current system is comprised of an 8F deflectable catheter, which houses a fiber optic and a pathway for circulation of saline. We incorporated a low cost pump system and a low-power diode laser to complete the system. Acute and chronic animal studies were performed to test the prototype system and the results were indeed dramatic. Using our CTLC system, we successfully produced large (1 cm in diameter) lesions that began on average 1 mm below the irradiated surface. These lesions were free of char or carbonization and well circumscribed by a distinct border separating the lesion form normal tissue. Additional advantages of our approach include the ability to monitor real-time electrophysiological activity during delivery of laser energy. In Phase II we plan to refine the current CTLC by including functional mapping electrodes and improving maneuverability. Animal studies are designed to characterize in a thorough manner the dose response for our system, compare it against current state of the art ablation technologies, and acquire data necessary for submission of an investigational device exemption from the FDA for clinical trials. PROPOSED COMMERCIAL APPLICATION: This research is specifically targeted towards the development of an improved laser-based catheter for treatment of VT. Cardiac arrhythmias including ventricular tachycardia (VT) and ventricular fibrillation (VF) are responsible for 400,000 cases of sudden death in the U.S. each year. Unlike other therapies, our catheter has potential for providing a curative means for patients who suffer from VT, and therefore could become the treatment of choice in such patients. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MECHANISM TACHYCARDIA

AND

BEHAVIOR

OF

SYMPTOMATIC

Principal Investigator & Institution: Pritchett, Edward L.; Duke University Durham, Nc 27706 Timing: Fiscal Year 2001 Summary: Investigators in the Divisions of Clinical Pharmacology and Cardiology at Duke University Medical Center have used the Rankin General Clinical Research Center to study patients with atrial fibrillation and other common disorders of the heart rhythm. Atrial fibrillation is the most common disorder of the heart rhythm requiring treatment with antiarrhythmic drugs, and it accounts for over one-third of all U.S. hospitalizations for arrhythmias. Patients with atrial fibrillation have their usually normal heart rhythm replaced by periods of rapid, irregular heart beating that may cause a sense of pounding in the chest, shortness of breath, chest pain, dizziness, or loss of consciousness. These periods may last for minutes or hours, or they may last indefinitely unless acute treatment is given by a physician. Studies conducted on the Rankin General Clinical Research Center have concentrated on elucidating the mechanism, clinical course, and optimal treatment of atrial fibrillation and related disorders of the heart rhythm. These studies have focused on measuring the frequency of spontaneous occurrence of atrial fibrillation and paroxysmal supraventricular tachycardia. Among 150 patients studied who had their antiarrhythmic drug therapy

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withdrawn, one-half had a spontaneous, symptomatic recurrence in about 3 weeks; in fact, about 1 in 5 had a symptomatic recurrence of their arrhythmia in less than 1 day. The average heart rate during recurrences was 132 beats/min for patients with atrial fibrillation and 198 beats/min for patients with paroxysmal supraventricular tachycardia. Among the patients with atrial fibrillation, about 1 in 9 had a second arrhythmia, atrial flutter, recorded along with fibrillation. The frequency of asymptomatic arrhythmias was approximately 12 times the rate of symptomatic arrhythmias. Curiously, quality of life was not affected by the frequency of arrhythmia occurrence. Similar methods were used to study patients with ventricular tachycardia who had an implanted cardioverter defibrillator (ICD). The frequency of ICD shocks in this population provided an estimate of the occurrence of ventricular tachycardia. About 1/3 of the patients had an episode of ventricular tachycardia within 1 month. Results of these studies are important for designing clinical trials of chronic antiarrhythmic drug therapy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MVPS: HEALTH CONCERNS, ROLE FUNCTION, HEALTH SERVICE USE Principal Investigator & Institution: Scordo, Kristine A.; None; Wright State University Colonel Glenn Hwy Dayton, Oh 45435 Timing: Fiscal Year 2002; Project Start 15-MAR-2002; Project End 14-MAR-2004 Summary: (provided by applicant) Mitral valve prolapse (MVP) is the most common valvular heart disease with millions of people newly diagnosed each year. Some of these patients have actual structural changes that require mitral valve replacement; others have a constellation of symptoms that are unrelated to these structural changes and are diagnosed with MVP syndrome (MVPS). For these individuals, treatment is aimed at symptom control. While the course for those with anatomical valvular dysfunction is documented, the course for those with MVPS is less well known. Anecdotal reports by individuals with MVPS indicate a variety of frightening symptoms, including chest pain, shortness of breath, palpitations, migraine headaches, lightheadedness, fatigue, dizziness on standing, mood swings, and anxiety or panic attacks. Individuals with these symptoms often seek help in emergency rooms; urgent care centers, and primary care offices. However, little is known about the profile and the effects of these symptoms on the individual's role status, and use of health care services. Thus, the purpose of this study is to develop a profile of health concerns, symptoms and treatments, and to examine the relationships of symptoms to functional and role status and use of health care services for patients diagnosed with MVPS. Specifically, the research questions are: (1) what are the health concerns, symptoms, and treatments reported by patients with MVPS? (2) Are symptoms related to age, time since diagnosis, symptoms, anxiety, social support, diet (magnesium, sodium, water and caffeine), and treatment (beta and calcium channel blockers; anxiolytics; mediation/relaxation therapy; fluid; exercise; activity limitation)? (3) What is the relationship of symptoms to patients' health concerns, functional and role status, and use of health care services? A descriptive cross-sectional design will be used. Questionnaire packets will be mailed to all of the men and women (N = 3022) on The Mitral Valve Prolapse Program of Cincinnati's mailing list diagnosed with MVPS. The self-complete questionnaires will include measures of MVPS symptoms (MVPS symptom checklist); the outcome variables of health concerns (MUIS), functional and role status (SF-36), and healthcare service use (Life History Calendar); and the independent variables of age, time since diagnosis, anxiety (STAI), social support (MOS Social Support), treatment, and diet (Food Frequency Questionnaire). Descriptive

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statistics and multiple regression analysis will be used to address the study's research questions. The proposed study is the next step in developing data on symptoms of MVPS and their effect on health and functioning. These data are necessary in developing and modifying existing education and self management interventions aimed at reducing anxiety and improving the health and well being of the millions of Americans newly diagnosed with this syndrome annually. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NEW TESTS OF VESTIBULAR FUNCTION Principal Investigator & Institution: Demer, Joseph L.; Professor; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, Ca 90024 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 30-JUN-2007 Summary: (provided by applicant): This project aims to develop new approaches to evaluation of human vestibular function, with the ultimate aim of improving pathophysiologic understanding, diagnosis, and management of the large number of patients with dizziness and disequilibrium. A central theme is to relate quantitative test performance to lesions of specific vestibular sensory organs or brain regions, through application of selective stimuli that by their transient nature can isolate vestibular responses from non-labyrinthine compensatory mechanisms. We propose to develop very high time resolution tests of vestibular function in response to angular and linear motion, and correlate the finding with other quantitative physiologic and pathologic indicators of vestibular structure and function in patients with clinically wellcharacterized vestibular disorders. We will employ magnetic search coil sensors to make precise measurements of eye and head movements to investigate in young and older human subjects the effects of aging, well-characterized forms of vestibulopathy, and cerebellar degeneration on vestibulo-ocular (VORs). We will employ precise angular and linear stimulation directed toward specific vestibular sensory organs to characterize their functions and central integration. Specific aims are: to evaluate transient pitch and roll VOR in the planes of individual semicircular canals during transient passive, wholebody rotation under visually salient conditions, and its interaction with otolith stimulation, in normal subjects and in patients with well-characterized surgical lesions, specific vestibular syndromes, and specific cerebellar degenerations; 2) to quantify the heave and surge transient linear c and its kinematic dependence on three-dimensional target location during whole-body translation, and the effects of well-characterized surgical lesions, specific vestibular syndromes, and specific cerebellar degenerations defined by molecular pathology; and, 3) to characterize the chronology of ocular motor adaptations to acute vestibular deafferentation in humans, including recovery of the yaw, pitch, and roll angular VORs, and heave and surge linear VORs, as well as development of extralabyrinthine compensatory mechanisms. Development of these novel tests will direct diagnostic inferences and should facilitate understanding of pathophysiology and the functional efficacy of compensatory mechanisms in patients with vestibular disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PHOTOPHYSICAL PROPERTIES OF TRICYCLIC ANTIEPILEPTIC DRUGS Principal Investigator & Institution: Garcia, Carmelo; University of Puerto Rico at Humacao Box 428, Barrio Tejas Humacao, Pr 00791 Timing: Fiscal Year 2003; Project Start 01-APR-2003; Project End 31-MAR-2007

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Summary: The intense research devoted over the last few years to the study of epilepsy and antiepileptic drugs (AEDs) has only dealt with the physiology of the disease. This quality research has been aimed to replace the older AEDs with broad activity profiles and several severe side effects with new AEDs with better defined mechanism of action and fewer side effects. Nevertheless, most of these drugs still produce serious adverse reactions, including among others, dizziness, ataxia, somnolence, headache, blurred vision, nausea, vomiting, skin, allergy and photosensitization. The molecular photochemical mechanisms for the photosensitizing ability of some AEDs has never been studied, even through it was reported over ten years ago. Recent studies on the laser flash phototysis of related neuroleptic drugs (imipramine) showed that the triplet state can be efficiently quenched by the protons in the solution. The effectiveness of the quenching is very sensitive to the structure of the drug and seems to be involve in their phototoxicity. We propose to perfor the same set of experiments on several phototoxic antiepileptics. The goal of this project is to measure the photophysicat properties of a selected group of tricydic antiepileptic drugs and to study their short-lived transients. Special attention will be given to those transients associated with adverse effects in vivo: the cation radical, the first triplet excited state and singlet oxygen, Basic UV-Vis and luminescence techniques will be employed to study their absorption/emission properties. The transients will be characterized using optical absorption measurements with a Nd-YAG laser set-up. For the triplet state of these compounds, the extinction coefficient and the quantum yield will be determined using a comparative method and the triplet-triplet energy transfer principle, respectively. The triplet state will be bleached with a second delayed pulse to elucidate the reaction mechanism of these u'ansients. Combined MM+/PM3/RHF theoretical calculations will be performed with HyperCHEM (TM) 7.0 on the whole set ofphotophysical parameters, The theoretical values will be correlated with the experimental ones. The major goal of this project is to find a molecular/photophysical descriptor for the phototoxic side effect of tricydic antiepileptics. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DISABILITIES

PREDOCTORAL

FELLOWSHIPS

FOR

STUDENTS

WITH

Principal Investigator & Institution: Wrisley, Diane M.; Otolaryngology; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2001; Project Start 15-SEP-2000 Summary: (Adapted from the Applicant's Abstract): This study will investigate the influence of head-on-trunk position on postural sway in healthy adults using galvanic vestibular stimulation (GVS). During GVS, a small electric current is applied through electrodes placed over the mastoid. The stimulus hyperpolarizes the vestibular nerve on the cathode side and hypopolarizes the vestibular nerve on the anode side. This results in postural sway towards the anode. It is hypothesized that turning the head relative to the trunk will result in a line of sway parallel to a line through the mastoids. Subjects will be asked to stand with their feet together on a force platform. Trials will be conducted with the head forward, and then turned 20,40 and 60 degrees to the right and left with and without the application of sinusoidal GVS. Direction and magnitude of the excursion of center of pressure will be measured using a force platform. The angular and linear movement of the head (forehead), thorax (T4/T5), and pelvis (S2) will be measured using electromagnetic sensors. If a significant difference is found in magnitude and direction of postural sway with different head positions, then the applicability to clinical practice will be investigated. The research protocol will be

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repeated, as part of a pilot study, with a few patients with a diagnosis of recent whiplash injury with and without complaints of dizziness. If a significant difference is found in the magnitude or direction of postural sway in patients with whiplash injuries as compared with healthy adults then it may prove useful as a diagnostic tool or as an outcome measure to evaluate treatment intervention. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: QUANTITATIVE MRI AND 1H-MRS IN TRAUMATIC BRAIN INJURY Principal Investigator & Institution: Grossman, Robert I.; Louis Marx Professor and Chairman; Radiology; New York University School of Medicine 550 1St Ave New York, Ny 10016 Timing: Fiscal Year 2001; Project Start 15-SEP-2000; Project End 31-JUL-2005 Summary: (Adapted from Applicant's Abstract): Traumatic brain injury 9TBI) has an incidence of nearly 2,000,000 cases per year, and is the leading cause of disability and death in children and young adults (peak incidence in 15 to 24 year olds) in the United States. Following mild head injury patients may suffer from a multitude of cognitive deficits including decreased speed in information processing, poor attention, concentration, and memory, and impaired logical reasoning skill, as well as more focal deficits including impairment of language or constructional abilities. A variety of other symptoms including headache, dizziness, nausea, neurasthenia, hyperesthesia, and emotional liability are commonly perceived. Head injury has been associated with shortterm increased b-amyloid protein deposition and long-term neurotic plaques characteristic of Alzheimer's Disease. Epidemiological studies have observed a statistically-significant relationship between TBI and the subsequent onset of AD. Indeed, there is growing evidence that head injury, even mild in nature, may have greater consequences than previously assumed. The investigators hypothesize that mild/moderate TBI can cause neuronal cell death (reflected primarily by gray matter volume lose) and that this is the primary factor in induction and progression of neurocognitive disability in head injured patients. The central hypothesis is to test this hypothesis that the investigators have developed and validated computerized quantitative methods based upon magnetic resonance (MR) imaging (MRI) to measure the effect of TBI on brain substance. The investigators have also devised and implemented a proton (+H) magnetic resonance spectroscopy (MRS) technique to quantitative the neuronal concentration of the entire brain based upon the measurement of N-acetylaspartate (WBNAA) which is considered to be a marker of neuronal integrity. This proposal will correlate these quantitative MR measures with clinical measures of disability and neurocognitive tests. The overarching goal is to utilize MRI and 'H MRS to detect and quantify the effects TBI in a well-characterized cohort of mild/moderate head injured patients over a duration of 5 years. The results from this research will provide new and important information regarding the full extent of TBI, aid in categorizing these patients, and serve as an arbiter to assess proposed treatment strategies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: POTENTIALS

SCREENING

VESTIBULAR

FUNCTION

USING

EVOKED

Principal Investigator & Institution: Jones, Sherri M.; Surgery; University of Missouri Columbia 310 Jesse Hall Columbia, Mo 65211

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Timing: Fiscal Year 2001; Project Start 27-SEP-1999; Project End 31-MAY-2003 Summary: There are no direct, noninvasive, physiological measures of vestibular function. This is in clear contrast to the wide variety of physiological measures available to directly assess function of the auditory system at all levels from the end organ to the cortex. Many of these auditory measures, most notably, auditory brainstem responses, have been used to screen for, or identify and characterize hearing loss in a large number of genetic mutants. These studies have provided important information about the genetics of hearing impairment. The proposed research will develop the techniques to assess the functional status of the vestibular end organs and eighth nerve. Meaurements will be direct, noninvasive and implemented by adapting established techniques for recording linear vestibular evoked potentials. Protocols will be suitable for screening and detailed functional assessment. Two specific aims will be addressed. First, stimulation and recording hardware and software will be developed. Peripheral vestibular and brainstem neural activity will be recorded using far-field evoked potential techniques. Adequate stimuli for activation of macular or ampullar neurons will be used to elicit responses. Stimuli will be applied to the cranium via a mechanical shaker/head mount system. Normal mice and genetic mutants with specific inner ear or central anomalies will be used to demonstrate test validity. Second, the effectiveness and efficiency of the measurement technique will be evaluated. Vestibular function will be surveyed based on two selection strategies. One strategy will measure mice that display behavioral signs of imbalance or vestibular dysfunction or have measurable hearing loss. The second strategy will measure random samples drawn from multiple genetic strains where vestibular dysfunction may be obscure or hidden. This research will produce a tool for the direct, noninvasive assessment of vestibular function and will generate a database quantifying vestibular function in relation to genetics. The knowledge gained will serve as a basis for future research ultimately leading to a better understanding of vestibular ontogeny, genetics of vestibular impairment and better diagnosis and treatment of dizziness in humans. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SENSORY PROCESSING IN THE VESTIBULAR ORGANS Principal Investigator & Institution: Eatock, Ruth; Assistant Professor; Otorhinolaryn & Communica Scis; Baylor College of Medicine 1 Baylor Plaza Houston, Tx 77030 Timing: Fiscal Year 2001; Project Start 01-APR-1994; Project End 31-MAR-2002 Summary: The long-term goal of this work is to understand how vestibular organs, which transduce head position and movement, function and develop. Good health depends on the normal function of these organs. Damage can lead to debilitating vertigo, dizziness and an inability to maintain steady gaze. The primary afferent neurons to vestibular organs vary in the sensitivity and time course of their responses to head movement stimuli. Some of the variation correlates with region within the sensory organ. In amniotes, a further source of variation is likely to be differences between two classes of sensory hair cell, type I and II. This application proposes to take three approaches to stimulus processing by mammalian vestibular organs, using the rodent utricle as a model. The first aim is to test whether there are regional and cell-typespecific differences in the properties of the hair cell's mechanosensitive transducer conductance, which converts head movement stimuli into the receptor potential. Second, the hair cells' voltage-gated potassium conductances, which shape the receptor potential, will be characterized at the molecular level by applying probes directed at candidate proteins and messenger RNA. These conductances differ substantially between type I and II hair cells. The third aim is to characterize the normal development

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of hair cells from the period of peak terminal mitoses (prenatal) to birth of the animal. At birth, mouse utricular hair cells express some voltage-gated conductances and ultrastructural analysis shows that although the utricle is immature in many ways, some cells can be recognized as type I or II. The prenatal time course of acquisition of voltagegated conductances will be determined with whole-cell recording. The expression of voltage-gated potassium channel proteins will be followed in time with molecular probes. Prenatal morphological differentiation of the utricle will be characterized. These experiments should provide insight into early differentiation of hair cells and supporting cells, as well as determine the utility of potassium channel proteins as markers of hair cell differentiation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: STRATEGIES TO REDUCE DIZZINESS IN OLDER ADULTS Principal Investigator & Institution: Helminski, Janet O.; Physical Therapy; Midwestern University 555 31St St Downers Grove, Il 60515 Timing: Fiscal Year 2000; Project Start 20-SEP-2000; Project End 31-AUG-2004 Summary: adapted from applicant's abstract) Dizziness is the most common presenting complaint of ambulatory care patients aged 75 years and older. Benign paroxysmal positional vertigo is the most common cause of dizziness in the elderly, accounting for 26 percent of all dizziness. Recently there have been striking improvements in the nonsurgical treatment of BPPV. A better understanding of the cause of BPPV led to the development of positional exercises. The canalith repositioning procedure is one of the most commonly used maneuvers in the United States with the average success rate being 76 percent following one treatment session. Although treatment is very effective BPPV often recurs. In a previous study the investigators found the rate of recurrence to be 47 percent when patients were followed for up to five years. The majority of recurrence occurred with in the first two years, with the rate of recurrence being 44 percent. The purpose of this study is to determine whether a daily routine of BrandtDaroff exercises will increase significantly the time to recur and/or reduce the rate of recurrence of BPPV. The investigators will identify 100 patients diagnosed with BPPV and treated successfully from the Otolaryngology Clinic of Northwestern University Medical Faculty Foundation. Subjects will be randomly assigned to one of two groups and followed for two years. Group 1 will perform no exercises; while group 2 will perform the Brandt-Daroff exercises one time per day. The time to recur and rate of recurrence of BPPV will be determined between the groups and identification of factors associated with recurrence of the groups will be determined. The investigators predict that a daily routine of Brandt-Daroff exercises will significantly reduce recurrence of BPPV. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: VESTIBULAR CLINICAL AND BASIC RESEARCH PROJECT CENTER Principal Investigator & Institution: Honrubia, Vicente; Professor; Surgery; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, Ca 90024 Timing: Fiscal Year 2001; Project Start 01-DEC-1996; Project End 30-NOV-2001 Summary: (Adapted from abstract): This application uses a multidisciplinary approach to ontoneurology in which clinical and basic scientists interact to achieve a better understanding of vestibular disorders. Three interrelated projects are proposed. Subproject 1, Pathophysiology of Vestibular Disorders, is directed toward acquisition of fundamental clinical information. A unique feature is the study of post-mortem material

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from patients whose performance has been documented by a battery of laboratory tests enabling clinical pathological correlations by classical and molecular methods. Patients suffering from familial vestibular disorders will be studied to identify genetic defects. The hope is that new insights into cause of such common disorders as migraine, Meniere's syndrome and dysequilibrium of aging will be obtained. Subproject 2, New approaches to Vestibular Testing, involves quantitative assessment of vestibular performance during routine daily activities. Such natural stimuli include high frequency angular and linear accelerations in all six degrees of freedom, interacting with visual stimuli. The subproject will develop tests of vestibular function during natural activities such as ambulation, as well as specific controlled tests of multidimensional angular and linear vestibulo-ocular reflexes, visual vestibular interaction, and dynamic visual acuity. The investigators will measure and theoretically model human gaze stability and eyehear kinematics in normal and vistibulopathic subjects. Data will be correlated with pathophysiologic studies in Subproject 1. Subproject 3, Studies on Vestibular Hair Cell Regeneration, seeks to understand the reparative mechanisms that ameliorate the disorders investigated in humans. Experiments will document morphological and functional aspects of vestibular hair cell recovery in chinchillas after ototoxic treatment. Several histological methods will be used to investigate mechanisms of repair and of hair cell reinnervation. The effect of brain derived neurotropic factor (BDNF) to the recovery process will be examined. Physiological tests are proposed to evaluate concomitant changes in vestibulo-visual-ocular, vestibulocollic and vestibulo-spinal reflexes. Results of these experiments have potential theoretical and practical value for the management of patients suffering from dizziness and dysequilibrium due to inner ear lesions as well as sensorineural disorders. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: VESTIBULAR COMPENSATION

NUCLEUS

ACTIVITY

IN

VESTIBULAR

Principal Investigator & Institution: Newlands, Shawn D.; Associate Professor; Otolaryngology; University of Texas Medical Br Galveston 301 University Blvd Galveston, Tx 77555 Timing: Fiscal Year 2001; Project Start 01-AUG-1999; Project End 31-JUL-2004 Summary: The purpose of this project is to elucidate the mechanisms involved in recovery from vestibular injury (vestibular compensation) in primates. Experiments will focus on the physiological processes underlying recovery of the vestibulo-ocular reflex (VOR) following unilateral labyrinthectomy or plugging of the semicircular canals. The role played by volition in compensatory ocular responses during head movement will be investigated by analyzing unrestrained eye and head saccadic movements (head-free gaze shifts) before and after labyrinthine lesion. Single-unit recordings of neurons in the vestibular nuclei will be analyzed for changes in their oculomotor and angular acceleration sensitivity before unilateral labyrinthine lesion and after compensation. The hypotheses to be tested are that (1) passive vestibular compensation seen in vestibuloocular responses is the result of plasticity in the commissural connections between the bilateral vestibular nuclei; (2) the neurons found in the vestibular nuclei of the compensated animal carry the same oculomotor sensitivity as in the intact animal; and (3) the animal is able to utilize efference copies of neural signals which encode head movements and/or cervical feedback to facilitate behavioral compensation during natural, unrestrained head movements. This research is an outgrowth of the candidate's interest in vestibular compensation, which developed from his previous research experience and from his work as an otolaryngologist treating patients complaining of

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dizziness. The work in this proposal will be done under the direction of Dr. W. Michael King in collaboration with a diverse group of investigators who study vestibular and oculomotor function at the University of Mississippi Medical Center. To complement the work in the lab, the candidate will undergo instruction in computer function and programming and biostatistics to facilitate establishment of the candidate as an independent investigator/clinician studying plasticity in the vestibular system, particularly as it pertains to natural head movements. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “dizziness” (or synonyms) into the search box. This search gives you access to fulltext articles. The following is a sample of items found for dizziness in the PubMed Central database: •

Diagnosis and management of benign paroxysmal positional vertigo (BPPV). by Parnes LS, Agrawal SK, Atlas J.; 2003 Sep 30; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=202288

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Hydatid Cyst in the Interventricular Septum: A Rare Cause of Dizziness? by Toquero J, Castedo E, Oteo JF, Rubio A, Canas A.; 2000; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=101116

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.

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

A 69-year-old man with chronic dizziness, 1 year later. Author(s): Parker RA, Hartman EE. Source: Jama : the Journal of the American Medical Association. 1999 July 28; 282(4): 378. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10432036&dopt=Abstract

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A case of dizziness, headache, aural fullness, and concentration difficulty following scuba diving. Author(s): Brookler KH. Source: Ear, Nose, & Throat Journal. 2003 May; 82(5): 356-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12789759&dopt=Abstract

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A clinical taxonomy of dizziness and anxiety in the otoneurological setting. Author(s): Furman JM, Jacob RG. Source: Journal of Anxiety Disorders. 2001 January-April; 15(1-2): 9-26. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11388360&dopt=Abstract

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A conceptual structure and methodology for the systematic approach to the evaluation and treatment of patients with chronic dizziness. Author(s): Clark MR, Swartz KL. Source: Journal of Anxiety Disorders. 2001 January-April; 15(1-2): 95-106. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11388361&dopt=Abstract

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A factor analytic study of the dizziness handicap inventory: does it assess phobic avoidance in vestibular referrals? Author(s): Asmundson GJ, Stein MB, Ireland D. Source: Journal of Vestibular Research : Equilibrium & Orientation. 1999; 9(1): 63-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10334018&dopt=Abstract

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A new measure for assessing the health-related quality of life of patients with vertigo, dizziness or imbalance: the VDI questionnaire. Author(s): Prieto L, Santed R, Cobo E, Alonso J. Source: Quality of Life Research : an International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation. 1999; 8(1-2): 131-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10457746&dopt=Abstract

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A practical assessment algorithm for diagnosis of dizziness. Author(s): Kentala E, Rauch SD. Source: Otolaryngology and Head and Neck Surgery. 2003 January; 128(1): 54-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12574760&dopt=Abstract

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A survey of dizziness management in General Practice. Author(s): Jayarajan V, Rajenderkumar D. Source: The Journal of Laryngology and Otology. 2003 August; 117(8): 599-604. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12956912&dopt=Abstract

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A woman with both positional and spontaneous dizziness. Author(s): Brookler KH. Source: Ear, Nose, & Throat Journal. 2001 July; 80(7): 442. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11480299&dopt=Abstract

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Abnormal auditory neural networks in patients with right hemispheric infarction, chronic dizziness, and moyamoya disease: a magnetoencephalogram study. Author(s): Kandori A, Oe H, Miyashita K, Date H, Yamada N, Naritomi H, Chiba Y, Miyashita T, Tsukada K. Source: Neuroscience Research. 2002 November; 44(3): 273-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12413656&dopt=Abstract

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An analysis of referral patterns for dizziness in the primary care setting. Author(s): Bird JC, Beynon GJ, Prevost AT, Baguley DM. Source: The British Journal of General Practice : the Journal of the Royal College of General Practitioners. 1998 December; 48(437): 1828-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10198501&dopt=Abstract

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Antidepressants and dizziness. Author(s): Blakley BW. Source: The Journal of Otolaryngology. 1999 December; 28(6): 313-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10604159&dopt=Abstract

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Anxiety disorders and other psychiatric subgroups in patients complaining of dizziness. Author(s): Eckhardt-Henn A, Breuer P, Thomalske C, Hoffmann SO, Hopf HC. Source: Journal of Anxiety Disorders. 2003; 17(4): 369-88. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12826087&dopt=Abstract

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Application of multivariate statistics to vestibular testing: discriminating between Meniere's disease and migraine associated dizziness. Author(s): Dimitri PS, Wall C 3rd, Oas JG, Rauch SD. Source: Journal of Vestibular Research : Equilibrium & Orientation. 2001; 11(1): 53-65. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11673678&dopt=Abstract

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Assessment and treatment of dizziness. Author(s): Coatesworth AP. Source: Journal of Neurology, Neurosurgery, and Psychiatry. 2000 November; 69(5): 706. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11184241&dopt=Abstract

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Assessment and treatment of dizziness. Author(s): Halmagyi GM, Cremer PD. Source: Journal of Neurology, Neurosurgery, and Psychiatry. 2000 February; 68(2): 12934. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10644773&dopt=Abstract

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Behaviour therapy for dizziness? Author(s): Sareen J. Source: Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie. 2003 May; 48(4): 283-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12776400&dopt=Abstract

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Case 1: a woman with headache and dizziness. Author(s): Gibbons C, Llinas R. Source: Medgenmed [electronic Resource] : Medscape General Medicine. 2003 February 13; 5(1): 35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12827096&dopt=Abstract

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Cases from the Aerospace Medicine Residents' Teaching File: acute onset of dizziness in a USAF aviator. Author(s): Clark RA. Source: Aviation, Space, and Environmental Medicine. 2001 June; 72(6): 586-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11398820&dopt=Abstract

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Central causes of dizziness. Author(s): Furman JM, Whitney SL. Source: Physical Therapy. 2000 February; 80(2): 179-87. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10654064&dopt=Abstract

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Cervicogenic dizziness: a review of diagnosis and treatment. Author(s): Wrisley DM, Sparto PJ, Whitney SL, Furman JM. Source: The Journal of Orthopaedic and Sports Physical Therapy. 2000 December; 30(12): 755-66. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11153554&dopt=Abstract

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Change in dizziness handicap after vestibular schwannoma excision. Author(s): Humphriss RL, Baguley DM, Moffat DA. Source: Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology. 2003 July; 24(4): 661-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12851561&dopt=Abstract

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Chronic dizziness among older adults. Author(s): Weintraub MI. Source: Annals of Internal Medicine. 2000 June 20; 132(12): 1009-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10858170&dopt=Abstract

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Chronic dizziness in older adults. Author(s): Cheng JS. Source: Annals of Internal Medicine. 2000 August 1; 133(3): 236. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10906844&dopt=Abstract

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Chronic dizziness in older adults. Author(s): Katsarkas A. Source: Annals of Internal Medicine. 2000 August 1; 133(3): 236. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10906843&dopt=Abstract

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Cortical functional abnormality assessed by auditory-evoked magnetic fields and therapeutic approach in patients with chronic dizziness. Author(s): Oe H, Kandori A, Murakami M, Miyashita K, Tsukada K, Naritomi H. Source: Brain Research. 2002 December 13; 957(2): 373-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12445982&dopt=Abstract

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Deep white matter lesions on MRI, and not silent brain infarcts are related to headache and dizziness of non-specific cause in non-stroke Japanese subjects. Author(s): Fujishima M, Yao H, Terashi A, Tagawa K, Matsumoto M, Hara H, Akiguchi I, Suzuki K, Nishimaru K, Udaka F, Gyoten T, Takeuchi J, Hamada R, Yoshida Y, Ibayashi S. Source: Intern Med. 2000 September; 39(9): 727-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10969904&dopt=Abstract

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Diagnosis and initiating treatment for peripheral system disorders: imbalance and dizziness with normal hearing. Author(s): El-Kashlan HK, Telian SA. Source: Otolaryngologic Clinics of North America. 2000 June; 33(3): 563-78. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10815037&dopt=Abstract

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Diagnosis and treatment of psychologic symptoms and psychiatric disorders in patients with dizziness and imbalance. Author(s): Staab JP. Source: Otolaryngologic Clinics of North America. 2000 June; 33(3): 617-36. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10815040&dopt=Abstract

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

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Different forms of dizziness occurring after cochlear implant. Author(s): Kubo T, Yamamoto K, Iwaki T, Doi K, Tamura M. Source: European Archives of Oto-Rhino-Laryngology : Official Journal of the European Federation of Oto-Rhino-Laryngological Societies (Eufos) : Affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery. 2001 January; 258(1): 9-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11271438&dopt=Abstract

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Dizziness among older adults: a possible geriatric syndrome. Author(s): Tinetti ME, Williams CS, Gill TM. Source: Annals of Internal Medicine. 2000 March 7; 132(5): 337-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10691583&dopt=Abstract

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Dizziness and headache: a common association in children and adolescents. Author(s): Weisleder P, Fife TD. Source: Journal of Child Neurology. 2001 October; 16(10): 727-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11669345&dopt=Abstract

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Dizziness and loss of consciousness. Cardiovascular causes. Author(s): Wright JJ, Arnolda LF. Source: Aust Fam Physician. 2003 April; 32(4): 207-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12735259&dopt=Abstract

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Dizziness and migraine: a causal relationship? Author(s): Versino M, Sances G, Anghileri E, Colnaghi S, Albizzati C, Bono G, Cosi V. Source: Funct Neurol. 2003 April-June; 18(2): 97-101. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12911141&dopt=Abstract

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Dizziness and panic in China: associated sensations of zang fu organ disequilibrium. Author(s): Park L, Hinton D. Source: Culture, Medicine and Psychiatry. 2002 June; 26(2): 225-57. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12211326&dopt=Abstract

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Dizziness and syncope in adolescence. Author(s): McLeod KA. Source: Heart (British Cardiac Society). 2001 September; 86(3): 350-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11514496&dopt=Abstract

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Dizziness and unsteadiness following whiplash injury: characteristic features and relationship with cervical joint position error. Author(s): Treleaven J, Jull G, Sterling M. Source: Journal of Rehabilitation Medicine : Official Journal of the Uems European Board of Physical and Rehabilitation Medicine. 2003 January; 35(1): 36-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12610847&dopt=Abstract

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Dizziness and vertigo after cochlear implantation. Author(s): Kiyomizu K, Tono T, Komune S, Ushisako Y, Morimitsu T. Source: Advances in Oto-Rhino-Laryngology. 2000; 57: 173-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11892139&dopt=Abstract

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Dizziness in discus throwers is related to motion sickness generated while spinning. Author(s): Perrin P, Perrot C, Deviterne D, Ragaru B, Kingma H. Source: Acta Oto-Laryngologica. 2000 March; 120(3): 390-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10894415&dopt=Abstract

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Dizziness in the elderly and age-related degeneration of the vestibular system. Author(s): Matheson AJ, Darlington CL, Smith PF. Source: Nz J Psychol. 1999 June; 28(1): 10-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11543297&dopt=Abstract

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Dizziness in the older adult, Part 1. Evaluation and general treatment strategies. Author(s): Eaton DA, Roland PS. Source: Geriatrics. 2003 April; 58(4): 28-30, 33-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12708153&dopt=Abstract

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Dizziness in the older adult, Part 2. Treatments for causes of the four most common symptoms. Author(s): Eaton DA, Roland PS. Source: Geriatrics. 2003 April; 58(4): 46, 49-52. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12708155&dopt=Abstract

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Dizziness symptom severity and impact on daily living as perceived by patients suffering from peripheral vestibular disorder. Author(s): Mendel B, Bergenius J, Langius A. Source: Clinical Otolaryngology and Allied Sciences. 1999 August; 24(4): 286-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10472462&dopt=Abstract

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Dizziness when eating: an unusual isolated presentation of cerebral venous thrombosis. Author(s): Fukutake T, Shimoe Y, Hattori T. Source: Intern Med. 2001 September; 40(9): 961-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11579966&dopt=Abstract

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Dizziness. Author(s): Tusa RJ. Source: The Medical Clinics of North America. 2003 May; 87(3): 609-41, Vii. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12812406&dopt=Abstract

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Dizziness: relating the severity of vertigo to the degree of handicap by measuring vestibular impairment. Author(s): Perez N, Martin E, Garcia-Tapia R. Source: Otolaryngology and Head and Neck Surgery. 2003 March; 128(3): 372-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12646840&dopt=Abstract

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Dizziness: state of the science. Author(s): Sloane PD, Coeytaux RR, Beck RS, Dallara J. Source: Annals of Internal Medicine. 2001 May 1; 134(9 Pt 2): 823-32. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11346317&dopt=Abstract

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Double-blind, randomized, multicenter study comparing the effect of betahistine and flunarizine on the dizziness handicap in patients with recurrent vestibular vertigo. Author(s): Albera R, Ciuffolotti R, Di Cicco M, De Benedittis G, Grazioli I, Melzi G, Mira E, Pallestrini E, Passali D, Serra A, Vicini C. Source: Acta Oto-Laryngologica. 2003 June; 123(5): 588-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12875580&dopt=Abstract

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Effects of acupuncture, cervical manipulation and NSAID therapy on dizziness and impaired head repositioning of suspected cervical origin: a pilot study. Author(s): Heikkila H, Johansson M, Wenngren BI. Source: Manual Therapy. 2000 August; 5(3): 151-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11034885&dopt=Abstract

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Effects of greater occipital nerve block on tinnitus and dizziness. Author(s): Matsushima JI, Sakai N, Uemi N, Ifukube T. Source: Int Tinnitus J. 1999; 5(1): 40-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10753418&dopt=Abstract

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Electronystagmography in a 13-year-old boy with dizziness and hyperacusis. Author(s): Brookler KH. Source: Ear, Nose, & Throat Journal. 2003 June; 82(6): 424-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12861865&dopt=Abstract

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Electronystagmography in a blind patient with dizziness. Author(s): Brookler KH. Source: Ear, Nose, & Throat Journal. 2001 February; 80(2): 74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11233348&dopt=Abstract

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Electronystagmography in a woman with aural fullness, hyperacusis, and dizziness. Author(s): Brookler KH. Source: Ear, Nose, & Throat Journal. 2003 March; 82(3): 165-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12696231&dopt=Abstract

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Electronystagmography: dizziness and syncope. Author(s): Brookler KH. Source: Ear, Nose, & Throat Journal. 2000 September; 79(9): 687. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11011485&dopt=Abstract

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Electronystagmography: dizziness and vestibulocollic symptoms. Author(s): Brookler KH. Source: Ear, Nose, & Throat Journal. 2000 November; 79(11): 841. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11107686&dopt=Abstract

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ENG in 16-year-old with a history of dizziness since early childhood. Author(s): Brookler KH. Source: Ear, Nose, & Throat Journal. 2001 August; 80(8): 496. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11523461&dopt=Abstract

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ENG in a 70-year-old woman with dizziness and inability to look down. Author(s): Brookler KH. Source: Ear, Nose, & Throat Journal. 2001 June; 80(6): 372-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11433839&dopt=Abstract

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ENG in a woman with a history of dizziness who became nauseous and lightheaded while reading. Author(s): Brookler KH. Source: Ear, Nose, & Throat Journal. 2000 August; 79(8): 549. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10969460&dopt=Abstract

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Evaluating dizziness. Author(s): Hoffman RM, Einstadter D, Kroenke K. Source: The American Journal of Medicine. 1999 November; 107(5): 468-78. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10569302&dopt=Abstract

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Evaluating the dizzy patient: bedside examination and laboratory assessment of the vestibular system. Author(s): Eggers SD, Zee DS. Source: Seminars in Neurology. 2003 March; 23(1): 47-58. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12870105&dopt=Abstract

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Exertional dizziness and autonomic dysregulation. Author(s): Staab JP, Ruckenstein MJ, Solomon D, Shepard NT. Source: The Laryngoscope. 2002 August; 112(8 Pt 1): 1346-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12172243&dopt=Abstract

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Experience in acupuncture treatment of dizziness and vertigo--a report of 3 cases. Author(s): Xu L. Source: J Tradit Chin Med. 2002 March; 22(1): 18-20. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11977511&dopt=Abstract

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Factor analysis and correlation between Dizziness Handicap Inventory and Dizziness Characteristics and Impact on Quality of Life scales. Author(s): Perez N, Garmendia I, Garcia-Granero M, Martin E, Garcia-Tapia R. Source: Acta Otolaryngol Suppl. 2001; 545: 145-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11677730&dopt=Abstract

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Health, functional, and psychological outcomes among older persons with chronic dizziness. Author(s): Tinetti ME, Williams CS, Gill TM. Source: Journal of the American Geriatrics Society. 2000 April; 48(4): 417-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10798469&dopt=Abstract

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How common are various causes of dizziness? A critical review. Author(s): Kroenke K, Hoffman RM, Einstadter D. Source: Southern Medical Journal. 2000 February; 93(2): 160-7; Quiz 168. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10701780&dopt=Abstract

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Hydatid cyst in the interventricular septum: a rare cause of dizziness? Author(s): Toquero J, Castedo E, Oteo JF, Rubio A, Canas A. Source: Texas Heart Institute Journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital. 2000; 27(4): 414-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11198320&dopt=Abstract

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Impaired autonomic function predicts dizziness at onset of paroxysmal atrial fibrillation. Author(s): van den Berg MP, Hassink RJ, Tuinenburg AE, Lefrandt JD, de Kam PJ, Crijns HJ. Source: International Journal of Cardiology. 2001 December; 81(2-3): 175-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11744134&dopt=Abstract

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Influence of beliefs about the consequences of dizziness on handicap in people with dizziness, and the effect of therapy on beliefs. Author(s): Yardley L, Beech S, Weinman J. Source: Journal of Psychosomatic Research. 2001 January; 50(1): 1-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11259793&dopt=Abstract

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Low-dose intratympanic gentamicin treatment for dizziness in Meniere's disease. Author(s): Longridge NS, Mallinson AI. Source: The Journal of Otolaryngology. 2000 February; 29(1): 35-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10709170&dopt=Abstract

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Magnetic resonance brain imaging in people with dizziness: a comparison with nondizzy people. Author(s): Colledge N, Lewis S, Mead G, Sellar R, Wardlaw J, Wilson J. Source: Journal of Neurology, Neurosurgery, and Psychiatry. 2002 May; 72(5): 587-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11971042&dopt=Abstract

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Management of chronic dizziness in elderly people. Author(s): Salles N, Kressig RW, Michel JP. Source: Zeitschrift Fur Gerontologie Und Geriatrie : Organ Der Deutschen Gesellschaft Fur Gerontologie Und Geriatrie. 2003 February; 36(1): 10-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12616402&dopt=Abstract

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Migraine-associated dizziness: patient characteristics and management options. Author(s): Reploeg MD, Goebel JA. Source: Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology. 2002 May; 23(3): 364-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11981397&dopt=Abstract

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Neurology. 3: Dizziness. Author(s): Waterston J. Source: The Medical Journal of Australia. 2000 May 15; 172(10): 506-11. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10901777&dopt=Abstract

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Nonadjacent mass compression dizziness and hearing loss: a case report. Author(s): Gerwin BD, Gerwin JM, Simpson LC, Gerwin KS. Source: American Journal of Otolaryngology. 2000 January-February; 21(1): 43-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10668676&dopt=Abstract

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Nurse-delivered exercise therapy for dizziness. Author(s): Yardley L, Beech S. Source: Nurs Times. 1999 March 10-16; 95(10): 50-1. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10214259&dopt=Abstract

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Outcome of symptoms of dizziness in a general practice community sample. Author(s): Nazareth I, Yardley L, Owen N, Luxon L. Source: Family Practice. 1999 December; 16(6): 616-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10625139&dopt=Abstract

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Overview of psychologic effects of chronic dizziness and balance disorders. Author(s): Yardley L. Source: Otolaryngologic Clinics of North America. 2000 June; 33(3): 603-16. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10815039&dopt=Abstract

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Pain, dizziness, and central nervous system blood flow in cervical extension: vascular correlations to beauty parlor stroke syndrome and salon sink radiculopathy. Author(s): Foye PM, Najar MP, Camme A A Jr, Stitik TP, DePrince ML, Nadler SF, Chen B. Source: American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists. 2002 June; 81(6): 395-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12023594&dopt=Abstract

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Panic disorder with agoraphobia associated with dizziness: characteristic symptoms and psychosocial sequelae. Author(s): Yardley L, Owen N, Nazareth I, Luxon L. Source: The Journal of Nervous and Mental Disease. 2001 May; 189(5): 321-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11379977&dopt=Abstract

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Pediatric fibromyalgia and dizziness: evaluation of vestibular function. Author(s): Rusy LM, Harvey SA, Beste DJ. Source: Journal of Developmental and Behavioral Pediatrics : Jdbp. 1999 August; 20(4): 211-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10475594&dopt=Abstract

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Perception of unsteadiness in patients with dizziness: association with handicap and imbalance. Author(s): Lin SI, Tsai TT, Lee IH, Wu YN. Source: Journal of Biomedical Science. 2002 September-October; 9(5): 428-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12218358&dopt=Abstract

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Persistent dizziness. Author(s): Sivakumar R, Ghosh P, Khan SA. Source: Postgraduate Medical Journal. 2002 November; 78(925): 690, 692-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12496332&dopt=Abstract

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Postural hypotension and postural dizziness in patients with non-insulin-dependent diabetes. Author(s): Wu JS, Lu FH, Yang YC, Chang CJ. Source: Archives of Internal Medicine. 1999 June 28; 159(12): 1350-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10386511&dopt=Abstract

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Psychiatric dysfunction and dizziness. Author(s): Sudo K, Tashiro K. Source: Lancet. 1999 June 12; 353(9169): 2069. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10376640&dopt=Abstract

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Psychiatric dysfunction and dizziness. Author(s): Yardley L, Nazareth I, Luxon L. Source: Lancet. 1999 June 12; 353(9169): 2069. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10376639&dopt=Abstract

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Randomized controlled trial of vestibular rehabilitation combined with cognitivebehavioral therapy for dizziness in older people. Author(s): Johansson M, Akerlund D, Larsen HC, Andersson G. Source: Otolaryngology and Head and Neck Surgery. 2001 September; 125(3): 151-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11555746&dopt=Abstract

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Recurrent dizziness with abnormal findings on only one ENG test--the simultaneous binaural bithermal. Author(s): Brookler KH. Source: Ear, Nose, & Throat Journal. 2002 September; 81(9): 616-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12353435&dopt=Abstract

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Serotonin reuptake inhibitors for dizziness with psychiatric symptoms. Author(s): Staab JP, Ruckenstein MJ, Solomon D, Shepard NT. Source: Archives of Otolaryngology--Head & Neck Surgery. 2002 May; 128(5): 554-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12003587&dopt=Abstract

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Severe, disabling dizziness after intratympanic aminoglycoside treatment for dizziness. Author(s): Brookler KH. Source: Ear, Nose, & Throat Journal. 2001 March; 80(3): 141-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11269214&dopt=Abstract

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Short form of the Dizziness Handicap Inventory: construction and validation through Rasch analysis. Author(s): Tesio L, Alpini D, Cesarani A, Perucca L. Source: American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists. 1999 May-June; 78(3): 233-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10340421&dopt=Abstract

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Sinusoidal vertical-axis rotation test in a patient with a long history of dizziness. Author(s): Brookler KH. Source: Ear, Nose, & Throat Journal. 2001 November; 80(11): 786-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11816889&dopt=Abstract

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Sudden bilateral hearing loss and dizziness occurred with cerebellar infarction. Author(s): Sunose H, Toshima M, Mitani S, Suzuki M, Yoshida F, Takasaka T. Source: Otolaryngology and Head and Neck Surgery. 2000 January; 122(1): 146-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10629504&dopt=Abstract

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The activities-specific balance confidence scale and the dizziness handicap inventory: a comparison. Author(s): Whitney SL, Hudak MT, Marchetti GF. Source: Journal of Vestibular Research : Equilibrium & Orientation. 1999; 9(4): 253-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10472037&dopt=Abstract

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The Basic Symptom Inventory-53 and its use in the management of patients with psychogenic dizziness. Author(s): Ruckenstein MJ, Staab JP. Source: Otolaryngology and Head and Neck Surgery. 2001 November; 125(5): 533-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11700456&dopt=Abstract

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The prevalence of dizziness and its association with functional disability in a biracial community population. Author(s): Aggarwal NT, Bennett DA, Bienias JL, Mendes de Leon CF, Morris MC, Evans DA. Source: The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 2000 May; 55(5): M288-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10819319&dopt=Abstract

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Time-series analysis of the relationship between dizziness and stress. Author(s): Andersson G, Yardley L. Source: Scandinavian Journal of Psychology. 2000 March; 41(1): 49-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10731843&dopt=Abstract

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Tinnitus, dizziness, and nonotologic otalgia improvement through temporomandibular disorder therapy. Author(s): Wright EF, Syms CA 3rd, Bifano SL. Source: Military Medicine. 2000 October; 165(10): 733-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11050868&dopt=Abstract

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Treatment of dizziness by massotherapy and traditional Chinese drugs--a report of 110 cases. Author(s): Su Y. Source: J Tradit Chin Med. 2000 September; 20(3): 187-90. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11038980&dopt=Abstract

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Triage and differential diagnosis of patients with headaches, dizziness, low back pain, and rashes: a basic primer. Author(s): Zimmermann PG. Source: Journal of Emergency Nursing: Jen : Official Publication of the Emergency Department Nurses Association. 2002 June; 28(3): 209-15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12029312&dopt=Abstract

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Validation of dizziness as a possible geriatric syndrome. Author(s): Kao AC, Nanda A, Williams CS, Tinetti ME. Source: Journal of the American Geriatrics Society. 2001 January; 49(1): 72-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11207845&dopt=Abstract

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Vestibular rehabilitation therapy for the patient with dizziness and balance disorders. Author(s): Girardi M, Konrad HR. Source: Orl Head Neck Nurs. 1998 Fall; 16(4): 13-22. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10232262&dopt=Abstract

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Which comes first? Psychogenic dizziness versus otogenic anxiety. Author(s): Staab JP, Ruckenstein MJ. Source: The Laryngoscope. 2003 October; 113(10): 1714-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14520095&dopt=Abstract

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You're the flight surgeon. Occasional episodes of light-headedness, dizziness and nausea. Author(s): Ladner T. Source: Aviation, Space, and Environmental Medicine. 1999 July; 70(7): 718-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10417013&dopt=Abstract

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

Finding Nutrition Studies on Dizziness 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 “dizziness” (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.

