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

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

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

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

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

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Surgery: 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: 0-597-83672-8 1. Surgery-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 surgery. 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 SURGERY ................................................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Surgery ......................................................................................... 7 E-Journals: PubMed Central ....................................................................................................... 64 The National Library of Medicine: PubMed ................................................................................ 69 CHAPTER 2. NUTRITION AND SURGERY ....................................................................................... 157 Overview.................................................................................................................................... 157 Finding Nutrition Studies on Surgery ...................................................................................... 157 Federal Resources on Nutrition ................................................................................................. 160 Additional Web Resources ......................................................................................................... 160 CHAPTER 3. ALTERNATIVE MEDICINE AND SURGERY ................................................................. 165 Overview.................................................................................................................................... 165 The Combined Health Information Database............................................................................. 165 National Center for Complementary and Alternative Medicine................................................ 166 Additional Web Resources ......................................................................................................... 172 General References ..................................................................................................................... 193 CHAPTER 4. DISSERTATIONS ON SURGERY ................................................................................... 195 Overview.................................................................................................................................... 195 Dissertations on Surgery ........................................................................................................... 195 Keeping Current ........................................................................................................................ 205 CHAPTER 5. CLINICAL TRIALS AND SURGERY .............................................................................. 207 Overview.................................................................................................................................... 207 Recent Trials on Surgery ........................................................................................................... 207 Keeping Current on Clinical Trials ........................................................................................... 228 CHAPTER 6. PATENTS ON SURGERY .............................................................................................. 231 Overview.................................................................................................................................... 231 Patents on Surgery .................................................................................................................... 231 Patent Applications on Surgery................................................................................................. 270 Keeping Current ........................................................................................................................ 310 CHAPTER 7. BOOKS ON SURGERY ................................................................................................. 311 Overview.................................................................................................................................... 311 Book Summaries: Federal Agencies............................................................................................ 311 Book Summaries: Online Booksellers......................................................................................... 316 The National Library of Medicine Book Index ........................................................................... 329 Chapters on Surgery .................................................................................................................. 330 Directories.................................................................................................................................. 336 CHAPTER 8. MULTIMEDIA ON SURGERY ....................................................................................... 339 Overview.................................................................................................................................... 339 Video Recordings ....................................................................................................................... 339 Audio Recordings....................................................................................................................... 342 Bibliography: Multimedia on Surgery ....................................................................................... 343 CHAPTER 9. PERIODICALS AND NEWS ON SURGERY .................................................................... 345 Overview.................................................................................................................................... 345 News Services and Press Releases.............................................................................................. 345 Newsletters on Surgery.............................................................................................................. 348 Newsletter Articles .................................................................................................................... 349 Academic Periodicals covering Surgery..................................................................................... 358 CHAPTER 10. RESEARCHING MEDICATIONS................................................................................. 359 Overview.................................................................................................................................... 359

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U.S. Pharmacopeia..................................................................................................................... 359 Commercial Databases ............................................................................................................... 367 Researching Orphan Drugs ....................................................................................................... 367 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 371 Overview.................................................................................................................................... 371 NIH Guidelines.......................................................................................................................... 371 NIH Databases........................................................................................................................... 373 Other Commercial Databases..................................................................................................... 377 APPENDIX B. PATIENT RESOURCES ............................................................................................... 379 Overview.................................................................................................................................... 379 Patient Guideline Sources.......................................................................................................... 379 Associations and Surgery .......................................................................................................... 401 Finding Associations.................................................................................................................. 411 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 413 Overview.................................................................................................................................... 413 Preparation................................................................................................................................. 413 Finding a Local Medical Library................................................................................................ 413 Medical Libraries in the U.S. and Canada ................................................................................. 413 ONLINE GLOSSARIES................................................................................................................ 419 Online Dictionary Directories ................................................................................................... 419 SURGERY DICTIONARY............................................................................................................ 421 INDEX .............................................................................................................................................. 565

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

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

Surgery and the Patient With Alzheimer's Disease Source: Geriatric Nursing. 9(4): 227-229. July-August 1988. Summary: This journal article discusses preoperative precautions and education for patients with Alzheimer's disease. Memory loss may make medical history taking difficult, therefore, a family member or guardian should be consulted. Behavioral changes such as aggressiveness, anxiety, depression, agitation, insomnia, and paranoia, may necessitate the use of antipsychotics, tranquilizers or antidepressants. However, drugs should be administered with extreme caution and in reduced dosages since Alzheimer's disease patients are extremely sensitive to medications. Use of preoperative medication in patients with advanced Alzheimer's disease should only be used for analgesia or agitation. Preoperative education for both the patient and family is essential in reducing confusion and anxiety and providing understanding and support.

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Preoperative instructions should be written for reinforcement. Surgery for most patients with Alzheimer's disease is performed under general anesthesia. Since delayed recovery from anesthesia is common, prolonged observation will be required in the recovery room and patient care unit. Nurses should instruct both patients and family members in any continued postoperative care to be followed at home, including drug therapy. As reinforcement, patients should receive concise, written instructions. With supportive assistance and an understanding of the behaviors associated with Alzheimer's disease, nurses can help patients through a surgical procedure. •

Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee, A Source: New England Journal of Medicine. 347(2): 81-88. July 11, 2002. Summary: This journal article provides health professionals with information on a randomized, placebo-controlled trial that assessed the efficacy of arthroscopic surgery of the knee in relieving pain and improving function in patients with osteoarthritis (OA). The study population consisted of 180 patients with knee OA who were randomly assigned to receive arthroscopic debridement, arthroscopic lavage, or placebo surgery. Patients in the placebo group received skin incisions and underwent a simulated debridement without insertion of the arthroscope. Patients and assessors of outcome were blinded to the treatment group assignment. Outcomes were assessed at multiple points over a 24 month period with the use of five self reported scores (three on scales for pain and two on scales for function) and one objective test of walking and stair climbing. A total of 165 patients completed the trial. The study found that at no point did either of the intervention groups report less pain or better function than the placebo group. For example, there was no difference in knee pain between the placebo group and either the lavage group or the debridement group at 1 year or 2 years. Similarly, there was no significant difference in arthritis pain between the placebo group and the lavage group or the debridement group at 1 or 2 years. Furthermore, at no time point did either arthroscopic intervention group have significantly greater improvement in function than the placebo group. For example, there was no significant difference between the placebo group and either the lavage group or the debridement group in the self reported ability to walk and bend at 1 year or at 2 years. In fact, objectively measured walking and stair climbing were poorer in the debridement group than in the placebo group at 2 weeks and 1 year and showed a trend toward worse functioning at 2 years. Lacking evidence of the superiority of the arthroscopic treatments over the placebo procedure in relieving pain or improving function, researchers considered whether the 95 percent confidence intervals for the differences in outcomes between each arthroscopic procedure and the placebo procedure included clinically important differences. At almost all time points during follow up, the confidence intervals excluded the minimal important differences used in the study. The article concludes that the outcomes after arthroscopic lavage or arthroscopic debridement were no better than those after a placebo procedure. 2 figures, 3 tables, and 35 references. (AA-M).

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Electrosurgery for the Skin Source: American Family Physician. 66(7): 1259-1266. October 1, 2002. Contact: Available from American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237 or (913) 906-6000. E-mail: [email protected]. Website: www.aafp.org. Summary: This journal article provides health professionals with information on electrosurgery for the skin. The purposes of electrosurgery are to destroy benign and

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malignant lesions, control bleeding, and cut or excise tissue. The major modalities in electrosurgery are electrodesiccation, fulguration, electrocoagulation, and electrosection. In electrodesiccation, an active electrode touches or is inserted into the skin to produce tissue destruction. In fulguration, the electrode is held away from the skin to produce a sparking at the skin surface and more shallow tissue destruction. Electrocoagulation is ideal for clotting small blood vessels in deep and superficial surgery. In electrosection, the electrode is used to cut tissue. Electrosurgery can be used for incisional techniques that produce full thickness excision of nevi, for shave techniques that produce partial thickness removal of superficial lesions, and for removal of vascular lesions such as hemangiomas or pyogenic granulomas. When selecting an electrosurgical unit, the physician must determine whether the equipment will be used for electrosection and cutting techniques, what safety features are available, what the cost is for purchasing and operating an electrosurgical unit, and what policies and warranties the manufacturer has for the equipment. The correct output power can be determined by starting low and increasing the power until the desired outcome is attained (destruction, coagulation, or cutting). Smaller cherry angiomas can be electrocoagulated lightly. Larger cherry angiomas may be easier to treat by shaving them first then electrocoagulating or desiccating the base. The elevated portion of pyogenic granulomas can be shaved off with a scalpel or a loop electrode using a cutting/coagulation current. The base of the lesion is curetted to remove the remaining tissue and then electrodesiccated. Complications such as burns, shocks, and transmission of infection can be prevented by careful use of the electrosurgical equipment. 4 figures, 3 tables, and 6 references. (AA-M). •

Arthroscopic Surgery for Athletic Elbow and Wrist Injuries Source: Clinics in Sports Medicine. 20(1): i-xiii,1-222. January 2001. Summary: This journal provides health professionals with information on arthroscopic surgery for athletic elbow and wrist injuries. The journal begins with an article on the etiology, clinical presentation, diagnosis, and treatment of osteochondritis dissecans of the elbow. This is followed by an article that explores the evaluation and arthroscopic treatment of posterior impingement of the elbow in athletes. The next article focuses on valgus instability of the elbow in athletes. Topics include clinical and functional anatomy, diagnosis, nonoperative and operative treatment, and postoperative management. The fourth article discusses the diagnosis and treatment of posterolateral rotatory instability of the elbow. This is followed by an article that examines fracture dislocations of the elbow in athletes, focusing on simple and complex dislocations and radial head, coronoid, and olecranon fractures. The next article deals with the etiology, epidemiology, pathophysiology, diagnosis, and treatment of epicondylitis in the athlete. The seventh article focuses on the anatomy, clinical presentation, treatment, and rehabilitation needed for return to sports after various nerve entrapments. This is followed by an article that offers concise procedural advice for arthroscopic treatment of flexion contractures of the elbow. The next article provides an overview of presentation, diagnosis, and nonoperative and operative treatments for scapholunate instability in athletes. The tenth article focuses on a study that investigated a technique for arthroscopic stabilization of the lunotriquentral joint by disk carpal ligament suture plication with arthroscopic reduction and internal fixation of the joint with interosseous Kirschener wires and reviewed the postoperative clinical outcome of a case series of 20 consecutive patients. The next article discusses the classification, diagnosis, debridement, and repair of triangular fibrocartilage complex tears in the athlete. This is followed by articles that describe carpal and distal radius fractures in athletes. Carpal fractures include scaphoid, hamate hook, triquetral, pisiform, trapezium, trapezoid,

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capitate, and lunate fractures. The final article discusses the causes, pathophysiology, clinical presentation, and treatment of nerve injuries of the elbow, wrist, and hand in athletes. 80 figures, 4 tables, and numerous references. •

What's New in Adult Reconstructive Knee Surgery Source: Journal of Bone and Joint Surgery. 83-A(9): 1444-1450. September 2001. Summary: This journal article provides health professionals with information on new developments in adult reconstructive surgery. The article summarizes topics presented at selected orthopedic meetings and those addressed in various articles. The article highlights findings concerning conservative treatment of patients with mild to moderate osteoarthritis of the knee, focusing on the effectiveness of glucosamine and chondroitin, manual physical therapy, and exercise. Investigations related to surgical treatment options focused on total knee arthroplasty following high tibial osteotomy, unicompartmental knee arthroplasty, alignment of the femoral and tibial components in total knee arthroplasty, cruciate ligament retaining and cruciate substituting designs, use of mobile bearing protheses, simultaneous femoral osteotomy and total knee arthroplasty, and revision total knee arthroplasty. Other topics include blood conservation in total knee arthroplasty, soft tissue balancing, fixation techniques, the diagnosis and treatment of infection in association with total knee arthroplasty, patellofemoral articulation as a common source of complications in total knee arthroplasty, and polyethylene wear. 9 references.

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Endoscopic Spinal Surgery: What Future Role? Source: Journal of Musculoskeletal Medicine. 18(11): 518-520,525-528. November 2001. Summary: This journal article, the sixth in a special series of articles on the evaluation and management of back pain, provides health professionals with information on traditional approaches to spine surgery, the evolution of alternative approaches, and the current state of endoscopic spinal surgery. Arthroscopic joint surgery has played a major role in promoting understanding of knee pain and shoulder pain. Now that endoscopic spinal surgery can be performed, spinal conditions previously not considered with traditional surgical techniques may be evaluated, diagnosed, and managed. Painful and nonpainful anatomic parts can be visually correlated with imaging studies when spinal probing is accomplished with the patient in an aware state. Patients not responding to traditional surgical methods now may find lasting pain relief with endoscopic spine surgery directed toward the pain generator. Perhaps the ideal lesion for selective endoscopic diskectomy is far lateral, extraforaminal disk herniation. As with arthroscopic knee surgery, the risk of serious complications or injury with endoscopic spinal surgery is low. Dysesthesia, the most common postoperative complaint, occurs about 5 percent of the time and is almost always transient. The learning curve for the minimally invasive procedure is high, but advances in training, techniques, and instrumentation will likely make it routinely available in the near future. Except for pregnancy, there are no absolute exclusion criteria but only relative contraindications. 3 figures and 16 references. (AA-M).

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Surgery vs Orthosis vs Watchful Waiting for Hallux Valgus: A Randomized Controlled Trial Source: JAMA. Journal of the American Medical Association. 285(19): 2474-2480. May 16, 2001.

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Summary: This journal article provides health professionals with information on a randomized controlled trial that compared the effectiveness and costs of surgical and orthotic treatments in patients with hallux valgus with no treatment. The study was conducted in four general community hospitals in Finland from 1997 to 1998, with a followup period of 12 months. The study population consisted of 209 consecutive patients with a painful bunion and a hallux valgus angle of 35 degrees or less. Seventyone patients were randomized to the surgical group, 69 to the orthosis group, and 69 to the control group. Main outcome measures were pain intensity during walking on a visual analog scale, patient assessment of global improvement, number of painful days, cosmetic disturbance, footwear problems, functional status, and treatment satisfaction. The study found that followup rates at 6 and 12 months were 99 percent and 98 percent, respectively. At 6 months, pain intensity decreased more in the surgical group than in the control group and more in the orthosis group than in the control group. At 1 year, 83 percent, 46 percent, and 24 percent in the surgery, orthosis, and control groups, respectively, thought they had improved compared with baseline. Number of painful days, cosmetic disturbance, and footwear problems were the least and functional status and satisfaction with treatment were the best in the surgical group. Total foot care costs were the least in the control group. Excluding the costs of intervention, health care costs were the least in the orthosis group. The article concludes that surgical osteotomy is an effective treatment for painful hallux valgus. Orthoses provide short tem symptomatic relief, so this treatment option may be considered when patients with disabling hallux valgus pain must wait for surgery. 2 figures, 4 tables, and 22 references. (AA-M). •

Cosmetic Laser Surgery Source: FDA Consumer. 34(3): 34-37. May-June 2000. Summary: This journal article provides the general public with information on cosmetic laser surgery. Laser resurfacing is used to remove wrinkles and lines caused by sun damage and facial expressions, acne scars, some folds and creases around the nose and mouth, and precancerous and benign superficial growths. Lasers are revolutionary surgical tools because they can cut through tissue without causing excessive bleeding, their energy can reach areas within the body more easily than a scalpel, and they can let surgeons target very specific types of tissues without affecting nearby tissue. Not everyone is an ideal candidate for laser resurfacing because certain people with very sensitive skin cannot tolerate the medications and lubricants used on the skin during healing. In addition, darker skinned ethnic groups are not candidates because laser resurfacing alters skin color too dramatically and unpredictably. People who expect instant results are also not good candidates. Certain complications occur with laser resurfacing, including a prolonged redness of the skin, tenderness, easy flushing, and some pigmentary changes. Although most of these complications are temporary, there are some more serious and possibly permanent complications, including hypopigmentation and scarring. There is no national policy for credentialing health professionals planning to practice laser surgery, so consumers must be very careful when selecting a practitioner. They need to interview several doctors, ask the right questions, and evaluate the doctors' answers and credentials.

Federally Funded Research on Surgery The U.S. Government supports a variety of research studies relating to surgery. These studies are tracked by the Office of Extramural Research at the National Institutes of

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

Project Title: 1H AND 31P MRSI FOR EPILEPSY LOCALIZATION Principal Investigator & Institution: Laxer, Kenneth D.; Professor of Clinical Medicine and Neuro; Neurology; University of California San Francisco 500 Parnassus Ave San Francisco, CA 94122 Timing: Fiscal Year 2001; Project Start 01-MAY-1994; Project End 31-MAR-2004 Summary: The long term goal of this application is to improve the outcome of seizure surgery by better presurgical localization of medically refractory epilepsy using a combination of neuroimaging techniques including magnetic resonance imaging (MRI), 1H and 31P MR spectroscopic imaging (MRSI), and 18F-PET. These techniques will be directed at three groups with medically refractory epilepsy who are being evaluated for seizure surgery (numbers for 5 years): 1)patients with medial temporal lobe epilepsy in whom MRI is non-concordant i.e., MRI shows no abnormality, or an abnormality contralateral to the EEG-defined seizure focus (NC-mTLE, n=75), 2) patients with nonlesional neocortical epilepsy (NE, n=100), and 3) children with Infantile Spasms (IS, n=100). NC-mTLE and NE patients frequently require invasive EEG recording, have less than a 50 percent probability of becoming seizure free with surgery, and are often not considered for surgery. Post-operative surgical outcome will be analyzed in relation to the pre-operative neuroimaging findings. Hypotheses: 1) NC-mTLE -Patients with medically refractory mTLE without MRI concordance, who have 1H and 31P MRSI measures concordant with the EEG localization (i.e., lobe and side), will have a significantly better post surgical outcome than patients without MRSI concordance. 2a) NE - NE patients without lesions on MRI, will have 1H and 31P MRSI concordant with the EEG localization (i.e., lobe and side), and this concordance will be greater than that provided by 18FDG-PET. 2b) NE - NE patients, who have 1H and 31P MRSI measures concordant with the EEG localization will have a significantly better post surgical outcome than patients without MRSI concordance. 3a) IS - Children with medically refractory Infantile Spasms will have 1H and 31P MRSI concordant with the seizure focus determined by a combination of two or more studies (VET, 18FDG-PET, and/or MRI) and this concordance will be greater than that provided by MRI or 18FDG-PET. 3b) IS - IS children, who have 1H and 31P MRSI concordant with the localization provided by the other clinical and imaging studies will have a significantly better post surgical outcome than patients without such concordance. These studies are expected to lead to improved surgical outcome, and to reduce unnecessary surgery, in patients with intractable epilepsy.

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

Project Title: A MULTI-CENTER STUDY OF EPILEPSY SURGERY Principal Investigator & Institution: Spencer, Susan S.; Professor; Neurology; Yale University 47 College Street, Suite 203 New Haven, CT 065208047 Timing: Fiscal Year 2001; Project Start 04-APR-1996; Project End 31-MAY-2006 Summary: (Applicant's Abstract): Nearly one percent of the United States population has epilepsy. By some estimates more than 20% of those patients are inadequately treated despite a growing number of anti-epileptic medications. Resective surgery is increasingly used to treat this population, despite its high costs. Outcome with regard to seizures following epilepsy surgery has rarely been systematically or prospectively assessed in large samples, and quality-of-life, cognitive, neurologic, and psychiatric status following epilepsy surgery in the long or short-term are largely unexplored. Over the past 5 years we enrolled a 400 patient cohort in the first multi-center study of epilepsy surgery. Evaluation and treatment of these patients incorporated uniformity and technological advances, as well as reliable and validated baseline and follow-up measures of psychiatric status, cognitive function, quality-of-life, seizure severity and frequency, productive activities, and family dynamic. We propose to complete two-year follow-up on the full cohort, and extend follow-up to 5 years. We seek to define the occurrence and predictors of seizure remission, as well as improvements in quality-oflife, and stability or improvement in psychiatric, cognitive and neurologic status, based on factors in the preoperative profile and postoperative observations. We also propose to define relapse and continued remission off all medications and the predictors for successful medications withdrawal, an important yet unstudied aspect of epilepsy surgery. Our primary goals are: 1. to study the probability of achieving 1, 2, and 5 year seizure remission after epilepsy surgery, and the probability of relapse after remission over a total 5 year follow-up, as well as the prognostic significance of specified preoperative and postoperative factors; 2. to determine the probability of relapse and prediction of relapse in patients who discontinue medications after 2 year remission, and prognostic factors for successful outcome; 3. to assess self reported quality-of-life and employment status yearly for 5 years after resective epilepsy surgery, and to determine the magnitude and time course of change, and the extent to which seizure response and medication changes are associated with alterations in self-perceived health and employment; 4. to identify the nature and magnitude of changes in cognitive and neurologic status after resective epilepsy surgery, the factors that predict changes, and their resilience and functional impact over 5 years of follow-up; and 5. to prospectively assess changes in behavior and psychiatric profile yearly for 5 years and examine predictive factors in long-term prognosis of depression, anxiety and other psychiatric diagnoses, as well as family dynamics. The proposed study represents a unique multicenter effort that will result in the largest systematic study of epilepsy surgery to date, and will provide definitive answers to key questions regarding the outcomes of epilepsy surgery, their measurement, and their prediction in a contemporary patient population. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ADVANCES IN OPTICS FOR BIOTECHNOLOGY, MEDICINE & SURGERY Principal Investigator & Institution: Brewer, Molly A.; Associate Professor; None; Polytechnic University 6 Metro Tech Center New York, NY 11201 Timing: Fiscal Year 2003; Project Start 01-AUG-2003; Project End 31-JUL-2004

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Summary: (provided by applicant): Funds are requested from the NIH Conference Grant Program to support the conference, "Advances in Optics for Biotechnology, Medicine and Surgery", which is scheduled for August 3-7, 2 003, in Banff, Alberta, Canada. The conference is being organized under the auspices of the Engineering Conferences International (formerly United Engineering Foundation). This meeting is residential in nature, broad in scope and emphasizes interactions and informal discussion among participants who come from universities, national laboratories and industry. This conference is the 8th in a series and has been among the most successful of the Engineering Foundation conferences. Its content spans nearly the entire field of optics in biology and medicine and will include sessions on laser-tissue interactions, photodynamic therapy, molecular imaging, in vivo spectroscopic diagnostics, cell microscopy and mesoscale imaging, optical coherence tomography, photon migration, and a session dedicated to contributed posters. We believe the conferences have been instrumental in generating ideas and disseminating information to a greater extent than is possible through more conventional forums. All participants contribute actively to the discussions. In addition, there is strong interaction between the scientists and clinicians who are leaders in their fields with the graduate students and postgraduate students, which adds a strong educational component to this conference. The complete program for the conference, including a roster of confirmed invited lecturers, is attached as an appendix to this application. Funding is requested to help reimburse the conference expenses of our outstanding invited speakers and of graduate students and postdoctoral fellows. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ADVANCING CLINICAL RESEARCH IN PEDIATRIC SURGERY Principal Investigator & Institution: Lally, Kevin P.; Surgery; University of Texas Hlth Sci Ctr Houston Box 20036 Houston, TX 77225 Timing: Fiscal Year 2002; Project Start 01-JUN-2002; Project End 31-MAY-2007 Summary: Congenital disorders requiring major pediatric surgical intervention are infrequent and present complex management problems. Most pediatric surgical studies are methodologically weak, single-center studies, and improved outcomes are likely to require a series of multi-center studies of exemplary quality. The applicant, Dr. Kevin Lally, the A.G. McNeese Professor and Chief of Pediatric Surgery at UT Houston, is a leader in promoting such studies. He has participated in 19 diaphragmatic hernia (CDH). CDH occurs in 1 per 2-4,000 live births; 35% of infants die; survivors are ventilated a mean of 18 days; and 34% have chronic lung disease. K24 funding is requested to substantially increase Dr. Lally's time for 1) Clinical Research including: a) A Multi-center placebo- controlled, randomized trial of antenatal steroids for infants with prenatally diagnosed CDH to improve their oxygenation and reduce time to ventilator independence. Fifteen centers have committed to participate; 7 have IRB approval; and 8, including UT-Houston, have GCRCs. The UT-Houston GCRC provides substantial statistical and database support for this trial. Collaborators at UT Houston include Drs. Larry Gilstrap and Jon Tyson, both experienced in steroid trials, and wellfunded investigators in steroid trials, and well-funded investigators in the NICHD Maternal-Fetal and Neonatal Research Networks; and b) Extensive analyses of the CDH registry to define improved predictors of outcome, assess geographic differences and temporal trends, and develop hypotheses and descriptive data needed to design trials to improve outcome. This database has strict quality control, data on 1650 infants and 48 institutions now participate. 2) Mentoring Dr. Lally is a talented mentor; 3 current mentees have recently received a K08 award, a K23 award, and a Young Investigator

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Award. To enhance his mentoring skills, promote the funding and productivity in his Division of Pediatric Surgery, and augment his methodologic skills in clinical research, Dr. Lally will complete the NIH funded Clinical Research Curriculum work and assist with mentoring teams for young investigators in the Curriculum. He will also conduct systematic reviews of the Cochrane Collaboration and complete the Master's Degree Program in Clinical Research at UT-Houston. K24 funding will help Dr. Lally with his research and mentoring to advance the quality of clinical research in pediatric surgery, develop an expanded international trials network, and improve the outcome of highrisk infants. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: AGING AND COGNITION AFTER CARDIAC SURGERY Principal Investigator & Institution: Reves, Joseph G.; Anesthesiology; Duke University Durham, NC 27706 Timing: Fiscal Year 2001; Project Start 15-FEB-1991; Project End 31-JAN-2004 Summary: Elderly patients are increasingly undergoing cardiac surgery and this trend is forecasted to continue. A very common and disturbing consequence of this surgery is deterioration in cognitive function. This impairment can be as high as 83% in the hospital and continue in up to 30% or more of patients for over a year. Elderly patients are particularly susceptible to this neurocognitive consequence of life- preserving surgery. This cause of cognitive dysfunction is postulate to be a result of cerebral emboli that occur during cardiac surgery. The cause of cognitive dysfunction is postulated to be a result of cerebral emboli that occur during cardiac surgery, which are impossible to prevent, and therefore strategies to protect the brain must be developed. It has become standard practice in cardiac surgery to allow the hematocrit advantages to blood flow during hypothermic cardiopulmonary bypass and fear of adverse consequences of transfusion. It is not known whether this hemodilution (50% reduction in oxygen carrying capacity of the blood) contributes to brain injury and cognitive impairment. We will test the hypothesis that preserving oxygen carrying capacity of the blood by limiting the amount of hemodilution during cardiopulmonary bypass improves cerebral protection. A prospective, randomized trial in 370 patients will be conducted in which half of the patients will be assigned to moderate hemodilution (hematocrit of greater than or equal to 27%-treatment group) and other half to profound hemodilution (hematocrit 15-18%-current practice group). Change in cognitive function over the first year after surgery will be compared between the groups. A secondary aim is to determine if serum markers of glial (S100beta) and neuronal (neuron-specific enolase) brain injury predict the changes in cognitive function. A positive association of brain injury markers with cognitive change will allow earlier detection and support the hypothesis that the cognitive changes are a result of brain ischemia. New knowledge gained in this study would be immediately transferred to clinical practice and could reduce the severity of cognitive impairment. The new information regarding cerebral protection would also have application in all ischemic brain syndromes including stroke. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: BEHAVIORAL MULTIMEDIA FOR ACL RECONSTRUCTIVE SURGERY Principal Investigator & Institution: Brewer, Britton W.; Virtual Brands 10 Echo Hill Rd Wilbraham, MA 01095

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Timing: Fiscal Year 2003; Project Start 01-AUG-2003; Project End 31-JUL-2004 Summary: (provided by applicant): Approximately 80,000 Americans sustain acute tears of the anterior cruciate ligament (ACL) of the knee each year, with associated healthcare costs estimated at roughly 1 billion dollars annually. Surgical reconstruction followed by an extended rehabilitation period is commonly recommended for ACL tears. The purpose of this STTR project is to develop a comprehensive behavioral multimedia package designed to reduce preoperative anxiety, decrease pain and anxiety during rehabilitation, and enhance rehabilitation outcome. In a novel application of existing technology, an interactive CD-ROM will be developed to provide ACL reconstruction patients with information on surgery- and rehabilitation-related matters and instruction in presurgical and postsurgical coping strategies. Audiotapes based on an empirically validated relaxation and guided imagery protocol for postsurgical ACL rehabilitation will also be produced. Phase I tasks will include: (a) developing content for the CDROM; (b) examining the accuracy and usability of the content generated for the CDROM; (c) producing initial prototypes of the CD-ROM and audiotapes; (d) evaluating the acceptability, usability and potential utility of the prototype multimedia package with the target population; and (e) finalizing plans to produce a revised prototype of the multimedia package, and evaluate its effect on presurgical and postsurgical processes and outcomes in Phase II. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: BIOMECHANICAL ANALYSIS IN STRABISMUS SURGERY Principal Investigator & Institution: Demer, Joseph L.; Professor; Jules Stein Eye Institute; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, CA 90024 Timing: Fiscal Year 2001; Project Start 06-JAN-1991; Project End 31-DEC-2005 Summary: (Adapted from applicant's abstract): Strabismus, the misalignment of the eyes, is prevalent in the US and usually treated surgically with imperfect results. This is the predictable result of an inadequate paradigm for understanding orbital anatomy and the biomechanics of binocular alignment, sometimes leading to erroneous diagnoses and surgery. The overall aim of this project is to develop a physiologically realistic, quantitative understanding of the biomechanics of the extraocular muscles (EOMS) and associated connective tissues responsible for the movement and alignment of the eyes, and to apply this information to the diagnosis and treatment of strabismus. Recent evidence in humans and other primates shows that orbital connective tissues form a complex gimbal system to regulate ocular kinematics. The global layer of each rectus extraocular muscle (EOM) rotates the eye, while the orbital layer of that EOM translates the connective tissue pulley that serves as the EOM's functional origin. Pulleys play a crucial role in normal biomechanical alignment. Congenital and acquired abnormalities of pulleys cause some types of pattern strabismus, and others may be related to manipulations of pulley tissues during strabismus surgery. We propose a multidisciplinary approach to understanding the mechanics of binocular alignment through parallel studies in humans and monkeys. We will employ magnetic resonance imaging (MRI) to obtain near-microscopic resolution of EOMs and connective tissues as they change with the direction of gaze in normal and strabismic subjects. We will test "the active pulley hypothesis" that the dynamic translational position of normal pulleys is regulated to be consistent with ocular kinematic behavior such as Listing's Law of ocular torsion. We will study EOM pulleys in normal aging, where characteristic forms of strabismus become prevalent. Comparison of orbital imaging in congenital and acquired cyclovertical strabismus will provide evidence concerning the causal

Studies 13

relationship between pulley heterotopy and strabismus. We will investigate the possible relationship between pulley abnormalities and two common co-morbidities of esotropia, dissociated vertical deviation and inferior oblique overaction. We will investigate in humans the effects of aging and other pathology on EOM connective tissue structure and constituents, and behaviorally and anatomically define the relationship of EOM proprioceptive organs to pulleys. We will compare pulleys in normal monkeys with those who are naturally and artificially strabismic. Data will be tested in computational models of binocular alignment suitable for clinical use. Findings will critically evaluate a new and potentially more useful paradigm for the understanding of ocular motility and treatment of strabismus. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: BONY EFFECTS OF TRANSIENT NONSKELETAL ILLNESS Principal Investigator & Institution: Heaney, Robert P.; John A. Creighton University Professor; None; Creighton University 2500 California St Omaha, NE 68178 Timing: Fiscal Year 2001; Project Start 15-AUG-1998; Project End 31-JUL-2004 Summary: (Adapted from the Applicant's Abstract): This project seeks to quantify the extent and time course of the bone loss produced by episodes of temporary illness of a sort associated with bed rest and catabolic influences. The underlying hypothesis is that recovery of bone lost under these circumstances is often incomplete, particularly in critical regions such as the spine and hip. If true, this would mean that some portion of age-related bone loss is a punctuated phenomenon, related to illness and/or immobilization, rather than being continuous and inexorable. This finding would open up additional opportunities for osteoporosis prevention. As a surrogate for a wide variety of catabolic episodes, the investigators will use routine, elective abdominal or pelvic surgery performed on individuals 55-70 years of age. They will measure bone mass by DEXA at spine and hip in 150 individuals before surgery, at 4-8 weeks post surgery, and then at 4, 8, and 12 months, to quantify and characterize the extent of bone lost under these circumstances. They will also measure various potentially modifying covariates, such as degree of temporary disability, Ca intake, hormonal therapy, vitamin D status, age, and life-style factors, any of which might plausibly influence extent of bone loss or degree of recovery. They will compare decreases at various time points after surgery to baseline values in each woman and will compare mean bone mass changes at 12 months with a non-operated control group matched for age and estrogen replacement therapy and measured twice across a 12-month interval. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CARPAL TUNNEL SYNDROME: DIAGNOSTIC AND TREATMENT STRATEGIES Principal Investigator & Institution: Jarvik, Jeffrey G.; Professor; University of Washington Seattle, WA 98195 Timing: Fiscal Year 2002; Project Start 15-FEB-2002; Project End 31-DEC-2006 Summary: (provided by applicant): While there is good evidence that patients with severe carpal tunnel syndrome (CTS) benefit from surgery, there is less evidence of a benefit for patients with mild to moderate disease. However, mild to moderate disease still accounts for important disability. Electrodiagnostic studies (EDS) have not been shown to accurately predict outcomes for patients with CTS. Recent advances in magnetic resonance (MR) permit high-resolution neurographic imaging of the median net-ve and pilot data suggest that MR neurographic imaging (MRNI) might be a better

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predictor of outcome than EDS. Thus, MRNI has the potential for playing a major role in the treatment of patients with CTS. We will test more hypotheses 1) that select patients with early, mild or moderate CTS benefit more from early surgery than with conservative therapy, and: 2) that MRNI accurately, identifies those patients more likely to benefit from early surgery. To test our hypotheses, we will recruit 500 patients with early, mild or moderate clinical CTS. After enrollment, patients will complete a standardized hand examination, EDS, symptom and functional status questionnaires, and a baseline high-resolution wrist MRNI. All patients will be treated for 2 weeks with standardized, optimal non-surgical therapy. Patients who improve within 2 weeks will be followed for I year. Patients who do not improve will be offered enrollment in trial in which they will be randomly assigned to either surgery or non-surgical therapy. We expect to randomize 200 subjects. We will offer to those patients who are randomized to non-surgical therapy an optimized, standardized hand therapy protocol, pharmaceutical and psychological intervention. We will offer localized ultrasound treatment to those who fail to improve after 3 months and surgery to patients who still have failed to improve after 6 months. The primary outcome measure will be the Carpal Tunnel Syndrome Assessment Questionnaire (CTSAQ) functional status index at 12 months. Our study design will allow us to determine if there are patients who benefit from early carpal runnel release and whether MRNI accurately identifies them. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CASPASE INHIBITION OF APOPTOSIS, INFANT CARDIAC SURGERY Principal Investigator & Institution: Mcgowan, Francis X.; Associate Professor; Children's Hospital (Boston) Boston, MA 021155737 Timing: Fiscal Year 2001; Project Start 01-JAN-2001; Project End 31-DEC-2005 Summary: (Verbatim from Applicant's Abstract): A major limitation to successful outcome of the repair of congenital heart lesions is the development of ventricular dysfunction. While the etiology is undoubtedly multifactorial, evidence suggests that it in large part may be due to myocyte loss resulting from chronic cyanosis, prolonged exposure to abnormal hemodynamic loads, and one or more episodes of ischemiareperfusion required for cardiac surgery. Death of myocytes can occur by either necrosis or apoptosis. In contrast to necrosis, apoptosis is the orderlv disassemblv of the cell by specific enzymatic pathways that are triggered by a wide variety of genetic, environmental and toxic stimuli. Recently, human and animal studies have shown that hypoxia, ischemia-reperfusion, abnormal mechanical loading, and inflammation can cause significant cardiomyocyte apoptosis. This occurs during myocardial ischemia, infarction, hypertrophy, and heart failure. The role of apoptosis in infants undergoing cardiac surgery is not known. Based upon this information and preliminary data from our laboratory, we believe that myocyte apoptosis is a significant problem in infants with normal and hypertrophied myocardium subjected to surgical ischemiareperfusion. This loss of myocytes will be particularly injurious to the infant myocardium because of the loads imposed by future growth and residual hemodynamic abnormalities. Because the pathways triggering apoptosis in this setting are multiple, we have chosen to focus on the role of the caspase enzymes. Caspases are the focal point of propagation and execution of apoptosis, and are directly responsible for the proteolytic cleavage of specific proteins required for the process to occur. Experiments in Aim I will be the first to l)define which caspases are expressed, activated, and what key intracellular proteins are thereby cleaved in normal and hypertrophied myocardium exposed to surgical ischemia-repercusion, 2)quantify the amount of apoptosis that

Studies 15

occurs in this setting, and 3)determine the effects of specific caspase inhibition on these events. Using a novel working heart transplant model with normal and hypertrophied infant hearts, Aim II will answer a question of critical importance, namely what is the effect of inhibition of caspases and apoptosis on long-term myocardial inflammation, fibrosis, and recovery of function? These experiments will be the first to study the beneficial versus harmful roles of apoptosis in myocardial ischemia-reperfusion injury. Overall, these studies will provide valuable new insights into therapeutic targets and strategies to preserve myocardial function in these patients. The results are also likely to be applicable to patients with ischemia, myocardial infarction, and heart failure. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CLINICAL APPLICATION OF IMAGE GUIDED LIVER SURGERY Principal Investigator & Institution: Chapman, William C.; Surgery; Vanderbilt University 3319 West End Ave. Nashville, TN 372036917 Timing: Fiscal Year 2002; Project Start 01-MAR-2002; Project End 31-MAY-2002 Summary: The surgical treatment of hepatic tumors is performed by removal or ablation of the involved tissue based on direct palpation and visual assessment sometimes aided with intraoperative ultrasound (IOUS). A new technology, interactive image-guided surgery (IIGS) displays current surgical positions on tomographic images (CT,MR,PET, etc) and permits the identification of precise working position with respect to previously identified anatomic and/or pathologic landmarks. Thus, the exact location in 3-D space can be shared and correlated throughout an operative procedure and significantly enhance surgical navigation. Engineering concepts and mathematical principles will be used in the development of an innovative IIGS system for hepatic surgery, including image processing for effective segmentation of the liver from abdominal CT scans, image registration to map physical space into image space, and integrated hardware and software development to create a system that can be used in th operating room. The specific aims of the R21 phase of this grant are: 1) Develop an automatic method for 3-D liver segmentation for accurate registration under image-guided hepatic surgery; 2) Develop techniques for track ultrasounds for specific use in image-guided hepatic surgery; 3) Adequately control hepatic motion and develop accurate registration algorithms incorporating liver surface data obtained in real-time with a laser scanner. The focus in the R33 phase of this grant will be on the clinical use of the system, with the eventual goal being image-guided ablation and resection of tumors. The specific aims proposed for years 2-4 of this project are: 1) Strengthen automatic methods for robust liver segmentation and surface registration during image-guided hepatic surgery; 2) Confirm system accuracy in tumor targeting using image-guidance in patients undergoing standard liver resection; 3) Determine th effectiveness of image-guided ablation in patients undergoing liver resection procedures; 4) Use image-guided ablation to accurately target and destroy primary and metastatic hepatic tumors and provide surgical navigation during hepatic resection. We believe that IIGS will significantly enhance currently performed clinical procedures and will permit accurate tumor localization for ablation and resection procedures. This technology also may permit minimally invasive treatment of liver tumors now performed in very limited circumstances. This work will also be carried out as a collaborative project between William Chapman, M.D. in the Department of Hepatobilliary Surgery and Liver Transplantation and Robert Galloway Ph.D., in the Department of Biomedical Engineering and other members within the center for Technology-Guided Therapy at Vanderbilt. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: COGNITIVE EFFECTS OF LUNG VOLUME REDUCTION SURGERY Principal Investigator & Institution: Kozora, Elizabeth; National Jewish Medical & Res Ctr and Research Center Denver, CO 80206 Timing: Fiscal Year 2001; Project Start 01-FEB-2000; Project End 31-JAN-2003 Summary: The primary goal of this study is to examine the neuropsychological functioning of emphysema patients undergoing lung volume reduction surgery (MT+LVRS) compared to medical therapy alone (MT). The study will include patients at two clinical sites for the National Emphysema Treatment Trial (NETT). Enhancements of ventilation and functional capacity are expected to contribute to greater long-term improvements in utilization of oxygen in the brain, thereby leading to improvements in cognitive performance greater than those observed among patients who exercise but do not receive LVRS (Specific Aim 1). A health control group will be retested on similar neuropsychological tests in order to control for practice effects (Specific Aim 2). Although we do not expect significant differences in emotional (depression and anxiety) functioning across groups, this study will enable us to evaluate the relationship between emotional status and neuropsychological scores in the MT+ LVRS and MT groups following randomization. In addition, since major neurological events are more likely following surgery, and major neurological events affect cognitive function, we will evaluate the incidence of neurological events in our sample and will determine the degree to which neurological events are associated with cognitive function (Specific Aim 3). No studies have examined the relationship between change in cognition and improve quality of life in COPD patients following LVRS surgery, therefore, we aim to explore these associations in Specific Aim 4. We propose to compare changes following LVRS and MT by examining 84 NETT patients (42 in MT, 42 in LVRS) at three times points (baseline, post 6-10 week medical treatment MT, and 6 months post MT or LVRS randomization) using select neuropsychological, psychological, neurological and QoL tests. Forty normal controls will be tested at baseline and 6-10 weeks follow- up. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: DECISIONS & OUTCOMES OF BRCA 1/2 TEST FOR BREAST PATIENT Principal Investigator & Institution: Schwartz, Marc D.; Co-Director; V T Lombardi Cancer Res Center; Georgetown University Washington, DC 20057 Timing: Fiscal Year 2001; Project Start 01-AUG-1997; Project End 31-MAY-2003 Summary: The investigators propose a prospective, longitudinal study to examine decision-making about pre-surgery BRCA1/2 testing and the medical, psychosocial, and economic outcomes of testing among newly-diagnosed breast cancer patients who are at high risk for having a BRCA1/2 mutation. The theoretical framework for this investigation is derived from Expected Utility Theory. The Specific aims are (1) to establish rates of uptake of the BRCA1/2 testing prior to surgical treatment for breast cancer and to identify the determinants of the decision to be tested; (2) to evaluate the impact of BRCA1/2 testing on patients' surgical treatment choices; (3) to evaluate the impact of pre-surgery BRTCA1/2 testing on psychological well-being; and (4) to develop a model to estimate the costs of BRCA1/2 testing for newly-diagnosed breast cancer patients per quality-adjusted life years saved. The subjects in this prospective longitudinal study are 400 newly diagnosed breast cancer patients who have an equal to or greater than 25 percent prior probability of having a BRCA1/2 mutation. A baseline assessment will be conducted prior to the offer of testing to collect data on background/controlling variables (sociodemographics, medical, physician and family

Studies 17

factors), predictor/moderator variables (preferences for health outcomes, coping style, anxiety, social support), and baseline levels of outcome variables (psychosocial well being, prevention and surveillance practices). Following pre-test education and informed consent, patients will have an opportunity to have BRCA1/2 testing and receive their result during an individual session with a genetic counselor. Follow-up interviews will be conducted at 1-, 6-, 12-, and 18-months post-surgery to collect outcome data. The primary group comparisons in multiple regression models will be between BRCA1/2 carriers, non carriers, and pre-surgery test decliners. The proposed cost-effectiveness analysis will incorporate prospective data on patient preferences and outcomes together with secondary data from the literature, into a decision-analytic model. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DEVICE FOR PROMOTING SURVIVAL OF CONGESTED TISSUE FLAPS Principal Investigator & Institution: Conforti, Michael L.; Spectro Con 2701 Van Hise Ave, Ste Fc Madison, WI 53705 Timing: Fiscal Year 2002; Project Start 01-FEB-2002; Project End 31-JUL-2002 Summary: (provided by applicant): New technology is needed for the treatment of venous congestion, a serious complication of reconstructive surgery. Currently, live leeches are used, but are psychologically traumatic to patients being treated, and are often ineffective in preventing tissue death. Because there are no other alternatives for treating venous congestion, a mechanical device for this purpose represents a pioneering concept, unique to the current marketplace. The long-term goal of this research is to develop a fully automated, clinically applicable medical device capable of treating venous congestion over an extended time period. The aim of Phase I is to demonstrate feasibility of using a rudimentary device prototype developed in our laboratory to successfully treat venous congestion for a 12-hour period. Congested fasciocutaneous pedicle flaps will be created in 16 pigs, with 8 treatment and 8 control animals. Tissue health during treatment and control experiments will be monitored by quantitative measurements of skin color, surface perfusion, subcutaneous oxygen tension, and blood volume removed. Histological analysis of tissue viability at the end of 12 hours will determine the success of the device in treating venous congestion. A device that effectively treats venous congestion will replace the use of live leeches and will have far-reaching societal benefits. PROPOSED COMMERCIAL APPLICATIONS: The innovative technology developed will completely replace medicinal leeches as the standard treatment for venous congestion, a serious complication of reconstructive surgery. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PROSTHESES

EFFICACY

OF

IMPLANT

SUPPORTED

MAXILLOFACIAL

Principal Investigator & Institution: Garrett, Neal R.; Assoc Professor; Removable Prosthodontics; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, CA 90024 Timing: Fiscal Year 2001; Project Start 01-JUN-1997; Project End 31-MAY-2003 Summary: (Adapted from the Applicant's Abstract): It is suggested that, objective outcome assessments are needed to determine the effectiveness of costly, timeconsuming surgical reconstructive procedures and implant-supported dental prostheses

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prior to their acceptance as treatment modalities of choice for oral cancer patients. The investigators outline a longitudinal study to test three hypotheses: (1) the conventional dental prosthesis restores specified oral functions and perceptions to the pre-cancer levels; (2) the implant-supported dental prosthesis restores oral functions and oral perceptions to the pre-cancer surgery levels; and (3) the conventional denture and implant-supported prostheses are equally efficient in restoring specified oral functions and perceptions. A total of 62 patients with early oral cancer will be recruited; in addition, 22 patients requiring a partial maxillectomy and 40 requiring a partial lateral mandibulectomy will be enrolled. The mandibular defects will be reconstructed with fibula free flap surgery. Following a healing period, implants will be placed and permitted to heal unloaded for six months. Conventional dental prostheses will be fabricated and used by patients for at least 16 weeks during Phase I healing before the implants are exposed and loaded. A few weeks after Phase II surgery, the patients will receive implant-supported dental prostheses. A complete series of oral functional tests and questionnaires will be administered at four time intervals: (1) prior to ablative surgery; (2) one week before insertion of conventional denture prostheses; (3) 16 weeks after conventional dental prostheses insertion; and (4) 16 weeks after implant-supported dental prostheses insertion. All patients will be followed at 6 month intervals, for 12-36 months, to establish implant success rates, using life table analysis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ENDOTHELIAL DYSFUNCTION AND PERIOPERATIVE EVENTS Principal Investigator & Institution: Gokce, Noyan; Boston Medical Center Gambro Bldg, 2Nd Fl, 660 Harrison Ave, Ste a Boston, MA 02118 Timing: Fiscal Year 2001; Project Start 01-SEP-2000; Project End 31-JUL-2005 Summary: The overall goal of this application is to provide support and training for the applicant towards becoming an independent, patient-oriented clinical investigator in the field of vascular biology. The proposed application builds on the applicant's previous research experience, provides new training, and examines a highly relevant clinical question conducted in a mentor-based environment ideally suited for the completion of this project. The overall objective of the proposed plan is to investigate the importance of examining endothelial function as a predictor of cardiovascular events in patients with atherosclerotic vascular disease. The vascular endothelium regulates vasomotor tone, platelet activity, and inflammation through the synthesis and elaboration of a number of factors including endothelium-derived nitric oxide (EDNO). Endotheliumdependent vasodilation and platelet inhibition are impaired in atherosclerosis and associated conditions, possibly due to increased vascular oxidative stress and reduced NO bioactivity. Loss of normal vascular endothelial function favors a local vasospastic, prothrombotic, and proinflammatory milieu, and is linked to the pathophysiology of cardiovascular events including myocardial infarction, stroke, and unstable angina. However, no study to date has demonstrated that impaired endothelial function is predictive of cardiovascular risk. Patients with peripheral arteriosclerotic disease undergoing vascular surgery have multiple risk factors for endothelial dysfunction, and are at high-risk for perioperative cardiovascular events. Using noninvasive, highresolution vascular ultrasound analysis of brachial arterial vasomotor function, this project proposes in specific aim 1: to determine whether patients with impaired preoperative vascular endothelial function have increased cardiovascular events at the time of vascular surgery compared to patients with normal endothelial function, and in specific aim 2: to determine whether pretreatment of subjects with impaired endothelial function using the antioxidant ascorbic acid (Vitamin C) reduces perioperative

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cardiovascular events during vascular surgery. Identifying high-risk subjects with impaired vascular function may lead to potential improvement in management of these patients. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EPIDEMIOLOGY OF LUMBAR SPINE SURGERY: RATES AND TRENDS Principal Investigator & Institution: Deyo, Richard A.; Professor; University of Washington Seattle, WA 98195 Timing: Fiscal Year 2002; Project Start 15-FEB-2002; Project End 31-DEC-2006 Summary: (provided by applicant): Spine surgery rates in the United States exceed those in most developed countries by at least twofold. Furthermore, they increased 55 % during the 1980's. Wide geographic variations in surgical rates may imply professional uncertainty about optimal indications. Recent technical changes in spine surgery, including new spinal implants and a shift towards ambulatory surgery, may affect surgical rates and reoperation rates. The goals of this project are to examine whether surgical rates continue to rise, and if the introduction of interbody fusion cages resulted in acceleration of surgery rates: to examine surgical rates among the elderly and for spinal stenosis in particular to examine whether reoperation rates are increasing over time; and to determine if certain surgical procedures are associated with unusually high rates of reoperation. The analyses will make use of existing survey and administrative data. We will use a previously validated algorithm for identifying patients with lumbar spine surgery from automated data, as well as a previously validated comorbidity index. National rates of surgery will be examined using the National Hospital Discharge Survey and the Healthcare Cost and Utilization Project, both available from the National Technical Information Service, Examination of rates and trends among elderly patients, and especially for spinal stenosis, will make use of these national databases and of Medicare claims data for selected years. The analysis of reoperation rates will depend largely on a Washington State hospital discharge registry which will provide data from 1987 through 2000. Reoperation rates will also be examined using Medicare claims data. Finally, we hope to examine the growth of ambulatory disc surgery, which became increasingly popular after 1994. Although previously available surveys of ambulatory surgery are no longer available, we will have an opportunity to examine the growth of the ambulatory surgery using Medicare claims data, and some state ambulatory surgery databases. This series of analyses is important because it will help to clarify factors associated with changes in surgical rates. It will also help to assess the impacts of recent technical and practice innovations. Reoperation is generally regarded as an unfavorable outcome of lumbar spine surgery, and rising reoperation rates would be alarming. Thus, rates and trends in the use of spinal surgery and repeat operations may help identify high priorities for research, suggest areas requiring a more consistent therapeutic approach, and indicate possible problems in quality of care. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ESTRADIOL FOR NEUROCOGNITIVE DYSFUNCTION AFTER CABG Principal Investigator & Institution: Hogue, Charles W.; Anesthesiology; Washington University Lindell and Skinker Blvd St. Louis, MO 63130 Timing: Fiscal Year 2001; Project Start 01-JUN-2001; Project End 31-MAY-2006

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Summary: Women undergoing coronary artery bypass graft (CABG) surgery have a higher operative mortality rate, longer hospitalizations, and higher hospital cost compared with men. A large proportion of this excess morbidity and mortality of surgery for women is due to perioperative neurologic injury. Estrogens have been consistently shown to reduce the extent of neurologic injury in a variety of in vitro and animal experimental stroke models. These data together strongly suggest that the higher risk for perioperative neurologic complications for elderly women may relate to their estrogen deficient state. In this randomized, placebo controlled study, we will test the hypothesis that perioperative estrogen replacement in postmenopausal women reduces the risk for neurologic injury after CABG surgery. Three hundred thirty four women undergoing CABG surgery will be prospectively randomized to receive either 17betaestradiol or placebo in a double-blind fashion beginning the day before surgery and continued for 5 days after surgery. Patients will be assessed for neurocognitive dysfunction, the most common manifestation of neurologic injury from cardiac surgery. Neurocognitive testing will be performed 1-2 days before surgery, 4 to 6 weeks postoperatively, and 6- months after surgery. The primary endpoint will be neurocognitive function 4 to 6 weeks after surgery for women who received 17betaestradiol compared with placebo perioperatively. We will also evaluate for the importance of postoperative cognitive decline on measures of cognitive function and quality of life 6 months after surgery and whether perioperative 17beta-estradiol treatment improves these latter outcomes. The results of this study will evaluate the efficacy and safety of an easily implemented therapy for improving neurologic outcome and quality of life after CABG surgery for postmenopausal women. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EXCELLENCE IN CLINICAL RESEARCH IN CHILDREN'S SURGERY Principal Investigator & Institution: Moss, R Lawrence.; Surgery; Yale University 47 College Street, Suite 203 New Haven, CT 065208047 Timing: Fiscal Year 2003; Project Start 15-JUL-2003; Project End 31-MAY-2008 Summary: (provided by applicant): This application seeks five years of support to allow R. Lawrence Moss, MD, to make major contributions to the level of Children's Surgery by achieving his career objectives in patient-oriented clinical research. His foremost professional objective is to introduce scientific rigor and established clinical research techniques into the manner in which surgical treatments in children are evaluated. Dr. Moss is an active clinical Pediatric Surgeon and an internationally recognized and established clinical investigator. He is the principal investigator for the first ever multicenter clinical trial in Children's Surgery ROl HD 38462. He serves as Stanford Site Director and only surgeon of the first multi-disciplinary patient-oriented research network in Pediatrics. He holds multiple national leadership positions in Pediatric Surgery, and is recognized as a leader in clinical research in the field. He has mentored twelve postdoctoral fellows in clinical research of whom the past five have each obtained extramural funding based on their outstanding productivity. Stanford University is an exceptionally rich environment for patient-oriented research, and has identified clinical investigation as a major focus of the Medical School for the next decade. Dr. Moss' work is an integral component of this institutional mission in clinical research. Examples of work to be conducted during the training period include; 1) leading a twelve-center trial of peritoneal drainage versus laparotomy for infants with perforated necrotizing enterocolitis; 2) establishment of the first multi-center neonatal surgical database for children with congenital anomalies; and 3) development of a multiinstitutional consortium to study biliary atresia. With the support of this award, the

Studies 21

awardee's underlying objectives are three-fold: 1) to make substantive contributions to the field Children' s Surgery that will directly impact the health and well-being of children; 2) to conduct multiple clinical research projects that change the shape of the discipline of academic Pediatric Surgery; and 3) to mentor the next generation of physician scientists in Children's Surgery to be critical thinkers who are well versed in clinical research techniques. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FEEDING BEHAVIORS & ENERGY COST IN INFANTS WITH CHD Principal Investigator & Institution: Medoff-Cooper, Barbara S.; Professor and Director of Center for Nur; None; University of Pennsylvania 3451 Walnut Street Philadelphia, PA 19104 Timing: Fiscal Year 2002; Project Start 01-JUN-1994; Project End 31-MAY-2007 Summary: (provided by applicant) This proposal requests continued support for a NINR funded study that had been entitled: Nutritive sucking: Physiological and Behavioral correlates. In the present proposal, we (1) deepen our analysis of feeding organization by integrating measures of sucking, swallowing and breathing over the course of full meals and (2) characterize the feeding patterns of another at-risk population - infants with congenital heart disease (CHD), and (3) relate feeding performance and energy expenditure to problems in growth and development over the first year of life in CHD infants. These infants are often difficult to feel, even when their surgery has improved their cardiac function. Indeed, the success of the surgery often unmasks their severe nutritional syndrome, failure to thrive (FTT). To address this important clinical problem, we propose to measure feeding performance and energy expenditures over the first hear of life in 120 infants who have undergone surgery during the first month of life to correct or palliate sever cardiac abnormalities and 60 healthy newborn controls. The specific aims of our proposed study are as follows: 1) to establish which aspects of feeding performance (e.g. suck/swallow/breathe coordination, temporal patterning of sucking with meals, suck pressure generation, adaptation to variation in flow rate) are most subject to disruption in CHD infant after corrective or palliative surgery; 2) to determine infants' pattern of oropharyngeal adaptation to variations in the flow rate through an artificial nipple, and whether flow rate adjustment represents a viable strategy for improving meal size outcomes; and 3) to determine the relative contributions of disrupted feeding organization and (potentially elevated) energy expenditure to unfavorable growth outcomes, i.e. (i) relate disrupted feeding to growth, (ii) relate energy expenditure to growth, and (iii) integrate energetic and feeding-performance characteristics in a predictive model of failure to thrive in infants with CHD. This study addresses what we believe is the central role of feeding organization in the nutritional status of this patient population; as such, it represents an approach toward early identification, based on feeding performance and energetic profiles, of infants most at risk for developing FTT by the age of one. The present work may offer prospects for targeted behavioral interventions involving modification of flow rates and paced feeds. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: FUNCTIONAL MRI FOR NEUROSURGICAL PLANNING IN EPILEPSY Principal Investigator & Institution: Constable, Robert T.; Diagnostic Radiology; Yale University 47 College Street, Suite 203 New Haven, CT 065208047

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Timing: Fiscal Year 2002; Project Start 01-APR-1999; Project End 31-MAR-2007 Description (provided by applicant): Epilepsy patients who are candidates for surgical resection of a brain lesion must have some form of functional mapping to determine if the lesion can be removed without creating a functional deficit. The current procedures for mapping language in these patients are spatially limited (e.g. hemispheric mapping with Wada testing) or highly invasive (cortical stimulation using subdural electrodes). Functional MR imaging (fMRI) has the potential to replace, or significantly enhance, the current methods used in Neurosurgical planning. It is noninvasive and has been shown to be able to localize cortical activity. However, the standard echo planar imaging fMR1 methods, based on the BOLD activation response, suffer from low spatial resolution, and sensitivity to static Bo magnetic field inhomogeneities which lead to image distortions and low signal intensity. These problems severely limit the ability of fMRI to localize brain activity for Neurosurgical planning. This project has 3 aims. First, it is designed to improve fMRI methodology. Our earlier work has identified the need to develop single shot approaches to maximize statistical power in fMRI studies, and thus the methodology developments will focus on single shot approaches to image distortion and signal loss, including the investigation of asymmetric spin echo EPI and dynamic shimming. This innovative program will allow for highly robust functional localization required for surgical planning, but the methods to be developed may be applied to any fMRI study. Secondly, we will continue our work on validating the fMRI activation detected through comparison with Wada testing and cortical stimulation. A battery of fMRI language paradigms, parallel to out-of-magnet behavioral studies, have been designed to address the specific deficits obtained in temporal lobe epilepsy patients and these will be applied to both control subjects and patients with intractable epilepsy who are candidates for surgery. Patients will be imaged and tested behaviorally both pre and post- surgery. Through such studies the ability of fMRI to predict surgical outcome will be evaluated. Finally, we will examine the relationship between disease states (mesial temporal sclerosis, cortical malformations, and tumors) and language reorganization both acutely (pre- and post- surgery) and chronically by relating the language organization and performance prior to surgery, to the type, location, and age at onset of epilepsy. Such a study will provide evidence not only of language reorganization but also of the specific cortical regions that reorganize, and the impact this reorganization has on performance and surgical outcome. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GENETICS, DYSFUNCTION

INFLAMMATION

&

POST-OP

COGNITIVE

Principal Investigator & Institution: Newman, Mark J.; Vice President; Anesthesiology; Duke University Durham, NC 27706 Timing: Fiscal Year 2001; Project Start 30-SEP-1999; Project End 31-JUL-2004 Summary: Our investigative team has recently discovered a genetic association between late-onset Alzheimer's disease and the apolipoprotein E (APOE, gene; apoE, protein) epsilon-4 gene. This finding has triggered many recent studies showing an important role of apoE in the determination of neurologic injury and recovery following a variety of acute ischemic insults including intracerebral hemorrhage, closed head injury, acute stroke and dementia pugilistica (chronic traumatic brain injury). An important aspect of our work is the finding of an association between APOE4 and neurocognitive decline after cardiac surgery. Although mounting evidence suggests apoE plays a role in acute and chronic neurological disease, the mechanism underlying these observations and the influence of aging is not completely understood. We hypothesize that a genetic

Studies 23

predisposition exists for the easily documented neurologic and neurocognitive dysfunction observed after anesthesia and surgery. ApoE may play a role in modulating the inflammatory response to ischemia and perioperative stress. We have recently determined that ApoE, in vivo, modulates the release of nitric oxide and TNF-alpha in glial cells. This may compound the autonomic dysregulation that we recently reported in the elderly. The combination of these two factors may modulate an exaggerated inflammatory response increasing the susceptibility to perioperative injury. Our pilot data associating APOE4 with cognitive impairment after cardiac surgery support this hypothesis. Therefore, we propose to determine the association between post-operative neurocognitive dysfunction, neurocognitive recovery, and APOE4 genotype in patients undergoing thoracic and vascular surgery. The unifying hypothesis is that a genetic susceptibility to neurologic dysfunction after surgery results either from a predisposition to immunologic dysregulation, the failure of normal genetically encoded reparative processes, or a combination of these mechanisms resulting in a greater incidence and severity of neurocognitive dysfunction and reduction in quality of life and independence in the aging population after surgery. Thus, our extensive preliminary work as well as our expanded collaborative interdisciplinary research group including cardiac anesthesiologists, cardiac surgeons, neuroscientists, geneticists and neurologists is uniquely able to investigate the genetic predisposition to neurocognitive dysfunction after surgery. Such an association is an important first step in elucidating the mechanism underlying genetic susceptibility to ischemic insults, and designing interventional strategies to improve outcome. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GUT ISCHEMIA/REPERFUSION INJURY: MODULATION BY NUTRIENTS Principal Investigator & Institution: Kozar, Rosemary A.; Surgery; University of Texas Hlth Sci Ctr Houston Box 20036 Houston, TX 77225 Timing: Fiscal Year 2002; Project Start 10-AUG-2002; Project End 31-JUL-2007 Summary: (provided by applicant): Candidate: Dr. Kozar is a new faculty member at the University of Texas-Houston Medical School (UTHMS), where she is a member of the Department of Surgery. She first acquired basic research skills as a NRSA Fellow while obtaining her PhD at Baylor College of Medicine. Following completion of her general surgery training, the candidate accepted a faculty position in Trauma and Critical Care at MCP-Hahnemann University School of Medicine under the direction of Dr. Joel Rosyln. During this time she began to develop research experience in the field of Trauma and Critical Care by investigating the activity of antioxidant enzymes in an acute lung injury model, funded by a private grant for which she was the principal investigator. Since becoming a faculty member in the Department of Surgery at UTHMS she has become very active in the NIGMS-sponsored Trauma Research Center, focusing on the role of the gut in multiple organ failure. A Career Development Award, in conjunction with the support of two highly respected mentors, would enhance the acquisition of the necessary skills and talents crucial to becoming a future independent investigator. Research: The proposed research project is an extension of the Trauma Research Center?s interest in the link between gut dysfunction and multiple organ failure. As proposed in this application, the candidate wilt test the hypothesis that specific enterat nutrients during gut ischemia/reperfusion impair gut function and enhance gut injury. The goal of the proposed project is to understand how enterat nutrients during times of metabolic stress can be detrimental to gut function. The results obtained will facilitate a better understanding of postinjury gut dysfunction and aide in

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future strategies to achieve enteral tolerance in patients at high risk for multiple organ failure. Environment: The UTHMS in the center of the Texas Medical Center is comprised of 42 member institutions dedicated not only to outstanding patient care but also to the highest standards and quality of research. As part of the Department of Surgery's Trauma Research Center, the candidate has the guidance and support of numerous researchers in the Department of Surgery as well as in Integrative Biology, and Medicine. The sponsors are an integral part of this arrangement and are especially suited to ensure success of the proposed project. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HAPTIC FEEDBACK FOR ROBOT-ASSISTED SURGICAL SYSTEMS Principal Investigator & Institution: Okamura, Allison M.; Mechanical Engineering; Johns Hopkins University 3400 N Charles St Baltimore, MD 21218 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-JUL-2007 Summary: (provided by applicant): Cardiac surgery is traditionally performed through a median sternotomy, providing optimal access to all cardiac structures and great vessels, but generating significant disfigurement and pain for the patient. The advent of robot-assisted minimally invasive surgery (MIS) holds great promise for improving the accuracy and dexterity of a surgeon while minimizing trauma to the patient. However, clinical success with robot-assisted cardiac MIS has been marginal; improved patlent outcomes and mitigated costs have not been proven. We hypothesize that this is due in large part to the lack of haptic feedback presented to the surgeon. Without the sense of touch naturally used in surgical tasks such as fine suture manipulation, surgeon performance is jeopardized. The general objective of the proposed research is to acquire and use haptic information during robot-assisted minimally invasive surgery, with a focus on manipulation of fine sutures. It is anticipated that this approach will offer two main benefits over current systems: (1) forces will be fed back to the user in real time, directly or through sensory substitution, improving task performance, and (2) haptic information will be used to create automatic virtual fixtures that assist the surgeon, e.g., by prevention of excessive applied suture forces and maintenance of constant retraction forces. The specific aims are: (1) to understand the sensing requirements for minimally invasive surgical tasks, (2) to test different modes of haptic feedback in robot-assisted minimally invasive surgical environment, (3) to create virtual fixtures that augment and improve the execution of surgical tasks, and (4) to apply feedback of haptic information during phantom experiments, creating a direct path to clinical applications. These specific aims contribute to a Iong-term research plan for using haptic information in robot-assisted minimally invasive surgery. The proposed work represents the development of operative technology that can provide significant improvements in patient outcomes, as well as Iay the groundwork necessary to address several other exciting research issues such as beating-heart (off-pump) procedures, procedure and tissue models, and virtual environments for training. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: HIGH INTENSITY ULTRASOUND FOR NON-INVASIVE SURGERY Principal Investigator & Institution: Cain, Charles A.; Chair; Bioengineering; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, MI 481091274 Timing: Fiscal Year 2001; Project Start 01-APR-2000; Project End 31-MAR-2005 Summary: (Adapted from Applicant's Abstract): Check thisWays to make acoustic cavitation predictable, and thus practical as a mechanism for noninvasive surgery, will

Studies 25

be explored in this research. Novel ways to accurately place therapy beams and verifying that surgical lesions have been formed will also be explored. With the use of large aperture phased array systems, and aberration correction techniques, it is possible to form high quality ultrasound beams around and through obstructions like ribs, or the skull, with the attractive possibility of noninvasive brain surgery or cardiac ablation for treatment of life threatening arrhythmias. With the loss of energy in propagating around and through such obstructions, thermal ablation, without heating the complex intervening tissue, is a difficult proposition. However, cavitation, particularly from arrays operating at lower ultrasound frequencies, becomes an exciting tissue ablation mechanism for further study. Of particular interest is the potential use of stabilized microbubbles, often used as ultrasound imaging contrast agents, to act as cavitation nuclei lowering cavitation thresholds and making spatial localization predictable. Cavitation has been intentionally avoided in the past because reproducible localization of ablation zones (or surgical lesions) has been difficult mostly due to large unpredictable spatial variations in cavitation thresholds in living tissues. Preliminary experiments with phased array systems suggest that surgical lesion size and shape become more predictable with prior administration of contrast agents. The applicants proposed to systematically explore the role of contrast agents on cavitation thresholds, surgical lesion size and histology, predictability of shape and spatial localization of necrotic zones, and role of contrast agent concentration. Such systems will allow highly predictable beams to be formed non-invasively, for example, around the ribs onto a moving target, e.g. the heart. Contrast agents will also be explored as means for targeting therapy beams and as a way to verify that surgical lesions have been formed in the desired treatment volume. This application is based on their experimental observation that microbubbles can be "collapsed" by low intensity ultrasound causing "darker" areas in the image, thus allowing sub-lesion forming intensities to be used for beam localization prior to application of surgical intensities. Since cavitationally induced lesions will likely destroy the local vasculature, a surgically necrosed volume will not reperfuse with contrast agent indicating lesion extent. The applicants will explore use of contrast agents as means to guide, enhance, and verify surgical lesion formation with high intensity ultrasound. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HIGH TEMPERATURE ULTRASOUND THERAPY GUIDED BY MRI Principal Investigator & Institution: Hynynen, Kullervo H.; Associate Professor; Brigham and Women's Hospital 75 Francis Street Boston, MA 02115 Timing: Fiscal Year 2001; Project Start 01-JUL-1988; Project End 31-MAR-2003 Summary: Surgical resection of secondary liver tumors has been shown to be an effective treatment in some patients with five year survival between 20-30 percent. Unfortunately, the surgery has a relatively high complication rate with 35 percent of patients suffering minor complications. About 15 percent suffer more serious complications with a mortality rate of 2-5 percent. In addition the average hospital stay is about two weeks without complications. Deep noninvasive coagulation of liver tumors could potentially eliminate some of these disadvantages of liver surgery. Most notably it could be feasible to eliminate infections and perform the procedure with short or no hospital stay. This could translate in to large cost savings and perhaps extend the therapy to patients who would not be eligible for major surgery due to other health reasons. During the current grant period we developed ultrasound phased array systems, and magnetic resonance temperature monitoring techniques that could be used for liver surgery. We have developed a 512 channel driving system for the phased

26 Surgery

arrays, theoretically designed and experimentally tested different array configurations, and developed array manufacturing techniques for magnetic resonance (MR) scanner compatible large scale arrays. We constructed a large scale array to demonstrate the feasibility of the proposed technique. Finally, we have shown that the temperature elevation induced during high power sonications in tissue can be quantified using MR temperature imaging. Now we propose to use our experience and hardware for the development of a noninvasive surgery technique for clinical liver tumor treatments. To reach this goal several basic ultrasound arrays and beam propagation concepts still need to be investigated prior to our ability to accurately execute noninvasive liver surgery. These will include theoretically optimizing the large scale array design for liver treatments, testing the designed arrays, and developing and testing ultrasound propagation models that take into account nonlinear propagation, tissue temperature elevation, and tissue changes due to thermal exposures. These theoretical models are required for accurate multi focal pattern sonication planning and control of the treatments. In addition the procedures for clinical liver treatments need to be developed and tested. Finally, we plan to investigate the potential of using ultrasound induced vascular occlusion for cancer therapy. In conclusion, during the current grant period we developed the basic tools that will make accurate noninvasive coagulation of liver tumors possible. During the next phase of this grant we plan to complete all of the required research so that the therapy can be tested in clinical treatments. The noninvasive focused ultrasound coagulation of liver tumors has a large clinical potential in reducing complication rates and costs associated with open surgery. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HOST RESPONSE TO POST-OPERATIVE PNEUMONIA Principal Investigator & Institution: Knight, Paul R.; Professor and Vice Chairman; Anesthesiology; State University of New York at Buffalo 402 Crofts Hall Buffalo, NY 14260 Timing: Fiscal Year 2001; Project Start 01-JUL-2001; Project End 31-MAY-2006 Summary: (Verbatim from the Applicant's Abstract): Anesthesia/surgery predisposes the patient to develop nosocomial pneumonia by mechanisms that are not completely defined. The presence of a viral respiratory tract infection (RTI) during anesthesia/surgery further complicates the host antibacterial response. Evidence from our laboratory has demonstrated anesthesia/surgery induces changes in cytokine response (e.g., TNFalpha, MIP-2, IFNgamma), leukocyte recruitment, and lung injury to influenza RTI. These responses are also critical to innate host defenses against bacterial pathogens. Our focus is to examine cellular mechanisms during a viral RTI that predispose the host to a post-surgical bacterial pneumonia. We hypothesize that anesthesia/surgery will change host responses differently during distinct periods in the course of a viral RTI by altering expression of pro- and antiinflammatory cytokines, thereby decreasing antibacterial defenses. Aim #1 will assess the effects of anesthesia/surgery during influenza on bacterial clearance, inflammatory cell influx, and cytokine expression an Escherichia coli challenge. We predict that laparotomy during influenza will promote the relative expression of MCP-1 and IL-10 over TNFalpha, MIP-2, and IFNgamma. Aim #2: will assess ex vivo the combined effect of laparotomy and influenza on a) LPS stimulated aMphi cytokine expression and phagocytic activity, and b) the ability of in vitro antiMCP-1, antiIL-10, or IFNgamma administration to improve M dysfunction. We postulate that laparotomy during influenza will alter aMphi regulatory functions and decrease effector functions as a result of selective enhancement of expression anti-compared to proinflammatory

Studies 27

cytokines. Finally, in Aim #3, we will examine the contribution of endogenous cytokines in the suppression of antibacterial defenses following laparotomy during influenza by selective cytokine manipulations. Bacterial clearance, inflammatory cell influx, and cytokine levels will be assessed. We anticipate that neutralization of IL-10 or MCP-1, administration of IFNgamma, or increased TNFalphaexpression will improve antibacterial host defenses following laparotomy during physical signs of influenza. These studies will examine mechanisms that lead to alterations in bacterial clearance post-surgically following a viral RTI, assess the pathogenesis of post-surgical pneumonia in general, and suggest immune adjuvant strategies to prevent this complication. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HYPOTHERMIA DURING INTRACRANIAL ANEURYSM SURGERY Principal Investigator & Institution: Todd, Michael M.; Anesthesia; University of Iowa Iowa City, IA 52242 Timing: Fiscal Year 2001; Project Start 05-SEP-1999; Project End 31-MAY-2004 Summary: Aneurysmal subarachnoid hemorrhage (SAH) remains a major cause of morbidity and mortality. Since the incidence peaks in mid-life, and since many survivors are permanently damaged, the human and economic costs are immense. Much of the death and disability is the acute and delayed result of blood in the subarachnoid space (e.g. vasospasm). However, an unknown - but we believe substantial - fraction of the adverse outcomes are a complication of surgery performed to obliterate the source of bleeding; as many as 25 percent of patients who undergo craniotomy for aneurysm clipping will have a new neurologic deficit when examined 12-24hrs postoperatively. This danger is well known, and almost all surgical teams utilize some method to protect patients during surgery, including barbiturates, etomidate, steroids, mannitol or varying degrees of hypothermia. Unfortunately, in spite of the popularity of such interventions, none has ever been systematically tested in humans (other than deep hypothermia and circulatory arrest), and none are known to provide any benefit at all. Of the aforementioned therapies, we believe the best laboratory evidence supports the use of hypothermia. Our goal, therefore, is to perform a prospective, randomized clinical trial to evaluate the safety and efficacy of intraoperative hypothermia (t=33 degrees C) as a means of reducing early and long-term postoperative neurologic morbidity following surgery for clipping of intracranial aneurysm. Control patients will remain normothermic during and after surgery; in hypothermic patients, body temperature will be normalized as quickly as possible after the aneurysm clip is in place. All other aspects of pre- and postoperative care will be managed routinely. We hypothesize that hypothermia, even when limited to the intraoperative period, will result in an improvement in neurologic outcome as measured by Glasgow Outcome Scale at 3months following surgery, and will also result in more rapid improvement during the first postoperative week. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: IMAGING THE VASCULAR RESPONSE TO IMPLANTS Principal Investigator & Institution: Barton, Jennifer K.; Assistant Professor; None; University of Arizona P O Box 3308 Tucson, AZ 857223308 Timing: Fiscal Year 2002; Project Start 01-AUG-2002; Project End 31-JUL-2007 Summary: (provided by applicant) Many commonly used implant materials elicit a strong foreign body response, leading to the encapsulation and failure of the implant. A

28 Surgery

preferred healing response involves a minimal inflammatory response and ingrowth of blood vessels. Currently, normal practice for evaluating novel implants involves surgically implanting devices in experimental animals, harvesting implants at various time points, and performing histological evaluation. The overall goal of this project is to identify the role that blood vessels serve in the healing response of an implant, through non-destructive optical imaging. Optical coherence tomography (OCT) and confocal microscopy will provide a greatly increased amount of data for the same number of implantations performed, and will allow a single implant to be followed for multiple weeks, mitigating concerns about animal-to-animal and surgery-to-surgery variations. As a long-term clinical goal, noninvasive imaging may allow identification of the earliest vascular response to the implant and prediction of its success. There are three specific aims associated with this application: Specific Aim 1. Evaluate the vascular response in glaucoma implant healing. Glaucoma implants offer an optically accessible model for implant healing. Both commercially available (Ahmed) and experimental expanded polytetrafluroethylene (ePTFE) implants will be placed in rabbit eyes with or without patches of ePTFE, pericardium or a scaffold-based three-dimensional human fibroblast culture. Time sequences of images will be acquired to determine the timing and degree of vascularization of the implants. Specific Aim 2. Evaluate the healing of vascular implants. Intra- and extra-vascular OCT imaging will be performed of stents and grafts placed in the peripheral arteries of large animals. The proper functioning of the implant and adverse reactions such as neointimal hyperplasia will be measured. Blood flow shear rate measurements will be made at the boundaries of the implant and native artery. Evaluation of the vascularization of grafts by small capillaries will be performed. Specific Aim 3. Expand OCT imaging capabilities through hardware and software developments. This aim includes developing miniature probes for intravascular and external use, increasing acquisition speed, and performing signal and image processing to measure perfusion, shear rate, and tissue image texture. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: INTRA-OPERATIVE CONFOCAL IMAGING-GUIDED MOHS SURGERY Principal Investigator & Institution: Rajadhyaksha, Milind M.; Ctr for Subsurface Sensing & Imaging Systems; Northeastern University 360 Huntington Ave Boston, MA 02115 Timing: Fiscal Year 2003; Project Start 20-SEP-2003; Project End 31-JUL-2007 Summary: (provided by applicant): The goal of this proposal is to develop and clinically test a real-time optical imaging modality based on confocal reflectance microscopy, with enhancement of nuclear-to-dermal contrast using acetic acid and crossed polarization, to intra-operatively examine basal cell cancers to guide Mohs micrographic surgery. Basal cell cancers (BCCs) are among the fastest growing cancers (>1.2 million new USA cases/year); because they occur most frequently on older people and in high risk anatomical sites (near or on the eyes, mouth, nose, ears), precise microsurgery is necessary with minimum damage to the surrounding normal tissue. Mohs surgery is time-consuming (one to several hours) and tedious because several (2-20) excisions must be made, and frozen histology sections carefully prepared and examined for each. Realtime confocal reflectance imaging may make Mohs surgery significantly more efficient by enabling direct intraoperative examination for cancer nests and cancer-tonormal tissue margins on the patient; this will reduce the number of excisions and avoid frozen histology. Both the patient and surgeon will save several hours per procedure in the operating room. Although proposed for Mohs surgery of BCCs, this real-time intra-

Studies 29

operative imaging modality may, in fact, prove useful in a variety of other microsurgical settings. The research will be a collaboration between Northeastern University (Boston) and Memorial Sloan-Kettering Cancer Center (New York). This project will be implemented in two phases: (1) an ex vivo study using freshly excised skin specimens from Mohs surgeries, to (a) design a confocal microscope that mimics the Mohs surgeon's examination of frozen histology: rapid low-resolution examination of BCC nests in wide fields-of-view followed by high-resolution inspection of nuclear morphology in small fields-of-view, and develop (b) optimum contrast enhancement methods using topical acetic acid (induces condensation of chromatin that increases light backscatter from nuclei) and optical crossed polarization (suppresses light backscatter from the surrounding normal dermis), (c) optimum hemostasis methods using either topical aluminum chloride or electrocautery, (d) image understanding by detailed correlation of images to histology; and (2) an intraoperative study, involving (a) design of a specialized confocal articulated telescope, to enable (b) imaging of BCCs on patients during surgery, to evaluate the optimum contrast enhancement and hemostasis methods, correlate confocal images to histology and quantitatively determine diagnostic/screening accuracy. The overall goal is to develop an optical (confocal) intraoperative imaging instrument for Mohs and other modes of microsurgery. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: LOW BACK PAIN--A MULTICENTER RANDOMIZED TRIAL Principal Investigator & Institution: Weinstein, James N.; Professor; Community and Family Medicine; Dartmouth College 11 Rope Ferry Rd. #6210 Hanover, NH 03755 Timing: Fiscal Year 2001; Project Start 04-JUL-1999; Project End 31-MAY-2004 Summary: Low back pain is considered one of the most widely experienced health problems in the U.S. and the world. This condition is second only to the common cold as the condition for which patients most frequently see a physician or suffer days lost from work. Estimated costs to those who are severely disabled from low back pain range from 30-70 billion dollars annually. Rates of spinal surgery in the U.S. have increased sharply over time, and 15-fold geographic variation in rates of these surgeries has been documented. In many cases the rates of surgery appear to be determined by where one lives and who one sees. Despite these trends, there is little evidence proving the effectiveness/efficacy of these therapies over non-operative management. This study will use the unique resource of the National Spine Network to conduct multicentered, randomized, controlled trials for the three most common diagnostic groups for which spine surgery is performed: lumbar intervertebral disc herniation (IDH), spinal stenosis (SpS) and spinal stenosis secondary to degenerative spondylolithesis (DS). The trials will compare the most commonly used standard surgical treatments to the most commonly used standard non-operative treatments. The study will be conducted at 16 sites throughout the United States. The primary endpoints of the study will be changes in general health-related quality of life as measured by the SF-36 health status questionnaire and spine-related disability as measured by the Oswestry Low Back Pain questionnaire. Secondary endpoints will include patient satisfaction with treatment, resource utilization for estimation of cost, and utility for current health for estimation of quality-adjusted life years (QALYs). The latter two endpoints will be used to complete a formal cost-effectiveness evaluation. Patients will be followed a minimum of 24 months with visits scheduled at 3, 6, 12, and 24 months. Data on all endpoints will be collected at each study visit. If possible, extended follow-up visits will be scheduled at 36 and 48 months. We anticipate that a total of 1450 subjects will be enrolled and randomly allocated. An additional observational cohort will be tracked to assess health and

30 Surgery

resource outcomes. Data from the RCT and observational cohorts will be integrated to formally estimate the cost-effectiveness of operative versus non-operative interventions for IDH, SpS, and DS. Based on this trial we will, for the first time, have scientific evidence as to the relative effectiveness/efficacy of surgical versus non-surgical treatment for these three common lumbar spine conditions. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MEASURING THE EFFICACY OF ENDOVASCULAR TREATMENT OF AAA Principal Investigator & Institution: Faries, Peter L.; Surgery; Weill Medical College of Cornell Univ New York, NY 10021 Timing: Fiscal Year 2003; Project Start 08-APR-2003; Project End 31-MAR-2008 Summary: (provided by applicant): This proposal describes a five year training program for the development of an academic career in Vascular Surgery for the Principal Investigator, who has completed a structured residency in Vascular Surgery at the Beth Israel Deaconess Medical Center / Harvard Medical School and is currently an Assistant Professor of Surgery in the tenure track at the Mount Sinai School of Medicine. The Mentored Scientist Clinical Development Award will support the development of the Principal Investigator, a vascular surgeon who is trained in experimental methods, into an independent investigator. The program will allow him to expand his expertise in vascular surgery research to develop, coordinate and translate laboratory findings into practical clinical applications for the endovascular treatment of patients with abdominal aortic aneurysms. The program will be performed under the mentorship of Valentin Fuster, M.D., Ph.D. He is the past-president of the American Heart Association, Chairman of the Fellowship Training Directors Program of the American College of Cardiology and Director of the Cardiovascular Institute at the Mount Sinai Medical Center and a Professor of Medicine at the Mount Sinai School of Medicine. He has trained 38 research fellows, many of whom now direct independent laboratories. Juan Badimon, Ph.D., Professor of Medicine, will provide further supervision and training in the areas of thrombus formation and organization. Michael Marin, M.D., Professor of Surgery, a leading pioneer of endovascular stent graft treatment of abdominal aortic aneurysms will enhance the clinical applicability of the hypotheses to be tested. The focus of the research will be measuring the efficacy of endovascular stent graft treatments of abdominal aortic aneurysms. Abdominal aortic aneurysms are a leading cause of death due to aneurysm rupture. Although surgery is the only effective treatment, endovascular surgical techniques utilizing stent grafts have reduced the morbidity of repairing abdominal aortic aneurysms considerably. Endovascular treatments are designed to eliminate arterial perfusion of the aneurysm and thereby eliminate the risk of aneurysm rupture. Although significant advances have been made, the effectiveness of endovascular treatments in eliminating pressure within the aneurysm has not been definitively demonstrated. In addition, no non-invasive means of confirming successful and ongoing elimination of pressure from the aneurysm has been developed. The study will use an experimental model of abdominal aortic aneurysm with an implanted pressure transducer, developed in the principal investigator's laboratory. The effect of retrograde perfusion of the aneurysm sac on intra-aneurysmal pressure after treatment with an endovascular stent graft will be evaluated. The impact of stent graft porosity on the transmission of pressure to the aneurysm will also be studied. Pressure within the aneurysm sac will be correlated with the change in the cross-sectional area and volume of the aneurysm during systole and diastole using cine magnetic resonance imaging. This information may provide a non-

Studies 31

invasive means of confirming the success of endovascular stent graft treatment in eliminating pressure from the aneurysm. The rich academic environment provided by the Mount Sinai School of Medicine and the Departments of Surgery and Medicine / Cardiology with the diverse resources and enthusiasm for promoting scientific research will maximize the potential for the principal investigator to establish an academic career as a clinician scientist. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MECHANISMS DEFENDING FAT MASS IN HUMAN AFTER LIPECTOMY Principal Investigator & Institution: Eckel, Robert H.; Professor of Medicine,; Medicine; University of Colorado Hlth Sciences Ctr P.O. Box 6508, Grants and Contracts Aurora, CO 800450508 Timing: Fiscal Year 2003; Project Start 01-AUG-2003; Project End 31-MAY-2008 Summary: (provided by applicant): Suction lipectomy (liposuction) is the most frequently performed esthetic procedure in the western world today; yet, there are no data to demonstrate that the regional removal of adipose tissue mass persists or that adipose tissue hypertrophy and/or hyperplasia does not occur after liposuction to defend body fat. We have published that by one yr., reduction at the lipectomized site occurs with variable increases in the circumference of non-lipectomized subcutaneous sites. Moreover, our unpublished data show that insulin sensitivity was inversely related to increases in circumference of both the lipectomized and non-lipectomized sites. Therefore, the goals of this study are to: 1) determine if suction lipectomy fails to modify regional and/or total body fat over 3 yr, 2) determine if the expression of genes of adipocyte differentiation and/or inflammation or fibrosis predict adipose tissue regional expression in the control and/or lipectomized site, and 3) assess novel adipose tissue genes that predict the response of regional adipose tissue to suction lipectomy. Men and women (n=54) will be randomly assigned to either a control or a surgery group. Lipectomized sites will include the abdomen for men and the hips and thighs for women. All eligible volunteers will complete body measurement visits at the beginning of the study and then at 6 wk and 6, 12, 24, and 36 mos. This visit will include ht, wt, and resting metabolic rate, and regional circumference (arms, thighs, waist, and hips), body fat composition (DEXA), and MRI (xiphoid to knees and upper arms) to determine fat distribution. All volunteers will also undergo a euglycemic clamp to assess insulin action at baseline, 6 wk, and 6 mo, as well as adipose tissue biopsies which will be analyzed for fat cell volume, genes related to regional inflammation and fibrosis and adipose tissue differentiation, and novel gene expression using DNA gene array technology. For those in the surgery group, suction lipectomy will be scheduled within 2 wk of the baseline measurements. Control subjects will be offered suction lipectomy at the end of the 3- yr study under the same protocol guidelines and benefits as those volunteers randomized to the surgery group. These studies will not only evaluate the efficacy of suction lipectomy and the genetic defense of body fat in humans, but may additionally provide insights into the regulation of regional adipose tissue distribution in humans. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MEDICAL AND SURGICAL TREATMENT OF ESOPHAGEAL REFLUX Principal Investigator & Institution: Finlayson, Samuel R.; Surgery; Dartmouth College 11 Rope Ferry Rd. #6210 Hanover, NH 03755

32 Surgery

Timing: Fiscal Year 2002; Project Start 01-JUN-2002; Project End 31-MAY-2004 Summary: Gastroesophageal reflux disease (GERD) is one of the most common disorders of the gastrointestinal tract. Approximately 75 million Americans suffer from "heartburn", the most typical symptom of GERD. Heartburn can severely impact quality of life and leads to an estimated 15 million physician consultations per year. Both medical and surgical treatments have been shown to be effective in controlling symptoms of GERD, but surgical intervention has traditionally been reserved for selected patients with intractable symptoms. However, for both medical and surgical treatment of GERD, the landscape has changed significantly in the last decade. Proton pump inhibitor therapy has proven vastly superior to older anti- acid medications. Concurrently, the advent of minimally invasive laparoscopic surgery as substantially lowered the threshold for surgical treatment of GERD and led to substantial increases in rates of anti-reflux surgery. Both of these advances have sharpened the debate surrounding optimal treatment of GERD, but at present there is insufficient evidence on which to base comparispon of medical and surgical treatment. A careful, prospective, multi-enter, randomized clinical trial would be the ideal mechanism for comparing proton pump inhibitor therapy and laparoscopic anti-reflux surgery for GERD. The purpose of this application is to seek funds to design and plan such a trial. As members of an experienced clinical trial consortium, we recognize that conducing this trial will require successfully overcoming several important challenges, including issues of patient recruitment and retention, generalizability, and measurement of quality-of-life outcomes. The R03 grant would provide the required financial resources to carefully address these challenges. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MIDDLE-EAR MECHANICS IN NORMAL AND PATHOLOGICAL EARS Principal Investigator & Institution: Merchant, Saumil N.; Associate Professor of Otology & Laryngo; Massachusetts Eye and Ear Infirmary 243 Charles St Boston, MA 02114 Timing: Fiscal Year 2001; Project Start 01-APR-2001; Project End 31-MAR-2006 Summary: The goal of this work is to understand sound transmission through normal, diseased and reconstructed middle ears so that better diagnostic tests and surgical procedures can be offered to patients with middle-ear disease. Middle-ear diseases such as chronic otitis media and otosclerosis, which affect over 10 million people in the US, are common causes of significant conductive hearing loss. The current battery of diagnostic tests (otoscopy, audiometry, tympanometry) cannot reliably differentiate ossicular pathology, especially when the tympanic membrane is intact or if there has been prior middle-ear surgery. Additionally, it is commonly acknowledged that postoperative hearing results after tympanoplasty procedures for chronic otitis media are often unsatisfactory. Factors contributing to the modest nature of surgical results include lack of clear understanding of the critical structure-function relationships in the reconstructed ear, and failure of current diagnostic tests to determine such relationships. Laser Doppler vibrometry has been demonstrated to be more sensitive than audiometry and tympanometry in assessing middle- ear function, because the laser spot (only 100 micrometers diameter) can be focused at various points on the tympanic membrane and malleus, and because vibrometry is unaffected by the ear canal (unlike tympanometry). We propose to use vibrometry, other acoustical measurements (admittance and reflectance), audiometry and tympanometry to investigate structure-function relationships in (a) normal ears, (b) diseased ears with ossicular pathologies, and (c)

Studies 33

reconstructed ears that have undergone surgery for chronic otitis media or otosclerosis. Similar vibrometry and acoustical measurements will also be made in a surgicallymodified human temporal bone preparation that mimics diseased and reconstructed ears. Our approach should lead to a better understanding of the structure-function relationships in normal and pathological middle ears, improved differential diagnosis of middle-ear lesions, better pre-operative patient counseling and surgical planning, optimization of surgical techniques and hearing results, and reduction in the number of failed surgeries. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MOLECULAR BASIS OF POSTOPERATIVE DELIRIUM IN THE ELDERLY Principal Investigator & Institution: Kwatra, Madan M.; Associate Professor; Anesthesiology; Duke University Durham, NC 27706 Timing: Fiscal Year 2003; Project Start 15-JAN-2003; Project End 31-DEC-2007 Summary: (provided by applicant): Postoperative delirium is a frequent complication in the elderly, with an incidence rate ranging from 10% to 70%. It is associated with several adverse outcomes, including prolonged hospitalizations, poor functional recovery, and in some cases increased mortality. Because the proportion of elderly surgical patients is increasing, it is critical to understand the pathophysiology of postoperative delirium. Several neurotransmitter systems appear to be involved in delirium, and the proposed studies will test the hypothesis that postoperative delirium is associated with changes in the expression of specific genes and proteins Identification of these genes and proteins will lead to novel strategies for diagnosing, treating, and possibly preventing postoperative delirium. The first aim will be to examine changes in gene expression in peripheral blood mononuclear cells (PBMCs) using DNA microarrays. This aim is based on our preliminary data indicating that surgery causes a twofold or greater change in the expression of 466 genes in PBMCs, with 329 getting up-regulated and 137 getting down-regulated. The magnitude of this surgery-inducing change in gene expression is unprecedented and raises the probability that some of these genes are the markers of and/or the cause of postoperative delirium. We will enroll 250 elderly patients (>65 years old) undergoing hip or knee replacement-a procedure that causes about 20% incidence of postoperative delirium-and assess postoperative delirium using a battery of instruments. Gene expression in pro- and post-surgery PBMCs from 50 delirious and 50 non-deledous patients will be determined using a DNA microarray chip containing 12,000 human genes. Statistical analysis of the gene expression data will identify the cluster of genes associated with postoperative delirium. The second specific aim will be to identify serum proteins that change with delirium by examining global protein expression using 2D-gel electrophoresis/mass spectrometry. The PI and the co-PI have assembled an interdisciplinary team with expertise in anesthesiology, bioinformatics, geriatrics, molecular pharmacology, nursing, psychiatry, psychology, orthopedic surgery, and statistics. In addition, consultants are available with expertise in delirium, DNA microarrays, and mass spectrometry. Our team is therefore in a unique position to successfully complete the proposed studies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MUSCLE FUNCTION AFTER TENDON TRANSFER SURGERY Principal Investigator & Institution: Delp, Scott L.; Chair; Mechanical Engineering; Stanford University Stanford, CA 94305

34 Surgery

Timing: Fiscal Year 2001; Project Start 01-SEP-1999; Project End 31-MAY-2003 Summary: The goal of this work is to provide a scientific basis for treating stiff-knee gait, a common movement abnormality among children with cerebral palsy. The rectus femoris transfer surgery is frequently performed to treat stiff-knee gait. In this surgery, the distal tendon of the rectus femoris is detached from the patella and reattached to one of several sites posterior to the knee. This surgery is thought to convert the muscle from knee extensor to a knee flexor thereby allowing the muscle to assist knee flexion during walking. However, the surgical outcomes are inconsistent, and the in vivo function of the transferred rectus femoris is unknown. We hypothesize that remodeling of the rectus femoris after surgery results in adhesions to surrounding tissues in some patients, which dramatically alters the postoperative function of the muscle and degrades the outcome of the surgery. This study will use biomechanical models, magnetic resonance imaging techniques, and experimental measurements on human subjects to evaluate the function of the rectus femoris following tendon transfer. Aim 1 will assess the potential of the rectus femoris to flex the knee after transfer. Biomechanical models, constructed from MR images, will provide quantitative descriptions of musculoskeletal geometry for 8-12 patients undergoing rectus femoris transfers to different surgical sites. This work will determine the differences in the knee flexion moment arm of the rectus femoris after transfer to different sites. Aim 2 will determine if forces at the proximal and distal tendons of the rectus femoris are equal after transfer, or if force at the distal tendon is disrupted after the surgery. Hip and knee moments, generated by selective stimulation of the rectus femoris, will be measured in subjects with stiff-knee gait. Tendon forces will be estimated by dividing the measured moments by the corresponding moment arms obtained from the MRI-based models. Aim 3 will use cine phase-contrast MR imaging to analyze and visualize the relative motions of the rectus femoris and the surrounding muscles in vivo. The extent of scar formation following rectus femoris transfer will be investigated, and the effects of adhesions on the mechanics of the muscle will be assessed. Aim 4 will examine how postoperative function of the rectus femoris influences knee motion during gait. The success of this work will result in better, more predictable treatment outcomes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MYELOMENINGOCELE REPAIR RANDOMIZED TRIAL-DSCC Principal Investigator & Institution: Thom, Elizabeth A.; Associate Research Professor of Statisti; Statistics; George Washington University 2121 I St Nw Washington, DC 20052 Timing: Fiscal Year 2002; Project Start 11-APR-2002; Project End 31-MAR-2007 Summary: Since 1997, 180 fetuses have had in utero closure of myelomeningocele (MMC) by open fetal surgery. Preliminary clinical evidence suggests that this procedure reduces the incidence of shunt-dependent hydrocephalus and restores the cerebellum and brainstem to more normal configuration. However, clinical results of fetal surgery for MMC are based on comparisons with historical controls and examine only efficacy and not safety. The Myelomeningocele Repair Randomized Trial is a multi-center unblinded randomized clinical trial of 200 patients that will be conducted at three Fetal Surgery Units (FSU), the University of California-San Francisco, Children's Hospital of Philadelphia, and Vanderbilt University Medical Center. The primary objective of the trial is to determine if intrauterine repair of fetal myelomeningocele at 18(0) to 25(6) weeks gestation improves outcome, as measured by 1) death or the need for ventricular decompressive shunting by one year of life and 2) death or Bayley Mental Development Index, as compared to standard postnatal repair This proposal is for the George Washington University Biostatistics Center to serve as the Data and Study Coordinating

Studies 35

Center (DSCC) for the MMC Repair Trial. The purpose of the DSCC, an important but independent member of the multi-center collaborative study group, is to provide expertise and support in study design, study conduct and statistical analysis. We will provide scientific leadership in the design of the study and prepare the final study documents including the protocol, manual of operations and case report forms. The DSCC will be responsible for all publicity for the MMC Repair Trial such as establishing a central web site, mailing of physician brochures, presenting trial information at appropriate professional meetings and placing print advertisements in medical journals and patient oriented publications. We will also serve as the central referral site for patients to learn more about the trial, conduct preliminary review of patient eligibility and assign the patient to a Fetal Surgery Unit for final evaluation. The DSCC will maintain an Internet randomization system and web-based data entry system for the patient eligibility data. We will provide a comprehensive data processing system including central data entry, data base management and data quality control. The DSCC will use appropriate statistical techniques to conduct interim and final analyses. We will assist the investigators in preparation of manuscripts and abstracts from study results. In summary, we will participate in cooperation with the FSUs on the proposed trial with the goal of demonstrating whether fetal intervention offers improved outcome with a reasonable quality of life for spina bifida children. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MYOCARDIAL GENE TRANSFER DURING CARDIAC SURGERY IN SWINE Principal Investigator & Institution: Milano, Carmelo A.; Surgery; Duke University Durham, NC 27706 Timing: Fiscal Year 2003; Project Start 01-AUG-2003; Project End 31-JUL-2007 Summary: (provided by applicant): A variety of experimental myocardial molecular alterations have suggested that genetic therapies may impact on cardiac disease (24,34,35). Vascular growth factor genes may serve in the treatment of coronary artery disease or ischemic cardiomyopathy (29,45,46). States of left ventricular dysfunction or heart failure (HF) can be ameliorated with exogenous genes which alter the native #adrenergic receptor (AR) system or which improve myocardial calcium handling(24,34,37). However, in order to utilize such genetic strategies to treat cardiac disease, safe and efficient methods for cardiac gene delivery must be developed. Importantly, to achieve alterations of heart function or structure, efficient gene delivery methods must be developed to transfect a majority of themyocardium. In this proposal, we investigate myocardial gene transfer in adult swine models employing cardiac surgery. The primary components of modem cardiac surgery include cardiopulmonary bypass (CPB), cardioplegic arrest and crossclamping of the ascending aorta. These steps may facilitate safer gene delivery since they result in an interruption of the coronary Circulation and an isolation of the coronary circulation from the systemic circulation, making "cardioselective" gene transfer possible.The central hypothesis is that global myocardial transgene expression and secondary functional changes can be achieve in adult swine utilizing adenoviral delivery during simulated cardiac surgery. The specific aims are: 1. Achieve safe and efficient myocardial gene transfer in adult pigs utilizing adenoviral and advanced generation vectors, delivered during simulated cardiac surgery. 2. Characterize post-cardiac surgery left ventricular dysfunction in adult pigs :and :reverse the dysfunction with betaAR based gene therapy delivered during the surgery. 3. Employ functional transgenes to achieve positive inotropic effects in a swine pacing heart failure model. i. Study inotropic effects of transgenes in cultured LV

36 Surgery

myocytes from failing pig hearts. ii. Deliver functional transgenes to failing pig hearts during simulated cardiac surgery and evaluate effect on LV performance. These studies will help to develop safer and more efficient methods for gene delivery which can be coupled to cardiac surgery. As our knowledge advances, gene therapy may supplement established surgical treatments. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NATIONAL SURGICAL ADJUVANT BREAST AND BOWEL PROJECT Principal Investigator & Institution: Wolmark, Norman; Associate Professor of Surgery; Nsabp Foundation, Inc. East Commons Professional Bldg Pittsburgh, PA 15212 Timing: Fiscal Year 2001; Project Start 01-DEC-1976; Project End 31-JAN-2006 Summary: The NSABP is comprised of 177 active member institutions that are participating in treatment trials in the United States, Canada, Puerto Rico, and Australia. The Group has a more than 40-year history of conducting large-scale controlled clinical trials that have improved treatment for patients with breast or colorectal cancer and have provided a better understanding of tumor biology. This application requests continued funding for the NSABP Operations Center for the period February 1, 2000, through January 31, 2006. Major areas of emphasis in the NSABP include: evaluation of therapies in the adjuvant treatment of breast and bowel cancer; testing of new drugs, combinations of drugs, and biological agents in patients with advanced disease, with the primary goal of determining therapies that should be further evaluated in the adjuvant setting; identification of and validation of molecular markers of prognosis and response to therapy; reduction of the morbidity associated with breast cancer surgery through the evaluation of minimally invasive cancer surgery procedures; assessment of quality-oflife issues in selected studies, particularly equivalence trials of newer or less toxic therapies; analysis of data and publication of the results of NSABP studies in peerreviewed medical journals; and enhancement of the participation of women and underrepresented minorities in NSABP trials. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: NATURAL HISTORY AND TREATMENT RESPONSE OF AVMS Principal Investigator & Institution: Halim, Alexander; Anesthesia and Perioperative Care; University of California San Francisco 500 Parnassus Ave San Francisco, CA 94122 Timing: Fiscal Year 2002; Project Start 01-JUN-2002; Project End 31-MAY-2003 Summary: (provided by applicant): Brain arteriovenous malformations (BAVM) are usually detected only when the patient presents with intracranial hemorrhages, seizures, headaches, focal neurological deficits, or other disorders. A smaller number are detected incidentally. Although BAVM themselves are rare, the severity of the clinical presentations underscores the need for a better understanding of etiology, natural history, and prognosis of the disorder. The primary reason for treating BAVM is the prevention of intracranial hemorrhage. However, the risk associated with treatment must be weighed against that of natural history of BAVM, on which there is little data. In addition, there is controversy involving the relative efficacies of the 2 most practiced treatment modalities: open surgery and stereotactic radiosurgery. Most of what is known about BAVM comes from referral series. There is a paucity of data from population-based studies. In this project, we will examine patient and BAVM characteristics in relation to BAVM presentation and subsequent hemorrhage using both referral-based and population-based data. We will especially focus on the

Studies 37

epidemiological issues involved in BAVM research methodologies. Our project will also investigate the settings for clinical equipoise in BAVM treatment using an improved observational study design. Results of this latter analysis will significantly contribute to the planning of a future randomized clinical trial for BAVM treatment, comparing open surgery with radiosurgery. This proposed project will serve as a critical training experience for the Principal Investigator, by affording him the opportunity to apply his epidemiological background and augment his research skills in preparation for independent scientific research. The results of this project may additionally further our understanding of the natural history and risk factors for intracranial hemorrhages in patients with BAVM, as well as evaluate the safety and efficacy of the different treatment modalities. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SURGERIES

NEW

BIOMATERIALS

FOR

SUTURELESS

OPHTHALMIC

Principal Investigator & Institution: Grinstaff, Mark W.; Associate Professor; Chemistry; Duke University Durham, NC 27706 Timing: Fiscal Year 2002; Project Start 01-FEB-2002; Project End 31-JAN-2006 Summary: We propose a systematic study to test the hypothesis that light-activated polymers can replace or supplement conventional sutures in ophthalmic surgeries. Specifically we have synthesized novel dendrimers, termed biodendrimers, composed of biocompatible monomers such as glycerol and lactic acid. We will take advantage of the favorable chemical and physical properties of these photocrosslinkable biodendrimers to seal corneal perforations and to secure corneal autografts in human enucleated eyes and chicken eyes in vivo. Accordingly, answers will be sought to the following questions: 1. Can the chemical structure of a biodendrimer be optimized to afford specific properties required for sutureless ophthalmic surgeries? 2. Will a biodendrimer seal a 3 mm full thickness linear or stellate corneal perforation? 3. Will a biodendrimer secure a corneal autograft? Corneal perforation and corneal transplantation are two models of corneal tissue injury that are ideal for testing new tissue sealants. The traditional approach to repair both these injuries involves sutures, yet the use of sutures affords a number of limitations and complications. Tissue adhesives such as cyanoacrylate are becoming more widely accepted in various corneal procedures, however these materials have only met with marginal success. Improvements made to the composition and/or to the method of application can potentially enhance the effectiveness of tissue sealants for treating wounds and even broaden the scope of clinical use. Potential indications in other ophthalmic areas include ruptured globe repair, wound closure in cataract surgery, and wound modulation in glaucoma filtering surgery. The novel photocrosslinkable biodendrimers described in this proposal represent a new class of ophthalmic tissue adhesives that may accomplish the objectives cited above sealing corneal perforations, and securing corneal autografts. Successful completion of these studies may lead to new ophthalmic surgical techniques, procedures, and treatments using unique, custom-designed biomaterials. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PROTECTION

OPIOID

HIBERNATION

FACTORS

FOR

MYOCARDIAL

Principal Investigator & Institution: Bolling, Steven F.; Professor; Surgery; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, MI 481091274

38 Surgery

Timing: Fiscal Year 2001; Project Start 08-FEB-1999; Project End 31-JAN-2003 Summary: (Adapted from investigator's abstract) Many patients have advanced cardiac disease, necessitating complicated cardiac surgery or transplantation. During cardiac surgery, including transplantation, the heart is rendered ischemic; and blood flow to the heart is stopped either to undertake the surgery or to transport the organ, which is currently limited to 4-6 hours. In order for the patient to be removed from cardiopulmonary bypass and return to activity, the heart has to function well following cardiac surgery. Any enhancement in myocardial energy preservation will increase the number of positive outcomes for patients and improve the quality of patient care. Interestingly, hibernating animals can preserve up to 90% of the energy required during normal euthermic metabolism. The mechanism of this energy preservation during hibernation is currently unknown; however, many studies point to an opioid "trigger" molecule, which has been termed the hibernation induction trigger or HIT. The opiate nature of HIT is well established, as HIT can be reversed or retarded by opiate antagonists. Evidence indicates that HIT initiates its potential metabolic inhibitory effects through specific membrane opioid receptors, particularly delta receptors. Delta opioids have been shown in many models and the investigators' preliminary results to produce profound behavioral, physiological and metabolic inhibitory effects favoring survival at the whole animal, the organ and the cellular level. The proposed study will investigate the mechanisms of action of delta opioids at both the organ and subcellular levels. These studies could result in extended safe cardiac ischemic time with potential application to cardiac surgery and cardiac transplantation. In these proposed isolated heart studies, the investigators will determine if delta opioids provide enhanced myocardial protection during ischemia. The investigators will also seek to elucidate the intracellular mechanism by which the delta opioids protect the ischemic myocardium. The ability of the delta opioids to effect myocardial protection suggests that the use of these molecules may be valuable in many clinical scenarios resulting in ischemia. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: OPTIMIZING LIFESTYLE ADJUSTMENT IN WEIGHT LOSS SURGERY Principal Investigator & Institution: Kalarchian, Melissa A.; Assistant Professor; Psychiatry; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, PA 15260 Timing: Fiscal Year 2002; Project Start 01-AUG-2002; Project End 31-JUL-2007 Summary: (provided by applicant): Although surgery is the treatment of choice for severe obesity, very little is known about the relationship of lifestyle factors to patient outcomes after operation. This Mentored Patient-Oriented Research Career Development Award (K23) describes integrated training and research plans designed to prepare the candidate to pursue research on helping patients achieve optimal weight loss and lifestyle adjustment after bariatric surgery. A model of treatment is presented in which an intervention targeting behavioral (eating, activity, and compliance) and psychosocial factors (e.g., symptoms of binge eating and personality style) is expected to impact weight loss, health-related quality of life, and overall well-being. Advanced training in genetic and environmental influences on severe obesity, an expanded working knowledge of how surgeons treat severely obese patients, and consolidation of skills in longitudinal research methodology will assist in refining and developing this model. The research plan involves prospectively tracking weight-related variables, eating and activity, compliance and satisfaction, and psychosocial factors over time among a group severely obese patients undergoing surgery for weight loss (Study 1),

Studies 39

and using the data to inform the development and evaluation of a lifestyle intervention geared to optimizing outcomes after operation (Study 2). The comprehensive lifestyle intervention will encompass 1) encouraging healthy eating habits, 2) increasing physical activity, 3) enhancing psychosocial adjustment. Adaptations to treatment will accommodate the unique needs of bariatric surgery patients. Specifically, a modular treatment format will address patients' changing needs in the preoperative, postoperative, and longer-term adjustment phases. Additionally, the intervention will be developed for delivery one-on-one at routine clinic visits with supplemental contact via the Internet. The data collected will contribute to the preparation of an R01 application that will involve conducting a full-scale randomized clinical trial to evaluate the modular, computer-aided lifestyle intervention. Future work may focus on adding adjunctive treatment components such as weight loss medication, the effects of which have not been adequately studied in bariatric surgery patients. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ORAL INFLAMMATION

SURGERY

AND

INITIATION

OF

NEUROGENIC

Principal Investigator & Institution: Swift, James; Diagnostic/Surgical Scis; University of Minnesota Twin Cities 200 Oak Street Se Minneapolis, MN 554552070 Timing: Fiscal Year 2001; Project Start 01-FEB-1995; Project End 31-MAY-2004 Summary: (Adapted from investigator's Abstract): Although neuropeptides are well known to exert a wide range of pro-inflammatory effects after administration of pharmacological dosages into normal tissue, relatively little is known about their physiologic functions in regulating inflammation and healing. The applicants have developed a technique for collecting inflammatory mediators, including neuropeptides, by implanting microdialysis probes into surgical wounds of awake, post-oral surgery patients or in anesthetized rats following tissue injury. Ongoing studies performed by the applicants show that physiologic levels of immunoreactive substance P (iSP) are released into the surgical wounds of dental patients, and that bradykinin, prostaglandin E2 (PGE2) and leukotriene B4 (LTB4) all mediate, via receptor-dependent mechanisms, increases in surgical wounds of iSP levels. In this competing renewal application, the proposed multidisciplinary studies are designed to identify physiologic systems regulating wound levels of iSP in humans, determine whether efferent dorsal root reflexes contribute to the initiation of neurogenic inflammation in human and rat surgical wounds, and to evaluate whether elevated iSP concentrations, detected in surgical wounds, mediate the development of surgery-induced neurogenic inflammation and wound healing. The applicants propose both clinical and animal studies. Clinical Studies: 1. To determine the peripheral effects of drugs that modulate neurogenic inflammation (capsaicin) on altering tissue levels of i-SP and an index of neurogenic inflammation (local hyperthermia) in the surgical wounds of awake patients following extraction of impacted mandibular third molars. 2. To determine the contribution of efferent neuronal outflow (e.g., dorsal root reflexes) on the initiation of neurogenic inflammation in the surgical wounds of awake patients following extraction of impacted mandibular third molars. Animal Studies: 1. To determine the magnitude of the neurogenic component of inflammation observed following surgical extraction of teeth in anesthetized rats. 2. To determine whether endogenous substance P (SP) contributes to the neurogenic component of inflammation observed following surgical extraction of teeth in anesthetized rats. 3. To determine the magnitude of the neurogenic component of wound healing observed following surgical extraction of teeth in anesthetized rats. 4. To determine whether endogenous SP contributes to wound healing

40 Surgery

observed following surgical extraction of teeth in anesthetized rats. Collectively, the proposed studies will determine the efferent regulation of iSP levels in surgical wounds of humans, and, in a parallel rat model, determine the role of SP in post-surgical inflammation and wound healing. This knowledge may well provide a physiological basis for improved surgical outcomes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ORTHOPEDIC ANALYSIS--DECISION AIDS FOR ELECTIVE SURRGERY Principal Investigator & Institution: Llewellyn-Thomas, Hilary; Professor; Dartmouth College 11 Rope Ferry Rd. #6210 Hanover, NH 03755 Timing: Fiscal Year 2003; Project Start 01-JAN-2003; Project End 31-DEC-2007 Summary: This study explores the opinions of members of the American Academy of Orthopedic Surgeons (AAOS) about using patients' decision aids (DAs) for elective surgery for herniated disc / spinal stenosis. These newly developed, high-quality DAs have been carefully assessed in randomised controlled study designs. The evidence indicates that they effectively help with shared decision-making (SDM). However, before introducing these DAs into regular use in clinical practice, we need to know surgeons' opinions about their "real world" usefulness. This project assesses surgeons' opinions about whether these DAs could complement their usual approaches to providing patients with treatment information, the relative importance of various cognitive, affective, and behavioural outcomes in evaluating their effectiveness, the most suitable media for DAs, and the perceived factors hindering / promoting the adoption of well-developed and carefully evaluated decision aids in their own clinical settings. It is also important to determine if these opinions about DAs are related to whether a surgeon's practice is located in a geographic region with a relatively higher / lower elective surgical rate. These data will be collected in a mailed survey. The recruitment target is 520 members of the AAOS (440 in a general sample and 40 in each of 2 geographic sub-samples). The study design involves a series of mailouts, an engaging questionnaire, and an explicit follow-up strategy. The responses from the 440 in the general sample will be analysed descriptively; the results for the two (i.e. higher / lower) geographic regions will be tested for differences. The ultimate objective is to provide empirical data that can guide: a) the valid design of future evaluative studies of these newly-developed patients' decision aids regarding elective orthopaedic surgery; and b) the clear identification of implementation / dissemination strategies most likely to support the incorporation of effective decision aids into regular orthopaedic surgical practice. Future work will involve the development of Web-based capabilities to collect comparable data from the patients' perspective. This will allow assessment of the extent to which surgeons' and patients' opinions about SDM are/are not congruent, across areas of regional disparity in surgical rates. Ultimately, these efforts could, in turn, help to foster greater degrees of physician-patient satisfaction with the communication processes that occur in orthopaedic surgery. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: OSTEOBLAST AND ADIPOCYTE DIFFERENTIATION BY FOSB Principal Investigator & Institution: Baron, Roland E.; Orthopedics and Rehabilitation; Yale University 47 College Street, Suite 203 New Haven, CT 065208047 Timing: Fiscal Year 2002; Project Start 01-APR-2002; Project End 31-MAR-2007

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Summary: Anterior cruciate ligament (ACL) injury is prevalent and often leads to instability, quadriceps muscle weakness and osteoarthritis. (OA) Many of those with chronic ACL deficiency have evidence of knee OA years after ACL rupture. Weakness and instability experienced by those who do not compensate well for ACL deficiency (non-copers) independently lead to compensation strategies that could precipitate or worsen knee OA. These poor compensation strategies do not uniformly resolve after surgical reconstruction and those who undergo reconstruction also have an increased risk of developing knee OA. The overall goal of this work is to determine whether effective rehabilitation programs to dynamically stabilize the knee reduce the adaptations that lead to osteoarthritis in a population at great risk for the development of knee OA. Eighty individuals with ACL rupture who are scheduled for surgery will be randomly assigned to a group that includes a form of neuromuscular training called perturbation training, or a standard group. They will be evaluated before and after surgery using motion analysis and radiography. In vivo measures of kinematics, kinetics, tibial translation and EMG based models of joint compression will be used for comparison. This randomized trial is designed to demonstrate that, after preoperative rehabilitation that includes perturbation training, movement patterns adopted by noncopers: 1) demonstrate improve joint stability and reduced muscle cocontraction, 2) persist after reconstruction and 3) result in better functional outcomes after reconstruction and 4) lead to the development of less knee pain and OA over time than standard preoperative treatment strategies. The information derived from this project will provide valuable insight into the management of the approximately 100,000 Americans who rupture their ACLs each year and undergo reconstructive surgery. More importantly, if the perturbation training program's ability to induce dynamic knee stability actually results in joint protection, its application to others at risk for the development knee OA may help reduce the incidence of this disabling clinical condition. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PATHOPHYSIOLOGIC RESPOSE TO FETAL CARDIAC SURGERY Principal Investigator & Institution: Hanley, Frank L.; Surgery; University of California San Francisco 500 Parnassus Ave San Francisco, CA 94122 Timing: Fiscal Year 2001; Project Start 01-FEB-1992; Project End 31-MAR-2002 Summary: The goal of this ongoing project is to continue the development of fetal cardiac surgery. Certain congenital defects are uncorrectable after birth and there is a clear advantage for intrauterine corrective surgery. This approach requires an understanding of the physiological effects of surgical intervention and extracorporeal circulation on the fetus. Our work in this area to date has allowed us to gain a substantial but incomplete understanding of these issues. The three major pathophysiological responses which limit fetal survival following intervention and extracorporeal circulation (which we identified in the original grant proposal) include: 1. The loss of fetal cardiovascular homeostasis in the pre-bypass phase of fetal intervention. 2. The "step function" rise in fetal vascular resistance at the institution of fetal bypass which is associated with acute decompensation. 3. The gradual rise in placental vascular resistance during and after fetal bypass which results in depressed placental blood flow. The specific focus of this project remains as stated in the original proposal, to identify the mediators and detailed pathophysiologic mechanisms of these three responses with an eye towards clinical application of this information to advance the development of human fetal cardiac surgery. Each of the three responses will be systematically evaluated. Experiments examining the pre-bypass problem will focus on the role of the fetal stress response. Further understanding of this response is presently

42 Surgery

limited by our fetal animal model (sheep). We propose to study the efficacy of narcotic anesthesia in blunting the stress response in an instrumented primate model. Experiments addressing the 'step function' rise in fetal vascular resistances will examine the inhibition of this response using specifically designed bypass circuitry. Our methodology will include ultrasonic flow transducers to continuously measure instantaneous changes in organ flow in addition to our more specific microsphere techniques, which do not have this capability. In recognition of the multiple factors effecting the placental vasculature, experiments addressing the gradual rise in post bypass placental resistance will examine the role of placental vascular dysfunction in addition to the role of eicosanoids. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PATIENT ORIENTED RESEARCH--ORAL AND MAXILLOFACIAL SURGER Principal Investigator & Institution: Dodson, Thomas B.; Associate Professor; Massachusetts General Hospital 55 Fruit St Boston, MA 02114 Timing: Fiscal Year 2001; Project Start 01-FEB-2000; Project End 31-JAN-2005 Summary: Multiple investigators have documented the importance of patient-oriented research in guiding therapy, implementing translational therapies and in evaluating diagnostic or therapeutic outcomes. Due to a shortage of investigators trained to conduct rigorous patient-oriented research in the field of oral and maxillofacial surgery (OMFS), the specialty literature consists largely of case reports and case series. The broad goals of this award are: 1) to develop a longitudinally funded fellowship program dedicated to training oral and maxillofacial surgeons in the principles and practice of clinical investigation; 2) to continue scientifically rigorous clinical research efforts in the area of reconstructive OMFS surgery; and 3) to initiate clinical research in the prevention and treatment of maxillofacial trauma. To accomplish these broad goals, we propose the following Specific Aims which address both the mentoring and patient oriented research aspects of the award: number 1) To establish the first funded fellowship in clinical investigation designed specifically for the training of oral and maxillofacial surgeons in patient-oriented research. Number 2) To measure the efficacy and safety of reconstructing alveolar bone defects with demineralized bone powder (DBP) or guided tissue regeneration (GTR) techniques in a 3rd molar extraction surgical model. Number 3) To determine the sensitivity and specificity of facial injuries as unambiguous diagnostic indicators of domestic violence and number 4) To identify risk factors for poor outcomes following treatment of mandibular condyle fractures. Specific aim 1 uses an extramurally funded two-year grant to support a Fellow studying the principles and practice of clinical investigation. Mentoring surgeons to be skilled clinical investigators addresses the acute shortage of well-trained clinical researchers in the specialty. Specific aim 2 uses an extramural award to conduct a single-blind, randomized clinical trial testing the efficacy of DBP and GTR-therapy for reconstructing alveolar defects following 3rd molar extraction. No current reconstructive techniques are clinically proven to be superior to natural healing of the extraction defect. Specific aim 3 uses a cross-sectional study to determine the diagnostic value of facial injuries as indicators of domestic violence (DV). As DV is characterized by recurrent violent episodes of increasing severity, the early identification of DV victims may prevent future injury. Specific aim 4 uses a retrospective study design to identify patients at risk for poor treatment outcomes after mandibular condyle fractures. Condylar fractures are common and treatment is controversial. Identifying patients at risk for poor outcomes from standard treatment begins to address treatment controversies. This award

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leverages the PI's skills and talents by providing protected time to mentor additional trainees and to conduct high quality patient-oriented research. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PERIPHERAL METABOLISM

ARTERIAL

DISEASE

AND

LEG

MUSCLE

Principal Investigator & Institution: Killewich, Lois A.; Surgery; University of Texas Medical Br Galveston 301 University Blvd Galveston, TX 77555 Timing: Fiscal Year 2002; Project Start 01-AUG-2002; Project End 31-JUL-2006 Summary: (provided by applicant): (provided by applicant): As a vascular surgeon I treat atherosclerosis of leg arteries, known as peripheral arterial occlusive disease (PAOD). PAOD occurs when arteries to the leg become stenosed or occluded, reducing leg blood flow. Subjects experience calf muscle pain with walking, because although the blood supply is adequate to meet the metabolic demands of resting muscle, it is not adequate to meet the increased demands associated with exercise. Leg bypass surgery (femoro-popliteal bypass) increases leg blood flow, but alone does not improve walking abilities and functional status of elderly PAOD subjects. Effective treatment of PAOD will require identification and therapy for other adverse physiological conditions present in elderly PAOD subjects which contribute to their disability. Older subjects also develop sarcopenia, a condition in which muscle mass and function decline with age. At the University of Texas Medical Branch, Dr. Robert Wolfe, a nationally-known authority on leg muscle physiology, is studying sarcopenia in the elderly. He has developed a three-pool model of leg muscle protein metabolism, using infusion of stable isotopes and gas chromatography-mass spectroscopy methodology. He shown that nutritional supplementation (specifically, amino acids) increases leg muscle protein synthesis, and may therefore offer a method for counteracting the effects of sarcopenia. I was recruited to UTMB in 1999, and have formed a collaboration with Dr. Wolfe. In this study, I am proposing to investigate the relationship between PAOD and leg muscle protein synthesis in elderly subjects with PAOD. It is my hypothesis that reduced leg muscle blood flow associated with PAOD will limit the availability of amino acids to leg muscle, and thus further impair protein synthesis. Femoro-popliteal bypass surgery, by increasing blood flow, should increase delivery of amino acids to muscle and hence ameliorate the effects of sarcopenia. It is my ultimate hope that the combined interventions of bypass surgery and nutritional supplementation with amino acids can be used to improve overall functional status of these elderly Americans. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PET IN MULTIMODALITY THERAPY FOR ESOPHAGEAL CANCER Principal Investigator & Institution: Levine, Edward A.; Surgery; Wake Forest University Health Sciences Winston-Salem, NC 27157 Timing: Fiscal Year 2001; Project Start 05-FEB-2001; Project End 31-JAN-2003 Summary: Historically, localized cancer of the esophagus was managed by either surgery or radiation therapy alone. Recently, studies have found a substantial improvement in survival when chemotherapy is combined with radiation therapy either alone or as an induction regimen prior to surgery. It has been demonstrated in several clinical trials of chemo- radiation followed by surgery that approximately 30% of patients will have no tumor found in the esophageal resection specimen at the time of resection. Clearly, local control after chemo-radiation is improved with the addition of surgery when residual disease is present. However, there is little data (none of which is

44 Surgery

randomized) demonstrating an outcome advantage with the addition of surgery when patients have achieved a complete pathologic response to preoperative therapy. Further, resection of the esophagus with a pathologic complete response has no clear therapeutic benefit and is associated with considerable morbidity. Consequently, rather than subjecting all patients to a resection, a more logical approach is to further refine current prognostic and diagnostic techniques to allow for a more rational selection of patients at risk of having residual disease after induction chemo-radiation. In a correlative study, we plan to evaluate the utility of [18F]-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) imaging, both before and at the completion of the induction chemo-radiation to assess changes in the tumor uptake FDG. Recent improvements in PET imaging suggest that this tool is sensitive for identifying subclinical disease; either at the time of initial staging or to determine recurrent/persistent disease during and following therapy. Further, although PET holds great promise, it is currently an expensive modality. Consequently, defining the optimal time for its use in a patient's course is clinically important. We plan to correlate the PET findings with endoscopic ultrasound (EUS), and spiral CT imaging to pathologic findings from resected specimens. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PHYSIOLOGY CORE Principal Investigator & Institution: Sherwin, Robert S.; Professor of Internal Medicine; Yale University 47 College Street, Suite 203 New Haven, CT 065208047 Timing: Fiscal Year 2003; Project Start 01-JAN-2003; Project End 31-DEC-2007 Summary: The obiective of the Physiology Core is to be a resource for DERC members to facilitate diabetes-related research dealing with biological outcomes in normal and diabetic rodents (rats and mice) as well as in genetically engineered rodents. These activities may require any or all of the following: a) placement of catheters or probes for infusion and sampling (rats and mice), b) isolation of islets (rats and mice), c) help in the performance of glucose clamps or tolerance tests (rats only), and d) measurements of glucoregulatory hormones (rats and mice). The Physiology Core provides the centralized facilities, services and expertise to efficiently accomplish these tasks. It is divided into two Sub-cores, i.e., Animal Surgery and Hormone Assay. The aims of the Animal Surgery Sub-core are two-fold: 1) to provide DERC investigators with laboratory facilities and expertise to conduct diabetes-related, in vivo physiological experiments in awake non-diabetic or diabetic rodents, and 2) to be a resource for DERC members to facilitate islet-related research by providing freshly isolated rodent pancreatic islets, insulinoma lines as well as pancreatic lymph node cells. A centralized facility to conduct surgery for chronic catheter placement to carry out difficult metabolic studies in rodents and to efficiently generate islets is very useful for diabetes research, but is not easily accessible to investigators without previous training or experience. The Sub-Core will provide expertise, services and education, thereby giving DERC members access to the specialized experimental methodologies and the equipment necessary to apply them to diabetes. Moreover, it is anticipated that the Sub-core will provide a vehicle for collaboration between members with basic science research, and members whose focus is clinical physiology and metabolism. The Hormone Assay Sub-core provides DERC members with centralized facilities for measurements of glucoregulatory hormones and neurotransmitters that are derived from animal studies. This component of the Physiology Core takes advantage of the Yale GCRC Core Laboratory that is used for clinical studies. The Subcore benefits from the technical expertise and equipment of an ongoing and productive radioimmunoassay and HPLC

Studies 45

facility, thereby allowing us to maximize quality and minimize the cost of operation. As a result, DERC members have access to a centralized facility that makes available personnel, methodology, instrumentation, and quality control required to efficiently perform hormone assays relevant to diabetes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PILOT--JOINT REPLACEMENT SURGERY: SOCIAL SUPPORT, ETHNICITY AND GENDER Principal Investigator & Institution: Chang, Huan J.; Northwestern University Office of Sponsored Programs Chicago, IL 60611 Timing: Fiscal Year 2002; Project Start 15-FEB-2002; Project End 31-DEC-2006 Summary: (provided by applicant): Osteoarthritis (OA), the leading cause of disability in the United States, has a significant impact on quality of life. Knee OA alone affects approximately 6% of the US adult population. In patients with severe knee OA total joint replacement JJR) surgery is considered an extremely valuable intervention, which relieves chronic pain, restores lost function, and is cost effective. Recent reports, however, indicated that TJR may be underutilized and that utilization varies widely by race/ethnicity and gender. For instance, women have significantly worse preoperative functional status at time of TJR for OA, suggesting they choose TJR at a more advanced disease stage, possibly at the expense of quality of life. To date, findings to explain these disparities are inconclusive, but our preliminary data supports the view that differences in the amount of perceived social support may contribute to the different utilization patterns. Based on results of our pilot studies, we hypothesize that social support may be critical in understanding race/ethnicity and gender differences in TJR rates. Specifically, 1) prior to surgery, perceived and actual social support affect TJR acceptance rates differently and this difference varies by race/ethnicity and gender, and 2) more perceived social support is related to less self-reported disease severity, which ultimately affects the TJR acceptance rates. We will conduct a prospective longitudinal study of 320 subjects with severe knee OA who are TJR candidates to establish measures of social support, disease activity, and functional status. This team will use results from the proposed study to generate a future longitudinal study to aid in developing an intervention to promote earlier clinical treatment for those individuals who are prone to wait until more advanced stages of disease before considering TJR. The results of such a study could be applied to the understanding and treatment of other chronic conditions. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: POSTMENOPAUSAL HORMONE REPLACEMENT THERAPY AFTER CABG Principal Investigator & Institution: Ouyang, Pamela C.; Associate Professor of Medicine; Medicine; Johns Hopkins University 3400 N Charles St Baltimore, MD 21218 Timing: Fiscal Year 2001; Project Start 15-AUG-1996; Project End 31-JUL-2004 Summary: Coronary atherosclerosis is a major cause of death in women in the USA. Although coronary artery bypass surgery decreases symptomatic and clinical evidence of ischemia, it does not alter the underlying process. Patients may present several years later with recurrent symptoms that may be a result of occlusion of saphenous vein grafts, development of atherosclerotic disease in the vein grafts, or progression of underlying disease. Any intervention that can reduce the rate of progression of coronary atherosclerosis following bypass surgery would provide significant benefit for women following bypass surgery and possibly for other women with atherosclerotic disease.

46 Surgery

Observational studies suggest that postmenopausal estrogen replacement therapy is associated with a reduction in cardiac morbidity. However the benefit for hormone replacement therapy in women with established coronary disease has not been demonstrated. This randomized, double-blind controlled trial tests the hypothesis that postmenopausal hormone replacement therapy in women following coronary bypass surgery will reduce the occurrence of graft occlusion and delay the development of graft atherosclerosis. Women will be randomized to esnadiol with daily medroxyprogesterone or placebo within 4 weeks of bypass surgery. Graft occlusion and development of vein graft atherosclerosis will be measured by comparing quantitative coronary angiographic and intravascular ultrasonographic assessment of disease severity and extent performed at 6 months and 3.5 years after randomization. The primary outcome variables will be the occurrence of graft occlusion at 6 months and the change in severity and extent of atherosclerosis in the saphenous vein grafts over 3 years. The proposal will determine th influence of hormone replacement therapy on the primary outcome variables. The pathophysiologic mechanisms of interest in this proposal are platelet activation, fibrinogen binding to platelets, vascular reactivity, coagulation and fibrinolytic factors and lipoprotein composition. The proposal will test the hypothesis that these variables predict the occurrence of graft occlusion and rate o development of graft atherosclerosis. The proposal also tests the hypothesis that hormone replacement therapy exerts its beneficial effects by its effects on those risk factors in addition to more traditional risk factors including the lipids and lipoprotein profile. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PRECONDITIONING IN OPEN HEART SURGERY Principal Investigator & Institution: Maulik, Nilanjana; Associate Professor; Surgery; University of Connecticut Sch of Med/Dnt Bb20, Mc 2806 Farmington, CT 060302806 Timing: Fiscal Year 2001; Project Start 01-FEB-1998; Project End 31-JAN-2003 Summary: (Investigator's abstract): "Myocardial preconditioning is believed to be the state of the art protective technique against ischemic injury. However, Preconditioning has not been applied in conjunction with open heart surgery. The mechanism of preconditioning is also not known. The proposed research will examine the mechanism of preconditioning and attempt to develop preconditioning modalities to salvage arrested heart during open heart surgery. The biochemical pathways activated by the preconditioning phenomenon and the molecular mechanism(s) of the gene expression will be studied. Hearts from the anesthetized rats and rabbits will be excised for isolated perfused heart preparation. To induce ischemic preconditioning, isolated hearts will be made globally ischemic for 5 minutes followed by 10 minutes of reperfusion. The process will be repeated four times. The hearts will then be made ischemic for 30 minutes followed by 60 minutes of reperfusion. To test our hypothesis that preconditioning occurs by tyrosine kinase receptor activation, we will use a tyrosine kinase blocker to inhibit preconditioning. To further explore whether the intracellular signaling occurs through tyrosine kinase-phospholipase D-protein kinase pathway, antiphospholipase D antibody will be used to inhibit phospholipase D activation associated with preconditioning. Activation of protein C kinase and its upstream regulators MAP kinase and MAPKAP kinase will be examined simultaneously. Biopsies and perfusate samples will be used to measure biochemical parameters which will include quantification of phospholipase C and D, diacyl glycerol, phosphatidic acid, protein kinase C, MAP kinase and MAPKAP kinase 2. The cellular injury will be monitored biochemically by measuring the LDH and CK releases. Functionally, both left

Studies 47

ventricular systolic and diastolic functional parameters will be continuously monitored on a beat to beat basis. These will include the left ventricular stroke work, elastance, and the time constant of isovolumic relaxation. Induction for the expression of stress-related genes will be studied by Differential Display Technique. The results of this study will not only enable us to understand whether tyrosine kinase-phospholipase D-protein C kinase-MAP kinase-MAPKAP kinase 2 signaling pathway is involved in preconditioning, but also will determine whether preconditioning occurs at the molecular level by reprogramming the gene expression. The results will be useful to develop treatment modalities for preconditioning the heart during open heart surgery." Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PREDICTORS OF OUTCOME IN COLORECTAL CANCER Principal Investigator & Institution: Meyerhardt, Jeffrey A.; Dana-Farber Cancer Institute 44 Binney St Boston, MA 02115 Timing: Fiscal Year 2003; Project Start 01-AUG-2003; Project End 31-JUL-2008 Summary: (provided by applicant): In 2001, approximately 135,400 Americans are expected to develop colorectal cancer, and 56,700 individuals will die from the disease. Though 80% of patients present at a stage when all apparent diseased tissue can be surgically resected, up to 40% of these patients will suffer from recurrence. Depth of tumor invasion and nodal status are considered the most important predictors of recurrence, and are the primary factors used by clinicians in recommending to patients adjuvant therapy after surgery. However, there is considerable variation in the outcome of patients with colorectal cancer not explained by traditional prognostic factors. The candidate for this award will utilize databases from two large, randomized adjuvant therapy trials to study other prognostic factors on outcomes in colon and rectal cancer. Specifically, these databases provide an opportunity to study the influence of potential modifiable treatment and patient characteristics on short- and long-term outcomes in patients with potentially curable colon and rectal cancers treated with surgery and adjuvant therapy. The specific aims of this proposal are (1) to examine whether hospital surgical volume and hospital characteristics affect cancer recurrence, overall survival, and treatment-related toxicity in patients undergoing curative surgery and adjuvant therapy for stages II and III rectal cancer, and (2) to examine the impact of diet and lifestyle on colon cancer recurrence and survival. Completion of these projects will improve our understanding of how potentially modifiable factors affect outcomes in patients treated with curative surgery and standard adjuvant therapy. These projects will provide insight into dietary and lifestyle behaviors of patients with colon cancer and which behaviors impact outcomes. Finally, these projects will allow the candidate to gain invaluable experience in database analysis and clinical epidemiologic and health outcomes research. The candidate will complete a Masters in Public Health (MPH) degree and advanced courses at the Harvard School of Public Health during the first two years of the proposed award. The projects will be performed under the mentorship of Dr. Charles Fuchs, a well-established researcher in prevention and health services research. At the completion of the project, the candidate will have gained the experience to become an independent researcher in clinical epidemiologic and health outcomes research. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

48 Surgery

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Project Title: PRESURGERY HYPNOSIS--BENEFITS ANALYSIS IN BREAST CANCER Principal Investigator & Institution: Montgomery, Guy; Ruttenberg Cancer Center; Mount Sinai School of Medicine of Nyu of New York University New York, NY 10029 Timing: Fiscal Year 2001; Project Start 17-AUG-2001; Project End 31-JUL-2004 Summary: Over 90% of the 184,000 women diagnosed with breast cancer in 2000 will undergo surgery as part of their curative treatment. Despite improvements in pharmacological management, surgical procedures under general anesthesia continue to be associated with clinically significant side effects, chief among which are pain and nausea. These clinical problems are particularly severe following surgical treatment for breast cancer and can require additional pharmacologic intervention, prolong recovery room stay, delay discharge, and lead to unanticipated readmission. Clinical research with other surgical populations has indicated that hypnosis can reduce intraoperative complications, reduce postoperative symptoms and enhance recovery (e.g., reduce pain, nausea, hospital stays), however, the treatment efficacy of hypnotic techniques with breast cancer surgical patients has yet to be established. A separate line of previous clinical research with surgery populations has indicated that preoperative psychological factors (emotional distress and cognitive expectations) are predictive of patients' postoperative experiences of side effects, but again research on breast cancer surgical patients is scant. The proposed research will bridge the two previous lines of research by combining a randomized clinical trial, (in which the effects of a preoperative hypnosis intervention to control side effects are compared to attention control), with a prospective quasi-naturalistic study, (in which the relations between preoperative psychological factors and patients' reactions to surgery are examined). In addition to establishing the applicability to breast cancer patients of findings in the general psychological, hypnosis and surgical literatures, the goal of proposed study is to make novel theoretical contribution by examining the potential role of psychological factors as the "active ingredients" in the beneficial effects of hypnosis. The proposed study will also make a novel practical contribution by examining cost-effectiveness of the hypnosis intervention, an approach which may have compelling implications for clinical practice as well as future behavioral research. The Specific Aims of the study are: 1) To investigate the impact of a presurgical hypnosis intervention on women scheduled for surgical treatment for breast cancer; 2) To investigate the contribution of preoperative emotional distress, and cognitive expectations to post- surgery side effects and recovery; 3) To determine whether the beneficial effects of the hypnosis intervention are accounted for (mediated) by differences in presurgery cognitive expectations and emotional distress; and 4) To investigate the cost-effectiveness of the presurgical hypnosis invention. o achieve these aims, 140 breast cancer patients scheduled for mastectomy will be randomly assigned to a hypnosis intervention group or an attention control group. The impact of the hypnosis intervention on postoperative nausea, pain, recovery from surgery, and cost- effectiveness will be analyzed within an experimental study design. The influence of presurgery distress and expectations of side effects will be analyzed within quasi-naturalistic study designs. The possible mediational role of these factors in hypnosis effects will be examined will classic statistical approaches. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PRESURGICAL STRESS REDUCTION MENTAL HEALTH AND CANCER Principal Investigator & Institution: Cohen, Lorenzo; Associate Professor; Behavioral Science; University of Texas Md Anderson Can Ctr Cancer Center Houston, TX 77030

Studies 49

Timing: Fiscal Year 2001; Project Start 01-AUG-1998; Project End 31-JUL-2003 Summary: Stress associated with a life threatening illness contributes to poor adjustment and psychological and physiological consequences harmful to adaptation and recovery from surgical treatment. Cancer and its treatment are associated with considerable distress, impaired quality of life, poor mental health, and reduced physical function. This is particularly true for men with prostate cancer undergoing a radical prostatectomy (RP), the surgical treatment of prostate cancer. Recovery from RP is often associated with urinary and sexual dysfunction in addition to more common sources of stress associated with surgery. At least 50 percent of RP patients have permanent impotence and many experience prolonged periods of urinary incontinence. In addition to the distress associated with these quality of life changes, prostate cancer patients face the fear of recurrence, progression, and death. Recent research has found that psychosocial and psychoeducational interventions can increase quality of life and mental health of cancer patients, and may also improve immune status, pain indices, hospital costs, and length of survival. Despite the dramatic increase in research on psychosocial aspects of cancer and of interventions for cancer patients, relatively little work has considered prostate cancer or the specific impact of surgery for cancer. The proposed study will randomly assign prostate cancer patients undergoing RP to a presurgical stress management group, an attention control group, or a usual care control group. Dimensions of response to surgery and recovery will include measures of mental health and psychological status, quality of life, and immune, endocrine, and cardiovascular function, as well as pain, use of analgesic medication, and length of hospital stay post- surgery. This design will allow characterization of distress associated with prostate cancer and RP and examination of psychological, physiological, and quality of life changes associated with surgery and short- and long-term recovery. We will also evaluate a theoretical model developed to examine dispositional and environmental factors as predictors of response to surgery and long-term recovery. We hypothesize that pre-surgical stress management will reduce the negative impact of RP assessed by psychological, physiological, and quality of life measures. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: QUANTITATIVE IMAGING & TREATMENT WITH FOCUSED ULTRASOUND Principal Investigator & Institution: Sanghvi, Narendra T.; President; Interscience Research, Inc. 3940 Pendleton Way Indianapolis, IN 46226 Timing: Fiscal Year 2001; Project Start 01-FEB-1999; Project End 31-MAR-2003 Summary: (Verbatim from Applicant's Abstract): A vital component of a successful clinical application of HIFU surgery is an accurate assessment of the treated tissue volume. It would be most beneficial if the HIFU-created lesion could be visualized and controlled in real-time so that treatment protocols could be modified to accommodate local and variable conditions in individual patients. The goal of this proposal is to upgrade the Sonablate device that would guide and control HIFU surgery by analyzing backscattered ultrasound signals. In our Phase I in vitro studies, several signal processing algorithms were successfully developed that measured changes in tissue parameters due to HIFU exposures. In this Phase II application, we propose (1) to utilize the signal processing algorithms developed in Phase I to separate the effects of cavitation and heat during HIFU surgery, (2) to perform a series of in vitro experiments to validate our signal and image processing algorithms, (3) to modify the Sonablate device to incorporate these lesion-imaging and control algorithms in real time, (4) to perform a series of in vivo experiments in animals with the modified Sonablate that

50 Surgery

would test the effectiveness of these algorithms, and (5) to perform a human feasibility study based on safe and efficacious results from the animal studies. PROPOSED COMMERCIAL APPLICATION: Prostate cancer is becoming an ever-more-frequent malady for man. Current annual market for treatment of prostate cancer in the United States is estimated around $5 billion. Currently, Focus Surgery Inc. manufactures the Sonablate TM system, which makes use of HIFU technology to treat benign prostatic hyperplasia (BPH). To extend the application of this system to treat prostate cancer, a reliable non-invasive feedback mechanism is necessary. The current proposal directly addresses this challenge. Successful completion of this project will open the enormous market of prostate cancer treatment for our Sonablate TM device. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: RACE,TREATMENT AND ENDOMETRIAL CANCER SURVIVAL Principal Investigator & Institution: Armstrong, Katrina; Medicine; University of Pennsylvania 3451 Walnut Street Philadelphia, PA 19104 Timing: Fiscal Year 2003; Project Start 11-APR-2003; Project End 31-MAR-2006 Summary: (provided by investigator): Survival after the diagnosis of endometrial cancer varies significantly between African-American and Caucasian women. Between 1992 and 1998, five-year survival for African-American women after endometrial cancer diagnosis was 58.9%, compared to 85.8% for Caucasian women. The disparity in survival is greatest among older women, with an absolute difference in five year survival of 10% for women under 50 compared to 30% for women 50 years of age and older. Prior studies have identified several factors that contribute to the observed racial disparity in endometrial cancer survival, including stage at diagnosis and tumor grade. However, significant differences in survival between Caucasian and African-American women persist even after adjusting for these factors. There are several reasons to believe that differences in the prevalence and characteristics of treatment may contribute to this residual survival disparity. African- Americans have been shown to be less likely to undergo definitive treatment for many different medical and surgical conditions. Characteristics of treatment (including provider characteristics, hospital characteristics and intensity of therapy) are associated with outcome for other surgical conditions, including surgery for lung, pancreatic and breast cancer. Understanding the prevalence and outcomes of differences in treatment characteristics between African-American and Caucasian women offers a potentially promising new approach to improving endometrial cancer survival among African-American women. In this application we propose to use SEER-Medicare linked data to examine the outcomes of AfricanAmerican and Caucasian women diagnosed with endometrial cancer between 1991 and 1999. The primary outcome will be overall and disease-specific survival times (which may be censored) as assessed by Medicare vital statistics and SEER linkage to the National Death Index respectively. Analyses will adjust for comorbidity, socioeconomic status and tumor characteristics using information provided in the SEER-Medicare database. Provider and hospital characteristics will be determined by linkage to the AMA practitioner database and AHA annual survey respectively. Our three specific aims explore the contribution of differences in treatment to the higher mortality among African-American women diagnosed with endometrial cancer. We group differences in treatment into three categories: (1) differences in the rates of treatment; (2) differences in the extent/intensity of treatment; and (3) differences in the providers and hospitals/facilities who deliver the treatment. For each category, we will explore differences between African-American and Caucasian women, their association with outcome, and to what extent variations in treatment explain the excess mortality among

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African-American women. In addition, within each category, we will investigate differences related to primary surgery and adjuvant radiation therapy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: RADIOTHERAPY--PREVENT LAMINECTOMY

FIBROSIS

AFTER

LUMBAR

Principal Investigator & Institution: Gerszten, Peter C.; Neurological Surgery; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, PA 15260 Timing: Fiscal Year 2001; Project Start 30-SEP-2000; Project End 31-JUL-2003 Summary: Perineural scar formation, also known as peridural fibrosis, is a common occurrence after lumbar discectomy surgery. Peridural fibrosis can cause compression or tethering of the nerve root and has been implicated in recurrent radicular and/or low back pain after a lumbar discectomy. Fibrosis may be the underlying cause in as many as a quarter of all failed back surgery syndrome cases. Reoperation with the intention of excising this fibrous tissue often produces a poor surgical result and further scarring. Furthermore, a large variety of materials have been implanted onto the dura in animal models with the goal of preventing perineural fibrosis with only modest success. Low dose radiation has long been known to inhibit fibroblast and osteoblast activity. Perioperative radiation therapy has been demonstrated to be a useful method to prevent both keloid and heterotopic bone formation in human trials. Radiation has not previously been studied as a means to inhibit peridural fibrosis. Our previous studies investigating in both rat and dog models showed a significant reduction in peridural fibrosis after laminectomy using low dose external beam radiation (700 cGy) given 24 hours prior to surgery. Based on these preliminary data, we will test the hypotheses that (1) preoperative low dose external beam radiation given 24 hours prior to surgery will decrease the amount of peridural fibrosis in humans, and (2) this reduction in peridural fibrosis will lead to an improvement in patient outcome. For this study, patients will be enrolled in a randomized double-blinded controlled clinical investigation either to preoperative radiation (treatment group) or no preoperative radiation (control group) prior to surgery. Patients will be followed at 1, 3, 6, and 12 months with self- report instruments of function, measures of impairment, and magnetic resonance imaging. As more than 10,000 patients per year in the United States have failed back surgery syndrome thought secondary to peridural fibrosis, this novel treatment strategy would be efficacious to a large number of patients with this disease process. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: RISK FACTORS FOR VENOUS THROMBOEMBOLISM IN THE COMMUNITY Principal Investigator & Institution: Heit, John A.; Professor; Mayo Clinic Rochester 200 1St St Sw Rochester, MN 55905 Timing: Fiscal Year 2001; Project Start 01-APR-2001; Project End 31-MAR-2005 Summary: This is a study of genetic and environmental determinants of venous thromboembolism (VTE) in the Rochester Minnesota Olmsted County population. The specific aims of the study are: 1) to update the 1966-95 inception cohort to include Olmsted County residents with VTE during the five year period, 1996-2000; 2) to extend the analysis of risk factors for VTE by identifying two Olmsted County residents (controls) without VTE matched by age and gender to each definite or probable case within the 1996-2000 cohort, and to obtain plasma and genomic DNA from all cases and controls and perform a case-control study to test the hypothesis that first specific

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diseases are related to VTE and mutations of the factor five and prothrombin are independent risk factors for VTE in the community; and interactions between environmental and genetic factors. They will determine the population attributable risk for VTE associated with each risk factor, both individually and collectively for all significant risk factors. They will then compare two Olmsted County residents who received major surgery without developing VTE matched by date and type of surgery to a case with VTE within three months after surgery in order to look at risk factors related to surgery and genetic markers. They will do a similar analysis this time using two Olmsted County residents who were hospitalized for medical illness without developing VTE matched by gender and date of hospitalization to a case who developed VTE within three months after hospitalization and perform a case-control study to test the hypothesis again that risk factors and genetic markers are associated with elevation of risk of VTE. Finally, the investigators will plan to extend their analysis of current VTE in relationship to use of standard heparin and low molecular weight heparin. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ROLE OF COAGULATION SYSTEM VARIABILITY: CARDIAC SURGERY Principal Investigator & Institution: Donahue, Brian S.; Anesthesiology; Vanderbilt University 3319 West End Ave. Nashville, TN 372036917 Timing: Fiscal Year 2002; Project Start 07-JAN-2002; Project End 31-DEC-2006 Summary: (provided by applicant): Hemostatic complications of cardiac surgery often occur for reasons that are not well understood. Despite efforts to limit blood loss and blood product transfusion, cardiac surgery patients consume 10-20% of the nation?s blood supply. Postoperative thrombotic events, such as coronary graft occlusion, are often unpredictable, and cause appreciable morbidity, resource utilization, such as need for additional revascularization. Many risk factors for these complications have been identified; among these, it is known that activation of the coagulation system occurs during cardiopulmonary bypass (CPB) and is responsible for mediating substantial postoperative hemostatic impairment. Although contact system activation unquestionably occurs during CPB, the role of the extrinsic system has not been characterized. Extrinsic system activation does occur on CPB, and may be the major contributor to thrombin generation. Furthermore, genetic variants within the genes for tissue factor, factor VII, and tissue factor pathway inhibitor have been described, and many of these significantly influence the activity of their respective protein gene products. However, the impact of these polymorphisms in contributing toward extrinsic system activation during CPB is undescribed. The overall goal of this study is to evaluate the contribution of extrinsic system variation toward observed variability in thrombin generation and impairment of hemostasis following CPB, and identify specific genetic variants in the extrinsic system that may place patients at increased risk for coagulation system abnormalities following CPB. This understanding will assist clinicians in identifying cardiac surgery patients at increased risk for hemostatic abnormalities, and target novel therapies toward those patients most likely to benefit. The project will make extensive use of data in the Vanderbilt Cardiac Surgery Registry, a valuable database of genetic and clinical data presently being prospectively collected on elective adult cardiac surgery patients. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: SURGERY

SENSORY

RE-TRAINING

FOLLOWING

ORTHOGNATHIC

Principal Investigator & Institution: Phillips, Ceib L.; Research Professor; Orthodontics; University of North Carolina Chapel Hill Office of Sponsored Research Chapel Hill, NC 27599 Timing: Fiscal Year 2001; Project Start 15-JUL-2001; Project End 31-MAY-2006 Summary: (provided by the applicant) Abnormal facial sensation has a negative impact on patient's oral behaviors and may adversely affect a patient's quality of life if the altered sensation persists. Many patients with abnormal sensations retain some sensory function and do not develop chronic pain, and for those individuals there are no currently evidence-based noninvasive therapies. The goal of this project is to evaluate sensory re-training, a rehabilitative therapy that offers significant potential for patients who experience impaired sensory function regardless of the cause. This behavior therapy approach has been used with substantial clinical success with hand injury patients since the 1970s. Re-training appears to enhance central reorganization of the impulses from an injured sensory nerve to the cerebral cortex so that the altered sensory signals can be interpreted and translated into functionally meaningful motor functions. Sensory re-training will be compared to a placebo jaw-opening exercise in a single blind, randomized two-arm parallel group stratified block clinical trial, using orthognathic surgery patients as subjects. Orthognathic surgery patients offer an uncompromised model for the evaluation of new rehabilitative therapies. These healthy patients, treated to correct dentofacial deformity, present for surgery with no neurosensory impairment, but yet routinely experience substantial alterations in facial sensation following the surgical procedure. The effcts of sensory re-training will be evaluated using three types of outcomes: patient-centered measures to assess the magnitude of the negative effect of altered sensation after surgery and the recovery time needed to reach little or no negative effect; neurosensory behavior measures to assess the patient's ability to learn alternate cues for touch perception and discrimination; and a conventional neurosensory contact threshold measure to assess the actual deficit. Our primary focus will be on the patient's perception of the negative impact of altered sensation on daily life. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SIXTH INTERNATIONAL MARFAN SYNDROME SYMPOSIUM Principal Investigator & Institution: Byers, Peter H.; Professor; Pathology; University of Washington Seattle, WA 98195 Timing: Fiscal Year 2001; Project Start 10-AUG-2001; Project End 31-JUL-2002 Summary: (provided by applicant): The Sixth International Marfan Syndrome Symposium will be held in Seattle, WA from August 11 -14, 2001. This meeting will bring together investigators who represent the most advanced research directed toward determining the underlying basis of Marfan Syndrome, the fundamental biology of the fibrillin genes and their interacting partners, the identification of other matrix components that are important for the construction of the elastic fiber network, the mechanisms by which the mutations are translated into the phenotypic findings, the issues of locus heterogeneity and the relationship to other disorders that result from mutations in related genes, the natural history of the disorder, the change in natural history by medical or surgical intervention, and the manner in which analysis of these genes assist in clinical decision making. The theme of the Symposium will be "Current Controversies in Research in Pathogenesis and Treatment of Marfan Syndrome and Related Disorders". These issues will be examined in five scientific sessions of

54 Surgery

approximately 3 to 3.5 hours each. The first session will be devoted to the relationship of genotype to phenotype, the role of molecular diagnostics, and the effect of mutations on the fibrillin proteins. The second will examine the function of fibrillitts, the cell biology of the proteins, their processing and fibrillogenesis, and interaction with other components of the matrix, and how defects in these processes lead to Marfan and other phenotypes. The third will examine the organization of tissues, the tole of fibrillins in non-Marfan phenotypes, and of other disorders that may mimic some of the Marfan phenotypes. The fourth will be devoted to issues in medical therapy, including the use of P-blockers, calcium channel blockers, and inhibitors of matrix degradation to slow the rate of aortic enlargement, the major risk factor for premature death. The fifth will examine issues surrounding cardiac surgery and surgery for lens dislocation. These issues include the use of "valve-sparing" surgery in aortic foot replacement, the timing of aortic surgery, and the role of lens removal for treatment of visual disturbance. This will be the first major gathering of investigators in three years and will be held in conjunction with the National Marfan Foundation annual meeting. The expected 125 participants should galvanize research efforts for the next years. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SOFTWARE TOOLKIT FOR IMAGE GUIDED SURGERY Principal Investigator & Institution: Cleary, Kevin R.; Associate Professor; Kitware, Inc. 469 Clifton Corporate Pky Clifton Park, NY 12065 Timing: Fiscal Year 2003; Project Start 15-MAY-2003; Project End 31-OCT-2004 Summary: (provided by applicant): This Phase I STTR application represents a partnership between a university-based research group (Imaging Science and Information Systems [ISIS] Center, Department of Radiology, Georgetown University) and a small business specializing in open-source software development (Kitware, Inc. of Clifton Park, NY). Over the past 1 1/2years, the ISIS Center has been developing a prototype image-guided surgery system called IGBiopsy to enhance the precision of instrument placement for minimally invasive abdominal interventions. This system incorporates a soon-to-be commercially available magnetic tracking system and specially designed needles whose tip position can be monitored. The software for this prototype is based on the Visualization Toolkit (VTK), an open-source software system developed and now supported by Kitware. This prototype software and hardware will be used as the starting point for the work proposed here. The specific aims are: 1. Integration. As a demonstration project, we will integrate the graphical user interface for image-guided abdominal interventions developed by Georgetown with the Insight Registration and Segmentation toolkit (ITK) developed by Kitware and others. 2. Preclinical evaluation. The software developed in Aim 1 will be evaluated in a pre-clinical study using a liver respiratory motion phantom already developed by Georgetown. The accuracy of the system in assisting the physician in placing a biopsy needle into a simulated liver lesion will be evaluated. These tests and Specific Aim 3 will also be used to evaluate the accuracy of the magnetic tracking hardware in the interventional suite. 3. Clinical evaluation. The system will be further evaluated using a cadaver study in the interventional suite. The accuracy of the system in assisting the physician in targeting selected points in the liver will be evaluated. If the Phase I work proposed here is successful, Kitware and Georgetown University will be in a position to develop an opensource software framework for image-guided surgery in a Phase II effort. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: SOLID STATE BETA IMAGING SENSOR FOR IMAGE GUIDED SURGERY Principal Investigator & Institution: Entine, Gerald; President; Radiation Monitoring Devices, Inc. 44 Hunt St Watertown, MA 02472 Timing: Fiscal Year 2002; Project Start 01-AUG-2002; Project End 31-JUL-2004 Summary: (provided by applicant): Nuclear Medicine imaging has been widely used to preoperatively image structures of interest for excisional biopsy. Radio-guided intraoperative procedures utilizing radiotracers have facilitated a cost-effective, highly specific means to locate suspect tissue and access it for pathologic analysis. The result of radio-guided surgery is increased tissue specificity obtained for biopsy, minimally accessed incisions, and the reduction of inpatient hospital utilization with an improved patient recovery. Nuclear medicine based surgical guidance with non-imaging gamma detector probes is gaining in acceptance and popularity. The main drawback of nonimaging guidance is the lack of ancillary information of the surveyed area, such as distinction between two neighboring radioactive regions, which can be overcome with an intraoperative imaging probe. Also, the highly penetrating gamma radiation arising from other parts of the body increases the background and limits the practical use of these probes. We propose to address these limitations by designing a new-generation intraoperative probe intended to rapidly image the tumor bed with short-range beta rays. This new design will be based on a solid-state, compact readout sensor coupled to a high resolution, high SNR converter. When developed, this detector will allow accurate delineation of the tumor, thus facilitating precise resection. PROPOSED COMMERCIAL APPLICATIONS: Advances in radiopharmaceuticals has dramatically escalated the use of intraoperative probes in surgery. The proposed research will provide a new class of digital imaging probes, which will exploit these advances allowing for complete and accurate tumor resection with enhanced quality of health care and increased lifespan of patients. This new imaging technology has enormous potential in both medical and non-medical applications. The estimated market size for probes is well over a hundred million dollars. A significant fraction of this market represents areas where the proposed technology will have a major impact. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: SPASTICITY AND STRENGTH AS INDICATORS FOR RHIZOTOMY Principal Investigator & Institution: Engsberg, Jack R.; Associate Professor; BarnesJewish Hospital Ms 90-94-212 St. Louis, MO 63110 Timing: Fiscal Year 2001; Project Start 15-AUG-1997; Project End 31-JUL-2002 Summary: (Adapted from the Applicant's Abstract): The long term goal is to improve function in children with cerebral palsy (CP). A selective dorsal rhizotomy (SDR) is performed to improve function by minimizing spasticity. A contraindication and limitation of the SDR is muscle weakness. Muscle weakness is related to reduced function. Thus, determining the degree of spasticity and strength/weakness in a child is a key consideration in the SDR selection process. Objective measures to assess spasticity and strength are not presently used in the process. In this study, objective measures to quantify spasticity and strength will be utilized to determine relationships between presurgery spasticity and strength and post-surgery functional measures. Based upon these relationships, an objective clinical tool to improve the selection of SDR candidates will be developed. In addition, comparisons of the measures among 4 different groups of children (n=40/group) will be made, those: 1) undergoing a SDR (SDR group), 2) undergoing physical therapy (PT) identical to the SDR group (PT group), 3) undergoing

56 Surgery

no change in current intervention (CP controls) and 4) having able bodies (AB controls). Specific Aim 1: Evaluate the importance of pre-surgery spasticity and strength as predictors of functional change due to SDR. Children from the SDR group will be tested on a dynamometer for spasticity and strength, evaluated using the Gross Motor Function Measure, have a gait analysis performed and answer a disability questionnaire. These assessments will be made 6 weeks and again 2 days prior to surgery, and at 8 and 20 months post surgery. Stepwise multiple regression with repeated measures will test the hypothesis that composite pre-surgery spasticity and strength from the ankles, knees, and hips in the SDR group will predict functional changes as a result of the SDR. Specific Aim 2: Compare impairment and functional measures among the SDR group, PT group and CP controls. The same assessments and testing sequence as the SDR group will be followed for these groups, but no surgery will be performed. ANOVA and ANCOVA will test the null hypotheses that the 3 CP groups will not change in impairment and function over all sessions and will not be different from one another. Specific Aim 3: Compare impairment and functional measures from 3 CP groups with those from AB controls. The children with able bodies will be assessed for spasticity, strength, and gait. ANOVA will test the null hypothesis that the CP groups will not be significantly different from the AB controls across all sessions. Descriptive statistics will describe the extent of differences from AP controls. The intent is that this investigation will improve the current methods for selecting SDR patients, thereby improving patient outcomes and reducing costs. It will also compare the efficacy of 3 modes of treatment for CP: SDR with intensive PT, intensive PT without SDR, and standard intervention. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: STUDY OF WOMEN WITH CONGENITAL ADRENAL HYPERPLASIA Principal Investigator & Institution: Migeon, Claude J.; Professor; Pediatrics; Johns Hopkins University 3400 N Charles St Baltimore, MD 21218 Timing: Fiscal Year 2001; Project Start 13-APR-2001; Project End 31-MAR-2005 Summary: (Adapted from the Investigator's Description): The principle goal of this study is to document long-term psychosexual development as it relates to excess androgen exposure during pre- and postnatal development in women with Congenital Adrenal Hyperplasia (CAH) due to 21-hydroxylase deficiency. Additionally, the investigators plan to study the impact of genital surgery on psychosexual development in CAH women. Participants include 150 CAH women over 18 years of age. Comparison subjects include 50 unaffected female siblings or first cousins of CAH participants and 50 patients with polycystic ovary disease (PCO). The specific aims are as follows: (1) determine degree of androgen exposure at various developmental stages in women with CAH, (2) identify factors such as timing and type of genital surgery that influence psychosexual development in women with CAH, (3) assess psychosexual development in women with CAH and (4) investigate relationships between degree of androgen exposure, timing of androgen exposure and genital surgery with psychosexual development in women with CAH. Knowledge gained from this investigation will contribute to our understanding of androgenic influences on individual differences in development and expression of cognitive and sexual behaviors. Furthermore, information obtained from this study will contribute to improved medical and surgical treatment of CAH women. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: SUBTLE DISTURBANCES OF COBALAMIN STATUS Principal Investigator & Institution: Carmel, Ralph; Director of Research; New York Methodist Hospital 506 60Th St New York, NY 11215 Timing: Fiscal Year 2003; Project Start 01-SEP-1983; Project End 31-MAY-2008 Summary: (provided by applicant): Low cobalamin (vitamin B12) levels are frequent, especially in the elderly, several million of whom are affected. Most often the low levels reflect "subclinical cobalamin deficiency", an asymptomatic state marked only by metabolic evidence of cobalamin insufficiency. It is unclear if these persons need intervention because progression to clinical deficiency may be uncommon, and many people with low levels have no deficiency at all. The proposal aims to study whether nitrous oxide (N2O), used in most general anesthesia in the US, worsens cobalamin status in elderly people who have unrecognized subclinical cobalamin deficiency. The reason for concern is that N2O inactivates cobalamin and therefore can cause neurological dysfunction in some patients with underlying clinically expressed cobalamin deficiency. The elderly are known to have an increased risk of postoperative cognitive complications. The study will recruit patients >60 years old who are scheduled for elective surgery in which N2O use for more than 1 hour is planned. Patients will be randomized in a blinded fashion to receive a standard anesthetic regimen of several agents, in which N2O is either included or replaced by air; the two regimens are equally safe and effective. They will undergo cognitive function and depression scale testing, blood testing of cobalamin-related metabolism, and clinical evaluation before surgery and at 48 hours, 14 days and 28 days after surgery. Those with cognitive changes will be treated with cobalamin and reevaluated after 3 months. Statistical analysis will compare the subgroups' metabolic, neuropsychological, demographic, genetic and clinical data. The primary question is what effect routine N2O anesthesia has on metabolic and clinical status related to subclinical cobalamin deficiency. It will also resolve whether or not the combination of N2O and the deficiency can explain the increased rate of postoperative cognitive problems in the elderly, and thus if preoperative or postoperative attention to cobalamin is needed in the elderly. A secondary goal is to extensively study cobalamin-related and homocysteine-related metabolism in these patients and their conditions, particularly as changes evolve after N2O use and later improvement. The clinical study provides a unique opportunity to establish these metabolic details and to compare their interactions with common genetic mutations in the patients that affect enzymes relevant to cobalamin deficiency, N2O effects, and their contribution to the clinical outcomes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: SURGERY Principal Investigator & Institution: Itzkowitz, Fred; Mayo Clinic Rochester 200 1St St Sw Rochester, MN 55905 Timing: Fiscal Year 2001; Project Start 01-JAN-1982; Project End 31-DEC-2005 Summary: The Surgery Committee makes important contributions to the NCCTG research programs in four major spheres: 1) Administration-85 new surgeons (total 162) have been recruited since the last grant cycle, allowing increasing emphasis on subspecialty contributions. The Committee has designated "disease-specific" program representatives (breast, colorectal, hepatic, and thoracic) from the Research Base. A newsletter has enhanced pre- and post-meeting communications. Future efforts will focus on developing a Liaison Program to enhance "disease- specific" community surgeon representation and a Direct Tailored Communication Network. 2) Scientific

