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

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

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

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

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

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Fistulas: 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: 0-597-84423-2 1. Fistulas-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 fistulas. 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 FISTULAS ................................................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Fistulas.......................................................................................... 6 E-Journals: PubMed Central ....................................................................................................... 11 The National Library of Medicine: PubMed ................................................................................ 13 CHAPTER 2. NUTRITION AND FISTULAS ......................................................................................... 39 Overview...................................................................................................................................... 39 Finding Nutrition Studies on Fistulas ........................................................................................ 39 Federal Resources on Nutrition ................................................................................................... 42 Additional Web Resources ........................................................................................................... 42 CHAPTER 3. ALTERNATIVE MEDICINE AND FISTULAS ................................................................... 45 Overview...................................................................................................................................... 45 National Center for Complementary and Alternative Medicine.................................................. 45 Additional Web Resources ........................................................................................................... 51 General References ....................................................................................................................... 53 CHAPTER 4. CLINICAL TRIALS AND FISTULAS................................................................................ 55 Overview...................................................................................................................................... 55 Recent Trials on Fistulas ............................................................................................................. 55 Keeping Current on Clinical Trials ............................................................................................. 56 CHAPTER 5. PATENTS ON FISTULAS ................................................................................................ 59 Overview...................................................................................................................................... 59 Patents on Fistulas....................................................................................................................... 59 Patent Applications on Fistulas................................................................................................... 75 Keeping Current .......................................................................................................................... 85 CHAPTER 6. BOOKS ON FISTULAS ................................................................................................... 87 Overview...................................................................................................................................... 87 Book Summaries: Federal Agencies.............................................................................................. 87 Book Summaries: Online Booksellers........................................................................................... 92 The National Library of Medicine Book Index ............................................................................. 93 Chapters on Fistulas .................................................................................................................... 93 CHAPTER 7. MULTIMEDIA ON FISTULAS ......................................................................................... 99 Overview...................................................................................................................................... 99 Video Recordings ......................................................................................................................... 99 CHAPTER 8. PERIODICALS AND NEWS ON FISTULAS .................................................................... 101 Overview.................................................................................................................................... 101 News Services and Press Releases.............................................................................................. 101 Newsletter Articles .................................................................................................................... 103 Academic Periodicals covering Fistulas ..................................................................................... 105 CHAPTER 9. RESEARCHING MEDICATIONS .................................................................................. 107 Overview.................................................................................................................................... 107 U.S. Pharmacopeia..................................................................................................................... 107 Commercial Databases ............................................................................................................... 108 Researching Orphan Drugs ....................................................................................................... 108 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 113 Overview.................................................................................................................................... 113 NIH Guidelines.......................................................................................................................... 113 NIH Databases........................................................................................................................... 115 Other Commercial Databases..................................................................................................... 117 The Genome Project and Fistulas............................................................................................... 117

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APPENDIX B. PATIENT RESOURCES ............................................................................................... 121 Overview.................................................................................................................................... 121 Patient Guideline Sources.......................................................................................................... 121 Associations and Fistulas........................................................................................................... 124 Finding Associations.................................................................................................................. 125 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 127 Overview.................................................................................................................................... 127 Preparation................................................................................................................................. 127 Finding a Local Medical Library................................................................................................ 127 Medical Libraries in the U.S. and Canada ................................................................................. 127 ONLINE GLOSSARIES................................................................................................................ 133 Online Dictionary Directories ................................................................................................... 134 FISTULAS DICTIONARY ........................................................................................................... 135 INDEX .............................................................................................................................................. 189

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

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

Recent Advances in the Diagnosis and Treatment of Renal Arteriovenous Malformations and Fistulas Source: Journal of Urology. 150(5: part 1 of 2): 1355-1359. November 1993. Summary: An arteriovenous fistula is any anomalous connection between the arterial and venous systems, and it can be acquired or idiopathic. The term arteriovenous malformation is usually reserved for congenital arteriovenous fistulas characterized by multiple communications between the main or segmental renal arteries and veins. This review article covers recent advances in the diagnosis and treatment of renal arteriovenous malformations and fistulas. Topics include anatomy, etiology and incidence, clinical presentation, imaging studies, and treatment, including surgery and embolization treatments. 2 figures. 1 table. 58 references.

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Increasing AV Fistula Creation: The Akron Experience Source: Nephrology News and Issues. 16(6): 44-51. May 2002. Contact: Available from Nephrology News and Issues Inc. 15150 North Hayden Road, Suite 101, Scottsdale, AZ 85260. (602) 443-4635. Summary: Hemodialysis (HD) access failure is a major source of morbidity (illness) and hospitalization for end stage renal disease (ESRD) patients. A native arteriovenous (AV) fistula remains the preferred HD vascular access because AV fistulas have the best long term patency, lowest complication and lowest infection rate of any available vascular access. Increasing arteriovenous (AV) fistula creation to more than 50 percent of patient accesses in a dialysis unit is one of the goals listed in the National Kidney Foundation's Kidney Disease Outcome Quality Initiative (NKF K/DOQI). This article reports the increase of AV fistula creation from 30.6 percent in 2001 to 53.3 percent in 2002 at one dialysis unit through the implementation of an AV fistula creation program initiated by the Akron, Ohio, Vascular Access Management Program. Increases in fistula creation were demonstrated in people with diabetes (27.8 percent to 51.8 percent), females (21.3 percent to 42.3 percent) and by eight of the 11 vascular access surgeons in Akron. The authors stress that this achievement was the result of using a team approach in a community-based quality improvement program. 6 figures. 11 references.

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Diagnostic Testing and Perilymphatic Fistulas: Critical Review Source: Seminars in Hearing. 15(1): 31-36. February 1994. Summary: This article critically reviews diagnostic tests used in the evaluation of perilymphatic fistulas. The author notes that, despite extensive diagnostic procedures used to evaluate the perilymphatic fistula (PLF) problem, it still elude definitive resolution. Topics covered include factors in the patient history; symptoms; the physical examination; the finding of positional nystagmus; the rapid turning test; auditory function testing; standard audiometry; positional auditory testing; electrocochleography; vestibular testing modalities; standard electronystagmography; and diagnostic imaging studies. The author stresses that one particular difficulty encountered in the diagnosis of PLF is the lack of any precise definition of what constitutes a perilymphatic fistula at surgery. 37 references.

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Congenital Abnormalities, Fistulas, Injury, Rings, and Systemic Disease Involving the Esophagus Source: Current Opinion in Gastroenterology. 8(4): 624-629. August 1992. Summary: This article describes recent advances in congenital abnormalities, fistulas, injury, rings, and systemic disease involving the esophagus. Topics include esophageal atresia, congenital fistulas, esophageal fistulas, esophageal perforation, traumatic injury to the esophagus, corrosive injury, esophageal webs, and the effect of systemic illness and other conditions on the esophagus. The author notes that congenital lesions such as H-type fistulas and congenital stenosis can be recognized in children and adults and treated surgically. 3 figures. 1 table. 38 annotated references. (AA-M).

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Tracheaesophageal Fistula and Esophageal Atresia: What Are They? Source: TEF/VATER Support Newsletter. p.3-5. Winter 1993. Contact: Available from TEF-VATER Support Network. c/o Terri Burke, 15301 Grey Fox Road, Upper Marlboro, MD 207702. (301) 627-2131.

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Summary: This article describes tracheoesophageal fistula, also called esophageal atresia. In this condition, the esophagus has a gap between its upper and lower segments, so that nothing can pass through, not even saliva. The fistula is a connection between the esophagus and trachea, which, depending on its position, either lets food or acidic stomach juices into the lungs. This article describes the prevalence of this condition; associated problems; how the anomaly is typically discovered; the types of tracheoesophageal fistulas (TEF); treatment after diagnosis; reconstructive surgery; parental reaction to learning of this anomaly in their infant; long-term effects of TEF as the child grows and develops; and the prognosis for children with TEF. The article concludes with a glossary of related terms. 5 figures. •

Interventions to Promote Fistula Maturation Source: Nephrology Nursing Journal. 29(4): 377, 402. August 2002. Contact: Available from American Nephrology Nurses' Association. East Holly Avenue, Box 56, Pitman, NJ 08071-0056. (856) 256-2320. Fax (856) 589-7463. Website: www.annanurse.org. Summary: This article is an entry from a regular column called Clinical Consult, in which common questions concerning clinical problems in nephrology (kidney specialty) nursing are addressed. In this entry, the author considers interventions to promote fistula maturation. The author first reviews the normal process of maturation and the nursing techniques used to promote it. The author provides specific strategies for first cannulation, preventing bleeding, and coping with possible complications from the patient's medications. The author notes that a few fistulas have taken almost a year of work and nursing care to get to the point where the staff can comfortably remove the catheter, but the persistence has paid off. However, if this period of time is unacceptable, surgical techniques for superficializing or transposing the vein are being developed and may be considered by the surgeon before giving up and placing a graft. 3 references.

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Update on Idiopathic Perilymphatic Fistulas Source: Otolaryngologic Clinics of North America. 29(2): 343-352. April 1996. Summary: This article provides an update on the diagnosis and treatment of idiopathic perilymphatic fistulas. The article addresses recent etiologic studies, diagnostic criteria, and pediatric considerations. The authors describe nonsurgical and surgical treatment options, complications, and results. The authors stress that all diagnosis and treatment of idiopathic perilymphatic fistula should rest on sound objective studies. They contend that until additional temporal bone histopathologic studies and appropriate physiologic studies are completed, proposals concerning labyrinthine mechanisms, mechanisms of recurrence, and alternative methods of treatment remain speculative. 3 figures. 1 table. 15 references.

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Treatment and Management of Perilymphatic Fistula Source: Seminars in Hearing. 15(1): 11-21. February 1994. Summary: This article reports on 45 cases of spontaneously occurring perilymphatic fistula. Eight patients presented with bilateral involvement; 7 with involvement of both oval and round window in the same ear; and 7 with fistulas believed to be of congenital origin. Seventeen patients (38 percent) required revision surgery. Endolymphatic shunt, labyrinthectomy, blocking the cochlear aqueduct, and streptomycin ablation were used

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variously for symptom control. The author discusses the diagnosis, treatment, and management of these patients. The author notes that the cases discussed here suggest the variety of presentations seen and the treatment modalities used in this diverse group of patients. 5 tables. 16 references. (AA-M). •

General Management of Gastrointestinal Fistulas: Recognition, Stabilization, and Correction of Fluid and Electrolyte Imbalances Source: Surgical Clinics of North America. 76(5): 1019-1033. October 1996. Contact: Available from W.B. Saunders Company. Periodicals Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887. (800) 654-2452. Summary: This review article, from an issue on the surgical management of gastrointestinal fistulas, discusses the general management of these fistulas. The authors note that much of the morbidity associated with GI fistulas results from fluid losses, electrolyte abnormalities, nutritional depletion, and sepsis. Early recognition of fistulas and correction of fluid and electrolyte imbalances, therefore, are important steps in their management. The authors outline an approach to the correction of the metabolic abnormalities resulting from GI fistulas, including esophageal fistulas, gastric and duodenal fistulas, pancreatic fistulas, and colonic fistulas. For each type, the authors describe three phases of management: diagnosis and recognition, stabilization and investigation, and treatment. 2 tables. 60 references. (AA-M).

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

Project Title: COLLABORATIVE CLINICAL TRIALS IN VASCULAR ACCESS Principal Investigator & Institution: Dixon, Bradley S.; Internal Medicine; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2002; Project Start 30-SEP-2000; Project End 31-JUL-2005 Summary: The Eastern Iowa Western Illinois Vascular Access Consortium (EIWIVAC) is a consortium of hemodialysis units surrounding the University of Iowa co-founded by a

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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vascular biologist and an expert in clinical trials design to address the problem of vascular access failure. Hemodialysis vascular access failure is a frequent cause of morbidity and a major expense in caring for hemodialysis patients. The cause of access failure is neointimal hyperplasia leading to stenosis and thrombosis. This process occurs in both arteriovenous grafts (AVG) and native fistulas (AVF). The hypothesis underlying the present proposal is that pharmacological agents that inhibit vascular smooth muscle cell (vsmc) proliferation will decrease the neointimal hyperplasia and prolong vascular access survival. Both HMG CoA reductase inhibitors and dipyridamole have been shown to inhibit vascular smooth muscle cell proliferation. HMG CoA reductase inhibitors prevent the isoprenylation of small GTP binding proteins such as Ras that are needed for cell proliferation. Dipyridamole increases extracellular adenosine levels that can inhibit proliferation by unclear mechanisms. Studies from our lab have shown that combined treatment with these agents in low doses is additive or even synergistic at inhibiting vsmc proliferation. Therefore, we propose a randomized placebo controlled primary prevention trial using a factorial design to test whether treatment with either dipyridamole or an HMG CoA reductase inhibitor will increase primary survival of a newly created vascular access: either an AVG or an AVF. In addition, we briefly propose two additional trials. With access monitoring to detect stenosis before access failure, many prevalent accesses will require angioplasty. However, the restenosis rate after angioplasty is very high and resistant to many pharmacological agents. We propose in a second trial to test the hypothesis that the more potent antiproliferative effects of rapamycin in combination with an HMG CoA reductase inhibitor will inhibit the smooth muscle cell proliferation leading to restenosis. Finally, data shows that an upper arm native fistula (UAF) has superior survival to an AVG. However, the UAF appears to be underutilized in part because of concerns over high access flow rates and the possibility of increased heart failure and distal steal syndromes. While a randomized trial is not possible, we propose to establish a registry to examine the safety of a UAF compared to an AVG. If safety issues can be addressed, increased utilization of UAF may be the most cost-effective intervention. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FEMTOSECOND LASER ENHANCED AQUEOUS OUTFLOW FACILITY Principal Investigator & Institution: Juhasz, Tibor; Associate Professor; Biomedical Engineering; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2003; Project Start 01-AUG-2003; Project End 31-JUL-2006 Summary: (provided by applicant): Femtosecond laser pulses can be delivered through transparent and translucent tissue to perform high precision surgical procedures without damage to superficial or adjacent tissues. These unique properties of femtosecond laser-tissue interactions may provide a marked advantage over traditional laser techniques for high precision subsurface procedures. We hypothesize that the application of femtosecond lasers to the treatment of glaucoma has several potential advantages over traditional surgical and laser treatments. Among these advantages, localized tissue effects, intra-scleral capabilities, highly precise beam delivery through the conjunctiva and sclera, minimally invasive treatments, short procedure times and a potentially decreased healing response are significant. To test our hypothesis we propose the evaluation of femtosecond laser created intra-scleral fistulas of various geometries for the facilitation of aqueous outflow. Initially, a comprehensive in vitro tissue study will be performed to understand the effects femtosecond laser cut fistulas

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on aqueous outflow and refine geometric requirements. Theoretical modeling of the aqueous outflow dynamics will also be performed in order to deeper understand the flow dynamics and to aid channel optimization. To ensure precise drainage channel creation, ultrasound imaging will be used to monitor the surgical procedures. Ultrasound imaging is a powerful tool that can provide high-resolution visualization of the femtosecond laser treatments in both optically transparent and non-transparent tissue. After the completion of the in vitro investigations animal experiments are planned to study the effect of femtosecond laser created intra-scleral fistulas on the aqueous humor outflow in vivo. Optimization of the experimental apparatus and surgical procedures will be first accomplished, allowing the execution of long-term wound-healing studies. The longevity and effectiveness of the femtosecond laser procedures will be compared to those of traditional surgical and laser therapies tested under similar conditions. The successful completion of this project will provide a proof of concept for a minimally invasive, high precision femtosecond laser treatment of glaucoma. Additionally, by providing information on the in vivo physiological properties of the aqueous humor outflow, the results will add to our understanding of the etiology and mechanisms of glaucoma. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MEDICAL MAINTENANCE OF HEMODIALYSIS VASCULAR ACCESS Principal Investigator & Institution: Vazquez, Miguel A.; Internal Medicine; University of Texas Sw Med Ctr/Dallas Dallas, Tx 753909105 Timing: Fiscal Year 2002; Project Start 30-SEP-2000; Project End 31-JUL-2005 Summary: End-stage renal disease (ESRD) is a devastating illness, and each year in the United States more than 80,000 new patients need initiation of therapy for ESRD. The majority of these patients will receive life-sustaining treatments in the form of hemodialysis. Unfortunately, the quality and duration of the lives of patients on hemodialysis are severely restricted by vascular access. Recent observations suggest that nearly 25% of hospitalizations in the ESRD population are related to vascular access, and problems that emanate from vascular access cost nearly $1 billion annually. Vascular access failure is arguably the most important reversible cause of morbidity in ESRD. This application is in response to RFA DK-00-012 and describes our competence to serve as a clinical center in the Hemodialysis Vascular Access Consortium. We have a strong track record in recruiting for and participating in similar multicenter trials in Nephrology, since we currently serve as large clinical sites for the African American Study of Kidney Disease and Hypertension (AASK) and the Morbidity and Mortality and in Hemodialysis (HEMO) trials. We propose a prevention trial with the cell cycle inhibitor Sirolimus (Rapamycin) in PTFE grafts. We will recruit from our pool of more than 2000 hemodialysis patients, and we will work with the Data Coordinating Center and the other sites to design and conduct a series of multicenter, randomized, placebocontrolled clinical trials of therapies to reduce the complication rate of AV grafts and fistulas in hemodialysis patients over a 5-year period. We anticipate that this consortium will be able to develop new approaches to managing hemodialysis vascular access, and that these new treatments can decrease the costs and complications of hemodialysis care of the US ESRD population. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: DISORDERS

MOLECULAR

GENETIC

STUDIES

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BRANCHIOGENIC

Principal Investigator & Institution: Kumar, Shrawan; Associate Professor & Staff Scientist; Father Flanagan's Boys' Home Boys Town, Ne 68010 Timing: Fiscal Year 2002; Project Start 01-JUN-2002; Project End 31-MAY-2007 Summary: The group of autosomal dominant disorders associated with branchial anomalies are characterized by external, middle and inner ear malformations, branchial cleft sinuses, cervical fistulas, mixed hearing loss, renal anomalies and occasional other manifestations. The Branchio-oto-renal (BOR), gene on chromosome 8q, has been identified as EYA1, however, some BOR, Branchio-renal (BR) and Branchio-oto (BO) families have not shown any mutation in the EYA1 gene. Gene mapping data suggests that multiple genes are involved and that this may be partly responsible for the variable phenotypic expression seen between families. We identified one large family with branchial and hearing anomalies (BO) unlinked to the 8q region and recently mapped the gene (named BGS2) to chromosome 1q. Also, there are at least two large families found to be unlinked to both regions suggesting the presence of a third locus associated with branchiogenic disorders. More than 50 - 60 percent of our BOR families did not show a mutation in the EYA1 gene or genetic linkage to 1q or 8q. We have collected the world's largest series of BOR type families, a resource that will allow us to identify the various genes involved in BOR syndrome. We propose to determine the distribution of mutations associated with the EYA1 gene, and to analyze clinical differences between families to determine to what degree they are correlated with different linkage groups. The possibility of genetic heterogeneity will be continually explored and families unlinked to 8q and 1q will be put through another round of genome searching to determine the location of any new BOR-related genes. The critical region of BGS2 has been narrowed from 22 cM to 9 cM. New families will be ascertained and tested for linkage with the markers on chromosome 8q and 1q. Refining the region is a gradual process, however, based on the completion of human genome project it may not be necessary to decrease the resolution to a smaller interval. Strong candidate genes lying within the critical region will be tested. The BGS2 gene will be identified among the candidate genes on the basis of its genomic position, tissue specific expression and consistent disease causing mutations in affected individuals. The BOR syndrome results in craniofacial anomalies in affected individuals and poses serious health problems. Defining the spectrum of defects and mapping and cloning the BGS genes are the first and foremost steps to a more comprehensive understanding of the pathogenesis and etiology of this syndrome. Finding the genes will lay the foundation for further research concerning effective treatment and genetic counseling. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: VASCULAR ACCESS CLINICAL TRIALS DATA COORDINATING CENTER Principal Investigator & Institution: Beck, Gerald J.; Acting Chairman; Cleveland Clinic Foundation 9500 Euclid Ave Cleveland, Oh 44195 Timing: Fiscal Year 2002; Project Start 30-SEP-2000; Project End 31-JUL-2003 Summary: The Data Coordinating Center (DCC) for the Hemodialysis Vascular Access Clinical Trial Consortium (HVACTC) will coordinate the scientific and operational aspects of a series of clinical trials. This consortium will design and conduct multicenter, randomized, placebocontrolled clinical trials of drug therapies to reduce the failure and complication rate of arteriovenous grafts and fistulas in hemodialysis patients. In

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the planning phase (Phase I), the DCC, in conjunction with the HVACTC, will design and develop protocols and data forms for each of the individual trials. A detailed proposal is suggested for the initial trial. Systems for data acquisition (via a secure webbased data entry) and data management will be established. A major activity of the DCC will be the development of procedures for enhancing the quality and completeness of the data collected. A detailed Manual of Operations will be developed describing the data collection procedures and other procedures for the Clinical Centers. The randomization schedule for entering patients will be generated. The DCC will provide centralized training of Clinical Center staff on the entry of trial patients, the completion of trial forms, and the use of the data management system. The DCC will arrange and actively participate in meetings and conference calls of the Steering Committee and its subcommittees. A major function of the DCC during the Recruitment and Follow-Up (Phase II) of each trial will be to monitor patient recruitment and compliance as a whole and by Clinical Center. The database management system developed in Phase I will be used to assure accurate and complete collection of trial data. An inquiry system will be used to resolve data discrepancies. Trial progress will be reported in monthly reports to the Clinical Centers, and reports to the Steering Committee and Data and Safety and Monitoring Board. Statistical and interim analyses will be performed during the course of each trial with final analyses completed and reported in Phase III. The DCC will develop new statistical methodology as needed to properly analyze the data being collected. Since the HVACTC is a multi-centered effort on several trials, the DCC will provide leadership to coordinate the trial designs and the conduct of the respective trials to optimize the efficiency of the information gained by the complete series of trials undertaken. The DCC will work to foster a spirit of cooperation which is important in this consortium. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: VASCULAR ACCESS IN HEMODIALYSIS PATIENTS Principal Investigator & Institution: Allon, Michael; Medicine; University of Alabama at Birmingham Uab Station Birmingham, Al 35294 Timing: Fiscal Year 2002; Project Start 30-SEP-2001; Project End 31-AUG-2006 Summary: (provided by applicant) Vascular access procedures and their subsequent complications represent a major cause of morbidity, hospitalization and cost for chronic hemodialysis patients. Over 20% of hospitalizations in hemodialysis patients in the United States are access-related, and the annual cost of access morbidity has been estimated at close to $1 billion. A-V fistulas have a lower incidence of stenosis, thrombosis, and infection than grafts, and increased longevity, but a large proportion of new fistulas never mature adequately to be usable for dialysis. A-V grafts are prone to frequent stenosis and thrombosis, requiring multiple radiologic and surgical interventions to maintain their long-term patency. Dialysis catheters are plagued with low blood flows and frequent thrombosis that impair the adequacy of dialysis, as well as frequent infections that result in bacteremia and life-threatening systemic complications. During the past few years the applicant has developed a multidisciplinary approach to vascular access at his institution, including a prospective, computerized database of all access procedures. In the context of this collaborative effort, the applicant has developed novel approaches to vascular access that have improved the standard of care and overall clinical outcomes related to vascular access. The goal of this grant is to optimize the applicant?s ability to pursue investigations regarding novel approaches aimed at improving vascular access outcomes in dialysis patients. Some of the specific questions that will be addressed include: (1) How can we increase the proportion of new A-V

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fistulas that mature adequately to be usable for dialysis? (2) How can we decrease the frequency of stenosis and thrombosis of A-V grafts? (3) How can we improve the blood flows and decrease the frequency of thrombosis of dialysis catheters? (4) How can we improve the clinical management of dialysis catheter-associated bacteremia? (5) How can we prevent the occurrence of dialysis catheter-associated infections? In the process of performing this clinical research, the candidate will also mentor Nephrology Fellows in the conduct of patient-oriented clinical research. The applicant will assist the trainees in acquiring the conceptual skills, research experience, and motivation required to pursue a successful career in Academic Nephrology. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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

Aorto --Right Atrial Fistula: A Rare Complication of Aortic Dissection. by Hsu RB, Chien CY, Wang SS, Chu SH.; 2000; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=101024

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Aortobronchial fistula secondary to chronic post-traumatic thoracic aneurysm. by Fernandez Gonzalez AL, Montero JA, Luna D, Gil O, Sanjuan VM, Monzonis AM.; 1996; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=325333

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Aortopulmonary artery fistula. Presenting with congestive heart failure in a patient with aortic dissection. by Atay Y, Can L, Yagdi T, Buket S.; 1998; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=325506

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Aorto-right ventricular fistula: a late complication of aortic valve replacement. by Roy D, Saba S, Grinberg I, Zughaib M, Sakwa M, Clancy P, McKendrick G.; 1999; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=325620

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Congenital circumflex coronary artery fistula with drainage into the left ventricle. by Teno LA, Santos JL, Bestetti RB, Zanardi AM, Ceccon C, Castilho OT.; 1993; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=325117

3 4

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

With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print.

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Coronary Artery Fistula: Management and Intermediate-Term Outcome after Transcatheter Coil Occlusion. by McMahon CJ, Nihill MR, Kovalchin JP, Mullins CE, Grifka RG.; 2001; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=101124

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Coronary Artery --Right Atrium Fistula. by Russo MG, Santoro G, Pisacane C, Pacileo G, Calabro R.; 2000; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=101062

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Coronary --Pulmonary Arteriovenous Fistula Used as Proximal Anastomotic Site for Saphenous Vein Grafts in Patient with Porcelain Aorta. by Wong AS, Chua YL, Chan CN.; 2003; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=161903

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Coronary --to --Pulmonary Fistulae: What Are They? What Are Their Causes? What Are Their Functional Consequences? by Angelini P.; 2000; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=101097

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Endoluminal Stenting of the Aorta as Treatment of Aortoesophageal Fistula due to Primary Aortic Disease. by D'Ancona G, Dagenais F, Bauset R.; 2002; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=124764

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Fistulotomy and drainage of deep postanal space abscess in the treatment of posterior horseshoe fistula. by Inceoglu R, Gencosmanoglu R.; 2003; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=317325

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Iliac arteriovenous fistula due to spinal disk surgery. Causes severe hemodynamic repercussion with pulmonary hypertension. by Machado-Atias I, Fornes O, GonzalezBello R, Machado-Hernandez I.; 1993; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=325056

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Induction and prevention of experimental arteriovenous fistula infections. by Lane TW, Abrutyn E.; 1979 Nov; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=352920

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Local Pulmonary Malformation Caused by Bilateral Coronary Artery and Bronchial Artery Fistulae to the Left Pulmonary Artery in a Patient with Coronary Artery Disease. by Cijan A, Zorc-Pleskovic R, Zorc M, Klokocovnik T.; 2000; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=101109

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Lymphocutaneous Fistula As a Long-Term Complication of Multiple Central Venous Catheter Placement. by Scharff RP, Recto MR, Austin EH III, Wilkerson SA.; 2000; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=101022

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Spontaneous Enterocutaneous Fistula 27-years Following Radiotherapy in a Patient of Carcinoma Penis. by Chintamani, Badran R, Rk D, Singhal V, Bhatnagar D.; 2003; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=269989

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Survival of Lactobacillus delbrueckii subsp. bulgaricus and Streptococcus thermophilus in the Terminal Ileum of Fistulated Gottingen Minipigs. by Lick S, Drescher K, Heller KJ.; 2001 Sep; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=93140

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Transcatheter Coil Occlusion of a Thoracic Arteriovenous Fistula in an Infant with Congestive Heart Failure. by Recto MR, Elbl F.; 2001; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=101150

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

30 years of experience with York-Mason repair of recto-urinary fistulas. Author(s): Renschler TD, Middleton RG. Source: The Journal of Urology. 2003 October; 170(4 Pt 1): 1222-5; Discussion 1225. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14501729&dopt=Abstract

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A decreasing trend in biliary output in fistulas is more important than cutoff value or duration. Author(s): Polat C, Yilmaz S, Gokce O. Source: World Journal of Surgery. 2003 June; 27(6): 759; Author Reply 759. Epub 2003 May 13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12732985&dopt=Abstract

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A new method for detection of postpneumonectomy broncho-pleural fistulas. Author(s): Alifano M, Sepulveda S, Mulot A, Schussler O, Regnard JF. Source: The Annals of Thoracic Surgery. 2003 May; 75(5): 1662-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12735609&dopt=Abstract

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A technique using a rectus abdominis muscle flap in the treatment of adult congenital tracheoesophageal fistulas. Author(s): Suzuki T, Masuda M, Mori T, Hirai Y, Sanada Y, Chiba M, Sumiya N. Source: Journal of Pediatric Surgery. 2003 July; 38(7): 1112-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12861554&dopt=Abstract

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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Abnormal perfusion of the pituitary gland secondary to dural arteriovenous fistulas in the cavernous sinus: dynamic MR findings. Author(s): Shigematsu Y, Korogi Y, Kitajima M, Ishii A, Liang L, Yamura M, Kawanaka K, Takahashi M. Source: Ajnr. American Journal of Neuroradiology. 2003 May; 24(5): 930-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12748096&dopt=Abstract

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Acquired gastrointestinal fistulas: classification, etiologies, and imaging evaluation. Author(s): Pickhardt PJ, Bhalla S, Balfe DM. Source: Radiology. 2002 July; 224(1): 9-23. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12091657&dopt=Abstract

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Alternative management considerations for ethmoidal dural arteriovenous fistulas. Author(s): Abrahams JM, Bagley LJ, Flamm ES, Hurst RW, Sinson GP. Source: Surgical Neurology. 2002 December; 58(6): 410-6; Discussion 416. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12517625&dopt=Abstract

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An alternative approach to the treatment of mammary duct fistulas: a combination of microwave and ultrasound. Author(s): Berna JD, Sanchez J, Madrigal M, Rodenas J, Berna JD Jr. Source: The American Surgeon. 2002 October; 68(10): 897-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12412720&dopt=Abstract

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Antibiotics and azathioprine for the treatment of perianal fistulas in Crohn's disease. Author(s): Dejaco C, Harrer M, Waldhoer T, Miehsler W, Vogelsang H, Reinisch W. Source: Alimentary Pharmacology & Therapeutics. 2003 December; 18(11-12): 1113-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14653831&dopt=Abstract

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Aorto-caval fistulas. Author(s): Davidovic LB, Kostic DM, Cvetkovic SD, Jakovljevic NS, Stojanov PL, Kacar AS, Pavlovic SU, Petrovic PL. Source: Cardiovascular Surgery (London, England). 2002 December; 10(6): 555-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12453686&dopt=Abstract

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Are metal stents effective for palliation of malignant dysphagia and fistulas? Author(s): Kostopoulos PP, Zissis MI, Polydorou AA, Premchand PP, Hendrickse MT, Shorrock CJ, Isaacs PE. Source: Dig Liver Dis. 2003 April; 35(4): 275-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12801040&dopt=Abstract

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Are somatostatin analogues (octreotide and lanreotide) effective in promoting healing of enterocutaneous fistulas? Author(s): Gray M, Jacobson T. Source: Journal of Wound, Ostomy, and Continence Nursing : Official Publication of the Wound, Ostomy and Continence Nurses Society / Wocn. 2002 September; 29(5): 228-33. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12510468&dopt=Abstract

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Arteriovenous fistulas: different types and surgical techniques. Author(s): Berardinelli L. Source: Contrib Nephrol. 2004; 142: 47-72. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14719386&dopt=Abstract

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Assessment of congenital coronary artery fistulas by transesophageal color Doppler echocardiography. Author(s): Vitarelli A, De Curtis G, Conde Y, Colantonio M, Di Benedetto G, Pecce P, De Nardo L, Squillaci E. Source: The American Journal of Medicine. 2002 August 1; 113(2): 127-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12133751&dopt=Abstract

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Autogenous arteriovenous fistulas for haemodialysis: a review. Author(s): Akoh JA, Dutta S. Source: Niger Postgrad Med J. 2003 June; 10(2): 125-30. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14567052&dopt=Abstract

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Benign cranial dural arteriovenous fistulas: outcome of conservative management based on the natural history of the lesion. Author(s): Satomi J, van Dijk JM, Terbrugge KG, Willinsky RA, Wallace MC. Source: Journal of Neurosurgery. 2002 October; 97(4): 767-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12405361&dopt=Abstract

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Benign dural arteriovenous fistulas. Author(s): Heros RC. Source: Journal of Neurosurgery. 2002 October; 97(4): 749-50; Discussion 750. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12405357&dopt=Abstract

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Bilateral oroantral fistulas following devitalization of teeth by arsenic trioxide: a case report. Author(s): Yalcin S, Aybar B, Haznedaroglu F, Yucel E. Source: Journal of Endodontics. 2003 March; 29(3): 205-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12669882&dopt=Abstract

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Bilateral pedicled myocutaneous vertical rectus abdominus muscle flaps to close vesicovaginal and pouch-vaginal fistulas with simultaneous vaginal and perineal reconstruction in irradiated pelvic wounds. Author(s): Horch RE, Gitsch G, Schultze-Seemann W. Source: Urology. 2002 September; 60(3): 502-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12350497&dopt=Abstract

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Bilateral superiorly based full-thickness nasolabial island flaps for closure of residual anterior palatal fistulas in an unoperated elderly patient. Author(s): Ercocen AR, Yilmaz S, Saydam M. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2003 January; 40(1): 91-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12498612&dopt=Abstract

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Carbon dioxide as a valuable contrast agent for identifying iatrogenic arteriovenous fistulas in transplanted kidneys. Author(s): Nicolini A, Ferraresso M, Lovaria A, Biondetti P, Raiteri M, Berardinelli L. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2003 October; 18(10): 2189-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=13679503&dopt=Abstract

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Carotid-cavernous and orbital arteriovenous fistulas: ocular features, diagnostic and hemodynamic considerations in relation to visual impairment and morbidity. Author(s): de Keizer R. Source: Orbit (Amsterdam, Netherlands). 2003 June; 22(2): 121-42. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12789591&dopt=Abstract

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Catheter closure of coronary artery fistulas. Author(s): Qureshi SA, Tynan M. Source: Journal of Interventional Cardiology. 2001 June; 14(3): 299-307. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12053388&dopt=Abstract

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Cavernous sinus fistulas: carotid cavernous fistulas and dural arteriovenous malformations. Author(s): Feiner L, Bennett J, Volpe NJ. Source: Curr Neurol Neurosci Rep. 2003 September; 3(5): 415-20. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12914685&dopt=Abstract

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Central bronchopleural fistulas closed by bronchoscopic injection of absolute ethanol. Author(s): Takaoka K, Inoue S, Ohira S. Source: Chest. 2002 July; 122(1): 374-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12114386&dopt=Abstract

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Choanal stenosis, hypothelia, deafness, recurrent dacryocystitis, neck fistulas, short stature, and microcephaly: report of a case. Author(s): Dumic M, Cvitanovic M, Saric B, Spehar A, Batinica S. Source: American Journal of Medical Genetics. 2002 December 1; 113(3): 295-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12439900&dopt=Abstract

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Closing fistulas in Crohn's disease--should the accent be on maintenance or safety? Author(s): Fiocchi C. Source: The New England Journal of Medicine. 2004 February 26; 350(9): 934-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14985492&dopt=Abstract

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Closure of bronchopleural fistulas using albumin-glutaraldehyde tissue adhesive. Author(s): Lin J, Iannettoni MD. Source: The Annals of Thoracic Surgery. 2004 January; 77(1): 326-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14726093&dopt=Abstract

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Closure of proximal colorectal fistulas using fibrin sealant. Author(s): Lamont JP, Hooker G, Espenschied JR, Lichliter WE, Franko E. Source: The American Surgeon. 2002 July; 68(7): 615-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12132744&dopt=Abstract

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Cocaine-induced oronasal fistulas with external nasal erosion but without palate involvement. Author(s): Vilela RJ, Langford C, McCullagh L, Kass ES. Source: Ear, Nose, & Throat Journal. 2002 August; 81(8): 562-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12199175&dopt=Abstract

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Coil embolization therapy in congenital coronary arterial fistulas. Author(s): Eicken A, Sebening W, Genz T, Lang D, Schreiber C, Hess J. Source: Pediatric Cardiology. 2003 March-April; 24(2): 149-53. Epub 2002 September 25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12360395&dopt=Abstract

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Color Doppler flow imaging of the superior ophthalmic vein in dural arteriovenous fistulas. Author(s): Kawaguchi S, Sakaki T, Uranishi R. Source: Stroke; a Journal of Cerebral Circulation. 2002 August; 33(8): 2009-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12154254&dopt=Abstract

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Colovaginal fistulas. Etiology and management. Author(s): Bahadursingh AM, Longo WE. Source: J Reprod Med. 2003 July; 48(7): 489-95. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12953321&dopt=Abstract

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Congenital coronary artery fistulas in Turkish patients undergoing diagnostic cardiac angiography. Author(s): Sercelik A, Mavi A, Ayalp R, Pestamalci T, Gumusburun E, Batiraliev T. Source: Int J Clin Pract. 2003 May; 57(4): 280-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12800458&dopt=Abstract

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Congenital tracheocutaneous fistulas. Author(s): Oxford L, Ducic Y. Source: The Laryngoscope. 2002 August; 112(8 Pt 1): 1441-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12172259&dopt=Abstract

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Conservative vs. endoscopic closure of colocutaneous fistulas after percutaneous endoscopic gastrostomy complications. Author(s): Gyokeres T, Burai M, Hamvas J, Varsanyi M, Macsai M, Paput L, Koveskuti A, Fekete C, Pap A. Source: Endoscopy. 2003 March; 35(3): 246-7; Author Reply 248. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12584646&dopt=Abstract

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Contrast radiology, computed tomography and ultrasonography in detecting internal fistulas and intra-abdominal abscesses in Crohn's disease: a prospective comparative study. Author(s): Maconi G, Sampietro GM, Parente F, Pompili G, Russo A, Cristaldi M, Arborio G, Ardizzone S, Matacena G, Taschieri AM, Bianchi Porro G. Source: The American Journal of Gastroenterology. 2003 July; 98(7): 1545-55. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12873576&dopt=Abstract

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Coronary artery fistulas in neonates, infants, and children: clinical findings and outcome. Author(s): Hsieh KS, Huang TC, Lee CL. Source: Pediatric Cardiology. 2002 July-August; 23(4): 415-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12170358&dopt=Abstract

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Corpectomy: a direct approach to perimedullary arteriovenous fistulas of the anterior cervical spinal cord. Author(s): Hida K, Iwasaki Y, Ushikoshi S, Fujimoto S, Seki T, Miyasaka K. Source: Journal of Neurosurgery. 2002 March; 96(2 Suppl): 157-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12450277&dopt=Abstract

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Correlation between radiotherapy and suture fistulas following colo-anal anastomosis for carcinoma of the rectum evaluation of 152 consecutive patients. Author(s): Civelli EM, Gallino G, Valvo F, Cozzi G, Belli F, Bonfanti G, Folini C, Suman L, Meroni R, Vercelli R, Leo E, Severini A. Source: Tumori. 2002 July-August; 88(4): 321-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12400984&dopt=Abstract

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Critical oropharyngocutaneous fistulas after microsurgical head and neck reconstruction: indications for management using the “tissue-plug” technique. Author(s): Salgado CJ, Mardini S, Chen HC, Chen S. Source: Plastic and Reconstructive Surgery. 2003 September 15; 112(4): 957-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12973209&dopt=Abstract

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CT demonstration of dilated thoracoabdominal veins in patients with arteriovenous fistulas or grafts for hemodialysis. Author(s): Haramati LB, Farkas S, Bogomol AR, Stein MW. Source: Journal of Computer Assisted Tomography. 2002 September-October; 26(5): 8014. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12439317&dopt=Abstract

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Current management of intestinal fistulas. Author(s): Maykel JA, Fischer JE. Source: Adv Surg. 2003; 37: 283-99. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12953638&dopt=Abstract

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Dermatologic manifestations and management of vascular steal syndrome in hemodialysis patients with arteriovenous fistulas. Author(s): Pelle MT, Miller OF 3rd. Source: Archives of Dermatology. 2002 October; 138(10): 1296-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12374533&dopt=Abstract

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Detection of cell-cycle regulators in failed arteriovenous fistulas for haemodialysis. Author(s): de Graaf R, Dammers R, Vainas T, Hoeks AP, Tordoir JH. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2003 April; 18(4): 814-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12637654&dopt=Abstract

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Diagnosis and management of enterovesical fistulas in patients with Crohn's disease. Author(s): Gruner JS, Sehon JK, Johnson LW. Source: The American Surgeon. 2002 August; 68(8): 714-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12206607&dopt=Abstract

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Diagnostic criteria for locating acquired arteriovenous fistulas with color Doppler sonography. Author(s): Li JC, Cai S, Jiang YX, Dai Q, Zhang JX, Wang YQ. Source: Journal of Clinical Ultrasound : Jcu. 2002 July-August; 30(6): 336-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12116095&dopt=Abstract

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Do anal fistulas in Crohn's disease behave differently and defy Goodsall's rule more frequently than fistulas that are cryptoglandular in origin? Author(s): Coremans G, Dockx S, Wyndaele J, Hendrickx A. Source: The American Journal of Gastroenterology. 2003 December; 98(12): 2732-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14687825&dopt=Abstract

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Does rich fiber diet accelerate the healing process of low-output colorectal fistulas? Author(s): Evrard S. Source: Digestive Diseases and Sciences. 2002 November; 47(11): 2635-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12452407&dopt=Abstract

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Double flap repair of transsphincteric fistulas. Author(s): Pescatori M. Source: Diseases of the Colon and Rectum. 2002 August; 45(8): 1122-4; Author Reply 1124. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12195209&dopt=Abstract

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Durability and cumulative functional patency of transposed and nontransposed arteriovenous fistulas. Author(s): Choi HM, Lal BK, Cerveira JJ, Padberg FT Jr, Silva MB Jr, Hobson RW 2nd, Pappas PJ. Source: Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter. 2003 December; 38(6): 1206-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14681614&dopt=Abstract

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Dural arteriovenous fistulas. Author(s): van Dijk JM, TerBrugge KG. Source: Journal of Neurosurgery. 2002 December; 97(6): 1486; Author Reply 1486-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12507156&dopt=Abstract

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Elbow fistulas using autogeneous vein: patency rates and results of revision. Author(s): Murphy GJ, Saunders R, Metcalfe M, Nicholson ML. Source: Postgraduate Medical Journal. 2002 August; 78(922): 483-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12185224&dopt=Abstract

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Endoscopic treatment of postoperative fistulas resistant to conservative management using biological fibrin glue. Author(s): Rabago LR, Ventosa N, Castro JL, Marco J, Herrera N, Gea F. Source: Endoscopy. 2002 August; 34(8): 632-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12173084&dopt=Abstract

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Endovascular treatment for bilateral vertebral arteriovenous fistulas in neurofibromatosis 1. Author(s): Siddhartha W, Chavhan GB, Shrivastava M, Limaye US. Source: Australasian Radiology. 2003 December; 47(4): 457-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14641204&dopt=Abstract

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Endovascular treatment of thoracic aortic fistulas. Author(s): Leobon B, Roux D, Mugniot A, Rousseau H, Cerene A, Glock Y, Fournial G. Source: The Annals of Thoracic Surgery. 2002 July; 74(1): 247-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12118773&dopt=Abstract

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Endovascular treatment strategy for direct carotid-cavernous fistulas resulting from rupture of intracavernous carotid aneurysms. Author(s): Kobayashi N, Miyachi S, Negoro M, Suzuki O, Hattori K, Kojima T, Yoshida J. Source: Ajnr. American Journal of Neuroradiology. 2003 October; 24(9): 1789-96. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14561604&dopt=Abstract

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Evaluation of the effectiveness of octreotide in the conservative treatment of postoperative enterocutaneous fistulas. Author(s): Alivizatos V, Felekis D, Zorbalas A. Source: Hepatogastroenterology. 2002 July-August; 49(46): 1010-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12143189&dopt=Abstract

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Extension of transcatheter coil occlusion to the treatment of complex coronary fistulas. Author(s): Fletcher S, Awadallah S, Amin Z. Source: Journal of Interventional Cardiology. 2003 April; 16(2): 165-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12768921&dopt=Abstract

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External fistulas arising from the gastrointestinal tract. And prospective overview. 1960. Author(s): Edmunds H Jr, Williams GM, Welch CE. Source: Nutrition (Burbank, Los Angeles County, Calif.). 2003 February; 19(2): 182-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12591558&dopt=Abstract

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Extrasphincteric rectal fistulas treated successfully by Soave's procedure despite marked local sepsis. Author(s): Maxwell-Armstrong CA, Phillips RK. Source: The British Journal of Surgery. 2003 February; 90(2): 237-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12555303&dopt=Abstract

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Fascia lata grafts for closure of secondary urethral fistulas. Author(s): Kargi E, Yesilli C, Akduman B, Babuccu O, Hosnuter M, Mungan A. Source: Urology. 2003 November; 62(5): 928-31; Discussion 931. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14624922&dopt=Abstract

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Fibrin glue and anal fistulas. Author(s): Shankar PJ, Saklani AP. Source: Diseases of the Colon and Rectum. 2003 August; 46(8): 1148; Author Reply 1149. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12907917&dopt=Abstract

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Fibrin glue for anal fistulas. Author(s): Koch TR. Source: The American Journal of Gastroenterology. 2003 October; 98(10): 2323-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14572587&dopt=Abstract

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Fibrin glue for anal fistulas: long-term results. Author(s): Sentovich SM. Source: Diseases of the Colon and Rectum. 2003 April; 46(4): 498-502. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12682544&dopt=Abstract

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Fibrin glue sealing in the treatment of perineal fistulas. Author(s): Zmora O, Mizrahi N, Rotholtz N, Pikarsky AJ, Weiss EG, Nogueras JJ, Wexner SD. Source: Diseases of the Colon and Rectum. 2003 May; 46(5): 584-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12792432&dopt=Abstract

