Kidney Stones - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References (Official Physician Guides)

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

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

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright Ó2003 by ICON Group International, Inc. Copyright Ó2003 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., 1960Kidney Stones: 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: 0-597-83603-5 1. Kidney Stones-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 kidney stones. 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 KIDNEY STONES ........................................................................................ 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Kidney Stones ............................................................................. 13 E-Journals: PubMed Central ....................................................................................................... 31 The National Library of Medicine: PubMed ................................................................................ 31 CHAPTER 2. NUTRITION AND KIDNEY STONES .............................................................................. 61 Overview...................................................................................................................................... 61 Finding Nutrition Studies on Kidney Stones .............................................................................. 61 Federal Resources on Nutrition ................................................................................................... 64 Additional Web Resources ........................................................................................................... 65 CHAPTER 3. ALTERNATIVE MEDICINE AND KIDNEY STONES ........................................................ 69 Overview...................................................................................................................................... 69 The Combined Health Information Database............................................................................... 69 National Center for Complementary and Alternative Medicine.................................................. 70 Additional Web Resources ........................................................................................................... 74 General References ....................................................................................................................... 79 CHAPTER 4. PATENTS ON KIDNEY STONES .................................................................................... 81 Overview...................................................................................................................................... 81 Patents on Kidney Stones ............................................................................................................ 81 Patent Applications on Kidney Stones......................................................................................... 90 Keeping Current .......................................................................................................................... 92 CHAPTER 5. BOOKS ON KIDNEY STONES ........................................................................................ 93 Overview...................................................................................................................................... 93 Book Summaries: Federal Agencies.............................................................................................. 93 Book Summaries: Online Booksellers........................................................................................... 94 The National Library of Medicine Book Index ............................................................................. 95 Chapters on Kidney Stones .......................................................................................................... 96 Directories.................................................................................................................................. 101 CHAPTER 6. MULTIMEDIA ON KIDNEY STONES ........................................................................... 103 Overview.................................................................................................................................... 103 Video Recordings ....................................................................................................................... 103 Bibliography: Multimedia on Kidney Stones ............................................................................. 104 CHAPTER 7. PERIODICALS AND NEWS ON KIDNEY STONES ........................................................ 105 Overview.................................................................................................................................... 105 News Services and Press Releases.............................................................................................. 105 Newsletters on Kidney Stones.................................................................................................... 109 Newsletter Articles .................................................................................................................... 109 Academic Periodicals covering Kidney Stones........................................................................... 111 CHAPTER 8. RESEARCHING MEDICATIONS................................................................................... 113 Overview.................................................................................................................................... 113 U.S. Pharmacopeia..................................................................................................................... 113 Commercial Databases ............................................................................................................... 115 Researching Orphan Drugs ....................................................................................................... 116 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 119 Overview.................................................................................................................................... 119 NIH Guidelines.......................................................................................................................... 119 NIH Databases........................................................................................................................... 121 Other Commercial Databases..................................................................................................... 124 APPENDIX B. PATIENT RESOURCES ............................................................................................... 125

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Overview.................................................................................................................................... 125 Patient Guideline Sources.......................................................................................................... 125 Associations and Kidney Stones ................................................................................................ 136 Finding Associations.................................................................................................................. 138 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 141 Overview.................................................................................................................................... 141 Preparation................................................................................................................................. 141 Finding a Local Medical Library................................................................................................ 141 Medical Libraries in the U.S. and Canada ................................................................................. 141 ONLINE GLOSSARIES ................................................................................................................ 147 Online Dictionary Directories ................................................................................................... 147 KIDNEY STONES DICTIONARY.............................................................................................. 149 INDEX .............................................................................................................................................. 191

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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 kidney stones 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 kidney stones, 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 kidney stones, 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 kidney stones. 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 kidney stones, 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 kidney stones. 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 KIDNEY STONES Overview In this chapter, we will show you how to locate peer-reviewed references and studies on kidney stones.

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

Stressful Life Events and Risk of Symptomatic Kidney Stones Source: International Journal of Epidemiology. 26(5): 1017-1023. October 1997. Contact: Available from Oxford University Press. Journals Subscription Department, Great Clarendon Street, Oxford OX2 6DP, UK. 44 (0)1865 267907. Fax 44 (0)1865 267485. Summary: A substantial proportion of cases of hypercalciuria (extra calcium in the urine) and nephrolithiasis (kidney stones) are idiopathic (undetermined cause). Several studies suggest that stressful life events increase lithogenic urinary constituents (calcium, oxalate, and uric acid). This article reports on a study undertaken to test the hypothesis that there is an association between stressful life events and symptomatic kidney stones. The case control study of 200 symptomatic kidney stone cases and 200 matched controls was designed. In this study, the stressors included those life events

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that the subjects perceived as highly stressful and inflicted upon them in an intense emotional impact with apprehension and distress for at least one week in duration. Ten of eleven (92 percent) categories and 41 of 60 (68 percent) subcategories of stressful events occurred more frequently among cases than controls. Eighteen stressful events had odds ratios of 1.5 or greater. Of the seven significant variables that were entered into a multivariate logistic regression model, the following three remained statistically significant between cases and controls: annual family income (lower for cases); stressful mortgage problems; and emotional life events. The overall prevalence rate of stressful life events was significantly higher among cases than controls. The authors conclude that the data support the hypothesis that there is an association between stressful life events and symptomatic kidney stones. Stress has already been implicated as an important factor in coronary heart disease and a variety of other illnesses. If the results of this preliminary study are confirmed, it would add another disease to the list of those influenced by stress and provide more compelling reasons to include stress detection and management as one component of regular health promotion and disease prevention examinations. 2 tables. 23 references. ·

Kidney Stones: Identifying the Causes Source: Patient Care. 24(15): 31-36, 39-40, 43-46. September 30, 1990. Summary: Advances in understanding the pathophysiology of kidney stone formation have paved the way for efficient metabolic evaluation, which in turn guides the design of an effective preventive regimen. So contend the authors of this article which focuses on identifying the causes of kidney stones. The authors stress that advances in acute treatment of renal calculi should not lead to neglect of metabolic evaluation and preventive treatment. Other topics discussed include hypercalciuria, systemic diseases associated with hypercalciuria, types of idiopathic hypercalciuria, noncalcium stones, metabolic evaluation of both first-time and recurrent stone patients, metabolic abnormalities in nephrolithiasis, and simplified metabolic evaluation available by mail. 1 figure. 1 table. 13 references. (AA-M).

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Beverage Use and Risk for Kidney Stones in Women Source: Annals of Internal Medicine. 128(7): 534-540. April 1, 1998. Summary: An increase in fluid intake is routinely recommended for patients who have had kidney stones to decrease the likelihood of recurrence. However, data on the effect of particular beverages on stone formation in women are limited. This article reports on a study undertaken to examine the association between the intake of 17 beverages and risk for kidney stones in women. The prospective cohort study included 8 years of followup. The participants were 81,093 women in the Nurses Health Study who were 40 to 65 years of age in 1986 and had no history of kidney stones. Beverage use and diet were assessed in 1986 and 1990 with validated, self-administered food frequency questionnaire. The main outcome measure was incident symptomatic kidney stones. During 553,081 person-years of followup over the 8 year period, 719 cases of kidney stones were documented. After risk factors other than fluid intake were controlled for, the relative risk for stone formation for women in the highest quintile of total fluid intake compared with women in the lowest quintile was 0.62. Inclusion of consumption of specific beverages in the multivariate model significantly added to prediction of risk for kidney stones. In a model that adjusted simultaneously for the 17 beverages and other possible risk factors, risk for stone formation decreased by the following amount for each 8 ounce serving consumed daily: 10 percent for caffeinated coffee, 9 percent for decaffeinated coffee, 8 percent for tea, and 59 percent for wine. In contrast, a 44 percent

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increase in risk was seen for each 8 ounce serving of grapefruit juice consumed daily. The authors note that the observed protective effect of caffeinated coffee, tea, and alcoholic beverages may be mediated through their effect on urinary concentration. Caffeine increases flow of a more dilute urine by interfering with the action of antidiuretic hormone on the distal nephron, thus decreasing risk for crystal formation. However, this beneficial effect may be partly offset by the increase in urinary calcium excretion caused by caffeine. The authors conclude that an increase in total fluid intake can reduce risk for kidney stones, and the choice of beverage may be meaningful. 3 tables. 32 references. (AA-M). ·

Comparison of Dietary Calcium with Supplemental Calcium and Other Nutrients as Factors Affecting the Risk for Kidney Stones in Women Source: Annals of Internal Medicine. 126(7): 497-504. April 1, 1997. Contact: Available from American College of Physicians. American Society of Internal Medicine. 190 North Independence Mall West, Philadelphia, PA 19106-1572. Website: www.acponline.org. Summary: Calcium intake is believed to play an important role in the formation of kidney stones, but data on the risk factors for stone formation in women are limited. This article reports on a study undertaken to examine the association between intake of dietary and supplemental calcium and the risk for kidney stones in women. The prospective cohort study with 12 year followup included 91,731 women participating in the Nurses' Health Study I who were 34 to 59 years of age in 1980 and had no history of kidney stones. Self administered food frequency questionnaires were used to assess diet in 1980, 1984, 1986, and 1990. The main outcome measure was incident symptomatic kidney stones. During 903,849 person years of followup, 864 cases of kidney stones were documented. After adjustment for potential risk factors, intake of dietary calcium was inversely associated with risk for kidney stones and intake of supplemental calcium was positively associated with risk. The relative risk in women who took supplemental calcium compared with women who did not was 1.20. In 67 percent of women who took supplemental calcium, the calcium either was not consumed with a meal or was consumed with meals whose oxalate content was probably low. The authors conclude that high intake of dietary calcium appears to decrease risk for symptomatic kidney stones, whereas intake of supplemental calcium may increase risk. Because dietary calcium reduces the absorption of oxalate, the apparently different effects caused by the type of calcium may be associated with the timing of calcium ingestion relative to the amount of oxalate consumed. However, other factors present in dairy products (the major source of dietary calcium) could be responsible for the decreased risk seen with dietary calcium. 6 tables. 33 references.

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Role of Bacteria in the Development of Kidney Stones Source: Current Opinion in Urology. 10(1): 35-38. January 2000. Contact: Available from Lippincott Williams and Wilkins. 241 Borough High Street, London, SE1 1GB, UK. +44 (0) 171940-7500. E-mail: [email protected]. Summary: Currently, only struvite stones are regarded as deriving from bacteria. Recent work has suggested that calcium based stones might also have an infectious origin. This article reviews related research and discusses the potential role of bacteria in the development of kidney stones. Nanobacteria, small intracellular bacteria found in human kidney stones, are capable of forming a calcium phosphate shell, and thus could serve as crystallization centers for renal calculi (stone) formation. Until now, however,

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all trials performed to confirm the presence of nanobacteria in human calculi, serum, or urine have failed. The authors note that if any other bacteria are to be implicated in the development of renal stones, the best way to identify them would be to screen more randomly for expression of nonhuman DNA or RNA in stone forming kidneys. 10 references. ·

Modification of Dietary Oxalate and Calcium Reduces Urinary Oxalate in Hyperoxaluric Patients with Kidney Stones Source: Journal of the American Dietetic Association. 93(11): 1305-1307. November 1993. Summary: Dietary restriction of oxalate intake has been used to reduce the risk of recurrence of calcium oxalate kidney stones. This article reports on a research study that entailed modification of dietary oxalate and calcium. Seventeen patients who experienced hyperoxaluria when consuming their usual diets were identified from patients with kidney stones who were referred for clinical studies. Thirteen of these patients volunteered for the study: six women aged 35 to 63 years and seven men aged 37 to 49 years. The study consisted of three diets: Diet A, a low-calcium diet; Diet B, which omitted eight high-oxalate foods and included 300-mg calcium per day; and Diet C, in which patients ate any high-oxalate foods they preferred. Results showed that urinary oxalate was significantly lower in patients when they consumed diets A and B than when they consumed diet C. Urinary calcium excretion was not significantly different among dietary treatments. 1 figure. 1 table. 12 references.

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100. Diet and Kidney Stones Source: New England Journal of Medicine. 346(2): 74-76. January 10, 2002. Summary: Kidney and bladder stones cause excruciating pain, tend to recur, and are distressingly common. This article briefly summarizes the history of medical understanding and treatment of kidney stones, reviews the dietary approaches to management and prevention, and offers an introduction to a related article elsewhere in the same journal. The author notes that the research study found that the participants (all male) assigned to a normal calcium diet (but low in animal protein and salt) had far fewer stones recurring than did men assigned to a low calcium diet. The author concludes that, while this approach has yet to be proven in men and women, or in a wider geographic area than in the original study, it may be worthwhile to try in a patient at risk of kidney or bladder stone recurrence. 1 figure.

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New Treatment Options for Kidney Stones Source: Family Urology. 6(2): 4-6. 2001. Contact: Available from American Foundation for Urologic Disease. 1126 North Charles Street, Baltimore, MD 21201. (800) 242-2383 or (410) 468-1800. Fax (410) 468-1808. Website: www.afud.org. Summary: Kidney stones (lithiasis) are formed by various crystals that gather in the kidneys or urinary tract. These materials build up over a period of time and ultimately interfere with urination. This article reviews new treatment options for kidney stones. Research has shown that shock waves generated outside the body can pulverize urinary stones inside the body, resulting in spontaneous passage of sand like particles. This treatment, called lithotripsy, is preferred to traditional surgical treatment in most cases. Approximately 50 to 80 percent of patients treated with lithotripsy become stone free, depending on the size and type of stone treated. Most of the remaining patients pass the

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majority of their stone(s) but are left with some residual stone fragments that cause no symptoms. Some patients (approximately 10 to 30 percent) require more than one lithotripsy treatment to completely pulverize their stone(s). The authors describe what the patient can expect during a lithotripsy treatment, which usually lasts approximately one hour. The authors then describe the use of ureteroscopy, a procedure which is often used to remove stones in the ureter and the kidney. Ureteroscopy uses a small flexible guide wire, small fiberoptic scopes, and laser or ultrasound devices to locate, fragment, and remove the stone(s). A final option for removal of kidney stones is discussed: percutaneous (PERC) nephrostolithotomy, which is used to treat extremely large kidney stones, difficult to fragment stones, patients with a blockage in the urinary tract as well as kidney stones, or patients in whom shock wave lithotripsy has not been successful. Depending on the type of kidney stone problem treated, antibiotics are commonly prescribed for a week or two following discharge from the hospital. ·

Family History and Risk of Kidney Stones Source: JASN. Journal of the American Society of Nephrology. 8(10): 1568-1573. October 1997. Contact: Available from Williams and Wilkins. 428 E. Preston Street, Baltimore, MD 21202. (800) 638-6423. Summary: Kidney stones develop more frequently in individuals with a family history of kidney stones than in those without a family history; however, little information is available regarding whether the increased risk is attributable to genetic factors, environmental exposures, or some combination. In this article, the authors report on a study in which the relation between family history and risk of kidney stone formation was investigated in a cohort of 37,999 male participants in the Health Professionals Follow-up Study. Information on family history, kidney stone formation, and other exposures of interest, including dietary intake, was obtained by mailed questionnaires. A family history of kidney stones was much more common in men with a personal history of stones at baseline in 1986 than in those without a history of stones. During 8 years of followup, 795 incident cases of stones were documented. After adjusting for a variety of risk factors, the relative risk of incident stone formation in men with a positive family history, compared with those without, was 2.57. Family history did not modify the inverse association between dietary calcium intake and the risk of stone formation. These results suggest that a family history of kidney stones substantially increases the risk of stone formation. In addition, the data suggest that dietary calcium restriction may increase the risk of stone formation among individuals with or without a family history of kidney stones. Despite the strong association between family history and kidney stones, most individuals who have kidney stones do not have a family history of stones. 5 tables. 21 references. (AA-M).

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Randomized Controlled Trial of a Low Animal Protein, High Fiber Diet in the Prevention of Recurrent Calcium Oxalate Kidney Stones Source: American Journal of Epidemiology. 144(1): 25-33. July 1, 1996. Summary: Low protein diets are commonly prescribed for patients with idiopathic calcium nephrolithiasis, who account for more than 80 percent of new diagnoses of kidney stones. This dietary advice is supported by metabolic studies and epidemiologic observational studies but has not been evaluated in a controlled trial. This article reports on a study in which the authors, using 1983 to 1985 data from three Northern California Kaiser Permanente Medical Centers, randomly assigned 99 persons who had calcium

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oxalate stones for the first time to a low animal protein, high fiber diet. The diet contained approximately 56 to 64 g daily of protein, 75 mg daily of purine (primarily from animal protein and legumes), one-fourth cup of wheat bran supplement, and fruits and vegetables. Intervention subjects were also instructed to drink six to eight glasses of liquid daily and to maintain adequate calcium intake from dairy products or calcium supplements. Control subjects were instructed only on fluid intake and adequate calcium intake. Both groups were followed regularly for up to 4.5 years with food frequency questionnaires, serum and urine chemistry analysis, and abdominal radiography; and they were urged to comply with dietary instructions. In the intervention group of 50 subjects, stones recurred in 12 (7.1 per 100 person-years) compared with 2 (1.2 per 100 person-years) in the control group; both groups received a mean of 3.4 person-years of followup. After adjustment for possible confounding effects of age, sex, education, and baseline protein and fluid intake, the relative risk of a recurrent stone in the intervention group was 5.6 compared with the control group. The authors conclude that advice to follow a low animal protein, high fiber, high fluid diet has no advantage over advice to increase fluid intake alone. 3 figures. 4 tables. 40 references. (AA-M). ·

Nanobacteria: An Infectious Cause for Kidney Stone Formation Source: Kidney International. 56(5): 1893-1898. November 1999. Contact: Available from Blackwell Science, Inc. Journals Fulfillment Department, 350 Main Street, Malden MA 02148. (781) 388-8250. Summary: Nanobacteria are cytotoxic, sterile filterable, gram negative, atypical bacteria detected in bovine (cow) and human blood. Nanobacteria produce carbonate apatite on their cell walls. Data on Randall's plaques suggest that apatite may initiate kidney stone formation. This article reports on a study that assessed nanobacteria in 72 consecutively collected kidney stones from Finnish patients. Nanobacteria and kidney stone units were compared using scanning electron microscopy (SEM). Demineralized kidney stones were screened for nanobacteria. SEM highlighted the resemblance in size and morphology of nanobacteria and the smallest apatite units in the kidney stones. Nanobacterial antigens could be detected after the demineralization of the stones (with hydrogen chloride). Nanobacteria were surprisingly resistant to this treatment, and cultures could be established from 93.1 percent of the stones. Only struvite stones had common bacteria, in addition to the nanobacteria. When the results of all of the assays were combined, 70 of the 72 stones (that is, 97.2 percent) were nanobacteria positive. Although apatite stones indicated highest nanobacteria antigen signals, the overall nanobacteria positivity did not depend on the stone type. The isolated nanobacteria produced apatite stones in vitro. The authors propose that kidney stone formation is a nanobacterial disease analogous to Helicobacter pylori infection and peptic ulcer disease. Both diseases are initiated by bacterial infection and subsequently endogenous and dietary factors influence their progression. 3 figures. 1 table. 29 references.

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Prospective Study of Beverage Use and the Risk of Kidney Stones Source: American Journal of Epidemiology. 143(3): 240-247. February 1, 1996. Summary: Patients with kidney stones are routinely advised to increase their fluid intake to decrease the risk of stone recurrence. However, there has been no detailed examination to determine whether the effect on recurrence varies by the type of beverages consumed. In this article, the authors report on their prospective study of the relation between the intake of 21 different beverages and the risk of symptomatic kidney

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stones in a cohort of 45, 289 men, 40 to 75 years of age, who had no history of kidney stones. During 6 years of followup, 753 incident cases of kidney stones were documented. After adjusting for other variables, consumption of specific beverages significantly added to the prediction of kidney stone risk. The risk of stone formation decreased by the following amount for each 240ml (8 oz) serving consumed daily: caffeinated coffee, 10 percent; decaffeinated coffee, 10 percent; tea, 14 percent; beer, 21 percent; and wine, 39 percent. For each 240ml serving consumed daily, the risk of stone formation increased by 35 percent for apple juice and 37 percent for grapefruit juice. 3 tables. 30 references. (AA-M). ·

New Insights into Causes and Treatments of Kidney Stones Source: Hospital Practice. 35(3):49-50, 53-56, 62-63. March 15, 2000. Contact: McGraw-Hill Healthcare Publications. 4530 West 77th Street, Minneapolis, MN 55435. (612) 835-3222. Fax (615) 835-3460. Summary: Recent findings have provided insight into the molecular basis of kidney stone formation and entirely changed the approach to management of calcium stones. This article reviews these new insights into the causes and treatments of kidney stones. Medical therapy for the underlying causes of kidney stones, such as the use of thiazides for hypercalciuria (too much calcium in the urine), potassium citrate for hypocitraturia (too little citrate in the urine), or allopurinol for hyperuricosuria (too much uric acid in the urine), will reduce the rate of stone recurrence. Increased water intake will also reduce the frequency of recurrences, as has been demonstrated in a randomized prospective trial. Rational dietary therapy is also beneficial. The author stresses that the financial benefits of reducing stone recurrence far outweigh the costs of diagnostic evaluation and therapy. All patients with recurrent stones should have a full metabolic evaluation. For those who do not respond to medical treatment, new surgical techniques, including extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy, ureteroscopy, and laser lithotripsy, are improvements over older surgical options for this painful disease. The author concludes that understanding the role of genetic factors and the various promotors and inhibitors of stone formation should lead to more effective prophylaxis and treatment of other types of stones as well. 3 figures. 2 tables. 12 references.

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Effects of 5 Different Diets on Urinary Risk Factors for Calcium Oxalate Kidney Stone Formation: Evidence of Different Renal Handling Mechanisms in Different Race Groups Source: Journal of Urology. 168(3): 931-936. September 2002. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-3030 or (301) 714-2334. Fax (301) 824-7290. Summary: Since the incidence of renal calculi (kidney stones) in the South African black population is extremely rare while in white subjects it occurs at the same rate as elsewhere in the western world, the authors of this article investigated the possibility that different renal (kidney) handling mechanisms in response to different dietary challenges might occur in the 2 race groups. The authors report on a study in which they administered 5 different dietary protocols, including low calcium, high oxalate, vitamin C, high salt and lacto-vegetarian, to 10 healthy male subjects from each race group. The low calcium diet caused statistically significant changes only in black subjects, which consisted of urinary oxalate increase, relative supersaturation of calcium oxalate decrease, and relative supersaturation of brushite increase. The high oxalate diet caused

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statistically significant changes in both race groups, but these changes were different in the 2 groups. Clinically unimportant changes occurred in both race groups after the other 3 diets. The authors conclude that renal handling of dietary calcium and oxalate in South African black and white subjects is different and may explain the different stone incidence in the 2 race groups. 6 tables. 32 references. ·

Diagnosis and Initial Management of Kidney Stones Source: American Family Physician. 63(7): 1329-1338. April 1, 2001. Contact: Available from American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237. Website: www.aafp.org. Summary: This article discusses the diagnosis and initial management of urinary stones (urolithiasis), which have undergone considerable evolution in recent years. The application of nonconstrast helical computed tomography (CT scan) in patients with suspected renal colic (kidney pain) is one major advance. The superior sensitivity and specificity of helical CT allow urolithiasis to be diagnosed or excluded definitively and expeditiously without the potential harmful effects of contrast media. Initial management is based on three key concepts: the recognition of urgent and emergency requirements for urologic consultation, the provision of effective pain control using a combination of narcotics and nonsteroidal antiinflammatory drugs (NSAIDs) in appropriate patients, and an understanding of the impact of stone location and size on natural history and definitive urologic management. The authors discuss these concepts with reference to contemporary literature, with the goal of providing tools that family physicians can use in the emergency department or clinic. A patient care algorithm is also provided. 2 figures. 5 tables. 32 references.

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Kidney Stones: Medical Management Source: Patient Care. 24(16): 85-88, 91-92, 94-97, 100, 102, 105. October 15, 1990. Summary: This article explores the current thinking in the medical management of kidney stones. The authors note that conservative treatment with dietary and fluid recommendations may prevent stone recurrence in some patients. In others, metabolic evaluation guides the design of a specific treatment regimen. Topics include drug therapy, the diagnosis and treatment of metabolic abnormalities in nephrolithiasis, the use of thiazides and sodium restriction, the use of calcium restriction, treating hyperuricosuria, treating secondary hyperoxaluria, the use of potassium citrate for treating hypocitraturia, treating noncalcium stones, and treatment protocol and followup, including the importance of long-term compliance. A patient care algorithm of the medical treatment of nephrolithiasis is presented. 1 table. 12 references.

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Many Facets of Kidney Stone Disease Source: Contemporary Urology. 2(1): 56-62. January-February 1990. Summary: This article presents a protocol for identifying the various causes of renal calculi and suggests several prophylactic treatment programs. Topics include the etiology of kidney stones, the medical evaluation of the patient at risk, diagnostic criteria, and preventive measures to be taken for each of the problems that can contribute to or cause kidney stones. 1 figure. 2 tables. 10 references.

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Prospective Study of Dietary Calcium and Other Nutrients and the Risk of Symptomatic Kidney Stones Source: New England Journal of Medicine. 328(12): 833-838. March 25, 1993. Summary: This article reports on a prospective study conducted on the relation between dietary calcium intake and the risk of symptomatic kidney stones in a cohort of 45,619 men, 40 to 75 years of age, who had no history of kidney stones. Dietary calcium was measured by means of a semiquantitative food-frequency questionnaire in 1988. During four years of follow-up, 505 cases of kidney stones were documented. Results show that, after adjustment for age, dietary calcium intake was inversely associated with the risk of kidney stones. Other potential risk factors discussed include alcohol consumption and dietary intake of animal protein, potassium, and fluid. The authors conclude that a high dietary calcium intake decreases the risk of symptomatic kidney stones. 5 tables. 40 references. (AA-M).

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Combination 'Sandwich' Therapy for Extensive Renal Calculi in 100 Consecutive Patients: Immediate, Long-Term and Stratified Results from a 10-Year Experience Source: Journal of Urology. 158(2): 342-345. August 1997. Summary: This article reports on a study that investigated the immediate and long term efficacy of combination 'sandwich' therapy for the management of large, extensively branched renal calculi (kidney stones) in 100 consecutively treated patients. 61 women and 39 men were treated for stones ranging from 2.2 to 66 cm (mean size 20.8 cm) with percutaneous debulking (with a nephroscope and ultrasound) followed by shock wave lithotripsy and, when necessary, secondary nephroscopy via the mature tract. The primary debulking was performed via 1 to 3 tracts, following which 1 to 3 shock wave treatments were administered. Subsequently, 62 patients underwent 71 secondary or tertiary percutaneous procedures. The total hospital stay ranged from 3 to 44 nights (mean 12.2 nights) and decreased with experience. In 34 patients, 40 complications developed, the most frequent of which were bleeding requiring transfusion (14 patients) and fever or sepsis delaying a planned procedure or hospital discharge (20 patients). For patients with struvite stones, the transfusion rate and fever sepsis rate were 20 and 33 percent, respectively, compared to only 10 and 12 percent, respectively, for those patients with noninfection related stones. Of 87 patients available for 1-month radiographic followup, 55 (63 percent) were stone-free, while 32 (37 percent) had discrete residual gravel. With time and experience, the stone free rate improved from 52 to 70 percent. Of 55 patients followed for a mean of 40.5 months, ipsilateral stones recurred in 13 (22.8 percent). Of 39 patients with struvite calculi, 11 (28 percent) had recurrent bacteriuria or infection. The authors conclude that this combined sandwich approach offers immediate and long-term results comparable to other forms of management currently available for these challenging cases. Furthermore, this approach may be applied successfully to virtually any patient with large, extensively branched, or otherwise complex stones. 1 figure. 3 tables. 19 references. (AA-M).

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Diets with Either Beef or Plant Proteins Reduce Risk of Calcium Oxalate Precipitation in Patients with a History of Calcium Kidney Stones Source: Journal of the American Dietetic Association. 101(3): 326-331. March 2001. Contact: Available from American Dietetic Association. 216 West Jackson Boulevard, Suite 800, Chicago, IL 60606-6995. (800) 877-4746.

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Summary: This article reports on a study undertaken to determine the effect of substituting equal amounts of dietary protein as animal protein (beef) for plant protein (legumes, seeds, nuts, and grains) on urinary components associated with calcium oxalate precipitability risk (which can lead to kidney stones made of calcium). The randomized crossover trial included 23 patients with normal levels of calcium in their urine who had a history of calcium kidney stones (8 women and 15 men, mean age 50.7 years plus or minus 14.6 years). The study included a 4 day, free living adaptation period, followed by a 2 day metabolic unit study. The study compared consumption of two servings of beef (43 g protein for women and 50 g for men) daily with an equal amount of protein from plant foods including legumes, nuts, and grains. Urinary calcium, oxalate, magnesium, citrate, phosphorus, volume, and Tiselius risk index (TRI) did not differ between diets. Urinary sodium and potassium were higher for patients on the plant protein diet. After correcting for variations in urinary sodium and potassium between diets, the difference in urinary calcium remained insignificant. The authors conclude that balanced diets containing moderate amounts of either beef or plant protein are equally effective in reducing calcium oxalate kidney stone risk based on changes in urinary composition. 4 tables. 27 references. ·

Kidney Stone Diet: A Teaching Tool Source: Journal of Renal Nutrition. 2(4): 174-175. October 1992. Summary: This brief article presents a teaching tool designed to educate patients about kidney stones and the role of nutrition in preventing and treating them. The first page consists of a chart of general risk factors, urinary risk factors, and nutritional factors that contribute to kidney stone formation. The second page lists specific food items to avoid, provides space for the nutritionist to individualize the information for a specific patient, and lists calcium, fluid, and sodium recommendations.

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Kidney Stones: Let Them Pass or Intervene? Source: Mayo Clinic Women's Healthsource. 2(2): 6. February 1998. Contact: Available from Mayo Foundation for Medical Education and Research. 200 First Street SW, Rochester, MN 55905. Summary: This brief article reviews the problem of kidney stones and offers suggestions for determining whether they require medical intervention. The article summarizes recommendations from a panel convened by the American Urological Association that can help a physician determine whether a patient's stones are the 'wait and see' type or need to be removed immediately. The article reviews the problem of kidney stones, which can be caused by heredity, diet, low fluid intake, and certain diseases, and which can cause bleeding, inflammation, infection, and severe pain. About 90 percent of kidney stones are small enough to pass through the urinary system on their own; however, this process can be extremely painful. Stones that pass into the ureter, are larger than one-half inch in diameter, or that cause obstruction should be removed by lithotripsy or ureteroscopy. The article concludes by emphasizing that the most important treatment and prevention strategy is to increase the amount of water that the patient drinks each day. The author recommends that everyone should drink enough fluid to produce approximately 2 quarts of urine per day. 1 figure.

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Pathogenesis and Treatment of Kidney Stones Source: New England Journal of Medicine. 327(16): 1141-1152. October 15, 1992.

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Summary: This review article addresses the pathogenesis and treatment of kidney stones. Topics include the physical chemistry of stone formation; the clinical presentation of stones; the management of stones; prevention of recurrence; remediable causes of calcium stones, including primary hyperparathyroidism, idiopathic hypercalciuria, low urinary citrate, renal tubular acidosis, hyperoxaluria, and hyperuricosuria; uric acid stones; struvite stones; and cystine stones. Treatment modalities discussed include drug therapy, dissolution therapy, and extracorporeal shock wave lithotripsy (ESWL). 1 figure. 3 tables. 155 references.

Federally Funded Research on Kidney Stones The U.S. Government supports a variety of research studies relating to kidney stones. 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 kidney stones. 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 kidney stones. The following is typical of the type of information found when searching the CRISP database for kidney stones: ·

Project Title: A NOVEL PREDICTOR OF NEPHROLITHIASIS Principal Investigator & Institution: Bergsland, Kristin J.; Litholink Corporation 2250 W Campbell Park Dr Chicago, IL 60612 Timing: Fiscal Year 2003; Project Start 01-MAY-2003; Project End 31-OCT-2003 Summary: (provided by applicant): The overall scientific and commercial objective of the proposed research is to develop a clinical assay that can predict the recurrence of kidney stones in patients with nephrolithiasis. Since currently available diagnostic tools cannot predict who will develop recurrent kidney stones, those destined to recur would benefit from tests that could identify them in advance. We propose to develop western blotting and ELISA methods to measure various forms of a urine protein that is a known inhibitor of calcium oxalate crystallization. Preliminary studies have shown that measurement of one form of this protein combined with standard stone risk chemistries improves the sensitivity of detection of stone formers compared with stone risk chemistries alone. We will perform the assays on urine from a random sample of 50 stone formers and 50 non-stone formers. We will identify the assay(s) that best discriminate stone formers from non-stone formers, either when used alone or combined with standard stone risk chemistries. In Phase II we will prospectively test whether these measurements can identify kidney stone patients at risk for recurrence. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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

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Project Title: ANGIOTENSIN ELIMINATION

II

REGULATION

OF

ENTERIC

OXALATE

Principal Investigator & Institution: Hatch, Marguerite; Associate Professor; Pediatrics; Northwestern University Office of Sponsored Programs Chicago, IL 60611 Timing: Fiscal Year 2001; Project Start 01-SEP-1999; Project End 31-MAY-2001 Summary: Approximately one million cases of stone diseases are diagnosed in the United States every year. Most kidney stones (80%) are comprised of calcium oxalate and a major risk factor in this disease is elevated urinary oxalate excretion. The broad aims are to investigate and enhance elimination of oxalate into the large intestine where it can be innocuously degraded by the substrate-specific bacteria (Oxalobacter sp.) which reside exclusively in this segment of the alimentary tract. The specific aims of this proposal focus on the signals involved in shifting the balance from renal to enteric oxalate elimination and on the modulation of this colonic oxalate secretion and excretion. Three key pieces of information have emerged from our recent studies of colonic oxalate transport in rats with chronic renal failure (CRF). 1). The large intestine is the primary site for the CRF-induced adaptation where basal oxalate absorption is reversed to a secretory flux inhibitable by angiotensin II (ANG II, subtype AT1) receptor antagonists. 2). In CRF rat intestine, AT1 receptors are up-regulated exclusively in the large intestinal segment. 3). The effects of AT1 receptor agonism and antagonism on oxalate transport in the CRF rat can be simulated in vitro in a control rat which normally supports a basal absorptive flux of oxalate. Together, these observations imply that ANG II plays a role in local modulation of colonic oxalate secretion. The working hypothesis to be tested is that the balance between renal and enteric oxalate elimination is modulated by an up- regulation in colonic AT1 receptors. The research plan is divided into two interrelated parts and involves using a cultured cell model along with a variety of animal models created in an effort to simulate human hyperoxaluric/hyperoxalemic conditions. Pr I is aimed at examining the signals involve din initiating the local upregulation of colonic T1 receptors in oxalate secreting colonic tissues. In Part II, the signaling transduction pathways involved in coupling AT1 receptor agonism to the transport systems initiating oxalate secretion will be addressed. The outcome of the propose studies will provide a significant advance in our fundamental understanding of adaptations in oxalate handling in kidney disease. The potential for oxalate excretion into the lumen of the large intestine, where it can be degraded by Oxalobacter enzymes, provides for a "sump" mechanism which, is exploited, could have significant impact on reducing hyperoxalemia, hyperoxaluria, oxalosis, and the resulting various pathophysiological and debilitating conditions. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: BINDING OF CALCIUM CRYSTALS WITH RENAL CELLS Principal Investigator & Institution: Toback, F. Gary. Professor of Medicine and Cell Biology; University of Chicago 5801 S Ellis Ave Chicago, IL 60637 Timing: Fiscal Year 2001 Summary: Although nephrolithiasis is a common condition, the sequence of events by which crystals are retained in the kidney and form stones is poorly understood. Therefore, additional knowledge is required to identify susceptible patients and formulate new therapeutic strategies to prevent kidney stones which cause pain, hematuria, urinary tract obstruction and infection, and to eliminate the need for expensive procedures such as extracorporeal shock wave lithotripsy or surgery. Our previous studies demonstrate that calcium oxalate monohydrate (COM) crystals bind

Studies 15

within seconds to anionic, sialic acid-containing glycoproteins on the apical surface of kidney epithelial cells in culture (employed to model the tubule), suggesting one mechanism whereby crystals could be retained in the kidney. Identification of those molecules on the renal cell surface that mediate crystal binding, and how their expression is modulated, will greatly increase insight into the pathogenesis of nephrolithiasis. Our Preliminary Studies provide evidence that the capacity of renal cells to bind COM crystals is not static, but is regulated by exogenous prostaglandin E (PGE) and intracellular cyclic AMP. Additionally, our recent work utilizing a novel experimental protocol, crystal-affinity chromatography, provides new information about the nature of receptors on the surface of cultured renal cells that bind calcium oxalate crystals, including one apparently novel Cell Surface Protein (CSP) that has been isolated and partially sequenced. Our Specific Aims are to: 1) Define mechanisms by which PGE modulates renal cell crystal affinity by investigating its effect on adhesion of hydroxyapatite (HA) crystals to cells, and its role during crystal adhesion to wounded monolayers; study PGE release in response to renal cell-crystal interactions; study regulation of intracellular cAMP in response to PGE; define the effect of PGE on renal cell protein and glycoprotein synthesis; and define the expression of specific crystal receptor proteins after exposure to PGE. 2) Identify and characterize renal epithelial cell surface glycoprotein receptor(s) for COM and HA crystals; obtain a full-length cDNA clone encoding an apparently novel CSP COM crystal receptor; study regulation of CSP expression in renal cells; define CSP gene and protein distribution in renal and nonrenal tissues; and characterize cell surface receptors for other urinary crystals, and in different types of cells. The results will provide new understanding of the mechanisms that control adhesion of urinary crystals to the surface of kidney epithelial cells. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: CHARACTERIZATION OF THE REGULATORY PROTEIN, URER Principal Investigator & Institution: Dattelbaum, Jonathan D. Microbiology and Immunology; University of Maryland Balt Prof School Baltimore, MD 21201 Timing: Fiscal Year 2002; Project Start 01-MAR-2002 Summary: (provided by the applicant): Urinary tract infections (UTIs) are one of the most frequently diagnosed kidney and urological disorders. While Proteus mirabilis is responsible for only a few percent of all UTIs, individuals with anatomical abnormalities or long-term indwelling medical devices are highly susceptible to P. mirabilis bladder and kidney infections. A hallmark of P. mirabilis UTI is the formation of bladder and kidney stones due to the urea-induced activity of urease. Ammonia formed by the urease-catalyzed breakdown of urea increases local pH resulting in crystallization of magnesium and calcium metal salts. Urease statement is regulated by UreR, a member of the AraC family of transcriptional regulators. UreR DNA-binding properties and transcriptional activity have been partially characterized. We hypothesize that urea binds directly to UreR resulting in a conformational change in the protein which alters its interaction DNA. Purified recombinant UreR will be used to study the effect of urea and DNA on UreR dimerization. Equilibrium dialysis will be used to measure the urea binding constant for UreR. In the absence of urea, we hypothesize that UreR stimulates DNA looping which shuts off transcription of urease. The ability of UreR to induce bends in DNA will be evaluated using circular permutation analysis. Further work will be performed using DNA minicircles containing UreR binding sites. We will determine if an inverted UreR dimer is formed in the presence and absence of urea. This research will be used to develop a model for the UreR-mediated transcription regulation of the urease operon.