58 Surgery

Contributions-Surgeons were listed as study chair (13) or co-chair (6) for a total of 19 diverse protocols in the last grant cycle, (5) Colorectal, (6) Hepatic Metastases Metastases, (2); Thoracic, (5); and Melanoma, (1). In the Breast Program, there are two protocols specifically addressing surgical questions: N9431 investigates the association between menstrual cycle phase, breast addressing surgical questions: N9431 investigates the association between menstrual cycle phase, breast cancer surgery, and disease-free survival. E5194 investigates results from local excision along for selected patients with ductal carcinoma in situ. 954-32-51 is a phase II follow-up study to the pilot studying Accelerated Hyperfractionated Radiation Therapy Following Lumpectomy and Axillary Lymph Node Dissection in Patients with Stage I/II Breast Cancer. Future plans include investigations into bone marrow analysis in breast cancer and how information on micrometastases can be used for staging and treatment. In the Colorectal Program, surgeons are study chairs on four protocols, two of which investigate independent surgical questions; 93-46-53(INT -0146) represents a unique effort to address whether laparoscopic surgery for colon cancer is oncologically is oncologically sound. 97-46-52 addresses the issue of surgeon variability in rectal cancer surgery in a communitybased USA practice. Future plans include additional adjuvant studies incorporating CTP-11 and 5-FU based chemotherapy, C89803. The Hepatic Metastases Program includes two important studies, 90-46-52 and 92-46-52, testing the role of adjuvant therapy and testing the ability to extend curative resections to patients with multiple metastases using systemic plus regional chemotherapy, respectively. A future study, 9746- 51, will study the possibility of rendering otherwise "unresectable" lesions "resectable" employing systemic oxaliplatin, 5-FU, and CF chemotherapy The Thoracic Program within surgery is new and promises to become active with esophageal and lung-protocols. Although most of these test surgical adjuvant therapies, one current protocol, C9334 (CALGB initiated), investigates a surgical question, whether Sclerosis of Pleural Effusions by Talc Thoracoscopy is good as Talc Slurry. NCCTG's success with 95-24-51, a phase II trial of preoperative paclitaxel and carboplatin in patients with resectable non-small cell lung cancer, puts the thoracic team in good position for future accrual to the phase III SWOG study (S9900). S9900 will test the paclitaxel/carboplatin preoperative adjuvant strategy against surgery alone. 3) Quality Assurance (QA)-In addition to surgical guidelines and a routine QL review process, unique aspects of NCCTG surgical QA include surgeon credentialing, video review audits, pre-enrollment surgical review, and standardized guidelines and data forms for colorectal cancer resulting from an NCI workshop organized by the NCCTG Surgical Scientific Coordinator. 4) Education-Symposia and workshops have become integral to the Surgery Committee meetings. Future efforts will focus on the training of new surgeons (residents in Cooperative Group activities. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SURGICAL TREATMENT OF CARDIAC ARRHYTHMIAS Principal Investigator & Institution: Boineau, John P.; Medical Science Service; Surgery; Washington University Lindell and Skinker Blvd St. Louis, MO 63130 Timing: Fiscal Year 2001; Project Start 08-AUG-1983; Project End 31-JUL-2003 Summary: This renewal application requests five years' support for work now in continuous progress for over 15 years at Washington University. Dr. John Boineau, the new PI, has replaced Dr. James Cox, the former P1, who transferred to Georgetown University Hospital. Dr. Cox remains as a special consultant. The broad aims continue to be the direct or surgical ablation of cardiac arrhythmias. The emphasis of the current renewal is focused upon the development of a new procedure, the radial incisions

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approach (RIA), to eradicate atrial fibrillation (AF) and restore atrial transport function and is directed primarily toward patients undergoing surgery for valvular or ischemic heart disease. Conventional valve or CABG surgery does not eliminate and may not prevent AF in these patients. The availability of an effective means of eradicating this arrhythmia in these patients at the time of surgery would permit control of rate and rhythm, limit embolic stroke, and improve cardiac performance, outcome, and the quality of life. Whereas the Maze and RIA assume randomly distributed and changing reentry which are eliminated without prior activation mapping, new data indicate that some forms of AF result from (spatially) stable reentry which can be identified by new mapping methods and focally ablated. Thus, a second project is directed toward map guided, focal cryoablation of AF. This could be performed off bypass as a more limited and rapid alternative to the more extensive and (bypass) time consuming RIA procedure. A third project is targeted at prevention and correction of postoperative atrial flutter (AFL) after the Fontan operation in congenital heart patients or after lung transplant surgery. Studies will be performed in both realistic animal models with atrial enlargement and patients with AF and AFL and will center about the use of new automated, 3-D mapping techniques and rapid numerical analysis of potentials recorded simultaneously from to 512 electrodes during the arrhythmias. Preliminary observations indicate that the proposed studies are feasible, will provide new information regarding the different mechanisms of AF and AFL that are related to atrial enlargement and/or atrial surgery, and this data will be used to develop the new surgical ablation techniques to control or prevent these arrhythmias. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SYSTEMATIC INTEGRATION POR INTO CLINICAL PATHWAY OF HCC Principal Investigator & Institution: Schwartz, Myron E.; Surgery; Mount Sinai School of Medicine of Nyu of New York University New York, NY 10029 Timing: Fiscal Year 2002; Project Start 01-MAR-2002; Project End 31-JAN-2007 Summary: HCC Hepatocellular carcinoma (HCC) is an increasing pubic health problem in the United States. The Mount Sinai Hospital in New York has become a major referral center for this disease, with 231 new patients with HCC or suspected HCC first seen in 2000. Myron Schwartz, MD (the applicant) is Associate Professor of Surgery, Deputy Director of Liver Transplantation, and Chief of Hepatobiliary Surgery at Mount Sinai. Dr. Schwartz has proven record of patient-oriented research (POR), with 156 peerreviewed publications, and a long history of mentoring trainees who go on to successful careers in academic surgery, including 7 who are now directors of transplant programs. Dr.Schwartz's clinical and academic focus is on HCC, and he is an internationally recognized expert on HCC care. The central hypothesis of this proposal is that a program which seamlessly incorporates clinical care and POR will maximize quality of care, provide unparalleled research opportunities, and create an ideal setting for the training of clinician/researches. Dr.Schwartz's role is as director of the program, principal investigator for surgery-related projects, and mentor for trainees. The specific aims are to conduct projects exploring: 1. Etiology-" Gene Expression Profiles in HCC"; 2.Diagnosis-"Utility of AFP-L3% in Screening, Diagnosis, and Prognosis of HCC";3. Secondary prevention after resection- "Prevention of HCC Recurrence after Surgical Resection by Vaccination with Tumor-Derived Heat Shock Protein gp96 and Associated Peptides"; 4. Secondary prevention after transplantation- "Sirolimus vs Tacrolimus as the Primary Immunosuppressive Agent after Liver Transplantation for HCC"; and 5. "Treatment of unresectable HCC- "Cytokine Inhibition in HCC". Mount Sinai's

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commitment to furthering POR and education is reflected in the recent awarding by the NIH of a K30 institutional Clinical Research Curriculum Award, a T32 institutional Training Grant in Investigative Gastroenterology, and a K23 Mentored POR Career Development Award to a junior faculty member to study novel HCC therapies. This program provides a truly remarkable opportunity to make meaningful progress in understanding, preventing and treating HCC, while in the process providing fertile training ground for young physician-scientists. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: THE ESOPHAGOGASTRIC JUNCTION IN HEALTH AND DISEASE Principal Investigator & Institution: Kahrilas, Peter J.; Professor of Medicine; Medicine; Northwestern University Office of Sponsored Programs Chicago, IL 60611 Timing: Fiscal Year 2001; Project Start 01-APR-2001; Project End 31-MAR-2006 Summary: (Verbatim from Applicant's Abstract): Gastroesophageal reflux disease (GERD) is a common disorder, affecting millions of Americans and caused by anatomical and physiological perturbations of the esophagogastric junction (EGJ). The economic impact of GERD in the US is evident by the annual expenditure of >$4 billion for pharmaceutical treatments. Although effective, medical therapy is by nature compensatory, as opposed to potentially curative surgery. However, a problem with antireflux surgery has been unpredictable postoperative dysphagia and bloating related to a diminished ability to belch. Thus, this revised RO1 application represents a collaborative effort by a gastroenterologist (Dr Kahrilas), a surgeon (Dr Joehl), and a mechanical engineer (Dr Brasseur) to study perturbations of the EGJ imposed by GERD and by surgical treatments of GERD (Nissen fundoplication). Specific aim #1 addresses antegrade EGJ function while specific aim #2 investigates mechanisms of reflux. Antegrade EGJ function will be quantified with an "esophageal stress test" using manometry with concurrent fluoroscopy while swallowing boluses of defined viscoelastic properties. These data will be complimented by a dysphagia questionnaire. Data from controls will be compared to that of GERD patients and patients after antireflux surgery. The underlying hypothesis of specific aim #1 is that a mathematical model of the EGJ, embedded within a "computer laboratory" and based on the best anatomical and physiological data obtainable will improve understanding and prevention of post-surgical dysphagia. Specific aim #2 is focused aboutextending our investigations into the interplay between anatomical and physiological factors in the pathophysiology of GERD. Investigational methodologies include using a barostat to create measured degrees of gastric distension and to ascertain EGJ compliance during fluoroscopy of the EGJ, using intragastric air insufflation to study the physiology of transient LES relaxations and high resolution manometry to map the geometry and mobility of the EGJ. An underlying hypothesis is that the optimal surgical management of a patient with tLESR induced reflux is different than of the patient with a patulous sphincter. The ultimate goal is to tailor the surgical management of GERD for the individual patient based on physiological studies of that patient with the hope that this will improve the efficacy and reduce the complications of antireflux surgery. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: THE MONOLITHIC FETAL PACEMAKER: PROTOTYPE AND DEPLOYMENT Principal Investigator & Institution: Zavitz, Daniel H.; Nanosignal, Llc. 33 N Stone Ave Tucson, AZ 85701

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Timing: Fiscal Year 2001; Project Start 01-AUG-2001; Project End 31-JUL-2002 Summary: (Verbatim from the Applicant's Abstract): Advances in ultrasound have increased the frequency of antenatal diagnosis of complete heart block with heart failure and hydrops fetalis Because no cardiac pacemaker modality exists for intrauterine application, these patients die prenatally or postnatally. A Monolithic Fetal Pacemaker System has been designed, capable of intrauterine placement, that avoids the problems incident to an exposed lead This is applicable to fetal heart block, where pacing for 2- 4 weeks prior to Cesarean delivery should resolve hydrops fetalis permitting survival. This system can also be used prophylactically for avoiding death after fetal surgery. The pacemaker is novel because it employs an intrapleural electrode to pace heart through the pericardium, because it uses an extraordinary pathway of current passage, traversing fetal skin, and because its low profile monolithic character, permits minimally invasive implantation while avoiding cord complications. This proposed research (1) develops techniques of ultrasound-guided placement of the prototype Monolithic Fetal Pacemaker, (2) creates prototypes, and (3) in a study in pregnant sheep, leads to development of surgical techniques of deployment. If successful, this research will lead to important advances in fetal medicine and surgery, permitting survival of fetuses with complete heart block and enhancing survival of fetuses that undergo fetal surgery. PROPOSED COMMERCIAL APPLICATION: The Monolithic Fetal Pacemaker will be used by fetal interventionalists and perinatologists in fetuses with complete heart blocck. It may become a mainstay of fetal surgery, where it will be prophylactically placed at the time of fetal surgery. Broad opportunities for commercialization exit, because of the wide range of its use and the international network of clinicians in the fields of Obstetrics, Cardiac Surgery, Pediatric Cardiology, Electrophysiology and Fetal Surgery. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TREATMENT OF DEPRESSION AFTER CORONARY BYPASS SURGERY Principal Investigator & Institution: Freedland, Kenneth E.; Professor of Medical Psychology; Psychiatry; Washington University Lindell and Skinker Blvd St. Louis, MO 63130 Timing: Fiscal Year 2001; Project Start 29-JUN-2001; Project End 31-MAY-2005 Summary: (Adapted from investigator's abstract): Depression is a common and persistent problem after coronary artery bypass graft (CABG) surgery that complicates recovery, increases the risk of cardiac events, and may exacerbate the neurocognitive deficits that are often observed in post-CABG patients. Although CABG is one of the most frequently performed operations in the United States, there have not been any randomized, controlled trials of treatments for depression in this population. The aims of this study are (1) to compare the efficacy of cognitive behavior therapy (CBT), stress management (SM), and usual care (UC) for major depression following CABG surgery; (2) to determine the effects of CBT on neurocognitive performance, psychosocial adjustment, functional status, employment status, and health-related quality of life; and (3) to collect pilot data on the relationship between the treatment of depression and the 12-month incidence of cardiac and cerebrovascular events following CABG. Consenting patients will be screened for depression 4 to 6 weeks after surgery. Those who screen positive will return for a psycho-diagnostic evaluation and additional testing approximately 1 week later. A sample of 165 patients with major depression who meet all other eligibility criteria will be randomized to 12 weeks of CBT, SM, or UC with no restriction on non-study antidepressants. Participants in all 3 arms will be monitored for

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worsening depression and will be referred for additional care if needed. Depression outcomes will be assessed 12 weeks post-randomization and 6 months after surgery (2 months after termination of CBT or SM.) The primary hypothesis is that the posttreatment severity of depression is lower in patients treated with CBT than with SM or UC, with baseline depression severity and non-study treatment as planned covariates. Secondary analyses will test the effects of treatment on remission, neurocognitive and functional recovery, quality of life, and examine the relationships between treatment process and outcome variables. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TRIAL OF ANTIBIOTICS TO REDUCE RECURRENT TRICHIASIS Principal Investigator & Institution: West, Sheila K.; Professor; Ophthalmology; Johns Hopkins University 3400 N Charles St Baltimore, MD 21218 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-MAR-2005 Summary: Trachoma, caused by C. trachomatis, is the second leading cause of blindness worldwide, and control is a top priority of the blindness prevention community. In trachoma-endemic areas, 10% or more of adults have trichiasis, resulting from years of repeated infection, which is high risk for subsequent visual loss. Trichiasis can be corrected with surgery, but the recurrence rate at one year is disappointingly high, 17%, and it increases in subsequent years. There is strong evidence that ongoing exposure to infection with C. trachomatis, either from a persistent injection or exposure within families, drives ongoing scarring and trichiasis in these cases. The primary questions to be addressed by this investigation are: 1) Does post-surgical treatment of trichiasis cases with azithromycin reduce the one-year recurrence rate of trichiasis compared to standard care (topical tetracycline)? 2) Does post-surgical treatment of cases plus household members with azithromycin reduce the one-year recurrence rate of trichiasis compared to standard treatment? We propose a randomized, controlled clinical trial of 1425 adults with trichiasis scheduled for surgery in two health centers in the Lanfuro district of Ethiopia to address this questions. The three arm trial will have one arm in which cases receive a single dose of azithromycin post- surgery; a third arm in which cases will receive topical tetracycline post- surgery. Data on other risk factors will include baseline severity of trichiasis, surgery-related factors, and laboratory evidence and re- infection. Cases will be examined at 2 weeks and 2, 6, and 12 months postsurgery for recurrence of trichiasis. The results of this trial will have immediate public health impact by providing information for WHO recommendations for post-surgical treatment of trichiasis, as well as by guiding policy on azithromycin use for the 22 countries beginning National Trachoma Control programs worldwide. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: TRIAL TO REDUCE ANTIMICROBIAL PROPHYLAXIS ERRORS Principal Investigator & Institution: Kritchevsky, Stephen B.; Preventive Medicine; University of Tennessee Health Sci Ctr Health Science Center Memphis, TN 38163 Timing: Fiscal Year 2002; Project Start 16-AUG-2002; Project End 31-JUL-2006 Summary: (APPLICATION ABSTRACT): Both epidemiologic studies and randomized trials have shown that many surgical site infections (SSI) are preventable with appropriately timed antimicrobial prophylaxis. Patients receiving prophylaxis either well before or well after surgery are up to five times more likely to develop an SSI than those receiving appropriate therapy (Classen et al., 1992). Unfortunately, errors in antimicrobial prophylaxis timing are extremely common, with error rates typically

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reported to be between 35 and 40 percent. Given that errors in antimicrobial prophylaxis are so common and the consequences of error so grave, identifying methods to assist hospitals in improving prophylaxis must be a high priority. We propose to evaluate a multifaceted, theory-based intervention to assist hospitals in progressing through stages of organizational change to improve the prophylaxis process. We will test the impact of the intervention using a rigorous group-randomized, nested, pretest-posttest design (Murray, 1998). Our specific aims over the four-year project period are: 1) Determine the incidence of medication errors related to antimicrobial prophylaxis for cardiovascular surgery, joint replacement surgery, and hysterectomy in 40 hospitals recruited to participate in the study; 2) identify organizational and system factors associated with error rates; and 3) randomize the 40 hospitals to evaluate the effectiveness of a multifaceted intervention. The intervention consists of a) the promotion of two specific process changes (the elimination of "on-call" ordering and the use of preprinted prophylaxis orders); b) a site visit; c) customized process feedback; d) facilitated benchmarking; and e) peer consultation. The 20 intervention hospitals will be compared with 20 hospitals that receive written feedback of their error rates only. The study has 80-percent power to detect a 12- to 15-percent improvement in the timing of prophylaxis in the full intervention group compared with the group that receives written feedback only. Data collection will be done at each participating hospital, and the medical records of 100 surgical patients before and after the intervention will be abstracted at each hospital to establish performance rates. Changes in the processes of care and the evolution through stages of organizational change will also be assessed. This application represents the combined efforts of three organizations devoted to improving patient care through error reduction: the Society for Healthcare Epidemiology of America, the Joint Commission on Accreditation of Healthcare Organizations, and the Centers for Disease Control and Prevention. Health Care Quality & Effectiveness Research SS KRITCHEVSKY, STEPHEN B. Each organization is providing unique abilities and expertise to address the important issue of antimicrobial prophylaxis errors. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ULTRASONIC SYSTEM FOR OCULAR VISUALIZATION AND BIOMETRY Principal Investigator & Institution: Wiseman, George D.; Ultralink, Llc 2083 Hawaii Ave Ne Saint Petersburg, FL 33703 Timing: Fiscal Year 2002; Project Start 01-FEB-2002; Project End 31-JUL-2002 Summary: (Provided by Applicant): The long-term objective of this program is a commercially viable system that will play a key role in restoring and preserving vision for millions of patients in this country and abroad. The system will couple highfrequency ultrasound (40 MHz) with novel signal processing to provide accurate, precise biometry of the cornea and anterior chamber. Measurements will be used by ophthalmologists to: 1) plan refractive laser surgery of the cornea (for vision correction and restoration); 2) select the appropriate type and size of recently developed intraocular lenses (IOL) to correct refractive errors or restore vision following cataract surgery; and, 3) document causes of undesired side-effects following laser and IOL procedures, so that corrective actions can be initiated promptly. The system will incorporate advanced, patented methodology developed by the Weill Medical College of Cornell University (WMC) and Riverside Research Institute (RRI). Ultralink, Inc. has already implemented an initial "proof-of-concept" system that successfully demonstrated the practicality of these objectives. This innovative system functioned extremely well, but it also identified several practical issues that will be addressed in

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this program so that these techniques can realize their full clinical and commercial potentials. The program will integrate system design (Phase I), and development and testing (Phase II) at Ultralink, WMC, and RRI. PROPOSED COMMERCIAL APPLICATION: The research will provide advanced ultrasonic systems to provide precise biometric data that is essential for optimal laser?refractive surgery and intraocular lens implants. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: VENTRICULAR FUNCTION DURING CARDIAC SURGERY Principal Investigator & Institution: Spotnitz, Henry M.; Humphreys Professor of Surgery; Surgery; Columbia University Health Sciences New York, NY 10032 Timing: Fiscal Year 2001; Project Start 01-MAY-1992; Project End 31-MAY-2006 Summary: (Provided by Applicant): These studies will examine the effect of surgical correction of acquired and congenital heart disease on the systolic and diastolic properties of the left and right ventricles in human adults, children, and infants. State of the art measuring devices and algorithms will be employed for intraoperative measurements and long-term followup. Improved pump function during corrective surgery will be correlated with changes in myocardial properties, since impaired contractility and compliance can be hidden by improved hemodynamics. For specific operations in which the pathophysiology of surgical correction is not well understood, mechanisms that promote a successful long term result will be defined. Outpatient studies will examine chronic changes in ventricular size and function, which will be related to intraoperative events. Laboratory studies will develop advanced methods for intraoperative study and reduce the cost of such studies, making the technology widely available. Intraoperative measurements will include pressure by micromanometer, flow by electromagnetic or ultrasonic flowmeter, and dimensions by sonomicrometry, twodimensional echocardiography, and ventricular conductance. End-diastolic volume will be correlated with end-diastolic pressure to measure compliance, and with pressurevolume stroke work to measure contractile function (preload recruitable stroke work). Contractility will also be measured from pressure-volume loops (end-systolic pressurevolume relation). End-diastolic pressure-ventricular performance relations will also be measured, since these directly influences patient symptoms. These goals will be accomplished by a dedicated faculty with the right combination of clinical experience and laboratory background to conduct such studies effectively and safely. Results will improve care of patients undergoing cardiac surgery, will clarify deficiencies of current management, will expand understanding of the pathophysiology of heart surgery, and will make low cost methods for the study of systolic and diastolic properties generally available to cardiac surgeons and laboratory scientists. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National

3

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

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Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “surgery” (or synonyms) into the search box. This search gives you access to fulltext articles. The following is a sample of items found for surgery in the PubMed Central database: •

A Simple Method to Prevent Calcium Embolization during Aortic Valve Surgery. by Neri E, Toscano T, Frati G, Capannini G, Bizzarri F, Sassi C. 2001; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=101213

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A snapshot of waiting times for cancer surgery provided by surgeons affiliated with regional cancer centres in Ontario. by Simunovic M, Gagliardi A, McCready D, Coates A, Levine M, DePetrillo D. 2001 Aug 21; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=81366

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Advice on driving after groin hernia surgery in the United Kingdom: questionnaire survey. by Ismail W, Taylor SJ, Beddow E. 2000 Oct 28; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=27514

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Assessment of neurocognitive impairment after off-pump and on-pump techniques for coronary artery bypass graft surgery: prospective randomised controlled trial. by Zamvar V, Williams D, Hall J, Payne N, Cann C, Young K, Karthikeyan S, Dunne J. 2002 Nov 30; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=136922

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Assessment of whether in-hospital mortality for lobectomy is a useful standard for the quality of lung cancer surgery: retrospective study. by Treasure T, Utley M, Bailey A. 2003 Jul 12; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=164918

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Attitudes and training of research fellows in surgery: national questionnaire survey. by Seow CS, Teo NB, Wilson CR, Oien KA. 2001 Sep 29; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=56890

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Bypass surgery or stenting for multivessel coronary artery disease? by Farquhar D. 2001 Jun 12; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=81178

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Can Stent-Angioplasty Be a Valid Alternative to Surgery When Revascularization Is Indicated for Anomalous Origination of a Coronary Artery from the Opposite Sinus? by Hariharan R, Kacere RD, Angelini P. 2002; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=140293

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Cardiac Surgery in Patients Infected with Human Immunodeficiency Virus. by Abad C, Cardenes MA, Jimenez PC, Armas MV, Betancor P. 2000; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=101104

4

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

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•

Caution with breast-conserving surgery. by Vandenberg TA, Bramwell VH. 2002 Nov 12; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=134277

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Changes in Endotoxin-Binding Proteins during Major Elective Surgery: Important Role for Soluble CD14 in Regulation of Biological Activity of Systemic Endotoxin. by Hiki N, Berger D, Dentener MA, Mimura Y, Buurman WA, Prigl C, Seidelmann M, Tsuji E, Kaminishi M, Beger HG. 1999 Nov; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=95786

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Cohort study of risk of fracture before and after surgery for primary hyperparathyroidism. by Vestergaard P, Mollerup CL, Frokjaer VG, Christiansen P, Blichert-Toft M, Mosekilde L. 2000 Sep 9; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=27473

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Cohort study on effects of parathyroid surgery on multiple outcomes in primary hyperparathyroidism. by Vestergaard P, Mosekilde L. 2003 Sep 6; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=192894

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Combined Coronary Artery and Abdominal Aortic Surgery without Cardiopulmonary Bypass. by Ascione R, Iannelli G, Spampinato N. 2000; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=101012

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Comparison of Concentrations of Sulbactam-Ampicillin Administered by Bolus Injections or Bolus plus Continuous Infusion in Tissues of Patients Undergoing Colorectal Surgery. by Martin C, Cotin A, Giraud A, Beccani-Argeme M, Alliot P, Mallet MN, Argeme M. 1998 May; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=105751

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Comparison of Intraoperative Transit-Time Flow Measurement with Early Postoperative Magnetic Resonance Flow Mapping in Off-Pump Coronary Artery Surgery. by Sanisoglu I, Guden M, Balci C, Sagbas E, Duran C, Akpinar B. 2003; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=152832

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Cumulative risk adjusted mortality chart for detecting changes in death rate: observational study of heart surgery. by Poloniecki J, Valencia O, Littlejohns P. 1998 Jun 6; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28566

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Early surgery or surveillance for small abdominal aortic aneurysms? by Myers KA. 2002 Jul 9; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=116647

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Effect of socioeconomic deprivation on waiting time for cardiac surgery: retrospective cohort study. by Pell JP, Pell AC, Norrie J, Ford I, Cobbe SM. 2000 Jan 1; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=27247

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Elimination of residual metastatic prostate cancer after surgery and adjunctive cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) blockade immunotherapy. by Kwon ED, Foster BA, Hurwitz AA, Madias C, Allison JP, Greenberg NM, Burg MB. 1999 Dec 21; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=24775

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Evaluation of a decision aid for patients considering autologous blood donation before open-heart surgery. by Grant FC, Laupacis A, O'Connor AM, Rubens F, Robblee J. 2001 Apr 17; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=80970

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Guidewire Perforation during PTCA with Subsequent Off-Pump Bypass Surgery. by Naik M, Lau KW, Chua YL. 2001; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=101138

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How often does surgery for peptic ulceration eradicate Helicobacter pylori? Systematic review of 36 studies. by Danesh J, Appleby P, Peto R. 1998 Mar 7; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28480

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Iatrogenic Right Ventricular Laceration: Delayed Presentation after Abdominal Surgery. by Neri E, Lisi G, Marchetti L, Sassi C. 2000; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=101086

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Impact of NICE guidance on laparoscopic surgery for inguinal hernias: analysis of interrupted time series. by Bloor K, Freemantle N, Khadjesari Z, Maynard A. 2003 Mar 15; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=151520

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Isolation of Abiotrophia adiacens from a Brain Abscess Which Developed in a Patient after Neurosurgery. by Biermann C, Fries G, Jehnichen P, Bhakdi S, Husmann M. 1999 Mar; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=84549

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Long term relative survival after surgery for abdominal aortic aneurysm in Western Australia: population based study. by Norman PE, Semmens JB, Lawrence-Brown MM, Holman CD. 1998 Sep 26; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=31917

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Longer waits for breast cancer surgery in Quebec could be good news. by HebertCroteau N, Villeneuve D. 2001 Nov 13; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=81616

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Lung Hernia as a Sequela to Limited-Access Mitral Valve Surgery. by Gouda H, Multz AS, Khan A, Rossoff LJ, Green D, Graver LM. 2002; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=124760

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Mechanical methods of reducing blood transfusion in cardiac surgery: randomised controlled trial. by McGill N, O'Shaughnessy D, Pickering R, Herbertson M, Gill R. 2002 Jun 1; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=113763

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Medical and psychosocial effects of early discharge after surgery for breast cancer: randomised trial. by Bonnema J, van Wersch AM, van Geel AN, Pruyn JF, Schmitz PI, Paul MA, Wiggers T. 1998 Apr 25; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28526

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Mortality and volume of cases in paediatric cardiac surgery: retrospective study based on routinely collected data. by Spiegelhalter DJ. 2002 Feb 2; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=65055

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Nontransplant Cardiac Surgery as a Bridge to Heart Transplantation in Pediatric Dilated Cardiomyopathy. by Hsu RB, Chien CY, Wang SS, Chu SH. 2002; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=124763

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Observational study of type of surgical training and outcome of definitive surgery for primary malignant melanoma. by MacKie RM, Bray CA, Hole DJ. 2002 Nov 30; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=136925

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Perioperative variation in phagocytic activity against Candida albicans measured by a flow-cytometric assay in cardiovascular-surgery patients. by Tran TL, Auger P, Marchand AR, Carrier M, Pelletier C. 1997 Jul; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=170548

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Profulla Kumar Sen His Contributions to Cardiovascular Surgery. by Mittal CM. 2002; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=101263

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Randomised controlled trial of effects of early discharge after surgery for breast cancer. by Bundred N, Maguire P, Reynolds J, Grimshaw J, Morris J, Thomson L, Barr L, Baildam A. 1998 Nov 7; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28705

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Risk of renal stone events in primary hyperparathyroidism before and after parathyroid surgery: controlled retrospective follow up study. by Mollerup CL, Vestergaard P, Frokjaer VG, Mosekilde L, Christiansen P, Blichert-Toft M. 2002 Oct 12; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=128947

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Taking a stand in Timmins: quit smoking, or forgo surgery. by Mackay B. 2003 Jun 10; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=156700

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Testicular neoplasia in cryptorchid boys at primary surgery: case series. by Cortes D, Visfeldt J, Moller H, Thorup J. 1999 Oct 2; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28244

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The Development of Coronary Artery Surgery Personal Recollections. by Connolly JE. 2002; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=101261

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The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire: longitudinal construct validity and measuring self-rated health change after surgery. by Gummesson C, Atroshi I, Ekdahl C. 2003; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=165599

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The use of breast conserving surgery: linking insurance claims with tumor registry data. by Maskarinec G, Dhakal S, Yamashiro G, Issell BF. 2002; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=100324

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Training in large bowel cancer surgery: observations from three prospective regional United Kingdom audits. by Aitken RJ, Thompson MR, Smith JA, Radcliffe AG, Stamatakis JD, Steele RJ. 1999 Mar 13; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=27780

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Use of magnetic resonance angiography to select candidates with recently symptomatic carotid stenosis for surgery: systematic review. by Westwood ME, Kelly S, Berry E, Bamford JM, Gough MJ, Airey CM, Meaney JF, Davies LM, Cullingworth J, Smith MA. 2002 Jan 26; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=64789

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Video-Assisted Thoracic Surgery for the Management of Pleural and Pericardial Effusion in Behcet's Syndrome. by Oz N, Sarper A, Erdogan A, Demircan A, Isin E. 2000; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=101087

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Waiting time for breast cancer surgery in Quebec. by Mayo NE, Scott SC, Shen N, Hanley J, Goldberg MS, MacDonald N. 2001 Apr 17; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=80969

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Waiting times for cancer surgery. by Alibhai SM. 2002 Mar 19; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=99444

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

A case of fatal West Nile virus meningoencephalitis associated with receipt of blood transfusions after open heart surgery. Author(s): Armstrong WS, Bashour CA, Smedira NG, Heupler FA, Hoeltge GA, Mawhorter SD, Sudheendra V, Gordon SM. Source: The Annals of Thoracic Surgery. 2003 August; 76(2): 605-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12902115&dopt=Abstract

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A consideration of the time taken to do dacryo-cystorhinostomy (DCR) surgery. Author(s): Malhotra R, Wright M, Olver JM. Source: Eye (London, England). 2003 August; 17(6): 691-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12928678&dopt=Abstract

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A history of the Ohio State University Department of Surgery. Author(s): Zollinger RM Sr, Ellison EC. Source: American Journal of Surgery. 2003 September; 186(3): 208-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12946818&dopt=Abstract

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 population-based study of surgery for spinal metastases. Survival rates and complications. Author(s): Finkelstein JA, Zaveri G, Wai E, Vidmar M, Kreder H, Chow E. Source: The Journal of Bone and Joint Surgery. British Volume. 2003 September; 85(7): 1045-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14516044&dopt=Abstract

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A practical method of surgical draping using the preformed RAE (Ring-Adair-Elwyn) nasotracheal tube and the Mayo table in maxillofacial surgery. Author(s): Baek RM, Song YT. Source: Plastic and Reconstructive Surgery. 2003 October; 112(5): 1484-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14504540&dopt=Abstract

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A rational approach to cholelithiasis in bariatric surgery: its application to the laparoscopically placed adjustable gastric band. Author(s): O'Brien PE, Dixon JB. Source: Archives of Surgery (Chicago, Ill. : 1960). 2003 August; 138(8): 908-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12912752&dopt=Abstract

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A selective history of hernia surgery in the late eighteenth century: the treatises of Percivall Pott, Jean Louis Petit, D. August Gottlieb Richter, Don Antonio de Gimbernat, and Pieter Camper. Author(s): Rutkow IM. Source: The Surgical Clinics of North America. 2003 October; 83(5): 1021-44, V. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14533901&dopt=Abstract

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A self-administered health questionnaire for the preoperative risk stratification of patients undergoing cataract surgery. Author(s): Reeves SW, Tielsch JM, Katz J, Bass EB, Schein OD. Source: American Journal of Ophthalmology. 2003 May; 135(5): 599-606. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12719065&dopt=Abstract

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Accuracy of the 'Paedfusor' in children undergoing cardiac surgery or catheterization. Author(s): Absalom A, Amutike D, Lal A, White M, Kenny GN. Source: British Journal of Anaesthesia. 2003 October; 91(4): 507-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14504151&dopt=Abstract

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Acetazolamide reduces referred postoperative pain after laparoscopic surgery with carbon dioxide insufflation. Author(s): Woehlck HJ, Otterson M, Yun H, Connolly LA, Eastwood D, Colpaert K. Source: Anesthesiology. 2003 October; 99(4): 924-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14508327&dopt=Abstract

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ACOG Committee Opinion Number 284, August 2003: Nonobstetric surgery in pregnancy. Author(s): ACOG Committee on Obstetric Practice. Source: Obstetrics and Gynecology. 2003 August; 102(2): 431. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12907126&dopt=Abstract

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Acute hemodynamic benefit of multisite ventricular pacing after congenital heart surgery. Author(s): Zimmerman FJ, Starr JP, Koenig PR, Smith P, Hijazi ZM, Bacha EA. Source: The Annals of Thoracic Surgery. 2003 June; 75(6): 1775-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12822614&dopt=Abstract

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Adenoid cystic carcinoma stage Ib1 treated with radical surgery displaying human papilloma virus 33 (HPV 33): immunoelectron microscopy and review. Author(s): Daponte A, Grayson W, Moisuc D, Ebrahim S, Guidozzi F. Source: Gynecologic Oncology. 2003 September; 90(3): 673-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=13678745&dopt=Abstract

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Adjunctive cosmetic procedures during rhinoplasty and sinus surgery. Author(s): Becker DG. Source: Journal of Long-Term Effects of Medical Implants. 2003; 13(3): 247-57. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14516188&dopt=Abstract

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Advances in cardiac surgery: valve repair. Author(s): Wiegand DL. Source: Critical Care Nurse. 2003 April; 23(2): 72-91. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12725197&dopt=Abstract

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Advantage of earlier thoracoscopic clipping of thoracic duct for post-operation chylothorax following thoracic aneurysm surgery. Author(s): Hirata N, Ueno T, Amemiya A, Shigemura N, Akashi A, Kido T. Source: Jpn J Thorac Cardiovasc Surg. 2003 August; 51(8): 378-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12962416&dopt=Abstract

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Advantages of using an image-guided system for transnasal endoscopic surgery. Author(s): Han D, Zhou B, Ge W, Zhang L, Zhang Y. Source: Chin Med J (Engl). 2003 July; 116(7): 1106-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12890394&dopt=Abstract

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Affected side and risk of pain recurrence after surgery for trigeminal neuralgia. Author(s): Cucchiara B, Messe S. Source: Archives of Neurology. 2003 August; 60(8): 1169-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12925379&dopt=Abstract

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Age does not limit quality of life improvement in cardiac valve surgery. Author(s): Sedrakyan A, Vaccarino V, Paltiel AD, Elefteriades JA, Mattera JA, Roumanis SA, Lin Z, Krumholz HM. Source: Journal of the American College of Cardiology. 2003 October 1; 42(7): 1208-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14522482&dopt=Abstract

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Algorithm of hair restoration surgery in children. Author(s): Kolasinski J, Kolenda M. Source: Plastic and Reconstructive Surgery. 2003 August; 112(2): 412-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12900598&dopt=Abstract

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An interesting etiologic reason for skin defect in plastic surgery: air bag deployment. Author(s): Sarifakioglu N, Aslan G, Cigsar B. Source: Plastic and Reconstructive Surgery. 2003 August; 112(2): 707-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12900652&dopt=Abstract

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Anaesthesia-related diplopia after cataract surgery. Author(s): Lanigan LP, Hammond CJ. Source: British Journal of Anaesthesia. 2003 July; 91(1): 152; Author Reply 152-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12821574&dopt=Abstract

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Analgesic efficacy of inhaled morphine in patients after bunionectomy surgery. Author(s): Thipphawong JB, Babul N, Morishige RJ, Findlay HK, Reber KR, Millward GJ, Otulana BA. Source: Anesthesiology. 2003 September; 99(3): 693-700; Discussion 6A. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12960555&dopt=Abstract

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Anatomic study of vaginal width in male-to-female transsexual surgery. Author(s): Fang RH, Chen TJ, Chen TH. Source: Plastic and Reconstructive Surgery. 2003 August; 112(2): 511-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12900609&dopt=Abstract

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Anesthesia for groin hernia surgery. Author(s): Amado WJ. Source: The Surgical Clinics of North America. 2003 October; 83(5): 1065-77. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14533904&dopt=Abstract

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Anesthesia management for spine surgery using spinal navigation in combination with computed tomography. Author(s): Fritz HG, Kuehn D, Haberland N, Kalff R. Source: Anesthesia and Analgesia. 2003 September; 97(3): 863-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12933417&dopt=Abstract

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Antibiotic resistance patterns of ocular bacterial flora: a prospective study of patients undergoing anterior segment surgery. Author(s): Ta CN, Chang RT, Singh K, Egbert PR, Shriver EM, Blumenkranz MS, Mino de Kaspar H. Source: Ophthalmology. 2003 October; 110(10): 1946-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14522770&dopt=Abstract

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Antibiotics and surgery for vesicoureteric reflux: a meta-analysis of randomised controlled trials. Author(s): Wheeler D, Vimalachandra D, Hodson EM, Roy LP, Smith G, Craig JC. Source: Archives of Disease in Childhood. 2003 August; 88(8): 688-94. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12876164&dopt=Abstract

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Anticoagulant therapy: consideration of modification in conjunction with minor surgery. Author(s): Todd DW. Source: Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons. 2003 September; 61(9): 1117-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12966494&dopt=Abstract

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Antiemetic prophylaxis for office-based surgery: methodologic concerns. Author(s): Alhashemi JA, Mujallid RH. Source: Anesthesiology. 2003 September; 99(3): 759; Author Reply 759-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12960571&dopt=Abstract

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Antiplatelet agents for preventing thrombosis after peripheral arterial bypass surgery. Author(s): Dorffler-Melly J, Koopman MM, Adam DJ, Buller HR, Prins MH. Source: Cochrane Database Syst Rev. 2003; (3): Cd000535. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12917893&dopt=Abstract

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Applications of FloSeal in nephron-sparing surgery. Author(s): User HM, Nadler RB. Source: Urology. 2003 August; 62(2): 342-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12893349&dopt=Abstract

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Argatroban for off-pump coronary artery bypass surgery. Author(s): Green JA, Cooper CL, Falcucci OA, Safwat A, Slaughter T, Spiess BD. Source: Anesthesia and Analgesia. 2003 October; 97(4): 1201; Author Reply 1201-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14500190&dopt=Abstract

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Aspirin and microvascular surgery: an update. Author(s): Peter FW, Steinau HU, Homann HH, Barker JH. Source: Plastic and Reconstructive Surgery. 2003 October; 112(5): 1368-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14504522&dopt=Abstract

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Assessment of basic human performance resources predicts operative performance of laparoscopic surgery. Author(s): Gettman MT, Kondraske GV, Traxer O, Ogan K, Napper C, Jones DB, Pearle MS, Cadeddu JA. Source: Journal of the American College of Surgeons. 2003 September; 197(3): 489-96. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12946804&dopt=Abstract

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Assessment of intraoperative blood transfusion practice during elective non-cardiac surgery in an Indian tertiary care hospital. Author(s): Niraj G, Puri GD, Arun D, Chakravarty V, Aveek J, Chari P. Source: British Journal of Anaesthesia. 2003 October; 91(4): 586-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14504164&dopt=Abstract

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Astigmatism management for modern phaco surgery. Author(s): Nichamin LD. Source: International Ophthalmology Clinics. 2003 Summer; 43(3): 53-63. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12881649&dopt=Abstract

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Atypical mycobacterial infection of the periocular region after periocular and facial surgery. Author(s): Mauriello JA Jr; Atypical Mycobacterial Study Group. Source: Ophthalmic Plastic and Reconstructive Surgery. 2003 May; 19(3): 182-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12918551&dopt=Abstract

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Augmentation of an anterior edentulous ridge for fixed prosthodontics with combined use of orthodontics and surgery: a clinical report. Author(s): Capri D, Albehbehani Y, Smukler H. Source: The Journal of Prosthetic Dentistry. 2003 August; 90(2): 111-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12886203&dopt=Abstract

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Autoimmune pancreatitis detected as a mass in the head of the pancreas without hypergammaglobulinemia, which relapsed after surgery: case report and review of the literature. Author(s): Taniguchi T, Tanio H, Seko S, Nishida O, Inoue F, Okamoto M, Ishigami S, Kobayashi H. Source: Digestive Diseases and Sciences. 2003 August; 48(8): 1465-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12924637&dopt=Abstract

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Bacteriemia in septoplasty and septorhinoplasty surgery. Author(s): Kaygusuz I, Kizirgil A, Karlidag T, Yalcin S, Keles E, Yakupogullari Y, Alpay C. Source: Rhinology. 2003 June; 41(2): 76-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12868371&dopt=Abstract

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Bariatric surgery options. Author(s): Woodward BG. Source: Critical Care Nursing Quarterly. 2003 April-June; 26(2): 89-100. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12744589&dopt=Abstract

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Bariatric weight loss surgery: patient education, preparation, and follow-up. Author(s): Garza SF. Source: Critical Care Nursing Quarterly. 2003 April-June; 26(2): 101-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12744590&dopt=Abstract

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Barrett's esophagus can and does regress after antireflux surgery: a study of prevalence and predictive features. Author(s): Gurski RR, Peters JH, Hagen JA, DeMeester SR, Bremner CG, Chandrasoma PT, DeMeester TR. Source: Journal of the American College of Surgeons. 2003 May; 196(5): 706-12; Discussion 712-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12742201&dopt=Abstract

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Basal and nitroglycerin-induced exhaled nitric oxide before and after cardiac surgery with cardiopulmonary bypass. Author(s): Kovesi T, Royston D, Yacoub M, Marczin N. Source: British Journal of Anaesthesia. 2003 May; 90(5): 608-16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12697588&dopt=Abstract

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Beating heart surgery in a patient with dextrocardia and complete situs inversus. Author(s): Stamou SC, Bafi AS, Kapetanakis EI, Lowery RC, Pfister AJ, Dullum MK, Boyce SW, Corso PJ. Source: Journal of Cardiac Surgery. 2003 March-April; 18(2): 170-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12757348&dopt=Abstract

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Beat-to-beat QT interval variability before and after cardiac surgery. Author(s): Frljak S, Avbelj V, Trobec R, Meglic B, Ujiie T, Gersak B. Source: Computers in Biology and Medicine. 2003 May; 33(3): 267-76. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12726805&dopt=Abstract

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Behavioral changes associated with deep brain stimulation surgery for Parkinson's disease. Author(s): Anderson KE, Mullins J. Source: Curr Neurol Neurosci Rep. 2003 July; 3(4): 306-13. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12930700&dopt=Abstract

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Beneficial hemodynamic and renal effects of intravenous enalaprilat following coronary artery bypass surgery complicated by left ventricular dysfunction. Author(s): Wagner F, Yeter R, Bisson S, Siniawski H, Hetzer R. Source: Critical Care Medicine. 2003 May; 31(5): 1421-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12771613&dopt=Abstract

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Benefit of rFVIIa administration for cirrhotic patients undergoing surgery. Author(s): Pardo M, Bartolome J, Carreno V, Sanchez J, Quemada FJ, Del Corral A. Source: World Journal of Surgery. 2003 June; 27(6): 758-9. Epub 2003 May 13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12732988&dopt=Abstract

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Benefit to quality of life after off-pump versus on-pump coronary bypass surgery. Author(s): Immer FF, Berdat PA, Immer-Bansi AS, Eckstein FS, Muller S, Saner H, Carrel TP. Source: The Annals of Thoracic Surgery. 2003 July; 76(1): 27-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12842507&dopt=Abstract

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Benefits of laparoscopic renal surgery are more pronounced in patients with a high body mass index. Author(s): Klingler HC, Remzi M, Janetschek G, Marberger M. Source: European Urology. 2003 May; 43(5): 522-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12705997&dopt=Abstract

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Benefits of off-pump coronary artery surgery? Author(s): Balacumaraswami L. Source: Anaesthesia. 2003 May; 58(5): 481-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12694007&dopt=Abstract

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Benefits of statin therapy in patients with special risks: coronary bypass surgery, stable coronary disease, and acute coronary syndromes. Author(s): Brown WV. Source: Clin Cardiol. 2003 April; 26(4 Suppl 3): Iii13-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12708634&dopt=Abstract

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Bias in patient assessments of general practice: general practice assessment survey scores in surgery and postal responders. Author(s): Bower P, Roland MO. Source: The British Journal of General Practice : the Journal of the Royal College of General Practitioners. 2003 February; 53(487): 126-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12817358&dopt=Abstract

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Bilateral diaphragmatic paralysis after aortic surgery with topical hypothermia: Ventilatory assistance by means of nasal mask bilevel positive pressure. Author(s): Tokuda Y, Matsumoto M, Sugita T, Nishizawa J, Matsuyama K, Yoshida K, Matsuo T. Source: The Journal of Thoracic and Cardiovascular Surgery. 2003 May; 125(5): 1158-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12771892&dopt=Abstract

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Bilateral posterior ischemic optic neuropathy after lumbar spine surgery. Author(s): Murphy MA. Source: Ophthalmology. 2003 July; 110(7): 1454-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12867409&dopt=Abstract

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Biochemical markers for post-operative fatigue after major surgery. Author(s): McGuire J, Ross GL, Price H, Mortensen N, Evans J, Castell LM. Source: Brain Research Bulletin. 2003 April 15; 60(1-2): 125-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12725900&dopt=Abstract

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Biochemical relapse of prostate cancer. Evidence after radical surgery. Author(s): Prott FJ, Spitz J, Michaelis M, Niles B, Barth S, Kollermann M, Kleinschmidt K. Source: Anticancer Res. 2003 March-April; 23(2A): 979-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12820334&dopt=Abstract

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Biphasic shocks compared with monophasic damped sine wave shocks for direct ventricular defibrillation during open heart surgery. Author(s): Schwarz B, Bowdle TA, Jett GK, Mair P, Lindner KH, Aldea GS, Lazzara RG, O'Grady SG, Schmitt PW, Walker RG, Chapman FW, Tacker WA. Source: Anesthesiology. 2003 May; 98(5): 1063-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12717126&dopt=Abstract

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Bispectral index monitoring in patients undergoing cardiac surgery under cardiopulmonary bypass. Author(s): Puri GD, Murthy SS. Source: European Journal of Anaesthesiology. 2003 June; 20(6): 451-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12803261&dopt=Abstract

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Blood use in patients undergoing coronary artery bypass surgery: impact of cardiopulmonary bypass pump, hematocrit, gender, age, and body weight. Author(s): Scott BH, Seifert FC, Glass PS, Grimson R. Source: Anesthesia and Analgesia. 2003 October; 97(4): 958-63, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14500140&dopt=Abstract

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Body dysmorphic disorder in cosmetic surgery patients. Author(s): Sarwer DB, Crerand CE, Didie ER. Source: Facial Plastic Surgery : Fps. 2003 February; 19(1): 7-18. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12739178&dopt=Abstract

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Brachytherapy boost to the tumour bed in high risk patients after limited surgery for breast cancer. Author(s): Ulutin HC, Ash D, Dodwell D. Source: Clin Oncol (R Coll Radiol). 2003 May; 15(3): 156-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12801055&dopt=Abstract

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Breast conservation surgery, with and without radiotherapy, in women with lymph node-negative breast cancer: a randomised clinical trial in a population with access to public mammography screening. Author(s): Malmstrom P, Holmberg L, Anderson H, Mattsson J, Jonsson PE, TennvallNittby L, Balldin G, Loven L, Svensson JH, Ingvar C, Moller T, Holmberg E, Wallgren A; Swedisj Breast Cancer Group. Source: European Journal of Cancer (Oxford, England : 1990). 2003 August; 39(12): 16907. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12888363&dopt=Abstract

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Brief intervention by surgeons can influence students toward a career in surgery. Author(s): Kozar RA, Lucci A, Miller CC, Azizzadeh A, Cocanour CS, Potts JR, Fischer CP, Brundage SI. Source: The Journal of Surgical Research. 2003 May 1; 111(1): 166-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12842462&dopt=Abstract

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Burned breast reconstructive surgery with Integra dermal regeneration template. Author(s): Palao R, Gomez P, Huguet P. Source: British Journal of Plastic Surgery. 2003 April; 56(3): 252-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12859921&dopt=Abstract

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By the way, doctor. The Harvard Health Letter seems pretty dubious about the PSA test for prostate cancer. But a PSA test seemed to catch Senator John Kerry's cancer early, so he got surgery that may have cured him. I just don't get why you have doubts about testing and early detection. Author(s): Lee TH. Source: Harvard Health Letter / from Harvard Medical School. 2003 May; 28(7): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12770836&dopt=Abstract

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Calcium channel blockers for reducing cardiac morbidity after noncardiac surgery: a meta-analysis. Author(s): Wijeysundera DN, Beattie WS. Source: Anesthesia and Analgesia. 2003 September; 97(3): 634-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12933374&dopt=Abstract

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Can we explain the high incidence of cardiac arrest during spinal anesthesia for hip surgery? Author(s): Pollard JB. Source: Anesthesiology. 2003 September; 99(3): 754-5; Author Reply 755. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12960565&dopt=Abstract

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Cardiac surgery in nonagenarians and centenarians. Author(s): Bridges CR, Edwards FH, Peterson ED, Coombs LP, Ferguson TB. Source: Journal of the American College of Surgeons. 2003 September; 197(3): 347-56; Discussion 356-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12946784&dopt=Abstract

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Cardiothoracic surgery: a specialty in transition--good to great? Author(s): Baumgartner WA. Source: The Annals of Thoracic Surgery. 2003 June; 75(6): 1685-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12822600&dopt=Abstract

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Cataract surgery and the 5-year incidence of late-stage age-related maculopathy: pooled findings from the Beaver Dam and Blue Mountains eye studies. Author(s): Wang JJ, Klein R, Smith W, Klein BE, Tomany S, Mitchell P. Source: Ophthalmology. 2003 October; 110(10): 1960-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14522772&dopt=Abstract

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Central neuraxial blockade in ambulatory surgery. Author(s): Arakawa M. Source: Journal of Anesthesia. 2003; 17(2): 149. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12903932&dopt=Abstract

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Children with class III malocclusion: development of multivariate statistical models to predict future need for orthognathic surgery. Author(s): Schuster G, Lux CJ, Stellzig-Eisenhauer A. Source: Angle Orthod. 2003 April; 73(2): 136-45. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12725369&dopt=Abstract

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Clinical and economic choices in anaesthesia for day surgery. Author(s): Lake AP, Khater M. Source: Anaesthesia. 2003 October; 58(10): 1031; Author Reply 1031-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12969057&dopt=Abstract

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Clinical manifestations of latex anaphylaxis during anesthesia differ from those not anesthesia/surgery-related. Author(s): Brock-Utne JG. Source: Anesthesia and Analgesia. 2003 October; 97(4): 1204; Author Reply 1204-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14500193&dopt=Abstract

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Clinical value of preoperative mechanical bowel cleansing in elective colorectal surgery: a systematic review. Author(s): Wille-Jorgensen P, Guenaga KF, Castro AA, Matos D. Source: Diseases of the Colon and Rectum. 2003 August; 46(8): 1013-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12907890&dopt=Abstract

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Clinical variables of preoperative risk in thoracic surgery. Author(s): Saad IA, De Capitani EM, Toro IF, Zambon L. Source: Sao Paulo Medical Journal = Revista Paulista De Medicina. 2003 May 5; 121(3): 107-10. Epub 2003 August 08. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12920471&dopt=Abstract

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Cohort study on effects of parathyroid surgery on multiple outcomes in primary hyperparathyroidism. Author(s): Vestergaard P, Mosekilde L. Source: Bmj (Clinical Research Ed.). 2003 September 6; 327(7414): 530-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12958111&dopt=Abstract

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Comparison of a levonorgestrel-releasing intrauterine device versus expectant management after conservative surgery for symptomatic endometriosis: a pilot study. Author(s): Vercellini P, Frontino G, De Giorgi O, Aimi G, Zaina B, Crosignani PG. Source: Fertility and Sterility. 2003 August; 80(2): 305-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12909492&dopt=Abstract

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Comparison of bypass surgery and stenting for the treatment of multivessel disease: results from the ARTS trial in Israel. Author(s): Gruberg L, Milo S, Ben Tzvi M, Lotan C, Merin G, Braun S, Mohr R, Tzivoni D, Bitran D, Beyar R; Israel Arterial Revascularization Therapy Study Group. Source: Isr Med Assoc J. 2003 August; 5(8): 539-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12929288&dopt=Abstract

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Comparison of early postoperative quality of life in minimally invasive versus conventional valve surgery. Author(s): Yamada T, Ochiai R, Takeda J, Shin H, Yozu R. Source: Journal of Anesthesia. 2003; 17(3): 171-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12911204&dopt=Abstract

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Comparison of minimal incision aortic surgery with endovascular aortic repair. Author(s): Turnipseed W, Tefera G, Carr S. Source: American Journal of Surgery. 2003 September; 186(3): 287-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12946834&dopt=Abstract

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Concomitant surgery with tension-free vaginal tape. Author(s): Huang KH, Kung FT, Liang HM, Huang LY, Chang SY. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2003 October; 82(10): 948-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12956846&dopt=Abstract

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Confirmation of research publications reported by neurological surgery residency applicants. Author(s): Cohen-Gadol AA, Koch CA, Raffel C, Spinner RJ. Source: Surgical Neurology. 2003 October; 60(4): 280-3; Discussion 283-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14505831&dopt=Abstract

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Continuous paravertebral catheter and outpatient infusion for breast surgery. Author(s): Buckenmaier CC 3rd, Klein SM, Nielsen KC, Steele SM. Source: Anesthesia and Analgesia. 2003 September; 97(3): 715-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12933392&dopt=Abstract

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Continuous wound infiltration with ropivacaine reduces pain and analgesic requirement after shoulder surgery. Author(s): Gottschalk A, Burmeister MA, Radtke P, Krieg M, Farokhzad F, Kreissl S, Strauss M, Standl T. Source: Anesthesia and Analgesia. 2003 October; 97(4): 1086-91, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14500162&dopt=Abstract

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Corneal abrasion after the wake-up test in spinal surgery. Author(s): Yanagidate F, Dohi S. Source: Journal of Anesthesia. 2003; 17(3): 211-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12911215&dopt=Abstract

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Coronary artery bypass surgery is still cost-effective: using calibrated models to update clinical trials. Author(s): Weinstein MC. Source: The American Journal of Medicine. 2003 October 1; 115(5): 410-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14553880&dopt=Abstract

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Coronary surgery with intermittent aortic cross-clamping: a word of caution on the incidence of cerebrovascular accidents: letter 2. Author(s): Antunes PE, Antunes MJ. Source: The Annals of Thoracic Surgery. 2003 August; 76(2): 661; Author Reply 661-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12902146&dopt=Abstract

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Correlation of vesicoureteral reflux with degree of hydronephrosis and the impact of antireflux surgery. Author(s): Aboutaleb H, Bolduc S, Bagli DJ, Khoury AE. Source: The Journal of Urology. 2003 October; 170(4 Pt 2): 1560-2; Discussion 1562. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14501660&dopt=Abstract

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Correlation of visual and refractive outcomes between eyes after same-session bilateral laser in situ keratomileusis surgery. Author(s): Van Gelder RN, Steger-May K, Pepose JS. Source: American Journal of Ophthalmology. 2003 May; 135(5): 577-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12719062&dopt=Abstract

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Cost-effectiveness of bypass surgery versus stenting in patients with multivessel coronary artery disease. Author(s): Yock CA, Boothroyd DB, Owens DK, Garber AM, Hlatky MA. Source: The American Journal of Medicine. 2003 October 1; 115(5): 382-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14553874&dopt=Abstract

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Craniofacial surgery for malignant skull base tumors: report of an international collaborative study. Author(s): Patel SG, Singh B, Polluri A, Bridger PG, Cantu G, Cheesman AD, deSa GM, Donald P, Fliss D, Gullane P, Janecka I, Kamata SE, Kowalski LP, Kraus DH, Levine PA, dos Santos LR, Pradhan S, Schramm V, Snyderman C, Wei WI, Shah JP. Source: Cancer. 2003 September 15; 98(6): 1179-87. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12973841&dopt=Abstract

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CSF galanin and cognition after shunt surgery in normal pressure hydrocephalus. Author(s): Mataro M, Poca MA, Del Mar Matarin M, Catalan R, Sahuquillo J, Galard R. Source: Journal of Neurology, Neurosurgery, and Psychiatry. 2003 September; 74(9): 1272-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12933934&dopt=Abstract

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Current methods of bowel-sparing surgery in Crohn's disease. Author(s): Fichera A, Hurst RD, Michelassi F. Source: Adv Surg. 2003; 37: 231-51. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12953636&dopt=Abstract

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Current status and future directions of geriatric general surgery. Author(s): Pofahl WE, Pories WJ. Source: Journal of the American Geriatrics Society. 2003 July; 51(7 Suppl): S351-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12823667&dopt=Abstract

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Cytoreductive surgery combined with organ resection for advanced ovarian carcinoma. Author(s): Todo Y, Sakuragi N, Oikawa M, Negishi H, Yamamoto R, Yoshiaki K, Tsumura N, Kawaguchi I, Fujimoto S. Source: International Journal of Clinical Oncology / Japan Society of Clinical Oncology. 2003 April; 8(2): 90-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12720101&dopt=Abstract

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Damage control: what is its role in colorectal surgery? Author(s): McPartland KJ, Hyman NH. Source: Diseases of the Colon and Rectum. 2003 July; 46(7): 981-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12847378&dopt=Abstract

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Day of surgery cancellations after nurse-led pre-assessment in an elective surgical centre: the first 2 years. Author(s): Rai MR, Pandit JJ. Source: Anaesthesia. 2003 July; 58(7): 692-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12886919&dopt=Abstract

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Decompensated hepatitis B virus-related cirrhosis successfully treated with lamivudine allowing surgery for hepatocellular carcinoma. Author(s): Nakanishi S, Michitaka K, Miyake T, Hidaka S, Yoshino I, Konishi I, Iuchi H, Horiike N, Onji M. Source: Intern Med. 2003 May; 42(5): 416-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12793712&dopt=Abstract

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Decreased cardiac output in humans during laparoscopic antireflux surgery: direct measurements. Author(s): Are C, Hardacre JM, Talamini MA, Murata K, Frank S. Source: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A. 2003 June; 13(3): 139-46. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12855094&dopt=Abstract

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Delayed acute angle closure after macular-hole surgery. Author(s): Bansal A, Salmon JF, Malhotra R, Patel CK, Rosen P. Source: Eye (London, England). 2003 August; 17(6): 779-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12928696&dopt=Abstract

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Dental surgery attendance amongst patients with moderately advanced dementia attending a day unit: a survey of carers' views. Author(s): Hilton C, Simons B. Source: British Dental Journal. 2003 July 12; 195(1): 39-40; Discussion 35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12856029&dopt=Abstract

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Dental surgery in the anticoagulated patient. Author(s): Mehta DK. Source: British Dental Journal. 2003 May 24; 194(10): 530; Author Reply 530. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12819713&dopt=Abstract

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Dental surgery in the anticoagulated patient. Author(s): Lloyd RE. Source: British Dental Journal. 2003 May 24; 194(10): 530; Author Reply 530. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12819712&dopt=Abstract

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Depression as a risk factor for mortality after coronary artery bypass surgery. Author(s): Blumenthal JA, Lett HS, Babyak MA, White W, Smith PK, Mark DB, Jones R, Mathew JP, Newman MF; NORG Investigators. Source: Lancet. 2003 August 23; 362(9384): 604-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12944059&dopt=Abstract

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Dermatofibrosarcoma protuberans of the head and neck: treatment with Mohs surgery using inverted horizontal paraffin sections. Author(s): Tom WD, Hybarger CP, Rasgon BM. Source: The Laryngoscope. 2003 August; 113(8): 1289-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12897547&dopt=Abstract

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Dermatologic surgery in geriatric patients: psychosocial considerations and perioperative decision-making. Author(s): Cook J, Prose N, Heflin M. Source: Dermatologic Surgery : Official Publication for American Society for Dermatologic Surgery [et Al.]. 2003 September; 29(9): 1994; Author Reply 1994-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12930351&dopt=Abstract

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Designing, conducting, and evaluating journal clubs in orthopaedic surgery. Author(s): Dirschl DR, Tornetta P 3rd, Bhandari M. Source: Clinical Orthopaedics and Related Research. 2003 August; (413): 146-57. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12897604&dopt=Abstract

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Detection of hepatocyte growth factor/scatter factor receptor (c-Met) and MUC1 from the axillary fluid drainage in patients after breast cancer surgery. Author(s): Greenberg R, Barnea Y, Schneebaum S, Kashtan H, Kaplan O, Skornik Y. Source: Isr Med Assoc J. 2003 September; 5(9): 649-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14509156&dopt=Abstract

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Developmental, audiological, and speech perception functioning in children after cochlear implant surgery. Author(s): Pulsifer MB, Salorio CF, Niparko JK. Source: Archives of Pediatrics & Adolescent Medicine. 2003 June; 157(6): 552-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12796235&dopt=Abstract

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Diaspirin-crosslinked hemoglobin reduces blood transfusion in noncardiac surgery: a multicenter, randomized, controlled, double-blinded trial. Author(s): Schubert A, Przybelski RJ, Eidt JF, Lasky LC, Marks KE, Karafa M, Novick AC, O'Hara JF Jr, Saunders ME, Blue JW, Tetzlaff JE, Mascha E; Perioperative Avoidance or Reduction of Transfusion Trial (PARTT) Study Group. Source: Anesthesia and Analgesia. 2003 August; 97(2): 323-32, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12873912&dopt=Abstract

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Diffusion-weighted MR imaging of cholesteatoma in pediatric and adult patients who have undergone middle ear surgery. Author(s): Aikele P, Kittner T, Offergeld C, Kaftan H, Huttenbrink KB, Laniado M. Source: Ajr. American Journal of Roentgenology. 2003 July; 181(1): 261-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12818870&dopt=Abstract

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Direct access carpal tunnel surgery. Author(s): Jarrett ME, Giddins GE. Source: The Journal of Bone and Joint Surgery. British Volume. 2003 August; 85(6): 86970. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12931808&dopt=Abstract

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Discount cosmetic surgery. Author(s): Feldman DL. Source: Plastic and Reconstructive Surgery. 2003 July; 112(1): 354. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12832934&dopt=Abstract

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Do hospitals and surgeons with higher coronary artery bypass graft surgery volumes still have lower risk-adjusted mortality rates? Author(s): Hannan EL, Wu C, Ryan TJ, Bennett E, Culliford AT, Gold JP, Hartman A, Isom OW, Jones RH, McNeil B, Rose EA, Subramanian VA. Source: Circulation. 2003 August 19; 108(7): 795-801. Epub 2003 July 28. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12885743&dopt=Abstract

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Do we still need CK-MB in coronary artery bypass grafting surgery? Author(s): Bimmel D, Patermann B, Schlosser T, Winkler K, Tiemann K, Likungu JA, Preusse CJ, Welz A. Source: The Journal of Cardiovascular Surgery. 2003 April; 44(2): 191-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12813382&dopt=Abstract

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Documentation in orthopaedic surgery - do integrated care pathways work? Author(s): Crawford JR, Shanahan M. Source: Annals of the Royal College of Surgeons of England. 2003 May; 85(3): 197-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12831495&dopt=Abstract

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Does a general surgery clerkship influence student perceptions of surgeons and surgical careers? Author(s): Cochran A, Paukert JL, Neumayer LA. Source: Surgery. 2003 August; 134(2): 153-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12947312&dopt=Abstract

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Does leukodepletion during elective cardiac surgery really influence the overall clinical outcome? Author(s): Efstathiou A, Vlachveis M, Tsonis G, Asteri T, Psarakis A, Fessatidis IT. Source: The Journal of Cardiovascular Surgery. 2003 April; 44(2): 197-204. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12813383&dopt=Abstract

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Does prolonged thromboprophylaxis improve outcome in patients undergoing surgery? Author(s): Rasmussen MS. Source: Cancer Treatment Reviews. 2003 June; 29 Suppl 2: 15-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12887945&dopt=Abstract

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Does the routine prophylactic use of antiemetics affect the incidence of postdischarge nausea and vomiting following ambulatory surgery?: A systematic review of randomized controlled trials. Author(s): Gupta A, Wu CL, Elkassabany N, Krug CE, Parker SD, Fleisher LA. Source: Anesthesiology. 2003 August; 99(2): 488-95. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12883424&dopt=Abstract

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Does the type of arthroscopic surgery modify the analgesic effect of intraarticular morphine and bupivacaine? A preliminary study. Author(s): Marchal JM, Delgado-Martinez AD, Poncela M, Valenzuela J, de Dios Luna J. Source: The Clinical Journal of Pain. 2003 July-August; 19(4): 240-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12840618&dopt=Abstract

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Duplicated inferior vena cava and crossed renal ectopia with abdominal aortic aneurysm: preoperative anatomic studies facilitate surgery. Author(s): Shaw MB, Cutress M, Papavassiliou V, White S, Thompson M, Sayers R. Source: Clinical Anatomy (New York, N.Y.). 2003 July; 16(4): 355-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12794923&dopt=Abstract

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Duration of prophylaxis against venous thromboembolism with fondaparinux after hip fracture surgery: a multicenter, randomized, placebo-controlled, double-blind study. Author(s): Eriksson BI, Lassen MR; PENTasaccharide in HIp-FRActure Surgery Plus Investigators. Source: Archives of Internal Medicine. 2003 June 9; 163(11): 1337-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12796070&dopt=Abstract

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Early postoperative prediction of cerebral damage after pediatric cardiac surgery. Author(s): Trittenwein G, Nardi A, Pansi H, Golej J, Burda G, Hermon M, Boigner H, Wollenek G; Verein zur Durchfuhrung wissenschaftlichter Forschung auf dem Gebeit der Neonatologie und Padiatrischen Intensivmedizin. Source: The Annals of Thoracic Surgery. 2003 August; 76(2): 576-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12902107&dopt=Abstract

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Effect of age and gender on heart rate recovery after submaximal exercise during cardiac rehabilitation in patients with angina pectoris, recent acute myocardial infarction, or coronary bypass surgery. Author(s): Kligfield P, McCormick A, Chai A, Jacobson A, Feuerstadt P, Hao SC. Source: The American Journal of Cardiology. 2003 September 1; 92(5): 600-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12943886&dopt=Abstract

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Effect of auditory evoked potential index monitoring on anesthetic drug requirements and recovery profile after laparoscopic surgery: a clinical utility study. Author(s): Recart A, White PF, Wang A, Gasanova I, Byerly S, Jones SB. Source: Anesthesiology. 2003 October; 99(4): 813-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14508311&dopt=Abstract

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Effect of body mass index on early outcomes in patients undergoing coronary artery bypass surgery. Author(s): Reeves BC, Ascione R, Chamberlain MH, Angelini GD. Source: Journal of the American College of Cardiology. 2003 August 20; 42(4): 668-76. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12932599&dopt=Abstract

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Effect of cavity margin shavings to ensure completeness of excision on local recurrence rates following breast conserving surgery. Author(s): Barthelmes L, Al Awa A, Crawford DJ. Source: European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2003 October; 29(8): 644-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14511610&dopt=Abstract

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Effect of celecoxib and dexamethasone on postoperative pain after lumbar disc surgery. Author(s): Karst M, Kegel T, Lukas A, Ludemann W, Hussein S, Piepenbrock S. Source: Neurosurgery. 2003 August; 53(2): 331-6; Discussion 336-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12925248&dopt=Abstract

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Effect of nitroglycerin inhalation on patients with pulmonary hypertension undergoing mitral valve replacement surgery. Author(s): Yurtseven N, Karaca P, Kaplan M, Ozkul V, Tuygun AK, Aksoy T, Canik S, Kopman E. Source: Anesthesiology. 2003 October; 99(4): 855-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14508317&dopt=Abstract

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Effect of right atrial pacing, intravenous amiodarone and beta blockers for suppression of atrial fibrillation after coronary artery bypass surgery: a pilot study. Author(s): Cardona F, Seide H, Cox RA, Perez CM. Source: P R Health Sci J. 2003 June; 22(2): 119-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12866134&dopt=Abstract

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Effect of volume replacement with hydroxyethyl starch solution on splanchnic oxygenation in patients undergoing cytoreductive surgery for ovarian cancer. Author(s): Guo X, Xu Z, Ren H, Luo A, Huang Y, Ye T. Source: Chin Med J (Engl). 2003 July; 116(7): 996-1000. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12890370&dopt=Abstract

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Effectiveness of presacral neurectomy in women with severe dysmenorrhea caused by endometriosis who were treated with laparoscopic conservative surgery: a 1-year prospective randomized double-blind controlled trial. Author(s): Zullo F, Palomba S, Zupi E, Russo T, Morelli M, Cappiello F, Mastrantonio P. Source: American Journal of Obstetrics and Gynecology. 2003 July; 189(1): 5-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12861130&dopt=Abstract

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Effects of lumbar disc surgery on bone mineral density in women with lumbar disc disease. Author(s): Erdogan B, Bagis T, Sen O, Erkanli S, Altinors N, Aslan E, Aydin MV, Atalay B. Source: Adv Ther. 2003 March-April; 20(2): 114-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12836811&dopt=Abstract

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Effects of propofol, desflurane, and sevoflurane on recovery of myocardial function after coronary surgery in elderly high-risk patients. Author(s): De Hert SG, Cromheecke S, ten Broecke PW, Mertens E, De Blier IG, Stockman BA, Rodrigus IE, Van der Linden PJ. Source: Anesthesiology. 2003 August; 99(2): 314-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12883404&dopt=Abstract

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Efficacy of acute normovolemic hemodilution in cardiac surgery. Author(s): Van der Linden PJ, De Hert SG. Source: Anesthesiology. 2003 May; 98(5): 1297; Author Reply 1297. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12717161&dopt=Abstract

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Efficacy of aprotinin in children undergoing craniofacial surgery. Author(s): D'Errico CC, Munro HM, Buchman SR, Wagner D, Muraszko KM. Source: Journal of Neurosurgery. 2003 August; 99(2): 287-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12924702&dopt=Abstract

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Efficacy of prophylactic antibiotic therapy in spinal surgery: a meta-analysis. Author(s): Savitz MH, Malis LI, Savitz SI. Source: Neurosurgery. 2003 July; 53(1): 243-4; Author Reply 244-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12879874&dopt=Abstract

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Efficacy of shunt surgery for refractory low flow priapism: a report on the incidence of failed detumescence and erectile dysfunction. Author(s): Nixon RG, O'Connor JL, Milam DF. Source: The Journal of Urology. 2003 September; 170(3): 883-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12913722&dopt=Abstract

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Emboli capture using the Embol-X intraaortic filter in cardiac surgery: a multicentered randomized trial of 1,289 patients. Author(s): Banbury MK, Kouchoukos NT, Allen KB, Slaughter MS, Weissman NJ, Berry GJ, Horvath KA; ICEM 2000 Investigators. Source: The Annals of Thoracic Surgery. 2003 August; 76(2): 508-15; Discussion 515. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12902095&dopt=Abstract

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Emergent surgery for 3 aged patients who refused elective operation for thoracic aortic aneurysm. Author(s): Kawachi Y, Nakashima A, Toshima Y, Kosuga T, Imasaka K, Tomoeda H. Source: Jpn J Thorac Cardiovasc Surg. 2003 September; 51(9): 438-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14529161&dopt=Abstract

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Endoscopic repair of large skull base defects after powered sinus surgery. Author(s): Church CA, Chiu AG, Vaughan WC. Source: Otolaryngology and Head and Neck Surgery. 2003 September; 129(3): 204-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12958568&dopt=Abstract

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Epidemiology and impact of aspiration pneumonia in patients undergoing surgery in Maryland, 1999-2000. Author(s): Kozlow JH, Berenholtz SM, Garrett E, Dorman T, Pronovost PJ. Source: Critical Care Medicine. 2003 July; 31(7): 1930-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12847385&dopt=Abstract

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Errors in surgery. Author(s): Summers JB, Kaminski J. Source: Canadian Journal of Surgery. Journal Canadien De Chirurgie. 2003 August; 46(4): 307. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12930113&dopt=Abstract

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Esophageal perforation by echoprobe during cardiac surgery: treatment by endoscopic stenting. Author(s): Nana AM, Stefanidis C, Chami JP, Deviere J, Barvais L, De Smet JM. Source: The Annals of Thoracic Surgery. 2003 June; 75(6): 1955-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12822645&dopt=Abstract

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Evaluation of POSSUM and P-POSSUM scoring systems in patients undergoing colorectal surgery (Br J Surg 2003; 90: 340-345). Author(s): Khoury G. Source: The British Journal of Surgery. 2003 August; 90(8): 1021; Author Reply 1021. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12905559&dopt=Abstract

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Evaluation of serum leptin levels and thyroid function in morbidly obese patients treated with bariatric surgery. Author(s): Alagna S, Cossu ML, Masala A, Atzeni MM, Ruggiu M, Satta FM, Fais E, Rovasio PP, Noya G. Source: Eat Weight Disord. 2003 June; 8(2): 95-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12880185&dopt=Abstract

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Evaluation of surgery in simple ovarian cysts. Author(s): Xiaoman D, Jinhua L, Jinghe L, Huajun L. Source: Chinese Medical Sciences Journal = Chung-Kuo I Hsueh K'o Hsueh Tsa Chih / Chinese Academy of Medical Sciences. 2003 June; 18(2): 93-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12903790&dopt=Abstract

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Evaluation of the lateral modified approach for continuous interscalene block after shoulder surgery. Author(s): Borgeat A, Dullenkopf A, Ekatodramis G, Nagy L. Source: Anesthesiology. 2003 August; 99(2): 436-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12883417&dopt=Abstract

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Evidence-based medicine in sleep apnea surgery. Author(s): McMains KC, Terris DJ. Source: Otolaryngologic Clinics of North America. 2003 June; 36(3): 539-61, Viii. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12956101&dopt=Abstract

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Evidence-based surgery. Author(s): Woodruff PW. Source: Journal of the American College of Surgeons. 2003 September; 197(3): 521-2; Discussion 522. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12946813&dopt=Abstract

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Exposure to high stress in the intensive care unit may have negative effects on healthrelated quality-of-life outcomes after cardiac surgery. Author(s): Schelling G, Richter M, Roozendaal B, Rothenhausler HB, Krauseneck T, Stoll C, Nollert G, Schmidt M, Kapfhammer HP. Source: Critical Care Medicine. 2003 July; 31(7): 1971-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12847391&dopt=Abstract

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Expulsive choroidal effusion: case report of a rare complication of intraocular surgery. Author(s): Babalola OE. Source: Afr J Med Med Sci. 1999 March-June; 28(1-2): 121-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12954001&dopt=Abstract

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Facial nerve paralysis following cochlear implant surgery. Author(s): Fayad JN, Wanna GB, Micheletto JN, Parisier SC. Source: The Laryngoscope. 2003 August; 113(8): 1344-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12897556&dopt=Abstract

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Factors affecting successful palliative surgery for malignant bowel obstruction due to peritoneal dissemination from colorectal cancer. Author(s): Higashi H, Shida H, Ban K, Yamagata S, Masuda K, Imanari T, Yamamoto T. Source: Japanese Journal of Clinical Oncology. 2003 July; 33(7): 357-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12949063&dopt=Abstract

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Factors predictive of survival for esophageal carcinoma treated with preoperative radiotherapy with or without chemotherapy followed by surgery. Author(s): Yeh AM, Mendenhall WM, Morris CG, Zlotecki RA, Desnoyers RJ, Vogel SB. Source: Journal of Surgical Oncology. 2003 May; 83(1): 14-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12722092&dopt=Abstract

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Factors related to long-term outcome after decompressive surgery for ossification of the ligamentum flavum of the thoracic spine. Author(s): Miyakoshi N, Shimada Y, Suzuki T, Hongo M, Kasukawa Y, Okada K, Itoi E. Source: Journal of Neurosurgery. 2003 October; 99(3 Suppl): 251-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14563141&dopt=Abstract

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Factors that influence the decision to undergo cosmetic breast augmentation surgery. Author(s): Didie ER, Sarwer DB. Source: Journal of Women's Health (2002). 2003 April; 12(3): 241-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12804355&dopt=Abstract

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Factors that influence the results of salvage surgery in patients with chemorefractory germ cell carcinomas with elevated tumor markers. Author(s): Habuchi T, Kamoto T, Hara I, Kawai K, Nakao M, Nonomura N, Kobayashi T, Ogawa O, Kamidono S, Akaza H, Okuyama A, Kato T, Miki T. Source: Cancer. 2003 October 15; 98(8): 1635-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14534879&dopt=Abstract

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Factors that predict prolonged length of stay after aortic surgery. Author(s): Chang JK, Calligaro KD, Lombardi JP, Dougherty MJ. Source: Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter. 2003 August; 38(2): 335-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12891117&dopt=Abstract

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Failed degenerative lumbar spine surgery. Author(s): Diwan AD, Parvartaneni H, Cammisa F. Source: The Orthopedic Clinics of North America. 2003 April; 34(2): 309-24. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12914270&dopt=Abstract

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Failed tarsal tunnel syndrome surgery. Author(s): Raikin SM, Minnich JM. Source: Foot Ankle Clin. 2003 March; 8(1): 159-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12760582&dopt=Abstract

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False aneurysm of cavernous carotid artery and carotid cavernous fistula: complications following transsphenoidal surgery. Author(s): Kachhara R, Menon G, Bhattacharya RN, Nair S, Gupta AK, Gadhinglajkar S, Rathod RC. Source: Neurology India. 2003 March; 51(1): 81-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12865528&dopt=Abstract

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Fatigue strength of a wire passing through a cannulated screw: implications for closure of the sternum following cardiac surgery. Author(s): Jutley RS, Shepherd DE, Hukins DW. Source: Proceedings of the Institution of Mechanical Engineers. Part H, Journal of Engineering in Medicine. 2003; 217(3): 221-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12807163&dopt=Abstract

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Femoral-sciatic nerve blocks for complex outpatient knee surgery are associated with less postoperative pain before same-day discharge: a review of 1,200 consecutive cases from the period 1996-1999. Author(s): Williams BA, Kentor ML, Vogt MT, Williams JP, Chelly JE, Valalik S, Harner CD, Fu FH. Source: Anesthesiology. 2003 May; 98(5): 1206-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12717143&dopt=Abstract

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Fibrin glue for conjunctival closure in strabismus surgery. Author(s): Mohan K, Malhi RK, Sharma A, Kumar S. Source: Journal of Pediatric Ophthalmology and Strabismus. 2003 May-June; 40(3): 15860. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12795435&dopt=Abstract

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Fibrin sealant improves hemostasis in peripheral vascular surgery: a randomized prospective trial. Author(s): Schenk WG 3rd, Burks SG, Gagne PJ, Kagan SA, Lawson JH, Spotnitz WD. Source: Annals of Surgery. 2003 June; 237(6): 871-6; Discussion 876. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12796584&dopt=Abstract

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Finance issue brief: women's health: inpatient mastectomy length of stay & breast reconstructive surgery coverage requirements: year end report-2002. Author(s): Plaza CI. Source: Issue Brief Health Policy Track Serv. 2002 December 31; : 1-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12901354&dopt=Abstract

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First experiences with recombinant human bone morphogenetic protein 7 (osteogenic protein 1) in a human case in maxillofacial surgery. Author(s): Warnke PH, Coren AJ. Source: Plastic and Reconstructive Surgery. 2003 June; 111(7): 2471-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12794499&dopt=Abstract

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Five- and 10-year survival rates after surgery for biliary atresia: a report from the Japanese Biliary Atresia Registry. Author(s): Nio M, Ohi R, Miyano T, Saeki M, Shiraki K, Tanaka K; Japanese Biliary Atresia Registry. Source: Journal of Pediatric Surgery. 2003 July; 38(7): 997-1000. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12861525&dopt=Abstract

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Five-year outcome and predictability of soft tissue profiles when wire or rigid fixation is used in mandibular advancement surgery. Author(s): Dolce C, Hatch JP, Van Sickels JE, Rugh JD. Source: American Journal of Orthodontics and Dentofacial Orthopedics : Official Publication of the American Association of Orthodontists, Its Constituent Societies, and the American Board of Orthodontics. 2003 September; 124(3): 249-56; Quiz 340. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12970658&dopt=Abstract

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Fixed flexion deformity and flexion after knee arthroplasty. What happens in the first 12 months after surgery and can a poor outcome be predicted? Author(s): Lam LO, Swift S, Shakespeare D. Source: The Knee. 2003 June; 10(2): 181-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12788004&dopt=Abstract

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Fixed forefoot adduction after clubfoot surgery. Author(s): Kremli MK. Source: Saudi Med J. 2003 July; 24(7): 742-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12883605&dopt=Abstract

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Flynn et al.: does the interval from primary surgery to chemotherapy influence progression-free survival in ovarian cancer? Author(s): Omura GA. Source: Gynecologic Oncology. 2003 August; 90(2): 498; Author Reply 498. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12893234&dopt=Abstract

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Foam-sclerotherapy, surgery, sclerotherapy, and combined treatment for varicose veins: a 10-year, prospective, randomized, controlled, trial (VEDICO trial). Author(s): Belcaro G, Cesarone MR, Di Renzo A, Brandolini R, Coen L, Acerbi G, Marelli C, Errichi BM, Malouf M, Myers K, Christopoulos D, Nicolaides A, Geroulakos G, Vasdekis S, Simeone E, Ricci A, Ruffini I, Stuard S, Ippolito E, Bavera P, Georgiev M, Corsi M, Scoccianti M, Cornelli U, Caizzi N, Dugall M, Christopoulos D, Veller M, Venniker R, Cazaubon M, Griffin M. Source: Angiology. 2003 May-June; 54(3): 307-15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12785023&dopt=Abstract

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Foreign body reaction to an oil-based ointment: a cause of persistent otorrhoea following mastoid surgery. Author(s): Mace AT, Marshall JN. Source: The Journal of Laryngology and Otology. 2003 June; 117(6): 496-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12818062&dopt=Abstract

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Frederic Mohs Tribute. History of Mohs micrographic surgery. Author(s): Hanke CW. Source: J Drugs Dermatol. 2002 September; 1(2): 169-74. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12847741&dopt=Abstract

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Free radicals and cardiac arrhythmias following coronary surgery: actors of the drama or bystanders of the spectacle? Author(s): Marczin N, El-Habashi N, Royston D. Source: Acta Anaesthesiologica Scandinavica. 2003 July; 47(6): 639-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12803579&dopt=Abstract

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From clear information to written consent for surgery. Author(s): Squifflet JP. Source: Acta Chir Belg. 2003 February; 103(1): 4-5. English, French. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12817596&dopt=Abstract

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Functional and biochemical evaluation of platelet aspirin resistance after coronary artery bypass surgery. Author(s): Zimmermann N, Wenk A, Kim U, Kienzle P, Weber AA, Gams E, Schror K, Hohlfeld T. Source: Circulation. 2003 August 5; 108(5): 542-7. Epub 2003 July 21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12874188&dopt=Abstract

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Functional near-infrared fluorescence imaging for cardiac surgery and targeted gene therapy. Author(s): Nakayama A, del Monte F, Hajjar RJ, Frangioni JV. Source: Molecular Imaging : Official Journal of the Society for Molecular Imaging. 2002 October; 1(4): 365-77. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12940233&dopt=Abstract

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Functional testing after coronary artery bypass graft surgery: a meta-analysis. Author(s): Chin AS, Goldman LE, Eisenberg MJ. Source: The Canadian Journal of Cardiology. 2003 June; 19(7): 802-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12813614&dopt=Abstract

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Gastric bypass surgery for obesity. Author(s): Buechner JS. Source: Medicine and Health, Rhode Island. 2003 March; 86(3): 81-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12703143&dopt=Abstract

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Gastric hypercarbia and adverse outcome after cardiac surgery. Author(s): Kavarana MN, Frumento RJ, Hirsch AL, Oz MC, Lee DC, Bennett-Guerrero E. Source: Intensive Care Medicine. 2003 May; 29(5): 742-8. Epub 2003 April 11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12690437&dopt=Abstract

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Gastric surgery as a long-term risk factor for malignant lesions of the larynx. Author(s): Cianci R, Galli J, Agostino S, Bartolozzi F, Gasbarrini A, Almadori G, D'Ugo D, Gasbarrini G, Cammarota G. Source: Archives of Surgery (Chicago, Ill. : 1960). 2003 July; 138(7): 751-4; Discussion 755. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12860756&dopt=Abstract

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Gastrointestinal complications after transperitoneal abdominal aortic surgery. Author(s): Alpagut U, Kalko Y, Dayioglu E. Source: Asian Cardiovascular & Thoracic Annals. 2003 March; 11(1): 3-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12692013&dopt=Abstract

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Gender differences in disability and health-related quality of life in patients with Parkinson's disease treated with stereotactic surgery. Author(s): Hariz GM, Lindberg M, Hariz MI, Bergenheim AT. Source: Acta Neurologica Scandinavica. 2003 July; 108(1): 28-37. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12807390&dopt=Abstract

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Gene therapy in cardiac surgery: is there a role? Author(s): Sellke FW. Source: The Journal of Thoracic and Cardiovascular Surgery. 2003 May; 125(5): 994-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12771871&dopt=Abstract

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Gene therapy in orthopaedic surgery. Author(s): Hannallah D, Peterson B, Lieberman JR, Fu FH, Huard J. Source: Instr Course Lect. 2003; 52: 753-68. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12690900&dopt=Abstract

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General medicine and surgery for dental practitioners Part 4: Neurological disorders. Author(s): Greenwood M, Meechan JG. Source: British Dental Journal. 2003 July 12; 195(1): 19-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12856021&dopt=Abstract

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General medicine and surgery for dental practitioners. Part 1: cardiovascular system. Author(s): Greenwood M, Meechan JG. Source: British Dental Journal. 2003 May 24; 194(10): 537-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12819722&dopt=Abstract

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General medicine and surgery for dental practitioners. Part 2: respiratory system. Author(s): Greenwood M, Meechan JG. Source: British Dental Journal. 2003 June 14; 194(11): 593-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12819686&dopt=Abstract

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General medicine and surgery for dental practitioners. Part 3: gastrointestinal system. Author(s): Greenwood M, Meechan JG. Source: British Dental Journal. 2003 June 28; 194(12): 659-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12830184&dopt=Abstract

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General medicine and surgery for dental practitioners. Part 5: liver disease. Author(s): Greenwood M, Meechan JG. Source: British Dental Journal. 2003 July 26; 195(2): 71-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12881742&dopt=Abstract

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General surgery residents improve efficiency but not outcome of trauma care. Author(s): Offner PJ, Hawkes A, Madayag R, Seale F, Maines C. Source: The Journal of Trauma. 2003 July; 55(1): 14-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12855875&dopt=Abstract

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General thoracic surgery--optimising opportunities at a European level. Author(s): Klepetko W, Aberg T, Bellenis I, Berrisford R. Source: European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery. 2003 June; 23(6): 857-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12829057&dopt=Abstract

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Ghrelin and adipose tissue regulatory peptides: effect of gastric bypass surgery in obese humans. Author(s): Holdstock C, Engstrom BE, Ohrvall M, Lind L, Sundbom M, Karlsson FA. Source: The Journal of Clinical Endocrinology and Metabolism. 2003 July; 88(7): 3177-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12843162&dopt=Abstract

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Glanzmann's thrombasthenia proposed optimal management during surgery and delivery. Author(s): Bell JA, Savidge GF. Source: Clinical and Applied Thrombosis/Hemostasis : Official Journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis. 2003 April; 9(2): 167-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12812388&dopt=Abstract

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Glove punctures in cardiac surgery. Author(s): Pate JW. Source: The Annals of Thoracic Surgery. 2003 May; 75(5): 1680-1; Author Reply 1681. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12735614&dopt=Abstract

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Glucose control during cardiac surgery: How sweet it is. Author(s): Jessen ME. Source: The Journal of Thoracic and Cardiovascular Surgery. 2003 May; 125(5): 985-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12771868&dopt=Abstract

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Granisetron versus granisetron/dexamethasone combination for the treatment of nausea, retching, and vomiting after major gynecologic surgery: a randomized, double-blind study. Author(s): Fujii Y, Tanaka H. Source: Clinical Therapeutics. 2003 February; 25(2): 507-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12749510&dopt=Abstract

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Granulomatous slack skin: treatment with extensive surgery and review of the literature. Author(s): Clarijs M, Poot F, Laka A, Pirard C, Bourlond A. Source: Dermatology (Basel, Switzerland). 2003; 206(4): 393-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12771496&dopt=Abstract

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Graphic representation of data resulting from measurement comparison trials in cataract and refractive surgery. Author(s): Krummenauer F, Storkebaum K, Dick HB. Source: Ophthalmic Surgery, Lasers & Imaging : the Official Journal of the International Society for Imaging in the Eye. 2003 May-June; 34(3): 240-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12757104&dopt=Abstract

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Guidance concerning surgery for emphysema. Author(s): Drazen JM, Epstein AM. Source: The New England Journal of Medicine. 2003 May 22; 348(21): 2134-6. Epub 2003 May 20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12759481&dopt=Abstract

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Guidelines for the treatment of abdominal aortic aneurysms. Report of a subcommittee of the Joint Council of the American Association for Vascular Surgery and Society for Vascular Surgery. Author(s): Brewster DC, Cronenwett JL, Hallett JW Jr, Johnston KW, Krupski WC, Matsumura JS; Joint Council of the American Association for Vascular Surgery and Society for Vascular Surgery. Source: Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter. 2003 May; 37(5): 1106-17. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12756363&dopt=Abstract

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Gynecological surgery: not a contraindication for continuation of CAPD. Author(s): Bellizzi V, Giannoulias D, Al-Sunaid M, Tziviskou E, Aggarwal HK, Khandelwal M, Bargman JM, Jassal SV, Vas SI, Oreopoulos DG. Source: Perit Dial Int. 2003 March-April; 23(2): 193-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12713089&dopt=Abstract

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Hair wear in surgery. Author(s): Girard NJ. Source: Aorn Journal. 2003 June; 77(6): 1081-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12817735&dopt=Abstract

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Hallux valgus surgery: a simple method for evaluating the first-second intermetatarsal angle in the presence of metatarsus adductus. Author(s): Kilmartin TE, Flintham C. Source: The Journal of Foot and Ankle Surgery : Official Publication of the American College of Foot and Ankle Surgeons. 2003 May-June; 42(3): 165-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12815586&dopt=Abstract

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He holds the triple crown of surgery. 1965. Author(s): McGarey M, Ellison EC. Source: American Journal of Surgery. 2003 September; 186(3): 238-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12946824&dopt=Abstract

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Healing patterns in anogenital injuries: a longitudinal study of injuries associated with sexual abuse, accidental injuries, or genital surgery in the preadolescent child. Author(s): Heppenstall-Heger A, McConnell G, Ticson L, Guerra L, Lister J, Zaragoza T. Source: Pediatrics. 2003 October; 112(4): 829-37. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14523174&dopt=Abstract

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Health-related quality of life after percutaneous coronary intervention versus coronary bypass surgery in high-risk patients with medically refractory ischemia. Author(s): Rumsfeld JS, Magid DJ, Plomondon ME, Sacks J, Henderson W, Hlatky M, Sethi G, Morrison DA; Department of Veterans Affairs Angina With Extremely Serious Operative Mortality (AWESOME) Investigators. Source: Journal of the American College of Cardiology. 2003 May 21; 41(10): 1732-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12767656&dopt=Abstract

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Health-related quality of life and psychosocial function 5 years after orthognathic surgery. Author(s): Motegi E, Hatch JP, Rugh JD, Yamaguchi H. Source: American Journal of Orthodontics and Dentofacial Orthopedics : Official Publication of the American Association of Orthodontists, Its Constituent Societies, and the American Board of Orthodontics. 2003 August; 124(2): 138-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12923507&dopt=Abstract

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Health-related quality of life in patients seeking gastric bypass surgery vs nontreatment-seeking controls. Author(s): Kolotkin RL, Crosby RD, Pendleton R, Strong M, Gress RE, Adams T. Source: Obesity Surgery : the Official Journal of the American Society for Bariatric Surgery and of the Obesity Surgery Society of Australia and New Zealand. 2003 June; 13(3): 371-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12841896&dopt=Abstract

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Heart surgery with extracorporeal circulation leads to platelet activation at the time of hospital discharge. Author(s): Wahba A, Videm V. Source: European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery. 2003 June; 23(6): 1046-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12829086&dopt=Abstract

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Hemodynamic and respiratory effect of pediatric urological laparoscopic surgery: a retrospective study. Author(s): Halachmi S, El-Ghoneimi A, Bissonnette B, Zaarour C, Bagli DJ, McLorie GA, Khoury AE, Farhat W. Source: The Journal of Urology. 2003 October; 170(4 Pt 2): 1651-4; Discussion 1654. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14501683&dopt=Abstract

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Hemodynamic effects of nasal continuous positive airway pressure after abdominal surgery. Author(s): Kiil C, Rosenberg J. Source: Journal of Anesthesia. 2003; 17(2): 136-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12903927&dopt=Abstract

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Hemorrhagic complication of stereotactic surgery in patients with movement disorders. Author(s): Terao T, Takahashi H, Yokochi F, Taniguchi M, Okiyama R, Hamada I. Source: Journal of Neurosurgery. 2003 June; 98(6): 1241-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12816271&dopt=Abstract

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Henry Wade (1876-1955) and cancer research: early years in the life of a pioneer of urological surgery. Author(s): Gardner DL. Source: J Med Biogr. 2003 May; 11(2): 81-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12717535&dopt=Abstract

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Heparin-induced thrombocytopenia and cardiac surgery. Author(s): Warkentin TE, Greinacher A. Source: The Annals of Thoracic Surgery. 2003 August; 76(2): 638-48. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12902132&dopt=Abstract

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Hepatic artery embolization for postoperative hemorrhage in upper abdominal surgery. Author(s): Miyamoto N, Kodama Y, Endo H, Shimizu T, Miyasaka K. Source: Abdominal Imaging. 2003 May-June; 28(3): 347-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12719904&dopt=Abstract

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HER2 and surgery: more questions to answer. Author(s): Spigel DR. Source: Lancet. 2003 August 16; 362(9383): 502-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12932377&dopt=Abstract

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Hereditary subluxated lenses: visual performances and long-term follow-up after surgery. Author(s): Anteby I, Isaac M, BenEzra D. Source: Ophthalmology. 2003 July; 110(7): 1344-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12867389&dopt=Abstract

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Heroic surgery. Author(s): Wells RJ. Source: The Hastings Center Report. 2001 September-October; 31(5): 5-6; Author Reply 6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12974109&dopt=Abstract

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High intensity focused ultrasound: surgery of the future? Author(s): Kennedy JE, Ter Haar GR, Cranston D. Source: The British Journal of Radiology. 2003 September; 76(909): 590-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14500272&dopt=Abstract

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High-risk localized prostate cancer: primary surgery and adjuvant therapy. Author(s): Skinner EC, Glode LM. Source: Urologic Oncology. 2003 May-June; 21(3): 219-27. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12810210&dopt=Abstract

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Hoarseness after cardiac surgery: possible contribution of low temperature to the recurrent nerve paralysis. Author(s): Ishimoto S, Kondo K, Ito K, Oshima K. Source: The Laryngoscope. 2003 June; 113(6): 1088-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12782830&dopt=Abstract

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Hook phlebectomy versus transilluminated powered phlebectomy for varicose vein surgery: early results. Author(s): Scavee V, Lesceu O, Theys S, Jamart J, Louagie Y, Schoevaerdts JC. Source: European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery. 2003 May; 25(5): 473-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12713789&dopt=Abstract

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Hospital volume and operative mortality in cancer surgery: a national study. Author(s): Finlayson EV, Goodney PP, Birkmeyer JD. Source: Archives of Surgery (Chicago, Ill. : 1960). 2003 July; 138(7): 721-5; Discussion 726. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12860752&dopt=Abstract

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Hospital volume, length of stay, and readmission rates in high-risk surgery. Author(s): Goodney PP, Stukel TA, Lucas FL, Finlayson EV, Birkmeyer JD. Source: Annals of Surgery. 2003 August; 238(2): 161-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12894006&dopt=Abstract

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How much has the introduction of laparoscopic surgery changed open surgery? Author(s): Poole G, Ooi S, Scott S, Frizelle F. Source: N Z Med J. 2003 July 25; 116(1178): U518. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12897886&dopt=Abstract

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How to promote medical student interest in surgery. Author(s): Gauvin JM. Source: Surgery. 2003 September; 134(3): 407-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14555921&dopt=Abstract

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Hyponatremia after transspheniodal surgery of pituitary adenoma. Author(s): Wei T, Zuyuan R, Changbao S, Renzhi W, Yi Y, Wenbin M. Source: Chinese Medical Sciences Journal = Chung-Kuo I Hsueh K'o Hsueh Tsa Chih / Chinese Academy of Medical Sciences. 2003 June; 18(2): 120-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12903796&dopt=Abstract

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Hypophosphatemia, osteomalacia and proximal muscle weakness treated by surgery. Author(s): Hoogendoorn EH, White KE, Econs MJ, Hermus AR. Source: Clinical Endocrinology. 2003 June; 58(6): 796-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12780759&dopt=Abstract

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Hypotensive technique and sitting position in shoulder surgery. Author(s): Sia S. Source: Anesthesia and Analgesia. 2003 October; 97(4): 1198; Author Reply 1199. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14500186&dopt=Abstract

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Hypothermia during head and neck surgery. Author(s): Agrawal N, Sewell DA, Griswold ME, Frank SM, Hessel TW, Eisele DW. Source: The Laryngoscope. 2003 August; 113(8): 1278-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12897545&dopt=Abstract

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Hypoxia following surgery - an unnecessary cause of morbidity and mortality? Author(s): Noble DW. Source: Minerva Anestesiol. 2003 May; 69(5): 447-50. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12768182&dopt=Abstract

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Impact of an endovascular program on the operative experience of abdominal aortic aneurysm in vascular fellowship and general surgery residency. Author(s): Lin PH, Bush RL, Milas M, Terramani TT, Dodson TF, Chen C, Chaikof EL, Lumsden AB. Source: American Journal of Surgery. 2003 August; 186(2): 189-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12885616&dopt=Abstract

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Impact of sodium-hydrogen exchange inhibition by cariporide on death or myocardial infarction in high-risk CABG surgery patients: results of the CABG surgery cohort of the GUARDIAN study. Author(s): Boyce SW, Bartels C, Bolli R, Chaitman B, Chen JC, Chi E, Jessel A, Kereiakes D, Knight J, Thulin L, Theroux P; GUARD During Ischemia Against Necrosis (GUARDIAN) Study Investigators. Source: The Journal of Thoracic and Cardiovascular Surgery. 2003 August; 126(2): 420-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12928639&dopt=Abstract

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Improving cardiac outcomes after noncardiac surgery. Author(s): Butterworth J, Furberg CD. Source: Anesthesia and Analgesia. 2003 September; 97(3): 613-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12933369&dopt=Abstract

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Incidence and clinical consequences of atrial fibrillation within 1 year of first-time isolated coronary bypass surgery. Author(s): Elahi M, Hadjinikolaou L, Galinanes M. Source: Circulation. 2003 September 9; 108 Suppl 1: Ii207-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12970234&dopt=Abstract

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Incidence of wrong-site surgery among hand surgeons. Author(s): Perlow DL, Perlow SM. Source: The Journal of Bone and Joint Surgery. American Volume. 2003 September; 85A(9): 1849; Author Reply 1849. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12954854&dopt=Abstract

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Incidence, etiology, and management of cerebrospinal fluid leaks following transsphenoidal surgery. Author(s): Shiley SG, Limonadi F, Delashaw JB, Barnwell SL, Andersen PE, Hwang PH, Wax MK. Source: The Laryngoscope. 2003 August; 113(8): 1283-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12897546&dopt=Abstract

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Increased plasma concentrations of the mature form of adrenomedullin during cardiac surgery and hepatosplanchnic hypoperfusion. Author(s): Yoshikawa D, Kawahara F, Okano N, Hiraoka H, Kadoi Y, Fujita N, Morita T, Goto F. Source: Anesthesia and Analgesia. 2003 September; 97(3): 663-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12933380&dopt=Abstract

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Indications, techniques, and outcomes of posterior surgery for chronic low back pain. Author(s): Kwon BK, Vaccaro AR, Grauer JN, Beiner J. Source: The Orthopedic Clinics of North America. 2003 April; 34(2): 297-308. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12914269&dopt=Abstract

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Indocyanine green in vitreomacular surgery--(why) is it a problem? Author(s): Kampik A, Sternberg P. Source: American Journal of Ophthalmology. 2003 September; 136(3): 527-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12967808&dopt=Abstract

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Infection after shoulder instability surgery. Author(s): Sperling JW, Cofield RH, Torchia ME, Hanssen AD. Source: Clinical Orthopaedics and Related Research. 2003 September; (414): 61-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12966278&dopt=Abstract

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Infective endophthalmitis caused by Bacillus cereus after cataract extraction surgery. Author(s): Chan WM, Liu DT, Chan CK, Chong KK, Lam DS. Source: Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 2003 August 1; 37(3): E31-4. Epub 2003 July 17. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12884186&dopt=Abstract

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Influence of cardiovascular risk factors on the outcome of coronary artery bypass surgery. Author(s): Unlu Y, Sonmez B. Source: Surgery Today. 2003; 33(7): 491-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14506992&dopt=Abstract

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Influence of thoracic epidural analgesia on cardiovascular autonomic control after thoracic surgery. Author(s): Licker M, Spiliopoulos A, Tschopp JM. Source: British Journal of Anaesthesia. 2003 October; 91(4): 525-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14504154&dopt=Abstract

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Influences of thoracic duct blockage on early enteral nutrition for patients who underwent esophageal cancer surgery. Author(s): Aiko S, Yoshizumi Y, Matsuyama T, Sugiura Y, Maehara T. Source: Jpn J Thorac Cardiovasc Surg. 2003 July; 51(7): 263-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12892455&dopt=Abstract

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Informed consent in dermatologic surgery. Author(s): Fleischman M, Garcia C. Source: Dermatologic Surgery : Official Publication for American Society for Dermatologic Surgery [et Al.]. 2003 September; 29(9): 952-5; Discussion 955. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12930338&dopt=Abstract

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Insight into cataract surgery. Improved implanted lenses boost benefits from cataract surgery. Author(s): Monica ML. Source: Health News. 2003 September; 9(9): 3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14584466&dopt=Abstract

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Intertask transfer in plastic surgery. Author(s): Karacalar A. Source: Plastic and Reconstructive Surgery. 2003 August; 112(2): 711-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12900656&dopt=Abstract

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Intracranial placement of a nasotracheal tube after transnasal trans-sphenoidal surgery. Author(s): Paul M, Dueck M, Kampe S, Petzke F, Ladra A. Source: British Journal of Anaesthesia. 2003 October; 91(4): 601-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14504169&dopt=Abstract

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Intraoperative and postoperative morbidity associated with cystoscopy performed in patients undergoing gynecologic surgery. Author(s): Ferro A, Byck D, Gallup D. Source: American Journal of Obstetrics and Gynecology. 2003 August; 189(2): 354-7; Discussion 357. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14520192&dopt=Abstract

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Intraoperative epidural anesthesia and postoperative analgesia with levobupivacaine for major orthopedic surgery: a double-blind, randomized comparison of racemic bupivacaine and ropivacaine. Author(s): Casati A, Santorsola R, Aldegheri G, Ravasi F, Fanelli G, Berti M, Fraschini G, Torri G. Source: Journal of Clinical Anesthesia. 2003 March; 15(2): 126-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12719052&dopt=Abstract

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Intraoperative intravenous ketamine in combination with epidural analgesia: postoperative analgesia after renal surgery. Author(s): Kararmaz A, Kaya S, Karaman H, Turhanoglu S, Ozyilmaz MA. Source: Anesthesia and Analgesia. 2003 October; 97(4): 1092-6, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14500163&dopt=Abstract

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Intraoperative management of severe pulmonary hypertension during cardiac surgery with inhaled iloprost. Author(s): Rex S, Busch T, Vettelschoss M, de Rossi L, Rossaint R, Buhre W. Source: Anesthesiology. 2003 September; 99(3): 745-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12960562&dopt=Abstract

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Intraoperative margin assessment reduces reexcision rates in patients with ductal carcinoma in situ treated with breast-conserving surgery. Author(s): Chagpar A, Yen T, Sahin A, Hunt KK, Whitman GJ, Ames FC, Ross MI, Meric-Bernstam F, Babiera GV, Singletary SE, Kuerer HM. Source: American Journal of Surgery. 2003 October; 186(4): 371-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14553853&dopt=Abstract

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Intraoperative ultrasound for hepatic neoplasm during surgery. Author(s): Yu J, Zhong S. Source: Chinese Medical Sciences Journal = Chung-Kuo I Hsueh K'o Hsueh Tsa Chih / Chinese Academy of Medical Sciences. 1999 September; 14(3): 170-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12903819&dopt=Abstract

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Intraretinal silicone oil vacuoles after macular hole surgery with internal limiting membrane peeling. Author(s): Chung J, Spaide R. Source: American Journal of Ophthalmology. 2003 October; 136(4): 766-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14516832&dopt=Abstract

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Intravenous anesthesia provides optimal surgical conditions during microscopic and endoscopic sinus surgery. Author(s): Eberhart LH, Folz BJ, Wulf H, Geldner G. Source: The Laryngoscope. 2003 August; 113(8): 1369-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12897561&dopt=Abstract

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Intravenous plus oral amiodarone, atrial septal pacing, or both strategies to prevent post-cardiothoracic surgery atrial fibrillation: the Atrial Fibrillation Suppression Trial II (AFIST II). Author(s): White CM, Caron MF, Kalus JS, Rose H, Song J, Reddy P, Gallagher R, Kluger J; Atrial Fibrillation Suppression Trial II. Source: Circulation. 2003 September 9; 108 Suppl 1: Ii200-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12970233&dopt=Abstract

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Investigations for incontinence and constipation after surgery for Hirschsprung's disease in children. Author(s): Keshtgar AS, Ward HC, Clayden GS, de Sousa NM. Source: Pediatric Surgery International. 2003 April; 19(1-2): 4-8. Epub 2002 November 14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12721712&dopt=Abstract

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Is extreme surgery so extreme? Author(s): Wong D. Source: The British Journal of Ophthalmology. 2003 September; 87(9): 1057. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12928263&dopt=Abstract

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Is the use of cardiopulmonary bypass for multivessel coronary artery bypass surgery an independent predictor of operative mortality in patients with ischemic left ventricular dysfunction? Author(s): Al-Ruzzeh S, Athanasiou T, George S, Glenville BE, DeSouza AC, Pepper JR, Amrani M. Source: The Annals of Thoracic Surgery. 2003 August; 76(2): 444-51; Discussion 451-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12902081&dopt=Abstract

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Ketamine anaesthesia for paediatric ophthalmology surgery. Author(s): Pun MS, Thakur J, Poudyal G, Gurung R, Rana S, Tabin G, Good WV, Ruit S. Source: The British Journal of Ophthalmology. 2003 May; 87(5): 535-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12714385&dopt=Abstract

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Knowledge of the scope of plastic and reconstructive surgery by surgical specialists at Ibadan and Ilorin, Nigeria. Author(s): Adigun IA, Oluwatosin OM. Source: Niger J Med. 2003 April-June; 12(2): 91-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12956015&dopt=Abstract

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Laparoscopic adrenal surgery for neuroblastomas in children. Author(s): de Lagausie P, Berrebi D, Michon J, Philippe-Chomette P, El Ghoneimi A, Garel C, Brisse H, Peuchmaur M, Aigrain Y. Source: The Journal of Urology. 2003 September; 170(3): 932-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12913744&dopt=Abstract

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Laparoscopic colorectal cancer surgery. Author(s): Macafee DA, Maxwell-Armstrong C, Scholefield JH. Source: Expert Rev Anticancer Ther. 2003 August; 3(4): 484-92. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12934660&dopt=Abstract

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Laparoscopic gastric surgery in a Japanese institution: analysis of the initial 100 procedures. Author(s): Shimizu S, Noshiro H, Nagai E, Uchiyama A, Tanaka M. Source: Journal of the American College of Surgeons. 2003 September; 197(3): 372-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12946791&dopt=Abstract

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Laparoscopic prophylactic surgery for HNPCC gene mutation carrier: has the time come? Author(s): Pocard M, Pomel C, Lasser P. Source: The Lancet Oncology. 2003 October; 4(10): 637-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14554242&dopt=Abstract

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Laparoscopic refundoplication with prosthetic hiatal closure for recurrent hiatal hernia after primary failed antireflux surgery. Author(s): Granderath FA, Kamolz T, Schweiger UM, Pointner R. Source: Archives of Surgery (Chicago, Ill. : 1960). 2003 August; 138(8): 902-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12912751&dopt=Abstract

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Laparoscopic renal surgery after spontaneous retroperitoneal hemorrhage. Author(s): Hernandez F, Ong AM, Rha KH, Pinto PA, Kavoussi LR. Source: The Journal of Urology. 2003 September; 170(3): 749-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12913689&dopt=Abstract

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Laparoscopic surgery for recurrent Crohn's disease. Author(s): Hasegawa H, Watanabe M, Nishibori H, Okabayashi K, Hibi T, Kitajima M. Source: The British Journal of Surgery. 2003 August; 90(8): 970-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12905550&dopt=Abstract

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Laparoscopic surgery in urology: nephrectomy and prostatectomy. Author(s): Joseph JV, Madeb R, Leung YY, Patel HR, Erturk E. Source: Hosp Med. 2003 July; 64(7): 411-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12886851&dopt=Abstract

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Large middle meatal antrostomy vs undisturbed maxillary ostium in the endoscopic sinus surgery of nasal polyposis. Author(s): Wadwongtham W, Aeumjaturapat S. Source: J Med Assoc Thai. 2003 June; 86 Suppl 2: S373-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12930013&dopt=Abstract

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Laryngeal resistance before and after minor surgery: endotracheal tube versus Laryngeal Mask Airway. Author(s): Tanaka A, Isono S, Ishikawa T, Sato J, Nishino T. Source: Anesthesiology. 2003 August; 99(2): 252-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12883396&dopt=Abstract

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Laser in situ keratomileusis for correction of induced astigmatism from cataract surgery. Author(s): Norouzi H, Rahmati-Kamel M. Source: Journal of Refractive Surgery (Thorofare, N.J. : 1995). 2003 July-August; 19(4): 416-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12899472&dopt=Abstract

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Lateral upper arm free flap for primary reconstruction of pharyngeal defects in ablative oncological surgery. Report of six consecutive cases. Author(s): Schipper J, Ridder GJ, Boedeker CC, Fradis M, Golz A, Gellrich NC. Source: The Annals of Otology, Rhinology, and Laryngology. 2003 July; 112(7): 611-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12903681&dopt=Abstract

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Length of stay after infant heart surgery is related to cognitive outcome at age 8 years. Author(s): Newburger JW, Wypij D, Bellinger DC, du Plessis AJ, Kuban KC, Rappaport LA, Almirall D, Wessel DL, Jonas RA, Wernovsky G. Source: The Journal of Pediatrics. 2003 July; 143(1): 67-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12915826&dopt=Abstract

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Lens-sparing surgery for retinopathy of prematurity. Author(s): Luna JD, Caribaux LJ, Reviglio VE, Juarez CP. Source: Ophthalmology. 2003 August; 110(8): 1669. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12917193&dopt=Abstract

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Limited benefit of intraoperative low-field magnetic resonance imaging in craniopharyngioma surgery. Author(s): Nimsky C, Ganslandt O, Hofmann B, Fahlbusch R. Source: Neurosurgery. 2003 July; 53(1): 72-80; Discussion 80-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12823875&dopt=Abstract

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Limited incision for breast surgery. Author(s): Biggs TM. Source: Plastic and Reconstructive Surgery. 2003 August; 112(2): 691; Author Reply 692. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12900637&dopt=Abstract

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Lip augmentation using eyelid tissue from upper blepharoplasty surgery. Author(s): Fezza JP, Cartwright M, Mack W, Flaharty P. Source: Ophthalmic Plastic and Reconstructive Surgery. 2003 May; 19(3): 225-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12918559&dopt=Abstract

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Live recordings of sound levels during the use of powered instruments in ENT surgery. Author(s): Prasad KR, Reddy KT. Source: The Journal of Laryngology and Otology. 2003 July; 117(7): 532-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12901806&dopt=Abstract

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Long-term anatomic and visual acuity outcomes after initial anatomic success with macular hole surgery. Author(s): Scott IU, Moraczewski AL, Smiddy WE, Flynn HW Jr, Feuer WJ. Source: American Journal of Ophthalmology. 2003 May; 135(5): 633-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12719070&dopt=Abstract

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Long-term follow-up of primary glaucoma surgery with Ahmed glaucoma valve implant versus trabeculectomy. Author(s): Wilson MR, Mendis U, Paliwal A, Haynatzka V. Source: American Journal of Ophthalmology. 2003 September; 136(3): 464-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12967799&dopt=Abstract

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Long-term psychological impact of carrying a BRCA1/2 mutation and prophylactic surgery: a 5-year follow-up study. Author(s): van Oostrom I, Meijers-Heijboer H, Ladder LN, Duivenvoorden HJ, van Gool AR, Seynaeve C, van der Meer CA, Klijn JG, van Geel BN, Burger CW. Source: Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 2003 October 15; 21(20): 3867-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14551306&dopt=Abstract

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Long-term results of endonasal sinus surgery in sinonasal papillomas. Author(s): Kraft M, Simmen D, Kaufmann T, Holzmann D. Source: The Laryngoscope. 2003 September; 113(9): 1541-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12972931&dopt=Abstract

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Long-term results of nephron-sparing surgery for renal cell carcinoma in 114 patients: risk factors for progressive disease. Author(s): Zigeuner R, Quehenberger F, Pummer K, Petritsch P, Hubmer G. Source: Bju International. 2003 October; 92(6): 567-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14511035&dopt=Abstract

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Long-term results of surgery for urethral stricture: a statistical analysis. Author(s): Kessler TM, Schreiter F, Kralidis G, Heitz M, Olianas R, Fisch M. Source: The Journal of Urology. 2003 September; 170(3): 840-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12913712&dopt=Abstract

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Long-term results of the Lyons R90-01 randomized trial of preoperative radiotherapy with delayed surgery and its effect on sphincter-saving surgery in rectal cancer. Author(s): Glehen O, Chapet O, Adham M, Nemoz JC, Gerard JP; Lyons Oncology Group. Source: The British Journal of Surgery. 2003 August; 90(8): 996-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12905554&dopt=Abstract

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Lumbar spinal stenosis. Treatment strategies and indications for surgery. Author(s): Sengupta DK, Herkowitz HN. Source: The Orthopedic Clinics of North America. 2003 April; 34(2): 281-95. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12914268&dopt=Abstract

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Lung-volume--reduction surgery. Author(s): Pakhale SS, Gutierrez C. Source: The New England Journal of Medicine. 2003 September 4; 349(10): 999-1000; Author Reply 999-1000. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12954751&dopt=Abstract

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Lymph node surgery in papillary thyroid carcinoma. Author(s): Gemsenjager E, Perren A, Seifert B, Schuler G, Schweizer I, Heitz PU. Source: Journal of the American College of Surgeons. 2003 August; 197(2): 182-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12892795&dopt=Abstract

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Magnetic resonance evaluation of the disk before and after arthroscopic surgery for temporomandibular joint disorders. Author(s): Ohnuki T, Fukuda M, Iino M, Takahashi T. Source: Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics. 2003 August; 96(2): 141-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12931085&dopt=Abstract

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Magnetic resonance imaging--aided navigation in endoscopic sinus surgery of a bone-destructive sphenoclinoid mucocele. Author(s): Landsberg R, Segev Y, DeRowe A, Fliss DM. Source: The Annals of Otology, Rhinology, and Laryngology. 2003 August; 112(8): 740-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12940675&dopt=Abstract

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Major reconstructive surgery for pelvic organ prolapse in elderly women, including the medically compromised. Author(s): Vetere PF, Putterman S, Kesselman E. Source: J Reprod Med. 2003 June; 48(6): 417-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12856511&dopt=Abstract

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Management of obstructive voiding dysfunction after incontinence surgery: lessons learned. Author(s): Gomelsky A, Nitti VW, Dmochowski RR. Source: Urology. 2003 September; 62(3): 391-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12946730&dopt=Abstract

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Management of port-site metastasis after laparoscopic surgery for ovarian cancer. Author(s): Huang KG, Wang CJ, Chang TC, Liou JD, Hsueh S, Lai CH, Huang LW. Source: American Journal of Obstetrics and Gynecology. 2003 July; 189(1): 16-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12861132&dopt=Abstract

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Maternal-fetal surgery for spina bifida: on the brink of a new era? Author(s): Moise KJ Jr. Source: American Journal of Obstetrics and Gynecology. 2003 August; 189(2): 311. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14520183&dopt=Abstract

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Maxillofacial surgery in World War I: the role of the dentists and surgeons. Author(s): Strother EA. Source: Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons. 2003 August; 61(8): 943-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12905448&dopt=Abstract

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Measuring outcomes in plastic surgery: body image and quality of life in abdominoplasty patients. Author(s): Bolton MA, Pruzinsky T, Cash TF, Persing JA. Source: Plastic and Reconstructive Surgery. 2003 August; 112(2): 619-25; Discussion 6267. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12900625&dopt=Abstract

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Mediastinitis after coronary artery bypass graft surgery: influence of the mammary grafting for diabetic patients. Author(s): Tavolacci MP, Merle V, Josset V, Bouchart F, Litzler PY, Tabley A, Bessou JP, Czernichow P. Source: The Journal of Hospital Infection. 2003 September; 55(1): 21-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14505605&dopt=Abstract

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Medical evaluation of patients before ocular surgery. Author(s): Marcus EN, Gayer S, Anderson DR. Source: American Journal of Ophthalmology. 2003 August; 136(2): 338-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12888058&dopt=Abstract

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Medical students' views on thoracic surgery residency programs in a Japanese medical school. Author(s): Morishita K, Naraoka S, Miyajima M, Uzuka T, Saito T, Abe T. Source: Jpn J Thorac Cardiovasc Surg. 2003 September; 51(9): 475-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14529172&dopt=Abstract

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Mentored retroperitoneal laparoscopic renal surgery in children: a safe approach to learning. Author(s): Farhat W, Khoury A, Bagli D, McLorie G, El-Ghoneimi A. Source: Bju International. 2003 October; 92(6): 617-20; Discussion 620. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14511047&dopt=Abstract

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Minimal access surgery for hydatid cyst disease: laparoscopic, thoracoscopic, and retroperitoneoscopic approach. Author(s): Chowbey PK, Shah S, Khullar R, Sharma A, Soni V, Baijal M, Vashistha A, Dhir A. Source: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A. 2003 June; 13(3): 159-65. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12855097&dopt=Abstract

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Minimally invasive aortic valve surgery in the elderly: a case-control study. Author(s): Sharony R, Grossi EA, Saunders PC, Schwartz CF, Ribakove GH, Culliford AT, Ursomanno P, Baumann FG, Galloway AC, Colvin SB. Source: Circulation. 2003 September 9; 108 Suppl 1: Ii43-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12970207&dopt=Abstract

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Minimally invasive nephron-sparing surgery. Author(s): Gill IS. Source: The Urologic Clinics of North America. 2003 August; 30(3): 551-79. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12953755&dopt=Abstract

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Minimally invasive pancreatic surgery. Author(s): Melvin WS. Source: American Journal of Surgery. 2003 September; 186(3): 274-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12946832&dopt=Abstract

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Minimally invasive pituitary surgery in a hemorrhagic necrosis of adenoma during pregnancy. Author(s): Gondim J, Ramos Junior F, Pinheiro I, Schops M, Tella Junior OI. Source: Minimally Invasive Neurosurgery : Min. 2003 June; 46(3): 173-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12872196&dopt=Abstract

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Minimally invasive surgery for pediatric solid neoplasms. Author(s): Sailhamer E, Jackson CC, Vogel AM, Kang S, Wu Y, Chwals WJ, Zimmerman BT, Hill CB, Liu DC. Source: The American Surgeon. 2003 July; 69(7): 566-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12889617&dopt=Abstract

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Minimally invasive surgery for small breast cancer. Author(s): Noguchi M. Source: Journal of Surgical Oncology. 2003 October; 84(2): 94-101; Discussion 102. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14502783&dopt=Abstract

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Minimally invasive surgery may result in lower peak levels of circulating vascular endothelial growth factor. Author(s): Fine AP. Source: Jsls. 2003 April-June; 7(2): 147-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12856846&dopt=Abstract

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Minimally invasive video-assisted mitral and aortic valve surgery--our initial clinical experience. Author(s): Shinfeld A, Kachel E, Paz Y, Praisman S, Smolinsky AK. Source: Isr Med Assoc J. 2003 July; 5(7): 482-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12901242&dopt=Abstract

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Mitral valve surgery can now routinely be performed endoscopically. Author(s): Casselman FP, Van Slycke S, Wellens F, De Geest R, Degrieck I, Van Praet F, Vermeulen Y, Vanermen H. Source: Circulation. 2003 September 9; 108 Suppl 1: Ii48-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12970208&dopt=Abstract

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Mitral valve surgery in a patient with spinal progressive muscular atrophy: report of a case. Author(s): Takami Y, Ina H, Terasawa A, Nakao M. Source: Surgery Today. 2003; 33(7): 521-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14506997&dopt=Abstract

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Modulation of T-cell functions by laser surgery in patients with allergic rhinitis. Author(s): Mori K, Tamura M, Kawamoto M, Shikina T, Asada H, Itami S, Kurane I, Kubo T. Source: Acta Oto-Laryngologica. 2003 August; 123(6): 704-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12953768&dopt=Abstract

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Mohs micrographic surgery as an alternative treatment method for cutaneous mucormycosis. Author(s): Clark FL, Batra RS, Gladstone HB. Source: Dermatologic Surgery : Official Publication for American Society for Dermatologic Surgery [et Al.]. 2003 August; 29(8): 882-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12859396&dopt=Abstract

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Multifocal versus monofocal intraocular lenses in cataract surgery: a systematic review. Author(s): Leyland M, Zinicola E. Source: Ophthalmology. 2003 September; 110(9): 1789-98. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=13129879&dopt=Abstract

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Multimodality treatment for esophageal cancer: the role of surgery and neoadjuvant therapy. Author(s): Makary MA, Kiernan PD, Sheridan MJ, Tonnesen G, Hetrick V, Vaughan B, Graling P, Elster E. Source: The American Surgeon. 2003 August; 69(8): 693-700; Discussion 700-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12953828&dopt=Abstract

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Multiple ipsilateral renal tumors discovered at planned nephron sparing surgery: importance of tumor histology and risk of metachronous recurrence. Author(s): Blute ML, Thibault GP, Leibovich BC, Cheville JC, Lohse CM, Zincke H. Source: The Journal of Urology. 2003 September; 170(3): 760-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12913692&dopt=Abstract

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Myocardial factor for timing of surgery in asymptomatic patients with mitral regurgitation. Author(s): Stewart WJ. Source: American Heart Journal. 2003 July; 146(1): 5-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12851602&dopt=Abstract

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Myocutaneous versus thoraco-abdominal flap cover for soft tissue defects following surgery for locally advanced and recurrent breast cancer. Author(s): Deo SV, Purkayastha J, Shukla NK, Asthana S. Source: Journal of Surgical Oncology. 2003 May; 83(1): 31-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12722094&dopt=Abstract

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Nasal polyposis: microsurgical ethmoidectomy and interruption of autonomic innervation vs conventional surgery. Author(s): Rucci L, Bocciolini C, Casucci A. Source: Acta Otorhinolaryngol Ital. 2003 February; 23(1): 26-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12812132&dopt=Abstract

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Neoadjuvant chemotherapy followed by surgery and adjuvant chemotherapy in patients with primarily unresectable, advanced-stage ovarian cancer. Author(s): Mazzeo F, Berliere M, Kerger J, Squifflet J, Duck L, D'Hondt V, Humblet Y, Donnez J, Machiels JP. Source: Gynecologic Oncology. 2003 July; 90(1): 163-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12821358&dopt=Abstract

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Neonatal surgery in New South Wales--what is performed where? Author(s): Badawi N, Adelson P, Roberts C, Spence K, Laing S, Cass D. Source: Journal of Pediatric Surgery. 2003 July; 38(7): 1025-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12861531&dopt=Abstract

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Nephron sparing surgery in renal cancer--individual decision or standard procedure? Author(s): Schmitz-Drager BJ, Beiche B, Fischer C, Jankevicius F, Ebert T. Source: Actas Urol Esp. 2003 January; 27(1): 10-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12701492&dopt=Abstract

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Neurodevelopmental outcome of infants supported with extracorporeal membrane oxygenation after cardiac surgery. Author(s): Hamrick SE, Gremmels DB, Keet CA, Leonard CH, Connell JK, Hawgood S, Piecuch RE. Source: Pediatrics. 2003 June; 111(6 Pt 1): E671-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12777584&dopt=Abstract

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Neuroendocrine stress response in patients undergoing benign ovarian cyst surgery by laparoscopy, minilaparotomy, and laparotomy. Author(s): Marana E, Scambia G, Maussier ML, Parpaglioni R, Ferrandina G, Meo F, Sciarra M, Marana R. Source: The Journal of the American Association of Gynecologic Laparoscopists. 2003 May; 10(2): 159-65. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12732764&dopt=Abstract

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Neuro-endoscopic surgery--experience and outcome analysis of 102 consecutive procedures in a busy neurosurgical centre of India. Author(s): Husain M, Jha D, Vatsal DK, Thaman D, Gupta A, Husain N, Gupta RK. Source: Acta Neurochirurgica. 2003 May; 145(5): 369-75; Discussion 375-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12820043&dopt=Abstract

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Neuronavigation combined with electrophysiological monitoring for surgery of lesions in eloquent brain areas in 42 cases: a retrospective comparison of the neurological outcome and the quality of resection with a control group with similar lesions. Author(s): Reithmeier T, Krammer M, Gumprecht H, Gerstner W, Lumenta CB. Source: Minimally Invasive Neurosurgery : Min. 2003 April; 46(2): 65-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12761674&dopt=Abstract

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Neuro-ophthalmologic complications of cataract surgery. Author(s): Lee MS, Rizzo JF 3rd, Lessell S. Source: Seminars in Ophthalmology. 2002 September-December; 17(3-4): 149-52. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12759844&dopt=Abstract

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Neuropathic pain following breast cancer surgery: proposed classification and research update. Author(s): Jung BF, Ahrendt GM, Oaklander AL, Dworkin RH. Source: Pain. 2003 July; 104(1-2): 1-13. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12855309&dopt=Abstract

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Neurophysiological criteria for intraoperative prediction of pure motor hemiplegia during aneurysm surgery. Case report. Author(s): Szelenyi A, Bueno de Camargo A, Flamm E, Deletis V. Source: Journal of Neurosurgery. 2003 September; 99(3): 575-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12959448&dopt=Abstract

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Neuroprotection during cardiac surgery: a randomised trial of a platelet activating factor antagonist. Author(s): Taggart DP, Browne SM, Wade DT, Halligan PW. Source: Heart (British Cardiac Society). 2003 August; 89(8): 897-900. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12860868&dopt=Abstract

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Neuropsychological functioning after surgery in children treated for brain tumor. Author(s): Carpentieri SC, Waber DP, Pomeroy SL, Scott RM, Goumnerova LC, Kieran MW, Billett AL, Tarbell NJ. Source: Neurosurgery. 2003 June; 52(6): 1348-56; Discussion 1356-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12762880&dopt=Abstract

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Neurotization of oculomotor, trochlear and abducent nerves in skull base surgery. Author(s): Li S, Pan Q, Liu N, Liu Z, Shen F. Source: Chin Med J (Engl). 2003 March; 116(3): 410-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12781048&dopt=Abstract

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New atrial fibrillation and elective surgery. Author(s): Oxorn D. Source: Anesthesiology. 2003 September; 99(3): 756; Author Reply 757. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12960567&dopt=Abstract

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New test to assess pilot's vision following refractive surgery. Author(s): Chisholm CM, Evans AD, Harlow JA, Barbur JL. Source: Aviation, Space, and Environmental Medicine. 2003 May; 74(5): 551-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12751585&dopt=Abstract

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Newly developed T-wave inversion with cardiac wall-motion abnormality predominantly occurs in middle-aged or elderly women after noncardiac surgery. Author(s): Ide M, Esaki Y, Yamazaki K, Kato H. Source: Journal of Anesthesia. 2003; 17(2): 79-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12903917&dopt=Abstract

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NICE guidance clarifies when to do preoperative tests in elective surgery. Author(s): Mayor S. Source: Bmj (Clinical Research Ed.). 2003 June 28; 326(7404): 1418. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12829551&dopt=Abstract

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NICE guidance on laparoscopic surgery for inguinal hernias: guidelines are less clinical excellence than hindrance. Author(s): Choudhary RK, Hassn AM. Source: Bmj (Clinical Research Ed.). 2003 May 24; 326(7399): 1144. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12763998&dopt=Abstract

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NICE guidance on laparoscopic surgery for inguinal hernias: late adapters may never change. Author(s): Waldron G. Source: Bmj (Clinical Research Ed.). 2003 May 24; 326(7399): 1144. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12763996&dopt=Abstract

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NICE guidance on laparoscopic surgery for inguinal hernias: NICE evaluation has data shortage and short analysis period. Author(s): Ryan J, Piercy J. Source: Bmj (Clinical Research Ed.). 2003 May 24; 326(7399): 1144. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12763997&dopt=Abstract

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Non-obstetric surgery during gestation: risk factors for lower birthweight. Author(s): Jenkins TM, Mackey SF, Benzoni EM, Tolosa JE, Sciscione AC. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 2003 February; 43(1): 27-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12755343&dopt=Abstract

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Nonrandomized comparison between definitive chemoradiotherapy and radical surgery in patients with T(2-3)N(any) M(0) squamous cell carcinoma of the esophagus. Author(s): Hironaka S, Ohtsu A, Boku N, Muto M, Nagashima F, Saito H, Yoshida S, Nishimura M, Haruno M, Ishikura S, Ogino T, Yamamoto S, Ochiai A. Source: International Journal of Radiation Oncology, Biology, Physics. 2003 October 1; 57(2): 425-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12957254&dopt=Abstract

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Non-transplant surgery for heart failure and severe left ventricular dysfunction. Opportunities and limitations. Author(s): Zingone B, Sinagra G, Pappalardo A, Di Lenarda A. Source: Ital Heart J. 2003 February; 4(2): 75-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12762268&dopt=Abstract

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Nurse-administered propofol sedation without anesthesia specialists in 9152 endoscopic cases in an ambulatory surgery center. Author(s): Walker JA, McIntyre RD, Schleinitz PF, Jacobson KN, Haulk AA, Adesman P, Tolleson S, Parent R, Donnelly R, Rex DK. Source: The American Journal of Gastroenterology. 2003 August; 98(8): 1744-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12907328&dopt=Abstract

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Nutritional considerations after bariatric surgery. Author(s): Elliot K. Source: Critical Care Nursing Quarterly. 2003 April-June; 26(2): 133-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12744593&dopt=Abstract

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Obesity and the risk of early and late mortality after coronary artery bypass graft surgery. Author(s): Kim J, Hammar N, Jakobsson K, Luepker RV, McGovern PG, Ivert T. Source: American Heart Journal. 2003 September; 146(3): 555-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12947378&dopt=Abstract

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Obesity in general elective surgery. Author(s): McCarthy R, Leslie T, Williams DJ. Source: Lancet. 2003 August 16; 362(9383): 577; Author Reply 577-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12932397&dopt=Abstract

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Obesity in general elective surgery. Author(s): Slim K, Kwiatkowski F, Chipponi J. Source: Lancet. 2003 August 16; 362(9383): 577; Author Reply 577-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12932396&dopt=Abstract

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Obesity in general elective surgery. Author(s): Pravinkumar E. Source: Lancet. 2003 August 16; 362(9383): 576-7; Author Reply 577-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12932394&dopt=Abstract

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Obesity surgery in India. Author(s): Jamieson AC. Source: Obesity Surgery : the Official Journal of the American Society for Bariatric Surgery and of the Obesity Surgery Society of Australia and New Zealand. 2003 June; 13(3): 330. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12852398&dopt=Abstract

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Occupational exposure from common fluoroscopic projections used in orthopaedic surgery. Author(s): Theocharopoulos N, Perisinakis K, Damilakis J, Papadokostakis G, Hadjipavlou A, Gourtsoyiannis N. Source: The Journal of Bone and Joint Surgery. American Volume. 2003 September; 85A(9): 1698-703. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12954827&dopt=Abstract

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Occupational exposure to inhalational anesthetics during cardiac surgery on cardiopulmonary bypass. Author(s): Mierdl S, Byhahn C, Abdel-Rahman U, Matheis G, Westphal K. Source: The Annals of Thoracic Surgery. 2003 June; 75(6): 1924-7; Discussion 1927-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12822637&dopt=Abstract

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Office-based surgical procedures have far greater risk than those in ambulatory surgery centers. Author(s): Rollins G. Source: Rep Med Guidel Outcomes Res. 2003 October 3; 14(19): 1, 6-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14567365&dopt=Abstract

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Off-Pump Coronary Artery Bypass (OPCAB) surgery reduces risk-stratified morbidity and mortality: a United Kingdom Multi-Center Comparative Analysis of Early Clinical Outcome. Author(s): Al-Ruzzeh S, Ambler G, Asimakopoulos G, Omar RZ, Hasan R, Fabri B, ElGamel A, DeSouza A, Zamvar V, Griffin S, Keenan D, Trivedi U, Pullan M, Cale A, Cowen M, Taylor K, Amrani M; United Kingdom Multi-Center Comparative Analysis of Early Clinical Outcome. Source: Circulation. 2003 September 9; 108 Suppl 1: Ii1-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12970199&dopt=Abstract

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Off-pump coronary artery bypass graft surgery: the incidence of postoperative atrial fibrillation. Author(s): Archbold RA, Curzen NP. Source: Heart (British Cardiac Society). 2003 October; 89(10): 1134-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12975397&dopt=Abstract

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Off-pump coronary artery bypass surgery: evaluation of extubation time and predictors of failed early extubation. Author(s): Cumpeeravut P, Visudharom K, Jotisakulratana V, Pitiguagool V, Banyatpiyaphod S, Pamornsing P. Source: J Med Assoc Thai. 2003 May; 86 Suppl 1: S28-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12866766&dopt=Abstract

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Off-pump coronary bypass surgery and all arterial conduits: learning experience at Bangkok Heart Institute. Author(s): Visudharom K, Jotisakulratana V, Pitiguagool V, Banyatpiyaphod S, Pamornsing P, Cumpeeravut P. Source: J Med Assoc Thai. 2003 May; 86 Suppl 1: S17-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12866764&dopt=Abstract

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On call. Breast cancer seems to run in my wife's family. She is healthy, I'm glad to say, but her mother died of it, and her sister needed surgery and chemo. Worst of all, our 44-year-old daughter just had a mastectomy and is waiting to hear if she needs more treatment. We also have two sons, ages 46 and 40. My question is, do they have anything to worry about? Author(s): Simon HB. Source: Harvard Men's Health Watch. 2003 July; 7(12): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12888464&dopt=Abstract

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One-level one-sided lumbar disc surgery with and without microscopic assistance: 1year outcome in 114 consecutive patients. Author(s): Tureyen K. Source: Journal of Neurosurgery. 2003 October; 99(3 Suppl): 247-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14563140&dopt=Abstract

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One-stage posterior surgery for treatment of advanced spinal tuberculosis. Author(s): Chen YC, Chang MC, Wang ST, Yu WK, Liu CL, Chen TH. Source: J Chin Med Assoc. 2003 July; 66(7): 411-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14509403&dopt=Abstract

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On-pump coronary artery bypass surgery activates human myocardial NF-kappaB and increases TNF-alpha in the heart. Author(s): Meldrum DR, Partrick DA, Cleveland JC Jr, Shenkar R, Meldrum KK, Raiesdana A, Ayala A, Brown JW, Harken AH. Source: The Journal of Surgical Research. 2003 June 15; 112(2): 175-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12888335&dopt=Abstract

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Open surgery for thoracic aortic disease. Author(s): Safi HJ, Taylor PR. Source: Heart (British Cardiac Society). 2003 August; 89(8): 825-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12860845&dopt=Abstract

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Ophthalmic complications of endoscopic sinus surgery. Author(s): Bhatti MT, Stankiewicz JA. Source: Survey of Ophthalmology. 2003 July-August; 48(4): 389-402. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12850228&dopt=Abstract

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Optical coherence tomography assessment of retinal nerve fiber layer thickness changes after glaucoma surgery. Author(s): Aydin A, Wollstein G, Price LL, Fujimoto JG, Schuman JS. Source: Ophthalmology. 2003 August; 110(8): 1506-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12917164&dopt=Abstract

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Optical coherence tomography in malignant glaucoma following filtration surgery. Author(s): Wirbelauer C, Karandish A, Haberle H, Pham DT. Source: The British Journal of Ophthalmology. 2003 August; 87(8): 952-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12881332&dopt=Abstract

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Optimal preoperative assessment and surgery for rectal cancer may greatly limit the need for radiotherapy. Author(s): Simunovic M, Sexton R, Rempel E, Moran BJ, Heald RJ. Source: The British Journal of Surgery. 2003 August; 90(8): 999-1003. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12905555&dopt=Abstract

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Options for sphincter preservation in surgery for low rectal cancer. Author(s): Tytherleigh MG, McC Mortensen NJ. Source: The British Journal of Surgery. 2003 August; 90(8): 922-33. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12905543&dopt=Abstract

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Orbital implants in enucleation surgery: a report by the American Academy of Ophthalmology. Author(s): Custer PL, Kennedy RH, Woog JJ, Kaltreider SA, Meyer DR. Source: Ophthalmology. 2003 October; 110(10): 2054-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14522788&dopt=Abstract

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Orthopaedic surgery in the elderly. Author(s): Borgeat A, Ekatodramis G. Source: Best Pract Res Clin Anaesthesiol. 2003 June; 17(2): 235-44. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12817917&dopt=Abstract

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Outcome of laparoscopic surgery for rectal cancer in 101 patients. Author(s): Anthuber M, Fuerst A, Elser F, Berger R, Jauch KW. Source: Diseases of the Colon and Rectum. 2003 August; 46(8): 1047-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12907898&dopt=Abstract

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Outcome of surgery on infants younger than 1 month with congenital glaucoma. Author(s): Mandal AK, Gothwal VK, Bagga H, Nutheti R, Mansoori T. Source: Ophthalmology. 2003 October; 110(10): 1909-15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14522762&dopt=Abstract

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Outcome results in macular hole surgery: an evaluation of internal limiting membrane peeling with and without indocyanine green. Author(s): Sheidow TG, Blinder KJ, Holekamp N, Joseph D, Shah G, Grand MG, Thomas MA, Bakal J, Sharma S. Source: Ophthalmology. 2003 September; 110(9): 1697-701. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=13129864&dopt=Abstract

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Outcomes analysis in hand surgery patients--get your project started! Author(s): Arslanian C. Source: Hand Clin. 2003 August; 19(3): 431-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12945640&dopt=Abstract

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Outcomes of surgery for retinal detachment associated with proliferative vitreoretinopathy using perfluoro-n-octane: a multicenter study. Author(s): Scott IU, Flynn HW Jr, Murray TG, Feuer WJ; Perfluoron study group. Source: American Journal of Ophthalmology. 2003 September; 136(3): 454-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12967798&dopt=Abstract

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Oxidative stress in patients undergoing cardiac surgery: comparative study of revascularization and valve replacement procedures. Author(s): Ochoa JJ, Vilchez MJ, Mataix J, Ibanez-Quiles S, Palacios MA, Munoz-Hoyos A. Source: The Journal of Surgical Research. 2003 May 15; 111(2): 248-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12850470&dopt=Abstract

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Paediatric surgery in sub-Saharan Africa. Author(s): Ameh EA. Source: Pediatric Surgery International. 2003 April; 19(1-2): 128. Epub 2003 March 21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12721748&dopt=Abstract

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Participatory plastic surgery. Author(s): Goldwyn RM. Source: Plastic and Reconstructive Surgery. 2003 October; 112(5): 1477-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14504538&dopt=Abstract

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Patient selection and current practice strategy for off-pump coronary artery bypass surgery. Author(s): Magee MJ, Coombs LP, Peterson ED, Mack MJ. Source: Circulation. 2003 September 9; 108 Suppl 1: Ii9-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12970200&dopt=Abstract

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Patient selection for endoscopic-assisted lower limb surgery. Author(s): Haeney JA, Southern SJ. Source: British Journal of Plastic Surgery. 2003 October; 56(7): 723. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12969678&dopt=Abstract

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Patient-controlled epidural analgesia after thoracic and upper abdominal surgery using sufentanil with and without bupivacaine 0.125%. Author(s): Poopalalingam R, Chow MY, Wong LT. Source: Singapore Med J. 2003 March; 44(3): 126-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12953725&dopt=Abstract

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Patients' perspectives on the short- and long-term outcomes following surgery for benign parotid neoplasms. Author(s): Marshall AH, Quraishi SM, Bradley PJ. Source: The Journal of Laryngology and Otology. 2003 August; 117(8): 624-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12956917&dopt=Abstract

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Perioperative corticosteroid supplementation and dento-alveolar surgery. Author(s): Key SJ, Hodder SC, Davies R, Thomas DW, Thompson S. Source: Dent Update. 2003 July-August; 30(6): 316-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12955953&dopt=Abstract

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Pharmacologic myocardial protection in patients undergoing noncardiac surgery: a quantitative systematic review. Author(s): Stevens RD, Burri H, Tramer MR. Source: Anesthesia and Analgesia. 2003 September; 97(3): 623-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12933373&dopt=Abstract

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Photodynamic therapy for recurrent myopic choroidal neovascularisation after limited macular translocation surgery. Author(s): Chan WM, Lam DS, Liu DT, Wong TH, Yuen KS. Source: The British Journal of Ophthalmology. 2003 September; 87(9): 1188-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12928298&dopt=Abstract

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Plasma surgery and topical estriol: effects on the nasal mucosa and long-term results in patients with Osler's disease. Author(s): Sadick H, Ramin N, Oulmi J, Karl H, Bergler W. Source: Otolaryngology and Head and Neck Surgery. 2003 September; 129(3): 233-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12958572&dopt=Abstract

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Polydimethylsiloxane injection versus open surgery for the treatment of vesicoureteral reflux in complete duplex systems. Author(s): Aboutaleb H, Bolduc S, Khoury AE, Upadhyay J, Bagli DJ, Farhat W; Division of Urology, The Hospital for Sick Children, University of Toronto, Ontario, Canada. Source: The Journal of Urology. 2003 October; 170(4 Pt 2): 1563-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14501661&dopt=Abstract

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Positive effect of patient education for hip surgery: a randomized trial. Author(s): Giraudet-Le Quintrec JS, Coste J, Vastel L, Pacault V, Jeanne L, Lamas JP, Kerboull L, Fougeray M, Conseiller C, Kahan A, Courpied JP. Source: Clinical Orthopaedics and Related Research. 2003 September; (414): 112-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12966284&dopt=Abstract

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Posterior cervical fusion failure in three morbidly obese patients following circumferential surgery. Author(s): Epstein NE. Source: Surgical Neurology. 2003 September; 60(3): 205-10; Discussion 210. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12922035&dopt=Abstract

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Postmyotomy dysphagia after laparoscopic surgery for achalasia. Author(s): Shiino Y, Awad ZT, Haynatzki GR, Davis RE, Hinder RA, Filipi CJ. Source: World Journal of Gastroenterology : Wjg. 2003 May; 9(5): 1129-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12717873&dopt=Abstract

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Predicting survival after treatment for fracture of the proximal femur and the effect of delays to surgery. Author(s): Elliott J, Beringer T, Kee F, Marsh D, Willis C, Stevenson M. Source: Journal of Clinical Epidemiology. 2003 August; 56(8): 788-95. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12954472&dopt=Abstract

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Predictors of readmission for complications of coronary artery bypass graft surgery. Author(s): Hannan EL, Racz MJ, Walford G, Ryan TJ, Isom OW, Bennett E, Jones RH. Source: Jama : the Journal of the American Medical Association. 2003 August 13; 290(6): 773-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12915430&dopt=Abstract

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Predictors of residual tricuspid regurgitation after mitral valve surgery. Author(s): Matsuyama K, Matsumoto M, Sugita T, Nishizawa J, Tokuda Y, Matsuo T. Source: The Annals of Thoracic Surgery. 2003 June; 75(6): 1826-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12822623&dopt=Abstract

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Pre-donated autologous blood transfusion in scoliosis surgery. Author(s): Ridgeway S, Tai C, Alton P, Barnardo P, Harrison DJ. Source: The Journal of Bone and Joint Surgery. British Volume. 2003 September; 85(7): 1032-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14516041&dopt=Abstract

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Preoperative combined with intraoperative skin-surface warming avoids hypothermia caused by general anesthesia and surgery. Author(s): Vanni SM, Braz JR, Modolo NS, Amorim RB, Rodrigues GR Jr. Source: Journal of Clinical Anesthesia. 2003 March; 15(2): 119-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12719051&dopt=Abstract

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Preoperative localization and radioguided parathyroid surgery. Author(s): Mariani G, Gulec SA, Rubello D, Boni G, Puccini M, Pelizzo MR, Manca G, Casara D, Sotti G, Erba P, Volterrani D, Giuliano AE. Source: Journal of Nuclear Medicine : Official Publication, Society of Nuclear Medicine. 2003 September; 44(9): 1443-58. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12960191&dopt=Abstract

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Preoperative monitoring of warfarin in cutaneous surgery. Author(s): Ah-Weng A, Natarajan S, Velangi S, Langtry JA. Source: The British Journal of Dermatology. 2003 August; 149(2): 386-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12932248&dopt=Abstract

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Prevalence of thyroid cancer in hyperthyroidism treated by surgery. Author(s): Lin CH, Chiang FY, Wang LF. Source: Kaohsiung J Med Sci. 2003 August; 19(8): 379-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12962424&dopt=Abstract

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Prevention of venous thromboembolism after major orthopaedic surgery: is fondaparinux an advance? Author(s): Lowe GD, Sandercock PA, Rosendaal FR. Source: Lancet. 2003 August 16; 362(9383): 504-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12932379&dopt=Abstract

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Prognostic significance of SSEP, BAEP and serum S-100B monitoring after aneurysm surgery. Author(s): Schick U, Dohnert J, Meyer JJ, Vitzthum HE. Source: Acta Neurologica Scandinavica. 2003 September; 108(3): 161-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12911458&dopt=Abstract

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Prophylaxis in elective colorectal surgery: the cost of ignoring the evidence. Author(s): Wasey N, Baughan J, de Gara CJ. Source: Canadian Journal of Surgery. Journal Canadien De Chirurgie. 2003 August; 46(4): 279-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12930105&dopt=Abstract

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Prophylaxis of venous thromboembolism in orthopaedic surgery. Author(s): Abad JI. Source: Pathophysiology of Haemostasis and Thrombosis. 2002 September-December; 32(5-6): 403-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=13679686&dopt=Abstract

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Propofol and halothane versus sevoflurane in paediatric day-case surgery. Author(s): Lake AP, Khater M. Source: British Journal of Anaesthesia. 2003 September; 91(3): 447; Author Reply 447-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12925494&dopt=Abstract

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Prospective study of peritoneal recurrence after curative surgery for gastric cancer. Author(s): Roviello F, Marrelli D, de Manzoni G, Morgagni P, Di Leo A, Saragoni L, De Stefano A; Italian Research Group for Gastric Cancer. Source: The British Journal of Surgery. 2003 September; 90(9): 1113-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12945079&dopt=Abstract

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Provider profiling and quality improvement efforts in coronary artery bypass graft surgery: the effect on short-term mortality among Medicare beneficiaries. Author(s): Hannan EL, Sarrazin MS, Doran DR, Rosenthal GE. Source: Medical Care. 2003 October; 41(10): 1164-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14515112&dopt=Abstract

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Quality of life after mitral valve surgery: differences between reconstruction and replacement. Author(s): Immer FE, Donati O, Wyss T, Immer-Bansi AS, Schmidli J, Berdat PA, Carrel TP. Source: J Heart Valve Dis. 2003 March; 12(2): 162-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12701787&dopt=Abstract

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Quality of life improves within 30 days of surgery for Crohn's disease. Author(s): Delaney CP, Kiran RP, Senagore AJ, O'Brien-Ermlich B, Church J, Hull TL, Remzi FH, Fazio VW. Source: Journal of the American College of Surgeons. 2003 May; 196(5): 714-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12742203&dopt=Abstract

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Quantification of incidental needle and suture contamination during strabismus surgery. Author(s): Carothers TS, Coats DK, McCreery KM, Rossman SN, Wilson P, Wu TG, Paysse EA. Source: Binocul Vis Strabismus Q. 2003 Spring-Summer; 18(2): 75-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12765540&dopt=Abstract

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Quantitative echocardiographic assessment of regional wall motion and left ventricular asynchrony with color kinesis in cardiac surgery patients. Author(s): Podgoreanu MV, Djaiani GN, Davis E, Phillips-Bute B, Mathew JP. Source: Anesthesia and Analgesia. 2003 May; 96(5): 1294-300, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12707122&dopt=Abstract

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Quantitative sensory testing and human surgery: effects of analgesic management on postoperative neuroplasticity. Author(s): Wilder-Smith OH, Tassonyi E, Crul BJ, Arendt-Nielsen L. Source: Anesthesiology. 2003 May; 98(5): 1214-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12717144&dopt=Abstract

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Racial differences pertaining to a belief about lung cancer surgery: results of a multicenter survey. Author(s): Margolis ML, Christie JD, Silvestri GA, Kaiser L, Santiago S, Hansen-Flaschen J. Source: Annals of Internal Medicine. 2003 October 7; 139(7): 558-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14530226&dopt=Abstract

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Radial versus right internal thoracic artery as a second arterial conduit for coronary surgery: early and midterm outcomes. Author(s): Caputo M, Reeves B, Marchetto G, Mahesh B, Lim K, Angelini GD. Source: The Journal of Thoracic and Cardiovascular Surgery. 2003 July; 126(1): 39-47. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12878937&dopt=Abstract

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Radial versus right internal thoracic artery as a second arterial conduit for coronary surgery: early and midterm outcomes. Author(s): Lytle BW. Source: The Journal of Thoracic and Cardiovascular Surgery. 2003 July; 126(1): 5-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12878932&dopt=Abstract

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Radiation therapy as an adjuvant treatment after sentinel lymph node surgery for breast cancer. Author(s): Buchholz TA, Strom EA, McNeese MD, Hunt KK. Source: The Surgical Clinics of North America. 2003 August; 83(4): 911-30, X. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12875602&dopt=Abstract

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Radio-guided surgery for lymph node recurrences of differentiated thyroid cancer. Author(s): Salvatori M, Rufini V, Reale F, Gajate AM, Maussier ML, Revelli L, Troncone L, Ardito G. Source: World Journal of Surgery. 2003 July; 27(7): 770-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14509503&dopt=Abstract

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Radiotherapy following breast-conserving surgery. Author(s): Appleton AL. Source: Annals of Oncology : Official Journal of the European Society for Medical Oncology / Esmo. 2003 August; 14(8): 1331. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12881403&dopt=Abstract

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Randomized clinical trial of preoperative intranasal mupirocin to reduce surgical-site infection after digestive surgery. Author(s): Suzuki Y, Kamigaki T, Fujino Y, Tominaga M, Ku Y, Kuroda Y. Source: The British Journal of Surgery. 2003 September; 90(9): 1072-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12945073&dopt=Abstract

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Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer. Author(s): Verwaal VJ, van Ruth S, de Bree E, van Sloothen GW, van Tinteren H, Boot H, Zoetmulder FA. Source: Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 2003 October 15; 21(20): 3737-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14551293&dopt=Abstract

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Re: Minimally invasive breast surgery (evolution, expansion, and what's on the horizon). Author(s): Elliott RL, Head JF. Source: The American Surgeon. 2003 July; 69(7): 631-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12889631&dopt=Abstract

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Re: Potential for bias in studies on efficacy of prophylactic surgery for BRCA1 and BRCA2 mutation carriers. Author(s): Foulkes WD. Source: Journal of the National Cancer Institute. 2003 September 3; 95(17): 1344; Author Reply 1344. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12953090&dopt=Abstract

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Readmission to the intensive care unit after "fast-track" cardiac surgery: risk factors and outcomes. Author(s): Kogan A, Cohen J, Raanani E, Sahar G, Orlov B, Singer P, Vidne BA. Source: The Annals of Thoracic Surgery. 2003 August; 76(2): 503-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12902094&dopt=Abstract

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Recoarctation and patients' freedom from re-intervention--a study of patients undergoing surgery for coarctation of the aorta at the Department of Cardiac Surgery of the Children's University Hospital, Bratislava. Author(s): Omeje IC, Kaldararova M, Sagat M, Sojak V, Nosal M, Siman J, Hraska V. Source: Bratisl Lek Listy. 2003; 104(3): 115-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12940696&dopt=Abstract

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Reconstruction of hypospadias and epispadias with buccal mucosa free graft as primary surgery: more than 10 years of experience. Author(s): Dessanti A, Iannuccelli M, Ginesu G, Feo C. Source: The Journal of Urology. 2003 October; 170(4 Pt 2): 1600-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14501671&dopt=Abstract

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Regression of intracardiac heparin-induced thrombosis after aortic root surgery. Author(s): Collart F, Derouck D, Kerbaul F, Feier H, Mesana TG. Source: The Annals of Thoracic Surgery. 2003 August; 76(2): 617-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12902121&dopt=Abstract

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Relationship between caseload and morbidity and mortality in pediatric cardiac surgery--a four year experience. Author(s): Dagan O, Birk E, Katz Y, Gelber O, Vidne B. Source: Isr Med Assoc J. 2003 July; 5(7): 471-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12901239&dopt=Abstract

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Relative influences of tumor volume before surgery and the cytoreductive outcome on survival for patients with advanced ovarian cancer: a prospective study. Author(s): Eisenkop SM, Spirtos NM, Friedman RL, Lin WC, Pisani AL, Perticucci S. Source: Gynecologic Oncology. 2003 August; 90(2): 390-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12893206&dopt=Abstract

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Reliability of perioperative SSEP recordings in spine surgery. Author(s): Strahm C, Min K, Boos N, Ruetsch Y, Curt A. Source: Spinal Cord : the Official Journal of the International Medical Society of Paraplegia. 2003 September; 41(9): 483-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12934088&dopt=Abstract

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Repeat surgery for hemolysis 6 years after replacement of the ascending aorta for acute aortic dissection. Author(s): Izumi S, Tano K, Horike K, Kaihotsu N. Source: Jpn J Thorac Cardiovasc Surg. 2003 September; 51(9): 459-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14529167&dopt=Abstract

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Restoration of euglycemia and normal acute insulin response to glucose in obese subjects with type 2 diabetes following bariatric surgery. Author(s): Polyzogopoulou EV, Kalfarentzos F, Vagenakis AG, Alexandrides TK. Source: Diabetes. 2003 May; 52(5): 1098-103. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12716738&dopt=Abstract

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Restoration of locomotion in paraplegics with aid of autologous bypass grafts for direct neurotisation of muscles by upper motor neurons--the future: surgery of the spinal cord? Author(s): von Wild KR, Brunelli GA. Source: Acta Neurochir Suppl. 2003; 87: 107-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14518535&dopt=Abstract

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Results of cataract surgery in renal transplantation patients. Author(s): Akbulut A, Tayanc E, Cetinkaya A, Akman A, Yilmaz G, Oto S, Akova Y, Aydin P, Haberal M. Source: Eye (London, England). 2003 April; 17(3): 346-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12724697&dopt=Abstract

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Results of single staged hypospadias surgery to repair penoscrotal hypospadias with bifid scrotum or penoscrotal transposition. Author(s): DeFoor W, Wacksman J. Source: The Journal of Urology. 2003 October; 170(4 Pt 2): 1585-8; Discussion 1588. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14501667&dopt=Abstract

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Results of surgery for malignant fibrous histiocytomas of soft tissue. Author(s): Matsumoto S, Ahmed AR, Kawaguchi N, Manabe J, Matsushita Y. Source: International Journal of Clinical Oncology / Japan Society of Clinical Oncology. 2003 April; 8(2): 104-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12720103&dopt=Abstract

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Revision stapes surgery: the malleus to oval window wire-piston technique. Author(s): Kohan D, Sorin A. Source: The Laryngoscope. 2003 September; 113(9): 1520-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12972927&dopt=Abstract

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Risk factors for local recurrence after breast-conserving surgery. Author(s): Fredriksson I, Liljegren G, Palm-Sjovall M, Arnesson LG, Emdin SO, Fornander T, Lindgren A, Nordgren H, Idvall I, Holmqvist M, Holmberg L, Frisell J. Source: The British Journal of Surgery. 2003 September; 90(9): 1093-102. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12945077&dopt=Abstract

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Risk factors for local-regional recurrence following preoperative radiation therapy and surgery for head and neck cancer (stage II-IVB). Author(s): Shikama N, Sasaki S, Nishikawa A, Koiwai K, Yoshino F, Hirase Y, Kawakami R, Kadoya M, Oguchi M. Source: Radiology. 2003 September; 228(3): 789-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12954897&dopt=Abstract

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Risk of clinical pulmonary embolism after joint surgery in patients receiving lowmolecular-weight heparin prophylaxis in hospital: a 10-year prospective register of 3,954 patients. Author(s): Dahl OE, Gudmundsen TE, Bjornara BT, Solheim DM. Source: Acta Orthopaedica Scandinavica. 2003 June; 74(3): 299-304. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12899550&dopt=Abstract

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Risks and benefits of anticoagulant and antiplatelet medication use before cataract surgery. Author(s): Katz J, Feldman MA, Bass EB, Lubomski LH, Tielsch JM, Petty BG, Fleisher LA, Schein OD; Study of Medical Testing for Cataract Surgery Team. Source: Ophthalmology. 2003 September; 110(9): 1784-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=13129878&dopt=Abstract

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Robot-assisted surgery: the future is here. Author(s): Gerhardus D. Source: Journal of Healthcare Management / American College of Healthcare Executives. 2003 July-August; 48(4): 242-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12908224&dopt=Abstract

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Role for opinion leaders in promoting evidence-based surgery. Author(s): Young JM, Hollands MJ, Ward J, Holman CD. Source: Archives of Surgery (Chicago, Ill. : 1960). 2003 July; 138(7): 785-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12860762&dopt=Abstract

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Sacrococcygeal local anaesthesia versus general anaesthesia for pilonidal sinus surgery: a prospective randomised trial. Author(s): Naja MZ, Ziade MF, El Rajab M. Source: Anaesthesia. 2003 October; 58(10): 1007-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12969043&dopt=Abstract

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Semimembranosus tendonitis after total knee arthroplasty: good outcome after surgery in 6 patients. Author(s): Hendel D, Weisbort M, Garti A. Source: Acta Orthopaedica Scandinavica. 2003 August; 74(4): 429-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14521293&dopt=Abstract

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Septoturbinal surgery in contact point headache syndrome: long-term results. Author(s): Giacomini PG, Alessandrini M, DePadova A. Source: Cranio. 2003 April; 21(2): 130-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12723859&dopt=Abstract

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Serial measurement of serum S-100B protein as a marker of cerebral damage after cardiac surgery. Author(s): Ueno T, Iguro Y, Yamamoto H, Sakata R, Kakihana Y, Nakamura K. Source: The Annals of Thoracic Surgery. 2003 June; 75(6): 1892-7; Discussion 1897-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12822633&dopt=Abstract

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Sevoflurane provides greater protection of the myocardium than propofol in patients undergoing off-pump coronary artery bypass surgery. Author(s): Conzen PF, Fischer S, Detter C, Peter K. Source: Anesthesiology. 2003 October; 99(4): 826-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14508313&dopt=Abstract

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Sevoflurane requirements during coloproctologic surgery: difference between two different epidural regimens. Author(s): Koo M, Sabate A, Dalmau A, Camprubi I. Source: Journal of Clinical Anesthesia. 2003 March; 15(2): 97-102. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12719047&dopt=Abstract

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Significance of fornix atrophy in temporal lobe epilepsy surgery outcome. Author(s): Burneo JG, Bilir E, Faught E, Morawetz R, Knowlton RC, Martin R, Kuzniecky RI. Source: Archives of Neurology. 2003 September; 60(9): 1238-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12975289&dopt=Abstract

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Single doses of parecoxib sodium intravenously are as effective as ketorolac in reducing pain after oral surgery. Author(s): Mehlisch DR, Desjardins PJ, Daniels S, Hubbard RC. Source: Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons. 2003 September; 61(9): 1030-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12966478&dopt=Abstract

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Siting of drains after surgery. Author(s): Chaturvedi HK, Geeta K. Source: Journal of Surgical Oncology. 2003 May; 83(1): 51; Discussion 52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12722098&dopt=Abstract

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Sources of variation in readmission rates, length of stay, and operative time associated with rotator cuff surgery. Author(s): Green LB, Pietrobon R, Paxton E, Higgins LD, Fithian D. Source: The Journal of Bone and Joint Surgery. American Volume. 2003 September; 85A(9): 1784-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12954838&dopt=Abstract

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Spinal anaesthesia: a comparison of plain ropivacaine 5 mg ml(-1) with bupivacaine 5 mg ml(-1) for major orthopaedic surgery. Author(s): Cook TM. Source: British Journal of Anaesthesia. 2003 July; 91(1): 155-6; Author Reply 156-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12821577&dopt=Abstract

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Stem cells: what is their future in surgery? Author(s): Farrow B, Evers BM. Source: Adv Surg. 2003; 37: 51-69. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12953627&dopt=Abstract

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Stop those anti-platelet drugs before surgery! Author(s): Alexandrou K, Matthews PN. Source: Bju International. 2003 October; 92(6): 655. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14511063&dopt=Abstract

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Stop those anti-platelet drugs before surgery! Author(s): Dudderidge TJ, Arya M, Young J, Davies AJ. Source: Bju International. 2003 October; 92(6): 654-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14511062&dopt=Abstract

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Stroke and atrial fibrillation following cardiac surgery. Author(s): Murdock DK, Rengel LR, Schlund A, Olson KJ, Kaliebe JW, Johnkoski JA, Riveron FA. Source: Wmj. 2003; 102(4): 26-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12967018&dopt=Abstract

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Subarachnoid block for lower abdominal and lower limb surgery: UITH experience. Author(s): Kolawole IK, Bolaji BO. Source: Niger J Med. 2002 October-December; 11(4): 153-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12955990&dopt=Abstract

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Subfascial endoscopic perforating vein surgery as treatment for lateral perforating vein incompetence and venous ulceration. Author(s): de Rijcke PA, Hop WC, Wittens CH. Source: Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter. 2003 October; 38(4): 799-803. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14560233&dopt=Abstract

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Subfascial endoscopic perforator surgery: a review. Author(s): Anwar S, Shrivastava V, Welch M, al-Khaffaf H. Source: Hosp Med. 2003 August; 64(8): 479-83. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12958760&dopt=Abstract

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Subjective visual experience during phacoemulsification cataract surgery under subTenon's block. Author(s): Prasad N, Kumar CM, Patil BB, Dowd TC. Source: Eye (London, England). 2003 April; 17(3): 407-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12724704&dopt=Abstract

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Successful photodynamic therapy with verteporfin for recurrent choroidal neovascularization beneath the new fovea after macular translocation surgery with 360-degree retinotomy. Author(s): Sawa M, Chan WM, Ohji M, Imai K, Fujikado T, Tano Y, Schachat AP. Source: American Journal of Ophthalmology. 2003 September; 136(3): 560-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12967821&dopt=Abstract

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Suprascapular nerve block prolongs analgesia after nonarthroscopic shoulder surgery but does not improve outcome: suprascapular nerve blocked one, two.or more times? Author(s): Karovic D, Blumenthal S, Schneeberger A, Borgeat A. Source: Anesthesia and Analgesia. 2003 October; 97(4): 1195; Author Reply 1195-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14500182&dopt=Abstract

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Surgeon specific mortality in adult cardiac surgery: quality of data is important. Author(s): Walker DR. Source: Bmj (Clinical Research Ed.). 2003 September 6; 327(7414): 563. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12958128&dopt=Abstract

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Surgery for congenital heart disease in low-birth weight neonates: a comprehensive statewide Connecticut program to improve outcomes. Author(s): Kopf GS, Mello DM. Source: Conn Med. 2003 June-July; 67(6): 327-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12956042&dopt=Abstract

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Surgery for sleep-disordered breathing in female patients. Author(s): Walker RP. Source: Otolaryngologic Clinics of North America. 2003 June; 36(3): 531-8, Viii. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12956100&dopt=Abstract

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Surgical hand scrub practices in orthopaedic surgery. Author(s): Khan A, McLaren SG, Nelson CL. Source: Clinical Orthopaedics and Related Research. 2003 September; (414): 65-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12966279&dopt=Abstract

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Surgical Pearl: colored tissue-mounting medium for Mohs surgery. Author(s): Kuwahara RT, McElroy R, Garcia CA, Cornelison RL. Source: Journal of the American Academy of Dermatology. 2003 October; 49(4): 706-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14512920&dopt=Abstract

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Surgical pearl: large single sections in Mohs micrographic surgery. Author(s): Gloster HM Jr. Source: Journal of the American Academy of Dermatology. 2003 September; 49(3): 506-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12963918&dopt=Abstract