52

Dizziness

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

206 cases of spinogenic dizziness treated by contralateral acupuncture. Author(s): Second Affiliated Hospital, Tianjin College of Traditional Chinese Medicine. Source: Cheng, B J-Tradit-Chin-Med. 1996 March; 16(1): 35-6 0254-6272

•

Cortical functional abnormality assessed by auditory-evoked magnetic fields and therapeutic approach in patients with chronic dizziness. Author(s): Department of Cerebrovascular Medicine, National Cardiovascular Center, 57-1 Fujishiro-dai, Suita, Osaka, Japan. [email protected] Source: Oe, H Kandori, A Murakami, M Miyashita, K Tsukada, K Naritomi, H BrainRes. 2002 December 13; 957(2): 373-81 0006-8993

•

Dizziness and panic in China: associated sensations of zang fu organ disequilibrium. Author(s): Department of Psychiatry, Massachusetts General Hospital, Boston 02114, USA. Source: Park, L Hinton, D Cult-Med-Psychiatry. 2002 June; 26(2): 225-57 0165-005X

•

Dizziness. Author(s): Department of Otolaryngology, University of Minnesota, Minnesota. Source: Paparella, M M Alleva, M Bequer, N G Prim-Care. 1990 June; 17(2): 299-308 0095-4543

•

Efficacy of antimigrainous therapy in the treatment of migraine-associated dizziness. Author(s): Department of Otolaryngology, Head and Neck Surgery, University of California, San Francisco, USA. Source: Bikhazi, P Jackson, C Ruckenstein, M J Am-J-Otol. 1997 May; 18(3): 350-4 01929763

•

Experience in acupuncture treatment of dizziness and vertigo--a report of 3 cases. Author(s): Xin'anmeng People's Hospital, Inner Mongonia 137400. Source: Xu, L J-Tradit-Chin-Med. 2002 March; 22(1): 18-20 0254-6272

•

Medical management of migraine-related dizziness and vertigo. Author(s): Department of Otolaryngology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA. Source: Johnson, G D Laryngoscope. 1998 January; 108(1 Pt 2): 1-28 0023-852X

•

Migraine-associated dizziness: patient characteristics and management options. Author(s): Department of Neurology, Washington University School of Medicine, Campus Box 8115, 660 S. Euclid Avenue, St. Louis, MO 63110, U.S.A. [email protected] Source: Reploeg, Mark D Goebel, Joel A Otol-Neurotol. 2002 May; 23(3): 364-71 15317129

•

Treatment of dizziness by massotherapy and traditional Chinese drugs--a report of 110 cases. Author(s): Wuxuan County Hospital of TCM, Guangxi Zhuang Autonomous Region. Source: Su, Y J-Tradit-Chin-Med. 2000 September; 20(3): 187-90 0254-6272

•

Vertigo. Author(s): Department of Neurology, Emory University, Atlanta, Georgia 30322, USA. [email protected] Source: Tusa, R J Neurol-Clin. 2001 February; 19(1): 23-55, v 0733-8619

Nutrition

53

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

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

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

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

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Dizziness

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

Vitamins Vitamin B Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10067,00.html Vitamin B6 Source: Healthnotes, Inc.; www.healthnotes.com

•

Minerals Azelastine Source: Healthnotes, Inc.; www.healthnotes.com Copper Source: Integrative Medicine Communications; www.drkoop.com Fluoxetine Source: Healthnotes, Inc.; www.healthnotes.com Gabapentin Source: Healthnotes, Inc.; www.healthnotes.com Magnesium Source: Integrative Medicine Communications; www.drkoop.com Paroxetine Source: Healthnotes, Inc.; www.healthnotes.com Vinpocetine Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10065,00.html Zinc Source: Integrative Medicine Communications; www.drkoop.com

•

Food and Diet Garlic Source: Prima Communications, Inc.www.personalhealthzone.com Low-Salt Diet Source: Healthnotes, Inc.; www.healthnotes.com

Nutrition

Wheat Source: Healthnotes, Inc.; www.healthnotes.com

55

57

CHAPTER 3. ALTERNATIVE MEDICINE AND DIZZINESS Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to dizziness. 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 dizziness 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 “dizziness” (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 dizziness: •

“Herbal Ecstasy”: a case series of adverse reactions. Author(s): Yates KM, O'Connor A, Horsley CA. Source: N Z Med J. 2000 July 28; 113(1114): 315-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10972312&dopt=Abstract

•

206 cases of spinogenic dizziness treated by contralateral acupuncture. Author(s): Cheng B. Source: J Tradit Chin Med. 1996 March; 16(1): 35-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8758707&dopt=Abstract

•

A combined approach for the treatment of cervical vertigo. Author(s): Bracher ES, Almeida CI, Almeida RR, Duprat AC, Bracher CB.

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Source: Journal of Manipulative and Physiological Therapeutics. 2000 February; 23(2): 96-100. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10714534&dopt=Abstract •

Abnormal auditory neural networks in patients with right hemispheric infarction, chronic dizziness, and moyamoya disease: a magnetoencephalogram study. Author(s): Kandori A, Oe H, Miyashita K, Date H, Yamada N, Naritomi H, Chiba Y, Miyashita T, Tsukada K. Source: Neuroscience Research. 2002 November; 44(3): 273-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12413656&dopt=Abstract

•

An experimental evaluation of the effects of transcutaneous nerve stimulation (TNS) and applied relaxation (AR) on hearing ability, tinnitus and dizziness in patients with Meniere's disease. Author(s): Scott B, Larsen HC, Lyttkens L, Melin L. Source: British Journal of Audiology. 1994 June; 28(3): 131-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7841897&dopt=Abstract

•

Behavioral treatment of dizziness secondary to benign positional vertigo following head trauma. Author(s): Shutty MS Jr, Dawdy L, McMahon M, Buckelew SP. Source: Archives of Physical Medicine and Rehabilitation. 1991 June; 72(7): 473-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1676257&dopt=Abstract

•

Cervicogenic dizziness: a review of diagnosis and treatment. Author(s): Wrisley DM, Sparto PJ, Whitney SL, Furman JM. Source: The Journal of Orthopaedic and Sports Physical Therapy. 2000 December; 30(12): 755-66. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11153554&dopt=Abstract

•

Changes in heart rate and respiration rate in patients with vestibular dysfunction following head movements which provoke dizziness. Author(s): Yardley L, Gresty M, Bronstein A, Beyts J. Source: Biological Psychology. 1998 September; 49(1-2): 95-108. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9792487&dopt=Abstract

•

Cortical functional abnormality assessed by auditory-evoked magnetic fields and therapeutic approach in patients with chronic dizziness. Author(s): Oe H, Kandori A, Murakami M, Miyashita K, Tsukada K, Naritomi H. Source: Brain Research. 2002 December 13; 957(2): 373-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12445982&dopt=Abstract

Alternative Medicine 59

•

Dizziness and panic in China: associated sensations of zang fu organ disequilibrium. Author(s): Park L, Hinton D. Source: Culture, Medicine and Psychiatry. 2002 June; 26(2): 225-57. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12211326&dopt=Abstract

•

Dizziness in primary care. Results from the National Ambulatory Medical Care Survey. Author(s): Sloane PD. Source: The Journal of Family Practice. 1989 July; 29(1): 33-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2738548&dopt=Abstract

•

Dizziness: state of the science. Author(s): Sloane PD, Coeytaux RR, Beck RS, Dallara J. Source: Annals of Internal Medicine. 2001 May 1; 134(9 Pt 2): 823-32. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11346317&dopt=Abstract

•

Effects of acupuncture, cervical manipulation and NSAID therapy on dizziness and impaired head repositioning of suspected cervical origin: a pilot study. Author(s): Heikkila H, Johansson M, Wenngren BI. Source: Manual Therapy. 2000 August; 5(3): 151-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11034885&dopt=Abstract

•

Evaluation of investigations to diagnose the cause of dizziness in elderly people: a community based controlled study. Author(s): Colledge NR, Barr-Hamilton RM, Lewis SJ, Sellar RJ, Wilson JA. Source: Bmj (Clinical Research Ed.). 1996 September 28; 313(7060): 788-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8842072&dopt=Abstract

•

Experience in acupuncture treatment of dizziness and vertigo--a report of 3 cases. Author(s): Xu L. Source: J Tradit Chin Med. 2002 March; 22(1): 18-20. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11977511&dopt=Abstract

•

Hyperventilation and dizziness: case reports and management. Author(s): Sama A, Meikle JC, Jones NS. Source: Br J Clin Pract. 1995 March-April; 49(2): 79-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7779649&dopt=Abstract

•

Magneto-encephalographic measurement of neural activity during period of vertigo induced by cold caloric stimulation. Author(s): Kandori A, Oe H, Miyashita K, Ohira S, Naritomi H, Chiba Y, Ogata K, Murakami M, Miyashita T, Tsukada K.

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Source: Neuroscience Research. 2003 July; 46(3): 281-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12804789&dopt=Abstract •

Medical management of migraine-related dizziness and vertigo. Author(s): Johnson GD. Source: The Laryngoscope. 1998 January; 108(1 Pt 2): 1-28. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9430502&dopt=Abstract

•

Outcome of an integrated approach to the investigation of dizziness, falls and syncope in elderly patients referred to a 'syncope' clinic. Author(s): McIntosh S, Da Costa D, Kenny RA. Source: Age and Ageing. 1993 January; 22(1): 53-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8438668&dopt=Abstract

•

Rotation: a valid premanipulative dizziness test? Does it predict safe manipulation? Author(s): Cote P. Source: Journal of Manipulative and Physiological Therapeutics. 1994 July-August; 17(6): 413-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7964204&dopt=Abstract

•

Rotation: a valid premanipulative dizziness test? Does it predict safe manipulation? Author(s): Refshauge KM. Source: Journal of Manipulative and Physiological Therapeutics. 1994 January; 17(1): 159. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7848394&dopt=Abstract

•

The problem of dizziness and syncope in old age: transient ischemic attacks versus hypersensitive carotid sinus reflex. Author(s): Uesu CT, Eisenman JI, Stemmer EA. Source: Journal of the American Geriatrics Society. 1976 March; 24(3): 126-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1249391&dopt=Abstract

•

Treatment of dizziness by massotherapy and traditional Chinese drugs--a report of 110 cases. Author(s): Su Y. Source: J Tradit Chin Med. 2000 September; 20(3): 187-90. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11038980&dopt=Abstract


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

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

•


•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

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

General Overview Alzheimer's Disease Source: Integrative Medicine Communications; www.drkoop.com Anxiety Source: Integrative Medicine Communications; www.drkoop.com Anxiety and Panic Attacks Source: Prima Communications, Inc.www.personalhealthzone.com Bronchitis Source: Integrative Medicine Communications; www.drkoop.com Burns Source: Integrative Medicine Communications; www.drkoop.com Cardiac Arrhythmia Source: Healthnotes, Inc.; www.healthnotes.com

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Dizziness

Cardiovascular Disease Overview Source: Healthnotes, Inc.; www.healthnotes.com Chronic Candidiasis Source: Healthnotes, Inc.; www.healthnotes.com Colorectal Cancer Source: Integrative Medicine Communications; www.drkoop.com Cough Source: Integrative Medicine Communications; www.drkoop.com Depression Source: Integrative Medicine Communications; www.drkoop.com Depression (mild to Moderate) Source: Prima Communications, Inc.www.personalhealthzone.com Fibromyalgia Source: Integrative Medicine Communications; www.drkoop.com Food Poisoning Source: Integrative Medicine Communications; www.drkoop.com Glaucoma Source: Integrative Medicine Communications; www.drkoop.com Heart Attack Source: Integrative Medicine Communications; www.drkoop.com Heat Exhaustion Source: Integrative Medicine Communications; www.drkoop.com Hemorrhoids Source: Integrative Medicine Communications; www.drkoop.com High Blood Pressure Source: Integrative Medicine Communications; www.drkoop.com High Cholesterol Source: Integrative Medicine Communications; www.drkoop.com High Cholesterol Source: Prima Communications, Inc.www.personalhealthzone.com Hypercholesterolemia Source: Integrative Medicine Communications; www.drkoop.com Hypertension Source: Healthnotes, Inc.; www.healthnotes.com


Hypertension Source: Integrative Medicine Communications; www.drkoop.com Hypoglycemia Source: Integrative Medicine Communications; www.drkoop.com Insect Bites and Stings Source: Integrative Medicine Communications; www.drkoop.com Insomnia Source: Healthnotes, Inc.; www.healthnotes.com Low Blood Sugar Source: Integrative Medicine Communications; www.drkoop.com Ménière's Disease Source: Healthnotes, Inc.; www.healthnotes.com Menopause Source: Integrative Medicine Communications; www.drkoop.com Miscarriage Source: Integrative Medicine Communications; www.drkoop.com Mitral Valve Prolapse Source: Healthnotes, Inc.; www.healthnotes.com Morning Sickness Source: Healthnotes, Inc.; www.healthnotes.com Motion Sickness Source: Healthnotes, Inc.; www.healthnotes.com Motion Sickness Source: Integrative Medicine Communications; www.drkoop.com Multiple Sclerosis Source: Healthnotes, Inc.; www.healthnotes.com Multiple Sclerosis Source: Integrative Medicine Communications; www.drkoop.com Myocardial Infarction Source: Integrative Medicine Communications; www.drkoop.com Nausea Source: Prima Communications, Inc.www.personalhealthzone.com Raynaud's Phenomenon Source: Integrative Medicine Communications; www.drkoop.com

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Spontaneous Abortion Source: Integrative Medicine Communications; www.drkoop.com Stroke Source: Healthnotes, Inc.; www.healthnotes.com Stroke Source: Integrative Medicine Communications; www.drkoop.com Systemic Lupus Erythematosus Source: Healthnotes, Inc.; www.healthnotes.com Temporomandibular Joint Dysfunction Source: Integrative Medicine Communications; www.drkoop.com Tias Source: Integrative Medicine Communications; www.drkoop.com Tinnitus Source: Healthnotes, Inc.; www.healthnotes.com Tmj Source: Integrative Medicine Communications; www.drkoop.com Transient Ischemic Attacks Source: Integrative Medicine Communications; www.drkoop.com Vertigo Source: Healthnotes, Inc.; www.healthnotes.com •

Alternative Therapy Chiropractic Source: Healthnotes, Inc.; www.healthnotes.com Craniosacral Therapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,685,00.html Fasting Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,694,00.html Homeopathy Source: Integrative Medicine Communications; www.drkoop.com Qigong Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,729,00.html


Tai Chi Source: Integrative Medicine Communications; www.drkoop.com Therapeutic Touch Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,739,00.html Yoga Source: Integrative Medicine Communications; www.drkoop.com •

Chinese Medicine Anshen Buxin Wan Alternative names: Anshen Buxin Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Baifuzi Alternative names: Giant Typhonium Rhizome; Rhizoma Typhonii Source: Chinese Materia Medica Baishao Alternative names: White Peony Root; Radix Paeoniae Alba Source: Chinese Materia Medica Baizhu Alternative names: Largehead Atractylodes Rhizome; Rhizoma Atractylodis Macrocephalae Source: Chinese Materia Medica Banxia Alternative names: Pinellia Tuber; Rhizoma Pinelliae Source: Chinese Materia Medica Biejia Alternative names: Turtle Shell; Carapax Trionycis Source: Chinese Materia Medica Biwen San Alternative names: Biwen Powder Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Chongweizi Alternative names: Motherwort Fruit; Fructus Leonuri Source: Chinese Materia Medica Chushizi Alternative names: Papermulberry Fruit; Fructus Broussonetiae Source: Chinese Materia Medica

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Cishi Alternative names: Magnetite; Magnetitum Source: Chinese Materia Medica Colla Corii Asini Alternative names: Donkey-hide Glue; %Colla Corii Asini%% Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Dahuang Qingwei Wan Alternative names: Dahuang Qingwei Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Daige San Alternative names: Daige Powder Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Danggui Alternative names: Chinese Angelica; Radix Angelicae Sinensis Source: Chinese Materia Medica Danggui Longhui Wan Alternative names: Danggui Longhui Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Dangshen Alternative names: Medicinal Changium Root; Mingdangshen; Radix Changii Source: Chinese Materia Medica Dihuang Alternative names: Digitalis Leaf; Yangdihuangye; Folium Digitalis Source: Chinese Materia Medica Erlong Zuoci Wan Alternative names: Erlong Zuoci Pills; Erlong Zuoci Wan (Er Long Zuo Ci Wan) Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Erzhi Wan Alternative names: Erzhi Pills; Erzhi Wan (Er Zhi Wan) Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Fabanxia Alternative names: Prepared Pinellia Tuber; Rhizoma Pinelliae Preparata Source: Chinese Materia Medica


Fuling Alternative names: Indian Bread; Poria Source: Chinese Materia Medica Fuzi Alternative names: Beivedere Fruit; Difuzi; Fructus Kochiae Source: Chinese Materia Medica Gengnian'an Pian Alternative names: Gengnian'an Tablets Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Gouguye Alternative names: Chinese Holly Leaf; Folium Ilicis Cornutae Source: Chinese Materia Medica Gouqizi Alternative names: Barbary Wolfberry Fruit; Fructus Lycii Source: Chinese Materia Medica Gouteng Alternative names: Gambir Plant; Ramulus Uncariae cum Uncis Source: Chinese Materia Medica Guijia Alternative names: Tortoise Shell; Carapax et Plastrum Testudinis Source: Chinese Materia Medica Guilu Bushen Wan Alternative names: Guilu Bushen Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Heizhima Alternative names: Black Sesame; Semen Sesami Nigrum Source: Chinese Materia Medica Heshi Alternative names: Wild Carrot Fruit; Nanheshi; Fructus Carotae Source: Chinese Materia Medica Heshouwu Alternative names: Fleeceflower Root; Radix Polygoni Multiflori Source: Chinese Materia Medica Hongling San Alternative names: Hongling Powder Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China

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Huaihua Alternative names: Pagodatree Flower; Flos Sophorae Source: Chinese Materia Medica Huoxiang Zhengqi Shui Alternative names: Huoxiang Zhengqi Solution Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Jiawei Xiaoyao Wan Alternative names: Jiawei Xiaoyao Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Jili Alternative names: Puncturevine Caltrop Fruit; Fructus Tribuli Source: Chinese Materia Medica Juemingzi Alternative names: Cassia Seed; Semen Cassiae Source: Chinese Materia Medica Juhua Alternative names: Chrysanthemum Flower; Flos Chrysanthemi Source: Chinese Materia Medica Lingyang Qingfei Wan Alternative names: Lingyang Qingfei Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Lingyangjiao Alternative names: Antelope Horn; Cornu Saigae Tataricae Source: Chinese Materia Medica Longdan Xiegan Wan Alternative names: Longdan Xiegan Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Luobumaye Alternative names: Dogbane Leaf; Folium Apocyni Veneti Source: Chinese Materia Medica Lurong Alternative names: Hairy Deer-horn (Hairy Antler); Cornu Cervi Pantotrichum Source: Chinese Materia Medica Maiwei Dihuang Wan Alternative names: Maiwei Dihuang Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China


Manjingzi Alternative names: Shrub Chastetree Fruit; Fructus Viticis Source: Chinese Materia Medica Mingdangshen Alternative names: Medicinal Changium Root; Radix Changii Source: Chinese Materia Medica Mohanlian Alternative names: Yerbadetajo Herb; Herba Ecliptae Source: Chinese Materia Medica Muli Alternative names: Oyster Shell; Concha Ostreae Source: Chinese Materia Medica Muxiang Alternative names: Slender Dutchmanspipe Root; Qingmuxiang; Radix Aristolochiae Source: Chinese Materia Medica Niuhuang Qingxin Wan Alternative names: Niuhuang Qingxin Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Niuxi Alternative names: Twotoothed Achyranthes Root; Radix Achyranthis Bidentatae Source: Chinese Materia Medica Nuzhenzi Alternative names: Glossy Privet Fruit; Fructus Ligustri Lucidi Source: Chinese Materia Medica Qiju Dihuang Wan Alternative names: Qiju Dihuang Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Qingmuxiang Alternative names: Slender Dutchmanspipe Root; Radix Aristolochiae Source: Chinese Materia Medica Qingnao Jiangya Pian Alternative names: Qingnao Jiangya Tablets Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China

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Qingning Wan Alternative names: Qingning Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Qingxiangzi Alternative names: Feather Cockscomb Seed; Semen Celosiae Source: Chinese Materia Medica Qingxuan Wan Alternative names: Qingxuan Pills Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Renshen Alternative names: Ginseng Leaf; Renshenye (Ren Shen Ye); Folium Ginseng Source: Chinese Materia Medica Renshenye Alternative names: Ginseng Leaf; Renshenye (Ren Shen Ye); Folium Ginseng Source: Chinese Materia Medica Rougui Alternative names: Cassia Bark; Cortex Cinnamomi Source: Chinese Materia Medica Sangshen Alternative names: Mulberry Fruit; Fructus Mori Source: Chinese Materia Medica Sangye Alternative names: Mulberry Leaf; Folium Mori Source: Chinese Materia Medica Shanzhuyu Alternative names: Asiatic Cornelian Cherry Fruit; Fructus Corni Source: Chinese Materia Medica Shayuanzi Alternative names: Flatstem Milkvetch Seed; Semen Astragali Complanati Source: Chinese Materia Medica Shenrong Guben Pian Alternative names: Shenrong Guben Tablets; Shenrong Guben Pian
(Shen Rong Gu Ben Pi An) Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Shijueming Alternative names: Sea-ear Shell; Concha Haliotidis Source: Chinese Materia Medica


Shiquan Dabu Wan Alternative names: Shiquan Dabu Pills; Shiquan Dabu Wan
(Shi Qu An Da Bu Wan) Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Shouwu Wan Alternative names: Shouwu Pills; Shouwu Wan
(Shou Wu Wan) Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Shudihuang Alternative names: Prepared Rehmannia Root; Radix Rehmanniae Preparata Source: Chinese Materia Medica Sizheng Wan Alternative names: Sizheng Pills; Sizheng Wan
(Si Zheng Wan) Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Suoyang Gujing Wan Alternative names: Suoyang Gujing Pills; Suoyang Gujing Wan
(Suo Yang Gu Jing Wan) Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Tianma Alternative names: Tall Gastrodia Tuber; Rhizoma Gastrodiae Source: Chinese Materia Medica Tiannanxing Alternative names: Jackinthepulpit Tuber; Rhizoma Arisaematis Source: Chinese Materia Medica Xiakucao Alternative names: Common Selfheal Fruit-Spike; Spica Prunellae Source: Chinese Materia Medica Yejuhua Alternative names: Wild Chrysanthemum Flower; Flos Chrysanthemi Indici Source: Chinese Materia Medica Zexie Alternative names: Oriental Waterplantain Rhizome; Rhizoma Alismatis Source: Chinese Materia Medica Zhenzhu Alternative names: Nacre; Zhenzhumu; Concha Margaritifera Usta Source: Chinese Materia Medica

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Zhenzhumu Alternative names: Nacre; Concha Margaritifera Usta Source: Chinese Materia Medica Zhiheshouwu Alternative names: Prepared FLeeceflower Root; Radix Polygoni Multiflori Preparata Source: Chinese Materia Medica •

Herbs and Supplements Allopurinol Source: Healthnotes, Inc.; www.healthnotes.com Aminoglycosides Source: Integrative Medicine Communications; www.drkoop.com Angkak Source: Integrative Medicine Communications; www.drkoop.com Anticonvulsants Source: Healthnotes, Inc.; www.healthnotes.com Arnica Alternative names: Arnica montana Source: Integrative Medicine Communications; www.drkoop.com Arnica Montana Source: Integrative Medicine Communications; www.drkoop.com Ava Source: Integrative Medicine Communications; www.drkoop.com Beni-koji Source: Integrative Medicine Communications; www.drkoop.com Bile Acid Sequestrants Source: Integrative Medicine Communications; www.drkoop.com Black Cohosh Alternative names: Cimicifuga racemosa Source: Healthnotes, Inc.; www.healthnotes.com Black Cohosh Alternative names: Cimicifuga racemosa (actea), Black Snakeroot Source: Integrative Medicine Communications; www.drkoop.com Black Cohosh Source: Prima Communications, Inc.www.personalhealthzone.com Black Cohosh Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com


Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10009,00.html Black Snakeroot Source: Integrative Medicine Communications; www.drkoop.com Brahmi Alternative names: Centella asiatica , Centella, March Pennywort, Indian Pennywort, Hydrocotyle, Brahmi (Sanskrit), Luei Gong Gen (Chinese)(Note: Gotu kola should not be confused with kola nut.) Source: Integrative Medicine Communications; www.drkoop.com Camellia Sinensis Source: Integrative Medicine Communications; www.drkoop.com Centella Source: Integrative Medicine Communications; www.drkoop.com Centella Asiatica Alternative names: Centella asiatica , Centella, March Pennywort, Indian Pennywort, Hydrocotyle, Brahmi (Sanskrit), Luei Gong Gen (Chinese)(Note: Gotu kola should not be confused with kola nut.) Source: Integrative Medicine Communications; www.drkoop.com Cimicifuga Racemosa (actea) Source: Integrative Medicine Communications; www.drkoop.com Corydalis Alternative names: Corydalis turtschaninovii, Corydalis yanhusuo Source: Healthnotes, Inc.; www.healthnotes.com Dimenhydrinate Source: Healthnotes, Inc.; www.healthnotes.com Ephedra (Ma Huang) Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,777,00.html Feverfew Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Ginger Alternative names: Zingiber officinale Source: Healthnotes, Inc.; www.healthnotes.com Ginger Alternative names: Zingiber officinale Source: Integrative Medicine Communications; www.drkoop.com

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Ginger Source: Prima Communications, Inc.www.personalhealthzone.com Ginger Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,787,00.html Ginkgo Source: Prima Communications, Inc.www.personalhealthzone.com Ginkgo Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Ginkgo Biloba Source: Healthnotes, Inc.; www.healthnotes.com Ginkgo Biloba Source: Integrative Medicine Communications; www.drkoop.com Ginkgo Biloba Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,788,00.html Ginseng Source: Prima Communications, Inc.www.personalhealthzone.com Gotu Kola Alternative names: Centella asiatica , Centella, March Pennywort, Indian Pennywort, Hydrocotyle, Brahmi (Sanskrit), Luei Gong Gen (Chinese)(Note: Gotu kola should not be confused with kola nut.) Source: Integrative Medicine Communications; www.drkoop.com Green Tea Alternative names: Camellia sinensis Source: Integrative Medicine Communications; www.drkoop.com Green Tea Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10032,00.html Hawthorn Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10035,00.html Histamine H2 Antagonists Source: Integrative Medicine Communications; www.drkoop.com


Hong Qu Source: Integrative Medicine Communications; www.drkoop.com Horse Chestnut Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10037,00.html Hung-chu Source: Integrative Medicine Communications; www.drkoop.com Huperzia Source: Healthnotes, Inc.; www.healthnotes.com Hydrocotyle Source: Integrative Medicine Communications; www.drkoop.com Hypericum Perforatum Source: Integrative Medicine Communications; www.drkoop.com Indian Pennywort Source: Integrative Medicine Communications; www.drkoop.com Indian Tobacco Source: Integrative Medicine Communications; www.drkoop.com Ipecac Alternative names: Cephaelis ipecacuanha Source: Healthnotes, Inc.; www.healthnotes.com Kava Source: Prima Communications, Inc.www.personalhealthzone.com Kava Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,798,00.html Kava Kava Alternative names: Piper methysticum, Ava Source: Integrative Medicine Communications; www.drkoop.com Klamathweed Source: Integrative Medicine Communications; www.drkoop.com Lobelia Alternative names: Lobelia inflata, Indian Tobacco Source: Integrative Medicine Communications; www.drkoop.com Lobelia Inflata Source: Integrative Medicine Communications; www.drkoop.com

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Maidenhair Tree Source: Integrative Medicine Communications; www.drkoop.com Marsh Pennywort Alternative names: Centella asiatica , Centella, March Pennywort, Indian Pennywort, Hydrocotyle, Brahmi (Sanskrit), Luei Gong Gen (Chinese)(Note: Gotu kola should not be confused with kola nut.) Source: Integrative Medicine Communications; www.drkoop.com Meclizine Source: Healthnotes, Inc.; www.healthnotes.com Mistletoe Alternative names: Viscum album Source: Healthnotes, Inc.; www.healthnotes.com Monascus Source: Integrative Medicine Communications; www.drkoop.com N-acetyl Cysteine Source: Healthnotes, Inc.; www.healthnotes.com Nonsteroidal Anti-inflammatory Drugs (nsaids) Source: Integrative Medicine Communications; www.drkoop.com Panax Alternative names: Ginseng; Panax ginseng Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Pennyroyal Alternative names: Hedeoma pulegoides, Mentha pulegium Source: Healthnotes, Inc.; www.healthnotes.com Phenobarbital Source: Healthnotes, Inc.; www.healthnotes.com Piper Methysticum Source: Integrative Medicine Communications; www.drkoop.com Red Koji Source: Integrative Medicine Communications; www.drkoop.com Red Leaven Source: Integrative Medicine Communications; www.drkoop.com Red Rice Source: Integrative Medicine Communications; www.drkoop.com Red Yeast Rice Alternative names: Monascus purpureus Source: Healthnotes, Inc.; www.healthnotes.com


Red Yeast Rice Alternative names: Angkak, Beni-koju, Hong Qu, Hung-chu, Monascus, Red Leaven, Red Rice, Red Koji, Zhitai, Xue Zhi Kang Source: Integrative Medicine Communications; www.drkoop.com Red Yeast Rice Source: Prima Communications, Inc.www.personalhealthzone.com Red Yeast Rice Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10054,00.html Reishi Alternative names: Ganoderma lucidum Source: Healthnotes, Inc.; www.healthnotes.com Salicylates Source: Integrative Medicine Communications; www.drkoop.com Salsalate Source: Healthnotes, Inc.; www.healthnotes.com Saw Palmetto Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,819,00.html Sertraline Source: Healthnotes, Inc.; www.healthnotes.com St. John's Wort Alternative names: Hypericum perforatum, Klamathweed Source: Integrative Medicine Communications; www.drkoop.com St. John's Wort Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,824,00.html Tanacetum V Alternative names: Tansy; Tanacetum vulgare (L.) Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Thyme Alternative names: Thymus vulgaris Source: Healthnotes, Inc.; www.healthnotes.com Uncaria Asian Alternative names: Asian species; Uncaria sp. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org

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Valerian Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10064,00.html Wormwood Alternative names: Artemisia absinthium Source: Healthnotes, Inc.; www.healthnotes.com Yohimbe Alternative names: Pausinystalia yohimbe Source: Healthnotes, Inc.; www.healthnotes.com Yohimbe Source: Prima Communications, Inc.www.personalhealthzone.com Zhitai Source: Integrative Medicine Communications; www.drkoop.com Zingiber Alternative names: Ginger; Zingiber officinale Roscoe Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Zingiber Officinale Source: Integrative Medicine Communications; www.drkoop.com Zue Zhi Kang Source: Integrative Medicine Communications; www.drkoop.com

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

79

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

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

The Reliability and Validity of the Vestibular Autorotation Test (vat) in a Clinical Sample of Subjects with Complaints of Dizziness by Blatt, Philip J.; PhD from University of Miami, 2003, 196 pages http://wwwlib.umi.com/dissertations/fullcit/3090846

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

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

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

Treatments for Postural Vertigo Condition(s): Vertigo Study Status: This study is completed. Sponsor(s): National Institute on Deafness and Other Communication Disorders (NIDCD) Purpose - Excerpt: The purpose of this study is to determine the relative short- and longterm efficacy of several physical treatment paradigms commonly employed for the treatment of benign paroxysmal positional vertigo (BPPV), including the Epley maneuver, the Semont maneuver, the Brandt-Daroff exercises and nonspecific vestibular habituation exercises. These procedures involve exercises and head manipulations. Vertigo intensity and frequency, the presence/absence of slow-phase eye movements, the degree of dizziness handicap and acts of daily living (ADL) shall be assessed. The study will also ascertain the effects of co-morbid conditions on the response to treatment. While BPPV is a common and significant public health problem that has been recognized for several decades, this is the first systematic study of the relative treatment efficacy of different physical treatment modalities for this disorder. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00000359

8

These are listed at www.ClinicalTrials.gov.

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

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

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•

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

•

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

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

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

9Adapted

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

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

Analgesic composition for treatment of migraine headaches Inventor(s): Mauskop; Alexander (17A Lafayette Rd., Larchmont, NY 10538) Assignee(s): none reported Patent Number: 5,538,959 Date filed: January 26, 1995 Abstract: A magnesium-containing analgesic composition used for treating migraine headaches and methods for using the same are described herein. The composition comprises an analgesic, a magnesium salt and an effervescing agent and is admixed with or dissolved in water prior to ingestion. The symptoms of migraine headache intended to be alleviated include nausea, unilateral pain, dizziness, pulsatile pain, worsening of pain by light physical activity, photophobia and phonophobia. Excerpt(s): This invention relates to magnesium-based compositions for treating migraine headaches, and methods for using the same. A deficiency of magnesium, i.e., hypomagnesemia, has been suggested to play a role in migraine headaches (B. A. Altura, Magnesium, 4:169 (1985); A. Mauskop et al., Cephalalgia, 14:241 (1994)). It had been shown that low serum ionized magnesium (IMg.sup.2+) levels were found in 42% of patients suffering migraine headaches (A. Mauskop et al., Headache, 33(3):135 (1993)). The magnesium salt of pyrrolidone carboxylic acid has been used to treat women with premenstrual migraine headache (F. Facchinetti et al., Headache, 31(5):298 (1991)). Amino-chelated magnesium compounds have been used to treat patients with classic migraine headache (K. Weaver in "Letter to the Editor," Headache, 30(2):168 (1990)). When some magnesium-based compositions are administered to patients having migraines, severe headaches or other painful conditions, the slowing of gastric motility which often accompanies these conditions delays the absorption of any medication taken orally. Such a delay in absorption is often more pronounced with tablet than with liquid medicaments. As a result, the onset of action associated with such compositions administered to migraine patients is undesirably delayed, resulting in the prolongation of pain and discomfort to the patient. Thus, there remains a need for compositions which can be used for treating migraine headaches and which are rapidly absorbed and provide rapid onset of action. Web site: http://www.delphion.com/details?pn=US05538959__

•

Anti-vertigo drug Inventor(s): Ishida; Ryuichi (Suita, JP), Kudo; Yukitsuka (Kyoto, JP) Assignee(s): Tanabe Seiyaku Co., Ltd. (Osaka, JP) Patent Number: 4,721,714 Date filed: June 26, 1986 Abstract: An anti-vertigo drug which comprises as an active ingredient 6-amino-2fluoromethyl-3-(o-tolyl)-4(3H)-quinazolinone (Afloqualone) or a pharmaceutically acceptable acid addition salt thereof, which is effective for the prophylaxis and treatment of vertigo and also such various symptoms accompanied with an abnormality in the reflex system of vestibulo-equilibrium sense as desesthesia of motion and

Patents 87

position, nystagmus, dysequilibrium, head deviation, nausea, vomiting, sweating, salivation and tachycardia. Excerpt(s): This invention relates to a new anti-vertigo drug containing as an active ingredient 6-amino-2-fluoromethyl-3-(o-tolyl)-4(3H)-quinozolinone or a pharmaceutically acceptable acid addition salt thereof. It is known that vertigo is an abnormality of integration mechanisms of information in the central nervous system resulting from rapid dysfunction of equilibrium nervous system occurring in a vestibular nervous system and it is accompanied with various symptoms such as desesthesia of motion and position, nystagmus, dysequilibrium, head deviation, nausea, vomiting, sweating, salivation and tachycardia. For the prophylaxis and treatment of the vertigo, there have been proposed various drugs, such as anticholinergic drugs, tranquiilizers, anti-histaminics, sedatives, vasodilators (e.g. cinnarizine, etc.), and antiemetics (e.g. diphenidol, etc.). Web site: http://www.delphion.com/details?pn=US04721714__ •

Apparatus for treatment of sensorineural hearing loss, vertigo, tinnitus and aural fullness Inventor(s): Burgert; Paul H. (611 W. Harvard, Glenwood Springs, CO 81601), Burke; Terry L. (404 Park Dr., Glenwood Springs, CO 81601), Goode; Richard L. (121 Giffen, Los Altos, CA 94022) Assignee(s): none reported Patent Number: 4,984,579 Date filed: July 21, 1989 Abstract: A portable apparatus for immediate self-treatment of sensorineural hearing loss, vertigo, tinnitus and aural fullness includes a probe for establishing a hermetic seal with the ear canal and a pump for establishing a positive or negative pressure in the ear canal via a hose connected to the probe. The portable apparatus further includes special controls accessible only to a physician or audiologist for establishing the maximum pump pressure and duration of operation optimal for the individual patient. The portable apparatus also includes controls accessible to the patient for initiating pump operation and varying the pump pressure and duration of operation within the limits established by the special controls. The apparatus includes its own independent power supply and may be conveniently carried anywhere by the patient so that it is with him at all times. Whenever the patient senses the onset of symptoms associated with sensorineural hearing loss, vertigo, tinnitus or aural fullness, he merely inserts the probe into the afflicted ear and, using the controls, activates the pump. Excerpt(s): The invention relates to a novel and improved method and apparatus for the treatment of symptoms such as dizziness, tinnitus, fluctuating hearing loss, aural fullness and visual fixation problems associated with endolympathic hydrops or Meniere's disease. Devices for studying afflictions associated with the ear are wellknown. Typically, such devices irrigate the ear with a hot or cold fluid. For example, U.S. Pat. No. 3,563,231 to B. A. Ducote discloses a device for irrigating the ear canal with hot or cold water in order to induce nystagmus. Irrigation of the ear with various hot or cold fluids for studying or evaluation purposes is disclosed in U.S. Pat. Nos. 4,023,561 (to Proctor et al.), 4,106,493 (to Proctor et al.), 4,023,561 (to G. H. Servos) and 3,000,271 (to Harvey et al.). Devices for treating or alleviating such afflictions by irrigating the ear

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with hot or cold fluids are disclosed in U.S. Pat. Nos. 4,325,386 and 4,466,438, both to Jay W. Katz. Such devices are disclosed as being portable for use by the patient. Web site: http://www.delphion.com/details?pn=US04984579__ •

Arrangement and method of simulating vertigo to train pilot overcoming vertigo Inventor(s): Feng; Genquan (P.O. Box 1796, New York, NY 10185-0016) Assignee(s): none reported Patent Number: 5,622,503 Date filed: June 28, 1993 Abstract: An enclosure having a horizon line, a scene, and lights is moved relative to a pilot to simulate vertigo during on-ground training of the pilot to overcome in-flight vertigo. Gravitational vertigo is simulated by a seat cushion inflatable to change the seated orientation of the pilot. Excerpt(s): This invention generally relates to an arrangement for and a method of simulating vertigo in on-ground training of pilots to overcome in-flight vertigo. Many pilots experience vertigo, i.e. the illusion of a false position in flight in the mind of the pilot. Since vertigo can lead to a flight emergency, the art has proposed screening pilots to test their likelihood of experiencing vertigo. Drugs to alleviate airsickness are also employed as temporary cures. Educating pilots in the nature and mechanism of vertigo is also useful, but, since experience is often the best teacher, training by actually simulating vertigo on the ground is the most effective technique. Vertigo can be simulated on the ground by electronic, chemical and thermal techniques. However, such invasive techniques are objectionable. In addition, it is known to strap a pilot in a rotary centrifuge where the pilot is rotated at high acceleration and speeds. However, this does not realistically simulate in-flight conditions. Some training simulators employ screens on which in-flight moving scenes are displayed, but experience has shown that this has not proven to be altogether satisfactory. Web site: http://www.delphion.com/details?pn=US05622503__

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Cockpit display system to reduce vertigo Inventor(s): Cohen; Edwin (Binghamton, NY), Maynard; Jack A. (Hallstead, PA) Assignee(s): The Singer Company (Binghamton, NY) Patent Number: 4,390,861 Date filed: March 11, 1981 Abstract: The disclosures gives a system for indicating visually to a pilot within his normal field of view, so that the pilot need not turn his head, both the identity of a knob or switch which the pilot's hand is touching and also the setting of that switch. The arrangement prevents spatial disorientation, or pilot's "vertigo", by informing the pilot the identity as well as the present setting of a switch located remotely in his cockpit, outside of his normal field of view, without the pilot having to turn his head to look at the switch. Excerpt(s): This invention, generally, relates to aircraft systems in which a pilot must function and, more particularly, to a new and improved system to provide information

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to a pilot under conditions that do not require the pilot to move his eyes from his normal field of vision. The problem relating to spatial disorientation in normal operational flight that are faced by a pilot are well recognized today. Many studies indicate that a pilot's "vertigo" is a significant factor in the cause of accidents and particularly so during flight training. During training, every possible effort is made today to eliminate spatial disorientation as a cause of attrition. A student pilot is indoctrinated very early in training regarding the psychological and physiological reactions experienced relative to orientation in space under varying flight conditions. Web site: http://www.delphion.com/details?pn=US04390861__ •

Composition and method for inhibiting the desire for tobacco Inventor(s): Ju; Wei (New York, NY), Robilotto; Frank J. (New York, NY), Westfried; Morris J. (Brooklyn, NY) Assignee(s): Herbs for Health, Inc. (New York, NY) Patent Number: 5,592,956 Date filed: July 3, 1995 Abstract: A mixture of oil of cloves, oil of wintergreen, monosodiumglutamate, extract of evodia fruit, and extract of Sichuan Lovage Rhizome is applied to certain specific acupuncture points on the human body. As a result of such application, the desire for tobacco is reduced or eliminated and, if use of tobacco is attempted, unpleasant reactions, such as nausea, headaches, dizziness, and vomiting, are experienced. Excerpt(s): The present Invention is directed to a composition and method which assists tobacco users in breaking the habit. While portions of this Specification may be expressly directed to smoking, it is to be understood that the method and composition set forth herein are applicable to other forms of tobacco use, such as chewing. As a result of various scientific studies, as well as official and semi-official pronouncements, the dangers of tobacco use have been brought home rather emphatically. As a result, many long-time tobacco users are trying to quit. Various psychological approaches have been tried, including mental therapy, hypnotism, etc. In spite of the foregoing, the percentage of failures and recidivism is relatively high. Therefore, there is a need for something which will reduce the craving for tobacco and assist smokers in ceasing their use thereof. It is, therefore, an object of the present Invention to provide a composition which, when introduced into the body, lessens or eliminates the desire for tobacco. It is a further object of the present Invention to provide a composition which, if the user does take a cigarette, will cause the taste of the smoke to be unpleasant and even, in extreme cases, cause nausea, headaches, dizziness, and vomiting. Web site: http://www.delphion.com/details?pn=US05592956__

