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

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

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

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

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

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Leg Pain: 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: 0-597-84005-9 1. Leg Pain-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 leg pain. 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 LEG PAIN .................................................................................................. 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Leg Pain ........................................................................................ 5 The National Library of Medicine: PubMed .................................................................................. 7 CHAPTER 2. NUTRITION AND LEG PAIN ........................................................................................ 27 Overview...................................................................................................................................... 27 Finding Nutrition Studies on Leg Pain ....................................................................................... 27 Federal Resources on Nutrition ................................................................................................... 28 Additional Web Resources ........................................................................................................... 28 CHAPTER 3. ALTERNATIVE MEDICINE AND LEG PAIN .................................................................. 31 Overview...................................................................................................................................... 31 National Center for Complementary and Alternative Medicine.................................................. 31 Additional Web Resources ........................................................................................................... 32 General References ....................................................................................................................... 33 CHAPTER 4. CLINICAL TRIALS AND LEG PAIN ............................................................................... 35 Overview...................................................................................................................................... 35 Recent Trials on Leg Pain ............................................................................................................ 35 Keeping Current on Clinical Trials ............................................................................................. 36 CHAPTER 5. PATENTS ON LEG PAIN ............................................................................................... 39 Overview...................................................................................................................................... 39 Patent Applications on Leg Pain ................................................................................................. 39 Keeping Current .......................................................................................................................... 41 CHAPTER 6. BOOKS ON LEG PAIN................................................................................................... 43 Overview...................................................................................................................................... 43 Book Summaries: Online Booksellers........................................................................................... 43 The National Library of Medicine Book Index ............................................................................. 44 Chapters on Leg Pain ................................................................................................................... 44 CHAPTER 7. PERIODICALS AND NEWS ON LEG PAIN ..................................................................... 47 Overview...................................................................................................................................... 47 News Services and Press Releases................................................................................................ 47 Newsletter Articles ...................................................................................................................... 49 Academic Periodicals covering Leg Pain...................................................................................... 49 CHAPTER 8. RESEARCHING MEDICATIONS .................................................................................... 51 Overview...................................................................................................................................... 51 U.S. Pharmacopeia....................................................................................................................... 51 Commercial Databases ................................................................................................................. 52 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 55 Overview...................................................................................................................................... 55 NIH Guidelines............................................................................................................................ 55 NIH Databases............................................................................................................................. 57 Other Commercial Databases....................................................................................................... 59 APPENDIX B. PATIENT RESOURCES ................................................................................................. 61 Overview...................................................................................................................................... 61 Patient Guideline Sources............................................................................................................ 61 Finding Associations.................................................................................................................... 63 APPENDIX C. FINDING MEDICAL LIBRARIES .................................................................................. 65 Overview...................................................................................................................................... 65 Preparation................................................................................................................................... 65 Finding a Local Medical Library.................................................................................................. 65

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Medical Libraries in the U.S. and Canada ................................................................................... 65 ONLINE GLOSSARIES.................................................................................................................. 71 Online Dictionary Directories ..................................................................................................... 73 LEG PAIN DICTIONARY.............................................................................................................. 75 INDEX .............................................................................................................................................. 101

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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 leg pain 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 leg pain, 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 leg pain, 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 leg pain. 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 leg pain, 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 leg pain. 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 LEG PAIN Overview In this chapter, we will show you how to locate peer-reviewed references and studies on leg pain.

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

On-Again, Off-Again Leg Pain: What It Is and What to Do About It Source: Diabetes Self-Management. 12(3): 10-12, 14, 16. May-June 1995. Contact: Available from R.A. Rapaport Publishing, Inc. 150 West 22nd Street, New York, NY 10011. (800) 234-0923. Summary: This article describes intermittent claudication, a condition that causes cramping pains in the legs during exercise. Caused by peripheral vascular disease, this condition is more likely to occur in people with diabetes. Topics include the symptoms of intermittent claudication; diagnosis of the condition; common spots for obstructions caused by peripheral vascular disease; symptoms of peripheral vascular disease; diagnostic tests used to confirm peripheral vascular disease; risk factors, including cigarette smoking, hypertension, hyperlipidemia, obesity, and physical inactivity; the

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effects of diabetes on peripheral vascular disease; and treatment options, including drug therapy, reducing risk factors, chelation therapy, balloon angioplasty, and bypass surgery. One sidebar lists typical symptoms associated with intermittent claudication and lists other disorders that can be easily confused with the condition. 1 figure. •

Exercise-Related Lower Leg Pain: An Overview Source: Medicine and Science in Sports and Exercise. 32(3 Supplement): S1-S3. March Supplement 2000. Summary: This journal article provides health professionals with information on the etiology and diagnosis of exercise related lower leg pain (ERLLP). The most common presentation of ERLLP, which is an extremely common complaint among athletes, is shin pain. Shin pain generally occurs in one or more of the following structures: bone, periosteum, and muscle compartment. Overuse may cause muscle compartments to become swollen and painful. Two common compartment syndromes seen in runners are deep posterior compartment syndrome and anterior compartment syndrome. One of the major causes of ERLLP is abnormal biomechanics. Other causes are neural and vascular. Diagnosis of ERLLP involves taking a good history, performing a physical examination, and conducting appropriate diagnostic tests. Compartment syndrome, particularly the anterior and deep posterior compartments of the lower leg, may mimic a stress fracture since it also presents with exercise related pain. Other conditions that mimic stress fracture include traction periostitis and medial tibial stress syndrome. Referred pain from the lumbar spine and vascular pathology should always be considered in the differential diagnosis of ERLLP. Tumor and infection are two bony pathologies that can mimic stress fracture. 2 figures and 2 tables.

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Exercise-Related Lower Leg Pain: Vascular Source: Medicine and Science in Sports and Exercise. 32(3 Supplement): S34-S36. March Supplement 2000. Summary: This journal article uses two case studies to provide health professionals with information on the vascular aspects of exercise related lower leg pain. Although vascular pathology is rare in exercise related lower leg pain, it is an important cause of such pain in athletes. Both arterial entrapment and atherosclerotic vessel disease are causes of exercise induced leg pain. The first case study involved a 24 year old woman sprinter with a 1 year history of exercise related distal calf and Achilles pain. Noninvasive vascular tests revealed complete occlusion of the popliteal artery with forced active plantar flexion of the ankle. Magnetic resonance angiography confirmed the diagnosis of bilateral popliteal artery entrapment. Surgical removal of an abnormally large plantaris muscle significantly reduced the woman's symptoms and allowed her to return to competitive athletics. The second case study involved a 30 year old female triathlete who had presented earlier at the age of 23 with a history of exercise related right sided hamstring pain. She sought numerous treatments with no success. She continued to train and compete despite her symptoms for several years. Referral to a vascular surgeon who organized conventional angiography resulted in a finding of multiple endofibrotic lesions of the right external iliac artery. Treatment of the largest of the lesions with balloon catheter dilation resulted in improvement, but not resolution, of her symptoms. The article discusses both popliteal artery entrapment syndrome and endofibrotic disease in terms of their clinical presentation, diagnosis, and treatment. 13 references.

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

Project Title: CLINICAL MORPHOLOGY

IMPLICATIONS

OF

PERIPHERAL

PLAQUE

Principal Investigator & Institution: Ouriel, Kenneth; Surgery; Cleveland Clinic Lerner Col/Med-Cwru Cleveland, Oh 44195 Timing: Fiscal Year 2003; Project Start 22-SEP-2003; Project End 31-AUG-2008 Summary: (provided by applicant): Peripheral arterial disease (PAD) is found in almost 20% of the population aged 55 and older. It is responsible for incapacitating symptoms of leg pain when walking, culminating in amputation in a small proportion of patients. Further, the presence of PAD is a strong marker for future cardiovascular events such as myocardial infarction and stroke. Despite the clinical significance of PAD, it is under diagnosed and its pathobiology remains ill defined. While imaging studies play an integral role in the study of most disease processes, angiography, standard ultrasound examination, and even magnetic resonance imaging do not provide adequate resolution of the arterial wall to quantify and characterize the extent of vascular wall abnormalities or to track changes over time. Intravascular ultrasound (IVUS) technology is associated with spatial resolution of 80-100 fm radially and 150-200 fm circumferentially. As such, IVUS appears ideally suited to the quantification of vascular wall changes. Our group has studied IVUS in the characterization of coronary artery plaque morphology, correlating clinical signs and symptoms with atheroma burden and content. We propose similar studies in the peripheral arterial bed, quantifying the amount and composition of lower extremity arterial atheroma and relating these findings to the patients' clinical presentation and subsequent course. This goal will be accomplished through the completion of three separate but concurrent studies: (1) Histologic sections of fresh arterial segments from cadaver limbs and amputation specimens will be correlated with IVUS-derived radiofrequency data to quantify arterial plaque burden and composition (calcium, collagen, fibro-lipidic and necrotic components). (2) Patients undergoing standard lower extremity angiography for PAD will be studied with IVUS at the same sitting. IVUS findings will be correlated with demographic factors (age, gender, race) and symptom severity (claudication, rest pain, tissue loss). Patients will be followed for 2

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

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up to five years, and the occurrence of ischemic events (worsening of leg ischemia, need for intervention and re-intervention, and distant complications such as Mi and stroke) will be reconciled with the arterial wall content at the baseline examination. (3) A randomized, blinded clinical trial of high-dose atorvastatin vs. placebo will be performed in patients with intermittent claudication, based on our hypothesis that statin therapy will result in stabilization or regression of femoral artery plaque, differences best assessed with high resolution imaging studies. IVUS data will be collected at baseline and at 24 months. The primary endpoint will be the change in femoral arterial plaque volume; baseline arterial wall parameters will be assessed in the subgroup of stain responders vs. non-responders. The completion of these three investigations should yield a validated, high resolution, real time imaging study with which to assess risk and base treatment decisions in patients with PAD. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DIRECT NEUROTOXICITY OF LOCAL ANESTHETICS Principal Investigator & Institution: Johnson, Michael E.; Mayo Clinic Rochester 200 1St St Sw Rochester, Mn 55905 Timing: Fiscal Year 2001; Project Start 01-APR-2000; Project End 31-MAR-2003 Summary: The objective of this proposal is to determine the mechanism of direct neurotoxicity of spinal (intrathecal) lidocaine. Other local anesthetics have a risk of persistent lumbosacral neurotoxicity of approximately 1 in 10,000. Lidocaine at doses producing surgical anesthesia has an increased risk of approximately 1 in 200 via continuous spinal anesthesia, and approximately 1 in 1300 via single injection spinal anesthesia. Transient neurologic symptoms (TNS) of buttock and leg pain occur in 16-40 percent of patients receiving spinal lidocaine in multiple large studies. Lidocaine is also neurotoxic in an animal model that produces lower extremity anesthesia with 5 percent lidocaine, and in cell culture and in vitro nerve studies. To address the mechanism of this neurotoxicity, most studies will be conducted at the level of the single cell, using digitized video fluorescence microscopy, phase microscopy, and flow cytometry, with appropriate, specific, fluorescent probes. Immunoblotting and fluorogenic assays of fractionated cell lysates will also be utilized. The ND7 cell line, derived from rat dorsal root ganglion, will be used as a model system for neuronal injury. Two hypotheses will be tested as specific aims: (1) Lidocaine interferes with multiple mechanisms for maintaining normal cytoplasmic calcium (Ca2+cyt), causing an increase to toxic levels. Preliminary data show a marked effect of lidocaine to elevate Ca2+cyt (5-7 fold with 5 percent lidocaine; greater than 15 percent cell death within 60 min). The effect of lidocaine on possible mechanisms of Ca2+cyt elevation will be tested, including influx from extracellular buffer, release from endoplasmic reticulum, and release from mitochondria. The causal relationship of lidocaine-induced Ca2+cyt elevation to neurite injury, plasma membrane blebbing, and neuronal death by necrosis and apoptosis will be determined. (2) Lidocaine activates multiple mechanisms of mitochondrial injury. Preliminary data show a marked effect of lidocaine to decrease mitochondrial membrane potential deltapsi in whole cells. Potential mechanisms of decreased deltapsi by lidocaine will be tested: protonophoric mitochondrial uncoupling, inhibition of mitochondrial respiration, and induction of the mitochondrial permeability transition. The effect of lidocaine will also be tested on mitochondrially based mechanisms of cell death: release of mitochondrial cytochrome c, and caspase activation. The Ca2+cyt dependence of each mechanism of mitochondrial injury will be determined by experiments with and without Ca2+cyt clamped at a normal level. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: DOSE RESPONSE EVALUATION OF ILOPROST IN TREATMENT OF CLAUDICATION Principal Investigator & Institution: Porter, John M.; Oregon Health & Science University Portland, or 972393098 Timing: Fiscal Year 2001 Summary: The primary purpose of this study is to evaluate the effectiveness and safety of the drug iloprost while evaluating the dose response characteristics of iloprost in patients diagnosed with claudication (leg pain) secondary to PAOD. This difficulty is called peripheral arterial occlusive disease (PAOD) and is due to lack of adequate blood flow to the legs due to partially or completely blocked arteries. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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

A 16-year-old boy with purpura and leg pain. Author(s): Bingham AC, Kimura Y, Imundo L. Source: The Journal of Pediatrics. 2003 May; 142(5): 560-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12756390&dopt=Abstract

•

A 20-year-old army private with leg pain, fever, and collapse during a forced road march. Author(s): Sherner JH, Yuan CM. Source: Military Medicine. 2002 April; 167(4): 363-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11977892&dopt=Abstract

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

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A 30-year-old man with a mass in the distal left thigh and radiating leg pain. Author(s): Marushack MM, Merkel KD, Gilula LA. Source: Orthop Rev. 1994 May; 23(5): 454-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8041581&dopt=Abstract

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A 78-year-old woman with leg pain and weakness. Author(s): Rastegar DA, Castellani RJ. Source: The American Journal of the Medical Sciences. 2000 June; 319(6): 404-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10875298&dopt=Abstract

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A case of Crohn's disease with leg pain. Author(s): Jo Y, Matsumoto T, Nagamine R. Source: The British Journal of Radiology. 2001 February; 74(878): 203-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11718397&dopt=Abstract

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A community-based study of postmenopausal white women with back and leg pain: health status and limitations in physical activity. Author(s): Vogt MT, Lauerman WC, Chirumbole M, Kuller LH. Source: The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 2002 August; 57(8): M544-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12145370&dopt=Abstract

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A prospective study of diagnostic epidural blockade in the assessment of chronic back and leg pain. Author(s): Stanley D, Stockley I, Davies GK, Getty CJ. Source: Journal of Spinal Disorders. 1993 June; 6(3): 208-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8347969&dopt=Abstract

•

A series of consecutive cases of low back pain with radiating leg pain treated by chiropractors. Author(s): Stern PJ, Cote P, Cassidy JD. Source: Journal of Manipulative and Physiological Therapeutics. 1995 July-August; 18(6): 335-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7595106&dopt=Abstract

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Abdominal and leg pain in a twenty-three-month-old child. Author(s): Rosenbloom JS, Barton LL, Rekate HL. Source: The Pediatric Infectious Disease Journal. 1998 May; 17(5): 441-2, 443-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9613669&dopt=Abstract

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Ability of middle-school soccer players to localize overuse leg pain correctly using a graphic self-report form. Author(s): Gomez JE, Neufeld MD, Cosby BK. Source: Percept Mot Skills. 1996 February; 82(1): 335-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8668499&dopt=Abstract