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Fibrin sealant for the management of genitourinary injuries, fistulas and surgical complications. Author(s): Evans LA, Ferguson KH, Foley JP, Rozanski TA, Morey AF. Source: The Journal of Urology. 2003 April; 169(4): 1360-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12629361&dopt=Abstract

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Fistulas to the urinary system in Crohn's disease: clinical features and outcomes. Author(s): Solem CA, Loftus EV Jr, Tremaine WJ, Pemberton JH, Wolff BG, Sandborn WJ. Source: The American Journal of Gastroenterology. 2002 September; 97(9): 2300-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12358248&dopt=Abstract

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Fitsari 'dan Duniya. An African (Hausa) praise song about vesicovaginal fistulas. Author(s): Wall LL. Source: Obstetrics and Gynecology. 2002 December; 100(6): 1328-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12468180&dopt=Abstract

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Gadolinium-enhanced digital subtraction angiography of hemodialysis fistulas: a diagnostic and therapeutic approach. Author(s): Le Blanche AF, Tassart M, Deux JF, Rossert J, Bigot JM, Boudghene F. Source: Ajr. American Journal of Roentgenology. 2002 October; 179(4): 1023-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12239059&dopt=Abstract

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Gamma knife surgery for the treatment of spontaneous dural carotid-cavernous fistulas. Author(s): Onizuka M, Mori K, Takahashi N, Kawahara I, Hiu T, Toda K, Baba H, Yonekura M. Source: Neurol Med Chir (Tokyo). 2003 October; 43(10): 477-82; Discussion 482-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14620198&dopt=Abstract

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Gender differences in outcomes of arteriovenous fistulas in hemodialysis patients. Author(s): Miller CD, Robbin ML, Allon M. Source: Kidney International. 2003 January; 63(1): 346-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12472802&dopt=Abstract

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Genitourinary fistulas of obstetric origin. Author(s): Rafique M. Source: International Urology and Nephrology. 2002-2003; 34(4): 489-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14577490&dopt=Abstract

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Hemodynamics of infrapopliteal PTFE bypasses and adjunctive arteriovenous fistulas. Author(s): Kallakuri S, Ascher E, Hingorani A, Jacob T, Salles-Cunha S. Source: Cardiovascular Surgery (London, England). 2003 April; 11(2): 125-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12664047&dopt=Abstract

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Hemodynamics of venous cuff interposition in prosthetic arteriovenous fistulas for hemodialysis. Author(s): Lemson S, Tordoir JH, Ezzahiri R, Leunissen KM, Kitslaar PJ, Hoeks AP. Source: Blood Purification. 2002; 20(6): 557-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12566672&dopt=Abstract

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How can the use of arteriovenous fistulas be increased? Author(s): Hemphill H, Allon M, Konner K, Work J, Vassalotti JA. Source: Seminars in Dialysis. 2003 May-June; 16(3): 214-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12753680&dopt=Abstract

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Ileosplenic fistula and splenic abscesses caused by migration of biliary stents in a liver transplant recipient. Author(s): Baccarani U, Risaliti A, Sainz-Barriga M, Adani GL, Donini A, Toniutto P, Bresadola F. Source: Gastrointestinal Endoscopy. 2003 November; 58(5): 811-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14997896&dopt=Abstract

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Image of the month. Bourne test, enterovesical fistulas. Author(s): Lawrence C, Shaffer HA Jr, Bickston SJ. Source: Gastroenterology. 2003 August; 125(2): 291, 641. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12891526&dopt=Abstract

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Incidence and clinical outcome of iatrogenic femoral arteriovenous fistulas: implications for risk stratification and treatment. Author(s): Kelm M, Perings SM, Jax T, Lauer T, Schoebel FC, Heintzen MP, Perings C, Strauer BE. Source: Journal of the American College of Cardiology. 2002 July 17; 40(2): 291-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12106934&dopt=Abstract

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Increased biliary fistulas after liver resection with the harmonic scalpel. Author(s): Kim J, Ahmad SA, Lowy AM, Buell JF, Pennington LJ, Soldano DA, James LE, Matthews JB, Hanto DW. Source: The American Surgeon. 2003 September; 69(9): 815-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14509335&dopt=Abstract

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Increasing arteriovenous fistulas in hemodialysis patients: problems and solutions. Author(s): Allon M, Robbin ML. Source: Kidney International. 2002 October; 62(4): 1109-24. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12234281&dopt=Abstract

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Interventional radiology in the treatment of high-flow renal arteriovenous fistulas. Report of two cases. Author(s): Mansueto G, D'Onofrio M, Gasparini A, Procacci C. Source: Radiol Med (Torino). 2003 March; 105(3): 195-204. English, Italian. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12835643&dopt=Abstract

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Intracranial dural arteriovenous fistulas: evaluation with combined 3D time-of-flight MR angiography and MR digital subtraction angiography. Author(s): Noguchi K, Melhem ER, Kanazawa T, Kubo M, Kuwayama N, Seto H. Source: Ajr. American Journal of Roentgenology. 2004 January; 182(1): 183-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14684537&dopt=Abstract

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Intracranial pial arteriovenous fistulas with single-vein drainage. Report of three cases and review of the literature. Author(s): Wang YC, Wong HF, Yeh YS. Source: Journal of Neurosurgery. 2004 February; 100(2): 201-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14758951&dopt=Abstract

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Intraoperative angiography in the surgical treatment of cerebral arteriovenous malformations and fistulas. Author(s): Yanaka K, Matsumaru Y, Okazaki M, Noguchi S, Asakawa H, Anno I, Nose T. Source: Acta Neurochirurgica. 2003 May; 145(5): 377-82; Discussion 382-383. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12820044&dopt=Abstract

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Intraoperative assessment of perilymphatic fistulas with intrathecal administration of fluorescein. Author(s): Gehrking E, Wisst F, Remmert S, Sommer K. Source: The Laryngoscope. 2002 September; 112(9): 1614-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12352674&dopt=Abstract

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Laparoscopic surgery for fistulas that complicate diverticular disease. Author(s): Menenakos E, Hahnloser D, Nassiopoulos K, Chanson C, Sinclair V, Petropoulos P. Source: Langenbeck's Archives of Surgery / Deutsche Gesellschaft Fur Chirurgie. 2003 July; 388(3): 189-93. Epub 2003 June 26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12836027&dopt=Abstract

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Large post-hysterectomy and post-radiation vesicovaginal fistulas: repair by ileocystoplasty. Author(s): Tabakov ID, Slavchev BN. Source: The Journal of Urology. 2004 January; 171(1): 272-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14665892&dopt=Abstract

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Long-term follow-up of polyurethane vascular grafts for hemoaccess bridge fistulas. Author(s): Kiyama H, Imazeki T, Kurihara S, Yoneshima H. Source: Annals of Vascular Surgery. 2003 September; 17(5): 516-21. Epub 2003 October 02. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14517729&dopt=Abstract

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Long-term results and quality-of-life outcomes in patients with transsphincteric fistulas after muscle-filling procedure. Author(s): Wang D, Yamana T, Iwadare J. Source: Diseases of the Colon and Rectum. 2002 August; 45(8): 1011-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12195183&dopt=Abstract

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Magnetic resonance angiography source images in carotid cavernous fistulas. Author(s): Rucker JC, Biousse V, Newman NJ. Source: The British Journal of Ophthalmology. 2004 February; 88(2): 311. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14736805&dopt=Abstract

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Magnetic resonance imaging findings in an unusual case of atlanto axial dislocation and vertebral artery-vein fistulas in a patient of neurofibromatosis-1. Author(s): Maheshwari S, Kale HA, Desai SB, Kohli A. Source: Australasian Radiology. 2002 September; 46(3): 316-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12196246&dopt=Abstract

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Management and treatment outcome of pouch-vaginal fistulas following restorative proctocolectomy. Author(s): Shah NS, Remzi F, Massmann A, Baixauli J, Fazio VW. Source: Diseases of the Colon and Rectum. 2003 July; 46(7): 911-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12847365&dopt=Abstract

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Management of enterocutaneous fistulas: 30-year clinical experience. Author(s): Li J, Ren J, Zhu W, Yin L, Han J. Source: Chinese Medical Journal. 2003 February; 116(2): 171-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12775223&dopt=Abstract

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Management of recurrent urethral fistulas after hypospadias repair. Author(s): Richter F, Pinto PA, Stock JA, Hanna MK. Source: Urology. 2003 February; 61(2): 448-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12597967&dopt=Abstract

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Management of tracheobronchial strictures and fistulas: a report and review of literature. Author(s): Riker AI, Vigneswaran WT. Source: Int Surg. 2002 April-June; 87(2): 114-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12222913&dopt=Abstract

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Management of traumatic arterio-venous fistulas, experience in Armed Forces General Hospital, Addis Ababa. Author(s): Bogale S, Alemayehu W, Abate N. Source: Ethiop Med J. 2002 April; 40(2): 129-39. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12240574&dopt=Abstract

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Managing carotid-cavernous fistulas in Ehlers-Danlos syndrome type IV. Author(s): Purdy PD. Source: Journal of Neuro-Ophthalmology : the Official Journal of the North American Neuro-Ophthalmology Society. 2002 June; 22(2): 73-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12131462&dopt=Abstract

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Methylene blue staining and probing for fistula resection: application in a case of bilateral congenital preauricular fistulas. Author(s): Martin-Granizo R, Perez-Herrero MC, Sanchez-Cuellar A. Source: International Journal of Oral and Maxillofacial Surgery. 2002 August; 31(4): 43941. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12361081&dopt=Abstract

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Molecular analysis of thrombophilic risk factors in patients with dural arteriovenous fistulas. Author(s): Kraus JA, Stuper BK, Muller J, Nahser HC, Klockgether T, Berlit P, Harbrecht U. Source: Journal of Neurology. 2002 June; 249(6): 680-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12111299&dopt=Abstract

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MR imaging of dural arteriovenous fistulas draining into cerebellar cortical veins. Author(s): Lee SK, Willinsky RA, Montanera W, terBrugge KG. Source: Ajnr. American Journal of Neuroradiology. 2003 September; 24(8): 1602-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=13679278&dopt=Abstract

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Multidisciplinary management of spinal dural arteriovenous fistulas: clinical presentation and long-term follow-up in 49 patients. Author(s): Van Dijk JM, TerBrugge KG, Willinsky RA, Farb RI, Wallace MC. Source: Stroke; a Journal of Cerebral Circulation. 2002 June; 33(6): 1578-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12052994&dopt=Abstract

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Multiple coronary artery fistulas visualised by three dimensional computed tomography. Author(s): Seguchi O, Terashima M, Awano K. Source: Heart (British Cardiac Society). 2003 December; 89(12): 1381. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14617536&dopt=Abstract

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Needling fistulas bevel down. Author(s): Blakely R. Source: Edtna Erca J. 2003 October-December; 29(4): 214. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14748432&dopt=Abstract

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New prospects in the treatment of traumatic and postoperative parotid fistulas with type A botulinum toxin. Author(s): von Lindern JJ, Niederhagen B, Appel T, Berge S, Reich RH. Source: Plastic and Reconstructive Surgery. 2002 June; 109(7): 2443-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12045574&dopt=Abstract

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Octreotide for enterocutaneous fistulas of Crohn's disease. Author(s): Lavy A, Yasin K. Source: Canadian Journal of Gastroenterology = Journal Canadien De Gastroenterologie. 2003 September; 17(9): 555-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14532930&dopt=Abstract

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Outcomes of primary repair of anorectal and rectovaginal fistulas using the endorectal advancement flap. Author(s): Sonoda T, Hull T, Piedmonte MR, Fazio VW. Source: Diseases of the Colon and Rectum. 2002 December; 45(12): 1622-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12473885&dopt=Abstract

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Outcomes of upper arm arteriovenous fistulas for maintenance hemodialysis access. Author(s): Fitzgerald JT, Schanzer A, Chin AI, McVicar JP, Perez RV, Troppmann C. Source: Archives of Surgery (Chicago, Ill. : 1960). 2004 February; 139(2): 201-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14769581&dopt=Abstract

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Palatal fistulas: rare with the two-flap palatoplasty repair. Author(s): Unlu RE, Uysal AC, Ozdemir R, Sensoz O. Source: Plastic and Reconstructive Surgery. 2002 September 1; 110(3): 995; Author Reply 995-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12172182&dopt=Abstract

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Paraspinous muscle flaps for the treatment and prevention of cerebrospinal fluid fistulas in neurosurgery. Author(s): Saint-Cyr M, Nikolis A, Moumdjian R, Frenette G, Ciaburro H, Harris PG, Cordoba C. Source: Spine. 2003 March 1; 28(5): E86-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12616171&dopt=Abstract

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Percutaneous transcatheter coil embolization of two coronary fistulas originating from the left main ostium and left anterior descending artery. Author(s): Boccalandro F, Awadalla H, Smalling RW. Source: Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions. 2002 October; 57(2): 221-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12357525&dopt=Abstract

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Pharmacomechanical thrombolysis of natural vein fistulas: reduced dose of TPA and long-term follow-up. Author(s): Schon D, Mishler R. Source: Seminars in Dialysis. 2003 May-June; 16(3): 272-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12753691&dopt=Abstract

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Postoperative aortic fistulas into the airways: etiology, pathogenesis, presentation, diagnosis, and management. Author(s): Piciche M, De Paulis R, Fabbri A, Chiariello L. Source: The Annals of Thoracic Surgery. 2003 June; 75(6): 1998-2006. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12822663&dopt=Abstract

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Pre- and post-treatment MR imaging and single photon emission CT in patients with dural arteriovenous fistulas and retrograde leptomeningeal venous drainage. Author(s): Kai Y, Hamada J, Morioka M, Todaka T, Mizuno T, Ushio Y. Source: Ajnr. American Journal of Neuroradiology. 2003 April; 24(4): 619-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12695191&dopt=Abstract

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Prevalence and treatment of cephalic arch stenosis in dysfunctional autogenous hemodialysis fistulas. Author(s): Rajan DK, Clark TW, Patel NK, Stavropoulos SW, Simons ME. Source: Journal of Vascular and Interventional Radiology : Jvir. 2003 May; 14(5): 567-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12761309&dopt=Abstract

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Procedural success and patency after percutaneous treatment of thrombosed autogenous arteriovenous dialysis fistulas. Author(s): Rajan DK, Clark TW, Simons ME, Kachura JR, Sniderman K. Source: Journal of Vascular and Interventional Radiology : Jvir. 2002 December; 13(12): 1211-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12471184&dopt=Abstract

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Prospective comparison of hydrogen peroxide-enhanced three-dimensional endoanal ultrasonography and endoanal magnetic resonance imaging of perianal fistulas. Author(s): West RL, Zimmerman DD, Dwarkasing S, Hussain SM, Hop WC, Schouten WR, Kuipers EJ, Felt-Bersma RJ. Source: Diseases of the Colon and Rectum. 2003 October; 46(10): 1407-15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14530683&dopt=Abstract

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Prosthetic grafts equal autogenous fistulas only when surgeons ignore reports in the literature. Author(s): Turmel-Rodrigues L. Source: European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery. 2004 January; 27(1): 105-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14654416&dopt=Abstract

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Pulmonary arteriovenous fistulas developed after chemotherapy of metastatic choriocarcinoma. Author(s): Choi SH, Goo JM, Kim HC, Im JG. Source: Ajr. American Journal of Roentgenology. 2003 December; 181(6): 1544-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14627570&dopt=Abstract

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Pulmonary hypertension in the setting of acquired systemic arteriovenous fistulas. Author(s): Bhatia S, Morrison JF, Bower TC, McGoon MD. Source: Mayo Clinic Proceedings. 2003 July; 78(7): 908-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12839088&dopt=Abstract

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Regarding “Vascular access survival and incidence of revisions: a comparison of prosthetic grafts, simple autogenous fistulas, and venous transposition fistulas from the United States Renal Data System Dialysis Morbidity and Mortality Study”. Author(s): Mosquera D. Source: Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter. 2003 January; 37(1): 238-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12514614&dopt=Abstract

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Retrograde transcatheter coil embolization of congenital coronary artery fistulas in infants and young children. Author(s): Kung GC, Moore P, McElhinney DB, Teitel DF. Source: Pediatric Cardiology. 2003 September-October; 24(5): 448-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14627311&dopt=Abstract

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Risks of rigid dilation for a radiated vaginal cuff: two related rectovaginal fistulas. Author(s): Hoffman MS, Wakeley KE, Cardosi RJ. Source: Obstetrics and Gynecology. 2003 May; 101(5 Pt 2): 1125-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12738124&dopt=Abstract

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Salvaging prosthetic dialysis fistulas with stents: forearm versus upper arm grafts. Author(s): Kolakowski S Jr, Dougherty MJ, Calligaro KD. Source: Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter. 2003 October; 38(4): 719-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14560220&dopt=Abstract

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Selective loss of Purkinje cells in transverse and sigmoid dural arteriovenous fistulas. Report of two cases. Author(s): Tominaga T, Shamoto H, Shimizu H, Watanabe M, Yoshimoto T. Source: Journal of Neurosurgery. 2003 March; 98(3): 617-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12650437&dopt=Abstract

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Self-reversed parallel wire balloon technique for dilating unyielding strictures in native dialysis fistulas. Author(s): Fukasawa M, Matsushita K, Araki I, Tanabe N, Takeda M. Source: Journal of Vascular and Interventional Radiology : Jvir. 2002 September; 13(9 Pt 1): 943-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12354831&dopt=Abstract

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Seton insertion for difficult anal fistulas. Author(s): Seow-Choen F. Source: Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland. 2003 July; 5(4): 373. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12814419&dopt=Abstract

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Should dialysis arteriovenous fistulas be closed after renal transplantation? Author(s): Mason PD. Source: Transplantation. 2002 July 15; 74(1): 1. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12134090&dopt=Abstract

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Simultaneous bronchopleural and esophagopleural fistulas after pneumonectomy. Author(s): Trigui W, Le Pimpec-Barthes F, Shaker W, Lang-Lazdunski L, Riquet M. Source: The Annals of Thoracic Surgery. 2002 September; 74(3): 923-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12238869&dopt=Abstract

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Skull base cerebrospinal fluid fistulas: a comprehensive diagnostic algorithm. Author(s): Zapalac JS, Marple BF, Schwade ND. Source: Otolaryngology and Head and Neck Surgery. 2002 June; 126(6): 669-76. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12087336&dopt=Abstract

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Smoking affects the outcome of transanal mucosal advancement flap repair of transsphincteric fistulas. Author(s): Zimmerman DD, Delemarre JB, Gosselink MP, Hop WC, Briel JW, Schouten WR. Source: The British Journal of Surgery. 2003 March; 90(3): 351-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12594672&dopt=Abstract

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Spinal dural arteriovenous fistulas: clinical features in 80 patients. Author(s): Jellema K, Canta LR, Tijssen CC, van Rooij WJ, Koudstaal PJ, van Gijn J. Source: Journal of Neurology, Neurosurgery, and Psychiatry. 2003 October; 74(10): 143840. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14570843&dopt=Abstract

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Spinal dural arteriovenous fistulas: experience with endovascular and surgical therapy. Author(s): Eskandar EN, Borges LF, Budzik RF Jr, Putman CM, Ogilvy CS. Source: Journal of Neurosurgery. 2002 March; 96(2 Suppl): 162-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12450278&dopt=Abstract

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Successful application of laparoscopic surgery to the treatment of Crohn's disease with fistulas. Author(s): Watanabe M, Hasegawa H, Yamamoto S, Hibi T, Kitajima M. Source: Diseases of the Colon and Rectum. 2002 August; 45(8): 1057-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12195190&dopt=Abstract

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Successful closure of ileal pouch-vaginal fistulas with infliximab. Author(s): Huang CS, Becker JM, Farraye FA. Source: Gastroenterology. 2003 August; 125(2): 631-3; Author Reply 633. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12891580&dopt=Abstract

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Successful management of spinal dural arteriovenous fistulas undetected by arteriography. Report of three cases. Author(s): Oldfield EH, Bennett A 3rd, Chen MY, Doppman JL. Source: Journal of Neurosurgery. 2002 March; 96(2 Suppl): 220-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12450286&dopt=Abstract

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Surgical repair of vesicovaginal fistulas. Author(s): Huang WC, Zinman LN, Bihrle W 3rd. Source: The Urologic Clinics of North America. 2002 August; 29(3): 709-23. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12476535&dopt=Abstract

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Surgical treatment of congenital coronary artery fistulas: 27 years' experience and a review of the literature. Author(s): Kamiya H, Yasuda T, Nagamine H, Sakakibara N, Nishida S, Kawasuji M, Watanabe G. Source: Journal of Cardiac Surgery. 2002 March-April; 17(2): 173-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12220072&dopt=Abstract

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Surgical treatment of intracranial dural arteriovenous fistulas. Author(s): Ushikoshi S, Houkin K, Kuroda S, Asano T, Iwasaki Y, Miyasaka K, Abe H. Source: Surgical Neurology. 2002 April; 57(4): 253-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12173392&dopt=Abstract

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Tacrolimus for the treatment of fistulas in patients with Crohn's disease: a randomized, placebo-controlled trial. Author(s): Sandborn WJ, Present DH, Isaacs KL, Wolf DC, Greenberg E, Hanauer SB, Feagan BG, Mayer L, Johnson T, Galanko J, Martin C, Sandler RS. Source: Gastroenterology. 2003 August; 125(2): 380-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12891539&dopt=Abstract

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Takayasu's arteritis with multiple fistulas from three coronary arteries to lung paranchima. Author(s): Ercan E, Tengiz I, Yakut N, Gurbuz A, Bozdemir H, Bozdemir G. Source: International Journal of Cardiology. 2003 April; 88(2-3): 319-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12714218&dopt=Abstract

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T-cell malignant lymphoma of the ileum causing ileac fistulas: report of a case. Author(s): Sakakibara T, Kurasawa T, Narumi K, Kamano T, Tsurumaru M. Source: Surgery Today. 2002; 32(6): 536-40. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12107782&dopt=Abstract

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Technical innovation. Using a covered stent (wallgraft) to treat pseudoaneurysms of dialysis grafts and fistulas. Author(s): Ryan JM, Dumbleton SA, Doherty J, Smith TP. Source: Ajr. American Journal of Roentgenology. 2003 April; 180(4): 1067-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12646456&dopt=Abstract

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The efficacy of self-expanding metal stents for palliation of malignant esophageal strictures and fistulas. Author(s): Sarper A, Oz N, Cihangir C, Demircan A, Isin E. Source: European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery. 2003 May; 23(5): 794-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12754035&dopt=Abstract

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The fistulectome: a new device for treatment of complex anal fistulas by “Core-Out” fistulectomy. Author(s): Tasci I. Source: Diseases of the Colon and Rectum. 2003 November; 46(11): 1566-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14605582&dopt=Abstract

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The initial creation of native arteriovenous fistulas: surgical aspects and their impact on the practice of nephrology. Author(s): Konner K. Source: Seminars in Dialysis. 2003 July-August; 16(4): 291-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12839502&dopt=Abstract

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The mechanism of formation of congenital vesicouterine and rectovaginal fistulas. Author(s): Jozwik M, Jozwik M. Source: Early Human Development. 2003 April; 71(2): 171-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12663154&dopt=Abstract

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The outcome of transanal advancement flap repair of rectovaginal fistulas is not improved by an additional labial fat flap transposition. Author(s): Zimmerman DD, Gosselink MP, Briel JW, Schouten WR. Source: Techniques in Coloproctology. 2002 April; 6(1): 37-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12077640&dopt=Abstract

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The role of sonography in the planning of arteriovenous fistulas for hemodialysis. Author(s): Malovrh M. Source: Seminars in Dialysis. 2003 July-August; 16(4): 299-303. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12839503&dopt=Abstract

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Therapeutic embolization of cavernous sinus dural arteriovenous fistulas via transvenous approach. Author(s): Hou K, Luo Q, Chen Q, Wang H, Luo Y, Wang C. Source: Chinese Medical Journal. 2003 May; 116(5): 661-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12875673&dopt=Abstract

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Therapeutic fistuloscopy: an alternative approach in the management of postoperative fistulas. Author(s): Eleftheriadis E, Kotzampassi K. Source: Digestive Surgery. 2002; 19(3): 230-5; Discussion 236. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12119527&dopt=Abstract

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Transcatheter embolization treatment of coronary arteriovenous fistulas. Author(s): Aydogan U. Source: Asian Cardiovascular & Thoracic Annals. 2003 March; 11(1): 63-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12692026&dopt=Abstract

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Transcranial approach for venous embolization of dural arteriovenous fistulas. Author(s): Houdart E, Saint-Maurice JP, Chapot R, Ditchfield A, Blanquet A, Lot G, Merland JJ. Source: Journal of Neurosurgery. 2002 August; 97(2): 280-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12186454&dopt=Abstract

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Transvenous embolisation of dural carotid-cavernous fistulas by multiple venous routes: a series of 27 cases. Author(s): Cheng KM, Chan CM, Cheung YL. Source: Acta Neurochirurgica. 2003 January; 145(1): 17-29. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12545258&dopt=Abstract

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Treatment and outcome of spinal dural arteriovenous fistulas. Author(s): Schick U, Hassler W. Source: European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2003 August; 12(4): 350-5. Epub 2002 November 20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12955607&dopt=Abstract

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Treatment of rectovaginal fistulas. Author(s): Shafik A. Source: Techniques in Coloproctology. 2003 April; 7(1): 65-6; Author Reply 66. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12769063&dopt=Abstract

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Ultrasound study of anal fistulas with hydrogen peroxide enhancement. Author(s): Navarro-Luna A, Garcia-Domingo MI, Rius-Macias J, Marco-Molina C. Source: Diseases of the Colon and Rectum. 2004 January; 47(1): 108-14. Epub 2004 January 05. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14719157&dopt=Abstract

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Underestimated drawbacks of combined simple dilation and thrombolytics for restoration of thrombosed brescia-cimino dialysis fistulas. Author(s): Turmel-Rodrigues LA. Source: Radiology. 2003 March; 226(3): 925; Author Reply 926-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12616027&dopt=Abstract

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Unusual thigh fistulas from tuberculous spondylitis. Case illustration. Author(s): Park DH, Park YK, Oh JI, Kwon TH, Chung HS. Source: Journal of Neurosurgery. 2002 October; 97(3 Suppl): 397. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12408401&dopt=Abstract

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Upper lip fistulas: three new cases. Author(s): Sancho MA, Albert A, Cusi V, Grande C, Aguilar C, Morales L. Source: The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association. 2002 July; 39(4): 457-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12071794&dopt=Abstract

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Urinary tract fistulas in Crohn's disease: surgery versus medical therapy. Author(s): Present DH. Source: The American Journal of Gastroenterology. 2002 September; 97(9): 2165-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12358227&dopt=Abstract

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Use of a wedged microcatheter for curative transarterial embolization of complex intracranial dural arteriovenous fistulas: indications, endovascular technique, and outcome in 21 patients. Author(s): Nelson PK, Russell SM, Woo HH, Alastra AJ, Vidovich DV. Source: Journal of Neurosurgery. 2003 March; 98(3): 498-506. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12650420&dopt=Abstract

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Use of sodium fluorescein solution for detection of cerebrospinal fluid fistulas: an analysis of 420 administrations and reported complications in Europe and the United States. Author(s): Keerl R, Weber RK, Draf W, Wienke A, Schaefer SD. Source: The Laryngoscope. 2004 February; 114(2): 266-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14755201&dopt=Abstract

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Use of the trispan device to assist coil embolization of high-flow arteriovenous fistulas. Author(s): Weill A, Roy D, Georganos SA, Guilbert F, Raymond J. Source: Ajnr. American Journal of Neuroradiology. 2002 August; 23(7): 1149-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12169472&dopt=Abstract

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Usefulness of hydrogen peroxide enhancement in diagnosis of anal and ano-vaginal fistulas. Author(s): Sudol-Szopinska I, Jakubowski W, Szczepkowski M, Sarti D. Source: European Radiology. 2003 May; 13(5): 1080-4. Epub 2002 August 15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12695831&dopt=Abstract

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Usefulness of source images from three-dimensional time-of-flight MR angiography after treatment of cavernous dural arteriovenous fistulas. Author(s): Hirai T, Korogi Y, Ikushima I, Shigematsu Y, Morishita S, Yamashita Y. Source: Radiat Med. 2003 September-October; 21(5): 205-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14632295&dopt=Abstract

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Value of MRI performed with phased-array coil in the diagnosis and pre-operative classification of perianal and anal fistulas. Author(s): Maccioni F, Colaiacomo MC, Stasolla A, Manganaro L, Izzo L, Marini M. Source: Radiol Med (Torino). 2002 July-August; 104(1-2): 58-67. English, Italian. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12386556&dopt=Abstract

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Vascular access surgery managed by renal physicians: the choice of native arteriovenous fistulas for hemodialysis. Author(s): Ravani P, Marcelli D, Malberti F. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 2002 December; 40(6): 1264-76. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12460046&dopt=Abstract

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Venous congestive encephalopathy related to cranial dural arteriovenous fistulas. Author(s): van Dijk JM, Willinsky RA. Source: Neuroimaging Clin N Am. 2003 February; 13(1): 55-72. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12802941&dopt=Abstract

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Venous manifestations of spinal arteriovenous fistulas. Author(s): Andersson T, van Dijk JM, Willinsky RA. Source: Neuroimaging Clin N Am. 2003 February; 13(1): 73-93. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12802942&dopt=Abstract

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Vesico-crural and vesicorectal fistulas 13 years after radiotherapy for prostate cancer. Author(s): Pesce F, Righetti R, Rubilotta E, Artibani W. Source: The Journal of Urology. 2002 November; 168(5): 2118-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12394724&dopt=Abstract

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Vesicouterine fistulas following cesarean section: report on a case, review and update of the literature. Author(s): Porcaro AB, Zicari M, Zecchini Antoniolli S, Pianon R, Monaco C, Migliorini F, Longo M, Comunale L. Source: International Urology and Nephrology. 2002; 34(3): 335-44. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12899224&dopt=Abstract

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Vesico-vaginal fistulas in developing countries. Author(s): Hilton P. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 2003 September; 82(3): 285-95. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14499975&dopt=Abstract

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Visualization of bilateral carotid cavernous sinus fistulas with duplex sonography. Author(s): Sanden U, Grosse U, Jaksche H. Source: Journal of Clinical Ultrasound : Jcu. 2003 July-August; 31(6): 319-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12811792&dopt=Abstract

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Where are all the AV fistulas? Author(s): Sands J, Perry M. Source: Seminars in Dialysis. 2002 May-June; 15(3): 146-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12100452&dopt=Abstract

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

Finding Nutrition Studies on Fistulas 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 “fistulas” (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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Fistulas

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

Analysis of pharyngocutaneous fistula following free jejunal transfer for total laryngopharyngectomy. Author(s): Department of Plastic and Reconstructive Surgery and the Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston 77030, USA. [email protected] Source: Chang, David W Hussussian, Christopher Lewin, January S Youssef, Adel A Robb, Geoffrey L Reece, Gregory P Plast-Reconstr-Surg. 2002 April 15; 109(5): 1522-7 0032-1052

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Closure of proximal colorectal fistulas using fibrin sealant. Author(s): Department of Surgery, Baylor University Medical Center, Dallas, Texas, USA. Source: Lamont, Jeffrey P Hooker, Glen Espenschied, Jonathan R Lichliter, Warren E Franko, Edward Am-Surg. 2002 July; 68(7): 615-8 0003-1348

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Does rich fiber diet accelerate the healing process of low-output colorectal fistulas? Author(s): Department of Surgical Oncology, Institut Bergonie, Universite Louis Pasteur, Bordeaux, France. Source: Evrard, S Dig-Dis-Sci. 2002 November; 47(11): 2635-7 0163-2116

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Endoscopic treatment of oesophagoairway fistula with oesophageal balloon prosthesis. Author(s): Dept of Surgical Gastroenterology, University Hospital of Aarhus, Denmark. Source: Pless, T K Wara, P Kruse, A Eur-J-Surg. 1996 December; 162(12): 957-9 1102-4151

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Fitsari 'dan Duniya. An African (Hausa) praise song about vesicovaginal fistulas. Author(s): Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri 63110, USA. [email protected] Source: Wall, L L Obstet-Gynecol. 2002 December; 100(6): 1328-32 0029-7844

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Gadolinium-enhanced digital subtraction angiography of hemodialysis fistulas: a diagnostic and therapeutic approach. Author(s): Department of Radiology, Tenon University Hospital, 4 rue de la Chine, F75970 Paris Cedex 20, France. Source: Le Blanche, A F Tassart, M Deux, J F Rossert, J Bigot, J M Boudghene, F AJRAm-J-Roentgenol. 2002 October; 179(4): 1023-8 0361-803X

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Long-term results and quality-of-life outcomes in patients with transsphincteric fistulas after muscle-filling procedure. Author(s): Department of Proctology, Social Health Insurance Hospital, Tokyo, Japan. Source: Wang, D Yamana, T Iwadare, J Dis-Colon-Rectum. 2002 August; 45(8): 1011-5 0012-3706

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Management of digestive tract fistulas. A review. Author(s): Servizio di Endocrinochirurgia, Dipartimento di Scienze Chirurgiche e Gastroenterologiche, Universita degli Studi di Verona, Italia. [email protected] Source: Falconi, M Sartori, N Caldiron, E Salvia, R Bassi, C Pederzoli, P Digestion. 1999; 60 Suppl 351-8 0012-2823

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Mycobacterium xenopi infection of a 50-year-old oil plombage complicated by bronchopleural and pleurocutaneous fistulas. Author(s): Department of Radiology, University of Vienna, Austria.

Nutrition

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Source: Bankier, A A Stauffer, F Lomoschitz, F Brunner, C J-Thorac-Imaging. 1999 October; 14(4): 307-11 0883-5993 •

New alternatives for the treatment of fistulas in Crohn's disease. Author(s): IInd Department of Internal Medicine University Hospital, Olomouc, Czech Republic. Source: Skvarilova, M Nicakova, R Axmann, K Acta-Univ-Palacki-Olomuc-Fac-Med. 1994; 13829-31 0301-2514

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Nutritional support in the management of external pancreatic fistulas. Author(s): Department of Surgery, University of Natal, Durban. Source: Madiba, T E Haffejee, A A Singh, B Reddy, R S-Afr-J-Surg. 1995 June; 33(2): 81-4 0038-2361

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Obstetric fistulas in Africa and the developing world: new efforts to solve an age-old problem. Author(s): Department of Obstetrics and Gynecology, Louisiana State University Medical Center, New Orleans, USA. Source: Wall, L L Womens-Health-Issues. 1996 Jul-August; 6(4): 229-34 1049-3867

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Oral KCl dietary supplement extends survivability of dogs with Heidenhain pouch gastric fistulas. Author(s): Research Laboratories, R.W. Johnson Pharmaceutical Research Institute,Raritan, NJ 08869. Source: Fernandez, J A Katz, L B Guilloud, N B Shriver, D A Lab-Anim-Sci. 1989 November; 39(6): 587-90 0023-6764

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Prophylactic use of intravenous prostaglandin E1 for radial arterial spasm in uremic patients undergoing construction of arteriovenous hemodialysis fistulas. Author(s): Department of Internal Medicine, Toride Kyodo General Hospital, Japan. Source: Owada, A Saito, H Nagai, T Iwamoto, H Shigai, T Int-J-Artif-Organs. 1994 October; 17(10): 511-4 0391-3988

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Segmental degradation of left ventricular wall motion after persistent coronary fistula in a posttransplantation patient: a case report and short review of literature. Author(s): Department of Cardiology, University of Graz, Austria. Source: Gasser, R Koppel, H Luha, O Brussee, H Stoschitzky, K Tscheliessnigg, K H Klein, W Transplantation. 2000 May 27; 69(10): 2108-11 0041-1337

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Silicone-covered self-expanding metallic stents for the palliation of malignant esophageal obstruction and esophagorespiratory fistulas: experience in 32 patients and a review of the literature. Author(s): Division of Gastroenterology, Oregon Health Sciences University, Portland 97201-3098. Source: Wu, W C Katon, R M Saxon, R R Barton, R E Uchida, B T Keller, F S Rosch, J Gastrointest-Endosc. 1994 Jan-February; 40(1): 22-33 0016-5107

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Tracheoesophageal fistula in the patient with lymphoma: case report and review of the literature. Author(s): Thoracic Oncology Section, National Cancer Institute, Bethesda, Md. 20892. Source: Perry, R R Rosenberg, R K Pass, H I Surgery. 1989 June; 105(6): 770-7 0039-6060

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Treatment of enterocutaneous fistulas by high-pressure suction with a normal diet. Author(s): Department of Surgery, Federal University of Rio Grande do Norte, Natal, Brazil. Source: Medeiros, A da C Soares, C E Am-J-Surg. 1990 April; 159(4): 411-3 0002-9610

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Treatment of malignant esophagorespiratory fistulas with silicone-covered metallic Z stents. Author(s): Dotter Interventional Institute, Oregon Health Sciences University, Portland 97201-3098, USA. Source: Saxon, R R Barton, R E Katon, R M Lakin, P C Timmermans, H A Uchida, B T Keller, F S Rosch, J J-Vasc-Interv-Radiol. 1995 Mar-April; 6(2): 237-42 1051-0443

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Treatment of perianal fistulas with ND:YAG laser--results in twenty cases. Author(s): Department of Small Animal Clinical Sciences, University of Florida, Gainesville 32610, USA. Source: Ellison, G W Bellah, J R Stubbs, W P Van Gilder, J Vet-Surg. 1995 Mar-April; 24(2): 140-7 0161-3499

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Use of somatostatin in the treatment of digestive fistulas. Pharmacoeconomic issues. Author(s): Service de Chirurgie Digestive, Hopital Henri-Mondor, Creteil, France. [email protected] Source: Fagniez, P L Yahchouchy, E Digestion. 1999; 60 Suppl 365-70 0012-2823

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

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

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

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

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

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

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

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

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

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

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

Nutrition

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

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

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

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

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

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

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

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

Adjuvant use of epsilon-aminocaproic acid (Amicar) in the endovascular treatment of cranial arteriovenous fistulae. Author(s): Kallmes DF, Marx WF, Jensen ME, Cloft HJ, Do HM, Lanzino G, West K, Dion JE. Source: Neuroradiology. 2000 April; 42(4): 302-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10872177&dopt=Abstract

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Chronic perilymph fistula in the guinea pig with implications in the human. Author(s): Parnes LS, Campbell KC. Source: The Annals of Otology, Rhinology, and Laryngology. 1992 February; 101(2 Pt 1): 176-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1739265&dopt=Abstract

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Colovesical fistula an unusual complication of cytotoxic therapy in a case of nonHodgkin's lymphoma. Author(s): Ansari MS, Nabi G, Singh I, Hemal AK, Pandey G. Source: International Urology and Nephrology. 2001; 33(2): 373-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12092659&dopt=Abstract

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EDTA-tromethamine lavage as an adjunct treatment for multiple fistulas in a dog. Author(s): Bjorling DE, Wooley RE. Source: J Am Vet Med Assoc. 1982 September 15; 181(6): 596-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6815143&dopt=Abstract

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Effect of perilymphatic fistulas on evoked otoacoustic emissions in the guinea pig. Author(s): Kokesh J, Norton SJ, Duckert LG. Source: The American Journal of Otology. 1994 July; 15(4): 466-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8588601&dopt=Abstract

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Electrocochleography in the diagnosis of perilymphatic fistula: intraoperative observations and assessment of a new diagnostic office procedure. Author(s): Gibson WP. Source: The American Journal of Otology. 1992 March; 13(2): 146-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1599007&dopt=Abstract

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Electrocochleography with postural changes in perilymphatic fistula. Animal studies. Author(s): Campbell KC, Abbas PJ. Source: The Annals of Otology, Rhinology, and Laryngology. 1994 June; 103(6): 474-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8203814&dopt=Abstract

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Endosonographic evidence of persistence of Crohn's disease-associated fistulas after infliximab treatment, irrespective of clinical response. Author(s): van Bodegraven AA, Sloots CE, Felt-Bersma RJ, Meuwissen SG. Source: Diseases of the Colon and Rectum. 2002 January; 45(1): 39-45; Discussion 45-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11786762&dopt=Abstract

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Epidemiological determinants of vesicovaginal fistulas. Author(s): Tahzib F. Source: British Journal of Obstetrics and Gynaecology. 1983 May; 90(5): 387-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6849845&dopt=Abstract

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Epidemiology of vesico--vaginal fistulae in northern Nigeria. Author(s): Ampofo K, Otu T, Uchebo G.

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Source: West Afr J Med. 1990 April-June; 9(2): 98-102. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2268575&dopt=Abstract •

Fistuloscopy--an adjuvant technique for sealing gastrointestinal fistulae. Author(s): Lange V, Meyer G, Wenk H, Schildberg FW. Source: Surgical Endoscopy. 1990; 4(4): 212-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2291162&dopt=Abstract

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Fitsari 'dan Duniya. An African (Hausa) praise song about vesicovaginal fistulas. Author(s): Wall LL. Source: Obstetrics and Gynecology. 2002 December; 100(6): 1328-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12468180&dopt=Abstract

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Gastrocolic fistula presenting as acute diarrhea. Author(s): Russell LJ, Kearl GW. Source: American Family Physician. 1989 October; 40(4): 223-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2801465&dopt=Abstract

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Gastrointestinal mucormycosis complicated by arterio-enteric fistula in a patient with non-Hodgkin's lymphoma. Author(s): Mir N, Edmonson R, Yeghen T, Rashid H. Source: Clinical and Laboratory Haematology. 2000 February; 22(1): 41-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10762303&dopt=Abstract

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Gastrojejunal fistula caused by gastric ulcer. Author(s): Matsuoka M, Yoshida Y, Hayakawa K, Fukuchi S. Source: Journal of Gastroenterology. 1998 April; 33(2): 267-71. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9605960&dopt=Abstract

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Gastrosplenic fistulas: a case report and review of the literature. Author(s): Carolin KA, Prakash SH, Silva YJ. Source: The American Surgeon. 1997 November; 63(11): 1007-10. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9358792&dopt=Abstract

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Histiocytosis X revealed by complex anal fistula. Author(s): Grapin C, Audry G, Josset P, Patte C, Sorrel Dejerine E, Gruner M. Source: European Journal of Pediatric Surgery : Official Journal of Austrian Association of Pediatric Surgery. [et Al] = Zeitschrift Fur Kinderchirurgie. 1994 June; 4(3): 184-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8086400&dopt=Abstract

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Hyperbaric oxygenation for rectovaginal fistula: a report of two cases. Author(s): Dohgomori H, Arikawa K, Nobori M, Tonari M.

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Source: The Journal of Obstetrics and Gynaecology Research. 1999 October; 25(5): 343-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10533330&dopt=Abstract •

Intracranial dural arteriovenous fistulas: analysis of 60 patients. Author(s): Chung SJ, Kim JS, Kim JC, Lee SK, Kwon SU, Lee MC, Suh DC. Source: Cerebrovascular Diseases (Basel, Switzerland). 2002; 13(2): 79-88. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11867880&dopt=Abstract

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Ksharsootra (medicated seton) treatment for fistula-in-ano. Author(s): Mohite JD, Gawai RS, Rohondia OS, Bapat RD. Source: Indian J Gastroenterol. 1997 July; 16(3): 96-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9248180&dopt=Abstract

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Long-term analysis of children with esophageal atresia and tracheoesophageal fistula. Author(s): Little DC, Rescorla FJ, Grosfeld JL, West KW, Scherer LR, Engum SA. Source: Journal of Pediatric Surgery. 2003 June; 38(6): 852-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12778380&dopt=Abstract

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Low-frequency modulation of compound action potential in experimental perilymphatic fistula and endolymphatic hydrops. Author(s): Tono T, Morizono T. Source: Hearing Research. 1992 June; 60(1): 27-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1500374&dopt=Abstract

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Massively bleeding gastrosplenic fistula following cytostatic chemotherapy of a malignant lymphoma. Author(s): Hiltunen KM, Airo I, Mattila J, Helve O. Source: Journal of Clinical Gastroenterology. 1991 August; 13(4): 478-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1918860&dopt=Abstract

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Multiple faecal and urinary fistulae as a complication of native treatment of inguinal hernia. Author(s): Udofot SU. Source: Trop Geogr Med. 1991 January-April; 43(1-2): 105-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1750097&dopt=Abstract

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Nonoperative management of iatrogenic prostatorectal fistula. Author(s): Evins SC. Source: Urology. 1989 May; 33(5): 418-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2775367&dopt=Abstract


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Obstetric fistulas in Africa and the developing world: new efforts to solve an age-old problem. Author(s): Wall LL. Source: Women's Health Issues : Official Publication of the Jacobs Institute of Women's Health. 1996 July-August; 6(4): 229-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8754673&dopt=Abstract

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On the pathomechanism of cochlear dysfunction in experimental perilymph fistulas. Author(s): Bohmer A. Source: The Laryngoscope. 1991 December; 101(12 Pt 1): 1307-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1766301&dopt=Abstract

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Oral intake of poppy seed: a reliable and simple method for diagnosing vesico-enteric fistula. Author(s): Schwaibold H, Popiel C, Geist E, Hartung R. Source: The Journal of Urology. 2001 August; 166(2): 530-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11458060&dopt=Abstract

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Oral KCl dietary supplement extends survivability of dogs with Heidenhain pouch gastric fistulas. Author(s): Fernandez JA, Katz LB, Guilloud NB, Shriver DA. Source: Laboratory Animal Science. 1989 November; 39(6): 587-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2593637&dopt=Abstract

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Positron emission tomography with 68Ga-EDTA in the diagnosis and localization of csf fistulas. Author(s): Bergstrand G, Bergstrom M, Eriksson L, Edner G, Widen L. Source: Journal of Computer Assisted Tomography. 1982 April; 6(2): 320-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6804537&dopt=Abstract

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Prospective randomised trial comparing ayurvedic cutting seton and fistulotomy for low fistula-in-ano. Author(s): Ho KS, Tsang C, Seow-Choen F, Ho YH, Tang CL, Heah SM, Eu KW. Source: Techniques in Coloproctology. 2001 December; 5(3): 137-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11875680&dopt=Abstract

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Rectal cancer in anorectal malformation with rectovestibular fistula: sphincterrestoring surgery by anterior resection and dynamic vaginoanograciloplasty. Author(s): Violi V, Boselli AS, Sarli L, Costi R, Roncoroni L. Source: Diseases of the Colon and Rectum. 2001 July; 44(7): 1043-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11496087&dopt=Abstract

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Schedule-induced polydipsia in rats with gastric fistulas. Author(s): Evered MD, Sargent R. Source: Physiology & Behavior. 1993 December; 54(6): 1103-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8295948&dopt=Abstract

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Segmental degradation of left ventricular wall motion after persistent coronary fistula in a posttransplantation patient: a case report and short review of literature. Author(s): Gasser R, Koppel H, Luha O, Brussee H, Stoschitzky K, Tscheliessnigg KH, Klein W. Source: Transplantation. 2000 May 27; 69(10): 2108-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10852606&dopt=Abstract

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Seminoma metastatic to the prostate resulting in a rectovesical fistula. Author(s): Plummer ER, Greene DR, Roberts JT. Source: Clin Oncol (R Coll Radiol). 2000; 12(4): 229-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11005688&dopt=Abstract

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Small cell carcinoma of the esophagus with an esophago-mediastinal fistula successfully treated by chemoradiation therapy and intubation: a case report. Author(s): Ohtsu A, Yoshida S, Boku N, Fujii T, Oda Y, Miyata Y, Koba I, Muro K, Ohnaka O, Shimizu W, et al. Source: Japanese Journal of Clinical Oncology. 1993 December; 23(6): 373-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8283791&dopt=Abstract

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Spontaneous disappearance of arteriovenous fistula between the vertebral artery and deep cervical vein--case report. Author(s): Kubota M, Watanabe O, Takase M, Hashimoto T. Source: Neurol Med Chir (Tokyo). 1992 February; 32(2): 84-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1376865&dopt=Abstract

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Spontaneous vertebral arteriovenous fistula--case report. Author(s): Yoshida S, Nakazawa K, Oda Y. Source: Neurol Med Chir (Tokyo). 2000 April; 40(4): 211-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10853320&dopt=Abstract

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System identification of perilymphatic fistula in an animal model. Author(s): Wall C 3rd, Casselbrant ML. Source: The American Journal of Otology. 1992 September; 13(5): 443-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1443080&dopt=Abstract

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Tracheoesophageal fistula developing during chemotherapy for non-Hodgkins lymphoma. Author(s): Lackner RP, Bierman PJ, Galbraith TA.