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Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: DEVELOPMENT OF A UREA BIOSENSOR USING THE URER PROTEIN Principal Investigator & Institution: Mobley, Harry L. Professor; Microbiology and Immunology; University of Maryland Balt Prof School Baltimore, MD 21201 Timing: Fiscal Year 2003; Project Start 01-JUL-2003; Project End 30-JUN-2005 Summary: (provided by applicant): Individuals in the U.S. with kidney conditions including infection, kidney stones, cancer, or missing kidney exceed 2.5 million annually. Most renal diseases affect serum urea concentration which provides a sensitive indicator of such disease. The blood urea nitrogen (BUN) test, a routine but critical clinical laboratory assay used to evaluate renal function, quantifies serum urea that is produced in the liver as an endpoint of protein degradation. Studies are proposed that will lead to the development of a fluorescence-based biosensor capable of quantifying urea in a sample in real time. The sensor will employ the UreR protein encoded by the urease operon of the uropathogenic bacterial species Proteus mirabilis. UreR, to date, is the only documented urea-binding protein. When UreR binds urea, the protein undergoes a conformational change that is detectable using fluorescence technology. Three approaches to biosensor design will include fluorescent labeling of genetically modified UreR, fluorescence resonance energy transfer of UreR-Yellowfluorescent-protein fusions, and an anisotropy approach using the binding of its target DNA by UreR. The proposed UreR biosensor will directly measure urea in real time without the necessity of hydrolyzing urea with urease, which is required in current sensor technology. Primary applications may include routine blood urea nitrogen determination and monitoring of blood urea nitrogen directly in the blood of patients undergoing kidney dialysis. In addition, the biosensor will be useful in basic science investigations including urea transport in the liver and kidney, the role of urea hydrolysis in urolithiasis, and urea metabolism in the gastric mucosa infected by ureasepositive Helicobacter pylori. This biosensor also offers the prospect of imaging urea concentration and fluxes in tissue using fluorescence and confocal microscopy. Our experimental approaches are organized into three Specific Aims: 1) To define the urea binding domain of the UreR protein 2) to develop a urea sensor using UreR; and 3) to construct a prototype UreR-based urea sensor and validate it in specific applications. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: DFT INVESTIGATIONS OF MN(II/III) OXALATE OXIDASE MODELS Principal Investigator & Institution: Chang, Christopher H. Chemistry; University of Florida Gainesville, FL 32611 Timing: Fiscal Year 2002; Project Start 04-MAR-2002 Summary: (provided by applicant): Several chronic ailments stem from the body?s inability to catabolize or excrete excess oxalic acid, including kidney stones and potentially fatal primary hyperoxaluria. Future treatment methods could include the use of enzymes from other organisms to digest oxalate into molecules that are more easily metabolized and excreted. Two such enzymes are an oxalate decarboxylase that transmutes oxalate into formate and carbon dioxide, and oxalate oxidase that produces carbon dioxide and hydrogen peroxide from oxalate and oxygen. Both enzymes contain manganese, and the decarboxylases appear to be a genetic duplication of the oxidases. How duplication leads to a change in overall reaction is currently mysterious. This project seeks to establish procedures by which the catalytic and structural properties of

Studies 17

these oxalate-degrading enzymes may be calculated from first principles. Density functional, semi-empirical, and free energy perturbation-molecular dynamics methods will be used to calculate geometries, EPR hyperfine coupling parameters, ultravioletvisible spectra, and reduction potentials of a variety of Mn (II/III) complexes with oxygen and/or nitrogen ligation. The method will be tested on the active site of superoxide dismutase, an enzyme with extensive experimental data available and identical ligands to those of oxalate oxidase. Methods developed for the dismutase active site will be valuable once the decarboxylase structure becomes known. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: DIET SALT, CALCIUM KIDNEY STONES, BONE IN STONE FORMERS Principal Investigator & Institution: Massey, Linda K. Professor; Food Science & Human Nutrition; Washington State University 423 Neill Hall Pullman, WA 99164 Timing: Fiscal Year 2001; Project Start 15-SEP-2001; Project End 31-DEC-2003 Summary: (Scanned from the applicant's description): Increases in dietary salt, i.e. sodium chloride (NaCI), increase urinary calcium over the range of intakes commonly consumed. Both salt loading studies and reports of within-population correlations find that increased urinary calcium losses are approximately 1 mmol (40 mg) for each 100 mmol (2300 mg) increase in dietary NaC1. Individuals with hypercalciuria and/or a history of calcium kidney stones appear to have 2 times greater proportional increases in urinary calcium per 100 mmol increase in salt intake. Thirty-two subjects with a history of at least one calcium oxalate kidney stone will be recruited; 16 with hypercalciuria, 16 normocalciuria. This study consists of two, seven-day periods. For all seven days of both dietary treatments, each participant will eat only the foods provided by the investigators, a nutritionally adequate diet prepared from common foods containing 50 mmol/d salt. The first five days of each treatment (adaptation), the participant will be free-living, the sixth and seventh in the WSU metabolic unit. One of the two weeks, 150 mmol supplemental salt will be added as tablets taken with each meal; the total of 200 mmol is the average consumption measured in previous studies of stone formers. The major outcome measures are urinary oxalate, calcium, magnesium, phosphate and citrate, and two measures of calcium salt saturation as indicators of risk of calcium salt precipitation. The two measures of calcium salt precipitability will be the Tiselius risk index, a measure of calcium oxalate precipitability from solution which includes the effects of volume, magnesium and citrate concentrations as well as calcium and oxalate, and Ap (CaP), a measure of calcium phosphate precipitability from solution, which includes the effects of volume, citrate and pH as well as calcium and phosphate. Because increased urinary calcium loss from adding salt occurs, bone breakdown may be increased in compensation, so 4 markers of bone turnover will be measured, bone alkaline phosphatase, osteocalcin, deoxypyridinoline, and Ntelopeptide. We will also compare the responsiveness of hypercalciuric vs normocalciuric participants for all the outcome variables, because the literature suggests that hypercalciuric stoneformers may be more sensitive to dietary salt effects on urinary calcium. Reduction of dietary NaC1 from typical intakes of 200 mmol/day to an intake of 50 mmol/day may decrease the risk of recurrence of calcium-containing kidney stones and slow rates of bone loss, thus reducing risk of osteoporosis as well. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: DIETARY OXALATE AND KIDNEY STONE FORMATION Principal Investigator & Institution: Assimos, Dean G. Professor; Neurology; Wake Forest University Health Sciences Winston-Salem, NC 27157 Timing: Fiscal Year 2002; Project Start 01-JUN-2002; Project End 31-MAY-2006 Summary: (provided by applicant): Calcium oxalate kidney stone formation affects a significant number of individuals in the United States and contributes billions of dollars to health care costs. Urinary oxalate excretion plays a major role in the formation of these calculi as it influences the supersaturation of urine with calcium oxalate, a prerequisite for calcium oxalate stone formation. Recent investigations have shown that a significant amount of urinary oxalate is derived from dietary sources. Therefore, reducing oxalate consumption or its absorption from the intestinal tract may prove to be useful methods for limiting an individual's risk of forming stones. Experiments with cultured cells and animal models have demonstrated that oxalate has the potential to damage renal tissue through the generation of chemicals called oxygenated free radicals. This process may play a causative role in calcium oxalate stone formation. Therefore, attenuating this response may also limit stone generation.There are three specific aims in this research proposal. The first is to compare the response of stone forming and nonstone forming adults to dietary oxalate. The second aim is to compare renal oxalate clearance in both of the aforementioned groups. These studies will determine whether there are any differences in the renal handling of oxalate between these two groups. The third aim is to determine whether urinary oxalate excretion and renal proximal tubular cell injury can be reduced with calcium supplements, vitamin E supplements, administration of oxalate degrading bacteria, or a combination of all three of these regimens. All of these studies will be conducted in our General Clinical Research Center where carefully controlled diets can be administered. Various responses will be assessed including gastrointestinal oxalate absorption, urinary supersaturation, oxalate excretion, oxidative stress and markers of renal proximal tubular cell injury. These studies will aid in the development of strategies to prevent kidney stone formation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: DIGESTION OF FOOD OXALATE Principal Investigator & Institution: Sidhu, Harmeet;; Ixion Biotechnology, Inc. Box 13, 13709 Progress Blvd Alachua, FL 32615 Timing: Fiscal Year 2001; Project Start 15-FEB-2000; Project End 31-AUG-2003 Summary: provided by applicant): Calcium oxalate stone disease is a prevalent disease with limited preventative treatment options. Dietary oxalate makes an important contribution to urinary oxalate excretion and a strong body of evidence suggests it plays an important role in calcium oxalate stone formation. The long-term objective of this project is to develop a commercial product based on the oxalate-degrading bacterium, Oxalobacter formigenes, which can reduce the absorption of dietary oxalate when taken with meals. The first two specific aims are designed to test the safety and efficacy of this approach. In these studies normal, healthy volunteers will consume diets with controlled contents of oxalate and other key nutrients. In the first specific aim in an oxalate load study, which simulates a single meal, the optimal dose of bacteria required to reduce oxalate absorption from the load will be determined. In the second specific aim this dose will be used to determine the effects of bacteria taken with each meal for 4 days. The urinary excretion relative to that of creatinine will be used as an index of oxalate absorption in each study. The third specific aim will optimize fermentation and freeze drying conditions to produce a product with satisfactory cost, efficacy, safety and

Studies 19

shelf life. Due to the wide spread occurrence of stone disease this product has the potential to be a viable treatment to prevent the formation of kidney stones.. PROPOSED COMMERCIAL APPLICATION: Urolithiasis is a common disease with few therapies that are effective in eliminating recurrences in susceptible individuals. Thus there is a large market for a product that can reduce urinary oxalate excretion that could benefit all calcium oxalate stone formers. The proposed therapy is to degrade dietary oxalate in the GI tract before it could gen absorbed. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: EFFECT OF ENALAPRIL ON URINARY CITRATE EXCRETION Principal Investigator & Institution: Sakhaee, Khashayar;; University of Texas Sw Med Ctr/Dallas Dallas, TX 753909105 Timing: Fiscal Year 2001 Summary: This study will determine if angiotensin converting enzyme inhibitors in humans exert a significant effect on urinary citrate excretion. Because these drugs are commonly used to treat many renal and cardiovascular diseases, knowledge of their effect on urinary citrate excretion would be important before prescribing them to persons at risk for developing kidney stones.. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: GENETIC MAPPING IN THE HYPERCALCIURIC STONE-FORMING RAT Principal Investigator & Institution: Scheinman, Steven J. Professor; Medicine; Upstate Medical University Research Administration Syracuse, NY 13210 Timing: Fiscal Year 2001; Project Start 01-JUN-2000; Project End 30-APR-2004 Summary: Idiopathic hypercalciuria (IH) is the most common metabolic abnormality associated with kidney stones in humans, and as many as 45 percent of patients with IH have a family history of nephrolithiasis. Defined subsets of patients with hypercalciuric nephrolithiasis include those with autosomal or X linked inheritance, but overall the phenotype of human IH is that of a complex, polygenic disease. A full-scale investigation of the genetics of human hypercalciuria would be made difficult by the large number of families required, dietary variables, and number of metabolic subsets described in patients with IH. However, an animal model exists in the genetic hypercalciuric stone-forming (GHS) rat, which is now in its 51st generation of inbreeding. The physiology of hypercalciuria in this model has been extensively characterized and resembles human IH in many important respects. The GHS rat colony was established by Dr. David Bushinsky by selectively breeding the most hypercalciuric littermates of each generation, and is likely to be enriched in alleles for genes that contribute to hypercalciuria. A robust armamentarium of tools for genetic and physical mapping in rats is now available, and expanding rapidly. The goal of this project is to map genes determining hypercalciuria in the GHS rat. The first aim of this project is to identify quantitative trait loci (QTL) linked to hypercalciuria through QTL mapping. This analysis will make use of selective genotyping of an F2 intercross between GHS and normocalciuric Wistar-Kyoto (WKY) rats, using simple sequence-length polymorphisms (SSLPs). The second aim is to refine the QTL localization further by constructing and analyzing congenic strains of rats. We have made substantial progress towards a whole-genome scan in an initial F2 of 156 rats, and have identified one QTL on chromosome 1 that meets conservative criteria for significance (LOD 4.5) and two loci that meet criteria "suggestive" of linkage. More precise localization should eventually

20 Kidney Stones

make possible physical mapping and positional cloning of genes contributing strongly to hypercalciuria, which will allow for future work in which homologues of these genes can be studied to determine their role in human idiopathic hypercalciuria. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: HYPEROXALURIA AND TUBULE INJURY AND KIDNEY STONE DISEASE Principal Investigator & Institution: Mandel, Neil S. Professor; Medicine; Medical College of Wisconsin Po Box26509 Milwaukee, WI 532264801 Timing: Fiscal Year 2003; Project Start 01-MAR-2003; Project End 28-FEB-2005 Summary: (provided by applicant): Kidney stone disease is a substantial health problem associated with significant pain, suffering, and economic costs. 5% to 15% of the population will have a symptomatic episode of a stone by the age of 70 and at least 50% of these individuals will have recurrent disease. To date, urolithiasis researchers have been limited to cell culure studies or a rat model where hyperoxaluria is induced by either ethylene glycol oral administration that is toxic to multiple organs or by high dose intraperitoneal sodium oxalate injection. The levels of induced urinary oxalate excretion in the rat needed to produce oxalate crystalluria and tisssue or cell response are criticized as being supraphysiologic compared to man. We propose that the pig is ideal for the development of an animal model of calcium oxalate crystalluria and calcium oxalate stone disease. The anatomy and physiology of the pig kidney is very similar to man. The anerobic bacteria Oxalobacter formigenes degrades oxalate to formate in the pig gut and normally stops the pig from becoming hyperoxaluric. We have successfully obtained Oxalobacter formigenes free pigs and report here for the first time that these pigs demonstrated a significant increase in urinary oxalate excretion as the result of an oral oxalate load similar to that experienced by man ingesting an oxalate rich diet. We propose to induce hyperoxaluria in the pig by feeding them an oxalate rich diet. We propose to study the effect of hyperoxaluria on pig kidney physiology and its impact on calcium oxalate crystal attachment and stone maturation. We hypothesize that pigs fed oxalate will form calcium oxalate crystalluria and calcium oxalate stones in their urinary tract in a manner very similar to man. We also hypothesize that these hyperoxaluric pigs are ideally suited for the extension of studies on the effect of hyperoxaluria on renal epithelial cell physiology, crystal attachment and stone maturation. This grant proposal contains three Specific Aims that test our hypotheses:Specific Aim I: To develop a new hyperoxaluric pig animal model.Specific Aim II: To initiate calcium oxalate crystalluria in the pig and to identify the site of crystal attachment along the nephron.Specific Aim III: To induce calcium oxalate stone disease in the pig and to characterize the process of stone maturation. These Specific Aims and their associated questions will allow us to fully describe the development of hyperoxaluria in the pig and the development of calcium oxalate crystalluria and calcium oxalate stones. The hyperoxaluric pig will have great potential in the advancement of many areas of urolithiasis research and in the design of new therapeutic modalities for the treatment of stone disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MECHANICAL ORGINS OF SHOCK INDUCED BIOEFFECTS IN SHOCK WAVE LITHOTRIPSY Principal Investigator & Institution: Sturtevant, Bradford;; Indiana Univ-Purdue Univ at Indianapolis 620 Union Drive, Room 618 Indianapolis, IN 462025167 Timing: Fiscal Year 2001

Studies 21

Summary: This grant is the continuation of a collaborative multi-disciplinary study of the mechanical initiation of injury to soft tissue in the kidney and of damage to tissue analogs by ESWL shock waves. Experiments are carried out in a laboratory lithotripter of our own design that mimics the Dornier HM3 electrohydraulic lithotripter. Finitedifference numerical solutions of the Euler equations are obtained for focusing shock waves interacting with tissue and kidney stones.. Cooperative research is carried out with the other Projects of this Program Project Grant to advance the objectives of the Grant. The aims of this Project are: I. Extend the dose criterion developed in our previous work on the cavitation-free failure of planar membranes to more complex weak mechanical structures and, in collaboration with Project 2, to in vitro cell cultures. Included in this aim is the development of a tissue phantom which reliably mimics the shock-wave scattering properties of soft tissue, development PVDF transducer arrays, investigation of membrane material/cavitation-free host fluid combinations and thinmembrane cylindrical structures for damage studies, and collaborations with Projects 1 and 2 to develop a physically-based quantitative definition of ESWL dose. II. Initiate a new effort in Project 4 to demonstrate the mechanisms of kidney stone comminution by ESWL. Included in this aim is utilization of the Hopkinson bar technique to characterize the failure dynamics of real and phantom calculi, and development of a stone phantom which faithfully mimics the failure models of kidney stones.. III. Develop numerical methods for solving the exact Euler equations of motion. Included in this aim is adaptation of the Amrita problem-solving environment to shock wave focusing problems, calculation of shock wave focusing by an ellipse in uniform and non-uniform media, and calculation of wave shapes and compressive stresses induced by impingement of a shock wave on a theoretical calculus. The hypothesis that the above aims are designed to test include: 1. A quantitative definition of ESWL dose, based on the physical properties of waves and tissue, can be developed to quantify the mechanical input of ESWL to tissue. 2. Comminution of kidney stones in ESWL occurs under shock compression by dynamic fatigue. 3. Accurate numerical calculations of shock pressure and wave geometry during shock wave focusing can be used with experimental data to elucidate mechanisms of stone comminution and tissue injury. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: MOLECULAR MECHANISM OF RENAL NA+ DEPENDENT COTRANSPORT Principal Investigator & Institution: Pajor, Ana M. Professor; Physiology and Biophysics; University of Texas Medical Br Galveston 301 University Blvd Galveston, TX 77555 Timing: Fiscal Year 2001; Project Start 01-APR-1993; Project End 31-DEC-2001 Summary: (Adapted from the Applicant's Abstract): The long-term objective of this project is to determine how the structures of sodium-dependent cotransport proteins determine their functional properties. The focus of the current proposal is to characterize at the molecular level the Na+/dicarboxylate cotransporters of the renal proximal tubule. These transporters are important to the function of the kidney in their reabsorption of Krebs cycle intermediates, and play a role in acid-base balance and organic anion excretion. The brush border Na+/dicarboxylate cotransporter has been implicated in the development of kidney stones by its regulation of urinary citrate concentrations. The principal investigator has recently cloned and sequenced a rabbit renal Na+/dicarboxylate cotransporter, NaDC-1 and the human homolog, hNaDC-1. NaDC-1 appears to correspond to the low affinity Na+/dicarboxylate cotransporter of the brush border membrane. The first Specific Aim of this study is to determine the role that histidine-106 plays in the transport of succinate by NaDC-1 and hNaDC-1. The

22 Kidney Stones

second Specific Aim is to identify domains or residues involved in substrate selectivity and binding, by preparing chimeras between related transporters. The third Specific Aim is to clone the renal high affinity Na+/dicarboxylate cotransporter. This transporter will be used to identify residues important for high affinity substrate binding. These studies should provide fundamental information on the functional properties of this family of sodium-dependent transporters, and on the physiological role of these transporters in the kidney. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: MOUSE EXTRACELLULAR CALCIUM SENSING RECEPTOR Principal Investigator & Institution: Pollak, Martin R. Assistant Professor of Medicine; Brigham and Women's Hospital 75 Francis Street Boston, MA 02115 Timing: Fiscal Year 2001; Project Start 26-SEP-1997; Project End 31-AUG-2004 Summary: Extracellular calcium homeostasis is precisely regulated by the interaction of several hormones with multiple target organs. In addition, calcium itself acts upon a Gprotein-coupled "calcium- sensing" receptor (CaSR) on the he surface of parathyroid cells to regulate the secretion of parathyroid hormone (PTH). This receptor is also expressed in other tissues, where its precise function is less well-defined. Humans with two copies of an inactivating mutation in the caSR gene are severely hypercalcemic, presumably because the normal inhibition of PTH secretion by calcium is no longer present. CaSR is expressed by diverse cell types of the kidney, where extracellular calcium has multiple effects. The purpose of this proposal is to clarify the role of CaSR in mediating specific effects of calcium on the kidney and to better define the role of renal CaSR in regulating whole animal calcium homeostasis. The aims of this proposal focus on the development of genetically altered mice which will serve as models in understanding the function of renal Car. Transgenic mice overexpressing CaSR in the thick ascending limb of the kidney will be generated. This mouse model should help clarify the contribution of CaSR activation to the regulation of calcium, sodium, and water homeostasis. It will also aid in defining which actions of calcium on the kidney are mediated by CaSR. In addition, the renal function of mice with a null mutation in CaSR will be investigated by a combination of genetic and physiologic methods. Normally these ~knockout~ mice do not live past the neonatal period. Crossing CaSR deficient mice with other mutant mice unable to mount a hypercalcemic response to PTH should generate viable CaSR-deficient mice which will aid in the investigation of CaSR function in the kidney and other tissues. Multiple hypotheses regarding the role of CaSR in renal calcium excretion and as well as its role in mediating renal responses to calcium will be investigated. Clarifying the functions of CaSR, a newly identified component of the calcium homeostatic system, will likely have implications for understanding and treatment of diseases of abnormal calcium regulation, including osteoporosis, hyperparathyroidism, kidney stones, and hypertension. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: NOVEL HYPEROXALURIA

ENZYME

FORMULATION

FOR

TREATMENT

OF

Principal Investigator & Institution: Shenoy, Bhami C.; Altus Biologics, Inc. 625 Putnam Ave Cambridge, MA 021394807 Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 31-MAR-2002 Summary: (provided by applicant): Design of new efficient drug delivery systems for proteins is one of the major themes of modern biotechnology and biopharmaceutical

Studies 23

industry. We found that crosslinked enzyme crystals (CLECs) show stability under low pH, on storage and against proteolysis. These properties make them ideal for gut lumenal therapy. The patient would swallow a tablet or liquid suspension of CLEC particles composed of a needed metabolic enzyme or protein. The CLEC agent would survive the harsh acidic pH and proteolytic environment of the stomach, and pass into the proximal small intestine. The CLEC particle would then carry out its therapeutic biochemistry within the gut lumen while remaining resistant to degradation by endogenous proteases. In this Phase I study, we propose to develop two types of CLECs: Oxalyl-CoA decarboxylase for oral lumenal therapy and Oxalate oxidase to be used in the extracorporeal device/dialysis equipment. The Oxalyl-CoA decarboxylaseCLEC will perform its action in the duodenum while remaining as crystalline material or by release of activity by dissolution of the CLEC particle. This target was chosen to address the problems of current therapies of hyperoxaluna caused by excessive absorption of oxalate due to the absence of Oxalobacter formigenes bacterium in the intestine or due to inflammatory bowel disease. In addition, Oxalate oxidase-CLEC may be used in dialysis equipment or extracorprealdevices to reduce the oxalate content of blood in patients with Primary Hyperoxaluria. If successful, these approaches will lead to the introduction of novel, efficient enzyme therapy for the prevention of Oxalate Kidney Stones.. PROPOSED COMMERCIAL APPLICATION: NOT AVAILABLE Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: NOVEL INHIBITOR OF CRYSTAL ADHESION TO RENAL CELLS Principal Investigator & Institution: Lieske, John C. Associate Professor; Mayo Clinic Rochester 200 1St St Sw Rochester, MN 55905 Timing: Fiscal Year 2001; Project Start 01-MAY-1999; Project End 30-APR-2004 Summary: Nephrolithiasis, the formation of kidney stones, is a common condition seen in up to 12 percent of adults during their lifetime. As the mechanisms by which stones form are poorly understood, new knowledge is required to identify susceptible patients for early treatment and to formulate new therapeutic strategies to prevent the appearance of single and/or recurrent stones. How nascent crystals that nucleate in tubular fluid are retained in the nephron and form calculi is not known. My studies during the past 8 years demonstrate that calcium oxalate monohydrate (COM) crystals bind within seconds to anionic, sialic acid- containing glycoproteins on the apical surface of cultured monkey kidney epithelial cells (BSC-1), employed to model the tubule, suggesting one mechanism whereby crystals could be retained in the kidney in vivo. Preliminary studies have identified constitutive release of a protein by BSC-1 cells that blocks adhesion of COM crystals to the apical cell surface; it has been named the Crystal Adhesion Inhibitor, or CAI. A novel method employing COM crystal affinity chromatography was used to purify CAI. Evidence provided in this revised application demonstrates that CAI is a constituent of normal human urine. Biochemical characterization identifies it as a sialic acid-containing glycoprotein. Microsequencing of the amino terminus and 9 fragments generated by lys-C and asp-N protease cleavage reveal that CAI is novel. Two monospecific antibodies against synthetic peptides prepared using amino acid sequence information each recognize the factor on Western blots of partially- purified normal human urine, renal cell conditioned medium, and total kidney cell protein. The goal of this revised research plan is to define the potential role of CAI in human nephrolithiasis. New Specific Aims are to: 1) Utilize 2 monospecific antibodies prepared against CAI to characterize and quantitate it in the urine of normal and stone- forming individuals; 2) Study inhibition of COM, hydroxyapatite, and uric acid crystal adhesion to renal cells by CAI isolated from

24 Kidney Stones

conditioned medium and the urine of normal and stone-forming subjects; 3) Study inhibition of COM crystal growth by CAI isolated from conditioned medium and the urine of normal and stone-forming subjects, 4) Study inhibition of COM crystal aggregation by CAI isolated from conditioned medium and the urine of normal and stone-forming individuals, 5) Utilize the monospecific antibodies prepared against CAI to isolate affinity-purified protein and study its physical-chemical properties; 6) Study the cell biology of CAI. Achieving these specific aims will provide new knowledge about mechanisms that mediate stone formation, and provide a rational basis for design of novel strategies to treat and/or prevent this disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: ORAL DISSOLUTION OF KIDNEY STONES WITH DRUGS FROM MEDICINAL PLANTS Principal Investigator & Institution: Souto, Fernando A.; University of Puerto Rico Mayaguez Mayaguez, PR 00709 Timing: Fiscal Year 2001 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PREDICTING KIDNEY STONES IN RELATIVES OF STONE FORMERS Principal Investigator & Institution: Coe, Brian J.; Litholink Corporation 2250 W Campbell Park Dr Chicago, IL 60612 Timing: Fiscal Year 2001; Project Start 01-AUG-1999; Project End 31-JAN-2003 Summary: The overall aim of Phase I and Phase II is to determine, if any, of the established urinary chemical abnormalities central to the pathogenesis of nephrolithiasis can be used prospectively to predict new onset of kidney stone disease in non-stone forming family members of calcium stone formers. This study proposes to measure potential urinary risk factors in all first degree relatives of the stone former (proband) upon entrance into the study and then follow subject for an average of 5 years in order to record stone formation and related morbidity. We will use a multivariate discriminate analysis to determine the independent predictors of new onset stone formation in family members. Family members at high risk might benefit from subsequent changes in lifestyle, diet, fluid intake or, possibly, pharmaceutical intervention that could stave off stone disease. To date no clinical trials have examined whether metabolic (laboratory) evaluation of health family members can predict stone formation. In addition to the established urine chemistries, we will examine whether a crystal growth assay can be a useful tool in predicting new stone formation. PROPOSED COMMERCIAL APPLICATIONS: Because of the extreme pain and suffering faced by kidney stone formers, many family members of stone formers are concerned about the possibility of their developing the disease. If we are able to establish which urinary markers for stone formation are predictive of disease onset in family members of stone formers, we will have developed a new indication for the testing which we currently sell. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PROT BIOMINERALIZATION

CRYSTAL

MOLECULAR

RECOGNITION

IN

Principal Investigator & Institution: Stayton, Patrick S. Bioengineering; University of Washington Seattle, WA 98195

Studies 25

Timing: Fiscal Year 2001; Project Start 30-SEP-1997; Project End 31-JUL-2002 Summary: Acidic proteins found in mineralized tissue act as biology's crystal engineers. Their activities are responsible for the material properties of hard tissues, and their activities directly control the hierarchical architecture of these tissues. However, despite their importance in such fundamental physiological processes as bone and tooth formation, there is remarkably little known of the protein structure-function relationships which govern crystal recognition. The primary goal of this program is to obtain a molecular description of the structure-function relationships used by small acidic proteins in the crystal engineering of hydroxyapatite and calcium oxalate (the principle mineral phases of bone/teeth and kidney stones, respectively). Preliminary genetic engineering results with a small model protein, consisting structurally of a long alpha-helix and two antiparallel beta-sheets, have demonstrated that the protein surface electrostatic charge distribution can directly dictate whether secondary nucleation and crystal growth is promoted or inhibited. The molecular recognition mechanisms underlying this observation will be studied with a combination of kinetic and thermodynamic techniques, along with direct solid-state NMR determination of the protein-crystal interfacial structure. Further studies will characterize how secondary structure scaffolds are used to present carboxylate side-chains with stereospecificities that direct interactions with hydroxyapatite and calcium oxalate. Genetic engineering techniques will be used to systematically place carboxylate side-chains on the alphahelix and anti- parallel beta-sheets, and the subsequent molecular interactions with the crystals will again be studied with solid-state NMR techniques. In addition, the functional properties of these proteins will be assessed using a variety of techniques including constant composition kinetics, direct binding adsorption analysis, particle size determination, electron microscopy, and zeta-potential measurements. The disruption of normal biomineralization processes can lead to pathological mineralization or demineralization, such as in atherosclerotic plaque formation, artificial heart valve calcification, kidney stone build-up, dental calculus formation, or bone and tooth demineralization. A better understanding of the biomolecular mechanisms used to promote or retard crystal growth could provide important design principles for the development of calcification inhibitors and promoters in orthopaedics, cardiology and dentistry. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: REGULATION OF ENTERIC HYPEROXALURI BY OXALOBACTER Principal Investigator & Institution: Peck, Ammon B. Professor; Pathology, Immunol & Lab Med; University of Florida Gainesville, FL 32611 Timing: Fiscal Year 2001; Project Start 27-MAR-1998; Project End 28-FEB-2003 Summary: Oxalobacter formigenes, a recently identified bacterium that colonizes the gastrointestinal (GI) tracts of all vertebrates, has gained considerable attention due to its important symbiotic relationship with its hosts in regulating oxalic acid absorption in the intestines as well as oxalic acid levels in plasma two factors associated with the risk to develop calcium-oxalate kidney stones.. Oxalic acid is a by-product of metabolism and a common constituent of most diets; however, if permitted to accumulate, it can cause numerous pathological conditions, including hyperoxaluria, cardiac conductance disorders, calcium oxalate stones, renal failure, death and possibly inflammatory bowel disease and vulvovestibulitis. Despite the potential significance of O. formigenes in controlling enteric hyperoxaluria, and thus oxalate-related disorders, research has been limited due to inherent difficulties in culturing and identifying this bacterium. Nevertheless, preliminary studies already suggest a correlation between the number of

26 Kidney Stones

colony forming units of Oxalobacter sp. per gram feces and the frequency of recurrent urolithiasis, inflammatory bowel disease and hyperoxaluria/nephrocalcinosis in cystic fibrosis. With the development of a rapid and sensitive DNA-based detection system highly specific for O. formigenes, we are now able to investigate the correlation between an increased risk for urolithiasis and the absence of O. formigenes from the GI tract. Using the laboratory rat as a model, we propose to: 1) study the colonization of noncolonized rats with various sub-strains of O. formigenes to determine if variations exist in the efficacy of different strains of O. formigenes to colonize and if primary colonization precludes secondary colonizations, 2) determine whether O. formigenes can prevent hyperoxaluria and subsequent formation of calcium-oxalate crystals in rats colonized with various sub-strains of the bacterium and challenged with high oxalatecontaining diets, and 3) examine the relationship between diet and/or antibiotic treatment with subsequent decolonization of the GI tract by O. formigenes known to occur in human populations and whether decolonization of the GI tract is irreversible. Results from these studies should provide insight into the role O. formigenes plays in regulating oxalate homeostasis in vertebrates, including humans, and should offer new modalities in prevention therapy for oxalate-associated disorders, such as recurrent kidney stone formation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: RENAL BASIS OF HYPOCITRATURIA Principal Investigator & Institution: Alpern, Robert J. Dean; University of Texas Sw Med Ctr/Dallas Dallas, TX 753909105 Timing: Fiscal Year 2001 Summary: (Taken directly from the application) Hypocitraturia is an important cause of kidney stones.. Citrate is freely filtered in the glomerulus, and urinary citrate excretion is regulated principally by the rate of citrate reabsorption and metabolism in the proximal tubule. Reabsorption is mediated by an apical membrane 3Na+/citrate cotransporter encoded by the NaDC-1 gene, and metabolism is mediate by one of two pathways: a mitochondrial pathway that mediates citrate metabolism in the tricarboxylic acid cycle; and a cytoplasmic pathway in which ATP citrate lyase metabolizes citrate to acetyl CoA and oxaloacetate. The proposed studies will examine the molecular mechanisms responsible for regulation of citrate reabsorption and metabolism, focusing on NaDC-1. Studies in Aim 1 will address the molecular mechanisms of NaDC-1 regulation in rats with chronic metabolic acidosis, K+ deficiency, alkali feeding, and starvation. Studies in Aim 2 will further address the molecular mechanisms of NaDC-1 regulation in cultured proximal tubule cells exposed to acidic extracellular fluid. These studies will utilize cells expressing native NaDC-1, as well as cells expressing stably transfected tagged NaDC-1, and transiently transfected reporter constructs. Aim 1 and 2 together will address the regulation of NaDC-1. Studies in Aim 3 will address the role of signaling pathways known to be activated by acidosis in the regulation of NaDC-1. These pathways include: 1) tyrosine kinase and MAP kinase pathways; 2) glucocorticoids; and 3) endothelin. Studies in Aim 4 will quantitate citrate metabolism in mitochondrial and cytoplasmic pathways of the renal proximal tubule using 13C NMR spectroscopy. Lastly, studies in Aim 5 will address whether hyperkalemia causes hypercitraturia and thus is responsible for the lack of predisposition to nephrolithiasis in hyperkalemic renal distal tubular acidosis. These studies will allow us to continue to pursue an understanding of the mechanisms of regulation of renal citrate handling in the proximal tubule. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

Studies 27

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Project Title: RENAL CRYSTAL GROWTH INHIBITOR PROTEINS Principal Investigator & Institution: Kleinman, Jack G. Professor; Medicine; Medical College of Wisconsin Po Box26509 Milwaukee, WI 532264801 Timing: Fiscal Year 2001; Project Start 01-JUL-1995; Project End 31-MAR-2003 Summary: Kidney stones are a common clinical problem responsible for significant morbidity and economic costs in excess of 2 billion dollars/year. Despite progress in treatment, the recurrence rate of stones remains high. Interrupting early steps in the formation of kidney stones have the greatest likelihood of successfully preventing recurrence. These early steps include nucleation of stone crystals in tubular fluid and their growth and aggregation within the nephron to a size that can interact with some intrarenal structure. It is the hypothesis of this grant that these processes are primarily determined by specific interactions between stone constituent crystals and macromolecules present in tubular fluid and urine. The overall goal of this project is to advance our understanding of the role of one of these interactions by studying those of the principal urinary inhibitory macromolecule osteopontin/uropontin (OPN) and other macromolecular inhibitors of crystal formation in general in the development of kidney stones.. The specific aims are: (1) Determining structural motifs of OPN responsible for effects on nucleation, growth, aggregation of calcium oxalate and hydroxyapatite (crystal formation), specifically, (a) the contributions of the N-terminal and C-terminal halves of the molecule, (b) the roles of putative Ca-binding sites, and (c) the effects of post-translational modifications; (2) Characterizing OPN from normals and Ca stoneformers with respect to its effects on crystal formation, including, (a) isolation and biochemical characterization of OPN from urine of normals and stone-formers, and (b) determining whether OPN from Ca-stone formers inhibits stone crystal formation to the same degree as OPN from normal individuals; (3) Investigating the physical chemistry of the interaction of OPN and other macromolecules and stone crystals, by determining (a) the quantitative relationship between macromolecules and growing crystal nuclei, (b) the relationship between their structure and crystal formation, and (c) the effects of the reactions conditions on the interaction between them and growing crystal nuclei, and by examining (d) the interactions between immobilized macromolecules and crystal formation; (4) Examining the effects of regulating OPN production on an experimental model of CaOx stone disease. Specifically, (a) determining whether pharmacolgic upregulation of OPN production ameliorates crystal deposition in animals given Na oxalate either acutely or chronically, (b) developing an in vivo system for transient renal expression of OPN, and (c) determining whether upregulation of OPN expression protects and down-regulation aggrevates crystal deposition in animals given Na oxalate either acutely or chronically. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: RISK FACTORS FOR RECURRENT NEPHROLITHIASIS Principal Investigator & Institution: Curhan, Gary C. Associate Professor of Medicine; Brigham and Women's Hospital 75 Francis Street Boston, MA 02115 Timing: Fiscal Year 2002; Project Start 15-MAR-2002; Project End 31-DEC-2006 Summary: (provided by applicant): We propose to build upon our initial findings of factors that influence risk of nephrolithiasis, which occurs in 12 percent of the US population and causes tremendous pain and suffering. Using a prospective study design, the primary objective is to identify and evaluate dietary and urinary risk factors for recurrent nephrolithiasis in female and male participants of three large prospective cohort studies: the Nurses' Health Study I (121,700 women), the Nurses' Health Study II

28 Kidney Stones

(116,671 women), and the Health Professionals Follow-up Study (51,529 men). Detailed dietary data are collected and updated in all three cohorts, and 24-hour urine samples were previously collected from a subset of subjects with incident kidney stones from all three cohorts. During the proposed 5-year study period, we will identify and confirm incident and recurrent kidney stones by medical record review. Further, we will collect two 24-hour urine samples from newly confirmed incident cases and randomly selected controls to measure 24-hour urine excretion of calcium, oxalate and other relevant factors. We will test the hypotheses that dietary and urinary factors proposed to be associated with incident stone formation are associated with recurrent stone formation. We also will explore interactions between dietary and urinary factors, especially calcium intake and urinary calcium excretion and risk of stone recurrence. Furthermore, we will examine if recurrence rates differ by gender and, if so, whether these differences can be explained by differences in dietary or urinary factors. Basing these analyses in these three existing cohorts has several major strengths. A substantial number of incident cases (n = 4953) and recurrent cases (n = 1114) have already been identified. The completeness of follow-up and the vast amount of information already collected make this a rich resource, particularly to study interactions between diet and urinary factors. Several important and intriguing results regarding kidney stone formation have already emerged from the cohorts. The study design and use of existing data provide an efficient means to increase the scientific value of these cohorts and to test several hypotheses of public health importance. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: ROLE OF BIOPOLYMERS AND LIPIDS IN KIDNEY STONE FORMATION Principal Investigator & Institution: Gower, Laurie A. Assistant Professor; Materials Science and Engr; University of Florida Gainesville, FL 32611 Timing: Fiscal Year 2001; Project Start 15-JUL-2001; Project End 30-JUN-2005 Summary: The objective of the proposed bioengineering research partnership (BRP), located at the University of Florida, is to examine two key issues relevant to urolithiasis; 1) the effects of acidic biopolymers and lipid membranes on nucleation, growth and aggregation of calcium oxalate (CaOx) crystals in an artificial urinary environment; and 2) the injurious effects of a liquid-phase mineral precursor on tubular epithelial cells grown in culture. With regard to 1), many investigators have examined the promotory and inhibitory effects of acidic glycoproteins on crystal growth and aggregation. Our work differs in that a primary focus will be to investigate the relevance of a recently discovered polymer-induced liquid-precursor (PILP) process to pathological biomineralization. The PILP process generates non- equilibrium crystal morphologies which exhibit features similar to crystals found in kidney stones, such as for example, stratified spherulites. Mineral films and coatings are also deposited by the process, and repetitive depositions might lead to concentrically laminated structures, such as those commonly observed in composite stones. In addition, the interfacial aspects of this liquid-liquid phase separation process lead to a pronounced aggregation tendency of crystals. Lastly, we hypothesize that the presence of this cementatious mineral precursor in the urinary tract could influence the attachment and retention of crystals to renal epithelial cells; or the highly ionic precursor phase could cause cell injury or death, leading to the release of modulatory factors or membrane fragments, which could promote heterogeneous nucleation and/or aggregation of crystals. The proposed work consists of ten Specific Aims which fall under four topical areas: crystal-macromolecule, crystal- crystal, crystal-lipid, and crystal-cell interactions. The bioengineering techniques

Studies 29

to be used include measurement of interparticle forces by Atomic Force Microscopy, measurement of long-range interactions between submicron CaOx particles and mimetic lipid membranes with an optical trap force transducer, and nucleation of crystals and PILP phase on mimetic lipid membranes using Langmuir monolayers. This 5-year project will enable us to assess the relevance of the PILP process to pathological calcification, as well as to perform a comparative analysis with the more traditional concepts pertaining to the role of lipids and acidic biopolymers in stone formation, and will contribute to the development of bioengineering techniques that are new to the field of stone research. The long-range clinical goal of this BRP is to provide a more effective means of diagnosis, treatment, and long-term prevention of renal calculi.. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: SPS OF STRUCTURALLY DIVERSE AFGP ANALOGUES Principal Investigator & Institution: Ben, Robert N. Assistant Professor; Chemistry; State University New York Binghamton Vestal Pky E Binghamton, NY 13901 Timing: Fiscal Year 2001; Project Start 01-JUL-2001; Project End 30-JUN-2006 Summary: (provided by applicant): The objective of this proposal is to facilitate a detailed understanding of how antifreeze glycoproteins (AFGPs) inhibit ice crystal growth. Towards this end, our laboratory has synthesized a series of first generation AFGP analogues and assessed their ability to inhibit ice crystal growth. Our approach centers on the preparation of glycosylated tripeptide building blocks that possess carbon-carbon linkages instead of carbon-oxygen linkages at the anomeric center. These building blocks (referred to as monomers) have been assembled into structural AFGP analogues using conventional solid phase synthesis (SPS). Preliminary data has shown that two of our C-linked AFGP analogues have antifreeze activity. This application describes studies designed to address what forces (hydrophilic or hydrophobic interactions etc.) are involved in AFGP function, and also, what structural features are necessary for antifreeze activity. The fact that the structures of these mimics are dramatically different than native AFGP suggests that the rational design of low molecular weight synthetic antifreezes is possible. Such compounds have tremendous potential as cryoprotective agents to protect cells from freeze-thaw damage and thus, have applications in cryomedicine where alternatives for the long-term storage of tissues and organs are urgently required. In addition, the concept of preventing or modifying ice crystal growth is a fundamental one that is closely related to biomineralization processes since; many biological molecules absorb onto crystalline surfaces and subsequently alter crystal growth. Examples of such processes include the deposition of cholesterol, the formation of gal bladder and kidney stones as well as consolidated biominerals such as bone and enamel. As a result, a detailed mechanistic understanding of how biological antifreezes function may have direct applications in many biomolecular processes of current medical interest. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: SWL AND RENAL INJURY AND STONE COMMINUTION Principal Investigator & Institution: Evan, Andrew P. Professor of Anatomy; Anatomy and Cell Biology; Indiana Univ-Purdue Univ at Indianapolis 620 Union Drive, Room 618 Indianapolis, IN 462025167 Timing: Fiscal Year 2001; Project Start 10-MAY-1994; Project End 28-FEB-2003 Summary: Shock wave lithotripsy (SWL) is a very effective non-invasive treatment modality for the removal of upper urinary tract stones. However, SWL causes trauma to

30 Kidney Stones

the kidney that can lead to serious long-term complications in some individuals (e.g. new onset hypertension in the elderly; delayed kidney growth in the very young). While the efficacy of SWL is not in question, the severity of complications raises concern for the long-term safety of SWL. Little is known about the cellular level mechanisms involved in SWL injury and the tissue level changes that lead to chronic alterations in kidney structure and function. Likewise, it is not known how lithotripter shock waves (Sw's) break kidney stones.. Thus, the principal objectives of the proposed research are to determine: 1) the physical mechanisms of stone comminution and tissue damage in SWL; 2) the cellular mechanisms of SW- physical mechanisms of stone comminution and tissue damage in SWL; 2) the cellular mechanisms of SW-induced tissue injury; 3) the progression of tissue level changes initiated changes initiated by SW trauma that lead to scar formation; and 4) the factors (renal and extrarenal) that place patients at increased risk of injury. Our research effort in this Program Project Grant is organized around four Projects and two Cores. Project 1 (Indiana University & Methodist Hospital of Indiana) will use a whole animal model (pig) to determine how SW treatment causes renal hemorrhage and vasoconstriction, to define the tissue response that leads to scar formation and to assess for potential risk factors that may enhance SWL injury. Project 2 (Indians University) will use cultured cells and a variety of in vitro models that determine the cellular mechanisms involved in tissue damage and how acoustic cavitation and shear cause cell injury. Project 3 (University of Washington) will use sophisticated methods of cavitation to determine the role of cavitation in stone comminution and tissue injury. Project 4 (California Institute of Technology) will examine the role of shock waves shear as a fundamental mechanism that contributes to tissue failure and stone comminution. The overall goal of this research is to determine the physical mechanisms of stone comminution and the cause and consequences of SWinduced renal injury so that strategies can be devised to minimized or eliminate adverse effect while improving the efficacy of SWL. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: UROLITHIASIS AND PEROXIDATIVE INJURY Principal Investigator & Institution: Thamilselvan, Sivagnanam; Urology; Case Western Reserve Univ-Henry Ford Hsc Research Administraion Cfp-046 Detroit, MI 48202 Timing: Fiscal Year 2001; Project Start 01-SEP-1999; Project End 31-JUL-2004 Summary: Urolithiasis is a major health problem in the United States, and the incidence and frequency of stone formation appears to be increasing in this country. The current cost to the nation for treating kidney stones is approximaately 2.39 billion dollars/year. About two thirds of the stones contain calcium oxalate. Chances of recurrences within 10 years are nearly 60 percent. Treatment program includes medications, open surgery, percutaneous techniques and extra corporeal shock wave lithotripsy. Despite recent advances in treatment, stone recurrence can be reduced by only 50 percent. To reduce the likelihood of stone recurrence it is necessary to determine and understand the mechanisms involved in stone formation. Our working hypothesis is that cell injury is central to the process of urolithiasis and that prevention of cell injury will prevent calcium oxalate formation, retention and deposition. Hyperoxaluria and calcium oxalate crystalluria are often associated with increased excretion of tubular marker enzymes, a finding consistent with damage to renal tubular cells. Moreover, these changes are observed even in the absence of crystalluria, suggesting that oxalate induced membrane damage is not due solely to injury produced by calcium oxalate crystals. Our studies have suggested that oxalate induces peroxidative injury to the kidney tubules which can alter membrane permeability, and result in the deterioration of ability of the cells to

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maintain normal ionic environment. The oxidant and antioxidant balance is therefore likely to be a critical determinant of cell sensitivity to free radical injury and a major impact on the magnitude of stone crystal nucleation on the injured renal tubular epithelium and the development of stone nidus. We propose to test this hypothesis in an animal model and renal epithelial cell culture (LLC-PK1 and MDCK). In an animal model hyperoxaluria is induced in male rats. In cell culture experiments, renal epithelial cells in culture are exposed to oxalate and calcium oxalate monohydrate crystals. The effect of antioxidants on these experimental models will be tested. These studies will provide valuable information on the importance of antioxidants in decreasing oxalate synthesis and deposition and, whether antioxidants offer promise as a therapeutic agent for recurrent stone formation. 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 “kidney stones” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for kidney stones in the PubMed Central database: ·

Nephrology: 1. Investigation and treatment of recurrent kidney stones. by Morton AR, Iliescu EA, Wilson JW. 2002 Jan 22; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=99277

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals.