•

An unusual extraspinal cause of bilateral leg pain. Author(s): Slipman CW, Rogers DP, Lipetz JS, Herzog R, Versilovic EJ, Jackson HB. Source: Archives of Physical Medicine and Rehabilitation. 1999 June; 80(6): 721-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10378503&dopt=Abstract

•

Ankle to brachial pressure index in normal subjects and trained cyclists with exercise-induced leg pain. Author(s): Taylor AJ, George KP. Source: Medicine and Science in Sports and Exercise. 2001 November; 33(11): 1862-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11689736&dopt=Abstract

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Ankle-brachial index and mortality in a cohort of questionnaire recorded leg pain on walking. Author(s): Jonsson B, Skau T. Source: European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery. 2002 November; 24(5): 405-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12435339&dopt=Abstract

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Assessment brings its own relief. Nursing care of individuals suffering from ischaemic leg pain. Author(s): Janman L. Source: Prof Nurse. 1993 May; 8(8): 524-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8483960&dopt=Abstract

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Assessment of functional status, low back disability, and use of diagnostic imaging in patients with low back pain and radiating leg pain. Author(s): Ren XS, Selim AJ, Fincke G, Deyo RA, Linzer M, Lee A, Kazis L. Source: Journal of Clinical Epidemiology. 1999 November; 52(11): 1063-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10527000&dopt=Abstract

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Back and leg pain in older adults. Presentation, diagnosis, and treatment. Author(s): Grobler LJ. Source: Clinics in Geriatric Medicine. 1998 August; 14(3): 543-76. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9664106&dopt=Abstract

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Back and leg pain secondary to abdominal aortic aneurysm. Author(s): Kramer PW. Source: Neurosurgery. 1980 December; 7(6): 626-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6451817&dopt=Abstract

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Bilateral buttock and leg pain after lidocaine epidural anesthesia. Author(s): Freedman JM, Rudow MP. Source: Anesthesia and Analgesia. 1999 May; 88(5): 1188. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10320197&dopt=Abstract

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Bilateral leg pain and bruising. Hypersensitivity vasculitis. Author(s): Miller DW, Norton VC. Source: Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine. 1997 September; 4(9): 916-7; 922-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9305435&dopt=Abstract

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Bilateral leg pain following lidocaine spinal anaesthesia. Author(s): Pinczower GR, Chadwick HS, Woodland R, Lowmiller M. Source: Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 1995 March; 42(3): 217-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7743573&dopt=Abstract

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Bizarre association of internal derangement of the temporomandibular joint with back and leg pain. Author(s): Williamson EH. Source: Facial Orthop Temporomandibular Arthrol. 1986 April; 3(4): 3-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2938982&dopt=Abstract

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By the way, doctor.I suffer from chronic leg pain that keeps me up at night. Doctors have been unsuccessful in diagnosing it, and I don't like taking lots of pain medication. Several people have suggested magnet therapy. Is there anything to this? Author(s): Goldfinger SE. Source: Harvard Health Letter / from Harvard Medical School. 1999 June; 24(8): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10233826&dopt=Abstract

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Case records of the Massachusetts General Medicine. Weekly clinicopathological exercises. Case 9-2003. An 18-year-old man with back and leg pain and a nondiagnostic biopsy specimen. Author(s): Friedmann AM, Oliva E, Zietman AL, Aquino SL. Source: The New England Journal of Medicine. 2003 March 20; 348(12): 1150-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12646672&dopt=Abstract

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Caudal epidural analgesia for neurogenic leg pain. Author(s): Driver-Jowitt JP. Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 1986 October 11; 70(8): 506-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3775595&dopt=Abstract

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Caudal epidural analgesia for neurogenic leg pain. Author(s): Scher MA. Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 1986 May 24; 69(11): 668. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3704851&dopt=Abstract

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Chronic leg pain - problem solved. Author(s): Chang S, Brow TD, Das SK. Source: European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery. 1999 July; 18(1): 89-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10388647&dopt=Abstract

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Chronic leg pain in an adolescent male. Author(s): Ferguson WS. Source: Medicine and Health, Rhode Island. 1999 November; 82(11): 407-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10618870&dopt=Abstract

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Chronic leg pain in athletes due to a recurrent compartment syndrome. Author(s): Martens MA, Backaert M, Vermaut G, Mulier JC. Source: The American Journal of Sports Medicine. 1984 March-April; 12(2): 148-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6742289&dopt=Abstract

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Chronic leg pain in the athlete. Author(s): Clanton TO, Solcher BW. Source: Clinics in Sports Medicine. 1994 October; 13(4): 743-59. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7805104&dopt=Abstract

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Chronic leg pain. Author(s): Chang S, Brow T, Das SK. Source: Postgraduate Medical Journal. 1998 July; 74(873): 431-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9799923&dopt=Abstract

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Chronic leg pain. Author(s): Detmer DE. Source: The American Journal of Sports Medicine. 1980 March-April; 8(2): 141-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7361985&dopt=Abstract

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Chronic lower leg pain in sport. Author(s): James T. Source: Aust Fam Physician. 1988 December; 17(12): 1041-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3240172&dopt=Abstract

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Clinical diagnosis of leg pain and nerve root involvement in low back disorders. Author(s): Waddell G. Source: Acta Orthop Belg. 1987; 53(2): 152-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2961192&dopt=Abstract

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Clinical images: leg pain and clubbing. Author(s): Yazici Y, Erkan D, Paget SA. Source: Arthritis and Rheumatism. 2000 February; 43(2): 472. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10693896&dopt=Abstract

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Clinical pearls: left leg pain and electrocardiographic ST-segment elevation. Author(s): Filley MJ. Source: Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine. 1999 September; 6(9): 921-2, 928-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10490255&dopt=Abstract

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Computed tomography, electrodiagnostic and clinical findings in chronic workers' compensation patients with back and leg pain. Author(s): Haldeman S, Shouka M, Robboy S. Source: Spine. 1988 March; 13(3): 345-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2968667&dopt=Abstract

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Correlation between the MRI changes in the lumbar multifidus muscles and leg pain. Author(s): Kader DF, Wardlaw D, Smith FW. Source: Clinical Radiology. 2000 February; 55(2): 145-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10657162&dopt=Abstract

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Counseling patients with leg pain. A review of peripheral vascular disease. Author(s): Ream I. Source: Nursing. 1977 October; 7(10): 54-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=242746&dopt=Abstract

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Cross leg pain and trunk list. Author(s): Khuffash B, Porter RW. Source: Spine. 1989 June; 14(6): 602-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2749374&dopt=Abstract

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Cyclosporin treatment in psoriatic arthritis: a cause of severe leg pain. Author(s): Lawson CA, Fraser A, Veale DJ, Emery P. Source: Annals of the Rheumatic Diseases. 2003 May; 62(5): 489. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12695169&dopt=Abstract

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Diagnostic approach to chronic exercise-induced leg pain. A review. Author(s): Hester JT. Source: Clin Podiatr Med Surg. 2001 April; 18(2): 285-306. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11417156&dopt=Abstract

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Differential diagnosis of leg pain in the athlete. Author(s): Fredericson M, Wun C. Source: Journal of the American Podiatric Medical Association. 2003 July-August; 93(4): 321-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12869603&dopt=Abstract

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Duration of leg pain as a predictor of outcome after surgery for lumbar disc herniation: a prospective cohort study with 1-year follow up. Author(s): Nygaard OP, Kloster R, Solberg T. Source: Journal of Neurosurgery. 2000 April; 92(2 Suppl): 131-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10763681&dopt=Abstract

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Effect of venous support on edema and leg pain in patients after coronary artery bypass graft surgery. Author(s): Liehr P, Todd B, Rossi M, Culligan M. Source: Heart & Lung : the Journal of Critical Care. 1992 January; 21(1): 6-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1735659&dopt=Abstract

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Erdheim Chester disease: a rare cause of knee and leg pain. Author(s): Sistermann R, Katthagen BD. Source: Archives of Orthopaedic and Trauma Surgery. 2000; 120(1-2): 112-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10653118&dopt=Abstract

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Evaluation of stress-related anterior lower leg pain with magnetic resonance imaging and intracompartmental pressure measurement. Author(s): Kiuru MJ, Mantysaari MJ, Pihlajamaki HK, Ahovuo JA. Source: Military Medicine. 2003 January; 168(1): 48-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12546246&dopt=Abstract

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Exercise and smoking habits in patients with and without low back and leg pain. Author(s): Nelson WA. Source: Journal of Manipulative and Physiological Therapeutics. 1988 April; 11(2): 134. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2968431&dopt=Abstract

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Exercise and smoking habits in patients with and without low back and leg pain. Author(s): Cox JM, Trier KK. Source: Journal of Manipulative and Physiological Therapeutics. 1987 October; 10(5): 239-45. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2961835&dopt=Abstract

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Exercise and smoking habits in patients with and without low back pain and leg pain. Author(s): Converse TA. Source: Journal of Manipulative and Physiological Therapeutics. 1988 August; 11(4): 337-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2971748&dopt=Abstract

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Exercise induced leg pain in young athletes misdiagnosed as pain of musculo-skeletal origin. Author(s): Taylor AJ, George KP. Source: Manual Therapy. 2001 February; 6(1): 48-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11243909&dopt=Abstract

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Exercise induced leg pain. Author(s): Kemp S, Batt M. Source: British Journal of Sports Medicine. 1997 June; 31(2): 164. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9192138&dopt=Abstract

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Exercise induced leg pain: chronic compartment syndrome. Is the increase in intracompartment pressure exercise specific? Author(s): Padhiar N, King JB. Source: British Journal of Sports Medicine. 1997 December; 31(4): 353. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9429022&dopt=Abstract

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Exercise induced leg pain-chronic compartment syndrome. Is the increase in intracompartment pressure exercise specific? Author(s): Padhiar N, King JB. Source: British Journal of Sports Medicine. 1996 December; 30(4): 360-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9015604&dopt=Abstract

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Exercise-induced leg pain. Author(s): Jonides LK. Source: Journal of Pediatric Health Care : Official Publication of National Association of Pediatric Nurse Associates & Practitioners. 1997 July-August; 11(4): 192, 202-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9281969&dopt=Abstract

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Exercise-induced lower leg pain. Author(s): Rochcongar P. Source: Rev Rhum Engl Ed. 1995 November; 62(10): 627-31. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8624671&dopt=Abstract

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Exercise-related chronic lower leg pain. Author(s): Locke S. Source: Aust Fam Physician. 1999 June; 28(6): 569-73. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10399389&dopt=Abstract

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Exercise-related leg pain: neurological perspective. Author(s): McCrory P. Source: Medicine and Science in Sports and Exercise. 2000 March; 32(3 Suppl): S11-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10730990&dopt=Abstract

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Exercise-related lower leg pain: an overview. Author(s): Brukner P. Source: Medicine and Science in Sports and Exercise. 2000 March; 32(3 Suppl): S1-3. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10730988&dopt=Abstract

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Exercise-related lower leg pain: bone. Author(s): Brukner P. Source: Medicine and Science in Sports and Exercise. 2000 March; 32(3 Suppl): S15-26. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10730991&dopt=Abstract

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Exercise-related lower leg pain: vascular. Author(s): Schep G, Bender M. Source: Medicine and Science in Sports and Exercise. 2000 November; 32(11): 1970-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11079530&dopt=Abstract

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Exercise-related lower leg pain: vascular. Author(s): Bradshaw C. Source: Medicine and Science in Sports and Exercise. 2000 March; 32(3 Suppl): S34-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10730993&dopt=Abstract

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Fever and leg pain in a 42-month-old. Author(s): Waibel KH, Regis DP, Uzel G, Rosenzweig SD, Holland SM. Source: Annals of Allergy, Asthma & Immunology : Official Publication of the American College of Allergy, Asthma, & Immunology. 2002 September; 89(3): 239-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12269642&dopt=Abstract

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Girl with a cough and leg pain. Author(s): Walsh S. Source: Journal of Pediatric Health Care : Official Publication of National Association of Pediatric Nurse Associates & Practitioners. 2001 January-February; 15(1): 41, 45-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11174663&dopt=Abstract

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Groin and leg pain after cancer surgery. Author(s): Weingarten NM, Musher D. Source: Hosp Pract. 1980 September; 15(9): 25-6, 30. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7409791&dopt=Abstract

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Hypokalaemia presenting with leg pain in Bartter's syndrome. Author(s): Bold AM, Elias J, Jenner B, Timms P, Bouskill KC. Source: Lancet. 1984 October 27; 2(8409): 989. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6149387&dopt=Abstract

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Iatrogenic and functional leg pain. Author(s): DeWolfe VG. Source: Geriatrics. 1973 September; 28(9): 60-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4125261&dopt=Abstract

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Idiopathic lumbosacral neuropathy: a cause of persistent leg pain. Author(s): Hinchey JA, Preston DC, Logigian EL. Source: Muscle & Nerve. 1996 November; 19(11): 1484-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8874408&dopt=Abstract

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Idiopathic spinal cord herniation in the thoracic spine as a cause of intractable leg pain: case report and review of the literature. Author(s): Sasaoka R, Nakamura H, Yamano Y. Source: Journal of Spinal Disorders & Techniques. 2003 June; 16(3): 288-94. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12792345&dopt=Abstract

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Intramuscular pressures in exercise-induced lower leg pain. Author(s): Wallensten R, Eriksson E. Source: International Journal of Sports Medicine. 1984 February; 5(1): 31-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6698681&dopt=Abstract

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Intrathecal infusion systems for treatment of chronic low back and leg pain of noncancer origin. Author(s): Tutak U, Doleys DM. Source: Southern Medical Journal. 1996 March; 89(3): 295-300. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8604459&dopt=Abstract

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Laparoscopic findings, management, histopathology, and outcome of 25 women with cyclic leg pain. Author(s): Vilos GA, Vilos AW, Haebe JJ. Source: The Journal of the American Association of Gynecologic Laparoscopists. 2002 May; 9(2): 145-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11960038&dopt=Abstract

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Lateral leg pain in a 26-year-old woman. Author(s): Kuklo TR, Islinger RB, Shekitka KM, Temple HT. Source: Clinical Orthopaedics and Related Research. 1997 July; (340): 276-80, 287-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9224266&dopt=Abstract

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Leg pain after sacral neuromodulation: anatomical considerations. Author(s): Swinn MJ, Schott GD, Oliver SE, Kitchen ND, Fowler CJ. Source: Bju International. 1999 December; 84(9): 1113-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10571653&dopt=Abstract

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Leg pain and kidney disease in a 38-year-old man. Author(s): Hariharan R, Fred HL. Source: Hosp Pract (Off Ed). 1996 July 15; 31(7): 119-20. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8682877&dopt=Abstract

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Leg pain and numbness in an elderly man. Author(s): Marsh CB, Mazzaferri EL. Source: Hosp Pract (Off Ed). 1995 January 15; 30(1): 59, 63. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7822447&dopt=Abstract

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Leg pain and platelet aggregates in thrombocythemic myeloproliferative disease. Author(s): Salem HH, van der Weyden MB, Koutts J, Firkin BG. Source: Jama : the Journal of the American Medical Association. 1980 September 5; 244(10): 1122-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7411766&dopt=Abstract