Source: Journal of Surgical Oncology. 1996 December; 63(4): 265-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8982372&dopt=Abstract •

Tracheoesophageal fistula in the patient with lymphoma: case report and review of the literature. Author(s): Perry RR, Rosenberg RK, Pass HI. Source: Surgery. 1989 June; 105(6): 770-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2471284&dopt=Abstract

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

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

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

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

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

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

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

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

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

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

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

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

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

The following is a specific Web list relating to fistulas; 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 Anal Fistulae Source: Integrative Medicine Communications; www.drkoop.com Crohn's Disease Source: Healthnotes, Inc.; www.healthnotes.com

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Diverticular Disease Source: Integrative Medicine Communications; www.drkoop.com Varicose Veins Source: Integrative Medicine Communications; www.drkoop.com •

Chinese Medicine Hongfen Alternative names: Red Mercuric Oxide; Hydrargyri Oxydum Rubrum Source: Chinese Materia Medica Jiuyi San Alternative names: Jiuyi Powder Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Mubiezi Alternative names: Cochinchina Momordica Seed; Semen Momordicae Source: Chinese Materia Medica

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Herbs and Supplements Astragalus Sp Alternative names: Vetch, Rattlepod, Locoweed; Astragalus sp. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Brahmi Alternative names: Centella asiatica, Centella, March Pennywort, Indian Pennywort, Hydrocotyle, Brahmi (Sanskrit), Luei Gong Gen (Chinese)(Note: Gotu kola should not be confused with kola nut.) Source: Integrative Medicine Communications; www.drkoop.com Centella Source: Integrative Medicine Communications; www.drkoop.com Centella asiatica Alternative names: Centella asiatica, Centella, March Pennywort, Indian Pennywort, Hydrocotyle, Brahmi (Sanskrit), Luei Gong Gen (Chinese)(Note: Gotu kola should not be confused with kola nut.) Source: Integrative Medicine Communications; www.drkoop.com Fenugreek Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Gotu Kola Alternative names: Centella asiatica, Centella, March Pennywort, Indian Pennywort, Hydrocotyle, Brahmi (Sanskrit), Luei Gong Gen (Chinese)(Note: Gotu kola should not be confused with kola nut.) Source: Integrative Medicine Communications; www.drkoop.com


Hydrocotyle Source: Integrative Medicine Communications; www.drkoop.com Indian Pennywort Source: Integrative Medicine Communications; www.drkoop.com Marsh Pennywort Alternative names: Centella asiatica , Centella, March Pennywort, Indian Pennywort, Hydrocotyle, Brahmi (Sanskrit), Luei Gong Gen (Chinese)(Note: Gotu kola should not be confused with kola nut.) Source: Integrative Medicine Communications; www.drkoop.com Terminalia Alternative names: Myrobalans; Terminalia arjuna Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Vitex Alternative names: Chaste; Vitex agnus-castus Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org

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

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CHAPTER 4. CLINICAL TRIALS AND FISTULAS Overview In this chapter, we will show you how to keep informed of the latest clinical trials concerning fistulas.

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

Evaluation and Treatment of Patients Spinal Blood Vessel Abnormalities Condition(s): Arteriovenous Fistula; Arteriovenous Malformation; Spinal Cord Disease Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Neurological Disorders and Stroke (NINDS) Purpose - Excerpt: Arteriovenous malformations (AVM) are abnormally formed blood vessels that can be located throughout the brain and spinal cord. Patients with abnormalities of the blood vessels located in and around the spinal cord can develop many neurological problems. Some problems include, weakness, pain, difficulty walking, paralysis, and even death. The treatment for these AVMs depends on their location, the type of malformation, the area of the spine involved, and the condition of the patient at the time of treatment. The treatment is aimed at stopping the neurologic problems from worsening and possibly correcting the existing problems. There are two commonly used treatments for AVMs, surgery and embolization (blocking off of blood flow to the AVM). However, researchers have limited experience treating these conditions because they are rare. In addition, it has been difficult to classify different kinds of AVMs and to develop new treatments for them. This study is designed to increase researchers understanding of AVMs by admitting and following patients diagnosed with the condition. By increasing the amount of patients studied diagnosed with spinal blood vessel abnormalities, researchers can begin to develop new management plans for patients with AVMs. Study Type: Observational

8

These are listed at www.ClinicalTrials.gov.

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Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00001364 •

Phase III Randomized Study of Anti-Tumor Necrosis Factor Chimeric Monoclonal Antibody (cA2) for Patients with Enterocutaneous Fistulae as a Complication of Crohn's Disease Condition(s): Crohn's Disease Study Status: This study is completed. Sponsor(s): FDA Office of Orphan Products Development; Centocor Purpose - Excerpt: Objectives: I. Evaluate the efficacy of chimeric monoclonal antibody (cA2) compared with placebo in closure of enterocutaneous fistulae in patients with Crohn's disease. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00004941

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 “fistulas” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: •

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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CHAPTER 5. PATENTS ON FISTULAS 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 “fistulas” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on fistulas, we have not necessarily excluded non-medical patents in this bibliography.

Patents on Fistulas By performing a patent search focusing on fistulas, 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 fistulas: •

AV fistula and function enhancing method Inventor(s): Fogarty; Thomas J. (Portola Valley, CA) Assignee(s): Vascular Architects, Inc (san Jose, Ca) Patent Number: 6,585,760 Date filed: June 30, 2000 Abstract: A coiled stent graft (10) is positionable within an AV fistula (4) and optionally into one or both of the artery (9) and the vein (6) to help reduce or eliminate blockages within the blood vessel at the junction (8) between the AV fistula and the blood vessel. Excerpt(s): A fistula is an abnormal passage typically between two organs, such as an artery and a vein. An arterio-venous (AV) fistula is a natural or an artificial graft, typically made of ePTFE (expanded PTFE), between a vein and an artery. An AV fistula, as used herein, also includes naturally-occurring native tissue tubular connections between a vein and an artery. AV fistulas are often used to provide multiple needle access sites for hemodialysis. The AV fistula also helps to increase blood flow through the vein to accommodate the flow rate of blood needed for hemodialysis. One problem associated with AV fistulas is the progressive narrowing of the AV fistula at the junction with the vein. Such obstructions occur when vascular muscle cells begin growing inwardly causing, for example, thrombosis within the AV fistula. When the thrombus becomes sufficiently large, blood flow decreases and the AV fistula ceases to be effective. It has been found that graft patency after six months is only 66% and that graft failure occurs, on the average, after 18 months. Improved graft patency has been achieved by the use of vascular clips instead of suturing the AV fistula to the vein. Variations in the angle of implantation have also been shown to affect AV fistula patency. The use of a short length of a PTFE graft has been inserted in the vein to improve patency. (A. S. Coulson, et al., A Combination of the Elephant Trunk Anastomosis Technique and Vascular Clips for Dialysis Grafts, Surgical Rounds, 596608, November 1999.) Also, a PTFE bypass graft to a proximal dilated vein has been used in response to the occurrence of graft-vein stenosis. (Polo, J. R., The State of the Art of Surgical Treatment for Failing Grafts, The Seventh Biannual Symposium on Dialysis Access--Vascular Access for Hemodialysis VII, pp.8-9, May 2000.) Balloon angioplasty and endovascular stents may be used to treat stenosis in AV fistulas (J. E. Aruny, et al., Quality Improvement Guidelines for Percutaneous Management of the Thrombosed on Dysfunctional Dialysis Access, JVIR, 10:491-498, April 1999.) However, there still exists the need to stop, or at least slow, the obstruction of the AV fistula to prolong the patency of the graft. Web site: http://www.delphion.com/details?pn=US06585760__

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Catheter apparatus and methodology for generating a fistula on-demand between closely associated blood vessels at a pre-chosen anatomic site in-vivo Inventor(s): Cohn; William E. (Chestnut Hill, MA), Kim; Ducksoo (Dover, MA) Assignee(s): Beth Israel Deaconess Medical Center (boston, Ma) Patent Number: 5,830,224 Date filed: March 15, 1996 Abstract: The present invention provides catheter apparatus and catheterization methodology for generating an arteriovenous fistula or a veno-venous fistula ondemand between closely associated blood vessels and at a chosen anatomic site in-vivo. The catheter apparatus is preferably employed in pairs, each catheter of the pair being suitable for percutaneous introduction into and extension through a blood vessel. The catheterization methodology employs the catheter apparatus preferably in conjunction with conventional radiological techniques in order to place, verify, and confirm a proper alignment, orientation, and positioning for the catheters in-vivo prior to activating the perforation means for generating a fistula. The invention permits the generation of arteriovenous fistulae and veno-venous fistulae anatomically anywhere in the vascular system of a patient; nevertheless, the invention is most desirably employed in the peripheral vascular system as exists in the extremities of the body to aid in the treatment of the patient under a variety of different medical ailments and pathologies. Excerpt(s): The present invention is concerned with improvements in catheter design and usage in-vivo; and is particularly directed to catheterization apparatus and methods for creating an arteriovenous fistula or a veno-venous fistula between adjacently positioned blood vessels. A catheter is a long flexible tube introduced into a blood vessel or a hollow organ for the purpose of introducing or removing fluids; implanting medical devices; or for performing diagnostic tests or therapeutic interventions. Catheters are conventionally known and frequently used; and a wide range and variety of catheters are available which are extremely diverse in shape, design and specific features. Typically a catheter is a long thin tube of fixed axial length, with two discrete, unique ends. One end is designed and engineered to be inserted in the body; the other end generally remains outside the body, and is so designed. Most catheters have at least one internal lumen of a volume sufficient to allow for on-demand passage of a diverse range of wires, rods, liquids, gases, transmitting energy, fiber optics, and specifically designed medical instruments. Web site: http://www.delphion.com/details?pn=US05830224__

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Catheter-based methods for enlarging blood vessels to facilitate the formation of penetration tracts, fistulas and/or blood flow channels Inventor(s): Flaherty; J. Christopher (Los Altos, CA), Garibotto; John T. (Palo Alto, CA), Lamson; Theodore C. (Pleasanton, CA) Assignee(s): Transvascular, Inc. (menlo Park, Ca) Patent Number: 6,508,824 Date filed: February 18, 2000 Abstract: Methods, devices and systems wherein a penetrating catheter or other penetrating device is used to penetrate into a target blood vessel, and wherein the target vessel is dilated prior to the penetration so as to improve the imaging, aiming at and/or

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penetration into the target vessel. In one embodiment, a tissue penetrating catheter device that is useable to penetrate from a blood vessel in which it is positioned to a target vessel comprises a flexible catheter advanceable into the first blood vessel and a tissue penetrator lumen adapted to receive an operative tissue penetrator which is usable to penetrate from the blood vessel to the target vessel when properly aimed. An imaging transducer may be fixedly mounted on or within the penetrating catheter to provide an imaging signal from which an image of the target vessel can be obtained. A target vessel dilating catheter is inserted into the target vessel and used to dilate the target vessel prior to imaging, aiming of the penetrator at and/or puncture thereof. Such vessel dilating catheters may comprise one or more occlusion member(s) (e.g., one or two balloons) to block flow through the target vessel and/or to isolate and pressurize a region of the vessel. Alternatively, the dilating catheter may comprise a dilating member that expands within the target vessel to cause a portion of the target vessel wall to enlarge, stretch, expand, bulge or otherwise dilate. Excerpt(s): The present invention relates generally to medical devices and methods, and more particularly to catheter devices and methods that are useable to form penetration tracts, fistulas or blood flow channels into target vessels in furtherance of a therapeutic purpose such as bypassing an arterial blockage, arterializing a vein, creating a dialysis fistula, or performing other interventional procedures. In most regions of the world, atherosclerotic cardiovascular disease remains a major cause of premature death and morbidity. Various transluminal, catheter-based interventional techniques have been used, or proposed for use, to dilate or otherwise treat atherosclerotic obstructions that occur in coronary and/or peripheral arteries. These therapies have traditionally focused on treating the disease intraluminally, or from "within" the vessel lumen. Included among the newer interventional techniques are certain percutaneous, transluminal techniques for bypassing obstructions in coronary or peripheral arteries through the use of the adjacent vein(s) as in situ bypass conduit(s); (e.g. using catheters to perform extra luminal procedures outside the diseased vessel lumen). These procedures include certain proprietary procedures known as PICVA.TM. and PICAB.TM. (PICVA.TM. and PICAB.TM. are trademarks of Transvascular, Inc. of Menlo Park, Calif.) as described in U.S. Pat. No. 5,830,222 (Makower) and in published PCT Applications WO 98/16161, WO 98/46119, WO99/49910 and WO99/49793. As described therein, in some instances, these procedures may be performed by a venous approach wherein a tissue penetrating catheter is inserted into a vein (the "host" vessel). The desired passageway or puncture is initially formed by facilitating the passage of a tissue penetrator (e.g., a flow of energy or an elongate penetration member) from the catheter, through the wall of the vein in which the catheter is positioned, and into a target location such as the lumen of an adjacent vessel (e.g. the artery). Alternatively, some of these procedures may be performed by an arterial approach wherein the catheter is inserted into an artery (the "host" vessel) and the desired passageway or puncture is initially formed by facilitating the passage of a tissue penetrator from the catheter, through the wall of the artery in which the catheter is positioned, and into the target location such as the lumen of an adjacent vessel (e.g. a vein). In some instances, the target vessel may be an artery. Web site: http://www.delphion.com/details?pn=US06508824__

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Endovascular electrolytically detachable wire and tip for the formation of thrombus in arteries, veins, aneurysms, vascular malformations and arteriovenous fistulas Inventor(s): Guglielmi; Guido (Santa Monica, CA), Sepetka; Ivan (Redwood City, CA) Assignee(s): The Regents of the University of California (oakland, Ca) Patent Number: 5,895,385 Date filed: November 6, 1997 Abstract: An artery, vein, aneurysms vascular malformation or arterial fistula is occluded through endovascular occlusion by the endovascular insertion of a platinum wire and/or tip into the vascular cavity. The vascular cavity is packed with the tip to obstruct blood flow or access of blood in the cavity such that the blood clots in the cavity and an occlusion if formed. The tip may be elongate and flexible so that it packs the cavity by being folded upon itself a multiple number of times, or may pack the cavity by virtue of a filamentary or fuzzy structure of the tip. The tip is then separated from the wire mechanically or by electrolytic separation of the tip from the wire. The wire and the microcatheter are thereafter removed leaving the tip embedded in the thrombus formed within the vascular cavity. Movement of wire in the microcatheter is more easily tracked by providing a radioopaque proximal marker on the microcatheter and a corresponding indicator marker on the wire. Electrothrombosis is facilitate by placing the ground electrode on the distal end of the microcatheter and flowing current between the microcatheter electrode and the tip. Excerpt(s): The invention relates to a method and apparatus for endovascular electrothrombic formation of thrombi in arteries, veins, aneurysms, vascular malformations and arteriovenous fistulas. Approximately 25,000 intracranial aneurysms rupture every year in North America. The primary purpose of treatment for ruptured intracranial aneurysm is to prevent rebleeding. At the present time, three general methods of treatment exist, namely an extravascular, endovascular and extraendovascular approach. The extravascular approach is comprised of surgery or microsurgery of the aneurysm or treatment site for the purpose of preserving the parent artery. This treatment is common with intracranial berry aneurysms. The methodology comprises the step of clipping the neck of the aneurysm, performing a sutureligation of the neck, or wrapping the entire aneurysm. Each of these surgical procedures is performed by intrusive invasion into the body and performed from outside the aneurysm or target site. General anesthesia, craniotomy, brain retraction and arachnoid dissection around the neck of the aneurysm and placement of a clip are typically required in these surgical procedures. Surgical treatment of vascular intracranial aneurysm can expect a mortality rate of 4-8% with a morbidity rate of 18-20%. Because of the mortality and morbidity rate expected, the surgical procedure is often delayed while waiting for the best surgical time with the result that an additional percentage of patients will die from the underlying disease or defect prior to surgery. For this reason the prior art has sought alternative means of treatment. Web site: http://www.delphion.com/details?pn=US05895385__

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Fistula device and method for in-vivo evaluation of fish egg development Inventor(s): Bakal; Robert Scott (Newnan, GA) Assignee(s): The United States of America AS Represented by the Secretary of the (washington, Dc) Patent Number: 6,485,435 Date filed: October 18, 2000 Abstract: A fistula device is provided for use with fish to gather materials, e.g., eggs, from inside an exterior body wall of the fish. The fistula device includes a body member having a flange at one end thereof. The flange, in use, engages an outside surface of the exterior body wall of the fish to hold the device in place. The device also includes a hollow cylindrical body portion having both internal and external threading. A retaining ring is adapted to be placed against an interior surface of the exterior wall of the fish, and includes internal threading permitting the ring to be screwed onto the external threading of the body member. A knitted plastic mesh is secured to the retaining ring and adapted to be sutured to the inside of the exterior body wall of the fish. A removable plug used to close off the device includes a threaded portion adapted to be screwed into the body member. Excerpt(s): The present invention relates to the collection and evaluation of materials such as eggs from the piscine species (i.e., fish) and, more particularly to a fistula device and method used in such collection and evaluation. In sturgeon culture, the currently accepted practice is to perform multiple surgical biopsies, annually, on individual fish to evaluate and collect eggs for spawning. These procedures are, understandably, extremely traumatic for the fish. The use of repeated surgical procedures causes increased trauma, pain and stress to the fish while increasing the risk of infection and contamination of samples that are collected in this manner. Fistulas have been designed for use with cattle which allow external access to the rumen of the animal to permit removal of ingesta. A further fistula of interest is the subject of U.S. Pat. No. 5,993,485 (Beckers). This patent discloses a bladder portal including a fistula threaded on the inside to accept a seatable screw. The fistula includes a flange fitting inside the bladder and a further flange positioned outside the body. The screw is removed to permit urine to flow. U.S. Pat. No. 4,265,244 (Hill) discloses a tubular stoma adapter for insertion into the lumen of a body orifice. The adapter is held in place by tabs formed at the outer edge of a circular lip and by an adhesive sheet which holds the taps against the walls of the corresponding wall of the patient. U.S. Pat. No. 3,313,289 (Kapral) discloses a chamber for implantation into the body cavity of an animal. The chamber comprises a ring having two faces and a pair of membranes which cover the ring faces. Web site: http://www.delphion.com/details?pn=US06485435__

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Healing device applied to persistent wounds, fistulas, pancreatitis, varicose ulcers, and other medical or veterinary pathologies of a patient Inventor(s): Fernandez; Ernesto Ramos (Artigas 1087 1 flr, A, Buenos Aires, AR) Assignee(s): None Reported Patent Number: 6,203,563 Date filed: May 26, 1999

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Abstract: A healing device applied to wounds, fistulas, pancreatitis, varicose ulcers, and other medical or veterinary pathologies includes a compacting chamber for covering the wound over the affected or diseased zone of the patient. The compacting chamber is defined by a self adhesive polymeric material laminar sheet, made out of a waterproof material. The compacting chamber has a replaceable mass of aerated polymer fiber flock therewithin, as a wound-stabilizing dressing. The compacting chamber uses a vacuum for deforming and compacting a mass of polymer fiber flock into effective healing contact with the wound. The vacuum means is terminated upon achieving compaction of the mass of polymer fiber flock and upon effective healing contact of the mass of polymer fiber flock with the wound. Excerpt(s): The main object for this invention is a healing device applied to wounds, fistulas, pancreatis, varicose ulcers and other medical or veterinary pathologies requiring compacting into said wound an aerated material by means of atmospheric depression, and it has as its secondary object the method for applying said device. It is well know to professionals skilled in the art of healing, that a wound at any part of the human body can be provoked either by a pathological agent, as well through a traumatic agent. In either cases, the final result is a wound which segregates fluids, accumulates detritus and creates a bacteria breeding site, which in direct function of the nature and size of the wound, may impede its healing. On the other hand, a fistula is an orifice open from within an organ or limb in the human body, with an outlet. A healing process implies cleansing the wound, drying same of noxious fluids, and since a wound may be considered as an infectious cavity within the body, a fistula is a wound defining a passage or opening communicating one of more internal organs with the outer environment. The healing process for these medical pathologies are successful when the wound is clean and dry, ceasing in its emission of humorous fluids and detritus. Most of these are provoked by the activity of bacteria and pathogenic agents, which according to their nature must have a sufficient threshold of oxygen pressure in order to live and multiply, or in the case of gangrene, the absence of oxygen is required for same to infest the body. Web site: http://www.delphion.com/details?pn=US06203563__ •

Inhibition of proliferation of vascular smooth muscle cell Inventor(s): Dzau; Victor J. (Los Altos, CA) Assignee(s): The Board of Trustees of the Leland Stanford Junior University (palo Alto, Ca) Patent Number: 5,821,234 Date filed: August 20, 1993 Abstract: This invention encompasses a method for inhibiting vascular cellular activity of cells associated with vascular lesion formation in mammals which involves administering an effective dosage of at least one antisense sequence to at least one gene expressing a cyclin or a cyclin dependent kinase which inhibits the expression of the gene. More particularly, the invention involves administering antisense sequences which inhibit the expression of cyclin A, B1, B2, C, D1, D2, D3, E or cyclin X (p46) cyclin X and cyclin dependent kinase cdc2, cdk2, cdk4 or cdk5. It is preferable to use two antisense sequences each from a different cyclin or cyclin dependent kinase. The cyclin or cyclin kinase depending kinase dosage is preferable administered in combination with proliferating cell nuclear antigen (PCNA). Antisense methods and compositions direct to inhibiting the expression of growth factors such as TGF-.beta.sub.1, TGF, bFGF,

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PDGF are also contemplated by the present invention.The antisense sequences are incorporated into liposomes, particularly liposomes containing HVJ and which are directly administered intraluminally, intramurally or periadventitiously.While the method of this invention are useful in treating a broad spectrum of vascular lesions such as lesions in the carotid femural and renal arteries, particularly lesions resulting from renal dialysis fistulas. The invention is particularly useful in treating vascular lesions associated with coronary artery angioplasty. Excerpt(s): The field of this invention is inhibition of cellular activity related to vascular lesions. In the growth and maintenance of multi-cellular organisms, the organism has had to develop processes to activate or inhibit the proliferation of cells. The organism has developed numerous mechanisms, whereby signals are given to cells, by either intracellular or extracellular messengers. Control of proliferation provides for modeling of organs, maintenance of subsets of leukocytes in hematopoiesis, wound healing and the like. However, in many situations, such as injury or disease states, the response of the organism to the injury or disease may, in fact, be deleterious to the health of the organism. The vascular response to injury involves an alteration in three fundamental cellular processes; cell growth, cell migration and extracellular matrix production. This vascular response to injury is characteristic of the pathogenesis of various vascular diseases including (but not limited to): atherosclerosis, restenosis after angioplasty, vein bypass graft stenosis, prosthetic graft stenosis, angiogenesis and hypertension. For example, atherosclerotic lesions evolve as a result of vascular smooth muscle migration into the subintimal space, proliferation and the production of abundant extracellular matrix. Similarly, restenosis after angioplasty, vein bypass graft stenosis, prosthetic graft stenosis, angiogenesis and hypertension involve abnormalities in vascular cell growth, migration and matrix composition. The precise mechanisms responsible for alterations in the regulation of these cellular processes are poorly characterized. Web site: http://www.delphion.com/details?pn=US05821234__ •

Method and composition for prevention of scar formation in glaucoma filtration bleb and drainage fistula Inventor(s): Resul; Bahram (Uppsala, SE), Stjernschantz; Johan (Uppsala, SE) Assignee(s): Synphora AB (uppsala, Se) Patent Number: 6,495,563 Date filed: November 2, 2001 Abstract: This invention is related to a method whereby scar formation in the drainage fistula and subconjunctival bleb created during and after glaucoma surgery using a prostaglandin subtype A or J. Excerpt(s): This is a U.S. National Phase Application Under 35 USC 371 and applicant herewith claims the benefit of priority of PCT/SE00/00357 filed Feb. 23, 2000, which was published under PCT Article 21(2) in English and Application No. 9900672-8 filed in Sweden on Feb. 25, 1999. The present invention is related to a method whereby scar formation in the drainage fistula and subconjunctival bleb created during glaucoma surgery can be prevented. The invention is also related to a composition used for prevention of scar formation in the drainage fistula and subconjunctival bleb after glaucoma surgery. Glaucoma is an eye disorder characterized by increased intraocular pressure, excavation of the optic nerve head, and gradual loss of visual field. An abnormally high intraocular pressure is commonly known to be detrimental to the eye,

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and there are clear indications that in glaucoma the intraocular pressure is the most important factor causing degenerative changes in the retina and the optic nerve head. The exact pathophysiological mechanism of open angle glaucoma is, however, still unknowns. Unless treated glaucoma may lead to blindness, the course of the disease typically being slow with progressive loss of vision. Web site: http://www.delphion.com/details?pn=US06495563__ •

Method for making an occlusive device Inventor(s): Mariant; Michael J. (San Jose, CA), Samson; Gene (Milpitas, CA) Assignee(s): Target Therapeutics, Inc. (fremont, Ca) Patent Number: 6,143,007 Date filed: April 28, 1995 Abstract: This invention is a surgical device. In particular, it is an implant which may be used to occlude vascular lumens, arteries, veins, aneurysms, vascular malformations, arteriovenous fistulas, or other cavities and lumens within a mammalian body. It is typically a substrate coil or braid to which a number of fibers have been secured using heat. Excerpt(s): This invention is an occlusive device, and typically includes a substrate, often a helical metal coil, and a multiplicity of fibers incorporated therewith for enhancing a tissue-ingrowth response for occlusion. We use the term "occlusive devices" to encompass devices for occluding vascular lumens as well as any other body cavities requiring occlusion to carry out a medical treatment. We use the term "vaso-occlusion devices" to encompass devices used in endovascular applications, such as in occluding veins, arteries, fistulas, or aneurysms. Although the invention is described largely in terms of vaso-occlusion devices, we intend the present invention to include the wider scope of occlusion devices. Web site: http://www.delphion.com/details?pn=US06143007__

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Method for treating tracheo-esophageal fistulas Inventor(s): Silverman; David E. (Palo Alto, CA), Stein; Alan (Moss Beach, CA) Assignee(s): Enteric Medical Technologies, Inc. (foster City, Ca) Patent Number: 6,248,058 Date filed: April 5, 1999 Abstract: A method for treating a tracheo-esophageal fistula. The method comprises the steps of augmenting the wall forming the esophagus in the vicinity of the fistula and placing a stent over the fistula in the esophagus so as to inhibit material traveling down the esophagus from passing into the trachea. The augmenting of the wall facilitates support of the stent in the esophagus so as to enhance isolation of the fistula. Excerpt(s): This invention pertains to the treatment of tracheo-esophageal fistulas and, more particularly, to the treatment of tracheo-esophageal fistulas by means of stenting the wall of the esophagus. Tracheo-esophageal fistulas are a serious, end stage complication of cancers arising in the lung, tracheo-bronchial tree and the esophagus. The nature and extent of the disease almost always precludes curative therapy and,

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therefore, palliative measures are the goals of therapy. Unfortunately, many reported successful procedures fail to improve the patients' conditions to the point that the patient is able to be released from the hospital. The "in-hospital" mortality is often higher than the 30-day mortality. Increases in the expertise of endoscopists and esophagoscopy have permitted esophageal endoprostheses to be utilized in the treatment of tracheo-esophageal fistulas. Such procedures include stenting or other intubation of the esophagus. Unfortunately, the funnel rim of conventional stents used in this regard is often a poor fit with gaps between the rim and the mucosa of the esophageal wall. As a result, food and saliva are often allowed to pass between the mucosa and the outer surface of the prosthesis, thereby deleating the purpose of the prosthesis. In light of the foregoing, there is a need for a new and improved procedure for treating tracheo-esophageal fistulas which overcomes the disadvantages of the currently provided procedures. Web site: http://www.delphion.com/details?pn=US06248058__ •

Method of treating peripheral bronchopleural fistulas Inventor(s): Aye; Ralph (1221 Madison, #1220, Seattle, WA 98104) Assignee(s): None Reported Patent Number: 6,358,269 Date filed: November 2, 1999 Abstract: A method of treating peripheral bronchopleural fistula using a collagen matrix hemostatic pad. The method includes the following steps: (1) selecting a peripheral bronchopleural fistula; (2) selecting a collagen matrix hemostatic pad having sufficient size to cover the fistula; (3) aligning the collagen matrix hemostatic pad completely over the fistula; and (4) securing the collagen matrix hemostatic pad to the tissue sorrounding the fistula. Excerpt(s): This invention relates to improved partial lung resection procedures and more particularly to improved methods of treating peripheral bronchopleural fistulas. In the United States, more than 30,000 lobectomies are performed annually in addition to numerous other partial lung resection procedures including segmentectomy, wedge and bleb resection. Prolonged air leak as a complication of these procedures reportedly occurs in 3-5 of cases. For lobectomies alone, this accounts for more than 1,500 cases per year. Thus, prolonged air leak is a significant cause of patient morbidity and increased hospital cost. Thoracic procedures including lobectomy, segmentectomy, wedge and bleb resections are all potentially complicated by prolonged air leak. With current surgical technique and postoperative care, it is the duration of these leaks that often dictates the length of hospitalization. Resolution of these leaks sometimes requires invasive measures, adding to patient morbidity and hospital costs. Any reduction in air leak duration shortens hospital stays, reduces morbidity, and decreases overall postoperative expense. Web site: http://www.delphion.com/details?pn=US06358269__

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Methods of making and using coiled sheet graft for single and bifurcated lumens Inventor(s): Hogendijk; Michael (Palo Alto, CA), Khosravi; Farhad (San Mateo, CA), Patel; Himanshu (San Jose, CA), Ross; Michael R. (Hillsborough, CA), Spiridigliozzi; John (Belmont, CA) Assignee(s): Endotex Interventional Systems, Inc. (menlo Park, Ca) Patent Number: 6,048,360 Date filed: March 25, 1998 Abstract: A prosthesis is provided for treating aneurysms, occlusive disease of vessels and body organs, and arterio-venous fistulas, occurring in single and bifurcated lumens. The prosthesis comprises an expandable coiled sheet portion having a biocompatible graft, either a sheet or tube, affixed thereto along part or all of the circumference of the coiled sheet portion. The prosthesis has a small delivery profile, making it suitable for use in a variety of body vessels. Methods of making and deploying the prosthesis in single and bifurcated lumens are also provided. Excerpt(s): The present invention relates to prostheses for treatment of aneurysms, arterio-venous fistulas, obstructive vascular disease and other applications. More specifically, the present invention relates to prostheses including coiled sheet portions having a biocompatible material affixed thereto which may be used in a variety of applications as an internal bandage. Millions of people worldwide are afflicted each year with vascular diseases, ranging from vascular obstructive disease, such as arteriosclerosis, to diseases that weakened the arteries or other vessels, resulting in potentially fatal aneurysms and arterio-venous fistulas. Arterio-venous fistulas commonly occur other than by progression of natural disease, for example, as a result of accidents and gun-shot wounds. Each of these diseases has lead to the development of specialized treatments ranging from minimally-invasive techniques to more conventional open surgical techniques. For example, a health problem afflicting an older segment of the population is the occurrence of disease that weakens the arteries and other body vessels, developing into aneurysms that may rupture, often with fatal consequences. A conventional treatment of aneurysms, especially those occurring in the abdominal aorta, has involved invasive surgery to resect and remove the diseased body vessel and replace it with either a native vessel, harvested from elsewhere in the body, or a synthetic graft material. Such treatments typically pose a major risk to the patient's health, and frequently cannot be undertaken at all, if (as is common) the patient is in poor health. Web site: http://www.delphion.com/details?pn=US06048360__

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Modified solder for delivery of bioactive substances and methods of use thereof Inventor(s): Poppas; Dix P. (Brookline, MA) Assignee(s): Children's Medical Center Corporation (boston, Ma), V.i. Technologies, Inc. (melville, Ny) Patent Number: 5,713,891 Date filed: June 2, 1995 Abstract: Methods for tissue welding using solders incorporating biologically active agents, such as growth factors or hemostatic agents, have been developed. Improved solder compositions have also been defined, yielding greater bursting strength as a

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function of protein concentration, and through the use of protein unfolding prior to laser-mediated denaturation and coupling. A method for repair of fistulas has been discovered, using water as a chromophore, in combination with solder concentration, to form columns to fill defects where tissue apposition is not possible. Methods have also been adapted for use with other forms of directed energy, including bipolar electrosurgery and light. Examples demonstrate increased strength of repairs by incorporation of growth factors into solders, alone and as a function of solder concentration. Increased adhesion is obtained through prevention of bleeding by incorporation of hemostatic agents such as thrombin or epinephrine, a vasoconstrictor. Excerpt(s): This is generally in the field of methods for tissue welding using laser mediated coupling of protein solders, and in particular is an improved method and composition incorporating biologically active compounds into the solder. The use of laser energy to join tissue is referred to as "tissue welding". The goal is to facilitate the joining of tissues with a minimum of scar and good tensile strength of the apposed edges. Lasers that have been used for tissue welding include neodymium:yttriumaluminum-garnet (Nd:YAG), argon and CO.sub.2 lasers. These apparently produce an interdigitation of collagen fibrils, presumably heating at the surface of the tissues which denatures and couples the proteins in the tissue. Initial studies focused on anastomosis of blood vessels. Later studies looked at other tissues, such as bowel, and nerve repair. The success of tissue union is dependent on several factors, including alignment of the edges of the tissue without tension and in close approximation, adjustment of laser parameters to minimize peripheral tissue destruction and control heating of tissues, and the use of an appropriate protein solder. Various solders such as 40% albumin are described by Poppas, et al., J. Urol. 139, 415-417 (1988), Poppas, et al., J. Urol. 150, 648650 (1993), Poppas, et al., Lasers in Surgery & Med. 13, 577-580 (1993), Choma, et al., Lasers in Surg. & Med. 12, 639-644 (1992), and Poppas, et al., J. Urol. 150, 1052-1055 (993). Albumin is a preferred solder since it significantly improves the tensile strength of laser wound closure, as compared to in the absence of solder or the use of blood, it significantly increases the leak point pressure, it is inexpensive and easily manufactured and does not elicit an immunogenic response, and is available in sterile, virus free form. As described in U.S. Pat. Nos. 5,334,191 and 5,409,148 to Poppas, et al., and Poppas, et al. (1993), the solder is further improved through the inclusion of a chromophore such as fluorescein or iron oxide, which increases the absorption of laser energy, reducing the amount of power required to effect a tissue weld, as well as through the use of fine temperature control. Web site: http://www.delphion.com/details?pn=US05713891__ •

Ophthalmologic instrument for producing a fistula in the sclera Inventor(s): Prywes; Arnold S. (4212 Hempstead Turnpike, Bethpage, NY 11714) Assignee(s): None Reported Patent Number: 6,264,668 Date filed: September 16, 1998 Abstract: An instrument for producing a fistula through a tissue wall of an eye of a patient. The instrument has a housing with a flat blade supported in the housing for penetrating through the tissue wall to form an incised slit in the wall forming a tunnel therein. By rotating the housing and the flat blade a lamellar flap can be formed at the top of the tunnel. The housing contains a second cutting device to remove a large portion of tissue material at the bottom of the tunnel producing an aperture joined to the

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slit for forming the fistula. The cutting device can be a curved blade having a scoopshaped cross-section, a punch or an optical fiber capable of transmitting a laser beam. The cutting device is operated while the flat blade remains in the tunnel. Excerpt(s): The invention relates to an instrument for producing a fistula in a tissue wall of a patient, and more particularly to a fistula in the sclera in the eye of the patient. The instrument is denoted as a trabeculectomy probe. The instrument is applicable to the formation of such a fistula to relieve intraocular pressure in the anterior chamber of the eye of a patient suffering from glaucoma. Glaucoma is a disease where the intraocular pressure is elevated. It affects significant numbers of our population. The treatment of glaucoma is usually medical, however, medications often fail to control some forms of glaucoma. When further treatment is required a microsurgical operative procedure is performed. This procedure involves constructing a fistula or opening in the tissue wall of the sclera to enhance fluid flow from the internal portion of the eye (ciliary body) which secretes the fluid (aqueous humor) through the newly formed opening. This opening is typically made in a cutting type of procedure. This involves incising the external ocular tissues (conjunctiva) and dissecting the scleral tissues. This dissection results in attendant risks including bleeding, and development of extremely low intraocular pressure or hypotony. Post operative care is prolonged due to the large size of the scleral incisions, the possibility of complications and variability in wound healing. The procedure is generally referred to as a filtering operation, as a trabeculectomy, sclerectomy or lamellar scleral flap procedure. In a so-called full thickness fistulization procedure, a hole of a diameter of 2-4 mm is formed through the sclera. In a so-called partial thickness fistulization, an opening in the form of a slit of 100-300 microns extends through the tissue wall into the anterior chamber and an ostium or aperture of 2-4 mm extends from the slit at the posterior surface of the tissue wall. The trabeculectomy, partial thickness sclerectomy or fistulization, has become the prevalent procedure since a valve effect occurs when a partial thickness aperture is present. Many of the immediate post operative complications of surgery are reduced by the more controlled outflow achieved by this type of surgery. Web site: http://www.delphion.com/details?pn=US06264668__ •

Rectovaginal surgical repair instrument Inventor(s): Willard; Cindylee (615 Justis St., Mountain Home, AR 72653) Assignee(s): None Reported Patent Number: 5,746,749 Date filed: April 26, 1995 Abstract: A rectovaginal surgical instrument for the repair of rectovaginal tears, incisions and fistulas, especially those associated with childbirth. The instrument includes an elongated generally cylindrically shaped member, one end being continuously curved toward a tip and the other end having a flange and optionally wing guides, curved, or post guides, for retaining and/or guiding forceps or other surgical instruments. Excerpt(s): The present invention relates to a surgical device to aid in the repair of rectovaginal tears, incisions and fistulas, especially those which occur in connection with childbirth and require suturing at the conclusion of the childbirth process. Despite the many advances in modern medical and surgical procedures, there are some procedures which remain relatively unchanged. In childbirth, tissue in and around the

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vagina and the vaginal opening quite often is torn or is surgically incised in an episiotomy during or in anticipation of parturition. Such tears or incisions must be surgically repaired by suturing after delivery. During the period before the repair has been accomplished, the mother may be in considerable discomfort and may be bleeding heavily. There is a need to accomplish the suturing as quickly as possible to relieve or minimize the discomfort and decrease the amount of blood loss. Web site: http://www.delphion.com/details?pn=US05746749__ •

Self-expanding intraluminal composite prosthesis Inventor(s): Chaikof; Elliot L. (Dunwoody, GA), Ludovice; Peter J. (Atlanta, GA) Assignee(s): Emory University (atlanta, Ga), Georgia Tech Research Corp. (atlanta, Ga) Patent Number: 5,741,325 Date filed: May 3, 1996 Abstract: This invention relates to a self-expanding intraluminal composite prosthesis comprised of a rigid reinforcing component and sealing component. The prosthesis may be fabricated as either a straight or bifurcated tubular structure and is applicable to the treatment of any bodily passage including, but not limited to, vascular applications, e.g., aneurysms, arteriovenous fistulas, as well as stenotic regions of the peripheral circulation which have been percutaneously dilated but are at high risk for restenosis. The major attributes of this prosthesis can include the use of a unique multilayered biaxial braid which thereby creates a homogeneously blended composite with isotropic deformation and expansion characteristics and an associated high contraction ratio. The use of multiple layers allows for the fabrication of a device of varied porosity while retaining adequate tensile or mechanical wall strength. Excerpt(s): This invention relates to intraluminal prosthetic devices. In particular, this invention relates to self-expanding intraluminal composite prosthetic devices for use, e.g., in endovascular applications. Since 1975, vascular prostheses composed of either knitted or woven Dacron.RTM. fibers or expanded PTFE (Gore-Tex.RTM.) have been established standards in anastomotic surgical arterial reconstruction. In the past decade, however, a steady growth of non-surgical transcatheter techniques and related devices have broadened both potential applications and overall suitability of endovascular reconstruction. In particular, angioplasty with or without endovascular stent placement has become an accepted adjunct in the management of atherosclerotic occlusive disease. In the past, aneurysmal aortic disease has been treated almost exclusively by resection and surgical graft placement. Recently, however, successful preliminary tests have been reported for transfemoral endovascular grafting as an alternative therapeutic option. In contrast to standard surgical repair, the use of an endovascular device does not entail the removal of the diseased aorta, but serves to create a conduit for blood flow in the event of subsequent aneurysm rupture. It has been postulated that an endovascular graft may, as a secondary effect, lower the rate of aneurysm expansion and late rupture via a reduction of hemodynamically induced wall stresses. Endovascular aortic prostheses under current commercial development consist almost exclusively of grafts and stents attached together to form a single device. The stent secures the graft in a desired position and reduces the risk of late prosthetic migration. Web site: http://www.delphion.com/details?pn=US05741325__

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Stent graft delivery system and methods of use Inventor(s): Abolfathi; Amir (Palo Alto, CA), Khosravi; Farhad (San Mateo, CA), Ross; Michael R. (Hillsborough, CA), Spiridigliozzi; John (Belmont, CA) Assignee(s): Endotex Interventional Systems, Inc. (menlo Park, Ca) Patent Number: 5,824,055 Date filed: March 25, 1997 Abstract: A stent-graft delivery system and methods for use are provided for use in treating aneurysms occurring in single and bifurcated lumen hollow-body organs or vessels and for treating arterio-venous fistulas. A graft delivery component provides a clinician with complete control over the location of a graft at any time prior to implantation of stents, even when the graft is deployed from its introducer catheter. The graft delivery component includes a plurality of radially expandable fingers that releasably engage the graft, while the stent delivery component includes a small diameter introducer catheter and permits a wide range of conventional stent designs to be used to permanently fix the graft in position. Excerpt(s): The present invention relates generally to minimally-invasive techniques for repairing aneurysms occurring in hollow-body biological organs or vessels, for example, the abdominal aorta, and for repairing arterio-venous fistulas. More particularly, the present invention relates to methods and apparatus for repairing aneurysms and fistulas that permit adjustment and/or retrieval of a graft within a single lumen or bifurcated lumen of a hollow-body organ or vessel. In recent years a number of minimally-invasive techniques have been developed to repair aneurysms occurring in hollow-body biological organs or vessels, for example, the abdominal aorta, using stentgraft techniques. These techniques generally seek to "re-line" a flow path through the organ, for example, by fixing a graft across the weakened tissue of the aneurysm. The graft is then held in place with one or more stents or barbed elements, which may be implanted, for example, using a balloon catheter. Such arrangements are described, for example, in Parodi U.S. Pat. No. 5,219,355, Clouse U.S. Pat. No. 5,211,658, and Kornberg U.S. Pat. No. 4,617,932. A drawback common to such previously known methods and apparatus, especially those such as the Parodi and Clouse patents, is the inability to adjust or retrieve the graft once it has been deployed from an introducer catheter. Generally, deployment of the graft (or the stent in Clouse system) marks a point of noreturn--if the graft is determined to be in an inappropriate position, or the graft size is inadequate, it is not possible to abort the procedure. Web site: http://www.delphion.com/details?pn=US05824055__