3 4

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

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

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

A comparative study of fracture strength, ultrasonic properties and chemical constituents of kidney stones. Author(s): Agarwal R, Singh VR. Source: Ultrasonics. 1991 January; 29(1): 89-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1990725&dopt=Abstract

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A new test for idiopathic kidney stones. Author(s): Chhabra HL, Manocha KK. Source: The Indian Journal of Medical Research. 1985 January; 81: 68-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3988331&dopt=Abstract

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A prospective study of dietary calcium and other nutrients and the risk of symptomatic kidney stones. Author(s): Menon M. Source: The Journal of Urology. 1993 August; 150(2 Pt 1): 563-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8326599&dopt=Abstract

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A prospective study of dietary calcium and other nutrients and the risk of symptomatic kidney stones. Author(s): Curhan GC, Willett WC, Rimm EB, Stampfer MJ. Source: The New England Journal of Medicine. 1993 March 25; 328(12): 833-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8441427&dopt=Abstract

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A prospective study of hypertension and the incidence of kidney stones in men. Author(s): Cappuccio FP, Siani A, Barba G, Mellone MC, Russo L, Farinaro E, Trevisan M, Mancini M, Strazzullo P. Source: Journal of Hypertension. 1999 July; 17(7): 1017-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10419076&dopt=Abstract

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Accuracy of hematuria in diagnosing kidney stones. Author(s): Koenig CJ, Lindbloom EJ. Source: The Journal of Family Practice. 1999 November; 48(11): 912-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10907632&dopt=Abstract

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Acoustic and mechanical properties of artificial stones in comparison to natural kidney stones. Author(s): Rassweiler J. Source: The Journal of Urology. 2000 August; 164(2): 273. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10991698&dopt=Abstract

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Acoustic and mechanical properties of artificial stones in comparison to natural kidney stones. Author(s): Heimbach D, Munver R, Zhong P, Jacobs J, Hesse A, Muller SC, Preminger GM. Source: The Journal of Urology. 2000 August; 164(2): 537-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10893640&dopt=Abstract

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Acute changes of serum markers for tissue damage after ESWL of kidney stones. Author(s): Apostolov I, Minkov N, Koycheva M, Isterkov M, Abadjyev M, Ondeva V, Trendafilova T. Source: International Urology and Nephrology. 1991; 23(3): 215-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1889966&dopt=Abstract

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Amyloid kidney stones of uremic patients consist of beta 2-microglobulin fragments. Author(s): Linke RP, Bommer J, Ritz E, Waldherr R, Eulitz M. Source: Biochemical and Biophysical Research Communications. 1986 April 29; 136(2): 665-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3085673&dopt=Abstract

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An intimate discussion of kidney stones. Author(s): Davis WE. Source: Northwest Med. 1971 December; 70(12): 825-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5130802&dopt=Abstract

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Analysis and classification of secondary sounds from the disintegration of kidney stones with acoustic shock waves. Author(s): Olsson L, Almquist LO, Grennberg A, Holmer NG. Source: Ultrasound in Medicine & Biology. 1991; 17(5): 491-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1962350&dopt=Abstract

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Analysis of the soluble organic matrix of five morphologically different kidney stones. Evidence for a specific role of albumin in the constitution of the stone protein matrix. Author(s): Dussol B, Geider S, Lilova A, Leonetti F, Dupuy P, Daudon M, Berland Y, Dagorn JC, Verdier JM. Source: Urological Research. 1995; 23(1): 45-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7618235&dopt=Abstract

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Are bacterial proteins part of the matrix of kidney stones? Author(s): Daskalova S, Kostadinova S, Gauster D, Prohaska R, Ivanov A. Source: Microbial Pathogenesis. 1998 October; 25(4): 197-201. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9817823&dopt=Abstract

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Ascorbic acid and kidney stones. Author(s): Hoffer A. Source: Can Med Assoc J. 1985 February 15; 132(4): 320. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3971246&dopt=Abstract

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Bacteria to blame for kidney stones? Author(s): Vogel G. Source: Science. 1998 July 10; 281(5374): 153. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9687272&dopt=Abstract

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Beverage use and risk for kidney stones in women. Author(s): Curhan GC, Willett WC, Speizer FE, Stampfer MJ. Source: Annals of Internal Medicine. 1998 April 1; 128(7): 534-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9518397&dopt=Abstract

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Beverages, diet, and prevention of kidney stones. Author(s): Goldfarb DS, Coe FL. Source: American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation. 1999 February; 33(2): 398-400; Discussion 401-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10023657&dopt=Abstract

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Body size and risk of kidney stones. Author(s): Curhan GC, Willett WC, Rimm EB, Speizer FE, Stampfer MJ. Source: Journal of the American Society of Nephrology : Jasn. 1998 September; 9(9): 1645-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9727373&dopt=Abstract

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Bone metaplasia of urothelial mucosa: an unusual biological phenomenon causing kidney stones. Author(s): Fernandez-Conde M, Serrano S, Alcover J, Aaron JE. Source: Bone. 1996 March; 18(3): 289-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8703586&dopt=Abstract

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Calcium and kidney stones. Author(s): Stern R. Source: The New England Journal of Medicine. 1993 August 12; 329(7): 509. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8332169&dopt=Abstract

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Calcium and kidney stones. Author(s): Burtis WJ, Broadus AE, Insogna KL. Source: The New England Journal of Medicine. 1993 August 12; 329(7): 508-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8332168&dopt=Abstract

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Calcium intake and kidney stones in women. Author(s): Heaney RP. Source: Annals of Internal Medicine. 1997 November 1; 127(9): 846. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9382410&dopt=Abstract

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Calcium oxalate kidney stones in patients on continuous ambulatory peritoneal dialysis. Author(s): Oren A, Husdan H, Cheng PT, Khanna R, Pierratos A, Digenis G, Oreopoulos DG. Source: Kidney International. 1984 March; 25(3): 534-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6547492&dopt=Abstract

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Cardiac dysrhythmias related to extracorporeal shock wave lithotripsy using a piezoelectric lithotriptor in patients with kidney stones. Author(s): Kataoka H. Source: The Journal of Urology. 1995 May; 153(5): 1390-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7714948&dopt=Abstract

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CBS domains in CIC chloride channels implicated in myotonia and nephrolithiasis (kidney stones). Author(s): Ponting CP. Source: Journal of Molecular Medicine (Berlin, Germany). 1997 March; 75(3): 160-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9106071&dopt=Abstract

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Changes in the excretion of glycosaminoglycans with urine in patients with kidney stones. Author(s): Kaznowska-Bystryk I. Source: Ann Univ Mariae Curie Sklodowska [med]. 1999; 54: 395-400. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11205798&dopt=Abstract

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Characterisation of renal chloride channel, CLCN5, mutations in hypercalciuric nephrolithiasis (kidney stones) disorders. Author(s): Lloyd SE, Gunther W, Pearce SH, Thomson A, Bianchi ML, Bosio M, Craig IW, Fisher SE, Scheinman SJ, Wrong O, Jentsch TJ, Thakker RV. Source: Human Molecular Genetics. 1997 August; 6(8): 1233-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9259268&dopt=Abstract

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ClC-5 chloride channel and kidney stones: what is the link? Author(s): Silva IV, Morales MM, Lopes AG. Source: Brazilian Journal of Medical and Biological Research = Revista Brasileira De Pesquisas Medicas E Biologicas / Sociedade Brasileira De Biofisica. [et Al.]. 2001 March; 34(3): 315-23. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11262581&dopt=Abstract

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Clinical and biochemical differences in patients with pure calcium oxalate monohydrate and calcium oxalate dihydrate kidney stones. Author(s): Pierratos AE, Khalaff H, Cheng PT, Psihramis K, Jewett MA. Source: The Journal of Urology. 1994 March; 151(3): 571-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8308959&dopt=Abstract

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Clinical snapshot: kidney stones. Author(s): Goshorn J. Source: The American Journal of Nursing. 1996 September; 96(9): 40-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8855911&dopt=Abstract

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Combined analysis of kidney stones by X-ray diffraction and electron microprobe. Author(s): Joost J, Tessadri R. Source: European Urology. 1983; 9(5): 305-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6628475&dopt=Abstract

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Comparative study of long-term stone recurrence after extracorporeal shock wave lithotripsy and open stone surgery for kidney stones. Author(s): Kosar A, Sarica K, Aydos K, Kupeli S, Turkolmez K, Gogus O. Source: International Journal of Urology : Official Journal of the Japanese Urological Association. 1999 March; 6(3): 125-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10226822&dopt=Abstract

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Comparison of dietary calcium with supplemental calcium and other nutrients as factors affecting the risk for kidney stones in women. Author(s): Curhan GC, Willett WC, Speizer FE, Spiegelman D, Stampfer MJ. Source: Annals of Internal Medicine. 1997 April 1; 126(7): 497-504. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9092314&dopt=Abstract

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Composition of the diet and calcium kidney stones. Author(s): Lemann J Jr. Source: The New England Journal of Medicine. 1993 March 25; 328(12): 880-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8441433&dopt=Abstract

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Cost effectiveness of extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy for medium-sized kidney stones. A randomised clinical trial. Author(s): Carlsson P, Kinn AC, Tiselius HG, Ohlsen H, Rahmqvist M. Source: Scandinavian Journal of Urology and Nephrology. 1992; 26(3): 257-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1439601&dopt=Abstract

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Cost effectiveness of extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy for medium-sized kidney stones: a randomised clinical trial. Author(s): Menon M. Source: The Journal of Urology. 1993 August; 150(2 Pt 1): 565. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8326600&dopt=Abstract

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Cost-effective workup for kidney stones. Author(s): Baum N. Source: Postgraduate Medicine. 1999 December; 106(7): 94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10608967&dopt=Abstract

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Current trend and risk factors for kidney stones in persons with spinal cord injury: a longitudinal study. Author(s): Chen Y, DeVivo MJ, Roseman JM. Source: Spinal Cord : the Official Journal of the International Medical Society of Paraplegia. 2000 June; 38(6): 346-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10889563&dopt=Abstract

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Demographic and geographic variability of kidney stones in the United States. Author(s): Soucie JM, Thun MJ, Coates RJ, McClellan W, Austin H. Source: Kidney International. 1994 September; 46(3): 893-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7996811&dopt=Abstract

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Dent's disease, a renal Fanconi syndrome with nephrocalcinosis and kidney stones, is associated with a microdeletion involving DXS255 and maps to Xp11.22. Author(s): Pook MA, Wrong O, Wooding C, Norden AG, Feest TG, Thakker RV. Source: Human Molecular Genetics. 1993 December; 2(12): 2129-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8111383&dopt=Abstract

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Development and application of confined blasting for bladder and kidney stones. Author(s): Watanabe H, Uchida M, Nakagawa Y, Fujito A, Kitamura K. Source: Urologia Internationalis. 1987; 42(1): 23-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3590403&dopt=Abstract

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Diagnosis and initial management of kidney stones. Author(s): Portis AJ, Sundaram CP. Source: American Family Physician. 2001 April 1; 63(7): 1329-38. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11310648&dopt=Abstract

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Diagnosis and treatment of calcium kidney stones. Author(s): Klugman V, Favus MJ. Source: Adv Endocrinol Metab. 1995; 6: 117-42. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7671093&dopt=Abstract

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Dielectric properties of kidney stones as electro-ceramics. Author(s): Agarwal R, Singh VR. Source: Bio-Medical Materials and Engineering. 1991; 1(3): 155-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1842513&dopt=Abstract

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Diet and kidney stones. Author(s): Ingelfinger JR. Source: The New England Journal of Medicine. 2002 January 10; 346(2): 74-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11784872&dopt=Abstract

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Dietary hypercalciuria in patients with calcium oxalate kidney stones. Author(s): Burtis WJ, Gay L, Insogna KL, Ellison A, Broadus AE. Source: The American Journal of Clinical Nutrition. 1994 September; 60(3): 424-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8074077&dopt=Abstract

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Diets with either beef or plant proteins reduce risk of calcium oxalate precipitation in patients with a history of calcium kidney stones. Author(s): Massey LK, Kynast-Gales SA. Source: Journal of the American Dietetic Association. 2001 March; 101(3): 326-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11269613&dopt=Abstract

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Drawing up guidelines for the management of kidney stones in Italy. Author(s): Baggio B. Source: Journal of Nephrology. 2000 November-December; 13 Suppl 3: S61-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11132034&dopt=Abstract

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E.S.W.I.: a shocking blow to kidney stones. Author(s): Cochran M. Source: Nursing. 1987 May; 17(5): 159. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3646528&dopt=Abstract

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Economic impact of kidney stones in white male adults. Author(s): Shuster J, Scheaffer RL. Source: Urology. 1984 October; 24(4): 327-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6485191&dopt=Abstract

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Editorial: Why it's hard to treat kidney stones. Author(s): Thier SO. Source: The New England Journal of Medicine. 1976 January 29; 294(5): 276-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1244554&dopt=Abstract

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Effect of daily MgO and vitamin B6 administration to patients with recurring calcium oxalate kidney stones. Author(s): Gershoff SN, Prien EL. Source: The American Journal of Clinical Nutrition. 1967 May; 20(5): 393-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6023850&dopt=Abstract

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Effect of dietary oxalate and calcium on urinary oxalate and risk of formation of calcium oxalate kidney stones. Author(s): Massey LK, Roman-Smith H, Sutton RA. Source: Journal of the American Dietetic Association. 1993 August; 93(8): 901-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8335871&dopt=Abstract

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Effects of high energy shock wave exposure on renal function during extracorporeal shock wave lithotripsy for kidney stones. Author(s): Kishimoto T, Senju M, Sugimoto T, Yamamoto K, Sakamoto W, Iimori M, Kanasawa T, Wada S, Maekawa M. Source: European Urology. 1990; 18(4): 290-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1705228&dopt=Abstract

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Effects of water hardness on urinary risk factors for kidney stones in patients with idiopathic nephrolithiasis. Author(s): Bellizzi V, De Nicola L, Minutolo R, Russo D, Cianciaruso B, Andreucci M, Conte G, Andreucci VE. Source: Nephron. 1999; 81 Suppl 1: 66-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9873217&dopt=Abstract

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Electrical conductivity of kidney stones. Author(s): Yagyik Y, Lal N, Talwar IM, Jethi RK. Source: Biomaterials. 1989 May; 10(4): 281-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2742955&dopt=Abstract

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Elevated blood pressure and positive history of kidney stones: results from a population-based study. Author(s): Cirillo M, Laurenzi M. Source: Journal of Hypertension. Supplement : Official Journal of the International Society of Hypertension. 1988 December; 6(4): S485-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3241240&dopt=Abstract

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Estimating the effectiveness of various methods of evacuation of kidney stones, on the basis of data obtained on percentage of “stone free” and recurrent stone formation. Author(s): Bilobrov VM, Roy A, Bilobrov SV. Source: International Urology and Nephrology. 2001; 33(2): 335-40. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12092650&dopt=Abstract

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Etiology, treatment and prevention of kidney stones. Author(s): Howard JE. Source: Med Times. 1970 April; 98(4): 107-15. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5422572&dopt=Abstract

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Experimental model to study sedimentary kidney stones. Author(s): Grases F, Llobera A. Source: Micron (Oxford, England : 1993). 1998 April-June; 29(2-3): 105-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9684348&dopt=Abstract

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Extracorporeal shock wave lithotripsy (ESWL) for kidney stones. An alternative to surgery? Author(s): Chaussy C, Schmiedt E. Source: Urol Radiol. 1984; 6(2): 80-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6740830&dopt=Abstract

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Extracorporeal shock wave lithotripsy of kidney stones does not induce transient bacteremia. A prospective study. The Copenhagen Extracorporeal Shock Wave Lithotripsy Study Group. Author(s): Westh H, Knudsen F, Hedengran AM, Weischer M, Mogensen P, Andersen JT. Source: The Journal of Urology. 1990 July; 144(1): 15-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2359167&dopt=Abstract

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Extracorporeal shock-wave lithotripsy treatment for kidney stones. Author(s): Parker-Cohen PD. Source: The Nurse Practitioner. 1988 March; 13(3): 32, 37-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3374867&dopt=Abstract

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Extracorporeally induced destruction of kidney stones by shock waves. Author(s): Chaussy C, Brendel W, Schmiedt E. Source: Lancet. 1980 December 13; 2(8207): 1265-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6108446&dopt=Abstract

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Family history and risk of kidney stones. Author(s): Curhan GC, Willett WC, Rimm EB, Stampfer MJ. Source: Journal of the American Society of Nephrology : Jasn. 1997 October; 8(10): 156873. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9335385&dopt=Abstract

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First clinical experience with extracorporeally induced destruction of kidney stones by shock waves. Author(s): Chaussy C, Schmiedt E, Jocham D, Brendel W, Forssmann B, Walther V. Source: The Journal of Urology. 1982 March; 127(3): 417-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6977650&dopt=Abstract

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First clinical experience with extracorporeally induced destruction of kidney stones by shock waves. 1981. Author(s): Chaussy C, Schmiedt E, Jocham D, Brendel W, Forssmann B, Walther V. Source: The Journal of Urology. 2002 May; 167(5): 1957-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11956416&dopt=Abstract

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First clinical experience with extracorporeally induced destruction of kidney stones by shock waves. 1981. Author(s): Chaussy C, Schmiedt E, Jocham D, Brendel W, Forssmann B, Walther V. Source: The Journal of Urology. 2002 February; 167(2 Pt 2): 844-7; Discussion 848. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11905908&dopt=Abstract

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First planned nephrectomy for kidney stones. Author(s): Scardino PL. Source: Urology. 1979 January; 13(1): 111-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=375532&dopt=Abstract

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Geographic variation and environmental risk factors for the incidence of initial kidney stones in patients with spinal cord injury. Author(s): Chen YY, Roseman JM, Devivo MJ, Huang CT. Source: The Journal of Urology. 2000 July; 164(1): 21-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10840416&dopt=Abstract

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Grapefruit juice and kidney stones. Author(s): Ameer B. Source: Annals of Internal Medicine. 1998 December 1; 129(11): 913. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9867737&dopt=Abstract

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Hypertension and kidney stones: hypotheses and implications. Author(s): Strazzullo P, Cappuccio FP. Source: Semin Nephrol. 1995 November; 15(6): 519-25. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8588112&dopt=Abstract

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I am a 54-year-old man with a history of kidney stones. My doctor recently sent me for a “spiral CT scan.” What is the difference between a spiral scan and a regular CT scan? Author(s): Simon HB. Source: Harvard Men's Health Watch. 1999 July; 3(12): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10368544&dopt=Abstract

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Immunological and bacteriological studies in chronic pyelonephritis associated with kidney stones. Author(s): Schena FP, Selvaggi FP, Salvatore C, Barbuti S, Marzullo F, Tallarigo A, Bonomo L. Source: Nephron. 1979; 23(4): 162-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=381953&dopt=Abstract

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Increased urinary excretion of lipids by patients with kidney stones. Author(s): Khan SR, Glenton PA. Source: British Journal of Urology. 1996 April; 77(4): 506-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8777608&dopt=Abstract

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Instrumental neutron activation analysis of kidney stones. Author(s): Sarmani S, Kuan LL, Bakar MA. Source: Biological Trace Element Research. 1990 July-December; 26-27: 497-502. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1704755&dopt=Abstract

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Investigation of the microstructure of kidney stones (oxalate type) by high voltage electron microscopy and electron diffraction. Author(s): El-Sayed K, Cosslett VE. Source: Experientia. 1977 July 15; 33(7): 919-21. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=891772&dopt=Abstract

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Is lower pole caliceal anatomy predictive of extracorporeal shock wave lithotripsy success for primary lower pole kidney stones? Author(s): Sorensen CM, Chandhoke PS. Source: The Journal of Urology. 2002 December; 168(6): 2377-82; Discussion 2382. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12441921&dopt=Abstract

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'Jackhammer' could crush cost of treating kidney stones. Author(s): Wagner M. Source: Modern Healthcare. 1991 June 10; 21(23): 19. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10110961&dopt=Abstract

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Kidney stones 1983: a preventable cause of morbidity. Author(s): Rao DS, Kleerekoper M, Littleton R, Levin NW. Source: Henry Ford Hosp Med J. 1983; 31(3): 182-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6643100&dopt=Abstract

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Kidney stones and cystic fibrosis. Author(s): Gutknecht DR. Source: The American Journal of Medicine. 2001 July; 111(1): 83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11460857&dopt=Abstract

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Kidney stones and drinking water. Author(s): Popovtzer MM, Stein P, Rubinger D, Friedlaender MM. Source: The New England Journal of Medicine. 1984 March 15; 310(11): 721. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6700649&dopt=Abstract

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Kidney stones and hypertension: population based study of an independent clinical association. Author(s): Cappuccio FP, Strazzullo P, Mancini M. Source: Bmj (Clinical Research Ed.). 1990 May 12; 300(6734): 1234-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2354291&dopt=Abstract

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Kidney stones and lithotripters: critical analysis of the introduction of extracorporeal shock wave lithotripsy into Canada. Author(s): Wiser LC, Plain RH, Dossetor JB. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 1990 December 15; 143(12): 1299-303. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2123736&dopt=Abstract

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Kidney stones and renal transplantation. Author(s): Narayana AS, Loening S, Culp DA. Source: Urology. 1978 July; 12(1): 61-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=356391&dopt=Abstract

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Kidney stones as a manifestation of hypercalcemic disorders. Hyperparathyroidism and sarcoidosis. Author(s): Rodman JS, Mahler RJ. Source: The Urologic Clinics of North America. 2000 May; 27(2): 275-85, Viii. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10778470&dopt=Abstract

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Kidney stones don't have to recur. Author(s): Cerrato PL. Source: Rn. 1992 June; 55(6): 63-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1529216&dopt=Abstract

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Kidney stones, carbonic anhydrase inhibitors, and the ketogenic diet. Author(s): Parmar MS. Source: Epilepsia. 2003 May; 44(5): 735; Author Reply 736. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12752480&dopt=Abstract

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Kidney stones, carbonic anhydrase inhibitors, and the ketogenic diet. Author(s): Kossoff EH, Pyzik PL, Furth SL, Hladky HD, Freeman JM, Vining EP. Source: Epilepsia. 2002 October; 43(10): 1168-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12366731&dopt=Abstract

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Kidney stones, urine, and cement. Author(s): Thomas WC Jr. Source: Md Med J. 1988 November; 37(11): 861-2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3185158&dopt=Abstract

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Kidney stones. Author(s): Bushinsky DA. Source: Adv Intern Med. 2001; 47: 219-38. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11795076&dopt=Abstract

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Kidney stones. Author(s): Pak CY. Source: Lancet. 1998 June 13; 351(9118): 1797-801. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9635968&dopt=Abstract

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Kidney stones. Author(s): Kleeman CR, Coburn JW, Brickman AS, Lee DB, Narins RG, Ehrlich RM. Source: The Western Journal of Medicine. 1980 April; 132(4): 313-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7385835&dopt=Abstract

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Kidney stones. How new technology has improved management. Author(s): Streem SB. Source: Postgraduate Medicine. 1988 December; 84(8): 77-8, 81-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2904142&dopt=Abstract

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Kidney stones. How to identify the cause and prevent recurrence. Author(s): LaPorte J, Baum N. Source: Postgraduate Medicine. 1990 April; 87(5): 219-23, 226. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2181426&dopt=Abstract

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Kidney stones. Medical management and newer options for stone 'removal'. Author(s): Kanig SP, Conn RL. Source: Postgraduate Medicine. 1985 November 1; 78(6): 38-44, 47-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4059131&dopt=Abstract

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Kidney stones: a medical approach. Author(s): Lespier-Dexter LE. Source: Bol Asoc Med P R. 1979 October; 71(10): 378-83. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=295650&dopt=Abstract

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Kidney stones: clinical problem. Author(s): Block MB. Source: Ariz Med. 1975 September; 32(9): 727-30. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1191091&dopt=Abstract

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Kidney stones: crushing traditional therapy. Author(s): Garbolski JM. Source: J Am Osteopath Assoc. 1987 October; 87(10): 707-11. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3679913&dopt=Abstract

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Kidney stones: current issues in diagnosis and therapy. Author(s): Brown DC. Source: Postgraduate Medicine. 1982 December; 72(6): 124-33. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6755415&dopt=Abstract

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Kidney stones: various forms and treatment. Author(s): Pak CY. Source: Nephron. 1979; 23(2-3): 142-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=220549&dopt=Abstract

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Letter: Kidney stones in children. Author(s): Wright-St RE. Source: N Z Med J. 1975 February 26; 81(534): 218. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1094347&dopt=Abstract

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Lithotripsy for kidney stones. Author(s): Costello A. Source: Aust Fam Physician. 1992 April; 21(4): 438-40. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1530469&dopt=Abstract

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Lithotripter treatment of kidney stones in outpatient surgery. Author(s): Brennan C. Source: J Post Anesth Nurs. 1989 June; 4(3): 170-1. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2732958&dopt=Abstract

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Lithotripters: noninvasive devices for the treatment of kidney stones. Guideline report. Author(s): Alder HC. Source: Hosp Technol Ser. 1985 March; 4(9): 1-53. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10270334&dopt=Abstract

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Long term follow-up after ESWL of large kidney stones. Author(s): Frick J, Baltaci S, Kohle R, Kunit G, Joos H. Source: Rev Med Suisse Romande. 1992 September; 112(9): 741-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1411032&dopt=Abstract

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Long-term follow-up after extracorporeal shock wave lithotripsy of large kidney stones. Author(s): Baltaci S, Kohle R, Kunit G, Joos H, Frick J. Source: European Urology. 1992; 22(2): 106-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1478223&dopt=Abstract

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Long-term followup after extracorporeal shock wave lithotripsy treatment of kidney stones in solitary kidneys. Author(s): Zanetti GR, Montanari E, Guarneri A, Trinchieri A, Mandressi A, Ceresoli A. Source: The Journal of Urology. 1992 September; 148(3 Pt 2): 1011-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1507318&dopt=Abstract

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Loss of regulation of circulating 1,25-dihydroxyvitamin D with paradoxically decreased serum phosphate levels in individuals with recurrent kidney stones. Author(s): Yamakawa K, Franco-Coronel OE, Ohnishi T, Suzuki R, Satani H, Kawamura J. Source: Urological Research. 2000 June; 28(3): 155-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10929423&dopt=Abstract

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Low voltage scanning electron microscopy of uncoated kidney stones. Author(s): Cheng PT, Reid AD. Source: Scan Electron Microsc. 1985; (Pt 4): 1551-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4095500&dopt=Abstract

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Low-molecular-weight variants of osteopontin generated by serine proteinases in urine of patients with kidney stones. Author(s): Bautista DS, Denstedt J, Chambers AF, Harris JF. Source: Journal of Cellular Biochemistry. 1996 June 1; 61(3): 402-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8761944&dopt=Abstract

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Management of kidney stones: how new technology has affected the indications for intervention. Author(s): Streem SB. Source: Cleve Clin J Med. 1994 January-February; 61(1): 13-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8124840&dopt=Abstract

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Management of nephrolithiasis: new approaches to “surgical” kidney stones. Author(s): Mulley AG Jr. Source: Annual Review of Medicine. 1988; 39: 347-55. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3285781&dopt=Abstract

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Mechanical and ultrasonic parameters of kidney stones. Author(s): Singh VR, Agarwal R. Source: J Lithotr Stone Dis. 1990 April; 2(2): 117-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10148928&dopt=Abstract

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Medical approach to the diagnosis of kidney stones. Author(s): Frame B. Source: Henry Ford Hosp Med J. 1965 December; 13(4): 435-45. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5865364&dopt=Abstract

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Menopause and postmenopausal hormone use and risk of incident kidney stones. Author(s): Mattix Kramer HJ, Grodstein F, Stampfer MJ, Curhan GC. Source: Journal of the American Society of Nephrology : Jasn. 2003 May; 14(5): 1272-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12707395&dopt=Abstract

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Metabolic studies in hypercalciuric acid hyperoxaluric children with kidney stones. Author(s): Kepozou L, Vretos C, Lapatsanis P. Source: Scand J Urol Nephrol Suppl. 1980; 53: 221-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6937999&dopt=Abstract

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Metaphylaxis for calcium containing kidney stones. A reappraisal. Author(s): Lockefeer JH. Source: The Netherlands Journal of Medicine. 1990 February; 36(1-2): 1-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2314515&dopt=Abstract

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Microanalysis of calcium-rich human kidney stones at the NAC nuclear microprobe. Author(s): Pineda CA, Rodgers AL, Prozesky VM, Przybylowicz WJ. Source: Cell Mol Biol (Noisy-Le-Grand). 1996 February; 42(1): 119-26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8833673&dopt=Abstract

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Modification of dietary oxalate and calcium reduces urinary oxalate in hyperoxaluric patients with kidney stones. Author(s): Massey LK, Sutton RA. Source: Journal of the American Dietetic Association. 1993 November; 93(11): 1305-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8227883&dopt=Abstract

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Multielement analysis of human hair and kidney stones by instrumental neutron activation analysis with the k0-standardization method. Author(s): Abugassa I, Sarmani SB, Samat SB. Source: Applied Radiation and Isotopes : Including Data, Instrumentation and Methods for Use in Agriculture, Industry and Medicine. 1999 June; 50(6): 989-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10355102&dopt=Abstract

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Myths & facts... about kidney stones. Author(s): McConnell EA. Source: Nursing. 2001 January; 31(1): 73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11216251&dopt=Abstract

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Nephrocalcinosis in very low birth weight neonates: family history of kidney stones and ethnicity as independent risk factors. Author(s): Karlowicz MG, Katz ME, Adelman RD, Solhaug MJ. Source: The Journal of Pediatrics. 1993 April; 122(4): 635-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8463917&dopt=Abstract

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Nephrology: 1. Investigation and treatment of recurrent kidney stones. Author(s): Morton AR, Iliescu EA, Wilson JW. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 2002 January 22; 166(2): 213-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11829004&dopt=Abstract

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New drug therapy for kidney stones: a review of cellulose sodium phosphate, acetohydroxamic acid, and potassium citrate. Author(s): Lake KD, Brown DC. Source: Drug Intell Clin Pharm. 1985 July-August; 19(7-8): 530-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3896714&dopt=Abstract

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New insights into causes and treatments of kidney stones. Author(s): Scheinman SJ. Source: Hosp Pract (Off Ed). 2000 March 15; 35(3): 49-50, 53-6, 62-3 Passim. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10737240&dopt=Abstract

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New techniques for kidney stones. Author(s): Whitfield HN. Source: Practitioner. 1988 March 22; 232(1445): 338, 340-1. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3064070&dopt=Abstract

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Normocalcemic hyperparathyroidism, kidney stones, and idiopathic hypercalciuria. Author(s): Johansson H, Thoren L, Werner I, Grimelius L. Source: Surgery. 1975 May; 77(5): 691-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1124510&dopt=Abstract

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Nutrient intake and use of beverages and the risk of kidney stones among male smokers. Author(s): Hirvonen T, Pietinen P, Virtanen M, Albanes D, Virtamo J. Source: American Journal of Epidemiology. 1999 July 15; 150(2): 187-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10412964&dopt=Abstract

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Nutritional management of patients with kidney stones. Author(s): Wendland BE. Source: Nephrol News Issues. 1991 October; 5(10): 32, 34, 40 Passim. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1956413&dopt=Abstract

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Observations of the ultrastructure of infected kidney stones. Author(s): McLean RJ, Nickel JC, Beveridge TJ, Costerton JW. Source: Journal of Medical Microbiology. 1989 May; 29(1): 1-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2470905&dopt=Abstract

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Oral pyridoxine in the prevention of oxalate kidney stones. Author(s): Goldenberg RM, Girone JA. Source: American Journal of Nephrology. 1996; 16(6): 552-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8955772&dopt=Abstract

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Outpatient extracorporeal lithotripsy of kidney stones: 1,200 treatments. Author(s): Vallancien G, Defourmestraux N, Leo JP, Cohen L, Puissan J, Veillon B, Brisset JM. Source: European Urology. 1988; 15(1-2): 1-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3215223&dopt=Abstract

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Outpatient metabolic evaluation of patients with recurrent kidney stones. Author(s): Leslie SW. Source: Ohio Med. 1989 April; 85(4): 292-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2717121&dopt=Abstract

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Pathogenesis of kidney stones. Author(s): van Aswegen CH, du Plessis DJ. Source: Medical Hypotheses. 1991 December; 36(4): 368-70. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1809856&dopt=Abstract

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Pathophysiology of kidney stones and strategies for treatment. Author(s): Coe FL, Parks JH. Source: Hosp Pract (Off Ed). 1988 March 15; 23(3): 185-9, 193-5, 199-200 Passim. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3126203&dopt=Abstract

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Patient adherence to long-term medical treatment of kidney stones. Author(s): Parks JH, Asplin JR, Coe FL. Source: The Journal of Urology. 2001 December; 166(6): 2057-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11696706&dopt=Abstract

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Percutaneous removal of kidney stones. Author(s): Daughtry JD, Bean WJ, Rodan BA. Source: J Fla Med Assoc. 1985 March; 72(3): 167-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4078553&dopt=Abstract

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Percutaneous removal of kidney stones. Author(s): Peartree RJ, Ruotolo RA, Khuri FJ, Valvo JR, Segal AJ. Source: N Y State J Med. 1984 October; 84(10): 494-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6594605&dopt=Abstract

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Percutaneous removal of kidney stones. Author(s): Castaneda-Zuniga WR, Miller RP, Amplatz K. Source: The Urologic Clinics of North America. 1982 February; 9(1): 113-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7080279&dopt=Abstract

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Percutaneous removal of kidney stones. Preliminary report. Author(s): Segura JW, Patterson DE, LeRoy AJ, McGough PF, Barrett DM. Source: Mayo Clinic Proceedings. 1982 October; 57(10): 615-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7121066&dopt=Abstract

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Percutaneous removal of kidney stones: review of 1,000 cases. Author(s): Segura JW, Patterson DE, LeRoy AJ, Williams HJ Jr, Barrett DM, Benson RC Jr, May GR, Bender CE. Source: The Journal of Urology. 1985 December; 134(6): 1077-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4057395&dopt=Abstract

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Percutaneous ultrasonic versus surgical removal of kidney stones. Author(s): Brannen GE, Bush WH. Source: Surg Gynecol Obstet. 1985 November; 161(5): 473-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4049217&dopt=Abstract

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Polymorphism of vitamin D receptor gene start codon in patients with calcium kidney stones. Author(s): Vezzoli G, Soldati L, Proverbio MC, Adamo D, Rubinacci A, Bianchi G, Mora S. Source: Journal of Nephrology. 2002 March-April; 15(2): 158-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12018632&dopt=Abstract

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Predictive value of kidney stone composition in the detection of metabolic abnormalities. Author(s): Pak CY, Poindexter JR, Adams-Huet B, Pearle MS. Source: The American Journal of Medicine. 2003 July; 115(1): 26-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12867231&dopt=Abstract

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Presence of lipids in urine, crystals and stones: implications for the formation of kidney stones. Author(s): Khan SR, Glenton PA, Backov R, Talham DR. Source: Kidney International. 2002 December; 62(6): 2062-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12427130&dopt=Abstract

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Prevention and treatment of kidney stones. Role of medical prevention. Author(s): Pak CY. Source: The Journal of Urology. 1989 March; 141(3 Pt 2): 798-801. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2918620&dopt=Abstract

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Prevention of kidney stones. Author(s): Coe FL. Source: The American Journal of Medicine. 1981 October; 71(4): 514-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7282739&dopt=Abstract

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Prevention of recurring kidney stones. Author(s): Murphy KJ. Source: British Journal of Urology. 1972 December; 44(6): 730. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4646233&dopt=Abstract

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Prospective study of beverage use and the risk of kidney stones. Author(s): Curhan GC, Willett WC, Rimm EB, Spiegelman D, Stampfer MJ. Source: American Journal of Epidemiology. 1996 February 1; 143(3): 240-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8561157&dopt=Abstract

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Protein components of amyloid-like kidney stones of chronic hemodialysis patients. Author(s): Ozasa H, Suzuki T, Takahashi K, Ota K. Source: Nephron. 1989; 53(3): 257-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2677809&dopt=Abstract

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Pulverizing kidney stones: what you should know about lithotripsy. Author(s): Harwood CT. Source: Rn. 1985 July; 48(7): 32-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3848085&dopt=Abstract

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Recurrent kidney stones: causes and diagnostic criteria in patients from Campania (southern Italy). Author(s): Nunziata V, Di Giovanni G, Giannattasio R, Lettera AM, Mancini M. Source: British Journal of Urology. 1991 August; 68(2): 125-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1653079&dopt=Abstract

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Relation between geographic variability in kidney stones prevalence and risk factors for stones. Author(s): Soucie JM, Coates RJ, McClellan W, Austin H, Thun M. Source: American Journal of Epidemiology. 1996 March 1; 143(5): 487-95. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8610664&dopt=Abstract

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Relation of serum ascorbic acid to serum vitamin B12, serum ferritin, and kidney stones in US adults. Author(s): Simon JA, Hudes ES. Source: Archives of Internal Medicine. 1999 March 22; 159(6): 619-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10090119&dopt=Abstract

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Relations between oxalic acid, calcium, magnesium and creatinine excretion in normal men and male patients with calcium oxalate kidney stones. Author(s): Hodgkinson A. Source: Clin Sci Mol Med. 1974 March; 46(3): 357-67. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4818216&dopt=Abstract

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Results of EDAP lithotriptor treatment of kidney stones in our first fifty patients. Author(s): Turbow B, Turbow A, Munoz R, Turbow R. Source: Urology. 1990 January; 35(1): 46-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2296815&dopt=Abstract

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Risk factors for kidney stones in older women in the southern United States. Author(s): Hall WD, Pettinger M, Oberman A, Watts NB, Johnson KC, Paskett ED, Limacher MC, Hays J. Source: The American Journal of the Medical Sciences. 2001 July; 322(1): 12-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11465241&dopt=Abstract

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Risk of kidney stones. Author(s): Ettinger B. Source: Jama : the Journal of the American Medical Association. 1982 October 22; 248(16): 1971. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7120618&dopt=Abstract

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Role of bacteria in the development of kidney stones. Author(s): Kramer G, Klingler HC, Steiner GE. Source: Current Opinion in Urology. 2000 January; 10(1): 35-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10650513&dopt=Abstract

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Seasonal variations in the incidence of kidney stones in Calgary, Alberta, Canada. Author(s): Levinson AA, Mandin H. Source: Clinical Nephrology. 1985 July; 24(1): 50-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4017300&dopt=Abstract

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Shock (wave) treatment for kidney stones. Author(s): Ruge CA. Source: The American Journal of Nursing. 1986 April; 86(4): 400-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3633692&dopt=Abstract

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Shock wave lithotripsy. Extracorporeal treatment of kidney stones. Author(s): Walker PL. Source: Aorn Journal. 1984 October; 40(4): 560-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6568100&dopt=Abstract

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Shock-wave lithotripsy for the removal of kidney stones. Author(s): Gillenwater JY, Jenkins AD. Source: Va Med. 1985 March; 112(3): 182-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3984474&dopt=Abstract

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Sound, shock waves shatter kidney stones. Author(s): Blume E. Source: Jama : the Journal of the American Medical Association. 1983 May 13; 249(18): 2434-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6842744&dopt=Abstract

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Stressful life events and risk of symptomatic kidney stones. Author(s): Najem GR, Seebode JJ, Samady AJ, Feuerman M, Friedman L. Source: International Journal of Epidemiology. 1997 October; 26(5): 1017-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9363523&dopt=Abstract

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Symposium on treatment of kidney stones. Foreword. Author(s): Kolb FO. Source: Mod Treat. 1967 May; 4(3): 461-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6045800&dopt=Abstract

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Ten years' experience with the use of thiazides in the prevention of kidney stones. Author(s): Yendt ER, Cohanim M. Source: Trans Am Clin Climatol Assoc. 1973; 85(0): 65-75. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4804100&dopt=Abstract

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The causes of kidney stones--their diagnosis and treatment. Author(s): Williams HE. Source: Med Times. 1977 May; 105(5): 55-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=853907&dopt=Abstract

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The dissolution of calcium oxalate kidney stones. A kinetic study. Author(s): Tomazic BB, Nancollas GH. Source: The Journal of Urology. 1982 July; 128(1): 205-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7109061&dopt=Abstract

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The effects of the calcium-restricted diet of urolithiasis patients with absorptive hypercalciuria type II on risk factors for kidney stones and osteopenia. Author(s): van Faassen A, van der Ploeg EM, Habets HM, van der Meer R, Hermus RJ, Janknegt RA. Source: Urological Research. 1998; 26(1): 65-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9537699&dopt=Abstract

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The electret effect of kidney stones. Author(s): Yagyik Y, Talwar IM, Lal N, Nagpaul KK, Jethi RK. Source: Biomaterials. 1987 November; 8(6): 503-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3427152&dopt=Abstract

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The hole truth: intracrystalline proteins and calcium oxalate kidney stones. Author(s): Ryall RL, Fleming DE, Grover PK, Chauvet M, Dean CJ, Marshall VR. Source: Molecular Urology. 2000 Winter; 4(4): 391-402. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11156707&dopt=Abstract

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The pathogenesis and treatment of kidney stones. Author(s): Sherrard DJ. Source: The New England Journal of Medicine. 1993 February 11; 328(6): 444. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8421468&dopt=Abstract

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The pathogenesis and treatment of kidney stones. Author(s): Cappuccio FP, MacGregor GA. Source: The New England Journal of Medicine. 1993 February 11; 328(6): 444. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8421467&dopt=Abstract

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The pathogenesis and treatment of kidney stones. Author(s): Brezis M. Source: The New England Journal of Medicine. 1993 February 11; 328(6): 444. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8421466&dopt=Abstract

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The pathogenesis and treatment of kidney stones. Author(s): Aguado JM, Morales JM. Source: The New England Journal of Medicine. 1993 February 11; 328(6): 444. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8421465&dopt=Abstract

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The pathogenesis and treatment of kidney stones. Author(s): Coe FL, Parks JH, Asplin JR. Source: The New England Journal of Medicine. 1992 October 15; 327(16): 1141-52. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1528210&dopt=Abstract

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The performance of different pressure pulse generators for extracorporeal lithotripsy: a comparison based on commercial lithotripters for kidney stones. Author(s): Buizza A, Dell'Aquila T, Giribona P, Spagno C. Source: Ultrasound in Medicine & Biology. 1995; 21(2): 259-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7571134&dopt=Abstract

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The prevalence of silent kidney stones--an ultrasonographic screening study. Author(s): Buchholz NP, Abbas F, Afzal M, Khan R, Rizvi I, Talati J. Source: J Pak Med Assoc. 2003 January; 53(1): 24-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12666848&dopt=Abstract

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The role of calcium in the prevention of kidney stones. Author(s): Heller HJ. Source: Journal of the American College of Nutrition. 1999 October; 18(5 Suppl): 373S378S. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10511317&dopt=Abstract

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The role of ESWL in the treatment of large kidney stones. Author(s): Groeneveld AE. Source: Singapore Med J. 1989 June; 30(3): 249-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2588015&dopt=Abstract

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The supracostal percutaneous nephrostomy for treatment of staghorn and complex kidney stones. Author(s): Golijanin D, Katz R, Verstandig A, Sasson T, Landau EH, Meretyk S. Source: Journal of Endourology / Endourological Society. 1998 October; 12(5): 403-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9847059&dopt=Abstract

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The true composition of kidney stones passed during triamterene therapy. Author(s): Sorgel F, Ettinger B, Benet LZ. Source: The Journal of Urology. 1985 November; 134(5): 871-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4057369&dopt=Abstract

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Thermally stimulated polarization studies of kidney stones. II. Effect of annealing and thickness. Author(s): Talwar IM, Yagyik Y, Lal N. Source: Biomaterials. 1991 July; 12(5): 518-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1892988&dopt=Abstract

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Thiazides in the prophylactic treatment of recurrent idiopathic kidney stones. Author(s): Mortensen JT, Schultz A, Ostergaard AH. Source: International Urology and Nephrology. 1986; 18(3): 265-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3533825&dopt=Abstract

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Time-lapse nondestructive assessment of shock wave damage to kidney stones in vitro using micro-computed tomography. Author(s): Cleveland RO, McAteer JA, Muller R. Source: The Journal of the Acoustical Society of America. 2001 October; 110(4): 1733-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11681352&dopt=Abstract

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Trace elements in kidney stones from three areas in the United States. Author(s): Levinson AA, Nosal M, Davidman M, Prien EL Sr, Prien EL Jr, Stevenson RG. Source: Invest Urol. 1978 January; 15(4): 270-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=627468&dopt=Abstract

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Treating and preventing kidney stones. Author(s): Shellenbarger T, Krouse A. Source: Medsurg Nursing : Official Journal of the Academy of Medical-Surgical Nurses. 1994 October; 3(5): 389-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7812336&dopt=Abstract

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Twenty-four-hour urine chemistries and the risk of kidney stones among women and men. Author(s): Curhan GC, Willett WC, Speizer FE, Stampfer MJ. Source: Kidney International. 2001 June; 59(6): 2290-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11380833&dopt=Abstract

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Ultrasonic destruction of kidney stones. Author(s): Brannen GE, Bush WH. Source: The Western Journal of Medicine. 1984 February; 140(2): 227-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6730470&dopt=Abstract

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Ultrasonic percutaneous lithotripsy. A revolutionary advancement in the extraction of kidney stones. Author(s): Rudney J. Source: Can Oper Room Nurs J. 1985 February; 3(1): 4-13. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3855113&dopt=Abstract

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Ultrasonic velocity and attenuation measurement in kidney stones: correlation to constituents and hardness. Author(s): Singh VR, Dhawan JB. Source: Bio-Medical Materials and Engineering. 1992 Summer; 2(2): 79-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1472910&dopt=Abstract

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Ultrastructure of whewellite kidney stones: electron-analytical investigation. Author(s): Ogbuji LU, Batich CD. Source: J Ultrastruct Res. 1985 January; 90(1): 1-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4068135&dopt=Abstract

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Unravelling the links between calcium excretion, salt intake, hypertension, kidney stones and bone metabolism. Author(s): Cappuccio FP, Kalaitzidis R, Duneclift S, Eastwood JB. Source: Journal of Nephrology. 2000 May-June; 13(3): 169-77. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10928292&dopt=Abstract

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Urinary calcium and kidney stones in paraplegia. Report of an attempted prospective study. Author(s): Burr RG, Walsh JJ. Source: Paraplegia. 1974 May; 12(1): 38-43. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4837663&dopt=Abstract

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Use of the discriminant index in dynamic treatment to reduce recurrence of calcium oxalate kidney stones. Author(s): Perlberg S, Azoury R, Garti N, Sarig S. Source: British Journal of Urology. 1985 October; 57(5): 500-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2998532&dopt=Abstract

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When tiny glands cause big problems. Kidney stones or osteoporosis may signal hyperparathyroidism, a disease that disrupts the distribution of calcium in the body. Author(s): Utiger RD. Source: Health News. 2003 January; 9(1): 5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12545949&dopt=Abstract

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Work loss cost factor and the comparison of treatment regime for kidney stones. Author(s): Birch S. Source: Community Med. 1987 February; 9(1): 96. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3581769&dopt=Abstract

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CHAPTER 2. NUTRITION AND KIDNEY STONES Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and kidney stones.

