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

FIBROIDS A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R EFERENCES

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., 1960Fibroids: 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: 0-597-83910-7 1. Fibroids-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 fibroids. 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 FIBROIDS .................................................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Fibroids ......................................................................................... 4 E-Journals: PubMed Central ....................................................................................................... 15 The National Library of Medicine: PubMed ................................................................................ 15 CHAPTER 2. NUTRITION AND FIBROIDS .......................................................................................... 35 Overview...................................................................................................................................... 35 Finding Nutrition Studies on Fibroids ........................................................................................ 35 Federal Resources on Nutrition ................................................................................................... 42 Additional Web Resources ........................................................................................................... 42 CHAPTER 3. ALTERNATIVE MEDICINE AND FIBROIDS.................................................................... 45 Overview...................................................................................................................................... 45 National Center for Complementary and Alternative Medicine.................................................. 45 Additional Web Resources ........................................................................................................... 48 General References ....................................................................................................................... 50 CHAPTER 4. DISSERTATIONS ON FIBROIDS...................................................................................... 51 Overview...................................................................................................................................... 51 Dissertations on Fibroids ............................................................................................................. 51 Keeping Current .......................................................................................................................... 51 CHAPTER 5. CLINICAL TRIALS AND FIBROIDS ................................................................................ 53 Overview...................................................................................................................................... 53 Recent Trials on Fibroids ............................................................................................................. 53 Keeping Current on Clinical Trials ............................................................................................. 54 CHAPTER 6. PATENTS ON FIBROIDS ................................................................................................ 57 Overview...................................................................................................................................... 57 Patents on Fibroids ...................................................................................................................... 57 Patent Applications on Fibroids................................................................................................... 64 Keeping Current .......................................................................................................................... 74 CHAPTER 7. BOOKS ON FIBROIDS .................................................................................................... 75 Overview...................................................................................................................................... 75 Book Summaries: Online Booksellers........................................................................................... 75 The National Library of Medicine Book Index ............................................................................. 78 Chapters on Fibroids .................................................................................................................... 79 CHAPTER 8. MULTIMEDIA ON FIBROIDS ......................................................................................... 81 Overview...................................................................................................................................... 81 Video Recordings ......................................................................................................................... 81 Bibliography: Multimedia on Fibroids ......................................................................................... 82 CHAPTER 9. PERIODICALS AND NEWS ON FIBROIDS ...................................................................... 83 Overview...................................................................................................................................... 83 News Services and Press Releases................................................................................................ 83 Newsletter Articles ...................................................................................................................... 88 Academic Periodicals covering Fibroids....................................................................................... 88 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 91 Overview...................................................................................................................................... 91 NIH Guidelines............................................................................................................................ 91 NIH Databases............................................................................................................................. 93 Other Commercial Databases....................................................................................................... 95 APPENDIX B. PATIENT RESOURCES ................................................................................................. 97 Overview...................................................................................................................................... 97

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Patient Guideline Sources............................................................................................................ 97 Finding Associations.................................................................................................................. 101 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 103 Overview.................................................................................................................................... 103 Preparation................................................................................................................................. 103 Finding a Local Medical Library................................................................................................ 103 Medical Libraries in the U.S. and Canada ................................................................................. 103 ONLINE GLOSSARIES................................................................................................................ 109 Online Dictionary Directories ................................................................................................... 110 FIBROIDS DICTIONARY ........................................................................................................... 111 INDEX .............................................................................................................................................. 153

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

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

Gynecology for the Gastroenterologist: The Woman in Her Forties and Beyond Source: Practical Gastroenterology. 20(5): 29-30, 32, 34-36. May 1996. Contact: Available from Shugar Publishing, Inc. 99B Main Street, Westhampton Beach, NY 11978. (631) 288-4404. Fax (631) 288-4435. E-Mail: [email protected]. Summary: This article, one in a series on gastrointestinal (GI) diseases of the elderly, considers gynecology for the gastroenterologist. The authors review a number of gynecologic conditions that may produce signs or symptoms suggesting GI disease. Indeed, they stress that distinguishing GI disease from gynecologic pathology may be difficult. A thorough understanding of pelvic anatomy, a careful history, and strong clinical suspicion will clarify the nature of the complaints. If doubt persists, expert consultation and a multidisciplinary approach are recommended. Benign conditions

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discussed include disorders of pelvic support, leiomyomata (uterine fibroids), endometriosis, and infections. Malignant conditions include ovarian cancer and uterine or cervical cancer. The article concludes with a discussion of anal incontinence and rectovaginal fistulas. 3 references. (AA-M).

Federally Funded Research on Fibroids The U.S. Government supports a variety of research studies relating to fibroids. 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 fibroids. 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 fibroids. The following is typical of the type of information found when searching the CRISP database for fibroids: •

Project Title: 2ND ULTRASOUND

INTERNATIONAL

SYMPOSIUM

ON

THERAPEUTIC

Principal Investigator & Institution: Crum, Lawrence A.; Research Professor; Applied Physics Laboratory; University of Washington Seattle, Wa 98195 Timing: Fiscal Year 2002; Project Start 15-JUL-2002; Project End 30-JUN-2003 Summary: (provided by applicant): Although medical ultrasound is well known as a modality for diagnosis, the concept of using High Intensity Focused Ultrasound (HIFU) for therapy was suggested over a half-century ago, with crude efforts made a treating diseases of the brain. Unfortunately, due to limitations in therapy guidance, no widescale attempts were made to commercialize this technology. In the last 10 years, however, ambitious efforts have been undertaken in a number of countries to develop HIFU methods and devices to stop bleeding (acoustic hemostasis) and to treat diseases, such as Benign Prostatic Hypertrophy (BPH), uterine fibroids, and various forms of cancer. In addition, ultrasound at moderate acoustic intensities has been shown to be successful in the transient opening of cellular membranes, which has spurred recent research in sonoporation, ultrasound-activated drug delivery, and gene therapy using ultrasound as a vector. This interest has resulted in the organization of two recent International Conferences: The First International Conference on Sonodynamic Therapy, held in Fukuoka, Japan, in April of 2000, and the First International Symposium on HIFU Therapy, held in Chongqing, PRC, in May of 2001. These conferences were exciting in their content, and attracted much interest, but were poorly attended by Western scientists, engineers and clinicians. Plans have been made to combine these conferences into the 2nd International Symposium on Therapeutic Ultrasound, to be 2

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

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held in Seattle, WA, from 30 July-1 August 2002. This conference will provide a forum for the discussion of recent research and clinical results, but also as an opportunity to bring together scientists, engineers, clinicians, government funding agency representatives, industry leaders, and private investors to view the clinical and commercial potential for this new technology. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: APPLICATION EMBOLIZATION

OF

ALGINATE

FOR

ENDOVASCULAR

Principal Investigator & Institution: Becker, Timothy A.; Neural Intervention Technologies 5041 Dexter-Pickney Rd Dexter, Mi 48169 Timing: Fiscal Year 2003; Project Start 08-AUG-2003; Project End 07-FEB-2004 Summary: (provided by applicant): Neurovascular lesions, such as aneurysms and arteriovenous malformations (AVMs), are insidious and unpredictable. They often go unnoticed until the occurrence of a catastrophic hemorrhage or stroke. Approximately 350,000 patients experience hemorrhage annually, resulting in permanent loss of motor function, seizures, and death. Current neurosurgical therapies are risky and often ineffective at removing the life-threatening condition. The purpose of this venture is to provide an innovative biomaterial for treating neurovascular lesions from inside the vessel (endovascular embolization) in order to significantly increase therapeutic effectiveness while minimizing the surgical risks. Preliminary studies have identified calcium alginate (ALGEL) as a potentially non-adhesive, injectable, mechanically stable, and biocompatible material for effective occlusion of vascular lesions. A preliminary comprehensive in vitro aneurysm model has been developed, utilizing documented and tested neurovascular modeling techniques, to test ALGEL injectability and occlusion stability. Techniques learned will then be utilized to occlude chronic aneurysm models in swine. Lastly, a final round of chronic AVM models will also be occluded. The goal of the continued animal experiments is to utilize our knowledge in vivo modeling to complete 6-month chronic AVM and 1-month aneurysm occlusion studies for determining the long-term ALGEL stability and biocompatibility. The outcomes of the proposed project will be a solid foundation for the eventual development of safer and more effective treatments for life threatening aneurysms and high-grade AVMs. More generally, alginate embolization may also prove useful for minimally invasive vascular therapy of other vessel areas as well, such as blocking blood flow to tumors, stopping pelvic bleeding, treating uterine fibroids, and occluding other peripheral vessel damage and lesions. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: BREAST TUMOR INHIBITION BY ANTIPROGESTINS Principal Investigator & Institution: Wiehle, Ronald D.; Zonagen, Inc. 2408 Timberloch Pl, B-4 the Woodlands, Tx 77380 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 30-JUN-2003 Summary: (provided by applicant): The use of antiestrogens in women for the treatment of breast cancer, although far from ideal, is one of the few therapies currently available. The following revised proposal outlines experiments to be performed under a SBIR that would clarify the properties of certain new antiprogestins as adjuvant therapies analogous to current therapies utilizing tamoxifen and SERMs. In May 1999, a Licensing Agreement between Zonagen and the NICHD was finalized to develop new antiprogestins. We expect that the new generation of compounds will be used for a

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number of indications where the etiology is dominated by progesterone. The promise of the first antiprogestin, RU 486, has gone unfulfilled because of its extensive antiglucocorticoid effects and the political backlash to its use as an abortifacient. Indications for antiprogestin use could include oral contraception, labor induction, cervical ripening, hormone replacement therapy (HRT), and treatment of uterine fibroids, endometriosis, and especially breast cancer. It is the overall aim of this proposed SBIR to determine effects on the growth of previously established rodent breast cancers with the ultimate intention of introducing a new adjuvant treatment for human breast cancer. The rat model has been shown to respond to antiprogestins such as RU 486 with a decrease in the growth of lesions following treatment. There is a need to determine whether our lead compound. CDB-4124, has the same anticancer properties as RU 486 as a proof-of-principle. Moreover, we need to determine the doseresponse of that lead compound. Phase II would determine whether a secondary class of compounds have similar activity, whether the best compound(s) reduce the ultimate size and appearance of lesions if used prior to frank appearance, and their synergism with antiestrogens. Additionally, the possibility that antiprogestins can inhibit breast tumor growth and development would greatly enhance the potential of such compounds for chemoprevention and other long-term therapies (fibroids, endometriosis, HRT) and such a drug should find wide and unqualified acceptance among women. PROPOSED COMMERCIAL APPLICATION: Antiprogestational compounds from the Licensing Agreement could fill Zonagen's developmental pipeline with drugs for those diseases and, potentially, several other indications. New antiprogestins discovered by NICHD and realized as drugs through this proposed SBIR, satisfy the need to bring the results of government-sponsored science into the public domain. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: COLLAGEN TYPE I/SPHINGOLIPID PATHWAYS IN REGULATION OF LEIOMYOMA GROWTH Principal Investigator & Institution: Mcclure, Shelia A.; Health Scientist Administrator; Spelman College 350 Spelman Ln Sw Atlanta, Ga 30314 Timing: Fiscal Year 2001 Summary: Uterine leiomyomas, also known as fibroid tumors, are the most common tumors of the uterus, occurring with a frequency of 20-25% in women of reproductive age. Their occurrence has been linked to diverse symptoms including excessive uterine bleeding, pelvic pressure and pain, premature births, and infertility. The increased incidence of leiomyomas after the onset of menarche, the growth of tumors during pregnancy and after administration of steroids as well as the regression of tumors after menopause gives clinical evidence to support the role of ovarian steroids in the growth of uterine fibroids. These tumors also exhibit growth- factor dependent growth potential. Three human uterine cell lines designated ST1 MT1 and HT1 have been established in our laboratory. The long-term objectives of this research are to identify the factors involved in the regulation of the proliferation of uterine leiomyomas utilizing these cell lines and to determine the mechanism of action of these factors. The specific aims of the proposed research are to: I. Determine if the presence of collagen type I in the extracellular matrix of leiomyomas has an effect on the response of these tumors to known mitogens such as estradiol, EGF and mitogenic factors from conditioned medium from ST1 cells. In these studies ST1 and HT1 cells will be grown on defined matrices. The level of collagen type I secretion by ST1 and HT1 cells grown on these matrices will be determined by ELISA. The effect of estradiol, EGF and the mitogenic

Studies

7

fraction of conditioned medium on the growth kinetics of these cell lines will also be assessed, when cells are grown on defined matrices. II. Purify the low molecular weight mitogenic factor from conditioned medium of ST1 cell lines and determine if the factor is a member of the sphingolipid class of growth factors. The content of sphingosine 1phosphate in the mitogenic fraction of conditioned medium will be determined by HPLC to determine any correlation between this activity and sphingosine 1-phosphate will also be assessed. III. Determine if growth factors for uterine leiomyomas act via a sphingolipid signaling pathways in the regulation of leiomyoma growth. In the proposed studies, ST1 and HT1 cell lines will be exposed to mitogens. Levels of all intermediates in the putative signal transduction pathway (ceramide, sphingosine and sphingosine 1-phosphate) will be monitored by thin-layer chromatography and/or HPLC. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ESTROGEN DEPENDENCY OF UTERINE LEIOMYOMA Principal Investigator & Institution: Al-Hendy, Ayman; Obstetrics and Gynecology; University of Texas Medical Br Galveston 301 University Blvd Galveston, Tx 77555 Timing: Fiscal Year 2003; Project Start 24-SEP-2003; Project End 31-JUL-2008 Summary: (provided by applicant): Uterine leiomyoma arise from the uterine smooth muscle compartment (myometrium) and are the most common gynecologic tumor in premenopausal women, occurring in up to 77% of all women. They are all significant cause of pelvic pain, menorrhagia, infertility, and pregnancy-related complications. These estrogen-dependent tumors are the leading indication for hysterectomy in reproductive age women. Currently, no medicinal therapy exists. Prolonged use of GnRH agonists, which can shrink tumors but induce a chemical menopause, is restricted due to serious side effects. The hormone-dependent phenotype of uterine leiomyoma suggests that interventions targeting the estrogen receptor (ER)-signaling pathway may have therapeutic efficacy. Proof-of-principal experiments have now established that treatment with anti-estrogen medications (e.g., tamoxifen and raloxifene) can significantly reduce tumor incidence, size, and proliferative index in the Eker rat, the only animal model known to acquire spontaneous uterine leiomyoma. Adenovirusmediated delivery of a mutated dominant-negative ER (Ad-ER-DN) inhibited cell proliferation and induced apoptosis in human and rat leiomyoma cell lines. In a pilot experiment, Ad-ER-DN injected directly intratumor in nude mice with pre- existing fibroids induced immediate arrest and regression of tumor growth due to extensive apoptosis. explants in nude In this project, we will (Specific Aim 1) determine if Ad-ERDN transduction inhibits endogenous ER signaling in estrogen-responsive rat and human leiomyoma cells, (Specific Aim 2) expand pilot results and evaluate the ability of Ad-ER-DN to ablate pre-established subcutaneous leiomyoma mice, and (Specific lira 3) conduct a pre-clinical trial to assess the ability of Ad-ER-DN to ablate uterine leiomyoma when delivered by direct intratumor injection in the immune-competent Eker rat. Tumor response will be correlated to proliferative and apoptotic indices, to markers of tumor angiogenesis, and to several estrogen-regulated genes. We will examine immune response and the safety of single vs. repeated recombinant adenovirus treatment alone or in combination with SERM (Raloxifene). Evident therapeutic potential aside, this project will add to our understanding of the molecular mechanisms of estrogen-dependence in this common uterine tumor. It will also show, in a wellcharacterized natural rat model, the effects of specific perturbing of ER signaling on several cellular functions (i.e., angiogenesis, apoptosis, and cell cycle). This knowledge

8

Fibroids

will impact many other estrogen-related conditions (e.g., breast and endometrial cancer, cardiovascular disease, osteoporosis). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FEMALE REPRODUCTIVE OUTCOMES AND TCDD EXPOSURE IN SEVESO Principal Investigator & Institution: Eskenazi, Brenda; Professor; Epidemiology and Biostatistics; University of California Berkeley Berkeley, Ca 94720 Timing: Fiscal Year 2002; Project Start 09-JAN-2001; Project End 31-MAR-2005 Summary: (provided by applicant): Over the last few decades, concern has heightened over the potential hormone-like effects of environmental chemicals on the reproductive health of fish, wildlife, and humans. The compound 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) is a widespread environmental contaminant, produced by various chemical reactions and combustion processes, including waste incineration, and has been shown in animals to be a potent endocrine disruptor. On July 10,1976, as a result of a chemical explosion, residents of Seveso, Italy experienced the highest levels of TCDD exposure in a human population. We followed up the women 20 years after the accident to determine whether they were at higher risk for reproductive disease. Women aged 0 to 40 years at the time of the explosion, and who lived in Zones A or B were interviewed extensively about their reproductive and pregnancy histories; had a blood draw, pelvic exam, and transvaginal ultrasound; and were asked to complete a menstrual diary. Serum specimens stored from the time of the explosion were analyzed to determine individual levels of TCDD exposure. The Seveso Women's Health Study, originally funded in 1996 (R01 ES07171) aimed to examine the relationship of serum TCDD levels and endometriosis. Continued funding in 1999 allowed the analysis of additional serum specimens for TCDD and examination of the relation to other reproductive endpoints: menstrual cycle characteristics, age of menarche, fetal loss and birthweight, age at menopause, and breast cancer incidence. The present application focuses on the health and function of the ovaries, uterus, and breast in order to document the substantial evidence in animals. Specifically, we aim to determine the relation of serum TCDD levels to fertility (time to conception and clinical infertility); ovarian function (number of ovarian follicles, presence of functional ovarian cysts, serum hormone levels); uterine health (uterine volume, endometrial thickness, and the occurrence/number of fibroids); the occurrence of benign breast disease, and the initiation/duration of lactation. We also will examine whether the above relationships are modified by developmental status (i.e., pre- or post-menarche) at the time of TCDD exposure. The Seveso Women's Health Study is the only comprehensive study to date of the reproductive health of a human female population exposed to TCDD. This study has the benefit of being a large cohort study with a wide range of TCDD exposure, documented by individual-level TCDD measured in sera collected soon after the explosion. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: GOSERELIN ACETATE PLUS IRON VS SHAM PLUS IRON FOR MANAGEMENT OF FIBRO Principal Investigator & Institution: Richard-Davis, Gloria; Tulane University of Louisiana New Orleans, La New Orleans, La 70112 Timing: Fiscal Year 2001 Summary: This study is of goserelin acetate (zoladex) 3-month 10.8 mg depot plus iron versus sham plus iron for the preoperative management of premenopausal women with

Studies

9

iron deficiency anemia due to uterine fibroids. The primary objectives of this study are to see the percentage of subjects who achieve an increase in hemoglobin concentrations, the percentage of subjects who receive hematologic recovery, and the mean increase in hemoglobin from randomization. The secondary objectives are to compare the differences between treatment groups for the relief of symptoms associated with uterine fibroids, compare the number of subjects requiring blood transfusions, compare the number of subjects who are eligible to provide blood for autologous blood transfusion, compare the changes in fibroid and total uterine volume, and to compare the safety and tolerability of goserelin acetate or sham plus iron. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HORMONE REPLACEMENT AND RISK OF UTERINE FIBROID GROWTH Principal Investigator & Institution: Kjerulff, Kristen H.; Epidemiology and Prev Medicine; University of Maryland Balt Prof School Baltimore, Md 21201 Timing: Fiscal Year 2001; Project Start 07-APR-1997; Project End 31-DEC-2002 Summary: (Adapted from Applicant's Abstract). The disease of uterine fibroids is a common and significant public health problem, affecting women of all ages, racial backgrounds and socioeconomic levels. When women with fibroids reach the perimenopausal or postmenopausal periods, they face a troubling treatment dilemma. If they wish to preserve their uterus, they take an unknown risk of causing fibroid growth by taking HRT. On the other hand, the benefits of using HRT are substantial, particularly for women at risk for cardiovascular disease or osteoporosis. There are been little, if any, research done to examine the effect of HRT use on fibroid proliferation and growth among uterine fibroid patients. The proposed randomized, controlled, doubleblinded clinical trial will investigate the extent to which a commonly prescribed low dose, continuous estrogen-progestin HRT regimen stimulates fibroid growth and proliferation among black and white postmenopausal fibroid patients. Ultrasound assessments will be conducted for 300 postmenopausal fibroid patients at baseline, 6, 12 and 24 months, which will allow an examination of the extent to which fibroid growth occurs, and if so, whether growth continues or plateaus. The extent to which this HRT regimen affects menopause-related symptoms, fibroid-related symptoms and quality of life will also be examined. A risk-benefit analysis will be conducted, taking into account both uterine and non-uterine risks and benefits, based on the results of this study and reviews of other studies. The results of this study will be of significant value to a growing body of fibroid patients reaching the menopause and to the clinicians who treat these patients. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

•

Project Title: MOLECULAR AND CYTOGENETIC STUDIES OF UTERINE LEIOMYOMATA Principal Investigator & Institution: Morton, Cynthia C.; Professor; Brigham and Women's Hospital 75 Francis Street Boston, Ma 02115 Timing: Fiscal Year 2001; Project Start 30-SEP-1992; Project End 31-MAR-2003 Summary: Uterine leiomyomata, or fibroids, are the most common pelvic tumors in females and occur in 20-25 percent of women of reproductive age. Although benign neoplasms, they constitute a major health problem as 25-50 percent of affected women experience debilitating symptoms including excessive menstrual bleeding and pelvic discomfort as well as reproductivefailure. Fibroids are the major indication for

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hysterectomy accounting for over 200,000 procedures annually in the United States. It is highly likely that there is a genetic liability to develop uterine leiomyomata; these tumors are at least three times more frequent in Black than Caucasian women and the twin pair correlations for hysterectomy in monozygotic twins are about twice that observed in dizygous twins. Despite these findings, relatively little is known about this racial predisposition or specific genes involved in the pathogenesis of fibroids. Also of particular interest is the observation that these tumors rarely; if ever, proceed to their malignant counterparts. Uterine leiomyomata may serve as an important model system to study the genetic events which distinguish benign and malignant neoplasms. Consistent chromosome aberrations have been observed in fibroids indicating the location of genes involved in these tumors. At least six cytogenetic subgroups have been identified and we have been successful in using positional candidate gene approaches in determining that two high mobility protein genes, HMGIC and HMGlY, located on chromosomes 12 and 6, respectively participate in the pathobiology of uterine leiomyomata. The major goal of this proposed renewal applicaiton is to further our understanding of the biology of uterine leiomyomata. We will use molecular and cytogenetic studies to characterize further the expression and mechanism of the two high mobility group protein genes, HMGiC and HMGlY. Additional experiments will be focused on the identification, isolation and characterization of othe genes involved in the pathogenesis and pathobiology of uterine leiomyomata. Two positional cloning projects already underway are focused on genes consistently involved in rearrangements in these tumors. Identification and molecular characterization of genes at these sites will contribute to understianding the role of these genes in normal cellular processes, and may facilitate developments in the clinical management of leiomyomate and other solid tumors. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NOVEL NON-PEPTIDE ANTAGONISTS OF THE GNRH RECEPTOR Principal Investigator & Institution: Struthers, Richard S.; Neurocrine Biosciences, Inc. 10555 Science Center Dr San Diego, Ca 921211100 Timing: Fiscal Year 2001; Project Start 05-APR-2000; Project End 31-AUG-2003 Summary: (provided by applicant): Prostate cancer, breast cancer, endometriosis and uterine fibroids are fairly common and serious diseases in men and women. Their etiology is not fully understood, but all can be treated by removal of endogenous gonadal steroid hormones, testosterone and estrogen. This has led to the discovery of several successful pharmaceutical products based on blocking the actions of the hypothalamic peptide, gonadotropin-releasing hormone (GnRH). Down-regulation of the GnRH receptor by peptide superagonists, or blockade by peptide antagonists, prevents pituitary gonadotropin secretion and leads to dramatic reductions in gonadal steroid production. GnRH-based drugs are now used extensively in these patients, as well as for hormonal manipulation as part of assisted reproductive therapy or for treatment of precocious puberty. Here we propose to develop orally active small molecule antagonists of the GnRH receptor, in order to overcome many of the limitations of these injectable peptide drugs and expand the clinical utility of GnRHbased strategies. In Phase I we have used high-throughput parallel organic synthesis to design multiple chemical series of highly potent, nonpeptide GnRH antagonists. We have also established a series of in vitro and in vivo assays to evaluate absorption, distribution and metabolism of these compounds. In Phase II we propose a combination of parallel synthetic chemistry and assay strategies to optimize pharmacokinetic and pharmacodynamic properties of compounds from three of these series in order to

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produce compounds suitable for clinical development. PROPOSED COMMERCIAL APPLICATION: NOT AVAILABLE Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PROTEIN TYROSINE KINASES IN LEIOMYOMATA UTERI Principal Investigator & Institution: Wang, Jean Y.; Professor and Associate Director of Basi; University of California San Diego 9500 Gilman Dr, Dept. 0934 La Jolla, Ca 92093 Timing: Fiscal Year 2003; Project Start 26-SEP-2003; Project End 31-JUL-2008 Summary: (provided by applicant): Uterine leiomyomas or flbroids are benign pelvic tumors that originate from uterine cells. The clinically apparent incidence of leiomyoma in women of productive age is about 25%, whereas pathological examination places the rate of incidence as high as 75%. The growth of leiomyoma is dependent on the female sex hormones, estrogen and progesterone. We propose that hormones stimulate the expression and/or activation of protein tyrosine kinases (YK's) to promote the growth of fibroids. This hypothesis predicts that inhibition of YK's involved in the proliferation of uterine cells would halt the growth of fibroids. Therefore, we propose to survey the expression and the activity of YK's in normal uterine myometrium and leiomyomas. We propose to create microarrays that are suitable for profiling the expression of all 90 human YK genes (Aim 1). Using these microarrays, we will profile the expression of YK's in specimens of normal myometrium and leiomyoma procured from patients in different age and ethnic groups because these factors are known to affect the risk for fibroid (Aim 2). In addition to the static view of YK expression profiles in patient samples, we will determine the influence of hormones on YK expression (Aim 3). We will examine the protein levels and kinase activities of YK's that are expressed in normal and fibroid tissues (Aim 4). We will develop the necessary anti-YK and "phosphospecific" antibodies if commercial antibodies are not available. We will disrupt the activity of YK's that are expressed and/or activated in fibroids by small molecule inhibitors, if available; or by siRNA, and then measure the hormone-dependent proliferative response of leiomyomas in athymic nude mice (Aim 5). Results from the proposed study will identify tyrosine kinases that are important for the proliferation of fibroids. Tyrosine kinases have been successfully targeted in the development of rational therapy for human cancers. Information gathered from the proposed research may therefore lead to the development of new therapeutics to control the growth of fibroids. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: RANDOMIZED CONTROL TRIAL OF MIFEPRISTONE FOR FIBROIDS Principal Investigator & Institution: Fiscella, Kevin; Associate Director; Family Medicine; University of Rochester Orpa - Rc Box 270140 Rochester, Ny 14627 Timing: Fiscal Year 2003; Project Start 25-JUL-2003; Project End 31-MAY-2005 Summary: (provided by applicant): Background: Uterine fibroids represent the leading indication for roughly 600,000 hysterectomies performed annually in the United States. There is no satisfactory long-term medical therapy for fibroids, which disproportionately affect black women. Preliminary data from our open label study show that oral administration of mifepristone 5 mg per day is associated with significant improvement in fibroid symptoms and nearly 50% reduction in fibroid size. However, findings from this study were limited by absence of a placebo control group, absence of blinding, and absence of a validated, disease-specific quality of life outcome measure.

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Aims: We propose a six-month randomized, double-blinded, placebo-controlled trial of low-dose mifepristone. Seventy women with moderate to severely symptomatic fibroids, confirmed by ultrasonography, will be randomly allocated to receive mifepristone 5 mg per day or an identical appearing placebo. The primary outcome measure will be change in disease-specific quality of life based on the recently validated Uterine Fibroid Symptom Quality of Life questionnaire. Secondary outcomes include change in global health status, fibroid size, pain, bleeding, and adverse effects including endometrial hyperplasia. We also propose to test the hypothesis that administration of mifepristone will be associated with significant reductions in fibroid blood flow, which in turn, will be associated with reductions in fibroid volume. Significance: The study offers the promise for a safe, effective medical treatment for symptomatic fibroids that could potentially benefit millions of women world-wide, prevent thousands of hysterectomies and reduce health care costs. The study may also offer valuable insight into a mechanism by which mifepristone reduces fibroid size. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: REACTIVE OXYGEN SPECIES REGULATE SMOOTH MUSCLE GROWTH* Principal Investigator & Institution: Nowak, Romana A.; Animal Sciences and Veterinary Pathobiology; University of Illinois Urbana-Champaign Henry Administration Bldg Champaign, Il 61820 Timing: Fiscal Year 2003; Project Start 26-SEP-2003; Project End 31-JUL-2008 Summary: (provided by applicant): Uterine leiomyomas, or fibroids, are the most common pelvic tumors in women and are the primary indication for hysterectomy in the US. The incidence of symptomatic leiomyomas is 3-6 times higher in African American women than in other groups. While there may be a genetic component to this increased incidence we believe other factors may play a role. African-Americans show an increased incidence of hypertension, obesity and diabetes. Studies have shown that factors such as angiotensin II, serotonin and oleic acid, which are elevated in the bloodstream of patients with hypertension or obesity, have significant effects on proliferation and matrix production by vascular smooth muscle cells (SMCs) in response to injury. These factors, along with growth factors, regulate growth and differentiation of SMCs via a signaling pathway involving the production of reactive oxygen species (ROS). We hypothesize that similar ROS-dependent mechanisms are involved in the regulation of leiomyoma SMCs. The specific aims of this proposal are: 1. To determine whether ROS are a critical component of the EGF and PDGF signalling pathways in leiomyoma SMCs. 2. To determine whether angiotensin II, serotonin and oleic acid regulate proliferation and extra-cellular matrix production by leiomyoma SMCs and to determine whether these molecules act through their own receptors and/or by transactivating EGF or PDGF receptors. We will also determine the role of ROS in both of these activation pathways. 3. To determine whether halofuginone inhibits growth factor-stimulated proliferation and collagen production by leiomyoma SMCs by either inhibiting the increase in intracellular ROS or one of the downstream targets of ROS. The efficacy of halofuginone in an animal model of leiomyomas will also be assessed. The overall goal of this proposal is to elucidate the role of ROS in the signaling pathways that regulate growth and differentiation of leiomyoma SMCs. Molecules that inhibit ROS production or inhibit downstream targets of ROS may prove to be useful therapeutic agents for the treatment of leiomyomas. Halofuginorle has been shown to inhibit neointimal formation by vascular SMCs in rats undergoing angioplasty and

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tumor formation in nude mice. We believe halofuginone may act by inhibiting ROSdependent signaling pathways in these cells as well as in leiomyoma SMCs. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: REGULATION OF UTERINE FIBROIDS BY CCN5 Principal Investigator & Institution: Castellot, John J.; Anatomy and Cellular Biology; Tufts University Boston Boston, Ma 02111 Timing: Fiscal Year 2003; Project Start 26-SEP-2003; Project End 31-JUL-2008 Summary: (provided by applicant): The long-term goal of this project is to elucidate the cellular, molecular, and biochemical mechanisms regulating the proliferation and motility of human uterine smooth muscle cells (UtSMC). UtSMC hyperproliferation is the cause of fibroids, a condition that afflicts 20-25% of all women and 75% of AfricanAmerican women. Fibroids cause severe pain and bleeding, impair fertility, and result in >200,000 hysterectomies annually in the U.S. There is no known treatment--medical or surgical--that permanently reduces or eliminates fibroids, other than hysterectomy. Clearly, a detailed understanding of the mechanisms and molecules that regulate UtSMC mitogenesis and migration will provide a therapeutic rationale for controlling fibroids, and may provide important insights into the pathophysiologic basis for fibroid formation. Our laboratory has provided strong evidence that CCN5, an estrogen-induced growth-arrest specific gene, inhibits proliferation and motility in cultured UtSMC. Furthermore, we have demonstrated that human leiomyomas have greatly reduced levels of CCN5 mRNA and protein compared to normal myometrium from the same uterus. Based on this evidence the following hypothesis will be tested: CCN5 is an autocrine regulator of UtSMC proliferation and motility in culture and in vivo, and exerts it anti-proliferative and anti-motility effects, at least in part, through regulation of extracellular matrix synthesis and composition. To test this hypothesis, we will: 1) Continue our functional analysis of CCN5 and its regulation by estrogen on proliferation, motility, and extracellular matrix in SMC cultured from matched pairs of normal and fibroid human uterine tissue. To do this we will use adenovirus vectors, recombinant CCN5, and small inhibitory RNA approaches. 2) Examine the physiologic functions and estrogen regulation of CCN5 in animal models, including normal cycling rats, ovariectomized rats, pregnant rats, wild-type mice, and genetically manipulated mice that either under- or over-express CCN5. Quantitative PCR, Western blot analysis, and immunohistochemistry will be used to determine the spatial and temporal expression pattern and estrogen regulation of CCN5 in each of these animal models. We will also explore the possibility that CCN5 gene or protein therapy might be a useful approach for suppressing human fibroids in a novel nude mouse model system. The experiments proposed in this application should provide new and important insights into UtSMC pathophysiology in humans. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: SOCIAL STRESS AND MENTAL AND PHYSICAL HEALTH Principal Investigator & Institution: Boynton-Jarrett, Renee D.; Health Science and Behavior; Harvard University (Sch of Public Hlth) Public Health Campus Boston, Ma 02460 Timing: Fiscal Year 2002; Project Start 10-MAR-2003; Project End 30-APR-2005 Summary: (provided by applicant): The proposed study will examine associations between early life chronic exposure to violence (ETV) and (1) incidence of somatic and co-morbid depression/anxiety symptoms in adolescence, and (2) hypertension (HTN)

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and uterine fibroids in adulthood using two longitudinal cohort studies. In a subsample of 2,400 children and adolescents, aged 9 -18, from the Project on Human Development in Chicago Neighborhoods (PHDCN), a 6-year, prospective study of ETV among children and youth, the following hypotheses will be tested: (la) youth exposed to higher levels of violence will have increased risk of somatic disorders relative to those with lower-levels of violence; and (lb) perceived threat will mediate the relationship between violence and somatic disorders in youth. In a second population of women, aged 35-52 years [Nurse's Health Study II (NHS II)] followed biannually in an ongoing prospective cohort study, two additional hypotheses will be tested: (2a) those with higher levels of cumulative violence exposure in childhood and adolescence will have a greater number of incident cases of fibroids and HTN in adulthood than those with lower levels of violence exposure; and (2b) hypothalamic-pituitary axis (HPA) dysregulation--as measured by mean sex steroid levels--mediates the relationship between early life exposure to chronic violence, HTN and fibroid incidence in adulthood. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: UTERINE TUMOR TREATMENT USING HIGH INTENSITY ULTRASOUND Principal Investigator & Institution: Vaezy, Shahram; Associate Professor; Sonic Concepts, Inc. 20018 163Rd Ave Ne Woodinville, Wa 98072 Timing: Fiscal Year 2002; Project Start 01-JUN-2000; Project End 30-APR-2004 Summary: (provided by the applicant): High Intensity Focused Ultrasound (HIFU) offers a non-invasive, non-surgical, bloodless, outpatient treatment for uterine fibroid tumors. These tumors develop in over half of all women, and account for approximately 30 percent of all hysterectomies. This proposal will develop an integrated transvaginal HIFU probe and imaging transducer for fibroid treatment. The proximal transvaginal approach facilitates optimal HIFU control, improves aiming and minimizes complications. Phase I of this grant successfully constructed a lab prototype HIFU/Imaging unit, measured the speed and attenuation of sound in excised human fibroids, and established optimal treatment parameters (frequency, intensity and dose). Phase II will utilize several imaging modalities to map numerous in-situ fibroid tumors and evaluate the range of uterine and intervening tissue structures in women, develop an anatomically correct integrated HIFU/Imaging clinical prototype probe, evaluate the safety and efficacy of this treatment in sheep studies and evaluate this probe?s placement and imaging characteristics in humans. This grant will develop the properly shaped HIFU probe and investigate the safety and efficacy of HIFU to treat fibroids in Phase Ill human clinical studies. Dramatic improvements in patient treatment, reduced complication rate, reduction in health care costs, reduced recovery time and preservation of a women?s fertility are the potential results. PROPOSED COMMERCIAL APPLICATION: The goal of this research is to develop a non-surgical, outpatient treatment system for uterine fibroid tumors based upon high intensity focused ultrasound (HIFU). It is anticipated that this treatment will improve patient care, facilitate an alternative to hysterectomy, and result in significantly lower treatment cost. Ultimately, this treatment approach may also provide an option to preserve fertility and improve reproductive outcomes in patients with fibroid tumors. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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

Influence of information sources on the adoption of uterine fibroid embolization by interventional radiologists. by Ankem K.; 2003 Oct; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=209511

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with fibroids, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “fibroids” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for fibroids (hyperlinks lead to article summaries): •

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A case of failed fibroid embolisation due to an unusual vascular supply. Author(s): Jones K, Walker WJ, Sutton C. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2003 August; 110(8): 782-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12892694&dopt=Abstract

Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.