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Stent-graft with bioabsorbable structural support Inventor(s): Burnside; Diane K. (Coon Rapids, MN), Chouinard; Paul F. (Roseville, MN), Stinson; Jonathan S. (Plymouth, MN) Assignee(s): Boston Scientific Scimed, Inc. (maple Grove, Mn) Patent Number: 6,626,939 Date filed: December 18, 1997 Abstract: The invention relates to a stent-graft with a bioabsorbable structure and a permanent graft for luminal support and treatment of arterial fistulas, occlusive disease, and aneurysms. The bioabsorbable structure is formed from braided filaments of

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materials such as PLA, PLLA, PDLA, and PGA and the graft is formed from materials such as PET, ePTFE, PCU or PU. Excerpt(s): The present invention relates generally to implantable, radially expandable medical prostheses which are frequently referred to as stent-grafts. In particular, the present invention is a self-expanding stent-graft having a bioabsorbable structural component and a permanent graft component. Self-expanding stents and methods for fabricating a stent are known and are, for example, shown in the U.S. Pat. Nos. 4,655,771; 4,954,126; 5,061,275; and in 5,645,559. Such devices are used within body vessels of humans for a variety of medical applications. Examples include intravascular stents for treating stenoses, stents for maintaining openings in the urinary, biliary, tracheobronchial, esophageal, renal tracts, and vena cava filters. A stent-graft is described in U.S. patent application Ser. No. 08/640,253, entitled "Cobalt-ChromiumMolybdenum Alloy Stent and Stent Graft", filed Apr. 30, 1996. A delivery device is used to deliver the stent-graft through vessels in the body to a treatment site. The flexible nature and reduced radius of the compressed stent-graft enables it to be delivered through relatively small and curved vessels. Web site: http://www.delphion.com/details?pn=US06626939__ •

Use of growth factor and antimetabolite combination to prevent or retard fistula closure following glaucoma filtration surgery Inventor(s): Nixon; Jon C. (Fort Worth, TX), York; Billie M. (Fort Worth, TX) Assignee(s): Alcon Laboratories, Inc. (fort Worth, Tx) Patent Number: 5,714,463 Date filed: February 21, 1995 Abstract: The intraocular use of combinations of stromal cell growth stimulators (e.g., TGF-.beta.) and antimetabolites (e.g., mitomycin C) in connection with glaucoma filtration surgery is described. The combination is applied to the surgical site to attract, mitogenically activate, and neutralize the potential for extracellular matrix synthesis leading to scar formation by stromal cells. Without such treatment, the formation of scar tissue may lead to impairment of the outflow of aqueous humor at the surgical site, particularly the fistula. The mitogenic activation of the stromal cells makes these cells susceptible to the anti-metabolites. This enables the antimetabolites to suppress the proliferation of the fibroblasts and other associated stromal cells to a much greater extent, relative to the proliferation seen when the metabolites alone are utilized. The increased suppression of the proliferation and metabolism of these cells results in a significant improvement in the ability to prevent or retard the formation of scar tissue, and thereby reduces the incidence of fistula closure following glaucoma filtration surgery. Excerpt(s): The present invention relates to the field of ophthalmology. More specifically, the invention relates to the field of glaucoma filtration surgery. The underlying causes of glaucoma are not fully understood. However, it is known that a principal symptom of this disease is elevated intraocular pressure. Elevations of intraocular pressure can ultimately lead to impairment or loss of normal visual function as a result of damage to the optic nerve. It is also known that the elevated intraocular pressure is caused by an excess of fluid (i.e., aqueous humor) within the eye. The excess intraocular fluid is believed to result from blockage or impairment of the normal drainage of fluid from the eye via the trabecular meshwork. The current drug therapies

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for treating glaucoma attempt to control intraocular pressure by means of increasing the drainage or "outflow" of aqueous humor from the eye or decreasing the production or "inflow" of aqueous humor by the ciliary processes of the eye. Unfortunately, the use of drug therapy alone is not sufficient to adequately control intraocular pressure in some patients, particularly if there is a severe blockage of the normal passages for the outflow of aqueous humor. Such patients may require surgical intervention to restore the normal outflow of aqueous humor and thereby normalize or at least control their intraocular pressure. The outflow of aqueous humor can be improved by means of various intraocular surgical procedures known to those skilled in the art, such as trabeculectomy, posterior lip sclerectomy, trephine and thermal sclerostomy. These surgical procedures are collectively referred to herein as "glaucoma filtration surgery". Web site: http://www.delphion.com/details?pn=US05714463__

Patent Applications on Fistulas 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 fistulas: •

Apparatus and method for treatment of cerebral aneurysms, arterial-vascular malformations and arterial fistulas Inventor(s): Chornenky, Victor I.; (Minnetonka, MN), Jaafar, Ali; (Eden Prairie, MN) Correspondence: Briggs And Morgan; 2200 First National Bank Building; 332 Minnesota Street; Saint Paul; MN; 55101; US Patent Application Number: 20020045848 Date filed: May 7, 2001 Abstract: An apparatus and method for stabilization of aneurysm is disclosed. The apparatus comprises an ultraviolet radiation generator for generating UV radiation having a wavelength, strongly absorbed by the DNA and a catheter including means for delivering the ultraviolet radiation to the aneurysm. The distal end of the catheter is placed inside the aneurysm. Stabilization of the aneurysm is achieved by forming a mural arterial thrombus inside the aneurysm. To make irradiation possible, the blood is displaced from the aneurysm by a steady stream of UV radiation transparent fluid. The injury to the endothelium that triggers the thrombus formation is caused by UV radiation delivered to the aneurysm. In several days after intervention the thrombus becomes fully organized, leaving on the inside surface of the aneurysm a thick layer of fibrotic tissue that stabilizes the aneurysm. Excerpt(s): The present invention relates generally to apparatus and methods for the treatment of vascular disease and particularly to apparatus and method for treatment of cerebral aneurysms, arterial vascular malformations and arterial fistulas using lasers. Cerebrovascular disease is the third leading cause of death in the United States, ranking behind only coronary artery disease and cancer. This disease can take several forms, including but not limited to cerebral aneurysm, arterial venous malformations (AVMs) and arterial fistulas (collectively referred to hereafter as "aneurysms.") One of the most

10

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

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important forms of this disease is the cerebral aneurysm, which manifest itself as a dilatation, or pouching of the arterial wall. As the disease progresses, the dilatation develops into a distended sac of thinned, stressed arterial tissue with a size of 5 to 10 mm in diameter. If not treated, an aneurysm continues to grow until it ruptures, causing a subarachnoid hemorrhage (that is, bleeding between the middle membrane covering of the brain and the brain itself), severe neurological complications, and, possibly, death. The components of the arterial wall that are primarily responsible for its mechanical strength and elasticity are the structural proteins collagen and elastin. Collagen, which serves a protective function, is very extensible and breaks at a stress of about 500 megapascals. Collagen is the substance that gives the artery wall its high resistance to the hemodynamic forces created by the heart pumping the blood through the vessel. Elastin fibers, on the other hand, can stretch to about 250% of their original length and have about 20 times lower modulus of elasticity than collagen. These two proteins cooperate to provide vessels with sufficient strength and flexibility to withstand the continuous pounding and pressure of the blood as it flows through the vessel in response to the beat of the heart. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Apparatus and method for using an ultrasonic probe to clear a vascular access device Inventor(s): Colgan, Peter C.; (Bedford, MA), Hare, Bradley A.; (Chelmsford, MA), Marciante, Rebecca I.; (North Reading, MA), Prasad, Janniah S.; (Norwalk, CT), Rabiner, Robert A.; (North Reading, MA), Ranucci, Kevin J.; (North Attleboro, MA), Robertson, Roy M.; (Ipswich, MA), Talbot, Scott A.; (North Andover, MA), Varady, Mark J.; (Holliston, MA) Correspondence: Palmer & Dodge, Llp; Richard B. Smith; 111 Huntington Avenue; Boston; MA; 02199; US Patent Application Number: 20030236539 Date filed: March 25, 2003 Abstract: The present invention provides an apparatus and a method for using an ultrasonic probe to remove an occlusion in vascular access devices including fistulas, grafts, catheters and subcutaneous access devices. The ultrasonic probe is inserted into the vascular access device and a section of a longitudinal axis of the ultrasonic probe engages the occlusion. A transducer transmits an ultrasonic energy from an ultrasonic energy source that produces a transverse ultrasonic vibration along the longitudinal axis of the ultrasonic probe. The transverse ultrasonic vibration of the ultrasonic probe provides a plurality of transverse anti-nodes along a portion of the longitudinal axis of the ultrasonic probe that cause a cavitation in a medium in communication with the ultrasonic probe to ablate the occlusion. Excerpt(s): This application is a continuation-in-part of Application Serial Number 09/776,015, filed Feb. 2, 2001, which is a continuation-in-part of Application Serial No. 09/618,352, filed Jul. 19, 2000, which claims benefit of Provisional Application Serial No. 60/178,901, filed Jan. 28, 2000, and claims benefit of Provisional Application Serial No. 60/157,824, filed Oct. 5, 1999, the entirety of all these applications are hereby incorporated herein by reference. The present invention relates to an ultrasonic medical device, and more particularly to an apparatus and a method of using an ultrasonic probe to clear an occlusion in a vascular access device to keep the vascular access device clear of the occlusion and prevent subsequent health risks. The use of vascular access devices has become a common practice across the world to address various health

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issues. Vascular access devices are used to administer pharmacological agents and to draw blood from vasculatures within the body. There are several different types of vascular access devices, with the choice of the vascular access device depending upon the type of treatment that is needed, the amount of time the patient will need the vascular access device, the type of pharmacological agent the patient needs and the condition of the patient's veins. Some patients require temporary vascular access devices while others require permanent vascular access devices. The use of vascular access devices has become especially important in cystic fibrosis patients who require frequent and prolonged intravenous antibiotics. Vascular access devices are also used in hemodialysis patients who require a treatment of the blood. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Assembly containing an electrolytically severable joint for endovascular embolic devices Inventor(s): Carrison, Harold F.; (Pleasanton, CA), Engelson, Erik T.; (Encinal, CA), Wheelock, E. Thomas; (Los Altos, CA) Correspondence: Lyon & Lyon Llp; 633 West Fifth Street; Suite 4700; Los Angeles; CA; 90071; US Patent Application Number: 20020091380 Date filed: February 28, 2002 Abstract: This invention is an apparatus for the formation of occlusions in spaces in the human body, occluding such as thrombi in arteries, veins, aneurysms, vascular malformations and arteriovenous fistulas. In particular, it deals with a one piece assembly having an improved electrolytically erodable link to an occlusive member and further having an incorporated return electrode in the assembly. The occlusion-forming member is introduced to and is intended to remain at the desired occlusion site. The invention also relates to the joint itself. The invention further includes a method for introduction and electrolytic separation of the device. Excerpt(s): This application is a continuation of U.S. patent application Ser. No. 09/026,373, entitled Assembly Containing an Electrolytically Severable Joint for Endovascular Embolic Devices, filed Feb. 19, 1998, the entirety of which is hereby incorporated by reference. Approximately 25,000 intracranial aneurysms rupture each year in North America. The primary purpose of treatment for a ruptured intracranial aneurysm is to prevent rebleeding. There are a variety of ways to treat ruptured and non-ruptured aneurysms. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Coiled sheet graft for single and bifurcated lumens and methods of making and use Inventor(s): Hogendijk, Michael; (Palo Alto, CA), Khosravi, Farhad; (San Mateo, CA), Patel, Himanshu; (San Jose, CA), Ross, Michael R.; (Hillsborough, CA), Spiridigliozzi, John; (Dedham, MA) Correspondence: Lyon & Lyon Llp; 633 West Fifth Street; Suite 4700; Los Angeles; CA; 90071; US Patent Application Number: 20020193864 Date filed: August 19, 2002 Abstract: A prosthesis is provided for treating aneurysms, occlusive disease of vessels and body organs, and arterio-venous fistulas, occurring in single and bifurcated lumens. The prosthesis comprises an expandable coiled sheet portion having a biocompatible graft, either a sheet or tube, affixed thereto along part or all of the circumference of the coiled sheet portion. The prosthesis has a small delivery profile, making it suitable for use in a variety of body vessels. Methods of making and deploying the prosthesis in single and bifurcated lumens are also provided. Excerpt(s): The present invention relates to prostheses for treatment of aneurysms, arterio-venous fistulas, obstructive vascular disease and other applications. More specifically, the present invention relates to prostheses including coiled sheet portions having a biocompatible material affixed thereto which may be used in a variety of applications as an internal bandage. For example, a health problem afflicting an older segment of the population is the occurrence of disease that weakens the arteries and other body vessels, developing into aneurysms that may rupture, often with fatal consequences. A conventional treatment of aneurysms, especially those occurring in the abdominal aorta, has involved invasive surgery to resect and remove the diseased body vessel and replace it with either a native vessel, harvested from elsewhere in the body, or a synthetic graft material. Such treatments typically pose a major risk to the patient's health, and frequently cannot be undertaken at all, if (as is common) the patient is in poor health. A number of vascular prostheses have therefore been developed that permit a synthetic graft to be placed transluminally within the aneurysm, to isolate the aneurysm from fluids flowing in the body vessel and which relieve pressure from the aneurysm. These previously known vascular prostheses generally anchor a tubular synthetic graft inside the body vessel, on either end of the aneurysm, using a stent, as described, for example, in U.S. Pat. No. 5,078,726 to Kreamer and U.S. Pat. No. 5,219,355 to Parodi et al. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Fistula thermotherapy device Inventor(s): Diang, Liang-Kuang; (Taipei Hsien, TW), Ho, Kuo-Hsin; (Taipei Hsien, TW) Correspondence: Birch Stewart Kolasch & Birch; PO Box 747; Falls Church; VA; 220400747; US Patent Application Number: 20030139792 Date filed: January 24, 2002 Abstract: A fistula thermotherapy device uses 4-14.mu.m infrared waves for thermotherapy on fistula. The infrared waves penetrate the epidermis of patients 2-3 centimeters deep so as to have sanative effect on fistula and cells nearby. Therefore, the

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blood circulation of fistula is improved, the cells nearby are activated, and the metabolism of that area is enhanced. Thus the fluency and elasticity of the fistula can be maintained. The fistula thermotherapy device includes an electric heating layer, an inner cover, and an outer cover. Excerpt(s): The present invention relates to a fistula thermotherapy device, especially to a fistula thermotherapy device that not only protects the arm with the fistula for hemodialysis, but also facilitate the metabolism of the cells near the needle insertions on fistula. Moreover, the fluency and the elasticity of the fistula are maintained. Before starting hemodialysis treatments, one important step is preparing a vascular access, which is the site on your body where blood will be removed and returned during dialysis. For most people, an arteriovenous (AV) fistula is the best kind of vascular access. An AV fistula is created by connecting an artery directly to a vein, usually in the forearm of patients. Then the vein grows larger and stronger, making repeated needle insertions easier. The blood tube for needle insertions is called fistula. However, the regular hemodialysis sessions take 2-3 times per week. In the long run, there is hundreds of pinholes concentrate on the fistula that is only several centimeters long. Thus the fistula is likely to form clots or get infected caused by repeatedly usage. Finally the fistula needs replacement sooner. The general way for protecting the arm with fistula thereof is to avoid heavy loading, the fistula can only be used for hemodialysis, no pressing on the area, or taking more exercise for increasing blood circulation. Such kind of methods can only protect the surface of the area without improving the fistula itself. Once the patients can't follow the above instruction, the fistula for needle insertion is easy to become scabbed or have obstruction. Sooner the complications cause the replacement of fistula. The patients need to prepare a new vascular access again. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Function-enhanced thrombolytic AV fistula and method Inventor(s): Barclay, Bruce J.; (Cupertino, CA), Fogarty, Thomas J.; (Portola Valley, CA) Correspondence: Haynes Beffel & Wolfeld Llp; P O Box 366; Half Moon Bay; CA; 94019; US Patent Application Number: 20030028245 Date filed: June 26, 2002 Abstract: A coiled stent graft (10), including a thrombolytic agent, is positionable within an AV fistula (4) and optionally into one or both of the artery (9) and the vein (6) to help reduce or eliminate blockages within the blood vessel at the junction (8) between the AV fistula and the blood vessel. Excerpt(s): This is a continuation in part of U.S. patent application Ser. No. 09/608,734 filed Jun. 20, 2000, and U.S. patent application Ser. No. 09/910,703 filed Jul. 20, 2001, which is a continuation in part of U.S. patent application Ser. No. 09/740,597 filed Dec. 19, 2000. U.S. patent application Ser. No. 09/910,703 incorporates by reference the following: U.S. Pat. No. 6,248,122 B1 issued Jun. 19, 2001; U.S. Pat. No. 6,238,430 B1 issued May 29, 2001; U.S. patent application Ser. No. 09/400,955 filed Sep. 22, 1999; and U.S. patent application Ser. No. 09/608,281 filed Jun. 30, 2000. A fistula is an abnormal passage typically between two organs, such as an artery and a vein. An arterio-venous (AV) fistula is a natural or an artificial graft, typically made of ePTFE (expanded PTFE), between a vein and an artery. An AV fistula, as used herein, also includes naturallyoccurring native tissue tubular connections between a vein and an artery. AV fistulas

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are often used to provide multiple needle access sites for hemodialysis. The AV fistula also helps to increase blood flow through the vein to accommodate the flow rate of blood needed for hemodialysis. One problem associated with AV fistulas is the progressive narrowing of the AV fistula at the junction with the vein. Such obstructions occur when vascular muscle cells begin growing inwardly causing, for example, thrombosis within the AV fistula. When the thrombus becomes sufficiently large, blood flow decreases and the AV fistula ceases to be effective. It has been found that graft patency after six months is only 66% and that graft failure occurs, on the average, after 18 months. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Gelatin based and Power-gelTM as solders for Cr4+ laser tissue welding and sealing of lung air leak and fistulas in organs Inventor(s): Alfano, Robert R.; (New York, NY), Evans, Jonathan M.; (New York, NY), Ho, Peng Pei; (Douglaston, NY), Tang, Jing; (Arlington, MA) Correspondence: Michael R. Brew, ESQ.; Dilworth & Barrese, Llp; 333 Earle Ovington BLVD.; Uniondale; NY; 11553; US Patent Application Number: 20020198517 Date filed: April 10, 2002 Abstract: Laser tissue welding can be achieved using tunable Cr.sup.4+ lasers, semiconductor lasers and fiber lasers, where the weld strength follows the absorption spectrum of water. The use of gelatin and esterified gelatin as solders in conjunction with laser inducted tissue welding impart much stronger tensile and torque strengths than albumin solders. Selected NIR wavelength from the above lasers can improve welding and avoid thermal injury to tissue when used alone or with gelatin and esterified gelatin solders. These discoveries can be used to enhance laser tissue welding of tissues such as skin, mucous, bone, blood vessel, nerve, brain, liver, pancreas, spleen, kidney, lung, bronchus, respiratory track, urinary tract, gastrointestinal tract, or gynecologic tract and as a sealant for pulmonary air leaks and fistulas such as intestinal, rectal and urinary fistulas. Excerpt(s): This application claims priority to U.S. provisional application Serial No. 60/282,827 filed Apr. 10, 2001, the contents of which are hereby incorporated by reference. The present invention relates to specific lasers to be used in laser assisted tissue welding (LTW) and novel solders to be used in conjunction therewith that impart enhanced torque and tensile strength to tissue that has been sutured or sealed using LTW. In the past, damaged tissue was repaired using a variety of conventional sutures such as stitches or staples. More recently, the use of radiation, such as lasers, has been utilized to suture or weld tissue and seal leaks. Laser assisted tissue welding (LTW) can be achieved by directing a low energy laser beam of appropriate wavelength at the edges or surface of a tissue cut. The technique has gained the interest of the medical profession as an attractive new tissue repair procedure. In the LTW procedure, the wounded tissue is illuminated by radiation that directly or indirectly heats the tissue constituents, causing bonding to occur in the tissue structure and linking previously unattached tissues. Repair of damaged tissue can thus be achieved in greatly reduced time compared to that required by conventional suture techniques. Other advantages that this type of laser surgery has over traditional suture techniques have been reported, such as less foreign body reaction, less constriction, and reduced surgical time. While the LTW technique has found success in the experimental and clinical arenas, a wider

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usage is envisioned with further improvements in the procedure. In principle the LTW operation may be utilized wherever a tissue injury is present in an animal, including humans. However, it is especially suited to wounds to the skin, veins, arteries, respiratory tract, digestive tract, stomach, bladder and cervix. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Hydrogel filament vaso-occlusive device Inventor(s): Helkowski, Richard A.; (Redwood City, CA), Ken, Christopher G.M.; (San Mateo, CA), Patel, Tina J.; (San Carlos, CA) Correspondence: Banner & Witcoff; 1001 G Street N W; Suite 1100; Washington; DC; 20001; US Patent Application Number: 20020193813 Date filed: May 6, 2002 Abstract: Methods and an apparatus for treating abnormal blood flow. The apparatus comprises a vaso-occlusive device of a hydratable filament comprising extruded polyacrylonitrile for implantation in a patient at a site of abnormal blood flow. The device treats ruptured blood vessels, aneurysms, arterio venus malformations (AVMs), fistulas and benign and malignant tumors. The methods include a method of making the vaso-occlusive device and methods of treating patients having abnormal blood flow by implanting the device at a site of abnormal blood flow. Excerpt(s): This application claims benefit under 37 CFR.sctn.1.78 of provisional application No. 60/288,458, filed May 4, 2001. The full disclosure of the application is incorporated hereby by reference. The present invention relates to medical devices and methods for vaso-occlusion. Ruptured blood vessels in the brain cause an acute condition known as hemorrhagic stroke. Ruptures or strokes can occur with a number of vascular abnormalities including arterio venous malformation (AVM), aneurysm (a ballooning of the arterial wall), fistula, or a burst blood vessel. In addition, abnormal vasculature is generated in the process of tumor growth and tumors including brain tumors are highly vascularized entities requiring larger than normal blood flow to sustain the tumor. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Methods and apparatus for treating aneurysms and arterio-venous fistulas Inventor(s): Abolfathi, Amir; (Palo Alto, CA), Hogendijk, Michael; (Palo Alto, CA), Khosravi, Farhad; (San Mateo, CA) Correspondence: Orrick, Herrington & Sutcliffe, Llp; 4 Park Plaza; Suite 1600; Irvine; CA; 92614-2558; US Patent Application Number: 20030036745 Date filed: April 4, 2001 Abstract: Methods and apparatus are provided for temporarily excluding an aneurysm or an arterio-venous fistula from a flow path by transluminally disposing a hollow balloon catheter structure within the aneurysm so that its proximal and distal ends extend past the aneurysm while maintaining continuity of the flow path, and then injecting a synthetic molding material or a biological hardening agent into the aneurysm

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cavity to cause solidification of the volume within the cavity. Once the material within the excluded aneurysm has solidified, the balloon catheter structure is deflated and removed, so that the hardened mass forms a new lining for the organ or vessel, and relieves the weakened tissue of the aneurysm or fistula from further flow-induced stress. Excerpt(s): The present invention relates generally to minimally-invasive techniques for repairing aneurysms occurring in hollow-body biological organs and vessels, for example, the aorta and iliac arteries, and arterio-venous fistulas. More particularly, the present invention relates to methods and apparatus for repairing aneurysms and fistulas using hardening agents that exclude the weakened tissue from a flow path. In recent years a number of minimally-invasive techniques have been developed to repair aneurysms occurring in hollow-body biological organs and vessels, for example, the aorta, using stent-graft techniques. These techniques generally seek to "re-line" the blood flow path through the organ, for example, by fixing a fabric material across the section of weakened tissue. The fabric is then held in place with one or more stents, which may be implanted, for example, using a balloon catheter. Such arrangements are described, for example, in Parodi U.S. Pat. No. 5,219,355 and European Application No. 0 461 791. Such methods and apparatus are suitable for use in only a limited number of aneurysm situations, however. In particular, for such previously known methods to be effective, the portions of the organ proximal and distal to the aneurysm (i.e., the proximal neck and the distal cuff of the aneurysm) must be relatively straight to permit the stents and liner to obtain sufficient apposition on the organ or vessel walls. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Methods and kits for the inhibition of hyperplasia in vascular fistulas and grafts Inventor(s): Brisken, Axel F.; (Fremont, CA), Corl, Paul D.; (Palo Alto, CA), McKenzie, John R.; (San Carlos, CA), Zuk, Robert F.; (Atherton, CA) Correspondence: Townsend And Townsend And Crew, Llp; Two Embarcadero Center; Eighth Floor; San Francisco; CA; 94111-3834; US Patent Application Number: 20020077694 Date filed: December 5, 2001 Abstract: A method for inhibiting hyperplasia at an anastomotic junction of a vascular fistula or vascular graft comprises exposing the anastomotic junction to vibrational energy at a mechanical index and for a time sufficient to inhibit hyperplasia. Kits are described comprising the catheter or a probe suitable for performing the methods together with instructions for use setting forth the methods. The methods and kits are particularly suitable for treating anastomotic junctions formed to provide vascular access for hemodialysis, hemofiltration, and the like. The methods and kits are also suitable for treating other vascular grafts, such as those formed during cardiac bypass graft surgery, vascular repair, and the like. Excerpt(s): This application is a continuation of application Ser. No. 09/345,661, filed on Jun. 30, 1999, the full disclosure of which is incorporated herein by reference. The subject matter of the present invention is related to the disclosure of copending application Ser. No. 09/223,230, the full disclosure of which is incorporated herein by reference. The present invention relates generally to medical methods, systems, and kits. More particularly, the present invention relates to methods for treating vascular fistulas and grafts to inhibit hyperplasia and subsequent occlusion thereof. In many cases, it has

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been found that the anastomotic junction which is created at the fistula or between the blood vessel and the implanted graft is at significant risk of occlusion due to hyperplasia. In particular, intimal hyperplasia of the vascular smooth muscles cells will often occur as an injury response to the surgical creation of the anastomosis. Occlusion resulting from the hyperplasia is exacerbated by thrombosis which occurs as a result of the blood flow turbulence at the site of the anastomosis. The most troublesome lesions are formed at anastomotic junctions between a graft or artery and a vein. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Methods and systems for vein harvesting and fistula creation Inventor(s): Hill, Bradley; (Woodside, CA), Holmgren, Neil; (Alameda, CA), Modesitt, Bruce; (San Carlos, CA) Correspondence: Townsend And Townsend And Crew, Llp; Two Embarcadero Center; Eighth Floor; San Francisco; CA; 94111-3834; US Patent Application Number: 20030225426 Date filed: February 12, 2003 Abstract: Veins are removed using a pull catheter introduced over a guidewire which extends between first and second percutaneous access points. Optionally, a side branch management tool including an excision device and/or a viewing scope can be advanced over the same guidewire in the direction opposite to that of the pull catheter. In that way, as the pull catheter inverts the vein being removed, side branches can be selectively viewed and/or severed using the side branch management tool. Arteriovenous fistulas are formed by inverting a length of a vein, mobilizing the inverted length relocating the mobilized end of the vein, and connecting the mobilized end to an artery. Excerpt(s): This application is a continuation-in-part of application Ser. No. 10/116,730 (Attorney Docket No. 021295-000100), filed Apr. 3, 2002, the full disclosure of which is incorporated herein by reference. The present invention relates generally to medical apparatus and methods. More particularly, the present invention relates to methods and systems for vascular surgery, including intraluminal vein harvesting and fistula creation. Cardiac and peripheral vascular bypass surgery commonly employs veins harvested from the patient undergoing surgery, usually obtained by autologous vein harvesting procedures. Vein harvesting commonly relies on making a long skin incision to expose the length of vein which is to be excised and removed. Such exposure of the vein allows for dissection and division of the veins which branch from the portion of vein being removed. The greater saphenous vein in the leg is most commonly used, followed by the lesser saphenous vein in the leg and the basilic and cephalic veins in the arm. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Methods for inhibiting or suppressing stenosis of arteriovenous access fistulas and grafts Inventor(s): Hill, John S.; (Solvang, CA), Nielsen, Heidi; (Lyngby, DK), Rychnovsky, Steven John; (Santa Barbara, CA), Stephens, W. Patrick; (Santa Rosa, CA), Walker, Jeffrey P.; (Goleta, CA), Waters, Christina Ann; (Leucadia, CA) Correspondence: Christopher J. Hayes, ESQ.; Bryan Cave Llp; Suite 3600; 211 North Broadway; ST. Louis; MO; 63102; US Patent Application Number: 20030100934 Date filed: November 21, 2001 Abstract: A method for inhibiting or suppressing stenosis associated with an arteriovenous access. A dosage of photosensitive compound is introduced into the artery or vein. An anastomotic area of the artery or vein is then exposed to a source of light having a wavelength suitable for photoactivating the photosensitive compound for a period of time sufficient to provide a therapeutic effect. A method is also described for the delivery of drugs into the anastomotic site of an AV access to inhibit the formation of stenotic lesions at those sites. Excerpt(s): The present invention relates to methods for using photodynamic therapy (PDT) to inhibit or suppress stenoses of arteriovenous (AV) access fistulas and grafts. Patients suffering from chronic renal failure must typically receive dialysis treatment two to three times a week. The most widely used form of dialysis is hemodialysis. In hemodialysis, blood is pumped out of the patient's body to an artificial kidney machine that removes waste and excess fluid from the blood. Treated blood is returned to the patient's body. A significant problem associated with AV access for long-term dialysis patients is frequent AV access failure. Primary patency rates for AV access are extremely low. [Hodges, C. H. et al, Longitudinal comparison of dialysis access methods: Risk factors for failure. J Vasc. Surgery December 1997] (reporting 1-year primary patency rates for AV access fistulas and polytetraflouroethylene (PTFE) AV access grafts at 43% and 41% respectively). A frequent cause of permanent peripheral hemodialysis AV access failure is vascular stenosis, which occurs most frequently at the venous anastomotic site. This stenosis is generally believed to be the result of a persistent injury condition that occurs at the venous anastomotic site as a result of the pressure differential that exists between the arterial and venous systems and the associated disruption in the local rheodynamics. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Methods of sustained treatment of fistulas in crohn's disease with chimeric anti-TNF antibodies Inventor(s): Daddona, Peter; (Menlo Park, CA), Ghrayeb, John; (Thorndale, PA), Knight, David; (Berwyn, PA), Le, Junming; (Jackson Heights, NY), Siegel, Scott; (Westborough, MA), Vilcek, Jan; (New York, NY) Correspondence: Hamilton, Brook, Smith & Reynolds, P.C.; 530 Virginia Road; P.O. Box 9133; Concord; MA; 01742-9133; US Patent Application Number: 20030194402 Date filed: December 12, 2002

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Abstract: Anti-TNF antibodies, fragments and regions thereof which are specific for human tumor necrosis factor-.alpha. (TNF.alpha.) and are useful in vivo diagnosis and therapy of a number of TNF.alpha.-mediated pathologies and conditions, as well as polynucleotides coding for murine and chimeric antibodies, methods of producing the antibody, methods of use of the anti-TNF antibody, or fragment, region or derivative thereof, in immunoassays and immunotherapeutic approaches are provided. Excerpt(s): This application is a continuation of U.S. application Ser. No. 09/756,398, filed Jan. 8, 2001, which is a divisional of U.S. application Ser. No. 09/133,119, filed Aug. 12, 1998, now U.S. Pat. No. 6,277,969, issued Aug. 21, 2001, which is a divisional of U.S. application Ser. No. 08/570,674, filed Dec. 11, 1995, now abandoned, which is a continuation-in-part of U.S. application Ser. No. 08/324,799, filed Oct. 18, 1994, now U.S. Pat. No. 5,698,195, issued Dec. 16, 1997, which is a continuation-in-part of U.S. application Ser. Nos. 08/192,102, now U.S. Pat. No. 5,656,272, issued Aug. 12, 1997, Ser. No. 08/192,861, now U.S. Pat. No. 5,919,452, issued Jul. 6, 1999, and Ser. No. 08/192,093, now U.S. Pat. No. 6,284,471, issued Sep. 4, 2001, all filed on Feb. 4, 1994 which are continuations-in-part of U.S. application Ser. No. 08/010,406, filed Jan. 29, 1993, now abandoned, and U.S. application Ser. No. 08/013,413, filed Feb. 2, 1993, now abandoned, which is a continuation-in-part of U.S. application Ser. No. 07/943,852, filed Sep. 11, 1992, now abandoned, which is a continuation-in-part of U.S. application Ser. No. 07/853,606, filed Mar. 18, 1992, now abandoned, which is a continuation-in-part of U.S. application Ser. No. 07/670,827, filed Mar. 18, 1991, now abandoned. Each of the above applications are entirely incorporated herein by reference. The present invention in the field of immunology and medicine relates to anti-tumor necrosis factor (TNF) antibodies, anti-TNF peptides and nucleic acids encoding therefor, and to pharmaceutical and diagnostic compositions and production, diagnostic and therapeutic methods thereof, and to methods for treating human TNF-mediated pathologies. Monocytes and macrophages secrete cytokines known as tumor necrosis factor-.alpha. (TNF.alpha.) and tumor necrosis factory-.beta. (TNF.beta.) in response to endotoxin or other stimuli. TNF.alpha. is a soluble homotrimer of 17 kD protein subunits (Smith, et al., J. Biol. Chem. 262:6951-6954 (1987)). A membrane-bound 26 kD precursor form of TNF also exists (Kriegler, et al., Cell 53:45-53 (1988)). For reviews of TNF, see Beutler, et al., Nature 320:584 (1986), Old, Science 230:630 (1986), and Le, et al., Lab. Invest. 56:234. 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 fistulas, 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 “fistulas” (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 fistulas. You can also use this procedure to view pending patent applications concerning fistulas. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 6. BOOKS ON FISTULAS Overview This chapter provides bibliographic book references relating to fistulas. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on fistulas include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “fistulas” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on fistulas: •

ABC of Colorectal Diseases. 2nd ed Source: London, UK: BMJ Publishing Group. 1999. 120 p. Contact: Available from BMJ Publishing Group. BMA Books, BMA House, Tavistock Square, London WCIH 9JR. Fax 44 (0)20 7383 6402. E-mail: [email protected]. Website: www.bmjbooks.com. PRICE: Contact publisher for price. ISBN: 0727911058. Summary: Colorectal diseases are common and patients may present to doctors in almost any sphere of medical practice. This atlas is a reference to all the major colorectal diseases, covering signs and symptoms, initial diagnoses, and patient care management, as well as advice on when to refer for specialist treatment. The editor notes that minor anorectal problems, such as hemorrhoids, may be regarded by doctor and patient as being of little consequence, but they can cause considerable distress and may indicate serious underlying pathology. Fortunately, most anorectal conditions are easily diagnosed and can be effectively treated. The atlas includes 26 chapters, covering

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anatomy and physiology, investigation of colorectal disorders, constipation, diarrhea, lower gastrointestinal hemorrhage, irritable bowel syndrome (IBS), hemorrhoids, anal fissures and fistulas, pilonidal sinus, pruritis (itching) ani, rectal prolapse, fecal incontinence, appendicitis, diverticular disease, inflammatory bowel disease (IBD), colorectal neoplasia (benign tumors and bowel cancer), anal cancer, intestinal stomas, large bowel volvulus, colorectal trauma, sexually transmitted diseases and papillomas, tropical colonic diseases, pediatric problems, and drugs in the management of colorectal diseases. Each chapter includes full color photographs and illustrations, sidebars that summarize the information presented, and patient care management algorithms. A subject index concludes the text. •

Hepatobiliary and Pancreatic Disease: The Team Approach to Management Source: Boston, MA: Little, Brown and Company. 1995. 493 p. Contact: Available from Lippincott-Raven Publishers. 12107 Insurance Way, Hagerstown, MD 21740. (800) 777-2295. Fax (301) 824-7390. E-mail: [email protected]. Website: http://www.lrpub.com. PRICE: $99.95. ISBN: 0316709158. Summary: In this book, the editors identify 42 hepatobiliary and pancreatic problems that require a team approach to management. For each of the 42 chapters, a surgeon, gastroenterologist, or radiologist is the lead author, and physicians from different specialties are coauthors. The authors discuss etiology, pathogenesis, and diagnosis, but focus on patient management and results. The chapters cover hepatitis, hepatic failure, cirrhosis, portal hypertension, primary biliary cirrhosis, Budd-Chiari syndrome, noninflammatory cysts, hepatic abscesses, hydatid disease, hemobilia, hepatic trauma, benign hepatic tumors, hepatocellular carcinoma, hepatic metastases, biliary atresia, biliary cysts, gallbladder stones, choledocholithiasis, hepatolithiasis, acute cholecystitis, acute cholangitis, biliary parasites, sclerosing cholangitis, benign strictures, motility disorders, gallbladder cancer, cholangiocarcinoma, acute pancreatitis, gallstone pancreatitis, pseudocysts, pancreatic abscesses, pancreatic necrosis, pancreatic hemorrhage, pancreas divisum, chronic pancreatitis, pancreatic fistulas, pancreatic trauma, islet cell tumors, cystic neoplasms, ampullary carcinoma, and pancreatic cancer. Each chapter includes numerous black-and-white photographs, and a subject index concludes the volume.

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Dialysis Access: Current Practice Source: London, England: Imperial College Press. 2001. 400 p. Contact: Available from World Scientific Publishing Co., Inc. 1060 Main Street, River Edge, NJ 07661. (800) 227-7562 or (201) 487-9655. Fax (888) 977-2665 or (201) 487-9656. Email: [email protected]. Website: www.wspc.com. PRICE: $75.00 plus shipping and handling. ISBN: 1860941699. Summary: The incidence of treated end stage renal disease (ESRD) continues to rise, particularly in the western world. Although renal (kidney) transplantation is the treatment of choice for ESRD, the decline in the number of cadaveric organs, coupled with the rising demand for transplantation, means that an increasing number of patients will have to depend on dialysis. Vascular (blood system) and peritoneal (abdominal cavity) access remains the primary issue of concern for dialysis. This book offers a description of the state of the art in providing and preserving a durable and reliable access for dialysis. The contributing authors are drawn from a wide background, with expertise in various aspects of dialysis access, including its history, the technique of

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placement, anesthesia, radiology, nursing care, and training of vascular access surgeons. Sixteen chapters cover the history of dialysis access; modality selection and patient outcome; continuing quality improvement; the access clinic; recirculation and dialysis access; the value of ultrasonic imaging in defining the anatomy for vascular access; anesthetic management; arteriovenous fistulas; use of autogenous (from the patient) vein or synthetic grafts; complications of vascular access; revision access surgery; central venous catheters; access for pediatric patients (children); radiology of access; peritoneal dialysis access; and the nursing care for patients with dialysis access. Each chapter concludes with a lengthy list of references, and a subject index concludes the volume. The book is intended for use by transplant surgeons, general surgeons with an interest in vascular access, vascular surgeons, nephrologists, trainees, and nurses. •

Handbook of Colon and Rectal Surgery Source: Philadelphia, PA: Lippincott Williams and Wilkins. 2002. 931 p. Contact: Available from Lippincott Williams and Wilkins. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-3030 or (301) 223-2300. Fax (301) 223-2365. PRICE: $79.00 plus shipping and handling. ISBN: 0781725860. Summary: This handbook provides a more portable version of the larger textbook with the same title: Colon and Rectal Surgery, 4th Edition. The coverage addresses the entire range of diseases affecting the colon, rectum, and anus. A stepwise approach to treatment guides physicians from evaluation to follow up with incisive coverage of symptoms, testing and diagnosis, preparation, medical and surgical management, and postoperative care. Thirty-three chapters cover anatomy and embryology of the anus, rectum, and colon; physiology of the colon; diet and drugs in colorectal surgery; evaluation and diagnostic techniques; flexible sigmoidoscopy and colonoscopy; setting up a colorectal physiology laboratory; analgesia (pain killing) in colon and rectal surgery; hemorrhoids; anal fissure; anorectal abscess; anal fistula; rectovaginal and rectourethral fistulas; anal incontinence; colorectal trauma; management of foreign bodies; disorders of defecation; rectal prolapse, solitary rectal ulcer, syndrome of the descending perineum, and rectocele; pediatric surgical problems; cutaneous conditions; colorectal manifestations of acquired immunodeficiency syndrome (HIV); polypoid diseases; carcinoma (cancer) of the colon; carcinoma of the rectum; malignant tumors of the anal canal; less common tumors and tumorlike lesions of the colon, rectum, and anus; diverticular disease; laparoscopic-assisted colon and rectal surgery; vascular diseases; ulcerative colitis; Crohn's disease and indeterminate colitis; intestinal stomas; enterostomal therapy; and miscellaneous colitides. The handbook includes the same illustrations as the larger text. A subject index concludes the volume.

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

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

Total Parenteral Nutrition. 2nd ed Source: Boston, MA: Little, Brown and Company. 1991. 486 p. Contact: Available from Little, Brown and Company. Order Department, 200 West Street, Waltham, MA 02154. PRICE: $91. ISBN: 0316283797. Summary: This medical textbook provides an overview of total parenteral nutrition (TPN). Twenty-seven chapters are presented in three sections: general principles, specific aspects, and supplemental techniques. The chapters address indications for TPN; complications; pharmaceutical considerations in TPN; patient and staff education; nutrition and immunity; nutritional assessment; energy requirements for TPN; acute renal failure; nutritional support in cardiac and pulmonary diseases; preoperative TPN; inflammatory bowel disease; fistulas; nutritional support in hepatic failure; TPN for patients with burns; pediatrics; sepsis; TPN in the cancer patient; home parenteral nutrition; peripheral amino acids; lipid emulsions; and enteral nutrition. Each chapter, written by experts in the field, includes numerous references. A detailed subject index concludes the volume.

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More Stories and Strategies: Coping with Vestibular Disorders Source: Portland, OR: Vestibular Disorders Association (VEDA). 1995. 57 p. Contact: Available from Vestibular Disorders Association (VEDA). P.O. Box 4467, Portland, OR 97208-4467. (503) 229-7705. Fax (503) 229-8064. E-mail: [email protected]. Website: www.vestibular.org. PRICE: $8.00 plus shipping and handling. Order number B-4. Summary: This spiral-bound book presents a collection of twenty-six first person narratives about life with a balance disorder. The book is intended to present a wide variety of information about how individual people are coping with the sometimes devastating effects of vestibular disorders. In these stories, the authors speak in their own voices about what happened to them and what they did about it. Their

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backgrounds and experiences vary widely, as do their coping strategies. Topics include managing families, work and employment issues, obtaining diagnoses, working with the health care system, travel, diet and nutrition, exercise, physical therapy, drug therapy, perilymph fistulas, etiology, tinnitus, and depression and other psychosocial factors. •

Vascular Access: Principles and Practice. 4th ed Source: St. Louis, MO: Mosby, Inc. 2002. 289 p. Contact: Available from Elsevier, Health Sciences Division, 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 325-4177. Website: www.us.elsevierhealth.com. PRICE: $99.00. ISBN: 0323011888. Summary: This text reviews the principles and practice of vascular access, including that used for hemodialysis and for critical care, chemotherapy, and nutrition. The text features 25 chapters that cover: the development of vascular access (VA) surgery, planning and patient assessment, anesthesia, surgical anatomy for VA procedures, physiology for the arteriovenous fistula, biologic properties of VA devices, biologic response to prosthetic dialysis grafts, epidemiology of chronic renal (kidney) failure (CRF) and guidelines for the initiation of hemodialysis, autologous arteriovenous fistulas, basilic vein transposition, vascular interposition (bridge fistulas) for hemodialysis, central venous cannulation for hemodialysis access, vascular access in the neonatal and pediatric patient, revision and outcome of VA procedures for hemodialysis, radiologic intervention and instrumentation for the salvage of hemodialysis access grafts, axillosubclavian vein thrombosis (clotting), thrombosis, venous hypertension, arterial steal, and neuropathy (nerve disease or damage), complications of VA procedures, care and use of VA devices, cardiovascular consequences of rapid hemodialysis, peritoneal dialysis, socioeconomic implications of VA surgery, placement of indwelling VA systems, VA for trauma and emergency surgery, and complications of percutaneous VA procedures and their management. Each chapter includes black and white illustrations and a list of references; a subject index concludes the volume.

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Female Pelvic Health and Reconstructive Surgery Source: New York, NY: Marcel Dekker, Inc. 2003. 503 p. Contact: Available from Marcel Dekker, Inc. 270 Madison Avenue, New York, NY 10016. (212) 696-9000. Fax (212) 685-4540. Website: www.dekker.com. PRICE: $185.00 plus shipping and handling. ISBN: 0824708229. Summary: This textbook provides comprehensive, authoritative coverage of female pelvic health and reconstructive surgery. The editors compiled contributions from many experts who specialize in the treatment of pelvic floor disorders. The text includes 27 chapters on the epidemiology and etiology of incontinence and voiding dysfunction; diagnostic evaluation of the female patient; bladder physiology and neurophysiological evaluation; diagnosis and assessment of female voiding function; radiological evaluation; urodynamic evaluation of pelvic floor dysfunction; injectable agents for the treatment of stress urinary incontinence in females; transabdominal procedures for the treatment of stress urinary incontinence; transvaginal surgery for stress urinary incontinence; laparoscopic approaches to female incontinence, voiding dysfunction, and prolapse; diagnosis and management of obstruction following anti-incontinence surgery; pediatric dysfunctional voiding in females; nonsurgical treatment of urinary incontinence; sacral nerve root neuromodulation or electrical stimulation;

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musculoskeletal evaluation for pelvic pain; diagnosis and management of interstitial cystitis (IC); abdominal approach to apical prolapse; the types and choice of operation for repair of vaginal prolapse; colpocleisis for the treatment of vaginal vault prolapse; technique of vaginal hysterectomy; urethral diverticulum; evaluation and management of urinary fistulas; iatrogenic urological trauma; surgical treatment of rectovaginal fistulas and complex perineal defects; pessaries; menopause and hormone replacement therapy; and diagnosis of female sexual dysfunction. Each chapter includes black and white photographs and charts and concludes with a list of references. A subject index concludes the volume.