Finding Nutrition Studies on Kidney Stones 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 “kidney stones” (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.

62 Kidney Stones

The following is a typical result when searching for recently indexed consumer information on kidney stones: ·

Medical conditions. Coping with kidney stones. Source: Anonymous Harv-Womens-Health-Watch. 2001 November; 9(4): 4-5 1070-910X

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New dietary strategy for avoiding kidney stones. Source: Tufts-Univ-diet-nutr-lett. New York, N.Y. : Tufts University Diet and Nutrition Letter, 1983-c1997. June 1993. volume 11 (4) page 7-8. 0747-4105

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Some passing thoughts on kidney stones. Source: Harv-Med-Sch-Health-Lett. Boston : Dept. of Continuing Education, Harvard Medical School. March 1983. volume 8 (5) page 1-2, 5. ill. 0161-7486

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Stop dietary calcium restriction in kidney stone-forming patients. Author(s): Nutrition Department, Faculdade de Saude Publica, Universidade de Sao Paulo, Brazil. Source: Martini, L A Nutr-Revolume 2002 July; 60(7 Pt 1): 212-4 0029-6643

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

Beverages, diet, and prevention of kidney stones. Author(s): Kidney Stone Prevention and Treatment Program, New York, VA Medical Center, and New York University School of Medicine, NY 10010, USA. [email protected] Source: Goldfarb, D S Coe, F L Am-J-Kidney-Dis. 1999 February; 33(2): 398-400; discussion 401-3 0272-6386

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Bone mineral density and fracture among prevalent kidney stone cases in the Third National Health and Nutrition Examination Survey. Author(s): Department of Health Studies, University of Chicago, Illinois 60637, USA. Source: Lauderdale, D S Thisted, R A Wen, M Favus, M J J-Bone-Miner-Res. 2001 October; 16(10): 1893-8 0884-0431

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Composition of the diet and calcium kidney stones. Source: Steinberg, E.P. N-Engl-J-Med. Boston, Mass. : Massachusetts Medical Society. March 25, 1993. volume 328 (12) page 880-882. 0028-4793

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Diagnosis and treatment of calcium kidney stones. Author(s): Section of Endocrinology and Metabolism, University of Chicago Pritzker School of Medicine, Illinois, USA. Source: Klugman, V Favus, M J Adv-Endocrinol-Metab. 1995; 6117-42 1049-6734

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Diet and kidney stones. Source: Ingelfinger, Julie R N-Engl-J-Med. 2002 January 10; 346(2): 74-6 1533-4406

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Effect of blackcurrant-, cranberry- and plum juice consumption on risk factors associated with kidney stone formation. Author(s): Division of Experimental Urology, Department of Urology, University of Bonn, Bonn, Germany. [email protected] Source: Kessler, T Jansen, B Hesse, A Eur-J-Clin-Nutr. 2002 October; 56(10): 1020-3 09543007

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Effects of water hardness on urinary risk factors for kidney stones in patients with idiopathic nephrolithiasis. Author(s): Division of Nephrology, School of Medicine, University Federico II, Naples, Italy.

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Source: Bellizzi, V De Nicola, L Minutolo, R Russo, D Cianciaruso, B Andreucci, M Conte, G Andreucci, V E Nephron. 1999; 81 Suppl 166-70 0028-2766 ·

Hypertension and kidney stones: hypotheses and implications. Author(s): Institute of Internal Medicine and Metabolic Diseases, University of Naples Federico II Medical School, Italy. Source: Strazzullo, P Cappuccio, F P Semin-Nephrol. 1995 November; 15(6): 519-25 02709295

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Intake of vitamins B6 and C and the risk of kidney stones in women. Author(s): Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. [email protected] Source: Curhan, G C Willett, W C Speizer, F E Stampfer, M J J-Am-Soc-Nephrol. 1999 April; 10(4): 840-5 1046-6673

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Kidney stones don't have to recur. Source: Cerrato, P L RN. 1992 June; 55(6): 63-4 0033-7021

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Kidney stones, carbonic anhydrase inhibitors, and the ketogenic diet. Author(s): The Pediatric Epilepsy Center, Departments of Neurology and Pediatrics, and Division of Pediatric Nephrology, Department of Pediatrics, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287-1000, USA. [email protected] Source: Kossoff, E H Pyzik, P L Furth, S L Hladky, H D Freeman, J M Vining, E P Epilepsia. 2002 October; 43(10): 1168-71 0013-9580

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Medical conditions. Coping with kidney stones. Source: Anonymous Harv-Womens-Health-Watch. 2001 November; 9(4): 4-5 1070-910X

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New dietary strategy for avoiding kidney stones. Source: Tufts-Univ-diet-nutr-lett. New York, N.Y. : Tufts University Diet and Nutrition Letter, 1983-c1997. June 1993. volume 11 (4) page 7-8. 0747-4105

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Nutrient intake and use of beverages and the risk of kidney stones among male smokers. Author(s): Department of Nutrition, National Public Health Institute, Helsinki, Finland. Source: Hirvonen, T Pietinen, P Virtanen, M Albanes, D Virtamo, J Am-J-Epidemiol. 1999 July 15; 150(2): 187-94 0002-9262

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Polymorphism of vitamin D receptor gene start codon in patients with calcium kidney stones. Author(s): Division of Nephrology Dialysis and Hypertension, San Raffaele Scientific Institute, Milan, Italy. [email protected] Source: Vezzoli, G Soldati, L Proverbio, M C Adamo, D Rubinacci, A Bianchi, G Mora, S J-Nephrol. 2002 Mar-April; 15(2): 158-64 1120-3625

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Preventing kidney stones: calcium restriction not warranted. Author(s): Department of Nephrology and Hypertension, Renal Stone Clinic, The Cleveland Clinic Foundation, Ohio 44195, USA. Source: Hall, P M Cleve-Clin-J-Med. 2002 November; 69(11): 885-8 0891-1150

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Relation of serum ascorbic acid to serum vitamin B12, serum ferritin, and kidney stones in US adults. Author(s): General Internal Medicine Section, Medical Service, Veterans Affairs Medical Center, San Francisco, Calif 94121, USA. [email protected] Source: Simon, J A Hudes, E S Arch-Intern-Med. 1999 March 22; 159(6): 619-24 0003-9926

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Some passing thoughts on kidney stones. Source: Harv-Med-Sch-Health-Lett. Boston : Dept. of Continuing Education, Harvard Medical School. March 1983. volume 8 (5) page 1-2, 5. ill. 0161-7486

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Stop dietary calcium restriction in kidney stone-forming patients. Author(s): Nutrition Department, Faculdade de Saude Publica, Universidade de Sao Paulo, Brazil. Source: Martini, L A Nutr-Revolume 2002 July; 60(7 Pt 1): 212-4 0029-6643

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The influence of Zea mays on urinary risk factors for kidney stones in rats. Source: Grases, F. March, J.G. Ramis, M. Costa Bauza, A. PTR,-Phytother-res. Sussex : John Wiley & Sons. Mar/April 1993. volume 7 (2) page 146-149. 0951-418X

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The role of calcium in the prevention of kidney stones. Author(s): University of Texas Southwestern Medical Center at Dallas, 75235-8885, USA. Source: Heller, H J J-Am-Coll-Nutr. 1999 October; 18(5 Suppl): 373S-378S 0731-5724

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Treating and preventing kidney stones. Source: Shellenbarger, T Krouse, A Medsurg-Nurs. 1994 October; 3(5): 389-94 1092-0811

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Ultrastructural immunodetection of osteopontin and osteocalcin as major matrix components of renal calculi. Author(s): Department of Stomatology, Faculty of Dentistry, Universite de Montreal, QC, Canada. Source: McKee, M D Nanci, A Khan, S R J-Bone-Miner-Res. 1995 December; 10(12): 191329 0884-0431

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Unravelling the links between calcium excretion, salt intake, hypertension, kidney stones and bone metabolism. Author(s): Department of Medicine, St George' s Hospital Medical School, London, UK. [email protected] Source: Cappuccio, F P Kalaitzidis, R Duneclift, S Eastwood, J B J-Nephrol. 2000 MayJune; 13(3): 169-77 1120-3625

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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WebMDÒHealth: http://my.webmd.com/nutrition

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

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

Vitamins Vitamin A Source: Prima Communications, Inc.www.personalhealthzone.com Vitamin A Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10066,00.html Vitamin B Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10067,00.html Vitamin B6 Source: Healthnotes, Inc. www.healthnotes.com Vitamin B6 Source: Prima Communications, Inc.www.personalhealthzone.com

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Vitamin C Source: Healthnotes, Inc. www.healthnotes.com Vitamin C Source: Prima Communications, Inc.www.personalhealthzone.com Vitamin D Source: Healthnotes, Inc. www.healthnotes.com Vitamin E Source: Healthnotes, Inc. www.healthnotes.com Vitamin K Alternative names: Menadione, Menaphthone, Menaquinone, Phylloquinone Source: Integrative Medicine Communications; www.drkoop.com ·

Minerals Calcium Source: Healthnotes, Inc. www.healthnotes.com Calcium Source: Integrative Medicine Communications; www.drkoop.com Calcium Source: Prima Communications, Inc.www.personalhealthzone.com Calcium Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,884,00.html Calcium: Which Form is Best? Source: Healthnotes, Inc. www.healthnotes.com Magnesium Source: Healthnotes, Inc. www.healthnotes.com Magnesium Source: Integrative Medicine Communications; www.drkoop.com Magnesium Source: Prima Communications, Inc.www.personalhealthzone.com Magnesium Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,890,00.html Potassium Source: Healthnotes, Inc. www.healthnotes.com

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Potassium Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10086,00.html Stinging Nettle Alternative names: Urtica dioica, Urtica urens, Nettle Source: Integrative Medicine Communications; www.drkoop.com Zinc/copper Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,938,00.html ·

Food and Diet Artichoke Source: Healthnotes, Inc. www.healthnotes.com Avocado Source: Healthnotes, Inc. www.healthnotes.com Beets Source: Healthnotes, Inc. www.healthnotes.com Chocolate Source: Healthnotes, Inc. www.healthnotes.com Chondroitin Sulfate Source: Healthnotes, Inc. www.healthnotes.com Coffee Source: Healthnotes, Inc. www.healthnotes.com Grapefruit Source: Healthnotes, Inc. www.healthnotes.com Kohlrabi Source: Healthnotes, Inc. www.healthnotes.com Kumquat Source: Healthnotes, Inc. www.healthnotes.com Lemons Source: Healthnotes, Inc. www.healthnotes.com Limes Source: Healthnotes, Inc. www.healthnotes.com Low-Oxalate Diet Source: Healthnotes, Inc. www.healthnotes.com

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Low-Salt Diet Source: Healthnotes, Inc. www.healthnotes.com Oranges Source: Healthnotes, Inc. www.healthnotes.com Parsnips Source: Healthnotes, Inc. www.healthnotes.com Porcini Mushrooms Source: Healthnotes, Inc. www.healthnotes.com Pumpkin Seeds Source: Healthnotes, Inc. www.healthnotes.com Radishes Source: Healthnotes, Inc. www.healthnotes.com Rhubarb Source: Healthnotes, Inc. www.healthnotes.com Rutabagas Source: Healthnotes, Inc. www.healthnotes.com Tangerines Source: Healthnotes, Inc. www.healthnotes.com Tea Source: Healthnotes, Inc. www.healthnotes.com Ugli Tangelo Fruit Source: Healthnotes, Inc. www.healthnotes.com Water Source: Healthnotes, Inc. www.healthnotes.com Winter Squash Source: Healthnotes, Inc. www.healthnotes.com Yams Source: Healthnotes, Inc. www.healthnotes.com

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CHAPTER 3. ALTERNATIVE MEDICINE AND KIDNEY STONES Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to kidney stones. At the conclusion of this chapter, we will provide additional sources.

The Combined Health Information Database The Combined Health Information Database (CHID) is a bibliographic database produced by health-related agencies of the U.S. federal government (mostly from the National Institutes of Health) that can offer concise information for a targeted search. The CHID database is updated four times a year at the end of January, April, July, and October. Check the titles, summaries, and availability of CAM-related information by using the “Simple Search” option at the following Web site: http://chid.nih.gov/simple/simple.html. In the drop box at the top, select “Complementary and Alternative Medicine.” Then type “kidney stones” (or synonyms) in the second search box. We recommend that you select 100 “documents per page” and to check the “whole records” options. The following was extracted using this technique: ·

Foods that Fight Pain: Revolutionary New Strategies for Maximum Pain Relief Source: New York, NY: Harmony Books. 1999. 347 p. Contact: Available from Harmony Books. 231 Broad Street, Nevada City, CA 95959. (530) 265-9564. PRICE: $14.00. ISBN: 0609804367. Summary: This book is intended to help people fight pain by using common foods, traditional supplements, and herbs. It explains which foods contribute to pain and how to avoid them, which foods are pain-safe but high in nutrition, and which foods can actively soothe pain by improving blood circulation, relieving inflammation, and balancing hormones. An introduction describes how food can fight pain at any of the stages of the pain process: the initial injury, the inflammatory response, the pain message traveling through the nerves, and the brain's perception of pain. Part 1 discusses conditions related to poor circulation, such as backaches and chest pain. Part 2

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addresses conditions caused by food sensitivities and inflammation, including migraines, other headaches, joint ailments, stomach aches and digestive problems, and fibromyalgia. Part 3 discusses hormone-related conditions such as menstrual pain, breast pain, and cancer pain. Part 4 discusses metabolic and immune problems, including carpal tunnel syndrome, diabetes, herpes and shingles, sickle cell anemia, kidney stones, and urinary infections. Part 5 discusses the roles of exercise, rest, and sleep in pain relief; describes several stress-reducing exercises; and explains why the body rebels against certain foods. The book includes menus and recipes, a glossary of ingredients, a list of resources, a list of suggested readings, and an index.

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 kidney stones 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 “kidney stones” (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 kidney stones: ·

A few comments on the recipes against kidney stones in the Croatian prayerbook. Author(s): Tiselius HG. Source: Scandinavian Journal of Urology and Nephrology. 1998 July; 32(4): 250. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9764449&dopt=Abstract

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A long-term study on the efficacy of a herbal plant, Orthosiphon grandiflorus, and sodium potassium citrate in renal calculi treatment. Author(s): Premgamone A, Sriboonlue P, Disatapornjaroen W, Maskasem S, Sinsupan N, Apinives C. Source: Southeast Asian J Trop Med Public Health. 2001 September; 32(3): 654-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11944733&dopt=Abstract

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A new apparatus for the dissolution of renal calculi. Experimental research. Author(s): Sesia G, Ferrando U, Laudi M, Tempia G. Source: Int Surg. 1970 April; 53(4): 262-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4984848&dopt=Abstract

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A prospective study of the intake of vitamins C and B6, and the risk of kidney stones in men. Author(s): Curhan GC, Willett WC, Rimm EB, Stampfer MJ. Source: The Journal of Urology. 1996 June; 155(6): 1847-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8618271&dopt=Abstract

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An oxalate-binding protein with crystal growth promoter activity from human kidney stone matrix. Author(s): Govindaraj A, Selvam R. Source: Bju International. 2002 August; 90(3): 336-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12133075&dopt=Abstract

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Control of hyperoxaluria with large doses of pyridoxine in patients with kidney stones. Author(s): Mitwalli A, Ayiomamitis A, Grass L, Oreopoulos DG. Source: International Urology and Nephrology. 1988; 20(4): 353-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3170105&dopt=Abstract

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Dietary calcium, dietary protein, and kidney stone formation. Author(s): Curhan GC. Source: Mineral and Electrolyte Metabolism. 1997; 23(3-6): 261-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9387129&dopt=Abstract

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Effect of blackcurrant-, cranberry- and plum juice consumption on risk factors associated with kidney stone formation. Author(s): Kessler T, Jansen B, Hesse A. Source: European Journal of Clinical Nutrition. 2002 October; 56(10): 1020-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12373623&dopt=Abstract

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Effects of 5 different diets on urinary risk factors for calcium oxalate kidney stone formation: evidence of different renal handling mechanisms in different race groups. Author(s): Rodgers AL, Lewandowski S. Source: The Journal of Urology. 2002 September; 168(3): 931-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12187193&dopt=Abstract

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Effects of ascorbate supplements on urinary oxalate and risk of kidney stones. Author(s): Massey LK. Source: Journal of the American Dietetic Association. 2000 May; 100(5): 516. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10841663&dopt=Abstract

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Effects of calcium carbonate, magnesium oxide and sodium citrate bicarbonate health supplements on the urinary risk factors for kidney stone formation. Author(s): Allie S, Rodgers A. Source: Clinical Chemistry and Laboratory Medicine : Cclm / Fescc. 2003 January; 41(1): 39-45. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12636048&dopt=Abstract

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Effects of ethylenediaminetetraacetic acid-4 sodium solution on the surface of renal calculi and the uroepithelium. Author(s): Kuwahara M, Matsuo S, Kato T, Tsuchida S. Source: The Journal of Urology. 1978 July; 120(1): 11-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=97399&dopt=Abstract

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Identification of hemoglobin and two serine proteases in acid extracts of calcium containing kidney stones. Author(s): Petersen TE, Thogersen I, Petersen SE. Source: The Journal of Urology. 1989 July; 142(1): 176-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2733100&dopt=Abstract

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Instrumental chemolysis of renal calculi: indications and dangers. Author(s): Mischol HR, Wildbolz E. Source: The Journal of Urology. 1971 May; 105(5): 607-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4996002&dopt=Abstract

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Intake of vitamins B6 and C and the risk of kidney stones in women. Author(s): Curhan GC, Willett WC, Speizer FE, Stampfer MJ. Source: Journal of the American Society of Nephrology : Jasn. 1999 April; 10(4): 840-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10203369&dopt=Abstract

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Intermittent irrigation system for dissolution of renal calculi monitored by computer. Author(s): Kuwahara M, Kambe K, Takahashi K, Orikasa S, Suzuki M. Source: The Journal of Urology. 1982 December; 128(6): 1379-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6818365&dopt=Abstract

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Intracrystalline proteins and the hidden ultrastructure of calcium oxalate urinary crystals: implications for kidney stone formation. Author(s): Lyons Ryall R, Fleming DE, Doyle IR, Evans NA, Dean CJ, Marshall VR. Source: Journal of Structural Biology. 2001 April; 134(1): 5-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11469872&dopt=Abstract

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Limited risk of kidney stone formation during long-term calcium citrate supplementation in nonstone forming subjects. Author(s): Sakhaee K, Baker S, Zerwekh J, Poindexter J, Garcia-Hernandez PA, Pak CY. Source: The Journal of Urology. 1994 August; 152(2 Pt 1): 324-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8015062&dopt=Abstract

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Microstructural matrix-crystal interactions in calcium oxalate monohydrate kidney stones. Author(s): Stacholy J, Goldberg EP.

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Source: Scan Electron Microsc. 1985; (Pt 2): 781-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3931207&dopt=Abstract ·

Modern aspects of chemical dissolution of human renal calculi by irrigation. Author(s): Timmermann A, Kallistratos G. Source: The Journal of Urology. 1966 April; 95(4): 469-75. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4956497&dopt=Abstract

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Preventing kidney stones: calcium restriction not warranted. Author(s): Hall PM. Source: Cleve Clin J Med. 2002 November; 69(11): 885-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12430973&dopt=Abstract

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Randomized controlled trial of a low animal protein, high fiber diet in the prevention of recurrent calcium oxalate kidney stones. Author(s): Hiatt RA, Ettinger B, Caan B, Quesenberry CP Jr, Duncan D, Citron JT. Source: American Journal of Epidemiology. 1996 July 1; 144(1): 25-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8659482&dopt=Abstract

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Relationship of animal protein-rich diet to kidney stone formation and calcium metabolism. Author(s): Breslau NA, Brinkley L, Hill KD, Pak CY. Source: The Journal of Clinical Endocrinology and Metabolism. 1988 January; 66(1): 1406. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2826524&dopt=Abstract

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Resolution of proteins in the kidney stone matrix using high-performance liquid chromatography. Author(s): Sugimoto T, Funae Y, Rubben H, Nishio S, Hautmann R, Lutzeyer W. Source: European Urology. 1985; 11(5): 334-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4076273&dopt=Abstract

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Solubility of inorganic kidney stone components in the presence of acid-base sensitive complexing agents. Author(s): Verplaetse H, Verbeeck RM, Minnaert H, Oosterlinck W. Source: European Urology. 1985; 11(1): 44-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2985396&dopt=Abstract

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The effect of ascorbic acid ingestion on the biochemical and physicochemical risk factors associated with calcium oxalate kidney stone formation. Author(s): Auer BL, Auer D, Rodgers AL.

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Source: Clinical Chemistry and Laboratory Medicine : Cclm / Fescc. 1998 March; 36(3): 143-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9589801&dopt=Abstract ·

The presence of protein-bound gamma-carboxyglutamic acid in calcium-containing renal calculi. Author(s): Lian JB, Prien EL Jr, Glimcher MJ, Gallop PM. Source: The Journal of Clinical Investigation. 1977 June; 59(6): 1151-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=864007&dopt=Abstract

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The uric acid-whewellite association in human kidney stones. Author(s): Deganello S, Chou C. Source: Scan Electron Microsc. 1985; (Pt 4): 1545-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3938066&dopt=Abstract

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Urinary osmolarity and excretion of sodium, calcium and magnesium in patients with renal calculi. Author(s): Raman A, Sreenevasan GA. Source: British Journal of Urology. 1972 October; 44(5): 537-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4628536&dopt=Abstract

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

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

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

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

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drkoop.comÒ: 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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WebMDÒHealth: http://my.webmd.com/drugs_and_herbs

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

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

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The following is a specific Web list relating to kidney stones; 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 Asthma Source: Prima Communications, Inc.www.personalhealthzone.com Cataracts (Prevention) Source: Prima Communications, Inc.www.personalhealthzone.com Epilepsy Source: Healthnotes, Inc. www.healthnotes.com Gout Source: Integrative Medicine Communications; www.drkoop.com Hyperparathyroidism Source: Integrative Medicine Communications; www.drkoop.com Hypertension Alternative names: High Blood Pressure Source: Prima Communications, Inc.www.personalhealthzone.com Inflammatory Bowel Disease Source: Integrative Medicine Communications; www.drkoop.com Kidney Stones Source: Healthnotes, Inc. www.healthnotes.com Kidney Stones Source: Integrative Medicine Communications; www.drkoop.com Obesity Source: Integrative Medicine Communications; www.drkoop.com Osteoporosis Source: Prima Communications, Inc.www.personalhealthzone.com Parathyroid, Overactive Source: Integrative Medicine Communications; www.drkoop.com Sarcoidosis Source: Integrative Medicine Communications; www.drkoop.com Ulcerative Colitis Source: Integrative Medicine Communications; www.drkoop.com

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Alternative Therapy Reflexology Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,730,00.html

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Herbs and Supplements Aloe Alternative names: Aloe vera, Aloe barbadensis, Aloe ferox , Aloe Vera Source: Integrative Medicine Communications; www.drkoop.com Aloe Vera Source: Integrative Medicine Communications; www.drkoop.com Althaea officinalis Source: Integrative Medicine Communications; www.drkoop.com Arctium Alternative names: Burdock, Gobo; Arctium lappa L. Source: Alternative Medicine Foundation, Inc. www.amfoundation.org Arctostaphylos Alternative names: Bearberry; Arctostaphylos uva-ursi (L.) Spreng. Source: Alternative Medicine Foundation, Inc. www.amfoundation.org Bilberry Alternative names: Vaccinium myrtillus Source: Healthnotes, Inc. www.healthnotes.com Bilberry Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10007,00.html Butcher's broom Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10010,00.html Cranberry Alternative names: Vaccinium macrocarpon Source: Healthnotes, Inc. www.healthnotes.com Cranberry Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10019,00.html

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Ephedra Source: Healthnotes, Inc. www.healthnotes.com Ephedra (Ma huang) Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,777,00.html Equisetum Alternative names: Horsetail; Equisetum arvense L. Source: Alternative Medicine Foundation, Inc. www.amfoundation.org Equisetum arvense Source: Integrative Medicine Communications; www.drkoop.com Fiber Source: Healthnotes, Inc. www.healthnotes.com Flurbiprofen Source: Healthnotes, Inc. www.healthnotes.com Goldenrod Alternative names: Solidago virgaurea Source: Integrative Medicine Communications; www.drkoop.com Goldenrod Source: Prima Communications, Inc.www.personalhealthzone.com Gravel Root Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Horseradish Alternative names: Cochlearia armoracia Source: Healthnotes, Inc. www.healthnotes.com Horsetail Alternative names: Equisetum arvense, Scouring Rush, Shave Grass Source: Integrative Medicine Communications; www.drkoop.com Horsetail Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10105,00.html Hydrangea Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Marshmallow Alternative names: Althaea officinalis Source: Integrative Medicine Communications; www.drkoop.com

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Menadione Source: Integrative Medicine Communications; www.drkoop.com Menaphthone Source: Integrative Medicine Communications; www.drkoop.com Menaquinone Source: Integrative Medicine Communications; www.drkoop.com Nettle Source: Integrative Medicine Communications; www.drkoop.com Oak bark Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10108,00.html Phylloquinone Source: Integrative Medicine Communications; www.drkoop.com Pumpkin Alternative names: Cucurbita pepo, Cucurbita maxima Source: Healthnotes, Inc. www.healthnotes.com Scouring Rush Source: Integrative Medicine Communications; www.drkoop.com Shave Grass Source: Integrative Medicine Communications; www.drkoop.com Solidago virgaurea Source: Integrative Medicine Communications; www.drkoop.com Taraxacum Alternative names: Dandelion; Taraxacum officinale (Dhudhal) Source: Alternative Medicine Foundation, Inc. www.amfoundation.org Urtica dioica Source: Integrative Medicine Communications; www.drkoop.com Urtica urens Source: Integrative Medicine Communications; www.drkoop.com Wild Yam Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10070,00.html

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

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CHAPTER 4. PATENTS ON KIDNEY STONES Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.8 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “kidney stones” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on kidney stones, we have not necessarily excluded non-medical patents in this bibliography.

Patents on Kidney Stones By performing a patent search focusing on kidney stones, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an 8Adapted

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

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example of the type of information that you can expect to obtain from a patent search on kidney stones: ·

Aiming system for kidney stone disintegrator Inventor(s): Dela-Cruz; Exequiel (Arlington Heights, IL), Burdick; Thomas H. (Deerfield, IL), Shene; William R. (Plattsburgh, NY), Nowacki; Christopher (Arlington Heights, IL), Brisson; Alfred G. (Kildeer, IL) Assignee(s): Northgate Research, Inc. (Arlington Heights, IL) Patent Number: 4,763,652 Date filed: April 16, 1986 Abstract: A kidney stone disintegrating system includes a computer-controlled aiming system. The disintegrating system includes a reflector containing water through which the reflector is coupled to a living body having a kidney stone. The reflector is a portion of an ellipsoid and a spark gap generator is located at one focus of the ellipsoid. An electrical energy source is connected to the spark gap generator for generating a spark which in turn generates a shock wave in the fluid. Three motors are connected to the reflector for moving it in respectively X-axis, Y-axis and Z-axis directions to locate the reflector so that the kidney stone lies at the second focus point thereof. A pair of ultrasound transducers are carried by an articulated support comprising a plurality of pivotally interconnected arms. Precision potentiometers are provided between the arms to indicate the relative positions thereof, and electrical potentials from the potentiometers are connected to a computer. The signals and the computer are connected to a monitor having a screen to display the kidney stone, and particularly the position thereof as determined by the two transducers. The computer is connected to the three motors to position the reflector in accordance with the positions of the transducers to locate the reflector with the second focus point coinciding with the kidney stone. Controls are provided for causing generation of a spark with the resulting shock wave focused on the kidney stone to destroy the kidney stone. Excerpt(s): Kidney stones, and also naturally-occurring stones in the bladder and the ureter can be exquisitely painful, and often require surgical relief. Excision or destruction of stones in the bladder and sometimes in the ureter can be relatively easily accomplished, but removal of stones from the kidney is a major procedure.... Removal of stones from the kidney is a very serious and traumatic procedure. A large incision is made in the body. The kidney is essentially removed from the body and cut open. The stone or stones are then removed, whereupon the kidney is sutured and returned to the body, with the body then being sutured. Typical recovery time is on the order of six months.... Chemotherapy is available as a non-invasive therapy for uric acid stones. In this therapy the urine is alkalized. The existing stone thus is dissolved over a substantial period of time, and in most cases the patient can be cured before his condition becomes acute. However, the patient's condition is often already acute when the stone is discovered, and immediate surgery is imperative. Attempts at chemical dissolution of other types of stones have not been successful. Web site: http://www.delphion.com/details?pn=US04763652__

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Apparatus for contact-free disintegration of kidney stones or other calculi Inventor(s): Hausler; Eberhard (Saarbrucken, DE) Assignee(s): Richard Wolf GmbH (Knittlengen, DE) Patent Number: 4,311,147 Date filed: May 8, 1980 Abstract: This invention relates to apparatus for contact-free disintegration of kidney stones or other calculi of the kind in which electrical discharges are generated across an under water spark gap in the focus line of an elliptical reflector having annular or spiral surfaces. The calculus which is to be disintegrated is located into the focus of the reflector and in accordance with invention electrode elements are positioned at intervals in the focus line of this reflector on an insulating carrier. The latter is provided with high tension connectors at its ends and the electrode elements are arranged to form consecutive individual spark gaps.The gaps between the electrode elements may be of constant dimensions or may vary so as to produce variations in pressure distributed at a focus point if so desired. Excerpt(s): The present invention relates to a device for contact-free disintegration of kidney stones or other calculi, of the kind in which means are provided to generate discharges across an underwater spark gap in the focus line of an elliptical reflector having annular or spiral surfaces, into whose focus the calculus which is to be disintegrated is located. Hereinafter, such apparatus will be referred to as "of the kind described".... Apparatus for generating hydraulic shock waves is already known in which a copper wire is stretched over an insulating bracket in the focal point line of an elliptical annular surface reflector or torus reflector and this copper wire is vapourised throughout the length of the supporting bracket upon being connected to a source of high voltage and by virtue of the gas discharge formed generated the hydraulic shock wave, for the purpose of generating a shock wave under water. The wire must be pulled over the bracket again in each case to generate the following shock waves, and this requires considerable expenditure of time by the doctor. With this apparatus therefore, it is not possible, if at all, easily to generate shock waves following each other at short intervals.... It is an object of the invention to provide apparatus for generating a plurality or series of underwater discharges at the same time in the focal point line of the reflector, without special operations being needed for this purpose. Web site: http://www.delphion.com/details?pn=US04311147__

·

Assay for determining the propensity of a person to form kidney stones Inventor(s): Karasikov; Nir (3 Biram St., Haifa, IL), Sarig; Sara (19, Hamaapilim St., Jerusalem, IL) Assignee(s): none reported Patent Number: 5,064,765 Date filed: March 1, 1990 Abstract: There is provided an assay for determining the propensity of a person to develop a certain type of kidney stones which is based on the inter-action of the urine of such a person with aqueous solutions of compounds which interact to form such stones. The number and size distribution of resulting particles is determined and the results are evaluated. There is further provided a device for carrying out such an assay, comprising

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means for interacting the urine of the patient with two solutions containing compounds which form kidney stones, means for breaking up crystal aggregates and means for passing a light beam through the sample positioned in a transparent container, and means for determining the number and size of the resulting particles. Excerpt(s): The invention relates to a novel method for determining the tendency of a person to develop kidney stones, and especially kidney stones of the oxalate type. The invention further relates to a device for carrying out such measurements and for their evaluation.... Other and further features of the invention will become apparent hereinafter.... The formation of stones in a kidney is a common pathological condition in humans. There exist a variety of kidney stones, according to their chemical composition, the most common consisting of calcium oxalate,.calcium phosphate and magnesium ammonium phosphate. It is important to find out whether a person has an inclination to form kidney stones, and of which type. This has been determined up to now mainly after surgery by analysis of the removed stones. In U.S. Pat. No. 4,399,003 there is described a method for diagnosing a patient's proneness to develop calcium oxalate kidney stones, which is based on an assay involving the urine of the patient and calcium and oxalate ions. The measurement is made by means of a calcium ion specific electrode. The present invention relates to an improvement of the said method. Web site: http://www.delphion.com/details?pn=US05064765__ ·

Device for disintegrating kidney stones by means of shock waves Inventor(s): Toftkjaer; Gert (Naerum, DK), Northeved; Allan (Farum, DK) Assignee(s): Non-Invasive Therapeutic Techniques A/S (Virum, DK) Patent Number: 4,844,081 Date filed: August 26, 1987 Abstract: A device for disintegrating kidney stones or gallstones by means of a focusing chamber being part of a rotation ellipsoid and comprising in one focal point a spark gap producing shock waves. Means fixing the device to the skin of the patient are provided in connection with the focusing chamber. A movable rubber sleeve or bellows may be provided in connection with the fixing means, said sleeve or bellows being glued onto the skin of the patient. As an alternative circumferential suction chambers may be provided along the rim of the sleeve, or the entire device may be shaped as a suction cup. An ultrasonic transducer is situated within the focusing chamber, said ultrasonic transducer optionally being situated on a cone-shaped body in turn situated on a pivotable bar within the focusing chamber. In this manner it is possible to localize a stone by means of an ultrasonic scanner without the ultrasonic transducer in question being damaged by shock waves. Excerpt(s): The invention relates to a device for disintegrating stones by means of a focusing chamber being part of an ellipsoid, preferably a rotation ellipsoid, and comprising in one focal point a spark gap producing shock waves.... In connection with one of the known devices the patient is situated in a tub containing water transmitting the shock waves.... According to a second device the tub is avoided by the focusing chamber being filled with water and covered by a thin membrane. This membrane abuts the skin of the patient, see, for example, DE-OS No. 3,146,626. Web site: http://www.delphion.com/details?pn=US04844081__

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Kidney stone retriever Inventor(s): Duthoy; Everette J. (1472 Cherry Hill Rd., St. Paul, MN 55118) Assignee(s): none reported Patent Number: 4,625,726 Date filed: August 7, 1984 Abstract: The present invention is directed to a kidney stone retrieval device which includes a basket between a ferrule and a tube. Both the tube and the ferrule have aligned passages for receiving a guide wire. In this way, the guide wire may be inserted into a ureter past the stone so that the retrieval device may be pushed along the guide wire until the basket reaches and passes the stone, whereupon the device is maneuvered for dislodging and retrieving the stone with the basket. Excerpt(s): The present invention is directed to the general field of urology and, more particularly, to a device for dislodging and capturing a stone from a person's ureter.... Waste body fluids flow from the kidney through the ureter to the bladder. The fluids pass from the bladder through the urethra to exit a person's body. A blockage occasionally forms in the ureter of some people. The blockage is usually comprised of a hard stone-like material called calculus. Such a blockage can be painful and dangerous since it restricts the flow of waste fluids through the ureter. Ureteral calculus, more commonly known as a kidney stone, may be removed surgically. It is preferable, however, to try to capture the stone and pull it through the ureter, baldder and urethra. Devices and procedures for such capture and removal are, thus, known.... The most common stone retriever device is made from a cable having a wire basket at one end of the cable with a relatively short, somewhat flexible, rod-like end member, called a filiform, at the end of the basket opposite the cable. The basket is usually made of four equally spaced-apart wires which are sufficiently rigid to hold a large V-shape. The filiform of the device is inserted into the ureter and worked past the stone. As the basket is maneuvered alongside the stone, the stone moves into the space surrounded by the wires and is hopefully captured for removal on removal of the cable and basket. The problem with this device is that it is extremely difficult to work the basket around or even with the stone in order to capture the stone. Consequently, the removal procedure may be time consuming and is prone to failure. Web site: http://www.delphion.com/details?pn=US04625726__

·

Kidney stone specimen collection system Inventor(s): Newman; Dennis (3519 Grennoch, Houston, TX 77025), Stein; Ronald B. (8810 Weymouth Dr., Houston, TX 77031) Assignee(s): none reported Patent Number: 5,762,071 Date filed: September 4, 1996 Abstract: A kidney stone specimen collection device having a tubular body with a longitudinal axis, a mesh screen affixed to an interior of the tubular body and extending transverse to a longitudinal axis of the tubular body, a first closure member affixed to one end of the tubular body so as to selectively seal the end of the tubular body, and a second closure member affixed to an opposite end of the tubular body for selectively sealing the opposite end of the tubular body. The tubular body is formed of an impact-

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resistant generally transparent plastic material. A flow indicator is positioned on a surface of the tubular body so as to be indicative of a direction of urine flow through the tubular body. Excerpt(s): The present application is a utility patent application which is based on U.S. Provisional patent application Ser. No. 60/009,260, filed on Dec. 26, 1995, and entitled "KIDNEY STONE SPECIMEN COLLECTION SYSTEM", presently pending.... The present invention relates to devices for the collection of kidney stones from a urine stream. More particularly, the present invention relates to containers for the receipt and capture of kidney stones.... It is a well known fact, at least to those of the medical profession, that there are hundreds of thousands of people in this country chronically or critically suffering from kidney stone afflictions. The patient is often advised to retrieve the foreign particles for purposes of clinical examination. This presents an obvious problem of inconvenience and perhaps embarrassment, particularly when it is impossible to have ordinary suitable household utensils at hand for the required purpose. Web site: http://www.delphion.com/details?pn=US05762071__ ·

Method for comminuting kidney stones Inventor(s): Cocks; Franklin H. (Durham, NC), Akers; Scott R. (Durham, NC) Assignee(s): Duke University (Durham, NC) Patent Number: 4,892,089 Date filed: February 23, 1989 Abstract: A method for comminuting kidney stones including treating a stone to be comminuted with a renal matrix-attacking substance and applying acoustic impulses to the stone so as to pulverize the stone into fragments small enough to be passed through the ureter and urethra. Excerpt(s): This invention relates generally to a method for comminuting kidney stones utilizing acoustic impulses, and more specifically to a treatment method which enhances the pulverizing effect of extracorporeal shock wave lithotripsy.... Kidney stones, also known as renal calculi, develop within the kidney and are in many cases too large to pass through the ureter and urethra. The stones are composed of both organic and inorganic materials. The inorganic components comprise most of the mass of the stone and are typically rigid crystalline masses of calcium or magnesium oxalates, phosphates, or various urates. The inorganic components ar different for each particular type of stone and therefore each stone may have different characteristics depending on the composition of its inorganic component.... The organic component of the stone is called the organic matrix (or renal matrix) and often forms an intricate mesh from the surface of the stone to the center of the stone. Although the organic component often comprises a small percentage (approximately 3% to 6%) of the entire kidney stone, it forms a mesh that extends throughout the stone and can be viewed as a "backbone" of the stone. The matrix composition is essentially the same in each urinary stone and typically comprises about 64% protein, 9.6% non-amino sugar, 5% glucosamine, and 10% bond water. The remainder of the matrix composition is inorganic ash composed mainly of calcium and various phosphates. Web site: http://www.delphion.com/details?pn=US04892089__