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Survival after coronary revascularization, with and without mitral valve surgery, in patients with ischemic mitral regurgitation. Author(s): Trichon BH, Glower DD, Shaw LK, Cabell CH, Anstrom KJ, Felker GM, O'Connor CM. Source: Circulation. 2003 September 9; 108 Suppl 1: Ii103-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12970217&dopt=Abstract

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Survival following surgery and prognostic factors for recently diagnosed malignant glioma: data from the Glioma Outcomes Project. Author(s): Laws ER, Parney IF, Huang W, Anderson F, Morris AM, Asher A, Lillehei KO, Bernstein M, Brem H, Sloan A, Berger MS, Chang S; Glioma Outcomes Investigators. Source: Journal of Neurosurgery. 2003 September; 99(3): 467-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12959431&dopt=Abstract

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Systematic review of endoscopic sinus surgery for nasal polyps. Author(s): Dalziel K, Stein K, Round A, Garside R, Royle P. Source: Health Technology Assessment (Winchester, England). 2003; 7(17): Iii, 1-159. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12969541&dopt=Abstract

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The abdominal muscles in anaesthesia and after surgery. Author(s): Drummond GB. Source: British Journal of Anaesthesia. 2003 July; 91(1): 73-80. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12821567&dopt=Abstract

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The Activities of Daily Vision Scale for cataract surgery outcomes: re-evaluating validity with Rasch analysis. Author(s): Pesudovs K, Garamendi E, Keeves JP, Elliott DB. Source: Investigative Ophthalmology & Visual Science. 2003 July; 44(7): 2892-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12824228&dopt=Abstract

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The arguments against fellowship training and early specialization in general surgery. Author(s): Ferguson CM. Source: Archives of Surgery (Chicago, Ill. : 1960). 2003 August; 138(8): 915-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12912754&dopt=Abstract

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The craft of urologic surgery: the T pouch. Author(s): Stein JP, Skinner DG. Source: The Urologic Clinics of North America. 2003 August; 30(3): 647-61, Xi. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12953762&dopt=Abstract

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The design of trials comparing sentinel-node surgery and axillary resection. Author(s): Krag D, Ashikaga T. Source: The New England Journal of Medicine. 2003 August 7; 349(6): 603-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12904526&dopt=Abstract

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The difference between laparoscopic and keyhole surgery. Author(s): Mathur P, Seow-Choen F. Source: The British Journal of Surgery. 2003 September; 90(9): 1029-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12945067&dopt=Abstract

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The effect of centralization of primary surgery on survival in ovarian cancer patients. Author(s): Tingulstad S, Skjeldestad FE, Hagen B. Source: Obstetrics and Gynecology. 2003 September; 102(3): 499-505. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12962932&dopt=Abstract

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The effect of indocyanine-green on functional outcome of macular pucker surgery. Author(s): Morris R, Witherspoon CD, Kuhn F, Taylor SW, Breaud S. Source: American Journal of Ophthalmology. 2003 October; 136(4): 778-9; Author Reply 779-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14516845&dopt=Abstract

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The effects of postoperative pain management on immune response to surgery. Author(s): Beilin B, Shavit Y, Trabekin E, Mordashev B, Mayburd E, Zeidel A, Bessler H. Source: Anesthesia and Analgesia. 2003 September; 97(3): 822-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12933409&dopt=Abstract

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The effects of small-dose ketamine on morphine consumption in surgical intensive care unit patients after major abdominal surgery. Author(s): Guillou N, Tanguy M, Seguin P, Branger B, Campion JP, Malledant Y. Source: Anesthesia and Analgesia. 2003 September; 97(3): 843-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12933413&dopt=Abstract

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The efficacy of curettage in delineating margins of basal cell carcinoma before Mohs micrographic surgery. Author(s): Ratner D, Bagiella E. Source: Dermatologic Surgery : Official Publication for American Society for Dermatologic Surgery [et Al.]. 2003 September; 29(9): 899-903. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12930329&dopt=Abstract

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The incidence of lung carcinoma after surgery for breast carcinoma with and without postoperative radiotherapy. Results of National Surgical Adjuvant Breast and Bowel Project (NSABP) clinical trials B-04 and B-06. Author(s): Deutsch M, Land SR, Begovic M, Wieand HS, Wolmark N, Fisher B. Source: Cancer. 2003 October 1; 98(7): 1362-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14508821&dopt=Abstract

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The limitations of isolated palatal surgery for patients with obstructive sleep apnea. Author(s): Dubin MG, Senior BA. Source: Otolaryngologic Clinics of North America. 2003 June; 36(3): 511-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12956098&dopt=Abstract

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The minimally invasive, endoscopic approach to sinus surgery. Author(s): Becker DG. Source: Journal of Long-Term Effects of Medical Implants. 2003; 13(3): 207-21. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14516186&dopt=Abstract

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The outcome and criteria for mitral valve surgery in patients with ischemic mitral regurgitation. Author(s): Yamaguchi A, Kawahito K, Adachi H, Ino T. Source: Jpn J Thorac Cardiovasc Surg. 2003 September; 51(9): 407-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14529155&dopt=Abstract

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The recruitment of medical students to careers in general surgery: emphasis on the first and second years of medical education. Author(s): Bland KI. Source: Surgery. 2003 September; 134(3): 409-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14555922&dopt=Abstract

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The role of initial debulking surgery in the management of anaplastic thyroid carcinoma. Author(s): Besic N. Source: Surgery. 2003 April; 133(4): 453-4; Author Reply 454-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12717370&dopt=Abstract

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The role of surgery in frozen shoulder. Author(s): Chambler AF, Carr AJ. Source: The Journal of Bone and Joint Surgery. British Volume. 2003 August; 85(6): 78995. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12931793&dopt=Abstract

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The significance of elevated levels of parathyroid hormone in patients with morbid obesity before and after bariatric surgery. Author(s): Hamoui N, Kim K, Anthone G, Crookes PF. Source: Archives of Surgery (Chicago, Ill. : 1960). 2003 August; 138(8): 891-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12912749&dopt=Abstract

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The value of routine electroencephalographic recordings in predicting postoperative seizures associated with meningioma surgery. Author(s): Rothoerl RD, Bernreuther D, Woertgen C, Brawanski A. Source: Neurosurgical Review. 2003 May; 26(2): 108-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12962296&dopt=Abstract

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Third look surgery and beyond for appendiceal malignancy with peritoneal dissemination. Author(s): Mohamed F, Chang D, Sugarbaker PH. Source: Journal of Surgical Oncology. 2003 May; 83(1): 5-12; Discussion 12-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12722090&dopt=Abstract

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Three-dimensional image reconstruction for preplanning of renal surgery. Author(s): Derweesh IH, Herts B, Novick AC. Source: The Urologic Clinics of North America. 2003 August; 30(3): 515-28. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12953752&dopt=Abstract

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Timing of surgery in regurgitant lesions. Author(s): Jose VJ. Source: J Indian Med Assoc. 2003 April; 101(4): 236-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12964640&dopt=Abstract

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Total arterial myocardial revascularization with composite grafts improves results of coronary surgery in elderly: a prospective randomized comparison with conventional coronary artery bypass surgery. Author(s): Muneretto C, Bisleri G, Negri A, Manfredi J, Metra M, Nodari S, Culot L, Dei Cas L. Source: Circulation. 2003 September 9; 108 Suppl 1: Ii29-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12970204&dopt=Abstract

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Towards a scientific basis for oncoplastic breast surgery. Author(s): Benson JR, Querci della Rovere G. Source: European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2003 September; 29(7): 629. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12943633&dopt=Abstract

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Transsphenoidal surgery for acromegaly in wales: results based on stringent criteria of remission. Author(s): De P, Rees DA, Davies N, John R, Neal J, Mills RG, Vafidis J, Davies JS, Scanlon MF. Source: The Journal of Clinical Endocrinology and Metabolism. 2003 August; 88(8): 3567-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12915637&dopt=Abstract

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Trends in surgery and chemotherapy for women diagnosed with ovarian cancer in the United States. Author(s): Harlan LC, Clegg LX, Trimble EL. Source: Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 2003 September 15; 21(18): 3488-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12972525&dopt=Abstract

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Tumor budding at the invasive margin can predict patients at high risk of recurrence after curative surgery for stage II, T3 colon cancer. Author(s): Tanaka M, Hashiguchi Y, Ueno H, Hase K, Mochizuki H. Source: Diseases of the Colon and Rectum. 2003 August; 46(8): 1054-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12907899&dopt=Abstract

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Tumor necrosis factor gene polymorphism is associated with enhanced systemic inflammatory response and increased cardiopulmonary morbidity after cardiac surgery. Author(s): Tomasdottir H, Hjartarson H, Ricksten A, Wasslavik C, Bengtsson A, Ricksten SE. Source: Anesthesia and Analgesia. 2003 October; 97(4): 944-9, Table of Contents. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14500138&dopt=Abstract

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Turning medical students on to the fun and excitement of a true, broad-based general surgery practice in the community outside the "ivory tower". Author(s): Rowekamp JD. Source: Surgery. 2003 September; 134(3): 418-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14555927&dopt=Abstract

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Ultra short-term antimicrobial prophylaxis in patients undergoing surgery for gynecologic cancer. Author(s): Cormio G, Di Fazio F, Di Gesu G, Scioscia M, Carriero C, Loverro G, Selvaggi L. Source: Eur J Gynaecol Oncol. 2003; 24(1): 63-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12691320&dopt=Abstract

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Ultracision in gynaecological laparoscopic surgery. Author(s): Kunde D, Welch C. Source: Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology. 2003 July; 23(4): 347-52. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12881068&dopt=Abstract

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Ultrastructural ciliary changes of maxillary sinus mucosa following functional endoscopic sinus surgery: an image analysis quantitative study. Author(s): Bassiouny A, Atef AM, Raouf MA, Nasr SM, Nasr M, Ayad EE. Source: The Journal of Laryngology and Otology. 2003 April; 117(4): 273-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12816216&dopt=Abstract

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Unbalanced middle ear anaesthesia. A response to 'A comparison of total intravenous with balanced anaesthesia for middle ear surgery: effects on postoperative nausea and vomiting, pain and conditions of surgery', Mukherjee K et al., Anaesthesia 2003; 58: 176-9. Author(s): Walsh E. Source: Anaesthesia. 2003 June; 58(6): 620. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12846668&dopt=Abstract

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Unexpected, dismal left ventricular function after surgery for mitral regurgitation: there is just no excuse for it anymore. Author(s): Wisenbaugh T. Source: Journal of the American College of Cardiology. 2003 August 6; 42(3): 464-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12906973&dopt=Abstract

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Unilateral corneal anaesthesia and ulceration following squint surgery in a child with Pendred syndrome and bilateral sixth nerve palsy. Author(s): Wintle RV, Choong YF, Laws DE. Source: The British Journal of Ophthalmology. 2003 September; 87(9): 1192. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12928303&dopt=Abstract

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Upper limb surgery for tetraplegia: a 10-year re-review of hand function. Author(s): Rothwell AG, Sinnott KA, Mohammed KD, Dunn JA, Sinclair SW. Source: The Journal of Hand Surgery. 2003 May; 28(3): 489-97. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12772110&dopt=Abstract

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Urethrocutaneous fistula repair after hypospadias surgery. Author(s): Cimador M, Castagnetti M, De Grazia E. Source: Bju International. 2003 October; 92(6): 621-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14511048&dopt=Abstract

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US government to pay for lung volume reduction surgery. Author(s): Ault A. Source: Lancet. 2003 August 30; 362(9385): 712. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12957109&dopt=Abstract

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US trends in refractive surgery: 2002 ISRS survey. Author(s): Duffey RJ, Leaming D. Source: Journal of Refractive Surgery (Thorofare, N.J. : 1995). 2003 May-June; 19(3): 35763. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12777033&dopt=Abstract

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Use and abuse of new technologies in colorectal surgery. Author(s): Pescatori M, Seow-Choen F. Source: Techniques in Coloproctology. 2003 April; 7(1): 1-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12769059&dopt=Abstract

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Use and influence of the internet on patients undergoing ileoanal pouch surgery. Author(s): Torkington J, Bevan LS, Morgan AR, Beynon J, Carr ND. Source: Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland. 2003 March; 5(2): 193-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12780912&dopt=Abstract

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Use of autologous pleural flap buttress in thoracoscopic lung volume reduction surgery. Author(s): Lee YC, Chang YL, Chen CW, Chien NC, Huang PM. Source: The Journal of Thoracic and Cardiovascular Surgery. 2003 July; 126(1): 298-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12878974&dopt=Abstract

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Use of continuous quality improvement to increase use of process measures in patients undergoing coronary artery bypass graft surgery: a randomized controlled trial. Author(s): Ferguson TB Jr, Peterson ED, Coombs LP, Eiken MC, Carey ML, Grover FL, DeLong ER; Society of Thoracic Surgeons and the National Cardiac Database. Source: Jama : the Journal of the American Medical Association. 2003 July 2; 290(1): 4956. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12837711&dopt=Abstract

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Use of discharge abstract databases to differentiate among pediatric hospitals based on operative procedures: surgery in infants and young children in the state of Iowa. Author(s): Dexter F, Wachtel RE, Yue JC. Source: Anesthesiology. 2003 August; 99(2): 480-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12883423&dopt=Abstract

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Use of external iliac artery in renal revascularization surgery: long-term angiographic assessment. Author(s): da Gama AD, Sarmento CS, do Carmo GX, Machado FS. Source: Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter. 2003 July; 38(1): 123-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12844101&dopt=Abstract

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Use of inhaled iloprost in a case of pulmonary hypertension during pediatric congenital heart surgery. Author(s): Muller M, Scholz S, Kwapisz M, Akinturk H, Thul J, Hempelmann G. Source: Anesthesiology. 2003 September; 99(3): 743-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12960561&dopt=Abstract

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Use of non-invasive cardiac investigations to predict clinical endpoints after coronary bypass graft surgery in coronary artery disease patients: results from the prognosis and evaluation of risk in the coronary operated patient (PERISCOP) study. Author(s): Sellier P, Chatellier G, D'Agrosa-Boiteux MC, Douard H, Dubois C, Goepfert PC, Monpere C, Saint Pierre A; Investigators of the PERISCOP study. Source: European Heart Journal. 2003 May; 24(10): 916-26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12714023&dopt=Abstract

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Use of off-label and non-approved drugs and devices in plastic surgery. Author(s): Rohrich RJ, Janis JE, Reisman NR. Source: Plastic and Reconstructive Surgery. 2003 July; 112(1): 241-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12832901&dopt=Abstract

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Use of parenteral testosterone prior to hypospadias surgery. Author(s): Luo CC, Lin JN, Chiu CH, Lo FS. Source: Pediatric Surgery International. 2003 April; 19(1-2): 82-4. Epub 2003 March 22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12721732&dopt=Abstract

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Use of patient satisfaction data in a continuous quality improvement program for endoscopic sinus surgery. Author(s): Tai CJ, Chu CC, Liang SC, Lin TF, Huang ZJ, Tsai YH, Wang PC. Source: Otolaryngology and Head and Neck Surgery. 2003 September; 129(3): 210-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12958569&dopt=Abstract

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Use of reconstructed, non-orthogonal plane, high-resolution computed tomography of the temporal bone in the planning of temporal bone surgery. Author(s): Manolidis S, Williamson B, Chan LL, Taber KH, Hayman LA. Source: Orl; Journal for Oto-Rhino-Laryngology and Its Related Specialties. 2003 MarchApril; 65(2): 71-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12824727&dopt=Abstract

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Use of the Shirodkar suture in shoulder surgery. Author(s): Cooper S, Acton D, Curtis MJ. Source: Annals of the Royal College of Surgeons of England. 2003 July; 85(4): 284. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12908474&dopt=Abstract

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Use of three-dimensional computer graphic animation to illustrate cleft lip and palate surgery. Author(s): Cutting C, Oliker A, Haring J, Dayan J, Smith D. Source: Computer Aided Surgery : Official Journal of the International Society for Computer Aided Surgery. 2002; 7(6): 326-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12731095&dopt=Abstract

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Use of transpelvic rectus abdominis musculocutaneous flap for anal cancer salvage surgery. Author(s): Tei TM, Stolzenburg T, Buntzen S, Laurberg S, Kjeldsen H. Source: The British Journal of Surgery. 2003 May; 90(5): 575-80. Erratum In: Br J Surg. 2003 August; 90(8): 1026. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12734865&dopt=Abstract

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Usefulness of intraoperative electrical subcortical mapping during surgery for lowgrade gliomas located within eloquent brain regions: functional results in a consecutive series of 103 patients. Author(s): Duffau H, Capelle L, Denvil D, Sichez N, Gatignol P, Taillandier L, Lopes M, Mitchell MC, Roche S, Muller JC, Bitar A, Sichez JP, van Effenterre R. Source: Journal of Neurosurgery. 2003 April; 98(4): 764-78. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12691401&dopt=Abstract

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Using diazepam and atropine before strabismus surgery to prevent postoperative nausea and vomiting: a randomized, controlled study. Author(s): Ozcan AA, Gunes Y, Haciyakupoglu G. Source: J Aapos. 2003 June; 7(3): 210-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12825062&dopt=Abstract

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Using tissue adhesives for closure of periareolar incisions in breast reduction surgery. Author(s): Yavuzer R, Basterzi Y, Tuncer S. Source: Plastic and Reconstructive Surgery. 2003 July; 112(1): 337. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12832919&dopt=Abstract

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Valid consent to surgery. Dispelling the myth and establishing the evidence. Author(s): Reid J. Source: Br J Perioper Nurs. 2003 July; 13(7): 288-93, 295-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12876754&dopt=Abstract

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Validation of the new venous severity scoring system in varicose vein surgery. Author(s): Kakkos SK, Rivera MA, Matsagas MI, Lazarides MK, Robless P, Belcaro G, Geroulakos G. Source: Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter. 2003 August; 38(2): 224-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12891101&dopt=Abstract

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Validity of a personal and family history of cataract and cataract surgery in genetic studies. Author(s): Bowie H, Congdon NG, Lai H, West SK. Source: Investigative Ophthalmology & Visual Science. 2003 July; 44(7): 2905-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12824230&dopt=Abstract

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Validity of simple mucosal biopsy criteria combined with endoscopy predicting patients with ulcerative colitis ultimately requiring surgery: a multicenter study. Author(s): Tanaka M, Kusumi T, Oshitani N, Nishigami T, Iwao Y, Hatada Y, Sugita A, Yao T, Takano M, Iizuka B, Mukai M, Maeda K, Fukuda S, Morita T, Hara M, Saito H, Kudo H. Source: Scandinavian Journal of Gastroenterology. 2003 June; 38(6): 594-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12825866&dopt=Abstract

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Valuable use of computer-aided surgery in congenital bony aural atresia. Author(s): Caversaccio M, Romualdez J, Baechler R, Nolte LP, Kompis M, Hausler R. Source: The Journal of Laryngology and Otology. 2003 April; 117(4): 241-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12816210&dopt=Abstract

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Valve surgery in the elderly: question of quality (of life)? Author(s): Rumsfeld JS. Source: Journal of the American College of Cardiology. 2003 October 1; 42(7): 1215-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14522483&dopt=Abstract

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Vanishing visual field defect that had appeared after macular hole surgery. Author(s): Fardin B, Weissgold DJ. Source: Can J Ophthalmol. 2003 June; 38(4): 306-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12870867&dopt=Abstract

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Variant Creutzfeldt-Jakob disease and the potential for its accidental transmission following surgery with contaminated instruments: the risk of transmission in Australia. Author(s): Ramasamy I, Law M, Collins S, Brooke F. Source: Folia Neuropathol. 2003; 41(1): 1-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12862389&dopt=Abstract

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Variations of coronary sinus acid-base and gas profile depending on the sampling position during bypass surgery. Author(s): Vretzakis GI, Hatzicostas G, Papaziogas BT. Source: Journal of Clinical Anesthesia. 2003 May; 15(3): 240-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12770664&dopt=Abstract

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Vascular surgery won a battle but is losing the war: a call to arms for every vascular surgeon. Author(s): Veith FJ. Source: Annals of Vascular Surgery. 2003 May; 17(3): 229-33. Epub 2003 April 28. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12712373&dopt=Abstract

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Vector analysis applications to photorefractive surgery. Author(s): Alpins N, Stamatelatos G. Source: International Ophthalmology Clinics. 2003 Summer; 43(3): 1-27. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12881646&dopt=Abstract

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Venous coronary artery bypass surgery: a more than 20-year follow-up study. Author(s): van Brussel BL, Voors AA, Ernst JM, Knaepen PJ, Plokker HW. Source: European Heart Journal. 2003 May; 24(10): 927-36. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12714024&dopt=Abstract

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Venous thrombosis after hallux valgus surgery. Author(s): Radl R, Kastner N, Aigner C, Portugaller H, Schreyer H, Windhager R. Source: The Journal of Bone and Joint Surgery. American Volume. 2003 July; 85-A(7): 1204-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12851343&dopt=Abstract

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Ventilator-associated pneumonia after heart surgery: a prospective analysis and the value of surveillance. Author(s): Bouza E, Perez A, Munoz P, Jesus Perez M, Rincon C, Sanchez C, MartinRabadan P, Riesgo M; Cardiovascular Infection Study Group. Source: Critical Care Medicine. 2003 July; 31(7): 1964-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12847390&dopt=Abstract

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Ventricular tachycardia as an electrocardiography artifact during functional endoscopic sinus surgery. Author(s): Gaiser RR, Demetry DJ, Schlosser R. Source: American Journal of Rhinology. 2003 March-April; 17(2): 83-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12751701&dopt=Abstract

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Ventriculoperitoneal shunt surgery and shunt infections in children with non-tumour hydrocephalus at the Kenyatta National Hospital, Nairobi. Author(s): Mwang'ombe NJ, Omulo T. Source: East Afr Med J. 2000 July; 77(7): 386-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12862159&dopt=Abstract

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Verbal and nonverbal fluency performance before and after seizure surgery. Author(s): Suchy Y, Sands K, Chelune GJ. Source: J Clin Exp Neuropsychol. 2003 April; 25(2): 190-200. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12754677&dopt=Abstract

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Vertical conjunctival bridge flaps in pterygium surgery. Author(s): Kaya M, Tunc M. Source: Ophthalmic Surgery, Lasers & Imaging : the Official Journal of the International Society for Imaging in the Eye. 2003 July-August; 34(4): 279-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12875455&dopt=Abstract

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Virtual imaging guiding implant surgery. Author(s): Owings JR Jr. Source: Compend Contin Educ Dent. 2003 May; 24(5): 333-6, 338, 340 Passim; Quiz 344. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12793218&dopt=Abstract

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Visual outcome after high volume cataract surgery in Pakistan. Author(s): Malik AR, Qazi ZA, Gilbert C. Source: The British Journal of Ophthalmology. 2003 August; 87(8): 937-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12881328&dopt=Abstract

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Visual perception during phacoemulsification cataract surgery under subtenons anaesthesia. Author(s): Wickremasinghe SS, Tranos PG, Sinclair N, Andreou PS, Harris ML, Little BC. Source: Eye (London, England). 2003 May; 17(4): 501-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12802351&dopt=Abstract

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Visual perception during phacoemulsification cataract surgery under topical and regional anaesthesia. Author(s): Tranos PG, Wickremasinghe SS, Sinclair N, Foster PJ, Asaria R, Harris ML, Little BC. Source: Acta Ophthalmologica Scandinavica. 2003 April; 81(2): 118-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12752048&dopt=Abstract

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Visual performance after congenital nystagmus surgery using extended hang back recession of the four horizontal rectus muscles. Author(s): Alio JL, Chipont E, Mulet E, De La Hoz F. Source: Eur J Ophthalmol. 2003 June; 13(5): 415-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12841563&dopt=Abstract

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Visual-spatial skills in children after open-heart surgery. Author(s): Bellinger DC, Bernstein JH, Kirkwood MW, Rappaport LA, Newburger JW. Source: Journal of Developmental and Behavioral Pediatrics : Jdbp. 2003 June; 24(3): 16979. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12806229&dopt=Abstract

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Vitreoretinal surgery for cystoid macular edema associated with retinitis pigmentosa. Author(s): Garcia-Arumi J, Martinez V, Sararols L, Corcostegui B. Source: Ophthalmology. 2003 June; 110(6): 1164-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12799242&dopt=Abstract

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Vitreous surgery for highly myopic eyes with foveal detachment and retinoschisis. Author(s): Kobayashi H, Kishi S. Source: Ophthalmology. 2003 September; 110(9): 1702-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=13129865&dopt=Abstract

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Voice quality after laser surgery or radiotherapy for T1a glottic carcinoma. Author(s): Tamura E, Kitahara S, Ogura M, Kohno N. Source: The Laryngoscope. 2003 May; 113(5): 910-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12792332&dopt=Abstract

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Volume expansion with albumin decreases mortality after coronary artery bypass graft surgery. Author(s): Sedrakyan A, Gondek K, Paltiel D, Elefteriades JA. Source: Chest. 2003 June; 123(6): 1853-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12796160&dopt=Abstract

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Voluntary changes in surgery career paths: a survey of the program directors in surgery. Author(s): Morris JB, Leibrandt TJ, Rhodes RS. Source: Journal of the American College of Surgeons. 2003 April; 196(4): 611-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12691942&dopt=Abstract

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Wada memory performance predicts seizure outcome after epilepsy surgery in children. Author(s): Lee GP, Park YD, Westerveld M, Hempel A, Blackburn LB, Loring DW. Source: Epilepsia. 2003 July; 44(7): 936-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12823577&dopt=Abstract

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Waterjet dissection in the brain: review of the experimental and clinical data with special reference to meningioma surgery. Author(s): Oertel J, Gaab MR, Warzok R, Piek J. Source: Neurosurgical Review. 2003 July; 26(3): 168-74. Epub 2002 December 06. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12845544&dopt=Abstract

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Weighted speculum buttock burn during gynecologic surgery. Author(s): Vilos GA, Vilos AG. Source: Obstetrics and Gynecology. 2003 May; 101(5 Pt 2): 1064-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12738103&dopt=Abstract

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Weighted speculum buttock burn during gynecologic surgery. Author(s): Sudduth SS. Source: Obstetrics and Gynecology. 2003 September; 102(3): 643-4; Author Reply 644. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12962960&dopt=Abstract

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Weight-elimination neural networks applied to coronary surgery mortality prediction. Author(s): Ennett CM, Frize M. Source: Ieee Transactions on Information Technology in Biomedicine : a Publication of the Ieee Engineering in Medicine and Biology Society. 2003 June; 7(2): 86-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12834163&dopt=Abstract

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What does the family pictures subtest of the Wechsler Memory Scale-III measure? Insight gained from patients evaluated for epilepsy surgery. Author(s): Dulay MF, Schefft BK, Testa SM, Fargo JD, Privitera M, Yeh HS. Source: Clin Neuropsychol. 2002 December; 16(4): 452-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12822054&dopt=Abstract

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What is appropriate coronary assessment prior to abdominal aortic surgery? Author(s): Karkos CD. Source: European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery. 2003 June; 25(6): 487-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12787689&dopt=Abstract

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What is the future of surgery? Author(s): Russell TR. Source: Archives of Surgery (Chicago, Ill. : 1960). 2003 August; 138(8): 825-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12912739&dopt=Abstract

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What percentage of 1980 vascular surgery will be replaced by endovascular procedures in 2003? Author(s): Diethrich EB. Source: The Journal of Cardiovascular Surgery. 2003 June; 44(3): 303-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12832981&dopt=Abstract

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What's new in adult reconstructive knee surgery. Author(s): Archibeck MJ, White RE Jr. Source: The Journal of Bone and Joint Surgery. American Volume. 2003 July; 85-A(7): 1404-11. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12851382&dopt=Abstract

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What's new in cardiac surgery. Author(s): Sundt TM. Source: Journal of the American College of Surgeons. 2003 May; 196(5): 768-77. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12742211&dopt=Abstract

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What's new in general surgery: endocrine. Author(s): De Jong SA. Source: Journal of the American College of Surgeons. 2003 September; 197(3): 436-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12946800&dopt=Abstract

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What's new in general surgery: surgical oncology. Author(s): Ota DM. Source: Journal of the American College of Surgeons. 2003 June; 196(6): 926-32. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12788430&dopt=Abstract

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What's new in general surgery: transplantation. Author(s): Ascher NL. Source: Journal of the American College of Surgeons. 2003 May; 196(5): 778-83. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12742212&dopt=Abstract

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What's new in general thoracic surgery. Author(s): Naunheim KS. Source: Journal of the American College of Surgeons. 2003 July; 197(1): 88-96. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12831929&dopt=Abstract

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What's new in neurological surgery. Author(s): Muraszko KM. Source: Journal of the American College of Surgeons. 2003 June; 196(6): 919-25. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12788429&dopt=Abstract

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What's new in otolaryngology--head and neck surgery. Author(s): Kim DW, Toriumi DM. Source: Journal of the American College of Surgeons. 2003 July; 197(1): 97-114. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12831930&dopt=Abstract

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What's new in pediatric surgery. Author(s): Colombani PM. Source: Journal of the American College of Surgeons. 2003 August; 197(2): 278-84. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12892812&dopt=Abstract

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What's new in prolapse surgery? Author(s): Deval B, Haab F. Source: Current Opinion in Urology. 2003 July; 13(4): 315-23. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12811296&dopt=Abstract

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What's new in spine surgery. Author(s): Zigler JE, Anderson PA, Boden SD, Bridwell KH, Vaccaro AR. Source: The Journal of Bone and Joint Surgery. American Volume. 2003 August; 85-A(8): 1626-36. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12925662&dopt=Abstract

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Which anaesthetic agents are cost-effective in day surgery? Literature review, national survey of practice and randomised controlled trial. Author(s): Elliott RA, Payne K, Moore JK, Davies LM, Harper NJ, St Leger AS, Moore EW, Thoms GM, Pollard BJ, McHugh GA, Bennett J, Lawrence G, Kerr J. Source: Health Technology Assessment (Winchester, England). 2002; 6(30): 1-264. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12709296&dopt=Abstract

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Why patients choose regional anesthesia for orthopedic and trauma surgery. Author(s): Pelinka LE, Pelinka H, Leixnering M, Mauritz W. Source: Archives of Orthopaedic and Trauma Surgery. 2003 May; 123(4): 164-7. Epub 2003 March 20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12734714&dopt=Abstract

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Why pediatric surgery? A personal journey through the first 50 years. Author(s): Haller JA Jr. Source: Annals of Surgery. 2003 May; 237(5): 597-606. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12724625&dopt=Abstract

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Why perform randomized clinical trials for sentinel node surgery for breast cancer? Author(s): Jennings WC. Source: American Journal of Surgery. 2003 June; 185(6): 601-2; Author Reply 603-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12781895&dopt=Abstract

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Wound infiltration with ropivacaine and fentanyl: effects on postoperative pain and PONV after breast surgery. Author(s): Johansson A, Kornfalt J, Nordin L, Svensson L, Ingvar C, Lundberg J. Source: Journal of Clinical Anesthesia. 2003 March; 15(2): 113-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12719050&dopt=Abstract

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Wrong-side surgery: systems for prevention. Author(s): Bernstein M. Source: Canadian Journal of Surgery. Journal Canadien De Chirurgie. 2003 April; 46(2): 144-6. Erratum In: Can J Surg. 2003 June; 46(3): 225. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12691358&dopt=Abstract

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

Finding Nutrition Studies on Surgery The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “surgery” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

7

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

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The following is a typical result when searching for recently indexed consumer information on surgery: •

By the way, doctor. My surgeon advised me to stop taking gingko biloba before my hip surgery. Can you explain why? Are there any other herbs I should avoid? Source: Robb Nicholson, C Harv-Womens-Health-Watch. 2000 June; 7(10): 8 1070-910X

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By the way, doctor. Last month I had a night of severe abdominal pain. My doctor ordered an ultrasound test, and it showed gallstones. She is recommending surgery to remove my gallbladder, but I'd rather not have an operation because of this one episode. Is it dangerous to hold off on surgery? Is there any diet to follow or medicine I can take to prevent another attack? I am 53 years old and healthy. Source: Goldfinger, S E Harv-Health-Lett. 1999 August; 24(10): 3 1052-1577

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Does supplemental arginine alter immune function following major surgery? Source: Anonymous Nutr-Revolume 1993 February; 51(2): 54-6 0029-6643

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Facing the knife. Could eating potatoes affect your recovery from surgery? Maybe. Here's a list of dos and don'ts. Source: Gorman, C Time. 1998 November 30; 152(22): 132 0040-781X

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Herbal medications can cause complications with surgery. Source: Anonymous Mayo-Clin-Health-Lett. 2001 November; 19(11): 4 0741-6245

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Keeping vessels clear after bypass surgery. Source: Anonymous Harv-Heart-Lett. 2000 December; 11(4): 5-6 1051-5313

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New drugs, safer surgery may help overcome overweight and obesity. Source: Webb, D. Environmental-nutrition (USA). (November 1998). volume 21(11) page 1, 6. trade marks surgical operations hormones overweight drugs 0893-4452

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New findings: diet offers alternative to heart bypass surgery, if you can follow the tough regimen. Source: Smith, S.M. Environmental-nutrition (USA). (March 1994). volume 17(3) page 2. diet circulatory disorders surgical operations 0893-4452

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Nutritional management after gastric bypass surgery. Source: Crapo, P.A. Nutr-M.D. Van Nuys, Calif. : Nutrition & the M.D. May 1985. volume 11 (5) page 4-5. 0732-0167

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

A rat model of ischaemic or dilated cardiomyopathy for investigating left ventricular repair surgery. Author(s): Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan. Source: Nishina, T Miwa, S Yuasa, S Nishimura, K Komeda, M Clin-Exp-PharmacolPhysiol. 2002 August; 29(8): 728-30 0305-1870

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Bariatric surgery in a patient with possible psychiatric contraindications. Author(s): Obesity and Psychiatric Co-Morbidity Outpatient Service (AMBESO), Institute of Psychiatry, Hospital das Clinicas, Medical College of Sao Paulo University, Sao Paulo, Brazil. [email protected] Source: Segal, A Libanori, H T Azevedo, A Obes-Surg. 2002 August; 12(4): 598-601 09608923

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Bariatric surgery. An option for long-term weight loss. Source: Craig, J Diabetes-Self-Manag. 2002 Sep-October; 19(5): 14, 17-8, 20-1 0741-6253

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Beating-heart valvular surgery: a possible alternative for patients with severely compromised ventricular function. Author(s): Division of Cardiothoracic Surgery, University of Miami/Jackson Memorial Hospital, Florida, USA. [email protected] Source: Kaplon, R J Pham, S M Salerno, T A J-Card-Surg. 2002 Mar-April; 17(2): 170-2 0886-0440

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Effectiveness of 0.12% chlorhexidine gluconate oral rinse in reducing prevalence of nosocomial pneumonia in patients undergoing heart surgery. Author(s): St. Luke's Episcopal Hospital, Houston, Tex, USA. Source: Houston, S Hougland, P Anderson, J J LaRocco, M Kennedy, V Gentry, L O AmJ-Crit-Care. 2002 November; 11(6): 567-70 1062-3264

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Facial nerve palsy after intracisternal papaverine application during aneurysm surgery--case report. Author(s): Department of Neurosurgery, Westmead Hospital, University of Sydney, Westmead, New South Wales, Australia. [email protected] Source: Lang, E W Neugebauer, M Ng, K Fung, V Clouston, P Dorsch, N W NeurolMed-Chir-(Tokyo). 2002 December; 42(12): 565-7 0470-8105

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Factor V Leiden (G1691A) and prothrombin gene G20210A mutations as potential risk factors for venous thromboembolism after total hip or total knee replacement surgery. Author(s): Department of Clinical Chemistry and Transfusion Medicine, Sahlgrenska University Hospital, Goteborg, Sweden. [email protected] Source: Wahlander, K Larson, G Lindahl, T L Andersson, C Frison, L Gustafsson, D Bylock, A Eriksson, B I Thromb-Haemost. 2002 April; 87(4): 580-5 0340-6245

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Feasibility of using the potassium titanyl phosphate laser with micromanipulators in robotic neurosurgery: a preliminary study in the rat. Author(s): Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan. Source: Goto, T Hongo, K Koyama, J Kobayashi, S J-Neurosurg. 2003 January; 98(1): 1315 0022-3085

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Mucosal reconstruction using an artificial dermis after KTP laser surgery. Author(s): Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan. [email protected] Source: Ishii, J Fujita, K Komori, T J-Clin-Laser-Med-Surg. 2002 December; 20(6): 313-7 1044-5471

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Preoperative twice-weekly paclitaxel with concurrent radiation therapy followed by surgery and postoperative doxorubicin-based chemotherapy in locally advanced breast cancer: a phase I/II trial. Author(s): Kaplan Comprehensive Cancer Center, New York University School of Medicine, New York, NY, USA. [email protected] Source: Formenti, S C Volm, M Skinner, K A Spicer, D Cohen, D Perez, E Bettini, A C Groshen, S Gee, C Florentine, B Press, M Danenberg, P Muggia, F J-Clin-Oncol. 2003 March 1; 21(5): 864-70 0732-183X

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Process improvement plan for the reduction of sternal surgical site infections among patients undergoing coronary artery bypass graft surgery. Author(s): Department of Infection Control, Greenville Hospital System, Greenville, South Carolina 29605, USA. Source: Usry, G H Johnson, L Weems, J J Jr Blackhurst, D Am-J-Infect-Control. 2002 November; 30(7): 434-6 0196-6553

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The following is a specific Web list relating to surgery; 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:

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Vitamins Ascorbic Acid Source: Integrative Medicine Communications; www.drkoop.com Pantothenic Acid Source: Integrative Medicine Communications; www.drkoop.com Vitamin A Source: Healthnotes, Inc. www.healthnotes.com Vitamin B1 Source: Healthnotes, Inc. www.healthnotes.com Vitamin B12 Source: Healthnotes, Inc. www.healthnotes.com Vitamin B12 Source: Prima Communications, Inc.www.personalhealthzone.com Vitamin B5 (Pantothenic Acid) Source: Integrative Medicine Communications; www.drkoop.com Vitamin B6 Source: Healthnotes, Inc. www.healthnotes.com Vitamin C Source: Healthnotes, Inc. www.healthnotes.com Vitamin C Source: Prima Communications, Inc.www.personalhealthzone.com Vitamin C (Ascorbic Acid) Source: Integrative Medicine Communications; www.drkoop.com Vitamin E Source: Healthnotes, Inc. www.healthnotes.com Vitamin E Source: Prima Communications, Inc.www.personalhealthzone.com Vitamin E Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,906,00.html Vitamin K Source: Healthnotes, Inc. www.healthnotes.com

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Minerals Iron Source: Healthnotes, Inc. www.healthnotes.com Magnesium Source: Prima Communications, Inc.www.personalhealthzone.com Potassium Source: Healthnotes, Inc. www.healthnotes.com Selenium Source: Healthnotes, Inc. www.healthnotes.com Zinc Source: Healthnotes, Inc. www.healthnotes.com

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Food and Diet Cartilage Alternative names: Shark Cartilage Source: Integrative Medicine Communications; www.drkoop.com Cartilage (Bovine and Shark) Source: Healthnotes, Inc. www.healthnotes.com Chondroitin Sulfate Source: Healthnotes, Inc. www.healthnotes.com Garlic Alternative names: Allium sativum Source: Healthnotes, Inc. www.healthnotes.com Garlic Alternative names: Allium sativum Source: Integrative Medicine Communications; www.drkoop.com Garlic Source: Prima Communications, Inc.www.personalhealthzone.com Garlic Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,786,00.html Hypoglycemia Source: Healthnotes, Inc. www.healthnotes.com Low Back Pain Source: Healthnotes, Inc. www.healthnotes.com

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The Dean Ornish Diet Source: Healthnotes, Inc. www.healthnotes.com Wound Healing Source: Healthnotes, Inc. www.healthnotes.com

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

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

Recommendations for Herbal Supplements and the Perioperative Patient Source: Kansas Nurse. 77(5): 3-5. May-June 2002. Summary: This article discusses the rising number of individuals who use complementary and alternative medicines, specifically herbal supplements, and their potential effects in the perioperative patient population. It provides information about properly identifying patients who are using herbal supplements and how to limit their risk for complications during or after surgery. Specific herbs that should not be used 10 to 14 days before surgery are listed. 6 references.

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Ayurveda: A Historical Perspective and Principles of the Traditional Health Care System in India Source: Alternative Therapies in Health and Medicine. 7(2): 36-42. March 2001.

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Summary: This journal article provides an overview of the history and principles of Ayurveda, the traditional medical system of India. Ayurveda, the science of life, has been the traditional system of health care in India for more than 5,000 years. This medical system was well established by 2500 to 600 BC, when it evolved into two schools, the School of Physicians and the School of Surgeons, similar to allopathy. 'Charak Samhita,' 'Susrut Samhita,' and 'Ashtang Hridaya Samhita' are the Senior Triad texts, and 'Madhav Nidan Samhita,' 'Sarangdhar Samhita,' and 'Bhavprakash Samhita' are the Junior Triad texts. Around 600 BC, Ayurveda branched into eight specialties: internal medicine; pediatrics; psychiatry; surgery; toxicology; geriatrics; eugenics and aphrodisiacs; and eye, ear, nose, and throat. According to Ayurveda, a person is composed of three body 'doshas,' three mental 'doshas,' seven 'dhatus,' and 'malas.' Harmony among the body 'doshas' of 'vata' (nervous system), 'pitta' (enzymes), and 'kapha' (mucus) and the mental 'doshas' constitutes health, and their disharmony constitutes disease. The management of illness requires balancing the 'doshas' back into a harmonious state through lifestyle interventions, spiritual nurturing, and herb-mineral formulas based on the individual's mental and bodily constitution. The article has 1 table and 14 references. (AA-M).

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 surgery 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 “surgery” (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 surgery: •

A critical analysis of 'normal' radionucleotide shuntograms in patients subsequently requiring surgery. Author(s): O'Brien DF, Taylor M, Park TS, Ojemann JG. Source: Child's Nervous System : Chns : Official Journal of the International Society for Pediatric Neurosurgery. 2003 June; 19(5-6): 337-41. Epub 2003 May 10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12740708&dopt=Abstract

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Altered healing following mucogingival surgery in a patient with Crohn's disease: a literature review and case report. Author(s): Andersen KM, Selvig KA, Leknes KN. Source: J Periodontol. 2003 April; 74(4): 537-46. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12747460&dopt=Abstract

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Bone and joint infection after traumatic implantation of Scedosporium prolificans treated with voriconazole and surgery. Author(s): Studahl M, Backteman T, Stalhammar F, Chryssanthou E, Petrini B. Source: Acta Paediatrica (Oslo, Norway : 1992). 2003 August; 92(8): 980-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12948078&dopt=Abstract

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Caring for your baby after heart surgery. Author(s): Pye S, Green A. Source: Advances in Neonatal Care : Official Journal of the National Association of Neonatal Nurses. 2003 June; 3(3): 157-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12891840&dopt=Abstract

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Cerebral glucose metabolism in long-term survivors of childhood primary brain tumors treated with surgery and radiotherapy. Author(s): Andersen PB, Krabbe K, Leffers AM, Schmiegelow M, Holm S, Laursen H, Muller JR, Paulson OB. Source: Journal of Neuro-Oncology. 2003 May; 62(3): 305-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12777083&dopt=Abstract

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Cisplatin plus vinorelbine as induction chemotherapy followed by surgery in the treatment of stage IIIB non-small cell lung cancer. Final results of a multicenter phase II study. Author(s): Cigolari S, Curcio C, Maiorino A, Sessa R, Cioffi A, Massimo M. Source: Anticancer Res. 2003 March-April; 23(2C): 1803-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12820462&dopt=Abstract

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Clinically occult recurrent ovarian cancer: patient selection for secondary cytoreductive surgery using combined PET/CT. Author(s): Bristow RE, del Carmen MG, Pannu HK, Cohade C, Zahurak ML, Fishman EK, Wahl RL, Montz FJ. Source: Gynecologic Oncology. 2003 September; 90(3): 519-28. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=13678719&dopt=Abstract

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Comparison of functional brain PET images and intraoperative brain-mapping data using image-guided surgery. Author(s): Sobottka SB, Bredow J, Beuthien-Baumann B, Reiss G, Schackert G, Steinmeier R. Source: Computer Aided Surgery : Official Journal of the International Society for Computer Aided Surgery. 2002; 7(6): 317-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12731094&dopt=Abstract

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Discharge planning in rehabilitation following surgery for a stoma. Author(s): O'Connor G. Source: British Journal of Nursing (Mark Allen Publishing). 2003 July 10-23; 12(13): 8007. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12920458&dopt=Abstract

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Effects of EC-IC bypass surgery on cognitive impairment in patients with hemodynamic cerebral ischemia.

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Author(s): Sasoh M, Ogasawara K, Kuroda K, Okuguchi T, Terasaki K, Yamadate K, Ogawa A. Source: Surgical Neurology. 2003 June; 59(6): 455-60; Discussion 460-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12826338&dopt=Abstract •

Elicitation of prior distributions for a phase III randomized controlled trial of adjuvant therapy with surgery for hepatocellular carcinoma. Author(s): Tan SB, Chung YF, Tai BC, Cheung YB, Machin D. Source: Controlled Clinical Trials. 2003 April; 24(2): 110-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12689733&dopt=Abstract

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Endoscopic-assisted microsurgery: microsurgery in the new millennium? A comparative experimental study. Author(s): El-Shazly M, El-Sonbaty M, Kamel A, Zaki M, Frick A, Baumeister R. Source: British Journal of Plastic Surgery. 2003 January; 56(1): 37-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12706148&dopt=Abstract

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Epilepsy surgery in infancy. A review of four cases. Author(s): Olavarria G, Petronio JA. Source: Pediatric Neurosurgery. 2003 July; 39(1): 44-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12784078&dopt=Abstract

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Focused high frequency repetitive transcranial magnetic stimulation for localisation of the unexposed primary motor cortex during brain tumour surgery. Author(s): Rohde V, Mayfrank L, Weinzierl M, Krings T, Gilsbach JM. Source: Journal of Neurology, Neurosurgery, and Psychiatry. 2003 September; 74(9): 1283-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12933937&dopt=Abstract

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Frameless stereotactic radiosurgery with mobile CT, mask immobilization and micromultileaf collimators. Author(s): Takeuchi H, Yoshida M, Kubota T, Ishii H, Sato K, Handa Y, Itoh H. Source: Minimally Invasive Neurosurgery : Min. 2003 April; 46(2): 82-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12761677&dopt=Abstract

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High-dose glucose-insulin-potassium after cardiac surgery: a retrospective analysis of clinical safety issues. Author(s): Szabo Z, Hakanson E, Maros T, Svedjeholm R. Source: Acta Anaesthesiologica Scandinavica. 2003 April; 47(4): 383-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12694134&dopt=Abstract

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Image-guided and intensity-modulated radiosurgery for patients with spinal metastasis.


Author(s): Ryu S, Fang Yin F, Rock J, Zhu J, Chu A, Kagan E, Rogers L, Ajlouni M, Rosenblum M, Kim JH. Source: Cancer. 2003 April 15; 97(8): 2013-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12673732&dopt=Abstract •

Implementation of intravascular ultrasound in vascular surgery. Author(s): Vogt KC. Source: Dan Med Bull. 2003 March; 50(1): 64-82. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12705145&dopt=Abstract

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Importance of neuropsychological evaluation after surgery in patients with unruptured cerebral aneurysms. Author(s): Ohue S, Oka Y, Kumon Y, Ohta S, Sakaki S, Hatakeyama T, Shiraishi T, Takeda S, Ohnishi T. Source: Surgical Neurology. 2003 April; 59(4): 269-75; Discussion 275-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12748007&dopt=Abstract

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Long-term outcome of phase II trial evaluating chemotherapy, chemoradiotherapy, and surgery for locoregionally advanced esophageal cancer. Author(s): Swisher SG, Ajani JA, Komaki R, Nesbitt JC, Correa AM, Cox JD, Lahoti S, Martin F, Putnam JB, Smythe WR, Vaporciyan AA, Walsh GL, Roth JA. Source: International Journal of Radiation Oncology, Biology, Physics. 2003 September 1; 57(1): 120-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12909224&dopt=Abstract

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Methionine positron emission tomography of recurrent metastatic brain tumor and radiation necrosis after stereotactic radiosurgery: is a differential diagnosis possible? Author(s): Tsuyuguchi N, Sunada I, Iwai Y, Yamanaka K, Tanaka K, Takami T, Otsuka Y, Sakamoto S, Ohata K, Goto T, Hara M. Source: Journal of Neurosurgery. 2003 May; 98(5): 1056-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12744366&dopt=Abstract

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MIBI SPECT and radioguided surgery in the accurate location of a posterior mediastinal parathyroid adenoma. Author(s): Banzo I, Pena FJ, Allende RH, Quirce R, Carril JM. Source: Clinical Nuclear Medicine. 2003 July; 28(7): 584-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12819415&dopt=Abstract

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Mixing medicines, herbs, food, and surgery. Author(s): Breunig J.

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Source: Plastic Surgical Nursing : Official Journal of the American Society of Plastic and Reconstructive Surgical Nurses. 2003 Spring; 23(1): 31-2. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12803100&dopt=Abstract •

Neoadjuvant radiotherapy concurrent with weekly paclitaxel and carboplatin and followed by surgery in locally advanced non-small-cell lung cancer. Author(s): Kuten A, Anacak Y, Abdah-Bortnyak R, Chetver L, Zen Al Deen I, Daoud K, Nijem R, Billan S, Best L. Source: American Journal of Clinical Oncology : the Official Publication of the American Radium Society. 2003 April; 26(2): 184-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12714893&dopt=Abstract

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New development of functional neurorehabilitation in neurosurgery. Author(s): von Wild KR. Source: Acta Neurochir Suppl. 2003; 87: 43-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14518522&dopt=Abstract

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Novel intracorporeal vascular knot applier for large vessel ligation in laparoscopic surgery: experience in pigs and preliminary clinical use. Author(s): Chiu AW, Wu ST, Sun GH, Liu CJ, Lin JJ, Tseng CY, Lin JT. Source: Journal of Endourology / Endourological Society. 2003 March; 17(2): 73-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12689398&dopt=Abstract

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Oral and maxillofacial surgery in patients with chronic orofacial pain. Author(s): Israel HA, Ward JD, Horrell B, Scrivani SJ. Source: Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons. 2003 June; 61(6): 662-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12796872&dopt=Abstract

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Poly(HEMA)--based embolic material in endovascular surgery of liver. Author(s): Horak D, Sitnikov A, Guseinov E, Kokov L, Titova M, Adamyan A, Gumargalieva K. Source: Polim Med. 2002; 32(3-4): 48-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12677651&dopt=Abstract

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Postchemotherapy retroperitoneal surgery remains necessary in patients with nonseminomatous testicular cancer and minimal residual tumor masses. Author(s): Oldenburg J, Alfsen GC, Lien HH, Aass N, Waehre H, Fossa SD. Source: Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 2003 September 1; 21(17): 3310-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12947067&dopt=Abstract


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Preoperative considerations: which herbal products should be discontinued before surgery? Author(s): Heyneman CA. Source: Critical Care Nurse. 2003 April; 23(2): 116-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12725201&dopt=Abstract

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Presurgical chemotherapy compared with immediate surgery and adjuvant chemotherapy for nonmetastatic osteosarcoma: Pediatric Oncology Group Study POG-8651. Author(s): Goorin AM, Schwartzentruber DJ, Devidas M, Gebhardt MC, Ayala AG, Harris MB, Helman LJ, Grier HE, Link MP; Pediatric Oncology Group. Source: Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 2003 April 15; 21(8): 1574-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12697883&dopt=Abstract

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Results of biofeedback therapy for fecal incontinence in children with encopresis and following surgery for anorectal malformations. Author(s): Hibi M, Iwai N, Kimura O, Sasaki Y, Tsuda T. Source: Diseases of the Colon and Rectum. 2003 October; 46(10): S54-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14530659&dopt=Abstract

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Review of the “ Chirurgia” of Giovanni de Vigo: estimate of his position in the history of surgery. Author(s): Gurunluoglu R, Gurunluoglu A, Piza-Katzer H. Source: World Journal of Surgery. 2003 May; 27(5): 616-23. Epub 2003 April 28. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12715234&dopt=Abstract

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Small doses of remifentanil and alfetanil in continuous total intravenous anesthesia in major abdominal surgery. A double blind comparison. Author(s): Iannuzzi E, Iannuzzi M, Cirillo V, Viola G, Parisi R, Chiefari M. Source: Minerva Anestesiol. 2003 March; 69(3): 127-33, 133-6. English, Italian. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12792581&dopt=Abstract

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Stapes prosthesis attachment: the effect of crimping on sound transfer in otosclerosis surgery. Author(s): Huber AM, Ma F, Felix H, Linder T. Source: The Laryngoscope. 2003 May; 113(5): 853-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12792322&dopt=Abstract

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Stereotactic body frame based fractionated radiosurgery on consecutive days for primary or metastatic tumors in the lung. Author(s): Lee SW, Choi EK, Park HJ, Ahn SD, Kim JH, Kim KJ, Yoon SM, Kim YS, Yi BY.

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Source: Lung Cancer (Amsterdam, Netherlands). 2003 June; 40(3): 309-15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12781430&dopt=Abstract •

Surgery as sole treatment for serous borderline tumors of the ovary with noninvasive implants. Author(s): Lackman F, Carey MS, Kirk ME, McLachlin CM, Elit L. Source: Gynecologic Oncology. 2003 August; 90(2): 407-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12893209&dopt=Abstract

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The effect of neoadjuvant chemotherapy and surgery in children with malignant germ cell tumors of the genital region: a pediatric intergroup trial. Author(s): Rescorla F, Billmire D, Vinocur C, Colombani P, London W, Giller R, Cushing B, Lauer S, Cullen J, Davis M, Hawkins E. Source: Journal of Pediatric Surgery. 2003 June; 38(6): 910-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12778391&dopt=Abstract

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The effect of progressive muscle relaxation training on anxiety and quality of life after stoma surgery in colorectal cancer patients. Author(s): Cheung YL, Molassiotis A, Chang AM. Source: Psycho-Oncology. 2003 April-May; 12(3): 254-66. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12673809&dopt=Abstract

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The effect of Shen-Fu on gastrointestinal tract injury and its potential mechanism during cardio-pulmonary bypass in patients undergoing cardiac surgery. Author(s): Xia ZY, Zhan LY, He YH, Liu XY. Source: Chinese Journal of Traumatology = Chung-Hua Ch'uang Shang Tsa Chih / Chinese Medical Association. 2003 August 1; 6(4): 245-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12857521&dopt=Abstract

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Usefulness of semiquantitative FDG-PET in the prediction of brain tumor treatment response to gamma knife radiosurgery. Author(s): Lee JK, Liu RS, Shiang HR, Pan DH. Source: Journal of Computer Assisted Tomography. 2003 July-August; 27(4): 525-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12886136&dopt=Abstract

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

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

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


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

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

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

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

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

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

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

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

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

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

The following is a specific Web list relating to surgery; 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 Abdominal Wall Inflammation Source: Integrative Medicine Communications; www.drkoop.com Acne Source: Integrative Medicine Communications; www.drkoop.com Alzheimer's Disease, Non-Alzheimer's Dementia, and Normal Age-Related Memory Loss Source: Prima Communications, Inc.www.personalhealthzone.com Amyloidosis Source: Integrative Medicine Communications; www.drkoop.com Anemia Source: Integrative Medicine Communications; www.drkoop.com Angina Source: Healthnotes, Inc. www.healthnotes.com Angina Source: Integrative Medicine Communications; www.drkoop.com Anxiety and Panic Attacks Source: Prima Communications, Inc.www.personalhealthzone.com Appendicitis Source: Integrative Medicine Communications; www.drkoop.com

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Arteriosclerosis Source: Integrative Medicine Communications; www.drkoop.com Ascariasis Source: Integrative Medicine Communications; www.drkoop.com Atherosclerosis Source: Integrative Medicine Communications; www.drkoop.com Atherosclerosis and Heart Disease Prevention Source: Prima Communications, Inc.www.personalhealthzone.com Bell's Palsy Source: Healthnotes, Inc. www.healthnotes.com Benign Prostatic Hyperplasia Source: Healthnotes, Inc. www.healthnotes.com Benign Prostatic Hyperplasia Source: Integrative Medicine Communications; www.drkoop.com Benign Prostatic Hyperplasia Alternative names: Prostate Enlargement Source: Prima Communications, Inc.www.personalhealthzone.com Bone Cancer Source: Integrative Medicine Communications; www.drkoop.com Bone Loss Source: Integrative Medicine Communications; www.drkoop.com BPH Source: Integrative Medicine Communications; www.drkoop.com Brain Cancer Source: Integrative Medicine Communications; www.drkoop.com Breast Cancer Source: Healthnotes, Inc. www.healthnotes.com Breast Cancer Source: Integrative Medicine Communications; www.drkoop.com Burns Source: Healthnotes, Inc. www.healthnotes.com Burns Source: Integrative Medicine Communications; www.drkoop.com Cancer Prevention (Reducing the Risk) Source: Prima Communications, Inc.www.personalhealthzone.com


Cardiomyopathy Source: Healthnotes, Inc. www.healthnotes.com Cardiovascular Disease Overview Source: Healthnotes, Inc. www.healthnotes.com Carpal Tunnel Syndrome Source: Healthnotes, Inc. www.healthnotes.com Carpal Tunnel Syndrome Source: Integrative Medicine Communications; www.drkoop.com Cataracts Source: Healthnotes, Inc. www.healthnotes.com Cataracts Source: Integrative Medicine Communications; www.drkoop.com Cataracts (Prevention) Source: Prima Communications, Inc.www.personalhealthzone.com Cellulitis Source: Integrative Medicine Communications; www.drkoop.com Chronic Obstructive Pulmonary Disease Source: Healthnotes, Inc. www.healthnotes.com Colon Cancer Source: Healthnotes, Inc. www.healthnotes.com Colorectal Cancer Source: Integrative Medicine Communications; www.drkoop.com Congestive Heart Failure Source: Integrative Medicine Communications; www.drkoop.com Constipation Source: Healthnotes, Inc. www.healthnotes.com Coronary Artery Disease Source: Integrative Medicine Communications; www.drkoop.com Crohn's Disease Source: Integrative Medicine Communications; www.drkoop.com Cyclic Mastalgia Alternative names: Cyclic Mastitis, Fibrocystic Breast Disease Source: Prima Communications, Inc.www.personalhealthzone.com Cystic Fibrosis Source: Integrative Medicine Communications; www.drkoop.com

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Depression (Mild to Moderate) Source: Prima Communications, Inc.www.personalhealthzone.com Diabetes Mellitus Source: Integrative Medicine Communications; www.drkoop.com Diverticular Disease Source: Healthnotes, Inc. www.healthnotes.com Diverticular Disease Source: Integrative Medicine Communications; www.drkoop.com Dupuytren's Contracture Source: Healthnotes, Inc. www.healthnotes.com Dysphagia Source: Integrative Medicine Communications; www.drkoop.com Edema Source: Healthnotes, Inc. www.healthnotes.com Edema Source: Integrative Medicine Communications; www.drkoop.com Endocarditis Source: Integrative Medicine Communications; www.drkoop.com Epilepsy Source: Healthnotes, Inc. www.healthnotes.com Fever of Unknown Origin Source: Integrative Medicine Communications; www.drkoop.com Fibrocystic Breast Disease Source: Healthnotes, Inc. www.healthnotes.com Frostbite Source: Integrative Medicine Communications; www.drkoop.com Gallbladder Disease Source: Integrative Medicine Communications; www.drkoop.com Gallstones Source: Healthnotes, Inc. www.healthnotes.com Gallstones Source: Prima Communications, Inc.www.personalhealthzone.com Gastritis Source: Healthnotes, Inc. www.healthnotes.com


Gastritis Source: Integrative Medicine Communications; www.drkoop.com Gastroesophageal Reflux Disease Source: Integrative Medicine Communications; www.drkoop.com Gingivitis Source: Healthnotes, Inc. www.healthnotes.com Glaucoma Source: Integrative Medicine Communications; www.drkoop.com Gout Source: Integrative Medicine Communications; www.drkoop.com Guinea Worm Disease Source: Integrative Medicine Communications; www.drkoop.com Heart Attack Source: Healthnotes, Inc. www.healthnotes.com Heart Attack Source: Integrative Medicine Communications; www.drkoop.com Heartburn Source: Integrative Medicine Communications; www.drkoop.com Hemophilia Source: Integrative Medicine Communications; www.drkoop.com High Cholesterol Source: Prima Communications, Inc.www.personalhealthzone.com Hirsuitism Source: Integrative Medicine Communications; www.drkoop.com Histoplasmosis Source: Integrative Medicine Communications; www.drkoop.com Hookworm Source: Integrative Medicine Communications; www.drkoop.com Hyperparathyroidism Source: Integrative Medicine Communications; www.drkoop.com Hypertension Alternative names: High Blood Pressure Source: Prima Communications, Inc.www.personalhealthzone.com Hypoglycemia Source: Integrative Medicine Communications; www.drkoop.com

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Hypoparathyroidism Source: Integrative Medicine Communications; www.drkoop.com Hypothyroidism Source: Healthnotes, Inc. www.healthnotes.com Immune Function Source: Healthnotes, Inc. www.healthnotes.com Inflammatory Bowel Disease Source: Integrative Medicine Communications; www.drkoop.com Insomnia Source: Prima Communications, Inc.www.personalhealthzone.com Insulin Resistance Syndrome Source: Healthnotes, Inc. www.healthnotes.com Intermittent Claudication Alternative names: Peripheral Vascular Disease Source: Prima Communications, Inc.www.personalhealthzone.com Kidney Stones Source: Healthnotes, Inc. www.healthnotes.com Kidney Stones Source: Integrative Medicine Communications; www.drkoop.com Loiasis Source: Integrative Medicine Communications; www.drkoop.com Low Back Pain Source: Integrative Medicine Communications; www.drkoop.com Low Blood Sugar Source: Integrative Medicine Communications; www.drkoop.com Lung Cancer Source: Healthnotes, Inc. www.healthnotes.com Lung Cancer Source: Integrative Medicine Communications; www.drkoop.com Lupus Source: Integrative Medicine Communications; www.drkoop.com Lymphatic Filariasis Source: Integrative Medicine Communications; www.drkoop.com Macular Degeneration Source: Healthnotes, Inc. www.healthnotes.com


Macular Degeneration Source: Integrative Medicine Communications; www.drkoop.com Malabsorption Source: Healthnotes, Inc. www.healthnotes.com Meningitis Source: Integrative Medicine Communications; www.drkoop.com Miscarriage Source: Integrative Medicine Communications; www.drkoop.com Mitral Valve Prolapse Source: Healthnotes, Inc. www.healthnotes.com Multiple Sclerosis Source: Integrative Medicine Communications; www.drkoop.com Muscular Dystrophy Source: Integrative Medicine Communications; www.drkoop.com Myocardial Infarction Source: Integrative Medicine Communications; www.drkoop.com Nausea Source: Prima Communications, Inc.www.personalhealthzone.com Obesity Source: Integrative Medicine Communications; www.drkoop.com Osteoarthritis Source: Integrative Medicine Communications; www.drkoop.com Osteoporosis Source: Integrative Medicine Communications; www.drkoop.com Pancreatic Insufficiency Source: Healthnotes, Inc. www.healthnotes.com Pancreatitis Source: Integrative Medicine Communications; www.drkoop.com Parkinson's Disease Source: Healthnotes, Inc. www.healthnotes.com Pelvic Inflammatory Disease Source: Integrative Medicine Communications; www.drkoop.com Peptic Ulcer Source: Integrative Medicine Communications; www.drkoop.com

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Pericarditis Source: Integrative Medicine Communications; www.drkoop.com Periodontal Disease Alternative names: Gum Disease Source: Prima Communications, Inc.www.personalhealthzone.com Peripheral Vascular Disease Source: Healthnotes, Inc. www.healthnotes.com Peritonitis Source: Integrative Medicine Communications; www.drkoop.com Pinworm Source: Integrative Medicine Communications; www.drkoop.com Proctitis Source: Integrative Medicine Communications; www.drkoop.com Prostate Cancer Source: Healthnotes, Inc. www.healthnotes.com Prostate Cancer Source: Integrative Medicine Communications; www.drkoop.com Prostate Enlargement Source: Integrative Medicine Communications; www.drkoop.com Prostate Infection Source: Integrative Medicine Communications; www.drkoop.com Prostatitis Source: Integrative Medicine Communications; www.drkoop.com Pulmonary Edema Source: Integrative Medicine Communications; www.drkoop.com Pyloric Stenosis Source: Integrative Medicine Communications; www.drkoop.com Radiation Damage Source: Integrative Medicine Communications; www.drkoop.com Raynaud's Phenomenon Source: Integrative Medicine Communications; www.drkoop.com Rectal Inflammation Source: Integrative Medicine Communications; www.drkoop.com Reiter's Syndrome Source: Integrative Medicine Communications; www.drkoop.com


Retinopathy Source: Healthnotes, Inc. www.healthnotes.com Rheumatoid Arthritis Source: Healthnotes, Inc. www.healthnotes.com Rheumatoid Arthritis Source: Integrative Medicine Communications; www.drkoop.com River Blindness Source: Integrative Medicine Communications; www.drkoop.com Roundworms Source: Integrative Medicine Communications; www.drkoop.com Sarcoidosis Source: Integrative Medicine Communications; www.drkoop.com Scleroderma Source: Integrative Medicine Communications; www.drkoop.com Sexual Dysfunction Source: Integrative Medicine Communications; www.drkoop.com Shock Source: Integrative Medicine Communications; www.drkoop.com Sinus Congestion Source: Healthnotes, Inc. www.healthnotes.com Sinusitis Source: Healthnotes, Inc. www.healthnotes.com Skin Cancer Source: Integrative Medicine Communications; www.drkoop.com Skin Infection Source: Integrative Medicine Communications; www.drkoop.com Sleep Apnea Source: Integrative Medicine Communications; www.drkoop.com Spontaneous Abortion Source: Integrative Medicine Communications; www.drkoop.com Sprains and Strains Source: Healthnotes, Inc. www.healthnotes.com Stomach Inflammation Source: Integrative Medicine Communications; www.drkoop.com

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Stress Source: Integrative Medicine Communications; www.drkoop.com Stroke Source: Integrative Medicine Communications; www.drkoop.com Systemic Lupus Erythematosus Source: Integrative Medicine Communications; www.drkoop.com Temporomandibular Joint Dysfunction Source: Integrative Medicine Communications; www.drkoop.com Tendinitis Source: Integrative Medicine Communications; www.drkoop.com Threadworm Source: Integrative Medicine Communications; www.drkoop.com TIAs Source: Integrative Medicine Communications; www.drkoop.com TMJ Source: Integrative Medicine Communications; www.drkoop.com Transient Ischemic Attacks Source: Integrative Medicine Communications; www.drkoop.com Trichinosis Source: Integrative Medicine Communications; www.drkoop.com Tuberculosis Source: Integrative Medicine Communications; www.drkoop.com Ulcer, Peptic Source: Integrative Medicine Communications; www.drkoop.com Ulcerative Colitis Source: Healthnotes, Inc. www.healthnotes.com Ulcerative Colitis Source: Integrative Medicine Communications; www.drkoop.com Ulcers Source: Prima Communications, Inc.www.personalhealthzone.com Urinary Incontinence Source: Integrative Medicine Communications; www.drkoop.com Uveitis Source: Integrative Medicine Communications; www.drkoop.com


Varicose Veins Source: Healthnotes, Inc. www.healthnotes.com Varicose Veins Source: Integrative Medicine Communications; www.drkoop.com Vertigo Source: Healthnotes, Inc. www.healthnotes.com Visceral Larva Migrans Source: Integrative Medicine Communications; www.drkoop.com Vitamin B12 Deficiency Source: Healthnotes, Inc. www.healthnotes.com Warts Source: Healthnotes, Inc. www.healthnotes.com Warts Source: Integrative Medicine Communications; www.drkoop.com Water Retention Source: Integrative Medicine Communications; www.drkoop.com Whipworm Source: Integrative Medicine Communications; www.drkoop.com Wounds Source: Integrative Medicine Communications; www.drkoop.com •

Alternative Therapy Acupressure Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,662,00.html Acupuncture Source: Integrative Medicine Communications; www.drkoop.com Acupuncture Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,663,00.html Acupuncture anesthesia Alternative names: acupuncture analgesia acupuncture assisted anesthesia anesthetic acupuncture Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/a.html

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Aromatherapy Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,664,00.html Chelation Therapy Source: Healthnotes, Inc. www.healthnotes.com Chelation therapy Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,679,00.html Chiropractic Source: Healthnotes, Inc. www.healthnotes.com Chiropractic Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,681,00.html Colon therapy Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,682,00.html Detoxification therapy Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10119,00.html Guided imagery Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,699,00.html Hemi-Sync Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/h.html Herbal Medicine Source: Integrative Medicine Communications; www.drkoop.com Homeopathy Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,703,00.html Hypnotherapy Source: Integrative Medicine Communications; www.drkoop.com


Hypnotherapy Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,706,00.html Magnet therapy Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,715,00.html Music therapy Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,719,00.html Native American medicine Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,721,00.html Naturopathic Medicine Source: Healthnotes, Inc. www.healthnotes.com Naturopathy Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,722,00.html Osteopathy Source: Integrative Medicine Communications; www.drkoop.com Osteopathy Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,724,00.html Paranormal healing Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/p.html Polarity therapy Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,727,00.html Prayer Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,728,00.html

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Psychic surgery Alternative names: etheric surgery Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/p.html Reiki Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,731,00.html Shiatsu Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,733,00.html Spirit surgery Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/s.html Spiritual Surgery Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/s.html Spirituality Source: Integrative Medicine Communications; www.drkoop.com Therapeutic touch Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,739,00.html Traditional Chinese medicine Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10085,00.html Trager approach Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,741,00.html Vibrational medicine Alternative names: energetic medicine energetics medicine energy medicine subtleenergy medicine vibrational healing vibrational therapies Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/v.html


Vital energy healing Alternative names: energy healing Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/v.html •

Homeopathy Aconitum napellus Source: Healthnotes, Inc. www.healthnotes.com Arnica Source: Healthnotes, Inc. www.healthnotes.com Bellis perennis Source: Healthnotes, Inc. www.healthnotes.com China (Chinchona) Source: Healthnotes, Inc. www.healthnotes.com Ferrum phosphoricum Source: Healthnotes, Inc. www.healthnotes.com Gelsemium Source: Healthnotes, Inc. www.healthnotes.com Hamamelis Source: Healthnotes, Inc. www.healthnotes.com Hypericum Source: Healthnotes, Inc. www.healthnotes.com Phosphorus Source: Healthnotes, Inc. www.healthnotes.com Ruta graveolens Source: Healthnotes, Inc. www.healthnotes.com Staphysagria 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 Allium sativum Source: Integrative Medicine Communications; www.drkoop.com

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Aloe Alternative names: Aloe vera L. Source: Alternative Medicine Foundation, Inc. www.amfoundation.org Aloe vera Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10001,00.html Alpha-Lipoic Acid Source: Integrative Medicine Communications; www.drkoop.com Ananas comosus Source: Integrative Medicine Communications; www.drkoop.com Arginine Source: Healthnotes, Inc. www.healthnotes.com Aristolochia Alternative names: Snakeroot, Guaco; Aristolochia sp Source: Alternative Medicine Foundation, Inc. www.amfoundation.org Barbiturates Source: Healthnotes, Inc. www.healthnotes.com BCAAs Source: Prima Communications, Inc.www.personalhealthzone.com Beta-Carotene Source: Healthnotes, Inc. www.healthnotes.com Beta-sitosterol Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,972,00.html Bilberry Source: Prima Communications, Inc.www.personalhealthzone.com Brahmi Alternative names: Centella asiatica , Centella, March Pennywort, Indian Pennywort, Hydrocotyle, Brahmi (Sanskrit), Luei Gong Gen (Chinese)(Note: Gotu kola should not be confused with kola nut.) Source: Integrative Medicine Communications; www.drkoop.com Bromelain Source: Healthnotes, Inc. www.healthnotes.com Bromelain Alternative names: Ananas comosus, Bromelainum Source: Integrative Medicine Communications; www.drkoop.com


Bromelain Source: Prima Communications, Inc.www.personalhealthzone.com Bromelain Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,760,00.html Bromelainum Source: Integrative Medicine Communications; www.drkoop.com Carnosine Source: Healthnotes, Inc. www.healthnotes.com Cascara sagrada Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10013,00.html Centella Source: Integrative Medicine Communications; www.drkoop.com Centella asiatica Alternative names: Centella asiatica , Centella, March Pennywort, Indian Pennywort, Hydrocotyle, Brahmi (Sanskrit), Luei Gong Gen (Chinese)(Note: Gotu kola should not be confused with kola nut.) Source: Integrative Medicine Communications; www.drkoop.com Coenzyme Q Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,768,00.html Coenzyme Q10 Source: Healthnotes, Inc. www.healthnotes.com Coenzyme Q10 Source: Integrative Medicine Communications; www.drkoop.com CoQ10 Source: Integrative Medicine Communications; www.drkoop.com EDTA Source: Integrative Medicine Communications; www.drkoop.com Ethylenediaminetetraacetic Acid (EDTA) Source: Integrative Medicine Communications; www.drkoop.com Fentanyl Source: Healthnotes, Inc. www.healthnotes.com

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Finasteride Source: Healthnotes, Inc. www.healthnotes.com Fructo-oligosaccharides (FOS) and Other Oligosaccharides Source: Healthnotes, Inc. www.healthnotes.com General Anesthetics Source: Healthnotes, Inc. www.healthnotes.com Ginger Alternative names: Zingiber officinale Source: Healthnotes, Inc. www.healthnotes.com Ginger Source: Prima Communications, Inc.www.personalhealthzone.com Ginger Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,787,00.html Ginkgo biloba Source: Healthnotes, Inc. www.healthnotes.com Glucomannan Source: Healthnotes, Inc. www.healthnotes.com Glutamic Acid Source: Healthnotes, Inc. www.healthnotes.com Glutamine Source: Healthnotes, Inc. www.healthnotes.com Glutamine Source: Integrative Medicine Communications; www.drkoop.com Glutamine Source: Prima Communications, Inc.www.personalhealthzone.com Gotu Kola Alternative names: Centella asiatica , Centella, March Pennywort, Indian Pennywort, Hydrocotyle, Brahmi (Sanskrit), Luei Gong Gen (Chinese)(Note: Gotu kola should not be confused with kola nut.) Source: Integrative Medicine Communications; www.drkoop.com Gotu Kola Source: Prima Communications, Inc.www.personalhealthzone.com Grape Seed Alternative names: Vitis vinifera Source: Integrative Medicine Communications; www.drkoop.com


Heparin Source: Healthnotes, Inc. www.healthnotes.com Horse Chestnut Alternative names: Aesculus hippocastanum Source: Healthnotes, Inc. www.healthnotes.com Horse Chestnut Source: Prima Communications, Inc.www.personalhealthzone.com Hydrocotyle Source: Integrative Medicine Communications; www.drkoop.com Indian Pennywort Source: Integrative Medicine Communications; www.drkoop.com Ketorolac Source: Healthnotes, Inc. www.healthnotes.com Loop Diuretics Source: Healthnotes, Inc. www.healthnotes.com Lysine Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,862,00.html Marsh Pennywort Alternative names: Centella asiatica , Centella, March Pennywort, Indian Pennywort, Hydrocotyle, Brahmi (Sanskrit), Luei Gong Gen (Chinese)(Note: Gotu kola should not be confused with kola nut.) Source: Integrative Medicine Communications; www.drkoop.com Melatonin Source: Prima Communications, Inc.www.personalhealthzone.com Neomycin Source: Healthnotes, Inc. www.healthnotes.com Nitrous Oxide Source: Healthnotes, Inc. www.healthnotes.com Non-steroidal Anti-Inflammatory Drugs Source: Healthnotes, Inc. www.healthnotes.com OPCs (Oligomeric Proanthocyanidins) Source: Prima Communications, Inc.www.personalhealthzone.com Oral Corticosteroids Source: Healthnotes, Inc. www.healthnotes.com

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Ornithine Source: Healthnotes, Inc. www.healthnotes.com Ornithine Alpha-Ketoglutarate Source: Healthnotes, Inc. www.healthnotes.com Peppermint Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,812,00.html Phenobarbital Source: Healthnotes, Inc. www.healthnotes.com Progesterone Source: Healthnotes, Inc. www.healthnotes.com Red yeast rice Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10054,00.html Saw Palmetto Source: Prima Communications, Inc.www.personalhealthzone.com Senna Alternative names: Cassia senna, Cassia angustifolia Source: Healthnotes, Inc. www.healthnotes.com Shark Cartilage Source: Integrative Medicine Communications; www.drkoop.com Shiitake Alternative names: Lentinus edodes Source: Healthnotes, Inc. www.healthnotes.com St. John's Wort Source: Prima Communications, Inc.www.personalhealthzone.com Taurine Source: Healthnotes, Inc. www.healthnotes.com Thiazide Diuretics Source: Healthnotes, Inc. www.healthnotes.com Ticlopidine Source: Healthnotes, Inc. www.healthnotes.com Turmeric Alternative names: Curcuma longa Source: Healthnotes, Inc. www.healthnotes.com


Valerian Source: Prima Communications, Inc.www.personalhealthzone.com Vitis vinifera Source: Integrative Medicine Communications; www.drkoop.com Warfarin Source: Healthnotes, Inc. www.healthnotes.com Zingiber Alternative names: Ginger; Zingiber officinale Roscoe Source: Alternative Medicine Foundation, Inc. www.amfoundation.org

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

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

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

A Comparative Study of Women Who Have Had Mastectomies and Reconstructive Surgery with Women Who Have Had Mastectomies without Reconstructive Surgery Relative to Body Image and Sexuality by Howell, Eleanor Mae, Phd from Purdue University, 1992, 132 pages http://wwwlib.umi.com/dissertations/fullcit/9229127

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A Comparison of Selected Preoperative Coronary Artery Disease Risk Factors in Patients 40 Years or Younger and Patients over 40 Years Undergoing Coronary Artery Bypass Graft Surgery by Frye, Laurie Perry; Mph from California State University, Fresno, 2002, 87 pages http://wwwlib.umi.com/dissertations/fullcit/1410142

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A Comparison of Three Types of Presurgical Psychological Intervention with Male Open Heart Surgery Patients. by Van Steenhouse, Andrea Lynne, Phd from Michigan State University, 1978, 110 pages http://wwwlib.umi.com/dissertations/fullcit/7815177

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A Study of Patients' Perception of Surgery by Dorbacker, Beatrice Marie, Edd from Boston University School of Education, 1973, 131 pages http://wwwlib.umi.com/dissertations/fullcit/7323549

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A Study of Post-surgery Cognitive Functioning in Elderly Subjects by Mccardle, Ellen Steele, Phd from University of Pittsburgh, 1986, 121 pages http://wwwlib.umi.com/dissertations/fullcit/8620218

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A Study of the Rotational Strength and Flexibility of the Knee Following Pes Anserinus Transplant Surgery. by Blanke, Daniel James, Phd from University of Oregon, 1975, 67 pages http://wwwlib.umi.com/dissertations/fullcit/7605144

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A Study on the Cost Effectiveness of Percutaneous Transluminal Coronary Angioplasty (ptca) and Coronary Artery Bypass Surgery (cabg) in Multivessel Artery Disease by Lee, Jae Sang, Phd from Emory University, 1996, 122 pages http://wwwlib.umi.com/dissertations/fullcit/9625925

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Acute Post-operative Physical Therapy Following Total Knee Revision Surgery by Rodriguez, Madeline Costello; Ms from Mgh Institute of Health Professions, 2002, 48 pages http://wwwlib.umi.com/dissertations/fullcit/1407947

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Add One Part Pharmacy to One Part Surgery and One Part Medicine: Jean De Saintamand and the Development of Medical Pharmacology in Thirteenth-century Paris by Schalick, Walton Orvyl, Iii, Phd from The Johns Hopkins University, 1997, 596 pages http://wwwlib.umi.com/dissertations/fullcit/9730782

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'Am I Still a Woman?': an Analysis of Gynecological Surgery and Gender Identity by Elson, Jean; Phd from Brandeis University, 2000, 268 pages http://wwwlib.umi.com/dissertations/fullcit/9967998

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An Economic Evaluation of Percutaneous Transluminal Coronary Angioplasty (ptca) Versus Coronary Artery Bypass Surgery (cabg) for the Treatment of Multivessel Coronary Artery Disease (angioplasty, Bypass Surgery, Health Economics) by Mauldin, Patrick Duriez, Phd from Emory University, 1993, 122 pages http://wwwlib.umi.com/dissertations/fullcit/9323175

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An Empirical Analysis of Quality Measures and Quality Performance Drivers: Evidence from a Laser Eye Surgery Firm by Sedatole, Karen Louise; Phd from University of Michigan, 2000, 106 pages http://wwwlib.umi.com/dissertations/fullcit/9963891

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An Exploration of the Incidence, Patterns and Course, and Correlates of Delirium among Patients Undergoing Off-pump Coronary Artery Bypass Graft Surgery by Watanuki, Shigeaki; Phd from University of Minnesota, 2003, 196 pages http://wwwlib.umi.com/dissertations/fullcit/3080129

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Anesthesia Delivery in Office-based Surgery: Quality-of-care and Patient Satisfaction Outcomes by Golinski, Mary Ann; Phd from Wayne State University, 2002, 152 pages http://wwwlib.umi.com/dissertations/fullcit/3047554

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Application of Augmented Reality to Laparoscopic Surgery by Ackerman, Jeremy David; Phd from The University of North Carolina at Chapel Hill, 2002, 195 pages http://wwwlib.umi.com/dissertations/fullcit/3061656

Dissertations 197

•

Attitudes of Parents in the United States toward Facial Reconstructive Surgery for Children with Down Syndrome by Tenicki, Cynthia Potter, Edd from Columbia University Teachers College, 1994, 242 pages http://wwwlib.umi.com/dissertations/fullcit/9432583

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Bernstein-bezier Representations for Facial Surgery Simulation by Roth, Samuel Hans Martin; Drsctech from Eidgenoessische Technische Hochschule Zuerich (switzerland), 2002, 236 pages http://wwwlib.umi.com/dissertations/fullcit/f398113

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Beyond Beauty: Philosophy, Ethics and Plastic Surgery by Webb, Mary Sharon, Phd from Yale University, 1984, 349 pages http://wwwlib.umi.com/dissertations/fullcit/8514894

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Blacks in the Coronary Artery Surgery Study (race, Health, Disease, Bypass Surgery, Mortality) by Maynard, Charles C., Phd from University of Washington, 1986, 172 pages http://wwwlib.umi.com/dissertations/fullcit/8613185

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Bodies of Work: Cosmetic Surgery and the Gendered Whitening of America by Eichberg, Sarah Lucile; Phd from University of Pennsylvania, 1999, 324 pages http://wwwlib.umi.com/dissertations/fullcit/9953526

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Body and Soul: Plastic Surgery in the United States, 1914-1990 by Haiken, Elizabeth Gail, Phd from University of California, Berkeley, 1994, 528 pages http://wwwlib.umi.com/dissertations/fullcit/9504826

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Calcium Homeostasis after Thyroid Surgery by Lindblom, Pia Monica; Phd from Lunds Universitet (sweden), 2002, 124 pages http://wwwlib.umi.com/dissertations/fullcit/f660753

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Career Development Issues Encountered by Surgery Faculty by Anderson, Kimberly Dean, Phd from Michigan State University, 1993, 151 pages http://wwwlib.umi.com/dissertations/fullcit/9406450

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Circadian Rhythms and the Experience of Fatigue in Women before and after Surgery for Breast Cancer by Dean, Grace Ellen; Phd from University of California, Los Angeles, 2002, 123 pages http://wwwlib.umi.com/dissertations/fullcit/3058500

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Computational and Analytical Modeling of Eye Refractive Surgery by Cabrera, Delia; Phd from University of Michigan, 2002, 203 pages http://wwwlib.umi.com/dissertations/fullcit/3057906

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Computer Assistance in Orthopaedic Surgery by Habets, Raymond Joseph Elisabeth; Dr from Technische Universiteit Eindhoven (the Netherlands), 2002, 207 pages http://wwwlib.umi.com/dissertations/fullcit/f540113

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Coronary Artery Bypass Surgery: Education of the Family (adult Heart Disease, Support, Prevention, Patient) by Kroon, Janet Ellen Rohr, Edd from University of South Dakota, 1985, 67 pages http://wwwlib.umi.com/dissertations/fullcit/8609385

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Creation of Static and Dynamic Models of Instruments for a Virtual Reality Trainer for Laparoscopic Surgery by Naidu Rammohan, Karthik Sunder; Msee from The University of Texas at Arlington, 2002, 51 pages http://wwwlib.umi.com/dissertations/fullcit/1412839

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Crisis Intervention with Open Heart Surgery Patients. by Fitzgerald, Owen Ray, Phd from The American University, 1978, 95 pages http://wwwlib.umi.com/dissertations/fullcit/7811094

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Cultural Analysis of Women, Breast Cancer Surgery and the Meaning of Breasts by Rosenbaum, Marcy Ellen, Phd from University of Kentucky, 1994, 306 pages http://wwwlib.umi.com/dissertations/fullcit/9501964

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Design, Implementation, and Analysis of a Three-dimensional Ultrasound System for Image-guided Surgery by Welch, Jacqueline Nerney; Phd from Stanford University, 2003, 102 pages http://wwwlib.umi.com/dissertations/fullcit/3085239

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Determinants of Waiting Time from Initial Diagnostic Procedure to Surgery among Women with Localized Breast Cancer in Quebec, 1992--1997 by Shen, Ningyan; Phd from Mcgill University (canada), 2002, 151 pages http://wwwlib.umi.com/dissertations/fullcit/NQ78772

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Development of Vessel Connectors for Coronary Bypass Surgery by Scheltes, Julien Serge; Phd from Technische Universiteit Te Delft (the Netherlands), 2003, 168 pages http://wwwlib.umi.com/dissertations/fullcit/f113537

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Early Neuropsychological Functioning of Patients Following Off-pump Coronary Artery Bypass Surgery by Sendelbach, Sue Ellen; Phd from University of Minnesota, 2003, 161 pages http://wwwlib.umi.com/dissertations/fullcit/3083286

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Educational Preparation for Surgery: an Examination of Physical and Behavioral Parameters Post-operatively. by Taylor, Frances Libby, Phd from Case Western Reserve University, 1977, 107 pages http://wwwlib.umi.com/dissertations/fullcit/7800555

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Effect of Stress Workshops for Surgery Clerkship Medical Students by Moretto, Jean Earlene Freiner, Phd from Saint Louis University, 1998, 73 pages http://wwwlib.umi.com/dissertations/fullcit/9926970

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Effects of Enhanced Decisional Control on Patients' Adjustment to and Recovery from Oral Surgery by Frantsve, Lisa Maria Elizabeth; Phd from Virginia Commonwealth University, 2002, 169 pages http://wwwlib.umi.com/dissertations/fullcit/3049594

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Effects of Programed Instruction Following Pulmonary Surgery. by Goodwin, Judy Ozbolt, Phd from The University of Michigan, 1976, 178 pages http://wwwlib.umi.com/dissertations/fullcit/7707924

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Epidemiology of Presumed Infectious Endophthalmitis Following Cataract Surgery in the United Kingdom and the Characterisation of Intraocular Lens-related Bacterial Biofilm by Kamalarajah, Srikandan; Md from Queen's University of Belfast (northern Ireland), 2002, 123 pages http://wwwlib.umi.com/dissertations/fullcit/f662017

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Estimation of the Level of Anesthesia during Surgery by Automatic Eeg Pattern Recognition by Mcewen, James Allen; Phd from The University of British Columbia (canada), 1975 http://wwwlib.umi.com/dissertations/fullcit/NK25926

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Expressive Work and Team Work: Conflicting Responsibilities in Residency Training (humanism, Professionalism, Surgery, Psychiatry) by Litt, Jacquelyn Sue, Phd from University of Pennsylvania, 1988, 302 pages http://wwwlib.umi.com/dissertations/fullcit/8816199

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Fitting the School to the Child: a Case History of a Child Returning to School from Brain Surgery, Radiation, and Chemotherapy by Coughlin, Deborah Ann, Phd from The University of Arizona, 1997, 268 pages http://wwwlib.umi.com/dissertations/fullcit/9729455

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Geometric Algorithms and Software Architecture for Computational Prototyping: Applications in Vascular Surgery and Mems by Wilson, Nathan Marshall; Phd from Stanford University, 2003, 254 pages http://wwwlib.umi.com/dissertations/fullcit/3085242

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George Washington Crile and Surgical Shock: Physiology and Surgery in America, 1888-1918. by English, Peter Calvin, Phd from Duke University, 1975, 405 pages http://wwwlib.umi.com/dissertations/fullcit/7529476

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Health Related Quality of Life: a Comparison of Bypass Surgery Patients by Kastl, Dian Evans; Phd from Touro University International, 2002, 158 pages http://wwwlib.umi.com/dissertations/fullcit/3077369

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Health, Aging, and the Economy of the Body: a Study of Retirement due to Health Following Coronary Bypass Surgery by Newquist, Deborah Denise, Phd from University of California, Los Angeles, 1987, 380 pages http://wwwlib.umi.com/dissertations/fullcit/8803652

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Healthcare Cost-effectiveness Analysis for Older Patients: Using Cataract Surgery and Breast Cancer Treatment Data by Naeim, Arash; Phd from The Rand Graduate School, 2002, 166 pages http://wwwlib.umi.com/dissertations/fullcit/3068072

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Human-product Interaction in Minimally Invasive Surgery: a Design Vision for Innovative Products by Van Veelen, Martine Aria; Dr from Technische Universiteit Te Delft (the Netherlands), 2003, 243 pages http://wwwlib.umi.com/dissertations/fullcit/f99553

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Identity, Appearance, and Corrective Lenswear: Predictors of College Students' Interest in Vision-correcting Myopia Surgery by Stratton, Terry Dean; Phd from University of Kentucky, 1999, 286 pages http://wwwlib.umi.com/dissertations/fullcit/9957056

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Informed Proxy Consent: Communication between Surgeons and Surrogates about Surgery by Lashley, Myrna, Phd from Mcgill University (canada), 1995, 155 pages http://wwwlib.umi.com/dissertations/fullcit/NN08124

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Laparoscopic or Open Antireflux Surgery: a Comparative Study with Special Reference to the Patient's Perspective by Nilsson, Gunilla Christina; Phd from Lunds Universitet (sweden), 2003, 136 pages http://wwwlib.umi.com/dissertations/fullcit/f113649

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Le Proces D'heteronomisation Des Chirurgiens Generaux Dans Un Centre Hospitalier Universitaire Quebecois, 1960-1990 (french Text, Hospital, Surgery, Quebec) by Dumas, Albert, Phd from Universite Laval (canada), 1995, 471 pages http://wwwlib.umi.com/dissertations/fullcit/NN07116

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Levels of Anxiety Associated with the Experience of Open Heart Surgery and Its Impact on Learning Discharge Instructions. by Frantz, Rita Ann Farren, Phd from The University of Iowa, 1978, 154 pages http://wwwlib.umi.com/dissertations/fullcit/7912849

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Life Change and Recovery from Surgery. by Rundall, Thomas Gene, Phd from Stanford University, 1976, 214 pages http://wwwlib.umi.com/dissertations/fullcit/7707161

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Magnetic Resonance Imaging of Skeletal Muscle Geometry and Motion after Surgery by Asakawa, Deanna Schmidt; Phd from Stanford University, 2003, 103 pages http://wwwlib.umi.com/dissertations/fullcit/3085253

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Measurement of and Factors Relating to Variation in Cataract Surgery Waiting Times in Manitoba by De Coster, Carolyn Aimee; Phd from The University of Manitoba (canada), 2002, 274 pages http://wwwlib.umi.com/dissertations/fullcit/NQ76722

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Neurocognitive Changes after Coronary Artery Bypass Graft Surgery and Effect on Return to Work, Hobbies and Activities of Daily Living by Owens, Sharon Gallagher; Phd from The Johns Hopkins University, 2002, 202 pages http://wwwlib.umi.com/dissertations/fullcit/3028310

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Neurodevelopmental Sequelae in Young Children with Congenital Heart Defects Undergoing Open Heart Surgery by Limperopoulos, Catherine; Phd from Mcgill University (canada), 2002, 204 pages http://wwwlib.umi.com/dissertations/fullcit/NQ78718

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Out of the Depths: a Study in the Sociology of Surgery. by Bleiweiss, Laura, Phd from University of Pennsylvania, 1974, 157 pages http://wwwlib.umi.com/dissertations/fullcit/7422810

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Pain before and after Infrainguinal Bypass Surgery by Devries, Susan Diana; Msc from University of Toronto (canada), 2002, 99 pages http://wwwlib.umi.com/dissertations/fullcit/MQ74118

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Pain Experiences of Children and Their Families at Home Following Short-stay Surgery by Wiggins, Shirley A. Bartruff; Phd from University of Colorado Health Sciences Center, 2002, 478 pages http://wwwlib.umi.com/dissertations/fullcit/3045755

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Pain, Anxiety and Depression in Orthopedic Surgery Patients by Spaulding, Harry Charles, Phd from University of South Florida, 1982, 101 pages http://wwwlib.umi.com/dissertations/fullcit/8309687

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Participation in Cardiac Rehabilitation Post-bypass Surgery: Intention, Barriers, and Benefits by Bone, Susan Goetz; Phd from The University of Southern Mississippi, 2002, 114 pages http://wwwlib.umi.com/dissertations/fullcit/3067213

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Patients' Pain Management at the End of the First Week after Discharge Following Coronary Artery Bypass Graft Surgery by Macmaster, Lesley Mary; Msc from University of Toronto (canada), 2002, 132 pages http://wwwlib.umi.com/dissertations/fullcit/MQ74119

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Perceived Changes in the Quality of Life after Weight Loss/gastric Restriction Surgery by Andrelis, Jo Ann; Phd from Capella University, 2002, 124 pages http://wwwlib.umi.com/dissertations/fullcit/3037361

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Perceived Control and Response to Elective Surgery by Winnick, Richard; Phd from University of Calgary (canada), 1983 http://wwwlib.umi.com/dissertations/fullcit/NL18334

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Physical and Psychological Impacts of Length of Stay Associated with Breast Cancer Surgery by Wong, Peggy Hsieh; Phd from Rutgers the State U. of N.j. - New Brunswick and U.m.d.n.j., 2003, 282 pages http://wwwlib.umi.com/dissertations/fullcit/3076817

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Physical Therapy in the Rehabilitation of Elderly Hip Surgery Patients in the Acute Setting by Beeson, Diane Ruth, Phd from University of California, San Francisco, 1981, 249 pages http://wwwlib.umi.com/dissertations/fullcit/8304202

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Preliminary Study of the Relationship of Knowledge to Compliance and Outcomes in Patients after Anterior Cruciate Ligament Surgery by Billek-sawhney, Barbara Jean; Edd from Duquesne University, 2001, 155 pages http://wwwlib.umi.com/dissertations/fullcit/3085495

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Preoperative Preparation of Adult Patients for Cardiac Surgery: the Relationship of Singularity and Interaction Elements. (volumes I and Ii) (patient Education) by Lloyd, Mary Bernice, Phd from Temple University, 1992, 614 pages http://wwwlib.umi.com/dissertations/fullcit/9218090

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Preparation for Practice: an Evaluation of Residency Education in General Surgery by Cohen, Adrianne Hazel, Edd from University of Toronto (canada), 1992, 186 pages http://wwwlib.umi.com/dissertations/fullcit/NN78806

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Psychosocial Aspects of Physical Appearance: a Study in Aesthetic Surgery by Coco, Mary Kay, Dsw from The University of Utah, 1980, 162 pages http://wwwlib.umi.com/dissertations/fullcit/8101002

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Psychosocial Responses of School-age Children to Cardiac Surgery by Connolly, Dana Marie; Phd from New York University, 2002, 157 pages http://wwwlib.umi.com/dissertations/fullcit/3045708

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Regional Oxygenation in Cardiac Surgery: Influence of Temperature, Pump Flow and Insulin by Lindholm, Lena Elisabeth; Phd from Goteborgs Universitet (sweden), 2002, 49 pages http://wwwlib.umi.com/dissertations/fullcit/f661889

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Response to Traumatic Surgery in the Light of Cognitive Dissonance Theory by Markson, Jordan Quenton, Edd from Boston University School of Education, 1973, 87 pages http://wwwlib.umi.com/dissertations/fullcit/7323586

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Resumption of Employment after Hip Replacement Surgery: What to Measure, and How? by Bohm, Eric Richard; Msc from Dalhousie University (canada), 2002, 118 pages http://wwwlib.umi.com/dissertations/fullcit/MQ75565

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Richard Selzer and the Rhetoric of Surgery (medical History, Emerson, Metaphor, Scientific Language, Doctor, Writer) by Anderson, Charles M., Phd from The University of Iowa, 1985, 238 pages http://wwwlib.umi.com/dissertations/fullcit/8518802

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Robotic Assisted Suturing in Minimally Invasive Surgery by Kang, Hyosig; Phd from Rensselaer Polytechnic Institute, 2002, 166 pages http://wwwlib.umi.com/dissertations/fullcit/3057670

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Saving Face: Women's Experiences with Cosmetic Surgery by Ancheta, Rebecca Wepsic; Phd from University of California, San Francisco, 2000, 167 pages http://wwwlib.umi.com/dissertations/fullcit/9974764

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Segregation or Surgery: the Mentally Retarded in America, 1850-1920 by Tyor, Peter Lawrence, Phd from Northwestern University, 1972, 254 pages http://wwwlib.umi.com/dissertations/fullcit/7232598

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Selected Aspects in the Attainment and Use of the Doctor of Medicine, Doctor of Dental Surgery, and Bachelor of Laws Degrees by Women Graduates of Tulane University and Loyola University of the South by Lueth, Carl Anthony, Edd from The University of Mississippi, 1973, 217 pages http://wwwlib.umi.com/dissertations/fullcit/7323654

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Selective Contracting and Hospital Quality under Managed Care: an Empirical Analysis of Network Open-heart Surgery Hospitals in California, over Time by Cubellis, James Michael, Phd from University of California, Irvine, 1997, 92 pages http://wwwlib.umi.com/dissertations/fullcit/9727749

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Selves in Transition: the Consumption of Aesthetic Plastic Surgery by Schouten, John W., Phd from The University of Utah, 1990, 142 pages http://wwwlib.umi.com/dissertations/fullcit/9024426

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Shedding the Obese Role: a Three-year Study of Twenty Obese Females, Ages 13-53, Who Had Surgery for Weight Loss (gastric Bypass, Intestinal Bypass) by Wrobel, Sylvia Burroughs, Phd from University of Kentucky, 1989, 221 pages http://wwwlib.umi.com/dissertations/fullcit/9014238

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Silver Sutures: the Medical Career of J. Marion Sims (childbirth, Sexual Surgery, Women, Slavery, Southern Medicine) by Mcgregor, Deborah Kuhn, Phd from State University of New York at Binghamton, 1986, 199 pages http://wwwlib.umi.com/dissertations/fullcit/8608714

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Simulation of Bleeding and Other Visual Effects for Virtual Laparoscopic Surgery by Raghupathi, Lakshminarasimhan; Msee from The University of Texas at Arlington, 2002, 63 pages http://wwwlib.umi.com/dissertations/fullcit/1412849

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Simulation of Insufflation of Abdominal Cavity with Carbon Dioxide for Laparoscopic Surgery by Phatak, Sarika Udaychandra; Msee from The University of Texas at Arlington, 2002, 97 pages http://wwwlib.umi.com/dissertations/fullcit/1408942

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Simulation of Preperitoneal Mesh in Laparoscopic Hernia Surgery by Sugavanam, Sivashanmugaraman; Msee from The University of Texas at Arlington, 2002, 66 pages http://wwwlib.umi.com/dissertations/fullcit/1412857

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Speech Intelligibility Measures of Cleft Palate Speakers before and after Pharyngeal Flap Surgery by Shupe, Lewis Kay, Phd from State University of New York at Buffalo, 1968, 141 pages http://wwwlib.umi.com/dissertations/fullcit/6817345

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Starting over at Forty-eight: Recovery from Brain Surgery by Naughton, Sarah; Edd from University of St. Thomas (st. Paul), 1999, 223 pages http://wwwlib.umi.com/dissertations/fullcit/9962607

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Studies in the Economics of Surgery by Garrison, Louis Preston, Jr., Phd from Stanford University, 1981, 215 pages http://wwwlib.umi.com/dissertations/fullcit/8115790

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Supplemental Bovine Colostrum in Elective Abdominal Aortic Aneurysm Surgery and Experimental Intestinal Ischaemia by Mccune, Kenneth Harold; Md from Queen's University of Belfast (northern Ireland), 2002, 341 pages http://wwwlib.umi.com/dissertations/fullcit/f661937

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Sweatbaths, Sacrifice, and Surgery: the Practice of Transmedical Health Care by Mixtec Migrant Families in California (mexico) by Bade, Bonnie Lynn, Phd from University of California, Riverside, 1994, 141 pages http://wwwlib.umi.com/dissertations/fullcit/9513159

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Symbolic Talk in Preschoolers Who Have Had Infant Heart Surgery by Ovadia, Rebecca, Edd from Harvard University, 1997, 143 pages http://wwwlib.umi.com/dissertations/fullcit/9734904

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Synthesis of Silicone Magnetic Fluids for Use in Eye Surgery by Rutnakornpituk, Metha; Phd from Virginia Polytechnic Institute and State University, 2002, 258 pages http://wwwlib.umi.com/dissertations/fullcit/3061274

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Synthetic Beauty: American Women and Cosmetic Surgery by Anderson, Lenore Wright, Phd from Rice University, 1989, 425 pages http://wwwlib.umi.com/dissertations/fullcit/9012773

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The Administration of Narcotic Analgesics in the Post-anesthetic Care Unit and the Length of Stay in the Ambulatory Surgery Unit by Taylor, Helen Catherine; Ms from D'youville College, 2002, 89 pages http://wwwlib.umi.com/dissertations/fullcit/1408488

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The Cardiovascular Response of Post Coronary Artery Bypass Surgery Patients to Hydraulic Circuit Training by Haennel, Robert Gerald, Phd from University of Alberta (canada), 1987 http://wwwlib.umi.com/dissertations/fullcit/f387733

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The Cardiovascular Response of Post Coronary Artery Bypass Surgery Patients to Hydraulic Circuit Training by Haennel, Robert Gerald; Phd from University of Alberta (canada), 1987 http://wwwlib.umi.com/dissertations/fullcit/NL41074

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The Changing Path of Inguinal Hernia Surgery by Berndsen, Fritz Hendrik; Phd from Lunds Universitet (sweden), 2003, 112 pages http://wwwlib.umi.com/dissertations/fullcit/f113761

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The Effect of Ambulatory Surgery Policy Provisions on Medical Expense Insurance Claims by Doerpinghaus, Helen Iris, Phd from University of Pennsylvania, 1989, 186 pages http://wwwlib.umi.com/dissertations/fullcit/8922488

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The Effect of Guided Imagery on the Physiological Stress of the Cardiac Surgery Patient by Worcester, Peggy Jean; Msn from Medical College of Ohio at Toledo, 2002, 80 pages http://wwwlib.umi.com/dissertations/fullcit/1408565

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The Effect of Some Psycho-social Variables on the Post - Cardiac-surgery Adjustment by Kurz, Bronka Harz, Dsw from Columbia University, 1972, 170 pages http://wwwlib.umi.com/dissertations/fullcit/7231219

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The Effects of Adjuvant Therapies for Colorectal Cancer on the Healing of Experimental Colonic Anastomosis and the Outcome of Surgery by El Malt, Mohamed Moustafa Hedaya; Phd from Rijksuniversiteit Te Gent (belgium), 2002, 105 pages http://wwwlib.umi.com/dissertations/fullcit/f661137

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The Effects of Preoperative Counseling As an Aid to Recovery from Major Surgery. by Hendren, Glen Roy, Phd from The University of Southern Mississippi, 1974, 66 pages http://wwwlib.umi.com/dissertations/fullcit/7425504

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The Effects of Preoperative Counselling on Postoperative Recovery : Open Heart Surgery Patients by Hunt, Larry R; Phd from University of Toronto (canada), 1978 http://wwwlib.umi.com/dissertations/fullcit/NK38746

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The Effects of Self-esteem, Success Vs. Failure Feedback, and Cognitive Load on Attitudes toward Tattooing and Cosmetic Surgery by Hill, Timothy; Ma from University of Louisville, 2002, 93 pages http://wwwlib.umi.com/dissertations/fullcit/1409359

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The Effects of Surgeon Supply on the Demand for Surgery (demand Inducement, Health Care Costs) by Jones, Alison Snow, Phd from The Johns Hopkins University, 1991, 377 pages http://wwwlib.umi.com/dissertations/fullcit/9132668

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The Making of the Unborn Patient: Medical Work and the Politics of Reproduction in Experimental Fetal Surgery, 1963-1993 (reproductive Medicine) by Casper, Monica Jean, Phd from University of California, San Francisco, 1995, 347 pages http://wwwlib.umi.com/dissertations/fullcit/9614328

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The Medicalization of Feminine Beauty: a Study of Cosmetic Surgery by Mark, Marie Elizabeth; Phd from City University of New York, 2001, 122 pages http://wwwlib.umi.com/dissertations/fullcit/9997107

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The Relationship of Preoperative Depression and Disability to Measures of Early Postoperative Course in Peripheral Vascular Surgery: a Pilot Study by Donayre, Dorene Kay; Ms from California State University, Long Beach, 2002, 186 pages http://wwwlib.umi.com/dissertations/fullcit/1410291

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The Role of Personal, Disease, and Situational Characteristics in Relation to Outcome from Breast Surgery by Funch, Donna P., Phd from State University of New York at Buffalo, 1980, 265 pages http://wwwlib.umi.com/dissertations/fullcit/8104190

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The Role of Self and Object Representations in the Response of Patients to the Argon Laser Treatment of Their Port Wine Stains (plastic Surgery, Patient Satisfaction) by Becker, Michael Frederic, Phd from Smith College School for Social Work, 1991, 302 pages http://wwwlib.umi.com/dissertations/fullcit/9229218

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The Royal College of San Carlos: Surgery and Spanish Medical Reform in the Late Eighteenth Century by Burke, Michael Edmund, Phd from Duke University, 1971, 351 pages http://wwwlib.umi.com/dissertations/fullcit/7205348

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Three Essays on Volume, Complications and Hospital Resource Use: the Case of Knee Replacement Surgery by Gutierrez, Benjamin, Phd from Indiana University, 1995, 115 pages http://wwwlib.umi.com/dissertations/fullcit/9539955

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Transesophageal Echocardiography in Patients Undergoing Elective Coronary Artery Bypass Surgery by Palmgren, Ingrid Maria Elisabet; Phd from Uppsala Universitet (sweden), 2002, 40 pages http://wwwlib.umi.com/dissertations/fullcit/f660801

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Use of the Accurate Expectations Theory in Designing Preoperative Preparations for Dental Surgery. by Wright, Anne Mcbrearty, Phd from Case Western Reserve University, 1977, 125 pages http://wwwlib.umi.com/dissertations/fullcit/7731019

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Women's Lived-experience of Pelvic Exenterative Surgery by Edwards, Beverley Eleanor, Phd from University of Alberta (canada), 1987 http://wwwlib.umi.com/dissertations/fullcit/f348933

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Women's Lived-experience of Pelvic Exenterative Surgery by Edwards, Beverley Eleanor; Phd from University of Alberta (canada), 1987 http://wwwlib.umi.com/dissertations/fullcit/NL37615

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

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

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

Chemoradiotherapy Followed By Surgery and Docetaxel in Treating Patients With Pancoast Tumors Condition(s): stage II non-small cell lung cancer; stage IIIA non-small cell lung cancer; stage IIIB non-small cell lung cancer Study Status: This study is currently recruiting patients. Sponsor(s): Southwest Oncology Group; National Cancer Institute (NCI); Eastern Cooperative Oncology Group; American College of Surgeons; National Cancer Institute of Canada Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy such as cisplatin, etoposide, and docetaxel use different ways to stop tumor cells from dividing so they stop growing or die. Radiation therapy uses high-energy x-rays to damage tumor cells. Combining cisplatin and etoposide with radiation therapy may shrink the tumor so it can be removed by surgery. Giving docetaxel after surgery may kill any remaining tumor cells. PURPOSE: Phase II trial to study the effectiveness of chemoradiotherapy with cisplatin and etoposide followed by surgery and docetaxel in treating patients who have newly diagnosed Pancoast tumors, a type of non-small cell lung cancer. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00062439

8

These are listed at www.ClinicalTrials.gov.

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Chemotherapy Before and After Surgery in Treating Children With Wilm's Tumor Condition(s): Wilms' Tumor; Wilms' tumor and other childhood kidney tumors Study Status: This study is currently recruiting patients. Sponsor(s): Societe Internationale d'Oncologie Pediatrique; Societe Francaise Oncologie Pediatrique; United Kingdom Children's Cancer Study Group; Gesellschaft fur Padiatrische Onkologie und Hamatologie - Germany Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Giving combination chemotherapy before surgery may shrink the tumor so it can be removed during surgery. Giving more chemotherapy after surgery may kill any remaining tumor cells. It is not yet known which chemotherapy regimen after surgery is most effective in treating Wilm's tumor. PURPOSE: Phase III trial to study the effectiveness of chemotherapy before and after surgery in treating children who have Wilm's tumor. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00047138

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Chemotherapy Plus Surgery in Treating Patients With Stage III or Stage IV Ovarian, Peritoneal, or Fallopian Tube Cancer Condition(s): stage III ovarian epithelial cancer; stage IV ovarian epithelial cancer; Fallopian Tube Cancer; peritoneal cavity cancer Study Status: This study is currently recruiting patients. Sponsor(s): EORTC Gynecological Cancer Cooperative Group Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining surgery with chemotherapy may kill more tumor cells. It is not yet known whether chemotherapy before surgery is more effective than chemotherapy after surgery in treating ovarian, peritoneal, or fallopian tube cancer. PURPOSE: Randomized phase III trial to compare the effectiveness of chemotherapy before surgery with that of chemotherapy after surgery, with or without additional surgery, in treating patients who have stage III or stage IV ovarian cancer, peritoneal cancer, or fallopian tube cancer. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00003636

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Chemotherapy, Radiation Therapy, and Surgery in Treating Patients With Rectal Cancer Condition(s): stage II rectal cancer; stage III rectal cancer; adenocarcinoma of the rectum Study Status: This study is currently recruiting patients. Sponsor(s): Eastern Cooperative Oncology Group; National Cancer Institute (NCI) Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Radiation therapy uses

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high-energy x-rays to damage tumor cells. Combining chemotherapy, radiation therapy, and surgery may be effective treatment for rectal cancer. PURPOSE: Phase I trial to study the effectiveness of radiation therapy plus chemotherapy followed by surgery and additional chemotherapy in treating patients who have advanced nonmetastatic primary cancer of the rectum. Phase(s): Phase I Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00003799 •

Combination Chemotherapy and Peripheral Stem Cell Transplantation With or Without Radiation Therapy and/or Surgery in Treating Patients With Ewing's Sarcoma Condition(s): localized tumors of the Ewing's family; metastatic tumors of the Ewing's family Study Status: This study is currently recruiting patients. Sponsor(s): European Ewing Tumour Working Initiative of National Groups; National Cancer Institute (NCI); United Kingdom Children's Cancer Study Group; Societe Francaise Oncologie Pediatrique; EORTC Soft Tissue and Bone Sarcoma Cooperative Group; Gesellschaft fur Padiatrische Onkologie und Hamatologie - Germany; Gesellschaft fur Padiatrische Onkologie und Hamatologie - Austria; Swiss Institute for Applied Cancer Research; EBMT Solid Tumors Working Party; Children's Oncology Group; EORTC Children's Leukemia Cooperative Group Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Radiation therapy uses high-energy x-rays to damage tumor cells. Peripheral stem cell transplantation may allow the doctor to give higher doses of chemotherapy and kill more tumor cells. It is not yet known if combination chemotherapy is more effective with or without radiation therapy and/or surgery in treating Ewing's sarcoma. PURPOSE: Randomized phase III trial to compare the effectiveness of combination chemotherapy and peripheral stem cell transplantation with or without radiation therapy and/or surgery in treating patients who have a Ewing's sarcoma. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00020566

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Combination Chemotherapy Before Surgery in Treating Children With Localized Neuroblastoma Condition(s): localized unresectable neuroblastoma Study Status: This study is currently recruiting patients. Sponsor(s): Societe Internationale d'Oncologie Pediatrique; United Kingdom Children's Cancer Study Group Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Giving chemotherapy drugs

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before surgery may shrink the tumor so that it can be removed during surgery. PURPOSE: Phase III trial to determine the effectiveness of combination chemotherapy given before surgery in treating children who have localized neuroblastoma. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00025428 •

Combination Chemotherapy Followed by Radiation Therapy Before Surgery in Treating Patients With Stage IIIB Non-Small Cell Lung Cancer Condition(s): squamous cell lung cancer; large cell lung cancer; stage IIIB non-small cell lung cancer; adenosquamous cell lung cancer Study Status: This study is currently recruiting patients. Sponsor(s): Swiss Institute for Applied Cancer Research Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Radiation therapy uses high energy x-rays to damage tumor cells. Combining chemotherapy with radiation therapy before surgery may shrink the tumor so that it can be removed during surgery. PURPOSE: Phase II trial to study the effectiveness of combination chemotherapy followed by radiation therapy before surgery in treating patients who have stage IIIB non-small cell lung cancer. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00030810

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Combination Chemotherapy Followed by Second-Look Surgery and Radiation Therapy in Treating Children With Nonmetastatic Medulloblastoma or Primitive Neuroectodermal Tumor Condition(s): untreated childhood supratentorial primitive neuroectodermal tumors; untreated childhood medulloblastoma Study Status: This study is currently recruiting patients. Sponsor(s): Children's Oncology Group; National Cancer Institute (NCI) Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Radiation therapy uses high-energy x-rays to damage tumor cells. Combining more than one drug and combining chemotherapy with surgery and radiation therapy may kill more tumor cells. PURPOSE: Phase III trial to study the effectiveness of combination chemotherapy followed by second-look surgery and radiation therapy in treating children who have nonmetastatic medulloblastoma or primitive neuroectodermal tumor. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00006461

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Combination Chemotherapy Followed by Surgery in Treating Infants With Newly Diagnosed Neuroblastoma Condition(s): disseminated neuroblastoma Study Status: This study is currently recruiting patients. Sponsor(s): European Infant Neuroblastoma Study Group - 1999 Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining more than one drug, and giving them before surgery, may shrink the tumor so that it can be removed during surgery. PURPOSE: Phase II trial to study the effectiveness of combination chemotherapy followed by surgery in treating infants who have newly diagnosed neuroblastoma. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00025623

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Combination Chemotherapy Followed by Surgery in Treating Infants With Newly Diagnosed Neuroblastoma. Condition(s): localized unresectable neuroblastoma Study Status: This study is currently recruiting patients. Sponsor(s): European Infant Neuroblastoma Study Group - 1999 Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Giving a chemotherapy drug before surgery may shrink the tumor so that it can be removed during surgery. PURPOSE: Phase II trial to study the effectiveness of combination chemotherapy followed by surgery in treating infants who have newly diagnosed neuroblastoma. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00025597

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Combination Chemotherapy Followed by Surgery in Treating Patients With Stomach Cancer Condition(s): stage I gastric cancer; stage II gastric cancer; stage III gastric cancer; stage IV gastric cancer Study Status: This study is currently recruiting patients. Sponsor(s): Kaplan Cancer Center; National Cancer Institute (NCI) Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining more than one drug and combining chemotherapy with surgery may kill more tumor cells. PURPOSE: Phase II trial to study the effectiveness of irinotecan and cisplatin followed by surgery, floxuridine, and cisplatin in treating patients who have stomach cancer. Phase(s): Phase II

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Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00004103 •

Combination Chemotherapy With or Without Filgrastim Before Surgery, High-Dose Chemotherapy, and Radiation Therapy Followed by Isotretinoin With or Without Monoclonal Antibody in Treating Patients With Neuroblastoma Condition(s): regional neuroblastoma; disseminated neuroblastoma; localized unresectable neuroblastoma

neuroblastoma;

stage

4S

Study Status: This study is currently recruiting patients. Sponsor(s): Societe Internationale d'Oncologie Pediatrique Purpose - Excerpt: RATIONALE: Colony-stimulating factors such as filgrastim may increase the number of immune cells found in bone marrow or peripheral blood and may help a person's immune system recover from the side effects of chemotherapy. Combining chemotherapy with peripheral stem cell transplantation may allow the doctor to give higher doses of chemotherapy drugs and kill more tumor cells. Monoclonal antibodies can locate tumor cells and either kill them or deliver tumorkilling substances to them without harming normal cells. Combining isotretinoin and monoclonal antibodies may kill any remaining tumor cells following surgery. It is not yet known which treatment regimen is more effective in treating neuroblastoma. PURPOSE: Randomized phase III trial to determine the effectiveness of combination chemotherapy with or without filgrastim before surgery, high-dose chemotherapy, and radiation therapy followed by isotretinoin with or without monoclonal antibody in treating patients who have neuroblastoma. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00030719 •

Combination Chemotherapy, Monoclonal Antibody Therapy, and Surgery in Treating Women With Stage II, Stage III, or Stage IV Breast Cancer Condition(s): stage II breast cancer; stage IV breast cancer; stage IIIA breast cancer; stage IIIB breast cancer; inflammatory breast cancer Study Status: This study is currently recruiting patients. Sponsor(s): UNC Lineberger Comprehensive Cancer Center; National Cancer Institute (NCI) Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Monoclonal antibodies such as trastuzumab can locate tumor cells and either kill them or deliver tumor-killing substances to them without harming normal cells. Combining chemotherapy, monoclonal antibody therapy, and surgery may be a more effective treatment for breast cancer. PURPOSE: Phase II trial to study the effectiveness of combination chemotherapy, monoclonal antibody therapy, and surgery in treating women who have stage II, stage III, or stage IV breast cancer. Phase(s): Phase II

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Combination Chemotherapy, Surgery or Radiation Therapy, and Peripheral Stem Cell Transplantation in Treating Patients With Recurrent Medulloblastoma or Primitive Neuroectodermal and Pineal Tumors Condition(s): recurrent childhood supratentorial primitive neuroectodermal tumors; recurrent childhood medulloblastoma Study Status: This study is currently recruiting patients. Sponsor(s): United Kingdom Children's Cancer Study Group Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Giving a chemotherapy drug before surgery or radiation therapy may shrink the tumor so that it can be removed during surgery or radiation therapy. Peripheral stem cell transplantation may be able to replace immune cells that were destroyed by chemotherapy or radiation therapy and allow doctors to give higher doses of chemotherapy. PURPOSE: Phase II trial to study the effectiveness of combination chemotherapy followed by surgery or radiation therapy and peripheral stem cell transplantation in treating patients who have recurrent medulloblastoma or primitive neuroectodermal and pineal tumors. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00025077

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Combination Chemotherapy, Surgery, and Radiation Therapy in Treating Patients With Non-Small Cell Lung Cancer Condition(s): stage II non-small cell lung cancer; stage IIIA non-small cell lung cancer; stage IIIB non-small cell lung cancer Study Status: This study is currently recruiting patients. Sponsor(s): Fox Chase Cancer Center; National Cancer Institute (NCI) Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Radiation therapy uses high-energy x-rays to damage tumor cells. Giving combination chemotherapy with radiation therapy before and after surgery may shrink the tumor so it can be removed during surgery and may kill any remaining tumor cells following surgery. PURPOSE: Phase II trial to study the effectiveness of combining paclitaxel and carboplatin with radiation therapy and surgery in treating patients who have newly diagnosed locally advanced non-small cell lung cancer. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00043108

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Comparison of Two Types of Surgery in Treating Patients With Rectal Cancer Condition(s): stage I rectal cancer; stage II rectal cancer; stage III rectal cancer Study Status: This study is currently recruiting patients. Sponsor(s): NMRC International Colorectal Cancer Trials Group Purpose - Excerpt: RATIONALE: Surgery to remove the tumor may be an effective treatment for rectal cancer. It is not yet known whether one type of surgery is more effective than another for rectal cancer. PURPOSE: Randomized phase III trial to compare the effectiveness of two types of surgery in treating patients who have rectal cancer. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00007930

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Conventional Surgery Compared With Laparoscopic-Assisted Surgery in Treating Patients With Colorectal Cancer Condition(s): Colon Cancer; Rectal Cancer Study Status: This study is currently recruiting patients. Sponsor(s): Medical Research Council Purpose - Excerpt: RATIONALE: Laparoscopic-assisted surgery is a less invasive type of surgery for colorectal cancer and may have fewer side effects and improve recovery. It is not yet known if undergoing conventional surgery is more effective than laparoscopicassisted surgery for colorectal cancer. PURPOSE: Randomized phase III trial to compare the effectiveness of conventional surgery with that of laparoscopic-assisted surgery in treating patients who have colorectal cancer. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00003354

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Correlation of Menstrual Cycle Phase at Time of Primary Surgery With 5-Year Disease-Free Survival in Women With Stage I or Stage II Breast Cancer Condition(s): stage I breast cancer; stage II breast cancer; perioperative/postoperative complications Study Status: This study is currently recruiting patients. Sponsor(s): North Central Cancer Treatment Group; National Cancer Institute (NCI); National Surgical Adjuvant Breast and Bowel Project (NSABP) Purpose - Excerpt: RATIONALE: Timing of breast cancer surgery may improve effectiveness of treatment and may help patients live longer. PURPOSE: Clinical trial to determine whether timing of primary surgery in relation to menstrual cycle is associated with disease-free survival 5 years after surgery in women who have stage I or stage II breast cancer. Study Type: Interventional

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Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00002762 •

Genetic Changes in Patients With Non-Small Cell Lung Cancer Who Are Receiving Vinorelbine and Gemcitabine Before Surgery Condition(s): stage I non-small cell lung cancer; stage II non-small cell lung cancer; stage IIIA non-small cell lung cancer; stage IIIB non-small cell lung cancer Study Status: This study is currently recruiting patients. Sponsor(s): Roswell Park Cancer Institute; National Cancer Institute (NCI) Purpose - Excerpt: RATIONALE: Determination of genetic changes in patients with nonsmall cell lung cancer may help predict the outcome of treatment. Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining more than one drug, and giving them before surgery, may shrink the tumor so that it can be removed during surgery. PURPOSE: Phase II trial to study genetic changes and the effectiveness of combining vinorelbine with gemcitabine before surgery in treating patients who have stage IB, stage II, or stage III non-small cell lung cancer. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00057798

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Neoadjuvant Chemoradiotherapy Followed By Surgery in Treating Patients With Limited-Stage Small Cell Lung Cancer Condition(s): limited stage small cell lung cancer Study Status: This study is currently recruiting patients. Sponsor(s): Fox Chase Cancer Center; National Cancer Institute (NCI) Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy such as irinotecan and cisplatin use different ways to stop tumor cells from dividing so they stop growing or die. Radiation therapy uses high-energy x-rays to damage tumor cells. Irinotecan and cisplatin may also make the tumor cells more sensitive to radiation therapy. Combining chemotherapy with radiation therapy before surgery may shrink the tumor so that it can be removed during surgery. PURPOSE: Phase I trial to study the effectiveness of neoadjuvant chemoradiotherapy with irinotecan and cisplatin followed by surgery in treating patients who have limited-stage small cell lung cancer. Phase(s): Phase I Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00062322

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Observation or Radiation Therapy and/or Chemotherapy and Second Surgery in Treating Children Who Have Undergone Surgery for Ependymoma Condition(s): childhood supratentorial ependymoma; newly diagnosed childhood ependymoma; childhood infratentorial ependymoma

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Study Status: This study is currently recruiting patients. Sponsor(s): Children's Oncology Group; National Cancer Institute (NCI) Purpose - Excerpt: RATIONALE: Specialized radiation therapy that delivers a high dose of radiation directly to the tumor may kill more tumor cells and cause less damage to normal tissue. Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Giving chemotherapy before surgery may shrink the tumor so that it can be removed during surgery. PURPOSE: Phase II trial to determine the effectiveness of specialized radiation therapy either alone or after chemotherapy and second surgery in treating children who have undergone surgery for localized ependymoma. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00027846 •

Surgery and Photodynamic Therapy in Treating Patients With Malignant Mesothelioma Condition(s): localized malignant mesothelioma; recurrent malignant mesothelioma; epithelial mesothelioma; sarcomatous mesothelioma Study Status: This study is currently recruiting patients. Sponsor(s): Roswell Park Cancer Institute; National Cancer Institute (NCI) Purpose - Excerpt: RATIONALE: Photodynamic therapy uses light and drugs that make cancer cells more sensitive to light to kill cancer cells. Combining photodynamic therapy with surgery may be an effective treatment for malignant mesothelioma. PURPOSE: Phase II trial to study the effectiveness of combining photodynamic therapy with surgery in treating patients who have malignant mesothelioma. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00054002

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Surgery and Radiation Therapy Compared With Chemotherapy and Radiation Therapy in Treating Patients With Stage III or Stage IV Head and Neck Cancer That Can Be Removed During Surgery Condition(s): Hypopharyngeal Cancer; Laryngeal Cancer; lip and oral cavity cancer; Oropharyngeal Cancer; paranasal sinus and nasal cavity cancer Study Status: This study is currently recruiting patients. Sponsor(s): NMRC Head and Neck Cancer Group Purpose - Excerpt: RATIONALE: Radiation therapy uses high-energy x-rays to damage tumor cells. Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. It is not yet known whether surgery plus radiation therapy is more effective than chemotherapy plus radiation therapy for head and neck cancer. PURPOSE: Randomized phase III trial to compare the effectiveness of surgery plus radiation therapy to chemotherapy plus radiation therapy in treating patients with stage III or stage IV head and neck cancer that can be removed during surgery.

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Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00003576 •

Surgery Followed by Chemotherapy in Treating Young Patients With Soft Tissue Sarcoma Condition(s): Ewing's family of tumors; childhood rhabdomyosarcoma; childhood soft tissue sarcoma Study Status: This study is currently recruiting patients. Sponsor(s): Societe Internationale d'Oncologie Pediatrique Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining more than one chemotherapy drug with surgery and/or radiation therapy may kill more tumor cells. PURPOSE: Phase III trial to study the effectiveness of different regimens of combination chemotherapy with or without surgery and/or radiation therapy in treating patients with soft tissue sarcoma. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00002898

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Surgery in Treating Children With Neuroblastoma Condition(s): localized resectable neuroblastoma; stage 4S neuroblastoma Study Status: This study is currently recruiting patients. Sponsor(s): Children's Oncology Group; National Cancer Institute (NCI) Purpose - Excerpt: RATIONALE: Surgery alone may be effective in treating children with neuroblastoma. PURPOSE: Phase III trial to study the effectiveness of surgery alone in treating children who have neuroblastoma. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00003119

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Surgery in Treating Patients With Metastatic Melanoma Condition(s): Stage IV Melanoma; Recurrent Melanoma Study Status: This study is currently recruiting patients. Sponsor(s): Southwest Oncology Group; National Cancer Institute (NCI); Eastern Cooperative Oncology Group Purpose - Excerpt: RATIONALE: Surgery may be effective therapy in treating patients with metastatic melanoma. PURPOSE: Phase II trial to study the effectiveness of surgery in treating patients with metastatic melanoma.

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Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00002860 •

Surgery With or Without Chemotherapy in Treating Patients With Soft Tissue Sarcoma Condition(s): adult soft tissue sarcoma; clear cell sarcoma of the kidney; ovarian sarcoma; Pheochromocytoma; uterine sarcoma Study Status: This study is currently recruiting patients. Sponsor(s): EORTC Soft Tissue and Bone Sarcoma Cooperative Group; National Cancer Institute of Canada Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. It is not yet known whether giving chemotherapy after surgery is more effective than surgery alone in treating soft tissue sarcoma. PURPOSE: Randomized phase III trial to compare the effectiveness of surgery with or without chemotherapy in treating patients who have soft tissue sarcoma. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00002641

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Surgery With or Without Combination Chemotherapy in Treating Patients With Cancer of the Esophagus Condition(s): stage I gastric cancer; stage II gastric cancer; stage I esophageal cancer; stage II esophageal cancer; adenocarcinoma of the stomach; Adenocarcinoma of the Esophagus Study Status: This study is currently recruiting patients. Sponsor(s): Federation Nationale des Centres de Lutte Contre le Cancer Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. It is not known whether combining chemotherapy with surgery is more effective than surgery alone. PURPOSE: Randomized phase III trial to compare the effectiveness of surgery with or without combination chemotherapy in treating patients with cancer of the esophagus. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00002883

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Surgery With or Without Combination Chemotherapy in Treating Patients With Liver Metastases from Colorectal Cancer Condition(s): stage IV colon cancer; Stage IV rectal cancer; recurrent colon cancer; recurrent rectal cancer; liver metastases

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Study Status: This study is currently recruiting patients. Sponsor(s): EORTC Gastrointestinal Tract Cancer Cooperative Group; Australasian Gastro-Intestinal Trials Group; Arbeitsgruppe Lebermetastasen und tumoren in der Chirurgischen Arbeitsgemeinschaft Onkologie; Cancer Research UK; Fondation Francaise de Cancerologie Digestive Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining more than one drug and combining chemotherapy with surgery may kill more tumor cells. It is not yet known if surgery is more effective with or without chemotherapy for liver metastases. PURPOSE: Randomized phase III trial to compare the effectiveness of surgery with or without combination chemotherapy in treating patients who have liver metastases from colorectal cancer. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00006479 •

Surgery With or Without Combination Chemotherapy in Treating Patients With Nonsmall Cell Lung Cancer Condition(s): stage I non-small cell lung cancer; stage II non-small cell lung cancer; stage IIIA non-small cell lung cancer Study Status: This study is currently recruiting patients. Sponsor(s): Southwest Oncology Group; National Cancer Institute (NCI); Eastern Cooperative Oncology Group; North Central Cancer Treatment Group; Radiation Therapy Oncology Group Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining more than one drug may kill more tumor cells. It is not yet known if surgery plus combination chemotherapy is more effective than surgery alone for non-small cell lung cancer. PURPOSE: Randomized phase III trial to compare the effectiveness of surgery with or without combination chemotherapy in treating patients who have non-small cell lung cancer. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00004011

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Surgery With or Without Radiation Therapy and Chemotherapy in Treating Patients With Esophageal Cancer Condition(s): Adenocarcinoma of the Esophagus; squamous cell carcinoma of the esophagus; stage I esophageal cancer; stage II esophageal cancer Study Status: This study is currently recruiting patients. Sponsor(s): Federation Francophone de Cancerologie Digestive; GERCOR; EORTC Radiotherapy Cooperative Group; EORTC Gastrointestinal Tract Cancer Cooperative

220 Surgery

Group; Federation Nationale des Centres de Lutte Contre le Cancer; Societe Francaise de Radiotherapie Oncologique Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Giving combination chemotherapy with radiation therapy before surgery may shrink the tumor so it can be removed during surgery. It is not yet known if surgery is more effective with or without radiation therapy and chemotherapy in treating esophageal cancer. PURPOSE: Randomized phase III trial to compare the effectiveness of surgery with or without radiation therapy and chemotherapy in treating patients who have esophageal cancer. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00047112 •

Surgery With or Without Radiofrequency Ablation Followed by Irinotecan in Treating Patients With Colorectal Cancer That is Metastatic to the Liver Condition(s): Colon Cancer; liver metastases; Rectal Cancer Study Status: This study is currently recruiting patients. Sponsor(s): University of Washington; National Cancer Institute (NCI) Purpose - Excerpt: RATIONALE: Radiofrequency ablation uses high-frequency electric current to kill tumor cells. Combining radiofrequency ablation with surgery may kill more tumor cells. Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Giving a chemotherapy drug after surgery and radiofrequency ablation may kill any remaining tumor cells. PURPOSE: Phase II trial to determine the effectiveness of surgery with or without radiofrequency ablation followed by irinotecan in treating patients who have colorectal cancer that is metastatic to the liver. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00030563

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Surgery, Chemotherapy, and Radiation Therapy in Treating Patients With Peritoneal Cancer Condition(s): localized malignant mesothelioma; advanced malignant mesothelioma; recurrent malignant mesothelioma Study Status: This study is currently recruiting patients. Sponsor(s): Herbert Irving Comprehensive Cancer Center; National Cancer Institute (NCI) Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Giving the drugs directly into the tumor after surgery and combining them with radiation therapy may kill more tumor cells. PURPOSE: Phase II trial to study the effectiveness of combining surgery, chemotherapy, and radiation therapy in treating patients who have peritoneal cancer. Phase(s): Phase II

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Topical Imiquimod Compared With Surgery in Treating Patients With Basal Cell Skin Cancer Condition(s): basal cell carcinoma of the skin Study Status: This study is currently recruiting patients. Sponsor(s): Cancer Research UK Purpose - Excerpt: RATIONALE: Biological therapies such as imiquimod use different ways to stimulate the immune system and stop cancer cells from growing. It is not yet known if topical imiquimod is more effective than surgery in treating basal cell skin cancer. PURPOSE: Randomized phase III trial to compare the effectiveness of topical imiquimod with that of surgery in treating patients who have basal cell skin cancer. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00066872

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Vaccine Therapy Following Surgery in Treating Patients With Locally Advanced Kidney Cancer Condition(s): stage II renal cell cancer; stage III renal cell cancer Study Status: This study is currently recruiting patients. Sponsor(s): Antigenics Purpose - Excerpt: RATIONALE: Vaccines made from a patient's white blood cells and tumor cells may make the body build an immune response to kill tumor cells. It is not yet known if surgery plus vaccine therapy is more effective than surgery alone for advanced kidney cancer. PURPOSE: Randomized phase III trial to determine the effectiveness of vaccine therapy following surgery in treating patients who have locally advanced kidney cancer. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00017420

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Chemotherapy Followed by Surgery or Radiation Therapy in Treating Patients With Stage III Non-small Cell Lung Cancer Condition(s): squamous cell lung cancer; large cell lung cancer; stage IIIA non-small cell lung cancer; adenocarcinoma of the lung; adenosquamous cell lung cancer; bronchoalveolar cell lung cancer Study Status: This study is no longer recruiting patients. Sponsor(s): EORTC Lung Cancer Cooperative Group

222 Surgery

Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Giving a chemotherapy drug before surgery may shrink the tumor so that it can be removed during surgery. Radiation therapy uses high-energy x-rays to damage tumor cells. It is not yet known whether chemotherapy followed by surgery with or without radiation therapy is more effective than chemotherapy followed by radiation therapy alone in treating non-small cell lung cancer. PURPOSE: Randomized phase III trial to compare the effectiveness of chemotherapy followed by surgery with or without radiation therapy to that of chemotherapy followed by radiation therapy alone in treating patients who have stage III non-small cell lung cancer. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00002623 •

Chemotherapy With or Without Surgery in Treating Patients With Recurrent Ovarian Cancer Condition(s): recurrent ovarian epithelial cancer Study Status: This study is no longer recruiting patients. Sponsor(s): EORTC Gynecological Cancer Cooperative Group Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Giving a chemotherapy drug before surgery may shrink the tumor so that it can be removed during surgery. PURPOSE: Randomized phase III trial to study the effectiveness of chemotherapy with or without surgery in treating patients who have recurrent epithelial ovarian cancer. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00006356

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Combination Chemotherapy and Surgery With or Without G-CSF in Treating Patients With Osteosarcoma Condition(s): localized osteosarcoma Study Status: This study is no longer recruiting patients. Sponsor(s): European Osteosarcoma Intergroup; Medical Research Council Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Colony-stimulating factors such as G-CSF may increase the number of immune cells found in bone marrow or peripheral blood and may help a person's immune system recover from the side effects of chemotherapy. It is not yet known whether chemotherapy and surgery plus G-CSF is more effective than chemotherapy and surgery alone in treating patients with osteosarcoma. PURPOSE: Randomized phase III trial to compare the effectiveness combination chemotherapy and surgery with or without G-CSF in treating patients who have newly diagnosed osteosarcoma. Phase(s): Phase III

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Laparoscopic-Assisted Surgery Compared With Open Surgery in Treating Patients With Colon Cancer Condition(s): stage III colon cancer; stage I colon cancer; adenocarcinoma of the colon; stage II colon cancer Study Status: This study is no longer recruiting patients. Sponsor(s): National Cancer Institute (NCI); Southwest Oncology Group; Eastern Cooperative Oncology Group; Radiation Therapy Oncology Group; Cancer and Leukemia Group B; National Cancer Institute of Canada; National Surgical Adjuvant Breast and Bowel Project (NSABP); North Central Cancer Treatment Group Purpose - Excerpt: RATIONALE: Less invasive types of surgery may help reduce the number of side effects and improve recovery. It is not yet known which type of surgery is more effective for colon cancer. PURPOSE: Randomized phase III trial to compare the effectiveness of laparoscopic-assisted colectomy with open colectomy in treating patients who have colon cancer. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00002575

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Radiation Therapy and Fluorouracil Before Surgery in Treating Patients With Primary or Recurrent Bile Duct Cancer Condition(s): localized resectable adult primary liver cancer; recurrent adult primary liver cancer; localized extrahepatic bile duct cancer; recurrent extrahepatic bile duct cancer Study Status: This study is no longer recruiting patients. Sponsor(s): EORTC Chronotherapy Study Group Purpose - Excerpt: RATIONALE: Radiation therapy uses high-energy x-rays to damage tumor cells. Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining radiation therapy with chemotherapy before surgery may shrink the tumor so that it can be removed during surgery. PURPOSE: Phase II trial to study the effectiveness of combining radiation therapy with fluorouracil before surgery in treating patients who have primary or recurrent bile duct cancer. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00030511

224 Surgery

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Radiation Therapy With or Without Surgery in Treating Patients Who Have Brain Metastases Condition(s): brain metastases Study Status: This study is no longer recruiting patients. Sponsor(s): National Cancer Institute (NCI); Jonsson Comprehensive Cancer Center Purpose - Excerpt: RATIONALE: Radiation therapy uses high-energy x-rays to damage tumor cells in a single high dose. Combining radiation therapy with surgery may be a more effective treatment for brain metastases. PURPOSE: Clinical trial to study the effectiveness of radiation therapy with or without surgery in treating patients who have brain metastases. Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00003324

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Surgery With or Without Lymph Node Removal in Treating Older Women With Stage I or Stage IIA Breast Cancer Condition(s): stage I breast cancer; stage II breast cancer Study Status: This study is no longer recruiting patients. Sponsor(s): International Breast Cancer Study Group Purpose - Excerpt: RATIONALE: Removing axillary lymph nodes may be effective in stopping the spread of breast cancer cells. It is not yet known if surgery to remove breast cancer is more effective with or without lymph node removal. PURPOSE: Randomized phase III trial to compare the effectiveness of breast surgery with or without removal of axillary lymph nodes in treating women who have stage I or stage IIA breast cancer. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00002528

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Carboplatin or Topotecan With or Without Surgery in Treating Patients With Recurrent Ovarian Epithelial or Primary Peritoneal Cancer That Has Responded to Platinum-Based Chemotherapy Condition(s): recurrent ovarian epithelial cancer; peritoneal cavity cancer Study Status: This study is not yet open for patient recruitment. Sponsor(s): Gynecologic Oncology Group; National Cancer Institute (NCI) Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy such as carboplatin and topotecan use different ways to stop tumor cells from dividing so they stop growing or die. Giving chemotherapy after surgery may kill any remaining tumor cells. It is not yet known whether either carboplatin or topotecan alone is more effective than a second surgery followed by carboplatin or topotecan in treating patients who have ovarian epithelial or primary peritoneal cancer. PURPOSE: Randomized phase III trial to compare the effectiveness of either carboplatin or topotecan alone with that of a second surgery followed by carboplatin or topotecan in treating patients who have recurrent

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ovarian epithelial or primary peritoneal cancer that has responded to previous platinum-based chemotherapy. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00062413 •

Chemotherapy Plus Radiation Therapy With or Without Surgery in Treating Patients With Stage IIIA Non-small Cell Lung Cancer Condition(s): squamous cell lung cancer; adenocarcinoma of the lung; bronchoalveolar cell lung cancer; stage IIIA non-small cell lung cancer; large cell lung cancer Study Status: This study is completed. Sponsor(s): National Cancer Institute (NCI); Southwest Oncology Group; Eastern Cooperative Oncology Group; Cancer and Leukemia Group B; North Central Cancer Treatment Group; National Cancer Institute of Canada; Radiation Therapy Oncology Group Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining radiation therapy with chemotherapy may kill more tumor cells. It is not yet known if chemotherapy plus radiation therapy is more effective with or without surgery for lung cancer. PURPOSE: Randomized phase III trial to compare the effectiveness of cisplatin and etoposide plus radiation therapy with or without surgery in treating patients with stage IIIA non-small cell lung cancer. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00002550

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Combination Chemotherapy, Surgery, and Radiation Therapy With or Without Dexrazoxane and Trastuzumab in Treating Women With Stage III or Stage IV Breast Cancer Condition(s): cardiac toxicity; stage IIIB breast cancer; stage IIIA breast cancer; inflammatory breast cancer; stage IV breast cancer Study Status: This study is completed. Sponsor(s): National Cancer Institute (NCI); Cancer and Leukemia Group B Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Chemoprotective drugs, such as dexrazoxane, may protect normal cells from the side effects of chemotherapy. Monoclonal antibodies such as trastuzumab can locate tumor cells and either kill them or deliver tumor-killing substances to them without harming normal cells. Radiation therapy uses high-energy x-rays to damage tumor cells. It is not yet known if chemotherapy combined with surgery and radiation therapy is more effective with or without dexrazoxane and trastuzumab in treating breast cancer. PURPOSE: Randomized phase III trial to compare the effectiveness of combination chemotherapy,

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surgery, and radiation therapy with or without dexrazoxane and trastuzumab in treating women who have stage IIIA, stage IIIB or stage IV breast cancer. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00016276 •

Image Guided System for Orthopaedic Surgery Condition(s): Orthopaedic trauma; Hip Fracture Study Status: This study is not yet open for patient recruitment. Sponsor(s): National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Purpose - Excerpt: This project focuses on the further development and clinical testing of an image-guided surgical system. The system will help surgeons perform procedures that involve inserting a screw, guide pin, drill bit, or other straight object into bone-for example, inserting screws in a broken hip bone. These surgeries are currently done with the help of a mobile x-ray device called a C-arm, which provides the surgeon with x-ray images during the procedure. C-arms have some disadvantages, including image distortion, radiation exposure, and the need for time-consuming adjustments of the Carm during the surgery. The new method would deal with these shortcomings with a computer-based system that adds to the existing C-arm system. It would provide the surgeon with a real-time view of the insertion process, and could improve the accuracy and speed of certain surgical procedures. Disadvantages associated with C-arms include image distortion, radiation exposure, and time consuming reconfiguration of the C-arm during the insertion process. The proposed system would address these shortcomings with a computer-based system that augments the existing C-arm system. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00022802

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Kidney-Sparing Surgery Compared With Kidney Removal in Treating Patients With Kidney Cancer Condition(s): stage I renal cell cancer; stage II renal cell cancer; Renal Cell Adenocarcinoma Study Status: This study is completed. Sponsor(s): EORTC Genito-Urinary Tract Cancer Cooperative Group; Eastern Cooperative Oncology Group; American College of Surgeons; Southwest Oncology Group; National Cancer Institute of Canada Purpose - Excerpt: RATIONALE: Kidney-sparing surgery is a less invasive type of surgery for kidney cancer, and may have fewer side effects and improve recovery. It is unknown whether kidney-sparing surgery is more effective than kidney removal in treating kidney cancer. PURPOSE: Randomized phase III trial to compare the effectiveness of surgery to completely remove the kidney with kidney-sparing surgery in treating patients with resectable kidney cancer.

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Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00002473 •

Surgery and Combination Chemotherapy in Treating Children With Extracranial Germ Cell Tumors Condition(s): childhood malignant ovarian germ cell tumor; childhood extragonadal malignant germ cell tumor; childhood mature and immature teratomas; childhood malignant testicular germ cell tumor Study Status: This study is not yet open for patient recruitment. Sponsor(s): Children's Oncology Group; National Cancer Institute (NCI) Purpose - Excerpt: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining more than one drug, and giving them after surgery, may kill any remaining tumor cells following surgery. It is not yet known whether combination chemotherapy is effective in decreasing the recurrence of childhood germ cell tumors. PURPOSE: Phase III trial to determine the effectiveness of surgery followed by combination chemotherapy in treating children who have germ cell tumors that are not located in the head. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00053352

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Timing of Menstrual Cycle and Surgery in Treating Premenopausal Women With Stage I, Stage II, or Stage III Breast Cancer Condition(s): stage I breast cancer; stage II breast cancer; stage IIIA breast cancer; stage IIIB breast cancer Study Status: This study is completed. Sponsor(s): Jonsson Comprehensive Cancer Center; National Cancer Institute (NCI) Purpose - Excerpt: RATIONALE: The timing of breast cancer surgery within the menstrual cycle may affect outcome. It is not yet known if treatment is more effective during the initial or final phase of the menstrual cycle. PURPOSE: Phase III trial to determine the effect of menstrual cycle phase at surgery in treating premenopausal women who have stage I, stage II, or stage III breast cancer. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00005079

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

9Adapted

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

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

Access and cannulation device and method for rapidly placing same and for rapidly closing same in minimally invasive surgery Inventor(s): Spence; Paul A. (Louisville, KY), Williamson, IV; Warren P. (Loveland, OH), Christakis; George (Toronto, CA) Assignee(s): Origin Medsystems, Inc. (Menlo Park, CA) Patent Number: 6,488,692 Date filed: March 7, 2000 Abstract: An access and cannulation device includes a mounting element such as the anastomosis mounting element disclosed in U.S. application Ser. No. 08/714,615 (now U.S. Pat. No. 5,868,763) and U.S. application Ser. No. 09/200,796. The device is used to provide access therethrough and via an incision to the interior of a hollow anatomical structure such as a vessel, an organ or the like during surgery, especially minimally invasive surgery. It includes a flexible sleeve with a suture therein for closing the sleeve and locating edges of the structure adjacent to the incision in position for proper healing after completion of a surgical procedure. A tool is also disclosed for manipulating the device to configure it for the surgery and to close it after completion of the surgery whereby the edges of the wall of the structure adjacent to an incision are approximated to promote proper healing. Excerpt(s): The present invention relates to the general art of surgery, and to the particular field of minimally invasive surgery... As discussed in the incorporated documents, there is current interest in surgical techniques that are less invasive than previous techniques. This current interest has engendered interest in many areas that were previously abandoned including coronary fastening and valve placement among other areas that will occur to those skilled in the surgical art... Furthermore, many of these procedures include use of cardiopulmonary bypass for their execution. Cardiopulmonary bypass removes the venous blood from the heart and returns it to the circulation system of the patient through the patient's aorta or through one of its branches after it has been oxygenated. This bypass procedure makes it possible to remove the heart from the circulation system in order to perform corrections on the heart and also makes it possible to arrest the heart so that there is a non-moving field that is relatively free of obstructions for the surgeon to work. Web site: http://www.delphion.com/details?pn=US06488692__

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Apparatus and method for determining the relative position of bones during surgery Inventor(s): Chan; Kwan-Ho (4803 1st Pl., Lubbock, TX 79410) Assignee(s): none reported Patent Number: 6,632,226 Date filed: February 27, 2001 Abstract: A measuring gauge for measuring the relative position of two bones during surgery, the measuring gauge comprising an anchor, an adapter, an outrigger and a locking joint.