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

Anal Fistula: Surgical Evaluation and Management by Robin K. S. Phillips (Editor), Peter J. Lunniss (Editor); ISBN: 041254430X; http://www.amazon.com/exec/obidos/ASIN/041254430X/icongroupinterna

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Bottom Line: About Hemorrhoids, Fissures and Fistulas by John Egerton; ISBN: 0939838184; http://www.amazon.com/exec/obidos/ASIN/0939838184/icongroupinterna

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Care and Treatment of Fistula, Piles by H.C. MAlhotra; ISBN: 817021601X; http://www.amazon.com/exec/obidos/ASIN/817021601X/icongroupinterna

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Neurosurgery of Arteriovenous Malformations and Fistulas by Hans-Jakob Steiger (Editor), et al; ISBN: 3211837035; http://www.amazon.com/exec/obidos/ASIN/3211837035/icongroupinterna

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Obstetric Fistula by Otto Kaser, Robert Fyfe Zacharin; ISBN: 0387820051; http://www.amazon.com/exec/obidos/ASIN/0387820051/icongroupinterna

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Pancreatic Fistulas by P. Pederzoli, et al; ISBN: 038755338X; http://www.amazon.com/exec/obidos/ASIN/038755338X/icongroupinterna

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Pancreatic Fistulas; ISBN: 354055338X; http://www.amazon.com/exec/obidos/ASIN/354055338X/icongroupinterna

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Perilymphatic Fistula: A Controversial Issue by J.-P. Guyot (Editor); ISBN: 3805569092; http://www.amazon.com/exec/obidos/ASIN/3805569092/icongroupinterna

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Sims and the Treatment of Vesico-vaginal Fistula: An Extract from the Autobiography of James Marion Sims (1813-1883) by J. Marion Sims; ISBN: 1857080246; http://www.amazon.com/exec/obidos/ASIN/1857080246/icongroupinterna

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Step-by-step Surgery of Vesico-vaginal Fistulas by Kees Waaldijk, I.R. Smidt (Preface); ISBN: 1873732171; http://www.amazon.com/exec/obidos/ASIN/1873732171/icongroupinterna

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Vascular Malformations and Fistulas of the Brain by Robert R. Smith; ISBN: 0890046832; http://www.amazon.com/exec/obidos/ASIN/0890046832/icongroupinterna

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

Atlas of colored plates illustrating features of anatomy, surgery, deformities, displacements, strictures, fistulas, cancer, syphilis, glanders, etc. etc. Designed for ready reference by Elias Smith. Author: Smith, Elias, M. D; Year: 1889

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Micro-surgery: experimental techniques in the rat and clinical applications: introduction to microvascular surgery, organtransplantation, shunts and internal fistulas in the rat, clinical applications of micro-surgical techniques. Author: edited by R. Marquet; Year: 1976

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Neurosurgery of arteriovenous malformations and fistulas: a multimodal approach. Author: Hans-Jakob Steiger. [et al.]; Year: 2002

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Obstetric fistulae: a review of available information. Author: J. Cottingham, E. Royston; Year: 1991

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Pancreatic fistulas. Author: P. Pederzoli (ed.); C. Bassi, S. Vesentini (co-eds.); Year: 1992

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Treatise on diseases in the urinary canal; particularly describing the various symptoms attending strictures, obstructions, gleets, seminal-weakness, fistulas, incontinency of urine, spasmodic affections, etc., and on the prevention of the stone and grave. Author: Dufour, William; Year: 1801

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Vesico-vaginal fistulas and related matters. Author: Russell, Charles Scott; Year: 1962

Chapters on Fistulas In order to find chapters that specifically relate to fistulas, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and fistulas 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 “fistulas” (or synonyms)

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

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into the “For these words:” box. The following is a typical result when searching for book chapters on fistulas: •

Fistula: A Hole in the Bladder Source: in Blaivas, J.G. Conquering Bladder and Prostate Problems: The Authoritative Guide for Men and Women. New York, NY: Plenum Publishing Corporation. 1998. p. 249-256. Contact: Available from Kluwer Academic-Plenum Publishing Corporation. 233 Spring Street, New York, NY 10013-1578. (800) 221-9369 or (212) 620-8035. Fax (212) 647-1898. Website: www.plenum.com. PRICE: $26.95. ISBN: 0306458640. Summary: A fistula is an abnormal passage or connection between a hollow body cavity, like the bladder, and the surface of the body. This chapter on urinary fistulas is from a book for people who have urinary bladder and prostate problems: people who urinate too often, who plan their daily activities around the availability of a bathroom, men with prostate problems, women with incontinence, and people with bladder pain. The book is written in a clear, nontechnical, humorous style that makes the material more accessible to the lay reader. A vesicovaginal fistula connects the bladder with the vagina; a urethrovaginal fistula connects the urethra to the vagina. These fistulas results in severe urinary incontinence because there is uncontrollable leakage of urine through the fistula, which bypasses the urethra and the sphincter. Fistulas are almost always the results of complications from pelvic surgery (hysterectomy, prolapse repair, or anti-incontinence surgery) or from childbirth injuries; rarely, they may be caused by pelvic cancer. Although diagnosis can be elusive, in the majority of patients the diagnosis will be obvious if the doctor does a physical examination when the patient has a full bladder. For practical purposes, the only treatments for fistulas are surgical. Some doctors recommend that an indwelling catheter be left in place for a prolonged period of time (weeks or months) to give the fistula a chance to heal on its own; however, this usually only results in a postponement of the inevitable surgery. The author discusses the two main types of surgical repair of vesicovaginal fistula: abdominal repair and vaginal repair. Other topics covered include the timing of surgery and preoperative management, postoperative management, urethrovaginal fistulas, and the preoperative evaluation for the women with a fistula. Vesicovaginal and urethrovaginal fistulas are rare in industrialized countries, but are common in developing countries because of inadequate obstetric care.

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Abdominal Abscesses and Gastrointestinal Fistulas Source: in Feldman, M.; Friedman, L.S.; Sleisenger, M.H. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 7th ed. [2-volume set]. St. Louis, MO: Saunders. 2002. p. 431-445. Contact: Available from Elsevier. 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 545-2522. Fax (800) 568-5136. Website: www.us.elsevierhealth.com. PRICE: $229.00 plus shipping and handling. ISBN: 0721689736. Summary: The development of an intra-abdominal abscess (IAA, infection) occurs as a result of a host response to intra-abdominal bacterial contamination secondary to, or in conjunction with, various pathologic clinical entities. In 60 to 80 percent of cases, IAA is associated with perforated hollow viscera, whether as a result of inflammatory disease such as appendicitis or diverticulitis, or as a consequence of penetrating or blunt trauma to the abdomen. A fistula is any abnormal anatomic connection between two epithelialized surfaces. Compared with fistulas connected to the skin that are obvious,

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internal fistulas may be difficult to diagnose. This chapter on abdominal abscesses and gastrointestinal fistulas is from a comprehensive and authoritative textbook that covers disorders of the gastrointestinal tract, biliary tree, pancreas, and liver, as well as the related topics of nutrition and peritoneal disorders. Topics include the pathophysiology, bacteriology, management, and expected outcome of abdominal abscesses; and definitions, classifications, pathophysiology, diagnosis, management, and outcomes associated with gastrointestinal fistulas. A patient care algorithm for the latter is also included. The chapter includes a mini-outline with page citations, full-color illustrations, and extensive references. 11 figures. 8 tables. 115 references. •

Gastrointestinal Fistulas Source: in Snape, W.J., ed. Consultations in Gastroenterology. Philadelphia, PA: W.B. Saunders Company. 1996. p. 121-126. Contact: Available from W.B. Saunders Company. Order Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887. (800) 545-2522. Fax (800) 874-6418 or (407) 352-3445. PRICE: $125.00. ISBN: 0721646700. Summary: This chapter from a gastroenterology textbook covers gastrointestinal (GI) fistulas. A fistula is defined as an abnormal communication between two epithelialized surfaces. Overall, a fistula is described by the anatomic feature and the organs involved. The authors discuss the factors that favor development of fistulas, their sequelae, and therapy. Specific topics include the classification of GI fistulas; complications of fistulas; prognostic factors; factors associated with poor fistula closure and prognosis; and the three phases of fistula management, stabilization, investigation, and definitive therapy. The authors stress that GI fistulas may require either medical or surgical therapy or a combination of the two modalities. The medical treatment includes nasogastric suction, fluid replacement, antibiotics, percutaneous abscess drainage, and enteral or parenteral nutrition. The surgical management consists of abscess drainage, fistula closure, obstruction relief and revision, and remaking of anastomosis. 2 tables. 30 references. (AA-M).

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Anal Fistula Source: in Corman, M.L.; Allison, S.I.; Kuehne, J.P. Handbook of Colon and Rectal Surgery. Philadelphia, PA: Lippincott Williams and Wilkins. 2002. p.161-183. Contact: Available from Lippincott Williams and Wilkins. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-3030 or (301) 223-2300. Fax (301) 223-2365. PRICE: $79.00 plus shipping and handling. ISBN: 0781725860. Summary: This chapter on anal fistula (abnormal passage) is from a handbook that addresses the entire range of diseases affecting the colon, rectum, and anus. The authors discuss symptoms, classification, practice parameters for treatment, identification of the fistula tract, principles of surgical treatment, surgical approaches, results of surgery for anal fistula, dual anal fistulas, anal fistula and Crohn's disease (a type of inflammatory bowel disease), anal fistula and carcinoma (cancer), and anal fistula in infants and children. The authors comment that the surgeon who has the opportunity to treat the patient initially is the one most likely to effect a cure, limit morbidity, and minimize disability. 12 figures.

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Autologous Arteriovenous Fistulas: Direct Anastomosis for Hemodialysis Access; Autogenous Vein for Fistulas and Interpositional Grafts Source: in Wilson, S.E. Vascular Access: Principles and Practice. 4th ed. St. Louis, MO: Mosby, Inc. 2002. p. 82-96. Contact: Available from Elsevier, Health Sciences Division, 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 325-4177. Website: www.us.elsevierhealth.com. PRICE: $99.00. ISBN: 0323011888. Summary: This chapter on autologous (using the patient's own tissues) arteriovenous fistulas is from a text that reviews the principles and practice of vascular access, including that used for hemodialysis and for critical care, chemotherapy, and nutrition. The first part of the chapter discusses the techniques used in constructing a BresciaCimino fistula. The second part reviews some of the other autogenous fistulas commonly constructed. The author describes the complications and their management that may be encountered in each type of fistula. The Brescia-Cimino fistula continues to be regarded as the ideal form of access because it offers superior long-term patency rates, lower incidence and ease of managing infectious complications, and a relatively low incidence of other complications such as aneurysm formation. However, this technique is used only in a minority of patients, for reasons such as urgency of dialysis and poor-quality vessels (particularly in the elderly and diabetes populations). The author encourages the access surgeon to familiarize him or herself with a larger range of possibilities from which to choose an appropriate autogenous fistula for the individual patient. 14 figures. 1 table. 59 references.

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Surgical Treatment of Rectovaginal Fistulas and Complex Perineal Defects Source: in Carlin, B.I. and Leong, F.C., eds. Female Pelvic Health and Reconstructive Surgery. New York, NY: Marcel Dekker, Inc. 2003. p. 397-406. Contact: Available from Marcel Dekker, Inc. 270 Madison Avenue, New York, NY 10016. (212) 696-9000. Fax (212) 685-4540. Website: www.dekker.com. PRICE: $185.00 plus shipping and handling. ISBN: 0824708229. Summary: This chapter on the surgical treatment of rectovaginal fistulas (abnormal opening between the rectum and vagina) and complex perineal defects is from a textbook that provides comprehensive, authoritative coverage of female pelvic health and reconstructive surgery. The author notes that the uncontrolled presence of flatus (gas) and stool in the vagina and on the perineum is the dreadful manifestation of rectovaginal fistula (RVF). Most of these have resulted from obstetric trauma, most often at the apex of an improperly healed fourth degree laceration. The author discusses the diagnosis or RVF and perineal defects, preoperative preparation and repair, and postoperative care after fistula repair. 4 figures. 10 references.

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Vascular Interposition (Bridge Fistulas) for Hemodialysis Source: in Wilson, S.E. Vascular Access: Principles and Practice. 4th ed. St. Louis, MO: Mosby, Inc. 2002. p. 101-113. Contact: Available from Elsevier, Health Sciences Division, 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 325-4177. Website: www.us.elsevierhealth.com. PRICE: $99.00. ISBN: 0323011888. Summary: This chapter on vascular interposition (bridge fistulas) for hemodialysis is from a text that reviews the principles and practice of vascular access, including that

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used for hemodialysis and for critical care, chemotherapy, and nutrition. The author notes that fistulas constructed from vascular (blood vessel) grafts provide the best second choice for the patient who cannot have a simple radiocephalic fistula. Prosthetic conduits can be placed from almost any artery to any vein of sufficient size to permit an anastomosis (a connection between two vessels) and are readily available in various lengths, diameters, and configurations. With care, early use (within 24 hours) can be accomplished without a higher incidence of complications, so it is technically possible to use the graft for dialysis immediately after surgery. This may eliminate the need for the placement of a central dialysis catheter, as was previously done to allow incorporation of the graft material. The author reviews considerations including site, graft materials, size of graft, precautions, and different surgical techniques used. 14 references. 32 references. •

Perilymphatic Fistulas Source: in Nadol, J.B., Jr. and Schuknecht. Surgery of the Ear and Temporal Bone. New York, NY: Raven Press, Ltd. 1993. p. 307-313. Contact: Available from Raven Press, Ltd. 1185 Avenue of the Americas, New York, NY 10036. (800) 77-RAVEN or (212) 930-9500. PRICE: $194.50 plus shipping and handling. ISBN: 0881678031. Summary: This chapter, from a book on surgery of the ear and temporal bone, discusses perilymphatic fistulas. The author notes that perilymph leaks have become established as an entity to be included in the differential diagnosis of a variety of auditory and vestibular complaints, including sudden hearing loss, tinnitus, aural fullness, episodic vertigo, and positional vertigo. Topics covered include pathophysiology; history of trauma; symptoms; physical findings; management considerations; repair of perilymph leakage; post-operative results; the risks and complications of exploratory tympanotomy for perilymph leakage; and postoperative management. 64 references.

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Perilymph Fistulas Source: in Sharpe, J.A. and Barber, H.O., eds. Vestibulo-Ocular Reflex and Vertigo. New York, NY: Raven Press, Ltd. 1993. p. 385-391. Contact: Available from Raven Press, Ltd. 1185 Avenue of the Americas, New York, NY 10036. (800) 77-RAVEN or (212) 930-9500. PRICE: $115.00 plus shipping and handling. ISBN: 0881679550. Summary: This chapter, from a medical textbook on the vestibulo-ocular reflex, otolithic and otolith-ocular function, presents an overview of perilymph fistulas (PLF). The book is directed to vestibular physiologists, otologists, neurologists, and internists actively engaged in treating patients with dizziness and balance disturbance and to therapists providing exercise programs for vestibular rehabilitation. The author reports on his experience with patients with PLF; diagnostic tests used to confirm PLF; anatomic facts relevant to PLF; PLF in the post-stapedectomy ear; congenital defects of the middle ear; congenital hearing loss associated with PLF; confusion of PLF with Meniere's disease; and reminders for the physician to be aware of the possibility of PLF. 36 references.

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Evaluation and Management of Urinary Fistulas Source: in Carlin, B.I. and Leong, F.C., eds. Female Pelvic Health and Reconstructive Surgery. New York, NY: Marcel Dekker, Inc. 2003. p. 363-380.

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Contact: Available from Marcel Dekker, Inc. 270 Madison Avenue, New York, NY 10016. (212) 696-9000. Fax (212) 685-4540. Website: www.dekker.com. PRICE: $185.00 plus shipping and handling. ISBN: 0824708229. Summary: Urinary fistulas (abnormal openings or passageways between the bladder or urinary tract and the vagina, typically) have been recognized in the literature for centuries as a distressing problem that results most commonly from birth trauma or urogynecological surgery. This chapter on the evaluation and management of urinary fistulas is from a textbook that provides comprehensive, authoritative coverage of female pelvic health and reconstructive surgery. The authors discuss the etiology, diagnosis, and surgical management of the most common urinary fistulas: vesicovaginal (between bladder and vagina), urethrovaginal (between urethra and vagina), and ureterovaginal (between ureter and vagina). 5 figures. 72 references. •

Vesicoenteric Fistula Source: in Graham, S.D., Jr., et al., eds. Glenn's Urologic Surgery. 5th ed. Philadelphia, PA: Lippincott Williams and Wilkins. 1998. p. 227-233. Contact: Available from Lippincott Williams and Wilkins. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-3030 or (301) 714-2300. Fax (301) 824-7390. Website: lww.com. PRICE: $199.00 plus shipping and handling. ISBN: 0397587376. Summary: Vesicoenteric fistula is an acquired communication or channel between the urinary tract and the intestines. This chapter on vesicoenteric fistula is from an exhaustive textbook on urologic surgery. Most manifestations of the condition occur toward the urinary tract, with passage of fecal matter and flatus from the gut to the bladder rather than in the opposite direction. Vesicoenteric fistulas are usually the consequences of inflammatory processes of the bowel, mainly diverticulitis; colorectal cancer and, more rarely, carcinoma of the bladder; trauma; and iatrogenic fistulas between bladder and sigmoid colon as a result of prostatic surgery. Surgical therapy aimed toward resolution of the primary process and abnormal passage is required and feasible in most cases. The author details the surgical techniques used, including repair of rectovesical fistula (the York Mason procedure), and anticipated outcomes. Any intervention involving an intestinal anastomosis needs to be protected by nasogastric suction for several days until the ileus resolves, generally in 3 to 5 days, heralded by the passage of flatus (gas) or by a bowel movement. Complications include bowel anastomotic leaks with resultant peritonitis, external fecal fistula or pelvic abscess, prolonged ileus, or bowel obstruction. In the event of any of these complications, surgery may again be indicated, perhaps in the form of fecal diversion, and appropriate drainage or repeat reconstruction may be necessary. 2 figures. 2 tables. 10 references.

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CHAPTER 7. MULTIMEDIA ON FISTULAS Overview In this chapter, we show you how to keep current on multimedia sources of information on fistulas. 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 fistulas is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “fistulas” 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 “fistulas” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on fistulas: •

Nutrition and Inflammatory Bowel Disease Source: Bethesda, MD: Weight-Control Information Network. 1995. (videocassette). Contact: Available from Weight-Control Information Network. 1 WIN Way, Bethesda, MD 20892-3665. (202) 828-1025 or (877) 946-4627. Fax (202) 828-1028. E-mail: [email protected]. Website: www.niddk.nih.gov. PRICE: $5.00. Summary: This videotape program presents coverage of a slide lecture presentation given by Dr. Michael Sitrin, the Director of the Clinical Nutrition Research Center at the University of Chicago. Dr. Sitrin discusses the nutritional therapy of inflammatory bowel disease (IBD), including enteral and parenteral nutrition therapies. He first covers the pathogenesis of malnutrition in patients with these types of disorders. Factors that contribute to malnutrition in IBD include decreased food intake (often to avoid symptoms), malabsorption (especially in patients with resections), excessive secretion of nutrients across the diseased mucosa, and increased nutrient requirements. Dr. Sitrin describes the prevalence of malnutrition in patients with IBD, particularly various

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vitamin deficiencies. The remainder of Dr. Sitrin's lecture discusses the five reasons that nutritional therapy might be utilized in a patient with IBD: as primary therapy for the disease itself, as preoperative nutritional support, to manage Crohn's disease and intestinal fistulas, to prevent growth retardation in children with IBD, and to maintain survival in patients with gut failure (accomplished predominantly through home total parenteral nutrition, or TPN). The videotape focuses primarily on Dr. Sitrin as he lectures, with shots of each slide as he shows them.

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CHAPTER 8. PERIODICALS AND NEWS ON FISTULAS Overview In this chapter, we suggest a number of news sources and present various periodicals that cover fistulas.

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

Infliximab resolves some cases of fistulizing Crohn's disease-related fistulas Source: Reuters Industry Breifing Date: February 26, 2004

•

Beta-trace protein measurement provides noninvasive test for CSF fistula Source: Reuters Medical News Date: September 23, 2002

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•

Gastropericardial fistula reported after laparoscopic Nissen procedure Source: Reuters Medical News Date: February 01, 2002

•

AV fistula for dialysis not better than PTFE graft in women, older men Source: Reuters Medical News Date: December 05, 2000

•

Commercial fibrin sealant safe and effective treatment for anorectal fistulae Source: Reuters Medical News Date: February 21, 2000

•

Infliximab effective against enterocutaneous fistulas in Crohn's disease Source: Reuters Medical News Date: May 06, 1999

•

Monoclonal Antibody Efficacious In Treatment Of Crohn's Fistulae Source: Reuters Medical News Date: November 05, 1997 The NIH

Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. 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 “fistulas” (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

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you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “fistulas” (or synonyms). If you know the name of a company that is relevant to fistulas, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “fistulas” (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 “fistulas” (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 fistulas: •

Vascular Access Procedures for American Indian Dialysis Patients Source: IHS Primary Care Provider. 25(10): 153-158. October 2000. Contact: Available from Indian Health Service Clinical Support Center. Two Renaissance Square, Suite 780, 40 North Central Avenue, Phoenix, AZ 85004. (602) 3647777. Fax (602) 364-7788. E-mail: [email protected]. Website: www.ihs.gov. Summary: More than 300,000 patients are currently receiving treatment for chronic renal failure with chronic dialysis in the United States. Access complications are the leading cause for hospitalizations in this population. This article examines renal (kidney) failure and the complications of dialysis access in two groups of patients from two southwestern Native American tribes. As in the general population, comorbid conditions (illnesses in addition to the kidney disease) were common. In the group from Tribe A, 84 percent had diabetes and 97 percent had hypertension (high blood pressure). In the Tribe B group, 66 percent had diabetes and 80 percent had hypertension. Renal failure associated with diabetes mellitus and hypertension is largely preventable by maintaining strict control of serum glucose and blood pressure. There are three general treatment options for end stage renal disease (ESRD): no therapy (which results in death), peritoneal dialysis, and hemodialysis. In this article, the authors review results from 60 patients from Tribe A who had 81 primary dialysis access procedures over a 6 year period, and from 58 patients from Tribe B who had 94 primary dialysis access procedures over a three year period. The authors discuss the types of grafts and fistulas used, and the complications that can be encountered, including thrombosis (clotting), infection, and arterial insufficiency. In the groups covered in this paper, arteriovenous fistulas had a higher initial failure rate than PTFE (polytetrafluoroethylene) grafts in both patient populations, but those that last a year have longer patency than grafts. The primary and secondary patency rates for Tribe B are less than those for Tribe A patients

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for PTFE grafts. Radiologic thrombectomy with angioplasty has as good results as surgical revisions as a treatment for graft thrombosis. The authors conclude that early placement of access in patients with progressive ESRD reduces the need for temporary access procedures and may reduce the incidence of subclavian vein stenosis. 5 figures. 3 tables. 28 references. •

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

•

Maintenance Therapy for Crohn's Source: Foundation Focus. Summer 1998. p. 20-21. Contact: Available from Crohn's and Colitis Foundation of America, Inc. 386 Park Avenue South, New York, NY 10016. (212) 685-3440 or (800) 932-2423. Summary: This newsletter article reviews the current thinking on maintenance therapy for Crohn's disease, a chronic intestinal disease that usually requires long term medical treatment. The first goal of therapy is to treat the active disease until the patient is in remission. A person in remission feels well, and has minimal, if any, signs of disease. The second goal is to maintain remission. The article discusses some of the agents that have been found to be effective in maintaining remission, including sulfasalazine and 5ASA preparations (mesalamine, olsalazine), azathioprine, 6-mercaptopurine, and methotrexate; topical preparations; and steroids (in acute illness not as a maintenance medication). Other topics are side effects of drugs; perianal disease and fistulas; postsurgical therapy, particularly with 5-ASA; and general health guidelines. The authors note that maintaining remission may depend on other factors besides successful therapy, including smoking cessation, avoidance of certain over the counter medications (such as aspirin), and dietary modifications.

•

Inflammatory Bowel Disease. Part II: Treatment Source: Intestinal Fortitude. 10(4): 1-3. 2000. Contact: Available from Intestinal Disease Foundation. 1323 Forbes Avenue, Suite 200, Pittsburgh, PA 15219. (412) 261-5888.

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Summary: This newsletter article, the second in a two part series on inflammatory bowel disease (IBD), reviews the treatment options for people with the disease. The goals of therapy for IBD include symptom control and remission; good nutrition, for healing and to avoid additional problems relating to nutritional deficiencies; and quality of life, a common goal for all of the therapies used, including medications, coping techniques, and surgeries. For ulcerative colitis (UC) patients, removal of the colon produces a cure. It is major surgery, however, and for that reason needs to be carefully considered. Surgery for Crohn's disease (CD) is usually done to treat obstructions (from strictures), infections (abscesses), or non healing fistulas. There is a 10 percent chance per year of recurrence of the CD following surgery, but use of medications, along with surgery, may help reduce the odds. The author reviews four traditional therapies for IBD: 5 aminosalicylates, antibiotics, corticosteroids, and immunomodulators. The authors also considers a new therapy, infliximab (Remicade), a medication that works on a cellular level to prevent inflammation and was recently approved by the FDA for treatment of CD. The future treatment of UC and CD will involve medications that better target the immune chemicals responsible for inflammation. For now, the treatment of IBD remains a multidisciplinary approach (medical, surgical, and nutritional) aimed at controlling symptoms and maintaining wellness. •

Optimal Vascular Access for American Indian Dialysis Patients: The Primary Care Provider's Role Source: IHS Primary Care Provider. 25(10): 158-159. October 2000. Contact: Available from Indian Health Service Clinical Support Center. Two Renaissance Square, Suite 780, 40 North Central Avenue, Phoenix, AZ 85004. (602) 3647777. Fax (602) 364-7788. E-mail: [email protected]. Website: www.ihs.gov. Summary: Vascular access (VA) complications are a major cause of morbidity (illness) for patients treated with hemodialysis and represent a large cost burden for the health care system. Current efforts to improve outcomes for patients are based on clinical practice guidelines developed by the National Kidney Foundation as part of the Dialysis Outcomes Quality Initiative (DOQI). This article reviews the guidelines on VA that Indian Health Service (HIS) should be familiar with. The guidelines include preservation of the veins for AV (arteriovenous) access, timing of access placement, access maturation, and goals of access placement (maximizing primary AV fistulas). The author stresses that the most important goal is to increase the proportion of patients with native AV fistulas. This is likely to occur if patients are referred early for vascular access placement. Primary AV fistulae should be constructed in at least 50 percent of all new patients electing to receive hemodialysis as their initial form of renal replacement therapy. A primary AV fistula is mature and suitable for use when the vein's diameter is sufficient to allow successful cannulation, but not sooner than 1 month (and preferably 3 to 4 months) after construction. Ultimately, 40 percent of prevalent patients should have a native AV fistula.

Academic Periodicals covering Fistulas Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to fistulas. In addition to these sources, you can search for articles covering fistulas that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to

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http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

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CHAPTER 9. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.

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

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following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to fistulas: Infliximab •

Systemic - U.S. Brands: Remicade http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203667.html

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

Mosby’s Drug Consult™ Mosby’s Drug Consult™ database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/. PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html. Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee.

Researching Orphan Drugs Although the list of orphan drugs is revised on a daily basis, you can quickly research orphan drugs that might be applicable to fistulas by using the database managed by the National Organization for Rare Disorders, Inc. (NORD), at http://www.rarediseases.org/. Scroll down the page, and on the left toolbar, click on “Orphan Drug Designation Database.” On this page (http://www.rarediseases.org/search/noddsearch.html), type “fistulas” (or synonyms) into the search box, and click “Submit Query.” When you receive your results, note that not all of the drugs may be relevant, as some may have been withdrawn from orphan status. Write down or print out the name of each drug and the relevant contact information. From there, visit the Pharmacopeia Web site and type the name of each orphan

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drug into the search box at http://www.nlm.nih.gov/medlineplus/druginformation.html. You may need to contact the sponsor or NORD for further information. NORD conducts “early access programs for investigational new drugs (IND) under the Food and Drug Administration’s (FDA’s) approval ‘Treatment INDs’ programs which allow for a limited number of individuals to receive investigational drugs before FDA marketing approval.” If the orphan product about which you are seeking information is approved for marketing, information on side effects can be found on the product’s label. If the product is not approved, you may need to contact the sponsor. The following is a list of orphan drugs currently listed in the NORD Orphan Drug Designation Database for fistulas: •

Vapreotide (trade name: Octastatin) http://www.rarediseases.org/nord/search/nodd_full?code=1017

•

Somatostatin (trade name: Zecnil) http://www.rarediseases.org/nord/search/nodd_full?code=216

If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.

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APPENDICES

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

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

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

•

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

•

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

•

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

•

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

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

•

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

•

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

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

•

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 “fistulas” (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 41379 291 53 12 35 41770

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 “fistulas” (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/.

The Genome Project and Fistulas In the following section, we will discuss databases and references which relate to the Genome Project and fistulas. Online Mendelian Inheritance in Man (OMIM) The Online Mendelian Inheritance in Man (OMIM) database is a catalog of human genes and genetic disorders authored and edited by Dr. Victor A. McKusick and his colleagues at Johns Hopkins and elsewhere. OMIM was developed for the World Wide Web by the National Center for Biotechnology Information (NCBI).23 The database contains textual information, pictures, and reference information. It also contains copious links to NCBI’s Entrez database of MEDLINE articles and sequence information. 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. 23 Adapted from http://www.ncbi.nlm.nih.gov/. Established in 1988 as a national resource for molecular biology information, NCBI creates public databases, conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information--all for the better understanding of molecular processes affecting human health and disease.

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To search the database, go to http://www.ncbi.nlm.nih.gov/Omim/searchomim.html. Type “fistulas” (or synonyms) into the search box, and click “Submit Search.” If too many results appear, you can narrow the search by adding the word “clinical.” Each report will have additional links to related research and databases. In particular, the option “Database Links” will search across technical databases that offer an abundance of information. The following is an example of the results you can obtain from the OMIM for fistulas: •

Angiokeratoma Corporis Diffusum with Arteriovenous Fistulas Web site: http://www.ncbi.nlm.nih.gov/entrez/dispomim.cgi?id=600419

•

Pulmonary Arteriovenous Fistulas Web site: http://www.ncbi.nlm.nih.gov/entrez/dispomim.cgi?id=265140 Genes and Disease (NCBI - Map)

The Genes and Disease database is produced by the National Center for Biotechnology Information of the National Library of Medicine at the National Institutes of Health. This Web site categorizes each disorder by system of the body. Go to http://www.ncbi.nlm.nih.gov/disease/, and browse the system pages to have a full view of important conditions linked to human genes. Since this site is regularly updated, you may wish to revisit it from time to time. The following systems and associated disorders are addressed: •

Cancer: Uncontrolled cell division. Examples: Breast and ovarian cancer, Burkitt lymphoma, chronic myeloid leukemia, colon cancer, lung cancer, malignant melanoma, multiple endocrine neoplasia, neurofibromatosis, p53 tumor suppressor, pancreatic cancer, prostate cancer, Ras oncogene, RB: retinoblastoma, von Hippel-Lindau syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Cancer.html

•

Immune System: Fights invaders. Examples: Asthma, autoimmune polyglandular syndrome, Crohn’s disease, DiGeorge syndrome, familial Mediterranean fever, immunodeficiency with Hyper-IgM, severe combined immunodeficiency. Web site: http://www.ncbi.nlm.nih.gov/disease/Immune.html

•

Metabolism: Food and energy. Examples: Adreno-leukodystrophy, atherosclerosis, Best disease, Gaucher disease, glucose galactose malabsorption, gyrate atrophy, juvenile-onset diabetes, obesity, paroxysmal nocturnal hemoglobinuria, phenylketonuria, Refsum disease, Tangier disease, Tay-Sachs disease. Web site: http://www.ncbi.nlm.nih.gov/disease/Metabolism.html

•

Muscle and Bone: Movement and growth. Examples: Duchenne muscular dystrophy, Ellis-van Creveld syndrome, Marfan syndrome, myotonic dystrophy, spinal muscular atrophy. Web site: http://www.ncbi.nlm.nih.gov/disease/Muscle.html

•

Nervous System: Mind and body. Examples: Alzheimer disease, amyotrophic lateral sclerosis, Angelman syndrome, Charcot-Marie-Tooth disease, epilepsy, essential tremor, fragile X syndrome, Friedreich’s ataxia, Huntington disease, Niemann-Pick disease, Parkinson disease,

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Prader-Willi syndrome, Rett syndrome, spinocerebellar atrophy, Williams syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Brain.html •

Signals: Cellular messages. Examples: Ataxia telangiectasia, Cockayne syndrome, glaucoma, male-patterned baldness, SRY: sex determination, tuberous sclerosis, Waardenburg syndrome, Werner syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Signals.html

•

Transporters: Pumps and channels. Examples: Cystic fibrosis, deafness, diastrophic dysplasia, Hemophilia A, long-QT syndrome, Menkes syndrome, Pendred syndrome, polycystic kidney disease, sickle cell anemia, Wilson’s disease, Zellweger syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Transporters.html Entrez

Entrez is a search and retrieval system that integrates several linked databases at the National Center for Biotechnology Information (NCBI). These databases include nucleotide sequences, protein sequences, macromolecular structures, whole genomes, and MEDLINE through PubMed. Entrez provides access to the following databases: •

3D Domains: Domains from Entrez Structure, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo

•

Books: Online books, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=books

•

Genome: Complete genome assemblies, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Genome

•

NCBI’s Protein Sequence Information Survey Results: Web site: http://www.ncbi.nlm.nih.gov/About/proteinsurvey/

•

Nucleotide Sequence Database (Genbank): Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Nucleotide

•

OMIM: Online Mendelian Inheritance in Man, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=OMIM

•

PopSet: Population study data sets, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Popset

•

ProbeSet: Gene Expression Omnibus (GEO), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo

•

Protein Sequence Database: Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Protein

•

PubMed: Biomedical literature (PubMed), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed

•

Structure: Three-dimensional macromolecular structures, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Structure

•

Taxonomy: Organisms in GenBank, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Taxonomy

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To access the Entrez system at the National Center for Biotechnology Information, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=genome, and then select the database that you would like to search. The databases available are listed in the drop box next to “Search.” Enter “fistulas” (or synonyms) into the search box and click “Go.” Jablonski’s Multiple Congenital Anomaly/Mental Retardation (MCA/MR) Syndromes Database24 This online resource has been developed to facilitate the identification and differentiation of syndromic entities. Special attention is given to the type of information that is usually limited or completely omitted in existing reference sources due to space limitations of the printed form. At http://www.nlm.nih.gov/mesh/jablonski/syndrome_toc/toc_a.html, you can search across syndromes using an alphabetical index. Search by keywords at http://www.nlm.nih.gov/mesh/jablonski/syndrome_db.html. The Genome Database25 Established at Johns Hopkins University in Baltimore, Maryland in 1990, the Genome Database (GDB) is the official central repository for genomic mapping data resulting from the Human Genome Initiative. In the spring of 1999, the Bioinformatics Supercomputing Centre (BiSC) at the Hospital for Sick Children in Toronto, Ontario assumed the management of GDB. The Human Genome Initiative is a worldwide research effort focusing on structural analysis of human DNA to determine the location and sequence of the estimated 100,000 human genes. In support of this project, GDB stores and curates data generated by researchers worldwide who are engaged in the mapping effort of the Human Genome Project (HGP). GDB’s mission is to provide scientists with an encyclopedia of the human genome which is continually revised and updated to reflect the current state of scientific knowledge. Although GDB has historically focused on gene mapping, its focus will broaden as the Genome Project moves from mapping to sequence, and finally, to functional analysis. To access the GDB, simply go to the following hyperlink: http://www.gdb.org/. Search “All Biological Data” by “Keyword.” Type “fistulas” (or synonyms) into the search box, and review the results. If more than one word is used in the search box, then separate each one with the word “and” or “or” (using “or” might be useful when using synonyms).

24

Adapted from the National Library of Medicine: http://www.nlm.nih.gov/mesh/jablonski/about_syndrome.html. 25 Adapted from the Genome Database: http://gdbwww.gdb.org/gdb/aboutGDB.html - mission.

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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 fistulas 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 fistulas. 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 fistulas. 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 “fistulas”:

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•

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Guides on fistulas Fistulas http://www.nlm.nih.gov/medlineplus/fistulas.html

•

Other guides Abscesses http://www.nlm.nih.gov/medlineplus/abscesses.html Anal and Rectal Diseases http://www.nlm.nih.gov/medlineplus/analandrectaldiseases.html Bladder Diseases http://www.nlm.nih.gov/medlineplus/bladderdiseases.html Crohn's Disease http://www.nlm.nih.gov/medlineplus/crohnsdisease.html Kidney Failure and Dialysis http://www.nlm.nih.gov/medlineplus/kidneyfailureanddialysis.html

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

Specific Conditions/Aspects Anal Abscess / Fistula Source: Cleveland Clinic Foundation http://www.clevelandclinic.org/colorectal/pinfo_fistula.htm Arteriovenous (A-V) Fistula Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=HQ00263 Bladder Fistula Source: American Urological Association http://urologyhealth.org/adult/index.cfm?cat=03&topic=35 Perilymph Fistula Source: American Hearing Research Foundation http://www.american-hearing.org/name/perilymph_fistula.html%2520

•

Children Esophageal Atresia and Tracheoesophageal Fistula Source: American Academy of Family Physicians http://familydoctor.org/345.xml

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.

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The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on fistulas. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •

Anal Fistulas: Symptoms and Treatment Source: Milwaukee, WI: International Foundation for Functional Gastrointestinal Disorders (IFFGD). 1998. 2 p. Contact: Available from International Foundation for Functional Gastrointestinal Disorders (IFFGD). P.O. Box 170864, Milwaukee, WI 53217. (888) 964-2001 or (414) 9641799. Fax (414) 964-7176. E-mail: [email protected]. Website: www.iffgd.org. PRICE: $0.50 plus shipping and handling; bulk copies available. Order number: 138. Summary: This fact sheet for patients and their families outlines the symptoms of and treatment for anal fistulas. An anal fistula is an abnormal connection between the anal canal and the skin. The fact sheet first reviews the anatomy of the anal canal, focusing on the sphincter muscles. The fact sheet then reviews the cause and symptoms of anal fistulae, noting that nearly all anal fistulae are a result of an anorectal abscess. The primary symptom of an anal fistula is persistent drainage because of chronic, low grade sepsis (infection) after treatment of the acute abscess. Diagnosis of an anal fistula rests on identifying the external opening on the perianal skin and the internal opening in the anal canal (this often requires examination under anesthesia in the operating room). The goals of treatment are the elimination of sepsis and of the fistula tract, the prevention of recurrence, and the preservation of continence. Treatment requires surgery in an operating room under general or regional anesthesia. The fact sheet briefly reviews the types of surgical techniques utilized to treat anal fistulae. 1 figure.

•

Perilymph Fistula Source: Portland, OR: Vestibular Disorders Association. 1991. 2 p. Contact: Available from Vestibular Disorders Association (VEDA). P.O. Box 4467, Portland, OR 97208-4467. (503) 229-7705. Fax (503) 229-8064. E-mail: [email protected]. Website: www.vestibular.org. PRICE: $0.50 plus shipping and handling. Order number F-3. Summary: This fact sheet from the Vestibular Disorders Association presents information on perilymph fistulas. Topics covered include the anatomy of the ear; the symptoms of perilymph fistula; the causes of these fistulas, notably head trauma; diagnostic tests used to confirm a fistula; treatment options, including bed rest and surgical repair; coping with dizziness; and changes to make in the home environment while coping with a perilymph fistula. The fact sheet concludes with a reminder that learning to cope with an illness that causes persistent dizziness takes time and patience. 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

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located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: •

Vascular Access for Hemodialysis Summary: Explains how vascular access is created for hemodialysis, including arteriovenous fistulas, grafts, and catheters. Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6547 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 fistulas. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •


•

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

•

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

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

Tracheo Oesophageal Fistula Support Group (TOFS) Telephone: 0115 961 3092 Fax: 0115 961 3097 Email: [email protected]

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Web Site: www.tofs.org.uk Background: The Tracheo Oesophageal Fistula Support Group (TOFS) is an international voluntary organization dedicated to providing information and support to parents who have a child born with tracheo-esophogeal fistula (TOF). In TOF, a section of the baby s throat is abnormally joined to the windpipe (esophagus) making it difficult for food and saliva to pass into the stomach. Established in 1982, TOFS consists of an 800 plus family membership and a national network of volunteers, all of whom are parents of children with TOF. The Support Group receives calls from affected families and professionals; maintains contact with sister organizations in other countries; and maintains a databank of information on matters such as feeding problems, tube feeding, and financial assistance. A video has been produced that explains the condition and the problems affecting children with TOF. In addition, TOFS raises funds to support its own work, to purchase equipment for hospitals and individuals, and to finance research. Support groups for affected individuals, family members, and healthcare professionals are provided along with educational materials. In addition to educational materials, audiovisual aides entitled, 'Your Life In Their Hands,' 'History of TOF,' and 'Reach,' along with many others are available. A national conference for members and professionals is organized every two years. A quarterly newsletter entitled, 'Chew' is also available. Fund-raising is undertaken to assist hospitals to purchase specialized equipment.

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to fistulas. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with fistulas. 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 fistulas. 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 “fistulas” (or a synonym), and you will receive information on all relevant organizations listed in the database.