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Leg pain and swelling in a 14 1/2-year-old boy. Author(s): Akbarnia H, Ganley TJ, Dormans JP, Mahboubi S, Finn LS. Source: Clinical Orthopaedics and Related Research. 1998 July; (352): 250-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9678054&dopt=Abstract

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Leg pain and swelling in an HIV-infected drug abuser. Author(s): Formica R, Perazella MA. Source: Hosp Pract (Off Ed). 1998 October 15; 33(10): 195-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9793550&dopt=Abstract

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Leg pain associated with subgluteal lipoma. Author(s): Wouda EJ, Vanneste JA. Source: Neurology. 1993 October; 43(10): 2149-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8413989&dopt=Abstract

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Leg pain following syringomyelia of conus medullaris. Author(s): Vanneste J, Van der Bent M. Source: Spine. 1990 May; 15(5): 434-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2363073&dopt=Abstract

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Leg pain in a patient with chronic hepatitis C. Author(s): Sizemore J, Mitre E. Source: Lancet. 2001 February 10; 357(9254): 440. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11273065&dopt=Abstract

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Leg pain in an 11-year-old boy. Author(s): Barbera C, Tornetta P 3rd, Vigorita VJ, Zilles M, Etienne G. Source: Clinical Orthopaedics and Related Research. 1999 June; (363): 264-7, 270-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10379331&dopt=Abstract

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Leg pain in the rural Iowa 65+ population. Prevalence, related factors, and association with functional status. Author(s): Herr KA, Mobily PR, Wallace RB, Chung Y. Source: The Clinical Journal of Pain. 1991 June; 7(2): 114-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1809417&dopt=Abstract

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Leg pain with a periosteal and endosteal reaction. Author(s): Belzunegui J, Maiz O, Lopez L, Gonzalez C, Figueroa M. Source: Arthritis and Rheumatism. 1997 February; 40(2): 385-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9041951&dopt=Abstract

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Leg pain with activity. Author(s): Swischuk LE. Source: Pediatric Emergency Care. 1993 February; 9(1): 53-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8488148&dopt=Abstract

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Leg pain: an uncommon presentation of perforated diverticular disease. Author(s): Haiart DC, Stevenson P, Hartley RC. Source: Journal of the Royal College of Surgeons of Edinburgh. 1989 February; 34(1): 1720. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2709351&dopt=Abstract

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Long-term intrathecal infusion of drug combinations for chronic back and leg pain. Author(s): Rainov NG, Heidecke V, Burkert W. Source: Journal of Pain and Symptom Management. 2001 October; 22(4): 862-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11576803&dopt=Abstract

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Low back and leg pain. Author(s): Schurman DJ, Nagel DA. Source: Primary Care. 1974 December; 1(4): 549-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4283594&dopt=Abstract

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Lower leg pain. Diagnosis and treatment of compartment syndromes and other pain syndromes of the leg. Author(s): Touliopolous S, Hershman EB. Source: Sports Medicine (Auckland, N.Z.). 1999 March; 27(3): 193-204. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10222542&dopt=Abstract

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Lumbar spine stenosis: a common cause of back and leg pain. Author(s): Alvarez JA, Hardy RH Jr. Source: American Family Physician. 1998 April 15; 57(8): 1825-34, 1839-40. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9575322&dopt=Abstract

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Manipulative therapy in lower back pain with leg pain and neurological deficit. Author(s): Bergmann TF, Jongeward BV. Source: Journal of Manipulative and Physiological Therapeutics. 1998 May; 21(4): 288-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9608384&dopt=Abstract

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MR imaging of exercise-induced lower leg pain. Author(s): Brown RR, Rosenberg ZS. Source: Magn Reson Imaging Clin N Am. 2001 August; 9(3): 533-52, X. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11694425&dopt=Abstract

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Myelographic defect on the side opposite the leg pain. A case report with an explanation of mechanism of action. Author(s): Auld AW, DeWall JG. Source: Spine. 1979 March-April; 4(2): 174-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=264033&dopt=Abstract

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Night leg pain in the elderly. Author(s): Herr KA. Source: Geriatric Nursing (New York, N.Y.). 1992 January-February; 13(1): 13-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1317806&dopt=Abstract

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Nocturnal leg pain that defied year of therapy. Author(s): Murray BJ. Source: Hosp Pract (Off Ed). 1983 December; 18(12): 22-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6196278&dopt=Abstract

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Nonfocal scintigraphic lesions in military recruits with lower leg pain. Author(s): Goldfarb R, Ongseng F, Finestone H, Wasserman I. Source: Clinical Orthopaedics and Related Research. 1988 December; (237): 286-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3191637&dopt=Abstract

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Non-period leg pain in patients with familial Mediterranean fever. Author(s): Dinc A. Source: Annals of the Rheumatic Diseases. 2000 May; 59(5): 400. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10836960&dopt=Abstract

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Nursing decisions: experiences in clinical problem solving. A postsurgical patient with leg pain. Author(s): de Tornyay R, Stillman MJ. Source: Rn. 1975 October; 38(10): 25-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1041414&dopt=Abstract

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Pathologic quiz case: a 26-year-old man with intermittent lower leg pain. Author(s): Islam S, Conley R, Sheridan T, Zaher A. Source: Archives of Pathology & Laboratory Medicine. 2003 July; 127(7): E311-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12823067&dopt=Abstract

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Persistent back and leg pain. Author(s): Simeone FA. Source: Neurosurgery. 1979 October; 5(4): 533-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=160512&dopt=Abstract

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Piriformis as leg pain cause. Author(s): Godfrey R. Source: Hosp Pract (Off Ed). 1991 September 15; 26(9): 10. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1894712&dopt=Abstract

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Pitfalls in the diagnosis of leg pain. Author(s): Provan JL, Moreau P, MacNab I. Source: Can Med Assoc J. 1979 July 21; 121(2): 167-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=229951&dopt=Abstract

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Pitfalls in the diagnosis of low-back and leg pain. Author(s): Rymer MM, Kao CC. Source: Postgraduate Medicine. 1974 July; 56(1): 76-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4365993&dopt=Abstract

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Problems of aging: diagnosing and treating leg pain due to arteriosclerosis obliterans. Author(s): Moylan JA. Source: Postgraduate Medicine. 1975 October; 58(4): 135-41. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1099566&dopt=Abstract

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Prognostic factors of spinal cord stimulation for chronic back and leg pain. Author(s): Burchiel KJ, Anderson VC, Wilson BJ, Denison DB, Olson KA, Shatin D. Source: Neurosurgery. 1995 June; 36(6): 1101-10; Discussion 1110-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7643988&dopt=Abstract

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Prompt re-exploration for persistent leg pain following disc surgery: a surgical viewpoint. Author(s): Auld AW. Source: Military Medicine. 1977 November; 142(11): 876-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=412130&dopt=Abstract

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Prospective outcome evaluation of spinal cord stimulation in patients with intractable leg pain. Author(s): Ohnmeiss DD, Rashbaum RF, Bogdanffy GM. Source: Spine. 1996 June 1; 21(11): 1344-50; Discussion 1351. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8725927&dopt=Abstract

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Prostate cancer with leg pain. Author(s): Imbriaco M, Yeung H, Narajanan G, Divgi C. Source: Journal of Nuclear Medicine : Official Publication, Society of Nuclear Medicine. 1998 May; 39(5): 5A, 932. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9591565&dopt=Abstract

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Psoas sheath chemical neurolysis for management of intractable leg pain from metastatic liposarcoma. Author(s): Calava JM, Patt RB, Reddy S, Varma DG, Chiang J. Source: The Clinical Journal of Pain. 1996 March; 12(1): 69-75. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8722739&dopt=Abstract

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Radiating leg pain and positive straight leg raising in spondylolysis in children. Author(s): Halperin N, Copeliovitch L, Schachner E. Source: Journal of Pediatric Orthopedics. 1983 September; 3(4): 486-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6226678&dopt=Abstract

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Radiating leg pain in the older patient. Author(s): Thorne RP, Curd JG. Source: Hosp Pract (Off Ed). 1991 March 15; 26(3): 61-4, 69-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1900853&dopt=Abstract

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Radiofrequency facet denervation. A treatment alternative in refractory low back pain with or without leg pain. Author(s): Rashbaum RF. Source: The Orthopedic Clinics of North America. 1983 July; 14(3): 569-75. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6223259&dopt=Abstract

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Recalcitrant chronic low back and leg pain--a new theory and different approach to management. Author(s): McConnell J. Source: Manual Therapy. 2002 November; 7(4): 183-92. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12481782&dopt=Abstract

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Relationship of the Pain Disability Index (PDI) and the Oswestry Disability Questionnaire (ODQ) with three dynamic physical tests in a group of patients with chronic low-back and leg pain. Author(s): Gronblad M, Jarvinen E, Hurri H, Hupli M, Karaharju EO. Source: The Clinical Journal of Pain. 1994 September; 10(3): 197-203. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7833577&dopt=Abstract

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Repeated episodes of transient radiating back and leg pain following spinal anesthesia with 1.5% mepivacaine and 2% lidocaine. Author(s): Liguori GA, Zayas VM. Source: Regional Anesthesia and Pain Medicine. 1998 September-October; 23(5): 511-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9773707&dopt=Abstract

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Respiratory distress and leg pain. Author(s): Sagarin MJ, Brown DF, Nadel ES. Source: The Journal of Emergency Medicine. 2000 January; 18(1): 95-100. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10645846&dopt=Abstract

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Sensitivity and specificity of dural sac and herniated disc dimensions in patients with low back-related leg pain. Author(s): Pneumaticos SG, Hipp JA, Esses SI. Source: Journal of Magnetic Resonance Imaging : Jmri. 2000 September; 12(3): 439-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10992311&dopt=Abstract

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Severe leg pain in an HIV-positive man. Author(s): Zuger A. Source: Aids Clin Care. 1999 December; 11(12): 98-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11366713&dopt=Abstract

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Spinal cord stimulation in low back and leg pain. Author(s): Meglio M, Cioni B, Visocchi M, Tancredi A, Pentimalli L. Source: Stereotactic and Functional Neurosurgery. 1994; 62(1-4): 263-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7631079&dopt=Abstract

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Spinal cord stimulation versus spinal infusion for low back and leg pain. Author(s): Hassenbusch SJ, Stanton-Hicks M, Covington EC. Source: Acta Neurochir Suppl (Wien). 1995; 64: 109-15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8748596&dopt=Abstract

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Spinal stenosis and ischaemic leg pain. Author(s): Morris T. Source: N Z Med J. 1989 May 24; 102(868): 260. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2726051&dopt=Abstract

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Spinal stenosis and ischaemic leg pain. Author(s): Maling PB. Source: N Z Med J. 1989 April 26; 102(866): 197. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2710450&dopt=Abstract

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Temporary back and leg pain after bupivacaine and morphine spinal anaesthesia. Author(s): Ong B, Baker C. Source: Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 1995 September; 42(9): 805-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7497563&dopt=Abstract

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Temporary increase in leg pain resulting from lumbar sympathetic blockade. Author(s): Johnson PW, Carpenter RL. Source: Pain. 1990 August; 42(2): 201-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2247317&dopt=Abstract

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The child with acute leg pain. Author(s): Sty JR, Wells RG, Smith WB. Source: Semin Nucl Med. 1988 April; 18(2): 137-58. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3291127&dopt=Abstract

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The importance of radiating leg pain in assessing health outcomes among patients with low back pain. Results from the Veterans Health Study. Author(s): Selim AJ, Ren XS, Fincke G, Deyo RA, Rogers W, Miller D, Linzer M, Kazis L. Source: Spine. 1998 February 15; 23(4): 470-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9516703&dopt=Abstract

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The long-term effect of popliteal vein ligation in 136 cases of severe bursting lower leg pain and oedema. Author(s): Bauer G. Source: The Journal of Cardiovascular Surgery. 1965 July-August; 6(4): 366-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5828243&dopt=Abstract

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The prevalence of chronic chest and leg pain following cardiac surgery: a historical cohort study. Author(s): Bruce J, Drury N, Poobalan AS, Jeffrey RR, Smith WC, Chambers WA. Source: Pain. 2003 July; 104(1-2): 265-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12855337&dopt=Abstract

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The results of surgery for low back and leg pain due to presumptive prolapsed intervertebral disc. Author(s): Dunkerley GE. Source: Postgraduate Medical Journal. 1971 February; 47(544): 120-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4252236&dopt=Abstract

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The therapeutic impact of lumbar spine MRI on patients with low back and leg pain. Author(s): Rankine JJ, Gill KP, Hutchinson CE, Ross ER, Williamson JB. Source: Clinical Radiology. 1998 September; 53(9): 688-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9766723&dopt=Abstract

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The three-phase bone scan and exercise induced lower-leg pain. The tibial stress test. Author(s): Samuelson DR, Cram RL. Source: Clinical Nuclear Medicine. 1996 February; 21(2): 89-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8697697&dopt=Abstract

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The value of 99Tcm-MDP bone scans in young patients with exercise-induced lower leg pain. Author(s): Allen MJ, O'Dwyer FG, Barnes MR, Belton IP, Finlay DB. Source: Nuclear Medicine Communications. 1995 February; 16(2): 88-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7731623&dopt=Abstract

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The value of MR neurography for evaluating extraspinal neuropathic leg pain: a pictorial essay. Author(s): Moore KR, Tsuruda JS, Dailey AT. Source: Ajnr. American Journal of Neuroradiology. 2001 April; 22(4): 786-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11290501&dopt=Abstract

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Therapeutic efficacy of selective nerve root blocks in the treatment of lumbar radicular leg pain. Author(s): Narozny M, Zanetti M, Boos N. Source: Swiss Medical Weekly : Official Journal of the Swiss Society of Infectious Diseases, the Swiss Society of Internal Medicine, the Swiss Society of Pneumology. 2001 February 10; 131(5-6): 75-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11383229&dopt=Abstract

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Tibial periosteal reactions in soldiers. A scintigraphic study of 29 cases of lower leg pain. Author(s): Nielsen MB, Hansen K, Holmer P, Dyrbye M. Source: Acta Orthopaedica Scandinavica. 1991 December; 62(6): 531-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1767641&dopt=Abstract

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Traumatic occlusion of the external iliac artery in a racing cyclist: a cause of ill defined leg pain. Author(s): Taylor AJ, Tennant WG, Batt ME, Wallace WA. Source: British Journal of Sports Medicine. 1997 June; 31(2): 155-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9192134&dopt=Abstract

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Treadmill ambulation with partial body weight support for the treatment of low back and leg pain. Author(s): Joffe D, Watkins M, Steiner L, Pfeifer BA. Source: The Journal of Orthopaedic and Sports Physical Therapy. 2002 May; 32(5): 20213; Discussion 213-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12014824&dopt=Abstract

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Treatment of discogenic back and leg pain based on differentiation of symptomcomplex according to traditional Chinese medicine. Author(s): Jiang WZ, Zhou W, Zhao YG, Li YM, Zheng GC, Meng WC, Zou BZ. Source: J Tradit Chin Med. 1986 December; 6(4): 267-72. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2955173&dopt=Abstract

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Unexplained lower leg pain in a 19-year-old. Author(s): Molitor L. Source: Journal of Emergency Nursing: Jen : Official Publication of the Emergency Department Nurses Association. 1985 March-April; 11(2): 113-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3884868&dopt=Abstract

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Unknown case #1. A 61-year-old women who had undergone a renal transplant in 1991 reported back and bilateral leg pain. Author(s): Herzog RJ, Slipman CW. Source: Spine. 1998 June 1; 23(11): 1287. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9729169&dopt=Abstract

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Vibrio vulnificus sepsis presenting as leg pain and lower extremity rash. Author(s): Koenig KL, Mueller J, Rose T. Source: The American Journal of Emergency Medicine. 1991 September; 9(5): 523-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1863312&dopt=Abstract

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Visual analog scales for interpretation of back and leg pain intensity in patients operated for degenerative lumbar spine disorders. Author(s): Zanoli G, Stromqvist B, Jonsson B. Source: Spine. 2001 November 1; 26(21): 2375-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11679824&dopt=Abstract

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What happens to patients with non-vascular leg pain? Author(s): Varty K, van Dorpe J, St Johnston JA, Campbell WB. Source: Bmj (Clinical Research Ed.). 1991 December 14; 303(6816): 1516. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1782493&dopt=Abstract

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CHAPTER 2. NUTRITION AND LEG PAIN Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and leg pain.

