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

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

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IAGRA 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., 1960Viagra: 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: 0-597-83647-7 1. Viagra-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 Viagra. 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 VIAGRA ..................................................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Viagra ......................................................................................... 15 E-Journals: PubMed Central ....................................................................................................... 21 The National Library of Medicine: PubMed ................................................................................ 22 CHAPTER 2. NUTRITION AND VIAGRA ........................................................................................... 55 Overview...................................................................................................................................... 55 Finding Nutrition Studies on Viagra .......................................................................................... 55 Federal Resources on Nutrition ................................................................................................... 57 Additional Web Resources ........................................................................................................... 57 CHAPTER 3. ALTERNATIVE MEDICINE AND VIAGRA ..................................................................... 59 Overview...................................................................................................................................... 59 National Center for Complementary and Alternative Medicine.................................................. 59 Additional Web Resources ........................................................................................................... 62 General References ....................................................................................................................... 63 CHAPTER 4. DISSERTATIONS ON VIAGRA ....................................................................................... 65 Overview...................................................................................................................................... 65 Dissertations on Viagra ............................................................................................................... 65 Keeping Current .......................................................................................................................... 65 CHAPTER 5. CLINICAL TRIALS AND VIAGRA.................................................................................. 67 Overview...................................................................................................................................... 67 Recent Trials on Viagra ............................................................................................................... 67 Keeping Current on Clinical Trials ............................................................................................. 69 CHAPTER 6. PATENTS ON VIAGRA .................................................................................................. 71 Overview...................................................................................................................................... 71 Patents on Viagra ........................................................................................................................ 71 Keeping Current .......................................................................................................................... 77 CHAPTER 7. BOOKS ON VIAGRA ..................................................................................................... 79 Overview...................................................................................................................................... 79 Book Summaries: Federal Agencies.............................................................................................. 79 Book Summaries: Online Booksellers........................................................................................... 80 The National Library of Medicine Book Index ............................................................................. 83 Chapters on Viagra ...................................................................................................................... 83 CHAPTER 8. MULTIMEDIA ON VIAGRA........................................................................................... 85 Overview...................................................................................................................................... 85 Video Recordings ......................................................................................................................... 85 Bibliography: Multimedia on Viagra ........................................................................................... 87 CHAPTER 9. PERIODICALS AND NEWS ON VIAGRA........................................................................ 89 Overview...................................................................................................................................... 89 News Services and Press Releases................................................................................................ 89 Newsletter Articles ...................................................................................................................... 95 Academic Periodicals covering Viagra......................................................................................... 96 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 99 Overview...................................................................................................................................... 99 NIH Guidelines............................................................................................................................ 99 NIH Databases........................................................................................................................... 101 Other Commercial Databases..................................................................................................... 103 APPENDIX B. PATIENT RESOURCES ............................................................................................... 105 Overview.................................................................................................................................... 105

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Patient Guideline Sources.......................................................................................................... 105 Finding Associations.................................................................................................................. 108 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 111 Overview.................................................................................................................................... 111 Preparation................................................................................................................................. 111 Finding a Local Medical Library................................................................................................ 111 Medical Libraries in the U.S. and Canada ................................................................................. 111 ONLINE GLOSSARIES................................................................................................................ 117 Online Dictionary Directories ................................................................................................... 117 VIAGRA DICTIONARY .............................................................................................................. 119 INDEX .............................................................................................................................................. 161

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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 Viagra is indexed in search engines, such as www.google.com or others, a nonsystematic 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 Viagra, 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 Viagra, 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 Viagra. 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 Viagra, 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 Viagra. 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 VIAGRA Overview In this chapter, we will show you how to locate peer-reviewed references and studies on Viagra.

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

Beyond Viagra Source: Diabetes Forecast. 54(11): 100-104. November 2001. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: Erectile dysfunction (ED, formerly know as impotence) is a condition with many causes. This article offers three real life examples that show the process by which solutions have been reached for three men affected by ED. The author cautions that these cases are not necessarily typical (for example, sildenafil or Viagra, was not the final treatment of choice for any of these men, although from 60 to 70 percent of men with ED do respond to sildenafil). Each case much be assessed and treated individually. The first case involved ED caused by drug effects (blood pressure medication), the

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second a patient who received a kidney transplant, and the third a patient who had received radiation therapy for prostate cancer. Sidebars review prevention strategies and other treatments for ED, and encourage readers to consult with their health care provider as there are many causes and many different treatments available for ED. Some possible causes of ED in men with diabetes include: uncontrolled diabetes, diabetic autonomic neuropathy (nerve disease), low testosterone levels (hypogonadism), severe peripheral vascular disease, pituitary tumor (prolactinoma), medications for hypertension, medications for depression or painful neuropathy, and psychological factors. Good diabetes control helps keep one's blood vessels and nerves healthy, required ingredients to get and maintain an erection. 4 figures. •

What is Impotence? Is Viagra a Viable Treatment for Dialysis Patients? Source: Renalife. 14(4): 22-23. Winter 1999. Contact: Available from American Association of Kidney Patients (AAKP). 100 South Ashley Drive, Suite 280, Tampa, FL 33602. (800) 749-AAKP or (813) 223-7099. E-mail: [email protected]. Website: www.aakp.org. Summary: This entry on Viagra (sildenafil) is one from a regular column that provides readers with an opportunity to submit renal related health questions to health care professionals. This column answers a reader's question about Viagra and its use as a treatment option for erectile dysfunction in patients on dialysis. The author notes that a loss of interest in sexual activity is common in patients with progressive kidney failure. Coping with the stress of an abdominal or vascular access for dialysis, surviving the usual muscle loss, and accommodating to drugs given to control hypertension, phosphate overload, and other components of uremia poses adjustment stresses that place sex at a relatively low priority. The author notes that recent publicity over Viagra has opened doors for more frank discussion between health care providers and patients regarding erectile dysfunction. The author briefly reviews four steps in the evaluation and treatment of erectile dysfunction: identify and correct all correctable medical problems; review all prescribed medications to check for any impact on sexual function; inspect all aspects of life quality, particularly those contributing to exhaustion, conflict, and psychological factors; and a comprehensive urologic evaluation. The author concludes that sildenafil (Viagra) may be an appropriate drug therapy for men on dialysis, but only after going through the steps noted above. The author cautions that men who have angina under treatment with nitroglycerine or similar drugs may be at extra risk of sudden death from a heart attack when treated with Viagra. However, this risk has not been confirmed and should be now classified as a worry rather than a reality.

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Role of Viagra in the Treatment of Male Impotence in ESRD Source: ANNA Journal. American Nephrology Nurses Association Journal. 26(2): 242. April 1999. Contact: Available from American Nephrology Nurses' Association. Box 56, East Holly Avenue, Pitman, NJ 08071. (609) 256-2320. Summary: This brief article, from a regular column called Clinical Consult, reviews the role of Viagra (sildenafil) in the treatment of erectile dysfunction (impotence) in men with end-stage renal disease (ESRD). The article emphasizes a treatment process that begins with the least invasive treatment. After a thorough medical evaluation, treatment options should be counseling, if appropriate; external vacuum devices; oral medication (sildenafil, yohimbine, testosterone); urethral suppositories; penile injection; penile

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implant surgery; and vascular surgery. Sildenafil is indicated for erectile dysfunction only; it does not increase libido or enhance performance. In clinical trials with over 3,000 subjects with erectile dysfunction ranging from mild to severe, the success rate for sildenafil was 65 to 85 percent compared to 39 percent of placebo subjects. Main adverse reactions to Viagra are headache (16 percent), flushing (10 percent), and dyspepsia (7 percent). Less than 4 percent of subjects experienced nasal congestion, urinary tract infection, abnormal pain, blue green vision, diarrhea, and dizziness. Viagra is contraindicated in persons using any form of nitrates. The use of Viagra may be problematic for ESRD patients in several areas. Hemodialysis patients are prescribed an average of 8 medications, and at least 75 percent of hemodialysis patients and 81 percent of peritoneal dialysis patients use at least one antihypertensive medication. These statistics increase the probability of drug interactions. 3 references. •

Viagra: Is the New Impotence Drug Safe for Dialysis Patients? Source: For Patients Only. 11(4): 23, 24. July-August 1998. Contact: Available from Contemporary Dialysis, Inc. 6300 Variel Avenue, Suite I, Woodland Hills, CA 91367. (818) 704-5555. Summary: This article provides information for dialysis patients about sildenafil citrate (Viagra), a drug used for the treatment of male erectile dysfunction. Erectile dysfunction (ED) is defined as the inability to achieve or maintain a penile erection sufficient for sexual intercourse. The authors of this article review the causes of impotence, which include end-stage renal disease (ESRD), conditions such as diabetes or hypertension, psychological conditions (such as depression), and some drug therapies commonly prescribed for dialysis patients. The authors also review how Viagra works, how it works in patients with different diseases, dosage and administration information, adverse effects, and drug interactions. Viagra has been shown to be effective regardless of the baseline severity or underlying cause of impotence and the race and age of the patient. The most commonly reported side effects of Viagra include headache, flushing, and indigestion; it can also lower blood pressure in some individuals. The special issues discussed include the use of Viagra in women, finding information about Viagra on the Internet, cost and insurance considerations, and Viagra look-alike drugs. The authors conclude by encouraging readers to first obtain an accurate diagnosis for their ED before evaluating and choosing a treatment option. 3 references.

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Viagra Revolution: Drug for Erectile Dysfunction is Redefining Our Ideas About Sexuality Among Older Couples (editorial) Source: Geriatrics. 53(10): 8-9. October 1998. Contact: Available from Advanstar Communications. 131 West First Street, Duluth, MN 55802-2065. (888) 527-7008. Fax (218) 723-9437. Summary: In this editorial, the author compares the impact of Viagra (sildenafil citrate) on older persons to the impact of the birth control pill on younger persons in the 1960's. The author considers how the popularity of Viagra may redefine general ideas about sexuality as an intimate expression in later life. The author notes that Viagra is neither an aphrodisiac nor a love potion for relationships in distress. It is a vehicle that can help couples enjoy the pleasures of sex and circumvent the disabling, demoralizing effects of erectile dysfunction. Physicians can advance the quality of life of older patients by appropriately prescribing Viagra after a careful medical history and physical examination. But they must also recommend psychological or marital counseling when the history reveals signs of emotional or interpersonal problems. The author reviews the

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administration and dosage, side effects, and economic considerations of Viagra. The author concludes that it is shortsighted of insurance or managed care companies to refuse to reimburse for Viagra. One additional dividend of Viagra is that it is motivating men in the 50-plus age group to seek medical treatment. This may allow earlier detection and control of chronic diseases, reducing morbidity and mortality and thereby resulting in cost savings. •

Viagra: What Every Physician Should Know Source: Ear, Nose and Throat Journal. 77(9): 783-786. September 1998. Contact: Available from MEDQUEST Communications LLC. 629 Euclid Avenue, Suite 1200, Cleveland, OH 44114. (216) 522-9700. Summary: Viagra (sildenafil), an oral drug taken 1 hour prior to sexual activity, improves erectile function in the majority of men with erectile dysfunction who receive the drug. This article familiarizes health care providers with basic information about erectile dysfunction (ED, formerly called impotence) and about Viagra, including its desired effects and possible adverse effects. The author notes that Viagra is not an aphrodisiac and therefore will not work without sexual stimulation. The drug is absolutely contraindicated in patients on organic nitrates, as this combination can lead to severe drops in blood pressure. Patients with heart disease, suspected heart disease, and risk factors for heart disease should discuss with their physicians the safety of resuming sexual activity. A cardiac work-up, including exercise treadmill testing, should be considered in appropriate patients. 19 months. (AA-M).

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Sildenafil Citrate for Treatment of Erectile Dysfunction in Men With Type 1 Diabetes Source: Diabetes Care. 26(2): 279-284. February 2003. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: In 5 to 10 percent of men with type 1 diabetes, erectile dysfunction (ED) may be a particularly common and unwanted complication. This study focuses on the effects of sildenafil (Viagra) in men with type 1 diabetes and ED. A total of 188 patients were entered into a double-blind, placebo-controlled, parallel-group, flexible-dose study and were randomized to received sildenafil (n = 95) or placebo (n = 93) for 12 weeks. Efficacy was evaluated using questions three (Q3; achieving an erection) and four (Q4; maintaining an erection) from the International Index of Erectile Function (IIEF), a global efficacy question (GEQ) and a patient event log of sexual activity. Improvements in mean scores from baseline to end of treatment for IIEF Q3 (35.7 percent versus 19.9 percent) and Q4 (68.4 percent versus 26.5 percent) were significant in patients receiving sildenafil compared with those receiving placebo. Moreover, the percent of improved erections (GEQ, 66.6 versus 28.6 percent) and successful intercourse attempts (63 percent versus 33 percent) was significantly increased with sildenafil compared with placebo. Improvements in sexual function were seen irrespective of the degree of ED severity. Adverse events were generally mild to moderate in severity, with headache (20 percent versus 8 percent), flushing (18 percent versus 3 percent), and dyspepsia (8 percent versus 1 percent) reported more often in the sildenafil than in placebo-treated patients. The authors conclude that treatment with sildenafil for ED was effective, resulting in an increased percentage of successful attempts at intercourse, and was well tolerated among men with type 1 diabetes. 2 figures. 2 tables. 32 references.

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Acute and Prolonged Effects of Sildenafil on Brachial Artery Flow-Mediated Dilation in Type 2 Diabetes Source: Diabetes Care. 25(8): 1336-1339. August 2002. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: Flow-mediated dilatation (FMD), induced by occlusion of the brachial artery (the principal artery of the upper arm), is an index of nitric oxide-dependent endothelial function that is impaired in patients with type 2 diabetes. Sildenafil (Viagra) is an inhibitors of phosphodiesterase 5 (PDE5) which is used for the management of erectile dysfunction (ED) in a broad range of patients, including those with type 2 diabetes. The effects of sildenafil on endothelial function in type 2 patients has not been previously assessed. This article reports on a study that assessed the acute and prolonged effects of a low dose of sildenafil (25 milligrams) on FMD in patients with type 2 diabetes. The authors performed a double-blind, placebo-controlled crossover trial in 16 patients (14 of whom completed the study) with type 2 diabetes who had ED without overt clinical heart disease. In these patients, the brachial artery diameter (BAD) measured by ultrasound was 4.33 plus or minus 0.6 millimeters. After inducing FMD, the BAD increased 8 percent to 4.66 plus or minus 0.6 millimeters. One hour after oral administration of sildenafil 25 milligrams, FMD increased the BAD significantly by 15 percent to 4.99 plus or minus 0.5 millimeters, whereas it did not change with placebo. After treatment with sildenafil 25 milligrams daily for 2 weeks and testing 24 hours after the last dose, the mean FMD was 14 percent. In contrast, the mean FMD with placebo was 9 percent. The authors conclude that acute and prolonged sildenafil treatment has a favorable effect on brachial artery flow-mediated dilatation that persists for at least 24 hours after the last dose. Further investigation is needed to determine whether this prolonged effect has clinical implications in patients with type 2 diabetes. 1 figure. 1 table. 16 references.

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Efficacy of Oral Sildenafil in Hemodialysis Patients with Erectile Dysfunction Source: JASN. Journal of the American Society of Nephrology. 13 (11): 2770-2775. November 2002. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-6423. Summary: This article reports on a study undertaken to evaluate the efficacy and safety of oral sildenafil (Viagra) to treat erectile dysfunction (ED) in chronic renal (kidney) failure in patients on hemodialysis (HD). The double-blind, randomized, placebocontrolled study included oral sildenafil (50 milligrams) administered as required in HD patients; 21 patients received placebo and 20 received sildenafil. Baseline clinical and demographic parameters were similar in both groups. Sildenafil was associated with improvement in the score of all questions and domains of the IIEF (International Index of Erectile Function), except those related to sexual desire. Using the erectile function domain to evaluate primary efficacy, improvement was observed in 85 percent of the sildenafil patients, compared with 9.5 percent of placebo patients. Sildenafil use resulted in normal EF scores in 35 percent of sildenafil patients. Sildenafil was well tolerated. Headache and flushing occurred in both groups. Dyspepsia was reported by two patients in the sildenafil group. The authors conclude that oral sildenafil seems to be an effective and safe treatment for ED in selected patients with chronic renal (kidney) failure on hemodialysis. 4 tables. 20 references.

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Clinical Efficacy of Sildenafil in Patients on Chronic Dialysis Source: Journal of Urology. 165(6): 819-821. March 2001. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-3030 or (301) 714-2334. Fax (301) 824-7290. Summary: This article reports on a study that evaluated the clinical efficacy of sildenafil citrate (Viagra) for patients who are on chronic dialysis and who have concomitant erectile dysfunction (ED, formerly called impotence). A total of 35 men (mean age 60.7 years) on dialysis and with ED of various etiologies (causes) were administered 25 to 100 mg sildenafil for at least 6 months. The International Index of Erectile Function (IIEF) questionnaire, a global assessment question and partner satisfaction question were used to evaluate sildenafil efficacy. Patients also reported any adverse events that occurred during treatment. Treatment was effective for 28 of the 35 men (80 percent), according to the results of the IIEF and global assessment questions. Partner satisfaction correlated with the IIEF overall response and global assessment question results. No correlation was found between sildenafil failure and patient age, the etiology of ED, duration of ED, prior treatments, testosterone and prolactin blood levels, and the duration and etiology of renal (kidney) failure. In 3 of the 35 patients, sildenafil was stopped due to intolerable headaches, and in 7 others for lack of efficacy. The authors conclude that sildenafil is an effective and safe treatment for erectile dysfunction in most patients on chronic dialysis. 1 table. 15 references.

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Preliminary Observations of Sildenafil Treatment for Erectile Dysfunction in Dialysis Patients Source: American Journal of Kidney Diseases. 37(1): 134-137. January 2001. Contact: Available from W.B. Saunders Company. Periodicals Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000. Summary: Erectile dysfunction (ED, formerly called impotence) is common in dialysis patients. This article reports the authors' experience with sildenafil citrate (Viagra) in patients who are undergoing dialysis therapy. Male subjects attending the Outpatient Dialysis Unit at the University of Pennsylvania who were prescribed sildenafil by their primary physician or nephrologist were asked to complete the International Index of Erectile Function before their first dose of sildenafil and after at least 4 weeks of therapy. Subjects' mean age was 50.3 years (plus or minus 14.63 years). Ninety-three percent of the subjects were black. Based on a global efficacy question, 66.7 percent of the subjects believed that treatment had improved their erections. Subjects reported no increase sexual desire despite experiencing a significant increase in erectile function, orgasmic function, and satisfaction with intercourse. The authors summarize that sildenafil was well tolerated in a selected group of patients who reported improved sexual function with no major adverse effects. The authors stress that as advances are made to improve survival on hemodialysis therapy, improvement in quality of life should also be of utmost importance and should include an evaluation for ED. 1 table. 19 references.

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Efficacy, Safety, and Use of Sildenafil in Urologic Practice Source: Urology. 57(6): 1141-1144. June 2001. Contact: Available from Urology. P.O. Box 2126, Marion, OH 43306-8226. (800) 215-4692. Fax (740) 382-5866.

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Summary: This article reports on a study undertaken to evaluate the efficacy, side effects, renewal patterns, and other relevant practice issues of the use of sildenafil (Viagra) in urologic practice after approval of this medication and release for public use. Consecutive male patients with erectile dysfunction (ED, formerly called impotence) were evaluated by one urologist, and sildenafil was prescribed when appropriate. Patients were monitored at two followup visits: at 3 to 4 months and then at 3 to 8 months (6 to 12 months after the initial prescription). At the follow up visits, each patient was given a questionnaire assessing his improvement in erectile function, satisfaction with sildenafil, and expectations. Data were obtained on side effects, medical history, tablets taken, subsequent treatment in sildenafil failures, and renewal patterns. A total of 164 and 82 patients were evaluated at the first and second followup visits, respectively. Patients used a mean of 1.2 to 1.4 tablets per week. At the first follow up visit, an improvement in erection was noted in 68.2 percent of patients. At the second followup visit, an improvement in erection was noted in 80.5 percent of patients. Sixty two percent and 78 percent of patients renewed sildenafil at the first and second follow up visits, respectively. In those patients who did not renew, a lack of efficacy was the most frequent reason. Intracavernous injection therapy was the most common treatment after sildenafil failure, followed by penile implants. The authors conclude that sildenafil is an effective and safe drug in the treatment of erectile dysfunction. 5 tables. 10 references. •

Sildenafil Versus the Vacuum Erection Device: Patient Preference Source: Journal of Urology. 166(5): 1779-1781. November 2001. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-3030 or (301) 714-2334. Fax (301) 824-7290. Summary: This article reports on a study that surveyed the preferences of patients with erectile dysfunction (ED, formerly called impotence) who had been effectively treated with a vacuum erection device and then switched to sildenafil (Viagra). A total of 52 patients with ED who achieved satisfactory erectile function according to the International Index of Erectile Function (IIEF) while using a vacuum erection device were switched to an increasing dose of sildenafil (range 25 to 100 milligrams) until satisfactory erection was maintained at least twice a week for at least 1 month. The two treatment methods were not used concomitantly (at the same time). A total of 36 patients with a mean age of 59 years (range 35 to 77) who claimed to have achieved satisfactory erections with a vacuum erection device and sildenafil reported their preference to continue sildenafil or to resume the use of a vacuum erection device, reasons for the choice, and any adverse side effects. Of the 36 participants in whom the efficacy of sildenafil was similar to that of a vacuum erection device according to the IIEF scores, 12 men (33.3 percent) decided to resume use of the vacuum erection device (group 1), while 24 men (66.6 percent) preferred to continue sildenafil (group 2). There were no statistically significant differences between the groups regarding patient age or the etiology and duration of erectile dysfunction. The increase in the IIEF score while using a vacuum erection device was higher in group 1 than group 2. The adverse side effects of sildenafil were the main reasons for preferring a vacuum erection device. Fewer ejaculatory difficulties, efficacy, comfort, and ease of use were the main reasons for choosing sildenafil. The authors conclude that even in an era of effective oral medication, the vacuum erection device remains a preferred treatment option for a substantial number of patients with erectile dysfunction. 3 tables. 9 references.

10 Viagra

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Improvement in Emotional Well-Being and Relationships of Users of Sildenafil Source: Journal of Urology. 166(5): 1774-1778. November 2001. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-3030 or (301) 714-2334. Fax (301) 824-7290. Summary: This article reports on a study undertaken to estimate the association of sildenafil (Viagra) use with erectile function, relationship with sexual partner, functional status, and emotional well being in men with erectile dysfunction (ED, formerly called impotence). Of the eligible sample, 124 men (53 percent) completed and returned a survey, including 85 who reported current sildenafil use. Sildenafil users reported an 88 percent increase in erectile function scores, 60 percent increase in overall sexual satisfaction related to the use of sildenafil. Of the respondents, 38 percent indicated that using sildenafil had definitely improved quality of life. Likewise, 29 percent of respondents indicated that using sildenafil definitely improved the relationship with their partner. With sildenafil there was a statistically significant improvement in the scores of erectile and sexual function, sexual partner relationship, and emotional well being. In a multivariate model, improved erectile function and sexual partner relationship were each significantly associated with improved emotional well being. 4 tables. 22 references.

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Erectile Dysfunction in Uremic Dialysis Patients: Diagnostic Evaluation in the Sildenafil Era Source: American Journal of Kidney Diseases. 38(4 Supplement 1): S115-S117. October 2001. Contact: Available from W.B. Saunders Company. Periodicals Department, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452 or (407) 345-4000. Summary: Sexual dysfunction in men is a common and often distressing side effect of kidney (renal) failure. This article explores erectile dysfunction (ED, formerly called impotence) in dialysis patients with uremia, focusing on the diagnostic evaluation and the use of sildenafil (Viagra). The authors differentiate between ED and impotence, defining impotence as a general male sexual dysfunction that includes libidinal (sex drive), orgasmic, and ejaculatory dysfunction. ED is defined as the inability to achieve or maintain an erection sufficient to allow satisfactory sexual intercourse. Uremic men of different ages report a variety of sexual problems, including sexual hormonal pattern alterations, reduction in or loss of libido, infertility, and impotence, conditioning their well being status. In evaluating and treating sexual dysfunction, a nephrologist (kidney specialist) must consider factors involved in its pathogenesis (development), such as hypothalamic pituitary gonadal axis alterations, psychological problems related to chronic disease, secondary hyperparathyroidism, anemia, autonomic neuropathy, derangements in arterial supply or venous outflow, and the normal structure of cavernous body smooth muscle cells. The introduction of sildenafil to treat patients with impotence has completely changed the approach to evaluating these subjects (primarily because this drug is considered an effective, well tolerated treatment for men with ED). In the past, the authors proposed a complex algorithm to diagnose and treat ED. In this article, the authors propose a new algorithm to test the possibility of using sildenafil to obtain an erection, and to classify patients as responders or nonresponders to the sildenafil test. 1 figure. 11 references.

Studies 11

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Cost-Effectiveness of Sildenafil Source: Annals of Internal Medicine. 132(12): 933-937. June 20, 2000. Contact: Available from American College of Physicians. American Society of Internal Medicine. 190 North Independence Mall West, Philadelphia, PA 19106-1572. Website: www.acponline.org. Summary: Coverage of Sildenafil (Viagra) by health insurance plans is a controversial issue. This article reports on a study undertaken to evaluate the cost effectiveness of Sildenafil treatment for erectile dysfunction. Values for the efficacy and safety of Sildenafil and quality of life utilities were obtained from the published medical literature. The target population was men 60 years of age with erectile dysfunction. The intervention was Sildenafil or no treatment in identical hypothetical cohorts. The cost per quality adjusted life year (QALY) gained for Sildenafil treatment compared with no therapy was $11,290 from the societal perspective and $11,230 from the third party payer perspective. The authors conclude that the cost effectiveness of Sildenafil treatment compared favorably with that of accepted therapies for other medical conditions, costing less than renal dialysis, cholesterol lowering medication, and coronary artery bypass grafting. It has been argued that because erectile dysfunction (impotence) is not a life threatening illness, Sildenafil should not merit insurance coverage. However, treatment for many other non life threatening illnesses that affect only quality of life (for example, migraines) is covered by insurers. In addition, penile implantation surgery for erectile dysfunction (average costs of $6,000 to $7,000) is covered by insurance. Before Sildenafil became available, expensive diagnostic evaluations for erectile dysfunction were also covered. The authors conclude that, based on cost effectiveness alone, insurance companies should not limit or deny coverage for Sildenafil. However, the authors caution that other factors may need to be taken into consideration, including the severe adverse effects of Sildenafil in some patients, the cost of supplying the drug to a large group of patients, and the ethics of covering Sildenafil when abuse is a possibility. 1 figure. 3 tables. 36 references.

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Tough Choices: Cost-Effectiveness of Sildenafil (editorial) Source: Annals of Internal Medicine. 132(12): 994-995. June 20, 2000. Contact: Available from American College of Physicians. American Society of Internal Medicine. 190 North Independence Mall West, Philadelphia, PA 19106-1572. Website: www.acponline.org. Summary: Coverage of sildenafil (Viagra) by health insurance plans is a controversial issue. This editorial serves as a commentary on an article in the same issue that reports on a study undertaken to evaluate the cost effectiveness of sildenafil treatment for erectile dysfunction. In that study, the authors conclude that the cost effectiveness of sildenafil treatment compared favorably with that of accepted therapies for other medical conditions, costing less than renal dialysis, cholesterol lowering medication, and coronary artery bypass grafting. The authors of the study conclude that, based on cost effectiveness alone, insurance companies should not limit or deny coverage for sildenafil. However, the authors do caution that other factors may need to be taken into consideration, including the severe adverse effects of sildenafil in some patients, the cost of supplying the drug to a large group of patients, and the ethics of covering sildenafil when abuse is a possibility. The author of the editorial asks readers to take a step back and consider the role of health insurance on a larger scale. The editorial reminds readers that at its simplest, health insurance was originally developed to protect people against financial ruin as a result of a serious illness, i.e., the sort of illness that often required

12 Viagra

hospitalization and incurred large bills from physicians and surgeons. The recent steady creep in what health insurance is expected to cover is largely the result of advancing technology, a growing sense of entitlement on the part of the insured, and the influence of managed care. The author concludes that health providers, insurers, and society should reconsider the role of health insurance in general as these controversial issues such as sildenafil arise. 8 references. •

Sildenafil Versus Intracavernous Injection Therapy: Efficacy and Preference in Patients on Intracavernous Injection for More Than 1 Year Source: Journal of Urology. 164(4): 1197-1200. October 2000. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-3030 or (301) 714-2334. Fax (301) 824-7290. Summary: This article reports on a study that evaluated the efficacy of sildenafil (Viagra, an oral drug) as well as patient preference in a group of men with erectile dysfunction (ED) who had been using intracavernous injection therapy for more than a year and who were without neurological disease. In Phase I, the authors determined the efficacy of 50 and 100 mg sildenafil citrate at home. In Phase II, responders to sildenafil were asked to use the preferred dose orally for a month and choose intracavernous injection (of vasoactive drugs such as alprostadil, papaverine, phentolamine) or sildenafil. In Phase III, patients were asked to continue either treatment for 3 more months. Patient preferences were reported at the end of phases II and III. The study included 155 men (mean age 56.4 years, plus or minus 12.6 years) on intravenous injection for a mean of 26 months (plus or minus 9 months). Overall, 116 men (74.8 percent) responded to sildenafil during study phase I. After 1 month of treatment, 71 responders (61.2 percent) preferred to continue with the oral drug, 31 (26.7 percent) returned to intracavernous injection, and 14 (12.1 percent) used both drugs alternately. Three months later, 74 of the 116 responders (63.8 percent) preferred oral treatment, and 38 (32.8 percent) chose intracavernous injection, while 4 (3.4 percent) continued to use both treatments alternately. The authors conclude that sildenafil is highly effective in intracavernous injection responders, although a certain group prefer to continue intracavernous injection. While sildenafil should be considered first line treatment, men with ED should be aware of all treatment options available because nonresponders to sildenafil may respond to intracavernous injection. 2 figures. 3 tables. 15 references.