With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 6 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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A new way to treat uterine fibroids. Author(s): Scholz M. Source: Rn. 1999 November; 62(11): 92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10640138&dopt=Abstract

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A prospective controlled study of the effect of intramural uterine fibroids on the outcome of assisted conception. Author(s): Hart R, Khalaf Y, Yeong CT, Seed P, Taylor A, Braude P. Source: Human Reproduction (Oxford, England). 2001 November; 16(11): 2411-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11679530&dopt=Abstract

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A randomized, placebo-controlled, dose-ranging trial comparing fulvestrant with goserelin in premenopausal patients with uterine fibroids awaiting hysterectomy. Author(s): Donnez J, Hervais Vivancos B, Kudela M, Audebert A, Jadoul P. Source: Fertility and Sterility. 2003 June; 79(6): 1380-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12798886&dopt=Abstract

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Abdominal myomectomy versus abdominal hysterectomy for symptomatic and big uterine fibroids. Author(s): Rouzi AA, Al-Noury AI, Shobokshi AS, Jamal HS, Abduljabbar HS. Source: Saudi Med J. 2001 November; 22(11): 984-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11744970&dopt=Abstract

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Alternative treatment for symptomatic fibroids. Author(s): Floridon C, Lund N, Thomsen SG. Source: Current Opinion in Obstetrics & Gynecology. 2001 October; 13(5): 491-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11547029&dopt=Abstract

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An evidence-based guideline for the management of uterine fibroids. Author(s): Farquhar C, Arroll B, Ekeroma A, Fentiman G, Lethaby A, Rademaker L, Roberts H, Sadler L, Strid J; Working Party of the New Zealand Guidelines Group. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 2001 May; 41(2): 125-40. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11453261&dopt=Abstract

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An image-guided high intensity focused ultrasound device for uterine fibroids treatment. Author(s): Chan AH, Fujimoto VY, Moore DE, Martin RW, Vaezy S. Source: Medical Physics. 2002 November; 29(11): 2611-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12462728&dopt=Abstract

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Arterial embolisation of uterine fibroids. Author(s): Howatson-Jones L. Source: Nursing Standard : Official Newspaper of the Royal College of Nursing. 1999 July 28-August 3; 13(45): 41-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10633707&dopt=Abstract

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Benign but no longer forgotten--fibroids get their own conference. Author(s): McBride G. Source: Lancet. 1999 October 23; 354(9188): 1450. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10543681&dopt=Abstract

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By the way, doctor. I went through menopause about 10 years ago and have been taking estrogen therapy ever since. My uterus was removed because of fibroids, so there is no risk of endometrial cancer, which is why I am taking estrogen without progesterone. Should I have a bone density scan? A lot of my friends are having them, but I'm not sure how this test could alter my therapy. Author(s): Lee TH. Source: Harvard Health Letter / from Harvard Medical School. 2000 March; 25(5): 7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10677201&dopt=Abstract

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Clinical outcomes following percutaneous magnetic resonance image guided laser ablation of symptomatic uterine fibroids. Author(s): Hindley JT, Law PA, Hickey M, Smith SC, Lamping DL, Gedroyc WM, Regan L. Source: Human Reproduction (Oxford, England). 2002 October; 17(10): 2737-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12351555&dopt=Abstract

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Complementary medicine treatment of uterine fibroids: a pilot study. Author(s): Mehl-Madrona L. Source: Alternative Therapies in Health and Medicine. 2002 March-April; 8(2): 34-6, 3840, 42, 44-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11890384&dopt=Abstract

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Cost effectiveness of pre-operative gonadotrophin releasing analogues for women with uterine fibroids undergoing hysterectomy or myomectomy. Author(s): Sharma M, Buck L, Mastrogamvrakis G, Kontos K, Magos A, Taylor A. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2003 July; 110(7): 712; Author Reply 712-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12842071&dopt=Abstract

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Cost effectiveness of pre-operative gonadotrophin releasing analogues for women with uterine fibroids undergoing hysterectomy or myomectomy. Author(s): Farquhar C, Brown PM, Furness S. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2002 November; 109(11): 1273-80. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12452466&dopt=Abstract

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Dextran uterine artery embolization to treat fibroids. Author(s): Wang J, Zhang G, Shi H, Feng Y, Wang W, Wang Y, Liu J. Source: Chinese Medical Journal. 2002 August; 115(8): 1132-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12215276&dopt=Abstract

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Doppler ultrasound examination of uterine arteries on the day of oocyte retrieval in patients with uterine fibroids undergoing IVF. Author(s): Ng EH, Ho PC. Source: Human Reproduction (Oxford, England). 2002 March; 17(3): 765-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11870133&dopt=Abstract

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Effect of fibroids on cumulative probability of pregnancy in women taking follicle maturing drugs without assisted reproductive technology. Author(s): Wang W, Check JH, Dietterich C, Lurie D. Source: Clin Exp Obstet Gynecol. 2001; 28(2): 86-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11491381&dopt=Abstract

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Effect of hormone replacement therapy on uterine fibroids in postmenopausal women--a 3-year study. Author(s): Yang CH, Lee JN, Hsu SC, Kuo CH, Tsai EM. Source: Maturitas. 2002 September 30; 43(1): 35-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12270580&dopt=Abstract

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Efficacy of pre-operative gonadotrophin hormone releasing analogues for women with uterine fibroids undergoing hysterectomy or myomectomy: a systematic review. Author(s): Lethaby A, Vollenhoven B, Sowter M. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2002 October; 109(10): 1097-108. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12387461&dopt=Abstract

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Etiology and treatment of uterine fibroids. Author(s): Chez RA. Source: Alternative Therapies in Health and Medicine. 2002 March-April; 8(2): 32-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11890383&dopt=Abstract

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Expression of progesterone receptors A and B and insulin-like growth factor-I in human myometrium and fibroids after treatment with a gonadotropin-releasing hormone analogue. Author(s): Wu X, Wang H, Englund K, Blanck A, Lindblom B, Sahlin L. Source: Fertility and Sterility. 2002 November; 78(5): 985-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12413982&dopt=Abstract

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Fibroids (uterine myomatosis, leiomyomas). Author(s): Lethaby A, Vollenhoven B. Source: Clin Evid. 2002 June; (7): 1666-78. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12230780&dopt=Abstract

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Fibroids and hypertension. A cross-sectional study of women undergoing hysterectomy. Author(s): Luoto R, Rutanen EM, Auvinen A. Source: J Reprod Med. 2001 April; 46(4): 359-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11354837&dopt=Abstract

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Fibroids and infertility: a systematic review of the evidence. Author(s): Pritts EA. Source: Obstetrical & Gynecological Survey. 2001 August; 56(8): 483-91. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11496160&dopt=Abstract

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Fibroids treated by uterine artery embolization. A review. Author(s): Lund N, Justesen P, Elle B, Thomsen SG, Floridon C. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2000 November; 79(11): 905-10. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11081668&dopt=Abstract

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Fibroids, infertility and pregnancy wastage. Author(s): Bajekal N, Li TC. Source: Human Reproduction Update. 2000 November-December; 6(6): 614-20. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11129696&dopt=Abstract

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Fibroids: pathophysiology and current medical treatment. Author(s): Nowak RA. Source: Bailliere's Best Practice & Research. Clinical Obstetrics & Gynaecology. 1999 June; 13(2): 223-38. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10755039&dopt=Abstract

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Gadolinium-enhanced MR imaging in the evaluation of uterine fibroids treated with uterine artery embolization. Author(s): Katsumori T, Nakajima K, Tokuhiro M. Source: Ajr. American Journal of Roentgenology. 2001 August; 177(2): 303-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11461850&dopt=Abstract

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Gene expression and tissue concentrations of IGF-I in human myometrium and fibroids under different hormonal conditions. Author(s): Englund K, Lindblom B, Carlstrom K, Gustavsson I, Sjoblom P, Blanck A. Source: Molecular Human Reproduction. 2000 October; 6(10): 915-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11006320&dopt=Abstract

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Genetics and the development of fibroids. Author(s): Gross KL, Morton CC. Source: Clinical Obstetrics and Gynecology. 2001 June; 44(2): 335-49. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11344997&dopt=Abstract

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Germline mutations in FH predispose to dominantly inherited uterine fibroids, skin leiomyomata and papillary renal cell cancer. Author(s): Tomlinson IP, Alam NA, Rowan AJ, Barclay E, Jaeger EE, Kelsell D, Leigh I, Gorman P, Lamlum H, Rahman S, Roylance RR, Olpin S, Bevan S, Barker K, Hearle N, Houlston RS, Kiuru M, Lehtonen R, Karhu A, Vilkki S, Laiho P, Eklund C, Vierimaa O, Aittomaki K, Hietala M, Sistonen P, Paetau A, Salovaara R, Herva R, Launonen V, Aaltonen LA; Multiple Leiomyoma Consortium. Source: Nature Genetics. 2002 April; 30(4): 406-10. Epub 2002 February 25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11865300&dopt=Abstract

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Goserelin acetate to avoid hysterectomy in pre-menopausal women with fibroids requiring surgery. Author(s): Parazzini F, Bortolotti A, Chiantera V, Scollo P, Del Monaco D, Bianchi M, Bennici S. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 1999 November; 87(1): 31-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10579613&dopt=Abstract

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Heritability and risk factors of uterine fibroids--the Finnish Twin Cohort study. Author(s): Luoto R, Kaprio J, Rutanen EM, Taipale P, Perola M, Koskenvuo M. Source: Maturitas. 2000 November 30; 37(1): 15-26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11099869&dopt=Abstract

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Hysteroscopic treatment of symptomatic submucous fibroids using a bipolar intrauterine system: a feasibility study. Author(s): Clark TJ, Mahajan D, Sunder P, Gupta JK. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2002 January 10; 100(2): 237-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11750972&dopt=Abstract

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Identifying the indications for laparoscopically assisted vaginal hysterectomy: a prospective, randomised comparison with abdominal hysterectomy in patients with symptomatic uterine fibroids. Author(s): Ferrari MM, Berlanda N, Mezzopane R, Ragusa G, Cavallo M, Pardi G. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2000 May; 107(5): 620-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10826576&dopt=Abstract

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Impact of uterine fibroids on ART outcome. Author(s): Healy DL. Source: Environmental Health Perspectives. 2000 October; 108 Suppl 5: 845-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11035993&dopt=Abstract

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Influence of exogenous estrogen receptor ligands on uterine leiomyoma: evidence from an in vitro/in vivo animal model for uterine fibroids. Author(s): Hunter DS, Hodges LC, Eagon PK, Vonier PM, Fuchs-Young R, Bergerson JS, Walker CL. Source: Environmental Health Perspectives. 2000 October; 108 Suppl 5: 829-34. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11035990&dopt=Abstract

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Interstitial thermo-ablation under MRI guidance for the treatment of fibroids. Author(s): Law P, Regan L. Source: Current Opinion in Obstetrics & Gynecology. 2000 August; 12(4): 277-82. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10954146&dopt=Abstract

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IVF outcome and intramural fibroids not compressing the uterine cavity. Author(s): Nawroth F, Foth D. Source: Human Reproduction (Oxford, England). 2002 September; 17(9): 2485; Discusson 2485-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12202450&dopt=Abstract

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Laparoscopic bipolar coagulation of uterine vessels: a new method for treating symptomatic fibroids. Author(s): Liu WM, Ng HT, Wu YC, Yen YK, Yuan CC. Source: Fertility and Sterility. 2001 February; 75(2): 417-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11172850&dopt=Abstract

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Laparoscopic myomectomy for fibroids penetrating the uterine cavity: is it a safe procedure? Author(s): Seracchioli R, Colombo FM, Bagnoli A, Govoni F, Missiroli S, Venturoli S. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2003 March; 110(3): 236-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12628260&dopt=Abstract

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Limited uterine artery embolization with tris-acryl gelatin microspheres for uterine fibroids. Author(s): Pelage JP, Le Dref O, Beregi JP, Nonent M, Robert Y, Cosson M, Jacob D, Truc JB, Laurent A, Rymer R. Source: Journal of Vascular and Interventional Radiology : Jvir. 2003 January; 14(1): 1520. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12525582&dopt=Abstract

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Localization of a gene (MCUL1) for multiple cutaneous leiomyomata and uterine fibroids to chromosome 1q42.3-q43. Author(s): Alam NA, Bevan S, Churchman M, Barclay E, Barker K, Jaeger EE, Nelson HM, Healy E, Pembroke AC, Friedmann PS, Dalziel K, Calonje E, Anderson J, August PJ, Davies MG, Felix R, Munro CS, Murdoch M, Rendall J, Kennedy S, Leigh IM, Kelsell DP, Tomlinson IP, Houlston RS. Source: American Journal of Human Genetics. 2001 May; 68(5): 1264-9. Epub 2001 March 14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11283798&dopt=Abstract

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Magnetic resonance-guided percutaneous laser ablation of uterine fibroids. Author(s): Law P, Gedroyc WM, Regan L. Source: Journal of Magnetic Resonance Imaging : Jmri. 2000 October; 12(4): 565-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11042638&dopt=Abstract

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Magnetic-resonance-guided percutaneous laser ablation of uterine fibroids. Author(s): Law P, Gedroyc WM, Regan L. Source: Lancet. 1999 December 11; 354(9195): 2049-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10636374&dopt=Abstract

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Medical treatment of uterine fibroids. Author(s): Chavez NF, Stewart EA. Source: Clinical Obstetrics and Gynecology. 2001 June; 44(2): 372-84. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11347559&dopt=Abstract

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Microarray analysis in fibroids: which gene list is the correct list? Author(s): Catherino WH, Segars JH. Source: Fertility and Sterility. 2003 August; 80(2): 293-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12909489&dopt=Abstract

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Migraine with ectopic hyperprolactinemia from uterine fibroids. Author(s): Herzog AG. Source: Neurology. 2000 July 12; 55(1): 148-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10891931&dopt=Abstract

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Minimally invasive management of uterine fibroids. Author(s): Falcone T, Bedaiwy MA. Source: Current Opinion in Obstetrics & Gynecology. 2002 August; 14(4): 401-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12151830&dopt=Abstract

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Mullerian duct remnant fibroids: a case report. Author(s): McIntyre G. Source: The West Indian Medical Journal. 2001 June; 50(2): 169-70. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11677921&dopt=Abstract

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Multiple fibroids in a postmenopausal woman with Mayer Rokitansky Kuster Hauser syndrome. Author(s): Edmonds DK. Source: Journal of Pediatric and Adolescent Gynecology. 2003 April; 16(2): 65-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12742138&dopt=Abstract

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Myomectomy and tuboplasty performed at the same time in cases of distal tubal obstruction with associated fibroids. Author(s): Guillaume J, Benjamin F, Jean-Gilles M, Ajah M, Tabassi G, Kenel-Pierre C. Source: J Reprod Med. 2000 June; 45(6): 461-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10900578&dopt=Abstract

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New approaches to the management of fibroids. Author(s): Olive DL. Source: Obstetrics and Gynecology Clinics of North America. 2000 September; 27(3): 669-75. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10958011&dopt=Abstract

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Oestrogen deficiency causes DNA damage in uterine leiomyoma cells: a possible mechanism for shrinkage of fibroids by GnRH agonists. Author(s): Cheng YM, Chou CY, Huang SC, Lin HC. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2001 January; 108(1): 95-102. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11213012&dopt=Abstract

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Outpatient uterine artery embolization for symptomatic uterine fibroids: experience in 49 patients. Author(s): Siskin GP, Stainken BF, Dowling K, Meo P, Ahn J, Dolen EG. Source: Journal of Vascular and Interventional Radiology : Jvir. 2000 March; 11(3): 30511. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10735424&dopt=Abstract

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Ovarian artery supply of uterine fibroids as a cause of treatment failure after uterine artery embolization: a case report. Author(s): Nikolic B, Spies JB, Abbara S, Goodwin SC. Source: Journal of Vascular and Interventional Radiology : Jvir. 1999 October; 10(9): 1167-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10527192&dopt=Abstract

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Permanent amenorrhea associated with endometrial atrophy after uterine artery embolization for symptomatic uterine fibroids. Author(s): Tropeano G, Litwicka K, Di Stasi C, Romano D, Mancuso S. Source: Fertility and Sterility. 2003 January; 79(1): 132-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12524076&dopt=Abstract

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Pre-operative GnRH analogue therapy before hysterectomy or myomectomy for uterine fibroids. Author(s): Lethaby A, Vollenhoven B, Sowter M. Source: Cochrane Database Syst Rev. 2001; (2): Cd000547. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11405968&dopt=Abstract

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Pre-operative GnRH analogue therapy before hysterectomy or myomectomy for uterine fibroids. Author(s): Lethaby A, Vollenhoven B, Sowter M. Source: Cochrane Database Syst Rev. 2000; (2): Cd000547. Review. Update In: http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10796723&dopt=Abstract

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Prospective sonographic assessment of uterine artery embolization for the treatment of fibroids. Author(s): Tranquart F, Brunereau L, Cottier JP, Marret H, Gallas S, Lebrun JL, Body G, Herbreteau D, Pourcelot L. Source: Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2002 January; 19(1): 81-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11851974&dopt=Abstract

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Randomized double-blind study evaluating the efficacy on uterine fibroids shrinkage and on intra-operative blood loss of different length of leuprolide acetate depot treatment before myomectomy. Author(s): Jasonni VM, D'Anna R, Mancuso A, Caruso C, Corrado F, Leonardi I. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2001 October; 80(10): 956-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11580742&dopt=Abstract

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Re: New Zealand evidence-based guidelines for management of uterine fibroids. Author(s): Farquhar C. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 2002 August; 42(3): 316-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12230077&dopt=Abstract

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Re: utility of nonselective abdominal aortography in demonstrating ovarian artery collaterals in patients undergoing uterine artery embolization for fibroids. Author(s): Pelage JP, Walker WJ, Le Dref O. Source: Journal of Vascular and Interventional Radiology : Jvir. 2002 June; 13(6): 656. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12090245&dopt=Abstract

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Real-time I-MR-imaging--guided cryoablation of uterine fibroids. Author(s): Sewell PE, Arriola RM, Robinette L, Cowan BD. Source: Journal of Vascular and Interventional Radiology : Jvir. 2001 July; 12(7): 891-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11435548&dopt=Abstract

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Regarding sloughing of fibroids after uterine artery embolization. Author(s): Worthington-Kirsch RL, Hutchins FL Jr, Berkowitz RP. Source: Journal of Vascular and Interventional Radiology : Jvir. 1999 September; 10(8): 1135. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10496723&dopt=Abstract

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Risk factors for uterine fibroids among women undergoing tubal sterilization. Author(s): Chen CR, Buck GM, Courey NG, Perez KM, Wactawski-Wende J. Source: American Journal of Epidemiology. 2001 January 1; 153(1): 20-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11159141&dopt=Abstract

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Sarcomas and the conservative management of uterine fibroids: a cause for concern? Author(s): Dover RW, Ferrier AJ, Torode HW. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 2000 August; 40(3): 308-12. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11065039&dopt=Abstract

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Serious complications of uterine artery embolization for conservative treatment of fibroids. Author(s): Payne JF, Haney AF. Source: Fertility and Sterility. 2003 January; 79(1): 128-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12524075&dopt=Abstract

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Spontaneous expulsion of three large fibroids after uterine artery embolization. Author(s): Laverge F, D'Angelo A, Davies NJ, Wood A, Amso NN. Source: Fertility and Sterility. 2003 August; 80(2): 450-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12909514&dopt=Abstract

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Successful embolization of collaterals from the ovarian artery during uterine artery embolization for fibroids: a case report. Author(s): Andrews RT, Bromley PJ, Pfister ME. Source: Journal of Vascular and Interventional Radiology : Jvir. 2000 May; 11(5): 607-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10834492&dopt=Abstract

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Successful myomectomy following infected ischaemic necrosis of uterine fibroids after uterine artery embolisation. Author(s): Sabatini L, Atiomo W, Magos A. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2003 July; 110(7): 704-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12842064&dopt=Abstract

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Successful pregnancy in a woman with symptomatic fibroids who underwent laparoscopic bipolar coagulation of uterine vessels. Author(s): Chen YJ, Wang PH, Yuan CC, Yang MJ, Yen YK, Liu WM. Source: Fertility and Sterility. 2002 April; 77(4): 838-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11937144&dopt=Abstract

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Technical results and effects of operator experience on uterine artery embolization for fibroids: the Ontario Uterine Fibroid Embolization Trial. Author(s): Pron G, Bennett J, Common A, Sniderman K, Asch M, Bell S, Kozak R, Vanderburgh L, Garvin G, Simons M, Tran C, Kachura J; Ontario UFE Collaborative Group. Source: Journal of Vascular and Interventional Radiology : Jvir. 2003 May; 14(5): 545-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12761307&dopt=Abstract

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The effect of intramural and subserous uterine fibroids on implantation and clinical pregnancy rates in patients having intracytoplasmic sperm injection. Author(s): Yarali H, Bukulmez O. Source: Archives of Gynecology and Obstetrics. 2002 January; 266(1): 30-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11998961&dopt=Abstract

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The effect of pelvic MR imaging on the diagnosis and treatment of women with presumed symptomatic uterine fibroids. Author(s): Omary RA, Vasireddy S, Chrisman HB, Ryu RK, Pereles FS, Carr JC, Resnick SA, Nemcek AA Jr, Vogelzang RL. Source: Journal of Vascular and Interventional Radiology : Jvir. 2002 November; 13(11): 1149-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12427815&dopt=Abstract

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The effect of submucous fibroids on the dose-dependent modulation of uterine bleeding by trimegestone in postmenopausal women treated with hormone replacement therapy. Author(s): Wahab M, Thompson J, Al-Azzawi F. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2000 March; 107(3): 329-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10740328&dopt=Abstract

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The effect on IVF outcome of small intramural fibroids not compressing the uterine cavity as determined by a prospective matched control study. Author(s): Check JH, Choe JK, Lee G, Dietterich C. Source: Human Reproduction (Oxford, England). 2002 May; 17(5): 1244-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11980746&dopt=Abstract

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The effect on menstrual blood loss in women with uterine fibroids of a novel “frameless” intrauterine levonorgestrel-releasing drug delivery system: a pilot study. Author(s): Wildemeersch D, Schacht E. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2002 April 10; 102(1): 74-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12039094&dopt=Abstract

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The emerging role of uterine artery embolization in the management of symptomatic uterine fibroids. Author(s): Dubel GJ, Ferland RJ, Murphy TP, Frishman G. Source: Medicine and Health, Rhode Island. 2000 October; 83(10): 305-11. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11070680&dopt=Abstract

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The Ontario Uterine Fibroid Embolization Trial. Part 2. Uterine fibroid reduction and symptom relief after uterine artery embolization for fibroids. Author(s): Pron G, Bennett J, Common A, Wall J, Asch M, Sniderman K; Ontario Uterine Fibroid Embolization Collaboration Group. Source: Fertility and Sterility. 2003 January; 79(1): 120-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12524074&dopt=Abstract

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The presence of small uterine fibroids not distorting the endometrial cavity does not adversely affect conception outcome following embryo transfer in older recipients. Author(s): Dietterich C, Check JH, Choe JK, Nazari A, Fox F. Source: Clin Exp Obstet Gynecol. 2000; 27(3-4): 168-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11214940&dopt=Abstract

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Thioredoxin expression in human myometrium and fibroids. Author(s): Sahlin L, Wang H, Lindblom B, Eriksson H, Holmgren A, Blanck A. Source: Molecular Human Reproduction. 2000 January; 6(1): 60-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10611262&dopt=Abstract

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Three-dimensional color Doppler sonography and uterine artery arteriography of fibroids: assessment of changes in vascularity before and after embolization. Author(s): Muniz CJ, Fleischer AC, Donnelly EF, Mazer MJ. Source: Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine. 2002 February; 21(2): 129-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11833868&dopt=Abstract

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Tissue differences but limited sex steroid responsiveness of c-fos and c-jun in human fibroids and myometrium. Author(s): Gustavsson I, Englund K, Faxen M, Sjoblom P, Lindblom B, Blanck A. Source: Molecular Human Reproduction. 2000 January; 6(1): 55-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10611261&dopt=Abstract

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Toward optimal health: the experts respond to fibroids. Interview by Jodi Godfrey Meisler. Author(s): Haas S, Spies JB. Source: Journal of Women's Health & Gender-Based Medicine. 1999 September; 8(7): 879-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10534290&dopt=Abstract

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Traditional surgical approaches to uterine fibroids: abdominal myomectomy and hysterectomy. Author(s): Guarnaccia MM, Rein MS. Source: Clinical Obstetrics and Gynecology. 2001 June; 44(2): 385-400. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11345000&dopt=Abstract

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Translabial sonography of vaginal fibroids: report of 2 cases and review of the literature. Author(s): Torreggiani W, Zwirewich C, Lyburn I, Harris A, Davis JE, Wilkie D, Fenster H, Marchinkow L. Source: Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine. 2001 August; 20(8): 909-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11503927&dopt=Abstract

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Treatment of uterine fibroids. Author(s): Kashyap AS, Kashyap S. Source: Lancet. 2001 May 12; 357(9267): 1530-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11383542&dopt=Abstract

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Treatment of uterine fibroids. Author(s): Pelage JP, Walker WJ, Le Dref O, Laurent A, Rymer R. Source: Lancet. 2001 May 12; 357(9267): 1530. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11383541&dopt=Abstract

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Unexplained infertility, endometriosis, and fibroids. Author(s): Hart R. Source: Bmj (Clinical Research Ed.). 2003 September 27; 327(7417): 721-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14512481&dopt=Abstract

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Uterine artery embolisation for symptomatic fibroids. Author(s): Dover RW, Torode HW, Briggs GM. Source: The Medical Journal of Australia. 2000 March 6; 172(5): 233-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10776397&dopt=Abstract

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Uterine artery embolisation for symptomatic fibroids: clinical results in 400 women with imaging follow up. Author(s): Walker WJ, Pelage JP. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2002 November; 109(11): 1262-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12452465&dopt=Abstract

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Uterine artery embolisation for the treatment of symptomatic fibroids in 114 women: reduction in size of the fibroids and women's views of the success of the treatment. Author(s): Watson GM, Walker WJ. Source: Bjog : an International Journal of Obstetrics and Gynaecology. 2002 February; 109(2): 129-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11905428&dopt=Abstract

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Uterine artery embolisation for the treatment of symptomatic uterine fibroids: shortterm results of work in progress. Author(s): Bapuraj JR, Suri S, Sidhu R, Nadh OV, Vasistha K. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 2002 November; 42(5): 508-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12495096&dopt=Abstract

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Uterine artery embolisation for treatment of fibroids: experience in Chinese women. Author(s): Chiu CY, Wong WK, Mak HL, Chan CS, Kwok CH, Chan CH, Chan MK. Source: Singapore Med J. 2001 April; 42(4): 148-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11465313&dopt=Abstract

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Uterine artery embolization for fibroids: considerations in patient selection and clinical follow-up. Author(s): Vedantham S, Goodwin SC, McLucas B, Lee M, Perrella R, Forno AE, DeLeon M. Source: Medscape Women's Health [electronic Resource]. 1999 October; 4(5): 2. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10629068&dopt=Abstract

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Uterine artery embolization for fibroids: understanding the technical causes of failure. Author(s): Spies JB. Source: Journal of Vascular and Interventional Radiology : Jvir. 2003 January; 14(1): 11-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12525581&dopt=Abstract

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Uterine artery embolization for the treatment of fibroids. Author(s): Topfer LA, Hailey D. Source: Issues Emerg Health Technol. 2002 August; (36): 1-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12195604&dopt=Abstract

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Uterine artery embolization for the treatment of uterine fibroids: an outpatient procedure. Author(s): Klein A, Schwartz ML. Source: American Journal of Obstetrics and Gynecology. 2001 June; 184(7): 1556-60; Discussion 1560-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11408880&dopt=Abstract

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Uterine artery embolization for uterine fibroids: a radiologist's perspective. Author(s): Goodwin SC, Wong GC. Source: Clinical Obstetrics and Gynecology. 2001 June; 44(2): 412-24. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11345002&dopt=Abstract