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Method for treating kidney stones Inventor(s): Imondi; Anthony R. (Doylestown, PA), Wolgemuth; Richard L. (Hatfield, PA) Assignee(s): Warren-Teed Laboratories, Inc. (Columbus, OH) Patent Number: 4,143,130 Date filed: August 29, 1977 Abstract: Water soluble and colloidially water soluble polymers of carboxylic acidcontaining monomers useful for treating kidney stones are disclosed. Excerpt(s): This invention relates to pharmaceutical compositions containing soluble and colloidally water soluble carboxylic acid polymers and to methods of using them to treat kidney stones. Biological studies employing rats as the test animal show that the compositions of this invention are useful in binding calcium and dissolving kidney stones.... In the United States alone, there are each year about 250,000 newly diagnosed patients with all types of kidney stones. Analysis of these stones shows that 70% of all kidney calculi contain calcium. Although there is no unanimously accepted regimen for urolthiasis, reduction in urinary calcium excretion is one means of ston prophylaxis.... Highly substituted sodium cellulose phosphate is presently being studied clinically and appears to be useful in the treatment for calcium calculi (Pak, et al., New England J. Med. 290:4 (1974)). This material also binds intestinal calcium. The increase in fecal calcium with sequestrant therapy is accompanied by lower urinary calcium output. In essence, by increasing the fecal calcium load, calcium sequestrants decrease the calcium load on the kidney. Web site: http://www.delphion.com/details?pn=US04143130__

·

Non-invasive destruction of kidney stones Inventor(s): Nowacki; Christopher (Arlington Heights, IL), Brisson; Alfred G. (Schaumburg, IL), Shene; William R. (Plattsburgh, NY) Assignee(s): Trutek Research, Inc. (Lake Zurich, IL) Patent Number: 4,696,299 Date filed: April 3, 1986 Abstract: Apparatus for the non-invasive disintegration of kidney stones and the like. An ellipsoidal reflector open at one end is positionable against the body, and may have a diaphragm across the opened end to prevent leakage of water contained in the reflector. A spark gap is located at the first focal point of the ellipsoid, and sonic aiming means is physically interconnected with the ellipsoid for aiming the ellipsoid at the kidney stone or the like to locate the kidney stone at the second focal point of the ellipsoid. A series of sparks discharged across the spark gap generates a succession of shock waves that travel through water in the reflector, and through the body to impinge on the kidney stone or the like and thereby to disintegrate the same. Excerpt(s): Kidney stones, and also naturally occuring stones in the bladder and the ureter can be exquisitely painful, and often require surgical relief. Excision or destruction of stones in the bladder and sometimes in the ureter can be relatively easily accomplished but removal of stones from the kidney is a major procedure.... Removal of stones from the kidney is a very serious and traumatic surgical procedure. A large incision is made in the body. The kidney is essentially removed from the body and cut

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open. The stone or stones are then removed, whereupon the kidney is sutured and returned to the body, with the body then being sutured.... Chemotherapy is available as a non-invasive therapy for uric acid stones. In this therapy the urine is alkalized. The existing stone thus is dissolved over a substantial period of time, and in most cases the patient can be cured before his condition becomes acute. However, the patient's condition is often already acute when the stone is discovered, and immediate surgery is imperative. Attempts at chemical dissolution of other types of stones have not been successful. Web site: http://www.delphion.com/details?pn=US04696299__ ·

Phantom kidney stone system Inventor(s): Schafer; Mark E. (Blue Bell, PA) Assignee(s): International Sonic Technologies (Horsham, PA) Patent Number: 5,014,686 Date filed: August 31, 1989 Abstract: The phantom kidney stone system for use with a commercial lithotripsy system includes a phantom kidney stone which simulates a human kidney stone and is suspended into the field of operation of the commerical lithotripsy system. The system also includes a trigger which is connected to receive a shock wave signal from the lithotripter which is representative of a shock wave output from the lithotripter. The trigger generates a trigger signal in response to the signal from the lithotripter. A counter is connected to receive the trigger signal and counts the number of trigger signals which is representative of the number of shock waves output from the lithotripter. A detection circuit is connected to the phantom kidney stone and produces a signal proportional to the detected size of the stone at a given point in time and compares the detected size of the stone to a predetermined reference size indicative of a condition wherein the stone would be crushed. The detection circuit generates an output signal at a time when the detected size of the stone is less than the reference size. A processor is connected to receive the output signal from the detection circuit and is connected tothe counter and outputs the number of trigger signals which were counted by the counter at a time when the detection circuit generates the output signal. A display indicated the number to the user of the lithotripter. Excerpt(s): The present invention relates to a phantom kidney stone system for use with a commercial lithotripsy system.... Currently there is no uniformly repeatable test procedure which can be used by manufacturers and/or users of commercial lithotripsy systems for quality control purposes in order to ascertain that the lithotripsy system is functioning properly.... Also, there is no uniformly repeatable test procedure which can be used to train operators of commercial lithotripsy systems to improve the accuracy with which the operators perform an actual lithotripsy operation. There is a need for the operators to be trained properly so that when an actual lithotripsy operation is performed, the lowest possible number of shock waves are used to break up the kidney stone. It is necessary to keep the number of shock waves which are input into human tissue as low as possible. Therefore, operators should be trained prior to performing an actual lithotripsy operation on a human patient. At the present time, the operators do not have an opportunity to work with the lithotripsy system until they actually use the equipment on a human patient. Web site: http://www.delphion.com/details?pn=US05014686__

Patents 89

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Pleated diaphragm for coupling kidney stone disintegrator to human body Inventor(s): Dela-Cruz; Exequiel (Arlington Heights, IL), Nowacki; Christopher (Arlington Heights, IL), Brisson; Alfred G. (Kildeer, IL) Assignee(s): Trutek Research, Inc. (Lake Zurich, IL) Patent Number: 4,745,921 Date filed: December 23, 1986 Abstract: An extracorporeal kidney stone disintegrator comprises an ellipsoidal reflector having an open end. A spark gap is positioned in said reflector at the first focus point thereof. A flexible cap closes the otherwise open end of said reflector, and a body of liquid fills said reflector and said cap. The cap is adapted for disposition against a human body having therein a concretion such as a kidney stone to be disintegrated. The reflector is positioned so that the concretion lies on the second focus point of the reflector. Generation of a spark across said spark gap causes generation of a shock wave focused on the concretion and coupled to the concretion by the body of liquid and the tissues of the body through the cap. The cap has an annular pleat enhancing flexibility of the cap. Excerpt(s): Kidney stones, and also naturally occurring stones in the bladder and the ureter can be exquisitely painful, and often require surgical relief. Excision or destruction of stones in the bladder and sometimes in the ureter can be relatively easily accomplished, but removal of stones from the kidney is a major procedure.... Removal of stones from the kidney is a very serious and traumatic surgical procedure. A large incision is made in the body. The kidney is essentially removed from the body and cut open. The stone or stones are then removed, whereupon the kidney is sutured and returned to the body, with the body then being sutured. Various efforts have been made to destroy or disintegrate kidney stones so that they can be excreted with the urine.... Chemotherapy is available as a non-invasive therapy for uric acid stones. In this therapy, the urine is alkalyzed, and the stone is dissolved over a substantial period of time. This requires detection of the stone before an acute phase is reached. Web site: http://www.delphion.com/details?pn=US04745921__

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Shroud for coupling kidney stone disintegrator to human body Inventor(s): Nowacki; Christopher (Arlington Heights, IL), Brisson; Alfred G. (Kildeer, IL) Assignee(s): Trutek Research, Inc. (Lake Zurich, IL) Patent Number: 4,798,196 Date filed: December 16, 1986 Abstract: An extracorporeal kidney stone disintegrator comprises an upwardly open ellipsoidal reflector having an open upper end. A spark gap is provided in said reflector at the first focus point thereof. A flexible waterproof shroud is fixed to the open end of the reflector and secured to the skin of a human body containing a concretion such as a kidney stone to be disintegrated. A body of water fills said reflector and said shroud and is in direct contact with the skin of said human body, the reflector being positioned relative to said body so that the concretion is at the second focus point of the reflector. Generation of a sprak across the spark gap causes generation of a shock wave focused

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on the concretion and coupled to the concretion by the body of water and by the tissues of the human body. Excerpt(s): Kidney stones, and also naturally-occurring stones in the bladder and the ureter can be exquisitely painful, and often require surgical relief. Excision or destruction of stones in the bladder and sometimes in the ureter can be relatively easily accomplished, but removal of stones from the kidney is a major procedure.... Removal of stones from the kidney is a very serious and traumatic surgical procedure A large incision is made in the body. The kidney is essentially removed from the body and cut open. The stone or stones are then removed, whereupon the kidney is sutured and returned to the body, with the body then being sutured. Various efforts have been made to destroy or disintegrate kidney stones so that they can be excreted with the urine.... Chemotherapy is available as a non-invasive therapy for uric acid stones. In this therapy, the urine is alkalyzed, and the stone is dissolved over a substantial period of time. This requires detection of the stone before an acute phase is reached. Web site: http://www.delphion.com/details?pn=US04798196__

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

Kidney stone collection device and method Inventor(s): Phan, Cu Ngoc; (Newport Coast, CA), Tran, Khiem Thanh; (Newport Coast, CA) Correspondence: HAYNES BEFFEL & WOLFELD LLP; P O BOX 366; HALF MOON BAY; CA; 94019; US Patent Application Number: 20030060787 Date filed: August 13, 2002 Abstract: A kidney stone collection device includes entrance and settling chambers coupled at a junction, an inlet opening into the entrance chamber, and an outlet conduit including the device outlet. The outlet conduit also has outlet conduit entrance which opens into the settling chamber. The device includes a base defining the bottom of the settling chamber when the body is in an upright orientation. The outlet conduit entrance is at a higher elevation than at least a portion of the base when the body is in the upright orientation. The body may be made of a pliable and/or transparent material so that the user may see and/or feel kidney stones collected at the base. A shape-maintaining frame element may be used at the inlet to permit the inlet to be maintained in an open configuration. Excerpt(s): This application claims the benefit of provisional patent application No. 60/______ filed on ______ Sep. 2001 and entitled Device/Apparatus and Method to Collect Kidney Stones or Stone Fragments from Urine.... The presence of upper urinary tract stones, commonly referred to as kidney stones, is a common medical problem. Fortunately, kidney stones can be effectively treated with extracorporeal shockwave

9

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

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lithotripsy. This is a relatively noninvasive technique during which kidney stones are fragmented by shockwaves applied to the skin surface. The stone fragments can then be passed along with urine via urination. Very small stones may be passed spontaneously without lithotripsy. However, it is a very important to collect the kidney stones and stone fragments for analysis and so that the physician can have the composition determined and then prescribe appropriate medication or other treatment to prevent stone recurrence. Stones and stone fragments will usually be referred to collectively as stones.... FIGS. 1 and 2 illustrate two different devices 10, 12 currently used to collect stones. Collection device 10 is a conical device typically having a paper or plastic body 14 with a net or mesh 16, or other filtering medium, at the lower end. Device 12 is a telescoping, collapsible-cup type device having a net or mesh 18 at the bottom of the device. The body 20 of device 12 is typically made of plastic. These conventional devices work on the filtration principle. Urine is introduced into the device and the net or mesh, or other filtering medium, is supposed to catch the stones. However these devices have some disadvantages. It is sometimes difficult to determine if there are stones or stone fragments caught by the filtering medium. There are often blood clots in the urine of patients with kidney stones. These blood clots may cover stone fragments. The patient may have to use his or her fingers to squeeze the blood clots to see if there stone fragments inside them, an unpleasant task. Very small stone fragments may pass through the filtering medium. In addition, very small stone fragments are often difficult to remove from the filtering medium. The device may be large and inconvenient to carry around; this may discourage patients from collecting stones when away from home. The device may also be relatively expensive. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·

Methods and devices for the in situ dissolution of renal calculi Inventor(s): Constantz, Brent R. (Menlo Park, CA) Correspondence: BOZICEVIC, FIELD & FRANCIS LLP; 200 MIDDLEFIELD RD; SUITE 200; MENLO PARK; CA; 94025; US Patent Application Number: 20030178030 Date filed: March 20, 2002 Abstract: Methods and devices for at least reducing the mass of, if not dissolving, renal calculi in situ are provided. In the subject methods, a renal calculus is contacted, e.g. flushed, with an acidic dissolution solution in situ, where the acidic dissolution solution is a solution of a strong, inorganic acid, e.g. hydrochloric acid. In many embodiments, the renal calculus is first enclosed in an isolated local environment of a device prior contact with the dissolution solution. Also provided are novel devices and kits for practicing the subject invention. Excerpt(s): The field of this invention is nephrolithiasis and the treatment thereof.... Nephrolithiasis, also known as urolithiasis or urinary tract stone disease, is the term used to refer to the condition in which renal calculi or kidney stones occupy one or more locations in the urinary tract, e.g. major calices, minor calices, renal pelvis, ureter, etc. Renal calculi or kidney stones spontaneously develop in the ureter and can cause significant health problems, including pain, bleeding, blockage of the ureter, etc.... A number of different types of kidney stones can form in the urinary tract. Approximately 75 to 85% of all stones are calcium stones, which are typically made up of calcium oxalate and/or calcium phosphate, where the calcium phosphate is typically hydroxyapatite or brushite. Uric acid stone are stones made up of crystallized uric acid

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and account for approximately 5 to 8% of all observed kidney stones. Cystine stones are rare, accounting for about 1% of all observed stones. Finally, struvite stones (MgNH.sub.4PO.sub.4) account for approximately 10 to 15% of all observed stones and are typically associated with the presence of a bacterial infection. 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 kidney stones, 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 “kidney stones” (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 kidney stones. You can also use this procedure to view pending patent applications concerning kidney stones. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 5. BOOKS ON KIDNEY STONES Overview This chapter provides bibliographic book references relating to kidney stones. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on kidney stones 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 “kidney stones” (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 kidney stones: ·

No More Kidney Stones Source: Somerset, NJ: John Wiley and Sons, Inc. 1996. 225 p. Contact: Available from John Wiley and Sons. One Wiley Drive, Somerset, NJ 08875. (800) 225-5945 or (732) 469-4400. Fax (732) 302-2300. E-mail: [email protected]. Website: www.wiley.com. PRICE: $15.95 plus shipping and handling. ISBN: 0471125873. Summary: This book offers readers a program designed to prevent the recurrence of kidney stones. The authors review essential lifestyle and diet changes and the latest medical research, and offer specific guidelines for both men and women. The authors note that no other disease has a more critical relation to diet and that at least 75 percent of patients with stone disease can avoid a recurrence through dietary changes alone. Topics include the risk factors for the different types of kidney stones, how to know what type of stone one is predisposed to and how to prevent them, which foods may trigger stone formation, what seasons of the year confer higher risk, drug therapy and

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who needs to take medications, choosing a health care provider, how to stay motivated, and how to modify one's diet and stay stone free. The authors emphasize that one of the more difficult aspects of preventing stone disease is keeping patients motivated. However, if patients can learn about the physiological causes of stones and really understand the background of dietary restrictions, they will be more successful overall in preventing recurrence. The book includes 25 chapters, an appendix of useful tables, an appendix of food diaries, a glossary of terms (which are italicized in the text), a bibliography, and a subject index. 25 references. ·

Kidney Stones Handbook: A Patient's Guide to Hope, Cure and Prevention. 2nd ed Source: Roseville, CA: Four Geez Press. 1999. 283 p. Contact: Available from Four Geez Press. 1911 Douglas Blvd., Suite 85-131, Roseville, CA 95661. (800) 2-Kidneys. Website: www.readerndex.com/fourgeez. PRICE: $17.95 plus shipping and handling. ISBN: 0963706861. Summary: This patient education handbook describes how virtually every patient who follows treatment based on appropriate testing, proper interpretation, and sound medical principles can substantially reduce or eliminate all future kidney stone production. The book covers common causes of kidney stones, the risk factors for kidney stone formation, which foods contribute to forming kidney stones in people who are prone to stone formation, pain medications, the need for metabolic stone risk testing (and how to obtain it), what to expect from lithotripsy, how to select realistic preventive treatment, surgical treatment for kidney stones, and patient rights. The authors emphasize the need for patients to educate themselves and to take a proactive approach to preventing new stones, in many cases to the point of educating their physicians and demanding appropriate diagnostic and treatment methods. The book also includes medical references for patients and physicians. The book includes a glossary of terms, a list of common medications and their uses, and a subject index.

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

All You Wanted to Know About Kidney Stones by Savitri Ramaiah; ISBN: 8120723058; http://www.amazon.com/exec/obidos/ASIN/8120723058/icongroupinterna

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Get It Out! Eliminating the Cause of Diverticulitis, Kidney Stones, Bladder Infections, Prostate Enlargement, Menopausal Discomfort, Cervical Dysplasia, PMS, and More by Soma Grismaijer, Sydney Ross Singer; ISBN: 1930858027; http://www.amazon.com/exec/obidos/ASIN/1930858027/icongroupinterna

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Herbs for the Urinary Tract: Herbal Relief for Kidney Stones, Bladder Infections and Other Problems of the Urinary Tract (Keats Good Herb Guide Series) by Michael

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Moore (1998); ISBN: 0879838159; http://www.amazon.com/exec/obidos/ASIN/0879838159/icongroupinterna ·

Kidney and Urinary Tract Diseases and Disorders Sourcebook: Basic Information About Kidney Stones, Urinary Incontinence, Bladder Disease, End Stage Renal Disease, Dialysis, and More, Along With Statistical and (Health Reference Series, Vol 21) by Linda M. Ross (Editor), Peter Dresser (Editor) (1997); ISBN: 0780800796; http://www.amazon.com/exec/obidos/ASIN/0780800796/icongroupinterna

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Kidney Stones Hdbk by G. Golomb (1996); ISBN: 0096370602; http://www.amazon.com/exec/obidos/ASIN/0096370602/icongroupinterna

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Kidney Stones: Medical and Surgical Management by Fredric L. Coe (Editor), et al; ISBN: 0781702631; http://www.amazon.com/exec/obidos/ASIN/0781702631/icongroupinterna

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No More Kidney Stones by John S. Rodman (Author), Cynthia Seidman (Author); ISBN: 0471125873; http://www.amazon.com/exec/obidos/ASIN/0471125873/icongroupinterna

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Percutaneous Surgery of Kidney Stones: Techniques and Tactics by Knut Korth (1984); ISBN: 0387135723; http://www.amazon.com/exec/obidos/ASIN/0387135723/icongroupinterna

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Pharmacological Treatment of Endocrinopathies: Bone Disease, Kidney Stones and Related Disorders by C.Y.C. Pak (Editor) (1991); ISBN: 3805552149; http://www.amazon.com/exec/obidos/ASIN/3805552149/icongroupinterna

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Technology Assessment and New Kidney Stone Treatment Methods (Commission of the European Communities Health Services Research Series, No 4) by Finn KamperJorgensen (Editor), et al; ISBN: 0192616498; http://www.amazon.com/exec/obidos/ASIN/0192616498/icongroupinterna

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The 2002 Official Patient's Sourcebook on Kidney Stones by James N. Parker (Editor), et al (2002); ISBN: 0597832234; http://www.amazon.com/exec/obidos/ASIN/0597832234/icongroupinterna

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The Kidney Stones Handbook : A Patient's Guide to Hope, Cure and Prevention by Gail Savitz, et al; ISBN: 0963706861; http://www.amazon.com/exec/obidos/ASIN/0963706861/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 “kidney stones” (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:10 10

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

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Extracorporeal shock wave lithotripsy (ESWL) procedures for the treatment of kidney stones Author: Farrell, John R.; Year: 1985; Rockville, MD: U.S. Dept. of Health and Human Services, Public Health Service, Office of the Assistant Secretary for Health, National Center for Health Services Research and Health Care Technology Assessment; Springfield, VA: Available from National Technical Information Service, [1985]

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Kidney stones. Author: Flocks, Rubin H. (Rubin Hyman),; Year: 1984; Chicago, Year Book Publishers, 1958

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Percutaneous ultrasound procedures for the treatment of kidney stones Author: Farrell, John R.; Year: 1987; Rockville, MD: U.S. Dept. of Health and Human Services, Public Health Service, Office of the Assistant Secretary for Health, National Center for Health Services Research and Health Care Technology Assessment; Springfield, VA: Available from National Technical Information Service, [1985]

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Prevention and treatment of kidney stones: January 1983 through February 1988: 524 citations Author: Abrams, Estelle J.; Year: 1991; Bethesda, Md. (8600 Rockvill Pike, Bethesda 20894): U.S. Dept. of Health and Human Services, Public Health Service, National Institutes of Health, National Library of Medicine, Reference Section, [1988]

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Transurethral ureteroscopic lithotripsy procedure for the treatment of kidney stones Author: Adams, Diane L.; Year: 1988; Rockville, MD: National Center for Health Services Research and Health Care Technology Assessment, U.S. Dept. of Health and Human Services, Public Health Service, 1987

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

Kidney Stones: Treatment Source: in Seal, G.M. Patient's Guide to Urology: Plumbing Problems in Layman's Terms. Toledo, OH: High Oaks Publishing Company. 1995. p. 146-149. Contact: Available from bookstores and libraries and, at the wholesale level, from Baker and Taylor, (908) 722-8000. Also available in orders of 10 or more copies from High Oaks Publishing Company, Center Urology of Toledo, Inc. 3425 Executive Parkway, Suite 214, Toledo, OH 43606. (419) 531-1700. PRICE: $21.95 (cloth); $12.95 (paperback). ISBN: 0964577305 (cloth), 0964577313 (paper). Summary: In this brief chapter, from a patient's guide to urology, the author discusses the treatment of kidney stone disease. The author divides the treatment options into three major categories: open surgical, endoscopic, and extracorporeal shock wave lithotripsy (ESWL). The author describes each type of treatment and briefly considers patient selection and cost-effectiveness. This chapter goes hand in hand with two other

between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.

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chapters on the physiology and prevention of kidney stones. The book concludes with a detailed glossary and brief subject index. 1 figure. ·

Kidney Stones: Causes Source: in Seal, G.M. Patient's Guide to Urology: Plumbing Problems in Layman's Terms. Toledo, OH: High Oaks Publishing Company. 1995. p. 137-145. Contact: Available from bookstores and libraries and, at the wholesale level, from Baker and Taylor, (908) 722-8000. Also available in orders of 10 or more copies from High Oaks Publishing Company, Center Urology of Toledo, Inc. 3425 Executive Parkway, Suite 214, Toledo, OH 43606. (419) 531-1700. PRICE: $21.95 (cloth); $12.95 (paperback). ISBN: 0964577305 (cloth), 0964577313 (paper). Summary: In this chapter, from a patient's guide to urology, the author discusses kidney stone disease. Topics include stone formation; symptoms of stone disease; kidney and ureter physiology; and damage caused by kidney stones. This chapter serves as an introduction to two subsequent chapters on the treatment and prevention of kidney stones. The book concludes with a detailed glossary and brief subject index. 3 figures.

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Not All Kidney Stones Are Created Equal Source: in Rodman, J.S. Seidman, C. Jones, R. No More Kidney Stones. Somerset, NJ: John Wiley and Sons, Inc. 1996. p. 20-27. Contact: Available from John Wiley and Sons. One Wiley Drive, Somerset, NJ 08875. (800) 225-5945 or (732) 469-4400. Fax (732) 302-2300. E-mail: [email protected]. Website: www.wiley.com. PRICE: $15.95 plus shipping and handling. ISBN: 0471125873. Summary: Kidney stones are composed of different substances and vary from one person to another. This chapter on the different types of kidney stones is from a book that offers readers a program designed to prevent the recurrence of kidney stones. The authors review essential lifestyle and diet changes and the latest medical research, and offer specific guidelines for both men and women. In this chapter, the authors describe calcium oxalate stones (75 percent of stones are this type), uric acid stones (10 percent), struvite or infected stones (10 percent), and cystine stones (1 percent); stones can also have a combination of these elements. For each type of stone, the authors note the causes, related diseases and medical conditions, complications (notably struvite layered on other types of stones), and risk factors (including in children). The chapter concludes with a discussion of bladder stones and the importance of stone analysis. Knowing the exact composition of a stone gives the doctor an important clue as to the reasons why the stone has formed; treatment strategies (including specific dietary modifications) can then be individualized and their success made more likely.

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Why Kidney Stones Are So Painful Source: in Rodman, J.S. Seidman, C. Jones, R. No More Kidney Stones. Somerset, NJ: John Wiley and Sons, Inc. 1996. p. 34-41. Contact: Available from John Wiley and Sons. One Wiley Drive, Somerset, NJ 08875. (800) 225-5945 or (732) 469-4400. Fax (732) 302-2300. E-mail: [email protected]. Website: www.wiley.com. PRICE: $15.95 plus shipping and handling. ISBN: 0471125873. Summary: Kidney stones may lie silently in the kidney for years. However, when a stone passes into and obstructs the ureter (the narrow tube connecting the kidney to the bladder), excruciating pain usually follows. This chapter on why kidney stones are so

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painful is from a book that offers readers a program designed to prevent the recurrence of kidney stones. The authors review essential lifestyle and diet changes and the latest medical research, and offer specific guidelines for both men and women. In this chapter, the authors describe the two kinds of pain that people experience when passing stones (soreness of the kidney and colic), three types of basic renal colic pain patterns (ureteropelvic stone, midureteral stone, low ureteral stone), three common places where stones can stop moving (pelvis of kidney, iliac artery or branch of the aorta, or bladder tunnel), the secondary symptoms of passing a kidney stone (vomiting, fever and chills, blood in the urine), the importance of getting an accurate diagnosis of renal colic, options for treating the pain, and when hospitalization is indicated. The authors emphasize that when a patient is having an episode of renal colic and then the pain stops, it does not necessarily mean that the stone is out. A stone stuck midureter can stop hurting, but it can eventually cause trouble to the kidney. Patients should always consult a physician after a stone episode or a suspected stone episode. 1 figure. ·

Kidney Stone Boom Source: in Rodman, J.S. Seidman, C. Jones, R. No More Kidney Stones. Somerset, NJ: John Wiley and Sons, Inc. 1996. p. 3-8. Contact: Available from John Wiley and Sons. One Wiley Drive, Somerset, NJ 08875. (800) 225-5945 or (732) 469-4400. Fax (732) 302-2300. E-mail: [email protected]. Website: www.wiley.com. PRICE: $15.95 plus shipping and handling. ISBN: 0471125873. Summary: Kidney stones occur when there are too many waste products or not enough fluid to flush those waste products out; the waste comes together to form a 'stone.' When the kidneys then eliminate these stones, the pain can be excruciating. This introductory chapter is from a book that offers readers a program designed to prevent the recurrence of kidney stones. The authors review essential lifestyle and diet changes and the latest medical research, and offer specific guidelines for both men and women. In this chapter, the authors review the physiology of kidney stones, why they happen, and why they seem to be becoming more prevalent. The authors note that, since World War II, the incidence of stone disease has been increasing dramatically in the Western industrialized nations; this is connected directly to the prevalence of a richer diet. After years of trying to find medicines that would cure stones, doctors found that two thirds of patients seen with recurring stones stopped making them by following basic dietary advice. The authors of this chapter contend that only a handful of patients need to take medication to prevent recurrence, if they closely follow dietary recommendations. The guidelines stress a two part approach to prevention: understanding how and why stones form, and then targeting the specific dietary and lifestyle changes that will prevent stone disease. The author concludes by encouraging patients to make the commitment to preventing further kidney stones.

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Renal Calculi Source: in Barakat, A.Y. Renal Disease in Children: Clinical Evaluation and Diagnosis. Secaucus, NJ: Springer-Verlag. 1990. p. 341-355. Contact: No longer available from publisher. Summary: Nephrolithiasis is an uncommon disorder in childhood; however, in view of the sometimes dramatic clinical presentations, the likelihood of recurrence, and the possibility of damage to the kidneys, the clinician should be conversant with renal stones and associated disorders. This chapter, from an extensive desk reference book about the clinical evaluation and diagnosis of renal disease in children, discusses renal

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calculi. Four sections cover the incidence and epidemiology of renal calculi; the clinical features; the types of calculi, including composition and formation; and the evaluation of patients with nephrolithiasis. The author stresses that nephrolithiasis should be considered a symptom; a systematic approach to investigation and management of possible underlying conditions should be the aim of the practicing pediatrician. Numerous figures and tables illustrate and summarize the main concepts. 28 references. ·

How and Why Kidney Stones Form Source: in Rodman, J.S. Seidman, C. Jones, R. No More Kidney Stones. Somerset, NJ: John Wiley and Sons, Inc. 1996. p. 28-33. Contact: Available from John Wiley and Sons. One Wiley Drive, Somerset, NJ 08875. (800) 225-5945 or (732) 469-4400. Fax (732) 302-2300. E-mail: [email protected]. Website: www.wiley.com. PRICE: $15.95 plus shipping and handling. ISBN: 0471125873. Summary: The chance of a person forming kidney stones is largely determined by their genetic makeup and by the way their diet and lifestyle interplay with this genetic inheritance. This chapter on how and why kidney stones form is from a book that offers readers a program designed to prevent the recurrence of kidney stones. The authors review essential lifestyle and diet changes and the latest medical research, and offer specific guidelines for both men and women. In this chapter, the authors stress that it is important to understand the basic factors that encourage the formation of urinary crystals. With this understanding, patients can better prevent recurrence of their kidney stone problems. Using the metaphor of making rock candy out of super saturated sugar water, the authors describe how crystals form and how to discourage their formation. Topics include the composition of kidney stones (notably calcium oxalate, a salt), the conditions that favor crystal formation, the best inhibitor of kidney stones, and how uric acid stones are formed. The authors note that there is a genetic tendency to form stones, but diet and fluid intake also make a big difference in whether or not the gene that controls stone formation can assert itself. 1 figure.

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Medical Conditions that Can Cause Kidney Stones Source: in Rodman, J.S. Seidman, C. Jones, R. No More Kidney Stones. Somerset, NJ: John Wiley and Sons, Inc. 1996. p. 58-68. Contact: Available from John Wiley and Sons. One Wiley Drive, Somerset, NJ 08875. (800) 225-5945 or (732) 469-4400. Fax (732) 302-2300. E-mail: [email protected]. Website: www.wiley.com. PRICE: $15.95 plus shipping and handling. ISBN: 0471125873. Summary: There are a number of medical conditions that dispose people to the formation and recurrence of kidney stones. This chapter on the 12 most common of these medical conditions is from a book that offers readers a program designed to prevent the recurrence of kidney stones. The authors review essential lifestyle and diet changes and the latest medical research, and offer specific guidelines for both men and women. In this chapter, the authors discuss bowel disease and its resulting fluid loss, bicarbonate loss, fat malabsorption, and magnesium metabolism; medullary sponge kidney (MSK); hyperparathyroidism; milk alkali syndrome and ulcers; anatomic abnormalities in the urinary tract, including slow flow of urine, reflux of urine from the bladder backward into the kidneys, and voiding problems; paralysis and immobilization; renal tubular acidosis (RTA), an inherited defect in the kidney's ability to excrete acid and lower the urinary pH to normal levels; acquired RTA in patients with glaucoma; cystinuria, an inherited error of metabolism; and oxalosis, an inherited disease that causes abnormally high oxalate excretions. The authors briefly describe how

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each of these conditions may contribute to kidney stone formation and offer specific dietary and fluid intake strategies to combat this occurrence. 3 figures. ·

Lifestyles of the Kidney Stone Former Source: in Rodman, J.S. Seidman, C. Jones, R. No More Kidney Stones. Somerset, NJ: John Wiley and Sons, Inc. 1996. p. 126-130. Contact: Available from John Wiley and Sons. One Wiley Drive, Somerset, NJ 08875. (800) 225-5945 or (732) 469-4400. Fax (732) 302-2300. E-mail: [email protected]. Website: www.wiley.com. PRICE: $15.95 plus shipping and handling. ISBN: 0471125873. Summary: There are certain occupations and lifestyles that may dispose people to the formation and recurrence of kidney stones. This chapter on the most common of these lifestyle factors is from a book that offers readers a program designed to prevent the recurrence of kidney stones. The authors review essential lifestyle and diet changes and the latest medical research, and offer specific guidelines for both men and women. In this chapter, the authors discuss the lifestyle factors that may contribute to stone disease, including bathroom access, situations that make the person lose fluids (like extra exercise, or high heat environments), ultraviolet (UV) light exposure, eating patterns, and changes in lifestyle. The authors discuss each of these factors, offering short vignettes of patients' lifestyles to illustrate the concept presented. The authors conclude that although it is not always possible to separate dietary and lifestyle factors, there are many stone formers who must look as closely at the way they live and the things they do as at their diet.

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Questions and Answers [About Kidney Stones] Source: in Savitz, G. and Leslie, S.W. Kidney Stones Handbook: A Patient's Guide to Hope, Cure and Prevention. 2nd ed. Roseville, CA: Four Geez Press. 1999. p. 213-223. Contact: Available from Four Geez Press. 1911 Douglas Blvd., Suite 85-131, Roseville, CA 95661. (800) 2-Kidneys. Website: www.readerndex.com/fourgeez. PRICE: $17.95 plus shipping and handling. ISBN: 0963706861. Summary: This chapter of common questions and answers about kidney stones is from a patient education handbook that describes how virtually every patient who follows treatment based on appropriate testing, proper interpretation, and sound medical principles can substantially reduce or eliminate all future kidney stone production. The authors emphasize the need for patients to educate themselves and to take a proactive approach to preventing new stones, in many cases to the point of educating their physicians and demanding appropriate diagnostic and treatment methods. Topics covered in this chapter include why kidney stone pain attacks hurt so much, the use of stents, indications for surgery, the chances for recurrence, dissolution therapy (dissolving the stone with medication), how to manage a kidney stone attack, the use of lithotripsy (the 'stone machine') to break up kidney stones, risk factors or other occupational considerations, dietary and food suggestions to help prevent stones (increasing fluids, limiting salt and meat proteins), other ways to prevent stone recurrence, metabolic testing for stone prevention, and the most common problems found in metabolic testing. The authors stress that the first essential step in the prevention of kidney stones is to guarantee that there will always be sufficient water intake to produce enough urine to easily dissolve all the minerals and chemicals the kidneys normally produce and excrete.

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Diagnosing Kidney Stones Source: in Savitz, G. and Leslie, S.W. Kidney Stones Handbook: A Patient's Guide to Hope, Cure and Prevention. 2nd ed. Roseville, CA: Four Geez Press. 1999. p. 53-58. Contact: Available from Four Geez Press. 1911 Douglas Blvd., Suite 85-131, Roseville, CA 95661. (800) 2-Kidneys. Website: www.readerndex.com/fourgeez. PRICE: $17.95 plus shipping and handling. ISBN: 0963706861. Summary: This chapter on the diagnosis of kidney stones is from a patient education handbook that describes how virtually every patient who follows treatment based on appropriate testing, proper interpretation, and sound medical principles can substantially reduce or eliminate all future kidney stone production. The authors emphasize the need for patients to educate themselves and to take a proactive approach to preventing new stones, in many cases to the point of educating their physicians and demanding appropriate diagnostic and treatment methods. Every patient with a possible kidney stone requires some type of imaging study of the urinary tract. This chapter describes the imaging tests used to confirm the presence of a kidney stone, including ultrasound, intravenous pyelogram (IVP), retrograde pyelograms, CT (computed tomography) scans, flat plate or KUB (kidneys, ureters, and bladder), and plain renal tomograms (a type of x-ray). For each type of diagnostic technique, the authors explain the indications for the test, the types of images or results that can be obtained, and what the patient can expect during the testing procedure. The authors conclude that with one or more of these imaging techniques, it should be possible to correctly identify any and all stones that might be present in the urinary system.

Directories In addition to the references and resources discussed earlier in this chapter, a number of directories relating to kidney stones have been published that consolidate information across various sources. The Combined Health Information Database lists the following, which you may wish to consult in your local medical library:11 ·

Directory of Plain Language Health Information Source: Ottawa, Ontario: Canadian Public Health Association. 1999. 104 p. Contact: Available from Canadian Public Health Association. 400-1565 Carling Avenue, Ottawa, Ontario, K1Z 8R1. (613) 725-3769. Fax (613) 725-9826. E-mail: [email protected]. PRICE: $19.95 plus shipping and handling. Also available at www.pls.cpha.ca for free. ISBN: 189432403X. Summary: Patient education materials are often written at a level that is higher than the reading level of the people who will need the materials. This directory lists 'plain language' patient education materials. An extensive introductory chapter in the directory describes how patient education materials are evaluated and offers specific information about the best strategies to create plain language materials. Each piece of health information in the directory is rated according to its design assessment, in order

11

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

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to help readers make informed decisions about choosing materials. Part I is a list of health subjects presented in alphabetical order, in the style of a typical index. The page number after a listing notes where to find that piece of health information in Part II. Part II is a list of organizations and their contact information. Below the contact information is a list of the plain language health titles produced by the organization. Each title is grouped under a grade level heading, is numbered, and has a design rating. Part III is an alphabetical list of all the organizations in Part II. Materials related to kidney and urologic diseases include kidney stones, urinary catheters, urinary tract infection, sexually transmitted diseases, bladder control, and sexuality. Appendices to the directory include a guide to the S.M.O.G. readability formula, clear design tips, and plain language tips.

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

Role of Medical Management in the Treatment of Urinary Calculus Disease Source: Marshfield, WI: Marshfield Clinic. 1991. Contact: Available from Marshfield Clinic. Office of Medical Education, 1000 North Oak Avenue, Marshfield, WI 54449-5777. (800) 782-8581, ext. 5127 in WI or (715) 387-5127. PRICE: $60 U-Matic or $45 VHS/Beta (purchase); $35 per tape for 30 days (rental). Order number 89-2576. Summary: In this videotape, Dr. Martin Resnick discusses the evaluation and medical management of the patient with kidney stones.. He also talks about the interpretation of laboratory information, patient history, and addresses the issues of treating patients who are trying to prevent recurrent disease. (AA-M).

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

Extracorporeal shockwave lithotripsy for kidney stones [videorecording] Source: produced by Ciné-Med; Year: 1992; Format: Videorecording; Woodbury, Conn.: American Cyanamid, c1992

·

Kidney stones [videorecording]. Year: 1999; Format: Videorecording; Carrollton, TX: HSTN, c1999

·

Lithotripsy [videorecording]: shocking news for kidney stones Source: from the West Michigan Kidney Stone Program; production unit, Biomedical Communications, Butterworth Hospital; Year: 1988; Format: Videorecording; Grand Rapids, Mich.: The Hospital, [1988]

·

NIH consensus statement, prevention and treatment of kidney stones [videorecording] Source: with Fredric L. Coe; Year: 1988; Format: Videorecording; Secaucus, N.J.: Network for Continuing Medical Education, c1988

·

What causes kidney stones [videorecording] Source: Department of Medicine, Emory University, School of Medicine; Year: 1980; Format: Videorecording; Atlanta: Emory Medical Television Network: [for loan or sale by A. W. Calhoun Medical Library], 1980

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CHAPTER 7. PERIODICALS AND NEWS ON KIDNEY STONES Overview In this chapter, we suggest a number of news sources and present various periodicals that cover kidney stones.

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

Heating pad relieves kidney stone pain Source: Reuters Health eLine Date: September 01, 2003

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New genetic mutation linked to urate kidney stones Source: Reuters Medical News Date: May 27, 2003

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·

Calcium supplementation may increase risk of kidney stones Source: Reuters Medical News Date: March 18, 2003

·

Underlying metabolic abnormalities cause many HIV-associated kidney stones Source: Reuters Medical News Date: February 07, 2003

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Blackcurrant juice may cut risk of kidney stones Source: Reuters Health eLine Date: October 28, 2002

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Gene mutations tied to kidney stones, osteoporosis Source: Reuters Health eLine Date: September 25, 2002

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FDA clears Fossa ureteral device for removal of kidney stones Source: Reuters Industry Breifing Date: August 13, 2002

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Independent link between gout and kidney stones suggests shared etiology Source: Reuters Medical News Date: August 02, 2002

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Size determines treatment of allograft kidney stones Source: Reuters Medical News Date: April 09, 2002

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Kidney stone back pain more likely in morning Source: Reuters Health eLine Date: April 01, 2002

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New dietary regimen prevents kidney stones better than low-calcium diet Source: Reuters Medical News Date: January 09, 2002

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Low-protein diet cuts risk of kidney stones Source: Reuters Health eLine Date: January 09, 2002

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Sleep position may play a role in kidney stones Source: Reuters Health eLine Date: April 09, 2001

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FDA clears EDAP TMS's lithotripter for kidney stones Source: Reuters Industry Breifing Date: February 15, 2001

·

AIDS drug linked to higher risk of kidney stones Source: Reuters Health eLine Date: December 25, 2000

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Ketogenic diet linked with high rate of kidney stones Source: Reuters Medical News Date: August 10, 2000

·

Association between dietary fat, kidney stones refuted Source: Reuters Medical News Date: August 07, 2000

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·

Novel protein may protect against kidney stone formation Source: Reuters Industry Breifing Date: July 24, 2000

·

Beer reduces kidney stone risk Source: Reuters Health eLine Date: July 15, 1999

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Nanobacteria may play role in kidney stone formation Source: Reuters Medical News Date: July 09, 1998

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Bacteria may cause kidney stones Source: Reuters Health eLine Date: July 09, 1998

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Type And Amount Of Fluid Intake Influences Kidney Stone Risk In Women Source: Reuters Medical News Date: April 03, 1998

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Stressful Life Events Linked To Development Of Kidney Stones Source: Reuters Medical News Date: November 28, 1997

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Astronauts at Higher Risk for Kidney Stones Source: Reuters Health eLine Date: November 28, 1997

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Guidelines On Management Of Patients With Kidney Stones Issued Source: Reuters Medical News Date: October 28, 1997

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New Guidelines for Treating Kidney Stones Source: Reuters Health eLine Date: September 24, 1997

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Indinavir Linked To Crystalluria, Kidney Stones Source: Reuters Medical News Date: July 15, 1997

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Dietary Calcium Curbs Kidney Stones Source: Reuters Health eLine Date: April 02, 1997

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Dietary Calcium Lowers Kidney Stone Risk In Women Source: Reuters Medical News Date: April 01, 1997

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Dietary Changes Don't Appear To Prevent Recurrent Kidney Stones Source: Reuters Medical News Date: June 25, 1996

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Kidney Stones: Prevalence And Risk Factors Vary By Geographic Area Source: Reuters Medical News Date: March 14, 1996

·

Common Molecular Basis For Three Inherited Kidney Stone Diseases Described Source: Reuters Medical News Date: February 01, 1996

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

Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name.

Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “kidney stones” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests.

Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “kidney stones” (or synonyms). If you know the name of a company that is relevant to kidney stones, 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 “kidney stones” (or synonyms).