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Efficacy, Safety and Patient Acceptance of Sildenafil Citrate as Treatment for Erectile Dysfunction Source: Journal of Urology. 164(4): 1192-1196. October 2000. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-3030 or (301) 714-2334. Fax (301) 824-7290. Summary: This article reports on a study that assessed the efficacy and safety of sildenafil citrate (Viagra) as treatment for erectile dysfunction (ED, formerly called impotence). A total of 433 completely evaluated men with chronic ED were treated with sildenafil. Response was assessed by baseline and followup physician interviews and by a patient self administered 15 item questionnaire. Of the 304 men (70.2 percent) who completed the questionnaire, 278 received sildenafil, including 186 who previously had undergone treatment for ED, principally involving intracavernous (penile) injection therapy. A response was elicited by a median dose of 100 mg of sildenafil in 188 patients (67.6 percent), who achieved erection suitable for sexual intercourse. Those with psychogenic erectile dsyfunction responded significantly better than those with organic

Studies 13

dysfunction. Erection suitable for intercourse was attained by 30.8 percent of patients with ED after radical prostatectomy (removal of the prostate), and 80 percent with cavernous venoocclusive dysfunction (obstructive pathology of the penile veins). Of previous intracavernous injection responders, 29.9 percent were refractory to sildenafil, while 33.3 percent of previous intracavernous injection nonresponders responded to sildenafil. Adverse effects of sildenafil in 53.6 percent of cases were assessed as mild in 56.4 percent, moderate in 38.3 percent, and severe in 5.3 percent. Multiple adverse effects were reported by 62.4 percent of patients, while 17 (6.1 percent) discontinued sildenafil as a direct result of intolerable adverse effects. The most common adverse effects were facial flushing (33.5 percent), headaches (23.4 percent), nasal congestion (12.6 percent), dyspepsia (10.1 percent), and dizziness (10.8 percent). Baseline patient and partner quality of life scores significantly improved after sildenafil treatment. The authors conclude that sildenafil citrate is effective oral first line treatment for ED. Although more than 50 percent of men reported adverse effects of the drug, most of these effects were considered mild and rarely resulted in treatment cessation. Intracavernous injection remains an effective ED treatment option for men who prefer its use as a single therapy or as an alternative to sildenafil. 3 tables. 21 references. •

Safety of Sildenafil (editorial) Source: Current Opinion in Urology. 10(6): 613-615. November 2000. Contact: Available from Lippincott Williams and Wilkins. 241 Borough High Street, London, SE1 1GB, UK. +44 (0) 171940-7500. E-mail: [email protected]. Summary: Sildenafil (Viagra) has an excellent safety record in its clinical trials, but there have been reports of deaths associated with its usage now that it is in widespread clinical use. This article reviews the safety of sildenafil. The efficacy of sildenafil is not in question, but the fact remains that the drug may be associated with episodes of myocardial ischemia in some patients. The author notes that many of the deaths that have been reported are clearly unrelated to the drug, and some may be related to usage where there are clear contradictions to its use. Some deaths may occur because the patients are at risk from cardiac problems, but there remains an occasional unexplained death. The author contends that it is important to keep a sense of proportion, because the incidence of such events is clearly low and needs to be balanced against the improved quality of life that the drug provides. The author concludes that there is no evidence at present to suggest that sildenafil is a specific causative factor and the research so far has failed to support it as such. 2 tables. 25 references (3 annotated).

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Effect of Sildenafil Citrate on Post-Radical Prostatectomy Erectile Dysfunction Source: Journal of Urology. 164(6): 1935-1938. December 2000. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-3030 or (301) 714-2334. Fax (301) 824-7290. Summary: This article reports on a study undertaken to assess the effect of sildenafil (Viagra) in a subgroup of patients after prostatectomy with erectile dysfunction (ED) and to determine whether nerve preservation techniques improve sildenafil response in this subgroup. In the study, 53 patients who had undergone radical retropubic prostatectomy (removal of the prostate) and were prescribed oral sildenafil answered a mail questionnaire. Of these patients, 21 underwent bilateral (both sides) and 15 unilateral (one side) neurovascular bundle sparing procedures, while in 17 patients, a non nerve sparing procedure was performed. All patients received 25 to 100 mg sildenafil in a flexible dose escalation manner. Of the 21 patients who underwent a

14 Viagra

bilateral nerve sparing procedure, 15 had a positive response to sildenafil. Of the 15 patients who had undergone a unilateral nerve sparing procedure, 12 had a positive response to the drug. In only 1 of the 17 patients who had undergone a non nerve sparing procedure was there any response to sildenafil. The most commonly reported adverse events of all causes were headaches (21 percent), flushing (8.3 percent), visual disturbance (6.3 percent), and nasal congestion (6.3 percent). Response was defined as erection sufficient for intercourse. One appendix reprints the questionnaire. 1 table. 13 references. •

Sildenafil for Treatment of Erectile Dysfunction in Men with Diabetes: A Randomized Controlled Trial Source: JAMA. Journal of the American Medical Association. 281(5): 421-426. February 3, 1999. Summary: Erectile dysfunction (ED) is common in men with diabetes. This article reports on a study undertaken to assess the efficacy and safety of oral sildenafil citrate (Viagra) in the treatment of erectile dysfunction in men with diabetes. The 1996 study involved 268 men (mean age, 57 years) with erectile dysfunction (mean duration, 5.6 years) and diabetes (mean duration, 12 years). Patients were randomized to receive sildenafil (n = 136) or placebo (n = 132) as needed, but not more than once daily, for 12 weeks. Patients took the study drug or placebo 1 hour before anticipated sexual activity. The starting dose of sildenafil citrate was 50 mg, with the option to adjust the dose to 100 mg or 25 mg based on efficacy and tolerability, to be taken as needed. The outcome measure was self reported ability to achieve and maintain an erection for sexual intercourse according to the International Index of Erectile Function and adverse events. Two hundred and fifty two patients (94 percent) completed the study (131 of 136 in the sildenafil group, 121 of 132 in the placebo group). At 12 weeks, 74 (56 percent) of 131 patients in the sildenafil group reported improved erections compared with 13 (10 percent) of 127 patients in the placebo group. The proportion of men with at least 1 successful attempt at sexual intercourse was 61 percent for the sildenafil groups versus 22 percent for the placebo group. Adverse events related to treatment were reported for 22 (16 percent) of the patients taking sildenafil and 1 (1 percent) of the patients receiving placebo. The most common adverse events were headache, dyspepsia, and respiratory tract disorder, predominantly sinus congestion or drainage. The authors conclude that oral sildenafil is an effective and well tolerated treatment for erectile dysfunction in men with diabetes. 2 figures. 4 tables. 24 references. (AA-M).

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Sildenafil: Medical Advance or Media Event? (commentary) Source: Lancet. 351(9116): 1599-1600. May 30, 1998. Summary: This commentary addresses the media hype that has surrounded the approval of sildenafil (Viagra) for treating erectile dysfunction (ED). The first safe and effective oral agent to be approved for the treatment of ED, sildenafil is generally well tolerated, with transient side effects of headache, flushing, nasal congestion, dyspepsia, and mild visual disturbances reported by less than 20 percent of those in a clinical trial of 532 men. Increasing doses of sildenafil are associated with greater efficacy in this same study. Not surprisingly, patients are clamoring for the drug. However, with a wholesale cost of about $7 per pill, insurance providers are concerned, and managed care health providers are seeking restrictions on the use of the drug. The author comments on the additional benefit resulting from the societal reaction to approval of the drug. The barrage of media attention has served to make sexual dysfunction more socially acceptable as a topic of discussion. A marker of this trend is the growing

Studies 15

number of prescriptions for sildenafil being written by primary care physicians, rather than urologists or other specialists in sexual dysfunction. The author then comments on two areas of concern regarding sildenafil. First, because sildenafil is so easy to use, the underlying causes of the ED, which may be easily treated (e.g., by changing a medication), may be neglected. A second concern is the possible overuse or inappropriate prescription of the drug. 1 figure. 12 references. •

Does Sildenafil Stand Up to the Hype? Source: Patient Care Nurse Practitioner. 1(7): 8-9. September 1998. Contact: Available from Medical Economics Company. Five Paragon Drive, Montvale, NJ 07645. (800) 223-0581 or (201) 358-7200. Summary: This article reviews the current focus on sildenafil (Viagra), an oral medication used to treat erectile dysfunction (impotence). The FDA's approval of this oral agent opens up treatment to a substantial population of men who are not candidates for the more obtrusive and invasive treatment options. Sildenafil works by augmenting the man's response to sexual stimulation. This article briefly reports on research used to study the efficacy and safety of sildenafil. For optimal effects, the article recommends starting patients at 50 mg and increasing the dose as needed up to 100 mg of sildenafil. For elderly patients and those with renal insufficiency, start at 25 mg and increase to 50 mg. The drug is absorbed more quickly on an empty stomach and should be taken 1 to 2 hours before anticipated sexual activity. Patients should avoid drinking alcohol while using sildenafil. Sildenafil is not recommended in patients who have multiple risk factors for coronary artery disease, or in patients who are hypertensive, overweight, or cigarette smokers. It is also contraindicated in patients taking organic nitrates as well as in those patients with active angina. The article concludes with a brief review of the step care management process recommended for the treatment of erectile dysfunction in the primary care setting. 1 figure. 1 reference.

Federally Funded Research on Viagra The U.S. Government supports a variety of research studies relating to Viagra. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to Viagra. 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 Viagra. The following is typical of the type of information found when searching the CRISP database for Viagra:

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).

16 Viagra

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Project Title: CENTER FOR PSYCHO-ONCOLOGY RESEARCH Principal Investigator & Institution: Antoni, Michael H. Psychology; University of Miami Coral Gables University Sta Coral Gables, FL 33124 Timing: Fiscal Year 2001; Project Start 30-SEP-1999; Project End 31-AUG-2004 Summary: This application is for a 5-year Center for Psycho-Oncology Research (CPOR) grant to conduct behavioral, psychological, social, and biomedical research on the interrelationships among cognition, emotion, biological processes, and physical health in patients with different forms of cancer including breast cancer, prostate cancer and AIDS-related cervical neoplasia. The Center will systematically evaluate the efficacy group-based Cognitive Behavioral Stress Management (CBSM) intervention in Projects 1, 2 and 3., and a pharmacological hormonal treatment in Project 4, for improving quality of life and physical health in patients with different types of cancer or carcinogenic processes associated with reproductive health or hormonal functioning. These include women with breast cancer, older men with prostate cancer, and women at high risk for cervical cancer due to co-infection with Human Immunodeficiency Virus (HIV+) AND Human Papillomavirus (HPV+). Our prior work has shown that CBSM intervention can improve mood, change cognitions and build coping resources; that it modulates the output of sympathetic nervous system (SNS), Hypothalamic Pituitary Adrenal (HPA), and Hypothalamic Pituitary Gonadal (HPG) hormones; and that it helps normalize immunologic status in different populations. The Center will directly address these issues through four (4) randomized clinical trials as follows. Project 1 will (a) evaluate the effects of CBSM intervention on psychological distress, quality of life and biopsy- determined level of cervical cellular atypia; and (b) examine the putative psycho-biological mediators (psychosocial, endocrine, and immunologic changes) on intervention effects observed. Project 2 will (a) investigate the effects of CBSM intervention and quality of life and disease status (change in CA15-3) antigen levels) in women with early-mid stage breast, and (b) examine the putative psycho-biological mediators of intervention effects observed. Project 3 will (a) investigate the effects of CBSM in combination with Viagra (sildenafil citrate) on quality of life and physical health in older men with prostate cancer, and (b) examine the putative psycho-biological mediators of intervention effects observed. Project 4 will (a) evaluate the effects of estrogen therapy (chronic low-dose oral 17- beta estradiotherapy) on mood and quality of life, and physical health in patients with metastatic prostate cancer, and (b) examine the putative psycho-biological mediators of intervention effects observed. The Center will also support and conduct pilot studies of interventions in men and women with other cancers, and will also develop and test other forms of intervention as well as Spanish translations of CBSM for Spanish- speaking Breast and Prostate cancer patients. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CRYSTAL PHOSPHODIESTERASE

STRUCT.

OF

CYCLIC

NUCLEOTIDE

Principal Investigator & Institution: Ke, Hengming; Associate Professor; Biochemistry and Biophysics; University of North Carolina Chapel Hill Office of Sponsored Research Chapel Hill, NC 27599 Timing: Fiscal Year 2001; Project Start 01-APR-2000; Project End 31-MAR-2004 Summary: (Verbatim from the Applicant's Abstract) Cyclic nucleotide phosphodiesterase (PDE) catalyzes the hydrolysis of adenosine 3',5'-cyclic monophosphate (cAMP) and guanosine 3',5'-cyclic monophosphate (cGMP) to produce, respectively, 5'-AMP and 5'-GMP. PDE is a key enzyme to control cellular

Studies 17

concentrations of cAMP that is known as "second messenger" and mediates the response of cells to a wide variety of hormones and neurotransmitters. Ten families and twenty two subtypes of human PDE have been identified. The mRNAs of the 22 subtype PDEs are further spliced to generate over 60 isoforms of PDE. The distinct isoforms of PDE are located in different cellular compartments and possess different specificity of substrate. These two features of PDE have attracted great attention from pharmaceutical companies in the past decade. Many selective PDE inhibitors have been studied as therapeutic agents such as cardiotonic agents, vasodilators, antiasthma, atithrombic compounds, smooth muscle relaxants and antidepressants. For example, VIAGRA, an inhibitor of PDE5, is a prescription drug for erectile dysfunction of male patients. This proposal aims at characterization of substrate specificity and inhibitor selectivity by the approach of crystallography. The specific aims are to determine crystal structures of PDEs and their complexes with inhibitors including (1) the catalytic domain of PDE4B, (2) the catalytic domain of PDE4B complexed with the inhibitors rolipram and iodonated cAMP, (3) full length PDE4D and its complexes with the inhibitors rolipram and denbufylline and (4) the catalytic domain of PDE3 and its complex with cilostamide. The structures in this proposal will reveal the details of inhibitor binding at the active site and provide insight into catalytic mechanism. Docking cGMP into the active site of PDE4B, together with the structure of PDE4B-cAMP analog, will shed light on the substrate specificity. Comparison of the structures of PDE-inhibited complexes will shed light on the selectivity of inhibition of different families of PDE, and thus provide a structural basis for design of selective drugs. The structures will be determined by multiple isomorphous replacement, multiwavelength anomalous diffraction, or molecular replacement. The structural models will be built with the program O and refined by the program CNS. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GENE DYSFUNCTION

THERAPY

OF

DIABETIC

PENILE

ENDOTHELIAL

Principal Investigator & Institution: Wessells, Hunter; Associate Professor; Urology; University of Washington Seattle, WA 98195 Timing: Fiscal Year 2001; Project Start 15-SEP-2000; Project End 30-JUN-2005 Summary: Gene therapy of diabetic penile endothelial dysfunction. Half of the 7.5 million diabetic men in the US will develop erectile dysfunction (ED). Despite advances in our understanding of erectile physiology, treatments for diabetic impotence remains limited, and phosphodiesterase-specific therapy (Viagra) fails in the majority of diabetics with ED. It is known that endothelium- dependent smooth muscle relaxation is impaired in vascular and penile tissue from diabetics. Nitric oxide generated in the endothelium is involved in vasorelaxation and is an important supporter of cardiovascular homeostasis. But the role of the endothelial cell during flaccidity and erection is not understood. We hypothesize that the endothelial cell is critical to the homeostasis of the corpus cavernosum and that iNOS gene therapy of the penile endothelium can mitigate the development of erectile dysfunction. The goals of this project are 1) to demonstrate that diabetes impairs endothelium-dependent erectile responses through changes in eNOS homeostasis and endothelial cytoskeletal organization and 2) to repair the penile endothelium with iNOS gene therapy. Specific Aim 1 will characterize the time course and severity of endothelium dependent erection in the normal and streptozotocin- induced diabetic rat. Specific Aims 2 and 3 will examine the effects of hyperglycemia on corporal endothelial structure and function in vitro and in vivo. Cultured corporal endothelial cells and a detailed analysis of rat and

18 Viagra

human diabetic corpora will provide different methodological approaches to characterize eNOS expression and activity, cytoskeletal integrity, and disturbances in the cell cycle. Specific Aim 4 will determine whether transplantation of iNOStransduced endothelial cells will generate high levels of nitric oxide, repair the corporal endothelium, and augment erectile responses in diabetic rats. By providing a more detailed understanding of the corporal endothelium, and the alterations induced by diabetes, we can develop a novel therapeutic strategy targeted to the endothelial cell and endothelium-dependent mechanisms of erectile dysfunction. Such a strategy may ultimately be beneficial to men with ED due to diabetes as well as smoking, hypercholesterolemia, and aging. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GRAPEFRUIT PHARMACOKINETICS

JUICE

AND

SILDENAFIL

(VIAGRA)

Principal Investigator & Institution: Min, David I.; University of Iowa Iowa City, IA 52242 Timing: Fiscal Year 2001 Summary: This study is evaluating the effect of grapefruit juice on sildenafil pharmacokinetics and the relationship of metabolic ratio of dextromethorphan and 3methoxymorphinan in healthy, elderly males. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MOLECULAR CONTROL OF CGMP SIGNALING BY PKGS AND PDES Principal Investigator & Institution: Corbin, Jackie D. Molecular Physiol & Biophysics; Vanderbilt University 3319 West End Ave. Nashville, TN 372036917 Timing: Fiscal Year 2003; Project Start 01-SEP-1989; Project End 30-JUN-2008 Summary: (provided by applicant): The rapidly increasing number of effects ascribed to cGMP in mammals include smooth muscle relaxation, platelet inhibition, neutrophil degranulation, vision, gene expression, ion and water transport, bone resorption, skin darkening, long-term nerve depression, and opiod action, cGMP mediates effects of natural signals such as nitric oxide, natriuretic peptides, and guanylins, as well as effects of medications such as nitroglycerin and sildenafil (Viagra/TM). Guanylyl cyclases catalyze synthesis of cGMP, and phosphodiesterases (PDE) catalyze cGMP degradation; the balance of these two activities determines the tissue level of cGMP. The known intracellular receptors that are believed to mediate cGMP effects are cGMP-dependent protein kinase (PKG), cGMP-gated ion channel proteins, cGMP-binding PDEs (PDE2, PDE5, PDE6, PDE 10, PDE11), and cAMP-dependent protein kinase (PKA) by crossactivation. The main subjects of this application are regulation of PKG and PDE5/PDE11, with particular emphasis on functional relationships between these two enzyme classes. It is suggested that up to six mechanisms exist by which PDE5 mediates decline of cGMP after PKG activation by cGMP elevation, which represents negative feedback regulation of the cGMP pathway. Some of these mechanisms increase PDE5 catalytic site affinity, so that elevation of cGMP by drugs such as Viagra TM would cause potentiation of their own effects. It is hypothesized that these mechanisms involve both allosteric regulation of PDE5 by cGMP binding as well as phosphorylation of PDE5 by PKG. The probability that prolonged cGMP elevation in tissues induces compensatory adjustment in levels of guanylyl cyclase, PDE5, and PKG will also be inspected. Investigation of the fundamental mechanisms by which PKG is autoinhibited,

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and by which autoinhibition is relieved will be carded out. Site-directed mutagenesis will be used to study the molecular roles of a conserved serine juxtaposed to the pseudosubstrate site of PKG, which contributes strongly to both autoinhibition and inhibition of cGMP binding. The roles of Arg- 59 in the pseudosubstrate site will also be scrutinized. Small angle x-ray scattering, 3D electron microscopy, and deuterium/hydrogen exchange will be used to examine the quaternary structure and domain topography of PKG, and to decipher the changes in these parameters produced by cGMP binding. Three potentially commercialized PDE5 inhibitors (sildenafil, vardenafil, tadalafil) have been labeled with tritium. They will be used to identify and quantify PDE5 and PDE11 in crude tissue extracts, and to search for other PDE inhibitor-binding proteins in these extracts. They will also be used to address unknown catalytic site features of PDE5 and PDE11 such as catalytic site heterogeneity, binding affinity, and effects of divalent cations on affinity. Effects of cGMP binding to allosteric sites (GAF domains) and effects of PDE5 phosphorylation by PKG on catalytic site affinity for radiolabeled PDE5 inhibitors will also be studied. A thorough physical and biochemical characterization of PDE11 will be carded out, and the likelihood of regulation of this enzyme by ligand binding to its GAF domains or by enzyme phosphorylation will be explored. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: REGULATION AND FUNCTION OF CYCLIC GMP IN THE CNS Principal Investigator & Institution: Morton, David B. Associate Professor; Biological Structure/Function; Oregon Health & Science University Portland, OR 972393098 Timing: Fiscal Year 2001; Project Start 18-JUL-1991; Project End 31-JUL-2006 Summary: (provided by applicant): Almost all cellular functions are modulated by a variety of different intracellular messengers. This proposal focuses on the regulation and function of one of these messengers, cyclic GMP (cGMP). The balance of its synthesis and breakdown regulates the level of cGMP within a cell. The synthesis of cGMP is controlled by the enzyme guanylyl cyclase and until recently two main classes of guanylyl cyclase were known, receptor and soluble guanylyl cyclases. Receptor guanylyl cyclases are integral membrane proteins that are regulated by either extracellular peptide hormones or intracellular calcium-binding proteins. Guanylyl cyclases of this class regulate the cGMP levels in the kidney and in the photoreceptors of the retina. Soluble guanylyl cyclases are located in the cytoplasm and have classically been regulated by the gaseous messenger, nitric oxide. They are particularly important in regulating blood pressure via vascular smooth muscle tone. An example of the importance of cGMP in human health and disease is shown by the widespread use of the drug, sildenafil (Viagra) that elevates cGMP levels by inhibiting an enzyme that normally breaks down cGMP. Using an insect, Manduca sexta, as a model organism my lab has identified two novel classes of guanylyl cyclase. The first is related to receptor guanylyl cyclases but is not an integral membrane protein. The second is related to soluble guanylyl cyclases but is nitric oxide insensitive. We have evidence to suggest that this nitric oxide-insensitive soluble guanylyl cyclase mediates the action of a neuropeptide that regulates a specific behavioral program and associated physiological changes in Manduca and another insect, Drosophila melanogaster. The major focus of this proposal is to test this hypothesis directly combining the use of cellular and molecular approaches in Manduca with a genetic approach in Drosophila. In addition, we will use molecular and biochemical techniques to determine the biochemical cascade involved in the activation of this novel guanylyl cyclase. Members of these novel classes of guanylyl cyclase are also present in another model organism, Caenorhabditis elegans.

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Most signal transduction cascades are highly evolutionarily conserved and it is likely that examples of these guanylyl cyclases will be identified in mammals. A more detailed knowledge of the variety of mechanisms that regulate the levels of cGMP in different tissues will undoubtedly have a significant impact basic cellular physiology in a wide variety of systems. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TREATMENT OF ED IN PATIENTS TREATED FOR PROSTATE CANCER Principal Investigator & Institution: Bruner, Deborah W.; American College of Radiology 1101 Market St, 14Th Fl Philadelphia, PA 19107 Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 31-AUG-2004 Summary: (provided by applicant): Antiandrogens are often combined with radiation therapy (RT) or surgery as neoadjuvant, adjuvant or concurrent therapy in an attempt to decrease disease relapse and improve survival. However, the optimal combination and timing of antiandrogen therapy remains controversial. The Radiation Therapy Oncology Group (RTOG) recently activated a Phase III clinical trial, RTOG 99-10, to study the optimal duration of neoadjuvant total androgen suppression (TAS) and RT in stage II-III prostate cancer. However, it is possible that diminished QGL, particularly related to sexual function, will accompany the improved clinical outcomes associated with TAS. Specifically, TAS and RT have a significant impact on erectile function. If interventions are available to treat erectile dysfunction (ED) after prostate cancer therapy, QOL impairments may be minimized. Sildenafil (Viagra TM, Pfizer) is a FDA approved drug for the treatment of ED. Small, nonrandomized; single institution studies have shown significant improvements in ED in men treated with sildenafil after RT. However, the effectiveness of sildenafil for ED as a consequence of combined treatment with RT with TAS has not been adequately described. Conventional wisdom held that after RT plus neoadjuvant or concurrent TAS, erectile function would be equivalent to that after RT alone (once the TAS are discontinued). However, we observed a higher ED rate with the combination of RT and TAS (even after the antiandrogens were discontinued) compared with RT alone in our preliminary work. Antiandrogens affect erectile function through a different mechanism than the etiologies previously studied. If sildenafil is efficacious in this setting, it may assist in both patient decision-making regarding choice of therapy and in clinical management of post-therapy ED. Since most men with prostate cancer have partners, a critical part of the sexual experience, currently lacking in the literature, is an assessment of relationship factors that may interact with ED therapy to predict or modify response to treatment. This knowledge would allow for more effective treatment approaches based on a clinical strategy that provides instruction both on the technical use of the medication as well as on the importance of creating an appropriate psychosexual environment. This study targets men (N=332) recruited for participation from RTOG 99-10, treated with either 8 or 28 weeks of neoadjuvant TAS and RT with concurrent (8 week duration) TAS. The primary aim of this study is to determine, in a randomized, double-blind crossover study, if there is a significant difference in erectile function between men treated with sildenafil versus placebo after RT plus neoadjuvant TAS for prostate cancer. The secondary aim is to determine if there is a significant difference in overall sexual function and satisfaction between men treated with sildenafil versus placebo, and the third and fourth aims are to assess differences in partner sexual satisfaction and dyad marital adjustment between the sildenafil versus placebo arms of this study. Lastly, this study will assess factors associated with response

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to ED therapy such as age, pre-treatment sexual functions, and tobacco use among others. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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

"Viagra" finds ready market in China. by [No authors listed]; 2001 Feb 20; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=80796

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Cardiovascular events in users of sildenafil: results from first phase of prescription event monitoring in England. by Shakir SA, Wilton LV, Boshier A, Layton D, Heeley E. 2001 Mar 17; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=26545

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Coronary artery flow reserve in diabetics with erectile dysfunction using sildenafil. by Dietz U, Tries HP, Merkle W, Jaursch-Hancke C, Lambertz H. 2003; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=194431

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Cost utility analysis of sildenafil compared with papaverine-phentolamine injections. by Stolk EA, Busschbach JJ, Caffa M, Meuleman EJ, Rutten FF. 2000 Apr 29; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=27357

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Hua Fo tablets tainted with sildenafil-like compound. by Wooltorton E. 2002 Jun 11; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=113806

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Incidence of erectile dysfunction and characteristics of patients before and after the introduction of sildenafil in the United Kingdom: cross sectional study with comparison patients. by Kaye JA, Jick H. 2003 Feb 22; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=149443

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Oral sildenafil (Viagra[TM]) in male erectile dysfunction: use, efficacy and safety profile in an unselected cohort presenting to a British district general hospital. by Sairam K, Kulinskaya E, Hanbury D, Boustead G, McNicholas T. 2002; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=111060

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

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

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Prolonged erections produced by dihydrocodeine and sildenafil. by Goldmeier D, Lamba H. 2002 Jun 29; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=116609

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Sildenafil (Viagra) for male erectile dysfunction: a meta-analysis of clinical trial reports. by Moore RA, Edwards JE, McQuay HJ. 2002; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=115867

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Sildenafil: from the bench to the bedside. by Michelakis E, Tymchak W, Archer S. 2000 Oct 31; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=80254

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Tonic-clonic seizures in patients taking sildenafil. by Gilad R, Lampl Y, Eshel Y, Sadeh M. 2002 Oct 19; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=129635

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 Viagra, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “Viagra” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for Viagra (hyperlinks lead to article summaries): •

A 36-week, open label, non-comparative study to assess the long-term safety of sildenafil citrate (VIAGRA) in patients with erectile dysfunction. Author(s): Goldstein I. Source: Int J Clin Pract Suppl. 1999 June; 102: 8-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10665112&dopt=Abstract

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A 4-year update on the safety of sildenafil citrate (Viagra). Author(s): Padma-nathan H, Eardley I, Kloner RA, Laties AM, Montorsi F. Source: Urology. 2002 September; 60(2 Suppl 2): 67-90. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12414335&dopt=Abstract

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

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A double-blind placebo-controlled evaluation of the acute effects of sildenafil citrate (Viagra) on visual function in subjects with early-stage age-related macular degeneration. Author(s): Birch DG, Toler SM, Swanson WH, Fish GE, Laties AM. Source: American Journal of Ophthalmology. 2002 May; 133(5): 665-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11992864&dopt=Abstract

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A study using Viagra in a mental health practice. Author(s): Pallas J, Levine SB, Althof SE, Risen CB. Source: Journal of Sex & Marital Therapy. 2000 January-March; 26(1): 41-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10693115&dopt=Abstract

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A two-part pilot study of sildenafil (VIAGRA) in men with erectile dysfunction caused by spinal cord injury. Author(s): Maytom MC, Derry FA, Dinsmore WW, Glass CA, Smith MD, Orr M, Osterloh IH. Source: Spinal Cord : the Official Journal of the International Medical Society of Paraplegia. 1999 February; 37(2): 110-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10065749&dopt=Abstract

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ACC/AHA expert consensus document. Use of sildenafil (Viagra) in patients with cardiovascular disease. American College of Cardiology/American Heart Association. Author(s): Cheitlin MD, Hutter AM Jr, Brindis RG, Ganz P, Kaul S, Russell RO Jr, Zusman RM. Source: Journal of the American College of Cardiology. 1999 January; 33(1): 273-82. Review. Erratum In: J Am Coll Cardiol 1999 November 15; 34(6): 1850. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9935041&dopt=Abstract

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Achieving treatment optimization with sildenafil citrate (Viagra) in patients with erectile dysfunction. Author(s): McCullough AR, Barada JH, Fawzy A, Guay AT, Hatzichristou D. Source: Urology. 2002 September; 60(2 Suppl 2): 28-38. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12414331&dopt=Abstract

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Acute effects of sildenafil (viagra) on blue-on-yellow and white-on-white Humphrey perimetry. Author(s): McCulley TJ, Lam BL, Marmor MF, Hoffman KB, Luu JK, Feuer WJ. Source: Journal of Neuro-Ophthalmology : the Official Journal of the North American Neuro-Ophthalmology Society. 2000 December; 20(4): 227-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11130743&dopt=Abstract

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Acute effects of sldenafil ctrate (Viagra) on intraocular pressure in open-angle glaucoma. Author(s): Grunwald JE, Jacob SS, Siu K, Piltz J, Dupont J. Source: American Journal of Ophthalmology. 2001 December; 132(6): 872-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11730651&dopt=Abstract

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Acute myocardial infarction associated wiht Sildenafil (Viagra) ingestion. Author(s): Muniz AE, Holstege CP. Source: The American Journal of Emergency Medicine. 2000 May; 18(3): 353-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10830707&dopt=Abstract

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Acute myocardial infarction following sildenafil citrate (Viagra) intake in a nitratefree patient. Author(s): Porter A, Mager A, Birnbaum Y, Strasberg B, Sclarovsky S, Rechavia E. Source: Clin Cardiol. 1999 November; 22(11): 762-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10554698&dopt=Abstract

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Acute renal failure in a young man, 9 days after a 5-h persisting erection following Viagra: is there a causal relationship? Author(s): Chang CH, Hung CJ, Chian SS, Yang AH. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 1999 August; 14(8): 2045-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10462302&dopt=Abstract

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After two years, did Viagra live up to its expectations? Author(s): Madduri SD. Source: Mo Med. 2001 June; 98(6): 243-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11439881&dopt=Abstract

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Anterior ischemic optic neuropathy associated with viagra. Author(s): Cunningham AV, Smith KH. Source: Journal of Neuro-Ophthalmology : the Official Journal of the North American Neuro-Ophthalmology Society. 2001 March; 21(1): 22-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11315976&dopt=Abstract

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Ask the doctor. A few years ago, I had a heart attack. My doctor treated me with angioplasty, and I haven't had any symptoms of heart disease since. I do carry a bottle nitroglycerin with me, but haven't taken any in years. I renew my prescription every six months because I know the pills go bad. My problem is that I also need Viagra to have sexual intercourse. Whenever I refill my prescription for Viagra, the pharmacist gives me a hard time because he knows I also have a prescription for nitroglycerin. Just how dangerous is Viagra? Author(s): Lee TH. Source: Harvard Heart Letter : from Harvard Medical School. 2001 July; 11(11): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11511445&dopt=Abstract

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Ask the doctor. I tried Viagra for impotence and it didn't work. Is there anything else that I can try? Author(s): Lee TH. Source: Harvard Heart Letter : from Harvard Medical School. 1999 November; 10(3): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10521899&dopt=Abstract