Finding Nutrition Studies on Leg Pain 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.4 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 “leg pain” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

4

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

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

Spinal cord stimulation versus spinal infusion for low back and leg pain. Author(s): Department of Neurosurgery, M.D. Anderson Cancer Center Houston, Texas, USA. Source: Hassenbusch, S J Stanton Hicks, M Covington, E C Acta-Neurochir-Suppl(Wien). 1995; 64109-15 0065-1419

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/

Nutrition

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

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

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

Food and Diet Low Back Pain Source: Healthnotes, Inc.; www.healthnotes.com

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

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to leg pain 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 “leg pain” (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 leg pain: •

A series of consecutive cases of low back pain with radiating leg pain treated by chiropractors. Author(s): Stern PJ, Cote P, Cassidy JD. Source: Journal of Manipulative and Physiological Therapeutics. 1995 July-August; 18(6): 335-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7595106&dopt=Abstract

•

By the way, doctor.I suffer from chronic leg pain that keeps me up at night. Doctors have been unsuccessful in diagnosing it, and I don't like taking lots of pain medication. Several people have suggested magnet therapy. Is there anything to this? Author(s): Goldfinger SE. Source: Harvard Health Letter / from Harvard Medical School. 1999 June; 24(8): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10233826&dopt=Abstract

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Exercise and smoking habits in patients with and without low back and leg pain. Author(s): Cox JM, Trier KK. Source: Journal of Manipulative and Physiological Therapeutics. 1987 October; 10(5): 239-45. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2961835&dopt=Abstract

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Exercise and smoking habits in patients with and without low back and leg pain. Author(s): Nelson WA. Source: Journal of Manipulative and Physiological Therapeutics. 1988 April; 11(2): 134. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2968431&dopt=Abstract

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Exercise and smoking habits in patients with and without low back pain and leg pain. Author(s): Converse TA. Source: Journal of Manipulative and Physiological Therapeutics. 1988 August; 11(4): 337-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2971748&dopt=Abstract

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Manipulative therapy in lower back pain with leg pain and neurological deficit. Author(s): Bergmann TF, Jongeward BV. Source: Journal of Manipulative and Physiological Therapeutics. 1998 May; 21(4): 288-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9608384&dopt=Abstract

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Treatment of discogenic back and leg pain based on differentiation of symptomcomplex according to traditional Chinese medicine. Author(s): Jiang WZ, Zhou W, Zhao YG, Li YM, Zheng GC, Meng WC, Zou BZ. Source: J Tradit Chin Med. 1986 December; 6(4): 267-72. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2955173&dopt=Abstract

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

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

•


•

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

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

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

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

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

Alternative Medicine 33

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

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

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

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

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

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

The following is a specific Web list relating to leg pain; 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 Atherosclerosis and Heart Disease Prevention Source: Prima Communications, Inc.www.personalhealthzone.com Intermittent Claudication Source: Healthnotes, Inc.; www.healthnotes.com

•

Herbs and Supplements Aesculus Alternative names: Horse Chestnut; Aesculus hippocastanum L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Amino Acids Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10003,00.html Butcher's Broom Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10010,00.html Ginkgo Alternative names: Ginkgo biloba Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org

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

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This Web site provides a general overview of various topics and can lead to a number of general sources.

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

Recent Trials on Leg Pain The following is a list of recent trials dedicated to leg pain.5 Further information on a trial is available at the Web site indicated. •

Study of Remodulin in Patients with Critical Limb Ischemia With No Planned Revascularization Procedures Condition(s): Critical Limb Ischemia; Peripheral Vascular Disease; Foot Ulcers; Rest Leg Pain Study Status: This study is currently recruiting patients. Sponsor(s): United Therapeutics Purpose - Excerpt: The purpose of this study is to assess and compare the safety of continuous and daily subcutaneous Remodulin therapy in patients with critical limb ischemia (CLI) with no planned vascular interventional procedures; and to determine the effect of Remodulin on wound healing and treadmill walk distance. Phase(s): Phase II; Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00060996

5

These are listed at www.ClinicalTrials.gov.

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

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

•

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

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

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

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

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

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

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

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

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

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

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

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

Clinical Trials 37

•

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

•

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

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CHAPTER 5. PATENTS ON LEG PAIN 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.6 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 “leg pain” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on leg pain, we have not necessarily excluded non-medical patents in this bibliography.

Patent Applications on Leg Pain As of December 2000, U.S. patent applications are open to public viewing.7 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 leg pain:

6Adapted

from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm. 7 This has been a common practice outside the United States prior to December 2000.

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•

Novel early intervention spinal treatment methods and devices for use therein Inventor(s): Pellegrino, Richard C.; (Mendon, MA), Reynolds, Martin; (Mansfield, MA) Correspondence: Audley A. Ciamporcero JR.; Johnson & Johnson; One Johnson & Johnson Plaza; New Brunswick; NJ; 08933-7003; US Patent Application Number: 20030181963 Date filed: March 21, 2002 Abstract: There is provided a device for therapeutically treating back or leg pain, comprising:a) a probe having a proximal portion and a distal portion,b) first and second treatment sources, each source located in the distal portion of the probe,wherein the first treatment source is adapted to therapeutically treat a first tissue site, the second treatment source is adapted to therapeutically treat a second different tissue site, andwherein the first and second different tissue sites are selected from the group consisting of:i) a first intervertebral disc,ii) a first vertebra,iii) a first spinal ligament, andiv) a first spinal facet joint capsule,v) a second intervertebral disc,vi) a second vertebra,vii) a second spinal ligament, andviii) a second spinal facet joint capsule. Excerpt(s): One of the leading causes of spine-related pain is the rupture or degeneration of discs located between lumbar vertebrae ("lumbar intervertebral discs"). Pain in the lower extremities may be caused by compression of spinal nerve roots by such damaged discs, while low back pain may be caused by collapse of these discs and by the adverse effects of bearing weight through a damaged, unstable vertebral joint. One conventional method of managing this problem is to treat the problematic intervertebral disc with energy. In some instances, the disc is globally heated. U.S. Pat. No. 5,433,739 ("Sluitjer I") proposes inserting an RF electrode or other heating electrode into the intervertebral disc and globally heating the entire intervertebral disc to a temperature significantly above body temperature. See col. 2, lines 52-56. Sluijter I teaches that this process can denervate the neural structures within the disc on a global or semi-global basis, thus relieving the patient of back pain related to stress of the disc and its surface. See col. 5, line 65-col. 6, line 2. Sluijter I further notes that the precise anatomical mechanism of this pain relieving process has not been totally clarified, and discloses not only that anatomical material changes within the disc material itself and the resulting volumetric changes may play some role, but also that the spread of heat to large neural structures in the proximity of the disc may be additional contributory factors of significance. See col. 13, lines 28-37. In some instances, only the nucleus of the disc is treated. For example, Choy et al., Spine, 17:8 (1992), pp. 949-956, discloses using a laser to evaporate the nucleus pulposus. It is believed that evaporation of the nucleus reduces the pressure within the disc, thereby relieving the pressure upon the nerves therein. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

•

Restraint and exercise device Inventor(s): Hoffman, Jonathan; (Sunnyvale, CA) Correspondence: Morgan Lewis & Bockius Llp; 1111 Pennsylvania Avenue NW; Washington; DC; 20004; US Patent Application Number: 20020183177 Date filed: May 31, 2002

Patents 41

Abstract: A restraint and exercise device is provided to treat acute or chronic mechanical pain, particularly lumbopelvic and/or leg pain, and to restore and/or increase range of motion in suitable users. The device is particularly useful during exercise. The device may contain a restraint, such as two straps, connected to a support structure. The straps help restrain a portion of a person's body such as the pelvic region. The portion of the person's body may be restrained in a substantially pain-free position so as to reduce the pain that would otherwise be felt during exercise. Excerpt(s): This invention generally relates to a restraint device. Various implementations of the invention are envisioned, including its use as a lumbopelvic restraint device during exercise to relieve pain and/or restore range of motion in lower back, pelvis, and leg pain suffers or in healthy persons who wish to restore or increase their range of motion. It may also be used to treat pain and/or restore or increase range of motion in the neck, shoulders, upper back, middle back and other body parts. In the human anatomy, the lower spine, known as the lumbar spine, is joined to the pelvic bone at a joint known as the sacro-iliac joint. The sacro-iliac joint is a relatively stiff or rigid joint. The upper leg bone, known as the femur, is joined to the pelvic bone at the hip joint by means of hip ligaments. Only a limited degree of movement of the lumbar spine relative to the pelvis is possible at the sacro-iliac joint, due to the relatively stiff or rigid nature of this joint. Thus, in general, upon movement of the lumbar spine in any direction, at least some of this movement is translated into a movement of the pelvis at the hip joint. This is because the hip joint is relatively free-moving in comparison to the stiff sacro-iliac joint. Upon movement of the leg, at least some of the hip ligaments start to wind up. When these hip ligaments are fully wound up, further movement of the leg is translated into a movement of the pelvis. A major and longstanding health problem that spans the world is acute or chronic back pain. A countless number of people suffer from pain in the lumbopelvic region including their lower back and hip. The causes of back pain are too numerous to enumerate, but include injuries, bad posture, accidents, genetic defects, disease, and aging. For some, the pain arises only during exercise. As a result, many eliminate beneficial exercises from their routines. For others, hip and/or lower back pain is always present. Exercise may be a desirable or a necessary treatment for the pain for many of these people. But again, the very exercises needed to alleviate the pain are difficult to perform due to the increased pain during exercise. These people often become stuck in a depressing cycle of increasing pain as the exercises and treatments needed to alleviate pain are too painful to perform, with the lack of proper exercise resulting in weakening of the muscles and increased pain and/or discomfort. The amount of money and effort spent on trying to cure back problems and/or alleviate the pain and/or discomfort is staggering. Modem medical attempts to address these issues, including drugs, surgery, traction, manual mobilization and exercise, are costly and have met with little success. There is no doubt there is a longstanding need for a safe, reliable and cost effective way to solve the problems associated with lumbopelvic back pain and disorders. Also, there is no doubt that the numerous attempts by others to meet this need and solve these problems have largely been failures. 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 leg pain, 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,

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and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “leg pain” (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 leg pain. You can also use this procedure to view pending patent applications concerning leg pain. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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

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

Chiropractic Manual of Low Back and Leg Pain by James Enos Thomas; ISBN: 0838510965; http://www.amazon.com/exec/obidos/ASIN/0838510965/icongroupinterna

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Leg Pain by Craig Donaldson (2004); ISBN: 1405116455; http://www.amazon.com/exec/obidos/ASIN/1405116455/icongroupinterna

•

Low Back and Leg Pain by James M. Cox (1988); ISBN: 096164883X; http://www.amazon.com/exec/obidos/ASIN/096164883X/icongroupinterna

•

Low Back and Leg Pain for Herniated Cervical Disk: New Method of Diagnosis and Conservative Treatment by Herman Kabat (1980); ISBN: 0875272460; http://www.amazon.com/exec/obidos/ASIN/0875272460/icongroupinterna

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The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “leg pain” (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:8 •

Low back and leg pain from slipped disc in the neck: instruction manual for patients Author: Kabat, Herman,; Year: 1983; St. Louis, Mo.: W.H. Green, c1983; ISBN: 0875272991 http://www.amazon.com/exec/obidos/ASIN/0875272991/icongroupinterna

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

Regional Problems of the Arm and Leg in Children Source: in Maddison, P.J.; et al., Eds. Oxford Textbook of Rheumatology. Volume 1. New York, NY: Oxford University Press, Inc. 1993. p. 80-85. Contact: Available from Oxford University Press, Inc., New York, NY. Summary: This chapter for health professionals describes regional problems of the arm and leg in children. The causes of regional musculoskeletal pain in children are highlighted. Regional pain syndromes of the shoulder, the elbow, the wrist, and the hand seen in children are identified. Common causes of generalized leg pains in children are discussed, including growing pains, shin splints, stress fractures, and unequal leg length. The features of various childhood disorders of the hip, the knee, the foot, and the ankle are described. In addition, generalized conditions that can present as regional musculoskeletal pain syndromes are discussed, including fibromyalgia. 31 references and 5 tables.

8

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

Books

•

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Symptoms of Disorders of the Genitourinary Tract Source: in Tanagho, E.A. and McAninch, J.W., eds. Smith's General Urology. Fifteenth Edition. Columbus, OH: McGraw-Hill, Inc. 2000. p. 31-40. Contact: Available from McGraw-Hill. Medical Publishing. 1221 P.O. Box 182615, Columbus, OH 43272-5046. (800) 262-4729. PRICE: $54.95;plus shipping and handling. ISBN: 0838586074. Summary: This chapter on symptoms of disorders of the genitourinary tract is from a textbook that offers a practical and concise guide to the understanding, diagnosis, and treatment of urologic diseases. The author notes that in the workup of any patient, the history is of paramount importance; this is particularly true in urology. The author discusses only those urologic symptoms that are apt to be brought to the physician's attention by the patient. It is important to know not only whether the disease is acute or chronic, but also whether it is recurrent, since recurring symptoms may represent acute exacerbations (worsening) of chronic disease. The author covers systemic manifestations, local and referred pain, kidney pain, pseudorenal pain (radiculitis), ureteral pain, vesical pain, prostatic pain, testicular pain, epididymal pain, back and leg pain, gastrointestinal symptoms of urologic diseases, symptoms related to the act of urination, frequency, nocturia (getting up at night to urinate), urgency, dysuria (painful urination), enuresis (bedwetting), symptoms of bladder outlet obstruction, urinary incontinence (involuntary loss of urine), oliguria (reduction of amount of urine), anuria (no urination), pneumaturia (gas in the urine), cloudy urine, chyluria (lymphatic fluid in the urine), bloody urine (hematuria), urethral discharge in men, skin lesions of the external genitalia, visible or palpable masses, edema (fluid accumulation), bloody ejaculation, gynecomastia (enlarged breasts), size of penis, infertility, and complaints related to sexual problems. The chapter concludes with references categorized by subject. 3 figures. 32 references.