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Computer based business model for a statistical method for the diagnosis and treatment of BPPV Inventor(s): Anthony; Philip F. (901 Hemphill, Fort Worth, TX 76104) Assignee(s): none reported Patent Number: 6,609,523 Date filed: October 24, 2000

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Abstract: A computational statistical determination is made as to whether a person suffers from benign paroxysmal positional vertigo (BPPV) based upon answers provided by a person to questions stored in a computer. The person answers questions about the characteristics of his or her vertigo, dizziness or imbalance symptoms. Based on proprietary information about the predictive value of each question, and the relationships between the questions, the person is given a statement of the chance of his or her having BPPV which would be responsive to a head maneuver designed to clear gravity sensitive crystals from a sensitive semicircular canal (SCC) area to a less sensitive area of the inner ear. Based on this determination, the person 1) is offered for sale an apparatus for further diagnosis and an apparatus to relieve his BPPV symptoms by self-treatment or 2) he may be told to go to a healthcare provider for treatment. For self-treatment, the 1) apparatus guides the person's head positioning to allow the diagnosis of which SCC is involved (if the user provided question answers do not specifically indicate the involved SCC), and 2) guide the person's head through a head maneuver to clear the gravity sensitive crystals from the position sensitive SCC to a less sensitive area of the inner ear. Excerpt(s): The invention relates to a business based model for the diagnosis of BPPV and the sale of devices for the diagnosis and treatment of BPPV. 90 million Americans (42% of the population) will experience vertigo some time in their life. Approximately three million people of the 250 million people in the US suffer some vertigo each year. Vertigo is the most common physician visit diagnosis in patients over 65 years of age. Seventeen percent of patients who have dizziness have benign paroxysmal positional vertigo (BPPV). According to Fife.sup.1, 91% of the BPPV patients were thought to have involvement of the posterior semicircular canal, 6% involvement of the horizontal canal (7.8% according to Takegoshi.sup.2), and 3% involvement of the superior (or anterior) semicircular canal. This application is directed to a new method for the diagnosis and treatment of posterior BPPV and the treatment of benign paroxysmal positional vertigo in the horizontal and superior semicircular canals. One ear is usually involved but reports of up to 15% of bilateral ear involvement have been made. Web site: http://www.delphion.com/details?pn=US06609523__ •

Electro-acupuncture method using an electrical stimulator Inventor(s): Grey; Thomas L. (Carlsbad, CA), Gruzdowich; Gregory J. (Carlsbad, CA) Assignee(s): Woodside Biomedical, Inc. (Carlsbad, CA) Patent Number: 6,272,383 Date filed: June 28, 1999 Abstract: A method of reducing nausea, dizziness, stomach pain and other symptoms in a patient utilizing a non-invasive nerve stimulation device applied over acupuncture points and nerves in the ankle or calf of the patient. Excerpt(s): This invention relates to moderation of nausea and electro-acupuncture. Bertolucci, Nausea Control Device, U.S. Pat. No. 4,981,146, Jan. 1, 1991, describes a nausea control device in the form of a watch-like housing attachable to the human wrist by an adjustable attachment band. The device uses non-invasive nerve stimulation whereby electricity is passed through two electrodes to stimulate nerves located on the inside of the wrist. The treatment provided by the device is sometimes referred to as electro-acupuncture, which is a form of acupuncture, and the ventral site of application is referred to in the acupuncture art as the P6 point, pericardium 6 point, or master point

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of the pericardium meridian (sometimes referred to as the vascular meridian). A primary object of the invention is to provide a non-chemical, non-invasive, painless and inexpensive method of alleviating nausea. It is also portable, self-contained and convenient to the patient. Electrical pulse repetition rate of approximately 70 pulses per second and a pulse width of 80 microseconds has been found to provide effective relief of nausea in a patient. Our currently preferred electrical pulse pattern comprises about 350 microsecond pulse width at about 31 pulses per second at power levels of about 1035 milli-amps peak pulse height. Thus a wide range of pulse patterns may be used in non-invasive nerve stimulation devices. The methods and devices described below use electro-acupuncture applied to acupuncture points on the calf and around the ankle to control nausea, stomach upset and similar conditions. A patient desiring to moderate his or her nausea places a pair of electrodes on the ankle, lower calf or upper calf, and applies electrical stimulation to the ankle through these electrodes. This has the effect of reducing nausea and stomach upset. The electrodes, pulse generating circuitry, and power supply are most conveniently packaged in a housing which is held to the ankle, lower calf or upper calf with a band. The device is placed so that the electrodes overlie an acupuncture point known to affect a desired therapy. Alternatively, the device is placed so that the electrodes overlie a nerve that runs under the acupuncture point, in which case the device may be placed on the leg some distance from the associated acupuncture point to provide a comfortable placement for the device. The technique accomplished by the device is referred to as electro-acupuncture or non-invasive nerve stimulation. Web site: http://www.delphion.com/details?pn=US06272383__ •

Method and composition for treatment of acne vulgaris Inventor(s): Skillern; Scott D. (722 E. Colfax St., South Bend, IN 46617) Assignee(s): none reported Patent Number: 4,443,442 Date filed: December 21, 1979 Excerpt(s): A method for the treatment of acne vulgaris as disclosed in U.S. Pat. No. 4,005,198, by the inventor herein which is herein incorporated by reference, is the bidaily oral administration of methyclothiazide, optionally with the daily concurrent administration of tetracycline. However, it has been observed that the oral ingestion of a therapeutically effective dosage of methylclothiazide or particularly other compounds such as polythiazide and trichlormethazide creates at least one of the unwanted side effects of diuresis, dizziness, nausea and clinical orthostatic hypotension in some patients. This invention relates to an improved method and composition for controlling all grades of acne vulgaris using a combination of sodium in the form of a pharmacologically acceptable sodium salt and an acne controlling compound selected from the group consisting of methyclothiazide, polythiazide and trichlormethazide, which is therapeutically effective in increasing sodium excretion in the sebaceous gland thereby controlling acne vulgaris eruptions. The conjoint use of the sodium salt and the acne controlling compound significantly reduces the unwanted side effects caused by the administration of the acne controlling compound including nausea, dizziness, hypotension and diuresis, which are experienced in some patients when the acne controlling compound is employed in acne treatment absent the conjoint of the sodium salt. In a preferred embodiment the acne controlling compound and the sodium salt are

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employed in an acne treatment therapy which includes the use of a therapeutic acne vulgaris affecting amount of an antibiotic effective against acne vulgaris. Web site: http://www.delphion.com/details?pn=US04443442__ •

Method of treating benign positional vertigo Inventor(s): Derakhshan; Iraj (Charleston, WV) Assignee(s): Mimicking Man Manually, Inc. (Charleston, WV) Patent Number: 6,333,352 Date filed: April 5, 2000 Abstract: A process and product for treating benign positional vertigo with antiepileptic drugs such as divalproex sodium or gabapentin. Excerpt(s): This invention relates to the field of treating vertigo, especially benign positional vertigo. Benign positional vertigo (BPV) is the most common cause of pathological vertigo. The cause of about half of the cases of BPV is unknown, particularly in the elderly, while the remaining cases are linked to causes such as head injury, vascular occlusion and viral labyrinthitis. Patients suffering from BPV develop brief episodes of vertigo. This particularly occurs while the patient is changing position in such tasks as bending over and standing up, extending the neck to acquire a more elevated view, getting in and out of bed, and turning over in bed. In most patients the symptoms spontaneously remit, but recurrence is frequent. A possible cause of BPV is thought to be free-floating calcium carbonate crystals, normally attached to the utricular macule, which accidently enter the long arm of the posterior semicircular canal. One therapy for alleviating the symptoms of BPV has been a bedside positioning maneuver used to remove the debris from the posterior canal on the affected side. This manipulation of the head; however, does not cure all symptoms and requires the patient to visit the office of a medical practitioner capable of performing such a manipulation. BPV has also be treated with the administration of meclazine; however, few patients respond to meclazine. Web site: http://www.delphion.com/details?pn=US06333352__

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Method to prevent and treat the signs and symptoms of motion sickness Inventor(s): Heinrich; William A. (565 Ashland Rd., Middlesex, NJ 08846) Assignee(s): none reported Patent Number: 4,777,170 Date filed: February 3, 1987 Abstract: Motion sickness is a disorder thought to be caused by the excessive stimulation of the vestibular apparatus caused by angular and linear acceleration and deceleration sometimes resulting in nausea and vomiting. Characteristic signs and symptoms of the condition in addition to nausea and vomiting include yawning, hyperventilation, salivation, pallor, profuse cold sweating, somnolence, aerophagia, dizziness, headache, general discomfort, fatigue, weakness, and inability to concentrate. When prolonged motion sickness is accompanied by vomiting, hypotension, dehydration, inanition and depression may occur. The present invention includes

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methods for prevention of motion sickness as well as methods for the treatment of the signs and symptoms of motion sickness after their onset. Excerpt(s): The present invention relates to the prevention of motion sickness and to the treatment of the signs and symptoms of motion sickness in warm-blooded animals and particularly in humans. The condition known as motion sickness has commonly been thought to caused chiefly by sea, air, car, train, and space travel as well as carnival-type amusements, and other types of motion. A variety of drugs have been used to prevent and treat motion sickness: specifically these include phenothiazines (i.e., chlorpromazine, perphenazine, prochlorperazine, promethazine, triethylperazine, triflupromazine), antihistamines (i.e., cyclizine, dimenhydrinate, diphenhydramine, meclizine, hydroxyzine, buclizine), anticholinergics (i.e., scopolamine), sedatives (i.e., phenobarbital, pentobarbital), benzodiazepines (i.e., diazepam), benzquinamide, diphenidol, trimethobenzamide, bismuth subsalicylate, fructose and glucose. A combination of two agents for the prevention of or the treatment of the signs and symptoms of motion sickness in warm-blooded animals and particularly in humans, the agents being of the phenothiazine family such as promethazine hydrochloride and of the sympathiminetics family such as pseudoephedrine hydrochloride in addition with any suitable agents such as, but not limited to, tablets, capsules, liquids, suppositories, injections, transdermal patches, ophthalmic preparations, solutions, ointments, creams and gels. Web site: http://www.delphion.com/details?pn=US04777170__ •

Methods and apparatus for alerting and/or repelling birds and other animals Inventor(s): Lenhardt; Martin L. (Hayes, VA), Ochs; Alfred L. (Richmond, VA) Assignee(s): Virginia Commonwealth University (Richmond, VA) Patent Number: 6,250,255 Date filed: August 6, 1999 Abstract: An external stimuli is provided that alerts animals to danger and/or repels the animals from certain areas. More specifically, the system and method of the present invention uses an external stimuli, such as, for example, pulsing microwaves, vibration or supersonic sound waves, in order to alert birds or other animals of danger and/or repel these same birds or animals from specific areas. These produced external stimuli may provide a reversible unpleasant sensation to the birds and other animals so that they will not only be repelled from a specific area, such as an airport, but also will avoid returning to such area. One such unpleasant sensation that is virtually harmless to the birds and other animals is the sensation of dizziness. Excerpt(s): The present invention generally relates to systems and methods of alerting and/or repelling birds and other animals and, more particularly, to systems and methods of alerting and/or repelling birds and other animals by use of an external stimuli which provides a reversible unpleasant sensation such that the birds and other animals will be alerted of danger and/or repelled from a desired area. It is well known that flying birds can represent hazards to aircraft, power lines, wind turbines, glass windows in tall buildings, and other objects which birds (or bats) might inadvertently strike during flight. By way of one example, it is well documented that birds roosting or feeding next to airport runways represent a hazard not only to themselves but also to the aircraft that are utilizing the airport. Being more specific, the birds are often startled by approaching aircraft and thus have a tendency to take to flight. In some instances,

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when the birds take to flight they may fly within the flight path of the aircraft and be sucked into a jet turbine with disastrous results. In further instances, the birds that have already taken to flight may be startled by the sound of an approaching aircraft traveling upwind, and in an attempt to escape may again be sucked into a jet turbine. It is also well documented that in remote airports, aircraft have been known to collide with other animals that are grazing on or near the runways. These animals range from almost any possible vertebrate species, such as deer, cow, alligators, etc. As can be imagined, colliding with such large animals as deer or cow can cause tremendous damage to the aircraft, which may also include the loss of human life. Web site: http://www.delphion.com/details?pn=US06250255__ •

Novel controlled release formulations of tetracycline compounds Inventor(s): Biehl; Raymond J. (Monsey, NY), Doelling; Michael K. (New City, NY), Sheth; Nitin V. (Middletown, NY), Strathy; Walter A. (Pearl River, NY), Valorose, Jr.; Joseph J. (Montgomery, NY) Assignee(s): American Cyanamid Company (Stamford, CT) Patent Number: 4,837,030 Date filed: October 6, 1987 Abstract: Pharmaceutical compositions comprising spherical granules including thereon or therein a 7- or 9-akylamino-6-deoxy-6-demethyltetracycline or an acid-addition salt thereof blended with at least one excipient are adapted to control the rate of drug release in the stomach and in the intenstine in order not to produce nausea or dizziness upon oral administration during antibacterial therapy. Excerpt(s): This invention is concerned with a pharmaceutical dosage form for the controlled release of antibacterial agents comprising tetracycline compounds. More specifically, it is concerned with spheres comprising a tetracycline compound blended with an excipient, the spheres being adapted to control the rate of release of the tetracycline in the human stomach and human intesting upon oral administration. When the spheres are filled into capsules or compressed into tablets, and the like, there are provided controlled release dosage forms of tetracycline compounds which do not produce the nausea or dizziness normally associated with other dosage forms. Tetracycline compounds are widely used in therapy primarily for their antimicrobial effect. A preferred family of such agents comprises the 7- or 9-alkylamino-6-deoxy-6demethyltetracyclines, including the non-toxic acid-addition salts thereof. Commonly assigned Boothe et al, U.S. Pat. No. 3,148,212, and Petisi et al, U.S. Pat. No. 3,226,436, describe the preparation of this family of tetracycline compounds. Although they have achieved widespread use in oral dosage forms, particularly 7-dimethylamino-6-deoxy-6demethyltetracycline hydrochloride, also known as minocycline hydrochloride, they have one drawback, and that is a tendency to cause CNS and gastrointestinal side effects including lightheadedness, dizziness, vertigo, nausea, vomiting and diarrhea. People on oral therapy with these drugs must, as a result, be cautioned about driving vehicles or using hazardous machinery, and also lowered patient compliance in continuing to take the drug naturally occurs. In Bechgaard, U.S. Pat. No. 4,606,909, the placement of a sparingly soluble active substance, such as tetracycline, in an oral controlled relese dosage form is disclosed. The spraingly soluble active substance must be used with a dispersion-enhancing substance, such as an anionic detergent to promote solubility in intestinal fluids. The composition is formed into small spheres and enteric coated to eliminate any release of drug in the stomach. The coated spheres are tabletted or loaded

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into capsules. There is no teaching that such a dosage form can be used to avoid dizziness and/or nausea associated with tetracycline therapy. Moveover the requirement to use a dispersion-enhancing substance, especially an anionic detergent, is a negative factor. Web site: http://www.delphion.com/details?pn=US04837030__ •

Optical viewing system for viewing 3-D images Inventor(s): Lawrence; John (2525 Verbena Dr., Los Angeles, CA 90068), Lukens; Linda S. (2525 Verbena Dr., Los Angeles, CA 90068) Assignee(s): none reported Patent Number: 5,559,632 Date filed: September 7, 1993 Abstract: Improved methods for 3-D motion picture, video or video game images with a one camera system. When a scene is photographed using this system to create 3-D, the scene must be lit so that the midground light intensity is approximately 50% greater than the intensity on the foreground and the background light intensity is approximately double that of the foreground with some subjects in the scene being backlit as well. The scene is photographed by a movable video or motion picture camera moving about the scene at a constant angular velocity in the range of 25-60 degrees per second. Additional cameras photograph the scene from fixed locations spaced approximately 120 degrees apart about the scene. When editing the 3-D film or video tape a method is used to alleviate dizziness by inserting approximately 5-40 seconds of the flat shots from said fixed locations between segments of 3-25 seconds of film or video shot by said moving camera and providing viewing glasses having lenses, one of metallized (mirrored) plastic film creating a silvered effect, void of spectral peaks and of color absorption across all wavelengths, and which gives the lens a neutral density in the range of 0.5 to 2.0; and one lens formed of clear film which provides 100% light transmission when viewing through it. Excerpt(s): It has long been known that human beings can have depth perception due to the fact that human eyes are spaced several inches apart and, hence, provide the brain with two separate, but similar images, which the brain combines and interprets as threedimensional. Attempts to reproduce this effect photographically have required the use of multiple cameras or cameras having a pair of spaced lenses. This has been relatively successful for still photography, as evidenced by the popularity of stereoscopic viewing devices, especially during the early part of this century. However, similar success has not been achieved heretofore for motion pictures using stereoscopic 3-D. There was a time, in the 1950's, when stereoscopic motion pictures were popular. Classics like "The House of Wax" (1953) "The Creature from the Black Lagoon" (1954), and others were produced with the two camera stereoscopic process. Some of these movies did well, but 3-D in general became impractical due to the excessive costs of stereoscopic movies over standard 2-D motion pictures. Since stereoscopic movies had to be photographed with the stereoscopic two camera system, the cost of film stock and processing was doubled. Also, other exorbitant expenses, such as special polarized motion picture screens, had to be built for each movie house. These costs became so prohibitive that film makers found it safer, easier and more profitable to produce 2-D movies. Thus, by the late 1950's, they stopped making stereoscopic movie: and, once again, the picture industry turned its full attention to standard 2-D films. The early 1970's saw a resurgence of stereoscopic 3-D. It spawned such features as "The Stewardess's" (1970), Andy Warhol's "Frankenstein in 3-

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D" (1974) and "Dracula in 3-D" (1975), as well as several others, but the interest, again, could not support the costs. Stereoscopic 3-D resurfaced, again, in 1982 with the very successful "Jaws 3-D" and "Metal Storm", but their cycle of success was short lived, again, because of the high prices that plagued the film producers of the '50's. Web site: http://www.delphion.com/details?pn=US05559632__ •

Process for the preparation of 1-aminomethyl-1-cyclohexaneacetic acid Inventor(s): Geibel; Wolfram (Hunfeld, DE), Hartenstein; Johannes (Stegen-Wittental, DE), Herrmann; Wolfgang (Merzhausen, DE), Witzke; Joachim (Nimburg, DE) Assignee(s): Godecke Aktiengesellschaft (Berlin, DE) Patent Number: 5,091,567 Date filed: August 21, 1990 Abstract: The instant invention concerns a novel process for the preparation of 1aminomethyl-1-cyclohexaneacetic acid (gabapentin), a known compound useful for treating certain cerebral diseases such as epilepsy and dizziness. Excerpt(s): Examples of the syntheses end in an isocyanate or urethane that can be converted into the desired (1-aminomethyl)-1-cyclohexaneacetic acid by acidic hydrolysis to give an acid or basic hydrolysis to give a basic salt or followed by acidification to give an acid salt. Gabapentin is a medicament described in Germany Patents 24 60 891 and 25 43 821 for the therapy of certain cerebral diseases, for example epilepsy and cases of dizziness. Various processes are known for the preparation of gabapentin and related compounds. For example, gabapentin can be prepared by converting 1,1-cyclohexanediacetic acid, via a reactive acid derivative, into the azide which is subsequently subjected by thermal decomposition to a Curtius reaction. Web site: http://www.delphion.com/details?pn=US05091567__

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Therapeutic use and formulation Inventor(s): Huckle; Richard Michael (Cambridge, GB) Assignee(s): Darwin Discovery, Ltd. (GB) Patent Number: 6,297,286 Date filed: November 8, 2000 Abstract: Substantially single-enantiomer(-)-tramadol, and its metabolites and structural and/or functional analogues, are useful for the prevention and/or treatment of one or more symptoms selected from nausea, vomiting, dizziness, blurred vision, drowsiness, somnolence, hallucinations, respiratory depression, constipation and euphoria. In particular, substantially single enantiomer (-)-tramadol, and its o-desmethyl metabolite, have been found to be potent anti-emetics. Excerpt(s): This invention relates to new therapeutic uses of tramadol and its structural and/or functional analogues, and to new formulations thereof. Tramadol has the chemical name (+/-)-trans (RR,SS)-2-[(di-methylamino)methyl]-1-(3-methoxyphenyl) cyclohexanol, and which is generally, and erroneously, referred to in literature as the cis(RS,SR) diastereomer, is a centrally acting, binary analgesic that is neither opiatederived, nor is a non-steroidal, anti-inflammatory drug (NSAID). It is used to control

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moderate pain in chronic pain settings, such as osteoarthritis and postoperative cases, and acute pain, such as dental pain. Used in therapy as a racemic mixture, the (+)enantiomer binds to the.mu.-opioid receptor, and both enantiomers inhibit 5hydroxytryptamine (serotonin) and noradrenaline (norepinephrine) reuptake. Tramadol's major active metabolite, O-desmethyltramadol (M1), shows higher affinity for the.mu.-opioid receptor and has at least twice the analgesic potency of the parent drug. Web site: http://www.delphion.com/details?pn=US06297286__ •

Timed release tablet comprising naproxen and pseudoephedrine Inventor(s): Platt; Chris E. (14352 Riviera Dr., Huntington Beach, CA 92647) Assignee(s): none reported Patent Number: 5,998,478 Date filed: December 17, 1998 Abstract: Disclosed herein is a pharmaceutical composition comprising naproxen and the decongestant pseudoephedrine in a time release tablet form in the therapy of sinusitis, or sinus headaches, generally exemplified by discomfort, pain, pressure, and dizziness. Excerpt(s): The present invention relates generally to novel pharmaceutical compositions of matter comprising the non-steroidal anti-inflammatory analgesic naproxen in combination with the decongestant pseudoephedrine and appropriate nontoxic carriers and to methods of using said compositions in the therapy or cure of sinusitis, or sinus headaches, generally exemplified by discomfort, pain, pressure, and dizziness. Non-narcotic analgesics, commonly known as non-steroidal antiinflammatory drugs, such as naproxen, are widely administered orally in the treatment of mild to severe pain. These drugs have been disclosed as useful in treating cough/cold symptoms in combination with certain antihistamines and decongestants. See, for example U.S. Pat. No. 4,552,899 to Sunshine. Naproxen as non-steroidal antiinflammatory pain reliever has greater advantage than other pain relievers acetaminophen, aspirin, and ibuprofen. Naproxen has a significantly greater duration or half-life that leads to twice a day dosage. It is generally accepted that decreased dosing leads to patient convenience and better compliance. Web site: http://www.delphion.com/details?pn=US05998478__

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Triple drug therapy for the treatment of narcotic and alcohol withdrawal symptoms Inventor(s): Ockert; David M. (145 E. 32nd St., Sixth Floor, New York, NY 10016) Assignee(s): none reported Patent Number: 6,503,950 Date filed: August 8, 2000 Abstract: A triple drug, pharmaceutical kit, composition, and method of treatment containing a combination of effective amounts of at least one anxiolytic agent, at least one centrally acting alpha antiadrenergic agent, and at least one central nervous system stimulant for the reduction or prevention of alcohol and narcotic withdrawal side effects of dizziness, drowsiness, depression, lethargy, orthostatic hypotension, weakness in the

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extremities, and difficulty in being mobile, caused by therapeutic agents utilized for the treatment of alcohol or narcotic withdrawal symptoms in patients overcoming alcohol or narcotic addiction. Excerpt(s): The present invention relates to the treatment of alcohol and narcotic withdrawal symptoms associated with alcohol and narcotic addiction. Alcohol and narcotic withdrawal symptoms associated with patient populations undergoing drug abuse treatment has become an important concern to those patients and their families as well as treating health care personnel. Due to alcohol and narcotic abuse, use, and the high rate of relapse to regular use, the management of withdrawal side effects is becoming increasingly important for the long-term rehabilitation of patients overcoming drug abuse addiction. Current treatment modalities for drug abuse can create or potentiate side effects from those medications used to treat alcohol or narcotic withdrawal. Frequently encountered side effects include depression, dizziness, orthostatic hypotension, drowsiness, lethargy, difficulty in being mobile, and weakness in the extremities. Such negative side effects prolong patient therapy or interfere with detoxification procedures, which leads to further use, abuse, and relapses to regular use, requiring subsequent detoxification. treatment episodes. The prior art teaches the use of benzodiazepines separately for the treatment of anxiety caused by a variety of conditions, including withdrawal. For example, the drug monograph for benzodiazepines listed within the Drug Facts and Comparisons, 1999 ed., Wolters Kulwar Co. 1998, p. 1600-03, indicates that such agents, through interaction with gamma-aminobutyrate (GABA) and BZ.sub.1 and BZ.sub.2 receptors in the human body, create a calming effect and subsequent reduction or prevention of anxiety. The prior art also teaches the use of azaspirodecanediones, such as buspirone, as an anxiolytic agent, because of their calming effect caused by interaction with 5-HT.sub.1 A and GABA receptors in the human body. Id. Finally, the prior art also teaches the use of piperazine derivatives, such as hydroxyzine, to create a calming effect in the human body through interaction with spasmogenic receptors for serotonin, acetylcholine and histamine. Id. at 1604-07. Yet, all these anxiolytic agents, due to their drug chemistry, cause the side effects of drowsiness, depression, lethargy, and difficulty in being mobile in patients undergoing drug abuse treatment. Such negative side effects frequently increase the need to treat such patients in an in-patient only setting to prevent the risk of injury. Web site: http://www.delphion.com/details?pn=US06503950__

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

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

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Antiemetic, anti-motion sustained release drug delivery system Inventor(s): Drizen, Alan; (Downsview, CA), Nath, Gary M.; (Bethesda, MD) Correspondence: Nath & Associates Pllc; 6th Floor; 1030th 15th Street, N.W.; Washington; DC; 20005; US Patent Application Number: 20020172712 Date filed: March 19, 2001 Abstract: This invention relates to a stable, sterilized, purified composition having a polymer matrix and a therapeutically effective amount of a drug, wherein the drug can be used to prevent or treat drug-induced, alcohol-induced, biologically-induced, trauma-induced or pain-induced nausea, vomiting, dizziness and other adverse effects arising from but not limited to motion sickness, cancer therapy, and pregnancy. In particular, the polymer matrix may be conformable to topical application on animal skin. Excerpt(s): This invention relates to a dermal dressing for conformable topical application and sustained release of a polymer matrix containing a drug or combinations of drugs to animal skin. The drug can be any pharmaceutically effective amount useful for preventing and treating nausea, vomiting, dizziness and other adverse effects arising from but not limited to motion sickness, cancer therapy, and pregnancy in an animal. Over the years, methods have been developed to achieve the efficient delivery of a therapeutic drug to a mammalian body part requiring pharmaceutical treatment. Intravenous delivery and oral ingestion are two examples of current delivery techniques. While these techniques are generally effective, they suffer from several pharmacokinetic limitations and often result in substantial non-compliance by patients. For example, the therapeutic benefit from conventional methods often wear off within several hours after the initial dosing while the pain and discomfort associated with injections and intravenous lines often lead to difficulties in administration and maintenance of intravenous lines. Even oral administration can be ineffective where a patient cannot ingest due to nausea and/or vomiting. Topical administration of a pharmaceutically effective agent may avoid the problems associated with known drug delivery methods. One known method of topical administration uses an aqueous liquid that is applied at room temperature but forms a semi-solid gel when warmed to body temperature. This technique has the reported benefit of being easier to use and improving drug retention at the treatment site. For example, U.S. Pat. No. 4,188,373 uses PLURONIC.RTM. polyols in aqueous compositions to thermally gel aqueous systems. A sol-gel transition temperature is adjusted by varying the concentration of the polyols. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Compositions and methods for enhancing analgesic potency of tramadol and attenuating its adverse side effects Inventor(s): Barbier, Remi; (San Francisco, CA), Crain, Stanley M.; (State College, PA), Friedmann, Nadav; (Lafayette, CA), Remien, Mary; (San Francisco, CA), Shen, Ke-Fei; (Flushing, NY), Sherman, Barry; (Hillsborough, CA) Correspondence: Mcandrews Held & Malloy, Ltd; 500 West Madison Street; Suite 3400; Chicago; IL; 60661 Patent Application Number: 20030148941 Date filed: March 12, 2002

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Abstract: The invention generally relates to compositions and methods with tramadol and an opioid antagonist to enhance analgesic potency and/or attenuate one or more adverse effects of tramadol, including adverse side effect(s) in humans such as nausea, vomiting, dizziness, headache, sedation (somnolence) or pruritis. This invention relates to compositions and methods for selectively enhancing the analgesic potency of tramadol and simultaneously attenuating anti-analgesia, hyperalgesia, hyperexcitability, physical dependence and/or tolerance effects associated with the administration of tramadol. The methods of the present invention comprise administering to a subject an analgesic or subanalgesic amount of tramadol and an amount of excitatory opioid receptor antagonist such as naltrexone or nalmefene effective to enhance the analgesic potency of tramadol and attenuate the anti-analgesia, hyperalgesia, hyperexcitability, physical dependence and/or tolerance effects of tramadol. Excerpt(s): This is a continuation-in-part of co-pending application Ser. No. 09/306,164 filed May 6, 1999, the content of which is hereby incorporated by reference in its entirety. Morphine or other bimodally-acting opioid agonists are administered to relieve severe pain due to the fact that they have analgesic effects mediated by their activation of inhibitory opioid receptors on nociceptive neurons (see North, Trends Neurosci., Vol. 9, pp. 114-117 (1986) and Crain and Shen, Trends Pharmacol. Sci., Vol. 11, pp. 77-81 (1990)). However, morphine and other bimodally-acting opioid agonists also activate opioid excitatory receptors on nociceptive neurons, which attenuate the analgesic potency of the opioids and result in the development of physical dependence and increased tolerance (see Shen and Crain, Brain Res., Vol. 597, pp. 74-83 (1992)), as well as hyperexcitability, hyperalgesia and other undesirable (excitatory) side effects. As a result, a long-standing need has existed to develop a method of both enhancing the analgesic (inhibitory) effects of bimodally-acting opioid agonists and blocking or preventing undesirable (excitatory) side effects caused by such opioid agonists. Tramadol is an orally active, clinically effective, centrally acting analgene compound with opioid and non-opioid activity. This synthetic analgesic has a novel mechanism of action involving a complementary and synergistic interaction between inhibition of neuronal monamine uptake and weak affinity for opioid receptors (Raffa et al., Rev. Contemp. Pharmacother. 6:485-497 (1995)). Tramadol is generally well tolerated, with dizziness, nausea, constipation, headache, somnolence (sedation), vomiting, pruritis, CNS stimulation, sezures, asthenia, dyspepsia, diarrhea, dry mouth and/or sweating as adverse side effects. Respiratory depression is uncommon (Lee et al., Drugs 46: 313-340 (1993); Vickers et al., Anaesthesia 47: 291-296 (1992)). Tramadol is marketed in the United States as ULTRAM.RTM. Data from a double-blind, crossover study suggest that oral tramadol 120 mg is equipotent to oral morphine 30 mg (Wilder et al., Ann. Oncol. 5: 141-146 (1994)). A need thus exists for compositions and methods that could enhance the analgesic potency of tramadol and/or block or prevent its adverse side effects, particularly its principal adverse effects in humans. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Galenical preparations of dapsone and related sulphones, and method of therapeutic and preventative treatment of disease Inventor(s): Aberg, A K Gunnar; (Sarasota, FL), Bain, Allen I; (Vancouver, CA), Zolotoy, Alexander; (Richmond, CA) Correspondence: Kevin S Lemack; Neilds & Lemack; 176 E Main Street; Westboro; MA; 01581; US Patent Application Number: 20030092635 Date filed: August 26, 2002 Abstract: Dapsone and related sulfones are known to have therapeutic activity against leprosy, dermatitis herpetiformis, actinomycotic mycetoma, asthma, malaria, rheumatoid arthritis, Kaposis sarcoma, pneumocystis carini (pneumonia), subcorneal pustular dermatosis and cystic acne, in patients in need of such therapy. These sulfones are also known to have therapeutic activity against memory loss in patients in need of such therapy, including patients suffering from Alzheimer's disease and related neurodegenerative disorders. It has now been found that new, modified-release formulations of dapsone and related sulfones may also be used that decrease side effects and increase effectiveness of the drugs. New methods are disclosed utilizing certain formulations of dapsone and related sulfones that improve the therapeutic index of said drugs. Side effects of these drugs are known to those skilled in the art and include, but are not restricted to anorexia, psychosis, agranulocytosis, peripheral neuritis, hemolysis, methemoglobinemia, nausea, vomiting, headache, dizziness, tachycardia, nervousness, insomnia and skin disorders. Modified-release (as defined herein) formulations of dapsone have now been found to avoid some or all of these side effects, and to have more efficacy on potency. Excerpt(s): The object of the present invention pertains to a method of treating or preventing certain diseases in a human being while increasing compliance, reducing side effects and improving efficacy of the active therapeutic ingredient(s) within a large therapeutic range. The method comprises the use of modified-release dosage formulations of sulfone compounds including 4,4'-diaminodiphenylsulfone, its didextrose sulfonate derivative(s), their analogs, metabolites, any enantiomers, any diasteriomers, or mixtures thereof and/or therapeutically acceptable salts thereof. Dapsone is an active substance that is known in the treatment of various infectious diseases and inflammatory conditions. There is a wealth of data and experimental studies regarding the activity of dapsone and related sulfones. In particular, there is a large amount of data regarding the bioavailability and pharmacokinetics of the drug. It is also known in the prior art that dapsone has therapeutic activity against leprosy, dermatitis herpetiformis, actinomycotic mycetoma, asthma, malaria, rheumatoid arthritis, Kaposis sarcoma, pneumocystis carinii (pneumonia), subcorneal pustular dermatosis and cystic acne, in patients in need of such therapy. However, since the acute or chronic toxicity of dapsone is unacceptable at the doses necessary to treat most diseases, it is not possible to use this compound for these indications in the presently available formulation(s). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Herbal suppositories Inventor(s): Liang, Kin C.; (Covina, CA), Liang, Liyin; (Covina, CA) Correspondence: Sheldon & Mak; Suite 900; 225 South Lake Avenue; Pasadena; CA; 91101; US Patent Application Number: 20020031559 Date filed: October 9, 2001 Abstract: A suppository for treating human ailments comprising at least one herb and a suppository vehicle. A method of treating undesired symptoms from allergic rhinitis, sinusitis, nasal congestion, nasal dripping, nasal polyps, infections, fevers, coughs, spasms, dizziness, convulsions in a human uses a suppository having herbs. Methods of producing, administrating and formulating herbal medicines in the form of suppositories to treat human aliments and disease are disclosed in this invention. Excerpt(s): This application is a continuation application to the U.S. patent application Ser. No. 09/520,978, filed on Mar. 8, 2000. This invention is in the field of administration of a medicinal herbal suppository, and, in the field of practicing and preparation of herbal suppositories that comprise various herbs. A suppository is a solid-form dosage that acts as a carrier to deliver medicine to a human body. Suppositories come with varying weights and shapes. They are applied via insertion into various body cavities such as rectum, vagina, urethra and nasal. When inserted, the suppository dissolves and releases the medicine. The medicine is mixed with body fluids. The fluids carry the medicine to mucous membrane tissues, which then absorb the medicine. The medicine can either have localized effects that treat the disease near where the suppository is applied, or systemic effects that treat the disease at other parts of the body. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Method of relieving dizziness or vertigo Inventor(s): Grey, Thomas L.; (Carlsbad, CA), Gruzdowich, Gregory j.; (Carlsbad, CA) Correspondence: Crockett & Crockett; Suite 400; 24012 Calle DE LA Plata; Laguna Hills; CA; 92653; US Patent Application Number: 20020156501 Date filed: April 18, 2001 Abstract: A device for providing noninvasive electrical stimulation of a single acupuncture site for treatment of dizziness, vertigo, and/or the symptoms associated with Meniere's disease is disclosed. Excerpt(s): The methods and devices described below relate to the fields of treatment of dizziness, vertigo, and/or the symptom's associated with Meniere's disease and noninvasive electrical stimulation of an acupuncture point. Dizziness is a feeling of faintness or an inability to keep normal balance in a standing or sitting position. The causes of dizziness are many. Vertigo is a type of dizziness characterized by a sensation of rotation or movement of one's self (subjective vertigo) or of one's surroundings (objective vertigo). Vertigo results mainly from diseases of the inner ear. Treatments for vertigo include medications such as antihistamines, anticholinergics, and sedativehypnotics. These medications all have side-effects which the patient may wish to avoid. Meniere's disease is an abnormality of the inner ear that causes a host of symptoms including severe dizziness and/or vertigo. Currently there is no cure for Meniere's

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disease. Operations may reverse the disease process, but the effectiveness of these operations has been difficult to establish. As with any inner ear operations, there is a risk of hearing loss. The most common surgery performed entails inserting a shunt into the inner ear to drain off excess fluid. A more reliable surgery called a vestibular neurectomy, includes severing the vestibular nerve. The vestibular nerve aids in balance and severing the nerve prevents it from sending distorted messages to the brain. A problem with this surgery is that the vestibular nerve is very close to hearing and facial nerves. Thus, the risk of affecting a patient's hearing and/or facial muscle control is increased with this surgery. Further, older patients often have difficultly recovering from this surgery. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Methods for treating vertigo and motion sickness using descarboethoxyloratadine Inventor(s): McCullough, John R.; (Worcester, MA) Correspondence: Pennie & Edmonds Llp; 1667 K Street NW; Suite 1000; Washington; DC; 20006 Patent Application Number: 20020183241 Date filed: May 16, 2002 Abstract: Methods for treating urinary incontinence, vertigo and motion sickness comprising administering a therapeutically effective amount of descarboethoxyloratadine, or a pharmaceutically acceptable salt thereof. Excerpt(s): The present invention relates to methods for treating urinary incontinence, vertigo and motion sickness. Urinary incontinence, such as incontinence caused by bladder detrusor muscle instability, is a prevalent problem that affects people of all ages and levels of physical health, both in healthcare settings and in the community at large. At present, urinary incontinence afflicts 15-30% of elderly people living at home, onethird of those living in acute-care settings, and at least one-half of those in long-term care institutions (Resnick, R. M., Lancet 346:94 (1995)). Medically, it predisposes persons to urinary tract infections, pressure ulcers, perineal rashes, and urosepsis. Psychosocially, urinary incontinence is associated with embarrassment, social stigmatization, depression, and with the risk of institutionalization (Herzo et al., Annu. Rev. Gerontol. Geriatr. 9:74 (1989)). Economically, the costs are great; in the United States alone, over $15 billion is spent per annum managing incontinence. Treatments for incontinence include drugs with bladder relaxant properties, i.e., which help to control bladder detrusor muscle overactivity. Such drugs are effective in 80 to 85% of patients with uninhibited bladder contractions. Anticholinergic medications represent the mainstay of this type of treatment. The major proportion of the neurohumoral stimulus for physiologic bladder contraction is acetylcholine-induced stimulation of post ganglionic muscarinic receptor sites on bladder smooth muscle. For example, anticholinergics such as propantheline bromide and glycopyrrolate, and combination smooth muscle relaxant/anticholinergics such as racemic oxybutynin and dicyclomine, have been used to treat urge incontinence. (See, e.g., Wein, A. J., Urol. Clin. N. Am. 22:557-577 (1995); Levin et al., J. Urol. 128:396-398 (1982); Cooke et al., S. Afr. Med. J. 63:3 (1983); R. K. Mirakhur et al., Anaesthesia 38:1195-1204 (1983)). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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System and method for sensing and evaluating physiological parameters and modeling an adaptable predictive analysis for symptoms management Inventor(s): Geatz, Michael W.; (Maple Groove, MN), Roiger, Richard J.; (Mankato, MN) Correspondence: Stuart R. Hemphill; Dorsey & Whitney Llp; Intellectual Property Department; 50 South Sixth Street, Suite 1500; Minneapolis; MN; 55402-1498; US Patent Application Number: 20030144829 Date filed: January 24, 2003 Abstract: A system senses various physiological parameters of a patient such as heart rate or temperature to evaluate the patient and predict when an episode of a chronic symptom may occur. The system further includes a modeling component which generates an individualized predictive model for a given patient wherein the patient's previous episodes of the symptom are utilized to shape the model. The system tests the model to assure accuracy and can revise the model as necessary. Once the model is established, the system monitors patient parameters and can alert the patient to the expected onset of the symptom and/or automatically administer an appropriate drug or other therapy to control the expected symptom. The system is applicable to allergic reactions, anxiety attacks, attention deficit hyperactivity disorders, backaches, depression, dizziness, drowsiness, epileptic seizures, fatigue, heart malfunction, hunger pangs, joint or other pain, loss of motor control, migraines, motion sickness, muscle spasm, nausea, nicotine fits, numbness, shaking, shortness of breath, sleep or sleep disorders, tremors, unconsciousness, vision impairment or other chronic symptoms. Excerpt(s): This patent application claims priority from provisional patent application No. 60/351,575, filed Jan. 25, 2002. This invention relates generally to medical devices, and more specifically to a method and apparatus for sensing and reacting to patient physiological data. Many people suffer from chronic or recurring symptoms or various other unpleasant or disturbing indications caused by a wide variety of medical ailments. Some possibilities include: allergic reactions, anxiety attacks, attention deficit hyperactivity disorders, backaches, depression, dizziness, drowsiness, epileptic seizures, fatigue, heart malfunction, hunger pangs, joint or other pain, loss of motor control, migraines, motion sickness, muscle spasm, nausea, nicotine "fit", numbness, shaking, shortness of breath, sleep or sleep disorders, tremors, unconsciousness, and vision impairment. In fact, approximately 1 in 5 people suffer from some sort of chronic acute symptoms during their lifetime. Understandably, these people desire and seek relief from the medical community. A typical patient suffering from such chronic symptoms might spend anywhere from $500 to $35,000 annually to treat or minimize their symptoms. Treatments for symptoms involve various drug and/or physical therapies, chiropractic care, acupuncture, meditation and yoga. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Triple drug therapy for the treatment and prevention of acute or chronic pain Inventor(s): Ockert, David M.; (New York, NY) Correspondence: Price Heneveld Cooper Dewitt & Litton; 695 Kenmoor, S.E.; P O Box 2567; Grand Rapids; MI; 49501; US Patent Application Number: 20020058656 Date filed: August 17, 2001

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Abstract: A triple drug therapy, pharmaceutical kit, composition, and method of treatment regimen utilized as a combination of effective amounts of an anxiolytic agent, centrally acting alpha antiadrenergic agent, and central nervous system stimulant for the reduction or prevention of dizziness, drowsiness, depression, delirium, lethargy, mania, orthostatic hypotension, restlessness, weakness in the extremities, and difficulty in being mobile negative side effects caused by therapeutic agents utilized in the treatment of acute and chronic pain syndromes. Excerpt(s): This application claims priority under 35 U.S.C.sctn.119(e) on U.S. Provisional Application No. 60/233,518, filed Sep. 19, 2000, the entire disclosure of which is incorporated herein by reference. The present invention relates to the treatment and prevention of acute or chronic pain syndromes. Pain sensation is complex and variable. Experiences considered painful by one subject may not be equally painful to another and may vary in the same subject depending on the circumstances presented. In addition, subjective experiences, i.e. "phantom limb pain" make it clear that there is a strong psychological component to pain. Wingard et al., Human Pharmacology: Molecular to Clinical, Mosby-Year Book, Inc., 1991, p. 383. 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 dizziness, 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 “dizziness” (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 dizziness. You can also use this procedure to view pending patent applications concerning dizziness. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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

Balancing Act for People with Dizziness and Balance Disorders Source: Portland, OR: Vestibular Disorders Association. 2001. 95 p. Contact: Vestibular Disorders Association. P.O. Box 4467, Portland, OR 97208-4467. Voice (800) 837-8428. E-mail: [email protected]. Website: http://www.vestibular.org. PRICE: $15.00. ISBN 0963261150. Summary: This book explains the causes of dizziness and describes how to cope with the symptoms. Written in lay terms, the chapters review the physiology of balance, sources of assistance, testing, and treatment strategies. The text also addresses insurance considerations and methods for controlling dizziness, from diet to organization. Resources for more information are identified. Emphasis is placed on self-advocacy and the education of family and friends.

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Vestibulo-Ocular Reflex and Vertigo Source: New York, NY: Raven Press, Ltd. 1993. 416 p. Contact: Available from Raven Press, Ltd. 1185 Avenue of the Americas, New York, NY 10036. (800) 77-RAVEN or (212) 930-9500. PRICE: $115.00 plus shipping and handling. ISBN: 0881679550. Summary: This book presents current information on the vestibulo-ocular reflex, otolithic and otolith-ocular function. The book is directed to vestibular physiologists, otologists, neurologists, and internists actively engaged in treating patients with dizziness and balance disturbance and to therapists providing exercise programs for vestibular rehabilitation. Thirty-three chapters, each written by experts in the field, are presented in five sections: the clinical anatomy and physiology of the vestibulo-ocular reflex; the otolithic-ocular reflex; smooth eye movements and visual vestibular interactions; nystagmus; and the diagnosis and treatment of vertigo. Each chapter includes extensive references, and a subject index concludes the volume.