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Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “fistulas”. 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 “fistulas” (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 “fistulas” (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.26

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

26

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)27: •

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)

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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/

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

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

•

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/

27

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

Finding Medical Libraries 129 •

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

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Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

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•

Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

•

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/

Finding Medical Libraries 131 •

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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•

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

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

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

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

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

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

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

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

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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 fistulas: •

Basic Guidelines for Fistulas Fistula Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002365.htm

•

Background Topics for Fistulas Bile Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002237.htm Cervix Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002317.htm Vagina Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002342.htm

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

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

•

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

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

•

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

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FISTULAS DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abdominal Pain: Sensation of discomfort, distress, or agony in the abdominal region. [NIH] Ablate: In surgery, is to remove. [NIH] Ablation: The removal of an organ by surgery. [NIH] Abortion: 1. The premature expulsion from the uterus of the products of conception - of the embryo, or of a nonviable fetus. The four classic symptoms, usually present in each type of abortion, are uterine contractions, uterine haemorrhage, softening and dilatation of the cervix, and presentation or expulsion of all or part of the products of conception. 2. Premature stoppage of a natural or a pathological process. [EU] Abscess: A localized, circumscribed collection of pus. [NIH] Acetaminophen: Analgesic antipyretic derivative of acetanilide. It has weak antiinflammatory properties and is used as a common analgesic, but may cause liver, blood cell, and kidney damage. [NIH] Acidity: The quality of being acid or sour; containing acid (hydrogen ions). [EU] Acquired Immunodeficiency Syndrome: An acquired defect of cellular immunity associated with infection by the human immunodeficiency virus (HIV), a CD4-positive Tlymphocyte count under 200 cells/microliter or less than 14% of total lymphocytes, and increased susceptibility to opportunistic infections and malignant neoplasms. Clinical manifestations also include emaciation (wasting) and dementia. These elements reflect criteria for AIDS as defined by the CDC in 1993. [NIH] Acuity: Clarity or clearness, especially of the vision. [EU] Acute renal: A condition in which the kidneys suddenly stop working. In most cases, kidneys can recover from almost complete loss of function. [NIH] Adenine: A purine base and a fundamental unit of adenine nucleotides. [NIH] Adenocarcinoma: A malignant epithelial tumor with a glandular organization. [NIH] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] 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]

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Adrenal Medulla: The inner part of the adrenal gland; it synthesizes, stores and releases catecholamines. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] 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] Airways: Tubes that carry air into and out of the lungs. [NIH] Albumin: 1. Any protein that is soluble in water and moderately concentrated salt solutions and is coagulable by heat. 2. Serum albumin; the major plasma protein (approximately 60 per cent of the total), which is responsible for much of the plasma colloidal osmotic pressure and serves as a transport protein carrying large organic anions, such as fatty acids, bilirubin, and many drugs, and also carrying certain hormones, such as cortisol and thyroxine, when their specific binding globulins are saturated. Albumin is synthesized in the liver. Low serum levels occur in protein malnutrition, active inflammation and serious hepatic and renal disease. [EU] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alpha Particles: Positively charged particles composed of two protons and two neutrons, i.e., helium nuclei, emitted during disintegration of very heavy isotopes; a beam of alpha particles or an alpha ray has very strong ionizing power, but weak penetrability. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Aluminum: A metallic element that has the atomic number 13, atomic symbol Al, and atomic weight 26.98. [NIH] Amino acid: Any organic compound containing an amino (-NH2 and a carboxyl (- COOH) group. The 20 a-amino acids listed in the accompanying table are the amino acids from which proteins are synthesized by formation of peptide bonds during ribosomal translation of messenger RNA; all except glycine, which is not optically active, have the L configuration. Other amino acids occurring in proteins, such as hydroxyproline in collagen, are formed by posttranslational enzymatic modification of amino acids residues in polypeptide chains. There are also several important amino acids, such as the neurotransmitter y-aminobutyric acid, that have no relation to proteins. Abbreviated AA. [EU] Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This

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is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Ampulla: A sac-like enlargement of a canal or duct. [NIH] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Anal Fissure: A small tear in the anus that may cause itching, pain, or bleeding. [NIH] Anal Fistula: A channel that develops between the anus and the skin. Most fistulas are the result of an abscess (infection) that spreads to the skin. [NIH] Anaplasia: Loss of structural differentiation and useful function of neoplastic cells. [NIH] Anastomosis: A procedure to connect healthy sections of tubular structures in the body after the diseased portion has been surgically removed. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Anesthetics: Agents that are capable of inducing a total or partial loss of sensation, especially tactile sensation and pain. They may act to induce general anesthesia, in which an unconscious state is achieved, or may act locally to induce numbness or lack of sensation at a targeted site. [NIH] Aneurysm: A sac formed by the dilatation of the wall of an artery, a vein, or the heart. [NIH] Angiogenesis: Blood vessel formation. Tumor angiogenesis is the growth of blood vessels from surrounding tissue to a solid tumor. This is caused by the release of chemicals by the tumor. [NIH] Angiography: Radiography of blood vessels after injection of a contrast medium. [NIH] 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] 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] Anions: Negatively charged atoms, radicals or groups of atoms which travel to the anode or positive pole during electrolysis. [NIH] Ankle: That part of the lower limb directly above the foot. [NIH] Anomalies: Birth defects; abnormalities. [NIH] Anorectal: Pertaining to the anus and rectum or to the junction region between the two. [EU] Anterior chamber: The space in front of the iris and behind the cornea. [NIH] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of

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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-infective: An agent that so acts. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Anti-Inflammatory Agents: Substances that reduce or suppress inflammation. [NIH] Antimetabolite: A chemical that is very similar to one required in a normal biochemical reaction in cells. Antimetabolites can stop or slow down the reaction. [NIH] Antineoplastic: Inhibiting or preventing the development of neoplasms, checking the maturation and proliferation of malignant cells. [EU] Antiproliferative: Counteracting a process of proliferation. [EU] Anus: The opening of the rectum to the outside of the body. [NIH] Aorta: The main trunk of the systemic arteries. [NIH] Aortic Valve: The valve between the left ventricle and the ascending aorta which prevents backflow into the left ventricle. [NIH] Aperture: A natural hole of perforation, especially one in a bone. [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] Appendicitis: Acute inflammation of the vermiform appendix. [NIH] Aqueous: Having to do with water. [NIH] Aqueous humor: Clear, watery fluid that flows between and nourishes the lens and the cornea; secreted by the ciliary processes. [NIH] Arachidonic Acid: An unsaturated, essential fatty acid. It is found in animal and human fat as well as in the liver, brain, and glandular organs, and is a constituent of animal phosphatides. It is formed by the synthesis from dietary linoleic acid and is a precursor in the biosynthesis of prostaglandins, thromboxanes, and leukotrienes. [NIH] Argon: A noble gas with the atomic symbol Ar, atomic number 18, and atomic weight

Dictionary 139

39.948. It is used in fluorescent tubes and wherever an inert atmosphere is desired and nitrogen cannot be used. [NIH] Arsenic trioxide: An anticancer drug that induces programmed cell death (apoptosis) in certain cancer cells. [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] Arteriolosclerosis: Sclerosis and thickening of the walls of the smaller arteries (arterioles). Hyaline arteriolosclerosis, in which there is homogeneous pink hyaline thickening of the arteriolar walls, is associated with benign nephrosclerosis. Hyperplastic arteriolosclerosis, in which there is a concentric thickening with progressive narrowing of the lumina may be associated with malignant hypertension, nephrosclerosis, and scleroderma. [EU] Arteriosclerosis: Thickening and loss of elasticity of arterial walls. Atherosclerosis is the most common form of arteriosclerosis and involves lipid deposition and thickening of the intimal cell layers within arteries. Additional forms of arteriosclerosis involve calcification of the media of muscular arteries (Monkeberg medial calcific sclerosis) and thickening of the walls of small arteries or arterioles due to cell proliferation or hyaline deposition (arteriolosclerosis). [NIH] Arteriovenous: Both arterial and venous; pertaining to or affecting an artery and a vein. [EU] Arteriovenous Fistula: An abnormal communication between an artery and a vein. [NIH] Arteritis: Inflammation of an artery. [NIH] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Aspirin: A drug that reduces pain, fever, inflammation, and blood clotting. Aspirin belongs to the family of drugs called nonsteroidal anti-inflammatory agents. It is also being studied in cancer prevention. [NIH] Asymptomatic: Having no signs or symptoms of disease. [NIH] Ataxia: Impairment of the ability to perform smoothly coordinated voluntary movements. This condition may affect the limbs, trunk, eyes, pharnyx, larnyx, and other structures. Ataxia may result from impaired sensory or motor function. Sensory ataxia may result from posterior column injury or peripheral nerve diseases. Motor ataxia may be associated with cerebellar diseases; cerebral cortex diseases; thalamic diseases; basal ganglia diseases; injury to the red nucleus; and other conditions. [NIH] Atresia: Lack of a normal opening from the esophagus, intestines, or anus. [NIH] Atrium: A chamber; used in anatomical nomenclature to designate a chamber affording entrance to another structure or organ. Usually used alone to designate an atrium of the heart. [EU] 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] Audiometry: The testing of the acuity of the sense of hearing to determine the thresholds of the lowest intensity levels at which an individual can hear a set of tones. The frequencies between 125 and 8000 Hz are used to test air conduction thresholds, and the frequencies between 250 and 4000 Hz are used to test bone conduction thresholds. [NIH]

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Auditory: Pertaining to the sense of hearing. [EU] Aural: Pertaining to or perceived by the ear, as an aural stimulus. [EU] Autodigestion: Autolysis; a condition found in disease of the stomach: the stomach wall is digested by the gastric juice. [NIH] Autologous: Taken from an individual's own tissues, cells, or DNA. [NIH] Axillary: Pertaining to the armpit area, including the lymph nodes that are located there. [NIH]

Axillary Vein: The venous trunk of the upper limb; a continuation of the basilar and brachial veins running from the lower border of the teres major muscle to the outer border of the first rib where it becomes the subclavian vein. [NIH] Axons: Nerve fibers that are capable of rapidly conducting impulses away from the neuron cell body. [NIH] Bacteremia: The presence of viable bacteria circulating in the blood. Fever, chills, tachycardia, and tachypnea are common acute manifestations of bacteremia. The majority of cases are seen in already hospitalized patients, most of whom have underlying diseases or procedures which render their bloodstreams susceptible to invasion. [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] Bactericidal: Substance lethal to bacteria; substance capable of killing bacteria. [NIH] Basal Ganglia: Large subcortical nuclear masses derived from the telencephalon and located in the basal regions of the cerebral hemispheres. [NIH] Basal Ganglia Diseases: Diseases of the basal ganglia including the putamen; globus pallidus; claustrum; amygdala; and caudate nucleus. Dyskinesias (most notably involuntary movements and alterations of the rate of movement) represent the primary clinical manifestations of these disorders. Common etiologies include cerebrovascular disease; neurodegenerative diseases; and craniocerebral trauma. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] 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] Basophils: Granular leukocytes characterized by a relatively pale-staining, lobate nucleus and cytoplasm containing coarse dark-staining granules of variable size and stainable by basic dyes. [NIH] Bed Rest: Confinement of an individual to bed for therapeutic or experimental reasons. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Bilateral: Affecting both the right and left side of body. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bile Acids: Acids made by the liver that work with bile to break down fats. [NIH]

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Bile duct: A tube through which bile passes in and out of the liver. [NIH] Bile Pigments: Pigments that give a characteristic color to bile including: bilirubin, biliverdine, and bilicyanin. [NIH] Biliary: Having to do with the liver, bile ducts, and/or gallbladder. [NIH] Biliary Atresia: Atresia of the biliary tract, most commonly of the extrahepatic bile ducts. [NIH]

Biliary Fistula: Abnormal passage in any organ of the biliary tract or between biliary organs and other organs. [NIH] Biliary Tract: The gallbladder and its ducts. [NIH] Bilirubin: A bile pigment that is a degradation product of heme. [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] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Bladder: The organ that stores urine. [NIH] Bloating: Fullness or swelling in the abdomen that often occurs after meals. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Bone Cements: Adhesives used to fix prosthetic devices to bones and to cement bone to bone in difficult fractures. Synthetic resins are commonly used as cements. A mixture of monocalcium phosphate, monohydrate, alpha-tricalcium phosphate, and calcium carbonate with a sodium phosphate solution is also a useful bone paste. [NIH] Bone Conduction: Sound transmission through the bones of the skull to the inner ear. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bone scan: A technique to create images of bones on a computer screen or on film. A small amount of radioactive material is injected into a blood vessel and travels through the

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bloodstream; it collects in the bones and is detected by a scanner. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Brachytherapy: A collective term for interstitial, intracavity, and surface radiotherapy. It uses small sealed or partly-sealed sources that may be placed on or near the body surface or within a natural body cavity or implanted directly into the tissues. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Breakdown: A physical, metal, or nervous collapse. [NIH] Breeding: The science or art of changing the constitution of a population of plants or animals through sexual reproduction. [NIH] Bronchi: The larger air passages of the lungs arising from the terminal bifurcation of the trachea. [NIH] Bronchial: Pertaining to one or more bronchi. [EU] Bronchus: A large air passage that leads from the trachea (windpipe) to the lung. [NIH] Burns: Injuries to tissues caused by contact with heat, steam, chemicals (burns, chemical), electricity (burns, electric), or the like. [NIH] Burns, Electric: Burns produced by contact with electric current or from a sudden discharge of electricity. [NIH] Bypass: A surgical procedure in which the doctor creates a new pathway for the flow of body fluids. [NIH] Calcification: Deposits of calcium in the tissues of the breast. Calcification in the breast can be seen on a mammogram, but cannot be detected by touch. There are two types of breast calcification, macrocalcification and microcalcification. Macrocalcifications are large deposits and are usually not related to cancer. Microcalcifications are specks of calcium that may be found in an area of rapidly dividing cells. Many microcalcifications clustered together may be a sign of cancer. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Capillary: Any one of the minute vessels that connect the arterioles and venules, forming a network in nearly all parts of the body. Their walls act as semipermeable membranes for the interchange of various substances, including fluids, between the blood and tissue fluid; called also vas capillare. [EU] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] 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]

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Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cardiovascular disease: Any abnormal condition characterized by dysfunction of the heart and blood vessels. CVD includes atherosclerosis (especially coronary heart disease, which can lead to heart attacks), cerebrovascular disease (e.g., stroke), and hypertension (high blood pressure). [NIH] 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] Catheter: A flexible tube used to deliver fluids into or withdraw fluids from the body. [NIH] Catheterization: Use or insertion of a tubular device into a duct, blood vessel, hollow organ, or body cavity for injecting or withdrawing fluids for diagnostic or therapeutic purposes. It differs from intubation in that the tube here is used to restore or maintain patency in obstructions. [NIH] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [EU] Cause of Death: Factors which produce cessation of all vital bodily functions. They can be analyzed from an epidemiologic viewpoint. [NIH] Caustic: An escharotic or corrosive agent. Called also cauterant. [EU] CDC2: It is crucial for entry into mitosis of eukaryotic cells. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Death: The termination of the cell's ability to carry out vital functions such as metabolism, growth, reproduction, responsiveness, and adaptability. [NIH] Cell Division: The fission of a cell. [NIH] Cell 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] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Cerebellar: Pertaining to the cerebellum. [EU] 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] Cerebral Cortex: The thin layer of gray matter on the surface of the cerebral hemisphere that develops from the telencephalon and folds into gyri. It reaches its highest development in man and is responsible for intellectual faculties and higher mental functions. [NIH] Cerebrospinal: Pertaining to the brain and spinal cord. [EU] Cerebrospinal fluid: CSF. The fluid flowing around the brain and spinal cord. Cerebrospinal fluid is produced in the ventricles in the brain. [NIH] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH]

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Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH] 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] Chemotherapeutic agent: A drug used to treat cancer. [NIH] Chemotherapy: Treatment with anticancer drugs. [NIH] Chin: The anatomical frontal portion of the mandible, also known as the mentum, that contains the line of fusion of the two separate halves of the mandible (symphysis menti). This line of fusion divides inferiorly to enclose a triangular area called the mental protuberance. On each side, inferior to the second premolar tooth, is the mental foramen for the passage of blood vessels and a nerve. [NIH] Cholangitis: Inflammation of a bile duct. [NIH] Cholecystectomy: Surgical removal of the gallbladder. [NIH] Cholecystitis: Inflammation of the gallbladder. [NIH] Choledocholithiasis: Gallstones in the bile ducts. [NIH] Cholelithiasis: Presence or formation of gallstones. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Choriocarcinoma: A malignant tumor of trophoblastic epithelium characterized by secretion of large amounts of chorionic gonadotropin. It usually originates from chorionic products of conception (i.e., hydatidiform mole, normal pregnancy, or following abortion), but can originate in a teratoma of the testis, mediastinum, or pineal gland. [NIH] Choroid: The thin, highly vascular membrane covering most of the posterior of the eye between the retina and sclera. [NIH] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic 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] Ciliary: Inflammation or infection of the glands of the margins of the eyelids. [NIH] Ciliary Body: A ring of tissue extending from the scleral spur to the ora serrata of the retina. It consists of the uveal portion and the epithelial portion. The ciliary muscle is in the uveal portion and the ciliary processes are in the epithelial portion. [NIH] Ciliary processes: The extensions or projections of the ciliary body that secrete aqueous humor. [NIH] Cirrhosis: A type of chronic, progressive liver disease. [NIH] Clinical Medicine: The study and practice of medicine by direct examination of the patient. [NIH]

Clinical study: A research study in which patients receive treatment in a clinic or other

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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] Cochlea: The part of the internal ear that is concerned with hearing. It forms the anterior part of the labyrinth, is conical, and is placed almost horizontally anterior to the vestibule. [NIH]

Cochlear: Of or pertaining to the cochlea. [EU] Cochlear Diseases: Diseases of the cochlea, the part of the inner ear that is concerned with hearing. [NIH] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] 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] Colloidal: Of the nature of a colloid. [EU] Colon: The long, coiled, tubelike organ that removes water from digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus. [NIH] Colonoscopy: Endoscopic examination, therapy or surgery of the luminal surface of the colon. [NIH] Colorectal: Having to do with the colon or the rectum. [NIH] Colorectal Cancer: Cancer that occurs in the colon (large intestine) or the rectum (the end of the large intestine). A number of digestive diseases may increase a person's risk of colorectal cancer, including polyposis and Zollinger-Ellison Syndrome. [NIH] Colorectal Surgery: A surgical specialty concerned with the diagnosis and treatment of disorders and abnormalities of the colon, rectum, and anal canal. [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

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classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complete remission: The disappearance of all signs of cancer. Also called a complete response. [NIH] Compliance: Distensibility measure of a chamber such as the lungs (lung compliance) or bladder. Compliance is expressed as a change in volume per unit change in pressure. [NIH] Compress: A plug used to occludate an orifice in the control of bleeding, or to mop up secretions; an absorbent pad. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Computed tomography: CT scan. A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized tomography and computerized axial tomography (CAT) scan. [NIH] Computerized tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized axial tomography (CAT) scan and computed tomography (CT scan). [NIH] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU]

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Concretion: Minute, hard, yellow masses found in the palpebral conjunctivae of elderly people or following chronic conjunctivitis, composed of the products of cellular degeneration retained in the depressions and tubular recesses in the conjunctiva. [NIH] Conduction: The transfer of sound waves, heat, nervous impulses, or electricity. [EU] Congestive heart failure: Weakness of the heart muscle that leads to a buildup of fluid in body tissues. [NIH] Conjunctiva: The mucous membrane that lines the inner surface of the eyelids and the anterior part of the sclera. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Constriction: The act of constricting. [NIH] Consumption: Pulmonary tuberculosis. [NIH] Contamination: The soiling or pollution by inferior material, as by the introduction of organisms into a wound, or sewage into a stream. [EU] Continence: The ability to hold in a bowel movement or urine. [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 medium: A substance that is introduced into or around a structure and, because of the difference in absorption of x-rays by the contrast medium and the surrounding tissues, allows radiographic visualization of the structure. [EU] Controlled clinical trial: A clinical study that includes a comparison (control) group. The comparison group receives a placebo, another treatment, or no treatment at all. [NIH] Conventional therapy: A currently accepted and widely used treatment for a certain type of disease, based on the results of past research. Also called conventional treatment. [NIH] Conventional treatment: A currently accepted and widely used treatment for a certain type of disease, based on the results of past research. Also called conventional therapy. [NIH] Cornea: The transparent part of the eye that covers the iris and the pupil and allows light to enter the inside. [NIH] Corneum: The superficial layer of the epidermis containing keratinized cells. [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] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU]

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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] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Craniocerebral Trauma: Traumatic injuries involving the cranium and intracranial structures (i.e., brain; cranial nerves; meninges; and other structures). Injuries may be classified by whether or not the skull is penetrated (i.e., penetrating vs. nonpenetrating) or whether there is an associated hemorrhage. [NIH] Craniotomy: An operation in which an opening is made in the skull. [NIH] Cricoid Cartilage: The small thick cartilage that forms the lower and posterior parts of the laryngeal wall. [NIH] Critical Care: Health care provided to a critically ill patient during a medical emergency or crisis. [NIH] CSF: Cerebrospinal fluid. The fluid flowing around the brain and spinal cord. CSF is produced in the ventricles of the brain. [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] Cyclin: Molecule that regulates the cell cycle. [NIH] Cyst: A sac or capsule filled with fluid. [NIH] Cystitis: Inflammation of the urinary bladder. [EU] Cytokines: Non-antibody proteins secreted by inflammatory leukocytes and some nonleukocytic cells, that act as intercellular mediators. They differ from classical hormones in that they are produced by a number of tissue or cell types rather than by specialized glands. They generally act locally in a paracrine or autocrine rather than endocrine manner. [NIH] Cytostatic: An agent that suppresses cell growth and multiplication. [EU] Cytotoxic: Cell-killing. [NIH] Data Collection: Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data. [NIH] Defecation: The normal process of elimination of fecal material from the rectum. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH] Denaturation: Rupture of the hydrogen bonds by heating a DNA solution and then cooling it rapidly causes the two complementary strands to separate. [NIH]

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Deuterium: Deuterium. The stable isotope of hydrogen. It has one neutron and one proton in the nucleus. [NIH] Developing Countries: Countries in the process of change directed toward economic growth, that is, an increase in production, per capita consumption, and income. The process of economic growth involves better utilization of natural and human resources, which results in a change in the social, political, and economic structures. [NIH] Diabetes Insipidus: A metabolic disorder due to disorders in the production or release of vasopressin. It is characterized by the chronic excretion of large amounts of low specific gravity urine and great thirst. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Dialyzer: A part of the hemodialysis machine. (See hemodialysis under dialysis.) The dialyzer has two sections separated by a membrane. One section holds dialysate. The other holds the patient's blood. [NIH] Diaphragm: The musculofibrous partition that separates the thoracic cavity from the abdominal cavity. Contraction of the diaphragm increases the volume of the thoracic cavity aiding inspiration. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Digestive tract: The organs through which food passes when food is eaten. These organs are the mouth, esophagus, stomach, small and large intestines, and rectum. [NIH] Dihydrotestosterone: Anabolic agent. [NIH] Dilatation: The act of dilating. [NIH] Dilate: Relax; expand. [NIH] Dilation: A process by which the pupil is temporarily enlarged with special eye drops (mydriatic); allows the eye care specialist to better view the inside of the eye. [NIH] Dipyridamole: A drug that prevents blood cell clumping and enhances the effectiveness of fluorouracil and other chemotherapeutic agents. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Discrete: Made up of separate parts or characterized by lesions which do not become blended; not running together; separate. [NIH] Disinfectant: An agent that disinfects; applied particularly to agents used on inanimate objects. [EU] Dislocation: The displacement of any part, more especially of a bone. Called also luxation. [EU]

Dissection: Cutting up of an organism for study. [NIH] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU]

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Diverticula: Plural form of diverticulum. [NIH] Diverticulitis: Inflammation of a diverticulum or diverticula. [NIH] Diverticulum: A pathological condition manifested as a pouch or sac opening from a tubular or sacular organ. [NIH] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Dorsal: 1. Pertaining to the back or to any dorsum. 2. Denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] 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] Dysphagia: Difficulty in swallowing. [EU] Dysplasia: Cells that look abnormal under a microscope but are not cancer. [NIH] Dystrophy: Any disorder arising from defective or faulty nutrition, especially the muscular dystrophies. [EU] Eating Disorders: A group of disorders characterized by physiological and psychological disturbances in appetite or food intake. [NIH] Echocardiography: Ultrasonic recording of the size, motion, and composition of the heart and surrounding tissues. The standard approach is transthoracic. [NIH] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Elasticity: Resistance and recovery from distortion of shape. [NIH] Elastin: The protein that gives flexibility to tissues. [NIH] Elective: Subject to the choice or decision of the patient or physician; applied to procedures that are advantageous to the patient but not urgent. [EU] Electrode: Component of the pacing system which is at the distal end of the lead. It is the interface with living cardiac tissue across which the stimulus is transmitted. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electronystagmography: Recording of nystagmus based on changes in the electrical field surrounding the eye produced by the difference in potential between the cornea and the retina. [NIH] Emaciation: Clinical manifestation of excessive leanness usually caused by disease or a lack of nutrition. [NIH] Embolectomy: Surgical removal of an obstructing clot or foreign material which has been transported from a distant vessel by the bloodstream. Removal of a clot at its original site is called thrombectomy. [NIH] Emboli: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat

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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] Embryology: The study of the development of an organism during the embryonic and fetal stages of life. [NIH] Emulsions: Colloids of two immiscible liquids where either phase may be either fatty or aqueous; lipid-in-water emulsions are usually liquid, like milk or lotion and water-in-lipid emulsions tend to be creams. [NIH] Encephalopathy: A disorder of the brain that can be caused by disease, injury, drugs, or chemicals. [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] Endoscope: A thin, lighted tube used to look at tissues inside the body. [NIH] Endoscopic: A technique where a lateral-view endoscope is passed orally to the duodenum for visualization of the ampulla of Vater. [NIH] Endoscopic retrograde cholangiopancreatography: ERCP. A procedure to x-ray the pancreatic duct, hepatic duct, common bile duct, duodenal papilla, and gallbladder. In this procedure, a thin, lighted tube (endoscope) is passed through the mouth and down into the first part of the small intestine (duodenum). A smaller tube (catheter) is then inserted through the endoscope into the bile and pancreatic ducts. A dye is injected through the catheter into the ducts, and an x-ray is taken. [NIH] Endoscopy: Endoscopic examination, therapy or surgery performed on interior parts of the body. [NIH] Endothelium: A layer of epithelium that lines the heart, blood vessels (endothelium, vascular), lymph vessels (endothelium, lymphatic), and the serous cavities of the body. [NIH] Endothelium, Lymphatic: Unbroken cellular lining (intima) of the lymph vessels (e.g., the high endothelial lymphatic venules). It is more permeable than vascular endothelium, lacking selective absorption and functioning mainly to remove plasma proteins that have filtered through the capillaries into the tissue spaces. [NIH] Endothelium, Vascular: Single pavement layer of cells which line the luminal surface of the entire vascular system and regulate the transport of macromolecules and blood components from interstitium to lumen; this function has been most intensively studied in the blood capillaries. [NIH] Endotoxin: Toxin from cell walls of bacteria. [NIH] 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] Enteral Nutrition: Nutritional support given via the alimentary canal or any route connected to the gastrointestinal system (i.e., the enteral route). This includes oral feeding, sip feeding, and tube feeding using nasogastric, gastrostomy, and jejunostomy tubes. [NIH] Enterostomal Therapy: A nurse who cares for patients with an ostomy. [NIH] Environmental Exposure: The exposure to potentially harmful chemical, physical, or biological agents in the environment or to environmental factors that may include ionizing radiation, pathogenic organisms, or toxic chemicals. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences,

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or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Eosinophils: Granular leukocytes with a nucleus that usually has two lobes connected by a slender thread of chromatin, and cytoplasm containing coarse, round granules that are uniform in size and stainable by eosin. [NIH] Epidermis: Nonvascular layer of the skin. It is made up, from within outward, of five layers: 1) basal layer (stratum basale epidermidis); 2) spinous layer (stratum spinosum epidermidis); 3) granular layer (stratum granulosum epidermidis); 4) clear layer (stratum lucidum epidermidis); and 5) horny layer (stratum corneum epidermidis). [NIH] Epigastric: Having to do with the upper middle area of the abdomen. [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Episiotomy: An incision of the posterior vaginal wall and a portion of the pudenda which enlarges the vaginal introitus to facilitate delivery and prevent lacerations. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] 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] Esophageal Fistula: Abnormal passage communicating with the esophagus. [NIH] Esophageal Motility Disorders: Disorders affecting the motor function of the upper or lower esophageal sphincters, the esophageal body, or a combination of these parts. The failure of the sphincters to maintain a tonic pressure may result in the impeding of the passage of food, regurgitation of food, or reflux of gastric acid into the esophagus. [NIH] Esophageal Perforation: A dilated vessel in the lower end of the esophagus that result from portal hypertension. [NIH] Esophageal Stricture: A narrowing of the esophagus often caused by acid flowing back from the stomach. This condition may require surgery. [NIH] Esophagoscopy: Endoscopic examination, therapy, or surgery of the esophagus. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Essential Tremor: A rhythmic, involuntary, purposeless, oscillating movement resulting from the alternate contraction and relaxation of opposing groups of muscles. [NIH] Ethanol: A clear, colorless liquid rapidly absorbed from the gastrointestinal tract and distributed throughout the body. It has bactericidal activity and is used often as a topical disinfectant. It is widely used as a solvent and preservative in pharmaceutical preparations as well as serving as the primary ingredient in alcoholic beverages. [NIH] Eukaryotic Cells: Cells of the higher organisms, containing a true nucleus bounded by a nuclear membrane. [NIH]

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Evacuation: An emptying, as of the bowels. [EU] Exocrine: Secreting outwardly, via a duct. [EU] External-beam radiation: Radiation therapy that uses a machine to aim high-energy rays at the cancer. Also called external radiation. [NIH] 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] Extravascular: Situated or occurring outside a vessel or the vessels. [EU] Eye Movements: Voluntary or reflex-controlled movements of the eye. [NIH] Facial: Of or pertaining to the face. [EU] Facial Nerve: The 7th cranial nerve. The facial nerve has two parts, the larger motor root which may be called the facial nerve proper, and the smaller intermediate or sensory root. Together they provide efferent innervation to the muscles of facial expression and to the lacrimal and salivary glands, and convey afferent information for taste from the anterior two-thirds of the tongue and for touch from the external ear. [NIH] Faecal: Pertaining to or of the nature of feces. [EU] Failure to Thrive: A condition in which an infant or child's weight gain and growth are far below usual levels for age. [NIH] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]

Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH] Fecal Incontinence: Failure of voluntary control of the anal sphincters, with involuntary passage of feces and flatus. [NIH] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Femoral: Pertaining to the femur, or to the thigh. [EU] Femur: The longest and largest bone of the skeleton, it is situated between the hip and the knee. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibrin: A protein derived from fibrinogen in the presence of thrombin, which forms part of the blood clot. [NIH] Fibrinogen: Plasma glycoprotein clotted by thrombin, composed of a dimer of three nonidentical pairs of polypeptide chains (alpha, beta, gamma) held together by disulfide bonds. Fibrinogen clotting is a sol-gel change involving complex molecular arrangements: whereas fibrinogen is cleaved by thrombin to form polypeptides A and B, the proteolytic action of other enzymes yields different fibrinogen degradation products. [NIH]

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Fibroblasts: Connective tissue cells which secrete an extracellular matrix rich in collagen and other macromolecules. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Fibrotic tissue: Inflamed tissue that has become scarred. [NIH] Filtration: The passage of a liquid through a filter, accomplished by gravity, pressure, or vacuum (suction). [EU] Fistula: Abnormal communication most commonly seen between two internal organs, or between an internal organ and the surface of the body. [NIH] Flatus: Gas passed through the rectum. [NIH] Fluid Therapy: Therapy whose basic objective is to restore the volume and composition of the body fluids to normal with respect to water-electrolyte balance. Fluids may be administered intravenously, orally, by intermittent gavage, or by hypodermoclysis. [NIH] Fluorouracil: A pyrimidine analog that acts as an antineoplastic antimetabolite and also has immunosuppressant. It interferes with DNA synthesis by blocking the thymidylate synthetase conversion of deoxyuridylic acid to thymidylic acid. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Fulminant Hepatic Failure: Liver failure that occurs suddenly in a previously healthy person. The most common causes of FHF are acute hepatitis, acetaminophen overdose, and liver damage from prescription drugs. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gallstones: The solid masses or stones made of cholesterol or bilirubin that form in the gallbladder or bile ducts. [NIH] Gamma Rays: Very powerful and penetrating, high-energy electromagnetic radiation of shorter wavelength than that of x-rays. They are emitted by a decaying nucleus, usually between 0.01 and 10 MeV. They are also called nuclear x-rays. [NIH] Gangrene: Death and putrefaction of tissue usually due to a loss of blood supply. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gastric: Having to do with the stomach. [NIH] Gastric Fistula: Abnormal passage communicating with the stomach. [NIH] Gastric Juices: Liquids produced in the stomach to help break down food and kill bacteria. [NIH]

Gastric Mucosa: Surface epithelium in the stomach that invaginates into the lamina propria, forming gastric pits. Tubular glands, characteristic of each region of the stomach (cardiac, gastric, and pyloric), empty into the gastric pits. The gastric mucosa is made up of several different kinds of cells. [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]

Gastritis: Inflammation of the stomach. [EU] Gastroenterologist: A doctor who specializes in diagnosing and treating disorders of the digestive system. [NIH] Gastroenterology: A subspecialty of internal medicine concerned with the study of the physiology and diseases of the digestive system and related structures (esophagus, liver,

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gallbladder, and pancreas). [NIH] Gastroesophageal Reflux: Reflux of gastric juice and/or duodenal contents (bile acids, pancreatic juice) into the distal esophagus, commonly due to incompetence of the lower esophageal sphincter. Gastric regurgitation is an extension of this process with entry of fluid into the pharynx or mouth. [NIH] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal Hemorrhage: Bleeding in the gastrointestinal tract. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gastrostomy: Creation of an artificial external opening into the stomach for nutritional support or gastrointestinal compression. [NIH] 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]

Generator: Any system incorporating a fixed parent radionuclide from which is produced a daughter radionuclide which is to be removed by elution or by any other method and used in a radiopharmaceutical. [NIH] Genetic Code: The specifications for how information, stored in nucleic acid sequence (base sequence), is translated into protein sequence (amino acid sequence). The start, stop, and order of amino acids of a protein is specified by consecutive triplets of nucleotides called codons (codon). [NIH] Genetic Counseling: Advising families of the risks involved pertaining to birth defects, in order that they may make an informed decision on current or future pregnancies. [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] Genitourinary: Pertaining to the genital and urinary organs; urogenital; urinosexual. [EU] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glanders: A contagious disease of horses that can be transmitted to humans. It is caused by Pseudomonas mallei and characterized by ulceration of the respiratory mucosa and an eruption of nodules on the skin. [NIH] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucose Intolerance: A pathological state in which the fasting plasma glucose level is less than 140 mg per deciliter and the 30-, 60-, or 90-minute plasma glucose concentration following a glucose tolerance test exceeds 200 mg per deciliter. This condition is seen frequently in diabetes mellitus but also occurs with other diseases. [NIH] Glycine: A non-essential amino acid. It is found primarily in gelatin and silk fibroin and used therapeutically as a nutrient. It is also a fast inhibitory neurotransmitter. [NIH] Glycoprotein: A protein that has sugar molecules attached to it. [NIH]

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Fistulas

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] Goniotomy: A surgical procedure for congenital glaucoma in which a sweeping incision is made in the neshwork at the filtration angle by means of a knife-needle inserted through the opposite limbus and carried across the anterior chamber parallel to the iris. [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] Groin: The external junctural region between the lower part of the abdomen and the thigh. [NIH]

Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Growth factors: Substances made by the body that function to regulate cell division and cell survival. Some growth factors are also produced in the laboratory and used in biological therapy. [NIH] Haemodialysis: The removal of certain elements from the blood by virtue of the difference in the rates of their diffusion through a semipermeable membrane, e.g., by means of a haemodialyzer. [EU] Heart attack: A seizure of weak or abnormal functioning of the heart. [NIH] Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, breathlessness, and excess fluid accumulation in body tissues. [NIH] Hematoma: An extravasation of blood localized in an organ, space, or tissue. [NIH] Hematopoiesis: The development and formation of various types of blood cells. [NIH] Hemobilia: Hemorrhage in or through the biliary tract, due to trauma, inflammation, cholelithiasis, vascular disease, or neoplasms. [NIH] Hemochromatosis: A disease that occurs when the body absorbs too much iron. The body stores the excess iron in the liver, pancreas, and other organs. May cause cirrhosis of the liver. Also called iron overload disease. [NIH] Hemodialysis: The use of a machine to clean wastes from the blood after the kidneys have failed. The blood travels through tubes to a dialyzer, which removes wastes and extra fluid. The cleaned blood then flows through another set of tubes back into the body. [NIH] Hemofiltration: Extracorporeal ultrafiltration technique without hemodialysis for treatment of fluid overload and electrolyte disturbances affecting renal, cardiac, or pulmonary function. [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

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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] Hemoglobinuria: The presence of free hemoglobin in the urine. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemorrhagic stroke: A disorder involving bleeding within ischemic brain tissue. Hemorrhagic stroke occurs when blood vessels that are damaged or dead from lack of blood supply (infarcted), located within an area of infarcted brain tissue, rupture and transform an "ischemic" stroke into a hemorrhagic stroke. Ischemia is inadequate tissue oxygenation caused by reduced blood flow; infarction is tissue death resulting from ischemia. Bleeding irritates the brain tissues, causing swelling (cerebral edema). Blood collects into a mass (hematoma). Both swelling and hematoma will compress and displace brain tissue. [NIH] Hemorrhoid: An enlarged or swollen blood vessel, usually located near the anus or the rectum. [NIH] Hepatic: Refers to the liver. [NIH] Hepatic Duct, Common: Predominantly extrahepatic bile duct which is formed by the junction of the right and left hepatic ducts, which are predominantly intrahepatic, and, in turn, joins the cystic duct to form the common bile duct. [NIH] Hepatic Encephalopathy: A condition that may cause loss of consciousness and coma. It is usually the result of advanced liver disease. Also called hepatic coma. [NIH] Hepatitis: Inflammation of the liver and liver disease involving degenerative or necrotic alterations of hepatocytes. [NIH] Hepatocellular: Pertaining to or affecting liver cells. [EU] Hepatocellular carcinoma: A type of adenocarcinoma, the most common type of liver tumor. [NIH] Hepatocytes: The main structural component of the liver. They are specialized epithelial cells that are organized into interconnected plates called lobules. [NIH] Hereditary: Of, relating to, or denoting factors that can be transmitted genetically from one generation to another. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] 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]

Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hormone Replacement Therapy: Therapeutic use of hormones to alleviate the effects of hormone deficiency. [NIH] Horny layer: The superficial layer of the epidermis containing keratinized cells. [NIH] Hospital Charges: The prices a hospital sets for its services. Hospital costs (the direct and indirect expenses incurred by the hospital in providing the services) are one factor in the determination of hospital charges. Other factors may include, for example, profits, competition, and the necessity of recouping the costs of uncompensated care. [NIH]

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Fistulas

Hospital Costs: The expenses incurred by a hospital in providing care. The hospital costs attributed to a particular patient care episode include the direct costs plus an appropriate proportion of the overhead for administration, personnel, building maintenance, equipment, etc. Hospital costs are one of the factors which determine hospital charges (the price the hospital sets for its services). [NIH] Host: Any animal that receives a transplanted graft. [NIH] Human Genome Project: A coordinated effort of researchers to map and sequence the human genome. [NIH] Hydatidiform Mole: A trophoblastic disease characterized by hydrops of the mesenchymal portion of the villus. Its karyotype is paternal and usually homozygotic. The tumor is indistinguishable from chorioadenoma destruens or invasive mole ( = hydatidiform mole, invasive) except by karyotype. There is no apparent relation by karyotype to choriocarcinoma. Hydatidiform refers to the presence of the hydropic state of some or all of the villi (Greek hydatis, a drop of water). [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrogen Peroxide: A strong oxidizing agent used in aqueous solution as a ripening agent, bleach, and topical anti-infective. It is relatively unstable and solutions deteriorate over time unless stabilized by the addition of acetanilide or similar organic materials. [NIH] 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] Hyperbilirubinemia: Pathologic process consisting of an abnormal increase in the amount of bilirubin in the circulating blood, which may result in jaundice. [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] 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] Hypospadias: A developmental anomaly in the male in which the urethra opens on the underside of the penis or on the perineum. [NIH] Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH] Hysterectomy: Excision of the uterus. [NIH] 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] Idiopathic: Describes a disease of unknown cause. [NIH]

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Ileal: Related to the ileum, the lowest end of the small intestine. [NIH] Ileum: The lower end of the small intestine. [NIH] Ileus: Obstruction of the intestines. [EU] Illusion: A false interpretation of a genuine percept. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunity: Nonsusceptibility to the invasive or pathogenic microorganisms or to the toxic effect of antigenic substances. [NIH]

effects

of

foreign

Immunization: Deliberate stimulation of the host's immune response. Active immunization involves administration of antigens or immunologic adjuvants. Passive immunization involves administration of immune sera or lymphocytes or their extracts (e.g., transfer factor, immune RNA) or transplantation of immunocompetent cell producing tissue (thymus or bone marrow). [NIH] Immunodeficiency: The decreased ability of the body to fight infection and disease. [NIH] Immunogenic: Producing immunity; evoking an immune response. [EU] Immunoglobulin: A protein that acts as an antibody. [NIH] Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Immunology: The study of the body's immune system. [NIH] Immunosuppressant: An agent capable of suppressing immune responses. [EU] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Implant radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called [NIH] Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU] In situ: In the natural or normal place; confined to the site of origin without invasion of neighbouring tissues. [EU] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incision: A cut made in the body during surgery. [NIH] Incisive: 1. Having the power or quality of cutting. 2. Pertaining to the incisor teeth. [EU] Incisor: Anything adapted for cutting; any one of the four front teeth in each jaw. [NIH] Incompetence: Physical or mental inadequacy or insufficiency. [EU] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [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]

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

Inferior vena cava: A large vein that empties into the heart. It carries blood from the legs and feet, and from organs in the abdomen and pelvis. [NIH] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Inflammatory bowel disease: A general term that refers to the inflammation of the colon and rectum. Inflammatory bowel disease includes ulcerative colitis and Crohn's disease. [NIH]

Ingestion: Taking into the body by mouth [NIH] Inguinal: Pertaining to the inguen, or groin. [EU] Inguinal Hernia: A small part of the large or small intestine or bladder that pushes into the groin. May cause pain and feelings of pressure or burning in the groin. Often requires surgery. [NIH] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH] Inlay: In dentistry, a filling first made to correspond with the form of a dental cavity and then cemented into the cavity. [NIH] Inner ear: The labyrinth, comprising the vestibule, cochlea, and semicircular canals. [NIH] 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] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Internal Medicine: A medical specialty concerned with the diagnosis and treatment of diseases of the internal organ systems of adults. [NIH] Internal radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called brachytherapy, implant radiation, or interstitial radiation therapy. [NIH] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intestinal: Having to do with the intestines. [NIH] Intestinal Fistula: Abnormal passage communicating 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] Intracranial Aneurysm: A saclike dilatation of the walls of a blood vessel, usually an artery. [NIH]

Intracranial Hypertension: Increased pressure within the cranial vault. This may result from several conditions, including hydrocephalus; brain edema; intracranial masses; severe

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systemic hypertension; pseudotumor cerebri; and other disorders. [NIH] Intramuscular: IM. Within or into muscle. [NIH] Intraocular: Within the eye. [EU] Intraocular pressure: Pressure of the fluid inside the eye; normal IOP varies among individuals. [NIH] Intravascular: Within a vessel or vessels. [EU] Intravenous: IV. Into a vein. [NIH] Intubation: Introduction of a tube into a hollow organ to restore or maintain patency if obstructed. It is differentiated from catheterization in that the insertion of a catheter is usually performed for the introducing or withdrawing of fluids from the body. [NIH] Intussusception: A rare disorder. A part of the intestines folds into another part of the intestines, causing blockage. Most common in infants. Can be treated with an operation. [NIH]

Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

Involuntary: Reaction occurring without intention or volition. [NIH] Ionizing: Radiation comprising charged particles, e. g. electrons, protons, alpha-particles, etc., having sufficient kinetic energy to produce ionization by collision. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Iris: The most anterior portion of the uveal layer, separating the anterior chamber from the posterior. It consists of two layers - the stroma and the pigmented epithelium. Color of the iris depends on the amount of melanin in the stroma on reflection from the pigmented epithelium. [NIH] Irradiation: The use of high-energy radiation from x-rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy) or from materials called radioisotopes. Radioisotopes produce radiation and can be placed in or near the tumor or in the area near cancer cells. This type of radiation treatment is called internal radiation therapy, implant radiation, interstitial radiation, or brachytherapy. Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Irradiation is also called radiation therapy, radiotherapy, and x-ray therapy. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Islet: Cell producing insulin in pancreas. [NIH] Jaundice: A clinical manifestation of hyperbilirubinemia, consisting of deposition of bile pigments in the skin, resulting in a yellowish staining of the skin and mucous membranes. [NIH]

Jejunostomy: Surgical formation of an opening through the abdominal wall into the jejunum, usually for enteral hyperalimentation. [NIH] Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH]

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Kidney Disease: Any one of several chronic conditions that are caused by damage to the cells of the kidney. People who have had diabetes for a long time may have kidney damage. Also called nephropathy. [NIH] Kidney Pelvis: The flattened, funnel-shaped expansion connecting the ureter to the kidney calices. [NIH] Labyrinth: The internal ear; the essential part of the organ of hearing. It consists of an osseous and a membranous portion. [NIH] Labyrinthine: A vestibular nystagmus resulting from stimulation, injury, or disease of the labyrinth. [NIH] Laceration: 1. The act of tearing. 2. A torn, ragged, mangled wound. [EU] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Larynx: An irregularly shaped, musculocartilaginous tubular structure, lined with mucous membrane, located at the top of the trachea and below the root of the tongue and the hyoid bone. It is the essential sphincter guarding the entrance into the trachea and functioning secondarily as the organ of voice. [NIH] Laser Surgery: The use of a laser either to vaporize surface lesions or to make bloodless cuts in tissue. It does not include the coagulation of tissue by laser. [NIH] Lavage: A cleaning of the stomach and colon. Uses a special drink and enemas. [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] Leukemia: Cancer of blood-forming tissue. [NIH] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] 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] Light microscope: A microscope (device to magnify small objects) in which objects are lit directly by white light. [NIH] Linkage: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Lip: Either of the two fleshy, full-blooded margins of the mouth. [NIH] Lipid: Fat. [NIH] Liposomes: Artificial, single or multilaminar vesicles (made from lecithins or other lipids) that are used for the delivery of a variety of biological molecules or molecular complexes to cells, for example, drug delivery and gene transfer. They are also used to study membranes and membrane proteins. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Liver scan: An image of the liver created on a computer screen or on film. A radioactive substance is injected into a blood vessel and travels through the bloodstream. It collects in

Dictionary 163

the liver, especially in abnormal areas, and can be detected by the scanner. [NIH] Liver Transplantation: The transference of a part of or an entire liver from one human or animal to another. [NIH] Lobe: A portion of an organ such as the liver, lung, breast, or brain. [NIH] Lobectomy: The removal of a lobe. [NIH] 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] Lower Esophageal Sphincter: The muscle between the esophagus and stomach. When a person swallows, this muscle relaxes to let food pass from the esophagus to the stomach. It stays closed at other times to keep stomach contents from flowing back into the esophagus. [NIH]

Lumen: The cavity or channel within a tube or tubular organ. [EU] Luxation: The displacement of the particular surface of a bone from its normal joint, without fracture. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]

Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphatic system: The tissues and organs that produce, store, and carry white blood cells that fight infection and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes and a network of thin tubes that carry lymph and white blood cells. These tubes branch, like blood vessels, into all the tissues of the body. [NIH] Lymphocyte: A white blood cell. Lymphocytes have a number of roles in the immune system, including the production of antibodies and other substances that fight infection and diseases. [NIH] Lymphocyte Count: A count of the number of lymphocytes in the blood. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Lymphoma: A general term for various neoplastic diseases of the lymphoid tissue. [NIH] Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. [NIH] Maintenance therapy: Treatment that is given to help a primary (original) treatment keep working. Maintenance therapy is often given to help keep cancer in remission. [NIH] Malabsorption: Impaired intestinal absorption of nutrients. [EU] Malabsorption syndrome: A group of symptoms such as gas, bloating, abdominal pain, and diarrhea resulting from the body's inability to properly absorb nutrients. [NIH] Malformation:

A

morphologic

defect

resulting

from

an

intrinsically

abnormal

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developmental process. [EU] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malignant tumor: A tumor capable of metastasizing. [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] Manifest: Being the part or aspect of a phenomenon that is directly observable : concretely expressed in behaviour. [EU] Maxillary: Pertaining to the maxilla : the irregularly shaped bone that with its fellow forms the upper jaw. [EU] Maxillary Sinus: One of the paired paranasal sinuses, located in the body of the maxilla, communicating with the middle meatus of the nasal cavity. [NIH] Medial: Lying near the midsaggital plane of the body; opposed to lateral. [NIH] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Melanocytes: Epidermal dendritic pigment cells which control long-term morphological color changes by alteration in their number or in the amount of pigment they produce and store in the pigment containing organelles called melanosomes. Melanophores are larger cells which do not exist in mammals. [NIH] Melanoma: A form of skin cancer that arises in melanocytes, the cells that produce pigment. Melanoma usually begins in a mole. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Membrane Proteins: Proteins which are found in membranes including cellular and intracellular membranes. They consist of two types, peripheral and integral proteins. They include most membrane-associated enzymes, antigenic proteins, transport proteins, and drug, hormone, and lectin receptors. [NIH] Menopause: Permanent cessation of menstruation. [NIH] Menstruation: The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] 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] Mercaptopurine: An anticancer drug that belongs to the family of drugs called antimetabolites. [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] Methotrexate: An antineoplastic antimetabolite with immunosuppressant properties. It is an inhibitor of dihydrofolate reductase and prevents the formation of tetrahydrofolate, necessary for synthesis of thymidylate, an essential component of DNA. [NIH]