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Excerpt(s): This invention relates to surgical apparatus and procedures in general, and more particularly to surgical apparatus and procedures for determining the relative position of bones during surgery, and still more particularly to surgical apparatus and procedures for determining the distal displacement and lateral offset of a patient's femur relative to that patient's ilium during total hip replacement surgery... Unacceptable leg length inequalities, mis-sized lateral offsets, and joint dislocations are possible adverse outcomes of total hip replacement surgeries. Leg length inequalities and mis-sized lateral offsets (including, particularly, insufficient lateral offsets) can result in a persistent limp for patients who have undergone total hip replacement surgeries. Also, joint dislocations are more likely to occur if the soft tissue tension across the replaced joint is too lax as a result of a shortened limb and/or an insufficient lateral offset... It is, therefore, generally desirable to maintain the leg length, and the amount of lateral offset, which existed prior to the total hip replacement surgery. Sometimes, however, it may he desirable during total hip replacement surgery to change the leg length, and/or the amount of lateral offset, so as to compensate for deficiencies existing in the hip joint prior to the total hip replacement surgery. Web site: http://www.delphion.com/details?pn=US06632226__ •

Apparatus for corneal surgery Inventor(s): Vinciguerra; Paolo (Milan, IT), Sborgia; Maurizio (Milan, IT), Epstein; Daniel (Langenthal, CH), Azzolini; Marco (Milan, IT), MacRae; Scott (Portland, OR) Assignee(s): Nidek Co., Ltd. (Aichi, JP) Patent Number: 6,607,521 Date filed: August 21, 2001 Abstract: An apparatus for corneal surgery to correct a refractive error by ablating corneal tissue with a laser beam emitted from a laser source and delivered onto a cornea of a patient's eye with a light delivering optical system, the apparatus comprising an irradiation area limiting device for limiting an irradiation area of the laser beam and for varying the irradiation area, a first control device for controlling the irradiation area limiting device so as to reduce an ablation amount as the laser beam irradiates further away from a flattest meridian of astigmatism whereby effecting astigmatic correction, a second control device for controlling the irradiation area limiting device so as to increase an ablation amount as the laser beam irradiates further away from a steepest meridian of astigmatism whereby effecting astigmatic correction, and an arithmetic device for dividing a refractive power required for astigmatic correction into halves approximately-equally so that an approximately half of the astigmatic correction is achieved by the first control device and the residual astigmatic correction is achieved by the second control device. Excerpt(s): The present invention relates to an apparatus for corneal surgery to correct a refractive error by ablating corneal tissue with a laser beam, and more particularly to an apparatus suitable for astigmatic correction... An apparatus for corneal surgery to correct an refractive error of an eyeball by ablating a corneal surface with an excimer laser is conventionally known... However, astigmatic correction, especially myopic astigmatic correction, performed by using this kind of apparatus has a problem that is a hyperopic shift of spherical component often occurs after such a correction. To address this problem, two methods have been suggested: one is to minimize a size of ablation area in a meridian direction for correction so as to reduce affect of the hyperopic shift,

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and the other is to combine myopic astigmatic correction and hyperopic astigmatic correction in order to correct myopic astigmatism. Web site: http://www.delphion.com/details?pn=US06607521__ •

Apparatus for the simulation of image-guided surgery Inventor(s): Chui; Chee-Kong (Singapore, SG), Chen; Percy (Singapore, SG), Wang; Yaoping (Singapore, SG), Ang, Jr.; Marcelo H. (Singapore, SG), Cai; Yiyu (Singapore, SG), Mak; Koon-Hou (Singapore, SG) Assignee(s): Kent Ridge Digital Labs (SG), The National University of Singapore (SG), Tan Tock Seng Hospital Pte Ltd. (SG) Patent Number: 6,538,634 Date filed: December 18, 1998 Abstract: An apparatus for use in simulated image guided surgery comprises a positional transducer, clamping means located proximate to the transducer, and a processor. The transducer is responsive to a thin flexible member that can be manipulated by a user, and produces signals representative of displacement and rotation of the thin flexible member. The clamping means responds to a controlling signal to apply a predetermined variable clamping force to the flexible member. The processor receives these displacement and rotation signals, and is programmed to plot the path of the flexible member therefrom as it is manipulated by the user. Additionally, the processor produces the controlling signal to the clamping means in response to the instantaneous position along the path. The processor may be coupled to a display device for displaying an image of the instantaneous position of the flexible wire therealong, or other information. The invention also includes a related method for the simulation of image guided surgery. Embodiments of the invention can be used to simulate the manual positioning of a catheter and guidewire, as well as the haptic forces exerted by the user's hand and fingers in that positioning, or can simulate the process of balloon angioplasty, including stent deployment. Excerpt(s): The present invention relates to the field of image-guided surgery, and particularly to apparatus for the simulation of such surgery, such as may be used for pre-planning, teaching or research purposes... Minimally invasive therapeutic procedures, including surgery and interventional radiology, reduce patient discomfort, hospital stay, and medical costs. The socioeconomic impact of compensation for lost work time is also reduced. Interventional radiology began as a tool for diagnosing and treating vascular disease (defects, notably narrowing in arteries) by catheters that move along the blood vessel and guided by fluoroscopy. The interventional radiologist uses a catheter passed into a blood vessel through a puncture in the skin to gain internal access to the site of disease. The catheter is then used as a conduit to pass therapeutic devices to treat the condition. Its principle advantages include direct surgical exposure by cutting through the flesh is not needed, and many of the procedures are performed on an outpatient basis. This reduces cost and the discomfort to the patient, as well as the time of convalescence... Such procedures are typically carried out in a cardiac CathLab, where a physician wishes to assess the functions of the heart and coronary artery anatomy, or to perform procedures such as coronary angioplasty. Web site: http://www.delphion.com/details?pn=US06538634__

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Applicator for laparoscopic or endoscopic surgery Inventor(s): D'Alessio; Keith R. (Cary, NC), Mainwaring; Lawrence H. (Raleigh, NC) Assignee(s): Closure Medical Corporation (Raleigh, NC) Patent Number: 6,494,896 Date filed: November 30, 1999 Abstract: A hand-held applicator delivers liquid or semi-liquid compositions, such as adhesives, to an internal tissue or organ in an even and controlled manner. The applicator includes a pump, a tubular extension that is thin enough to pass through an endoscopic pathway or trocar, a proximal end of the tubular extension being sealingly connected to the pump, and an applicator tip that attaches to the distal end of the tubular extension. The tip includes the liquid and the pump pumps the liquid to the internal tissue in an even and controlled manner without contact of the liquid by the pump. The pump is preferably a micropipetter that includes a hand-held portion having a hand-actuatable plunger that does not come in direct, physical contact with the liquid to be dispensed. The composition may be an adhesive such as an alpha-cyanoacrylate. The device may further include a wound closure device including at least two closure pins extending from the distal end of the tubular extension. The wound closure device retracts from the applicator device and orients and aligns a wound or incision target tissue site immediately prior to application of the medical composition. The device provides improved control, ergonomics, and convenience. The device is particularly useful in the field of surgery, especially in the field of laparoscopic or endoscopic surgery, where an even and controlled amount of a medically-acceptable adhesive is to be applied to a target site on an internal tissue or organ. Excerpt(s): This invention relates to the field of surgery and wound closure. More particularly, this invention relates to devices for applying medically-acceptable adhesives, such as 1,1-disubstituted ethylene monomers, to surgical sites... Medical adhesives are used as alternates and/or adjuncts to sutures and staples as wound closure devices. As used herein, "wound" encompasses all disruptions of animal tissue, regardless of manner inflicted, and includes, for example, wounds that are inflicted unintentionally, through surgery, and through natural causes (e.g., degeneration of tissue, infection, etc.) One group of medical adhesives is the monomeric forms of 1,1disubstituted ethylene monomers, such as .alpha.-cyanoacrylates. Members of this group are disclosed in, for example, U.S. Pat. Nos. 5,328,687 to Leung et al; U.S. Pat. No. 3,527,841 to Wicker et al.; U.S. Pat. No. 3,722,599 to Robertson et al.; U.S. Pat. No. 3,995,641 to Kronenthal et al.; and U.S. Pat. No. 3,940,362 to Overhults... Applying medically acceptable adhesives to surgical sites for wound closure requires that the adhesive be dispensed in a precise and controlled manner to the site. Medical practitioners have encountered problems in applying this type of adhesive to internal organs and other deep tissues due to the current limited ability to evenly and controllably dispense an appropriate and accurate amount of the desired adhesive to the site to be closed. Although devices for delivering substances to wound sites are known in the art, none of the devices provide an adequate means for delivering a predetermined amount of adhesive to the site in a controlled and even manner. Web site: http://www.delphion.com/details?pn=US06494896__

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Balloon device for use in surgery and method of use Inventor(s): Jervis; James E. (Atherton, CA), Echeverry; Jan M. (San Jose, CA) Assignee(s): General Surgical Innovations, Inc. (Norwalk, CT) Patent Number: 6,565,589 Date filed: September 5, 1997 Abstract: A balloon device useful for dissecting tissue or retracting tissue for the purpose of providing space for laparoscopic surgery comprising a balloon having at least two protuberances in its distal region. The present device is particularly useful in bladder neck suspension and hernia repair procedures. Excerpt(s): The present invention constitutes specially shaped balloon dissection or retraction devices and their use. The invention relates generally to an apparatus and method for developing an anatomic space for laparoscopic procedures and, more specifically, to an apparatus and method particularly suitable for surgical procedures in which there is a need to dissect around an obstruction or around an area which it would be undesirable to dissect. The present invention provides a device which can be used to dissect around a hernia and in bladder neck suspension procedures, also known as urethropoxy, in which avoidance of the pubic symphysis is desirable... The present invention comprises a balloon suitable for tissue dissection or tissue retraction which has at least two protuberances (which may be referred to as "legs", "arms", "horns" or other descriptive term) at its distal region and its method of use... These protuberances may be relatively large relative to the remainder of the balloon or they may be relatively small, depending upon the anatomy of the region in which the balloon is to be used. The purpose of the protuberances is to achieve dissection in the desired location and to avoid dissection where it would be detrimental to the patient. Web site: http://www.delphion.com/details?pn=US06565589__

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Bipolar coagulation and cutting device for endoscopic surgery Inventor(s): Trapp; Rainer (Graben-Neudorf, DE), Dux; Uwe (Au am Rhein, DE) Assignee(s): Forschungszenlrum Karlsruhe GmbH (Karlsruhe, DE) Patent Number: 6,478,794 Date filed: September 2, 2000 Abstract: In a bipolar coagulation and cutting device for endoscopic surgery with a proximal operating part and a distal grasping part interconnected by a shaft, the distal grasping part includes jaws, each having two spaced branches supported on flexible wires. The jaws are held apart but are movable toward each other by actuating means extending along the shaft for the engagement of tissue between the jaws. HF energy can be supplied for the coagulation of the tissue engaged between the jaws. A wire electrode is also mounted on the shaft so as to be movable by the actuating means between the spaced branches of the jaws for cutting, by HF energy application, the coagulated tissue engaged between the jaws. Excerpt(s): The invention relates to a bipolar coagulation and cutting device for use in endoscopic surgeries with two U-shaped jaws, which are supported at the end of an operating shaft so as to be movable relative to each other for coagulating tissue engaged between the jaws and a cutting structure for severing the coagulated tissue... Such a combined instrument is known from the information leaflet of the Cabot Technology

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Corporation,2150 Cabot Boulevard West, Langhorne Pa. 19047, USA, which was distributed in 1995. The instrument described therein includes a grasping structure comprising two branches, which are U-shaped and along which tissue is coagulated. Subsequently, a cutting blade is moved forwardly through the grasping and coagulation structure, which cuts the tissue between the coagulated areas... A combination instrument, which is operated in principle in the same manner, is disclosed in U.S. Pat. No. 5,445,638. Both instruments have in common that the grasping structure is also used for bipolar coagulation and, after coagulation, the intermediate tissue area is cut mechanically by a cutting blade. This procedure is performed by the surgeon. The forces required for the cutting of the tissue have to be transmitted from one end of the instrument to the other. Web site: http://www.delphion.com/details?pn=US06478794__ •

Corneal surgery apparatus Inventor(s): Sumiya; Toshifumi (Aichi, JP) Assignee(s): Nidek Co., Ltd. (Aichi, JP) Patent Number: 6,585,723 Date filed: September 2, 1999 Abstract: In a corneal surgery apparatus, a corneal shape measurement unit for measuring a three-dimensional shape of a cornea includes a measurement light projecting optical system for projecting measurement light onto the cornea and its convergent point is shifted by moving a focusing lens along an optical axis, a measurement light receiving optical system including a photo-detector for receiving reflected light from the cornea and its convergent point is shifted by moving a focusing lens along an optical axis, a scanning unit for shifting a projection spot of the measurement light on the cornea in XY directions and an arithmetic unit for performing arithmetic to obtain the three-dimensional shape of the cornea from a position of the projection spot, a result detected by the photo-detector and a position to which the focusing lens is moved. Excerpt(s): The present invention relates to a corneal surgery apparatus for ablating a part of a cornea of a patient's eye to correct a refractive error of the eye or to remove a lesion therefrom... Conventionally known is a corneal surgery apparatus that ablates a corneal stroma of a patient's eye with an excimer laser or the like to change a refractive power of the eye to correct ametropia including myopia, hypermetropia, astigmatism and the like, or to remove an affected part of the cornea such as opacity. Also known is a corneal shape measurement apparatus (hereinafter referred to as a topography apparatus) that projects a placido ring onto a cornea and photographs an image of the placido ring to measure the corneal surface shape. Further, it has also been suggested to input the corneal shape data obtained by the topography apparatus to a corneal surgery apparatus. An amount to be ablated is calculated from the data and also the postoperative refractive power to be obtained. The ablation is carried out in accordance with the calculated ablation amount... However, the above-described way presents the following problems. One of the problems lies in the case of measuring a corneal shape of a patient's eye by a topography apparatus first, and then performing surgery to correct the refractive power by a separate corneal surgery apparatus based on the data captured from the topography apparatus. In this case, the positional relationship between the topography apparatus and the patient's eye is not necessarily the same as the positional relationship between the corneal surgery apparatus and the patient's eye. It is especially

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so, when the measurement by the topography apparatus is carried out with the patient being sit and fixed by the face, while the surgery by the corneal surgery apparatus is carried out with the patient being laid on his back. Due to the inclination of the face, the gravity and other various factors, it is often the case that the patient's eye is not in a uniform state. This results in the possibility of ablating an unintended part of the cornea. In this case, the post-operative corneal shape may differ from the expected one and the refractive error may not be corrected as expected. Web site: http://www.delphion.com/details?pn=US06585723__ •

Coronary stabilizer for performing beating heart surgery Inventor(s): Paolitto; Anthony (St. Leonard, CA), Valentini; Valerio (Montreal, CA), Cartier; Raymond (Town of Mount Royal, CA) Assignee(s): Coroneo, Inc. (Montreal, CA) Patent Number: 6,488,618 Date filed: April 14, 2000 Abstract: The present invention provides an improved coronary stabilizer for use in cardiac surgery, and more particularly during a coronary artery bypass graft (CABG) surgery performed directly on a beating heart. The coronary stabilizer is comprised of a body contact member and a handle. An opening or arterial window is provided in the body contact member, in order to allow surgical access to a target coronary artery which is exposed through said arterial window. In a first embodiment, the body contact member is a bifurcated hand comprising first and second body contacting portions, for placement alongside a target artery. Each of said body contacting portions is contoured to provide a coronary stabilizer with a substantially saddle-shaped body contacting surface, thereby tending to promote the extrusion of immobilized myocardium tissue through the arterial window generally disposed between first and second contacting portions. The coronary stabilizer according to this first embodiment preferably has a pull-type handle and is best suited to immobilize a posterior or inferior portion of the beating heart surface, during posterior coronary artery revascularizations. In a second embodiment, a coronary stabilizer with a substantially cup-shaped body contacting surface is provided and preferably configured with a push-type handle. It is best suited to immobilize an anterior portion of the beating heart surface, during anterior coronary artery revascularizations. The coronary stabilizers according to the present invention are preferably configured with an array of surgical wire attachment fittings for engaging an elastic surgical wire, that may be looped about a target artery, in order to create a substantially bloodless surgical field during a beating heart anastomosis. The contact surfaces of the coronary stabilizers preferably have a tread or tissue-engaging texture which may be configured to provide a tractive gradient. Excerpt(s): The present invention relates to the field of surgical apparatus, and more specifically to tissue stabilizers such as may be used, for example, to perform cardiac surgery on a beating heart... The growing interest in less invasive surgery has placed emphasis on cardiac surgery as well. The main difference in heart surgery with respect to other organ surgeries, gall bladder for instance, is that the beating motion of the heart tends to complicate the delicate surgical interventions that are normally performed in cardiac surgery... Cardiac surgery has been traditionally performed with the support of a cardio-pulmonary machine, whereby the patient's blood is oxygenated outside the body through extracorporeal circulation (ECC). This allows the surgeon to perform surgical procedures on a perfectly still heart, while the patient's life support is

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maintained by cardiopulmonary assistance. During traditional coronary artery bypass graft (CABG) surgery, the surgeon or assistant may manually or otherwise manipulate the arrested heart into a position and orientation that yields the best access to a target coronary artery requiring a bypass graft, or coronary artery revascularization. Web site: http://www.delphion.com/details?pn=US06488618__ •

Device for photorefractive cornea surgery in higher-order visual disorders Inventor(s): Seiler; Theo (Zell, DE), Mrochen; Michael (Dresden, DE), Kaemmerer; Maik (Dresden, DE) Assignee(s): Wavelight Laser Technologie AG (Erlangen, DE) Patent Number: 6,530,917 Date filed: September 28, 2000 Abstract: A device for photorefractive cornea surgery, in particular LASIK and PRK, of the eye for the correction of sight defects of a higher order provides for the following devices:an aberroscope (12, 14, 16, 22, 24, 28) for measuring the wave-front aberration of the entire optical system of the eye to be corrected in relation to a specific eye position,means (48) for deriving a photoablation profile from the measured wave-front aberration in such a way that a photoablation in accordance with the photoablation profile minimises the wave-front aberration, anda laser radiation source (30) and means (32, 38, 40, 48) for controlling the laser radiation in relation to the specific eye position in accordance with the photoablation profile. Excerpt(s): The invention relates to a device for photorefractive surgery on the cornea of the eye for the correction of sight defects of a higher order... Photorefractive keratectomy is a hitherto widely established procedure for correcting defective vision of a lower order, i.e. for example of myopia, hyperopia, astigmatism, myopic astigmatism and hyperopic astigmatism. The term "photorefractive keratectomy (PRK)" is usually understood to mean that an intervention on the surface of the cornea is only intended after the so-called corneal epithelium has been removed. After removal of the epithelium the Bowman's membrane or the corneal stroma is exposed and can be removed by a laser. The LASIK procedure (laser in situ keratomileusis) is generally distinguished from PRK. In the LASIK procedure an approximately 100 .mu.m to 200 .mu.m thick cornea slice (so-called "flap") with a diameter of 8 to 10 mm is cut down to a small remnant serving as a "hinge" with a so-called microkeratome. This slice (flap) is folded to the side and ablation (removal) of material is then effected by laser radiation directly in the stroma, i.e. not on the surface of the cornea. After laser treatment the lid is folded back to its original position again and healing generally takes place relatively quickly... The invention described below is suitable both for the above-described PRK as well as in particular the LASIK technique. Web site: http://www.delphion.com/details?pn=US06530917__

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Device for postoperative autotransfusion, particularly in heart surgery Inventor(s): Balugani; Fabio (Cavezzo, IT), Fontanili; Paolo (Correggio, IT) Assignee(s): Eurosets S.r.l. (Medolla, IT) Patent Number: 6,478,774 Date filed: November 15, 2000 Abstract: A device for postoperative autotransfusion particularly in heart surgery, comprising elements adapted to act simultaneously at least on tubes that are connected to the atmosphere and to a drainage system of a patient, so as to selectively provide a condition in which the tube connected to the atmosphere is closed and the tube connected to the patient drainage system is open, and a condition in which the tube connected to the atmosphere is open and the tube connected to the patient drainage system is closed. Excerpt(s): The present invention relates to a device for postoperative autotransfusion, particularly in heart surgery... It is known that the technique of postoperative autotransfusion is used particularly in heart surgery and consists in collecting the blood spilled by the drainages of the surgical wound, evacuating it together with air from the pleural-mediastinal cavity of a patient in order to reinfuse it into the patient after filtration... The classical method, which can be performed without problems in the first hours after the operation, when the patient is under assisted ventilation, requires the adoption of a system which comprises a chamber which is connected to a vacuum generator, typically provided as a water seal valve which ensures downstream, in a known manner, the constancy of the degree of vacuum, and the direct connection thereof to a blood collection chamber which is connected to the drainages of the patient and thus receives the blood by way of the suction determined by the vacuum that is present therein. Web site: http://www.delphion.com/details?pn=US06478774__

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Devices and methods for port-access multivessel coronary artery bypass surgery Inventor(s): Boyd; Stephen W. (Redwood City, CA), Rapacki; Alan R. (San Francisco, CA), Vaska; Matthias (Palo Alto, CA), Donlon; Brian S. (Los Altos Hills, CA), Peters; William S. (Woodside, CA) Assignee(s): Hearport, Inc. (Redwood City, IA) Patent Number: 6,478,029 Date filed: August 5, 2000 Abstract: Surgical methods and instruments are disclosed for performing port-access or closed-chest coronary artery bypass (CABG) surgery in multivessel coronary artery disease. In contrast to standard open-chest CABG surgery, which requires a median sternotomy or other gross thoracotomy to expose the patient's heart, post-access CABG surgery is performed through small incisions or access ports made through the intercostal spaces between the patient's ribs, resulting in greatly reduced pain and morbidity to the patient. In situ arterial bypass grafts, such as the internal mammary arteries and/or the right gastroepiploic artery, are prepared for grafting by thoracoscopic or laparoscopic takedown techniques. Free grafts, such as a saphenous vein graft or a free arterial graft, can be used to augment the in situ arterial grafts. The graft vessels are anastomosed to the coronary arteries under direct visualization through

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a cardioscopic microscope inserted through an intercostal access port. Retraction instruments are provided to manipulate the heart within the closed chest of the patient to expose each of the coronary arteries for visualization and anastomosis. Disclosed are a tunneler and an articulated tunneling grasper for rerouting the graft vessels, and a finger-like retractor, a suction cup retractor, a snare retractor and a loop retractor for manipulating the heart. Also disclosed is a port-access topical cooling device for improving myocardial protection during the port-access CABG procedure. An alternate surgical approach using an anterior mediastinotomy is also described. Excerpt(s): The present invention relates generally to devices and methods for performing thoracoscopic cardiac procedures. More particularly, the present invention relates to devices and methods for performing coronary artery bypass graft (CABG) surgery for multivessel coronary artery disease through port-access or closed-chest thoracoscopic methods... Coronary artery disease remains the leading cause of morbidity and mortality in Western societies. Coronary artery disease is manifested in a number of ways. For example, disease of the coronary arteries can lead to insufficient blood flow resulting in the discomfort and risks of angina and ischemia. In severe cases, acute blockage of coronary blood flow can result in myocardial infarction, leading to immediate death or damage to the myocardial tissue... A number of approaches have been developed for treating coronary artery disease. In less severe cases, it is often sufficient to treat the symptoms with pharmaceuticals and lifestyle modification to lessen the underlying causes of disease. In more severe cases, the coronary blockage(s) can often be treated endovascularly using techniques such as balloon angioplasty, atherectomy, laser ablation, stents, hot tip probes, and the like. Web site: http://www.delphion.com/details?pn=US06478029__ •

Disposable speculum with included light and mechanisms for examination and gynecological surgery Inventor(s): Nieto; German (1306 E. Hawthorne Cir., Hollywood, FL 33021) Assignee(s): none reported Patent Number: 6,595,917 Date filed: February 27, 2001 Abstract: The disposable speculum with included light and complementary mechanisms for examination and gynecological surgery is a device used for medical and surgical procedures in the vagina, neck level and the uterus. It has two separate sheets joined in their own handles; the upper sheet has three cuts to evacuate the gases and smoke produced on the surgery area. It also has a light bulb to give clarity on the surgery area, to optimize the visibility with aluminum reflexive cover; the lower sheet has three cuts connected among themselves for an internal central channel, to evacuate the blood and fluids coming from the surgical area; the upper sheet's handle has some buttons to activate an opening and close mechanism of these sheets. Excerpt(s): The disposable speculum with included light and complementary mechanisms for gynecological examination and surgery, is a medical instrument that gives positive advantage compared with others which are used now in this health branch... The vaginal speculum is a medical device, which is introduced through the introito to the vagina separating its walls, to be examined and making the medical or surgical proceedings easier at the vaginas neck level by sight or guided by colposcopya and of the uterus by the endoscopya... The speculum upper sheet external face is

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convex, with flat surface and rounded edges to avoid pinches, that happen frequently using disposable speculas with sharp sides. Web site: http://www.delphion.com/details?pn=US06595917__ •

Distractor for use in spinal surgery Inventor(s): Michelson; Gary K. (438 Sherman Canal, Venice, CA 90291) Assignee(s): none reported Patent Number: 6,565,574 Date filed: January 23, 2001 Abstract: A distractor for use in spinal surgery for urging two adjacent vertebral bodies apart is disclosed. The distractor includes a disc penetrating portion having a hollow with an open leading end configured to facilitate insertion of the distractor into at least a portion of the disc space. The hollow is adapted to contain disc material within the extension as the distractor is being inserted at least in part between the adjacent vertebral bodies. Excerpt(s): This invention relates generally to intervertebral spinal surgery, and more particularly to surgical instrumentation and to a method for creating one or more spaces between adjacent vertebral bodies in which the space has a shape and vertebral surfaces adapted in size to receive an implant or implants to be implanted in the space, and the method of implanting those implants... The spinal disc that resides between adjacent vertebral bodies maintains the spacing between those vertebral bodies and, in a healthy spine, allows for relative motion between the vertebrae. With disease and/or degeneration a disc may become painful and/or mechanically insufficient warranting surgical fusion across the affected disc. Where fusion is intended to occur between adjacent vertebral bodies of a patient's spine, the surgeon typically prepares an opening at the site of the intended fusion by removing some or all of the disc material that exists between the adjacent vertebral bodies to be fused. Because the outermost layers of bone of the vertebral endplate are relatively inert to new bone growth, the surgeon must work on the endplate to remove at least the outermost cell layers of bone to gain access to the blood-rich, vascular bone tissue within the vertebral body. In this manner, the vertebrae are prepared in a way that encourages new bone to grow onto or through an implant that is placed between the vertebrae. An implant or insert may or may not promote fusion of the adjacent vertebral bodies, may be an artificial spinal disc, may permit surface ingrowth, and may be made of bone or inert material, such as titanium. All of these examples and more are implants... Present methods of forming this space between adjacent vertebrae generally include the use of one or more of the following: hand held biting and grasping instruments known as rongeurs; drills and drill guides; rotating burrs driven by a motor; and osteotomes, chisels, and scraping implements. Surgeons often prefer a drilling technique due to its being ease, quick, and accurate. Sometimes the vertebral endplate must be sacrificed as occurs when a drill is used to drill across the disc space and deeper into the vertebrae than the thickness of the endplate. Such a surgical procedure is typically used to prepare a space in the spine for an implant having a circular cross section and necessarily results in the loss of the hardest and strongest bone tissue of the vertebrae, the endplate, and thereby robs the vertebrae of that portion of its structure best suited to absorbing and supporting the loads placed on the spine by everyday activity. Where the surgeon chooses to forego drilling a large bore across the disc space in an attempt to preserve that good bone he must nevertheless use one of the above instruments to work upon the endplates of the adjacent vertebrae to

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access the vascular, cancellous bone that is capable of participating in the fusion and causing active bone growth, and also to attempt to obtain an appropriately shaped surface in the vertebral bodies to receive the implant, which means and method are unreliable for that purpose. Web site: http://www.delphion.com/details?pn=US06565574__ •

Double endobronchial catheter for one lung isolation anesthesia and surgery Inventor(s): Amar; David (Hillcrest, NY) Assignee(s): Memorial Sloan-Kettering Cancer Center (New York, NY) Patent Number: 6,520,183 Date filed: June 11, 2001 Abstract: A double endobronchial catheter that is suited for one lung isolation anesthesia and surgery that has an outer sheath that is adapted to be introduced into the patient such that the distal end of the sheath is positioned within the patient and the proximal end remains exterior of the patient. A pair of catheters are slidingly retained in separate lumens within the outer sheath lumen. Each of the catheters has an inflatable balloon at the distal end thereof with the proximal ends extending outwardly from the proximal end of the outer sheath. A stylet is removably positioned within each of the catheters so that each catheter can be manipulated independently of the other catheter within the confines of the outer sheath so that the distal ends of the catheters can be positioned at a site within the bronchi of the patient and, upon inflation of the balloons, one of the patient's lungs can be isolated and ventilation and anesthesia administered to the other lung. Excerpt(s): The present invention relates to catheters, and more particularly, to a double endobronchial catheter that is used to isolate one lung of a patient during anesthesia and surgery... There are many operations that are carried out or performed today on a patient that require one lung of that patient to be isolated, that is, one of the patient's lungs must be kept relatively immobilized during the operation so that the surgery can be performed. Typical of such operations include thoracoscopic lung surgery, minor or major lung resection, thoracic aorta repair or reconstruction, esophageal surgery and anterior thoracic spine surgery... The need to isolate such lungs in order to operate stem from the very nature of a surgical operation performed under general anesthesia. In such operations, an anesthesia apparatus actually breathes for the patient by means of an anesthesia ventilator that acts in conjunction with an anesthesia machine. The anesthesia ventilator provides a timed, intermittent flow of gas to the patient to force that gas into the patient to expand the lungs, while the gas is expelled from the lungs as the lungs deflate. The anesthesia machine adds the anesthetic, in the form of a vapor, to the gas so that the anesthetic laden gas is provided to the patient to carry out the induction and maintenance of anesthesia in the patient during the operation. Thus under normal operation, both lungs are continually expanded and contracted during the inhalation and exhalation of the anesthetic laden gases in accordance with the normal cycling of the anesthesia ventilator. Web site: http://www.delphion.com/details?pn=US06520183__

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Efficient magnet system for magnetically-assisted surgery Inventor(s): Creighton, IV; Francis M. (St. Louis, MO), Ritter; Rogers C. (Charlottesville, VA), Hall; Andrew F. (St. Charles, MO), Hastings; Roger N. (Maple Grove, MN) Assignee(s): Stereotaxis, Inc. (St. Louis, MO) Patent Number: 6,630,879 Date filed: February 3, 2000 Abstract: A system for magnetically assisted surgery includes a magnetic support structure, a patient support structure and a magnet having at least four poles attached to the magnetic support structure so that the magnet provides a near-field magnetic field in an operating region of a patient supported by the patient support structure. The magnet is moveable so that the direction of the magnetic field lines in the operating region is adjustable. The magnet may include a pair of essentially semicircular halfsegments permanently magnetized and joined in an extremely stable disk configuration. The magnetic field and gradient field provided by the magnet is such that movement of the disk in one plane combined with rotation of the disk is sufficient to orient the magnetic field during surgical use, thereby reducing interference to medical imaging devices needed during surgery. An example of a medical delivery device that may be used for surgery in conjunction with this system is a flexible endoscope or catheter having a series of magnetically permeable rings. Excerpt(s): This invention relates to systems for magnetically-assisted surgery and more particularly to systems for producing the magnetic fields required to guide surgically implanted magnetic medical devices... Several magnet systems to provide guidance for magnetic medical devices for navigation within a patient have been devised or are under development. An example of such a system is disclosed in commonly assigned application Ser. No. 09/189,633, "Articulated Magnetic Guidance System," which is hereby incorporated by reference in its entirety. A device disclosed therein includes a bed, a bed articulation system, a pair of x-ray sources, a coil or magnet articulation system, and an optional pair of additional magnets. The magnet articulation system comprises an articulation support, servo control mechanisms to provide movement of a coil or a permanent magnet along an arcuate arm both through a polar angle and in a radial direction. Optionally, the entire arm may also be pivoted through an azimuthal angle. The arm itself may comprise a track and gimbal assembly. Additional embodiments described in the referenced application include one in which the arm itself is moveable via an articulation support, another in which the magnet or coil is mounted on a pivotable ring support, and another in which the magnet or coil is mounted as an effector on a robotic arm. In the latter embodiment, it is desirable for the effector and all other parts of the robotic arm to be provided with exclusion zones to prevent accidental contact with a patient, with medical personnel, and, of course, with other items that might be damaged by such contact... Still other magnetic systems providing guidance for magnetic medical devices navigated within a patient are disclosed in commonly assigned Provisional App. Ser. No. 60/095,710, filed Dec. 14, 1998, "Method and Apparatus for Magnetically Controlling Catheters for body Lumens and Cavities," which is also incorporated by reference in its entirety. The apparatus of the invention disclosed therein generally comprises a magnet system for applying a magnetic field to a magnet-tipped distal end of a medical device. The magnetic field provides a field that can navigate, orient, and hold the distal end of the medical device in the body. The apparatus also includes a computer for controlling the magnet system. Imaging devices connected to the computer provide images of the body part through which the catheter is being navigated. Displays are provided of these images. A controller connected to the

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computer has a joystick and a trigger to enable a user to input points on the displays for two-point and three-point navigation. The magnet system itself is preferably a set of electromagnetic coils that can be disposed around the body part to create a magnetic field of variable direction and intensity. Magnet systems suitable for such use are disclosed in U.S. Pat. Nos. 4,869,247, issued Sep. 26, 1989, "Video Tumor Fighting System," and 5,125,888, issued on Jun. 30, 1992, entitled "Magnetic Stereotactic System for Treatment Delivery," the disclosures of both of which are also incorporated by reference in their entirety. Web site: http://www.delphion.com/details?pn=US06630879__ •

Electrode leads for use in laparoscopic surgery Inventor(s): Greenstein; Robert J. (Tenafly, NJ) Assignee(s): Transneuronix, Inc. (Mt. Arlington, NJ) Patent Number: 6,510,332 Date filed: August 16, 2000 Abstract: This invention relates to an implant device which is designed and adapted use in laparoscopic surgery. This implant device is especially adapted for electrostimulation and/or electrical monitoring of endo-abdominal tissue or viscera. The implant device has an elongated body having on, or near, its distal end a flexible attachment member which can be folded back on to the elongated body and attached to the elongated body thereby forming a closed loop around the tissue of interest. By "looping" around or through the tissue of interest, the attachment member and the elongated body are securely attached to the tissue and will resisted displacement even in cases where the tissue is subject to vigorous, periodic peristaltic movement within the body (e.g., digestive organs). One preferred implant device of this invention has an elongated body equipped with two or more electric poles that are electrically connected to an electric connection terminal for connection to a power source, mechanism to penetrate the tissue or viscera to be treated, quick-release connecting devices to separate the penetration device from the elongated body, and a locking or attachment device which is capable of folding back and attaching to the elongated body whereby the locking device and the elongated body forms a secure and essentially continuous loop around the tissue or viscera to be treated. Excerpt(s): This invention relates to a medical implant device for electrostimulation and/or electrical monitoring of endo-abdominal tissue or viscera. More specifically, this invention provides a medical implant device having electrode leads which can be attached or affixed to the enteric or endo-abdominal tissue or viscera such that the electrode leads resist detachment in spite of the vigorous and/or periodic action or movement of the enteric or endo-abdominal tissue or viscera. The medical implant device of this invention is especially adapted for location or implantation in the endoabdominal cavity over extended periods of time... It is well known that more than 70% of illnesses affecting the digestive tract are of a functional nature. Today such illnesses are treated predominantly using pharmacological means. Since drugs generally have side effects, particularly when the drugs cure the symptom and not the underlying problem or dysfunction, they must often be administered temporally. Indeed, if the side effects are sufficiently serious, the drug may have to be discontinued before full benefit to the patient is realized; in many cases the underlying illness remains... The important role played by electrophysiology in controlling gastrointestinal activity has become increasingly apparent in recent years. Thus, the possibility exits of correcting

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dysfunction by means of electrostimulation applied at specific frequencies, sites, and modalities and with regard to the self-regulating electromotor physiology of the gastrointestinal organs or tract. It has recently been shown, for example, that changes occur in the motility and electromotor conduct of the gastric tract in eating disorders (e.g., obesity, thinness, bulimia, anorexia). Disturbances in electromotor activity in diabetic gastroparesis, reflux in the upper digestive tract, and numerous other gastroenterological functional pathologies have also been observed. Web site: http://www.delphion.com/details?pn=US06510332__ •

Hyaluronic acid esters, threads and biomaterials containing them, and their use in surgery Inventor(s): Bellini; Davide (Montegrotto Terme, IT), Callegaro; Lanfranco (Thiene, IT) Assignee(s): Fidia Advanced Biopolymers S.r.l. (Abano Terme, IT) Patent Number: 6,632,802 Date filed: August 28, 2001 Abstract: The application discloses esters of hyaluronic acid, wherein a first part of the carboxylic functions is esterified with an araliphatic alcohol and a second part is esterified with at least one long-chain, straight aliphatic alcohol with between 10 and 22 carbon atoms. The possible remaining non-esterified carboxylic functions, if present, are salified. The application further discloses biocompatible threads having a multifilament conformation comprising filaments formed by the aforesaid esters, and their use in the fields of medicine and surgery. Excerpt(s): The present invention concerns the preparation of a new series of ester derivatives of hyaluronic acid, biocompatible threads in a multifilament conformation comprising filaments constituted by such derivatives, and their use in the fields of medicine and surgery... Suture threads are now widely used in modern surgical practice and can be made of a wide range of materials, according to the type of surgery to be performed (Abraham R. Katz et al. "A new synthetic monofilament absorbable suture made from polytrimethylene carbonate" Surgery, Gynecology & Obstetrics, September 1985, vol. 161, pages 213-222; Abraham R. Katz et al. "Evaluation of tensile and absorption properties of polyglycolic acid sutures" Surgery, Gynaecology & Obstetrics, October 1970, vol. 131, pages 701-716). It is possible, therefore, to imagine different types of suture thread with different characteristics of gauge, tensile strength, biocompatibility and biodegradability, according to whether they are intended for extensive lacerations (abdominal wall, thorax, lower limbs), or for small cuts and wounds as on the face, mouth and soft tissues. Some conditions require the material to be biocompatible but not biodegradable (as in cardiovascular surgery), while others necessitate both these characteristics (as in surgery to the urinary tract). The suture threads currently on the market vary first and foremost in the type of polymer with which they are made. Indeed, they vary from non-reabsorbable threads based on polyester, polypropylene, nylon and silk, such as Surgilene.RTM., Surgilon.RTM., Novafil.RTM. and Dermalon.RTM. by DG (Davis+Geck--American Cyanamid Company), to reabsorbable threads based on glycolic acid and collagen, such as Vicryl.RTM. and Catgut.RTM. by Ethicon (A. Pavan et al. "A Comparative Study of Poly(Glycolic acid) and Catgut as Suture Materials. Histomorphology and Mechanical Properties", Journal of Biomedical Materials Research, vol. 13, pages 477-496, 1979). As these materials all have a synthetic polymeric matrix, they are poorly biocompatible and only some of them are biodegradable, so they may cause inflammatory reactions at the lesion site where they

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are applied (E. A. Bakkum et al. "Quantitative analysis of the inflammatory reaction surrounding sutures commonly used in operative procedures and the relation to postsurgical adhesion formation" Biomaterials 1995, vol. 16, No. 17, pages 1283-1289) and may necessitate a second surgical operation to remove them from the application site. In particular the materials used to date to stitch wounds have given rise to an inflammatory response and hyperfibrotic process, because the organism recognises that they are foreign bodies. On account of this phenomenon, hypertrophic scars and keloids are prone to form around the stitches any of the anatomical or functional characteristics of healthy tissues. Apart from being unsightly, such scars may. If they are external, cause impairment of the motor functions. For examples if they occur on the joints such as the elbow or knee. When internal organs are stitched, the hyperfibrotic process may cause the formation of adhesions with the tissues surrounding the operation site... Lastly, the use of ester derivatives of hyaluronic acid is known in the preparation of biomaterials, including suture threads, in the medical-surgical sector (European Patents EP 341745 and EP 216453). Web site: http://www.delphion.com/details?pn=US06632802__ •

Imaging modality for image guided surgery Inventor(s): Zylka; Waldemar (Hamburg, DE), Proksa; Roland (Hamburg, DE), Van Der Brug; Willem P. (Eindhoven, NL) Assignee(s): Koninklijke Philips Electronics N.V. (Eindhoven, NL) Patent Number: 6,490,477 Date filed: April 30, 1999 Abstract: An imaging modality, in particular a mobile CT system, comprises an imaging system for imaging an object to be examined. The imaging modality is also provided with an image guided surgery system which includes a position measuring system for measuring positions within the object and a data processor for deriving a transformation between positions within the object and the corresponding positions in the image. The position measuring device is also arranged to measure the position of the imaging system and the data processor is arranged to derive the transformation from the position and/or orientation of the imaging system. The position measuring system is notably an optical position measuring system which is arranged to measure the position of the gantry of the CT system. The data processor is arranged to derive the transformation from the measured position of the gantry. A highly accurate result is obtained when a calibration is carried out which links the position of the CT gantry to the position of the scanning plane. Excerpt(s): The invention relates to an imaging modality, including an imaging system for forming an image of an object to be examined, and an image guided surgery system, including: a position measuring system for measuring positions within the object, and a data processor for deriving a transformation between positions in the image of the object and corresponding positions within the object. The invention also relates to a method of forming an image of an object to be examined by means of an imaging system wherein a position and/or orientation in the object to be examined is measured. The invention further relates to a method of determining the position of a slice in an imaging system which forms slice images of an examination zone... Imaging systems of this kind, capable of forming a slice image of an examination zone for medical purposes, are, for example X-ray computer tomography apparatus, MR apparatus or ultrasound apparatus. Since recently systems of this kind are also used for image guided surgery in

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order to reproduce or track surgical instruments during an intervention in the body of a patient. The exact position of the surgical instruments can then be determined by means of a position measuring system which measures the position of markers, for example light-emitting diodes (LEDs), provided on the instruments... An imaging modality of this kind is particularly suitable for use in conjunction with image guided surgery. The image guided surgery system is used to show a position and/or orientation of a surgical instrument in an operating zone within the body of the patient to a user, such as a surgeon, during a surgical intervention. For these applications the object to be examined is a patient to be examined. The patient is examined notably so as to enable a surgical operation to be carried out as well as possible. Such a surgical operation is, for example a (radiological) intervention during which a surgical instrument is introduced into the body of the patient. The surgical instrument introduced into the body of the patient can be used to examine or treat the patient. For the introduction of the surgical instrument use is made of images made before and/or during the operation or intervention, for example X-ray images, computer tomography images or magnetic resonance images. The image guided surgery system includes the position measuring system for measuring the position and/or orientation of the surgical instrument. The image guided surgery system also includes the data processor which is provided with a computer for deriving corresponding positions in a relevant image from the measured positions of the surgical instrument. During the operation the position measuring system measures the position and/or orientation of the surgical instrument relative to the patient and the computer calculates the position and/or orientation corresponding to the measured position and/or orientation of the surgical instrument in such a previously made image. Said previously made image is displayed on a monitor, the actual position and/or orientation of the surgical instrument also being shown therein. The surgeon can observe the image on the monitor so as to see the position of the surgical instrument in the operating zone without having a direct view thereof. For example, the surgeon can observe the image on the monitor so as to determine how to move the surgical instrument in the operating zone without high risk of unnecessary damaging of tissues and notably without risk of damaging vital parts. Web site: http://www.delphion.com/details?pn=US06490477__ •

Instrument for application in endoscopic surgery Inventor(s): Manhes; Hubert (Vichy, FR) Assignee(s): Karl Storz GmbH & Co. KG (DE) Patent Number: 6,508,827 Date filed: July 14, 2000 Abstract: What is described here is an instrument for application in endoscopic surgery, comprising a shaft (10)including two forceps elements at its distal end which are operable independently of each other by operating elements (17),whereof one is pivotable about an axis at least approximately orthogonal on the longitudinal axis of the instrument andincluding at least one continuous passage (12) between the jaws of said two forceps elements.The inventive instrument is characterised by the provisions that the other forceps element is not pivotable, and that the pivotable jaw element or elements (16) of each forceps element are pivotable about axes (16a) which are each arranged approximately in parallel with the connecting line between the seizing regions of said forceps elements.

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Excerpt(s): The present invention relates to an instrument for application in endoscopic surgery... An instrument which the wording of the introductory clause of Patent claim 1 starts out from is known from the German Patent De 43 24 254 C1... That prior art reference discloses a surgical instrument for endoscopic operations which comprises a shaft. Three passages are provided in that shaft, which are disposed at the apices of an isosceles triangle. A pair of forceps or the like can be inserted into two of the passages, which present each a forceps jaw which can be pivoted. The third passage is provided for the insertion of an optical system. Web site: http://www.delphion.com/details?pn=US06508827__ •

Instrument guidance method and system for image guided surgery Inventor(s): Henderson; Jaimie (St. Louis, MO), Bucholz; Richard D. (St. Louis, MO), Smith; Kurt R. (Eldorado Springs, CO), Frank; Kevin J. (Lafayette, CO), Clayton; John B. (Supeior, CO), Carroll; Catalina J. (Memphis, TN), Ulberg; Phillip T. (Reno, NV) Assignee(s): Surgical Navigation Technologies, Inc. (Louisville, CO) Patent Number: 6,491,699 Date filed: April 20, 2000 Abstract: Generally, the present invention is directed to a method and system for a aligning surgical guide instrument over a burr hole in a patient's body. More particularly, the present invention is directed to a stand-alone instrument guidance unit that is attachable to a patient's skull. Adjustments of a surgical instrument can be made in x, y, z, and angular directions using the system and method of the present invention. In one aspect of the present invention, an instrument guide unit includes an instrument guide for guiding a surgical instrument into the body of a patient and a base unit operative to be secured to the body in an area in which surgery. is to occur. The base unit is coupled to the instrument guide. An adjustment mechanism, coupled to the base unit and the instrument guide, is operative to adjust the instrument guide in lateral directions with respect the surface of the area. The adjustment mechanism is operative to adjust the instrument guide in x and y directions. The adjustment mechanism includes an x direction control mechanism for adjusting the instrument in an x direction and a y direction control mechanism for adjusting the instrument in a y direction. The y direction control mechanism may be coupled to the x direction control mechanism. The positional movement of the surgical instrument in the z direction may be tracked by sensing the location of a transducer coupled to the surgical instrument. Excerpt(s): The present invention relates generally to computer assisted image guided medical and surgical navigation systems that generate images during medical and surgical procedures indicating the relative position of various body parts, surgical implants, and instruments. In particular, the present invention relates to a reference frame and instrument guide frame for use in an image guided surgery navigation system... In image guided medical and surgical procedures, images, obtained either preoperatively or intraoperatively (i.e., prior to or during a medical or surgical procedure), are used to aid a doctor in guiding a surgical instrument. Computer assisted image guided medical and surgical navigation systems are known and are disclosed, for example, in U.S. Pat. No. 5,383,454 to Bucholz; U.S. Pat. No. 5,891,034 to Bucholz; U.S. Pat. No. 5,851,183 to Bucholz; U.S. Pat. No. 5,871,445 to Bucholz; PCT Application No. PCT/US94/04530 (Publication No. WO 94/24933) to Bucholz; PCT Application No. PCT/US95/12984 (Publication No. WO 96/11624) to Bucholz et al.; and U.S. patent application Ser. No. 08/623,956 to Foley et al., the entire disclosures of which are

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incorporated herein by reference... In general, these image guided systems use images of a body part or other surgical object, obtained from a scan, such as CT or MRI scan, taken before surgery to generate images on a display screen during surgery. The images of the body are correlated with a synthesized image of a surgical instrument and are used to produce, on a display screen, a real-time representation of the surgical instrument used by a surgeon with respect to the body. Prior to the scan of the body to produce body images, markers such as fiducial scanning markers are placed on the parts of the body to be scanned in order to produce fiducial image points on the scanned part of the body. The locations of the fiducial markers represented on the scanned image are correlated with the fiducial scanning markers on the body to provide a coordinate registration to be used by the computer system in determining the relative location of the various objects that the computer tracks. The surgical instrument is also registered with respect to the fiducial scanning markers, as known to those skilled in the art, by positioning the surgical instrument at each of scanning markers and recording the relative location of the instrument and markers. Web site: http://www.delphion.com/details?pn=US06491699__ •

Instrumented and actuated guidance fixture for sterotactic surgery Inventor(s): Franck; Joel I. (Durham, ME), Haer; Frederick C. (Brunswick, ME), Franklin; Ronald J. (Bowdoinham, ME) Assignee(s): Neutar L.L.C. (Bowdoinham, ME) Patent Number: 6,529,765 Date filed: May 24, 1999 Abstract: A method and apparatus for stereotactic surgery on a body, such as surgery on the brain or spine. A guidance fixture is used that includes a mounting base having a central axis, a controllable instrument drive for moving a surgical instrument along a constrained trajectory in response to a drive control signal, an actuated adjustment mechanism coupled between the mounting base and the controllable instrument drive, and a sensor system coupled to the adjustment mechanism. The mounting base of the guidance fixture is attached to the body and a location of the mounting base in a threedimensional image of the body is determined, for example, using a remote sensing device, such as a camera, and tracking markers, such as LEDs, attached to the guidance fixture. Sensor signals encoding the orientation of the constrained trajectory and encoding a position of the surgical instrument along the constrained trajectory are generated and transmitted from the guidance fixture. An adjustment control signal is received and the orientation of the constrained trajectory relative to the mounting base is adjusted in response to the received adjustment control signal. Excerpt(s): This invention relates to instrument guidance for stereotactic surgery... Stereotactic localization is a method for locating a target within a three-dimensional object. This method is used in the medical arts and sciences to locate a target in the human body, in particular in the brain or spine, for medical and surgical treatment. Stereotactic surgery has a history dating back to the turn of the century, when the Horsely-Clark Apparatus was described as a mechanical frame system in which an animal was immobilized. This frame system permitted reproducible targeting within the animal's brain for physiological experiments. This and similar technology found application in 1948 in the work of Wycis and Speigel. In their work, a frame was attached to a human skull. The frame permitted targeting of sites within the human brain for neurosurgical treatment. A detailed survey of the field of stereotactic surgery

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can be found in Textbook of Stereotactic and Functional Neurosurgery, P. L. Gildenberg and R. R. Tasker (eds.), McGraw-Hill, June 1997 (ISBN: 0070236046)... One approach to stereotactic surgery involves the following steps. Fiducial scanning markers are attached to the body in one of a variety of manners, including using an attachable frame or attaching the markers to the skin with an adhesive. A scan is then taken of a body, for example of the head, to produce a three-dimensional image of the body. Scanning can be done using a variety of techniques including CT, MRI, PET, and SPECT. Images of the fiducial scanning markers that are located around the body are then located in the threedimensional image at fiducial image points. Points of interest, such as the location of a tumor, are located in the three-dimensional image with reference to these fiducial image points. The body and the image are registered by matching the locations of the scanning markers and the coordinates of the fiducial image points. In an approach to stereotactic brain surgery, a three-dimensional frame is screwed to the patient's skull prior to scanning the head. This frame serves as a mechanical reference mechanism that supports scanning fiducial markers at fiducial points around the body. The frame remains attached to the patient's skull from before scanning until after surgery is complete. Prior to surgery, a mechanical guide assembly is attached to the frame. The relative location in the image of the point of interest with respect to the fiducial image points is determined, and this relationship is used to adjust the mechanical guide assembly with respect to the fiducial points on the frame. Using the adjusted mechanical guide assembly, a surgical instrument is then guided to a location in the body that corresponds to the point of interest in the image. Web site: http://www.delphion.com/details?pn=US06529765__ •

Interface for laser eye surgery Inventor(s): Cowperthwaite; Michael (Mountain View, CA) Assignee(s): Visx, Incorporated (Santa Clara, CA) Patent Number: 6,558,373 Date filed: March 28, 2000 Abstract: A laser surgery system having a computer control system coupled to a laser subsystem and a patient seat. The control system is coupled to the laser through a laser alignment system. The control system can be coupled to the patient seat through a patient alignment system. The control system sends a nominal position signal to move the patient seat, laser subsystem, or both so that the patient's first eye is moved into substantial alignment with the laser beam axis. The control system can send a second nominal signal to move the patient's second eye into substantial alignment with the laser beam axis. The control system can optionally comprise both an operator display and an assistant display. The assistant display provides real-time information to an assistant positioned at an assistant station adjacent the patient seat. The control system can be programmed to display edit fields with different colors to provide an obvious indication of the refractive information of the eye. The control system can comprise an operator input for providing a pre-determined secondary ablative treatment. If it is determined that the first ablative treatment did not completely remove the epithelial layer from a target region, the operator actuates the operator input to deliver the secondary ablative treatment. Excerpt(s): The present invention relates generally to methods, systems and devices for performing corrective eye surgery. More particularly, the present invention relates to improved computer and laser system interface methods, computer interface programs,

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and operator system interfaces. The present invention is particularly useful for enhancing the speed, ease, safety, and efficacy of laser eye surgical procedures such as photorefractive keratectomy (PRK), laser in situ keratomileusis (LASIK), and the like... Laser eye procedures typically employ ultraviolet or infrared lasers to remove a microscopic layer of stromal tissue from the cornea to alter its refractive power. Excimer lasers (i.e. ultraviolet laser), such as the VISX STAR.TM. or STAR S2.TM. laser system, use argon and fluorine gas to create a non-thermal laser light to break molecular bonds, in a process known as photoablation. Ultraviolet laser ablation results in the photodecomposition of the corneal tissue, but generally does not cause significant thermal damage to adjacent and underlying tissues of the eye. The photoablation removes stromal tissue to change the contour of the cornea to correct myopia (nearsightedness), hyperopia (far-sightedness), and astigmatism... In general, existing laser eye surgery systems have included an operator interface for use by the laser system operator in setting-up, controlling, monitoring, and generally directing the laser treatment of the patient's eyes. The safety and efficacy of a photorefractive procedure depends in part on the operator's ability to interact with the laser control system using the operator interface. The costs of each surgical procedure are significantly affected by any unnecessary time delays in setting-up or directing the procedure. Unfortunately, existing operator interfaces are less than ideal in a number of aspects. Web site: http://www.delphion.com/details?pn=US06558373__ •

Lamp, especially a surgery lamp, with at least two bulbs Inventor(s): Maier; Stefan (Weiterstadt, DE), Wasow; Soren (Freigericht, DE) Assignee(s): Heraeus Med GmbH (Hanau, DE) Patent Number: 6,572,234 Date filed: October 3, 2000 Abstract: To achieve great security against failure in lamps for medical applications, especially lamps for surgery, two electric bulbs are placed each in a concave mirror of ellipsoidal shape as part of a reflector, the two concave mirrors having focal points which are aligned with one another along an optical axis. The concave mirror provided to serve as the main lamp is configured as a ring reflector, while the concave mirror designed to operate as a reserve lamp closes off the reflector on the side facing away from the direction of emergence of the light. Thus, in the event of a change from main lamp operation to reserve lamp operation, the illuminated field is maintained at least approximately in its size and the location does not change (X and Y directions). Excerpt(s): The invention relates to a lamp, especially a surgery lamp, with at least two electrical bulbs which can be positioned at the focal point of at least one concave mirror serving as reflector... In German Gebrauchsmuster G 93 11 156.8 there is disclosed an apparatus for the positioning on alternate sides of at least two bulbs in a predetermined position, especially in a focal point of a lamp having a concave mirror, the bulbs being disposed on an apparatus bearing a bistable mechanical position memory. The apparatus can be shifted automatically upon receiving a signal (bulb failure), whereupon a first bulb is brought away from the focal point and a second bulb is moved into the focal point, circuitry producing the movement being associated with the apparatus... Even though in this case, when a first bulb as the main bulb fails, an equally strong additional illumination without lateral shifting of the cone of light is made possible by a second bulb as a reserve bulb, the changeover requires a controlling signal which, on the basis of the shifting mechanism, does not bring about a changeover to the

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reserve bulb without a certain delay. The result is an at least slight time-delay during some operation, which should be prevented if possible (the action of the anaesthetic decreases). In addition, there is possible wear due to natural movement, so that constant inspection of the positioning mechanism is necessary. Web site: http://www.delphion.com/details?pn=US06572234__ •

Mattress for support of a patient recovering from surgery Inventor(s): Erickson; Tomiko (10100 E. Calusa Club Dr., Miami, FL 33186) Assignee(s): none reported Patent Number: 6,516,481 Date filed: February 5, 2001 Abstract: A mattress assembly generally designed for use in hospitals and the like which is structured to effectively and comfortably support a patient during a period of recovery from a predetermined surgical procedure. The mattress assembly includes an elongated support platform having a corresponding dimension to that of a conventional hospital or like medical-type mattress and includes an opening formed therein and preferably extending therethrough. The opening is disposed in aligned, at least partially receiving relation to a predetermined portion of the patient's body directly involved in an invasive surgical procedure such as prostate surgery. More specifically, the opening is disposed, dimensioned and configured to receive and maintain portions of the patient's body, including external body parts, in an at least partially protected orientation and specifically out of supported engagement with a remainder of the support platform of the mattress. The opening may include a completely closed or at least partially open periphery, wherein the support platform may include an open area of access to facilitate positioning of medical equipment or instrumentation. The support platform preferably also includes an inclined portion disposed and configured to orient and support the head and upper torso portion of the patient's body in a partially inclined position. Excerpt(s): Virtually all health care facilities including hospitals, clinics, out-patient emergency rooms, etc. utilize substantially conventional mattresses intended for use with a hospital bed, gurney, stretcher, etc. These medical-type mattress are typically designed to include an elongated support platform of generally standard length and width, dependent upon whether the support platform is to be mounted on a hospital bed or gurney, stretcher, etc. More specifically, conventional hospital mattresses, particularly of the type designed to be mounted on an electrically powered, mechanically adjustable hospital bed have a length of substantially 80 inches and a somewhat standard width or transverse dimension of substantially 36 inches. The support platform normally includes two primary outer walls, each of which may include a supporting surface. One of the supporting surfaces is disposed in supporting relation to the frame of the hospital bed and the other is disposed in supporting relation to the patient. In addition, the interior structures of such mattresses typically include a number of coils or springs alone or in combination with a compressible, foam or other cushion like material, in order to provide a predetermined amount of support to the patient's body while at the same time allowing the mattress to be selectively disposed between a complete horizontal or flat orientation and a partially inclined orientation. The latter orientation of the support platform is typically defined by the head or proximal end of the mattress being oriented at any one of a plurality of inclined angles, which serves to orient the head, shoulders, and generally upper torso region of the

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patient's body in an upwardly, partially inclined position. This inclined orientation of the upper portion of the patient's body is frequently accomplished to make the patient more comfortable or to allow the patient to better view his or her surroundings and to communicate with medical personnel, visitors, etc. There are, however, a few situations wherein the patient is instructed to maintain as much as possible, the upwardly, inclined orientation described above, in order to help alleviate swelling, assist with drainage of a wound, etc... As mentioned above, the mattresses used in hospitals or like health care facilities usually comprise a standard structure which is intended to provide adequate support to the patient while resting or sleeping in a fully reclined position or in an at least partially inclined position, as set forth above. However, it is believed that medical institutions have never provided a mattress or like support platform, which is structurally adapted to more readily accommodate certain medical conditions for which the patient is being treated... More specifically, patients which have been involved in surgery or other invasive procedures frequently must remain in the hospital or like medical facility during a somewhat prolonged period of recovery. During such a recovery period the patient often experiences considerable pain or discomfort, directly associated with the surgical procedure. Such discomfort is experienced until the healing of the patient's body progresses at least to a sufficient degree to where pain is no longer an acute problem. In typical fashion, a patient recovering from surgery is placed on a conventional hospital mattress and oriented in either a fully reclined or partially reclined position, as set forth above. However, it is well known by medical personnel that forced engagement with the supporting surface of the mattress or direct contact of certain portions of the patient's body, which are directly associated with the attendant surgical procedure, frequently results in considerable pain. Because of the generally standardized design of medical type mattresses, as set forth above, the patient is forced to be oriented into a position which almost certainly results in added and oftentimes unnecessary discomfort. This is particularly true when the portion of the patient's body directly related to the surgery comes in direct supported engagement with an adjacently disposed portion of the support platform of the medical mattress on which the patient is disposed. Web site: http://www.delphion.com/details?pn=US06516481__ •

Method and apparatus for collecting and processing physical space data for use while performing image-guided surgery Inventor(s): Galloway, Jr.; Robert L. (Nashville, TN), Chapman; William C. (Nashville, TN), Stefansic; James D. (Nashville, TN), Herline; Alan J. (Nashville, TN), Pinson; Candice D. (Mountain View, CA) Assignee(s): Vanderbilt University (Nashville, TN) Patent Number: 6,584,339 Date filed: June 27, 2001 Abstract: A method and apparatus for collecting and processing physical space data used while performing image-guided surgery is disclosed. Physical space data is collected by probing physical surface points of surgically exposed tissue. The physical space data provides three-dimensional (3-D) coordinates for each of the physical surface points. Based on the physical space data collected, point-based registrations used to indicate surgical position in both image space and physical space are determined. The registrations are used to map into image space, image data describing the physical space of an ablative instrument used to perform the image-guided surgery, an ablation zone of

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the instrument, the surgically exposed tissue, and a particular portion of the tissue to be resected or ablated. The image data is updated on a periodic basis. Excerpt(s): The present invention relates to using image-guided surgery techniques to collect data to insure accurate tracking of an ablation device... For over fifty years, diagnostic images have been used for surgical guidance, especially in the field of neurosurgery. Image-guided surgery implements two fundamental ideas: first, the concept of an image-space to physical-space mapping or registration, and second, the use of an extracranial device for accurate surgical guidance without direct visualization. Such ideas gave birth to stereotactic neurosurgery, a technique for locating targets of surgical interest within the brain relative to an external frame of reference. This is traditionally defined as the temporary attachment of a mechanical frame to the skull or scalp in order to define a 3-D frame space around a patient. With the advent of computed tomography (CT), the coordinates of a target (i.e. tumor) in image space could be assigned coordinates in frame space if the CT images were obtained with the attached frame. Unfortunately, frames are uncomfortable to patients, must be applied prior to imaging, and are cumbersome in the imaging environment and the operating room... These factors led to the development of frameless stereotactic surgical systems, or interactive, image-guided surgery (IIGS) systems. In traditional IIGS systems, present surgical position is tracked during an operation and displayed on pre-operatively obtained tomographic images. As the surgeon changes the current surgical position, displayed images are updated in real time. In one of the earliest IIGS systems, physical space surgical position was determined using articulated arms. The position of an articulated pointer was calculated using a personal computer (PC) and overlayed on tomographic images. Magnetic resonance images (MRI) and CT negative films were scanned into the computer and displayed as images on a video interface. Other early image-guided surgical systems also used electromechanical 3-D coordinate digitizers to indicate present surgical position on various representations of patient data, including 2-D transverse, coronal and sagittal CT or MRI slices, and on image renderings of the physical object surface. Since it was necessary to have computers capable of managing large volumes of image information (>100 Mbytes) and updating the display quickly, most early IIGS systems were developed with VME bus devices running UNIX. Web site: http://www.delphion.com/details?pn=US06584339__ •

Method and apparatus for improved eye-hand co-ordination during videoscopic surgery Inventor(s): Street; Graham S. B. (Impstone House, Pamber Road, Silchester, Reading, Berkshire, GB) Assignee(s): none reported Patent Number: 6,547,720 Date filed: May 5, 1999 Abstract: A stereoscopic image acquisition and display system and associated method, suitable for effective eye-hand co-ordination during videoscopic surgery, is provided. The problems of previous three-dimensional acquisition and display systems are addressed by ensuring that the convergence angle for image acquisition lies within the range of 3 to 16 degrees and that the observer's visual convergence is set within similar limits. Simultaneous display of left and right eye images avoids the problems of field sequential displays. By providing the observer with a displayed image which is sufficiently bright and ensuring that the binocular disparity between corresponding

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points in the left and right eye images is correct, the system allows the observer to fuse a pair of stereo-images, without causing conflict between visual accommodation and convergence. The location of the displayed image may be adjusted. Excerpt(s): This invention is concerned with the field of three-dimensional imaging and in particular with the provision of a natural three-dimensional image of an operative site via, inter alia, an endoscope, thereby improving the eye-hand co-ordination of a surgeon, whilst he/she carries out such a surgical procedure... The field of Minimally Invasive Endoscopic Surgery (MIES) has, for a period in excess of 10 years, been dependent on the use of small diameter viewing devices, collectively known as endoscopes. Some of these are flexible and a majority rigid in construction. A typical working length of the insertion portion of such an instrument would be in excess of 30 cm. The diameter of this part of the instrument will typically vary from 10 mm to as low as 1 mm or less. Small diameter optics or a coherent fibre-optic bundle transfers an image of the operative site, via the distal tip of the insertion portion located inside the patient, to an external CCD camera. The image acquired in this way is displayed on a conventional television monitor placed at a comfortable viewing distance from the surgeon... We are used to viewing live imagery on a television screen from a distance of between 6 to 12 feet. Such a screen is of considerable size and typically provides a convenient viewing window, at such a distance. Conventional television quality is sufficient to provide the definition required within this window for such passive viewing. Web site: http://www.delphion.com/details?pn=US06547720__ •

Method and system for planning corrective refractive surgery Inventor(s): Halpern; Barton L. (175 Delp Rd., Lancaster, PA 17601), Gallagher; Shawn P. (Lancaster, PA) Assignee(s): Halpern; Barton L. (Lancaster, PA) Patent Number: 6,582,078 Date filed: February 27, 2001 Abstract: The invention provides a system and method which include receiving inputs from the surgeon based upon patient data and eye measurements, calculating precise corrective settings for laser equipment utilized in the surgery, and outputting the precise corrective settings along with recommendations and cautions for the surgical procedure. It should be understood by those reasonably skilled in the art that the nomograms and formulas described in the invention are dynamic formulas subject to change over time. Changes in the nomogram are required to customize a nonogram for an individual surgeon. In addition, as the art advances, adjustments in the nomograms, including addition and removal of variables, and changes in constants will be required to keep the nomogram consistent with the rapidly evolving state of the art. These changes can be accomplished through upgrades in computer programs. However, it is this very rapidly changing art and changing industry standards, as well as the need to customize nomograms to allow for individual surgeon variability, that make this invention ideally suited for use over the internet. Excerpt(s): This invention is related to refractive eye surgery, and more particularly to a software tool for assisting surgeons in planning this surgery... Refractive errors result when the optical elements of the eye, namely the cornea and the lens, do not focus a clear image onto the retina. An eye is considered emmetropic if it has no refractive error.

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Most eyes have at least some degree of refractive error. In myopia, the optical elements are too strong for the length of the eye, and the image is focused in front of the retina. In hyperopia, the optical elements are too weak for the length of the eye, and the image is focused behind the retina. In astigmatism, the optical elements cannot focus an image to a single point, and the image is split and focused at two separate points... When a refractive error is present, a lens may be used to refocus light onto the retina. This lens may be in the form of a spectacle lens or contact lens. Additionally, a lens surgically implanted within the eye (intrastromal or intraocular) can be used. Web site: http://www.delphion.com/details?pn=US06582078__ •

Method for minimally invasive surgery in the digestive system Inventor(s): Freeman; Lynetta J. (West Chester, OH) Assignee(s): Ethicon Endo-Surgery, Inc. (Cincinnati, OH) Patent Number: 6,543,456 Date filed: May 31, 2002 Abstract: A method for intraluminally performing a gastric bypass surgery is provided. Two anastomosis members are inserted transorally and located in a proximal position and a distal position within the digestive system. The stomach and the small intestine are transected to create a gastric pouch, a drainage loop, and a Roux limb. The distal anastomosis member joins the drainage loop to a distal portion of the intestine, and the proximal anastomosis member joins the Roux limb to the gastric pouch. Excerpt(s): The present invention relates, in general, to surgery and, more particularly, to a method of performing a surgical procedure on the digestive system... The percentage of the world population suffering from morbid obesity is steadily increasing. Severely obese persons are susceptible to increased risk of heart disease, stroke, diabetes, pulmonary disease, and accidents. Because of the effect of morbid obesity to the life of the patient, methods of treating morbid obesity are being researched... Numerous non-operative therapies for morbid obesity have been tried with virtually no permanent success. Dietary counseling, behavior modification, wiring a patient's jaws shut, and pharmacologic methods have all been tried, and, though temporarily effective, failed to correct the condition. Nonsurgical approaches using mechanical devices, such as esophago-gastric balloons to fill the stomach have also been used to treat the condition. Such devices cannot be employed over a long term, however, as they often cause severe irritation, necessitating their periodic removal and hence interruption of treatment. Thus, the medical community has evolved surgical approaches to treatment of morbid obesity. Many surgical procedures for treatment of morbid obesity may generally be classified as being directed toward creation of a smaller stomach, also known as gastro-restrictive surgery, or toward the prevention of absorption of food, the most common of which is the gastric bypass. In variations of the gastric bypass, the stomach is divided into two pouches, with the upper pouch connected to the esophagus and having a small food capacity. The lower pouch remains in situ connected to the duodenum. The upper pouch is then surgically attached to a portion of the small intestine, called the jejunum, through a small opening. The opening restricts the passage of food by the greatly reduced useable stomach. The smaller stomach causes a feeling of fullness, or early satiety, with less food consumption, causing the patient to eat less food overall. Web site: http://www.delphion.com/details?pn=US06543456__

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Method for use in cataract surgery Inventor(s): Holmen; Jorgen (Kulla, Ballefors, S-549 93 Moholm, SE) Assignee(s): none reported Patent Number: 6,533,769 Date filed: May 3, 2001 Abstract: A method for treatment of residual lens epithelial cells is disclosed. The method provides increased safety during local treatment in ocular surgery by improved administration of active agents. The method is particularly useful in treatment of proliferative events in ocular surgery, such as posterior capsular opacification. Excerpt(s): The present invention relates to cataract surgery, specifically to a method for preventing proliferation of remaining lens epithelial cells after cataract surgery... The crystalline lens of the human eye is located in the posterior chamber between the posterior iris surface and the vitreous body. It is a biconvex transparent tissue without nerves and blood vessels, weighing approximately 0.2 g. The lens is enveloped in a capsule, a structureless, transparent and elastic membrane bag. Approximately 80 zonular fibres, extending between the capsule and the ciliary body, suspend the lens. The inside of the lens capsule consists of lens epithelial cells and lens fibres. The lens epithelial cells form a monolayer underlying the capsule from the anterior pole to the equator of the lens. These cells continue to undergo cell mitosis throughout life in the area located between the anterior pole and the lens equator. The lens epithelial cells that underwent cell mitosis gradually move toward the lens equator and differentiate into lens fibres. These cells make up the rest of the lens. New layers of fibre cells are constantly formed on top of those previously formed. The older fibre cells become denser and during the 3.sup.rd decade of life a hard nucleus is formed in the middle of the human lens, consisting of old dehydrated fibre cells... A cataract is defined as every form of opacity in the lens or its capsule; the lens becomes cloudy, resulting in a loss of visual ability. A cataract is a painless phenomenon, but decreases the quality of life if the lens is not surgically extracted and replaced by an artificial lens. Web site: http://www.delphion.com/details?pn=US06533769__

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Method of laser cosmetic surgery Inventor(s): Keller; Gregory S. (2323 De La Vina, #104, Santa Barbara, CA 93105) Assignee(s): Keller; Gregory S. (Santa Barbara, CA) Patent Number: RE36,903 Date filed: July 26, 1999 Abstract: Laser surgery is utilized to perform cosmetic surgery. A quartz fiber is used to direct the laser energy to the target area for the incision, division or resection of tissue. An endoscope may be utilized in conjunction with the quartz fiber to perform the cosmetic surgical techniques. One application utilizes laser energy to eliminate glabellar frown lines and/or forehead wrinkles. Another application employs laser energy to rectify brow descent. A further application uses laser energy to perform a neck lift. In yet another application, laser energy is utilized to reduce nasolabial folds. The use of laser energy in cosmetic surgical procedures greatly reduces the size of the incision

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required in the skin to perform cosmetic surgical procedures, and as a result greatly reduces the risks of potential complications. Excerpt(s): The field of the present invention is cosmetic surgery... In recent years, laser technology has been utilized in a variety of applications in industry, surveying, communications and the medical field. In the field of cosmetic surgery, however, standard procedures typically involve extensive use of scalpels for incising, dividing and resecting tissue. Depending upon the particular procedure, disadvantageous complications may result including scarring, nerve damage and reduced blood flow to the affected area which can result in skin slough... For example, to remove glabellar frown lines (between the eyebrows) and forehead wrinkles, standard cosmetic surgical technique involves an extensive procedure called a forehead lift which entails a large incision that extends from ear to ear over the top of the forehead. The forehead lift is particularly disadvantageous because it opens the patient up widely requiring the physician to stop bleeders and risk cauterizing nerves. Since this procedure creates a large thin skin flap and reduces the blood supply to the skin, there is also an increased risk of skin slough and alopecia (balding). An alternate procedure for removing glabellar frown lines and forehead wrinkles is collagen treatment. However, this treatment is temporary at best and also involves a risk of allergic reaction. Moreover, collagen has been reported to cause autoimmune disease and blindness. Web site: http://www.delphion.com/details?pn=US0RE36903__ •

Method of using matrix metalloproteinase inhibitors in filtering blebs following glaucoma filtering surgery and in the treatment of ischemic damage to the retina and optic nerve Inventor(s): Schuman; Joel S. (Wayland, MA), Fini; M. Elizabeth (Milton, MA), Chintala; Shravan K. (Quincy, MA) Assignee(s): New England Medical Center Hospitals Inc. (Boston, MA) Patent Number: 6,503,892 Date filed: April 25, 2001 Abstract: This invention provides a method of inhibiting, preventing, and/or treating conjunctival filtering bleb leaks that may occur following glaucoma filtering surgery by administering Matrix Metalloproteinase inhibitors to glaucoma patients who have undergone such surgery. The invention additionally includes a method of using Matrix Metalloproteinase inhibitors to inhibit, prevent, and/or treat ischemic damage to the retina and optic nerve in patients in need of such treatment. Excerpt(s): The invention relates to methods of using matrix metalloproteinase inhibitors in glaucoma filtering surgery and in the treatment of ischemic damage to the retina and optic nerve... The retina is comprised of a network of light sensitive nerve cells that line the back of the eye. Located at the innermost cell layer are the ganglion cells. Long filamentous extensions from the axons of these cells wind their way across the retinal surface to a central location at the back of the eye, where they turn and bunch together to form the optic nerve leading to the brain. Light-induced signals are transmitted to produce our perception of sight. The place where the axons turn is called the optic nerve head. The term glaucoma describes a group of diseases that involve optic nerve damage at the level of the optic nerve head. Glaucoma results in a progressive loss of sight and may eventually lead to blindness... Elevated intraocular pressure (IOP) is the major risk for patients who suffer from glaucoma. In a normal subject's eye, a fluid,

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known as the aqueous humor, circulates freely through the anterior chamber of the eye. This fluid, which is continuously produced by the eye's ciliary body, is drained from the eye, through the trabecular meshwork, back into the bloodstream. When the fluid drains properly, an appropriate fluid pressure is maintained in the anterior chamber, maintaining the shape of the cornea. Elevated IOP develops when the filtration mechanism of the trabecular meshwork is no longer adequate, leading to an increase in fluid within the anterior chamber. This increase in fluid, in turn, leads to an increase in the IOP. It is this increase in IOP that subsequently causes pressure on the optic nerve at the level of the optic nerve head. This causes damage to the optic nerve, which, in turn, may lead to blindness. Web site: http://www.delphion.com/details?pn=US06503892__ •

Methods of protecting a patient from embolization during surgery Inventor(s): Tsugita; Ross S. (Mountain View, CA), Maahs; Tracy D. (Redwood City, CA), Jang; Yue-Teh (Fremont, CA) Assignee(s): Embol-X, Inc. (Mountain View, CA) Patent Number: 6,537,297 Date filed: June 26, 2001 Abstract: A method for open surgery using a flexible elongate member having a filter on a distal region thereof. The flexible elongate member is introduced into a peripheral artery. The flexible elongate member is advanced to a site within the aorta upstream of a branch vessel from the aorta. The filter is deployed. The aorta is manipulated by diret access. The filter is removed from the aorta. Embolic material is generated and filtered before the flexible elongate member is removed from the aorta. Excerpt(s): The present invention relates generally to treating plaque deposits and occlusions within major blood vessels, more particularly to an apparatus and method for preventing detachment of mobile aortic plaque within the ascending aorta, the aortic arch, or the carotid arteries, and to an apparatus and method for providing a stent and a filter in a percutaneous catheter for treating occlusions within the carotid arteries... Several procedures are now used to open stenosed or occluded blood vessels in a patient caused by the deposit of plaque or other material on the walls of the blood vessels. Angioplasty, for example, is a widely known procedure wherein an inflatable balloon is introduced into the occluded region. The balloon is inflated, dilating the occlusion, and thereby increasing intraluminal diameter. Plaque material may be inadvertently dislodged during angioplasty, and this material is then free to travel downstream, possibly lodging within another portion of the blood vessel or possibly reaching a vital organ, causing damage to the patient... In another procedure, stenosis within arteries and other blood vessels is treated by permanently or temporarily introducing a stent into the stenosed region to open the lumen of the vessel. The stent typically comprises a substantially cylindrical tube or mesh sleeve made from such materials as stainless steel or nitinol. The design of the material permits the diameter of the stent to be radially expanded, while still providing sufficient rigidity such that the stent maintains its shape once it has been enlarged to a desired size. Web site: http://www.delphion.com/details?pn=US06537297__

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Multi-function surgical instrument for facilitating ophthalmic laser surgery Inventor(s): LaHaye; Leon C. (566 Sand Pit Rd., Arnaudville, LA 70512) Assignee(s): none reported Patent Number: 6,569,153 Date filed: September 21, 2001 Abstract: A multi-function surgical instrument for facilitating ophthalmic surgery of the eye by laser means. Included are a lower ring and an upper ring. One or two intermediate rings may also be included. The lower ring includes a central aperture to capture the limbus and aid in positioning of the eye. Protuberances on the lower surface of said ring, application of vacuum between the lower surface of the ring and the eye, or both may be used to more firmly grip the eye. Ports disposed on the upper surface of the lower ring and connected to a vacuum source may be used to control hydration of the surgical field. Attached to and extending above the upper surface of the lower ring is a sterile platform for reposing temporarily removed tissues during the administration of laser pulses to other tissues. The upper ring is disposed above the surgical bed. Ports disposed along said upper ring and connected to a vacuum source may be used to control smoke and splatters resulting from the ablative procedure and create additional airflow to further control hydration of the surgical field. One, or two, intermediate rings, proximate the upper ring, may be employed to dispense irrigating liquids, gases such as air or oxygen, or both liquids and gases as may be desired onto open tissues of the eye proximate to the lower ring below. Excerpt(s): The new matter disclosed and claimed herein relates to disclosure of two additional rings, one of which may be used to dispense liquids, and the other which may be used to dispense gas, onto opened tissues of the eye during ophthalmic surgery... In the field of ophthalmic surgery the use of lasers is well known. In laser assisted in-situ kerotomileusis pulses of laser light are used to ablate desired portions of the stromal bed following temporary removal of the outer tissues of the cornea. After replacement of the temporarily removed tissues the cornea is reshaped. During such procedure, and other ophthalmic procedures involving ablation of eye tissue, positioning and fixation of the eye against movement is important, as is proper tissue hydration, control of smoke, plume and splatter, maintaining cleanliness of open tissues, etc. The invention disclosed and claimed herein relates to a multifunction instrument placed on the surface of the eye during ablative eye surgery to assist the ophthalmic surgeon to perform laser ablative eye surgery... In corneal surgery the use of lasers is well known. In such procedures precisely controlled pulses of laser light are used to remove thin layers of tissue by ablation. For instance, in photorefractive keratectomy ("PRK") the cornea is reshaped by first removing the epithelium and Bowman's layer (by various means) and ablating the stromal bed by laser (after which the epithelium and Bowman's layer are left to re-form by healing). In laser assisted in-situ kerotomileusis ("LASIK") the cornea is reshaped by temporarily removing the outer layers (epithelium, Bowman's layer and a portion of the stromal bed) thereof by sharp instrument, ablating selected areas of the underlying stromal bed by laser and then replacement of the removed tissues. Various other corneal surgery is also performed using a laser to ablatively remove selected eye tissue. Web site: http://www.delphion.com/details?pn=US06569153__

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Non-invasive methods for surgery in the vasculature Inventor(s): Unger; Evan C. (Tucson, AZ) Assignee(s): ImaRx Therapeutics, Inc. (Tucson, AZ) Patent Number: 6,576,220 Date filed: May 10, 2001 Abstract: Novel methods of non-invasive intravascular surgery are disclosed, which include the intravascular administration of a composition comprising gas or gaseous precursor filled vesicles, followed by application of ultrasound in an amount sufficient to induce activation or rupture of the vesicles. The methods optionally also include the step of scanning the patient with diagnostic imaging to determine the presence of the vesicles in the region. Excerpt(s): This invention relates to the field of magnetic resonance imaging, more specifically to the use of stabilized gas filled vesicles as contrast media for magnetic resonance imaging (MRI) directed ultrasound surgery... There are a variety of imaging techniques that have been used to diagnose disease in humans. One of the first imaging techniques employed was X-rays. In X-rays, the images produced of the patients' body reflect the different densities of body structures. To improve the diagnostic utility of this imaging technique, contrast agents are employed to increase the density of tissues of interest as compared to surrounding tissues to make the tissues of interest more visible on X-ray. Barium and iodinated contrast media, for example, are used extensively for Xray gastrointestinal studies to visualize the esophagus, stomach, intestines and rectum. Likewise, these contrast agents are used for X-ray computed tomographic studies (that is, computer assisted tomography or CAT) to improve visualization of the gastrointestinal tract and to provide, for example, a contrast between the tract and the structures adjacent to it, such as the vessels or lymph nodes. Such contrast agents permit one to increase the density inside the esophagus, stomach, intestines and rectum, and allow differentiation of the gastrointestinal system from surrounding structures... Magnetic resonance imaging (MRI) is a relatively new imaging technique which, unlike X-rays, does not utilize ionizing radiation. Like computer assisted tomography (CAT), MRI can make cross-sectional images of the body, however MRI has the additional advantage of being able to make images in any scan plane (i.e., axial, coronal, sagittal or orthogonal). Unfortunately, the full utility of MRI as a diagnostic modality for the body is hampered by the need for new or better contrast agents. Without suitable agents, it is often difficult using MRI to differentiate the target tissue from adjacent tissues. If better contrast agents were available, the overall usefulness of MRI as an imaging tool would improve, and the diagnostic accuracy of this modality would be greatly enhanced. Web site: http://www.delphion.com/details?pn=US06576220__

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Ophthalmic surgery apparatus Inventor(s): Toh; Minoru (Aichi, JP) Assignee(s): Nidek Co., Ltd. (Aichi, JP) Patent Number: 6,585,724 Date filed: March 30, 2001 Abstract: An ophthalmic surgery apparatus by which treatment laser beam is irradiated onto a desired portion of a patient's eye and for treatment of the portion, the apparatus

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includes: a laser irradiating unit having a laser beam source which emits the treatment laser beam, and an irradiating optical system which optically guides the treatment laser beam emitted from the laser beam source onto the portion; an ocular movement detecting unit which detects a potential difference between a cornea and a retina, and detects an ocular movement of the patient's eye based on the detected potential difference; and an irradiation controlling unit which controls the irradiating unit based on a result of detection by the detecting unit. Excerpt(s): The present invention relates to an ophthalmic surgery apparatus for performing treatment by irradiating a treatment laser beam to a subject's eye, and more particularly to a mechanism for aligning the irradiation optical axis of a laser irradiating optical system for applying a treatment laser beam, with a patient's eye, and also to a laser irradiation controlling mechanism associated with the alignment... As an ophthalmic surgery apparatus for performing treatment by irradiating a laser beam for treatment to a patient's eye, a corneal surgery apparatus using an excimer laser beam, for example, is known. This apparatus is used for refractive correction by changing the curvature of the cornea with an excimer laser beam irradiated to the corneal surface... In this apparatus, the patient is caused to gaze at a fixation target to fix the position of the patient's eyeball, and the irradiation optical axis of the laser irradiating optical system and the patient's eye are brought into alignment in a desired state by using an alignment target or the like. After completion of the alignment, a part of the cornea is ablated at a set amount within an intended area. Web site: http://www.delphion.com/details?pn=US06585724__ •

Ophthalmic surgery method using non-contact scanning laser Inventor(s): Lin; J. T. (Winter Springs, FL) Assignee(s): LaserSight Technologies, Inc. (Winter Park, FL) Patent Number: RE37,504 Date filed: May 27, 1998 Abstract: A refractive laser surgery process is disclosed for using compact, low-cost ophthalmic laser systems which have computer-controlled scanning with a non-contact delivery device for both photo-ablation and photo-coagulation in corneal reshaping. The basic laser systems may include flash-lamp and diode pumped UV solid state lasers (193-215 nm), compact excimer laser (193 nm), free-running Er:glass (1.54 microns), Ho:YAG (2.1 microns), Q-switched Er:YAG (2.94 microns), and tunable IR lasers, (7501100) nm and (2.5-3.2) microns. The advantages of the non-contact, scanning device used in the process over other prior art lasers include being safer, reduced cost, more compact and more precise and with greater flexibility. The theory of beam overlap and of ablation rate and coagulation patterns is also disclosed for system parameters. Lasers are selected with energy of (0.01-10) mJ, repetition rate of (1-10,000), pulse duration of 0.01 nanoseconds to a few hundreds of microseconds, and with spot size of (0.05-2) mm for use with refractive laser surgery. Excerpt(s): The present invention relates to laser ophthalmic surgery using a compact, low-cost, low-power laser system with a computer-controlled, non-contact process and corneal topography to perform corneal reshaping using either surface ablation or thermal coagulation... Various lasers have been used for ophthalmic applications including the treatments of glaucoma, cataract and refractive surgery. For non-refractive treatments (glaucoma and cataract), suitable laser wavelengths are in the ranges of

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visible to near infrared. They include: Nd:YAG (1064 nm), doubled-YAG (532 nm), argon (488, 514 nm), krypton (568, 647 nm), semiconductor lasers (630-690 nm and 780860 nm) and tunable dye lasers (577-630 nm). For refractive surgeries (or corneal reshaping), ultraviolet (UV) lasers (excimer at 193 nm and fifth-harmonic of Nd:YAG at 213 nm) have been used for large area surface corneal ablation in a process called photorefractive keratectomy (PRK). Corneal reshaping may also be performed by laser thermal coagulation currently conducted with Ho:YAG lasers using a fiber-coupled, contact-type process. However, the existing ophthalmic lasers as above described have one or more of the following limitations and disadvantages: high cost due to the highpower requirement in UV lasers for photorefractive keratectomy; large size and weight; high maintenance cost and gas cost (for excimer laser), and high fiber-cost for contacttype laser coagulation... In light of the above, it is an object of the present invention to provide ophthalmic laser systems which offer the advantages of: low-cost, reduced size and weight, reliability, easy-operation and reduced maintenance. Another object of this invention is to provide a computer-controlled scanning device which enables use of a low-cost, low-energy laser for photorefractive keratectomy currently performed only by high-power UV lasers. Web site: http://www.delphion.com/details?pn=US0RE37504__ •

Remote surgery support system Inventor(s): Uchikubo; Akinobu (Oume, JP) Assignee(s): Olympus Optical Co., Ltd. (JP) Patent Number: 6,602,185 Date filed: February 14, 2000 Abstract: A first signal transmission apparatus installed in an operating room and a second signal transmission apparatus installed in a remote control room in a remote place are linked by a public line. Assuming that surgery is performed on a patient using a surgical instrument in the operating room while endoscopic images are viewed, the surgical instrument can be controlled using a first controller. The control and patient data are displayed on a display device via a second controller connected to the second signal transmission apparatus. The state of the surgical instrument and the patient data can always be checked in the remote control room. Surgical instructions or any other surgical support can be given easily. Excerpt(s): The present invention relates to a remote surgery support system for remotely supporting surgery... Normally, an operator performs surgery on a patient in an operating room. For example, an operator in an operating room may have to carry out a surgical procedure in which the operator has little experience. A support system for helping the operator appropriately perform surgery on a patient in an operating room is presumably such that the operator in the operating room can perform surgery while remotely supported by a remotely supporting operator. Specifically, the operator in the operating room communicates with the remotely supporting operator staying in a remote place over a public line, and receives instructions on a region to be resected from the remotely supporting operator during surgery... Related arts concerning the remote surgery support system for remotely supporting surgery include an art disclosed in Japanese Patent Application No. 10-318019. Web site: http://www.delphion.com/details?pn=US06602185__

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Securing component for a ring fixator used in orthopaedic surgery Inventor(s): Venturini; Daniele (Verona, IT), Coati; Michele (Verona, IT), Rossi; Graziano (Verona, IT) Assignee(s): Orthodix S.r.l. (Bussolengo, IT) Patent Number: 6,537,275 Date filed: May 2, 2001 Abstract: The invention relates to a clamp element for external fixator apparatuses of the rod and ring type used for stabilizing bone fractures in orthopedic surgery; a clamp connector secures at least one of the bone fragment stretching wires and the bone screws to the rings. The invention comprises a swivel joint comprising a first part and a second part associated with each other around a common pivot axis, each part being formed with at least one hole of a predetermined diameter for clamping the stretching wire or the bone screw therein. Also provided on each of the parts are clamping mechanisms for attaching to a rod or to a ring of the fixator device. The clamping mechanisms are used for clamping the stretching wire or the bone screw in the part of the swivel joint which is not connected to the rod or to the ring. Excerpt(s): This invention broadly relates to an element for an external ring fixator used for stabilizing bone fractures in orthopedic surgery... More particularly, the invention relates to a clamp element for external fixators of the rod and ring type used for stabilizing bone fractures in orthopedic surgery; such clamp element secures at least one of the bone fragment stretching wires and the bone screws to one of the fixator rings... As it is known in this technical field, external fixators are modular apparatuses, comprising a plurality of component parts, which can be assembled with each other into a variety of different configurations. Web site: http://www.delphion.com/details?pn=US06537275__

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Shoulder surgery attachment for a surgical table Inventor(s): VanSteenburg; Kip P. (Sudbury, MA), Licari; Paul A. (Boxborough, MA) Assignee(s): Hill-Rom Services, Inc. (Wilmington, DE) Patent Number: 6,564,406 Date filed: March 22, 2001 Abstract: A surgical table has an articulated leg section with accessory attachment rails on opposite sides thereof. A shoulder surgery attachment for the surgical table includes a chair back assembly having a base on one end thereof and a cooperating second connector at each of its sides. Each second connector is releasably attachable to its corresponding first connector. A pair of mounting blades are provided on opposite sides of the base. A rail clamp is positionable along the attachment rails to be fastened to each of the attachment rails to provide a first connector at each side of the leg section. Excerpt(s): The present invention relates to surgical attachments for positioning a patient for surgical procedures and particularly to a shoulder surgery attachment for a surgical table... Surgical procedures on the shoulders of patients are often performed with the patients in the so called beach-chair position. In the beach-chair position, a patient is positioned in a sitting position during surgery, although the patient may be anesthetized in a supine position... There are presently several devices that are used for positioning patients in the beach-chair position, such as dedicated surgical tables that

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are factory-made with the required mechanisms, and such as accessories for regular tables that adapt them for positioning patients in the beach-chair position. U.S. Pat. No. 5,661,859 to Schaefer discloses a shoulder arthroscopy attachment for use with a surgical table wherein the attachment may be attached to a seat section of the table in place of an articulated leg section. U.S. Pat. No. 5,926,876 to Haigh et al. discloses a device for adapting a surgical operating table so that the upper torso of a patient can be raised in order to place the patient in a seated position. The device shown in the '876 patent is positioned on a horizontal surface and is pivotal with respect to the horizontal surface. Both the '859 and '876 patents are hereby incorporated herein by reference to establish the background for the present application. Web site: http://www.delphion.com/details?pn=US06564406__ •

Splint for surgery of lacrimal passages Inventor(s): Bernard; Jean-Antoine (Paris, FR), Klap; Patrick (Paris, FR) Assignee(s): France Chirurgie Instrumentation, F.C.I. (Les Moulineaux, FR) Patent Number: 6,569,110 Date filed: September 11, 2001 Abstract: Splint for surgery of lacrimal passages includes a plate adapted for insertion in a nasal passage, the plate comprising two arms made of a flexible material, the two arms defining therebetween an open angle, a convex side being formed on the plate opposite the open angle and a flange formed on a first edge of one of the arms, the flange being located on the convex side of the plate. Excerpt(s): The present application claims priority under 35 U.S.C.sctn.119 of French Patent Application No. 00/11568, filed Sep. 12, 2000... The present invention relates to a splint for surgery of the lacrimal passages... The invention relates to a splint which can be used more particularly for endonasal dacryocystorhinostomy, an operation which consists of anastomosing the lacrimal sac in the nasal cavities, following an obstruction of the lacrimal passages. Web site: http://www.delphion.com/details?pn=US06569110__

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Support pillow for rectal surgery Inventor(s): Graham; Bruce D. (5655 W. 150th St., Overland Park, KS 66223) Assignee(s): none reported Patent Number: 6,557,197 Date filed: November 1, 2001 Abstract: A surgical pillow is provided for supporting, cushioning and positioning a patient while in a prone position on an operating table during rectal surgery. The pillow comprises an elongated, self-sustaining, flexible body unit of compressible material having shape return memory. The body unit is provided with an indented upper face defined by a longitudinally extending, centrally located channel and chamfered downwardly inclined patient positioning surfaces on opposite sides of the central channel. Converging, inclined side surfaces of the body unit are configured and strategically located to accommodate the axilla areas of a patient while the patient is

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supported on the body unit. A removable cover that substantially conforms to the configuration of the body unit is provided in full covering relationship to the body unit. Excerpt(s): This invention relates to an improved surgical pillow especially adapted to support, cushion and position a patient while in a prone position on an operating table during rectal surgery... At the present time, positioning of a patient for rectal surgery on a conventional operating table is most usually accomplished by making up rolls of blankets, towels or other similar items which are then placed along opposite sides of the patient's torso. That technique has many disadvantages including the tendency for the rolled support to shift and tend to be displaced from the original patient supporting locations thereof, and the fact that the rolls do not provide optimum patient cushioning and positioning. Furthermore, it is difficult to arrange the blanket or towel rolls in this position such that the patient's arms can be placed comfortably hanging over the edges of the operating table. Equally as significant, although support is provided by the rolls, blanket or towels for the patient's torso, the patient is still lying flat on the table in a prone positions such that pressure is inherently applied to the central part of the patient's body. The result is a tendency for the compressive forces on the patient's torso to impede veinous blood return to the patient's heart... Efforts to solve the problem of providing comfortable and effective support and positioning of a patient in a prone position during rectal surgery have not found widespread acceptance and universal usage in part because of the complexity and cost of prior devices, the inability of the supporting devices to adequately accommodate patients of different sizes and weights, and the inordinate setup and adjustment time encountered with certain units. Web site: http://www.delphion.com/details?pn=US06557197__ •

Surgery stretcher Inventor(s): Heimbrock; Richard H. (Cincinnati, OH), Turner; Jonathan D. (Dillsboro, IN), Manlove; D. Scott (Osgood, IN) Assignee(s): Hill-Rom Services, Inc. (Wilmington, DE) Patent Number: 6,578,215 Date filed: September 29, 2000 Abstract: An illustrative eye surgery stretcher includes a head rest configured to support a patient's head, a head frame configured to support a patient's shoulders, a back frame configured to support a patient's back, and a seat frame configured to support a patient's seat. The head rest is adjustably movable relative to the head frame. The head frame is adjustably movable relative to the back frame. The back frame is adjustably movable relative to the seat frame. Excerpt(s): The present invention relates to a hospital stretcher, and particularly, to a surgical stretcher used for eye surgery... Hospital stretchers having head rests that support the head of a patient during eye, head, or neck surgery are known. For example, U.S. Pat. No. 6,076,208 issued to Heimbrock et al. describes a stretcher suitable for such surgeries, which patent is hereby incorporated herein in its entirety by reference. See also U.S. Pat. No. 4,882,797 to Failor et al. Many eye surgery procedures approaching a side of the patient while seated in a surgeon's chair. In addition, it is common for a microscope or other surgical equipment to be located above the patient's eye during eye surgery. Hence, there is a limited amount of space between a surgeon's lap and a microscope or other surgical equipment used by the surgeon during eye surgery. Therefore, surgeons would appreciate a surgical stretcher having a minimum amount of

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structure beneath the patient's shoulder, neck, and head area thereby permitting comfortable placement of the surgeon's legs beneath the patient while, at the same time, allowing ergonomic access to the surgical equipment located above the patient. In addition, it would be desirable for any stretcher controls used to adjust the position of the patient to be readily accessible to the surgeon while the surgeon is seated alongside the patient... According to one aspect of the illustrative embodiment, the back frame defines a first, generally horizontal, upwardly facing support surface. The head frame angles upwardly to define a second, generally horizontal, upwardly facing support surface that is raised relative to the first, generally horizontal, upwardly facing support surface defined by the back frame to provide room for comfortable placement of the surgeon's legs beneath the patient. Web site: http://www.delphion.com/details?pn=US06578215__ •

System for performing port off-pump beating heart coronary artery bypass surgery Inventor(s): Castaneda; Javier E. (Miami, FL), Francese; Jose Luis (Miami, FL), de la Torre; Ralph (Charlestown, MA), Palmer; Matthew A. (Miami, FL) Assignee(s): Medcania, Inc. (Miami, FL) Patent Number: 6,554,823 Date filed: December 8, 2000 Abstract: A system for performing through port off-pump coronary artery bypass surgery includes a port insertable between ribs into a chest wall of a patient, a heart stabilizer extendable through and stably couplable to the port, and an instrument stabilizer adapted to dampen extraneous movement to which a surgical instrument extending through the stabilizer is subject. Excerpt(s): This invention relates broadly to surgical instruments. More particularly, this invention relates to a system of surgical instruments for performing port beating heart coronary artery bypass surgery... Substantially all coronary artery bypass (CAB) procedures are performed via an open chest method. In the procedure, the chest is opened through an incision in the middle of the chest, called a sternotomy, and the ribs are retracted and held stably open with a retractor. This provides a sufficient amount of access to the heart. The heart is then arrested and the blood flow is rerouted through a heart-lung machine. The bypass procedure is then performed, and once complete, the heart is then restarted and blood is permitted to flow through the "bypass". While this procedure is the norm, it is far from desirable. First, arresting the heart is a dangerous procedure and can lead to serious complications and even death. Second, the procedure requires a sternotomy, which is painful and traumatic. Because of this incision the recovery time is relatively long and the patient is left with a permanent large scar... More recently, some surgeons have performed coronary artery bypass surgery on a beating heart. The chest is opened via a sternotomy and retracted. Using a device called a heart stabilizer, the surgical site on the heart is essentially immobilized for suturing. The heart stabilizer is typically anchored to the retractors which are in turn anchored to the walls of the chest at the site of the incision. Direct access to the surgical site as well as immobilization of the surgical site are key to the surgery. These factors allow the surgeon to perform a suture or other operation with precision. While the methodology is effective and eliminates the potential complications of arresting the heart, the drawbacks associated with the sternotomy remain. Web site: http://www.delphion.com/details?pn=US06554823__

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Transvaginal tube as an aid to laparoscopic surgery Inventor(s): McCartney; Anthony John (Swanbourne, AU) Assignee(s): Gynetech Pty Ltd. (AU) Patent Number: 6,572,631 Date filed: November 19, 1999 Abstract: A transvaginal tube adapted for insertion into the vaginal tract of a patient for use during performance of a laparoscopic hysterectomy or other laparoscopic surgery on the patient. The tube has a diameter greater than the patient's cervix opening and has a distal end and a proximal end. The proximal end is cut in a plane non-normal to its tubular axis being adapted to define the patient's cervico-vaginal junction. The tube further includes a sealing structure capable of forming a seal at the distal end of the tube during the surgery. The tube is capable of maintaining the pneumoperitoneum when inserted into the vaginal tract of the patient with the seal formed at the distal end of the tube. Excerpt(s): This invention relates to transvaginal tube which is particularly useful in laparoscopic surgery, and also to a procedure for the use of such a tube... Modern advances in laparoscopic surgical equipment have meant that surgeons are able to remove the uterus and/or ovaries laparoscopically, removing the need for a long abdominal incision... A laparoscopic radical hysterectomy for cancer has evolved from the efforts of a few oncology centres with an interest in minimising invasive surgery. The operative technique is analogous to a modification of the operation originally described by Wertheim and Meigs. The laparoscope surgeon passes a 10 mm laparoscope trans-abdominally through a sub-umbilical incision after establishing a pneumoperitineum. Using two lateral portals the ovarian pedicles are divided down to the level of the uterine arteries. The ureter is isolated and protected and the uterine vessels and parametrium are divided after mobilising the bladder. The next stage is to remove the uterus and close the vaginal vault so the pneumoperitoneum can be reestablished for the lymphadenectomy. The lymph nodes are removed by plucking them from their bed and dragging them out of the abdomen through the trans-abdominal wall port used for the grasping forceps. Web site: http://www.delphion.com/details?pn=US06572631__

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Two-pivot scanning for laser eye surgery Inventor(s): Sobiech; Jeff (San Jose, CA), Glockler; Herrmann (Cupertino, CA), Price; Henry (San Jose, CA) Assignee(s): VISX, Incorporated (Santa Clara, CA) Patent Number: 6,488,676 Date filed: September 24, 1999 Abstract: Laser eye surgery systems, methods, and devices makes use of a two-pivot scanning system for laterally deflecting the laser beam across the corneal surface to provide X-Y scanning. An imaging lens pivots about two eccentric axes extending along, but disposed beyond the laser beam. As the lens pivots, the beam will follow a substantially arc-shaped path. The eccentric axes are offset about the laser beam axis by about 90.degree., and the system controller can compensate for the arc-shaped path

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deflections by adjusting the angular position of the imaging lens about complementary stage. Excerpt(s): The present invention is generally related to ophthalmic instruments and surgery. In a particular embodiment, the invention provides a mechanism and method for scanning a laser beam over a surface of a patient's eye to effect resculpting... Laserbased systems are now used in ophthalmological surgery on the surface of the cornea to correct vision defects. These systems use lasers to achieve a desired change in corneal shape, with the laser removing thin layers of corneal tissue using a technique generally described as ablative photodecomposition. These laser eye surgery techniques are useful in procedures such as photorefractive keratectomy, phototherapeutic keratectomy, laser insitu keratomileusis (LASIK), and the like... The ability to track or follow movements of a patient's tissue is recognized as a desirable feature in laser eye surgery systems. Movements of the eye include both voluntary movements and involuntary movements. In other words, even when the patient is holding "steady" fixation on a visual target, eye movement still occurs. Tracking of the eye during laser eye surgery has been proposed to avoid uncomfortable structures which attempt to achieve total immobilization of the eye. Tracking may enhance known laser eye surgery procedures, and may also facilitate new procedures, such as treatment of irregular astigmatism. Web site: http://www.delphion.com/details?pn=US06488676__

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

Adhesion barriers applicable by minimally invasive surgery and methods of use thereof Inventor(s): Sawhney, Amarpreet S. ; (Lexington, MA) Correspondence: PATTERSON, THUENTE, SKAAR & CHRISTENSEN, P.A.; 4800 IDS CENTER; 80 SOUTH 8TH STREET; MINNEAPOLIS; MN; 55402-2100; US Patent Application Number: 20030108511 Date filed: December 13, 2002 Abstract: Biocompatible crosslinked polymers, and methods for their preparation and use with minimally invasive surgery applicators are disclosed. The disclosure includes compositions and methods for in situ formation of hydrogels using minimally invasive surgical techniques. Excerpt(s): The present patent application is a Continuation-In-Part of U.S. patent application Ser. No. 10/010,715, filed Nov. 9, 2001, entitled "Biocompatible Crosslinked Polymers", which is a Continuation-In-Part of: U.S. patent application Ser. No. 09/454,900, filed Dec. 3, 1999, entitled "Biocompatible Crosslinked Polymers" which has a priority date based on U.S. Patent Application No. 60/110,849, filed Dec. 4, 1998. The present patent application is also a Continuation-In-Part of U.S. patent application Ser. No. 09/513,491, filed Feb. 25, 2000, entitled "Methods and Apparatus for In Situ

10

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

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Formation of Hydrogels", which is a Divisional of U.S. patent application Ser. No. 09/134,198, filed Aug. 14, 1998, now issued as U.S. Pat. No. 6,179,862, entitled "Methods and Apparatus for In Situ Formation of Hydrogels". The present patent application also claims priority to U.S. Patent Application No. 60/359,236, filed Feb. 20, 2002, entitled "Sprayable Adhesions Barrier". All of these patents and patent applications are hereby claimed as priority documents and are hereby incorporated by reference herein... The present invention relates generally to biocompatible crosslinked polymers, methods for preparing and using the same... Almost every surgical treatment carries a risk that bodily tissues exposed during the course of the surgery will adhere to each other, a condition termed an adhesion. Gynecological and abdominal surgeries, in particular, are prone to causing adhesions, which often have the appearance of scar-like masses. Adhesions are frequently painful and are a significant cause of infertility resulting from gynecological surgeries. Adhesions caused by surgeries are often called surgical adhesions. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Apparatus and method for joint surgery Inventor(s): Dew, Douglas K. ; (Palm Coast, FL) Correspondence: BEUSSE, BROWNLEE, BOWDOIN & WOLTER, P. A.; 390 NORTH ORANGE AVENUE; SUITE 2500; ORLANDO; FL; 32801; US Patent Application Number: 20030032994 Date filed: July 30, 2002 Abstract: Apparatuses for controlling the surgical tissue heating process. An irrigation fluid pump provides both positive and negative pressure to allow the surgeon to accurately determine the condition of the tissue under both pressurized and nonpressurized states. The temperature of the irrigation fluid is monitored to ensure that the tissue is not overheated. The heating probe tip is supplied with a sleeve to control the heat profile during the surgery. Excerpt(s): This application claims the benefit of Provisional Patent Application No. 60/308,771, filed on Jul. 30, 2001... The present invention relates generally to joint surgery and more particularly to advantageous surgical apparatuses for shoulder surgery, including thermal capsulorrhaphy... Arthroscopy is a surgical procedure that allows the physician to visually examine the interior of a joint in the body. During an arthroscopy procedure, the physician inspects the joint surfaces and the surrounding soft tissues, such as ligaments connecting bone to bone and cartilage covering the ends of the bones at the joints. This procedure can be used to diagnose a joint problem, perform surgery that repairs a joint problem, monitor a disease, collect a tissue sample for laboratory analysis or determine the effectiveness of a treatment. Arthroscopy is commonly performed on the knee, shoulder, ankle, hip, elbow, and wrist. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Apparatus and method for performing spinal surgery Inventor(s): Cooper, Doug Wayne ; (Redwing, MN), Buttermann, Glenn Robin ; (Mahtomedi, MN) Correspondence: FOLEY AND LARDNER; SUITE 500; 3000 K STREET NW; WASHINGTON; DC; 20007; US Patent Application Number: 20030135217 Date filed: January 14, 2002 Abstract: A cutting guide for use in spinal surgery includes a sidewall defining an internal cavity. A chisel guide, for use with the cutting guide, includes a first block member to be inserted into the internal cavity of the cutting guide to position the first block member adjacent the vertebral body. The chisel guide also includes a second block member connected to the first block member. An apparatus for creating a cavity in a vertebral body endplate and in an intervertebral disc may be a compressor or a distractor having at least one cutting implement thereon. A tensioner determines a proper elongation distance in a prosthesis implanted in a vertebral body. Excerpt(s): This invention relates to the field of spinal surgery. More specifically, this invention relates to apparatuses for creating cavities in vertebral bodies and in intervertebral discs located between the vertebral bodies. This invention also relates to methods for creating such cavities. Once the cavities are created with the apparatuses and according to the methods of the present invention, an intervertebral prosthetic device, designed to replace a damaged intervertebral disc, can be implanted in the cavities. Moreover, the implanted device may be used in vertebral body fusion or in reconstruction of mobile discs through spinal arthroplasty (i.e., disc replacement)... The human spine is a flexible structure comprised of twenty-five vertebrae. Intervertebral discs separate and cushion adjacent vertebrae. The intervertebral discs act as shock absorbers and allow bending between the vertebrae... An intervertebral disc comprises two major components: the nucleus pulposus and the annulus fibrosis. The nucleus pulposus is centrally located in the disc and occupies 25-40% of the disc's total crosssectional area. The nucleus pulposus usually contains 70-90% water by weight and mechanically may function like an incompressible hydrostatic material. The annulus fibrosis surrounds the nucleus pulposus and resists torsional and bending forces applied to the disc. Thus, the annulus fibrosis serves as the disc's main stabilizing structure. A healthy disc relies on the unique relationship of the nucleus and annulus to one another. The top and bottom surfaces of intervertebral discs abut vertebral body endplates. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Beam position monitoring for laser eye surgery Inventor(s): Schroder, Russell ; (San Jose, CA) Correspondence: TOWNSEND AND TOWNSEND AND CREW, LLP; TWO EMBARCADERO CENTER; EIGHTH FLOOR; SAN FRANCISCO; CA; 94111-3834; US Patent Application Number: 20030197908 Date filed: April 22, 2002 Abstract: Improved methods, apparatus and systems for monitoring laser beam position enhance the safety and efficacy of laser eye surgery systems. The present invention will advantageously be used in laser eye surgery where accurate control of the laser beam is

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crucial for patient safety and successful vision correction. In one embodiment, a first beam of laser energy is directed through a scanning mechanism toward an eye to ablate the eye, and a second beam of laser energy is directed through the scanning mechanism toward a sensor. When the scanning mechanism is moved by a laser eye surgery system to move the first beam across the eye, the scanning mechanism also moves the second beam across the sensor. Movement of the beam across the sensor can be used to monitor movement of the first beam across the eye. If actual movement of the first beam across the eye does not match desired movement of the beam, one or more components of the laser surgery system will shut down in order to stop the laser eye surgery procedure, thus preventing undesirable ablation of the eye. Excerpt(s): The present invention relates generally to methods, apparatus and systems for performing laser eye surgery. More particularly, the present invention relates to laser beam position monitoring methods, apparatus and systems for enhancing safety of laser eye surgery systems... Photorefractive keratectomy (PRK) and phototherapeutic keratectomy (PTK) employ laser beam delivery systems for directing laser energy to a patient's eye to selectively ablate corneal tissue to reform or sculpt the shape of the cornea and, thereby, to improve vision. Present commercial systems often employ excimer lasers. In a first type of system, positioning of the beam is generally fixed and the beam has a cross-sectional area generally corresponding to an entire surface area of a surgical site on the cornea. Cross-sectional portions of the beam are then sequentially masked or adjusted so as to selectively vary the amount of energy exposure of different portions of the surgical site so as to effect the desired sculpting. This can typically be achieved by using an iris or other exposure control mechanism. While highly effective and relatively easy to control, employing a laser beam having a cross-sectional area generally equal to the area of the treatment or surgical site (typically having a diameter of 5.0 mm to 10.0 mm) often involves the use of relatively large amounts of energy. This is typically relatively expensive, and leads to relatively large laser systems... As an alternative to such large beam diameter systems, laser "scanning" systems can be employed for corneal ablation. Such scanning systems typically employ a laser beam having a smaller cross-sectional area, thereby decreasing energy requirements. Accordingly, laser scanning systems delivering laser beams of relatively small crosssectional area can be more economic to use and normally are of smaller construction than laser systems having larger diameter beams. However, the use of such small beams complicates certain aspects of the treatment protocols required to perform the sculpting. For example, to achieve a desired level of volumetric tissue removal or ablation from the eye, the treatment beam is scanned over or otherwise moved across the eye from one position to a next during the surgical procedure. Movement of the beam is typically achieved through motorized scanning mechanisms, devices, or the like. These scanning mechanisms often regulate the position of an optical element, such as the angle of a mirrored surface, the lateral position of an offset imaging lens or the like, so as to adjust the lateral position of the beam across the treatment site. In a related type of system, the laser beam is scanned over the corneal surface while varying the cross-section of the laser beam. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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BIOCOMPATIBLE, INJECTABLE AQUEOUS ULTRASOUND ENERGY ASSISTED SURGERY

SOLUTION

FOR

USE

IN

Inventor(s): TOPAZ, MORIS ; (KIBBUTZ RAMAT HAKOVESH, IL) Correspondence: BERNHARD D SAXE; FOLEY & LARDNER; WASHINGTON HARBOUR; 3000 K STREET NW SUITE 500; WASHINGTON; DC; 200075109 Patent Application Number: 20030032943 Date filed: January 6, 2000 Abstract: The invention provides a biocompatible, injectable aqueous solution for use in high intensity ultrasound energy assisted surgery comprising a gas selected from the group consisting of carbon dioxide, nitrogen and mixtures thereof for the reduction and limitation of cavitation. Excerpt(s): The present invention relates to a biocompatible, injectable aqueous solution for use in high intensity ultrasound energy assisted surgery. More specifically the irrigation solution of the present invention contains a gas selected from the group consisting of carbon dioxide, nitrogen and mixtures thereof for the reduction and limitation of cavitation and the reduction and limitation of sonoluminescence and sonochemistry... Ultrasound energy has been extensively used in the medical field, mainly for diagnostic and therapeutic purposes it has been utilized for diagnosis in medicine mainly at a sonar pulse mode of very short duration and of high frequency and peak intensity, or at low intensities of 10.sup.-2 to 10.sup.-3 W/cm.sup.2 CW, and at a high frequency in dopier mode. Ultrasound is used in physical therapy in intensities of up to 3-5 W/Cm.sup.2 CW, for a short exposure time. Ultrasonic ablative surgery instrumentation, such as those used in phacoemulsification in ophthalmology, recanalization and thrombus dissolution in peripheral arteries, in neurosurgery, hepatic, renal, prostate and bladder resections, as well as in extracorporeal shock wave lithotripter, utilize higher power intensities that are above 10W/cm.sup.2CW. The longterm safety of diagnostic ultrasonic equipment in clinical use was questioned and evaluated with no significant effects demonstrated at intensities below 100 mW/cm.sup.2 spatial and temporal peak average intensity... High-intensity ultrasound energy (HIUE) has been used in the last three decades in a wide range of surgical procedures for the extraction of tissues such as soft tissues and other target tissues, said target tissues including kidney tissues, brain tissues, liver tissues, cataracts, etc. In the last ten years, HIUE has been utilized for aesthetic surgery in Ultrasound-Assisted Lipoplasty (UAL). In UAL, subcutaneous fatty tissue in the human body is irrigated with wetting solution, emulsified by exposure to HIUE through a probe via a stab wound in the skin, and can be evacuated simultaneously or immediately following, by the application of low-vacuum suction. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Blade for corneal surgery and corneal surgical apparatus comprising the same Inventor(s): Sugimura, Masahiro ; (Aichi, JP), Amano, Masanori ; (Aichi, JP) Correspondence: Finnegan, Henderson, Farabow,; Garrett & Dunner, L.L.P.; 1300 I Street, N.W.; Washington; DC; 20005-3315; US Patent Application Number: 20030130676 Date filed: December 11, 2002

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Abstract: A blade for corneal surgery for separating a corneal epithelium in a flap shape, includes: upper and lower blade surfaces; and an edge surface connecting the upper and lower blade surfaces, the edge surface having a height of 1 to 70 .mu.m and a connecting portion with each of the upper and lower blade surfaces having a curved surface. Excerpt(s): The present invention relates to a blade for corneal surgery which is suitable for separating (incising) a corneal epithelium like a flap and a corneal surgical apparatus comprising the blade... There has been known LASIK (Laser in Situ Keratomileusis) for the keratorefractive surgery in which a flap is formed by incising a corneal portion with a thickness of about 0.15 mm ranging from a corneal epithelium to a corneal stroma with a part of the cornea remaining connected like a hinge, ablating the corneal stroma in a refractive correction amount by a laser beam, and returning the flap. In the LASIK, there is used a corneal surgical apparatus called a microkeratome which serves to incise the cornea in a layered form... In recent years, attention has been paid to a method of LASEK (Laser Epithelial Keratomileusis) in which a corneal epithelium except a hinge is cut in an annular by an epi-trephine, and the corneal epithelium is immersed in alcohol and is swollen, and a flap is formed by separating the corneal epithelium from a Bowan's membrane by means of a golf knife, and a corneal stroma is ablated by a laser beam and the flap into an original position is returned. The LASEK cart also be applied to a thin cornea to which the LASIK cannot be applied. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Corneal-ablation-data determining apparatus and a corneal surgery apparatus Inventor(s): Maeda, Naoyuki ; (Minoo-shi, JP) Correspondence: OLIFF & BERRIDGE, PLC; P.O. BOX 19928; ALEXANDRIA; VA; 22320; US Patent Application Number: 20030073984 Date filed: October 11, 2002 Abstract: A corneal-ablation-data determining apparatus and a corneal surgery apparatus capable of performing corneal ablation surgery efficiently while improving an aberration of a patient's eye. The corneal-ablation-data determining apparatus for obtaining ablation data for corneal ablation surgery to correct a refractive error by ablating a cornea, the apparatus comprising an input device for inputting measurement data of a patient's eye and size data of an ablation zone and a calculation device for calculating ablation data including aberration improvement data for the patient's eye based on the inputted measurement data and size data, wherein the calculation device divides the ablation zone into a central zone and a peripheral zone outside the central zone, then calculates ablation data for a component not being a non-spherical component in the central zone, and calculates ablation data for a non-spherical component in at least part of the peripheral zone, including the aberration improvement data. Excerpt(s): The present invention relates to a corneal-ablation-data determining apparatus for calculating corneal ablation data for corneal ablation surgery in order to correct a refractive error by ablating a cornea and a corneal surgery apparatus for performing the corneal ablation surgery based on the corneal ablation data... Conventionally, there is known a corneal surgery apparatus which ablates a cornea with a laser beam and changes the shape of the cornea in order to correct a refractive error of a patient's eye. Methods for ablating a cornea with this kind of the apparatus include a

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method (a one-shot method) for performing one-shot irradiation of a laser beam for ablation, wherein a beam cross section is vertical to a laser irradiation optical axis and has a large circular shape (a large spot), a method (a slit scan method) for irradiating and scanning a laser beam in at least one direction for ablation, wherein a beam cross section is rectangular, a method (a spot scan method) for two-dimensionally irradiating and scanning a laser beam for ablation, wherein a beam cross section has a small circular shape (a small spot), and other methods... In addition, as for the one-shot method and the slit scan method, Japanese Patent Application Unexamined Publication No. Hei 09266925 corresponding to U.S. Pat. No. 5,906,608 suggests a method for ablation by irradiating a laser beam of which cross section is limited to a circular or rectangular small zone by a small aperture which is circular, rectangular or the like. By these methods, a non-spherical component (mentioned as a rotationally symmetrical component and a linearly symmetrical component which are not spherical nor toric, and an asymmetric component in the present specification) may be ablated to improve (correct) an aberration of an eye. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

CURVED SURGICAL INSTRUMENTS AND METHOD OF MAPPING A CURVED PATH FOR STEREOTACTIC SURGERY Inventor(s): NOWINSKI, WIESLAW LUCJAN ; (SINGAPORE, SG), POSTON, TIMOTHY ; (SINGAPORE, SG) Correspondence: LADAS & PARRY; 26 WEST 61ST STREET; NEW YORK; NY; 10023; US Patent Application Number: 20030149351 Date filed: July 12, 1999 Abstract: The method of mapping a curved path for stereotactic surgery involves the selection of a helical-shaped path. The first step is to obtain an accurate image of the pertinent structures of the patient's internal areas. The image includes the lesion or target region and a potential opening site. Using the image, the non-target areas surrounding the lesion area are determined and evaluated for the medical acceptability of passing through them. A curved path which is substantially helical in shape is then selected within the image such that the curve avoids these non-target areas but intersects the target region and the opening site. The corresponding surgical instrument which will be used to follow the selected curved path has a rigid body having a shape which is substantially identical to the path. Excerpt(s): This invention relates to the field of stereotactic surgery, and particularly to curved instruments and method of mapping a curved path for stereotactic surgery for situations where a straight path is impossible or would be more invasive or risky than a curved path... Currently, stereotaxis is generally associated with neurosurgery, and particularly with intracranial surgery. However, in the following description, the terms "stereotaxis" or "stereotactic surgery" or "stereotactic surgical procedure" shall not be used in that limited sense; rather it should be understood that the term shall be used more generally to distinguish it from the "conventional" surgical procedures where a large incision is made in a patient. Hence, the terms "stereotaxis", "stereotactic surgery", "stereotactic surgical procedure" shall encompass those clinical procedures where a rigid instrument is inserted into a small opening and is navigated, by control of the part that remains outside, to a pre-determined area of a patient's body. However, frequent references will be made to intracranial surgery as a way of illustrating the invention and

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its mode of operation, and therefore, such references should not be construed as a limitation on the present invention... Stereotactic surgery (also known as "stereotaxis") is well known to those skilled in the art. It is a special surgical procedure for treating an interior portion of a patient, usually the brain and other intracranial structures, by inserting a rigid probe into a small opening. In conventional open surgery, the surgeon makes an incision large enough for the surgeon to see the path leading to the area of pathology. Stereotaxis, on the other hand, does not require the surgeon to actually see the entire path, so a small opening, only big enough to insert the probe, is required. Hence, stereotactic surgical procedures offer the advantage of minimizing the damage to the tissues surrounding the lesion area, and promotes faster recovery of the patient. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Device to permit offpump beating heart coronary bypass surgery Inventor(s): Williamson, Warren P. IV ; (Loveland, OH), Ortiz, Mark ; (Milford, OH), Spence, Paul A. ; (Louisville, KY) Correspondence: BOZICEVIC, FIELD & FRANCIS LLP; 200 MIDDLEFIELD RD; SUITE 200; MENLO PARK; CA; 94025; US Patent Application Number: 20030187333 Date filed: March 24, 2003 Abstract: A system for manipulating a heart during cardiac surgery links lifting of the heart and regional immobilization which stops one part of the heart from moving to allow expeditious suturing while permitting other parts of the heart to continue to function whereby coronary surgery can be performed on a beating heart while maintaining cardiac output unabated and uninterrupted. Circumflex coronary artery surgery can be performed using the system for manipulating a heart during cardiac surgery of the present invention. The system is an improvement on the retractor disclosed in parent application Ser. No. 08/936,184 filed on Sep. 17, 1997 and locates a suspension head near the apical region of the heart and a gross support near the base of the heart near the AV groove. A frame is positioned within the patient's thoracic region and moves with the patient, and a surgical target immobilizer can be used to assist in the movement of the heart if desired. A special suction cup is used which accommodates multiplanar movement of the heart and the myocardium while also preventing heart tissue from interrupting the suction being applied to the heart. One form of the system can be used in minimally invasive surgery. Excerpt(s): The present application is a continuation-in-part application of co-pending patent application Ser. No. 08/936,184 filed on Sep. 17, 1997 by the inventors of the present application. The disclosure of the just-referenced patent application is incorporated herein by reference... The present invention relates to the general art of cardiac surgery, and to the particular field of heart retractors used in beating heart surgery... There are as many as 300,000 coronary bypass graft procedures performed annually in the United States. Each of those procedures may include one or more graft vessels. Currently, each graft vessel must be hand sutured. As many as four or more grafts are placed in a procedure. Until recently, coronary artery bypass procedures have been performed with the patient on cardio-pulmonary bypass whereby the heart is stopped with cardioplegia and the surgery performed on an exposed and still heart. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Devices and methods for percutaneous surgery Inventor(s): Smith, Maurice Mell ; (Cordova, TN), Foley, Kevin Thomas ; (Germantown, TN), Clayton, John B. ; (Germantown, TN), Moctezuma, Joseph ; (Memphis, TN) Correspondence: Woodard, Emhardt, Naughton,; Moriarty and McNett LLP; Bank One Center/Tower; 111 Monument Circle, Suite 3700; Indianapolis; IN; 46204-5137; US Patent Application Number: 20030139648 Date filed: February 6, 2003 Abstract: Devices and methods for performing percutaneous spinal surgery under direct visualization and through a single cannula are shown. A device (10) is provided which includes an elongated cannula (20) having a first inner diameter (D.sub.I) and an outer diameter (D.sub.O) sized for percutaneous introduction into a patient. The cannula (20) defines a working channel (25) between its ends (21, 22) which has a second diameter (D.sub.2) equal to the diameter (D.sub.I) of the cannula sized for receiving a tool therethrough. An elongated viewing element (50) is engageable to the cannula (20) adjacent the working channel (25), preferably by a fixture (30). The fixture (30) includes a housing (31) attachable to the proximal end (22) of the cannula (20) that defines a working channel opening (35) which is in communication with the working channel (25). The housing (31) also defines an optics bore (60) adjacent the working channel opening (35). In certain embodiments, the fixture (30) supports the viewing element (50) for translation and/or rotation within the optics bore (60) along the longitudinal axis of the bore, and for rotation of the housing (31) relative to the cannula (20) so that the longitudinal axis of the optics bore (60) will rotate about the longitudinal axis of the working channel (25). Methods are also provided for performing spinal surgeries percutaneously with direct visualization and without the requirement for a fluidmaintained workspace. Excerpt(s): The present invention relates to devices, instruments and methods for performing percutaneous surgeries, particularly at locations deep within the body. One specific application of the invention concern devices, instruments and techniques for percutaneous, minimally invasive spinal surgery. In another aspect of the invention, the percutaneous surgery is performed under direct vision at any location in the body... Traditional surgical procedures for pathologies located deep within the body can cause significant trauma to the intervening tissues. These open procedures often require a long incision, extensive muscle stripping, prolonged retraction of tissues, denervation and devascularization of tissue. Most of these surgeries require a recovery room time of several hours and several weeks of post-operative recovery time due to the use of general anesthesia and the destruction of tissue during the surgical procedure. In some cases, these invasive procedures lead to permanent scarring and pain that can be more severe than the pain leading to the surgical intervention... Minimally invasive alternatives such as arthroscopic techniques reduce pain, post-operative recovery time and the destruction of healthy tissue. Orthopedic surgical patients have particularly benefitted from minimally invasive surgical techniques. The site of pathology is accessed through portals rather than through a significant incision thus preserving the integrity of the intervening tissues. These minimally invasive techniques also often require only local anesthesia. The avoidance of general anesthesia reduces postoperative recovery time and the risk of complications. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Devices and methods for percutaneous tissue retraction and surgery Inventor(s): Roehm, Thomas E. III ; (Braden, TN), Lim, Roy ; (Cordova, TN), Foley, Kevin T. ; (Germantown, TN), Smith, Maurice M. ; (Cordova, TN) Correspondence: Douglas A. Collier; Woodard, Emhardt, Naughton, Moriarty and McNett; Bank One Center/Tower; 111 Monument Circle, Suite 3700; Indianapolis; IN; 46204-5137; US Patent Application Number: 20030191371 Date filed: April 5, 2002 Abstract: Methods and devices for performing percutaneous surgery in a patient are provided. A retractor includes a working channel formed by a first portion coupled to a second portion. The first and second portions are movable relative to one another from an unexpanded configuration to an expanded configuration to increase the size of the working channel along the length of the working channel while minimizing trauma to skin and tissue. Excerpt(s): The present invention relates to devices, instruments and methods for performing percutaneous surgeries... Traditional surgical procedures for pathologies located deep within the body can cause significant trauma to the intervening tissues. These open procedures often require a long incision, extensive muscle stripping, prolonged retraction of tissues, denervation and devascularization of tissue. These surgeries can require operating room time of several hours and several weeks of postoperative recovery time due to the use of general anesthesia and the destruction of tissue during the surgical procedure. In some cases, these invasive procedures lead to permanent scarring and pain that can be more severe than the pain leading to the surgical intervention... The development of percutaneous procedures has yielded a major improvement in reducing recovery time and post-operative pain because minimal muscle and tissue dissection is required and the procedures can be performed under local anesthesia. For example, minimally invasive surgical techniques are desirable for spinal and neurosurgical applications because of the need for access to locations deep within the body and the danger of damage to vital intervening tissues. While developments in minimally invasive surgery are steps in the right direction, there remains a need for further development in minimally invasive surgical devices and techniques. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Distraction device for maxillofacial surgery Inventor(s): Wolgen, Philippe ; (Amsterdam, NL) Correspondence: GREER, BURNS & CRAIN; 300 S WACKER DR; 25TH FLOOR; CHICAGO; IL; 60606; US Patent Application Number: 20030105463 Date filed: September 23, 2002 Abstract: The invention relates to a device that may be used in maxillofacial surgery and dentistry. The device comprises a translating bracket with a cylinder and a fixed bracket with a chamber. A distraction screw is mounted through the cylinder and with one end resting on the chamber. By turning this screw when the device has been mounted on

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bone pieces osteogenesis can be achieved. The device can be made suitable for both dentulous and edentulous patients with alveolar defects. Excerpt(s): Distraction Osteogenesis has been used in the facial skeleton following the principles laid down by Codvilla in 1905 and Ilizarov in 1952. McCarthy first introduced distraction osteogenesis in the mandible (lower jaw). Several distraction devices have been disclosed in the art... Unidirectional distraction devices with the numbers 51-50010, 51-500-15 and 51-500-20 by Martin, comprise each 2 guiding rails, a fixed bracket, a translating bracket, 1 distraction screw, 6 osteosynthesis pins and 1 or more cranks. The distractor requires an interconnecting bar between the guiding rails. This distractor is large and requires a complex surgical operation for fixation and removal under general anesthesia... Dyna Form is marketed and is an intraoral distraction system for widening of the jaw. It consists of a translating bracket with a cylinder, a distraction screw, a fixed bracket that extends above the translating bracket, two guiding rails, and pins. The distraction screw pushes against the extension of the fixed bracket. Size and construction of the device make it too bulky to be used in vertical alveolar distraction. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Double irrigating bipolar surgery forceps Inventor(s): Spitzer, Daniel E. ; (Piermont, NY) Correspondence: Lance J. Lieberman, Esq.; Cohen, Pontani, Lieberman & Pavane; Suite 1210; 551 Fifth Avenue; New York; NY; 10176; US Patent Application Number: 20030139743 Date filed: January 23, 2003 Abstract: A double irrigating bipolar surgery forceps for reducing char buildup on working regions of the forceps. Each of the two forceps arms provides electrical current to the working regions and carries a fluid conduit for delivering irrigating fluid to the working region of the arm. The fluid conduits are, in a preferred form of the invention, carried on an outside surface of each arm and deliver irrigating fluid to an inside surface of each arm proximate to or within the working region. In a particularly preferred embodiment, an open channel is formed on the inside surface of each working region and in communication with the distal end of the arm's fluid conduit for improved delivery of irrigating fluid from the fluid conduit onto the working region and to the cautery site. Excerpt(s): This application claims priority from U.S. Provisional Patent Application Serial No. 60/352,002 which was filed on Jan. 23, 2002 and from U.S. Provisional Patent Application Serial No. 60/365,729 which was filed on Mar. 19, 2002... This invention pertains to instruments used for surgical procedures. More particularly, the present invention is directed to improved bipolar surgery forceps having irrigated tips... Bipolar Cautery Electro-Mechanical Instruments ("bipolar instruments") have many uses in modern surgical practice including dissection and hemostatis and the like. The basic structure of these bipolar surgical instruments includes two elongated members or arms that are connected at one, i.e. the proximal, end of the members. The members are coupled to an alternating current power source for supplying an electrical potential across the conductive tips which are defined at the other (i.e. distal) ends of the members. In operation, these bipolar instruments pass a high frequency AC electrical current between the conductive tips which are placed into contact with patient tissue or vessels. Each tip of the bipolar instrument alternately functions as an active and a

Patents 281

ground electrode to provide a more accurate transfer and delivery, to the tissue, of electrical energy than that attainable using Monopolar Electro-Mechanical Instruments. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Dual-use suturing device for suturing wound induced from celioscope surgery Inventor(s): Guo, Qi-Zhao ; (Tai-Chung Hsien, TW) Correspondence: Qi-Zhao Guo; 235 Chung-Ho Box 8-24; Taipei; TW Patent Application Number: 20030153929 Date filed: February 13, 2002 Abstract: A dual-use suturing device for suturing a wound induced from a celioscope surgery is formed by a needle positioning seat, an auxiliary positioning device, and an upper cover buckled to the needle positioning seat. The positioning pieces at the top of the auxiliary positioning device are buckled to the embedding groove at a lower end of the needle positioning seat. The guide holes of the needle positioning seat have a tapered inner surface. Hollowed portions of the guide trenches provide clamping spaces at two sides of the auxiliary positioning device. Then two clean auxiliary positioning devices are used to clamp the wire needle and hooked needle so that the hand of the doctor can pinch the needles. The non-hollowed portions at the upper side of the guide trenches of the auxiliary positioning device are exactly formed as resisting portions for resisting against the needles. Excerpt(s): The present invention relates to surgical devices, and particularly to dual-use suturing device for suturing a wound induced from a celioscope surgery... Therefore, in the conventional celioscope surgery, the doctor adheres a medical tape on the wound so as to avoid hernia. However, this will slow the cure process and the patient will feel uneasy at the portion around the wound. The cured skin will not be smooth and sarcoma will generate around the wound so as to present an unpleasant outlook... Accordingly, the primary object of the present invention is to provide a dual-use suturing device for suturing a wound induced from a celioscope surgery, wherein The dual-use suturing device for suturing a wound induced from a celioscope surgery is formed by a needle positioning seat, an auxiliary positioning device at a lower end of the needle positioning seat, and an upper cover buckled to the needle positioning seat, the positioning piece at the top of the auxiliary positioning device is buckled to the embedding groove at a lower end of the needle positioning seat. The guide holes of the needle positioning seat is inclined so that the needles T and P can be inserted into the periphery of a wound. Moreover, by the gaps, 12 mm and 15 mm, of the guide holes of the needle positioning seat, the auxiliary positioning device can be buckled with the embedding groove by the positioning piece thereof along a horizontal position or a vertical position. Thereby, it can be used for a larger wound (15 mm) or a small wound (12 mm). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Environmental chamber for laser refractive surgery Inventor(s): Patel, Anilbhai S. ; (Arlington, TX) Correspondence: ALCON RESEARCH, LTD.; R&D COUNSEL, Q-148; 6201 SOUTH FREEWAY; FORT WORTH; TX; 76134-2099; US Patent Application Number: 20030153904 Date filed: February 13, 2002 Abstract: An environmental chamber that can be fixed to the eye during laser refractive surgery. The chamber is held in place by a suction ring or the like and contains a window that is transparent to necessary ultraviolet radiation, visible light and infrared radiation wavelengths. The chamber is connected to a control system that controls the temperature and humidity within the chamber and provides for the evacuation of ablation by-products from the surgical site. Excerpt(s): This invention relates generally to the field of laser refractive surgery and, more particularly, to a device for controlling the environment at the surgical site during laser refractive surgery... The human eye in its simplest terms functions to provide vision by transmitting light through a clear outer portion called the cornea, and focusing the image by way of a crystalline lens onto a retina. The quality of the focused image depends on many factors including the size and shape of the eye, and the transparency of the cornea and the lens... The optical power of the eye is determined by the optical power of the cornea and the crystalline lens. In the normal, healthy eye, sharp images are formed on the retina (emmetropia). In many eyes, images are either formed in front of the retina because the eye is abnormally long (axial myopia), or formed in back of the retina because the eye is abnormally short (axial hyperopia). The cornea also may be asymmetric or toric, resulting in an uncompensated cylindrical refractive error referred to as corneal astigmatism. In addition, due to age-related reduction in lens accommodation, the eye may become presbyopic resulting in the need for a bifocal or multifocal correction device. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Epicardial cooled stabilizer for beating heart surgery Inventor(s): Oz, Mehmet C. ; (Cliffside Park, NJ), D'Alessandro, David A. ; (New York, NY) Correspondence: REED SMITH, LLP; ATTN: PATENT RECORDS DEPARTMENT; 599 LEXINGTON AVENUE, 29TH FLOOR; NEW YORK; NY; 10022-7650; US Patent Application Number: 20030065372 Date filed: September 28, 2001 Abstract: An epicardial cooled stabilizer system is useful for surgical or laparoscopic applications, especially beating heart surgery. The system comprises a stabilizer connected to a cooler/pump where coolant flows into tubing at the distal end of the stabilizer. The tubing is positioned at a surgical site to enhance traction and minimize trauma. Excerpt(s): This invention relates generally to methods and devices for performing surgical procedures. More particularly, this invention relates to a device useful for coronary revascularization and laparoscopic surgery. The device comprises a system which uses cooled instruments to grasp tissue... In coronary artery disease, the build up

Patents 283

of artherosclerotic plaque on the inner walls of the coronary arteries causes a narrowing or a complete closure of these arteries, resulting in insufficient blood flow to the heart. This condition has become one of the most common life threatening medical problems facing older men and women... A number of approaches have been developed for treating coronary artery diseases. In less severe cases, it is often sufficient to treat the symptoms with pharmaceuticals and life style modification to lessen the underlying causes of the disease. In more severe cases, a coronary artery blockage can often be treated using endovascular techniques, such as balloon angioplasty, atherectomy, laser or hot tip ablation, stents, and the like. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Flat implant for use in surgery Inventor(s): Langanke, Dennis ; (Tuttlingen, DE), Goldmann, Helmut ; (Tuttlingen, DE), Bertholdt, Guenther ; (Heiningen, DE), Weis, Christine ; (Tuttlingen, DE) Correspondence: BAKER & BOTTS; 30 ROCKEFELLER PLAZA; NEW YORK; NY; 10112 Patent Application Number: 20030040809 Date filed: July 21, 2002 Abstract: A flat implant for use in surgery is described. The implant includes a flexible fabric comprising two sides and having on one side a substantially closed surface and on the other side a three-dimensional microstructure permitting a growing in of cells. The implant can be more particularly used for the treatment of wall defects in body cavities, such as abdominal wall defects. Excerpt(s): This application is a continuation-in-part of U.S. patent application Ser. No. 09/531,842, which was filed on Mar. 20, 2000, which in turn claims priority from German patent application No. 19112648.8, filed Mar. 20, 1999... The present invention relates to a flat implant for use in surgery and a process for its production... Hernia is a frequently encountered illness. It generally consists of a passage of organs or organ parts out of the natural body cavity through a preformed or acquired gap. Among external hernias, where the hernial sac is always surrounded by the peritoneum, the most frequently encountered forms are groin, umbilical and incisional hernias. The reason for hernias occurring are in particular muscle or connective tissue weakness in conjunction with overstressing, age-caused atonia, congenital weakness of the abdominal wall or inadequate cicatrization following a body section (incisional hernia). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Fluoroscopic image guided orthopaedic surgery system with intraoperative registration Inventor(s): Barrick, Earl Frederick ; (McLean, VA) Correspondence: HARNESS, DICKEY & PIERCE, P.L.C.; P.O. BOX 828; BLOOMFIELD HILLS; MI; 48303; US Patent Application Number: 20030060703 Date filed: August 29, 2002

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Abstract: A fluoroscopic image guided surgery system, comprising a C-arm fluoroscope for obtaining fluoroscopic images of an object bone, the C-arm fluoroscope including at least one set of emitters; a reference bar capable of attaching to an object bone, the reference bar including emitters; a surgical instrument for performing an operation, the instrument including emitters; a digitizer system in communication with the at least one set of emitters of the C-arm fluoroscope, the emitters of the reference bar, and the emitters of the surgical instrument so that the digitizer system can determine a position of each of the C-arm fluoroscope, the reference bar, and the surgical instrument; and a single fiducial marker for attachment to an object bone, the single fiducial marker being visible in the fluoroscopic images for determining a position of an object bone relative to the digitizer system. Excerpt(s): In orthopaedic surgery it is often necessary to insert a guide pin for a cannulated screw, drill bit, or other screw (hereafter referred to as a fixation device) into a bone at a predetermined trajectory. Pre-operative planning depends on twodimensional radiographic images which typically consist of two views taken at approximately right angles to one another. From these two views it is possible to determine the shape and structure of a long bone. Using that method, the path of insertion for a guide pin for a cannulated screw, drill bit, or screw is accurately determined. However, in practice the actual aiming of a fixation device is an inaccurate art, as the object bone is often seen only at one surface or is not seen at all and, therefore, positioning is dependent on fluoroscopic visualization. This method is also time consuming as the C-arm images must be taken separately and the drapes must be rearranged each time an image is taken. As bony tissue is unyielding, the track of the pin or drill bit is determined by the angular approach before entering the object bone. This angular approach is difficult to determine under normal circumstances and often multiple attempts are needed, as feedback is obtained from repeated fluoroscopic images. Existing methods of calculating the proper angle of guide pin for a cannulated hip screw insertion for hip pinning involve placing data manually into a computer program, which in turn outputs an angle of guide pin for a cannulated hip screw insertion... Radiation exposure is a necessary part of any procedure for calculating the proper angle of a guide pin, drill bit, or screw insertion. Radiation exposure is considered to be a hazard. Ionizing radiation has no safe threshold of exposure below which it ceases to have adverse effects, although an arbitrary level is assumed. There has been a recent upward revision of risk estimates of radiation exposure, but absolute levels of safe exposure remain unknown. Exposure to the surgical team as well as the patient during orthopaedic procedures using fluoroscopy is a universal concern. Consequently, a reduction in the amount of radiation exposure is highly desirable... Operative stereotactic localization using either frames or three-dimensional digitizers is currently being used in neurosurgery or otoloaryngology. Those methods require the use of computed axial tomography (CT) or magnetic resonance imaging (MRI) prior to surgery. They also involve placing markers on the scalp prior to the imaging study of the head. The markers must be left in the same position until surgery is performed in order to confirm intraoperative registration. Such imaging studies are routinely performed for most intracranial procedures but are impractical for most orthopaedic procedures, especially those involving long bones. A probe marked with light emitting diodes (LEDs) or other digitizing emitters is used to localize these markers or pins using a three-dimensional digitizing device at the time of surgery. A disadvantage of this system is that the images are normally obtained hours before use; thus, the images used are not up to date (real time) and are often not reflective of the current condition of the object bone. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Patents 285

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Hand, wrist and forearm device for patients during surgery Inventor(s): Atwater, Kim A. ; (Washington, DC), Bryant, Marian J. ; (Silver Spring, MD) Correspondence: KILE GOEKJIAN LERNER & REED PLLC; THE EVENING STAR BUILDING; 1101 PENNSYLVANIA AVE, N.W.; SUITE 800; WASHINGTON; DC; 20004; US Patent Application Number: 20030056793 Date filed: September 23, 2002 Abstract: A hand, wrist and forearm device for patients during surgery, comprising a pair of mating shells which fit about the patient's hand, and wrist and forearm. Each shell has a generally accurate lateral section wrist and forearm channel and a larger, generally accurate longitudinal section hand enclosure. The two shells are loosely hinged together along one edge, with a mutually mating closure provided along the edge generally opposite the hinges. The interior is preferably lined with removable padding, such as gel packs, visco-elastic material in order to apply light pressure to the hand and stabilize the position of surgical device on the hand. The pressure of the removable padding also provides a light outward pressure to stabilize the two halves of the assembly during use. Excerpt(s): Surgical procedures have evolved into a broad range of different types of operations, with patient positioning depending upon the specific procedure to be accomplished. While most general surgery is performed on a supine patient under the influence of a general anesthetic, other types of surgery require the patient to be positioned in other than a supine position, with hands and arms extended beside or tucked along the side of the patient. An example is the lithotomy position, wherein a patient is generally positioned in a modified supine position with the hips and knees flexed and the legs supported by canvas straps or stirrups, the arms and hands being placed beside the patient, often on arm boards, or loosely cradled over the lower abdomen and secured by the lower end of a blanket. Occasionally the patient may incur injury to the hands through improper positioning of the arms and hands, through pressure when a surgeon leans over and inadvertently bears against the hand, or through crush injuries when the leg portion of the surgical table is raised after the surgery is completed. During surgery a patient is unusually very vulnerable, as the patient is under anesthesia and normal pain warning reactions are blocked... The bones and other structure of the hands are some of the more fragile components of the human body, and oftentimes inadvertent pressure upon one or both hands, can lead to damage to the hands in the form of a broken bone or pulled tendon, soft tissue, or nerve damage, in addition to transient ischemic problems due to loss of circulation. Such problems are, of course, extremely difficult for a patient, who is often bedridden after surgery and who may have no significant ability to perform any physical act other than with his or her hands and arms. Injury to a patient's hands may deprive the patient of the only other physical activity available until the primary surgical healing process is well underway. Of course, such extra incapacity is a distraction to a positive emotional attitude of the patient during recovery. The cost of inadvertent hand and arm injuries to patients during surgery can be considerable, as the medical profession has a duty of great care during such operations, when the unconscious patient is totally at the mercy of the medical staff performing the procedure... Accordingly, a need exists for a device which may be applied to the hand(s), wrist(s) and lower arm(s) of a patient who is to experience general anesthesia in order to isolate the extremities of the patient from

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compression or other damage due to inadvertent pressure upon the hands, wrists and lower arm as the patient is positioned prior to, during, and/or after a surgical procedure. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Implant system for glaucoma surgery Inventor(s): Patel, Anilbhai S. ; (Arlington, TX) Correspondence: ALCON RESEARCH, LTD.; R&D COUNSEL, Q-148; 6201 SOUTH FREEWAY; FORT WORTH; TX; 76134-2099; US Patent Application Number: 20030153863 Date filed: February 13, 2002 Abstract: An implant system which facilitates and improves the non-penetrating deep sclerectomy/canalostomy surgery by assured maintenance of the scleral aqueous filled space by a basic permanent chamber which can be easily connected into the opening of the Schlemm's canal by adjustable connecting tubes. This implant system also provides surgical options for penetrating through Descemet's membrane as well as for outflow into the subconjunctival space though the superficial scleral layer. Excerpt(s): This invention relates generally to the field of glaucoma surgery and, more particularly, to an implant for glaucoma surgery... Glaucoma is a disease of the eye that causes blindness in millions of people. The disease is not understood totally, and many do not even categorize glaucoma as a single disease. Glaucoma is more accurately identified as an optic neuropathy characterized by a specific pattern of optic nerve head and visual field damage, which are the end result of a number of different conditions that can affect the eye. Elevated intraocular pressure (IOP) is an important risk factor for the development or progression of glaucomatous damage. Elevated IOP can be caused either by elevated production of aqueous humor in the eye or by restricted flow of the aqueous from the eye. There are several pharmaceutical treatments for glaucoma, including beta-blockers and prostaglandin analogs but in extreme cases, surgical intervention to increase aqueous outflow is used... There are several and confusing terms used for the glaucoma surgery involving deep sclerectomy. They include viscocanalostomy, non-penetrating deep sclerectomy, and penetrating conversions of these operations. Deep sclerectomy is the term commonly used for the non-penetrating glaucoma surgery in which deep layers of sclera are removed after the deep scleral delamination down to the Descemet's membrane without penetrating into the anterior chamber. This delamination is carried out carefully up to and including the transition zone into the anterior trabecula up to about 1 mm in front of Schwalbe's line, resulting in a window for the controlled outflow of the aqueous humor through the trabeculaDescemet's membrane and the controlled reduction in the IOP, thus avoiding postsurgical hypotony. Schlemm's canal is also excised for the width of the removed deep sclera. Also removed if necessary is the juxta-canalicular trabecular meshwork tissue with a fine forceps, leaving behind the innermost bulk of the trabecular meshwork. This is done to assure sufficient percolation of the aqueous humor. This additional step has also been called "ab externo trabeculectomy" and is also considered non-penetrating because no direct entry in the anterior chamber is done as is the case with trabeculectomy which removes the entire trabecular meshwork. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Patents 287

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Inflatable blanket for use in cardiac surgery Inventor(s): Kappel, Thomas ; (St. Louis, MO), Chivetta, Dennis ; (Ballwin, MO), Feit, Karin ; (St. Augustin, DE), Schuessler, Wayne ; (St. Louis, MO), Vardanega, Michael ; (Livermore, CA) Correspondence: ROTHWELL, FIGG, ERNST & MANBECK, P.C.; 1425 K STREET, N.W.; SUITE 800; WASHINGTON; DC; 20005; US Patent Application Number: 20030135251 Date filed: December 19, 2002 Abstract: A method of performing cardiac surgery on a patient's heart, including covering a patient with an inflatable blanket for a forced air convection system, the inflatable blanket having at least one separable seal line within the blanket. The separable seal line may be separated to form a slit. A patient's femoral artery is accessed through the slit, and an elongate medical instrument is passed through the slit, and through the femoral artery toward the patient's heart. Cardiac surgery is performed with the elongate medical instrument, and the elongate medical instrument is withdrawn from the femoral artery through the slit. Excerpt(s): This application claims the benefit of Provisional Application Serial No. 60/348,671, filed Jan. 17, 2002... The invention relates to inflatable blankets for use with patients... Certain heart surgeries such as angioplasty involve inserting a catheter or other elongate medical instrument into the femoral artery of a patient's thigh, and passing the elongate medical instrument through the blood vessels to the heart. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Instrument guidance method and system for image guided surgery Inventor(s): Clayton, John B. ; (Superior, CO), Bucholz, Richard D. ; (St. Louis, MO), Frank, Kevin J. ; (Lafayette, CO), Ulberg, Phillip T. ; (Reno, NV), Carroll, Catalina J. ; (Memphis, TN), Smith, Kurt R. ; (Eldorado Springs, CO), Henderson, Jaimie ; (St. Louis, MO) Correspondence: HARNESS, DICKEY & PIERCE, P.L.C.; P.O. BOX 828; BLOOMFIELD HILLS; MI; 48303; US Patent Application Number: 20030114752 Date filed: October 15, 2002 Abstract: Generally, the present invention is directed to a method and system for a aligning surgical guide instrument over a burr hole in a patient's body. More particularly, the present invention is directed to a stand-alone instrument guidance unit that is attachable to a patient's skull. Adjustments of a surgical instrument can be made in x, y, z, and angular directions using the system and method of the present invention. In one aspect of the present invention, an instrument guide unit includes an instrument guide for guiding a surgical instrument into the body of a patient and a base unit operative to be secured to the body in an area in which surgery is to occur. The base unit is coupled to the instrument guide. An adjustment mechanism, coupled to the base unit and the instrument guide, is operative to adjust the instrument guide in lateral directions with respect the surface of the area. The adjustment mechanism is operative to adjust the instrument guide in x and y directions. The adjustment mechanism includes an x direction control mechanism for adjusting the instrument in an x direction

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and a y direction control mechanism for adjusting the instrument in a y direction. The y direction control mechanism may be coupled to the x direction control mechanism. The positional movement of the surgical instrument in the z direction may be tracked by sensing the location of a transducer coupled to the surgical instrument. Excerpt(s): This application claims priority benefit to U.S. Provisional Patent Application No. 60/130,118 entitled "Instrument Guidance Method and System For Image Guided Surgery", filed on Apr. 20, 1999... The present invention relates generally to computer assisted image guided medical and surgical navigation systems that generate images during medical and surgical procedures indicating the relative position of various body parts, surgical implants, and instruments. In particular, the present invention relates to a reference frame and instrument guide frame for use in an image guided surgery navigation system... In image guided medical and surgical procedures, images, obtained either preoperatively or intraoperatively (i.e., prior to or during a medical or surgical procedure), are used to aid a doctor in guiding a surgical instrument. Computer assisted image guided medical and surgical navigation systems are known and are disclosed, for example, in U.S. Pat. No. 5,383,454 to Bucholz; U.S. Pat. No. 5,891,034 to Bucholz; U.S. Pat. No. 5,851,183 to Bucholz; U.S. Pat. No. 5,871,445 to Bucholz; PCT Application No. PCT/US 94/04530 (Publication No. WO 94/24933) to Bucholz; PCT Application No. PCT/US 95/12984 (Publication No. WO 96/11624) to Bucholz et al.; and U.S. patent application Ser. No. 08/623,956 to Foley et al., the entire disclosures of which are incorporated herein by reference. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Irrigator used in celioscope surgery Inventor(s): Guo, Qi-Zhao ; (Taipei, TW) Correspondence: Qi-Zhao Guo; 235 Chung - Ho; Box 8-24; Taipei; TW Patent Application Number: 20030120203 Date filed: December 26, 2001 Abstract: An irrigator used in a celioscope surgery comprises a main casing, a water pumping stud and a water control stud which are engaged with the main casing. An interior of the main casing has a pumping opening and a suction opening, and a water outlet channel and a pumping flow channel which are vertical to the pumping opening and suction opening. Thereby, the water outlet channel and pumping flow channel are at an upper portion of the main casing. Thereby, dirty water accumulated in the affected part can be pumped out from a water outlet tube through the pumping flow channel. Since the water is pumped out along a straight way, it is prevented that dirty water is left in some bending portions. Therefore, dirty water can be pumped out completely. Furthermore, users may hold it by any hand conveniently. Excerpt(s): The present invention relates to irrigators, and particularly to an irrigator used in a celioscope surgery for preventing that dirty water is left in some bending portions. Therefore, dirty water can be pumped out completely... An irrigator used in a celioscope surgery serves for pumping blood of a patient so as to sustain the cleanness of the surgical portion and thus the affected part can be viewed clearly... FIGS. 5 and 6 shows a prior art irrigator. The irrigator is formed by a main casing 5 having a pumping opening 51 and a suction opening 52 which are engaged with the water pumping stud 6 and the water control stud 7, respectively, above the pumping opening 51 and the suction opening 52 of the main casing 5.

Patents 289

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

Lenticular net instruments and methods of cataract surgery using a lenticular net Inventor(s): Sabet, Sina J. ; (Alexandria, VA) Correspondence: Karen M. Gerken; Epstein & Gerken; Suite 340; 1901 Research Blvd.; Rockville; MD; 20850; US Patent Application Number: 20030135221 Date filed: December 18, 2002 Abstract: A lenticular net instrument comprises an elongate handle coupled with a lenticular net movable to contracted and expanded configurations via an actuator of the handle. The net in the contracted configuration has a narrow profile for insertion in and removal from a lens capsule through a small incision in the eye. The net is movable to the expanded configuration within the lens capsule between a cataractous nucleus and a ruptured capsular wall. The net has a plurality of openings therein of a size to prevent fragments of the cataractous nucleus produced by fragmentation with a fragmenting instrument from passing therethrough such that the fragments do not pass through the ruptured wall. A method of cataract surgery involves deploying a net between a cataractous nucleus and a ruptured capsular wall upon the occurrence of the rupture in the wall. Excerpt(s): The subject patent application claims priority from prior provisional patent application Serial No. 60/340,480 filed Dec. 18, 2001, the entire disclosure of which is incorporated herein by reference... The present invention relates generally to ocular medical instruments and, more specifically, to safety net instruments for use in cataract surgery... During their lifetimes, many people become afflicted with cataracts, i.e. lenticular opacities that interfere with vision. Indeed, cataracts may be considered the most prevalent visually disabling eye disease in the world. The cloudiness or opacity associated with cataract arises in the nucleus of the anatomical lens, which includes a lens capsule also known as the capsular bag, the nucleus within the lens capsule, and gelatinous cortical material between the nucleus and the lens capsule. Currently, the only effective treatment for cataract is surgical removal of the cataract from the eye. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Medical instrument for surgery Inventor(s): Frank, Timothy Graham ; (Fife, GB), Cuschieri, Alfred ; (Fife, GB) Correspondence: ST. ONGE STEWARD JOHNSTON & REENS, LLC; 986 BEDFORD STREET; STAMFORD; CT; 06905-5619; US Patent Application Number: 20030158541 Date filed: January 21, 2003 Abstract: The invention relates to a medical instrument for surgery. A medical instrument especially suited for the HALS operating technique can be entirely inserted together with one of the surgeon's hands into the operating area for operating purposes and includes a housing (1) and at least one tool (2) arranged in the housing (1), where the tool (2) can be moved between a rest position arranged in the housing (1) and a working position extending out of the housing (1).

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Excerpt(s): This application claims priority of pending European Application No. 02 001 415.5 filed on Jan. 21, 2002... The invention relates to a medical instrument for surgery... Although increasing use has been made recently of minimally invasive operating technique, partly because of briefer patient recovery times, as opposed to the classic open surgery, less invasive technology is not likely to replace open surgery completely. This is because, on the one hand, not all operations can also be conducted endoscopically and, on the other hand, the surgeon must often manually grip the tissue to be operated and examine it by palpation, actions which are not possible in endoscopic surgery. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Method and apparatus to assist in orthognathic surgery Inventor(s): Tremont, Timothy J. ; (McKeesport, PA) Correspondence: PAUL A. BECK & ASSOCIATES; SUITE 100; 1575 McFARLAND ROAD; PITTSBURGH; PA; 15216-1808; US Patent Application Number: 20030138755 Date filed: January 22, 2002 Abstract: A method and apparatus to assist in accurate placement of teeth and jaws at orthognathic surgery. A recording of reference planes used prior to surgery to plan desired changes to an original position of teeth and jaws of a patient is made with a teeth indexing member. The teeth indexing member has a horizontal slot and scribe lines indicating the orientation of the reference planes. During surgery, the recording of the reference planes is transferred to the patient by positioning the teeth indexing member onto the patient's teeth. A swivel member is attached to the patient's head by a cranial structure. A port in the swivel member is oriented to the reference planes by inserting a coupling member into the horizontal slot of the teeth indexing member and into the port of the swivel member, aligning the coupling member to the scribe lines on the teeth indexing member, and securing the oriented swivel member in place. The port thereby records the reference planes. With the teeth indexing member removed and the coupling member reinserted into the oriented port of the swivel member, the coupling member can measure an original position of the teeth and jaws and indicate desired changes to the original position of the teeth and jaws relative to the reference planes in x-, y-, and z-dimensions. An indicator member when independently inserted into the slot of the teeth indexing member assists in designing osteotomies relative to the reference planes. Excerpt(s): The applicant's invention is a method and apparatus for use in orthognathic surgery. This type of surgery involves the correction of dentofacial deformities and is also referred to as maxillofacial surgery, reconstructive jaw surgery or surgical orthodontics... During orthognathic surgery teeth and jaws of a patient are repositioned. Prior to surgery, desired changes to an original position of the patient's teeth and jaws can be determined by clinical evaluation of the patient's head, evaluation of the patient's head X-ray, and evaluation of articulator mounted dental models. The desired changes to the teeth and jaws can be measured in three dimensions, parallel and perpendicular to reference planes. Three reference planes that can be used are a horizontal plane, a sagittal plane and a frontal plane. The horizontal plane is defined by three points on the patient's head. The sagittal and frontal planes are perpendicular to each other as well as to the horizontal plane. The reference planes are common to the patient's head, head Xray and articulator mounted dental models. The desired changes to the teeth and jaws

Patents 291

can be described in terms of x-, y-, and z-dimensions. The surgeon attempts to make actual changes to the original position of the teeth and jaws that are identical to the desired changes... Prior art has been published by G. Wylie, B. Epker and J. Mosop in the International Journal of Adult Orthodontics and Orthognathic Surgery, 1988; 3:143-147. A technique is described to assist in designing osteotomies using a maxillary measuring appliance. The device consists of a horizontal table indexed to the teeth and having an adjustable calibrated vertical pillar that can slide along the length of the horizontal table. This technique is deficient in that orientation of the horizontal table is limited to a row of teeth as a reference line. Also, it is limited to one side of a dental arch at a time. Measuring as well as marking osteotomy lines is inaccurate due to parallax problems. Osteotomies cannot be designed in a continuous manner on both sides of a jaw. In addition, the device is limited to designing osteotomies and cannot measure and record an original position of or actual changes to teeth and jaws relative to reference planes. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Method for treating nerve injury caused as a result of surgery Inventor(s): Steiner, Joseph P. ; (Mount Airy, MD), Burnett, Arthur L. ; (Baltimore, MD), Snyder, Solomon ; (Baltimore, MD) Correspondence: GUILFORD PHARMACEUTICALS C/O; FOLEY & LARDNER; 3000 K STREET, NW; WASHINGTON; DC; 20007-5143; US Patent Application Number: 20030203890 Date filed: May 29, 2002 Abstract: The present invention relates generally to methods for treating or preventing nerve injury in a warm-blooded animal caused as a consequence of surgery by administering neurotrophic compounds described below. The invention relates more specifically to methods for treating or preventing nerve injury caused as a consequence of prostate surgery as well as erectile dysfunction. Excerpt(s): The invention relates generally to methods for treating nerve injury caused as a consequence of surgery. The present invention relates more specifically to methods for treating nerve injury caused as a consequence of prostate surgery, or for methods of neuroprotection of penile innervation, by administering a neurotrophic compound to a patient in need thereof... The peptidyl-prolyl isomerases ("PPIases") are a family of ubiquitous enzymes which catalyze the interconversion of cis and trans amide bond rotamers adjacent to proline residues in peptide substrates. See, for example, Galat, A., Eur. J. Biochem. (1993) 216:689-707 and Kay, J. E., Biochem. J. (1996) 314:361-385. The PPIases have been referred to as "immunophilins" because of their interaction with certain immunosuppressant drugs. Schreiber, S. L., Science (1991) 251:283-287; Rosen, M. K. and Schreiber, S. L., Angew. Chem. Intl. Ed. Engi. (1992) 31:384-400... The PPIase, cyclophilin A, was found to be the intracellular protein target for the potent immunosuppressant drug cyclosporin A. Subsequently, the structurally unrelated macrolide immunosuppressant FK506 was discovered to bind to a different PPIase enzyme which was named FK506-binding protein, or FKBP. Rapamycin, another macrolide drug which is a structural analogue of FK506, also interacts with FKBP. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Method of interventional surgery Inventor(s): Seward, Kirk Patrick ; (Dublin, CA), Pisano, Albert P. ; (Danville, CA) Correspondence: FISH & RICHARDSON P.C.; 500 ARGUELLO STREET, SUITE 500; REDWOOD CITY; CA; 94063; US Patent Application Number: 20030055400 Date filed: September 20, 2001 Abstract: A method of interventional surgery is described. The method may include inserting an actuator within a body of a vascularized organism and positioning the actuator adjacent a target region within a vessel of the body. The actuator is operated to cause a needle thereof to move in a substantially perpendicular direction relative to a wall of the vessel to produce an opening therein. A therapeutic or diagnostic agent may be delivered by the needle to the target region via the opening in the vessel wall. Excerpt(s): The present relates generally to surgical devices, and more particularly to microfabricated surgical devices for use in catheter-based interventional procedures... Biological and surgical microelectromechanical systems (MEMS), useful for their ability to be placed into and easily maneuvered within a patient's body, are touted as the fastest growing area of micro-systems. For example, microcatheters are used in many medical applications for minimally invasive surgery. There are presently over one million surgical uses of catheters per year in the United States, representing a huge market... As surgeons continue to adopt and perform advanced surgical procedures, the miniaturization of medical devices is taking place, allowing surgery with small external incisions and catheter-based microsurgical tools. With roots in laparoscopic surgery (entering the abdomen through the navel and small holes in the midsection), minimally invasive surgery can be performed by inserting catheters in the femoral artery at the base of a patient's thigh, navigating the blood vessels in the patient's body, and arriving at problem areas like the heart or brain. Once the distal tip of the catheter is precisely positioned inside the body, a microsurgical procedure like balloon angioplasty, stent placement, localized cauterization, or drug delivery can take place. With the reduced bodily reaction to microsurgery and the minimization of scar tissue, these procedures are highly preferred over more typical "macro" surgeries. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Method of minimizing damage to heart tissue during cardiac surgery and cardiac transplantation Inventor(s): Blevins, Roger D. ; (Apex, NC), Molina-Viamonte, Victor ; (Buenos Aires, AR), Mentzer, Robert M. JR. ; (Lexington, KY), Leung, Edward ; (Cary, NC) Correspondence: EDWARDS & ANGELL, LLP; P.O. BOX 9169; BOSTON; MA; 02209; US Patent Application Number: 20030166605 Date filed: December 6, 2002 Abstract: Methods for minimizing ischemic damage and/or reperfusion injury to heart tissue during cardiac surgery where the heart is removed from the body and then reimplanted into the same body, as well as cardiac transplantation, where the heart is removed from one body and transplanted into another body, are disclosed. Prior to removing the heart from the body, adenosine or adenosine A.sub.1 or A.sub.3 receptor

Patents 293

agonists can be administered to the patient in a manner which provides cardioprotection to the heart. When the heart is removed from the body, it can be stored in a cardioplegic solution which contains adenosine, hypoxanthine and/or adenosine A.sub.1 or A.sub.3 receptor agonists. After the heart is reimplanted or transplanted, reperfusion injury can be minimized by administering adenosine or adenosine A.sub.2 receptor agonists to the patient in a manner which minimizes reperfusion injury. Preferably, all three steps are taken in order to minimize the amount of ischemic damage and reperfusion injury to the heart. Excerpt(s): This invention is generally in the area of minimizing ischemic damage and/or reperfusion injury to heart tissue during cardiac surgery where the heart is removed from the body and then re-implanted into the same body, as well as cardiac transplantation, where the heart is removed from one body and transplanted into another body... There are many surgical procedures for correcting complex congenital heart abnormalities, placing cardiac valvular prostheses, repairing defective valves, and bypassing obstructed coronary vessels which require the body to be supported with a heart-lung machine while the heart is rendered quiescent by interrupting its blood supply and briefly perfusing it with a cold solution of electrolytes with a relatively high potassium concentration (known as a cardioplegic solution). Placing the heart in a cardioplegic solution allows the surgeon to perform intricate surgical procedures on the heart without the distraction of having the heart pumping while the surgeon is operating, and the absence of blood also allows the surgeon to see more clearly... When the heart is placed in cardioplegic solution, the surgeon only has a limited amount of time to perform the surgery before irreversible ischemic damage is incurred. That amount of time is approximately 20 to 30 minutes. With the onset of ischemia, the supply of substrates for energy production ceases, and the high energy phosphate adenosine triphosphate (ATP) (which provides energy for contraction and operation of ion pumps in the myocardial cell) is degraded over time to its precursors ADP and AMP. AMP can undergo further degradation at the myocardial membrane to the diffusable purine nucleoside adenosine. Adenosine is also rapidly metabolized to inosine, hypoxanthine and xanthine. With the restoration of blood flow, these nucleosides are washed out of the heart via the circulation. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Method of performing surgery Inventor(s): Bonutti, Peter M. ; (Effingham, IL) Correspondence: Paul D. Bianco; Fleit, Kain, Gibbons, Gutman & Bongini P.L.; 520 Brickell Key Drive, Suite A201; Miami; FL; 33131; US Patent Application Number: 20030028196 Date filed: July 8, 2002 Abstract: An improved method of performing surgery on a joint in a patient's body, such as a knee, includes making an incision in a knee portion of one leg while a lower portion of the one leg is extending downward from an upper portion of the one leg and while a foot connected with the lower portion of the one leg is below a support surface on which the patient is disposed. The incision is relatively short, for example, between seven and thirteen centimeters. A patella may be offset from its normal position with an inner side of the patella facing inward during cutting of a bone with a cutting tool. During cutting of the bone, one or more guide members having opposite ends which are

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spaced apart by a distance less than the width of an implant may be utilized to guide movement of a cutting tool. Excerpt(s): This application is a continuation-in-part of U.S. patent application Ser. No. 09/976,396 filed Oct. 11, 2001. This application is also a continuation-in-part of U.S. patent application Ser. No. 09/941,185 filed Aug. 28, 2001. This application is also a continuation-in-part of U.S. patent application Ser. No. 09/566,070. This application is also a continuation-in-part of U.S. patent application Ser. No. 09/737,380 filed Dec. 15, 2000. This application is also a continuation-in-part of U.S. patent application Ser. No. 09/815,405 filed Mar. 22, 2001. This application is also a continuation-in-part of U.S. patent application Ser. No. 09/569,020 filed May 11, 2000. This application is also a continuation-in-part of U.S. patent application Ser. No. 09/483,676 filed Jan. 14, 2000. This application is also a continuation-in-part of U.S. patent application Ser. No. 09/602,743 filed Jun. 23, 2000. This application is also a continuation-in-part of U.S. patent application Ser. No. 09/526,949 filed on Mar. 16, 2000. This application is also a continuation-in-part of U.S. patent application Ser. No. 09/789,621 filed Feb. 21, 2001... The present invention relates to a new and improved method of performing surgery, and instruments, implants, and other surgical implements that can be used in surgery. The surgery may be of any desired type. The surgery may be performed on joints in a patient's body. The surgery may be performed on any desired joint in a patient's body. Regardless of the type of surgery to be performed, a limited incision may advantageously be utilized... In some embodiments, this specification relates to limited incision partial or total knee joint replacements and revisions and is the result of a continuation of work which was previously performed in conjunction with the subject matter of U.S. Pat. No. 5,514,143. This specification also contains subject matter which relates to U.S. Pat. Nos. 5,163,949; 5,269,785; 5,549,683; 5,662,710; 5,667,520; 5,961,499; 6,059,817; and 6,099,531. Although this specification refers to knee joints, it should be understood that the subject matter of this application is also applicable to joints in many different portions of a patient's body, for example a shoulder, spine, arm, hand, hip or foot of a patient. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Methods & devices for minimally invasive cardiac surgery for atrial fibrillation Inventor(s): Bertolero, Arthur A. ; (Danville, CA) Correspondence: TOWNSEND AND TOWNSEND AND CREW, LLP; TWO EMBARCADERO CENTER; EIGHTH FLOOR; SAN FRANCISCO; CA; 94111-3834; US Patent Application Number: 20030158464 Date filed: December 4, 2002 Abstract: Devices for enhancing minimally invasive cardiac surgery include a visualization device including an inflatable balloon at or near the distal end. Some visualization devices also include one or more lumens for allowing the introduction of one or more devices to a surgical site through the visualization device. Systems of the invention involve a visualization device which has at least one lumen for allowing introduction of an ablation device and/or other devices. A visualization device with an inflatable balloon may be positioned to create a space between a heart and pericardium when the balloon is inflated. Excerpt(s): The present application claims priority to U.S. Provisional Patent Application Serial No. 60/337,070, filed Dec. 4, 2001, entitled "Methods and Devices for the Least

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Invasive Cardiac Surgery of Atrial Fibrillation," the entire contents of which is hereby incorporated by reference... The present invention relates generally to medical devices and methods. More specifically, the invention relates to devices and methods for enhancing minimally invasive cardiac surgery of atrial fibrillation... Atrial fibrillation (AF) is a heart beat rhythm disorder (or "cardiac arrhythmia") in which the upper chambers of the heart known as the atria quiver rapidly instead of beating in a steady rhythm. This rapid quivering reduces the heart's ability to properly function as a pump. AF is characterized by circular waves of electrical impulses that travel across the atria in a continuous cycle. It is the most common clinical heart arrhythmia, affecting more than two million people in the United States and some six million people worldwide. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Methods and apparatus for determination and decrease of dynamic positioning errors of an ablating laser during refractive laser surgery Inventor(s): Teiwes, Winfried ; (Teltow/Berlin, DE), Weise, Ralf ; (Teltow/Berlin, DE), Huppertz, Michael ; (Teltow/Berlin, DE), Jacobs, Jorg ; (Teltow/Berlin, DE) Correspondence: THE FIRM OF KARL F ROSS; 5676 RIVERDALE AVENUE; PO BOX 900; RIVERDALE (BRONX); NY; 10471-0900; US Patent Application Number: 20030144651 Date filed: November 19, 2002 Abstract: The above described apparatus and methods provide the possibility to reduce or even eliminate the effects of delay between image acquisition and laser ablation. Thus this will lead to less positioning errors and therefore to better ablation results in laser refractive surgery. The importance of this invention will increase with decreasing ablating beam diameter. The use of synchronization leads to shorter delay times. Hence it follows that the duration of the whole treatment decreases as well. Excerpt(s): The present invention is directed to applications for improving vision with small- or large-spot scanning refractive laser surgery of the cornea, described in greater detail in Elander, R., Rich, L. F., Robin, J. B.: "Principles and Practice of Refractive Surgery"; W. B. Saunders Company, Philadelphia; 1.sup.st ed., 1997 and in Seiler, T.: "Refraktre Chirurgie der Hornhaut"; Thieme, Stuttgart; 1.sup.st ed., 2000. Here the corneal shape is adjusted by an aggregate of hundreds to thousands of laser shots in a pre-calculated ablation profile, according to the intended change of the corneal shape determined in a preceding diagnostic procedure. The temporal sequence of these laser shots is usually defined together with the ablation co-ordinates relative to the eye in a so-called shot-table before the laser treatment. During the surgery procedure the laser spot is positioned using a positioning device, for example a x-y scanner... Together, both delays can lead to considerable positioning errors of laser shots onto the eye due to the patient's eye movements: During fast eye movements (saccades) which exist during the surgery procedure (although the patient is urged to fixate on a point during refractive surgery procedure) a positioning error on the cornea of up to 2 mm can occur with a common overall delay time of 50 ms. Larger errors occur only in a few percent of all laser shots, however they can result in an inaccurate corneal shape, thus imperfect vision correction... The present invention provides methods and an apparatus for measurement and decrease of these dynamic positioning errors. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Minimally invasive cardiac surgery procedure Inventor(s): Cosgrove, Delos M. ; (Hunting Valley, OH) Correspondence: EDWARD LIFESCIENCES CORPORATION; ONE EDWARDS WAY; IRVINE; CA; 92614; US Patent Application Number: 20030178033 Date filed: February 10, 2003 Abstract: A minimally invasive approach for surgery on portions of the heart and great vessels. A parasternal incision is made extending across a predetermined number of costal cartilages, e.g., a right parasternal incision extending from the lower edge of the second costal cartilage to the superior edge of the fifth costal cartilage. One or more costal cartilages, e.g., the third and fourth, are then excised to provide access to the portion of the heart or great vessels of interest, for example between a point approximately three centimeters above supra annular ridge and the mid ventricular cavity, and a desired procedure completed. A minimally invasive procedure for repair or replacement of the aortic valve is disclosed that includes making a transverse incision of about 10 cm in length over the second or third intercostal space in the thorax of the patient, dividing the sternum transversely following the incision, retracting the transversely divided sternum, exposing the ascending aorta, and incising the ascending aorta to provide access to an area adjacent the aortic valve. Excerpt(s): This application is a continuation of U.S. application Ser. No. 08/801,494, filed Feb. 18, 1997, which is a continuation-in-part of U.S. application Ser. No. 08/603,313, filed Feb. 19, 1996, now issued as U.S. Pat. No. 5,752,526... The present invention relates to surgical procedures and, more specifically, to minimally invasive procedures for mitral and aortic valve repair or replacement surgeries including making small access incisions in the sternal area... Various types of surgical procedures are performed on the heart and the great vessels. Many of such procedures, particularly those involving the aorta, and aortic valve employ a gross thoracotomy, e.g., a median sternotomy, in order to gain access to the involved portion of the heart or vessel. In other words, the procedures entail splitting open the patient's chest. Such procedures cause significant trauma to the patient, and recovery time. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Modular neck for femur replacement surgery Inventor(s): Murray, Ian P. ; (Phoenix, MD) Correspondence: ARMSTRONG, WESTERMAN & HATTORI, LLP; Suite 220; 502 Washington Avenue; Towson; MD; 21204; US Patent Application Number: 20030074080 Date filed: October 15, 2002 Abstract: A prosthesis device for hip surgery replacement has a main body portion which is implanted in the femur of a patient. A series of adapters are provided from which one is selected. Each adapter has a tapered shank which is received a corresponding tapered bore in the main body portion forming a first lock therein. The adapter has tapered teeth which engage corresponding tapered teeth in the bore in the main body portion, forming a second lock. The adapter is indexed with respect to the main body portion. A method of use is disclosed.