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Dizziness, Hearing Loss, and Tinnitus Source: Philadelphia, PA: F.A. Davis Company. 1998. 240 p. Contact: Available from Oxford University Press, Inc. Business Office, 2001 Evans Road, Cary, NC 27513. (800) 451-7556 or (919) 677-0977. Fax (919) 677-1303. PRICE: $65.00 plus shipping and handling. Summary: This textbook presents a concise approach to evaluating patients with dizziness, hearing loss, and tinnitus. In the first section, the author briefly reviews clinically relevant anatomy and physiology to provide a framework for understanding the pathophysiology of vestibular and auditory symptoms. The second section outlines the important features in the patient's history and examination that determine the probable site of a lesion. Separate chapters provide a systematic approach to evaluating patients with different types of dizziness and tinnitus. Numerous tables and flowcharts guide the reader through the diagnostic workup. The section on diagnosis and treatment covers the key differential diagnosis points that help the clinician decide the cause of the patient's problem and how to treat it. The description of each disease begins with an outline of symptoms, signs, laboratory findings, and treatment options. Each chapter includes references and a subject index concludes the volume.

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

A Dozen Dizzy Dogs (1990); ISBN: 9994995391; http://www.amazon.com/exec/obidos/ASIN/9994995391/icongroupinterna

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Abogada del Vertigo, La by Piero Meldini (1998); ISBN: 8423326667; http://www.amazon.com/exec/obidos/ASIN/8423326667/icongroupinterna

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Balancing Act: For People With Dizziness and Balance Disorders by Mary A. Watson, Helen Sinclair; ISBN: 096326110X; http://www.amazon.com/exec/obidos/ASIN/096326110X/icongroupinterna

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Bob the Builder: Scarecrow Dizzy (Bob the Builder); ISBN: 0563475994; http://www.amazon.com/exec/obidos/ASIN/0563475994/icongroupinterna

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Bon Appetite - Vegetables: Stry of Dizzy Dean & BSBL by Knapp (1994); ISBN: 0517135949; http://www.amazon.com/exec/obidos/ASIN/0517135949/icongroupinterna

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Building a Marriage: Stry of Dizzy Dean & BSBL by C. Graves (1994); ISBN: 0517136473; http://www.amazon.com/exec/obidos/ASIN/0517136473/icongroupinterna

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Da Kandinsky a Pollock : la vertigine della non-forma = From Kandinsky to Pollock : the vertigo of non-form; ISBN: 8871793250; http://www.amazon.com/exec/obidos/ASIN/8871793250/icongroupinterna

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Desde El Vertigo by Javier Perez Bazo (2001); ISBN: 8489972362; http://www.amazon.com/exec/obidos/ASIN/8489972362/icongroupinterna

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Dizziness by B. Todd Troost; ISBN: 0750671335; http://www.amazon.com/exec/obidos/ASIN/0750671335/icongroupinterna

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Dizziness and Balance Disorders - An interdisciplinary approach by I. Kaufman Arenberg (Editor); ISBN: 9062991009; http://www.amazon.com/exec/obidos/ASIN/9062991009/icongroupinterna

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Dizziness and Vertigo: Diagnosis and Treatment by Spector; ISBN: 0808904450; http://www.amazon.com/exec/obidos/ASIN/0808904450/icongroupinterna

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Dizziness, Hearing Loss, and Tinnitus by Robert W., Md. Baloh; ISBN: 0803603304; http://www.amazon.com/exec/obidos/ASIN/0803603304/icongroupinterna

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Dizziness, Hearing Loss, and Tinnitus: The Essentials of Neurotology by Robert W. Baloh; ISBN: 0803605811; http://www.amazon.com/exec/obidos/ASIN/0803605811/icongroupinterna

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Dizziness: A Guide to Disorders of Balance by Tony Wright, Anthony Wright; ISBN: 0709936591; http://www.amazon.com/exec/obidos/ASIN/0709936591/icongroupinterna

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Dizziness: Etiologic Approach to Management by Wallace Rubin MD, Kenneth H. Brookler MD MS FRCS FACS; ISBN: 3137718015; http://www.amazon.com/exec/obidos/ASIN/3137718015/icongroupinterna

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Dizziness: Hope Through Research by 1749001344; ISBN: 9997580982; http://www.amazon.com/exec/obidos/ASIN/9997580982/icongroupinterna

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Dizzy : What You Need to Know About Managing and Treating Balance Disorders by Jack J. Wazen (Author) (2004); ISBN: 074323622X; http://www.amazon.com/exec/obidos/ASIN/074323622X/icongroupinterna

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Dizzy and Terry by Alison Swimley; ISBN: 075411080X; http://www.amazon.com/exec/obidos/ASIN/075411080X/icongroupinterna

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Dizzy Gillespie by Isabelle Leymarie; ISBN: 2909828735; http://www.amazon.com/exec/obidos/ASIN/2909828735/icongroupinterna

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Dizzy Gillespie - Life & Times by Spellmount Ltd Publishers, Barry McRae (1986); ISBN: 0946771340; http://www.amazon.com/exec/obidos/ASIN/0946771340/icongroupinterna

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Dizzy Gillespie : sein Leben, seine Musik, seine Schallplatten by Jürgen Wölfer; ISBN: 3923657161; http://www.amazon.com/exec/obidos/ASIN/3923657161/icongroupinterna

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Dizzy: SS:Foundation:Dizzy (SS) by M Coles, C Hall; ISBN: 0582406439; http://www.amazon.com/exec/obidos/ASIN/0582406439/icongroupinterna

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Doin' the Box Step: Stry of Dizzy Dean & BSBL by Suzanne Falter-Barns (1994); ISBN: 0517137313; http://www.amazon.com/exec/obidos/ASIN/0517137313/icongroupinterna

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Dream House: Stry of Dizzy Dean & BSBL by Joe Coomer (1994); ISBN: 0517136236; http://www.amazon.com/exec/obidos/ASIN/0517136236/icongroupinterna

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Ear Clinics International Sensorineural Hearing Loss, Vertigo and Tinnitus by Michael Paparella; ISBN: 0686777689; http://www.amazon.com/exec/obidos/ASIN/0686777689/icongroupinterna

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Ear Diseases, Deafness, and Dizziness [Edited] by Victor Goodhill; ISBN: 0061409812; http://www.amazon.com/exec/obidos/ASIN/0061409812/icongroupinterna

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El vertigo de Rusia : Lenin by Fernando de González-Doria; ISBN: 8423000451; http://www.amazon.com/exec/obidos/ASIN/8423000451/icongroupinterna

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Evaluation and clinical management of dizziness and vertigo; ISBN: 072367003X; http://www.amazon.com/exec/obidos/ASIN/072367003X/icongroupinterna

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Feeling Dizzy : Understanding and Treating Vertigo, Dizziness, and Other Balance Disorders by Brian W. Blakley (Author), Mary-Ellen Siegel (Author); ISBN: 0028616804; http://www.amazon.com/exec/obidos/ASIN/0028616804/icongroupinterna

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Feeling Dizzy: Vertigo, Dizziness, and Other Balance Disorders by Brian W. Blakley, Mary-Ellen Siegel; ISBN: 0890436258; http://www.amazon.com/exec/obidos/ASIN/0890436258/icongroupinterna

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Film and the Interpretive Process: A Study of Blow-Up, Rashomon, Citizen Kane, 8 1/2, Vertigo and Persona (Ars Interpretandi, the Art of Interpretat) by David Boyd (1989); ISBN: 0820409871; http://www.amazon.com/exec/obidos/ASIN/0820409871/icongroupinterna

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Headache and Dizziness by William M.D. Hunter; ISBN: 9996673731; http://www.amazon.com/exec/obidos/ASIN/9996673731/icongroupinterna

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Hearing Loss and Dizziness by Yasuya Nomura (Editor) (1985); ISBN: 0896401138; http://www.amazon.com/exec/obidos/ASIN/0896401138/icongroupinterna

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Hearing Loss and Dizziness; ISBN: 4260141139; http://www.amazon.com/exec/obidos/ASIN/4260141139/icongroupinterna

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Mayo Clinic on Hearing: Strategies for Managing Hearing Loss, Dizziness and Other Ear Problems by Wayne, Ph.D. Olsen (Editor) (2003); ISBN: 1893005291; http://www.amazon.com/exec/obidos/ASIN/1893005291/icongroupinterna

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Newscapes: Dizziness of Incommensurable by Paola Gregory (2003); ISBN: 3764367369; http://www.amazon.com/exec/obidos/ASIN/3764367369/icongroupinterna

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Nystagmus and Vertigo: Clinical Approaches to the Patient With Dizziness (UCLA Forum in Medical Sciences; No. 24) by Vicente Honrubia; ISBN: 0123550807; http://www.amazon.com/exec/obidos/ASIN/0123550807/icongroupinterna

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Pointers to the Common Remedies: Vertigo, Headache, Apoplexy, Sleeplessness, Collapse, Sunstroke by M.L. Tyler (1981); ISBN: 0946717516; http://www.amazon.com/exec/obidos/ASIN/0946717516/icongroupinterna

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Practical Management of the Dizzy Patient by Joel A. Goebel (Editor); ISBN: 0781718201; http://www.amazon.com/exec/obidos/ASIN/0781718201/icongroupinterna

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Sensorineural Hearing Loss, Vertigo, and Tinnitus by Meyerhof (1981); ISBN: 0683067508; http://www.amazon.com/exec/obidos/ASIN/0683067508/icongroupinterna

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Superior Cat: Stry of Dizzy Dean & BSBL by Miller M (1994); ISBN: 0517136562; http://www.amazon.com/exec/obidos/ASIN/0517136562/icongroupinterna

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Surgery for Vertigo by John R. E. Dickins; ISBN: 9995121166; http://www.amazon.com/exec/obidos/ASIN/9995121166/icongroupinterna

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The London Vertigo: After Macklin by Brian Friel (1990); ISBN: 185235058X; http://www.amazon.com/exec/obidos/ASIN/185235058X/icongroupinterna

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Theophrastus of Eresus: On Sweat, on Dizziness and on Fatigue (Philosophia Antiqua, 93) by William W. Fortenbaugh, et al (2003); ISBN: 9004128905; http://www.amazon.com/exec/obidos/ASIN/9004128905/icongroupinterna

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Titmuss Regained: Stry of Dizzy Dean & BSBL by John Clifford Mortimer (1994); ISBN: 0517135817; http://www.amazon.com/exec/obidos/ASIN/0517135817/icongroupinterna

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Toddler Story Book: Silly Goose and Dizzy Duck Play Hide and Seek by Sally Grindley (Illustrator), et al; ISBN: 0789448440; http://www.amazon.com/exec/obidos/ASIN/0789448440/icongroupinterna

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Up the Dizzy Mountain: Step 11 (Literary Land) by M. Coles, C. Hall; ISBN: 0582463769; http://www.amazon.com/exec/obidos/ASIN/0582463769/icongroupinterna

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Update on dizziness (SuDoc HE 20.3502:D 64/2) by U.S. Dept of Health and Human Services; ISBN: B00010GAQ2; http://www.amazon.com/exec/obidos/ASIN/B00010GAQ2/icongroupinterna

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Vertigo by Kristin MC Cloy (1990); ISBN: 9500705982; http://www.amazon.com/exec/obidos/ASIN/9500705982/icongroupinterna

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Vertigo by Leonard Nolens; ISBN: 9022309207; http://www.amazon.com/exec/obidos/ASIN/9022309207/icongroupinterna

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Vertigo by Maike Hallmann (Author); ISBN: 3811851519; http://www.amazon.com/exec/obidos/ASIN/3811851519/icongroupinterna

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Vertigo and Dizziness; ISBN: 0415102081; http://www.amazon.com/exec/obidos/ASIN/0415102081/icongroupinterna

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Vertigo and Dizziness (The Experience of Illness) by Lucy Yardley; ISBN: 041510209X; http://www.amazon.com/exec/obidos/ASIN/041510209X/icongroupinterna

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Vertigo and Dizziness Rehabilitation: The McS Method by Dario Alpini, et al (1999); ISBN: 3540640843; http://www.amazon.com/exec/obidos/ASIN/3540640843/icongroupinterna

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Vertigo and other stories by Richard De Canio; ISBN: 9579375232; http://www.amazon.com/exec/obidos/ASIN/9579375232/icongroupinterna

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Vertigo Covermount (Sight & Sound); ISBN: 0747535337; http://www.amazon.com/exec/obidos/ASIN/0747535337/icongroupinterna

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Vertigo Explained by Robert E. Primavera, Dorothy E. Primavera (Editor); ISBN: 0966794206; http://www.amazon.com/exec/obidos/ASIN/0966794206/icongroupinterna

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Vertigo, Nausea, Tinnitus and Hearing Loss in Cardiovascular Diseases: Proceedings of the Neurootological and Equilibriometric Society: Vertigo in by C.F. Claussen (1988); ISBN: 0444808256; http://www.amazon.com/exec/obidos/ASIN/0444808256/icongroupinterna

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Vertigo, Nausea, Tinnitus, and Hypoacusia in Metabolic Disorders: Proceedings (International Congress Series, No 791) by Claus-Frenz Claussen, et al; ISBN: 0444810242; http://www.amazon.com/exec/obidos/ASIN/0444810242/icongroupinterna

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Video Textbook Volume 5 - Dizziness (PAL) by Martin A. Samuels MD; ISBN: 0750699787; http://www.amazon.com/exec/obidos/ASIN/0750699787/icongroupinterna

The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “dizziness” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:11 •

Dizziness: etiologic approach to management Author: Rubin, Wallace.; Year: 1982; New York: Thieme Medical Publishers, 1991; ISBN: 0865773912 http://www.amazon.com/exec/obidos/ASIN/0865773912/icongroupinterna

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Dizziness: hope through research Author: National Institute of Neurological and Communicative Disorders and Stroke. Office of Scientific and Health Reports.; Year: 1986; Bethesda, Md.: The Office, 1986

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

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Dizziness and balance disorders: an interdisciplinary approach to diagnosis, treatment, and rehabilitation Author: Arenberg, I. Kaufman (Irving Kaufman),; Year: 1991; Amsterdam; New York: Kugler Publications, c1993; ISBN: 0962991009

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Dizziness and discontinuation of oral contraceptives in Bangladesh Author: Measham, A. R.; Year: 1985; 1979

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Dizziness, hearing loss, and tinnitus: the essentials of neurotology Author: Baloh, Robert W. (Robert William),; Year: 1989; Philadelphia: Davis, c1984; ISBN: 0830605811

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Dizziness; an evaluation and classification. Author: De Weese, David Downs,; Year: 1994; Springfield, Ill., Thomas [c1954]

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Electronystagmography and the dizzy patient Author: Teter, Darrel L.; Year: 1986; [New York, NY]: Thieme-Stratton, [c1983]

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On vertigo or dizziness: its causes, importance as a symptom, and treatment Author: Bradbury, J. B. (John Buckley),; Year: 1992; London: Macmillan and Co., 1870

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Vestibular physiology in understanding the dizzy patient Author: McCabe, Brian F. (Brian Francis); Year: 1977; Washington, DC: American Academy of Otolaryngology-Head and Neck Surgery Foundation, 1987

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

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

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

Approach to the Patient with Dizziness Source: in Baloh, R.W. Dizziness, Hearing Loss, and Tinnitus. Philadelphia, PA: F.A. Davis Company. 1998. p. 107-125. Contact: Available from Oxford University Press, Inc. Business Office, 2001 Evans Road, Cary, NC 27513. (800) 451-7556 or (919) 677-0977. Fax (919) 677-1303. PRICE: $65.00 plus shipping and handling. Summary: Dizziness can represent many overlapping sensations and can be caused by different pathophysiological mechanisms; therefore, it is critical that the examining physician take a careful history to determine the type of dizziness before proceeding with the diagnostic evaluation. This chapter is from a textbook that presents a concise approach to evaluating patients with dizziness, hearing loss, and tinnitus. Topics include distinguishing between different types of dizziness, such as vertigo, near-faint dizziness, psychophysiological dizziness, hypoglycemic dizziness, disequilibrium, and drug-induced dizziness; and the workup of common presentations of vestibular dizziness, including an acute prolonged attack of vertigo, recurrent spontaneous attacks of vertigo, recurrent episodes of positional vertigo, posttraumatic dizziness, and disequilibrium without vertigo. Numerous tables and flowcharts guide the reader through the diagnostic workup. Important points are highlighted and presented in the margins of the text. 4 figures. 6 tables. 30 references.

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Objective Evaluation of a Patient with Dizziness Source: in Canalis, R.F. and Lambert, P.R., eds. Ear: Comprehensive Otology. Philadelphia, PA: Lippincott Williams and Wilkins. 2000. p. 181-196. Contact: Available from Lippincott Williams and Wilkins. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-3030. Fax (301) 223-2300. Website: www.lww.com. PRICE: $179.00 plus shipping and handling. ISBN: 078171558X. Summary: Objective evaluation of dizziness is undertaken after a thorough history and physical examination provide the information needed to formulate a diagnostic impression. Vestibular tests are used to confirm the clinical diagnostic impression. This chapter is from a textbook that offers complete coverage of the field of clinical otology (study of the ear). The book is oriented to serve both the otolaryngology resident as a practical learning tool and the practicing otolaryngologist as an updated reference source of clinical and basic information. This chapter outlines the objective evaluation of a patient with dizziness, including electronystagmography (ENG); the methods of ENG testing, including evaluation of abnormal eye movements, evaluation of vestibular oculomotor function, evaluation of visual oculomotor function, and clinical application; rotation tests, including rotary chair testing and head shake testing; and posturography, including the sensory organization test, motor coordination test, pressure test, and clinical significance. The authors first provide a brief review of vestibular anatomy and

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physiology, in order to better understand vestibular function testing. 6 figures. 62 references. •

Finding the Cause of Dizziness and Vertigo Source: in Blakley, B.W.; Siegel, M.E. Feeling Dizzy: Understanding and Treating Dizziness, Vertigo, and Other Balancing Disorders. New York, NY: Macmillan Publishing. 1995. p. 43-82. Contact: Available from Macmillan Publishing. 201 West 103rd Street, Indianapolis, IN 46290. (800) 428-5331; Fax (800) 882-8583. PRICE: $21.95 plus shipping and handling. ISBN: 0028600096. Summary: This chapter is from a layperson's guide to vertigo, imbalance, fainting, and other balance disorders. This chapter describes the diagnostic process used to investigate vestibular disorders. Topics covered include what to expect during the first visit to the doctor, the patient history and physical examination, testing the cardiovascular system, the head and neck examination, otitis media, labyrinthitis, fistula, hearing loss, examination of the eyes, the neurological examination, testing muscle strength and tone, coordination, gait and stance, cranial nerves, positional testing, the Hallpike test, ear tests, electronystagmography, the gaze test, saccade and calibration test, tracking test, optokinetic test, rotary chair testing, dynamic platform posturography, the platform fistula test, and miscellaneous tests that may be recommended. The authors conclude with a section encouraging readers to become active participants in their own health care team.

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Symptomatic Treatment of Vertigo Source: in Baloh, R.W. Dizziness, Hearing Loss, and Tinnitus. Philadelphia, PA: F.A. Davis Company. 1998. p. 199-206. Contact: Available from Oxford University Press, Inc. Business Office, 2001 Evans Road, Cary, NC 27513. (800) 451-7556 or (919) 677-0977. Fax (919) 677-1303. PRICE: $65.00 plus shipping and handling. Summary: This chapter is from a textbook that presents a concise approach to evaluating patients with dizziness, hearing loss, and tinnitus. This chapter describes the symptomatic treatment of vertigo. The author stresses that the best therapy for vertigo is to eliminate it by treating the underlying illness. When this is not possible, symptomatic therapy is needed. The ideal symptomatic treatment of vertigo should suppress the sensation of vertigo, help restore normal balance, and prevent vomiting. Side effects should be minimal, and treatment should not impede the normal process of recovery from vestibular illness. No medication now available meets all these ideals. In the absence of an ideal drug, the choice of therapy must take into account the patient's underlying disease, the expected course of illness, and the patient's need for mobility during recovery. The author then discusses vestibular suppressant drugs and antiemetic (anti-vomiting) drugs. A final section considers vestibular rehabilitation. Important points are highlighted and presented in the margins of the text. 1 figure. 3 tables. 14 references.

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Evaluation of the Dizzy Patient Source: in Jafek, B.W.; Stark, A.K., eds. ENT Secrets: Questions You Will Be Asked On Rounds, In the Clinic, In the OR, On Exams. Philadelphia, PA: Hanley and Belfus. 1996. p. 47-53.

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Contact: Available from Hanley and Belfus. Medical Publishers, 210 South 13th Street, Philadelphia, PA 19107. (800) 962-1892 or (215) 546-7293; Fax (215) 790-9330; http://www.hanleyandbelfus.com. PRICE: $35.95 plus shipping and handling. ISBN: 1560531592. Summary: This chapter on the evaluation of the dizzy patient is from a book that utilizes a question and answer format to review details of the specialty of otorhinolaryngology (ear, nose and throat, or ENT). Topics discussed include the major categories of dizziness, the lesions that should be recognized as needing urgent treatment, the main central and peripheral vestibular disorders that commonly cause dizziness, the patient's vertigo and how to control it during the diagnostic work-up period, the differences between vertigo and dizziness, the diagnosis of peripheral or central vestibular disorders, the evaluation of the patient for systemic disease, the evaluation of the patient for anxiety, the length of the dizzy spell and how to narrow the possible etiology, the components of a complete neurologic examination, the evaluation of a patient for spontaneous and gaze-evoked nystagmus, the four general categories of nystagmus, the Dix-Hallpike maneuver (to evaluate for benign paroxysmal positional vertigo, BPPV), the doll's eye test, the diagnostic tests that should be performed on the dizzy patient, the normal caloric responses, and the controversies in the evaluation of dizziness, including the use of posturography. The chapter focuses on helping readers acquire the vocabulary required to discuss vestibular disorders. 3 figures. 1 table. 8 references. •

Vertigo of Central Origin Source: in Canalis, R.F. and Lambert, P.R., eds. Ear: Comprehensive Otology. Philadelphia, PA: Lippincott Williams and Wilkins. 2000. p. 665-679. Contact: Available from Lippincott Williams and Wilkins. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-3030. Fax (301) 223-2300. Website: www.lww.com. PRICE: $179.00 plus shipping and handling. ISBN: 078171558X. Summary: This chapter on vertigo of central origin is from a textbook that offers complete coverage of the field of clinical otology (study of the ear). The book is oriented to serve both the otolaryngology resident as a practical learning tool and the practicing otolaryngologist as an updated reference source of clinical and basic information. Topics include differentiating central and peripheral causes of vertigo; the neurologic complications of ear infections, including epidural abscess and brain abscess; vascular disease, including vertebrobasilar insufficiency, infarction of the brainstem and cerebellum, hemorrhage into the brainstem and cerebellum, and the diagnosis of vascular causes of vertigo; migraine, including the clinical profile, migraine equivalents, and the mechanism of vertigo with migraine; tumors, including tumors of the cerebellopontine angle, and brain tumors; brain trauma, including the mechanism of brain injury, brainstem contusion, postconcussion syndrome, and the diagnosis of persistent dizziness after head trauma; cerebellar degeneration syndromes, including alcohol cerebellar degeneration and familial ataxia syndromes; disorders of the cranial vertebral junction, including the mechanism of brain damage, basilar impression, atlantoaxial dislocation, and Chiari malformation; multiple sclerosis; and vertigo and focal seizure disorders. For each disorder, the author discusses diagnosis, diagnostic tests, and treatment options. 3 figures. 2 tables. 74 references.

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Vertigo of Peripheral Origin Source: in Canalis, R.F. and Lambert, P.R., eds. Ear: Comprehensive Otology. Philadelphia, PA: Lippincott Williams and Wilkins. 2000. p. 647-664.

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Contact: Available from Lippincott Williams and Wilkins. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-3030. Fax (301) 223-2300. Website: www.lww.com. PRICE: $179.00 plus shipping and handling. ISBN: 078171558X. Summary: This chapter on vertigo of peripheral origin is from a textbook that offers complete coverage of the field of clinical otology (study of the ear). The book is oriented to serve both the otolaryngology resident as a practical learning tool and the practicing otolaryngologist as an updated reference source of clinical and basic information. Topics include differentiating types of dizziness; the mechanisms of vertigo; features of peripheral vertigo, including time course, precipitating factors, associated symptoms, compensation, and predisposing factors; benign positional vertigo; infections of the inner ear, including bacterial infections, viral neurolabyrinthitis, syphilitic infections of the inner ear, and differential diagnosis of labyrinthitis; Meniere's disease; vascular diseases of the inner ear; tumors of the ear and temporal bone (malignant and benign); trauma, including temporal bone fractures, labyrinthine concussion, posttraumatic positional vertigo, perilymph fistula, and the differential diagnosis of posttraumatic inner ear disorders; metabolic disorders, including diabetes mellitus, uremia, hypothyroidism, otosclerosis, Paget's disease, and management of inner ear metabolic disorders; acute alcohol intoxication; ototoxins (medications that can damage the ear), including aminoglycosides, salicylates, and cisplatinum; and autoimmune inner ear disease. For each condition, the author covers clinical features, mechanisms, diagnosis, and treatment options. 2 figures. 5 tables. 75 references. •

Psychogenic Dizziness Source: in Sharpe, J.A. and Barber, H.O., eds. Vestibulo-Ocular Reflex and Vertigo. New York, NY: Raven Press, Ltd. 1993. p. 305-315. Contact: Available from Raven Press, Ltd. 1185 Avenue of the Americas, New York, NY 10036. (800) 77-RAVEN or (212) 930-9500. PRICE: $115.00 plus shipping and handling. ISBN: 0881679550. Summary: This chapter, from a medical textbook on the vestibulo-ocular reflex, otolithic and otolith-ocular function, presents an overview of psychogenic dizziness. The book is directed to vestibular physiologists, otologists, neurologists, and internists actively engaged in treating patients with dizziness and balance disturbance and to therapists providing exercise programs for vestibular rehabilitation. The authors of this chapter note that, with symptoms of dizziness and vertigo, the possibility of psychogenicity or somatization is usually considered in four types of patients: those whose dizziness is associated with anxiety; those whose dizziness may be an expression of psychiatric disorders other than anxiety, such as depression and somatoform disorders; those whose dizziness is suspected to be feigned because of malingering; and those who have an objectively verifiable balance disorder but whose symptoms seem excessive in the eyes of the treating physician. Of these categories, the first, dizziness associated with anxiety, is the most important and is discussed in detail in this chapter. The authors then consider the remaining types of patients and conclude the chapter with a brief discussion of management strategies. 2 figures. 52 references.

Directories In addition to the references and resources discussed earlier in this chapter, a number of directories relating to dizziness have been published that consolidate information across

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various sources. The Combined Health Information Database lists the following, which you may wish to consult in your local medical library:12 •

Parent Resources: Agencies, Organizations, Support Groups Source: in DeFeo, A.B., ed. Parent Articles 2. San Antonio, TX: Communication Skill Builders. 1995. p. 213-234. Contact: Available from Communication Skill Builders. Customer Service, 555 Academic Court, San Antonio, TX 78204-2498. (800) 211-8378; Fax (800) 232-1223. PRICE: $55.00 plus shipping and handling. Order Number 076-163-0732. Summary: This appendix section is from a parent education skill builders textbook. The appendix lists agencies, organizations, and support groups that parents might want to contact as they work with developing communication skills in and with their child. National information and advocacy groups are listed, including groups for consumer information, education, financial aid, home care, legal assistance, nonoral communication, orthotics and prosthetics, psychiatry, psychology, rare disorders, rehabilitation, residential placement, self-help, severe disabilities, sibling support, social workers, and telephone usage for persons with disabilities. Also listed are national organizations for specific disabilities and conditions, including acoustic neuroma, autism, birth defects, chronic dizziness and balance disorders, cleft palate and craniofacial disorders, developmental disabilities, Down's syndrome, dyslexia, dystonia, genetic conditions, head injuries, hearing impairments, learning disabilities, mental retardation, neurofibromatosis, neurological disorders, stuttering, Tourette syndrome, and voice disorders and laryngectomies. The address and telephone number for each organization are noted.

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Brain Connections: Your Source Guide to Information on Brain Diseases and Disorders. 5th ed Source: New York, NY: Dana Alliance for Brain Initiatives. 2000. 49 p. Contact: Available from Dana Press. Charles A. Dana Foundation, 745 Fifth Avenue, Suite 700, New York, NY 10151. Fax (212) 593-7623. Website: www.dana.org. PRICE: Single copy free. Summary: This guide lists organizations that assist people with a brain-related disorder or disease as well as those organizations that assist caregivers and health care providers in these areas. The guide lists more than 275 organizations alphabetically by disease or disorder. Listings of particular relevance to communication disorders include: acoustic neuroma, aphasia, ataxia, attention deficit hyperactivity disorder, autism, deafness and hearing loss, disability and rehabilitation, dizziness, dyslexia, dystonia, head injury, learning disabilities, neurofibromatosis, smell and taste (chemosensory) disorders, spasmodic dysphonia, stuttering, tinnitus, Tourette syndrome, and vestibular disorders. Emphasis is placed on organizations that have a national focus, however, many of these groups sponsor local chapters or affiliates and make referrals to local medical professionals and organizations. For each organization listed, the guide notes mailing address, telephone numbers, e-mail and web sites; also provided are symbols which indicate that the organization offers support groups, referrals to doctors, referrals to

12 You will need to limit your search to “Directory” and “dizziness” using the "Detailed Search" option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find directories, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Select your preferred language and the format option “Directory.” Type “dizziness” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months.

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other sources of information, regional chapters, availability of literature, availability of speakers, and volunteer opportunities. The guide also describes the publishing body, the Dana Alliance for Brain Initiatives, and provides a list of ways in which readers can support and further brain research.

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CHAPTER 8. MULTIMEDIA ON DIZZINESS Overview In this chapter, we show you how to keep current on multimedia sources of information on dizziness. 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 dizziness is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “dizziness” 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 “dizziness” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on dizziness: •

Meniere's Disease: An Inner Ear Disorder Source: Englewood, CO: International Meniere's Disease Research Institute (IMDRI). 1993. (Videocassette). Contact: Available from International Meniere's Disease Research Institute (IMDRI). 300 East Hampden Avenue, Suite 401, Englewood, CO 80110. Voice (303) 781-7223 or (303) 788-4235; Fax (303) 788-4234. PRICE: $5.00 donation appreciated. Summary: This videotape presents an overview of information about Meniere's disease. The narrator discusses the symptoms of Meniere's, likening them to the dizziness experienced following some carnival rides. The discovery that Vincent Van Gogh suffered from Meniere's, rather than from epilepsy and madness, is discussed in some detail. Other topics include the work of the International Meniere's Disease Research Institute (IMDRI) at the Ear Center; treatment options, including diet, drug therapy, and surgery; the anatomy and physiology of the ear and hearing; and possible causes of Meniere's disease. Two patients recount their own experiences with Meniere's, and their

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struggle with misdiagnosis. The program concludes with a discussion of the Ear Center's research and educational activities and a listing of available publications. •

Managing Your Symptoms Source: Portland, OR: Vestibular Disorders Association. 2000. (videocassette). Contact: Available from Vestibular Disorders Association. P.O. Box 4467, Portland, OR 97208-4467. (800) 837-8428. E-mail: [email protected]. Website: www.vestibular.org. PRICE: $25.00 plus shipping and handling. Summary: This videotape program on vestibular disorders helps viewers understand dizziness and vertigo; related problems with memory and concentration, vision, and imbalance; and how to cope with recurring symptoms. The video features interviews with patients who have overcome most of their vestibular symptoms. The video also includes interviews with professionals in the areas of diagnosis, treatment, diet, vision, and physical therapy. The program encourages viewers to become active in their own recovery process and to allow enough time for compensation to occur. The videotape is closed captioned.

•

Managing Earaches in Children Source: Timonium, MD: Milner-Fenwick. 199x. (videocassette). Contact: Available from Milner-Fenwick, 2125 Greenspring Drive, Timonium, MD 21093. (800) 432-8433. PRICE: $125.00. Number CC-12. Summary: This videotape, designed for parents, describes common causes, symptoms, complications, treatment, and coping tips for ear infections in children. The program begins by briefly describing how the ear works and illustrating the structure of the inner ear. Temporary measures are suggested to relieve pain until a doctor can be consulted. Treatments discussed include antibiotics; antihistamines or decongestants; saline nasal sprays; and, for chronic infection, potential surgical treatment such as surgery to release fluid, insertion of tubes, and removal of the adenoids. Potential complications of ear infection are described, including ruptured eardrum, mastoiditis, and chronic serous otitis media. Parents are strongly urged to consult a physician any time a child experiences symptoms such as earache, clogged ears, discharge, dizziness, irritability, ear pulling, fever, or loss of hearing. The video concludes with some suggestions to help prevent infection, including avoiding exposure to colds and other infections, keeping children away from cigarette smoke, and never bottle feeding a child while the child is lying down.

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

Advances in the diagnosis & management of TIA's, sleep disorders, back pain, and dizziness [videorecording] Source: CME Conference Video, Inc.; sponsored by the Duke

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University Medical Center, Division of Neurology and the Office of Continuing Medical Educatio; Year: 1995; Format: Videorecording; Mt. Laurel, NJ: CME Conference Video, 1995 •

Anatomy of dizziness [videorecording] Source: University of Toronto, Faculty of Medicine, Division of Instructional Media Services; Year: 1974; Format: Videorecording; Toronto: The Division, [1974]

•

Dealing with dizziness [videorecording] Source: produced by the Johns Hopkins Center for Hearing and Balance with support from the National Institute on Deafness and Other Communication Disorders, National Institutes of Health; Year: 1998; Format: Videorecording; [Baltimore, Md.]: Johns Hopkins University, c1998

•

Dizziness [slide]. Year: 1986; Format: Slide; [Columbus, Ohio]: Center for Continuing Medical Education, the Ohio State University College of Medicine, [1986]

•

Dizziness [videorecording] Source: Council on Continuing Physician Education; Year: 1979; Format: Videorecording; Chicago: American Medical Assn., c1979

•

Dizziness [videorecording] Source: Martin A. Samuels; Year: 1996; Format: Videorecording; Los Angeles, CA: Mayer Media, 1996

•

Dizziness of unknown origin [videorecording]: office evaluation and management Source: Ear Research Institute; Year: 1979; Format: Videorecording; [Los Angeles]: The Institute, c1979

•

Evaluating the dizzy patient [videorecording] Source: produced for the American Academy of Ophthalmology and Otolaryngology by Instructional Media Services, Faculty of Medicine, University of Toronto; Year: 1978; Format: Videorecording; Rochester, Minn.: The Academy, c1978

•

Evaluation of the dizzy patient [motion picture] Source: Medical Illustration and Audiovisual Education, Baylor College of Medicine, Texas Medical Center; Year: 1974; Format: Motion picture; Houston, Tex.: The College: [for loan by its Learning Resources Center, 1974]

•

Evaluation of the dizzy patient [videorecording] Source: produced by Southern Illinois University School of Medicine, Division of Biomedical Communications, Medical Television Section; Year: 1989; Format: Videorecording; [Alexandria, Va.: American Academy of Otolaryngology--Head and Neck Surgery Foundation, 1989]

•

Primary care [videorecording]: dizziness Source: a co-production of Multimedia Communications and Physician Education and Development; Year: 1998; Format: Videorecording; [Oakland, Calif.] : Kaiser Foundation Health Plan, c1998

•

The Dizzy patient [videorecording] Source: Ear Research Institute; Year: 1973; Format: Videorecording; Los Angeles: The Institute, [1973]

•

The Dizzy patient [videorecording]: diagnosis and treatment Source: produced in the facilities of Instructional Media Services, University of Washington; Year: 1993; Format: Videorecording; [Seattle, Wash.]: The University, c1993

•

Vertigo [motion picture]: differential diagnosis Source: [presented by] Smith Kline & French Laboratories; Year: 1967; Format: Motion picture; United States: The Laboratories, c1967

•

Vertigo [videorecording] Source: Brooke Army Medical Center; Year: 1971; Format: Videorecording; Fort Sam Houston, Tex.: Academy of Health Sciences, 1971

•

Vertigo [videorecording]: etiology & diagnosis Source: with Myron Frederic; Year: 1985; Format: Videorecording; Secaucus, N.J.: Network for Continuing Medical Education, 1985

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•

Vestibular function in the dizzy patient [videorecording] Source: American Academy of Ophthalmology and Otolaryngology; Year: 1976; Format: Videorecording; Rochester, Minn.: The Academy, c1976

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

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

Nicergoline appears safe and effective as treatment for vertigo Source: Reuters Industry Breifing Date: December 27, 2002

•

SSRIs relieve dizziness in patients with psychiatric symptoms Source: Reuters Industry Breifing Date: June 05, 2002

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•

Intratympanic gentamicin therapy relieves persistent vertigo Source: Reuters Medical News Date: February 13, 2002 The NIH

Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “dizziness” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “dizziness” (or synonyms). If you know the name of a company that is relevant to dizziness, 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 “dizziness” (or synonyms).

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

Cervicogenic Dizziness Source: Portland, OR: Vestibular Disorders Association. On the Level. Fall 2002. 19(4). p. 1-2. Contact: Vestibular Disorders Association. P.O. Box 4467, Portland, OR 97208-4467. (800) 837-8428. E-mail: [email protected]. Web site: www.vestibular.org. Summary: Cervicogenic dizziness is a syndrome that includes feelings of disequilibrium accompanied by neck pain and injury. This article describes the symptoms of cervicogenic dizziness, along with its potential causes, diagnosis, and treatment.

•

Tullio Phenomenon (Noise-Induced Imbalance and Dizziness) Source: On the Level. 17(3): 3. Summer 2000. Contact: Available from Vestibular Disorders Association. P.O. Box 4467, Portland, OR 97208-4467. (800) 837-8428. E-mail: [email protected]. Website: www.vestibular.org. Summary: This brief article from a newsletter for people with vestibular disorders, reports on the Tullio phenomenon (noise induced imbalance and dizziness). The article features a letter from a reader who has experienced noise induced hearing loss, tinnitus (ringing in the ears), and noise induced imbalance. The reader's concerns are addressed by Dr. Moller who notes that the Tullio phenomenon is a rare disorder in which exposure to very loud sounds can trigger imbalance, dizziness, and nystagmus (involuntary rhythmic eye movements). Various disorders have been reported to cause such sound sensitivity, including Meniere's disease, changes in the middle ear (dislocated stirrup footplate), and fistulas of the bony canals of the inner ears. In cases involving the Tullio phenomenon, MRI or CT scans are usually normal, and surgical exploration of the middle ear seldom reveals any abnormalities. The treatment for the Tullio phenomenon is to block loud low frequency sounds. The most effective way to do this is to use earmuffs. The next best solution is to use custom made earmolds.

•

Dizziness: A Doctor's Perspective Source: Steady. 6(4): 3-4. Fall 1994. Contact: Available from Ear Foundation. 2000 Church Street, Box 111, Nashville, TN 37236. (800) 545-HEAR; (615) 329-7809; TTY (615) 329-7849. PRICE: Reprints are available for $25.00/200 copies. Summary: This brief article, from the newsletter of the Meniere's Network, presents a doctor's perspective on dizziness. The author describes dizziness and other balance disturbances, and then discusses the common causes of central dizziness; vertigo and its causes, including Meniere's disease; the importance of diagnostic testing to reach

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accurate diagnosis; and treatment options, including medical or surgical modalities. The author concludes that most cases of dizziness are not serious and do respond to treatment, but it may take time. •

Dizziness: Procedure Improves Care of a Common Complaint Source: Mayo Clinic Health Letter. 12(12): 1-3. December 1994. Contact: Available from Mayo Clinic Health Letter. Subscription Services, P.O. Box 53889, Boulder, CO 80322-3889. (800) 633-4567. PRICE: $3.00 for single copy of newsletter, plus shipping and handling. Summary: This health newsletter article describes problems with dizziness and how some of those problems can be addressed with a technique called the canalith repositioning procedure. The article first describes dizziness, its many causes, and the different types of dizziness, including benign paroxysmal positional vertigo (BPPV). The article then describes the five simple maneuvers that make up the canalith repositing procedure and why they may work to eliminate dizziness. The authors note that standard treatment of BPPV involves a variety of approaches, including avoiding problem positions, doing difficult head exercises, and taking medications that may make patients drowsy and less aware of their dizziness. The canalith repositioning procedure improves on standard approaches because it is more effective, better tolerated, easy to perform, and inexpensive. The article concludes with a brief mention of typical diagnostic tests done to confirm BPPV. 2 figures.

•

Vertigo: Tracking Down a Moving Target Source: Harvard Health Letter. 24(8): 6-7. June 1999. Contact: Available from Harvard Health Letter. P.O. Box 380, Boston, MA 02117. (800) 829-9045 or (617) 432-1485. Summary: This health newsletter article reviews the problem of vertigo, a form of dizziness that features an illusory sense of moving or spinning. Vertigo can occur as a symptom of many conditions, including inner ear disorders, stroke and migraine, as a side effect of certain antibiotic drugs, and sometimes simply from tilting one's head back or to one side. Fortunately, treating underlying diseases, replacing or reducing drugs that cause vertigo, learning balancing exercises, or taking antihistamine medications can reduce or halt many cases. The author reviews the physiology of the vestibular system and defines some of the forms of vertigo, including benign positional vertigo and vestibular neuronitis. The author also discusses Meniere's disease and how it is treated. The author concludes by encouraging readers who have vertigo to apprise their doctor of any unexplained dizziness, in order to find and treat the cause of the problem. 1 figure.

•

Vertigo: Taking the Spin Out of Life Source: Mayo Clinic Health Letter. 18(7): 1-3. July 2000. Contact: Available from Mayo Foundation for Medical Education and Research. 200 First Street SW, Rochester, MN 55905. Summary: This newsletter article explores the issue of vertigo (a spinning type of dizziness) and what can be done to manage or prevent it. True vertigo, the most common form of dizziness, can result from a number of different causes. The author reviews the anatomy and structures of the inner ear and the balance system, including

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the role of the eyes, sensory nerves, and inner ear. The article also explains the canalith repositioning procedure, a common office procedure used to help relieve benign paroxysmal positional vertigo (BPPV). The author explores some of the causes of dizziness, including BPPV, Meniere's disease, inflammation of the inner ear (labyrinthitis or acute vestibular neuronitis); and some of the treatment options, including dietary changes, diuretics, sedatives, and antihistamines. One sidebar reviews the symptoms that should trigger a visit to the health care provider; these symptoms include vertigo or dizziness along with any of the following: new, different or severe headache, blurred vision, hearing loss, speech impairment, leg or arm weakness, loss of consciousness, falling or difficulty with walking, numbness or tingling, and chest pain or rapid or slow heart rate. 2 figures. •

Ask the Doctor: Benign Positional Paroxysmal Vertigo (BPPV) Source: On the Level. 17(1): 5-6. Winter 2000. Contact: Available from Vestibular Disorders Association. P.O. Box 4467, Portland, OR 97208-4467. (800) 837-8428. E-mail: [email protected]. Website: www.vestibular.org. Summary: This newsletter article offers readers information about benign positional paroxysmal vertigo (BPPV), a disorder related to the position of the head, characterized by sudden onset vertigo (spinning sensations). BPPV is a common disorder, and an estimated 15 to 20 percent of new patients seen at a vestibular clinic have this disorder. Patients with BPPV have very short by often intense episodes of vertigo lasting a few seconds but not more than 30 seconds. The vertigo is brought on by a change in head position: stooping forward, bending the head backwards to reach something on a high shelf, or turning in bed or getting up from bed. The author describes the pathology of BPPV, how the diagnosis is made, typical symptoms, and treatment options, notably the Canalith Repositioning Procedure (CRP, also called the Epley maneuver), and surgical options. 2 references.

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

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CHAPTER 10. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.

U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for dizziness. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a nonprofit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DI Advice for the Patient can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with dizziness. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The

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following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to dizziness: Androgens and Estrogens •

Systemic - U.S. Brands: Andrest 90-4; Andro-Estro 90-4; Androgyn L.A.; DeComberol; Deladumone; Delatestadiol; depAndrogyn; Depo-Testadiol; Depotestogen; Duo-Cyp; Duo-Gen L.A.; Dura-Dumone 90/4; Duratestin; Estratest; Estratest H.S.; Halodrin; Menoject-L.A.; OB; Premarin with http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202037.html

Anticholinergics/Antispasmodics •

Systemic - U.S. Brands: Anaspaz; A-Spas S/L; Banthine; Bentyl; Cantil; Cystospaz; Cystospaz-M; Donnamar; ED-SPAZ; Gastrosed; Homapin; Levbid; Levsin; Levsin/SL; Levsinex Timecaps; Pro-Banthine; Quarzan; Robinul; Robinul Forte; Symax SL; Transderm-Scop http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202049.html

Antihistamines •

Systemic - U.S. Brands: Aller-Chlor; AllerMax Caplets; Aller-med; Atarax; Banophen; Banophen Caplets; Benadryl; Benadryl Allergy; Bromphen; Calm X; Chlo-Amine; Chlorate; Chlor-Trimeton; Chlor-Trimeton Allergy; Chlor-Trimeton Repetabs; Claritin; Claritin Reditabs; Compoz; Conta http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202060.html

Antihistamines, Phenothiazine-Derivative •

Systemic - U.S. Brands: Anergan 25; Anergan 50; Antinaus 50; Pentazine; Phenazine 25; Phenazine 50; Phencen-50; Phenergan; Phenergan Fortis; Phenergan Plain; Phenerzine; Phenoject-50; Pro-50; Promacot; Pro-Med 50; Promet; Prorex-25; Prorex-50; Prothazine; Prothazine Plain; Sho http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202063.html

Attapulgite •

Oral - U.S. Brands: Diar-Aid; Diarrest; Diasorb; Diatrol; Donnagel; Kaopectate; Kaopek; K-Pek; Parepectolin; Rheaban http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202076.html

Bismuth Subsalicylate •

Oral - U.S. Brands: Bismatrol; Pepto-Bismol http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202092.html

Clomiphene •

Systemic - U.S. Brands: Clomid; Milophene; Serophene http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202151.html

Conjugated Estrogens and Medroxyprogesterone for Ovarian Hormone Therapy (Oht) •

Systemic - U.S. Brands: Note: http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/209441.html

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Difenoxin and Atropine •

Systemic - U.S. Brands: Motofen http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202193.html

Diphenoxylate and Atropine •

Systemic - U.S. Brands: Lofene; Logen; Lomocot; Lomotil; Lonox; Vi-Atro http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202200.html

Estrogens •

Systemic - U.S. Brands: Alora; Aquest; Climara; Clinagen LA 40; Delestrogen; depGynogen; Depo-Estradiol; Depogen; Dioval 40; Dioval XX; Dura-Estrin; Duragen-20; E-Cypionate; Estinyl; Estrace; Estraderm; Estragyn 5; Estragyn LA 5; Estra-L 40; Estratab; Estro-A; Estro-Cyp; Estro http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202226.html

Estrogens and Progestins (Ovarian Hormone Therapy) •

Systemic - U.S. Brands: Activella; Note: http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500070.html

Ethchlorvynol •

Systemic - U.S. Brands: Placidyl http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202230.html

Kaolin and Pectin •

Oral - U.S. Brands: Kao-Spen; Kapectolin; K-P http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202313.html

Loperamide •

Oral - U.S. Brands: Imodium http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202332.html

Meclizine/Buclizine/Cyclizine •

Systemic - U.S. Brands: Antivert; Antivert/25; Antivert/50; Bonine; Dramamine II; Marezine; Meclicot; Medivert http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202343.html

Nitrates Lingual Aerosol •

Systemic - U.S. Brands: Nitrolingual http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202410.html

Nitrates Sublingual, Chewable, or Buccal •

Systemic - U.S. Brands: Isordil; Nitrogard; Nitrostat; Sorbitrate http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202412.html

Thiabendazole •

Systemic - U.S. Brands: Mintezol http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202558.html

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Trazodone •

Systemic - U.S. Brands: Desyrel http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202573.html

Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.