•

Section Six: Knee and Lower Leg Source: in Greene, W.B., Ed. Essentials of Musculoskeletal Care. 2nd ed. Rosemont, IL: American Academy of Orthopaedic Surgeons (AAOS). 2001. p. 340-405. Contact: Available from American Academy of Orthopaedic Surgeons (AAOS). 6300 North River Road, Rosemont, IL 60018-4262. (800) 626-6726 (toll-free) or (847) 823-7186. Fax (800) 823-8025 (toll-free) or (847) 823-8025. E-mail: [email protected]. Website: www.aaos.org. PRICE: $105.00 for nonmembers; $90.00 AAOS members; $80.00 for residents; plus shipping and handling. ISBN 0892032170. Summary: This section of a book on musculoskeletal care provides health professionals with information on common conditions affecting the knee and lower leg, including acute and chronic or repetitive injuries and degenerative, inflammatory, or idiopathic conditions. The section begins with information on the principles of evaluating and examining a patient presenting with a knee or lower leg complaint, focusing on inspection, palpation, range of motion, muscle testing, and special testing. This is followed by a description of an anterior cruciate, collateral, and posterior cruciate ligament tear; arthritis and bursitis of the knee; bipartite patella; fractures about the knee; a meniscal tear; osteochondritis dissecans; osteonecrosis of the femoral condyle; patellofemoral instability and malalignment; patellofemoral pain; patellar or quadriceps tendinitis; plica syndrome; popliteal cyst; prepatellar bursitis; and quadriceps and patella tendon ruptures. Information includes synonyms for and red flags associated with each condition; the definition, clinical symptoms, diagnosis, differential diagnosis, adverse outcomes, and treatment of the condition; diagnostic tests; and adverse

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treatment outcomes. Other topics include acute and chronic leg pain and knee joint aspiration and injection. 48 figures. •

Chapter 39-D: Pediatric Rheumatic Diseases: Pain Syndromes Source: in Klippel, J.H., et al., eds. Primer on the Rheumatic Diseases. 12th ed. Atlanta, GA: Arthritis Foundation. 2001. p. 548-554. Contact: Available from Arthritis Foundation. P.O. Box 1616, Alpharetta, GA 300091616. (800) 207-8633. Fax (credit card orders only) (770) 442-9742. Website: www.arthritis.org. PRICE: $69.95 plus shipping and handling. ISBN: 0912423293. Summary: This section of a chapter on pediatric rheumatic diseases provides health professionals with information on pain syndromes. All children experience pain except those with congenital indifference to it. Although most pain is of short duration and due to noxious stimuli, chronic or recurrent musculoskeletal pain can be caused by inflammation, trauma, or psychological distress. There are various presentations of childhood chronic musculoskeletal pain, including generalized and localized hypermobility, growing pains, and amplified musculoskeletal pain syndromes. Hypermobility syndrome, which usually occurs in children aged 3 to 10, is characterized by intermittent nocturnal leg pain. Although reassurance is the main treatment for hypermobility, supportive footwear and an evening dose of acetaminophen or a nonsteroidal antiinflammatory drug may be helpful. The most common areas affected by hypermobility are the pes planus, genu recurvatum, and patella. Hypermobility is treated with exercise, orthotics, and, sometimes, surgery. There are various pain amplification syndromes affecting children. These syndromes are on a continuum and frequently overlap. The etiology of amplified musculoskeletal pain in children is unknown. Some possible causes include injury, illness, and psychological distress. Factors such as age, gender, hormones, and genetics may have a role. Diagnosis is based on medical history and a physical examination. A common form of treatment for any of the pain amplification syndromes is aggressive exercise therapy. Psychotherapy may also benefit many children. Musculoskeletal pain in children may be a manifestation of other diseases, including malignancies that affect the bones or bone marrow, endocrine disorders, and genetic disorders of collagen metabolism. 4 tables and 26 references.

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CHAPTER 7. PERIODICALS AND NEWS ON LEG PAIN Overview In this chapter, we suggest a number of news sources and present various periodicals that cover leg pain.

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

Marrow cells may ease heart patients' leg pain Source: Reuters Health eLine Date: November 18, 2002

•

"Legs for Life" aims to diagnose leg pain Source: Reuters Health eLine Date: September 17, 1999

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•

FDA approves drug for leg pain Source: Reuters Health eLine Date: January 18, 1999 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 “leg pain” (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 “leg pain” (or synonyms). If you know the name of a company that is relevant to leg pain, 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 “leg pain” (or synonyms).

Periodicals and News

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

Spinal Stenosis: Low Back Pain May be Degenerative Disease Source: Mayo Clinic Women's Health Source. 5(12): 6. December 2001. Contact: Available from Mayo Clinic Women's Health Source. 200 First Street SW, Rochester, MN 55905. (800) 876-8633 or (303) 604-1465. Email: [email protected]. Summary: This newsletter article presents information on spinal stenosis to patients with low back pain. Spinal stenosis is a narrowing of the spinal canal, most often caused by osteoarthritis, resulting in back and lower leg pain. Symptoms may include pain, numbness, or tingling. Diagnosing spinal stenosis may require magenetic resonance imaging, computerized tomography, or myelography. Treatment depends upon the severity and cause of the problem and includes physical therapy, NSAIDs, and bracing. In severe cases surgery to relieve compression on the spine is performed.

Academic Periodicals covering Leg Pain Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to leg pain. In addition to these sources, you can search for articles covering leg pain 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 leg pain. 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 DI Advice for the Patient can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with leg pain. 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 leg pain: Cilostazol •

Systemic - U.S. Brands: Pletal http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500026.html

Pentoxifylline •

Systemic - U.S. Brands: Trental http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202450.html

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

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

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APPENDICES

55

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 Institute9: •

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/

9

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

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•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.10 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:11 •

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

10

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

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•

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

•

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

The NLM Gateway12 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.13 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “leg pain” (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 6352 54 1000 17 1 7424

HSTAT14 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.15 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.16 Simply search by “leg pain” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

12

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

13

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

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

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

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Coffee Break: Tutorials for Biologists17 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.18 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.19 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

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

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

•

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

17 Adapted 18

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

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 19 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 leg pain 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 leg pain. 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 leg pain. 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 “leg pain”:

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•

Other guides Hip Injuries and Disorders http://www.nlm.nih.gov/medlineplus/hipinjuriesanddisorders.html Knee Injuries and Disorders http://www.nlm.nih.gov/medlineplus/kneeinjuriesanddisorders.html Leg Injuries and Disorders http://www.nlm.nih.gov/medlineplus/leginjuriesanddisorders.html Spinal Stenosis http://www.nlm.nih.gov/medlineplus/spinalstenosis.html

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

Lumbar Spinal Canal Stenosis: A Common Guide of Back and Leg Pain Source: American Academy of Family Physicians. March 2003. 2 p. Contact: Available online from American Academy of Family Physicians. Website: http://familydoctor.org. Summary: This fact sheet provides patients with information about lumbar spine canal stenosis, a condition characterized by a narrowing of the space in the lower spine that carries nerves to the legs. Symptoms include constant back and leg pain, numbness, and weakness. Neural claudication is often associated with lumbar canal stenosis. The symptoms of neural leg claudication are cramping, tiredness, or weakness that gets worse with activity. Treatment options for lumbar spine canal stenosis include exercise, physical therapy, anti-inflammatory drugs, and surgery. 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:

Patient Resources

•

63

Lumbar Spinal Canal Stenosis: A Common Cause of Back and Leg Pain Summary: A general overview on lumbar spinal canal stenosis that includes a definition of the disorder, diagnosis and treatment. Source: American Academy of Family Physicians http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6247 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 leg pain. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •


•

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

•

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

•

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

•

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

•

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

•

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

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

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

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

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.20

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

20

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)21: •

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

•

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

•

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

•

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

•

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

•

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

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

21

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

Finding Medical Libraries

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•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

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•

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

•

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

•

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

Finding Medical Libraries

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•

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

•

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Basic Guidelines for Leg Pain Leg pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003182.htm

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Signs & Symptoms for Leg Pain Back pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003108.htm Fatigue Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003088.htm Fever Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003090.htm Leg cramps Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003193.htm

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Muscle Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003193.htm Muscle spasm Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003193.htm Numbness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003206.htm Numbness and tingling Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003206.htm Paralysis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003190.htm Shin splints Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003177.htm Tingling Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003206.htm Weakness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003174.htm •

Diagnostics and Tests for Leg Pain Arteriogram Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003327.htm Duplex Doppler/ultrasound exam of extremity Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003433.htm X-ray Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003337.htm

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Background Topics for Leg Pain Blood clots Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001124.htm Exercise Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001941.htm Fracture Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000001.htm Medial Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002255.htm Pain medications Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002123.htm

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Physical examination Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002274.htm Relieved by Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002288.htm Strain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000042.htm Thrombi Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001124.htm

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

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

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

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

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LEG PAIN DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Acetaminophen: Analgesic antipyretic derivative of acetanilide. It has weak antiinflammatory properties and is used as a common analgesic, but may cause liver, blood cell, and kidney damage. [NIH] Adaptability: Ability to develop some form of tolerance to conditions extremely different from those under which a living organism evolved. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Aerobic: In biochemistry, reactions that need oxygen to happen or happen when oxygen is present. [NIH] Afferent: Concerned with the transmission of neural impulse toward the central part of the nervous system. [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]

Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alkaline: Having the reactions of an alkali. [EU] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] 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] Amplification: The production of additional copies of a chromosomal DNA sequence, found as either intrachromosomal or extrachromosomal DNA. [NIH] Amputation: Surgery to remove part or all of a limb or appendage. [NIH] Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] 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

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of surgery or other painful procedures. [NIH] Anesthetics: Agents that are capable of inducing a total or partial loss of sensation, especially tactile sensation and pain. They may act to induce general anesthesia, in which an unconscious state is achieved, or may act locally to induce numbness or lack of sensation at a targeted site. [NIH] Angiography: Radiography of blood vessels after injection of a contrast medium. [NIH] Angioplasty: Endovascular reconstruction of an artery, which may include the removal of atheromatous plaque and/or the endothelial lining as well as simple dilatation. These are procedures performed by catheterization. When reconstruction of an artery is performed surgically, it is called endarterectomy. [NIH] Animal model: An animal with a disease either the same as or like a disease in humans. Animal models are used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Ankle: That part of the lower limb directly above the foot. [NIH] Anterior Compartment Syndrome: Rapid swelling, increased tension, pain, and ischemic necrosis of the muscles of the anterior tibial compartment of the leg, often following excessive exertion. [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] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Antipyretic: An agent that relieves or reduces fever. Called also antifebrile, antithermic and febrifuge. [EU] Anuria: Inability to form or excrete urine. [NIH] Aorta: The main trunk of the systemic arteries. [NIH] Aortic Aneurysm: Aneurysm of the aorta. [NIH] Aponeurosis: Tendinous expansion consisting of a fibrous or membranous sheath which serves as a fascia to enclose or bind a group of muscles. [NIH] Apoptosis: One of the two mechanisms by which cell death occurs (the other being the pathological process of necrosis). Apoptosis is the mechanism responsible for the physiological deletion of cells and appears to be intrinsically programmed. It is characterized by distinctive morphologic changes in the nucleus and cytoplasm, chromatin cleavage at regularly spaced sites, and the endonucleolytic cleavage of genomic DNA (DNA fragmentation) at internucleosomal sites. This mode of cell death serves as a balance to mitosis in regulating the size of animal tissues and in mediating pathologic processes associated with tumor growth. [NIH]

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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] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Arteriolosclerosis: Sclerosis and thickening of the walls of the smaller arteries (arterioles). Hyaline arteriolosclerosis, in which there is homogeneous pink hyaline thickening of the arteriolar walls, is associated with benign nephrosclerosis. Hyperplastic arteriolosclerosis, in which there is a concentric thickening with progressive narrowing of the lumina may be associated with malignant hypertension, nephrosclerosis, and scleroderma. [EU] Arteriosclerosis: Thickening and loss of elasticity of arterial walls. Atherosclerosis is the most common form of arteriosclerosis and involves lipid deposition and thickening of the intimal cell layers within arteries. Additional forms of arteriosclerosis involve calcification of the media of muscular arteries (Monkeberg medial calcific sclerosis) and thickening of the walls of small arteries or arterioles due to cell proliferation or hyaline deposition (arteriolosclerosis). [NIH] Arteriosclerosis Obliterans: Arteriosclerosis in which proliferation of the intima leads to occlusion of the lumen of the arteries. [NIH] Articular: Of or pertaining to a joint. [EU] Ascites: Accumulation or retention of free fluid within the peritoneal cavity. [NIH] Aspiration: The act of inhaling. [NIH] Autonomic: Self-controlling; functionally independent. [EU] Axons: Nerve fibers that are capable of rapidly conducting impulses away from the neuron cell body. [NIH] Back Pain: Acute or chronic pain located in the posterior regions of the trunk, including the thoracic, lumbar, sacral, or adjacent regions. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacteriophage: A virus whose host is a bacterial cell; A virus that exclusively infects bacteria. It generally has a protein coat surrounding the genome (DNA or RNA). One of the coliphages most extensively studied is the lambda phage, which is also one of the most important. [NIH] Basal Ganglia: Large subcortical nuclear masses derived from the telencephalon and located in the basal regions of the cerebral hemispheres. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Benign tumor: A noncancerous growth that does not invade nearby tissue or spread to other

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parts of the body. [NIH] Bilateral: Affecting both the right and left side of body. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biomechanics: The study of the application of mechanical laws and the action of forces to living structures. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biopsy specimen: Tissue removed from the body and examined under a microscope to determine whether disease is present. [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 pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bone scan: A technique to create images of bones on a computer screen or on film. A small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it collects in the bones and is detected by a scanner. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Brachial: All the nerves from the arm are ripped from the spinal cord. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Breakdown: A physical, metal, or nervous collapse. [NIH] Bupivacaine: A widely used local anesthetic agent. [NIH] Bursitis: Inflammation of a bursa, occasionally accompanied by a calcific deposit in the underlying supraspinatus tendon; the most common site is the subdeltoid bursa. [EU]

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Bypass: A surgical procedure in which the doctor creates a new pathway for the flow of body fluids. [NIH] Cadaver: A dead body, usually a human body. [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] 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] Cardiac: Having to do with the heart. [NIH] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Caspase: Enzyme released by the cell at a crucial stage in apoptosis in order to shred all cellular proteins. [NIH] Catheterization: Use or insertion of a tubular device into a duct, blood vessel, hollow organ, or body cavity for injecting or withdrawing fluids for diagnostic or therapeutic purposes. It differs from intubation in that the tube here is used to restore or maintain patency in obstructions. [NIH] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [EU] Causal: Pertaining to a cause; directed against a cause. [EU] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Death: The termination of the cell's ability to carry out vital functions such as metabolism, growth, reproduction, responsiveness, and adaptability. [NIH] Cell proliferation: An increase in the number of cells as a result of cell growth and cell division. [NIH] Cell Respiration: The metabolic process of all living cells (animal and plant) in which oxygen is used to provide a source of energy for the cell. [NIH] Cell Size: The physical dimensions of a cell. It refers mainly to changes in dimensions correlated with physiological or pathological changes in cells. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH] Character: In current usage, approximately equivalent to personality. The sum of the

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relatively fixed personality traits and habitual modes of response of an individual. [NIH] Chelation: Combination with a metal in complexes in which the metal is part of a ring. [EU] Chelation Therapy: Therapy of heavy metal poisoning using agents which sequester the metal from organs or tissues and bind it firmly within the ring structure of a new compound which can be eliminated from the body. [NIH] Choroid: The thin, highly vascular membrane covering most of the posterior of the eye between the retina and sclera. [NIH] Chromatin: The material of chromosomes. It is a complex of DNA, histones, and nonhistone proteins (chromosomal proteins, non-histone) found within the nucleus of a cell. [NIH] Chromosomal: Pertaining to chromosomes. [EU] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic Disease: Disease or ailment of long duration. [NIH] Claudication: Limping or lameness. [EU] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Clubbing: A proliferative change in the soft tissues about the terminal phalanges of the fingers or toes, with no constant osseous changes. [NIH] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Collapse: 1. A state of extreme prostration and depression, with failure of circulation. 2. Abnormal falling in of the walls of any part of organ. [EU] Compartment Syndromes: Conditions in which increased pressure within a limited space compromises the circulation and function of tissue within that space. Compartmentation involves mainly the leg but also involved are the forearm, arm, thigh, shoulder, and buttock. Some of the causes of increased pressure are trauma, tight dressings, hemorrhage, and exercise. Sequelae include nerve compression, paralysis, and contracture. [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.