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Uterine artery embolization in a 10-week cervical pregnancy with coexisting fibroids. Author(s): Has R, Balci NC, Ibrahimoglu L, Rozanes I, Topuz S. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 2001 March; 72(3): 253-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11226446&dopt=Abstract

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Uterine artery embolization to treat uterine fibroids. Author(s): Machan L, Martin M. Source: Canadian Association of Radiologists Journal = Journal L'association Canadienne Des Radiologistes. 2001 June; 52(3): 183-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11436413&dopt=Abstract

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Uterine artery embolization treatment of uterine fibroids: effect on ovarian function in younger women. Author(s): Ahmad A, Qadan L, Hassan N, Najarian K. Source: Journal of Vascular and Interventional Radiology : Jvir. 2002 October; 13(10): 1017-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12397123&dopt=Abstract

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Uterine artery embolization using gelatin sponge particles alone for symptomatic uterine fibroids: midterm results. Author(s): Katsumori T, Nakajima K, Mihara T, Tokuhiro M. Source: Ajr. American Journal of Roentgenology. 2002 January; 178(1): 135-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11756107&dopt=Abstract

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Uterine artery embolization: a minimally invasive technique for the treatment of uterine fibroids. Author(s): Wong GC, Muir SJ, Lai AP, Goodwin SC. Source: Journal of Women's Health & Gender-Based Medicine. 2000 May; 9(4): 357-62. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10868607&dopt=Abstract

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Uterine fibroid embolization: nonsurgical treatment for symptomatic fibroids. Author(s): McLucas B, Adler L, Perrella R. Source: Journal of the American College of Surgeons. 2001 January; 192(1): 95-105. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11192931&dopt=Abstract

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Uterine fibroids and adenomyosis in a woman with Rokitansky-Kuster-Hauser syndrome. Author(s): Yan CM, Mok KM. Source: Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology. 2002 September; 22(5): 561-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12521437&dopt=Abstract

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Uterine fibroids. Author(s): Stewart EA. Source: Lancet. 2001 January 27; 357(9252): 293-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11214143&dopt=Abstract

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Uterine fibroids: a ten-year clinical review in Ilorin, Nigeria. Author(s): Aboyeji AP, Ijaiya MA. Source: Niger J Med. 2002 January-March; 11(1): 16-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12073294&dopt=Abstract

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Uterine fibroids: primary treatment with therapeutic embolization. Author(s): Garcia MJ, Gheyi VK, Uppot RN, Nowakowski FS, Storm ES. Source: Del Med J. 2000 September; 72(9): 397-401. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11042954&dopt=Abstract

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Uterine fibroids: uterine artery embolization versus abdominal hysterectomy for treatment--a prospective, randomized, and controlled clinical trial. Author(s): Pinto I, Chimeno P, Romo A, Paul L, Haya J, de la Cal MA, Bajo J. Source: Radiology. 2003 February; 226(2): 425-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12563136&dopt=Abstract

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Uterine fistula induced by hysteroscopic resection of an embolized migrated fibroid: a rare complication after embolization of uterine fibroids. Author(s): De Iaco P, Golfieri R, Ghi T, Muzzupapa G, Ceccarini M, Bovicelli L. Source: Fertility and Sterility. 2001 April; 75(4): 818-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11287042&dopt=Abstract

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Utility of nonselective abdominal aortography in demonstrating ovarian artery collaterals in patients undergoing uterine artery embolization for fibroids. Author(s): Binkert CA, Andrews RT, Kaufman JA. Source: Journal of Vascular and Interventional Radiology : Jvir. 2001 July; 12(7): 841-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11435540&dopt=Abstract

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Why is parity protective for uterine fibroids? Author(s): Baird DD, Dunson DB. Source: Epidemiology (Cambridge, Mass.). 2003 March; 14(2): 247-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12606893&dopt=Abstract

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Women's decision-making determinants in choosing uterine artery embolization for symptomatic fibroids. Author(s): Nevadunsky NS, Bachmann GA, Nosher J, Yu T. Source: J Reprod Med. 2001 October; 46(10): 870-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11725729&dopt=Abstract

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

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

7

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

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Fibroids

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

Add-back therapy for long-term use in dysfunctional uterine bleeding and uterine fibroids. Author(s): Department of Obstetrics and Gynaecology, Princess Anne Hospital, Southampton, UK. Source: Thomas, E J Br-J-Obstet-Gynaecol. 1996 October; 103 Suppl 1418-21 0306-5456

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Alternative treatment for symptomatic fibroids. Author(s): Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark. [email protected] Source: Floridon, C Lund, N Thomsen, S G Curr-Opin-Obstet-Gynecol. 2001 October; 13(5): 491-5 1040-872X

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An open study of luteinizing hormone releasing hormone agonists in infertile women with uterine fibroids. Author(s): Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia. Source: Vollenhoven, B J McCloud, P Shekleton, P McDonald, J Healy, D L GynecolEndocrinol. 1993 March; 7(1): 57-61 0951-3590

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Changes in serum electrolytes after transcervical resection of endometrium and submucous fibroids with use of glycine 1.5% for uterine irrigation. Author(s): Department of Obstetrics and Gynecology, Hamar County Hospital, Norway. Source: Istre, O Skajaa, K Schjoensby, A P Forman, A Obstet-Gynecol. 1992 August; 80(2): 218-22 0029-7844

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Clinical experience in the treatment of fibroids with leuprolide and other GnRH agonists. Author(s): Department of Obstetrics/Gynecology, Harvard Medical School, Boston, Massachusetts. Source: Friedman, A J Obstet-Gynecol-Survolume 1989 May; 44(5): 311-3 0029-7828

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Complementary medicine treatment of uterine fibroids: a pilot study. Author(s): Program in Integrative Medicine of the University of Arizona in Tucson, USA. Source: Mehl Madrona, Lewis Altern-Ther-Health-Med. 2002 Mar-April; 8(2): 34-6, 3840, 42, 44-6 1078-6791

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Cornual fibroids: a conservative approach to restoring tubal patency using a gonadotropin-releasing hormone agonist (goserelin) with successful pregnancy. Author(s): Department of Obstetrics and Gynaecology, Royal Free Hospital, Pond Street, London, United Kingdom. Source: Gardner, R L Shaw, R W Fertil-Steril. 1989 August; 52(2): 332-4 0015-0282

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Cryomyolysis, a new procedure for the conservative treatment of uterine fibroids. Author(s): Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, Yale University School of Medicine, P.O. Box 208063, New Haven, CT 06520-8063, USA. Source: Zreik, T G Rutherford, T J Palter, S F Troiano, R N Williams, E Brown, J M Olive, D L J-Am-Assoc-Gynecol-Laparosc. 1998 February; 5(1): 33-8 1074-3804

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Doppler assessment of uterine blood flow changes in patients with fibroids receiving the gonadotropin-releasing hormone agonist Buserelin. Author(s): Academic Department of Obstetrics and Gynaecology, Royal Free Hospital School of Medicine, London, United Kingdom.

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Source: Matta, W H Stabile, I Shaw, R W Campbell, S Fertil-Steril. 1988 June; 49(6): 10835 0015-0282 •

Effects of gonadotrophin-releasing hormone agonist on uterine fibroids and bone density. Author(s): Institute E. Bruzzone, Rheumatological Centre, University of Genoa, Italy. Source: Bianchi, G Costantini, S Anserini, P Rovetta, G Monteforte, P Menada, M V Faga, L De Cecco, L Maturitas. 1989 September; 11(3): 179-85 0378-5122

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Estrogenic action of tamoxifen in women treated with luteinizing hormone-releasing hormone agonists (goserelin)--lack of shrinkage of uterine fibroids. Author(s): Department of Obstetrics and Gynaecology, University of Edinburgh, Scotland. Source: Lumsden, M A West, C P Hillier, H Baird, D T Fertil-Steril. 1989 December; 52(6): 924-9 0015-0282

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Etiology and treatment of uterine fibroids. Author(s): Institute for Information Biology in Corona Del Mar, Calif, USA. Source: Chez, Ronald A Altern-Ther-Health-Med. 2002 Mar-April; 8(2): 32-3 1078-6791

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Experience with leuprorelin acetate depot in the treatment of fibroids: a German multicentre study. Author(s): Universitats-Frauenklinik Munster, Germany. Source: Cirkel, U Ochs, H Schneider, H P Mettler, L Mayer Eichberger, D Schindler, A E Buhler, K Winkler, U Zahradnik, H P Kunzig, H J et al. Clin-Ther. 1992; 14 Suppl A37-50 0149-2918

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Expression of progesterone receptors A and B and insulin-like growth factor-I in human myometrium and fibroids after treatment with a gonadotropin-releasing hormone analogue. Author(s): Division for Reproductive Endocrinology, Department of Woman and Child Health, Karolinska Institutet, Stockholm, Sweden. [email protected] Source: Wu, X Wang, H Englund, K Blanck, A Lindblom, B Sahlin, L Fertil-Steril. 2002 November; 78(5): 985-93 0015-0282

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Facing fibroids. Source: Edmunds, J Midwifery-Today-Childbirth-Educ. 1993 Spring; (25): 35-6 1522-2888

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Fibroids (uterine myomatosis, leiomyomas). Author(s): Cochrane Menstrual Disorders and Subfertility Group, Auckland, New Zealand. Source: Lethaby, A Vollenhoven, B Clin-Evid. 2002 June; (7): 1666-78 1462-3846

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Fibroids: overview of current and future treatment options. Author(s): 1st Institute of Obstetrics and Gynecology, University La Sapienza, Rome, Italy. Source: Benagiano, G Morini, A Primiero, F M Br-J-Obstet-Gynaecol. 1992 February; 99 Suppl 718-22 0306-5456

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Gonadotrophin hormone-releasing hormone analogue treatment of fibroids. Author(s): Department of Obstetrics and Gynaecology, University of Wales College of Medicine, Cardiff, UK. Source: Shaw, R W Baillieres-Clin-Obstet-Gynaecol. 1998 June; 12(2): 245-68 0950-3552

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Goserelin (Zoladex) in the treatment of fibroids. Author(s): Department of Obstetrics and Gynaecology, University of Edinburgh, UK. Source: West, C P Lumsden, M A Baird, D T Br-J-Obstet-Gynaecol. 1992 February; 99 Suppl 727-30 0306-5456

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Goserelin acetate to avoid hysterectomy in pre-menopausal women with fibroids requiring surgery. Author(s): Istituto di Ricerche Farmacologiche, Mario Negri, Milan, Italy. [email protected] Source: Parazzini, F Bortolotti, A Chiantera, V Scollo, P Del Monaco, D Bianchi, M Bennici, S Eur-J-Obstet-Gynecol-Reprod-Biol. 1999 November; 87(1): 31-3 0301-2115

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Influence of exogenous estrogen receptor ligands on uterine leiomyoma: evidence from an in vitro/in vivo animal model for uterine fibroids. Author(s): Department of Carcinogenesis, University of Texas M.D. Anderson Cancer Center, Smithville, Texas, USA. Source: Hunter, D S Hodges, L C Eagon, P K Vonier, P M Fuchs Young, R Bergerson, J S Walker, C L Environ-Health-Perspect. 2000 October; 108 Suppl 5829-34 0091-6765

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LHRH analogues and fibroids--potential for longer-term use. Author(s): Department of Obstetrics and Gyneacology, University of Edinburgh, UK. Source: West, C P Lumsden, M A Baird, D T Horm-Res. 1989; 32 Suppl 1146-9 0301-0163

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LHRH analogues in the management of uterine fibroids, premenstrual syndrome and breast malignancies. Source: West, C P Baillieres-Clin-Obstet-Gynaecol. 1988 September; 2(3): 689-709 09503552

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Long-term follow-up of patients with uterine fibroids after treatment with the LHRH agonist buserelin. Author(s): Royal Free Hospital School of Medicine, London. Source: Matta, W H Shaw, R W Nye, M Br-J-Obstet-Gynaecol. 1989 February; 96(2): 2006 0306-5456

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Management of fibroids. Author(s): Mount Sinai School of Medicine, Mount Sinai Hospital, New York, New York. Source: Altchek, A Curr-Opin-Obstet-Gynecol. 1992 June; 4(3): 463-71 1040-872X

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Management of uterine fibroids. Author(s): Obstetrics and Gynaecology, Queen Elizabeth Hospital, Kings Lynn. Source: al Taher, H Farquharson, R G Br-J-Hosp-Med. 1993 July 14-August 17; 50(2-3): 133-6 0007-1064

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Mechanism of LHRH analogue action in uterine fibroids. Author(s): Academic Department of Obstetrics and Gynaecology, Royal Free Hospital School of Medicine, London, UK. Source: Shaw, R W Horm-Res. 1989; 32 Suppl 1150-3 0301-0163

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Medical management of fibroids. Author(s): Department of Obstetrics and Gynaecology, University of Edinburgh. Source: Baird, D T West, C P Br-Med-J-(Clin-Res-Ed). 1988 June 18; 296(6638): 1684-5 0267-0623

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Medical treatment of uterine fibroids. Author(s): Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. Source: Chavez, N F Stewart, E A Clin-Obstet-Gynecol. 2001 June; 44(2): 372-84 00099201

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Medroxyprogesterone acetate with Zoladex for long-term treatment of fibroids: effects on bone density and patient acceptability. Author(s): Department of Obstetrics and Gynaecology, University of Edinburgh, Centre for Reproductive Biology, UK. Source: Caird, L E West, C P Lumsden, M A Hannan, W J Gow, S M Hum-Reprod. 1997 March; 12(3): 436-40 0268-1161

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Oestrogen deficiency causes DNA damage in uterine leiomyoma cells: a possible mechanism for shrinkage of fibroids by GnRH agonists. Author(s): Department of Obstetrics and Gynaecology, National Cheng Kung University Medical College, Taiwan. Source: Cheng, Y M Chou, C Y Huang, S C Lin, H C BJOG. 2001 January; 108(1): 95-102

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Other medical management of uterine fibroids. Author(s): Monash IVF, Epworth Hospital, Victoria, Australia. Source: Eldar Geva, T Healy, D L Baillieres-Clin-Obstet-Gynaecol. 1998 June; 12(2): 26988 0950-3552

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Pelvic pain complicating LHRH analogue treatment of fibroids. Author(s): Monash University, Department of Obstetrics and Gynaecology, Monash Medical Centre, Melbourne, Clayton, Australia. Source: Chipato, T Healy, D L Vollenhoven, B Buckler, H M Aust-N-Z-J-ObstetGynaecol. 1991 November; 31(4): 383-4 0004-8666

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Peripheral CA 125 levels in patients with uterine fibroids. Author(s): Department of Obstetrics and Gynaecology, University of Geneva, Switzerland. Source: Bischof, P Galfetti, M A Seydoux, J von Hospenthal, J U Campana, A HumReprod. 1992 January; 7(1): 35-8 0268-1161

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Potential role for medroxyprogesterone acetate as an adjunct to goserelin (Zoladex) in the medical management of uterine fibroids. Author(s): Department of Obstetrics and Gynaecology, University of Edinburgh, UK. Source: West, C P Lumsden, M A Hillier, H Sweeting, V Baird, D T Hum-Reprod. 1992 March; 7(3): 328-32 0268-1161

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Presurgical treatment of uterine fibroids by using gonadotropin-releasing hormone agonists. Author(s): Dept. of Obstetrics and Gynecology, University of Brescia, Italy. Source: Falsetti, L Mazzani, M D Rubessa, S Ruggeri, C Acta-Eur-Fertil. 1992 JanFebruary; 23(1): 29-32 0587-2421

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Randomized double-blind study evaluating the efficacy on uterine fibroids shrinkage and on intra-operative blood loss of different length of leuprolide acetate depot treatment before myomectomy. Author(s): Departments of Obstetrics and Gynaecology, University of Modena and Reggio Emilia, Modena, Italy. Source: Jasonni, V M D'Anna, R Mancuso, A Caruso, C Corrado, F Leonardi, I ActaObstet-Gynecol-Scand. 2001 October; 80(10): 956-8 0001-6349

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Role of goserelin-depot in the clinical management of uterine fibroids. Author(s): Department of Obstetrics and Gynecology, University of Cagliari, Italy. Source: Cagnacci, A Paoletti, A M Soldani, R Angiolucci, M Arangino, S Falqui, A Melis, G B Clin-Exp-Obstet-Gynecol. 1994; 21(4): 263-5 0390-6663

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Sarcomas and the conservative management of uterine fibroids: a cause for concern? Author(s): Royal North Shore Hospital, St Leonards, Sydney, New South Wales, Australia. Source: Dover, R W Ferrier, A J Torode, H W Aust-N-Z-J-Obstet-Gynaecol. 2000 August; 40(3): 308-12 0004-8666

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Serum CA 125 concentrations in women with endometriosis or uterine fibroids treated with gonadotrophin-releasing hormone agonist analogues. Author(s): Department of Obstetrics and Gynaecology, Groote Schuur Hospital. Source: van der Spuy, Z M Wood, M Fieggen, G Hendricks, M S S-Afr-Med-J. 1993 July; 83(7): 510-3 0038-2469

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Sex steroid receptors in human myometrium and fibroids: changes during the menstrual cycle and gonadotropin-releasing hormone treatment. Author(s): Department of Clinical Science, Karolinska Institute, Huddinge University Hospital, Sweden. Source: Englund, K Blanck, A Gustavsson, I Lundkvist, U Sjoblom, P Norgren, A Lindblom, B J-Clin-Endocrinol-Metab. 1998 November; 83(11): 4092-6 0021-972X

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Shrinkage of uterine fibroids by preoperative LHRH analogue injection. Author(s): Gynaecological Unit, Ulster Hospital, Dundonald, Belfast. Source: McClelland, H R Quinn, A J Ulster-Med-J. 1992 April; 61(1): 51-5 0041-6193

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Symptom-free interval after triptorelin treatment of uterine fibroids: long-term results. Author(s): Department of Gynaecology, Rijnstate-EG Hospital, Arnhem, The Netherlands. Source: van Leusden, H A Gynecol-Endocrinol. 1992 September; 6(3): 189-98 0951-3590

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The binding of steroids to myometrium and leiomyomata (fibroids) in women treated with the gonadotrophin-releasing hormone agonist Zoladex (ICI 118630). Author(s): Department of Obstetrics and Gynaecology, University of Edinburgh. Source: Lumsden, M A West, C P Hawkins, R A Bramley, T A Rumgay, L Baird, D T JEndocrinol. 1989 May; 121(2): 389-96 0022-0795

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The effect of intramural and subserous uterine fibroids on implantation and clinical pregnancy rates in patients having intracytoplasmic sperm injection. Author(s): Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Hacettepe University School of Medicine, Gaziosmanpasa, Ankara, Turkey. Source: Yarali, H Bukulmez, O Arch-Gynecol-Obstet. 2002 January; 266(1): 30-3 09320067

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The effect of large uterine fibroids on urinary bladder function and symptoms. Author(s): Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel. Source: Langer, R Golan, A Neuman, M Schneider, D Bukovsky, I Caspi, E Am-J-ObstetGynecol. 1990 October; 163(4 Pt 1): 1139-41 0002-9378

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The effects of hormone replacement therapy on uterine fibroids in postmenopausal women. Author(s): Dr. Zekai Tahir Burak Women's Hospital, Menopause Center, Ankara, Turkey. Source: Sener, A B Seckin, N C Ozmen, S Gokmen, O Dogu, N Ekici, E Fertil-Steril. 1996 February; 65(2): 354-7 0015-0282

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The place of GnRH agonists in the treatment of endometriosis and fibroids by advanced endoscopic techniques. Author(s): Department of Gynecology, Catholic University of Louvain, Brussels, Belgium. Source: Donnez, J Nisolle, M Grandjean, P Gillerot, S Clerckx, F Br-J-Obstet-Gynaecol. 1992 February; 99 Suppl 731-3 0306-5456

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The place of Zoladex in deferred surgery for uterine fibroids. Zoladex Myoma Study Group. Author(s): Department of Obstetries Middelheim Clinic, Antwerp, Belgium. Source: Gerris, J Degueldre, M Peters, A A Romao, F Stjernquist, M al Taher, H HormRes. 1996; 45(6): 279-84 0301-0163

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The response of uterine fibroids to GnRH-agonist treatment can be predicted in most cases after one month. Author(s): Department of Obstetrics and Gynecology, Philipps-University, Marburg, FRG. Source: Hackenberg, R Gesenhues, T Deichert, U Duda, V Schmidt Rhode, P Schulz, K D Eur-J-Obstet-Gynecol-Reprod-Biol. 1992 July 3; 45(2): 125-9 0301-2115

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The role of GnRH agonists in the treatment of uterine fibroids. Author(s): Department of Obstetrics and Gynaecology, Monash University, Melborne, Victoria, Australia. Source: Healy, D L Vollenhoven, B J Br-J-Obstet-Gynaecol. 1992 February; 99 Suppl 7236 0306-5456

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The short-term use of luteinising hormone-releasing hormone analogues in uterine fibroids. Author(s): Department of Obstetrics and Gynaecology, University of Cape Town Medical School, Observatory, South Africa. Source: Van der Spuy, Z M Fieggan, A G Wood, M J Pienaar, C A Horm-Res. 1989; 32 Suppl 1137-40 0301-0163

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Treatment of large fibroids with high doses of gestrinone. Author(s): Federal University, Bahia, Brazil. Source: Coutinho, E M Gynecol-Obstet-Invest. 1990; 30(1): 44-7 0378-7346

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Treatment of submucous fibroids, and outcome of assisted conception. Author(s): The Churchill Clinic Fertility and IVF Centre, 80 Lambeth Road, London, SE1 7PW, United Kingdom. Source: Narayan, R Rajat Goswamy, K J-Am-Assoc-Gynecol-Laparosc. 1994 August; 1(4 Pt 1): 307-11 1074-3804

•

Treatment of uterine fibroid with triptorelin before hysterectomy. Author(s): Department of Obstetrics and Gynaecology, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong. Source: Loong, E P Lo, K W Chin-Med-J-(Engl). 1998 January; 111(1): 67-70 0366-6999

•

Use of GnRH depot analogue in the treatment of uterine fibroids. Author(s): Department of Obstetrics and Gynecology, University of Trieste, Italy. Source: Auber, G Ricci, G Barciulli, F Pregazzi, R D'Ancona, R L Toffoletti, F G Acta-EurFertil. 1990 Jul-August; 21(4): 185-9 0587-2421

•

Uterine fibroids: protocols of integrated medical/surgical treatment. Author(s): Gynaecology and Obstetrics Dept I, II Faculty of Medicine and Surgery, Federico II University, Naples, Italy.

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Source: Montemagno, U De Placido, G Colacurci, N Zullo, F Locci, M Clin-Exp-ObstetGynecol. 1993; 20(3): 167-72 0390-6663 •

Vaginal expulsion of submucosal fibroids after uterine artery embolization. A report of three cases. Author(s): Philadelphia Fibroid Center, Pennsylvania 19004, USA. Source: Berkowitz, R P Hutchins, F L Worthington Kirsch, R L J-Reprod-Med. 1999 April; 44(4): 373-6 0024-7758

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

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

•

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/

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

•

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

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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/

Nutrition

•

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

•

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

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The following is a specific Web list relating to fibroids; 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: •

Food and Diet Weight Loss and Obesity Source: Healthnotes, Inc.; www.healthnotes.com

45

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

38 cases of hysteromyoma treated with tumor-resolving decoction. Author(s): Sun L. Source: J Tradit Chin Med. 1995 December; 15(4): 273-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8709608&dopt=Abstract

•

A national survey of the complications of endometrial destruction for menstrual disorders: the MISTLETOE study. Minimally Invasive Surgical Techniques--Laser, EndoThermal or Endorescetion. Author(s): Overton C, Hargreaves J, Maresh M. Source: British Journal of Obstetrics and Gynaecology. 1997 December; 104(12): 1351-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9422012&dopt=Abstract

•

A review of recent research studies on the efficacy of Esogetic Colorpuncture Therapy--A wholistic acu-light system. Author(s): Croke M, Bourne RD.

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Source: Am J Acupunct. 1999; 27(1-2): 85-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10513101&dopt=Abstract •

Alkaline phosphatase from human uterine myoma. I. Purification and some properties. Author(s): Purzyc L, Otrebski E, Goluda M, Kwiatkowska J. Source: Neoplasma. 1984; 31(3): 307-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6429557&dopt=Abstract

•

An image-guided high intensity focused ultrasound device for uterine fibroids treatment. Author(s): Chan AH, Fujimoto VY, Moore DE, Martin RW, Vaezy S. Source: Medical Physics. 2002 November; 29(11): 2611-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12462728&dopt=Abstract

•

An in vivo/in vitro model to assess endocrine disrupting activity of xenoestrogens in uterine leiomyoma. Author(s): Hodges LC, Hunter DS, Bergerson JS, Fuchs-Young R, Walker CL. Source: Annals of the New York Academy of Sciences. 2001 December; 948: 100-11. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11795388&dopt=Abstract

•

Anesthesia for a Jehovah's Witness with a low hematocrit. Author(s): Lorhan PH, Burch J. Source: Anesthesiology. 1968 July-August; 29(4): 847-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5662920&dopt=Abstract

•

Complementary and alternative medicine (CAM) in reproductive-age women: a review of randomized controlled trials. Author(s): Fugh-Berman A, Kronenberg F. Source: Reproductive Toxicology (Elmsford, N.Y.). 2003 March-April; 17(2): 137-52. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12642146&dopt=Abstract

•

Complementary medicine treatment of uterine fibroids: a pilot study. Author(s): Mehl-Madrona L. Source: Alternative Therapies in Health and Medicine. 2002 March-April; 8(2): 34-6, 3840, 42, 44-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11890384&dopt=Abstract

•

Conservative management for perimenopausal women with uterine leiomyomas using Chinese herbal medicines and synthetic analogs of gonadotropin-releasing hormone.

Alternative Medicine 47

Author(s): Sakamoto S, Mitamura T, Iwasawa M, Kitsunai H, Shindou K, Yagishita Y, Zhou YF, Sassa S. Source: In Vivo. 1998 May-June; 12(3): 333-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9706480&dopt=Abstract •

Diagnosis and surgical treatment of esophageal leiomyoma. Author(s): Wang Y, Zhang R, Ouyang Z, Zhang D, Wang L, Zhang D. Source: Zhonghua Zhong Liu Za Zhi. 2002 July; 24(4): 394-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12408774&dopt=Abstract

•

Effect of the frequency of transcutaneous electrical nerve stimulation on the postoperative opioid analgesic requirement and recovery profile. Author(s): Hamza MA, White PF, Ahmed HE, Ghoname EA. Source: Anesthesiology. 1999 November; 91(5): 1232-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10551571&dopt=Abstract

•

Effective treatment of a patient with a high-grade endometrial stromal sarcoma with an accelerated regimen of carboplatin and paclitaxel. Author(s): Szlosarek PW, Lofts FJ, Pettengell R, Carter P, Young M, Harmer C. Source: Anti-Cancer Drugs. 2000 April; 11(4): 275-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10898543&dopt=Abstract

•

Effects of herbal medicines on menopausal symptoms induced by gonadotropinreleasing hormone agonist therapy. Author(s): Tanaka T. Source: Clin Exp Obstet Gynecol. 2001; 28(1): 20-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11332582&dopt=Abstract

•

Efficacy of ipriflavone in preventing adverse effects of leuprolide. Author(s): Somekawa Y, Chiguchi M, Ishibashi T, Wakana K, Aso T. Source: The Journal of Clinical Endocrinology and Metabolism. 2001 July; 86(7): 3202-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11443189&dopt=Abstract

•

Electron microscopic observations of the effects of gossypol on the human endometrium. Author(s): Zu PD, Sun YT, Cheng J, Tian L, Dang MY, Han ML. Source: American Journal of Obstetrics and Gynecology. 1984 August 1; 149(7): 780-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6465231&dopt=Abstract

•

Estrogen receptor activation via activation function 2 predicts agonism of xenoestrogens in normal and neoplastic cells of the uterine myometrium. Author(s): Hunter DS, Hodges LC, Vonier PM, Fuchs-Young R, Gottardis MM, Walker CL.

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Source: Cancer Research. 1999 July 1; 59(13): 3090-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10397250&dopt=Abstract •

Ethnobotanical literature survey of medicinal plants in the Dominican Republic used for women's health conditions. Author(s): Ososki AL, Lohr P, Reiff M, Balick MJ, Kronenberg F, Fugh-Berman A, O'Connor B. Source: Journal of Ethnopharmacology. 2002 March; 79(3): 285-98. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11849831&dopt=Abstract

•

Etiology and treatment of uterine fibroids. Author(s): Chez RA. Source: Alternative Therapies in Health and Medicine. 2002 March-April; 8(2): 32-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11890383&dopt=Abstract

•

Influence of exogenous estrogen receptor ligands on uterine leiomyoma: evidence from an in vitro/in vivo animal model for uterine fibroids. Author(s): Hunter DS, Hodges LC, Eagon PK, Vonier PM, Fuchs-Young R, Bergerson JS, Walker CL. Source: Environmental Health Perspectives. 2000 October; 108 Suppl 5: 829-34. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11035990&dopt=Abstract

•

Other medical management of uterine fibroids. Author(s): Eldar-Geva T, Healy DL. Source: Baillieres Clin Obstet Gynaecol. 1998 June; 12(2): 269-88. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10023422&dopt=Abstract

•

Uterine fibroids and adenomyosis in a woman with Rokitansky-Kuster-Hauser syndrome. Author(s): Yan CM, Mok KM. Source: Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology. 2002 September; 22(5): 561-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12521437&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/

•

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

•

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

Alternative Medicine 49

•

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

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

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

•

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

•

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

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

•

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

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

•

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

•

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

The following is a specific Web list relating to fibroids; 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 Dysmenorrhea Source: Integrative Medicine Communications; www.drkoop.com Dysmenorrhea Alternative names: Painful Menstruation Source: Prima Communications, Inc.www.personalhealthzone.com Menstrual Pain Source: Integrative Medicine Communications; www.drkoop.com

•

Alternative Therapy Color Therapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,683,00.html

•

Herbs and Supplements Blue Flag Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Shephard's Purse Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca

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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.

51

CHAPTER 4. DISSERTATIONS ON FIBROIDS Overview In this chapter, we will give you a bibliography on recent dissertations relating to fibroids. 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 “fibroids” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on fibroids, we have not necessarily excluded non-medical dissertations in this bibliography.

Dissertations on Fibroids 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 fibroids. 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: •

An Examination of the Association between Uterine Leiomyomas (Fibroids) and Heavy Menstrual Bleeding by Wegienka, Ganesa Rebecca; PhD from The University of North Carolina at Chapel Hill, 2002, 52 pages http://wwwlib.umi.com/dissertations/fullcit/3061736

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 FIBROIDS Overview In this chapter, we will show you how to keep informed of the latest clinical trials concerning fibroids.

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

Treatment of Uterine Fibroids with CDB-2914, an Progesterone Receptor Antagonist

Experimental Selective

Condition(s): Leiomyoma Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Child Health and Human Development (NICHD) Purpose - Excerpt: This study will evaluate the selective progesterone receptor modulator CDB-2914 for treating uterine fibroids in pre-menopausal women. It will compare fibroid size, hormone levels and symptoms in women who take CDB-2914 with that of women who take a placebo (an inactive substance). The study will also evaluate the endocrine effects of chronic daily administration of CDB-2914, including possible effects on the menstrual cycle and on adrenal gland function. Pre-menopausal women between 33 and 50 years of age who have predictable menstrual cycles of normal length and uterine fibroids of at least 2 cm in size may be eligible for this study. Only women who need and want hysterectomy for treatment of fibroids will be enrolled. Candidates will be screened with a medical history and physical examination, including a breast and pelvic examination, blood and urine tests, and completion of a questionnaire about quality of life. They will be taught to use a kit to test their urine for LH, a hormone produced in large amounts just before ovulation, and will be given a calendar to record the LH surge, as well as any spotting, bleeding, or other symptoms. The study will take place over four menstrual cycles, after which hysterectomy will be performed. Participants will undergo the following procedures: - First (pre-treatment) cycle: 8

These are listed at www.ClinicalTrials.gov.