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Assessment of the efficacy and safety of Viagra (sildenafil citrate) in men with erectile dysfunction during long-term treatment. Author(s): Steers W, Guay AT, Leriche A, Gingell C, Hargreave TB, Wright PJ, Price DE, Feldman RA. Source: International Journal of Impotence Research : Official Journal of the International Society for Impotence Research. 2001 October; 13(5): 261-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11890512&dopt=Abstract

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Before and beyond Viagra. Author(s): van der Linde I. Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 1998 October; 88(10): 1290-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9807176&dopt=Abstract

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Beyond Viagra. Psychological issues in the assessment and treatment of erectile dysfunction. Author(s): McDowell AJ, Snellgrove CA, Bond MJ. Source: Aust Fam Physician. 2001 September; 30(9): 867-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11676316&dopt=Abstract

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By the way, doctor. I'm 68, and I've been taking Viagra for about a year now. The drug is working for me, but I'm always a little scared that I am going to give myself a heart attack. Should I be? Author(s): Lee TH. Source: Harvard Health Letter / from Harvard Medical School. 2000 August; 25(10): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10927649&dopt=Abstract

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Can Viagra help patients who experience treatment-related erectile dysfunction? Author(s): Stempkowski L. Source: Clinical Journal of Oncology Nursing. 1999 January; 3(1): 4-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10232166&dopt=Abstract

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Cardiovascular effects of sildenafil citrate (Viagra): a naturalistic cross-over study. Author(s): Agelink MW, Schmitz T, Rembrink K, Beckerling D, Muck-Weymann M, Mercik D, Brockmeyer NH. Source: European Journal of Medical Research. 2001 November 20; 6(11): 459-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11726304&dopt=Abstract

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Cautions on using Viagra and P.I.s issued. Author(s): Slovick J. Source: Posit Living. 1999 June; 8(5): 16. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12492071&dopt=Abstract

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Central effects of sildenafil (Viagra) on auditory selective attention and verbal recognition memory in humans: a study with event-related brain potentials. Author(s): Schultheiss D, Muller SV, Nager W, Stief CG, Schlote N, Jonas U, Asvestis C, Johannes S, Munte TF. Source: World Journal of Urology. 2001 February; 19(1): 46-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11289570&dopt=Abstract

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Changes in ED therapy in the Viagra era. Author(s): Krane RJ. Source: World Journal of Urology. 2001 February; 19(1): 23-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11289566&dopt=Abstract

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Clinical efficacy and safety of sildenafil citrate (Viagra) in a multi-racial population in Singapore: A retrospective study of 1520 patients. Author(s): Lim PH, Li MK, Ng FC, Chia SJ, Consigliere D, Gooren L, Ng KK, Munisamy M, Perianan M. Source: International Journal of Urology : Official Journal of the Japanese Urological Association. 2002 June; 9(6): 308-15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12110094&dopt=Abstract

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Clinical safety of oral sildenafil citrate (VIAGRA) in the treatment of erectile dysfunction. Author(s): Morales A, Gingell C, Collins M, Wicker PA, Osterloh IH. Source: International Journal of Impotence Research : Official Journal of the International Society for Impotence Research. 1998 June; 10(2): 69-73; Discussion 73-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9647940&dopt=Abstract

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Commentary on the possibility that Viagra may contribute to transmission of HIV and other sexual diseases among older adults. Author(s): Paniagua FA. Source: Psychological Reports. 1999 December; 85(3 Pt 1): 942-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10672755&dopt=Abstract

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Comparison of reported and expected deaths in sildenafil (Viagra) users. Author(s): Wysowski DK, Farinas E, Swartz L. Source: The American Journal of Cardiology. 2002 June 1; 89(11): 1331-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12031744&dopt=Abstract

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Comparison of the efficacy and safety of sildenafil citrate (Viagra) and oral phentolamine for the treatment of erectile dysfunction. Author(s): Ugarte F, Hurtado-Coll A. Source: International Journal of Impotence Research : Official Journal of the International Society for Impotence Research. 2002 August; 14 Suppl 2: S48-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12161768&dopt=Abstract

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Competition for Viagra. Author(s): Cutler D. Source: Trends in Pharmacological Sciences. 2001 August; 22(8): 401. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11478994&dopt=Abstract

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Current treatment of impotence: Viagra and other options. Author(s): Rutherford D, Duffy FJ. Source: British Journal of Nursing (Mark Allen Publishing). 1999 February 25-March 10; 8(4): 235-41. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10347410&dopt=Abstract

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Depression, antidepressant therapies, and erectile dysfunction: clinical trials of sildenafil citrate (Viagra) in treated and untreated patients with depression. Author(s): Nurnberg HG, Seidman SN, Gelenberg AJ, Fava M, Rosen R, Shabsigh R. Source: Urology. 2002 September; 60(2 Suppl 2): 58-66. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12414334&dopt=Abstract

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Development of an assay for the simultaneous determination of sildenafil (Viagra) and its metabolite (UK-103,320) using automated sequential trace enrichment of dialysates and high-performance liquid chromatography. Author(s): Cooper JD, Muirhead DC, Taylor JE, Baker PR. Source: J Chromatogr B Biomed Sci Appl. 1997 November 7; 701(1): 87-95. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9389342&dopt=Abstract

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Direct sale of sildenafil (Viagra) to consumers over the Internet. Author(s): deKieffer DE. Source: The New England Journal of Medicine. 2000 March 9; 342(10): 742. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10712128&dopt=Abstract

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Direct sale of sildenafil (Viagra) to consumers over the Internet. Author(s): Henney JE, Shuren JE. Source: The New England Journal of Medicine. 2000 March 9; 342(10): 740, 742. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10712127&dopt=Abstract

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Direct sale of sildenafil (Viagra) to consumers over the Internet. Author(s): Armstrong K, Schwartz JS, Asch DA. Source: The New England Journal of Medicine. 1999 October 28; 341(18): 1389-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10536133&dopt=Abstract

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Editor's comment on: “Press release: further research supports Viagra safety profile”. Author(s): Jackson G. Source: Bju International. 2001 June; 87(9): 907; Author Reply 907-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11774876&dopt=Abstract

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Editor's comment on: “Press release: further research supports Viagra safety profile”. Author(s): Osterloh I, Hargreaves R. Source: Bju International. 2001 June; 87(9): 905-7; Author Reply 907-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11412240&dopt=Abstract

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Editor's comment. Press release: further research supports Viagra safety profile. Author(s): Williams G. Source: Bju International. 2000 October; 86(6): I-Ii. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11774878&dopt=Abstract

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Effect of sildenafil (Viagra) on cerebral blood flow velocity: a pilot study. Author(s): Arnavaz A, Aurich A, Weissenborn K, Hartmann U, Emrich HM, Schneider U. Source: Psychiatry Research. 2003 April 1; 122(3): 207-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12694895&dopt=Abstract

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Effect of sildenafil citrate (Viagra) on erectile dysfunction in a patient with familial amyloidotic polyneuropathy ATTR Val30Met. Author(s): Obayashi K, Ando Y, Terazaki H, Yamashita S, Nakagawa K, Nakamura M, Yamashita T, Suga M, Ishizaki T, Uchino M, Ando M. Source: Journal of the Autonomic Nervous System. 2000 April 12; 80(1-2): 89-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10742545&dopt=Abstract

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Effect of sildenafil citrate (Viagra) on retinal blood vessel diameter. Author(s): Grunwald JE, Metelitsina T, Grunwald L. Source: American Journal of Ophthalmology. 2002 June; 133(6): 809-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12036673&dopt=Abstract

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Effect of sildenafil citrate (viagra) on the ocular circulation. Author(s): Singh Hayreh S. Source: American Journal of Ophthalmology. 2002 January; 133(1): 169-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11755872&dopt=Abstract

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Effect of sildenafil citrate (Viagra) on the ocular circulation. Author(s): Grunwald JE, Siu KK, Jacob SS, Dupont J. Source: American Journal of Ophthalmology. 2001 June; 131(6): 751-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11384572&dopt=Abstract

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Effects of sildenafil (Viagra) administration on seminal parameters and postejaculatory refractory time in normal males. Author(s): Aversa A, Mazzilli F, Rossi T, Delfino M, Isidori AM, Fabbri A. Source: Human Reproduction (Oxford, England). 2000 January; 15(1): 131-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10611201&dopt=Abstract

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Effects of sildenafil citrate (viagra) on blood pressure in normotensive and hypertensive men. Author(s): Vardi Y, Klein L, Nassar S, Sprecher E, Gruenwald I. Source: Urology. 2002 May; 59(5): 747-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11992853&dopt=Abstract

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Effects of sildenafil citrate (viagra) on cardiac repolarization and on autonomic control in subjects with chronic heart failure. Author(s): Piccirillo G, Nocco M, Lionetti M, Moise A, Naso C, Marigliano V, Cacciafesta M. Source: American Heart Journal. 2002 April; 143(4): 703-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11923809&dopt=Abstract

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Effects of sildenafil citrate (Viagra) on choroidal congestion. Author(s): McCulley TJ, Luu JK, Marmor MF, Feuer WJ. Source: Ophthalmologica. Journal International D'ophtalmologie. International Journal of Ophthalmology. Zeitschrift Fur Augenheilkunde. 2002 November-December; 216(6): 455-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12566892&dopt=Abstract

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Effects of sildenafil citrate (Viagra) on hemodynamic parameters during exercise testing and occurrence of ventricular arrhythmias in patients with erectile dysfunction and cardiovascular disease. Author(s): Vardi Y, Bulus M, Reisner S, Nassar S, Aboud L, Sprecher E, Gruenwald I. Source: European Urology. 2003 May; 43(5): 544-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12706001&dopt=Abstract

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Efficacy and safety of flexible-dose oral sildenafil citrate (Viagra) in the treatment of erectile dysfunction in Brazilian and Mexican men. Author(s): Glina S, Bertero E, Claro J, Damiao R, Faria G, Fregonesi A, Jaspersen J, Mendoza A, Mattos D Jr, Rocha LC, Sotomayor M, Teloken C, Ureta S, Zonana E, Ugarte F. Source: International Journal of Impotence Research : Official Journal of the International Society for Impotence Research. 2002 August; 14 Suppl 2: S27-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12161765&dopt=Abstract

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Efficacy and safety of oral sildenafil (Viagra) in men with erectile dysfunction caused by spinal cord injury. Author(s): Derry FA, Dinsmore WW, Fraser M, Gardner BP, Glass CA, Maytom MC, Smith MD. Source: Neurology. 1998 December; 51(6): 1629-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9855514&dopt=Abstract

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Efficacy and safety of oral sildenafil citrate (Viagra) in the treatment of male erectile dysfunction in Colombia, Ecuador, and Venezuela: a double-blind, multicenter, placebo-controlled study. Author(s): Gomez F, Davila H, Costa A, Acuna A, Wadskier LA, Plua P; Andean Group of Erectile Dysfunction Study. Source: International Journal of Impotence Research : Official Journal of the International Society for Impotence Research. 2002 August; 14 Suppl 2: S42-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12161767&dopt=Abstract

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Efficacy and safety of sildenafil citrate (Viagra) in black and Hispanic American men. Author(s): Young JM, Bennett C, Gilhooly P, Wessells H, Ramos DE. Source: Urology. 2002 September; 60(2 Suppl 2): 39-48. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12414332&dopt=Abstract

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Efficacy and safety of sildenafil citrate (Viagra) in men with erectile dysfunction and spinal cord injury: a review. Author(s): Derry F, Hultling C, Seftel AD, Sipski ML. Source: Urology. 2002 September; 60(2 Suppl 2): 49-57. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12414333&dopt=Abstract

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Efficacy of sildenafil citrate (VIAGRA) is not affected by aetiology of erectile dysfunction. Author(s): Shabsigh R. Source: Int J Clin Pract Suppl. 1999 June; 102: 19-20. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10665116&dopt=Abstract

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Erectile dysfunction in Latin America and treatment with sildenafil citrate (Viagra): introduction. Author(s): Becher E, Glina S. Source: International Journal of Impotence Research : Official Journal of the International Society for Impotence Research. 2002 August; 14 Suppl 2: S1-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12161761&dopt=Abstract

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Evaluation of health-related quality of life in patients treated for erectile dysfunction with viagra (sildenafil citrate) using SF-36 score. Author(s): Fujisawa M, Sawada K, Okada H, Arakawa S, Saito S, Kamidono S. Source: Archives of Andrology. 2002 January-February; 48(1): 15-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11789678&dopt=Abstract

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Fatal overdosage with sildenafil citrate (Viagra): first report and review of the literature. Author(s): Tracqui A, Miras A, Tabib A, Raul JS, Ludes B, Malicier D. Source: Human & Experimental Toxicology. 2002 November; 21(11): 623-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12507258&dopt=Abstract

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FDA committee recommends approval for viagra rival. Author(s): Gottlieb S. Source: Bmj (Clinical Research Ed.). 2000 April 22; 320(7242): 1094. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10775211&dopt=Abstract

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Gender discrimination within the reproductive health care system: Viagra v. birth control. Author(s): Hayden LA. Source: J Law Health. 1998-99; 13(2): 171-98. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10947393&dopt=Abstract

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Hair analysis for pharmaceutical drugs. II. Effective extraction and determination of sildenafil (Viagra) and its N-desmethyl metabolite in rat and human hair by GC-MS. Author(s): Saisho K, Scott KS, Morimoto S, Nakahara Y. Source: Biological & Pharmaceutical Bulletin. 2001 December; 24(12): 1384-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11767107&dopt=Abstract

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Hemi-retinal artery occlusion associated with sexual activity and sildenafil citrate (Viagra). Author(s): Bertolucci A, Latkany RA, Gentile RC, Rosen RB. Source: Acta Ophthalmologica Scandinavica. 2003 April; 81(2): 198-200. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12752064&dopt=Abstract

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Impact of sildenafil citrate (Viagra) on the DSM-IV diagnosis of male erectile disorder due to psychological factors. Author(s): Fishbain DA. Source: Urology. 1999 September; 54(3): 579. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10475378&dopt=Abstract

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In vitro biotransformation of sildenafil (Viagra): identification of human cytochromes and potential drug interactions. Author(s): Warrington JS, Shader RI, von Moltke LL, Greenblatt DJ. Source: Drug Metabolism and Disposition: the Biological Fate of Chemicals. 2000 April; 28(4): 392-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10725306&dopt=Abstract

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Increased risk of HIV and sexually transmitted disease transmission among gay or bisexual men who use Viagra, San Francisco 2000-2001. Author(s): Kim AA, Kent CK, Klausner JD. Source: Aids (London, England). 2002 July 5; 16(10): 1425-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12131222&dopt=Abstract

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Indian doctor in protest after using Viagra to save “blue babies”. Author(s): Kumar S. Source: Bmj (Clinical Research Ed.). 2002 July 27; 325(7357): 181. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12142299&dopt=Abstract

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Indications and early results of sildenafil (Viagra) in erectile dysfunction. Author(s): Virag R. Source: Urology. 1999 December; 54(6): 1073-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10604711&dopt=Abstract

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Intracavernous alprostadil alfadex (EDEX/VIRIDAL) is effective and safe in patients with erectile dysfunction after failing sildenafil (Viagra). Author(s): Shabsigh R, Padma-Nathan H, Gittleman M, McMurray J, Kaufman J, Goldstein I. Source: Urology. 2000 April; 55(4): 477-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10736486&dopt=Abstract

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Is it okay for men with macular degeneration to take the anti-impotence drug Viagra? Can it accelerate blindness by rupturing blood vessels in the eye? Author(s): Marmor M. Source: Health News. 2000 October; 6(10): 10. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11070789&dopt=Abstract

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Is sex medically necessary? Who should pay for Viagra? Author(s): La Puma J. Source: Manag Care. 1998 June; 7(6): 52, 55. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10180804&dopt=Abstract

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Is sildenafil (viagra) an efficacious treatment for sexual arousal disorder in premenopausal women? Author(s): Baty PJ. Source: The Journal of Family Practice. 2001 November; 50(11): 921. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11711001&dopt=Abstract

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Last performance with VIAGRA: post-mortem identification of sildenafil and its metabolites in biological specimens including hair sample. Author(s): Dumestre-Toulet V, Cirimele V, Gromb S, Belooussoff T, Lavault D, Ludes B, Kintz P. Source: Forensic Science International. 2002 March 28; 126(1): 71-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11955836&dopt=Abstract

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Long-term efficacy and safety of oral Viagra (sildenafil citrate) in men with erectile dysfunction and the effect of randomised treatment withdrawal. Author(s): Christiansen E, Guirguis WR, Cox D, Osterloh IH; Sildenafil Multicentre Study Group. Source: International Journal of Impotence Research : Official Journal of the International Society for Impotence Research. 2000 June; 12(3): 177-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11045912&dopt=Abstract

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Looking beyond Viagra. The 30 million American men with impotence problems may soon have two oral treatments to choose from. How do they compare? Author(s): Cowley G. Source: Newsweek. 2000 April 24; 135(17): 77-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10848380&dopt=Abstract

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Medicaid and Viagra: restoring potency to an old program? Author(s): Chavkin DF. Source: Health Matrix (Cleveland, Ohio : 1991). 2001 Winter; 11(1): 189-262. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11345675&dopt=Abstract

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Micellar electrokinetic capillary chromatography for the determination of Viagra and its metabolite (UK-103,320) in human serum. Author(s): Berzas Nevado JJ, Rodriguez Flores J, Castaneda Penalvo G, Rodriguez Farinas N. Source: Electrophoresis. 2001 June; 22(10): 2004-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11465499&dopt=Abstract

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Molecular mechanisms of the effects of sildenafil (VIAGRA). Author(s): Glossmann H, Petrischor G, Bartsch G. Source: Experimental Gerontology. 1999 June; 34(3): 305-18. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10433386&dopt=Abstract

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My insurance company won't pay for my prescription for Viagra without a letter from my doctor saying that I have been evaluated. As far as I know, I am the only one who can tell whether I have impotence. What does the insurance company want? Author(s): Lee TH. Source: Harvard Heart Letter : from Harvard Medical School. 1999 March; 9(7): 7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10066324&dopt=Abstract

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Myocardial infarction following the combined recreational use of Viagra and cannabis. Author(s): McLeod AL, McKenna CJ, Northridge DB. Source: Clin Cardiol. 2002 March; 25(3): 133-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11890373&dopt=Abstract

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No clinically important effects on intraocular pressure after short-term administration of sildenafil citrate (Viagra). Author(s): Yajima T, Yajima Y, Koppiker N, Grunwald JE, Laties AM. Source: American Journal of Ophthalmology. 2000 May; 129(5): 675-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10844068&dopt=Abstract

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Nose-bleeds after sildenafil (Viagra). Author(s): Hicklin LA, Ryan C, Wong DK, Hinton AE. Source: Journal of the Royal Society of Medicine. 2002 August; 95(8): 402-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12151491&dopt=Abstract

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Ocular safety of Viagra, (sildenafil citrate). Author(s): Laties AM, Fraunfelder FT. Source: Trans Am Ophthalmol Soc. 1999; 97: 115-25; Discussion 125-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10703120&dopt=Abstract

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Oral sildenafil (Viagra) on trial. Author(s): van der Linde I. Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 1998 October; 88(10): 1290. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9807177&dopt=Abstract

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Oral sildenafil citrate (VIAGRA) in the treatment of erectile dysfunction: assessment of erections hard enough for sexual intercourse. Author(s): Padma-Nathan H. Source: Int J Clin Pract Suppl. 1999 June; 102: 13-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10665114&dopt=Abstract

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Partners' perceptions of the efficacy of sildenafil citrate (VIAGRA) in the treatment of erectile dysfunction. Author(s): Hultling C. Source: Int J Clin Pract Suppl. 1999 June; 102: 16-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10665115&dopt=Abstract

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Patient and partner satisfaction with Viagra (sildenafil citrate) treatment as determined by the Erectile Dysfunction Inventory of Treatment Satisfaction Questionnaire. Author(s): Lewis R, Bennett CJ, Borkon WD, Boykin WH, Althof SE, Stecher VJ, Siegel RL. Source: Urology. 2001 May; 57(5): 960-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11337303&dopt=Abstract

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Perspectives. Viagra or bust: is pharmacy cost crisis unraveling HMO utilization strategy? Author(s): Hagland M. Source: Med Health. 1998 July 13; 52(28): Suppl 1-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10181087&dopt=Abstract

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Post-mortem detection and identification of sildenafil (Viagra) and its metabolites by LC/MS and LC/MS/MS. Author(s): Weinmann W, Bohnert M, Wiedemann A, Renz M, Lehmann N, Pollak S. Source: International Journal of Legal Medicine. 2001; 114(4-5): 252-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11355405&dopt=Abstract

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Protease inhibitors and sildenafil (Viagra) should not be combined. Author(s): Highleyman L. Source: Beta. 1999 April; 12(2): 3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11366694&dopt=Abstract

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Protease inhibitors, sexual dysfunction and Viagra. Author(s): Gilden D. Source: Gmhc Treat Issues. 1999 March; 13(3): 12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11366202&dopt=Abstract

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Public safety delays putting Viagra on the shelf. Author(s): van der Linde I. Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 1999 February; 89(2): 112. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10191852&dopt=Abstract

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Pulsatile visual phenomenon, ipsilateral to a metastatic orbital carcinoid, occurring during usage of sildenafil (Viagra). Author(s): Smith JM, Rose GE, Plowman PN. Source: Eye (London, England). 2001 December; 15(Pt 6): 809-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11827018&dopt=Abstract

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Pupil-sparing third nerve palsy associated with sildenafil citrate (Viagra). Author(s): Donahue SP, Taylor RJ. Source: American Journal of Ophthalmology. 1998 September; 126(3): 476-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9744392&dopt=Abstract

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Quality of life in patients with spinal cord injury receiving Viagra (sildenafil citrate) for the treatment of erectile dysfunction. Author(s): Hultling C, Giuliano F, Quirk F, Pena B, Mishra A, Smith MD. Source: Spinal Cord : the Official Journal of the International Medical Society of Paraplegia. 2000 June; 38(6): 363-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10889565&dopt=Abstract

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Randomized, double-blind, placebo-controlled trial of sildenafil (Viagra) for erectile dysfunction after rectal excision for cancer and inflammatory bowel disease. Author(s): Lindsey I, George B, Kettlewell M, Mortensen N. Source: Diseases of the Colon and Rectum. 2002 June; 45(6): 727-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12072621&dopt=Abstract

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Rationalising rationing: economic and other considerations in the debate about funding of Viagra. Author(s): Stolk EA, Brouwer WB, Busschbach JJ. Source: Health Policy (Amsterdam, Netherlands). 2002 January; 59(1): 53-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11786174&dopt=Abstract

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Role of Viagra after radical prostatectomy. Author(s): Zippe CD, Jhaveri FM, Klein EA, Kedia S, Pasqualotto FF, Kedia A, Agarwal A, Montague DK, Lakin MM. Source: Urology. 2000 February; 55(2): 241-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10688087&dopt=Abstract

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Should male patients with chest pain be questioned about Viagra use during triage screening? Author(s): Walsh R. Source: Journal of Emergency Nursing: Jen : Official Publication of the Emergency Department Nurses Association. 2001 February; 27(1): 8-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11174258&dopt=Abstract

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Should prescription plans cover Viagra? Author(s): Moreno JD. Source: Journal of Andrology. 1999 March-April; 20(2): 196-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10232654&dopt=Abstract

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Side-effect profile of sildenafil citrate (Viagra) in clinical practice. Author(s): Moreira SG Jr, Brannigan RE, Spitz A, Orejuela FJ, Lipshultz LI, Kim ED. Source: Urology. 2000 September 1; 56(3): 474-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10962318&dopt=Abstract

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Sildenafil (Viagra) a cause of proliferative diabetic retinopathy? Author(s): Burton AJ, Reynolds A, O'Neill D. Source: Eye (London, England). 2000 October; 14 Pt 5: 785-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11116706&dopt=Abstract

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Sildenafil (Viagra) and endolymphatic hydrops. Author(s): Black B. Source: The American Journal of Otology. 2000 September; 21(5): 771. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10993474&dopt=Abstract

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Sildenafil (Viagra) and ophthalmology. Author(s): Marmor MF, Kessler R. Source: Survey of Ophthalmology. 1999 September-October; 44(2): 153-62. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10541153&dopt=Abstract

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Sildenafil (Viagra) and ophthalmology. Author(s): Marmor MF. Source: Archives of Ophthalmology. 1999 April; 117(4): 518-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10206581&dopt=Abstract

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Sildenafil (Viagra) associated anterior ischemic optic neuropathy. Author(s): Egan R, Pomeranz H. Source: Archives of Ophthalmology. 2000 February; 118(2): 291-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10676804&dopt=Abstract

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Sildenafil (viagra) facilitates weaning of inhaled nitric oxide following placement of a biventricular-assist device. Author(s): Mychaskiw G, Sachdev V, Heath BJ. Source: Journal of Clinical Anesthesia. 2001 May; 13(3): 218-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11377161&dopt=Abstract

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Sildenafil (Viagra) for the treatment of erectile dysfunction in men with diabetes. Author(s): Setter SM, Baker DE, Campbell RK, Johnson SB. Source: Diabetes Educ. 1999 January-February; 25(1): 79-80, 83-4, 87 Passim. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10232183&dopt=Abstract

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Sildenafil (Viagra) for treating male erectile dysfunction. Author(s): Licht MR. Source: Cleve Clin J Med. 1998 June; 65(6): 301-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9637957&dopt=Abstract

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Sildenafil (Viagra) has been reported to be an effective treatment for erectile dysfunction. Author(s): Ivy ME, Atweh NA, Possenti PA, Caushaj PF. Source: The Journal of Trauma. 1999 February; 46(2): 357. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10029050&dopt=Abstract

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Sildenafil (Viagra) in kidney transplant recipients with erectile dysfunction. Author(s): Espinoza R, Melchor JL, Gracida C. Source: Transplantation Proceedings. 2002 February; 34(1): 408-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11959347&dopt=Abstract

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Sildenafil (Viagra) in the treatment of male erectile dysfunction in Nairobi. Author(s): Magoha GA. Source: East Afr Med J. 2000 February; 77(2): 76-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10774079&dopt=Abstract

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Sildenafil (viagra) is a risk factor for acute variceal bleeding. Author(s): Tzathas C, Christidou A, Ladas SD. Source: The American Journal of Gastroenterology. 2002 July; 97(7): 1856. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12135063&dopt=Abstract

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Sildenafil (Viagra) is used as a recreational drug in England. Author(s): Aldridge J, Measham F. Source: Bmj (Clinical Research Ed.). 1999 March 6; 318(7184): 669. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10066221&dopt=Abstract

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Sildenafil (Viagra) prolongs cardiac repolarization by blocking the rapid component of the delayed rectifier potassium current. Author(s): Butrous G, Siegel RL. Source: Circulation. 2001 June 12; 103(23): E119-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11401951&dopt=Abstract

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Sildenafil (Viagra) prolongs cardiac repolarization by blocking the rapid component of the delayed rectifier potassium current. Author(s): Geelen P, Drolet B, Rail J, Berube J, Daleau P, Rousseau G, Cardinal R, O'Hara GE, Turgeon J. Source: Circulation. 2000 July 18; 102(3): 275-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10899088&dopt=Abstract

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Sildenafil (Viagra) 'reaches the parts other drugs cannot reach'. Author(s): Jackson G. Source: Int J Clin Pract. 1998 September; 52(6): 359. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9894370&dopt=Abstract

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Sildenafil (Viagra): cardiac risks. Author(s): Morrison H. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 2000 July 11; 163(1): 86-7, 90-1. English, French. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10920745&dopt=Abstract

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Sildenafil (Viagra): is there an influence on psychological performance? Author(s): Grass H, Klotz T, Fathian-Sabet B, Berghaus G, Engelmann U, Kaferstein H. Source: International Urology and Nephrology. 2001; 32(3): 409-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11583362&dopt=Abstract

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Sildenafil (Viagra): new data, new confidence in treating erectile dysfunction in the cardiovascular patient. Author(s): Jackson G. Source: Int J Clin Pract. 2002 March; 56(2): 75. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11926708&dopt=Abstract

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Sildenafil (Viagra): new data, new confidence in treating erectile dysfunction in the cardiovascular patient. Author(s): Ann Intern Med. 2002 Apr 2;136(7):I35 Source: Int J Clin Pract. 2002 March; 56(2): 75. No Abstract Available. /entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11926808

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Sildenafil (Viagra)-induced spontaneous intracerebral haemorrhage. Author(s): Buxton N, Flannery T, Wild D, Bassi S. Source: British Journal of Neurosurgery. 2001 August; 15(4): 347-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11599452&dopt=Abstract

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Sildenafil citrate (Viagra) after radical retropubic prostatectomy: con. Author(s): Nehra A, Goldstein I. Source: Urology. 1999 October; 54(4): 587-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10510911&dopt=Abstract

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Sildenafil citrate (Viagra) after radical retropubic prostatectomy: pro. Author(s): Zippe CD, Kedia S, Kedia AW, Pasqualotto F. Source: Urology. 1999 October; 54(4): 583-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10510910&dopt=Abstract

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Sildenafil citrate (Viagra) and erectile dysfunction following external beam radiotherapy for prostate cancer: a randomized, double-blind, placebo-controlled, cross-over study. Author(s): Incrocci L, Koper PC, Hop WC, Slob AK. Source: International Journal of Radiation Oncology, Biology, Physics. 2001 December 1; 51(5): 1190-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11728676&dopt=Abstract

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Sildenafil citrate (Viagra) efficacy in the treatment of erectile dysfunction in patients with common concomitant conditions. Sildenafil Study Group. Author(s): Price D. Source: Int J Clin Pract Suppl. 1999 June; 102: 21-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10665117&dopt=Abstract

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Sildenafil citrate (Viagra) for the treatment of erectile dysfunction in men with Parkinson's disease. Author(s): Zesiewicz TA, Helal M, Hauser RA. Source: Movement Disorders : Official Journal of the Movement Disorder Society. 2000 March; 15(2): 305-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10752581&dopt=Abstract

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Sildenafil citrate (VIAGRA) improves erectile function in elderly patients with erectile dysfunction: a subgroup analysis. Author(s): Wagner G, Montorsi F, Auerbach S, Collins M. Source: The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 2001 February; 56(2): M113-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11213274&dopt=Abstract

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Sildenafil citrate (Viagra) in erectile dysfunction: near normalization in men with broad-spectrum erectile dysfunction compared with age-matched healthy control subjects. Author(s): Dinsmore WW, Hodges M, Hargreaves C, Osterloh IH, Smith MD, Rosen RC. Source: Urology. 1999 April; 53(4): 800-5. Erratum In: Urology 1999 May; 53(5): 1072. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10197860&dopt=Abstract

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Sildenafil citrate (VIAGRA) in the treatment of erectile dysfunction: a 12-week, flexible-dose study to assess efficacy and safety. Author(s): Young J. Source: Int J Clin Pract Suppl. 1999 June; 102: 6-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10665111&dopt=Abstract

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Sildenafil citrate (VIAGRA) in the treatment of erectile dysfunction: analysis of two flexible dose-escalation studies. Sildenafil Study Group. Author(s): Feldman R, Meuleman EJ, Steers W. Source: Int J Clin Pract Suppl. 1999 June; 102: 10-2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10665113&dopt=Abstract