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Excerpt(s): The present invention is a continuation-in-part application of application Ser. No. 09/505,876, filed Feb. 17, 2000, which in turn, is a continuation-in-part of application Ser. No. 09/059,698, filed Apr. 14, 1998, the disclosure of which are incorporated in their entirety by reference herein... The present application relates to a prosthesis for femur replacement surgery and more particularly to a prosthesis which receives a modular neck assembly selected for a desired neck length, neck angle, anteversion and offset... Surgery to replace the femur in total joint surgery involves the insertion of a stem in a cavity formed in the femur. The end of the stem extending from the cavity has a neck which is formed at an angle and the neck is mated with a socket in the hip. Every patient requires individual fitting due to the unique anatomical requirements of the particular patient. A prosthesis in which the stem and neck are a unitary device requires that the surgeon have a large quantity of prostheses available to provide a correct biomechanical function of the prosthesis with the patient. It is very costly to maintain a large inventory of prostheses and, despite the number of prostheses available, quite often the appropriate size and angle are not completely met. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Multifocal refractive surgery optimized to pupil dimensions and visual acuity requirements Inventor(s): Schelonka, Lee Paul ; (Lakewood, CO) Correspondence: LEE P. SCHELONKA; 3083 SOUTH OAK WAY; LAKEWOOD; CO; 80227; US Patent Application Number: 20030199858 Date filed: April 18, 2002 Abstract: Multifocal corneal refractive surgery for the correction of presbyopia is optimized, based on patient pupil measurements and acuity requirements. Measurements are made of the patient's pupil dimensions in bright and dim light, with near and distant focusing. A series of mathematical models of the wavefront transmitted through the eye/multifocal optic system is constructed, and the modulation transfer functions are calculated, for a series of optical zone dimensions and decentrations. The maximum resolvable spatial frequency and the expected visual acuity are calculated as functions of the zone dimensions and decentration. The patient's near and distant visual acuity requirements are compared to the expected visual acuity, and the optimized zone dimensions and decentration meeting the acuity requirements are determined. A required postoperative multifocal corneal profile is calculated. A computer-controlled laser, mechanical, thermal, or conductive device reshapes the cornea or a corneal implant. Nomograms are disclosed for centered, circular multifocal refractive surgery. Excerpt(s): This invention relates to the optics of the eye, the cornea, and refractive surgery. It specifies an improved method to create a multifocal cornea, with optical zone dimensions and decentration optimized, based on measurements of the patient's pupils and the patient visual acuity requirements. The refractive surgery corrects myopia, hyperopia, regular astigmatism and higher order aberrations, in addition to presbyopia... The visual acuity required by a patient depends on the visual tasks. For distant tasks such as driving, many patients require 20/20 acuity. The Snellen units of 20/20 correspond to a minimum angle of resolution of about one arc minute, a maximum resolvable spatial frequency of about 30 cycles per degree, and a decimal acuity of 1.0. However, many near visual tasks require a lower level of acuity. For example, reading seven point lowercase printed matter at a standard distance of 14

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inches (0.36 meters) requires only about 20 cycles per degree of angular resolution. This is equivalent to about 0.67 decimal acuity, or 20/30 distant acuity, and is termed Jaeger 2 or J2 near acuity... The visual acuity at near depends on accommodation, which is the eye's ability to change focus, and on the depth of focus of the eye. With age, the eye's ability to accommodate declines, resulting in presbyopia. Correcting for near vision requires additional optical power, increasing with increasing age, as in Table 1 (Ref Strauss). Between the ages of 40 and 60, an additional 1.0 Diopter of add power is required for each decade of life. The depth of focus of the eye, also termed pseudoaccommodation or apparent accommodation, is inversely proportional to the required visual acuity and depends also on the pupil diameter and the optics of the eye, including uncorrected refractive error and aberrations (Refs Green (1980) and Fukuyama). Conventionally, presbyopia has been treated with bifocal, trifocal or multifocal glasses or contact lenses. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Multifunctional tool and method for minimally invasive surgery Inventor(s): Frecker, Mary I. ; (State College, PA), Dziedzic, Ryan P. ; (McLean, VA), Haluck, Randy S. ; (Hershey, PA), Schadler, Jeremy R. ; (Fleetwood, PA) Correspondence: MCKEE, VOORHEES & SEASE, P.L.C.; ATTN: PENNSYLVANIA STATE UNIVERSITY; 801 GRAND AVENUE, SUITE 3200; DES MOINES; IA; 503092721; US Patent Application Number: 20030065358 Date filed: August 5, 2002 Abstract: An apparatus and method for minimally invasive surgery. The apparatus can comprise a tool which includes a multi-functioning end effector for insertion into a patient, a user control adapted for use by the surgeon external of the patient, and an intermediate section between the end effector and the user control to translate control instructions from the user control through an actuating mechanism to operate the end effector in one of at least two different functioning states. No instrument exchange is necessary to change between states. The actuation mechanism could be a manually operated mechanical mechanism. Alternatively, it could be partially or fully electromechanical or electrical or electronic. According to one aspect, the end effector is a rigid link mechanism. According to another aspect, the end effector could be a compliant mechanism, at least in part. Another aspect of the invention includes the ability of the end effector to have at least some articulation in addition to grasping and cutting functions. Excerpt(s): This application is based upon U.S. Provisional Application Ser. No. 60/310,314, filed Aug. 6, 2001, and Ser. No. 60/310,315, filed Aug. 6, 2001... The entire contents of U.S. Provisional Applications Ser. Nos. 60/310,314, and 60/310,315, both filed Aug. 6, 2001, are incorporated by reference herein... This invention relates to Minimally Invasive Surgery tools and methods, and in particular, to multifunction tools and methods. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Non-aspirating transitional viscoelastics for use in surgery Inventor(s): Brunstedt, Michael R. ; (Cleveland, OH), Jinkerson, David L. ; (Benbrook, TX), Patel, Anilbhai S. ; (Arlington, TX), Chan, Kwan Y. ; (Fort Worth, TX), Karakelle, Mutlu ; (Fort Worth, TX) Correspondence: ALCON RESEARCH, LTD.; R&D COUNSEL, Q-148; 6201 SOUTH FREEWAY; FORT WORTH; TX; 76134-2099; US Patent Application Number: 20030060447 Date filed: April 24, 2002 Abstract: Non-aspirating viscoelastics, compositions and methods of use are disclosed. The non-aspirating, transitional viscoelastics possess sufficient viscosity to be useful in ophthalmic viscosurgery, but may be left in the eye with little or no resulting IOP spike. The compositions are particularly useful in cataract surgery Excerpt(s): The present invention relates to the field of viscous and viscoelastic materials suitable for use in surgical procedures. In particular, non-aspirating viscoelastics, including transitional viscoelastics (having non-shear related variable viscosities), which may be left iii situ at the close of surgery are disclosed. Methods of using transitional viscoelastics in surgery, especially ophthalmic surgery are also disclosed... Viscous or viscoelastic agents used in surgery may perform a number of different functions, including without limitation maintenance and support of soft tissue, tissue manipulation, lubrication, tissue protection, and adhesion prevention. It is recognized that the differing rheological properties of these agents will necessarily impact their ability to perform these functions, and, as a result, their suitability for certain surgical procedures. See, for example, U.S. Pat. No. 5,273,056... Cataracts are opacities of the ocular lens which generally arise in the elderly. In order to improve eyesight, the cataractous lens is surgically removed and an artificial intraocular lens is inserted in its place. During these surgical procedures, viscoelastic materials are typically injected in the anterior chamber and capsular bag to prevent collapse of the anterior chamber and to protect tissue from damage resulting from physical manipulation. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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NON-INVASIVE METHODS FOR SURGERY IN THE VASCULATURE Inventor(s): Unger, Evan C. ; (Tucson, AZ) Correspondence: S. Maurice Valla; Woodcock Washburn Kurtz; Mackiewicz & Norris LLP; One Liberty Place - 46th Floor; Philadelphia; PA; 19103; US Patent Application Number: 20030088176 Date filed: May 10, 2001 Abstract: Novel methods of non-invasive intravascular surgery are disclosed. Excerpt(s): This application is a divisional of copending application Ser. No. 09/613,210, filed Jul. 10, 2000, which in turn is a divisional of application Ser. No. 08/476,317, filed Jun. 7, 1995, now U.S. Pat. No. 6,088,613... Application Ser. No. 08/476,317 is, in turn, a continuation-in-part of copending application Ser. No. 08/401,974, filed Mar. 9, 1995, now U.S. Pat. No. 5,922,304, which is a continuation-in-part of copending application Ser. No. 08/212,553, filed Mar. 11, 1994, now abandoned, the disclosures of which are hereby incorporated herein by reference, in their entirety, and priority to which is hereby claimed... Copending application Ser. No. 08/076,250, filed Jun. 11, 1993, now

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U.S. Pat. No. 5,580,575, which is a continuation-in-part of U.S. Ser. No. 716,899, now abandoned, and Ser. No. 717,084, now U.S. Pat. No. 5,228,446, each filed Jun. 18, 1991, which in turn are continuations-in-part of U.S. Ser. No. 569,828, filed Aug. 20, 1990, now U.S. Pat. No. 5,088,499, which in turn is a continuation-in-part of U.S. Ser. No. 455,707, filed Dec. 22, 1989, now abandoned, discloses therapeutic drug delivery systems comprising gas filled micro spheres containing a therapeutic agent, with particular emphasis on the use of ultrasound techniques to monitor and determine the presence of said microspheres in a patient's body, and then to rupture said microspheres in order to release said therapeutic agent in the region of the patient's body where said microspheres are found. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Ophthalmic apparatus and corneal surgery apparatus Inventor(s): Fujieda, Masanao ; (Toyohashi-shi, JP) Correspondence: RADER FISHMAN & GRAUER PLLC; LION BUILDING; 1233 20TH STREET N.W., SUITE 501; WASHINGTON; DC; 20036; US Patent Application Number: 20030120266 Date filed: December 2, 2002 Abstract: An ophthalmic apparatus for obtaining differences between the pupil positions in photopia and scotopia accurately, and a corneal surgery apparatus for ablating a cornea of an eye by laser beam irradiation allowing for the differences. The ophthalmic apparatus has devices for inputting a first image of an anterior eye segment in photopia and a second one in scotopia, for obtaining pupil information in the images and differences between the pupil information in photopia and that in scotopia, and for outputting the differences. The corneal surgery apparatus has devices for irradiating the cornea with a laser beam, for aligning an irradiation position with the eye, for inputting differences between the pupil positions in photopia and scotopia, for detecting the photopic pupil position, for obtaining an alignment position of the laser beam based on the pupil position and the positional difference, and for controlling the alignment device based on the alignment position. Excerpt(s): The present invention relates to an ophthalmic apparatus and a corneal surgery apparatus used in ophthalmic clinics and the like... On ophthalmic diagnosis, examination, treatment and prescription, it is sometimes necessary to obtain information about the position and/or shape of a pupil. For example, in corneal surgery for correcting refractive power by ablating a cornea with a laser beam, it is common practice to align a reference axis of irradiation of the laser beam with the position of a pupil center... In addition, among multifocal contact lenses, in which different lens diopters are provided in the form of concentric circles around an axis of an optical center of the lens, there are some in which the axis of the optical center is decentered with respect to the geometric center of the lens. The amount of the decentering is determined in consideration of the pupil center position. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Performing cardiac surgery without cardioplegia Inventor(s): Wilson, Christopher P. ; (La Honda, CA), Pendleton, Rand P. ; (Palo Alto, CA), Ramans, Andris D. ; (Mountain View, CA), Rosa, David J. ; (San Jose, CA), Falk, Volkmar ; (Woodside, CA), Guthart, Gary S. ; (Foster City, CA), Nowlin, William C. ; (Los Altos, CA), Moll, Frederic H. ; (Woodside, CA), Evans, Philip C. ; (Portola Valley, CA), Younge, Robert G. ; (Portola Valley, CA) Correspondence: TOWNSEND AND TOWNSEND AND CREW, LLP; TWO EMBARCADERO CENTER; EIGHTH FLOOR; SAN FRANCISCO; CA; 94111-3834; US Patent Application Number: 20030055410 Date filed: August 6, 2002 Abstract: A surgical system or assembly for performing cardiac surgery includes a surgical instrument; a servo-mechanical system engaged to the surgical instrument for operating the surgical instrument; and an attachment assembly for removing at least one degree of movement from a moving surgical cardiac worksite to produce a resultant surgical cardiac worksite. The surgical system or assembly also includes a motion tracking system for gathering movement information on a resultant surgical cardiac worksite. A control computer is engaged to the attachment assembly and to the motion tracking system and to the servo-mechanical system for controlling movement of the attachment assembly and for feeding gathered information to the servo-mechanical system for moving the surgical instrument in unison with the resultant surgical cardiac worksite such that a relative position of the moving surgical instrument with respect to the resultant surgical cardiac worksite is generally constant. A video monitor is coupled to the control computer; and an input system is coupled to the servo-mechanical system and to the control computer for providing a movement of the surgical instrument. The video monitor displays movement of the surgical instrument while the resultant surgical cardiac worksite appears substantially stationary, and while a relative position of the surgical instrument moving in unison with the resultant surgical cardiac worksite, as a result from the movement information gathered by the motion tracking system, remains generally constant. A method of performing cardiac surgery without cardioplegia comprising removing at least one degree of movement freedom from a moving surgical cardiac worksite to produce at least a partially stationary surgical cardiac worksite while allowing a residual heart section, generally separate from the at least partially stationary surgical cardiac worksite, to move as a residual moving heart part. Cardiac surgery is performed on the at least partially stationary cardiac worksite with a surgical instrument such as needle drivers, forceps, blades and scissors. Excerpt(s): The present application is a divisional of U.S. application Ser. No. 09/436,982, filed Nov. 9, 1999 which claims priority from U.S. Provisional Patent Application No. 60/109,359, filed Nov. 20, 1998; U.S. Provisional Patent Application No. 60/109,301, filed Nov. 20, 1998; U.S. Provisional Patent Application No. 60/109,303, filed Nov. 20, 1998; U.S. application Ser. No. 09/374,643, filed Aug. 16, 1999; U.S. Provisional Application No. 60/150,145, filed Aug. 20, 1999; U.S. patent application Ser. No. 09/399,457, filed Sep. 17, 1999; and U.S. application Ser. No. 09/433,120, filed Nov. 3, 1999, entitled "Cooperative Minimally Invasive Telesurgical System" (Attorney Docket No. 17516-004720), the complete disclosures of which are incorporated herein by reference... This invention relates generally to cardiac surgery. More specifically, this invention provides methods for enhancing the performance of cardiac surgery. In particular, this invention relates to systems and methods which use servo-mechanisms under surgeon control to augment a surgeon's ability to perform surgical procedures on a beating heart... Coronary artery disease remains the leading cause of morbidity and

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mortality in Western societies. Coronary artery disease is manifested in a number of ways. For example, disease of the coronary arteries can lead to insufficient blood flow resulting in the discomfort and risks of angina and ischemia. In severe cases, acute blockage of coronary blood flow can result in myocardial infarction, leading to immediate death or damage to the myocardial tissue. A number of approaches have been developed for treating coronary artery disease. In less severe cases, it is often sufficient to treat the symptoms with pharmaceuticals and lifestyle modification to lessen the underlying causes of disease. In more severe cases, the coronary blockages can often be treated endovascularly using techniques such as balloon angioplasty, atherectomy, laser ablation, stents, hot tip probes, and the like. In cases where pharmaceutical treatment and/or endovascular approaches have failed, or are likely to fail, it is often necessary to perform a coronary artery bypass graft (CABG) procedure. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Pyruvate cardioplegia solutions for administration cardiopulmonary surgery and methods of use thereof

to

the

heart

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Inventor(s): Mallet, Robert T. ; (Weatherford, TX), Olivencia-Yurvati, Albert H. ; (Southlake, TX) Correspondence: BAKER BOTTS L.L.P.; 2001 ROSS AVENUE; SUITE 600; DALLAS; TX; 75201-2980; US Patent Application Number: 20030124503 Date filed: December 28, 2001 Abstract: The invention includes a novel cardioplegia solution in which pyruvate serves as the primary energy source. The solution may be used in any surgery where the heart must be arrested, but it is particularly useful in cardiopulmonary bypass surgery. Because the solution relies primarily upon pyruvate to protect the heart from damage during and immediately after arrest, other additives are not as necessary as with current cardioplegia solutions or are not necessary at all. The invention also includes a method for making the cardioplegia solution and a process of performing cardiopulmonary bypass surgery using the novel cardioplegia solution. Excerpt(s): This invention concerns a novel pyruvate-containing cardioplegia solution and its use for arresting and preserving the heart during heart surgery. To arrest the heart, the solution is introduced into the heart's coronary blood vessels. Chemical components of the solution protect the heart from injury and preserve heart muscle tissue throughout the period of cardiac arrest, allowing for improved post-surgical recovery of the heart's contractile performance as compared to lactate or glucose-based solutions currently used in the art... Heart surgeries, such as coronary artery bypass grafting, valve replacement and repair of structural defects of the heart, are delicate procedures demanding a high level of surgical precision. It is typically necessary to temporarily stop the heart beat during these procedures so that the organ remains motionless, thereby facilitating the surgeon's work. The heart beat is arrested by introducing into the heart's coronary blood vessels special aqueous solutions, termed cardioplegia solutions, which contain chemicals that interrupt the physiological processes that cause the heart to beat... A mechanical pump assumes the heart's role of supplying blood to the rest of the body while the heart is arrested. However, the heart's own coronary blood flow is interrupted during cardiac arrest and is not restored by the mechanical pump; the heart becomes ischemic. Coronary blood flow is critical because it supplies the heart with the fuels and oxygen it needs to generate ATP, the heart's main

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source of chemical energy. ATP supplies energy for numerous cellular processes that enable the heart to pump blood and which sustain the cells of the heart muscle. Cardiac arrest minimizes the heart's energy demands by interrupting the major energyconsuming process, that of pumping blood, but some energy is still required to support other cellular functions. Consequently the heart's energy reserves are depleted, albeit slowly, during cardiac arrest, due to the lack of coronary blood flow. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Support arm for cardiac surgery Inventor(s): Skinkle, David William ; (Denver, CO), Nguyen, Hieu Cong ; (Denver, CO), Wright, John Thomas Matthew ; (Denver, CO) Correspondence: SWANSON & BRATSCHUN L.L.C.; 1745 SHEA CENTER DRIVE; SUITE 330; HIGHLANDS RANCH; CO; 80129; US Patent Application Number: 20030158542 Date filed: January 23, 2003 Abstract: A support arm assembly for assisting in the performance of cardiac surgery has an articulated arm movable axially of a support base and rotatable relative to the support base. A distal end of the articulated arm receives a contact member and the contact member is moveable relative to the distal end. A surgeon may configure the support arm assembly to contact a desired portion of a heart and fix the articulated arm, its axial position, its rotated position and the orientation of the contact member with a single control. Excerpt(s): The present invention relates generally to surgical tools including surgical tools for cardiac surgery, and more specifically to surgical tools used in conjunction with Coronary Artery Bypass surgery, both the on-pump and the off-pump variety... OffPump Coronary Artery Bypass (OPCAB) has evolved since about 1990, following the pioneering work done in North America by Ankeney in the period 1970-75, Akins et al. 1979, and Fanning et al. 1979-1992 in the U.S, and by Trapp & Bisarya in the early 1970's in Canada. In South America other pioneering was done by Benetti (1978-85) in Argentina and Buffolo (1981-85) in Brazil. Generally the anastomotic site was immobilized with stay sutures, such as the technique described by Trapp & Bisarya, who encircled the anastomotic area with sutures placed deep in the myocardium to incorporate enough muscle to suspend the heart yet prevent damage to the coronary artery. Later in the U.S. Phister (1985-90) and Gundry in 1990 (among others) performed OPCAB surgery but both had an assistant with a hand held instrument press on the surface of the heart near the anastomotic site to aid in epicardial immobilization... In the mid 1990's various epicardial stabilizing instrument that could be attached to sternal retractors were evolved. For example U.S. Pat. No. 5,836,311 described a vacuum epicardial stabilizer, U.S. Pat. No. 5,786,746 described an adhesive coated and vacuum epicardial stabilizer, and U.S. Pat. No. 6,213,941 described a mechanical foot that pressed on the myocardium to stabilize the anastomotic site. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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SUPPORT PILLOW FOR RECTAL SURGERY Inventor(s): Graham, Bruce D. ; (Overland Park, KS) Correspondence: HOVEY, WILLIAMS, TIMMONS & COLLINS; 2405 Grand, Suite 400; Kansas City; MO; 64108; US Patent Application Number: 20030079291 Date filed: November 1, 2001 Abstract: A surgical pillow is provided for supporting, cushioning and positioning a patient while in a prone position on an operating table during rectal surgery. The pillow comprises an elongated, self-sustaining, flexible body unit of compressible material having shape return memory. The body unit is provided with an indented upper face defined by a longitudinally extending, centrally located channel and chamfered downwardly inclined patient positioning surfaces on opposite sides of the central channel. Converging, inclined side surfaces of the body unit are configured and strategically located to accommodate the axilla areas of a patient while the patient is supported on the body unit. A removable cover that substantially conforms to the configuration of the body unit is provided in full covering relationship to the body unit. Excerpt(s): This invention relates to an improved surgical pillow especially adapted to support, cushion and position a patient while in a prone position on an operating table during rectal surgery... At the present time, positioning of a patient for rectal surgery on a conventional operating table is most usually accomplished by making up rolls of blankets, towels or other similar items which are then placed along opposite sides of the patient's torso. That technique has many disadvantages including the tendency for the rolled support to shift and tend to be displaced from the original patient supporting locations thereof, and the fact that the rolls do not provide optimum patient cushioning and positioning. Furthermore, it is difficult to arrange the blanket or towel rolls in this position such that the patient's arms can be placed comfortably hanging over the edges of the operating table. Equally as significant, although support is provided by the rolls, blanket or towels for the patient's torso, the patient is still lying flat on the table in a prone positions such that pressure is inherently applied to the central part of the patient's body. The result is a tendency for the compressive forces on the patient's torso to impede veinous blood return to the patient's heart... Efforts to solve the problem of providing comfortable and effective support and positioning of a patient in a prone position during rectal surgery have not found widespread acceptance and universal usage in part because of the complexity and cost of prior devices, the inability of the supporting devices to adequately accommodate patients of different sizes and weights, and the inordinate setup and adjustment time encountered with certain units. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Surgery center with a matrix of flow patterns and interaction nodes Inventor(s): Taylor, Wade C. ; (Wauwatosa, WI) Correspondence: Lisa A. Brzycki; GEHRKE & ASSOCIATES, S.C.; 610 North 77th Street; Wauwatosa; WI; 53213; US Patent Application Number: 20030195768 Date filed: April 11, 2002

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Abstract: A surgery center includes a matrix of flow patterns and interaction nodes that are optimized by providing a physical structure that includes an admit/reception node, a pre-operative node, a surgical node, an acute recovery node and an observation node. The pre-operative node is located adjacent the admit/reception node. The surgical node is located adjacent the pre-operative node. The acute recovery node is located adjacent to the surgical node and between the surgical node and the observation node. The patient flow throughout each of the nodes is unidirectional. An instrument flow is circular and confined to the surgical node, a staff/physician flow includes a separate entry to the surgery center separate from the admit/reception node and the observation node, a supply flow is linear, and an environmental waste flow includes transitioning between a sterile zone and a non-sterile zone. The patient flow, the instrument flow, the staff/physician flow, the supply flow and the environmental waste flow intersect at the surgical node. Excerpt(s): This invention relates to a surgery center that optimizes flow patterns by integrating them into a combination of nodes representing general areas (admit, preoperative, surgical, acute recovery, and observation)... Good ambulatory surgery center design is not based on clever schemes developed over the centuries by gifted architects and planners. Good surgery center design is based on a rudimentary understanding of the absolute nature of the significant circulation patterns and the activities that occur within the created space... Although an architect Louis Sullivan coined the phrase "form follows function" in the late 19th century, the concept applies to the design of surgery centers today. Today ambulatory surgery centers are still being designed without the fundamental understanding of the actual process of surgery, which results in the inefficient and costly facilities that are being built. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

System for generating ablation profiles for laser refractive eye surgery Inventor(s): Williams, Roy E. ; (Collierville, TN), Davis, Jack H. ; (Collierville, TN) Correspondence: Gordon & Jacobson, P.C.; 65 Woods End Road; Stamford; CT; 06905; US Patent Application Number: 20030069566 Date filed: October 16, 2002 Abstract: A laser eye surgery system and method include a laser for producing a laser beam capable of making refractive corrections, an optical system for shaping and conditioning the laser beam, a digital micromirror device (DMD) for reflecting the shaped and conditioned beam toward the eye, and a computer system for controlling the mirrors of the DMD. The computer system and methodology utilize a higher order polynomial equation to generate a smooth refraction correction profile and determines the coefficients for the higher order polynomial equation from preferably first-, second-, or third-order curves based on the correlation between the coefficients and the desired diopter correction. Excerpt(s): This application is a continuation-in-part of U.S. Ser. No. 09/568,166, filed May 9, 2000, which is a continuation-in-part of U.S. Pat. No. 6,394,999, and which are each hereby incorporated by reference herein in their entireties... This invention relates broadly to eye surgery. More particularly, this invention relates to refractive laser systems for eye surgery... The laser refractive surgery (or laser keratectomy) field has rapidly grown over the past few years with many new lasers and algorithms to correct

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human vision. Systems are now using laser wavelengths from the ultraviolet (excimer) to the infrared to change the shape of the cornea in a calculated pattern which makes it possible for the eye to focus properly. For example, in the treatment of myopia, the excimer laser is used to remove or ablate tissue from the cornea in order to flatten its shape. Infrared (IR) energy is also used by some companies to treat myopia by reshaping the corneal tissue by a "thermal" method as opposed to ablation with the excimer wavelength. The correction of hyperopia is produced by steepening the cornea by removing tissue at the outer edges of the cornea (excimer) or by reshaping the cornea at the outer edges (IR energy). The correction of astigmatism, both myopic and hyperopic, requires the laser to remove or reshape tissue in a more complex pattern. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Systems and methods for monitoring and controlling the temperature of an organ during surgery Inventor(s): Benetti Diaz De Brito, Juan Ignacio ; (Rosario, AR), Chin, Sing-Fatt ; (Fremont, CA) Correspondence: BOZICEVIC, FIELD & FRANCIS LLP; 200 MIDDLEFIELD RD; SUITE 200; MENLO PARK; CA; 94025; US Patent Application Number: 20030149401 Date filed: February 6, 2002 Abstract: Systems and methods are provided for monitoring and controlling the temperature of an organ during surgery, and are particularly useful for monitoring and controlling the temperature of the heart during surgery. The subject systems include a temperature sensor for application to the organ, reservoirs for containing temperaturecontrolled fluids to be delivered to the organ, a temperature regulator for regulating or maintaining the temperatures of such fluids, a pump for transferring the fluids from the reservoirs to the organ, a display for displaying certain system operating parameters and other information, a user interface module and a controller for controlling the functions of the system based on certain system operating parameters. The subject methods generally involve monitoring the temperature of an organ and, based on the organ's temperature, controlling the application of temperature-controlled fluids to the organ. Excerpt(s): The present invention is related to systems and methods for monitoring and controlling the temperature of an organ or an internal portion of the body during surgery... During surgery it is often desirable or necessary to maintain an organ or a portion of the body at a certain temperature. For example, in open-heart surgery wherein cardiopulmonary bypass is employed, a cold solution having a temperature of about 4.degree. C. is delivered under controlled conditions to the coronary arteries via the aortic root. The solution arrests the contractions of the heart through chemical action, supplies the heart muscle with oxygen and also cools the heart to a temperature typically in the range from about 10.degree. to 14.degree. C. in order to minimize deterioration of the heart muscle during the surgery. This cold solution includes cardioplegia which is a crystalloid chemical solution containing potassium and other additives. Depending on surgeon preference and the progress of the surgery, the solution may be comprised of 100% cardioplegia ("cold cardioplegia") or some mixture of cardioplegia and blood ("warm cardioplegia"). The temperature and application of the cardioplegic solution is typically controlled by the heart-lung machine... Due to many of the drawbacks of temperature monitoring and temperature control and

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regulation of the heart during surgery, there is continued interest in the development of new devices and techniques for monitoring and controlling the temperature of organs during surgery. Of particular interest would be the development of systems and methods wherein the monitoring and controlling of an organ's temperature during surgery is continuous and automatic, thus obviating the need for physician intervention. It would be additionally beneficial if such system and method were applicable to both stopped and beating heart surgeries, and in both open and minimally invasive surgeries. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Universal hand surgery table Inventor(s): Ames, Elliot L. ; (Cherry Hill, NJ) Correspondence: WOODCOCK WASHBURN LLP; ONE LIBERTY PLACE, 46TH FLOOR; 1650 MARKET STREET; PHILADELPHIA; PA; 19103; US Patent Application Number: 20030192122 Date filed: May 27, 2003 Abstract: A hand surgery table has a top for supporting a patient's arm during hand surgery. A concave end of the hand surgery-table accommodates the attending surgeon's torso so that the attending surgeon may sit comfortably. A tongue-shaped end portion extends from the end opposite the concave end for securing the hand surgery table to a conventional operating table where the patient may lie and rest his or her forearm on the hand surgery table top. Elbow support structures are attached to respective sides of the hand surgery table and have convex peripheries for the attending surgeon and the nurse assistant to rest their elbows and forearms. The elbow support structures are retractable to the underside of the table and are moveable longitudinally along the hand surgery table. Excerpt(s): This invention relates to an operating table for use in hand surgery... Hand surgery tables have been used in the medical field to perform surgery on a patient's hand for many years. Conventional hand surgery tables utilize rigid elbow support structures attached in a fixed manner to respective sides of the hand surgery table. The attending surgeon and the nurse assistant utilize the elbow support structures to rest their elbows during the surgical procedure... Conventional elbow support structures are not pivotable or retractable underneath the hand surgery table. The elbow support structures have a tendency to get in the way during surgery or afterwards when the hand surgery table is detached from a conventional operating table for storage. Additionally, the elbow support structures are rectangularly shaped and boxy and do not permit the attending surgeon or the nurse assistant to sit comfortably at the hand surgery table. Further, the elbow support structures are hard and not cushioned, making it uncomfortable for the attending surgeon to rest his elbows. All of these problems tend to impair the attending surgeon's and the nurse assistant's comfort, maneuverability, and performance during hand surgery on a patient. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Visualization during closed-chest surgery Inventor(s): Bertolero, Raymond S. ; (Danville, CA), Bertolero, Arthur A. ; (Danville, CA), Riebman, Jerome B. ; (Sunnyvale, CA) Correspondence: GREGORY SMITH & ASSOCIATES; 3900 NEWPARK MALL ROAD, 3RD FLOOR; NEWARK; CA; 94560; US Patent Application Number: 20030153810 Date filed: February 21, 2003 Abstract: An improvement in a method for closed-chest, video-assisted diagnostic or surgical treatment of a patient is provided. The improvement comprises draping a video monitor with a transparent sterile surgical drape and positioning the draped monitor within the surgical field so that a surgeon can perform an internal surgical or diagnostic procedure and view it on the monitor to provide improved visual alignment for the surgeon. A flexible, sterile drape for covering the video monitor is disclosed. An apparatus for assisting the surgeon in performing closed-chest, video-assisted surgical or diagnostic treatment of a patient is disclosed which comprises a movable cabinet having an adjustable arm to which is affixed a video monitor that can be extended into the surgical field of an operating room to improve the visualization of the surgery performed by the surgeon. An improved operating table for assisting a surgeon in performing closed-chest, video-assisted surgical or diagnostic treatment of a patient is also disclosed along with endoscopic visualization apparatus and an improved design of a view scope that allows the doctor to get closer to a patient during the operation. Excerpt(s): This is a continuation-in-part of Provisional patent application U.S. 60/014,922 filed Apr. 10, 1996 in the name of inventors Arthur Bertolero, Raymond Bertolero and Jerome Riebman. This application is related to concurrently-filed patent applications ESTC-001/01WO, ESTC-001/02WO, ESTC-001/04WO and ESTC001/05US. Each of the above-identified patent applications is incorporated herein by reference... This invention relates methods and apparatus for improving a surgeon's ability to perform video-assisted, closed-chest diagnostic and surgical procedures on patients requiring such procedures. It particularly relates to bringing a viewing monitor into the surgical field and positioning the monitor to provide the surgeon with nearly perfect visual alignment so that he or she has the feel of open-chest surgery. This is achieved by using specifically designed surgical drapes for the viewing monitor and apparatus designed to unobtrusively position the viewing monitor within the surgical field... Surgery on the heart is one of the most commonly performed types of surgery that is done in hospitals across the U.S. Cardiac surgery can involve the correction of defects in the valves of the heart, defects to the veins or the arteries of the heart and defects such as aneurysms or thromboses that relate to the circulation of blood from the heart to the body. In the past, most cardiac surgery was performed as open-chest surgery, in which a primary median sternotomy was performed. That procedure involves vertical midline skin incision from just below the super sternal notch to a point one to three centimeters below the tip of the xiphoid. This is followed by scoring the sternum with a cautery, then dividing the sternum down the middle and spreading the sternal edges to expose the area of the heart in the thoracic cavity. This technique causes significant physical trauma to the patient and can require one week of hospital recovery time and up to eight weeks of convalescence. This can be very expensive in terms of hospital costs and disability, to say nothing of pain to the patient. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Wicking instrument for LASIK surgery Inventor(s): Feinsod, Matthew ; (Grear Neck, NY) Correspondence: FROMMER LAWRENCE & HAUG; 745 FIFTH AVENUE- 10TH FL.; NEW YORK; NY; 10151; US Patent Application Number: 20030120226 Date filed: December 3, 2002 Abstract: An apparatus and method are provided for use in removing liquid from under a corneal flap generated during LASIK surgery. The apparatus comprises a handle, a sickle-shaped end coupled to the handle, the sickle-shaped end having a concave and a convex portion, and a sponge coupled with the concave portion of the sickle-shaped end, extending along the convex portion thereof, and being shaped substantially similarly to the sickle-shaped end. The sickle-shaped end extends from approximately 180.degree. to 270.degree., or any other desired part of a circle and may have sponge on one or both sides thereof. The radius of the sickle-shaped end is the same or slightly larger than the diameter of a corneal flap generated during LASIK surgery so that when the apparatus is placed adjacent the cornea of a patient about the corneal flap, liquid is wicked from thereunder without requiring any contact with the corneal flap. Excerpt(s): Refractive eye surgery is a general term for a surgical procedure intended to improve or correct the focus of a patient's eyes by changing the shape of the eye, thereby changing the optics by which the eye sees various images. While surgeries reshaping various portions of a patient's eye have been employed for some time, most recently, refractive eye surgery has involved reshaping the cornea of a patient's eye... The cornea is the clear, front surface of the eye of a person which refracts, or bends light as it enters the eye. This light that is bent by the cornea is focused on the retina of the eye. The retina is a layer of light-sensitive cells that lines the back of the eye. The retina converts light rays incident thereon into electrical impulses. These electrical impulses are sent through the optic nerve of the person to his or her brain. In the brain, these impulses are interpreted as images. If images received by the eye and refracted or bent by the cornea are not properly focused on the retina, the eye is said to have a refractive error. Myopia (near-sightedness), hyperopia (far-sightedness), and astigmatism (distortion at both near and far distances) are terms used to describe the refractive error of an eye. These refractive errors are the result of various irregular corneal curvatures, lens curvatures, or axial eye lengths that prevent images from being focused to a single point on the eye's retina... In performing refractive eye surgery, an excimer laser (excited dimer) may be used to reshape the cornea, thereby enabling the cornea to properly focus received light on the retina. The excimer laser interacts with the corneal tissue of the eye utilizing a laser-tissue interaction called photoablation. In photoablation, ultraviolet laser pulses precisely etch the cornea by uncoupling various intermolecular bonds thereof, thereby removing a submicron layer of cornea under highly controlled conditions. Because there is a relative absence of thermal injury to the corneal tissue during this procedure, the corneal cells can be ablated without opacifying (rendering so that light cannot pass therethrough) adjacent tissue. Such opacification might result in the inability to see through the opacified tissue of the eye. By carefully controlling the number of pulses of the ultraviolet laser, and the diameter and location of each pulse, the corneal tissue of a patient can be resculpted as necessary in order to improve the patient's vision. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Keeping Current In order to stay informed about patents and patent applications dealing with surgery, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “surgery” (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 surgery. You can also use this procedure to view pending patent applications concerning surgery. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 7. BOOKS ON SURGERY Overview This chapter provides bibliographic book references relating to surgery. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on surgery include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

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

Otorhinolaryngology: Head and Neck Surgery Source: Baltimore, MD: Williams and Wilkins. 1996. 1280 p. Contact: Available from Williams and Wilkins. P.O. Box 64686, Baltimore, MD 212644786. (800) 638-0672; Fax (800) 447-8438. PRICE: $179.00 plus shipping and handling. ISBN: 0683003151. Summary: This medical textbook on otorhinolaryngology and head and neck surgery presents normal human anatomy and physiology as a basis for the appreciation of altered conditions that underlie disease, its signs, and symptoms. Sixty-four chapters are presented in six sections: the nose and paranasal sinuses; neck, pharynx, oropharynx and nasopharynx, maxilla and mandible; the larynx; imaging of the head and neck; the ear; and bronchoesophagology. Topics particularly relevant to deafness and communication disorders include: the anatomy and physiology of the ear, auditory and vestibular systems, evaluation of the vestibular system, diagnostic audiology and

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hearing aids, diseases of the external ear, reconstruction of the outstanding ear (otoplasty), otitis media and middle ear effusions, the anatomy and physiology of the larynx, laryngeal trauma, infectious and inflammatory diseases of the larynx, otosclerosis, hearing impairment, occupational hearing loss, ototoxicity, sudden hearing loss, Meniere's disease, presbycusis, cochlear implants, and disorders of voice, speech, and language. Each chapter includes extensive references and suggested readings; a detailed subject index concludes the volume. •

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

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Guide to Laparoscopic Surgery Source: Malden, MA: Blackwell Science, Inc. 1998. 169 p. Contact: Available from Blackwell Science, Inc. 350 Main Street, Commerce Place, Malden, MA 02148. (800) 215-1000 or (617) 388-8250. Fax (617) 388-8270. E-mail: [email protected]. Website: www.blackwell-science.com. PRICE: $54.95. ISBN: 086542649X. Summary: This book reviews the important aspects of laparoscopy that every surgeon needs to know. The authors address the needs of trainees in all surgical disciplines, as well as the concerns of qualified surgeons, urologists, and gynecologists. The emphasis is on procedures and practical approaches; four sections are included. In the introduction, the authors review the advantages and disadvantages of laparoscopy, risk factors, combined laparoscopy and open surgery, physiological changes during laparoscopy, anesthesia during the procedures, and postoperative management. The second section on equipment, instruments, basic techniques, problems and solutions includes: imaging and viewing, sterilization and maintenance of optics and the camera,

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creation of the pneumoperitoneum access, gasless laparoscopy, Veress needle procedures, primary cannula insertion, open cannulation (Hasson's technique), secondary cannula, extraperitoneal laparoscopy, instruments for dissection, diathermy and electrocautery, hemostasis, laser, ultrasound, high velocity water jet, ligation and suturing, and specimen extraction. The section on setting up in the operating theater covers hand instruments, equipment, patient position and preparation, and setting up for the procedure. The final section on laparoscopic procedures themselves, covers diagnostic laparoscopy, laparoscopic ultrasonography, adhesiolysis, cholecystectomy (gallbladder removal), management of common bile duct stones, appendectomy, laparoscopic Nissen's fundoplication, gastroenterostomy, truncal vagotomy, laparoscopy for perforated duodenal ulcer, splenectomy, laparoscopy for undescended testicles, varicocele, laparoscopic simple nephrectomy (kidney removal), and inguinal hernia repair. The book is illustrated with numerous line drawings of the equipment and procedures being discussed. A subject index concludes the book. •

Surgery of the Esophagus, Stomach, and Small Intestine. 5th ed Source: Boston, MA: Little, Brown and Company. 1995. 1,004 p. Contact: Available from Lippincott-Raven Publishers. 12107 Insurance Way, Hagerstown, MD 21740. (800) 777-2295. Fax (301) 824-7390. E-mail: [email protected]. Website: http://www.lrpub.com. PRICE: $199.95. ISBN: 0316924423. Summary: This medical textbook brings together the work of international specialists in the fields of surgery of the esophagus, stomach, and small intestine. Seventy-four chapters are presented in 22 sections and cover topics including the history of esophageal surgery; anatomy and physiology of the esophagus; diagnostic tests of the esophagus; esophageal motility disorders; gastroesophageal reflux; neoplasia of the esophagus; acute and other diseases affecting the esophagus; the history of gastric surgery; the anatomy and physiology of the stomach and duodenum; benign ulcers; neoplasia of the stomach and duodenum; acute and other diseases of the stomach and duodenum; the history of small-intestine surgery; the anatomy and physiology of the small intestine; inflammatory diseases of the small intestine; neoplasia of the small intestine; operations on the small intestine; and perforations. Each chapter includes extensive references and black-and-white photographs where appropriate; a detailed subject index concludes the volume.

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Minimally Invasive Surgery of the Foregut Source: St. Louis, MO: Quality Medical Publishing, Inc. 1994. 300 p. Contact: Available from Quality Medical Publishing, Inc. 11970 Borman Drive, Suite 222, St. Louis, MO 63146. (800) 348-7808 or, in Missouri, (314) 878-7808. Fax (314) 878-9937. PRICE: $115. ISBN: 0942219627. Summary: This medical textbook presents a comprehensive look at minimally invasive surgery of the foregut. The authors focus not only on the technical aspects of minimally invasive operative techniques, but also on diagnostic methods and patient selection. Diagnosis, evaluation, patient selection, and treatment methods are reviewed for the spectrum of foregut disorders commonly encountered in surgical practice. Specific topics include anesthetic considerations; diagnostic evaluation of foregut function; esophageal motor disorders; gastroesophageal reflux; peptic ulcer disease; foregut neoplasms; and acute foregut problems and new therapeutic approaches. The authors are experts in laparoscopy and foregut surgery. 340 figures. (AA-M).

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Principles and Practices of Surgery for the Colon, Rectum, and Anus Source: St. Louis, MO: Quality Medical Publishing, Inc. 1992. 1116 p. Contact: Available from Quality Medical Publishing, Inc. 11970 Borman Drive, Suite 222, St. Louis, MO 63146. (314) 878-7808; (800) 423-6865; FAX, (314) 878-9937. PRICE: $235 plus shipping and handling. ISBN: 068314507X. Summary: This medical textbook, designed for the practicing surgeon, covers the principles and practice of surgery for the colon, rectum, and anus. Thirty-seven chapters are presented in five sections. Part I covers anatomy and physiology and discusses the general principles of investigation and preparation of the patient for operation. Part II focuses on anorectal disorders, offering discussions of the various disease entities. Part III describes colorectal disorders and their management. Part IV groups a series of subjects related to problem solving, including the complications of diseases and their management and the complications of colorectal operations. Part V comprises a group of miscellaneous entities. Each chapter includes medical illustrations, color photographs, and numerous references. A detailed subject index concludes the volume.

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Current Therapy in Colon and Rectal Surgery Source: Philadelphia, PA: B.C. Decker, Inc. 1990. 440 p. Contact: Available from C.V. Mosby Company. 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 426-4545. PRICE: $99; plus shipping and handling (as of 1994). ISBN: 1556640439. Summary: This book, comprised of 81 papers by surgeons, provides specific information and guidelines concerning current surgical practices in the treatment of colorectal diseases. The papers cover disease processes occurring proximal to or outside the large intestine, but within the domain of the abdominal or colorectal surgeon. Medical management of certain conditions commonly encountered by surgeons, such as inflammatory bowel disease, also is covered. In certain cases, information which is not readily available is provided on complications of common specific procedures and methods of management. In some sections, such as those dealing with ulcerative colitis and rectal cancer, surgical options are discussed. The 81 papers are grouped among five general categories: anal and perianal region (anatomy and physiology of the anorectum; hemorrhoids; anal fissure and fistula; pruritus ani; Bowen's, Paget's and Hirschsprung's disease; and anal carcinoma); rectal and pararectal region (rectal stricture, prolapse, and trauma; tumors; and rectal cancer); the colon (medical and surgical alternatives for and complications of ulcerative colitis; Crohn's disease; diverticulitis of the colon; vascular ectasia; large bowel obstruction; volvulus of the colon; colorectal cancer, tumors, and polyps; and constipation); the small bowel (small bowel obstruction, short bowel syndrome, Crohn's disease, and small bowel and carcinoid tumors); and other complications (stapling techniques in rectal surgery, nutritional support, urologic complications of colorectal surgery, stoma complications, and enterostomal therapy). Selected tabular data and numerous illustrations are presented throughout the text.

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Moving Forward: Guidelines on Care and Recovery Following Ileostomy Surgery Source: Lincoln, NE: Hospital Educators Resource Catalogue, Inc. 1990. 32 p. Contact: Available from Hospital Educators Resource Catalogue, Inc. (HERC, Inc.). P.O. Box 30090, Lincoln, NE 68503. (800) 676-0321. PRICE: $4.25 plus shipping and handling. Bulk pricing available. ISBN: 0916999076.

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Summary: This booklet provides general information on the day-to-day care of an ileostomy. Designed for patients who are about to undergo or have recently had ileostomy surgery, the booklet covers topics including a definition of ileostomy, why ileostomy surgery is necessary, types of ileostomies, the role of the enterostomal (ET) nurse, preparing for surgery, dealing with emotions, post-operative care, ileostomy care, skin care, skin problems, the perineal incision, living with an ileostomy, and friends and intimacy. Simple line drawings illustrate many of the concepts presented. Detailed instructions for activities of daily living are provided. The contact information for two resource organizations is included. •

Female Pelvic Health and Reconstructive Surgery Source: New York, NY: Marcel Dekker, Inc. 2003. 503 p. Contact: Available from Marcel Dekker, Inc. 270 Madison Avenue, New York, NY 10016. (212) 696-9000. Fax (212) 685-4540. Website: www.dekker.com. PRICE: $185.00 plus shipping and handling. ISBN: 0824708229. Summary: This textbook provides comprehensive, authoritative coverage of female pelvic health and reconstructive surgery. The editors compiled contributions from many experts who specialize in the treatment of pelvic floor disorders. The text includes 27 chapters on the epidemiology and etiology of incontinence and voiding dysfunction; diagnostic evaluation of the female patient; bladder physiology and neurophysiological evaluation; diagnosis and assessment of female voiding function; radiological evaluation; urodynamic evaluation of pelvic floor dysfunction; injectable agents for the treatment of stress urinary incontinence in females; transabdominal procedures for the treatment of stress urinary incontinence; transvaginal surgery for stress urinary incontinence; laparoscopic approaches to female incontinence, voiding dysfunction, and prolapse; diagnosis and management of obstruction following anti-incontinence surgery; pediatric dysfunctional voiding in females; nonsurgical treatment of urinary incontinence; sacral nerve root neuromodulation or electrical stimulation; musculoskeletal evaluation for pelvic pain; diagnosis and management of interstitial cystitis (IC); abdominal approach to apical prolapse; the types and choice of operation for repair of vaginal prolapse; colpocleisis for the treatment of vaginal vault prolapse; technique of vaginal hysterectomy; urethral diverticulum; evaluation and management of urinary fistulas; iatrogenic urological trauma; surgical treatment of rectovaginal fistulas and complex perineal defects; pessaries; menopause and hormone replacement therapy; and diagnosis of female sexual dysfunction. Each chapter includes black and white photographs and charts and concludes with a list of references. A subject index concludes the volume.

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Glenn's Urologic Surgery. 5th ed Source: Philadelphia, PA: Lippincott Williams and Wilkins. 1998. 1149 p. Contact: Available from Lippincott Williams and Wilkins. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-3030 or (301) 714-2300. Fax (301) 824-7390. Website: lww.com. PRICE: $199.00 plus shipping and handling. ISBN: 0397587376. Summary: This massive textbook on urologic surgery offers 137 chapters on every aspect of anesthesia, antibiosis, medical techniques, diagnostics, and the fundamental considerations and technical aspects of urologic surgery. The chapters are organized into 14 sections: adrenal, kidney, ureter and pelvis, bladder, prostate, urethra, vas deferens and seminal vesicle, testes, penis and scrotum, urinary diversion, pediatric urology, endoscopy, laparoscopy, and frontiers (future developments). Some specific

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topics covered are Cushing's disease, primary aldosteronism, nephrectomy (removal of the kidney), renovascular disease, renal trauma, kidney transplantation, ureteral reconstruction, cystectomy (bladder removal), bladder augmentation, fistula, interstitial cystitis, prostatectomy (removal of the prostate), prostatic ultrasound and needle biopsy, bladder neck suspension techniques, pelvic floor relaxation, cystocele, female urethral diverticula, vaginal hysterectomy, urethral stricture, vasectomy, simple orchiectomy (removal of the testes), scrotal trauma and reconstruction, Peyronie's disease, priapism, penile prosthesis, penile trauma, urinary diversion techniques, bladder replacement, congenital anomalies, patient selection, circumcision, cystoscopy, kidney stone treatment, urinary stone treatment, stents, and thermotherapy. Each chapter includes diagrams, tables, and a list of references. A detailed subject index concludes the textbook.

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 “surgery” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “surgery” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “surgery” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •

A Guide to Canine and Feline Orthopaedic Surgery by Hamish R., Ma, Vetmb, Phd, Dsao, Frcvs Denny, et al (2000); ISBN: 0632051035; http://www.amazon.com/exec/obidos/ASIN/0632051035/icongroupinterna

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A Manual of Oral and Maxillofacial Surgery for Nurses by Colin Yates (Editor) (2000); ISBN: 0632051566; http://www.amazon.com/exec/obidos/ASIN/0632051566/icongroupinterna

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A Survivor's Guide to Open Heart Surgery by Rick Froyd, Rose Froyd (2003); ISBN: 1592860192; http://www.amazon.com/exec/obidos/ASIN/1592860192/icongroupinterna

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ACS Surgery: Principles and Practice by Douglas W. Wilmore (Editor), et al; ISBN: 0970390246; http://www.amazon.com/exec/obidos/ASIN/0970390246/icongroupinterna

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Ageless Beauty: A Dermatologist's Secrets to Looking Younger Without Surgery by Steven M.D. Victor, Ina L. Yalof (2003); ISBN: 0812932196; http://www.amazon.com/exec/obidos/ASIN/0812932196/icongroupinterna

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Alexander's Care of the Patient in Surgery by Jane C., Rn, Dnsc, Dnor, Faan Rothrock (Editor), et al; ISBN: 0323016227; http://www.amazon.com/exec/obidos/ASIN/0323016227/icongroupinterna

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All You Need to Know About Joint Surgery: Preparing for Surgery, Recovery and an Active New Lifestyle by Arthritis Foundation (Editor), John H., MD Klippel (Editor) (2002); ISBN: 0912423331; http://www.amazon.com/exec/obidos/ASIN/0912423331/icongroupinterna

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Ancient Medicine: From Sorcery to Surgery (Ancient Technology) by Michael Woods, Mary B. Woods; ISBN: 0822529920; http://www.amazon.com/exec/obidos/ASIN/0822529920/icongroupinterna

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Anesthesia and Neurosurgery by James E. Cottrell (Editor), et al; ISBN: 0815103212; http://www.amazon.com/exec/obidos/ASIN/0815103212/icongroupinterna

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Appleton & Lange Review of Surgery by Simon Wapnick (Editor), et al; ISBN: 0071378146; http://www.amazon.com/exec/obidos/ASIN/0071378146/icongroupinterna

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Art of Man: Faces of Plastic Surgery by Daniel Man MD, L. C. Faye; ISBN: 0966634519; http://www.amazon.com/exec/obidos/ASIN/0966634519/icongroupinterna

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Atlas of Head & Neck Surgery-Otolaryngology by Byron J., Md. Bailey (Editor), et al; ISBN: 0781729076; http://www.amazon.com/exec/obidos/ASIN/0781729076/icongroupinterna

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Atlas of Laparoscopic Retroperitoneal Surgery by Jay T., Md. Bishoff, et al; ISBN: 0721684513; http://www.amazon.com/exec/obidos/ASIN/0721684513/icongroupinterna

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Atlas of Operative Microneurosurgery, Volume 2 by Harry R., Md Van Loveren, et al; ISBN: 0721657303; http://www.amazon.com/exec/obidos/ASIN/0721657303/icongroupinterna

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Atlas of Pelvic Anatomy and Gynecologic Surgery by Michael S., M.D. Baggish, et al; ISBN: 0721683185; http://www.amazon.com/exec/obidos/ASIN/0721683185/icongroupinterna

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Atlas of Peripheral Nerve Surgery by David G., Md. Kline, et al (2001); ISBN: 0721695647; http://www.amazon.com/exec/obidos/ASIN/0721695647/icongroupinterna

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Atlas of Vascular Surgery: Operative Procedures by Kenneth Ouriel, et al; ISBN: 0721669948; http://www.amazon.com/exec/obidos/ASIN/0721669948/icongroupinterna

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Avian Medicine and Surgery by Robert B. Altman (Editor), et al; ISBN: 0721654460; http://www.amazon.com/exec/obidos/ASIN/0721654460/icongroupinterna

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Before and After: Living and Eating Well After Weight Loss Surgery by Susan Nuziato Leach (2004); ISBN: 0060567228; http://www.amazon.com/exec/obidos/ASIN/0060567228/icongroupinterna

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Biology, Medicine, and Surgery of South American Wild Animals by Murray E. Fowler (Editor), Zalmir S. Cubas (Editor); ISBN: 0813828465; http://www.amazon.com/exec/obidos/ASIN/0813828465/icongroupinterna

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Blueprints in Surgery (Blueprints) by James P. G. Morris, et al; ISBN: 063204487X; http://www.amazon.com/exec/obidos/ASIN/063204487X/icongroupinterna

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Blueprints Q&A Step 2: Surgery by Edward W. Nelson (Editor), Michael S. Clement (Editor) (2001); ISBN: 0632045965; http://www.amazon.com/exec/obidos/ASIN/0632045965/icongroupinterna

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Blueprints Q&A Step 3: Surgery by Edward W. Nelson (Editor), Michael S. Clement (2001); ISBN: 0632046163; http://www.amazon.com/exec/obidos/ASIN/0632046163/icongroupinterna

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BodySculpture: Plastic Surgery of the Body for Men and Women by Alan M. Engler; ISBN: 0966382749; http://www.amazon.com/exec/obidos/ASIN/0966382749/icongroupinterna

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Bypassing Bypass Surgery: Chelation Therapy: A Non-Surgical Treatment for Reversing Arteriosclersis, Improving Blocked Circulation, and Slowing the Aging Process by Elmer M. Cranton (Editor) (2001); ISBN: 1571742972; http://www.amazon.com/exec/obidos/ASIN/1571742972/icongroupinterna

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Cancer: Curing the Incurable Without Surgery, Chemotherapy, or Radiation by William Donald Kelley, Fred Rohe (Contributor); ISBN: 0970429002; http://www.amazon.com/exec/obidos/ASIN/0970429002/icongroupinterna

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Cardiac Surgery (2 Volume Set) by Nicholas Kouchoukos (Editor), et al; ISBN: 0443075263; http://www.amazon.com/exec/obidos/ASIN/0443075263/icongroupinterna

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Cardiac Surgery in the Adult by Lawrence H. Cohn (Editor), et al; ISBN: 0071391290; http://www.amazon.com/exec/obidos/ASIN/0071391290/icongroupinterna

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Cardiac Surgery: Safeguards and Pitfalls in Operative Technique by Siavosh Khonsari (2003); ISBN: 0397516266; http://www.amazon.com/exec/obidos/ASIN/0397516266/icongroupinterna

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Case Studies In Pediatric Surgery by R. Lawrence Moss, et al; ISBN: 0838515487; http://www.amazon.com/exec/obidos/ASIN/0838515487/icongroupinterna

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Change Your Looks, Change Your Life : Quick Fixes and Cosmetic Surgery Solutions for Looking Younger, Feeling Healthier, and Living Better by Michelle Copeland (Author) (2002); ISBN: 0066213738; http://www.amazon.com/exec/obidos/ASIN/0066213738/icongroupinterna

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Chassin's Operative Strategy in General Surgery by Carol Scottconner, Carol E. H. Scott-Conner; ISBN: 0387952047; http://www.amazon.com/exec/obidos/ASIN/0387952047/icongroupinterna

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Chiropractic First: The Fastest Growing Healthcare Choice Before Drugs or Surgery by Terry A. Rondberg (1996); ISBN: 0964716828; http://www.amazon.com/exec/obidos/ASIN/0964716828/icongroupinterna

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Clinical Neurology and Neurosurgery: Q & A Color Review (Q&a Specialty Reveiew) by Guy M., Ii, Md. McKhann (Editor), et al (2003); ISBN: 1588901548; http://www.amazon.com/exec/obidos/ASIN/1588901548/icongroupinterna

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Complications in Oral and Maxillofacial Surgery by Leonard B. Kaban (Editor), et al; ISBN: 0721648614; http://www.amazon.com/exec/obidos/ASIN/0721648614/icongroupinterna

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Contemporary Oral and Maxillofacial Surgery by Larry J. Peterson (Editor), et al (2002); ISBN: 0323018874; http://www.amazon.com/exec/obidos/ASIN/0323018874/icongroupinterna

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Coping With Heart Surgery and Bypassing Depression: A Family's Guide to the Medical, Emotional, and Practical Issues by Carol Cohan MA, et al (1998); ISBN: 1887841075; http://www.amazon.com/exec/obidos/ASIN/1887841075/icongroupinterna

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Cosmetic Dermatologic Surgery by Leonard M. Dzubow (Editor); ISBN: 0397517408; http://www.amazon.com/exec/obidos/ASIN/0397517408/icongroupinterna

Books 319

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Cosmetic Surgery for Teens: Choices and Consequences (Teen Issues) by Kathleen Winkler; ISBN: 0766019578; http://www.amazon.com/exec/obidos/ASIN/0766019578/icongroupinterna

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Cosmetic Surgery: Before, Between and After by Susan Gail; ISBN: 0967816807; http://www.amazon.com/exec/obidos/ASIN/0967816807/icongroupinterna

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Cosmetic Surgery: The Cutting Edge of Commercial Medicine in America by Deborah A. Sullivan (2001); ISBN: 0813528607; http://www.amazon.com/exec/obidos/ASIN/0813528607/icongroupinterna

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Cranial Base Surgery by James T. Robertson, et al; ISBN: 0443056854; http://www.amazon.com/exec/obidos/ASIN/0443056854/icongroupinterna

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Craniomaxillofacial Reconstructive & Corrective Bone Surgery by Alex M., Dds Greenberg (Editor), Joachim, Md, Dds Prein (Editor); ISBN: 0387946861; http://www.amazon.com/exec/obidos/ASIN/0387946861/icongroupinterna

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Decision Making in Vascular Surgery by Jack L. Cronenwett (Editor), Robert B. Rutherford; ISBN: 0721686842; http://www.amazon.com/exec/obidos/ASIN/0721686842/icongroupinterna

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Defining your Own Success: Breastfeeding After Breast Reduction Surgery by Diana West, Jack Newman; ISBN: 0912500867; http://www.amazon.com/exec/obidos/ASIN/0912500867/icongroupinterna

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Disease Mechanisms in Small Animal Surgery by M. Joseph Bojrab (Editor), et al (1993); ISBN: 0812114914; http://www.amazon.com/exec/obidos/ASIN/0812114914/icongroupinterna

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Dr. Dean Ornish's Program for Reversing Heart Disease: The Only System Scientifically Proven to Reverse Heart Disease Without Drugs or Surgery by Dean Ornish; ISBN: 0804110387; http://www.amazon.com/exec/obidos/ASIN/0804110387/icongroupinterna

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Dr. Scott's Knee Book : Symptoms, Diagnosis, and Treatment of Knee Problems Including Torn Cartilage, Ligament Damage, Arthritis, Tendinitis, Arthroscopic Surgery, and Total Knee Replacement by W. Norman Scott (Author) (1996); ISBN: 0684811049; http://www.amazon.com/exec/obidos/ASIN/0684811049/icongroupinterna

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Esophageal Surgery by F. Griffith Pearson (Editor), et al; ISBN: 0443076057; http://www.amazon.com/exec/obidos/ASIN/0443076057/icongroupinterna

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Essential Practice of Surgery by Jeffrey A. Norton (Editor), et al; ISBN: 0387955100; http://www.amazon.com/exec/obidos/ASIN/0387955100/icongroupinterna

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Essentials of Hand Surgery by John Gray, III Seiler (Editor), American Society for Surgery of the Hand; ISBN: 0781735858; http://www.amazon.com/exec/obidos/ASIN/0781735858/icongroupinterna

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Everything You Ever Wanted to Know About Cosmetic Surgery but Couldn't Afford to Ask: A Complete Look at the Latest Techniques and Why They Are Safer and Less Expensive by One of Today's Most Prominent Cosmetic Surgeons by Alan, Md. Gaynor (1999); ISBN: 076790172X; http://www.amazon.com/exec/obidos/ASIN/076790172X/icongroupinterna

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Everything You Need to Know About the Dangers of Cosmetic Surgery (Need to Know Library) by Magdalena Alagna; ISBN: 0823935523; http://www.amazon.com/exec/obidos/ASIN/0823935523/icongroupinterna

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Facial Plastic and Reconstructive Surgery by Ira D. Papel (Editor), et al; ISBN: 086577918X; http://www.amazon.com/exec/obidos/ASIN/086577918X/icongroupinterna

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Female Pelvic Reconstructive Surgery by Stuart L. Stanton (Editor), Philippe Zimmern (Editor); ISBN: 1852333626; http://www.amazon.com/exec/obidos/ASIN/1852333626/icongroupinterna

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Ferret Husbandry, Medicine and Surgery by John H. Lewington; ISBN: 0750642513; http://www.amazon.com/exec/obidos/ASIN/0750642513/icongroupinterna

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Ferrets, Rabbits, and Rodents: Clinical Medicine and Surgery by Elizabeth V. Hillyer (Editor), Katherine E. Quesenberry (Editor); ISBN: 0721640230; http://www.amazon.com/exec/obidos/ASIN/0721640230/icongroupinterna

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First Aid for the Surgery Clerkship (First Aid Series) by Latha Stead (Editor), et al; ISBN: 0071364226; http://www.amazon.com/exec/obidos/ASIN/0071364226/icongroupinterna

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Flesh Wounds: The Culture of Cosmetic Surgery by Virginia L. Blum (2003); ISBN: 0520217233; http://www.amazon.com/exec/obidos/ASIN/0520217233/icongroupinterna

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Fundamentals of Operative Techniques in Neurosurgery by E. Sanders Connolly (Editor), et al (2002); ISBN: 0865778361; http://www.amazon.com/exec/obidos/ASIN/0865778361/icongroupinterna

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General Surgery Board Review by Michael S. Gold (Editor), et al; ISBN: 039751851X; http://www.amazon.com/exec/obidos/ASIN/039751851X/icongroupinterna

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Getting Back on Your Feet: How to Recover Mobility and Fitness After Injury or Surgery to Your Foot, Leg, Hip, or Knee by Sally R. Pryor, Joan Thomson (Illustrator) (1991); ISBN: 0930031385; http://www.amazon.com/exec/obidos/ASIN/0930031385/icongroupinterna

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Getting Ready: Preparing for Surgery, Chemotherapy, and Other Treatments by Bernie S. Siegel (Reader); ISBN: 1561706493; http://www.amazon.com/exec/obidos/ASIN/1561706493/icongroupinterna

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Going Under: Preparing Yourself for Anesthesia: Your Guide to Pain Control and Healing Techniques - Before, During and After Surgery by Monica Winefryck Furlong, Elliot T. Essman (Contributor) (1993); ISBN: 0963645161; http://www.amazon.com/exec/obidos/ASIN/0963645161/icongroupinterna

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Grabb and Smith's Plastic Surgery (Book with CD-ROM) by Sherrell J., Md. Aston (Editor), et al; ISBN: 0316322555; http://www.amazon.com/exec/obidos/ASIN/0316322555/icongroupinterna

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Gray's Anatomy: The Anatomical Basis of Medicine & Surgery by Henry Gray, et al; ISBN: 0443045607; http://www.amazon.com/exec/obidos/ASIN/0443045607/icongroupinterna

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Green's Operative Hand Surgery (2-Volume Set) by David P. Green (Editor), et al (1999); ISBN: 0443079552; http://www.amazon.com/exec/obidos/ASIN/0443079552/icongroupinterna

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Guided Imagery for Surgery: Enlist Your Mind and Body's Innate Wisdom for Healing Before, During and After Surgery [ABRIDGED] by Judith, Ph.D. Prager; ISBN: 1588720349; http://www.amazon.com/exec/obidos/ASIN/1588720349/icongroupinterna

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Hand Surgery: A Clinical Atlas by Vincent R., Md Hentz, et al; ISBN: 0721655327; http://www.amazon.com/exec/obidos/ASIN/0721655327/icongroupinterna

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Handbook of Neurosurgery by Greenberg. S. H., Mark S. Greenberg; ISBN: 0865779090; http://www.amazon.com/exec/obidos/ASIN/0865779090/icongroupinterna

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Handbook of Patient Care in Cardiac Surgery (Spiral Manual Series) by John H. Lemmer Jr., et al (2003); ISBN: 0781729068; http://www.amazon.com/exec/obidos/ASIN/0781729068/icongroupinterna

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Handbook of Third Molar Surgery by George Dimitroulis (2001); ISBN: 0723610843; http://www.amazon.com/exec/obidos/ASIN/0723610843/icongroupinterna

•

Head and Neck Surgery and Oncology, Third Edition by Jatin P. Shah; ISBN: 0723432236; http://www.amazon.com/exec/obidos/ASIN/0723432236/icongroupinterna

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Heal Your Hips : How to Prevent Hip Surgery—and What to Do If You Need It by Robert Klapper (Author), Lynda Huey (Author); ISBN: 0471249971; http://www.amazon.com/exec/obidos/ASIN/0471249971/icongroupinterna

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Healing Hip, Joint, and Knee Pain: A Mind-Body Guide to Recovering from Surgery and Injuries by Kate S. O'Shea (1998); ISBN: 1556432585; http://www.amazon.com/exec/obidos/ASIN/1556432585/icongroupinterna

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History of Surgery in the United States, 1775-1900, Vol. II: The Periodical & Pamphlet Literature (Bibliography Ser. No. 5 & Surgery Ser. No. 4) by Ira M. Rutkow; ISBN: 093040548X; http://www.amazon.com/exec/obidos/ASIN/093040548X/icongroupinterna

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Ischemia-Reperfusion Injury in Cardiac Surgery by Friedhelm, MD Beyersdorf; ISBN: 1587060027; http://www.amazon.com/exec/obidos/ASIN/1587060027/icongroupinterna

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Key Topics in Thoracic Surgery by Alan G. Casson, Michael R. Johnston (1998); ISBN: 185996155X; http://www.amazon.com/exec/obidos/ASIN/185996155X/icongroupinterna

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King of Hearts: The True Story of the Maverick Who Pioneered Open Heart Surgery by G. Wayne Miller (2002); ISBN: 0609807242; http://www.amazon.com/exec/obidos/ASIN/0609807242/icongroupinterna

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Koko Bear's Big Earache: Preparing Your Child for Ear Tube Surgery by Vicki Lansky (2003); ISBN: 0916773264; http://www.amazon.com/exec/obidos/ASIN/0916773264/icongroupinterna

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Laparoscopic Bariatric Surgery: Techniques and Outcomes by Eric J. Demaria, et al; ISBN: 1570596778; http://www.amazon.com/exec/obidos/ASIN/1570596778/icongroupinterna

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Laparoscopic Surgery by Moises Jacobs, et al; ISBN: 0071364811; http://www.amazon.com/exec/obidos/ASIN/0071364811/icongroupinterna

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Laser Applications in Oral and Maxillofacial Surgery by Guy A. Catone (Editor), Charles C. Alling (Editor); ISBN: 0721650201; http://www.amazon.com/exec/obidos/ASIN/0721650201/icongroupinterna

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Lasers in Cutaneous and Cosmetic Surgery by Gary P. Lask, Nicholas J. Lowe; ISBN: 0443076391; http://www.amazon.com/exec/obidos/ASIN/0443076391/icongroupinterna

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Less Stress Surgery : A Guided Imagery Relaxation Tape by Neil F. Neimark; ISBN: 1893557006; http://www.amazon.com/exec/obidos/ASIN/1893557006/icongroupinterna

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Manual of Perioperative Care in Cardiac Surgery by Robert M Bojar, Robert M. Manual of Perioperative Care in Cardiac and Thoracic Bojar; ISBN: 0632043652; http://www.amazon.com/exec/obidos/ASIN/0632043652/icongroupinterna

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Massachusetts General Hospital Manual of Oral and Maxillofacial Surgery by R. Bruce Donoff (Editor), et al; ISBN: 0815127553; http://www.amazon.com/exec/obidos/ASIN/0815127553/icongroupinterna

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Master Dentistry-Oral and Maxillofacial Surgery, Radiology, Pathology and Oral Medicine by Paul Coulthard, et al; ISBN: 0443061920; http://www.amazon.com/exec/obidos/ASIN/0443061920/icongroupinterna

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Master Techniques in Orthopaedic Surgery: The Elbow by Bernard F. Morrey (Editor), et al; ISBN: 0781719917; http://www.amazon.com/exec/obidos/ASIN/0781719917/icongroupinterna

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Master Techniques in Orthopaedic Surgery: The Foot and Ankle by Harold B. Kitaoka (Editor), Deborah Ravin (Illustrator); ISBN: 0781733634; http://www.amazon.com/exec/obidos/ASIN/0781733634/icongroupinterna

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McGlamry's Comprehensive Textbook of Foot and Ankle Surgery (2-Volume Set) by Alan S. Banks (Editor), et al; ISBN: 0683304712; http://www.amazon.com/exec/obidos/ASIN/0683304712/icongroupinterna

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Medicine and Surgery of South American Camelids: Llama, Alpaca, Vicuna, Guanaco by Murray E. Fowler; ISBN: 0813803977; http://www.amazon.com/exec/obidos/ASIN/0813803977/icongroupinterna

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Mortal Lessons: Notes on the Art of Surgery by Richard Selzer (1996); ISBN: 0156004003; http://www.amazon.com/exec/obidos/ASIN/0156004003/icongroupinterna

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Mosby's Review for the Clinical Competency Test: Large Animal Medicine & Surgery by Corrine R. Sweeney, Corinne R. Sweeney (1997); ISBN: 0815144431; http://www.amazon.com/exec/obidos/ASIN/0815144431/icongroupinterna

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Mosby's Review Questions & Answers for Veterinary Boards: Large Animal Medicine and Surgery (2nd Ed) by Paul W., Vmd. Pratt (Editor), James Pratt (1998); ISBN: 0815174667; http://www.amazon.com/exec/obidos/ASIN/0815174667/icongroupinterna

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Mosby's Review Questions & Answers for Veterinary Boards: Small Animal Medicine and Surgery (2nd Ed) by Paul W., Vmd. Pratt (Editor) (1998); ISBN: 0815174659; http://www.amazon.com/exec/obidos/ASIN/0815174659/icongroupinterna

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Musculoskeletal Cancer Surgery: Treatment of Sarcomas and Allied Diseases by Martin Malawer (Editor), Paul H. Sugarbaker (Editor) (2001); ISBN: 0792363949; http://www.amazon.com/exec/obidos/ASIN/0792363949/icongroupinterna

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Nasal and Sinus Surgery by Steven C. Marks, et al (2000); ISBN: 0721678041; http://www.amazon.com/exec/obidos/ASIN/0721678041/icongroupinterna

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Neurology and Neurosurgery Illustrated by Kenneth W. Lindsay, Ian Bone; ISBN: 0443050619; http://www.amazon.com/exec/obidos/ASIN/0443050619/icongroupinterna

Books 323

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Neurophysiology in Neurosurgery: A Modern Intraoperative Approach by Vedran Deletis (Editor), Jay L. Shils (Editor); ISBN: 0122090365; http://www.amazon.com/exec/obidos/ASIN/0122090365/icongroupinterna

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NMS Surgery (Book with CD-ROM 1.0 for Windows) by Bruce E. Jarrell (Editor), et al; ISBN: 0683306154; http://www.amazon.com/exec/obidos/ASIN/0683306154/icongroupinterna

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Oculoplastic Surgery: The Requisites in Ophthalmology (Requisites in Ophthalmology Series) by Jeffrey A., Md Nerad, et al; ISBN: 0323001742; http://www.amazon.com/exec/obidos/ASIN/0323001742/icongroupinterna

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On Call Surgery by Gregg A. Adams, Stephen D. Bresnick; ISBN: 0721693512; http://www.amazon.com/exec/obidos/ASIN/0721693512/icongroupinterna

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Operative Plastic Surgery by Gregory R. Evans (Editor); ISBN: 0838576761; http://www.amazon.com/exec/obidos/ASIN/0838576761/icongroupinterna

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Operative Surgery by Vijay P. Khatri, et al (2003); ISBN: 0721678645; http://www.amazon.com/exec/obidos/ASIN/0721678645/icongroupinterna

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Ophthalmic Surgery: Principles and Practice by George L. Spaeth (Editor), Birck Cox (Illustrator) (2003); ISBN: 0721669727; http://www.amazon.com/exec/obidos/ASIN/0721669727/icongroupinterna

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Oral and Maxillofacial Surgery Secrets (The Secrets Series) by A. Omar Abubaker (Editor), et al; ISBN: 156053401X; http://www.amazon.com/exec/obidos/ASIN/156053401X/icongroupinterna

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Oral and Maxillofacial Surgery: An Objective-Based Textbook by Jonathan Pedlar (Editor), et al (2003); ISBN: 0443060177; http://www.amazon.com/exec/obidos/ASIN/0443060177/icongroupinterna

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Otolaryngology - Head & Neck Surgery: Clinical Reference Guide by R. Pasha; ISBN: 0769300537; http://www.amazon.com/exec/obidos/ASIN/0769300537/icongroupinterna

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Otolaryngology: Head & Neck Surgery (5 Volume Set) by Charles W. Cummings, et al (1998); ISBN: 0815120672; http://www.amazon.com/exec/obidos/ASIN/0815120672/icongroupinterna

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Oxford Handbook of Clinical Surgery by S. Parameswaran, et al; ISBN: 0192617109; http://www.amazon.com/exec/obidos/ASIN/0192617109/icongroupinterna

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Pain Free for Life: How to Heal Yourself Naturally Without Drugs or Surgery by Darrell J. Stoddard (2003); ISBN: 1887089462; http://www.amazon.com/exec/obidos/ASIN/1887089462/icongroupinterna

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Parkinson's Disease : The Way Forward! An Integrated Approach including Drugs, Surgery, Nutrition, Bowel and Muscle Function, Self-Esteem, Sexuality, Stress Control and Carers by Geoffrey Leader, et al (2003); ISBN: 0952605686; http://www.amazon.com/exec/obidos/ASIN/0952605686/icongroupinterna

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Pediatric Neurosurgery: Surgery of the Developing Nervous System by David G. McLone, et al; ISBN: 072168209X; http://www.amazon.com/exec/obidos/ASIN/072168209X/icongroupinterna

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Pediatric Plastic Surgery by Michael L. Bentz (Editor); ISBN: 0838578209; http://www.amazon.com/exec/obidos/ASIN/0838578209/icongroupinterna

324 Surgery

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Pediatric Surgery by Keith W. Ashcraft (Editor), et al; ISBN: 0721673120; http://www.amazon.com/exec/obidos/ASIN/0721673120/icongroupinterna

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Phat Finish: Weight Loss Surgery by Melissa Anne Hathaway (2003); ISBN: 1579215890; http://www.amazon.com/exec/obidos/ASIN/1579215890/icongroupinterna

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Plastic Surgery : What You Need To Know - Before, During, and After by Richard A. Marfuggi; ISBN: 039952374X; http://www.amazon.com/exec/obidos/ASIN/039952374X/icongroupinterna

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Plastic Surgery: Indications, Operations, and Outcomes (5-Volume Set) by Bruce M. Achauer (Editor), et al; ISBN: 0815109849; http://www.amazon.com/exec/obidos/ASIN/0815109849/icongroupinterna

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Pocket Companion to Sabiston Textbook of Surgery by Courtney M. Townsend (Editor), David C. Sabiston (Editor); ISBN: 0721692796; http://www.amazon.com/exec/obidos/ASIN/0721692796/icongroupinterna

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Prepare for Surgery, Heal Faster: A Guide of Mind-Body Techniques by Peggy Huddleston, Christiane Northrup; ISBN: 0964575744; http://www.amazon.com/exec/obidos/ASIN/0964575744/icongroupinterna

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Principles of Surgery by Seymour I. Schwartz (Editor), et al; ISBN: 007912318X; http://www.amazon.com/exec/obidos/ASIN/007912318X/icongroupinterna

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Principles of Surgery Self-Assessment and Review by Seymour I. Schwartz (Editor); ISBN: 0070579644; http://www.amazon.com/exec/obidos/ASIN/0070579644/icongroupinterna

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Principles of Surgery, Companion Handbook by Seymour I. Schwartz (Editor), et al; ISBN: 0070580855; http://www.amazon.com/exec/obidos/ASIN/0070580855/icongroupinterna

•

Pterygium Surgery by Lucio Buratto, et al; ISBN: 1556424922; http://www.amazon.com/exec/obidos/ASIN/1556424922/icongroupinterna

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Reconstructive Aesthetic Implant Surgery by Abd El Salam El Askary (2003); ISBN: 0813821088; http://www.amazon.com/exec/obidos/ASIN/0813821088/icongroupinterna

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Reconstructive Surgery: Principles, Anatomy, and Technique (Two-Volume Set) by Foad Nahai, Stephen J. Mathes; ISBN: 0443079811; http://www.amazon.com/exec/obidos/ASIN/0443079811/icongroupinterna

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Recovering from Breast Surgery: Exercises to Strengthen Your Body and Relieve Pain by Diana Stumm (1995); ISBN: 0897931807; http://www.amazon.com/exec/obidos/ASIN/0897931807/icongroupinterna

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Reoperative Colon and Rectal Surgery by Walter Longo, et al (2003); ISBN: 1841841838; http://www.amazon.com/exec/obidos/ASIN/1841841838/icongroupinterna

•

Reptile Medicine and Surgery by Douglas R. Mader (Editor), Geoff Stein (Illustrator); ISBN: 0721652085; http://www.amazon.com/exec/obidos/ASIN/0721652085/icongroupinterna

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Reshaping the Female Body: The Dilemma of Cosmetic Surgery by Kathy Davis (1995); ISBN: 0415906326; http://www.amazon.com/exec/obidos/ASIN/0415906326/icongroupinterna

Books 325

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Reversing Heart Disease: A Vital New Program to Help Prevent, Treat, and Eliminate Cardiac Problems Without Surgery by Julian, MD Whitaker (2002); ISBN: 0446676578; http://www.amazon.com/exec/obidos/ASIN/0446676578/icongroupinterna

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Review for Surgery: Scientific Principles and Practice by Lazar J. Greenfield (Editor), et al; ISBN: 0781731895; http://www.amazon.com/exec/obidos/ASIN/0781731895/icongroupinterna

•

Rush University Review of Surgery by Daniel J. Deziel (Editor), et al; ISBN: 0721675816; http://www.amazon.com/exec/obidos/ASIN/0721675816/icongroupinterna

•

Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice by Courtney M. Townsend (Editor), et al; ISBN: 0721682693; http://www.amazon.com/exec/obidos/ASIN/0721682693/icongroupinterna

•

Secrets of a Beverly Hills Cosmetic Surgeon: The Expert's Guide to Safe, Successful Surgery by Robert, Md. Kotler, Robert Kotler; ISBN: 0971226202; http://www.amazon.com/exec/obidos/ASIN/0971226202/icongroupinterna

•

Simplifying Phacoemulsification: Safe and Efficient Methods for Cataract Surgery by Paul S. Koch; ISBN: 1556423527; http://www.amazon.com/exec/obidos/ASIN/1556423527/icongroupinterna

•

Small Animal Surgery by Theresa Welch Fossum, et al; ISBN: 0323012388; http://www.amazon.com/exec/obidos/ASIN/0323012388/icongroupinterna

•

Small Animal Surgery (The National Veterinary Medical Series for Independent Study) by Joseph Harari (Editor) (1996); ISBN: 0683039105; http://www.amazon.com/exec/obidos/ASIN/0683039105/icongroupinterna

•

Smith's Ophthalmic Plastic and Reconstructive Surgery by Frank A. Nesi, et al; ISBN: 0815163568; http://www.amazon.com/exec/obidos/ASIN/0815163568/icongroupinterna

•

So You're Having Heart Bypass Surgery by Tracey J. Colella (Author), et al (2003); ISBN: 0470833467; http://www.amazon.com/exec/obidos/ASIN/0470833467/icongroupinterna

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Spinal Surgery Written Simply by a Spinal Surgeon by Kenneth L. Jarolem (2002); ISBN: 1587361388; http://www.amazon.com/exec/obidos/ASIN/1587361388/icongroupinterna

•

Spine Surgery: A Practical Atlas by F. Todd Wetzel, Edward N. Hanley; ISBN: 0838586171; http://www.amazon.com/exec/obidos/ASIN/0838586171/icongroupinterna

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Stedman's Plastic Surgery/Ent/Dentistry Words (Stedman's Word Books) by Thomas Lathrop Stedman (Editor) (1999); ISBN: 0683404601; http://www.amazon.com/exec/obidos/ASIN/0683404601/icongroupinterna

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Stedman's Surgery Words: Includes Anatomy, Anesthesia & Pain Management by Thomas Lathrop Stedman (Editor), et al; ISBN: 0781738318; http://www.amazon.com/exec/obidos/ASIN/0781738318/icongroupinterna

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Stereotaxic Surgery In The Rat: A Photographic Series by Richard K. Cooley, C.H. Vanderwolf; ISBN: 0920700004; http://www.amazon.com/exec/obidos/ASIN/0920700004/icongroupinterna

326 Surgery

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Surgery and Its Alternatives: How to Make the Right Choices for Your Health by Sandra A., Md. McLanahan, et al (2003); ISBN: 1575667398; http://www.amazon.com/exec/obidos/ASIN/1575667398/icongroupinterna

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Surgery and Trauma (Platinum Vignettes Series: Ultra High Yield Clinical Case Scenarios for USMLE Step 2) by Adam, MD Brochert, A Hanley & Belfus Publication (2002); ISBN: 1560535350; http://www.amazon.com/exec/obidos/ASIN/1560535350/icongroupinterna

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Surgery at a Glance (At a Glance Series) by Neil R. Borley, Pierce A. Grace (2002); ISBN: 0632059885; http://www.amazon.com/exec/obidos/ASIN/0632059885/icongroupinterna

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Surgery on Call by Leonard G. Gomella MD (Editor), Alan T. Lefor MD (Editor); ISBN: 0838588174; http://www.amazon.com/exec/obidos/ASIN/0838588174/icongroupinterna

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Surgery, Anesthesia and Experimental Techniques in Swine by M. Michael Swindle; ISBN: 081381829X; http://www.amazon.com/exec/obidos/ASIN/081381829X/icongroupinterna

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Surgery: Basic Science and Clinical Evidence (Book with CD-ROM) by Jeffrey A. Norton (Editor), et al (2000); ISBN: 038798447X; http://www.amazon.com/exec/obidos/ASIN/038798447X/icongroupinterna

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Surgery: PreTest Self-Assessment and Review by Peter L. Geller (Editor), Pretest; ISBN: 0071359540; http://www.amazon.com/exec/obidos/ASIN/0071359540/icongroupinterna

•

Surgery: Scientific Principles and Practice (Free CD-ROM with Return of Enclosed Card) by Lazar J., Md. Greenfield (Editor), et al; ISBN: 0781722543; http://www.amazon.com/exec/obidos/ASIN/0781722543/icongroupinterna

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Surgical Directives: Pediatric Surgery by Peter Mattei (Editor), Helen Streubert Speziale; ISBN: 0781730007; http://www.amazon.com/exec/obidos/ASIN/0781730007/icongroupinterna

•

Surveys on Surgery Theory: Papers, Dedicated to C.T.C. Wall (Annals of Mathematics Studies, 149) by Sylvain Cappell (Editor), et al; ISBN: 0691088152; http://www.amazon.com/exec/obidos/ASIN/0691088152/icongroupinterna

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Techniques in Dermatologic Surgery by Keyvan Nouri (Editor), et al; ISBN: 0323018564; http://www.amazon.com/exec/obidos/ASIN/0323018564/icongroupinterna

•

Textbook of Bunion Surgery by Joshuat Gerbert (Editor), et al; ISBN: 0721677843; http://www.amazon.com/exec/obidos/ASIN/0721677843/icongroupinterna

•

Textbook of Small Animal Surgery, Two Volume Set by Douglas H. Slatter (Editor) (2002); ISBN: 0721686079; http://www.amazon.com/exec/obidos/ASIN/0721686079/icongroupinterna

•

The Chiropractic Way: How Chiropractic Care Can Stop Your Pain and Help You Regain Your Health Without Drugs or Surgery by Michael Lenarz, et al (2003); ISBN: 0553381598; http://www.amazon.com/exec/obidos/ASIN/0553381598/icongroupinterna

•

The Columbia Presbyterian Guide to Surgery: A Step-By-Step Guide to What You Can Expect Before, During, and After Forty-Five of the Most Common Surgical

Books 327

Procedures by Eric A. Rose (2001); ISBN: 0312270925; http://www.amazon.com/exec/obidos/ASIN/0312270925/icongroupinterna •

The Complete Book of Laser Eye Surgery by Stephen G., Md Slade, et al; ISBN: 0553584227; http://www.amazon.com/exec/obidos/ASIN/0553584227/icongroupinterna

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The Complete Guide to Symptoms, Illness, and Surgery (Complete Guide to Symptoms, Illness and Surgery, Ed 4) by H. Winter, Md. Griffith, et al (2000); ISBN: 0399526099; http://www.amazon.com/exec/obidos/ASIN/0399526099/icongroupinterna

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The Complete Idiot's Guide to Cosmetic Surgery by Jeff, Ph.D. St.John, et al; ISBN: 0028639936; http://www.amazon.com/exec/obidos/ASIN/0028639936/icongroupinterna

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The Doctor's Guide to Weight Loss Surgery: How to Make the Decision That Could Save Your Life by Erica Manfred, et al (2003); ISBN: 0553382462; http://www.amazon.com/exec/obidos/ASIN/0553382462/icongroupinterna

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The Evolution of Cardiac Surgery by Harris B. Shumacker (1992); ISBN: 0253352215; http://www.amazon.com/exec/obidos/ASIN/0253352215/icongroupinterna

•

The Face Book: The Consumer's Guide to Facial Plastic Surgery by American Academy of Facial Plastic & Rec, T. Susan Hill (Editor) (1997); ISBN: 0965123111; http://www.amazon.com/exec/obidos/ASIN/0965123111/icongroupinterna

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The Healing Blade: A Tale of Neurosurgery by Edward J. Sylvester; ISBN: 0671760548; http://www.amazon.com/exec/obidos/ASIN/0671760548/icongroupinterna

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The Patient's Guide to Weight Loss Surgery: Everything You Need To Know About Gastric Bypass and Bariatric Surgery by April Hochstrasser, S. Ross Fox (2004); ISBN: 1578261651; http://www.amazon.com/exec/obidos/ASIN/1578261651/icongroupinterna

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The Physiologic Basis of Surgery by J. Patrick O'Leary (Editor), et al; ISBN: 0781738393; http://www.amazon.com/exec/obidos/ASIN/0781738393/icongroupinterna

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The Psychology of Spine Surgery by Andrew R. Block (Editor), et al (2003); ISBN: 1557989974; http://www.amazon.com/exec/obidos/ASIN/1557989974/icongroupinterna

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The Smart Woman's Guide to Plastic Surgery : Essential Information from a Female Plastic Surgeon by Jean M. Loftus MD; ISBN: 0809225832; http://www.amazon.com/exec/obidos/ASIN/0809225832/icongroupinterna

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The Surgery Book: An Illustrated Guide to 73 of the Most Common Operations by Robert Youngson, Diagram Group (Contributor) (1997); ISBN: 0312152183; http://www.amazon.com/exec/obidos/ASIN/0312152183/icongroupinterna

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The Washington Manual of Surgery by Gerard Md. Doherty (Editor), et al; ISBN: 0781733898; http://www.amazon.com/exec/obidos/ASIN/0781733898/icongroupinterna

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The Washington Manual Surgery Survival Guide (Washington Manual Survival Guide Series) by Washington University School of Medicine Department of Medicine, et al (2003); ISBN: 0781743680; http://www.amazon.com/exec/obidos/ASIN/0781743680/icongroupinterna

328 Surgery

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This Ain't Brain Surgery : How to Win the Pennant Without Losing Your Mind by Larry Dierker (Author); ISBN: 074320400X; http://www.amazon.com/exec/obidos/ASIN/074320400X/icongroupinterna

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This is NOT Brain Surgery.But There IS a Magic Pill! by Teri Kai Holtzclaw; ISBN: 0971260133; http://www.amazon.com/exec/obidos/ASIN/0971260133/icongroupinterna

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Thoracic Surgery by F. Griffith Pearson (Editor), et al (2002); ISBN: 0443075956; http://www.amazon.com/exec/obidos/ASIN/0443075956/icongroupinterna

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Thoracic Surgery Secrets (The Secrets Series) by Tomas A., MD Salerno, et al (2001); ISBN: 1560533730; http://www.amazon.com/exec/obidos/ASIN/1560533730/icongroupinterna

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Tiny Bites: A Guide to Gastric Surgery for the Morbidly Obese by Saundra Beauchamp-Parke; ISBN: 184310704X; http://www.amazon.com/exec/obidos/ASIN/184310704X/icongroupinterna

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Transplantation Surgery by David K. James (Editor), et al; ISBN: 070202547X; http://www.amazon.com/exec/obidos/ASIN/070202547X/icongroupinterna

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Treat Your Back Without Surgery: The Best Nonsurgical Alternatives for Eliminating Back and Neck Pain by Stephen, Md Hochschuler, et al; ISBN: 0897933729; http://www.amazon.com/exec/obidos/ASIN/0897933729/icongroupinterna

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Two Girlfriends Get Real About Cosmetic Surgery by Susan J. Collini, et al (2000); ISBN: 1580631274; http://www.amazon.com/exec/obidos/ASIN/1580631274/icongroupinterna

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Underground Clinical Vignettes Set of 9 (Internal Medicine Vol. 1, Internal Medicine Vol. 2, Ob/Gyn, Surgery, Pediatrics, Psychiatry, Neurology, Emergency Medicine and Color Atlas) by Vikas Bhushan, et al (2002); ISBN: 0632045779; http://www.amazon.com/exec/obidos/ASIN/0632045779/icongroupinterna

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Vascular Surgery (2-Volume Set) by Robert B. Rutherford (Editor); ISBN: 072168078X; http://www.amazon.com/exec/obidos/ASIN/072168078X/icongroupinterna

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Venus Envy: A History of Cosmetic Surgery by Elizabeth Haiken (2000); ISBN: 080186254X; http://www.amazon.com/exec/obidos/ASIN/080186254X/icongroupinterna

•

War Hospital: A True Story of Surgery and Survival by Sheri Fink (2003); ISBN: 1586481134; http://www.amazon.com/exec/obidos/ASIN/1586481134/icongroupinterna

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Warm Heart Surgery by Tomas A. Salerno (Editor) (1995); ISBN: 0340610239; http://www.amazon.com/exec/obidos/ASIN/0340610239/icongroupinterna

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Weight Loss Surgery : Understanding & Overcoming Morbid Obesity - Life Before, During & After Surgery by Michelle Boasten; ISBN: 1931033013; http://www.amazon.com/exec/obidos/ASIN/1931033013/icongroupinterna

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Weight Loss Surgery: Finding the Thin Person Hiding Inside You, Third Edition by Barbara Thompson; ISBN: 1932205306; http://www.amazon.com/exec/obidos/ASIN/1932205306/icongroupinterna

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Welcome to Your Facelift: What to Expect Before, During, and After Cosmetic Surgery by Helen Bransford; ISBN: 0385485492; http://www.amazon.com/exec/obidos/ASIN/0385485492/icongroupinterna

Books 329

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What Your Doctor May Not Tell You About Circumcision: Untold Facts on America's Most Widely Performed-and Most Unnecessary Surgery by Paul M. Fleiss, Frederick M. Hodges (2002); ISBN: 0446678805; http://www.amazon.com/exec/obidos/ASIN/0446678805/icongroupinterna

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What Your Doctor May Not Tell You About Knee Pain and Surgery : Learn The Truth About MRIs And Common Misdiagnoses--And Avoid Unnecessary Surgery by Ronald P. Grelsamer M.D. (2002); ISBN: 0446678198; http://www.amazon.com/exec/obidos/ASIN/0446678198/icongroupinterna

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You Don't Need a Hysterectomy: New and Effective Ways of Avoiding Surgery by Ivan K. Strausz; ISBN: 0201608278; http://www.amazon.com/exec/obidos/ASIN/0201608278/icongroupinterna

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You Don't Need Plastic Surgery: The Doctor's Guide to Youthful Looks With No Surgery, No Pain, No Downtime by Everett M. Lautin, et al (2003); ISBN: 1590770005; http://www.amazon.com/exec/obidos/ASIN/1590770005/icongroupinterna

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Your Best Face: Looking Your Best Without Plastic Surgery by Brandith Irwin, Mark, Phd McPherson (2002); ISBN: 1561709530; http://www.amazon.com/exec/obidos/ASIN/1561709530/icongroupinterna

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

1988 clinical indicators for otolaryngic-head & neck surgery. Author: American Academy of Otolaryngology--Head and Neck Surgery Foundation.; Year: 1859; [Alexandria, Va.?]: American Academy of Otolaryngology-Head and Neck

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Advances in epilepsy surgery and radiosurgery Author: Sutter, B. (Bernhard); Year: 1850; Wien; New York: Springer, c2002; ISBN: 3211838376 http://www.amazon.com/exec/obidos/ASIN/3211838376/icongroupinterna

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Cardiac surgery: safeguards and pitfalls in operative technique Author: Khonsari, Siavosh.; Year: 1988; Philadelphia: Lippincott Williams; Wilkins, c2003; ISBN: 0781735408 http://www.amazon.com/exec/obidos/ASIN/0781735408/icongroupinterna

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Color atlas of microneurosurgery of acoustic neurinomas: endoscope-asisted techniques, neuronavigational techniques, radiosurgery Author: Koos, Wolfgang Th.; Year: 2001; Stuttgart; New York: Thieme, c2002; ISBN: 3131276614

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

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http://www.amazon.com/exec/obidos/ASIN/3131276614/icongroupinterna •

Complications in ophthalmic plastic surgery Author: Brazzo, Brian G.; Year: 1862; New York: Springer, c2003; ISBN: 0387002839 http://www.amazon.com/exec/obidos/ASIN/0387002839/icongroupinterna

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Endoscopic endonasal transsphenoidal surgery Author: De Divitiis, Enrico.; Year: 2003; Wien; New York: Springer, c2003; ISBN: 3211009728 http://www.amazon.com/exec/obidos/ASIN/3211009728/icongroupinterna

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Endoscopic surgery in ophthalmology Author: Uram, Martin.; Year: 2000; Philadelphia: Lippincott Williams; Wilkins, c2003; ISBN: 078173651X http://www.amazon.com/exec/obidos/ASIN/078173651X/icongroupinterna

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Introductory for 1844-5: on the present position of some of the most important of the modern operations of surgery Author: Mütter, Thomas D. (Thomas Dent),; Year: 1617; Philadelphia: Merrihew; Thompson, Printers., 1844

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Middle ear and mastoid microsurgery Author: Sanna, M.; Year: 2003; Stuttgart; New York: Thieme, c2003; ISBN: 3131320915

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Principles and practice of spine surgery Author: Vaccaro, Alexander R.; Year: 1844; St. Louis: Mosby, c2003; ISBN: 0323010776 http://www.amazon.com/exec/obidos/ASIN/0323010776/icongroupinterna

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Strabismus surgery: basic and advanced strategies Author: Plager, David A.; Year: 2002; New York: Oxford University Press in cooperation with the American Academy of Opthalmology, 2004; ISBN: 0195170237 http://www.amazon.com/exec/obidos/ASIN/0195170237/icongroupinterna

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Surgery; a concise guide to clinical practice, by 49 authors. Edited by George L. Nardi [and] George D. Zuidema. Author: Nardi, George L. (George Lionel),; Year: 1972; Boston, Little, Brown [c1972]; ISBN: 031659800

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The unfavorable result in plastic surgery; avoidance and treatment. Author: Goldwyn, Robert M.; Year: 1972; Boston, Little, Brown [c1972]; ISBN: 031631970

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

Surgery of Rheumatic Disease in Adults Source: in Maddison, P.J. et al., Eds. Oxford Textbook of Rheumatology. Volume 2. New York, NY: Oxford University Press, Inc. 1993. p. 1099-1115. Contact: Available from Oxford University Press, Inc., New York, NY. Summary: This chapter for health professionals describes the surgical procedures performed on patients with arthritis. These techniques include arthroscopy and arthroscopic debridement, osteotomy, and hemiarthroplasty. The indications for total

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joint replacement in the rheumatoid patient are identified. Nonsurgical management of painful joints is considered. Conditions that may occur in the inflammatory arthropathies that may require surgery are described. Preoperative, medical, anesthetic, and surgical considerations that surgeons must address with regard to patients with rheumatoid arthritis are highlighted. The outcome of total replacement and revision surgery for the hip and the knee is discussed, and complications that may occur following replacement and revision surgery are identified. Data on the outcome of total replacement of the shoulder, the elbow, and the ankle are provided. Radiographic evaluation of arthroplasty is described. Complications of total joint replacement are discussed, including infection, wound healing, wear, and heterotopic bone formation. In addition, the natural history, assessment, and surgical treatment of the rheumatoid cervical spine are examined. 91 references and 15 figures. •

Role of Surgery in the Management of Rheumatic Diseases in Children Source: in Maddison, P.J. et al., Eds. Oxford Textbook of Rheumatology. Volume 2. New York, NY: Oxford University Press, Inc. 1993. p. 1115-1123. Contact: Available from Oxford University Press, Inc., New York, NY. Summary: This chapter for health professionals examines surgical management of rheumatic diseases in children. Principles that apply to the surgical management of juvenile chronic arthritis are presented. The terms contraction, contracture, and spasm are defined. Causes of deformity of the hip and the knee are identified, and surgical management of these deformities is explained. Indications for surgical management of forefoot, hindfoot, and ankle problems are considered. Surgical techniques that may be beneficial in treating problems of the shoulder, the elbow, the hand, and the wrist are identified. Indications for surgical management of cervical spinal problems occurring in children with rheumatic disease are also highlighted. 22 references and 6 figures.

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Complications of Cochlear Implant Surgery Source: in Waltzman, S.B. and Cohen, N.L., eds. Cochlear Implants. New York, NY: Thieme. 2000. p. 171-184. Contact: Available from Thieme. 333 Seventh Avenue, New York, NY 10001. (800) 7823488. Fax (212) 947-0108. E-mail: [email protected]. PRICE: $89.00 plus shipping and handling. ISBN: 0865778825. Summary: This chapter on complications of cochlear implant surgery is from a book that incorporates original chapters on relevant topics with related papers. The papers were presented at the Fifth International Cochlear Implant Conference held in New York, in May, 1997. The book provides professionals involved in the field of cochlear implants with a comprehensive reference text. All aspects of implantation are covered including the effects of electrical stimulation, processing capabilities, preoperative criteria, medical, surgical and radiological issues, results and postoperative programming, rehabilitation, and education. In this chapter, the author outlines complications related to cochlear implantation and provides suggestions for prevention of these complications. Surgical and medical complications discussed include scalp flap, otitis media (ear infection) and meningitis (brain infection), facial nerve paralysis, tinnitus (ringing in the ears), vertigo, and device migration. Device related complications covered include device failure and facial nerve stimulation. Accompanying the chapter are five articles covering: surgical complications and equipment failures of the University of Navarra cochlear implant program; insertional trauma with different types of electrodes in Combi 40 cochlear implantation; reimplantation of Ineraid cochlear

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implants; the practical and ethical considerations of facial nerve monitoring during cochlear implant surgery; and nonauditory stimulation in cochlear implant patients. 1 figure. 5 tables. 36 references. •

Surgery Source: in Hayback, P.J. BPPV: What You Need to Know. Portland, OR: Vestibular Disorders Association. 2000. p. 79-92. Contact: Available from Vestibular Disorders Association. P.O. Box 4467, Portland, OR 97208-4467. (800) 837-8428. E-mail: [email protected]. Website: www.vestibular.org. PRICE: $34.95 plus shipping and handling. ISBN: 0963261142. Summary: Benign paroxysmal positional vertigo (BPPV) is an inner ear balance disorder characterized by sudden brief bouts of intense vertigo (a sensation of spinning dizziness) and nystagmus (rapid eyeball movements) induced by specific head movements. This chapter on surgery for BPPV is from a book that was written for people who have or suspect they have BPPV and who want to know more about its nature, causes, diagnosis, and treatments as well as strategies for coping with its effects. The author explains that the majority of people with BPPV will never have inner ear surgery; they will either improve on their own or while undergoing one medical (non surgical) treatment or another. Physicians look at a number of different factors to determine if surgery would be an appropriate treatment option; factors can be divided into three groups: patient, physician, and general. The chapter lists suggested questions for patients to ask their doctors, and offers strategies to help in the decision making process about surgery. The author then describes the types of surgeries that may be performed, including posterior semicircular canal occlusion, singular neurectomy (nerve section), and utricular macular ablation. For each type, the author describes the procedure, postoperative recovery, success rates, possible reasons for failure, and potential complications. The book is published by the Vestibular Disorders Association (VEDA), a nonprofit organization that provides information and support to people with inner ear disorders. 1 figure. 21 references.

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Vocal Fold and Laryngeal Surgery Source: in Thurman, L. and Welch, G., eds. Bodymind and Voice: Foundations of Voice Education, Volumes 1-3. 2nd ed. Collegeville, MN: VoiceCare Network. 2000. p. 620-631. Contact: Available from National Center for Voice and Speech (NCVS). Book Sales, 334 Speech and Hearing Center, University of Iowa, Iowa City, IA 52242. Website: www.ncvs.org. PRICE: $75.00 plus shipping and handling. ISBN: 0874141230. Summary: Microsurgery on the vocal folds sometimes becomes the only option available to restore or optimize the sound quality or capabilities of a person's voice. This chapter on vocal fold and laryngeal surgery is from a multi-volume text that brings a biopsychosocial approach to the study of the voice. The authors use the phrase 'bodyminds' to describe the interrelationship of perception, memory, learning, behavior, and health, as they combine to affect all environmental interactions, adaptations, and learning. The books are written for teachers, voice professionals, people who use their voices on an avocational basis, and interested members of the general public. This chapter uses the term phonosurgery for voice restorative surgery. The most common mucosal disorders for which such surgery may be appropriate are polyps, cysts, capillary ectasia, and nodules that have been treated therapeutically for a considerable time, with complete patient cooperation, and they have not resolved. Treatment for these disorders is discussed in the first section; other kinds of phonosurgery, including

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vocal fold injections and laryngeal framework surgery, are discussed in the latter section. The chapter is written primarily in question and answer format, with the goal of answering common questions that readers may have about vocal fold surgery. The author concludes that it is important to maintain a positive outlook on how the voice will be healthier and more capable after healing and reconditioning. 29 references. •

Cochlear Implant Surgery: What Parents Need to Know Source: in Estabrooks, W., ed. Cochlear Implants for Kids. Washington, DC: Alexander Graham Bell Association for the Deaf. 1998. p. 47-57. Contact: Available from Alexander Graham Bell Association for the Deaf. 3417 Volta Place, NW, Washington, DC 20007-2778. (202) 337-5220. PRICE: $42.95 plus shipping and handling. ISBN: 0882002082. Summary: This chapter discusses the information that parents need to know about cochlear implant surgery in young children. The chapter is from a book that brings together experts from the fields of education, medicine, and related disciplines to provide an overview of cochlear implants for the pediatric population. The author stresses that the actual surgery occupies but a small percentage of the total time taken up by the testing, evaluation, stimulation, programming, and rehabilitation of the child, yet the surgical period is a time of anxiety, great tension, and potential risk. If the surgery is not correctly performed, the child may suffer complications or the implant may not function properly. Topics include preparing for the surgery, going to the hospital, how the operation is performed (the surgical techniques used), the risks of the surgery, the postoperative period, taking the child home, the healing period, activity and other limitations, longterm considerations, and device failures. The author encourages parents to take an active role in preparing their child for cochlear implant surgery to help maximize the chances of a successful outcome. 2 figures.

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History of Phonosurgery Source: in Sataloff, R.T., ed. Professional Voice: The Science and Art of Clinical Care. 2nd ed. San Diego, CA: Singular Publishing Group, Inc. 1997. p. 561-580. Contact: Available from Singular Publishing Group, Inc. 401 West 'A' Street, Suite 325, San Diego, CA 92101-7904. (800) 521-8545 or (619) 238-6777. Fax (800) 774-8398 or (619) 238-6789. E-mail: [email protected]. Website: www.singpub.com. PRICE: $325.00 plus shipping and handling. ISBN: 1565937287. Summary: Phonosurgery, or aesthetic surgery of the vocal organ, became an accepted surgical modality in the late 1950s and early 1960s when the entire field of surgery experienced an interest in procedures for functional improvement. This chapter, from a book on the clinical care of the professional voice, reviews the history of phonosurgery. Phonosurgery includes any surgery designed primarily for the improvement or restoration of the voice. Topics include phonosurgery in vocal fold paralysis, microsurgical techniques for phonosurgery, the leading surgeons in the field, phonosurgery of the laryngeal nerves, phonosurgery for spastic dysphonia, phonosurgery after laryngectomy, phonosurgery of the laryngeal framework, and transplants in phonosurgery. The author concludes that only in the last 30 years have concerted efforts by surgeons in the U.S., Japan, and Germany established reliable and effective procedures for transforming the human voice. The chapter includes photographs of many of these leaders. 30 figures. 36 references.

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History and Development of Phonomicrosurgery Source: in Sataloff, R.T., ed. Professional Voice: The Science and Art of Clinical Care. 2nd ed. San Diego, CA: Singular Publishing Group, Inc. 1997. p. 581-602. Contact: Available from Singular Publishing Group, Inc. 401 West 'A' Street, Suite 325, San Diego, CA 92101-7904. (800) 521-8545 or (619) 238-6777. Fax (800) 774-8398 or (619) 238-6789. E-mail: [email protected]. Website: www.singpub.com. PRICE: $325.00 plus shipping and handling. ISBN: 1565937287. Summary: This chapter, from a book on the clinical care of the professional voice, reviews the history and development of phonomicrosurgery. In the 20th century, a variety of technological developments improved direct examination of the larynx, such as improved laryngoscopes, hand instruments, and lighting, as well as the surgical microscope, the carbon dioxide laser, and general anesthesia. Through the last two decades, there has been a greater understanding of the physiology underlying vocal fold oscillation. These principles have been joined with the technological developments of microlaryngeal surgery and have led to current concepts of phonomicrosurgery. Topics covered in this chapter include the prelaryngology era of indirect mirror laryngoscopy, the origin of laryngology, transoral management of larynx cancer and Crown Prince Frederick, the era of direct surgical laryngoscopy, microlaryngoscopy, the body cover theory of voice production, and current concepts in phonomicrosurgery. 22 figures. 127 references.

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Voice Surgery Source: in Sataloff, R.T., ed. Professional Voice: The Science and Art of Clinical Care. 2nd ed. San Diego, CA: Singular Publishing Group, Inc. 1997. p. 603-645. Contact: Available from Singular Publishing Group, Inc. 401 West 'A' Street, Suite 325, San Diego, CA 92101-7904. (800) 521-8545 or (619) 238-6777. Fax (800) 774-8398 or (619) 238-6789. E-mail: [email protected]. Website: www.singpub.com. PRICE: $325.00 plus shipping and handling. ISBN: 1565937287. Summary: This chapter, from a book on the clinical care of the professional voice, reviews the current thinking regarding voice surgery. Most surgical procedures for voice disorders can be performed endoscopically, obviating the need for external incisions and minimizing the amount of tissue disruption. The author stresses that, when endoscopic visualization is not adequate because of patient anatomy, disease extent, or other factors, the surgeon should not compromise the results of treatment or risk patient injury by attempting to complete an endoscopic procedure. Topics include patient selection and consent, documentation (preoperative assessment), timing of voice surgery, indirect laryngoscopy, direct laryngoscopy, anesthesia (local and general), instrumentation, laryngeal microsurgery, contact endoscopy, vocal fold cysts, vocal fold polyps, varicosities and ectatic vessels and vocal fold hemorrhage, Reinke's edema, granulomas and vocal process ulcers, papillomas, ventricular fold cysts, epiglottic cysts, laryngoceles, miscellaneous masses, sulcus vocalis, laryngeal webs, bowed vocal folds, presbyphonia, vocal fold paralysis and framework dysfunction, Teflon injection, Gelfoam injection, collagen injection, autologous fat injection, removal of Teflon, thyroplasty, nomenclature, arytenoid adduction or rotation, nerve anastomosis, nerve muscle pedicle surgery, arytenoid reduction for arytenoid dislocation, arytenoidectomy, voice rest, and related surgery, including that for velopharyngeal insufficiency and obstructive sleep apnea syndrome in professional voice users. 31 figures. 1 table. 99 references.

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Facial Plastic Surgery in Professional Voice Users Source: in Sataloff, R.T., ed. Professional Voice: The Science and Art of Clinical Care. 2nd ed. San Diego, CA: Singular Publishing Group, Inc. 1997. p. 659-663. Contact: Available from Singular Publishing Group, Inc. 401 West 'A' Street, Suite 325, San Diego, CA 92101-7904. (800) 521-8545 or (619) 238-6777. Fax (800) 774-8398 or (619) 238-6789. E-mail: [email protected]. Website: www.singpub.com. PRICE: $325.00 plus shipping and handling. ISBN: 1565937287. Summary: Plastic surgery refers to procedures that repair or reconstruct tissues. Cosmetic surgery encompasses any plastic surgical procedure or set of procedures used to enhance appearance. This chapter, from a book on the clinical care of the professional voice, discusses facial plastic surgery in professional voice users. Many singers also play musical instruments, so the authors include a few additional comments to highlight selected effects of facial plastic surgery on instrumental performance. Topics include general considerations, such as the choice of surgeon, procedures, limitations, and financial concerns; and special considerations, including anesthesia and effects on voice and instrumental performance. A final section discusses the role of the rehabilitative team. The authors conclude that if all questions and concerns are dealt with preoperatively, safe and effective cosmetic surgery can be accomplished in the professional voice user population. 2 tables. 3 references.

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Pitfalls in Cochlear Implant Surgery in Children Source: in Uziel, A.S. Mondain, M., eds. Cochlear Implants in Children: Advances in Otorhinolaryngology, Volume 50. Basel, Switzerland: S. Karger AG. 1995. p. 45-50. Contact: Available from S. Karger AG. 26 West Avon Road, P.O. Box 529, Framington, CT 06085. (800) 828-5479 or (203) 675-7834. PRICE: $99.50 plus shipping and handling, unless prepaid. ISBN: 3805560958. Summary: This chapter from a text on cochlear implants in children reviews surgical complications encountered in a population of 37 children when compared to 43 adults. All of the patients were implanted with a Nucleus 22 device at the University Clinic of Navarra (Spain) by the same surgeon. Using this experience and considering the anatomical variations described later, the authors explain the surgical techniques they have used to solve the pitfalls in implanting young children. Their discussion focuses on the following surgical steps: skin incision and musculoperiosteal flap, posterior tympanotomy, the bed for the receiver-stimulator, and stabilization of the implants. 3 figures. 1 table. 7 references. (AA-M).

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Iatrogenic Causes of Taste Disturbances: Radiation Therapy, Surgery, and Medication Source: in Doty, R.L., ed. Handbook of Olfaction and Gustation. New York, NY: Marcel Dekker, Inc. 1995. p. 785-791. Contact: Available from Marcel Dekker, Inc. 270 Madison Avenue, New York, NY 10016. (800) 228-1160 or (212) 696-9000; Fax (212) 685-4540. PRICE: $225.00 plus shipping and handling. ISBN: 0824792521. Summary: This chapter, from a medical text on olfaction and gustation, discusses the iatrogenic causes of taste disturbances, including those attributable to radiation therapy, surgery, and medication. The authors note that recent findings concerning the physiology of taste cells, taste transduction mechanisms, and central nervous system (CNS) processing of gustatory information are beginning to provide some basis for

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understanding mechanisms for these iatrogenically-caused taste disturbances. Topics covered include surgical procedures of the head or neck that damage cranial nerves innervating the taste structures, or any of the central neural pathways involved in gustation; surgical risk; tonsillectomy; radiation-induced taste dysfunction, including that due to damage of the salivary glands; taste dysfunction as a side effect of drug therapy; and some of the medications associated with alterations in taste function. 57 references. (AA-M).

Directories In addition to the references and resources discussed earlier in this chapter, a number of directories relating to surgery have been published that consolidate information across various sources. The Combined Health Information Database lists the following, which you may wish to consult in your local medical library:12 •

Spasmodic Dysphonia: Myths and Facts Source: National Spasmodic Dysphonia Association (NSDA). 199x. 4 p. Contact: Available from National Spasmodic Dysphonia Association (NSDA). P.O. Box 203, Atwood, CA 92601-0203. (800) 795-6732 or (714) 961-0945; Fax (714) 961-0945. PRICE: Single copy free. Summary: This fact sheet provides basic information about spasmodic dysphonia (SD). The authors list common statements about SD, then note whether the statement is a fact or myth. Topics include the incidence of SD, the role of emotional trauma or stress, other etiologic factors, diagnostic considerations, variability among patients with SD, variability in each patient, the natural history and prognosis of SD, the vocal cords of SD patients, the vocal quality of patients with SD, the psychosocial implications of SD, the role of voice therapy in managing SD, the role of surgery in managing SD, stress reduction methods, and research in the diagnosis and treatment of SD.

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Indiana Directory: Dental Care for People with Disabilities Source: Indianapolis, IN: Indiana State Board of Health. 199x. 30 p. Contact: Available from Indiana State Board of Health. Division of Dental Health, 1330 West Michigan Street, Indianapolis, IN 46206-1964. (317) 633-8417; FAX, (317) 633-0776. PRICE: Single copy free. Reproducible with permission and credit noted. Summary: To help promote the oral health of people with disabilities in Indiana, information regarding physical access to dental facilities and dentists' willingness to accept Medicaid coverage has been compiled in this directory. Dentists listed in the

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

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directory are divided by County of practice with codes assigned to specify information regarding the physical facilities of the office, whether Medicaid is accepted, and to indicate whether each dentist is a general practitioner or dental specialist. Specialities covered include general practice; oral and maxillofacial To help; endodontics; orthodontics; pediatric dentistry; periodontics; prosthodontics; and oral pathology.

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CHAPTER 8. MULTIMEDIA ON SURGERY Overview In this chapter, we show you how to keep current on multimedia sources of information on surgery. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.

Video Recordings An excellent source of multimedia information on surgery is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “surgery” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” Type “surgery” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on surgery: •

AAO-HNS Presents: Surgery of the Middle Ear Source: Alexandria, VA: American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS). 1996. (videocassette). Contact: Available from American Academy of Otolaryngology-Head and Neck Surgery, Inc. (AAO-HNS). One Prince Street, Alexandria, VA 22314. (703) 836-4444. Fax (703) 683-5100. Website: www.entnet.org. PRICE: $175.00 for members; $250.00 for nonmembers; plus shipping and handling. Item Number OT-17. Summary: This patient education videotape explains how the middle ear can become infected and when surgery is necessary. The goals and risks of four major types of surgery (myringoplasty, tympanoplasty, cholesteatoma removal, and mastoidectomy) are discussed. The program also covers preparing for surgery, anesthesia, and discharge from the hospital, as well as the symptoms patients may have during recovery. Home recovery guidelines are given regarding strenuous activity, bandages, keeping the ear dry, and sneezing. The videotape is closed captioned. (AA-M).

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Patient Education for Laparoscopic Biliary Tract Surgery Source: St. Louis, MO: Quality Medical Publishing, Inc. 1992. Contact: Available from Quality Medical Publishing, Inc. 11970 Borman Drive, Suite 222, St. Louis, MO 63146. (800) 348-7808 or, in Missouri, (314) 878-7808. Fax (314) 878-9937. PRICE: $59 for 1/2 in NTSC; $84 for PAL, SECAM, and 3/4 in formats. Summary: This videotape program is from a series of instructional videotapes designed to take viewers into the operating room for a firsthand look at laparoscopic procedures. This program focuses on patient education for laparoscopic biliary tract surgery. Dr. Robert Fitzgibbons narrates this concise description of the technique for laparoscopic cholecystectomy. With the aid of diagrams and actual operative footage, he describes the condition, the step-by-step procedure, and complications. (AA-M).

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Surgery for Urinary Incontinence in Women Source: Timonium, MD: Milner-Fenwick, Inc. 1995. Contact: Available from Milner-Fenwick, Inc. 2125 Greenspring Drive, Timonium, MD 21093. (800) 432-8433. Fax (410) 252-6316. PRICE: $175 (as of 1995). Order Number OB135. Summary: This patient education videotape is for female patients with stress incontinence who are being recommended for surgery. The program describes the various operations that may be performed and their associated length of recovery in hospital or at home. Techniques include the open abdominal, laparoscopic, and vaginal approaches to bladder surgery. The program also provides general information on the risks involved with bladder surgery, including infection, bleeding, reaction to anesthesia, injury to the bladder or urethra, and difficulty urinating. The videotape depicts a patient discussing these options with her physician. This video is also available with closed captioning. (AA-M).

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Laparoscopic Surgery in Evolution Source: Bellaire, TX: American Urological Association (AUA) Office of Education. 1993. (videocassette). Contact: Available from Karol Media. 350 North Pennsylvania Avenue, P.O. Box 7600, Wilkes-Barre, PA 18773-7600. (800) 608-0096. Fax (717) 822-8226. PRICE: $20.00. Item number 919-2068. Summary: This videocassette program, one of a series from the American Urological Association, presents six laparoscopic techniques. Techniques featured are laparoscopic partial nephrectomy in an animal model; laparoscopic ureterolysis; laparoscopic orchiectomy; laparoscopic varicocele ligation; and laparoscopic ileal loop conduit. The program begins with a group discussion of clinical experiences with laparoscopic nephrectomy. The video also features interviews with five of the urologists, who describe patient indications, details of the procedures they performed, and potential complications.

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Vesical Diverticula Endoscopic Surgery Source: Purchase, NY: P.C. Communication, Inc. 1990. Contact: Available from VideoUrology Times. 270 Madison Avenue, New York, NY 10016. (800) 342-8244. (One of six video presentations comprising a videocassette

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program representing Program 3 of Volume 3 of VideoUrology). PRICE: $59.95 for 6title set; $150 for 24-title set. Summary: This program, from a video journal on urology, shows how diverticula of the bladder can be resected and fulgurated endoscopically, thus preventing the need for open surgery. (AA-M). •

Endoscopic Surgery of Ureteral Tumors Source: Purchase, NY: P.C. Communication, Inc. 1990. Contact: Available from VideoUrology Times. 270 Madison Avenue, New York, NY 10016. (800) 342-8244. (One of six video presentations comprising a videocassette program representing Program 1 of Volume 3 of VideoUrology). PRICE: $59.95 for 6title set; $150 for 24-title set. Summary: Endoscopic treatment of ureteral tumors using a ureteroresectoscope is shown in two cases in this program, from a video journal on urology. (AA-M).

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Penile Implant Surgery: Enhancing Informed Consent Source: Goleta, CA: Mentor Corporation. 199x. Contact: Available from Mentor Corporation. 600 Pine Avenue, Goleta, CA 93117. (800) 235-5731. PRICE: Single copy free. Summary: This videotape, the second in a series of patient education videos about penile implants, discusses the risks and complications of penile implant surgery. The videotape discusses the surgery involved for both the malleable and inflatable types of penile implants. Topics covered include the types of problems with the devices themselves; the use of corrective surgery for problems including discomfort, urinary tract problems, or a patient whose body produces extensive scarring; and the typical recovery time involved. A brief section considers some of the issues associated with choosing between the malleable and inflatable types of implants.

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New Horizons: Kidney Transplant for a Better Life. Part I: The Kidney Transplant Decision and Evaluation. Part II: Kidney Transplant Surgery and Hospital Stay Source: Nutley, NJ: Kidney Transplant Patient Partnering Program, Roche Laboratories. 1996. (videocassettes). Contact: Available from Kidney Transplant Patient Partnering Program. P.O. Box 16514, Kansas City, MO 64133. (800) 893-1995. Price: Single copy free. Summary: These two videocassette programs are part of the Kidney Transplant Partnering Program, an educational service of Roche Laboratories. The first videotape covers the kidney transplant decision and evaluation. The program emphasizes the patient's role in decision making and in all aspects of patient care management. The program features interviews with real life kidney patients describing their feelings through the kidney transplant decision making process. Topics include considering a transplant, meeting the transplant team, the pretransplant evaluation process, sources of kidneys (living donors and cadaver donors), dealing with being on the kidney waiting list, paying for the kidney transplant, and making the decision. The program emphasizes that patients should learn as much as they can about kidney transplants before they make their decision. The second videotape covers the kidney transplant surgery itself and the hospital stay. Topics include what happens when a donor kidney becomes available, the surgery itself, postoperative recovery, the role of antirejection

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medications, preventing transplant rejection, and other steps to keeping the new kidney healthy. (AA-M). •

Dental Surgery Source: Princeton, NJ: Films for the Humanities and Sciences. 199x. (videocassette). Contact: Available from Films for the Humanities and Sciences. P. O. Box 2053, Princeton, NJ 08543-2053. (800) 257-5126; (609) 452-1128. PRICE: $149.00 for purchase; $75.00 for rental. Order Number TF-2360. Summary: This videotape focuses on temporomandibular jaw (TMJ) problems, on the pain and problems that can be caused by a malformed or misaligned jaw, and on the nature of reconstructive dental surgery. The program also covers detection of cancer of the jaw, and explains that the primary cause of this cancer is smoking. (AA-M).

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Oral and Maxillofacial Surgery: How it Serves the Public Source: Rosemont, IL: American Association of Oral and Maxillofacial Surgeons (AAOMS). 199x. (videocassette). Contact: Available from American Association of Oral and Maxillofacial Surgeons (AAOMS). 9700 West Bryn Mawr Avenue, Rosemont, IL 60018-5701. (800) 822-6637; Fax (708) 241-9805. PRICE: $59.00 (members); $65.00 (nonmembers); plus shipping and handling. Summary: This videotape program explains to viewers the specialty of oral and maxillofacial surgery. The videotape program presents slides showing the general circumstances in which oral and maxillofacial surgeons may be consulted, including a broken jaw in a child, jaw and chin abnormalities, and problems with dentures. The program then briefly reviews this history of orofacial surgery and outlines the typical academic training for these surgeons. The educational process includes at least a 4 year residency program during which physicians learn to manage patient anxiety, to control pain, and to provide total medical and surgical patient care management. The program then describes three areas of the specialty of oral and maxillofacial surgery: diagnosis, office surgery, and major oral and maxillofacial surgery. Maxillofacial techniques are described, including facial trauma repair, orthognathic surgery, reconstructive surgery, dental implants, temporomandibular joint (TMJ) surgery, oncologic surgery, cleft lip and cleft palate repair, and cosmetic surgery. The program concludes with suggestions for locating an oral and maxillofacial surgeon. The program features numerous 'before and after' photographs of surgical patients.

Audio Recordings The Combined Health Information Database contains abstracts on audio productions. To search CHID, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find audio productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Sound Recordings.” Type “surgery” (or synonyms) into the “For these words:” box. The following is a typical result when searching for sound recordings on surgery:

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AIDS/Surgery in the Elderly Contact: California Medical Association, Audio Digest Foundation, 1577 E Chevy Chase Dr, Glendale, CA, 91206, (213) 245-8505. Summary: This sound recording, along with accompanying pre-test and post-test questions, is part of an ongoing series of educational activities. The first 47:45 of this hour-long session deals with the Acquired immunodeficiency syndrome (AIDS) epidemic; the concluding segment touches on surgery in elderly patients. The program opens with remarks made by U.S. Surgeon General C. Everett Koop. He discusses the extent of the epidemic in the U.S., then outlines recent developments in the areas of vaccines and Azidothymidine (AZT). Koop explains modes of Human immunodeficiency virus (HIV) tranmission and methods of prevention. He emphasizes the need to educate young people about the disease, and the need for physicians to accept AIDS patients into their practice. The second speaker, Ted Wisniewski, serves as primary care coordinator for the New Orleans AIDS Project, and is administrator of the AIDS Clinic at Charity Hospital in New Orleans. Wisniewski outlines the essential elements of a primary care program, which start with screening, testing, and prevention, and routine intake and follow-up treatment. He says patients should be referred to experienced specialists as needed, that admission and discharge procedures should be planned, and home and hospice care considered. All Persons with AIDS (PWA's) should have access to appropriate services, including those for neuropsychiatric treatment and substance-abuse treatment. He also addressed the need for patient education and for research. The final speaker, Richard E. Waltman, discusses the unrelated topic of surgery in the geriatric patient.

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

Cancer of the bladder [motion picture]: a combination of surgery and radiation therapy in the treatment of certain types of bladder malignancy: surgical exposure of the lesion combined with intravesical low voltage contact x-radiation Source: from the Urologi; Year: 1944; Format: Motion picture; United States: Billy Burke, [1944]

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Osseous surgery in the maxilla, part II [motion picture] Source: Veterans Administration Dental Training Center; Year: 1968; Format: Motion picture; Washington: The Center: [for sale by National Audiovisual Center, 1968]

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

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

Quality of life benefit with cardiac valve surgery not dependent on age Source: Reuters Medical News Date: October 07, 2003 http://www.reutershealth.com/archive/2003/10/07/professional/links/20031007clin0 08.html

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Modern cryosurgery effective treatment for renal and prostatic tumors Source: Reuters Medical News Date: October 07, 2003

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Belief may cause some to reject lung cancer surgery Source: Reuters Health eLine Date: October 06, 2003

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Obesity doesn't raise death risk after heart surgery Source: Reuters Health eLine Date: October 02, 2003

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Old patients can often achieve heart surgery survival similar to younger patients Source: Reuters Medical News Date: September 25, 2003

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ACE inhibitors before bypass surgery may lower acute graft thrombosis risk Source: Reuters Industry Breifing Date: September 24, 2003

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Surgery prolongs survival for patients with obstructive sleep apnea Source: Reuters Medical News Date: September 22, 2003

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Surgery can reduce breathing problems in obese kids Source: Reuters Health eLine Date: September 19, 2003

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Bypass surgery better than angioplasty and stenting in relieving angina Source: Reuters Medical News Date: September 15, 2003

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DuPont sues Cardinal, BBA over surgery fabrics Source: Reuters Industry Breifing Date: September 12, 2003

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Exercise before surgery aids recovery Source: Reuters Health eLine Date: September 05, 2003

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Surgery at teaching hospital may improve survival for advanced ovarian cancer Source: Reuters Medical News Date: September 04, 2003

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Epilepsy trial will compare brain surgery to drugs Source: Reuters Health eLine Date: September 03, 2003

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Adding chemotherapy to surgery improves bladder cancer survival Source: Reuters Medical News Date: August 29, 2003

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Long-term outcome good in epileptics initially seizure-free after surgery Source: Reuters Medical News Date: August 25, 2003

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Brain surgery can free epileptics from seizures Source: Reuters Health eLine Date: August 25, 2003

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Medicare to pay for pricey new lung surgery Source: Reuters Health eLine Date: August 21, 2003

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Medicare to pay for costly emphysema surgery Source: Reuters Medical News Date: August 21, 2003 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 “surgery” (or synonyms) into the search box, and click on “Search News.” As this service is technology

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

Newsletters on Surgery Find newsletters on surgery using the Combined Health Information Database (CHID). You will need to use the “Detailed Search” option. To access CHID, go to the following hyperlink: http://chid.nih.gov/detail/detail.html. Limit your search to “Newsletter” and “surgery.” Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter.” Type “surgery” (or synonyms) into the “For these words:” box. The following list was generated using the options described above: •

Determining the Need for Surgery Source: CCFA Newsletter. Crohn's and Colitis Foundation of America Newsletter. p. 2. Winter 1993. Contact: Available from Crohn's and Colitis Foundation of America. 386 Park Avenue South, 17th Floor, New York, NY 10016. VOICE (800) 932-2423 or (212) 685-3440; FAX (212) 779-4098. Summary: Inflammatory bowel disease (IBD), both ulcerative colitis and Crohn's disease, is a chronic disease affecting a young population, often with significant morbidity and mortality, and often requiring surgery. This brief newsletter article discusses the assessment of complications and the need for surgery. The author reports on the experience of the Cleveland Clinic Foundation, including its extensive long-term follow-up program. The article concludes with a list of indications for surgery in Crohn's disease.

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Laparoscopic Surgery is Not for Adults Only Anymore (editorial) Source: Urology Times. 22(3): 13. March 1994.


Contact: Available from Advanstar Communications, Inc. Corporate and Editorial Offices, 7500 Old Oak Boulevard, Cleveland, OH 44130. (216) 243-8100. Summary: This brief professional newsletter article describes recent advances in the use of laparoscopic surgery to localize and free intra-abdominal undescended testicles (crypt-orchidism). The author discusses the advantages of laparoscopic surgery over open surgery; demands on the surgeon working in the smaller abdominal cavity of a child; the lack of instruments available that are specifically designed for use in children; and the results of one surgeon in using laparoscopy to treat crypt-orchidism.

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 “surgery” (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 surgery: •

Joint Surgery in Ehlers-Danlos Patients: Results of a Survey Source: Loose Connections. XV(1): 1,8-9,11. February-March 2000. Contact: Available from Ehlers-Danlos National Foundation. 6399 Wilshire Blvd., Suite 510, Los Angeles, CA 90048. (323) 651-3038. Summary: This newsletter article provides health professionals and people who have Ehlers-Danlos syndrome (EDS) with information on a study that evaluated the success rates, complication rates, and satisfaction rates of surgical procedures in patients who have it. EDS, a rare, hereditary, connective tissue disorder is characterized by joint hypermobility, skin extensibility, tissue fragility, and a bleeding diathesis that result from flawed collagen cross linking. The study population consisted of 44 patients who responded to a survey about joint problems related to shoulders, elbows, knees, and ankles. They were asked to categorize the procedures that they underwent for these joints into primary indications of improved stability, pain reduction, or improved range of motion. A total of 214 procedures were performed on 95 joints. Several procedures had multiple indications, and each indication was addressed separately. Thus, there were 240 indications for 214 surgical procedures. The respondents indicated that they thought the preoperative goals were met in 53 percent of all indications. Specific success rates were 50 percent in the stabilization procedures, 50 percent in the pain reducing procedures, and 100 percent in the range of motion procedures. Wound healing problems were reported in 11 percent of all procedures. The article concludes that the study demonstrates that problems with surgical procedures in patients with EDS may be high relative to other populations without connective tissue disorders. More study is needed in this patient population to validate the results in a larger cohort. 5 tables and 20 references.

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Back Surgery: Coming Back from Pain Source: Mayo Clinic Health Letter. 18(6): 1-3. June 2000.

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Contact: Available from Mayo Foundation for Medical Education and Research, 200 First Street SW, Rochester, MN 55905. (800) 291-1128 ext. 250. Summary: This newsletter article provides people who have back pain with information on the use of surgery to relieve pain. Most back problems respond to nonsurgical treatments, so surgery is usually reserved for problems in which a nerve is severely pinched, the spinal cord is compressed, or the spine is unstable. Back problems that have the best chance of being helped by surgery include herniated disk, back pain caused by disk degeneration, spinal stenosis, fractures, infections and tumors, and spinal deformity. The most common types of back surgery are laminotomy or laminectomy, diskectomy, and fusion. Laminotomy or laminectomy involves removing a small amount of the lamina. Diskectomy involves the removal of a portion of a disk to relieve pressure on a nerve. Spinal fusion permanently connects two or more bones in the spine. Less invasive surgical techniques include endoscopic procedures, vertebroplasty, kyphoplasty, intradiskal electrothermal therapy, and use of bone substitutes. 2 figures. •

Surgery: Total Knee Replacement Source: Harvard Health Letter. 25(12): 4-5. October 2000. Contact: Available from Harvard Health Letter, P.O. Box 380, Department BI, Boston, MA 02117. (800) 829-9045 or (617) 432-1485. E-mail: [email protected]. Summary: This newsletter article provides people who need total knee replacement with information on this surgical procedure. Severe, intractable pain from osteoarthritis is the most common reason for total knee replacement. However, individual circumstances and expectations about pain and mobility have as much to do with the decision to undergo total knee replacement as the condition itself. The article describes the anatomy of the knee, discusses the materials used in knee replacements, and explains the procedure used. The knee is accessed through an incision made down the front of the leg from mid thigh to several inches below the knee. The ends of the femur and top of the tibia are removed. Then the menisci are removed and the anterior cruciate ligament is cut. The posterior cruciate ligament may also be cut. The patella may either be left intact or have the inside resurfaced. Knee replacements come in three main parts: a femoral component, a tibial component, and a disc that fits on top of the tibial component. Although progress varies, most people do not feel completely recovered from knee replacement surgery for a full year or more. 1 figure.

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Elbow Surgery for Arthritis: Relief When Other Therapies Don't Work Source: Mayo Clinic Health Letter. 18(10): 4-5. October 2000. Contact: Available from Mayo Clinic Health Letter, 200 First Street SW, Rochester, MN 55905. (800) 333-9037 or (303) 604-1465. Email: [email protected]. Summary: This newsletter article provides people who have arthritis in the elbow with information on the use of a surgical technique known as debridement to relieve elbow pain and improve function and motion. The most common types of arthritis are osteoarthritis, which is a degenerative disease, and rheumatoid arthritis, which is associated with inflammation of the lining of joints. When treatments such as medications, activity modification, and physical therapy no longer help, for arthritis pain and immobility, surgery may be needed. Joint replacement is the standard of care for people who have advanced arthritis in the elbow. However, some people with an earlier stage of disease may have the option of undergoing traditional or arthroscopic


debridement. Although debridement is traditionally performed with an open incision, arthroscopic surgery is proving promising. One form of arthroscopic debridement is known as osteocapsular arthroplasty. The article outlines the characteristics of people who may benefit from arthroscopic debridement and highlights the risks associated with it. 1 figure. •

Totally Hip: What To Know About and Expect From Hip Replacement Surgery Source: Mayo Clinic Women's HealthSource. 4(11): 4-5. November 2000. Contact: Available from Mayo Clinic Women's HealthSource, 200 First Street SW, Rochester, MN 55905. (800) 876-8633 or (303) 604-1465. Email: [email protected]. Summary: This newsletter article provides women who need hip replacement surgery with information on this procedure. People who are candidates for this surgery include those who have severe pain resulting from osteoarthritis, rheumatoid arthritis, injury, or bone tumors. A physician may suggest that a patient try other less invasive options before considering hip replacement surgery. If these options fail, surgery may be recommended. The procedure involves removing the head of the femur and the socket, inserting a metal ball and stem into the femur, and placing a cup made of metal and plastic in the socket. The artificial hip is then fixed in place, muscles and tendons are returned to their proper position, and the incision is closed. The article explains postoperative care procedures and highlights possible complications, including infection, hip dislocation, blood clots, prosthetic loosening or breakage, and inflammation. The article also includes precautions that patients should take following surgery. 3 figures.

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Laser Surgery: Sometimes the Right Choice, Sometimes Not Source: Mayo Clinic Health Letter. 18(4): 1-3. April 2000. Contact: Available from Mayo Clinic Health Letter. 200 First Street SW, Rochester, MN 55905. (800) 333-9037 or (303) 604-1465. E-mail: [email protected]. Summary: This newsletter article provides people who may need a surgical procedure with information on laser surgery. Laser is a acronym that stands for light amplification by stimulated emission of radiation. Laser beams are strong beams of light produced by electrically simulating a solid, liquid, or gas. Lasers are usually named for the substances that produce them. Uses include cutting or destroying abnormal or diseased tissue, shrinking or destroying tumors or lesions, burning off or vaporizing tissue, sculpting tissue, and sealing bleeding blood vessels. Lasers have some distinct advantages over traditional methods, such as causing minimal bleeding, posing less risk of infection, causing minimal scarring, and being faster than traditional surgery. However, in many cases, conventional surgery is more effective than laser surgery, and laser surgery is not necessarily pain free or risk free. The article discusses common uses of laser surgery in dermatology, plastic surgery, ophthalmology, gastroenterology, gynecology, urology, cardiology, neurosurgery, dentistry, otorhinolaryngology, and orthopedics.

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Let There Be Light: Cosmetic Laser Surgery Comes of Age Source: Dermatology Focus. 15(3):1-2; January 1997. Summary: This newsletter article for health professionals presents information on the use of the newest generation of lasers in cosmetic surgery. However, their use is hampered by the difficulty in using them and by the lack of published guidelines for

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operating parameters. Findings on the clinical application of these new lasers and their safe and effective use are presented. •

Cosmetic Surgery: Laser Resurfacing Slows the Hands of Time Source: Harvard Health Letter. 21(10):4-5; August 1996. Contact: Available from Harvard Health Letter, P.O. Box 380, Boston, MA 02117. Summary: This newsletter article for the general public describes the use of lasers to resurface skin to remove wrinkles, roughness, and discoloration that accompany aging. Although dermabrasion and chemical peels have been used for many years by dermatologists and other specialists to improve photoaged skin or remove acne or chicken pox scars, short-pulse and rapid-scanning carbon dioxide lasers are now being used in cosmetic surgery. Reasons for the increasing use of laser resurfacing are identified. The process of laser resurfacing is described, and postoperative care is explained. In addition, complications are highlighted. 1 figure.

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Headaches After Acoustic Neuroma Surgery Source: ANA Notes. Number 75: 1, 8-10. March 2001. Contact: Available from Acoustic Neuroma Association (ANA). 600 Peachtree Parkway, Suite 108, Cumming, GA 30041-8211. (770) 205-8211. Fax (770 www.ANAUSA.org. Summary: This newsletter article reports on the incidence of headaches after acoustic neuroma surgery. The author notes that although headaches as a symptom prior to treatment are relatively uncommon for vestibular schwannoma, they occur with surprising frequency after treatment and can have a profound impact upon quality of life in acoustic neuroma patients. The pain often persists for prolonged periods of time and does not always respond well to a number of medical and surgical treatments directed at the headache. The author discusses the frequency of headache following neuroma surgery, the nature of the headache, their causes, and current therapies. Causes of the headaches can include the surgical approach (craniectomy versus craniotomy), aspetic meningitis, muscle pain, nerve entrapment, and low cerebrospinal fluid pressure. The best treatment is prevention, since these headaches have proven to be difficult to treat once they occur. The author also discusses the use of cranioplasty, medication, local therapy to neck muscles, nerve block or section, stress reduction and antidepressants, and care from a multidisciplinary pain center. The author notes that most surgeons are aware of the need to prevent these headaches and take measures to minimize muscle incisions, to replace skull bone whenever possible, and to limit the distribution of bone dust within the operative field.

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Preparing for Acoustic Neuroma Surgery Source: ANA Notes. Number 78: 1, 9-11. June 2001. Contact: Available from Acoustic Neuroma Association. 600 Peachtree Parkway, Suite 108, Cumming, GA 30041-6899. (770) 205-8211. Fax (770) 205-0239. E-mail: [email protected]. Website: www.ANAUSA.org. Summary: This article, from the journal of the Acoustic Neuroma Association (ANA), reviews the preoperative care and preparation for patients undergoing surgery for acoustic neuroma. Topics include admission procedures, the hospital admission and preoperative care, what to expect on the morning the surgery is scheduled, the recovery unit (intensive care), what to expect the day after surgery, rehabilitation during the


hospital stay, and discharge from the hospital (going home). The author stresses that patients who begin treatment with a positive mental attitude and who maintain that attitude throughout the recovery period seem to have an easier and more complete recovery. Readers are advised to talk with a former patient about his or her experiences; often it is helpful to hear how others have coped with having had an acoustic neuroma. •

Facial Weakness and Facial Paralysis Following Acoustic Neuroma Surgery Source: ANA Notes. Number 74: 1, 4-5. June 2000. Contact: Available from Acoustic Neuroma Association (ANA). 600 Peachtree Parkway, Suite 108, Cumming, GA 30041-8211. (770) 205-8211. Fax (770 www.ANAUSA.org. Summary: This newsletter article describes the facial weakness and facial paralysis that can follow surgery for acoustic neuroma. The article is a reprint of the lecture given by the author at ANA's 14th National Symposium in Milwaukee, Wisconsin. The author discusses four primary causes for facial weakness following this type of surgery: traction, heat, loss of blood supply, and transection of the nerve. The first three result in a temporary facial weakness; however, transection of the nerve can result in a permanent facial paralysis unless secondary procedures are then performed. The author describes some approaches to the immediate postoperative period, including the use of artificial tears and lubricant in the ear (to protect the cornea), oral guards to protect the inside of the upper cheek, and weighing the upper eyelid to assist in eye closure. The author also describes the reparative surgery that may be undertaken in patients who no longer have a facial nerve, or whose facial nerve is transected. Observation only is the treatment for patients whose nerve was anatomically preserved and who are likely to regain facial movement. The author cautions that it can take from one month to one year for the nerve to regenerate (grow back). The article concludes with a reprint of a brief question and answer session that the author conducted after giving this lecture; topics covered include the use of Botox, free tissue transfer, the use of facial retraining, testing the amount of moisture in the eye, and patient selection for secondary surgical procedures.

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Radiosurgery for Acoustic Neuromas Source: ANA Notes. Number 75: 1, 4. September 2000. Contact: Available from Acoustic Neuroma Association (ANA). 600 Peachtree Parkway, Suite 108, Cumming, GA 30041-8211. (770) 205-8211. Fax (770 www.ANAUSA.org. Summary: Stereotactic radiosurgery (SRS) is a minimally invasive procedure that delivers a large, one-time dose of radiation to a specific target within the head, while sparing surrounding tissue. This newsletter article discusses radiosurgery, an attractive alternative for some acoustic neuroma patients. Obvious advantages are its noninvasive nature, its shortened immediate recovery time, its preservation of hearing in many cases, and its value as an alternative for patients unable or unwilling to undergo surgery. The authors describe the procedure and its development, a typical radiosurgical treatment, and what the patient can expect as results from this type of surgery. The authors caution that the role of radiosurgery is limited by its inability to remove excess weight from the brainstem immediately. Therefore, patients with large, symptomatic tumors should undergo conventional surgery in order to decompress the brainstem more quickly. However, for acoustic neuromas under 3 cm in diameter, the results of SRS compare favorably with the best published surgical results. Hearing preservation rates of 70 percent have been reported for very small tumors. 2 figures.

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Laparoscopic Surgery for the Treatment of High Anorectal Malformations Source: PTN News. 11(1): 1-3. February 2002. Contact: Pull-thru Network (PTN). 2312 Savoy Street, Hoover, AL 35226-1528. E-mail: [email protected]. Website: www.pullthrough.org. Summary: This newsletter article reviews the use of laparoscopic surgery for the treatment of high anorectal malformations. To treat diseases or abnormal anatomy, pediatric surgeons have traditionally had to dissect through normal tissue in order to provide adequate surgical exposure. However, new minimally invasive surgical techniques have revolutionized many procedures, including anorectal pull-through in infants. This approach involves the use of a laparoscope (an instrument used to see inside the body through a small incision) as well as trocars (instruments used to puncture the wall of a body cavity). Laparoscopic magnification and illumination enhances surgical exposure and anatomic visualization. The use of trocars creates small puncture wounds rather than the much large incisions required in traditional open surgery, thus reducing the likelihood of complications such as infection, wound breakdown, and physiologic stress to the infant. The article reviews the anatomy and physiology of normal bowel continence, the classification of anorectal malformations, the rationale for the laparoscopically assisted anorectal pull-through (LAARP), special considerations for coexisting medical conditions, the three-stage surgical approach, and the outcomes that can be expected from traditional open surgery compared with LAARP. The contact information for the author and for a pediatric nurse practitioner who is a colleague of the author, is provided for readers with additional questions. 1 reference.

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Answers to Your Questions About Digestive Health: GERD, Hiatal Hernia, and Surgery Source: Digestive Health Matters. 4(3): 1-2. Fall 2002. Contact: Available from International Foundation for Functional Gastrointestinal Disorders (IFFGD). P.O. Box 170864, Milwaukee, WI 53217. (888) 964-2001 or (414) 9641799. Fax (414) 964-7176. Website: www.iffgd.org. Summary: This newsletter article answers a question from a reader who is coping with gastroesophageal reflux disease (GERD, the return of stomach acid back into the esophagus) and a hiatal hernia. The reader has been advised to have surgery for the hernia and is interested in finding out the impact of surgery on the GERD, as well as other risk factors. The author first explains the basic anatomy and physiology of the esophagus, the lower esophageal sphincter (LES), and the stomach, then describes how surgical therapy can correct the underlying physical anomalies. The author then describes postoperative complications, followup data from research studies on this type of surgery, and areas of controversy. One sidebar describes the laparoscopic approach to this type of surgery. The author concludes by explaining the circumstances in which surgery would be an appropriate answer to the problems described.

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Gallbladder Surgery: A Second Look at a First-Line Treatment Source: Harvard Health Letter. 22(1): 6-8. November 1996. Contact: Available from Harvard Health Letter. P.O. Box 420300, Palm Coast, FL 321420300. (800) 829-9045.


Summary: This newsletter article reviews the differences between laparoscopy and open surgery for treating gallbladder disease. Unlike open gallbladder surgery, in which the surgeon makes an incision in the abdomen, the laparoscopic method requires only several tiny punctures in the belly to allow for the insertion of a small video camera and surgical instruments. The author reports results of a recent British study of 200 patients that showed that laparoscopic cholecystectomy (gallbladder removal) takes longer to do than mini-incision open surgery and offers no added benefit in recovery time, length of hospital stay, and time back to work. These results were in contrast to earlier evidence showing that people who undergo laparoscopy recover more quickly and with less pain and scarring than those treated with conventional open surgery. The author discusses the incidence of gallstones, the indications for cholecystectomy, rising rates of gallbladder removal, malpractice claims for bile duct injuries from laparoscopic cholecystectomy, and the differential diagnosis of gallbladder disease. The author stresses that the decision to have surgery is an individual one. People with infrequent gallstone attacks may be able to live with the prospect of having another down the road, while those whose episodes are more common or severe may find that laparoscopic cholecystectomy greatly improves the quality of their lives. 1 figure. •

Surgery for Stress Urinary Incontinence Source: Informer, The. 14(1): 1,3. Fall 2002. Contact: Available from Simon Foundation for Continence. P.O. Box 835-F, Wilmette, IL 60091. (800) 23SIMON or (800) 237-4666 or (847) 864-3913. Fax (847) 864-9758. E-mail: [email protected]. Website: www.simonfoundation.org. Summary: Stress urinary incontinence (SUI) is the uncontrolled loss of urine caused when abdominal pressure overrides the closure mechanism of the bladder, allowing urine to leak out. Most women experiencing this type of leakage do so when coughing, sneezing, laughing, exercising, or lifting. One of the treatment options for SUI is surgical correction of this loss of support. This article describes this type of surgery, noting that a thorough evaluation needs to be done before surgery to consider non-surgical options and design the best surgical procedure if surgery is the treatment of choice. Topics include the goals of surgery, the surgical procedures that may be used, other support problems, what to expect after surgery, and the importance of making an informed choice about surgical options.

•

Surgery for Stress Incontinence Source: AUA News. 2(1): 16-17. January-February 1997. Contact: Available from AUA News. Williams and Wilkins, 351 West Camden Street, Baltimore, MD 21201-2436. Summary: This newsletter article reports on surgery for stress urinary incontinence (UI). All surgical approaches for stress incontinence have the common goal of restoring normal anatomic relationships; that is, to replace the bladder neck and proximal urethra into their appropriate position above the level of the pelvic floor muscle group. This positioning can be accomplished transvaginally or transabdominally; the approach is based on surgeon experience and preference, as well as on patient indications. The author reports on the surgical strategy to treat intrinsic sphincteric deficiency (ISD) or type III stress urinary incontinence. Generally, it is stated that there is an 85 percent cure rate of stress UI regardless of which procedure is performed. The author contends that the literature does not support this conclusion. The author also stresses that surgery only corrects one of the factors important for normal urinary control. Recurrence of UI

356 Surgery

with good anatomic support is not to be considered a surgical failure. The author concludes that more important than the choice of therapy is the identification of the proper patient for treatment. Correction of an anatomic abnormality by one of the many resuspension procedures will be inadequate for correction in those patients with ISD. Current urodynamic, radiographic, and endoscopic techniques must be used to select properly those patients who require augmentation of outlet function rather than an outlet stabilization (suspension) procedure. 1 figure. 3 references. (AA-M). •

Laser Surgery for Cancer of the Larynx (Voice Box) Source: News from SPOHNC. News from Support for People with Oral and Head and Neck Cancer, Inc. 12(4): 1-2, 7. Winter 2002. Contact: Available from Support for People with Oral and Head and Neck Cancer, Inc. (SPOHNC). P.O. Box 53, Locust Valley, NY 11560-0053. (516) 759-5333. E-mail: [email protected]. Website: www.spohnc.org. Summary: Over the past 30 years, surgical lasers have become a very useful tool in the treatment of cancer of the head and neck. This newsletter article describes the use of laser surgery for cancer of the larynx (voice box). Many surgeons have come to favor endoscopic excision over radiation therapy for early cancers on the vocal folds in order to avoid the disadvantages of radiation. The carbon dioxide laser was used in a large portion of the patients who were treated with endoscopic excision, which is an ambulatory surgery procedure. The authors note that high cure rates have been achieved treating early glottic (vocal cord) cancer with endoscopic excision, usually using the carbon dioxide laser. The authors caution that the decision as to when it is best to use, or not to use, a laser in the treatment of cancer of the larynx is complex. 8 references.

•

Organ Preservation Surgery: Is Total Removal of the Larynx Always Needed After Radiation Failure? Source: News from SPOHNC. News from Support for People with Oral and Head and Neck Cancer, Inc. 11(1): 1-3. September 2001. Contact: Available from Support for People with Oral and Head and Neck Cancer, Inc. (SPOHNC). P.O. Box 53, Locust Valley, NY 11560-0053. (516) 759-5333. E-mail: [email protected]. Website: www.spohnc.org. Summary: This article reviews the different types of surgery that may be used for cancer of the larynx (voice box). The author first briefly reviews the anatomy and function of the larynx. The author notes that most patients, when given the diagnosis of cancer of the larynx, assume that if they have surgery, it will mean loss of the voice box and loss of speech; this is not necessarily so. The author then describes the different approaches to surgery and to rehabilitation, including the ways that speech tone can be generated: with an electrical device that creates a tone (electrolarynx); with air expelled from the esophagus (esophageal speech); or with a one way valve that is surgically placed between the windpipe and the esophagus to allow air to be pushed from the lungs to the throat, making the throat vibrate and generating the tone to speak (voice prosthesis). The author then reviews the surgical approaches used to save the larynx, as alternatives to nonsurgical therapies such as radiation therapy alone or radiation therapy with chemotherapy. The author stresses that all patients who fail radiation therapy (whose cancers are not cured by radiation therapy) should be evaluated by a surgeon who regularly uses all of the organ preservation surgical techniques to determine if the patient is a candidate for one of them. 11 references.


•

Major Advances in Reconstructive Surgery of the Head and Neck Source: News from SPOHNC. News from Support for People with Oral and Head and Neck Cancer, Inc. 8(8): 1-3. May 1999. Contact: Available from Support for People with Oral and Head and Neck Cancer, Inc. (SPOHNC). P.O. Box 53, Locust Valley, NY 11560-0053. (516) 759-5333. E-mail: [email protected]. Website: www.spohnc.org. Summary: This article, from a newsletter for people with oral or head and neck cancer, reviews the major advances in reconstructive surgery of the head and neck. The author notes that surgical treatment of tumors of the head and neck is similar to that of tumors elsewhere in the body, in that the goals of treatment are to remove the tumor in its entirety while preserving the form and function of the region. However, this may not be as easy to accomplish in the head and neck region as it is in other parts of the body. After a brief presentation of the historical perspective, the author's discussion revolves around four issues: the anatomic parts that are affected by the tumor and therefore require removal to obtain clear margins around the disease; the factors that exist that would lead to an impairment in wound healing; the best surgical approaches for tumor removal, leading to the least alteration in form and function; and the best method to reconstruct the missing anatomic parts to restore appearance as well as physiologic function.

•

Gamma Knife: No Incision in Newest TN Surgery Source: Barnegat Light, N.J.: Trigeminal Neuralgia Association. Spring 1996. p. 1, 4. Contact: Available from Trigeminal Neuralgia Association. P.O. Box 340, Barnegat Light, NJ 08006. (609) 361-1014; Fax (609) 361-0982. Summary: This newsletter article describes the use of the Gamma Knife to treat trigeminal neuralgia (TN). The Gamma Knife uses Gamma rays to perform the equivalent of a surgical procedure without opening the skull. In treating TN, the Gamma Knife is focused on the root of the trigeminal nerve. The author reports on the experience thus far in 235 patients worldwide with TN treated with the Gamma Knife; more detailed information is provided on 45 patients with intractable facial pain treated at the Northwest Hospital Gamma Knife Center in Seattle, Washington. The author also discusses complications of Gamma Knife procedures, cost considerations, and insurance issues.

•

Oral Exercises Following Head and Neck Surgery Source: Comfort Zone. p. 8-9. Spring 1996. Contact: Available from MGI Pharma, Inc. 9900 Bren Road East, Suite 300E, Minnetonka, MN 55343-9667. (800) 644-4811 or (612) 935-7335; Fax (612) 935-0468. Summary: This newsletter article provides exercises for improving the strength and flexibility of the oral structures. The author notes that surgery involving the tongue, jaw, lips and cheeks can result in decreased strength and mobility of these structures. The exercises are especially vital for patients who receive postoperative radiation therapy. The article provides exercises for improving strength in the tongue, lips, and cheeks, and for improving mobility (flexibility) of the tongue, jaw, and lips. In addition a list of suggestions to follow for each exercise session is provided.

358 Surgery

Academic Periodicals covering Surgery Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to surgery. In addition to these sources, you can search for articles covering surgery 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.”

359

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

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

360 Surgery

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

Parenteral-Local - U.S. Brands: Carbocaine; Carbocaine with Neo-Cobefrin; Chirocaine; Citanest Forte; Citanest Plain; Dalcaine; Dilocaine; Duranest; Duranest-MPF; Isocaine; L-Caine; Lidoject-1; Lidoject-2; Marcaine; Marcaine Spinal; Nesacaine; Nesacaine-MPF; Novocain; Octocaine; Poloc http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202040.html

•

Topical - U.S. Brands: Almay Anti-itch Lotion; Americaine Topical Anesthetic First Aid Ointment; Americaine Topical Anesthetic Spray; Butesin Picrate; DermaFlex; Dermoplast; Lagol; Nupercainal Cream; Nupercainal Ointment; Pontocaine Cream; Pontocaine Ointment; Pramegel; Prax; http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202042.html

Anesthetics, General •

Systemic - U.S. Brands: Amidate; Brevital; Diprivan; Ethrane; Fluothane; Forane; Ketalar; Penthrane; Pentothal http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203043.html

Anticholinergics/Antispasmodics •

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

Antidiabetic Agents, Sulfonylurea •

Systemic - U.S. Brands: Amaryl; DiaBeta; Diabinese; Dymelor; Glucotrol; Glucotrol XL; Glynase PresTab; Micronase; Orinase; Tolinase http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202742.html

Antihistamines •

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

Antihistamines, Phenothiazine-Derivative •

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

Anti-Inflammatory Drugs, Nonsteroidal •

Ophthalmic - U.S. Brands: Ocufen; Profenal; Voltaren Ophthalmic http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202647.html

Researching Medications 361

Antimyasthenics •

Systemic - U.S. Brands: Mestinon; Mestinon Timespans; Mytelase Caplets; Prostigmin; Regonol http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202065.html

Apraclonidine •

Ophthalmic - U.S. Brands: Iopidine http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202070.html

Ardeparin •

Systemic - U.S. Brands: Normiflo http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203494.html

Ascorbic Acid (Vitamin C) •

Systemic - U.S. Brands: Ascorbicap; Cecon; Cee-500; Cemill; Cenolate; Cetane; Cevi-Bid; Flavorcee; Ortho/CS; Sunkist http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202071.html

Atropine/Homatropine/Scopolamine •

Ophthalmic - U.S. Brands: AK-Homatropine; Atropair; Atropine Care; Atropine Sulfate S.O.P. Atropisol; Atrosulf; I-Homatrine; Isopto Atropine; Isopto Homatropine; Isopto Hyoscine; I-Tropine; Ocu-Tropine; Spectro-Homatropine http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202074.html

Caffeine •

Systemic - U.S. Brands: Cafcit; Caffedrine Caplets; Dexitac Stay Alert Stimulant; Enerjets; Keep Alert; Maximum Strength SnapBack Stimulant Powders; NoDoz Maximum Strength Caplets; Pep-Back; Quick Pep; Ultra Pep-Back; Vivarin http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202105.html

Carbachol •

Ophthalmic - U.S. Brands: Carbastat; Carboptic; Miostat http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202110.html

Carbohydrates and Electrolytes •

Systemic - U.S. Brands: Infalyte; Kao Lectrolyte; Naturalyte; Oralyte; Pedialyte; Pedialyte Freezer Pops; Rehydralyte; Resol$ http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202112.html

Cephalosporins •

Systemic - U.S. Brands: Ancef; Ceclor; Ceclor CD; Cedax; Cefadyl; Cefizox; Cefobid; Cefotan; Ceftin; Cefzil; Ceptaz; Claforan; Duricef; Fortaz; Keflex 20; Keftab 20; Kefurox; Kefzol; Mandol; Maxipime; Mefoxin; Monocid; Omnicef; Rocephin; Suprax; Tazicef; Tazidime; Vantin; Velo http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202119.html

362 Surgery

Corticosteroids •

Nasal - U.S. Brands: Beconase; Beconase AQ; Dexacort Turbinaire; Flonase; Nasacort; Nasacort AQ; Nasalide; Nasarel; Nasonex; Rhinocort; Vancenase; Vancenase AQ 84 mcg; Vancenase pockethaler http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202012.html

Dalteparin •

Systemic - U.S. Brands: Fragmin http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202910.html

Danaparoid •

Systemic - U.S. Brands: Orgaran http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203583.html

Dantrolene •

Systemic - U.S. Brands: Dantrium http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202181.html

Desflurane •

Inhalation-Systemic - U.S. Brands: Suprane http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202685.html

Dolasetron •

Systemic - U.S. Brands: Anzemet http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203375.html

Doxazosin •

Systemic - U.S. Brands: Cardura http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202629.html

Droperidol •

Systemic - U.S. Brands: Inapsine http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203411.html

Enoxaparin •

Systemic - U.S. Brands: Lovenox http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202686.html

Enteral Nutrition Formulas •

Systemic - U.S. Brands: 206 Shake; Accupep HPF; Advera; Alitraq; Amin-Aid; Attain; Carnation Instant Breakfast; Carnation Instant Breakfast No Sugar Added; Casec; CitriSource; Citrotein; Compleat Modified; Compleat Regular; Comply; Criticare HN; Crucial; Deliver 2.0; DiabetiSo http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202673.html

Epinephrine •

Ophthalmic - U.S. Brands: Epifrin; Epinal; Eppy/N; Glaucon http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202213.html


Epoetin •

Systemic - U.S. Brands: Epogen; Procrit http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202214.html

Estrogens and Progestins Oral Contraceptives •

Systemic - U.S. Brands: Alesse; Brevicon; Demulen 1/35; Demulen 1/50; Desogen; Estrostep; Estrostep Fe; Genora 0.5/35; Genora 1/35; Genora 1/50; Intercon 0.5/35; Intercon 1/35; Intercon 1/50; Jenest; Levlen; Levlite; Levora 0.15/30; Lo/Ovral; Loestrin 1.5/30; Loestrin 1/20; Lo http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202228.html

Etidronate •

Systemic - U.S. Brands: Didronel http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202233.html

Fat Emulsions •

Systemic - U.S. Brands: Intralipid http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202236.html

Fluorouracil •

Systemic - U.S. Brands: Adrucil http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202245.html

Ganciclovir •

Implantation-Ophthalmic - U.S. Brands: Vitrasert http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203488.html

Glycerin •

Systemic - U.S. Brands: Glyrol; Osmoglyn http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202263.html

Goserelin •

Systemic - U.S. Brands: Zoladex http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202267.html

Headache Medicines, Ergot Derivative-Containing •

Systemic - U.S. Brands: Cafergot; Cafertine; Cafetrate; D.H.E. 45; Ercaf; ErgoCaff; Ergomar; Ergostat; Gotamine; Migergot; Wigraine http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202216.html

Heparin •

Systemic - U.S. Brands: Calciparine; Liquaemin http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202280.html

Hydroxypropyl Methylcellulose •

Parenteral-Local - U.S. Brands: Ocucoat http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203682.html

364 Surgery

Kanamycin •

Oral - U.S. Brands: Kantrex http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202312.html

Ketorolac •

Ophthalmic - U.S. Brands: Acular http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202714.html

•

Systemic - U.S. Brands: Toradol http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202318.html

Laxatives •

Oral - U.S. Brands: Afko-Lube; Afko-Lube Lax 40; Agoral Marshmallow; Agoral Raspberry; Alaxin; Alophen; Alphamul; Alramucil Orange; Alramucil Regular; Bilagog; Bilax; Bisac-Evac; Black-Draught; Black-Draught Lax-Senna; Carter's Little Pills; Cholac; Chronulac; Cillium; Cit http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202319.html

•

Rectal - U.S. Brands: Bisco-Lax; Ceo-Two; Dacodyl; Deficol; Dulcolax; Fleet Babylax; Fleet Bisacodyl; Fleet Enema; Fleet Enema for Children; Fleet Enema Mineral Oil; Fleet Glycerin Laxative; Fleet Laxative; Sani-Supp; Senokot; Theralax; Therevac Plus; Therevac-SB http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202320.html

Lidocaine and Prilocaine •

Topical - U.S. Brands: EMLA http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203679.html

Loteprednol •

Ophthalmic - U.S. Brands: Alrex; Lotemax http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203541.html

Meclizine/Buclizine/Cyclizine •

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

Metoclopramide •

Systemic - U.S. Brands: Octamide; Reglan http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202364.html

Midazolam •

Systemic - U.S. Brands: Versed http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202372.html

Monoctanoin •

Local - U.S. Brands: Moctanin http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202380.html


Narcotic Analgesics for Surgery and Obstetrics •

Systemic - U.S. Brands: Alfenta; Astramorph; Astramorph PF; Buprenex; Demerol; Duramorph; Nubain; Stadol; Sublimaze; Sufenta; Ultiva http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202391.html

Neomycin •

Oral - U.S. Brands: Mycifradin http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202396.html

Ondansetron •

Systemic - U.S. Brands: Zofran http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202424.html

Penicillins and Beta-Lactamase Inhibitors •

Systemic - U.S. Brands: Augmentin; Timentin; Unasyn; Zosyn http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202705.html

Phenylephrine •

Ophthalmic - U.S. Brands: Ak-Dilate; Ak-Nefrin; Dilatair; I-Phrine; Mydfrin; Neofrin; Neo-Synephrine; Ocugestrin; Phenoptic http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202461.html

Podophyllum •

Topical - U.S. Brands: Podocon-; Podofin http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202469.html

Polyethylene Glycol and Electrolytes •

Local - U.S. Brands: Co-Lav; Colovage; Colyte; Colyte-flavored; Go-Evac; GoLYTELY; NuLYTELY; OCL http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202636.html

Progesterone Intrauterine Device •

Iud) - U.S. Brands: Progestasert http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202774.html

Propiomazine •

Systemic - U.S. Brands: Largon http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202487.html

Rimexolone •

Ophthalmic - U.S. Brands: Vexol http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203590.html

Rofecoxib •

Systemic - U.S. Brands: Vioxx http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203782.html

366 Surgery

Ropivacaine •

Parenteral-Local - U.S. Brands: Naropin http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202913.html

Salicylates •

Systemic - U.S. Brands: Acuprin 81; Amigesic; Anacin Caplets; Anacin Maximum Strength; Anacin Tablets; Anaflex 750; Arthritis Pain Ascriptin; Arthritis Pain Formula; Arthritis Strength Bufferin; Arthropan; Aspergum; Aspirin Regimen Bayer Adult Low Dose; Aspirin Regimen Bayer R http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202515.html

Sevoflurane •

Inhalation-Systemic - U.S. Brands: Ultane http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202793.html

Tamsulosin •

Systemic - U.S. Brands: Flomax http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203479.html

Terazosin •

Systemic - U.S. Brands: Hytrin http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202546.html

Tinzaparin •

Systemic - U.S. Brands: Innohep http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500175.html

Tramadol •

Systemic - U.S. Brands: Ultram http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202789.html

Tropicamide •

Ophthalmic - U.S. Brands: I-Picamide; Mydriacyl; Mydriafair; Ocu-Tropic; Opticyl; Spectro-Cyl; Tropicacyl http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202581.html

Ursodiol •

Systemic - U.S. Brands: Actigall http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202587.html

Vancomycin •

Systemic - U.S. Brands: Vancocin http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202590.html


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

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

Researching Orphan Drugs Although the list of orphan drugs is revised on a daily basis, you can quickly research orphan drugs that might be applicable to surgery by using the database managed by the National Organization for Rare Disorders, Inc. (NORD), at http://www.rarediseases.org/. Scroll down the page, and on the left toolbar, click on “Orphan Drug Designation Database.” On this page (http://www.rarediseases.org/search/noddsearch.html), type “surgery” (or synonyms) into the search box, and click “Submit Query.” When you receive your results, note that not all of the drugs may be relevant, as some may have been withdrawn from orphan status. Write down or print out the name of each drug and the relevant contact information. From there, visit the Pharmacopeia Web site and type the name of each orphan drug into the search box at http://www.nlm.nih.gov/medlineplus/druginformation.html. You may need to contact the sponsor or NORD for further information. NORD conducts “early access programs for investigational new drugs (IND) under the Food and Drug Administration’s (FDA’s) approval ‘Treatment INDs’ programs which allow for a limited number of individuals to receive investigational drugs before FDA marketing approval.” If the orphan product about which you are seeking information is approved for

368 Surgery

marketing, information on side effects can be found on the product’s label. If the product is not approved, you may need to contact the sponsor. The following is a list of orphan drugs currently listed in the NORD Orphan Drug Designation Database for surgery: •

Temoporfin (trade name: Foscan) http://www.rarediseases.org/nord/search/nodd_full?code=1000

•

Urogastrone http://www.rarediseases.org/nord/search/nodd_full?code=251

•

Factor VIIa (recombinant, DNA origin) http://www.rarediseases.org/nord/search/nodd_full?code=497

•

Antihemophilic factor (recombinant) (trade name: Kogenate) http://www.rarediseases.org/nord/search/nodd_full?code=563

•

Chenodiol (trade name: Chenix) http://www.rarediseases.org/nord/search/nodd_full?code=627

•

Coagulation Factor IX (human) (trade name: AlphaNine) http://www.rarediseases.org/nord/search/nodd_full?code=656

•

Antithrombin III human (trade name: Antithrombin III human) http://www.rarediseases.org/nord/search/nodd_full?code=666

•

Aprotinin (trade name: Trasylol) http://www.rarediseases.org/nord/search/nodd_full?code=671

•

Mitomycin-C http://www.rarediseases.org/nord/search/nodd_full?code=88

•

Sodium phenylbutyrate http://www.rarediseases.org/nord/search/nodd_full?code=913

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.

369

APPENDICES

371

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

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

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

13

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

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•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

Physician Resources 373

NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.14 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:15 •

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

•

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

14

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 15 See http://www.nlm.nih.gov/databases/databases.html.

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•

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

•

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

A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to one of the following: Brochure/Pamphlet, Fact Sheet, or Information Package, and “surgery” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For the publication date, select “All Years.” Select your preferred language and the format option “Fact Sheet.” Type “surgery” (or synonyms) into the “For these words:” box. The following is a sample result: •

Recommendations for the Prevention of Human Immunodeficiency Virus (HIV) Transmission in the Practice of Orthopaedic Surgery Contact: American Academy of Orthopaedic Surgeons, 6300 N River Rd, Rosemont, IL, 60018-4262, (847) 823-7186. Summary: This report makes recommendations to prevent the transmission of the Human immunodeficiency virus (HIV) during surgical procedures. It says that orthopaedic surgeons face a particular risk because of their dealings with trauma cases, the sharpness of skeletal fragments, and the nature of their instruments. However, it also says surgeons have an obligation to provide high-quality care to all patients, including those with Acquired immunodeficiency syndrome (AIDS). The first section of the report deals with the possible risk that orthopaedic surgeons face of contracting HIV through occupational exposure. The second section provides scientific and epidemiologic data on HIV and AIDS, including modes of transmission, the risk from blood transfusions, the risk to health-care workers, universal precautions, and antibody tests. The third and final section outlines specific recommendations on universal precautions, including invasive procedures, use of blood, bone and soft-tissue allografts, responsibility toward patients, and testing of both patients and health-care workers.

•

Hepatitis B Virus Infection Without Immunological Markers After Open-Heart Surgery Source: Lancet. 345(8946): 355-357. February 11, 1995. Summary: Posttransfusion hepatitis is still an important problem, despite the screening of blood donors for hepatitis B virus (HBV) and hepatitis C virus infections. This article reports on a study in which the researchers assessed whether HBV DNA might be detected by PCR in prospectively collected serum samples of patients with unexplained posttransfusion hepatitis but no immunological HBV markers. They found HBV DNA in 4 (20 percent) of 20 patients with unexplained posttransfusion hepatitis and in 5 patients with mildly increased aminotransferases. The clinical course of these HBV infections was usually mild and self-limiting. The researchers conclude that low-titre, immunologically negative HBV infections do exist and might represent a significant cause of post-transfusion hepatitis.


•

Gastrointestinal Surgery for Severe Obesity Source: Bethesda, MD: National Institutes of Health. 1991. 22 p. Contact: Available from National Institutes of Health. Office of Medical Applications of Research, Building 1, Room 260, Bethesda, MD 20892. (301) 496-1144. Summary: The National Institutes of Health Consensus Development Conference on Gastrointestinal Surgery for Severe Obesity brought together surgeons, gastroenterologists, endocrinologists, psychiatrists, nutritionists, and other health care professionals as well as the public in March of 1991. The conference addressed the nonsurgical treatment options for severe obesity, the surgical treatments for severe obesity and the criteria for selection, the efficacy and risks of surgical treatments for severe obesity, and the need for future research on and epidemiological evaluation of these therapies. This brochure reprints the full text of the consensus panel's statement. Among their findings, the panel recommended that patients seeking therapy for severe obesity for the first time should be considered for treatment in a nonsurgical program with integrated components of a dietary regimen, appropriate exercise, and behavioral modification and support; gastric restrictive or bypass procedures could be considered for well-informed and motivated patients with acceptable operative risks; patients who are candidates for surgical procedures should be selected carefully after evaluation by a multidisciplinary team; the operation should be performed by a surgeon with substantial experience with the appropriate procedures and working in a clinical setting with adequate support for all aspects of management and assessment; and lifelong medical surveillance after surgical therapy is a necessity.

The NLM Gateway16 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.17 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “surgery” (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

16 17

Items Found 1223451 10000 2660 2841 169 1239121

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

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).

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HSTAT18 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.19 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.20 Simply search by “surgery” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

Coffee Break: Tutorials for Biologists21 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.22 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.23 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for 18

Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html.

19

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

20

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. 21 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. 22

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 23 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.


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/.

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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 surgery 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 surgery. 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 surgery. 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 “surgery”:

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•

Other guides Knee Injuries and Disorders http://www.nlm.nih.gov/medlineplus/kneeinjuriesanddisorders.html Laser Eye Surgery http://www.nlm.nih.gov/medlineplus/lasereyesurgery.html Osteoarthritis http://www.nlm.nih.gov/medlineplus/osteoarthritis.html Plastic & Cosmetic Surgery http://www.nlm.nih.gov/medlineplus/plasticcosmeticsurgery.html

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

General/Overviews Bariatric Surgery Source: American Medical Association http://www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZZCVJLXI9D&s ub_cat=382 Surgery for Obesity: What Is It and When Is It Appropriate? Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=HQ01465

•

Specific Conditions/Aspects Gastric Bypass Procedure: Questions and Answers Source: Cleveland Clinic Foundation http://www.clevelandclinic.org/health/healthinfo/docs/2500/2534.asp?index=9671 Implanted Stomach Band to Treat Severe Obesity Approved Source: Food and Drug Administration http://www.fda.gov/bbs/topics/ANSWERS/2001/ANS01087.html Laparoscopic Gastric Bypass Procedure Source: Cleveland Clinic Foundation http://www.clevelandclinic.org/health/healthinfo/docs/1900/1993.asp?index=4355 Lap-Band Adjustable Gastric Banding (LAGB) System Source: Center for Devices and Radiological Health http://www.fda.gov/cdrh/mda/docs/p000008.html Obesity Surgery Source: American Obesity Association http://www.obesity.org/education/advisor.shtml Several Factors Contribute to Complications Following Weight Loss Surgery Source: American Medical Association http://www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZZD2N03RFD& sub_cat=651

Patient Resources 381

•

From the National Institutes of Health Gastric Surgery for Severe Obesity Source: Weight-control Information Network http://www.niddk.nih.gov/health/nutrit/pubs/gastric/gastricsurgery.htm

•

Latest News Weight Loss Boosts Mood in the Severely Obese Source: 09/29/2003, Reuters Health http://www.nlm.nih.gov//www.nlm.nih.gov/medlineplus/news/fullstory_14127 .html

•

Organizations American Obesity Association http://www.obesity.org/ National Institute of Diabetes and Digestive and Kidney Diseases http://www.niddk.nih.gov/

•

Research Innovative Approach to Body Contouring after Massive Weight Loss Gives Patients New Body Image Source: American Society of Plastic Surgeons http://www.plasticsurgery.org/news_room/press_releases/Innovative-Approachto-Body-Contouring-After-Massive-Weight-Loss-Gives-Patients-New-Body-ImageASPS-Study-Reveals.cfm Mayo Clinic Study Finds Gastric Bypass Surgery Effective Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.org/news2000-rst/705.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 surgery. 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:

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•

Spinal Fusion Surgery Source: LaGrange, IL: North American Spine Society (NASS). 2001. 8 p. Contact: Available from North American Spine Society. For bulk orders write to: NASS, Dept 77-6663, Chicago, IL 60678-6663. For single copies write to: NASS, 22 Calendar Court, 2nd Floor, LaGrange, IL 60525. (877) SPINE-DR. Fax (708) 588-1080. E-Mail: [email protected]. Website: www.spine.org. PRICE: Sets of 25 for $15.00 (members) or $20.00 (nonmembers); single copy free (send self-addressed, stamped envelope). Summary: This full color patient education brochure uses a question and answer format to provide people who have spinal conditions with information on spinal fusion surgery. A surgeon may consider spinal fusion to treat a fractured vertebrae, correct certain types of spinal deformities such as scoliosis, eliminate pain from painful spinal motion, treat instability, and treat some cervical disc herniations. However, treatment of back or neck pain alone by spinal fusion is somewhat controversial because it is difficult to locate the source of pain in many patients. Surgical approaches and methods to fuse the spine all involve placement of a bone graft between the vertebrae. Fusion may or may not involve the use of hardware such as plates, screws, and cages. Regardless of whether or not hardware is used, bone or bone substitutes must be used to get the vertebrae to fuse together. Pain and recovery following spinal fusion are generally greater than with other types of spinal surgeries. Methods of postoperative pain control include oral pain medications, intravenous injections, and a patient controlled postoperative pain control pump. Return to normal activities is slower after spinal fusion because evidence of bone healing must be found before normal activities can be resumed. A brace is sometimes used for the early postoperative period. A postoperative rehabilitation that includes back strengthening exercises, a cardiovascular conditioning program, and a comprehensive program custom designed for the patient's work environment may be recommended. Spinal fusion is a good treatment for some spinal conditions, but it does not return the spine to normal.