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Participants will undergo magnetic resonance imaging (MRI) and a special ultrasound test called saline hysterosonogram. MRI uses radio waves and a magnetic field to image body tissues. The subject lies in a narrow metal cylinder (the scanner) for about an hour during the imaging. A contrast material is injected into a vein to brighten the images. The saline hysterosonogram involves placing a speculum in the vagina, as if for a Pap test, and then putting a very small amount of liquid inside the uterus, using a small plastic tube. An ultrasound examination is then done by inserting a probe into the vagina. The probe emits and receives sound waves that are used to form a picture of the internal structures. - Second through fourth menstrual cycles - Participants will have a pregnancy test on the first or second day of each cycle. Those who are not pregnant will take CDB-2914 once a day for three menstrual cycles, or up to 102 days if the cycles are irregular. At specific times during the cycles, subject will have blood tests to measure the effect of CDB-2914 on hormones, blood count, blood chemistries, and liver function, and ultrasound tests to check the number and size of follicles in the ovaries. They will test their urine to detect the LH surge and will have additional hormone blood tests. At three times during the study-during the first, second and third menstrual cycles-subjects will bring a 24-hour urine collection to the clinic for measurements of cortisol and adrenal gland function. A transvaginal ultrasound study will be repeated after 4 to 6 weeks of treatment to check fibroid growth. A repeat saline hysterosonogram and MRI will be done within 2 weeks of surgery to count the number of fibroids and measure their size. Women who have completed the study to the end of the four menstrual cycles and still require hysterectomy will stop taking CDB-2914. They will complete another quality of life questionnaire. Their blood levels of CDB-2914 will be measured, and they will have a hysterectomy, in which the uterus, and possibly the ovaries, will be removed. Subjects will be discharged from the hospital 2 to 4 days after surgery and will return to the clinic for post-operative evaluation after 4 to 6 weeks. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00044876

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 “fibroids” (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:

Clinical Trials 55

•

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

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

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

•

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

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

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

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

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

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

•

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

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

•

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 FIBROIDS 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 “fibroids” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on fibroids, we have not necessarily excluded non-medical patents in this bibliography.

Patents on Fibroids By performing a patent search focusing on fibroids, 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 fibroids: •

Cloning and expression of dog gonadotropin releasing hormone receptor Inventor(s): Cui; Jisong (Scotch Plains, NJ), Lo; Jane-Ling (North Brunswick, NJ), Mount; George R. (Morrisville, PA) Assignee(s): Merck & Co., Inc. (Rahway, NJ) Patent Number: 6,407,222 Date filed: May 31, 2000 Abstract: The dog GnRH receptor has been isolated, cloned and sequenced. The dog GnRH receptor may be used to screen and identify compounds which bind to the GnRH receptor. Such identified compounds may be used in the treatment of sex hormone related conditions such as endometriosis, uterine fibroids, polycystic ovarian disease, hirsutism, precocious puberty, gonadal steroid-dependent neoplasias such as cancers of the prostate, breast and ovary, gonadotrophe pituitary adenomas, sleep apnea, irritable bowel syndrome, premenstrual syndrome and benign prostatic hypertrophy. The receptor proteins and polypeptides, nucleic acids, cells and assays of this invention are useful in drug screening and development, diagnosis and therapeutic applications. Excerpt(s): This invention relates to the cloning and isolation of the dog gonadotropinreleasing hormone (GnRH) receptor, and also to mutant or polymorphic forms of the receptor and recombinant nucleic acids encoding the same. The invention also relates to genetically engineered host cells which express the receptor, antibodies against the receptor and polypeptides thereof. The invention also relates to uses of the receptor, recombinant nucleic acids and recombinant host cells in drug screening and development, diagnosis and therapeutic applications. Gonadotropin-releasing hormone (GnRH) plays a pivotal role in the control of reproduction. It is a neuronal decapeptide hormone released from hypothalamus in a pulsatile manner. GnRH interacts with its receptor on the gonadotropes in the anterior pituitary and which, in turn, activates phospholipase C (PLC) via a pertussis toxin-insensitive G protein, Gq/G11. Two second messengers, inositol trisphosphate (IP3) and diacylglycerol (DG), are formed from the hydrolysis of phosphoinositide bisphosphate by PLC. IP3 and DG then act either separately or in concert, via increase of intracellular Ca.sup.2+ and activation of protein kinase C, to regulate the synthesis and release of both luteinizing hormone (LH) and follicle stimulating hormone (FSH). LH released from the pituitary gland is primarily responsible for the regulation of gonadal steroid production in both sexes, whereas FSH regulates spermatogenesis in males and follicle development in females. The GnRH receptor (GnRH-R) is mainly expressed in the pituitary gland. It was also detected in extrapituitary tissues such as brain, breast, gonads, and ovarian tumors. The GnRH receptor has been cloned and sequenced from several mammalian species including human, ovine, bovine, pig, rat, and mouse. The cloning and expression of the murine and human receptors has recently been described in U.S. Pat. No. 5,750,366. The GnRH receptor from bovine, cow, sheep, and human contains 328 amino acids, while the rodent receptor has 327 amino acids, due to a deletion of a residue in the second extracellular domain. Analysis of the primary sequence identifies the GnRH receptor as a member of the G protein-coupled receptor (GPCR) family with seven transmembrane (TM) domains. However, the mammalian GnRH receptors have several unique structural features compared with other GPCRs. These include (1) the lack of the entire intracellular C-terminal tail; (2) the replacement of Tyr by Ser in the conserved G protein

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signature DRY motif of the proximal second intracellular domain; and (3) the reciprocal exchange of two amino acids, Asp in TM II and Asn in TM VII, that are highly conserved in most other GPCRs. In addition to pituitary gland, the expression of GnRH receptor message has also been demonstrated in extrapituitary tissues such as brain, breast, gonads, and ovarian tumors. The receptor sequences obtained from extrapituitary sources were identical to the corresponding pituitary GnRH receptor cDNAs. Web site: http://www.delphion.com/details?pn=US06407222__ •

Compositions and methods for the non-invasive treatment of uterine fibroid cells Inventor(s): Copland; John Alton (747 Cambridge, #71, Houston, TX 77054), Young; Steven L. (4817 Woodrow Ave., Galveston, TX 77551) Assignee(s): none reported Patent Number: 6,537,566 Date filed: March 8, 2000 Abstract: The proliferation of uterine fibroid leiomyoma cells is inhibited by certain Fibroid Cell Growth Inhibitor (FGI) agents. The pharmacological doses of these FGI agents in the milieu of uterine fibroid cells can be made high enough to not only inhibit proliferation, but to also causes cell death. Non-invasive or minimally invasive, nonsystemic delivery methods are used to deliver the FGI agent to the milieu of the target fibroid leiomyoma cell population, thereby avoiding the disadvantages and side effects of surgical and systemic hormonal therapy interventions in the treatment of uterine fibroids. The FGI agents are substrates that are normally present or are well tolerated in the human body. The efficacy of the FGI agents appears to be related to their ability to moderate the Protein Kinase C and Mitogen Activated Protein Kinase pathways. Specific FGI agents shown to be useful to inhibit growth or proliferation of uterine fibroid cells include:.alpha.-tocopherol,.alpha.-tocopherol succinate, and troglitazone. Delivery of the FGI agents to the milieu of the target uterine fibroid cells may be accomplished by intra-vaginal and in situ injection techniques already known in the art. Excerpt(s): The present invention is in the field of bio-effecting compositions and methods. More specifically, the present invention relates to compositions and methods of using the compositions to inhibit the growth of uterine fibroid cells. Uterine fibroids (leiomyomata) are "benign" tumors of the uterus, which occur in about 20 percent of women of reproductive age. Uterine fibroids are one of the most common tumors. Complications arising from uterine fibroids account for about 30% of all hysterectomies performed in the U.S., with a resulting direct cost of inpatient care of about $1 billion per year. Despite this enormous impact on women's health, the factors causing formation and growth of these benign tumors remain largely enigmatic. A uterine fibroid (leiomyomata) consists of a mass or population of smooth muscle cells and connective tissue that grows, usually slowly, within the uterine wall. Epidemiologic studies demonstrate that fibroids initially form after menarche. It is suspected that fibroid growth is due to a monoclonal, deregulated proliferation of uterine smooth muscle myometrial cells. The primary tumor cell type resulting from the growth of the fibroid are derived from myometrial cells and are referred to herein as leiomyoma cells. Uterine fibroid leiomyoma cells tend to proliferate during pregnancy and regress in menopause. Studies have clearly implicated gonadal steroids (estrogen and progesterone) as a likely factor in formation and growth of these benign tumors. This

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has motivated the search for therapies aiming at suppressing endogenous gonadal steroid production. Web site: http://www.delphion.com/details?pn=US06537566__ •

Cyclic peptide LHRH antagonists Inventor(s): Haviv; Fortuna (Deerfield, IL), Sauer; Daryl R. (Gurnee, IL) Assignee(s): Tap Holdings Inc. (Deerfield, IL) Patent Number: 5,508,383 Date filed: March 9, 1994 Abstract: A class of cyclic peptides are effective inhibitors of LHRH and are useful in the treatment of disease conditions which are mediated by sex hormones including prostate cancer, endometriosis, uterine fibroids, and precocious puberty. Excerpt(s): The present invention relates to organic compounds having biological activity, to compositions containing those compounds, and to a method for their use. More particularly, the present invention concerns a class of cyclic peptides which are antagonists of LHRH, to pharmaceutical compositions containing those cyclic peptides, and to a method of treatment employing the compounds and compositions. The gonadotropins: follicle stimulating hormone (FSH), luteinizing hormone (LH), and chorionic gonadotropin (CG), are required for ovulation, spermatogenesis, and the biosynthesis of sex steroids. A single hypothalamic hormone, gonadotropin-releasing hormone (GnRH, also known as luteinizing hormone-releasing hormone, (LHRH) is responsible for regulating the secretion of both FSH and LH in mammals. Early attempts to prepare peptides having LHRH-like activity centered on the synthesis of compounds which were LHRH agonists. However, in 1976 it was found that while individual does of LHRH stimulated the release of gonadotropins, the continuous administration of small doses of LHRH or chronic administration of LHRH agonists had the opposite effect. This finding stimulated research for the discovery of both agonist and antagonist analogs of LHRH as agents useful for regulating sex steroids in mammals. A considerable number of patents and articles in the open literature disclose analogs of LHRH which either act as agonists of LHRH (i.e. act to stimulate the release of LH and FSH) or as antagonists of LHRH (i.e. act to inhibit the release of LH and FSH). For the most part, these compounds contain nine or ten aminoacyl residues, substituting naturally-occurring or non-naturally-occurring amino acid residues at one or more positions in the natural sequence of LHRH. In some cases, active antagonists of LHRH have been reported which contain fewer than ten amino acid residues. The literature has reported that LHRH antagonists are useful for the treatment of a variety of conditions in which the suppression of sex steroids plays a key role including contraception, delay of puberty, treatment of benign prostatic hyperplasia, palliative treatment or remission of hormonal-dependent tumors of the breast and ovaries, palliative treatment or remission of hormonal-dependent tumors of the prostate, the treatment of cryptoorchidism, hirsutism in women, gastric motility disorders, dysmenorrhea, and endometriosis. Web site: http://www.delphion.com/details?pn=US05508383__

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Gynecologic embolotherapy methods Inventor(s): Greff; Richard J. (St. Pete Beach, FL) Assignee(s): Micro Therapeutics, Inc. (Irvine, CA) Patent Number: 6,059,766 Date filed: February 27, 1998 Abstract: This invention is directed to novel methods for gynecologic embolotherapy. The methods directly access the blood vessels to be embolized transcervically rather than arterially. The methods provide precise directed delivery of embolizing compositions, and are particularly suited for treating uterine fibroids. Kits containing one or more devices for transcervical injection and an embolizing composition are also provided. In a preferred embodiment, fluid embolizing compositions are used. In a more preferred embodiment, these fluid embolic compositions comprise a biocompatible polymer, a biocompatible solvent and a biocompatible water insoluble contrast agent. In a most preferred embodiment, the contrast agent is characterized by having an average particle size of about 10.mu.m or less. Excerpt(s): This invention is directed to novel methods for gynecologic embolotherapy. The methods of this invention specifically access the blood vessels to be embolized transcervically rather than arterially. The methods provide precise directed delivery of embolizing compositions, and are particularly suited for treating uterine fibroids. Kits containing one or more devices for transcervical injection and an embolizing composition are also provided. In a preferred embodiment, fluid embolizing compositions are used. In a more preferred embodiment, these fluid embolic compositions comprise a biocompatible polymer, a biocompatible solvent and a biocompatible water insoluble contrast agent. In a most preferred embodiment, the contrast agent is characterized by having an average particle size of about 10.mu.m or less.sup.9 Evans, et al., U.S. patent application Ser. No. 08/802,252 for "Novel Compositions for Use in Embolizing Blood Vessels", filed Feb. 19, 1997. Web site: http://www.delphion.com/details?pn=US06059766__

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Methods for occlusion of the uterine arteries Inventor(s): Burbank; Fred (San Juan Capistrano, CA), Jones; Michael (Capistrano Beach, CA), Lubock; Paul (Laguna Niguel, CA) Assignee(s): HysteRx, Inc. (San Juan Capistrano, CA) Patent Number: 6,254,601 Date filed: December 8, 1998 Abstract: Devices and methods are disclosed for treating a uterine disorder which receive its blood supply from a uterine artery. In particular, uterine fibroids are effectively treated by occluding the uterine arteries using trans-vaginal, trans-uterine, transrectal, or retroperitoneal approaches. The devices and methods are advantageous because the inventive procedures may be performed by a patient's gynecologist in the course of treatment, avoiding the need for referrals to specialist practitioners and for more radical treatments, such as hysterectomies. The methods include both temporary and permanent occlusion of the arteries. A cannula carries an imaging device and a member which will easily penetrate tissue, the member including a device which partially or completely, and temporarily or permanently, occludes a uterine artery.

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Excerpt(s): The present invention relates generally to the treatment of disorders which receive blood flow from the uterine arteries, and more particularly to devices and methods for occlusion of the uterine arteries. Hysterectomy (surgical removal of the uterus) is performed on approximately 600,000 women annually in the United States. For approximately 340,000 women, hysterectomy is probably the best current therapeutic choice for the treatment of their diseases (uterine cancer, endometriosis, menorrhagia, and prolapse). For approximately 60,000 women with dysfunctional uterine bleeding (abnormal menstrual bleeding that has no discrete anatomic explanation such as a tumor or growth), newer endometrial ablation techniques may be an alternative to hysterectomy. For approximately 200,000 women with benign but symptomatic (excessive bleeding, pain, and "bulk" sensations) muscular tumors of the uterus, known as leiomyoma or fibroids, newer treatment methods have been developed which may spare these women a hysterectomy, as well. Hysterectomy for treating uterine fibroid disorders, though effective, has many undesirable characteristics. Thus, any method which can approximate the therapeutic result of a hysterectomy without removing the uterus (and commonly the ovaries since they are closely adjacent to the uterus) would be a significant improvement in this field. Web site: http://www.delphion.com/details?pn=US06254601__ •

Needle myolysis system for uterine fibriods Inventor(s): Savage; George M. (Portola Valley, CA), Webber; Margaret (Los Altos, CA) Assignee(s): FemRx, Inc. (Sunnyvale, CA) Patent Number: 5,979,453 Date filed: November 6, 1996 Abstract: The present invention provides electrosurgical needles, needle systems, and methods for their use which will allow the surgeon to target a tumor's blood supply. Generally, the invention facilities targeting the bloodflow of the tumor by incorporating a doppler ultrasound transducer into the needle or needle sheath. Preferably, the surgeon will also be able to control the temperature of the needle using an integral temperature sensor to effect maximum transfer of the RF energy into the tissue, thereby maximizing the volume of tissue destroyed. Furthermore, when used (for example) in the treatment of uterine fibroids, the present invention will reduce damage to the serosa by monitoring the uterine surface temperature during myolysis through a temperature sensor integrated into the sheath holding the myolysis needle. Excerpt(s): Benign leiomyomata (uterine fibroids) are common tumors which affect more than 25% of all women at some time during the reproductive years. Many women wish to have fibroid-related symptoms such as bleeding and pain treated without resort to hysterectomy. Pharmacologic therapy alone is of limited utility due to side-effects associated with long-term use. Hysteroscopic resection using the loop or vaporizing resectoscope is appropriate for those tumors which protrude into the uterine cavity--so called submucous myomas. Surgical myomectormy (removal of the fibroid) is often used for tumors which are thought to be the cause of infertility. However, this approach usually requires a laparotomy and is often associated with adhesion formation between the uterus, bowel and other adjacent structures. These adhesions can be the cause of chronic pain in some patients. Needle myolysis is a promising technique whereby a laparoscope is used to introduce one or more needles into a fibroid tumor under visual control. Bipolar Radio Frequency ("RF") current is then delivered between two adjacent needles, or unipolar current between a single needle and a distant dispersive electrode

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affixed to the thigh or back. The aim of needle myolysis is to coagulate a significant volume of the tumor and thereby cause it to shrink substantially. The traditional technique is to make multiple passes through different areas of the tumor using the coagulating needle to destroy many cylindrical cores of abnormal tissue. However, the desirability of multiple passes is mitigated by the risk of adhesion formation, which is thought to increase with increasing amounts of injured uterine serosa, and by the operative time and skill required. Recently, Goldrath and others have demonstrated that tumor shrinkage can be preferentially induced by destroying the tumor's blood supply, which is generally located on the periphery, rather than by targeting the bulk of the fibroid. Physicians acting on this observation use the needles to ring the tumor with cores of coagulation. This technique still calls for multiple tumor passes and, in the end, the operator remains uncertain as to the status of the tumor's blood supply. Web site: http://www.delphion.com/details?pn=US05979453__ •

Textured surface polypropylene film Inventor(s): Carley; Emilie L. (Hartford, NY), Eustance; John W. (So. Glens Falls, NY), Hobbs; Stanley Y. (Scotia, NY) Assignee(s): General Electric Company (Hudson Falls, NY) Patent Number: 4,287,249 Date filed: April 16, 1979 Abstract: A thin polypropylene film with improved surface impregnation properties for dielectric fluids is disclosed. The film has one predetermined textured surface consisting essentially of fibroids intertwined and overlapping, and coextensive and uniform over its continuous length and is characterized by a space factor of above about 5%. Excerpt(s): This invention relates to a synthetic resin polypropylene film and more particularly to a textured surface polypropylene film defined as a film having a uniformly irregular or raised relief surface whose irregularities are in a predetermined form or pattern and with a predetermined degree of relief. Polypropylene film has found widespread use as the dielectric medium in dielectric liquid impregnated electrical capacitors. In the production of one such capacitor as illustrated in U.S. Pat. No. 3,363,156, very thin polypropylene strips are interleaved with aluminum foil strips and the composite wound into a tight roll form. The roll is placed in a suitable housing and impregnated with a dielectric liquid impregnant. Alternatively the aluminum foil strips may be replaced with metal coatings formed on appropriate dielectric strips, often referred to as metalized capacitors. Polypropylene film, as produced by the well known blown tube and draft and tentering processes, usually has very smooth blocky surfaces which tend to cling very tightly to each other or to other adjacent surfaces. This creates a problem in attempting to impregnate the film when incorporated in a tightly wound capacitor roll. It is particularly difficult to cause the impregnant, such as an oil, to completely permeate the capacitor roll particularly into the interfaces of polypropylene strips and polypropylene and foil strips. For this reason many prior art attempts have been made to expedite impregnation of capacitor rolls by roughening the adjacent film strips, foils, etc. whether by etching, embossing, abrading, or forming processes. The result of these processes have not been entirely satisfactory for a number of reasons. Particularly, many of these roughening processes tend to affect the physical strength of the film as well as its dielectric strength. Also forming processes which increase the overall thickness of film, such as corrugation and embossing, increase the overall thickness of the roll and therefore make the final roll excessively large. The blown tube

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process has been noted to produce film having surface areas which are slightly roughened. However, the roughness was non uniform and sporadic, and not subject to predetermination in the film making process. Web site: http://www.delphion.com/details?pn=US04287249__ •

Uterine fibroid treatment Inventor(s): Ahmed; Asif Syed (Birmingham, GB) Assignee(s): The University of Birmingham (Birmingham, GB) Patent Number: 5,981,470 Date filed: February 19, 1997 Abstract: The use of a) an angiotensin-converting enzyme (ACE) inhibitor such as Captopril or Enalapril, b) an angiotensin II-receptor antagonist such as Saralasin or Losartan, or c) a renin inhibitor, such as Remikiren or [N-(pyridyl-3-propionyl)phenylalanyl-histidyl-(3S,4S) ACHPA-isoleucylamino]-2-methyl-2-dihydroxy-1,3propane, for the manufacture of a medicament for the treatment of uterine fibroids is disclosed. The ACE inhibitor may be used concomitantly or sequentially with a gonadotropin-releasing hormone agonist such as Buserelin or Goserelin. Excerpt(s): This invention relates to uterine fibroid treatment. Cellular proliferation and differentiation in uterine tissue is considered to be regulated by ovarian steroids as fibroids appear in the reproductive years and regress after the menopause. Uterine fibroids are most commonly treated by surgery, usually by full or partial hysterectomy, although removal of individual fibroids (myomectomy) is also undertaken at rather greater risk on women who have not completed child bearing. As far as medical treatment is concerned, agonist analogues of LHRH (luteinizing hormone-releasing hormone) such as Buserilin (GnRH analogue) have been employed to suppress oestrogen-progesterone as fibroids are ovarian steroid dependent. Such medical treatments, however, suffer from a variety of side effects such as predisposition to osteopetrosis and are not recommended for long term use. It is an object of the present invention to provide an alternative medical treatment for uterine fibroids which, it is believed, may have potential for use in situations where the above-mentioned medical treatments are inadvisable. Web site: http://www.delphion.com/details?pn=US05981470__

Patent Applications on Fibroids 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 fibroids:

10

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

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21-SUBSTITUTED PROGESTERONE ANTIPROGESTATIONAL AGENTS

DERIVATIVES

AS

NEW

Inventor(s): ACOSTA, CARMIE K.; (SAN ANTONIO, TX), BLYE, RICHARD P.; (HIGHLAND, MD), CESSAC, JAMES W.; (SAN ANTONIO, TX), KIM, HYUN K.; (BETHESDA, MD), RAO, PEMMARAJU N.; (SAN ANTONIO, TX) Correspondence: Eugenia Garrett Wackowski; Townsend And Townsend And Crew; Two Embarcadero Center; 8th Floor; San Francisco; CA; 94111 Patent Application Number: 20020025951 Date filed: May 24, 1999 Abstract: A compound having the general formula: 1in which: R.sup.1 is a member selected from the group consisting of --OCH.sub.3, --SCH.sub.3, --N(CH.sub.3).sub.2,-NHCH.sub.3, --CHO, --COCH.sub.3 and --CHOHCH.sub.3; R.sup.2 is a member selected from the group consisting of halogen, alkyl, acyl, hydroxy, alkoxy, acyloxy, alkyl carbonate, cypionyloxy, S-alkyl and S-acyl; R.sup.3 is a member selected from the group consisting of alkyl, hydroxy, alkoxy and acyloxy; R.sup.4 is a member selected from the group consisting of hydrogen and alkyl; and X is a member selected from the group consisting of.sub.dbd.O and.sub.dbd.N--OR.sup.5 , wherein R.sup.5 is a member selected from the group consisting of hydrogen and alkyl.In addition to providing the compounds of Formula I, the present invention provides methods wherein the compounds of Formula I are advantageously used, inter alia, to antagonize endogenous progesterone; to induce menses; to treat endometriosis; to treat dysmenorrhea; to treat endocrine hormone-dependent tumors; to treat uterine fibroids; to inhibit uterine endometrial proliferation; to induce labor; and for contraception. Excerpt(s): The present invention relates generally to the field of steroids and, in particular, to new 11.beta.-substituted-21-substituted-19-nor-pro- gesterone analogs which possess potent antiprogestational activity with minimal antiglucocorticoid activity. There have been numerous attempts over the past few decades to prepare steroids with antihormonal activity. These have been reasonably successful where antiestrogens and anti-androgens are concerned. However, the discovery of effective antiprogestational and antiglucocorticoid steroids has proved to be a formidable task for the steroid chemist. It has been generally recognized for some years, however, that antiprogestational steroids would find wide applicability in population control, while antiglucocorticoids would be extremely valuable in the treatment of, for example, Cushing's syndrome and other conditions characterized by excessive endogenous production of cortisone. In the last decade, largely through the efforts of Teutsch, et al. of the Roussel-Uclaf group in France, a new series of 19-nortestosterone derivatives has been synthesized with strong affinity for the progesterone and glucocorticoid receptors and with marked antiprogestational and antiglucocorticoid activity in vivo. This important discovery revealed the existence of a pocket in the progesterone/glucocorticoid receptors that is able to accommodate a large 11.beta.substituent on selected 19-nortestosterone derivatives. By suitable selection of such a substituent, steroids with antihormonal properties were obtained. The pioneering studies of Teutsch, et al. on the synthesis of antiprogestational and antiglucocorticoid steroids is summarized in a recent review article (G. Teutsch in Adrenal Steroid Antagonism. Ed. M. K. Agarwal, Walter de Gruyter and Co., Berlin, 1984. pp. 43-75) describing the work leading to the discovery of RU-38,486, the first steroid of this type selected for clinical development. RU-38,486 or mifepristone was found to be an effective antiprogestational/contragestat- ive agent when administered during the early stages of pregnancy (IPPF Medical Bulletin 20; No. 5, 1986). In addition to these

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antiprogestational properties, mifepristone has very significant antiglucocorticoid activity and was successfully used by Nieman, et al. (J. Clin. Endocrinology Metab. 61:536, 1985) in the treatment of Cushing's syndrome. In common with the vast majority of steroidal hormone analogs, mifepristone additionally exhibits a range of biological properties. Thus, for example, it exhibits growth-inhibitory properties towards estrogeninsensitive T47Dco human breast cancer cells (Horwitz, Endocrinology 116:2236, 1985). Experimental evidence suggests that the metabolic products derived from mifepristone contribute to its antiprogestational and antiglucocorticoid properties (Heikinheimo, et al., J. Steroid Biochem. 26:279, 1987). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Adenovirus-mediated therapy for uterine fibroids Inventor(s): Al-Hendy, Ayman; (Houston, TX), Jameson, J. Larry; (Winnetka, IL), Lee, Eun Jig; (Northbrook, IL) Correspondence: Fulbright & Jaworski L.L.P.; 600 Congress AVE.; Suite 2400; Austin; TX; 78701; US Patent Application Number: 20030199472 Date filed: March 19, 2003 Abstract: The present invention provides methods of treating and preventing uterine fibroids that is non-surgical, using a modified estrogen receptor gene delivered via an adenoviral vector. The modified estrogen receptor induced apoptosis in vitro and decreased tumor growth in vivo. The invention provides a major improvement above that of current available procedures for women having uterine fibroids, or in preventing fibroids in women at risk of having fibroids. The present invention further provides a safe means of treating fibroids and preserving fertility in young women, or maintaining pregnancy in pregnant women having fibroids. Excerpt(s): The present invention claims priority to U.S. Provisional Patent Application Serial No. 60/365,760 filed on Mar. 19, 2002. The entire text of the above-referenced disclosure is specifically incorporated herein by reference. without disclaimer. The present invention relates generally to the fields of molecular biology, gene therapy and gynecology. More particularly, it concerns down-regulation of estrogen responsive transcription in estrogen-responsive cells using modified estrogen receptors, an it further concerns adenoviral gene therapy for the treatment and prevention of uterine fibroids. Uterine fibroids are the most common pelvic tumors in the United States, occurring in up to 77% of all women (Buttram and Reiter, 1981; Vollenhoven et al., 1990). They can cause some severe symptoms such as heavy, irregular, and prolonged menstrual bleeding and anemia. They also may cause pelvic discomfort, and bowel and bladder dysfunction from pressure. Fibroids have also been associated with infertility and recurrent abortion. These tumors tend to grow rapidly during pregnancy due to the influence of abundant estrogen available in the circulation, and can cause obstructed labor necessitating cesarean section, fetal malpresentation, and fetal anomalies, as well as postpartum hemorrhage secondary to uterine atony. Uterine fibroids account for 35% of all hysterectomies done in the United States with a huge economic impact on healthcare delivery system (Calson et al., 1993). Histologically, fibroids arise from a single uterine muscle cell, and they grow under the influence of local growth factors and sex hormones including estrogen and progesterone (Rein et al., 1995). Fibroids appear after menarche, proliferate and grow during the reproductive years, and stabilize or regress after menopause. They may regrow after hormone replacement therapy (Sener et

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al., 1996). The diagnosis of fibroids is based on patient signs and symptoms, followed by pelvic examination, demonstrating a pelvic mass, and confirmation by transabdominal or transvaginal ultrasonic measurements. The etiology is not clearly understood. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Compositions and methods for contraception and for treatment of benign gynecological disorders Inventor(s): Daniels, John R.; (Pacific Palisades, CA), Pike, Malcolm Cecil; (Long Beach, CA), Spicer, Darcy V.; (Pasadena, CA) Correspondence: Christie, Parker & Hale, Llp; 350 West Colorado Boulevard; Suite 500; Pasadena; CA; 91105; US Patent Application Number: 20010016578 Date filed: May 1, 2001 Abstract: Compositions and methods for use in preventing conception or treating benign gynecological disorders, wherein an effective amount of an antiprogestational agent [e.g., progesterone (progestin, progestogen, gestagen) antagonist or progesterone synthesis inhibitor] administered over a first period of time is combined with an effective amount of a progestogen for a second period of time. The antiprogestational agent is selected from single agents or mixtures thereof. The progestogen is selected from single agents or mixtures of natural or synthetic progestogens. The formulations are effective as contraceptive agents and for treatment of benign gynecological disorders including uterine fibroids, premenstrual syndrome, dysfunctional uterine bleeding, polycystic ovarian syndrome and endometriosis. Excerpt(s): This invention relates to compositions and methods useful for contraception and for treatment of benign gynecological disorders in mammals, especially human females. More particularly, the present invention is directed to contraceptive methods and methods of treating benign gynecological disorders and preparations for use therein which are effective for reducing exposure to progestational agents. The first progestogen antagonist synthesized and tested was RU 486 [RU 38486; 17-hydroxy-11-(4dimethylaminophenyl)-17-(prop-1-ynyl)estra-4,9-dien-3-one; beta-[(4-N,Ndimethylaminno)-phenyl]-17.beta.-hydroxy-17.alp- ha.-propynyl-4,9(10)-oestradiene-3one; mefepristone]. Mefepristone has high affinity for the progesterone receptor, with predominantly antiprogestational effects. Mefepristone is known to have growthinhibitory effects in breast cancer cells in in vitro and in vivo preclinical studies and in human clinical trials [Klijn, J. G. M. et al., Cancer Research 49:2851-2856 (1989)]. Other antiprogestational agents have been synthesized and tested including ZK 98.299 (onapristone) and ZK 112.993, which also have antitumor efficacy [Michna, H. et al., J. Sieroid Biochem. Molec. Biol. 43:203-210 (1992)]. Mefepristone is known to be useful as a medical abortifacient (because of its antiprogestational activities) and as a postcoital contraceptive. Mefepristone has been evaluated as a potential contraceptive agent using several schedules. A single dose of mefepristone late in the menstrual cycle may be a useful contraceptive approach [Nieman, L. K. et al., N. Engl. J. Med. 316:187-191 (1987)]. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Devices for occlusion of the uterine arteries Inventor(s): Burbank, Fred; (San Juan Capistrano, CA), Jones, Michael; (Capistrano Beach, CA), Lubock, Paul; (Laguna Niguel, CA) Correspondence: Robert B. Krebs; Burns, Doane, Swecker & Mathis, L.L.P.; P.O. Box 1404; Alexandria; VA; 22313-1404; US Patent Application Number: 20010014805 Date filed: April 17, 2001 Abstract: Devices and methods are disclosed for treating a uterine disorder which receive its blood supply from a uterine arteries. In particular, uterine fibroids are effectively treated by occluding the uterine arteries using trans-vaginal, trans-uterine, transrectal, or retroperitoneal approaches. The devices and methods are advantageous because the inventive procedures may be performed by a patient's gynecologist in the course of treatment, avoiding the need for referrals to specialist practitioners and for more radical treatments, such as hysterectomies. The methods include both temporary and permanent occlusion of the arteries. A cannula carries an imaging device and a member which will easily penetrate tissue, the member including a device which partially or completely, and temporarily or permanently, occludes a uterine artery. Excerpt(s): The present invention relates generally to the treatment of disorders which receive blood flow from the uterine arteries, and more particularly to devices and methods for occlusion of the uterine arteries. Hysterectomy (surgical removal of the uterus) is performed on approximately 600,000 women annually in the n States. For approximately 340,000 women, hysterectomy is probably the best current therapeutic choice for the treatment of their diseases (uterine cancer, endometriosis, menorrhagia, and prolapse). For approximately 60,000 women with dysfunctional uterine bleeding (abnormal menstrual bleeding that has no discrete anatomic explanation such as a tumor or growth), newer endometrial ablation techniques may be an alternative to hysterectomy. For approximately 200,000 women with benign but symptomatic (excessive bleeding, pain, and "bulk" sensations) muscular tumors of the uterus, known as leiomyoma or fibroids, newer treatment methods have been developed which may spare these women a hysterectomy, as well. Hysterectomy for treating uterine fibroid disorders, though effective, has many undesirable characteristics. Thus, any method which can approximate the therapeutic result of a hysterectomy without removing the uterus (and commonly the ovaries since they are closely adjacent to the uterus) would be a significant improvement in this field. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Embolization systems and techniques for treating tumors Inventor(s): Adorjan, Tass; (Kecskemet, HU), Shadduck, John H.; (Tiburon, CA), Truckai, Csaba; (Saratoga, CA) Correspondence: Csaba Truckai; 19566 Arden Court; Saratoga; CA; 95070; US Patent Application Number: 20030050635 Date filed: August 21, 2002 Abstract: This invention relates to medical systems and least invasive techniques for treatment of hypervascularized tumors, both benign and cancerous, by catheter-based embolization of vessels that feed the tumor, for example in a patient's lung. The least