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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] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Computed tomography: CT scan. A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized tomography and computerized axial tomography (CAT) scan. [NIH] Computerized axial tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called CAT scan, computed tomography (CT scan), or computerized tomography. [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] Conjugated: Acting or operating as if joined; simultaneous. [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] Constriction: The act of constricting. [NIH] Continuum: An area over which the vegetation or animal population is of constantly changing composition so that homogeneous, separate communities cannot be distinguished.

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[NIH]

Contracture: A condition of fixed high resistance to passive stretch of a muscle, resulting from fibrosis of the tissues supporting the muscles or the joints, or from disorders of the muscle fibres. [EU] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] 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] Conus: A large, circular, white patch around the optic disk due to the exposing of the sclera as a result of degenerative change or congenital abnormality in the choroid and retina. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Artery Bypass: Surgical therapy of ischemic coronary artery disease achieved by grafting a section of saphenous vein, internal mammary artery, or other substitute between the aorta and the obstructed coronary artery distal to the obstructive lesion. [NIH] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Corpus: The body of the uterus. [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] Cytochrome: Any electron transfer hemoprotein having a mode of action in which the transfer of a single electron is effected by a reversible valence change of the central iron atom of the heme prosthetic group between the +2 and +3 oxidation states; classified as cytochromes a in which the heme contains a formyl side chain, cytochromes b, which contain protoheme or a closely similar heme that is not covalently bound to the protein, cytochromes c in which protoheme or other heme is covalently bound to the protein, and cytochromes d in which the iron-tetrapyrrole has fewer conjugated double bonds than the hemes have. Well-known cytochromes have been numbered consecutively within groups and are designated by subscripts (beginning with no subscript), e.g. cytochromes c, c1, C2, . New cytochromes are named according to the wavelength in nanometres of the absorption maximum of the a-band of the iron (II) form in pyridine, e.g., c-555. [EU] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Databases, Bibliographic: Extensive collections, reputedly complete, of references and citations to books, articles, publications, etc., generally on a single subject or specialized subject area. Databases can operate through automated files, libraries, or computer disks. The concept should be differentiated from factual databases which is used for collections of data and facts apart from bibliographic references to them. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Deletion: A genetic rearrangement through loss of segments of DNA (chromosomes), bringing sequences, which are normally separated, into close proximity. [NIH] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH]

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Diagnosis, Differential: Determination of which one of two or more diseases or conditions a patient is suffering from by systematically comparing and contrasting results of diagnostic measures. [NIH] Diagnostic Imaging: Any visual display of structural or functional patterns of organs or tissues for diagnostic evaluation. It includes measuring physiologic and metabolic responses to physical and chemical stimuli, as well as ultramicroscopy. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Dilatation: The act of dilating. [NIH] Dilation: A process by which the pupil is temporarily enlarged with special eye drops (mydriatic); allows the eye care specialist to better view the inside of the eye. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] 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] Dorsal: 1. Pertaining to the back or to any dorsum. 2. Denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Dorsum: A plate of bone which forms the posterior boundary of the sella turcica. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Dysuria: Painful or difficult urination. [EU] 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] Ejaculation: The release of semen through the penis during orgasm. [NIH] Elasticity: Resistance and recovery from distortion of shape. [NIH] Elastin: The protein that gives flexibility to tissues. [NIH] Elbow Joint: A hinge joint connecting the forearm to the arm. [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] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the latter being a high-energy biproduct of nuclear decay. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Endarterectomy:

Surgical

excision,

performed

under

general

anesthesia,

of

the

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atheromatous tunica intima of an artery. When reconstruction of an artery is performed as an endovascular procedure through a catheter, it is called atherectomy. [NIH] Endocrine Glands: Ductless glands that secrete substances which are released directly into the circulation and which influence metabolism and other body functions. [NIH] Enuresis: Involuntary discharge of urine after the age at which urinary control should have been achieved; often used alone with specific reference to involuntary discharge of urine occurring during sleep at night (bed-wetting, nocturnal enuresis). [EU] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzymes: Biological molecules that possess catalytic activity. They may occur naturally or be synthetically created. Enzymes are usually proteins, however catalytic RNA and catalytic DNA molecules have also been identified. [NIH] Epidermis: Nonvascular layer of the skin. It is made up, from within outward, of five layers: 1) basal layer (stratum basale epidermidis); 2) spinous layer (stratum spinosum epidermidis); 3) granular layer (stratum granulosum epidermidis); 4) clear layer (stratum lucidum epidermidis); and 5) horny layer (stratum corneum epidermidis). [NIH] Epidural: The space between the wall of the spinal canal and the covering of the spinal cord. An epidural injection is given into this space. [NIH] Epidural block: An injection of an anesthetic drug into the space between the wall of the spinal canal and the covering of the spinal cord. [NIH] Epoprostenol: A prostaglandin that is biosynthesized enzymatically from prostaglandin endoperoxides in human vascular tissue. It is a potent inhibitor of platelet aggregation. The sodium salt has been also used to treat primary pulmonary hypertension. [NIH] Erectile: The inability to get or maintain an erection for satisfactory sexual intercourse. Also called impotence. [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]

Excitation: An act of irritation or stimulation or of responding to a stimulus; the addition of energy, as the excitation of a molecule by absorption of photons. [EU] Excrete: To get rid of waste from the body. [NIH] Exercise Therapy: Motion of the body or its parts to relieve symptoms or to improve function, leading to physical fitness, but not physical education and training. [NIH] Expiration: The act of breathing out, or expelling air from the lungs. [EU] Extracellular: Outside a cell or cells. [EU] Extremity: A limb; an arm or leg (membrum); sometimes applied specifically to a hand or foot. [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] Femoral: Pertaining to the femur, or to the thigh. [EU] Femoral Artery: The main artery of the thigh, a continuation of the external iliac artery. [NIH]

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Femoral Vein: The vein accompanying the femoral artery in the same sheath; it is a continuation of the popliteal vein and becomes the external iliac vein. [NIH] Femur: The longest and largest bone of the skeleton, it is situated between the hip and the knee. [NIH] Fibula: The bone of the lower leg lateral to and smaller than the tibia. In proportion to its length, it is the most slender of the long bones. [NIH] Flatus: Gas passed through the rectum. [NIH] Flexion: In gynaecology, a displacement of the uterus in which the organ is bent so far forward or backward that an acute angle forms between the fundus and the cervix. [EU] Flow Cytometry: Technique using an instrument system for making, processing, and displaying one or more measurements on individual cells obtained from a cell suspension. Cells are usually stained with one or more fluorescent dyes specific to cell components of interest, e.g., DNA, and fluorescence of each cell is measured as it rapidly transverses the excitation beam (laser or mercury arc lamp). Fluorescence provides a quantitative measure of various biochemical and biophysical properties of the cell, as well as a basis for cell sorting. Other measurable optical parameters include light absorption and light scattering, the latter being applicable to the measurement of cell size, shape, density, granularity, and stain uptake. [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] Fluorescent Dyes: Dyes that emit light when exposed to light. The wave length of the emitted light is usually longer than that of the incident light. Fluorochromes are substances that cause fluorescence in other substances, i.e., dyes used to mark or label other compounds with fluorescent tags. They are used as markers in biochemistry and immunology. [NIH] Fold: A plication or doubling of various parts of the body. [NIH] Foramen: A natural hole of perforation, especially one in a bone. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Fossa: A cavity, depression, or pit. [NIH] Fundus: The larger part of a hollow organ that is farthest away from the organ's opening. The bladder, gallbladder, stomach, uterus, eye, and cavity of the middle ear all have a fundus. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Ganglion: 1. A knot, or knotlike mass. 2. A general term for a group of nerve cell bodies located outside the central nervous system; occasionally applied to certain nuclear groups within the brain or spinal cord, e.g. basal ganglia. 3. A benign cystic tumour occurring on a aponeurosis or tendon, as in the wrist or dorsum of the foot; it consists of a thin fibrous capsule enclosing a clear mucinous fluid. [EU] 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] 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]

Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Genital: Pertaining to the genitalia. [EU] Genitourinary: Pertaining to the genital and urinary organs; urogenital; urinosexual. [EU] Gliosis: The production of a dense fibrous network of neuroglia; includes astrocytosis, which is a proliferation of astrocytes in the area of a degenerative lesion. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Grafting: The operation of transfer of tissue from one site to another. [NIH] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Half-Life: The time it takes for a substance (drug, radioactive nuclide, or other) to lose half of its pharmacologic, physiologic, or radiologic activity. [NIH] Health Status: The level of health of the individual, group, or population as subjectively assessed by the individual or by more objective measures. [NIH] Heart 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] Heme: The color-furnishing portion of hemoglobin. It is found free in tissues and as the prosthetic group in many hemeproteins. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hepatitis: Inflammation of the liver and liver disease involving degenerative or necrotic alterations of hepatocytes. [NIH] Hepatocytes: The main structural component of the liver. They are specialized epithelial cells that are organized into interconnected plates called lobules. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Herniated: Protrusion of a degenerated or fragmented intervertebral disc into the intervertebral foramen compressing the nerve root. [NIH] Homogeneous: Consisting of or composed of similar elements or ingredients; of a uniform quality throughout. [EU] Hormones: Chemical substances having a specific regulatory effect on the activity of a certain organ or organs. The term was originally applied to substances secreted by various endocrine glands and transported in the bloodstream to the target organs. It is sometimes extended to include those substances that are not produced by the endocrine glands but that have similar effects. [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]

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Hydroxylysine: A hydroxylated derivative of the amino acid lysine that is present in certain collagens. [NIH] Hydroxyproline: A hydroxylated form of the imino acid proline. A deficiency in ascorbic acid can result in impaired hydroxyproline formation. [NIH] Hyperlipidemia: An excess of lipids in the blood. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [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] Iloprost: An eicosanoid, derived from the cyclooxygenase pathway of arachidonic acid metabolism. It is a stable and synthetic analog of epoprostenol, but with a longer half-life than the parent compound. Its actions are similar to prostacyclin. Iloprost produces vasodilation and inhibits platelet aggregation. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] 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] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Infertility: The diminished or absent ability to conceive or produce an offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU]

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Intervertebral: Situated between two contiguous vertebrae. [EU] Intervertebral Disk Displacement: An intervertebral disk in which the nucleus pulposus has protruded through surrounding fibrocartilage. This occurs most frequently in the lower lumbar region. [NIH] Intestines: The section of the alimentary canal from the stomach to the anus. It includes the large intestine and small intestine. [NIH] Intracellular: Inside a cell. [NIH] Intrathecal: Describes the fluid-filled space between the thin layers of tissue that cover the brain and spinal cord. Drugs can be injected into the fluid or a sample of the fluid can be removed for testing. [NIH] Intravenous: IV. Into a vein. [NIH] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

Involuntary: Reaction occurring without intention or volition. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Joint Capsule: The sac enclosing a joint. It is composed of an outer fibrous articular capsule and an inner synovial membrane. [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] 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] 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] Lesion: An area of abnormal tissue change. [NIH] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Lidocaine: A local anesthetic and cardiac depressant used as an antiarrhythmia agent. Its actions are more intense and its effects more prolonged than those of procaine but its duration of action is shorter than that of bupivacaine or prilocaine. [NIH] Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Ligation: Application of a ligature to tie a vessel or strangulate a part. [NIH] Lipid: Fat. [NIH]

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Lipoma: A benign tumor composed of fat cells. [NIH] Liposarcoma: A rare cancer of the fat cells. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Low Back Pain: Acute or chronic pain in the lumbar or sacral regions, which may be associated with musculo-ligamentous sprains and strains; intervertebral disk displacement; and other conditions. [NIH] Lumbar: Pertaining to the loins, the part of the back between the thorax and the pelvis. [EU] 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] 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] Mammary: Pertaining to the mamma, or breast. [EU] Medial: Lying near the midsaggital plane of the body; opposed to lateral. [NIH] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Menopause: Permanent cessation of menstruation. [NIH] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mercury: A silver metallic element that exists as a liquid at room temperature. It has the atomic symbol Hg (from hydrargyrum, liquid silver), atomic number 80, and atomic weight 200.59. Mercury is used in many industrial applications and its salts have been employed therapeutically as purgatives, antisyphilitics, disinfectants, and astringents. It can be absorbed through the skin and mucous membranes which leads to mercury poisoning. Because of its toxicity, the clinical use of mercury and mercurials is diminishing. [NIH] Metastasis: The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors" and contain cells that are like those in the original (primary) tumor. The plural is metastases. [NIH] Metastatic: Having to do with metastasis, which is the spread of cancer from one part of the body to another. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH]

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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] Mitochondria: Parts of a cell where aerobic production (also known as cell respiration) takes place. [NIH] Mitochondrial Swelling: Increase in volume of mitochondria due to an influx of fluid; it occurs in hypotonic solutions due to osmotic pressure and in isotonic solutions as a result of altered permeability of the membranes of respiring mitochondria. [NIH] Mitosis: A method of indirect cell division by means of which the two daughter nuclei normally receive identical complements of the number of chromosomes of the somatic cells of the species. [NIH] Mobilization: The process of making a fixed part or stored substance mobile, as by separating a part from surrounding structures to make it accessible for an operative procedure or by causing release into the circulation for body use of a substance stored in the body. [EU] 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] Morphine: The principal alkaloid in opium and the prototype opiate analgesic and narcotic. Morphine has widespread effects in the central nervous system and on smooth muscle. [NIH] Morphology: The science of the form and structure of organisms (plants, animals, and other forms of life). [NIH] Mucinous: Containing or resembling mucin, the main compound in mucus. [NIH] Mydriatic: 1. Dilating the pupil. 2. Any drug that dilates the pupil. [EU] Myelography: X-ray visualization of the spinal cord following injection of contrast medium into the spinal arachnoid space. [NIH] Myocardial infarction: Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Narcotic: 1. Pertaining to or producing narcosis. 2. An agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] 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] Nephropathy: Disease of the kidneys. [EU]

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Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nerve Fibers: Slender processes of neurons, especially the prolonged axons that conduct nerve impulses. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neurogenic: Loss of bladder control caused by damage to the nerves controlling the bladder. [NIH] Neurologic: Having to do with nerves or the nervous system. [NIH] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropathy: A problem in any part of the nervous system except the brain and spinal cord. Neuropathies can be caused by infection, toxic substances, or disease. [NIH] Neurotoxic: Poisonous or destructive to nerve tissue. [EU] Neurotoxicity: The tendency of some treatments to cause damage to the nervous system. [NIH]