•

Hip and Knee Replacement Surgery Source: Atlanta, GA: Arthritis Foundation. 2003. 20 p. Contact: Available from Arthritis Foundation. P.O. Box 7669, Atlanta, GA 30357-0669. (800) 283-7800. Website: www.arthritis.org. Summary: This brochure discusses joint replacement in patients with arthritis in their hips and knees. Hip and knee joints are replaced when pain in these joints has become so severe that the patient is unable to perform activities of daily living. Total joint replacement is performed when all other treatment methods have failed. The damaged bone or cartilage is removed and replaced with an artificial joint made up of polyethylene, metal and/or ceramic. Partial knee replacements are performed on patients with osteoarthritis on only one side of their knee. The three main types of knee and hip replacements are cemented, cementless, and hybrid. Cemented implants work best for older patients and patients with osteoporosis. Cementless implants last longer but require a longer recovery time. Hybrid implants are a combination of cemented and cementless components. The best way to find an orthopedic surgeon is to get a referral from a primary care physician or rheumatologist. A list of questions for interviewing potential surgeons is included. Patients should prepare for surgery by choosing anesthesia, losing weight if overweight, exercising to improve endurance, enlisting family members for help after the surgery, considering blood donation, and preparing the home for post-surgery recovery. The surgical procedure for hip and knee


replacement is described. Information for successful recovery in the hospital and at home is also included. •

Laminectomy and Laminotomy: Low Back Surgery To Reduce Your Pain Source: San Bruno, CA: StayWell Company. 2000. 16 p. Contact: Available from StayWell Company. 1100 Grundy Lane, San Bruno, CA 940663030. (800) 333-3032. Website: www.staywell.com. PRICE: Call or write for current pricing on single and bulk orders. Summary: This illustrated booklet provides people who have low back pain with information on surgical procedures to reduce back pain. Laminotomy and laminectomy are procedures that remove a small amount of bone from the spine so that pressure is taken off nerves in the low back. The booklet describes the anatomy of a healthy spinal column and explains what happens when a disk or bone presses against a nerve. This is followed by guidelines on preparing for surgery and a description of how a laminotomy and laminectomy are performed. The booklet then explains what happens after surgery in the postanesthesia care unit and in a hospital room. Topics include controlling pain, getting up and moving, and clearing the lungs. In addition, the booklet offers tips on getting out of bed, sitting and standing up, standing and turning, getting into bed, caring for the incision, resuming normal activities, improving strength and motion, and lifting safely. The booklet includes a surgical checklist to help readers remember what to do before and after surgery. Numerous figures.

•

Lumbar Disk Surgery: Treating Low Back Pain and Sciatica Source: San Bruno, CA: StayWell Company. 2000. 8 p. Contact: Available from StayWell Company. 1100 Grundy Lane, San Bruno, CA 940663030. (800) 333-3032. Website: www.staywell.com. PRICE: Call or write for current pricing on single and bulk orders. Summary: This illustrated booklet provides people who have low back pain and sciatica with information on disk surgery. Although a conservative treatment plan may relieve pain in some people, others may need surgery. The booklet describes the anatomy and function of the lower back and explains how disk problems cause pain. This is followed by a discussion of the medical examination, focusing on the medical history, the physical examination, and diagnostic tests. The booklet then describes various types of disk surgery, including classic diskectomy, microdiskectomy, and percutaneous diskectomy. In addition, the booklet offers guidelines on recovering from back surgery, focusing on undergoing physical therapy, using proper body mechanics, exercising regularly, and obtaining followup care. 13 figures.

•

Meniscus Surgery: Treatment for Your Torn Knee Cartilage Source: San Bruno, CA: StayWell Company. 2000. 8 p. Contact: Available from StayWell Company. 1100 Grundy Lane, San Bruno, CA 940663030. (800) 333-3032. Website: www.staywell.com. PRICE: Call or write for current pricing on single and bulk orders. Summary: This illustrated booklet provides people who have a torn meniscus with information on meniscus surgery. This procedure can repair or remove torn, uneven cartilage. The booklet describes the anatomy of a healthy meniscus and ways the meniscus can be torn. This is followed by an explanation of the orthopedic evaluation

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for a knee injury, focusing on the medical history, the physical examination, and diagnostic tests. The booklet then describes the procedures for repairing or removing tissue and identifies risks and complications. In addition, the booklet discusses home based recovery, followup care, and physical therapy. 15 figures. •

Post-Op Back Book: Taking Charge of Your Recovery From Surgery Source: San Bruno, CA: StayWell Company. 2000. 16 p. Contact: Available from StayWell Company. 1100 Grundy Lane, San Bruno, CA 940663030. (800) 333-3032. Website: www.staywell.com. PRICE: Call or write for current pricing on single and bulk orders. Summary: This illustrated booklet provides people who have undergone back surgery with information on recovery. The booklet explains why some people need surgery to correct spinal damage and identifies common types of lumbar surgery such as laminotomy, laminectomy, diskectomy, and fusion. This is followed by information on recovering in the hospital and at home. During the hospital stay, patients will receive medication to reduce pain and learn how to turn and brace themselves. Once at home, patients should increase their activity level steadily but gradually. The booklet explains what patients should expect during the first few weeks and at 6 weeks and afterward. The booklet then provides guidelines on lying on the back and side, sitting up after lying down, standing and turning, reaching, sitting in a chair, standing up from a seated position, bending, lifting, pushing, and pulling. In addition, the booklet includes tips on performing activities such dressing, having sex, grooming, working in the kitchen, showering, eating, doing deskwork, using the toilet, driving, shopping, and caring for a child. Exercises that can help stretch and strengthen muscles so that these activities are easier to perform are also presented. Numerous figures.

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Shoulder Replacement Surgery: Relieving Your Shoulder Pain Source: San Bruno, CA: StayWell Company. 2000. 16 p. Contact: Available from StayWell Company. 1100 Grundy Lane, San Bruno, CA 940663030. (800) 333-3032. Website: www.staywell.com. PRICE: Call or write for current pricing on single and bulk orders. Summary: This illustrated booklet provides people who have shoulder replacement surgery with information on undergoing and recovering from this surgical procedure. The booklet describes the anatomy of the healthy shoulder and identifies problems that can cause pain and stiffness, such as osteoarthritis, rheumatoid arthritis, fracture, avascular necrosis, and rotator cuff tear. This is followed by a discussion of the orthopedic evaluation to assess the shoulder, focusing on the medical history, the physical examination, and diagnostic tests such as x rays, computed tomography, and magnetic resonance imaging. The booklet then outlines the steps involved in preparing for surgery, that is, having a general physical and dental examination, storing blood, informing the surgeon about any medications being taken, and planning ahead to make home recovery go more smoothly. In addition, the booklet discusses preparations in the days before surgery, describes the surgical technique for replacing part or all of the shoulder, and offers guidelines on recovering in the hospital and at home. The booklet includes a surgical checklist to help readers remember what to do before and after surgery. 11 figures.


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Spinal Surgery for Your Lower Back: Getting Back Into the Swing of Things Source: San Bruno, CA: StayWell Company. 2000. 16 p. Contact: Available from StayWell Company. 1100 Grundy Lane, San Bruno, CA 940663030. (800) 333-3032. Website: www.staywell.com. PRICE: Call or write for current pricing on single and bulk orders. Summary: This illustrated booklet provides people who have low back problems with information on spinal surgery. The booklet begins by presenting a self assessment that readers can use to help them understand how much their back symptoms are affecting their life. This is followed by a description of the anatomy of the spine and a discussion of such spinal problems as a bulging disk, a ruptured or herniated disk, arthritis, and instability. The booklet then focuses on the use of a medical history, a physical examination, and diagnostic tests such as x rays, computed tomography, electromyograms, nerve blocks, and magnetic resonance imaging, to decide on a course of treatment. In addition, the booklet presents treatment options, including conservative management that involves limited activity, medication, physical therapy, manual therapy, and back supports, as well as surgery. The booklet discusses surgery in terms of changing medications, storing blood, quitting smoking, conditioning the body, reducing weight, and receiving psychological counseling in advance; undergoing a laminotomy or laminectomy, diskectomy, or fusion; and recovering in the hospital and at home. The booklet concludes with guidelines on exercises that promote strength, flexibility, and endurance and ways to improve and maintain back health. Numerous figures.

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Cervical Disk Surgery: Treating Neck and Arm Pain and Weakness Source: San Bruno, CA: StayWell Company. 1999. 16 p. Contact: Available from StayWell Company. 1100 Grundy Lane, San Bruno, CA 940663030. (800) 333-3032. Website: www.staywell.com. PRICE: Call or write for current pricing on single and bulk orders. Summary: This illustrated booklet provides people who have pain caused by a cervical spine disk problem with information on surgery. Although most cervical disk problems improve with conservative care, many patients find that their pain and weakness are relieved only by surgery. The booklet begins with a quiz readers can take to assess the effect of their cervical spine problem. The booklet then describes the anatomy of the cervical spine and explains why problems occur. This is followed by information on the medical evaluation for a cervical spine problem, focusing on the medical history, the physical examination, and diagnostic tests. The booklet then describes the components of a nonsurgical treatment plan, such as relieving symptoms by using medications, bed rest, and orthotic devices; restoring mobility and strength through physical therapy; and taking appropriate self care measures. In addition, the booklet discusses surgery in terms of preoperative measures, surgical techniques, and postoperative care. Preoperative preparation includes planning ahead for surgery, having realistic expectations about what surgery can achieve, and following the doctor's preoperative instructions. Surgical techniques that may be used are the anterior and posterior approaches. Postoperative care involves following the doctor's instructions about restricting activities and wearing a neck brace. Numerous figures.

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Endoscopic Carpal Tunnel Release: Surgery To Restore Comfort and Function Source: San Bruno, CA: StayWell Company. 1999. 8 p.

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Contact: Available from StayWell Company. 1100 Grundy Lane, San Bruno, CA 940663030. (800) 333-3032. Website: www.staywell.com. PRICE: Call or write for current pricing on single and bulk orders. Summary: This illustrated booklet provides people who have carpal tunnel syndrome (CTS) with information on endoscopic carpal tunnel release. The booklet describes the anatomy of the carpal tunnel and explains how CTS develops. This is followed by information on the endoscopic procedure. Preoperative preparation includes having a physical examination, undergoing laboratory and other tests, and discussing anesthesia options with an anesthesiologist. During the endoscopic procedure, a surgeon makes one or two small incisions in the palm or wrist, inserts the endoscope and surgical instruments through the incisions, uses these instruments to release the ligament, removes them, and closes the incisions. The booklet discusses postoperative care in terms of what patients should expect immediately after surgery and offers guidelines on recovering at home, getting stronger, returning to normal activities, and following up with the doctor. The booklet contains a checklist that readers may need to follow both before and after surgery. 5 figures. •

Hand Surgery: Relieving Your Pain and Restoring Function Source: San Bruno, CA: StayWell Company. 1999. 16 p. Contact: Available from StayWell Company. 1100 Grundy Lane, San Bruno, CA 940663030. (800) 333-3032. Website: www.staywell.com. PRICE: Call or write for current pricing on single and bulk orders. Summary: This illustrated booklet provides people who have hand problems such as tendinitis, cysts, tumors, or contractures with information on hand surgery. Although conservative treatment may be helpful, surgery is sometimes the best option for relieving pain and restoring movement and function. The booklet describes the anatomy of the hands and explains how they work. This is followed by information on the medical evaluation for a hand problem, focusing on the medical history, the physical examination, and diagnostic tests. The booklet then describes the procedures used to correct trigger finger, de Quervain's tendinitis, intersection syndrome, ganglion cyst, giant cell tumor, pyogenic granuloma, Dupuytren's contracture, jammed finger, and basal joint arthritis. The result of these procedures is highlighted. In addition, the booklet provides guidelines on helping the hand heal and following up with the surgeon. Numerous figures.

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Orthopaedic Foot Surgery: Relieving Pain and Improving Function Source: San Bruno, CA: StayWell Company. 1999. 16 p. Contact: Available from StayWell Company. 1100 Grundy Lane, San Bruno, CA 940663030. (800) 333-3032. Website: www.staywell.com. PRICE: Call or write for current pricing on single and bulk orders. Summary: This illustrated booklet provides people who have a foot problem with information on foot surgery. Conservative measures may not relieve symptoms, so orthopedic surgery may be needed to relieve pain and restore the foot to full function. The booklet describes the anatomy of a healthy foot and identifies areas where problems may occur, including the first toe, the lesser toes and forefoot, and the midfoot and hindfoot. This is followed by an explanation of the orthopedic evaluation for a foot problem, focusing on the medical history, the physical examination, and diagnostic tests. The booklet then presents guidelines on preparing for foot surgery. In addition,


the booklet describes various foot problems, such as bunions, degenerative joint disease, ingrown nails, curled toes, corns and calluses, neuromas, curved toes, ganglions, bone spurs, and fallen arches, and presents the procedures used to correct these problems. Other topics include bearing weight after surgery, relieving pain, driving a car, following up with the surgeon, and strengthening the foot. Numerous figures. •

Spinal Fusion: Understanding Your Surgery Source: San Bruno, CA: StayWell Company. 1999. 16 p. Contact: Available from StayWell Company. 1100 Grundy Lane, San Bruno, CA 940663030. (800) 333-3032. Website: www.staywell.com. PRICE: Call or write for current pricing on single and bulk orders. Summary: This illustrated booklet provides people who have a neck or back problem with information on spinal fusion. This surgical procedure may be the best way to control pain for some people. The booklet describes the anatomy of a normal spine and explains why fusing bones in the spine may help relieve pain. This is followed by a discussion of grafting bone into the spine, using bone from a bone bank or from the patient. The booklet then outlines the steps involved in preparing for fusion surgery, that is having a medical checkup, storing blood, planning ahead to make home recovery go more smoothly, quitting smoking, stopping aspirin use, getting ready on the day of the surgery, and talking with the anesthesiologist. In addition, the booklet explains the steps involved in performing a cervical fusion, an anterior lumbar fusion, and a posterior lumbar fusion. Other topics include recovering in the hospital and at home. The booklet concludes with guidelines on protecting the spine when standing and turning, getting in and out of a chair, lying in bed, turning in bed, and getting out of bed. The booklet also includes a surgical checklist to help readers remember what to do before and after surgery. Numerous figures.

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Surgery and Arthritis: What You Need to Know Source: Atlanta, GA: Arthritis Foundation. 1998. 20 p. Contact: Available from Arthritis Foundation. P.O. Box 1616, Alpharetta, GA 300091616. (800) 207-8633. Fax (credit card orders only) (770) 442-9742. http://www.arthritis.org. PRICE: Single copy free from local Arthritis Foundation chapter (call 800-283-7800 for closest local chapter); bulk orders may be purchased from address above. Summary: This brochure for people with arthritis addresses issues surrounding the use of surgery to lessen the pain, disability, and deformity caused by this disease. First, it describes the structure of joints so patients can understand what surgery can do for them. Then it identifies the benefits and risks of surgery, lists questions that patients should ask before proceeding with surgical treatment, and highlights the factors that will influence its cost. The brochure describes various types of surgical procedures and explains in detail how surgery can benefit the hip and other joints. In addition, it offers guidelines on preparing for and recuperating from joint surgery. Information on the Arthritis Foundation is also provided. 7 figures.

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Surgery of the Foot and Ankle Source: Park Ridge, IL: American College of Foot and Ankle Surgeons. 1998. 3 p. Contact: Available from American College of Foot and Ankle Surgeons. 515 Busse Highway, Park Ridge, IL 60068. (800) 421-2237 or (847) 292-2237. Fax (800) 382-8270 or

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(847) 292-2022. E-mail: [email protected]. Website: www.acfas.org. PRICE: Package of 50 for members, $18.50 plus shipping; for non-members, $27.50 plus shipping. Summary: This brochure uses a question and answer format to provide people who have foot and ankle problems with information on the causes and surgical treatment of these problems. Foot and ankle problems include congenital, acquired, traumatic, and infectious problems, as well as neoplastic and arthritic disorders. Many foot and ankle conditions, including sprains, fractures, arthritis and joint disease, benign and malignant tumors, and congenital and acquired deformities, respond well to surgery. Surgical management of foot and ankle problems may be needed if conservative treatment is ineffective. Surgery can be performed in the office or in an outpatient setting. Postoperative care usually involves the use of an immobilization device and some form of therapy. •

Lumbar Microsurgery: Low-Back Surgery To Reduce Your Pain Source: San Bruno, CA: StayWell Company. 1998. 16 p. Contact: Available from StayWell Company. 1100 Grundy Lane, San Bruno, CA 940663030. (800) 333-3032. Website: www.staywell.com. PRICE: Call or write for current pricing on single and bulk orders. Summary: This illustrated booklet provides people who have low back pain with information on lumbar microsurgery, which is performed through a small incision. The two types of lumbar microsurgery are microdecompression and microdiskectomy. The booklet describes the anatomy of a healthy spinal column and explains what happens when a disk or bone presses against a nerve. This is followed by guidelines on preparing for surgery and a description of how microdecompression and microdiskectomy are performed. The booklet then explains what happens after surgery in the recovery room and in a hospital room. Topics include controlling pain, getting up and moving, and clearing the lungs. In addition, the booklet offers tips on caring for the incision, resuming normal activities, using good body mechanics to move, lifting safely, sitting and standing up, standing and turning, getting into and out of bed, and improving strength and motion. The booklet includes a surgical checklist to help readers remember what to do before and after surgery. Numerous figures.

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Dermatologic Surgery Source: Schaumburg, IL: American Academy of Dermatology. 1998. 8 p. Contact: American Academy of Dermatology. Communications Department, 930 North Meacham Road, P.O. Box 4014, Schaumburg, IL 60168-4014. (847) 330-0230. Fax (847) 330-0050. Website: www.aad.org. PRICE: Contact for pricing information; bulk discounts available. Summary: This pamphlet for the general public focuses on dermatologic surgery. It presents reasons for performing skin surgery, including preventing or providing early control of disease, improving the appearance of the skin, and establishing a definite diagnosis. Types of skin cancer are identified, including basal cell cancer, squamous cell cancer, and malignant melanoma. Common forms of treatment for skin cancer are explained, including curettage and electrodesiccation, surgical excision, cryosurgery, Mohs' surgery, topical chemotherapy, and radiation therapy. Other skin blemishes that may be eliminated or improved by a dermatological surgical procedure are described, including age or liver spots, birthmarks, moles, warts, scars, wrinkles, actinic or


seborrheic keratoses, cysts, and baldness. In addition, the pamphlet presents the events of a typical visit to the dermatologist's office. •

Your Podiatric Physician Talks About Forefoot Surgery Source: Bethesda, MD: American Podiatric Medical Association. 1997. 8 p. Contact: Available from American Podiatric Medical Association. 9312 Old Georgetown Road, Bethesda, MD 20814-1698. (800) 275-2762 or (301) 581-9277. Fax (301) 530-2752. Website: www.apma.org. PRICE: Single copy free; bulk orders available at cost. Summary: This pamphlet provides people who have foot problems with information on foot surgery. Surgical intervention may be needed to help alleviate pain or to restore function. The pamphlet describes various foot problems, including bunions, hammertoes, neuromas, bunionettes, toenail deformities, and bone spurs. In addition, the pamphlet explains when surgical intervention may be warranted, discusses preoperative testing and care, and offers guidelines for postoperative care. 4 figures.

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Your Podiatric Physician Talks About Rearfoot Surgery Source: Bethesda, MD: American Podiatric Medical Association. 1997. 6 p. Contact: Available from American Podiatric Medical Association. 9312 Old Georgetown Road, Bethesda, MD 20814-1698. (800) 275-2762 or (301) 581-9277. Fax (301) 530-2752. Website: www.apma.org. PRICE: Single copy free; bulk orders available at cost. Summary: This pamphlet provides people who have problems affecting the back portion of the foot and ankle with information on rearfoot surgery, which may be needed to help alleviate pain or to correct a deformity. The pamphlet discusses surgical intervention for common conditions that cause pain at the bottom of the heel, including plantar fasciitis and heel spurs; describes various other deformities, including Haglund's deformity and insertional Achilles calcification or spur; and explains when surgical intervention may be warranted. In addition, the pamphlet comments on reconstructive surgery of the foot and ankle, discusses preoperative testing and care, and offers guidelines on postoperative care. 2 figures.

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Hair Restoration Surgery Source: Schaumburg, IL: American Society for Dermatologic Surgery ASDS). 1997. 6 p. Contact: Available from American Society for Dermatologic Surgery. ATTN: Pamphlets, 930 North Meacham Road, Schaumburg, IL 60173-6016. (800) 441-2737 or (847) 330-9830. Fax (847) 330-1135. Website: www.asds-net.org. PRICE: Package of 50 for members, $25.00; for nonmembers, $40.00; bulk orders sold to physicians only. Call '800' number or access website for single free copy. Summary: This pamphlet uses a question and answer format to provide people who have hair loss with information on hair restoration surgery. Common causes of temporary or permanent hair loss include heredity, illness or disease, nutritional deficiencies, stress, medications, injury, high fever, improper or abusive hair treatment, and cancer treatments. Male or female pattern baldness accounts for most hair loss. Hair restoration surgery may be performed to correct hair loss and create a natural looking hairline. A board certified dermatologic surgeon who is an expert in the causes and treatment of hair loss should be consulted to achieve maximum safety and the best looking results. The ideal candidate for hair restoration surgery has healthy, dense hair on the sides and the back of the head. Surgical options for hair replacement include hair

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transplant surgery, scalp reduction, scalp extenders or tissue expanders, and scalp lifts and scalp flaps. The pamphlet also answers questions about where treatment is usually performed, what can be expected after surgery, how many treatments are needed, and what complications can occur. •

Dermatologic Surgery: Pathways to Healthy Skin Source: Schaumburg, IL: American Society for Dermatologic Surgery (ASDS). 1997. 6 p. Contact: Available from American Society for Dermatologic Surgery. ATTN: Pamphlets, 930 North Meacham Road, Schaumburg, IL 60173-6016. (800) 441-2737 or (847) 330-9830. Fax (847) 330-1135. Website: www.asds-net.org. PRICE: Package of 50 for members, $25.00; for nonmembers, $40.00; bulk orders sold to physicians only. Call '800' number or access website for single free copy. Summary: This pamphlet for the general public uses a question and answer format to provide information on dermatologic surgery. This discipline deals with the diagnosis and treatment of conditions of the skin, hair, nails, mucous membranes, and adjacent tissues by various surgical methods. The pamphlet outlines the conditions that may be diagnosed and treated by a dermatologic surgeon and provides information on the training and qualifications of a dermatologic surgeon. It describes common surgical procedures used to treat various skin and nail conditions. Other topics include where treatment is usually performed, the results that can be expected from dermatologic surgery, the risks of dermatologic surgery, and ways of finding a qualified dermatologic surgeon. In addition, the pamphlet lists common skin conditions and their treatment.

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The Effect of Upper Airway Surgery on Voice Source: Otolaryngology-Head and Neck Surgery. 2002:127(1) 32-35. Contact: American Academy of Otolaryngology-Head and Neck Surgery. Full text of this article is available to subscribers and for pay-per-view at http://www2.us.elsevierhealth.com/scripts/om.dll/serve?action=searchD B&searchDBfor=art&artType=full&id=a126589. Reprint requests: Alison Behrman, PhD, Schein Voice and Laryngeal Center, Department of Otolaryngology, Long Island Jewish Medical Center, 270-05 76th Avenue, New Hyde Park, NY 11040; e-mail, [email protected]. Summary: This report presents details and findings of a study conducted to assess patient perception and acoustic characteristics of voice before and after upper airway surgery. The study participants were 44 surgical patients, and operations included septoplasty and turbinectomy (n = 28); and septoplasty, turbinectomy, uvulopalatopharyngoplasty, and tonsillectomy (n = 16). The authors concluded that upper airway operations can affect acoustics and perception of voice. 2 tables. 3 figures. 20 references.

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Middle Ear Surgery: For Better Health and Hearing Source: San Bruno, CA: StayWell Company. 2000. 16 p. Contact: Available from StayWell Company. 1100 Grundy Lane, San Bruno, CA 940663030. (800) 333-3032. Website: www.staywell.com. PRICE: $1.50 plus shipping and handling. Summary: This booklet informs patients about middle ear surgery, which is often undertaken to improve hearing and ease other symptoms in people with chronic middle


ear problems. The booklet covers the basics of middle ear anatomy and function, typical symptoms of middle ear problems, the treatment plan, preoperative care and information, tympanoplasty (repair of a damaged eardrum), mastoidectomy (removal of infected bone and growths from the middle ear), ossicular chain reconstruction (replacement of the three middle ear bones), stapes surgery (to replace all or part of a damaged stapes bone), hospital recovery, and postoperative care at home. Detailed illustrations of the middle ear are provided. The booklet is illustrated with full color line drawings of the medical settings and the procedure used for each of the surgical techniques described. 32 figures. •

Surgery in the Age of AIDS: The Prevention of Viral Transmission in the Operating Room Contact: University of Washington, Novela Health Education, 901 Boren St Ste 1100, Seattle, WA, 98104, (800) 677-4799. Summary: This teaching aid presents a training program for health care services personnel who work in surgery; its purpose is to reduce their risk of exposure to communicable diseases, including Hepatitis B and Human immunodeficiency virus (HIV), the etiologic agent of Acquired immunodeficiency syndrome (AIDS). The program describes HIV and Hepatitis transmission, the rationale for universal precautions, indications for receiving a Hepatitis B vaccine, conditions when use of protective equipment and supplies is appropriate, the definition of significant exposure to blood or body fluids, and procedures to follow after exposure to body fluids. Participants in the program become aware that any patient could be contagious and that they must make time to follow all precautions. The need for compulsory blood tests for surgical paitnets is analyzed. Three aspects of protection are taught: Proper use of barriers, proper handling of sharp instruments and objects, and Hepatitis B vaccination. In addition, the training program emphasizes protection of one's colleagues through proper passing of sharp instruments, removal of soiled gloves after performing surgical tasks, and proper waste disposal procedures.

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Bunion Surgery Source: Rosemont, IL: American Academy of Orthopaedic Surgeons. 1995. 18 p. Contact: American Academy of Orthopaedic Surgeons, 6300 North River Road, Rosemont, IL 60018. Summary: This brochure for individuals with bunions helps them understand more about the surgical option for treating bunions. Bunions are defined, and the causes of bunions are identified. Ways of preventing bunions are suggested, including wearing shoes that fit properly. Guidelines for selecting proper footwear are provided. Reasons why individuals may undergo bunion surgery are presented. Types of bunion surgery are described, including repair of the tendons and ligaments around the big toe, arthrodesis , exostectomy , resection arthroplasty , and osteotomy. The components of the orthopaedic evaluation are discussed. Guidelines are provided for preparing for surgery, undergoing surgery, and recovering from surgery. An exercise and activity guide is also included. 25 illustrations.

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Dermal Electrosurgery Shave Excision Source: American Family Physician. 65(9). May 1, 2002. 2 p.

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Summary: This fact sheet provides patients with information about dermal electroshave excision, a technique used to remove skin tumors and skin growths. This technique allows the tumor or growth to be removed without penetrating the skin. Shave excision is less expensive and results in less noticeable scarring and fewer infections than full thickness skin excision. Local anesthesia is used. After excision the tumor or growth is sent to a lab for analysis. Any scarring caused by the procedure will eventually fade. After the surgery, an antibiotic cream and a solution to stop bleeding will be applied to the wound. Nonprescription pain relievers may be taken. If the wound becomes infected or if the scar becomes hard the patient should contact the doctor. •

Rodding Surgery in Children With Osteogenesis Imperfecta Source: Gaithersburg, MD: Osteogenesis Imperfecta Foundation (OIF). 1997. 2 p. Contact: Available from Osteogenesis Imperfecta Foundation. 804 West Diamond Avenue, Suite 210, Gaithersburg, MD 20878. (800) 981-2663 or (301) 947-0083. Fax (301) 947-0456. Website: www.oif.org. PRICE: Single copy free. Summary: This fact sheet provides health professionals, people who have osteogenesis imperfecta (OI), and their families with information on the use of rodding surgery in children with moderate and severe forms of OI. This type of surgery involves the straightening and internal splinting of one or more long bones. The fact sheet explains the purpose of rodding, discusses the timing of surgery, and describes the procedure using with nonexpanding and expanding rods. Other topics include anesthesia and postoperative care.

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Plastic Surgery Considered Source: Sharon, MA: PXE International. 2001. 4 p. Contact: Available from PXE International. 23 Mountain Street, Sharon, MA 02067. (781) 784-3817. Fax (781) 784-6672. E-mail: [email protected]. Website: www.pxe.org. PRICE: Single copy free. Summary: This fact sheet, which is based on a presentation given at the International Centennial Meeting on Pseudoxanthoma Elasticum (PXE), provides people who have PXE with information on plastic surgery. Wrinkles, folds, and looseness of the skin may result from PXE, and these can be removed with plastic surgery. However, the cobblestone appearance of the skin cannot be changed by surgery. One surgical technique that can be used in people affected by PXE is a procedure called direct excision. The folds and loose skin are smoothed out by pulling the skin in one direction, and the excess skin is cut away. However, this procedure may leave an obvious scar. Other procedures that can be used to improve the appearance of folds and loose skin include a face lift, a neck lift, or tightening of the skin of the breasts or abdomen. Anyone considering one of these procedures should find out where the incisions will be and understand that permanent scarring could occur. A person who is considering surgery should have a thorough preoperative cardiac workup and an evaluation of all other systems. Postoperative complications include scarring, calcium extrusion, infections, reaction to anesthesia, and risk of hematoma. One difficulty PXE patients deal with in deciding whether to undergo plastic surgery is that insurance coverage may be initially denied for some patients. The key to the decision is usually based on the definition of plastic surgery as either reconstructive surgery or cosmetic surgery. PXE is a congenital condition, so corrective procedures should be defined as reconstructive surgery and, thus, covered by insurance.


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Facts About Dermatologic Surgery Source: Schaumburg, IL: American Society for Dermatologic Surgery (ASDS). 1998. 2 p. Contact: Available from American Society for Dermatologic Surgery. 930 North Meacham Road, Schaumburg, IL 60173-6016. (800) 441-2737 or (847) 330-9830. Fax (847) 330-0050. Website: www.asds-net.org. PRICE: Call '800' number or access website for single free copy. Summary: This fact sheet uses a question and answer format to provide the general public with basic facts about dermatologic surgery, which deals with the diagnosis and treatment of conditions of the skin, hair, nails, veins, mucous membranes, and genitalia. The fact sheet outlines the conditions that may be diagnosed and treated by a dermatologic surgeon, including cancerous growths, warts, some precancerous lesions, cysts and moles, aging and sun-damaged skin, baldness, fatty tumors, scars, spider and varicose veins, and tattoos. The fact sheet offers suggestions to help determine which surgical technique is best for a particular patient. Also included are information on the American Society for Dermatologic Surgery and a source for further information.

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Laser Applications in Dermatologic Surgery Source: Schaumburg, IL: American Society for Dermatologic Surgery (ASDS). 1998. 2 p. Contact: Available from American Society for Dermatologic Surgery. 930 North Meacham Road, Schaumburg, IL 60173-6016. (800) 441-2737 or (847) 330-9830. Fax (847) 330-0050. Website: www.asds-net.org. PRICE: Call '800' number or access website for single free copy. Summary: This fact sheet uses a question and answer format to provide the general public with information on the use of lasers in dermatology. Laser stands for Light Amplification by the Stimulated Emission of Radiation. The fact sheet explains how a laser works, what type of laser should be used to treat various skin conditions, and who is qualified to perform laser surgery. It presents an overview of the types of lasers, including the carbon dioxide laser, the argon laser, the yellow and red light lasers, the Q-switched neodymium laser, and the KTP laser, and their uses in dermatology. Other topics include the benefits of laser surgery and other applications of laser technology. In addition, the fact sheet provides information on the American Society for Dermatologic Surgery and presents a source for further information. The National Guideline Clearinghouse™

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

ACC/AHA guidelines for coronary artery bypass graft surgery: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1991 Guidelines for Coronary Artery Bypass Graft Surgery) Source: American College of Cardiology Foundation - Medical Specialty Society; 1999 October; 80 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2121&nbr=1347&a mp;string=surgery

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Antibiotic prophylaxis in surgery. A national clinical guideline Source: Scottish Intercollegiate Guidelines Network - National Government Agency [Non-U.S.]; 2000 July; 36 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2911&nbr=2137&a mp;string=surgery

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ASHP therapeutic guidelines on antimicrobial prophylaxis in surgery Source: American Society of Health-System Pharmacists - Professional Association; 1999 September 15; 50 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2182&nbr=1408&a mp;string=surgery

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CO2 laser surgery of the face and eyelids Source: American Society of Plastic Surgeons - Medical Specialty Society; 1998 June 26; 10 pages http://www.guideline.gov/summary/summary.aspx?doc_id=1713&nbr=939&am p;string=surgery

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Criteria for cervical surgery related to entrapment of a single cervical nerve root Source: Washington State Department of Labor and Industries - State/Local Government Agency [U.S.]; 1999; 1 page http://www.guideline.gov/summary/summary.aspx?doc_id=1894&nbr=1120&a mp;string=surgery

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Hysteroscopic surgery. A national clinical guideline Source: Scottish Intercollegiate Guidelines Network - National Government Agency [Non-U.S.]; 1999 April; 19 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2908&nbr=2134&a mp;string=surgery

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Laser refractive surgery Source: National Committee on Ophthalmology (Singapore) - National Government Agency [Non-U.S.]; 2001 July; 32 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2890&nbr=2116&a mp;string=surgery


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SAGES guidelines for laparoscopic surgery during pregnancy Source: Society of American Gastrointestinal Endoscopic Surgeons - Medical Specialty Society; 1996 February (revised 2000 Oct); 4 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3146&nbr=2372&a mp;string=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: •

Archives of Otolaryngology-Head & Neck Surgery Summary: Information for physicians and scientists concerned with diseases of the head and neck. The Archives publishes clinical and basic research from an array of disciplines. Source: American Medical Association http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=4283

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Breast Implants: An Informational Update Summary: The information on this web page is designed to inform women and other interested persons about breast implants and breast implant surgery. Source: U.S. Food and Drug Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=1173

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CHEST: Cardiopulmonary and Critical Care Journal Summary: This monthly journal features cutting edge clinical investigations in the multidisciplinary specialties of chest medicine, such as pulmonology, cardiology, thoracic surgery, transplantation, sleep and Source: American College of Chest Physicians http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=1941

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Cosmetic Laser Surgery: A High-Tech Weapon in the Fight Against Aging Skin Summary: This brochure discusses the use of laser in cosmetic surgery and provides information about the different procedures. Source: Federal Citizen Information Center, U.S. General Services Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=5967

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Daily Activities After Hip Replacement Surgery Summary: healthfinder® — your guide to reliable health information health library just for you health care organizations search: go help | about healthfinder® Daily Activities Source: American Occupational Therapy Association http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=7319

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Dental More Gentle with Painless Drilling and Matching Fillings Summary: This FDA Consumer magazine article discusses innovative methods -- the erbium:YAG laser and the microair abrasion unit -- dentists are using in gum surgery and tooth decay treatment. Source: U.S. Food and Drug Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=4483

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Dermatologic Surgery Summary: Dermatologic surgeons are board-certified specialists in dermatology who are trained and experienced in procedures to repair the function and improve the appearance of the skin. Source: American Society For Dermatologic Surgery http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6739

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FAQ - About Hip Replacement Summary: Questions about this procedure and alternatives are addressed here. The goals of hip replacement surgery are to improve mobility by relieving pain and improve function of the hip joint. Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=1240

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FAQ About - Ambulatory Surgery Centers (ASCs) Summary: The Federated Ambulatory Surgery Association answers consumers' most commonly asked questions about ambulatory surgery and the role of ambulatory surgery centers in health care. Source: Federated Ambulatory Surgery Association http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6229

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Functional Endoscopic Sinus Surgery Summary: A discussion on the use of functional endoscopic sinus surgery -- a minimally invasive technique used to restore sinus ventilation and normal function. Source: American Academy of Family Physicians http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=4282


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Giving Your Informed Consent Summary: This document covers questions you should ask your doctor before consenting to surgery. Source: American College of Surgeons http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=4887

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Help for Smokers: Ideas to Help You Quit Summary: Information that can help you kick the smoking habit. Includes information about pregnancy and smoking and discusses the added risks for a smoker facing surgery. Source: Agency for Healthcare Research and Quality http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=2462

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Hernia Information Home Page Summary: This web site covers all kinds of hernias and provides information by leading specialist on tension-free hernia repair surgery. Source: Nonprofit/Professional Entity--Follow the Resource URL for More Information http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=3897

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Hip Spica Cast: A Guide for Patients Summary: Information about how to take care of a child in a hip spica cast and what to expect if your child is going to have this surgery. Source: Educational Institution--Follow the Resource URL for More Information http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=4090

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How to Look for A Qualified Surgeon Summary: This document provides consumers with a list of do's and don't's to follow when selecting a doctor for surgery -- what qualifications you should look for and how to check on those qualifications. Source: American College of Surgeons http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=4924

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Ileostomy, Colostomy, and Ileoanal Reservoir Surgery Summary: This document defines the types of surgeries involved for patients with digestive diseases requiring partial or total removal of the intestines. Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=1999

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Journal of Gastrointestinal Surgery Summary: The Journal of Gastrointestinal Surgery is the official publication of the Society for Surgery of the Alimentary Tract (SSAT). This web site offers only the Abstracts from the Journal of GI Surgery. Source: Society for Surgery of the Alimentary Tract http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=5579

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Lasers in Cancer Treatment Summary: Discussion on the types of lasers, the use of laser light surgery in cancer treatment and the types of cancers for which laser light treatment is currently used. Source: National Cancer Institute, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=4356

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LASIK Eye Surgery Summary: This web site offers objective information about LASIK surgery -- a procedure intended to reduce a person's dependency on glasses or contact lenses. Source: Center for Devices and Radiological Health, U.S. Food and Drug Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=5768

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LASIK Eye Surgery Glossary Summary: A list of medical terms and definations related to the structure of the eye and LASIK eye surgery. Source: Center for Devices and Radiological Health, U.S. Food and Drug Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=5769

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LASIK Surgery Check List Summary: If you are considering LASIK eye surgery this online checklist could help you to decide if the procedure is right for you. Source: Center for Devices and Radiological Health, U.S. Food and Drug Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=5775

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Liposuction Surgery Summary: In the early 1980s, dermatologic surgeons pioneered liposuction techniques to safely and effectively remove undesired fat from nearly all body area, including the face, neck, chin, breast, back, arms, Source: American Society For Dermatologic Surgery http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6745


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Low Doses of Aspirin and Surgery Better for Stroke Prevention Summary: Report on the findings of the Aspirin and Carotid Endarterectomy (ACE) trial, sponsored by the National Institute of Neurological Disorders and Stroke (NINDS). Source: National Institute of Neurological Disorders and Stroke, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=757

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OI Issues: Rodding Surgery Summary: Rodding surgery involves internal Source: Osteogenesis Imperfecta Foundation, Inc. http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=7029

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Patient Information About The Eye Summary: Basic educational information for eye care patients. Includes an eye care glossary; information about cataracts, and refractive eye surgery. Source: American Society of Cataract and Refractive Surgery http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=2631

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Practice Parameters for Ambulatory Anorectal Surgery Summary: These guidelines were written for clinicians and surgeons with a warning that they Source: American Society of Colon and Rectal Surgeons http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=2317

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The Electronic Journal of Hand Surgery Summary: This journal contains abstracts, brief reports, case reports and correspondence related to surgery of the hand and upper limb. Source: Commercial Entity--Follow the Resource URL for More Information http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=4517

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Tips on Selecting a Surgeon for the LASIK Procedure Summary: This web site presents criteria and suggested reading that will help you select a surgeon to perform the LASIK procedure -- surgery used in correcting a wide range of nearsightedness (myopia), Source: LASIK Institute http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=5302

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Total Knee Replacement: A Patient Guide Summary: Consumer information about total knee replacement surgery including surgical procedures, pre-operative and post-operative care, the risks and benefits of surgery, and rehabilitation. Source: Educational Institution--Follow the Resource URL for More Information http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=4088

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Transplantation (Journal) Summary: This bi-monthly journal features articles and reports related to advances in transplantation surgery. Source: American Society of Transplantation http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=5131

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What Is Hair Replacement Surgery? Summary: This brochure provides information about hair replacement surgery -- hair grafting techniques performed by a physician. Source: American Hair Loss Council http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=3944

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What Will Your Operation Cost Summary: Advice on what questions you should ask your surgeon, as well as the hospital where you are scheduled to have surgery, regarding his or her fees and those of his assistants and hospital rates. Source: American College of Surgeons http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=4890

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Who Should Do Your Operation? Summary: This document advises consumers on what qualifications to look for when selecting a physician to do their surgery. Source: American College of Surgeons http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=4891

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X-Plain™ Abdominal Aortic Aneurysm Vascular Surgery: Reference Summary Summary: A review of the risks and benefits of surgery for people suffering from an abdominal aortic aneurysm. Source: National Library of Medicine, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6124


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Your Podiatric Physician Brochure Series Summary: Consumer health information pamphlets discuss several foot health conditions and concerns, including athlete's foot, occupational foot health, warts, foot orthoses, children's feet, foot surgery, heel Source: American Podiatric Medical Association http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=4289 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 surgery. 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: •


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

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

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

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

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

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

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

AirLifeLine Telephone: (916) 641-7800 Toll-free: (800) 446-1231 Fax: (916) 641-0600 Email: [email protected] Web Site: http://www.airlifeline.org

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Background: AirLifeLine is a national nonprofit organization of private pilots who donate their time, skills, aircraft, and fuel to fly medical missions. Founded in 1978, the program was initially established to provide efficient transportation of time-critical medical cargo. In 1984, the organization's services were expanded to include ambulatory patients who require life-sustaining treatments, such as surgery, chemotherapy, radiation, or medical care, at medical facilities far from home and who cannot afford the cost of travel. The program, which initially included 25 interested pilots in California, has grown to include over 900 pilots nationwide. The program's services are provided at no cost to patients or referring agencies. AirLifeLine provides flights for patients who fulfill certain criteria (e.g., demonstrated medical and financial needs, etc.) and for an accompanying support person or persons, such as the parents of an ill child. The organization does not limit its services to a specific age group of patients nor to specific medical diagnoses. In addition to providing flights for patients who need to travel to medical treatment centers, AirLifeLine also offers flights to help fulfill the wishes of terminally ill patients. This type of request must come for an organization, agency, or hospital that is aware of the patient's situation. To a limited degree, the program also flies time-critical cargo, such as blood or donor organs for transplants and other types of surgery. AirLifeLine receives referrals from health care and hospital social workers, discharge planners, and voluntary organizations. In addition, patients and family members may directly contact the organization for assistance. •

Craniofacial Foundation of America Telephone: (423) 778-9192 Toll-free: (800) 418-3223 Fax: (423) 778-8172 Email: [email protected] Web Site: http://www.erlanger.org/cranio Background: The Craniofacial Foundation of America (CFA) is a not-for-profit organization dedicated to improving the quality of life for individuals and families affected by head and/or facial difference(s) as a result of birth defect, tumor, or traumarelated injury. Established in 1989, the Foundation provides financial assistance for food, travel, and lodging expenses to qualified families traveling to the Tennessee Craniofacial Center for evaluation and treatment. The Foundation provides support services for both affected individuals and their families including regularly scheduled support group meetings and a parent to parent network. CFA also maintains a toll-free hotline and offers educational materials including brochures on 'The History of Craniofacial Surgery' and 'Post Traumatic Deformities and Facial Reconstruction in Treacher Collins Syndrome.'.

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Crohn's and Colitis Foundation of Canada Telephone: (416) 920-5035 Toll-free: (800) 387-1479 Fax: (416) 929-0364 Email: [email protected] Web Site: http://www.ccfc.ca Background: The Crohn s and Colitis Foundation of Canada (CCFC) is a not-for-profit voluntary health organization dedicated to raising funds for research to determine the cause of and the cure for Crohn s disease and colitis. Crohn s disease and ulcerative colitis, known as inflammatory bowel diseases, are chronic digestive disorders of


unknown cause. Crohn s disease may affect any part of the digestive tract and often results in swelling, soreness, and inflammation of layers of the large and/or small intestinal wall. Ulcerative colitis affects the colon (large intestine), causing inflammation of the inner lining and resulting in diarrhea, often mixed with blood, cramping abdominal pain, and other symptoms. Established in 1974, CCFC s mission is to help find the cure for Crohn s disease and ulcerative colitis. The Foundation provides educational programs for affected individuals, their families, health professionals, and the general public. In addition, the Foundation provides educational and awareness initiatives through approximately 75 local CCFC volunteer groups and CCFC community education events, featuring leading IBD specialists. The Foundation publishes a brochure series in both French and English. Titles include 'Surgery and Inflammatory Bowel Disease,' 'Nutrition, Diet and Inflammatory Bowel Disease,' 'Medication for Inflammatory Bowel Disease,' 'Sexuality, Fertility, Pregnancy and Inflammatory Bowel Disease,' and 'Living with Inflammatory Bowel Disease.' 'The Journal,' a regularly published newsletter, is also available. •

European Organization for Research and Treatment of Cancer Telephone: 322 774 1630 Fax: 322 772 2004 Email: [email protected] Web Site: http://www.eortc.be Background: The European Organization for Research and Treatment of Cancer (EORTC) is an international not-for-profit research organization dedicated to conducting, developing, coordinating, and stimulating basic and clinical research on cancer and related problems. The EORTC was established in 1962 by a group of oncologists who felt that extensive, comprehensive research in such fields may often be beyond the means of individual European laboratories and hospitals and could best be accomplished through multidisciplinary, multinational efforts of clinical and basic research groups of the European continent. The EORTC's primary objective is to raise the standard of cancer treatment through the development of new drugs and new regimens in order to improve and save the lives of individuals affected by cancer. The Organization is involved with new drug development from preclinical evaluation up to Phase III clinical trials as well as in strategy trials dealing with combined therapeutic modalities (surgery, radiotherapy, chemotherapy, immunotherapy), quality of life evaluation, and health economic assessment. The EORTC consists of a pan-European network involving more than 2,500 clinical investigators and scientists in more than 350 hospitals and research institutions in over 30 countries. The European Organization for Research and Treatment of Cancer publishes an annual directory entitled 'Organization, Activities, and Current Research' and has a web site on the Internet that discusses its mission, services, and ongoing research activities. In addition, the 'European Journal of Cancer' (EJC) is the official journal of the EORTC, the European School of Oncology, the European Association for Cancer Research, and the Federation of European Cancer Societies. The EJC is a comprehensive international oncology journal that publishes international cancer news, original articles, editorials, reviews, and letters and covers current controversies in oncology.

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Extracorporeal Membrane Oxygenation Support Group Telephone: (806) 743-2284 Toll-free: TTY:

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Fax: (806) 743-2314 Background: The Extracorporeal Membrane Oxygenation (ECMO) Support Group is a not-for-profit self-help organization dedicated to providing information and support to parents of children facing surgery for ECMO. This is a technique that provides respiratory support by oxygenating the blood outside the body and then returning it to the circulatory system. Established in 1987, the ECMO Support Group provides educational and supportive information through a regular newsletter and materials discussing surgery for ECMO. •

FACES: The National Craniofacial Association Telephone: (423) 266-1632 Toll-free: (800) 332-2373 Fax: (423) 267-3124 Email: [email protected] Web Site: http://www.faces-cranio.org Background: FACES: The National Craniofacial Association is a not-for-profit organization whose purpose is to provides families with financial assistance for travel to major medical centers for reconstructive surgery; offer information and support to affected families; and increase public awareness and understanding of facial abnormalities. Educational materials produced by FACES include brochures, a quarterly newsletter, and a statement of services and other resources.

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Forward Face, Inc Telephone: (212) 684-5860 Toll-free: (800) 393-3223 TTY: Fax: (212) 684-5864 Background: Forward Face, Inc. is a self-help group affiliated with the Institute of Reconstructive Plastic Surgery at the New York University Medical Center and the National Foundation for Facial Reconstruction. Established in 1978, Forward Face is dedicated to helping affected individuals and family members successfully cope with craniofacial disorders. Forward Face networks affected individuals and families with similar conditions and offers a comprehensive support system including medical, psychological, and financial services. The organization works to facilitate communication between affected families and their physicians, conducts workshops, and distributes a variety of resource materials. Forward Face also funds pediatric projects at New York University, conducts community outreach programs, publishes periodic newsletters, and promotes education and networking opportunities.

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Healing the Children Northeast, Inc Telephone: (860) 355-1828 Fax: (860) 350-6634 Email: [email protected] Background: Healing The Children Northeast, Inc. (HTCNE) is an international voluntary organization dedicated to providing medical and surgical treatment to children from impoverished backgrounds. Established in 1985 and currently consisting of approximately 2,000 members and 14 chapters, HTCNE assembles volunteer teams of medical and surgical health professionals to travel to host countries where children and young adults are treated free of charge. HTCNE s 'Medical Missions Abroad' program


serves over 3,000 children annually and provides over three million dollars in donated services. Healing The Children Northeast is committed to expanding the Medical Missions Abroad program to meet the increasing needs of children worldwide. HTCNE provides referrals to appropriate health care agencies, has a database, and offers a variety of materials including brochures, pamphlets, booklets, reports, Spanish language materials, videos, and a quarterly newsletter entitled 'Healing.'. •

International Institute of Reconstructive Microsurgery Telephone: (757) 625-6347 Fax: (757) 625-2131 Email: [email protected] Background: The International Institute of Reconstructive Microsurgery (IIRM) is a voluntary organization dedicated to research and education in the area of reconstructive microsurgery. Established in 1992, IIRM has a fellowship program that trains three to five fellows each year in microsurgery; supports clinical research on procedures to correct facial paralysis, infant injuries at birth, nerve damage, etc. and offers patient care programs that provide necessary surgery for children who are medically needy. The organization produces a regular newsletter entitled 'International Institute of Reconstructive Microsurgery.'.

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International Ostomy Association Telephone: 44 1189 391537 Fax: 44 1189 569095 Email: [email protected] Web Site: http://www.ostomyinternational.org Background: The International Ostomy Association (IOA) is a not-for-profit federation of over 60 ostomy associations committed to improving the quality of life of individuals with ostomies and other related surgeries. An ostomy is a surgical procedure (e.g., colostomy, ileostomy, urostomy) in which an artificial opening (stoma) is formed in the abdominal wall to allow the passage of urine or intestinal contents. Ostomies are required when individuals have lost normal functioning of the bladder or bowel due to birth defects, disease, or injury. The International Ostomy Association is committed to encouraging the highest possible standards of surgery, medical attention, and patient after-care and assisting member organizations in helping affected individuals achieve the quality of life they seek after such surgical procedures. The aims of the Association include providing information and management guidelines to member associations, helping to form new ostomy associations, and representing the interests of all individuals who receive ostomies and related surgeries by advocating on all ostomyrelated matters and policies. The IOA provides and distributes information to its member associations by publishing the 'Ostomy International' journal and the 'IOA News,' publishing other advisory information and news material, and organizing meetings and congresses. The Association works to promote and support the formation of new ostomy associations by developing guidelines for founding and maintaining such organizations and providing mentorship. In addition, the IOA's advocacy efforts include maintaining an awareness of issues that are impacting or may influence affected individuals' quality of life and initiating policies and activities to address these issues; coordinating and supporting all efforts to develop, establish, and provide basic

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standards in ostomy care and rehabilitation; and cooperating with medical and nursing associations, government health administrations, and other allied organizations. •

Intersex Society of North America Telephone: (206) 633-6077 Fax: (206) 633-6049 Email: [email protected] Web Site: http://www.isna.org Background: The Intersex Society of North America works through public education and advocacy for medical reform to create a world free of shame, secrecy, and unwanted genital surgery for people born with atypical anatomy. Founded in 1993, the Society is a voluntary organization providing patient advocacy, networking, informational materials, and audio-visual aids. It serves patients and family members, health professionals, and the general public.

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

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National Association of Laryngectomee Clubs (UK) Telephone: 0207 381 9993 Fax: 0207 381 0025 Email: [email protected] Web Site: http://members.aol.com/nalcuk/ Background: The National Association of Laryngectomee Clubs (NALC) is a national not-for-profit organization in the United Kingdom dedicated to providing information, support, and resources to individuals who have undergone surgical removal (laryngectomy) of all or a part of the voice box (larynx) as treatment for laryngeal cancer. The Association, which was established in 1976, is committed to offering assistance to clubs and groups of patients across the United Kingdom. Its programs and services include visiting patients and their families before and after surgery; providing advice and support concerning difficulties associated with laryngectomies, such as learning new ways of communicating; and offering a problem-solving and help service


for affected individuals, family members, and health care professionals. The Association is also committed to increasing professional awareness concerning laryngectomies and the needs of individuals who undergo such procedures. To help fulfill this goal, Association members regularly participate in lectures at nursing schools and demonstrate speech aids. The NALC also produces a variety of educational materials including booklets entitled 'Laryngectomee Stoma Care: a Guide for the Laryngectomee and Family,' 'Living with a Laryngectomy,' 'Handbook for Laryngectomy Patients,' and 'After Your Laryngectomy.' The Association also publishes a quarterly newsletter entitled 'CLAN' for affected individuals; family members; ear, nose, and throat specialists; and speech therapists. The NALC's web site on the Internet discusses the Association's services; includes press releases, the 'CLAN' newsletter, and club newsletters; has patient information including an 'Ask the Doctor' FAQ ('frequently asked questions') area; and provides links to additional sources of information on the Internet. •

National Foundation for Facial Reconstruction Telephone: (212) 263-6656 Toll-free: (800) 422-3223 Fax: (212) 263-7534 Email: [email protected] Web Site: http://www.nffr.org Background: The National Foundation for Facial Reconstruction is a not-for-profit organization dedicated to helping people affected by craniofacial disorders lead productive and fulfilling lives. Established in 1951, the National Foundation for Facial Reconstruction, through its support of the Institute of Reconstructive Plastic Surgery at New York University Medical Center, provides assistance to those affected by craniofacial conditions. The Foundation s broad programs include sponsorship of medical research; professional training; social, psychological, and financial assistance, and programs of public education. Educational materials produced and distributed by the Foundation include a variety of informative brochures.

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Pituitary Network Association (PNA) Telephone: (805) 499-9973 Fax: (805) 480-0633 Email: [email protected] Web Site: http://www.pituitary.org, www.acromegaly.org Background: The Pituitary Network Association (PNA) is a support organization dedicated to promoting, supporting, and, where possible, funding research on pituitary tumors in a sustained effort to find a cure for these illnesses. Established in 1992 by four pituitary patients undergoing experimental treatment, the Association is now the world s largest pituitary support network. Its members include affected individuals, physicians, and pharmaceutical companies. The Association disseminates information to affected families, the medical community, and the public concerning early detection, symptoms, treatments, and resources available to pituitary patients. The Pituitary Network Association publishes a regular newsletter and a comprehensive resource guide. The guide, entitled 'The Pituitary Patient Resource Guide,' assists affected individuals to locate a variety of medical, surgical, insurance, occupational, lifestyle, and health maintenance services. It also helps primary-care physicians and other medical

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personnel to determine where to call for advice and consultation, where to send patients for specialized treatment and surgery, and what other medical specialties should be involved in treatment. •

Reach: The Association for Children with Hand or Arm Deficiency Telephone: 0845 1306225 Fax: 01872 262098 Email: [email protected] Web Site: http://www.reach.org.uk Background: Reach: The Association for Children with Hand or Limb Deficiency is a registered charity dedicated to providing information and support to families of children who have any form of upper limb deficiency. Such deficiencies may be present at birth (congenital) or acquired through accident or necessary surgery. Established in 1978, Reach provides networking opportunities that enable affected families to share information and encourage one another. Reach also provides referrals for children requiring prosthetic limbs, adaptive equipment, or surgery, and raises funds for research into new technology for the development of improved prosthetic arms. Reach also contributes to research projects, such as the effort to discover why some children are born with an incomplete arm or hand. The Association publishes information including brochures, booklets such as 'A Guide to Artificial Limbs,' and a quarterly newsletter entitled 'Within Reach.' While Reach mainly serves residents of the United Kingdom, it does answer queries from all over the world.

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RSDHope Group Telephone: (207) 583-4589 Fax: (207) 583-4978 Email: [email protected] Web Site: http://www.rsdhope.org Background: The American RSDHope Group is a national not-for-profit organization dedicated to increasing awareness of Reflex Sympathetic Dystrophy Syndrome (RSDS) among affected individuals, their family members, health professionals, and the general public. RSDS is a rare disorder of the sympathetic nervous system that is characterized by chronic, severe pain following a simple trauma, break or fracture, sharp force injury, or surgery. The sympathetic nervous system is that part of the autonomic nervous system which regulates involuntary, bodily functions such as increasing heart rate, constricting blood vessels, and increasing blood pressure. Excessive or abnormal responses of portions of the sympathetic nervous system are thought to be responsible for the pain associated with Reflex Sympathetic Dystrophy Syndrome. Established in 1995, the American RSDHope Group produces educational materials including newsletters, national seminars, videotapes, information packets, and one on one assistance when needed. It makes information available to patients, their families, and their healthcare professionals. RSDHope has established the Hope For Tomorrow Research Fund, which has no administrative costs.

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Scottish Society for Autism Telephone: 01259 720044


Fax: 01259 720051 Email: [email protected] Web Site: http://www.autism-in-scotland.org.uk Background: The Scottish Society for Autism is a not-for-profit voluntary organization dedicated to providing the best possible care, support, and education for people of all ages with autism throughout Scotland. The Society also works to raise the awareness of autism among the general public and professionals working in this field. Autism is a genetic disorder characterized by difficulties in relating to, or understanding, other people and social situations; difficulties in acquiring any form of communication; and a lack of imaginative ability, often substituted by obsessive, repetitive behavior and a strong resistance to change. Established in 1976, the Society has programs that provide residential and day services for people with autism from all over Scotland. Relevant area(s) of interest: Surgery •

Second Wind Lung Transplant Association, Inc Telephone: Toll-free: (888) 222-2690 Fax: (727) 442-9762 Email: [email protected] Web Site: http://www.2ndwind.org Background: Second Wind Lung Transplant Association, Inc. is a not-for-profit organization dedicated to improving the quality of life for lung transplant recipients, lung surgery candidates, people with related pulmonary concerns, and their families. The Association provides support, advocacy, education, information, and guidance through a spirit of service, 'adding years to their lives and life to their years.' Established in 1995 by a group of lung transplant recipients, candidates, and their families, Second Wind has quarterly support group meetings to provide educational programs (e.g., on nutrition, effects of medications and exercise, physical therapy) for both lung transplant candidates and recipients; to share experiences; and to enjoy social activities. In addition, the organization provides educational programs; seeks to increase Organ Donor Awareness; and provides a quarterly newsletter entitled 'AirWays' to its members.

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Swedish Hemophilia Society Telephone: 46 08 661 9455 Fax: 46 08 661 9465 Email: [email protected] Web Site: http://www.xpress.se/fbis/ Background: The Swedish Hemophilia Society (FBIS) is a nonprofit organization for individuals affected by hemophilia in Sweden. Hemophilia is a group of hereditary bleeding disorders characterized by deficiency of one of the blood factors necessary for blood clotting (coagulation). Affected individuals may experience bleeding episodes that occur for no apparent reason or due to surgery, dental extractions, or injuries. Recurrent bleeding into the joints and muscles may cause painful inflammation of the joints (arthritis) and associated deformities. The Swedish Hemophilia Society, which was established in 1964, currently serves as an umbrella organization consisting of eight local societies. The FBIS disseminates information and provides assistance to these local

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societies. On the national level, the Society establishes contacts with authorities and other government-supported organizations for disabled individuals. The Swedish Hemophilia Society has several primary objectives, including informing the general public, the community, and governmental institutions about hemophilia disease and improving the quality of life of affected individuals by arranging conferences and meetings where current issues are discussed. The Society offers several programs and services, including providing summer and winter camps for affected children and youths and recreation trips that provide physical training opportunities. The Swedish Hemophilia Society also maintains a web site on the Internet. •

United Ostomy Association, Inc Telephone: (949) 660-8624 Toll-free: (800) 826-0826 Fax: (949) 660-9262 Email: [email protected] Web Site: http://www.uoa.org Background: Established in 1962, the United Ostomy Association, Inc. is a volunteerbased nonprofit health organization dedicated to providing education, information, support and advocacy for people who have had or will have intestinal or urinary diversion. The Association, which has approximately 25,000 members and 450 chapters nationwide, offers networking programs, distributes educational materials, provides referrals to other resources, and conducts a yearly national conference. The Association also operates a camp for children between the ages of 11 and 17 who have had ostomy surgery or have bowel or bladder concerns. The United Ostomy Association produces educational materials including a quarterly magazine, patient care guides, and a website. Special services are provided to networks of teens, young adults, thirty-plus, parents of children with ostomies, gay and lesbian ostomates and individuals with continent diversions.

•

World Federation of Hemophilia Telephone: 514-875-7944 Fax: 514-875-8916 Email: [email protected] Web Site: http://www.wfh.org Background: The World Federation of Hemophilia is an international not-for-profit organization in Canada that was founded in 1963 to promote the care of individuals with hemophilia throughout the world. Hemophilia is a group of hereditary bleeding disorders characterized by deficiency of one of the blood factors necessary for blood clotting (coagulation). Affected individuals may experience bleeding episodes that occur for no apparent reason or due to surgery, dental extractions, or injuries. Recurring bleeding into the joints and muscles may cause painful inflammation of the joints (arthritis) and associated deformities. The primary objective of the World Federation of Hemophilia is to help bring treatment to individuals with hemophilia throughout the world. To help fulfill its objective, the Federation conducts international symposia, offers educational materials for affected individuals and family members, and maintains a web site on the Internet. The Federation's web site discusses the organization's mission, goals, and services; offers information concerning hemophilia product notifications, withdrawals, and medical advisories; provides access to educational


materials on hemophilia; and offers an FAQ ('frequently asked questions') area entitled 'Ask the Expert' with answers to questions submitted by individuals with hemophilia, family members, health care professionals, and other organizational members. The FAQ includes sections on general guidelines, information for parents, specific hemophilia topics, blood-related topics, hemophilia carriers, musculoskeletal and surgical issues, von Willebrand's disease, gene therapy, hepatitis, HIV/AIDS and hemophilia, inhibitors, product information/queries, and issues/reports from developing countries.

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to surgery. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with surgery. 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 surgery. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “surgery” (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 “surgery”. Type the following hyperlink into your Web

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

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

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.24

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

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

24

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

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)25: •

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

•

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

•

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

•

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

•

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

•

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

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

25

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

Finding Medical Libraries 415

•

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/

416 Surgery

•

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 417

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

418 Surgery

•

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

•

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

•

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

•

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

419

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

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

•

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

•

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

•

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

•

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

•

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

•

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

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

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

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

•

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

•

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

•

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

421

SURGERY DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. 3-dimensional: 3-D. A graphic display of depth, width, and height. Three-dimensional radiation therapy uses computers to create a 3-dimensional picture of the tumor. This allows doctors to give the highest possible dose of radiation to the tumor, while sparing the normal tissue as much as possible. [NIH] Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abdominal Pain: Sensation of discomfort, distress, or agony in the abdominal region. [NIH] Abducens: A striated, extrinsic muscle of the eyeball that originates from the annulus of Zinn. [NIH] Abducens Nerve: The 6th cranial nerve. The abducens nerve originates in the abducens nucleus of the pons and sends motor fibers to the lateral rectus muscles of the eye. Damage to the nerve or its nucleus disrupts horizontal eye movement control. [NIH] Abducens Nerve Diseases: Diseases of the sixth cranial (abducens) nerve or its nucleus in the pons. The nerve may be injured along its course in the pons, intracranially as it travels along the base of the brain, in the cavernous sinus, or at the level of superior orbital fissure or orbit. Dysfunction of the nerve causes lateral rectus muscle weakness, resulting in horizontal diplopia that is maximal when the affected eye is abducted and esotropia. Common conditions associated with nerve injury include intracranial hypertension; craniocerebral trauma; ischemia; and infratentorial neoplasms. [NIH] Aberrant: Wandering or deviating from the usual or normal course. [EU] Ablate: In surgery, is to remove. [NIH] Ablation: The removal of an organ by surgery. [NIH] Ablation zone: The area of tissue that is removed during laser surgery. [NIH] Abrasion: 1. The wearing away of a substance or structure (such as the skin or the teeth) through some unusual or abnormal mechanical process. 2. An area of body surface denuded of skin or mucous membrane by some unusual or abnormal mechanical process. [EU] Abscess: Accumulation of purulent material in tissues, organs, or circumscribed spaces, usually associated with signs of infection. [NIH] Acceptor: A substance which, while normally not oxidized by oxygen or reduced by hydrogen, can be oxidized or reduced in presence of a substance which is itself undergoing oxidation or reduction. [NIH] Accommodation: Adjustment, especially that of the eye for various distances. [EU] Acetone: A colorless liquid used as a solvent and an antiseptic. It is one of the ketone bodies produced during ketoacidosis. [NIH] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is

422 Surgery

generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Acidosis: A pathologic condition resulting from accumulation of acid or depletion of the alkaline reserve (bicarbonate content) in the blood and body tissues, and characterized by an increase in hydrogen ion concentration. [EU] Acne: A disorder of the skin marked by inflammation of oil glands and hair glands. [NIH] Acne Vulgaris: A chronic disorder of the pilosebaceous apparatus associated with an increase in sebum secretion. It is characterized by open comedones (blackheads), closed comedones (whiteheads), and pustular nodules. The cause is unknown, but heredity and age are predisposing factors. [NIH] Acoustic: Having to do with sound or hearing. [NIH] Acquired Immunodeficiency Syndrome: An acquired defect of cellular immunity associated with infection by the human immunodeficiency virus (HIV), a CD4-positive Tlymphocyte count under 200 cells/microliter or less than 14% of total lymphocytes, and increased susceptibility to opportunistic infections and malignant neoplasms. Clinical manifestations also include emaciation (wasting) and dementia. These elements reflect criteria for AIDS as defined by the CDC in 1993. [NIH] Acrylonitrile: A highly poisonous compound used widely in the manufacture of plastics, adhesives and synthetic rubber. [NIH] Actin: Essential component of the cell skeleton. [NIH] Activities of Daily Living: The performance of the basic activities of self care, such as dressing, ambulation, eating, etc., in rehabilitation. [NIH] Acuity: Clarity or clearness, especially of the vision. [EU] Acupuncture Analgesia: Analgesia produced by the insertion of acupuncture needles at certain points in the body. These activate the small myelinated nerve fibers in the muscle which transmit impulses to the spinal cord and then activate three centers - the spinal cord, midbrain and pituitary hypothalamus - to produce analgesia. [NIH] Acute lymphoblastic leukemia: ALL. A quickly progressing disease in which too many immature white blood cells called lymphoblasts are found in the blood and bone marrow. Also called acute lymphocytic leukemia. [NIH] Acute lymphocytic leukemia: ALL. A quickly progressing disease in which too many immature white blood cells called lymphoblasts are found in the blood and bone marrow. Also called acute lymphoblastic leukemia. [NIH] Acute renal: A condition in which the kidneys suddenly stop working. In most cases, kidneys can recover from almost complete loss of function. [NIH] Adaptability: Ability to develop some form of tolerance to conditions extremely different from those under which a living organism evolved. [NIH] Adaptation: 1. The adjustment of an organism to its environment, or the process by which it enhances such fitness. 2. The normal ability of the eye to adjust itself to variations in the intensity of light; the adjustment to such variations. 3. The decline in the frequency of firing of a neuron, particularly of a receptor, under conditions of constant stimulation. 4. In dentistry, (a) the proper fitting of a denture, (b) the degree of proximity and interlocking of restorative material to a tooth preparation, (c) the exact adjustment of bands to teeth. 5. In microbiology, the adjustment of bacterial physiology to a new environment. [EU] Adduction: The rotation of an eye toward the midline (nasally). [NIH] Adenine: A purine base and a fundamental unit of adenine nucleotides. [NIH]

Dictionary 423

Adenocarcinoma: A malignant epithelial tumor with a glandular organization. [NIH] Adenoma: A benign epithelial tumor with a glandular organization. [NIH] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adenosine Triphosphate: Adenosine 5'-(tetrahydrogen triphosphate). An adenine nucleotide containing three phosphate groups esterified to the sugar moiety. In addition to its crucial roles in metabolism adenosine triphosphate is a neurotransmitter. [NIH] Adhesions: Pathological processes consisting of the union of the opposing surfaces of a wound. [NIH] Adhesives: Substances that cause the adherence of two surfaces. They include glues (properly collagen-derived adhesives), mucilages, sticky pastes, gums, resins, or latex. [NIH] Adipocytes: Fat-storing cells found mostly in the abdominal cavity and subcutaneous tissue. Fat is usually stored in the form of tryglycerides. [NIH] Adipose Tissue: Connective tissue composed of fat cells lodged in the meshes of areolar tissue. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Adjuvant Therapy: Treatment given after the primary treatment to increase the chances of a cure. Adjuvant therapy may include chemotherapy, radiation therapy, or hormone therapy. [NIH]

Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adrenal Medulla: The inner part of the adrenal gland; it synthesizes, stores and releases catecholamines. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Adsorption: The condensation of gases, liquids, or dissolved substances on the surfaces of solids. It includes adsorptive phenomena of bacteria and viruses as well as of tissues treated with exogenous drugs and chemicals. [NIH] Adsorptive: It captures volatile compounds by binding them to agents such as activated carbon or adsorptive resins. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Aerobic: In biochemistry, reactions that need oxygen to happen or happen when oxygen is present. [NIH] Aeroembolism: Joint pains, respiratory distress, and central nervous system symptoms which may follow decompression after exposure to air or other gas mixture at a pressure greater than the normal atmospheric pressure. [NIH]

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Aerosol: A solution of a drug which can be atomized into a fine mist for inhalation therapy. [EU]

Afferent: Concerned with the transmission of neural impulse toward the central part of the nervous system. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] 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]

Age Groups: Persons classified by age from birth (infant, newborn) to octogenarians and older (aged, 80 and over). [NIH] Age of Onset: The age or period of life at which a disease or the initial symptoms or manifestations of a disease appear in an individual. [NIH] Aged, 80 and Over: A person 80 years of age and older. [NIH] Aggressiveness: The quality of being aggressive (= characterized by aggression; militant; enterprising; spreading with vigour; chemically active; variable and adaptable). [EU] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Air Sacs: Thin-walled sacs or spaces which function as a part of the respiratory system in birds, fishes, insects, and mammals. [NIH] Airway: A device for securing unobstructed passage of air into and out of the lungs during general anesthesia. [NIH] Airway Obstruction: Any hindrance to the passage of air into and out of the lungs. [NIH] Albumin: 1. Any protein that is soluble in water and moderately concentrated salt solutions and is coagulable by heat. 2. Serum albumin; the major plasma protein (approximately 60 per cent of the total), which is responsible for much of the plasma colloidal osmotic pressure and serves as a transport protein carrying large organic anions, such as fatty acids, bilirubin, and many drugs, and also carrying certain hormones, such as cortisol and thyroxine, when their specific binding globulins are saturated. Albumin is synthesized in the liver. Low serum levels occur in protein malnutrition, active inflammation and serious hepatic and renal disease. [EU] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alkaline: Having the reactions of an alkali. [EU]

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Alkaline Phosphatase: An enzyme that catalyzes the conversion of an orthophosphoric monoester and water to an alcohol and orthophosphate. EC 3.1.3.1. [NIH] 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] Allergen: An antigenic substance capable of producing immediate-type hypersensitivity (allergy). [EU] Allergic Rhinitis: Inflammation of the nasal mucous membrane associated with hay fever; fits may be provoked by substances in the working environment. [NIH] Allogeneic: Taken from different individuals of the same species. [NIH] Allografts: A graft of tissue obtained from the body of another animal of the same species but with genotype differing from that of the recipient; tissue graft from a donor of one genotype to a host of another genotype with host and donor being members of the same species. [NIH] Alpha Particles: Positively charged particles composed of two protons and two neutrons, i.e., helium nuclei, emitted during disintegration of very heavy isotopes; a beam of alpha particles or an alpha ray has very strong ionizing power, but weak penetrability. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Aluminum: A metallic element that has the atomic number 13, atomic symbol Al, and atomic weight 26.98. [NIH] Alveoli: Tiny air sacs at the end of the bronchioles in the lungs. [NIH] Amebiasis: Infection with any of various amebae. It is an asymptomatic carrier state in most individuals, but diseases ranging from chronic, mild diarrhea to fulminant dysentery may occur. [NIH] Ameliorated: A changeable condition which prevents the consequence of a failure or accident from becoming as bad as it otherwise would. [NIH] Ameliorating: A changeable condition which prevents the consequence of a failure or accident from becoming as bad as it otherwise would. [NIH] Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amiodarone: An antianginal and antiarrhythmic drug. It increases the duration of ventricular and atrial muscle action by inhibiting Na,K-activated myocardial adenosine triphosphatase. There is a resulting decrease in heart rate and in vascular resistance. [NIH] Ammonia: A colorless alkaline gas. It is formed in the body during decomposition of organic materials during a large number of metabolically important reactions. [NIH] Amnestic: Nominal aphasia; a difficulty in finding the right name for an object. [NIH]

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Amplification: The production of additional copies of a chromosomal DNA sequence, found as either intrachromosomal or extrachromosomal DNA. [NIH] Ampulla: A sac-like enlargement of a canal or duct. [NIH] Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Anaesthetic: 1. Pertaining to, characterized by, or producing anaesthesia. 2. A drug or agent that is used to abolish the sensation of pain. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Anal Fissure: A small tear in the anus that may cause itching, pain, or bleeding. [NIH] Anal Fistula: A channel that develops between the anus and the skin. Most fistulas are the result of an abscess (infection) that spreads to the skin. [NIH] 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] Analysis of Variance: A statistical technique that isolates and assesses the contributions of categorical independent variables to variation in the mean of a continuous dependent variable. [NIH] Anaphylactic: Pertaining to anaphylaxis. [EU] Anaphylatoxins: The family of peptides C3a, C4a, C5a, and C5a des-arginine produced in the serum during complement activation. They produce smooth muscle contraction, mast cell histamine release, affect platelet aggregation, and act as mediators of the local inflammatory process. The order of anaphylatoxin activity from strongest to weakest is C5a, C3a, C4a, and C5a des-arginine. The latter is the so-called "classical" anaphylatoxin but shows no spasmogenic activity though it contains some chemotactic ability. [NIH] Anaplasia: Loss of structural differentiation and useful function of neoplastic cells. [NIH] Anastomosis: A procedure to connect healthy sections of tubular structures in the body after the diseased portion has been surgically removed. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Androgenic: Producing masculine characteristics. [EU] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Anesthesiology: A specialty concerned with the study of anesthetics and anesthesia. [NIH] Anesthetics: Agents that are capable of inducing a total or partial loss of sensation, especially tactile sensation and pain. They may act to induce general anesthesia, in which an unconscious state is achieved, or may act locally to induce numbness or lack of sensation at a targeted site. [NIH] Aneurysm: A sac formed by the dilatation of the wall of an artery, a vein, or the heart. [NIH] Angina: Chest pain that originates in the heart. [NIH] Angina Pectoris: The symptom of paroxysmal pain consequent to myocardial ischemia usually of distinctive character, location and radiation, and provoked by a transient stressful situation during which the oxygen requirements of the myocardium exceed the capacity of the coronary circulation to supply it. [NIH]

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Angiogenesis: Blood vessel formation. Tumor angiogenesis is the growth of blood vessels from surrounding tissue to a solid tumor. This is caused by the release of chemicals by the tumor. [NIH] Angiogram: An x-ray of blood vessels; the person receives an injection of dye to outline the vessels on the x-ray. [NIH] Angiography: Radiography of blood vessels after injection of a contrast medium. [NIH] Angioid Streaks: Small breaks in the elastin-filled tissue of the retina. [NIH] Angioplasty: Endovascular reconstruction of an artery, which may include the removal of atheromatous plaque and/or the endothelial lining as well as simple dilatation. These are procedures performed by catheterization. When reconstruction of an artery is performed surgically, it is called endarterectomy. [NIH] Animal model: An animal with a disease either the same as or like a disease in humans. Animal models are used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Anions: Negatively charged atoms, radicals or groups of atoms which travel to the anode or positive pole during electrolysis. [NIH] Anisometropia: A condition of an inequality of refractive power of the two eyes. [NIH] Ankle: That part of the lower limb directly above the foot. [NIH] Annealing: The spontaneous alignment of two single DNA strands to form a double helix. [NIH]

Anomalies: Birth defects; abnormalities. [NIH] Anorectal: Pertaining to the anus and rectum or to the junction region between the two. [EU] Anorexia: Lack or loss of appetite for food. Appetite is psychologic, dependent on memory and associations. Anorexia can be brought about by unattractive food, surroundings, or company. [NIH] Antecedent: Existing or occurring before in time or order often with consequential effects. [EU]

Anterior chamber: The space in front of the iris and behind the cornea. [NIH] Anterior Cruciate Ligament: A strong ligament of the knee that originates from the posteromedial portion of the lateral condyle of the femur, passes anteriorly and inferiorly between the condyles, and attaches to the depression in front of the intercondylar eminence of the tibia. [NIH] Anterior Eye Segment: That part of the eyeball anterior to the lens. [NIH] Anterior mediastinotomy: A procedure in which a tube is inserted into the chest to view the tissues and organs in the area between the lungs and between the breastbone and spine. The tube is inserted through an incision next to the breastbone. This procedure is usually used to get a tissue sample from the lymph nodes on the left side of the chest. Also called the Chamberlain procedure. [NIH] Anthracycline: A member of a family of anticancer drugs that are also antibiotics. [NIH] Antianginal: Counteracting angina or anginal conditions. [EU] Antiarrhythmic: An agent that prevents or alleviates cardiac arrhythmia. [EU] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiosis: A property of microorganisms which enables one microorganism to kill, injure,

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or inhibit the growth of a different microorganism. [NIH] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Antibody therapy: Treatment with an antibody, a substance that can directly kill specific tumor cells or stimulate the immune system to kill tumor cells. [NIH] Anticoagulant: A drug that helps prevent blood clots from forming. Also called a blood thinner. [NIH] Antiemetic: An agent that prevents or alleviates nausea and vomiting. Also antinauseant. [EU]

Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antigen-Antibody Complex: The complex formed by the binding of antigen and antibody molecules. The deposition of large antigen-antibody complexes leading to tissue damage causes immune complex diseases. [NIH] Anti-infective: An agent that so acts. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Anti-Inflammatory Agents: Substances that reduce or suppress inflammation. [NIH] Antimetabolite: A chemical that is very similar to one required in a normal biochemical reaction in cells. Antimetabolites can stop or slow down the reaction. [NIH] Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Antineoplastic: Inhibiting or preventing the development of neoplasms, checking the maturation and proliferation of malignant cells. [EU] Antioxidant: A substance that prevents damage caused by free radicals. Free radicals are highly reactive chemicals that often contain oxygen. They are produced when molecules are split to give products that have unpaired electrons. This process is called oxidation. [NIH] Antiproliferative: Counteracting a process of proliferation. [EU] Antipruritic: Relieving or preventing itching. [EU] Antipyretic: An agent that relieves or reduces fever. Called also antifebrile, antithermic and febrifuge. [EU] Antiseptic: A substance that inhibits the growth and development of microorganisms without necessarily killing them. [EU] Antrectomy: An operation to remove the upper portion of the stomach, called the antrum. This operation helps reduce the amount of stomach acid. It is used when a person has

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complications from ulcers. [NIH] Anus: The opening of the rectum to the outside of the body. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Anxiolytic: An anxiolytic or antianxiety agent. [EU] Aorta: The main trunk of the systemic arteries. [NIH] Aortic Aneurysm: Aneurysm of the aorta. [NIH] Aortic Valve: The valve between the left ventricle and the ascending aorta which prevents backflow into the left ventricle. [NIH] Aperture: A natural hole of perforation, especially one in a bone. [NIH] Aphakia: Absence of crystalline lens totally or partially from field of vision, from any cause except after cataract extraction. Aphakia is mainly congenital or as result of lens dislocation and subluxation. [NIH] Apnea: A transient absence of spontaneous respiration. [NIH] Apolipoproteins: The protein components of lipoproteins which remain after the lipids to which the proteins are bound have been removed. They play an important role in lipid transport and metabolism. [NIH] 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] Appendectomy: An operation to remove the appendix. [NIH] Applicability: A list of the commodities to which the candidate method can be applied as presented or with minor modifications. [NIH] Aqueous: Having to do with water. [NIH] Aqueous fluid: Clear, watery fluid that flows between and nourishes the lens and the cornea; secreted by the ciliary processes. [NIH] Aqueous humor: Clear, watery fluid that flows between and nourishes the lens and the cornea; secreted by the ciliary processes. [NIH] Arachidonic Acid: An unsaturated, essential fatty acid. It is found in animal and human fat as well as in the liver, brain, and glandular organs, and is a constituent of animal phosphatides. It is formed by the synthesis from dietary linoleic acid and is a precursor in the biosynthesis of prostaglandins, thromboxanes, and leukotrienes. [NIH] Areola: The area of dark-colored skin on the breast that surrounds the nipple. [NIH] Arginine: An essential amino acid that is physiologically active in the L-form. [NIH] Argon: A noble gas with the atomic symbol Ar, atomic number 18, and atomic weight 39.948. It is used in fluorescent tubes and wherever an inert atmosphere is desired and nitrogen cannot be used. [NIH] Arm Injuries: General or unspecified injuries involving the arm. [NIH]

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Aromatic: Having a spicy odour. [EU] Arrhythmia: Any variation from the normal rhythm or rate of the heart beat. [NIH] Arrhythmogenic: Producing or promoting arrhythmia. [EU] Arrhythmogenic Right Ventricular Dysplasia: A weakening of the right ventricle that results in the back up of blood in the venous system, liver, gastrointestinal tract, and extremities. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arteriolar: Pertaining to or resembling arterioles. [EU] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] 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] Arteriosus: Circle composed of anastomosing arteries derived from two long posterior ciliary and seven anterior ciliary arteries, located in the ciliary body about the root of the iris. [NIH]

Arteriovenous: Both arterial and venous; pertaining to or affecting an artery and a vein. [EU] Arthroplasty: Surgical reconstruction of a joint to relieve pain or restore motion. [NIH] Arthroscopy: Endoscopic examination, therapy and surgery of the joint. [NIH] Arthrosis: A disease of a joint. [EU] Articular: Of or pertaining to a joint. [EU] Articulation: The relationship of two bodies by means of a moveable joint. [NIH] Articulator: A mechanical device that represents the temporo-mandibular joints and jaw members, to which maxillary and mandibular casts may be attached. [NIH] Artificial Eye: Usually made of artificial plastic material or glass to which small quantities of metallic oxides have been added in order to imitate the features and coloring of the various parts of t he human eye; a prosthesis made of glass, plastic, or similar material. [NIH] Artificial Limbs: Prosthetic replacements for arms, legs, and parts therof. [NIH] Artificial Organs: Devices intended to replace non-functioning organs. They may be temporary or permanent. Since they are intended always to function as the natural organs they are replacing, they should be differentiated from prostheses and implants and specific types of prostheses which, though also replacements for body parts, are frequently cosmetic (artificial eye) as well as functional (artificial limbs). [NIH] Asbestos: Fibrous incombustible mineral composed of magnesium and calcium silicates with or without other elements. It is relatively inert chemically and used in thermal insulation and fireproofing. Inhalation of dust causes asbestosis and later lung and gastrointestinal neoplasms. [NIH] Ascorbic Acid: A six carbon compound related to glucose. It is found naturally in citrus fruits and many vegetables. Ascorbic acid is an essential nutrient in human diets, and necessary to maintain connective tissue and bone. Its biologically active form, vitamin C, functions as a reducing agent and coenzyme in several metabolic pathways. Vitamin C is

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considered an antioxidant. [NIH] Aseptic: Free from infection or septic material; sterile. [EU] Aspartate: A synthetic amino acid. [NIH] Asphyxia: A pathological condition caused by lack of oxygen, manifested in impending or actual cessation of life. [NIH] Aspirate: Fluid withdrawn from a lump, often a cyst, or a nipple. [NIH] Aspiration: The act of inhaling. [NIH] Aspirin: A drug that reduces pain, fever, inflammation, and blood clotting. Aspirin belongs to the family of drugs called nonsteroidal anti-inflammatory agents. It is also being studied in cancer prevention. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Astigmatism: A condition in which the surface of the cornea is not spherical; causes a blurred image to be received at the retina. [NIH] Astrocytoma: A tumor that begins in the brain or spinal cord in small, star-shaped cells called astrocytes. [NIH] Asymptomatic: Having no signs or symptoms of disease. [NIH] Ataxia: Impairment of the ability to perform smoothly coordinated voluntary movements. This condition may affect the limbs, trunk, eyes, pharnyx, larnyx, and other structures. Ataxia may result from impaired sensory or motor function. Sensory ataxia may result from posterior column injury or peripheral nerve diseases. Motor ataxia may be associated with cerebellar diseases; cerebral cortex diseases; thalamic diseases; basal ganglia diseases; injury to the red nucleus; and other conditions. [NIH] Atelectasis: Incomplete expansion of the lung. [NIH] Atherectomy: Endovascular procedure in which atheromatous plaque is excised by a cutting or rotating catheter. It differs from balloon and laser angioplasty procedures which enlarge vessels by dilation but frequently do not remove much plaque. If the plaque is removed by surgical excision under general anesthesia rather than by an endovascular procedure through a catheter, it is called endarterectomy. [NIH] Atmospheric Pressure: The pressure at any point in an atmosphere due solely to the weight of the atmospheric gases above the point concerned. [NIH] Atresia: Lack of a normal opening from the esophagus, intestines, or anus. [NIH] Atrial: Pertaining to an atrium. [EU] Atrial Fibrillation: Disorder of cardiac rhythm characterized by rapid, irregular atrial impulses and ineffective atrial contractions. [NIH] Atrial Flutter: Rapid, irregular atrial contractions due to an abnormality of atrial excitation. [NIH]

Atrioventricular: Pertaining to an atrium of the heart and to a ventricle. [EU] Atrium: A chamber; used in anatomical nomenclature to designate a chamber affording entrance to another structure or organ. Usually used alone to designate an atrium of the heart. [EU] Atropine: A toxic alkaloid, originally from Atropa belladonna, but found in other plants, mainly Solanaceae. [NIH] Attenuated: Strain with weakened or reduced virulence. [NIH]

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Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Audiologist: Study of hearing including treatment of persons with hearing defects. [NIH] Audiology: The study of hearing and hearing impairment. [NIH] Audiometry: The testing of the acuity of the sense of hearing to determine the thresholds of the lowest intensity levels at which an individual can hear a set of tones. The frequencies between 125 and 8000 Hz are used to test air conduction thresholds, and the frequencies between 250 and 4000 Hz are used to test bone conduction thresholds. [NIH] Auditory: Pertaining to the sense of hearing. [EU] Auditory nerve: The eight cranial nerve; also called vestibulocochlear nerve or acoustic nerve. [NIH] Aural: Pertaining to or perceived by the ear, as an aural stimulus. [EU] Autoclave: Apparatus using superheated steam under pressure. [NIH] Autodigestion: Autolysis; a condition found in disease of the stomach: the stomach wall is digested by the gastric juice. [NIH] Autologous: Taken from an individual's own tissues, cells, or DNA. [NIH] Autonomic: Self-controlling; functionally independent. [EU] Autonomic Nervous System: The enteric, parasympathetic, and sympathetic nervous systems taken together. Generally speaking, the autonomic nervous system regulates the internal environment during both peaceful activity and physical or emotional stress. Autonomic activity is controlled and integrated by the central nervous system, especially the hypothalamus and the solitary nucleus, which receive information relayed from visceral afferents; these and related central and sensory structures are sometimes (but not here) considered to be part of the autonomic nervous system itself. [NIH] Autopsy: Postmortem examination of the body. [NIH] Autosuggestion: Suggestion coming from the subject himself. [NIH] Axilla: The underarm or armpit. [NIH] Axillary: Pertaining to the armpit area, including the lymph nodes that are located there. [NIH]

Axillary dissection: Surgery to remove lymph nodes found in the armpit region. [NIH] Axillary lymph nodes: Lymph nodes found in the armpit that drain the lymph channels from the breast. [NIH] Axons: Nerve fibers that are capable of rapidly conducting impulses away from the neuron cell body. [NIH] Azithromycin: A semi-synthetic macrolide antibiotic structurally related to erythromycin. It has been used in the treatment of Mycobacterium avium intracellulare infections, toxoplasmosis, and cryptosporidiosis. [NIH] Back Injuries: General or unspecified injuries to the posterior part of the trunk. It includes injuries to the muscles of the back. [NIH] Back Pain: Acute or chronic pain located in the posterior regions of the trunk, including the thoracic, lumbar, sacral, or adjacent regions. [NIH] Bacteremia: The presence of viable bacteria circulating in the blood. Fever, chills, tachycardia, and tachypnea are common acute manifestations of bacteremia. The majority of cases are seen in already hospitalized patients, most of whom have underlying diseases or procedures which render their bloodstreams susceptible to invasion. [NIH]

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Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacterial Physiology: Physiological processes and activities of bacteria. [NIH] Bacterial Translocation: The passage of viable bacteria from the gastrointestinal tract to extra-intestinal sites, such as the mesenteric lymph node complex, liver, spleen, kidney, and blood. Factors that promote bacterial translocation include overgrowth with gram-negative enteric bacilli, impaired host immune defenses, and injury to the intestinal mucosa resulting in increased intestinal permeability. These mechanisms can act in concert to promote synergistically the systemic spread of indigenous translocating bacteria to cause lethal sepsis. [NIH] Bactericidal: Substance lethal to bacteria; substance capable of killing bacteria. [NIH] Bacteriophage: A virus whose host is a bacterial cell; A virus that exclusively infects bacteria. It generally has a protein coat surrounding the genome (DNA or RNA). One of the coliphages most extensively studied is the lambda phage, which is also one of the most important. [NIH] Bacterium: Microscopic organism which may have a spherical, rod-like, or spiral unicellular or non-cellular body. Bacteria usually reproduce through asexual processes. [NIH] Barbiturate: A drug with sedative and hypnotic effects. Barbiturates have been used as sedatives and anesthetics, and they have been used to treat the convulsions associated with epilepsy. [NIH] Barium: An element of the alkaline earth group of metals. It has an atomic symbol Ba, atomic number 56, and atomic weight 138. All of its acid-soluble salts are poisonous. [NIH] Basal cell carcinoma: A type of skin cancer that arises from the basal cells, small round cells found in the lower part (or base) of the epidermis, the outer layer of the skin. [NIH] Basal cells: Small, round cells found in the lower part (or base) of the epidermis, the outer layer of the skin. [NIH] Basal Ganglia: Large subcortical nuclear masses derived from the telencephalon and located in the basal regions of the cerebral hemispheres. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Basement Membrane: Ubiquitous supportive tissue adjacent to epithelium and around smooth and striated muscle cells. This tissue contains intrinsic macromolecular components such as collagen, laminin, and sulfated proteoglycans. As seen by light microscopy one of its subdivisions is the basal (basement) lamina. [NIH] Basilar Artery: The artery formed by the union of the right and left vertebral arteries; it runs from the lower to the upper border of the pons, where it bifurcates into the two posterior cerebral arteries. [NIH] Basophils: Granular leukocytes characterized by a relatively pale-staining, lobate nucleus and cytoplasm containing coarse dark-staining granules of variable size and stainable by basic dyes. [NIH] Bed Rest: Confinement of an individual to bed for therapeutic or experimental reasons. [NIH] Behavior Therapy: The application of modern theories of learning and conditioning in the treatment of behavior disorders. [NIH]

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Belladonna: A species of very poisonous Solanaceous plants yielding atropine (hyoscyamine), scopolamine, and other belladonna alkaloids, used to block the muscarinic autonomic nervous system. [NIH] Benchmarking: Method of measuring performance against established standards of best practice. [NIH] Bends: The form of aeroembolism that is marked by intense pain in muscles and joints due to formation of gas bubbles in the tissues. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Benign prostatic hyperplasia: A benign (noncancerous) condition in which an overgrowth of prostate tissue pushes against the urethra and the bladder, blocking the flow of urine. Also called benign prostatic hypertrophy or BPH. [NIH] Beta Rays: A stream of positive or negative electrons ejected with high energy from a disintegrating atomic nucleus; most biomedically used isotopes emit negative particles (electrons or negatrons, rather than positrons). Cathode rays are low-energy negative electrons produced in cathode ray tubes, also called television tubes or oscilloscopes. [NIH] Beta-Endorphin: A peptide consisting of amino acid sequence 61-91 of the endogenous pituitary hormone beta-lipotropin. The first four amino acids show a common tetrapeptide sequence with methionine- and leucine enkephalin. The compound shows opiate-like activity. Injection of beta-endorphin induces a profound analgesia of the whole body for several hours. This action is reversed after administration of naloxone. [NIH] Beta-Thromboglobulin: A platelet-specific protein which is released when platelets aggregate. Elevated plasma levels have been reported after deep venous thrombosis, preeclampsia, myocardial infarction with mural thrombosis, and myeloproliferative disorders. Measurement of beta-thromboglobulin in biological fluids by radioimmunoassay is used for the diagnosis and assessment of progress of thromboembolic disorders. [NIH] Bewilderment: Impairment or loss of will power. [NIH] Biconvex: A double-convex lens has two convex surfaces. It is used in various magnifying glasses. [NIH] Bifida: A defect in development of the vertebral column in which there is a central deficiency of the vertebral lamina. [NIH] Bilateral: Affecting both the right and left side of body. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bile Acids: Acids made by the liver that work with bile to break down fats. [NIH] Bile Acids and Salts: Steroid acids and salts. The primary bile acids are derived from cholesterol in the liver and usually conjugated with glycine or taurine. The secondary bile acids are further modified by bacteria in the intestine. They play an important role in the digestion and absorption of fat. They have also been used pharmacologically, especially in the treatment of gallstones. [NIH] Bile Ducts: Tubes that carry bile from the liver to the gallbladder for storage and to the small intestine for use in digestion. [NIH] Biliary: Having to do with the liver, bile ducts, and/or gallbladder. [NIH] Biliary Atresia: Atresia of the biliary tract, most commonly of the extrahepatic bile ducts. [NIH]

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Biliary Tract: The gallbladder and its ducts. [NIH] Biliopancreatic Diversion: A surgical procedure which diverts pancreatobiliary secretions via the duodenum and the jejunum into the colon, the remaining small intestine being anastomosed to the stomach after antrectomy. The procedure produces less diarrhea than does jejunoileal bypass. [NIH] Bilirubin: A bile pigment that is a degradation product of heme. [NIH] Binding Sites: The reactive parts of a macromolecule that directly participate in its specific combination with another molecule. [NIH] Binocular vision: The blending of the separate images seen by each eye into a single image; allows images to be seen with depth. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Bioengineering: The application of engineering principles to the solution of biological problems, for example, remote-handling devices, life-support systems, controls, and displays. [NIH] Biological therapy: Treatment to stimulate or restore the ability of the immune system to fight infection and disease. Also used to lessen side effects that may be caused by some cancer treatments. Also known as immunotherapy, biotherapy, or biological response modifier (BRM) therapy. [NIH] Biological Transport: The movement of materials (including biochemical substances and drugs) across cell membranes and epithelial layers, usually by passive diffusion. [NIH] Biomarkers: Substances sometimes found in an increased amount in the blood, other body fluids, or tissues and that may suggest the presence of some types of cancer. Biomarkers include CA 125 (ovarian cancer), CA 15-3 (breast cancer), CEA (ovarian, lung, breast, pancreas, and GI tract cancers), and PSA (prostate cancer). Also called tumor markers. [NIH] Biomechanics: The study of the application of mechanical laws and the action of forces to living structures. [NIH] Biometry: The use of statistical methods to analyze biological observations and phenomena. [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] Biosynthesis: The building up of a chemical compound in the physiologic processes of a living organism. [EU] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Bladder: The organ that stores urine. [NIH] Blastocyst: The mammalian embryo in the post-morula stage in which a fluid-filled cavity, enclosed primarily by trophoblast, contains an inner cell mass which becomes the embryonic disc. [NIH] Blebs: Cysts on or near the surface of the lungs. [NIH]

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Bleeding Time: Duration of blood flow after skin puncture. This test is used as a measure of capillary and platelet function. [NIH] Blepharitis: Inflammation of the eyelids. [NIH] Blepharoplasty: Plastic surgery of the eyelid. [NIH] Bloating: Fullness or swelling in the abdomen that often occurs after meals. [NIH] Blood Cell Count: A count of the number of leukocytes and erythrocytes per unit volume in a sample of venous blood. A complete blood count (CBC) also includes measurement of the hemoglobin, hematocrit, and erythrocyte indices. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood Flow Velocity: A value equal to the total volume flow divided by the cross-sectional area of the vascular bed. [NIH] Blood Glucose: Glucose in blood. [NIH] Blood Platelets: Non-nucleated disk-shaped cells formed in the megakaryocyte and found in the blood of all mammals. They are mainly involved in blood coagulation. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood transfusion: The administration of blood or blood products into a blood vessel. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Blood Viscosity: The internal resistance of the blood to shear forces. The in vitro measure of whole blood viscosity is of limited clinical utility because it bears little relationship to the actual viscosity within the circulation, but an increase in the viscosity of circulating blood can contribute to morbidity in patients suffering from disorders such as sickle cell anemia and polycythemia. [NIH] Blood Volume: Volume of circulating blood. It is the sum of the plasma volume and erythrocyte volume. [NIH] Body Composition: The relative amounts of various components in the body, such as percent body fat. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Body Image: Individuals' personal concept of their bodies as objects in and bound by space, independently and apart from all other objects. [NIH] Body Mass Index: One of the anthropometric measures of body mass; it has the highest correlation with skinfold thickness or body density. [NIH] Bolus: A single dose of drug usually injected into a blood vessel over a short period of time. Also called bolus infusion. [NIH] Bolus infusion: A single dose of drug usually injected into a blood vessel over a short period of time. Also called bolus. [NIH] Bone Cements: Adhesives used to fix prosthetic devices to bones and to cement bone to bone in difficult fractures. Synthetic resins are commonly used as cements. A mixture of monocalcium phosphate, monohydrate, alpha-tricalcium phosphate, and calcium carbonate with a sodium phosphate solution is also a useful bone paste. [NIH] Bone Conduction: Sound transmission through the bones of the skull to the inner ear. [NIH]

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Bone Density: The amount of mineral per square centimeter of bone. This is the definition used in clinical practice. Actual bone density would be expressed in grams per milliliter. It is most frequently measured by photon absorptiometry or x-ray computed tomography. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bone metastases: Cancer that has spread from the original (primary) tumor to the bone. [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] Bone Substitutes: Synthetic or natural materials for the replacement of bones or bone tissue. They include hard tissue replacement polymers, natural coral, hydroxyapatite, betatricalcium phosphate, and various other biomaterials. The bone substitutes as inert materials can be incorporated into surrounding tissue or gradually replaced by original tissue. [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] Bowel Prep: The process used to clean the colon with enemas and a special drink. Used before surgery of the colon, colonoscopy, or barium x-ray. [NIH] Brachial: All the nerves from the arm are ripped from the spinal cord. [NIH] Brachial Artery: The continuation of the axillary artery; it branches into the radial and ulnar arteries. [NIH] Brachial Plexus: The large network of nerve fibers which distributes the innervation of the upper extremity. The brachial plexus extends from the neck into the axilla. In humans, the nerves of the plexus usually originate from the lower cervical and the first thoracic spinal cord segments (C5-C8 and T1), but variations are not uncommon. [NIH] Brachiocephalic Veins: Large veins on either side of the root of the neck formed by the junction of the internal jugular and subclavian veins. They drain blood from the head, neck, and upper extremities, and unite to form the superior vena cava. [NIH] Brachytherapy: A collective term for interstitial, intracavity, and surface radiotherapy. It uses small sealed or partly-sealed sources that may be placed on or near the body surface or within a natural body cavity or implanted directly into the tissues. [NIH] Bradykinin: A nonapeptide messenger that is enzymatically produced from kallidin in the blood where it is a potent but short-lived agent of arteriolar dilation and increased capillary permeability. Bradykinin is also released from mast cells during asthma attacks, from gut walls as a gastrointestinal vasodilator, from damaged tissues as a pain signal, and may be a neurotransmitter. [NIH] Brain Diseases: Pathologic conditions affecting the brain, which is composed of the intracranial components of the central nervous system. This includes (but is not limited to) the cerebral cortex; intracranial white matter; basal ganglia; thalamus; hypothalamus; brain stem; and cerebellum. [NIH] Brain Hypoxia: Lack of oxygen leading to unconsciousness. [NIH] Brain Infarction: The formation of an area of necrosis in the brain, including the cerebral

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hemispheres (cerebral infarction), thalami, basal ganglia, brain stem (brain stem infarctions), or cerebellum secondary to an insufficiency of arterial or venous blood flow. [NIH] Brain Ischemia: Localized reduction of blood flow to brain tissue due to arterial obtruction or systemic hypoperfusion. This frequently occurs in conjuction with brain hypoxia. Prolonged ischemia is associated with brain infarction. [NIH] Brain metastases: Cancer that has spread from the original (primary) tumor to the brain. [NIH]

Brain Neoplasms: Neoplasms of the intracranial components of the central nervous system, including the cerebral hemispheres, basal ganglia, hypothalamus, thalamus, brain stem, and cerebellum. Brain neoplasms are subdivided into primary (originating from brain tissue) and secondary (i.e., metastatic) forms. Primary neoplasms are subdivided into benign and malignant forms. In general, brain tumors may also be classified by age of onset, histologic type, or presenting location in the brain. [NIH] Brain Stem: The part of the brain that connects the cerebral hemispheres with the spinal cord. It consists of the mesencephalon, pons, and medulla oblongata. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Breakdown: A physical, metal, or nervous collapse. [NIH] Breast Implants: Implants used to reconstruct and/or cosmetically enhance the female breast. They have an outer shell or envelope of silicone elastomer and are filled with either saline or silicone gel. The outer shell may be either smooth or textured. [NIH] Breast reconstruction: Surgery to rebuild a breast's shape after a mastectomy. [NIH] Breast-conserving surgery: An operation to remove the breast cancer but not the breast itself. Types of breast-conserving surgery include lumpectomy (removal of the lump), quadrantectomy (removal of one quarter of the breast), and segmental mastectomy (removal of the cancer as well as some of the breast tissue around the tumor and the lining over the chest muscles below the tumor). [NIH] Breeding: The science or art of changing the constitution of a population of plants or animals through sexual reproduction. [NIH] Bronchi: The larger air passages of the lungs arising from the terminal bifurcation of the trachea. [NIH] Bronchial: Pertaining to one or more bronchi. [EU] Bronchioles: The tiny branches of air tubes in the lungs. [NIH] Bronchitis: Inflammation (swelling and reddening) of the bronchi. [NIH] Bronchoconstriction: Diminution of the caliber of a bronchus physiologically or as a result of pharmacological intervention. [NIH] Bronchodilator: A drug that relaxes the smooth muscles in the constricted airway. [NIH] Bronchoscopy: Endoscopic examination, therapy or surgery of the bronchi. [NIH] Buccal: Pertaining to or directed toward the cheek. In dental anatomy, used to refer to the buccal surface of a tooth. [EU] Bunion: A swelling of the bursa mucosa of the ball of the great toe, with thickening of the overlying skin and forcing of the toe outward. [NIH] Bupivacaine: A widely used local anesthetic agent. [NIH] Burns: Injuries to tissues caused by contact with heat, steam, chemicals (burns, chemical), electricity (burns, electric), or the like. [NIH]

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Burns, Electric: Burns produced by contact with electric current or from a sudden discharge of electricity. [NIH] Butyric Acid: A four carbon acid, CH3CH2CH2COOH, with an unpleasant odor that occurs in butter and animal fat as the glycerol ester. [NIH] 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] Calcium channel blocker: A drug used to relax the blood vessel and heart muscle, causing pressure inside blood vessels to drop. It also can regulate heart rhythm. [NIH] Calcium Channel Blockers: A class of drugs that act by selective inhibition of calcium influx through cell membranes or on the release and binding of calcium in intracellular pools. Since they are inducers of vascular and other smooth muscle relaxation, they are used in the drug therapy of hypertension and cerebrovascular spasms, as myocardial protective agents, and in the relaxation of uterine spasms. [NIH] Calcium Channels: Voltage-dependent cell membrane glycoproteins selectively permeable to calcium ions. They are categorized as L-, T-, N-, P-, Q-, and R-types based on the activation and inactivation kinetics, ion specificity, and sensitivity to drugs and toxins. The L- and T-types are present throughout the cardiovascular and central nervous systems and the N-, P-, Q-, & R-types are located in neuronal tissue. [NIH] Camptothecin: An alkaloid isolated from the stem wood of the Chinese tree, Camptotheca acuminata. This compound selectively inhibits the nuclear enzyme DNA topoisomerase. Several semisynthetic analogs of camptothecin have demonstrated antitumor activity. [NIH] Cannula: A tube for insertion into a duct or cavity; during insertion its lumen is usually occupied by a trocar. [EU] Capillary: Any one of the minute vessels that connect the arterioles and venules, forming a network in nearly all parts of the body. Their walls act as semipermeable membranes for the interchange of various substances, including fluids, between the blood and tissue fluid; called also vas capillare. [EU] Capillary Permeability: Property of blood capillary walls that allows for the selective exchange of substances. Small lipid-soluble molecules such as carbon dioxide and oxygen move freely by diffusion. Water and water-soluble molecules cannot pass through the endothelial walls and are dependent on microscopic pores. These pores show narrow areas (tight junctions) which may limit large molecule movement. [NIH] Capsaicin: Cytotoxic alkaloid from various species of Capsicum (pepper, paprika), of the Solanaceae. [NIH]

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Capsular: Cataract which is initiated by an opacification at the surface of the lens. [NIH] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbogen: An inhalant of oxygen and carbon dioxide that increases the sensitivity of tumor cells to the effects of radiation therapy. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Carbonate Dehydratase: A zinc-containing enzyme of erythrocytes with molecular weight of 30 kD. It is among the most active of known enzymes and catalyzes the reversible hydration of carbon dioxide, which is significant in the transport of CO2 from the tissues to the lungs. The enzyme is inhibited by acetazolamide. EC 4.2.1.1. [NIH] Carbonic Anhydrase Inhibitors: A class of compounds that reduces the secretion of H+ ions by the proximal kidney tubule through inhibition of carbonic anhydrase (carbonate dehydratase). [NIH] Carboplatin: An organoplatinum compound that possesses antineoplastic activity. [NIH] Carboxymethylcellulose: It is used as an emulsifier, thickener, suspending agent, etc., in cosmetics and pharmaceuticals; in research as a culture medium; in chromatography as a stabilizer for reagents; and therapeutically as a bulk laxative with antacid properties. [NIH] Carcinoembryonic Antigen: A glycoprotein that is secreted into the luminal surface of the epithelia in the gastrointestinal tract. It is found in the feces and pancreaticobiliary secretions and is used to monitor the respone to colon cancer treatment. [NIH] Carcinogen: Any substance that causes cancer. [NIH] Carcinogenic: Producing carcinoma. [EU] Carcinoid: A type of tumor usually found in the gastrointestinal system (most often in the appendix), and sometimes in the lungs or other sites. Carcinoid tumors are usually benign. [NIH]

Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs. [NIH]

Carcinoma in Situ: A malignant tumor that has not yet invaded the basement membrane of the epithelial cell of origin and has not spread to other tissues. [NIH] Cardiac: Having to do with the heart. [NIH] Cardiac arrest: A sudden stop of heart function. [NIH] Cardiac catheterization: A procedure in which a thin, hollow tube is inserted into a blood vessel. The tube is then advanced through the vessel into the heart, enabling a physician to study the heart and its pumping activity. [NIH] Cardiac Output: The volume of blood passing through the heart per unit of time. It is usually expressed as liters (volume) per minute so as not to be confused with stroke volume (volume per beat). [NIH] Cardiac Surgical Procedures: Surgery performed on the heart. [NIH] Cardiology: The study of the heart, its physiology, and its functions. [NIH] Cardiomyopathy: A general diagnostic term designating primary myocardial disease, often

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of obscure or unknown etiology. [EU] Cardiopulmonary: Having to do with the heart and lungs. [NIH] Cardiopulmonary Bypass: Diversion of the flow of blood from the entrance of the right atrium directly to the aorta (or femoral artery) via an oxygenator thus bypassing both the heart and lungs. [NIH] Cardiorespiratory: Relating to the heart and lungs and their function. [EU] Cardioselective: Having greater activity on heart tissue than on other tissue. [EU] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cardiovascular disease: Any abnormal condition characterized by dysfunction of the heart and blood vessels. CVD includes atherosclerosis (especially coronary heart disease, which can lead to heart attacks), cerebrovascular disease (e.g., stroke), and hypertension (high blood pressure). [NIH] Cardiovascular System: The heart and the blood vessels by which blood is pumped and circulated through the body. [NIH] Career Choice: Selection of a type of occupation or profession. [NIH] Carotene: The general name for a group of pigments found in green, yellow, and leafy vegetables, and yellow fruits. The pigments are fat-soluble, unsaturated aliphatic hydrocarbons functioning as provitamins and are converted to vitamin A through enzymatic processes in the intestinal wall. [NIH] Carotid Stenosis: The constriction or narrowing of an orifice or the lumen of a hollow or tubular organ. [NIH] Carpal Tunnel Syndrome: A median nerve injury inside the carpal tunnel that results in symptoms of pain, numbness, tingling, clumsiness, and a lack of sweating, which can be caused by work with certain hand and wrist postures. [NIH] Carrier Proteins: Transport proteins that carry specific substances in the blood or across cell membranes. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Case series: A group or series of case reports involving patients who were given similar treatment. Reports of case series usually contain detailed information about the individual patients. This includes demographic information (for example, age, gender, ethnic origin) and information on diagnosis, treatment, response to treatment, and follow-up after treatment. [NIH] Caspase: Enzyme released by the cell at a crucial stage in apoptosis in order to shred all cellular proteins. [NIH] Catabolism: Any destructive metabolic process by which organisms convert substances into excreted compounds. [EU] Cataract: An opacity, partial or complete, of one or both eyes, on or in the lens or capsule, especially an opacity impairing vision or causing blindness. The many kinds of cataract are classified by their morphology (size, shape, location) or etiology (cause and time of occurrence). [EU] Catecholamine: A group of chemical substances manufactured by the adrenal medulla and secreted during physiological stress. [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

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differs from intubation in that the tube here is used to restore or maintain patency in obstructions. [NIH] Catheters: A small, flexible tube that may be inserted into various parts of the body to inject or remove liquids. [NIH] Cathode: An electrode, usually an incandescent filament of tungsten, which emits electrons in an X-ray tube. [NIH] Cations: Postively charged atoms, radicals or groups of atoms which travel to the cathode or negative pole during electrolysis. [NIH] Cauda Equina: The lower part of the spinal cord consisting of the lumbar, sacral, and coccygeal nerve roots. [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] Cause of Death: Factors which produce cessation of all vital bodily functions. They can be analyzed from an epidemiologic viewpoint. [NIH] Caustic: An escharotic or corrosive agent. Called also cauterant. [EU] Cauterization: The destruction of tissue with a hot instrument, an electrical current, or a caustic substance. [NIH] Cecum: The beginning of the large intestine. The cecum is connected to the lower part of the small intestine, called the ileum. [NIH] Celecoxib: A drug that reduces pain. Celecoxib belongs to the family of drugs called nonsteroidal anti-inflammatory agents. It is being studied for cancer prevention. [NIH] Celiac Artery: The arterial trunk that arises from the abdominal aorta and after a short course divides into the left gastric, common hepatic and splenic arteries. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Adhesion: Adherence of cells to surfaces or to other cells. [NIH] Cell Cycle: The complex series of phenomena, occurring between the end of one cell division and the end of the next, by which cellular material is divided between daughter cells. [NIH] Cell Death: The termination of the cell's ability to carry out vital functions such as metabolism, growth, reproduction, responsiveness, and adaptability. [NIH] Cell Differentiation: Progressive restriction of the developmental potential and increasing specialization of function which takes place during the development of the embryo and leads to the formation of specialized cells, tissues, and organs. [NIH] Cell Division: The fission of a cell. [NIH] Cell membrane: Cell membrane = plasma membrane. The structure enveloping a cell, enclosing the cytoplasm, and forming a selective permeability barrier; it consists of lipids, proteins, and some carbohydrates, the lipids thought to form a bilayer in which integral proteins are embedded to varying degrees. [EU] Cell proliferation: An increase in the number of cells as a result of cell growth and cell division. [NIH] Cell Survival: The span of viability of a cell characterized by the capacity to perform certain functions such as metabolism, growth, reproduction, some form of responsiveness, and adaptability. [NIH]

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Cell Transplantation: Transference of cells within an individual, between individuals of the same species, or between individuals of different species. [NIH] Cellulose: A polysaccharide with glucose units linked as in cellobiose. It is the chief constituent of plant fibers, cotton being the purest natural form of the substance. As a raw material, it forms the basis for many derivatives used in chromatography, ion exchange materials, explosives manufacturing, and pharmaceutical preparations. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Central Nervous System Infections: Pathogenic infections of the brain, spinal cord, and meninges. DNA virus infections; RNA virus infections; bacterial infections; mycoplasma infections; Spirochaetales infections; fungal infections; protozoan infections; helminthiasis; and prion diseases may involve the central nervous system as a primary or secondary process. [NIH] Centrifugation: A method of separating organelles or large molecules that relies upon differential sedimentation through a preformed density gradient under the influence of a gravitational field generated in a centrifuge. [NIH] Cerebellum: Part of the metencephalon that lies in the posterior cranial fossa behind the brain stem. It is concerned with the coordination of movement. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebral Angiography: Radiography of the vascular system of the brain after injection of a contrast medium. [NIH] Cerebral Aqueduct: Narrow channel in the mesencephalon that connects the third and fourth ventricles. [NIH] Cerebral hemispheres: The two halves of the cerebrum, the part of the brain that controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. The right hemisphere controls muscle movement on the left side of the body, and the left hemisphere controls muscle movement on the right side of the body. [NIH] Cerebral Infarction: The formation of an area of necrosis in the cerebrum caused by an insufficiency of arterial or venous blood flow. Infarcts of the cerebrum are generally classified by hemisphere (i.e., left vs. right), lobe (e.g., frontal lobe infarction), arterial distribution (e.g., infarction, anterior cerebral artery), and etiology (e.g., embolic infarction). [NIH]

Cerebral Palsy: Refers to a motor disability caused by a brain dysfunction. [NIH] Cerebrospinal: Pertaining to the brain and spinal cord. [EU] Cerebrospinal fluid: CSF. The fluid flowing around the brain and spinal cord. Cerebrospinal fluid is produced in the ventricles in the brain. [NIH] Cerebrospinal Fluid Pressure: Manometric pressure of the cerebrospinal fluid as measured by lumbar, cerebroventricular, or cisternal puncture. Within the cranial cavity it is called intracranial pressure. [NIH] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH]

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Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH] Cesarean Section: Extraction of the fetus by means of abdominal hysterotomy. [NIH] Character: In current usage, approximately equivalent to personality. The sum of the relatively fixed personality traits and habitual modes of response of an individual. [NIH] Checkup: A general physical examination. [NIH] Check-up: A general physical examination. [NIH] Chemoembolization: A procedure in which the blood supply to the tumor is blocked surgically or mechanically, and anticancer drugs are administered directly into the tumor. This permits a higher concentration of drug to be in contact with the tumor for a longer period of time. [NIH] Chemopreventive: Natural or synthetic compound used to intervene in the early precancerous stages of carcinogenesis. [NIH] Chemoprotective: A quality of some drugs used in cancer treatment. Chemoprotective agents protect healthy tissue from the toxic effects of anticancer drugs. [NIH] Chemotactic Factors: Chemical substances that attract or repel cells or organisms. The concept denotes especially those factors released as a result of tissue injury, invasion, or immunologic activity, that attract leukocytes, macrophages, or other cells to the site of infection or insult. [NIH] Chemotherapy: Treatment with anticancer drugs. [NIH] Chest cavity: Space in body surrounding the lungs. [NIH] Chest Pain: Pressure, burning, or numbness in the chest. [NIH] Chest Tubes: Plastic tubes used for drainage of air or fluid from the pleural space. Their surgical insertion is called tube thoracostomy. [NIH] Chest wall: The ribs and muscles, bones, and joints that make up the area of the body between the neck and the abdomen. [NIH] Chin: The anatomical frontal portion of the mandible, also known as the mentum, that contains the line of fusion of the two separate halves of the mandible (symphysis menti). This line of fusion divides inferiorly to enclose a triangular area called the mental protuberance. On each side, inferior to the second premolar tooth, is the mental foramen for the passage of blood vessels and a nerve. [NIH] Chlorhexidine: Disinfectant and topical anti-infective agent used also as mouthwash to prevent oral plaque. [NIH] Cholecystectomy: Surgical removal of the gallbladder. [NIH] Cholelithiasis: Presence or formation of gallstones. [NIH] Cholesteatoma: A non-neoplastic keratinizing mass with stratified squamous epithelium, frequently occurring in the meninges, central nervous system, bones of the skull, and most commonly in the middle ear and mastoid region. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Cholesterol Esters: Fatty acid esters of cholesterol which constitute about two-thirds of the cholesterol in the plasma. The accumulation of cholesterol esters in the arterial intima is a characteristic feature of atherosclerosis. [NIH] Chondroitin sulfate: The major glycosaminoglycan (a type of sugar molecule) in cartilage. [NIH]

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Chorioretinitis: Inflammation of the choroid in which the sensory retina becomes edematous and opaque. The inflammatory cells and exudate may burst through the sensory retina to cloud the vitreous body. [NIH] Choroid: The thin, highly vascular membrane covering most of the posterior of the eye between the retina and sclera. [NIH] Choroidal Neovascularization: A pathological process consisting of the formation of new blood vessels in the choroid. [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] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic Disease: Disease or ailment of long duration. [NIH] Chronic lymphocytic leukemia: A slowly progressing disease in which too many white blood cells (called lymphocytes) are found in the body. [NIH] Chronic Obstructive Pulmonary Disease: Collective term for chronic bronchitis and emphysema. [NIH] Chronic renal: Slow and progressive loss of kidney function over several years, often resulting in end-stage renal disease. People with end-stage renal disease need dialysis or transplantation to replace the work of the kidneys. [NIH] Chylomicrons: A class of lipoproteins that carry dietary cholesterol and triglycerides from the small intestines to the tissues. [NIH] Cicatricial: Ectropion due to scar tissue on the margins or the surrounding surfaces of the eyelids. [NIH] Cicatrix: The formation of new tissue in the process of wound healing. [NIH] Cicatrization: The formation of a cicatrix or scar. [EU] Ciliary: Inflammation or infection of the glands of the margins of the eyelids. [NIH] Ciliary Body: A ring of tissue extending from the scleral spur to the ora serrata of the retina. It consists of the uveal portion and the epithelial portion. The ciliary muscle is in the uveal portion and the ciliary processes are in the epithelial portion. [NIH] Ciliary processes: The extensions or projections of the ciliary body that secrete aqueous humor. [NIH] Circulatory system: The system that contains the heart and the blood vessels and moves blood throughout the body. This system helps tissues get enough oxygen and nutrients, and it helps them get rid of waste products. The lymph system, which connects with the blood system, is often considered part of the circulatory system. [NIH] Circumcision: Excision of the prepuce or part of it. [NIH] CIS: Cancer Information Service. The CIS is the National Cancer Institute's link to the public, interpreting and explaining research findings in a clear and understandable manner, and providing personalized responses to specific questions about cancer. Access the CIS by calling 1-800-4-CANCER, or by using the Web site at http://cis.nci.nih.gov. [NIH] Cisplatin: An inorganic and water-soluble platinum complex. After undergoing hydrolysis, it reacts with DNA to produce both intra and interstrand crosslinks. These crosslinks appear to impair replication and transcription of DNA. The cytotoxicity of cisplatin correlates with

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cellular arrest in the G2 phase of the cell cycle. [NIH] Citrus: Any tree or shrub of the Rue family or the fruit of these plants. [NIH] Clamp: A u-shaped steel rod used with a pin or wire for skeletal traction in the treatment of certain fractures. [NIH] Clear cell carcinoma: A rare type of tumor of the female genital tract in which the inside of the cells looks clear when viewed under a microscope. [NIH] Cleft Palate: Congenital fissure of the soft and/or hard palate, due to faulty fusion. [NIH] Clinical Protocols: Precise and detailed plans for the study of a medical or biomedical problem and/or plans for a regimen of therapy. [NIH] Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Clot Retraction: Retraction of a clot resulting from contraction of platelet pseudopods attached to fibrin strands that is dependent on the contractile protein thrombosthenin. Used as a measure of platelet function. [NIH] Coagulation: 1. The process of clot formation. 2. In colloid chemistry, the solidification of a sol into a gelatinous mass; an alteration of a disperse phase or of a dissolved solid which causes the separation of the system into a liquid phase and an insoluble mass called the clot or curd. Coagulation is usually irreversible. 3. In surgery, the disruption of tissue by physical means to form an amorphous residuum, as in electrocoagulation and photocoagulation. [EU] Cochlea: The part of the internal ear that is concerned with hearing. It forms the anterior part of the labyrinth, is conical, and is placed almost horizontally anterior to the vestibule. [NIH]

Cochlear: Of or pertaining to the cochlea. [EU] Cochlear Diseases: Diseases of the cochlea, the part of the inner ear that is concerned with hearing. [NIH] Cochlear Implantation: Surgical insertion of an electronic device implanted beneath the skin with electrodes to the cochlear nerve to create sound sensation in persons with sensorineural deafness. [NIH] Cochlear Implants: Electronic devices implanted beneath the skin with electrodes to the cochlear nerve to create sound sensation in persons with sensorineural deafness. [NIH] Cochlear Nerve: The cochlear part of the 8th cranial nerve (vestibulocochlear nerve). The cochlear nerve fibers originate from neurons of the spiral ganglion and project peripherally to cochlear hair cells and centrally to the cochlear nuclei (cochlear nucleus) of the brain stem. They mediate the sense of hearing. [NIH] Coenzyme: An organic nonprotein molecule, frequently a phosphorylated derivative of a water-soluble vitamin, that binds with the protein molecule (apoenzyme) to form the active enzyme (holoenzyme). [EU] Cofactor: A substance, microorganism or environmental factor that activates or enhances the

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action of another entity such as a disease-causing agent. [NIH] Cognition: Intellectual or mental process whereby an organism becomes aware of or obtains knowledge. [NIH] Cognitive behavior therapy: A system of psychotherapy based on the premise that distorted or dysfunctional thinking, which influences a person's mood or behavior, is common to all psychosocial problems. The focus of therapy is to identify the distorted thinking and to replace it with more rational, adaptive thoughts and beliefs. [NIH] Cognitive restructuring: A method of identifying and replacing fear-promoting, irrational beliefs with more realistic and functional ones. [NIH] Cognitive Therapy: A direct form of psychotherapy based on the interpretation of situations (cognitive structure of experiences) that determine how an individual feels and behaves. It is based on the premise that cognition, the process of acquiring knowledge and forming beliefs, is a primary determinant of mood and behavior. The therapy uses behavioral and verbal techniques to identify and correct negative thinking that is at the root of the aberrant behavior. [NIH] Cohort Studies: Studies in which subsets of a defined population are identified. These groups may or may not be exposed to factors hypothesized to influence the probability of the occurrence of a particular disease or other outcome. Cohorts are defined populations which, as a whole, are followed in an attempt to determine distinguishing subgroup characteristics. [NIH] Colectomy: An operation to remove the colon. An open colectomy is the removal of the colon through a surgical incision made in the wall of the abdomen. Laparoscopic-assisted colectomy uses a thin, lighted tube attached to a video camera. It allows the surgeon to remove the colon without a large incision. [NIH] Colitis: Inflammation of the colon. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Collapse: 1. A state of extreme prostration and depression, with failure of circulation. 2. Abnormal falling in of the walls of any part of organ. [EU] Colloidal: Of the nature of a colloid. [EU] Colonoscopy: Endoscopic examination, therapy or surgery of the luminal surface of the colon. [NIH] Colorectal: Having to do with the colon or the rectum. [NIH] Colorectal Cancer: Cancer that occurs in the colon (large intestine) or the rectum (the end of the large intestine). A number of digestive diseases may increase a person's risk of colorectal cancer, including polyposis and Zollinger-Ellison Syndrome. [NIH] Colorectal Surgery: A surgical specialty concerned with the diagnosis and treatment of disorders and abnormalities of the colon, rectum, and anal canal. [NIH] Colostomy: An opening into the colon from the outside of the body. A colostomy provides a new path for waste material to leave the body after part of the colon has been removed. [NIH] Combination chemotherapy: Treatment using more than one anticancer drug. [NIH]

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Combination Therapy: Association of 3 drugs to treat AIDS (AZT + DDC or DDI + protease inhibitor). [NIH] Common Bile Duct: The largest biliary duct. It is formed by the junction of the cystic duct and the hepatic duct. [NIH] Communicable disease: A disease that can be transmitted by contact between persons. [NIH] Communication Disorders: Disorders of verbal and nonverbal communication caused by receptive or expressive language disorders, cognitive dysfunction (e.g., mental retardation), psychiatric conditions, and hearing disorders. [NIH] Comorbidity: The presence of co-existing or additional diseases with reference to an initial diagnosis or with reference to the index condition that is the subject of study. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival. [NIH] Competency: The capacity of the bacterium to take up DNA from its surroundings. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complement Activation: The sequential activation of serum components C1 through C9, initiated by an erythrocyte-antibody complex or by microbial polysaccharides and properdin, and producing an inflammatory response. [NIH] 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]

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Complete remission: The disappearance of all signs of cancer. Also called a complete response. [NIH] Complete response: The disappearance of all signs of cancer in response to treatment. This does not always mean the cancer has been cured. [NIH] Compress: A plug used to occludate an orifice in the control of bleeding, or to mop up secretions; an absorbent pad. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Computed tomography: CT scan. A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized tomography and computerized axial tomography (CAT) scan. [NIH] Computerized 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] Concentric: Having a common center of curvature or symmetry. [NIH] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Concomitant: Accompanying; accessory; joined with another. [EU] Conduction: The transfer of sound waves, heat, nervous impulses, or electricity. [EU] Cone: One of the special retinal receptor elements which are presumed to be primarily concerned with perception of light and color stimuli when the eye is adapted to light. [NIH] Confidence Intervals: A range of values for a variable of interest, e.g., a rate, constructed so that this range has a specified probability of including the true value of the variable. [NIH] Confounding: Extraneous variables resulting in outcome effects that obscure or exaggerate the "true" effect of an intervention. [NIH] Confusion: A mental state characterized by bewilderment, emotional disturbance, lack of clear thinking, and perceptual disorientation. [NIH] Congestion: Excessive or abnormal accumulation of blood in a part. [EU] Congestive heart failure: Weakness of the heart muscle that leads to a buildup of fluid in body tissues. [NIH] Conjugated: Acting or operating as if joined; simultaneous. [EU] Conjunctiva: The mucous membrane that lines the inner surface of the eyelids and the anterior part of the sclera. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective

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tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue Cells: A group of cells that includes fibroblasts, cartilage cells, adipocytes, smooth muscle cells, and bone cells. [NIH] Conscious Sedation: An alternative to general anesthesia in patients for whom general anesthesia is refused or considered inadvisable. It involves the administering of an antianxiety drug (minor tranquilizer) and an analgesic or local anesthetic. This renders the patient free of anxiety and pain while allowing the patient to remain in verbal contact with the physician or dentist. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Consolidation: The healing process of a bone fracture. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Constitutional: 1. Affecting the whole constitution of the body; not local. 2. Pertaining to the constitution. [EU] Constriction: The act of constricting. [NIH] Consultation: A deliberation between two or more physicians concerning the diagnosis and the proper method of treatment in a case. [NIH] Consumption: Pulmonary tuberculosis. [NIH] Contamination: The soiling or pollution by inferior material, as by the introduction of organisms into a wound, or sewage into a stream. [EU] Continence: The ability to hold in a bowel movement or urine. [NIH] Continuous infusion: The administration of a fluid into a blood vessel, usually over a prolonged period of time. [NIH] Contraception: Use of agents, devices, methods, or procedures which diminish the likelihood of or prevent conception. [NIH] Contraceptive: An agent that diminishes the likelihood of or prevents conception. [EU] Contractility: Capacity for becoming short in response to a suitable stimulus. [EU] 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] Contralateral: Having to do with the opposite side of the body. [NIH] Contrast Media: Substances used in radiography that allow visualization of certain tissues. [NIH]

Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works. [NIH] Controlled clinical trial: A clinical study that includes a comparison (control) group. The comparison group receives a placebo, another treatment, or no treatment at all. [NIH] Controlled study: An experiment or clinical trial that includes a comparison (control) group. [NIH]

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] Convalescence: The period of recovery following an illness. [NIH]

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Conventional therapy: A currently accepted and widely used treatment for a certain type of disease, based on the results of past research. Also called conventional treatment. [NIH] Conventional treatment: A currently accepted and widely used treatment for a certain type of disease, based on the results of past research. Also called conventional therapy. [NIH] Convulsions: A general term referring to sudden and often violent motor activity of cerebral or brainstem origin. Convulsions may also occur in the absence of an electrical cerebral discharge (e.g., in response to hypotension). [NIH] Cooperative group: A group of physicians, hospitals, or both formed to treat a large number of persons in the same way so that new treatment can be evaluated quickly. Clinical trials of new cancer treatments often require many more people than a single physician or hospital can care for. [NIH] Coordination: Muscular or motor regulation or the harmonious cooperation of muscles or groups of muscles, in a complex action or series of actions. [NIH] Cor: The muscular organ that maintains the circulation of the blood. c. adiposum a heart that has undergone fatty degeneration or that has an accumulation of fat around it; called also fat or fatty, heart. c. arteriosum the left side of the heart, so called because it contains oxygenated (arterial) blood. c. biloculare a congenital anomaly characterized by failure of formation of the atrial and ventricular septums, the heart having only two chambers, a single atrium and a single ventricle, and a common atrioventricular valve. c. bovinum (L. 'ox heart') a greatly enlarged heart due to a hypertrophied left ventricle; called also c. taurinum and bucardia. c. dextrum (L. 'right heart') the right atrium and ventricle. c. hirsutum, c. villosum. c. mobile (obs.) an abnormally movable heart. c. pendulum a heart so movable that it seems to be hanging by the great blood vessels. c. pseudotriloculare biatriatum a congenital cardiac anomaly in which the heart functions as a three-chambered heart because of tricuspid atresia, the right ventricle being extremely small or rudimentary and the right atrium greatly dilated. Blood passes from the right to the left atrium and thence disease due to pulmonary hypertension secondary to disease of the lung, or its blood vessels, with hypertrophy of the right ventricle. [EU] Cornea: The transparent part of the eye that covers the iris and the pupil and allows light to enter the inside. [NIH] Corneal Edema: An excessive amount of fluid in the cornea due to damage of the epithelium or endothelium causing decreased visual acuity. [NIH] Corneal Opacity: Disorder occurring in the central or peripheral area of the cornea. The usual degree of transparency becomes relatively opaque. [NIH] Corneal Stroma: The lamellated connective tissue constituting the thickest layer of the cornea between the Bowman and Descemet membranes. [NIH] Corneal Transplantation: Partial or total replacement of the cornea from one human or animal to another. [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 Arteriosclerosis: Thickening and loss of elasticity of the coronary arteries. [NIH] 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 Circulation: The circulation of blood through the coronary vessels of the heart. [NIH]

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Coronary Disease: Disorder of cardiac function due to an imbalance between myocardial function and the capacity of the coronary vessels to supply sufficient flow for normal function. It is a form of myocardial ischemia (insufficient blood supply to the heart muscle) caused by a decreased capacity of the coronary vessels. [NIH] Coronary heart disease: A type of heart disease caused by narrowing of the coronary arteries that feed the heart, which needs a constant supply of oxygen and nutrients carried by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by fat and cholesterol deposits and cannot supply enough blood to the heart, CHD results. [NIH] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Coronary Vessels: The veins and arteries of the heart. [NIH] Corpus: The body of the uterus. [NIH] Corpus Callosum: Broad plate of dense myelinated fibers that reciprocally interconnect regions of the cortex in all lobes with corresponding regions of the opposite hemisphere. The corpus callosum is located deep in the longitudinal fissure. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Cortical: Pertaining to or of the nature of a cortex or bark. [EU] Cortices: The outer layer of an organ; used especially of the cerebrum and cerebellum. [NIH] Corticosteroids: Hormones that have antitumor activity in lymphomas and lymphoid leukemias; in addition, corticosteroids (steroids) may be used for hormone replacement and for the management of some of the complications of cancer and its treatment. [NIH] Cortisol: A steroid hormone secreted by the adrenal cortex as part of the body's response to stress. [NIH] Cortisone: A natural steroid hormone produced in the adrenal gland. It can also be made in the laboratory. Cortisone reduces swelling and can suppress immune responses. [NIH] Cost Savings: Reductions in all or any portion of the costs of providing goods or services. Savings may be incurred by the provider or the consumer. [NIH] Cost-benefit: A quantitative technique of economic analysis which, when applied to radiation practice, compares the health detriment from the radiation doses concerned with the cost of radiation dose reduction in that practice. [NIH] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Cranial Nerves: Twelve pairs of nerves that carry general afferent, visceral afferent, special afferent, somatic efferent, and autonomic efferent fibers. [NIH] Craniocerebral Trauma: Traumatic injuries involving the cranium and intracranial structures (i.e., brain; cranial nerves; meninges; and other structures). Injuries may be classified by whether or not the skull is penetrated (i.e., penetrating vs. nonpenetrating) or whether there is an associated hemorrhage. [NIH] Craniopharyngioma: A benign brain tumor that may be considered malignant because it can damage the hypothalamus, the area of the brain that controls body temperature, hunger, and thirst. [NIH] Craniotomy: An operation in which an opening is made in the skull. [NIH] Creatine: An amino acid that occurs in vertebrate tissues and in urine. In muscle tissue, creatine generally occurs as phosphocreatine. Creatine is excreted as creatinine in the urine.

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[NIH]

Creatine Kinase: A transferase that catalyzes formation of phosphocreatine from ATP + creatine. The reaction stores ATP energy as phosphocreatine. Three cytoplasmic isoenzymes have been identified in human tissues: MM from skeletal muscle, MB from myocardial tissue, and BB from nervous tissue as well as a mitochondrial isoenzyme. Macro-creatine kinase refers to creatine kinase complexed with other serum proteins. EC 2.7.3.2. [NIH] Creatinine: A compound that is excreted from the body in urine. Creatinine levels are measured to monitor kidney function. [NIH] Credentialing: The recognition of professional or technical competence through registration, certification, licensure, admission to association membership, the award of a diploma or degree, etc. [NIH] Cricoid Cartilage: The small thick cartilage that forms the lower and posterior parts of the laryngeal wall. [NIH] Criterion: A standard by which something may be judged. [EU] Cross-Sectional Studies: Studies in which the presence or absence of disease or other health-related variables are determined in each member of the study population or in a representative sample at one particular time. This contrasts with longitudinal studies which are followed over a period of time. [NIH] Crowns: A prosthetic restoration that reproduces the entire surface anatomy of the visible natural crown of a tooth. It may be partial (covering three or more surfaces of a tooth) or complete (covering all surfaces). It is made of gold or other metal, porcelain, or resin. [NIH] Cryostat: A batchwise operating apparatus in which a cryogenic liquid or solid is used to maintain by evaporation a cryotemperature which needs not be constant but may vary in a predetermined fashion. [NIH] Cryosurgery: The use of freezing as a special surgical technique to destroy or excise tissue. [NIH]

Cryotherapy: Any method that uses cold temperature to treat disease. [NIH] Cryptosporidiosis: Parasitic intestinal infection with severe diarrhea caused by a protozoan, Cryptosporidium. It occurs in both animals and humans. [NIH] Cues: Signals for an action; that specific portion of a perceptual field or pattern of stimuli to which a subject has learned to respond. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Curettage: Removal of tissue with a curette, a spoon-shaped instrument with a sharp edge. [NIH]

Curette: A spoon-shaped instrument with a sharp edge. [NIH] Cutaneous: Having to do with the skin. [NIH] Cyanoacrylates: A group of compounds having the general formula CH2=C(CN)-COOR; it polymerizes on contact with moisture; used as tissue adhesive; higher homologs have hemostatic and antibacterial properties. [NIH] Cyanosis: A bluish or purplish discoloration of the skin and mucous membranes due to an increase in the amount of deoxygenated hemoglobin in the blood or a structural defect in the hemoglobin molecule. [NIH] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cyclin: Molecule that regulates the cell cycle. [NIH]

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Cyclophosphamide: Precursor of an alkylating nitrogen mustard antineoplastic and immunosuppressive agent that must be activated in the liver to form the active aldophosphamide. It is used in the treatment of lymphomas, leukemias, etc. Its side effect, alopecia, has been made use of in defleecing sheep. Cyclophosphamide may also cause sterility, birth defects, mutations, and cancer. [NIH] Cyst: A sac or capsule filled with fluid. [NIH] Cystectomy: Used for excision of the urinary bladder. [NIH] Cystic Duct: The tube that carries bile from the gallbladder into the common bile duct and the small intestine. [NIH] Cystitis: Inflammation of the urinary bladder. [EU] Cystocele: Fallen bladder. When the bladder falls or sags from its normal position down to the pelvic floor, it can cause either urinary leakage or urinary retention. [NIH] Cystoid: Like a bladder or a cyst. [NIH] Cystoscopy: Endoscopic examination, therapy or surgery of the urinary bladder. [NIH] 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] Cytokine: Small but highly potent protein that modulates the activity of many cell types, including T and B cells. [NIH] Cytomegalovirus: A genus of the family Herpesviridae, subfamily Betaherpesvirinae, infecting the salivary glands, liver, spleen, lungs, eyes, and other organs, in which they produce characteristically enlarged cells with intranuclear inclusions. Infection with Cytomegalovirus is also seen as an opportunistic infection in AIDS. [NIH] Cytomegalovirus Infections: Infection with Cytomegalovirus, characterized by enlarged cells bearing intranuclear inclusions. Infection may be in almost any organ, but the salivary glands are the most common site in children, as are the lungs in adults. [NIH] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Cytoskeleton: The network of filaments, tubules, and interconnecting filamentous bridges which give shape, structure, and organization to the cytoplasm. [NIH] Cytotoxic: Cell-killing. [NIH] Cytotoxic chemotherapy: Anticancer drugs that kill cells, especially cancer cells. [NIH] Cytotoxicity: Quality of being capable of producing a specific toxic action upon cells of special organs. [NIH] Dacryocystorhinostomy: Surgical fistulization of the lacrimal sac for external drainage of an obstructed nasolacrimal duct. [NIH] Data Collection: Systematic gathering of data for a particular purpose from various sources,

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including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data. [NIH] Databases, Bibliographic: Extensive collections, reputedly complete, of references and citations to books, articles, publications, etc., generally on a single subject or specialized subject area. Databases can operate through automated files, libraries, or computer disks. The concept should be differentiated from factual databases which is used for collections of data and facts apart from bibliographic references to them. [NIH] Daunorubicin: Very toxic anthracycline aminoglycoside antibiotic isolated from Streptomyces peucetius and others, used in treatment of leukemias and other neoplasms. [NIH]

Day Care: Institutional health care of patients during the day. The patients return home at night. [NIH] De novo: In cancer, the first occurrence of cancer in the body. [NIH] Decision Making: The process of making a selective intellectual judgment when presented with several complex alternatives consisting of several variables, and usually defining a course of action or an idea. [NIH] Decompensation: Failure of compensation; cardiac decompensation is marked by dyspnea, venous engorgement, and edema. [EU] Decompression: Decompression external to the body, most often the slow lessening of external pressure on the whole body (especially in caisson workers, deep sea divers, and persons who ascend to great heights) to prevent decompression sickness. It includes also sudden accidental decompression, but not surgical (local) decompression or decompression applied through body openings. [NIH] Decompression Sickness: A condition occurring as a result of exposure to a rapid fall in ambient pressure. Gases, nitrogen in particular, come out of solution and form bubbles in body fluid and blood. These gas bubbles accumulate in joint spaces and the peripheral circulation impairing tissue oxygenation causing disorientation, severe pain, and potentially death. [NIH] Decubitus: An act of lying down; also the position assumed in lying down. [EU] Decubitus Ulcer: An ulceration caused by prolonged pressure in patients permitted to lie too still for a long period of time. The bony prominences of the body are the most frequently affected sites. The ulcer is caused by ischemia of the underlying structures of the skin, fat, and muscles as a result of the sustained and constant pressure. [NIH] Defecation: The normal process of elimination of fecal material from the rectum. [NIH] Defense Mechanisms: Unconscious process used by an individual or a group of individuals in order to cope with impulses, feelings or ideas which are not acceptable at their conscious level; various types include reaction formation, projection and self reversal. [NIH] Defibrillation: The act to arrest the fibrillation of (heart muscle) by applying electric shock across the chest, thus depolarizing the heart cells and allowing normal rhythm to return. [EU] 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] Delirium: (DSM III-R) an acute, reversible organic mental disorder characterized by reduced ability to maintain attention to external stimuli and disorganized thinking as manifested by rambling, irrelevant, or incoherent speech; there are also a reduced level of consciousness, sensory misperceptions, disturbance of the sleep-wakefulness cycle and level of

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psychomotor activity, disorientation to time, place, or person, and memory impairment. Delirium may be caused by a large number of conditions resulting in derangement of cerebral metabolism, including systemic infection, poisoning, drug intoxication or withdrawal, seizures or head trauma, and metabolic disturbances such as hypoxia, hypoglycaemia, fluid, electrolyte, or acid-base imbalances, or hepatic or renal failure. Called also acute confusional state and acute brain syndrome. [EU] Delivery of Health Care: The concept concerned with all aspects of providing and distributing health services to a patient population. [NIH] Delusions: A false belief regarding the self or persons or objects outside the self that persists despite the facts, and is not considered tenable by one's associates. [NIH] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH] Denaturation: Rupture of the hydrogen bonds by heating a DNA solution and then cooling it rapidly causes the two complementary strands to separate. [NIH] Dendrites: Extensions of the nerve cell body. They are short and branched and receive stimuli from other neurons. [NIH] Dendritic: 1. Branched like a tree. 2. Pertaining to or possessing dendrites. [EU] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Dental Abutments: Natural teeth or teeth roots used as anchorage for a fixed or removable denture or other prosthesis (such as an implant) serving the same purpose. [NIH] Dental Care: The total of dental diagnostic, preventive, and restorative services provided to meet the needs of a patient (from Illustrated Dictionary of Dentistry, 1982). [NIH] Dental Caries: Localized destruction of the tooth surface initiated by decalcification of the enamel followed by enzymatic lysis of organic structures and leading to cavity formation. If left unchecked, the cavity may penetrate the enamel and dentin and reach the pulp. The three most prominent theories used to explain the etiology of the disase are that acids produced by bacteria lead to decalcification; that micro-organisms destroy the enamel protein; or that keratolytic micro-organisms produce chelates that lead to decalcification. [NIH]

Dental Facilities: Use for material on dental facilities in general or for which there is no specific heading. [NIH] Dental implant: A small metal pin placed inside the jawbone to mimic the root of a tooth. Dental implants can be used to help anchor a false tooth or teeth, or a crown or bridge. [NIH] Dental Instruments: Hand-held tools or implements especially used by dental professionals for the performance of clinical tasks. [NIH] Dentate Gyrus: Gray matter situated above the gyrus hippocampi. It is composed of three layers. The molecular layer is continuous with the hippocampus in the hippocampal fissure. The granular layer consists of closely arranged spherical or oval neurons, called granule cells, whose axons pass through the polymorphic layer ending on the dendrites of pyramidal cells in the hippocampus. [NIH] Dentists: Individuals licensed to practice dentistry. [NIH] Dentures: An appliance used as an artificial or prosthetic replacement for missing teeth and adjacent tissues. It does not include crowns, dental abutments, nor artificial teeth. [NIH]

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Depolarization: The process or act of neutralizing polarity. In neurophysiology, the reversal of the resting potential in excitable cell membranes when stimulated, i.e., the tendency of the cell membrane potential to become positive with respect to the potential outside the cell. [EU] Depressive Disorder: An affective disorder manifested by either a dysphoric mood or loss of interest or pleasure in usual activities. The mood disturbance is prominent and relatively persistent. [NIH] Deprivation: Loss or absence of parts, organs, powers, or things that are needed. [EU] Depth Perception: Perception of three-dimensionality. [NIH] Dermal: Pertaining to or coming from the skin. [NIH] Dermatologist: A doctor who specializes in the diagnosis and treatment of skin problems. [NIH]

Dermatology: A medical specialty concerned with the skin, its structure, functions, diseases, and treatment. [NIH] DES: Diethylstilbestrol. A synthetic hormone that was prescribed from the early 1940s until 1971 to help women with complications of pregnancy. DES has been linked to an increased risk of clear cell carcinoma of the vagina in daughters of women who used DES. DES may also increase the risk of breast cancer in women who used DES. [NIH] Desensitization: The prevention or reduction of immediate hypersensitivity reactions by administration of graded doses of allergen; called also hyposensitization and immunotherapy. [EU] Detergents: Purifying or cleansing agents, usually salts of long-chain aliphatic bases or acids, that exert cleansing (oil-dissolving) and antimicrobial effects through a surface action that depends on possessing both hydrophilic and hydrophobic properties. [NIH] Developed Countries: Countries that have reached a level of economic achievement through an increase of production, per capita income and consumption, and utilization of natural and human resources. [NIH] Developing Countries: Countries in the process of change directed toward economic growth, that is, an increase in production, per capita consumption, and income. The process of economic growth involves better utilization of natural and human resources, which results in a change in the social, political, and economic structures. [NIH] Dexamethasone: (11 beta,16 alpha)-9-Fluoro-11,17,21-trihydroxy-16-methylpregna-1,4diene-3,20-dione. An anti-inflammatory glucocorticoid used either in the free alcohol or esterified form in treatment of conditions that respond generally to cortisone. [NIH] Dexrazoxane: A drug used to protect the heart from the toxic effects of anthracycline drugs such as doxorubicin. It belongs to the family of drugs called chemoprotective agents. [NIH] Dexterity: Ability to move the hands easily and skillfully. [NIH] Dextrocardia: Location of the heart in the right hemithorax, with the apex directed to the right. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diabetic Retinopathy: Retinopathy associated with diabetes mellitus, which may be of the background type, progressively characterized by microaneurysms, interretinal punctuate macular edema, or of the proliferative type, characterized by neovascularization of the retina and optic disk, which may project into the vitreous, proliferation of fibrous tissue, vitreous hemorrhage, and retinal detachment. [NIH] Diagnostic Imaging: Any visual display of structural or functional patterns of organs or

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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] Dialysate: A cleansing liquid used in the two major forms of dialysis--hemodialysis and peritoneal dialysis. [NIH] Diaphragm: The musculofibrous partition that separates the thoracic cavity from the abdominal cavity. Contraction of the diaphragm increases the volume of the thoracic cavity aiding inspiration. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diastole: Period of relaxation of the heart, especially the ventricles. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Diastolic pressure: The lowest pressure to which blood pressure falls between contractions of the ventricles. [NIH] Diathermy: The induction of local hyperthermia by either short radio waves or highfrequency sound waves. [NIH] Diathesis: A constitution or condition of the body which makes the tissues react in special ways to certain extrinsic stimuli and thus tends to make the person more than usually susceptible to certain diseases. [EU] Diclofenac: A non-steroidal anti-inflammatory agent (NSAID) with antipyretic and analgesic actions. It is primarily available as the sodium salt, diclofenac sodium. [NIH] Diclofenac Sodium: The sodium form of diclofenac. It is used for its analgesic and antiinflammatory properties. [NIH] Diencephalon: The paired caudal parts of the prosencephalon from which the thalamus, hypothalamus, epithalamus, and subthalamus are derived. [NIH] Diestrus: Period of sexual quiescence separating phases of the estrous cycle in polyestrous animals. [NIH] Diffusion: The tendency of a gas or solute to pass from a point of higher pressure or concentration to a point of lower pressure or concentration and to distribute itself throughout the available space; a major mechanism of biological transport. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Digestive tract: The organs through which food passes when food is eaten. These organs are the mouth, esophagus, stomach, small and large intestines, and rectum. [NIH] Dilatation: The act of dilating. [NIH] Dilatation, Pathologic: The condition of an anatomical structure's being dilated beyond normal dimensions. [NIH] Dilated cardiomyopathy: Heart muscle disease that leads to enlargement of the heart's chambers, robbing the heart of its pumping ability. [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] Dilator: A device used to stretch or enlarge an opening. [NIH]

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Dilution: A diluted or attenuated medicine; in homeopathy, the diffusion of a given quantity of a medicinal agent in ten or one hundred times the same quantity of water. [NIH] Diopter: The measurement of refractive error. A negative diopter value signifies an eye with myopia and positive diopter value signifies an eye with hyperopia. [NIH] Diplopia: A visual symptom in which a single object is perceived by the visual cortex as two objects rather than one. Disorders associated with this condition include refractive errors; strabismus; oculomotor nerve diseases; trochlear nerve diseases; abducens nerve diseases; and diseases of the brain stem and occipital lobe. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Discrimination: The act of qualitative and/or quantitative differentiation between two or more stimuli. [NIH] Disease Progression: The worsening of a disease over time. This concept is most often used for chronic and incurable diseases where the stage of the disease is an important determinant of therapy and prognosis. [NIH] Disease-Free Survival: Period after successful treatment in which there is no appearance of the symptoms or effects of the disease. [NIH] Disease-specific survival: The percentage of subjects in a study who have survived a particular disease for a defined period of time. Usually reported as time since diagnosis or treatment. In calculating this percentage, only deaths from the disease being studied are counted. Subjects who died from some other cause are not included in the calculation. [NIH] Disinfectant: An agent that disinfects; applied particularly to agents used on inanimate objects. [EU] Disinfection: Rendering pathogens harmless through the use of heat, antiseptics, antibacterial agents, etc. [NIH] Diskectomy: Excision, in part or whole, of an intervertebral disk. The most common indication is disk displacement or herniation. In addition to standard surgical removal, it can be performed by percutaneous diskectomy or by laparoscopic diskectomy, the former being the more common. [NIH] Dislocation: The displacement of any part, more especially of a bone. Called also luxation. [EU]

Disorientation: The loss of proper bearings, or a state of mental confusion as to time, place, or identity. [EU] Disparity: Failure of the two retinal images of an object to fall on corresponding retinal points. [NIH] Dissection: Cutting up of an organism for study. [NIH] Dissociation: 1. The act of separating or state of being separated. 2. The separation of a molecule into two or more fragments (atoms, molecules, ions, or free radicals) produced by the absorption of light or thermal energy or by solvation. 3. In psychology, a defense mechanism in which a group of mental processes are segregated from the rest of a person's mental activity in order to avoid emotional distress, as in the dissociative disorders (q.v.), or in which an idea or object is segregated from its emotional significance; in the first sense it is roughly equivalent to splitting, in the second, to isolation. 4. A defect of mental integration in which one or more groups of mental processes become separated off from normal consciousness and, thus separated, function as a unitary whole. [EU] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU]

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Diuretic: A drug that increases the production of urine. [NIH] Diverticula: Plural form of diverticulum. [NIH] Diverticulitis: Inflammation of a diverticulum or diverticula. [NIH] Diverticulum: A pathological condition manifested as a pouch or sac opening from a tubular or sacular organ. [NIH] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Docetaxel: An anticancer drug that belongs to the family of drugs called mitotic inhibitors. [NIH]

Domestic Violence: Deliberate, often repetitive, physical abuse by one family member against another: marital partners, parents, children, siblings, or any other member of a household. [NIH] Dopamine: An endogenous catecholamine and prominent neurotransmitter in several systems of the brain. In the synthesis of catecholamines from tyrosine, it is the immediate precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. A family of dopaminergic receptor subtypes mediate its action. Dopamine is used pharmacologically for its direct (beta adrenergic agonist) and indirect (adrenergic releasing) sympathomimetic effects including its actions as an inotropic agent and as a renal vasodilator. [NIH] Dorsal: 1. Pertaining to the back or to any dorsum. 2. Denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Dorsum: A plate of bone which forms the posterior boundary of the sella turcica. [NIH] Dosimetry: All the methods either of measuring directly, or of measuring indirectly and computing, absorbed dose, absorbed dose rate, exposure, exposure rate, dose equivalent, and the science associated with these methods. [NIH] Double-blinded: A clinical trial in which neither the medical staff nor the person knows which of several possible therapies the person is receiving. [NIH] Doxorubicin: Antineoplastic antibiotic obtained from Streptomyces peucetics. It is a hydroxy derivative of daunorubicin and is used in treatment of both leukemia and solid tumors. [NIH] Drive: A state of internal activity of an organism that is a necessary condition before a given stimulus will elicit a class of responses; e.g., a certain level of hunger (drive) must be present before food will elicit an eating response. [NIH] Drug Delivery Systems: Systems of administering drugs through controlled delivery so that an optimum amount reaches the target site. Drug delivery systems encompass the carrier, route, and target. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Drug Tolerance: Progressive diminution of the susceptibility of a human or animal to the effects of a drug, resulting from its continued administration. It should be differentiated from drug resistance wherein an organism, disease, or tissue fails to respond to the intended effectiveness of a chemical or drug. It should also be differentiated from maximum tolerated dose and no-observed-adverse-effect level. [NIH] Drusen: Tiny yellow or white deposits in the retina or optic nerve head. [NIH] Duct: A tube through which body fluids pass. [NIH]

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Ductal carcinoma in situ: DCIS. Abnormal cells that involve only the lining of a duct. The cells have not spread outside the duct to other tissues in the breast. Also called intraductal carcinoma. [NIH] Duodenal Ulcer: An ulcer in the lining of the first part of the small intestine (duodenum). [NIH]

Duodenum: The first part of the small intestine. [NIH] Dura mater: The outermost, toughest, and most fibrous of the three membranes (meninges) covering the brain and spinal cord; called also pachymeninx. [EU] Dwell time: In peritoneal dialysis, the amount of time a bag of dialysate remains in the patient's abdominal cavity during an exchange. [NIH] Dynamometer: An instrument for measuring the force of muscular contraction. [NIH] Dyskinesias: Abnormal involuntary movements which primarily affect the extremities, trunk, or jaw that occur as a manifestation of an underlying disease process. Conditions which feature recurrent or persistent episodes of dyskinesia as a primary manifestation of disease may be referred to as dyskinesia syndromes (movement disorders). Dyskinesias are also a relatively common manifestation of basal ganglia diseases. [NIH] Dysmenorrhea: Painful menstruation. [NIH] Dyspareunia: Painful sexual intercourse. [NIH] Dysphagia: Difficulty in swallowing. [EU] Dysphonia: Difficulty or pain in speaking; impairment of the voice. [NIH] Dysphoric: A feeling of unpleasantness and discomfort. [NIH] Dysplasia: Cells that look abnormal under a microscope but are not cancer. [NIH] Dyspnea: Difficult or labored breathing. [NIH] Ear Diseases: Diseases of the ear, general or unspecified. [NIH] Eardrum: A thin, tense membrane forming the greater part of the outer wall of the tympanic cavity and separating it from the external auditory meatus; it constitutes the boundary between the external and middle ear. [NIH] Eating Disorders: A group of disorders characterized by physiological and psychological disturbances in appetite or food intake. [NIH] Echocardiography: Ultrasonic recording of the size, motion, and composition of the heart and surrounding tissues. The standard approach is transthoracic. [NIH] Ectoderm: The outer of the three germ layers of the embryo. [NIH] Ectopic: Pertaining to or characterized by ectopia. [EU] Ectopic Pregnancy: The pregnancy occurring elsewhere than in the cavity of the uterus. [NIH]

Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Effector cell: A cell that performs a specific function in response to a stimulus; usually used to describe cells in the immune system. [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]

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Effusion: The escape of fluid into a part or tissue, as an exudation or a transudation. [EU] Eicosanoids: A class of oxygenated, endogenous, unsaturated fatty acids derived from arachidonic acid. They include prostaglandins, leukotrienes, thromboxanes, and hydroxyeicosatetraenoic acid compounds (HETE). They are hormone-like substances that act near the site of synthesis without altering functions throughout the body. [NIH] Elasticity: Resistance and recovery from distortion of shape. [NIH] Elastin: The protein that gives flexibility to tissues. [NIH] Elastomers: A generic term for all substances having the properties of natural, reclaimed, vulcanized, or synthetic rubber, in that they stretch under tension, have a high tensile strength, retract rapidly, and recover their original dimensions fully. [NIH] Elbow Joint: A hinge joint connecting the forearm to the arm. [NIH] Elective: Subject to the choice or decision of the patient or physician; applied to procedures that are advantageous to the patient but not urgent. [EU] Electric shock: A dangerous patho-physiological effect resulting from an electric current passing through the body of a human or animal. [NIH] Electrocardiography: Recording of the moment-to-moment electromotive forces of the heart as projected onto various sites on the body's surface, delineated as a scalar function of time. [NIH]

Electrocoagulation: Electrosurgical procedures used to treat hemorrhage (e.g., bleeding ulcers) and to ablate tumors, mucosal lesions, and refractory arrhythmias. [NIH] Electrode: Component of the pacing system which is at the distal end of the lead. It is the interface with living cardiac tissue across which the stimulus is transmitted. [NIH] Electrodesiccation: The drying of tissue by a high-frequency electric current applied with a needle-shaped electrode. [NIH] Electroencephalography: Recording of electric currents developed in the brain by means of electrodes applied to the scalp, to the surface of the brain, or placed within the substance of the brain. [NIH] Electrolarynx: A battery-operated instrument that makes a humming sound. An electrolarynx is used to help people whose voice boxes (larynxes) have been removed. [NIH] Electrolysis: Destruction by passage of a galvanic electric current, as in disintegration of a chemical compound in solution. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electromyography: Recording of the changes in electric potential of muscle by means of surface or needle electrodes. [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] Electrophoresis: An electrochemical process in which macromolecules or colloidal particles with a net electric charge migrate in a solution under the influence of an electric current. [NIH]

Electrophysiological: Pertaining to electrophysiology, that is a branch of physiology that is concerned with the electric phenomena associated with living bodies and involved in their functional activity. [EU]

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Emaciation: Clinical manifestation of excessive leanness usually caused by disease or a lack of nutrition. [NIH] Emboli: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] Embolism: Blocking of a blood vessel by a blood clot or foreign matter that has been transported from a distant site by the blood stream. [NIH] Embolization: The blocking of an artery by a clot or foreign material. Embolization can be done as treatment to block the flow of blood to a tumor. [NIH] Embolus: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Embryology: The study of the development of an organism during the embryonic and fetal stages of life. [NIH] Emollient: Softening or soothing; called also malactic. [EU] Emphysema: A pathological accumulation of air in tissues or organs. [NIH] Empirical: A treatment based on an assumed diagnosis, prior to receiving confirmatory laboratory test results. [NIH] Empyema: Presence of pus in a hollow organ or body cavity. [NIH] Emulsify: To convert or to be converted into an emulsion. [EU] Emulsion: A preparation of one liquid distributed in small globules throughout the body of a second liquid. The dispersed liquid is the discontinuous phase, and the dispersion medium is the continuous phase. When oil is the dispersed liquid and an aqueous solution is the continuous phase, it is known as an oil-in-water emulsion, whereas when water or aqueous solution is the dispersed phase and oil or oleaginous substance is the continuous phase, it is known as a water-in-oil emulsion. Pharmaceutical emulsions for which official standards have been promulgated include cod liver oil emulsion, cod liver oil emulsion with malt, liquid petrolatum emulsion, and phenolphthalein in liquid petrolatum emulsion. [EU] Enalapril: An angiotensin-converting enzyme inhibitor that is used to treat hypertension. [NIH]

Enalaprilat: The active metabolite of enalapril and a potent intravenously administered angiotensin-converting enzyme inhibitor. It is an effective agent for the treatment of essential hypertension and has beneficial hemodynamic effects in heart failure. The drug produces renal vasodilation with an increase in sodium excretion. [NIH] Encapsulated: Confined to a specific, localized area and surrounded by a thin layer of tissue. [NIH]

Encephalitis: Inflammation of the brain due to infection, autoimmune processes, toxins, and other conditions. Viral infections (see encephalitis, viral) are a relatively frequent cause of this condition. [NIH] Encephalitis, Viral: Inflammation of brain parenchymal tissue as a result of viral infection. Encephalitis may occur as primary or secondary manifestation of Togaviridae infections; Herpesviridae infections; Adenoviridae infections; Flaviviridae infections; Bunyaviridae infections; Picornaviridae infections; Paramyxoviridae infections; Orthomyxoviridae infections; Retroviridae infections; and Arenaviridae infections. [NIH]

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Encephalocele: Cerebral tissue herniation through a congenital or acquired defect in the skull. The majority of congenital encephaloceles occur in the occipital or frontal regions. Clinical features include a protuberant mass that may be pulsatile. The quantity and location of protruding neural tissue determines the type and degree of neurologic deficit. Visual defects, psychomotor developmental delay, and persistent motor deficits frequently occur. [NIH]

Encopresis: Incontinence of feces not due to organic defect or illness. [NIH] Endarterectomy: Surgical excision, performed under general anesthesia, of the atheromatous tunica intima of an artery. When reconstruction of an artery is performed as an endovascular procedure through a catheter, it is called atherectomy. [NIH] Endemic: Present or usually prevalent in a population or geographical area at all times; said of a disease or agent. Called also endemial. [EU] Endocarditis: Exudative and proliferative inflammatory alterations of the endocardium, characterized by the presence of vegetations on the surface of the endocardium or in the endocardium itself, and most commonly involving a heart valve, but sometimes affecting the inner lining of the cardiac chambers or the endocardium elsewhere. It may occur as a primary disorder or as a complication of or in association with another disease. [EU] Endocardium: The innermost layer of the heart, comprised of endothelial cells. [NIH] Endocrine System: The system of glands that release their secretions (hormones) directly into the circulatory system. In addition to the endocrine glands, included are the chromaffin system and the neurosecretory systems. [NIH] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Endodontics: A dental specialty concerned with the maintenance of the dental pulp in a state of health and the treatment of the pulp cavity (pulp chamber and pulp canal). [NIH] Endometrial: Having to do with the endometrium (the layer of tissue that lines the uterus). [NIH]

Endometriosis: A condition in which tissue more or less perfectly resembling the uterine mucous membrane (the endometrium) and containing typical endometrial granular and stromal elements occurs aberrantly in various locations in the pelvic cavity. [NIH] Endometrium: The layer of tissue that lines the uterus. [NIH] Endophthalmitis: Suppurative inflammation of the tissues of the internal structures of the eye; not all layers of the uvea are affected. Fungi, necrosis of intraocular tumors, and retained intraocular foreign bodies often cause a purulent endophthalmitis. [NIH] Endorphin: Opioid peptides derived from beta-lipotropin. Endorphin is the most potent naturally occurring analgesic agent. It is present in pituitary, brain, and peripheral tissues. [NIH]

Endoscope: A thin, lighted tube used to look at tissues inside the body. [NIH] Endoscopic: A technique where a lateral-view endoscope is passed orally to the duodenum for visualization of the ampulla of Vater. [NIH] Endoscopic retrograde cholangiopancreatography: ERCP. A procedure to x-ray the pancreatic duct, hepatic duct, common bile duct, duodenal papilla, and gallbladder. In this procedure, a thin, lighted tube (endoscope) is passed through the mouth and down into the first part of the small intestine (duodenum). A smaller tube (catheter) is then inserted through the endoscope into the bile and pancreatic ducts. A dye is injected through the catheter into the ducts, and an x-ray is taken. [NIH] Endoscopy: Endoscopic examination, therapy or surgery performed on interior parts of the

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body. [NIH] Endothelial cell: The main type of cell found in the inside lining of blood vessels, lymph vessels, and the heart. [NIH] Endothelium: A layer of epithelium that lines the heart, blood vessels (endothelium, vascular), lymph vessels (endothelium, lymphatic), and the serous cavities of the body. [NIH] Endothelium, Lymphatic: Unbroken cellular lining (intima) of the lymph vessels (e.g., the high endothelial lymphatic venules). It is more permeable than vascular endothelium, lacking selective absorption and functioning mainly to remove plasma proteins that have filtered through the capillaries into the tissue spaces. [NIH] Endothelium, Vascular: Single pavement layer of cells which line the luminal surface of the entire vascular system and regulate the transport of macromolecules and blood components from interstitium to lumen; this function has been most intensively studied in the blood capillaries. [NIH] Endothelium-derived: Small molecule that diffuses to the adjacent muscle layer and relaxes it. [NIH] Endotoxemia: A condition characterized by the presence of endotoxins in the blood. If endotoxemia is the result of gram-negative rod-shaped bacteria, shock may occur. [NIH] Endotoxin: Toxin from cell walls of bacteria. [NIH] End-stage renal: Total chronic kidney failure. When the kidneys fail, the body retains fluid and harmful wastes build up. A person with ESRD needs treatment to replace the work of the failed kidneys. [NIH] Energetic: Exhibiting energy : strenuous; operating with force, vigour, or effect. [EU] Energy balance: Energy is the capacity of a body or a physical system for doing work. Energy balance is the state in which the total energy intake equals total energy needs. [NIH] Enhancer: Transcriptional element in the virus genome. [NIH] Enkephalin: A natural opiate painkiller, in the hypothalamus. [NIH] Enteral Nutrition: Nutritional support given via the alimentary canal or any route connected to the gastrointestinal system (i.e., the enteral route). This includes oral feeding, sip feeding, and tube feeding using nasogastric, gastrostomy, and jejunostomy tubes. [NIH] Enteric Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Enterostomal Therapy: A nurse who cares for patients with an ostomy. [NIH] Entorhinal Cortex: Cortex where the signals are combined with those from other sensory systems. [NIH] Environmental Exposure: The exposure to potentially harmful chemical, physical, or biological agents in the environment or to environmental factors that may include ionizing radiation, pathogenic organisms, or toxic chemicals. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Enzyme Inhibitors: Compounds or agents that combine with an enzyme in such a manner as to prevent the normal substrate-enzyme combination and the catalytic reaction. [NIH] Eosinophilia: Abnormal increase in eosinophils in the blood, tissues or organs. [NIH]

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Eosinophils: Granular leukocytes with a nucleus that usually has two lobes connected by a slender thread of chromatin, and cytoplasm containing coarse, round granules that are uniform in size and stainable by eosin. [NIH] Ependyma: A thin membrane that lines the ventricles of the brain and the central canal of the spinal cord. [NIH] Epicondylitis: Inflammation of the epicondyle or of the tissues adjoining the epicondyle of the humerus. [EU] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other healthrelated event occurring in such outbreaks. [EU] Epidemiologic Studies: Studies designed to examine associations, commonly, hypothesized causal relations. They are usually concerned with identifying or measuring the effects of risk factors or exposures. The common types of analytic study are case-control studies, cohort studies, and cross-sectional studies. [NIH] Epidemiological: Relating to, or involving epidemiology. [EU] Epidermal: Pertaining to or resembling epidermis. Called also epidermic or epidermoid. [EU] 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] Epidermoid carcinoma: A type of cancer in which the cells are flat and look like fish scales. Also called squamous cell carcinoma. [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] Epigastric: Having to do with the upper middle area of the abdomen. [NIH] Epikeratophakia: A procedure that modifies the refractive error of the lens by the transplantation of a donor cornea to the anterior surface of the patient's cornea. The basic indication for epikeratophakia is the incapability of correcting refractive errors with conservative methods, such as glasses, contact lenses, or intraocular lenses. [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Episode of Care: An interval of care by a health care facility or provider for a specific medical problem or condition. It may be continuous or it may consist of a series of intervals marked by one or more brief separations from care, and can also identify the sequence of care (e.g., emergency, inpatient, outpatient), thus serving as one measure of health care provided. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelial Cells: Cells that line the inner and outer surfaces of the body. [NIH] Epithelial ovarian cancer: Cancer that occurs in the cells lining the ovaries. [NIH] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] Epoprostenol: A prostaglandin that is biosynthesized enzymatically from prostaglandin endoperoxides in human vascular tissue. It is a potent inhibitor of platelet aggregation. The

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sodium salt has been also used to treat primary pulmonary hypertension. [NIH] Equinus Deformity: Plantar declination of the foot. [NIH] Equipment and Supplies: Expendable and nonexpendable equipment, supplies, apparatus, and instruments that are used in diagnostic, surgical, therapeutic, scientific, and experimental procedures. [NIH] Equipment Failure: Failure of equipment to perform up to standards. The failure may be due to defects or improper use. [NIH] Erbium: Erbium. An element of the rare earth family of metals. It has the atomic symbol Er, atomic number 68, and atomic weight 167.26. [NIH] Erectile: The inability to get or maintain an erection for satisfactory sexual intercourse. Also called impotence. [NIH] Erection: The condition of being made rigid and elevated; as erectile tissue when filled with blood. [EU] Ergonomics: Study of the relationships between man and machines; adjusting the design of machines to the need and capacities of man; study of the effect of machines on man's behavior. [NIH] Erythrocyte Volume: Volume of circulating erythrocytes. It is usually measured by radioisotope dilution technique. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Erythromycin: A bacteriostatic antibiotic substance produced by Streptomyces erythreus. Erythromycin A is considered its major active component. In sensitive organisms, it inhibits protein synthesis by binding to 50S ribosomal subunits. This binding process inhibits peptidyl transferase activity and interferes with translocation of amino acids during translation and assembly of proteins. [NIH] Erythropoietin: Glycoprotein hormone, secreted chiefly by the kidney in the adult and the liver in the fetus, that acts on erythroid stem cells of the bone marrow to stimulate proliferation and differentiation. [NIH] Esophageal: Having to do with the esophagus, the muscular tube through which food passes from the throat to the stomach. [NIH] Esophageal Achalasia: Disorder of lower esophagogastric motility due to failure of the lower esophageal sphincter to relax with swallowing. It is sometimes caused by degeneration of the ganglion cells of the myenteric plexus or of the vagal motor nuclei. [NIH] Esophageal Motility Disorders: Disorders affecting the motor function of the upper or lower esophageal sphincters, the esophageal body, or a combination of these parts. The failure of the sphincters to maintain a tonic pressure may result in the impeding of the passage of food, regurgitation of food, or reflux of gastric acid into the esophagus. [NIH] Esophageal speech: Speech produced by trapping air in the esophagus and forcing it out again. It is used by people whose voice boxes (larynxes) have been removed. [NIH] Esophageal Varices: Stretched veins in the esophagus that occur when the liver is not working properly. If the veins burst, the bleeding can cause death. [NIH] Esophagitis: Inflammation, acute or chronic, of the esophagus caused by bacteria, chemicals, or trauma. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Esotropia: A form of ocular misalignment characterized by an excessive convergence of the

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visual axes, resulting in a "cross-eye" appearance. An example of this condition occurs when paralysis of the lateral rectus muscle causes an abnormal inward deviation of one eye on attempted gaze. [NIH] Estradiol: The most potent mammalian estrogenic hormone. It is produced in the ovary, placenta, testis, and possibly the adrenal cortex. [NIH] Estrogen: One of the two female sex hormones. [NIH] Estrogen Replacement Therapy: The use of hormonal agents with estrogen-like activity in postmenopausal or other estrogen-deficient women to alleviate effects of hormone deficiency, such as vasomotor symptoms, dyspareunia, and progressive development of osteoporosis. This may also include the use of progestational agents in combination therapy. [NIH]

Ether: One of a class of organic compounds in which any two organic radicals are attached directly to a single oxygen atom. [NIH] Ethionine: 2-Amino-4-(ethylthio)butyric acid. An antimetabolite and methionine antagonist that interferes with amino acid incorporation into proteins and with cellular ATP utilization. It also produces liver neoplasms. [NIH] Ethmoid: An unpaired cranial bone which helps form the medial walls of the orbits and contains the themoidal air cells which drain into the nose. [NIH] Ethnic Groups: A group of people with a common cultural heritage that sets them apart from others in a variety of social relationships. [NIH] Etomidate: Imidazole derivative anesthetic and hypnotic with little effect on blood gases, ventilation, or the cardiovascular system. It has been proposed as an induction anesthetic. [NIH]

Etoposide: A semisynthetic derivative of podophyllotoxin that exhibits antitumor activity. Etoposide inhibits DNA synthesis by forming a complex with topoisomerase II and DNA. This complex induces breaks in double stranded DNA and prevents repair by topoisomerase II binding. Accumulated breaks in DNA prevent entry into the mitotic phase of cell division, and lead to cell death. Etoposide acts primarily in the G2 and S phases of the cell cycle. [NIH] Euthanasia: The act or practice of putting to death people or animals suffering from incurable conditions or diseases. [NIH] Evacuation: An emptying, as of the bowels. [EU] Evoke: The electric response recorded from the cerebral cortex after stimulation of a peripheral sense organ. [NIH] Evoked Potentials: The electric response evoked in the central nervous system by stimulation of sensory receptors or some point on the sensory pathway leading from the receptor to the cortex. The evoked stimulus can be auditory, somatosensory, or visual, although other modalities have been reported. Event-related potentials is sometimes used synonymously with evoked potentials but is often associated with the execution of a motor, cognitive, or psychophysiological task, as well as with the response to a stimulus. [NIH] Excimer laser: An ultraviolet laser used in refractive surgery to remove corneal tissue. [NIH] Excisional: The surgical procedure of removing a tumor by cutting it out. The biopsy is then examined under a microscope. [NIH] Excisional biopsy: A surgical procedure in which an entire lump or suspicious area is removed for diagnosis. The tissue is then examined under a microscope. [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]

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Excitatory: When cortical neurons are excited, their output increases and each new input they receive while they are still excited raises their output markedly. [NIH] Excitatory Amino Acids: Endogenous amino acids released by neurons as excitatory neurotransmitters. Glutamic acid is the most common excitatory neurotransmitter in the brain. Aspartic acid has been regarded as an excitatory transmitter for many years, but the extent of its role as a transmitter is unclear. [NIH] Excitotoxicity: Excessive exposure to glutamate or related compounds can kill brain neurons, presumably by overstimulating them. [NIH] Exercise Test: Controlled physical activity, more strenuous than at rest, which is performed in order to allow assessment of physiological functions, particularly cardiovascular and pulmonary, but also aerobic capacity. Maximal (most intense) exercise is usually required but submaximal exercise is also used. The intensity of exercise is often graded, using criteria such as rate of work done, oxygen consumption, and heart rate. Physiological data obtained from an exercise test may be used for diagnosis, prognosis, and evaluation of disease severity, and to evaluate therapy. Data may also be used in prescribing exercise by determining a person's exercise capacity. [NIH] Exocrine: Secreting outwardly, via a duct. [EU] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Exotropia: A form of ocular misalignment where the visual axes diverge inappropriately. For example, medial rectus muscle weakness may produce this condition as the affected eye will deviate laterally upon attempted forward gaze. An exotropia occurs due to the relatively unopposed force exerted on the eye by the lateral rectus muscle, which pulls the eye in an outward direction. [NIH] Expander: Any of several colloidal substances of high molecular weight. used as a blood or plasma substitute in transfusion for increasing the volume of the circulating blood. called also extender. [NIH] Expert Systems: Computer programs based on knowledge developed from consultation with experts on a problem, and the processing and/or formalizing of this knowledge using these programs in such a manner that the problems may be solved. [NIH] Expiration: The act of breathing out, or expelling air from the lungs. [EU] Expiratory: The volume of air which leaves the breathing organs in each expiration. [NIH] Extensor: A muscle whose contraction tends to straighten a limb; the antagonist of a flexor. [NIH]

External Fixators: External devices which hold wires or pins that are placed through one or both cortices of bone in order to hold the position of a fracture in proper alignment. These devices allow easy access to wounds, adjustment during the course of healing, and more functional use of the limbs involved. [NIH] External radiation: Radiation therapy that uses a machine to aim high-energy rays at the cancer. Also called external-beam radiation. [NIH] External-beam radiation: Radiation therapy that uses a machine to aim high-energy rays at the cancer. Also called external radiation. [NIH] Extracellular: Outside a cell or cells. [EU] Extracellular Matrix: A meshwork-like substance found within the extracellular space and in association with the basement membrane of the cell surface. It promotes cellular proliferation and provides a supporting structure to which cells or cell lysates in culture dishes adhere. [NIH]

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Extracellular Matrix Proteins: Macromolecular organic compounds that contain carbon, hydrogen, oxygen, nitrogen, and usually, sulfur. These macromolecules (proteins) form an intricate meshwork in which cells are embedded to construct tissues. Variations in the relative types of macromolecules and their organization determine the type of extracellular matrix, each adapted to the functional requirements of the tissue. The two main classes of macromolecules that form the extracellular matrix are: glycosaminoglycans, usually linked to proteins (proteoglycans), and fibrous proteins (e.g., collagen, elastin, fibronectins and laminin). [NIH] Extracellular Space: Interstitial space between cells, occupied by fluid as well as amorphous and fibrous substances. [NIH] Extracorporeal: Situated or occurring outside the body. [EU] Extracorporeal Circulation: Diversion of blood flow through a circuit located outside the body but continuous with the bodily circulation. [NIH] Extracorporeal Membrane Oxygenation: Application of a life support system that circulates the blood through an oxygenating system, which may consist of a pump, a membrane oxygenator, and a heat exchanger. Examples of its use are to assist victims of smoke inhalation injury, respiratory failure, and cardiac failure. [NIH] Extraction: The process or act of pulling or drawing out. [EU] Extraocular: External to or outside of the eye. [NIH] Extravasation: A discharge or escape, as of blood, from a vessel into the tissues. [EU] Extremity: A limb; an arm or leg (membrum); sometimes applied specifically to a hand or foot. [EU] Eye Movements: Voluntary or reflex-controlled movements of the eye. [NIH] Facial: Of or pertaining to the face. [EU] Facial Asymmetry: Congenital or acquired asymmetry of the face. [NIH] Facial Injuries: General or unspecified injuries to the soft tissue or bony portions of the face. [NIH]

Facial Nerve: The 7th cranial nerve. The facial nerve has two parts, the larger motor root which may be called the facial nerve proper, and the smaller intermediate or sensory root. Together they provide efferent innervation to the muscles of facial expression and to the lacrimal and salivary glands, and convey afferent information for taste from the anterior two-thirds of the tongue and for touch from the external ear. [NIH] Facial Pain: Pain in the facial region including orofacial pain and craniofacial pain. Associated conditions include local inflammatory and neoplastic disorders and neuralgic syndromes involving the trigeminal, facial, and glossopharyngeal nerves. Conditions which feature recurrent or persistent facial pain as the primary manifestation of disease are referred to as facial pain syndromes. [NIH] Facial Paralysis: Severe or complete loss of facial muscle motor function. This condition may result from central or peripheral lesions. Damage to CNS motor pathways from the cerebral cortex to the facial nuclei in the pons leads to facial weakness that generally spares the forehead muscles. Facial nerve diseases generally results in generalized hemifacial weakness. Neuromuscular junction diseases and muscular diseases may also cause facial paralysis or paresis. [NIH] Failure to Thrive: A condition in which an infant or child's weight gain and growth are far below usual levels for age. [NIH] Fallopian Tubes: Two long muscular tubes that transport ova from the ovaries to the uterus.