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Newsletters on Kidney Stones Find newsletters on kidney stones using the Combined Health Information Database (CHID). You will need to use the “Detailed Search” option. To access CHID, go to the following hyperlink: http://chid.nih.gov/detail/detail.html. Limit your search to “Newsletter” and “kidney stones.” 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.” Type “kidney stones” (or synonyms) into the “For these words:” box. The following list was generated using the options described above: ·

Kidney Disease Source: Sarcoidosis Networking. 8(3): 2. May-June 2000. Contact: Available from Sarcoid Network Association. Sarcoidosis Networking, 13925 80th Street East, Puyallup, WA 98372-3614. Email: [email protected]. Summary: Sarcoidosis is a chronic, progressive systemic granulomatous (causing lesions) disease of unknown cause (etiology), involving almost any organ or tissue, including the skin, lungs, lymph nodes, liver, spleen, eyes, and small bones of the hands or feet. This brief article, from a newsletter for patients with sarcoidosis, reviews kidney disease, its types, diagnosis, and management. The article begins with a summary of the anatomy and function of the kidneys, which filter the blood (removing waste and excess body fluids), and maintain the balance of some essential nutrients helping to regulate blood pressure, red blood cells, and elements such as potassium and calcium. Without functioning kidneys, one cannot live without dialysis, the mechanical filtration of the blood. Kidneys fail for a variety of reasons, including trauma to the kidney, toxins, heart failure, obstruction (kidney stones), overuse of some medications, and diseases that invade the kidney, such as sarcoidosis. Diabetes and high blood pressure are the most common causes for loss of kidney function. Warning signs of kidney disease are high blood pressure (hypertension), blood or protein in the urine, creatinine level greater than 1.2 in women or 1.4 in men, more frequent urination (especially at night), difficult or painful urination, and puffy eyes or swelling of the hands or feet (especially in children). Loss of kidney function can produce symptoms including fatigue, weakness, nausea, vomiting, diarrhea or constipation, headaches, loss of appetite, increased edema (fluid retention), and fever or chills. Kidney failure is characterized as acute kidney failure, chronic kidney insufficiency, and chronic kidney failure. The need to put a person on dialysis depends upon the levels of creatinine and urea nitrogen in the blood and the evaluation of body parameters such as fluid status, and symptoms of toxicity. The author encourages readers to practice preventive measures which include drinking 8 to 10 glasses of water per day, preventing or treating diabetes and high blood pressure, avoiding tobacco, eating a well balanced diet, practicing good hygiene, treating wounds and infections, limiting exposure to heavy metals and toxic chemicals, and avoiding unnecessary over the counter drug use.

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

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prefer. For the format option, select “Newsletter Article.” Type “kidney stones” (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 kidney stones: ·

What Causes Kidney Stones Source: Columbia-Presbyterian Urology. p. 4. Fall 1996. Contact: Available from Columbia-Presbyterian Urology. Dana W. Atchley Pavilion, 11 Floor, 161 Fort Washington Avenue, New York, NY 10032-3784. (212) 305-0111. Summary: This brief newsletter article describes the causes of kidney stones. There are four factors that lead to stone formation: urine saturation, crystallization, particle retention, and matrix foundation. The author first describes who is at risk for forming kidney stones and briefly outlines the different types of stones: calcium oxalate (75 percent of patients develop these), uric acid, and struvite stones. Urine saturation occurs when urine has excessive amounts of calcium, uric acid, and oxalate crystals, which are all stone-forming substances. This saturation may occur during the day but frequently occurs after meals or during the sleeping hours or hot weather because of the lack of fluids consumed. Stone inhibiting substances include pyrophosphate, citrate, magnesium, and nephrocalcin. Freshly voided urine from most healthy individuals contains small crystals, which are flushed out of the urinary tract. However, some people have anatomic abnormalities in the kidney and or ureter, making the crystals stick to the lining of these structures. In addition to being composed of crystals, stones are also formed from an organic material called matrix. Matrix acts as the foundation for stone formation by controlling crystallization. The matrix is composed of a carbohydrate and protein. The article concludes with a section on preventing kidney stones, offering the following suggestions: increase fluid intake to lower saturation; make sure one half the fluid intake is water; produce two and a half quarts of urine in 24 hours; avoid eating grapes, berries, plums and citrus fruits; limit intake of coffee, tea and chocolate; avoid eating sardines, shrimp, and oysters; and, to prevent uric acid stones, avoid eating liver, sweet breads, and brains. Some people may require medication because they form calcium and uric acid stones even though they have adequate fluid intake and do not consume an excessive amount of dairy products. 1 figure.

·

Kidney Stones: Often Painful, But Manageable Source: Mayo Clinic Health Letter. 20(4): 6. April 2002. Contact: Available from Mayo Clinic Health Letter. Subscription Services, P.O. Box 53889, Boulder, CO 80322-3889. (800) 333-9037 or (303) 604-1465. Summary: This brief newsletter article reviews the problem of kidney stones (nephrolithiasis) and their treatment. The author first reviews the different types of kidney stones, including calcium stones, uric acid stones, struvite stones, and cystine stones. The author cautions that kidney stones often first occur between the ages of 20 and 50 and tend to recur. Small stones may pass with little or no pain. Others can be quite painful as they pass through the narrow tubes that connect each kidney to the bladder (the ureters). Drinking plenty of fluids and staying physically active can help to move a stone through the patient's system. Stones that are too large to pass or that are causing bleeding, kidney damage, or ongoing urinary tract infection (UTI) may require surgical treatment. Stone removal techniques include extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy, and ureteroscopic stone removal. One sidebar reviews strategies to prevent future stones.

Periodicals and News 111

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

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CHAPTER 8. 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 kidney stones. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DIÒ Advice for the PatientÒ 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 kidney stones. 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 kidney stones: Allopurinol ·

Systemic - U.S. Brands: Aloprim; Zyloprim http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202021.html

Antacids ·

Oral - U.S. Brands: Advanced Formula Di-Gel; Alamag; Alamag Plus; Alenic Alka; Alenic Alka Extra Strength; Alka-Mints; Alkets; Alkets Extra Strength; Almacone; Almacone II; AlternaGEL; Alu-Cap; Aludrox; Alu-Tab; Amitone; Amphojel; Antacid Gelcaps; Antacid Liquid; Antacid L http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202047.html

Citrates ·

Systemic - U.S. Brands: Bicitra; Citrolith; Oracit; Polycitra Syrup; Polycitra-K; Polycitra-K Crystals; Polycitra-LC; Urocit-K http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202144.html

Diuretics, Thiazide ·

Systemic - U.S. Brands: Aquatensen; Diucardin; Diulo; Diuril; Enduron; Esidrix; Hydro-chlor; Hydro-D; HydroDIURIL; Hydromox; Hygroton; Metahydrin; Microzide; Mykrox; Naqua; Naturetin; Oretic; Renese; Saluron; Thalitone; Trichlorex 10; Zaroxolyn http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202208.html

Erythromycin and Sulfisoxazole ·

Systemic - U.S. Brands: Eryzole; Pediazole http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202224.html

Indinavir ·

Systemic - U.S. Brands: Crixivan http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203523.html

Penicillamine ·

Systemic - U.S. Brands: Cuprimine; Depen http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202445.html

Phosphates ·

Systemic - U.S. Brands: K-Phos M. F. K-Phos Neutral; K-Phos No. 2; K-Phos Original; Neutra-Phos; Neutra-Phos-K; Uro-KP-Neutral http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202463.html

Probenecid ·

Systemic - U.S. Brands: Benemid; Probalan http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202480.html

Researching Medications 115

Probenecid and Colchicine ·

Systemic - U.S. Brands: ColBenemid; Col-Probenecid; Proben-C http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202481.html

Pyridoxine (Vitamin B 6 ) ·

Systemic - U.S. Brands: Beesix; Doxine; Nestrex; Pyri; Rodex http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202493.html

Sulfadoxine and Pyrimethamine ·

Systemic - U.S. Brands: Fansidar http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202534.html

Sulfinpyrazone ·

Systemic - U.S. Brands: Anturane http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202538.html

Sulfonamides and Phenazopyridine ·

Systemic - U.S. Brands: Azo Gantanol; Azo Gantrisin; Azo-Sulfamethoxazole; Azo-Sulfisoxazole; Azo-Truxazole; Sul-Azo http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202542.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 ConsultÔ Mosby’s Drug ConsultÔ 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,

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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 kidney stones 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 “kidney stones” (or synonyms) into the search box, and click “Submit Query.” When you receive your results, note that not all of the drugs may be relevant, as some may have been withdrawn from orphan status. Write down or print out the name of each drug and the relevant contact information. From there, visit the Pharmacopeia Web site and type the name of each orphan drug into the search box at http://www.nlm.nih.gov/medlineplus/druginformation.html. You may need to contact the sponsor or NORD for further information. NORD conducts “early access programs for investigational new drugs (IND) under the Food and Drug Administration’s (FDA’s) approval ‘Treatment INDs’ programs which allow for a limited number of individuals to receive investigational drugs before FDA marketing approval.” If the orphan product about which you are seeking information is approved for marketing, information on side effects can be found on the product’s label. If the product is not approved, you may need to contact the sponsor. The following is a list of orphan drugs currently listed in the NORD Orphan Drug Designation Database for kidney stones: ·

Succimer (trade name: Chemet) http://www.rarediseases.org/nord/search/nodd_full?code=169

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

119

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

·

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

·

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

·

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

·

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

·

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

·

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

·

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

·

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

·

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

·

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

·

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

·

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

13

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

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

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

A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to one of the following: Brochure/Pamphlet, Fact Sheet, or Information Package, and “kidney stones” using the “Detailed Search” option. Go directly to the following hyperlink: 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 the publication date, select “All Years.” Select your preferred language and the format option “Fact Sheet.” Type “kidney stones” (or synonyms) into the “For these words:” box. The following is a sample result: ·

Report on the Management of Staghorn Calculi Source: Baltimore, MD: American Urological Association. 1994. [54 p.]. Contact: Available from American Urological Association. 1120 North Charles Street, Baltimore, MD 21201. (410) 727-1100. Fax (410) 223-4370. E-mail: [email protected]. Website: www.auanet.org. PRICE: Single copy free while supplies last; payment of postage required. Summary: This report offers recommendations to assist physicians specifically in the treatment of struvite staghorn calculi (kidney stones). Although relatively uncommon, these kidney stones present serious problems because they occur in the presence of urinary tract infections (UTI) and because the stones themselves are infected. Treatment must remove stones completely to eradicate all infected stone material. Accepted alternatives for treating patients with struvite staghorn calculi are grouped into five general modalities: watchful waiting, open surgery (referring to any method of open surgical exposure of the kidney and removal of stones), extracorporeal shock wave lithotripsy (SWL), percutaneous nephrolithotomy (PNL, removal of the kidney stone through the skin), and combinations of PNL and SWL. As a standard, a newly diagnosed struvite staghorn calculus (stone) represents an indication for active treatment intervention. Patients must be informed about the relative benefits and risks associated with each of these treatments. As a guideline, PNL, followed by shock wave lithotripsy or repeat percutaneous procedures as warranted, should be utilized for most standard patients with struvite staghorn calculi. The report also summarizes the literature reviewed by the panel (in chart form), describes the methodology used, and includes a list of references and a subject index. 3 appendices. 15 figures. 19 tables. 151 references.

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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 “kidney stones” (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 11132 160 131 13 0 11436

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 “kidney stones” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

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

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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/.

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

21

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story.

22 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

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

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·

Other guides Anatomy http://www.nlm.nih.gov/medlineplus/anatomy.html Bladder Diseases http://www.nlm.nih.gov/medlineplus/bladderdiseases.html Interstitial Cystitis http://www.nlm.nih.gov/medlineplus/interstitialcystitis.html Kidney Diseases http://www.nlm.nih.gov/medlineplus/kidneydiseases.html Kidney Failure and Dialysis http://www.nlm.nih.gov/medlineplus/kidneyfailureanddialysis.html Kidney Stones http://www.nlm.nih.gov/medlineplus/kidneystones.html Kidney Stones http://www.nlm.nih.gov/medlineplus/tutorials/kidneystonesloader.html Urinary Tract Infections http://www.nlm.nih.gov/medlineplus/urinarytractinfections.html

Within the health topic page dedicated to kidney stones, the following was listed: ·

General/Overviews Kidney Stones http://www.nlm.nih.gov/medlineplus/tutorials/kidneystonesloader.html Kidney Stones Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=DS00282

·

Diagnosis/Symptoms Abdominal Pain, Acute: Self-Care Flowcharts Source: American Academy of Family Physicians http://familydoctor.org/flowcharts/527.html Calcium Test Source: American Association for Clinical Chemistry http://www.labtestsonline.org/understanding/analytes/calcium/test.html Lower Back Pain: Self-Care Flowcharts Source: American Academy of Family Physicians http://familydoctor.org/flowcharts/531.html Ultrasound-Abdomen Source: American College of Radiology, Radiological Society of North America http://www.radiologyinfo.org/content/ultrasound-abdomen.htm Uric Acid Test Source: American Association for Clinical Chemistry http://www.labtestsonline.org/understanding/analytes/uric_acid/test.html

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Urination Problems: Self-Care Flowcharts Source: American Academy of Family Physicians http://familydoctor.org/flowcharts/535.html ·

Treatment How Are Kidney Stones Treated? Source: American Foundation for Urologic Disease http://www.afud.org/education/kidney/kidneystones1.asp Percutaneous Nephrolithotomy: What Are the Risks? Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=AN00665

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Nutrition Oxalate Kidney Stones and Diet Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=AN00261

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Specific Conditions/Aspects About Primary Hyperoxaluria Source: Oxalosis and Hyperoxaluria Foundation http://www.ohf.org/about_ph.html

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From the National Institutes of Health What Are Kidney Stones? http://kidney.niddk.nih.gov/kudiseases/pubs/stones_ez/index.htm

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Men Women Showing Increasing Incidence of Kidney Stones-Diet Changes May be to Blame Source: National Kidney Foundation http://www.kidney.org/meetings/kidneymonth/htdietchange.cfm

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Organizations American Foundation for Urologic Disease http://www.afud.org/ National Institute of Diabetes and Digestive and Kidney Diseases http://www.niddk.nih.gov/ National Kidney and Urologic Diseases Information Clearinghouse Source: National Institute of Diabetes and Digestive and Kidney Diseases http://kidney.niddk.nih.gov/ National Kidney Foundation http://www.kidney.org/ Oxalosis and Hyperoxaluria Foundation http://www.ohf.org/

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Research Studies Show Amount and Choice of Beverages Can Affect Risk for Kidney Stones Source: National Kidney Foundation http://www.kidney.org/meetings/kidneymonth/htbeverages.cfm

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Statistics Kidney and Urologic Disease Statistics for the United States Source: National Kidney and Urologic Diseases Information Clearinghouse http://kidney.niddk.nih.gov/kudiseases/pubs/kustats/index.htm

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Women Women Showing Increasing Incidence of Kidney Stones-Diet Changes May be to Blame Source: National Kidney Foundation http://www.kidney.org/meetings/kidneymonth/htdietchange.cfm

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

Kidney Stone Diet: Cystine Stones Source: Camp Hill, PA: Chek-Med Systems, Inc. 199x. [4 p.]. Contact: Available from Chek-Med Systems, Inc. 200 Grandview Avenue, Camp Hill, PA 17011-1706. (800) 451-5797 or (717) 761-0216. Fax (717) 761-0216. PRICE: $0.75 each; plus shipping and handling; bulk copies available. Booklets must be ordered in quantities of 10. Order number: D27. Summary: A small number of people develop cystine kidney stones, as the result of an inherited disease called cystinuria. This booklet outlines the recommended diet for people who have been treated for cystine stones and want to prevent recurrence of the problem. Treatment to prevent cystine stones is usually with medication, which is used to raise the pH of urine and therefore improve the solubility of cystine and prevent stone formation. Dietary changes may help the medication raise and maintain the

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alkaline level of urine. The booklet outlines four strategies that include increasing fluid intake, incorporating alkaline-ash foods in the diet, monitoring protein intake (not exceeding the RDA for protein), and restricting sodium intake to 2000 to 3000 mg per day. The booklet concludes with a chart that lists foods that produce acid ash or alkaline ash, and foods that are neutral; foods are listed in categories of meats, fats, milk, starches, vegetables, fruits, sweets, and beverages. Blank space is provided for the patient or dietitian to write special instructions. 1 table. ·

Kidney Stone Diet: Uric Acid Stones Source: Camp Hill, PA: Chek-Med Systems, Inc. 199x. [4 p.]. Contact: Available from Chek-Med Systems, Inc. 200 Grandview Avenue, Camp Hill, PA 17011-1706. (800) 451-5797 or (717) 761-0216. Fax (717) 761-0216. PRICE: $0.75 each; plus shipping and handling; bulk copies available. Booklets must be ordered in quantities of 10. Order number: D28. Summary: About 5 percent of all kidney stones are uric acid or urate kidney stones. Certain diseases, such as gout, can lead to the formation of uric acid kidney stones. Normally, urine is slightly acid. The most important factor leading to the formation of uric acid stones is the production of urine that is too acid. This booklet outlines the recommended diet for people who have been treated for uric acid stones and want to prevent recurrence of the problem. Treatment to prevent uric acid stones is usually with medication which is used to raise the pH of urine (make it less acidic) and prevent stone formation. Dietary changes may help the medication raise and maintain the alkaline level of urine. The booklet outlines five strategies that include increasing fluid intake, incorporating alkaline-ash foods in the diet, monitoring protein intake (not exceeding the RDA for protein and sometimes limiting foods high in purines), avoiding certain medications (such as aspirin), and limiting the use of alcohol (which increases uric acid production). One chart lists foods with high, moderate, and low content of purine. Another chart lists foods that produce acid ash or alkaline ash, and foods that are neutral; foods are listed in categories of meats, fats, milk, starches, vegetables, fruits, sweets, and beverages. A final chart offers a sample menu for patients with uric acid stone formation tendencies. 3 tables.

·

Kidney Stones: Basic Facts About Kidney Stones. What Every Individual Should Know Source: Baltimore, MD: American Foundation for Urologic Disease. 200x. 16 p. Contact: Available from American Foundation for Urologic Disease (AFUD). 1128 North Charles Street, Baltimore, MD 21201. (800) 242-2383. Website: www.afud.org. PRICE: $13.00 for pack of 50; plus shipping and handling. Summary: Each year, roughly 500,000 Americans have kidney stones (nephrolithiasis) and over one third of those patients have to be hospitalized. This health education brochure describes kidney stones, risk factors for getting kidney stones, the tests that are used to diagnose problems with kidney stones, treatment options, and prevention strategies. The brochure begins with a six item pretest to determine the reader's knowledge of kidney stones. Early symptoms of kidney stones include an ache in the back and side, burning during urination, blood in the urine, frequent urge to urinate, nausea and vomiting, and a flank or lower abdomen that is sensitive (painful) to the touch. Kidney stones usually form because there is a breakdown in the balance of liquids and dissolved solids in the urine. Kidney stones tend to occur more frequently in men between the ages of 20 and 60 years old with a family history of stone formation.

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The brochure defines and describes different types of stones, including calcium oxalate and phosphate, struvite (infection), uric acid, and cystine stones. Diagnostic tests can include x ray, ultrasound, and intravenous pyelogram (an x ray of the urinary system, assisted by an injection of dye). Treatment options focus on lithotripsy, which uses shock waves to disintegrate the kidney stone into fragments small enough to pass out of the body in the urine. Prevention strategies include drinking plenty of fluids, monitoring the color of one's urine (should be pale yellow), dietary modifications, and the use of some medications. The brochure concludes with a glossary of terms used in the text and the answers to the pretest. 2 figures. 1 table. ·

About Kidney Stones Source: New York, NY: National Kidney Foundation, Inc. 1990. 4 p. Contact: National Kidney Foundation, Inc. 30 East 33rd Street, New York, NY 10016. (800) 622-9010. PRICE: Single Copy Free. Order No. 08-47. Summary: The cause, mechanism and clinical management of kidney stones are better understood today due to scientific progress. This leaflet defines and describes the mechanisms and causes of stone formation, the symptoms due to pressure of a stone, diagnosis and treatment. A diagram shows the location of stones in the urinary tract. The formation of a kidney stone and the resulting obstruction may be related to age, sex, activity, climate, water intake, metabolic disturbances, misuse of medications, urinary infection and stagnation. A new treatment, extracorporeal shock wave lithotripsy (ESWL) is an example of a non-surgical technique being used to remove kidney stones. There are effective treatments that can possibly prevent stone formation in all situations where stones are formed.

·

Lithotripsy: For Treatment of Kidney Stones Source: San Bruno, CA: StayWell Company. 2000. [2 p.]. Contact: Available from StayWell Company. Order Department, 1100 Grundy Lane, San Bruno, CA 94066-9821. (800) 333-3032. Fax (650) 244-4512. E-mail: [email protected]. Website: www.staywell.com. PRICE: $20.00 for pack of 50; plus shipping and handling. Summary: The function of the kidneys is to filter chemicals that the body does not need out of the blood. Under certain conditions, chemicals in the urine may form crystals, which build up and stick together to form kidney stones (lithiasis). Kidney stones may block the flow of urine through the urinary tract, causing severe pain. This patient education brochure describes kidney stones and the use of lithotripsy (extracorporeal shock wave lithotripsy, or ESWL) to treat them. Lithotripsy is a method of crushing a kidney stone while it is still inside the patient's body. During lithotripsy, carefully directed shock waves pass harmlessly through the patient's body and hit the stone, causing it to crumble into sandlike particles. These particles can then pass easily out of the urinary tract. Complications of lithotripsy are rare but can include infection, bleeding of the kidney, bruising of the kidney or skin, obstruction of the ureter (the passageway from the kidney to the bladder), or failure of the stone to fragment. The brochure describes what patients can expect during and after the procedure and reminds readers when to contact the physician. The brochure concludes with a section outlining the recommended steps for preventing future kidney stones, including drinking lots of water, following the diet recommended by the health care provider, taking prescribed medications, and attending regular followup visits. The brochure is illustrated with full color line drawings. 7 figures.

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·

Kidney Stones: Symptoms and Treatments Source: Cleveland, OH: Kidney Foundation of Ohio, Inc. 199x. 4 p. Contact: Available from Kidney Foundation of Ohio, Inc. 11400 Euclid Avenue, Suite 280, Cleveland, OH 44106. (216) 231-9004. PRICE: Single copy free, additional copies $0.60 each. Summary: This brochure discusses the symptoms and treatments for kidney stones. Topics include a definition of kidney stones, what causes kidney stone formation, symptoms, diagnosis, and the use of extracorporeal shock wave lithotripsy (ESWL). Most of the brochure focuses on ESWL, including a description of the treatment, the use of anesthesia and hospitalization, what to expect after the procedure, the possible complications of ESWL, patient selection, the success rate of ESWL, and costs and insurance issues.

·

Kidney Stones: What You Need to Know Source: Baltimore, MD: Kidney Health Fund. 1996. 12 p. Contact: Available from American Foundation for Urologic Disease. 1126 North Charles Street, Baltimore, MD 21201. (800) 242-2383 or (410) 468-1800. Fax (410) 468-1808. Website: www.afud.org. PRICE: Single copy free. Summary: This brochure educates readers about kidney stones. The brochure starts with a quiz of the reader's knowledge (inside the front cover) and then discusses the symptoms of kidney stones, the urinary system and how it works, the causes of kidney stones, the physical appearance of kidney stones, how kidney stones can damage the kidney, risk factors for developing kidney stones, the different types of stones and their causes (including calcium oxalate, phosphate, struvite, uric acid, and cystine), how kidney stones are diagnosed, treatment choices (primarily lithotripsy), the recurrence of kidney stones, and how to prevent future kidney stones. The brochure concludes with a glossary of terms and the answers to the pre-test. 3 figures. 1 table. (AA-M).

·

Facts About Kidney Stones Source: Rockville, MD: American Kidney Fund. 1997. 4 p. Contact: Available from American Kidney Fund. 6110 Executive Boulevard, Suite 1010, Rockville, MD 20852. (800) 638-8299 or (301) 881-3052. Fax (301) 881-0898. E-mail: [email protected]. Website: http://www.arbon.com/kidney. PRICE: Single copy free; bulk copies available. Summary: This brochure provides basic information for people with kidney stones. As many as 2 million Americans are affected by kidney stones. The brochure discusses what kidney stones are, what they look like, who is affected, symptoms, prevention, and the damage they cause to the kidneys. The brochure also discusses approaches to treating kidney stones, including 'flushing out' the kidney stone with water, using medications to dissolve some kinds of stones, and percutaneous and shock wave lithotripsy.

·

Diet and Kidney Stones Source: New York, NY: National Kidney Foundation, Inc. 1991. 2 p. Contact: Available from National Kidney Foundation, Inc. 30 East 33rd Street, New York, NY 10016. (800) 622-9010. Order number KU-1. PRICE: Single copy free.

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Summary: This fact sheet from the National Kidney Foundation presents a brief overview of diet and kidney stones. Written in a question-and-answer format, the fact sheet includes information on preventing kidney stones through diet, the role of medication in conjunction with diet therapy, the role of calcium in stone formation, the importance of adequate calcium, the role of oxalate in stone formation, fluids and fluid intake, vitamin and mineral supplements, and the activities of the National Kidney Foundation. ·

Kidney Stones (Renal Calculi; Urinary Calculi) Source: in Griffith, H.W. Instructions for Patients. 5th ed. Philadelphia, PA: W.B. Saunders Company. 1994. p. 265. Contact: Available from W.B. Saunders Company. Book Order Fulfillment, 6277 Sea Harbor Drive, Orlando, FL 32887-4430. (800) 545-2522. Fax (800) 874-6418. PRICE: $49.95. ISBN: 0721649300 (English); 0721669972 (Spanish). Summary: This fact sheet on kidney stones is from a compilation of instructions for patients, published in book format. The fact sheet covers a description of the condition, frequent signs and symptoms, causes, risk factors, preventive measures, expected outcome, and possible complications; treatment, including general measures, medication, activity guidelines, and diet; and when to contact one's health care provider. The fact sheet can be photocopied and distributed to patients as a reinforcement of oral instructions and as a teaching tool. The book in which the fact sheet appears is available in English or Spanish.

·

New Techniques for Treating Kidney Stones: Extracorporeal Shock Wave Lithotripsy Source: New York, NY: National Kidney Foundation. 1995. 3 p. Contact: Available from National Kidney Foundation. 30 East 33rd Street, New York, NY 10016. (800) 622-9010. PRICE: Single copy free. Summary: This fact sheet provides basic information about extracorporeal shock wave lithotripsy (ESWL), a treatment that uses high energy shock waves for treating stones in the kidney and ureter. Written in a question and answer format, the fact sheet covers the ESWL treatment; its advantages and disadvantages; what the patient can expect during and after ESWL treatment; complications or side effects; patient selection; success rates; other treatment choices for stone removal, including percutaneous stone removal and ureteroscopic stone removal; the cost of lithotripsy; and preventing kidney stones. The fact sheet concludes with a brief description of the National Kidney Foundation (NKF) and its activities.

·

Kidney Stones in Adults Source: Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH). 2000. 12 p. Contact: Available from National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). 3 Information Way, Bethesda, MD 20892-3580. (800) 891-5390 or (301) 654-4415. Fax (301)634-0716. E-mail: [email protected]. Website: http://www.niddk.nih.gov/health/kidney/nkudic.htm. PRICE: Full-text available online at no charge; single copy free; bulk orders available. Order number: KU-04.

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Summary: This fact sheet reviews the problem of kidney stones (urolithiasis) in adults. A common problem, occurring in an estimated 10 percent of people in the United States, kidney stones will often pass out of the body without any intervention by a physician. Stones that cause lasting symptoms or other complications may be treated by various techniques, most of which do not involve major surgery. Research advances have led to a better understanding of the many factors that promote stone formation. The fact sheet first reviews the anatomy and physiology of the urinary tract and kidneys, then defines a kidney stone as a hard mass developed from crystals that separate from the urine and build up on the inner surfaces of the kidney. Certain foods may promote stone formation in people who are susceptible, and a person with a family history of kidney stones may be more likely to develop stones. Urinary tract infections, kidney disorders such as cystic kidney diseases, and metabolic disorders such as hyperparathyroidism are also linked to stone formation. The fact sheet reviews the symptoms and diagnosis of kidney stones, then describes treatment options, focusing on prevention for people at risk. Treatment options described include drug therapy, surgery, extracorporeal shockwave lithotripsy (ESWL), percutaneous nephrolithotomy, and ureteroscopic stone removal. The fact sheet concludes with a brief list of current research strategies in this area, a list of suggested readings, and prevention points to remember. The fact sheet lists resource organizations for readers who wish to obtain additional information about kidney stones, hyperparathyroidism, and gout. A brief description of the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) is also provided. 6 figures. 5 references. ·

Understanding Kidney Stones: Management for a Lifetime Source: San Bruno CA: Krames Communications. 1999. 16 p. Contact: Available from Krames Communications. Order Department, 1100 Grundy Lane, San Bruno, CA 94066. (800) 333-3032. Fax (650) 244-4512. PRICE: $1.35 each; bulk discounts available. Order number 1261. Summary: This illustrated brochure for patients with kidney stones outlines the symptoms, risk factors, diagnosis, evaluation, treatments, and prevention of kidney stones. Treatments addressed include 'expectant therapy' (the 'wait and see' approach), medications, extracorporeal shock wave lithotripsy (ESWL), and surgery. Recovery and followup are also discussed. The booklet emphasizes preventive techniques, including drinking lots of water. The specific prevention of uric acid stones, cystine stones, and infection stones also is covered.

·

Learning About Kidney Stones and Diet Source: Hamilton, Ontario: St. Joseph's Hospital, Nephrology Program. 1995. 8 p. Contact: Available from Veena Juneja, Renal Dietitian. St. Joseph's Hospital, 50 Charlton Avenue East, Hamilton, Ontario, L8N 4A6, Canada. PRICE: $4.00 per copy plus $2.00 shipping and handling; for 10 or more copies, $3.00 per copy plus shipping and handling. Summary: This patient education booklet gives readers information about the interplay of diet and kidney stones. The booklet defines kidney stones and describes their symptoms, covers diagnosis and treatment of kidney stones, discusses who gets kidney stones, and describes the importance of diet therapy in preventing stones or in preventing a recurrence of stones. The author then discusses five concepts of the diet plan and provides detailed suggestions for each: animal protein, calcium, oxalate, fluids, and salt. The booklet includes numerous charts and blank spaces for the health care

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provider to individualize with the reader's information (such as the results of urine testing). The author encourages readers to eat in moderation and follow healthy eating habits to help control risk factors for kidney stones. 1 figure. 5 tables. ·

Kidney Stones Source: Marietta, GA: GU Logic. 1994. 2 p. Contact: Available from GU Logic. 2470 Windy Hill Road, Suite 108, Marietta, GA 30067. (800) 451-8107. PRICE: $35 for 50 copies. Order Number: GU110. Summary: This patient education brochure describes kidney stones, crystallizations of material formed in the kidney. Written in a question-and-answer format, the brochure defines kidney stones and then discusses who gets them, the symptoms, and treatment options. Treatment options outlined include extracorporeal shock wave lithotripsy (ESWL); urethroscopy; percutaneous methods; and open surgery. The brochure concludes with a section on preventing the recurrence of kidney stones. One figure depicts the basic anatomy of the kidney and urinary tract.

·

What You Should Know About Kidney Stones Source: West Haven, CT: Miles, Inc., Pharmaceutical Division. 1992. 8 p. Contact: Available from Miles, Inc. Pharmaceutical Division. 400 Morgan Lane, West Haven, CT 06516. (800) 468-0894. PRICE: Free. Summary: This patient education brochure, written in question-and-answer format, discusses kidney stones. Topics include the function of the kidneys; a definition of kidney stones; types of stones and what causes them; symptoms of kidney stones; diagnosing kidney stones; and treatment options, including medical treatment, lithotripsy, surgical treatment, and prevention. The brochure concludes with a blank space for the health care provider to individualize patient instructions. 3 figures.

·

Passing a Kidney Stone Source: Patient Care. 33(15): 44. September 30, 1999. Contact: Available from Medical Economics. 5 Paragon Drive, Montvale, NJ 07645. (800) 432-4570. Fax (201) 573-4956. Summary: This patient education fact sheet offers information about passing a kidney stone. Kidney stones are tiny, hard objects, usually made from calcium. Although the pain involved in passing a kidney stone can make them feel large, most kidney stones are as small as a grain of sand. Kidney stones do not do much harm in the kidneys; however, they can cause great pain if they drop from the kidney into the ureter (the tube that brings urine from the kidney to the bladder). Kidney stones can form when the patient does not drink enough fluids; if the urine is yellow, the person is not drinking enough (urine should be almost clear). Stones can also form when there is too much or too little of certain substances in the urine; diet and genes are two of many possible causes. Most of the time, stones pass out on their own in the urine. Most stones pass in a few hours, but some take a few days. The fact sheet describes how to catch the stone by urinating through a fine strainer or coffee filter paper; the stone can then be taken to the physician for testing. This can help the physician decide how best to prevent future stones. If the stone does not pass in a few days, lithotripsy may be needed. The lithotripsy procedure breaks the stones into tiny pieces that will pass more easily. The fact sheet concludes by encouraging readers to drink 10 glasses of water (10 ounces

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each) every day. The fact sheet also leaves blank space for patient notes or physician instructions. 1 figure. ·

Management of Staghorn Kidney Stones: A Patient's Guide Source: Baltimore, MD: American Urological Association, Inc. 1994. 7 p. Contact: Available from Amerian Urological Association, Inc. Health Policy Department, P.O. Box 17274, Baltimore, MD 21203. (410) 727-1100. Fax: (410) 783-1566. PRICE: $14 for packet of 25 for American Urological Association members; $18 for nonmembers. Summary: This publication, written for patients and lay readers, is a summary of the report on the Management of Staghorn Kidney Stones, developed by the American Urological Association and the Nephrolithiasis Clinical Guidelines Panel. Topics include a definition of staghorn kidney stones, complications arising from kidney stones, the choices for treating kidney stones, extracorporeal shock waves, percutaneous nephrolithotomy (PNL), combination treatment, open surgery, and the likely benefits and risks of each treatment option. One chart summarizes treatments and their estimated outcomes. The remainder of the text explains and discusses each of the treatment outcomes. The document concludes with a list of questions to ask a doctor and a brief glossary of terms.

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

Kidney Stones Fact Sheet Summary: The information on this site is intended to educate lay persons about kidney stones: what causes kidney stones, who gets them, what kinds of treatments are available, and how kidney stones can be Source: American Foundation for Urologic Disease http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=3966

·

Kidney Stones in Adults Summary: Kidney stones are one of the most common disorders of the urinary tract. More than 1 million cases of kidney stones were diagnosed in 1985. Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=830

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·

What Are Kidney Stones Summary: This easy-to-read consumer health information document provides basic need-to-know information about kidney stones. Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=3970 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 kidney stones. 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: ·

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

·

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

·

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

·

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

·

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

·

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

·

WebMDÒHealth: http://my.webmd.com/health_topics

Associations and Kidney Stones The following is a list of associations that provide information on and resources relating to kidney stones: ·

American Foundation for Urologic Disease Telephone: (410) 468-1800 Toll-free: (800) 242-2383 Fax: (410) 468-1808 Email: [email protected] Web Site: http://www.afud.org

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Background: The American Foundation for Urologic Disease (AFUD) is a national notfor-profit health organization dedicated to the prevention and cure of urologic diseases through the expansion of medical research and the education of health care professionals and the public. Such urologic diseases include bladder cancer, urinary incontinence, urinary tract disorders, interstitial cystitis, kidney stones, benign prostatic hyperplasia, prostate cancer, prostatitis, and sexual dysfunction. Established in 1987, the Foundation sponsors a Research Scholars Program to encourage physicians to conduct research into urologic diseases, provides appropriate referrals, engages in patient advocacy, and offers networking services. AFUD also offers a variety of educational materials including brochures, pamphlets, and a quarterly magazine entitled 'Family Urology.'. Relevant area(s) of interest: Kidney Stones ·

Cystinuria Support Network Telephone: (425) 868-2996 Fax: (425) 897-0675 Email: [email protected] Web Site: http://www.cystinuria.com Background: The Cystinuria Support Network is a national self-help organization that functions as a mutual aid and support network for people with cystinuria and their caregivers. Cystinuria is a rare genetic disorder characterized by excessive urinary excretion of the amino acid cystine and other amino acids, and the formation of urinary cystine kidney stones.. The network was developed to provide a central resource to encourage mutual support and provide practical advice to affected individuals. The organization allows people to come together with their own unique strengths, hopes, and concerns to offer support and understanding to one another. Established in 1994, the Cystinuria Support Network publishes a periodic newsletter with input from group participants and medical professionals.

·

National Kidney Foundation Telephone: (212) 889-2210 Toll-free: (800) 622-9010 Fax: (212) 689-9261 Web Site: http://www.kidney.org Background: Established in 1950, the National Kidney Foundation is a voluntary notfor-profit organization dedicated to preventing kidney and urinary tract diseases, improving the health and well-being of individuals and families affected by these diseases, and increasing the availability of organs for transplantation. The Foundation is committed to gaining adequate support for research and research training; fostering continuing education of health care professionals; expanding and developing patient services and community resources; increasing public awareness of kidney diseases; monitoring health policy development; and increasing fund-raising for new programs and research. In addition, the Foundation supports and promotes medical research into the causes, prevention, and treatment of kidney diseases. A wide variety of educational materials is produced and distributed by the Foundation. These materials are listed in a booklet entitled Public and Professional Education Materials. Relevant area(s) of interest: Kidney Stones

138 Kidney Stones

·

Oxalosis and Hyperoxaluria Foundation Telephone: (212) 777-0470 Fax: (212) 777-0471 Email: [email protected] Web Site: http://www.ohf.org/ Background: The Oxalosis and Hyperoxaluria Foundation is a national voluntary organization established to inform the public, especially affected individuals, families, physicians, and medical professionals about hyperoxaluria and related conditions such as oxalosis and calcium-oxalate kidney stones.. The foundation endeavors to provide a support network to those affected by hyperoxaluria. Founded in 1989, it supports and encourages research to find a cure for hyperoxaluria. The organization publishes educational materials including a summer camp list, reprints of medical journal articles, a patient resource list, and brochures entitled 'Understanding Oxalosis' and 'Hyperoxaluria and Low Oxalate Diet List.' The organization also supports a toll-free telebraille number ([800] 833-6385).

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

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 kidney stones. 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 “kidney stones” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given

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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 “kidney stones”. 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 “kidney stones” (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 “kidney stones” (or a synonym) into the search box, and click “Submit Query.”

141

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

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

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

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

23

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

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

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

·

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

·

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

·

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

·

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

·

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

·

California: Gateway Health Library (Sutter Gould Medical Foundation)

·

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

·

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

·

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

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

·

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

·

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

·

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

·

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

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

·

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

·

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

24

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

Finding Medical Libraries 143

·

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

·

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

·

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

·

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

·

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

·

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

·

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

·

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

·

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

·

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

·

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

·

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

·

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

·

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

·

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

·

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

·

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

·

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

·

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

·

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

144 Kidney Stones

·

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 145

·

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

·

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

·

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

·

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

·

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

·

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

·

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

·

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

·

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

·

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

·

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

·

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

·

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

·

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

·

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

·

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

·

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

·

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

·

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

·

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

146 Kidney Stones

·

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

·

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

·

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

·

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

147

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

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

·

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

·

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

·

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

·

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

·

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

·

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

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

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

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

·

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

·

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

·

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

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KIDNEY STONES 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] Acetylgalactosamine: The N-acetyl derivative of galactosamine. [NIH] Acetylglucosamine: The N-acetyl derivative of glucosamine. [NIH] Acidity: The quality of being acid or sour; containing acid (hydrogen ions). [EU] Acidosis: A pathologic condition resulting from accumulation of acid or depletion of the alkaline reserve (bicarbonate content) in the blood and body tissues, and characterized by an increase in hydrogen ion concentration. [EU] Acoustic: Having to do with sound or hearing. [NIH] Acrylonitrile: A highly poisonous compound used widely in the manufacture of plastics, adhesives and synthetic rubber. [NIH] Adaptation: 1. The adjustment of an organism to its environment, or the process by which it enhances such fitness. 2. The normal ability of the eye to adjust itself to variations in the intensity of light; the adjustment to such variations. 3. The decline in the frequency of firing of a neuron, particularly of a receptor, under conditions of constant stimulation. 4. In dentistry, (a) the proper fitting of a denture, (b) the degree of proximity and interlocking of restorative material to a tooth preparation, (c) the exact adjustment of bands to teeth. 5. In microbiology, the adjustment of bacterial physiology to a new environment. [EU] Adenine: A purine base and a fundamental unit of adenine nucleotides. [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] Adsorption: The condensation of gases, liquids, or dissolved substances on the surfaces of solids. It includes adsorptive phenomena of bacteria and viruses as well as of tissues treated with exogenous drugs and chemicals. [NIH] Adsorptive: It captures volatile compounds by binding them to agents such as activated carbon or adsorptive resins. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Aeroembolism: Joint pains, respiratory distress, and central nervous system symptoms which may follow decompression after exposure to air or other gas mixture at a pressure greater than the normal atmospheric pressure. [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

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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] Affinity Chromatography: In affinity chromatography, a ligand attached to a column binds specifically to the molecule to be purified. [NIH] Agar: A complex sulfated polymer of galactose units, extracted from Gelidium cartilagineum, Gracilaria confervoides, and related red algae. It is used as a gel in the preparation of solid culture media for microorganisms, as a bulk laxative, in making emulsions, and as a supporting medium for immunodiffusion and immunoelectrophoresis. [NIH]

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] Alertness: A state of readiness to detect and respond to certain specified small changes occurring at random intervals in the environment. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alkaline: Having the reactions of an alkali. [EU] Alkaline Phosphatase: An enzyme that catalyzes the conversion of an orthophosphoric monoester and water to an alcohol and orthophosphate. EC 3.1.3.1. [NIH] Alleles: Mutually exclusive forms of the same gene, occupying the same locus on homologous chromosomes, and governing the same biochemical and developmental process. [NIH] Allograft: An organ or tissue transplant between two humans. [NIH] Allopurinol: A xanthine oxidase inhibitor that decreases uric acid production. [NIH] Alpha-helix: One of the secondary element of protein. [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] 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

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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 is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Ammonia: A colorless alkaline gas. It is formed in the body during decomposition of organic materials during a large number of metabolically important reactions. [NIH] Ampulla: A sac-like enlargement of a canal or duct. [NIH] Amyloid: A general term for a variety of different proteins that accumulate as extracellular fibrils of 7-10 nm and have common structural features, including a beta-pleated sheet conformation and the ability to bind such dyes as Congo red and thioflavine (Kandel, Schwartz, and Jessel, Principles of Neural Science, 3rd ed). [NIH] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analogous: Resembling or similar in some respects, as in function or appearance, but not in origin or development;. [EU] Analytes: A component of a test sample the presence of which has to be demonstrated. The term "analyte" includes where appropriate formed from the analyte during the analyses. [NIH]

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] Angiotensin converting enzyme inhibitor: A drug used to decrease pressure inside blood vessels. [NIH] Animal model: An animal with a disease either the same as or like a disease in humans. Animal models are used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Anionic: Pertaining to or containing an anion. [EU] Anions: Negatively charged atoms, radicals or groups of atoms which travel to the anode or positive pole during electrolysis. [NIH] Anisotropy: A physical property showing different values in relation to the direction in or along which the measurement is made. The physical property may be with regard to thermal or electric conductivity or light refraction. In crystallography, it describes crystals whose index of refraction varies with the direction of the incident light. It is also called acolotropy and colotropy. The opposite of anisotropy is isotropy wherein the same values characterize the object when measured along axes in all directions. [NIH] Annealing: The spontaneous alignment of two single DNA strands to form a double helix. [NIH]

Antagonism: Interference with, or inhibition of, the growth of a living organism by another living organism, due either to creation of unfavorable conditions (e. g. exhaustion of food supplies) or to production of a specific antibiotic substance (e. g. penicillin). [NIH] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms.