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invasive techniques typically can be performed by interventional radiologists for treatment of lung tumors. The invention also can be used to treat hypervascularized tumor tissues in other locations in a patient's body, for example, uterine fibroids and liver tumors. Excerpt(s): This application also is related to U.S. Patent Application Serial No. 10/198,041 filed Jul. 20, 2002 titled Systems and Techniques for Lung Volume Reduction. This application claims benefit of Provisional U.S. Patent Application Ser. No. 60/314,513 filed Aug. 22, 2001 (Docket No. CTX-004) having the same title as this disclosure, which is incorporated herein by reference. This invention relates to medical systems and least invasive techniques for treatment of hypervascularized tumors, both benign and cancerous, by a catheter-based embolization of vessels that feed the tumor, for example in a patient's lung. The least invasive techniques typically can be performed by interventional radiologists to treat lung tumors. The invention also can be used to treat hypervascularized tumor tissues in other locations in a patient's body, for example, uterine fibroids and liver tumors. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

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

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incision. For example, removal of a gall bladder requires that the cystic duct and the cystic artery feeding the gall bladder be cut and then closed, typically with a luminal clip, to prevent leakage of blood or bile, and to promote healing of the cut artery and duct. However, it is often difficult to distinguish between blood vessels, ducts, and other tissues, and to identify the proper tissue to which to apply a luminal clip. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Methods of treatment of uterine pathological conditions Inventor(s): Jabbour, Henry Nicolas; (Edinburgh, GB) Correspondence: Michael L. Goldman; Nixon Peabody Llp; Clinton Square; P.O. Box 31051; Rochester; NY; 14603-1051; US Patent Application Number: 20030100591 Date filed: October 8, 2002 Abstract: A method of treating or preventing a pathological condition of the uterus in an individual the method comprising administering to the individual any one or more of an inhibitor of cyclooxygenase-2 (COX-2), an inhibitor of prostaglandin E synthase (PGES), or an EP2 or EP4 receptor antagonist. Typically, the pathological condition is uterine cancer, fibroids or endometriosis. Excerpt(s): The present invention relates to methods of treatment, and in particular methods of treating uterine pathological conditions. Pathological conditions of the uterus represent a serious health problem in women, particularly women of the Western world. Such pathological conditions include uterine carcinoma, and endometrial or myometrial pathological conditions such as endometriosis (endometrial) and fibroids (myometrial). Cyclooxygenase (COX) enzymes, also called prostaglandin endoperoxide synthase, (PGHS), catalyse the rate limiting step in the conversion of arachidonic acid to prostaglandin H.sub.2 (PGH.sub.2). In turn PGH.sub.2 serves as a substrate for specific prostaglandin synthase enzymes that synthesise the natural prostaglandins. These are named according to the prostaglandin they produce such that prostaglandin D.sub.2 is synthesised by prostaglandin-D-synthase, prostaglandin E.sub.2 (PGE.sub.2) by prostaglandin-E-synthase (PGES) and prostaglandin F.sub.2.alpha. by prostaglandin-Fsynthase. To-date, there are two identified isoforms of the COX enzyme, COX-1 and COX-2 (DeWitt, 1991). COX-1 is constitutively expressed in many tissues and cell types and generates prostaglandins for normal physiological function (Herschman, 1996). By contrast, the expression of COX-2 is rapidly induced following stimulation of quiescent cells by growth factors, oncogenes, carcinogens and tumour-promoting phorbol esters (Herschman, 1996; Subbaramaiah et al., 1996). In addition, two isoforms of PGES have been isolated; a microsomal glutathione-dependent inducible PGES (mPGES) and a constitutive cytosolic glutathione dependent PGES (Jakobsson et al., 1999; Tanioka et al., 2000). In vitro studies support the idea that COX-2 and possibly PGE.sub.2 are involved in neoplastic transformation of certain epithelial cells and subsequently carcinogenesis. Over-expression of COX-2 and PGE.sub.2 synthesis in rat intestinal epithelial cells increases their proliferation rate, resistance to apoptosis, and their invasiveness by suppressing the transcription of target genes that may be involved in cellular growth/transformation and adhesion (Tsujii & DuBois, 1995), In addition, it has been proposed recently that COX-2 and PGE.sub.2 promote cancer development and invasiveness by mediating the transcription of angiogenic factors that induce both migration of endothelial cells and their arrangement into tubular structures (Tsujii et al., 1998; Jones et al., 1999b).

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

Noise-free real time ultrasonic imaging of a treatment site undergoing high intensity focused ultrasound therapy Inventor(s): Crum, Lawrence A.; (Bellevue, WA), Fujimoto, Victor Y.; (Seattle, WA), Keilman, George W.; (Woodinville, WA), Martin, Roy W.; (Redmond, WA), Vaezy, Shahram; (Seattle, WA), Carter, Stephen J.; (La Conner, WA) Correspondence: Law Offices OF Ronald M. Anderson; Suite 507; 600 - 108th Avenue N.E.; Bellevue; WA; 98004; US Patent Application Number: 20030028111 Date filed: June 7, 2002 Abstract: Method and apparatus for the simultaneous use of ultrasound on a probe for imaging and therapeutic purposes. The probe limits the effects of undesirable interference noise in a display by synchronizing high intensity focused ultrasound (HIFU) waves with an imaging transducer to cause the noise to be displayed in an area of the image that does not overlap the treatment site. In one embodiment, the HIFU is first energized at a low power level that does not cause tissue damage, so that the focal point of the HIFU can be identified by a change in the echogenicity of the tissue caused by the HIFU. Once the focal point is properly targeted on a desired treatment site, the power level is increased to a therapeutic level. The location of each treatment site is stored and displayed to the user to enable a plurality of spaced-apart treatment sites to be achieved. As the treatment progresses, any changes in the treatment site can be seen in the real time, noise-free image. A preferred application of the HIFU waves is to cause lesions in blood vessels, so that the supply of nutrients and oxygen to a region, such as a tumor, is interrupted. The tumor will thus eventually be destroyed. In a preferred embodiment, the HIFU is used to treat disorders of the female reproductive system, such as uterine fibroids. The HIFU treatment can be repeated at spaced-apart intervals, until any remaining fibroid tissue is destroyed. Excerpt(s): This application is based on U.S. provisional patent application Serial No. 60/100,812; filed on Sep. 18, 1998, the benefit of the filing date of which is hereby claimed under 35 U.S.C.sctn.119(e). The present invention relates to ultrasonic imaging and therapy apparatus and method incorporating both ultrasonic observation and therapeutic waves, and more specifically to apparatus and method designed to allow real time, noise-free imaging of a treatment site to which high intensity focused ultrasound is directed. Specially manufactured medical diagnostic equipment using ultrasound became available in the 1950's. An ultrasound examination is a safe diagnostic procedure that uses very high-frequency sound waves to produce an image of the internal structures of the body. Many studies have shown that these sound waves are harmless and may be used with complete safety, even on pregnant women, where the use of X-rays would be inappropriate. Furthermore, ultrasound examinations are sometimes quicker and typically less expensive than other imaging techniques. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Novel heteroatom containing tetracyclic derivatives as selective estrogen receptor modulators Inventor(s): Jain, Nareshkumar F.; (Raritan, NJ), Kanojia, Ramesh M.; (Raritan, NJ), Ng, Raymond; (Raritan, NJ), Sui, Zhihua; (Raritan, NJ), Xu, Jiayi; (Raritan, NJ) Correspondence: Audley A. Ciamporcero JR.; Johnson & Johnson; One Johnson & Johnson Plaza; New Brunswick; NJ; 08933-7003; US Patent Application Number: 20030216463 Date filed: December 2, 2002 Abstract: The present invention is directed to novel heteroatom containing tetracyclic derivatives, pharmaceutical compositions containing them, their use in the treatment and/or prevention of disorders mediated by one or more estrogen receptors and processes for their preparation. The compounds of the invention are useful in the treatment and/or prevention of disorders associated with the depletion of estrogen such as hot flashes, vaginal dryness, osteopenia and osteoporosis; hormone sensitive cancers and hyperplasia of the breast, endometrium, cervix and prostate; endometriosis, uterine fibroids, osteoarthritis and as contraceptive agents, alone or in combination with a progestogen or progestogen antagonist. Excerpt(s): This application claims the benefit of U. S. Provisional Application 60/341,957, filed on Dec. 19, 2001, which is incorporated by reference herein in its entirety. The present invention is directed to novel heteroatom containing tetracyclic derivatives, pharmaceutical compositions containing them, their use in the treatment of disorders mediated by one or more estrogen receptors and processes for their preparation. The compounds of the invention are thus useful for the treatment and/or prevention of disorders associated with estrogen depletion (including, but not limited to hot flashes, vaginal dryness, osteopenia, osteoporosis, hyperlipidemia, loss of cognitive function, degenerative brain diseases, cardiovascular and cerebrovascular diseases); for the treatment of hormone sensitive cancers and hyperplasia (in tissues including breast, endometrium, and cervix in women and prostate in men); for the treatment and prevention of endometriosis, uterine fibroids, and osteoarthritis; and as contraceptive agents either alone or in combination with a progestogen or progestogen antagonist. Estrogens are a group of female hormones essential for the reproductive process and for the development of the uterus, breasts, and other physical changes associated with puberty. Estrogens have an effect on various tissues throughout a woman's body, not only those involved in the reproductive process, such as the uterus, breasts, and external genitalia, but also tissues in the central nervous system, bones, the liver, skin, and the urinary tract. The ovaries produce most of the estrogens in a woman's body. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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NOVEL METHOD OF DETECTING AND TREATING CANCER Inventor(s): SCHMIDT, CARL J; (EXTON, PA), WANG, XIN-MIN; (SCHWENKSVILLE, PA) Correspondence: Smithkline Beecham Corporation; Corporate Intellectual Property-us, Uw2220; P. O. Box 1539; King OF Prussia; PA; 19406-0939; US Patent Application Number: 20030175279 Date filed: November 3, 1999

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Abstract: The presentinvention provides a new method for diagnosing and treating cancers, endometriosis and endometrial fibroids. Further provided are therapeutic agents and pharmaceutical compositions for treating cancers, endometriosis and endometrial fibroids. Excerpt(s): This invention relates, in part, to newly developed assay for diagnosing cancers, particularly endometrial and mammary, endometriosis and endometrial fibroids along with methods for identifying therapeutic agents that modulate Endometrial steroid binding protein II activity for treatment of the above disorders. Endometrial cancer occurs at a rate of approximately 44,500 new cases per year with approximately 10,000 deaths per year. If diagnosed and treated early, when the cancer is still confined to the endometrium, cure can be achieved in approximately 95% of the cases by hysterectomy. Pap smears can show endometrial cancers but are effective in only 50% of the cases. For the remainder, abnormal vaginal bleeding is typically the first clinical sign of endometrial cancer. There is a great need for sensitive methods for the detection of organ-confined endometrial cancer. Steroid binding proteins, including uteroglobin and CC10, are a class of proteins which bind steroids along with methylsulfonyl metabolites of polychlorinated biphenyls. The exact function of members of this class of protein is uncertain, but uteroglobin has been shown to inhibit PLA.sub.2 mediated responses. The gene and gene product of the present invention display homology to uteroglobin and CC 10, show elevated expression of mRNA in endometrial cancer samples and is expressed in mammary tissue. This gene encoded product will be referred to as Endometrial Steroid Binding Protein II (ESBPII), and their polypeptide and polynucleotide sequences are given in Table 1 and 2, respectively. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Process for preparing17alpha-acetoxy-11beta-[4-n,n(dimethylamino)phenyl]-2- 1methoxy-19-norpregna-4,9-diene -3,20-dione, intermediates useful in the process , and processes for preparing such intermediates Inventor(s): Cessac, James W; (San Antonio, TX), Kim, Hyun Koo; (Bethesda, MD), Rao, Pemmaraju N; (San Antonio, TX), Simmons, Anne Marie; (San Antonio, TX) Correspondence: Leydig Voit & Mayer, Ltd; 700 Thirteenth ST. NW; Suite 300; Washington; DC; 20005-3960; US Patent Application Number: 20030060646 Date filed: June 27, 2002 Abstract: A compound having general formula (I) in which R.sup.1 is a member selected from the group consisting of --OCH.sub.3, --SCH.sub.3, --N(CH.sub.3).sub.2, -NHCH.sub.3, --CHO, --COCH.sub.3 and --CHOHCH.sub.3; R.sup.2 is a member selected from the group consisting of halogen, alkyl, acyl, hydroxy, alkoxy, acyloxy, alkyl carbonate, cypionyloxy, S-alkyl and S-acyl; R.sup.3 is a member selected from the group consisting of alkyl, hydroxy, alkoxy and acyloxy; R.sup.4 is a member selected from the group consisting of hydrogen and alkyl; and X is a member selected from the group consisting of --O and --N--OR.sup.5, wherein R.sup.5 is a member selected from the group consisting of hydrogen and alkyl. In addition to providing the compounds of formula (I), the present invention provides methods wherein the compounds of formula (I) are advantageously used, inter alia. to antagonize endogenous progesterone; to induce menses; to treat endometriosis; to treat dysmenorrhea; to treat endocrine hormone-dependent tumors; to treat uterine fibroids; to inhibit uterine endometrial proliferation; to induce labor; and for contraception. 1

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Excerpt(s): This application claims the benefit of U.S. provisional patent application No. 60/173,470, filed Dec. 29, 1999, the disclosure of which is incorporated by reference in its entirety. The present invention relates generally to steroids, and in particular to a process for preparing 17.alpha.-acetoxy-11.beta.-[4-N,N-(- dimethylamino)phenyl]-21methoxy-19-norpregna-4,9-diene-3,20-dione, intermediates useful in the process, and processes for preparing such intermediates. International patent application No. PCT/US 97/07373, filed Apr. 30, 1997, WO 97/41145, published Nov. 6, 1997, and U.S. provisional patent application No. 60/016,628, filed May 1, 1996, both assigned to the same assignee as the present application, disclose, inter alia, 17.alpha.-acetoxy-11.beta.[4-N,N-(dimethylamino)phenyl]-21-methoxy-19-no- rpregna-4,9-diene-3,20-dione as an antiprogestational agent. This compound also is useful in other treatments, e.g., to induce menses or labor, to treat diseases such as endometriosis, dysmenorrhea, and endocrine hormone-dependent tumors, uterine fibroids, and to inhibit uterine endometrial proliferation. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Treatment for cancer Inventor(s): Hall, Linneth; (Valley Stream, NY) Correspondence: Nolte Nolte & Hunter; Christopher B Garvey; 1077 Northern Blvd; Roslyn; NY; 11701; US Patent Application Number: 20030082250 Date filed: October 21, 2002 Abstract: A method of treating abnormal growths in a patient. The growths include: cancers, tumors, fibroids, cysts, and cystadenomas. Dry leaves and stalks of a Chenopodium ambrosioides plant into a dried tea. Brew the dried tea in boiled water into a tea beverage. Administer the tea beverage to the patient by having the patient drink the tea daily. The method also reduces high PSA counts. Excerpt(s): This application claims benefit of provisional Application No. 60/343,624, filed Oct. 22, 2001. None. The present invention relates to a method of treatment for growths of various types. 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 fibroids, 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 “fibroids” (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 fibroids. You can also use this procedure to view pending patent applications concerning fibroids. 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 FIBROIDS Overview This chapter provides bibliographic book references relating to fibroids. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on fibroids 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: 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 “fibroids” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “fibroids” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “fibroids” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •

Bloody Monday: Fibroid Tumors My Ordeal by E. Jean Alexander; ISBN: 0971138702; http://www.amazon.com/exec/obidos/ASIN/0971138702/icongroupinterna

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Choosing a treatment for uterine fibroids (SuDoc HE 20.4010/A:UT 2) by Eleanor Mayfield; ISBN: B00010GY6S; http://www.amazon.com/exec/obidos/ASIN/B00010GY6S/icongroupinterna

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Clinical Recommendations for the Use of Uterine Artery Embolisation in the Management of Fibroids (2001); ISBN: 1900364468; http://www.amazon.com/exec/obidos/ASIN/1900364468/icongroupinterna

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Coping With Fibroids by Marie-Claire Mason, Mary-Claire Mason (1997); ISBN: 0859697665; http://www.amazon.com/exec/obidos/ASIN/0859697665/icongroupinterna

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Dr. Susan Lark's Heavy Menstrual Flow & Anemia Self Help Book: Effective Solutions for Premenopause, Bleeding Due to Fibroid Tumors, Hormonal Imbalance, Endometriosis, Endometrial Cancer, and Low Blood Count by Susan M. Lark (1996);

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ISBN: 0890877742; http://www.amazon.com/exec/obidos/ASIN/0890877742/icongroupinterna •

Endometriosis & Fibroids by Brewer Dr; ISBN: 0091816491; http://www.amazon.com/exec/obidos/ASIN/0091816491/icongroupinterna

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Endometriosis and Fibroids by Brewer Dr; ISBN: 0091807530; http://www.amazon.com/exec/obidos/ASIN/0091807530/icongroupinterna

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Fibroid Tumor and Endometriosis Self Help Book by Susan M. Lark (1995); ISBN: 0890877734; http://www.amazon.com/exec/obidos/ASIN/0890877734/icongroupinterna

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Fibroid Tumors & Endometriosis by Susan M. Lark; ISBN: 091701054X; http://www.amazon.com/exec/obidos/ASIN/091701054X/icongroupinterna

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Fibroid Tumors, Where Do They Come From? by Jedda Queen (1997); ISBN: 096725440X; http://www.amazon.com/exec/obidos/ASIN/096725440X/icongroupinterna

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Fibroids : A Guide for Women by Andrew J. Friedman; ISBN: 1885274246; http://www.amazon.com/exec/obidos/ASIN/1885274246/icongroupinterna

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Fibroids: The Complete Guide to Taking Charge of Your Physical, Emotional, and Sexual Well-Being by Johanna Skilling, Eileen Hoffman Md; ISBN: 1569246203; http://www.amazon.com/exec/obidos/ASIN/1569246203/icongroupinterna

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Fibroids: The Latest Treatment Options for This Common Problem by Felicity Smart, Stuart Campbell; ISBN: 0722528019; http://www.amazon.com/exec/obidos/ASIN/0722528019/icongroupinterna

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Healing Fibroids: A Doctor's Guide to a Natural Cure by Allan, Md Warshowsky, Elena, Phd Oumano (2002); ISBN: 0743418247; http://www.amazon.com/exec/obidos/ASIN/0743418247/icongroupinterna

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It's a Sistah Thing: A Guide to Understanding and Dealing with Fibroids for Black Women by Monique R. Brown, et al (2002); ISBN: 075820065X; http://www.amazon.com/exec/obidos/ASIN/075820065X/icongroupinterna

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Management of Uterine Fibroids by David B. Matchar (2001); ISBN: 1587630532; http://www.amazon.com/exec/obidos/ASIN/1587630532/icongroupinterna

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Natural Treatment of Fibroid Tumors and Endometriosis by Susan M., MD Lark, Phyllis Herman (Editor); ISBN: 0879836903; http://www.amazon.com/exec/obidos/ASIN/0879836903/icongroupinterna

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Natural Ways to Relieve Heavy Menstrual Flow and Anemia: Effective Treatment of Premenopausal Symptoms, Hormone Imbalance-Related Bleeding, Low Blood Count and Fibroid Tumors by Susan M. Lark; ISBN: 0879837616; http://www.amazon.com/exec/obidos/ASIN/0879837616/icongroupinterna

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Opinions in Uterine Fibroid Management: Is there a need for pharmacological therapies? [DOWNLOAD: PDF] by Datamonitor (Author); ISBN: B00008R3OD; http://www.amazon.com/exec/obidos/ASIN/B00008R3OD/icongroupinterna

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Pathogenesis and Medical Management of Uterine Fibroids by I. A. Brosens (Editor), et al; ISBN: 1850700982; http://www.amazon.com/exec/obidos/ASIN/1850700982/icongroupinterna

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Renewing Female Balance: PMS, Breast & Uterine Fibroids, Ovarian Cysts, Endometriosis, & More by Linda Rector-Page, Linda R. Page (1997); ISBN: 1884334644; http://www.amazon.com/exec/obidos/ASIN/1884334644/icongroupinterna

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Sex, Lies, and the Truth About Uterine Fibroids: A Journey from Diagnosis to Treatment to Renewed Good Health by Carla Dionne (2001); ISBN: 1583330704; http://www.amazon.com/exec/obidos/ASIN/1583330704/icongroupinterna

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The Fibroid Book by Francis L. Hutchins; ISBN: 0966264800; http://www.amazon.com/exec/obidos/ASIN/0966264800/icongroupinterna

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The First Year--Fibroids: An Essential Guide for the Newly Diagnosed by Johanna Skilling, Nelson Stringer (Foreword); ISBN: 1569245428; http://www.amazon.com/exec/obidos/ASIN/1569245428/icongroupinterna

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The Official Patient's Sourcebook on Uterine Fibroids by Icon Health Publications, et al (2002); ISBN: 0597831335; http://www.amazon.com/exec/obidos/ASIN/0597831335/icongroupinterna

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The Other Choice: A Comprehensive Guide for Women with Uterine Fibroids by Sophie Bartsich, Ernst G., Dr Bartsich; ISBN: 0738826065; http://www.amazon.com/exec/obidos/ASIN/0738826065/icongroupinterna

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The Treatment of Fibroids by Carl Wood (Editor); ISBN: 085572305X; http://www.amazon.com/exec/obidos/ASIN/085572305X/icongroupinterna

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Uterine fibroids (SuDoc HE 20.3352:UT 2) by U.S. Dept of Health and Human Services; ISBN: B00010XIA8; http://www.amazon.com/exec/obidos/ASIN/B00010XIA8/icongroupinterna

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Uterine Fibroids : Embolization and other Treatments by Togas Tulandi (Editor) (2003); ISBN: 0521819385; http://www.amazon.com/exec/obidos/ASIN/0521819385/icongroupinterna

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Uterine Fibroids: Time for Review (Advances in Reproductive Endocrinology, Vol 4) by R.W. Shaw (Editor); ISBN: 1850704309; http://www.amazon.com/exec/obidos/ASIN/1850704309/icongroupinterna

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Uterine Fibroids: What Every Woman Needs to Know by Nelson, Md. Stringer (2000); ISBN: 0924428139; http://www.amazon.com/exec/obidos/ASIN/0924428139/icongroupinterna

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What to Do When the Doctor Says It's Endometriosis or Fibroids; What to Do When the Doctor Says Its Endometriosis by Cheryl Kimball, Thomas L. Lyons (2003); ISBN: 1592330290; http://www.amazon.com/exec/obidos/ASIN/1592330290/icongroupinterna

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What Your Doctor May Not Tell You About Fibroids: New Techniques and Therapies--Including Breakthrough Alternatives to Hysterectomy by Goodwin/Broder (Author); ISBN: 0446678538; http://www.amazon.com/exec/obidos/ASIN/0446678538/icongroupinterna

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Women's Health Guide: A Natural Approach to Breast Cancer, Hearst Disease, Fibroids, Pms, Bulemia, Childbirth, Menopause, and Osteoporosis by Gale Jack (Editor), Wendy Esko (Editor); ISBN: 1882984250; http://www.amazon.com/exec/obidos/ASIN/1882984250/icongroupinterna

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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 “fibroids” (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 •

Clinical observations upon the treatment of uterine fibroids; with a case illustrating the operation of enucleation. Author: Goodell, William,; Year: 1879; Philadelphia: H. C. Lea, 1879

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Contributions to gynecology. Fasc. I. The galvanic treatment of uterine fibroids. Full text of the first fifty cases. Author: Cutter, Ephraim,; Year: 1887; New York: W. A. Kellogg, 1887

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Fibroids and allied tumours (myoma and adenomyoma); their pathology, clinical features and surgical treatment, by Cuthbert Lockyer. with an introductory notice by Alban Doran. with 316 illustrations including 37 coloured plates. Author: Lockyer, Cuthbert Henry Jones,; Year: 1918; London, Macmillan and co., ltd., 1918

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Fibroids of the uterus: their pathology, diagnosis and treatment. Author: BlandSutton, John,; Year: 1913; [London] Science Reviews [1913]

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On some novelties in my electrical treatment of uterine fibroids, with answers to objections. Paper read at the congress of the British Medical Association, Glasgow, August, 1888. Transl. by Woodham Webb. Author: Apostoli, Georges,; Year: 1888; Paris: C. Schlaeber, 1888

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On the treatment of fibroids of the uterus by means of dry earth. With outline tracings of three cases so treated, in their various stages of progress. Author: Hewson, Addinell,; Year: 1880; Philadelphia: Collins, 1880

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Results of forty-four cases of subserous uterine fibroids treated by galvanism. Author: Kimball, Gilman,; Year: 1877; Cambridge, 1877

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Ten cases of pregnancy and labor complicated with fibroids: with remarks Author: Chadwick, James R. (James Read),; Year: 1885; [Massachesetts?: s.n., 1885?]

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Treatment and removal of fibroids from the uterus by traction Author: Emmet, Thomas Addis,; Year: 1875; New York: G.P. Putnam's Sons, 1875

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Uterine fibroid embolization for the treatment of fibroids Author: ECRI (Organization). Health Technology Assessment Information Service.; Year: 2001; Plymouth Meeting, PA: ECRI, c2001

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Uterine fibroids Author: Dubuisson, Jean-Bernard; Year: 1997; Paris: Arnette, 1997

11

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

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Chapters on Fibroids In order to find chapters that specifically relate to fibroids, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and fibroids 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 “fibroids” (or synonyms) into the “For these words:” box.

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

Uterine Fibroids Source: Timonium, MD: Milner-Fenwick. 1994. Contact: Available from Milner-Fenwick. 2125 Greenspring Drive, Timonium, MD 21093. (800) 432-8433. Fax (301) 252-6316. PRICE: $250. Catalog No.OB0127. Summary: This videotape provides an overview of uterine fibroids. Through realistic animation and live film footage, the program explains what fibroids are, the different types, and how they can be treated. The program focuses on explaining how treatment is individualized based on the type of fibroid and the patient's situation. Treatment options covered include laparoscopy, myomectomy, and GNRH agonists. The program is designed to provide information to the newly-diagnosed patient, to reduce the patient's anxiety, and to save the physician's time.

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Bibliography: Multimedia on Fibroids 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 fibroids (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 fibroids: •

Transuterine resection of fibroids [videorecording] Source: produced by MSTL Television Section, School of Medicine, University of North Carolina at Chapel Hill; Year: 1987; Format: Videorecording; Chapel Hill, NC: Medical Sciences Teaching Labs, School of Medicine, University of North Carolina at Chapel Hill, c1987

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

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

Focused ultrasound destroys fibroids Source: Reuters Health eLine Date: August 05, 2003

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Doctors test new therapy for fibroids Source: Reuters Health eLine Date: July 16, 2003

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Levonorgestrel-eluting IUD reduces bleeding associated with fibroids Source: Reuters Industry Breifing Date: June 04, 2003

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Laparoscopic cryomyolysis shrinks fibroids, reduces symptoms with low pain Source: Reuters Medical News Date: April 30, 2003

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Freezing shrinks fibroids, avoids surgery Source: Reuters Health eLine Date: April 30, 2003

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Pregnancy possible for some after fibroid procedure Source: Reuters Health eLine Date: April 02, 2003

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Mifepristone shows promise as treatment for fibroids Source: Reuters Industry Breifing Date: January 31, 2003

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"Abortion pill" may also help shrink fibroids Source: Reuters Health eLine Date: January 31, 2003

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Uterine artery embolization: the procedure of choice for uterine fibroids Source: Reuters Medical News Date: January 16, 2003

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Vaginal hysterectomy valid for fibroid management, even for enlarged uteri Source: Reuters Medical News Date: January 14, 2003

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Embolization method less costly than surgery for uterine fibroids Source: Reuters Medical News Date: December 09, 2002

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BioSphere embolization device wins US clearance for uterine fibroids Source: Reuters Industry Breifing Date: November 26, 2002

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GnRH analog treatment should precede surgery in some women with fibroids Source: Reuters Industry Breifing Date: November 11, 2002

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Fibroid procedure may complicate pregnancy Source: Reuters Health eLine Date: November 01, 2002

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InSightec uterine fibroid system cleared in Europe Source: Reuters Industry Breifing Date: October 28, 2002

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Outpatient treatment zaps fibroids, eases symptoms Source: Reuters Health eLine Date: September 27, 2002

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MRI-guided laser ablation of fibroids may provide alternative to hysterectomy Source: Reuters Medical News Date: September 27, 2002

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Israel clears Insightec's ultrasound ablation system for uterine fibroids Source: Reuters Industry Breifing Date: August 29, 2002

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MRI-guided cryotherapy shows promise as uterine fibroid treatment Source: Reuters Medical News Date: July 02, 2002

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Biosphere seeks FDA approval to use microspheres for uterine fibroids Source: Reuters Medical News Date: May 13, 2002

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Biosphere files to use microspheres for uterine fibroids Source: Reuters Industry Breifing Date: May 13, 2002

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Radiofrequency ablation shows promise as fibroid treatment Source: Reuters Medical News Date: May 08, 2002

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Heat technique could fight fibroids, avoid surgery Source: Reuters Health eLine Date: May 07, 2002

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Tiny spheres can be used to treat fibroids: study Source: Reuters Health eLine Date: April 08, 2002

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BioSphere uterine fibroid embolization device comparable to hysterectomy in study Source: Reuters Industry Breifing Date: April 08, 2002

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Uterine artery embolization shrinks fibroids; most patients satisfied with results Source: Reuters Medical News Date: March 28, 2002

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Researchers discover gene related to fibroids Source: Reuters Health eLine Date: February 25, 2002

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BioSphere treatment on pace for uterine fibroid indication Source: Reuters Industry Breifing Date: January 22, 2002

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Ultrasound surgery shrinks symptomatic uterine fibroids Source: Reuters Medical News Date: November 26, 2001

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Osteoporosis drug found to shrink uterine fibroids Source: Reuters Health eLine Date: July 19, 2001

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Large, long-term study confirms uterine artery embolization effective for fibroids Source: Reuters Medical News Date: July 05, 2001

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Procedure provides relief for women with fibroids Source: Reuters Health eLine Date: July 03, 2001

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Fibroids may increase risk of hypertension Source: Reuters Medical News Date: May 02, 2001

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Sexual function improves after fibroid procedure Source: Reuters Health eLine Date: March 07, 2001

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Uterine fibroid embolization deemed superior to myomectomy Source: Reuters Medical News Date: March 06, 2001

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Sexual function improves after uterine fibroid embolization Source: Reuters Medical News Date: March 06, 2001

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Uterine vessel coagulation method shows promise in treatment of fibroids Source: Reuters Medical News Date: February 23, 2001

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Fibroid embolization can be effective, but associated with complications Source: Reuters Medical News Date: October 09, 2000

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Pregnancy may be possible after fibroid treatment Source: Reuters Health eLine Date: June 27, 2000

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Study of heritable component of fibroid development under way Source: Reuters Medical News Date: May 26, 2000

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Are fibroids inherited? New study may tell Source: Reuters Health eLine Date: May 24, 2000

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Procedure shrinks fibroids by up to 70% Source: Reuters Health eLine Date: May 23, 2000

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Menorrhagia, pelvic pain improve after uterine fibroid embolization Source: Reuters Medical News Date: March 28, 2000

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Ultrasound promising as uterine fibroid therapy Source: Reuters Health eLine Date: October 05, 1999

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High-intensity focused ultrasound zaps uterine fibroids in mouse model Source: Reuters Medical News Date: October 04, 1999

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Diet high in red meat, low in green vegetables, fruit may moderately increase risk of uterine fibroids Source: Reuters Medical News Date: September 01, 1999

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Red meat may raise uterine fibroid risk Source: Reuters Health eLine Date: August 31, 1999

Periodicals and News

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Use of oral contraceptives does not increase risk of uterine fibroids Source: Reuters Medical News Date: August 23, 1999

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Embolization effectively shrinks uterine fibroids Source: Reuters Medical News Date: March 26, 1999

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New procedure for uterine fibroid tumors Source: Reuters Health eLine Date: March 25, 1999

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

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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 “fibroids” (or synonyms).