Nocturia: Excessive urination at night. [EU] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Oedema: The presence of abnormally large amounts of fluid in the intercellular tissue spaces of the body; usually applied to demonstrable accumulation of excessive fluid in the subcutaneous tissues. Edema may be localized, due to venous or lymphatic obstruction or to increased vascular permeability, or it may be systemic due to heart failure or renal disease. Collections of edema fluid are designated according to the site, e.g. ascites (peritoneal cavity), hydrothorax (pleural cavity), and hydropericardium (pericardial sac). Massive generalized edema is called anasarca. [EU] Oliguria: Clinical manifestation of the urinary system consisting of a decrease in the amount of urine secreted. [NIH] Opium: The air-dried exudate from the unripe seed capsule of the opium poppy, Papaver somniferum, or its variant, P. album. It contains a number of alkaloids, but only a few morphine, codeine, and papaverine - have clinical significance. Opium has been used as an analgesic, antitussive, antidiarrheal, and antispasmodic. [NIH] Optic Disk: The portion of the optic nerve seen in the fundus with the ophthalmoscope. It is formed by the meeting of all the retinal ganglion cell axons as they enter the optic nerve. [NIH]

Orgasm: The crisis of sexual excitement in either humans or animals. [NIH] Osteoarthritis: A progressive, degenerative joint disease, the most common form of arthritis,

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especially in older persons. The disease is thought to result not from the aging process but from biochemical changes and biomechanical stresses affecting articular cartilage. In the foreign literature it is often called osteoarthrosis deformans. [NIH] Osteochondritis Dissecans: A type of osteochondritis in which articular cartilage and associated bone becomes partially or totally detached to form joint loose bodies. Affects mainly the knee, ankle, and elbow joints. [NIH] Osteonecrosis: Death of a bone or part of a bone, either atraumatic or posttraumatic. [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]

Oxygen Consumption: The oxygen consumption is determined by calculating the difference between the amount of oxygen inhaled and exhaled. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Palpation: Application of fingers with light pressure to the surface of the body to determine consistence of parts beneath in physical diagnosis; includes palpation for determining the outlines of organs. [NIH] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Paralysis: Loss of ability to move all or part of the body. [NIH] Patch: A piece of material used to cover or protect a wound, an injured part, etc.: a patch over the eye. [NIH] Patella: The flat, triangular bone situated at the anterior part of the knee. [NIH] Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathologic Processes: The abnormal mechanisms and forms involved in the dysfunctions of tissues and organs. [NIH] Pathologies: The study of abnormality, especially the study of diseases. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Pelvic: Pertaining to the pelvis. [EU] Penis: The external reproductive organ of males. It is composed of a mass of erectile tissue enclosed in three cylindrical fibrous compartments. Two of the three compartments, the corpus cavernosa, are placed side-by-side along the upper part of the organ. The third compartment below, the corpus spongiosum, houses the urethra. [NIH] Peripheral Vascular Disease: Disease in the large blood vessels of the arms, legs, and feet. People who have had diabetes for a long time may get this because major blood vessels in their arms, legs, and feet are blocked and these limbs do not receive enough blood. The signs of PVD are aching pains in the arms, legs, and feet (especially when walking) and foot sores that heal slowly. Although people with diabetes cannot always avoid PVD, doctors say they have a better chance of avoiding it if they take good care of their feet, do not smoke, and keep both their blood pressure and diabetes under good control. [NIH]

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

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

Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plaque: A clear zone in a bacterial culture grown on an agar plate caused by localized destruction of bacterial cells by a bacteriophage. The concentration of infective virus in a fluid can be estimated by applying the fluid to a culture and counting the number of. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Platelet Aggregation: The attachment of platelets to one another. This clumping together can be induced by a number of agents (e.g., thrombin, collagen) and is part of the mechanism leading to the formation of a thrombus. [NIH] Pleural: A circumscribed area of hyaline whorled fibrous tissue which appears on the surface of the parietal pleura, on the fibrous part of the diaphragm or on the pleura in the interlobar fissures. [NIH] Pleural cavity: A space enclosed by the pleura (thin tissue covering the lungs and lining the interior wall of the chest cavity). It is bound by thin membranes. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Popliteal: Compression of the nerve at the neck of the fibula. [NIH] Popliteal Artery: The continuation of the femoral artery coursing through the popliteal fossa; it divides into the anterior and posterior tibial arteries. [NIH] Popliteal Cyst: A synovial cyst in the popliteal space arising from the semimembranous bursa or the knee joint. [NIH]

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Popliteal Vein: The vein formed by the union of the anterior and posterior tibial veins; it courses through the popliteal space and becomes the femoral vein. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Posterior Cruciate Ligament: A strong ligament of the knee that originates from the anterolateral surface of the medial condyle of the femur, passes posteriorly and inferiorly between the condyles, and attaches to the posterior intercondylar area of the tibia. [NIH] 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] 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] Presumptive: A treatment based on an assumed diagnosis, prior to receiving confirmatory laboratory test results. [NIH] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Primary endpoint: The main result that is measured at the end of a study to see if a given treatment worked (e.g., the number of deaths or the difference in survival between the treatment group and the control group). What the primary endpoint will be is decided before the study begins. [NIH] Probe: An instrument used in exploring cavities, or in the detection and dilatation of strictures, or in demonstrating the potency of channels; an elongated instrument for exploring or sounding body cavities. [NIH] Problem Solving: A learning situation involving more than one alternative from which a selection is made in order to attain a specific goal. [NIH] Procaine: A local anesthetic of the ester type that has a slow onset and a short duration of action. It is mainly used for infiltration anesthesia, peripheral nerve block, and spinal block. (From Martindale, The Extra Pharmacopoeia, 30th ed, p1016). [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Proline: A non-essential amino acid that is synthesized from glutamic acid. It is an essential component of collagen and is important for proper functioning of joints and tendons. [NIH] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] 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

Dictionary 95

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] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [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] Pulposus: Prolapse of the nucleus pulposus into the body of the vertebra; necrobacillosis of rabbits. [NIH] Pupil: The aperture in the iris through which light passes. [NIH] Purpura: Purplish or brownish red discoloration, easily visible through the epidermis, caused by hemorrhage into the tissues. [NIH] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radicular: Having the character of or relating to a radicle or root. [NIH] Radioactive: Giving off radiation. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Reassurance: A procedure in psychotherapy that seeks to give the client confidence in a favorable outcome. It makes use of suggestion, of the prestige of the therapist. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Refractory: Not readily yielding to treatment. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Restoration: Broad term applied to any inlay, crown, bridge or complete denture which restores or replaces loss of teeth or oral tissues. [NIH] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Rheumatic Diseases: Disorders of connective tissue, especially the joints and related structures, characterized by inflammation, degeneration, or metabolic derangement. [NIH] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH]

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Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Saphenous: Applied to certain structures in the leg, e. g. nerve vein. [NIH] Saphenous Vein: The vein which drains the foot and leg. [NIH] Sclera: The tough white outer coat of the eyeball, covering approximately the posterior fivesixths of its surface, and continuous anteriorly with the cornea and posteriorly with the external sheath of the optic nerve. [EU] Sclerosis: A pathological process consisting of hardening or fibrosis of an anatomical structure, often a vessel or a nerve. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Segmental: Describing or pertaining to a structure which is repeated in similar form in successive segments of an organism, or which is undergoing segmentation. [NIH] 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] Sensibility: The ability to receive, feel and appreciate sensations and impressions; the quality of being sensitive; the extend to which a method gives results that are free from false negatives. [NIH] Sepsis: The presence of bacteria in the bloodstream. [NIH] Sequester: A portion of dead bone which has become detached from the healthy bone tissue, as occurs in necrosis. [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] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Spasm: An involuntary contraction of a muscle or group of muscles. Spasms may involve skeletal muscle or smooth muscle. [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

Dictionary 97

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] 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 Nerve Roots: The paired bundles of nerve fibers entering and leaving the spinal cord at each segment. The dorsal and ventral nerve roots join to form the mixed segmental spinal nerves. The dorsal roots are generally afferent, formed by the central projections of the spinal (dorsal root) ganglia sensory cells, and the ventral roots efferent, comprising the axons of spinal motor and autonomic preganglionic neurons. There are, however, some exceptions to this afferent/efferent rule. [NIH] Spinal Nerves: The 31 paired peripheral nerves formed by the union of the dorsal and ventral spinal roots from each spinal cord segment. The spinal nerve plexuses and the spinal roots are also included. [NIH] Spinal Stenosis: Narrowing of the spinal canal. [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] Spondylolysis: Dissolution of a vertebra, especially the pars interarticularis. [NIH] Sprains and Strains: A collective term for muscle and ligament injuries without dislocation or fracture. A sprain is a joint injury in which some of the fibers of a supporting ligament are ruptured but the continuity of the ligament remains intact. A strain is an overstretching or overexertion of some part of the musculature. [NIH] Stabilization: The creation of a stable state. [EU] Sterility: 1. The inability to produce offspring, i.e., the inability to conceive (female s.) or to induce conception (male s.). 2. The state of being aseptic, or free from microorganisms. [EU] 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] 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] Synovial: Of pertaining to, or secreting synovia. [EU] Synovial Cyst: A nodular, tumorlike lesion in or about a tendon sheath or joint capsule, especially of the hands, wrists, or feet. It is not a true cyst as it lacks an epithelial wall, and it

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does not communicate with the underlying synovial space. The lesion represents a focal accumulation of mucin in the dermis of the dorsal aspect of the distal phalanges or, less often, other portions of the extremities. [NIH] Synovial Membrane: The inner membrane of a joint capsule surrounding a freely movable joint. It is loosely attached to the external fibrous capsule and secretes synovial fluid. [NIH] Syringomyelia: The presence in the spinal cord of elongated central fluid containing cavities surrounded by gliosis. [NIH] Systemic: Affecting the entire body. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Tendinitis: Inflammation of tendons and of tendon-muscle attachments. [EU] Testicular: Pertaining to a testis. [EU] Testis: Either of the paired male reproductive glands that produce the male germ cells and the male hormones. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thigh: A leg; in anatomy, any elongated process or part of a structure more or less comparable to a leg. [NIH] Thoracic: Having to do with the chest. [NIH] Thorax: A part of the trunk between the neck and the abdomen; the chest. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thymus: An organ that is part of the lymphatic system, in which T lymphocytes grow and multiply. The thymus is in the chest behind the breastbone. [NIH] 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] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Trace element: Substance or element essential to plant or animal life, but present in extremely small amounts. [NIH]

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Traction: The act of pulling. [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Treatment Outcome: Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, practicability, etc., of these interventions in individual cases or series. [NIH]

Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tumour: 1. Swelling, one of the cardinal signs of inflammations; morbid enlargement. 2. A new growth of tissue in which the multiplication of cells is uncontrolled and progressive; called also neoplasm. [EU] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary tract: The organs of the body that produce and discharge urine. These include the kidneys, ureters, bladder, and urethra. [NIH] 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] Urogenital: Pertaining to the urinary and genital apparatus; genitourinary. [EU] Urogenital Diseases: Diseases of the urogenital tract. [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] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasculitis: Inflammation of a blood vessel. [NIH] Vasodilation: Physiological dilation of the blood vessels without anatomic change. For dilation with anatomic change, dilatation, pathologic or aneurysm (or specific aneurysm) is used. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Ventral: 1. Pertaining to the belly or to any venter. 2. Denoting a position more toward the belly surface than some other object of reference; same as anterior in human anatomy. [EU] Vertebrae: A bony unit of the segmented spinal column. [NIH]

100 Leg Pain

Vertebral: Of or pertaining to a vertebra. [EU] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [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] 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] Volition: Voluntary activity without external compulsion. [NIH] Wound Healing: Restoration of integrity to traumatized tissue. [NIH] Xenograft: The cells of one species transplanted to another species. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH]

101

INDEX A Abdominal, 8, 10, 75, 87, 92, 93 Acetaminophen, 46, 75 Adaptability, 75, 79 Adverse Effect, 40, 75, 96 Aerobic, 75, 90 Afferent, 75, 97 Agar, 75, 93 Algorithms, 75, 78 Alkaline, 75, 79 Alkaloid, 75, 90 Alternative medicine, 48, 75 Amplification, 46, 75 Amputation, 5, 75 Anaesthesia, 10, 24, 75, 87 Analgesic, 75, 90, 91 Analog, 26, 75, 87 Anatomical, 17, 40, 75, 87, 96 Anesthesia, 6, 10, 23, 75, 76, 83, 94 Anesthetics, 6, 76 Angiography, 4, 5, 76 Angioplasty, 4, 76 Animal model, 6, 76 Ankle, 4, 9, 44, 76, 92 Anterior Compartment Syndrome, 4, 76 Antibody, 76, 80, 87, 97 Antigen, 76, 81, 87 Anti-inflammatory, 62, 75, 76 Antipyretic, 75, 76 Anuria, 45, 76 Aorta, 76, 82, 87 Aortic Aneurysm, 10, 76 Aponeurosis, 76, 85 Apoptosis, 6, 76, 79 Aqueous, 77, 82 Arachidonic Acid, 77, 87 Arterial, 4, 5, 7, 77, 87, 95, 98 Arteries, 7, 76, 77, 78, 82, 87, 89, 90, 93 Arterioles, 77, 78 Arteriolosclerosis, 77 Arteriosclerosis, 21, 77 Arteriosclerosis Obliterans, 21, 77 Articular, 77, 88, 92 Ascites, 77, 91 Aspiration, 46, 77 Autonomic, 77, 97 Axons, 77, 91, 97

B Back Pain, 19, 32, 40, 41, 77 Bacteria, 76, 77, 96 Bacteriophage, 77, 93 Basal Ganglia, 77, 85 Base, 6, 77, 82, 88 Benign, 77, 85, 89 Benign tumor, 77, 89 Bilateral, 4, 9, 10, 26, 78 Biochemical, 78, 85, 92 Biomechanics, 4, 78 Biopsy, 10, 78 Biopsy specimen, 10, 78 Biotechnology, 7, 44, 48, 57, 78 Bladder, 45, 78, 85, 87, 91, 99 Blood Coagulation, 78, 79 Blood pressure, 78, 87, 92 Blood vessel, 76, 78, 79, 88, 92, 96, 97, 98, 99 Body Fluids, 78, 79 Bone Marrow, 46, 78, 89 Bone scan, 25, 78 Bowel, 78, 83, 97 Bowel Movement, 78, 83, 97 Brachial, 9, 78 Branch, 69, 78, 92, 96, 98 Breakdown, 78, 85 Bupivacaine, 24, 78, 88 Bursitis, 45, 78 Bypass, 4, 79 C Cadaver, 5, 79 Calcification, 77, 79 Calcium, 5, 6, 79, 80 Carbon Dioxide, 79, 95 Cardiac, 24, 79, 83, 88, 90 Cardiovascular, 5, 24, 79 Case report, 16, 20, 79 Caspase, 6, 79 Catheterization, 76, 79 Caudal, 11, 79, 94 Causal, 6, 79 Cell, 6, 75, 76, 77, 78, 79, 80, 81, 82, 84, 85, 88, 90, 91, 93, 95 Cell Death, 6, 76, 79, 90 Cell proliferation, 77, 79 Cell Respiration, 79, 90, 95 Cell Size, 79, 85