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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] Microsurgery: Surgical procedures on the cellular level; a light microscope and miniaturized instruments are used. [NIH] Migration: The systematic movement of genes between populations of the same species, geographic race, or variety. [NIH] Mitomycin: An antineoplastic antibiotic produced by Streptomyces caespitosus. It acts as a bi- or trifunctional alkylating agent causing cross-linking of DNA and inhibition of DNA synthesis. [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] Modeling: A treatment procedure whereby the therapist presents the target behavior which the learner is to imitate and make part of his repertoire. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monoclonal: An antibody produced by culturing a single type of cell. It therefore consists of a single species of immunoglobulin molecules. [NIH] Monocytes: Large, phagocytic mononuclear leukocytes produced in the vertebrate bone marrow and released into the blood; contain a large, oval or somewhat indented nucleus surrounded by voluminous cytoplasm and numerous organelles. [NIH] Mononuclear: A cell with one nucleus. [NIH] Motility: The ability to move spontaneously. [EU] Mucins: A secretion containing mucopolysaccharides and protein that is the chief constituent of mucus. [NIH] Mucosa: A mucous membrane, or tunica mucosa. [EU] Mucus: The viscous secretion of mucous membranes. It contains mucin, white blood cells, water, inorganic salts, and exfoliated cells. [NIH] Muscle Fibers: Large single cells, either cylindrical or prismatic in shape, that form the basic unit of muscle tissue. They consist of a soft contractile substance enclosed in a tubular sheath. [NIH] Muscular Atrophy: Derangement in size and number of muscle fibers occurring with aging, reduction in blood supply, or following immobilization, prolonged weightlessness, malnutrition, and particularly in denervation. [NIH]

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Muscular Dystrophies: A general term for a group of inherited disorders which are characterized by progressive degeneration of skeletal muscles. [NIH] Mydriatic: 1. Dilating the pupil. 2. Any drug that dilates the pupil. [EU] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Myotonic Dystrophy: A condition presenting muscle weakness and wasting which may be progressive. [NIH] Nasogastric: The process of passing a small, flexible plastic tube through the nose or mouth into the stomach or small intestine. [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] 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] Neodymium: Neodymium. An element of the rare earth family of metals. It has the atomic symbol Nd, atomic number 60, and atomic weight 144.24, and is used in industrial applications. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Neoplasia: Abnormal and uncontrolled cell growth. [NIH] Neoplasms: New abnormal growth of tissue. Malignant neoplasms show a greater degree of anaplasia and have the properties of invasion and metastasis, compared to benign neoplasms. [NIH] Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU] Nephrology: A subspecialty of internal medicine concerned with the anatomy, physiology, and pathology of the kidney. [NIH] Nephropathy: Disease of the kidneys. [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] Neurologic: Having to do with nerves or the nervous system. [NIH] Neuropathy: A problem in any part of the nervous system except the brain and spinal cord. Neuropathies can be caused by infection, toxic substances, or disease. [NIH] Neurosurgery: A surgical specialty concerned with the treatment of diseases and disorders of the brain, spinal cord, and peripheral and sympathetic nervous system. [NIH] Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light

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hydrogen; the mass is equal to that of the proton and electron combined and they are unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal, and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier nuclei during their decay. [NIH] Neutrophils: Granular leukocytes having a nucleus with three to five lobes connected by slender threads of chromatin, and cytoplasm containing fine inconspicuous granules and stainable by neutral dyes. [NIH] 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] Nosocomial: Pertaining to or originating in the hospital, said of an infection not present or incubating prior to admittance to the hospital, but generally occurring 72 hours after admittance; the term is usually used to refer to patient disease, but hospital personnel may also acquire nosocomial infection. [EU] 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] Nursing Care: Care given to patients by nursing service personnel. [NIH] Nutritional Support: The administration of nutrients for assimilation and utilization by a patient by means other than normal eating. It does not include fluid therapy which normalizes body fluids to restore water-electrolyte balance. [NIH] Nystagmus: Rhythmical oscillation of the eyeballs, either pendular or jerky. [NIH] Ocular: 1. Of, pertaining to, or affecting the eye. 2. Eyepiece. [EU] Oncogene: A gene that normally directs cell growth. If altered, an oncogene can promote or allow the uncontrolled growth of cancer. Alterations can be inherited or caused by an environmental exposure to carcinogens. [NIH] Ophthalmic: Pertaining to the eye. [EU] Ophthalmology: A surgical specialty concerned with the structure and function of the eye and the medical and surgical treatment of its defects and diseases. [NIH] Opportunistic Infections: An infection caused by an organism which becomes pathogenic under certain conditions, e.g., during immunosuppression. [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]

Optic Nerve: The 2nd cranial nerve. The optic nerve conveys visual information from the retina to the brain. The nerve carries the axons of the retinal ganglion cells which sort at the optic chiasm and continue via the optic tracts to the brain. The largest projection is to the lateral geniculate nuclei; other important targets include the superior colliculi and the suprachiasmatic nuclei. Though known as the second cranial nerve, it is considered part of the central nervous system. [NIH] Optic nerve head: The circular area (disc) where the optic nerve connects to the retina. [NIH]

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Orbit: One of the two cavities in the skull which contains an eyeball. Each eye is located in a bony socket or orbit. [NIH] Orbital: Pertaining to the orbit (= the bony cavity that contains the eyeball). [EU] Oroantral Fistula: A fistula between the maxillary sinus and the oral cavity. [NIH] Osmotic: Pertaining to or of the nature of osmosis (= the passage of pure solvent from a solution of lesser to one of greater solute concentration when the two solutions are separated by a membrane which selectively prevents the passage of solute molecules, but is permeable to the solvent). [EU] Ostomy: Surgical construction of an artificial opening (stoma) for external fistulization of a duct or vessel by insertion of a tube with or without a supportive stent. [NIH] Otolith: A complex calcareous concretion in the inner ear which controls man's sense of balance and reactions to acceleration. [NIH] Ovary: Either of the paired glands in the female that produce the female germ cells and secrete some of the female sex hormones. [NIH] Overdose: An accidental or deliberate dose of a medication or street drug that is in excess of what is normally used. [NIH] Oxygenation: The process of supplying, treating, or mixing with oxygen. No:1245 oxygenation the process of supplying, treating, or mixing with oxygen. [EU] Palate: The structure that forms the roof of the mouth. It consists of the anterior hard palate and the posterior soft palate. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Pancreatic: Having to do with the pancreas. [NIH] Pancreatic cancer: Cancer of the pancreas, a salivary gland of the abdomen. [NIH] Pancreatic Ducts: Ducts that collect pancreatic juice from the pancreas and supply it to the duodenum. [NIH] Pancreatic Fistula: Abnormal passage communicating with the pancreas. [NIH] Pancreatic Juice: The fluid containing digestive enzymes secreted by the pancreas in response to food in the duodenum. [NIH] Pancreatitis: Acute or chronic inflammation of the pancreas, which may be asymptomatic or symptomatic, and which is due to autodigestion of a pancreatic tissue by its own enzymes. It is caused most often by alcoholism or biliary tract disease; less commonly it may be associated with hyperlipaemia, hyperparathyroidism, abdominal trauma (accidental or operative injury), vasculitis, or uraemia. [EU] Papilla: A small nipple-shaped elevation. [NIH] Paralysis: Loss of ability to move all or part of the body. [NIH] Parasite: An animal or a plant that lives on or in an organism of another species and gets at least some of its nutrition from that other organism. [NIH] Parasitic: Having to do with or being a parasite. A parasite is an animal or a plant that lives on or in an organism of another species and gets at least some of its nutrients from it. [NIH] Parasitic Diseases: Infections or infestations with parasitic organisms. They are often contracted through contact with an intermediate vector, but may occur as the result of direct

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exposure. [NIH] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Parenteral Nutrition: The administering of nutrients for assimilation and utilization by a patient who cannot maintain adequate nutrition by enteral feeding alone. Nutrients are administered by a route other than the alimentary canal (e.g., intravenously, subcutaneously). [NIH] Parietal: 1. Of or pertaining to the walls of a cavity. 2. Pertaining to or located near the parietal bone, as the parietal lobe. [EU] Parotid: The space that contains the parotid gland, the facial nerve, the external carotid artery, and the retromandibular vein. [NIH] Paroxysmal: Recurring in paroxysms (= spasms or seizures). [EU] Partial remission: The shrinking, but not complete disappearance, of a tumor in response to therapy. Also called partial response. [NIH] Parturition: The act or process of given birth to a child. [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] Pathologies: The study of abnormality, especially the study of diseases. [NIH] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Patient Care Management: Generating, planning, organizing, and administering medical and nursing care and services for patients. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Pediatrics: A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence. [NIH] Pelvic: Pertaining to the pelvis. [EU] Pelvis: The lower part of the abdomen, located between the hip bones. [NIH] Penis: The external reproductive organ of males. It is composed of a mass of erectile tissue enclosed in three cylindrical fibrous compartments. Two of the three compartments, the corpus cavernosa, are placed side-by-side along the upper part of the organ. The third compartment below, the corpus spongiosum, houses the urethra. [NIH] Pepsin: An enzyme made in the stomach that breaks down proteins. [NIH] Pepsin A: Formed from pig pepsinogen by cleavage of one peptide bond. The enzyme is a single polypeptide chain and is inhibited by methyl 2-diaazoacetamidohexanoate. It cleaves peptides preferentially at the carbonyl linkages of phenylalanine or leucine and acts as the principal digestive enzyme of gastric juice. [NIH] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Peptic Ulcer: Ulcer that occurs in those portions of the alimentary tract which come into contact with gastric juice containing pepsin and acid. It occurs when the amount of acid and pepsin is sufficient to overcome the gastric mucosal barrier. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of

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proteins. Peptides are combined to make proteins. [NIH] Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] Perforation: 1. The act of boring or piercing through a part. 2. A hole made through a part or substance. [EU] Perfusion: Bathing an organ or tissue with a fluid. In regional perfusion, a specific area of the body (usually an arm or a leg) receives high doses of anticancer drugs through a blood vessel. Such a procedure is performed to treat cancer that has not spread. [NIH] Perianal: Located around the anus. [EU] Perilymph: The fluid contained within the space separating the membranous from the osseous labyrinth of the ear. [NIH] Perineal: Pertaining to the perineum. [EU] Perineum: The area between the anus and the sex organs. [NIH] Peripheral Nervous System: The nervous system outside of the brain and spinal cord. The peripheral nervous system has autonomic and somatic divisions. The autonomic nervous system includes the enteric, parasympathetic, and sympathetic subdivisions. The somatic nervous system includes the cranial and spinal nerves and their ganglia and the peripheral sensory receptors. [NIH] Peripheral vision: Side vision; ability to see objects and movement outside of the direct line of vision. [NIH] Peritoneal: Having to do with the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH] Peritoneal Cavity: The space enclosed by the peritoneum. It is divided into two portions, the greater sac and the lesser sac or omental bursa, which lies behind the stomach. The two sacs are connected by the foramen of Winslow, or epiploic foramen. [NIH] Peritoneal Dialysis: Dialysis fluid being introduced into and removed from the peritoneal cavity as either a continuous or an intermittent procedure. [NIH] Peritoneum: Endothelial lining of the abdominal cavity, the parietal peritoneum covering the inside of the abdominal wall and the visceral peritoneum covering the bowel, the mesentery, and certain of the organs. The portion that covers the bowel becomes the serosal layer of the bowel wall. [NIH] Peritonitis: Inflammation of the peritoneum; a condition marked by exudations in the peritoneum of serum, fibrin, cells, and pus. It is attended by abdominal pain and tenderness, constipation, vomiting, and moderate fever. [EU] 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] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Pharynx: The hollow tube about 5 inches long that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes to the stomach). [NIH] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine

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(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] Photodynamic therapy: Treatment with drugs that become active when exposed to light. These drugs kill cancer cells. [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physical Therapy: The restoration of function and the prevention of disability following disease or injury with the use of light, heat, cold, water, electricity, ultrasound, and exercise. [NIH]

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

Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pilonidal Sinus: A hair-containing cyst or sinus, occurring chiefly in the coccygeal region. [NIH]

Pineal gland: A tiny organ located in the cerebrum that produces melatonin. Also called pineal body or pineal organ. [NIH] Pituitary Gland: A small, unpaired gland situated in the sella turcica tissue. It is connected to the hypothalamus by a short stalk. [NIH] Planets: Heavenly bodies with their own motion among the stars, revolving, in the case of the solar system, around the sun, along the plane of the ecliptic. They are grouped into inner planets and outer planets, based on distance from the sun and common characteristics. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plaque: A clear zone in a bacterial culture grown on an agar plate caused by localized destruction of bacterial cells by a bacteriophage. The concentration of infective virus in a fluid can be estimated by applying the fluid to a culture and counting the number of. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma cells: A type of white blood cell that produces antibodies. [NIH] Plasma protein: One of the hundreds of different proteins present in blood plasma, including carrier proteins ( such albumin, transferrin, and haptoglobin), fibrinogen and other coagulation factors, complement components, immunoglobulins, enzyme inhibitors, precursors of substances such as angiotension and bradykinin, and many other types of proteins. [EU] Platelets: A type of blood cell that helps prevent bleeding by causing blood clots to form. Also called thrombocytes. [NIH] Platinum: Platinum. A heavy, soft, whitish metal, resembling tin, atomic number 78, atomic weight 195.09, symbol Pt. (From Dorland, 28th ed) It is used in manufacturing equipment for laboratory and industrial use. It occurs as a black powder (platinum black) and as a spongy substance (spongy platinum) and may have been known in Pliny's time as "alutiae". [NIH]

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Pleura: The thin serous membrane enveloping the lungs and lining the thoracic cavity. [NIH] Pleural: A circumscribed area of hyaline whorled fibrous tissue which appears on the surface of the parietal pleura, on the fibrous part of the diaphragm or on the pleura in the interlobar fissures. [NIH] Pneumonectomy: An operation to remove an entire lung. [NIH] Pneumonia: Inflammation of the lungs. [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] Polydipsia: Chronic excessive thirst, as in diabetes mellitus or diabetes insipidus. [EU] Polyposis: The development of numerous polyps (growths that protrude from a mucous membrane). [NIH] Polytetrafluoroethylene: Homopolymer of tetrafluoroethylene. Nonflammable, tough, inert plastic tubing or sheeting; used to line vessels, insulate, protect or lubricate apparatus; also as filter, coating for surgical implants or as prosthetic material. Synonyms: Fluoroflex; Fluoroplast; Ftoroplast; Halon; Polyfene; PTFE; Tetron. [NIH] Porosity: Condition of having pores or open spaces. This often refers to bones, bone implants, or bone cements, but can refer to the porous state of any solid substance. [NIH] Portal Hypertension: High blood pressure in the portal vein. This vein carries blood into the liver. Portal hypertension is caused by a blood clot. This is a common complication of cirrhosis. [NIH] Portal Vein: A short thick vein formed by union of the superior mesenteric vein and the splenic vein. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postoperative: After surgery. [NIH] Post-traumatic: Occurring as a result of or after injury. [EU] Postural: Pertaining to posture or position. [EU] Practicability: A non-standard characteristic of an analytical procedure. It is dependent on the scope of the method and is determined by requirements such as sample throughout and costs. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Preoperative: Preceding an operation. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Primary Biliary Cirrhosis: A chronic liver disease. Slowly destroys the bile ducts in the

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liver. This prevents release of bile. Long-term irritation of the liver may cause scarring and cirrhosis in later stages of the disease. [NIH] Primary Prevention: Prevention of disease or mental disorders in susceptible individuals or populations through promotion of health, including mental health, and specific protection, as in immunization, as distinguished from the prevention of complications or after-effects of existing disease. [NIH] Primary Sclerosing Cholangitis: Irritation, scarring, and narrowing of the bile ducts inside and outside the liver. Bile builds up in the liver and may damage its cells. Many people with this condition also have ulcerative colitis. [NIH] 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] Proctocolectomy: An operation to remove the colon and rectum. Also called coloproctectomy. [NIH] Prognostic factor: A situation or condition, or a characteristic of a patient, that can be used to estimate the chance of recovery from a disease, or the chance of the disease recurring (coming back). [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Projection: A defense mechanism, operating unconsciously, whereby that which is emotionally unacceptable in the self is rejected and attributed (projected) to others. [NIH] Prolapse: The protrusion of an organ or part of an organ into a natural or artificial orifice. [NIH]

Proliferating Cell Nuclear Antigen: Nuclear antigen with a role in DNA synthesis, DNA repair, and cell cycle progression. PCNA is required for the coordinated synthesis of both leading and lagging strands at the replication fork during DNA replication. PCNA expression correlates with the proliferation activity of several malignant and non-malignant cell types. [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] Prone: Having the front portion of the body downwards. [NIH] Prostaglandin: Any of a group of components derived from unsaturated 20-carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway that are extremely potent mediators of a diverse group of physiologic processes. The abbreviation for prostaglandin is PG; specific compounds are designated by adding one of the letters A through I to indicate the type of substituents found on the hydrocarbon skeleton and a subscript (1, 2 or 3) to indicate the number of double bonds in the hydrocarbon skeleton e.g., PGE2. The predominant naturally occurring prostaglandins all have two double bonds and are synthesized from arachidonic acid (5,8,11,14-eicosatetraenoic acid) by the pathway shown in the illustration. The 1 series and 3 series are produced by the same pathway with fatty acids having one fewer double bond (8,11,14-eicosatrienoic acid or one more double bond (5,8,11,14,17-eicosapentaenoic acid) than arachidonic acid. The subscript a or ß indicates the configuration at C-9 (a denotes a substituent below the plane of the ring, ß, above the plane). The naturally occurring PGF's have the a configuration, e.g., PGF2a. All of the prostaglandins act by binding to specific cell-surface receptors causing an increase in the level of the intracellular second messenger cyclic AMP (and in some cases cyclic GMP also). The effect produced by the cyclic AMP increase depends on the specific cell type. In some

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cases there is also a positive feedback effect. Increased cyclic AMP increases prostaglandin synthesis leading to further increases in cyclic AMP. [EU] Prostaglandins A: (13E,15S)-15-Hydroxy-9-oxoprosta-10,13-dien-1-oic acid (PGA(1)); (5Z,13E,15S)-15-hydroxy-9-oxoprosta-5,10,13-trien-1-oic acid (PGA(2)); (5Z,13E,15S,17Z)-15hydroxy-9-oxoprosta-5,10,13,17-tetraen-1-oic acid (PGA(3)). A group of naturally occurring secondary prostaglandins derived from PGE. PGA(1) and PGA(2) as well as their 19hydroxy derivatives are found in many organs and tissues. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Prosthesis: An artificial replacement of a part of the body. [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 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] Protein Subunits: Single chains of amino acids that are the units of a multimeric protein. They can be identical or non-identical subunits. [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] Prothrombin: A plasma protein that is the inactive precursor of thrombin. It is converted to thrombin by a prothrombin activator complex consisting of factor Xa, factor V, phospholipid, and calcium ions. Deficiency of prothrombin leads to hypoprothrombinemia. [NIH]

Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Pseudocysts: A collection of enzyme-rich pancreatic fluid and tissue debris arising within areas of necrosis or an obstructed smaller duct. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulmonary hypertension: Abnormally high blood pressure in the arteries of the lungs. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]

Pupil: The aperture in the iris through which light passes. [NIH] Putrefaction: The process of decomposition of animal and vegetable matter by living organisms. [NIH] Quality of Life: A generic concept reflecting concern with the modification and

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enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radiation therapy: The use of high-energy radiation from x-rays, gamma rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body in the area near cancer cells (internal radiation therapy, implant radiation, or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy. [NIH] Radioactive: Giving off radiation. [NIH] Radioimmunotherapy: Radiotherapy where cytotoxic radionuclides are linked to antibodies in order to deliver toxins directly to tumor targets. Therapy with targeted radiation rather than antibody-targeted toxins (immunotoxins) has the advantage that adjacent tumor cells, which lack the appropriate antigenic determinants, can be destroyed by radiation cross-fire. Radioimmunotherapy is sometimes called targeted radiotherapy, but this latter term can also refer to radionuclides linked to non-immune molecules (radiotherapy). [NIH] Radiolabeled: Any compound that has been joined with a radioactive substance. [NIH] Radiological: Pertaining to radiodiagnostic and radiotherapeutic procedures, and interventional radiology or other planning and guiding medical radiology. [NIH] Radiologist: A doctor who specializes in creating and interpreting pictures of areas inside the body. The pictures are produced with x-rays, sound waves, or other types of energy. [NIH]

Radiology: A specialty concerned with the use of x-ray and other forms of radiant energy in the diagnosis and treatment of disease. [NIH] Radiopharmaceutical: Any medicinal product which, when ready for use, contains one or more radionuclides (radioactive isotopes) included for a medicinal purpose. [NIH] Radiotherapy: The use of ionizing radiation to treat malignant neoplasms and other benign conditions. The most common forms of ionizing radiation used as therapy are x-rays, gamma rays, and electrons. A special form of radiotherapy, targeted radiotherapy, links a cytotoxic radionuclide to a molecule that targets the tumor. When this molecule is an antibody or other immunologic molecule, the technique is called radioimmunotherapy. [NIH] Radius: The lateral bone of the forearm. [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 influence allocation. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects

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are assigned by chance to separate groups that compare different treatments. [NIH] Rectal: By or having to do with the rectum. The rectum is the last 8 to 10 inches of the large intestine and ends at the anus. [NIH] Rectal Fistula: Abnormal passage communicating with the rectum. [NIH] Rectal Prolapse: Protrusion of the rectal mucous membrane through the anus. There are various degrees: incomplete with no displacement of the anal sphincter muscle; complete with displacement of the anal sphincter muscle; complete with no displacement of the anal sphincter muscle but with herniation of the bowel; and internal complete with rectosigmoid or upper rectum intussusception into the lower rectum. [NIH] 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] Red Nucleus: A pinkish-yellow portion of the midbrain situated in the rostral mesencephalic tegmentum. It receives a large projection from the contralateral half of the cerebellum via the superior cerebellar peduncle and a projection from the ipsilateral motor cortex. [NIH] Reductase: Enzyme converting testosterone to dihydrotestosterone. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reflex: An involuntary movement or exercise of function in a part, excited in response to a stimulus applied to the periphery and transmitted to the brain or spinal cord. [NIH] Reflux: The term used when liquid backs up into the esophagus from the stomach. [NIH] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive error (myopia, hyperopia, or astigmatism). [NIH] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Regurgitation: A backward flowing, as the casting up of undigested food, or the backward flowing of blood into the heart, or between the chambers of the heart when a valve is incompetent. [EU] 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 Dialysis: Removal of certain elements from the blood based on the difference in their rates of diffusion through a semipermeable membrane. [NIH] Resection: Removal of tissue or part or all of an organ by surgery. [NIH] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Respiratory Mucosa: The mucous membrane lining the respiratory tract. [NIH] Restoration: Broad term applied to any inlay, crown, bridge or complete denture which restores or replaces loss of teeth or oral tissues. [NIH] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its

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outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Retinal: 1. Pertaining to the retina. 2. The aldehyde of retinol, derived by the oxidative enzymatic splitting of absorbed dietary carotene, and having vitamin A activity. In the retina, retinal combines with opsins to form visual pigments. One isomer, 11-cis retinal combines with opsin in the rods (scotopsin) to form rhodopsin, or visual purple. Another, all-trans retinal (trans-r.); visual yellow; xanthopsin) results from the bleaching of rhodopsin by light, in which the 11-cis form is converted to the all-trans form. Retinal also combines with opsins in the cones (photopsins) to form the three pigments responsible for colour vision. Called also retinal, and retinene1. [EU] Retinal Ganglion Cells: Cells of the innermost nuclear layer of the retina, the ganglion cell layer, which project axons through the optic nerve to the brain. They are quite variable in size and in the shapes of their dendritic arbors, which are generally confined to the inner plexiform layer. [NIH] Retinoblastoma: An eye cancer that most often occurs in children younger than 5 years. It occurs in hereditary and nonhereditary (sporadic) forms. [NIH] Retrograde: 1. Moving backward or against the usual direction of flow. 2. Degenerating, deteriorating, or catabolic. [EU] Ribose: A pentose active in biological systems usually in its D-form. [NIH] Rickets: A condition caused by deficiency of vitamin D, especially in infancy and childhood, with disturbance of normal ossification. The disease is marked by bending and distortion of the bones under muscular action, by the formation of nodular enlargements on the ends and sides of the bones, by delayed closure of the fontanelles, pain in the muscles, and sweating of the head. Vitamin D and sunlight together with an adequate diet are curative, provided that the parathyroid glands are functioning properly. [EU] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Round Window: Fenestra of the cochlea; an opening in the medial wall of the middle ear leading into the cochlea. [NIH] Saliva: The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptylin. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Saphenous: Applied to certain structures in the leg, e. g. nerve vein. [NIH] Saphenous Vein: The vein which drains the foot and leg. [NIH] Scalpel: A small pointed knife with a convex edge. [NIH] Scans: Pictures of structures inside the body. Scans often used in diagnosing, staging, and monitoring disease include liver scans, bone scans, and computed tomography (CT) or computerized axial tomography (CAT) scans and magnetic resonance imaging (MRI) scans. In liver scanning and bone scanning, radioactive substances that are injected into the bloodstream collect in these organs. A scanner that detects the radiation is used to create pictures. In CT scanning, an x-ray machine linked to a computer is used to produce detailed pictures of organs inside the body. MRI scans use a large magnet connected to a computer to create pictures of areas inside the body. [NIH] Scatter: The extent to which relative success and failure are divergently manifested in qualitatively different tests. [NIH]

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Sclera: The tough white outer coat of the eyeball, covering approximately the posterior fivesixths of its surface, and continuous anteriorly with the cornea and posteriorly with the external sheath of the optic nerve. [EU] Sclerosis: A pathological process consisting of hardening or fibrosis of an anatomical structure, often a vessel or a nerve. [NIH] Sclerostomy: Surgical formation of an external opening in the sclera, primarily in the treatment of glaucoma. [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] Segmental: Describing or pertaining to a structure which is repeated in similar form in successive segments of an organism, or which is undergoing segmentation. [NIH] Segmentation: The process by which muscles in the intestines move food and wastes through the body. [NIH] 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] 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] Semicircular canal: Three long canals of the bony labyrinth of the ear, forming loops and opening into the vestibule by five openings. [NIH] Sepsis: The presence of bacteria in the bloodstream. [NIH] Serous: Having to do with serum, the clear liquid part of blood. [NIH] Serrata: The serrated anterior border of the retina located approximately 8.5 mm from the limbus and adjacent to the pars plana of the ciliary body. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Seton: A thin strand of linen or silk drawn through a cutaneus wound in order to lay down the foundations of a drain. [NIH] Sex Determination: The biological characteristics which distinguish human beings as female or male. [NIH] Sexually Transmitted Diseases: Diseases due to or propagated by sexual contact. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Shunt: A surgically created diversion of fluid (e.g., blood or cerebrospinal fluid) from one area of the body to another area of the body. [NIH] Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the

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one sought to be benefited by its administration. [EU] Sigmoid: 1. Shaped like the letter S or the letter C. 2. The sigmoid colon. [EU] Sigmoid Colon: The lower part of the colon that empties into the rectum. [NIH] Sigmoidoscopy: Endoscopic examination, therapy or surgery of the sigmoid flexure. [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] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smoking Cessation: Discontinuation of the habit of smoking, the inhaling and exhaling of tobacco smoke. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Sneezing: Sudden, forceful, involuntary expulsion of air from the nose and mouth caused by irritation to the mucous membranes of the upper respiratory tract. [NIH] Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] 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] Solid tumor: Cancer of body tissues other than blood, bone marrow, or the lymphatic system. [NIH] Solitary Rectal Ulcer: A rare type of ulcer in the rectum. May develop because of straining to have a bowel movement. [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] Somatostatin: A polypeptide hormone produced in the hypothalamus, and other tissues and organs. It inhibits the release of human growth hormone, and also modulates important physiological functions of the kidney, pancreas, and gastrointestinal tract. Somatostatin receptors are widely expressed throughout the body. Somatostatin also acts as a neurotransmitter in the central and peripheral nervous systems. [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] Spasm: An involuntary contraction of a muscle or group of muscles. Spasms may involve skeletal muscle or smooth muscle. [NIH] Spasmodic: Of the nature of a spasm. [EU]

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Spatial disorientation: Loss of orientation in space where person does not know which way is up. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sperm: The fecundating fluid of the male. [NIH] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spinous: Like a spine or thorn in shape; having spines. [NIH] Spirochete: Lyme disease. [NIH] Spleen: An organ that is part of the lymphatic system. The spleen produces lymphocytes, filters the blood, stores blood cells, and destroys old blood cells. It is located on the left side of the abdomen near the stomach. [NIH] Spondylitis: Inflammation of the vertebrae. [EU] Sporadic: Neither endemic nor epidemic; occurring occasionally in a random or isolated manner. [EU] Stabilization: The creation of a stable state. [EU] Staging: Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. [NIH]

Stenosis: Narrowing or stricture of a duct or canal. [EU] Stent: A device placed in a body structure (such as a blood vessel or the gastrointestinal tract) to provide support and keep the structure open. [NIH] Sterile: Unable to produce children. [NIH] Steroids: Drugs used to relieve swelling and inflammation. [NIH] Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stoma: A surgically created opening from an area inside the body to the outside. [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] Strand: DNA normally exists in the bacterial nucleus in a helix, in which two strands are coiled together. [NIH] Streptomycin: O-2-Deoxy-2-(methylamino)-alpha-L-glucopyranosyl-(1-2)-O-5- deoxy-3-Cformyl-alpha-L-lyxofuranosyl-(1-4)-N,N'-bis(aminoiminomethyl)-D-streptamine.

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Antibiotic substance produced by the soil actinomycete Streptomyces griseus. It acts by inhibiting the initiation and elongation processes during protein synthesis. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stress urinary: Leakage of urine caused by actions--such as coughing, laughing, sneezing, running, or lifting--that place pressure on the bladder from inside the body. Stress urinary incontinence can result from either a fallen bladder or weak sphincter muscles. [NIH] Stricture: The abnormal narrowing of a body opening. Also called stenosis. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Stromal: Large, veil-like cell in the bone marrow. [NIH] Stromal Cells: Connective tissue cells of an organ found in the loose connective tissue. These are most often associated with the uterine mucosa and the ovary as well as the hematopoietic system and elsewhere. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subarachnoid: Situated or occurring between the arachnoid and the pia mater. [EU] Subclavian: The direct continuation of the axillary vein at the lateral border of the first rib. It passes medially to join the internal jugular vein and form the brachiocephalic vein on each side. [NIH] Subclavian Artery: Artery arising from the brachiocephalic trunk on the right side and from the arch of the aorta on the left side. It distributes to the neck, thoracic wall, spinal cord, brain, meninges, and upper limb. [NIH] Subclavian Vein: The continuation of the axillary vein which follows the subclavian artery and then joins the internal jugular vein to form the brachiocephalic vein. [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] Subconjunctival: Situated or occurring beneath the conjunctiva. [EU] Subcutaneous: Beneath the skin. [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] Suction: The removal of secretions, gas or fluid from hollow or tubular organs or cavities by means of a tube and a device that acts on negative pressure. [NIH] Sunburn: An injury to the skin causing erythema, tenderness, and sometimes blistering and resulting from excessive exposure to the sun. The reaction is produced by the ultraviolet radiation in sunlight. [NIH] Suppositories: A small cone-shaped medicament having cocoa butter or gelatin at its basis and usually intended for the treatment of local conditions in the rectum. [NIH]

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Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Surgical Instruments: Hand-held tools or implements used by health professionals for the performance of surgical tasks. [NIH] Sympathetic Nervous System: The thoracolumbar division of the autonomic nervous system. Sympathetic preganglionic fibers originate in neurons of the intermediolateral column of the spinal cord and project to the paravertebral and prevertebral ganglia, which in turn project to target organs. The sympathetic nervous system mediates the body's response to stressful situations, i.e., the fight or flight reactions. It often acts reciprocally to the parasympathetic system. [NIH] Sympathomimetic: 1. Mimicking the effects of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. 2. An agent that produces effects similar to those of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. Called also adrenergic. [EU] Symphysis: A secondary cartilaginous joint. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Synergistic: Acting together; enhancing the effect of another force or agent. [EU] Syphilis: A contagious venereal disease caused by the spirochete Treponema pallidum. [NIH]

Systemic: Affecting the entire body. [NIH] Systemic disease: Disease that affects the whole body. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Tachycardia: Excessive rapidity in the action of the heart, usually with a heart rate above 100 beats per minute. [NIH] Tachypnea: Rapid breathing. [NIH] Telangiectasia: The permanent enlargement of blood vessels, causing redness in the skin or mucous membranes. [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] Teratoma: A type of germ cell tumor that may contain several different types of tissue, such as hair, muscle, and bone. Teratomas occur most often in the ovaries in women, the testicles in men, and the tailbone in children. Not all teratomas are malignant. [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] Thalamic: Cell that reaches the lateral nucleus of amygdala. [NIH] Thalamic Diseases: Disorders of the centrally located thalamus, which integrates a wide range of cortical and subcortical information. Manifestations include sensory loss, movement disorders; ataxia, pain syndromes, visual disorders, a variety of neuropsychological conditions, and coma. Relatively common etiologies include cerebrovascular disorders; craniocerebral trauma; brain neoplasms; brain hypoxia; intracranial hemorrhages; and infectious processes. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases,

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palliative or curative. [NIH] Thermal: Pertaining to or characterized by heat. [EU] Thigh: A leg; in anatomy, any elongated process or part of a structure more or less comparable to a leg. [NIH] Thoracic: Having to do with the chest. [NIH] Thorax: A part of the trunk between the neck and the abdomen; the chest. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombectomy: Surgical removal of an obstructing clot or foreign material from a blood vessel at the point of its formation. Removal of a clot arising from a distant site is called embolectomy. [NIH] Thrombin: An enzyme formed from prothrombin that converts fibrinogen to fibrin. (Dorland, 27th ed) EC 3.4.21.5. [NIH] Thrombolytic: 1. Dissolving or splitting up a thrombus. 2. A thrombolytic agent. [EU] 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]

Thrombosed: A localized clot that either forms in the vein of a hemorrhoid or arises from a ruptured hemorrhoidal blood vessel. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thrombus: An aggregation of blood factors, primarily platelets and fibrin with entrapment of cellular elements, frequently causing vascular obstruction at the point of its formation. Some authorities thus differentiate thrombus formation from simple coagulation or clot formation. [EU] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Tin: A trace element that is required in bone formation. It has the atomic symbol Sn, atomic number 50, and atomic weight 118.71. [NIH] Tinnitus: Sounds that are perceived in the absence of any external noise source which may take the form of buzzing, ringing, clicking, pulsations, and other noises. Objective tinnitus refers to noises generated from within the ear or adjacent structures that can be heard by other individuals. The term subjective tinnitus is used when the sound is audible only to the affected individual. Tinnitus may occur as a manifestation of cochlear diseases; vestibulocochlear nerve diseases; intracranial hypertension; craniocerebral trauma; and other conditions. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] 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] Tonic: 1. Producing and restoring the normal tone. 2. Characterized by continuous tension. 3. A term formerly used for a class of medicinal preparations believed to have the power of restoring normal tone to tissue. [EU] Topical: On the surface of the body. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances

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Fistulas

usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxin: A poison; frequently used to refer specifically to a protein produced by some higher plants, certain animals, and pathogenic bacteria, which is highly toxic for other living organisms. Such substances are differentiated from the simple chemical poisons and the vegetable alkaloids by their high molecular weight and antigenicity. [EU] Trabecular Meshwork: A porelike structure surrounding the entire circumference of the anterior chamber through which aqueous humor circulates to the canal of Schlemm. [NIH] Trabeculectomy: Any surgical procedure for treatment of glaucoma by means of puncture or reshaping of the trabecular meshwork. It includes goniotomy, trabeculotomy, and laser perforation. [NIH] Trachea: The cartilaginous and membranous tube descending from the larynx and branching into the right and left main bronchi. [NIH] Tracheoesophageal Fistula: Abnormal communication between the esophagus and the trachea, acquired or congenital, often associated with esophageal atresia. [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Translation: The process whereby the genetic information present in the linear sequence of ribonucleotides in mRNA is converted into a corresponding sequence of amino acids in a protein. It occurs on the ribosome and is unidirectional. [NIH] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Treatment Outcome: Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, practicability, etc., of these interventions in individual cases or series. [NIH]

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] Tuberous Sclerosis: A rare congenital disease in which the essential pathology is the appearance of multiple tumors in the cerebrum and in other organs, such as the heart or kidneys. [NIH] Tumor Necrosis Factor: Serum glycoprotein produced by activated macrophages and other mammalian mononuclear leukocytes which has necrotizing activity against tumor cell lines and increases ability to reject tumor transplants. It mimics the action of endotoxin but differs from it. It has a molecular weight of less than 70,000 kDa. [NIH] Tunica: A rather vague term to denote the lining coat of hollow organs, tubes, or cavities. [NIH]

Ulcer: A localized necrotic lesion of the skin or a mucous surface. [NIH] Ulceration: 1. The formation or development of an ulcer. 2. An ulcer. [EU] Ulcerative colitis: Chronic inflammation of the colon that produces ulcers in its lining. This

Dictionary 185

condition is marked by abdominal pain, cramps, and loose discharges of pus, blood, and mucus from the bowel. [NIH] Ultrafiltration: The separation of particles from a suspension by passage through a filter with very fine pores. In ultrafiltration the separation is accomplished by convective transport; in dialysis separation relies instead upon differential diffusion. Ultrafiltration occurs naturally and is a laboratory procedure. Artificial ultrafiltration of the blood is referred to as hemofiltration or hemodiafiltration (if combined with hemodialysis). [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] Ultraviolet radiation: Invisible rays that are part of the energy that comes from the sun. UV radiation can damage the skin and cause melanoma and other types of skin cancer. UV radiation that reaches the earth's surface is made up of two types of rays, called UVA and UVB rays. UVB rays are more likely than UVA rays to cause sunburn, but UVA rays pass deeper into the skin. Scientists have long thought that UVB radiation can cause melanoma and other types of skin cancer. They now think that UVA radiation also may add to skin damage that can lead to skin cancer and cause premature aging. For this reason, skin specialists recommend that people use sunscreens that reflect, absorb, or scatter both kinds of UV radiation. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Uraemia: 1. An excess in the blood of urea, creatinine, and other nitrogenous end products of protein and amino acids metabolism; more correctly referred to as azotemia. 2. In current usage the entire constellation of signs and symptoms of chronic renal failure, including nausea, vomiting anorexia, a metallic taste in the mouth, a uraemic odour of the breath, pruritus, uraemic frost on the skin, neuromuscular disorders, pain and twitching in the muscles, hypertension, edema, mental confusion, and acid-base and electrolyte imbalances. [EU]

Ureter: One of a pair of thick-walled tubes that transports urine from the kidney pelvis to the bladder. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary Fistula: An abnormal passage in any organ of the urinary tract or between urinary organs and other organs. [NIH] Urinary tract: The organs of the body that produce and discharge urine. These include the kidneys, ureters, bladder, and urethra. [NIH] Urinate: To release urine from the bladder to the outside. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Urodynamic: Measures of the bladder's ability to hold and release urine. [NIH] Urogenital: Pertaining to the urinary and genital apparatus; genitourinary. [EU] 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

186

Fistulas

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] Vaginal Fistula: An abnormal passage communicating with the vagina. [NIH] Varicose: The common ulcer in the lower third of the leg or near the ankle. [NIH] Varicose Ulcer: Ulcer due to varicose veins. Chronic venous insufficiency in the deep veins of the legs leads to shunting the venous return into the superficial veins, in which pressure and flow rate, as well as oxygen content, are increased. [NIH] Varicose vein: An abnormal swelling and tortuosity especially of the superficial veins of the legs. [EU] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vascular Fistula: An abnormal passage between two or more arteries, or between an artery and a vein. [NIH] Vasculitis: Inflammation of a blood vessel. [NIH] Vasoconstriction: Narrowing of the blood vessels without anatomic change, for which constriction, pathologic is used. [NIH] Vector: Plasmid or other self-replicating DNA molecule that transfers DNA between cells in nature or in recombinant DNA technology. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Vena: A vessel conducting blood from the capillary bed to the heart. [NIH] Vena Cava Filters: Mechanical devices inserted in the inferior vena cava that prevent the migration of blood clots from deep venous thrombosis of the leg. [NIH] Venereal: Pertaining or related to or transmitted by sexual contact. [EU] Venous: Of or pertaining to the veins. [EU] Venous Insufficiency: Inadequacy of the venous valves and impairment of venous return (venous stasis) usually from the legs, often with edema and sometimes with stasis ulcers at the ankle. [NIH] Venous Thrombosis: The formation or presence of a thrombus within a vein. [NIH] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Ventricular: Pertaining to a ventricle. [EU] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Venus: The second planet in order from the sun. It has no known natural satellites. It is one of the four inner or terrestrial planets of the solar system. [NIH] Vertebrae: A bony unit of the segmented spinal column. [NIH] Vertebral: Of or pertaining to a vertebra. [EU] Vertebral Artery: The first branch of the subclavian artery with distribution to muscles of the neck, vertebrae, spinal cord, cerebellum and interior of the cerebrum. [NIH] Vertigo: An illusion of movement; a sensation as if the external world were revolving

Dictionary 187

around the patient (objective vertigo) or as if he himself were revolving in space (subjective vertigo). The term is sometimes erroneously used to mean any form of dizziness. [EU] Vesicovaginal Fistula: An abnormal communication between the bladder and the vagina. [NIH]

Vestibular: Pertaining to or toward a vestibule. In dental anatomy, used to refer to the tooth surface directed toward the vestibule of the mouth. [EU] Vestibule: A small, oval, bony chamber of the labyrinth. The vestibule contains the utricle and saccule, organs which are part of the balancing apparatus of the ear. [NIH] Vestibulocochlear Nerve: The 8th cranial nerve. The vestibulocochlear nerve has a cochlear part (cochlear nerve) which is concerned with hearing and a vestibular part (vestibular nerve) which mediates the sense of balance and head position. The fibers of the cochlear nerve originate from neurons of the spiral ganglion and project to the cochlear nuclei (cochlear nucleus). The fibers of the vestibular nerve arise from neurons of Scarpa's ganglion and project to the vestibular nuclei. [NIH] Vestibulocochlear Nerve Diseases: Diseases of the vestibular and/or cochlear (acoustic) nerves, which join to form the vestibulocochlear nerve. Vestibular neuritis, cochlear neuritis, and acoustic neuromas are relatively common conditions that affect these nerves. Clinical manifestations vary with which nerve is primarily affected, and include hearing loss, vertigo, and tinnitus. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Viral Hepatitis: Hepatitis caused by a virus. Five different viruses (A, B, C, D, and E) most commonly cause this form of hepatitis. Other rare viruses may also cause hepatitis. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Visual field: The entire area that can be seen when the eye is forward, including peripheral vision. [NIH] Vitamin D: The vitamin that mediates intestinal calcium absorption, bone calcium metabolism, and probably muscle activity. It usually acts as a hormone precursor, requiring 2 stages of metabolism before reaching actual hormonal form. It is isolated from fish liver oils and used in the treatment and prevention of rickets. [NIH] Vitreous: Glasslike or hyaline; often used alone to designate the vitreous body of the eye (corpus vitreum). [EU] Vitreous Body: The transparent, semigelatinous substance that fills the cavity behind the crystalline lens of the eye and in front of the retina. It is contained in a thin hyoid membrane and forms about four fifths of the optic globe. [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] Volition: Voluntary activity without external compulsion. [NIH] Volvulus: A twisting of the stomach or large intestine. May be caused by the stomach being in the wrong position, a foreign substance, or abnormal joining of one part of the stomach or intestine to another. Volvulus can lead to blockage, perforation, peritonitis, and poor blood

188

Fistulas

flow. [NIH] Weight Gain: Increase in body weight over existing weight. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]

Windpipe: A rigid tube, 10 cm long, extending from the cricoid cartilage to the upper border of the fifth thoracic vertebra. [NIH] Wound Healing: Restoration of integrity to traumatized tissue. [NIH] 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] X-ray therapy: The use of high-energy radiation from x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy) or from materials called radioisotopes. Radioisotopes produce radiation and can be placed in or near the tumor or in the area near cancer cells. This type of radiation treatment is called internal radiation therapy, implant radiation, interstitial radiation, or brachytherapy. Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. X-ray therapy is also called radiation therapy, radiotherapy, and irradiation. [NIH] Yttrium: An element of the rare earth family of metals. It has the atomic symbol Y, atomic number 39, and atomic weight 88.91. In conjunction with other rare earths, yttrium is used as a phosphor in television receivers and is a component of the yttrium-aluminum garnet (YAG) lasers. [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]