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[NIH]

Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticoagulant: A drug that helps prevent blood clots from forming. Also called a blood thinner. [NIH] Antidiuretic: Suppressing the rate of urine formation. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Anti-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] Antioxidant: A substance that prevents damage caused by free radicals. Free radicals are highly reactive chemicals that often contain oxygen. They are produced when molecules are split to give products that have unpaired electrons. This process is called oxidation. [NIH] Anuria: Inability to form or excrete urine. [NIH] Aorta: The main trunk of the systemic arteries. [NIH] Aqueous: Having to do with water. [NIH] Arachidonic Acid: An unsaturated, essential fatty acid. It is found in animal and human fat as well as in the liver, brain, and glandular organs, and is a constituent of animal phosphatides. It is formed by the synthesis from dietary linoleic acid and is a precursor in the biosynthesis of prostaglandins, thromboxanes, and leukotrienes. [NIH] Arginine: An essential amino acid that is physiologically active in the L-form. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Ascorbic Acid: A six carbon compound related to glucose. It is found naturally in citrus fruits and many vegetables. Ascorbic acid is an essential nutrient in human diets, and necessary to maintain connective tissue and bone. Its biologically active form, vitamin C, functions as a reducing agent and coenzyme in several metabolic pathways. Vitamin C is considered an antioxidant. [NIH] Aspirin: A drug that reduces pain, fever, inflammation, and blood clotting. Aspirin belongs to the family of drugs called nonsteroidal anti-inflammatory agents. It is also being studied in cancer prevention. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the

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biological or pharmacological potency of a drug. [EU] Attenuation: Reduction of transmitted sound energy or its electrical equivalent. [NIH] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Back Pain: Acute or chronic pain located in the posterior regions of the trunk, including the thoracic, lumbar, sacral, or adjacent regions. [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] Bacterial Physiology: Physiological processes and activities of bacteria. [NIH] Bacterial Proteins: Proteins found in any species of bacterium. [NIH] Bacteriophage: A virus whose host is a bacterial cell; A virus that exclusively infects bacteria. It generally has a protein coat surrounding the genome (DNA or RNA). One of the coliphages most extensively studied is the lambda phage, which is also one of the most important. [NIH] Bacterium: Microscopic organism which may have a spherical, rod-like, or spiral unicellular or non-cellular body. Bacteria usually reproduce through asexual processes. [NIH] Bacteriuria: The presence of bacteria in the urine with or without consequent urinary tract infection. Since bacteriuria is a clinical entity, the term does not preclude the use of urine/microbiology for technical discussions on the isolation and segregation of bacteria in the urine. [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] Beer: An alcoholic beverage usually made from malted cereal grain (as barley), flavored with hops, and brewed by slow fermentation. [NIH] Bends: The form of aeroembolism that is marked by intense pain in muscles and joints due to formation of gas bubbles in the tissues. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Benign prostatic hyperplasia: A benign (noncancerous) condition in which an overgrowth of prostate tissue pushes against the urethra and the bladder, blocking the flow of urine. Also called benign prostatic hypertrophy or BPH. [NIH] Beta 2-Microglobulin: An 11 kDa protein associated with the outer membrane of many cells including lymphocytes. It is the small subunit of the MHC class I molecule. Association with beta 2-microglobulin is generally required for the transport of class I heavy chains from the endoplasmic reticulum to the cell surface. Beta 2-microglobulin is present in small amounts in serum, csf, and urine of normal people, and to a much greater degree in the urine and plasma of patients with tubular proteinemia, renal failure, or kidney transplants. [NIH] Beta-pleated: Particular three-dimensional pattern of amyloidoses. [NIH] Beta-sheet: Two or more parallel or anti-parallel strands are arranged in rows. [NIH]

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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 duct: A tube through which bile passes in and out of the liver. [NIH] Biliary: Having to do with the liver, bile ducts, and/or gallbladder. [NIH] Biliary Tract: The gallbladder and its ducts. [NIH] Bilirubin: A bile pigment that is a degradation product of heme. [NIH] Binding Sites: The reactive parts of a macromolecule that directly participate in its specific combination with another molecule. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Bioengineering: The application of engineering principles to the solution of biological problems, for example, remote-handling devices, life-support systems, controls, and displays. [NIH] Biomolecular: A scientific field at the interface between advanced computing and biotechnology. [NIH] Biopolymers: Polymers, such as proteins, DNA, RNA, or polysaccharides formed by any living organism. [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] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood Glucose: Glucose in blood. [NIH] Blood 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 urea: A waste product in the blood that comes from the breakdown of food protein. The kidneys filter blood to remove urea. As kidney function decreases, the BUN level increases. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Body Regions: Anatomical areas of the body. [NIH] Bone Development: Gross development of bones from fetus to adult. It includes osteogenesis, which is restricted to formation and development of bone from the undifferentiated cells of the germ layers of the embryo. It does not include osseointegration.

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[NIH]

Bone scan: A technique to create images of bones on a computer screen or on film. A small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it collects in the bones and is detected by a scanner. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Brain Diseases: Pathologic conditions affecting the brain, which is composed of the intracranial components of the central nervous system. This includes (but is not limited to) the cerebral cortex; intracranial white matter; basal ganglia; thalamus; hypothalamus; brain stem; and cerebellum. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

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] Caffeine: A methylxanthine naturally occurring in some beverages and also used as a pharmacological agent. Caffeine's most notable pharmacological effect is as a central nervous system stimulant, increasing alertness and producing agitation. It also relaxes smooth muscle, stimulates cardiac muscle, stimulates diuresis, and appears to be useful in the treatment of some types of headache. Several cellular actions of caffeine have been observed, but it is not entirely clear how each contributes to its pharmacological profile. Among the most important are inhibition of cyclic nucleotide phosphodiesterases, antagonism of adenosine receptors, and modulation of intracellular calcium handling. [NIH] Calcification: Deposits of calcium in the tissues of the breast. Calcification in the breast can be seen on a mammogram, but cannot be detected by touch. There are two types of breast calcification, macrocalcification and microcalcification. Macrocalcifications are large deposits and are usually not related to cancer. Microcalcifications are specks of calcium that may be found in an area of rapidly dividing cells. Many microcalcifications clustered together may be a sign of cancer. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Calcium Carbonate: Carbonic acid calcium salt (CaCO3). An odorless, tasteless powder or crystal that occurs in nature. It is used therapeutically as a phosphate buffer in hemodialysis patients and as a calcium supplement. [NIH] Calcium Oxalate: The calcium salt of oxalic acid, occurring in the urine as crystals and in certain calculi. [NIH] Calcium, Dietary: Calcium compounds used as food supplements or in food to supply the body with calcium. Dietary calcium is needed during growth for bone development and for maintenance of skeletal integrity later in life to prevent osteoporosis. [NIH] Calculi: An abnormal concretion occurring mostly in the urinary and biliary tracts, usually composed of mineral salts. Also called stones. [NIH] Calculus I: An abnormal concretion occurring within the animal body and usually composed of mineral salts. [EU]

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Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Carbonate Dehydratase: A zinc-containing enzyme of erythrocytes with molecular weight of 30 kD. It is among the most active of known enzymes and catalyzes the reversible hydration of carbon dioxide, which is significant in the transport of CO2 from the tissues to the lungs. The enzyme is inhibited by acetazolamide. EC 4.2.1.1. [NIH] Carbonic Anhydrase Inhibitors: A class of compounds that reduces the secretion of H+ ions by the proximal kidney tubule through inhibition of carbonic anhydrase (carbonate dehydratase). [NIH] Carcinogenic: Producing carcinoma. [EU] Cardiac: Having to do with the heart. [NIH] Cardiology: The study of the heart, its physiology, and its functions. [NIH] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cardiovascular disease: Any abnormal condition characterized by dysfunction of the heart and blood vessels. CVD includes atherosclerosis (especially coronary heart disease, which can lead to heart attacks), cerebrovascular disease (e.g., stroke), and hypertension (high blood pressure). [NIH] Carpal Tunnel Syndrome: A median nerve injury inside the carpal tunnel that results in symptoms of pain, numbness, tingling, clumsiness, and a lack of sweating, which can be caused by work with certain hand and wrist postures. [NIH] Catheter: A flexible tube used to deliver fluids into or withdraw fluids from the body. [NIH] Cations: Postively charged atoms, radicals or groups of atoms which travel to the cathode or negative pole during electrolysis. [NIH] Cecum: The beginning of the large intestine. The cecum is connected to the lower part of the small intestine, called the ileum. [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 Physiology: Characteristics and physiological processes of cells from cell division to cell death. [NIH] Cellobiose: A disaccharide consisting of two glucose units in beta (1-4) glycosidic linkage. Obtained from the partial hydrolysis of cellulose. [NIH] Cellulose: A polysaccharide with glucose units linked as in cellobiose. It is the chief constituent of plant fibers, cotton being the purest natural form of the substance. As a raw material, it forms the basis for many derivatives used in chromatography, ion exchange materials, explosives manufacturing, and pharmaceutical preparations. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH]

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Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] Chest Pain: Pressure, burning, or numbness in the chest. [NIH] Chimeras: Organism that contains a mixture of genetically different cells. [NIH] Chloride Channels: Cell membrane glycoproteins selective for chloride ions. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic 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] Citrus: Any tree or shrub of the Rue family or the fruit of these plants. [NIH] Clinical Medicine: The study and practice of medicine by direct examination of the patient. [NIH]

Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Clone: The term "clone" has acquired a new meaning. It is applied specifically to the bits of inserted foreign DNA in the hybrid molecules of the population. Each inserted segment originally resided in the DNA of a complex genome amid millions of other DNA segment. [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] Codon: A set of three nucleotides in a protein coding sequence that specifies individual amino acids or a termination signal (codon, terminator). Most codons are universal, but some organisms do not produce the transfer RNAs (RNA, transfer) complementary to all codons. These codons are referred to as unassigned codons (codons, nonsense). [NIH] Coenzyme: An organic nonprotein molecule, frequently a phosphorylated derivative of a water-soluble vitamin, that binds with the protein molecule (apoenzyme) to form the active enzyme (holoenzyme). [EU] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Cohort Studies: Studies in which subsets of a defined population are identified. These groups may or may not be exposed to factors hypothesized to influence the probability of the occurrence of a particular disease or other outcome. Cohorts are defined populations which, as a whole, are followed in an attempt to determine distinguishing subgroup characteristics. [NIH] Colic: Paroxysms of pain. This condition usually occurs in the abdominal region but may occur in other body regions as well. [NIH] Colitis: Inflammation of the colon. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is

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differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Collapse: 1. A state of extreme prostration and depression, with failure of circulation. 2. Abnormal falling in of the walls of any part of organ. [EU] Colloidal: Of the nature of a colloid. [EU] 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] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] 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] 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,

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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] 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] Cone: One of the special retinal receptor elements which are presumed to be primarily concerned with perception of light and color stimuli when the eye is adapted to light. [NIH] Confounding: Extraneous variables resulting in outcome effects that obscure or exaggerate the "true" effect of an intervention. [NIH] Conjunctiva: The mucous membrane that lines the inner surface of the eyelids and the anterior part of the sclera. [NIH] Conjunctivitis: Inflammation of the conjunctiva, generally consisting of conjunctival hyperaemia associated with a discharge. [EU] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Constriction: The act of constricting. [NIH] Constriction, Pathologic: The condition of an anatomical structure's being constricted beyond normal dimensions. [NIH] Consultation: A deliberation between two or more physicians concerning the diagnosis and the proper method of treatment in a case. [NIH] Consumption: Pulmonary tuberculosis. [NIH] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Contrast Media: Substances used in radiography that allow visualization of certain tissues. [NIH]

Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works. [NIH] Cor: The muscular organ that maintains the circulation of the blood. c. adiposum a heart that has undergone fatty degeneration or that has an accumulation of fat around it; called also fat or fatty, heart. c. arteriosum the left side of the heart, so called because it contains oxygenated (arterial) blood. c. biloculare a congenital anomaly characterized by failure of formation of the atrial and ventricular septums, the heart having only two chambers, a single atrium and a single ventricle, and a common atrioventricular valve. c. bovinum (L. 'ox heart') a greatly enlarged heart due to a hypertrophied left ventricle; called also c. taurinum and bucardia. c. dextrum (L. 'right heart') the right atrium and ventricle. c. hirsutum, c. villosum. c. mobile (obs.) an abnormally movable heart. c. pendulum a heart so movable that it seems to be hanging by the great blood vessels. c. pseudotriloculare biatriatum a

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congenital cardiac anomaly in which the heart functions as a three-chambered heart because of tricuspid atresia, the right ventricle being extremely small or rudimentary and the right atrium greatly dilated. Blood passes from the right to the left atrium and thence disease due to pulmonary hypertension secondary to disease of the lung, or its blood vessels, with hypertrophy of the right ventricle. [EU] 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] 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] Creatinine: A compound that is excreted from the body in urine. Creatinine levels are measured to monitor kidney function. [NIH] Criterion: A standard by which something may be judged. [EU] Cryoprotective: Any substance added to a living tissue for improving its survival during frozen preservation. [NIH] Cryoprotective Agents: Substances that provide protection against the harmful effects of freezing temperatures. [NIH] Crystallization: The formation of crystals; conversion to a crystalline form. [EU] Crystalluria: The excretion of crystals in the urine, producing renal irritation. [EU] CSF: Cerebrospinal fluid. The fluid flowing around the brain and spinal cord. CSF is produced in the ventricles of the brain. [NIH] Cultured cells: Animal or human cells that are grown in the laboratory. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] 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] Cystine: A covalently linked dimeric nonessential amino acid formed by the oxidation of cysteine. Two molecules of cysteine are joined together by a disulfide bridge to form cystine. [NIH]

Cystine stone: A rare form of kidney stone consisting of the amino acid cystine. [NIH] Cystinuria: An inherited abnormality of renal tubular transport of dibasic amino acids leading to massive urinary excretion of cystine, lysine, arginine, and ornithine. [NIH] Cystitis: Inflammation of the urinary bladder. [EU] Cytotoxic: Cell-killing. [NIH] Dairy Products: Raw and processed or manufactured milk and milk-derived products. These are usually from cows (bovine) but are also from goats, sheep, reindeer, and water

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buffalo. [NIH] Deamination: The removal of an amino group (NH2) from a chemical compound. [NIH] Delivery of Health Care: The concept concerned with all aspects of providing and distributing health services to a patient population. [NIH] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Dental Calculus: Abnormal concretion or calcified deposit that forms around the teeth or dental prostheses. [NIH] Dental Caries: Localized destruction of the tooth surface initiated by decalcification of the enamel followed by enzymatic lysis of organic structures and leading to cavity formation. If left unchecked, the cavity may penetrate the enamel and dentin and reach the pulp. The three most prominent theories used to explain the etiology of the disase are that acids produced by bacteria lead to decalcification; that micro-organisms destroy the enamel protein; or that keratolytic micro-organisms produce chelates that lead to decalcification. [NIH]

Deuterium: Deuterium. The stable isotope of hydrogen. It has one neutron and one proton in the nucleus. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diagnostic 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] Dietitian: An expert in nutrition who helps people plan what and how much food to eat. [NIH]

Digestion: The process of breakdown of food for metabolism and use by the body. [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] Dihydroxy: AMPA/Kainate antagonist. [NIH] Dimerization: The process by which two molecules of the same chemical composition form a condensation product or polymer. [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] Disposition: A tendency either physical or mental toward certain diseases. [EU] Dissociation: 1. The act of separating or state of being separated. 2. The separation of a molecule into two or more fragments (atoms, molecules, ions, or free radicals) produced by the absorption of light or thermal energy or by solvation. 3. In psychology, a defense mechanism in which a group of mental processes are segregated from the rest of a person's mental activity in order to avoid emotional distress, as in the dissociative disorders (q.v.), or

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in which an idea or object is segregated from its emotional significance; in the first sense it is roughly equivalent to splitting, in the second, to isolation. 4. A defect of mental integration in which one or more groups of mental processes become separated off from normal consciousness and, thus separated, function as a unitary whole. [EU] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Diuresis: Increased excretion of urine. [EU] Drug Delivery Systems: Systems of administering drugs through controlled delivery so that an optimum amount reaches the target site. Drug delivery systems encompass the carrier, route, and target. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Duodenum: The first part of the small intestine. [NIH] Dyes: Chemical substances that are used to stain and color other materials. The coloring may or may not be permanent. Dyes can also be used as therapeutic agents and test reagents in medicine and scientific research. [NIH] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] 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] 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] Electric Conductivity: The ability of a substrate to allow the passage of electrons. [NIH] Electrode: Component of the pacing system which is at the distal end of the lead. It is the interface with living cardiac tissue across which the stimulus is transmitted. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Empirical: A treatment based on an assumed diagnosis, prior to receiving confirmatory laboratory test results. [NIH] Enamel: A very hard whitish substance which covers the dentine of the anatomical crown of a tooth. [NIH] Endogenous: Produced inside an organism or cell. The opposite is external (exogenous) production. [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] 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] 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, or forces surrounding man which relate to promoting, establishing, and maintaining health.

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[NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelial Cells: Cells that line the inner and outer 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] Esophagus: The muscular tube through which food passes from the throat to the stomach. [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] Ethylene Glycol: A colorless, odorless, viscous dihydroxy alcohol. It has a sweet taste, but is poisonous if ingested. Ethylene glycol is the most important glycol commercially available and is manufactured on a large scale in the United States. It is used as an antifreeze and coolant, in hydraulic fluids, and in the manufacture of low-freezing dynamites and resins. [NIH]

Evacuation: An emptying, as of the bowels. [EU] Excrete: To get rid of waste from the body. [NIH] Exhaustion: The feeling of weariness of mind and body. [NIH] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Expectorant: 1. Promoting the ejection, by spitting, of mucus or other fluids from the lungs and trachea. 2. An agent that promotes the ejection of mucus or exudate from the lungs, bronchi, and trachea; sometimes extended to all remedies that quiet cough (antitussives). [EU]

Extracellular: Outside a cell or cells. [EU] Extracorporeal: Situated or occurring outside the body. [EU] Extraction: The process or act of pulling or drawing out. [EU] Extrarenal: Outside of the kidney. [EU] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] 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]

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Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Fermentation: An enzyme-induced chemical change in organic compounds that takes place in the absence of oxygen. The change usually results in the production of ethanol or lactic acid, and the production of energy. [NIH] Ferritin: An iron-containing protein complex that is formed by a combination of ferric iron with the protein apoferritin. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Filtration: The passage of a liquid through a filter, accomplished by gravity, pressure, or vacuum (suction). [EU] Flatus: Gas passed through the rectum. [NIH] Fluorescence: The property of emitting radiation while being irradiated. The radiation emitted is usually of longer wavelength than that incident or absorbed, e.g., a substance can be irradiated with invisible radiation and emit visible light. X-ray fluorescence is used in diagnosis. [NIH] Flush: Transient, episodic redness of the face and neck caused by certain diseases, ingestion of certain drugs or other substances, heat, emotional factors, or physical exertion. [EU] Flushing: A transient reddening of the face that may be due to fever, certain drugs, exertion, stress, or a disease process. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Free Radicals: Highly reactive molecules with an unsatisfied electron valence pair. Free radicals are produced in both normal and pathological processes. They are proven or suspected agents of tissue damage in a wide variety of circumstances including radiation, damage from environment chemicals, and aging. Natural and pharmacological prevention of free radical damage is being actively investigated. [NIH] Freeze Drying: Method of tissue preparation in which the tissue specimen is frozen and then dehydrated at low temperature in a high vacuum. This method is also used for dehydrating pharmaceutical and food products. [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] 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 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]

Gastrointestinal: Refers to the stomach and intestines. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes

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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 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] Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Genital: Pertaining to the genitalia. [EU] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Giant Cells: Multinucleated masses produced by the fusion of many cells; often associated with viral infections. In AIDS, they are induced when the envelope glycoprotein of the HIV virus binds to the CD4 antigen of uninfected neighboring T4 cells. The resulting syncytium leads to cell death and thus may account for the cytopathic effect of the virus. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glomerular: Pertaining to or of the nature of a glomerulus, especially a renal glomerulus. [EU]

Glomeruli: Plural of glomerulus. [NIH] Glomerulus: A tiny set of looping blood vessels in the nephron where blood is filtered in the kidney. [NIH] Glucocorticoids: A group of corticosteroids that affect carbohydrate metabolism (gluconeogenesis, liver glycogen deposition, elevation of blood sugar), inhibit corticotropin secretion, and possess pronounced anti-inflammatory activity. They also play a role in fat and protein metabolism, maintenance of arterial blood pressure, alteration of the connective tissue response to injury, reduction in the number of circulating lymphocytes, and functioning of the central nervous system. [NIH] Gluconeogenesis: The process by which glucose is formed from a non-carbohydrate source. [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] 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] Glycogen: A sugar stored in the liver and muscles. It releases glucose into the blood when cells need it for energy. Glycogen is the chief source of stored fuel in the body. [NIH] Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Glycosaminoglycans: Heteropolysaccharides which contain an N-acetylated hexosamine in a characteristic repeating disaccharide unit. The repeating structure of each disaccharide involves alternate 1,4- and 1,3-linkages consisting of either N-acetylglucosamine or Nacetylgalactosamine. [NIH] Goats: Any of numerous agile, hollow-horned ruminants of the genus Capra, closely related to the sheep. [NIH]

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Gout: Hereditary metabolic disorder characterized by recurrent acute arthritis, hyperuricemia and deposition of sodium urate in and around the joints, sometimes with formation of uric acid calculi. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] 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] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Guanine: One of the four DNA bases. [NIH] Haptens: Small antigenic determinants capable of eliciting an immune response only when coupled to a carrier. Haptens bind to antibodies but by themselves cannot elicit an antibody response. [NIH] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] Health Care Costs: The actual costs of providing services related to the delivery of health care, including the costs of procedures, therapies, and medications. It is differentiated from health expenditures, which refers to the amount of money paid for the services, and from fees, which refers to the amount charged, regardless of cost. [NIH] Health Education: Education that increases the awareness and favorably influences the attitudes and knowledge relating to the improvement of health on a personal or community basis. [NIH] Health Expenditures: The amounts spent by individuals, groups, nations, or private or public organizations for total health care and/or its various components. These amounts may or may not be equivalent to the actual costs (health care costs) and may or may not be shared among the patient, insurers, and/or employers. [NIH] Health Policy: Decisions, usually developed by government policymakers, for determining present and future objectives pertaining to the health care system. [NIH] Health Promotion: Encouraging consumer behaviors most likely to optimize health potentials (physical and psychosocial) through health information, preventive programs, and access to medical care. [NIH] 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] Hematuria: Presence of blood in the urine. [NIH] Hemodialysis: The use of a machine to clean wastes from the blood after the kidneys have failed. The blood travels through tubes to a dialyzer, which removes wastes and extra fluid. The cleaned blood then flows through another set of tubes back into the body. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to

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hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemoglobin A: Normal adult human hemoglobin. The globin moiety consists of two alpha and two beta chains. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hepatic: Refers to the liver. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU] Herpes Zoster: Acute vesicular inflammation. [NIH] Heterogeneity: The property of one or more samples or populations which implies that they are not identical in respect of some or all of their parameters, e. g. heterogeneity of variance. [NIH]

Histamine: 1H-Imidazole-4-ethanamine. A depressor amine derived by enzymatic decarboxylation of histidine. It is a powerful stimulant of gastric secretion, a constrictor of bronchial smooth muscle, a vasodilator, and also a centrally acting neurotransmitter. [NIH] Histidine: An essential amino acid important in a number of metabolic processes. It is required for the production of histamine. [NIH] Homeostasis: The processes whereby the internal environment of an organism tends to remain balanced and stable. [NIH] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Host: Any animal that receives a transplanted graft. [NIH] Hybrid: Cross fertilization between two varieties or, more usually, two species of vines, see also crossing. [NIH] Hydrochloric Acid: A strong corrosive acid that is commonly used as a laboratory reagent. It is formed by dissolving hydrogen chloride in water. Gastric acid is the hydrochloric acid component of gastric juice. [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]

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Hydrolysis: The process of cleaving a chemical compound by the addition of a molecule of water. [NIH] Hydrophilic: Readily absorbing moisture; hygroscopic; having strongly polar groups that readily interact with water. [EU] Hydrophobic: Not readily absorbing water, or being adversely affected by water, as a hydrophobic colloid. [EU] Hydroxyproline: A hydroxylated form of the imino acid proline. A deficiency in ascorbic acid can result in impaired hydroxyproline formation. [NIH] Hypercalciuria: Abnormally large amounts of calcium in the urine. [NIH] Hyperoxaluria: Excretion of an excessive amount of oxalate in the urine. [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] Hyperuricemia: A buildup of uric acid (a byproduct of metabolism) in the blood; a side effect of some anticancer drugs. [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] Iliac Artery: Either of two large arteries originating from the abdominal aorta; they supply blood to the pelvis, abdominal wall and legs. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immunology: The study of the body's immune system. [NIH] 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] Inbreeding: The mating of plants or non-human animals which are closely related genetically. [NIH] Incision: A cut made in the body during surgery. [NIH] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

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

Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] Ingestion: Taking into the body by mouth [NIH] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH] Inorganic: Pertaining to substances not of organic origin. [EU] Insight: The capacity to understand one's own motives, to be aware of one's own psychodynamics, to appreciate the meaning of symbolic behavior. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intestinal: Having to do with the intestines. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intracellular: Inside a cell. [NIH] Intraperitoneal: IP. Within the peritoneal cavity (the area that contains the abdominal organs). [NIH] Intravenous: IV. Into a vein. [NIH] Intravenous pyelogram: IVP. A series of x-rays of the kidneys, ureters, and bladder. The xrays are taken after a dye is injected into a blood vessel. The dye is concentrated in the urine, which outlines the kidneys, ureters, and bladder on the x-rays. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

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] Ipsilateral: Having to do with the same side of the body. [NIH] Irrigation: The washing of a body cavity or surface by flowing solution which is inserted and then removed. Any drug in the irrigation solution may be absorbed. [NIH] 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 Calculi: Calculi occurring in the kidney. Calculi too large to pass spontaneously range in size from 1 cm to the staghorn stones that occupy the renal pelvis and calyces. [NIH] 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 Failure: The inability of a kidney to excrete metabolites at normal plasma levels under conditions of normal loading, or the inability to retain electrolytes under conditions of normal intake. In the acute form (kidney failure, acute), it is marked by uremia and usually by oliguria or anuria, with hyperkalemia and pulmonary edema. The chronic form (kidney failure, chronic) is irreversible and requires hemodialysis. [NIH] Kidney Failure, Acute: A clinical syndrome characterized by a sudden decrease in glomerular filtration rate, often to values of less than 1 to 2 ml per minute. It is usually associated with oliguria (urine volumes of less than 400 ml per day) and is always associated with biochemical consequences of the reduction in glomerular filtration rate such as a rise in blood urea nitrogen (BUN) and serum creatinine concentrations. [NIH] Kidney Failure, Chronic: An irreversible and usually progressive reduction in renal function in which both kidneys have been damaged by a variety of diseases to the extent that they are unable to adequately remove the metabolic products from the blood and regulate the body's electrolyte composition and acid-base balance. Chronic kidney failure requires hemodialysis or surgery, usually kidney transplantation. [NIH] Kidney Pelvis: The flattened, funnel-shaped expansion connecting the ureter to the kidney calices. [NIH] Kidney stone: A stone that develops from crystals that form in urine and build up on the inner surfaces of the kidney, in the renal pelvis, or in the ureters. [NIH] Kidney Transplantation: The transference of a kidney from one human or animal to another. [NIH] Kinetic: Pertaining to or producing motion. [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] Latent: Phoria which occurs at one distance or another and which usually has no troublesome effect. [NIH] Laxative: An agent that acts to promote evacuation of the bowel; a cathartic or purgative. [EU]

Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Ligands: A RNA simulation method developed by the MIT. [NIH] Ligation: Application of a ligature to tie a vessel or strangulate a part. [NIH] 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] Lipid: Fat. [NIH] Lipid Peroxidation: Peroxidase catalyzed oxidation of lipids using hydrogen peroxide as an

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electron acceptor. [NIH] Lithiasis: A condition characterized by the formation of calculi and concretions in the hollow organs or ducts of the body. They occur most often in the gallbladder, kidney, and lower urinary tract. [NIH] Lithotripsy: The destruction of a calculus of the kidney, ureter, bladder, or gallbladder by physical forces, including crushing with a lithotriptor through a catheter. Focused percutaneous ultrasound and focused hydraulic shock waves may be used without surgery. Lithotripsy does not include the dissolving of stones by acids or litholysis. Lithotripsy by laser is laser lithotripsy. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Liver scan: An image of the liver created on a computer screen or on film. A radioactive substance is injected into a blood vessel and travels through the bloodstream. It collects in the liver, especially in abnormal areas, and can be detected by the scanner. [NIH] Localization: The process of determining or marking the location or site of a lesion or 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] Longitudinal study: Also referred to as a "cohort study" or "prospective study"; the analytic method of epidemiologic study in which subsets of a defined population can be identified who are, have been, or in the future may be exposed or not exposed, or exposed in different degrees, to a factor or factors hypothesized to influence the probability of occurrence of a given disease or other outcome. The main feature of this type of study is to observe large numbers of subjects over an extended time, with comparisons of incidence rates in groups that differ in exposure levels. [NIH] Lumbar: Pertaining to the loins, the part of the back between the thorax and the pelvis. [EU] Lumen: The cavity or channel within a tube or tubular organ. [EU] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]

Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphatic system: The tissues and organs that produce, store, and carry white blood cells that fight infection and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes and a network of thin tubes that carry lymph and white blood cells. These tubes branch, like blood vessels, into all the tissues of the body. [NIH] Lymphocyte: A white blood cell. Lymphocytes have a number of roles in the immune system, including the production of antibodies and other substances that fight infection and diseases. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Lysine: An essential amino acid. It is often added to animal feed. [NIH] Magnesium Hydroxide: Magnesium hydroxide (Mg(OH)2). An inorganic compound that

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occurs in nature as the mineral brucite. It acts as an antacid with cathartic effects. [NIH] Magnesium Oxide: Magnesium oxide (MgO). An inorganic compound that occurs in nature as the mineral periclase. In aqueous media combines quickly with water to form magnesium hydroxide. It is used as an antacid and mild laxative and has many nonmedicinal uses. [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] Malabsorption: Impaired intestinal absorption of nutrients. [EU] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]

Mammogram: An x-ray of the breast. [NIH] Meat: The edible portions of any animal used for food including domestic mammals (the major ones being cattle, swine, and sheep) along with poultry, fish, shellfish, and game. [NIH]

Median Nerve: A major nerve of the upper extremity. In humans, the fibers of the median nerve originate in the lower cervical and upper thoracic spinal cord (usually C6 to T1), travel via the brachial plexus, and supply sensory and motor innervation to parts of the forearm and hand. [NIH] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] Medical Records: Recording of pertinent information concerning patient's illness or illnesses. [NIH] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Medullary: Pertaining to the marrow or to any medulla; resembling marrow. [EU] Melanin: The substance that gives the skin its color. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Membrane Glycoproteins: Glycoproteins found on the membrane or surface of cells. [NIH] Menopause: Permanent cessation of menstruation. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Mental Health: The state wherein the person is well adjusted. [NIH] Metabolic disorder: A condition in which normal metabolic processes are disrupted, usually because of a missing enzyme. [NIH] Metaplasia: A condition in which there is a change of one adult cell type to another similar adult cell type. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microcalcifications: Tiny deposits of calcium in the breast that cannot be felt but can be detected on a mammogram. A cluster of these very small specks of calcium may indicate that cancer is present. [NIH]

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Microscopy: The application of microscope magnification to the study of materials that cannot be properly seen by the unaided eye. [NIH] Mineralization: The action of mineralizing; the state of being mineralized. [EU] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Morphology: The science of the form and structure of organisms (plants, animals, and other forms of life). [NIH] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH] Mucosa: A mucous membrane, or tunica mucosa. [EU] Muscle Relaxation: That phase of a muscle twitch during which a muscle returns to a resting position. [NIH] Muscular Diseases: Acquired, familial, and congenital disorders of skeletal muscle and smooth muscle. [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Myotonia: Prolonged failure of muscle relaxation after contraction. This may occur after voluntary contractions, muscle percussion, or electrical stimulation of the muscle. Myotonia is a characteristic feature of myotonic disorders. [NIH] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Neonatal period: The first 4 weeks after birth. [NIH] Nephrectomy: Surgery to remove a kidney. Radical nephrectomy removes the kidney, the adrenal gland, nearby lymph nodes, and other surrounding tissue. Simple nephrectomy removes only the kidney. Partial nephrectomy removes the tumor but not the entire kidney. [NIH]

Nephrolithiasis: Kidney stones. [NIH] Nephron: A tiny part of the kidneys. Each kidney is made up of about 1 million nephrons, which are the working units of the kidneys, removing wastes and extra fluids from the blood. [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]

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Neuromuscular: Pertaining to muscles and nerves. [EU] Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the next. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Odds Ratio: The ratio of two odds. The exposure-odds ratio for case control data is the ratio of the odds in favor of exposure among cases to the odds in favor of exposure among noncases. The disease-odds ratio for a cohort or cross section is the ratio of the odds in favor of disease among the exposed to the odds in favor of disease among the unexposed. The prevalence-odds ratio refers to an odds ratio derived cross-sectionally from studies of prevalent cases. [NIH] Oliguria: Clinical manifestation of the urinary system consisting of a decrease in the amount of urine secreted. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH] Operon: The genetic unit consisting of a feedback system under the control of an operator gene, in which a structural gene transcribes its message in the form of mRNA upon blockade of a repressor produced by a regulator gene. Included here is the attenuator site of bacterial operons where transcription termination is regulated. [NIH] Ornithine: An amino acid produced in the urea cycle by the splitting off of urea from arginine. [NIH] Osmolarity: The concentration of osmotically active particles expressed in terms of osmoles of solute per litre of solution. [EU] Osmoles: The standard unit of osmotic pressure. [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] Osteoblasts: Bone-forming cells which secrete an extracellular matrix. Hydroxyapatite crystals are then deposited into the matrix to form bone. [NIH] Osteocalcin: Vitamin K-dependent calcium-binding protein synthesized by osteoblasts and

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found primarily in bone. Serum osteocalcin measurements provide a noninvasive specific marker of bone metabolism. The protein contains three residues of the amino acid gammacarboxyglutamic acid (GLA), which, in the presence of calcium, promotes binding to hydroxyapatite and subsequent accumulation in bone matrix. [NIH] Osteoporosis: Reduction of bone mass without alteration in the composition of bone, leading to fractures. Primary osteoporosis can be of two major types: postmenopausal osteoporosis and age-related (or senile) osteoporosis. [NIH] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Oxalate: A chemical that combines with calcium in urine to form the most common type of kidney stone (calcium oxalate stone). [NIH] Oxalic Acid: A strong dicarboxylic acid occurring in many plants and vegetables. It is produced in the body by metabolism of glyoxylic acid or ascorbic acid. It is not metabolized but excreted in the urine. It is used as an analytical reagent and general reducing agent. [NIH] Oxaloacetate: An anionic form of oxaloacetic acid. [NIH] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]

Oxidative Stress: A disturbance in the prooxidant-antioxidant balance in favor of the former, leading to potential damage. Indicators of oxidative stress include damaged DNA bases, protein oxidation products, and lipid peroxidation products (Sies, Oxidative Stress, 1991, pxv-xvi). [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Paralysis: Loss of ability to move all or part of the body. [NIH] Paraplegia: Severe or complete loss of motor function in the lower extremities and lower portions of the trunk. This condition is most often associated with spinal cord diseases, although brain diseases; peripheral nervous system diseases; neuromuscular diseases; and muscular diseases may also cause bilateral leg weakness. [NIH] Parathyroid: 1. Situated beside the thyroid gland. 2. One of the parathyroid glands. 3. A sterile preparation of the water-soluble principle(s) of the parathyroid glands, ad-ministered parenterally as an antihypocalcaemic, especially in the treatment of acute hypoparathyroidism with tetany. [EU] Parathyroid Glands: Two small paired endocrine glands in the region of the thyroid gland. They secrete parathyroid hormone and are concerned with the metabolism of calcium and phosphorus. [NIH] Parathyroid hormone: A substance made by the parathyroid gland that helps the body store and use calcium. Also called parathormone, parathyrin, or PTH. [NIH] Parotid: The space that contains the parotid gland, the facial nerve, the external carotid artery, and the retromandibular vein. [NIH] Pathogenesis: The cellular events and reactions that occur in the development of disease.

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[NIH]

Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Patient Advocacy: Promotion and protection of the rights of patients, frequently through a legal process. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Patient Selection: Criteria and standards used for the determination of the appropriateness of the inclusion of patients with specific conditions in proposed treatment plans and the criteria used for the inclusion of subjects in various clinical trials and other research protocols. [NIH] Pelvic: Pertaining to the pelvis. [EU] Pelvis: The lower part of the abdomen, located between the hip bones. [NIH] Penicillin: An antibiotic drug used to treat infection. [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 proteins. Peptides are combined to make proteins. [NIH] Perception: The ability quickly and accurately to recognize similarities and differences among presented objects, whether these be pairs of words, pairs of number series, or multiple sets of these or other symbols such as geometric figures. [NIH] Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] 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 Nervous System Diseases: Diseases of the peripheral nerves external to the brain and spinal cord, which includes diseases of the nerve roots, ganglia, plexi, autonomic nerves, sensory nerves, and motor nerves. [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

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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] 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] Phantom: Used to absorb and/or scatter radiation equivalently to a patient, and hence to estimate radiation doses and test imaging systems without actually exposing a patient. It may be an anthropomorphic or a physical test object. [NIH] 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] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phenylalanine: An aromatic amino acid that is essential in the animal diet. It is a precursor of melanin, dopamine, noradrenalin, and thyroxine. [NIH] Phosphates: Inorganic salts of phosphoric acid. [NIH] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Physicochemical: Pertaining to physics and chemistry. [EU] 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] Plant Proteins: Proteins found in plants (flowers, herbs, shrubs, trees, etc.). The concept does not include proteins found in vegetables for which vegetable proteins is available. [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]

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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] Pneumonia: Inflammation of the lungs. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Polymers: Compounds formed by the joining of smaller, usually repeating, units linked by covalent bonds. These compounds often form large macromolecules (e.g., polypeptides, proteins, plastics). [NIH] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postmenopausal: Refers to the time after menopause. Menopause is the time in a woman's life when menstrual periods stop permanently; also called "change of life." [NIH] Post-translational: The cleavage of signal sequence that directs the passage of the protein through a cell or organelle membrane. [NIH] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Potassium Citrate: A powder that dissolves in water, which is administered orally, and is used as a diuretic, expectorant, systemic alkalizer, and electrolyte replenisher. [NIH] 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] Precipitation: The act or process of precipitating. [EU] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] 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]

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Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Promoter: A chemical substance that increases the activity of a carcinogenic process. [NIH] Prone: Having the front portion of the body downwards. [NIH] Proneness: Susceptibility to accidents due to human factors. [NIH] Prophylaxis: An attempt to prevent disease. [NIH] Proportional: Being in proportion : corresponding in size, degree, or intensity, having the same or a constant ratio; of, relating to, or used in determining proportions. [EU] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Prostaglandin: Any of a group of components derived from unsaturated 20-carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway that are extremely potent mediators of a diverse group of physiologic processes. The abbreviation for prostaglandin is PG; specific compounds are designated by adding one of the letters A through I to indicate the type of substituents found on the hydrocarbon skeleton and a subscript (1, 2 or 3) to indicate the number of double bonds in the hydrocarbon skeleton e.g., PGE2. The predominant naturally occurring prostaglandins all have two double bonds and are synthesized from arachidonic acid (5,8,11,14-eicosatetraenoic acid) by the pathway shown in the illustration. The 1 series and 3 series are produced by the same pathway with fatty acids having one fewer double bond (8,11,14-eicosatrienoic acid or one more double bond (5,8,11,14,17-eicosapentaenoic acid) than arachidonic acid. The subscript a or ß indicates the configuration at C-9 (a denotes a substituent below the plane of the ring, ß, above the plane). The naturally occurring PGF's have the a configuration, e.g., PGF2a. All of the prostaglandins act by binding to specific cell-surface receptors causing an increase in the level of the intracellular second messenger cyclic AMP (and in some cases cyclic GMP also). The effect produced by the cyclic AMP increase depends on the specific cell type. In some cases there is also a positive feedback effect. Increased cyclic AMP increases prostaglandin synthesis leading to further increases in cyclic AMP. [EU] Prostaglandins A: (13E,15S)-15-Hydroxy-9-oxoprosta-10,13-dien-1-oic acid (PGA(1)); (5Z,13E,15S)-15-hydroxy-9-oxoprosta-5,10,13-trien-1-oic acid (PGA(2)); (5Z,13E,15S,17Z)-15hydroxy-9-oxoprosta-5,10,13,17-tetraen-1-oic acid (PGA(3)). A group of naturally occurring secondary prostaglandins derived from PGE. PGA(1) and PGA(2) as well as their 19hydroxy derivatives are found in many organs and tissues. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Prostatic Hyperplasia: Enlargement or overgrowth of the prostate gland as a result of an increase in the number of its constituent cells. [NIH] Prostatitis: Inflammation of the prostate. [EU] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] 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

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and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein Conformation: The characteristic 3-dimensional shape of a protein, including the secondary, supersecondary (motifs), tertiary (domains) and quaternary structure of the peptide chain. Quaternary protein structure describes the conformation assumed by multimeric proteins (aggregates of more than one polypeptide chain). [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] 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 Edema: An accumulation of an excessive amount of watery fluid in the lungs, may be caused by acute exposure to dangerous concentrations of irritant gasses. [NIH] 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]

Purines: A series of heterocyclic compounds that are variously substituted in nature and are known also as purine bases. They include adenine and guanine, constituents of nucleic acids, as well as many alkaloids such as caffeine and theophylline. Uric acid is the metabolic end product of purine metabolism. [NIH] Pyelonephritis: Inflammation of the kidney and its pelvis, beginning in the interstitium and rapidly extending to involve the tubules, glomeruli, and blood vessels; due to bacterial infection. [EU] Pyrimidines: A family of 6-membered heterocyclic compounds occurring in nature in a wide variety of forms. They include several nucleic acid constituents (cytosine, thymine, and uracil) and form the basic structure of the barbiturates. [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]

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Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radioactive: Giving off radiation. [NIH] Radiography: Examination of any part of the body for diagnostic purposes by means of roentgen rays, recording the image on a sensitized surface (such as photographic film). [NIH] Radiological: Pertaining to radiodiagnostic and radiotherapeutic procedures, and interventional radiology or other planning and guiding medical radiology. [NIH] Radiopharmaceutical: Any medicinal product which, when ready for use, contains one or more radionuclides (radioactive isotopes) included for a medicinal purpose. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Reagent: A substance employed to produce a chemical reaction so as to detect, measure, produce, etc., other substances. [EU] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Recombinant: A cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recur: To occur again. Recurrence is the return of cancer, at the same site as the original (primary) tumor or in another location, after the tumor had disappeared. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Red blood cells: RBCs. Cells that carry oxygen to all parts of the body. Also called erythrocytes. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reflux: The term used when liquid backs up into the esophagus from the stomach. [NIH] 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] Relative risk: The ratio of the incidence rate of a disease among individuals exposed to a specific risk factor to the incidence rate among unexposed individuals; synonymous with risk ratio. Alternatively, the ratio of the cumulative incidence rate in the exposed to the cumulative incidence rate in the unexposed (cumulative incidence ratio). The term relative risk has also been used synonymously with odds ratio. This is because the odds ratio and relative risk approach each other if the disease is rare ( 5 percent of population) and the number of subjects is large. [NIH] Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Renal failure: Progressive renal insufficiency and uremia, due to irreversible and progressive renal glomerular tubular or interstitial disease. [NIH] Renal pelvis: The area at the center of the kidney. Urine collects here and is funneled into the ureter, the tube that connects the kidney to the bladder. [NIH]