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

Chronic Pelvic Pain in Women Source: Quality Care. 20(4): 1, 5. Fourth Quarter 2002. Contact: Available from National Association for Continence. P.O. Box 8310, Spartanburg, SC 29305-8310. (800) BLADDER OR (800) 252-3337 or (864) 579-7900. Fax (864) 579-7902. Website: www.nafc.org. Summary: This newsletter article discusses chronic pelvic pain (CPP) in women, a complex and debilitating problem that can significantly impair many aspects of the quality of life of women. Typical characteristics of chronic pain are incomplete relief by previous treatments, pain out of proportion to tissue damage, loss of physical function, signs of depression, and altered family dynamics. The author considers factors that can lead to CPP, including hysterectomy, uterine fibroids, endometriosis, interstitial cystitis (IC), vulvodynea, and vulvar vestibulitis. For each, the author briefly outlines potential treatment options.

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

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APPENDICES

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

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

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

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

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

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

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

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

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

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

12

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.13 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:14 •

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

•

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

•

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

•

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

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

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

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

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

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

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

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

13

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 14 See http://www.nlm.nih.gov/databases/databases.html.

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

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

The NLM Gateway15 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.16 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “fibroids” (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 10321 120 227 6 3 10677

HSTAT17 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.18 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.19 Simply search by “fibroids” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

15

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

16

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 17 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 18 19

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

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.

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Coffee Break: Tutorials for Biologists20 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.21 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.22 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

20 Adapted 21

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

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 22 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on fibroids 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 fibroids. 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 fibroids. 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 “fibroids”:

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•

Other guides Endometriosis http://www.nlm.nih.gov/medlineplus/endometriosis.html Uterine Cancer http://www.nlm.nih.gov/medlineplus/uterinecancer.html Uterine Diseases http://www.nlm.nih.gov/medlineplus/uterinediseases.html Uterine Fibroids http://www.nlm.nih.gov/medlineplus/uterinefibroids.html

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

Treatment Alternatives to Hysterectomy: New Technologies, More Options Source: Food and Drug Administration http://www.fda.gov/fdac/features/2001/601_tech.html Dilation and Curettage http://www.nlm.nih.gov/medlineplus/tutorials/dilationandcurettageloader.html Uterine Fibroids Treatment Options Source: Society of Interventional Radiology http://www.sirweb.org/patPub/uterineTreatments.shtml

•

Organizations National Institute of Child Health and Human Development http://www.nichd.nih.gov/ National Uterine Fibroids Foundation http://www.nuff.org National Women's Health Information Center Source: Dept. of Health and Human Services http://www.4woman.gov/

•

Prevention/Screening Uterine Fibroids: Risk Factors Source: National Uterine Fibroids Foundation http://www.nuff.org/health_riskfactors.htm

•

Research Scientists One Step Closer to Cause of Uterine Fibroids Source: National Institute of Child Health and Human Development http://www.nih.gov/news/pr/jul2002/nichd-22.htm

Patient Resources

•

99

Statistics Hysterectomy Statistics Source: National Uterine Fibroids Foundation http://www.nuff.org/health_statistics.htm

You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The 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 “fibroids” (or synonyms). The following was recently posted: •

Guidelines for the management of uterine fibroids Source: New Zealand Guidelines Group - Private Nonprofit Organization; 1999 August; 120 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2279&nbr=1505&a mp;string=fibroids 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: •

Hysterectomy: Know Your Options Summary: Answers to women's concerns about this medical procedure that is frequently recommended as a solution to relieve chronic pain and/or heavy bleeding that is caused by fibroids, endometriosis, and other Source: National Women's Health Resource Center http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=2596

•

Management of Uterine Fibroids Summary: This is a summary of the evidence report/technology assessment on the management of uterine fibroids. Sections include an overview, methodology, findings, and a link to the full report. Source: Agency for Healthcare Research and Quality http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=7259

100 Fibroids

•

Uterine Fibroid Embolization: A New Way to Treat Fibroids Summary: There are several ways to treat fibroids. One way to treat women with fibroids is called uterine fibroid embolization. Source: American Academy of Family Physicians http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=7263

•

Uterine Fibroid Symptoms and Diagnosis Summary: Fibroid tumors of the uterus are very common, but for most women, they either do not cause symptoms or cause only minor symptoms. Source: Society of Interventional Radiology http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=7262

•

Uterine Fibroid Treatment Options Summary: This patient information from the Society of Interventional Radiology explores treatment options for uterine fibroids: drug therapy, myomectomy, hysterectomy, and uterine fibroid embolization. Source: Society of Interventional Radiology http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=7264

•

Uterine Fibroids Summary: This fact sheet answers many questions from women about uterine fibroids. These benign tumors are the most frequently diagnosed tumor of the female pelvis. Source: National Institute of Child Health and Human Development, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=743 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 fibroids. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html.

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

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

•

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

•

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

•

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

•

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

•

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

•

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

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to fibroids. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with fibroids. 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 fibroids. 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 “fibroids” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received

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your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “fibroids”. 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 “fibroids” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “fibroids” (or a synonym) into the search box, and click “Submit Query.”

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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.23

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

23

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)24: •

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

•

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/

24

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

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•

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

•

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/

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•

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

•

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

•

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

•

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

109

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 fibroids: •

Basic Guidelines for Fibroids Fibroid tumor treatment Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002090.htm

•

Signs & Symptoms for Fibroids Vaginal bleeding Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003156.htm

•

Surgery and Procedures for Fibroids Hysterectomy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002915.htm

110 Fibroids

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

111

FIBROIDS DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. 1-phosphate: A drug that halts cell suicide in human white blood cells. [NIH] Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abdominal Pain: Sensation of discomfort, distress, or agony in the abdominal region. [NIH] Ablate: In surgery, is to remove. [NIH] Ablation: The removal of an organ by surgery. [NIH] Acoustic: Having to do with sound or hearing. [NIH] Acyl: Chemical signal used by bacteria to communicate. [NIH] Adaptability: Ability to develop some form of tolerance to conditions extremely different from those under which a living organism evolved. [NIH] Adenovirus: A group of viruses that cause respiratory tract and eye infections. Adenoviruses used in gene therapy are altered to carry a specific tumor-fighting gene. [NIH] Adhesions: Pathological processes consisting of the union of the opposing surfaces of a wound. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] 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] Adverse Effect: An unwanted side effect of treatment. [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] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Airway: A device for securing unobstructed passage of air into and out of the lungs during

112 Fibroids

general anesthesia. [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] 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] Aluminum: A metallic element that has the atomic number 13, atomic symbol Al, and atomic weight 26.98. [NIH] Amenorrhea: Absence of menstruation. [NIH] Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Ampulla: A sac-like enlargement of a canal or duct. [NIH] Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Analogous: Resembling or similar in some respects, as in function or appearance, but not in origin or development;. [EU] Anaplasia: Loss of structural differentiation and useful function of neoplastic cells. [NIH] Androgens: A class of sex hormones associated with the development and maintenance of the secondary male sex characteristics, sperm induction, and sexual differentiation. In addition to increasing virility and libido, they also increase nitrogen and water retention and stimulate skeletal growth. [NIH] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Aneurysm: A sac formed by the dilatation of the wall of an artery, a vein, or the heart. [NIH] Angiogenesis: Blood vessel formation. Tumor angiogenesis is the growth of blood vessels from surrounding tissue to a solid tumor. This is caused by the release of chemicals by the tumor. [NIH] Angioplasty: Endovascular reconstruction of an artery, which may include the removal of atheromatous plaque and/or the endothelial lining as well as simple dilatation. These are procedures performed by catheterization. When reconstruction of an artery is performed surgically, it is called endarterectomy. [NIH]

Dictionary 113

Angiotensinogen: An alpha-globulin of which a fragment of 14 amino acids is converted by renin to angiotensin I, the inactive precursor of angiotensin II. It is a member of the serpin superfamily. [NIH] Animal model: An animal with a disease either the same as or like a disease in humans. Animal models are used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Anomalies: Birth defects; abnormalities. [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] Anticoagulant: A drug that helps prevent blood clots from forming. Also called a blood thinner. [NIH] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Antineoplastic: Inhibiting or preventing the development of neoplasms, checking the maturation and proliferation of malignant cells. [EU] Anus: The opening of the rectum to the outside of the body. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Aorta: The main trunk of the systemic arteries. [NIH] Aortography: Radiographic visualization of the aorta and its branches by injection of contrast media, using percutaneous puncture or catheterization procedures. [NIH] Apnea: A transient absence of spontaneous respiration. [NIH] Apoptosis: One of the two mechanisms by which cell death occurs (the other being the pathological process of necrosis). Apoptosis is the mechanism responsible for the physiological deletion of cells and appears to be intrinsically programmed. It is characterized by distinctive morphologic changes in the nucleus and cytoplasm, chromatin cleavage at regularly spaced sites, and the endonucleolytic cleavage of genomic DNA (DNA fragmentation) at internucleosomal sites. This mode of cell death serves as a balance to mitosis in regulating the size of animal tissues and in mediating pathologic processes associated with tumor growth. [NIH] Appendectomy: An operation to remove the appendix. [NIH] Applicability: A list of the commodities to which the candidate method can be applied as presented or with minor modifications. [NIH] Approximate: Approximal [EU]

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Arachidonic Acid: An unsaturated, essential fatty acid. It is found in animal and human fat as well as in the liver, brain, and glandular organs, and is a constituent of animal phosphatides. It is formed by the synthesis from dietary linoleic acid and is a precursor in the biosynthesis of prostaglandins, thromboxanes, and leukotrienes. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arteriography: A procedure to x-ray arteries. The arteries can be seen because of an injection of a dye that outlines the vessels on an x-ray. [NIH] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Arteriovenous: Both arterial and venous; pertaining to or affecting an artery and a vein. [EU] Articular: Of or pertaining to a joint. [EU] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Atony: Lack of normal tone or strength. [EU] Atrophy: Decrease in the size of a cell, tissue, organ, or multiple organs, associated with a variety of pathological conditions such as abnormal cellular changes, ischemia, malnutrition, or hormonal changes. [NIH] Attenuation: Reduction of transmitted sound energy or its electrical equivalent. [NIH] Autologous: Taken from an individual's own tissues, cells, or DNA. [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] Bacteriophage: A virus whose host is a bacterial cell; A virus that exclusively infects bacteria. It generally has a protein coat surrounding the genome (DNA or RNA). One of the coliphages most extensively studied is the lambda phage, which is also one of the most important. [NIH] Basal Ganglia: Large subcortical nuclear masses derived from the telencephalon and located in the basal regions of the cerebral hemispheres. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Basement Membrane: Ubiquitous supportive tissue adjacent to epithelium and around smooth and striated muscle cells. This tissue contains intrinsic macromolecular components such as collagen, laminin, and sulfated proteoglycans. As seen by light microscopy one of its subdivisions is the basal (basement) lamina. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Benign prostatic hyperplasia: A benign (noncancerous) condition in which an overgrowth of prostate tissue pushes against the urethra and the bladder, blocking the flow of urine. Also called benign prostatic hypertrophy or BPH. [NIH] Benign tumor: A noncancerous growth that does not invade nearby tissue or spread to other parts of the body. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its

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composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bile Acids: Acids made by the liver that work with bile to break down fats. [NIH] Bile Acids and Salts: Steroid acids and salts. The primary bile acids are derived from cholesterol in the liver and usually conjugated with glycine or taurine. The secondary bile acids are further modified by bacteria in the intestine. They play an important role in the digestion and absorption of fat. They have also been used pharmacologically, especially in the treatment of gallstones. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biological therapy: Treatment to stimulate or restore the ability of the immune system to fight infection and disease. Also used to lessen side effects that may be caused by some cancer treatments. Also known as immunotherapy, biotherapy, or biological response modifier (BRM) therapy. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biosynthesis: The building up of a chemical compound in the physiologic processes of a living organism. [EU] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Bladder: The organ that stores urine. [NIH] Blastocyst: The mammalian embryo in the post-morula stage in which a fluid-filled cavity, enclosed primarily by trophoblast, contains an inner cell mass which becomes the embryonic disc. [NIH] Bloating: Fullness or swelling in the abdomen that often occurs after meals. [NIH] Blood Cell Count: A count of the number of leukocytes and erythrocytes per unit volume in a sample of venous blood. A complete blood count (CBC) also includes measurement of the hemoglobin, hematocrit, and erythrocyte indices. [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, in the forearm. [NIH] Blood transfusion: The administration of blood or blood products into a blood vessel. [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] Blot: To transfer DNA, RNA, or proteins to an immobilizing matrix such as nitrocellulose. [NIH]

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Body Fluids: Liquid components of living organisms. [NIH] Bone Density: The amount of mineral per square centimeter of bone. This is the definition used in clinical practice. Actual bone density would be expressed in grams per milliliter. It is most frequently measured by photon absorptiometry or x-ray computed tomography. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Brain Diseases: Pathologic conditions affecting the brain, which is composed of the intracranial components of the central nervous system. This includes (but is not limited to) the cerebral cortex; intracranial white matter; basal ganglia; thalamus; hypothalamus; brain stem; and cerebellum. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Bronchial: Pertaining to one or more bronchi. [EU] Bronchiseptica: A small, gram-negative, motile bacillus. A normal inhabitant of the respiratory tract in man, dogs, and pigs, but is also associated with canine infectious tracheobronchitis and atrophic rhinitis in pigs. [NIH] Buserelin: A potent and durable analog of naturally occurring gonadotropin-releasing hormone (GnRH). [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] Cannula: A tube for insertion into a duct or cavity; during insertion its lumen is usually occupied by a trocar. [EU] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carboplatin: An organoplatinum compound that possesses antineoplastic activity. [NIH] Carcinogenesis: The process by which normal cells are transformed into cancer cells. [NIH] Carcinogenic: Producing carcinoma. [EU] Carcinogens: Substances that increase the risk of neoplasms in humans or animals. Both genotoxic chemicals, which affect DNA directly, and nongenotoxic chemicals, which induce neoplasms by other mechanism, are included. [NIH] Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs. [NIH]

Cardiac: Having to do with the heart. [NIH] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cardiovascular disease: Any abnormal condition characterized by dysfunction of the heart and blood vessels. CVD includes atherosclerosis (especially coronary heart disease, which

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can lead to heart attacks), cerebrovascular disease (e.g., stroke), and hypertension (high blood pressure). [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Catalyse: To speed up a chemical reaction. [EU] Catheterization: Use or insertion of a tubular device into a duct, blood vessel, hollow organ, or body cavity for injecting or withdrawing fluids for diagnostic or therapeutic purposes. It differs from intubation in that the tube here is used to restore or maintain patency in obstructions. [NIH] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [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 Aggregation: The phenomenon by which dissociated cells intermixed in vitro tend to group themselves with cells of their own type. [NIH] Cell Cycle: The complex series of phenomena, occurring between the end of one cell division and the end of the next, by which cellular material is divided between daughter 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 Division: The fission of a cell. [NIH] Cell proliferation: An increase in the number of cells as a result of cell growth and cell division. [NIH] Cell Survival: The span of viability of a cell characterized by the capacity to perform certain functions such as metabolism, growth, reproduction, some form of responsiveness, and adaptability. [NIH] Cellulose: A polysaccharide with glucose units linked as in cellobiose. It is the chief constituent of plant fibers, cotton being the purest natural form of the substance. As a raw material, it forms the basis for many derivatives used in chromatography, ion exchange materials, explosives manufacturing, and pharmaceutical preparations. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Centrifugation: A method of separating organelles or large molecules that relies upon differential sedimentation through a preformed density gradient under the influence of a gravitational field generated in a centrifuge. [NIH] Ceramide: A type of fat produced in the body. It may cause some types of cells to die, and is being studied in cancer treatment. [NIH] 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] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU]

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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] Cervical Ripening: A change in the cervix with respect to its readiness to relax. The cervix becomes softer, more flexible, more distensible, and shorter in the final weeks of pregnancy. Though naturally occurring during normal pregnancy, it can also be induced for certain cases of prolonged or high-risk pregnancy by administration of hormones. [NIH] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH] Cesarean Section: Extraction of the fetus by means of abdominal hysterotomy. [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] Chemoprevention: The use of drugs, vitamins, or other agents to try to reduce the risk of, or delay the development or recurrence of, cancer. [NIH] Cholecystectomy: Surgical removal of the gallbladder. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Chromatin: The material of chromosomes. It is a complex of DNA, histones, and nonhistone proteins (chromosomal proteins, non-histone) found within the nucleus of a cell. [NIH] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chromosome Aberrations: Deviations from the normal number or structure of chromosomes, not necessarily associated with disease. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic renal: Slow and progressive loss of kidney function over several years, often resulting in end-stage renal disease. People with end-stage renal disease need dialysis or transplantation to replace the work of the kidneys. [NIH] Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Coagulation: 1. The process of clot formation. 2. In colloid chemistry, the solidification of a sol into a gelatinous mass; an alteration of a disperse phase or of a dissolved solid which causes the separation of the system into a liquid phase and an insoluble mass called the clot or curd. Coagulation is usually irreversible. 3. In surgery, the disruption of tissue by physical means to form an amorphous residuum, as in electrocoagulation and photocoagulation. [EU] Cofactor: A substance, microorganism or environmental factor that activates or enhances the

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action of another entity such as a disease-causing agent. [NIH] Cohort Studies: Studies in which subsets of a defined population are identified. These groups may or may not be exposed to factors hypothesized to influence the probability of the occurrence of a particular disease or other outcome. Cohorts are defined populations which, as a whole, are followed in an attempt to determine distinguishing subgroup characteristics. [NIH] Colitis: Inflammation of the colon. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Collapse: 1. A state of extreme prostration and depression, with failure of circulation. 2. Abnormal falling in of the walls of any part of organ. [EU] Common Bile Duct: The largest biliary duct. It is formed by the junction of the cystic duct and the hepatic duct. [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

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as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complete remission: The disappearance of all signs of cancer. Also called a complete response. [NIH] Compress: A plug used to occludate an orifice in the control of bleeding, or to mop up secretions; an absorbent pad. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue Cells: A group of cells that includes fibroblasts, cartilage cells, adipocytes, smooth muscle cells, and bone cells. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Consultation: A deliberation between two or more physicians concerning the diagnosis and the proper method of treatment in a case. [NIH] Contraception: Use of agents, devices, methods, or procedures which diminish the likelihood of or prevent conception. [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] Contrast Media: Substances used in radiography that allow visualization of certain tissues. [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]

Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary heart disease: A type of heart disease caused by narrowing of the coronary arteries that feed the heart, which needs a constant supply of oxygen and nutrients carried by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by fat and cholesterol deposits and cannot supply enough blood to the heart, CHD results. [NIH]

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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] Corticosteroids: Hormones that have antitumor activity in lymphomas and lymphoid leukemias; in addition, corticosteroids (steroids) may be used for hormone replacement and for the management of some of the complications of cancer and its treatment. [NIH] Cortisol: A steroid hormone secreted by the adrenal cortex as part of the body's response to stress. [NIH] Cortisone: A natural steroid hormone produced in the adrenal gland. It can also be made in the laboratory. Cortisone reduces swelling and can suppress immune responses. [NIH] Croton Oil: Viscous, nauseating oil obtained from the shrub Croton tiglium (Euphorbaceae). It is a vesicant and skin irritant used as pharmacologic standard for skin inflammation and allergy and causes skin cancer. It was formerly used as an emetic and cathartic with frequent mortality. [NIH] Cryotherapy: Any method that uses cold temperature to treat disease. [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] Cystic Duct: The tube that carries bile from the gallbladder into the common bile duct and the small intestine. [NIH] Cystitis: Inflammation of the urinary bladder. [EU] 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] Cytotoxic: Cell-killing. [NIH] Databases, Bibliographic: Extensive collections, reputedly complete, of references and citations to books, articles, publications, etc., generally on a single subject or specialized subject area. Databases can operate through automated files, libraries, or computer disks. The concept should be differentiated from factual databases which is used for collections of data and facts apart from bibliographic references to them. [NIH] Decidua: The epithelial lining of the endometrium that is formed before the fertilized ovum reaches the uterus. The fertilized ovum embeds in the decidua. If the ovum is not fertilized, the decidua is shed during menstruation. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Deletion: A genetic rearrangement through loss of segments of DNA (chromosomes), bringing sequences, which are normally separated, into close proximity. [NIH] Delivery of Health Care: The concept concerned with all aspects of providing and distributing health services to a patient population. [NIH]

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Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Depolarization: The process or act of neutralizing polarity. In neurophysiology, the reversal of the resting potential in excitable cell membranes when stimulated, i.e., the tendency of the cell membrane potential to become positive with respect to the potential outside the cell. [EU] Deuterium: Deuterium. The stable isotope of hydrogen. It has one neutron and one proton in the nucleus. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diagnostic Equipment: Nonexpendable items used in examinination. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Diencephalon: The paired caudal parts of the prosencephalon from which the thalamus, hypothalamus, epithalamus, and subthalamus are derived. [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] Dihydroxy: AMPA/Kainate antagonist. [NIH] Dilatation: The act of dilating. [NIH] Diploid: Having two sets of chromosomes. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] 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] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Dose-dependent: Refers to the effects of treatment with a drug. If the effects change when the dose of the drug is changed, the effects are said to be dose dependent. [NIH] Double-blinded: A clinical trial in which neither the medical staff nor the person knows which of several possible therapies the person is receiving. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Duct: A tube through which body fluids pass. [NIH] Duodenum: The first part of the small intestine. [NIH] Dysmenorrhea: Painful menstruation. [NIH]

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Ectopic: Pertaining to or characterized by ectopia. [EU] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Elastin: The protein that gives flexibility to tissues. [NIH] Electrocoagulation: Electrosurgical procedures used to treat hemorrhage (e.g., bleeding ulcers) and to ablate tumors, mucosal lesions, and refractory arrhythmias. [NIH] Electrode: Component of the pacing system which is at the distal end of the lead. It is the interface with living cardiac tissue across which the stimulus is transmitted. [NIH] Electrolytes: Substances that break up into ions (electrically charged particles) when they are dissolved in body fluids or water. Some examples are sodium, potassium, chloride, and calcium. Electrolytes are primarily responsible for the movement of nutrients into cells, and the movement of wastes out of cells. [NIH] Emboli: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] Embolization: The blocking of an artery by a clot or foreign material. Embolization can be done as treatment to block the flow of blood to a tumor. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Embryo Transfer: Removal of a mammalian embryo from one environment and replacement in the same or a new environment. The embryo is usually in the pre-nidation phase, i.e., a blastocyst. The process includes embryo or blastocyst transplantation or transfer after in vitro fertilization and transfer of the inner cell mass of the blastocyst. It is not used for transfer of differentiated embryonic tissue, e.g., germ layer cells. [NIH] Endarterectomy: Surgical excision, performed under general anesthesia, of the atheromatous tunica intima of an artery. When reconstruction of an artery is performed as an endovascular procedure through a catheter, it is called atherectomy. [NIH] Endemic: Present or usually prevalent in a population or geographical area at all times; said of a disease or agent. Called also endemial. [EU] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Endometrial: Having to do with the endometrium (the layer of tissue that lines the uterus). [NIH]

Endometriosis: A condition in which tissue more or less perfectly resembling the uterine mucous membrane (the endometrium) and containing typical endometrial granular and stromal elements occurs aberrantly in various locations in the pelvic cavity. [NIH] Endometrium: The layer of tissue that lines the uterus. [NIH] Endoscope: A thin, lighted tube used to look at tissues inside the body. [NIH] Endoscopic: A technique where a lateral-view endoscope is passed orally to the duodenum for visualization of the ampulla of Vater. [NIH] Endothelial cell: The main type of cell found in the inside lining of blood vessels, lymph vessels, and the heart. [NIH] End-stage renal: Total chronic kidney failure. When the kidneys fail, the body retains fluid and harmful wastes build up. A person with ESRD needs treatment to replace the work of the failed kidneys. [NIH]

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Enucleation: Removal of the nucleus from an eucaryiotic cell. [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]

Environmental Pollutants: Substances which pollute the environment. Use environmental pollutants in general or for which there is no specific heading. [NIH]

for

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other healthrelated event occurring in such outbreaks. [EU] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelial Cells: Cells that line the inner and outer surfaces of the body. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Esophageal: Having to do with the esophagus, the muscular tube through which food passes from the throat to the stomach. [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] Estrogen: One of the two female sex hormones. [NIH] Estrogen receptor: ER. Protein found on some cancer cells to which estrogen will attach. [NIH]

Ethnic Groups: A group of people with a common cultural heritage that sets them apart from others in a variety of social relationships. [NIH] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Extracellular: Outside a cell or cells. [EU] Extracellular Matrix: A meshwork-like substance found within the extracellular space and in association with the basement membrane of the cell surface. It promotes cellular proliferation and provides a supporting structure to which cells or cell lysates in culture dishes adhere. [NIH] Extracellular Space: Interstitial space between cells, occupied by fluid as well as amorphous and fibrous substances. [NIH] Eye Infections: Infection, moderate to severe, caused by bacteria, fungi, or viruses, which occurs either on the external surface of the eye or intraocularly with probable inflammation, visual impairment, or blindness. [NIH] Fallopian Tubes: Two long muscular tubes that transport ova from the ovaries to the uterus. They extend from the horn of the uterus to the ovaries and consist of an ampulla, an infundibulum, an isthmus, two ostia, and a pars uterina. The walls of the tubes are

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composed of three layers: mucosal, muscular, and serosal. [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] Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibroid: A benign smooth muscle tumor, usually in the uterus or gastrointestinal tract. Also called leiomyoma. [NIH] Fistula: Abnormal communication most commonly seen between two internal organs, or between an internal organ and the surface of the body. [NIH] Foetoplacental: Pertaining to the fetus and placenta. [EU] Follicles: Shafts through which hair grows. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [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]

Gastroenterologist: A doctor who specializes in diagnosing and treating disorders of the digestive system. [NIH] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gelatin: A product formed from skin, white connective tissue, or bone collagen. It is used as a protein food adjuvant, plasma substitute, hemostatic, suspending agent in pharmaceutical preparations, and in the manufacturing of capsules and suppositories. [NIH] 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]

Genetic Code: The specifications for how information, stored in nucleic acid sequence (base sequence), is translated into protein sequence (amino acid sequence). The start, stop, and order of amino acids of a protein is specified by consecutive triplets of nucleotides called codons (codon). [NIH] Genetic Engineering: Directed modification of the gene complement of a living organism by such techniques as altering the DNA, substituting genetic material by means of a virus, transplanting whole nuclei, transplanting cell hybrids, etc. [NIH] Genital: Pertaining to the genitalia. [EU] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Germ Cells: The reproductive cells in multicellular organisms. [NIH] Gestrinone: A non-estrogenic contraceptive which is a weak progestin with strong antiprogesterone properties. It is effective if used once a week orally or can also be used in intravaginal devices. [NIH] Gland: An organ that produces and releases one or more substances for use in the body.

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Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glottis: The vocal apparatus of the larynx, consisting of the true vocal cords (plica vocalis) and the opening between them (rima glottidis). [NIH] Glucocorticoid: A compound that belongs to the family of compounds called corticosteroids (steroids). Glucocorticoids affect metabolism and have anti-inflammatory and immunosuppressive effects. They may be naturally produced (hormones) or synthetic (drugs). [NIH] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glutamic Acid: A non-essential amino acid naturally occurring in the L-form. Glutamic acid (glutamate) is the most common excitatory neurotransmitter in the central nervous system. [NIH]

Glycine: A non-essential amino acid. It is found primarily in gelatin and silk fibroin and used therapeutically as a nutrient. It is also a fast inhibitory neurotransmitter. [NIH] Gonad: A sex organ, such as an ovary or a testicle, which produces the gametes in most multicellular animals. [NIH] Gonadal: Pertaining to a gonad. [EU] Gonadorelin: A decapeptide hormone released by the hypothalamus. It stimulates the synthesis and secretion of both follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from the pituitary gland. [NIH] Gonadotropin: The water-soluble follicle stimulating substance, by some believed to originate in chorionic tissue, obtained from the serum of pregnant mares. It is used to supplement the action of estrogens. [NIH] Goserelin: 6-(O-(1,1-Dimethylethyl)-D-serine)-10-deglycinamideluteinizing hormonereleasing factor (pig) 2-(aminocarbonyl)hydrazide. A long-acting gonadorelin agonist. It is used in the treatment of malignant neoplasms of the prostate, uterine fibromas, and metastatic breast cancer. [NIH] Gossypol: Poisonous pigment found in cottonseed and potentially irritating to gastrointestinal tract. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer. [NIH] Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Grafting: The operation of transfer of tissue from one site to another. [NIH] Granulocytes: Leukocytes with abundant granules in the cytoplasm. They are divided into three groups: neutrophils, eosinophils, and basophils. [NIH] Gravidity: Pregnancy; the condition of being pregnant, without regard to the outcome. [EU] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Growth factors: Substances made by the body that function to regulate cell division and cell survival. Some growth factors are also produced in the laboratory and used in biological

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therapy. [NIH] Gynecology: A medical-surgical specialty concerned with the physiology and disorders primarily of the female genital tract, as well as female endocrinology and reproductive physiology. [NIH] Haploid: An organism with one basic chromosome set, symbolized by n; the normal condition of gametes in diploids. [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] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] Health Care Costs: The actual costs of providing services related to the delivery of health care, including the costs of procedures, therapies, and medications. It is differentiated from health expenditures, which refers to the amount of money paid for the services, and from fees, which refers to the amount charged, regardless of cost. [NIH] Health Expenditures: The amounts spent by individuals, groups, nations, or private or public organizations for total health care and/or its various components. These amounts may or may not be equivalent to the actual costs (health care costs) and may or may not be shared among the patient, insurers, and/or employers. [NIH] Health Status: The level of health of the individual, group, or population as subjectively assessed by the individual or by more objective measures. [NIH] Heart attack: A seizure of weak or abnormal functioning of the heart. [NIH] Hematocrit: Measurement of the volume of packed red cells in a blood specimen by centrifugation. The procedure is performed using a tube with graduated markings or with automated blood cell counters. It is used as an indicator of erythrocyte status in disease. For example, anemia shows a low hematocrit, polycythemia, high values. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemoglobin C: A commonly occurring abnormal hemoglobin in which lysine replaces a glutamic acid residue at the sixth position of the beta chains. It results in reduced plasticity of erythrocytes. [NIH] 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]

Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring.