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Sildenafil citrate (Viagra) in the treatment of men with erectile dysfunction in southern Latin America: a double-blind, randomized, placebo-controlled, parallelgroup, multicenter, flexible-dose escalation study. Author(s): Becher E, Tejada Noriega A, Gomez R, Decia R; Southern Latin America Sildenafil Study Group, Buenos Aires, Argentina. Source: International Journal of Impotence Research : Official Journal of the International Society for Impotence Research. 2002 August; 14 Suppl 2: S33-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12161766&dopt=Abstract

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Sildenafil citrate (Viagra) is effective and well tolerated for treating erectile dysfunction of psychogenic or mixed aetiology. Author(s): Olsson AM, Speakman MJ, Dinsmore WW, Giuliano F, Gingell C, Maytom M, Smith MD, Osterloh I; Sildenafil Multicentre Study Group. Source: Int J Clin Pract. 2000 November; 54(9): 561-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11220982&dopt=Abstract

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Sildenafil citrate (Viagra) treatment of sexual dysfunction in a schizophrenic patient. Author(s): Benatov R, Reznik I, Zemishlany Z. Source: European Psychiatry : the Journal of the Association of European Psychiatrists. 1999 October; 14(6): 353-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10572370&dopt=Abstract

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Sildenafil citrate (VIAGRA), an oral treatment for erectile function: 1-year, openlabel, extension studies. Multicentre Study Group. Author(s): Gingell C, Buvat J, Jardin A, Olsson AM, Dinsmore WW, Maytom MC, Orr MM, Smith MD, Osterloh IH. Source: Int J Clin Pract Suppl. 1999 June; 102: 30-1. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10665120&dopt=Abstract

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Sildenafil citrate (Viagra). Author(s): MacConnachie AM. Source: Intensive & Critical Care Nursing : the Official Journal of the British Association of Critical Care Nurses. 1999 June; 15(3): 177-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10595058&dopt=Abstract

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Sildenafil citrate (VIAGRA): a novel oral treatment for erectile dysfunction caused by traumatic spinal cord injury. Author(s): Giuliano F, Hultling C, el Masry WS, Luchner E, Stien R, Maytom MC, Orr M, Smith MD, Osterloh IH. Source: Int J Clin Pract Suppl. 1999 June; 102: 24-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10665118&dopt=Abstract

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Sildenafil citrate (VIAGRA): an oral treatment for erectile function with activity for up to four hours' duration. Author(s): Eardley I, Brooks J, Yates PK, Ellis P, Boolell M. Source: Int J Clin Pract Suppl. 1999 June; 102: 32-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10665121&dopt=Abstract

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Sildenafil citrate (VIAGRA): analysis of preferred doses in a European, six-month, double-blind, placebo-controlled, flexible dose-escalation study in patients with erectile dysfunction. Multicentre Study Group. Author(s): Hartmann U, Meuleman EJ, Cuzin B, Emrich HM, Declercq GA, Bailey MJ, Maytom MC, Smith MD, Osterloh IH. Source: Int J Clin Pract Suppl. 1999 June; 102: 27-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10665119&dopt=Abstract

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Sildenafil citrate (Viagra): oral medication for treating erectile dysfunction. Author(s): Kosier JH, Newton M, Smith D. Source: Urologic Nursing : Official Journal of the American Urological Association Allied. 1999 June; 19(2): 158-60. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10633767&dopt=Abstract

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Sildenafil citrate (VIAGRA): overall safety profile in 18 double-blind, placebo controlled, clinical trials. Author(s): Osterloh IH, Collins M, Wicker P, Wagner G. Source: Int J Clin Pract Suppl. 1999 June; 102: 3-5. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10665110&dopt=Abstract

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Sildenafil-associated NAION. Author(s): Gandhi JS. Source: Ophthalmology. 2003 September; 110(9): 1860-1; Author Reply 1861. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=13129901&dopt=Abstract

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Some men who take Viagra die--why? Author(s): Mitka M. Source: Jama : the Journal of the American Medical Association. 2000 February 2; 283(5): 590, 593. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10665685&dopt=Abstract

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Studies of Viagra offer some reassurance to men with concerns about cardiac effects. Author(s): Mitka M. Source: Jama : the Journal of the American Medical Association. 2001 April 18; 285(15): 1950-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11308415&dopt=Abstract

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Subjective visual halos after sildenafil (Viagra) administration: Electroretinographic evaluation. Author(s): Gabrieli CB, Regine F, Vingolo EM, Rispoli E, Fabbri A, Isidori A. Source: Ophthalmology. 2001 May; 108(5): 877-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11320016&dopt=Abstract

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Systematic review of Viagra RCTs. Author(s): Blanker MH, Thomas S, Bohnen AM. Source: The British Journal of General Practice : the Journal of the Royal College of General Practitioners. 2002 April; 52(477): 329. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11942454&dopt=Abstract

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Taking on Viagra. Author(s): Simons J. Source: Fortune. 2003 June 9; 147(11): 102-4, 108, 110 Passim. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12800577&dopt=Abstract

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The clinical safety of viagra. Author(s): Lim PH, Moorthy P, Benton KG. Source: Annals of the New York Academy of Sciences. 2002 May; 962: 378-88. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12076989&dopt=Abstract

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The economics of Viagra. Author(s): Keith A. Source: Health Aff (Millwood). 2000 March-April; 19(2): 147-57. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10718028&dopt=Abstract

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The efficacy of sildenafil citrate (Viagra) in clinical populations: an update. Author(s): Carson CC, Burnett AL, Levine LA, Nehra A. Source: Urology. 2002 September; 60(2 Suppl 2): 12-27. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12414330&dopt=Abstract

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The fallout from Viagra means it is time to come clean about NHS rationing. Author(s): Harris E. Source: Nurs Times. 1998 July 22-28; 94(29): 17. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9749015&dopt=Abstract

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The Israel Heart Society Expert Consensus Document: the cardiac patient and sexual activity in the era of sildenafil (Viagra). Author(s): Tzivoni D, Klein J, Hisdai D, Roth A. Source: Isr Med Assoc J. 2000 January; 2(1): 63-5. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10892379&dopt=Abstract

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The Marlboro man needs Viagra. Author(s): Davis RM. Source: Tobacco Control. 1998 Autumn; 7(3): 227. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9825410&dopt=Abstract

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The rise and fall of viagra. Author(s): Berger A. Source: Bmj (Clinical Research Ed.). 1998 September 19; 317(7161): 824. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9740588&dopt=Abstract

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The rise of Viagra. Author(s): Willis J. Source: Nurs Times. 1998 August 12-18; 94(32): 30-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9752175&dopt=Abstract

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The role of Viagra in the treatment of male impotence in ESRD. Author(s): Zarifian A. Source: Anna J. 1999 April; 26(2): 242. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10418355&dopt=Abstract

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The 'sextasy' craze. Clubland's dangerous party mix: Viagra and ecstasy. Author(s): Breslau K. Source: Newsweek. 2002 June 3; 139(22): 30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12066318&dopt=Abstract

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The ten most commonly asked questions about sildenafil (Viagra). Author(s): Cheitlin MD. Source: Cardiology in Review. 1999 July-August; 7(4): 173-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10454860&dopt=Abstract

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The Viagra revolution. Author(s): Butler RN. Source: Geriatrics. 1998 October; 53(10): 8-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9791191&dopt=Abstract

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Three-year update of sildenafil citrate (Viagra) efficacy and safety. Author(s): Sadovsky R, Miller T, Moskowitz M, Hackett G. Source: Int J Clin Pract. 2001 March; 55(2): 115-28. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11321851&dopt=Abstract

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Tolerability and safety profile of sildenafil citrate (Viagra) in Latin American patient populations. Author(s): Coelho OR. Source: International Journal of Impotence Research : Official Journal of the International Society for Impotence Research. 2002 August; 14 Suppl 2: S54-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12161769&dopt=Abstract

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Transient global amnesia after sildenafil (Viagra) use. Author(s): Savitz SA, Caplan LR. Source: Neurology. 2002 September 10; 59(5): 778. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12221181&dopt=Abstract

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Transient ischemic attack an stroke associated with sildenafil (Viagra) use. Author(s): Egan RA, Pomeranz H. Source: Neurology. 2002 July 23; 59(2): 293; Author Reply 293-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12136078&dopt=Abstract

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Transient ischemic attack and stroke associated with sildenafil (Viagra) use. Author(s): Morgan JC, Alhatou M, Oberlies J, Johnston KC. Source: Neurology. 2001 November 13; 57(9): 1730-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11706126&dopt=Abstract

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Treatment of erectile dysfunction after radical prostatectomy with sildenafil citrate (Viagra). Author(s): Zippe CD, Kedia AW, Kedia K, Nelson DR, Agarwal A. Source: Urology. 1998 December; 52(6): 963-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9836537&dopt=Abstract

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Treatment of erectile dysfunction with sildenafil citrate (Viagra) after radiation therapy for prostate cancer. Author(s): Kedia S, Zippe CD, Agarwal A, Nelson DR, Lakin MM. Source: Urology. 1999 August; 54(2): 308-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10443730&dopt=Abstract

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Treatment of erectile dysfunction with sildenafil citrate (Viagra) in parkinsonism due to Parkinson's disease or multiple system atrophy with observations on orthostatic hypotension. Author(s): Hussain IF, Brady CM, Swinn MJ, Mathias CJ, Fowler CJ. Source: Journal of Neurology, Neurosurgery, and Psychiatry. 2001 September; 71(3): 371-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11511713&dopt=Abstract

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UK issues guidance on prescribing Viagra. Author(s): Beecham L. Source: Bmj (Clinical Research Ed.). 1999 January 30; 318(7179): 279. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9924039&dopt=Abstract

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Use of oral sildenafil (Viagra) in the treatment of erectile dysfunction. Author(s): Licht MR. Source: Compr Ther. 1999 February; 25(2): 90-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10091013&dopt=Abstract

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Use of sildenafil (Viagra) in patients with cardiovascular disease. Technology and Practice Executive Committee. Author(s): Cheitlin MD, Hutter AM Jr, Brindis RG, Ganz P, Kaul S, Russell RO Jr, Zusman RM. Source: Circulation. 1999 January 5-12; 99(1): 168-77. Review. Erratum In: Circulation 1999 December 7; 100(23): 2389. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9884398&dopt=Abstract

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Use of Viagra by patients with heart disease. Author(s): Holdright D. Source: Hosp Med. 2000 August; 61(8): 584. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11045234&dopt=Abstract

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Vaginal sildenafil (Viagra): a preliminary report of a novel method to improve uterine artery blood flow and endometrial development in patients undergoing IVF. Author(s): Sher G, Fisch JD. Source: Human Reproduction (Oxford, England). 2000 April; 15(4): 806-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10739824&dopt=Abstract

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Valuing Viagra: what is restoring potency worth? Author(s): Kwok YS, Kim C. Source: Effective Clinical Practice : Ecp. 1999 July-August; 2(4): 171-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10539542&dopt=Abstract

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Viagra (sildenafil citrate) and ophthalmology. Author(s): Laties A, Zrenner E. Source: Progress in Retinal and Eye Research. 2002 September; 21(5): 485-506. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12207947&dopt=Abstract

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VIAGRA (sildenafil citrate) in clinical practice. Author(s): Padma-Nathan H. Source: Int J Clin Pract Suppl. 1999 June; 102: 2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10665109&dopt=Abstract

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Viagra and broken hearts. Author(s): Holzapfel S. Source: Can Fam Physician. 2000 February; 46: 257-9, 267-9. English, French. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10690480&dopt=Abstract

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Viagra and contraceptives. Author(s): Phillips KA, Spetz J, Haas JS. Source: Health Aff (Millwood). 2003 January-February; 22(1): 277. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12528859&dopt=Abstract

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Viagra and HAART. Author(s): Stricker BR, Thomas GD. Source: Southern Medical Journal. 2000 October; 93(10): 1037. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11147472&dopt=Abstract

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Viagra and its use in cardiovascular disease. Author(s): Tomlinson J. Source: Journal of Human Hypertension. 1999 September; 13(9): 593-4. Review. Erratum In: J Hum Hypertens 2000 April; 14(4): 283. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10482968&dopt=Abstract

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Viagra and male erectile dysfunction: prescribing restrictions should be abolished. Author(s): Jackson G. Source: Int J Clin Pract. 2000 May; 54(4): 207. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10912305&dopt=Abstract

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Viagra and penicillin: the same problem? Author(s): Haslam D. Source: Practitioner. 1998 October; 242(1591): 725. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10343452&dopt=Abstract

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Viagra and rationing. Let the sunlight in, let the people speak. Author(s): Smith R. Source: Bmj (Clinical Research Ed.). 1998 September 19; 317(7161): 760-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9740556&dopt=Abstract

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'Viagra effect' - influence of mass media on patient behavior. Author(s): Braun M, Klotz T, Mathers MJ, Klingebiel J, Zumbe J, Schoenenberger A, Engelmann U. Source: Urologia Internationalis. 2001; 66(3): 145-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11316976&dopt=Abstract

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Viagra for home care patients. Author(s): Catania PN. Source: Home Care Provider. 1998 August; 3(4): 197-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9814198&dopt=Abstract

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Viagra for impotence of pulmonary vasodilator therapy? Author(s): Lodato RF. Source: American Journal of Respiratory and Critical Care Medicine. 2001 February; 163(2): 312-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11179097&dopt=Abstract

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Viagra for temporary erectile dysfunction during treatments with assisted reproductive technologies. Author(s): Tur-Kaspa I, Segal S, Moffa F, Massobrio M, Meltzer S. Source: Human Reproduction (Oxford, England). 1999 July; 14(7): 1783-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10402389&dopt=Abstract

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Viagra guidance declared unlawful. Author(s): Dyer C. Source: Bmj (Clinical Research Ed.). 1999 June 5; 318(7197): 1509. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10355999&dopt=Abstract

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Viagra is licensed in Europe, but rationed in Britain. Author(s): Brooks A. Source: Bmj (Clinical Research Ed.). 1998 September 19; 317(7161): 765. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9786658&dopt=Abstract

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Viagra leads as rivals are moving up. Author(s): Mitka M. Source: Jama : the Journal of the American Medical Association. 1998 July 8; 280(2): 11920. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9669771&dopt=Abstract

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Viagra neonatal experimentation - the Pandora's box! Author(s): Lewin S. Source: Indian Pediatrics. 2002 September; 39(9): 894-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12368555&dopt=Abstract

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Viagra on the internet: unsafe sexual practice. Author(s): Solomon H, Man J, Gill J, Jackson G. Source: Int J Clin Pract. 2002 June; 56(5): 403-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12137453&dopt=Abstract

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Viagra presents special concerns for the hygienist and the dental team. Author(s): Biron CR. Source: Rdh. 1998 October; 18(10): 54-6, 58, 79. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10825918&dopt=Abstract

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Viagra soft on sales. Author(s): Jones JS. Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 1999 July; 89(7): 718. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10470301&dopt=Abstract

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Viagra turns 5. Author(s): Gorman C. Source: Time. 2003 January 20; 161(3): 146. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12545580&dopt=Abstract

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Viagra use and sexual risk behaviour among gay men in London. Author(s): Sherr L, Bolding G, Maguire M, Elford J. Source: Aids (London, England). 2000 September 8; 14(13): 2051-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10997413&dopt=Abstract

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Viagra use in a community-recruited sample of men who have sex with men, San Francisco. Author(s): Chu PL, McFarland W, Gibson S, Weide D, Henne J, Miller P, Partridge T, Schwarcz S. Source: Journal of Acquired Immune Deficiency Syndromes (1999). 2003 June 1; 33(2): 191-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12794553&dopt=Abstract

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Viagra users should be cautious. Author(s): Engle L. Source: Body Posit. 1998 August; 11(8): 12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11365694&dopt=Abstract

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Viagra warning re “poppers” and notice re protease inhibitors. Author(s): James JS. Source: Aids Treat News. 1998 May 1; (No 294): 1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11365402&dopt=Abstract

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Viagra! Are we ready? Author(s): Evans MF. Source: Can Fam Physician. 1998 October; 44: 2103-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9805164&dopt=Abstract

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Viagra, sexual intercourse and acute myocardial infarction. Author(s): Dakik HA, Al-Sayyed A, Sawaya JI. Source: Cardiology. 1999; 92(3): 220. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10754356&dopt=Abstract

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Viagra, the latest cardio-VASCULAR drug. Author(s): Nassar ME. Source: Clin Cardiol. 1999 January; 22(1): 2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9929744&dopt=Abstract

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Viagra, the latest cardio-VASCULAR drug. Author(s): Conti CR. Source: Clin Cardiol. 1998 September; 21(9): 616. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9755375&dopt=Abstract

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Viagra: a botched test case for rationing. Author(s): Chisholm J. Source: Bmj (Clinical Research Ed.). 1999 January 30; 318(7179): 273-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9924034&dopt=Abstract

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Viagra: a success story for rationing? Author(s): Klein R, Sturm H. Source: Health Aff (Millwood). 2002 November-December; 21(6): 177-87. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12442853&dopt=Abstract

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Viagra: a three-year sexual revolution and the need to recognise its role within the NHS. Author(s): Jackson G. Source: Int J Clin Pract. 2001 March; 55(2): 75-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11321862&dopt=Abstract

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Viagra: an option, not a miracle. Author(s): Barada JH. Source: Health News. 1998 June 1; 4(7): 4-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9624914&dopt=Abstract

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Viagra: are anaesthetists rising to the challenge? Author(s): Carvalho B, Smith M. Source: Anaesthesia. 2001 January; 56(1): 91-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11167459&dopt=Abstract

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Viagra: new warning with protease inhibitors. Author(s): James JS. Source: Aids Treat News. 1999 May 7; (No 318): 3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11366455&dopt=Abstract

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Viagra: on release. Evidence on the effectiveness of sildenafil is good. Author(s): Gregoire A. Source: Bmj (Clinical Research Ed.). 1998 September 19; 317(7161): 759-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9740555&dopt=Abstract

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Viagra: the facts behind the hysteria. Author(s): Jamieson S. Source: Nursing Standard : Official Newspaper of the Royal College of Nursing. 1998 November 11-17; 13(8): 26-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9923357&dopt=Abstract

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Viagra: what every physician should know. Author(s): Kloner RA. Source: Ear, Nose, & Throat Journal. 1998 September; 77(9): 783-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9787522&dopt=Abstract

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Viagra--after one year. Author(s): Steers WD. Source: Urology. 1999 July; 54(1): 12-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10414719&dopt=Abstract

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Viagra--beware the quick fix. Author(s): Hundertmark JD. Source: The Medical Journal of Australia. 1998 November 2; 169(9): 504. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9847911&dopt=Abstract

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Viagra--it's no free ride. Author(s): van der Linde I. Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 1998 November; 88(11): 1383. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9861940&dopt=Abstract

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Vioxx-Viagra confusion. Author(s): Kennedy AG, Littenberg B, Vezina LC. Source: American Journal of Health-System Pharmacy : Ajhp : Official Journal of the American Society of Health-System Pharmacists. 2002 November 1; 59(21): 2112. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12434730&dopt=Abstract

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Visual halos after sildenafil (Viagra). Author(s): Potter MJ, Behn D. Source: Ophthalmology. 2002 May; 109(5): 823; Author Reply 823-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11986069&dopt=Abstract

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When sex pales, women may need more than Viagra. Author(s): Schultz S. Source: U.S. News & World Report. 2000 June 26; 128(25): 64-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10977370&dopt=Abstract

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Where is the boundary between clinical and social need for Viagra? Author(s): Biggs H, Mackenzie R. Source: Journal of Health Services Research & Policy. 2000 January; 5(1): 64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10787594&dopt=Abstract

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

Finding Nutrition Studies on Viagra 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 “Viagra” (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 information is typical of that found when using the “Full IBIDS Database” to search for “Viagra” (or a synonym): •

Clinical efficacy and safety of sildenafil citrate (Viagra) in a multi-racial population in Singapore: A retrospective study of 1520 patients. Author(s): Department of Urology, Changi General Hospital, Urology Center, National University Hospital, Singapore. [email protected] Source: Lim, P H Li, M K Ng, F C Chia, S J Consigliere, D Gooren, L Ng, K K Munisamy, M Perianan, M Int-J-Urol. 2002 June; 9(6): 308-15 0919-8172

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Intracavernous alprostadil alfadex (EDEX/VIRIDAL) is effective and safe in patients with erectile dysfunction after failing sildenafil (Viagra). Author(s): Columbia-Presbyterian Medical Center, New York, New York, USA. Source: Shabsigh, R Padma Nathan, H Gittleman, M McMurray, J Kaufman, J Goldstein, I Urology. 2000 April; 55(4): 477-80 0090-4295

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Intracavernous injections for erectile dysfunction in patients with cardiovascular diseases and failure or contraindications for sildenafil citrate. Author(s): Institute of Urology, Rabin Medical Center, Beilinson Campus, Petah Tiqva 49110, Israel. Source: Israilov, S Niv, E Livne, P M Shmueli, J Engelstein, D Segenreich, E Baniel, J IntJ-Impot-Res. 2002 February; 14(1): 38-43 0955-9930

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Is there an herbal viagra. Source: Duke, J.A. J-med-food. Larchmont, NY : Mary Ann Liebert, Inc., c1998-. 1998. volume 1 (3) page 227-231. 1096-620X

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I've heard of an herbal alternative to Viagra for impotence. Does it work and is it safe? Source: Anonymous Mayo-Clin-Health-Lett. 2001 February; 19(2): 8 0741-6245

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Lysophosphatidic acid stimulates proliferation of cultured smooth muscle cells from human BPH tissue: sildenafil and papaverin generate inhibition. Author(s): Department of Medicine and Care, Division of Pharmacology, Faculty of Health Science, Linkoping University, Linkoping, Sweden. [email protected] Source: Adolfsson, Per I Ahlstrand, Christer Varenhorst, Eberhard Svensson, Samuel P S Prostate. 2002 April 1; 51(1): 50-8 0270-4137

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Molecular mechanisms of the effects of sildenafil (VIAGRA). Author(s): Institute of Biochemical Pharmacology, Innsbruck, Austria. [email protected] Source: Glossmann, H Petrischor, G Bartsch, G Exp-Gerontol. 1999 June; 34(3): 305-18 0531-5565

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Sildenafil as a selective pulmonary vasodilator in childhood primary pulmonary hypertension. Author(s): Department of Paediatric Cardiology, Royal Brompton & Harefield NHS Trust, Sydney Street, London SW3 6NP, UK. Source: Abrams, D Schulze Neick, I Magee, A G Heart. 2000 August; 84(2): E4 1468-201X

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Vaginal sildenafil (Viagra): a preliminary report of a novel method to improve uterine artery blood flow and endometrial development in patients undergoing IVF. Author(s): Sher Institute for Reproductive Medicine, 3121 S. Maryland Parkway, Suite 300, Las Vegas, Nevada 89109, USA. Source: Sher, G Fisch, J D Hum-Reprod. 2000 April; 15(4): 806-9 0268-1161

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What Malaysian women believe about Viagra: a qualitative inquiry. Author(s): Health Research Development Unit, University of Malaya Medical Center, 50603 Kuala Lumpur, Malaysia. Source: Low, W Y Zulkifli, S N Wong, Y L Tan, H M Aging-Male. 2002 March; 5(1): 57-63 1368-5538

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

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

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

A comparative study of Ferula hermonis root extracts and sildenafil on copulatory behaviour of male rats. Author(s): Hadidi KA, Aburjai T, Battah AK. Source: Fitoterapia. 2003 April; 74(3): 242-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12727488&dopt=Abstract

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Aphrodisiacs past and present: a historical review. Author(s): Sandroni P. Source: Clinical Autonomic Research : Official Journal of the Clinical Autonomic Research Society. 2001 October; 11(5): 303-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11758796&dopt=Abstract

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Assessment and management of erectile dysfunction in men with diabetes. Author(s): Spollett GR.

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Source: Diabetes Educ. 1999 January-February; 25(1): 65-73; Quiz 75. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10232182&dopt=Abstract •

Clinical efficacy of sildenafil citrate and predictors of long-term response. Author(s): Gonzalgo ML, Brotzman M, Trock BJ, Geringer AM, Burnett AL, Jarow JP. Source: The Journal of Urology. 2003 August; 170(2 Pt 1): 503-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12853809&dopt=Abstract

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FDA issues warning on “all-natural” herbal product found to contain viagra. Author(s): Mitka M. Source: Jama : the Journal of the American Medical Association. 2003 June 4; 289(21): 2786. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12783897&dopt=Abstract

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Female sexual dysfunction. Author(s): Walton B, Thorton T. Source: Curr Womens Health Rep. 2003 August; 3(4): 319-26. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12844457&dopt=Abstract

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Global perspectives and controversies in the epidemiology of male erectile dysfunction. Author(s): Nehra A, Kulaksizoglu H. Source: Current Opinion in Urology. 2002 November; 12(6): 493-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12409879&dopt=Abstract

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Hua Fo tablets tainted with sildenafil-like compound. Author(s): Wooltorton E. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 2002 June 11; 166(12): 1568. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12074127&dopt=Abstract

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Korean red ginseng effective for treatment of erectile dysfunction. Author(s): Price A, Gazewood J. Source: The Journal of Family Practice. 2003 January; 52(1): 20-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12540305&dopt=Abstract

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On the “proper use” of the Internet: self-help medical information and on-line health care. Author(s): Oravec JA. Source: J Health Soc Policy. 2001; 14(1): 37-60. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11374297&dopt=Abstract

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Oral treatment of erectile dysfunction: from herbal remedies to designer drugs. Author(s): Guirguis WR. Source: Journal of Sex & Marital Therapy. 1998 April-June; 24(2): 69-73. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9611686&dopt=Abstract

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Pyrano-isoflavones with erectile-dysfunction activity from Eriosema kraussianum. Author(s): Drewes SE, Horn MM, Munro OQ, Dhlamini JT, Meyer JJ, Rakuambo NC. Source: Phytochemistry. 2002 April; 59(7): 739-47. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11909631&dopt=Abstract

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Recent findings on natural products with erectile-dysfunction activity. Author(s): Drewes SE, George J, Khan F. Source: Phytochemistry. 2003 April; 62(7): 1019-25. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12591255&dopt=Abstract

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Sildenafil for St. John Wort-induced sexual dysfunction. Author(s): Assalian P. Source: Journal of Sex & Marital Therapy. 2000 October-December; 26(4): 357-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11056902&dopt=Abstract

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Sildenafil in the treatment of female sexual dysfunction induced by selective serotonin reuptake inhibitors. Author(s): Shen WW, Urosevich Z, Clayton DO. Source: J Reprod Med. 1999 June; 44(6): 535-42. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10394548&dopt=Abstract

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Solution to a conservation problem? Author(s): von Hippel FA, von Hippel W. Source: Science. 1998 September 18; 281(5384): 1805. Erratum In: Science 1998 October 9; 282(5387): 243. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9776681&dopt=Abstract

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Systematic review of randomised controlled trials of sildenafil (Viagra) in the treatment of male erectile dysfunction. Author(s): Burls A, Gold L, Clark W. Source: The British Journal of General Practice : the Journal of the Royal College of General Practitioners. 2001 December; 51(473): 1004-12. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11766850&dopt=Abstract

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The effect of sildenafil on electrostimulation-induced erection in the rat model. Author(s): Ueno N, Iwamoto Y, Segawa N, Kinoshita M, Ueda H, Katsuoka Y.

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Source: International Journal of Impotence Research : Official Journal of the International Society for Impotence Research. 2002 August; 14(4): 251-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12152113&dopt=Abstract •

The top medical advances of 1998. Author(s): Freinkel S, Kanigel R, Mason M. Source: Indian Journal of Medical Sciences. 1999 December; 53(12): 553-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10862282&dopt=Abstract

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Urology. Author(s): Litwin MS. Source: Jama : the Journal of the American Medical Association. 1999 February 10; 281(6): 495-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10022088&dopt=Abstract

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What Malaysian women believe about Viagra: a qualitative inquiry. Author(s): Low WY, Zulkifli SN, Wong YL, Tan HM. Source: The Aging Male : the Official Journal of the International Society for the Study of the Aging Male. 2002 March; 5(1): 57-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12040977&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/

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The following is a specific Web list relating to Viagra; 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 Erectile Dysfunction Source: Healthnotes, Inc. www.healthnotes.com Impotence Source: Prima Communications, Inc.www.personalhealthzone.com Sexual Dysfunction Source: Integrative Medicine Communications; www.drkoop.com

•

Herbs and Supplements Arginine Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10005,00.html Hawthorn Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10035,00.html Sildenafil Source: Healthnotes, Inc. www.healthnotes.com Yohimbe Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,830,00.html

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

Dissertations on Viagra 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 Viagra. 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: •

(de) Constructing the Viagra Phenomenon: Claims, Markets, and the Science of Sex by Loe, Meika E. Phd from University of California, Santa Barbara, 2002, 375 pages http://wwwlib.umi.com/dissertations/fullcit/3056008

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

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

Evaluation of Hydroxyurea Plus L-arginine or Sildenafil to Treat Sickle Cell Anemia Condition(s): Sickle Cell Anemia Study Status: This study is currently recruiting patients. Sponsor(s): Warren G Magnuson Clinical Center (CC) Purpose - Excerpt: Patients with sickle cell disease have abnormal hemoglobin (the protein in red blood cells that carries oxygen to the body). This abnormality causes red blood cells to take on a sickle shape, producing disease symptoms. Fetal hemoglobin, a type of hemoglobin present in fetuses and babies, can prevent red cells from sickling. The drug hydroxyurea increases fetal hemoglobin production in patients with sickle cell disease by making a molecule called nitric oxide. The drugs L-arginine and Sildenafil (Viagra) increase the amount or the effect of nitric oxide. This study will evaluate: - The safety of giving L-arginine or Sildenafil together with hydroxyurea in patients with sickle cell disease; - The effectiveness of L-arginine plus hydroxyurea or Sildenafil plus hydroxyurea in increasing fetal hemoglobin in patients with sickle cell disease; and The effectiveness of L-arginine plus hydroxyurea or Sildenafil and hydroxyurea in lowering blood pressure in the lungs of patients with sickle cell disease. (Pulmonary blood pressure is elevated in about one-third of patients with sickle cell disease, and this condition increases the risk of dying from the disease.) Patients with hemoglobin S-only, S-beta-thalassemia, or other sickle cell disease genotype may be eligible for this study. Before starting treatment, patients will have a complete medical history and physical examination. All patients will take hydroxyurea once a day every day by mouth for at

8

These are listed at www.ClinicalTrials.gov.