Mosby’s Drug Consult Mosby’s Drug Consult database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/. PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html. Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee. If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.

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APPENDICES

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

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute13: •

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/

13

These publications are typically written by one or more of the various NIH Institutes.

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•

National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

•

National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

•

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

•

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

•

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

•

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

•

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

•

National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

•

National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

•

National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

•

National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

•

National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

•

National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

•

Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

•

National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

•

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

•

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

•

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

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.14 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:15 •

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

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

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

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

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

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Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

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

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

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

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

14

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

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

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

The NLM Gateway16 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.17 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “dizziness” (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 6567 193 1011 64 0 7835

HSTAT18 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.19 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.20 Simply search by “dizziness” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

16

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

17

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). 18 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 19 20

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 Biologists21 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.22 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.23 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/.

21 Adapted 22

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. 23 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 dizziness 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 dizziness. 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 dizziness. 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 “dizziness”:

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Guides on dizziness Dizziness and Vertigo http://www.nlm.nih.gov/medlineplus/dizzinessandvertigo.html

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Other guides Acoustic Neuroma http://www.nlm.nih.gov/medlineplus/acousticneuroma.html Arrhythmia http://www.nlm.nih.gov/medlineplus/arrhythmia.html Ear Disorders http://www.nlm.nih.gov/medlineplus/eardisorders.html Falls http://www.nlm.nih.gov/medlineplus/falls.html Head and Brain Injuries http://www.nlm.nih.gov/medlineplus/headandbraininjuries.html Hearing Disorders & Deafness http://www.nlm.nih.gov/medlineplus/hearingdisordersdeafness.html Heat Illness http://www.nlm.nih.gov/medlineplus/heatillness.html Meniere's Disease http://www.nlm.nih.gov/medlineplus/menieresdisease.html Motion Sickness http://www.nlm.nih.gov/medlineplus/motionsickness.html

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

General/Overviews Dizziness Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=DS00435 Dizziness and Motion Sickness Source: American Academy of Otolaryngology--Head and Neck Surgery http://www.entnet.org/healthinfo/balance/dizziness.cfm Vestibular Disorders: An Overview Source: Vestibular Disorders Association http://www.vestibular.org/overview.html

•

Diagnosis/Symptoms Diagnostic Tests Source: Vestibular Disorders Association http://www.vestibular.org/tests.html

Patient Resources

Possible Symptoms of Vestibular Disorders Source: Vestibular Disorders Association http://www.vestibular.org/symptoms.html Trouble Getting a Diagnosis? Source: Vestibular Disorders Association http://www.vestibular.org/trouble.html •

Treatment Hydrops and Meniere's Diet Suggestions Source: Vestibular Disorders Association http://www.vestibular.org/diet.html Surgical Treatments of Vertigo Source: American Hearing Research Foundation http://www.american-hearing.org/name/surgical_treatment.html

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Nutrition Specific Dietary Concerns Source: Vestibular Disorders Association http://www.vestibular.org/dietaryconcerns.html

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Coping Dining Out Source: Vestibular Disorders Association http://www.vestibular.org/dining.html

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Specific Conditions/Aspects Barotrauma Source: American Hearing Research Foundation http://www.american-hearing.org/name/barotrauma.html Benign Paroxysmal Positional Vertigo Source: Vestibular Disorders Association http://www.vestibular.org/bppv.html Benign Paroxysmal Positional Vertigo (BPPV) Source: American Hearing Research Foundation http://www.american-hearing.org/name/bppv.html Bilateral Vestibulopathy Source: American Hearing Research Foundation http://www.american-hearing.org/name/bilateral_vestibulopathy.html Cervical Vertigo Source: American Hearing Research Foundation http://www.american-hearing.org/name/cervical_vertigo.html Endolymphatic Hydrops Source: Vestibular Disorders Association http://www.vestibular.org/endolym.html

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Epileptic Vertigo Source: American Hearing Research Foundation http://www.american-hearing.org/name/epileptic_vertigo.html Mal de Debarquement (MDD) Source: American Hearing Research Foundation http://www.american-hearing.org/name/mdd.html Migraine and Vertigo Source: Vestibular Disorders Association http://www.vestibular.org/migraine.html Ototoxicity Source: Vestibular Disorders Association http://www.vestibular.org/ototox.html Vestibular Neuritis and Labyrinthitis Source: American Hearing Research Foundation http://www.american-hearing.org/name/vestibular_neuritis.html •

From the National Institutes of Health Balance Disorders Source: National Institute on Deafness and Other Communication Disorders http://www.nidcd.nih.gov/health/balance/balance_disorders.asp Balance, Dizziness, and You Source: National Institute on Deafness and Other Communication Disorders http://www.nidcd.nih.gov/health/balance/baldizz.asp NIHSeniorHealth: Balance Problems Source: National Institute on Deafness and Other Communication Disorders http://nihseniorhealth.gov/balanceproblems/toc.html

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Prevention/Screening Preventing Balance and Hearing Problems Source: Vestibular Disorders Association http://www.vestibular.org/prevent.html

You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on dizziness. 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.

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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: •

Dizziness Explained Source: Lemoyne, PA: Dizziness and Balance Disorders Center, Pennsylvania Neurological Associates, LTD. 1997. 40 p. Contact: Available from Dizziness and Balance Disorders Center. Pennsylvania Neurological Associates, LTD, 108 Lowther Street, Lemoyne, PA 17043. (717) 774-2202. PRICE: $7.50 each. Also available at users.aol.com/paneuro1/. Summary: This booklet presents an overview of dizziness and the vestibular system. Written by a physician, the booklet addresses the difficulty of obtaining an accurate diagnosis of the cause of a particular patient's dizziness. The first section outlines the kinds of dizziness, including vertigo, light-headedness, imbalance-disequilibrium, and psychic change. The author then describes the neurological examination done to diagnose a problem with dizziness. The section on the causes of dizziness discusses benign paroxysmal positional vertigo (BPPV), vestibular neuronitis, Meniere's disease (endolymphatic hydrops), labyrinthine concussion, perilymph fistula, cupulolithiasis, lateral medullary syndrome, and multiple sclerosis. The booklet concludes with a section on therapeutic options for treating dizziness and a section on the psychiatric aspects of dizziness. The addresses of four resource organizations are provided. The booklet concludes with an introduction to the concept of the brain as a computer and describes some physiological aspects of balance and brain function. 9 figures. (AA-M).

•

What You Can For Dizziness and Motion Sickness Source: Alexandria, VA: American Academy of Otolaryngology-Head and Neck Surgery. 2000. 4p. Contact: Available from American Academy of Otolaryngology-Head and Neck Surgery. One Prince St., Alexandria, VA 22314-3357. (703) 836-4444. TTY: (703) 519-1585. Web site: www.entnet.org. PRICE: Available free online; print brochure is $30.00 for 100 for non-members, plus shipping and handling. Discounted for members. Summary: This brochure discusses dizziness, vertigo, and motion sickness. Dizziness is used to describe a feeling of imbalance, without a sensation of turning or spinning; whereas vertigo includes a component of spinning. Motion sickness is a feeling of nausea or vomiting that occurs when riding in an airplane, automobile, amusement park ride, etc. The brochure details the anatomy of balance and the vestibular system and then explores the medical diseases that can cause dizziness. Circulation problems, injury, infection, allergy, and neurological diseases are some conditions that can cause dizziness. The brochure provides strategies for preventing and dealing with motion sickness. Another section explains the typical diagnostic procedures that a physician will use to confirm a vestibular disorder. The brochure concludes with a brief description of the medical specialty of otolaryngology-head and neck surgery. (AA-M).

•

Discussion of Dizziness Source: Los Angeles, CA: House Ear Institute. 1992. 40 p. Contact: Available from House Ear Institute. 2100 West Third Street, Fifth Floor, Los Angeles, CA 90057. Voice (800) 552-HEAR; (213) 483-4431; TTY (213) 484-2642; Fax (213) 483-8789. PRICE: $1.00 per booklet. Order Number BR-2.

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Summary: This brochure discusses dizziness. The booklet begins with a discussion of the function of the normal ear, and then describes the four parts of the human balance system. Additional topics include: types of dizziness; symptoms of ear dizziness; diagnosing the cause of dizziness; circulation changes due to blood vessel spasm, occlusion, or hemorrhage; treatment of dizziness due to changes in circulation; postural or positional dizziness; balance disorders related to aging; dizziness related to ear infection; neuritis; metabolic disturbances and allergies; dizziness attributed to head injury; perilymphatic fistula; autoimmune inner ear disease; tumors; Dandy's syndrome; vascular compression syndrome; Meniere's disease; surgical treatment for dizziness; and risks and complications of surgery for dizziness. •

On Balance: A Patient's Introduction to the Diagnosis and Treatment of Dizziness Source: Schaumburg, IL: ICS Medical Corporation. 2002. [4 p.]. Contact: Available from ICS Medical Corporation. 125 Commerce Drive, Schaumburg, IL 60173-5329. (800) 289-2150; Fax (847) 534-2152. E-mail: [email protected]. Website: http://www.icsmedical.com. PRICE: $15.00 for package of 50. Summary: This brochure discusses the diagnosis and treatment of dizziness. The author emphasizes that most causes of dizziness are detectable and treatable with the use of computerized diagnostics, drug therapy, and surgical techniques. Topics covered include the symptoms of dizziness, dizziness versus vertigo, the varied causes of dizziness, the use of eye movement testing (electronystagmography, or ENG), what to expect during an ENG, and how the ENG test results help the health care provider to establish an accurate diagnosis of the cause of a patient's dizziness.

•

Dizziness or Vertigo?: Understanding Balance Problems Source: San Bruno, CA: Staywell Company. 1999. 8 p. Contact: Available from Krames Communications. 1100 Grundy Lane, San Bruno, CA 94066-3030. (800) 333-3032. PRICE: $1.25 each plus shipping and handling; bulk discounts available. Stock Number 1111. Summary: This brochure provides basic patient education information about dizziness, vertigo, and other balance problems. Topics covered include the anatomy of the vestibular (balance) system; the difference between dizziness and vertigo; nystagmus; the medical evaluation of balance problems; diagnostic tests used, including electronystagmography (ENG), auditory brainstem response (ABR), magnetic resonance imaging (MRI), and neurologic consultations; possible causes of dizziness and vertigo; and suggestions for managing balance problems. The brochure is illustrated with fullcolor drawings and written in clear, easy-to-understand language.

•

Balance, Dizziness, and You Source: Bethesda, MD: National Institute on Deafness and Other Communication Disorders (NIDCD), National Institutes of Health (NIH). Contact: Available from NIDCD Information Clearinghouse. 1 Communication Avenue, Bethesda, MD 20892-3456. Voice (800) 241-1044. TTY (800) 241-1055. Fax (301) 907-8830. E-mail: [email protected]. Web site: www.nidcd.nih.gov. PRICE: Single copy free. Summary: This fact sheet explains balance disorders with common terminology used to describe the disorder, symptoms, and treatments. The document also provides tips for

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talking to your doctor about your symptoms and includes a form on which you can record medical information that may affect your diagnosis. The fact sheet includes resources and referrals for additional information. 5pp. •

Asking Your Audiologist About Vertigo (Dizziness) Source: Rockville, MD: American Speech-Language-Hearing Association (ASHA). 2000. 2 p. Contact: Available from American Speech-Language-Hearing Association (ASHA). Action Center, 10801 Rockville Pike, Rockville, MD 20852. (800) 638-8255. E-mail: [email protected]. Website: www.asha.org. PRICE: Single copy free for members. Summary: This fact sheet offers information on vertigo (dizziness). Written in a question and answer format, the fact sheet discusses the following topics: the causes of dizziness; symptoms of dizziness; how vertigo is treated; diagnostic tests that establish the cause and type of dizziness; vestibular rehabilitation services (individualized exercise activities that involve head, eye, or environmental visual movements that may influence the balance system function); and the role of the audiologist in the diagnosis and care of the person with dizziness. Results from audiology assessments, in combination with medical findings, provide diagnostic information on how best to treat vertigo. The fact sheet concludes with the contact information for the American Speech Language Hearing Association (ASHA), including their web site (www.asha.org).

•

Benign Paroxysmal Positional Vertigo Source: Portland, OR: Vestibular Disorders Association (VEDA). 1997. 4 p. Contact: Available from Vestibular Disorders Association (VEDA). P.O. Box 4467, Portland, OR 97208-4467. (503) 229-7705. Fax (503) 229-8064. E-mail: [email protected]. Website: www.vestibular.org. PRICE: $0.50 per copy. Order number R-5. Summary: This fact sheet provides detailed information on benign paroxysmal positional vertigo (BPPV), which causes dizziness due to debris that has collected within a part of the inner ear. Topics covered include the symptoms of BPPV; the causes of BPPV, including head trauma, viral infection, and Meniere's disease; diagnostic considerations; the office treatment of BPPV, including the Semont maneuver and the Elpey maneuver; post-procedure instructions for patients; home treatment using BrandtDaroff exercises, including a recommended schedule; the surgical treatment of BPPV; and the impact of BPPV on one's daily life. The fact sheet lists physicians in various regions of the U.S. (as well as one in Canada and two in France) who are known for treating BPPV. 2 figures. 11 references.

•

Causes of Dizziness Source: Portland, OR: Vestibular Disorders Association (VEDA). 199x. 4 p. Contact: Available from Vestibular Disorders Association (VEDA). P.O. Box 4467, Portland, OR 97208-4467. (503) 229-7705. Fax (503) 229-8064. E-mail: [email protected]. Website: www.vestibular.org. PRICE: $0.50 plus shipping and handling. Order number S-9. Summary: This fact sheet summarizes the various causes of dizziness and vertigo. The author begins with a review of how patients tend to describe different types of dizziness, and then describes the possible causes for each type. The fact sheet discusses

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cardiovascular disorders and dizziness, including arrhythmia, embolism, heart attack, defective heart valve, aneurysm, orthostatic hypotension, hardening of the vertebral arteries, and slowness of the carotid sinus reflex. Other topics include vestibular disorders and dizziness and multiple sensory deficits. The author concludes with a brief discussion of the drug therapy available to treat dizziness. •

Understanding Dizziness and Imbalance Source: London, England: Royal National Institute for Deaf People. 1995. 7 p. Contact: Available from RNID Helpline. P.O. Box 16464, London EC1Y 8TT, United Kingdom. 0870 60 50 123. Fax 0171-296 8199. E-mail: [email protected]. Website: www.rnid.org.uk. PRICE: Single copy free. Summary: This fact sheet, from the British Royal National Institute for Deaf People (RNID), gives basic information about dizziness and imbalance. Written in a question and answer format, the fact sheet discusses the causes of dizziness, disorientation, and unsteadiness; the vestibular system; specific types of balance problems including vertigo, neck related dizziness, position related dizziness, vestibular imbalance or dysfunction, and Meniere's disease; coping with dizziness and imbalance, including short term measures, medical treatments, and therapeutic exercises; and self help measures that can help people who have to live with long lasting dizziness. 2 figures.

•

Dealing with Dizziness Source: Baltimore, MD: Johns Hopkins Center for Hearing and Balance. 1999. (videocassette, brochure). Contact: Available from Vestibular Disorders Association. P.O. Box 4467, Portland, OR 97208-4467. (800) 837-8428. Fax (503) 229-8064. E-mail: [email protected]. Website: www.vestibular.org. PRICE: $20.00 to purchase; $7.00 to rent. Summary: This video and brochure provide information that clears up common misconceptions about balance disorders and offers hope that, in many cases, dizziness can be treated. The video describes the treatable inner ear conditions that can cause chronic dizziness (including Meniere's disease) and features patients who have recovered from serious vertigo and other vestibular problems. The brochure provides a step by step guide to getting help for dizziness and tips on communicating with one's physician. The program is a joint effort developed by the Johns Hopkins Center for Hearing and Balance, with support from the National Institute on Deafness and Other Communication Disorders (NIDCD) of the National Institutes of Health. The video is closed captioned. The National Guideline Clearinghouse™

The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search this site located at http://www.guideline.gov/ by using the keyword “dizziness” (or synonyms). The following was recently posted:

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ACR Appropriateness Criteria for vertigo and hearing loss Source: American College of Radiology - Medical Specialty Society; 1996 (revised 1999); 8 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2440&nbr=1666&a mp;string=dizziness Healthfinder™

Healthfinder™ is sponsored by the U.S. Department of Health and Human Services and offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: •

Ménière's Disease Summary: This consumer health information brochure discusses causes, symptoms, diagnosis and treatment of this Ménière's disease -- an abnormality of the inner ear that causes vertigo or severe dizziness, Source: National Institute on Deafness and Other Communication Disorders Information Clearinghouse http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=52

•

Treating Insulin Reactions Summary: Answers to questions about insulin reactions -- symptoms (shakiness, dizziness, sweating, hunger, headache, or sudden mood changes) and treatment. Source: American Diabetes Association http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=2218

•

Vestibular Schwannoma (Acoustic Neurinoma) and Neurofibromatosis Summary: This fact sheet provides consumers with basic facts about acoustic neurinoma -- a benign tumor which often causes gradual hearing loss, tinnitus or ringing in the ears, and dizziness. Source: National Institute on Deafness and Other Communication Disorders Information Clearinghouse http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=2066

•

What You Can Do for Dizziness and Motion Sickness Summary: This brochure provides basic information about dizziness and motion sickness and discusses causes, prevention and treatment options. Source: American Academy of Otolaryngology--Head and Neck Surgery http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=2181

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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 dizziness. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •


•

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

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

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

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

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

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

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

Meniere's Disease and Dizziness Support Group Telephone: (248) 585-8519 Fax: (248) 585-8519 Email: [email protected] Background: The Meniere s Disease and Dizziness Support Group is a not-for-profit self-help organization dedicated to helping individuals affected by Meniere s Disease to cope in society, family, and employment. Meniere s Disease is characterized by recurrent dizziness (vertigo), possible hearing loss, and ringing sounds (tinnitus). Established in 1989, the organization provides educational materials and maintains support groups for affected individuals and their families. Monthly meetings include professional speakers such as a specialist in the medical treatment and surgery of the ear (otologist); a specialist in the diagnosis and treatment of neurological disorders (neurologist); ear, nose, and throat specialist; physical therapist; and nutritionist. In addition, the Group helps affected individuals to help themselves to prevent an episode of symptoms.

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Relevant area(s) of interest: Dizziness, Vertigo

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to dizziness. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with dizziness. 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 dizziness. 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 “dizziness” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “dizziness”. 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 “dizziness” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months.

154 Dizziness

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 “dizziness” (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.24

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

24

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)25: •

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

•

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

•

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

•

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

•

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

•

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

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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/

25

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

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157

•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

•

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

•

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

•

Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

•

Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

•

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

•

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

•

Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

•

Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

•

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

•

Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

•

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

•

Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

•

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

•

Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

•

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

•

Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

•

Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

•

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

•

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

•

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

•

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

•

Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

•

Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

•

Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

•

Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

•

Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

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•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

160 Dizziness

•

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

•

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

•

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

•

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

161

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

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

•

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

•

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

•

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

•

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

•

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

•

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

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

Basic Guidelines for Dizziness Dizziness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003093.htm Vertigo-associated disorders Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001432.htm

•

Signs & Symptoms for Dizziness Anxiety Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003211.htm Chest pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003079.htm Confused Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003205.htm

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Coughing Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003072.htm Fainting Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003092.htm Faintness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003092.htm Headache Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003024.htm High blood pressure Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003082.htm Hyperventilation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003071.htm Hypotension Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003083.htm Lightheadedness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003092.htm Loss of consciousness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003202.htm Low blood pressure Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003083.htm Nausea Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm Nausea and vomiting Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm Numbness and tingling Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003206.htm Nystagmus Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003037.htm Seizures Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003200.htm Stress Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003211.htm Vertigo Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003093.htm

Online Glossaries 163

Weakness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003174.htm •

Diagnostics and Tests for Dizziness Blood pressure Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003398.htm Caloric stimulation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003429.htm ECG Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003868.htm EEG Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003931.htm Electronystagmography Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003448.htm ENG Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003448.htm Head CT Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003786.htm MRI Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003335.htm

•

Surgery and Procedures for Dizziness Middle ear surgery Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003015.htm

•

Background Topics for Dizziness Fractures Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000001.htm Physical examination Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002274.htm Shock Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000039.htm

164 Dizziness

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

165

DIZZINESS DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abdominal Pain: Sensation of discomfort, distress, or agony in the abdominal region. [NIH] Ablation: The removal of an organ by surgery. [NIH] Abscess: Accumulation of purulent material in tissues, organs, or circumscribed spaces, usually associated with signs of infection. [NIH] Acetaminophen: Analgesic antipyretic derivative of acetanilide. It has weak antiinflammatory properties and is used as a common analgesic, but may cause liver, blood cell, and kidney damage. [NIH] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Acne: A disorder of the skin marked by inflammation of oil glands and hair glands. [NIH] Acne Vulgaris: A chronic disorder of the pilosebaceous apparatus associated with an increase in sebum secretion. It is characterized by open comedones (blackheads), closed comedones (whiteheads), and pustular nodules. The cause is unknown, but heredity and age are predisposing factors. [NIH] Acoustic: Having to do with sound or hearing. [NIH] Activities of Daily Living: The performance of the basic activities of self care, such as dressing, ambulation, eating, etc., in rehabilitation. [NIH] Acupuncture Points: Designated locations along nerves or organ meridians for inserting acupuncture needles. [NIH] Adaptability: Ability to develop some form of tolerance to conditions extremely different from those under which a living organism evolved. [NIH] Adaptation: 1. The adjustment of an organism to its environment, or the process by which it enhances such fitness. 2. The normal ability of the eye to adjust itself to variations in the intensity of light; the adjustment to such variations. 3. The decline in the frequency of firing of a neuron, particularly of a receptor, under conditions of constant stimulation. 4. In dentistry, (a) the proper fitting of a denture, (b) the degree of proximity and interlocking of restorative material to a tooth preparation, (c) the exact adjustment of bands to teeth. 5. In microbiology, the adjustment of bacterial physiology to a new environment. [EU] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH]

166 Dizziness

Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adrenal Medulla: The inner part of the adrenal gland; it synthesizes, stores and releases catecholamines. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Aerophagia: A condition that occurs when a person swallows too much air. Causes gas and frequent belching. [NIH] Afferent: Concerned with the transmission of neural impulse toward the central part of the nervous system. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Age Groups: Persons classified by age from birth (infant, newborn) to octogenarians and older (aged, 80 and over). [NIH] Age of Onset: The age or period of life at which a disease or the initial symptoms or manifestations of a disease appear in an individual. [NIH] Aged, 80 and Over: A person 80 years of age and older. [NIH] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Agoraphobia: Obsessive, persistent, intense fear of open places. [NIH] Agranulocytosis: A decrease in the number of granulocytes (basophils, eosinophils, and neutrophils). [NIH] Alertness: A state of readiness to detect and respond to certain specified small changes occurring at random intervals in the environment. [NIH] Alexia: The inability to recognize or comprehend written or printed words. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alkaline: Having the reactions of an alkali. [EU] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Allergic Rhinitis: Inflammation of the nasal mucous membrane associated with hay fever; fits may be provoked by substances in the working environment. [NIH]

Dictionary 167

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] Ambulatory Care: Health care services provided to patients on an ambulatory basis, rather than by admission to a hospital or other health care facility. The services may be a part of a hospital, augmenting its inpatient services, or may be provided at a free-standing facility. [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] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amyloid: A general term for a variety of different proteins that accumulate as extracellular fibrils of 7-10 nm and have common structural features, including a beta-pleated sheet conformation and the ability to bind such dyes as Congo red and thioflavine (Kandel, Schwartz, and Jessel, Principles of Neural Science, 3rd ed). [NIH] Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Anaphylatoxins: The family of peptides C3a, C4a, C5a, and C5a des-arginine produced in the serum during complement activation. They produce smooth muscle contraction, mast cell histamine release, affect platelet aggregation, and act as mediators of the local inflammatory process. The order of anaphylatoxin activity from strongest to weakest is C5a, C3a, C4a, and C5a des-arginine. The latter is the so-called "classical" anaphylatoxin but shows no spasmogenic activity though it contains some chemotactic ability. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anecdotal report: An incomplete description of the medical and treatment history of one or more patients. Anecdotal reports may be published in places other than peer-reviewed, scientific journals. [NIH] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anesthetics: Agents that are capable of inducing a total or partial loss of sensation, especially tactile sensation and pain. They may act to induce general anesthesia, in which an unconscious state is achieved, or may act locally to induce numbness or lack of sensation at a targeted site. [NIH]

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Aneurysm: A sac formed by the dilatation of the wall of an artery, a vein, or the heart. [NIH] Angina: Chest pain that originates in the heart. [NIH] Angina Pectoris: The symptom of paroxysmal pain consequent to myocardial ischemia usually of distinctive character, location and radiation, and provoked by a transient stressful situation during which the oxygen requirements of the myocardium exceed the capacity of the coronary circulation to supply it. [NIH] Angiogenesis: Blood vessel formation. Tumor angiogenesis is the growth of blood vessels from surrounding tissue to a solid tumor. This is caused by the release of chemicals by the tumor. [NIH] Anionic: Pertaining to or containing an anion. [EU] Ankle: That part of the lower limb directly above the foot. [NIH] Anode: Electrode held at a positive potential with respect to a cathode. [NIH] Anomalies: Birth defects; abnormalities. [NIH] Anorexia: Lack or loss of appetite for food. Appetite is psychologic, dependent on memory and associations. Anorexia can be brought about by unattractive food, surroundings, or company. [NIH] Antagonism: Interference with, or inhibition of, the growth of a living organism by another living organism, due either to creation of unfavorable conditions (e. g. exhaustion of food supplies) or to production of a specific antibiotic substance (e. g. penicillin). [NIH] Antiallergic: Counteracting allergy or allergic conditions. [EU] Antiarrhythmic: An agent that prevents or alleviates cardiac arrhythmia. [EU] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticholinergic: An agent that blocks the parasympathetic nerves. Called also parasympatholytic. [EU] Anticonvulsant: An agent that prevents or relieves convulsions. [EU] Antidepressant: A drug used to treat depression. [NIH] Antiemetic: An agent that prevents or alleviates nausea and vomiting. Also antinauseant. [EU]

Antiepileptic: An agent that combats epilepsy. [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

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antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antigen-Antibody Complex: The complex formed by the binding of antigen and antibody molecules. The deposition of large antigen-antibody complexes leading to tissue damage causes immune complex diseases. [NIH] Antihistamine: A drug that counteracts the action of histamine. The antihistamines are of two types. The conventional ones, as those used in allergies, block the H1 histamine receptors, whereas the others block the H2 receptors. Called also antihistaminic. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Anti-Inflammatory Agents: Substances that reduce or suppress inflammation. [NIH] Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Antipsychotic: Effective in the treatment of psychosis. Antipsychotic drugs (called also neuroleptic drugs and major tranquilizers) are a chemically diverse (including phenothiazines, thioxanthenes, butyrophenones, dibenzoxazepines, dibenzodiazepines, and diphenylbutylpiperidines) but pharmacologically similar class of drugs used to treat schizophrenic, paranoid, schizoaffective, and other psychotic disorders; acute delirium and dementia, and manic episodes (during induction of lithium therapy); to control the movement disorders associated with Huntington's chorea, Gilles de la Tourette's syndrome, and ballismus; and to treat intractable hiccups and severe nausea and vomiting. Antipsychotic agents bind to dopamine, histamine, muscarinic cholinergic, a-adrenergic, and serotonin receptors. Blockade of dopaminergic transmission in various areas is thought to be responsible for their major effects : antipsychotic action by blockade in the mesolimbic and mesocortical areas; extrapyramidal side effects (dystonia, akathisia, parkinsonism, and tardive dyskinesia) by blockade in the basal ganglia; and antiemetic effects by blockade in the chemoreceptor trigger zone of the medulla. Sedation and autonomic side effects (orthostatic hypotension, blurred vision, dry mouth, nasal congestion and constipation) are caused by blockade of histamine, cholinergic, and adrenergic receptors. [EU] Antipyretic: An agent that relieves or reduces fever. Called also antifebrile, antithermic and febrifuge. [EU] Antispasmodic: An agent that relieves spasm. [EU] Antitussive: An agent that relieves or prevents cough. [EU] Anus: The opening of the rectum to the outside of the body. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Anxiolytic: An anxiolytic or antianxiety agent. [EU] Apathy: Lack of feeling or emotion; indifference. [EU] Aphasia: A cognitive disorder marked by an impaired ability to comprehend or express language in its written or spoken form. This condition is caused by diseases which affect the language areas of the dominant hemisphere. Clinical features are used to classify the various subtypes of this condition. General categories include receptive, expressive, and mixed forms of aphasia. [NIH] Apolipoproteins: The protein components of lipoproteins which remain after the lipids to which the proteins are bound have been removed. They play an important role in lipid transport and metabolism. [NIH] Applicability: A list of the commodities to which the candidate method can be applied as presented or with minor modifications. [NIH] Aqueous: Having to do with water. [NIH]

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Arginine: An essential amino acid that is physiologically active in the L-form. [NIH] Arrhythmia: Any variation from the normal rhythm or rate of the heart beat. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Articular: Of or pertaining to a joint. [EU] Aspirin: A drug that reduces pain, fever, inflammation, and blood clotting. Aspirin belongs to the family of drugs called nonsteroidal anti-inflammatory agents. It is also being studied in cancer prevention. [NIH] Asthenia: Clinical sign or symptom manifested as debility, or lack or loss of strength and energy. [NIH] Asymptomatic: Having no signs or symptoms of disease. [NIH] Ataxia: Impairment of the ability to perform smoothly coordinated voluntary movements. This condition may affect the limbs, trunk, eyes, pharnyx, larnyx, and other structures. Ataxia may result from impaired sensory or motor function. Sensory ataxia may result from posterior column injury or peripheral nerve diseases. Motor ataxia may be associated with cerebellar diseases; cerebral cortex diseases; thalamic diseases; basal ganglia diseases; injury to the red nucleus; and other conditions. [NIH] Atrial: Pertaining to an atrium. [EU] Atrial Fibrillation: Disorder of cardiac rhythm characterized by rapid, irregular atrial impulses and ineffective atrial contractions. [NIH] Atrial Flutter: Rapid, irregular atrial contractions due to an abnormality of atrial excitation. [NIH]

Atrioventricular: Pertaining to an atrium of the heart and to a ventricle. [EU] Atrioventricular Node: A small nodular mass of specialized muscle fibers located in the interatrial septum near the opening of the coronary sinus. It gives rise to the atrioventricular bundle of the conduction system of the heart. [NIH] Atrium: A chamber; used in anatomical nomenclature to designate a chamber affording entrance to another structure or organ. Usually used alone to designate an atrium of the heart. [EU] Atropine: A toxic alkaloid, originally from Atropa belladonna, but found in other plants, mainly Solanaceae. [NIH] Attenuated: Strain with weakened or reduced virulence. [NIH] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Audiologist: Study of hearing including treatment of persons with hearing defects. [NIH] Audiology: The study of hearing and hearing impairment. [NIH] Auditory: Pertaining to the sense of hearing. [EU] Aura: A subjective sensation or motor phenomenon that precedes and marks the of a paroxysmal attack, such as an epileptic attack on set. [EU] Aural: Pertaining to or perceived by the ear, as an aural stimulus. [EU] Autoantibodies: Antibodies that react with self-antigens (autoantigens) of the organism that produced them. [NIH]

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Autoimmune disease: A condition in which the body recognizes its own tissues as foreign and directs an immune response against them. [NIH] Autonomic: Self-controlling; functionally independent. [EU] Autonomic Nervous System: The enteric, parasympathetic, and sympathetic nervous systems taken together. Generally speaking, the autonomic nervous system regulates the internal environment during both peaceful activity and physical or emotional stress. Autonomic activity is controlled and integrated by the central nervous system, especially the hypothalamus and the solitary nucleus, which receive information relayed from visceral afferents; these and related central and sensory structures are sometimes (but not here) considered to be part of the autonomic nervous system itself. [NIH] Axons: Nerve fibers that are capable of rapidly conducting impulses away from the neuron cell body. [NIH] Azithromycin: A semi-synthetic macrolide antibiotic structurally related to erythromycin. It has been used in the treatment of Mycobacterium avium intracellulare infections, toxoplasmosis, and cryptosporidiosis. [NIH] Back Pain: Acute or chronic pain located in the posterior regions of the trunk, including the thoracic, lumbar, sacral, or adjacent regions. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacterial Infections: Infections by bacteria, general or unspecified. [NIH] Bacterial Physiology: Physiological processes and activities of bacteria. [NIH] Bacterium: Microscopic organism which may have a spherical, rod-like, or spiral unicellular or non-cellular body. Bacteria usually reproduce through asexual processes. [NIH] Baroreflex: A negative feedback system which buffers short-term changes in blood pressure. Increased pressure stretches blood vessels which activates pressoreceptors (baroreceptors) in the vessel walls. The net response of the central nervous system is a reduction of central sympathetic outflow. This reduces blood pressure both by decreasing peripheral vascular resistance and by lowering cardiac output. Because the baroreceptors are tonically active, the baroreflex can compensate rapidly for both increases and decreases in blood pressure. [NIH]

Barotrauma: Injury following pressure changes; includes injury to the eustachian tube, ear drum, lung and stomach. [NIH] Basal Ganglia: Large subcortical nuclear masses derived from the telencephalon and located in the basal regions of the cerebral hemispheres. [NIH] Basal Ganglia Diseases: Diseases of the basal ganglia including the putamen; globus pallidus; claustrum; amygdala; and caudate nucleus. Dyskinesias (most notably involuntary movements and alterations of the rate of movement) represent the primary clinical manifestations of these disorders. Common etiologies include cerebrovascular disease; neurodegenerative diseases; and craniocerebral trauma. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Basophils: Granular leukocytes characterized by a relatively pale-staining, lobate nucleus and cytoplasm containing coarse dark-staining granules of variable size and stainable by basic dyes. [NIH]

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Belching: Noisy release of gas from the stomach through the mouth. Also called burping. [NIH]

Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Benign tumor: A noncancerous growth that does not invade nearby tissue or spread to other parts of the body. [NIH] Benzene: Toxic, volatile, flammable liquid hydrocarbon biproduct of coal distillation. It is used as an industrial solvent in paints, varnishes, lacquer thinners, gasoline, etc. Benzene causes central nervous system damage acutely and bone marrow damage chronically and is carcinogenic. It was formerly used as parasiticide. [NIH] Benzodiazepines: A two-ring heterocyclic compound consisting of a benzene ring fused to a diazepine ring. Permitted is any degree of hydrogenation, any substituents and any Hisomer. [NIH] Betahistine: N-Methyl-2-pyridineethanamine. A physiological histamine analog vasodilator agent that also acts as a histamine H1 receptor agonist. It is used in Meniere's disease and in vascular headaches but may exacerbate bronchial asthma and peptic ulcers. [NIH] Beta-pleated: Particular three-dimensional pattern of amyloidoses. [NIH] Bilateral: Affecting both the right and left side of body. [NIH] Biliary: Having to do with the liver, bile ducts, and/or gallbladder. [NIH] Binaural: Used of the two ears functioning together. [NIH] Bioavailability: The degree to which a drug or other substance becomes available to the target tissue after administration. [EU] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Bioluminescence: The emission of light by living organisms such as the firefly, certain mollusks, beetles, fish, bacteria, fungi and protozoa. [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] Bismuth: A metallic element that has the atomic symbol Bi, atomic number 83 and atomic weight 208.98. [NIH] Bismuth Subsalicylate: A nonprescription medicine such as Pepto-Bismol. Used to treat diarrhea, heartburn, indigestion, and nausea. It is also part of the treatment for ulcers caused by the bacterium Helicobacter pylori (HELL-uh-koh-BAK-tur py-LOH-ree). [NIH] Bladder: The organ that stores urine. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood Glucose: Glucose in blood. [NIH] Blood Platelets: Non-nucleated disk-shaped cells formed in the megakaryocyte and found in the blood of all mammals. They are mainly involved in blood coagulation. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example,

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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] Bone Conduction: Sound transmission through the bones of the skull to the inner ear. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bone scan: A technique to create images of bones on a computer screen or on film. A small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it collects in the bones and is detected by a scanner. [NIH] Bottle Feeding: Use of nursing bottles for feeding. Applies to humans and animals. [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] Bradykinin: A nonapeptide messenger that is enzymatically produced from kallidin in the blood where it is a potent but short-lived agent of arteriolar dilation and increased capillary permeability. Bradykinin is also released from mast cells during asthma attacks, from gut walls as a gastrointestinal vasodilator, from damaged tissues as a pain signal, and may be a neurotransmitter. [NIH] Brain Infarction: The formation of an area of necrosis in the brain, including the cerebral hemispheres (cerebral infarction), thalami, basal ganglia, brain stem (brain stem infarctions), or cerebellum secondary to an insufficiency of arterial or venous blood flow. [NIH] Brain Stem: The part of the brain that connects the cerebral hemispheres with the spinal cord. It consists of the mesencephalon, pons, and medulla oblongata. [NIH] Brain Stem Infarctions: Infarctions that occur in the brain stem which is comprised of the midbrain, pons, and medulla. There are several named syndromes characterized by their distinctive clinical manifestations and specific sites of ischemic injury. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Breakdown: A physical, metal, or nervous collapse. [NIH] Bronchial: Pertaining to one or more bronchi. [EU] Buffers: A chemical system that functions to control the levels of specific ions in solution. When the level of hydrogen ion in solution is controlled the system is called a pH buffer. [NIH]

Bullous: Pertaining to or characterized by bullae. [EU] Buspirone: An anxiolytic agent and a serotonin receptor agonist belonging to the azaspirodecanedione class of compounds. Its structure is unrelated to those of the benzodiazepines, but it has an efficacy comparable to diazepam. [NIH] Caffeine: A methylxanthine naturally occurring in some beverages and also used as a pharmacological agent. Caffeine's most notable pharmacological effect is as a central nervous system stimulant, increasing alertness and producing agitation. It also relaxes smooth muscle, stimulates cardiac muscle, stimulates diuresis, and appears to be useful in

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the treatment of some types of headache. Several cellular actions of caffeine have been observed, but it is not entirely clear how each contributes to its pharmacological profile. Among the most important are inhibition of cyclic nucleotide phosphodiesterases, antagonism of adenosine receptors, and modulation of intracellular calcium handling. [NIH] Calcification: Deposits of calcium in the tissues of the breast. Calcification in the breast can be seen on a mammogram, but cannot be detected by touch. There are two types of breast calcification, macrocalcification and microcalcification. Macrocalcifications are large deposits and are usually not related to cancer. Microcalcifications are specks of calcium that may be found in an area of rapidly dividing cells. Many microcalcifications clustered together may be a sign of cancer. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Calcium Carbonate: Carbonic acid calcium salt (CaCO3). An odorless, tasteless powder or crystal that occurs in nature. It is used therapeutically as a phosphate buffer in hemodialysis patients and as a calcium supplement. [NIH] Calcium channel blocker: A drug used to relax the blood vessel and heart muscle, causing pressure inside blood vessels to drop. It also can regulate heart rhythm. [NIH] Calcium Channel Blockers: A class of drugs that act by selective inhibition of calcium influx through cell membranes or on the release and binding of calcium in intracellular pools. Since they are inducers of vascular and other smooth muscle relaxation, they are used in the drug therapy of hypertension and cerebrovascular spasms, as myocardial protective agents, and in the relaxation of uterine spasms. [NIH] Calcium Channels: Voltage-dependent cell membrane glycoproteins selectively permeable to calcium ions. They are categorized as L-, T-, N-, P-, Q-, and R-types based on the activation and inactivation kinetics, ion specificity, and sensitivity to drugs and toxins. The L- and T-types are present throughout the cardiovascular and central nervous systems and the N-, P-, Q-, & R-types are located in neuronal tissue. [NIH] Calmodulin: A heat-stable, low-molecular-weight activator protein found mainly in the brain and heart. The binding of calcium ions to this protein allows this protein to bind to cyclic nucleotide phosphodiesterases and to adenyl cyclase with subsequent activation. Thereby this protein modulates cyclic AMP and cyclic GMP levels. [NIH] Caloric Tests: Elicitation of a rotatory nystagmus by stimulating the semicircular canals with water or air which is above or below body temperature. In warm caloric stimulation a rotatory nystagmus is developed toward the side of the stimulated ear; in cold, away from the stimulated side. Absence of nystagmus indicates the labyrinth is not functioning. [NIH] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Carcinogen: Any substance that causes cancer. [NIH] Cardiac: Having to do with the heart. [NIH] Cardiac arrest: A sudden stop of heart function. [NIH] Cardiac Output: The volume of blood passing through the heart per unit of time. It is usually expressed as liters (volume) per minute so as not to be confused with stroke volume

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(volume per beat). [NIH] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cardiovascular disease: Any abnormal condition characterized by dysfunction of the heart and blood vessels. CVD includes atherosclerosis (especially coronary heart disease, which can lead to heart attacks), cerebrovascular disease (e.g., stroke), and hypertension (high blood pressure). [NIH] Cardiovascular System: The heart and the blood vessels by which blood is pumped and circulated through the body. [NIH] Carotid Sinus: The dilated portion of the common carotid artery at its bifurcation into external and internal carotids. It contains baroreceptors which, when stimulated, cause slowing of the heart, vasodilatation, and a fall in blood pressure. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] 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] Cathode: An electrode, usually an incandescent filament of tungsten, which emits electrons in an X-ray tube. [NIH] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [EU] Causal: Pertaining to a cause; directed against a cause. [EU] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Death: The termination of the cell's ability to carry out vital functions such as metabolism, growth, reproduction, responsiveness, and adaptability. [NIH] Cell Differentiation: Progressive restriction of the developmental potential and increasing specialization of function which takes place during the development of the embryo and leads to the formation of specialized cells, tissues, and organs. [NIH] Cell membrane: Cell membrane = plasma membrane. The structure enveloping a cell, enclosing the cytoplasm, and forming a selective permeability barrier; it consists of lipids, proteins, and some carbohydrates, the lipids thought to form a bilayer in which integral proteins are embedded to varying degrees. [EU] Cell Respiration: The metabolic process of all living cells (animal and plant) in which oxygen is used to provide a source of energy for the cell. [NIH] Cellular Structures: Components of a cell. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Central Nervous System Infections: Pathogenic infections of the brain, spinal cord, and meninges. DNA virus infections; RNA virus infections; bacterial infections; mycoplasma infections; Spirochaetales infections; fungal infections; protozoan infections; helminthiasis; and prion diseases may involve the central nervous system as a primary or secondary process. [NIH] Cerebellar: Pertaining to the cerebellum. [EU]

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Cerebellopontine: Going from the cerebellum (the part of the brain responsible for coordinating movement) to the pons (part of the central nervous system located near the base of the brain.) [NIH] Cerebellopontine Angle: Junction between the cerebellum and the pons. [NIH] Cerebellum: Part of the metencephalon that lies in the posterior cranial fossa behind the brain stem. It is concerned with the coordination of movement. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebrospinal: Pertaining to the brain and spinal cord. [EU] Cerebrospinal fluid: CSF. The fluid flowing around the brain and spinal cord. Cerebrospinal fluid is produced in the ventricles in the brain. [NIH] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH] Cetirizine: A potent second-generation histamine H1 antagonist that is effective in the treatment of allergic rhinitis, chronic urticaria, and pollen-induced asthma. Unlike many traditional antihistamines, it does not cause drowsiness or anticholinergic side effects. [NIH] Character: In current usage, approximately equivalent to personality. The sum of the relatively fixed personality traits and habitual modes of response of an individual. [NIH] Chemoreceptor: A receptor adapted for excitation by chemical substances, e.g., olfactory and gustatory receptors, or a sense organ, as the carotid body or the aortic (supracardial) bodies, which is sensitive to chemical changes in the blood stream, especially reduced oxygen content, and reflexly increases both respiration and blood pressure. [EU] Chemotactic Factors: Chemical substances that attract or repel cells or organisms. The concept denotes especially those factors released as a result of tissue injury, invasion, or immunologic activity, that attract leukocytes, macrophages, or other cells to the site of infection or insult. [NIH] Chemotherapy: Treatment with anticancer drugs. [NIH] Chest Pain: Pressure, burning, or numbness in the chest. [NIH] Chiropractic: A system of treating bodily disorders by manipulation of the spine and other parts, based on the belief that the cause is the abnormal functioning of a nerve. [NIH] Chlorpromazine: The prototypical phenothiazine antipsychotic drug. Like the other drugs in this class chlorpromazine's antipsychotic actions are thought to be due to long-term adaptation by the brain to blocking dopamine receptors. Chlorpromazine has several other actions and therapeutic uses, including as an antiemetic and in the treatment of intractable hiccup. [NIH] Cholesteatoma: A non-neoplastic keratinizing mass with stratified squamous epithelium, frequently occurring in the meninges, central nervous system, bones of the skull, and most commonly in the middle ear and mastoid region. [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]