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Central Nervous System, 79, 85, 90 Cervix, 79, 85 Character, 79, 82, 95 Chelation, 4, 80 Chelation Therapy, 4, 80 Choroid, 80, 82, 95 Chromatin, 76, 80 Chromosomal, 75, 80 Chronic, 8, 10, 11, 12, 13, 14, 15, 17, 18, 19, 21, 22, 24, 31, 41, 45, 46, 77, 80, 87, 88, 89, 97 Chronic Disease, 45, 80 Claudication, 3, 5, 7, 33, 62, 80 Clinical trial, 5, 6, 35, 36, 57, 80, 82, 95 Cloning, 78, 80 Clubbing, 12, 80 Cofactor, 80, 94 Collagen, 5, 46, 80, 93, 94 Collapse, 7, 40, 78, 80 Compartment Syndromes, 4, 19, 80 Complement, 80, 81 Complementary and alternative medicine, 31, 33, 81 Complementary medicine, 31, 81 Computational Biology, 57, 81 Computed tomography, 12, 81 Computerized axial tomography, 81 Computerized tomography, 49, 81 Conjugated, 81, 82 Connective Tissue, 78, 80, 81, 85, 89, 95 Constriction, 81, 88 Continuum, 46, 81 Contracture, 80, 82 Contraindications, ii, 82 Control group, 82, 94 Conus, 18, 82 Coronary, 5, 13, 82, 89, 90 Coronary Artery Bypass, 13, 82 Coronary Thrombosis, 82, 89, 90 Corpus, 82, 92 Curative, 82, 98 Cyclic, 17, 82 Cytochrome, 6, 82 Cytoplasm, 76, 82 D Databases, Bibliographic, 57, 82 Degenerative, 26, 45, 49, 82, 86, 91 Deletion, 76, 82 Density, 82, 85 Diagnosis, Differential, 45, 83 Diagnostic Imaging, 9, 83 Diagnostic procedure, 39, 48, 83

Diastolic, 83, 87 Digestive system, 36, 83 Dilatation, 76, 83, 94, 99 Dilation, 4, 83, 99 Direct, iii, 6, 51, 83, 95 Distal, 4, 8, 40, 82, 83, 95, 98 Dorsal, 6, 83, 94, 97, 98 Dorsum, 83, 85 Drug Interactions, 52, 83 Dysuria, 45, 83 E Edema, 13, 45, 83, 91 Efficacy, 25, 83, 99 Ejaculation, 45, 83, 96 Elasticity, 77, 83 Elastin, 80, 83 Elbow Joint, 83, 92 Electrode, 40, 83 Electrons, 77, 83, 88, 92, 95 Embryo, 83, 87 Endarterectomy, 76, 83 Endocrine Glands, 84, 86 Enuresis, 45, 84 Environmental Health, 56, 58, 84 Enzymatic, 79, 81, 84 Enzymes, 84, 90, 92 Epidermis, 84, 95 Epidural, 8, 10, 11, 84 Epidural block, 8, 84 Epoprostenol, 84, 87 Erectile, 84, 92 Erythrocytes, 78, 84 Esophagus, 83, 84, 97 Excitation, 84, 85 Excrete, 76, 84 Exercise Therapy, 46, 84 Expiration, 84, 95 Extracellular, 6, 81, 84 Extremity, 5, 6, 26, 72, 84 F Family Planning, 57, 84 Fat, 77, 78, 84, 88, 89, 96 Femoral, 6, 45, 84, 85, 93, 94 Femoral Artery, 6, 84, 85, 93 Femoral Vein, 85, 94 Femur, 41, 84, 85, 94 Fibula, 85, 93 Flatus, 85 Flexion, 4, 85 Flow Cytometry, 6, 85 Fluorescence, 6, 85 Fluorescent Dyes, 85

Index 103

Fold, 6, 85 Foramen, 85, 86, 93 Forearm, 78, 80, 83, 85 Fossa, 85, 93 Fundus, 85, 91 G Gallbladder, 75, 83, 85 Ganglia, 85, 91, 97 Ganglion, 6, 85, 91 Gas, 45, 79, 85, 86 Gastrointestinal, 45, 85 Gene, 44, 78, 85 Genetics, 46, 86 Genital, 86, 99 Genitourinary, 45, 86, 99 Gliosis, 86, 98 Governing Board, 86, 94 Graft, 13, 86 Grafting, 82, 86 Growth, 76, 77, 79, 86, 93, 99 H Half-Life, 86, 87 Health Status, 8, 86 Heart failure, 86, 91 Hematuria, 45, 86 Heme, 82, 86 Hemorrhage, 80, 86, 95, 97 Hepatitis, 18, 86 Hepatocytes, 86 Heredity, 85, 86 Herniated, 23, 43, 86 Homogeneous, 77, 81, 86 Hormones, 46, 86, 98 Hydrogen, 77, 86, 90, 92 Hydroxylysine, 80, 87 Hydroxyproline, 80, 87 Hyperlipidemia, 3, 87 Hypertension, 3, 77, 84, 87 I Id, 28, 32, 63, 68, 70, 87 Idiopathic, 16, 45, 87 Iliac Artery, 4, 25, 84, 87 Iloprost, 7, 87 Impairment, 87, 89 In vitro, 6, 87 In vivo, 87 Incontinence, 45, 87 Indicative, 43, 87, 92, 99 Induction, 6, 87 Infarction, 87 Infection, 4, 87, 89, 91, 97 Infertility, 45, 87, 99

Inflammation, 46, 76, 78, 86, 87, 95, 98, 99 Infusion, 17, 19, 23, 28, 87 Intermittent, 3, 6, 20, 33, 46, 87 Intervertebral, 24, 40, 86, 88, 89 Intervertebral Disk Displacement, 88, 89 Intestines, 75, 85, 88 Intracellular, 87, 88 Intrathecal, 6, 17, 19, 88 Intravenous, 87, 88 Invasive, 88, 89 Involuntary, 45, 84, 88, 90, 96 Ions, 77, 86, 88 Ischemia, 6, 35, 88 J Joint, 10, 40, 41, 46, 77, 83, 88, 91, 92, 93, 97, 98 Joint Capsule, 40, 88, 97, 98 K Kb, 56, 88 Kidney Disease, 17, 36, 56, 88 L Large Intestine, 83, 88, 95 Lesion, 82, 86, 88, 97 Leukocytes, 78, 88 Library Services, 68, 88 Lidocaine, 6, 10, 23, 88 Ligament, 40, 88, 94, 97 Ligation, 24, 88 Lipid, 5, 77, 88 Lipoma, 18, 89 Liposarcoma, 22, 89 Liver, 75, 77, 83, 85, 86, 89 Localized, 46, 87, 89, 91, 93 Low Back Pain, 8, 9, 14, 22, 24, 29, 31, 32, 40, 49, 89 Lumbar, 4, 12, 13, 19, 24, 25, 26, 40, 41, 62, 63, 77, 88, 89 Lumen, 77, 89 Lymph, 89 Lymph node, 89 Lymphatic, 45, 87, 89, 91, 97, 98 M Magnetic Resonance Imaging, 5, 13, 23, 89 Mammary, 82, 89 Medial, 4, 72, 77, 89, 94 MEDLINE, 57, 89 Membrane, 6, 80, 81, 89, 95, 98 Menopause, 89, 94 Mental Disorders, 37, 89 Mercury, 85, 89 Metastasis, 89 Metastatic, 22, 89

104 Leg Pain

MI, 73, 89 Microscopy, 6, 90 Mitochondria, 6, 90 Mitochondrial Swelling, 90 Mitosis, 76, 90 Mobilization, 41, 90 Molecular, 57, 59, 78, 81, 90 Molecule, 76, 77, 81, 84, 90, 92 Morphine, 24, 90, 91 Morphology, 5, 90 Mucinous, 85, 90 Mydriatic, 83, 90 Myelography, 49, 90 Myocardial infarction, 5, 82, 89, 90 Myocardium, 89, 90 N Narcotic, 90 NCI, 1, 36, 55, 90 Necrosis, 6, 76, 87, 89, 90, 96 Need, 3, 6, 41, 44, 49, 64, 75, 90 Nephropathy, 88, 90 Nerve, 6, 12, 16, 25, 75, 77, 80, 85, 86, 91, 93, 94, 95, 96, 97 Nerve Fibers, 91, 97 Nervous System, 75, 79, 91 Neural, 4, 40, 62, 75, 91 Neurogenic, 11, 91 Neurologic, 6, 91 Neuronal, 6, 91 Neurons, 85, 91, 97 Neuropathy, 16, 91 Neurotoxic, 6, 91 Neurotoxicity, 6, 91 Nocturia, 45, 91 Nuclear, 22, 25, 77, 83, 85, 90, 91 Nuclei, 83, 89, 90, 91 Nucleus, 40, 76, 80, 82, 88, 91, 95 O Oedema, 24, 91 Oliguria, 45, 91 Opium, 90, 91 Optic Disk, 82, 91 Orgasm, 83, 91 Osteoarthritis, 49, 91 Osteochondritis Dissecans, 45, 92 Osteonecrosis, 45, 92 Oxidation, 82, 92 Oxygen Consumption, 92, 95 P Palliative, 92, 98 Palpation, 45, 92 Pancreas, 75, 83, 92

Paralysis, 72, 80, 92 Patch, 82, 92 Patella, 45, 46, 92 Pathologic, 20, 76, 78, 82, 92, 99 Pathologic Processes, 76, 92 Pathologies, 4, 92 Patient Education, 62, 66, 68, 73, 92 Pelvic, 41, 92 Penis, 45, 83, 92 Peripheral Vascular Disease, 3, 12, 35, 92 Peritoneal, 77, 91, 93 Peritoneal Cavity, 77, 91, 93 Pharmacologic, 75, 86, 93, 98 Phosphorus, 79, 93 Physical Examination, 4, 46, 93 Physical Fitness, 84, 93 Physical Therapy, 26, 49, 62, 93 Physiologic, 83, 86, 93 Plants, 75, 79, 90, 93, 98 Plaque, 5, 76, 93 Plasma, 6, 93, 96 Platelet Aggregation, 84, 87, 93 Pleural, 91, 93 Pleural cavity, 91, 93 Poisoning, 80, 89, 93 Polypeptide, 80, 93 Popliteal, 4, 24, 45, 85, 93, 94 Popliteal Artery, 4, 93 Popliteal Cyst, 45, 93 Popliteal Vein, 24, 85, 94 Posterior, 4, 45, 77, 80, 83, 92, 93, 94, 96 Posterior Cruciate Ligament, 45, 94 Postmenopausal, 8, 94 Practicability, 94, 99 Practice Guidelines, 58, 94 Presumptive, 24, 94 Prevalence, 18, 24, 94 Primary endpoint, 6, 94 Probe, 40, 94 Problem Solving, 20, 94 Procaine, 88, 94 Progression, 76, 94 Progressive, 77, 86, 90, 91, 94, 99 Proline, 80, 87, 94 Prospective study, 8, 94 Protein S, 44, 78, 94 Proteins, 76, 79, 80, 84, 90, 93, 95, 98 Proximal, 40, 83, 95 Psychotherapy, 46, 95 Public Policy, 57, 95 Pulposus, 40, 88, 95 Pupil, 83, 90, 95

Index 105

Purpura, 7, 95 R Race, 5, 95 Radiation, 85, 95, 100 Radicular, 25, 95 Radioactive, 78, 86, 91, 95 Randomized, 6, 83, 95 Reassurance, 46, 95 Rectum, 78, 83, 85, 87, 88, 95 Refer, 1, 80, 95 Refractory, 22, 95 Regimen, 83, 95 Respiration, 6, 79, 95 Restoration, 93, 95, 100 Retina, 80, 82, 95 Rheumatic Diseases, 13, 20, 46, 95 Risk factor, 3, 94, 95 S Salivary, 83, 96 Salivary glands, 83, 96 Saphenous, 82, 96 Saphenous Vein, 82, 96 Sclera, 80, 82, 96 Sclerosis, 77, 96 Screening, 80, 96 Segmental, 96, 97 Semen, 83, 96 Sensibility, 75, 96 Sepsis, 26, 96 Sequester, 80, 96 Shock, 96, 99 Side effect, 51, 75, 96, 98 Signs and Symptoms, 5, 96 Skeletal, 14, 96 Skeleton, 85, 88, 96 Smooth muscle, 90, 96 Soft tissue, 78, 80, 96 Spasm, 72, 96 Specialist, 64, 83, 96 Species, 90, 95, 96, 100 Specificity, 23, 97 Spinal cord, 16, 21, 23, 28, 78, 79, 84, 85, 88, 90, 91, 97, 98 Spinal Nerve Roots, 40, 97 Spinal Nerves, 97 Spinal Stenosis, 49, 62, 97 Spleen, 89, 97 Spondylolysis, 22, 97 Sprains and Strains, 89, 97 Stabilization, 6, 97 Sterility, 87, 97 Stimulus, 83, 84, 97, 98

Stomach, 75, 83, 84, 85, 88, 93, 97 Stool, 87, 88, 97 Stress, 4, 13, 25, 40, 44, 97 Stroke, 5, 37, 56, 97 Subacute, 87, 97 Subclinical, 87, 97 Subcutaneous, 35, 83, 91, 97 Synovial, 88, 93, 97, 98 Synovial Cyst, 93, 97 Synovial Membrane, 88, 98 Syringomyelia, 18, 98 Systemic, 45, 52, 76, 78, 87, 91, 98 Systolic, 87, 98 T Tendinitis, 45, 98 Testicular, 45, 98 Testis, 98 Therapeutics, 8, 14, 19, 31, 32, 35, 52, 98 Thigh, 8, 80, 84, 98 Thoracic, 16, 77, 98 Thorax, 89, 98 Threshold, 87, 98 Thrombosis, 95, 97, 98 Thymus, 89, 98 Tin, 49, 72, 98 Tissue, 5, 40, 76, 77, 78, 80, 81, 83, 84, 86, 88, 89, 90, 91, 92, 93, 95, 96, 98, 99, 100 Tomography, 98 Toxic, iv, 6, 91, 98 Toxicity, 83, 89, 98 Toxicology, 58, 98 Toxins, 76, 87, 98 Trace element, 98 Traction, 4, 41, 99 Transfection, 78, 99 Trauma, 13, 46, 80, 90, 99 Treatment Outcome, 46, 99 Tryptophan, 80, 99 Tumour, 85, 99 U Unconscious, 76, 87, 99 Urethra, 92, 99 Urinary, 45, 84, 86, 87, 91, 99 Urinary tract, 99 Urinate, 45, 99 Urine, 45, 76, 78, 84, 86, 87, 91, 99 Urogenital, 86, 99 Urogenital Diseases, 99 Urologic Diseases, 45, 99 Urology, 45, 99 Uterus, 79, 82, 85, 99

106 Leg Pain

V Vascular, 3, 4, 5, 9, 11, 15, 16, 26, 35, 80, 84, 87, 91, 99 Vasculitis, 10, 99 Vasodilation, 87, 99 Vein, 85, 88, 91, 94, 96, 99 Venous, 13, 91, 95, 99 Ventral, 97, 99 Vertebrae, 40, 88, 97, 99 Vertebral, 40, 100

Veterinary Medicine, 57, 100 Virus, 77, 93, 100 Vitro, 100 Volition, 88, 100 W Wound Healing, 35, 100 X Xenograft, 76, 100 X-ray, 72, 81, 85, 90, 91, 100

Index 107

108 Leg Pain

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