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least 2 months. They will be admitted to the NIH Clinical Center to take their first dose of hydroxyurea, and will have blood drawn through a catheter (plastic tube placed in a vein) every hour for 6 hours for tests to determine nitric oxide levels. After discharge, they will return to the clinic once every 2 weeks to check for treatment side effects and for blood tests to monitor hemoglobin and fetal hemoglobin levels. After fetal hemoglobin levels have been stable for 2 months, patients will be admitted to the Clinical Center for their first dose of L-arginine (for men) or Sildenafil (for women). Again, blood samples will be collected through a catheter once an hour for 6 hours. If there are no complications, patients will be discharged and will continue taking hydroxyurea once a day and L-arginine or Sildenafil three times a day for at least 3 months until fetal hemoglobin levels have been stable for at least 2 months. Patients will return to the clinic for blood tests every week for 2 weeks and then every 2 weeks to monitor hemoglobin and fetal hemoglobin levels and to check for treatment side effects. Patients will have eye examinations before and during treatment. Some patients with sickle cell disease develop abnormalities in the blood vessels of the eye. Also, Sildenafil can cause temporary changes in color vision. Rarely, more serious eye problems can occur, such as bleeding from the eye blood vessels or damage to the retina-a layer of tissue that lines the back of the eye. Patients will also have an echocardiogram (ultrasound of the heart) before beginning treatment, after hydroxyurea treatment, and after 1 and 3 months of combined treatment with hydroxyurea and L-arginine or Sildenafil to help measure blood pressure in the lungs. Patients who develop complications from L-arginine or Sildenafil may continue in the study on hydroxyurea alone. Patients whose fetal hemoglobin levels increase with the combination therapy of hydroxyurea and L-arginine or Sildenafil may continue to take them. Phase(s): Phase I Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00056433 •

Sildenafil in Treating Erectile Dysfunction in Patients With Prostate Cancer Condition(s): sexual dysfunction and infertility; sexuality and reproductive issues; radiation toxicity; stage II prostate cancer; stage III prostate cancer; psychosocial effects/treatment Study Status: This study is currently recruiting patients. Sponsor(s): Radiation Therapy Oncology Group; National Cancer Institute (NCI) Purpose - Excerpt: RATIONALE: Sildenafil may be effective in helping patients who have undergone treatment for prostate cancer to have an erection for sexual activity and may improve sexual satisfaction and quality of life. PURPOSE: Randomized clinical trial to study the effectiveness of sildenafil in treating erectile dysfunction in patients who have undergone radiation therapy and hormone therapy for prostate cancer in clinical trial RTOG-9910. Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00057759

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

Patents on Viagra By performing a patent search focusing on Viagra, 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 Viagra: •

Apomorphine and sildenafil composition Inventor(s): El-Rashidy; Ragab (Deerfield, IL) Assignee(s): Pentech Pharmaceuticals, Inc. (Buffalo Grove, IL) Patent Number: 6,087,362 Date filed: March 16, 1999 Abstract: The treatment of sexual dysfunction in human patients by an oral therapy regimen of administration of apomorphine and sildenafil is disclosed. This treatment optimizes the efficacy of each drug and substantially minimizes the undesirable side effects associated individually therewith. Apomorphine and sildenafil can be coadministered with a combination dosage unit or administered sequentially in separate dosage units, substantially prior to sexual activity. Other erectogenic agents can be administered along with apomorphine and sildenafil. Excerpt(s): This invention relates to compositions, dosage forms and methods for treating sexual dysfunction in humans. More particularly, this invention relates to the use of compositions containing apomorphine and sildenafil. A normal erection occurs as a result of a coordinated vascular event in the penis. This is usually triggered neurally and consists of vasodilation and smooth muscle relaxation in the penis and its supplying arterial vessels. Arterial inflow causes enlargement of the substance of the corpora cavernosa. Venous outflow is trapped by this enlargement, permitting sustained high blood pressures in the penis sufficient to cause and maintain rigidity. Muscles in the perineum also assist in creating and maintaining penile rigidity. Erections are induced centrally in the nervous system by sexual thoughts, fantasy, and/or stimulation and can be reinforced locally by reflex mechanisms (e.g., tactile stimulation). Impotence or male erectile dysfunction is defined as an inability to achieve and sustain an erection sufficient for satisfactory sexual performance and intercourse. Impotence in any given case can result from psychological disturbances (psychogenic), from physiological abnormalities in general (organic), from neurological disturbances (neurogenic), hormonal deficiencies (endocrine) or from a combination of the foregoing. Web site: http://www.delphion.com/details?pn=US06087362__

•

Method of administration of sildenafil to produce instantaneous response for the treatment of erectile dysfunction Inventor(s): Dittert; Lewis W. (4999 Hartland Pkwy., Lexington, KY 40515), Hussain; Anwar A. (886 McMeekin Pl., Lexington, KY 40502) Assignee(s): none reported Patent Number: 6,200,591 Date filed: December 10, 1998 Abstract: This invention provides a method of rapidly and reliably delivering sildenafil, or derivatives thereof, alone or in combination with other compounds, to the systemic circulation by administration via the nasal route so as to produce virtually instantaneous onset of beneficial effects in the treatment of erectile dysfunction. The present invention further provides pharmaceutical compositions comprising sildenafil, or derivatives

Patents 73

thereof, and/or pharmaceutically acceptable salts thereof in a variety of unique pharmaceutical dosage forms, with and without apomorphine. Excerpt(s): This invention relates to a method for greatly accelerating the rate of delivery of sildenafil, and derivatives thereof, to the central nervous system by administration via the nasal route to provide extremely rapid response in the treatment of erectile dysfunction in a patient in need of such prevention or treatment. This method provides response in less than five minutes, compared with 60 minutes or more required by the currently used oral route of administration. Male sexual dysfunction, or impotence, may be manifested in various ways: loss of desire, inability to obtain or maintain an erection, premature ejaculation, absence of emission, inability to achieve orgasm. The organic causes of erectile impotence can be grouped into endocrine, drug, local, neurologic, and vascular causes. Vascular insufficiency causes impotence because blood flow into the vascular network of the penis is insufficient to obtain (or maintain) the erect state. Likewise, occlusion in smaller vessels supplying the penis can also lead to impotence. Together with neuropathy, vascular insufficiency contributes to the impotence in many men with diabetes mellitus. Erectile impotence or dysfunction may be defined as an inability to achieve or sustain an erection adequate for intercourse. Its prevalence is claimed to be between 2 and 7% of the human male population as a whole, and the incidence increases with age up to 50 years. Between 18 and 75% of the male population between 55 and 80 years of age are impotent. In the USA alone, for example, it has been estimated that there are up to 10 million impotent males, with the majority suffering from problems of organic rather than psychogenic origin. Web site: http://www.delphion.com/details?pn=US06200591__ •

Processes for preparing sildenafil Inventor(s): Oudenes; Jan (Aurora, CA), Lu; Yee-Fung (Scarborough, CA), Tao; Yong (Richmond Hill, CA), Antczak; Casimir (Aurora, CA) Assignee(s): Torcan Chemical Ltd. (Aurora, CA) Patent Number: 6,204,383 Date filed: June 3, 1998 Abstract: Sildenafil, a known pharmaceutical chemical useful in treatment of male sexual dysfunction, is prepared by processes in which the final chemical intermediate is of significantly lower basicity than sildenafil itself, so that sildenafil can be extracted in substantially pure form from the organic reaction mixture in which it is made by adding an aqueous medium of appropriately chosen acidic pH and causing phase shift of the sildenafil to occur selectively into the aqueous phase. Excerpt(s): This invention relates to the pharmaceutical chemical 5-[2-ethoxy-5-(4methylpiperazin-1-yl sulphonyl)-phenyl]-1-methyl-3-n-propyl-1,6-dihydro-7Hpyrazolo[4,3-d]pyrim idin-7-one, known generically as sildenafil, and more specifically to novel processes for preparing sildenafil. is known, from e.g. European Patents EP-A0463756 and EP-A-0812845. It has pharmaceutical utility in the treatment of male sexual dysfunction. As a relatively complicated synthetic organic chemical molecule, sildenafil requires a multi-step chemical synthesis. Web site: http://www.delphion.com/details?pn=US06204383__

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•

Sildenafil citrate chewing gum formulations and methods of using the same Inventor(s): Li; Weisheng (Bridgewater, NJ), Ream; Ronald L. (Plano, TX), Gmunder; Charlean B. (Branchburg, NJ), Gmunder; Charlean B. (Branchburg, NJ), Li; Weisheng (Bridgewater, NJ), Ream; Ronald L. (Plano, TX), Li; Weisheng (Bridgewater, NJ), Ream; Ronald L. (Plano, TX), Gmunder; Charlean B. (Branchburg, NJ), Gmunder; Charlean B. (Branchburg, NJ), Li; Weisheng (Bridgewater, NJ), Ream; Ronald L. (Plano, TX) Assignee(s): Wm. Wrigley Jr. Company (Chicago, IL), Wm. Wrigley Jr. Company (Chicago, IL), Wm. Wrigley Jr. Company (Chicago, IL), Wm. Wrigley Jr. Company (Chicago, IL) Patent Number: 6,592,850 Date filed: September 19, 2001 Abstract: Methods and chewing gum formulations for delivering a medicament, namely sildenafil citrate, to an individual are provided. Further, an improved dosage form and method of treating erectile dysfunction are provided. Methods of treating esophageal spasms, dysphagia, and gastroparesis utilizing chewing gum formulations containing sildenafil citrate are also provided. Excerpt(s): The present invention generally relates to medicaments and other agents. More specifically, the present invention relates to the delivery of medicaments or other agents. The present invention generally relates to medicaments and other agents. More specifically, the present invention relates to the delivery of medicaments or other agents. The present invention generally relates to medicaments and other agents. More specifically, the present invention relates to the delivery of medicaments or other agents. The present invention generally relates to medicaments and other agents. More specifically, the present invention relates to the delivery of medicaments or other agents. It is of course known to provide agents to individuals for various purposes. There are a great variety of such agents. These agents can be used to treat diseases and as such are typically referred to as drugs or medicaments. Likewise, the drugs or medicaments can be used for prophylactic purposes. In addition, some agents are taken on an as needed basis while others must be taken at regular intervals by the individual being treated. It is of course known to provide agents to individuals for various purposes. There are a great variety of such agents. These agents can be used to treat diseases and as such are typically referred to as drugs or medicaments. Likewise, the drugs or medicaments can be used for prophylactic purposes. In addition, some agents are taken on an as needed basis while others must be taken at regular intervals by the individual being treated. It is of course known to provide agents to individuals for various purposes. There are a great variety of such agents. These agents can be used to treat diseases and as such are typically referred to as drugs or medicaments. Likewise, the drugs or medicaments can be used for prophylactic purposes. In addition, some agents are taken on an as needed basis while others must be taken at regular intervals by the individual being treated. It is of course known to provide agents to individuals for various purposes. There are a great variety of such agents. These agents can be used to treat diseases and as such are typically referred to as drugs or medicaments. Likewise, the drugs or medicaments can be used for prophylactic purposes. In addition, some agents are taken on an as needed basis while others must be taken at regular intervals by the individual being treated. Still, it is known to provide such agents to an individual for a variety of indicated medicinal purposes such as sildenafil citrate for the treatment of male erectile dysfunction. Typically, drugs (medicaments) are administered parenterally or enterally. Of course, parenteral administration is the administration of the drug intravenously directly into the blood stream. Enteral refers to the administration of the drug into the

Patents 75

gastrointestinal tract. In either case, the goal of the drug administration is to move the drug from the site of administration towards the systemic circulation. Except when given intravenously, a drug must traverse several semi-permeable cell membranes before reaching general circulation. These membranes act as a biological barrier that inhibits the passage of drug molecules. There are believed to be four processes by which drugs move across a biological barrier: passive diffusion; facilitated diffusion; active transport; and pinocytosis. Still, it is known to provide such agents to an individual for a variety of indicated medicinal purposes such as sildenafil citrate for the treatment of male erectile dysfunction. Typically, drugs (medicaments) are administered parenterally or enterally. Of course, parenteral administration is the administration of the drug intravenously directly into the blood stream. Enteral refers to the administration of the drug into the gastrointestinal tract. In either case, the goal of the drug administration is to move the drug from the site of administration towards the systemic circulation. Except when given intravenously, a drug must traverse several semi-permeable cell membranes before reaching general circulation. These membranes act as a biological barrier that inhibits the passage of drug molecules. There are believed to be four processes by which drugs move across a biological barrier: passive diffusion; facilitated diffusion; active transport; and pinocytosis. Still, it is known to provide such agents to an individual for a variety of indicated medicinal purposes such as sildenafil citrate for the treatment of male erectile dysfunction. Typically, drugs (medicaments) are administered parenterally or enterally. Of course, parenteral administration is the administration of the drug intravenously directly into the blood stream. Enteral refers to the administration of the drug into the gastrointestinal tract. In either case, the goal of the drug administration is to move the drug from the site of administration towards the systemic circulation. Except when given intravenously, a drug must traverse several semi-permeable cell membranes before reaching general circulation. These membranes act as a biological barrier that inhibits the passage of drug molecules. There are believed to be four processes by which drugs move across a biological barrier: passive diffusion; facilitated diffusion; active transport; and pinocytosis. Still, it is known to provide such agents to an individual for a variety of indicated medicinal purposes such as sildenafil citrate for the treatment of male erectile dysfunction. Typically, drugs (medicaments) are administered parenterally or enterally. Of course, parenteral administration is the administration of the drug intravenously directly into the blood stream. Enteral refers to the administration of the drug into the gastrointestinal tract. In either case, the goal of the drug administration is to move the drug from the site of administration towards the systemic circulation. Except when given intravenously, a drug must traverse several semi-permeable cell membranes before reaching general circulation. These membranes act as a biological barrier that inhibits the passage of drug molecules. There are believed to be four processes by which drugs move across a biological barrier: passive diffusion; facilitated diffusion; active transport; and pinocytosis. Web site: http://www.delphion.com/details?pn=US06592850__

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•

Sildenafil citrate chewing gum formulations and methods of using the same Inventor(s): Li; Weisheng (Bridgewater, NJ), Ream; Ronald L. (Plano, TX), Gmunder; Charlean B. (Branchburg, NJ), Gmunder; Charlean B. (Branchburg, NJ), Li; Weisheng (Bridgewater, NJ), Ream; Ronald L. (Plano, TX), Li; Weisheng (Bridgewater, NJ), Ream; Ronald L. (Plano, TX), Gmunder; Charlean B. (Branchburg, NJ), Gmunder; Charlean B. (Branchburg, NJ), Li; Weisheng (Bridgewater, NJ), Ream; Ronald L. (Plano, TX) Assignee(s): Wm. Wrigley Jr. Company (Chicago, IL), Wm. Wrigley Jr. Company (Chicago, IL), Wm. Wrigley Jr. Company (Chicago, IL), Wm. Wrigley Jr. Company (Chicago, IL) Patent Number: 6,592,850 Date filed: September 19, 2001 Abstract: Methods and chewing gum formulations for delivering a medicament, namely sildenafil citrate, to an individual are provided. Further, an improved dosage form and method of treating erectile dysfunction are provided. Methods of treating esophageal spasms, dysphagia, and gastroparesis utilizing chewing gum formulations containing sildenafil citrate are also provided. Excerpt(s): The present invention generally relates to medicaments and other agents. More specifically, the present invention relates to the delivery of medicaments or other agents. The present invention generally relates to medicaments and other agents. More specifically, the present invention relates to the delivery of medicaments or other agents. The present invention generally relates to medicaments and other agents. More specifically, the present invention relates to the delivery of medicaments or other agents. The present invention generally relates to medicaments and other agents. More specifically, the present invention relates to the delivery of medicaments or other agents. It is of course known to provide agents to individuals for various purposes. There are a great variety of such agents. These agents can be used to treat diseases and as such are typically referred to as drugs or medicaments. Likewise, the drugs or medicaments can be used for prophylactic purposes. In addition, some agents are taken on an as needed basis while others must be taken at regular intervals by the individual being treated. It is of course known to provide agents to individuals for various purposes. There are a great variety of such agents. These agents can be used to treat diseases and as such are typically referred to as drugs or medicaments. Likewise, the drugs or medicaments can be used for prophylactic purposes. In addition, some agents are taken on an as needed basis while others must be taken at regular intervals by the individual being treated. It is of course known to provide agents to individuals for various purposes. There are a great variety of such agents. These agents can be used to treat diseases and as such are typically referred to as drugs or medicaments. Likewise, the drugs or medicaments can be used for prophylactic purposes. In addition, some agents are taken on an as needed basis while others must be taken at regular intervals by the individual being treated. It is of course known to provide agents to individuals for various purposes. There are a great variety of such agents. These agents can be used to treat diseases and as such are typically referred to as drugs or medicaments. Likewise, the drugs or medicaments can be used for prophylactic purposes. In addition, some agents are taken on an as needed basis while others must be taken at regular intervals by the individual being treated. Still, it is known to provide such agents to an individual for a variety of indicated medicinal purposes such as sildenafil citrate for the treatment of male erectile dysfunction. Typically, drugs (medicaments) are administered parenterally or enterally. Of course, parenteral administration is the administration of the drug intravenously directly into the blood stream. Enteral refers to the administration of the drug into the

Patents 77

gastrointestinal tract. In either case, the goal of the drug administration is to move the drug from the site of administration towards the systemic circulation. Except when given intravenously, a drug must traverse several semi-permeable cell membranes before reaching general circulation. These membranes act as a biological barrier that inhibits the passage of drug molecules. There are believed to be four processes by which drugs move across a biological barrier: passive diffusion; facilitated diffusion; active transport; and pinocytosis. Still, it is known to provide such agents to an individual for a variety of indicated medicinal purposes such as sildenafil citrate for the treatment of male erectile dysfunction. Typically, drugs (medicaments) are administered parenterally or enterally. Of course, parenteral administration is the administration of the drug intravenously directly into the blood stream. Enteral refers to the administration of the drug into the gastrointestinal tract. In either case, the goal of the drug administration is to move the drug from the site of administration towards the systemic circulation. Except when given intravenously, a drug must traverse several semi-permeable cell membranes before reaching general circulation. These membranes act as a biological barrier that inhibits the passage of drug molecules. There are believed to be four processes by which drugs move across a biological barrier: passive diffusion; facilitated diffusion; active transport; and pinocytosis. Still, it is known to provide such agents to an individual for a variety of indicated medicinal purposes such as sildenafil citrate for the treatment of male erectile dysfunction. Typically, drugs (medicaments) are administered parenterally or enterally. Of course, parenteral administration is the administration of the drug intravenously directly into the blood stream. Enteral refers to the administration of the drug into the gastrointestinal tract. In either case, the goal of the drug administration is to move the drug from the site of administration towards the systemic circulation. Except when given intravenously, a drug must traverse several semi-permeable cell membranes before reaching general circulation. These membranes act as a biological barrier that inhibits the passage of drug molecules. There are believed to be four processes by which drugs move across a biological barrier: passive diffusion; facilitated diffusion; active transport; and pinocytosis. Still, it is known to provide such agents to an individual for a variety of indicated medicinal purposes such as sildenafil citrate for the treatment of male erectile dysfunction. Typically, drugs (medicaments) are administered parenterally or enterally. Of course, parenteral administration is the administration of the drug intravenously directly into the blood stream. Enteral refers to the administration of the drug into the gastrointestinal tract. In either case, the goal of the drug administration is to move the drug from the site of administration towards the systemic circulation. Except when given intravenously, a drug must traverse several semi-permeable cell membranes before reaching general circulation. These membranes act as a biological barrier that inhibits the passage of drug molecules. There are believed to be four processes by which drugs move across a biological barrier: passive diffusion; facilitated diffusion; active transport; and pinocytosis. Web site: http://www.delphion.com/details?pn=US06592850__

Keeping Current In order to stay informed about patents and patent applications dealing with Viagra, 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 “Viagra” (or synonyms) into the

78 Viagra

“Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on Viagra. You can also use this procedure to view pending patent applications concerning Viagra. 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 VIAGRA Overview This chapter provides bibliographic book references relating to Viagra. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on Viagra 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 “Viagra” (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 Viagra: •

Beyond Viagra: Plain Talk About Treating Male and Female Sexual Dysfunction Source: Montgomery, AL: Starrhill Press. 1999. 196 p. Contact: Available from Black Belt Press. P.O. Box 551, Montgomery, AL 36101. (800) 959-3245 or (334) 265-6753. Fax (334) 265-8880. PRICE: $13.95 plus shipping and handling. ISBN: 1573590142. Summary: This book discusses the drug sildenafil (Viagra) in the context of a larger discussion about sexuality and sexual dysfunction. Twenty-four chapters cover normal male sexual function, an overview of male sexual dysfunction, the causes of male erectile dysfunction, evaluating the male with erectile dysfunction, treatment strategies for metabolic disorders (including diabetes and prolactinoma), hormone replacement therapy, penile injections with vasoactive drugs, urethral suppository with vasoactive drugs, vacuum erection devices, vascular surgery for impotence, an overview of penile implants, treatment of Peyronie's disease, treatment of psychological impotence, the role

80 Viagra

of impotence support groups, herbal medicine for males, Viagra for male erectile dysfunction, Viagra in combination with injections or vacuum erection devices, Viagra in combination with penile implants, future treatments for erectile dysfunction, normal female sexual function, the causes and treatment of female sexual dysfunction, Viagra and apomorphine for females, herbal medicine for females, and healthy relationships and sexual function. The chapters are written in nontechnical language but include enough medical information to be of use to medical professionals wishing to learn more about sexual dysfunction. The book concludes with a list of resources and a subject index. 10 figures. 5 tables. 237 references.

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 “Viagra” at online booksellers’ Web sites, you may discover nonmedical books that use the generic term “Viagra” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “Viagra” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •

Alternativas Naturales Al Viagra by Erwin Moller (2000); ISBN: 9700511936; http://www.amazon.com/exec/obidos/ASIN/9700511936/icongroupinterna

•

Beyond Viagra/Female Dysfunction Set: Beyond Viagra/Fem Dysfunction Set by Neil Osterweil, Paula Moyer; ISBN: 186067416X; http://www.amazon.com/exec/obidos/ASIN/186067416X/icongroupinterna

•

Beyond Viagra: A Commonsense Guide to Building a Healthy Sexual Relationship for Both Men and Women by Gerald A., Md. Melchiode, Bill Sloan (Contributor); ISBN: 080506060X; http://www.amazon.com/exec/obidos/ASIN/080506060X/icongroupinterna

•

Beyond Viagra: Drugs,Devices and Markets: Osterweil:Beyond Viagra by Neil Osterweil; ISBN: 1860673872; http://www.amazon.com/exec/obidos/ASIN/1860673872/icongroupinterna

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Beyond Viagra: Plain Talk About Treating Male and Female Sexual Dysfunction by Alfred J. Newman (1999); ISBN: 1573590142; http://www.amazon.com/exec/obidos/ASIN/1573590142/icongroupinterna

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From Voodoo to Viagra: The Magic of Medicine by Oscar, M.D. London (2001); ISBN: 1580082874; http://www.amazon.com/exec/obidos/ASIN/1580082874/icongroupinterna

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Impotence in the Age of Viagra : A Scientific American article [DOWNLOAD: PDF] by Arnold Melman (Author); ISBN: B00006BNON; http://www.amazon.com/exec/obidos/ASIN/B00006BNON/icongroupinterna

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Natural Alternatives to Viagra: How to Recharge Your Sexual Performance Without Surgery or Prescription Drugs by John Byington, et al; ISBN: 1559725273; http://www.amazon.com/exec/obidos/ASIN/1559725273/icongroupinterna

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•

Sexy Up: Nature's Alternatives to Viagra for Men and Women by Beth Ann Petro Roybal, et al; ISBN: 1569752990; http://www.amazon.com/exec/obidos/ASIN/1569752990/icongroupinterna

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Strategic Perspectives: Female Sexual Dysfunction - Are Physicians and Patients Ready For a Female Viagra? [DOWNLOAD: PDF] by Datamonitor (Author); ISBN: B00008R3YU; http://www.amazon.com/exec/obidos/ASIN/B00008R3YU/icongroupinterna

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Thanks to Viagra I Don't Roll Out of Bed Anymore by Richard Stites, Leather Publishing; ISBN: 1585970875; http://www.amazon.com/exec/obidos/ASIN/1585970875/icongroupinterna

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The Psychology of Humor and Wit: From Banana Peels to Viagra Jokes by Donald M. Johnson; ISBN: 1564743055; http://www.amazon.com/exec/obidos/ASIN/1564743055/icongroupinterna

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The Viagra Affair by Tik-Tok (2000); ISBN: 1587214628; http://www.amazon.com/exec/obidos/ASIN/1587214628/icongroupinterna

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The Viagra Alternative: The Complete Guide to Overcoming Erectile Dysfunction Naturally by Marc Bonnard, Marc, M.D. Bonnard (1999); ISBN: 0892817895; http://www.amazon.com/exec/obidos/ASIN/0892817895/icongroupinterna

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The Viagra Myth : The Surprising Impact On Love And Relationships by Abraham Morgentaler (Author); ISBN: 0787968013; http://www.amazon.com/exec/obidos/ASIN/0787968013/icongroupinterna

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The Virility Solution: Everything You Need to Know About Viagra, the Potency Pill That Can Restore and Enhance Male Sexuality by Gerald Secor Couzens, Steven, Md. Lamm (1999); ISBN: 0684854317; http://www.amazon.com/exec/obidos/ASIN/0684854317/icongroupinterna

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Viagra by Steven Lamm, Gerald Secor Couzens (2001); ISBN: 8449305969; http://www.amazon.com/exec/obidos/ASIN/8449305969/icongroupinterna

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Viagra by Larry Katzenstein (1998); ISBN: 8479532424; http://www.amazon.com/exec/obidos/ASIN/8479532424/icongroupinterna

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Viagra & You: New Treatments for Potency and Sexual Health by Mark W. Stolar, et al; ISBN: 0425168026; http://www.amazon.com/exec/obidos/ASIN/0425168026/icongroupinterna

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Viagra And The Quest For Potency by Brian Drew, et al; ISBN: 0938716557; http://www.amazon.com/exec/obidos/ASIN/0938716557/icongroupinterna

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Viagra Dlia Rozumu, Abo, Spovid' Vershytelia by Mykola Pavlenko (2002); ISBN: 9668060016; http://www.amazon.com/exec/obidos/ASIN/9668060016/icongroupinterna

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Viagra for Women (Aids: Psychological, Nutritional, and Pharmaceutical) for Women's Sexuality 2nd Edition by Thomas J. Rundquist; ISBN: 1884239668; http://www.amazon.com/exec/obidos/ASIN/1884239668/icongroupinterna

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Viagra for Women : Aids (Psychological, Nutritional, and Pharmacology) For Women's Sexuality by Thomas J. Rundquist (1999); ISBN: 1884239196; http://www.amazon.com/exec/obidos/ASIN/1884239196/icongroupinterna

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Viagra Humor- Something Other Than the Pill to Make You Smile by unknown; ISBN: 096676210X; http://www.amazon.com/exec/obidos/ASIN/096676210X/icongroupinterna

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Viagra Mac by Rafa Ziemkiewicz (2002); ISBN: 8389011018; http://www.amazon.com/exec/obidos/ASIN/8389011018/icongroupinterna

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Viagra Nation: The Definitive Guide to Life in the New Sexual Utopia by Bruce McCall, Lee Eisenberg; ISBN: 0060193115; http://www.amazon.com/exec/obidos/ASIN/0060193115/icongroupinterna

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Viagra the Potency Promise: The Potency Promise by Larry Katzenstein, Larry Katzenstein; ISBN: 0312969295; http://www.amazon.com/exec/obidos/ASIN/0312969295/icongroupinterna

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Viagra, Sex, and Romance -The Women Who Take It Reveal Their Erotic Tales by Elizabeth Myles, et al; ISBN: 0965958310; http://www.amazon.com/exec/obidos/ASIN/0965958310/icongroupinterna

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Viagra, What You Must Know by Mark Frances, et al; ISBN: 1570020809; http://www.amazon.com/exec/obidos/ASIN/1570020809/icongroupinterna

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Viagra. Como Actua, Efectos Secundarios y Cont by Otheniel J. Seiden, Dr. Othniel J. Seiden; ISBN: 8424125975; http://www.amazon.com/exec/obidos/ASIN/8424125975/icongroupinterna

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Viagra: A Guide to the Phenomenal Potency-Promoting Drug by Susan C. Vaughan; ISBN: 0671027336; http://www.amazon.com/exec/obidos/ASIN/0671027336/icongroupinterna

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Viagra: How the Miracle Drug Happened & What It Can Do for You by Robert A. Kloner, et al; ISBN: 0871318776; http://www.amazon.com/exec/obidos/ASIN/0871318776/icongroupinterna

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Viagra: Making the Most Out of the Man in Your Life by Peter Maddocks; ISBN: 1854794116; http://www.amazon.com/exec/obidos/ASIN/1854794116/icongroupinterna

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Viagra: The Potency Pill by Consumer Guide; ISBN: 0451197925; http://www.amazon.com/exec/obidos/ASIN/0451197925/icongroupinterna

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Viagra: The Potency Promise Clip Strip: How It Can Work to Change Your Life by Larry Katzenstein; ISBN: 0312969325; http://www.amazon.com/exec/obidos/ASIN/0312969325/icongroupinterna

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Viagra: The Virility Breakthrough by Othniel J. Seiden; ISBN: 0761517332; http://www.amazon.com/exec/obidos/ASIN/0761517332/icongroupinterna

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Viagra: the Virility Solution by Steven Lamm MD, Gerald Secor Couzens; ISBN: 0671022792; http://www.amazon.com/exec/obidos/ASIN/0671022792/icongroupinterna

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Viagra: The Wonder Drug For Peak Performance by Whitehead E. Douglas, et al; ISBN: 0440234883; http://www.amazon.com/exec/obidos/ASIN/0440234883/icongroupinterna

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The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “Viagra” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:10 •

Viagra (sildenafil citrate): the remarkable story of the discovery and launch Author: Katzenstein, Larry.; Year: 2001; New York: Medical Information Press, 2001; ISBN: 0966371313

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

Enter Viagra!: Viagra for Male Erectile Dysfunction Source: in Newman, A.J. Beyond Viagra: Plain Talk About Treating Male and Female Sexual Dysfunction. Montgomery, AL: Starrhill Press. 1999. p. 118-129. Contact: Available from Black Belt Press. P.O. Box 551, Montgomery, AL 36101. (800) 959-3245 or (334) 265-6753. Fax (334) 265-8880. PRICE: $13.95 plus shipping and handling. ISBN: 1573590142. Summary: This chapter is from a book that discusses the drug sildenafil (Viagra) in the context of a larger discussion about sexuality and sexual dysfunction. The author offers a question and answer format that introduces sildenafil, its use, advantages and disadvantages, how it works, patient selection (and contraindications), age factors, costs, and insurance coverage for the drug. Readers are reminded that Viagra has no effect in the absence of sexual stimulation. The beneficial effect can be seen as late as 8 hours after taking the tablet, but the average time for maximum blood level is about 60 minutes. Adverse effects with Viagra can include mild headache, flushing, indigestion, runny nose, transient visual disturbance (blue haze), urinary tract infection, diarrhea, dizziness, and a rash. The only contraindication to Viagra therapy is the concurrent use of nitrates, including sublingual nitroglycerine, long acting oral nitrates, and nitrate

10

In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is currently adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a "Books" button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created 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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paste. Viagra's cost is about the same as some of the newer, very potent antibiotics that are taken for severe prostate infections; it ranges from about $8 to $11 per tablet. The chapter is written in nontechnical language but includes enough medical information to be of use to medical professionals wishing to learn more about sexuality and sexual dysfunction. •

Under Investigation: Viagra in Combination with Injections, VEDs Source: in Newman, A.J. Beyond Viagra: Plain Talk About Treating Male and Female Sexual Dysfunction. Montgomery, AL: Starrhill Press. 1999. p. 130. Contact: Available from Black Belt Press. P.O. Box 551, Montgomery, AL 36101. (800) 959-3245 or (334) 265-6753. Fax (334) 265-8880. PRICE: $13.95 plus shipping and handling. ISBN: 1573590142. Summary: This very brief chapter on the use of Viagra in combination with injections or vacuum erection devices (VEDs) is from a book that discusses the drug sildenafil (Viagra) in the context of a larger discussion about sexuality and sexual dysfunction. The author notes that all urologists who treat large numbers of men with erectile dysfunction have anecdotal cases involving patients who, under close supervision, have used a combination of Viagra and one of the injections. This combination in generally used when neither the penile injection protocol nor Viagra, when used by themselves, has a satisfactory result. In those individuals, an enhancement is sometimes seen with a combination of the two treatment forms, but the author stresses that they should not be done without the close supervision of the patient's urologist. The chapter is written in nontechnical language but includes enough medical information to be of use to medical professionals wishing to learn more about sexuality and sexual dysfunction.