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Renal tubular: A defect in the kidneys that hinders their normal excretion of acids. Failure to excrete acids can lead to weak bones, kidney stones, and poor growth in children. [NIH] Renal tubular acidosis: A rare disorder in which structures in the kidney that filter the blood are impaired, producing using that is more acid than normal. [NIH] Repressor: Any of the specific allosteric protein molecules, products of regulator genes, which bind to the operator of operons and prevent RNA polymerase from proceeding into the operon to transcribe messenger RNA. [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] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Retinal: 1. Pertaining to the retina. 2. The aldehyde of retinol, derived by the oxidative enzymatic splitting of absorbed dietary carotene, and having vitamin A activity. In the retina, retinal combines with opsins to form visual pigments. One isomer, 11-cis retinal combines with opsin in the rods (scotopsin) to form rhodopsin, or visual purple. Another, all-trans retinal (trans-r.); visual yellow; xanthopsin) results from the bleaching of rhodopsin by light, in which the 11-cis form is converted to the all-trans form. Retinal also combines with opsins in the cones (photopsins) to form the three pigments responsible for colour vision. Called also retinal, and retinene1. [EU] Retinoids: Derivatives of vitamin A. Used clinically in the treatment of severe cystic acne, psoriasis, and other disorders of keratinization. Their possible use in the prophylaxis and treatment of cancer is being actively explored. [NIH] Retrograde: 1. Moving backward or against the usual direction of flow. 2. Degenerating, deteriorating, or catabolic. [EU] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Rod: A reception for vision, located in the retina. [NIH] Rubber: A high-molecular-weight polymeric elastomer derived from the milk juice (latex) of Hevea brasiliensis and other trees. It is a substance that can be stretched at room temperature to atleast twice its original length and after releasing the stress, retractrapidly, and recover its original dimensions fully. Synthetic rubber is made from many different chemicals, including styrene, acrylonitrile, ethylene, propylene, and isoprene. [NIH] Sarcoidosis: An idiopathic systemic inflammatory granulomatous disorder comprised of epithelioid and multinucleated giant cells with little necrosis. It usually invades the lungs with fibrosis and may also involve lymph nodes, skin, liver, spleen, eyes, phalangeal bones, and parotid glands. [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

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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] 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] Secretory: Secreting; relating to or influencing secretion or the secretions. [NIH] Segregation: The separation in meiotic cell division of homologous chromosome pairs and their contained allelomorphic gene pairs. [NIH] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Senile: Relating or belonging to old age; characteristic of old age; resulting from infirmity of old age. [NIH] Sensor: A device designed to respond to physical stimuli such as temperature, light, magnetism or movement and transmit resulting impulses for interpretation, recording, movement, or operating control. [NIH] Sepsis: The presence of bacteria in the bloodstream. [NIH] Serine: A non-essential amino acid occurring in natural form as the L-isomer. It is synthesized from glycine or threonine. It is involved in the biosynthesis of purines, pyrimidines, and other amino acids. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [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]

Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] 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] Skin graft: Skin that is moved from one part of the body to another. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for

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oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] Sperm: The fecundating fluid of the male. [NIH] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spinal Cord Diseases: Pathologic conditions which feature spinal cord damage or dysfunction, including disorders involving the meninges and perimeningeal spaces surrounding the spinal cord. Traumatic injuries, vascular diseases, infections, and inflammatory/autoimmune processes may affect the spinal cord. [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] 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]

Statistically significant: Describes a mathematical measure of difference between groups. The difference is said to be statistically significant if it is greater than what might be expected to happen by chance alone. [NIH] Stents: Devices that provide support for tubular structures that are being anastomosed or for body cavities during skin grafting. [NIH] Sterile: Unable to produce children. [NIH] Stimulant: 1. Producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. An agent or remedy that produces stimulation. [EU]

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

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Struvite: A type of kidney stone caused by infection. [NIH] Styrene: A colorless, toxic liquid with a strong aromatic odor. It is used to make rubbers, polymers and copolymers, and polystyrene plastics. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] 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] Superoxide: Derivative of molecular oxygen that can damage cells. [NIH] Superoxide Dismutase: An oxidoreductase that catalyzes the reaction between superoxide anions and hydrogen to yield molecular oxygen and hydrogen peroxide. The enzyme protects the cell against dangerous levels of superoxide. EC 1.15.1.1. [NIH] Supplementation: Adding nutrients to the diet. [NIH] Symphysis: A secondary cartilaginous joint. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [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] Terminator: A DNA sequence sited at the end of a transcriptional unit that signals the end of transcription. [NIH] Tetany: 1. Hyperexcitability of nerves and muscles due to decrease in concentration of extracellular ionized calcium, which may be associated with such conditions as parathyroid hypofunction, vitamin D deficiency, and alkalosis or result from ingestion of alkaline salts; it is characterized by carpopedal spasm, muscular twitching and cramps, laryngospasm with inspiratory stridor, hyperreflexia and choreiform movements. 2. Tetanus. [EU] Theophylline: Alkaloid obtained from Thea sinensis (tea) and others. It stimulates the heart and central nervous system, dilates bronchi and blood vessels, and causes diuresis. The drug is used mainly in bronchial asthma and for myocardial stimulation. Among its more prominent cellular effects are inhibition of cyclic nucleotide phosphodiesterases and antagonism of adenosine receptors. [NIH]

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Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thermal: Pertaining to or characterized by heat. [EU] Thoracic: Having to do with the chest. [NIH] Thorax: A part of the trunk between the neck and the abdomen; the chest. [NIH] Threonine: An essential amino acid occurring naturally in the L-form, which is the active form. It is found in eggs, milk, gelatin, and other proteins. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombin: An enzyme formed from prothrombin that converts fibrinogen to fibrin. (Dorland, 27th ed) EC 3.4.21.5. [NIH] Thrombomodulin: A cell surface glycoprotein of endothelial cells that binds thrombin and serves as a cofactor in the activation of protein C and its regulation of blood coagulation. [NIH]

Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Thyroid Gland: A highly vascular endocrine gland consisting of two lobes, one on either side of the trachea, joined by a narrow isthmus; it produces the thyroid hormones which are concerned in regulating the metabolic rate of the body. [NIH] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Tin: A trace element that is required in bone formation. It has the atomic symbol Sn, atomic number 50, and atomic weight 118.71. [NIH] 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] Tone: 1. The normal degree of vigour and tension; in muscle, the resistance to passive elongation or stretch; tonus. 2. A particular quality of sound or of voice. 3. To make permanent, or to change, the colour of silver stain by chemical treatment, usually with a heavy metal. [EU] Tonus: A state of slight tension usually present in muscles even when they are not undergoing active contraction. [NIH] Tooth Demineralization: A tooth's loss of minerals, such as calcium in hydroxyapatite from the tooth matrix, caused by acidic exposure. An example of the occurrence of demineralization is in the formation of dental caries. [NIH] Tooth Preparation: Procedures carried out with regard to the teeth or tooth structures preparatory to specified dental therapeutic and surgical measures. [NIH] Topical: On the surface of the body. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU]

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Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Transduction: The transfer of genes from one cell to another by means of a viral (in the case of bacteria, a bacteriophage) vector or a vector which is similar to a virus particle (pseudovirion). [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transfusion: The infusion of components of blood or whole blood into the bloodstream. The blood may be donated from another person, or it may have been taken from the person earlier and stored until needed. [NIH] 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] Translational: The cleavage of signal sequence that directs the passage of the protein through a cell or organelle membrane. [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]

Trees: Woody, usually tall, perennial higher plants (Angiosperms, Gymnosperms, and some Pterophyta) having usually a main stem and numerous branches. [NIH] Triamterene: A pteridine that is used as a mild diuretic. [NIH] Tunica: A rather vague term to denote the lining coat of hollow organs, tubes, or cavities. [NIH]

Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Urea: A compound (CO(NH2)2), formed in the liver from ammonia produced by the deamination of amino acids. It is the principal end product of protein catabolism and constitutes about one half of the total urinary solids. [NIH] Urease: An enzyme that catalyzes the conversion of urea and water to carbon dioxide and ammonia. EC 3.5.1.5. [NIH] Uremia: The illness associated with the buildup of urea in the blood because the kidneys are not working effectively. Symptoms include nausea, vomiting, loss of appetite, weakness, and mental confusion. [NIH] Ureter: One of a pair of thick-walled tubes that transports urine from the kidney pelvis to the bladder. [NIH]

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Ureteroscopy: Endoscopic examination, therapy or surgery of the ureter. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Uric: A kidney stone that may result from a diet high in animal protein. When the body breaks down this protein, uric acid levels rise and can form stones. [NIH] Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary tract: The organs of the body that produce and discharge urine. These include the kidneys, ureters, bladder, and urethra. [NIH] Urinary tract infection: An illness caused by harmful bacteria growing in the urinary tract. [NIH]

Urinate: To release urine from the bladder to the outside. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Urine Testing: Checking urine to see if it contains glucose (sugar) and ketones. Special strips of paper or tablets (called reagents) are put into a small amount of urine or urine plus water. Changes in the color of the strip show the amount of glucose or ketones in the urine. Urine testing is the only way to check for the presence of ketones, a sign of serious illness. However, urine testing is less desirable then blood testing for monitoring the level of glucose in the body. [NIH] Urogenital: Pertaining to the urinary and genital apparatus; genitourinary. [EU] Urogenital Diseases: Diseases of the urogenital tract. [NIH] Urolithiasis: Stones in the urinary system. [NIH] Urologic Diseases: Diseases of the urinary tract in both male and female. It does not include the male genitalia for which urogenital diseases is used for general discussions of diseases of both the urinary tract and the genitalia. [NIH] Urology: A surgical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in both sexes and the genital tract in the male. It includes the specialty of andrology which addresses both male genital diseases and male infertility. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] 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] Vegetable Proteins: Proteins which are present in or isolated from vegetables or vegetable products used as food. The concept is distinguished from plant proteins which refers to nondietary proteins from plants. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH]

Dictionary 189

Vertebrae: A bony unit of the segmented spinal column. [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] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Vitamin A: A substance used in cancer prevention; it belongs to the family of drugs called retinoids. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Watchful waiting: Closely monitoring a patient's condition but withholding treatment until symptoms appear or change. Also called observation. [NIH] Xanthine: An urinary calculus. [NIH] Xanthine Oxidase: An iron-molybdenum flavoprotein containing FAD that oxidizes hypoxanthine, some other purines and pterins, and aldehydes. Deficiency of the enzyme, an autosomal recessive trait, causes xanthinuria. EC 1.1.3.22. [NIH] Xenograft: The cells of one species transplanted to another species. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH] Yeasts: A general term for single-celled rounded fungi that reproduce by budding. Brewers' and bakers' yeasts are Saccharomyces cerevisiae; therapeutic dried yeast is dried yeast. [NIH] 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]

191

INDEX A Abdomen, 126, 129, 149, 155, 169, 171, 176, 184, 186 Abdominal, 8, 126, 149, 157, 161, 168, 169, 175, 176, 177 Acetylgalactosamine, 149, 165 Acetylglucosamine, 149, 165 Acidity, 149, 177 Acidosis, 26, 149 Acoustic, 30, 33, 86, 149 Acrylonitrile, 149, 182 Adaptation, 12, 14, 17, 21, 149 Adenine, 149, 180 Adenosine, 149, 155, 177, 185 Adjustment, 5, 8, 11, 149 Adsorption, 25, 149 Adsorptive, 149 Adverse Effect, 30, 149, 183 Aeroembolism, 149, 153 Affinity, 15, 21, 23, 149, 150, 183 Affinity Chromatography, 15, 23, 150 Agar, 150, 177 Albumin, 33, 150, 178 Alertness, 150, 155 Algorithms, 150, 154 Alimentary, 14, 150, 176 Alkaline, 17, 129, 149, 150, 151, 155, 185 Alkaline Phosphatase, 17, 150 Alleles, 19, 150 Allograft, 106, 150 Allopurinol, 9, 114, 150 Alpha-helix, 25, 150 Alternative medicine, 108, 150 Amino Acid Sequence, 23, 151, 152 Ammonia, 15, 151, 187 Ampulla, 151, 162 Amyloid, 33, 52, 151 Anal, 151, 171 Analogous, 8, 151, 187 Analytes, 126, 151 Anatomical, 15, 151, 154, 159, 162 Anemia, 70, 151 Anesthesia, 131, 151 Angiotensin converting enzyme inhibitor, 19, 151 Animal model, 14, 18, 19, 20, 30, 31, 151 Anionic, 15, 23, 151, 175 Anions, 150, 151, 169, 185

Anisotropy, 16, 151 Annealing, 57, 151 Antagonism, 14, 151, 155, 185 Antibiotic, 26, 151, 176 Antibodies, 23, 152, 166, 171, 178 Antibody, 150, 152, 158, 166, 167, 168, 184 Anticoagulant, 152, 179 Antidiuretic, 5, 152 Antigen, 8, 150, 152, 158, 165, 167, 168 Anti-infective, 152, 167 Anti-inflammatory, 152, 165 Anti-Inflammatory Agents, 152 Antioxidant, 31, 152, 175 Anuria, 152, 170 Aorta, 98, 152, 168, 188 Aqueous, 83, 152, 153, 167, 172 Arachidonic Acid, 152, 179 Arginine, 152, 160, 174 Arterial, 152, 159, 165, 168, 180, 185 Arteries, 152, 154, 160, 168, 172 Artery, 152, 160, 175, 180 Ascorbic Acid, 53, 63, 73, 152, 168, 175 Aspirin, 129, 152 Assay, 13, 16, 24, 83, 84, 152 Attenuation, 58, 153 Atypical, 8, 153 B Back Pain, 106, 126, 153 Bacteremia, 40, 153 Bacteria, 5, 8, 14, 18, 20, 34, 54, 107, 149, 151, 152, 153, 161, 164, 172, 183, 187, 188 Bacterial Physiology, 149, 153 Bacterial Proteins, 34, 153 Bacteriophage, 153, 177, 187 Bacterium, 18, 23, 25, 153 Bacteriuria, 11, 153 Base, 21, 73, 90, 149, 153, 161, 169, 170 Beer, 9, 107, 153 Bends, 15, 153 Benign, 137, 153, 166 Benign prostatic hyperplasia, 137, 153 Beta 2-Microglobulin, 33, 153 Beta-pleated, 151, 153 Beta-sheet, 25, 153 Bilateral, 154, 175 Bile, 154, 164, 171 Bile duct, 154, 164 Biliary, 154, 155

192 Kidney Stones

Biliary Tract, 154, 155 Bilirubin, 150, 154, 164 Binding Sites, 15, 27, 154 Biochemical, 23, 27, 33, 36, 73, 150, 154, 170 Bioengineering, 24, 28, 120, 154 Biomolecular, 25, 29, 154 Biopolymers, 28, 154 Biopsy, 154, 176 Biotechnology, 18, 22, 31, 95, 108, 121, 154 Blood Coagulation, 154, 155, 186 Blood Glucose, 154, 167 Blood pressure, 40, 109, 154, 156, 165, 168, 173, 184 Blood urea, 16, 154, 170 Blood vessel, 151, 154, 155, 156, 157, 159, 165, 169, 171, 180, 183, 184, 185, 186, 188 Body Fluids, 85, 109, 154, 184 Body Regions, 154, 157 Bone Development, 154, 155 Bone scan, 155, 182 Bowel, 26, 75, 99, 151, 155, 169, 170, 177, 184 Brain Diseases, 155, 175 Branch, 98, 145, 155, 171, 176, 180, 184, 186 Breakdown, 15, 17, 129, 154, 155, 161, 164 Breeding, 19, 155 C Caffeine, 5, 155, 180 Calcification, 25, 29, 155 Calcium, 3, 5, 6, 7, 9, 10, 11, 12, 13, 14, 15, 17, 18, 20, 22, 23, 24, 25, 27, 28, 30, 32, 35, 36, 37, 38, 39, 48, 51, 53, 55, 56, 58, 59, 62, 63, 64, 66, 71, 72, 73, 74, 84, 86, 87, 91, 97, 99, 106, 107, 109, 110, 126, 130, 131, 132, 133, 134, 138, 155, 158, 168, 172, 174, 175, 185, 186 Calcium Carbonate, 71, 155 Calcium, Dietary, 71, 155 Calculus I, 91, 155 Carbohydrate, 110, 156, 165, 178 Carbon Dioxide, 16, 156, 182, 187 Carbonate Dehydratase, 156 Carbonic Anhydrase Inhibitors, 44, 63, 156 Carcinogenic, 156, 169, 179 Cardiac, 25, 35, 155, 156, 160, 162, 163, 164, 173 Cardiology, 25, 156 Cardiovascular, 19, 156 Cardiovascular disease, 19, 156 Carpal Tunnel Syndrome, 70, 156

Catheter, 156, 171 Cations, 156, 169 Cecum, 156, 170 Cell Death, 156, 165 Cell Division, 153, 156, 177, 183 Cell Physiology, 20, 156 Cellobiose, 156 Cellulose, 49, 87, 156, 177 Central Nervous System, 149, 155, 156, 165, 166, 185 Cerebrovascular, 156, 157 Chest Pain, 69, 157 Chimeras, 22, 157 Chloride Channels, 35, 157 Cholesterol, 29, 154, 157, 160, 164 Chromosome, 19, 157, 170, 183 Chronic, 14, 16, 26, 30, 42, 52, 109, 153, 157, 159, 162, 168, 170, 185 Chronic renal, 14, 157 Citrus, 110, 152, 157 Clinical Medicine, 157, 178 Clinical trial, 13, 24, 37, 121, 157, 159, 176, 180, 181 Clone, 15, 22, 157 Cloning, 20, 154, 157 Codon, 51, 63, 157 Coenzyme, 152, 157 Cofactor, 157, 180, 186 Cohort Studies, 27, 157 Colic, 10, 98, 157 Colitis, 75, 157, 169 Collagen, 150, 157 Collapse, 155, 158 Colloidal, 150, 158 Colon, 157, 158, 169, 170 Complement, 158, 165, 178 Complementary and alternative medicine, 69, 70, 79, 158 Complementary medicine, 70, 158 Compliance, 10, 158 Computational Biology, 121, 158 Computed tomography, 10, 57, 101, 158, 159, 182 Computerized tomography, 159 Concretion, 89, 155, 159, 161 Cone, 84, 159 Confounding, 8, 159 Conjunctiva, 159 Conjunctivitis, 159 Connective Tissue, 152, 157, 159, 164, 165, 171 Constipation, 109, 159

Index 193

Constriction, 159, 188 Constriction, Pathologic, 159, 188 Consultation, 10, 159 Consumption, 4, 9, 11, 12, 17, 18, 62, 71, 159, 182 Contraindications, ii, 159 Contrast Media, 10, 159 Control group, 8, 159 Cor, 159, 165 Coronary, 4, 156, 160, 172 Coronary heart disease, 4, 156, 160 Coronary Thrombosis, 160, 172 Corticosteroids, 160, 165 Cortisol, 150, 160 Creatinine, 18, 53, 109, 160, 170 Criterion, 21, 160 Cryoprotective, 29, 160 Cryoprotective Agents, 29, 160 Crystallization, 5, 13, 15, 110, 160 Crystalluria, 20, 30, 107, 160 CSF, 153, 160 Cultured cells, 18, 30, 160 Curative, 160, 186 Cyclic, 15, 155, 160, 179, 185 Cystine, 13, 92, 97, 110, 128, 130, 131, 133, 137, 160 Cystine stone, 13, 92, 97, 110, 128, 130, 133, 160 Cystinuria, 99, 128, 137, 160 Cystitis, 126, 137, 160 Cytotoxic, 8, 160 D Dairy Products, 5, 8, 110, 160 Deamination, 161, 187 Delivery of Health Care, 161, 166 Density, 17, 62, 161, 174 Dental Calculus, 25, 161 Dental Caries, 161, 186 Deuterium, 161, 167 Diabetes Mellitus, 161, 167 Diagnostic procedure, 81, 108, 161 Dialyzer, 161, 166 Diaphragm, 87, 89, 161 Diarrhea, 109, 161 Diastolic, 161, 168 Dietitian, 129, 133, 161 Digestion, 150, 154, 155, 161, 169, 171, 176, 184 Digestive tract, 161, 183 Dihydroxy, 161, 163 Dimerization, 15, 161 Direct, iii, 25, 29, 89, 113, 157, 161, 181

Discrete, 11, 161 Disposition, 89, 161 Dissociation, 150, 161 Distal, 5, 26, 162, 180 Diuresis, 155, 162, 185 Drug Delivery Systems, 22, 162 Drug Interactions, 115, 162 Duodenum, 23, 154, 162, 184 Dyes, 151, 162 E Edema, 109, 162 Efficacy, 11, 18, 26, 30, 70, 162, 187 Elective, 157, 162 Electric Conductivity, 151, 162 Electrode, 83, 84, 162 Electrolyte, 71, 162, 170, 178, 184 Empirical, 17, 162 Enamel, 29, 161, 162 Endogenous, 8, 23, 162 Endoscope, 162 Endoscopic, 96, 162, 188 End-stage renal, 157, 162 Environmental Exposure, 7, 162 Environmental Health, 120, 122, 162 Enzymatic, 151, 155, 158, 161, 163, 167, 182 Enzyme, 17, 23, 150, 156, 157, 163, 164, 172, 176, 178, 179, 180, 185, 186, 187, 189 Epinephrine, 163, 174, 187 Epithelial, 15, 20, 23, 28, 31, 163 Epithelial Cells, 15, 23, 28, 31, 163 Epithelium, 31, 163, 164 Erythrocytes, 151, 156, 163, 181 Esophagus, 161, 163, 181, 184 Ethanol, 163, 164 Ethylene Glycol, 20, 163 Evacuation, 40, 159, 163, 170 Excrete, 16, 99, 100, 152, 163, 170, 182 Exhaustion, 151, 163 Exogenous, 15, 149, 162, 163 Expectorant, 163, 178 Extracellular, 22, 26, 151, 159, 163, 174, 184, 185 Extraction, 58, 163 Extrarenal, 30, 163 F Family Planning, 121, 163 Fat, 99, 106, 152, 159, 160, 163, 165, 170, 184 Fatigue, 21, 109, 163, 166 Fatty acids, 150, 163, 179 Feces, 26, 159, 164, 184 Fermentation, 18, 153, 164

194 Kidney Stones

Ferritin, 53, 63, 164 Fibrosis, 26, 43, 164, 182 Filtration, 91, 109, 164, 170 Flatus, 164 Fluorescence, 16, 164 Flush, 98, 164 Flushing, 131, 164 Forearm, 154, 164, 172 Free Radicals, 18, 152, 161, 164 Freeze Drying, 18, 164 G Gallbladder, 149, 154, 164, 171 Gallstones, 84, 164 Gas, 83, 149, 151, 153, 156, 164, 167, 174, 185 Gastric, 16, 164, 167, 176 Gastric Juices, 164, 176 Gastric Mucosa, 16, 164, 176 Gastrin, 164, 167 Gastrointestinal, 18, 25, 163, 164, 185 Gene, 15, 22, 26, 51, 63, 95, 99, 106, 150, 154, 164, 165, 174, 183 Generator, 82, 165 Genetic Engineering, 25, 154, 157, 165 Genetics, 19, 36, 37, 165 Genital, 165, 188 Genotype, 165, 177 Giant Cells, 165, 182 Gland, 165, 171, 173, 175, 179, 183, 184, 186 Glomerular, 165, 170, 181 Glomeruli, 165, 180 Glomerulus, 26, 165 Glucocorticoids, 26, 165 Gluconeogenesis, 165 Glucose, 152, 154, 156, 161, 165, 166, 188 Glycine, 150, 165, 174, 183 Glycogen, 165 Glycoprotein, 15, 23, 165, 186 Glycosaminoglycans, 35, 165 Goats, 160, 165 Gout, 75, 106, 129, 133, 166 Governing Board, 166, 178 Grade, 102, 166 Graft, 166, 167 Growth, 24, 25, 27, 28, 29, 30, 71, 151, 155, 156, 166, 177, 182, 186 Guanine, 166, 180 H Haptens, 150, 166 Headache, 155, 166 Health Care Costs, 18, 166

Health Education, 129, 166 Health Expenditures, 166 Health Policy, 135, 137, 166 Health Promotion, 4, 166 Heart attack, 156, 166 Heart failure, 109, 166 Hematuria, 14, 32, 166 Hemodialysis, 52, 155, 161, 166, 170 Hemoglobin, 72, 151, 163, 166, 167 Hemoglobin A, 72, 167 Hemorrhage, 30, 166, 167, 184 Hepatic, 150, 167 Heredity, 12, 164, 165, 167 Herpes, 70, 167 Herpes Zoster, 167 Heterogeneity, 150, 167 Histamine, 167 Histidine, 21, 167 Homeostasis, 22, 26, 167 Homologous, 150, 167, 183 Hormone, 5, 48, 70, 160, 163, 164, 167, 186 Host, 21, 153, 167, 189 Hybrid, 157, 167 Hydrochloric Acid, 91, 167 Hydrogen, 8, 16, 149, 153, 156, 161, 167, 170, 173, 175, 177, 180, 185 Hydrogen Peroxide, 16, 167, 170, 185 Hydrolysis, 16, 156, 168, 180 Hydrophilic, 29, 168 Hydrophobic, 29, 168 Hydroxyproline, 150, 158, 168 Hypercalciuria, 3, 4, 9, 13, 17, 19, 38, 49, 55, 168 Hyperoxaluria, 6, 10, 13, 14, 16, 20, 23, 25, 30, 71, 127, 138, 168 Hypertension, 22, 30, 32, 40, 42, 43, 58, 63, 64, 75, 109, 156, 160, 166, 168 Hypertrophy, 153, 160, 168 Hyperuricemia, 166, 168 I Id, 65, 74, 126, 127, 136, 144, 146, 168 Idiopathic, 3, 4, 7, 13, 19, 32, 39, 49, 57, 62, 168, 182 Iliac Artery, 98, 168 Immune response, 152, 166, 168, 185, 189 Immunology, 15, 16, 150, 168 In situ, 91, 168 In vitro, 8, 14, 21, 30, 57, 168 In vivo, 23, 27, 168 Inbreeding, 19, 168 Incision, 82, 87, 89, 90, 168, 169 Incontinence, 95, 137, 168

Index 195

Indicative, 86, 88, 94, 168, 176, 188 Infarction, 160, 168, 172 Infection, 8, 11, 12, 14, 16, 92, 130, 133, 168, 171, 176, 180, 185 Infertility, 169, 188 Inflammation, 12, 69, 150, 152, 157, 159, 160, 164, 167, 169, 178, 179, 180 Inflammatory bowel disease, 23, 25, 169 Infusion, 169, 187 Ingestion, 5, 73, 164, 169, 178, 185 Initiation, 21, 169 Inorganic, 73, 86, 91, 169, 171, 172, 177 Insight, 9, 15, 26, 169 Intermittent, 72, 169, 177 Interstitial, 126, 137, 169, 181 Intestinal, 14, 18, 87, 169, 172 Intestine, 14, 23, 155, 169, 170 Intracellular, 5, 15, 155, 168, 169, 178, 179 Intraperitoneal, 20, 169 Intravenous, 101, 130, 169 Intravenous pyelogram, 101, 130, 169 Intrinsic, 150, 169 Invasive, 29, 82, 84, 87, 88, 89, 90, 169, 172 Ionizing, 162, 169 Ions, 84, 149, 153, 156, 157, 161, 162, 167, 169 Ipsilateral, 11, 169 Irrigation, 72, 73, 169 J Joint, 70, 149, 169, 185 K Kb, 120, 169 Kidney Calculi, 87, 170 Kidney Disease, 14, 34, 109, 120, 126, 127, 132, 133, 135, 136, 137, 170 Kidney Failure, 109, 126, 162, 170 Kidney Failure, Acute, 170 Kidney Failure, Chronic, 109, 170 Kidney Pelvis, 170, 187 Kidney Transplantation, 170 Kinetic, 25, 55, 169, 170 L Large Intestine, 14, 156, 161, 169, 170, 181, 183 Latent, 170, 178 Laxative, 150, 170, 172 Library Services, 144, 170 Ligament, 170, 179 Ligands, 17, 170 Ligation, 17, 170 Linkage, 19, 156, 170 Lipid, 28, 170, 175

Lipid Peroxidation, 170, 175 Lithiasis, 6, 130, 171 Liver, 16, 109, 110, 149, 150, 152, 154, 164, 165, 167, 171, 182, 187 Liver scan, 171, 182 Localization, 19, 171 Localized, 161, 168, 171, 177 Longitudinal study, 37, 171 Lumbar, 153, 171 Lumen, 14, 23, 171 Lymph, 109, 171, 173, 182 Lymph node, 109, 171, 173, 182 Lymphatic, 168, 171, 184 Lymphatic system, 171, 184 Lymphocyte, 152, 171 Lymphoid, 152, 160, 171 Lysine, 160, 171 M Magnesium Hydroxide, 171, 172 Magnesium Oxide, 71, 172 Magnetic Resonance Imaging, 172, 182 Malabsorption, 99, 172 Malnutrition, 150, 172 Mammogram, 155, 172 Meat, 100, 172 Median Nerve, 156, 172 Mediate, 15, 24, 26, 172 Medical Records, 172 MEDLINE, 121, 172 Medullary, 99, 172 Melanin, 172, 177, 187 Membrane, 21, 26, 28, 30, 84, 153, 157, 158, 159, 161, 172, 173, 174, 177, 178, 182, 187 Membrane Glycoproteins, 157, 172 Menopause, 48, 172, 178 Mental, iv, 13, 120, 123, 161, 163, 172, 180, 187 Mental Health, iv, 13, 120, 123, 172, 180 Metabolic disorder, 133, 166, 172 Metaplasia, 34, 172 MI, 30, 91, 147, 172 Microbe, 172, 186 Microbiology, 15, 16, 50, 149, 153, 172 Microcalcifications, 155, 172 Microscopy, 8, 16, 25, 29, 43, 47, 173 Mineralization, 25, 173 Modification, 6, 48, 151, 165, 173 Molecular, 9, 17, 21, 25, 26, 29, 35, 36, 37, 47, 55, 107, 121, 124, 154, 156, 158, 173, 182, 185 Molecule, 27, 150, 152, 153, 154, 157, 158, 161, 168, 173, 175, 181, 188

196 Kidney Stones

Monitor, 82, 160, 173, 174 Morphology, 8, 173 Motion Sickness, 173 Mucosa, 34, 164, 173 Muscle Relaxation, 173 Muscular Diseases, 173, 175 Myocardium, 172, 173 Myotonia, 35, 173 N Nausea, 109, 129, 173, 187 Need, 3, 12, 14, 88, 93, 94, 96, 98, 100, 101, 103, 109, 116, 122, 130, 131, 136, 139, 157, 165, 173 Neonatal, 22, 173 Neonatal period, 22, 173 Nephrectomy, 41, 173 Nephron, 5, 20, 23, 27, 39, 42, 46, 52, 63, 165, 173 Nephropathy, 170, 173 Nerve, 151, 172, 173, 175, 176, 182, 184 Neuromuscular, 174, 175 Neurotransmitter, 149, 151, 165, 167, 174, 185 Nitrogen, 16, 17, 109, 170, 174 Nuclear, 48, 174 Nuclei, 27, 165, 172, 174, 180 Nucleic acid, 174, 180 Nucleus, 160, 161, 174, 180 O Odds Ratio, 4, 174, 181 Oliguria, 170, 174 Opacity, 161, 174 Operon, 15, 16, 174, 182 Ornithine, 160, 174 Osmolarity, 74, 174 Osmoles, 174 Osmotic, 150, 174 Osteoblasts, 174 Osteocalcin, 17, 64, 174 Osteoporosis, 17, 22, 59, 75, 106, 155, 175 Outpatient, 46, 50, 175 Oxalate, 3, 5, 6, 7, 8, 9, 11, 12, 13, 14, 16, 17, 18, 20, 23, 25, 27, 28, 30, 35, 36, 38, 39, 43, 48, 50, 53, 55, 59, 67, 71, 72, 73, 84, 91, 97, 99, 110, 127, 130, 131, 132, 133, 138, 155, 168, 175 Oxalic Acid, 16, 25, 53, 155, 175 Oxaloacetate, 26, 175 Oxidation, 152, 160, 170, 175 Oxidative Stress, 18, 175 P Palliative, 175, 186

Pancreas, 149, 175 Paralysis, 99, 175 Paraplegia, 37, 58, 175 Parathyroid, 22, 75, 175, 185 Parathyroid Glands, 175 Parathyroid hormone, 22, 175 Parotid, 175, 182 Pathogenesis, 12, 13, 15, 24, 34, 50, 55, 56, 175 Pathologic, 149, 154, 155, 160, 176, 184 Pathophysiology, 4, 50, 176 Patient Advocacy, 137, 176 Patient Education, 94, 100, 101, 128, 130, 133, 134, 142, 144, 147, 176 Patient Selection, 96, 131, 132, 176 Pelvic, 176, 179 Pelvis, 98, 149, 168, 171, 176, 180 Penicillin, 151, 176 Pepsin, 176 Pepsin A, 176 Peptic, 8, 176 Peptic Ulcer, 8, 176 Peptide, 150, 176, 179, 180 Perception, 69, 159, 176 Peripheral Nervous System, 174, 175, 176, 185 Peripheral Nervous System Diseases, 175, 176 Peritoneal, 35, 169, 176 Peritoneal Cavity, 169, 176, 177 Peritoneal Dialysis, 35, 176 Peritoneum, 176, 177 PH, 127, 177 Phantom, 21, 88, 177 Pharmaceutical Preparations, 156, 163, 177 Pharmacologic, 151, 177, 187 Phenotype, 19, 177 Phenylalanine, 176, 177, 187 Phosphates, 86, 114, 177 Phospholipids, 163, 177 Phosphorus, 12, 155, 175, 177 Physicochemical, 73, 177 Physiologic, 22, 177, 179, 181 Physiology, 19, 20, 21, 97, 98, 133, 156, 177 Plant Proteins, 11, 38, 177, 188 Plants, 155, 156, 157, 165, 168, 173, 175, 177, 187, 188 Plaque, 25, 177 Plasma, 25, 150, 152, 153, 167, 170, 178, 183 Plasma cells, 152, 178

Index 197

Plasma protein, 150, 178 Pneumonia, 159, 178 Poisoning, 173, 178 Polymers, 87, 154, 178, 180, 185 Polysaccharide, 152, 156, 178 Posterior, 151, 153, 175, 178 Postmenopausal, 48, 175, 178 Post-translational, 27, 178 Potassium, 9, 10, 11, 12, 49, 66, 67, 70, 109, 178 Potassium Citrate, 9, 10, 49, 70, 178 Practicability, 178, 187 Practice Guidelines, 123, 178 Precipitation, 11, 17, 38, 178 Precursor, 28, 152, 163, 177, 178, 187 Predisposition, 26, 178 Prevalence, 4, 53, 56, 98, 107, 174, 178 Progression, 8, 30, 151, 179 Progressive, 109, 157, 166, 170, 179, 181 Promoter, 71, 179 Prone, 85, 94, 179 Proneness, 84, 179 Prophylaxis, 9, 87, 179, 182 Proportional, 17, 88, 179 Prospective study, 8, 11, 27, 32, 40, 52, 58, 70, 171, 179 Prostaglandin, 15, 179 Prostaglandins A, 179 Prostate, 94, 137, 153, 179 Prostatic Hyperplasia, 179 Prostatitis, 137, 179 Protease, 23, 179 Protein C, 13, 150, 151, 153, 157, 164, 175, 179, 180, 187 Protein Conformation, 151, 180 Protein S, 25, 95, 154, 174, 180 Proteolytic, 23, 158, 180 Protocol, 10, 15, 180 Protons, 167, 169, 180, 181 Proximal, 18, 21, 23, 26, 156, 162, 180 Public Health, 28, 63, 70, 96, 101, 123, 180 Public Policy, 121, 180 Pulmonary, 154, 159, 160, 170, 180, 188 Pulmonary Artery, 154, 180, 188 Pulmonary Edema, 170, 180 Pulse, 56, 173, 180 Purines, 129, 180, 183, 189 Pyelonephritis, 42, 180 Pyrimidines, 180, 183 R Race, 9, 57, 71, 180

Radiation, 48, 162, 164, 169, 177, 181, 182, 189 Radioactive, 155, 167, 171, 174, 181, 182 Radiography, 8, 159, 181 Radiological, 126, 176, 181 Radiopharmaceutical, 165, 181 Randomized, 7, 9, 12, 73, 162, 181 Reagent, 167, 175, 181 Receptor, 14, 15, 22, 51, 63, 149, 152, 159, 181 Recombinant, 15, 181, 188 Rectum, 158, 161, 164, 168, 169, 170, 179, 181 Recur, 6, 13, 44, 63, 110, 181 Red blood cells, 109, 163, 181 Refer, 1, 91, 158, 167, 171, 181 Reflux, 99, 181 Refraction, 151, 181 Regimen, 4, 10, 87, 106, 162, 181 Relative risk, 4, 5, 7, 8, 181 Remission, 181 Renal failure, 25, 153, 181 Renal pelvis, 91, 170, 181 Renal tubular, 13, 30, 99, 160, 182 Renal tubular acidosis, 13, 99, 182 Repressor, 174, 182 Respiration, 156, 173, 182 Retina, 182 Retinal, 159, 182 Retinoids, 182, 189 Retrograde, 101, 182 Rod, 85, 153, 182 Rubber, 84, 149, 182 S Sarcoidosis, 44, 75, 109, 182 Scans, 101, 182 Scatter, 177, 183 Screening, 56, 157, 183 Secretion, 14, 22, 156, 165, 167, 183 Secretory, 14, 183 Segregation, 153, 183 Semen, 179, 183 Senile, 175, 183 Sensor, 16, 183 Sepsis, 11, 183 Serine, 47, 72, 183 Serum, 6, 8, 16, 33, 47, 53, 63, 150, 153, 158, 170, 175, 183 Sexually Transmitted Diseases, 102, 183 Side effect, 113, 116, 132, 149, 168, 183, 186 Signs and Symptoms, 132, 181, 183 Skeletal, 155, 173, 183

198 Kidney Stones

Skeleton, 169, 179, 183 Skin graft, 183, 184 Small intestine, 23, 156, 162, 167, 169, 183 Smooth muscle, 155, 167, 173, 183, 185 Sodium, 10, 12, 17, 20, 21, 22, 49, 70, 71, 72, 74, 87, 129, 166, 183 Soft tissue, 21, 183, 184 Specialist, 138, 184 Species, 16, 153, 163, 167, 180, 184, 185, 187, 189 Specificity, 10, 150, 184 Sperm, 157, 184 Spinal cord, 37, 42, 156, 157, 160, 172, 175, 176, 184 Spinal Cord Diseases, 175, 184 Spleen, 109, 171, 182, 184 Staging, 182, 184 Statistically significant, 4, 9, 184 Stents, 100, 184 Sterile, 8, 175, 184 Stimulant, 155, 167, 184 Stimulus, 162, 184, 186 Stomach, 23, 70, 149, 161, 163, 164, 167, 173, 176, 181, 183, 184 Stool, 158, 168, 170, 184 Stress, 4, 70, 98, 99, 100, 160, 164, 173, 175, 178, 182, 184 Stroke, 120, 156, 184 Struvite, 5, 8, 11, 13, 92, 97, 110, 122, 130, 131, 185 Styrene, 182, 185 Subacute, 168, 185 Subclinical, 168, 185 Subcutaneous, 162, 185 Subspecies, 184, 185 Substance P, 183, 185 Substrate, 14, 22, 162, 185 Suction, 84, 164, 185 Superoxide, 17, 185 Superoxide Dismutase, 17, 185 Supplementation, 72, 106, 185 Symphysis, 179, 185 Symptomatic, 3, 4, 5, 8, 11, 20, 32, 54, 185 Systemic, 4, 109, 114, 115, 152, 154, 163, 168, 178, 182, 185 Systemic disease, 4, 185 Systolic, 168, 185 T Tachycardia, 153, 185 Tachypnea, 153, 185 Terminator, 157, 185 Tetany, 175, 185

Theophylline, 180, 185 Therapeutics, 116, 186 Thermal, 151, 161, 186 Thoracic, 153, 161, 172, 186 Thorax, 149, 171, 186 Threonine, 183, 186 Threshold, 168, 186 Thrombin, 179, 186 Thrombomodulin, 179, 186 Thrombosis, 180, 184, 186 Thyroid, 175, 186, 187 Thyroid Gland, 175, 186 Thyroxine, 150, 177, 186 Tin, 156, 186 Tomography, 159, 182, 186 Tone, 186 Tonus, 186 Tooth Demineralization, 25, 186 Tooth Preparation, 149, 186 Topical, 28, 163, 167, 186 Toxic, iv, 20, 109, 162, 185, 186, 187 Toxicity, 109, 162, 186 Toxicology, 122, 187 Toxins, 109, 152, 168, 187 Transduction, 14, 187 Transfection, 154, 187 Transfusion, 11, 187 Translation, 150, 187 Translational, 187 Transplantation, 44, 137, 157, 187 Trauma, 29, 109, 166, 187 Treatment Outcome, 135, 187 Trees, 177, 182, 187 Triamterene, 57, 187 Tunica, 173, 187 Tyrosine, 26, 187 U Unconscious, 168, 187 Urea, 15, 16, 109, 154, 174, 187 Urease, 15, 16, 187 Uremia, 170, 181, 187 Ureter, 7, 12, 82, 85, 86, 87, 89, 90, 91, 97, 110, 130, 132, 134, 170, 171, 181, 187, 188 Ureteroscopy, 7, 9, 12, 188 Urethra, 85, 86, 153, 179, 188 Urinary tract infection, 15, 102, 110, 122, 133, 153, 188 Urinate, 129, 188 Urine, 3, 5, 6, 8, 9, 12, 13, 18, 23, 24, 27, 28, 35, 44, 47, 52, 58, 82, 83, 84, 86, 88, 89, 90, 98, 99, 100, 109, 110, 128, 129, 130,

Index 199

133, 134, 152, 153, 154, 155, 160, 162, 166, 168, 169, 170, 174, 175, 181, 187, 188 Urine Testing, 134, 188 Urogenital, 188 Urogenital Diseases, 188 Urolithiasis, 10, 16, 19, 20, 26, 28, 30, 55, 91, 133, 188 Urologic Diseases, 102, 127, 128, 132, 133, 137, 188 V Vaccine, 180, 188 Vascular, 168, 184, 186, 188 Vasoconstriction, 30, 163, 188 Vector, 187, 188 Vegetable Proteins, 177, 188 Vein, 169, 174, 175, 188 Venous, 180, 188 Ventricle, 159, 180, 185, 188 Vertebrae, 184, 189

Veterinary Medicine, 121, 189 Viral, 165, 187, 189 Virulence, 186, 189 Virus, 153, 165, 177, 187, 189 Vitamin A, 65, 132, 189 Vitro, 189 Vivo, 189 W Watchful waiting, 122, 189 X Xanthine, 150, 189 Xanthine Oxidase, 150, 189 Xenograft, 151, 189 X-ray, 36, 101, 159, 164, 169, 172, 174, 182, 189 Y Yeasts, 177, 189 Z Zymogen, 179, 189

200 Kidney Stones