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They extend from the horn of the uterus to the ovaries and consist of an ampulla, an infundibulum, an isthmus, two ostia, and a pars uterina. The walls of the tubes are composed of three layers: mucosal, muscular, and serosal. [NIH] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Farsightedness: The common term for hyperopia. [NIH] Fasciitis: Inflammation of the fascia. There are three major types: 1) Eosinophilic fasciitis, an inflammatory reaction with eosinophilia, producing hard thickened skin with an orangepeel configuration suggestive of scleroderma and considered by some a variant of scleroderma; 2) Necrotizing fasciitis, a serious fulminating infection (usually by a beta hemolytic Streptococcus) causing extensive necrosis of superficial fascia; 3) Nodular/Pseudosarcomatous/Proliferative fasciitis, characterized by a rapid growth of fibroblasts with mononuclear inflammatory cells and proliferating capillaries in soft tissue, often the forearm; it is not malignant but is sometimes mistaken for fibrosarcoma. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]

Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH] Fatty Liver: The buildup of fat in liver cells. The most common cause is alcoholism. Other causes include obesity, diabetes, and pregnancy. Also called steatosis. [NIH] Feasibility Studies: Studies to determine the advantages or disadvantages, practicability, or capability of accomplishing a projected plan, study, or project. [NIH] Fecal Incontinence: Failure of voluntary control of the anal sphincters, with involuntary passage of feces and flatus. [NIH] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Femoral: Pertaining to the femur, or to the thigh. [EU] Femoral Artery: The main artery of the thigh, a continuation of the external iliac artery. [NIH] Femoral Neck Fractures: Fractures of the short, constricted portion of the thigh bone between the femur head and the trochanters. It excludes intertrochanteric fractures which are hip fractures. [NIH] Femur: The longest and largest bone of the skeleton, it is situated between the hip and the knee. [NIH] Fenretinide: A synthetic retinoid that is used orally as a chemopreventive against prostate cancer and in women at risk of developing contralateral breast cancer. It is also effective as an antineoplastic agent. [NIH] Fentanyl: A narcotic opioid drug that is used in the treatment of pain. [NIH] Fetal Blood: Blood of the fetus. Exchange of nutrients and waste between the fetal and maternal blood occurs via the placenta. The cord blood is blood contained in the umbilical vessels at the time of delivery. [NIH] Fetal Development: Morphologic and physiologic growth and development of the mammalian embryo or fetus. [NIH] Fetal Heart: The heart of the fetus of any viviparous animal. It refers to the heart in the postembryonic period and is differentiated from the embryonic heart (heart/embryology)

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only on the basis of time. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibrillation: A small, local, involuntary contraction of muscle, invisible under the skin, resulting from spontaneous activation of single muscle cells or muscle fibres. [EU] Fibrin: A protein derived from fibrinogen in the presence of thrombin, which forms part of the blood clot. [NIH] Fibrinogen: Plasma glycoprotein clotted by thrombin, composed of a dimer of three nonidentical pairs of polypeptide chains (alpha, beta, gamma) held together by disulfide bonds. Fibrinogen clotting is a sol-gel change involving complex molecular arrangements: whereas fibrinogen is cleaved by thrombin to form polypeptides A and B, the proteolytic action of other enzymes yields different fibrinogen degradation products. [NIH] Fibrinolytic: Pertaining to, characterized by, or causing the dissolution of fibrin by enzymatic action [EU] Fibroblasts: Connective tissue cells which secrete an extracellular matrix rich in collagen and other macromolecules. [NIH] Fibromuscular Dysplasia: An idiopathic, segmental, nonatheromatous disease of the musculature of arterial walls, leading to stenosis of small and medium-sized arteries. Most commonly affected are the renal arteries; involvement of the axillary, iliac, basilar, carotid, hepatic and intracranial arteries have been reported. [NIH] Fibrosarcoma: A type of soft tissue sarcoma that begins in fibrous tissue, which holds bones, muscles, and other organs in place. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [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] Filgrastim: A colony-stimulating factor that stimulates the production of neutrophils (a type of white blood cell). It is a cytokine that belongs to the family of drugs called hematopoietic (blood-forming) agents. Also called granulocyte colony-stimulating factor (G-CSF). [NIH] Filler: An inactive substance used to make a product bigger or easier to handle. For example, fillers are often used to make pills or capsules because the amount of active drug is too small to be handled conveniently. [NIH] Filtration: The passage of a liquid through a filter, accomplished by gravity, pressure, or vacuum (suction). [EU] Fine-needle aspiration: The removal of tissue or fluid with a needle for examination under a microscope. Also called needle biopsy. [NIH] Fissure: Any cleft or groove, normal or otherwise; especially a deep fold in the cerebral cortex which involves the entire thickness of the brain wall. [EU] Fistula: Abnormal communication most commonly seen between two internal organs, or between an internal organ and the surface of the body. [NIH] Fixation: 1. The act or operation of holding, suturing, or fastening in a fixed position. 2. The condition of being held in a fixed position. 3. In psychiatry, a term with two related but distinct meanings : (1) arrest of development at a particular stage, which like regression (return to an earlier stage), if temporary is a normal reaction to setbacks and difficulties but if protracted or frequent is a cause of developmental failures and emotional problems, and (2) a close and suffocating attachment to another person, especially a childhood figure, such as one's mother or father. Both meanings are derived from psychoanalytic theory and refer

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to 'fixation' of libidinal energy either in a specific erogenous zone, hence fixation at the oral, anal, or phallic stage, or in a specific object, hence mother or father fixation. 4. The use of a fixative (q.v.) to preserve histological or cytological specimens. 5. In chemistry, the process whereby a substance is removed from the gaseous or solution phase and localized, as in carbon dioxide fixation or nitrogen fixation. 6. In ophthalmology, direction of the gaze so that the visual image of the object falls on the fovea centralis. 7. In film processing, the chemical removal of all undeveloped salts of the film emulsion, leaving only the developed silver to form a permanent image. [EU] Flaccid: Weak, lax and soft. [EU] Flatus: Gas passed through the rectum. [NIH] Flecainide: A potent anti-arrhythmia agent, effective in a wide range of ventricular and atrial arrhythmias and tachycardias. Paradoxically, however, in myocardial infarct patients with either symptomatic or asymptomatic arrhythmia, flecainide exacerbates the arrhythmia and is not recommended for use in these patients. [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] Flexor: Muscles which flex a joint. [NIH] Floxuridine: An antineoplastic antimetabolite that is metabolized to fluorouracil when administered by rapid injection; when administered by slow, continuous, intra-arterial infusion, it is converted to floxuridine monophosphate. It has been used to treat hepatic metastases of gastrointestinal adenocarcinomas and for palliation in malignant neoplasms of the liver and gastrointestinal tract. [NIH] Fluid Therapy: Therapy whose basic objective is to restore the volume and composition of the body fluids to normal with respect to water-electrolyte balance. Fluids may be administered intravenously, orally, by intermittent gavage, or by hypodermoclysis. [NIH] 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] Fluorine: A nonmetallic, diatomic gas that is a trace element and member of the halogen family. It is used in dentistry as flouride to prevent dental caries. [NIH] Fluoroscope: An x-ray machine that makes it possible to see internal organs in motion. [NIH] Fluoroscopy: Production of an image when X-rays strike a fluorescent screen. [NIH] Fluorouracil: A pyrimidine analog that acts as an antineoplastic antimetabolite and also has immunosuppressant. It interferes with DNA synthesis by blocking the thymidylate synthetase conversion of deoxyuridylic acid to thymidylic acid. [NIH] Flush: Transient, episodic redness of the face and neck caused by certain diseases, ingestion of certain drugs or other substances, heat, emotional factors, or physical exertion. [EU] Flushing: A transient reddening of the face that may be due to fever, certain drugs, exertion, stress, or a disease process. [NIH] Focus Groups: A method of data collection and a qualitative research tool in which a small group of individuals are brought together and allowed to interact in a discussion of their opinions about topics, issues, or questions. [NIH] Fold: A plication or doubling of various parts of the body. [NIH] Follow-Up Studies: Studies in which individuals or populations are followed to assess the outcome of exposures, procedures, or effects of a characteristic, e.g., occurrence of disease.

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[NIH]

Foot Care: Taking special steps to avoid foot problems such as sores, cuts, bunions, and calluses. Good care includes daily examination of the feet, toes, and toenails and choosing shoes and socks or stockings that fit well. People with diabetes have to take special care of their feet because nerve damage and reduced blood flow sometimes mean they will have less feeling in their feet than normal. They may not notice cuts and other problems as soon as they should. [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] Fourth Ventricle: An irregularly shaped cavity in the rhombencephalon, between the medulla oblongata, the pons, and the isthmus in front, and the cerebellum behind. It is continuous with the central canal of the cord below and with the cerebral aqueduct above, and through its lateral and median apertures it communicates with the subarachnoid space. [NIH]

Fovea: The central part of the macula that provides the sharpest vision. [NIH] Frail Elderly: Older adults or aged individuals who are lacking in general strength and are unusually susceptible to disease or to other infirmity. [NIH] Friction: Surface resistance to the relative motion of one body against the rubbing, sliding, rolling, or flowing of another with which it is in contact. [NIH] Frontal Lobe: The anterior part of the cerebral hemisphere. [NIH] Frozen Sections: Thinly cut sections of frozen tissue specimens prepared with a cryostat or freezing microtome. [NIH] Fulguration: Destroying tissue using an electric current. [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] Fundus of the Eye: The back or deep part of the eye, including the retina. [NIH] Fungi: A kingdom of eukaryotic, heterotrophic organisms that live as saprobes or parasites, including mushrooms, yeasts, smuts, molds, etc. They reproduce either sexually or asexually, and have life cycles that range from simple to complex. Filamentous fungi refer to those that grow as multicelluar colonies (mushrooms and molds). [NIH] Fuzzy Logic: Approximate, quantitative reasoning that is concerned with the linguistic ambiguity which exists in natural or synthetic language. At its core are variables such as good, bad, and young as well as modifiers such as more, less, and very. These ordinary terms represent fuzzy sets in a particular problem. Fuzzy logic plays a key role in many medical expert systems. [NIH] Gait: Manner or style of walking. [NIH] Galanin: A neurotransmitter. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gallstones: The solid masses or stones made of cholesterol or bilirubin that form in the gallbladder or bile ducts. [NIH] Gamma knife: Radiation therapy in which high-energy rays are aimed at a tumor from many angles in a single treatment session. [NIH]

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Gamma Rays: Very powerful and penetrating, high-energy electromagnetic radiation of shorter wavelength than that of x-rays. They are emitted by a decaying nucleus, usually between 0.01 and 10 MeV. They are also called nuclear x-rays. [NIH] Gamma-Endorphin: An endogenous opioid peptide derived from the pro-opiomelanocortin precursor peptide. It differs from alpha-endorphin by one amino acid. [NIH] Ganciclovir: Acyclovir analog that is a potent inhibitor of the Herpesvirus family including cytomegalovirus. Ganciclovir is used to treat complications from AIDS-associated cytomegalovirus infections. [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] Gas exchange: Primary function of the lungs; transfer of oxygen from inhaled air into the blood and of carbon dioxide from the blood into the lungs. [NIH] Gastrectomy: An operation to remove all or part of the stomach. [NIH] Gastric: Having to do with the stomach. [NIH] Gastric Acid: Hydrochloric acid present in gastric juice. [NIH] Gastric Bypass: Surgical procedure in which the stomach is transected high on the body. The resulting proximal remnant is joined to a loop of the jejunum in an end-to-side anastomosis. This procedure is used frequently in the treatment of morbid obesity. [NIH] Gastric Juices: Liquids produced in the stomach to help break down food and kill bacteria. [NIH]

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

Gastroenterologist: A doctor who specializes in diagnosing and treating disorders of the digestive system. [NIH] Gastroenterology: A subspecialty of internal medicine concerned with the study of the physiology and diseases of the digestive system and related structures (esophagus, liver, gallbladder, and pancreas). [NIH] Gastroenterostomy: Surgical construction of a channel between the stomach and intestines. [NIH]

Gastroesophageal Reflux: Reflux of gastric juice and/or duodenal contents (bile acids, pancreatic juice) into the distal esophagus, commonly due to incompetence of the lower esophageal sphincter. Gastric regurgitation is an extension of this process with entry of fluid into the pharynx or mouth. [NIH] Gastroesophageal Reflux Disease: Flow of the stomach's contents back up into the esophagus. Happens when the muscle between the esophagus and the stomach (the lower

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esophageal sphincter) is weak or relaxes when it shouldn't. May cause esophagitis. Also called esophageal reflux or reflux esophagitis. [NIH] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gastrostomy: Creation of an artificial external opening into the stomach for nutritional support or gastrointestinal compression. [NIH] Gastrula: The embryo in the early stage following the blastula, characterized by morphogenetic cell movements, cell differentiation, and the formation of the three germ layers. [NIH] Gemcitabine: An anticancer drug that belongs to the family of drugs called antimetabolites. [NIH]

Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Gene Expression: The phenotypic manifestation of a gene or genes by the processes of gene action. [NIH] General practitioner: A medical practitioner who does not specialize in a particular branch of medicine or limit his practice to a specific class of diseases. [NIH] Generator: Any system incorporating a fixed parent radionuclide from which is produced a daughter radionuclide which is to be removed by elution or by any other method and used in a radiopharmaceutical. [NIH] Genetic Markers: A phenotypically recognizable genetic trait which can be used to identify a genetic locus, a linkage group, or a recombination event. [NIH] Genetic testing: Analyzing DNA to look for a genetic alteration that may indicate an increased risk for developing a specific disease or disorder. [NIH] Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Genital: Pertaining to the genitalia. [EU] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Geriatric: Pertaining to the treatment of the aged. [EU] Germ cell tumors: Tumors that begin in the cells that give rise to sperm or eggs. They can occur virtually anywhere in the body and can be either benign or malignant. [NIH] Germ Cells: The reproductive cells in multicellular organisms. [NIH] Gestation: The period of development of the young in viviparous animals, from the time of fertilization of the ovum until birth. [EU] Giardiasis: An infection of the small intestine caused by the flagellated protozoan Giardia lamblia. It is spread via contaminated food and water and by direct person-to-person contact. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glioblastoma: A malignant form of astrocytoma histologically characterized by pleomorphism of cells, nuclear atypia, microhemorrhage, and necrosis. They may arise in any region of the central nervous system, with a predilection for the cerebral hemispheres, basal ganglia, and commissural pathways. Clinical presentation most frequently occurs in

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the fifth or sixth decade of life with focal neurologic signs or seizures. [NIH] Glioblastoma multiforme: A type of brain tumor that forms from glial (supportive) tissue of the brain. It grows very quickly and has cells that look very different from normal cells. Also called grade IV astrocytoma. [NIH] Glioma: A cancer of the brain that comes from glial, or supportive, cells. [NIH] Glomerular: Pertaining to or of the nature of a glomerulus, especially a renal glomerulus. [EU]

Glomerular Filtration Rate: The volume of water filtered out of plasma through glomerular capillary walls into Bowman's capsules per unit of time. It is considered to be equivalent to inulin clearance. [NIH] Glossopharyngeal Nerve: The 9th cranial nerve. The glossopharyngeal nerve is a mixed motor and sensory nerve; it conveys somatic and autonomic efferents as well as general, special, and visceral afferents. Among the connections are motor fibers to the stylopharyngeus muscle, parasympathetic fibers to the parotid glands, general and taste afferents from the posterior third of the tongue, the nasopharynx, and the palate, and afferents from baroreceptors and chemoreceptors of the carotid sinus. [NIH] Glottis: The vocal apparatus of the larynx, consisting of the true vocal cords (plica vocalis) and the opening between them (rima glottidis). [NIH] Glucocorticoid: A compound that belongs to the family of compounds called corticosteroids (steroids). Glucocorticoids affect metabolism and have anti-inflammatory and immunosuppressive effects. They may be naturally produced (hormones) or synthetic (drugs). [NIH] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucuronic Acid: Derivatives of uronic acid found throughout the plant and animal kingdoms. They detoxify drugs and toxins by conjugating with them to form glucuronides in the liver which are more water-soluble metabolites that can be easily eliminated from the body. [NIH] Glutamate: Excitatory neurotransmitter of the brain. [NIH] Glutamic Acid: A non-essential amino acid naturally occurring in the L-form. Glutamic acid (glutamate) is the most common excitatory neurotransmitter in the central nervous system. [NIH]

Glycerol: A trihydroxy sugar alcohol that is an intermediate in carbohydrate and lipid metabolism. It is used as a solvent, emollient, pharmaceutical agent, and sweetening agent. [NIH]

Glycols: A generic grouping for dihydric alcohols with the hydroxy groups (-OH) located on different carbon atoms. They are viscous liquids with high boiling points for their molecular weights. [NIH] Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Glycosaminoglycan: A type of long, unbranched polysaccharide molecule. Glycosaminoglycans are major structural components of cartilage and are also found in the cornea of the eye. [NIH] Glycosidic: Formed by elimination of water between the anomeric hydroxyl of one sugar and a hydroxyl of another sugar molecule. [NIH] Gonadal: Pertaining to a gonad. [EU]

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Gonadotropin: The water-soluble follicle stimulating substance, by some believed to originate in chorionic tissue, obtained from the serum of pregnant mares. It is used to supplement the action of estrogens. [NIH] Goniotomy: A surgical procedure for congenital glaucoma in which a sweeping incision is made in the neshwork at the filtration angle by means of a knife-needle inserted through the opposite limbus and carried across the anterior chamber parallel to the iris. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer. [NIH] Grading: A system for classifying cancer cells in terms of how abnormal they appear when examined under a microscope. The objective of a grading system is to provide information about the probable growth rate of the tumor and its tendency to spread. The systems used to grade tumors vary with each type of cancer. Grading plays a role in treatment decisions. [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] Graft Rejection: An immune response with both cellular and humoral components, directed against an allogeneic transplant, whose tissue antigens are not compatible with those of the recipient. [NIH] Grafting: The operation of transfer of tissue from one site to another. [NIH] Gram-negative: Losing the stain or decolorized by alcohol in Gram's method of staining, a primary characteristic of bacteria having a cell wall composed of a thin layer of peptidoglycan covered by an outer membrane of lipoprotein and lipopolysaccharide. [EU] Gram-positive: Retaining the stain or resisting decolorization by alcohol in Gram's method of staining, a primary characteristic of bacteria whose cell wall is composed of a thick layer of peptidologlycan with attached teichoic acids. [EU] Granisetron: A serotonin receptor (5HT-3 selective) antagonist that has been used as an antiemetic for cancer chemotherapy patients. [NIH] Granulation Tissue: A vascular connective tissue formed on the surface of a healing wound, ulcer, or inflamed tissue. It consists of new capillaries and an infiltrate containing lymphoid cells, macrophages, and plasma cells. [NIH] Granule: A small pill made from sucrose. [EU] Granulocyte Colony-Stimulating Factor: A glycoprotein of MW 25 kDa containing internal disulfide bonds. It induces the survival, proliferation, and differentiation of neutrophilic granulocyte precursor cells and functionally activates mature blood neutrophils. Among the family of colony-stimulating factors, G-CSF is the most potent inducer of terminal differentiation to granulocytes and macrophages of leukemic myeloid cell lines. [NIH] Granulocytes: Leukocytes with abundant granules in the cytoplasm. They are divided into three groups: neutrophils, eosinophils, and basophils. [NIH] Granuloma: A relatively small nodular inflammatory lesion containing grouped mononuclear phagocytes, caused by infectious and noninfectious agents. [NIH] Groin: The external junctural region between the lower part of the abdomen and the thigh. [NIH]

Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH]

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Growth factors: Substances made by the body that function to regulate cell division and cell survival. Some growth factors are also produced in the laboratory and used in biological therapy. [NIH] Guanylate Cyclase: An enzyme that catalyzes the conversion of GTP to 3',5'-cyclic GMP and pyrophosphate. It also acts on ITP and dGTP. (From Enzyme Nomenclature, 1992) EC 4.6.1.2. [NIH] Guided Tissue Regeneration: The repopulating of the periodontium, after treatment for periodontal disease. Repopulation is achieved by guiding the periodontal ligament progenitor cells to reproduce in the desired location by blocking contact of epithelial and gingival connective tissues with the root during healing. This blocking is accomplished by using synthetic membranes or collagen membranes. [NIH] Gynaecological: Pertaining to gynaecology. [EU] Gynecologic cancer: Cancer of the female reproductive tract, including the cervix, endometrium, fallopian tubes, ovaries, uterus, and vagina. [NIH] Gynecology: A medical-surgical specialty concerned with the physiology and disorders primarily of the female genital tract, as well as female endocrinology and reproductive physiology. [NIH] Habitual: Of the nature of a habit; according to habit; established by or repeated by force of habit, customary. [EU] Haematoma: A localized collection of blood, usually clotted, in an organ, space, or tissue, due to a break in the wall of a blood vessel. [EU] 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] Hallux Valgus: Lateral displacement of the great toe, producing deformity of the first metatarsophalangeal joint with callous, bursa, or bunion formation over the bony prominence. [NIH] Hand Deformities: Alterations or deviations from normal shape or size which result in a disfigurement of the hand. [NIH] Handedness: Preference for using right or left hand. [NIH] Haptens: Small antigenic determinants capable of eliciting an immune response only when coupled to a carrier. Haptens bind to antibodies but by themselves cannot elicit an antibody response. [NIH] Head Movements: Voluntary or involuntary motion of head that may be relative to or independent of body; includes animals and humans. [NIH] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] Headache Disorders: Common conditions characterized by persistent or recurrent headaches. Headache syndrome classification systems may be based on etiology (e.g., vascular headache, post-traumatic headaches, etc.), temporal pattern (e.g., cluster headache, paroxysmal hemicrania, etc.), and precipitating factors (e.g., cough headache). [NIH] Health Care Costs: The actual costs of providing services related to the delivery of health care, including the costs of procedures, therapies, and medications. It is differentiated from health expenditures, which refers to the amount of money paid for the services, and from

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fees, which refers to the amount charged, regardless of cost. [NIH] Health Expenditures: The amounts spent by individuals, groups, nations, or private or public organizations for total health care and/or its various components. These amounts may or may not be equivalent to the actual costs (health care costs) and may or may not be shared among the patient, insurers, and/or employers. [NIH] Health Policy: Decisions, usually developed by government policymakers, for determining present and future objectives pertaining to the health care system. [NIH] Health Services: Services for the diagnosis and treatment of disease and the maintenance of health. [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] Hearing aid: A miniature, portable sound amplifier for persons with impaired hearing, consisting of a microphone, audio amplifier, earphone, and battery. [NIH] Hearing Disorders: Conditions that impair the transmission or perception of auditory impulses and information from the level of the ear to the temporal cortices, including the sensorineural pathways. [NIH] Heart Arrest: Sudden and usually momentary cessation of the heart beat. This sudden cessation may, but not usually, lead to death, sudden, cardiac. [NIH] Heart attack: A seizure of weak or abnormal functioning of the heart. [NIH] Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, breathlessness, and excess fluid accumulation in body tissues. [NIH] Heart Valves: Flaps of tissue that prevent regurgitation of blood from the ventricles to the atria or from the pulmonary arteries or aorta to the ventricles. [NIH] Heartbeat: One complete contraction of the heart. [NIH] Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Heart-Lung Machine: A mechanical device that temporarily takes over the functions of the heart and lungs; called also a pump-oxygenator. It is used as an aid to surgery. [NIH] Hematocrit: Measurement of the volume of packed red cells in a blood specimen by centrifugation. The procedure is performed using a tube with graduated markings or with automated blood cell counters. It is used as an indicator of erythrocyte status in disease. For example, anemia shows a low hematocrit, polycythemia, high values. [NIH] Hematoma: An extravasation of blood localized in an organ, space, or tissue. [NIH] Hematoxylin: A dye obtained from the heartwood of logwood (Haematoxylon campechianum Linn., Leguminosae) used as a stain in microscopy and in the manufacture of ink. [NIH] Heme: The color-furnishing portion of hemoglobin. It is found free in tissues and as the prosthetic group in many hemeproteins. [NIH] Hemiparesis: The weakness or paralysis affecting one side of the body. [NIH] Hemiplegia: Severe or complete loss of motor function on one side of the body. This condition is usually caused by BRAIN DISEASES that are localized to the cerebral hemisphere opposite to the side of weakness. Less frequently, BRAIN STEM lesions; cervical spinal cord diseases; peripheral nervous system diseases; and other conditions may manifest as hemiplegia. The term hemiparesis (see paresis) refers to mild to moderate weakness involving one side of the body. [NIH]

Dictionary 481

Hemodiafiltration: The combination of hemodialysis and hemofiltration either simultaneously or sequentially. Convective transport (hemofiltration) may be better for removal of larger molecular weight substances and diffusive transport (hemodialysis) for smaller molecular weight solutes. [NIH] Hemodialysis: The use of a machine to clean wastes from the blood after the kidneys have failed. The blood travels through tubes to a dialyzer, which removes wastes and extra fluid. The cleaned blood then flows through another set of tubes back into the body. [NIH] Hemodilution: Reduction of blood viscosity usually by the addition of cell free solutions. Used clinically l) in states of impaired microcirculation, 2) for replacement of intraoperative blood loss without homologous blood transfusion, and 3) in cardiopulmonary bypass and hypothermia. [NIH] Hemodynamics: The movements of the blood and the forces involved in systemic or regional blood circulation. [NIH] Hemofiltration: Extracorporeal ultrafiltration technique without hemodialysis for treatment of fluid overload and electrolyte disturbances affecting renal, cardiac, or pulmonary function. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemoglobin C: A commonly occurring abnormal hemoglobin in which lysine replaces a glutamic acid residue at the sixth position of the beta chains. It results in reduced plasticity of erythrocytes. [NIH] Hemoglobin M: A group of abnormal hemoglobins in which amino acid substitutions take place in either the alpha or beta chains but near the heme iron. This results in facilitated oxidation of the hemoglobin to yield excess methemoglobin which leads to cyanosis. [NIH] Hemolytic: A disease that affects the blood and blood vessels. It destroys red blood cells, cells that cause the blood to clot, and the lining of blood vessels. HUS is often caused by the Escherichia coli bacterium in contaminated food. People with HUS may develop acute renal failure. [NIH] Hemoperitoneum: Hemorrhage into the peritoneal cavity. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemorrhoids: Varicosities of the hemorrhoidal venous plexuses. [NIH] Hemostasis: The process which spontaneously arrests the flow of blood from vessels carrying blood under pressure. It is accomplished by contraction of the vessels, adhesion and aggregation of formed blood elements, and the process of blood or plasma coagulation. [NIH]

Heparin: Heparinic acid. A highly acidic mucopolysaccharide formed of equal parts of sulfated D-glucosamine and D-glucuronic acid with sulfaminic bridges. The molecular weight ranges from six to twenty thousand. Heparin occurs in and is obtained from liver, lung, mast cells, etc., of vertebrates. Its function is unknown, but it is used to prevent blood clotting in vivo and vitro, in the form of many different salts. [NIH]

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Hepatic: Refers to the liver. [NIH] Hepatic Artery: A branch of the celiac artery that distributes to the stomach, pancreas, duodenum, liver, gallbladder, and greater omentum. [NIH] Hepatic Duct, Common: Predominantly extrahepatic bile duct which is formed by the junction of the right and left hepatic ducts, which are predominantly intrahepatic, and, in turn, joins the cystic duct to form the common bile duct. [NIH] Hepatitis: Inflammation of the liver and liver disease involving degenerative or necrotic alterations of hepatocytes. [NIH] Hepatitis A: Hepatitis caused by hepatovirus. It can be transmitted through fecal contamination of food or water. [NIH] Hepatitis B: Hepatitis caused by hepatitis B virus. It may be transmitted by transfusion of contaminated blood or blood products. [NIH] Hepatobiliary: Pertaining to the liver and the bile or the biliary ducts. [EU] Hepatocellular: Pertaining to or affecting liver cells. [EU] Hepatocellular carcinoma: A type of adenocarcinoma, the most common type of liver tumor. [NIH] Hepatocyte: A liver cell. [NIH] Hepatovirus: A genus of Picornaviridae causing infectious hepatitis naturally in humans and experimentally in other primates. It is transmitted through fecal contamination of food or water. [NIH] Hereditary: Of, relating to, or denoting factors that can be transmitted genetically from one generation to another. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Hernia: Protrusion of a loop or knuckle of an organ or tissue through an abnormal opening. [NIH]

Herniated: Protrusion of a degenerated or fragmented intervertebral disc into the intervertebral foramen compressing the nerve root. [NIH] Heterodimers: Zippered pair of nonidentical proteins. [NIH] Heterogeneity: The property of one or more samples or populations which implies that they are not identical in respect of some or all of their parameters, e. g. heterogeneity of variance. [NIH]

Heterotrophic: Pertaining to organisms that are consumers and dependent on other organisms for their source of energy (food). [NIH] Heterotropia: One in which the angle of squint remains relatively unaltered on conjugate movement of the eyes. [NIH] Hiatal Hernia: A small opening in the diaphragm that allows the upper part of the stomach to move up into the chest. Causes heartburn from stomach acid flowing back up through the opening. [NIH] Hibernation: The dormant state in which some animal species pass the winter. It is characterized by narcosis and by sharp reduction in body temperature and metabolic activity and by a depression of vital signs. It is a natural physiological process in many warm-blooded animals. [NIH] Hiccup: A spasm of the diaphragm that causes a sudden inhalation followed by rapid closure of the glottis which produces a sound. [NIH]

Dictionary 483

Hip Fractures: Fractures of the femur head, the femur neck, the trochanters, or the inter- or subtrochanteric region. Excludes fractures of the acetabulum and fractures of the femoral shaft below the subtrochanteric region. For the fractures of the femur neck the specific term femoral neck fractures is available. [NIH] Hip Prosthesis: Replacement for a hip joint. [NIH] Hippocampus: A curved elevation of gray matter extending the entire length of the floor of the temporal horn of the lateral ventricle (Dorland, 28th ed). The hippocampus, subiculum, and dentate gyrus constitute the hippocampal formation. Sometimes authors include the entorhinal cortex in the hippocampal formation. [NIH] Histology: The study of tissues and cells under a microscope. [NIH] Homeostasis: The processes whereby the internal environment of an organism tends to remain balanced and stable. [NIH] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormonal therapy: Treatment of cancer by removing, blocking, or adding hormones. Also called hormone therapy or endocrine therapy. [NIH] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hormone Replacement Therapy: Therapeutic use of hormones to alleviate the effects of hormone deficiency. [NIH] Hormone therapy: Treatment of cancer by removing, blocking, or adding hormones. Also called endocrine therapy. [NIH] Hospice: Institution dedicated to caring for the terminally ill. [NIH] Hospital Charges: The prices a hospital sets for its services. Hospital costs (the direct and indirect expenses incurred by the hospital in providing the services) are one factor in the determination of hospital charges. Other factors may include, for example, profits, competition, and the necessity of recouping the costs of uncompensated care. [NIH] Hospital Costs: The expenses incurred by a hospital in providing care. The hospital costs attributed to a particular patient care episode include the direct costs plus an appropriate proportion of the overhead for administration, personnel, building maintenance, equipment, etc. Hospital costs are one of the factors which determine hospital charges (the price the hospital sets for its services). [NIH] Hospital Mortality: A vital statistic measuring or recording the rate of death from any cause in hospitalized populations. [NIH] Host: Any animal that receives a transplanted graft. [NIH] Humanism: An ethical system which emphasizes human values and the personal worth of each individual, as well as concern for the dignity and freedom of humankind. [NIH] Hybrid: Cross fertilization between two varieties or, more usually, two species of vines, see also crossing. [NIH] Hybridomas: Cells artificially created by fusion of activated lymphocytes with neoplastic cells. The resulting hybrid cells are cloned and produce pure or "monoclonal" antibodies or T-cell products, identical to those produced by the immunologically competent parent, and continually grow and divide as the neoplastic parent. [NIH] Hydra: A genus of freshwater cnidarians, of interest because of their complex organization

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and because their adult organization corresponds roughly to the gastrula of higher animals. [NIH]

Hydrocephalus: Excessive accumulation of cerebrospinal fluid within the cranium which may be associated with dilation of cerebral ventricles, intracranial hypertension; headache; lethargy; urinary incontinence; and ataxia (and in infants macrocephaly). This condition may be caused by obstruction of cerebrospinal fluid pathways due to neurologic abnormalities, intracranial hemorrhages; central nervous system infections; brain neoplasms; craniocerebral trauma; and other conditions. Impaired resorption of cerebrospinal fluid from the arachnoid villi results in a communicating form of hydrocephalus. Hydrocephalus ex-vacuo refers to ventricular dilation that occurs as a result of brain substance loss from cerebral infarction and other conditions. [NIH] Hydrochloric Acid: A strong corrosive acid that is commonly used as a laboratory reagent. It is formed by dissolving hydrogen chloride in water. Gastric acid is the hydrochloric acid component of gastric juice. [NIH] Hydrogel: A network of cross-linked hydrophilic macromolecules used in biomedical applications. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrogen Peroxide: A strong oxidizing agent used in aqueous solution as a ripening agent, bleach, and topical anti-infective. It is relatively unstable and solutions deteriorate over time unless stabilized by the addition of acetanilide or similar organic materials. [NIH] Hydrolysis: The process of cleaving a chemical compound by the addition of a molecule of water. [NIH] Hydrophilic: Readily absorbing moisture; hygroscopic; having strongly polar groups that readily interact with water. [EU] Hydrophobic: Not readily absorbing water, or being adversely affected by water, as a hydrophobic colloid. [EU] Hydrops Fetalis: Edema of the entire body due to abnormal accumulation of serous fluid in the tissues, associated with severe anemia and occurring in fetal erythroblastosis. [NIH] Hydroxides: Inorganic compounds that contain the OH- group. [NIH] Hydroxyl Radical: The univalent radical OH that is present in hydroxides, alcohols, phenols, glycols. [NIH] Hydroxylysine: A hydroxylated derivative of the amino acid lysine that is present in certain collagens. [NIH] Hydroxyproline: A hydroxylated form of the imino acid proline. A deficiency in ascorbic acid can result in impaired hydroxyproline formation. [NIH] Hygienic: Pertaining to hygiene, or conducive to health. [EU] Hyperbaric: Characterized by greater than normal pressure or weight; applied to gases under greater than atmospheric pressure, as hyperbaric oxygen, or to a solution of greater specific gravity than another taken as a standard of reference. [EU] Hyperbaric oxygen: Oxygen that is at an atmospheric pressure higher than the pressure at sea level. Breathing hyperbaric oxygen to enhance the effectiveness of radiation therapy is being studied. [NIH]

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Hypercarbia: Excess of carbon dioxide in the blood. [NIH] Hyperlipidemia: An excess of lipids in the blood. [NIH] Hypermetropia: Visual disorder caused by an insufficient refractive power of the eye; only objects far from the eyes appear to be in focus. [NIH] Hyperopia: Farsightedness; ability to see distant objects more clearly than close objects; may be corrected with glasses or contact lenses. [NIH] Hyperplasia: An increase in the number of cells in a tissue or organ, not due to tumor formation. It differs from hypertrophy, which is an increase in bulk without an increase in the number of cells. [NIH] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hyperthermia: A type of treatment in which body tissue is exposed to high temperatures to damage and kill cancer cells or to make cancer cells more sensitive to the effects of radiation and certain anticancer drugs. [NIH] Hyperthermic perfusion: A procedure in which a warmed solution containing anticancer drugs is used to bathe, or is passed through the blood vessels of, the tissue or organ containing the tumor. [NIH] Hyperthyroidism: Excessive functional activity of the thyroid gland. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH] Hypnotic: A drug that acts to induce sleep. [EU] Hypodermic: Applied or administered beneath the skin. [EU] Hypoglycaemia: An abnormally diminished concentration of glucose in the blood, which may lead to tremulousness, cold sweat, piloerection, hypothermia, and headache, accompanied by irritability, confusion, hallucinations, bizarre behaviour, and ultimately, convulsions and coma. [EU] Hypopigmentation: A condition caused by a deficiency in melanin formation or a loss of pre-existing melanin or melanocytes. It can be complete or partial and may result from trauma, inflammation, and certain infections. [NIH] Hypospadias: A developmental anomaly in the male in which the urethra opens on the underside of the penis or on the perineum. [NIH] Hypotension: Abnormally low blood pressure. [NIH] Hypotensive: Characterized by or causing diminished tension or pressure, as abnormally low blood pressure. [EU] Hypothalamic: Of or involving the hypothalamus. [EU] Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH] Hypothermia: Lower than normal body temperature, especially in warm-blooded animals; in man usually accidental or unintentional. [NIH] Hypoventilation: A reduction in the amount of air entering the pulmonary alveoli. [NIH] Hypoxanthine: A purine and a reaction intermediate in the metabolism of adenosine and in the formation of nucleic acids by the salvage pathway. [NIH]

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Hypoxemia: Deficient oxygenation of the blood; hypoxia. [EU] Hypoxia: Reduction of oxygen supply to tissue below physiological levels despite adequate perfusion of the tissue by blood. [EU] Hysterectomy: Excision of the uterus. [NIH] Hysterotomy: An incision in the uterus, performed through either the abdomen or the vagina. [NIH] Iatrogenic: Resulting from the activity of physicians. Originally applied to disorders induced in the patient by autosuggestion based on the physician's examination, manner, or discussion, the term is now applied to any adverse condition in a patient occurring as the result of treatment by a physician or surgeon, especially to infections acquired by the patient during the course of treatment. [EU] 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] Ifosfamide: Positional isomer of cyclophosphamide which is active as an alkylating agent and an immunosuppressive agent. [NIH] Ileal: Related to the ileum, the lowest end of the small intestine. [NIH] Ileostomy: Surgical creation of an external opening into the ileum for fecal diversion or drainage. Loop or tube procedures are most often employed. [NIH] Ileum: The lower end of the small intestine. [NIH] Ileus: Obstruction of the intestines. [EU] Iliac Artery: Either of two large arteries originating from the abdominal aorta; they supply blood to the pelvis, abdominal wall and legs. [NIH] Iliac Vein: A vein on either side of the body which is formed by the union of the external and internal iliac veins and passes upward to join with its fellow of the opposite side to form the inferior vena cava. [NIH] Illusion: A false interpretation of a genuine percept. [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] Immune adjuvant: A drug that stimulates the immune system to respond to disease. [NIH] Immune function: Production and action of cells that fight disease or infection. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immune Sera: Serum that contains antibodies. It is obtained from an animal that has been immunized either by antigen injection or infection with microorganisms containing the antigen. [NIH] Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunity: Nonsusceptibility to the invasive or pathogenic microorganisms or to the toxic effect of antigenic substances. [NIH]

effects

of

foreign

Immunization: Deliberate stimulation of the host's immune response. Active immunization involves administration of antigens or immunologic adjuvants. Passive immunization involves administration of immune sera or lymphocytes or their extracts (e.g., transfer

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factor, immune RNA) or transplantation of immunocompetent cell producing tissue (thymus or bone marrow). [NIH] Immunochemistry: Field of chemistry that pertains to immunological phenomena and the study of chemical reactions related to antigen stimulation of tissues. It includes physicochemical interactions between antigens and antibodies. [NIH] Immunodeficiency: The decreased ability of the body to fight infection and disease. [NIH] Immunodeficiency syndrome: The inability of the body to produce an immune response. [NIH]

Immunogenic: Producing immunity; evoking an immune response. [EU] Immunoglobulin: A protein that acts as an antibody. [NIH] Immunohistochemistry: Histochemical localization of immunoreactive substances using labeled antibodies as reagents. [NIH] Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Immunology: The study of the body's immune system. [NIH] Immunosuppressant: An agent capable of suppressing immune responses. [EU] Immunosuppressive: Describes the ability to lower immune system responses. [NIH] Immunosuppressive therapy: Therapy used to decrease the body's immune response, such as drugs given to prevent transplant rejection. [NIH] Immunotherapy: Manipulation of the host's immune system in treatment of disease. It includes both active and passive immunization as well as immunosuppressive therapy to prevent graft rejection. [NIH] Impaction: The trapping of an object in a body passage. Examples are stones in the bile duct or hardened stool in the colon. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Implant radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called [NIH] Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU] Impotence: The inability to perform sexual intercourse. [NIH] In situ: In the natural or normal place; confined to the site of origin without invasion of neighbouring tissues. [EU] In situ cancer: Early cancer that has not spread to neighboring tissue. [NIH] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incision: A cut made in the body during surgery. [NIH] Incisional: The removal of a sample of tissue for examination under a microscope. [NIH] Incisive: 1. Having the power or quality of cutting. 2. Pertaining to the incisor teeth. [EU] Incisor: Anything adapted for cutting; any one of the four front teeth in each jaw. [NIH] Incompetence: Physical or mental inadequacy or insufficiency. [EU] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence)

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or the escape of stool from the rectum (fecal incontinence). [NIH] Incus: One of three ossicles of the middle ear. It conducts sound vibrations from the malleus to the stapes. [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Indolent: A type of cancer that grows slowly. [NIH] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infancy: The period of complete dependency prior to the acquisition of competence in walking, talking, and self-feeding. [NIH] Infant, Newborn: An infant during the first month after birth. [NIH] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Inferior vena cava: A large vein that empties into the heart. It carries blood from the legs and feet, and from organs in the abdomen and pelvis. [NIH] 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] Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Inflammatory bowel disease: A general term that refers to the inflammation of the colon and rectum. Inflammatory bowel disease includes ulcerative colitis and Crohn's disease. [NIH]

Inflammatory breast cancer: A type of breast cancer in which the breast looks red and swollen and feels warm. The skin of the breast may also show the pitted appearance called peau d'orange (like the skin of an orange). The redness and warmth occur because the cancer cells block the lymph vessels in the skin. [NIH] Influenza: An acute viral infection involving the respiratory tract. It is marked by inflammation of the nasal mucosa, the pharynx, and conjunctiva, and by headache and severe, often generalized, myalgia. [NIH] Informed Consent: Voluntary authorization, given to the physician by the patient, with full comprehension of the risks involved, for diagnostic or investigative procedures and medical and surgical treatment. [NIH] Infuse: To pour (a liquid) into something. [EU]

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Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] Ingestion: Taking into the body by mouth [NIH] Inguinal: Pertaining to the inguen, or groin. [EU] Inguinal Hernia: A small part of the large or small intestine or bladder that pushes into the groin. May cause pain and feelings of pressure or burning in the groin. Often requires surgery. [NIH] Inhalation: The drawing of air or other substances into the lungs. [EU] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH] Inlay: In dentistry, a filling first made to correspond with the form of a dental cavity and then cemented into the cavity. [NIH] Inner ear: The labyrinth, comprising the vestibule, cochlea, and semicircular canals. [NIH] Innervation: 1. The distribution or supply of nerves to a part. 2. The supply of nervous energy or of nerve stimulus sent to a part. [EU] Inorganic: Pertaining to substances not of organic origin. [EU] Inotropic: Affecting the force or energy of muscular contractions. [EU] Insertional: A technique in which foreign DNA is cloned into a restriction site which occupies a position within the coding sequence of a gene in the cloning vector molecule. Insertion interrupts the gene's sequence such that its original function is no longer expressed. [NIH] Insight: The capacity to understand one's own motives, to be aware of one's own psychodynamics, to appreciate the meaning of symbolic behavior. [NIH] Insomnia: Difficulty in going to sleep or getting enough sleep. [NIH] Insufflation: The act of blowing a powder, vapor, or gas into any body cavity for experimental, diagnostic, or therapeutic purposes. [NIH] Insulator: Material covering the metal conductor of the lead. It is usually polyurethane or silicone. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Insulin-like: Muscular growth factor. [NIH] Integrins: A family of transmembrane glycoproteins consisting of noncovalent heterodimers. They interact with a wide variety of ligands including extracellular matrix glycoproteins, complement, and other cells, while their intracellular domains interact with the cytoskeleton. The integrins consist of at least three identified families: the cytoadhesin receptors, the leukocyte adhesion receptors, and the very-late-antigen receptors. Each family contains a common beta-subunit combined with one or more distinct alpha-subunits. These receptors participate in cell-matrix and cell-cell adhesion in many physiologically important processes, including embryological development, hemostasis, thrombosis, wound healing, immune and nonimmune defense mechanisms, and oncogenic transformation. [NIH]

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Intensive Care: Advanced and highly specialized care provided to medical or surgical patients whose conditions are life-threatening and require comprehensive care and constant monitoring. It is usually administered in specially equipped units of a health care facility. [NIH]

Intercostal: Situated between the ribs. [EU] Interleukin-1: A soluble factor produced by monocytes, macrophages, and other cells which activates T-lymphocytes and potentiates their response to mitogens or antigens. IL-1 consists of two distinct forms, IL-1 alpha and IL-1 beta which perform the same functions but are distinct proteins. The biological effects of IL-1 include the ability to replace macrophage requirements for T-cell activation. The factor is distinct from interleukin-2. [NIH] Interleukin-10: Factor that is a coregulator of mast cell growth. It is produced by T-cells and B-cells and shows extensive homology with the Epstein-Barr virus BCRFI gene. [NIH] Interleukin-2: Chemical mediator produced by activated T lymphocytes and which regulates the proliferation of T cells, as well as playing a role in the regulation of NK cell activity. [NIH] Interleukin-6: Factor that stimulates the growth and differentiation of human B-cells and is also a growth factor for hybridomas and plasmacytomas. It is produced by many different cells including T-cells, monocytes, and fibroblasts. [NIH] Interleukin-8: A cytokine that activates neutrophils and attracts neutrophils and Tlymphocytes. It is released by several cell types including monocytes, macrophages, Tlymphocytes, fibroblasts, endothelial cells, and keratinocytes by an inflammatory stimulus. IL-8 is a member of the beta-thromboglobulin superfamily and structurally related to platelet factor 4. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Internal Medicine: A medical specialty concerned with the diagnosis and treatment of diseases of the internal organ systems of adults. [NIH] Internal radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called brachytherapy, implant radiation, or interstitial radiation therapy. [NIH] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intervertebral: Situated between two contiguous vertebrae. [EU] Intervertebral Disk Displacement: An intervertebral disk in which the nucleus pulposus has protruded through surrounding fibrocartilage. This occurs most frequently in the lower lumbar region. [NIH] Intestinal: Having to do with the intestines. [NIH] Intestinal Obstruction: Any impairment, arrest, or reversal of the normal flow of intestinal contents toward the anus. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intoxication: Poisoning, the state of being poisoned. [EU] Intracellular: Inside a cell. [NIH] Intracranial Aneurysm: A saclike dilatation of the walls of a blood vessel, usually an artery. [NIH]

Intracranial Hemorrhages: Bleeding within the intracranial cavity, including hemorrhages in the brain and within the cranial epidural, subdural, and subarachnoid spaces. [NIH] Intracranial Hypertension: Increased pressure within the cranial vault. This may result

Dictionary 491

from several conditions, including hydrocephalus; brain edema; intracranial masses; severe systemic hypertension; pseudotumor cerebri; and other disorders. [NIH] Intracranial Pressure: Pressure within the cranial cavity. It is influenced by brain mass, the circulatory system, CSF dynamics, and skull rigidity. [NIH] Intraductal carcinoma: Abnormal cells that involve only the lining of a duct. The cells have not spread outside the duct to other tissues in the breast. Also called ductal carcinoma in situ. [NIH] Intramuscular: IM. Within or into muscle. [NIH] Intraocular: Within the eye. [EU] Intraocular pressure: Pressure of the fluid inside the eye; normal IOP varies among individuals. [NIH] Intraoperative Complications: Complications that affect patients during surgery. They may or may not be associated with the disease for which the surgery is done, or within the same surgical procedure. [NIH] Intraoperative Period: The period during a surgical operation. [NIH] Intraperitoneal: IP. Within the peritoneal cavity (the area that contains the abdominal organs). [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] Intravascular: Within a vessel or vessels. [EU] Intravenous: IV. Into a vein. [NIH] Intravesical: Within the bladder. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Intubation: Introduction of a tube into a hollow organ to restore or maintain patency if obstructed. It is differentiated from catheterization in that the insertion of a catheter is usually performed for the introducing or withdrawing of fluids from the body. [NIH] Intussusception: A rare disorder. A part of the intestines folds into another part of the intestines, causing blockage. Most common in infants. Can be treated with an operation. [NIH]

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

Involuntary: Reaction occurring without intention or volition. [NIH] Ion Channels: Gated, ion-selective glycoproteins that traverse membranes. The stimulus for channel gating can be a membrane potential, drug, transmitter, cytoplasmic messenger, or a mechanical deformation. Ion channels which are integral parts of ionotropic neurotransmitter receptors are not included. [NIH] Ion Pumps: Integral membrane proteins that transport ions across a membrane against an electrochemical gradient. [NIH] Ionizing: Radiation comprising charged particles, e. g. electrons, protons, alpha-particles, etc., having sufficient kinetic energy to produce ionization by collision. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH]

492 Surgery

Ipsilateral: Having to do with the same side of the body. [NIH] Irinotecan: An anticancer drug that belongs to a family of anticancer drugs called topoisomerase inhibitors. It is a camptothecin analogue. Also called CPT 11. [NIH] Iris: The most anterior portion of the uveal layer, separating the anterior chamber from the posterior. It consists of two layers - the stroma and the pigmented epithelium. Color of the iris depends on the amount of melanin in the stroma on reflection from the pigmented epithelium. [NIH] Irradiation: The use of high-energy radiation from x-rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy) or from materials called radioisotopes. Radioisotopes produce radiation and can be placed in or near the tumor or in the area near cancer cells. This type of radiation treatment is called internal radiation therapy, implant radiation, interstitial radiation, or brachytherapy. Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Irradiation is also called radiation therapy, radiotherapy, and x-ray therapy. [NIH] Irrigation: The washing of a body cavity or surface by flowing solution which is inserted and then removed. Any drug in the irrigation solution may be absorbed. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Islet: Cell producing insulin in pancreas. [NIH] Isoenzyme: Different forms of an enzyme, usually occurring in different tissues. The isoenzymes of a particular enzyme catalyze the same reaction but they differ in some of their properties. [NIH] Isoflurane: A stable, non-explosive inhalation anesthetic, relatively free from significant side effects. [NIH] Isoproterenol: Isopropyl analog of epinephrine; beta-sympathomimetic that acts on the heart, bronchi, skeletal muscle, alimentary tract, etc. It is used mainly as bronchodilator and heart stimulant. [NIH] Isotretinoin: A topical dermatologic agent that is used in the treatment of acne vulgaris and several other skin diseases. The drug has teratogenic and other adverse effects. [NIH] Jealousy: An irrational reaction compounded of grief, loss of self-esteem, enmity against the rival and self criticism. [NIH] Jejunoileal Bypass: A surgical procedure consisting of the anastomosis of the proximal part of the jejunum to the distal portion of the ileum, so as to bypass the nutrient-absorptive segment of the small intestine, to treat morbid obesity. [NIH] Jejunostomy: Surgical formation of an opening through the abdominal wall into the jejunum, usually for enteral hyperalimentation. [NIH] Jejunum: That portion of the small intestine which extends from the duodenum to the ileum; called also intestinum jejunum. [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] Kallidin: A decapeptide bradykinin homolog produced by the action of tissue and glandular kallikreins on low-molecular-weight kininogen. It is a smooth-muscle stimulant and hypotensive agent that functions through vasodilatation. [NIH]

Dictionary 493

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] Keloid: A sharply elevated, irregularly shaped, progressively enlarging scar resulting from formation of excessive amounts of collagen in the dermis during connective tissue repair. It is differentiated from a hypertrophic scar (cicatrix, hypertrophic) in that the former does not spread to surrounding tissues. [NIH] Keratectomy: The surgical removal of corneal tissue. [NIH] Keratinocytes: Epidermal cells which synthesize keratin and undergo characteristic changes as they move upward from the basal layers of the epidermis to the cornified (horny) layer of the skin. Successive stages of differentiation of the keratinocytes forming the epidermal layers are basal cell, spinous or prickle cell, and the granular cell. [NIH] Kerato: Prefix indicating relationship to the cornea. [NIH] Keratoconjunctivitis: Simultaneous inflammation of the cornea and conjunctiva. [NIH] Keratoconjunctivitis Sicca: Drying and inflammation of the conjunctiva as a result of insufficient lacrimal secretion. When found in association with xerostomia and polyarthritis, it is called Sjogren's syndrome. [NIH] Keratomileusis: Carving of the cornea to reshape it. [NIH] Keratotomy: A surgical incision (cut) of the cornea. [NIH] Ketamine: A cyclohexanone derivative used for induction of anesthesia. Its mechanism of action is not well understood, but ketamine can block NMDA receptors (receptors, NMethyl-D-Aspartate) and may interact with sigma receptors. [NIH] Keto: It consists of 8 carbon atoms and within the endotoxins, it connects poysaccharide and lipid A. [NIH] Ketone Bodies: Chemicals that the body makes when there is not enough insulin in the blood and it must break down fat for its energy. Ketone bodies can poison and even kill body cells. When the body does not have the help of insulin, the ketones build up in the blood and then "spill" over into the urine so that the body can get rid of them. The body can also rid itself of one type of ketone, called acetone, through the lungs. This gives the breath a fruity odor. Ketones that build up in the body for a long time lead to serious illness and coma. [NIH] Ketorolac: A drug that belongs to a family of drugs called nonsteroidal anti-inflammatory agents. It is being studied in cancer prevention. [NIH] Keyhole: A carrier molecule. [NIH] Kidney Failure: The inability of a kidney to excrete metabolites at normal plasma levels under conditions of normal loading, or the inability to retain electrolytes under conditions of normal intake. In the acute form (kidney failure, acute), it is marked by uremia and usually by oliguria or anuria, with hyperkalemia and pulmonary edema. The chronic form (kidney failure, chronic) is irreversible and requires hemodialysis. [NIH] Kidney Pelvis: The flattened, funnel-shaped expansion connecting the ureter to the kidney calices. [NIH] Kidney stone: A stone that develops from crystals that form in urine and build up on the inner surfaces of the kidney, in the renal pelvis, or in the ureters. [NIH] Kidney Transplantation: The transference of a kidney from one human or animal to another. [NIH] Kinesis: Locomotor behavior not involving a steering reaction, but in which there may be a turning random in direction. It includes orthokinesis, the rate of movement and klinokinesis,

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the amount of turning, which are related to the intensity of stimulation. [NIH] Kinetic: Pertaining to or producing motion. [EU] Kyphosis: A deformity of the spine characterized by extensive flexion. [NIH] Labile: 1. Gliding; moving from point to point over the surface; unstable; fluctuating. 2. Chemically unstable. [EU] Labyrinth: The internal ear; the essential part of the organ of hearing. It consists of an osseous and a membranous portion. [NIH] Lacerations: Torn, ragged, mangled wounds. [NIH] Lacrimal: Pertaining to the tears. [EU] Lactation: The period of the secretion of milk. [EU] Lamella: A layer of the iris containing the fibrils of the dilator pupillae muscle, exclusive of their cell bodies, located between the anterior pigment layer of Fuchs and the stroma. [NIH] Laminin: Large, noncollagenous glycoprotein with antigenic properties. It is localized in the basement membrane lamina lucida and functions to bind epithelial cells to the basement membrane. Evidence suggests that the protein plays a role in tumor invasion. [NIH] Language Disorders: Conditions characterized by deficiencies of comprehension or expression of written and spoken forms of language. These include acquired and developmental disorders. [NIH] Laparoscopic-assisted colectomy: Surgery done with the aid of a laparoscope (a thin, lighted tube) to remove part or all of the colon through small incisions made in the wall of the abdomen. [NIH] Laparoscopy: Examination, therapy or surgery of the abdomen's interior by means of a laparoscope. [NIH] Laparotomy: A surgical incision made in the wall of the abdomen. [NIH] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Laryngeal: Having to do with the larynx. [NIH] Laryngeal Nerves: Branches of the vagus nerve (the tenth cranial nerve). The superior laryngeal nerves originate near the nodose ganglion and separate into external branches, which supply motor fibers to the cricothyroid muscles, and internal branches, which carry sensory fibers. The recurrent (inferior) laryngeal nerve originates more caudally and carries efferents to all muscles of the larynx except the cricothyroid. The laryngeal nerves and their various branches also carry sensory and autonomic fibers to the laryngeal, pharyngeal, tracheal, and cardiac regions. [NIH] Laryngectomy: Total or partial excision of the larynx. [NIH] Laryngoscopes: Endoscopes for examining the interior of the larynx. [NIH] Laryngoscopy: Examination, therapy, or surgery of the interior of the larynx performed with a specially designed endoscope. [NIH] Larynx: An irregularly shaped, musculocartilaginous tubular structure, lined with mucous membrane, located at the top of the trachea and below the root of the tongue and the hyoid bone. It is the essential sphincter guarding the entrance into the trachea and functioning secondarily as the organ of voice. [NIH] Laser Surgery: The use of a laser either to vaporize surface lesions or to make bloodless cuts

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in tissue. It does not include the coagulation of tissue by laser. [NIH] Latent: Phoria which occurs at one distance or another and which usually has no troublesome effect. [NIH] Latent period: A seemingly inactive period, as that between exposure of tissue to an injurious agent and the manifestation of response, or that between the instant of stimulation and the beginning of response. [EU] Lateral Ventricles: Cavity in each of the cerebral hemispheres derived from the cavity of the embryonic neural tube. They are separated from each other by the septum pellucidum, and each communicates with the third ventricle by the foramen of Monro, through which also the choroid plexuses of the lateral ventricles become continuous with that of the third ventricle. [NIH] Lavage: A cleaning of the stomach and colon. Uses a special drink and enemas. [NIH] Laxative: An agent that acts to promote evacuation of the bowel; a cathartic or purgative. [EU]

Least-Squares Analysis: A principle of estimation in which the estimates of a set of parameters in a statistical model are those quantities minimizing the sum of squared differences between the observed values of a dependent variable and the values predicted by the model. [NIH] Legal blindness: In the U.S., (1) visual acuity of 20/200 or worse in the better eye with corrective lenses (20/200 means that a person must be at 20 feet from an eye chart to see what a person with normal vision can see at 200 feet) or (2) visual field restricted to 20 d [NIH]

Length of Stay: The period of confinement of a patient to a hospital or other health facility. [NIH]

Lens: The transparent, double convex (outward curve on both sides) structure suspended between the aqueous and vitreous; helps to focus light on the retina. [NIH] Lenticular: 1. Pertaining to or shaped like a lens. 2. Pertaining to the crystalline lens. 3. Pertaining to the lenticular nucleus. [EU] Leprosy: A chronic granulomatous infection caused by Mycobacterium leprae. The granulomatous lesions are manifested in the skin, the mucous membranes, and the peripheral nerves. Two polar or principal types are lepromatous and tuberculoid. [NIH] Leptin: A 16-kD peptide hormone secreted from white adipocytes and implicated in the regulation of food intake and energy balance. Leptin provides the key afferent signal from fat cells in the feedback system that controls body fat stores. [NIH] Lesion: An area of abnormal tissue change. [NIH] Lethal: Deadly, fatal. [EU] Lethargy: Abnormal drowsiness or stupor; a condition of indifference. [EU] Leucine: An essential branched-chain amino acid important for hemoglobin formation. [NIH] Leukemia: Cancer of blood-forming tissue. [NIH] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Leukocytosis: A transient increase in the number of leukocytes in a body fluid. [NIH] Leukotrienes: A family of biologically active compounds derived from arachidonic acid by oxidative metabolism through the 5-lipoxygenase pathway. They participate in host defense reactions and pathophysiological conditions such as immediate hypersensitivity and inflammation. They have potent actions on many essential organs and systems, including

496 Surgery

the cardiovascular, pulmonary, and central nervous system as well as the gastrointestinal tract and the immune system. [NIH] Levonorgestrel: A progestational hormone with actions similar to those of progesterone and about twice as potent as its racemic or (+-)-isomer (norgestrel). It is used for contraception, control of menstrual disorders, and treatment of endometriosis. [NIH] 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] Life cycle: The successive stages through which an organism passes from fertilized ovum or spore to the fertilized ovum or spore of the next generation. [NIH] Life Expectancy: A figure representing the number of years, based on known statistics, to which any person of a given age may reasonably expect to live. [NIH] Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Ligamentum Flavum: The paired bands of yellow elastic tissue that connect adjoining laminae of the vertebrae. With the laminae, it forms the posterior wall of the spinal canal and helps hold the body erect. [NIH] Ligands: A RNA simulation method developed by the MIT. [NIH] Ligation: Application of a ligature to tie a vessel or strangulate a part. [NIH] Light microscope: A microscope (device to magnify small objects) in which objects are lit directly by white light. [NIH] Likelihood Functions: Functions constructed from a statistical model and a set of observed data which give the probability of that data for various values of the unknown model parameters. Those parameter values that maximize the probability are the maximum likelihood estimates of the parameters. [NIH] Limited-stage small cell lung cancer: Cancer found in one lung and in nearby lymph nodes. [NIH]

Linear Models: Statistical models in which the value of a parameter for a given value of a factor is assumed to be equal to a + bx, where a and b are constants. The models predict a linear regression. [NIH] Linkage: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Lip: Either of the two fleshy, full-blooded margins of the mouth. [NIH] Lipectomy: Removal of localized subcutaneous fat deposits by suction curettage or blunt cannulization in the cosmetic correction of obesity and other esthetic contour defects. [NIH] Lipid: Fat. [NIH] Lipid Peroxidation: Peroxidase catalyzed oxidation of lipids using hydrogen peroxide as an electron acceptor. [NIH] Lipopolysaccharide: Substance consisting of polysaccaride and lipid. [NIH] Lipoprotein: Any of the lipid-protein complexes in which lipids are transported in the blood; lipoprotein particles consist of a spherical hydrophobic core of triglycerides or cholesterol esters surrounded by an amphipathic monolayer of phospholipids, cholesterol, and apolipoproteins; the four principal classes are high-density, low-density, and very-low-

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density lipoproteins and chylomicrons. [EU] Liposomal: A drug preparation that contains the active drug in very tiny fat particles. This fat-encapsulated drug is absorbed better, and its distribution to the tumor site is improved. [NIH]

Liquor: 1. A liquid, especially an aqueous solution containing a medicinal substance. 2. A general term used in anatomical nomenclature for certain fluids of the body. [EU] Lithotomy: A position in which the patient lies on his back with legs flexed and his thighs on his abdomen and abducted. [NIH] Lithotomy position: A position in which the patient lies on his back with legs flexed and his thighs on his abdomen and abducted. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Liver cancer: A disease in which malignant (cancer) cells are found in the tissues of the liver. [NIH]

Liver metastases: Cancer that has spread from the original (primary) tumor to the liver. [NIH]

Liver Neoplasms: Tumors or cancer of the liver. [NIH] Liver scan: An image of the liver created on a computer screen or on film. A radioactive substance is injected into a blood vessel and travels through the bloodstream. It collects in the liver, especially in abnormal areas, and can be detected by the scanner. [NIH] Liver Transplantation: The transference of a part of or an entire liver from one human or animal to another. [NIH] Lobe: A portion of an organ such as the liver, lung, breast, or brain. [NIH] Lobectomy: The removal of a lobe. [NIH] Local therapy: Treatment that affects cells in the tumor and the area close to it. [NIH] Localization: The process of determining or marking the location or site of a lesion or disease. May also refer to the process of keeping a lesion or disease in a specific location or site. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Logistic Models: Statistical models which describe the relationship between a qualitative dependent variable (that is, one which can take only certain discrete values, such as the presence or absence of a disease) and an independent variable. A common application is in epidemiology for estimating an individual's risk (probability of a disease) as a function of a given risk factor. [NIH] Longitudinal Studies: Studies in which variables relating to an individual or group of individuals are assessed over a period of time. [NIH] Longitudinal study: Also referred to as a "cohort study" or "prospective study"; the analytic method of epidemiologic study in which subsets of a defined population can be identified who are, have been, or in the future may be exposed or not exposed, or exposed in different degrees, to a factor or factors hypothesized to influence the probability of occurrence of a given disease or other outcome. The main feature of this type of study is to observe large numbers of subjects over an extended time, with comparisons of incidence rates in groups that differ in exposure levels. [NIH] Long-Term Care: Care over an extended period, usually for a chronic condition or disability, requiring periodic, intermittent, or continuous care. [NIH] Loop: A wire usually of platinum bent at one end into a small loop (usually 4 mm inside

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diameter) and used in transferring microorganisms. [NIH] Lordosis: The anterior concavity in the curvature of the lumbar and cervical spine as viewed from the side. The term usually refers to abnormally increased curvature (hollow back, saddle back, swayback). It does not include lordosis as normal mating posture in certain animals ( = posture + sex behavior, animal). [NIH] Lordotic: An investigation of the chest for which the body is arched backwards from the waist and the useful beam enters from behind. [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] Low vision: Visual loss that cannot be corrected with eyeglasses or contact lenses and interferes with daily living activities. [NIH] Low-density lipoprotein: Lipoprotein that contains most of the cholesterol in the blood. LDL carries cholesterol to the tissues of the body, including the arteries. A high level of LDL increases the risk of heart disease. LDL typically contains 60 to 70 percent of the total serum cholesterol and both are directly correlated with CHD risk. [NIH] Lower Esophageal Sphincter: The muscle between the esophagus and stomach. When a person swallows, this muscle relaxes to let food pass from the esophagus to the stomach. It stays closed at other times to keep stomach contents from flowing back into the esophagus. [NIH]

Lubricants: Oily or slippery substances. [NIH] Lubrication: The application of a substance to diminish friction between two surfaces. It may refer to oils, greases, and similar substances for the lubrication of medical equipment but it can be used for the application of substances to tissue to reduce friction, such as lotions for skin and vaginal lubricants. [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] Lumpectomy: Surgery to remove the tumor and a small amount of normal tissue around it. [NIH]

Lunate: A curved sulcus of the lateral surface which forms the anterior limit of the visual cortex. [NIH] Lung metastases: Cancer that has spread from the original (primary) tumor to the lung. [NIH]

Lung Transplantation: The transference of either one or both of the lungs from one human or animal to another. [NIH] Lung volume: The amount of air the lungs hold. [NIH] Lutein Cells: The cells of the corpus luteum which are derived from the granulosa cells and the theca cells of the Graafian follicle. [NIH] Luxation: The displacement of the particular surface of a bone from its normal joint, without fracture. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]

Dictionary 499

Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphatic system: The tissues and organs that produce, store, and carry white blood cells that fight infection and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes and a network of thin tubes that carry lymph and white blood cells. These tubes branch, like blood vessels, into all the tissues of the body. [NIH] Lymphedema: Edema due to obstruction of lymph vessels or disorders of the lymph nodes. [NIH]

Lymphoblastic: One of the most aggressive types of non-Hodgkin lymphoma. [NIH] Lymphoblasts: Interferon produced predominantly by leucocyte cells. [NIH] Lymphocyte: A white blood cell. Lymphocytes have a number of roles in the immune system, including the production of antibodies and other substances that fight infection and diseases. [NIH] Lymphocyte Count: A count of the number of lymphocytes in the blood. [NIH] Lymphocytic: Referring to lymphocytes, a type of white blood cell. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Lymphoma: A general term for various neoplastic diseases of the lymphoid tissue. [NIH] Lysine: An essential amino acid. It is often added to animal feed. [NIH] Macrophage: A type of white blood cell that surrounds and kills microorganisms, removes dead cells, and stimulates the action of other immune system cells. [NIH] Macula: A stain, spot, or thickening. Often used alone to refer to the macula retinae. [EU] Macula Lutea: An oval area in the retina, 3 to 5 mm in diameter, usually located temporal to the superior pole of the eye and slightly below the level of the optic disk. [NIH] Macular Degeneration: Degenerative changes in the macula lutea of the retina. [NIH] Magnetic Resonance Angiography: Non-invasive method of vascular imaging and determination of internal anatomy without injection of contrast media or radiation exposure. The technique is used especially in cerebral angiography as well as for studies of other vascular structures. [NIH] Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. [NIH] Malabsorption: Impaired intestinal absorption of nutrients. [EU] Malabsorption syndrome: A group of symptoms such as gas, bloating, abdominal pain, and diarrhea resulting from the body's inability to properly absorb nutrients. [NIH] Malformation: A morphologic developmental process. [EU]

defect

resulting

from

an

intrinsically

abnormal

Malignancy: A cancerous tumor that can invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malignant mesothelioma: A rare type of cancer in which malignant cells are found in the sac lining the chest or abdomen. Exposure to airborne asbestos particles increases one's risk of developing malignant mesothelioma. [NIH]

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Malignant tumor: A tumor capable of metastasizing. [NIH] Malleus: The largest of the auditory ossicles, and the one attached to the membrana tympani (tympanic membrane). Its club-shaped head articulates with the incus. [NIH] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]

Mammaplasty: Surgical reconstruction of the breast including both augmentation and reduction. [NIH] Mammary: Pertaining to the mamma, or breast. [EU] Mammary Arteries: Arteries originating from the subclavian or axillary arteries and distributing to the anterior thoracic wall, mediastinal structures, diaphragm, pectoral muscles and mammary gland. [NIH] Mammogram: An x-ray of the breast. [NIH] Mammography: Radiographic examination of the breast. [NIH] Mandible: The largest and strongest bone of the face constituting the lower jaw. It supports the lower teeth. [NIH] Mandibular Condyle: The posterior process on the ramus of the mandible composed of two parts: a superior part, the articular portion, and an inferior part, the condylar neck. [NIH] Manifest: Being the part or aspect of a phenomenon that is directly observable : concretely expressed in behaviour. [EU] Mannitol: A diuretic and renal diagnostic aid related to sorbitol. It has little significant energy value as it is largely eliminated from the body before any metabolism can take place. It can be used to treat oliguria associated with kidney failure or other manifestations of inadequate renal function and has been used for determination of glomerular filtration rate. Mannitol is also commonly used as a research tool in cell biological studies, usually to control osmolarity. [NIH] Manometry: Tests that measure muscle pressure and movements in the GI tract. [NIH] Mastectomy: Surgery to remove the breast (or as much of the breast tissue as possible). [NIH] Mastication: The act and process of chewing and grinding food in the mouth. [NIH] Maternal-Fetal Exchange: Exchange of substances between the maternal blood and the fetal blood through the placental barrier. It excludes microbial or viral transmission. [NIH] Matrix metalloproteinase: A member of a group of enzymes that can break down proteins, such as collagen, that are normally found in the spaces between cells in tissues (i.e., extracellular matrix proteins). Because these enzymes need zinc or calcium atoms to work properly, they are called metalloproteinases. Matrix metalloproteinases are involved in wound healing, angiogenesis, and tumor cell metastasis. [NIH] Maxillary: Pertaining to the maxilla : the irregularly shaped bone that with its fellow forms the upper jaw. [EU] Maxillary Nerve: The intermediate sensory division of the trigeminal (5th cranial) nerve. The maxillary nerve carries general afferents from the intermediate region of the face including the lower eyelid, nose and upper lip, the maxillary teeth, and parts of the dura. [NIH]

Maxillary Sinus: One of the paired paranasal sinuses, located in the body of the maxilla, communicating with the middle meatus of the nasal cavity. [NIH] Meatus: A canal running from the internal auditory foramen through the petrous portion of the temporal bone. It gives passage to the facial and auditory nerves together with the auditory branch of the basilar artery and the internal auditory veins. [NIH]

Dictionary 501

Mechanical ventilation: Use of a machine called a ventilator or respirator to improve the exchange of air between the lungs and the atmosphere. [NIH] Mechanoreceptors: Cells specialized to transduce mechanical stimuli and relay that information centrally in the nervous system. Mechanoreceptors include hair cells, which mediate hearing and balance, and the various somatosensory receptors, often with nonneural accessory structures. [NIH] Medial: Lying near the midsaggital plane of the body; opposed to lateral. [NIH] Median Nerve: A major nerve of the upper extremity. In humans, the fibers of the median nerve originate in the lower cervical and upper thoracic spinal cord (usually C6 to T1), travel via the brachial plexus, and supply sensory and motor innervation to parts of the forearm and hand. [NIH] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Medical Assistance: Financing of medical care provided to public assistance recipients. [NIH] Medical Illustration: The field which deals with illustrative clarification of biomedical concepts, as in the use of diagrams and drawings. The illustration may be produced by hand, photography, computer, or other electronic or mechanical methods. [NIH] Medical Records: Recording of pertinent information concerning patient's illness or illnesses. [NIH] Medical Staff: Professional medical personnel who provide care to patients in an organized facility, institution or agency. [NIH] Medication Errors: Errors in prescribing, dispensing, or administering medication with the result that the patient fails to receive the correct drug or the indicated proper drug dosage. [NIH]

MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Medroxyprogesterone: (6 alpha)-17-Hydroxy-6-methylpregn-4-ene-3,20-dione. A synthetic progestational hormone used in veterinary practice as an estrus regulator. [NIH] Medullary: Pertaining to the marrow or to any medulla; resembling marrow. [EU] Medulloblastoma: A malignant brain tumor that begins in the lower part of the brain and can spread to the spine or to other parts of the body. Medulloblastomas are sometimes called primitive neuroectodermal tumors (PNET). [NIH] Melanin: The substance that gives the skin its color. [NIH] Melanocytes: Epidermal dendritic pigment cells which control long-term morphological color changes by alteration in their number or in the amount of pigment they produce and store in the pigment containing organelles called melanosomes. Melanophores are larger cells which do not exist in mammals. [NIH] Melanoma: A form of skin cancer that arises in melanocytes, the cells that produce pigment. Melanoma usually begins in a mole. [NIH] Melanosomes: Melanin-containing organelles found in melanocytes and melanophores. [NIH]

Membrane: A very thin layer of tissue that covers a surface. [NIH]

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Membrane Proteins: Proteins which are found in membranes including cellular and intracellular membranes. They consist of two types, peripheral and integral proteins. They include most membrane-associated enzymes, antigenic proteins, transport proteins, and drug, hormone, and lectin receptors. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Meningioma: A type of tumor that occurs in the meninges, the membranes that cover and protect the brain and spinal cord. Meningiomas usually grow slowly. [NIH] Meningitis: Inflammation of the meninges. When it affects the dura mater, the disease is termed pachymeningitis; when the arachnoid and pia mater are involved, it is called leptomeningitis, or meningitis proper. [EU] Meningoencephalitis: An inflammatory process involving the brain (encephalitis) and meninges (meningitis), most often produced by pathogenic organisms which invade the central nervous system, and occasionally by toxins, autoimmune disorders, and other conditions. [NIH] Meniscus: A fibro-cartilage within a joint, especially of the knee. [NIH] Menopause: Permanent cessation of menstruation. [NIH] Menstrual Cycle: The period of the regularly recurring physiologic changes in the endometrium occurring during the reproductive period in human females and some primates and culminating in partial sloughing of the endometrium (menstruation). [NIH] Menstruation: The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus. [NIH] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH] Mental Processes: Conceptual functions or thinking in all its forms. [NIH] Mental Retardation: Refers to sub-average general intellectual functioning which originated during the developmental period and is associated with impairment in adaptive behavior. [NIH]

Mentors: Senior professionals who provide guidance, direction and support to those persons desirous of improvement in academic positions, administrative positions or other career development situations. [NIH] Mesenchymal: Refers to cells that develop into connective tissue, blood vessels, and lymphatic tissue. [NIH] Mesenteric: Pertaining to the mesentery : a membranous fold attaching various organs to the body wall. [EU] Mesentery: A layer of the peritoneum which attaches the abdominal viscera to the abdominal wall and conveys their blood vessels and nerves. [NIH] Mesoderm: The middle germ layer of the embryo. [NIH] Mesothelioma: A benign (noncancerous) or malignant (cancerous) tumor affecting the lining of the chest or abdomen. Exposure to asbestos particles in the air increases the risk of developing malignant mesothelioma. [NIH]

Dictionary 503

Meta-Analysis: A quantitative method of combining the results of independent studies (usually drawn from the published literature) and synthesizing summaries and conclusions which may be used to evaluate therapeutic effectiveness, plan new studies, etc., with application chiefly in the areas of research and medicine. [NIH] Metabolite: Any substance produced by metabolism or by a metabolic process. [EU] Metaplasia: A condition in which there is a change of one adult cell type to another similar adult cell type. [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] Metatarsophalangeal Joint: The articulation between a metatarsal bone and a phalanx. [NIH] Metestrus: Short period following estrus during which the phenomena of estrus subside in those animals in which pseudopregnancy does not occur. Does not apply to humans. [NIH] Methionine: A sulfur containing essential amino acid that is important in many body functions. It is a chelating agent for heavy metals. [NIH] Methylcellulose: Methylester of cellulose. Methylcellulose is used as an emulsifying and suspending agent in cosmetics, pharmaceutics and the chemical industry. It is used therapeutically as a bulk laxative. [NIH] Metopic: The suture separating the two halves of the frontal bone in infancy and occasionally persisting in the adult. [NIH] Metronidazole: Antiprotozoal used in amebiasis, trichomoniasis, giardiasis, and as treponemacide in livestock. It has also been proposed as a radiation sensitizer for hypoxic cells. According to the Fourth Annual Report on Carcinogens (NTP 85-002, 1985, p133), this substance may reasonably be anticipated to be a carcinogen (Merck, 11th ed). [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microcalcifications: Tiny deposits of calcium in the breast that cannot be felt but can be detected on a mammogram. A cluster of these very small specks of calcium may indicate that cancer is present. [NIH] Microcirculation: The vascular network lying between the arterioles and venules; includes capillaries, metarterioles and arteriovenous anastomoses. Also, the flow of blood through this network. [NIH] Microdialysis: A technique for measuring extracellular concentrations of substances in tissues, usually in vivo, by means of a small probe equipped with a semipermeable membrane. Substances may also be introduced into the extracellular space through the membrane. [NIH] Microkeratome: A surgical device that is affixed to the eye by use of a vacuum ring. When secured, a very sharp blade cuts a layer of the cornea at a predetermined depth. [NIH] Micromanipulators: A high precision instrument used in microinjection or chromosome

504 Surgery

dissection activities. [NIH] Microorganism: An organism that can be seen only through a microscope. Microorganisms include bacteria, protozoa, algae, and fungi. Although viruses are not considered living organisms, they are sometimes classified as microorganisms. [NIH] Microscopy: The application of microscope magnification to the study of materials that cannot be properly seen by the unaided eye. [NIH] Microspheres: Small uniformly-sized spherical particles frequently radioisotopes or various reagents acting as tags or markers. [NIH]

labeled

with

Microsurgery: Surgical procedures on the cellular level; a light microscope and miniaturized instruments are used. [NIH] Microtubules: Slender, cylindrical filaments found in the cytoskeleton of plant and animal cells. They are composed of the protein tubulin. [NIH] Midazolam: A short-acting compound, water-soluble at pH less than 4 and lipid-soluble at physiological pH. It is a hypnotic-sedative drug with anxiolytic and amnestic properties. It is used for sedation in dentistry, cardiac surgery, endoscopic procedures, as preanesthetic medication, and as an adjunct to local anesthesia. Because of its short duration and cardiorespiratory stability, it is particularly useful in poor-risk, elderly, and cardiac patients. [NIH]

Migration: The systematic movement of genes between populations of the same species, geographic race, or variety. [NIH] Milliliter: A measure of volume for a liquid. A milliliter is approximately 950-times smaller than a quart and 30-times smaller than a fluid ounce. A milliliter of liquid and a cubic centimeter (cc) of liquid are the same. [NIH] Millimeter: A measure of length. A millimeter is approximately 26-times smaller than an inch. [NIH] Mineralization: The action of mineralizing; the state of being mineralized. [EU] Miosis: Pupillary constriction. This may result from congenital absence of the dilatator pupillary muscle, defective sympathetic innervation, or irritation of the conjunctiva or cornea. [NIH] Miotic: 1. Pertaining to, characterized by, or producing miosis : contraction of the pupil. 2. An agent that causes the pupil to contract. 3. Meiotic: characterized by cell division. [EU] 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] Mitomycin: An antineoplastic antibiotic produced by Streptomyces caespitosus. It acts as a bi- or trifunctional alkylating agent causing cross-linking of DNA and inhibition of DNA synthesis. [NIH] Mitosis: A method of indirect cell division by means of which the two daughter nuclei normally receive identical complements of the number of chromosomes of the somatic cells of the species. [NIH] Mitotic: Cell resulting from mitosis. [NIH] Mitotic inhibitors: Drugs that kill cancer cells by interfering with cell division (mitostis). [NIH]

Mitral Valve: The valve between the left atrium and left ventricle of the heart. [NIH] Mitral Valve Prolapse: Abnormal protrusion of one or both of the leaflets of the mitral valve into the left atrium during systole. This may be accompanied by mitral regurgitation,

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systolic murmur, nonejection click, or cardiac arrhythmia. [NIH] Mobility: Capability of movement, of being moved, or of flowing freely. [EU] Modeling: A treatment procedure whereby the therapist presents the target behavior which the learner is to imitate and make part of his repertoire. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Mohs Surgery: A surgical technique used primarily in the treatment of skin neoplasms, especially basal cell or squamous cell carcinoma of the skin. This procedure is a microscopically controlled excision of cutaneous tumors either after fixation in vivo or after freezing the tissue. Serial examinations of fresh tissue specimens are most frequently done. [NIH]

Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecular mass: The sum of the atomic masses of all atoms in a molecule, based on a scale in which the atomic masses of hydrogen, carbon, nitrogen, and oxygen are 1, 12, 14, and 16, respectively. For example, the molecular mass of water, which has two atoms of hydrogen and one atom of oxygen, is 18 (i.e., 2 + 16). [NIH] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monoclonal: An antibody produced by culturing a single type of cell. It therefore consists of a single species of immunoglobulin molecules. [NIH] Monoclonal antibodies: Laboratory-produced substances that can locate and bind to cancer cells wherever they are in the body. Many monoclonal antibodies are used in cancer detection or therapy; each one recognizes a different protein on certain cancer cells. Monoclonal antibodies can be used alone, or they can be used to deliver drugs, toxins, or radioactive material directly to a tumor. [NIH] Monocytes: Large, phagocytic mononuclear leukocytes produced in the vertebrate bone marrow and released into the blood; contain a large, oval or somewhat indented nucleus surrounded by voluminous cytoplasm and numerous organelles. [NIH] Mononuclear: A cell with one nucleus. [NIH] Monophosphate: So called second messenger for neurotransmitters and hormones. [NIH] Morphine: The principal alkaloid in opium and the prototype opiate analgesic and narcotic. Morphine has widespread effects in the central nervous system and on smooth muscle. [NIH] Morphological: Relating to the configuration or the structure of live organs. [NIH] Morphology: The science of the form and structure of organisms (plants, animals, and other forms of life). [NIH] Motility: The ability to move spontaneously. [EU] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH] Motor Cortex: Area of the frontal lobe concerned with primary motor control. It lies anterior to the central sulcus. [NIH]

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Motor nerve: An efferent nerve conveying an impulse that excites muscular contraction. [NIH]

Motor Skills: Performance of complex motor acts. [NIH] Movement Disorders: Syndromes which feature dyskinesias as a cardinal manifestation of the disease process. Included in this category are degenerative, hereditary, post-infectious, medication-induced, post-inflammatory, and post-traumatic conditions. [NIH] Mucinous: Containing or resembling mucin, the main compound in mucus. [NIH] Mucins: A secretion containing mucopolysaccharides and protein that is the chief constituent of mucus. [NIH] Mucosa: A mucous membrane, or tunica mucosa. [EU] Mucositis: A complication of some cancer therapies in which the lining of the digestive system becomes inflamed. Often seen as sores in the mouth. [NIH] Mucus: The viscous secretion of mucous membranes. It contains mucin, white blood cells, water, inorganic salts, and exfoliated cells. [NIH] Multicenter study: A clinical trial that is carried out at more than one medical institution. [NIH]

Multiple Organ Failure: A progressive condition usually characterized by combined failure of several organs such as the lungs, liver, kidney, along with some clotting mechanisms, usually postinjury or postoperative. [NIH] Multivariate Analysis: A set of techniques used when variation in several variables has to be studied simultaneously. In statistics, multivariate analysis is interpreted as any analytic method that allows simultaneous study of two or more dependent variables. [NIH] Muscle Fibers: Large single cells, either cylindrical or prismatic in shape, that form the basic unit of muscle tissue. They consist of a soft contractile substance enclosed in a tubular sheath. [NIH] Muscle Relaxation: That phase of a muscle twitch during which a muscle returns to a resting position. [NIH] Muscular Atrophy: Derangement in size and number of muscle fibers occurring with aging, reduction in blood supply, or following immobilization, prolonged weightlessness, malnutrition, and particularly in denervation. [NIH] Muscular Diseases: Acquired, familial, and congenital disorders of skeletal muscle and smooth muscle. [NIH] Musculature: The muscular apparatus of the body, or of any part of it. [EU] Musculoskeletal System: Themuscles, bones, and cartilage of the body. [NIH] Myalgia: Pain in a muscle or muscles. [EU] Mydriatic: 1. Dilating the pupil. 2. Any drug that dilates the pupil. [EU] Myenteric: On stimulation of an intestinal segment, the segment above contracts and that below relaxes. [NIH] Myocardial infarction: Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Myocardial Ischemia: A disorder of cardiac function caused by insufficient blood flow to the muscle tissue of the heart. The decreased blood flow may be due to narrowing of the coronary arteries (coronary arteriosclerosis), to obstruction by a thrombus (coronary thrombosis), or less commonly, to diffuse narrowing of arterioles and other small vessels

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within the heart. Severe interruption of the blood supply to the myocardial tissue may result in necrosis of cardiac muscle (myocardial infarction). [NIH] Myocardial Reperfusion: Generally, restoration of blood supply to heart tissue which is ischemic due to decrease in normal blood supply. The decrease may result from any source including atherosclerotic obstruction, narrowing of the artery, or surgical clamping. Reperfusion can be induced to treat ischemia. Methods include chemical dissolution of an occluding thrombus, administration of vasodilator drugs, angioplasty, catheterization, and artery bypass graft surgery. However, it is thought that reperfusion can itself further damage the ischemic tissue, causing myocardial reperfusion injury. [NIH] Myocardial Reperfusion Injury: Functional, metabolic, or structural changes in ischemic heart muscle thought to result from reperfusion to the ischemic areas. Changes can be fatal to muscle cells and may include edema with explosive cell swelling and disintegration, sarcolemma disruption, fragmentation of mitochondria, contraction band necrosis, enzyme washout, and calcium overload. Other damage may include hemorrhage and ventricular arrhythmias. One possible mechanism of damage is thought to be oxygen free radicals. Treatment currently includes the introduction of scavengers of oxygen free radicals, and injury is thought to be prevented by warm blood cardioplegic infusion prior to reperfusion. [NIH]

Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Myopia: That error of refraction in which rays of light entering the eye parallel to the optic axis are brought to a focus in front of the retina, as a result of the eyeball being too long from front to back (axial m.) or of an increased strength in refractive power of the media of the eye (index m.). Called also nearsightedness, because the near point is less distant than it is in emmetropia with an equal amplitude of accommodation. [EU] Myosin: Chief protein in muscle and the main constituent of the thick filaments of muscle fibers. In conjunction with actin, it is responsible for the contraction and relaxation of muscles. [NIH] Naloxone: A specific opiate antagonist that has no agonist activity. It is a competitive antagonist at mu, delta, and kappa opioid receptors. [NIH] Narcosis: A general and nonspecific reversible depression of neuronal excitability, produced by a number of physical and chemical aspects, usually resulting in stupor. [NIH] Narcotic: 1. Pertaining to or producing narcosis. 2. An agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Nasal Cavity: The proximal portion of the respiratory passages on either side of the nasal septum, lined with ciliated mucosa, extending from the nares to the pharynx. [NIH] Nasal Mucosa: The mucous membrane lining the nasal cavity. [NIH] Nasal Septum: The partition separating the two nasal cavities in the midplane, composed of cartilaginous, membranous and bony parts. [NIH] Nasogastric: The process of passing a small, flexible plastic tube through the nose or mouth into the stomach or small intestine. [NIH] Nasolacrimal: Pertaining to the nose and lacrimal apparatus. [EU] Nasopharynx: The nasal part of the pharynx, lying above the level of the soft palate. [NIH] Natural Disasters: Sudden calamitous events producing great material damage, loss, and distress. They are the result of natural phenomena such as earthquakes, floods, etc. [NIH] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit.

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Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] Nearsightedness: The common term for myopia. [NIH] Neck Muscles: The neck muscles consist of the platysma, splenius cervicis, sternocleidomastoid(eus), longus colli, the anterior, medius, and posterior scalenes, digastric(us), stylohyoid(eus), mylohyoid(eus), geniohyoid(eus), sternohyoid(eus), omohyoid(eus), sternothyroid(eus), and thyrohyoid(eus). [NIH] Neck Pain: Discomfort or more intense forms of pain that are localized to the cervical region. This term generally refers to pain in the posterior or lateral regions of the neck. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Necrotizing Enterocolitis: A condition in which part of the tissue in the intestines is destroyed. Occurs mainly in under-weight newborn babies. A temporary ileostomy may be necessary. [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] Needle biopsy: The removal of tissue or fluid with a needle for examination under a microscope. Also called fine-needle aspiration. [NIH] Needlestick Injuries: Penetrating stab wounds caused by needles. They are of special concern to health care workers since such injuries put them at risk for developing infectious disease. [NIH] Neoadjuvant Therapy: Preliminary cancer therapy (chemotherapy, radiation therapy, hormone/endocrine therapy, immunotherapy, hyperthermia, etc.) that precedes a necessary second modality of treatment. [NIH] Neodymium: Neodymium. An element of the rare earth family of metals. It has the atomic symbol Nd, atomic number 60, and atomic weight 144.24, and is used in industrial applications. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Neonatologist: Doctor who specializes in treating the diseases and disorders of newborn babies. [NIH] Neoplasia: Abnormal and uncontrolled cell growth. [NIH] Neoplasm: A new growth of benign or malignant tissue. [NIH] Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU] Nephrectomy: Surgery to remove a kidney. Radical nephrectomy removes the kidney, the adrenal gland, nearby lymph nodes, and other surrounding tissue. Simple nephrectomy removes only the kidney. Partial nephrectomy removes the tumor but not the entire kidney. [NIH]

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

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blood. [NIH] 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] Nerve Growth Factor: Nerve growth factor is the first of a series of neurotrophic factors that were found to influence the growth and differentiation of sympathetic and sensory neurons. It is comprised of alpha, beta, and gamma subunits. The beta subunit is responsible for its growth stimulating activity. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Networks: Pertaining to a nerve or to the nerves, a meshlike structure of interlocking fibers or strands. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neural Crest: A strip of specialized ectoderm flanking each side of the embryonal neural plate, which after the closure of the neural tube, forms a column of isolated cells along the dorsal aspect of the neural tube. Most of the cranial and all of the spinal sensory ganglion cells arise by differentiation of neural crest cells. [NIH] Neural Pathways: Neural tracts connecting one part of the nervous system with another. [NIH]

Neural tube defects: These defects include problems stemming from fetal development of the spinal cord, spine, brain, and skull, and include birth defects such as spina bifida, anencephaly, and encephalocele. Neural tube defects occur early in pregnancy at about 4 to 6 weeks, usually before a woman knows she is pregnant. Many babies with neural tube defects have difficulty walking and with bladder and bowel control. [NIH] Neuralgia: Intense or aching pain that occurs along the course or distribution of a peripheral or cranial nerve. [NIH] Neuroblastoma: Cancer that arises in immature nerve cells and affects mostly infants and children. [NIH] Neuroectodermal Tumors: Malignant neoplasms arising in the neuroectoderm, the portion of the ectoderm of the early embryo that gives rise to the central and peripheral nervous systems, including some glial cells. [NIH] Neuroendocrine: Having to do with the interactions between the nervous system and the endocrine system. Describes certain cells that release hormones into the blood in response to stimulation of the nervous system. [NIH] Neuroendocrine tumor: A tumor derived from cells that release a hormone in response to a signal from the nervous system. Some examples of neuroendocrine tumors are carcinoid tumors, islet cell tumors, medullary thyroid carcinoma, and pheochromocytoma. These tumors secrete hormones in excess, causing a variety of symptoms. [NIH] Neurogenic: Loss of bladder control caused by damage to the nerves controlling the bladder. [NIH] Neurogenic Inflammation: Inflammation caused by an injurious stimulus of peripheral neurons and resulting in release of neuropeptides which affect vascular permeability and help initiate proinflammatory and immune reactions at the site of injury. [NIH] Neuroleptic: A term coined to refer to the effects on cognition and behaviour of

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antipsychotic drugs, which produce a state of apathy, lack of initiative, and limited range of emotion and in psychotic patients cause a reduction in confusion and agitation and normalization of psychomotor activity. [EU] Neurologic: Having to do with nerves or the nervous system. [NIH] Neurologist: A doctor who specializes in the diagnosis and treatment of disorders of the nervous system. [NIH] Neurology: A medical specialty concerned with the study of the structures, functions, and diseases of the nervous system. [NIH] Neuroma: A tumor that arises in nerve cells. [NIH] Neuromuscular: Pertaining to muscles and nerves. [EU] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neuronal Plasticity: The capacity of the nervous system to change its reactivity as the result of successive activations. [NIH] 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] Neuropeptide: A member of a class of protein-like molecules made in the brain. Neuropeptides consist of short chains of amino acids, with some functioning as neurotransmitters and some functioning as hormones. [NIH] Neuroprotective Agents: Drugs intended to prevent damage to the brain or spinal cord from ischemia, stroke, convulsions, or trauma. Some must be administered before the event, but others may be effective for some time after. They act by a variety of mechanisms, but often directly or indirectly minimize the damage produced by endogenous excitatory amino acids. [NIH] Neuropsychological Tests: Tests designed to assess neurological function associated with certain behaviors. They are used in diagnosing brain dysfunction or damage and central nervous system disorders or injury. [NIH] Neuroretinitis: Inflammation of the optic nerve head and adjacent retina. [NIH] Neurosurgeon: A doctor who specializes in surgery on the brain, spine, and other parts of the nervous system. [NIH] Neurosurgery: A surgical specialty concerned with the treatment of diseases and disorders of the brain, spinal cord, and peripheral and sympathetic nervous system. [NIH] Neurosurgical Procedures: Surgery performed on the nervous system or its parts. [NIH] Neurotransmitters: Endogenous signaling molecules that alter the behavior of neurons or effector cells. Neurotransmitter is used here in its most general sense, including not only messengers that act directly to regulate ion channels, but also those that act through second messenger systems, and those that act at a distance from their site of release. Included are neuromodulators, neuroregulators, neuromediators, and neurohumors, whether or not acting at synapses. [NIH] Neurotrophins: A nerve growth factor. [NIH] Neutralization: An act or process of neutralizing. [EU] Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light hydrogen; the mass is equal to that of the proton and electron combined and they are

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unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal, and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier nuclei during their decay. [NIH] Neutropenia: An abnormal decrease in the number of neutrophils, a type of white blood cell. [NIH] Neutrophils: Granular leukocytes having a nucleus with three to five lobes connected by slender threads of chromatin, and cytoplasm containing fine inconspicuous granules and stainable by neutral dyes. [NIH] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Night Blindness: Anomaly of vision in which there is a pronounced inadequacy or complete absence of dark-adaptation. [NIH] Nipples: The conic organs which usually give outlet to milk from the mammary glands. [NIH]

Nitric Oxide: A free radical gas produced endogenously by a variety of mammalian cells. It is synthesized from arginine by a complex reaction, catalyzed by nitric oxide synthase. Nitric oxide is endothelium-derived relaxing factor. It is released by the vascular endothelium and mediates the relaxation induced by some vasodilators such as acetylcholine and bradykinin. It also inhibits platelet aggregation, induces disaggregation of aggregated platelets, and inhibits platelet adhesion to the vascular endothelium. Nitric oxide activates cytosolic guanylate cyclase and thus elevates intracellular levels of cyclic GMP. [NIH]

Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Nitroglycerin: A highly volatile organic nitrate that acts as a dilator of arterial and venous smooth muscle and is used in the treatment of angina. It provides relief through improvement of the balance between myocardial oxygen supply and demand. Although total coronary blood flow is not increased, there is redistribution of blood flow in the heart when partial occlusion of coronary circulation is effected. [NIH] Nitrous Oxide: Nitrogen oxide (N2O). A colorless, odorless gas that is used as an anesthetic and analgesic. High concentrations cause a narcotic effect and may replace oxygen, causing death by asphyxia. It is also used as a food aerosol in the preparation of whipping cream. [NIH]

Nodose: Having nodes or projections. [EU] Nodose Ganglion: The inferior (caudal) ganglion of the vagus (10th cranial) nerve. The unipolar nodose ganglion cells are sensory cells with central projections to the medulla and peripheral processes traveling in various branches of the vagus nerve. [NIH] Nonmetastatic: Cancer that has not spread from the primary (original) site to other sites in the body. [NIH] Non-small cell lung cancer: A group of lung cancers that includes squamous cell carcinoma, adenocarcinoma, and large cell carcinoma. [NIH] Nonverbal Communication: Transmission of emotions, ideas, and attitudes between individuals in ways other than the spoken language. [NIH] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal

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transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Norgestrel: (+-)-13-Ethyl-17-hydroxy-18,19-dinorpregn-4-en-20-yn-3-one. A progestational agent with actions similar to those of progesterone. This racemic or (+-)-form has about half the potency of the levo form (levonorgestrel). Norgestrel is used as a contraceptive and ovulation inhibitor and for the control of menstrual disorders and endometriosis. [NIH] Nosocomial: Pertaining to or originating in the hospital, said of an infection not present or incubating prior to admittance to the hospital, but generally occurring 72 hours after admittance; the term is usually used to refer to patient disease, but hospital personnel may also acquire nosocomial infection. [EU] 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] Nuclear Medicine: A specialty field of radiology concerned with diagnostic, therapeutic, and investigative use of radioactive compounds in a pharmaceutical form. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the next. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nursing Care: Care given to patients by nursing service personnel. [NIH] Nursing Staff: Personnel who provide nursing service to patients in an organized facility, institution, or agency. [NIH] Nutritional Status: State of the body in relation to the consumption and utilization of nutrients. [NIH] Nutritional Support: The administration of nutrients for assimilation and utilization by a patient by means other than normal eating. It does not include fluid therapy which normalizes body fluids to restore water-electrolyte balance. [NIH] Nystagmus: Rhythmical oscillation of the eyeballs, either pendular or jerky. [NIH] Observational study: An epidemiologic study that does not involve any intervention, experimental or otherwise. Such a study may be one in which nature is allowed to take its course, with changes in one characteristic being studied in relation to changes in other characteristics. Analytical epidemiologic methods, such as case-control and cohort study designs, are properly called observational epidemiology because the investigator is observing without intervention other than to record, classify, count, and statistically analyze results. [NIH] Occipital Lobe: Posterior part of the cerebral hemisphere. [NIH] Occult: Obscure; concealed from observation, difficult to understand. [EU] Occupational Exposure: The exposure to potentially harmful chemical, physical, or biological agents that occurs as a result of one's occupation. [NIH] Ocular: 1. Of, pertaining to, or affecting the eye. 2. Eyepiece. [EU] Oculomotor: Cranial nerve III. It originate from the lower ventral surface of the midbrain

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and is classified as a motor nerve. [NIH] Oculomotor Nerve: The 3d cranial nerve. The oculomotor nerve sends motor fibers to the levator muscles of the eyelid and to the superior rectus, inferior rectus, and inferior oblique muscles of the eye. It also sends parasympathetic efferents (via the ciliary ganglion) to the muscles controlling pupillary constriction and accommodation. The motor fibers originate in the oculomotor nuclei of the midbrain. [NIH] Odds Ratio: The ratio of two odds. The exposure-odds ratio for case control data is the ratio of the odds in favor of exposure among cases to the odds in favor of exposure among noncases. The disease-odds ratio for a cohort or cross section is the ratio of the odds in favor of disease among the exposed to the odds in favor of disease among the unexposed. The prevalence-odds ratio refers to an odds ratio derived cross-sectionally from studies of prevalent cases. [NIH] Ointments: Semisolid preparations used topically for protective emollient effects or as a vehicle for local administration of medications. Ointment bases are various mixtures of fats, waxes, animal and plant oils and solid and liquid hydrocarbons. [NIH] Olfaction: Function of the olfactory apparatus to perceive and discriminate between the molecules that reach it, in gas form from an external environment, directly or indirectly via the nose. [NIH] Oligosaccharides: Carbohydrates consisting of between two and ten monosaccharides connected by either an alpha- or beta-glycosidic link. They are found throughout nature in both the free and bound form. [NIH] Oliguria: Clinical manifestation of the urinary system consisting of a decrease in the amount of urine secreted. [NIH] Omentum: A fold of the peritoneum (the thin tissue that lines the abdomen) that surrounds the stomach and other organs in the abdomen. [NIH] Oncogene: A gene that normally directs cell growth. If altered, an oncogene can promote or allow the uncontrolled growth of cancer. Alterations can be inherited or caused by an environmental exposure to carcinogens. [NIH] Oncogenic: Chemical, viral, radioactive or other agent that causes cancer; carcinogenic. [NIH] Oncology: The study of cancer. [NIH] Ondansetron: A competitive serotonin type 3 receptor antagonist. It is effective in the treatment of nausea and vomiting caused by cytotoxic chemotherapy drugs, including cisplatin, and it has reported anxiolytic and neuroleptic properties. [NIH] Oophorectomy: Surgery to remove one or both ovaries. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH] Operating Rooms: Facilities equipped for performing surgery. [NIH] Ophthalmic: Pertaining to the eye. [EU] Ophthalmic Artery: Artery originating from the internal carotid artery and distributing to the eye, orbit and adjacent facial structures. [NIH] Ophthalmologic: Pertaining to ophthalmology (= the branch of medicine dealing with the eye). [EU] Ophthalmologist: A medical doctor specializing in the diagnosis and medical or surgical treatment of visual disorders and eye disease. [NIH] Ophthalmology: A surgical specialty concerned with the structure and function of the eye and the medical and surgical treatment of its defects and diseases. [NIH]

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Ophthalmoscopes: Instrument for viewing the fundus and the interior of the eye consisting essentially of a mirror, a prism, and a viewing aperture or optical system. [NIH] Opioid Peptides: The endogenous peptides with opiate-like activity. The three major classes currently recognized are the enkephalins, the dynorphins, and the endorphins. Each of these families derives from different precursors, proenkephalin, prodynorphin, and proopiomelanocortin, respectively. There are also at least three classes of opioid receptors, but the peptide families do not map to the receptors in a simple way. [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] Opportunistic Infections: An infection caused by an organism which becomes pathogenic under certain conditions, e.g., during immunosuppression. [NIH] Opsin: A protein formed, together with retinene, by the chemical breakdown of metarhodopsin. [NIH] Optic Chiasm: The X-shaped structure formed by the meeting of the two optic nerves. At the optic chiasm the fibers from the medial part of each retina cross to project to the other side of the brain while the lateral retinal fibers continue on the same side. As a result each half of the brain receives information about the contralateral visual field from both eyes. [NIH]

Optic cup: The white, cup-like area in the center of the optic disc. [NIH] Optic Nerve: The 2nd cranial nerve. The optic nerve conveys visual information from the retina to the brain. The nerve carries the axons of the retinal ganglion cells which sort at the optic chiasm and continue via the optic tracts to the brain. The largest projection is to the lateral geniculate nuclei; other important targets include the superior colliculi and the suprachiasmatic nuclei. Though known as the second cranial nerve, it is considered part of the central nervous system. [NIH] Optic Nerve Diseases: Conditions which produce injury or dysfunction of the second cranial or optic nerve, which is generally considered a component of the central nervous system. Damage to optic nerve fibers may occur at or near their origin in the retina, at the optic disk, or in the nerve, optic chiasm, optic tract, or lateral geniculate nuclei. Clinical manifestations may include decreased visual acuity and contrast sensitivity, impaired color vision, and an afferent pupillary defect. [NIH] Optic nerve head: The circular area (disc) where the optic nerve connects to the retina. [NIH] Oral Health: The optimal state of the mouth and normal functioning of the organs of the mouth without evidence of disease. [NIH] Oral Surgical Procedures: Procedures used to treat disease, injuries, and defects of the oral and maxillofacial region. [NIH] Orbit: One of the two cavities in the skull which contains an eyeball. Each eye is located in a bony socket or orbit. [NIH] Orbital: Pertaining to the orbit (= the bony cavity that contains the eyeball). [EU] Orchiectomy: The surgical removal of one or both testicles. [NIH] Organ Culture: The growth in aseptic culture of plant organs such as roots or shoots, beginning with organ primordia or segments and maintaining the characteristics of the organ. [NIH] Organ Preservation: The process by which organs are kept viable outside of the organism from which they were removed (i.e., kept from decay by means of a chemical agent, cooling,

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or a fluid substitute that mimics the natural state within the organism). [NIH] Organ Transplantation: Transference of an organ between individuals of the same species or between individuals of different species. [NIH] Organelles: Specific particles of membrane-bound organized living substances present in eukaryotic cells, such as the mitochondria; the golgi apparatus; endoplasmic reticulum; lysomomes; plastids; and vacuoles. [NIH] Organizational Culture: Beliefs and values shared by all members of the organization. These shared values are reflected in the day to day operations of the organization. [NIH] Orofacial: Of or relating to the mouth and face. [EU] Oropharynx: Oral part of the pharynx. [NIH] Orthodontics: A dental specialty concerned with the prevention and correction of dental and oral anomalies (malocclusion). [NIH] Orthopaedic: Pertaining to the correction of deformities of the musculoskeletal system; pertaining to orthopaedics. [EU] Orthopedic Procedures: Procedures used to treat and correct deformities, diseases, and injuries to the skeletal system, its articulations, and associated structures. [NIH] Orthopedics: A surgical specialty which utilizes medical, surgical, and physical methods to treat and correct deformities, diseases, and injuries to the skeletal system, its articulations, and associated structures. [NIH] Orthotic Devices: Apparatus used to support, align, prevent, or correct deformities or to improve the function of movable parts of the body. [NIH] Osmolarity: The concentration of osmotically active particles expressed in terms of osmoles of solute per litre of solution. [EU] Osmotic: Pertaining to or of the nature of osmosis (= the passage of pure solvent from a solution of lesser to one of greater solute concentration when the two solutions are separated by a membrane which selectively prevents the passage of solute molecules, but is permeable to the solvent). [EU] Ossicles: The hammer, anvil and stirrup, the small bones of the middle ear, which transmit the vibrations from the tympanic membrane to the oval window. [NIH] Ossification: The formation of bone or of a bony substance; the conversion of fibrous tissue or of cartilage into bone or a bony substance. [EU] Osteoarthritis: A progressive, degenerative joint disease, the most common form of arthritis, especially in older persons. The disease is thought to result not from the aging process but from biochemical changes and biomechanical stresses affecting articular cartilage. In the foreign literature it is often called osteoarthrosis deformans. [NIH] Osteoblasts: Bone-forming cells which secrete an extracellular matrix. Hydroxyapatite crystals are then deposited into the matrix to form bone. [NIH] Osteocalcin: Vitamin K-dependent calcium-binding protein synthesized by osteoblasts and found primarily in bone. Serum osteocalcin measurements provide a noninvasive specific marker of bone metabolism. The protein contains three residues of the amino acid gammacarboxyglutamic acid (GLA), which, in the presence of calcium, promotes binding to hydroxyapatite and subsequent accumulation in bone matrix. [NIH] 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] Osteogenesis: The histogenesis of bone including ossification. It occurs continuously but

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particularly in the embryo and child and during fracture repair. [NIH] Osteogenesis Imperfecta: A collagen disorder resulting from defective biosynthesis of type I collagen and characterized by brittle, osteoporotic, and easily fractured bones. It may also present with blue sclerae, loose joints, and imperfect dentin formation. There are four major types, I-IV. [NIH] Osteogenic sarcoma: A malignant tumor of the bone. Also called osteosarcoma. [NIH] Osteomalacia: A condition marked by softening of the bones (due to impaired mineralization, with excess accumulation of osteoid), with pain, tenderness, muscular weakness, anorexia, and loss of weight, resulting from deficiency of vitamin D and calcium. [EU]

Osteomyelitis: Inflammation of bone caused by a pyogenic organism. It may remain localized or may spread through the bone to involve the marrow, cortex, cancellous tissue, and periosteum. [EU] Osteoporosis: Reduction of bone mass without alteration in the composition of bone, leading to fractures. Primary osteoporosis can be of two major types: postmenopausal osteoporosis and age-related (or senile) osteoporosis. [NIH] Osteosarcoma: A cancer of the bone that affects primarily children and adolescents. Also called osteogenic sarcoma. [NIH] Osteotomy: The surgical cutting of a bone. [EU] Ostomy: Surgical construction of an artificial opening (stoma) for external fistulization of a duct or vessel by insertion of a tube with or without a supportive stent. [NIH] Otitis: Inflammation of the ear, which may be marked by pain, fever, abnormalities of hearing, hearing loss, tinnitus, and vertigo. [EU] Otitis Media: Inflammation of the middle ear. [NIH] Otolaryngologist: A doctor who specializes in treating diseases of the ear, nose, and throat. Also called an ENT doctor. [NIH] Otolaryngology: A surgical specialty concerned with the study and treatment of disorders of the ear, nose, and throat. [NIH] Otorhinolaryngology: That branch of medicine concerned with medical and surgical treatment of the head and neck, including the ears, nose and throat. [EU] Otosclerosis: The formation of spongy bone in the labyrinth capsule. The ossicles can become fixed and unable to transmit sound vibrations, thereby causing deafness. [NIH] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Ovarian epithelial cancer: Cancer that occurs in the cells lining the ovaries. [NIH] Ovaries: The pair of female reproductive glands in which the ova, or eggs, are formed. The ovaries are located in the pelvis, one on each side of the uterus. [NIH] Ovary: Either of the paired glands in the female that produce the female germ cells and secrete some of the female sex hormones. [NIH] Overall survival: The percentage of subjects in a study who have survived for a defined period of time. Usually reported as time since diagnosis or treatment. Often called the survival rate. [NIH] Overweight: An excess of body weight but not necessarily body fat; a body mass index of 25 to 29.9 kg/m2. [NIH] Ovum: A female germ cell extruded from the ovary at ovulation. [NIH]

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Ovum Implantation: Endometrial implantation of the blastocyst. [NIH] Oxaliplatin: An anticancer drug that belongs to the family of drugs called platinum compounds. [NIH] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]

Oxidative Stress: A disturbance in the prooxidant-antioxidant balance in favor of the former, leading to potential damage. Indicators of oxidative stress include damaged DNA bases, protein oxidation products, and lipid peroxidation products (Sies, Oxidative Stress, 1991, pxv-xvi). [NIH] Oxygen Consumption: The oxygen consumption is determined by calculating the difference between the amount of oxygen inhaled and exhaled. [NIH] Oxygenation: The process of supplying, treating, or mixing with oxygen. No:1245 oxygenation the process of supplying, treating, or mixing with oxygen. [EU] Oxygenator: An apparatus by which oxygen is introduced into the blood during circulation outside the body, as during open heart surgery. [NIH] Pacemaker: An object or substance that influences the rate at which a certain phenomenon occurs; often used alone to indicate the natural cardiac pacemaker or an artificial cardiac pacemaker. In biochemistry, a substance whose rate of reaction sets the pace for a series of interrelated reactions. [EU] Pachymeningitis: Inflammation of the dura mater of the brain, the spinal cord or the optic nerve. [NIH] Paclitaxel: Antineoplastic agent isolated from the bark of the Pacific yew tree, Taxus brevifolia. Paclitaxel stabilizes microtubules in their polymerized form and thus mimics the action of the proto-oncogene proteins c-mos. [NIH] Paediatric: Of or relating to the care and medical treatment of children; belonging to or concerned with paediatrics. [EU] Pain, Postoperative: Pain during the period after surgery. [NIH] Palate: The structure that forms the roof of the mouth. It consists of the anterior hard palate and the posterior soft palate. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] 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] Palsy: Disease of the peripheral nervous system occurring usually after many years of increased lead absorption. [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] Pancreatic: Having to do with the pancreas. [NIH] Pancreatic cancer: Cancer of the pancreas, a salivary gland of the abdomen. [NIH] Pancreatic Ducts: Ducts that collect pancreatic juice from the pancreas and supply it to the

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duodenum. [NIH] Pancreatic Juice: The fluid containing digestive enzymes secreted by the pancreas in response to food in the duodenum. [NIH] Pancreatitis: Acute or chronic inflammation of the pancreas, which may be asymptomatic or symptomatic, and which is due to autodigestion of a pancreatic tissue by its own enzymes. It is caused most often by alcoholism or biliary tract disease; less commonly it may be associated with hyperlipaemia, hyperparathyroidism, abdominal trauma (accidental or operative injury), vasculitis, or uraemia. [EU] Papaverine: An alkaloid found in opium but not closely related to the other opium alkaloids in its structure or pharmacological actions. It is a direct-acting smooth muscle relaxant used in the treatment of impotence and as a vasodilator, especially for cerebral vasodilation. The mechanism of its pharmacological actions is not clear, but it apparently can inhibit phosphodiesterases and it may have direct actions on calcium channels. [NIH] Papilla: A small nipple-shaped elevation. [NIH] Papillary: Pertaining to or resembling papilla, or nipple. [EU] Papilledema: Swelling around the optic disk. [NIH] Paraffin: A mixture of solid hydrocarbons obtained from petroleum. It has a wide range of uses including as a stiffening agent in ointments, as a lubricant, and as a topical antiinflammatory. It is also commonly used as an embedding material in histology. [NIH] Parallax: The apparent change in direction or lateral displacement of a viewed object when the eye is moved from one position to another, or when the object is viewed first with one eye and then with the other. [NIH] Paralysis: Loss of ability to move all or part of the body. [NIH] Paranasal Sinuses: Air-filled extensions of the respiratory part of the nasal cavity into the frontal, ethmoid, sphenoid, and maxillary cranial bones. They vary in size and form in different individuals and are lined by the ciliated mucous membranes of the nasal cavity. [NIH]

Paranoia: A psychotic disorder marked by persistent delusions of persecution or delusional jealousy and behaviour like that of the paranoid personality, such as suspiciousness, mistrust, and combativeness. It differs from paranoid schizophrenia, in which hallucinations or formal thought disorder are present, in that the delusions are logically consistent and that there are no other psychotic features. The designation in DSM III-R is delusional (paranoid) disorders, with five types : persecutory, jealous, erotomanic, somatic, and grandiose. [EU] Paraplegia: Severe or complete loss of motor function in the lower extremities and lower portions of the trunk. This condition is most often associated with spinal cord diseases, although brain diseases; peripheral nervous system diseases; neuromuscular diseases; and muscular diseases may also cause bilateral leg weakness. [NIH] Parathyroid: 1. Situated beside the thyroid gland. 2. One of the parathyroid glands. 3. A sterile preparation of the water-soluble principle(s) of the parathyroid glands, ad-ministered parenterally as an antihypocalcaemic, especially in the treatment of acute hypoparathyroidism with tetany. [EU] Parathyroid Glands: Two small paired endocrine glands in the region of the thyroid gland. They secrete parathyroid hormone and are concerned with the metabolism of calcium and phosphorus. [NIH] Parathyroid hormone: A substance made by the parathyroid gland that helps the body store and use calcium. Also called parathormone, parathyrin, or PTH. [NIH] Parenteral: Not through the alimentary canal but rather by injection through some other

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route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Paresis: A general term referring to a mild to moderate degree of muscular weakness, occasionally used as a synonym for paralysis (severe or complete loss of motor function). In the older literature, paresis often referred specifically to paretic neurosyphilis. "General paresis" and "general paralysis" may still carry that connotation. Bilateral lower extremity paresis is referred to as paraparesis. [NIH] Parietal: 1. Of or pertaining to the walls of a cavity. 2. Pertaining to or located near the parietal bone, as the parietal lobe. [EU] Paroxysmal: Recurring in paroxysms (= spasms or seizures). [EU] Partial remission: The shrinking, but not complete disappearance, of a tumor in response to therapy. Also called partial response. [NIH] Particle: A tiny mass of material. [EU] Parturition: The act or process of given birth to a child. [EU] 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] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]

Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathologic Processes: The abnormal mechanisms and forms involved in the dysfunctions of tissues and organs. [NIH] Pathologies: The study of abnormality, especially the study of diseases. [NIH] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Patient Advocacy: Promotion and protection of the rights of patients, frequently through a legal process. [NIH] Patient Care Management: Generating, planning, organizing, and administering medical and nursing care and services for patients. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Patient Satisfaction: The degree to which the individual regards the health care service or product or the manner in which it is delivered by the provider as useful, effective, or beneficial. [NIH] Patient Selection: Criteria and standards used for the determination of the appropriateness of the inclusion of patients with specific conditions in proposed treatment plans and the criteria used for the inclusion of subjects in various clinical trials and other research protocols. [NIH] Patient Transfer: Interfacility or intrahospital transfer of patients. Intrahospital transfer is usually to obtain a specific kind of care and interfacility transfer is usually for economic reasons as well as type of care provided. [NIH] Peau d'orange: A dimpled condition of the skin of the breast, resembling the skin of an orange, sometimes found in inflammatory breast cancer. [NIH] Pediatric Dentistry: The practice of dentistry concerned with the dental problems of

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children, proper maintenance, and treatment. The dental care may include the services provided by dental specialists. [NIH] Pediatrics: A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence. [NIH] Pedicle: Embryonic link between the optic vesicle or optic cup and the forebrain or diencephalon, which becomes the optic nerve. [NIH] Peer Review: An organized procedure carried out by a select committee of professionals in evaluating the performance of other professionals in meeting the standards of their specialty. Review by peers is used by editors in the evaluation of articles and other papers submitted for publication. Peer review is used also in the evaluation of grant applications. It is applied also in evaluating the quality of health care provided to patients. [NIH] Pefloxacin: An orally administered broad spectrum quinolone antibacterial agent active against most gram-negative and gram-positive bacteria. It is effective against urinary tract infections as well as against many other systemic infections. The drug is well tolerated in adults, but should not be given to children and pregnant women. [NIH] Pelvic: Pertaining to the pelvis. [EU] Penile Prosthesis: Rigid, semi-rigid, or inflatable cylindric hydraulic devices, with either combined or separate reservoir and pumping systems, implanted for the surgical treatment of organic impotence. [NIH] Penis: The external reproductive organ of males. It is composed of a mass of erectile tissue enclosed in three cylindrical fibrous compartments. Two of the three compartments, the corpus cavernosa, are placed side-by-side along the upper part of the organ. The third compartment below, the corpus spongiosum, houses the urethra. [NIH] Pepsin: An enzyme made in the stomach that breaks down proteins. [NIH] Pepsin A: Formed from pig pepsinogen by cleavage of one peptide bond. The enzyme is a single polypeptide chain and is inhibited by methyl 2-diaazoacetamidohexanoate. It cleaves peptides preferentially at the carbonyl linkages of phenylalanine or leucine and acts as the principal digestive enzyme of gastric juice. [NIH] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Peptic Ulcer: Ulcer that occurs in those portions of the alimentary tract which come into contact with gastric juice containing pepsin and acid. It occurs when the amount of acid and pepsin is sufficient to overcome the gastric mucosal barrier. [NIH] Peptic Ulcer Hemorrhage: Bleeding from a peptic ulcer. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Perception: The ability quickly and accurately to recognize similarities and differences among presented objects, whether these be pairs of words, pairs of number series, or multiple sets of these or other symbols such as geometric figures. [NIH] Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] Perforation: 1. The act of boring or piercing through a part. 2. A hole made through a part or substance. [EU] Perfusion: Bathing an organ or tissue with a fluid. In regional perfusion, a specific area of the body (usually an arm or a leg) receives high doses of anticancer drugs through a blood vessel. Such a procedure is performed to treat cancer that has not spread. [NIH] Perianal: Located around the anus. [EU]

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Pericardial Effusion: Presence of fluid within the pericardium. [NIH] Pericardium: The fibroserous sac surrounding the heart and the roots of the great vessels. [NIH]

Peridural: Around or external to the dura mater. [EU] Perineal: Pertaining to the perineum. [EU] Perineum: The area between the anus and the sex organs. [NIH] Perineural: Around a nerve or group of nerves. [NIH] Periodontal disease: Disease involving the supporting structures of the teeth (as the gums and periodontal membranes). [NIH] Periodontal Ligament: Fibrous connective tissue surrounding the root of a tooth that separates it from and attaches it to the alveolar bone. [NIH] Periodontics: A dental specialty concerned with the histology, physiology, and pathology of the tissues that support, attach, and surround the teeth, and of the treatment and prevention of disease affecting these tissues. [NIH] Perioperative: Around the time of surgery; usually lasts from the time of going into the hospital or doctor's office for surgery until the time the patient goes home. [NIH] Peripheral blood: Blood circulating throughout the body. [NIH] Peripheral Nerves: The nerves outside of the brain and spinal cord, including the autonomic, cranial, and spinal nerves. Peripheral nerves contain non-neuronal cells and connective tissue as well as axons. The connective tissue layers include, from the outside to the inside, the epineurium, the perineurium, and the endoneurium. [NIH] Peripheral Nervous System: The nervous system outside of the brain and spinal cord. The peripheral nervous system has autonomic and somatic divisions. The autonomic nervous system includes the enteric, parasympathetic, and sympathetic subdivisions. The somatic nervous system includes the cranial and spinal nerves and their ganglia and the peripheral sensory receptors. [NIH] Peripheral Nervous System Diseases: Diseases of the peripheral nerves external to the brain and spinal cord, which includes diseases of the nerve roots, ganglia, plexi, autonomic nerves, sensory nerves, and motor nerves. [NIH] Peripheral stem cell transplantation: A method of replacing blood-forming cells destroyed by cancer treatment. Immature blood cells (stem cells) in the circulating blood that are similar to those in the bone marrow are given after treatment to help the bone marrow recover and continue producing healthy blood cells. Transplantation may be autologous (an individual's own blood cells saved earlier), allogeneic (blood cells donated by someone else), or syngeneic (blood cells donated by an identical twin). Also called peripheral stem cell support. [NIH] Peripheral vision: Side vision; ability to see objects and movement outside of the direct line of vision. [NIH] Peristalsis: The rippling motion of muscles in the intestine or other tubular organs characterized by the alternate contraction and relaxation of the muscles that propel the contents onward. [NIH] Peritoneal: Having to do with the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH] Peritoneal Cavity: The space enclosed by the peritoneum. It is divided into two portions, the greater sac and the lesser sac or omental bursa, which lies behind the stomach. The two sacs are connected by the foramen of Winslow, or epiploic foramen. [NIH]

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Peritoneal Dialysis: Dialysis fluid being introduced into and removed from the peritoneal cavity as either a continuous or an intermittent procedure. [NIH] Peritoneum: Endothelial lining of the abdominal cavity, the parietal peritoneum covering the inside of the abdominal wall and the visceral peritoneum covering the bowel, the mesentery, and certain of the organs. The portion that covers the bowel becomes the serosal layer of the bowel wall. [NIH] Peritonitis: Inflammation of the peritoneum; a condition marked by exudations in the peritoneum of serum, fibrin, cells, and pus. It is attended by abdominal pain and tenderness, constipation, vomiting, and moderate fever. [EU] Peroneal Nerve: The lateral of the two terminal branches of the sciatic nerve. The peroneal (or fibular) nerve provides motor and sensory innervation to parts of the leg and foot. [NIH] Pessary: 1. An instrument placed in the vagina to support the uterus or rectum or as a contraceptive device. 2. A medicated vaginal suppository. [EU] Petroleum: Naturally occurring complex liquid hydrocarbons which, after distillation, yield combustible fuels, petrochemicals, and lubricants. [NIH] PH: The symbol relating the hydrogen ion (H+) concentration or activity of a solution to that of a given standard solution. Numerically the pH is approximately equal to the negative logarithm of H+ concentration expressed in molarity. pH 7 is neutral; above it alkalinity increases and below it acidity increases. [EU] Phallic: Pertaining to the phallus, or penis. [EU] Pharmacokinetic: The mathematical analysis of the time courses of absorption, distribution, and elimination of drugs. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Pharynx: The hollow tube about 5 inches long that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes to the stomach). [NIH] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phenylalanine: An aromatic amino acid that is essential in the animal diet. It is a precursor of melanin, dopamine, noradrenalin, and thyroxine. [NIH] Phenylbutyrate: An anticancer drug that belongs to the family of drugs called differentiating agents. [NIH] Phospholipases: A class of enzymes that catalyze the hydrolysis of phosphoglycerides or glycerophosphatidates. EC 3.1.-. [NIH] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Phosphorylation: The introduction of a phosphoryl group into a compound through the formation of an ester bond between the compound and a phosphorus moiety. [NIH] Photocoagulation: Using a special strong beam of light (laser) to seal off bleeding blood vessels such as in the eye. The laser can also burn away blood vessels that should not have

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grown in the eye. This is the main treatment for diabetic retinopathy. [NIH] Photodynamic therapy: Treatment with drugs that become active when exposed to light. These drugs kill cancer cells. [NIH] Photoreceptors: Cells specialized to detect and transduce light. [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]

Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pigment: A substance that gives color to tissue. Pigments are responsible for the color of skin, eyes, and hair. [NIH] Pigmentation: Coloration or discoloration of a part by a pigment. [NIH] Pilot study: The initial study examining a new method or treatment. [NIH] Pitch: The subjective awareness of the frequency or spectral distribution of a sound. [NIH] Placenta: A highly vascular fetal organ through which the fetus absorbs oxygen and other nutrients and excretes carbon dioxide and other wastes. It begins to form about the eighth day of gestation when the blastocyst adheres to the decidua. [NIH] Plague: An acute infectious disease caused by Yersinia pestis that affects humans, wild rodents, and their ectoparasites. This condition persists due to its firm entrenchment in sylvatic rodent-flea ecosystems throughout the world. Bubonic plague is the most common form. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plaque: A clear zone in a bacterial culture grown on an agar plate caused by localized destruction of bacterial cells by a bacteriophage. The concentration of infective virus in a fluid can be estimated by applying the fluid to a culture and counting the number of. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma cells: A type of white blood cell that produces antibodies. [NIH] Plasma protein: One of the hundreds of different proteins present in blood plasma, including carrier proteins ( such albumin, transferrin, and haptoglobin), fibrinogen and other coagulation factors, complement components, immunoglobulins, enzyme inhibitors, precursors of substances such as angiotension and bradykinin, and many other types of proteins. [EU] Plasma Volume: Volume of plasma in the circulation. It is usually measured by indicator dilution techniques. [NIH]

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Plastic surgeon: A surgeon who specializes in reducing scarring or disfigurement that may occur as a result of accidents, birth defects, or treatment for diseases. [NIH] Plasticity: In an individual or a population, the capacity for adaptation: a) through gene changes (genetic plasticity) or b) through internal physiological modifications in response to changes of environment (physiological plasticity). [NIH] Platelet Activating Factor: A phospholipid derivative formed by platelets, basophils, neutrophils, monocytes, and macrophages. It is a potent platelet aggregating agent and inducer of systemic anaphylactic symptoms, including hypotension, thrombocytopenia, neutropenia, and bronchoconstriction. [NIH] Platelet Activation: A series of progressive, overlapping events triggered by exposure of the platelets to subendothelial tissue. These events include shape change, adhesiveness, aggregation, and release reactions. When carried through to completion, these events lead to the formation of a stable hemostatic plug. [NIH] 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] Platelet Factor 4: A high-molecular-weight proteoglycan-platelet factor complex which is released from blood platelets by thrombin. It acts as a mediator in the heparin-neutralizing capacity of the blood and plays a role in platelet aggregation. At high ionic strength (I=0.75), the complex dissociates into the active component (molecular weight 29,000) and the proteoglycan carrier (chondroitin 4-sulfate, molecular weight 350,000). The molecule exists in the form of a dimer consisting of 8 moles of platelet factor 4 and 2 moles of proteoglycan. [NIH]

Platelet Transfusion: The transfer of blood platelets from a donor to a recipient or reinfusion to the donor. [NIH] Platelets: A type of blood cell that helps prevent bleeding by causing blood clots to form. Also called thrombocytes. [NIH] Platinum: Platinum. A heavy, soft, whitish metal, resembling tin, atomic number 78, atomic weight 195.09, symbol Pt. (From Dorland, 28th ed) It is used in manufacturing equipment for laboratory and industrial use. It occurs as a black powder (platinum black) and as a spongy substance (spongy platinum) and may have been known in Pliny's time as "alutiae". [NIH]

Platinum Compounds: Inorganic compounds which contain platinum as the central atom. [NIH]

Plethysmography: Recording of change in the size of a part as modified by the circulation in it. [NIH] Pleura: The thin serous membrane enveloping the lungs and lining the thoracic cavity. [NIH] Pleural: A circumscribed area of hyaline whorled fibrous tissue which appears on the surface of the parietal pleura, on the fibrous part of the diaphragm or on the pleura in the interlobar fissures. [NIH] Plexus: A network or tangle; a general term for a network of lymphatic vessels, nerves, or veins. [EU] Pneumothorax: Accumulation of air or gas in the space between the lung and chest wall, resulting in partial or complete collapse of the lung. [NIH] Podophyllotoxin: The main active constituent of the resin from the roots of may apple or mandrake (Podophyllum peltatum and P. emodi). It is a potent spindle poison, toxic if taken internally, and has been used as a cathartic. It is very irritating to skin and mucous

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membranes, has keratolytic actions, has been used to treat warts and keratoses, and may have antineoplastic properties, as do some of its congeners and derivatives. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Polyarthritis: An inflammation of several joints together. [EU] Polychromatic: Erythrocyte that, on staining, shows various shades of blue combined with tinges of pink. [NIH] Polycystic: An inherited disorder characterized by many grape-like clusters of fluid-filled cysts that make both kidneys larger over time. These cysts take over and destroy working kidney tissue. PKD may cause chronic renal failure and end-stage renal disease. [NIH] Polyethylene: A vinyl polymer made from ethylene. It can be branched or linear. Branched or low-density polyethylene is tough and pliable but not to the same degree as linear polyethylene. Linear or high-density polyethylene has a greater hardness and tensile strength. Polyethylene is used in a variety of products, including implants and prostheses. [NIH]

Polyethyleneimine: Strongly cationic polymer that binds to certain proteins; used as a marker in immunology, to precipitate and purify enzymes and lipids. Synonyms: aziridine polymer; Epamine; Epomine; ethylenimine polymer; Montrek; PEI; Polymin(e). [NIH] Polyglycolic Acid: Poly(oxy(1-oxo-1,2-ethanediyl)). A biocompatible polymer used as a surgical suture material. [NIH] Polymerase: An enzyme which catalyses the synthesis of DNA using a single DNA strand as a template. The polymerase copies the template in the 5'-3'direction provided that sufficient quantities of free nucleotides, dATP and dTTP are present. [NIH] Polymerase Chain Reaction: In vitro method for producing large amounts of specific DNA or RNA fragments of defined length and sequence from small amounts of short oligonucleotide flanking sequences (primers). The essential steps include thermal denaturation of the double-stranded target molecules, annealing of the primers to their complementary sequences, and extension of the annealed primers by enzymatic synthesis with DNA polymerase. The reaction is efficient, specific, and extremely sensitive. Uses for the reaction include disease diagnosis, detection of difficult-to-isolate pathogens, mutation analysis, genetic testing, DNA sequencing, and analyzing evolutionary relationships. [NIH] Polymers: Compounds formed by the joining of smaller, usually repeating, units linked by covalent bonds. These compounds often form large macromolecules (e.g., polypeptides, proteins, plastics). [NIH] 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] Polyposis: The development of numerous polyps (growths that protrude from a mucous membrane). [NIH] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] Polyurethanes: A group of thermoplastic or thermosetting polymers containing polyisocyanate. They are used as elastomers, as coatings, as fibers and as foams. [NIH] Polyvinyl Alcohol: A polymer prepared from polyvinyl acetates by replacement of the acetate groups with hydroxyl groups. It is used as a pharmaceutic aid and ophthalmic lubricant as well as in the manufacture of surface coatings artificial sponges, cosmetics, and other products. [NIH] Pons: The part of the central nervous system lying between the medulla oblongata and the

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mesencephalon, ventral to the cerebellum, and consisting of a pars dorsalis and a pars ventralis. [NIH] Popliteal: Compression of the nerve at the neck of the fibula. [NIH] Porosity: Condition of having pores or open spaces. This often refers to bones, bone implants, or bone cements, but can refer to the porous state of any solid substance. [NIH] Port: An implanted device through which blood may be withdrawn and drugs may be infused without repeated needle sticks. Also called a port-a-cath. [NIH] Port-a-cath: An implanted device through which blood may be withdrawn and drugs may be infused without repeated needle sticks. Also called a port. [NIH] Positive pressure ventilation: Provision of oxygen under pressure by a mechanical respirator. [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 chamber: The space between the back of the iris and the front face of the vitreous; filled with aqueous fluid. [NIH] 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] Postnatal: Occurring after birth, with reference to the newborn. [EU] Postoperative: After surgery. [NIH] Postoperative Complications: Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery. [NIH] Postoperative Hemorrhage: Hemorrhage following any surgical procedure. It may be immediate or delayed and is not restricted to the surgical wound. [NIH] Postoperative Period: The period following a surgical operation. [NIH] Postsynaptic: Nerve potential generated by an inhibitory hyperpolarizing stimulation. [NIH] Post-traumatic: Occurring as a result of or after injury. [EU] Post-traumatic stress disorder: A psychological disorder that develops in some individuals after a major traumatic experience such as war, rape, domestic violence, or accident. [NIH] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Potentiates: A degree of synergism which causes the exposure of the organism to a harmful substance to worsen a disease already contracted. [NIH] Potentiation: An overall effect of two drugs taken together which is greater than the sum of the effects of each drug taken alone. [NIH] 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,

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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] Praseodymium: Praseodymium. An element of the rare earth family of metals. It has the atomic symbol Pr, atomic number 59, and atomic weight 140.91. [NIH] Precancerous: A term used to describe a condition that may (or is likely to) become cancer. Also called premalignant. [NIH] Precipitation: The act or process of precipitating. [EU] Preclinical: Before a disease becomes clinically recognizable. [EU] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Predictive factor: A situation or condition that may increase a person's risk of developing a certain disease or disorder. [NIH] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Preload: The tension in the heart muscle at the end of diastole (before the contraction). [EU] Premalignant: A term used to describe a condition that may (or is likely to) become cancer. Also called precancerous. [NIH] Premenopausal: Refers to the time before menopause. Menopause is the time of life when a women's menstrual periods stop permanently; also called "change of life." [NIH] Prepuce: A covering fold of skin; often used alone to designate the preputium penis. [EU] Presbycusis: Progressive bilateral loss of hearing that occurs in the aged. Syn: senile deafness. [NIH] Presbyopia: The normal decreasing elasticity of the crystalline lens that leads to loss of accommodation. [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] Priapism: Persistent abnormal erection of the penis, usually without sexual desire, and accompanied by pain and tenderness. It is seen in diseases and injuries of the spinal cord, and may be caused by vesical calculus and certain injuries to the penis. [EU] 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] Primary tumor: The original tumor. [NIH] Primitive neuroectodermal tumors: PNET. A type of bone cancer that forms in the middle (shaft) of large bones. Also called Ewing's sarcoma/primitive neuroectodermal tumor. [NIH] Probe: An instrument used in exploring cavities, or in the detection and dilatation of strictures, or in demonstrating the potency of channels; an elongated instrument for exploring or sounding body cavities. [NIH] Problem Solving: A learning situation involving more than one alternative from which a selection is made in order to attain a specific goal. [NIH]

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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] Proctocolectomy: An operation to remove the colon and rectum. Also called coloproctectomy. [NIH] Proestrus: Phase of the estrous cycle preceding estrus during which the Graafian follicle undergoes maturation. Applies to animals. [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Prognostic factor: A situation or condition, or a characteristic of a patient, that can be used to estimate the chance of recovery from a disease, or the chance of the disease recurring (coming back). [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Progressive disease: Cancer that is increasing in scope or severity. [NIH] Projection: A defense mechanism, operating unconsciously, whereby that which is emotionally unacceptable in the self is rejected and attributed (projected) to others. [NIH] Prolactin: Pituitary lactogenic hormone. A polypeptide hormone with a molecular weight of about 23,000. It is essential in the induction of lactation in mammals at parturition and is synergistic with estrogen. The hormone also brings about the release of progesterone from lutein cells, which renders the uterine mucosa suited for the embedding of the ovum should fertilization occur. [NIH] Prolapse: The protrusion of an organ or part of an organ into a natural or artificial orifice. [NIH]

Proline: A non-essential amino acid that is synthesized from glutamic acid. It is an essential component of collagen and is important for proper functioning of joints and tendons. [NIH] Promoter: A chemical substance that increases the activity of a carcinogenic process. [NIH] Prone: Having the front portion of the body downwards. [NIH] Prone Position: The posture of an individual lying face down. [NIH] Pro-Opiomelanocortin: A precursor protein, MW 30,000, synthesized mainly in the anterior pituitary gland but also found in the hypothalamus, brain, and several peripheral tissues. It incorporates the amino acid sequences of ACTH and beta-lipotropin. These two hormones, in turn, contain the biologically active peptides MSH, corticotropin-like intermediate lobe peptide, alpha-lipotropin, endorphins, and methionine enkephalin. [NIH] Prophylactic mastectomy: Surgery to remove one or both breasts in order to decrease the risk of developing breast cancer. Also called preventive mastectomy. [NIH] Prophylactic oophorectomy: Surgery intended to reduce the risk of ovarian cancer by removing the ovaries before disease develops. [NIH] Prophylaxis: An attempt to prevent disease. [NIH] Propofol: A widely used anesthetic. [NIH] Prospective Studies: Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the

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selection of the study group. [NIH] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Prostaglandin: Any of a group of components derived from unsaturated 20-carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway that are extremely potent mediators of a diverse group of physiologic processes. The abbreviation for prostaglandin is PG; specific compounds are designated by adding one of the letters A through I to indicate the type of substituents found on the hydrocarbon skeleton and a subscript (1, 2 or 3) to indicate the number of double bonds in the hydrocarbon skeleton e.g., PGE2. The predominant naturally occurring prostaglandins all have two double bonds and are synthesized from arachidonic acid (5,8,11,14-eicosatetraenoic acid) by the pathway shown in the illustration. The 1 series and 3 series are produced by the same pathway with fatty acids having one fewer double bond (8,11,14-eicosatrienoic acid or one more double bond (5,8,11,14,17-eicosapentaenoic acid) than arachidonic acid. The subscript a or ß indicates the configuration at C-9 (a denotes a substituent below the plane of the ring, ß, above the plane). The naturally occurring PGF's have the a configuration, e.g., PGF2a. All of the prostaglandins act by binding to specific cell-surface receptors causing an increase in the level of the intracellular second messenger cyclic AMP (and in some cases cyclic GMP also). The effect produced by the cyclic AMP increase depends on the specific cell type. In some cases there is also a positive feedback effect. Increased cyclic AMP increases prostaglandin synthesis leading to further increases in cyclic AMP. [EU] Prostaglandins A: (13E,15S)-15-Hydroxy-9-oxoprosta-10,13-dien-1-oic acid (PGA(1)); (5Z,13E,15S)-15-hydroxy-9-oxoprosta-5,10,13-trien-1-oic acid (PGA(2)); (5Z,13E,15S,17Z)-15hydroxy-9-oxoprosta-5,10,13,17-tetraen-1-oic acid (PGA(3)). A group of naturally occurring secondary prostaglandins derived from PGE. PGA(1) and PGA(2) as well as their 19hydroxy derivatives are found in many organs and tissues. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Prostate gland: A gland in the male reproductive system just below the bladder. It surrounds part of the urethra, the canal that empties the bladder, and produces a fluid that forms part of semen. [NIH] Prostatectomy: Complete or partial surgical removal of the prostate. Three primary approaches are commonly employed: suprapubic - removal through an incision above the pubis and through the urinary bladder; retropubic - as for suprapubic but without entering the urinary bladder; and transurethral (transurethral resection of prostate). [NIH] Prostatic Hyperplasia: Enlargement or overgrowth of the prostate gland as a result of an increase in the number of its constituent cells. [NIH] Prostheses and Implants: Artificial substitutes for body parts, and materials inserted into tissue for functional, cosmetic, or therapeutic purposes. Prostheses can be functional, as in the case of artificial arms and legs, or cosmetic, as in the case of an artificial eye. Implants, all surgically inserted or grafted into the body, tend to be used therapeutically. Experimental implants is available for those used experimentally. [NIH] Prosthesis: An artificial replacement of a part of the body. [NIH] Prosthodontics: A dental specialty concerned with the restoration and maintenance of oral

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function by the replacement of missing teeth and structures by artificial devices or prostheses. [NIH] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Protective Agents: Synthetic or natural substances which are given to prevent a disease or disorder or are used in the process of treating a disease or injury due to a poisonous agent. [NIH]

Protein Binding: The process in which substances, either endogenous or exogenous, bind to proteins, peptides, enzymes, protein precursors, or allied compounds. Specific proteinbinding measures are often used as assays in diagnostic assessments. [NIH] Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteoglycans: Glycoproteins which have a very high polysaccharide content. [NIH] Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Prothrombin: A plasma protein that is the inactive precursor of thrombin. It is converted to thrombin by a prothrombin activator complex consisting of factor Xa, factor V, phospholipid, and calcium ions. Deficiency of prothrombin leads to hypoprothrombinemia. [NIH]

Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Proton Pump: Integral membrane proteins that transport protons across a membrane against a concentration gradient. This transport is driven by hydrolysis of ATP by H(+)transporting ATP synthase. [NIH] Proton Pump Inhibitors: Medicines that stop the stomach's acid pump. Examples are omeprazole (oh-MEH-prah-zol) (Prilosec) and lansoprazole (lan-SOH-prah-zol) (Prevacid). [NIH]

Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Proto-Oncogene Proteins: Products of proto-oncogenes. Normally they do not have oncogenic or transforming properties, but are involved in the regulation or differentiation of cell growth. They often have protein kinase activity. [NIH] Proto-Oncogene Proteins c-mos: Cellular proteins encoded by the c-mos genes. They function in the cell cycle to maintain maturation promoting factor in the active state and have protein-serine/threonine kinase activity. Oncogenic transformation can take place when c-mos proteins are expressed at the wrong time. [NIH] Protozoal: Having to do with the simplest organisms in the animal kingdom. Protozoa are single-cell organisms, such as ameba, and are different from bacteria, which are not

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members of the animal kingdom. Some protozoa can be seen without a microscope. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Pruritus: An intense itching sensation that produces the urge to rub or scratch the skin to obtain relief. [NIH] Pruritus Ani: Intense chronic itching in the anal area. [NIH] Pseudopregnancy: Any abdominal condition resembling pregnancy. [NIH] Pseudotumor Cerebri: A condition marked by raised intracranial pressure and characterized clinically by headaches; nausea; papilledema, peripheral constriction of the visual fields, transient visual obscurations, and pulsatile tinnitus. Obesity is frequently associated with this condition, which primarily affects women between 20 and 44 years of age. Chronic papilledema may lead to optic nerve injury (optic nerve diseases) and visual loss (blindness). [NIH] Pseudoxanthoma: A rare disease of the skin characterized by the appearance of elevated yellowish papules or plaques, particularly on the neck, chest an abdomen and infrequently on the eyelids. [NIH] Pseudoxanthoma Elasticum: A rare, progressive inherited disorder resulting from extensive basophilic degeneration of elastic tissue, usually presenting after puberty and involving the skin, eye, and cardiovascular system. Characteristic manifestations are small, circumscribed yellowish patches at sites of considerable movement of the skin, angioid streaks in the retina, and a tendency towards hemorrhage and arterial insufficiency. [NIH] Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychogenic: Produced or caused by psychic or mental factors rather than organic factors. [EU]

Psychological Adaptation: The alteration of the selective response of a neural unit due to the received signals. [NIH] Psychology: The science dealing with the study of mental processes and behavior in man and animals. [NIH] Psychomotor: Pertaining to motor effects of cerebral or psychic activity. [EU] Psychopathology: The study of significant causes and processes in the development of mental illness. [NIH] Psychosexual: Pertaining to the mental aspects of sex. [NIH] Psychosexual Development: The stages of development of the psychological aspects of sexuality from birth to adulthood; i.e., oral, anal, genital, and latent periods. [NIH] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH] Ptosis: 1. Prolapse of an organ or part. 2. Drooping of the upper eyelid from paralysis of the third nerve or from sympathetic innervation. [EU] Puberty: The period during which the secondary sex characteristics begin to develop and the capability of sexual reproduction is attained. [EU] Public Assistance: Financial assistance to impoverished persons for the essentials of living through federal, state or local government programs. [NIH] Public Health: Branch of medicine concerned with the prevention and control of disease

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and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Publishing: "The business or profession of the commercial production and issuance of literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing. [NIH]

Pulmonary: Relating to the lungs. [NIH] Pulmonary Alveoli: Small polyhedral outpouchings along the walls of the alveolar sacs, alveolar ducts and terminal bronchioles through the walls of which gas exchange between alveolar air and pulmonary capillary blood takes place. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulmonary Edema: An accumulation of an excessive amount of watery fluid in the lungs, may be caused by acute exposure to dangerous concentrations of irritant gasses. [NIH] Pulmonary Embolism: Embolism in the pulmonary artery or one of its branches. [NIH] Pulmonary hypertension: Abnormally high blood pressure in the arteries of the lungs. [NIH] Pulmonary Ventilation: The total volume of gas per minute inspired or expired measured in liters per minute. [NIH] Pulposus: Prolapse of the nucleus pulposus into the body of the vertebra; necrobacillosis of rabbits. [NIH] Pulsation: A throb or rhythmical beat, as of the heart. [EU] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]

Punctures: Incision of tissues for injection of medication or for other diagnostic or therapeutic procedures. Punctures of the skin, for example may be used for diagnostic drainage; of blood vessels for diagnostic imaging procedures. [NIH] Pupil: The aperture in the iris through which light passes. [NIH] Purifying: Respiratory equipment whose function is to remove contaminants from otherwise wholesome air. [NIH] Purulent: Consisting of or containing pus; associated with the formation of or caused by pus. [EU] Pyogenic: Producing pus; pyopoietic (= liquid inflammation product made up of cells and a thin fluid called liquor puris). [EU] Quadrantectomy: Surgical removal of the region of the breast (approximately one quarter) containing cancer. [NIH] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Quiescent: Marked by a state of inactivity or repose. [EU] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Radial Artery: The direct continuation of the brachial trunk, originating at the bifurcation of

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the brachial artery opposite the neck of the radius. Its branches may be divided into three groups corresponding to the three regions in which the vessel is situated, the forearm, wrist, and hand. [NIH] Radial Keratotomy: Commonly referred to as RK; a surgical procedure designed to correct myopia (nearsightedness) by flattening the cornea using radial cuts. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radiation therapy: The use of high-energy radiation from x-rays, gamma rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body in the area near cancer cells (internal radiation therapy, implant radiation, or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy. [NIH] Radical prostatectomy: Surgery to remove the entire prostate. The two types of radical prostatectomy are retropubic prostatectomy and perineal prostatectomy. [NIH] Radicular: Having the character of or relating to a radicle or root. [NIH] Radiculopathy: Disease involving a spinal nerve root (see spinal nerve roots) which may result from compression related to intervertebral disk displacement; spinal cord injuries; spinal diseases; and other conditions. Clinical manifestations include radicular pain, weakness, and sensory loss referable to structures innervated by the involved nerve root. [NIH]

Radio Waves: That portion of the electromagnetic spectrum beyond the microwaves, with wavelengths as high as 30 KM. They are used in communications, including television. Short Wave or HF (high frequency), UHF (ultrahigh frequency) and VHF (very high frequency) waves are used in citizen's band communication. [NIH] Radioactive: Giving off radiation. [NIH] Radiofrequency ablation: The use of electrical current to destroy tissue. [NIH] Radiography: Examination of any part of the body for diagnostic purposes by means of roentgen rays, recording the image on a sensitized surface (such as photographic film). [NIH] Radioimmunoassay: Classic quantitative assay for detection of antigen-antibody reactions using a radioactively labeled substance (radioligand) either directly or indirectly to measure the binding of the unlabeled substance to a specific antibody or other receptor system. Nonimmunogenic substances (e.g., haptens) can be measured if coupled to larger carrier proteins (e.g., bovine gamma-globulin or human serum albumin) capable of inducing antibody formation. [NIH] Radioimmunotherapy: Radiotherapy where cytotoxic radionuclides are linked to antibodies in order to deliver toxins directly to tumor targets. Therapy with targeted radiation rather than antibody-targeted toxins (immunotoxins) has the advantage that adjacent tumor cells, which lack the appropriate antigenic determinants, can be destroyed by radiation cross-fire. Radioimmunotherapy is sometimes called targeted radiotherapy, but this latter term can also refer to radionuclides linked to non-immune molecules (radiotherapy). [NIH] Radiolabeled: Any compound that has been joined with a radioactive substance. [NIH] Radiological: Pertaining to radiodiagnostic and radiotherapeutic procedures, and interventional radiology or other planning and guiding medical radiology. [NIH] Radiologist: A doctor who specializes in creating and interpreting pictures of areas inside

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the body. The pictures are produced with x-rays, sound waves, or other types of energy. [NIH]

Radiology: A specialty concerned with the use of x-ray and other forms of radiant energy in the diagnosis and treatment of disease. [NIH] Radiolucent: Partly or wholly permeable to X-rays or other forms of radiation contrasted with radiopaque. [NIH] Radiopharmaceutical: Any medicinal product which, when ready for use, contains one or more radionuclides (radioactive isotopes) included for a medicinal purpose. [NIH] Radiotherapy: The use of ionizing radiation to treat malignant neoplasms and other benign conditions. The most common forms of ionizing radiation used as therapy are x-rays, gamma rays, and electrons. A special form of radiotherapy, targeted radiotherapy, links a cytotoxic radionuclide to a molecule that targets the tumor. When this molecule is an antibody or other immunologic molecule, the technique is called radioimmunotherapy. [NIH] Radius: The lateral bone of the forearm. [NIH] Ramus: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Random Allocation: A process involving chance used in therapeutic trials or other research endeavor for allocating experimental subjects, human or animal, between treatment and control groups, or among treatment groups. It may also apply to experiments on inanimate objects. [NIH] Randomization: Also called random allocation. Is allocation of individuals to groups, e.g., for experimental and control regimens, by chance. Within the limits of chance variation, random allocation should make the control and experimental groups similar at the start of an investigation and ensure that personal judgment and prejudices of the investigator do not influence allocation. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Randomized clinical trial: A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial. [NIH] Randomized Controlled Trials: Clinical trials that involve at least one test treatment and one control treatment, concurrent enrollment and follow-up of the test- and control-treated groups, and in which the treatments to be administered are selected by a random process, such as the use of a random-numbers table. Treatment allocations using coin flips, odd-even numbers, patient social security numbers, days of the week, medical record numbers, or other such pseudo- or quasi-random processes, are not truly randomized and trials employing any of these techniques for patient assignment are designated simply controlled clinical trials. [NIH] Rape: Unlawful sexual intercourse without consent of the victim. [NIH] Reagent: A substance employed to produce a chemical reaction so as to detect, measure, produce, etc., other substances. [EU] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Recombinant: A cell or an individual with a new combination of genes not found together

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in either parent; usually applied to linked genes. [EU] Recombination: The formation of new combinations of genes as a result of segregation in crosses between genetically different parents; also the rearrangement of linked genes due to crossing-over. [NIH] Recovery of Function: A partial or complete return to the normal or proper physiologic activity of an organ or part following disease or trauma. [NIH] Recovery Room: Hospital unit providing continuous monitoring of the patient following anesthesia. [NIH] Rectal: By or having to do with the rectum. The rectum is the last 8 to 10 inches of the large intestine and ends at the anus. [NIH] Rectal Prolapse: Protrusion of the rectal mucous membrane through the anus. There are various degrees: incomplete with no displacement of the anal sphincter muscle; complete with displacement of the anal sphincter muscle; complete with no displacement of the anal sphincter muscle but with herniation of the bowel; and internal complete with rectosigmoid or upper rectum intussusception into the lower rectum. [NIH] Rectovaginal Fistula: Abnormal communication between the rectum and the vagina. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recuperation: The recovery of health and strength. [EU] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Recurrent cancer: Cancer that has returned, at the same site as the original (primary) tumor or in another location, after the tumor had disappeared. [NIH] Red blood cells: RBCs. Cells that carry oxygen to all parts of the body. Also called erythrocytes. [NIH] Reentry: Reexcitation caused by continuous propagation of the same impulse for one or more cycles. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reference point: The midpoint of a line connecting the centers of the two end faces of the acoustic test fixture. [NIH] Reflective: Capable of throwing back light, images, sound waves : reflecting. [EU] Reflex: An involuntary movement or exercise of function in a part, excited in response to a stimulus applied to the periphery and transmitted to the brain or spinal cord. [NIH] Reflux: The term used when liquid backs up into the esophagus from the stomach. [NIH] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive error (myopia, hyperopia, or astigmatism). [NIH] Refractive Errors: Deviations from the average or standard indices of refraction of the eye through its dioptric or refractive apparatus. [NIH] Refractive Power: The ability of an object, such as the eye, to bend light as light passes through it. [NIH] Refractory: Not readily yielding to treatment. [EU] Regeneration: The natural renewal of a structure, as of a lost tissue or part. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Regional cancer: Refers to cancer that has grown beyond the original (primary) tumor to nearby lymph nodes or organs and tissues. [NIH]