•

Research Continues: Viagra in Combination with Penile Implants Source: in Newman, A.J. Beyond Viagra: Plain Talk About Treating Male and Female Sexual Dysfunction. Montgomery, AL: Starrhill Press. 1999. p. 131-133. Contact: Available from Black Belt Press. P.O. Box 551, Montgomery, AL 36101. (800) 959-3245 or (334) 265-6753. Fax (334) 265-8880. PRICE: $13.95 plus shipping and handling. ISBN: 1573590142. Summary: This brief chapter on the use of Viagra in combination with penile implants is from a book that discusses the drug sildenafil (Viagra) in the context of a larger discussion about sexuality and sexual dysfunction. The author notes that, even though penile implants have an excellent track record and a very high satisfaction rate, patients still ask for some improvement. The major areas of concern are lack of engorgement of the glans penis (the head of the penis), delayed sensation of the glans penis with or without difficulty in achieving orgasm, decreased penile length, and smaller penile girth (width) compared with the natural erection. The author notes that research studies are under way to investigate the role of Viagra in addressing these concerns. This research study compares Viagra with placebo in men who have an inflatable penile implant in place. 1 figure.

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

Impotence and Diabetes Source: Los Angeles, CA: National Health Video, Inc. 1999. (videocassette). Contact: Available from National Health Video, Inc. 12021 Wilshire Blvd., Suite 550, Los Angeles, CA 90025. (800) 543-6803. Fax (310) 477-8198. E-mail: [email protected]. PRICE: $89.00 plus shipping and handling. Summary: This patient education videotape program reviews the problem of erectile dysfunction (impotence) and diabetes mellitus. The program defines erectile dysfunction (ED) as the consistent inability to get and maintain an erection. The program first explores the physiology of erections (how they happen), including the need for mental and physical stimulation, nerve impulses in the brain, and responses in muscles, fibrous tissues, and veins and arteries. The program offers a diagram and the use of a balloon to describe how an erection happens, the anatomy of the corpera cavernosa, and the role of nitrous oxide as a neurochemical transmitter. Age is noted as a factor in ED, and men with diabetes tend to develop ED 10 to 15 years earlier than

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men who do not have diabetes. The program notes that psychological factors (stress, depression, guilt, and performance anxiety) can cause 10 to 15 percent of ED; a series of self test questions are included for viewers to determine if psychological factors may play a role in their own ED. For men with diabetes, nerve damage (peripheral neuropathy) is the most likely culprit for causing ED; damage to the blood vessels (atherosclerosis) is another cause. Poor blood glucose control is the most important factor in both of these problems. The program includes a section noting the impact of drugs (including alcohol and nicotine) on ED. The program outlines the steps in diagnosing erectile problems, including first admitting that there is a problem, talking with a doctor, undergoing diagnostic tests, and participating in treatment. The final section reviews treatment options, reiterating the importance of good blood glucose control and describing the use of drug therapy (Viagra), vacuum erectile systems, self injection, and surgery (blood vessel repair and penile implants). The program includes drawings, graphics, and footage of patients and their physicians through the diagnosis and treatment processes. •

Current Approaches to Erectile Dysfunction Source: Madison, WI: University of Wisconsin Hospitals and Clinics, Department of Outreach Education. 1999. (videocassette). Contact: Available from University of Wisconsin Hospital and Clinics. Picture of Health, 702 North Blackhawk Avenue, Suite 215, Madison, WI 53705-3357. (800) 757-4354 or (608) 263-6510. Fax (608) 262-7172. PRICE: $19.95 plus shipping and handling; bulk copies available. Order number 060699A. Summary: Erectile dysfunction (impotence) is a common, treatable condition experienced by 10 to 20 million men in the United States. This videotape program, moderated by Carol Koby, discusses the current approaches to the diagnosis and treatment of erectile dysfunction (ED). The program features Dr. Wolfram Nolten, an endocrinologist, who first defines ED as the inability to achieve or maintain erection satisfactory for intercourse at least 50 percent of the time. Dr. Nolten stresses that effective treatments are available. Focusing primarily on Viagra (sildenafil), Dr. Nolten discusses the history of the drug's development, how Viagra works, cost considerations, side effects, patient selection issues, and the use of Viagra in women (an 'off label' use that is not recommended). Other topics covered include the role of depression and stress, hormones, systemic diseases (such as diabetes mellitus or cardiovascular diseases), and drug effects on the development of ED. Dr. Nolten then covers diagnostic issues, the appropriate use of primary care providers to treat most men with ED, other drugs used to treat ED (self injection and urethral administration of vasoactive drugs), penile implants, vacuum erection devices, and the implications of the presence of noctural erections. Dr. Nolten concludes by reminding viewers that 'erection is good for erection'; in other words, frequent erections oxygenate the penis and keep the physiology in good working condition. As the population ages, there is an accompanying change in awareness of sexuality and general health. The program concludes with a reference to a physician's guide to ED information and resources (www.pslgroup.com).

Multimedia 87

Bibliography: Multimedia on Viagra 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 Viagra (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 Viagra: •

Viagra [videorecording]: a new sexual revolution? Source: a presentation of Films for the Humanities & Sciences; Nightline, ABCNEWS; Year: 1999; Format: Videorecording; Princeton, N.J.: Films for the Humanities and Sciences, c1999

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

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

Vardenafil beats sildenafil study Source: Reuters Medical News Date: October 09, 2003 http://www.reutershealth.com/archive/2003/10/09/professional/links/20031009clin0 12.html

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Levitra may help when Viagra lets you down - study Source: Reuters Health eLine Date: October 09, 2003

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Bayer, Glaxo drug Levitra beats Viagra in study Source: Reuters Industry Breifing Date: October 09, 2003

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Viagra doesn't promote prostate cancer growth Source: Reuters Health eLine Date: October 02, 2003

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Pfizer files new complaint in Viagra case: Bayer Source: Reuters Industry Breifing Date: September 24, 2003

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S. Korean firm eyes Viagra side effects breakthrough Source: Reuters Industry Breifing Date: September 04, 2003

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Viagra rival a $1 bln opportunity for Bayer, Glaxo Source: Reuters Industry Breifing Date: August 20, 2003

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U.S. approves Viagra rival from Glaxo, Bayer Source: Reuters Health eLine Date: August 20, 2003

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U.S. approves Levitra from Glaxo, Bayer, rival to Viagra Source: Reuters Medical News Date: August 20, 2003

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Ad agencies may reap spoils of Viagra battle Source: Reuters Industry Breifing Date: August 19, 2003

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Vyagra is Viagra, U.N. copyright agency rules Source: Reuters Industry Breifing Date: August 18, 2003

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More than 4,000 fake Viagra pills seized in China Source: Reuters Industry Breifing Date: August 18, 2003

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Aventis' Lantus soars away like Viagra in Britain Source: Reuters Industry Breifing Date: July 22, 2003

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Sildenafil shows promise as adjunct therapy for severe pulmonary hypertension Source: Reuters Industry Breifing Date: July 02, 2003

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No major heart risk from Viagra rival Levitra Source: Reuters Health eLine Date: May 30, 2003

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U.S. says unapproved Viagra mishandled at border Source: Reuters Industry Breifing Date: May 21, 2003

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U.S. says unapproved sildenafil mishandled at border Source: Reuters Medical News Date: May 21, 2003

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Five years on, company eyes new Viagra uses Source: Reuters Health eLine Date: May 13, 2003

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UK man loses appeal in Internet Viagra case Source: Reuters Health eLine Date: May 12, 2003

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U.K. online Viagra seller loses appeal Source: Reuters Industry Breifing Date: May 12, 2003

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Study shows exercise on par with Viagra for some Source: Reuters Health eLine Date: May 01, 2003

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Penile implants may benefit in Viagra market battle Source: Reuters Health eLine Date: April 30, 2003

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Exercise may be as effective as sildenafil for some ED patients Source: Reuters Medical News Date: April 30, 2003

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Viagra shows promise in women on antidepressants Source: Reuters Health eLine Date: April 29, 2003

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Viagra may restore erections after prostate surgery Source: Reuters Health eLine Date: April 28, 2003

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Supplement potentially laced with Viagra is recalled Source: Reuters Industry Breifing Date: April 08, 2003

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Viagra once-weekly not enough, UK researchers say Source: Reuters Health eLine Date: March 14, 2003

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Pfizer says Viagra better than Abbott's Uprima in study Source: Reuters Industry Breifing Date: March 12, 2003

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Makers claim new impotence drug better than Viagra Source: Reuters Health eLine Date: March 11, 2003

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Bayer and Glaxo claim Levitra more potent than Viagra Source: Reuters Industry Breifing Date: March 10, 2003

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Glaxo, Bayer win EU approval for Viagra rival Source: Reuters Industry Breifing Date: March 07, 2003

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Bayer, Glaxo to launch second Viagra rival Source: Reuters Health eLine Date: February 05, 2003

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Bayer, Glaxo target March launch in Europe for Viagra rival Source: Reuters Industry Breifing Date: February 05, 2003

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Viagra, antidepressant help premature ejaculation Source: Reuters Health eLine Date: February 04, 2003


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Lilly prices new impotence drug same as Viagra Source: Reuters Health eLine Date: February 03, 2003

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European men get new pill to rival Viagra Source: Reuters Health eLine Date: February 03, 2003

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Italian court upholds Viagra patent Source: Reuters Health eLine Date: January 31, 2003

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Palatin drug wins test against Viagra Source: Reuters Industry Breifing Date: January 22, 2003

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Novel erectile dysfunction drug superior to sildenafil Source: Reuters Medical News Date: January 22, 2003

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Sildenafil can stimulate platelet aggregation if atherosclerosis is present Source: Reuters Industry Breifing Date: January 16, 2003

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Pfizer to act against Italian pharmacists over pirated Viagra sales Source: Reuters Industry Breifing Date: January 16, 2003

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Viagra may influence blood's stickiness: study Source: Reuters Health eLine Date: January 15, 2003

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Actelion plays down Viagra threat, CSFB cuts rating Source: Reuters Industry Breifing Date: January 15, 2003

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Sildenafil may improve lower urinary tract symptoms in men Source: Reuters Industry Breifing Date: January 07, 2003

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Viagra may fight antidepressants' sex side effects Source: Reuters Health eLine Date: January 01, 2003

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Viagra may improve urinary tract problems in men Source: Reuters Health eLine Date: December 23, 2002

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Viagra may help some infertile women get pregnant Source: Reuters Health eLine Date: December 06, 2002

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Scientists debate possible Viagra-aggression link Source: Reuters Health eLine Date: December 06, 2002

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Scientists debate possible link between Viagra and aggression Source: Reuters Industry Breifing Date: December 06, 2002

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Possible link between Viagra and aggression debated Source: Reuters Medical News Date: December 06, 2002 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 “Viagra” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests.


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

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

Viagra: Why Aren't More Men Taking It? Source: Harvard Health Letter. 24(12): 6. October 1999. Contact: Available from Harvard Medical School Health Publications Group. Harvard Health Letter, P.O. Box 420300, Palm Coast, FL 32142-0300. (800) 829-9045. E-mail: [email protected]. Summary: This brief article explores the recent use of sildenafil (Viagra) for erectile dysfunction (the preferred term for impotence). A poll published in the summer of 1999 by the American Association of Retired Persons (AARP) showed that of men over age 45, only about 25 percent with some degree of erectile dysfunction took medication for the problem. The author reviews the potential reasons for these data. First, many men choose not to seek medical attention for their erectile dysfunction (ED); even though ED is more commonly talked about, many men continue to feel uncomfortable dealing with it even in a medical context. Second, the actual clinical experience with Viagra can be less than the effectiveness reported in the original research studies. For example, Viagra may not work very well for men with vascular problems (including that due to diabetes mellitus). In addition, Viagra has common side effects, including headache (16 percent of all patients), flushing (10 percent), and indigestion (7 percent), none of which contribute to the likelihood of sexual activity. Some men also avoid Viagra because of the well publicized dangers of its interaction with other drugs, notably nitrate (including nitroglycerin tablets and amyl nitrates, a recreational drug known as poppers).

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

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APPENDICES

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

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute11: •

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

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

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

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

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

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

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

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

11

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Physician Resources 101

NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.12 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:13 •

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

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

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

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

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

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

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

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

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

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

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

12

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

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

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

The NLM Gateway14 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.15 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “Viagra” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 1314 12 29 17 0 1372

HSTAT16 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.17 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.18 Simply search by “Viagra” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

14

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

15

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). 16 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 17 18

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

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

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Coffee Break: Tutorials for Biologists19 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.20 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.21 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

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

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

•

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

19 Adapted 20

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

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 21 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

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

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Other guides Erectile Dysfunction - Viagra http://www.nlm.nih.gov/medlineplus/tutorials/erectiledysfunctionviagraloader.t ml Female Sexual Dysfunction http://www.nlm.nih.gov/medlineplus/femalesexualdysfunction.html Herbal Medicine http://www.nlm.nih.gov/medlineplus/herbalmedicine.html Prostate Cancer http://www.nlm.nih.gov/medlineplus/prostatecancer.html Respiratory Diseases http://www.nlm.nih.gov/medlineplus/respiratorydiseases.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 Viagra. 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: •

Vinarol and Viga Tablets Contaminated with Sildenafil (Viagra) Source: Gaithersburg, MD: National Center for Complementary and Alternative Medicine. 2003. 2 p. Contact: Available from National Center for Complementary and Alternative Medicine Clearinghouse. P.O. Box 7923, Gaithersburg, MD 20898. (888) 644-6226; INTERNATIONAL PHONE: (301) 519-3153; TTY: (866) 464-3615; FAX: (866) 464-3616; EMAIL: [email protected]. PRICE: Free. Summary: This consumer advisory from the National Center for Complementary and Alternative Medicine (NCCAM) warns consumers not to purchase or consume the dietary supplement products Vinarol and Viga, which are promoted for increasing desire, confidence, and sexual performance. It informs users of the recall of these products after U.S. Food and Drug Administration (FDA) investigators found that they contained the unlabeled prescription drug ingredient, sildenafil, which may pose possible serious health risks to some users. The advisory provides advice to consumers who use Vinarol or Viga and refers readers to a press release from the FDA.

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•

Viagra Story Source: Patient Care. 34(11): 99. June 15, 2000. Contact: Available from Medical Economics. 5 Paragon Drive, Montvale, NJ 07645. (800) 432-4570. Fax (201) 573-4956. Summary: This single page patient education handout offers information about sildenafil (Viagra). Viagra has the best record of any medication so far in helping men with erectile dysfunction (ED, formerly called impotence) to improve their sex life. Viagra helps men to maintain rigidity long enough to have sexual intercourse. It does not usually increase interest in sex or help to get an erection in the first place. So, the desire to have sex and the ability to start an erection must be present for Viagra to work. The handout reviews the dosage and administration of Viagra, the side effects, and safety considerations. After taking Viagra, some men get a headache, redness of the face, upset stomach, nasal congestion, or a blue tint to their vision. Patients who are taking nitrates (nitroglycerin, isosorbide nitrate or mononitrate, transdermal nitroglycerin patches, and drugs with the word tetranitrate in their name) should not take Viagra. One sidebar lists five websites with additional information on ED. A small section of the handout offers blank lines for the reader to record information or questions. The handout may be photocopied for distribution by physicians to their patients.

•

Using Viagra Source: American Family Physician. 60(4): 1172. September 15, 1999. Contact: Available from American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237. Website: www.aafp.org. Summary: This patient education handout reviews the indications and effects of Viagra (sildenafil), a medicine that helps men with erectile dysfunction (impotence) have sexual intercourse. Erectile dysfunction is defined as the inability of the penis to become rigid (hard) or to stay rigid long enough to complete the sex act. The handout notes that the medicine comes in tablets of 25 mg, 50 mg, and 100 mg; most patients start with 50 mg, taken 1 hour before they plan to have sexual intercourse. The handout emphasizes that even with the use of Viagra, men will still need physical and mental stimulation and desire in order to have an erection. The handout lists some common side effects of the medication, including headache, flushing (face and upper body turning red and warm), stomach upset, runny nose (sniffles), and vision changes (things look blue). Patients are cautioned against using Viagra if they take any forms of nitroglycerin or other nitrates; the handout lists the generic and brand names of these drugs. 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:

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FAQ - About Viagra Summary: In response to numerous inquiries, the FDA answers your questions online concerning Viagra, the first oral pill approved to treat impotence. Source: Center for Drug Evaluation and Research, U.S. Food and Drug Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=2266

•

Viagra Information for Consumers Summary: This document answers consumers' most frequently asked questions received by the Center for Drug Evaluation and Research concerning the drug Viagra. Source: Center for Drug Evaluation and Research, U.S. Food and Drug Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=3644 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 Viagra. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources

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


•

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

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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

•

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

•

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

•

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

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to Viagra. By consulting all of associations listed in this

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chapter, you will have nearly exhausted all sources for patient associations concerned with Viagra. 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 Viagra. 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 “Viagra” (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 “Viagra”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “Viagra” (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 “Viagra” (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.22

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

22

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)23: •

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/

23

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

Finding Medical Libraries 113

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

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•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

•

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

Finding Medical Libraries 115

•

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

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

•

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

•

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

•

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

•

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

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

•

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

•

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

•

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

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

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

•

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

•

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

•

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

•

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

•

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

•

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

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

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

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

•

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

•

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

•

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

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VIAGRA DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Ablation: The removal of an organ by surgery. [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 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] Adenine: A purine base and a fundamental unit of adenine nucleotides. [NIH] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Adverse Effect: An unwanted side effect of treatment. [NIH] Aerobic: In biochemistry, reactions that need oxygen to happen or happen when oxygen is present. [NIH] Aerosol: A solution of a drug which can be atomized into a fine mist for inhalation therapy. [EU]

Aetiology: Study of the causes of disease. [EU] 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] Age Factors: Age as a constituent element or influence contributing to the production of a

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result. It may be applicable to the cause or the effect of a circumstance. It is used with human or animal concepts but should be differentiated from aging, a physiological process, and time factors which refers only to the passage of time. [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] 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] 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] 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] 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] Alprostadil: A potent vasodilator agent that increases peripheral blood flow. It inhibits platelet aggregation and has many other biological effects such as bronchodilation, mediation of inflammation, etc. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Amino acid: Any organic compound containing an amino (-NH2 and a carboxyl (- COOH) group. The 20 a-amino acids listed in the accompanying table are the amino acids from which proteins are synthesized by formation of peptide bonds during ribosomal translation of messenger RNA; all except glycine, which is not optically active, have the L configuration. Other amino acids occurring in proteins, such as hydroxyproline in collagen, are formed by posttranslational enzymatic modification of amino acids residues in polypeptide chains. There are also several important amino acids, such as the neurotransmitter y-aminobutyric acid, that have no relation to proteins. Abbreviated AA. [EU] Amnesia: Lack or loss of memory; inability to remember past experiences. [EU] Amphetamines: Analogs or derivatives of amphetamine. Many are sympathomimetics and central nervous system stimulators causing excitation, vasopression, bronchodilation, and to varying degrees, anorexia, analepsis, nasal decongestion, and some smooth muscle relaxation. [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] Androgen suppression: Treatment to suppress or block the production of male hormones. Androgen suppression is achieved by surgical removal of the testicles, by taking female sex hormones, or by taking other drugs. Also called androgen ablation. [NIH] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Aneurysm: A sac formed by the dilatation of the wall of an artery, a vein, or the heart. [NIH]

Dictionary 121

Angina: Chest pain that originates in the heart. [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] Antiandrogen therapy: Treatment with drugs used to block production or interfere with the action of male sex hormones. [NIH] Antiandrogens: Drugs used to block the production or interfere with the action of male sex hormones. [NIH] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [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] Antidepressant: A drug used to treat depression. [NIH] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antihypertensive: An agent that reduces high blood pressure. [EU] Antineoplastic: Inhibiting or preventing the development of neoplasms, checking the maturation and proliferation of malignant cells. [EU] Antitussive: An agent that relieves or prevents cough. [EU] Anuria: Inability to form or excrete urine. [NIH] Anus: The opening of the rectum to the outside of the body. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Aorta: The main trunk of the systemic arteries. [NIH] Apomorphine: A derivative of morphine that is a dopamine D2 agonist. It is a powerful emetic and has been used for that effect in acute poisoning. It has also been used in the diagnosis and treatment of parkinsonism, but its adverse effects limit its use. [NIH] Aqueous: Having to do with water. [NIH] Arginine: An essential amino acid that is physiologically active in the L-form. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Aspartate: A synthetic amino acid. [NIH] Asphyxia: A pathological condition caused by lack of oxygen, manifested in impending or

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actual cessation of life. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Asymptomatic: Having no signs or symptoms of disease. [NIH] Atrophy: Decrease in the size of a cell, tissue, organ, or multiple organs, associated with a variety of pathological conditions such as abnormal cellular changes, ischemia, malnutrition, or hormonal changes. [NIH] Auditory: Pertaining to the sense of hearing. [EU] 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] Autonomic Neuropathy: A disease of the nerves affecting mostly the internal organs such as the bladder muscles, the cardiovascular system, the digestive tract, and the genital organs. These nerves are not under a person's conscious control and function automatically. Also called visceral neuropathy. [NIH] Axillary: Pertaining to the armpit area, including the lymph nodes that are located there. [NIH]

Axillary Artery: The continuation of the subclavian artery; it distributes over the upper limb, axilla, chest and shoulder. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Benzene: Toxic, volatile, flammable liquid hydrocarbon biproduct of coal distillation. It is used as an industrial solvent in paints, varnishes, lacquer thinners, gasoline, etc. Benzene causes central nervous system damage acutely and bone marrow damage chronically and is carcinogenic. It was formerly used as parasiticide. [NIH] Beta-Thalassemia: A disorder characterized by reduced synthesis of the beta chains of hemoglobin. There is retardation of hemoglobin A synthesis in the heterozygous form (thalassemia minor), which is asymptomatic, while in the homozygous form (thalassemia major, Cooley's anemia, Mediterranean anemia, erythroblastic anemia), which can result in severe complications and even death, hemoglobin A synthesis is absent. [NIH] Bilateral: Affecting both the right and left side of body. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH]

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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] Biotransformation: The chemical alteration of an exogenous substance by or in a biological system. The alteration may inactivate the compound or it may result in the production of an active metabolite of an inactive parent compound. The alteration may be either nonsynthetic (oxidation-reduction, hydrolysis) or synthetic (glucuronide formation, sulfate conjugation, acetylation, methylation). This also includes metabolic detoxication and clearance. [NIH] Bladder: The organ that stores urine. [NIH] Bloating: Fullness or swelling in the abdomen that often occurs after meals. [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 vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Body Mass Index: One of the anthropometric measures of body mass; it has the highest correlation with skinfold thickness or body density. [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 Resorption: Bone loss due to osteoclastic activity. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Brachial: All the nerves from the arm are ripped from the spinal cord. [NIH] Brachial Artery: The continuation of the axillary artery; it branches into the radial and ulnar arteries. [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

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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] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Breakdown: A physical, metal, or nervous collapse. [NIH] Broad-spectrum: Effective against a wide range of microorganisms; said of an antibiotic. [EU] 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 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] Calcium-Binding Proteins: Proteins to which calcium ions are bound. They can act as transport proteins, regulator proteins or activator proteins. [NIH] Cannabis: The hemp plant Cannabis sativa. Products prepared from the dried flowering tops of the plant include marijuana, hashish, bhang, and ganja. [NIH] Capillary: Any one of the minute vessels that connect the arterioles and venules, forming a network in nearly all parts of the body. Their walls act as semipermeable membranes for the interchange of various substances, including fluids, between the blood and tissue fluid; called also vas capillare. [EU] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrates: The largest class of organic compounds, including starches, glycogens, cellulose, gums, and simple sugars. Carbohydrates are composed of carbon, hydrogen, and oxygen in a ratio of Cn(H2O)n. [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]

Cardiac: Having to do with the heart. [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] Cardiotonic: 1. Having a tonic effect on the heart. 2. An agent that has a tonic effect on the heart. [EU] Cardiotonic Agents: Agents that have a tonic effect on the heart or increase cardiac output. They may be glycosidic steroids related to Digitalis products, sympathomimetics, or other drugs and are used after myocardial infarcts, cardiac surgery, in shock, or in congestive heart failure. [NIH]

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Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cardiovascular disease: Any abnormal condition characterized by dysfunction of the heart and blood vessels. CVD includes atherosclerosis (especially coronary heart disease, which can lead to heart attacks), cerebrovascular disease (e.g., stroke), and hypertension (high blood pressure). [NIH] Cardiovascular System: The heart and the blood vessels by which blood is pumped and circulated through the body. [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] Catalytic Domain: The region of an enzyme that interacts with its substrate to cause the enzymatic reaction. [NIH] Catheter: A flexible tube used to deliver fluids into or withdraw fluids from the body. [NIH] Catheterization: Use or insertion of a tubular device into a duct, blood vessel, hollow organ, or body cavity for injecting or withdrawing fluids for diagnostic or therapeutic purposes. It differs from intubation in that the tube here is used to restore or maintain patency in obstructions. [NIH] 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] Causal: Pertaining to a cause; directed against a cause. [EU] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell 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 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] 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] Central retinal artery: The blood vessel that carries blood into eye; supplies nutrition to the retina. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] 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

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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] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH] Chest Pain: Pressure, burning, or numbness in the chest. [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] 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] Cholinergic: Resembling acetylcholine in pharmacological action; stimulated by or releasing acetylcholine or a related compound. [EU] Choroid: The thin, highly vascular membrane covering most of the posterior of the eye between the retina and sclera. [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 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] 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] 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] Clonic: Pertaining to or of the nature of clonus. [EU] 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] Codeine: An opioid analgesic related to morphine but with less potent analgesic properties and mild sedative effects. It also acts centrally to suppress cough. [NIH] Cofactor: A substance, microorganism or environmental factor that activates or enhances the 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] Colitis: Inflammation of the colon. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is

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differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Collapse: 1. A state of extreme prostration and depression, with failure of circulation. 2. Abnormal falling in of the walls of any part of organ. [EU] Colon: The long, coiled, tubelike organ that removes water from digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus. [NIH] Combination Therapy: Association of 3 drugs to treat AIDS (AZT + DDC or DDI + protease inhibitor). [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] 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] Concomitant: Accompanying; accessory; joined with another. [EU] Concurrent therapy: A treatment that is given at the same time as another. [NIH]

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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] 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] Conjugation: 1. The act of joining together or the state of being conjugated. 2. A sexual process seen in bacteria, ciliate protozoa, and certain fungi in which nuclear material is exchanged during the temporary fusion of two cells (conjugants). In bacterial genetics a form of sexual reproduction in which a donor bacterium (male) contributes some, or all, of its DNA (in the form of a replicated set) to a recipient (female) which then incorporates differing genetic information into its own chromosome by recombination and passes the recombined set on to its progeny by replication. In ciliate protozoa, two conjugants of separate mating types exchange micronuclear material and then separate, each now being a fertilized cell. In certain fungi, the process involves fusion of two gametes, resulting in union of their nuclei and formation of a zygote. 3. In chemistry, the joining together of two compounds to produce another compound, such as the combination of a toxic product with some substance in the body to form a detoxified product, which is then eliminated. [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] Controlled study: An experiment or clinical trial that includes a comparison (control) group. [NIH]

Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary 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 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] Corpus: The body of the uterus. [NIH] Cortical: Pertaining to or of the nature of a cortex or bark. [EU] 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] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Craniocerebral Trauma: Traumatic injuries involving the cranium and intracranial structures (i.e., brain; cranial nerves; meninges; and other structures). Injuries may be classified by whether or not the skull is penetrated (i.e., penetrating vs. nonpenetrating) or whether there is an associated hemorrhage. [NIH] 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]

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Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Cytotoxic: Cell-killing. [NIH] 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] Dermis: A layer of vascular connective tissue underneath the epidermis. The surface of the dermis contains sensitive papillae. Embedded in or beneath the dermis are sweat glands, hair follicles, and sebaceous glands. [NIH] Designer Drugs: Drugs designed and synthesized, often for illegal street use, by modification of existing drug structures (e.g., amphetamines). Of special interest are MPTP (a reverse ester of meperidine), MDA (3,4-methylenedioxyamphetamine), and MDMA (3,4methylenedioxymethamphetamine). Many drugs act on the aminergic system, the physiologically active biogenic amines. [NIH] Deuterium: Deuterium. The stable isotope of hydrogen. It has one neutron and one proton in the nucleus. [NIH] Dextromethorphan: The d-isomer of the codeine analog of levorphanol. Dextromethorphan shows high affinity binding to several regions of the brain, including the medullary cough center. This compound is a NMDA receptor antagonist (receptors, N-methyl-D-aspartate) and acts as a non-competitive channel blocker. It is used widely as an antitussive agent, and is also used to study the involvement of glutamate receptors in neurotoxicity. [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 procedure: A method used to identify a disease. [NIH] Dialyzer: A part of the hemodialysis machine. (See hemodialysis under dialysis.) The dialyzer has two sections separated by a membrane. One section holds dialysate. The other holds the patient's blood. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Digestive tract: The organs through which food passes when food is eaten. These organs are the mouth, esophagus, stomach, small and large intestines, and rectum. [NIH] Dilatation: The act of dilating. [NIH] Dilatation, Pathologic: The condition of an anatomical structure's being dilated beyond normal dimensions. [NIH] Dilation: A process by which the pupil is temporarily enlarged with special eye drops

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(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] 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 Transmission: The transmission of infectious disease or pathogens. When transmission is within the same species, the mode can be horizontal (disease transmission, horizontal) or vertical (disease transmission, vertical). [NIH] Disease Transmission, Horizontal: The transmission of infectious disease or pathogens from one individual to another in the same generation. [NIH] Disease Transmission, Vertical: The transmission of infectious disease or pathogens from one generation to another. It includes transmission in utero or intrapartum by exposure to blood and secretions, and postpartum exposure via breastfeeding. [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] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [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] Dosage Forms: Completed forms of the pharmaceutical preparation in which prescribed doses of medication are included. They are designed to resist action by gastric fluids, prevent vomiting and nausea, reduce or alleviate the undesirable taste and smells associated with oral administration, achieve a high concentration of drug at target site, or produce a delayed or long-acting drug effect. They include capsules, liniments, ointments, pharmaceutical solutions, powders, tablets, etc. [NIH] Double-blind: Pertaining to a clinical trial or other experiment in which neither the subject nor the person administering treatment knows which treatment any particular subject is receiving. [EU] 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 Interactions: The action of a drug that may affect the activity, metabolism, or toxicity