189

INDEX A Abdomen, 94, 135, 141, 142, 152, 156, 158, 160, 162, 168, 169, 170, 180, 183 Abdominal, 18, 69, 73, 78, 88, 90, 92, 94, 135, 144, 149, 161, 163, 168, 170, 185 Abdominal Pain, 90, 135, 163, 170, 185 Ablate, 76, 135 Ablation, 5, 135 Abortion, 135, 144 Abscess, 12, 89, 94, 95, 98, 122, 123, 135, 137 Acetaminophen, 135, 154 Acidity, 135, 170 Acquired Immunodeficiency Syndrome, 89, 135 Acuity, 135, 139 Acute renal, 90, 135 Adenine, 135 Adenocarcinoma, 135, 157 Adenosine, 7, 135 Adjustment, 70, 73, 135 Adjuvant, 45, 47, 135, 155 Adolescence, 135, 169 Adrenal Medulla, 136, 152 Adrenergic, 136, 152, 182 Adverse Effect, 136, 178 Affinity, 136, 179 Airways, 29, 136 Albumin, 17, 70, 80, 136, 171 Algorithms, 88, 90, 136, 141 Alimentary, 14, 136, 151, 169 Alpha Particles, 136, 175 Alternative medicine, 102, 136 Aluminum, 70, 136, 188 Amino acid, 90, 136, 137, 155, 158, 169, 173, 174, 181, 183, 184, 185 Amino Acid Sequence, 136, 137, 155 Ampulla, 137, 151 Anal, 19, 20, 22, 31, 34, 36, 37, 47, 51, 88, 89, 92, 95, 122, 123, 137, 145, 153, 176 Anal Fissure, 88, 89, 137 Anal Fistula, 20, 22, 31, 34, 36, 37, 47, 51, 89, 92, 95, 123, 137 Anaplasia, 137, 166 Anastomosis, 19, 60, 70, 83, 95, 96, 97, 98, 137 Anatomical, 137, 139, 144, 159, 178 Anemia, 119, 137

Anesthesia, 63, 89, 91, 123, 137, 151 Anesthetics, 137, 152 Aneurysm, 11, 63, 72, 73, 75, 77, 78, 81, 82, 96, 137 Angiogenesis, 66, 137 Angiography, 18, 23, 25, 26, 29, 37, 40, 137 Angioplasty, 7, 60, 66, 72, 104, 137 Animal model, 50, 137 Anions, 136, 137, 161 Ankle, 137, 186 Anomalies, 9, 137 Anorectal, 28, 49, 87, 89, 102, 123, 137 Anterior chamber, 71, 137, 156, 161, 184 Antibacterial, 137, 180 Antibiotic, 137, 165, 180, 181 Antibodies, 84, 85, 137, 138, 163, 171, 175 Antibody, 56, 85, 102, 136, 138, 145, 148, 159, 160, 161, 165, 175, 188 Anticoagulant, 138, 174 Antigen, 136, 138, 146, 159, 160, 173 Anti-infective, 138, 158 Anti-inflammatory, 135, 138, 139 Anti-Inflammatory Agents, 138, 139 Antimetabolite, 74, 138, 154, 164 Antineoplastic, 138, 154, 164, 165 Antiproliferative, 7, 138 Anus, 89, 95, 137, 138, 139, 142, 145, 157, 170, 176 Aorta, 12, 69, 72, 73, 78, 82, 138, 181, 186 Aortic Valve, 11, 138 Aperture, 70, 71, 138, 174 Apoptosis, 138, 139 Appendicitis, 88, 90, 94, 138 Aqueous, 7, 71, 74, 138, 140, 144, 151, 158, 162, 184 Aqueous humor, 8, 71, 74, 138, 144, 184 Arachidonic Acid, 138, 173 Argon, 70, 138 Arsenic trioxide, 15, 139 Arterial, 3, 17, 41, 62, 63, 72, 73, 75, 81, 84, 91, 103, 139, 158, 174, 182 Arteries, 3, 33, 62, 63, 66, 67, 69, 77, 78, 81, 82, 138, 139, 141, 147, 165, 174, 186 Arteriography, 33, 139 Arterioles, 139, 141, 142 Arteriolosclerosis, 139 Arteriosclerosis, 69, 139

190

Fistulas

Arteriovenous Fistula, 3, 12, 14, 15, 16, 18, 19, 20, 21, 23, 24, 25, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 45, 48, 50, 55, 61, 63, 67, 72, 77, 89, 91, 96, 103, 118, 124, 139 Arteritis, 33, 139 Aspirin, 104, 139 Asymptomatic, 139, 168 Ataxia, 118, 119, 139, 182 Atresia, 4, 5, 48, 90, 122, 139, 141, 184 Atrium, 12, 139, 186 Atrophy, 118, 119, 139 Audiometry, 4, 139 Auditory, 4, 97, 140 Aural, 97, 140 Autodigestion, 140, 168 Autologous, 83, 91, 96, 140 Axillary, 140, 181 Axillary Vein, 140, 181 Axons, 140, 167, 177 B Bacteremia, 10, 140 Bacteria, 65, 137, 138, 140, 151, 153, 154, 165, 178, 180, 184, 186 Bactericidal, 140, 152 Basal Ganglia, 139, 140 Basal Ganglia Diseases, 139, 140 Base, 32, 135, 140, 155, 161, 182, 185 Basement Membrane, 140, 153 Basophils, 140, 162 Bed Rest, 123, 140 Benign, 15, 81, 88, 139, 140, 166, 175 Bilateral, 5, 12, 15, 16, 21, 27, 38, 140 Bile, 133, 140, 141, 144, 151, 154, 155, 157, 161, 162, 172, 173 Bile Acids, 140, 155 Bile duct, 141, 144, 151, 154, 157, 172, 173 Bile Pigments, 141, 161 Biliary, 13, 24, 74, 88, 89, 95, 141, 156, 168 Biliary Atresia, 88, 141 Biliary Fistula, 24, 141 Biliary Tract, 89, 141, 156, 168 Bilirubin, 136, 141, 154, 158 Biochemical, 138, 141 Biological therapy, 141, 156 Biopsy, 141, 170 Biotechnology, 11, 13, 93, 102, 115, 117, 118, 119, 120, 141 Bladder, 64, 81, 91, 94, 98, 122, 141, 146, 148, 159, 160, 174, 181, 185, 187 Bloating, 141, 163

Blood pressure, 103, 141, 143, 158, 165, 172, 174, 179 Body Fluids, 141, 142, 150, 154, 167, 179 Bone Cements, 141, 172 Bone Conduction, 139, 141 Bone Marrow, 141, 159, 163, 165, 179, 181 Bone scan, 141, 177 Bowel, 70, 88, 98, 99, 104, 137, 142, 147, 149, 160, 170, 176, 179, 180, 185 Bowel Movement, 98, 142, 147, 149, 179, 180 Brachytherapy, 142, 160, 161, 175, 188 Branch, 83, 131, 142, 163, 169, 180, 182, 186 Breakdown, 142, 149, 154 Breeding, 65, 142 Bronchi, 142, 152, 184 Bronchial, 12, 67, 142 Bronchus, 80, 142 Burns, 90, 142 Burns, Electric, 142 Bypass, 60, 62, 66, 82, 83, 142 C Calcification, 139, 142 Calcium, 141, 142, 146, 174, 187 Capillary, 142, 186 Capsules, 142, 155 Carcinogenic, 142, 160 Carcinogens, 142, 167 Carcinoma, 12, 19, 50, 88, 89, 95, 98, 142 Cardiac, 18, 28, 29, 33, 82, 83, 90, 142, 150, 152, 154, 156, 166 Cardiovascular, 14, 20, 24, 29, 30, 31, 35, 62, 91, 143 Cardiovascular disease, 62, 143 Case report, 15, 41, 47, 50, 51, 143, 145 Catheter, 5, 11, 12, 16, 61, 62, 73, 75, 81, 82, 83, 94, 97, 143, 151, 161 Catheterization, 29, 61, 137, 143, 161 Caudal, 143, 158, 172 Cause of Death, 75, 143 Caustic, 90, 143 CDC2, 65, 143 Cell Death, 138, 139, 143 Cell Division, 118, 140, 143, 156, 165, 171 Cell proliferation, 7, 139, 143 Cell Survival, 143, 156 Central Nervous System, 143, 167 Cerebellar, 27, 139, 143, 176 Cerebellum, 143, 176, 186 Cerebral, 18, 25, 28, 75, 139, 140, 143, 152, 157 Cerebral Cortex, 139, 143

Index 191

Cerebrospinal, 29, 32, 36, 143, 148, 178 Cerebrospinal fluid, 29, 32, 36, 143, 148, 178 Cerebrovascular, 48, 75, 140, 143, 182 Cerebrum, 143, 171, 184, 186 Cervical, 9, 19, 35, 50, 144 Cervix, 81, 133, 135, 144 Cesarean Section, 38, 144 Character, 144, 148 Chemotherapeutic agent, 144, 149 Chemotherapy, 30, 48, 50, 91, 96, 97, 144 Chin, 28, 144, 164 Cholangitis, 88, 144 Cholecystectomy, 90, 144 Cholecystitis, 88, 90, 144 Choledocholithiasis, 88, 144 Cholelithiasis, 144, 156 Cholesterol, 140, 144, 147, 154 Choriocarcinoma, 30, 144, 158 Choroid, 144, 177 Chromosome, 9, 144, 162 Chronic renal, 84, 91, 103, 144, 172, 185 Ciliary, 71, 75, 138, 144, 178 Ciliary Body, 71, 144, 178 Ciliary processes, 75, 138, 144 Cirrhosis, 88, 144, 156, 172, 173 Clinical Medicine, 144, 172 Clinical study, 144, 147 Clinical trial, 6, 7, 9, 55, 56, 115, 145, 175 Cloning, 9, 141, 145 Coagulation, 142, 145, 162, 171, 183 Cochlea, 145, 160, 177 Cochlear, 5, 49, 145, 183, 187 Cochlear Diseases, 145, 183 Cofactor, 145, 174, 183 Colitis, 89, 104, 145 Collagen, 68, 70, 76, 136, 140, 145, 154, 155, 173 Colloidal, 136, 145 Colon, 20, 22, 26, 28, 30, 32, 34, 36, 40, 46, 49, 89, 95, 105, 118, 145, 160, 162, 173, 179, 184 Colonoscopy, 89, 145 Colorectal, 17, 20, 31, 40, 87, 89, 98, 122, 145 Colorectal Cancer, 98, 145 Colorectal Surgery, 89, 145 Complement, 145, 146, 155, 171 Complementary and alternative medicine, 45, 53, 146 Complementary medicine, 45, 146 Complete remission, 146, 176

Compliance, 10, 146 Compress, 146, 157 Computational Biology, 115, 117, 146 Computed tomography, 18, 28, 146, 177 Computerized tomography, 146 Conception, 135, 144, 146, 153 Concretion, 147, 168 Conduction, 139, 147 Congestive heart failure, 11, 147 Conjunctiva, 7, 71, 147, 181 Connective Tissue, 141, 145, 147, 154, 155, 163, 181 Consciousness, 147, 148, 157 Constipation, 88, 90, 147, 170 Constriction, 80, 147, 161, 186 Consumption, 147, 149, 176 Contamination, 64, 94, 147 Continence, 15, 123, 147 Contraindications, ii, 147 Contrast medium, 137, 147 Controlled clinical trial, 8, 9, 147 Conventional therapy, 147 Conventional treatment, 69, 78, 147 Cornea, 137, 138, 147, 150, 178 Corneum, 147, 152 Coronary, 11, 12, 15, 16, 17, 18, 21, 28, 29, 31, 33, 35, 41, 50, 62, 66, 75, 143, 147, 165 Coronary heart disease, 143, 147 Coronary Thrombosis, 147, 165 Cortex, 147, 148, 176 Cortical, 27, 148, 178, 182 Corticosteroids, 105, 148 Cortisol, 136, 148 Cranial, 15, 37, 45, 143, 148, 153, 160, 167, 170, 187 Craniocerebral Trauma, 140, 148, 182, 183 Craniotomy, 63, 148 Cricoid Cartilage, 148, 188 Critical Care, 91, 96, 97, 148 CSF, 49, 101, 143, 148 Curative, 36, 67, 148, 177, 183 Cutaneous, 89, 148 Cyclic, 148, 173 Cyclin, 65, 148 Cyst, 148, 171 Cystitis, 92, 148 Cytokines, 85, 148 Cytostatic, 48, 148 Cytotoxic, 46, 148, 175 D Data Collection, 10, 148 Defecation, 89, 148

192

Fistulas

Degenerative, 67, 148, 157 Dementia, 135, 148 Denaturation, 70, 148 Deuterium, 149, 158 Developing Countries, 38, 94, 149 Diabetes Insipidus, 149, 172 Diabetes Mellitus, 103, 149, 155, 156, 160, 172 Diagnostic procedure, 4, 59, 102, 149 Dialyzer, 149, 156 Diaphragm, 149, 172 Diarrhea, 47, 88, 149, 163 Diastolic, 149, 158 Digestion, 40, 42, 136, 140, 142, 149, 160, 162, 169, 180 Digestive system, 57, 149, 154 Digestive tract, 40, 81, 149, 179 Dihydrotestosterone, 149, 176 Dilatation, 76, 135, 137, 149, 160, 173 Dilate, 62, 149 Dilation, 31, 36, 149 Dipyridamole, 7, 149 Direct, iii, 19, 21, 65, 96, 107, 144, 149, 157, 158, 168, 170, 176, 181 Discrete, 61, 149 Disinfectant, 149, 152 Dislocation, 26, 149 Dissection, 11, 63, 71, 83, 149 Distal, 7, 63, 75, 81, 82, 149, 150, 155, 174 Diverticula, 150 Diverticulitis, 94, 98, 150 Diverticulum, 92, 150 Dizziness, 97, 104, 123, 150, 187 Dorsal, 150, 172 Drug Interactions, 108, 150 Duct, 14, 137, 143, 150, 151, 153, 157, 168, 174, 177, 180 Duodenum, 140, 150, 151, 168, 180 Dysphagia, 14, 150 Dysplasia, 119, 150 Dystrophy, 118, 150 E Eating Disorders, 90, 150 Echocardiography, 15, 150 Edema, 150, 157, 160, 185, 186 Efficacy, 34, 56, 150, 184 Elasticity, 76, 79, 139, 150 Elastin, 76, 145, 150 Elective, 31, 150 Electrode, 63, 77, 150 Electrolyte, 6, 150, 154, 156, 167, 179, 185 Electronystagmography, 4, 150

Emaciation, 135, 150 Embolectomy, 150, 183 Emboli, 3, 17, 29, 31, 35, 36, 37, 55, 150, 151 Embolization, 3, 17, 29, 31, 35, 36, 37, 55, 151 Embryology, 89, 151 Emulsions, 90, 151 Encephalopathy, 37, 151 Endarterectomy, 137, 151 Endoscope, 151 Endoscopic, 18, 21, 40, 90, 145, 151, 152, 179 Endoscopic retrograde cholangiopancreatography, 90, 151 Endoscopy, 18, 21, 24, 47, 90, 151 Endothelium, 75, 151 Endothelium, Lymphatic, 151 Endothelium, Vascular, 151 Endotoxin, 85, 151, 184 End-stage renal, 8, 144, 151, 172 Enteral Nutrition, 90, 151 Enterostomal Therapy, 89, 151 Environmental Exposure, 151, 167 Environmental Health, 114, 116, 151 Enzymatic, 136, 142, 146, 152, 177 Enzyme, 152, 169, 171, 174, 176, 181, 183, 187, 188 Eosinophils, 152, 162 Epidermis, 78, 147, 152, 157 Epigastric, 152, 168 Epinephrine, 70, 136, 152, 166 Episiotomy, 72, 152 Epithelial, 135, 144, 152, 157 Epithelium, 140, 144, 151, 152, 154, 161 Erythrocytes, 137, 141, 152 Esophageal, 4, 5, 6, 34, 41, 48, 67, 74, 90, 122, 152, 184 Esophageal Fistula, 4, 6, 67, 152 Esophageal Motility Disorders, 90, 152 Esophageal Perforation, 4, 152 Esophageal Stricture, 34, 152 Esophagoscopy, 68, 152 Esophagus, 4, 5, 50, 67, 125, 139, 149, 152, 154, 155, 163, 170, 176, 180, 184 Essential Tremor, 118, 152 Ethanol, 17, 152 Eukaryotic Cells, 143, 152 Evacuation, 147, 153 Exocrine, 153, 168 External-beam radiation, 153, 161, 175, 188 Extracellular, 7, 66, 74, 147, 153, 154, 179

Index 193

Extracellular Matrix, 66, 74, 147, 153, 154 Extracellular Space, 153 Extravascular, 63, 153 Eye Movements, 104, 153 F Facial, 153, 169 Facial Nerve, 153, 169 Faecal, 48, 153 Failure to Thrive, 90, 153 Family Planning, 115, 153 Fat, 34, 138, 141, 147, 150, 153, 162 Fatigue, 153, 156 Fatty acids, 136, 153, 173 Fecal Incontinence, 88, 153, 159 Feces, 147, 153, 180 Femoral, 24, 153 Femur, 153 Fetus, 135, 144, 153, 185 Fibrin, 17, 21, 22, 23, 40, 102, 153, 170, 183 Fibrinogen, 153, 171, 183 Fibroblasts, 74, 154 Fibrosis, 77, 90, 119, 154, 178 Fibrotic tissue, 75, 154 Filtration, 66, 74, 154, 156 Flatus, 96, 98, 153, 154 Fluid Therapy, 154, 167 Fluorouracil, 149, 154 Forearm, 31, 79, 141, 154, 175 Fulminant Hepatic Failure, 90, 154 G Gallbladder, 88, 89, 135, 141, 144, 149, 151, 154, 155 Gallstones, 90, 144, 154 Gamma Rays, 154, 175 Gangrene, 65, 154 Gas, 96, 98, 138, 154, 158, 163, 167, 181 Gastric, 6, 41, 47, 49, 50, 140, 152, 154, 155, 169 Gastric Fistula, 41, 49, 50, 154 Gastric Juices, 154, 169 Gastric Mucosa, 154, 169 Gastrin, 154, 157 Gastritis, 90, 154 Gastroenterologist, 88, 154 Gastroenterology, 4, 18, 20, 22, 23, 24, 28, 32, 33, 36, 40, 41, 47, 48, 89, 95, 154 Gastroesophageal Reflux, 90, 155 Gastrointestinal, 6, 14, 22, 24, 47, 80, 88, 90, 94, 95, 123, 151, 152, 155, 179, 180, 181 Gastrointestinal Hemorrhage, 88, 155

Gastrointestinal tract, 22, 80, 95, 152, 155, 179, 180 Gastrostomy, 18, 151, 155 Gelatin, 80, 155, 181 Gene, 9, 65, 67, 93, 119, 120, 141, 155, 162, 167 Generator, 75, 155 Genetic Code, 155, 167 Genetic Counseling, 9, 155 Genetic Engineering, 141, 145, 155 Genital, 155, 185 Genitourinary, 23, 155, 185 Gland, 136, 155, 163, 168, 169, 171, 174, 178, 180, 183 Glanders, 93, 155 Glucose, 103, 118, 149, 155, 156, 160 Glucose Intolerance, 149, 155 Glycine, 136, 155, 166 Glycoprotein, 153, 155, 183, 184 Gonadotropin, 144, 156 Goniotomy, 156, 184 Governing Board, 156, 172 Grade, 123, 156 Graft, 5, 60, 66, 69, 72, 73, 74, 78, 79, 82, 83, 97, 102, 104, 156, 158 Grafting, 72, 156, 159 Groin, 156, 160 Growth factors, 65, 69, 156 H Haemodialysis, 15, 19, 156 Heart attack, 143, 156 Heart failure, 7, 156 Hematoma, 156, 157 Hematopoiesis, 66, 156 Hemobilia, 88, 156 Hemochromatosis, 90, 156 Hemofiltration, 82, 156, 185 Hemoglobin, 137, 152, 156, 157 Hemoglobinuria, 118, 157 Hemorrhage, 76, 88, 148, 156, 157, 181 Hemorrhagic stroke, 81, 157 Hemorrhoid, 157, 183 Hepatic, 88, 89, 90, 136, 151, 157 Hepatic Duct, Common, 151, 157 Hepatic Encephalopathy, 90, 157 Hepatitis, 88, 90, 154, 157, 187 Hepatocellular, 88, 157 Hepatocellular carcinoma, 88, 157 Hepatocytes, 157 Hereditary, 157, 177 Heredity, 155, 157 Heterogeneity, 9, 136, 157

194

Fistulas

Hormonal, 139, 157, 187 Hormone, 92, 148, 152, 154, 157, 160, 164, 179, 182, 187 Hormone Replacement Therapy, 92, 157 Horny layer, 152, 157 Hospital Charges, 157, 158 Hospital Costs, 68, 158 Host, 62, 94, 158, 159 Human Genome Project, 9, 120, 158 Hydatidiform Mole, 144, 158 Hydrogen, 30, 36, 37, 135, 140, 148, 149, 158, 165, 167, 170, 174 Hydrogen Peroxide, 30, 36, 37, 158 Hydroxylysine, 145, 158 Hydroxyproline, 136, 145, 158 Hyperbilirubinemia, 158, 161 Hyperplasia, 7, 82, 158 Hypertension, 8, 66, 91, 103, 139, 143, 158, 161, 172, 185 Hypertrophy, 158 Hypospadias, 27, 158 Hypothalamus, 158, 171, 179 Hysterectomy, 26, 92, 94, 158 Hysterotomy, 144, 158 I Id, 42, 51, 118, 122, 124, 130, 132, 158 Idiopathic, 3, 5, 158 Ileal, 32, 159 Ileum, 12, 33, 159 Ileus, 98, 159 Illusion, 159, 186 Immune response, 135, 138, 159, 181, 187 Immune system, 141, 159, 163, 185, 188 Immunity, 90, 135, 159 Immunization, 159, 173 Immunodeficiency, 118, 135, 159 Immunogenic, 70, 159 Immunoglobulin, 137, 159, 165 Immunologic, 159, 175 Immunology, 85, 135, 136, 159 Immunosuppressant, 154, 159, 164 Impairment, 16, 74, 139, 159, 164, 186 Implant radiation, 159, 160, 161, 175, 188 Implantation, 60, 64, 73, 81, 146, 159 In situ, 62, 159 In vitro, 7, 159 In vivo, 8, 85, 159 Incision, 83, 152, 156, 158, 159, 161 Incisive, 89, 159 Incisor, 159 Incompetence, 155, 159 Incontinence, 89, 90, 91, 94, 159, 181

Indicative, 92, 159, 169, 186 Infarction, 147, 157, 159, 165 Infection, 4, 10, 40, 64, 90, 94, 103, 123, 135, 137, 141, 144, 159, 160, 163, 166, 167, 181, 188 Inferior vena cava, 160, 186 Inflammation, 105, 136, 138, 139, 144, 145, 148, 150, 154, 156, 157, 160, 168, 170, 172, 180, 184, 186 Inflammatory bowel disease, 88, 90, 95, 99, 105, 160 Ingestion, 90, 160 Inguinal, 48, 160 Inguinal Hernia, 48, 160 Initiation, 8, 91, 160, 181 Inlay, 160, 176 Inner ear, 9, 104, 141, 145, 160, 168 Insulin, 160, 161 Intermittent, 154, 160, 170 Internal Medicine, 6, 8, 41, 154, 160, 166 Internal radiation, 160, 161, 175, 188 Interstitial, 92, 142, 153, 160, 161, 188 Intestinal, 19, 80, 88, 89, 98, 100, 104, 160, 163, 187 Intestinal Fistula, 19, 100, 160 Intestine, 142, 145, 160, 162, 187 Intracellular, 66, 160, 164, 173 Intracranial Aneurysm, 63, 77, 160 Intracranial Hypertension, 160, 183 Intramuscular, 161, 169 Intraocular, 66, 71, 74, 161 Intraocular pressure, 66, 71, 74, 161 Intravascular, 74, 161 Intravenous, 41, 77, 161, 169 Intubation, 50, 68, 143, 161 Intussusception, 161, 176 Invasive, 7, 68, 69, 73, 78, 82, 158, 159, 161, 163 Involuntary, 104, 140, 152, 153, 161, 166, 176, 179 Ionizing, 136, 151, 161, 175 Ions, 135, 140, 150, 158, 161, 174 Iris, 137, 147, 156, 161, 174 Irradiation, 75, 161, 188 Ischemia, 139, 157, 161 Islet, 88, 161 J Jaundice, 89, 158, 161 Jejunostomy, 151, 161 Joint, 77, 161, 163, 182 K Kb, 114, 161

Index 195

Kidney Disease, 4, 8, 37, 57, 103, 114, 119, 124, 162 Kidney Pelvis, 162, 185 L Labyrinth, 145, 160, 162, 170, 178, 187 Labyrinthine, 5, 162 Laceration, 96, 162 Large Intestine, 145, 149, 160, 162, 176, 179, 187 Larynx, 162, 184 Laser Surgery, 80, 162 Lavage, 46, 162 Lens, 138, 162, 187 Leukemia, 118, 162 Leukocytes, 66, 140, 141, 148, 152, 162, 165, 167, 184 Library Services, 130, 162 Ligament, 162, 174 Light microscope, 162, 165 Linkage, 9, 162 Lip, 36, 64, 75, 162 Lipid, 90, 139, 151, 160, 162 Liposomes, 66, 162 Liver scan, 162, 177 Liver Transplantation, 90, 163 Lobe, 163, 169 Lobectomy, 68, 163 Localization, 49, 163 Localized, 7, 135, 156, 160, 163, 171, 183, 184 Lower Esophageal Sphincter, 152, 155, 163 Lumen, 61, 62, 64, 73, 151, 163 Luxation, 149, 163 Lymph, 140, 144, 151, 163 Lymph node, 140, 144, 163 Lymphatic, 151, 160, 163, 179, 180 Lymphatic system, 163, 179, 180 Lymphocyte, 135, 138, 163 Lymphocyte Count, 135, 163 Lymphoid, 138, 148, 163 Lymphoma, 33, 41, 46, 47, 48, 50, 51, 118, 163 M Magnetic Resonance Imaging, 30, 163, 177 Maintenance therapy, 104, 163 Malabsorption, 90, 99, 118, 163 Malabsorption syndrome, 90, 163 Malformation, 3, 12, 49, 55, 63, 81, 163 Malignant, 14, 33, 34, 41, 42, 48, 81, 89, 118, 135, 138, 139, 144, 164, 166, 173, 175, 182 Malignant tumor, 81, 89, 144, 164

Malnutrition, 99, 136, 139, 164, 165 Mammary, 14, 164 Manifest, 76, 164 Maxillary, 164, 168 Maxillary Sinus, 164, 168 Medial, 139, 164, 167, 177 MEDLINE, 115, 117, 119, 164 Melanocytes, 164 Melanoma, 118, 164, 185 Membrane Proteins, 162, 164 Menopause, 92, 164 Menstruation, 164 Mental, iv, 6, 57, 114, 116, 120, 143, 144, 148, 153, 159, 164, 173, 174, 185 Mental Disorders, 57, 164, 173 Mental Health, iv, 6, 57, 114, 116, 164, 173 Mercaptopurine, 104, 164 Metastasis, 164, 166 Metastatic, 30, 50, 164 Methotrexate, 104, 164 MI, 14, 36, 134, 165 Microorganism, 145, 165, 187 Microsurgery, 63, 165 Migration, 24, 66, 72, 165, 186 Mitomycin, 74, 165 Mitosis, 138, 143, 165 Modeling, 8, 66, 165 Modification, 136, 155, 165, 174 Molecular, 27, 115, 117, 141, 146, 153, 162, 165, 184 Molecule, 138, 140, 146, 148, 165, 175, 186 Monitor, 8, 10, 165 Monoclonal, 56, 102, 161, 165, 175, 188 Monocytes, 85, 162, 165 Mononuclear, 165, 184 Motility, 88, 165 Mucins, 165, 177 Mucosa, 68, 99, 154, 165, 181 Mucus, 165, 185 Muscle Fibers, 165 Muscular Atrophy, 118, 165 Muscular Dystrophies, 150, 166 Mydriatic, 149, 166 Myocardium, 165, 166 Myotonic Dystrophy, 118, 166 N Nasogastric, 95, 98, 151, 166 NCI, 1, 56, 113, 166 Need, 3, 8, 60, 68, 72, 77, 79, 87, 93, 97, 99, 103, 104, 109, 126, 144, 166 Neodymium, 70, 166 Neonatal, 91, 166

196

Fistulas

Neoplasia, 88, 118, 166 Neoplasms, 88, 135, 138, 142, 156, 166, 175, 182 Neoplastic, 137, 163, 166 Nephrology, 4, 5, 8, 11, 16, 19, 23, 34, 38, 46, 166 Nephropathy, 162, 166 Nerve, 67, 70, 80, 91, 136, 137, 139, 140, 144, 153, 166, 167, 177, 178, 180, 187 Nervous System, 118, 143, 166, 170, 182 Neurologic, 55, 166 Neuropathy, 91, 166 Neurosurgery, 15, 19, 20, 25, 29, 31, 32, 33, 35, 36, 92, 93, 166 Neurotransmitter, 135, 136, 155, 166, 179, 181 Neutrons, 136, 161, 166, 175 Neutrophils, 162, 167 Nitrogen, 139, 167, 184 Nosocomial, 90, 167 Nuclei, 136, 155, 163, 165, 166, 167, 174, 187 Nucleic acid, 85, 155, 167 Nursing Care, 5, 89, 167, 169 Nutritional Support, 90, 100, 155, 167 Nystagmus, 4, 104, 150, 162, 167 O Ocular, 16, 71, 97, 167 Oncogene, 118, 167 Ophthalmic, 18, 167 Ophthalmology, 26, 27, 74, 167 Opportunistic Infections, 135, 167 Optic Chiasm, 158, 167 Optic Nerve, 66, 74, 167, 176, 177, 178 Optic nerve head, 66, 167 Orbit, 16, 168 Orbital, 16, 168 Oroantral Fistula, 15, 168 Osmotic, 136, 168 Ostomy, 15, 151, 168 Otolith, 97, 168 Ovary, 168, 181 Overdose, 154, 168 Oxygenation, 47, 157, 168 P Palate, 16, 17, 36, 168 Palliative, 68, 168, 183 Pancreas, 80, 88, 89, 95, 135, 149, 155, 156, 160, 161, 168, 179 Pancreatic, 6, 41, 88, 90, 92, 93, 118, 151, 155, 168, 174 Pancreatic cancer, 88, 118, 168

Pancreatic Ducts, 151, 168 Pancreatic Fistula, 6, 41, 88, 90, 92, 168 Pancreatic Juice, 155, 168 Pancreatitis, 64, 65, 88, 90, 168 Papilla, 151, 168 Paralysis, 55, 168 Parasite, 168 Parasitic, 90, 168 Parasitic Diseases, 90, 168 Parenteral, 90, 95, 99, 169 Parenteral Nutrition, 90, 95, 99, 169 Parietal, 169, 170, 172 Parotid, 28, 169 Paroxysmal, 118, 169 Partial remission, 169, 176 Parturition, 72, 169 Pathogenesis, 9, 29, 66, 88, 99, 169 Pathologic, 94, 138, 141, 147, 158, 169, 186 Pathologies, 61, 64, 65, 85, 169 Pathophysiology, 94, 95, 97, 169 Patient Care Management, 87, 169 Patient Education, 123, 128, 130, 134, 169 Pediatrics, 90, 169 Pelvic, 16, 91, 94, 96, 97, 98, 169, 174 Pelvis, 135, 160, 169, 185 Penis, 12, 158, 169 Pepsin, 169 Pepsin A, 169 Peptic, 90, 169 Peptic Ulcer, 90, 169 Peptide, 136, 169, 174 Percutaneous, 18, 29, 30, 60, 61, 62, 83, 91, 95, 170 Perforation, 61, 138, 170, 184, 187 Perfusion, 14, 170 Perianal, 14, 30, 37, 42, 104, 123, 170 Perilymph, 45, 49, 91, 97, 122, 123, 170 Perineal, 16, 22, 92, 96, 170 Perineum, 89, 96, 158, 170 Peripheral Nervous System, 166, 170, 179, 181 Peripheral vision, 170, 187 Peritoneal, 88, 91, 95, 103, 170 Peritoneal Cavity, 170 Peritoneal Dialysis, 89, 91, 103, 170 Peritoneum, 170 Peritonitis, 98, 170, 187 PH, 29, 170 Pharmaceutical Preparations, 152, 155, 170 Pharmacologic, 137, 170, 184 Pharynx, 155, 170

Index 197

Phospholipids, 153, 170 Photodynamic therapy, 84, 171 Physical Examination, 4, 94, 171 Physical Therapy, 91, 171 Physiologic, 5, 164, 171, 173 Physiology, 50, 88, 89, 90, 91, 154, 166, 171 Pilonidal Sinus, 88, 171 Pineal gland, 144, 171 Pituitary Gland, 14, 171 Planets, 171, 186 Plants, 142, 155, 171, 184 Plaque, 137, 171 Plasma, 136, 138, 151, 153, 155, 156, 171, 174, 178 Plasma cells, 138, 171 Plasma protein, 136, 151, 171, 174 Platelets, 171, 183 Platinum, 63, 171 Pleura, 172 Pleural, 13, 172 Pneumonectomy, 32, 172 Pneumonia, 147, 172 Polycystic, 119, 172 Polydipsia, 50, 172 Polyposis, 145, 172 Polytetrafluoroethylene, 103, 172 Porosity, 72, 172 Portal Hypertension, 88, 90, 152, 172 Portal Vein, 172 Posterior, 12, 71, 75, 137, 139, 143, 144, 148, 150, 152, 161, 168, 172, 178 Postoperative, 21, 28, 29, 35, 68, 89, 94, 96, 97, 172 Post-traumatic, 11, 172 Postural, 46, 172 Practicability, 172, 184 Practice Guidelines, 105, 116, 172 Precursor, 85, 138, 152, 172, 174, 184, 187 Preoperative, 90, 94, 96, 100, 172 Prevalence, 5, 29, 99, 172 Primary Biliary Cirrhosis, 88, 172 Primary Prevention, 7, 173 Primary Sclerosing Cholangitis, 90, 173 Probe, 71, 76, 82, 173 Proctocolectomy, 26, 173 Prognostic factor, 95, 173 Progression, 69, 137, 173 Progressive, 60, 67, 80, 104, 139, 144, 148, 156, 166, 173 Projection, 167, 173, 176 Prolapse, 91, 94, 173

Proliferating Cell Nuclear Antigen, 65, 173 Proline, 145, 158, 173 Prone, 10, 173 Prostaglandin, 41, 66, 173 Prostaglandins A, 173, 174 Prostate, 38, 50, 94, 118, 174 Prosthesis, 40, 68, 69, 72, 78, 174 Protein C, 70, 136, 137, 174 Protein S, 70, 85, 93, 119, 141, 155, 174, 181 Protein Subunits, 85, 174 Proteins, 7, 70, 76, 136, 137, 138, 145, 148, 164, 165, 167, 169, 170, 171, 174, 178 Prothrombin, 174, 183 Protons, 136, 158, 161, 174, 175 Proximal, 12, 17, 40, 60, 63, 81, 82, 149, 174 Pseudocysts, 88, 174 Psychic, 164, 174, 178 Public Policy, 115, 174 Pulmonary, 12, 30, 80, 90, 118, 141, 147, 156, 174, 186 Pulmonary Artery, 12, 141, 174, 186 Pulmonary hypertension, 12, 30, 174 Pulse, 165, 174 Pupil, 147, 149, 166, 174 Putrefaction, 154, 174 Q Quality of Life, 105, 174 R Race, 165, 175 Radiation, 26, 75, 80, 151, 153, 154, 160, 161, 175, 177, 185, 188 Radiation therapy, 153, 160, 161, 175, 188 Radioactive, 141, 158, 159, 160, 161, 162, 175, 177, 188 Radioimmunotherapy, 175 Radiolabeled, 161, 175, 188 Radiological, 61, 91, 170, 175 Radiologist, 88, 175 Radiology, 14, 18, 21, 25, 26, 29, 30, 31, 36, 37, 40, 89, 175 Radiopharmaceutical, 155, 175 Radiotherapy, 12, 19, 38, 142, 161, 175, 188 Radius, 74, 175 Random Allocation, 175 Randomization, 10, 175 Randomized, 7, 8, 9, 33, 56, 150, 175 Rectal, 22, 49, 80, 88, 89, 95, 122, 176 Rectal Fistula, 22, 176 Rectal Prolapse, 88, 89, 176 Rectovaginal Fistula, 28, 31, 34, 35, 47, 92, 96, 176

198

Fistulas

Recurrence, 5, 105, 123, 176 Red Nucleus, 139, 176 Reductase, 7, 164, 176 Refer, 1, 87, 145, 150, 163, 167, 172, 175, 176, 184, 187 Reflex, 97, 153, 176 Reflux, 152, 155, 176 Refraction, 176, 180 Regimen, 150, 176 Regurgitation, 152, 155, 176 Remission, 104, 105, 163, 176 Renal Dialysis, 66, 176 Resection, 24, 27, 49, 68, 72, 176 Respiration, 165, 176 Respiratory Mucosa, 155, 176 Restoration, 36, 171, 176, 188 Retina, 67, 144, 150, 162, 167, 176, 177, 178, 187 Retinal, 167, 177 Retinal Ganglion Cells, 167, 177 Retinoblastoma, 118, 177 Retrograde, 29, 31, 177 Ribose, 135, 177 Rickets, 177, 187 Risk factor, 27, 84, 177 Round Window, 5, 177 S Saliva, 5, 68, 125, 177 Salivary, 149, 153, 168, 177 Salivary glands, 149, 153, 177 Saphenous, 12, 83, 177 Saphenous Vein, 12, 83, 177 Scalpel, 24, 177 Scans, 104, 177 Scatter, 177, 185 Sclera, 7, 70, 71, 144, 147, 178 Sclerosis, 118, 139, 178 Sclerostomy, 75, 178 Screening, 145, 178 Secretion, 99, 144, 165, 178 Segmental, 3, 41, 50, 178 Segmentation, 178 Seizures, 169, 178 Sella, 171, 178 Semen, 52, 174, 178 Semicircular canal, 160, 178 Sepsis, 6, 22, 90, 123, 178 Serous, 151, 172, 178 Serrata, 144, 178 Serum, 103, 136, 145, 156, 170, 178, 184 Seton, 31, 48, 49, 178 Sex Determination, 119, 178

Sexually Transmitted Diseases, 88, 178 Shock, 178, 184 Shunt, 5, 178 Side effect, 104, 107, 109, 136, 141, 178, 184 Sigmoid, 31, 98, 179 Sigmoid Colon, 98, 179 Sigmoidoscopy, 89, 179 Signs and Symptoms, 87, 176, 179, 185 Skeletal, 166, 179 Skeleton, 153, 161, 173, 179 Skull, 32, 141, 148, 168, 179, 182 Small intestine, 150, 151, 157, 159, 160, 166, 179 Smoking Cessation, 104, 179 Smooth muscle, 7, 65, 66, 83, 179, 181 Sneezing, 179, 181 Social Environment, 175, 179 Sodium, 36, 141, 179 Solid tumor, 137, 179 Solitary Rectal Ulcer, 89, 179 Solvent, 152, 168, 179 Somatostatin, 15, 42, 109, 179 Sound wave, 147, 175, 179 Spasm, 41, 179 Spasmodic, 93, 179 Spatial disorientation, 150, 180 Specialist, 87, 125, 149, 180 Species, 64, 152, 165, 168, 175, 180, 181, 184, 188 Spectrum, 9, 66, 80, 180 Sperm, 144, 180 Sphincter, 49, 94, 123, 162, 176, 180, 181 Spinal cord, 19, 55, 143, 144, 148, 166, 170, 176, 180, 181, 182, 186 Spinous, 152, 180 Spirochete, 180, 182 Spleen, 80, 163, 180 Spondylitis, 36, 180 Sporadic, 177, 180 Stabilization, 6, 75, 95, 180 Staging, 177, 180 Stenosis, 4, 7, 10, 17, 29, 60, 66, 84, 104, 180, 181 Stent, 34, 60, 67, 72, 73, 74, 78, 79, 82, 168, 180 Sterile, 70, 180 Steroids, 104, 148, 180 Stimulus, 140, 150, 176, 180, 183 Stoma, 64, 168, 180 Stool, 96, 145, 159, 162, 180 Strand, 178, 180 Streptomycin, 5, 180

Index 199

Stress, 4, 5, 64, 76, 82, 91, 95, 148, 181 Stress urinary, 91, 181 Stricture, 180, 181 Stroke, 18, 28, 55, 57, 114, 143, 157, 181 Stromal, 74, 181 Stromal Cells, 74, 181 Subacute, 160, 181 Subarachnoid, 76, 181 Subclavian, 104, 140, 181, 186 Subclavian Artery, 181, 186 Subclavian Vein, 104, 140, 181 Subclinical, 160, 178, 181 Subconjunctival, 66, 181 Subcutaneous, 76, 150, 169, 181 Subspecies, 180, 181 Substance P, 178, 181 Substrate, 67, 181 Suction, 41, 95, 98, 154, 181 Sunburn, 181, 185 Suppositories, 155, 181 Suppression, 74, 182 Surgical Instruments, 71, 182 Sympathetic Nervous System, 166, 182 Sympathomimetic, 152, 182 Symphysis, 144, 174, 182 Symptomatic, 168, 182 Synergistic, 7, 182 Syphilis, 93, 182 Systemic, 4, 10, 30, 108, 138, 141, 152, 160, 161, 175, 182, 188 Systemic disease, 4, 182 Systolic, 158, 182 T Tachycardia, 140, 182 Tachypnea, 140, 182 Telangiectasia, 119, 182 Temporal, 5, 97, 182 Teratoma, 144, 182 Testis, 144, 182 Testosterone, 176, 182 Thalamic, 139, 182 Thalamic Diseases, 139, 182 Therapeutics, 14, 67, 108, 182 Thermal, 75, 80, 167, 183 Thigh, 36, 153, 156, 183 Thoracic, 11, 12, 13, 17, 21, 29, 32, 34, 35, 41, 68, 149, 172, 181, 183, 188 Thorax, 135, 183 Threshold, 65, 158, 183 Thrombectomy, 104, 150, 183 Thrombin, 70, 153, 174, 183 Thrombolytic, 79, 183

Thrombomodulin, 174, 183 Thrombosed, 30, 36, 60, 183 Thrombosis, 7, 10, 60, 80, 83, 91, 103, 174, 181, 183 Thrombus, 60, 63, 75, 80, 147, 159, 183, 186 Thyroxine, 136, 183 Tin, 171, 183 Tinnitus, 91, 97, 104, 183, 187 Tomography, 19, 49, 146, 177, 183 Tonic, 152, 183 Topical, 104, 152, 158, 183 Toxic, iv, 151, 159, 166, 183, 184 Toxicity, 150, 184 Toxicology, 116, 184 Toxin, 28, 151, 184 Trabecular Meshwork, 74, 184 Trabeculectomy, 71, 75, 184 Trachea, 5, 67, 142, 162, 170, 184 Tracheoesophageal Fistula, 5, 13, 48, 122, 184 Transfection, 141, 184 Translation, 136, 184 Transplantation, 16, 19, 31, 41, 50, 88, 90, 144, 159, 184 Trauma, 64, 88, 89, 91, 92, 94, 96, 97, 98, 123, 156, 168, 184 Treatment Outcome, 26, 184 Tryptophan, 145, 184 Tuberous Sclerosis, 119, 184 Tumor Necrosis Factor, 56, 85, 184 Tunica, 151, 165, 184 U Ulcer, 47, 169, 179, 184, 186 Ulceration, 155, 184 Ulcerative colitis, 89, 105, 160, 173, 184 Ultrafiltration, 156, 185 Ultrasonography, 18, 30, 185 Ultraviolet radiation, 75, 181, 185 Unconscious, 137, 158, 185 Uraemia, 168, 185 Ureter, 98, 162, 185 Urethra, 94, 98, 158, 169, 174, 185 Urinary, 13, 23, 36, 48, 74, 80, 91, 93, 94, 97, 98, 148, 155, 159, 181, 185 Urinary Fistula, 13, 48, 80, 92, 94, 97, 98, 185 Urinary tract, 36, 80, 98, 185 Urinate, 94, 185 Urine, 64, 93, 94, 141, 147, 149, 157, 159, 181, 185 Urodynamic, 91, 185 Urogenital, 155, 185

200

Fistulas

Uterus, 135, 144, 158, 164, 185, 186 V Vaccine, 135, 185 Vagina, 72, 94, 96, 98, 133, 144, 158, 164, 176, 186, 187 Vaginal, 16, 26, 31, 32, 37, 38, 46, 72, 92, 93, 94, 152, 186 Vaginal Fistula, 16, 26, 32, 37, 38, 46, 93, 186 Varicose, 52, 64, 65, 186 Varicose Ulcer, 64, 65, 186 Varicose vein, 186 Vascular Fistula, 82, 186 Vasculitis, 168, 186 Vasoconstriction, 152, 186 Vector, 168, 186 Vena, 74, 186 Vena Cava Filters, 74, 186 Venereal, 182, 186 Venous Insufficiency, 186 Venous Thrombosis, 186 Ventricle, 11, 138, 158, 174, 182, 186 Ventricular, 11, 41, 50, 186 Venules, 141, 142, 151, 186 Venus, 81, 186 Vertebrae, 180, 186 Vertebral, 21, 26, 50, 186 Vertebral Artery, 26, 50, 186 Vertigo, 97, 186, 187 Vesicovaginal Fistula, 23, 26, 33, 40, 46, 47, 94, 187 Vestibular, 4, 90, 97, 104, 123, 162, 187

Vestibule, 145, 160, 178, 187 Vestibulocochlear Nerve, 183, 187 Vestibulocochlear Nerve Diseases, 183, 187 Veterinary Medicine, 115, 187 Viral, 89, 187 Viral Hepatitis, 89, 187 Virus, 70, 135, 155, 171, 187 Visual field, 66, 167, 187 Vitamin D, 100, 177, 187 Vitreous, 162, 177, 187 Vitreous Body, 177, 187 Vitro, 8, 187 Vivo, 8, 61, 64, 187 Volition, 161, 187 Volvulus, 88, 187 W Weight Gain, 153, 188 White blood cell, 138, 162, 163, 165, 171, 188 Windpipe, 125, 142, 170, 188 Wound Healing, 66, 71, 188 X Xenograft, 137, 188 X-ray, 139, 146, 147, 151, 154, 161, 175, 177, 188 X-ray therapy, 161, 188 Y Yttrium, 70, 188 Z Zymogen, 174, 188

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