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Cholinergic: Resembling acetylcholine in pharmacological action; stimulated by or releasing acetylcholine or a related compound. [EU] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic Disease: Disease or ailment of long duration. [NIH] Cinnarizine: A piperazine derivative with histamine H1-receptor and calcium-channel blocking activity and considerable antiemetic properties. [NIH] CIS: Cancer Information Service. The CIS is the National Cancer Institute's link to the public, interpreting and explaining research findings in a clear and understandable manner, and providing personalized responses to specific questions about cancer. Access the CIS by calling 1-800-4-CANCER, or by using the Web site at http://cis.nci.nih.gov. [NIH] Classic Migraine: Migraine preceded or accompanied by characteristic visual sensory disturbances, especially peripheral scintillations and hemianopsia. [NIH] Cleft Palate: Congenital fissure of the soft and/or hard palate, due to faulty fusion. [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] Cochlea: The part of the internal ear that is concerned with hearing. It forms the anterior part of the labyrinth, is conical, and is placed almost horizontally anterior to the vestibule. [NIH]

Cochlear: Of or pertaining to the cochlea. [EU] Cochlear Diseases: Diseases of the cochlea, the part of the inner ear that is concerned with hearing. [NIH] Cochlear Implantation: Surgical insertion of an electronic device implanted beneath the skin with electrodes to the cochlear nerve to create sound sensation in persons with sensorineural deafness. [NIH] Cochlear Nerve: The cochlear part of the 8th cranial nerve (vestibulocochlear nerve). The cochlear nerve fibers originate from neurons of the spiral ganglion and project peripherally to cochlear hair cells and centrally to the cochlear nuclei (cochlear nucleus) of the brain stem. They mediate the sense of hearing. [NIH] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Cognition: Intellectual or mental process whereby an organism becomes aware of or obtains knowledge. [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]

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Communication Disorders: Disorders of verbal and nonverbal communication caused by receptive or expressive language disorders, cognitive dysfunction (e.g., mental retardation), psychiatric conditions, and hearing disorders. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the 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] Compulsion: In psychology, an irresistible urge, sometimes amounting to obsession to perform a particular act which usually is carried out against the performer's will or better judgment. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Computed tomography: CT scan. A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized tomography and computerized axial tomography (CAT) scan. [NIH] Computerized axial tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray

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machine. Also called CAT scan, computed tomography (CT scan), or computerized tomography. [NIH] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Concomitant: Accompanying; accessory; joined with another. [EU] Concretion: Minute, hard, yellow masses found in the palpebral conjunctivae of elderly people or following chronic conjunctivitis, composed of the products of cellular degeneration retained in the depressions and tubular recesses in the conjunctiva. [NIH] Conduction: The transfer of sound waves, heat, nervous impulses, or electricity. [EU] Cone: One of the special retinal receptor elements which are presumed to be primarily concerned with perception of light and color stimuli when the eye is adapted to light. [NIH] Confusion: A mental state characterized by bewilderment, emotional disturbance, lack of clear thinking, and perceptual disorientation. [NIH] Congestion: Excessive or abnormal accumulation of blood in a part. [EU] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] 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] Constriction, Pathologic: The condition of an anatomical structure's being constricted beyond normal dimensions. [NIH] Contraceptive: An agent that diminishes the likelihood of or prevents conception. [EU] Contraceptive Agents: Chemical substances that prevent or reduce the probability of conception. [NIH] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Contralateral: Having to do with the opposite side of the body. [NIH] Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works. [NIH] Controlled clinical trial: A clinical study that includes a comparison (control) group. The comparison group receives a placebo, another treatment, or no treatment at all. [NIH] Controlled study: An experiment or clinical trial that includes a comparison (control) group. [NIH]

Contusion: A bruise; an injury of a part without a break in the skin. [EU] Convulsions: A general term referring to sudden and often violent motor activity of cerebral or brainstem origin. Convulsions may also occur in the absence of an electrical cerebral discharge (e.g., in response to hypotension). [NIH] Coordination: Muscular or motor regulation or the harmonious cooperation of muscles or groups of muscles, in a complex action or series of actions. [NIH] Cornea: The transparent part of the eye that covers the iris and the pupil and allows light to enter the inside. [NIH]

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Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Circulation: The circulation of blood through the coronary vessels of the heart. [NIH]

Coronary heart disease: A type of heart disease caused by narrowing of the coronary arteries that feed the heart, which needs a constant supply of oxygen and nutrients carried by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by fat and cholesterol deposits and cannot supply enough blood to the heart, CHD results. [NIH] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Corpus: The body of the uterus. [NIH] Corpus Luteum: The yellow glandular mass formed in the ovary by an ovarian follicle that has ruptured and discharged its ovum. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Cortical: Pertaining to or of the nature of a cortex or bark. [EU] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Cranial Nerves: Twelve pairs of nerves that carry general afferent, visceral afferent, special afferent, somatic efferent, and autonomic efferent fibers. [NIH] Craniocerebral Trauma: Traumatic injuries involving the cranium and intracranial structures (i.e., brain; cranial nerves; meninges; and other structures). Injuries may be classified by whether or not the skull is penetrated (i.e., penetrating vs. nonpenetrating) or whether there is an associated hemorrhage. [NIH] Cryptosporidiosis: Parasitic intestinal infection with severe diarrhea caused by a protozoan, Cryptosporidium. It occurs in both animals and humans. [NIH] Cues: Signals for an action; that specific portion of a perceptual field or pattern of stimuli to which a subject has learned to respond. [NIH] Curare: Plant extracts from several species, including Strychnos toxifera, S. castelnaei, S. crevauxii, and Chondodendron tomentosum, that produce paralysis of skeletal muscle and are used adjunctively with general anesthesia. These extracts are toxic and must be used with the administration of artificial respiration. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cutaneous: Having to do with the skin. [NIH] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cyst: A sac or capsule filled with fluid. [NIH] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Databases, Bibliographic: Extensive collections, reputedly complete, of references and citations to books, articles, publications, etc., generally on a single subject or specialized subject area. Databases can operate through automated files, libraries, or computer disks. The concept should be differentiated from factual databases which is used for collections of

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data and facts apart from bibliographic references to them. [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] Decongestant: An agent that reduces congestion or swelling. [EU] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dehydration: The condition that results from excessive loss of body water. [NIH] Delirium: (DSM III-R) an acute, reversible organic mental disorder characterized by reduced ability to maintain attention to external stimuli and disorganized thinking as manifested by rambling, irrelevant, or incoherent speech; there are also a reduced level of consciousness, sensory misperceptions, disturbance of the sleep-wakefulness cycle and level of psychomotor activity, disorientation to time, place, or person, and memory impairment. Delirium may be caused by a large number of conditions resulting in derangement of cerebral metabolism, including systemic infection, poisoning, drug intoxication or withdrawal, seizures or head trauma, and metabolic disturbances such as hypoxia, hypoglycaemia, fluid, electrolyte, or acid-base imbalances, or hepatic or renal failure. Called also acute confusional state and acute brain syndrome. [EU] Delusions: A false belief regarding the self or persons or objects outside the self that persists despite the facts, and is not considered tenable by one's associates. [NIH] Dendrites: Extensions of the nerve cell body. They are short and branched and receive stimuli from other neurons. [NIH] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Depth Perception: Perception of three-dimensionality. [NIH] Dermal: Pertaining to or coming from the skin. [NIH] Dermatitis: Any inflammation of the skin. [NIH] Dermatitis Herpetiformis: Rare, chronic, papulo-vesicular disease characterized by an intensely pruritic eruption consisting of various combinations of symmetrical, erythematous, papular, vesicular, or bullous lesions. The disease is strongly associated with the presence of HLA-B8 and HLA-DR3 antigens. A variety of different autoantibodies has been detected in small numbers in patients with dermatitis herpetiformis. [NIH] Dermatosis: Any skin disease, especially one not characterized by inflammation. [EU] Detoxification: Treatment designed to free an addict from his drug habit. [EU] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diagnostic Errors: Incorrect diagnoses after clinical examination or technical diagnostic procedures. [NIH] Diagnostic procedure: A method used to identify a disease. [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]

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Dicyclomine: A muscarinic antagonist used as an antispasmodic and in urinary incontinence. It has little effect on glandular secretion or the cardiovascular system. It does have some local anesthetic properties and is used in gastrointestinal, biliary, and urinary tract spasms. [NIH] Diffusion: The tendency of a gas or solute to pass from a point of higher pressure or concentration to a point of lower pressure or concentration and to distribute itself throughout the available space; a major mechanism of biological transport. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Dilatation: The act of dilating. [NIH] Dilatation, Pathologic: The condition of an anatomical structure's being dilated beyond normal dimensions. [NIH] Dilation: A process by which the pupil is temporarily enlarged with special eye drops (mydriatic); allows the eye care specialist to better view the inside of the eye. [NIH] Dimenhydrinate: A drug combination that contains diphenhydramine and theophylline. It is used for treating vertigo, motion sickness, and nausea associated with pregnancy. It is not effective in the treatment of nausea associated with cancer chemotherapy. [NIH] Diphenhydramine: A histamine H1 antagonist used as an antiemetic, antitussive, for dermatoses and pruritus, for hypersensitivity reactions, as a hypnotic, an antiparkinson, and as an ingredient in common cold preparations. It has some undesired antimuscarinic and sedative effects. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Dislocation: The displacement of any part, more especially of a bone. Called also luxation. [EU]

Disorientation: The loss of proper bearings, or a state of mental confusion as to time, place, or identity. [EU] Disparity: Failure of the two retinal images of an object to fall on corresponding retinal points. [NIH] Dissociation: 1. The act of separating or state of being separated. 2. The separation of a molecule into two or more fragments (atoms, molecules, ions, or free radicals) produced by the absorption of light or thermal energy or by solvation. 3. In psychology, a defense mechanism in which a group of mental processes are segregated from the rest of a person's mental activity in order to avoid emotional distress, as in the dissociative disorders (q.v.), or in which an idea or object is segregated from its emotional significance; in the first sense it is roughly equivalent to splitting, in the second, to isolation. 4. A defect of mental integration in which one or more groups of mental processes become separated off from normal consciousness and, thus separated, function as a unitary whole. [EU] Diuresis: Increased excretion of urine. [EU] Diving: An activity in which the organism plunges into water. It includes scuba and bell diving. Diving as natural behavior of animals goes here, as well as diving in decompression experiments with humans or animals. [NIH] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH]

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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] Dorsal: 1. Pertaining to the back or to any dorsum. 2. Denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Dosage Forms: Completed forms of the pharmaceutical preparation in which prescribed doses of medication are included. They are designed to resist action by gastric fluids, prevent vomiting and nausea, reduce or alleviate the undesirable taste and smells associated with oral administration, achieve a high concentration of drug at target site, or produce a delayed or long-acting drug effect. They include capsules, liniments, ointments, pharmaceutical solutions, powders, tablets, etc. [NIH] Doxycycline: A synthetic tetracycline derivative with a range of antimicrobial activity and mode of action similar to that of tetracycline, but more effective against many species. Animal studies suggest that it may cause less tooth staining than other tetracyclines. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Drug Tolerance: Progressive diminution of the susceptibility of a human or animal to the effects of a drug, resulting from its continued administration. It should be differentiated from drug resistance wherein an organism, disease, or tissue fails to respond to the intended effectiveness of a chemical or drug. It should also be differentiated from maximum tolerated dose and no-observed-adverse-effect level. [NIH] Duodenum: The first part of the small intestine. [NIH] Dyes: Chemical substances that are used to stain and color other materials. The coloring may or may not be permanent. Dyes can also be used as therapeutic agents and test reagents in medicine and scientific research. [NIH] Dyslexia: Partial alexia in which letters but not words may be read, or in which words may be read but not understood. [NIH] Dyspepsia: Impaired digestion, especially after eating. [NIH] Dysphagia: Difficulty in swallowing. [EU] Dysphonia: Difficulty or pain in speaking; impairment of the voice. [NIH] Dystonia: Disordered tonicity of muscle. [EU] Earache: Pain in the ear. [NIH] Eardrum: A thin, tense membrane forming the greater part of the outer wall of the tympanic cavity and separating it from the external auditory meatus; it constitutes the boundary between the external and middle ear. [NIH] Eccentricities: Oddness of behavior or conduct without insanity. [NIH] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service

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produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Elastin: The protein that gives flexibility to tissues. [NIH] 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] 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] Electronystagmography: Recording of nystagmus based on changes in the electrical field surrounding the eye produced by the difference in potential between the cornea and the retina. [NIH] Electrophysiological: Pertaining to electrophysiology, that is a branch of physiology that is concerned with the electric phenomena associated with living bodies and involved in their functional activity. [EU] Elementary Particles: Individual components of atoms, usually subatomic; subnuclear particles are usually detected only when the atomic nucleus decays and then only transiently, as most of them are unstable, often yielding pure energy without substance, i.e., radiation. [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] Embolus: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Emesis: Vomiting; an act of vomiting. Also used as a word termination, as in haematemesis. [EU]

Emetics: Agents that cause vomiting. They may act directly on the gastrointestinal tract, bringing about emesis through local irritant effects, or indirectly, through their effects on the chemoreceptor trigger zone in the postremal area near the medulla. [NIH] Emollient: Softening or soothing; called also malactic. [EU] Empirical: A treatment based on an assumed diagnosis, prior to receiving confirmatory laboratory test results. [NIH] Emulsion: A preparation of one liquid distributed in small globules throughout the body of a second liquid. The dispersed liquid is the discontinuous phase, and the dispersion medium is the continuous phase. When oil is the dispersed liquid and an aqueous solution is the continuous phase, it is known as an oil-in-water emulsion, whereas when water or aqueous solution is the dispersed phase and oil or oleaginous substance is the continuous phase, it is known as a water-in-oil emulsion. Pharmaceutical emulsions for which official standards have been promulgated include cod liver oil emulsion, cod liver oil emulsion with malt, liquid petrolatum emulsion, and phenolphthalein in liquid petrolatum emulsion. [EU] Endemic: Present or usually prevalent in a population or geographical area at all times; said of a disease or agent. Called also endemial. [EU]

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Endocardium: The innermost layer of the heart, comprised of endothelial cells. [NIH] Endometrium: The layer of tissue that lines the uterus. [NIH] Endothelial cell: The main type of cell found in the inside lining of blood vessels, lymph vessels, and the heart. [NIH] Endothelium: A layer of epithelium that lines the heart, blood vessels (endothelium, vascular), lymph vessels (endothelium, lymphatic), and the serous cavities of the body. [NIH] Endothelium-derived: Small molecule that diffuses to the adjacent muscle layer and relaxes it. [NIH] Endotoxins: Toxins closely associated with the living cytoplasm or cell wall of certain microorganisms, which do not readily diffuse into the culture medium, but are released upon lysis of the cells. [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] Energy Intake: Total number of calories taken in daily whether ingested or by parenteral routes. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Eosinophils: Granular leukocytes with a nucleus that usually has two lobes connected by a slender thread of chromatin, and cytoplasm containing coarse, round granules that are uniform in size and stainable by eosin. [NIH] Epidermis: Nonvascular layer of the skin. It is made up, from within outward, of five layers: 1) basal layer (stratum basale epidermidis); 2) spinous layer (stratum spinosum epidermidis); 3) granular layer (stratum granulosum epidermidis); 4) clear layer (stratum lucidum epidermidis); and 5) horny layer (stratum corneum epidermidis). [NIH] Epidural: The space between the wall of the spinal canal and the covering of the spinal cord. An epidural injection is given into this space. [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Erythromycin: A bacteriostatic antibiotic substance produced by Streptomyces erythreus. Erythromycin A is considered its major active component. In sensitive organisms, it inhibits protein synthesis by binding to 50S ribosomal subunits. This binding process inhibits peptidyl transferase activity and interferes with translocation of amino acids during translation and assembly of proteins. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Estradiol: The most potent mammalian estrogenic hormone. It is produced in the ovary, placenta, testis, and possibly the adrenal cortex. [NIH] Euphoria: An exaggerated feeling of physical and emotional well-being not consonant with

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apparent stimuli or events; usually of psychologic origin, but also seen in organic brain disease and toxic states. [NIH] Eustachian tube: The middle ear cavity is in communication with the back of the nose through the Eustachian tube, which is normally closed, but opens on swallowing, in order to maintain equal air pressure. [NIH] Evacuation: An emptying, as of the bowels. [EU] Evoke: The electric response recorded from the cerebral cortex after stimulation of a peripheral sense organ. [NIH] Evoked Potentials: The electric response evoked in the central nervous system by stimulation of sensory receptors or some point on the sensory pathway leading from the receptor to the cortex. The evoked stimulus can be auditory, somatosensory, or visual, although other modalities have been reported. Event-related potentials is sometimes used synonymously with evoked potentials but is often associated with the execution of a motor, cognitive, or psychophysiological task, as well as with the response to a stimulus. [NIH] Excipient: Any more or less inert substance added to a prescription in order to confer a suitable consistency or form to the drug; a vehicle. [EU] Excitability: Property of a cardiac cell whereby, when the cell is depolarized to a critical level (called threshold), the membrane becomes permeable and a regenerative inward current causes an action potential. [NIH] Excitation: An act of irritation or stimulation or of responding to a stimulus; the addition of energy, as the excitation of a molecule by absorption of photons. [EU] Excitatory: When cortical neurons are excited, their output increases and each new input they receive while they are still excited raises their output markedly. [NIH] Exercise Therapy: Motion of the body or its parts to relieve symptoms or to improve function, leading to physical fitness, but not physical education and training. [NIH] Exhaustion: The feeling of weariness of mind and body. [NIH] Expiration: The act of breathing out, or expelling air from the lungs. [EU] Extracellular: Outside a cell or cells. [EU] Extracellular Matrix: A meshwork-like substance found within the extracellular space and in association with the basement membrane of the cell surface. It promotes cellular proliferation and provides a supporting structure to which cells or cell lysates in culture dishes adhere. [NIH] Extracellular Matrix Proteins: Macromolecular organic compounds that contain carbon, hydrogen, oxygen, nitrogen, and usually, sulfur. These macromolecules (proteins) form an intricate meshwork in which cells are embedded to construct tissues. Variations in the relative types of macromolecules and their organization determine the type of extracellular matrix, each adapted to the functional requirements of the tissue. The two main classes of macromolecules that form the extracellular matrix are: glycosaminoglycans, usually linked to proteins (proteoglycans), and fibrous proteins (e.g., collagen, elastin, fibronectins and laminin). [NIH] Extrapyramidal: Outside of the pyramidal tracts. [EU] Eye Movements: Voluntary or reflex-controlled movements of the eye. [NIH] Facial: Of or pertaining to the face. [EU] Facial Nerve: The 7th cranial nerve. The facial nerve has two parts, the larger motor root which may be called the facial nerve proper, and the smaller intermediate or sensory root. Together they provide efferent innervation to the muscles of facial expression and to the

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lacrimal and salivary glands, and convey afferent information for taste from the anterior two-thirds of the tongue and for touch from the external ear. [NIH] Facial Nerve Diseases: Diseases of the facial nerve or nuclei. Pontine disorders may affect the facial nuclei or nerve fascicle. The nerve may be involved intracranially, along its course through the petrous portion of the temporal bone, or along its extracranial course. Clinical manifestations include facial muscle weakness, loss of taste from the anterior tongue, hyperacusis, and decreased lacrimation. [NIH] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]

Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibrillation: A small, local, involuntary contraction of muscle, invisible under the skin, resulting from spontaneous activation of single muscle cells or muscle fibres. [EU] Fissure: Any cleft or groove, normal or otherwise; especially a deep fold in the cerebral cortex which involves the entire thickness of the brain wall. [EU] Fistula: Abnormal communication most commonly seen between two internal organs, or between an internal organ and the surface of the body. [NIH] Fixation: 1. The act or operation of holding, suturing, or fastening in a fixed position. 2. The condition of being held in a fixed position. 3. In psychiatry, a term with two related but distinct meanings : (1) arrest of development at a particular stage, which like regression (return to an earlier stage), if temporary is a normal reaction to setbacks and difficulties but if protracted or frequent is a cause of developmental failures and emotional problems, and (2) a close and suffocating attachment to another person, especially a childhood figure, such as one's mother or father. Both meanings are derived from psychoanalytic theory and refer to 'fixation' of libidinal energy either in a specific erogenous zone, hence fixation at the oral, anal, or phallic stage, or in a specific object, hence mother or father fixation. 4. The use of a fixative (q.v.) to preserve histological or cytological specimens. 5. In chemistry, the process whereby a substance is removed from the gaseous or solution phase and localized, as in carbon dioxide fixation or nitrogen fixation. 6. In ophthalmology, direction of the gaze so that the visual image of the object falls on the fovea centralis. 7. In film processing, the chemical removal of all undeveloped salts of the film emulsion, leaving only the developed silver to form a permanent image. [EU] Flunarizine: Flunarizine is a selective calcium entry blocker with calmodulin binding properties and histamine H1 blocking activity. It is effective in the prophylaxis of migraine, occlusive peripheral vascular disease, vertigo of central and peripheral origin, and as an adjuvant in the therapy of epilepsy. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Fossa: A cavity, depression, or pit. [NIH] Fovea: The central part of the macula that provides the sharpest vision. [NIH] Fructose: A type of sugar found in many fruits and vegetables and in honey. Fructose is used to sweeten some diet foods. It is considered a nutritive sweetener because it has calories. [NIH]

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Gait: Manner or style of walking. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Ganglion: 1. A knot, or knotlike mass. 2. A general term for a group of nerve cell bodies located outside the central nervous system; occasionally applied to certain nuclear groups within the brain or spinal cord, e.g. basal ganglia. 3. A benign cystic tumour occurring on a aponeurosis or tendon, as in the wrist or dorsum of the foot; it consists of a thin fibrous capsule enclosing a clear mucinous fluid. [EU] Gap Junctions: Connections between cells which allow passage of small molecules and electric current. Gap junctions were first described anatomically as regions of close apposition between cells with a narrow (1-2 nm) gap between cell membranes. The variety in the properties of gap junctions is reflected in the number of connexins, the family of proteins which form the junctions. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gastric: Having to do with the stomach. [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]

Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gelatin: A product formed from skin, white connective tissue, or bone collagen. It is used as a protein food adjuvant, plasma substitute, hemostatic, suspending agent in pharmaceutical preparations, and in the manufacturing of capsules and suppositories. [NIH] Gels: Colloids with a solid continuous phase and liquid as the dispersed phase; gels may be unstable when, due to temperature or other cause, the solid phase liquifies; the resulting colloid is called a sol. [NIH] Gemfibrozil: A lipid-regulating agent that lowers elevated serum lipids primarily by decreasing serum triglycerides with a variable reduction in total cholesterol. These decreases occur primarily in the VLDL fraction and less frequently in the LDL fraction. Gemfibrozil increases HDL subfractions HDL2 and HDL3 as well as apolipoproteins A-I and A-II. Its mechanism of action has not been definitely established. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Gene Expression: The phenotypic manifestation of a gene or genes by the processes of gene action. [NIH] Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Geriatric: Pertaining to the treatment of the aged. [EU] Ginseng: An araliaceous genus of plants that contains a number of pharmacologically active agents used as stimulants, sedatives, and tonics, especially in traditional medicine. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH]

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Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucose Intolerance: A pathological state in which the fasting plasma glucose level is less than 140 mg per deciliter and the 30-, 60-, or 90-minute plasma glucose concentration following a glucose tolerance test exceeds 200 mg per deciliter. This condition is seen frequently in diabetes mellitus but also occurs with other diseases. [NIH] Glutamate: Excitatory neurotransmitter of the brain. [NIH] Glycopyrrolate: A muscarinic antagonist used as an antispasmodic, in some disorders of the gastrointestinal tract, and to reduce salivation with some anesthetics. [NIH] Glycosaminoglycans: Heteropolysaccharides which contain an N-acetylated hexosamine in a characteristic repeating disaccharide unit. The repeating structure of each disaccharide involves alternate 1,4- and 1,3-linkages consisting of either N-acetylglucosamine or Nacetylgalactosamine. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Granulocytes: Leukocytes with abundant granules in the cytoplasm. They are divided into three groups: neutrophils, eosinophils, and basophils. [NIH] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Guanylate Cyclase: An enzyme that catalyzes the conversion of GTP to 3',5'-cyclic GMP and pyrophosphate. It also acts on ITP and dGTP. (From Enzyme Nomenclature, 1992) EC 4.6.1.2. [NIH] Habitual: Of the nature of a habit; according to habit; established by or repeated by force of habit, customary. [EU] Habituation: Decline in response of an organism to environmental or other stimuli with repeated or maintained exposure. [NIH] Hair Cells: Mechanoreceptors located in the organ of Corti that are sensitive to auditory stimuli and in the vestibular apparatus that are sensitive to movement of the head. In each case the accessory sensory structures are arranged so that appropriate stimuli cause movement of the hair-like projections (stereocilia and kinocilia) which relay the information centrally in the nervous system. [NIH] Hair follicles: Shafts or openings on the surface of the skin through which hair grows. [NIH] Half-Life: The time it takes for a substance (drug, radioactive nuclide, or other) to lose half of its pharmacologic, physiologic, or radiologic activity. [NIH] Handicap: A handicap occurs as a result of disability, but disability does not always constitute a handicap. A handicap may be said to exist when a disability causes a substantial and continuing reduction in a person's capacity to function socially and vocationally. [NIH] Haptens: Small antigenic determinants capable of eliciting an immune response only when coupled to a carrier. Haptens bind to antibodies but by themselves cannot elicit an antibody response. [NIH] Head Movements: Voluntary or involuntary motion of head that may be relative to or independent of body; includes animals and humans. [NIH] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or

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as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] Headache Disorders: Common conditions characterized by persistent or recurrent headaches. Headache syndrome classification systems may be based on etiology (e.g., vascular headache, post-traumatic headaches, etc.), temporal pattern (e.g., cluster headache, paroxysmal hemicrania, etc.), and precipitating factors (e.g., cough headache). [NIH] Hearing Disorders: Conditions that impair the transmission or perception of auditory impulses and information from the level of the ear to the temporal cortices, including the sensorineural pathways. [NIH] Heart attack: A seizure of weak or abnormal functioning of the heart. [NIH] Heartbeat: One complete contraction of the heart. [NIH] Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Hemianopsia: Partial or complete loss of vision in one half of the visual field(s) of one or both eyes. Subtypes include altitudinal hemianopsia, characterized by a visual defect above or below the horizontal meridian of the visual field. Homonymous hemianopsia refers to a visual defect that affects both eyes equally, and occurs either to the left or right of the midline of the visual field. Binasal hemianopsia consists of loss of vision in the nasal hemifields of both eyes. Bitemporal hemianopsia is the bilateral loss of vision in the temporal fields. Quadrantanopsia refers to loss of vision in one quarter of the visual field in one or both eyes. [NIH] Hemodialysis: The use of a machine to clean wastes from the blood after the kidneys have failed. The blood travels through tubes to a dialyzer, which removes wastes and extra fluid. The cleaned blood then flows through another set of tubes back into the body. [NIH] Hemolysis: The destruction of erythrocytes by many different causal agents such as antibodies, bacteria, chemicals, temperature, and changes in tonicity. [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] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Hermetic: Impervious to air; airtight. [EU] Heterogeneity: The property of one or more samples or populations which implies that they are not identical in respect of some or all of their parameters, e. g. heterogeneity of variance. [NIH]

Hiccup: A spasm of the diaphragm that causes a sudden inhalation followed by rapid closure of the glottis which produces a sound. [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]

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Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hormone Replacement Therapy: Therapeutic use of hormones to alleviate the effects of hormone deficiency. [NIH] Host: Any animal that receives a transplanted graft. [NIH] Hybridization: The genetic process of crossbreeding to produce a hybrid. Hybrid nucleic acids can be formed by nucleic acid hybridization of DNA and RNA molecules. Protein hybridization allows for hybrid proteins to be formed from polypeptide chains. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrolysis: The process of cleaving a chemical compound by the addition of a molecule of water. [NIH] Hydroxylysine: A hydroxylated derivative of the amino acid lysine that is present in certain collagens. [NIH] Hydroxyproline: A hydroxylated form of the imino acid proline. A deficiency in ascorbic acid can result in impaired hydroxyproline formation. [NIH] Hydroxyzine: A histamine H1 receptor antagonist that is effective in the treatment of chronic urticaria, dermatitis, and histamine-mediated pruritus. Unlike its major metabolite cetirizine, it does cause drowsiness. It is also effective as an antiemetic, for relief of anxiety and tension, and as a sedative. [NIH] Hyperacusis: An abnormally disproportionate increase in the sensation of loudness in response to auditory stimuli of normal volume. Cochlear diseases; vestibulocochlear nerve diseases; facial nerve diseases; stapes surgery; and other disorders may be associated with this condition. [NIH] Hyperalgesia: Excessive sensitiveness or sensibility to pain. [EU] Hyperesthesia: Increased sensitivity to cutaneous stimulation due to a diminished threshold or an increased response to stimuli. [NIH] Hyperlipidemia: An excess of lipids in the blood. [NIH] Hyperplasia: An increase in the number of cells in a tissue or organ, not due to tumor formation. It differs from hypertrophy, which is an increase in bulk without an increase in the number of cells. [NIH] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hyperventilation: A pulmonary ventilation rate faster than is metabolically necessary for the exchange of gases. It is the result of an increased frequency of breathing, an increased tidal volume, or a combination of both. It causes an excess intake of oxygen and the blowing off of carbon dioxide. [NIH]

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Hypesthesia: Absent or reduced sensitivity to cutaneous stimulation. [NIH] Hypnotic: A drug that acts to induce sleep. [EU] Hypoglycaemia: An abnormally diminished concentration of glucose in the blood, which may lead to tremulousness, cold sweat, piloerection, hypothermia, and headache, accompanied by irritability, confusion, hallucinations, bizarre behaviour, and ultimately, convulsions and coma. [EU] Hypoglycemia: Abnormally low blood sugar [NIH] Hypoglycemic: An orally active drug that produces a fall in blood glucose concentration. [NIH]

Hypotension: Abnormally low blood pressure. [NIH] Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH] Hypothyroidism: Deficiency of thyroid activity. In adults, it is most common in women and is characterized by decrease in basal metabolic rate, tiredness and lethargy, sensitivity to cold, and menstrual disturbances. If untreated, it progresses to full-blown myxoedema. In infants, severe hypothyroidism leads to cretinism. In juveniles, the manifestations are intermediate, with less severe mental and developmental retardation and only mild symptoms of the adult form. When due to pituitary deficiency of thyrotropin secretion it is called secondary hypothyroidism. [EU] Hypoxia: Reduction of oxygen supply to tissue below physiological levels despite adequate perfusion of the tissue by blood. [EU] Ibuprofen: A nonsteroidal anti-inflammatory agent with analgesic properties used in the therapy of rheumatism and arthritis. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Idiopathic: Describes a disease of unknown cause. [NIH] Illusion: A false interpretation of a genuine percept. [NIH] Imipramine: The prototypical tricyclic antidepressant. It has been used in major depression, dysthymia, bipolar depression, attention-deficit disorders, agoraphobia, and panic disorders. It has less sedative effect than some other members of this therapeutic group. [NIH]

Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immune Sera: Serum that contains antibodies. It is obtained from an animal that has been immunized either by antigen injection or infection with microorganisms containing the antigen. [NIH] Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunization: Deliberate stimulation of the host's immune response. Active immunization involves administration of antigens or immunologic adjuvants. Passive immunization involves administration of immune sera or lymphocytes or their extracts (e.g., transfer factor, immune RNA) or transplantation of immunocompetent cell producing tissue (thymus or bone marrow). [NIH] Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large

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amounts of antibody. [NIH] Immunology: The study of the body's immune system. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incision: A cut made in the body during surgery. [NIH] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Indigestion: Poor digestion. Symptoms include heartburn, nausea, bloating, and gas. Also called dyspepsia. [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] Infant, Newborn: An infant during the first month after birth. [NIH] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] Ingestion: Taking into the body by mouth [NIH] Inner ear: The labyrinth, comprising the vestibule, cochlea, and semicircular canals. [NIH] Innervation: 1. The distribution or supply of nerves to a part. 2. The supply of nervous energy or of nerve stimulus sent to a part. [EU] Inorganic: Pertaining to substances not of organic origin. [EU] Insight: The capacity to understand one's own motives, to be aware of one's own psychodynamics, to appreciate the meaning of symbolic behavior. [NIH] Insomnia: Difficulty in going to sleep or getting enough sleep. [NIH] Institutionalization: The caring for individuals in institutions and their adaptation to routines characteristic of the institutional environment, and/or their loss of adaptation to

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life outside the institution. [NIH] Insulator: Material covering the metal conductor of the lead. It is usually polyurethane or silicone. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Internal Medicine: A medical specialty concerned with the diagnosis and treatment of diseases of the internal organ systems of adults. [NIH] Intervertebral: Situated between two contiguous vertebrae. [EU] Intervertebral Disk Displacement: An intervertebral disk in which the nucleus pulposus has protruded through surrounding fibrocartilage. This occurs most frequently in the lower lumbar region. [NIH] Intestinal: Having to do with the intestines. [NIH] Intestines: The section of the alimentary canal from the stomach to the anus. It includes the large intestine and small intestine. [NIH] Intoxication: Poisoning, the state of being poisoned. [EU] Intracellular: Inside a cell. [NIH] Intracranial Hypertension: Increased pressure within the cranial vault. This may result from several conditions, including hydrocephalus; brain edema; intracranial masses; severe systemic hypertension; pseudotumor cerebri; and other disorders. [NIH] Intravenous: IV. Into a vein. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

Invertebrates: Animals that have no spinal column. [NIH] Involuntary: Reaction occurring without intention or volition. [NIH] Ion Channels: Gated, ion-selective glycoproteins that traverse membranes. The stimulus for channel gating can be a membrane potential, drug, transmitter, cytoplasmic messenger, or a mechanical deformation. Ion channels which are integral parts of ionotropic neurotransmitter receptors are not included. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH]

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Kinetics: The study of rate dynamics in chemical or physical systems. [NIH] Labile: 1. Gliding; moving from point to point over the surface; unstable; fluctuating. 2. Chemically unstable. [EU] Labyrinth: The internal ear; the essential part of the organ of hearing. It consists of an osseous and a membranous portion. [NIH] Labyrinthine: A vestibular nystagmus resulting from stimulation, injury, or disease of the labyrinth. [NIH] Labyrinthitis: Inflammation of the inner ear. [NIH] Lacrimal: Pertaining to the tears. [EU] Language Disorders: Conditions characterized by deficiencies of comprehension or expression of written and spoken forms of language. These include acquired and developmental disorders. [NIH] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Least-Squares Analysis: A principle of estimation in which the estimates of a set of parameters in a statistical model are those quantities minimizing the sum of squared differences between the observed values of a dependent variable and the values predicted by the model. [NIH] Lens: The transparent, double convex (outward curve on both sides) structure suspended between the aqueous and vitreous; helps to focus light on the retina. [NIH] Leprosy: A chronic granulomatous infection caused by Mycobacterium leprae. The granulomatous lesions are manifested in the skin, the mucous membranes, and the peripheral nerves. Two polar or principal types are lepromatous and tuberculoid. [NIH] Lesion: An area of abnormal tissue change. [NIH] Lethargy: Abnormal drowsiness or stupor; a condition of indifference. [EU] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Likelihood Functions: Functions constructed from a statistical model and a set of observed data which give the probability of that data for various values of the unknown model parameters. Those parameter values that maximize the probability are the maximum likelihood estimates of the parameters. [NIH] Linear Models: Statistical models in which the value of a parameter for a given value of a factor is assumed to be equal to a + bx, where a and b are constants. The models predict a linear regression. [NIH] Lipid: Fat. [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 scan: An image of the liver created on a computer screen or on film. A radioactive substance is injected into a blood vessel and travels through the bloodstream. It collects in the liver, especially in abnormal areas, and can be detected by the scanner. [NIH] Localization: The process of determining or marking the location or site of a lesion or

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disease. May also refer to the process of keeping a lesion or disease in a specific location or site. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Logistic Models: Statistical models which describe the relationship between a qualitative dependent variable (that is, one which can take only certain discrete values, such as the presence or absence of a disease) and an independent variable. A common application is in epidemiology for estimating an individual's risk (probability of a disease) as a function of a given risk factor. [NIH] Longitudinal Studies: Studies in which variables relating to an individual or group of individuals are assessed over a period of time. [NIH] Longitudinal study: Also referred to as a "cohort study" or "prospective study"; the analytic method of epidemiologic study in which subsets of a defined population can be identified who are, have been, or in the future may be exposed or not exposed, or exposed in different degrees, to a factor or factors hypothesized to influence the probability of occurrence of a given disease or other outcome. The main feature of this type of study is to observe large numbers of subjects over an extended time, with comparisons of incidence rates in groups that differ in exposure levels. [NIH] Long-Term Care: Care over an extended period, usually for a chronic condition or disability, requiring periodic, intermittent, or continuous care. [NIH] Low Back Pain: Acute or chronic pain in the lumbar or sacral regions, which may be associated with musculo-ligamentous sprains and strains; intervertebral disk displacement; and other conditions. [NIH] Lumbar: Pertaining to the loins, the part of the back between the thorax and the pelvis. [EU] Luminescence: The property of giving off light without emitting a corresponding degree of heat. It includes the luminescence of inorganic matter or the bioluminescence of human matter, invertebrates and other living organisms. For the luminescence of bacteria, bacterial luminescence is available. [NIH] Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [NIH] Luxation: The displacement of the particular surface of a bone from its normal joint, without fracture. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]

Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Magnesium Compounds: Inorganic compounds that contain magnesium as an integral part of the molecule. [NIH] Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. [NIH] Magnetic Resonance Spectroscopy: Spectroscopic method of measuring the magnetic moment of elementary particles such as atomic nuclei, protons or electrons. It is employed in

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clinical applications such as NMR Tomography (magnetic resonance imaging). [NIH] Malaria: A protozoan disease caused in humans by four species of the genus Plasmodium (P. falciparum (malaria, falciparum), P. vivax (malaria, vivax), P. ovale, and P. malariae) and transmitted by the bite of an infected female mosquito of the genus Anopheles. Malaria is endemic in parts of Asia, Africa, Central and South America, Oceania, and certain Caribbean islands. It is characterized by extreme exhaustion associated with paroxysms of high fever, sweating, shaking chills, and anemia. Malaria in animals is caused by other species of plasmodia. [NIH] Malaria, Falciparum: Malaria caused by Plasmodium falciparum. This is the severest form of malaria and is associated with the highest levels of parasites in the blood. This disease is characterized by irregularly recurring febrile paroxysms that in extreme cases occur with acute cerebral, renal, or gastrointestinal manifestations. [NIH] Malaria, Vivax: Malaria caused by Plasmodium vivax. This form of malaria is less severe than malaria, falciparum, but there is a higher probability for relapses to occur. Febrile paroxysms often occur every other day. [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] Malingering: Simulation of symptoms of illness or injury with intent to deceive in order to obtain a goal, e.g., a claim of physical illness to avoid jury duty. [NIH] Mammogram: An x-ray of the breast. [NIH] Mania: Excitement of psychotic proportions manifested by mental and physical hyperactivity, disorganization of behaviour, and elevation of mood. [EU] Manic: Affected with mania. [EU] Manic-depressive psychosis: One of a group of psychotic reactions, fundamentally marked by severe mood swings and a tendency to remission and recurrence. [NIH] Mastoiditis: Inflammation of the cavity and air cells in the mastoid part of the temporal bone. [NIH] Matrix metalloproteinase: A member of a group of enzymes that can break down proteins, such as collagen, that are normally found in the spaces between cells in tissues (i.e., extracellular matrix proteins). Because these enzymes need zinc or calcium atoms to work properly, they are called metalloproteinases. Matrix metalloproteinases are involved in wound healing, angiogenesis, and tumor cell metastasis. [NIH] Meatus: A canal running from the internal auditory foramen through the petrous portion of the temporal bone. It gives passage to the facial and auditory nerves together with the auditory branch of the basilar artery and the internal auditory veins. [NIH] Meclizine: A histamine H1 antagonist used in the treatment of motion sickness, vertigo, and nausea during pregnancy and radiation sickness. [NIH] Medial: Lying near the midsaggital plane of the body; opposed to lateral. [NIH] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU]

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Medicament: A medicinal substance or agent. [EU] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Medullary: Pertaining to the marrow or to any medulla; resembling marrow. [EU] Meiosis: A special method of cell division, occurring in maturation of the germ cells, by means of which each daughter nucleus receives half the number of chromosomes characteristic of the somatic cells of the species. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Meningitis: Inflammation of the meninges. When it affects the dura mater, the disease is termed pachymeningitis; when the arachnoid and pia mater are involved, it is called leptomeningitis, or meningitis proper. [EU] Menopause: Permanent cessation of menstruation. [NIH] Menstrual Cycle: The period of the regularly recurring physiologic changes in the endometrium occurring during the reproductive period in human females and some primates and culminating in partial sloughing of the endometrium (menstruation). [NIH] Menstruation: The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus. [NIH] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH] Mental Processes: Conceptual functions or thinking in all its forms. [NIH] Mental Retardation: Refers to sub-average general intellectual functioning which originated during the developmental period and is associated with impairment in adaptive behavior. [NIH]

Metabolic disorder: A condition in which normal metabolic processes are disrupted, usually because of a missing enzyme. [NIH] Metabolite: Any substance produced by metabolism or by a metabolic process. [EU] 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] Methionine: A sulfur containing essential amino acid that is important in many body functions. It is a chelating agent for heavy metals. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microcalcifications: Tiny deposits of calcium in the breast that cannot be felt but can be

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detected on a mammogram. A cluster of these very small specks of calcium may indicate that cancer is present. [NIH] Microorganism: An organism that can be seen only through a microscope. Microorganisms include bacteria, protozoa, algae, and fungi. Although viruses are not considered living organisms, they are sometimes classified as microorganisms. [NIH] Microwaves: That portion of the electromagnetic spectrum lying between UHF (ultrahigh frequency) radio waves and heat (infrared) waves. Microwaves are used to generate heat, especially in some types of diathermy. They may cause heat damage to tissues. [NIH] Minocycline: A semisynthetic staphylococcus infections. [NIH]

antibiotic

effective

against

tetracycline-resistant

Mitral Valve: The valve between the left atrium and left ventricle of the heart. [NIH] Mobility: Capability of movement, of being moved, or of flowing freely. [EU] Modeling: A treatment procedure whereby the therapist presents the target behavior which the learner is to imitate and make part of his repertoire. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecular Probes: A group of atoms or molecules attached to other molecules or cellular structures and used in studying the properties of these molecules and structures. Radioactive DNA or RNA sequences are used in molecular genetics to detect the presence of a complementary sequence by molecular hybridization. [NIH] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monocytes: Large, phagocytic mononuclear leukocytes produced in the vertebrate bone marrow and released into the blood; contain a large, oval or somewhat indented nucleus surrounded by voluminous cytoplasm and numerous organelles. [NIH] Mononuclear: A cell with one nucleus. [NIH] Morphine: The principal alkaloid in opium and the prototype opiate analgesic and narcotic. Morphine has widespread effects in the central nervous system and on smooth muscle. [NIH] Morphological: Relating to the configuration or the structure of live organs. [NIH] Morphology: The science of the form and structure of organisms (plants, animals, and other forms of life). [NIH] Motility: The ability to move spontaneously. [EU] Motion Pictures: The art, technique, or business of producing motion pictures for entertainment, propaganda, or instruction. [NIH] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH] Motor Activity: The physical activity of an organism as a behavioral phenomenon. [NIH] Motor nerve: An efferent nerve conveying an impulse that excites muscular contraction. [NIH]

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Mucociliary: Pertaining to or affecting the mucus membrane and hairs (including eyelashes, nose hair, .): mucociliary clearing: the clearance of mucus by ciliary movement ( particularly in the respiratory system). [EU] Multicenter study: A clinical trial that is carried out at more than one medical institution. [NIH]

Multiple sclerosis: A disorder of the central nervous system marked by weakness, numbness, a loss of muscle coordination, and problems with vision, speech, and bladder control. Multiple sclerosis is thought to be an autoimmune disease in which the body's immune system destroys myelin. Myelin is a substance that contains both protein and fat (lipid) and serves as a nerve insulator and helps in the transmission of nerve signals. [NIH] Muscle relaxant: An agent that specifically aids in reducing muscle tension, as those acting at the polysynaptic neurons of motor nerves (e.g. meprobamate) or at the myoneural junction (curare and related compounds). [EU] Muscle tension: A force in a material tending to produce extension; the state of being stretched. [NIH] Mydriatic: 1. Dilating the pupil. 2. Any drug that dilates the pupil. [EU] Myelin: The fatty substance that covers and protects nerves. [NIH] Myocardial infarction: Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Myocardial Ischemia: A disorder of cardiac function caused by insufficient blood flow to the muscle tissue of the heart. The decreased blood flow may be due to narrowing of the coronary arteries (coronary arteriosclerosis), to obstruction by a thrombus (coronary thrombosis), or less commonly, to diffuse narrowing of arterioles and other small vessels within the heart. Severe interruption of the blood supply to the myocardial tissue may result in necrosis of cardiac muscle (myocardial infarction). [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Naloxone: A specific opiate antagonist that has no agonist activity. It is a competitive antagonist at mu, delta, and kappa opioid receptors. [NIH] Naltrexone: Derivative of noroxymorphone that is the N-cyclopropylmethyl congener of naloxone. It is a narcotic antagonist that is effective orally, longer lasting and more potent than naloxone, and has been proposed for the treatment of heroin addiction. The FDA has approved naltrexone for the treatment of alcohol dependence. [NIH] Narcosis: A general and nonspecific reversible depression of neuronal excitability, produced by a number of physical and chemical aspects, usually resulting in stupor. [NIH] Narcotic: 1. Pertaining to or producing narcosis. 2. An agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Nasal Mucosa: The mucous membrane lining the nasal cavity. [NIH] Nasal Polyps: Focal accumulations of edema fluid in the nasal mucosa accompanied by hyperplasia of the associated submucosal connective tissue. Polyps may be neoplasms, foci of inflammation, degenerative lesions, or malformations. [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]