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of another drug. [NIH] Duodenum: The first part of the small intestine. [NIH] Dyspepsia: Impaired digestion, especially after eating. [NIH] Dysphagia: Difficulty in swallowing. [EU] 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] Ejaculation: The release of semen through the penis during orgasm. [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] 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] Emetic: An agent that causes vomiting. [EU] 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] Endometrial: Having to do with the endometrium (the layer of tissue that lines the uterus). [NIH]

Endometrium: The layer of tissue that lines the uterus. [NIH] Endopeptidases: A subclass of peptide hydrolases. They are classified primarily by their catalytic mechanism. Specificity is used only for identification of individual enzymes. They comprise the serine endopeptidases, EC 3.4.21; cysteine endopeptidases, EC 3.4.22; aspartic endopeptidases, EC 3.4.23, metalloendopeptidases, EC 3.4.24; and a group of enzymes yet to be assigned to any of the above sub-classes, EC 3.4.99. EC 3.4.-. [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]

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Endothelium-derived: Small molecule that diffuses to the adjacent muscle layer and relaxes it. [NIH] End-stage renal: Total chronic kidney failure. When the kidneys fail, the body retains fluid and harmful wastes build up. A person with ESRD needs treatment to replace the work of the failed kidneys. [NIH] Environmental 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] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [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] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Escalation: Progressive use of more harmful drugs. [NIH] Esophageal: Having to do with the esophagus, the muscular tube through which food passes from the throat to the stomach. [NIH] Esophageal Spasms: Muscle cramps in the esophagus that cause pain in the chest. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Estrogen: One of the two female sex hormones. [NIH] Excrete: To get rid of waste from the body. [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] Exhaustion: The feeling of weariness of mind and body. [NIH] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] External-beam radiation: Radiation therapy that uses a machine to aim high-energy rays at the cancer. Also called external radiation. [NIH] Extracellular: Outside a cell or cells. [EU] Extraction: The process or act of pulling or drawing out. [EU] Facial: Of or pertaining to the face. [EU] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH]

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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]

Fetal Hemoglobin: The major component of hemoglobin in the fetus. This hemoglobin has two alpha and two gamma polypeptide subunits in comparison to normal adult hemoglobin, which has two alpha and two beta polypeptide subunits. Fetal hemoglobin concentrations can be elevated (usually above 0.5%) in children and adults affected by leukemia and several types of anemia. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Flushing: A transient reddening of the face that may be due to fever, certain drugs, exertion, stress, or a disease process. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Frostbite: Damage to tissues as the result of low environmental temperatures. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gamma Rays: Very powerful and penetrating, high-energy electromagnetic radiation of shorter wavelength than that of x-rays. They are emitted by a decaying nucleus, usually between 0.01 and 10 MeV. They are also called nuclear x-rays. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gastric: Having to do with the stomach. [NIH] Gastric Emptying: The evacuation of food from the stomach into the duodenum. [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]

Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gastroparesis: Nerve or muscle damage in the stomach. Causes slow digestion and emptying, vomiting, nausea, or bloating. Also called delayed gastric emptying. [NIH] Gelatin: A product formed from skin, white connective tissue, or bone collagen. It is used as a protein food adjuvant, plasma substitute, hemostatic, suspending agent in pharmaceutical preparations, and in the manufacturing of capsules and suppositories. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Gene Expression: The phenotypic manifestation of a gene or genes by the processes of gene action. [NIH] Gene Therapy: The introduction of new genes into cells for the purpose of treating disease by restoring or adding gene expression. Techniques include insertion of retroviral vectors, transfection, homologous recombination, and injection of new genes into the nuclei of single cell embryos. The entire gene therapy process may consist of multiple steps. The new genes may be introduced into proliferating cells in vivo (e.g., bone marrow) or in vitro (e.g., fibroblast cultures) and the modified cells transferred to the site where the gene expression is required. Gene therapy may be particularly useful for treating enzyme deficiency diseases, hemoglobinopathies, and leukemias and may also prove useful in restoring drug

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sensitivity, particularly for leukemia. [NIH] Genital: Pertaining to the genitalia. [EU] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Ginseng: An araliaceous genus of plants that contains a number of pharmacologically active agents used as stimulants, sedatives, and tonics, especially in traditional medicine. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glomerular: Pertaining to or of the nature of a glomerulus, especially a renal glomerulus. [EU]

Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucose Intolerance: A pathological state in which the fasting plasma glucose level is less than 140 mg per deciliter and the 30-, 60-, or 90-minute plasma glucose concentration following a glucose tolerance test exceeds 200 mg per deciliter. This condition is seen frequently in diabetes mellitus but also occurs with other diseases. [NIH] Glutamate: Excitatory neurotransmitter of the brain. [NIH] Glycine: A non-essential amino acid. It is found primarily in gelatin and silk fibroin and used therapeutically as a nutrient. It is also a fast inhibitory neurotransmitter. [NIH] Glycosidic: Formed by elimination of water between the anomeric hydroxyl of one sugar and a hydroxyl of another sugar molecule. [NIH] Gonad: A sex organ, such as an ovary or a testicle, which produces the gametes in most multicellular animals. [NIH] Gonadal: Pertaining to a gonad. [EU] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Grafting: The operation of transfer of tissue from one site to another. [NIH] Granulocytes: Leukocytes with abundant granules in the cytoplasm. They are divided into three groups: neutrophils, eosinophils, and basophils. [NIH] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [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] 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] Haemorrhage: The escape of blood from the vessels; bleeding. Small haemorrhages are classified according to size as petechiae (very small), purpura (up to 1 cm), and ecchymoses (larger). The massive accumulation of blood within a tissue is called a haematoma. [EU] Halos: Rings around lights due to optical imperfections in or in front of the eye. [NIH] Haptens: Small antigenic determinants capable of eliciting an immune response only when coupled to a carrier. Haptens bind to antibodies but by themselves cannot elicit an antibody response. [NIH] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or

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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] 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] 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] Hemodialysis: The use of a machine to clean wastes from the blood after the kidneys have failed. The blood travels through tubes to a dialyzer, which removes wastes and extra fluid. The cleaned blood then flows through another set of tubes back into the body. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemoglobin A: Normal adult human hemoglobin. The globin moiety consists of two alpha and two beta chains. [NIH] Hemoglobin H: An abnormal hemoglobin composed of four beta chains. It is caused by the reduced synthesis of the alpha chain. This abnormality results in alpha-thalassemia. [NIH] Hemoglobinopathies: A group of inherited disorders characterized by structural alterations within the hemoglobin molecule. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemostasis: The process which spontaneously arrests the flow of blood from vessels carrying blood under pressure. It is accomplished by contraction of the vessels, adhesion and aggregation of formed blood elements, and the process of blood or plasma coagulation. [NIH]

Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Heterogeneity: The property of one or more samples or populations which implies that they are not identical in respect of some or all of their parameters, e. g. heterogeneity of variance. [NIH]

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]

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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] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrolysis: The process of cleaving a chemical compound by the addition of a molecule of water. [NIH] Hydroxyurea: An antineoplastic agent that inhibits DNA synthesis through the inhibition of ribonucleoside diphosphate reductase. [NIH] Hypercholesterolemia: Abnormally high levels of cholesterol in the blood. [NIH] Hyperglycemia: Abnormally high blood sugar. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hypogonadism: Condition resulting from or characterized by abnormally decreased functional activity of the gonads, with retardation of growth and sexual development. [NIH] Hypokinesia: Slow or diminished movement of body musculature. It may be associated with basal ganglia diseases; mental disorders; prolonged inactivity due to illness; experimental protocols used to evaluate the physiologic effects of immobility; and other conditions. [NIH] Hypotension: Abnormally low blood pressure. [NIH] Hypothalamic: Of or involving the hypothalamus. [EU] Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH] Hysteria: Historical term for a chronic, but fluctuating, disorder beginning in early life and characterized by recurrent and multiple somatic complaints not apparently due to physical illness. This diagnosis is not used in contemporary practice. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

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] 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,

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wires, or catheters is placed directly into or near the tumor. Also called [NIH] Impotence: The inability to perform sexual intercourse. [NIH] Impotent: Unable to have an erection adequate for sexual intercourse. [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] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Indigestion: Poor digestion. Symptoms include heartburn, nausea, bloating, and gas. Also called dyspepsia. [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] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

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

Ingestion: Taking into the body by mouth [NIH] 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] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Internal 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] Intestines: The section of the alimentary canal from the stomach to the anus. It includes the large intestine and small intestine. [NIH]

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Intoxication: Poisoning, the state of being poisoned. [EU] Intracellular: Inside a cell. [NIH] Intracellular Membranes: Membranes of subcellular structures. [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] Intravenous: IV. Into a vein. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

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] Ionizing: Radiation comprising charged particles, e. g. electrons, protons, alpha-particles, etc., having sufficient kinetic energy to produce ionization by collision. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Ipsilateral: Having to do with the same side of the body. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Isoflavones: 3-Phenylchromones. Isomeric form of flavones in which the benzene group is attached to the 3 position of the benzopyran ring instead of the 2 position. [NIH] Isosorbide: 1,4:3,6-Dianhydro D-glucitol. Chemically inert osmotic diuretic used mainly to treat hydrocephalus; also used in glaucoma. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Kidney Failure: The inability of a kidney to excrete metabolites at normal plasma levels under conditions of normal loading, or the inability to retain electrolytes under conditions of normal intake. In the acute form (kidney failure, acute), it is marked by uremia and usually by oliguria or anuria, with hyperkalemia and pulmonary edema. The chronic form (kidney failure, chronic) is irreversible and requires hemodialysis. [NIH] Kidney Failure, Acute: A clinical syndrome characterized by a sudden decrease in glomerular filtration rate, often to values of less than 1 to 2 ml per minute. It is usually associated with oliguria (urine volumes of less than 400 ml per day) and is always associated with biochemical consequences of the reduction in glomerular filtration rate such as a rise in blood urea nitrogen (BUN) and serum creatinine concentrations. [NIH] Kidney Failure, Chronic: An irreversible and usually progressive reduction in renal function in which both kidneys have been damaged by a variety of diseases to the extent that they are unable to adequately remove the metabolic products from the blood and regulate the body's electrolyte composition and acid-base balance. Chronic kidney failure

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requires hemodialysis or surgery, usually kidney transplantation. [NIH] Kinetic: Pertaining to or producing motion. [EU] Lactation: The period of the secretion of milk. [EU] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Lectin: A complex molecule that has both protein and sugars. Lectins are able to bind to the outside of a cell and cause biochemical changes in it. Lectins are made by both animals and plants. [NIH] Leukemia: Cancer of blood-forming tissue. [NIH] Levorphanol: A narcotic analgesic that may be habit-forming. It is nearly as effective orally as by injection. [NIH] Libido: The psychic drive or energy associated with sexual instinct in the broad sense (pleasure and love-object seeking). It may also connote the psychic energy associated with instincts in general that motivate behavior. [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Linkages: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Lutein Cells: The cells of the corpus luteum which are derived from the granulosa cells and the theca cells of the Graafian follicle. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]

Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] 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] 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] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH]

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Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]

Mammary: Pertaining to the mamma, or breast. [EU] Mass Media: Instruments or technological means of communication that reach large numbers of people with a common message: press, radio, television, etc. [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 Records: Recording of pertinent information concerning patient's illness or illnesses. [NIH] Medicament: A medicinal substance or agent. [EU] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Medullary: Pertaining to the marrow or to any medulla; resembling marrow. [EU] Membrane: A very thin layer of tissue that covers a surface. [NIH] Membrane Proteins: Proteins which are found in membranes including cellular and intracellular membranes. They consist of two types, peripheral and integral proteins. They include most membrane-associated enzymes, antigenic proteins, transport proteins, and drug, hormone, and lectin receptors. [NIH] 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] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH] Meperidine: 1-Methyl-4-phenyl-4-piperidinecarboxylic acid ethyl ester. A narcotic analgesic that can be used for the relief of most types of moderate to severe pain, including postoperative pain and the pain of labor. Prolonged use may lead to dependence of the morphine type; withdrawal symptoms appear more rapidly than with morphine and are of shorter duration. [NIH] 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] Metabolic disorder: A condition in which normal metabolic processes are disrupted, usually because of a missing enzyme. [NIH] Metabolite: Any substance produced by metabolism or by a metabolic process. [EU] 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

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the original (primary) tumor. The plural is metastases. [NIH] Metastatic: Having to do with metastasis, which is the spread of cancer from one part of the body to another. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [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] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monoclonal: An antibody produced by culturing a single type of cell. It therefore consists of a single species of immunoglobulin molecules. [NIH] 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] Motility: The ability to move spontaneously. [EU] Mucosa: A mucous membrane, or tunica mucosa. [EU] Mydriatic: 1. Dilating the pupil. 2. Any drug that dilates the pupil. [EU] 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 within the heart. Severe interruption of the blood supply to the myocardial tissue may result in necrosis of cardiac muscle (myocardial infarction). [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Narcotic: 1. Pertaining to or producing narcosis. 2. An agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU]

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Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Neoplasia: Abnormal and uncontrolled cell growth. [NIH] Neoplasms: New abnormal growth of tissue. Malignant neoplasms show a greater degree of anaplasia and have the properties of invasion and metastasis, compared to benign neoplasms. [NIH] Nephrologist: A doctor who treats patients with kidney problems or hypertension. [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] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neurogenic: Loss of bladder control caused by damage to the nerves controlling the bladder. [NIH] Neurologic: Having to do with nerves or the nervous system. [NIH] 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] Neurotoxicity: The tendency of some treatments to cause damage to the nervous system. [NIH]

Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light hydrogen; the mass is equal to that of the proton and electron combined and they are unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal, and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier nuclei during their decay. [NIH] Neutrophil: A type of white blood cell. [NIH] Nicotine: Nicotine is highly toxic alkaloid. It is the prototypical agonist at nicotinic

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cholinergic receptors where it dramatically stimulates neurons and ultimately blocks synaptic transmission. Nicotine is also important medically because of its presence in tobacco smoke. [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]

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]

Normotensive: 1. Characterized by normal tone, tension, or pressure, as by normal blood pressure. 2. A person with normal blood pressure. [EU] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Ocular: 1. Of, pertaining to, or affecting the eye. 2. Eyepiece. [EU] 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] Oliguria: Clinical manifestation of the urinary system consisting of a decrease in the amount of urine secreted. [NIH] On-line: A sexually-reproducing population derived from a common parentage. [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] 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] 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] Opsin: A protein formed, together with retinene, by the chemical breakdown of metarhodopsin. [NIH] Optic Disk: The portion of the optic nerve seen in the fundus with the ophthalmoscope. It is formed by the meeting of all the retinal ganglion cell axons as they enter the optic nerve. [NIH]

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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] 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] 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] Orgasm: The crisis of sexual excitement in either humans or animals. [NIH] Orthostatic: Pertaining to or caused by standing erect. [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] Overdosage: 1. The administration of an excessive dose. 2. The condition resulting from an excessive dose. [EU] 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] 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]

Oxidation-Reduction: A chemical reaction in which an electron is transferred from one molecule to another. The electron-donating molecule is the reducing agent or reductant; the electron-accepting molecule is the oxidizing agent or oxidant. Reducing and oxidizing agents function as conjugate reductant-oxidant pairs or redox pairs (Lehninger, Principles of Biochemistry, 1982, p471). [NIH] Oxygen Consumption: The oxygen consumption is determined by calculating the difference between the amount of oxygen inhaled and exhaled. [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] 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]

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Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Parkinsonism: A group of neurological disorders characterized by hypokinesia, tremor, and muscular rigidity. [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] 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] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Patient Selection: Criteria and standards used for the determination of the appropriateness of the inclusion of patients with specific conditions in proposed treatment plans and the criteria used for the inclusion of subjects in various clinical trials and other research protocols. [NIH] Pelvic: Pertaining to the pelvis. [EU] Penicillin: An antibiotic drug used to treat infection. [NIH] Penile Erection: The state of the penis when the erectile tissue becomes filled with blood and causes the penis to become rigid and elevated. [NIH] Penile Implantation: Surgical insertion of cylindric hydraulic devices for the 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] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Perimetry: Determination of the extent of the visual field for various types and intensities of stimuli. [NIH] Perineal: Pertaining to the perineum. [EU] Perineum: The area between the anus and the sex organs. [NIH] Peripheral blood: Blood circulating throughout the body. [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 Neuropathy: Nerve damage, usually affecting the feet and legs; causing pain, numbness, or a tingling feeling. Also called "somatic neuropathy" or "distal sensory polyneuropathy." [NIH] Peripheral Vascular Disease: Disease in the large blood vessels of the arms, legs, and feet. People who have had diabetes for a long time may get this because major blood vessels in

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their arms, legs, and feet are blocked and these limbs do not receive enough blood. The signs of PVD are aching pains in the arms, legs, and feet (especially when walking) and foot sores that heal slowly. Although people with diabetes cannot always avoid PVD, doctors say they have a better chance of avoiding it if they take good care of their feet, do not smoke, and keep both their blood pressure and diabetes under good control. [NIH] Peritoneal: Having to do with the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH] Peritoneal Cavity: The space enclosed by the peritoneum. It is divided into two portions, the greater sac and the lesser sac or omental bursa, which lies behind the stomach. The two sacs are connected by the foramen of Winslow, or epiploic foramen. [NIH] Peritoneal Dialysis: Dialysis fluid being introduced into and removed from the peritoneal cavity as either a continuous or an intermittent procedure. [NIH] Peritoneum: Endothelial lining of the abdominal cavity, the parietal peritoneum covering the inside of the abdominal wall and the visceral peritoneum covering the bowel, the mesentery, and certain of the organs. The portion that covers the bowel becomes the serosal layer of the bowel wall. [NIH] Petechiae: Pinpoint, unraised, round red spots under the skin caused by bleeding. [NIH] Pharmaceutical Solutions: Homogeneous liquid preparations that contain one or more chemical substances dissolved, i.e., molecularly dispersed, in a suitable solvent or mixture of mutually miscible solvents. For reasons of their ingredients, method of preparation, or use, they do not fall into another group of products. [NIH] Pharmacist: A person trained to prepare and distribute medicines and to give information about them. [NIH] Pharmacokinetic: The mathematical analysis of the time courses of absorption, distribution, and elimination of drugs. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phentolamine: A nonselective alpha-adrenergic antagonist. It is used in the treatment of hypertension and hypertensive emergencies, pheochromocytoma, vasospasm of Raynaud's disease and frostbite, clonidine withdrawal syndrome, impotence, and peripheral vascular disease. [NIH] Phenyl: Ingredient used in cold and flu remedies. [NIH] Phosphodiesterase: Effector enzyme that regulates the levels of a second messenger, the cyclic GMP. [NIH] Phospholipases: A class of enzymes that catalyze the hydrolysis of phosphoglycerides or glycerophosphatidates. EC 3.1.-. [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] 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] 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]

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Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pigments: Any normal or abnormal coloring matter in plants, animals, or micro-organisms. [NIH]

Pilot study: The initial study examining a new method or treatment. [NIH] Pinocytosis: The engulfing of liquids by cells by a process of invagination and closure of the cell membrane to form fluid-filled vacuoles. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plaque: A clear zone in a bacterial culture grown on an agar plate caused by localized destruction of bacterial cells by a bacteriophage. The concentration of infective virus in a fluid can be estimated by applying the fluid to a culture and counting the number of. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Platelet 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] Platelets: A type of blood cell that helps prevent bleeding by causing blood clots to form. Also called thrombocytes. [NIH] Pneumonia: Inflammation of the lungs. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] 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]

Polyethylene Glycols: Alpha-Hydro-omega-hydroxypoly(oxy-1,2-ethanediyls). Additional polymers of ethylene oxide and water and their ethers. They vary in consistency from liquid to solid, depending on the molecular weight, indicated by a number following the name. Used as surfactants in industry, including foods, cosmetics and pharmaceutics; in biomedicine, as dispersing agents, solvents, ointment and suppository bases, vehicles, tablet excipients. Some specific groups are lauromagrogols, nonoxynols, octoxynols and poloxamers. [NIH] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] Postsynaptic: Nerve potential generated by an inhibitory hyperpolarizing stimulation. [NIH] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in

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the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Potentiation: An overall effect of two drugs taken together which is greater than the sum of the effects of each drug taken alone. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] 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] 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] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] 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] 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] 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] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Protease Inhibitors: Compounds which inhibit or antagonize biosynthesis or actions of proteases (endopeptidases). [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] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU]

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Psychoactive: Those drugs which alter sensation, mood, consciousness or other psychological or behavioral functions. [NIH] Psychogenic: Produced or caused by psychic or mental factors rather than organic factors. [EU]

Psychosexual: Pertaining to the mental aspects of sex. [NIH] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulmonary Edema: An accumulation of an excessive amount of watery fluid in the lungs, may be caused by acute exposure to dangerous concentrations of irritant gasses. [NIH] Pulmonary hypertension: Abnormally high blood pressure in the arteries of the lungs. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]

Purines: A series of heterocyclic compounds that are variously substituted in nature and are known also as purine bases. They include adenine and guanine, constituents of nucleic acids, as well as many alkaloids such as caffeine and theophylline. Uric acid is the metabolic end product of purine metabolism. [NIH] Purpura: Purplish or brownish red discoloration, easily visible through the epidermis, caused by hemorrhage into the tissues. [NIH] Pyrimidines: A family of 6-membered heterocyclic compounds occurring in nature in a wide variety of forms. They include several nucleic acid constituents (cytosine, thymine, and uracil) and form the basic structure of the barbiturates. [NIH] 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] Quaternary: 1. Fourth in order. 2. Containing four elements or groups. [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] 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] Radioactive: Giving off radiation. [NIH]

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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] 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] 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] Reassurance: A procedure in psychotherapy that seeks to give the client confidence in a favorable outcome. It makes use of suggestion, of the prestige of the therapist. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Receptors, Serotonin: Cell-surface proteins that bind serotonin and trigger intracellular changes which influence the behavior of cells. Several types of serotonin receptors have been recognized which differ in their pharmacology, molecular biology, and mode of action. [NIH] 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] 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] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Red blood cells: RBCs. Cells that carry oxygen to all parts of the body. Also called erythrocytes. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] 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] Refractory: Not readily yielding to treatment. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Relapse: The return of signs and symptoms of cancer after a period of improvement. [NIH] Relaxant: 1. Lessening or reducing tension. 2. An agent that lessens tension. [EU] Renal Dialysis: Removal of certain elements from the blood based on the difference in their rates of diffusion through a semipermeable membrane. [NIH] Renal failure: Progressive renal insufficiency and uremia, due to irreversible and

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progressive renal glomerular tubular or interstitial disease. [NIH] Research Support: Financial support of research activities. [NIH] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Retinal: 1. Pertaining to the retina. 2. The aldehyde of retinol, derived by the oxidative enzymatic splitting of absorbed dietary carotene, and having vitamin A activity. In the retina, retinal combines with opsins to form visual pigments. One isomer, 11-cis retinal combines with opsin in the rods (scotopsin) to form rhodopsin, or visual purple. Another, all-trans retinal (trans-r.); visual yellow; xanthopsin) results from the bleaching of rhodopsin by light, in which the 11-cis form is converted to the all-trans form. Retinal also combines with opsins in the cones (photopsins) to form the three pigments responsible for colour vision. Called also retinal, and retinene1. [EU] 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 Artery Occlusion: Occlusion or closure of the central retinal artery causing sudden, usually nearly complete, loss of vision in one eye. Occlusion of the branch retinal artery causes sudden visual loss in only a portion of the visual field. [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] 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 study: A study that looks backward in time, usually using medical records and interviews with patients who already have or had a disease. [NIH] Retroviral vector: RNA from a virus that is used to insert genetic material into cells. [NIH] Rhodopsin: A photoreceptor protein found in retinal rods. It is a complex formed by the binding of retinal, the oxidized form of retinol, to the protein opsin and undergoes a series of complex reactions in response to visible light resulting in the transmission of nerve impulses to the brain. [NIH] Ribonucleoside Diphosphate Reductase: An enzyme of the oxidoreductase class that catalyzes the formation of 2'-deoxyribonucleotides from the corresponding ribonucleotides using NADPH as the ultimate electron donor. The deoxyribonucleoside diphosphates are used in DNA synthesis. (From Dorland, 27th ed) EC 1.17.4.1. [NIH] Ribose: A pentose active in biological systems usually in its D-form. [NIH] Rigidity: Stiffness or inflexibility, chiefly that which is abnormal or morbid; rigor. [EU]

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Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Rolipram: A phosphodiesterase inhibitor with antidepressant properties. [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] 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] Screening: Checking for disease when there are no symptoms. [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] 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] 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] Serine: A non-essential amino acid occurring in natural form as the L-isomer. It is synthesized from glycine or threonine. It is involved in the biosynthesis of purines, pyrimidines, and other amino acids. [NIH] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Serous: Having to do with serum, the clear liquid part of blood. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [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]

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Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] 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] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [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] 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] Statistically significant: Describes a mathematical measure of difference between groups.

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The difference is said to be statistically significant if it is greater than what might be expected to happen by chance alone. [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] Steroids: Drugs used to relieve swelling and inflammation. [NIH] Stimulants: Any drug or agent which causes stimulation. [NIH] Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] 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] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subarachnoid: Situated or occurring between the arachnoid and the pia mater. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Sublingual: Located beneath the tongue. [EU] 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] Substrate Specificity: A characteristic feature of enzyme activity in relation to the kind of substrate on which the enzyme or catalytic molecule reacts. [NIH] Sudden death: Cardiac arrest caused by an irregular heartbeat. The term "death" is somewhat misleading, because some patients survive. [NIH] Support group: A group of people with similar disease who meet to discuss how better to cope with their cancer and treatment. [NIH] Suppositories: A small cone-shaped medicament having cocoa butter or gelatin at its basis and usually intended for the treatment of local conditions in the rectum. [NIH] Suppository: A medicated mass adapted for introduction into the rectal, vaginal, or urethral orifice of the body, suppository bases are solid at room temperature but melt or dissolve at body temperature. Commonly used bases are cocoa butter, glycerinated gelatin, hydrogenated vegetable oils, polyethylene glycols of various molecular weights, and fatty acid esters of polyethylene glycol. [EU] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [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

Dictionary 155

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] Sympathomimetics: Drugs that mimic the effects of stimulating postganglionic adrenergic sympathetic nerves. Included here are drugs that directly stimulate adrenergic receptors and drugs that act indirectly by provoking the release of adrenergic transmitters. [NIH] Symphysis: A secondary cartilaginous joint. [NIH] Synapse: The region where the processes of two neurons come into close contiguity, and the nervous impulse passes from one to the other; the fibers of the two are intermeshed, but, according to the general view, there is no direct contiguity. [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] Synaptic Transmission: The communication from a neuron to a target (neuron, muscle, or secretory cell) across a synapse. In chemical synaptic transmission, the presynaptic neuron releases a neurotransmitter that diffuses across the synaptic cleft and binds to specific synaptic receptors. These activated receptors modulate ion channels and/or secondmessenger systems to influence the postsynaptic cell. Electrical transmission is less common in the nervous system, and, as in other tissues, is mediated by gap junctions. [NIH] Synergistic: Acting together; enhancing the effect of another force or agent. [EU] Systemic: Affecting the entire body. [NIH] Systemic disease: Disease that affects the whole body. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Testicles: The two egg-shaped glands found inside the scrotum. They produce sperm and male hormones. Also called testes. [NIH] Testosterone: A hormone that promotes the development and maintenance of male sex characteristics. [NIH] Thalassemia: A group of hereditary hemolytic anemias in which there is decreased synthesis of one or more hemoglobin polypeptide chains. There are several genetic types with clinical pictures ranging from barely detectable hematologic abnormality to severe and fatal anemia. [NIH] Threonine: An essential amino acid occurring naturally in the L-form, which is the active form. It is found in eggs, milk, gelatin, and other proteins. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombin: An enzyme formed from prothrombin that converts fibrinogen to fibrin. (Dorland, 27th ed) EC 3.4.21.5. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thrombus: An aggregation of blood factors, primarily platelets and fibrin with entrapment of cellular elements, frequently causing vascular obstruction at the point of its formation. Some authorities thus differentiate thrombus formation from simple coagulation or clot formation. [EU]

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Time Factors: Elements of limited time intervals, contributing to particular results or situations. [NIH] Tin: A trace element that is required in bone formation. It has the atomic symbol Sn, atomic number 50, and atomic weight 118.71. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tissue Extracts: Preparations made from animal tissues or organs; they usually contain many components, any one of which may be pharmacologically or physiologically active; extracts may contain specific, but uncharacterized factors or proteins with specific actions. [NIH]

Tone: 1. The normal degree of vigour and tension; in muscle, the resistance to passive elongation or stretch; tonus. 2. A particular quality of sound or of voice. 3. To make permanent, or to change, the colour of silver stain by chemical treatment, usually with a heavy metal. [EU] 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] Tonus: A state of slight tension usually present in muscles even when they are not undergoing active contraction. [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] Toxicokinetics: Study of the absorption, distribution, metabolism, and excretion of test substances. [NIH] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Transdermal: Entering through the dermis, or skin, as in administration of a drug applied to the skin in ointment or patch form. [EU] Transduction: The transfer of genes from one cell to another by means of a viral (in the case of bacteria, a bacteriophage) vector or a vector which is similar to a virus particle (pseudovirion). [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Translations: Products resulting from the conversion of one language to another. [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] Transurethral: Performed through the urethra. [EU]

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Transurethral resection: Surgery performed with a special instrument inserted through the urethra. Also called TUR. [NIH] Transurethral Resection of Prostate: Resection of the prostate using a cystoscope passed through the urethra. [NIH] Tremor: Cyclical movement of a body part that can represent either a physiologic process or a manifestation of disease. Intention or action tremor, a common manifestation of cerebellar diseases, is aggravated by movement. In contrast, resting tremor is maximal when there is no attempt at voluntary movement, and occurs as a relatively frequent manifestation of Parkinson disease. [NIH] Triage: The sorting out and classification of patients or casualties to determine priority of need and proper place of treatment. [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] 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] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Urea: A compound (CO(NH2)2), formed in the liver from ammonia produced by the deamination of amino acids. It is the principal end product of protein catabolism and constitutes about one half of the total urinary solids. [NIH] 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] Ureters: Tubes that carry urine from the kidneys to the bladder. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary tract: The organs of the body that produce and discharge urine. These include the kidneys, ureters, bladder, and urethra. [NIH] Urinary tract infection: An illness caused by harmful bacteria growing in the urinary tract. [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] Urologist: A doctor who specializes in diseases of the urinary organs in females and the urinary and sex organs in males. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vacuoles: Any spaces or cavities within a cell. They may function in digestion, storage, secretion, or excretion. [NIH] Vaginal: Of or having to do with the vagina, the birth canal. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU]

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Vasoactive: Exerting an effect upon the calibre of blood vessels. [EU] 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] VE: The total volume of gas either inspired or expired in one minute. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Ventricular: Pertaining to a ventricle. [EU] 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] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] 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] Visceral: , from viscus a viscus) pertaining to a viscus. [EU] Visual field: The entire area that can be seen when the eye is forward, including peripheral vision. [NIH] Vitreous: Glasslike or hyaline; often used alone to designate the vitreous body of the eye (corpus vitreum). [EU] Vitreous Body: The transparent, semigelatinous substance that fills the cavity behind the crystalline lens of the eye and in front of the retina. It is contained in a thin hyoid membrane and forms about four fifths of the optic globe. [NIH] Vitreous Hemorrhage: Hemorrhage into the vitreous body. [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] 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]