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2. The genetic constitution of an individual. [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]

Hirsutism: Excess hair in females and children with an adult male pattern of distribution. The concept does not include hypertrichosis, which is localized or generalized excess hair. [NIH]

Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormonal therapy: Treatment of cancer by removing, blocking, or adding hormones. Also called hormone therapy or endocrine therapy. [NIH] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hormone Replacement Therapy: Therapeutic use of hormones to alleviate the effects of hormone deficiency. [NIH] Hormone therapy: Treatment of cancer by removing, blocking, or adding hormones. Also called endocrine therapy. [NIH] Host: Any animal that receives a transplanted graft. [NIH] 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] 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] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hypertrichosis: Localized or generalized excess hair. The concept does not include hirsutism, which is excess hair in females and children with an adult male pattern of distribution. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH] Hypothalamic: Of or involving the hypothalamus. [EU] 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] Hysterectomy: Excision of the uterus. [NIH]

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Hysterotomy: An incision in the uterus, performed through either the abdomen or the vagina. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunoglobulin: A protein that acts as an antibody. [NIH] Immunohistochemistry: Histochemical localization of immunoreactive substances using labeled antibodies as reagents. [NIH] Immunology: The study of the body's immune system. [NIH] Immunosuppressive: Describes the ability to lower immune system responses. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU] Impregnation: 1. The act of fecundation or of rendering pregnant. 2. The process or act of saturation; a saturated condition. [EU] In situ: In the natural or normal place; confined to the site of origin without invasion of neighbouring tissues. [EU] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incineration: High temperature destruction of waste by burning with subsequent reduction to ashes or conversion to an inert mass. [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] Incubation: The development of an infectious disease from the entrance of the pathogen to the appearance of clinical symptoms. [EU] Incubation period: The period of time likely to elapse between exposure to the agent of the disease and the onset of clinical symptoms. [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic

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clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Infertility: The diminished or absent ability to conceive or produce an offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH] Inositol: An isomer of glucose that has traditionally been considered to be a B vitamin although it has an uncertain status as a vitamin and a deficiency syndrome has not been identified in man. (From Martindale, The Extra Pharmacopoeia, 30th ed, p1379) Inositol phospholipids are important in signal transduction. [NIH] 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] 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] Insulin-like: Muscular growth factor. [NIH] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intestinal: Having to do with the intestines. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intracellular: Inside a cell. [NIH] 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]

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] Irrigation: The washing of a body cavity or surface by flowing solution which is inserted and then removed. Any drug in the irrigation solution may be absorbed. [NIH] Irritable Bowel Syndrome: A disorder that comes and goes. Nerves that control the muscles in the GI tract are too active. The GI tract becomes sensitive to food, stool, gas, and stress. Causes abdominal pain, bloating, and constipation or diarrhea. Also called spastic colon or mucous colitis. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] 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] Lactation: The period of the secretion of milk. [EU] Laparoscopy: Examination, therapy or surgery of the abdomen's interior by means of a laparoscope. [NIH] Laparotomy: A surgical incision made in the wall of the abdomen. [NIH] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Latent: Phoria which occurs at one distance or another and which usually has no troublesome effect. [NIH] Leiomyoma: A benign tumor derived from smooth muscle tissue, also known as a fibroid tumor. They rarely occur outside of the uterus and the gastrointestinal tract but can occur in the skin and subcutaneous tissues, probably arising from the smooth muscle of small blood vessels in these tissues. [NIH] Lens: The transparent, double convex (outward curve on both sides) structure suspended between the aqueous and vitreous; helps to focus light on the retina. [NIH] Leukotrienes: A family of biologically active compounds derived from arachidonic acid by oxidative metabolism through the 5-lipoxygenase pathway. They participate in host defense reactions and pathophysiological conditions such as immediate hypersensitivity and inflammation. They have potent actions on many essential organs and systems, including the cardiovascular, pulmonary, and central nervous system as well as the gastrointestinal tract and the immune system. [NIH] Leuprolide: A potent and long acting analog of naturally occurring gonadotropin-releasing hormone (gonadorelin). Its action is similar to gonadorelin, which regulates the synthesis and release of pituitary gonadotropins. [NIH] Levonorgestrel: A progestational hormone with actions similar to those of progesterone and about twice as potent as its racemic or (+-)-isomer (norgestrel). It is used for contraception, control of menstrual disorders, and treatment of endometriosis. [NIH] Libido: The psychic drive or energy associated with sexual instinct in the broad sense (pleasure and love-object seeking). It may also connote the psychic energy associated with instincts in general that motivate behavior. [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Ligands: A RNA simulation method developed by the MIT. [NIH] Ligation: Application of a ligature to tie a vessel or strangulate a part. [NIH] Linkages: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Lipid: Fat. [NIH] Lipophilic: Having an affinity for fat; pertaining to or characterized by lipophilia. [EU] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH]

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Localization: The process of determining or marking the location or site of a lesion or disease. May also refer to the process of keeping a lesion or disease in a specific location or site. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Locomotion: Movement or the ability to move from one place or another. It can refer to humans, vertebrate or invertebrate animals, and microorganisms. [NIH] Loop: A wire usually of platinum bent at one end into a small loop (usually 4 mm inside diameter) and used in transferring microorganisms. [NIH] Lumen: The cavity or channel within a tube or tubular organ. [EU] Luteal Phase: The period of the menstrual cycle that begins with ovulation and ends with menstruation. [NIH] Luteinizing hormone-releasing hormone agonist: LH-RH agonist. A drug that inhibits the secretion of sex hormones. In men, LH-RH agonist causes testosterone levels to fall. In women, LH-RH agonist causes the levels of estrogen and other sex hormones to fall. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]

Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphatic system: The tissues and organs that produce, store, and carry white blood cells that fight infection and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes and a network of thin tubes that carry lymph and white blood cells. These tubes branch, like blood vessels, into all the tissues of the body. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Lysine: An essential amino acid. It is often added to animal feed. [NIH] 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] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]

Mammary: Pertaining to the mamma, or breast. [EU] Meat: The edible portions of any animal used for food including domestic mammals (the major ones being cattle, swine, and sheep) along with poultry, fish, shellfish, and game. [NIH]

Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen

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with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Medical Staff: Professional medical personnel who provide care to patients in an organized facility, institution or agency. [NIH] 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] Medroxyprogesterone: (6 alpha)-17-Hydroxy-6-methylpregn-4-ene-3,20-dione. A synthetic progestational hormone used in veterinary practice as an estrus regulator. [NIH] Medroxyprogesterone Acetate: An injectable contraceptive, generally marketed under the name Depo-Provera. [NIH] Melanin: The substance that gives the skin its color. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Menarche: The establishment or beginning of the menstrual function. [EU] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Menopause: Permanent cessation of menstruation. [NIH] Menorrhagia: Excessive menstrual flow. [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] Metastasis: The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors" and contain cells that are like those in the original (primary) tumor. The plural is metastases. [NIH] Metastatic: Having to do with metastasis, which is the spread of cancer from one part of the body to another. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] 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] Microsomal: Of or pertaining to microsomes : vesicular fragments of endoplasmic reticulum formed after disruption and centrifugation of cells. [EU] Microspheres: Small uniformly-sized spherical particles frequently radioisotopes or various reagents acting as tags or markers. [NIH]

labeled

with

Microtubules: Slender, cylindrical filaments found in the cytoskeleton of plant and animal cells. They are composed of the protein tubulin. [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,

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especially in some types of diathermy. They may cause heat damage to tissues. [NIH] Mifepristone: A progestational and glucocorticoid hormone antagonist. Its inhibition of progesterone induces bleeding during the luteal phase and in early pregnancy by releasing endogenous prostaglandins from the endometrium or decidua. As a glucocorticoid receptor antagonist, the drug has been used to treat hypercortisolism in patients with nonpituitary Cushing syndrome. [NIH] Migration: The systematic movement of genes between populations of the same species, geographic race, or variety. [NIH] Milliliter: A measure of volume for a liquid. A milliliter is approximately 950-times smaller than a quart and 30-times smaller than a fluid ounce. A milliliter of liquid and a cubic centimeter (cc) of liquid are the same. [NIH] Mitochondrial Swelling: Increase in volume of mitochondria due to an influx of fluid; it occurs in hypotonic solutions due to osmotic pressure and in isotonic solutions as a result of altered permeability of the membranes of respiring mitochondria. [NIH] Mitosis: A method of indirect cell division by means of which the two daughter nuclei normally receive identical complements of the number of chromosomes of the somatic cells of the species. [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] Modulator: A specific inductor that brings out characteristics peculiar to a definite region. [EU]

Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] 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] Monoclonal: An antibody produced by culturing a single type of cell. It therefore consists of a single species of immunoglobulin molecules. [NIH] Morphological: Relating to the configuration or the structure of live organs. [NIH] Motility: The ability to move spontaneously. [EU] Mucosa: A mucous membrane, or tunica mucosa. [EU] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Myometrium: The smooth muscle coat of the uterus, which forms the main mass of the organ. [NIH] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH]

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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] Neoplasia: Abnormal and uncontrolled cell growth. [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] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [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 system. [NIH] Nidation: Implantation of the conceptus in the endometrium. [EU] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Norgestrel: (+-)-13-Ethyl-17-hydroxy-18,19-dinorpregn-4-en-20-yn-3-one. A progestational agent with actions similar to those of progesterone. This racemic or (+-)-form has about half the potency of the levo form (levonorgestrel). Norgestrel is used as a contraceptive and ovulation inhibitor and for the control of menstrual disorders and endometriosis. [NIH] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the next. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Oestrogen: A generic term for oestrus-producing steroid compounds; the female sex hormones. In humans, oestrogen is formed in the ovary, possibly the adrenal cortex, the testis, and the foetoplacental unit; it has various functions in both sexes. It is responsible for the development of the female secondary sex characteristics, and during the menstrual cycle it acts on the female genitalia to produce an environment suitable for the fertilization, implantation, and nutrition of the early embryo. Oestrogen is used in oral contraceptives and as a palliative in cancer of the breast after menopause and cancer of the prostate; other uses include the relief of the discomforts of menopause, inhibition of lactation, and treatment of osteoporosis, threatened abortion, and various functional ovarian disorders. [EU]

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Oncogenes: Genes which can potentially induce neoplastic transformation. They include genes for growth factors, growth factor receptors, protein kinases, signal transducers, nuclear phosphoproteins, and transcription factors. When these genes are constitutively expressed after structural and/or regulatory changes, uncontrolled cell proliferation may result. Viral oncogenes have prefix "v-" before the gene symbol; cellular oncogenes (protooncogenes) have the prefix "c-" before the gene symbol. [NIH] Optic Chiasm: The X-shaped structure formed by the meeting of the two optic nerves. At the optic chiasm the fibers from the medial part of each retina cross to project to the other side of the brain while the lateral retinal fibers continue on the same side. As a result each half of the brain receives information about the contralateral visual field from both eyes. [NIH]

Osteoarthritis: Degeneration of articular cartilage. Primary osteoarthritis is very common in older persons, especially affecting weight-bearing joints. Articular cartilage becomes soft, frayed and thinned. [NIH] Osteopetrosis: Excessive formation of dense trabecular bone leading to pathological fractures, osteitis, splenomegaly with infarct, anemia, and extramedullary hemopoiesis. [NIH]

Osteoporosis: Reduction of bone mass without alteration in the composition of bone, leading to fractures. Primary osteoporosis can be of two major types: postmenopausal osteoporosis and age-related (or senile) osteoporosis. [NIH] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Ovarian Cysts: General term for cysts and cystic diseases of the ovary. [NIH] Ovarian Follicle: Spheroidal cell aggregation in the ovary containing an ovum. It consists of an external fibro-vascular coat, an internal coat of nucleated cells, and a transparent, albuminous fluid in which the ovum is suspended. [NIH] Ovaries: The pair of female reproductive glands in which the ova, or eggs, are formed. The ovaries are located in the pelvis, one on each side of the uterus. [NIH] Ovary: Either of the paired glands in the female that produce the female germ cells and secrete some of the female sex hormones. [NIH] 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] Paclitaxel: Antineoplastic agent isolated from the bark of the Pacific yew tree, Taxus brevifolia. Paclitaxel stabilizes microtubules in their polymerized form and thus mimics the action of the proto-oncogene proteins c-mos. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Papilla: A small nipple-shaped elevation. [NIH] Papillary: Pertaining to or resembling papilla, or nipple. [EU] Parity: The number of offspring a female has borne. It is contrasted with gravidity, which refers to the number of pregnancies, regardless of outcome. [NIH] Paroxysmal: Recurring in paroxysms (= spasms or seizures). [EU] Partial remission: The shrinking, but not complete disappearance, of a tumor in response to

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therapy. Also called partial response. [NIH] Particle: A tiny mass of material. [EU] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]

Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathologic Processes: The abnormal mechanisms and forms involved in the dysfunctions of tissues and organs. [NIH] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Patient Selection: Criteria and standards used for the determination of the appropriateness of the inclusion of patients with specific conditions in proposed treatment plans and the criteria used for the inclusion of subjects in various clinical trials and other research protocols. [NIH] Pelvic: Pertaining to the pelvis. [EU] Penis: The external reproductive organ of males. It is composed of a mass of erectile tissue enclosed in three cylindrical fibrous compartments. Two of the three compartments, the corpus cavernosa, are placed side-by-side along the upper part of the organ. The third compartment below, the corpus spongiosum, houses the urethra. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] Perimenopausal: The time of a woman's life when menstrual periods become irregular. Refers to the time near menopause. [NIH] Peritoneum: Endothelial lining of the abdominal cavity, the parietal peritoneum covering the inside of the abdominal wall and the visceral peritoneum covering the bowel, the mesentery, and certain of the organs. The portion that covers the bowel becomes the serosal layer of the bowel wall. [NIH] Pertussis: An acute, highly contagious infection of the respiratory tract, most frequently affecting young children, usually caused by Bordetella pertussis; a similar illness has been associated with infection by B. parapertussis and B. bronchiseptica. It is characterized by a catarrhal stage, beginning after an incubation period of about two weeks, with slight fever, sneezing, running at the nose, and a dry cough. In a week or two the paroxysmal stage begins, with the characteristic paroxysmal cough, consisting of a deep inspiration, followed by a series of quick, short coughs, continuing until the air is expelled from the lungs; the close of the paroxysm is marked by a long-drawn, shrill, whooping inspiration, due to spasmodic closure of the glottis. This stage lasts three to four weeks, after which the convalescent stage begins, in which paroxysms grow less frequent and less violent, and finally cease. Called also whooping cough. [EU] PH: The symbol relating the hydrogen ion (H+) concentration or activity of a solution to that of a given standard solution. Numerically the pH is approximately equal to the negative logarithm of H+ concentration expressed in molarity. pH 7 is neutral; above it alkalinity increases and below it acidity increases. [EU] Pharmaceutical Preparations: Drugs intended for human or veterinary use, presented in their finished dosage form. Included here are materials used in the preparation and/or formulation of the finished dosage form. [NIH]

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Pharmacodynamic: Is concerned with the response of living tissues to chemical stimuli, that is, the action of drugs on the living organism in the absence of disease. [NIH] 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] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phenyl: Ingredient used in cold and flu remedies. [NIH] Phenylalanine: An aromatic amino acid that is essential in the animal diet. It is a precursor of melanin, dopamine, noradrenalin, and thyroxine. [NIH] Phorbol: Class of chemicals that promotes the development of tumors. [NIH] Phorbol Esters: Tumor-promoting compounds obtained from croton oil (Croton tiglium). Some of these are used in cell biological experiments as activators of protein kinase C. [NIH] Phospholipases: A class of enzymes that catalyze the hydrolysis of phosphoglycerides or glycerophosphatidates. EC 3.1.-. [NIH] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] 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] Photocoagulation: Using a special strong beam of light (laser) to seal off bleeding blood vessels such as in the eye. The laser can also burn away blood vessels that should not have grown in the eye. This is the main treatment for diabetic retinopathy. [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pigment: A substance that gives color to tissue. Pigments are responsible for the color of skin, eyes, and hair. [NIH] Pilot study: The initial study examining a new method or treatment. [NIH] Pituitary Gland: A small, unpaired gland situated in the sella turcica tissue. It is connected to the hypothalamus by a short stalk. [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

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and diploid generations. [NIH] Plaque: A clear zone in a bacterial culture grown on an agar plate caused by localized destruction of bacterial cells by a bacteriophage. The concentration of infective virus in a fluid can be estimated by applying the fluid to a culture and counting the number of. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma cells: A type of white blood cell that produces antibodies. [NIH] 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 Activation: A series of progressive, overlapping events triggered by exposure of the platelets to subendothelial tissue. These events include shape change, adhesiveness, aggregation, and release reactions. When carried through to completion, these events lead to the formation of a stable hemostatic plug. [NIH] Platinum: Platinum. A heavy, soft, whitish metal, resembling tin, atomic number 78, atomic weight 195.09, symbol Pt. (From Dorland, 28th ed) It is used in manufacturing equipment for laboratory and industrial use. It occurs as a black powder (platinum black) and as a spongy substance (spongy platinum) and may have been known in Pliny's time as "alutiae". [NIH]

Polychlorinated Biphenyls: Industrial products consisting of a mixture of chlorinated biphenyl congeners and isomers. These compounds are highly lipophilic and tend to accumulate in fat stores of animals. Many of these compounds are considered toxic and potential environmental pollutants. [NIH] Polycystic: An inherited disorder characterized by many grape-like clusters of fluid-filled cysts that make both kidneys larger over time. These cysts take over and destroy working kidney tissue. PKD may cause chronic renal failure and end-stage renal disease. [NIH] Polymorphic: Occurring in several or many forms; appearing in different forms at different stages of development. [EU] 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] Population Control: Includes mechanisms or programs which control the numbers of individuals in a population of humans or animals. [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] Postpartum Hemorrhage: The presence of abnormal uterine bleeding immediately after labor or childbirth. [NIH] Postsynaptic: Nerve potential generated by an inhibitory hyperpolarizing stimulation. [NIH] 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] Potentiation: An overall effect of two drugs taken together which is greater than the sum of the effects of each drug taken alone. [NIH]

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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] Preclinical: Before a disease becomes clinically recognizable. [EU] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Premenopausal: Refers to the time before menopause. Menopause is the time of life when a women's menstrual periods stop permanently; also called "change of life." [NIH] Premenstrual: Occurring before menstruation. [EU] Premenstrual Syndrome: A syndrome occurring most often during the last week of the menstrual cycle and ending soon after the onset of menses. Some of the symptoms are emotional instability, insomnia, headache, nausea, vomiting, abdominal distension, and painful breasts. [NIH] Prenatal: Existing or occurring before birth, with reference to the fetus. [EU] Primary tumor: The original tumor. [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] Progestogen: A term applied to any substance possessing progestational activity. [EU] 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] 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] 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

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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] Prostaglandins A: (13E,15S)-15-Hydroxy-9-oxoprosta-10,13-dien-1-oic acid (PGA(1)); (5Z,13E,15S)-15-hydroxy-9-oxoprosta-5,10,13-trien-1-oic acid (PGA(2)); (5Z,13E,15S,17Z)-15hydroxy-9-oxoprosta-5,10,13,17-tetraen-1-oic acid (PGA(3)). A group of naturally occurring secondary prostaglandins derived from PGE. PGA(1) and PGA(2) as well as their 19hydroxy derivatives are found in many organs and tissues. [NIH] Prostaglandins F: (9 alpha,11 alpha,13E,15S)-9,11,15-Trihydroxyprost-13-en-1-oic acid (PGF(1 alpha)); (5Z,9 alpha,11,alpha,13E,15S)-9,11,15-trihydroxyprosta-5,13-dien-1-oic acid (PGF(2 alpha)); (5Z,9 alpha,11 alpha,13E,15S,17Z)-9,11,15-trihydroxyprosta-5,13,17-trien-1oic acid (PGF(3 alpha)). A family of prostaglandins that includes three of the six naturally occurring prostaglandins. All naturally occurring PGF have an alpha configuration at the 9carbon position. They stimulate uterine and bronchial smooth muscle and are often used as oxytocics. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Prostatic Hyperplasia: Enlargement or overgrowth of the prostate gland as a result of an increase in the number of its constituent cells. [NIH] Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein Kinases: A family of enzymes that catalyze the conversion of ATP and a protein to ADP and a phosphoprotein. EC 2.7.1.37. [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] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Proto-Oncogene Proteins: Products of proto-oncogenes. Normally they do not have oncogenic or transforming properties, but are involved in the regulation or differentiation of cell growth. They often have protein kinase activity. [NIH] Proto-Oncogene Proteins c-mos: Cellular proteins encoded by the c-mos genes. They function in the cell cycle to maintain maturation promoting factor in the active state and

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have protein-serine/threonine kinase activity. Oncogenic transformation can take place when c-mos proteins are expressed at the wrong time. [NIH] Proto-Oncogenes: Normal cellular genes homologous to viral oncogenes. The products of proto-oncogenes are important regulators of biological processes and appear to be involved in the events that serve to maintain the ordered procession through the cell cycle. Protooncogenes have names of the form c-onc. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Puberty: The period during which the secondary sex characteristics begin to develop and the capability of sexual reproduction is attained. [EU] 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]

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] Quiescent: Marked by a state of inactivity or repose. [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] 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] Radiological: Pertaining to radiodiagnostic and radiotherapeutic procedures, and interventional radiology or other planning and guiding medical radiology. [NIH] Radiologist: A doctor who specializes in creating and interpreting pictures of areas inside the body. The pictures are produced with x-rays, sound waves, or other types of energy. [NIH]

Raloxifene: A second generation selective estrogen receptor modulator (SERM) used to prevent osteoporosis in postmenopausal women. It has estrogen agonist effects on bone and cholesterol metabolism but behaves as a complete estrogen antagonist on mammary gland and uterine tissue. [NIH] Random Allocation: A process involving chance used in therapeutic trials or other research endeavor for allocating experimental subjects, human or animal, between treatment and control groups, or among treatment groups. It may also apply to experiments on inanimate objects. [NIH] Randomization: Also called random allocation. Is allocation of individuals to groups, e.g., for experimental and control regimens, by chance. Within the limits of chance variation, random allocation should make the control and experimental groups similar at the start of an investigation and ensure that personal judgment and prejudices of the investigator do not

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influence allocation.

[NIH]

Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Randomized Controlled Trials: Clinical trials that involve at least one test treatment and one control treatment, concurrent enrollment and follow-up of the test- and control-treated groups, and in which the treatments to be administered are selected by a random process, such as the use of a random-numbers table. Treatment allocations using coin flips, odd-even numbers, patient social security numbers, days of the week, medical record numbers, or other such pseudo- or quasi-random processes, are not truly randomized and trials employing any of these techniques for patient assignment are designated simply controlled clinical trials. [NIH] Reactive Oxygen Species: Reactive intermediate oxygen species including both radicals and non-radicals. These substances are constantly formed in the human body and have been shown to kill bacteria and inactivate proteins, and have been implicated in a number of diseases. Scientific data exist that link the reactive oxygen species produced by inflammatory phagocytes to cancer development. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Receptors, Serotonin: Cell-surface proteins that bind serotonin and trigger intracellular changes which influence the behavior of cells. Several types of serotonin receptors have been recognized which differ in their pharmacology, molecular biology, and mode of action. [NIH] Recombinant: A cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Rectovaginal Fistula: Abnormal communication between the rectum and the vagina. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Renal cell cancer: Cancer that develops in the lining of the renal tubules, which filter the blood and produce urine. [NIH] Renin: An enzyme which is secreted by the kidney and is formed from prorenin in plasma and kidney. The enzyme cleaves the Leu-Leu bond in angiotensinogen to generate angiotensin I. EC 3.4.23.15. (Formerly EC 3.4.99.19). [NIH] Reproductive system: In women, this system includes the ovaries, the fallopian tubes, the uterus (womb), the cervix, and the vagina (birth canal). The reproductive system in men includes the prostate, the testes, and the penis. [NIH] Resection: Removal of tissue or part or all of an organ by surgery. [NIH] Resolving: The ability of the eye or of a lens to make small objects that are close together, separately visible; thus revealing the structure of an object. [NIH] Retroperitoneal: Having to do with the area outside or behind the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH]

144 Fibroids

Rigidity: Stiffness or inflexibility, chiefly that which is abnormal or morbid; rigor. [EU] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Saline: A solution of salt and water. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Saponins: Sapogenin glycosides. A type of glycoside widely distributed in plants. Each consists of a sapogenin as the aglycon moiety, and a sugar. The sapogenin may be a steroid or a triterpene and the sugar may be glucose, galactose, a pentose, or a methylpentose. Sapogenins are poisonous towards the lower forms of life and are powerful hemolytics when injected into the blood stream able to dissolve red blood cells at even extreme dilutions. [NIH] Sarcoma: A connective tissue neoplasm formed by proliferation of mesodermal cells; it is usually highly malignant. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Selective estrogen receptor modulator: SERM. A drug that acts like estrogen on some tissues, but blocks the effect of estrogen on other tissues. Tamoxifen and raloxifene are SERMs. [NIH] Sella: A deep depression in the shape of a Turkish saddle in the upper surface of the body of the sphenoid bone in the deepest part of which is lodged the hypophysis cerebri. [NIH] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Senile: Relating or belonging to old age; characteristic of old age; resulting from infirmity of old age. [NIH] Sensor: A device designed to respond to physical stimuli such as temperature, light, magnetism or movement and transmit resulting impulses for interpretation, recording, movement, or operating control. [NIH] Serine: A non-essential amino acid occurring in natural form as the L-isomer. It is synthesized from glycine or threonine. It is involved in the biosynthesis of purines, pyrimidines, and other amino acids. [NIH] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH]

Dictionary 145

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] Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Signal Transduction: The intercellular or intracellular transfer of information (biological activation/inhibition) through a signal pathway. In each signal transduction system, an activation/inhibition signal from a biologically active molecule (hormone, neurotransmitter) is mediated via the coupling of a receptor/enzyme to a second messenger system or to an ion channel. Signal transduction plays an important role in activating cellular functions, cell differentiation, and cell proliferation. Examples of signal transduction systems are the GABA-postsynaptic receptor-calcium ion channel system, the receptor-mediated T-cell activation pathway, and the receptor-mediated activation of phospholipases. Those coupled to membrane depolarization or intracellular release of calcium include the receptormediated activation of cytotoxic functions in granulocytes and the synaptic potentiation of protein kinase activation. Some signal transduction pathways may be part of larger signal transduction pathways; for example, protein kinase activation is part of the platelet activation signal pathway. [NIH] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Sleep apnea: A serious, potentially life-threatening breathing disorder characterized by repeated cessation of breathing due to either collapse of the upper airway during sleep or absence of respiratory effort. [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]

Smooth Muscle Tumor: A tumor composed of smooth muscle tissue, as opposed to leiomyoma, a tumor derived from smooth muscle. [NIH] Sneezing: Sudden, forceful, involuntary expulsion of air from the nose and mouth caused by irritation to the mucous membranes of the upper respiratory tract. [NIH] Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH]

146 Fibroids

Solid tumor: Cancer of body tissues other than blood, bone marrow, or the lymphatic system. [NIH] Solvent: 1. Dissolving; effecting a solution. 2. A liquid that dissolves or that is capable of dissolving; the component of a solution that is present in greater amount. [EU] Soma: The body as distinct from the mind; all the body tissue except the germ cells; all the axial body. [NIH] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Sonogram: A computer picture of areas inside the body created by bouncing sound waves off organs and other tissues. Also called ultrasonogram or ultrasound. [NIH] Sound wave: An alteration of properties of an elastic medium, such as pressure, particle displacement, or density, that propagates through the medium, or a superposition of such alterations. [NIH] Spasmodic: Of the nature of a spasm. [EU] Spastic: 1. Of the nature of or characterized by spasms. 2. Hypertonic, so that the muscles are stiff and the movements awkward. 3. A person exhibiting spasticity, such as occurs in spastic paralysis or in cerebral palsy. [EU] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a 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] Speculum: An instrument used to widen an opening of the body to make it easier to look inside. [NIH] Sperm: The fecundating fluid of the male. [NIH] Spermatogenesis: Process of formation and development of spermatozoa, including spermatocytogenesis and spermiogenesis. [NIH] Spermatozoa: Mature male germ cells that develop in the seminiferous tubules of the testes. Each consists of a head, a body, and a tail that provides propulsion. The head consists mainly of chromatin. [NIH] 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] Splenomegaly: Enlargement of the spleen. [NIH] Sporadic: Neither endemic nor epidemic; occurring occasionally in a random or isolated manner. [EU] Spotting: A slight discharge of blood via the vagina, especially as a side-effect of oral contraceptives. [EU]

Dictionary 147

Sterility: 1. The inability to produce offspring, i.e., the inability to conceive (female s.) or to induce conception (male s.). 2. The state of being aseptic, or free from microorganisms. [EU] Sterilization: The destroying of all forms of life, especially microorganisms, by heat, chemical, or other means. [NIH] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] 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] Stromal: Large, veil-like cell in the bone marrow. [NIH] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Submucous: Occurring beneath the mucosa or a mucous membrane. [NIH] Subspecies: A category intermediate in rank between species and variety, based on a smaller number of correlated characters than are used to differentiate species and generally conditioned by geographical and/or ecological occurrence. [NIH] Substance P: An eleven-amino acid neurotransmitter that appears in both the central and peripheral nervous systems. It is involved in transmission of pain, causes rapid contractions of the gastrointestinal smooth muscle, and modulates inflammatory and immune responses. [NIH]

Substrate: A substance upon which an enzyme acts. [EU] 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] Symphysis: A secondary cartilaginous joint. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Systemic: Affecting the entire body. [NIH]

148 Fibroids

Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Tamoxifen: A first generation selective estrogen receptor modulator (SERM). It acts as an agonist for bone tissue and cholesterol metabolism but is an estrogen antagonist in mammary and uterine. [NIH] 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] Testis: Either of the paired male reproductive glands that produce the male germ cells and the male hormones. [NIH] Testosterone: A hormone that promotes the development and maintenance of male sex characteristics. [NIH] 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]

Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thigh: A leg; in anatomy, any elongated process or part of a structure more or less comparable to a leg. [NIH] Third Ventricle: A narrow cleft inferior to the corpus callosum, within the diencephalon, between the paired thalami. Its floor is formed by the hypothalamus, its anterior wall by the lamina terminalis, and its roof by ependyma. It communicates with the fourth ventricle by the cerebral aqueduct, and with the lateral ventricles by the interventricular foramina. [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] Thrombin: An enzyme formed from prothrombin that converts fibrinogen to fibrin. (Dorland, 27th ed) EC 3.4.21.5. [NIH] Thrombomodulin: A cell surface glycoprotein of endothelial cells that binds thrombin and serves as a cofactor in the activation of protein C and its regulation of blood coagulation. [NIH]

Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thromboxanes: Physiologically active compounds found in many organs of the body. They are formed in vivo from the prostaglandin endoperoxides and cause platelet aggregation, contraction of arteries, and other biological effects. Thromboxanes are important mediators of the actions of polyunsaturated fatty acids transformed by cyclooxygenase. [NIH] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tomography: Imaging methods that result in sharp images of objects located on a chosen plane and blurred images located above or below the plane. [NIH] 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]

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Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Traction: The act of pulling. [NIH] Transcription Factors: Endogenous substances, usually proteins, which are effective in the initiation, stimulation, or termination of the genetic transcription process. [NIH] Transcutaneous: Transdermal. [EU] Transduction: The transfer of genes from one cell to another by means of a viral (in the case of bacteria, a bacteriophage) vector or a vector which is similar to a virus particle (pseudovirion). [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transfusion: The infusion of components of blood or whole blood into the bloodstream. The blood may be donated from another person, or it may have been taken from the person earlier and stored until needed. [NIH] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Transvaginal ultrasound: A procedure used to examine the vagina, uterus, fallopian tubes, and bladder. An instrument is inserted into the vagina, and sound waves bounce off organs inside the pelvic area. These sound waves create echoes, which a computer uses to create a picture called a sonogram. Also called TVS. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Treatment Failure: A measure of the quality of health care by assessment of unsuccessful results of management and procedures used in combating disease, in individual cases or series. [NIH] Triptorelin: A long-acting gonadorelin analog agonist. It has been used in the treatment of prostatic cancer, ovarian cancer, precocious puberty, endometriosis, and to induce ovulation for in vitro fertilization. [NIH] Troglitazone: A drug used in diabetes treatment that is being studied for its effect on reducing the risk of cancer cell growth in fat tissue. [NIH] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tubal ligation: An operation to tie the fallopian tubes closed. This procedure prevents pregnancy by blocking the passage of eggs from the ovaries to the uterus. [NIH] Tumour: 1. Swelling, one of the cardinal signs of inflammations; morbid enlargement. 2. A new growth of tissue in which the multiplication of cells is uncontrolled and progressive; called also neoplasm. [EU] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Ultrasound test: A test that bounces sound waves off tissues and internal organs and changes the echoes into pictures (sonograms). [NIH]

150 Fibroids

Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Ureters: Tubes that carry urine from the kidneys to the bladder. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

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] 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] Uteroglobin: A protein fraction of pregnant uterine fluid which can induce and regulate blastocystic development. Blastokinin is thought to be similar or identical to uteroglobin. Presence in uterine fluid regulated by progesterone. [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] Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Vaginal: Of or having to do with the vagina, the birth canal. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vector: Plasmid or other self-replicating DNA molecule that transfers DNA between cells in nature or in recombinant DNA technology. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Vesicular: 1. Composed of or relating to small, saclike bodies. 2. Pertaining to or made up of vesicles on the skin. [EU] 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] 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] Viscera: Any of the large interior organs in any one of the three great cavities of the body, especially in the abdomen. [NIH] Vitamin A: A substance used in cancer prevention; it belongs to the family of drugs called retinoids. [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]

Dictionary 151

Weight-Bearing: The physical state of supporting an applied load. This often refers to the weight-bearing bones or joints that support the body's weight, especially those in the spine, hip, knee, and foot. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]

Whooping Cough: A respiratory infection caused by Bordetella pertussis and characterized by paroxysmal coughing ending in a prolonged crowing intake of breath. [NIH] Whooping Cough: A respiratory infection caused by Bordetella pertussis and characterized by paroxysmal coughing ending in a prolonged crowing intake of breath. [NIH] Womb: A hollow, thick-walled, muscular organ in which the impregnated ovum is developed into a child. [NIH] Xenograft: The cells of one species transplanted to another species. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH] Yeasts: A general term for single-celled rounded fungi that reproduce by budding. Brewers' and bakers' yeasts are Saccharomyces cerevisiae; therapeutic dried yeast is dried yeast. [NIH] Zygote: The fertilized ovum. [NIH] Zymogen: Inactive form of an enzyme which can then be converted to the active form, usually by excision of a polypeptide, e. g. trypsinogen is the zymogen of trypsin. [NIH]