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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] Neck Pain: Discomfort or more intense forms of pain that are localized to the cervical region. This term generally refers to pain in the posterior or lateral regions of the neck. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Neoplasm: A new growth of benign or malignant tissue. [NIH] Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nerve Fibers: Slender processes of neurons, especially the prolonged axons that conduct nerve impulses. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Nervousness: Excessive excitability and irritability, with mental and physical unrest. [EU] 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] Neuralgia: Intense or aching pain that occurs along the course or distribution of a peripheral or cranial nerve. [NIH] Neurasthenia: A mental disorder characterized by chronic fatigue and concomitant physiologic symptoms. [NIH] Neuritis: A general term indicating inflammation of a peripheral or cranial nerve. Clinical manifestation may include pain; paresthesias; paresis; or hypesthesia. [NIH] 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] Neurologic: Having to do with nerves or the nervous system. [NIH] Neurologist: A doctor who specializes in the diagnosis and treatment of disorders of the nervous system. [NIH] Neuroma: A tumor that arises in nerve cells. [NIH] Neuromuscular: Pertaining to muscles and nerves. [EU] Neuromuscular Junction: The synapse between a neuron and a muscle. [NIH] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous

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system. [NIH] Neurosis: Functional derangement due to disorders of the nervous system which does not affect the psychic personality of the patient. [NIH] Neurotic: 1. Pertaining to or characterized by neurosis. 2. A person affected with a neurosis. [EU]

Neutrophils: Granular leukocytes having a nucleus with three to five lobes connected by slender threads of chromatin, and cytoplasm containing fine inconspicuous granules and stainable by neutral dyes. [NIH] Nicotine: Nicotine is highly toxic alkaloid. It is the prototypical agonist at nicotinic cholinergic receptors where it dramatically stimulates neurons and ultimately blocks synaptic transmission. Nicotine is also important medically because of its presence in tobacco smoke. [NIH] Nitric Oxide: A free radical gas produced endogenously by a variety of mammalian cells. It is synthesized from arginine by a complex reaction, catalyzed by nitric oxide synthase. Nitric oxide is endothelium-derived relaxing factor. It is released by the vascular endothelium and mediates the relaxation induced by some vasodilators such as acetylcholine and bradykinin. It also inhibits platelet aggregation, induces disaggregation of aggregated platelets, and inhibits platelet adhesion to the vascular endothelium. Nitric oxide activates cytosolic guanylate cyclase and thus elevates intracellular levels of cyclic GMP. [NIH]

Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Nonverbal Communication: Transmission of emotions, ideas, and attitudes between individuals in ways other than the spoken language. [NIH] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] NSAIDs: Nonsteroidal anti-inflammatory drugs. A group of drugs that decrease fever, swelling, pain, and redness. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nystagmus: Rhythmical oscillation of the eyeballs, either pendular or jerky. [NIH] Occipital Lobe: Posterior part of the cerebral hemisphere. [NIH] Ocular: 1. Of, pertaining to, or affecting the eye. 2. Eyepiece. [EU] Oculomotor: Cranial nerve III. It originate from the lower ventral surface of the midbrain and is classified as a motor nerve. [NIH] Office Management: Planning, organizing, and administering activities in an office. [NIH] Ointments: Semisolid preparations used topically for protective emollient effects or as a vehicle for local administration of medications. Ointment bases are various mixtures of fats, waxes, animal and plant oils and solid and liquid hydrocarbons. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH]

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Ophthalmic: Pertaining to the eye. [EU] Ophthalmology: A surgical specialty concerned with the structure and function of the eye and the medical and surgical treatment of its defects and diseases. [NIH] Opium: The air-dried exudate from the unripe seed capsule of the opium poppy, Papaver somniferum, or its variant, P. album. It contains a number of alkaloids, but only a few morphine, codeine, and papaverine - have clinical significance. Opium has been used as an analgesic, antitussive, antidiarrheal, and antispasmodic. [NIH] Organelles: Specific particles of membrane-bound organized living substances present in eukaryotic cells, such as the mitochondria; the golgi apparatus; endoplasmic reticulum; lysomomes; plastids; and vacuoles. [NIH] Orthostatic: Pertaining to or caused by standing erect. [EU] Ossicles: The hammer, anvil and stirrup, the small bones of the middle ear, which transmit the vibrations from the tympanic membrane to the oval window. [NIH] Osteoarthritis: A progressive, degenerative joint disease, the most common form of arthritis, especially in older persons. The disease is thought to result not from the aging process but from biochemical changes and biomechanical stresses affecting articular cartilage. In the foreign literature it is often called osteoarthrosis deformans. [NIH] Otitis: Inflammation of the ear, which may be marked by pain, fever, abnormalities of hearing, hearing loss, tinnitus, and vertigo. [EU] Otitis Media: Inflammation of the middle ear. [NIH] Otolaryngologist: A doctor who specializes in treating diseases of the ear, nose, and throat. Also called an ENT doctor. [NIH] Otolaryngology: A surgical specialty concerned with the study and treatment of disorders of the ear, nose, and throat. [NIH] Otolith: A complex calcareous concretion in the inner ear which controls man's sense of balance and reactions to acceleration. [NIH] Otology: The branch of medicine which deals with the diagnosis and treatment of the disorders and diseases of the ear. [NIH] Otorhinolaryngology: That branch of medicine concerned with medical and surgical treatment of the head and neck, including the ears, nose and throat. [EU] Otosclerosis: The formation of spongy bone in the labyrinth capsule. The ossicles can become fixed and unable to transmit sound vibrations, thereby causing deafness. [NIH] Ototoxic: Having a deleterious effect upon the eighth nerve, or upon the organs of hearing and balance. [EU] 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] Ovary: Either of the paired glands in the female that produce the female germ cells and secrete some of the female sex hormones. [NIH] Ovulation: The discharge of a secondary oocyte from a ruptured graafian follicle. [NIH] Ovum: A female germ cell extruded from the ovary at ovulation. [NIH] Oxygen Consumption: The oxygen consumption is determined by calculating the difference between the amount of oxygen inhaled and exhaled. [NIH] Palate: The structure that forms the roof of the mouth. It consists of the anterior hard palate and the posterior soft palate. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU]

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Pallor: A clinical manifestation consisting of an unnatural paleness of the skin. [NIH] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Panic: A state of extreme acute, intense anxiety and unreasoning fear accompanied by disorganization of personality function. [NIH] Panic Disorder: A type of anxiety disorder characterized by unexpected panic attacks that last minutes or, rarely, hours. Panic attacks begin with intense apprehension, fear or terror and, often, a feeling of impending doom. Symptoms experienced during a panic attack include dyspnea or sensations of being smothered; dizziness, loss of balance or faintness; choking sensations; palpitations or accelerated heart rate; shakiness; sweating; nausea or other form of abdominal distress; depersonalization or derealization; paresthesias; hot flashes or chills; chest discomfort or pain; fear of dying and fear of not being in control of oneself or going crazy. Agoraphobia may also develop. Similar to other anxiety disorders, it may be inherited as an autosomal dominant trait. [NIH] Paranasal Sinuses: Air-filled extensions of the respiratory part of the nasal cavity into the frontal, ethmoid, sphenoid, and maxillary cranial bones. They vary in size and form in different individuals and are lined by the ciliated mucous membranes of the nasal cavity. [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] Paresis: A general term referring to a mild to moderate degree of muscular weakness, occasionally used as a synonym for paralysis (severe or complete loss of motor function). In the older literature, paresis often referred specifically to paretic neurosyphilis. "General paresis" and "general paralysis" may still carry that connotation. Bilateral lower extremity paresis is referred to as paraparesis. [NIH] Paresthesias: Abnormal touch sensations, such as burning or prickling, that occur without an outside stimulus. [NIH] Paroxysmal: Recurring in paroxysms (= spasms or seizures). [EU] Particle: A tiny mass of material. [EU] Patch: A piece of material used to cover or protect a wound, an injured part, etc.: a patch over the eye. [NIH] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]

Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Patient Compliance: Voluntary cooperation of the patient in following a prescribed regimen. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Peptic Ulcer: Ulcer that occurs in those portions of the alimentary tract which come into contact with gastric juice containing pepsin and acid. It occurs when the amount of acid and

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pepsin is sufficient to overcome the gastric mucosal barrier. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Pericardium: The fibroserous sac surrounding the heart and the roots of the great vessels. [NIH]

Perilymph: The fluid contained within the space separating the membranous from the osseous labyrinth of the ear. [NIH] Perineal: Pertaining to the perineum. [EU] Perineum: The area between the anus and the sex organs. [NIH] Peripheral blood: Blood circulating throughout the body. [NIH] Peripheral Nerves: The nerves outside of the brain and spinal cord, including the autonomic, cranial, and spinal nerves. Peripheral nerves contain non-neuronal cells and connective tissue as well as axons. The connective tissue layers include, from the outside to the inside, the epineurium, the perineurium, and the endoneurium. [NIH] Peripheral Nervous System: The nervous system outside of the brain and spinal cord. The peripheral nervous system has autonomic and somatic divisions. The autonomic nervous system includes the enteric, parasympathetic, and sympathetic subdivisions. The somatic nervous system includes the cranial and spinal nerves and their ganglia and the peripheral sensory receptors. [NIH] Peripheral Vascular Disease: Disease in the large blood vessels of the arms, legs, and feet. People who have had diabetes for a long time may get this because major blood vessels in their arms, legs, and feet are blocked and these limbs do not receive enough blood. The signs of PVD are aching pains in the arms, legs, and feet (especially when walking) and foot sores that heal slowly. Although people with diabetes cannot always avoid PVD, doctors say they have a better chance of avoiding it if they take good care of their feet, do not smoke, and keep both their blood pressure and diabetes under good control. [NIH] Perphenazine: An antipsychotic phenothiazine derivative with actions and uses similar to those of chlorpromazine. [NIH] Phallic: Pertaining to the phallus, or penis. [EU] Pharmaceutical Solutions: Homogeneous liquid preparations that contain one or more chemical substances dissolved, i.e., molecularly dispersed, in a suitable solvent or mixture of mutually miscible solvents. For reasons of their ingredients, method of preparation, or use, they do not fall into another group of products. [NIH] Pharmacokinetic: The mathematical analysis of the time courses of absorption, distribution, and elimination of drugs. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phenobarbital: A barbituric acid derivative that acts as a nonselective central nervous system depressant. It promotes binding to inhibitory GABA subtype receptors, and modulates chloride currents through receptor channels. It also inhibits glutamate induced depolarizations. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Photophobia: Abnormal sensitivity to light. This may occur as a manifestation of eye diseases; migraine; subarachnoid hemorrhage; meningitis; and other disorders. Photophobia may also occur in association with depression and other mental disorders. [NIH]

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Photosensitization: The development of abnormally heightened reactivity of the skin to sunlight. [EU] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physical Fitness: A state of well-being in which performance is optimal, often as a result of physical conditioning which may be prescribed for disease therapy. [NIH] Physical Therapy: The restoration of function and the prevention of disability following disease or injury with the use of light, heat, cold, water, electricity, ultrasound, and exercise. [NIH]

Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pilot study: The initial study examining a new method or treatment. [NIH] Pitch: The subjective awareness of the frequency or spectral distribution of a sound. [NIH] Placenta: A highly vascular fetal organ through which the fetus absorbs oxygen and other nutrients and excretes carbon dioxide and other wastes. It begins to form about the eighth day of gestation when the blastocyst adheres to the decidua. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plasticity: In an individual or a population, the capacity for adaptation: a) through gene changes (genetic plasticity) or b) through internal physiological modifications in response to changes of environment (physiological plasticity). [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] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] Pons: The part of the central nervous system lying between the medulla oblongata and the mesencephalon, ventral to the cerebellum, and consisting of a pars dorsalis and a pars ventralis. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postmenopausal: Refers to the time after menopause. Menopause is the time in a woman's life when menstrual periods stop permanently; also called "change of life." [NIH] Postoperative: After surgery. [NIH]

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Postprandial: Occurring after dinner, or after a meal; postcibal. [EU] Postsynaptic: Nerve potential generated by an inhibitory hyperpolarizing stimulation. [NIH] Postural: Pertaining to posture or position. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Potentiate: A degree of synergism which causes the exposure of the organism to a harmful substance to worsen a disease already contracted. [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] Precipitating Factors: Factors associated with the definitive onset of a disease, illness, accident, behavioral response, or course of action. Usually one factor is more important or more obviously recognizable than others, if several are involved, and one may often be regarded as "necessary". Examples include exposure to specific disease; amount or level of an infectious organism, drug, or noxious agent, etc. [NIH] 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] Premenstrual: Occurring before menstruation. [EU] Prenatal: Existing or occurring before birth, with reference to the fetus. [EU] Pressoreceptors: Receptors in the vascular system, particularly the aorta and carotid sinus, which are sensitive to stretch of the vessel walls. [NIH] Presynaptic: Situated proximal to a synapse, or occurring before the synapse is crossed. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Primary endpoint: The main result that is measured at the end of a study to see if a given treatment worked (e.g., the number of deaths or the difference in survival between the treatment group and the control group). What the primary endpoint will be is decided before the study begins. [NIH] Probe: An instrument used in exploring cavities, or in the detection and dilatation of strictures, or in demonstrating the potency of channels; an elongated instrument for exploring or sounding body cavities. [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Projection: A defense mechanism, operating unconsciously, whereby that which is

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emotionally unacceptable in the self is rejected and attributed (projected) to others. [NIH] Prolapse: The protrusion of an organ or part of an organ into a natural or artificial orifice. [NIH]

Proline: A non-essential amino acid that is synthesized from glutamic acid. It is an essential component of collagen and is important for proper functioning of joints and tendons. [NIH] Promethazine: A phenothiazine derivative with histamine H1-blocking, antimuscarinic, and sedative properties. It is used as an antiallergic, in pruritus, for motion sickness and sedation, and also in animals. [NIH] Propantheline: A muscarinic antagonist used as an antispasmodic, in rhinitis, in urinary incontinence, and in the treatment of ulcers. At high doses it has nicotinic effects resulting in neuromuscular blocking. [NIH] Prophase: The first phase of cell division, in which the chromosomes become visible, the nucleus starts to lose its identity, the spindle appears, and the centrioles migrate toward opposite poles. [NIH] Prophylaxis: An attempt to prevent disease. [NIH] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Prostaglandin: Any of a group of components derived from unsaturated 20-carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway that are extremely potent mediators of a diverse group of physiologic processes. The abbreviation for prostaglandin is PG; specific compounds are designated by adding one of the letters A through I to indicate the type of substituents found on the hydrocarbon skeleton and a subscript (1, 2 or 3) to indicate the number of double bonds in the hydrocarbon skeleton e.g., PGE2. The predominant naturally occurring prostaglandins all have two double bonds and are synthesized from arachidonic acid (5,8,11,14-eicosatetraenoic acid) by the pathway shown in the illustration. The 1 series and 3 series are produced by the same pathway with fatty acids having one fewer double bond (8,11,14-eicosatrienoic acid or one more double bond (5,8,11,14,17-eicosapentaenoic acid) than arachidonic acid. The subscript a or ß indicates the configuration at C-9 (a denotes a substituent below the plane of the ring, ß, above the plane). The naturally occurring PGF's have the a configuration, e.g., PGF2a. All of the prostaglandins act by binding to specific cell-surface receptors causing an increase in the level of the intracellular second messenger cyclic AMP (and in some cases cyclic GMP also). The effect produced by the cyclic AMP increase depends on the specific cell type. In some cases there is also a positive feedback effect. Increased cyclic AMP increases prostaglandin synthesis leading to further increases in cyclic AMP. [EU] Prosthesis: An artificial replacement of a part of the body. [NIH] Protective Agents: Synthetic or natural substances which are given to prevent a disease or disorder or are used in the process of treating a disease or injury due to a poisonous agent. [NIH]

Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteoglycan: A molecule that contains both protein and glycosaminoglycans, which are a type of polysaccharide. Proteoglycans are found in cartilage and other connective tissues.

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[NIH]

Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Pruritic: Pertaining to or characterized by pruritus. [EU] Pruritus: An intense itching sensation that produces the urge to rub or scratch the skin to obtain relief. [NIH] Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychogenic: Produced or caused by psychic or mental factors rather than organic factors. [EU]

Psychology: The science dealing with the study of mental processes and behavior in man and animals. [NIH] Psychomotor: Pertaining to motor effects of cerebral or psychic activity. [EU] Psychosis: A mental disorder characterized by gross impairment in reality testing as evidenced by delusions, hallucinations, markedly incoherent speech, or disorganized and agitated behaviour without apparent awareness on the part of the patient of the incomprehensibility of his behaviour; the term is also used in a more general sense to refer to mental disorders in which mental functioning is sufficiently impaired as to interfere grossly with the patient's capacity to meet the ordinary demands of life. Historically, the term has been applied to many conditions, e.g. manic-depressive psychosis, that were first described in psychotic patients, although many patients with the disorder are not judged psychotic. [EU] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH] Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Publishing: "The business or profession of the commercial production and issuance of literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing. [NIH]

Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH]

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Pulmonary Ventilation: The total volume of gas per minute inspired or expired measured in liters per minute. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]

Purulent: Consisting of or containing pus; associated with the formation of or caused by pus. [EU] Pustular: Pertaining to or of the nature of a pustule; consisting of pustules (= a visible collection of pus within or beneath the epidermis). [EU] Pyramidal Tracts: Fibers that arise from cells within the cerebral cortex, pass through the medullary pyramid, and descend in the spinal cord. Many authorities say the pyramidal tracts include both the corticospinal and corticobulbar tracts. [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] Quaternary: 1. Fourth in order. 2. Containing four elements or groups. [EU] 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] Radicular: Having the character of or relating to a radicle or root. [NIH] Radiculopathy: Disease involving a spinal nerve root (see spinal nerve roots) which may result from compression related to intervertebral disk displacement; spinal cord injuries; spinal diseases; and other conditions. Clinical manifestations include radicular pain, weakness, and sensory loss referable to structures innervated by the involved nerve root. [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] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Reality Testing: The individual's objective evaluation of the external world and the ability to differentiate adequately between it and the internal world; considered to be a primary ego function. [NIH] Reassurance: A procedure in psychotherapy that seeks to give the client confidence in a favorable outcome. It makes use of suggestion, of the prestige of the therapist. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Receptors, Serotonin: Cell-surface proteins that bind serotonin and trigger intracellular changes which influence the behavior of cells. Several types of serotonin receptors have been recognized which differ in their pharmacology, molecular biology, and mode of action. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recur: To occur again. Recurrence is the return of cancer, at the same site as the original

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(primary) tumor or in another location, after the tumor had disappeared. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Red Nucleus: A pinkish-yellow portion of the midbrain situated in the rostral mesencephalic tegmentum. It receives a large projection from the contralateral half of the cerebellum via the superior cerebellar peduncle and a projection from the ipsilateral motor cortex. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reflex: An involuntary movement or exercise of function in a part, excited in response to a stimulus applied to the periphery and transmitted to the brain or spinal cord. [NIH] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Regression Analysis: Procedures for finding the mathematical function which best describes the relationship between a dependent variable and one or more independent variables. In linear regression (see linear models) the relationship is constrained to be a straight line and least-squares analysis is used to determine the best fit. In logistic regression (see logistic models) the dependent variable is qualitative rather than continuously variable and likelihood functions are used to find the best relationship. In multiple regression the dependent variable is considered to depend on more than a single independent variable. [NIH]

Relapse: The return of signs and symptoms of cancer after a period of improvement. [NIH] Relaxant: 1. Lessening or reducing tension. 2. An agent that lessens tension. [EU] Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Renal failure: Progressive renal insufficiency and uremia, due to irreversible and progressive renal glomerular tubular or interstitial disease. [NIH] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Restoration: Broad term applied to any inlay, crown, bridge or complete denture which restores or replaces loss of teeth or oral tissues. [NIH] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Retinal: 1. Pertaining to the retina. 2. The aldehyde of retinol, derived by the oxidative enzymatic splitting of absorbed dietary carotene, and having vitamin A activity. In the retina, retinal combines with opsins to form visual pigments. One isomer, 11-cis retinal combines with opsin in the rods (scotopsin) to form rhodopsin, or visual purple. Another, all-trans retinal (trans-r.); visual yellow; xanthopsin) results from the bleaching of rhodopsin by light, in which the 11-cis form is converted to the all-trans form. Retinal also combines with opsins in the cones (photopsins) to form the three pigments responsible for colour vision. Called also retinal, and retinene1. [EU] Retrocochlear: Hearing loss in which the air conduction threshold and the bone conduction

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threshold have risen almost equally with no gap between them. In such cases the defect is usually either in the cochlea of the inner ear or in the central pathways. [NIH] Rheumatism: A group of disorders marked by inflammation or pain in the connective tissue structures of the body. These structures include bone, cartilage, and fat. [NIH] Rheumatoid: Resembling rheumatism. [EU] Rheumatoid arthritis: A form of arthritis, the cause of which is unknown, although infection, hypersensitivity, hormone imbalance and psychologic stress have been suggested as possible causes. [NIH] Rhinitis: Inflammation of the mucous membrane of the nose. [NIH] Ribosome: A granule of protein and RNA, synthesized in the nucleolus and found in the cytoplasm of cells. Ribosomes are the main sites of protein synthesis. Messenger RNA attaches to them and there receives molecules of transfer RNA bearing amino acids. [NIH] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Salicylate: Non-steroidal anti-inflammatory drugs. [NIH] Salicylic: A tuberculosis drug. [NIH] Salicylic Acids: Derivatives and salts of salicylic acid. [NIH] Saline: A solution of salt and water. [NIH] Saliva: The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptylin. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Salivation: 1. The secretion of saliva. 2. Ptyalism (= excessive flow of saliva). [EU] Sarcoma: A connective tissue neoplasm formed by proliferation of mesodermal cells; it is usually highly malignant. [NIH] Scans: Pictures of structures inside the body. Scans often used in diagnosing, staging, and monitoring disease include liver scans, bone scans, and computed tomography (CT) or computerized axial tomography (CAT) scans and magnetic resonance imaging (MRI) scans. In liver scanning and bone scanning, radioactive substances that are injected into the bloodstream collect in these organs. A scanner that detects the radiation is used to create pictures. In CT scanning, an x-ray machine linked to a computer is used to produce detailed pictures of organs inside the body. MRI scans use a large magnet connected to a computer to create pictures of areas inside the body. [NIH] Schizoid: Having qualities resembling those found in greater degree in schizophrenics; a person of schizoid personality. [NIH] Schizophrenia: A mental disorder characterized by a special type of disintegration of the personality. [NIH] Schizotypal Personality Disorder: A personality disorder in which there are oddities of thought (magical thinking, paranoid ideation, suspiciousness), perception (illusions, depersonalization), speech (digressive, vague, overelaborate), and behavior (inappropriate affect in social interactions, frequently social isolation) that are not severe enough to characterize schizophrenia. [NIH] Schwannoma: A tumor of the peripheral nervous system that begins in the nerve sheath (protective covering). It is almost always benign, but rare malignant schwannomas have been reported. [NIH]

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Sclerosis: A pathological process consisting of hardening or fibrosis of an anatomical structure, often a vessel or a nerve. [NIH] Scopolamine: An alkaloid from Solanaceae, especially Datura metel L. and Scopola carniolica. Scopolamine and its quaternary derivatives act as antimuscarinics like atropine, but may have more central nervous system effects. Among the many uses are as an anesthetic premedication, in urinary incontinence, in motion sickness, as an antispasmodic, and as a mydriatic and cycloplegic. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Sebaceous: Gland that secretes sebum. [NIH] Sebaceous gland: Gland that secretes sebum. [NIH] Sebum: The oily substance secreted by sebaceous glands. It is composed of keratin, fat, and cellular debris. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Secretory: Secreting; relating to or influencing secretion or the secretions. [NIH] Sedative: 1. Allaying activity and excitement. 2. An agent that allays excitement. [EU] Sedentary: 1. Sitting habitually; of inactive habits. 2. Pertaining to a sitting posture. [EU] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Self Care: Performance of activities or tasks traditionally performed by professional health care providers. The concept includes care of oneself or one's family and friends. [NIH] Semicircular canal: Three long canals of the bony labyrinth of the ear, forming loops and opening into the vestibule by five openings. [NIH] Semisynthetic: Produced by chemical manipulation of naturally occurring substances. [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] Sensory loss: A disease of the nerves whereby the myelin or insulating sheath of myelin on the nerves does not stay intact and the messages from the brain to the muscles through the nerves are not carried properly. [NIH] Septal: An abscess occurring at the root of the tooth on the proximal surface. [NIH] Septic: Produced by or due to decomposition by microorganisms; putrefactive. [EU] Septum: A dividing wall or partition; a general term for such a structure. The term is often used alone to refer to the septal area or to the septum pellucidum. [EU] Septum Pellucidum: A triangular double membrane separating the anterior horns of the lateral ventricles of the brain. It is situated in the median plane and bounded by the corpus callosum and the body and columns of the fornix. [NIH] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the

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broad physiological actions and distribution of this biochemical mediator. [NIH] Serous: Having to do with serum, the clear liquid part of blood. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Sex Characteristics: Those characteristics that distinguish one sex from the other. The primary sex characteristics are the ovaries and testes and their related hormones. Secondary sex characteristics are those which are masculine or feminine but not directly related to reproduction. [NIH] Sharpness: The apparent blurring of the border between two adjacent areas of a radiograph having different optical densities. [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] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Sinusitis: An inflammatory process of the mucous membranes of the paranasal sinuses that occurs in three stages: acute, subacute, and chronic. Sinusitis results from any condition causing ostial obstruction or from pathophysiologic changes in the mucociliary transport mechanism. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Social Support: Support systems that provide assistance and encouragement to individuals with physical or emotional disabilities in order that they may better cope. Informal social support is usually provided by friends, relatives, or peers, while formal assistance is provided by churches, groups, etc. [NIH] Social Work: The use of community resources, individual case work, or group work to promote the adaptive capacities of individuals in relation to their social and economic environments. It includes social service agencies. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for

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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] Solitary Nucleus: Gray matter located in the dorsomedial part of the medulla oblongata associated with the solitary tract. The solitary nucleus receives inputs from most organ systems including the terminations of the facial, glossopharyngeal, and vagus nerves. It is a major coordinator of autonomic nervous system regulation of cardiovascular, respiratory, gustatory, gastrointestinal, and chemoreceptive aspects of homeostasis. The solitary nucleus is also notable for the large number of neurotransmitters which are found therein. [NIH] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Somnolence: Sleepiness; also unnatural drowsiness. [EU] Sound wave: An alteration of properties of an elastic medium, such as pressure, particle displacement, or density, that propagates through the medium, or a superposition of such alterations. [NIH] Spasm: An involuntary contraction of a muscle or group of muscles. Spasms may involve skeletal muscle or smooth muscle. [NIH] Spasmodic: Of the nature of a spasm. [EU] Spasmogenic: Capable of producing convulsions. [NIH] Spatial disorientation: Loss of orientation in space where person does not know which way is up. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] 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] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spinal Cord Injuries: Penetrating and non-penetrating injuries to the spinal cord resulting from traumatic external forces (e.g., wounds, gunshot; whiplash injuries; etc.). [NIH] Spinal Nerve Roots: The paired bundles of nerve fibers entering and leaving the spinal cord at each segment. The dorsal and ventral nerve roots join to form the mixed segmental spinal nerves. The dorsal roots are generally afferent, formed by the central projections of the spinal (dorsal root) ganglia sensory cells, and the ventral roots efferent, comprising the axons of spinal motor and autonomic preganglionic neurons. There are, however, some exceptions to this afferent/efferent rule. [NIH] Spondylitis: Inflammation of the vertebrae. [EU]

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Spondylolisthesis: Forward displacement of one vertebra over another. [NIH] Sprains and Strains: A collective term for muscle and ligament injuries without dislocation or fracture. A sprain is a joint injury in which some of the fibers of a supporting ligament are ruptured but the continuity of the ligament remains intact. A strain is an overstretching or overexertion of some part of the musculature. [NIH] Squamous: Scaly, or platelike. [EU] Squamous Epithelium: Tissue in an organ such as the esophagus. Consists of layers of flat, scaly cells. [NIH] Stabilization: The creation of a stable state. [EU] Staging: Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. [NIH]

Stapes: One of the three ossicles of the middle ear. It transmits sound vibrations from the incus to the internal ear. [NIH] Staphylococcus: A genus of gram-positive, facultatively anaerobic, coccoid bacteria. Its organisms occur singly, in pairs, and in tetrads and characteristically divide in more than one plane to form irregular clusters. Natural populations of Staphylococcus are membranes of warm-blooded animals. Some species are opportunistic pathogens of humans and animals. [NIH] Stereoscopic: Accurate depth perception in the presence of binocular single vision, due to the slight disparity in the two retinal images of the same object. [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] 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] Stupor: Partial or nearly complete unconsciousness, manifested by the subject's responding only to vigorous stimulation. Also, in psychiatry, a disorder marked by reduced responsiveness. [EU] Subacute: Somewhat acute; between acute and chronic. [EU] Subarachnoid: Situated or occurring between the arachnoid and the pia mater. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subspecies: A category intermediate in rank between species and variety, based on a smaller number of correlated characters than are used to differentiate species and generally conditioned by geographical and/or ecological occurrence. [NIH] Substance P: An eleven-amino acid neurotransmitter that appears in both the central and

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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]

Sudden death: Cardiac arrest caused by an irregular heartbeat. The term "death" is somewhat misleading, because some patients survive. [NIH] Sulfur: An element that is a member of the chalcogen family. It has an atomic symbol S, atomic number 16, and atomic weight 32.066. It is found in the amino acids cysteine and methionine. [NIH] Supine: Having the front portion of the body upwards. [NIH] Support group: A group of people with similar disease who meet to discuss how better to cope with their cancer and treatment. [NIH] Suppositories: A small cone-shaped medicament having cocoa butter or gelatin at its basis and usually intended for the treatment of local conditions in the rectum. [NIH] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Supraventricular: Situated or occurring above the ventricles, especially in an atrium or atrioventricular node. [EU] Sympathetic Nervous System: The thoracolumbar division of the autonomic nervous system. Sympathetic preganglionic fibers originate in neurons of the intermediolateral column of the spinal cord and project to the paravertebral and prevertebral ganglia, which in turn project to target organs. The sympathetic nervous system mediates the body's response to stressful situations, i.e., the fight or flight reactions. It often acts reciprocally to the parasympathetic system. [NIH] Sympathomimetic: 1. Mimicking the effects of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. 2. An agent that produces effects similar to those of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. Called also adrenergic. [EU] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Symptomatic treatment: Therapy that eases symptoms without addressing the cause of disease. [NIH] Synapses: Specialized junctions at which a neuron communicates with a target cell. At classical synapses, a neuron's presynaptic terminal releases a chemical transmitter stored in synaptic vesicles which diffuses across a narrow synaptic cleft and activates receptors on the postsynaptic membrane of the target cell. The target may be a dendrite, cell body, or axon of another neuron, or a specialized region of a muscle or secretory cell. Neurons may also communicate through direct electrical connections which are sometimes called electrical synapses; these are not included here but rather in gap junctions. [NIH] Synapsis: The pairing between homologous chromosomes of maternal and paternal origin during the prophase of meiosis, leading to the formation of gametes. [NIH] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Synaptic Transmission: The communication from a neuron to a target (neuron, muscle, or secretory cell) across a synapse. In chemical synaptic transmission, the presynaptic neuron releases a neurotransmitter that diffuses across the synaptic cleft and binds to specific

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synaptic receptors. These activated receptors modulate ion channels and/or secondmessenger systems to influence the postsynaptic cell. Electrical transmission is less common in the nervous system, and, as in other tissues, is mediated by gap junctions. [NIH] Synaptic Vesicles: Membrane-bound compartments which contain transmitter molecules. Synaptic vesicles are concentrated at presynaptic terminals. They actively sequester transmitter molecules from the cytoplasm. In at least some synapses, transmitter release occurs by fusion of these vesicles with the presynaptic membrane, followed by exocytosis of their contents. [NIH] Syncope: A temporary suspension of consciousness due to generalized cerebral schemia, a faint or swoon. [EU] Synergistic: Acting together; enhancing the effect of another force or agent. [EU] Systemic: Affecting the entire body. [NIH] Systemic disease: Disease that affects the whole body. [NIH] Systemic lupus erythematosus: SLE. A chronic inflammatory connective tissue disease marked by skin rashes, joint pain and swelling, inflammation of the kidneys, inflammation of the fibrous tissue surrounding the heart (i.e., the pericardium), as well as other problems. Not all affected individuals display all of these problems. May be referred to as lupus. [NIH] Tachycardia: Excessive rapidity in the action of the heart, usually with a heart rate above 100 beats per minute. [NIH] Temporal: One of the two irregular bones forming part of the lateral surfaces and base of the skull, and containing the organs of hearing. [NIH] Temporal Lobe: Lower lateral part of the cerebral hemisphere. [NIH] Testis: Either of the paired male reproductive glands that produce the male germ cells and the male hormones. [NIH] Tetracycline: An antibiotic originally produced by Streptomyces viridifaciens, but used mostly in synthetic form. It is an inhibitor of aminoacyl-tRNA binding during protein synthesis. [NIH] Thalamic: Cell that reaches the lateral nucleus of amygdala. [NIH] Thalamic Diseases: Disorders of the centrally located thalamus, which integrates a wide range of cortical and subcortical information. Manifestations include sensory loss, movement disorders; ataxia, pain syndromes, visual disorders, a variety of neuropsychological conditions, and coma. Relatively common etiologies include cerebrovascular disorders; craniocerebral trauma; brain neoplasms; brain hypoxia; intracranial hemorrhages; and infectious processes. [NIH] Thalamus: Paired bodies containing mostly gray substance and forming part of the lateral wall of the third ventricle of the brain. The thalamus represents the major portion of the diencephalon and is commonly divided into cellular aggregates known as nuclear groups. [NIH]

Theophylline: Alkaloid obtained from Thea sinensis (tea) and others. It stimulates the heart and central nervous system, dilates bronchi and blood vessels, and causes diuresis. The drug is used mainly in bronchial asthma and for myocardial stimulation. Among its more prominent cellular effects are inhibition of cyclic nucleotide phosphodiesterases and antagonism of adenosine receptors. [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]

Dictionary 219

Thoracic: Having to do with the chest. [NIH] Thorax: A part of the trunk between the neck and the abdomen; the chest. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombophlebitis: Inflammation of a vein associated with thrombus formation. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thrombus: An aggregation of blood factors, primarily platelets and fibrin with entrapment of cellular elements, frequently causing vascular obstruction at the point of its formation. Some authorities thus differentiate thrombus formation from simple coagulation or clot formation. [EU] Thymus: An organ that is part of the lymphatic system, in which T lymphocytes grow and multiply. The thymus is in the chest behind the breastbone. [NIH] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Thyrotropin: A peptide hormone secreted by the anterior pituitary. It promotes the growth of the thyroid gland and stimulates the synthesis of thyroid hormones and the release of thyroxine by the thyroid gland. [NIH] Tidal Volume: The volume of air inspired or expired during each normal, quiet respiratory cycle. Common abbreviations are TV or V with subscript T. [NIH] Tin: A trace element that is required in bone formation. It has the atomic symbol Sn, atomic number 50, and atomic weight 118.71. [NIH] Tinnitus: Sounds that are perceived in the absence of any external noise source which may take the form of buzzing, ringing, clicking, pulsations, and other noises. Objective tinnitus refers to noises generated from within the ear or adjacent structures that can be heard by other individuals. The term subjective tinnitus is used when the sound is audible only to the affected individual. Tinnitus may occur as a manifestation of cochlear diseases; vestibulocochlear nerve diseases; intracranial hypertension; craniocerebral trauma; and other conditions. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tolerance: 1. The ability to endure unusually large doses of a drug or toxin. 2. Acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU] Tonicity: The normal state of muscular tension. [NIH] Tooth Preparation: Procedures carried out with regard to the teeth or tooth structures preparatory to specified dental therapeutic and surgical measures. [NIH] Topical: On the surface of the body. [NIH] Torsion: A twisting or rotation of a bodily part or member on its axis. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic 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

220 Dizziness

toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Toxoplasmosis: The acquired form of infection by Toxoplasma gondii in animals and man. [NIH]

Trace element: Substance or element essential to plant or animal life, but present in extremely small amounts. [NIH] Tramadol: A narcotic analgesic proposed for severe pain. It may be habituating. [NIH] Transcutaneous: Transdermal. [EU] Transdermal: Entering through the dermis, or skin, as in administration of a drug applied to the skin in ointment or patch form. [EU] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transfer Factor: Factor derived from leukocyte lysates of immune donors which can transfer both local and systemic cellular immunity to nonimmune recipients. [NIH] Transient Ischemic Attacks: Focal neurologic abnormalities of sudden onset and brief duration that reflect dysfunction in the distribution of the internal carotid-middle cerebral or the vertebrobasilar arterial system. [NIH] Translation: The process whereby the genetic information present in the linear sequence of ribonucleotides in mRNA is converted into a corresponding sequence of amino acids in a protein. It occurs on the ribosome and is unidirectional. [NIH] Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [NIH] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Triage: The sorting out and classification of patients or casualties to determine priority of need and proper place of treatment. [NIH] Tricyclic: Containing three fused rings or closed chains in the molecular structure. [EU] Triflupromazine: A phenothiazine used as an antipsychotic agent and as an antiemetic. [NIH]

Trigger zone: Dolorogenic zone (= producing or causing pain). [EU] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tungsten: A metallic element with the atomic symbol W, atomic number 74, and atomic weight 183.85. It is used in many manufacturing applications, including increasing the hardness, toughness, and tensile strength of steel; manufacture of filaments for incandescent light bulbs; and in contact points for automotive and electrical apparatus. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Urea: A compound (CO(NH2)2), formed in the liver from ammonia produced by the deamination of amino acids. It is the principal end product of protein catabolism and constitutes about one half of the total urinary solids. [NIH]

Dictionary 221

Uremia: The illness associated with the buildup of urea in the blood because the kidneys are not working effectively. Symptoms include nausea, vomiting, loss of appetite, weakness, and mental confusion. [NIH] Ureters: Tubes that carry urine from the kidneys to the bladder. [NIH] Urethane: Antineoplastic agent that is also used as a veterinary anesthetic. It has also been used as an intermediate in organic synthesis. Urethane is suspected to be a carcinogen. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

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

Urinate: To release urine from the bladder to the outside. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Urticaria: A vascular reaction of the skin characterized by erythema and wheal formation due to localized increase of vascular permeability. The causative mechanism may be allergy, infection, or stress. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vagal: Pertaining to the vagus nerve. [EU] Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Vaginitis: Inflammation of the vagina characterized by pain and a purulent discharge. [NIH] Vagus Nerve: The 10th cranial nerve. The vagus is a mixed nerve which contains somatic afferents (from skin in back of the ear and the external auditory meatus), visceral afferents (from the pharynx, larynx, thorax, and abdomen), parasympathetic efferents (to the thorax and abdomen), and efferents to striated muscle (of the larynx and pharynx). [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vascular Headaches: A group of disorders characterized by recurrent headaches associated with abnormal dilation and constriction of cerebral blood vessels. Representative disorders from this category include migraine, cluster headache, and paroxysmal hemicrania. [NIH] Vascular Resistance: An expression of the resistance offered by the systemic arterioles, and to a lesser extent by the capillaries, to the flow of blood. [NIH] Vasoconstriction: Narrowing of the blood vessels without anatomic change, for which constriction, pathologic is used. [NIH] Vasodilatation: A state of increased calibre of the blood vessels. [EU] Vasodilation: Physiological dilation of the blood vessels without anatomic change. For dilation with anatomic change, dilatation, pathologic or aneurysm (or specific aneurysm) is used. [NIH] Vasodilator: An agent that widens blood vessels. [NIH]

222 Dizziness

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] Ventral: 1. Pertaining to the belly or to any venter. 2. Denoting a position more toward the belly surface than some other object of reference; same as anterior in human anatomy. [EU] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Ventricular: Pertaining to a ventricle. [EU] Ventricular fibrillation: Rapid, irregular quivering of the heart's ventricles, with no effective heartbeat. [NIH] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Vertebrae: A bony unit of the segmented spinal column. [NIH] Vertebral: Of or pertaining to a vertebra. [EU] Vertebrobasilar Insufficiency: Localized or diffuse reduction in blood flow through the vertebrobasilar arterial system, which supplies the brain stem; cerebellum; occipital lobe; medial temporal lobe; and thalamus. Characteristic clinical features include syncope; lightheadedness; visual disturbances; and vertigo. brain stem infarctions or other brain infarction may be associated. [NIH] Vertigo: An illusion of movement; a sensation as if the external world were revolving around the patient (objective vertigo) or as if he himself were revolving in space (subjective vertigo). The term is sometimes erroneously used to mean any form of dizziness. [EU] Vesicular: 1. Composed of or relating to small, saclike bodies. 2. Pertaining to or made up of vesicles on the skin. [EU] Vestibular: Pertaining to or toward a vestibule. In dental anatomy, used to refer to the tooth surface directed toward the vestibule of the mouth. [EU] Vestibular Nerve: The vestibular part of the 8th cranial nerve (vestibulocochlear nerve). The vestibular nerve fibers arise from neurons of Scarpa's ganglion and project peripherally to vestibular hair cells and centrally to the vestibular nuclei of the brain stem. These fibers mediate the sense of balance and head position. [NIH] Vestibular Neuronitis: That due to a lesion in the labyrinth or vestibule. [NIH] Vestibule: A small, oval, bony chamber of the labyrinth. The vestibule contains the utricle and saccule, organs which are part of the balancing apparatus of the ear. [NIH] Vestibulocochlear Nerve: The 8th cranial nerve. The vestibulocochlear nerve has a cochlear part (cochlear nerve) which is concerned with hearing and a vestibular part (vestibular nerve) which mediates the sense of balance and head position. The fibers of the cochlear nerve originate from neurons of the spiral ganglion and project to the cochlear nuclei (cochlear nucleus). The fibers of the vestibular nerve arise from neurons of Scarpa's ganglion and project to the vestibular nuclei. [NIH] Vestibulocochlear Nerve Diseases: Diseases of the vestibular and/or cochlear (acoustic) nerves, which join to form the vestibulocochlear nerve. Vestibular neuritis, cochlear neuritis, and acoustic neuromas are relatively common conditions that affect these nerves. Clinical manifestations vary with which nerve is primarily affected, and include hearing loss, vertigo, and tinnitus. [NIH]

Dictionary 223

Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Visceral: , from viscus a viscus) pertaining to a viscus. [EU] Visceral Afferents: The sensory fibers innervating the viscera. [NIH] Visual Acuity: Acuteness or clearness of vision, especially of form vision, which is dependent mainly on the sharpness of the retinal focus. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Voice Disorders: Disorders of voice pitch, loudness, or quality. Dysphonia refers to impaired utterance of sounds by the vocal folds. [NIH] Void: To urinate, empty the bladder. [NIH] Volition: Voluntary activity without external compulsion. [NIH] Voltage-gated: It is opened by the altered charge distribution across the cell membrane. [NIH]

Vulgaris: An affection of the skin, especially of the face, the back and the chest, due to chronic inflammation of the sebaceous glands and the hair follicles. [NIH] Wakefulness: A state in which there is an enhanced potential for sensitivity and an efficient responsiveness to external stimuli. [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 Healing: Restoration of integrity to traumatized tissue. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH] Yawning: An involuntary deep inspiration with the mouth open, often accompanied by the act of stretching. [NIH]

225

INDEX A Abdominal, 21, 165, 204 Abdominal Pain, 21, 165 Ablation, 12, 18, 27, 165 Abscess, 116, 165, 213 Acetaminophen, 97, 165 Acetylcholine, 98, 103, 165, 177, 202 Acne, 91, 101, 165 Acne Vulgaris, 91, 165 Acoustic, 7, 12, 13, 114, 118, 144, 151, 165, 222 Activities of Daily Living, 12, 165 Acupuncture Points, 89, 90, 91, 165 Adaptability, 165, 175 Adaptation, 11, 19, 165, 176, 193, 206 Adenosine, 165, 174, 205, 218 Adjustment, 12, 165 Adjuvant, 166, 187, 188 Adolescence, 41, 166 Adrenal Cortex, 166, 185, 207 Adrenal Medulla, 166, 185, 202 Adverse Effect, 30, 99, 100, 166, 214 Aerophagia, 92, 166 Afferent, 23, 32, 166, 180, 187, 215 Affinity, 20, 97, 100, 166, 214 Age Groups, 9, 113, 166 Age of Onset, 9, 166 Aged, 80 and Over, 166 Agonist, 166, 172, 173, 183, 200, 202 Agoraphobia, 47, 166, 192, 204 Agranulocytosis, 101, 166 Alertness, 166, 173 Alexia, 166, 183 Algorithms, 13, 166, 172 Alkaline, 166, 174 Alkaloid, 166, 170, 199, 202, 213, 218 Allergic Rhinitis, 102, 166, 176 Alternative medicine, 20, 126, 167 Ambulatory Care, 33, 167 Amine, 132, 167, 190 Amino Acids, 20, 167, 185, 205, 206, 208, 212, 217, 220 Amyloid, 31, 167 Anaesthesia, 100, 103, 167, 193 Anal, 36, 167, 187, 196 Analgesic, 86, 96, 97, 99, 100, 165, 167, 192, 199, 203, 220 Analog, 167, 172