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] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH] Yohimbine: A plant alkaloid with alpha-2-adrenergic blocking activity. Yohimbine has been

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used as a mydriatic and in the treatment of impotence. It is also alleged to be an aphrodisiac. [NIH]

161

INDEX A Abdomen, 119, 123, 139, 146, 154 Abdominal, 4, 119, 144, 146, 151 Ablation, 119, 120 Acetylcholine, 119, 126, 142, 143 Adenine, 119, 149 Adenosine, 16, 119, 146 Adjustment, 4, 18, 20, 119 Adjuvant, 20, 119, 133 Adrenergic, 119, 130, 146, 155, 158 Adverse Effect, 5, 6, 8, 11, 13, 119, 121, 153 Aerobic, 119, 132 Aerosol, 119, 143 Aetiology, 31, 42, 119 Affinity, 18, 119, 120, 129 Age Factors, 83, 119 Age of Onset, 120, 157 Agonist, 120, 121, 130, 142 Algorithms, 120, 123 Alimentary, 120, 137, 145 Alkaline, 120, 124 Alkaloid, 120, 141, 142, 144, 158 Alpha Particles, 120, 149 Alprostadil, 12, 32, 56, 120 Alternative medicine, 94, 120 Amino acid, 120, 121, 134, 142, 145, 148, 152, 154, 155, 157 Amnesia, 46, 120 Amphetamines, 120, 129 Analgesic, 120, 126, 139, 140, 141, 143 Analog, 17, 120, 129 Androgen suppression, 20, 120 Anemia, 10, 67, 120, 122, 133, 155 Aneurysm, 120, 158 Angina, 4, 15, 121, 143 Angioplasty, 25, 121 Antiandrogen therapy, 20, 121 Antiandrogens, 20, 121 Antibiotic, 121, 124, 145, 153 Antibody, 119, 121, 127, 134, 135, 136, 137, 140, 141, 149, 150, 153 Antidepressant, 27, 92, 121, 152 Antigen, 16, 119, 121, 127, 135, 136, 137, 140 Antihypertensive, 5, 121 Antineoplastic, 121, 136 Antitussive, 121, 129, 143 Anuria, 121, 138

Anus, 121, 123, 127, 137, 145, 150 Anxiety, 86, 121 Aorta, 121, 128, 158 Apomorphine, 72, 73, 80, 121 Aqueous, 73, 121, 122, 129 Arginine, 63, 67, 121, 143 Arterial, 10, 72, 121, 136, 143, 148, 155 Arteries, 85, 121, 123, 128, 141, 149 Arterioles, 121, 123, 124, 141 Artery, 7, 15, 21, 47, 56, 120, 121, 122, 128, 131, 143, 149, 151 Aspartate, 121, 129 Asphyxia, 121, 143 Assay, 27, 122 Asymptomatic, 122 Atrophy, 46, 122 Auditory, 26, 122 Autonomic, 4, 10, 28, 29, 59, 119, 122, 145, 154 Autonomic Nervous System, 28, 122, 145, 154 Autonomic Neuropathy, 4, 10, 122 Axillary, 122, 123 Axillary Artery, 122, 123 B Bacteria, 121, 122, 128, 131, 141, 153, 156, 157 Base, 119, 122, 138 Benign, 122, 124, 134, 142, 150 Benzene, 122, 138 Beta-Thalassemia, 67, 122 Bilateral, 13, 122 Biochemical, 19, 56, 122, 138, 139, 152 Biopsy, 16, 122 Biotechnology, 21, 22, 83, 94, 101, 123 Biotransformation, 32, 123 Bladder, 122, 123, 142, 148, 151, 157 Bloating, 123, 133, 137 Blood Coagulation, 123, 124 Blood Flow Velocity, 28, 123 Blood Glucose, 86, 123, 135 Blood Platelets, 123, 152 Blood pressure, 3, 5, 6, 19, 29, 67, 72, 121, 123, 125, 136, 141, 143, 146, 149 Blood vessel, 4, 29, 33, 68, 86, 123, 125, 126, 131, 134, 138, 145, 153, 154, 155, 157, 158 Body Mass Index, 123, 144

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Bone Marrow, 122, 123, 133, 139 Bone Resorption, 18, 123 Bowel, 123, 129, 137, 146 Bowel Movement, 123, 129 Brachial, 7, 123 Brachial Artery, 7, 123 Brachytherapy, 123, 137, 149 Bradykinin, 123, 143 Branch, 115, 124, 145, 151, 153 Breakdown, 19, 124, 129, 133, 143 Broad-spectrum, 41, 124 C Calcium, 19, 124, 127, 144, 153 Calcium Channels, 124, 144 Calcium-Binding Proteins, 19, 124 Cannabis, 34, 124 Capillary, 34, 124, 158 Capsules, 124, 130, 133 Carbohydrates, 124, 125 Carcinogenic, 16, 122, 124 Carcinoid, 36, 124 Carcinoma, 124 Cardiac, 6, 13, 29, 39, 43, 44, 124, 141, 154 Cardiac Output, 124 Cardiotonic, 17, 124 Cardiotonic Agents, 17, 124 Cardiovascular, 17, 21, 23, 26, 30, 40, 47, 48, 56, 86, 122, 124, 125, 132, 152 Cardiovascular disease, 23, 30, 47, 48, 56, 86, 125 Cardiovascular System, 122, 125 Carotene, 125, 151 Catalytic Domain, 17, 125 Catheter, 68, 125, 131 Catheterization, 121, 125 Cathode, 125 Cations, 19, 125, 138 Causal, 24, 125 Cell Differentiation, 125, 153 Cell membrane, 75, 77, 124, 125, 129, 147 Cell proliferation, 125, 153 Central Nervous System, 73, 119, 120, 122, 124, 125, 133, 135, 141, 144, 152 Central Nervous System Infections, 125, 135 Central retinal artery, 125, 151 Cerebral, 28, 125, 126, 144 Cerebrovascular, 125 Cerebrum, 125 Cervical, 16, 126 Cervix, 126 Chest Pain, 37, 126

Chin, 126, 140 Cholesterol, 11, 126, 128, 136 Cholinergic, 126, 143 Choroid, 126, 151 Chronic, 6, 7, 8, 10, 12, 16, 29, 126, 132, 136, 137, 138, 154 Chronic Disease, 6, 10, 126 Chronic renal, 7, 126 CIS, 126, 151 Clinical trial, 5, 13, 14, 15, 20, 22, 27, 43, 67, 68, 69, 101, 126, 128, 130, 145, 148, 150 Clonic, 22, 126 Cloning, 123, 126 Codeine, 126, 129, 143 Cofactor, 126, 148 Cognition, 16, 126 Colitis, 126, 137 Collagen, 120, 126, 133, 147 Collapse, 124, 127 Colon, 36, 126, 127, 137, 139 Combination Therapy, 68, 127 Complement, 127 Complementary and alternative medicine, 59, 63, 127 Complementary medicine, 59, 127 Computational Biology, 101, 127 Concomitant, 8, 40, 127 Concurrent therapy, 20, 127 Cone, 128, 154 Congestion, 5, 13, 14, 29, 107, 128 Congestive heart failure, 124, 128 Conjugation, 123, 128 Contraindications, ii, 56, 83, 128 Controlled study, 7, 30, 128 Coronary, 11, 15, 21, 125, 128, 141, 143 Coronary Arteriosclerosis, 128, 141 Coronary Artery Bypass, 11, 128 Coronary heart disease, 125, 128 Coronary Thrombosis, 128, 141 Corpus, 17, 128, 139, 145, 148, 158 Cortical, 128, 152 Cost Savings, 6, 128 Cranial, 128, 134, 144, 145 Craniocerebral Trauma, 128, 135 Cyclic, 16, 19, 128, 134, 143, 146, 152 Cytoplasm, 19, 125, 129, 134 Cytotoxic, 129, 150, 153 D Depolarization, 129, 153 Dermis, 129, 156 Designer Drugs, 61, 129

Index 163

Deuterium, 19, 129, 136 Dextromethorphan, 18, 129 Diabetes Mellitus, 73, 85, 86, 95, 129, 134, 135, 137 Diabetic Retinopathy, 37, 129 Diagnostic procedure, 71, 94, 129 Dialyzer, 129, 135 Diarrhea, 5, 83, 129 Diastolic, 129, 136 Digestion, 120, 123, 129, 131, 133, 137, 139, 154, 157 Digestive system, 69, 129 Digestive tract, 122, 129, 153 Dilatation, 7, 120, 121, 129, 158 Dilatation, Pathologic, 129, 158 Dilation, 7, 124, 129, 158 Dilator, 130, 143 Direct, iii, 13, 28, 130, 144, 150, 155 Discrimination, 31, 130 Disease Transmission, 32, 130 Disease Transmission, Horizontal, 130 Disease Transmission, Vertical, 130 Dissociation, 119, 130 Distal, 128, 130, 145 Dizziness, 5, 13, 83, 130 Dopamine, 121, 130, 142 Dosage Forms, 72, 73, 130 Double-blind, 6, 7, 20, 23, 30, 36, 40, 41, 43, 130 Drive, ii, vi, 4, 8, 10, 15, 55, 107, 130, 139 Drug Interactions, 5, 32, 130 Duodenum, 131, 133, 154 Dyspepsia, 5, 6, 7, 13, 14, 131, 137 Dysphagia, 74, 76, 131 E Edema, 129, 131 Effector, 119, 127, 131, 146 Effector cell, 131 Ejaculation, 73, 92, 131, 152 Electrolysis, 125, 131 Electrolyte, 131, 138, 147 Embolus, 131, 137 Emetic, 121, 131 Endarterectomy, 121, 131 Endometrial, 47, 56, 131 Endometrium, 131 Endopeptidases, 131, 148 Endothelial cell, 17, 131 Endothelium, 17, 131, 132, 143 Endothelium, Lymphatic, 131 Endothelium, Vascular, 131 Endothelium-derived, 132, 143

End-stage renal, 4, 5, 126, 132 Environmental Health, 100, 102, 132 Enzymatic, 120, 124, 125, 127, 132, 151 Enzyme, 16, 18, 19, 125, 131, 132, 133, 134, 140, 146, 148, 151, 153, 154, 155, 158 Epithelium, 131, 132 Erection, 4, 6, 9, 10, 12, 14, 17, 24, 61, 68, 72, 73, 79, 84, 85, 86, 107, 132, 137 Erythrocytes, 120, 123, 132, 150 Escalation, 13, 41, 43, 132 Esophageal, 74, 76, 132 Esophageal Spasms, 74, 76, 132 Esophagus, 129, 132, 135, 154 Estrogen, 16, 132, 148 Excrete, 121, 132, 138 Exercise Test, 30, 132 Exhaustion, 4, 132 Exogenous, 123, 132, 157 External-beam radiation, 132, 149 Extracellular, 19, 132 Extraction, 31, 132 F Facial, 13, 132, 143 Family Planning, 101, 132 Fat, 123, 125, 128, 131, 132, 144 Fatigue, 133, 135 Fetal Hemoglobin, 67, 133 Fetus, 133, 157 Flushing, 5, 6, 7, 13, 14, 83, 95, 107, 133 Forearm, 123, 133 Frostbite, 133, 146 G Gallbladder, 119, 129, 133 Gamma Rays, 133, 149, 150 Ganglia, 119, 133, 136, 142, 145, 154 Gas, 133, 136, 137, 143, 158 Gastric, 130, 133, 135 Gastric Emptying, 133 Gastrin, 133, 136 Gastrointestinal, 75, 77, 124, 133, 152, 154 Gastrointestinal tract, 75, 77, 133, 152 Gastroparesis, 74, 76, 133 Gelatin, 133, 134, 154, 155 Gene, 17, 18, 83, 123, 133 Gene Expression, 18, 133 Gene Therapy, 17, 133 Genital, 122, 134 Genotype, 67, 134 Ginseng, 60, 134 Gland, 134, 139, 144, 148, 154 Glomerular, 134, 138, 151 Glucose, 86, 123, 129, 134, 135, 137

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Glucose Intolerance, 129, 134 Glutamate, 129, 134 Glycine, 120, 134, 142, 152 Glycosidic, 124, 134 Gonad, 134 Gonadal, 10, 16, 134 Governing Board, 134, 148 Grafting, 11, 128, 134 Granulocytes, 134, 153, 158 Growth, 90, 125, 134, 136, 139, 142, 147, 152, 157 Guanylate Cyclase, 134, 143 H Haematoma, 134 Haemorrhage, 40, 134 Halos, 43, 53, 134 Haptens, 119, 134 Headache, 5, 6, 7, 14, 83, 95, 107, 134, 135 Headache Disorders, 135 Heart attack, 4, 25, 125, 135 Heart failure, 29, 135 Heartbeat, 135, 154 Heartburn, 135, 137 Hemodialysis, 5, 7, 8, 129, 135, 138, 139 Hemoglobin, 67, 120, 122, 132, 133, 135, 155 Hemoglobin A, 68, 135 Hemoglobin H, 133, 135 Hemoglobinopathies, 133, 135 Hemorrhage, 128, 135, 149, 154, 158 Hemostasis, 135, 152 Heredity, 133, 135 Heterogeneity, 19, 119, 135 Homeostasis, 17, 135 Homologous, 133, 135, 155 Hormonal, 10, 16, 72, 122, 135 Hormone, 68, 79, 133, 135, 136, 137, 140, 148, 152, 153, 155 Hormone Replacement Therapy, 79, 136 Hormone therapy, 68, 136 Hydrogen, 19, 122, 124, 129, 136, 141, 142, 144, 148 Hydrolysis, 16, 123, 136, 146 Hydroxyurea, 67, 136 Hypercholesterolemia, 18, 136 Hyperglycemia, 17, 136 Hypertension, 4, 5, 48, 125, 135, 136, 142, 146 Hypogonadism, 4, 136 Hypokinesia, 136, 145 Hypotension, 46, 136 Hypothalamic, 10, 16, 136

Hypothalamus, 122, 136 Hysteria, 52, 136 I Id, 57, 62, 108, 114, 116, 136 Immune response, 119, 121, 134, 136, 154 Immunologic, 16, 136, 150 Immunology, 119, 136 Impairment, 136, 140 Implant radiation, 136, 137, 149 Impotent, 73, 137 In vitro, 17, 32, 133, 137 In vivo, 17, 133, 137 Incision, 137, 138, 148, 151 Indicative, 80, 137, 145, 157 Indigestion, 5, 83, 95, 137 Induction, 137, 148 Infarction, 137 Infection, 16, 137, 139, 142, 145, 154, 158 Infertility, 10, 68, 137 Inflammation, 120, 126, 137, 147, 154 Inflammatory bowel disease, 36, 137 Ingestion, 24, 137, 147 Insight, 17, 137 Insulin, 137, 157 Intermittent, 137, 146 Internal radiation, 137, 149 Interstitial, 123, 137, 151 Intestines, 119, 133, 137 Intoxication, 138, 158 Intracellular, 18, 19, 137, 138, 140, 143, 147, 150, 152, 153 Intracellular Membranes, 138, 140 Intramuscular, 138, 145 Intraocular, 24, 34, 138 Intraocular pressure, 24, 34, 138 Intravenous, 12, 138, 145 Intrinsic, 119, 138 Invasive, 4, 15, 138 Involuntary, 138, 141, 150 Ion Channels, 138, 155 Ionizing, 120, 138, 150 Ions, 122, 124, 130, 131, 136, 138 Ipsilateral, 36, 138 Ischemia, 122, 138 Isoflavones, 61, 138 Isosorbide, 107, 138 K Kb, 100, 138 Kidney Failure, 4, 132, 138 Kidney Failure, Acute, 138 Kidney Failure, Chronic, 138 Kinetic, 138, 139

Index 165

L Lactation, 139, 148 Large Intestine, 129, 137, 139, 150, 153 Lectin, 139, 140 Leukemia, 133, 134, 139 Levorphanol, 129, 139 Libido, 5, 10, 139 Library Services, 114, 139 Ligament, 139, 148 Linkages, 135, 139 Liver, 119, 129, 133, 139, 157 Localized, 134, 137, 139, 147 Lutein Cells, 139, 148 Lymph, 122, 126, 131, 139 Lymph node, 122, 126, 139 Lymphatic, 131, 137, 139 Lymphocyte, 121, 139, 140 M Macula, 139 Macula Lutea, 139 Macular Degeneration, 23, 33, 139 Malignant, 121, 139, 142, 150 Malnutrition, 122, 140 Mammary, 128, 140 Mass Media, 49, 140 Mediate, 18, 130, 140 Mediator, 140, 152 Medical Records, 140, 151 Medicament, 74, 76, 140, 154 MEDLINE, 101, 140 Medullary, 129, 140 Membrane, 19, 125, 126, 127, 129, 138, 140, 141, 144, 150, 151, 153, 158 Membrane Proteins, 19, 140 Memory, 26, 120, 140 Meninges, 125, 128, 140 Mental, iv, 15, 23, 70, 85, 100, 102, 107, 126, 130, 133, 136, 140, 148, 149, 152, 157 Mental Disorders, 70, 136, 140 Mental Health, iv, 15, 23, 70, 100, 102, 140 Meperidine, 129, 140 Meta-Analysis, 22, 140 Metabolic disorder, 79, 140 Metabolite, 27, 31, 34, 123, 140 Metastasis, 140, 141, 142 Metastatic, 16, 36, 141 MI, 117, 141 Microbe, 141, 156 Microorganism, 126, 141, 158 Microscopy, 19, 141 Modification, 120, 129, 141, 149

Molecular, 17, 18, 19, 34, 56, 101, 103, 123, 127, 141, 147, 148, 150, 154 Molecule, 67, 73, 121, 122, 127, 130, 131, 132, 134, 135, 136, 139, 141, 144, 150, 153, 154 Monitor, 68, 141 Monoclonal, 141, 149 Monophosphate, 16, 141 Morphine, 121, 126, 140, 141, 143 Motility, 141, 152 Mucosa, 141, 148 Mydriatic, 130, 141, 159 Myocardial infarction, 24, 34, 51, 128, 141 Myocardial Ischemia, 13, 141 Myocardium, 141 N Narcotic, 139, 140, 141, 143 Nausea, 130, 133, 137, 142, 157 NCI, 1, 68, 69, 99, 126, 142 Need, 3, 11, 25, 52, 53, 73, 79, 81, 83, 85, 95, 107, 109, 119, 126, 142, 157 Neonatal, 50, 142 Neoplasia, 16, 142 Neoplasms, 121, 142, 150 Nephrologist, 8, 10, 142 Nerve, 4, 13, 18, 36, 85, 119, 126, 133, 140, 142, 143, 144, 145, 147, 151, 152, 154, 156 Nervous System, 72, 122, 125, 140, 142, 145, 155 Neurogenic, 72, 142 Neurologic, 73, 142 Neurons, 133, 142, 143, 154, 155 Neuropathy, 4, 24, 38, 73, 122, 142, 145 Neuropeptide, 19, 142 Neurotoxicity, 129, 142 Neurotransmitter, 119, 120, 124, 130, 134, 138, 142, 152, 153, 154, 155 Neutrons, 120, 142, 149 Neutrophil, 18, 142 Nicotine, 86, 142 Nitric Oxide, 7, 18, 19, 38, 67, 143 Nitroglycerin, 18, 25, 95, 107, 143 Nitrous Oxide, 85, 143 Normotensive, 29, 143 Nuclei, 120, 128, 133, 142, 143, 144, 148 Nucleus, 122, 128, 129, 133, 142, 143, 148 O Ocular, 29, 34, 143 Ointments, 130, 143 Oliguria, 138, 143 On-line, 60, 117, 143 Ophthalmic, 143, 151

166 Viagra

Ophthalmic Artery, 143, 151 Ophthalmology, 23, 24, 29, 34, 36, 37, 38, 43, 47, 53, 143 Opium, 141, 143, 144 Opsin, 143, 151 Optic Disk, 129, 139, 143 Optic Nerve, 143, 144, 151 Orbit, 143, 144 Orbital, 36, 144 Organelles, 129, 144 Orgasm, 73, 84, 131, 144 Orthostatic, 46, 144 Osmotic, 138, 144 Overdosage, 31, 144 Overweight, 15, 57, 144 Ovum, 144, 148 Oxidation, 123, 144 Oxidation-Reduction, 123, 144 Oxygen Consumption, 132, 144, 151 P Palsy, 36, 144 Pancreas, 119, 129, 137, 144 Papaverine, 12, 21, 143, 144 Parenteral, 74, 76, 145 Parkinsonism, 46, 121, 145 Parturition, 145, 148 Patch, 145, 156 Pathogenesis, 10, 145 Pathologic, 122, 128, 145 Patient Education, 85, 106, 107, 112, 114, 117, 145 Patient Selection, 83, 86, 145 Pelvic, 145, 148 Penicillin, 48, 145 Penile Erection, 5, 145 Penile Implantation, 11, 145 Penis, 72, 73, 84, 86, 107, 131, 145 Peptide, 19, 120, 131, 145, 148 Perimetry, 23, 145 Perineal, 145, 149 Perineum, 72, 145 Peripheral blood, 120, 145 Peripheral Nervous System, 142, 144, 145, 154 Peripheral Neuropathy, 86, 145 Peripheral Vascular Disease, 4, 145, 146 Peritoneal, 5, 146 Peritoneal Cavity, 146 Peritoneal Dialysis, 5, 146 Peritoneum, 146 Petechiae, 134, 146 Pharmaceutical Solutions, 130, 146

Pharmacist, 25, 146 Pharmacokinetic, 146 Pharmacologic, 146, 156 Phentolamine, 12, 21, 27, 146 Phenyl, 73, 140, 146 Phosphodiesterase, 7, 16, 17, 146, 152 Phospholipases, 146, 153 Phosphorus, 124, 146 Phosphorylation, 18, 146 Photoreceptors, 19, 146 Physical Examination, 5, 67, 146 Physiologic, 120, 136, 146, 150, 157 Physiology, 17, 20, 85, 86, 147 Pigments, 125, 147, 151 Pilot study, 23, 28, 147 Pinocytosis, 75, 77, 147 Plants, 120, 134, 139, 147, 156 Plaque, 121, 147 Plasma, 125, 131, 133, 134, 135, 138, 147, 152 Platelet Activation, 147, 153 Platelet Aggregation, 93, 120, 143, 147 Platelets, 143, 147, 155 Pneumonia, 128, 147 Poisoning, 121, 138, 142, 147 Polyethylene, 147, 154 Polyethylene Glycols, 147, 154 Polysaccharide, 121, 147 Postsynaptic, 147, 153, 155 Potassium, 39, 147 Potentiation, 18, 148, 153 Practice Guidelines, 102, 148 Prevalence, 73, 148 Progesterone, 148 Progressive, 4, 125, 126, 132, 134, 138, 147, 148, 150 Prolactin, 8, 148 Prostate, 4, 13, 16, 20, 40, 46, 56, 68, 84, 90, 92, 106, 148, 149, 151, 157 Prostatectomy, 13, 148, 149 Protease, 35, 36, 51, 52, 127, 148 Protease Inhibitors, 51, 52, 148 Protein S, 83, 123, 148 Proteins, 18, 120, 121, 124, 125, 127, 131, 140, 141, 145, 147, 148, 150, 152, 155, 156 Protocol, 84, 148 Protons, 120, 136, 138, 148, 149 Psychic, 139, 140, 148, 149, 152 Psychoactive, 149, 158 Psychogenic, 12, 42, 72, 73, 149 Psychosexual, 20, 149 Psychotherapy, 149, 150

Index 167

Public Policy, 101, 149 Pulmonary, 49, 56, 67, 91, 123, 132, 138, 149, 158 Pulmonary Artery, 123, 149, 158 Pulmonary Edema, 138, 149 Pulmonary hypertension, 56, 91, 149 Pulse, 141, 149 Purines, 149, 152 Purpura, 134, 149 Pyrimidines, 149, 152 Q Quality of Life, 5, 8, 10, 11, 13, 16, 31, 68, 149 Quaternary, 19, 149 R Race, 5, 149 Radiation, 4, 20, 40, 46, 68, 132, 133, 137, 138, 149, 150, 158 Radiation therapy, 4, 20, 46, 68, 132, 137, 149 Radical prostatectomy, 13, 37, 46, 149 Radioactive, 136, 137, 149, 150 Radioimmunotherapy, 150 Radiolabeled, 19, 149, 150 Radiotherapy, 40, 123, 149, 150 Randomized, 6, 7, 14, 16, 20, 36, 40, 41, 68, 131, 150 Randomized clinical trial, 16, 68, 150 Reassurance, 43, 150 Receptor, 19, 121, 128, 129, 130, 150, 152, 153 Receptors, Serotonin, 150, 152 Recombination, 128, 133, 150 Rectal, 36, 150, 154 Rectum, 36, 121, 123, 127, 129, 133, 137, 139, 148, 150, 154 Red blood cells, 67, 132, 150 Refer, 1, 127, 130, 139, 142, 150 Reflex, 72, 150 Refractory, 13, 29, 150 Regimen, 72, 131, 150 Relapse, 20, 150 Relaxant, 144, 150 Renal Dialysis, 11, 150 Renal failure, 24, 150 Research Support, 28, 151 Respiration, 141, 151 Retina, 19, 68, 125, 126, 129, 139, 144, 151, 158 Retinal, 29, 32, 47, 128, 129, 143, 144, 151 Retinal Artery, 32, 151 Retinal Artery Occlusion, 32, 151

Retinol, 151 Retropubic, 13, 40, 148, 149, 151 Retropubic prostatectomy, 13, 40, 149, 151 Retrospective, 26, 56, 151 Retrospective study, 26, 56, 151 Retroviral vector, 133, 151 Rhodopsin, 143, 151 Ribonucleoside Diphosphate Reductase, 136, 151 Ribose, 119, 151 Rigidity, 72, 107, 145, 147, 151 Risk factor, 6, 15, 39, 152 Rolipram, 17, 152 S Salivary, 129, 152 Salivary glands, 129, 152 Saphenous, 128, 152 Saphenous Vein, 128, 152 Schizoid, 152, 158 Schizophrenia, 152, 158 Schizotypal Personality Disorder, 152, 158 Screening, 37, 126, 152 Second Messenger Systems, 152 Seizures, 22, 152 Semen, 131, 148, 152 Serine, 19, 131, 152 Serotonin, 61, 142, 150, 152, 157 Serous, 131, 152 Serum, 34, 127, 138, 152 Sex Characteristics, 152, 155 Shock, 124, 153 Side effect, 5, 6, 9, 10, 14, 68, 72, 86, 90, 93, 95, 107, 119, 153, 156 Signal Transduction, 20, 153 Signs and Symptoms, 150, 153 Small intestine, 131, 136, 137, 153 Smooth muscle, 10, 17, 18, 19, 56, 72, 120, 141, 143, 144, 153, 154 Social Environment, 149, 153 Somatic, 136, 145, 153 Spatial disorientation, 130, 153 Specialist, 10, 109, 130, 153 Species, 130, 141, 149, 153, 156, 158 Specificity, 17, 119, 124, 131, 153 Spectrum, 153 Spinal cord, 23, 30, 36, 42, 123, 125, 126, 140, 142, 145, 150, 153, 154 Statistically significant, 9, 10, 153 Sterility, 137, 154 Steroids, 124, 154 Stimulants, 134, 154 Stimulus, 130, 131, 138, 150, 154, 155

168 Viagra

Stomach, 15, 107, 119, 129, 132, 133, 136, 137, 142, 146, 153, 154 Stress, 4, 8, 16, 86, 122, 133, 142, 154 Stroke, 46, 70, 100, 124, 125, 154 Subacute, 137, 154 Subarachnoid, 135, 154 Subclinical, 137, 152, 154 Subcutaneous, 131, 145, 154 Sublingual, 83, 154 Substance P, 140, 154 Substrate, 17, 125, 154 Substrate Specificity, 17, 154 Sudden death, 4, 154 Support group, 80, 154 Suppositories, 4, 133, 154 Suppository, 79, 147, 154 Suppression, 120, 154 Sympathetic Nervous System, 16, 122, 154 Sympathomimetics, 120, 124, 155 Symphysis, 126, 148, 155 Synapse, 119, 155, 156 Synaptic, 142, 143, 153, 155 Synaptic Transmission, 143, 155 Synergistic, 148, 155 Systemic, 72, 75, 77, 86, 121, 123, 137, 149, 155 Systemic disease, 86, 155 Systolic, 136, 155 T Testicles, 120, 155 Testosterone, 4, 8, 155 Thalassemia, 122, 135, 155 Threonine, 152, 155 Threshold, 136, 155 Thrombin, 147, 155 Thrombosis, 148, 154, 155 Thrombus, 128, 137, 141, 147, 155 Time Factors, 120, 156 Tin, 145, 156 Tissue, 17, 18, 56, 68, 121, 122, 123, 124, 126, 129, 131, 132, 133, 134, 137, 139, 140, 141, 142, 145, 146, 147, 151, 153, 156 Tissue Extracts, 19, 156 Tone, 19, 143, 156 Tonic, 22, 124, 156 Tonus, 156 Torsion, 137, 156 Toxic, iv, 122, 128, 142, 156 Toxicity, 68, 130, 156 Toxicokinetics, 156 Toxicology, 31, 102, 156 Toxins, 121, 124, 137, 150, 156

Transdermal, 107, 156 Transduction, 153, 156 Transfection, 123, 133, 156 Translations, 16, 156 Transmitter, 85, 119, 130, 138, 140, 156 Transplantation, 18, 24, 38, 126, 139, 156 Transurethral, 148, 156, 157 Transurethral resection, 148, 157 Transurethral Resection of Prostate, 148, 157 Tremor, 145, 157 Triage, 37, 157 Tryptophan, 127, 152, 157 Type 2 diabetes, 7, 157 U Unconscious, 136, 157 Urea, 138, 157 Uremia, 4, 10, 138, 150, 157 Ureters, 157 Urethra, 145, 148, 156, 157 Urinary, 5, 83, 93, 94, 143, 148, 151, 157 Urinary tract, 5, 83, 93, 94, 157 Urinary tract infection, 5, 83, 157 Urine, 121, 123, 138, 143, 157 Urologist, 9, 84, 157 Uterus, 126, 128, 131, 148, 157 V Vaccine, 119, 148, 157 Vacuoles, 144, 147, 157 Vaginal, 47, 56, 154, 157 Vascular, 4, 5, 17, 19, 72, 73, 79, 95, 123, 126, 129, 131, 135, 137, 143, 155, 157 Vasoactive, 12, 79, 86, 158 Vasodilation, 72, 144, 158 Vasodilator, 49, 56, 120, 124, 130, 144, 158 VE, 25, 56, 158 Vein, 68, 120, 138, 152, 158 Venous, 10, 72, 143, 148, 158 Ventricle, 136, 149, 155, 158 Ventricular, 30, 158 Venules, 123, 124, 131, 158 Vertebrae, 153, 158 Veterinary Medicine, 101, 158 Virulence, 156, 158 Visceral, 122, 146, 158 Visual field, 145, 151, 158 Vitreous, 129, 151, 158 Vitreous Body, 151, 158 Vitreous Hemorrhage, 129, 158 Vitro, 158 Vivo, 158

Index 169

W White blood cell, 121, 139, 142, 158 Withdrawal, 33, 140, 146, 158

X X-ray, 19, 125, 133, 149, 150, 158 Y Yohimbine, 4, 158

170 Viagra

Index 171

172 Viagra

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