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Regional chemotherapy: Treatment with anticancer drugs that is directed to a specific area. [NIH]

Regional lymph node: In oncology, a lymph node that drains lymph from the region around a tumor. [NIH] Registries: The systems and processes involved in the establishment, support, management, and operation of registers, e.g., disease registers. [NIH] Regression Analysis: Procedures for finding the mathematical function which best describes the relationship between a dependent variable and one or more independent variables. In linear regression (see linear models) the relationship is constrained to be a straight line and least-squares analysis is used to determine the best fit. In logistic regression (see logistic models) the dependent variable is qualitative rather than continuously variable and likelihood functions are used to find the best relationship. In multiple regression the dependent variable is considered to depend on more than a single independent variable. [NIH]

Regurgitation: A backward flowing, as the casting up of undigested food, or the backward flowing of blood into the heart, or between the chambers of the heart when a valve is incompetent. [EU] Rehabilitative: Instruction of incapacitated individuals or of those affected with some mental disorder, so that some or all of their lost ability may be regained. [NIH] Relapse: The return of signs and symptoms of cancer after a period of improvement. [NIH] Relative risk: The ratio of the incidence rate of a disease among individuals exposed to a specific risk factor to the incidence rate among unexposed individuals; synonymous with risk ratio. Alternatively, the ratio of the cumulative incidence rate in the exposed to the cumulative incidence rate in the unexposed (cumulative incidence ratio). The term relative risk has also been used synonymously with odds ratio. This is because the odds ratio and relative risk approach each other if the disease is rare ( 5 percent of population) and the number of subjects is large. [NIH] Relaxant: 1. Lessening or reducing tension. 2. An agent that lessens tension. [EU] Reliability: Used technically, in a statistical sense, of consistency of a test with itself, i. e. the extent to which we can assume that it will yield the same result if repeated a second time. [NIH]

Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Renal cell cancer: Cancer that develops in the lining of the renal tubules, which filter the blood and produce urine. [NIH] Renal failure: Progressive renal insufficiency and uremia, due to irreversible and progressive renal glomerular tubular or interstitial disease. [NIH] Renal pelvis: The area at the center of the kidney. Urine collects here and is funneled into the ureter, the tube that connects the kidney to the bladder. [NIH] Renovascular: Of or pertaining to the blood vessels of the kidneys. [EU] Reoperation: A repeat operation for the same condition in the same patient. It includes reoperation for reexamination, reoperation for disease progression or recurrence, or reoperation following operative failure. [NIH] Reperfusion: Restoration of blood supply to tissue which is ischemic due to decrease in normal blood supply. The decrease may result from any source including atherosclerotic

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obstruction, narrowing of the artery, or surgical clamping. It is primarily a procedure for treating infarction or other ischemia, by enabling viable ischemic tissue to recover, thus limiting further necrosis. However, it is thought that reperfusion can itself further damage the ischemic tissue, causing reperfusion injury. [NIH] Reperfusion Injury: Functional, metabolic, or structural changes, including necrosis, in ischemic tissues thought to result from reperfusion to ischemic areas of the tissue. The most common instance is myocardial reperfusion injury. [NIH] Reproductive system: In women, this system includes the ovaries, the fallopian tubes, the uterus (womb), the cervix, and the vagina (birth canal). The reproductive system in men includes the prostate, the testes, and the penis. [NIH] Research Design: A plan for collecting and utilizing data so that desired information can be obtained with sufficient precision or so that an hypothesis can be tested properly. [NIH] Resected: Surgical removal of part of an organ. [NIH] Resection: Removal of tissue or part or all of an organ by surgery. [NIH] Resident physician: A physician who lives in a hospital and is constantly available, as an intern. [NIH] Residual disease: Cancer cells that remain after attempts have been made to remove the cancer. [NIH] Resorption: The loss of substance through physiologic or pathologic means, such as loss of dentin and cementum of a tooth, or of the alveolar process of the mandible or maxilla. [EU] 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] Respirator: A mechanical device that helps a patient breathe; a mechanical ventilator. [NIH] Respiratory distress syndrome: A lung disease that occurs primarily in premature infants; the newborn must struggle for each breath and blueing of its skin reflects the baby's inability to get enough oxygen. [NIH] Respiratory failure: Inability of the lungs to conduct gas exchange. [NIH] Respiratory Mechanics: The physical or mechanical action of the lungs, diaphragm, ribs, and chest wall during respiration. It includes airflow, lung volume, neural and reflex controls, mechanoreceptors, breathing patterns, etc. [NIH] Respiratory Physiology: Functions and activities of the respiratory tract as a whole or of any of its parts. [NIH] Respiratory System: The tubular and cavernous organs and structures, by means of which pulmonary ventilation and gas exchange between ambient air and the blood are brought about. [NIH] Resting metabolic rate: RMR accounts for 65 to 75 percent of daily energy expenditure and represents the minimum energy needed to maintain all physiological cell functions in the resting state. The principal determinant of RMR is lean body mass (LBM). Obese subjects have a higher RMR in absolute terms than lean individuals, an equivalent RMR when corrected for LBM and per unit surface area, and a lower RMR when expressed per kilogram of body weight. Obese persons require more energy for any given activity because of a larger mass, but they tend to be more sedentary than lean subjects. [NIH] Restoration: Broad term applied to any inlay, crown, bridge or complete denture which

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restores or replaces loss of teeth or oral tissues. [NIH] Resuscitation: The restoration to life or consciousness of one apparently dead; it includes such measures as artificial respiration and cardiac massage. [EU] Retching: Dry vomiting. [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] Retinae: A congenital notch or cleft of the retina, usually located inferiorly. [NIH] Retinal: 1. Pertaining to the retina. 2. The aldehyde of retinol, derived by the oxidative enzymatic splitting of absorbed dietary carotene, and having vitamin A activity. In the retina, retinal combines with opsins to form visual pigments. One isomer, 11-cis retinal combines with opsin in the rods (scotopsin) to form rhodopsin, or visual purple. Another, all-trans retinal (trans-r.); visual yellow; xanthopsin) results from the bleaching of rhodopsin by light, in which the 11-cis form is converted to the all-trans form. Retinal also combines with opsins in the cones (photopsins) to form the three pigments responsible for colour vision. Called also retinal, and retinene1. [EU] Retinal Artery: Central retinal artery and its branches. It arises from the ophthalmic artery, pierces the optic nerve and runs through its center, enters the eye through the porus opticus and branches to supply the retina. [NIH] Retinal Detachment: Separation of the inner layers of the retina (neural retina) from the pigment epithelium. Retinal detachment occurs more commonly in men than in women, in eyes with degenerative myopia, in aging and in aphakia. It may occur after an uncomplicated cataract extraction, but it is seen more often if vitreous humor has been lost during surgery. (Dorland, 27th ed; Newell, Ophthalmology: Principles and Concepts, 7th ed, p310-12). [NIH] Retinal Ganglion Cells: Cells of the innermost nuclear layer of the retina, the ganglion cell layer, which project axons through the optic nerve to the brain. They are quite variable in size and in the shapes of their dendritic arbors, which are generally confined to the inner plexiform layer. [NIH] Retinal Hemorrhage: Bleeding from the vessels of the retina. [NIH] Retinitis: Inflammation of the retina. It is rarely limited to the retina, but is commonly associated with diseases of the choroid (chorioretinitis) and of the optic nerve (neuroretinitis). The disease may be confined to one eye, but since it is generally dependent on a constitutional factor, it is almost always bilateral. It may be acute in course, but as a rule it lasts many weeks or even several months. [NIH] Retinitis Pigmentosa: Hereditary, progressive degeneration of the neuroepithelium of the retina characterized by night blindness and progressive contraction of the visual field. [NIH] Retinoid: Vitamin A or a vitamin A-like compound. [NIH] Retinol: Vitamin A. It is essential for proper vision and healthy skin and mucous membranes. Retinol is being studied for cancer prevention; it belongs to the family of drugs called retinoids. [NIH] Retinopathy: 1. Retinitis (= inflammation of the retina). 2. Retinosis (= degenerative, noninflammatory condition of the retina). [EU] Retractor: An instrument designed for pulling aside tissues to improve exposure at operation; an instrument for drawing back the edge of a wound. [NIH]

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Retrograde: 1. Moving backward or against the usual direction of flow. 2. Degenerating, deteriorating, or catabolic. [EU] Retroperitoneal: Having to do with the area outside or behind the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH] Retropubic: A potential space between the urinary bladder and the symphisis and body of the pubis. [NIH] Retropubic prostatectomy: Surgery to remove the prostate through an incision made in the abdominal wall. [NIH] Retrospective: Looking back at events that have already taken place. [NIH] Retrospective Studies: Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons. [NIH] Retrospective study: A study that looks backward in time, usually using medical records and interviews with patients who already have or had a disease. [NIH] Rhabdomyosarcoma: A malignant tumor of muscle tissue. [NIH] Rheumatic Diseases: Disorders of connective tissue, especially the joints and related structures, characterized by inflammation, degeneration, or metabolic derangement. [NIH] Rheumatism: A group of disorders marked by inflammation or pain in the connective tissue structures of the body. These structures include bone, cartilage, and fat. [NIH] Rheumatoid: Resembling rheumatism. [EU] Rheumatoid arthritis: A form of arthritis, the cause of which is unknown, although infection, hypersensitivity, hormone imbalance and psychologic stress have been suggested as possible causes. [NIH] Rheumatology: A subspecialty of internal medicine concerned with the study of inflammatory or degenerative processes and metabolic derangement of connective tissue structures which pertain to a variety of musculoskeletal disorders, such as arthritis. [NIH] Ribose: A pentose active in biological systems usually in its D-form. [NIH] Ribosome: A granule of protein and RNA, synthesized in the nucleolus and found in the cytoplasm of cells. Ribosomes are the main sites of protein synthesis. Messenger RNA attaches to them and there receives molecules of transfer RNA bearing amino acids. [NIH] Rigidity: Stiffness or inflexibility, chiefly that which is abnormal or morbid; rigor. [EU] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Risk patient: Patient who is at risk, because of his/her behaviour or because of the type of person he/she is. [EU] Rod: A reception for vision, located in the retina. [NIH] Rotator: A muscle by which a part can be turned circularly. [NIH] Rotator Cuff: The musculotendinous sheath formed by the supraspinatus, infraspinatus, subscapularis, and teres minor muscles. These help stabilize the head of the humerus in the glenoid fossa and allow for rotation of the shoulder joint about its longitudinal axis. [NIH] Rubber: A high-molecular-weight polymeric elastomer derived from the milk juice (latex) of Hevea brasiliensis and other trees. It is a substance that can be stretched at room temperature to atleast twice its original length and after releasing the stress, retractrapidly,

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and recover its original dimensions fully. Synthetic rubber is made from many different chemicals, including styrene, acrylonitrile, ethylene, propylene, and isoprene. [NIH] Saccades: An abrupt voluntary shift in ocular fixation from one point to another, as occurs in reading. [NIH] Saccule: The smaller of the 2 sacs within the vestibule of the ear. [NIH] Sagittal: The line of direction passing through the body from back to front, or any vertical plane parallel to the medial plane of the body and inclusive of that plane; often restricted to the medial plane, the plane of the sagittal suture. [NIH] Saline: A solution of salt and water. [NIH] Saliva: The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptylin. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Saphenous: Applied to certain structures in the leg, e. g. nerve vein. [NIH] Saphenous Vein: The vein which drains the foot and leg. [NIH] Saponins: Sapogenin glycosides. A type of glycoside widely distributed in plants. Each consists of a sapogenin as the aglycon moiety, and a sugar. The sapogenin may be a steroid or a triterpene and the sugar may be glucose, galactose, a pentose, or a methylpentose. Sapogenins are poisonous towards the lower forms of life and are powerful hemolytics when injected into the blood stream able to dissolve red blood cells at even extreme dilutions. [NIH] Sarcoma: A connective tissue neoplasm formed by proliferation of mesodermal cells; it is usually highly malignant. [NIH] Sarcomere: The repeating structural unit of a striated muscle fiber. [NIH] Scalpel: A small pointed knife with a convex edge. [NIH] Scans: Pictures of structures inside the body. Scans often used in diagnosing, staging, and monitoring disease include liver scans, bone scans, and computed tomography (CT) or computerized axial tomography (CAT) scans and magnetic resonance imaging (MRI) scans. In liver scanning and bone scanning, radioactive substances that are injected into the bloodstream collect in these organs. A scanner that detects the radiation is used to create pictures. In CT scanning, an x-ray machine linked to a computer is used to produce detailed pictures of organs inside the body. MRI scans use a large magnet connected to a computer to create pictures of areas inside the body. [NIH] Schematic: Representative or schematic eye computed from the average of a large number of human eye measurements by Allvar Gullstrand. [NIH] Schizoid: Having qualities resembling those found in greater degree in schizophrenics; a person of schizoid personality. [NIH] Schizophrenia: A mental disorder characterized by a special type of disintegration of the personality. [NIH] Schizotypal Personality Disorder: A personality disorder in which there are oddities of thought (magical thinking, paranoid ideation, suspiciousness), perception (illusions, depersonalization), speech (digressive, vague, overelaborate), and behavior (inappropriate affect in social interactions, frequently social isolation) that are not severe enough to characterize schizophrenia. [NIH] Schwannoma: A tumor of the peripheral nervous system that begins in the nerve sheath (protective covering). It is almost always benign, but rare malignant schwannomas have

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been reported. [NIH] Sciatic Nerve: A nerve which originates in the lumbar and sacral spinal cord (L4 to S3) and supplies motor and sensory innervation to the lower extremity. The sciatic nerve, which is the main continuation of the sacral plexus, is the largest nerve in the body. It has two major branches, the tibial nerve and the peroneal nerve. [NIH] Sciatica: A condition characterized by pain radiating from the back into the buttock and posterior/lateral aspects of the leg. Sciatica may be a manifestation of sciatic neuropathy; radiculopathy (involving the L4, L5, S1 or S2 spinal nerve roots; often associated with intervertebral disk displacement); or lesions of the cauda equina. [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] Sclerae: A circular furrow between the sclerocorneal junction and the iris. [NIH] Scleral Buckling: An operation for retinal detachment which reduces the size of the globe by indenting the sclera so that it approximates the retina. [NIH] Scleroderma: A chronic disorder marked by hardening and thickening of the skin. Scleroderma can be localized or it can affect the entire body (systemic). [NIH] Sclerosis: A pathological process consisting of hardening or fibrosis of an anatomical structure, often a vessel or a nerve. [NIH] Sclerotherapy: Treatment of varicose veins, hemorrhoids, gastric and esophageal varices, and peptic ulcer hemorrhage by injection or infusion of chemical agents which cause localized thrombosis and eventual fibrosis and obliteration of the vessels. [NIH] Scoliosis: A lateral curvature of the spine. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Scrotum: In males, the external sac that contains the testicles. [NIH] Sebaceous: Gland that secretes sebum. [NIH] Sebum: The oily substance secreted by sebaceous glands. It is composed of keratin, fat, and cellular debris. [NIH] Second Messenger Systems: Systems in which an intracellular signal is generated in response to an intercellular primary messenger such as a hormone or neurotransmitter. They are intermediate signals in cellular processes such as metabolism, secretion, contraction, phototransduction, and cell growth. Examples of second messenger systems are the adenyl cyclase-cyclic AMP system, the phosphatidylinositol diphosphate-inositol triphosphate system, and the cyclic GMP system. [NIH] Secondary tumor: Cancer that has spread from the organ in which it first appeared to another organ. For example, breast cancer cells may spread (metastasize) to the lungs and cause the growth of a new tumor. When this happens, the disease is called metastatic breast cancer, and the tumor in the lungs is called a secondary tumor. Also called secondary cancer. [NIH] Second-look surgery: Surgery performed after primary treatment to determine whether tumor cells remain. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Sedative: 1. Allaying activity and excitement. 2. An agent that allays excitement. [EU] Sedentary: 1. Sitting habitually; of inactive habits. 2. Pertaining to a sitting posture. [EU]

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Segal: The alternate presentation of two visual stimuli consisting of concentric circular spots of light of different size. [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] Segmental mastectomy: The removal of the cancer as well as some of the breast tissue around the tumor and the lining over the chest muscles below the tumor. Usually some of the lymph nodes under the arm are also taken out. Sometimes called partial mastectomy. [NIH]

Segmentation: The process by which muscles in the intestines move food and wastes through the body. [NIH] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Selective estrogen receptor modulator: SERM. A drug that acts like estrogen on some tissues, but blocks the effect of estrogen on other tissues. Tamoxifen and raloxifene are SERMs. [NIH] Self Care: Performance of activities or tasks traditionally performed by professional health care providers. The concept includes care of oneself or one's family and friends. [NIH] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Semicircular canal: Three long canals of the bony labyrinth of the ear, forming loops and opening into the vestibule by five openings. [NIH] Seminal vesicles: Glands that help produce semen. [NIH] Semisynthetic: Produced by chemical manipulation of naturally occurring substances. [EU] Senile: Relating or belonging to old age; characteristic of old age; resulting from infirmity of old age. [NIH] Senna: Preparations of Cassia senna L. and C. angustifolia of the Leguminosae. They contain sennosides, which are anthraquinone type cathartics and are used in many different preparations as laxatives. [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] Sensitization: 1. Administration of antigen to induce a primary immune response; priming; immunization. 2. Exposure to allergen that results in the development of hypersensitivity. 3. The coating of erythrocytes with antibody so that they are subject to lysis by complement in the presence of homologous antigen, the first stage of a complement fixation test. [EU] Sensor: A device designed to respond to physical stimuli such as temperature, light, magnetism or movement and transmit resulting impulses for interpretation, recording, movement, or operating control. [NIH] Sensory Thresholds: The minimum amount of stimulus energy necessary to elicit a sensory response. [NIH] Sentinel lymph node: The first lymph node that cancer is likely to spread to from the primary tumor. Cancer cells may appear first in the sentinel node before spreading to other lymph nodes. [NIH]

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Sepsis: The presence of bacteria in the bloodstream. [NIH] Septal: An abscess occurring at the root of the tooth on the proximal surface. [NIH] Septicemia: Systemic disease associated with the presence and persistence of pathogenic microorganisms or their toxins in the blood. Called also blood poisoning. [EU] Septum: A dividing wall or partition; a general term for such a structure. The term is often used alone to refer to the septal area or to the septum pellucidum. [EU] Septum Pellucidum: A triangular double membrane separating the anterior horns of the lateral ventricles of the brain. It is situated in the median plane and bounded by the corpus callosum and the body and columns of the fornix. [NIH] Sequencing: The determination of the order of nucleotides in a DNA or RNA chain. [NIH] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Serous: Having to do with serum, the clear liquid part of blood. [NIH] Serrata: The serrated anterior border of the retina located approximately 8.5 mm from the limbus and adjacent to the pars plana of the ciliary body. [NIH] Serrated: Having notches or teeth on the edge as a saw has. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Serum Albumin: A major plasma protein that serves in maintaining the plasma colloidal osmotic pressure and transporting large organic anions. [NIH] Sex Behavior: Sexual activities of humans. [NIH] Sex Behavior, Animal: Sexual activities of animals. [NIH] Sex Characteristics: Those characteristics that distinguish one sex from the other. The primary sex characteristics are the ovaries and testes and their related hormones. Secondary sex characteristics are those which are masculine or feminine but not directly related to reproduction. [NIH] Shame: An emotional attitude excited by realization of a shortcoming or impropriety. [NIH] Sharpness: The apparent blurring of the border between two adjacent areas of a radiograph having different optical densities. [NIH] Ships: Large vessels propelled by power or sail used for transportation on rivers, seas, oceans, or other navigable waters. Boats are smaller vessels propelled by oars, paddles, sail, or power; they may or may not have a deck. [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]

Short Bowel Syndrome: A malabsorption syndrome resulting from extensive operative resection of small bowel. [NIH] Shoulder Pain: Unilateral or bilateral pain of the shoulder. It is often caused by physical activities such as work or sports participation, but may also be pathologic in origin. [NIH] Shunt: A surgically created diversion of fluid (e.g., blood or cerebrospinal fluid) from one

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area of the body to another area of the body. [NIH] Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Sigmoid: 1. Shaped like the letter S or the letter C. 2. The sigmoid colon. [EU] Sigmoidoscopy: Endoscopic examination, therapy or surgery of the sigmoid flexure. [NIH] Signal Transduction: The intercellular or intracellular transfer of information (biological activation/inhibition) through a signal pathway. In each signal transduction system, an activation/inhibition signal from a biologically active molecule (hormone, neurotransmitter) is mediated via the coupling of a receptor/enzyme to a second messenger system or to an ion channel. Signal transduction plays an important role in activating cellular functions, cell differentiation, and cell proliferation. Examples of signal transduction systems are the GABA-postsynaptic receptor-calcium ion channel system, the receptor-mediated T-cell activation pathway, and the receptor-mediated activation of phospholipases. Those coupled to membrane depolarization or intracellular release of calcium include the receptormediated activation of cytotoxic functions in granulocytes and the synaptic potentiation of protein kinase activation. Some signal transduction pathways may be part of larger signal transduction pathways; for example, protein kinase activation is part of the platelet activation signal pathway. [NIH] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Silicon: A trace element that constitutes about 27.6% of the earth's crust in the form of silicon dioxide. It does not occur free in nature. Silicon has the atomic symbol Si, atomic number 14, and atomic weight 28.09. [NIH] Silicon Dioxide: Silica. Transparent, tasteless crystals found in nature as agate, amethyst, chalcedony, cristobalite, flint, sand, quartz, and tridymite. The compound is insoluble in water or acids except hydrofluoric acid. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Skin Care: Maintenance of the hygienic state of the skin under optimal conditions of cleanliness and comfort. Effective in skin care are proper washing, bathing, cleansing, and the use of soaps, detergents, oils, etc. In various disease states, therapeutic and protective solutions and ointments are useful. The care of the skin is particularly important in various occupations, in exposure to sunlight, in neonates, and in decubitus ulcer. [NIH] Skin Neoplasms: Tumors or cancer of the skin. [NIH] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Skull Base: The inferior region of the skull consisting of an internal (cerebral), and an external (basilar) surface. [NIH] Sleep apnea: A serious, potentially life-threatening breathing disorder characterized by repeated cessation of breathing due to either collapse of the upper airway during sleep or absence of respiratory effort. [NIH] Sleep Deprivation: The state of being deprived of sleep under experimental conditions, due to life events, or from a wide variety of pathophysiologic causes such as medication effect, chronic illness, psychiatric illness, or sleep disorder. [NIH]

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Small cell lung cancer: A type of lung cancer in which the cells appear small and round when viewed under the microscope. Also called oat cell lung cancer. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smoke Inhalation Injury: Pulmonary injury following the breathing in of toxic smoke from burning materials such as plastics, synthetics, building materials, etc. This injury is the most frequent cause of death in burn patients. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Sneezing: Sudden, forceful, involuntary expulsion of air from the nose and mouth caused by irritation to the mucous membranes of the upper respiratory tract. [NIH] Soaps: Sodium or potassium salts of long chain fatty acids. These detergent substances are obtained by boiling natural oils or fats with caustic alkali. Sodium soaps are harder and are used as topical anti-infectives and vehicles in pills and liniments; potassium soaps are soft, used as vehicles for ointments and also as topical antimicrobials. [NIH] Social Change: Social process whereby the values, attitudes, or institutions of society, such as education, family, religion, and industry become modified. It includes both the natural process and action programs initiated by members of the community. [NIH] Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Social Support: Support systems that provide assistance and encouragement to individuals with physical or emotional disabilities in order that they may better cope. Informal social support is usually provided by friends, relatives, or peers, while formal assistance is provided by churches, groups, etc. [NIH] Social Work: The use of community resources, individual case work, or group work to promote the adaptive capacities of individuals in relation to their social and economic environments. It includes social service agencies. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Soft tissue sarcoma: A sarcoma that begins in the muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Solid tumor: Cancer of body tissues other than blood, bone marrow, or the lymphatic system. [NIH] Solitary Nucleus: Gray matter located in the dorsomedial part of the medulla oblongata associated with the solitary tract. The solitary nucleus receives inputs from most organ systems including the terminations of the facial, glossopharyngeal, and vagus nerves. It is a major coordinator of autonomic nervous system regulation of cardiovascular, respiratory, gustatory, gastrointestinal, and chemoreceptive aspects of homeostasis. The solitary nucleus is also notable for the large number of neurotransmitters which are found therein. [NIH] Solitary Rectal Ulcer: A rare type of ulcer in the rectum. May develop because of straining to have a bowel movement. [NIH]

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Solvent: 1. Dissolving; effecting a solution. 2. A liquid that dissolves or that is capable of dissolving; the component of a solution that is present in greater amount. [EU] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Somatic cells: All the body cells except the reproductive (germ) cells. [NIH] Somatostatin: A polypeptide hormone produced in the hypothalamus, and other tissues and organs. It inhibits the release of human growth hormone, and also modulates important physiological functions of the kidney, pancreas, and gastrointestinal tract. Somatostatin receptors are widely expressed throughout the body. Somatostatin also acts as a neurotransmitter in the central and peripheral nervous systems. [NIH] Sonogram: A computer picture of areas inside the body created by bouncing sound waves off organs and other tissues. Also called ultrasonogram or ultrasound. [NIH] Sorbitol: A polyhydric alcohol with about half the sweetness of sucrose. Sorbitol occurs naturally and is also produced synthetically from glucose. It was formerly used as a diuretic and may still be used as a laxative and in irrigating solutions for some surgical procedures. It is also used in many manufacturing processes, as a pharmaceutical aid, and in several research applications. [NIH] Sound wave: An alteration of properties of an elastic medium, such as pressure, particle displacement, or density, that propagates through the medium, or a superposition of such alterations. [NIH] Spasm: An involuntary contraction of a muscle or group of muscles. Spasms may involve skeletal muscle or smooth muscle. [NIH] Spasmodic: Of the nature of a spasm. [EU] Spastic: 1. Of the nature of or characterized by spasms. 2. Hypertonic, so that the muscles are stiff and the movements awkward. 3. A person exhibiting spasticity, such as occurs in spastic paralysis or in cerebral palsy. [EU] Spasticity: A state of hypertonicity, or increase over the normal tone of a muscle, with heightened deep tendon reflexes. [EU] Spatial disorientation: Loss of orientation in space where person does not know which way is up. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Speculum: An instrument used to widen an opening of the body to make it easier to look inside. [NIH] Speech Perception: The process whereby an utterance is decoded into a representation in

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terms of linguistic units (sequences of phonetic segments which combine to form lexical and grammatical morphemes). [NIH] Sperm: The fecundating fluid of the male. [NIH] Spermatozoa: Mature male germ cells that develop in the seminiferous tubules of the testes. Each consists of a head, a body, and a tail that provides propulsion. The head consists mainly of chromatin. [NIH] Sphenoid: An unpaired cranial bone with a body containing the sphenoid sinus and forming the posterior part of the medial walls of the orbits. [NIH] Sphenoidal: Relating or belonging to the sphenoid bone. [NIH] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU] Spike: The activation of synapses causes changes in the permeability of the dendritic membrane leading to changes in the membrane potential. This difference of the potential travels along the axon of the neuron and is called spike. [NIH] Spina bifida: A defect in development of the vertebral column in which there is a central deficiency of the vertebral lamina. [NIH] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spinal Cord Diseases: Pathologic conditions which feature spinal cord damage or dysfunction, including disorders involving the meninges and perimeningeal spaces surrounding the spinal cord. Traumatic injuries, vascular diseases, infections, and inflammatory/autoimmune processes may affect the spinal cord. [NIH] Spinal Cord Injuries: Penetrating and non-penetrating injuries to the spinal cord resulting from traumatic external forces (e.g., wounds, gunshot; whiplash injuries; etc.). [NIH] Spinal Cord Ischemia: Reduced blood flow to the spinal cord which is supplied by the anterior spinal artery and the paired posterior spinal arteries. This condition may be associated with arteriosclerosis, trauma, emboli, diseases of the aorta, and other disorders. Prolonged ischemia may lead to infarction of spinal cord tissue. [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 Stenosis: Narrowing of the spinal canal. [NIH] Spinous: Like a spine or thorn in shape; having spines. [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] Splenectomy: An operation to remove the spleen. [NIH] Splint: A rigid appliance used for the immobilization of a part or for the correction of deformity. [NIH] Spondylolisthesis: Forward displacement of one vertebra over another. [NIH] Sports Medicine: The field of medicine concerned with physical fitness and the diagnosis and treatment of injuries sustained in sports activities. [NIH]

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Sprains and Strains: A collective term for muscle and ligament injuries without dislocation or fracture. A sprain is a joint injury in which some of the fibers of a supporting ligament are ruptured but the continuity of the ligament remains intact. A strain is an overstretching or overexertion of some part of the musculature. [NIH] Squamous: Scaly, or platelike. [EU] Squamous cell carcinoma: Cancer that begins in squamous cells, which are thin, flat cells resembling fish scales. Squamous cells are found in the tissue that forms the surface of the skin, the lining of the hollow organs of the body, and the passages of the respiratory and digestive tracts. Also called epidermoid carcinoma. [NIH] Squamous cell carcinoma: Cancer that begins in squamous cells, which are thin, flat cells resembling fish scales. Squamous cells are found in the tissue that forms the surface of the skin, the lining of the hollow organs of the body, and the passages of the respiratory and digestive tracts. Also called epidermoid carcinoma. [NIH] Squamous cells: Flat cells that look like fish scales under a microscope. These cells cover internal and external surfaces of the body. [NIH] Squamous Epithelium: Tissue in an organ such as the esophagus. Consists of layers of flat, scaly cells. [NIH] Stabilization: The creation of a stable state. [EU] Stabilizer: A device for maintaining constant X-ray tube voltage or current. [NIH] Staging: Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. [NIH]

Stapes: One of the three ossicles of the middle ear. It transmits sound vibrations from the incus to the internal ear. [NIH] Steatosis: Fatty degeneration. [EU] Steel: A tough, malleable, iron-based alloy containing up to, but no more than, two percent carbon and often other metals. It is used in medicine and dentistry in implants and instrumentation. [NIH] Stellate: Star shaped. [NIH] Stem cell transplantation: A method of replacing immature blood-forming cells that were destroyed by cancer treatment. The stem cells are given to the person after treatment to help the bone marrow recover and continue producing healthy blood cells. [NIH] Stem Cells: Relatively undifferentiated cells of the same lineage (family type) that retain the ability to divide and cycle throughout postnatal life to provide cells that can become specialized and take the place of those that die or are lost. [NIH] Stent: A device placed in a body structure (such as a blood vessel or the gastrointestinal tract) to provide support and keep the structure open. [NIH] Stereoscopic: Accurate depth perception in the presence of binocular single vision, due to the slight disparity in the two retinal images of the same object. [NIH] Stereotactic: Radiotherapy that treats brain tumors by using a special frame affixed directly to the patient's cranium. By aiming the X-ray source with respect to the rigid frame, technicians can position the beam extremely precisely during each treatment. [NIH] Stereotactic radiosurgery: A radiation therapy technique involving a rigid head frame that is attached to the skull; high-dose radiation is administered through openings in the head frame to the tumor while decreasing the amount of radiation given to normal brain tissue. This procedure does not involve surgery. Also called stereotaxic radiosurgery and

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stereotactic radiation therapy. [NIH] Stereotaxis: Use of a computer and scanning devices to create three-dimensional pictures. This method can be used to direct a biopsy, external radiation, or the insertion of radiation implants. [NIH] Sterile: Unable to produce children. [NIH] Sterility: 1. The inability to produce offspring, i.e., the inability to conceive (female s.) or to induce conception (male s.). 2. The state of being aseptic, or free from microorganisms. [EU] Sterilization: The destroying of all forms of life, especially microorganisms, by heat, chemical, or other means. [NIH] Sternum: Breast bone. [NIH] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stimulant: 1. Producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. An agent or remedy that produces stimulation. [EU]

Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stoma: A surgically created opening from an area inside the body to the outside. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Strabismus: Deviation of the eye which the patient cannot overcome. The visual axes assume a position relative to each other different from that required by the physiological conditions. The various forms of strabismus are spoken of as tropias, their direction being indicated by the appropriate prefix, as cyclo tropia, esotropia, exotropia, hypertropia, and hypotropia. Called also cast, heterotropia, manifest deviation, and squint. [EU] Strand: DNA normally exists in the bacterial nucleus in a helix, in which two strands are coiled together. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stress incontinence: An involuntary loss of urine that occurs at the same time that internal abdominal pressure is increased, such as with laughing, sneezing, coughing, or physical activity. [NIH] Stress management: A set of techniques used to help an individual cope more effectively with difficult situations in order to feel better emotionally, improve behavioral skills, and often to enhance feelings of control. Stress management may include relaxation exercises, assertiveness training, cognitive restructuring, time management, and social support. It can be delivered either on a one-to-one basis or in a group format. [NIH] Stress urinary: Leakage of urine caused by actions--such as coughing, laughing, sneezing, running, or lifting--that place pressure on the bladder from inside the body. Stress urinary incontinence can result from either a fallen bladder or weak sphincter muscles. [NIH] Stricture: The abnormal narrowing of a body opening. Also called stenosis. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may

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be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Stroke Volume: The amount of blood pumped out of the heart per beat not to be confused with cardiac output (volume/time). [NIH] Stroma: The middle, thickest layer of tissue in the cornea. [NIH] Stromal: Large, veil-like cell in the bone marrow. [NIH] Stupor: Partial or nearly complete unconsciousness, manifested by the subject's responding only to vigorous stimulation. Also, in psychiatry, a disorder marked by reduced responsiveness. [EU] Styrene: A colorless, toxic liquid with a strong aromatic odor. It is used to make rubbers, polymers and copolymers, and polystyrene plastics. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subarachnoid: Situated or occurring between the arachnoid and the pia mater. [EU] Subclavian: The direct continuation of the axillary vein at the lateral border of the first rib. It passes medially to join the internal jugular vein and form the brachiocephalic vein on each side. [NIH] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subconjunctival: Situated or occurring beneath the conjunctiva. [EU] Subcutaneous: Beneath the skin. [NIH] Subiculum: A region of the hippocampus that projects to other areas of the brain. [NIH] Submucous: Occurring beneath the mucosa or a mucous membrane. [NIH] Substance P: An eleven-amino acid neurotransmitter that appears in both the central and peripheral nervous systems. It is involved in transmission of pain, causes rapid contractions of the gastrointestinal smooth muscle, and modulates inflammatory and immune responses. [NIH]

Substrate: A substance upon which an enzyme acts. [EU] Suction: The removal of secretions, gas or fluid from hollow or tubular organs or cavities by means of a tube and a device that acts on negative pressure. [NIH] Sufentanil: An opioid analgesic that is used as an adjunct in anesthesia, in balanced anesthesia, and as a primary anesthetic agent. [NIH] Superior vena cava: Vein which returns blood from the head and neck, upper limbs, and thorax. It is formed by the union of the two brachiocephalic veins. [NIH] Supine: Having the front portion of the body upwards. [NIH] Supine Position: The posture of an individual lying face up. [NIH] Supplementation: Adding nutrients to the diet. [NIH] Support group: A group of people with similar disease who meet to discuss how better to cope with their cancer and treatment. [NIH] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Supratentorial: Located in the upper part of the brain. [NIH] Surgery, Plastic: The branch of surgery concerned with restoration, reconstruction, or improvement of defective, damaged, or missing structures. [NIH]

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Surgical Equipment: Nonexpendable apparatus used during surgical procedures. They are differentiated from surgical instruments, usually hand-held and used in the immediate operative field. [NIH] Surgical Instruments: Hand-held tools or implements used by health professionals for the performance of surgical tasks. [NIH] Survival Rate: The proportion of survivors in a group, e.g., of patients, studied and followed over a period, or the proportion of persons in a specified group alive at the beginning of a time interval who survive to the end of the interval. It is often studied using life table methods. [NIH] Sweat: The fluid excreted by the sweat glands. It consists of water containing sodium chloride, phosphate, urea, ammonia, and other waste products. [NIH] Sweat Glands: Sweat-producing structures that are embedded in the dermis. Each gland consists of a single tube, a coiled body, and a superficial duct. [NIH] Sympathetic Nervous System: The thoracolumbar division of the autonomic nervous system. Sympathetic preganglionic fibers originate in neurons of the intermediolateral column of the spinal cord and project to the paravertebral and prevertebral ganglia, which in turn project to target organs. The sympathetic nervous system mediates the body's response to stressful situations, i.e., the fight or flight reactions. It often acts reciprocally to the parasympathetic system. [NIH] Sympathomimetic: 1. Mimicking the effects of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. 2. An agent that produces effects similar to those of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. Called also adrenergic. [EU] Symphysis: A secondary cartilaginous joint. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Symptomatology: 1. That branch of medicine with treats of symptoms; the systematic discussion of symptoms. 2. The combined symptoms of a disease. [EU] Synapses: Specialized junctions at which a neuron communicates with a target cell. At classical synapses, a neuron's presynaptic terminal releases a chemical transmitter stored in synaptic vesicles which diffuses across a narrow synaptic cleft and activates receptors on the postsynaptic membrane of the target cell. The target may be a dendrite, cell body, or axon of another neuron, or a specialized region of a muscle or secretory cell. Neurons may also communicate through direct electrical connections which are sometimes called electrical synapses; these are not included here but rather in gap junctions. [NIH] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Synchrony: The normal physiologic sequencing of atrial and ventricular activation and contraction. [NIH] Synergistic: Acting together; enhancing the effect of another force or agent. [EU] Synostosis: The joining of contiguous and separate bones by osseous tissue. [NIH] Synovial: Of pertaining to, or secreting synovia. [EU] Synovial Fluid: The clear, viscous fluid secreted by the synovial membrane. It contains mucin, albumin, fat, and mineral salts and serves to lubricate joints. [NIH]

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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] Synthetic retinoid: A substance related to vitamin A that is produced in a laboratory. [NIH] Systemic: Affecting the entire body. [NIH] Systemic disease: Disease that affects the whole body. [NIH] Systemic therapy: Treatment that uses substances that travel through the bloodstream, reaching and affecting cells all over the body. [NIH] Systole: Period of contraction of the heart, especially of the ventricles. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Systolic pressure: The highest pressure to which blood pressure rises with the contraction of the ventricles. [NIH] Tachycardia: Excessive rapidity in the action of the heart, usually with a heart rate above 100 beats per minute. [NIH] Tachypnea: Rapid breathing. [NIH] Tamoxifen: A first generation selective estrogen receptor modulator (SERM). It acts as an agonist for bone tissue and cholesterol metabolism but is an estrogen antagonist in mammary and uterine. [NIH] Tarsal Tunnel Syndrome: A syndrome produced by entrapment neuropathy of posterior tibial nerve. [NIH] Taurine: 2-Aminoethanesulfonic acid. A conditionally essential nutrient, important during mammalian development. It is present in milk but is isolated mostly from ox bile and strongly conjugates bile acids. [NIH] Teichoic Acids: Bacterial polysaccharides that are rich in phosphodiester linkages. They are the major components of the cell walls and membranes of many bacteria. [NIH] Temporal: One of the two irregular bones forming part of the lateral surfaces and base of the skull, and containing the organs of hearing. [NIH] Temporal Lobe: Lower lateral part of the cerebral hemisphere. [NIH] Tendinitis: Inflammation of tendons and of tendon-muscle attachments. [EU] Tendon Transfer: Surgical procedure by which a tendon is incised at its insertion and placed at an anatomical site distant from the original insertion. The tendon remains attached at the point of origin and takes over the function of a muscle inactivated by trauma or disease. [NIH] Teratogenic: Tending to produce anomalies of formation, or teratism (= anomaly of formation or development : condition of a monster). [EU] Terminalis: A groove on the lateral surface of the right atrium. [NIH] Testicles: The two egg-shaped glands found inside the scrotum. They produce sperm and male hormones. Also called testes. [NIH] 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] Testosterone: A hormone that promotes the development and maintenance of male sex characteristics. [NIH] Tetany: 1. Hyperexcitability of nerves and muscles due to decrease in concentration of

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extracellular ionized calcium, which may be associated with such conditions as parathyroid hypofunction, vitamin D deficiency, and alkalosis or result from ingestion of alkaline salts; it is characterized by carpopedal spasm, muscular twitching and cramps, laryngospasm with inspiratory stridor, hyperreflexia and choreiform movements. 2. Tetanus. [EU] Tetracycline: An antibiotic originally produced by Streptomyces viridifaciens, but used mostly in synthetic form. It is an inhibitor of aminoacyl-tRNA binding during protein synthesis. [NIH] Thalamus: Paired bodies containing mostly gray substance and forming part of the lateral wall of the third ventricle of the brain. The thalamus represents the major portion of the diencephalon and is commonly divided into cellular aggregates known as nuclear groups. [NIH]

Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thermal: Pertaining to or characterized by heat. [EU] Thermal ablation: A procedure using heat to remove tissue or a part of the body, or destroy its function. For example, to remove the lining of the uterus, a catheter is inserted through the cervix into the uterus, a balloon at the end of the catheter is inflated, and fluid inside the balloon is heated to destroy the lining of the uterus. [NIH] Thermodilution: Measurement of blood flow based on induction at one point of the circulation of a known change in the intravascular heat content of flowing blood and detection of the resultant change in temperature at a point downstream. [NIH] Thigh: A leg; in anatomy, any elongated process or part of a structure more or less comparable to a leg. [NIH] Third Ventricle: A narrow cleft inferior to the corpus callosum, within the diencephalon, between the paired thalami. Its floor is formed by the hypothalamus, its anterior wall by the lamina terminalis, and its roof by ependyma. It communicates with the fourth ventricle by the cerebral aqueduct, and with the lateral ventricles by the interventricular foramina. [NIH] Thoracic: Having to do with the chest. [NIH] Thoracic Surgery: A surgical specialty concerned with diagnosis and treatment of disorders of the heart, lungs, and esophagus. Two major types of thoracic surgery are classified as pulmonary and cardiovascular. [NIH] Thoracostomy: Surgical creation of an opening (stoma) into the chest cavity for drainage; used in the treatment of pleural effusion, pneumothorax, hemothorax and empyema. [NIH] Thoracotomy: Surgical incision into the chest wall. [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] Thrombasthenia: A congenital bleeding disorder with prolonged bleeding time, absence of aggregation of platelets in response to most agents, especially ADP, and impaired or absent clot retraction. Platelet membranes are deficient in or have a defect in the glycoprotein IIbIIIa complex (platelet glycoprotein GPIIB-IIIA complex). [NIH] Thrombin: An enzyme formed from prothrombin that converts fibrinogen to fibrin. (Dorland, 27th ed) EC 3.4.21.5. [NIH] Thrombocytes: Blood cells that help prevent bleeding by causing blood clots to form. Also called platelets. [NIH]

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Thrombocytopenia: A decrease in the number of blood platelets. [NIH] Thromboembolism: Obstruction of a vessel by a blood clot that has been transported from a distant site by the blood stream. [NIH] Thromboses: The formation or presence of a blood clot within a blood vessel during life. [NIH]

Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thromboxanes: Physiologically active compounds found in many organs of the body. They are formed in vivo from the prostaglandin endoperoxides and cause platelet aggregation, contraction of arteries, and other biological effects. Thromboxanes are important mediators of the actions of polyunsaturated fatty acids transformed by cyclooxygenase. [NIH] Thrombus: An aggregation of blood factors, primarily platelets and fibrin with entrapment of cellular elements, frequently causing vascular obstruction at the point of its formation. Some authorities thus differentiate thrombus formation from simple coagulation or clot formation. [EU] Thymidine: A chemical compound found in DNA. Also used as treatment for mucositis. [NIH]

Thymidine Kinase: An enzyme that catalyzes the conversion of ATP and thymidine to ADP and thymidine 5'-phosphate. Deoxyuridine can also act as an acceptor and dGTP as a donor. (From Enzyme Nomenclature, 1992) EC 2.7.1.21. [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] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Thyroid Gland: A highly vascular endocrine gland consisting of two lobes, one on either side of the trachea, joined by a narrow isthmus; it produces the thyroid hormones which are concerned in regulating the metabolic rate of the body. [NIH] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Tibial Nerve: The medial terminal branch of the sciatic nerve. The tibial nerve fibers originate in lumbar and sacral spinal segments (L4 to S2). They supply motor and sensory innervation to parts of the calf and foot. [NIH] Time Management: Planning and control of time to improve efficiency and effectiveness. [NIH]

Tin: A trace element that is required in bone formation. It has the atomic symbol Sn, atomic number 50, and atomic weight 118.71. [NIH] Tinnitus: Sounds that are perceived in the absence of any external noise source which may take the form of buzzing, ringing, clicking, pulsations, and other noises. Objective tinnitus refers to noises generated from within the ear or adjacent structures that can be heard by other individuals. The term subjective tinnitus is used when the sound is audible only to the affected individual. Tinnitus may occur as a manifestation of cochlear diseases; vestibulocochlear nerve diseases; intracranial hypertension; craniocerebral trauma; and other conditions. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tissue Adhesives: Substances used to cause adherence of tissue to tissue or tissue to nontissue surfaces, as for prostheses. [NIH]

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Tissue Banks: Centers for acquiring, characterizing, and storing organs or tissue for future use. [NIH] Tissue Culture: Maintaining or growing of tissue, organ primordia, or the whole or part of an organ in vitro so as to preserve its architecture and/or function (Dorland, 28th ed). Tissue culture includes both organ culture and cell culture. [NIH] Tissue Distribution: Accumulation of a drug or chemical substance in various organs (including those not relevant to its pharmacologic or therapeutic action). This distribution depends on the blood flow or perfusion rate of the organ, the ability of the drug to penetrate organ membranes, tissue specificity, protein binding. The distribution is usually expressed as tissue to plasma ratios. [NIH] Tissue Expanders: Inflatable reservoirs, usually made of silicone, which are implanted subcutaneously in order to generate tissue needed for surgical reconstruction. After implantation, the reservoir is inflated over several weeks by percutaneous injection of fluid. Once the tissue has grown, the expander is surgically removed and the expanded skin is used to cover the area being reconstructed. [NIH] Titre: The quantity of a substance required to produce a reaction with a given volume of another substance, or the amount of one substance required to correspond with a given amount of another substance. [EU] Tolerance: 1. The ability to endure unusually large doses of a drug or toxin. 2. Acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU] Tome: A zone produced by a number of irregular spaces contained in the outermost layer of denture of the root of a tooth. [NIH] Tomography: Imaging methods that result in sharp images of objects located on a chosen plane and blurred images located above or below the plane. [NIH] Tonic: 1. Producing and restoring the normal tone. 2. Characterized by continuous tension. 3. A term formerly used for a class of medicinal preparations believed to have the power of restoring normal tone to tissue. [EU] Tooth Preparation: Procedures carried out with regard to the teeth or tooth structures preparatory to specified dental therapeutic and surgical measures. [NIH] Topical: On the surface of the body. [NIH] Topical chemotherapy: Treatment with anticancer drugs in a lotion or cream applied to the skin. [NIH] Topoisomerase inhibitors: A family of anticancer drugs. The topoisomerase enzymes are responsible for the arrangement and rearrangement of DNA in the cell and for cell growth and replication. Inhibiting these enzymes may kill cancer cells or stop their growth. [NIH] Topotecan: An antineoplastic agent used to treat ovarian cancer. It works by inhibiting DNA topoisomerase. [NIH] Torsion: A twisting or rotation of a bodily part or member on its axis. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH]

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Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Toxoplasmosis: The acquired form of infection by Toxoplasma gondii in animals and man. [NIH]

Trabecular Meshwork: A porelike structure surrounding the entire circumference of the anterior chamber through which aqueous humor circulates to the canal of Schlemm. [NIH] Trabeculectomy: Any surgical procedure for treatment of glaucoma by means of puncture or reshaping of the trabecular meshwork. It includes goniotomy, trabeculotomy, and laser perforation. [NIH] Trace element: Substance or element essential to plant or animal life, but present in extremely small amounts. [NIH] Trachea: The cartilaginous and membranous tube descending from the larynx and branching into the right and left main bronchi. [NIH] Tracheostomy: Surgical formation of an opening into the trachea through the neck, or the opening so created. [NIH] Trachoma: A chronic infection of the conjunctiva and cornea caused by Chlamydia trachomatis. [NIH] Traction: The act of pulling. [NIH] Tramadol: A narcotic analgesic proposed for severe pain. It may be habituating. [NIH] Tranexamic Acid: Antifibrinolytic hemostatic used in severe hemorrhage. [NIH] Transaminases: A subclass of enzymes of the transferase class that catalyze the transfer of an amino group from a donor (generally an amino acid) to an acceptor (generally a 2-keto acid). Most of these enzymes are pyridoxyl phosphate proteins. (Dorland, 28th ed) EC 2.6.1. [NIH]

Transcriptase: An enzyme which catalyses the synthesis of a complementary mRNA molecule from a DNA template in the presence of a mixture of the four ribonucleotides (ATP, UTP, GTP and CTP). [NIH] Transcription Factors: Endogenous substances, usually proteins, which are effective in the initiation, stimulation, or termination of the genetic transcription process. [NIH] Transduction: The transfer of genes from one cell to another by means of a viral (in the case of bacteria, a bacteriophage) vector or a vector which is similar to a virus particle (pseudovirion). [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transfer Factor: Factor derived from leukocyte lysates of immune donors which can transfer both local and systemic cellular immunity to nonimmune recipients. [NIH] Transfusion: The infusion of components of blood or whole blood into the bloodstream. The blood may be donated from another person, or it may have been taken from the person earlier and stored until needed. [NIH] Transgenes: Genes that are introduced into an organism using gene transfer techniques. [NIH]

Translating: Conversion from one language to another language. [NIH] Translation: The process whereby the genetic information present in the linear sequence of ribonucleotides in mRNA is converted into a corresponding sequence of amino acids in a protein. It occurs on the ribosome and is unidirectional. [NIH]

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Translational: The cleavage of signal sequence that directs the passage of the protein through a cell or organelle membrane. [NIH] Translocating: The attachment of a fragment of one chromosome to a non-homologous chromosome. [NIH] Translocation: The movement of material in solution inside the body of the plant. [NIH] Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [NIH] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Transrectal ultrasound: A procedure used to examine the prostate. An instrument is inserted into the rectum, and sound waves bounce off the prostate. These sound waves create echoes, which a computer uses to create a picture called a sonogram. [NIH] Transurethral: Performed through the urethra. [EU] Transurethral Resection of Prostate: Resection of the prostate using a cystoscope passed through the urethra. [NIH] Trastuzumab: A type of monoclonal antibody used in cancer detection or therapy. Monoclonal antibodies are laboratory-produced substances that can locate and bind to cancer cells. Trastuzumab blocks the effects of the growth factor protein HER2, which transmits growth signals to breast cancer cells. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Treatment Outcome: Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, practicability, etc., of these interventions in individual cases or series. [NIH]

Trees: Woody, usually tall, perennial higher plants (Angiosperms, Gymnosperms, and some Pterophyta) having usually a main stem and numerous branches. [NIH] Trichomoniasis: An infection with the protozoan parasite Trichomonas vaginalis. [NIH] Tricuspid Atresia: Absence of the orifice between the right atrium and ventricle, with the presence of an atrial defect through which all the systemic venous return reaches the left heart. As a result, there is left ventricular hypertrophy because the right ventricle is absent or not functional. [NIH] Trigeminal: Cranial nerve V. It is sensory for the eyeball, the conjunctiva, the eyebrow, the skin of face and scalp, the teeth, the mucous membranes in the mouth and nose, and is motor to the muscles of mastication. [NIH] Trigeminal Nerve: The 5th and largest cranial nerve. The trigeminal nerve is a mixed motor and sensory nerve. The larger sensory part forms the ophthalmic, mandibular, and maxillary nerves which carry afferents sensitive to external or internal stimuli from the skin, muscles, and joints of the face and mouth and from the teeth. Most of these fibers originate from cells of the trigeminal ganglion and project to the trigeminal nucleus of the brain stem. The smaller motor part arises from the brain stem trigeminal motor nucleus and innervates the muscles of mastication. [NIH] Triglyceride: A lipid carried through the blood stream to tissues. Most of the body's fat tissue is in the form of triglycerides, stored for use as energy. Triglycerides are obtained primarily from fat in foods. [NIH] Trochlear Nerve: The 4th cranial nerve. The trochlear nerve carries the motor innervation of

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the superior oblique muscles of the eye. [NIH] Trochlear Nerve Diseases: Diseases of the fourth cranial (trochlear) nerve or its nucleus in the midbrain. The nerve crosses as it exits the midbrain dorsally and may be injured along its course through the intracranial space, cavernous sinus, superior orbital fissure, or orbit. Clinical manifestations include weakness of the superior oblique muscle which causes vertical diplopia that is maximal when the affected eye is adducted and directed inferiorly. Head tilt may be seen as a compensatory mechanism for diplopia and rotation of the visual axis. Common etiologies include craniocerebral trauma and infratentorial neoplasms. [NIH] Trophoblast: The outer layer of cells of the blastocyst which works its way into the endometrium during ovum implantation and grows rapidly, later combining with mesoderm. [NIH] Tropomyosin: A protein found in the thin filaments of muscle fibers. It inhibits contraction of the muscle unless its position is modified by troponin. [NIH] Troponin: One of the minor protein components of skeletal muscle. Its function is to serve as the calcium-binding component in the troponin-tropomyosin B-actin-myosin complex by conferring calcium sensitivity to the cross-linked actin and myosin filaments. [NIH] Truncal: The bilateral dissection of the abdominal branches of the vagus nerve. [NIH] Trypan Blue: An azo that that is used in protozoal infections. [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] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of Mycobacterium. [NIH] Tumor marker: A substance sometimes found in an increased amount in the blood, other body fluids, or tissues and which may mean that a certain type of cancer is in the body. Examples of tumor markers include CA 125 (ovarian cancer), CA 15-3 (breast cancer), CEA (ovarian, lung, breast, pancreas, and gastrointestinal tract cancers), and PSA (prostate cancer). Also called biomarker. [NIH] Tumor model: A type of animal model which can be 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] Tumor Necrosis Factor: Serum glycoprotein produced by activated macrophages and other mammalian mononuclear leukocytes which has necrotizing activity against tumor cell lines and increases ability to reject tumor transplants. It mimics the action of endotoxin but differs from it. It has a molecular weight of less than 70,000 kDa. [NIH] 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] Tungsten: A metallic element with the atomic symbol W, atomic number 74, and atomic weight 183.85. It is used in many manufacturing applications, including increasing the hardness, toughness, and tensile strength of steel; manufacture of filaments for incandescent light bulbs; and in contact points for automotive and electrical apparatus. [NIH] Tunica Intima: The innermost coat of blood vessels, consisting of a thin lining of endothelial cells longitudinally oriented and continuous with the endothelium of capillaries on the one hand and the endocardium of the heart on the other. [NIH] Tympani: The part of the cochlea below the spiral lamina. [NIH] Tympanic membrane: A thin, tense membrane forming the greater part of the outer wall of

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the tympanic cavity and separating it from the external auditory meatus; it constitutes the boundary between the external and middle ear. [NIH] Type 2 diabetes: Usually characterized by a gradual onset with minimal or no symptoms of metabolic disturbance and no requirement for exogenous insulin. The peak age of onset is 50 to 60 years. Obesity and possibly a genetic factor are usually present. [NIH] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Ulcer: A localized necrotic lesion of the skin or a mucous surface. [NIH] Ulcerative colitis: Chronic inflammation of the colon that produces ulcers in its lining. This condition is marked by abdominal pain, cramps, and loose discharges of pus, blood, and mucus from the bowel. [NIH] Ulnar Nerve: A major nerve of the upper extremity. In humans, the fibers of the ulnar nerve originate in the lower cervical and upper thoracic spinal cord (usually C7 to T1), travel via the medial cord of the brachial plexus, and supply sensory and motor innervation to parts of the hand and forearm. [NIH] Ultrafiltration: The separation of particles from a suspension by passage through a filter with very fine pores. In ultrafiltration the separation is accomplished by convective transport; in dialysis separation relies instead upon differential diffusion. Ultrafiltration occurs naturally and is a laboratory procedure. Artificial ultrafiltration of the blood is referred to as hemofiltration or hemodiafiltration (if combined with hemodialysis). [NIH] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Ultrasound energy: A form of therapy being studied as an anticancer treatment. Intensified ultrasound energy can be directed at cancer cells to heat them and kill them. [NIH] Ultrasound test: A test that bounces sound waves off tissues and internal organs and changes the echoes into pictures (sonograms). [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Univalent: Pertaining to an unpaired chromosome during the zygotene stage of prophase to first metaphase in meiosis. [NIH] Universal Precautions: Prudent standard preventive measures to be taken by professional and other health personnel in contact with persons afflicted with a communicable disease, to avoid contracting the disease by contagion or infection. Precautions are especially applicable in the diagnosis and care of AIDS patients. [NIH] Unresectable: Unable to be surgically removed. [NIH] Uraemia: 1. An excess in the blood of urea, creatinine, and other nitrogenous end products of protein and amino acids metabolism; more correctly referred to as azotemia. 2. In current usage the entire constellation of signs and symptoms of chronic renal failure, including nausea, vomiting anorexia, a metallic taste in the mouth, a uraemic odour of the breath, pruritus, uraemic frost on the skin, neuromuscular disorders, pain and twitching in the muscles, hypertension, edema, mental confusion, and acid-base and electrolyte imbalances. [EU]

Urea: A compound (CO(NH2)2), formed in the liver from ammonia produced by the deamination of amino acids. It is the principal end product of protein catabolism and constitutes about one half of the total urinary solids. [NIH]

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Uremia: The illness associated with the buildup of urea in the blood because the kidneys are not working effectively. Symptoms include nausea, vomiting, loss of appetite, weakness, and mental confusion. [NIH] Ureter: One of a pair of thick-walled tubes that transports urine from the kidney pelvis to the bladder. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Urethritis: Inflammation of the urethra. [EU] Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary Fistula: An abnormal passage in any organ of the urinary tract or between urinary organs and other organs. [NIH] Urinary Retention: Inability to urinate. The etiology of this disorder includes obstructive, neurogenic, pharmacologic, and psychogenic causes. [NIH] Urinary tract: The organs of the body that produce and discharge urine. These include the kidneys, ureters, bladder, and urethra. [NIH] Urinary tract infection: An illness caused by harmful bacteria growing in the urinary tract. [NIH]

Urinate: To release urine from the bladder to the outside. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Urodynamic: Measures of the bladder's ability to hold and release urine. [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] Urostomy: An operation to create an opening from inside the body to the outside, making a new way to pass urine. [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] Uvea: The middle coat of the eyeball, consisting of the choroid in the back of the eye and the ciliary body and iris in the front of the eye. [NIH] Uveitis: An inflammation of part or all of the uvea, the middle (vascular) tunic of the eye, and commonly involving the other tunics (the sclera and cornea, and the retina). [EU] Vaccination: Administration of vaccines to stimulate the host's immune response. This includes any preparation intended for active immunological prophylaxis. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vagal: Pertaining to the vagus nerve. [EU] Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Vaginal: Of or having to do with the vagina, the birth canal. [NIH] Vagotomy: The interruption or removal of any part of the vagus (10th cranial) nerve. Vagotomy may be performed for research or for therapeutic purposes. [NIH] Vagus Nerve: The 10th cranial nerve. The vagus is a mixed nerve which contains somatic afferents (from skin in back of the ear and the external auditory meatus), visceral afferents

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(from the pharynx, larynx, thorax, and abdomen), parasympathetic efferents (to the thorax and abdomen), and efferents to striated muscle (of the larynx and pharynx). [NIH] Valves: Flap-like structures that control the direction of blood flow through the heart. [NIH] Varicocele: A complex of dilated veins which surround the testicle, usually on the left side. [NIH]

Varicose: The common ulcer in the lower third of the leg or near the ankle. [NIH] Varicose vein: An abnormal swelling and tortuosity especially of the superficial veins of the legs. [EU] Vas Deferens: The excretory duct of the testes that carries spermatozoa. It rises from the scrotum and joins the seminal vesicles to form the ejaculatory duct. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vascular endothelial growth factor: VEGF. A substance made by cells that stimulates new blood vessel formation. [NIH] Vascular Resistance: An expression of the resistance offered by the systemic arterioles, and to a lesser extent by the capillaries, to the flow of blood. [NIH] Vasculitis: Inflammation of a blood vessel. [NIH] Vasectomy: An operation to cut or tie off the two tubes that carry sperm out of the testicles. [NIH]

Vasoactive: Exerting an effect upon the calibre of blood vessels. [EU] Vasoconstriction: Narrowing of the blood vessels without anatomic change, for which constriction, pathologic is used. [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] Vasodilator: An agent that widens blood vessels. [NIH] Vasomotor: 1. Affecting the calibre of a vessel, especially of a blood vessel. 2. Any element or agent that effects the calibre of a blood vessel. [EU] VE: The total volume of gas either inspired or expired in one minute. [NIH] Vector: Plasmid or other self-replicating DNA molecule that transfers DNA between cells in nature or in recombinant DNA technology. [NIH] Vegetative: 1. Concerned with growth and with nutrition. 2. Functioning involuntarily or unconsciously, as the vegetative nervous system. 3. Resting; denoting the portion of a cell cycle during which the cell is not involved in replication. 4. Of, pertaining to, or characteristic of plants. [EU] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Velopharyngeal Insufficiency: Failure of the soft palate to reach the posterior pharyngeal wall. It may be caused by cleft palate surgery, palatal or pharyngeal abnormalities or injury, or neuromuscular dysfunction of the velopharyngeal sphincter. It causes hypernasality of speech. [NIH] Vena: A vessel conducting blood from the capillary bed to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Venous blood: Blood that has given up its oxygen to the tissues and carries carbon dioxide back for gas exchange. [NIH] Venous Thrombosis: The formation or presence of a thrombus within a vein. [NIH]

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Ventilation: 1. In respiratory physiology, the process of exchange of air between the lungs and the ambient air. Pulmonary ventilation (usually measured in litres per minute) refers to the total exchange, whereas alveolar ventilation refers to the effective ventilation of the alveoli, in which gas exchange with the blood takes place. 2. In psychiatry, verbalization of one's emotional problems. [EU] Ventilator: A breathing machine that is used to treat respiratory failure by promoting ventilation; also called a respirator. [NIH] Ventral: 1. Pertaining to the belly or to any venter. 2. Denoting a position more toward the belly surface than some other object of reference; same as anterior in human anatomy. [EU] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Ventricular: Pertaining to a ventricle. [EU] Ventricular Dysfunction: A condition in which the ventricles of the heart exhibit a decreased functionality. [NIH] Ventricular Function: The hemodynamic and electrophysiological action of the ventricles. [NIH]

Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Vertebrae: A bony unit of the segmented spinal column. [NIH] Vertebral: Of or pertaining to a vertebra. [EU] Vertigo: An illusion of movement; a sensation as if the external world were revolving around the patient (objective vertigo) or as if he himself were revolving in space (subjective vertigo). The term is sometimes erroneously used to mean any form of dizziness. [EU] Vestibular: Pertaining to or toward a vestibule. In dental anatomy, used to refer to the tooth surface directed toward the vestibule of the mouth. [EU] Vestibule: A small, oval, bony chamber of the labyrinth. The vestibule contains the utricle and saccule, organs which are part of the balancing apparatus of the ear. [NIH] Vestibulocochlear Nerve: The 8th cranial nerve. The vestibulocochlear nerve has a cochlear part (cochlear nerve) which is concerned with hearing and a vestibular part (vestibular nerve) which mediates the sense of balance and head position. The fibers of the cochlear nerve originate from neurons of the spiral ganglion and project to the cochlear nuclei (cochlear nucleus). The fibers of the vestibular nerve arise from neurons of Scarpa's ganglion and project to the vestibular nuclei. [NIH] Vestibulocochlear Nerve Diseases: Diseases of the vestibular and/or cochlear (acoustic) nerves, which join to form the vestibulocochlear nerve. Vestibular neuritis, cochlear neuritis, and acoustic neuromas are relatively common conditions that affect these nerves. Clinical manifestations vary with which nerve is primarily affected, and include hearing loss, vertigo, and tinnitus. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Villi: The tiny, fingerlike projections on the surface of the small intestine. Villi help absorb nutrients. [NIH] Vinca Alkaloids: A class of alkaloids from the genus of apocyanaceous woody herbs including periwinkles. They are some of the most useful antineoplastic agents. [NIH]

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Vinorelbine: An anticancer drug that belongs to the family of plant drugs called vinca alkaloids. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Visceral: , from viscus a viscus) pertaining to a viscus. [EU] Visceral Afferents: The sensory fibers innervating the viscera. [NIH] Viscosity: A physical property of fluids that determines the internal resistance to shear forces. [EU] Visual Acuity: Acuteness or clearness of vision, especially of form vision, which is dependent mainly on the sharpness of the retinal focus. [NIH] Visual Cortex: Area of the occipital lobe concerned with vision. [NIH] Visual field: The entire area that can be seen when the eye is forward, including peripheral vision. [NIH] Vital Statistics: Used for general articles concerning statistics of births, deaths, marriages, etc. [NIH] Vitrectomy: Removal of the whole or part of the vitreous body in treating endophthalmitis, diabetic retinopathy, retinal detachment, intraocular foreign bodies, and some types of glaucoma. [NIH] Vitreoretinal: A rare familial condition characterized by a clear vitreous, except for preretinal filaments and veils which have been loosened from the retina, a dense hyaloid membrane which is perforated and detached, and masses of peripheral retinal pigmentation inters. [NIH] Vitreous Body: The transparent, semigelatinous substance that fills the cavity behind the crystalline lens of the eye and in front of the retina. It is contained in a thin hyoid membrane and forms about four fifths of the optic globe. [NIH] Vitreous Humor: The transparent, colorless mass of gel that lies behind the lens and in front of the retina and fills the center of the eyeball. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Vocal cord: The vocal folds of the larynx. [NIH] Voice Disorders: Disorders of voice pitch, loudness, or quality. Dysphonia refers to impaired utterance of sounds by the vocal folds. [NIH] Void: To urinate, empty the bladder. [NIH] Volition: Voluntary activity without external compulsion. [NIH] Volvulus: A twisting of the stomach or large intestine. May be caused by the stomach being in the wrong position, a foreign substance, or abnormal joining of one part of the stomach or intestine to another. Volvulus can lead to blockage, perforation, peritonitis, and poor blood flow. [NIH]

564 Surgery

Voriconazole: A drug that treats infections caused by fungi. [NIH] Wakefulness: A state in which there is an enhanced potential for sensitivity and an efficient responsiveness to external stimuli. [NIH] War: Hostile conflict between organized groups of people. [NIH] Warfarin: An anticoagulant that acts by inhibiting the synthesis of vitamin K-dependent coagulation factors. Warfarin is indicated for the prophylaxis and/or treatment of venous thrombosis and its extension, pulmonary embolism, and atrial fibrillation with embolization. It is also used as an adjunct in the prophylaxis of systemic embolism after myocardial infarction. Warfarin is also used as a rodenticide. [NIH] Warts: Benign epidermal proliferations or tumors; some are viral in origin. [NIH] Weight Gain: Increase in body weight over existing weight. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]

Windpipe: A rigid tube, 10 cm long, extending from the cricoid cartilage to the upper border of the fifth thoracic vertebra. [NIH] Withdrawal: 1. A pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) A substance-specific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU] Womb: A hollow, thick-walled, muscular organ in which the impregnated ovum is developed into a child. [NIH] Wound Healing: Restoration of integrity to traumatized tissue. [NIH] Wound Infection: Invasion of the site of trauma by pathogenic microorganisms. [NIH] Wounds, Gunshot: Disruption of structural continuity of the body as a result of the discharge of firearms. [NIH] Wrist Injuries: Injuries to the wrist or the wrist joint. [NIH] Xanthine: An urinary calculus. [NIH] Xenograft: The cells of one species transplanted to another species. [NIH] Xerostomia: Decreased salivary flow. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH] X-ray therapy: The use of high-energy radiation from x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy) or from materials called radioisotopes. Radioisotopes produce radiation and can be placed in or near the tumor or in the area near cancer cells. This type of radiation treatment is called internal radiation therapy, implant radiation, interstitial radiation, or brachytherapy. Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. X-ray therapy is also called radiation therapy, radiotherapy, and irradiation. [NIH] Yeasts: A general term for single-celled rounded fungi that reproduce by budding. Brewers' and bakers' yeasts are Saccharomyces cerevisiae; therapeutic dried yeast is dried yeast. [NIH]

565

INDEX 3 3-dimensional, 421 A Abdominal Pain, 158, 403, 421, 499, 522, 559 Abducens, 421, 459 Abducens Nerve, 421, 459 Abducens Nerve Diseases, 421, 459 Aberrant, 421, 447 Ablate, 421, 462 Ablation, 220, 332, 421 Ablation zone, 421 Abrasion, 396, 421 Abscess, 67, 312, 421, 426, 543 Acceptor, 421, 496, 517, 554, 556 Accommodation, 421, 507, 513, 527 Acetone, 421, 493 Acetylcholine, 421, 511 Acidosis, 422 Acne, 7, 173, 352, 422, 492 Acne Vulgaris, 422, 492 Acoustic, 329, 352, 353, 390, 422, 432, 535, 562 Acquired Immunodeficiency Syndrome, 312, 422 Acrylonitrile, 422, 540 Actin, 422, 507, 558 Activities of Daily Living, 200, 315, 382, 422 Acuity, 422, 432 Acupuncture Analgesia, 183, 422 Acute lymphoblastic leukemia, 422 Acute lymphocytic leukemia, 422 Acute renal, 422, 481 Adaptability, 422, 442 Adaptation, 422, 511, 524 Adduction, 334, 422 Adenine, 422, 423 Adenocarcinoma, 208, 218, 219, 221, 223, 225, 226, 423, 482, 511 Adenoma, 169, 423 Adenosine, 423, 425, 485, 522 Adenosine Triphosphate, 423, 522 Adhesions, 423 Adhesives, 422, 423, 436 Adipocytes, 423, 450, 495 Adipose Tissue, 423 Adjuvant, 168, 171, 204, 214, 223, 423

Adjuvant Therapy, 168, 423 Adolescence, 423, 520 Adrenal Cortex, 423, 452, 468, 528 Adrenal Medulla, 423, 441, 466, 511 Adrenergic, 423, 460, 466, 551 Adsorption, 423 Adsorptive, 423 Adverse Effect, 423, 492, 544 Aerobic, 423, 469 Aeroembolism, 423, 434 Aerosol, 424, 511 Afferent, 424, 452, 470, 495, 514, 547 Affinity, 424, 545 Agar, 424, 523 Age Groups, 424 Age of Onset, 424, 438, 559 Aged, 80 and Over, 424 Aggressiveness, 3, 424 Agonist, 424, 460, 507, 552 Air Sacs, 424, 425 Airway, 390, 424, 438, 544 Airway Obstruction, 424 Albumin, 424, 523, 551 Algorithms, 199, 424, 435 Alimentary, 398, 424, 465, 492, 518, 520 Alkaline, 422, 424, 425, 433, 439, 553 Alkaline Phosphatase, 425 Alkaloid, 425, 431, 439, 505, 518 Allergen, 425, 457, 542 Allergic Rhinitis, 425 Allogeneic, 425, 478, 521 Allografts, 374, 425 Alpha Particles, 425, 533 Alternative medicine, 347, 425 Aluminum, 425 Alveoli, 425, 562 Amebiasis, 425, 503 Ameliorated, 425 Ameliorating, 425 Amino Acid Sequence, 425, 428, 434, 528 Amino Acids, 425, 434, 467, 469, 510, 520, 525, 530, 539, 556, 559 Amiodarone, 425 Ammonia, 425, 551, 559 Amnestic, 425, 504 Amplification, 351, 393, 426 Ampulla, 426, 464, 471 Anaesthetic, 426

566 Surgery

Anal, 312, 314, 426, 447, 466, 471, 473, 497, 506, 531, 535 Anal Fissure, 312, 314, 426 Anal Fistula, 312, 426 Analgesic, 426, 450, 458, 464, 505, 511, 514, 550, 556 Analog, 7, 426, 473, 475, 486, 492 Analysis of Variance, 426 Anaphylactic, 426, 524 Anaphylatoxins, 426, 448 Anaplasia, 426 Anastomosis, 204, 334, 426, 475, 492 Androgenic, 426 Anemia, 173, 426, 436, 480, 484 Anesthetics, 190, 360, 426, 433, 466 Aneurysm, 159, 426, 429, 561 Angina Pectoris, 426 Angiogenesis, 427, 500 Angiogram, 427 Angiography, 427 Angioid Streaks, 427, 531 Angioplasty, 65, 196, 346, 427, 431, 507 Animal model, 340, 427, 558 Anions, 424, 427, 491, 543 Anisometropia, 427 Ankle, 322, 331, 387, 388, 389, 427, 515, 561 Annealing, 427, 525 Anomalies, 316, 354, 427, 515, 552 Anorectal, 171, 312, 314, 354, 399, 427 Anorexia, 427, 516, 559 Antecedent, 427 Anterior chamber, 427, 478, 492, 556 Anterior Cruciate Ligament, 201, 350, 427 Anterior Eye Segment, 427 Anterior mediastinotomy, 427 Anthracycline, 427, 455, 457 Antianginal, 425, 427 Antiarrhythmic, 425, 427 Antibacterial, 427, 453, 459, 520, 546 Antibiosis, 315, 427 Antibiotic, 392, 394, 428, 432, 455, 460, 467, 504, 546, 553 Antibodies, 212, 428, 479, 483, 486, 487, 499, 505, 523, 533 Antibody therapy, 212, 428 Anticoagulant, 428, 530, 564 Antiemetic, 428, 478 Antigen, 66, 424, 428, 448, 483, 485, 486, 487, 488, 489, 501, 533, 542 Antigen-Antibody Complex, 428, 448 Anti-infective, 428, 444, 484, 545

Anti-inflammatory, 428, 431, 442, 457, 458, 477, 493, 518 Anti-Inflammatory Agents, 428, 431, 442, 493 Antimetabolite, 428, 468, 473 Antimicrobial, 394, 428, 457 Antineoplastic, 428, 440, 454, 460, 471, 473, 504, 517, 525, 555, 562 Antioxidant, 428, 431, 517 Antiproliferative, 428 Antipruritic, 428 Antipyretic, 428, 458 Antiseptic, 421, 428 Antrectomy, 428, 435 Anus, 312, 314, 426, 427, 429, 431, 437, 490, 520, 521, 535 Anxiety, 3, 172, 173, 200, 333, 342, 429, 450 Anxiolytic, 429, 504, 513 Aortic Aneurysm, 66, 67, 203, 400, 429 Aortic Valve, 65, 429 Aperture, 429, 514, 532 Aphakia, 429, 538 Apnea, 181, 429 Apolipoproteins, 429, 496 Aponeurosis, 429, 475 Apoptosis, 429, 441 Appendectomy, 313, 429 Applicability, 429 Aqueous fluid, 429, 526 Aqueous humor, 429, 445, 556 Arachidonic Acid, 429, 462, 486, 495, 529 Areola, 429 Arginine, 158, 188, 426, 429, 511 Argon, 204, 393, 429 Arm Injuries, 429 Aromatic, 430, 522, 550 Arrhythmia, 427, 430, 473, 505 Arrhythmogenic, 430 Arrhythmogenic Right Ventricular Dysplasia, 430 Arteriolar, 430, 437 Arterioles, 430, 436, 439, 503, 506, 561 Arteriosclerosis, 174, 430, 547 Arteriosus, 430, 532 Arteriovenous, 430, 503 Arthroplasty, 6, 331, 351, 391, 430 Arthroscopy, 330, 430 Arthrosis, 430 Articular, 430, 492, 500, 515 Articulation, 6, 430, 503 Articulator, 430 Artificial Eye, 430, 529

Index 567

Artificial Limbs, 408, 430 Artificial Organs, 430 Asbestos, 430, 499, 502 Ascorbic Acid, 161, 361, 430, 484 Aseptic, 431, 514, 549 Aspartate, 431, 493 Asphyxia, 431, 511 Aspirate, 431 Aspiration, 431 Aspirin, 366, 387, 399, 431 Assay, 68, 431, 533 Astrocytoma, 431, 476, 477 Asymptomatic, 425, 431, 473, 518 Ataxia, 431, 484 Atelectasis, 431 Atherectomy, 431, 464 Atmospheric Pressure, 423, 431, 484 Atresia, 431, 434 Atrial Fibrillation, 431, 564 Atrial Flutter, 431 Atrioventricular, 431, 451 Atrium, 431, 441, 451, 504, 552, 557, 562 Atropine, 361, 431, 434 Attenuated, 431, 459 Atypical, 406, 432 Audiologist, 432 Audiology, 311, 432 Audiometry, 432 Auditory, 311, 432, 461, 468, 480, 500, 559, 560 Auditory nerve, 432, 500 Aural, 432 Autoclave, 432 Autodigestion, 432, 518 Autologous, 67, 334, 432, 521 Autonomic, 408, 421, 432, 434, 452, 477, 494, 511, 521, 545, 547, 551 Autonomic Nervous System, 408, 432, 434, 521, 545, 551 Autopsy, 432 Autosuggestion, 432, 486 Axilla, 432, 437 Axillary, 224, 432, 437, 472, 500, 550 Axillary dissection, 432 Axillary lymph nodes, 224, 432 Axons, 432, 456, 509, 514, 521, 538, 547 Azithromycin, 432 B Back Injuries, 432 Back Pain, 6, 350, 383, 432 Bacteremia, 432 Bacterial Physiology, 422, 433

Bacterial Translocation, 433 Bactericidal, 433 Bacteriophage, 433, 523, 556 Bacterium, 433, 448, 481 Barbiturate, 433 Barium, 433, 437 Basal cell carcinoma, 221, 433 Basal cells, 433 Basal Ganglia, 431, 433, 437, 438, 461, 475, 476 Basement Membrane, 433, 440, 469, 494 Basilar Artery, 433, 500 Basophils, 433, 478, 495, 524 Bed Rest, 385, 433 Behavior Therapy, 433 Belladonna, 431, 434 Benchmarking, 434 Bends, 434 Benign prostatic hyperplasia, 434 Beta Rays, 434, 462 Beta-Endorphin, 434 Beta-Thromboglobulin, 434, 490 Bewilderment, 434, 449 Biconvex, 434 Bifida, 434 Bilateral, 434, 518, 519, 527, 538, 543, 558 Bile, 223, 355, 434, 435, 454, 464, 474, 475, 482, 487, 497, 549, 552 Bile Acids, 434, 475, 549, 552 Bile Acids and Salts, 434 Bile Ducts, 434, 474 Biliary, 340, 434, 435, 448, 482, 518 Biliary Atresia, 434 Biliary Tract, 340, 434, 435, 518 Biliopancreatic Diversion, 435 Bilirubin, 424, 435, 474 Binding Sites, 435 Binocular vision, 435 Biochemical, 428, 435, 515, 543 Bioengineering, 372, 435 Biological therapy, 435, 479 Biological Transport, 435, 458 Biomarkers, 435 Biomechanics, 435 Biometry, 435 Biopsy, 435, 468, 520, 549 Biopsy specimen, 435 Biosynthesis, 429, 435, 516 Biotechnology, 64, 329, 347, 373, 435 Blastocyst, 435, 449, 517, 523, 558 Blebs, 435 Bleeding Time, 436, 553

568 Surgery

Blepharitis, 436 Blepharoplasty, 436 Bloating, 436, 499 Blood Cell Count, 436, 480 Blood Coagulation, 436, 439 Blood Flow Velocity, 436 Blood Glucose, 436, 481, 489 Blood Platelets, 436, 524, 543, 554 Blood pressure, 408, 436, 441, 458, 485, 505, 532, 545, 552 Blood transfusion, 67, 374, 436, 481 Blood Viscosity, 436, 481 Blood Volume, 436 Body Composition, 436 Body Fluids, 391, 435, 436, 439, 460, 473, 512, 545, 558 Body Image, 195, 381, 436 Body Mass Index, 436, 516 Bolus, 66, 436 Bolus infusion, 436 Bone Cements, 436, 526 Bone Conduction, 432, 436 Bone Density, 437 Bone Marrow, 212, 222, 422, 437, 467, 487, 499, 505, 521, 545, 548, 550 Bone metastases, 437 Bone scan, 437, 540 Bone Substitutes, 350, 382, 437 Bowel Movement, 437, 450, 458, 545, 549 Bowel Prep, 437 Brachial, 437, 501, 532, 559 Brachial Artery, 437, 533 Brachial Plexus, 437, 501, 559 Brachiocephalic Veins, 437, 550 Brachytherapy, 437, 490, 492, 533, 564 Bradykinin, 437, 492, 511, 523 Brain Diseases, 437, 518 Brain Hypoxia, 437, 438 Brain Infarction, 437, 438 Brain Ischemia, 438 Brain metastases, 224, 438 Brain Neoplasms, 438, 484 Brain Stem, 437, 438, 443, 446, 459, 557 Breakdown, 354, 438, 458, 475, 514 Breast Implants, 395, 438 Breast reconstruction, 438 Breast-conserving surgery, 66, 438 Breeding, 438 Bronchi, 438, 466, 492, 556 Bronchial, 438 Bronchioles, 425, 438, 532 Bronchitis, 438, 445

Bronchoconstriction, 438, 524 Bronchodilator, 438, 492 Bronchoscopy, 438 Buccal, 438 Bunion, 7, 326, 391, 438, 479 Bupivacaine, 438, 496 Burns, 5, 174, 438, 439 Burns, Electric, 438, 439 Butyric Acid, 439, 468 Bypass, 65, 66, 67, 158, 159, 167, 172, 195, 196, 197, 198, 199, 200, 202, 203, 205, 318, 325, 346, 375, 393, 439, 441, 451, 481, 492, 507 C Cadaver, 341, 439 Calcification, 389, 430, 439 Calcium channel blocker, 439 Calcium Channel Blockers, 439 Calcium Channels, 439, 518 Camptothecin, 439, 492 Capillary, 332, 436, 437, 439, 477, 532, 561, 562 Capillary Permeability, 437, 439 Capsaicin, 439 Capsular, 440 Capsules, 440, 472, 477 Carbogen, 440 Carbohydrate, 440, 477, 525 Carbonate Dehydratase, 440 Carbonic Anhydrase Inhibitors, 440 Carboplatin, 170, 213, 224, 440 Carboxymethylcellulose, 440 Carcinoembryonic Antigen, 440 Carcinogen, 440, 503 Carcinogenic, 440, 489, 513, 528, 549 Carcinoid, 314, 440, 509 Carcinoma, 312, 314, 440, 509, 511 Carcinoma in Situ, 440 Cardiac arrest, 440 Cardiac catheterization, 440 Cardiac Output, 440, 550 Cardiac Surgical Procedures, 440 Cardiomyopathy, 68, 175, 440 Cardiorespiratory, 441, 504 Cardioselective, 441 Cardiovascular disease, 441 Cardiovascular System, 441, 468, 531 Career Choice, 441 Carotene, 188, 441, 538 Carotid Stenosis, 68, 441 Carpal Tunnel Syndrome, 175, 386, 441 Carrier Proteins, 441, 523, 533

Index 569

Case report, 159, 166, 399, 441, 446 Case series, 5, 68, 441, 446 Caspase, 441 Catabolism, 441 Catecholamine, 441, 460 Catheterization, 427, 441, 491, 507 Catheters, 442, 487, 490 Cathode, 434, 442, 462 Cations, 442, 491 Cauda Equina, 442, 541 Caudal, 442, 458, 485, 511, 526 Causal, 442, 466, 539 Cause of Death, 442, 545 Caustic, 442, 545 Cauterization, 442 Cecum, 442, 494 Celecoxib, 442 Celiac Artery, 442, 482 Cell Adhesion, 442, 489 Cell Cycle, 442, 446, 453, 468, 530, 561 Cell Death, 429, 442, 468, 508 Cell Differentiation, 442, 476, 544 Cell Division, 433, 442, 468, 479, 504, 523 Cell membrane, 435, 439, 441, 442, 457, 522 Cell proliferation, 430, 442, 544 Cell Survival, 442, 479 Cell Transplantation, 209, 213, 443 Cellulose, 443, 503, 523 Central Nervous System Infections, 443, 479, 484 Centrifugation, 443, 480 Cerebellum, 437, 438, 443, 452, 474, 526 Cerebral Angiography, 443, 499 Cerebral Aqueduct, 443, 474, 553 Cerebral hemispheres, 433, 438, 443, 476, 495 Cerebral Infarction, 438, 443, 484 Cerebral Palsy, 443, 546 Cerebrospinal, 352, 443, 484, 543 Cerebrospinal fluid, 352, 443, 484, 543 Cerebrospinal Fluid Pressure, 352, 443 Cerebrovascular, 439, 441, 443 Cerebrum, 443, 452 Cervix, 443, 444, 473, 479, 537, 553 Cesarean Section, 444 Character, 426, 444, 455, 533 Checkup, 387, 444 Check-up, 444 Chemoembolization, 444 Chemopreventive, 444, 471 Chemoprotective, 225, 444, 457

Chemotactic Factors, 444, 448 Chest cavity, 444, 553 Chest Pain, 444 Chest Tubes, 444 Chest wall, 444, 524, 537, 553 Chin, 342, 398, 444 Chlorhexidine, 159, 444 Cholecystectomy, 313, 340, 355, 444 Cholelithiasis, 444 Cholesteatoma, 339, 444 Cholesterol, 177, 434, 444, 445, 452, 474, 496, 498, 549, 552 Cholesterol Esters, 444, 496 Chondroitin sulfate, 444 Chorioretinitis, 445, 538 Choroid, 445, 450, 495, 538, 560 Choroidal Neovascularization, 445 Chromatin, 429, 445, 466, 511, 547 Chromosomal, 426, 445 Chromosome, 445, 496, 503, 557, 559 Chronic Disease, 348, 445 Chronic lymphocytic leukemia, 445 Chronic Obstructive Pulmonary Disease, 175, 445 Chronic renal, 445, 525, 559 Chylomicrons, 445, 497 Cicatricial, 445 Cicatrix, 445, 493 Cicatrization, 445 Ciliary, 429, 430, 445, 513, 543, 560 Ciliary Body, 430, 445, 543, 560 Ciliary processes, 429, 445 Circulatory system, 404, 445, 464, 491 Circumcision, 316, 329, 445 CIS, 445, 538 Cisplatin, 167, 207, 211, 215, 225, 445, 513 Citrus, 430, 446 Clamp, 446 Clear cell carcinoma, 446, 457 Cleft Palate, 202, 342, 446, 561 Clinical Protocols, 446 Clinical study, 446, 450 Cloning, 435, 446, 489 Clot Retraction, 446, 553 Cochlea, 446, 489, 558 Cochlear, 312, 331, 333, 335, 446, 554, 562 Cochlear Diseases, 446, 554 Cochlear Implantation, 331, 446 Cochlear Implants, 312, 331, 333, 335, 446 Cochlear Nerve, 446, 562 Coenzyme, 189, 430, 446 Cofactor, 446, 530

570 Surgery

Cognition, 447, 509 Cognitive behavior therapy, 447 Cognitive restructuring, 447, 549 Cognitive Therapy, 447 Cohort Studies, 447, 466 Colectomy, 223, 447 Colitis, 182, 312, 314, 348, 402, 447 Collapse, 438, 447, 524, 544 Colloidal, 424, 447, 462, 469, 543 Colonoscopy, 312, 437, 447 Colorectal Surgery, 66, 312, 314, 447 Colostomy, 397, 405, 447 Combination Therapy, 448, 468 Common Bile Duct, 313, 448, 454, 482 Communicable disease, 391, 448, 559 Communication Disorders, 228, 311, 372, 448 Comorbidity, 448 Competency, 322, 448 Complement, 426, 448, 489, 523, 542 Complement Activation, 426, 448 Complementary and alternative medicine, 165, 166, 193, 448 Complementary medicine, 166, 448 Complete remission, 449, 536 Complete response, 449 Compress, 449 Computational Biology, 373, 449 Computed tomography, 384, 385, 437, 449, 540 Computerized axial tomography, 449, 540 Computerized tomography, 449 Concentric, 449, 542 Conception, 449, 450, 472, 549 Concomitant, 449 Conduction, 432, 449 Cone, 449 Confidence Intervals, 4, 449 Confounding, 449 Confusion, 3, 449, 459, 485, 510, 559, 560 Congestion, 181, 449 Congestive heart failure, 449 Conjugated, 434, 449, 454 Conjunctiva, 449, 488, 493, 504, 550, 556, 557 Connective Tissue Cells, 449, 450 Conscious Sedation, 450 Consciousness, 426, 450, 455, 456, 459, 538 Consolidation, 450 Constipation, 175, 314, 450, 522 Constitutional, 450, 538

Constriction, 441, 450, 492, 504, 513, 531, 561 Consultation, 408, 450, 469 Consumption, 202, 450, 457, 512, 517 Contamination, 450, 482 Continence, 354, 355, 450 Continuous infusion, 450 Contraception, 450, 496 Contraceptive, 450, 512, 522 Contractility, 450 Contracture, 176, 331, 386, 450 Contraindications, ii, 6, 158, 450 Contralateral, 450, 471, 514 Contrast Media, 450, 499 Control group, 7, 450, 527, 534 Controlled clinical trial, 450, 534 Controlled study, 450 Conus, 450, 532 Convalescence, 450 Conventional therapy, 451 Conventional treatment, 451 Convulsions, 433, 451, 485, 510 Cooperative group, 451 Coordination, 443, 451 Cor, 451, 528 Corneal Edema, 451 Corneal Opacity, 451 Corneal Stroma, 451 Corneal Transplantation, 451 Coronary Arteriosclerosis, 451, 506 Coronary Circulation, 426, 451, 511 Coronary Disease, 452 Coronary heart disease, 441, 452 Coronary Thrombosis, 452, 503, 506 Coronary Vessels, 451, 452 Corpus, 452, 498, 520, 528, 543, 553 Corpus Callosum, 452, 543, 553 Cortex, 431, 437, 452, 465, 468, 470, 472, 516 Cortical, 452, 469, 542 Cortices, 452, 469, 480 Corticosteroids, 191, 362, 452, 477 Cortisol, 424, 452 Cortisone, 452, 457 Cost Savings, 452 Cost-benefit, 452 Cranial Nerves, 336, 452 Craniocerebral Trauma, 421, 452, 479, 484, 554, 558 Craniopharyngioma, 452 Craniotomy, 352, 452 Creatine, 452, 453

Index 571

Creatine Kinase, 453 Creatinine, 452, 453, 559 Credentialing, 7, 453 Cricoid Cartilage, 453, 564 Criterion, 453 Cross-Sectional Studies, 453, 466 Crowns, 453, 456 Cryostat, 453, 474 Cryosurgery, 346, 388, 453 Cryotherapy, 453 Cryptosporidiosis, 432, 453 Cues, 453 Curative, 453, 511, 553 Curettage, 388, 453, 496 Curette, 453 Cutaneous, 312, 321, 453, 505 Cyanoacrylates, 453 Cyanosis, 453, 481 Cyclic, 175, 453, 479, 511, 529, 541 Cyclin, 453 Cyclophosphamide, 454, 486 Cyst, 386, 431, 454 Cystectomy, 316, 454 Cystic Duct, 448, 454, 482 Cystitis, 315, 316, 454 Cystocele, 316, 454 Cystoid, 454 Cystoscopy, 316, 454 Cytochrome, 454 Cytokine, 454, 472, 490 Cytomegalovirus, 454, 475 Cytomegalovirus Infections, 454, 475 Cytoplasm, 429, 433, 442, 454, 466, 478, 505, 511, 539 Cytoskeleton, 454, 489, 504 Cytotoxic, 66, 439, 454, 513, 533, 534, 544 Cytotoxic chemotherapy, 454, 513 Cytotoxicity, 445, 454 D Dacryocystorhinostomy, 454 Data Collection, 454, 473 Databases, Bibliographic, 373, 455 Daunorubicin, 455, 460 Day Care, 315, 455 De novo, 455 Decision Making, 319, 332, 341, 455 Decompensation, 455 Decompression, 423, 455 Decompression Sickness, 455 Decubitus, 455, 544 Decubitus Ulcer, 455, 544 Defecation, 312, 455

Defense Mechanisms, 455, 489 Defibrillation, 455 Degenerative, 350, 387, 450, 455, 482, 499, 506, 515, 538, 539 Deletion, 429, 455 Delirium, 196, 455 Delivery of Health Care, 456, 479 Delusions, 456, 518 Dementia, 173, 422, 456 Denaturation, 456, 525 Dendrites, 456, 510 Dendritic, 456, 501, 538, 547 Dental Abutments, 456 Dental Care, 336, 456, 520 Dental Caries, 456, 473 Dental Facilities, 336, 456 Dental implant, 342, 456 Dental Instruments, 456 Dentate Gyrus, 456, 483 Dentists, 336, 396, 456 Dentures, 342, 456 Depolarization, 457, 544 Depressive Disorder, 457 Deprivation, 66, 457 Depth Perception, 457, 548 Dermal, 391, 392, 457 Dermatologist, 316, 389, 457 Dermatology, 351, 388, 393, 396, 457 DES, 218, 220, 426, 457 Desensitization, 457 Detergents, 457, 544 Developed Countries, 457 Developing Countries, 411, 457 Dexamethasone, 457 Dexrazoxane, 225, 457 Dexterity, 457 Dextrocardia, 457 Diabetes Mellitus, 176, 457, 481 Diabetic Retinopathy, 457, 523, 563 Diagnostic Imaging, 457, 532 Diagnostic procedure, 231, 348, 458 Dialysate, 458, 461 Diaphragm, 458, 482, 500, 524, 537 Diarrhea, 403, 425, 435, 453, 458, 499 Diastole, 458, 527 Diastolic, 458, 485 Diastolic pressure, 458, 485 Diathermy, 313, 458 Diathesis, 349, 458 Diclofenac, 458 Diclofenac Sodium, 458 Diencephalon, 458, 485, 520, 553

572 Surgery

Diestrus, 458 Diffusion, 435, 439, 458, 459, 488, 559 Digestion, 424, 434, 437, 458, 490, 497, 520, 549 Digestive system, 228, 458, 475, 506 Digestive tract, 403, 458, 545, 548 Dilatation, 426, 427, 458, 490, 527, 561 Dilatation, Pathologic, 458, 561 Dilated cardiomyopathy, 158, 458 Dilation, 431, 437, 458, 484, 561 Dilator, 458, 494, 511 Dilution, 459, 467, 523 Diopter, 459 Diplopia, 421, 459, 558 Discrimination, 459 Disease Progression, 459, 536 Disease-Free Survival, 214, 459 Disease-specific survival, 459 Disinfectant, 444, 459 Disinfection, 459 Diskectomy, 6, 350, 383, 384, 385, 459 Dislocation, 334, 351, 429, 459, 548 Disorientation, 449, 455, 456, 459 Disparity, 459, 548 Dissection, 313, 459, 504, 558 Dissociation, 424, 459 Diuretic, 460, 500, 546 Diverticula, 316, 340, 341, 460 Diverticulitis, 314, 460 Diverticulum, 315, 460 Dizziness, 332, 406, 460, 562 Docetaxel, 207, 460 Domestic Violence, 460, 526 Dopamine, 460, 522 Dorsal, 460, 509, 526, 547 Dorsum, 460, 475 Dosimetry, 460 Double-blinded, 460 Doxorubicin, 159, 457, 460 Drive, ii, vi, 157, 313, 314, 340, 460 Drug Delivery Systems, 460 Drug Interactions, 367, 460 Drug Tolerance, 460, 555 Drusen, 460 Ductal carcinoma in situ, 461, 491 Duodenal Ulcer, 313, 461 Duodenum, 313, 434, 435, 461, 464, 482, 492, 518, 549 Dura mater, 461, 502, 517, 521 Dwell time, 461 Dynamometer, 461 Dyskinesias, 461, 506

Dysmenorrhea, 461 Dyspareunia, 461, 468 Dysphagia, 176, 461 Dysphonia, 333, 336, 461, 563 Dysphoric, 457, 461 Dysplasia, 461 Dyspnea, 455, 461 E Ear Diseases, 461 Eardrum, 391, 461 Eating Disorders, 461 Echocardiography, 205, 461 Ectoderm, 461, 509 Ectopic, 461 Ectopic Pregnancy, 461 Edema, 176, 334, 455, 457, 461, 484, 491, 499, 507, 559 Effector, 421, 448, 461, 510 Effector cell, 461, 510 Efficacy, 4, 375, 461, 557 Effusion, 462, 553 Eicosanoids, 462 Elasticity, 430, 451, 462, 527 Elastin, 427, 447, 462, 470 Elastomers, 462, 525 Elbow Joint, 462, 515 Electric shock, 455, 462 Electrocardiography, 462 Electrocoagulation, 5, 446, 462 Electrode, 5, 442, 462 Electrodesiccation, 5, 388, 462 Electroencephalography, 462 Electrolarynx, 356, 462 Electrolysis, 427, 442, 462 Electrolyte, 456, 462, 473, 481, 512, 526, 545, 559 Electromyography, 462 Electrons, 428, 433, 434, 442, 462, 491, 517, 533, 534 Electrophoresis, 462 Electrophysiological, 462, 562 Emaciation, 422, 463 Emboli, 65, 463, 547, 564 Embolism, 463, 532, 564 Embolization, 65, 463, 564 Embolus, 463, 488 Embryo, 435, 442, 461, 463, 471, 476, 488, 502, 509, 516 Embryology, 312, 463, 471 Emollient, 463, 477, 513 Emphysema, 347, 445, 463 Empirical, 196, 202, 463

Index 573

Empyema, 463, 553 Emulsify, 463 Emulsion, 463, 473 Enalapril, 463 Enalaprilat, 463 Encapsulated, 463, 497 Encephalitis, 463, 502 Encephalitis, Viral, 463 Encephalocele, 464, 509 Encopresis, 171, 464 Endarterectomy, 399, 427, 431, 464 Endemic, 464 Endocarditis, 176, 464 Endocardium, 464, 558 Endocrine System, 464, 509 Endocrinology, 464, 479 Endodontics, 337, 464 Endometrial, 464, 517 Endometriosis, 464, 496, 512 Endometrium, 464, 479, 502, 558 Endophthalmitis, 198, 464, 563 Endorphin, 434, 464, 475 Endoscopic retrograde cholangiopancreatography, 464 Endoscopy, 315, 334, 464 Endothelial cell, 464, 465, 490, 558 Endothelium, 451, 465, 511, 558 Endothelium, Lymphatic, 465 Endothelium, Vascular, 465 Endothelium-derived, 465, 511 Endotoxemia, 465 Endotoxin, 66, 465, 558 End-stage renal, 445, 465, 525 Energetic, 186, 465 Energy balance, 465, 495 Enhancer, 465 Enkephalin, 434, 465, 528 Enteral Nutrition, 362, 465 Enteric Nervous System, 465 Enterostomal Therapy, 312, 314, 465 Entorhinal Cortex, 465, 483 Environmental Exposure, 465, 513 Environmental Health, 372, 374, 465 Enzymatic, 439, 441, 448, 456, 465, 472, 525, 538 Enzyme Inhibitors, 465, 523 Eosinophilia, 465, 471 Eosinophils, 465, 466, 478, 495 Ependyma, 466, 553 Epicondylitis, 5, 466 Epidemic, 343, 466 Epidemiologic Studies, 466

Epidemiological, 375, 466 Epidermal, 466, 493, 501, 564 Epidermis, 433, 466, 493 Epidermoid carcinoma, 466, 548 Epidural, 466, 490 Epigastric, 466, 517 Epikeratophakia, 466 Epinephrine, 362, 423, 460, 466, 492, 511, 559 Episode of Care, 466 Epithelial Cells, 466, 494 Epithelial ovarian cancer, 222, 466 Epithelium, 433, 451, 465, 466, 475, 492, 538 Epoprostenol, 466, 486 Equinus Deformity, 467 Equipment and Supplies, 391, 467 Equipment Failure, 331, 467 Erbium, 396, 467 Erectile, 467, 520 Erection, 467, 527 Ergonomics, 467 Erythrocyte Volume, 436, 467 Erythrocytes, 426, 436, 437, 440, 467, 481, 535, 542 Erythromycin, 432, 467 Erythropoietin, 467 Esophageal Achalasia, 467 Esophageal Motility Disorders, 313, 467 Esophageal speech, 356, 467 Esophageal Varices, 467, 541 Esophagitis, 467, 476 Esotropia, 421, 467, 549 Estradiol, 468 Estrogen, 468, 528, 542, 552 Estrogen Replacement Therapy, 468 Ether, 468 Ethionine, 468 Ethmoid, 468, 518 Ethnic Groups, 7, 468 Etomidate, 468 Etoposide, 207, 225, 468 Euthanasia, 468 Evacuation, 450, 468, 495 Evoke, 468, 549 Evoked Potentials, 468 Excisional, 468 Excisional biopsy, 468 Excitation, 431, 468 Excitatory, 469, 477, 510 Excitatory Amino Acids, 469, 510 Excitotoxicity, 469

574 Surgery

Exercise Test, 469 Exocrine, 469, 517 Exogenous, 423, 469, 530, 559 Exotropia, 469, 549 Expander, 469, 555 Expert Systems, 469, 474 Expiration, 469, 537 Expiratory, 469 Extensor, 469 External Fixators, 469 External radiation, 469, 549 External-beam radiation, 469, 492, 533, 564 Extracellular, 449, 450, 469, 470, 472, 489, 500, 503, 515, 545, 553 Extracellular Matrix, 449, 450, 469, 470, 472, 489, 500, 515 Extracellular Matrix Proteins, 470, 500 Extracellular Space, 469, 470, 503 Extracorporeal, 403, 404, 470, 481 Extracorporeal Circulation, 470 Extracorporeal Membrane Oxygenation, 403, 404, 470 Extraocular, 470 Extravasation, 470, 480 Extremity, 437, 470, 501, 519, 541, 559 Eye Movements, 470 F Facial Asymmetry, 470 Facial Injuries, 470 Facial Nerve, 331, 353, 470 Facial Pain, 357, 470 Facial Paralysis, 353, 405, 470 Failure to Thrive, 470 Fallopian Tubes, 470, 479, 537 Family Planning, 373, 471 Farsightedness, 471, 485 Fasciitis, 389, 471 Fatigue, 197, 471, 480 Fatty acids, 424, 462, 471, 529, 545, 554 Fatty Liver, 471 Feasibility Studies, 471 Fecal Incontinence, 171, 471, 488 Feces, 440, 450, 464, 471, 549 Femoral, 6, 350, 441, 471, 483 Femoral Artery, 441, 471 Femoral Neck Fractures, 471, 483 Femur, 350, 351, 427, 471, 483, 526 Fenretinide, 471 Fentanyl, 189, 471 Fetal Blood, 471, 500 Fetal Development, 471, 509

Fetal Heart, 471 Fetus, 444, 467, 471, 472, 523, 560 Fibrillation, 455, 472 Fibrin, 436, 446, 472, 522, 553, 554 Fibrinogen, 472, 523, 553 Fibrinolytic, 472 Fibroblasts, 450, 471, 472, 490 Fibromuscular Dysplasia, 472 Fibrosarcoma, 471, 472 Fibrosis, 175, 450, 472, 541 Fibula, 472, 526 Filgrastim, 212, 472 Filler, 472 Filtration, 472, 478 Fine-needle aspiration, 472, 508 Fissure, 421, 446, 452, 456, 472, 558 Fistula, 314, 316, 472 Flaccid, 473 Flatus, 471, 473, 475 Flecainide, 473 Flexion, 5, 473, 494 Flexor, 469, 473 Floxuridine, 211, 473 Fluid Therapy, 473, 512 Fluorescence, 473 Fluorine, 473 Fluoroscope, 473 Fluoroscopy, 473 Fluorouracil, 223, 363, 473 Flush, 473 Flushing, 7, 473 Focus Groups, 473 Fold, 332, 333, 334, 472, 473, 502, 513, 527 Follow-Up Studies, 473 Foot Care, 7, 474 Foramen, 444, 474, 482, 495, 500, 521 Forearm, 436, 462, 471, 474, 501, 533, 534, 559 Fossa, 170, 443, 474, 539 Fourth Ventricle, 443, 474, 553 Fovea, 473, 474 Frail Elderly, 474 Friction, 474, 498 Frontal Lobe, 443, 474, 505 Frozen Sections, 474 Fulguration, 5, 474 Fundus, 473, 474, 514 Fundus of the Eye, 474 Fungi, 464, 474, 503, 504, 564 Fuzzy Logic, 474 G Gait, 474

Index 575

Galanin, 474 Gallbladder, 158, 176, 313, 354, 355, 421, 434, 435, 444, 454, 458, 464, 474, 475, 482 Gallstones, 158, 176, 355, 434, 444, 474 Gamma knife, 172, 474 Gamma Rays, 475, 533, 534 Gamma-Endorphin, 475 Ganciclovir, 363, 475 Ganglia, 421, 465, 475, 509, 521, 547, 551 Ganglion, 386, 446, 467, 475, 509, 511, 513, 538, 557, 562 Gas exchange, 475, 532, 537, 561, 562 Gastrectomy, 475 Gastric Acid, 467, 475 Gastric Bypass, 158, 327, 380, 381, 475 Gastric Juices, 475, 520 Gastric Mucosa, 475, 520 Gastrin, 475, 483 Gastroenterologist, 475 Gastroenterology, 351, 475 Gastroenterostomy, 313, 475 Gastroesophageal Reflux, 177, 313, 354, 475 Gastroesophageal Reflux Disease, 177, 354, 475 Gastrointestinal, 172, 219, 354, 375, 395, 398, 430, 433, 437, 440, 465, 466, 473, 476, 496, 543, 545, 546, 548, 550, 558 Gastrointestinal tract, 172, 430, 433, 440, 473, 476, 496, 543, 546, 548, 558 Gastrostomy, 465, 476 Gastrula, 476, 484 Gemcitabine, 215, 476 Gene Expression, 476 General practitioner, 337, 476 Generator, 6, 476 Genetic Markers, 476 Genetic testing, 476, 525 Genetics, 476 Genital, 172, 406, 446, 476, 479, 531, 560 Genotype, 425, 476, 522 Geriatric, 3, 343, 476 Germ cell tumors, 172, 227, 476 Germ Cells, 476, 516, 547, 552 Gestation, 476, 523 Giardiasis, 476, 503 Gland, 423, 452, 476, 498, 500, 508, 517, 518, 528, 529, 541, 549, 551, 554 Glioblastoma, 476, 477 Glioblastoma multiforme, 477 Glioma, 477 Glomerular, 477, 500, 536

Glomerular Filtration Rate, 477, 500 Glossopharyngeal Nerve, 470, 477 Glottis, 477, 482 Glucocorticoid, 457, 477 Glucuronic Acid, 477, 481 Glutamate, 469, 477 Glutamic Acid, 190, 477, 481, 528 Glycerol, 439, 477, 522 Glycols, 477, 484 Glycoprotein, 440, 467, 472, 477, 478, 494, 553, 558 Glycosaminoglycan, 444, 477 Glycosidic, 477, 513 Gonadal, 477, 549 Gonadotropin, 478 Goniotomy, 478, 556 Governing Board, 478, 527 Grade, 477, 478 Grading, 478 Graft Rejection, 478, 487 Grafting, 387, 400, 451, 478, 487 Gram-negative, 433, 465, 478, 520 Gram-positive, 478, 520 Granisetron, 478 Granulation Tissue, 478 Granule, 456, 478, 539 Granulocyte Colony-Stimulating Factor, 472, 478 Granulocytes, 478, 544, 564 Granuloma, 386, 478 Groin, 65, 478, 489 Growth factors, 479 Guanylate Cyclase, 479, 511 Guided Tissue Regeneration, 479 Gynaecological, 479 Gynecologic cancer, 479 H Habitual, 444, 479 Haematoma, 479 Half-Life, 479, 486 Hallux Valgus, 6, 7, 479 Hand Deformities, 479 Handedness, 479 Haptens, 424, 479, 533 Head Movements, 332, 479 Headache, 352, 363, 479, 484, 485, 488 Headache Disorders, 479 Health Care Costs, 7, 204, 479, 480 Health Expenditures, 479, 480 Health Policy, 480 Health Services, 456, 480 Health Status, 480

576 Surgery

Hearing aid, 312, 480 Hearing Disorders, 448, 480 Heart Arrest, 480 Heart attack, 441, 480 Heart failure, 463, 480 Heart Valves, 480 Heartbeat, 480 Heartburn, 177, 480, 482 Heart-Lung Machine, 480 Hematocrit, 436, 480 Hematoma, 392, 480 Hematoxylin, 480 Heme, 435, 454, 480, 481 Hemiparesis, 480 Hemiplegia, 480 Hemodiafiltration, 481, 559 Hemodialysis, 458, 481, 493, 559 Hemodilution, 481 Hemodynamics, 481 Hemofiltration, 481, 559 Hemoglobin, 426, 436, 453, 467, 480, 481, 495 Hemoglobin C, 481 Hemoglobin M, 453, 481 Hemolytic, 471, 481 Hemoperitoneum, 481 Hemorrhoids, 312, 314, 481, 541 Hemostasis, 313, 481, 489, 543 Heparin, 191, 363, 481, 524 Hepatic Artery, 482 Hepatic Duct, Common, 464, 482 Hepatitis, 374, 391, 411, 482 Hepatitis A, 374, 482 Hepatitis B, 374, 391, 482 Hepatobiliary, 482 Hepatocellular, 168, 482 Hepatocellular carcinoma, 168, 482 Hepatocyte, 482 Hepatovirus, 482 Hereditary, 349, 409, 410, 482, 506, 538 Heredity, 389, 422, 476, 482 Hernia, 65, 67, 202, 354, 397, 482 Herniated, 350, 385, 482 Heterodimers, 482, 489 Heterogeneity, 424, 482 Heterotrophic, 474, 482 Heterotropia, 482, 549 Hiatal Hernia, 354, 482 Hibernation, 482 Hiccup, 482 Hip Fractures, 471, 483 Hip Prosthesis, 483

Hippocampus, 456, 483, 550 Histology, 483, 518, 521 Homeostasis, 197, 483, 545 Homologous, 481, 483, 542, 551, 557 Hormonal, 468, 483 Hormonal therapy, 483 Hormone Replacement Therapy, 315, 483 Hormone therapy, 423, 483 Hospice, 343, 483 Hospital Charges, 483 Hospital Costs, 483 Hospital Mortality, 65, 483 Host, 404, 425, 433, 483, 486, 487, 495, 560, 563 Humanism, 199, 483 Hybrid, 382, 483 Hybridomas, 483, 490 Hydra, 483 Hydrocephalus, 484, 491 Hydrochloric Acid, 484 Hydrogel, 484 Hydrogen, 421, 422, 433, 440, 456, 470, 484, 496, 505, 510, 517, 522, 530 Hydrogen Peroxide, 484, 496 Hydrolysis, 445, 484, 522, 525, 530 Hydrophilic, 457, 484 Hydrophobic, 457, 484, 496 Hydrops Fetalis, 484 Hydroxides, 484 Hydroxyl Radical, 484 Hydroxylysine, 447, 484 Hydroxyproline, 447, 484 Hygienic, 484, 544 Hyperbaric, 484 Hyperbaric oxygen, 484 Hypercarbia, 485 Hyperlipidemia, 485 Hypermetropia, 485 Hyperopia, 459, 471, 485, 535 Hyperplasia, 485 Hypersensitivity, 425, 457, 485, 495, 539, 542 Hypertension, 177, 439, 441, 463, 485, 491, 559 Hyperthermia, 458, 485, 508 Hyperthermic perfusion, 485 Hyperthyroidism, 485 Hypertrophy, 434, 451, 485, 557 Hypnotic, 433, 468, 485, 504 Hypodermic, 485 Hypoglycaemia, 456, 485 Hypopigmentation, 7, 485

Index 577

Hypospadias, 485 Hypotension, 451, 485, 524 Hypotensive, 485, 492 Hypothalamic, 485 Hypothalamus, 422, 432, 437, 438, 452, 458, 465, 485, 528, 546, 553 Hypothermia, 481, 485 Hypoventilation, 485 Hypoxanthine, 485 Hypoxemia, 486 Hypoxia, 456, 486 Hysterectomy, 315, 316, 329, 486 Hysterotomy, 444, 486 I Iatrogenic, 67, 315, 335, 486 Id, 160, 172, 380, 390, 393, 394, 395, 401, 416, 418, 486 Idiopathic, 472, 486 Ifosfamide, 486 Ileal, 340, 486 Ileostomy, 314, 315, 397, 405, 486, 508 Ileum, 442, 486, 492 Ileus, 486 Iliac Artery, 471, 486 Iliac Vein, 486 Illusion, 486, 562 Iloprost, 486 Immune adjuvant, 486 Immune function, 158, 486 Immune response, 221, 423, 428, 452, 478, 479, 486, 487, 542, 550, 560, 563 Immune Sera, 486 Immune system, 212, 221, 222, 428, 435, 461, 486, 487, 496, 499, 560, 564 Immunity, 422, 486, 487, 556 Immunization, 486, 487, 542 Immunochemistry, 487 Immunodeficiency, 65, 343, 374, 391, 422, 487 Immunodeficiency syndrome, 343, 374, 391, 487 Immunogenic, 487, 533 Immunoglobulin, 428, 487, 505 Immunohistochemistry, 487 Immunologic, 444, 486, 487, 534 Immunology, 423, 424, 487, 525 Immunosuppressant, 473, 487 Immunosuppressive, 454, 477, 486, 487 Immunosuppressive therapy, 487 Immunotherapy, 66, 403, 435, 457, 487, 508 Impaction, 487

Implant radiation, 487, 490, 492, 533, 564 Implantation, 166, 331, 363, 449, 487, 517, 555 Impotence, 467, 487, 518, 520 In situ, 487 In situ cancer, 487 In vitro, 436, 487, 525, 555 Incisional, 5, 487 Incisive, 312, 487 Incisor, 487 Incompetence, 475, 487 Incontinence, 182, 312, 315, 340, 355, 464, 484, 487, 549 Incus, 488, 500, 548 Indicative, 316, 488, 519, 561 Indolent, 488 Induction, 167, 458, 468, 488, 493, 528, 553 Infancy, 168, 488, 503 Infant, Newborn, 424, 488 Infarction, 179, 443, 488, 537, 547 Inferior vena cava, 486, 488 Infertility, 488, 560 Infiltration, 488, 528 Inflammatory bowel disease, 314, 348, 402, 488 Inflammatory breast cancer, 212, 225, 488, 519 Influenza, 488 Informed Consent, 341, 397, 488 Infuse, 488 Infusion, 66, 473, 489, 507, 541, 556 Ingestion, 473, 489, 525, 553 Inguinal, 67, 203, 313, 489 Inguinal Hernia, 67, 203, 313, 489 Inhalation, 362, 366, 424, 430, 482, 489, 492, 525 Initiation, 489, 556 Inlay, 489, 537 Inner ear, 332, 436, 446, 489 Innervation, 437, 470, 489, 501, 504, 522, 531, 541, 554, 557, 559 Inorganic, 445, 484, 489, 506, 524 Inotropic, 460, 489 Insertional, 331, 389, 489 Insight, 489 Insomnia, 3, 178, 489 Insufflation, 202, 489 Insulator, 489 Insulin, 168, 178, 201, 489, 492, 493, 559 Insulin-dependent diabetes mellitus, 489 Insulin-like, 489 Integrins, 489

578 Surgery

Intensive Care, 352, 490 Intercostal, 490 Interleukin-1, 490 Interleukin-10, 490 Interleukin-2, 490 Interleukin-6, 490 Interleukin-8, 490 Intermittent, 178, 473, 490, 497, 522 Internal Medicine, 166, 328, 464, 475, 490, 539 Internal radiation, 490, 492, 533, 564 Interstitial, 315, 316, 437, 470, 490, 492, 536, 564 Intervertebral, 459, 482, 490, 498, 533, 541 Intervertebral Disk Displacement, 490, 498, 533, 541 Intestinal, 202, 203, 219, 312, 403, 405, 410, 433, 441, 453, 490, 499, 506 Intestinal Obstruction, 490 Intestine, 313, 434, 435, 437, 442, 447, 454, 461, 464, 476, 483, 486, 489, 490, 492, 494, 507, 521, 545, 562, 563 Intoxication, 456, 490, 564 Intracellular, 439, 488, 489, 490, 502, 511, 526, 529, 541, 544 Intracranial Aneurysm, 490 Intracranial Hemorrhages, 484, 490 Intracranial Hypertension, 421, 479, 484, 490, 554 Intracranial Pressure, 443, 491, 531 Intraductal carcinoma, 461, 491 Intramuscular, 491, 519 Intraocular pressure, 491 Intraoperative Complications, 491 Intraoperative Period, 491 Intraperitoneal, 491 Intrathecal, 491 Intravascular, 169, 491, 553 Intravenous, 171, 382, 489, 491, 519 Intravesical, 343, 491 Intrinsic, 355, 424, 433, 491 Intubation, 442, 491 Intussusception, 491, 535 Involuntary, 408, 461, 471, 472, 479, 491, 507, 535, 545, 546, 549 Ion Channels, 491, 510 Ion Pumps, 491 Ionizing, 425, 465, 491, 534 Ions, 433, 439, 440, 459, 462, 484, 491, 530 Ipsilateral, 492 Irinotecan, 211, 215, 220, 492

Iris, 203, 427, 430, 451, 478, 492, 494, 526, 532, 541, 560 Irradiation, 492, 564 Irrigation, 492 Islet, 492, 509 Isoenzyme, 453, 492 Isoflurane, 492 Isoproterenol, 492 Isotretinoin, 212, 492 J Jealousy, 492, 518 Jejunoileal Bypass, 435, 492 Jejunostomy, 465, 492 Jejunum, 435, 475, 492 Joint Capsule, 492, 552 K Kallidin, 437, 492 Kb, 372, 493 Keloid, 493 Keratectomy, 493 Keratinocytes, 490, 493 Kerato, 493 Keratoconjunctivitis, 493 Keratoconjunctivitis Sicca, 493 Keratomileusis, 493 Keratotomy, 493 Ketamine, 493 Keto, 493, 556 Ketone Bodies, 421, 493 Ketorolac, 191, 364, 493 Keyhole, 493 Kidney Failure, 465, 493, 500 Kidney Pelvis, 493, 560 Kidney stone, 316, 493 Kidney Transplantation, 316, 493 Kinesis, 493 Kinetic, 491, 494 Kyphosis, 494 L Labile, 448, 494 Labyrinth, 446, 489, 494, 516, 542, 562 Lacerations, 494 Lacrimal, 454, 470, 493, 494, 507 Lactation, 494, 528 Lamella, 494 Laminin, 433, 470, 494 Language Disorders, 448, 494 Laparoscopic-assisted colectomy, 223, 447, 494 Laparoscopy, 312, 313, 315, 349, 355, 494 Laparotomy, 494

Index 579

Large Intestine, 314, 403, 442, 447, 458, 490, 494, 535, 545, 563 Laryngeal, 216, 312, 332, 333, 334, 390, 406, 453, 494 Laryngeal Nerves, 333, 494 Laryngectomy, 333, 406, 494 Laryngoscopes, 334, 494 Laryngoscopy, 334, 494 Larynx, 311, 334, 356, 406, 477, 494, 556, 561, 563 Latent, 495, 527, 531 Latent period, 495, 531 Lateral Ventricles, 495, 543, 553 Lavage, 4, 495 Laxative, 364, 424, 440, 495, 503, 546 Least-Squares Analysis, 495, 536 Legal blindness, 495 Length of Stay, 201, 203, 495 Lenticular, 495 Leprosy, 495 Leptin, 495 Lethal, 433, 495 Lethargy, 484, 495 Leucine, 434, 495, 520 Leukemia, 209, 223, 225, 460, 495 Leukocytes, 433, 436, 437, 444, 466, 478, 495, 505, 511, 558 Leukocytosis, 495 Leukotrienes, 429, 462, 495 Levonorgestrel, 496, 512 Library Services, 416, 496 Lidocaine, 364, 496 Life cycle, 474, 496 Life Expectancy, 496 Ligament, 5, 6, 319, 386, 427, 496, 526, 529, 548 Ligamentum Flavum, 496 Ligands, 489, 496 Ligation, 170, 313, 340, 496 Light microscope, 496, 504 Likelihood Functions, 496, 536 Limited-stage small cell lung cancer, 215, 496 Linear Models, 496, 536 Linkage, 476, 496 Lip, 216, 342, 496, 500 Lipectomy, 496 Lipid, 429, 430, 439, 477, 489, 493, 496, 504, 517, 557 Lipid Peroxidation, 496, 517 Lipopolysaccharide, 478, 496 Lipoprotein, 478, 496, 498

Liposomal, 497 Liquor, 497, 532 Lithotomy, 497 Lithotomy position, 497 Liver cancer, 223, 497 Liver metastases, 218, 219, 220, 497 Liver Neoplasms, 468, 497 Liver scan, 497, 540 Liver Transplantation, 497 Lobe, 443, 497, 519, 528 Lobectomy, 65, 497 Local therapy, 352, 497 Localization, 487, 497 Logistic Models, 497, 536 Longitudinal Studies, 453, 497 Longitudinal study, 497 Long-Term Care, 497 Loop, 5, 191, 340, 475, 482, 486, 497 Lordosis, 498 Lordotic, 498 Low Back Pain, 162, 178, 383, 388, 498 Low vision, 498 Low-density lipoprotein, 497, 498 Lower Esophageal Sphincter, 354, 467, 475, 476, 498 Lubricants, 7, 498, 522 Lubrication, 498 Lumen, 439, 441, 465, 498 Lumpectomy, 438, 498 Lunate, 6, 498 Lung metastases, 498 Lung Transplantation, 498 Lung volume, 498, 537 Lutein Cells, 498, 528 Luxation, 459, 498 Lymphatic, 178, 465, 488, 498, 499, 502, 524, 545, 547, 554 Lymphatic system, 498, 499, 545, 547, 554 Lymphedema, 499 Lymphoblastic, 499 Lymphoblasts, 422, 499 Lymphocyte, 66, 422, 428, 499, 501 Lymphocyte Count, 422, 499 Lymphocytic, 499 Lymphoid, 428, 452, 478, 499 Lymphoma, 499 Lysine, 191, 481, 484, 499 M Macrophage, 490, 499 Macula, 474, 499 Macula Lutea, 499 Macular Degeneration, 178, 179, 499

580 Surgery

Magnetic Resonance Angiography, 68, 499 Magnetic Resonance Imaging, 200, 384, 385, 499, 540 Malabsorption, 179, 499, 543 Malabsorption syndrome, 499, 543 Malformation, 499 Malignancy, 343, 499 Malignant mesothelioma, 216, 220, 499, 502 Malignant tumor, 312, 388, 440, 500, 516, 539 Malleus, 488, 500 Malnutrition, 424, 500, 506 Mammaplasty, 500 Mammary, 451, 500, 511, 552 Mammary Arteries, 500 Mammogram, 439, 500, 503 Mammography, 500 Mandible, 311, 444, 500, 537 Mandibular Condyle, 500 Manifest, 480, 500, 549 Mannitol, 500 Manometry, 500 Mastectomy, 438, 500, 528, 542 Mastication, 500, 557 Maternal-Fetal Exchange, 500 Matrix metalloproteinase, 500 Maxillary, 430, 500, 518, 557 Maxillary Nerve, 500, 557 Maxillary Sinus, 500 Meatus, 461, 500, 559, 560 Mechanical ventilation, 501 Mechanoreceptors, 501, 537 Medial, 430, 468, 469, 501, 514, 526, 540, 547, 554, 559 Median Nerve, 441, 501 Mediate, 446, 460, 501 Mediator, 490, 501, 524, 543 Medical Assistance, 501 Medical Illustration, 314, 501 Medical Records, 501, 539 Medical Staff, 460, 501 Medication Errors, 501 MEDLINE, 373, 501 Medroxyprogesterone, 501 Medullary, 501, 509 Medulloblastoma, 210, 213, 501 Melanin, 485, 492, 501, 522, 559 Melanocytes, 485, 501 Melanoma, 68, 217, 388, 501 Melanosomes, 501

Membrane Proteins, 491, 502, 530 Memory, 3, 173, 332, 427, 456, 502 Meninges, 443, 444, 452, 461, 502, 547 Meningioma, 502 Meningitis, 179, 331, 352, 502 Meningoencephalitis, 502 Meniscus, 383, 502 Menopause, 315, 502, 526, 527 Menstrual Cycle, 214, 227, 502, 528 Menstruation, 461, 502 Mental Disorders, 229, 502, 531 Mental Health, iv, 229, 372, 376, 502, 532 Mental Processes, 459, 502, 531 Mental Retardation, 448, 502 Mentors, 502 Mesenchymal, 502 Mesenteric, 433, 502 Mesentery, 502, 522 Mesoderm, 502, 558 Mesothelioma, 216, 220, 499, 502 Meta-Analysis, 503 Metabolite, 463, 503 Metaplasia, 503 Metastasis, 168, 500, 503 Metastatic, 66, 169, 171, 209, 217, 220, 438, 503, 541 Metatarsophalangeal Joint, 479, 503 Metestrus, 503 Methionine, 169, 434, 468, 503, 528 Methylcellulose, 363, 503 Metopic, 503 Metronidazole, 503 Microbe, 503, 555 Microbiology, 422, 432, 503 Microcalcifications, 439, 503 Microcirculation, 481, 503 Microdialysis, 503 Microkeratome, 503 Micromanipulators, 159, 503 Microorganism, 427, 446, 504, 563 Microscopy, 433, 480, 504 Microspheres, 504 Microsurgery, 168, 330, 332, 334, 388, 405, 504 Microtubules, 504, 517 Midazolam, 364, 504 Migration, 331, 504 Milliliter, 437, 504 Millimeter, 504 Mineralization, 504, 516 Miosis, 504 Miotic, 504

Index 581

Mitochondrial Swelling, 504, 508 Mitomycin, 368, 504 Mitosis, 429, 504 Mitotic, 460, 468, 504 Mitotic inhibitors, 460, 504 Mitral Valve, 67, 179, 504 Mitral Valve Prolapse, 179, 504 Mobility, 320, 350, 357, 385, 396, 505 Modeling, 197, 505 Modification, 350, 375, 505, 532 Mohs Surgery, 505 Molecular mass, 505 Monoclonal, 212, 225, 483, 492, 505, 533, 557, 564 Monoclonal antibodies, 212, 225, 505, 557 Monocytes, 490, 495, 505, 524 Mononuclear, 471, 478, 505, 558 Monophosphate, 473, 505 Morphine, 505, 507, 514 Morphological, 463, 501, 505 Morphology, 441, 505 Motility, 467, 505, 543 Motion Sickness, 505, 508 Motor Cortex, 168, 505 Motor nerve, 506, 513, 521 Motor Skills, 506 Movement Disorders, 461, 506 Mucinous, 475, 506 Mucins, 506, 540 Mucosa, 433, 438, 475, 506, 507, 528, 550 Mucositis, 506, 554 Mucus, 166, 506, 559 Multicenter study, 506 Multiple Organ Failure, 506 Multivariate Analysis, 506 Muscle Fibers, 506, 507, 558 Muscle Relaxation, 172, 506 Muscular Atrophy, 506 Muscular Diseases, 470, 506, 518 Musculature, 472, 506, 548 Musculoskeletal System, 506, 515 Myalgia, 488, 506 Mydriatic, 458, 506 Myenteric, 467, 506 Myocardial infarction, 434, 452, 503, 506, 507, 564 Myocardial Ischemia, 426, 452, 506 Myocardial Reperfusion, 507, 537 Myocardial Reperfusion Injury, 507, 537 Myosin, 507, 558 N Naloxone, 434, 507

Narcosis, 482, 507 Narcotic, 203, 365, 471, 505, 507, 511, 556 Nasal Cavity, 216, 500, 507, 518 Nasal Mucosa, 488, 507 Nasal Septum, 507 Nasogastric, 465, 507 Nasolacrimal, 454, 507 Nasopharynx, 311, 477, 507 Natural Disasters, 507 Nausea, 179, 428, 507, 513, 531, 559, 560 Nearsightedness, 399, 507, 508, 533 Neck Muscles, 352, 508 Neck Pain, 328, 382, 508 Necrosis, 169, 384, 429, 437, 443, 464, 471, 476, 488, 503, 506, 507, 508, 537 Necrotizing Enterocolitis, 508 Needle biopsy, 316, 472, 508 Needlestick Injuries, 508 Neoadjuvant Therapy, 508 Neodymium, 393, 508 Neonatal, 167, 508 Neonatologist, 508 Neoplasia, 68, 313, 508 Neoplasm, 508, 540, 558 Neoplastic, 388, 426, 444, 470, 483, 499, 508 Nephrectomy, 313, 316, 340, 508 Nephron, 508 Nerve Fibers, 422, 437, 446, 509, 514, 547, 554 Nerve Growth Factor, 509, 510 Nervous System, 166, 323, 335, 408, 421, 423, 424, 432, 437, 438, 439, 443, 444, 468, 475, 476, 477, 496, 501, 502, 505, 509, 510, 514, 521, 525, 543, 551, 561 Networks, 404, 410, 509 Neural, 336, 424, 464, 495, 501, 509, 531, 537, 538 Neural Crest, 509 Neural Pathways, 336, 509 Neural tube defects, 509 Neuralgia, 357, 509 Neuroblastoma, 209, 210, 211, 212, 217, 509 Neuroectodermal Tumors, 509 Neuroendocrine, 509 Neuroendocrine tumor, 509 Neurogenic, 509, 560 Neurogenic Inflammation, 509 Neuroleptic, 509, 513 Neurologic, 464, 477, 484, 510 Neurologist, 406, 510

582 Surgery

Neuroma, 352, 353, 510 Neuromuscular, 421, 470, 510, 518, 559, 561 Neuronal, 439, 507, 510, 521 Neuronal Plasticity, 510 Neurons, 446, 456, 469, 475, 509, 510, 547, 551, 562 Neuropathy, 510, 541, 552 Neuropeptide, 510 Neuroprotective Agents, 510 Neuropsychological Tests, 510 Neuroretinitis, 510, 538 Neurosurgeon, 510 Neurosurgical Procedures, 510 Neurotransmitters, 469, 505, 510, 545 Neurotrophins, 510 Neutralization, 510 Neutrons, 425, 492, 510, 533 Neutropenia, 511, 524 Neutrophils, 472, 478, 490, 495, 511, 524 Niacin, 511, 558 Night Blindness, 511, 538 Nipples, 511 Nitric Oxide, 511 Nitrogen, 425, 429, 454, 455, 470, 473, 505, 511, 558 Nitroglycerin, 511 Nitrous Oxide, 191, 511 Nodose, 494, 511 Nodose Ganglion, 494, 511 Nonmetastatic, 171, 209, 210, 511 Non-small cell lung cancer, 167, 207, 210, 213, 215, 219, 221, 222, 225, 511 Nonverbal Communication, 448, 511, 531 Norepinephrine, 423, 460, 511 Norgestrel, 496, 512 Nosocomial, 159, 512 Nuclear, 169, 433, 439, 462, 475, 476, 508, 512, 538, 553 Nuclear Medicine, 169, 512 Nuclei, 425, 446, 462, 467, 470, 499, 504, 510, 512, 513, 514, 530, 562 Nucleic acid, 485, 511, 512 Nursing Care, 512, 519 Nursing Staff, 512 Nutritional Status, 512 Nutritional Support, 314, 476, 512 Nystagmus, 332, 512 O Observational study, 66, 68, 512 Occipital Lobe, 459, 512, 563 Occult, 167, 512

Occupational Exposure, 374, 512 Oculomotor, 459, 512, 513 Oculomotor Nerve, 459, 513 Odds Ratio, 513, 536 Ointments, 513, 518, 544, 545 Olfaction, 335, 513 Oligosaccharides, 190, 513 Oliguria, 493, 500, 513 Omentum, 482, 513 Oncogene, 513 Oncogenic, 489, 513, 530 Ondansetron, 365, 513 Oophorectomy, 513 Opacity, 441, 456, 513 Operating Rooms, 513 Ophthalmic Artery, 513, 538 Ophthalmologic, 513 Ophthalmologist, 513 Ophthalmoscopes, 514 Opioid Peptides, 514 Opium, 505, 514, 518 Opportunistic Infections, 422, 514 Opsin, 514, 538 Optic Chiasm, 485, 514 Optic cup, 514, 520 Optic Nerve, 460, 510, 514, 517, 520, 531, 538, 541 Optic Nerve Diseases, 514, 531 Optic nerve head, 460, 510, 514 Oral Health, 336, 514 Oral Surgical Procedures, 514 Orbit, 421, 513, 514, 558 Orbital, 421, 514, 558 Orchiectomy, 316, 340, 514 Organ Culture, 514, 555 Organ Preservation, 356, 514 Organ Transplantation, 515 Organelles, 443, 454, 501, 505, 515 Organizational Culture, 515 Orofacial, 170, 342, 470, 515 Oropharynx, 311, 515 Orthodontics, 337, 515 Orthopedic Procedures, 515 Orthopedics, 351, 515 Orthotic Devices, 385, 515 Osmolarity, 500, 515 Osmotic, 424, 504, 515, 543 Ossicles, 488, 500, 515, 516, 548 Ossification, 515 Osteoarthritis, 4, 6, 179, 350, 351, 380, 382, 384, 515 Osteoblasts, 515

Index 583

Osteocalcin, 515 Osteochondritis Dissecans, 5, 515 Osteogenesis, 392, 399, 515, 516 Osteogenesis Imperfecta, 392, 399, 516 Osteogenic sarcoma, 516 Osteomalacia, 516 Osteomyelitis, 516 Osteoporosis, 179, 382, 468, 516 Osteosarcoma, 171, 222, 516 Osteotomy, 6, 7, 330, 391, 516 Ostomy, 405, 410, 465, 516 Otitis, 312, 331, 516 Otitis Media, 312, 331, 516 Otolaryngologist, 516 Otorhinolaryngology, 311, 335, 351, 516 Otosclerosis, 171, 312, 516 Outpatient, 158, 388, 466, 516 Ovarian epithelial cancer, 208, 222, 224, 516 Ovaries, 466, 470, 479, 513, 516, 528, 537, 543 Ovary, 172, 468, 516 Overall survival, 516 Overweight, 158, 160, 382, 516 Ovum, 476, 496, 516, 517, 528, 558, 564 Ovum Implantation, 517, 558 Oxaliplatin, 517 Oxidation, 421, 428, 454, 481, 496, 517 Oxidative Stress, 517 Oxygen Consumption, 469, 517, 537 Oxygenation, 201, 455, 486, 517 Oxygenator, 441, 470, 480, 517 P Pacemaker, 517 Pachymeningitis, 502, 517 Paclitaxel, 159, 170, 213, 517 Paediatric, 67, 517 Pain, Postoperative, 517 Palate, 446, 477, 507, 517, 561 Palliative, 517, 553 Palpation, 517 Palsy, 159, 174, 517 Pancreas, 421, 435, 458, 475, 482, 489, 492, 517, 518, 546, 558 Pancreatic, 179, 464, 475, 517, 518 Pancreatic cancer, 517 Pancreatic Ducts, 464, 517 Pancreatic Juice, 475, 517, 518 Pancreatitis, 179, 518 Papaverine, 159, 514, 518 Papilla, 464, 518 Papillary, 518

Papilledema, 518, 531 Paraffin, 518 Parallax, 518 Paralysis, 331, 333, 334, 353, 468, 470, 480, 518, 519, 531, 546 Paranasal Sinuses, 311, 500, 518 Paranoia, 3, 518 Paraplegia, 518 Parathyroid, 66, 68, 169, 518, 553 Parathyroid Glands, 518 Parathyroid hormone, 518 Parenteral, 360, 363, 366, 518 Paresis, 470, 480, 519 Parietal, 519, 522, 524 Paroxysmal, 332, 426, 479, 519 Partial remission, 519, 536 Particle, 519, 546, 556 Parturition, 519, 528 Patch, 450, 519 Patella, 350, 519 Pathogenesis, 519 Pathologic, 422, 429, 435, 437, 451, 485, 519, 526, 537, 543, 547, 561 Pathologic Processes, 429, 519 Pathologies, 519 Pathophysiology, 5, 519 Patient Advocacy, 406, 519 Patient Care Management, 341, 342, 519 Patient Education, 339, 340, 341, 343, 381, 382, 414, 416, 419, 519 Patient Satisfaction, 196, 204, 519 Patient Selection, 167, 313, 316, 334, 353, 519 Patient Transfer, 519 Peau d'orange, 488, 519 Pediatric Dentistry, 337, 519 Pediatrics, 166, 328, 520 Pedicle, 334, 520 Peer Review, 157, 520 Pefloxacin, 520 Penile Prosthesis, 316, 520 Penis, 315, 485, 520, 522, 527, 537 Pepsin, 520 Pepsin A, 520 Peptic, 67, 179, 182, 313, 520, 541 Peptic Ulcer, 67, 179, 313, 520, 541 Peptic Ulcer Hemorrhage, 520, 541 Peptide, 434, 475, 495, 514, 520, 525, 528, 530 Perception, 196, 332, 390, 449, 457, 480, 520, 540 Perforation, 67, 429, 474, 520, 556, 563

584 Surgery

Perfusion, 486, 520, 555 Perianal, 314, 520 Pericardial Effusion, 69, 521 Pericardium, 521 Peridural, 521 Perineal, 315, 521, 533 Perineum, 312, 485, 521 Perineural, 521 Periodontal disease, 479, 521 Periodontal Ligament, 479, 521 Periodontics, 337, 521 Peripheral blood, 212, 222, 521 Peripheral Nerves, 495, 521 Peripheral Nervous System, 480, 509, 517, 518, 521, 540, 546, 550 Peripheral Nervous System Diseases, 480, 518, 521 Peripheral stem cell transplantation, 209, 212, 213, 521 Peripheral vision, 521, 563 Peristalsis, 521 Peritoneal, 208, 220, 224, 458, 461, 481, 491, 521, 522 Peritoneal Cavity, 208, 224, 481, 491, 521, 522 Peritoneal Dialysis, 458, 461, 522 Peritoneum, 502, 513, 521, 522, 539 Peritonitis, 180, 522, 563 Peroneal Nerve, 522, 541 Pessary, 522 Petroleum, 518, 522 PH, 437, 522 Phallic, 473, 522 Pharmacokinetic, 522 Pharmacologic, 426, 479, 522, 555, 560 Pharynx, 311, 475, 488, 507, 515, 522, 561 Phenotype, 522 Phenylalanine, 520, 522, 559 Phenylbutyrate, 368, 522 Phospholipases, 522, 544 Phospholipids, 471, 496, 522 Phosphorus, 187, 439, 518, 522 Phosphorylation, 522 Photocoagulation, 446, 522 Photodynamic therapy, 216, 523 Photoreceptors, 523 Physical Examination, 383, 384, 385, 386, 444, 523 Physical Fitness, 523, 547 Physical Therapy, 6, 196, 201, 350, 383, 384, 385, 409, 523 Pigment, 435, 494, 501, 523, 538

Pigmentation, 523, 563 Pilot study, 523 Pitch, 523, 563 Placenta, 468, 471, 523, 528 Plague, 523 Plants, 425, 431, 434, 438, 440, 446, 477, 505, 512, 523, 540, 556, 557, 561 Plaque, 427, 431, 444, 523 Plasma cells, 428, 478, 523 Plasma protein, 424, 465, 523, 530, 543 Plasma Volume, 436, 523 Plastic surgeon, 524 Plasticity, 481, 524 Platelet Activating Factor, 524 Platelet Activation, 524, 544 Platelet Aggregation, 426, 466, 486, 511, 524, 554 Platelet Factor 4, 490, 524 Platelet Transfusion, 524 Platelets, 434, 511, 524, 553, 554 Platinum, 224, 225, 326, 445, 497, 517, 524 Platinum Compounds, 517, 524 Plethysmography, 524 Pleura, 524 Pleural, 69, 444, 524, 553 Plexus, 437, 467, 524, 541 Pneumothorax, 524, 553 Podophyllotoxin, 468, 524 Poisoning, 456, 490, 508, 525, 543 Polyarthritis, 493, 525 Polychromatic, 525 Polycystic, 525 Polyethylene, 6, 365, 382, 525 Polyethyleneimine, 525 Polyglycolic Acid, 525 Polymerase, 525 Polymerase Chain Reaction, 525 Polymers, 437, 525, 530, 550 Polypeptide, 425, 447, 472, 520, 525, 528, 546 Polyposis, 447, 525 Polysaccharide, 428, 443, 477, 525, 530 Polyurethanes, 525 Polyvinyl Alcohol, 525 Pons, 421, 433, 438, 470, 474, 525 Popliteal, 526 Porosity, 526 Port-a-cath, 526 Positive pressure ventilation, 526 Posterior chamber, 526 Posterior Cruciate Ligament, 350, 526 Postmenopausal, 468, 516, 526

Index 585

Postnatal, 526, 548 Postoperative Complications, 214, 354, 526 Postoperative Hemorrhage, 526 Postoperative Period, 333, 353, 382, 526 Postsynaptic, 526, 544, 551 Post-traumatic, 479, 506, 526 Post-traumatic stress disorder, 526 Potassium, 159, 162, 168, 526, 545 Potentiates, 490, 526 Potentiation, 526, 544 Practicability, 471, 526, 557 Practice Guidelines, 376, 393, 526 Praseodymium, 527 Precancerous, 7, 393, 444, 527 Precipitation, 527 Preclinical, 403, 527 Precursor, 429, 454, 460, 461, 465, 475, 478, 511, 522, 527, 528, 530, 558, 559 Predictive factor, 527 Predisposition, 527 Preload, 527 Premalignant, 527 Premenopausal, 227, 527 Prepuce, 445, 527 Presbycusis, 312, 527 Presbyopia, 527 Prevalence, 159, 513, 527 Priapism, 316, 527 Primary endpoint, 527 Primary tumor, 527, 542 Primitive neuroectodermal tumors, 210, 213, 501, 527 Probe, 503, 527 Problem Solving, 314, 527 Procaine, 496, 528 Proctocolectomy, 528 Proestrus, 528 Progesterone, 192, 365, 496, 512, 528, 549 Prognostic factor, 528 Progression, 427, 528, 558 Progressive, 172, 442, 445, 456, 460, 468, 478, 506, 508, 515, 524, 527, 528, 531, 536, 538, 558 Progressive disease, 528 Projection, 455, 512, 514, 528 Prolactin, 528 Prolapse, 314, 315, 528, 531, 532 Proline, 447, 484, 528 Promoter, 528 Prone, 528 Prone Position, 528

Pro-Opiomelanocortin, 475, 514, 528 Prophylactic mastectomy, 528 Prophylactic oophorectomy, 528 Prophylaxis, 394, 528, 560, 564 Propofol, 528 Prospective Studies, 528 Prospective study, 497, 529 Prostaglandin, 466, 529, 554 Prostaglandins A, 529 Prostate, 66, 174, 180, 315, 434, 435, 471, 529, 533, 537, 539, 557, 558 Prostate gland, 529 Prostatectomy, 316, 529, 533 Prostatic Hyperplasia, 174, 529 Prostheses and Implants, 430, 529 Prosthesis, 171, 356, 430, 456, 529 Prosthodontics, 337, 529 Protease, 448, 530 Protective Agents, 439, 530 Protein Binding, 530, 555 Protein C, 424, 425, 429, 433, 496, 515, 530, 558, 559 Protein S, 329, 435, 467, 515, 530, 539, 553 Proteoglycans, 433, 470, 530 Proteolytic, 448, 472, 530 Prothrombin, 159, 530, 553 Proton Pump, 530 Proton Pump Inhibitors, 530 Protons, 425, 484, 491, 530, 533 Proto-Oncogene Proteins, 517, 530 Proto-Oncogene Proteins c-mos, 517, 530 Protozoal, 530, 558 Pruritus, 314, 531, 559 Pruritus Ani, 314, 531 Pseudopregnancy, 503, 531 Pseudotumor Cerebri, 491, 531 Pseudoxanthoma, 392, 531 Pseudoxanthoma Elasticum, 392, 531 Psychiatric, 158, 448, 502, 531, 544 Psychic, 186, 531, 542 Psychogenic, 531, 560 Psychological Adaptation, 531 Psychology, 327, 459, 531 Psychomotor, 456, 464, 510, 531 Psychopathology, 531 Psychosexual, 531 Psychosexual Development, 531 Psychotherapy, 447, 531 Ptosis, 531 Puberty, 531 Public Assistance, 501, 531 Public Health, 376, 531

586 Surgery

Public Policy, 373, 532 Publishing, 65, 167, 313, 314, 333, 334, 335, 340, 405, 532 Pulmonary Alveoli, 485, 532 Pulmonary Artery, 436, 532, 562 Pulmonary Edema, 180, 493, 532 Pulmonary Embolism, 532, 564 Pulmonary hypertension, 451, 467, 532 Pulmonary Ventilation, 532, 537 Pulposus, 490, 532 Pulsation, 532 Pulse, 352, 505, 532 Punctures, 355, 532 Pupil, 451, 458, 504, 506, 532 Purifying, 457, 532 Purulent, 421, 464, 532 Pyogenic, 5, 386, 516, 532 Q Quadrantectomy, 438, 532 Quality of Life, 172, 199, 200, 352, 402, 403, 405, 409, 410, 532 Quiescent, 532 R Race, 197, 496, 504, 512, 532 Radial Artery, 532 Radial Keratotomy, 533 Radical prostatectomy, 533 Radicular, 533 Radiculopathy, 533, 541 Radio Waves, 458, 533 Radioactive, 437, 479, 484, 487, 490, 492, 497, 505, 512, 513, 533, 534, 540, 564 Radiofrequency ablation, 220, 533 Radiography, 427, 443, 450, 533 Radioimmunoassay, 434, 533 Radioimmunotherapy, 533, 534 Radiolabeled, 492, 533, 564 Radiological, 315, 331, 380, 398, 520, 533 Radiologist, 533 Radiology, 322, 512, 533, 534 Radiolucent, 534 Radiopharmaceutical, 476, 534 Radius, 5, 533, 534 Ramus, 500, 534 Random Allocation, 534 Randomization, 534 Randomized Controlled Trials, 534 Rape, 526, 534 Reagent, 484, 534 Recombinant, 368, 534, 561 Recombination, 476, 535 Recovery of Function, 535

Recovery Room, 4, 388, 535 Rectal Prolapse, 312, 535 Rectovaginal Fistula, 315, 535 Recuperation, 535 Recurrent cancer, 535 Red blood cells, 467, 481, 535, 540 Reentry, 535 Refer, 1, 438, 448, 460, 472, 474, 497, 498, 499, 509, 511, 512, 526, 533, 535, 543, 562 Reference point, 535 Reflective, 535 Reflex, 408, 470, 535, 537 Reflux, 467, 475, 476, 535 Refraction, 507, 535, 546 Refractive Errors, 459, 466, 535 Refractive Power, 427, 485, 507, 535 Refractory, 462, 535 Regeneration, 535 Regimen, 158, 208, 212, 366, 375, 446, 461, 535 Regional cancer, 65, 535 Regional chemotherapy, 536 Regional lymph node, 536 Registries, 536 Regression Analysis, 536 Regurgitation, 467, 475, 480, 504, 536 Rehabilitative, 335, 536 Relapse, 536 Relative risk, 536 Relaxant, 518, 536 Reliability, 536 Remission, 535, 536 Renal cell cancer, 221, 226, 536 Renal failure, 456, 536 Renal pelvis, 493, 536 Renovascular, 316, 536 Reoperation, 536 Reperfusion, 321, 507, 536, 537 Reperfusion Injury, 321, 537 Reproductive system, 529, 537 Research Design, 537 Resected, 341, 537 Resident physician, 537 Residual disease, 537 Resorption, 484, 537 Respiration, 429, 440, 505, 537, 538 Respirator, 501, 526, 537, 562 Respiratory distress syndrome, 537 Respiratory failure, 470, 537, 562 Respiratory Mechanics, 537 Respiratory Physiology, 537, 562 Respiratory System, 424, 537

Index 587

Resting metabolic rate, 537 Restoration, 333, 389, 453, 507, 523, 529, 536, 537, 538, 550, 564 Resuscitation, 538 Retching, 538 Retinae, 499, 538 Retinal Artery, 538 Retinal Detachment, 457, 538, 541, 563 Retinal Ganglion Cells, 514, 538 Retinal Hemorrhage, 538 Retinitis, 538 Retinitis Pigmentosa, 538 Retinoid, 538 Retinol, 538 Retinopathy, 181, 457, 538 Retractor, 538 Retrograde, 539 Retroperitoneal, 170, 317, 539 Retropubic, 529, 533, 539 Retropubic prostatectomy, 533, 539 Retrospective, 65, 66, 67, 68, 168, 539 Retrospective Studies, 539 Retrospective study, 65, 67, 539 Rhabdomyosarcoma, 217, 539 Rheumatic Diseases, 331, 539 Rheumatism, 539 Rheumatoid, 181, 331, 350, 351, 384, 539 Rheumatoid arthritis, 331, 350, 351, 384, 539 Rheumatology, 330, 331, 539 Ribose, 423, 539 Ribosome, 539, 556 Rigidity, 491, 523, 539 Risk patient, 334, 539 Rod, 433, 446, 465, 539 Rotator, 384, 539 Rotator Cuff, 384, 539 Rubber, 422, 462, 539 S Saccades, 540 Saccule, 540, 562 Sagittal, 540 Saline, 438, 540 Saliva, 540 Salivary, 336, 454, 458, 470, 517, 540, 564 Salivary glands, 336, 454, 458, 470, 540 Saphenous, 451, 540 Saphenous Vein, 451, 540 Saponins, 540, 549 Sarcoma, 209, 217, 218, 527, 540, 545 Sarcomere, 540 Scalpel, 5, 7, 540

Scans, 540 Schematic, 540 Schizoid, 540, 564 Schizophrenia, 518, 540, 564 Schizotypal Personality Disorder, 540, 564 Schwannoma, 352, 540 Sciatic Nerve, 522, 541, 554 Sciatica, 383, 541 Sclera, 445, 449, 450, 541, 560 Sclerae, 516, 541 Scleral Buckling, 541 Scleroderma, 181, 471, 541 Sclerosis, 179, 430, 541 Sclerotherapy, 541 Scoliosis, 382, 541 Screening, 343, 374, 446, 541 Scrotum, 315, 541, 552, 561 Sebaceous, 541 Sebum, 422, 541 Second Messenger Systems, 510, 541 Secondary tumor, 503, 541 Second-look surgery, 210, 541 Secretion, 422, 440, 489, 493, 494, 506, 541, 542 Sedative, 433, 504, 541 Sedentary, 537, 541 Segal, 158, 542 Segmental, 438, 472, 542, 547 Segmental mastectomy, 438, 542 Segmentation, 542 Seizures, 347, 456, 477, 519, 542 Selective estrogen receptor modulator, 542, 552 Self Care, 385, 422, 542 Semen, 529, 542 Semicircular canal, 332, 489, 542 Seminal vesicles, 542, 561 Semisynthetic, 439, 468, 542 Senile, 516, 527, 542 Senna, 192, 364, 542 Sensibility, 426, 542 Sensitization, 542 Sensor, 542 Sensory Thresholds, 542 Sentinel lymph node, 542 Sepsis, 433, 543 Septal, 543 Septicemia, 543 Septum, 495, 543 Septum Pellucidum, 495, 543 Sequencing, 525, 543, 551 Serotonin, 478, 513, 543, 558

588 Surgery

Serous, 172, 465, 484, 524, 543 Serrata, 445, 543 Serrated, 543 Serum Albumin, 533, 543 Sex Behavior, 498, 543 Sex Behavior, Animal, 498, 543 Sex Characteristics, 423, 531, 543, 552 Shame, 406, 543 Sharpness, 374, 543, 563 Ships, 543 Shock, 181, 199, 465, 543, 557 Short Bowel Syndrome, 314, 543 Shoulder Pain, 6, 384, 543 Shunt, 543 Side effect, 212, 214, 222, 223, 225, 226, 336, 359, 368, 423, 435, 454, 492, 544, 555 Sigmoid, 544 Sigmoidoscopy, 312, 544 Signal Transduction, 544 Signs and Symptoms, 536, 544, 559 Silicon, 544 Silicon Dioxide, 544 Skeletal, 200, 374, 446, 453, 492, 506, 515, 544, 546, 558 Skeleton, 422, 471, 492, 529, 544 Skin Care, 315, 544 Skin Neoplasms, 505, 544 Skull Base, 544 Sleep apnea, 334, 346, 544 Sleep Deprivation, 544 Small cell lung cancer, 207, 213, 215, 219, 222, 545 Smoke Inhalation Injury, 470, 545 Smooth muscle, 426, 438, 439, 450, 505, 506, 511, 518, 545, 546, 550 Sneezing, 339, 355, 545, 549 Soaps, 544, 545 Social Change, 545 Social Environment, 532, 545 Social Support, 545, 549 Social Work, 204, 402, 545 Sodium, 368, 436, 458, 463, 467, 545, 551 Soft tissue sarcoma, 217, 218, 472, 545 Solid tumor, 427, 460, 545 Solitary Nucleus, 432, 545 Solitary Rectal Ulcer, 312, 545 Solvent, 421, 477, 515, 546 Somatic, 423, 452, 477, 504, 518, 521, 546, 560 Somatic cells, 504, 546 Somatostatin, 546 Sonogram, 546, 557

Sorbitol, 500, 546 Sound wave, 449, 458, 534, 535, 546, 557, 559 Spasm, 331, 482, 546, 553 Spasmodic, 336, 546 Spastic, 333, 546 Spasticity, 546 Spatial disorientation, 460, 546 Specialist, 337, 397, 406, 411, 458, 546 Species, 425, 434, 439, 443, 466, 482, 483, 504, 505, 515, 532, 546, 557, 558, 563, 564 Specificity, 424, 439, 546, 555 Spectrum, 313, 520, 533, 546 Speculum, 546 Speech Perception, 546 Sperm, 445, 476, 547, 552, 561 Spermatozoa, 542, 547, 561 Sphenoid, 518, 547 Sphenoidal, 547 Sphincter, 494, 535, 547, 549, 561 Spike, 547 Spina bifida, 509, 547 Spinal Cord Diseases, 480, 518, 547 Spinal Cord Injuries, 533, 547 Spinal Cord Ischemia, 547 Spinal Nerve Roots, 533, 541, 547 Spinal Stenosis, 350, 547 Spinous, 466, 493, 547 Spleen, 433, 454, 499, 547 Splenectomy, 313, 547 Splint, 547 Spondylolisthesis, 547 Sports Medicine, 5, 414, 547 Sprains and Strains, 181, 498, 548 Squamous, 210, 219, 221, 225, 388, 444, 466, 505, 511, 548 Squamous cell carcinoma, 219, 466, 505, 511, 548 Squamous cells, 548 Squamous Epithelium, 444, 548 Stabilization, 5, 335, 349, 356, 548 Stabilizer, 440, 548 Staging, 540, 548 Stapes, 171, 391, 488, 548 Steatosis, 471, 548 Steel, 446, 548, 558 Stellate, 548 Stem cell transplantation, 209, 213, 548 Stem Cells, 467, 521, 548 Stent, 65, 516, 548 Stereoscopic, 548

Index 589

Stereotactic radiosurgery, 168, 169, 353, 548 Stereotaxis, 549 Sterile, 431, 518, 549 Sterility, 454, 488, 549 Sterilization, 312, 549 Sternum, 549 Steroid, 434, 452, 540, 549 Stimulant, 361, 492, 549 Stimulus, 432, 450, 460, 461, 462, 468, 489, 490, 491, 509, 535, 542, 549, 553 Stoma, 167, 172, 314, 405, 407, 516, 549, 553 Stool, 487, 488, 494, 549 Strabismus, 330, 459, 549 Strand, 525, 549 Stress incontinence, 340, 355, 549 Stress management, 549 Stress urinary, 315, 355, 549 Stricture, 314, 316, 549 Stroke Volume, 440, 550 Stroma, 492, 494, 550 Stromal, 464, 550 Stupor, 495, 507, 550 Styrene, 540, 550 Subacute, 488, 550 Subarachnoid, 474, 479, 490, 550 Subclavian, 437, 500, 550 Subclinical, 488, 542, 550 Subconjunctival, 550 Subcutaneous, 423, 461, 496, 519, 550 Subiculum, 483, 550 Submucous, 550 Substance P, 467, 503, 541, 550 Substrate, 465, 550 Sufentanil, 550 Superior vena cava, 437, 550 Supine, 550 Supine Position, 550 Supplementation, 550 Support group, 402, 406, 409, 550 Suppression, 550 Supratentorial, 210, 213, 215, 550 Surgery, Plastic, 550 Surgical Equipment, 551 Survival Rate, 516, 551 Sweat, 485, 551 Sweat Glands, 551 Sympathetic Nervous System, 408, 432, 510, 551 Sympathomimetic, 460, 466, 492, 512, 551 Symphysis, 444, 529, 551

Symptomatic, 7, 68, 353, 473, 518, 551 Symptomatology, 551 Synapses, 510, 547, 551 Synaptic, 544, 551 Synchrony, 551 Synergistic, 528, 551 Synostosis, 551 Synovial, 492, 551, 552 Synovial Fluid, 551, 552 Synovial Membrane, 492, 551, 552 Synthetic retinoid, 471, 552 Systemic disease, 543, 552 Systemic therapy, 552 Systole, 504, 552 Systolic, 485, 505, 552 Systolic pressure, 552 T Tachycardia, 432, 552 Tachypnea, 432, 552 Tamoxifen, 542, 552 Tarsal Tunnel Syndrome, 552 Taurine, 192, 434, 552 Teichoic Acids, 478, 552 Temporal, 479, 480, 483, 499, 500, 552 Temporal Lobe, 552 Tendinitis, 182, 319, 386, 552 Tendon Transfer, 552 Teratogenic, 492, 552 Terminalis, 552, 553 Testicles, 313, 349, 514, 541, 552, 561 Testicular, 68, 170, 227, 552 Testis, 468, 552 Testosterone, 552 Tetany, 518, 552 Tetracycline, 553 Thalamus, 437, 438, 458, 553 Therapeutics, 367, 553 Thermal ablation, 553 Thermodilution, 553 Thigh, 350, 471, 478, 553 Third Ventricle, 485, 495, 553 Thoracostomy, 444, 553 Thoracotomy, 553 Thorax, 421, 498, 550, 553, 561 Threshold, 485, 553 Thrombasthenia, 553 Thrombin, 472, 524, 530, 553 Thrombocytes, 524, 553 Thrombocytopenia, 524, 554 Thromboembolism, 159, 554 Thromboses, 554

590 Surgery

Thrombosis, 346, 434, 489, 530, 541, 550, 554 Thromboxanes, 429, 462, 554 Thrombus, 452, 488, 506, 507, 524, 554, 561 Thymidine, 554 Thymidine Kinase, 554 Thymus, 487, 499, 554 Thyroid, 197, 485, 509, 518, 554, 559 Thyroid Gland, 485, 518, 554 Thyroxine, 424, 522, 554 Tibial Nerve, 541, 552, 554 Time Management, 549, 554 Tin, 441, 524, 554 Tinnitus, 331, 406, 516, 531, 554, 562 Tissue Adhesives, 554 Tissue Banks, 555 Tissue Culture, 555 Tissue Distribution, 555 Tissue Expanders, 390, 555 Titre, 374, 555 Tolerance, 422, 555 Tome, 555 Tomography, 169, 172, 555 Tonic, 467, 555 Tooth Preparation, 422, 555 Topical chemotherapy, 388, 555 Topoisomerase inhibitors, 492, 555 Topotecan, 224, 555 Torsion, 488, 555 Toxic, iv, 431, 444, 454, 455, 457, 465, 486, 510, 524, 545, 550, 555 Toxicity, 225, 460, 555 Toxicology, 166, 374, 555 Toxins, 428, 439, 463, 477, 488, 502, 505, 533, 543, 556 Toxoplasmosis, 432, 556 Trabecular Meshwork, 556 Trabeculectomy, 556 Trace element, 473, 544, 554, 556 Trachea, 438, 494, 522, 554, 556 Tracheostomy, 556 Trachoma, 556 Traction, 353, 446, 556 Tramadol, 366, 556 Tranexamic Acid, 556 Transaminases, 556 Transcriptase, 556 Transcription Factors, 556 Transduction, 335, 544, 556 Transfection, 435, 556 Transfer Factor, 487, 556 Transfusion, 159, 374, 469, 482, 556

Transgenes, 556 Translating, 556 Translation, 467, 556 Translational, 557 Translocating, 433, 557 Translocation, 433, 467, 557 Transmitter, 421, 460, 469, 491, 501, 512, 551, 557 Transrectal ultrasound, 557 Transurethral, 529, 557 Transurethral Resection of Prostate, 529, 557 Trastuzumab, 212, 225, 557 Treatment Outcome, 557 Trees, 539, 557 Trichomoniasis, 503, 557 Tricuspid Atresia, 451, 557 Trigeminal, 357, 470, 500, 557 Trigeminal Nerve, 357, 557 Triglyceride, 557 Trochlear Nerve, 459, 557, 558 Trochlear Nerve Diseases, 459, 558 Trophoblast, 435, 558 Tropomyosin, 558 Troponin, 558 Truncal, 313, 558 Trypan Blue, 558 Tryptophan, 447, 543, 558 Tuberculosis, 182, 450, 558 Tumor marker, 435, 558 Tumor model, 558 Tumor Necrosis Factor, 558 Tumour, 168, 209, 475, 558 Tungsten, 442, 558 Tunica Intima, 464, 558 Tympani, 500, 558 Tympanic membrane, 500, 515, 558 Type 2 diabetes, 559 Tyrosine, 460, 559 U Ulcer, 182, 455, 461, 478, 520, 545, 559, 561 Ulcerative colitis, 312, 314, 348, 402, 488, 559 Ulnar Nerve, 559 Ultrafiltration, 481, 559 Ultrasonography, 313, 559 Ultrasound energy, 559 Ultrasound test, 158, 559 Unconscious, 426, 455, 486, 559 Univalent, 484, 517, 559 Universal Precautions, 374, 391, 559 Unresectable, 209, 211, 212, 559

Index 591

Uraemia, 518, 559 Urea, 551, 559, 560 Uremia, 493, 536, 560 Ureter, 315, 493, 536, 560 Urethra, 315, 340, 355, 434, 485, 520, 529, 557, 560 Urethritis, 560 Urinary Fistula, 315, 560 Urinary Retention, 454, 560 Urinary tract, 341, 520, 560 Urinary tract infection, 520, 560 Urinate, 560, 563 Urine, 355, 405, 434, 435, 450, 452, 453, 460, 487, 493, 513, 536, 549, 560 Urodynamic, 315, 356, 560 Urostomy, 405, 560 Uvea, 464, 560 Uveitis, 182, 560 V Vaccination, 391, 560 Vaccine, 221, 391, 423, 530, 560 Vagal, 467, 560 Vagina, 444, 457, 479, 486, 502, 522, 535, 537, 560 Vaginal, 315, 316, 340, 498, 522, 560 Vagotomy, 313, 560 Vagus Nerve, 494, 511, 545, 558, 560 Valves, 561 Varicocele, 313, 340, 561 Varicose, 183, 393, 541, 561 Varicose vein, 393, 541, 561 Vas Deferens, 315, 561 Vascular endothelial growth factor, 561 Vascular Resistance, 425, 561 Vasculitis, 518, 561 Vasectomy, 316, 561 Vasoactive, 561 Vasoconstriction, 466, 561 Vasodilation, 463, 486, 518, 561 Vasodilator, 437, 460, 507, 518, 561 Vasomotor, 468, 561 VE, 561 Vector, 489, 556, 561 Vegetative, 561 Velopharyngeal Insufficiency, 334, 561 Vena, 561 Venous blood, 436, 438, 443, 561 Venous Thrombosis, 434, 561, 564 Ventilation, 396, 468, 562 Ventilator, 501, 537, 562 Ventral, 485, 512, 526, 547, 562 Ventricular Dysfunction, 562

Ventricular Function, 159, 562 Venules, 436, 439, 465, 503, 562 Vertebrae, 382, 490, 496, 547, 562 Vertebral, 433, 434, 547, 562 Vertigo, 183, 331, 332, 406, 516, 562 Vestibular, 311, 332, 352, 562 Vestibule, 446, 489, 540, 542, 562 Vestibulocochlear Nerve, 432, 446, 554, 562 Vestibulocochlear Nerve Diseases, 554, 562 Veterinary Medicine, 373, 562 Villi, 484, 562 Vinca Alkaloids, 562, 563 Vinorelbine, 167, 215, 563 Viral, 391, 463, 488, 500, 513, 556, 563, 564 Virulence, 431, 555, 563 Virus, 65, 343, 374, 391, 422, 433, 443, 465, 482, 490, 523, 556, 563 Visceral, 183, 432, 452, 477, 522, 560, 563 Visceral Afferents, 432, 477, 560, 563 Viscosity, 436, 563 Visual Acuity, 451, 495, 514, 563 Visual Cortex, 459, 498, 563 Visual field, 495, 514, 531, 538, 563 Vital Statistics, 563 Vitrectomy, 563 Vitreoretinal, 563 Vitreous Body, 445, 538, 563 Vitreous Humor, 538, 563 Vitro, 481, 563 Vivo, 481, 487, 503, 505, 554, 563 Vocal cord, 336, 356, 477, 563 Voice Disorders, 334, 563 Void, 563 Volition, 491, 563 Volvulus, 314, 563 Voriconazole, 166, 564 W Wakefulness, 455, 564 War, 328, 526, 564 Warfarin, 193, 564 Warts, 183, 388, 393, 401, 525, 564 Weight Gain, 470, 564 White blood cell, 221, 422, 428, 445, 472, 495, 499, 506, 511, 523, 564 Windpipe, 356, 522, 554, 564 Withdrawal, 456, 564 Womb, 537, 560, 564 Wound Infection, 564 Wounds, Gunshot, 547, 564 Wrist Injuries, 5, 564

592 Surgery

X Xanthine, 564 Xenograft, 427, 558, 564 Xerostomia, 493, 564

X-ray therapy, 492, 564 Y Yeasts, 474, 522, 564

Index 593

594 Surgery

Index 595

596 Surgery

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