153

INDEX 1 1-phosphate, 7, 111 A Abdomen, 111, 115, 116, 129, 130, 131, 143, 147, 150 Abdominal, 16, 21, 25, 28, 32, 111, 118, 130, 136, 137, 140, 143 Abdominal Pain, 111, 130 Ablate, 7, 111, 123 Ablation, 17, 21, 22, 62, 68, 84, 85, 111 Acoustic, 4, 111 Acyl, 65, 73, 111 Adaptability, 111, 117 Adenovirus, 7, 13, 66, 111 Adhesions, 62, 111 Adjuvant, 5, 111, 125 Adolescence, 13, 111 Adrenal Cortex, 111, 121, 124, 135, 140 Adverse Effect, 12, 47, 111, 145 Affinity, 65, 67, 111, 131, 145 Agonist, 36, 37, 38, 40, 41, 47, 60, 64, 111, 126, 132, 142, 148, 149 Airway, 111, 145 Algorithms, 112, 115 Alkaline, 46, 112, 116 Alternative medicine, 87, 112 Aluminum, 63, 112 Amenorrhea, 24, 112 Amino Acid Sequence, 112, 113, 125 Amino Acids, 58, 112, 113, 125, 137, 139, 141, 144 Ampulla, 112, 123, 124 Anaesthesia, 112, 129 Anal, 4, 112 Analgesic, 47, 112 Analog, 84, 112, 116, 131, 149 Analogous, 5, 112, 149 Anaplasia, 112 Androgens, 65, 111, 112 Anemia, 9, 66, 75, 76, 112, 127, 136 Aneurysm, 5, 112 Angiogenesis, 7, 112 Angioplasty, 12, 112 Angiotensinogen, 113, 143 Animal model, 7, 12, 13, 21, 38, 48, 113 Anomalies, 66, 113 Antibodies, 11, 58, 113, 127, 129, 139

Antibody, 111, 113, 119, 127, 129, 133, 134, 146 Anticoagulant, 113, 141 Antigen, 111, 113, 119, 129, 132 Anti-inflammatory, 113, 126 Antineoplastic, 113, 116, 136 Anus, 112, 113, 116 Anxiety, 13, 81, 113 Aorta, 113 Aortography, 25, 32, 113 Apnea, 113 Apoptosis, 7, 66, 70, 113 Appendectomy, 69, 113 Applicability, 65, 113 Approximate, 62, 68, 113 Arachidonic Acid, 70, 114, 131, 140 Arterial, 17, 114, 128, 141, 148 Arteries, 18, 61, 62, 68, 69, 113, 114, 115, 120, 133, 148 Arteriography, 28, 114 Arterioles, 114, 115 Arteriovenous, 5, 114 Articular, 114, 136 Assay, 10, 73, 114 Atony, 66, 114 Atrophy, 24, 114 Attenuation, 14, 114 Autologous, 9, 114 B Bacteria, 111, 113, 114, 115, 123, 124, 133, 143, 146, 149, 150 Bacteriophage, 114, 139, 149 Basal Ganglia, 114, 116 Base, 114, 122, 125, 130, 148 Basement Membrane, 114, 124 Benign, 3, 4, 8, 9, 11, 17, 58, 59, 60, 62, 67, 68, 69, 100, 114, 125, 127, 131, 135 Benign prostatic hyperplasia, 60, 114 Benign tumor, 59, 100, 114, 131 Bile, 70, 114, 115, 121, 125, 131, 147 Bile Acids, 115, 147 Bile Acids and Salts, 115 Biochemical, 13, 115, 144 Biological therapy, 115, 127 Biopsy, 69, 115, 137 Biosynthesis, 60, 114, 115, 144 Biotechnology, 15, 78, 87, 93, 115

154 Fibroids

Bladder, 40, 66, 70, 114, 115, 121, 129, 141, 149, 150 Blastocyst, 115, 120, 123, 138 Bloating, 115, 130 Blood Cell Count, 115, 127 Blood Coagulation, 115, 116, 148 Blood Glucose, 115, 127, 130 Blood Platelets, 115, 144 Blood pressure, 115, 117, 128, 145 Blood transfusion, 9, 115 Blood vessel, 61, 69, 71, 112, 115, 116, 117, 123, 130, 131, 132, 138, 145, 147, 148, 150 Blot, 13, 115 Body Fluids, 116, 122, 123, 145 Bone Density, 17, 37, 39, 116 Bone Marrow, 116, 132, 146, 147 Bowel, 62, 66, 112, 116, 122, 130, 137, 147 Bowel Movement, 116, 122, 147 Brain Diseases, 72, 116 Branch, 107, 116, 132, 137, 142, 146, 148 Bronchial, 116, 141 Bronchiseptica, 116, 137 Buserelin, 36, 38, 64, 116 C Calcium, 5, 116, 119, 123, 145 Cannula, 61, 68, 116 Capsules, 116, 125 Carboplatin, 47, 116 Carcinogenesis, 38, 70, 116 Carcinogenic, 116, 130, 147 Carcinogens, 70, 116 Carcinoma, 70, 116 Cardiac, 116, 123, 124, 134, 147 Cardiovascular, 8, 9, 72, 116, 131, 144 Cardiovascular disease, 8, 9, 116 Case report, 23, 24, 26, 117, 118 Catalyse, 70, 117 Catheterization, 112, 113, 117 Caudal, 117, 122, 128, 139 Cell Aggregation, 117, 136 Cell Cycle, 7, 117, 141, 142 Cell Death, 59, 113, 117, 135 Cell Differentiation, 117, 145 Cell Division, 114, 117, 126, 134, 138 Cell proliferation, 7, 117, 136, 145 Cell Survival, 117, 126 Cellulose, 117, 138 Central Nervous System, 72, 116, 117, 126, 127, 131, 144 Centrifugation, 117, 127, 133 Ceramide, 7, 117 Cerebellum, 116, 117

Cerebral, 114, 116, 117, 118, 124, 146, 148 Cerebrovascular, 72, 117 Cerebrum, 117, 118 Cervical, 4, 6, 31, 118 Cervical Ripening, 6, 118 Cervix, 72, 118, 143 Cesarean Section, 66, 118 Character, 118, 121 Chemoprevention, 6, 118 Cholecystectomy, 69, 118 Cholesterol, 115, 118, 120, 142, 147, 148 Chromatin, 113, 118, 146 Chromosome, 10, 22, 118, 127, 131 Chromosome Aberrations, 10, 118 Chronic, 5, 13, 53, 60, 62, 88, 99, 118, 123, 129, 139 Chronic renal, 118, 139 Clinical study, 118, 120 Clinical trial, 4, 7, 9, 53, 54, 67, 93, 118, 120, 122, 137, 143 Cloning, 10, 58, 115, 118 Coagulation, 22, 26, 63, 86, 115, 118, 127 Cofactor, 118, 141, 148 Cohort Studies, 14, 119 Colitis, 119, 130 Collagen, 6, 12, 114, 119, 125, 140 Collapse, 119, 145 Common Bile Duct, 119, 121 Complement, 119, 125 Complementary and alternative medicine, 45, 46, 50, 119 Complementary medicine, 17, 36, 45, 46, 119 Complete remission, 120, 143 Compress, 69, 120 Computational Biology, 93, 120 Conception, 8, 16, 28, 41, 67, 120, 125, 147 Connective Tissue, 59, 116, 119, 120, 125, 132, 144 Connective Tissue Cells, 120 Consciousness, 112, 120, 122 Constipation, 120, 130 Consultation, 3, 120 Contraception, 6, 60, 65, 67, 73, 120, 131 Contraceptive, 67, 72, 120, 125, 133, 135 Contraceptive Agents, 67, 72, 120 Contraindications, ii, 120 Contrast Media, 113, 120 Control group, 11, 120, 142 Controlled clinical trial, 32, 120, 143 Controlled study, 16, 120 Coronary, 116, 120, 121, 133

Index 155

Coronary heart disease, 116, 120 Coronary Thrombosis, 121, 133 Corpus, 121, 137, 140, 148 Corpus Luteum, 121, 140 Cortex, 116, 121 Cortical, 121, 144 Corticosteroids, 121, 126 Cortisol, 54, 121 Cortisone, 65, 121 Croton Oil, 121, 138 Cryotherapy, 85, 121 Curative, 121, 148 Cutaneous, 22, 121 Cyclic, 60, 121, 141 Cystic Duct, 70, 119, 121 Cystitis, 88, 121 Cytoplasm, 113, 121, 126 Cytotoxic, 121, 145 D Databases, Bibliographic, 93, 121 Decidua, 121, 134, 138 Degenerative, 72, 121 Deletion, 58, 113, 121 Delivery of Health Care, 121, 127 Density, 116, 117, 122, 146 Depolarization, 122, 145 Deuterium, 122, 128 Diabetes Mellitus, 122, 127 Diagnostic Equipment, 71, 122 Diagnostic procedure, 57, 71, 87, 122 Diarrhea, 122, 130 Diastolic, 122, 128 Diencephalon, 122, 128, 148 Digestion, 115, 116, 122, 130, 131, 147 Digestive system, 55, 122, 125 Dihydroxy, 64, 122 Dilatation, 112, 122, 140 Diploid, 122, 139 Direct, iii, 7, 59, 122, 143 Dissociation, 111, 122 Distal, 23, 122, 123, 142 Dose-dependent, 27, 122 Double-blinded, 9, 12, 122 Drug Interactions, 122 Duct, 23, 69, 112, 116, 117, 119, 122, 144 Duodenum, 114, 122, 123, 147 Dysmenorrhea, 49, 60, 65, 73, 74, 122 E Ectopic, 23, 123 Efficacy, 7, 12, 14, 18, 25, 39, 45, 47, 59, 67, 123 Elastin, 119, 123

Electrocoagulation, 118, 123 Electrode, 62, 123 Electrolytes, 36, 115, 123 Embolization, 5, 15, 18, 19, 20, 22, 24, 25, 26, 27, 28, 30, 31, 32, 33, 42, 68, 69, 77, 78, 84, 85, 86, 87, 100, 123 Embryo, 28, 115, 117, 123, 129, 135 Embryo Transfer, 28, 123 Endarterectomy, 112, 123 Endemic, 123, 146 Endocrinology, 36, 37, 40, 47, 66, 77, 123, 127 Endometrial, 8, 12, 17, 24, 28, 45, 47, 62, 65, 68, 70, 73, 74, 75, 123 Endometrium, 36, 47, 72, 73, 121, 123, 133, 134, 135 Endoscope, 123 Endoscopic, 41, 123 Endothelial cell, 70, 123, 148 End-stage renal, 118, 123, 139 Enucleation, 78, 124 Environmental Health, 21, 48, 92, 94, 124 Environmental Pollutants, 124, 139 Enzymatic, 116, 119, 124 Enzyme, 64, 70, 124, 143, 145, 147, 148, 150, 151 Epidemic, 124, 146 Epinephrine, 124, 149 Epithelial, 70, 121, 124 Epithelial Cells, 70, 124 Erythrocytes, 112, 115, 116, 124, 127 Esophageal, 47, 124 Esophagus, 122, 124, 147 Estradiol, 6, 124 Estrogen, 7, 9, 10, 11, 13, 17, 21, 38, 47, 48, 59, 66, 72, 124, 132, 142, 144, 148 Estrogen receptor, 7, 21, 38, 47, 48, 66, 72, 124 Ethnic Groups, 11, 124 Exogenous, 21, 38, 48, 124 Extracellular, 6, 13, 58, 120, 124, 145 Extracellular Matrix, 6, 13, 120, 124 Extracellular Space, 124 Eye Infections, 111, 124 F Fallopian Tubes, 124, 143, 149 Family Planning, 93, 125 Fat, 114, 115, 116, 117, 120, 123, 125, 131, 139, 149 Fatty acids, 125, 140, 148 Fetus, 118, 125, 138, 140, 150 Fistula, 32, 125

156 Fibroids

Foetoplacental, 125, 135 Follicles, 54, 125 G Gallbladder, 111, 118, 121, 122, 125 Gas, 125, 128, 130, 135 Gastric, 60, 125 Gastrin, 125, 128 Gastroenterologist, 3, 125 Gastrointestinal, 3, 124, 125, 126, 131, 144, 147 Gastrointestinal tract, 125, 126, 131, 144 Gelatin, 22, 31, 125, 126, 147 Gene, 4, 10, 13, 20, 22, 23, 66, 73, 78, 85, 111, 115, 125, 136, 139 Genetic Code, 125, 135 Genetic Engineering, 115, 118, 125 Genital, 125, 127 Genotype, 125, 138 Germ Cells, 125, 136, 146, 148 Gestrinone, 41, 125 Gland, 53, 58, 111, 121, 125, 132, 136, 138, 141, 142, 144, 147, 148 Glottis, 126, 137 Glucocorticoid, 65, 126, 134 Glucose, 115, 117, 122, 126, 127, 130, 144 Glutamic Acid, 126, 127, 140 Glycine, 36, 115, 126, 144 Gonad, 126 Gonadal, 10, 58, 59, 126, 147 Gonadorelin, 126, 131, 149 Gonadotropin, 10, 19, 36, 37, 39, 40, 46, 47, 58, 60, 64, 116, 126, 131 Goserelin, 8, 16, 20, 36, 37, 38, 39, 64, 126 Gossypol, 47, 126 Governing Board, 126, 140 Grade, 5, 47, 126 Graft, 126, 128 Grafting, 126, 129 Granulocytes, 126, 145, 151 Gravidity, 126, 136 Growth factors, 7, 12, 66, 70, 126, 136 Gynecology, 3, 7, 16, 20, 21, 23, 25, 27, 28, 30, 36, 37, 39, 40, 41, 47, 66, 78, 127 H Haploid, 127, 138 Haptens, 111, 127 Headache, 127, 140 Health Care Costs, 12, 14, 127 Health Expenditures, 127 Health Status, 12, 127 Heart attack, 117, 127 Hematocrit, 46, 115, 127

Hemoglobin, 9, 112, 115, 124, 127 Hemoglobin C, 9, 127 Hemorrhage, 5, 123, 127, 147 Hemostasis, 4, 127, 144 Heredity, 125, 127 Heterogeneity, 111, 128 Hirsutism, 58, 60, 128 Hormonal, 10, 20, 59, 60, 75, 114, 128 Hormonal therapy, 59, 128 Hormone Replacement Therapy, 6, 18, 27, 40, 66, 128 Hormone therapy, 128 Host, 58, 114, 128, 131 Hydrogen, 65, 73, 114, 122, 128, 134, 137, 141 Hydrolysis, 58, 128, 138, 139 Hydroxylysine, 119, 128 Hydroxyproline, 119, 128 Hyperlipidemia, 72, 128 Hyperplasia, 12, 72, 128 Hypertension, 12, 13, 19, 86, 117, 127, 128 Hypertrichosis, 128 Hypertrophy, 4, 58, 114, 128 Hypothalamic, 10, 14, 60, 128 Hypothalamus, 58, 116, 122, 126, 128, 138, 148 Hysterotomy, 118, 129 I Id, 42, 48, 99, 101, 106, 108, 129 Immune response, 7, 111, 113, 121, 127, 129, 147, 150 Immune system, 115, 129, 131, 150, 151 Immunoglobulin, 113, 129, 134 Immunohistochemistry, 13, 129 Immunology, 111, 129 Immunosuppressive, 126, 129 Impairment, 124, 129, 133 Implantation, 27, 40, 120, 129, 135 Impregnation, 63, 129 In situ, 59, 64, 129 In vitro, 5, 10, 21, 38, 46, 48, 66, 67, 70, 117, 123, 129, 149 In vivo, 5, 10, 13, 21, 38, 46, 48, 65, 66, 67, 129, 148 Incineration, 8, 129 Incision, 70, 129, 130, 131 Incontinence, 4, 129 Incubation, 129, 137 Incubation period, 129, 137 Indicative, 75, 129, 137, 150 Induction, 6, 112, 129 Infarction, 121, 129, 133

Index 157

Infection, 115, 124, 129, 132, 137, 147, 151 Infertility, 6, 7, 8, 19, 29, 40, 62, 66, 130 Infusion, 130, 149 Initiation, 8, 130, 149 Inositol, 58, 130 Insight, 12, 130 Insomnia, 130, 140 Insulin, 19, 37, 130 Insulin-dependent diabetes mellitus, 130 Insulin-like, 19, 37, 130 Interstitial, 21, 88, 124, 130 Intestinal, 70, 130 Intestine, 115, 116, 130, 131 Intracellular, 12, 58, 129, 130, 139, 141, 143, 145 Intrinsic, 111, 114, 130 Invasive, 5, 14, 23, 31, 45, 59, 68, 69, 130, 132 Ions, 114, 122, 123, 128, 130 Irrigation, 36, 130 Irritable Bowel Syndrome, 58, 130 Ischemia, 114, 130 K Kb, 92, 130 Kinetics, 7, 131 L Lactation, 8, 131, 135 Laparoscopy, 81, 131 Laparotomy, 62, 131 Large Intestine, 122, 130, 131, 143, 145 Latent, 131, 140 Leiomyoma, 7, 11, 12, 20, 21, 24, 38, 39, 46, 47, 48, 53, 59, 62, 68, 125, 131, 145 Lens, 131, 143 Leukotrienes, 114, 131 Leuprolide, 25, 36, 39, 47, 131 Levonorgestrel, 27, 84, 131, 135 Libido, 112, 131 Library Services, 106, 131 Ligament, 131, 141 Ligands, 21, 38, 48, 131 Ligation, 131 Linkages, 127, 131 Lipid, 130, 131 Lipophilic, 131, 139 Liver, 54, 69, 72, 111, 114, 115, 122, 125, 131 Localization, 22, 129, 132 Localized, 128, 129, 132, 138, 139 Locomotion, 132, 138 Loop, 62, 132 Lumen, 69, 116, 132

Luteal Phase, 132, 134 Luteinizing hormone-releasing hormone agonist, 37, 132 Lymph, 69, 118, 123, 132 Lymph node, 69, 118, 132 Lymphatic, 130, 132, 146 Lymphatic system, 132, 146 Lymphoid, 113, 121, 132 Lysine, 127, 128, 132 M Magnetic Resonance Imaging, 22, 54, 132 Malignant, 4, 10, 113, 126, 132, 135, 144 Malnutrition, 114, 132 Mammary, 73, 132, 142, 148 Meat, 86, 132 Mediate, 14, 132 Mediator, 132, 144 Medical Staff, 122, 133 Medicament, 64, 133, 147 MEDLINE, 93, 133 Medroxyprogesterone, 39, 133 Medroxyprogesterone Acetate, 39, 133 Melanin, 133, 138, 149 Membrane, 119, 122, 123, 133, 134, 138, 145, 147 Menarche, 6, 8, 59, 66, 133 Meninges, 117, 133 Menopause, 6, 7, 8, 9, 17, 40, 59, 64, 66, 77, 133, 135, 137, 139, 140 Menorrhagia, 7, 62, 68, 86, 133 Menstrual Cycle, 8, 40, 53, 67, 132, 133, 135, 140 Menstruation, 49, 112, 121, 122, 132, 133, 140 Mental Disorders, 55, 133 Mental Health, iv, 4, 55, 92, 94, 133, 142 Metastasis, 133 Metastatic, 126, 133 MI, 110, 133 Microorganism, 118, 133, 150 Microsomal, 70, 133 Microspheres, 22, 85, 133 Microtubules, 133, 136 Microwaves, 133, 142 Mifepristone, 11, 65, 84, 134 Migration, 13, 70, 134 Milliliter, 116, 134 Mitochondrial Swelling, 134, 135 Mitosis, 113, 134 Mobility, 10, 134 Modeling, 5, 134 Modification, 125, 134, 142

158 Fibroids

Modulator, 53, 134 Molecular, 7, 10, 13, 20, 28, 66, 93, 95, 115, 120, 134, 143 Molecule, 10, 11, 113, 114, 119, 122, 128, 134, 143, 145, 150 Monoclonal, 59, 134 Morphological, 123, 134 Motility, 13, 60, 134, 144 Mucosa, 134, 147 Myocardium, 133, 134 Myometrium, 7, 11, 13, 19, 20, 28, 37, 40, 47, 134 N Nausea, 134, 140 NCI, 1, 55, 91, 134 Necrosis, 26, 113, 129, 133, 135 Need, 3, 6, 53, 61, 68, 73, 76, 79, 81, 88, 102, 118, 135 Neoplasia, 135 Neoplasm, 135, 144, 149 Neoplastic, 47, 70, 112, 135, 136 Nerve, 47, 132, 135, 139, 147 Nervous System, 117, 132, 135, 147 Neuronal, 58, 135 Neurons, 135, 147 Nidation, 123, 135 Nitrogen, 112, 135, 149 Norgestrel, 131, 135 Nuclear, 114, 135, 136, 148 Nuclei, 125, 132, 134, 135, 141 Nucleic acid, 58, 125, 135 Nucleus, 113, 118, 121, 122, 124, 135, 141 O Oestrogen, 24, 39, 64, 135 Oncogenes, 70, 136, 142 Optic Chiasm, 128, 136 Osteoarthritis, 72, 136 Osteopetrosis, 64, 136 Osteoporosis, 8, 9, 72, 77, 85, 135, 136, 142 Outpatient, 14, 24, 30, 84, 136 Ovarian Cysts, 8, 77, 136 Ovarian Follicle, 8, 121, 136 Ovaries, 8, 54, 60, 62, 68, 72, 124, 136, 143, 145, 149 Ovary, 58, 121, 124, 126, 135, 136 Ovulation, 53, 60, 132, 135, 136, 149 Ovum, 121, 136, 140, 151 P Paclitaxel, 47, 136 Palliative, 60, 135, 136, 148 Pancreas, 111, 122, 130, 136 Papilla, 136

Papillary, 20, 136 Parity, 32, 136 Paroxysmal, 136, 137, 151 Partial remission, 136, 143 Particle, 61, 137, 146, 149 Pathogenesis, 10, 76, 137 Pathologic, 113, 115, 116, 120, 137 Pathologic Processes, 113, 137 Pathophysiology, 13, 19, 137 Patient Selection, 30, 137 Pelvic, 3, 5, 6, 7, 8, 9, 11, 12, 27, 39, 53, 66, 86, 88, 123, 137, 141, 149 Penis, 137, 143 Peptide, 10, 60, 137, 139, 141 Percutaneous, 17, 22, 113, 137 Perimenopausal, 9, 46, 137 Peritoneum, 137, 143 Pertussis, 58, 137, 151 PH, 26, 46, 116, 137 Pharmaceutical Preparations, 117, 125, 137 Pharmacodynamic, 10, 138 Pharmacokinetic, 10, 138 Pharmacologic, 62, 121, 138, 149 Phenotype, 7, 138 Phenyl, 67, 73, 74, 138 Phenylalanine, 138, 149 Phorbol, 70, 138 Phorbol Esters, 70, 138 Phospholipases, 138, 145 Phospholipids, 125, 130, 138 Phosphorus, 116, 138 Photocoagulation, 118, 138 Physical Examination, 53, 138 Physiologic, 13, 111, 115, 133, 138, 140, 143 Physiology, 123, 127, 138 Pigment, 126, 138 Pilot study, 17, 27, 36, 46, 138 Pituitary Gland, 58, 126, 138 Placenta, 124, 125, 138, 140 Plants, 48, 126, 138, 144 Plaque, 112, 139 Plasma, 113, 125, 127, 139, 143, 144 Plasma cells, 113, 139 Plasticity, 127, 139 Platelet Activation, 139, 145 Platinum, 132, 139 Polychlorinated Biphenyls, 73, 139 Polycystic, 58, 67, 139 Polymorphic, 58, 139 Polypeptide, 73, 112, 119, 139, 151 Population Control, 65, 139

Index 159

Posterior, 112, 117, 136, 139 Postmenopausal, 9, 18, 23, 27, 40, 136, 139, 142 Postoperative, 47, 139 Postpartum Hemorrhage, 66, 139 Postsynaptic, 139, 145 Potassium, 123, 139 Potentiation, 139, 145 Practice Guidelines, 94, 99, 140 Preclinical, 67, 140 Precursor, 113, 114, 124, 138, 140, 149 Predisposition, 10, 64, 140 Premenopausal, 7, 8, 16, 76, 140 Premenstrual, 38, 58, 67, 140 Premenstrual Syndrome, 38, 58, 67, 140 Prenatal, 123, 140 Primary tumor, 59, 140 Probe, 14, 54, 71, 140 Progesterone, 6, 11, 17, 19, 37, 53, 59, 64, 65, 66, 67, 73, 125, 131, 134, 135, 140, 147, 150 Progestogen, 67, 72, 140 Progression, 113, 140 Progressive, 117, 118, 126, 135, 139, 140, 149 Prolapse, 62, 68, 140 Proline, 119, 128, 140 Prospective study, 14, 140 Prostaglandin, 70, 140, 148 Prostaglandins A, 141 Prostaglandins F, 70, 134, 141 Prostate, 10, 58, 60, 72, 114, 126, 135, 141, 143 Prostatic Hyperplasia, 141 Protein C, 13, 112, 114, 141 Protein Kinases, 136, 141 Protein S, 59, 78, 115, 125, 141 Proteins, 58, 73, 112, 113, 115, 118, 119, 134, 135, 137, 139, 141, 143, 144, 149 Protons, 128, 141 Proto-Oncogene Proteins, 136, 141 Proto-Oncogene Proteins c-mos, 136, 141 Proto-Oncogenes, 136, 141, 142 Proximal, 14, 59, 122, 142 Psychic, 131, 142, 144 Puberty, 10, 58, 60, 72, 142, 149 Public Health, 9, 13, 94, 142 Public Policy, 93, 142 Publishing, 3, 15, 142 Q Quality of Life, 9, 11, 53, 88, 142 Quiescent, 70, 142

R Race, 131, 134, 135, 142 Radio Waves, 54, 133, 142 Radioactive, 128, 129, 135, 142 Radiological, 137, 142 Radiologist, 30, 142 Raloxifene, 7, 142, 144 Random Allocation, 142 Randomization, 9, 142 Randomized, 9, 12, 16, 25, 32, 39, 46, 123, 143 Randomized Controlled Trials, 46, 143 Reactive Oxygen Species, 12, 143 Receptor, 10, 53, 58, 64, 66, 67, 70, 113, 134, 143, 144, 145 Receptors, Serotonin, 143, 144 Recombinant, 7, 13, 58, 143, 150 Rectovaginal Fistula, 4, 143 Rectum, 113, 116, 122, 125, 129, 131, 141, 143, 147 Recurrence, 118, 143 Refer, 1, 119, 132, 143 Regimen, 9, 47, 123, 143 Remission, 60, 143 Renal cell cancer, 20, 143 Renin, 64, 113, 143 Reproductive system, 71, 143 Resection, 32, 36, 62, 82, 143 Resolving, 45, 143 Retroperitoneal, 61, 68, 143 Rigidity, 138, 144 Risk factor, 20, 25, 140, 144 S Saline, 54, 144 Salivary, 122, 144 Salivary glands, 122, 144 Saponins, 144, 147 Sarcoma, 47, 144 Screening, 58, 118, 144 Secretion, 6, 10, 60, 126, 130, 131, 132, 144 Seizures, 5, 136, 144 Selective estrogen receptor modulator, 72, 142, 144, 148 Sella, 138, 144 Semen, 141, 144 Senile, 136, 144 Sensor, 62, 69, 144 Serine, 126, 142, 144 Serotonin, 12, 143, 144, 149 Serum, 8, 36, 40, 119, 126, 144 Sex Characteristics, 111, 112, 135, 142, 145, 148

160 Fibroids

Side effect, 7, 59, 64, 111, 115, 145, 148 Signal Transduction, 7, 130, 145 Signs and Symptoms, 67, 143, 145 Skeletal, 112, 145 Skeleton, 140, 145 Skull, 145, 148 Sleep apnea, 58, 145 Small intestine, 121, 122, 128, 130, 145 Smooth muscle, 7, 12, 13, 59, 120, 125, 131, 134, 141, 145, 147 Smooth Muscle Tumor, 125, 145 Sneezing, 137, 145 Social Environment, 142, 145 Sodium, 123, 145 Solid tumor, 10, 112, 146 Solvent, 61, 146 Soma, 146 Somatic, 13, 111, 134, 146 Sonogram, 146, 149 Sound wave, 54, 71, 142, 146, 149 Spasmodic, 137, 146 Spastic, 130, 146 Specialist, 61, 68, 101, 146 Species, 58, 124, 134, 142, 143, 146, 147, 149, 151 Specificity, 111, 146 Spectrum, 133, 142, 146 Speculum, 54, 146 Sperm, 27, 40, 112, 118, 146 Spermatogenesis, 58, 60, 146 Spermatozoa, 144, 146 Spinal cord, 117, 118, 133, 135, 146 Splenomegaly, 136, 146 Sporadic, 64, 146 Spotting, 53, 146 Sterility, 16, 19, 22, 23, 24, 26, 28, 32, 130, 147 Sterilization, 25, 147 Steroid, 10, 14, 28, 40, 58, 60, 64, 65, 73, 115, 121, 135, 144, 147 Stimulus, 123, 147, 148 Stomach, 111, 122, 124, 125, 128, 134, 145, 147 Stool, 129, 130, 131, 147 Stress, 3, 121, 130, 134, 140, 147 Stroke, 5, 55, 92, 117, 147 Stromal, 47, 123, 147 Subclinical, 129, 144, 147 Subcutaneous, 7, 131, 147 Submucous, 21, 27, 36, 41, 62, 147 Subspecies, 146, 147 Substance P, 140, 144, 147

Substrate, 70, 147 Suppositories, 125, 147 Suppression, 60, 147 Symphysis, 141, 147 Symptomatic, 12, 16, 17, 21, 22, 24, 26, 27, 29, 30, 31, 33, 36, 62, 68, 85, 147 Synaptic, 145, 147 Systemic, 59, 113, 115, 124, 130, 147 Systolic, 128, 148 T Tamoxifen, 5, 7, 37, 144, 148 Temporal, 13, 148 Testis, 124, 135, 148 Testosterone, 10, 132, 148 Thalamus, 116, 122, 148 Therapeutics, 11, 61, 148 Thigh, 63, 148 Third Ventricle, 128, 148 Threshold, 128, 148 Thrombin, 141, 148 Thrombomodulin, 141, 148 Thrombosis, 141, 147, 148 Thromboxanes, 114, 148 Thyroid, 148, 149 Tomography, 116, 148 Toxic, iv, 139, 148, 149 Toxicity, 122, 148 Toxicology, 46, 94, 149 Traction, 78, 149 Transcription Factors, 136, 149 Transcutaneous, 47, 149 Transduction, 7, 145, 149 Transfection, 115, 149 Transfusion, 9, 149 Transplantation, 118, 123, 149 Transvaginal ultrasound, 8, 54, 149 Trauma, 127, 135, 149 Treatment Failure, 24, 149 Triptorelin, 40, 41, 149 Troglitazone, 59, 149 Tryptophan, 119, 144, 149 Tubal ligation, 69, 149 Tumour, 70, 149 Tyrosine, 11, 149 U Ultrasonography, 12, 149 Ultrasound test, 54, 149 Unconscious, 129, 150 Ureters, 150 Urethra, 114, 137, 141, 150 Urinary, 40, 72, 121, 129, 150 Urinary tract, 72, 150

Index 161

Urine, 53, 114, 115, 129, 143, 150 Uteroglobin, 73, 150 V Vaccine, 111, 150 Vagina, 54, 118, 129, 133, 143, 146, 149, 150 Vaginal, 21, 29, 42, 59, 61, 68, 72, 73, 84, 109, 150 Vascular, 5, 12, 15, 22, 24, 25, 26, 27, 30, 31, 32, 129, 130, 136, 138, 150 Vector, 4, 66, 149, 150 Vein, 54, 112, 114, 135, 150 Venous, 114, 115, 141, 150 Venules, 115, 150 Vesicular, 133, 150 Veterinary Medicine, 93, 150 Viral, 136, 142, 149, 150 Virus, 114, 125, 139, 149, 150

Viscera, 146, 150 Vitamin A, 130, 150 Vitro, 150 Vivo, 47, 150 W Weight-Bearing, 136, 151 White blood cell, 111, 113, 132, 139, 151 Whooping Cough, 137, 151 Womb, 143, 150, 151 X Xenograft, 113, 151 X-ray, 71, 114, 116, 135, 142, 151 Y Yeasts, 138, 151 Z Zygote, 120, 151 Zymogen, 141, 151

162 Fibroids

Index 163

164 Fibroids