Anaphylatoxins, 167, 178 Anatomical, 24, 28, 167, 170, 179, 182, 193, 213 Anecdotal report, 26, 28, 167 Anemia, 167, 197 Anesthetics, 167, 185, 189 Aneurysm, 150, 168, 221 Angina, 20, 168 Angina Pectoris, 20, 168 Angiogenesis, 168, 197 Anionic, 94, 168 Ankle, 90, 91, 168 Anode, 30, 168 Anomalies, 32, 168 Anorexia, 101, 168 Antagonism, 168, 174, 218 Antiallergic, 168, 208 Antiarrhythmic, 27, 168 Antibacterial, 21, 94, 168, 215 Antibiotic, 92, 128, 168, 171, 185, 199, 207, 215, 218 Antibodies, 168, 170, 189, 190, 192 Antibody, 166, 168, 169, 178, 189, 191, 192, 193, 197, 215 Anticholinergic, 87, 103, 168, 176 Anticonvulsant, 20, 168 Antidepressant, 168, 192 Antiemetic, 4, 16, 99, 115, 168, 169, 176, 177, 182, 191, 220 Antiepileptic, 30, 168 Antigen, 166, 168, 169, 178, 191, 192, 193, 197 Antigen-Antibody Complex, 169, 178 Antihistamine, 128, 169 Anti-inflammatory, 15, 76, 96, 97, 165, 169, 170, 192, 202, 212 Anti-Inflammatory Agents, 169, 170 Antimicrobial, 21, 94, 169, 183 Antipsychotic, 169, 176, 201, 205, 220 Antipyretic, 165, 169 Antispasmodic, 169, 182, 189, 203, 208, 213 Antitussive, 169, 182, 203 Anus, 167, 169, 173, 194, 205 Anxiety, 6, 9, 11, 26, 28, 36, 37, 50, 61, 98, 104, 116, 117, 161, 169, 191, 204, 207 Anxiolytic, 97, 98, 105, 169, 173 Apathy, 169, 201

226 Dizziness

Aphasia, 118, 169 Apolipoproteins, 169, 188 Applicability, 30, 169 Aqueous, 99, 169, 171, 180, 184, 195 Arginine, 167, 170, 202 Arrhythmia, 4, 28, 61, 113, 144, 150, 168, 170 Arterial, 19, 170, 173, 191, 208, 220, 222 Arteries, 150, 170, 172, 173, 180, 198, 200 Arterioles, 170, 173, 200, 221 Articular, 170, 203 Aspirin, 97, 170 Asthenia, 100, 170 Asymptomatic, 28, 170 Ataxia, 30, 116, 118, 170, 218 Atrial, 27, 45, 170 Atrial Fibrillation, 27, 45, 170 Atrial Flutter, 28, 170 Atrioventricular, 170, 217 Atrioventricular Node, 170, 217 Atrium, 170, 199, 217, 222 Atropine, 133, 170, 213 Attenuated, 19, 170 Atypical, 12, 170 Audiologist, 7, 9, 87, 149, 170 Audiology, 9, 58, 149, 170 Auditory, 7, 10, 11, 25, 32, 37, 39, 52, 58, 108, 148, 170, 183, 186, 189, 190, 191, 197, 221 Aura, 8, 170 Aural, 36, 43, 87, 170 Autoantibodies, 170, 181 Autoimmune disease, 11, 25, 171, 200 Autonomic, 16, 19, 26, 44, 45, 165, 169, 171, 180, 202, 205, 215, 217 Autonomic Nervous System, 19, 171, 205, 215, 217 Axons, 171, 201, 205, 215 Azithromycin, 21, 171 B Back Pain, 122, 171 Bacteria, 168, 171, 172, 184, 187, 190, 196, 198, 199, 215, 216, 221 Bacterial Infections, 117, 171, 175 Bacterial Physiology, 165, 171 Bacterium, 171, 172 Baroreflex, 19, 171 Barotrauma, 145, 171 Basal Ganglia, 169, 170, 171, 173, 188 Basal Ganglia Diseases, 170, 171 Base, 171, 176, 181, 194, 218 Basophils, 166, 171, 189, 195

Belching, 166, 172 Benign tumor, 151, 172 Benzene, 172 Benzodiazepines, 93, 98, 172, 173 Betahistine, 42, 172 Beta-pleated, 167, 172 Bilateral, 10, 13, 18, 19, 34, 48, 90, 145, 172, 190, 204 Biliary, 172, 182 Binaural, 24, 48, 172 Bioavailability, 101, 172 Biochemical, 21, 172, 203, 213 Bioluminescence, 172, 196 Biotechnology, 35, 112, 126, 139, 172 Bismuth, 93, 132, 172 Bismuth Subsalicylate, 93, 132, 172 Bladder, 103, 172, 193, 200, 221, 223 Blood Coagulation, 172, 174 Blood Glucose, 172, 192, 194 Blood Platelets, 172, 213 Blood pressure, 6, 8, 19, 162, 163, 171, 172, 175, 176, 191, 192, 199, 205, 215 Body Fluids, 102, 173, 215 Bone Conduction, 173, 211 Bone Marrow, 172, 173, 192, 196, 199 Bone scan, 173, 212 Bottle Feeding, 122, 173 Bowel, 167, 173, 182, 216 Bowel Movement, 173, 182, 216 Bradykinin, 173, 202 Brain Infarction, 173, 222 Brain Stem, 173, 176, 177, 222 Brain Stem Infarctions, 173, 222 Branch, 19, 159, 173, 184, 197, 203, 204, 209, 215, 218 Breakdown, 173, 182, 188 Bronchial, 172, 173, 190, 218 Buffers, 171, 173 Bullous, 173, 181 Buspirone, 98, 173 C Caffeine, 28, 173 Calcification, 15, 174 Calcium, 15, 20, 28, 92, 174, 177, 178, 187, 197, 198 Calcium Carbonate, 92, 174 Calcium channel blocker, 28, 174 Calcium Channel Blockers, 28, 174 Calcium Channels, 20, 174 Calmodulin, 174, 187 Caloric Tests, 7, 174 Capsules, 93, 94, 174, 183, 188

Index 227

Carbon Dioxide, 174, 181, 187, 191, 206, 211 Carcinogen, 174, 221 Cardiac, 4, 19, 27, 40, 41, 61, 113, 168, 170, 171, 173, 174, 184, 185, 186, 200, 217 Cardiac arrest, 27, 174, 217 Cardiac Output, 171, 174 Cardiovascular, 5, 6, 7, 19, 20, 22, 26, 40, 52, 62, 112, 115, 150, 174, 175, 182, 213, 215 Cardiovascular disease, 7, 175 Cardiovascular System, 115, 175, 182 Carotid Sinus, 5, 60, 150, 175, 207 Case report, 8, 16, 46, 59, 175, 177 Case series, 57, 175, 177 Cathode, 30, 168, 175, 184 Caudal, 175, 192, 206 Causal, 15, 40, 175, 190 Cell Death, 31, 175, 201 Cell Differentiation, 33, 175 Cell membrane, 174, 175, 188, 223 Cell Respiration, 175, 211 Cellular Structures, 175, 199 Central Nervous System Infections, 175, 190 Cerebellar, 11, 17, 18, 29, 48, 116, 170, 175, 211 Cerebellopontine, 11, 116, 176 Cerebellopontine Angle, 11, 116, 176 Cerebellum, 116, 173, 175, 176, 206, 211, 222 Cerebrospinal, 176, 214 Cerebrospinal fluid, 176, 214 Cerebrovascular, 4, 13, 14, 20, 52, 171, 174, 175, 176, 218 Cerebrum, 176 Cervical, 10, 11, 15, 23, 34, 41, 42, 46, 57, 59, 145, 176, 201 Cervix, 176 Cetirizine, 176, 191 Character, 168, 176, 181, 210 Chemoreceptor, 169, 176, 184 Chemotactic Factors, 176, 178 Chemotherapy, 176, 182 Chest Pain, 6, 27, 28, 129, 176 Chiropractic, 64, 104, 176 Chlorpromazine, 93, 176, 205 Cholesteatoma, 12, 176 Cholesterol, 62, 176, 180, 188 Cholinergic, 169, 177, 202 Chronic Disease, 19, 25, 177 Cinnarizine, 87, 177

CIS, 96, 177, 211 Classic Migraine, 86, 177 Cleft Palate, 118, 177 Clinical study, 177, 179 Clinical trial, 18, 27, 28, 81, 82, 139, 177, 179, 200, 209, 210 Cloning, 172, 177 Cochlea, 177, 193, 212 Cochlear, 18, 40, 41, 177, 191, 219, 222 Cochlear Diseases, 177, 219 Cochlear Implantation, 41, 177 Cochlear Nerve, 177, 222 Cofactor, 177, 208 Cognition, 177, 201 Collagen, 21, 177, 186, 188, 197, 206, 208 Communication Disorders, 81, 82, 118, 123, 138, 146, 148, 150, 151, 178 Complement, 35, 167, 178 Complementary and alternative medicine, 57, 78, 178 Complementary medicine, 57, 178 Compulsion, 178, 223 Computational Biology, 139, 178 Computed tomography, 178, 179, 212 Computerized axial tomography, 178, 212 Conception, 179, 187 Concomitant, 10, 34, 179, 201 Concretion, 179, 203 Conduction, 170, 179, 211 Cone, 179, 217 Confusion, 179, 182, 192, 201, 221 Congestion, 102, 169, 179, 181 Connective Tissue, 173, 177, 179, 188, 196, 200, 205, 208, 212, 218 Consciousness, 14, 27, 40, 129, 162, 167, 179, 181, 182, 218 Constipation, 96, 100, 169, 179 Constriction, 179, 194, 221 Constriction, Pathologic, 179, 221 Contraceptive, 26, 179 Contraceptive Agents, 26, 179 Contraindications, ii, 179 Contralateral, 52, 57, 179, 211 Control group, 179, 207 Controlled clinical trial, 21, 179 Controlled study, 59, 179 Contusion, 116, 179 Convulsions, 102, 168, 179, 192, 215 Coordination, 114, 115, 176, 179, 200 Cornea, 179, 184 Coronary, 168, 170, 175, 180, 198, 200 Coronary Circulation, 168, 180

228 Dizziness

Coronary heart disease, 175, 180 Coronary Thrombosis, 180, 198, 200 Corpus, 180, 207, 213 Corpus Luteum, 180, 207 Cortex, 32, 70, 170, 180, 186, 187, 210, 211 Cortical, 39, 52, 58, 180, 186, 213, 218 Cranial, 115, 116, 176, 177, 180, 186, 189, 194, 201, 202, 204, 205, 221, 222 Cranial Nerves, 115, 180 Craniocerebral Trauma, 171, 180, 190, 218, 219 Cryptosporidiosis, 171, 180 Cues, 19, 180 Curare, 180, 200 Curative, 27, 180, 218 Cutaneous, 180, 191, 192, 196 Cyclic, 174, 180, 189, 202, 208, 218 Cyst, 35, 45, 180 Cytoplasm, 171, 175, 180, 185, 189, 199, 202, 212, 218 D Databases, Bibliographic, 139, 180 Decarboxylation, 181, 190 Decompression, 181, 182 Decongestant, 97, 181 Degenerative, 181, 200, 203 Dehydration, 92, 181 Delirium, 6, 105, 169, 181 Delusions, 181, 209 Dendrites, 181, 201 Density, 95, 181, 202, 215 Depth Perception, 95, 181, 216 Dermal, 99, 181 Dermatitis, 101, 181, 191 Dermatitis Herpetiformis, 101, 181 Dermatosis, 101, 181 Detoxification, 98, 181 Diabetes Mellitus, 117, 181, 189 Diagnostic Errors, 22, 181 Diagnostic procedure, 85, 126, 147, 181 Diarrhea, 21, 94, 100, 172, 180, 181 Diathermy, 181, 199 Dicyclomine, 103, 182 Diffusion, 182, 193 Digestion, 19, 173, 182, 183, 193, 195, 204, 216 Digestive system, 82, 182 Dilatation, 168, 182, 207, 221 Dilatation, Pathologic, 182, 221 Dilation, 173, 182, 221 Dimenhydrinate, 73, 93, 182 Diphenhydramine, 93, 182

Direct, iii, 20, 29, 32, 131, 182, 183, 211, 217 Dislocation, 116, 182, 216 Disorientation, 89, 150, 179, 181, 182 Disparity, 182, 216 Dissociation, 166, 182 Diuresis, 91, 173, 182, 218 Diving, 36, 182 Dopamine, 169, 176, 183 Dorsal, 183, 206, 215 Dosage Forms, 94, 183 Doxycycline, 21, 183 Drug Interactions, 134, 183 Drug Tolerance, 183, 219 Duodenum, 183, 216 Dyes, 167, 171, 183, 202 Dyslexia, 118, 183 Dyspepsia, 100, 183, 193 Dysphagia, 15, 183 Dysphonia, 118, 183, 223 Dystonia, 118, 169, 183 E Earache, 122, 183 Eardrum, 122, 183 Eccentricities, 18, 183 Edema, 183, 194, 200 Effector, 165, 178, 183 Efficacy, 12, 20, 21, 29, 52, 81, 101, 173, 183 Elastin, 177, 184, 186 Electrode, 168, 175, 184 Electrolyte, 181, 184, 207, 215 Electrons, 171, 175, 184, 194, 196, 210 Electronystagmography, 9, 11, 14, 43, 113, 114, 115, 148, 163, 184 Electrophysiological, 15, 27, 184 Elementary Particles, 184, 196, 209 Embolism, 150, 184 Embolus, 184, 193 Embryo, 175, 184, 193 Emesis, 184 Emetics, 96, 184 Emollient, 184, 202 Empirical, 5, 184 Emulsion, 184, 187 Endemic, 184, 197 Endocardium, 27, 185 Endometrium, 185, 198 Endothelial cell, 185 Endothelium, 185, 202 Endothelium-derived, 185, 202 Endotoxins, 178, 185 Energy balance, 19, 185 Energy Intake, 19, 185

Index 229

Environmental Health, 138, 140, 185 Enzymatic, 174, 178, 185, 190, 211 Enzyme, 21, 183, 185, 189, 198, 209, 223 Eosinophils, 166, 185, 189, 195 Epidermis, 185, 210 Epidural, 116, 185 Epinephrine, 183, 185, 202 Erythrocytes, 167, 173, 185, 190 Erythromycin, 171, 185 Esophagus, 182, 185, 190, 216 Estradiol, 26, 133, 185 Euphoria, 96, 185 Eustachian tube, 171, 186 Evacuation, 179, 186 Evoke, 186, 216 Evoked Potentials, 32, 186 Excipient, 94, 186 Excitability, 186, 200, 201 Excitation, 170, 176, 186 Excitatory, 100, 186, 189 Exercise Therapy, 12, 46, 186 Exhaustion, 62, 168, 186, 197 Expiration, 186, 211 Extracellular, 167, 179, 186, 197, 215 Extracellular Matrix, 179, 186, 197 Extracellular Matrix Proteins, 186, 197 Extrapyramidal, 14, 169, 183, 186 Eye Movements, 18, 81, 108, 114, 127, 186 F Facial, 103, 186, 187, 191, 197, 215 Facial Nerve, 103, 186, 187, 191 Facial Nerve Diseases, 187, 191 Family Planning, 139, 187 Fat, 173, 180, 184, 187, 195, 200, 212, 213 Fatigue, 6, 21, 28, 92, 104, 111, 187, 201 Feces, 179, 187, 216 Fetus, 187, 206, 207, 221 Fibrillation, 27, 187 Fissure, 177, 187 Fistula, 8, 11, 12, 114, 115, 117, 147, 148, 187 Fixation, 87, 187 Flunarizine, 42, 187 Forearm, 173, 187 Fossa, 176, 187 Fovea, 187 Fructose, 93, 187 G Gait, 115, 188 Gallbladder, 165, 172, 182, 188 Ganglia, 165, 171, 188, 201, 205, 215, 217 Ganglion, 177, 188, 222

Gap Junctions, 188, 217, 218 Gas, 166, 172, 174, 182, 188, 191, 193, 202, 210 Gastric, 86, 183, 188, 190, 204 Gastrin, 188, 191 Gastrointestinal, 21, 94, 173, 182, 184, 185, 188, 189, 197, 213, 215, 217 Gastrointestinal tract, 184, 188, 189, 213 Gelatin, 188, 217 Gels, 93, 188 Gemfibrozil, 14, 188 Gene, 25, 112, 172, 188, 206 Gene Expression, 25, 188 Genetics, 32, 188, 199 Geriatric, 4, 5, 6, 40, 50, 188 Ginseng, 70, 74, 76, 188 Gland, 166, 188, 196, 204, 213, 216, 219 Glucose, 93, 172, 181, 189, 192, 194 Glucose Intolerance, 181, 189 Glutamate, 189, 205 Glycopyrrolate, 103, 189 Glycosaminoglycans, 186, 189, 208 Governing Board, 189, 207 Graft, 189, 191 Granulocytes, 166, 189 Growth, 166, 168, 169, 172, 175, 189, 197, 201, 206, 219, 220 Guanylate Cyclase, 189, 202 H Habitual, 20, 176, 189 Habituation, 13, 81, 189 Hair Cells, 23, 32, 177, 189, 222 Hair follicles, 189, 223 Half-Life, 97, 189 Handicap, 11, 36, 39, 42, 44, 45, 47, 48, 49, 81, 189 Haptens, 166, 189 Head Movements, 10, 18, 23, 24, 29, 34, 58, 189 Headache Disorders, 190 Hearing Disorders, 144, 178, 190 Heart attack, 150, 175, 190 Heartbeat, 190, 217, 222 Heartburn, 172, 190, 193 Hemianopsia, 177, 190 Hemodialysis, 174, 190 Hemolysis, 101, 190 Hemorrhage, 116, 148, 180, 190, 205, 216 Hemostasis, 190, 213 Hepatic, 181, 190 Heredity, 165, 188, 190 Hermetic, 87, 190

230 Dizziness

Heterogeneity, 166, 190 Hiccup, 176, 190 Histamine, 74, 98, 167, 169, 172, 176, 177, 182, 187, 190, 191, 197, 208 Histidine, 190 Homologous, 191, 217 Hormonal, 26, 191 Hormone, 20, 26, 132, 133, 185, 188, 191, 194, 207, 212, 219 Hormone Replacement Therapy, 20, 191 Host, 102, 191, 192, 223 Hybridization, 191, 199 Hydrogen, 167, 171, 173, 186, 191, 199, 209 Hydrolysis, 96, 191, 206, 209 Hydroxylysine, 177, 191 Hydroxyproline, 177, 191 Hydroxyzine, 93, 98, 191 Hyperacusis, 43, 187, 191 Hyperalgesia, 100, 191 Hyperesthesia, 31, 191 Hyperlipidemia, 14, 191 Hyperplasia, 191, 200 Hypersensitivity, 5, 8, 182, 191, 212 Hypertension, 62, 63, 174, 175, 191, 194 Hyperventilation, 8, 59, 92, 162, 191 Hypesthesia, 192, 201 Hypnotic, 182, 192 Hypoglycaemia, 181, 192 Hypoglycemia, 11, 63, 192 Hypoglycemic, 114, 192 Hypotension, 5, 6, 8, 12, 19, 47, 91, 92, 97, 98, 105, 150, 162, 169, 179, 192 Hypothalamus, 171, 192 Hypothyroidism, 11, 117, 192 Hypoxia, 181, 192, 218 I Ibuprofen, 97, 192 Id, 53, 61, 98, 144, 151, 152, 158, 160, 192 Idiopathic, 10, 14, 192 Illusion, 5, 16, 88, 192, 222 Imipramine, 30, 192 Immune response, 25, 166, 168, 171, 189, 192, 217, 223 Immune Sera, 192 Immune system, 192, 193, 200, 221 Immunization, 25, 192 Immunologic, 176, 192 Immunology, 166, 193 Impairment, 6, 18, 31, 32, 42, 104, 129, 170, 181, 183, 193, 198, 209 In vitro, 22, 23, 193 In vivo, 30, 193

Incision, 193, 194 Incontinence, 103, 182, 193, 208, 213 Indicative, 108, 193, 204, 221 Indigestion, 172, 193 Induction, 31, 169, 181, 193 Infant, Newborn, 166, 193 Infarction, 37, 48, 58, 63, 116, 173, 193 Infiltration, 21, 193 Infusion, 21, 193 Ingestion, 86, 91, 99, 193, 206 Innervation, 186, 193 Inorganic, 193, 196 Insight, 20, 33, 193 Insomnia, 63, 101, 193 Institutionalization, 103, 193 Insulator, 194, 200 Insulin, 19, 47, 151, 194 Insulin-dependent diabetes mellitus, 194 Intermittent, 194, 196 Internal Medicine, 5, 6, 8, 14, 39, 40, 42, 47, 59, 194 Intervertebral, 194, 196, 210 Intervertebral Disk Displacement, 194, 196, 210 Intestinal, 94, 180, 194 Intestines, 165, 187, 188, 194 Intoxication, 117, 181, 194, 223 Intracellular, 174, 193, 194, 202, 207, 208, 210 Intracranial Hypertension, 190, 194, 219 Intravenous, 99, 193, 194, 204 Intrinsic, 166, 194 Invasive, 11, 88, 90, 194, 196 Invertebrates, 194, 196 Involuntary, 127, 171, 187, 189, 194, 200, 211, 215, 223 Ion Channels, 194, 218 Ions, 171, 173, 174, 182, 184, 191, 194 Ischemia, 7, 20, 113, 194 J Joint, 21, 41, 64, 104, 150, 170, 194, 196, 203, 216, 218 K Kb, 138, 194 Kinetics, 174, 195 L Labile, 178, 195 Labyrinth, 174, 177, 193, 195, 203, 205, 213, 222 Labyrinthine, 29, 34, 117, 147, 195 Labyrinthitis, 6, 7, 11, 12, 13, 92, 114, 115, 117, 129, 146, 195

Index 231

Lacrimal, 187, 195 Language Disorders, 178, 195 Large Intestine, 182, 194, 195, 210, 214 Least-Squares Analysis, 195, 211 Lens, 95, 195 Leprosy, 101, 195 Lesion, 15, 27, 34, 108, 195, 222 Lethargy, 97, 98, 105, 192, 195 Leukocytes, 171, 173, 176, 185, 189, 195, 199, 202 Library Services, 158, 195 Likelihood Functions, 195, 211 Linear Models, 195, 211 Lipid, 14, 169, 188, 194, 195, 200 Liver, 165, 172, 182, 184, 187, 188, 190, 195, 212, 220 Liver scan, 195, 212 Localization, 24, 195 Localized, 21, 102, 187, 193, 196, 201, 206, 221, 222 Logistic Models, 196, 211 Longitudinal Studies, 25, 196 Longitudinal study, 25, 196 Long-Term Care, 103, 196 Low Back Pain, 49, 196 Lumbar, 171, 194, 196 Luminescence, 30, 196 Lupus, 64, 196, 218 Luxation, 182, 196 Lymph, 176, 185, 196 Lymph node, 176, 196 Lymphatic, 185, 193, 196, 219 M Magnesium Compounds, 86, 196 Magnetic Resonance Imaging, 148, 196, 197, 212 Magnetic Resonance Spectroscopy, 31, 196 Malaria, 101, 197 Malaria, Falciparum, 197 Malaria, Vivax, 197 Malformation, 116, 197 Malignant, 117, 197, 201, 212 Malingering, 117, 197 Mammogram, 174, 197, 199 Mania, 105, 197 Manic, 169, 197, 209 Manic-depressive psychosis, 197, 209 Mastoiditis, 122, 197 Matrix metalloproteinase, 21, 197 Meatus, 183, 197, 221 Meclizine, 24, 76, 93, 133, 197

Medial, 197, 222 Mediate, 177, 183, 197, 222 Mediator, 197, 214 Medicament, 96, 198, 217 MEDLINE, 3, 139, 198 Medullary, 147, 198, 210 Meiosis, 198, 217 Membrane, 23, 102, 166, 175, 178, 183, 186, 194, 198, 200, 203, 211, 212, 213, 217, 218 Memory, 31, 101, 122, 168, 181, 198 Meninges, 175, 176, 180, 198 Meningitis, 198, 205 Menopause, 63, 198, 206 Menstrual Cycle, 26, 198, 207 Menstruation, 26, 198, 207 Mental Disorders, 83, 198, 205, 209 Mental Health, iv, 17, 83, 138, 140, 198, 209 Mental Processes, 182, 198, 209 Mental Retardation, 118, 178, 198 Metabolic disorder, 117, 198 Metabolite, 96, 97, 191, 198 Metastasis, 197, 198 Methionine, 20, 198, 217 MI, 39, 164, 198 Microbe, 198, 219 Microbiology, 165, 170, 198 Microcalcifications, 174, 198 Microorganism, 177, 199, 223 Microwaves, 93, 199, 210 Minocycline, 94, 199 Mitral Valve, 28, 63, 199 Mobility, 115, 199 Modeling, 104, 199 Modification, 24, 199, 210 Molecular, 29, 30, 32, 34, 105, 139, 141, 172, 174, 178, 199, 210, 220 Molecular Probes, 33, 199 Molecule, 168, 171, 178, 182, 183, 185, 186, 191, 196, 199, 208, 210 Monitor, 27, 199 Monocytes, 21, 195, 199 Mononuclear, 25, 199 Morphine, 100, 199, 200, 203 Morphological, 33, 34, 184, 199 Morphology, 25, 199 Motility, 86, 199, 213 Motion Pictures, 95, 199 Motion Sickness, 24, 41, 63, 92, 93, 99, 103, 104, 144, 147, 151, 182, 197, 199, 200, 208, 213 Motor Activity, 179, 199

232 Dizziness

Motor nerve, 199, 200, 202 Mucociliary, 200, 214 Multicenter study, 42, 200 Multiple sclerosis, 11, 25, 116, 147, 200 Muscle relaxant, 103, 200 Muscle tension, 200 Mydriatic, 182, 200, 213 Myelin, 200, 213 Myocardial infarction, 6, 180, 198, 200 Myocardial Ischemia, 168, 200 Myocardium, 168, 198, 200 N Naloxone, 200 Naltrexone, 100, 200 Narcosis, 200 Narcotic, 97, 98, 199, 200, 220 Nasal Mucosa, 200 Nasal Polyps, 102, 200 NCI, 1, 82, 137, 177, 201 Neck Pain, 127, 201 Necrosis, 173, 193, 198, 200, 201 Need, 3, 8, 86, 88, 89, 98, 100, 101, 107, 109, 113, 115, 118, 121, 127, 153, 197, 201, 219, 220 Neoplasm, 201, 212 Neoplastic, 176, 201 Nerve, 15, 19, 23, 30, 32, 43, 58, 90, 103, 170, 171, 176, 177, 181, 186, 187, 188, 193, 197, 199, 200, 201, 202, 203, 207, 210, 211, 212, 213, 215, 216, 220, 221, 222 Nerve Fibers, 23, 177, 201, 215, 222 Nervous System, 13, 17, 19, 20, 23, 46, 87, 97, 105, 113, 165, 166, 171, 172, 173, 174, 175, 176, 186, 188, 189, 197, 199, 200, 201, 202, 205, 206, 213, 217, 218 Nervousness, 101, 201 Networks, 37, 58, 201 Neural, 18, 32, 34, 37, 58, 59, 166, 167, 201 Neuralgia, 15, 201 Neurasthenia, 31, 201 Neuritis, 4, 6, 8, 10, 11, 16, 101, 146, 148, 201, 222 Neuroleptic, 30, 169, 201 Neurologic, 6, 9, 11, 14, 21, 22, 114, 116, 148, 201, 220 Neurologist, 152, 201 Neuroma, 7, 12, 13, 118, 144, 201 Neuromuscular, 165, 201, 208 Neuromuscular Junction, 165, 201 Neuronal, 31, 100, 174, 200, 201, 205 Neurons, 23, 32, 34, 100, 177, 181, 186, 188, 200, 201, 202, 215, 217, 222

Neurosis, 202 Neurotic, 31, 202 Neutrophils, 166, 189, 195, 202 Nicotine, 104, 202 Nitric Oxide, 21, 202 Nitrogen, 166, 167, 186, 187, 202, 220 Nonverbal Communication, 178, 202, 209 Norepinephrine, 97, 183, 202 NSAIDs, 76, 202 Nuclei, 34, 177, 184, 187, 196, 202, 209, 222 Nucleus, 22, 171, 177, 180, 184, 185, 194, 198, 199, 202, 208, 209, 215, 218, 222 Nystagmus, 7, 8, 10, 11, 13, 18, 87, 108, 111, 114, 116, 127, 148, 162, 174, 184, 195, 202 O Occipital Lobe, 202, 222 Ocular, 6, 7, 18, 19, 23, 24, 29, 34, 108, 117, 202 Oculomotor, 18, 24, 34, 114, 202 Office Management, 11, 202 Ointments, 93, 183, 202 Opacity, 181, 202 Ophthalmic, 93, 203 Ophthalmology, 123, 124, 187, 203 Opium, 199, 203 Organelles, 180, 199, 203 Orthostatic, 5, 8, 12, 26, 91, 97, 98, 105, 150, 169, 203 Ossicles, 203, 216 Osteoarthritis, 15, 97, 203 Otitis, 115, 122, 203 Otitis Media, 115, 122, 203 Otolaryngologist, 16, 34, 113, 114, 116, 117, 203 Otolith, 18, 19, 29, 108, 117, 203 Otology, 14, 37, 39, 46, 113, 114, 116, 117, 203 Otorhinolaryngology, 8, 116, 203 Otosclerosis, 117, 203 Ototoxic, 34, 203 Outpatient, 203 Ovary, 180, 185, 203 Ovulation, 26, 203 Ovum, 180, 203, 207 Oxygen Consumption, 203, 211 P Palate, 177, 203 Palliative, 203, 218 Pallor, 9, 16, 92, 204 Pancreas, 165, 182, 194, 204 Panic, 8, 28, 41, 47, 52, 59, 61, 192, 204

Index 233

Panic Disorder, 192, 204 Paranasal Sinuses, 204, 214 Parenteral, 185, 204 Paresis, 201, 204 Paresthesias, 201, 204 Particle, 11, 204, 215 Patch, 23, 204, 220 Pathogenesis, 10, 21, 204 Pathologic, 4, 29, 113, 180, 191, 204 Pathophysiology, 7, 29, 33, 108, 114, 204 Patient Compliance, 94, 204 Patient Education, 146, 148, 156, 158, 164, 204 Peptic, 172, 204 Peptic Ulcer, 172, 204 Peptide, 205, 206, 208, 209, 219 Pericardium, 90, 205, 218 Perilymph, 7, 11, 114, 117, 147, 205 Perineal, 103, 205 Perineum, 205 Peripheral blood, 25, 205 Peripheral Nerves, 195, 205 Peripheral Nervous System, 205, 212, 217 Peripheral Vascular Disease, 187, 205 Perphenazine, 93, 205 Phallic, 187, 205 Pharmaceutical Solutions, 183, 205 Pharmacokinetic, 99, 205 Pharmacologic, 189, 205, 219 Phenobarbital, 76, 93, 205 Phosphorus, 174, 205 Photophobia, 9, 86, 205 Photosensitization, 30, 206 Physical Examination, 11, 14, 16, 113, 114, 115, 206 Physical Fitness, 186, 206 Physical Therapy, 16, 17, 33, 38, 58, 122, 206 Physiologic, 4, 29, 103, 166, 189, 198, 201, 206, 208, 210 Physiology, 4, 19, 22, 30, 107, 108, 113, 115, 121, 128, 184, 206 Pilot study, 31, 42, 59, 206 Pitch, 29, 206, 223 Placenta, 185, 206, 207 Plants, 166, 170, 174, 188, 189, 199, 202, 206, 220 Plasticity, 34, 206 Platelet Aggregation, 167, 202, 206 Platelets, 202, 206, 219 Poisoning, 62, 181, 194, 200, 206 Polypeptide, 177, 191, 206

Polysaccharide, 168, 206, 208 Pons, 173, 176, 206 Posterior, 10, 11, 23, 90, 92, 167, 170, 171, 176, 183, 201, 202, 203, 204, 206 Postmenopausal, 20, 206 Postoperative, 97, 206 Postprandial, 19, 207 Postsynaptic, 23, 207, 217, 218 Postural, 6, 8, 13, 14, 23, 30, 47, 81, 148, 207 Potassium, 32, 207 Potentiate, 98, 207 Practice Guidelines, 140, 150, 207 Precipitating Factors, 117, 190, 207 Premedication, 207, 213 Premenstrual, 86, 207 Prenatal, 33, 184, 207 Pressoreceptors, 171, 207 Presynaptic, 23, 207, 217, 218 Prevalence, 6, 7, 8, 17, 49, 207 Primary endpoint, 21, 207 Probe, 87, 207 Progesterone, 26, 207 Progression, 31, 207 Progressive, 175, 183, 189, 201, 203, 207, 211 Projection, 202, 207, 211 Prolapse, 28, 63, 208 Proline, 177, 191, 208 Promethazine, 93, 208 Propantheline, 103, 208 Prophase, 208, 217 Prophylaxis, 86, 87, 187, 207, 208 Prospective study, 196, 208 Prostaglandin, 208 Prosthesis, 18, 208 Protective Agents, 174, 208 Protein S, 112, 172, 185, 208, 212, 218 Proteoglycan, 21, 208 Proteolytic, 178, 209 Protocol, 13, 15, 30, 209 Protons, 30, 191, 196, 209, 210 Proximal, 207, 209, 213 Pruritic, 181, 209 Pruritus, 182, 191, 208, 209 Psychiatric, 4, 7, 22, 37, 40, 47, 48, 117, 125, 147, 178, 198, 209 Psychiatry, 38, 41, 45, 52, 59, 118, 187, 209, 216 Psychic, 147, 202, 209, 213 Psychogenic, 12, 49, 50, 117, 209 Psychology, 49, 58, 118, 178, 182, 209 Psychomotor, 181, 201, 209

234 Dizziness

Psychosis, 101, 169, 209 Psychotherapy, 209, 210 Public Health, 81, 140, 209 Public Policy, 139, 209 Publishing, 12, 14, 35, 115, 119, 209 Pulmonary, 172, 191, 209, 210, 222 Pulmonary Artery, 172, 209, 222 Pulmonary Ventilation, 191, 210 Pulse, 30, 91, 199, 210 Purulent, 165, 210, 221 Pustular, 101, 165, 210 Pyramidal Tracts, 186, 210 Q Quality of Life, 28, 36, 44, 210 Quaternary, 210, 213 R Race, 97, 103, 210 Radiation, 168, 184, 197, 210, 212, 223 Radicular, 210 Radiculopathy, 46, 210 Radio Waves, 181, 199, 210 Radioactive, 173, 189, 191, 195, 199, 210, 212 Randomized, 17, 21, 22, 24, 42, 48, 184, 210 Reality Testing, 209, 210 Reassurance, 5, 113, 210 Receptor, 23, 32, 97, 100, 103, 165, 169, 172, 173, 176, 177, 179, 183, 186, 191, 205, 210, 213 Receptors, Serotonin, 210, 213 Rectum, 102, 169, 173, 182, 188, 193, 195, 210, 217 Recur, 33, 210 Recurrence, 5, 28, 33, 92, 197, 210, 211 Red Nucleus, 170, 211 Refer, 1, 178, 182, 187, 196, 201, 209, 211, 213, 222 Reflex, 6, 7, 24, 26, 34, 60, 86, 108, 117, 150, 186, 211 Regimen, 105, 183, 204, 211 Regression Analysis, 29, 211 Relapse, 98, 211 Relaxant, 103, 211 Remission, 197, 211 Renal failure, 181, 211 Respiration, 58, 174, 176, 180, 199, 211 Restoration, 206, 211, 223 Retina, 184, 195, 211 Retinal, 179, 182, 211, 216, 223 Retrocochlear, 13, 211 Rheumatism, 192, 212 Rheumatoid, 15, 21, 25, 101, 212

Rheumatoid arthritis, 15, 21, 25, 101, 212 Rhinitis, 208, 212 Ribosome, 212, 220 Risk factor, 4, 196, 208, 212 S Salicylate, 212 Salicylic, 212 Salicylic Acids, 212 Saline, 27, 122, 212 Saliva, 212 Salivary, 182, 187, 212 Salivary glands, 182, 187, 212 Salivation, 87, 92, 189, 212 Sarcoma, 101, 212 Scans, 127, 212 Schizoid, 212, 223 Schizophrenia, 212, 223 Schizotypal Personality Disorder, 212, 223 Schwannoma, 39, 114, 151, 212 Sclerosis, 63, 200, 213 Scopolamine, 93, 213 Screening, 12, 15, 32, 88, 177, 213 Sebaceous, 91, 213, 223 Sebaceous gland, 91, 213, 223 Sebum, 165, 213 Secretion, 165, 182, 190, 192, 194, 212, 213 Secretory, 213, 217 Sedative, 102, 182, 191, 192, 208, 213 Sedentary, 19, 213 Seizures, 104, 162, 181, 204, 213 Self Care, 165, 213 Semicircular canal, 10, 11, 13, 16, 18, 19, 23, 29, 34, 90, 92, 174, 193, 213 Semisynthetic, 199, 213 Sensibility, 167, 191, 213 Sensory loss, 210, 213, 218 Septal, 213 Septic, 15, 213 Septum, 35, 45, 170, 213 Septum Pellucidum, 213 Serotonin, 48, 97, 98, 169, 173, 210, 213, 220 Serous, 122, 185, 214 Serum, 20, 26, 86, 167, 178, 188, 192, 214 Sex Characteristics, 166, 214 Sharpness, 214, 223 Shock, 163, 214, 220 Shunt, 103, 214 Side effect, 20, 30, 91, 94, 97, 98, 99, 100, 101, 105, 115, 128, 131, 166, 169, 176, 214, 219 Signs and Symptoms, 17, 92, 93, 211, 214

Index 235

Sinusitis, 97, 102, 214 Skeletal, 19, 180, 214, 215 Skeleton, 194, 208, 214 Skull, 173, 176, 180, 214, 218 Small intestine, 183, 191, 194, 214 Smooth muscle, 103, 167, 173, 174, 190, 199, 214, 215, 217 Social Environment, 210, 214 Social Support, 28, 214 Social Work, 118, 214 Sodium, 28, 91, 92, 214 Solitary Nucleus, 171, 215 Somatic, 166, 180, 198, 205, 215, 221 Somnolence, 30, 92, 96, 100, 215 Sound wave, 93, 179, 181, 215 Spasm, 15, 104, 148, 169, 190, 215 Spasmodic, 118, 215 Spasmogenic, 98, 167, 215 Spatial disorientation, 18, 88, 89, 182, 215 Specialist, 5, 152, 153, 182, 215 Species, 77, 94, 180, 183, 185, 197, 198, 210, 215, 216, 220, 223 Specificity, 166, 174, 215 Spectrum, 199, 210, 215 Spinal cord, 173, 175, 176, 185, 188, 198, 201, 205, 210, 211, 215, 217 Spinal Cord Injuries, 210, 215 Spinal Nerve Roots, 210, 215 Spondylitis, 15, 215 Spondylolisthesis, 15, 216 Sprains and Strains, 196, 216 Squamous, 176, 216 Squamous Epithelium, 176, 216 Stabilization, 18, 216 Staging, 212, 216 Stapes, 191, 216 Staphylococcus, 199, 216 Stereoscopic, 95, 216 Stimulant, 97, 105, 173, 190, 216 Stimulus, 18, 24, 30, 32, 103, 170, 184, 186, 193, 194, 204, 211, 216, 219 Stomach, 90, 91, 94, 165, 171, 172, 182, 185, 188, 191, 194, 200, 214, 216 Stool, 193, 195, 216 Stress, 10, 49, 162, 171, 200, 212, 216, 221 Stroke, 17, 39, 46, 64, 83, 112, 128, 138, 174, 175, 216 Stupor, 195, 200, 216 Subacute, 193, 214, 216 Subarachnoid, 190, 205, 216 Subclinical, 193, 213, 216 Subspecies, 215, 216

Substance P, 185, 198, 213, 216 Sudden death, 27, 217 Sulfur, 186, 198, 217 Supine, 26, 217 Support group, 118, 152, 217 Suppositories, 93, 102, 188, 217 Suppression, 16, 217 Supraventricular, 27, 217 Sympathetic Nervous System, 19, 171, 217 Sympathomimetic, 183, 185, 202, 217 Symptomatic, 28, 115, 217 Symptomatic treatment, 115, 217 Synapses, 23, 217, 218 Synapsis, 217 Synaptic, 23, 202, 217, 218 Synaptic Transmission, 23, 202, 217 Synaptic Vesicles, 217, 218 Syncope, 5, 12, 20, 40, 41, 43, 60, 218, 222 Synergistic, 100, 218 Systemic, 25, 64, 102, 116, 132, 133, 134, 172, 181, 185, 193, 194, 218, 220, 221 Systemic disease, 116, 218 Systemic lupus erythematosus, 25, 218 T Tachycardia, 19, 26, 27, 87, 101, 218 Temporal, 6, 8, 11, 25, 113, 117, 187, 190, 197, 218, 222 Temporal Lobe, 11, 218, 222 Testis, 185, 218 Tetracycline, 91, 94, 183, 199, 218 Thalamic, 170, 218 Thalamic Diseases, 170, 218 Thalamus, 218, 222 Theophylline, 182, 218 Therapeutics, 58, 60, 134, 218 Thermal, 27, 88, 96, 182, 218 Thoracic, 171, 219 Thorax, 30, 196, 219, 221 Threshold, 186, 191, 211, 219 Thrombophlebitis, 21, 219 Thrombosis, 208, 216, 219 Thrombus, 180, 193, 200, 206, 219, 222 Thymus, 77, 192, 196, 219 Thyroid, 192, 219 Thyrotropin, 192, 219 Tidal Volume, 191, 219 Tin, 129, 162, 219 Tolerance, 26, 100, 165, 189, 219 Tonicity, 183, 190, 219 Tooth Preparation, 165, 219 Topical, 99, 219 Torsion, 193, 219

236 Dizziness

Toxic, iv, 15, 94, 97, 170, 172, 180, 186, 202, 219 Toxicity, 101, 183, 219 Toxicology, 140, 219 Toxins, 114, 168, 174, 185, 193, 220 Toxoplasmosis, 171, 220 Trace element, 219, 220 Tramadol, 96, 99, 100, 220 Transcutaneous, 58, 220 Transdermal, 93, 220 Transfection, 172, 220 Transfer Factor, 192, 220 Transient Ischemic Attacks, 8, 14, 60, 64, 220 Translation, 29, 185, 220 Transmitter, 165, 183, 194, 197, 202, 217, 218, 220 Transplantation, 192, 220 Trauma, 10, 12, 15, 17, 18, 58, 99, 114, 116, 117, 149, 181, 201, 220 Triage, 22, 49, 220 Tricyclic, 192, 220 Triflupromazine, 93, 220 Trigger zone, 169, 184, 220 Tryptophan, 177, 213, 220 Tungsten, 175, 220 U Unconscious, 167, 192, 220 Urea, 220, 221 Uremia, 117, 211, 221 Ureters, 221 Urethane, 96, 221 Urethra, 102, 221 Urinary, 21, 103, 182, 193, 208, 213, 220, 221 Urinary tract, 103, 182, 221 Urinary tract infection, 103, 221 Urinate, 221, 223 Urine, 172, 182, 193, 221 Urticaria, 176, 191, 221 Uterus, 176, 180, 185, 198, 207, 221 V Vaccine, 166, 209, 221 Vagal, 19, 221 Vagina, 102, 176, 198, 221 Vaginitis, 21, 221 Vagus Nerve, 215, 221 Vascular, 11, 46, 91, 92, 114, 116, 117, 148, 171, 172, 174, 185, 190, 193, 202, 206, 207, 219, 221

Vascular Headaches, 172, 221 Vascular Resistance, 171, 221 Vasoconstriction, 19, 185, 221 Vasodilatation, 175, 221 Vasodilation, 19, 221 Vasodilator, 172, 173, 183, 190, 221 Vein, 168, 194, 219, 222 Venous, 42, 173, 208, 222 Venous Thrombosis, 42, 222 Ventral, 90, 192, 202, 206, 215, 222 Ventricle, 170, 192, 199, 209, 210, 218, 222 Ventricular, 26, 28, 222 Ventricular fibrillation, 27, 222 Venules, 173, 222 Vertebrae, 194, 215, 222 Vertebral, 114, 116, 150, 222 Vertebrobasilar Insufficiency, 4, 13, 15, 16, 116, 222 Vesicular, 23, 181, 222 Vestibular Nerve, 30, 103, 222 Vestibular Neuronitis, 7, 10, 128, 129, 147, 222 Vestibule, 177, 193, 213, 222 Vestibulocochlear Nerve, 177, 191, 219, 222 Vestibulocochlear Nerve Diseases, 191, 219, 222 Veterinary Medicine, 139, 223 Viral, 13, 92, 117, 149, 223 Virulence, 170, 219, 223 Virus, 175, 223 Visceral, 171, 180, 221, 223 Visceral Afferents, 171, 221, 223 Visual Acuity, 7, 34, 223 Vitro, 22, 23, 223 Vivo, 223 Voice Disorders, 118, 223 Void, 95, 223 Volition, 34, 194, 223 Voltage-gated, 20, 32, 223 Vulgaris, 77, 91, 223 W Wakefulness, 181, 223 Withdrawal, 97, 98, 181, 223 Wound Healing, 197, 223 X X-ray, 175, 178, 197, 212, 223 Y Yawning, 92, 223

Index 237

238 Dizziness

Index 239

240 Dizziness

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

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